Search Results (1,230)

Mesoporous silicate nanoparticles are known for their pore size, pore volume, high surface area, and tunable surface properties and, as a result, have found application in medicine, healthcare, advanced materials, and devices. Furthermore, tailoring the silicate domain with certain metals has advanced the tissue engineering properties by moderating the cellular function at the molecular level for therapeutic response. However, limited efforts have been made to explore systemic synthesis protocols that could change structure or shape of mesoporous metal silicate nanostructures as the change in shape has inherent potential to tailor biological response. Here, we have focused on using Design of Experiments (DoE) to optimize reaction conditions for the synthesis of mesoporous strontium silicate nanostructures (MPSrSiO₂ NSs) (nanoparticles—NPs and nanorods—NRs) with different physicochemical properties. The conditions allowed a change in shape from NPs to NRs by tailoring the concentration of liquid ammonia (liq. NH₃, NH₄OH, 82.7 mM to 248.2 mM) during the pre-synthesis incubation state. The MPSrSiO₂ NPs had a significantly higher zeta potential compared to NPs (p = 0.0061). Also, NPs possessed significantly higher surface area (p = 0.0306), pore diameter (p = 0.0003), and pore volume (p = 0.0004) than NRs. In addition, the optimized reaction conditions allowed modulation of the physicochemical properties such as surface area, surface charge, amount of metal, pore diameter, pore volume, tailored degradation profile and release profile of loaded drug (gentamicin). Finally, the protocol has the advantage of allowing incorporation of other metals such as cerium, rhodium, and ruthenium independently and/or in combination. Full article

Background: Pediatric autoimmune disorders are increasingly common, yet outcomes remain poor due to delayed diagnosis and lack of appropriate actions. Immune system dysfunction frequently coincides with deficiencies in essential micronutrients and cofactors, including vitamin D. Objectives: This study evaluated the contribution of vitamin D and cofactor (e.g., magnesium) deficiencies to impaired endocrine secretion and autoimmune susceptibility, which may trigger or exacerbate autoimmunity in children. Methods: This systematic review examines the complex interactions between micronutrients—particularly vitamin D—and cofactors such as zinc, selenium, probiotics, and omega-3 fatty acids, and their effects on endocrine and immune function. These interactions influence enzymatic activity, immune regulatory mechanisms, and endocrine pathways, potentially causing hormonal disequilibrium and increasing the risk of pediatric autoimmune disorders. Results: The review underscores the importance of early diagnosis, cost-effective non-pharmacological interventions, and targeted micronutrient strategies in reducing the risk, incidence, and severity of these disorders, prior to using expensive patented agents. Proactive supplementation—particularly with vitamin D₃ and complementary cofactor micronutrients—known to strengthen immune functions, reduce inflammation and oxidative stress, and mitigate the development of autoimmune disease. Understanding the interconnected roles of micronutrient balance, gut microbiota, and immune dysregulation is essential for effective prevention and management of these conditions in childhood. Conclusions: This review encourages pediatricians and other healthcare professionals to adopt integrative, cost-efficient approaches—including holistic, orthomolecular strategies centered on personalized nutritional therapy—in addition to optimizing general health, to reduce the risk of autoimmune disorders and mitigate associated complications. Such approaches are likely to improve clinical outcomes, reform future research and public health strategy, and reduce healthcare costs. Optimizing micronutrient status may substantially enhance children’s well-being and long-term quality of life. Full article

Enterobacter cloacae (E. cloacae) is an important healthcare-associated pathogen with increasing antimicrobial resistance. Prophages and phage-inducible chromosomal islands (PICIs) are integral components of the E. cloacae genome, yet their contribution to resistance, virulence, and anti-phage defense remains poorly understood. To address this gap, we analyzed 35 complete E. cloacae genomes, identifying 139 intact prophages (10.8–85.7 kb) with an average GC content (~52%) close to that of the host (54–55%). Most prophages (86.6%) were assigned to the families Peduoviridae and Drexlerviridae within the class Caudoviricetes, and proteome-based clustering showed strong relatedness to phages infecting Enterobacteriaceae. The E. cloacae genomes harbored multiple antimicrobial resistance genes, notably fosA (97%), oqxA/oqxB (89%) and blaCMH-3 (77%). However, on genomic-context verification none were genuinely prophage-encoded; they were instead located on the chromosome or plasmids. Virulence profiling revealed universal presence of ompA and high prevalence of csgG (94%), while the only confirmed prophage-encoded virulence determinants were the Shiga toxin genes stxA and stx1B. Additionally, 16 phage satellites were identified, containing conserved integration, replication, and packaging modules together with diverse accessory and anti-phage defense systems. Overall, prophages and phage satellites drive genome diversification in E. cloacae, with satellites notably serving as reservoirs of anti-phage defense, whereas resistance and virulence genes are located outside prophage and satellite regions. Full article

