Search Results (1,711)

Background and Objectives: Pediatric-onset metabolic bone diseases, including osteogenesis imperfecta (OI), hypophosphatemic rickets (XLH), hypoparathyroidism, and McCune–Albright syndrome (MAS), require lifelong follow-up because of persistent skeletal fragility, biochemical abnormalities, and functional morbidity extending into adulthood. However, evidence regarding structured transition from pediatric to adult care in these rare disorders remains limited. This study evaluated one-year outcomes of a multidisciplinary transition program for adolescents and young adults with rare metabolic bone diseases. Materials and Methods: This retrospective cohort study included 20 patients aged ≥17 years who underwent evaluation through a structured transition pathway consisting of multidisciplinary team meetings, a joint pediatric–adult transition clinic, and subsequent follow-up in adult endocrinology. Demographic, clinical, treatment, and transition-related data were extracted from medical records. The primary outcome was successful transition, defined as at least one adult endocrinology visit within 12 months. Secondary outcomes included attendance at the transition clinic, follow-up continuity, and treatment modifications. Results: All patients underwent multidisciplinary evaluation, and 85% attended the joint transition clinic. Successful transfer to adult endocrinology was achieved in 90% (18/20), while regular follow-up during the first year was maintained in 75%. Retention was highest in patients with OI, MAS, XLH, vitamin D-dependent rickets, and DiGeorge syndrome (100%). Greater variability was observed in postoperative and primary hypoparathyroidism. Treatment adjustments were required in 40% of patients, including optimization of phosphate/calcitriol replacement and reassessment of bisphosphonate or burosumab therapy. Three patients were lost to follow-up. No acute transition-related complications were observed. Conclusions: In this small exploratory cohort, implementation of a structured multidisciplinary transition pathway was feasible and was accompanied by high transfer and one-year retention rates. Observed differences across diagnostic subgroups should be interpreted cautiously, and larger multicenter comparative studies are needed to evaluate the effectiveness of structured transition frameworks. Full article

Background: Moral distress is a significant concern in nursing, particularly among newly graduated registered nurses transitioning into professional practice. Limited experience, high workloads, and exposure to ethically challenging situations may negatively affect well-being and contribute to early-career attrition. Evidence on how NGRNs experience and manage moral distress globally and in Saudi Arabia remains limited, and the role of healthcare organisational factors in shaping this phenomenon is not yet well understood. Aim: This study aims to examine the experiences of NGRNs regarding moral distress in adult tertiary care hospitals in Saudi Arabia, focusing on contributing factors, coping strategies, and organisational influences. Methods: A mixed-methods sequential explanatory design will be used. In the quantitative phase, NGRNs will complete the Measure of Moral Distress—Healthcare Professionals (MMD-HP) and a demographic questionnaire. Data will be analysed using descriptive and inferential statistics to assess levels of moral distress and associations with intention to leave. The qualitative phase will involve semi-structured interviews with NGRNs and focus groups with nursing managers, which will be analysed using reflexive thematic analysis. Integration will occur at the data collection and interpretation stages. The study is guided by Bronfenbrenner’s Ecological Systems Theory. Ethical approval has been obtained from Queen’s University Belfast and the Najran Health Cluster. Expected Impact: The study is expected to provide a comprehensive understanding of moral distress among NGRNs and inform the development of targeted organisational strategies to support Registered Nurse wellbeing, retention, and quality of care. Full article

Background/Objectives: Contemporary healthcare systems face compound challenges (including technological acceleration, demographic aging, rising chronic disease burden, and growing patient expectations) that demand models that are simultaneously efficient, high-quality, and person-centered. Despite a substantial body of research addressing organizational design, human capital management, and clinical competencies, these dimensions have largely been theorized in isolation. This study aims to construct and justify an integrated theoretical framework explaining how organizational models, human capital, and transversal competencies may jointly shape care quality, patient safety, and institutional sustainability in healthcare organizations. Methods: A narrative literature review was conducted, integrating contributions from business economics, healthcare management, organizational psychology, and nursing sciences. This design was selected for its suitability in synthesizing heterogeneous, multidisciplinary knowledge into a coherent conceptual framework, a purpose for which systematic meta-analytic approaches are not appropriate. Sources encompassed 79 references: peer-reviewed journals (PubMed, JSTOR, Google Scholar), institutional reports (WHO, OECD, European Commission, Joint Commission), normative standards (ISO 30414:2018), and Italian regulatory frameworks, spanning foundational twentieth-century contributions through the most recent literature (2025). Results: Four principal findings emerged: (1) healthcare organizations are evolving from rigid hierarchical structures toward flexible, value-based configurations, with the Value-Based Healthcare (VBHC) paradigm redirecting institutional attention from service volume to patient-meaningful outcomes per unit of cost; (2) transversal competencies (communication, empathy, emotional intelligence, teamwork, and transformational leadership) are closely associated with care quality and patient safety, with 70–80% of sentinel events associated with communication failures; (3) human capital, encompassing technical expertise and relational capacity, constitutes the primary lever of competitive advantage in healthcare institutions; and (4) the trajectory from pyramidal toward participatory and self-managed models is supported by international evidence, including the Buurtzorg experience in the Netherlands. Conclusions: The integrated three-pillar framework (combining resource-based theory and dynamic capabilities, Value-Based Healthcare, and evolutionary organizational theory) provides a theoretically grounded basis for understanding how organizational structure, human capital, and transversal competencies are jointly associated with clinical performance. Healthcare institutions should systematically integrate soft-skills training into professional education and invest in participatory organizational structures. Health policy should revise financing mechanisms to incentivize patient-meaningful outcomes over service volumes and support the broader transition toward Value-Based Healthcare models. The Italian SSN is discussed as an illustrative national context rather than as the primary empirical focus of the review. Full article

