Search Results (170)

Background: Missed primary care appointments disrupt continuity, reduce care quality, and increase healthcare costs. Despite numerous studies, global patterns and predictors of appointment non-adherence remain inconsistently reported. Objective: To identify, categorize, and evaluate the consistency of predictors of appointment non-adherence in primary care across diverse populations and healthcare systems. Methods: A systematic review was conducted following PRISMA guidelines (PROSPERO ID: CRD420251121963). PubMed/MEDLINE, Scopus, Web of Science, and Cochrane were searched in August 2025 for observational studies examining predictors of missed, canceled, or rescheduled primary care appointments. Study quality was appraised using the MINORS tool. Results: Twenty-seven observational studies (1982–2025) across eight countries were included, representing a total of more than 13 million appointments analyzed. Reported non-attendance varied widely (~5–31%). Predictors clustered into: patient-level (younger age, socioeconomic disadvantage, minority status in North American studies, mental health burden, and lower literacy/greater social needs), appointment-level (prior non-attendance and longer time between booking and visit), and clinic/system-level (access barriers such as transportation and scheduling friction). Telemedicine and continuity with the same clinician were associated with lower non-attendance in more recent studies. Due to heterogeneity in definitions and analyses, the results were synthesized narratively; overall study quality was modest–moderate by MINORS. Conclusions: Missed appointments reflect interacting patient- and system-level determinants, with the highest risk among younger and socioeconomically disadvantaged patients and those with mental health conditions. Interventions that reduce access friction (e.g., reminders, flexible scheduling/shorter lead times, transportation support) and equity-focused hybrid telemedicine may reduce non-adherence. Full article

Introduction: Chronic wounds affect approximately six million people in the United States. Despite established multidisciplinary wound care protocols, patient adherence to follow-up care remains suboptimal. We aimed to understand the impact of social drivers of health on patient decision-making for improving wound care follow-up adherence. Methods: We conducted a retrospective review of all hospitalized patients who consulted in-house wound care staff at a tertiary care center between August 2017 and June 2020, regardless of primary admission diagnosis. Referred patients received standardized care from a multidisciplinary team at an outpatient wound care facility. Primary endpoints were pre-discharge scheduling and follow-up rates. Follow-up efficacy was assessed through 90-day hospital readmission rates. Results: Of 444 patients, 205 (46.2%) were readmitted or expired within 90 days. Adjusted analysis identified lack of follow-up care reception as an independent predictor of hospital readmission (hazard ratio 2.39; 95% CI, 1.45–3.89; p < 0.001). Among 156 (35.1%) patients who scheduled follow-up, 110 (70.5%) adhered to their appointment. Patients not scheduling follow-up were older (median age 79 vs. 70 years, p < 0.001), longer hospital stays (median 9 vs. 6 days, p < 0.0001), and more frequently discharged to skilled nursing facilities (47.6% vs. 26.3%, p < 0.0001). Among scheduled patients, skilled nursing home residents demonstrated lower follow-up adherence (OR 0.3; 95% CI, 0.14–0.65; p < 0.01). Conclusions: Pre-hospital discharge communication for scheduling follow ups serves as a critical intervention point in patient decision-making for wound follow-up. Considering the limitations of a retrospective single-center study, we find that pre-discharge education about follow-up scheduling for high-risk groups, including patients ≥ 80 years and skilled nursing facility residents, may improve follow-up adherence and reduce readmissions. Full article

