Search Results (184)

Objective: To evaluate whether virtual clinic appointments in cardiology are equivalent to face-to-face appointments in terms of investigations as a consequence of the appointment and a reduction in travel for the whole care episode. Design: Retrospective observational cohort study of 9445 patients. Setting: Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, a medium-sized NHS trust in the north-west of England. Participants: 9445 patients referred for new cardiology appointments between 2023 and 2025. Methods: Data were extracted from electronic records and test ordering systems and appointments with corresponding investigations were retrieved. The data was validated using random samples, and the extraction was modified until accuracy was achieved. Principle component analysis was used to compare groups, and Welch t-test was used to statistically analyse the results. Distance travelled was calculated using postcodes and the number of visits was calculated using investigations conducted on separate days. Results: Patients who had virtual appointments showed no statistical difference in the number of investigations or visits for investigations. The care provided via virtual and face-to-face appointments was found to be comparable in terms of clinical effectiveness and quality of care. The distance travelled for both types of appointment is therefore not different, but if the initial appointment is taken into consideration where there was no travel for the virtual appointment patients, then the reduction in miles travelled is 5002 km, resulting in a carbon saving of 784 kgCO₂eq. Conclusions: Virtual Clinics in Cardiology offer an equitable service but only a small reduction in travel. Full article

Background/Objectives: The purpose of this study was to indicate factors influencing the healing of maxillary sinusitis of endodontic origin (MSEO) after non-surgical endodontic treatment. Methods: The study was performed retrospectively on medical records and CBCT data of 114 teeth in 114 patients, who were referred to endodontic treatment between 2016 and 2024, performed by the same operator and according to the same treatment protocol. Fifteen factors were chosen for their possible influence on the healing of MSEO. Results: The rate of the complete healing of MSEO after RCT was 76.32%. The healing of MSEO was higher when CHX was applied in the final irrigation protocol (p = 0.022) and was less likely when there was a flare-up in-between visits or after obturation of the canals (p = 0.002). MSEO was more likely to heal when a tooth was treated in two appointments than with single-visit RCT (p = 0.012). The number of endodontic interventions significantly influenced the healing of MSEO, as it was less likely to heal when there was more than one endodontic retreatment for a tooth (p = 0.01). Conclusions: Within the limitations of this retrospective study, four factors significantly influenced the healing of MSEO, and these should be taken into consideration in obtaining treatment protocols for dental-induced sinusitis and the better assessment of the possible success of this non-invasive treatment approach. Full article

Background/Objectives: Breastfeeding is essential to maternal and child health, and multiple factors influence its success. This study examined the factors associated with breastfeeding type among infants aged 0 to 12 weeks. Methods: A mixed-methods study, employing a convergent design, was conducted in the rooming in unit of a hospital in Espírito Santo, Brazil. A total of 296 mothers of neonates ≥ 34 weeks participated in both the quantitative and qualitative phases. The qualitative phase involved semi-structured interviews conducted in the hospital setting. In the quantitative phase, data were collected via telephone in three waves (on days 14, 40, and 90 postpartum), critical moments for establishing and maintaining breastfeeding, analyzing sociodemographic factors (age, education, marital status, number of pregnancies), clinical factors (gestational age, mode of delivery, milk production) and support factors (social and hospital). Descriptive statistical analysis and binomial and multinomial logistic regression models were used, conducted in R 4.3.3 software. The qualitative and quantitative findings were integrated through simultaneous incorporation and presented in a joint display. Results: The analysis showed that although most mothers had high adherence to prenatal care, breastfeeding counseling was insufficient. In addition to the type of delivery and immediate skin-to-skin contact, other factors were also found to be relevant to maintaining exclusive breastfeeding. Higher maternal education and a greater number of pregnancies were associated with better breastfeeding practices, albeit with variations in statistical significance. Support received during hospitalization, especially from the healthcare team, also emerged as a central element in the qualitative reports, reinforcing its role as a protective factor for continued breastfeeding. Early formula use within the first 48 h was identified as a barrier to initiating and maintaining breastfeeding. Conclusions: The duration and maintenance of exclusive breastfeeding varied over time, depending on factors such as the number of prenatal appointments, education level, number of pregnancies, mode of delivery, immediate skin-to-skin contact, and, most importantly, the use of formula in the first 48 h. The early introduction of formula in maternity wards represented a significant obstacle to breastfeeding, reinforcing the importance of integrated public policies and multidisciplinary initiatives that promote breastfeeding from birth. Full article