Corrosion of carbon steel components represents a major economic and safety challenge in industrial applications, motivating the development of protective thin film coatings with optimized deposition parameters. This study investigates the deposition of nickel nitride (Ni-N) thin films on AISI 1016 carbon steel and silicon (111) wafers by reactive radio-frequency (r.f.) magnetron sputtering at three power levels: 150, 175, and 200 W. Surface color, film thickness, roughness, crystal structure, mechanical properties, and electrochemical behavior were evaluated using optical microscopy, stylus profilometry, atomic force microscopy (AFM), X-ray diffraction (XRD), nanoindentation, and potentiodynamic polarization combined with electrochemical impedance spectroscopy (EIS). Increasing r.f.-power produced systematic surface color changes consistent with variations in film thickness, which ranged from approximately 25.0 to 50.7 nm. Higher deposition power promoted smoother surfaces, with average roughness (Ra) decreasing from 64.28 nm at 150 W to 20.62 nm at 200 W. XRD analysis revealed a monocrystalline Ni₃N hexagonal close-packed (HCP) phase at 150 W, transitioning to a dual-phase Ni₃N (HCP) and Ni₄N face-centered cubic (FCC) microstructure at 175 and 200 W. The highest hardness (11.80 ± 3.34 GPa) was recorded at 150 W, accompanied by pop-in events attributed to dislocation nucleation in the HCP lattice. Electrochemical evaluation in 3.5 wt.% NaCl solution demonstrated that films deposited at 150 and 175 W exhibited corrosion current densities and rates exceeding those of bare steel, confirming that these conditions accelerate rather than inhibit corrosion. Only the film deposited at 200 W achieved superior corrosion protection, with a corrosion current density and rate approximately 50% lower than bare steel, attributed to its denser microstructure and smoother surface morphology. These findings demonstrate that r.f. power is a critical parameter governing the properties of Ni-N thin films, and that careful optimization of deposition conditions is essential before recommending such coatings for industrial corrosion-protective applications. Full article

Radioguided surgery has become a key component of contemporary breast cancer care, supporting less invasive approaches while maintaining oncologic safety. This narrative review summarizes current practice and recent developments in radioguided breast and axillary surgery, from established molecular imaging workflows to emerging three-dimensional and intraoperative technologies. Modern breast cancer management is increasingly shaped by tumor biology and the widespread use of neoadjuvant systemic therapy, which is transforming surgical decision-making and driving a shift toward personalized, patient-tailored pathways. In this context, radioguided techniques help maintain procedural accuracy despite therapy-induced changes in breast and nodal anatomy, enabling reliable lesion localization and targeted management of the axilla. We discuss sentinel lymph node strategies and de-escalation concepts, including targeted axillary dissection (TAD) after neoadjuvant therapy using marked nodes and selective removal approaches. We also review localization methods, including radioactive seed–based techniques, and the expanding role of molecular imaging–guided surgery to support intraoperative decision-making. Particular attention is paid to technologies aimed at improving surgical precision and margin assessment, including portable/freehand SPECT concepts and intraoperative PET/CT-based specimen imaging for immediate evaluation of excised tissue. Finally, we highlight how artificial intelligence and digital tools may enable workflow optimization, navigation, image interpretation, and decision support, accelerating the transition toward individualized treatment. Overall, integrating molecular information with real-time 3D guidance can help tailor breast and axillary management to each patient while reducing morbidity. Full article