The integration of Large Language Models is transforming recommender systems, offering unprecedented capabilities for complex reasoning and natural language generation. However, their propensity to generate hallucinations (incorrect or invented information) compromises reliability and user trust, limiting their adoption in critical domains. Grounding techniques, which link LLM outputs to external, verifiable knowledge sources, are emerging as a fundamental solution, yet the field’s literature remains fragmented. This study aims to conduct systematic literature mapping to characterize and structure knowledge of grounding techniques applied to LLM-based recommender systems. A systematic literature mapping was conducted following the PRISMA protocol. A search of seven academic databases yielded an initial corpus of 1669 documents. After applying inclusion and exclusion criteria, a final set of 57 primary studies was selected and analyzed. The analysis reveals that Retrieval-Augmented Generation is the most widely used grounding technique (29.5%), indicating a clear preference for architectures that decouple LLM reasoning from the knowledge store. A technological bifurcation is observed between proprietary models, such as the GPT family (37.2%), and open-source models, such as LLaMA (24.8%). The application of these systems is expanding from e-commerce to highly critical domains, such as healthcare and finance. Based on the results, a multidimensional taxonomy is proposed to classify grounding techniques by architectural paradigm, data source, underlying mechanism, and intervention phase. The frequent adoption of grounding mechanisms indicates they are transitioning from an optional improvement to a highly prioritized architectural component for LLM-based recommender systems. Full article

Respiratory allergies are among the most prevalent chronic diseases worldwide, and seasonal allergic rhinitis and asthma place a substantial burden on patients and healthcare systems. Pollen from trees, grasses, and weeds contribute to a wide spectrum of clinical manifestations, while globalization, urban landscaping, biological invasions, and climate change are facilitating the spread of new allergenic plants across continents. Ailanthus altissima (tree of heaven) is a fast-growing deciduous tree native to China that has become widely distributed in North America and Europe, including Romania. Although initially introduced as an ornamental and shade tree, its rapid growth, tolerance of pollution and drought, and ability to colonize disturbed urban habitats have increased its relevance as a potential aeroallergen. This narrative clinical review synthesizes evidence from clinical case reports, sensitization studies, molecular allergen characterization, aerobiological monitoring, and Romanian distribution data. To improve clinical and public health applicability, the review includes summary tables comparing Ailanthus with other emerging allergens such as ragweed and Platanus, outlining Romanian ecological and pollen-monitoring evidence, summarizing diagnostic implications for ENT and allergy practice, identifying evidence gaps, and presenting future research priorities. Current evidence supports A. altissima pollen as an emerging but under-recognized respiratory allergen, particularly in urban areas where the tree is established. However, major limitations remain, including the lack of standardized diagnostic extracts, incomplete molecular allergen validation, limited routine pollen monitoring, and absence of Romanian clinical sensitization studies. Greater clinical awareness, species-specific aerobiological surveillance, standardized allergen characterization, and coordinated Romanian sensitization studies are needed to determine the extent to which A. altissima pollen contributes to allergic rhinitis and asthma. Future research should explicitly distinguish species occurrence, airborne pollen exposure, IgE sensitization, and clinically relevant respiratory disease when evaluating the emerging allergenic importance of A. altissima. Full article