Background: Administering several separate childhood vaccines can reduce adherence to immunization schedules due to missed appointments and the burden of repeated injections. A hexavalent formulation targeting diphtheria, tetanus, pertussis, hepatitis B, Haemophilus influenzae type B, and poliovirus offers a practical approach to improve compliance and streamline immunization. Methods: Toxicity testing was performed in Wistar rats and New Zealand White rabbits (60 rats and 30 rabbits). Animals were distributed into three groups: hexavalent vaccine + low-dose sIPV, hexavalent vaccine + high-dose sIPV, and control. Each animal received a 0.5 mL intramuscular injection at weeks 0, 4, 8, and 12. Clinical observations were conducted throughout the study. Serum samples were collected one day before each injection and at the endpoint, while liver tissue was collected at the endpoint. ALT and AST concentrations were analyzed using an automated analyzer, and hepatic morphology was evaluated microscopically. Results: No abnormal clinical signs related to vaccination were observed. ALT concentrations showed no significant differences (p > 0.05). AST differences (p < 0.05) were detected between the high-dose group and the control on day 27 in female rabbits and on day 83 in female rats; however, all values remained within normal physiological limits. Histopathological examination revealed no irreversible hepatic lesions, including hydropic degeneration, portal inflammation, focal necrosis, or connective tissue proliferation, and no significant differences were noted (p > 0.05). Conclusions: Repeated administration of the hexavalent vaccine candidate at low and high doses produced no toxicological effects in animal models, supporting its safety for further clinical development. Full article

This paper presents the design, implementation and evaluation of an agentic virtual assistant (VA) for a medical clinic, combining large language models (LLMs) with retrieval-augmented generation (RAG) technology and multi-agent artificial intelligence (AI) frameworks to enhance reliability, clinical accuracy and explainability. The assistant has multiple functionalities and is built around an orchestrator architecture in which a central agent dynamically routes user queries to specialized tools for retrieval-augmented question answering (Q&A), document interpretation and appointment scheduling. The implementation combines LangChain and LangGraph with interactive visualizations to track reasoning steps, prompts using Gemini 2.5 Flash defines tool usage and strict formatting rules, maintaining reliability and mitigating hallucinations. Prompt engineering has an important role in the implementation and thus, it is designed to assist the patient in the human–computer interaction. Evaluation through qualitative and quantitative metrics, including ROUGE, BLEU, LLM-as-a-judge and sentiment analysis, confirmed that the multi-agent architecture enhances interpretability, accuracy and context-aware performance. Evaluation shows that the multi-agent architecture improves reliability, interpretability and alignment with medical requirements, supporting diverse clinical tasks. Furthermore, the evaluation shows that Gemini 2.5 Flash combined with clinic-specific RAG significantly improves response quality, grounding and coherence compared with earlier models. SBERT analyses confirm strong semantic alignment across configurations, while LLM-as-a-judge scores highlight the superior relevance and completeness of the 2.5 RAG setup. Although some limitations remain, the updated system provides a more reliable and context-aware solution for clinical question answering. Full article

Background/Objectives: The increasing availability of online health information underscores the importance of digital resources and internet use, especially for older adults. Despite the benefits, utilization of Welcome to Medicare (WTM) and Annual Wellness Visits (AWV) remains suboptimal, particularly for those with diabetes. This study examined the relationship between internet use and WTM/AWV utilization among Medicare beneficiaries with diabetes. Methods: The 2021 Medicare Current Beneficiary Survey was analyzed, which is a nationally representative survey of Medicare beneficiaries aged ≥65 years with self-reported type 2 diabetes (n = 1444). The binary dependent variable was self-reported WTM/AWV utilization. The 3 binary independent variables were whether beneficiaries used the internet to (1) look up health information; (2) schedule an appointment with healthcare provider; and (3) communicate with healthcare provider. A survey-weighted logistic regression model was used to examine their associations, adjusted for socio-demographics and comorbidities. Results: Of study beneficiaries, 57.5% reported WTM/AWV utilization. Among WTM/AWV users and non-users, 56.1% and 42.5%, respectively, looked up health information online. Additionally, among WTM/AWV users and non-users, 31.6% and 26.1%, respectively, scheduled appointments online, and 39.8% and 34.3%, respectively, communicated with providers online. Adjusted analysis found that looking up health information online was associated with higher odds of WTM/AWV utilization (OR: 1.76, 95% CI: 1.36–2.28), while the other internet use behaviors were not statistically significant. Conclusions: Approximately 40% of study beneficiaries did not report using WTM/AWV. Improving internet use for health information and digital literacy among at-risk Medicare beneficiaries with diabetes may have a positive influence on WTM/AWV utilization and may support broader use of digital tools in diabetes care. Full article

