Search Results (2,061)

Background: Undergraduate nursing students (UNSs) often enter clinical training just as they are still mastering the emotional labor of the profession. In Nepal, where teaching hierarchies discourage upward dialogue and hospitals routinely struggle with overcrowding, supply shortages, and outward nurse migration, these learners confront a distinct, under-documented burden of psychological distress. Objective: This study examines how UNSs interpret, negotiate, and cope with the mental health challenges that arise at the intersection of cultural deference, resource scarcity, and migration-fueled uncertainty. Methods: A qualitative design employing reflexive thematic analysis (RTA), guided by the Reflexive Thematic Analysis Reporting Guidelines (RTARG), was used. Fifteen second-, third-, and fourth-year Bachelor of Science in Nursing students at a major urban tertiary institution in Nepal were purposively recruited via on-campus digital flyers and brief in-class announcements that directed students (by QR code) to a secure sign-up form. Participants then completed semi-structured interviews; audio files were transcribed verbatim and iteratively analyzed through an inductive, reflexive coding process to ensure methodological rigor. Results: Four themes portray a continuum from silenced struggle to systemic constraint. First, Shrouded Voices, Quiet Connections captures how students confide only in trusted peers, fearing that formal disclosure could be perceived as weakness or incompetence. Second, Performing Resilience: Masking Authentic Struggles describes the institutional narratives of “strong nurses” that drive students to suppress anxiety, adopting scripted positivity to satisfy assessment expectations. Third, Power, Hierarchy, and the Weight of Tradition reveals that strict authority gradients inhibit questions in classrooms and clinical placements, leaving stress unvoiced and unaddressed. Finally, Overshadowed by Systemic Realities shows how chronic understaffing, equipment shortages, and patient poverty compel students to prioritize patients’ hardships, normalizing self-neglect. Conclusions: Psychological distress among Nepalese UNSs is not an individual failing but a product of structural silence and resource poverty. Educators and policymakers must move beyond resilience-only rhetoric toward concrete reforms that dismantle punitive hierarchies, create confidential support avenues, and embed collaborative pedagogy. Institutional accountability—through regulated workloads, faculty-endorsed wellbeing forums, and systematic mentoring—can shift mental health care from a private struggle to a shared professional responsibility. Multi-site studies across low- and middle-income countries are now essential for testing such system-level interventions and building a globally resilient, compassionate nursing workforce. Full article

Nephrotic syndrome (NS) is a complex kidney disorder characterized by profound proteinuria, hypoalbuminemia, hyperlipidemia, and edema, significantly impacting patients’ quality of life. While corticosteroids and calcineurin inhibitors (CNIs) have traditionally been the primary treatments, B cell-targeted therapies, especially the anti-CD20 monoclonal antibody rituximab, have transformed the management of steroid-dependent and multidrug-resistant NS (MRNS). Rituximab has demonstrated efficacy in reducing relapse rates and steroid dependence by depleting CD20+ B cells, which play a pivotal role in autoantibody production and immune dysregulation. However, limitations such as incomplete B cell depletion, immunogenicity leading to anti-rituximab antibodies, and variable efficacy in refractory cases have led to the development of next-generation therapies. This review critically examines recent advances in B cell-targeted therapies for NS, with a particular focus on overcoming the limitations of conventional rituximab treatment. This review systematically analyzes next-generation anti-CD20 monoclonal antibodies, CD38-targeted therapies, and emerging CAR-T cell approaches, evaluating their distinct mechanisms of action and clinical trial outcomes. The analysis extends to innovative combination strategies and biomarker-guided treatment algorithms for refractory cases. By synthesizing preclinical data with clinical evidence, this work provides a framework for optimizing therapeutic decision-making in NS, while identifying key knowledge gaps that warrant future investigation. Collaborative research and translational studies are essential for advancing precision medicine in NS, ensuring that new therapies provide lasting clinical benefits for patients. The evolving field of anti-B cell therapies marks a new era in managing refractory NS, offering hope for better long-term prognoses. Full article