Antibacterial coatings are essential for preventing infections and maintaining adequate hygiene standards in high-density and high-risk environments, such as public spaces, public transportation systems, schools, and healthcare facilities. In this context, it is essential that such coatings are easy to apply and compatible with large-scale production processes. Among the various strategies for developing antimicrobial surfaces, the incorporation of antibacterial agents into paints represents a particularly practical and versatile approach. In this work, antimicrobial coatings were developed by incorporating curcumin, a naturally derived antibacterial compound, into a commercially available water-based paint. For comparison, coatings were also developed by incorporating a commercially available silver-ion-based additive, a well-established antibacterial agent, into the same paint. Antimicrobial dispersions were deposited onto polycarbonate (PC) and polymethyl methacrylate (PMMA) substrates using a spray coating technique. The produced coatings were evaluated in terms of adhesion and hardness according to the ASTM D3359 and ASTM D3363 standards, respectively, achieving ratings of 4B for adhesion and 4B/5B for hardness. Moreover, after five days of continuous water immersion, no visible signs of cracking, delamination, or discoloration were observed. The resulting curcumin- and silver-based coatings, under the tested surface-contact assay conditions, markedly reduced viable bacterial recovery against both S. aureus and E. coli, with no colonies recovered at the dilution range used for comparison with the Paint-Blank control. These results support the potential of curcumin as a naturally derived antibacterial additive for the development of water-based antibacterial coatings and provide a basis for further investigation of their long-term stability, durability, and practical applicability. Full article

Background and Objectives: Antimicrobial resistance represents an important patient-safety concern in surgical departments, where empirical therapy, invasive procedures, intensive-care exposure, and healthcare-associated infections may contribute to adverse outcomes. This study aimed to describe temporal changes in institutional surveillance indicators related to microbiological testing coverage, selected antimicrobial-resistance phenotypes among clinical isolates, selected-antibiotic use profiles, and infection-related patient-safety outcomes in surgical departments and the intensive care unit of a Romanian tertiary clinical emergency hospital. Materials and Methods: A retrospective, longitudinal, single-center observational study was conducted from January 2023 to December 2025. Data were extracted from four institutional sources: microbiology laboratory records, pharmacy antimicrobial-use data, the infection prevention and control registry, and the clinical-administrative hospital information system. Microbiological testing coverage, the selected resistance phenotypes and healthcare-associated infection indicators were analyzed at semester level, with selected-antibiotic DDD profiles being analyzed at department level. Statistical analyses included descriptive statistics, Cochran–Armitage trend testing, Fisher’s exact test, and exploratory Spearman correlation. Results: The hospital-wide microbiological testing intensity index based on 1892 antibiogram events among 8141 antibiotic-treated patient records increased significantly from 18.05% (Semester I 2023) to 28.20% (Semester II 2025). When expressed as proportions of clinical isolates, E. coli MDR decreased from 10/136 isolates (7.4%) in Semester II 2023 to 0/122 isolates (0.0%) in Semester II 2025, and S. aureus MRSA+MLSB decreased from 11/36 isolates (30.6%) to 0/22 isolates (0.0%) over the same interval. Undetected several semesters, P. aeruginosa XDR/PDR accounted for 4/25 clinical isolates (16.0%) in the final semester. Selected-antibiotic DDD profiles differed across departments, with General Surgery and ICU accounting for the largest selected-antibiotic totals. Preoperative bacteriological screening increased from 48 tests in Semester I 2024 to 329 tests in Semester II 2025, MRSA-positive screening results decreasing from 10/48 (20.8%) to 2/329 (0.6%) over this interval, this finding being interpreted descriptively because the screened population and screening protocol could not be fully standardized retrospectively. Among 46 validated cases of healthcare or Clostridioides difficile infections, the overall mean length of stay was 15.35 days, peaking at 20.80 days in surgical departments. Conclusions: Routinely collected hospital data can generate useful institutional surveillance signals related to antimicrobial resistance, antimicrobial use, and infection-related patient safety. Increased microbiological testing coverage and lower proportions of selected MDR/MRSA phenotypes were observed during the study period, while late detection of XDR/PDR P. aeruginosa highlighted the need for sustained microbiological surveillance and department-specific stewardship review. Full article