Background/Objectives: Chronic pain represents a major global health burden and significantly impacts quality of life and functional capacity. Physiotherapy plays a central role in its management, yet the rapid growth of research in this field makes it difficult to identify current trends and emerging directions. The aim of this study was to analyze global research trends in chronic pain physiotherapy using a bibliometric approach. Methods: A bibliometric analysis was conducted using data retrieved from PubMed, Scopus, and Web of Science. A predefined search strategy was applied to identify relevant publications. Data were analyzed and visualized using VOSviewer. Co-occurrence analysis of terms based on titles and abstracts was performed using full counting. The most relevant terms were selected using a relevance score threshold, and a thesaurus file was applied to improve data quality. Results: The number of publications increased steadily from 2015 to 2025, indicating growing research interest in chronic pain physiotherapy. Network analysis revealed key research clusters related to clinical interventions, functional assessment, and outcome evaluation. The most prominent and central terms included “pelvic pain”, “neck disability index”, and “radicular pain”. Overlay visualization identified emerging topics such as “stratified care”, “multidisciplinary rehabilitation”, and “psychometric property”, reflecting a shift toward personalized and patient-centered approaches. Conclusions: Research in chronic pain physiotherapy is rapidly expanding, with a clear transition from traditional intervention-focused approaches toward individualized, multidisciplinary, and outcome-driven strategies. These findings provide insight into current research directions and may support clinicians and researchers in identifying future priorities in chronic pain management. Full article

Chronic wounds remain a major global health challenge despite substantial advances in biomaterials, regenerative medicine, and wound-care technologies. Current therapeutic strategies are largely based on the assumption that chronic wounds represent impaired or incomplete healing responses and therefore require augmentation of regenerative processes. This paradigm has driven the development of increasingly sophisticated wound dressings incorporating extracellular matrix analogs, growth factors, stem cells, extracellular vesicles, biosensors, and bioelectronic components. However, the clinical impact of these innovations has often fallen short of expectations. In this review, we propose a conceptual framework intended to generate experimentally testable hypotheses rather than provide a definitive mechanistic model. Persistent alterations in immune, stromal, vascular, extracellular matrix, metabolic, mechanical, and microbial networks create interconnected feedback systems that resist transition toward regeneration. From this perspective, successful therapy requires not only stimulation of repair mechanisms but also disruption of the processes that stabilize chronicity. We discuss how advances in systems biology, immunomodulatory biomaterials, bioelectronics, artificial intelligence, and precision medicine support the emergence of adaptive therapeutic interfaces capable of sensing, interpreting, and reprogramming pathological tissue behavior. Unlike previous reviews that primarily summarize emerging wound dressings or regenerative biomaterials, this Review proposes a systems-level conceptual framework in which chronic wounds are interpreted as stable pathological tissue states maintained by multiscale biological memory. This perspective integrates biomaterials, systems biology, artificial intelligence, and tissue-state dynamics into a unified translational model that has not previously been presented in the wound-healing literature. Previous reviews have predominantly focused on the design, biological activity, or clinical performance of individual biomaterials. In contrast, the present Review proposes a systems-level framework that integrates wound biology, biological memory, tissue-state dynamics, artificial intelligence, and adaptive biomaterials into a unified conceptual model for precision wound medicine. This state-based model reframes advanced wound dressings as tools for biological state engineering and provides a translational framework for the future of chronic wound management. Full article

Brunei Darussalam has undergone a rapid demographic and epidemiological transition characterized by declining fertility, increased life expectancy, and a shift from infectious diseases to chronic non-communicable conditions. While these transitions are well described at the population level, their implications for family support systems are less explored. This study synthesizes national data to examine how changes in population structure and disease burden are reshaping caregiving and intergenerational support. Findings highlight shrinking family size, increasing dependency, and growing care complexity. Applying the welfare diamond framework, the analysis shows that these transitions are progressively shifting care responsibilities beyond the traditional family towards greater roles for the state, market and community sectors. These findings suggest that Brunei Darussalam is undergoing an emerging care transition that has important implications for long-term care policy. Full article

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women’s nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women’s experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women’s experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating “good motherhood”; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support. Full article