The evolving paradigm of precision medicine is redefining the landscape of orthobiologic therapies by moving beyond traditional diagnosis-driven approaches toward biologically tailored interventions. This review synthesizes current evidence supporting precision orthobiologics, emphasizing the significance of individualized treatment strategies in musculoskeletal regenerative medicine. This narrative review synthesized literature from PubMed, Embase, and Web of Science databases (January 2015–December 2024) using search terms, including ‘precision medicine,’ ‘orthobiologics,’ ‘regenerative medicine,’ ‘biomarkers,’ and ‘artificial intelligence’. Biological heterogeneity among patients with ostensibly similar clinical diagnoses—reflected in diverse inflammatory states, genetic backgrounds, and tissue degeneration patterns—necessitates patient stratification informed by molecular, genetic, and multi-omics biomarkers. These biomarkers not only enhance diagnostic accuracy but also improve prognostication and monitoring of therapeutic responses. Advanced imaging modalities such as T2 mapping, DTI, DCE-MRI, and molecular PET offer non-invasive quantification of tissue health and regenerative dynamics, further refining patient selection and treatment evaluation. Simultaneously, bioengineered delivery systems, including hydrogels, nanoparticles, and scaffolds, enable precise and sustained release of orthobiologic agents, optimizing therapeutic efficacy. Artificial intelligence and machine learning approaches are increasingly employed to integrate high-dimensional clinical, imaging, and omics datasets, facilitating predictive modeling and personalized treatment planning. Despite these advances, significant challenges persist—ranging from assay variability and lack of standardization to regulatory and economic barriers. Future progress requires large-scale multicenter validation studies, harmonization of protocols, and cross-disciplinary collaboration. By addressing these limitations, precision orthobiologics has the potential to deliver safer, more effective, and individualized care. This shift from generalized to patient-specific interventions holds promise for improving outcomes in degenerative and traumatic musculoskeletal disorders through a truly integrative, data-informed therapeutic framework. Full article

Background/Objectives: The Internet of Things (IoT), integrated with application software, has increasingly been used to support health management through monitoring indicators like physical activity, sleep, and heart rate, in pregnant and postpartum women. However, limited evidence exists regarding its effectiveness in improving health outcomes for pregnant and postpartum women. The objective of this systematic review and meta-analysis was to evaluate and synthesize the role of IoT in enhancing the health outcomes of pregnant and postpartum women. Methods: A systematic search was conducted on 13 February 2023, across CENTRAL, CINAHL, ClinicalTrials.gov, Embase, MEDLINE, PsycINFO, PubMed, and WHO ICTRP to identify all randomized controlled trials. Studies were included if they involved pregnant or postpartum women in high-income countries and used sensor-based data collection via smartphones or wearable devices. Two reviewers independently selected the studies, extracted data, and assessed the risk of bias using the Cochrane Collaboration’s risk of bias assessment tool 2.0. We performed a pairwise meta-analysis using a random effects model. The findings were reported according to PRISMA guidelines. Results: Seven studies with 1638 pregnant and postpartum women were included in this review. Of the seven included studies, half targeted women with gestational diabetes and the other half targeted obese women. A meta-analysis revealed that IoT interventions may reduce gestational weight gain in women with obesity with a mean difference of −3.35 kg (95% confidence interval (CI): −5.23 to−1.46; I² = 36%; two studies; 242 women; moderate certainty of evidence). Conclusions: This review suggested that IoT interventions may limit gestational weight gain in pregnant women with obesity. Future studies should evaluate the long-term effects of IoT-based interventions on maternal and neonatal health outcomes. Full article