Background/Objectives: Contemporary health systems continue to face persistent challenges in financing, equity, and governance, particularly under conditions of limited resources, workforce shortages, and demographic pressures. While the World Health Organization calls for strengthening social participation to achieve universal health coverage, evidence suggests that such participation often remains largely symbolic. Existing global examples of social participation in health are limited either by their short duration of implementation or by their limited scope. In contrast, the experience of former Yugoslavia (1945–1991) represents a distinctive case. In the early post-war period, health reforms were directed towards the development of a decentralised, self-managed health system that emphasised universal coverage, participatory governance, social solidarity, and local autonomy. The trajectory of these reforms was further shaped by global economic and political pressures, including neoliberal trends, international debt, and the oil crises, which constrained resources and exposed systemic vulnerabilities. The so-called Yugoslav Experiment may offer an alternative to existing market-oriented and, at times, inefficient health systems. This review aims to synthesise evidence on the governance, financing, organisation, and outcomes of Yugoslavia’s self-managed health system and to evaluate its relevance to contemporary debates on health system resilience, decentralisation, participatory governance, equity, and sustainability. It examines power relations, stakeholder interests, and resource allocation, and assesses the lessons that the Yugoslav experience offers for contemporary debates on participatory governance and the sustainability of healthcare systems, while identifying areas of convergence, debate, and gaps in the existing scholarship. Methods: We conducted a systematic narrative review of peer-reviewed articles, book chapters, conference papers, and commentaries published in English or Bosnian–Croatian–Montenegrin–Serbian that covered the period 1945–1991. Scopus, PubMed, and EBSCOhost (including CINAHL Plus with full text, Medline and PsychInfo) were searched on 19 January 2026. Studies were included if they addressed health system reform, self-management, governance, financing, or institutional continuity. Contextual studies of selected services—primary care, mental health, reproductive health, and vaccination—were included only if they illuminated reform trajectories. Data synthesis focused on reform phases, institutional transformations, financing arrangements, governance mechanisms, and power relations, with particular attention to continuity, path dependence, and critical junctures. Given the heterogeneous and predominantly historical, analytical, and policy-oriented nature of the literature, we did not apply conventional study-design-specific risk-of-bias tools. Instead, we used an overarching framework to classify and contextualise the included evidence according to five dimensions: source type, nature of contribution, evidentiary role, temporal context, and health-system domain. The protocol was not registered. The study was financed by the Provincial Secretariat for Higher Education and Scientific Research, Autonomous Province of Vojvodina, Republic of Serbia. Results: The database searches yielded 265 records, of which 193 were selected for title and abstract screening after removing 72 duplicates. At this stage, 133 publications were excluded because they did not meet the eligibility criteria and 60 publications were selected for full-text review. Application of the predefined inclusion and exclusion criteria resulted in 22 eligible publications. An additional 18 studies were identified through citation chaining and targeted Google Scholar searches. Twenty-two publications were coded as primary studies, directly examining health system reform, governance, or self-management, while 18 were classified as contextual studies addressing specialty areas. The analysis identified key reforms that followed the social participation, i.e., ‘self-management’, approach, which expanded primary care, preventive services, and local participation. It revealed institutional changes, as well as the role of power and health financing in health reforms aimed at strengthening social participation. Nonetheless, challenges—including bureaucratic and managerial elitism, unequal professional authority, resource scarcity, and tensions between market-oriented policies and social solidarity—were amplified by global economic forces and neoliberal trends, ultimately contributing to the system’s collapse by the late 1980s. This review was limited by its search strategy, the exclusion of grey literature, the potential omission or inaccessibility of relevant studies, and its focus on selected aspects of health reform, namely post-war recovery and self-management. Conclusions: The Yugoslav experience illustrates both the promise and the fragility of socially oriented, participatory health systems, demonstrating how international political alignments and global economic pressures can profoundly shape domestic health reform trajectories. Lessons from this case remain relevant to contemporary efforts to strengthen social participation for universal health coverage through designing sustainable, resilient, equitable, and socially accountable health systems under complex global conditions. Full article