Background: Parents make vital decisions regarding their children’s health and safety. Poor parental self-efficacy is associated with unfavorable health outcomes among their children. This study aims to investigate parental self-efficacy in managing pediatric medications and treatments in Jordan. Methods: This is an online cross-sectional survey study that was conducted in Jordan between 20 April and 4 July 2025. Self-efficacy in managing medications and treatments for children was assessed utilizing a previously validated questionnaire, including healthcare information or decision-making, symptom identification or management, general treatment management, general healthcare navigation, and feeding management. Logistic regression analysis was performed to identify predictors of a higher level of self-efficacy. Results: A total of 597 parents were included in this study. The majority of parents reported high levels of confidence (self-efficacy) in managing various aspects of their child’s care. The highest proportion of parents indicated they were very confident in knowing when their child needs to visit a healthcare provider (35.2%) and in following their child’s diet or nutrition plan (36.9%). Very confident was the most selected response for knowing how to contact healthcare providers (38.4%) and scheduling an appointment (37.0%). Higher income was strongly linked to greater self-efficacy, with parents earning 1001–1500 Jordanian dinars (JOD) showing significantly higher odds (odds ratio (OR) = 4.44, 95% confidence interval (CI): 2.42–8.15, p < 0.001) compared to those earning less than 500 JOD. Parents working in medical fields also had higher odds (OR = 3.30, 95% CI: 1.69–6.45, p < 0.001) compared to those not working. Parents with 2–3 children (OR = 1.73, 95% CI: 1.00–3.00, p = 0.049) or 4–5 children (OR = 1.59, 95% CI: 1.05–3.63, p = 0.03) had greater odds of self-efficacy compared to those with one child. Conclusions: The majority of the parents in this study expressed strong self-efficacy in managing their child’s care, specifically in healthcare-related tasks. Higher self-efficacy was significantly associated with parents’ socioeconomic characteristics such as marital status, medical employment, income, insurance coverage, and number of children. At the same time, lower confidence levels and self-efficacy were observed among divorced parents. More support should be directed towards low-income families and parents who work outside the medical field to enhance their self-efficacy and ultimately the health outcomes of their children. Full article

The aim of this study was to analyze the effectiveness of implementing an automated appointment confirmation system in a mental health clinic and to assess its impact on patient attendance, which may indirectly support the patient recovery process. The study was conducted at a mental health outpatient clinic in Gdańsk, Poland, and focused on medical appointments across three affiliated outpatient units. Data from 2019 and 2023 were compared, focusing particularly on the rate of missed appointments (relationship between number of visits that did not take place and total number of visits that were scheduled in the software), form return rates (the relationship between the number of forms returned by patients and the total number sent), and patient opinions regarding the usability of the new system. The results showed a significant reduction in no-show rates—from 18.55% to 7.01%—confirming the high effectiveness of the automated system. The form return rate reached 55.41%, with the highest engagement observed among individuals aged 35–44. Patient evaluation of the system was highly positive—over 93% found it intuitive and meeting their expectations. A proprietary software solution developed in Python, alongside databases and Microsoft Office Access/Excel tools, was used for data collection and analysis. The study demonstrated that a comprehensive approach, combining automated reminders with the ability for quick patient response and telephone support, is an effective tool for improving the accessibility and quality of healthcare services. The analysis also considered limitations related to digital barriers and identified directions for further research, including studies on how patient abstention from appointments affects their recovery process. Full article

