Search Results (1,444)

Objective: To test whether inpatient electrical muscle stimulation (EMS) using Russian current (5 kHz carrier, 50 Hz modulation; 4 s ON/6 s OFF) improves mobility and balance in elderly people with chronic cerebral ischaemia. Design: Prospective single-centre controlled observational pilot, embedded in routine inpatient rehabilitation; no concealed randomisation (EMS + standard care; sham EMS + standard care; standard care only (control)). Methods: A single-centre controlled observational study with three groups was conducted (EMS n = 27, control n = 10, sham n = 7) with 3–9 sessions over 2 weeks (20 min; quadriceps and calves). Pre/Post Outcomes: Tinetti (balance/gait), Rivermead Mobility Index, Timed Up and Go (TUG), ankle extensor maximal voluntary force (MVF), stabilography (statokinesiogram path length (L), mean velocity of COP (V), sway area (S), and myotonometry; ANOVA, α = 0.05). Ethics approval and informed consent were obtained. Between-group differences in change scores were evaluated descriptively, and no formal hypothesis-testing was planned. Results: EMS showed significant gains versus control/sham—higher Tinetti total and Rivermead scores, faster TUG, higher MVF, and improved stabilography in the eyes-closed condition (reduced L, V, and S), with good tolerability and no serious adverse events (SAEs). Conclusions: Short-course Russian-current EMS is feasible and associated with clinically meaningful improvements in balance, gait, and strength in elderly patients with chronic cerebral ischaemia; however, larger randomised trials are warranted. Full article

Multimodal methods provide valuable opportunities within Participatory Action Research (PAR), to foster meaningful participation, and amplify marginalized voices. However, conventional research approaches have not always adequately captured the complex realities of the lived experiences of families, and multimodal techniques have remained underutilized for the exploration of such experiences. This study aimed to explore the use of creative multimodal methods, within a PAR framework, grounded in care among vulnerable South African families. A qualitative design was adopted, incorporating Human-centered Design principles, within a PAR approach. The participants were recruited from the Saldanha Bay Municipality area (n = 70), as well as Mitchells Plain (n = 59). The multimodal methodology included Draw-and-Tell, painting, object and photo elicitation, I-Poems, and LEGO^®-based activities. Data were annotated and transcribed verbatim, followed by thematic analysis. A total of 42 participants contributed towards the validation of the methods. The participants described experiences of deep emotional insight, self-reflection, and self-recognition, through engagement with the multimodal activities. The findings revealed that these approaches were: (1) credible, producing internally valid and contextually rich data; (2) contributory, generating original and applicable insights into family life; (3) communicable, offering accessible and structured ways for diverse participants to express their experiences; and (4) conforming, ensuring ethical engagement through inclusive participation. These findings demonstrate the potential of creative, arts-based, and participatory approaches, to advance methodological innovation in qualitative family research. Full article

The limitations of conventional diabetes management are increasingly evident. As a result, both type 1 and 2 diabetes in pediatric populations have become major global health concerns. As new technologies emerge, particularly artificial intelligence (AI), they offer new opportunities to improve diagnostic accuracy, treatment outcomes, and patient self-management. A PRISMA-based systematic review was conducted using PubMed, Web of Science, and BIREME. The research covered studies published up to February 2025, where twenty-two studies met the inclusion criteria. These studies examined machine learning algorithms, continuous glucose monitoring (CGM), closed-loop insulin delivery systems, telemedicine platforms, and digital educational interventions. AI-driven interventions were consistently associated with reductions in HbA1c and extended time in range. Furthermore, they reported earlier detection of complications, personalized insulin dosing, and greater patient autonomy. Predictive models, including digital twins and self-learning neural networks, significantly improved diagnostic accuracy and early risk stratification. Digital health platforms enhanced treatment adherence. Nonetheless, the barriers included unequal access to technology and limited long-term clinical validation. Artificial intelligence is progressively reshaping pediatric diabetes care toward a predictive, preventive, personalized, and participatory paradigm. Broader implementation will require rigorous multiethnic validation and robust ethical frameworks to ensure equitable deployment. Full article