The convergence of Large Language Models (LLMs) with the Internet of Things (IoT) is driving a transformative shift toward a continuous, context-aware smart healthcare ecosystem. Due to its novelty, existing research in this domain remains fragmented, leaving a critical gap in unified frameworks that synthesize domain applications, functional AI deployment roles, network architectures, and security boundaries. Following PRISMA 2020 guidelines, this paper presents a systematic literature review and quantitative analysis evaluating a selected corpus of 61 peer-reviewed and 14 preprint papers in this domain. Methodologically, we assess a novel hybrid article discovery strategy, finding that an AI-powered prompt-based literature search strategy achieves higher precision than traditional keyword-based Boolean queries (86% vs. 42%) on the evaluated search sample, which may reduce screening workloads. We found that the major limitation of AI-based literature search is non-determinism, which is also an inherent property of LLM-powered applications. To address this, we propose methodological guidelines for using an AI-assisted hybrid literature search strategy. Based on the selected literature, we establish a multi-layer taxonomy organizing the IoT-LLM advances in the healthcare domain across four pillars: application domain, LLM role, IoT device type, and architectural deployment pattern. Quantitative synthesis reveals a heavy research concentration in remote patient monitoring and personal health management (representing 59% of the corpus combined), primarily driven by the data accessibility of wearable sensors (64%). Cross-tabulation uncovers a distinct capability–constraint spectrum: cloud-based deployments lean on heavyweight state-of-the-art models (mainly GPT-family models) for complex semantic reasoning, whereas edge, federated, and blockchain-based hybrid systems leverage localized models (BERT and LLaMA families). Patient data privacy and reduced communication overhead were among the main reasons for choosing localized models. Crucially, our assessment reveals a pervasive neglect of LLM-specific vulnerabilities such as prompt injection and jailbreak attacks and a tendency to treat regulatory frameworks (e.g., HIPAA, GDPR) as design features rather than empirically validated compliance metrics. Finally, we propose an actionable future research agenda prioritizing multi-device system orchestration, emergency care integration, privacy-preserving LLMs, and deployment-scale clinical validation. Full article

Background: Oral cavity cancer is a clinically relevant subgroup of head and neck malignancies and is associated with substantial treatment burden and healthcare utilization. Hospital length of stay (LOS) is an important indicator of inpatient resource use and complexity of care, yet large multicenter data from Germany are limited. Methods: This retrospective multicenter analysis used anonymized inpatient administrative data from 49 German hospitals; eligible oral cavity cancer hospitalizations were contributed by 34 of these hospitals. Adult inpatient hospitalizations (≥18 years) with malignant neoplasms of the oral cavity, defined using ICD-10-GM codes C00–C06, recorded between January 1 2019 and 31 December 2024 were included. The primary outcome was hospital LOS in days. Multimorbidity was quantified using the van Walraven-weighted Elixhauser Comorbidity Score. Prolonged hospitalization was defined as LOS ≥ 7 days and LOS ≥ 14 days. Associations between demographic, clinical, and treatment-related variables and LOS were examined using multivariable Poisson regression models. Because overdispersion was present, a negative binomial mixed model was additionally fitted as a sensitivity analysis. To account for inter-hospital variability, hospital was included as a random intercept in all multivariable models. Associations with prolonged LOS were analyzed using multivariable logistic regression models. All analyses were performed at the hospitalization level. Results: A total of 3957 inpatient hospitalizations for oral cavity cancer were included. Mean age was 65.6 years, and 66.2% of hospitalizations involved male patients. The median LOS was 6 days (interquartile range [IQR] 3–13; mean 10.2 days, standard deviation 11.8). Overall, 49.4% of hospitalizations had an LOS ≥ 7 days and 23.5% had an LOS ≥ 14 days. Older age, particularly >80 years, and higher comorbidity burden were associated with longer LOS (adjusted Poisson rate ratio [RR] for age > 80 years 1.17, 95% CI 1.13–1.21; high comorbidity burden RR 1.58, 95% CI 1.54–1.63). Several treatment-related variables, including surgical procedures in the oral and facial region, lymphatic system operations, blood transfusions, and complex intensive care treatment, were associated with prolonged hospitalization (e.g., blood transfusion RR 1.80, 95% CI 1.76–1.85; complex intensive care RR 1.70, 95% CI 1.65–1.75). Chemotherapy-related hospitalizations were associated with shorter LOS. Conclusions: LOS varied substantially across inpatient hospitalizations for oral cavity cancer in Germany. Older age, higher comorbidity burden, and markers of more complex inpatient treatment were associated with extended hospital stay. These findings may help identify hospitalizations at increased risk of prolonged LOS and inform inpatient planning and resource allocation. Full article