The Maxillary Skeletal Expander (MSE) is used for maxillary expansion in adolescents and young adults. Virtual planning using 3D models, CBCT and 3D printers help in case selection, appliance design and fabrication. Using the proposed digital workflow, the accuracy of the patient selection phase and appliance delivery are increased, and the required number of visits to the clinic is decreased. The MSE serves as a guide for the insertion of mini-implants, reducing the number of appointments needed for installation. (1) Introduction: Mini-Implant-Assisted Rapid Palatal Expansion (MARPE) appliances, like the MSE, decrease the side effects that regular tooth-anchored appliances have on dental and periodontal structures, especially for skeletally mature patients, combining palatal anchorage with dental support for guidance. The digital planning of the insertion sites, length and angulation of the mini screws, and the fabrication of the 3D-printed appliance that stands as a mini-implant insertion guide give an undeniable precision. (2) Materials and methods: The laboratory steps used in the digital design and fabrication, and clinical steps needed for the insertion protocol are described. (3) Discussions: The individual assessment of the anatomical structures and the use of virtual integrated dental impressions and CBCT increase the accuracy of diagnosis, appliance fabrication and treatment progress. Implementing a digital workflow for mini-implant-supported expansion is a real advantage for both dental teams and patients. (4) Conclusions: The wide range of advantages and the ease of the process support the introduction of this digital workflow in every orthodontic practice. Full article

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

Background: The rapid growth of international maritime trade has intensified operational challenges at marine terminals due to increased interaction between vessels, trucks, and trains. Key issues include berth congestion, inefficient truck arrivals, and underutilization of terminal resources. Ensuring coordinated planning among transport modes and fostering collaboration between stakeholders such as vessel operators, logistics providers, and terminal managers is critical to mitigating these inefficiencies. Methods: This study proposes a multi-agent, multi-objective coordination model that synchronizes vessel berth allocation with truck appointment scheduling. A solution method combining prioritized planning with a neighborhood search heuristic is introduced to explore Pareto-optimal trade-offs. The performance of this approach is benchmarked against well-established multi-objective evolutionary algorithms (MOEAs), including NSGA-II and SPEA2. Results: Numerical experiments demonstrate that the proposed method generates a greater number of Pareto-optimal solutions and achieves higher hypervolume indicators compared to MOEAs. These results show improved balance among objectives such as minimizing vessel waiting times, reducing truck congestion, and optimizing terminal resource usage. Conclusions: By integrating berth allocation and truck scheduling through a transparent, multi-agent approach, this work provides decision-makers with better tools to evaluate trade-offs in port terminal operations. The proposed strategy supports more efficient, fair, and informed coordination in complex multimodal environments. Full article

Background/Objectives: The timely initiation of antiretroviral therapy (ART) in persons living with HIV (PLWH) can improve clinical outcomes. However, ART commencement is often delayed. Portugal, despite having one of the highest new HIV diagnosis rates within the European Union, has limited available national-level data. Prior evidence from 2017 to 2018 suggests that the average time to ART initiation exceeds the recommendations for optimal patient benefits. This study aimed to determine the number of days from the first hospital appointment to the commencement of ART among newly diagnosed PLWH in Portugal between 2017 and 2022 at the national level and across different hospitals. It was hypothesized that newly diagnosed PLWH in Portugal experience a delay in ART initiation beyond the recommended timeframe. Methods: A retrospective analysis of records from Portuguese public tertiary care hospitals, which manage most HIV patients, was conducted. Descriptive statistics (measures of central tendency, dispersion, and frequency) were applied, along with association tests and a binary logistic regression model to examine factors influencing the timing of ART initiation. Results: A total of 2229 cases (out of 3434 received) from 19 hospitals were considered eligible. The median time interval between the first hospital appointment and ART initiation was 29.00 days, with a decreasing tendency between 2017 and 2022. Patients initiating therapy after 14 days had higher CD4 levels and lower viral loads compared to those starting within 14 days, with statistical significance. Conclusions: Continuous and regular monitoring of key indicators, such as the time to ART initiation, is pivotal for assessing the effectiveness of HIV treatment programs and pinpointing areas in need of improvement. Full article