Invertebrates are increasingly consumed and kept as pets, research models, and in zoological exhibits, creating a growing need to better understand their clinical management and welfare. However, the knowledge regarding nociception, pain perception, and euthanasia in invertebrates remains limited, and standardized protocols are largely absent. Current guidelines are incomplete, often anecdotal, and omit several major invertebrate phyla. To address this gap, we conducted a narrative review of the literature, aiming to critically evaluate existing euthanasia methods, associated welfare implications, and opportunities for refinement. The amount of peer-reviewed species-specific literature is limited and scattered. In addition, most described methods are insufficiently studied and/or do not align with our definition of euthanasia. Based on the available literature, and to provide practical guidance despite these limitations, we propose a two-step approach to invertebrate euthanasia. The first step consists of inducing anesthesia to achieve loss of responsiveness, followed by a second step; a terminal procedure involving physical or chemical destruction of the brain or major ganglia. Our review focuses on the application of this two-step approach. The effectiveness and humaneness of euthanasia techniques vary considerably across taxa and life stages. Substantial further research is required to validate and optimize humane end-of-life procedures for diverse invertebrate species. Full article

Background/Objectives: Gastrointestinal and eating disorders are highly prevalent problems in children with Down syndrome (DS) and have a significant impact on their daily lives. It is important to investigate the bowel habits of children with DS, specifically the prevalence of functional constipation (FC), in order to develop practice guidelines for pediatricians that support diagnosis and treatment. Materials and Methods: This observational, analytical, and cross-sectional study was approved by the Ethics Committee and included 36 children with DS under pediatric outpatient follow-up at a university hospital. To assess bowel habits, an interview was held with the parents using the Rome IV criteria and the Bristol Stool Scale. The children were divided into two groups: those with and those without FC. Specific curves for individuals with DS were used for nutritional assessment. Results: The median age of the children was 46.6 months (5 to 144 months); a total of 80.5% of those included were eutrophic. The median age at initiation of toilet training was 36 months. Most children achieved bowel control when training started after 30 months of age. A total of 15 (41.7%) of the 36 children included were assigned to the group with FC, and 21 (58.3%) were assigned to the group without FC. The FC group had a lower frequency of bowel movements, hardened stools, pain during bowel movement, and used laxatives. According to the Rome IV criteria, the three most prevalent criteria were hard stools, large-volume stools, and painful bowel movements. Conclusions: Children with DS had a high prevalence of FC, and it was possible to identify an association between delayed sphincter training and FC. A care and monitoring protocol and flowchart are useful tools for the general pediatrician. Full article

Every act of design tells a story about who belongs, who is seen, and who is heard. This paper looks at how participatory design-based research (PDR), practiced with relational care and reflexivity, can help shift interactions among marginalized youth from urban Indigenous and newcomer immigrant communities in Canada from othering toward understanding. Moving beyond surface-level celebrations of multiculturalism, the study frames design as a relational and ethical practice, one that surfaces assumptions, holds space for difference, and creates openings for intercultural dialogue. The study draws on a series of design circles (d.circles) in which youth co-created visual communication artefacts reflecting their lived experiences. These artefacts became catalysts for dialogue, enabling participants to challenge stereotypes, articulate concerns, and develop shared perspectives. Reflexivity was integral to the process, guiding both participants and the facilitator to consider power, positionality, and relational accountability throughout. Findings show that participatory design, grounded in Indigenous relational principles and participatory action research, can unsettle dominant narratives, foster mutual recognition, and support youth-led meaning-making. This work contributes to emerging conversations that position design thinking as a practice of ethical engagement rather than a tool for problem-solving alone. The learnings from this study show how critically practiced PDR can cultivate more inclusive and socially responsive pathways for intercultural understanding to take shape. Full article

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. The aim of this study is therefore to assess how ethical issues are managed in Italian NICUs, with particular attention to the availability, use, and perceived usefulness of clinical ethics support in everyday practice. Methods: A 25-item questionnaire was developed by adapting an existing tool for investigating clinical ethics activities to the neonatal context. Following expert review by the GIBCE (Gruppo Interdisciplinare di Bioetica Clinica e Consulenza Etica in ambito sanitario), the final instrument covered four areas (general data, experience with ethical dilemmas, tools and procedures, opinions and training needs). A manual web search identified all Italian NICUs and their clinical directors, who were asked to disseminate the survey among staff. Participation was voluntary and anonymous. Data collection was conducted via Google Forms and analyzed through qualitative thematic analysis. Results: A total of 217 questionnaires were collected. The most frequent ethical dilemmas concern quality of life with anticipated multiple or severe disabilities (72.4%) and decisions to withdraw or withhold life-sustaining treatments (64.5%). Major challenges include fear of medico-legal repercussions (57.6%) and communication divergences between physicians and nurses (49.8%). More than half of respondents (52.1%) reported no formal training in clinical ethics, and 68.7% had never developed a Shared Care Plan (Shared Document for healthcare ethics planning) as defined by the Italian Law 219/2017. Conclusions: Findings highlight marked fragmentation in ethical practices across Italian NICUs. On this basis, establishing structured and accessible CEC services could help promote consistency, reinforce shared ethical standards, and support transparent and equitable decision-making in critical neonatal care. Full article