Digital transformation (DT) is a strategic priority for healthcare systems seeking to improve the quality of care, patient safety, and operational efficiency. In Saudi Arabia, DT is central to Vision 2030; however, evidence regarding its effects on healthcare quality and safety remains dispersed across technologies and healthcare settings. This narrative review aimed to examine the impact of digital transformation on healthcare quality and patient safety in Saudi Arabia and to identify the principal implementation facilitators, barriers, and policy implications. A structured narrative literature search was conducted for publications from January 2010 to March 2026 using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, the Saudi Digital Library, and relevant Saudi governmental and policy documents. In total, 64 peer-reviewed studies, reviews, reports, and policy documents addressing digital health initiatives and outcomes related to quality, safety, efficiency, or patient experience were included. Evidence was synthesized thematically, focusing on electronic health records, digital prescribing, online appointment systems, clinical and pharmacy automation, claims and financial analytics, telemedicine, governance, and workforce factors. The reviewed evidence indicates that Electronic Health Record (EHRs), computerized provider order entry, e-prescribing, barcode-supported medication systems, telemedicine, digital appointment platforms, and automated workflows can improve access to care, documentation, care coordination, medication safety, workflow efficiency, and patient experience. However, the benefits of DT are constrained by fragmented infrastructure, limited interoperability, workforce resistance, insufficient digital literacy, funding limitations, and unclear or fragmented governance and regulatory arrangements. In conclusion, digital transformation has substantial potential to enhance healthcare quality and patient safety in Saudi Arabia. Achieving these benefits requires context-sensitive implementation, interoperable systems, strong governance, sustained investment in infrastructure and workforce capacity, and effective leadership and change-management strategies aligned with Vision 2030. Full article

Objective: This study aims to evaluate the validity and reliability of the “e-Nabız Usage Behavior Scale” (eNUBS), developed to measure user behaviors toward Türkiye’s national personal health record system. Methods: This methodological study included 304 voluntary adult, non-healthcare participants at a hospital. Data were collected via an 8-item sociodemographic form and a 6-item draft scale. Construct validity was evaluated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA); reliability was assessed using Cronbach’s alpha and item-total correlations. Results: Participants were 61.8% male, with a mean age of 37.79 ± 9.40. EFA confirmed a unidimensional structure, explaining 46.21% of the total variance. The Cronbach’s alpha was 0.72, and corrected item-total correlations ranged from 0.43 to 0.59. CFA demonstrated adequate model fit indices. Conclusions: The eNUBS is a brief, valid, and reliable tool for assessing real-world digital health portal usage, offering valuable guidance for digital health policy and for monitoring patient engagement. Full article

Healthcare cleaning services are essential for infection prevention and control, but they also contribute to the carbon footprint of healthcare facilities through recurrent consumption of detergents, disinfectants, textiles, water, energy, and transport-related resources. This sequential, non-randomized, single-facility evaluation compared a traditional cleaning protocol with a Green protocol oriented to the Italian Minimum Environmental Criteria (Criteri Ambientali Minimi, CAM) for cleaning services at Domus Nova Hospital, a private accredited healthcare facility in Ravenna, Italy. A risk-based microbiological monitoring plan was applied to low-, medium-, and medium-high-risk areas, prioritizing high-touch surfaces and using RODAC contact plates and sterile swabs. In parallel, a comparative Life Cycle Assessment was conducted in accordance with ISO 14040, ISO 14044, and ISO 14067 principles, using Global Warming Potential over 100 years as the main impact indicator and the functional unit of one square meter of cleaned hospital surface maintained for one year. The two protocols were assessed during different monitoring periods of unequal duration; therefore, the study was interpreted as a whole-system operational comparison rather than as a randomized trial or formal equivalence/non-inferiority assessment. After cleaning, all 64 observations obtained under the Green protocol met the adopted surface-hygiene acceptability criteria, compared with 55 of 64 observations under the Traditional protocol. No predefined target pathogenic indicators were recovered from post-cleaning samples under the applied culture conditions. From a climate-impact perspective, the Green protocol reduced the carbon footprint by 39.0%, corresponding to an avoided impact of 450 g CO2e m⁻² year⁻¹ and 2663.5 kg CO2e year⁻¹ at the facility scale. The main climate-related benefits were associated with the combined effect of textile-system redesign, lower energy consumption, optimized product use, and reduced operator transport. These findings support the use of integrated surface-hygiene indicators and life-cycle metrics to inform healthcare cleaning procurement, while highlighting that the results concern culture-based surface contamination indicators from a single facility and do not directly assess infection transmission or patient outcomes. Full article