Background/Objectives: Cervical spinal cord injury (SCI) carries a significant burden in Saudi Arabia, frequently resulting in permanent ventilator dependence and high morbidity. While laparoscopic diaphragmatic pacing (DP) has emerged as an alternative to long-term mechanical ventilation (MV) globally, regional evidence regarding its application within the Middle East remains limited. This study evaluates a single-center cohort of ventilator-dependent cervical SCI patients undergoing laparoscopic DP. Methods: We conducted a retrospective analysis of all ventilator-dependent patients with cervical SCI admitted to a tertiary hospital in Riyadh between 2012 and 2024 who underwent laparoscopic DP after failing traditional weaning attempts. Inclusion criteria required at least 3 months of MV dependence, intraoperative diaphragmatic stimulability and a minimum one-year follow-up post-implantation. Across the entire cohort, the long-term follow-up duration reached a median of 60.0 months (interquartile range [IQR]: 36.0–84.0 months; range: 12.0–120.0 months). Results: Out of 30 initial candidates with cervical SCI, 28 patients (22 males, 6 females; median age 24.0 years (interquartile range [IQR]: 15.0–33.0 years)) were included. Patients had been on MV for a median of 13.0 months (IQR: 10.5–16.0 months) prior to the procedure. Utilizing a combined weaning success rate (complete or partial weaning), 26 patients (92.86%; 95% CI: 77.42–98.01%) were successfully transitioned to the pacing protocol, while 2 patients (7.14%) experienced DP failure. Complete (24 h) daily MV independence was achieved by 18 patients (64.29%), and partial weaning (≥4 h/day of MV-free time) was achieved by 8 patients (28.57%). Age at the time of injury ranged from 5 to 62 years. No major intraoperative or postoperative complications occurred. Minor exit-site skin irritation was observed in 3 patients (10.71%), all of which resolved completely with conservative local care alone without requiring antibiotic therapy. Conclusions: In this selected single-center Saudi cohort of ventilator-dependent cervical SCI patients, laparoscopic DP was feasible and was associated with high rates of partial or complete ventilator-free breathing. Larger prospective multicenter studies with standardized selection criteria, safety reporting, respiratory outcomes, quality-of-life measures, and longer follow-up are needed. Full article

Transition to higher education represents a critical period marked by academic, emotional, and social challenges that can affect students’ well-being. Although social and emotional competence (SEC) and self-care practices have been identified as protective factors of well-being, there is a gap in understanding how these concepts intersect within higher education. In an exploratory sequential mixed-methods study, we first explored the main challenges perceived by higher education students in adapting to university and which SEC and self-care practices they perceived as most relevant to promoting their personal and academic well-being. Building on these insights, we then investigated the mediating role of self-care practices in the relationship between students’ SEC and their well-being. In the first stage of the study, 16 higher education students (81.3% female, M = 22.19 years) participated in semi-structured interviews; additionally, 204 higher education students (77.9% female, M = 22.10 years) responded to an online survey. Qualitative findings suggested that the most significant challenges in the adaptation to university were of a social and emotional nature, related to emotional challenges, interpersonal relationships, and personal organization. To overcome these, students primarily valued intrapersonal competencies such as self-awareness and self-regulation. Participants predominantly described using personal self-care practices, focusing on psychological and emotional care. Generalized linear model-based mediation analysis sustained that both personal and academic self-care practices mediated SEC effects on students’ personal well-being. However, only academic self-care practices mediated SEC effects on their academic well-being. Self-regulation competencies had the strongest effect on students’ personal and academic well-being, providing quantitative support for the prominence attributed to this competency by students during the qualitative phase. This research contributes to a strengthened theoretical understanding of the interplay between higher education students’ SEC, self-care practices, and well-being, offering new empirical evidence on how these relate. Full article

Background: As a crucial transitional period from campus to society, providing comprehensive undergraduate health psychological care is essential for addressing Social Anxiety Disorder (SAD). Current global healthcare research is actively exploring innovative digital interventions, with a specific focus on leveraging Augmented Reality (AR) as a transformative auxiliary tool in clinical settings. Methods: This study investigates the factors influencing the acceptance of AR-assisted Cognitive Behavioral Therapy (CBT) within student healthcare frameworks by developing a research model based on the Technology Acceptance Model (TAM). The framework incorporates key clinical and behavioral constructs: self-efficacy (SE), facilitating conditions (FC), and social influence (SI). Results: SE, FC, and SI significantly and positively impact the willingness to adopt AR technology for mental health purposes. Based on these findings, practical recommendations are provided for healthcare technology developers, therapists, and university psychological care providers to enhance the integration of AR-assisted CBT. Conclusions: Strengthening these digital pathways is vital for improving healthcare outcomes and enabling students to navigate future social and professional environments effectively. Because the sample consisted solely of Chinese undergraduate students, the findings should be interpreted within this specific cultural and educational context and require further validation in cross-cultural and multi-regional samples. Full article