Objective—Partial do-not-resuscitate (DNR) orders, directives specifying limited resuscitative efforts, are intended to align medical interventions with patient preferences. However, their complexity may introduce ambiguity, inconsistent care, and ethical challenges. Design—A retrospective review was conducted of inpatient partial code order entries over a three-year period at a single institution with a pediatric oncology and immunology cohort. Partial DNR orders were identified and categorized based on included or excluded interventions (chest compressions, defibrillation, intubation, mechanical ventilation, medications). Data was analyzed to assess the frequency, variation, and internal consistency of documented preferences as well as alignment with institutional definitions and clinical feasibility. Results—Partial DNR orders represented a small (n = 15, 7%) but notable proportion of total code status entries. Wide variability was observed in the combinations of permitted and withheld interventions, with orders containing internally conflicting instructions. Documentation of inconsistencies and unclear terminology were common, raising concerns about interpretability during emergent situations. Conclusions—Partial DNR orders demonstrate heterogeneity and potential for miscommunication. These findings suggest that while partial codes may reflect nuanced patient preferences, they pose operational and ethical risks that could compromise care clarity. Clinical implications are reviewed. These findings will guide institutional deliberations regarding whether to refine, restrict, or eliminate partial code order options to enhance patient safety and decision-making transparency. Full article

Dementia is a progressive condition that affects cognition, communication, mobility, and independence, posing growing challenges for individuals, caregivers, and healthcare systems. While traditional care models often focus on symptom management in later stages, emerging artificial intelligence (AI) technologies offer new opportunities for proactive and personalized support across the dementia trajectory. This concept paper presents the Assistive Intelligence framework, which aligns AI-powered interventions with each stage of dementia: preclinical, mild, moderate, and severe. These are mapped across four core domains: cognition, mental health, physical health and independence, and caregiver support. We illustrate how AI applications, including generative AI, natural language processing, and sensor-based monitoring, can enable early detection, cognitive stimulation, emotional support, safe daily functioning, and reduced caregiver burden. The paper also addresses critical implementation considerations such as interoperability, usability, and scalability, and examines ethical challenges related to privacy, fairness, and explainability. We propose a research and innovation roadmap to guide the responsible development, validation, and dissemination of AI technologies that are adaptive, inclusive, and centered on individual well-being. By advancing this framework, we aim to promote equitable and person-centered dementia care that evolves with individuals’ changing needs. Full article