Objective: The objective of this study is to synthesize and critically appraise how artificial intelligence (AI) is being integrated into oral and maxillofacial surgery (OMFS). This review’s novel contribution is to jointly map clinical applications (diagnostics, virtual surgical planning, intraoperative guidance) and operational uses (triage, scheduling, documentation, patient communication), quantifying evidence and validation status to provide practice-oriented guidance for adoption. Study Design: A narrative review of the recent literature and expert analysis, supplemented by illustrative multicenter implementation data from OMFS practice, was carried out. Results: AI demonstrates high performance in radiographic analysis and virtual planning (up to 96% predictive accuracy and sub-millimeter soft-tissue simulation error), with clinical reports of shorter planning times and more efficient patient communication. Early deployments in OMFS clinics have increased appointment bookings, while maintaining high patient satisfaction, and reduced the administrative burden. Remaining challenges include data quality, explainability, and limited multicenter and pediatric validation, which constrain generalizability and require clinician oversight. Conclusions: AI offers substantive benefits across the OMFS care continuum—improving diagnostic accuracy, surgical planning, and patient engagement while streamlining workflows. Responsible adoption depends on transparent validation, data governance, and targeted training, with attention to cost-effectiveness. Immediate priorities include standardized reporting of quantitative outcomes (e.g., sensitivity, specificity, time saved) and prospective multicenter studies, ensuring that AI augments—rather than replaces—human-centered care. Full article

People living in rural communities are typically underserved by public transportation services and face challenges in accessing healthcare, jobs, stores, and other destinations. Understanding the lived experiences of people who use public transportation in rural communities can help to inform a more equitable transportation system. This qualitative study gathered the perspectives of community health center employees about the public bus system for Hawai‘i Island, a rural county in the United States. Using a community-engaged research approach, the evaluation team interviewed 10 employees through either in-person small group interviews or online individual interviews between April and July 2023. Transcripts were coded and analyzed using a thematic analysis approach. While all study participants were selected for their interest in commuting to work by bus, most believed the bus was not a reliable or convenient option. Participants shared their experiences about not being able to rely on the bus schedule, feeling unsafe while walking to bus stops or waiting for the bus, and other barriers to using the bus system. Participants also shared their insights about how a reliable bus system would benefit community health center patients who needed transportation to more than just their medical appointments, but also to places like pharmacies, laboratory services, and grocery stores. These findings can be used to initiate discussions around the ways that community health centers can further address transportation as a social determinant of health and inform transportation providers about how to best plan and invest in transportation infrastructure and services to meet the needs of rural populations. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

Lack of leadership succession planning in South African public hospitals places nursing leadership at great risk instead of improving healthcare. There is a significant demand for nurse managers in the Free State Province; therefore, leadership succession planning is important. The re-advertising of unfilled leadership roles, the projected volume of nurse managers who will be retiring, and the number of professional nurses opting for better international opportunities indicate the need for effective succession planning. The study aims to determine leadership succession planning for professional nurses in a selected public hospital in the Mangaung District, Free State Province. A qualitative, explorative, and descriptive research design will be used. Non-probability purposive sampling will be adopted to explore the leadership succession planning. The research participants will consist of professional nurses who are currently permanently employed within the Mangaung district, Free State Province. The sample size will be determined by data saturation. An estimated sample size of ±20 participants will be expected. Data collection will be performed through in-depth, unstructured interviews to answer the research question. A central place for interviews will be organised, and appointments will be made with participants as per their schedule or availability. Data will be analysed using Braun and Clarke’s thematic method. The conclusion and the recommendations will be based on the findings of the study. Full article