Introduction: Recent guidelines developed by the European Association for the Study of Obesity (EASO) and the European Federation of the Associations of Dietitians (EFAD) focused on the dietetic management of obesity in adults. The present study aimed to explore the perspectives of healthcare professionals regarding these guidelines. Methods: In total, 85 registered dietitians/nutritionists from Greece, the Netherlands, the Republic of Ireland, and the United Kingdom completed an online survey, and 10 were interviewed, in February–March 2023. Demographic data were also collected. Results: Awareness of the EASO-EFAD guidelines among registered dietitians/nutritionists was moderate (57.6%), but only 20% had read them in full. Dietitians with higher education and relevant experience were more likely to have read the guidelines. Less than half reported that key evidence-based recommendations, such as individualized medical nutrition therapy and intensive behavioral interventions, are already included in national guidance. Recommendations like portfolio or DASH diets, partial meal replacements, and calorie restriction were less commonly part of national guidance/usual practice. A small percentage of participants described their adoption of several nutritional approaches novel to them. These included the portfolio dietary pattern, partial meal replacements, and intermittent fasting or continuous calorie restriction. For some Irish dietitians, prioritizing weight as the main outcome conflicted with their emphasis on overall health and individualized nutrition therapy. Other barriers of recommendation implementation included exclusive availability in English, rapid changes in obesity management, staffing shortages, limited multidisciplinary collaboration, and inconsistent knowledge among healthcare providers. Conclusions: The present study identified gaps in the adoption of the EASO-EFAD guidelines into dietetic/clinical practice. EFAD will develop strategies to disseminate these guidelines at different levels of stakeholders (national/local authorities, dietitians/nutritionists, and patients). Full article

Objectives: Acute drug poisoning represents a significant public health issue among the pediatric population. The aim of this study was to evaluate the characteristics of drug poisoning in children and adolescents in the Vojvodina region from 2018 to 2023. Methods: In a retrospective observational study, 82 patients with confirmed drug poisoning were included, and data was collected regarding demographic characteristics, clinical manifestations, types of drugs involved, and the therapeutic interventions administered. The severity of poisonings was evaluated using the Poisoning Severity Score, and toxicological analysis was performed using gas chromatography–mass spectrometry. Results: The results indicated that poisonings were most prevalent in adolescent girls (72%), with 78% of cases resulting from intentional poisoning, while unintentional poisoning was more common in children. Benzodiazepines, antipsychotics, and analgesics were the primary drugs causing these poisoning incidents. The majority of patients (78%) experienced mild clinical symptoms, whereas 9% of pediatric patients suffered from severe poisoning, related to complications such as aspiration pneumonia and acute renal failure. Addressing pediatric drug poisoning in Vojvodina requires an increased focus on preventive strategies, including parental education and appropriate psychosocial support for the youth. Conclusions: Through collaborative efforts among healthcare providers, educators, and policymakers, prevention, treatment, and support mechanisms can be enhanced to combat this pressing public health challenge. Full article

Black Canadians are one of the fastest-growing groups in Canada, with 59% of this population comprising immigrants. Ongoing systemic racism and discrimination have serious consequences for the mental health of Black Canadians. While research and policy efforts to address the mental health needs of this population are ongoing, a greater understanding of the healing practices relevant to this diverse population is needed. This scoping review synthesized and discussed key features of culturally inclusive, affirming, and contextually relevant approaches and practices for mental health care and healing with Black Canadians, as well as identified limitations and gaps in the current research. This study followed the PRISMA guidelines for scoping reviews and conducted a search in PsycINFO, MEDLINE, Embase, SocINDEX, CINAHL, Sociological Abstracts, and Global Health in October 2023. A total of 34 articles met the inclusion criteria. The review identified that most studies were conducted in one Canadian province (i.e., Ontario) and involved diverse perspectives, including service users and providers. The thematic review of articles revealed limited research regarding specific interventions, but identified many commonly reported features of culturally and contextually relevant approaches to mental health care and healing for Black Canadians that broaden the scope of mental health care beyond Euro-Western clinical models, including taking a holistic and empowerment-based approach, engaging in culturally affirming care, a social justice approach, community-centred and collaborative healing, and the necessity of practitioner education. Recommendations for practice, policy, education, and research are provided to support more inclusive and responsive mental health care systems for Black Canadians. Full article