Background: Patient complaints provide critical insights into healthcare quality and patient experience, serving as a direct feedback mechanism for service improvement. Objective: This study aimed to characterize major complaint categories, departmental distribution, personnel attribution, and resolution effectiveness of patient complaints at a large Chinese tertiary hospital using empirical data from 2022 to 2024. Methods: A retrospective observational design was conducted on complaint records (2022: n = 187; 2023: n = 192; 2024: n = 201) at Xiangya Hospital. All data presented are empirically observed records from the hospital’s internal complaint management system; no hypothetical projections or modelled data are included. Complaints were independently categorized into six themes by two researchers (Cohen’s κ = 0.84). Resolution effectiveness was coded by the hospital’s complaints office. Descriptive statistics and chi-square tests were performed using R software. A complementary SWOT analysis was conducted to assess institutional complaint management capacity. Results: Service attitude (25.1% in 2022, 23.4% in 2023, 21.9% in 2024) and communication (20.3%, 18.8%, 17.2%) constituted the largest complaint categories, both showing significant declining trends (χ²_trend = 6.54, df = 2, p = 0.038 for communication; χ²_trend = 5.98, df = 2, p = 0.045 for service attitude). The top three departments with the highest complaint volumes were General Surgery (16.6% in 2022), Gastroenterology (12.8%), and Otolaryngology (9.6%). Seasonal analysis revealed that the third quarter (July–September) was the peak complaint period (29.4% in 2022). The overall effective resolution rate improved from 62.3% in 2022 to 67.7% in 2023 and 71.5% in 2024 (χ²_trend = 8.12, df = 2, p = 0.017). Treatment outcome complaints showed a relative increase from 18.2% in 2022 to 20.1% in 2024, while billing/administrative complaints increased from 15.0% to 17.4%. Conclusion: Systematic analysis of patient complaints effectively identifies recurrent issues and informs quality improvement strategies. A balanced focus on both “soft skills” (e.g., communication, empathy) and “hard system” factors (e.g., processes, resources) is essential. Continuous monitoring and responsive feedback mechanisms are crucial for sustaining improvements in patient safety and satisfaction. Full article

The rapid digitalisation of healthcare has accelerated the adoption of telemedicine, Electronic Health Records (EHRs), and the Internet of Medical Things (IoMT), transforming healthcare delivery into a highly interconnected and patient-centric ecosystem. In response to growing concerns about data security, privacy, and interoperability, blockchain technology has emerged as a promising solution for its decentralization, immutability, auditability, and secure access control. However, many existing blockchain infrastructures rely on classical cryptographic primitives, including RSA- or elliptic-curve-based public-key mechanisms and cryptographic hash functions such as SHA-256, whose relevant security properties may be affected by sufficiently powerful quantum attacks. This review investigates the convergence of blockchain and quantum technologies to address emerging security threats in e-health systems. A structured literature review was conducted in accordance with the PRISMA 2020 guidelines using the IEEE Xplore, PubMed, ACM Digital Library, Google Scholar, and Crossref databases, covering studies published between January 2018 and June 2025. Following a systematic screening and eligibility-verification process, 57 relevant studies were selected and analyzed. The review evaluates quantum-resilient security mechanisms, including Quantum Key Distribution (QKD), Quantum Random Number Generation (QRNG), and NIST-standardized Post-Quantum Cryptography (PQC) algorithms specified in FIPS 203, FIPS 204, and FIPS 205. Based on the identified research gaps in the state of the art, this study also proposes a novel four-layer Quantum-Blockchain Security Architecture (QBSA) designed for secure healthcare environments. The analysis further reveals significant challenges associated with lightweight PQC deployment for IoMT devices, interoperability standardization, quantum hardware limitations, and regulatory compliance in cross-institutional healthcare systems. The findings highlight the necessity of integrating quantum-resilient cryptographic frameworks with blockchain infrastructures to support the development of secure, scalable, and patient-centric next-generation e-health ecosystems. Full article