Background/Objectives: Generating real-world data on the efficacy of multidisciplinary care in cardiometabolic risk management is essential to ensure that guidelines are both applicable and effective, especially in public healthcare settings, where organizational structures may impede healthcare professionals’ agility. This study aimed to generate data on patient follow-up and cardiometabolic risk management during the early years of a public university family medicine group in Québec (Canada) that provides multidisciplinary care to adults with cardiometabolic conditions, in order to evaluate the implementation and effectiveness of its care model. Methods: This was a retrospective longitudinal study. Patients treated at the clinic from 31 January 2020 (clinic opening) to 8 May 2024 (n = 96) were invited to consent to the use of their medical data for research. Results: A total of 52 patients consented and were included in the study. Upon entry at the clinic, >90% of patients had anthropometry and blood pressure (BP) measured, but plasma glucose and lipids were assessed among 50% and 79% of patients, respectively. A total of 36 patients completed the personalized multidisciplinary care program. No evidence of associations between the total number of appointments or appointments with the registered dietitian specifically with changes in BMI, waist circumference, and BP was found. However, each pharmaceutical intervention was associated with a −0.51 cm (95%CI: −1.03, 0.02; p = 0.06) change in waist circumference and a −1.49 mm Hg (95%CI: −2.56, −0.43, p = 0.01) change in diastolic BP. Conclusions: These data highlight the challenges of implementing a research-oriented clinic within Québec’s public healthcare system. Full article

Background: Understanding patient perceptions of cancer care is crucial for improving treatment experiences and health outcomes. This study explores female patient-reported experiences with cancer care. Our aim was to identify areas for improvement and enhance patient-centered approaches in specialty and primary care settings. Methods: This was a prospective observational study using ResearchMatch. Our eligibility criteria were 40 years or older adult cancer diagnosis, female, and treated for cancer in the United States. Results: Among the eligible participants (n = 1224), 64 responded to the invitation and 57 completed the survey (89% participation proportion). The majority of the respondents were not receiving treatment during the study period (68%). Of those, 89% completed the recommended treatment, and 10% stopped the treatment before completion. Nearly 80% of respondents saw the same oncologist during the treatment at every appointment, and only 8% reported changing clinicians during their primary cancer treatment. Over 63% of respondents were not seeing the same primary care clinician as they did when they were first diagnosed. Respondents reported facing challenges with employment and ability to return to work (26%), being able to afford medication (21%), and paying medical bills (15%). Discussion: This study, albeit for a small number of participants (n = 57) identified strengths and challenges in cancer care. Consistent oncologist involvement and proximity to care centers was consistently reported during active treatment. Discontinuity with primary care, however, may warrant further inquiry. Reported financial, employment and access issues support previous studies that identified these as major challenges during and after active cancer treatment. Our study underscored the need to enhance patient-centered coordination and support to improve cancer and survivorship care outcomes. Full article

Cone-beam computed tomography (CBCT) offers low radiation, cross-sectional imaging that is a suitable alternative to conventional fan-beam computed tomography (FBCT). The initial experience using in-clinic CBCT in the Rhinology outpatient clinic at Waikato Hospital, New Zealand, is described. The first 5 months of CBCT use for Rhinologic imaging was compared to FBCT use in the equivalent 5-month period one year prior. Data relating to 61 CBCTs and 115 FBCTs was analysed. We compared the time and number of hospital visits required for a confirmed treatment decision (CTD) to be made and the duration of the clinic appointment at which the scan was requested between the two groups. The CBCT group required significantly less time (171 vs. 316 days, p < 0.001) and fewer hospital visits (1.5 vs. 3.2 visits, p < 0.001) before a CTD was made, but a longer appointment duration (86 vs. 53 min, p < 0.001). The use of in-clinic CBCT in Rhinology was therefore associated with reduced time and fewer hospital visits before definitive management was decided, but longer clinic appointments were observed. Increased access to CT imaging may result in increased demand. Expertise is required to optimise the quality of imaging, and we recommend that a dedicated Radiographer be allocated. Full article