Background: Patient-centered care (PCC) is a cornerstone of quality, yet its translation into managerial decision-making remains underexplored. Middle nurse managers (MNMs) play a pivotal role in enabling patient-centeredness, but their perspectives on PCC decisions are rarely investigated. Aim: This study explored MNMs’ perceptions of what constitutes a patient-centered decision in hospital settings and identified the essential dimensions underpinning such decisions. Methods: A qualitative descriptive design was adopted using semi-structured interviews. Thirty-eight MNMs from three hospitals in central Italy were included. Data were analyzed using Elo and Kyngäs’ content analysis approach. Results: Two overarching themes emerged as central to patient-centered managerial decision-making (PCMDM): “Meaning and definition of PCMDM,” and “Influencing dimensions of PCMDM”. MNMs described PCMDM as an evolving and adaptable process shaped by patient needs and organizational constraints and unfolding across distinct phases. Key influencing dimensions included the manager’s role, organizational environment, human resource management and knowledge of the patient. Conclusions: PCMDM is a continuous, ethical, and reflective process mediated by MNMs, who reconcile institutional priorities, team dynamics, and patient needs to create conditions for high-quality PCC. Implications for Practice: Strengthening PCMDM requires coordinated action aimed at equipping nurse managers with advanced leadership capabilities, building organizational structures that sustain patient-centered decisions, and empowering patients to actively co-shape the care process. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Biomarker-based prevention is rapidly expanding, driven by advances in molecular diagnostics, genetic profiling, and commercial direct-to-consumer (DTC) testing. General practitioners (GPs) increasingly encounter biomarker results of uncertain relevance, often introduced outside the guideline frameworks. This creates new challenges in interpretation, communication, and equitable resource use in primary care. This narrative review synthesizes evidence from population-based studies, guideline frameworks, consensus statements, and communication research to evaluate the predictive value, limitations, and real-world implications of biomarkers in asymptomatic adults. Attention is given to polygenic risk scores, DTC genetic tests, neurodegenerative and cardiovascular biomarkers, and emerging multi-omics and aging markers. Several biomarkers, including high-sensitivity cardiac troponins, N-terminal pro–B-type natriuretic peptide, lipoprotein(a), coronary artery calcium scoring, and plasma p-tau species, showed robust predictive validity. However, many widely marketed biomarkers lack evidence of clinical utility, offer limited actionable benefits, or perform poorly in primary care populations. Unintended consequences, such as overdiagnosis, false positives, psychological distress, diagnostic cascades, and widening inequities, are well documented. Patients often misinterpret unvalidated biomarker results, whereas DTC testing amplifies demand without providing adequate counseling or follow-up. Only a minority of biomarkers currently meet the thresholds of analytical validity, clinical validity, and clinical utility required for preventive use in general practices. GPs play a critical role in contextualizing biomarker results, guiding shared decision-making, and mitigating potential harm. The responsible integration of biomarkers into preventive medicine requires clear communication, strong ethical safeguards, robust evidence, and system-level support for equitable, patient-centered care. Full article

Nature-connection is increasingly promoted as a way of prompting care and concern for nature and encouraging pro-environmental behaviours. Yet its conceptual foundations remain unclear and contested, with researchers defining the construct in divergent ways. In this study, a situational analysis of interviews with nature-connection practitioners is used to provide empirical evidence demonstrating entwined and contradictory discourses at work in their talk about nature-connection theory and practice. The analysis illustrates the ways in which Cartesian dualism and relational ontologies occupy the same discursive space. The data are used to discuss possible routes toward a more coherent premise for an environmental ethic than the ubiquitous biophilia hypothesis, introducing panpsychism as a promising rationale for the moral consideration of nonhumans and the fostering of cultural intuitions of animacy in relationship to urban environments and human-made artefacts. Conservationists and educators are encouraged to explore panpsychism for its potential to provide an ethical framework for promoting a greater sense of ecological responsibility. Full article

Background/Objectives: The integration of artificial intelligence (AI) into primary health care (PHC) holds significant potential to enhance efficiency, equity, and clinical decision-making. However, its implementation remains uneven across contexts. This study aimed to identify the systemic, contextual, and governance-related determinants influencing AI readiness in PHC, comparing two distinct health systems, Quebec (Canada) and Iran. Methods: A qualitative, comparative design was employed. Data were collected through semi-structured interviews and focus group discussions with key informants in both settings. A framework-guided content analysis was conducted based on the four Primary Care Evaluation Tool (PCET): stewardship, financing, resource generation, and service delivery. The analysis explored shared context-specific challenges and requirements for AI implementation in PHC. Results: Analysis revealed that AI readiness is shaped more by systemic coherence rather than technological availability alone. Across both contexts, governance- and financing-related challenges were reported by the majority of participants, alongside limited data interoperability. In Quebec, challenges were more commonly articulated around operational and ethical concerns, including workflow integration, transparency, and professional trust. In contrast, participants in Iran emphasized foundational deficiencies in governance stability, financing mechanisms, and digital infrastructure as primary barriers. Across both settings, adaptive governance, sustainable investment, data standardization, and workforce capacity-building consistently emerged as key requirements for AI integration in PHC. Conclusions: AI readiness in PHC is a multidimensional process, in which implementation priorities must align with system maturity. This comparative analysis underscores that while high-resource systems must prioritize ethical integration and workflow alignment, middle-resource settings require foundational investments in governance and infrastructure. This reinforces that AI readiness is a context-dependent and phased process rather than a one-size-fits-all endeavor. Full article

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs. Full article