Suboptimal ART adherence contributes to treatment failure and is common among adolescents. The study sought to assess factors associated with antiretroviral therapy (ART) adherence among adolescents living with HIV. This was a retrospective cross-sectional study design with a random sample of 137 records of adolescents aged 10–19 years from four high-volume ART sites (35 records per site). Data was collected using a customized data extraction tool. Descriptive statistics and Fisher’s exact tests were used to analyze data and identify factors associated with ART adherence at 5% significance level. Most participants (80.3%) were females. Females were more likely to access ART literacy information than males (p = 0.033); poor ART outcomes were prevalent, characterized by high unsuppressed viral loads (73%), low status disclosure (49.6%), inadequate treatment support-lack of treatment buddies (51.2%), missed scheduled ART-related appointments (97.1%), and low rates of follow-up visits (1.5%). Some adolescents (36.5%) rely on alternative medication for HIV treatment. In conclusion, targeted interventions must focus on improving ART adherence, strengthening support systems, and promoting disclosure among adolescents living with HIV, including addressing the use of unproven HIV therapies. Full article

Background: The digitalization of medical services is promoted as a solution for improving access, quality, and efficiency within healthcare systems. In this context, the study investigates the extent to which digitalization in Romania meets the current needs of patients through a convergent analysis of user perceptions and managerial perspectives. Based on the specialized literature, the research tests two hypotheses: (H1) the implementation of digital technologies significantly contributes to improving the quality of medical services and operational efficiency; (H2) digitalization has a positive impact on patient satisfaction by facilitating access to care and improving communication with medical personnel. Methods: The study adopted methodology is cross-sectional and mixed, including an online mixed-methods questionnaire for patients, distributed between 6 and 14 May 2025, and a qualitative questionnaire with open-ended questions distributed via e-mail to managers from public hospitals through The Administration of Hospitals and Medical Services of Bucharest, between 3 and 24 March 2025. Results: In total, 125 patients and 15 hospital managers participated in the study. Statistical analysis (χ², ordinal regression) and data triangulation highlight a predominantly positive, yet heterogeneous, patient perception of digitalization, with Hypothesis H1 only partially supported (weak, inconsistent, and in some cases negative associations between technology use and perceived service quality). By contrast, H2 was robustly validated, with patient satisfaction strongly linked to tangible benefits, particularly easier access and online appointment scheduling. However, use remains limited to administrative functions, while advanced technologies such as telemedicine or electronic health records are poorly adopted. From an institutional perspective, hospitals predominantly use IT systems for internal purposes, without real patient access to their own data, no interoperability between medical units, and marginal implementation of telemedicine. This reveals a significant gap between user perception and organizational realities, emphasizing the lack of a patient-oriented digital infrastructure. Conclusions: The results highlight the potential of digitalization to enhance patient experience and service efficiency, while also pointing out structural limitations that hinder the full realization of this potential. Patient satisfaction is strongly associated with tangible benefits, particularly easier access and online scheduling, whereas the effect on perceived quality is weaker and sometimes inconsistent. There are significant disparities in digitalization levels between healthcare providers, perceived by patients as public–private differences, and gaps among public hospitals are also confirmed by managerial data. These findings suggest that a successful digital transformation of the medical system in Romania must address both technological infrastructure gaps and organizational barriers, within a coordinated national strategy that ensures interoperability, patient-centered design, and sustainable implementation. Full article