Background/Objectives: Extraction and replacement of hopeless teeth is a common practice in dentistry. Tooth autotransplantation (TA) offers several advantages as a viable and biological treatment option. However, its utilization in Saudi Arabia appears limited. Understanding dentists’ knowledge and attitudes toward TA is crucial for promoting its adoption in clinical practice. Therefore, the aim of this study is to assess the knowledge and attitudes of dentists in Saudi Arabia toward tooth autotransplantation. Methods: A cross-sectional study was conducted using a web-based questionnaire distributed to dentists across Saudi Arabia. The questionnaire included 19 questions assessing demographic characteristics, knowledge of TA, and attitudes toward its clinical application. Data were analyzed using SPSS v23 with chi-square and Cramér’s V tests to explore associations between variables (p < 0.05). Results: 253 dentists participated in this study. All participants had heard of TA, while only 26.5% reported moderate-to-high familiarity. Female dentists showed significantly greater interest in adopting TA than males (p = 0.038, Cramér’s V = 0.183). Specialists expressed higher familiarity than general dentists and underscored the importance of clinical guidelines, evidence-based outcomes, confidence in their capacity to engage in a TA team, the total number of required appointments, and malpractice concerns (p < 0.05) in their decision-making process. Nevertheless, general dentists demonstrated significantly more interest in implementing TA (p = 0.025, Cramér’s V = 0.192). Participants with more than 5 years of clinical dental experience were significantly more familiar with TA (p = 0.015, Cramér’s V = 0.204) and were more influenced by appointment numbers in decision-making (p = 0.012, Cramér’s V = 0.225). Conclusions: The study reveals limited familiarity but notable interest among dentists in Saudi Arabia toward TA. Addressing educational gaps by integrating TA training into dental curricula and offering clinical exposure opportunities to students, along with providing evidence-based clinical guidelines, and improving access to advanced imaging technologies, may enhance the adoption of TA as a viable treatment modality for tooth replacement. Full article

Background/Objectives: Although there is a general consensus that patients should have dental evaluation before heart valve surgery, data on the extent and complications of this evaluation are scarce. The objective was to analyze safety and feasibility of dental evaluation in patients undergoing heart valve surgery. Methods: A retrospective chart review of patients referred for dental evaluation prior to heart valve surgery in 2021–2023 was conducted. Demographic, medical, and dental data were recorded. The number and type of dental procedures and their complications were recorded, along with the number of appointments and the time required to achieve dental clearance for heart valve surgery. Results: One hundred and fifty-three patients were referred in the observed period. The predominant procedure was tooth extraction, accounting for 76 (49.7%) cases. Complications were recorded in 3 (1.9%) patients, with delayed bleeding being the most prevalent issue, occurring in 2 (1.3%) patients. The median time required to obtain dental clearance for cardiosurgical procedure was 1 day, with 124 (81%) patients obtaining clearance in a single appointment. No dental emergencies were observed during hospital admission for the cardiosurgical procedure. Conclusions: Our results suggest that dental evaluation before heart valve surgery can be conducted in a reasonable amount of time with a low complication rate and without the need to delay cardiosurgical procedures. Full article

The Middle East and North Africa (MENA) region has faced challenges like political instability and economic fluctuations, which have impacted non-performing loans (NPL) levels. At the same time, over the years, reforms and regulations have encouraged stronger board structures to enhance corporate governance and improve risk management. The purpose of this paper is to investigate how board characteristics affect non-performing in the MENA region. Board characteristics shape governance quality, which influences risk management and reduces banks’ risk-taking behaviours. Hence, effective governance can reduce non-performing loans by improving oversight and credit decisions. To this end, we used a sample of 70 banks operating in 12 countries in the MENA region from 2010 to 2022. The System Generalized Method of Moments (SGMM) was employed as an empirical technique. To benefit from a comparative analysis, we divided the entire sample into two subsamples. The first subsample covers six Gulf Cooperation Council (GCC) countries with 42 banks. The second subsample is also relative to six non-Gulf Cooperation Council (non-GCC) countries with 28 banks. The empirical findings indicate that the presence of independent board members, a higher number of female board members, board remuneration, and the board index decrease NPLs across all regions, including MENA, GCC, and non-GCC. However, we found that board size, tenure, and duality increase NPLs. The results of this paper are beneficial for both policymakers and bankers, as they provide insights into how governance through board characteristics influences credit risk. These results support better decision-making in board appointments and governance practices to improve risk management and reduce non-performing loans. Full article