The integration of organoids with biosensors serves as a miniaturized model of human physiology and diseases, significantly transforming the research frameworks surrounding drug development, toxicity testing, and personalized medicine. This review aims to provide a comprehensive framework for researchers to identify suitable technical approaches and to promote the advancement of organoid sensing towards enhanced biomimicry and intelligence. To this end, several primary methods for technology integration are systematically outlined and compared, which include microfluidic integrated systems, microelectrode array (MEA)-based electrophysiological recording systems, optical sensing systems, mechanical force sensing technologies, field-effect transistor (FET)-based sensing techniques, biohybrid systems based on synthetic biology tools, and label-free technologies, including impedance, surface plasmon resonance (SPR), and mass spectrometry imaging. Through multimodal collaboration such as the combination of MEA for recording electrical signals from cardiac organoids with micropillar arrays for monitoring contractile force, these technologies can overcome the limitations inherent in singular sensing modalities and enable a comprehensive analysis of the dynamic responses of organoids. Furthermore, this review discusses strategies for integrating strategies of multimodal sensing approaches (e.g., the combination of microfluidics with MEA and optical methods) and highlights future challenges related to sensor implantation in vascularized organoids, signal stability during long-term culture, and the standardization of clinical translation. Full article

The identification of recent HIV infections among newly diagnosed HIV cases is relevant to both implementing targeted prevention measures and estimating HIV incidence. We analyzed data on new HIV diagnoses in Italy from 2012 to 2023. We selected cases that were tested by at least one of three criteria (test for HIV recency, data on HIV seroconversion, clinical signs of acute HIV infection) to assess the rate of recent (<1 year) HIV infections. We analyzed these cases by gender, age group, nationality, and mode of transmission, and revaluated cases that were initially scored as a late diagnosis but then classified as a recent infection. Out of 36,289 new HIV diagnoses, 17,558 (48.8%) were tested for recent infection by at least one criterion and 3772 (21.5%) were classified as recent. At multivariate analysis, the probability of being recently infected was significantly higher among males, people aged 15–44 years, Italians, individuals diagnosed in Northern and Central Italy, heterosexual males, MSM, and people with a CD4 count ≥ 350 cells/uL at diagnosis. Of 8658 cases initially classified as late diagnoses, 979 (11.3%) were reclassified as recent by the aforementioned criteria. Monitoring recent infections among new HIV diagnoses is beneficial to individuals—because it motivates recently infected people to comply with antiretroviral treatment (which is more effective if started early) and to collaborate to partner notification, and to public health, as it provides evidence of epidemiological changes and stresses the need for targeted prevention in well-defined populations at risk. Full article

Background/Objectives: Despite advances in diagnosis and treatment, colorectal cancer (CRC) remains one of the most prevalent and challenging malignancies worldwide. The dysregulation of microRNAs (miRNAs) has emerged as a critical factor in CRC onset, progression, and therapeutic resistance. This study aims to provide an overview of global research trends on miRNAs in CRC, (i) identifying the most studied miRNAs, (ii) exploring under-investigated areas, and (iii) highlighting emerging themes and potential future directions. Methods: To assess the evolution of the global miRNA–CRC research trends, we conducted a bibliometric analysis of 828 CRC–miRNA-focused articles published between 2008 and 2024, sourced from the Scopus database. Bibliometric mapping was performed using the R/Bibliometrix package and by leveraging a customized Python-based pipeline, which is useful for extracting and validating miRNA identifiers (miRNA IDs) based on the miRBase database. This miRNA ID-related approach enabled us to systematically identify the most frequently studied miRNAs over time while highlighting underexplored miRNA. Results: The analysis revealed a substantial and accelerating publication growth rate, delineating three major phases in CRC–miRNA research. China emerged as the leading contributor in terms of the publication volume. miR-21, miR-34a, and miR-195-5p were among the most frequently studied miRNAs, underscoring their relevance to CRC biology and therapy. Keyword and citation analyses identified key thematic areas, such as cell proliferation, epithelial–mesenchymal transition, and chemoresistance, especially to oxaliplatin and 5-fluorouracil. Emerging research frontiers included ferroptosis, ceRNA networks, and exosome-mediated miRNA transport. An analysis of the collaborations indicated strong intra-national collaborations, with room for expanding international research networks. Conclusions: This study provides an in-depth bibliometric landscape of the CRC-related miRNA research by highlighting influential studies and journals while identifying gaps and underexplored topics. These insights offer valuable guidance for future translational and clinical research on this topic. Full article