Electronic Health Records (EHRs) have enhanced access to medical information but have also introduced challenges for healthcare providers, such as increased documentation workload and reduced face-to-face interaction with patients. To mitigate these issues, we propose RAGMed, a Retrieval-Augmented Generation (RAG)-based AI assistant designed to deliver automated and clinically grounded responses to frequently asked patient questions. This system combines a vector database for semantic retrieval with the generative capabilities of a large language model to provide accurate, reliable answers without requiring direct physician involvement. In addition to patient-facing support, the assistant facilitates appointment scheduling and assists clinicians by summarizing clinical notes, thereby streamlining healthcare workflows. Additionally, to evaluate the influence of retrieval quality on overall system performance, we compare two embedding models, gte-large and all-MiniLM-L6-v2, using real-world medical queries. The models are assessed within the RAG-Triad Framework, focusing on context relevance, answer relevance, and factual groundedness. The results indicate that gte-large, owing to its higher-dimensional embeddings, retrieves more informative context, resulting in more accurate and trustworthy responses. These findings underscore the importance of not only the potential of incorporating RAG-based systems to alleviate physician workload and enhance the efficiency and accessibility of healthcare delivery but also the dimensionality of models used to generate embeddings, as this directly influences the relevance, accuracy, and contextual understanding of retrieved information. This prototype is intended for the retrieval-augmented answering of medical FAQs and general informational queries, and is not designed for diagnostic use or treatment recommendations without professional validation. Full article

Introduction: Oral health problems are prevalent among people receiving palliative care, affecting their quality of life. However, little is known about dental practitioners’ perspectives in this setting. Thus, this study aimed to explore the perceptions of public dental practitioners regarding the provision of dental care for people who receive palliative care. Methods: An exploratory focus group with 21 public dental practitioners, with a mean of 8.24 years of experience, was conducted in a public oral health service in Sydney, Australia. The focus group was transcribed and analysed using thematic analysis. Results: Three themes were identified: (1) enhancing quality of life in palliative care through improved oral health; (2) navigating the systemic and practical challenges of palliative dental care; (3) competent, collaborative, and optimised: a palliative oral care model. Participants highlighted the importance of oral health to quality of life while receiving palliative care. Nevertheless, there were several systematic and practical challenges to delivering appropriate dental care, which included competing priorities among clients, disconnects and gaps in care coordination with palliative care providers, limited training, and adapting treatment planning during appointments. Participants highlighted the need for a new model of care in the future that improved dental practitioners’ competence through comprehensive palliative dental training, included protocols to facilitate interdisciplinary collaboration, and optimised dental treatment planning and appointment scheduling. Conclusions: Public dental practitioners in this study demonstrated positive attitudes, but systemic barriers and limited training restrict their care provision. A palliative oral health care model for this setting should include palliative dental training, foster interdisciplinary collaboration, and optimise dental treatment planning. Full article

Background/Objectives: Dental fear and anxiety are areas of concern in clinical pediatric dentistry, often leading to treatment avoidance and negative oral-health consequences. Cortisol and alpha amylase, measurable in saliva, have been proposed as biomarkers of stress and may provide an objective means of assessing and monitoring distress over time. This study examined measures of psychological and physiological distress in pediatric patients undergoing dental procedures and their correlation. Methods: 7-to-17-year-old new patients scheduled for a dental procedure or orthodontic bonding completed a psychological battery assessing dental fear (using Children’s Fear Survey Schedule—Dental Subscale), stress (Perceived Stress Scale), and dental anxiety (Modified Children Dental Anxiety Scale). Before the dental appointment, we assessed anticipated pain intensity, heart rate (HR), and collected two saliva samples to quantify cortisol and alpha amylase. Correlations between psychological and physiological measures were assessed with Pearson’s correlation and treatment groups were compared with independent t-tests. Results: Out 34 participants (12.8 ± 2.7 y/o, 52.9% females, 73.5% pediatric patients and 26.5% orthodontic patients), 38.2% endorsed moderate anxiety; 85.3% reported moderate to high stress; and 29.6% indicated dental fear. Psychological distress was not influenced by procedure type. Dental fear positively correlated with dental anxiety (p < 0.001) and HR (p < 0.001); dental anxiety positively correlated with anticipated pain (p = 0.010) and HR (p = 0.003); stress positively correlated with HR (p = 0.006). Even if 72.2% of participants had cortisol value outside normal range and those with greater stress exhibited elevated cortisol, cortisol and alpha amylase levels (measured on n = 18) were not correlated with psychological variables. Conclusions: Cortisol and alpha amylase levels were not correlated with psychological measures in a cross-sectional study on pediatric patients undergoing dental procedures. 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