Primary and Hospital Care

This study explored communication access and barriers from the perspectives of 96 hospital staff across Canada in February 2025. A cross-sectional observational design was used, with an online survey distributed through social media platforms. Statistical analyses, including binary logistic regression, were conducted using IBM SPSS Statistics version 29. Most respondents identified as female (89.0%) and were between 19 and 49 years old. One in ten hospital staff reported that patients always received communication support from staff, and fewer than 5.0% reported consistent access to communication devices. Support from communication professionals was limited, with 20.2% indicating that this support was never available. Environmental barriers included difficulty accessing devices independently (24.8%), lack of privacy (21.7%), poor Wi-Fi or cellular connectivity (17.2%), and noise (14.7%). When communicating with older adults, staff cited time constraints (53.0%), unclear explanations (13.0%), language barriers (13.0%), and emotional stress (7.0%) as key challenges. Hospital staff appeared committed to supporting patient communication; however, barriers such as limited time, staffing availability, access to communication devices, and environmental challenges may affect the consistency of this support. Communication training was associated with staff perceptions of communication needs and inequities among patients. These findings highlight perceived communication gaps and may support further assessment of communication resources, staff support, and organizational approaches to improving patient-centered communication in hospital settings. Full article

Accurate assessment of volume status in acute decompensated heart failure (ADHF) remains challenging. Point-of-care ultrasound (POCUS) offers a rapid, non-invasive approach to directly evaluate venous and pulmonary congestion. In this exploratory study, 25 veterans admitted with ADHF underwent serial POCUS examinations of jugular venous pressure (JVP), inferior vena cava (IVC) diameter and collapsibility, and pulmonary B-lines. Pulmonary B-lines were measured using a novel 4-quadrant method. Daily clinical assessments and laboratory data were used to adjudicate volume status. Associations between POCUS findings and clinical congestion were analyzed using chi-square testing. Twenty-four patients were included in the final analysis (mean age 76 years; 96% male; mean BMI 30.86 kg/m²). Elevated JVP on POCUS (≥10 cm H₂O) and IVC diameter > 21 mm were strongly associated with clinical volume overload (p < 0.001 for both). B-lines showed no significant association (p = 0.806). Obesity limited bedside JVP evaluation but did not affect POCUS JVP acquisition. Combined JVP + IVC positivity produced the highest diagnostic concordance with overload status (p <0.001). POCUS assessment of JVP and IVC diameter provided a feasible and reliable method for evaluating congestion in hospitalized patients with ADHF. A novel four-quadrant method of lung ultrasound offered limited additional value. Full article

Background: Type II workplace violence by patients, relatives, or visitors is an occupational health and patient-safety concern in primary care. Cranston Ridge Medical Clinic (CRMC), a single urban family medicine and walk-in primary care clinic in Calgary, Alberta, plans to implement a universal, risk-informed workplace-safety bundle that is based on observable behaviour, situational risk, and documented safety concerns rather than demographic profiling. Methods: This article describes a single-site internal quality improvement and workplace-safety evaluation protocol. The comparison is CRMC usual practice during the pre-implementation baseline period; there is no concurrent external control group. The planned evaluation will use aggregate, de-identified operational data from a 12-month pre-implementation baseline, a four-week implementation period, and 12 months of post-implementation monitoring. All clinic staff will receive workplace-safety training as part of routine implementation. No staff, patients, or visitors will be recruited as research participants, and the evaluation will not use individual-level staff survey, interview, or focus-group data. Patient/visitor information will be used only as aggregate operational monitoring data when needed to assess safety, access, patient flow, and complaints. Intervention and analysis: The bundle includes worksite analysis, staff training, a brief arrival safety screen, a response algorithm, standardized reporting, monthly safety huddles, and post-incident support. The primary metric will be the Type II workplace-violence incident rate per 1000 clinic visits. Planned analyses include run charts, pre–post rate ratios, and Poisson or negative binomial segmented regression if monthly counts are sufficient. Implementation learning will be summarized from routine training records, safety-huddle summaries, post-incident debrief themes, and other aggregate de-identified operational indicators. Expected contribution: The protocol contributes a transparent, equity-sensitive, and operationally feasible model for balancing staff safety with patient access in primary care. Full article

Artificial intelligence (AI) is increasingly integrated into emergency general surgery (EGS), where rapid diagnosis, accurate decision-making, and timely intervention are essential for improving patient outcomes. Recent advances in machine learning, deep learning, computer vision, and predictive analytics have enabled AI-assisted systems to support clinicians throughout the perioperative workflow. Current applications include radiologic image interpretation, diagnosis of acute abdominal conditions, surgical workflow recognition, intraoperative anatomical guidance, postoperative complication prediction, and intensive care monitoring. AI technologies may improve diagnostic accuracy, optimize operative planning, enhance surgical safety, and facilitate personalized perioperative management. In minimally invasive surgery, computer vision and real-time data analysis have shown promising results for intraoperative decision support and surgical education. However, important limitations remain, including concerns regarding data quality, algorithm transparency, ethical governance, regulatory approval, and implementation disparities between healthcare systems. In addition, much of the current evidence is derived from retrospective or highly specialized datasets, limiting broad clinical applicability. This narrative review summarizes the current clinical applications of AI in emergency general surgery and discusses emerging technologies, existing challenges, and future perspectives regarding the integration of AI into acute surgical care. Full article