Background/Objectives. The intestinal microbiota is a key contributor to postoperative complications, yet direct interventions targeting dysbiosis—antibiotics, probiotics, and synbiotics—have produced inconsistent results. This paradox indicates a fundamental gap in understanding host–microbiota interactions under surgical stress. We aimed to re-examine the causal role of dysbiosis in postoperative pathogenesis and propose a revised therapeutic paradigm centered on host barrier protection. Methods. A narrative literature review was conducted, searching PubMed/MEDLINE, Scopus, and Web of Science for articles published between 2009 and 2025. Reference lists of included publications were additionally screened. Studies in English and Russian were eligible; 107 references were included. Results. We hypothesize that dysbiosis in surgical patients may, at least in part, represent a predictable ecological response to systemic hypoperfusion, pharmacological burden, and ischemia–reperfusion injury, rather than acting solely as an independent pathogenic agent. Microbial shifts, characterized by the depletion of short-chain fatty acid-producing commensals and the expansion of pathobionts, frequently accompany epithelial injury; however, available human data are predominantly observational and do not permit definitive determination of the temporal sequence. This hypothesis provides the conceptual foundation for the proposed therapeutic reorientation. Conclusions. The present findings support the rationale for transitioning from microbiome manipulation to a “host-first” strategy, which prioritizes the restoration of intestinal barrier integrity through the administration of cytoprotective agents and targeted metabolic substrates (glutamine and butyrate). We propose the Gut Resilience Index (GRI) as a theoretical construct to identify patients approaching a critical threshold necessitating rescue therapy. It must be emphasized that both the “host-first” strategy and the GRI remain hypothetical frameworks requiring prospective validation. The most critical next steps include the development and validation of the GRI in prospective cohort studies, as well as randomized controlled trials directly comparing barrier-oriented strategies with standard care. Full article

Background: Maternal identity is the perception and recognition of a woman as a mother. Within this emerging identity, the maternal role takes on special importance as a manifestation of the set of responsibilities that a woman assumes in the care and upbringing of her baby. Respectful professional accompaniment during the period of maternal role acquisition is key to perinatal mental health and secure bonding with the baby. The main objective of this systematic review with narrative synthesis was to analyze the effects of psychological support programs aimed at maternal role acquisition during the transition to motherhood. Methods: Studies with experimental and quasi-experimental designs addressing maternal role acquisition in pregnant or postpartum women were included. A systematic search was conducted in PsycINFO, MEDLINE, PubMed and SCOPUS from inception to March 2025 following PRISMA recommendations. Due to the heterogeneity in study designs, interventions and outcome measures, a narrative synthesis was performed instead of a meta-analysis. Results: A total of 11 studies were extracted with a total sample of 1244 women, including five randomized controlled trials and six quasi-experimental studies. Psychological support programs focusing on maternal role acquisition generally showed improvements in maternal identity construction, self-efficacy and maternal competence, although not all findings reached statistical significance. In addition, several studies reported reductions in postnatal depressive symptoms, as well as improvements in subjective well-being and maternal role perception. Conclusions: results suggest that psychological support programs targeting maternal role acquisition may represent a promising approach for supporting perinatal mental health. However, the evidence should be interpreted with caution due to methodological limitations and heterogeneity across studies. In fact, most included studies were conducted in Eastern cultural contexts (Iran, China), limiting generalizability to Western populations without further adaptation and validation. Additionally, incomplete reporting of standardized effect sizes and precision measures across studies limits the quantitative interpretation of the findings. This review was not prospectively registered, and title/abstract screening was conducted by a single reviewer, increasing the risk of selection bias. Further research using rigorous and standardized designs is needed to clarify the effectiveness and generalizability of these interventions. Full article

What does it mean to bring climate adaptation and sustainability “on the ground” into a Thuringian small town that is both urban and rural? From 2021 to 2024, we conducted a cooperative research project with the municipality to investigate this. For three years, the research partners explored ways to integrate the “big” topics of climate adaptation, sustainability, public services, and demographic change into the everyday urban development processes of a small town in rural Thuringia, an area experiencing long-term population decline. The result of the project is three volumes in the ISDN series that provide initial answers, which are often derived from the combination of research and teaching. One volume focuses on energy, housing, and mobility, presenting stakeholders, projects, and research results that can be used to address these issues locally in rural-urban municipalities more broadly. Another collects findings on socio-infrastructural planning, offering a dedicated perspective on gender and youth “in the countryside”. Ultimately, all socio-infrastructural planning activities aim to support an “Urban Social Cultural Care”. This article aims to contextualize transfer-oriented research within theoretical debates on sustainability transitions, paying special attention to the opportunities available to municipalities with limited administrative resources to enhance their own scope of action. Full article