Background: Respectful maternity care (RMC) prioritizes dignity, privacy, and autonomy during childbirth. In low-resource primary health centers (PHCs), the lack of delivery gown availability compromises these aspects, leading to discomfort and reduced patient satisfaction in PHCs. This study on Maathru Samman Pants (MSPs), a culturally sensitive garment designed with functional flaps, aims to enhance privacy, comfort, and dignity during labor, as well as assess the satisfaction, acceptability, and demand for MSPs among pregnant women and their birth companions in PHC settings across four Indian regions. Methods: A cross-sectional study was conducted across eight PHCs in North, South, East, and West India. A total of 80 pregnant women and 60 birth companions participated. Data were collected through structured questionnaires and in-depth interviews. The quantitative data covered satisfaction, acceptability, and demand using Likert scales, yes/no, and open-ended formats. The qualitative data were analyzed thematically. Results: Most PW (pregnant women) were aged 21–30 years, mainly Hindu, 34 (42.5%), or Christian, 27 (33.75%), with 71.25% homemakers. PW highly rated MSPs for covering the body, preventing cold, comfort, and ease of use. They felt cared for and respected, with a mean ± SD of 4.47 ± 0.57, and agreed that MSPs maintained privacy and cultural norms. Demand was strong, with 76 (95%) supporting the introduction of MSPs and 74 (92.5%) willing to use them again. Most PW, 66 (82.5%), and BCs (birth companions), 49 (81.67%), accepted MSPs positively, with a few reporting discomfort or changes. Conclusions: MSPs demonstrated high satisfaction, strong acceptability, and future demand among PW. This study addresses key gaps in respectful maternity care at the PHC level by enhancing privacy, preserving cultural norms, and improving comfort. Integrating MSPs into maternal health protocols could significantly improve birthing experiences in resource-limited settings. Full article

Non-suicidal self-injury (NSSI) is a major concern in adolescent mental health, yet the psychometric properties of the Inventory of Statements About Self-Injury (ISAS) have not previously been examined in a Greek adolescent inpatient sample. This preliminary study evaluated the internal consistency, factorial structure, and construct validity evidence of the ISAS in 95 Greek adolescents receiving inpatient psychiatric care (mean age = 14.69 years, SD = 1.30; 86.3% female). Data were obtained retrospectively from clinical records. Psychometric evaluation included Cronbach’s alpha coefficients, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and correlations with the Youth Self-Report (YSR). The ISAS showed satisfactory internal consistency at the higher-order factor level, with alpha coefficients of 0.82 for the interpersonal factor and 0.85 for the intrapersonal factor, although Autonomy and Interpersonal Boundaries showed weak reliability. EFA supported a broad two-factor intrapersonal–interpersonal structure. CFA findings were exploratory and mixed. The original CFA models showed inadequate fit, whereas exploratory modified and post hoc sensitivity models showed improved but non-definitive fit. Convergent validity evidence was modest and was supported by associations between the original broad ISAS intrapersonal score and YSR self-harm behavior, suicidal ideation, internalizing-related dimensions, and Total Problems. Discriminant-pattern evidence was limited. Overall, the findings provide preliminary support for the clinical usefulness of the ISAS as an adjunctive assessment tool in this population, but they do not constitute definitive validation. Further prospective validation in larger, more diverse, and independent samples is needed. Full article

This prospective observational study aimed to estimate the annual service-based incidence of individuals with First Episode Psychosis (FEP) and high-risk states for psychosis presenting to a public Community Mental Health Center within a defined urban catchment area in Northwestern Greece. It offers novel real-world insights into early intervention in psychosis within a resource-constrained, post-crisis health care setting. All individuals aged ≥16 years who presented to the Community Mental Health Center of the University of Ioannina between January 2023 and December 2024 were assessed. Those diagnosed with FEP or identified as being at a high risk for psychosis using the Comprehensive Assessment of At-Risk Mental States were included, while duration of untreated psychosis (DUP) was estimated with the Symptom Onset in Schizophrenia inventory. Among 1115 service users, 51 (4.6%) met criteria for FEP (N = 33) or high-risk states (N = 18), rising to 7.5% among those aged 16–36 years. The annual service-based incidence of FEP was 10.26 per 100,000 in the general population, increasing to 51.62 in individuals aged 16–36 and 63.17 in those aged 16–26. Including high-risk cases, service-based incidence reached 109.71 per 100,000 in the 16–26 age group. Mean DUP was 39.4 weeks but was 7.0 weeks among 80% with DUP < 1 year. Most FEP patients (63.6%) required brief hospitalization, and over half reported family history of mental illness. These findings highlight substantial community caseloads and the need to strengthen early intervention services. Full article