Background: Scedosporium apiospermum is a filamentous fungus increasingly recognized as an opportunistic pathogen in immunocompromised hosts, though rare infections in immunocompetent individuals with structural lung disease have been reported. Its diagnosis and management remain challenging due to non-specific clinical presentation and intrinsic resistance to multiple antifungal agents. Case Presentation: We report the case of a 66-year-old immunocompetent woman with idiopathic bilateral non-cystic fibrosis bronchiectasis, who presented with subacute cough and increased sputum production. Chest high-resolution CT revealed new subsolid and ground-glass infiltrates superimposed on stable bronchiectatic changes. Bronchoalveolar lavage (BAL) cultures isolated S. apiospermum as the sole pathogen. The patient was treated with oral voriconazole (200 mg BID) for 4 weeks, followed by a 4-week course of aerosolized amphotericin B. Clinical and radiological improvement was observed, and no relapse occurred during follow-up. Discussion: This case highlights the potential for S. apiospermum to cause clinically relevant pulmonary infection in structurally abnormal but immunocompetent lungs. Non-CF bronchiectasis may facilitate fungal colonization due to impaired mucociliary clearance and chronic mucus retention. Combined antifungal therapy involving systemic voriconazole and inhaled amphotericin B (though not yet standardized) was employed based on clinical rationale and the available literature, resulting in favorable outcomes. Conclusions:S. apiospermum pulmonary infection, although rare in immunocompetent hosts with bronchiectasis, should be considered in cases of new or persistent infiltrates. Early recognition and individualized antifungal strategies, including the potential role of inhaled agents, may improve clinical outcomes. This case reinforces the importance of multidisciplinary collaboration in the management of complex fungal infections in chronic airway disease. Full article

Phytochemicals exhibit a broad spectrum of pharmacological activities, including significant anticancer potential. However, their clinical translation is often hampered by poor aqueous solubility, low bioavailability, and chemical instability. Lipid-based nanocarriers, especially solid lipid nanoparticles (SLNs) and nanostructured lipid carriers (NLCs), have proven to be effective strategies for addressing these challenges. These nanocarriers improve the solubility, stability, and bioavailability of phytochemical-based anticancer agents, while enabling controlled and tumor-specific drug release. Encapsulation of anticancer phytochemicals such as curcumin, quercetin, resveratrol, silymarin, and naringenin in SLNs and NLCs has demonstrated improved therapeutic efficacy, cellular uptake, and reduced systemic toxicity. Co-delivery strategies, combining multiple phytochemicals or phytochemical–synthetic drug pairs, further contribute to synergistic anticancer effects, dose reduction, and minimized side effects, particularly important in complex cancers such as glioblastoma, breast, and colon cancers. This review presents a comparative overview of SLNs and NLCs in terms of formulation methods, in vitro characterization, and classification of key phytochemicals based on chemical structure and botanical sources. The roles of these lipidic carriers in enhancing anticancer activity, challenges in formulation, and recent patent filings are discussed to highlight ongoing innovations. Additionally, hybrid lipid–polymer nanoparticles are introduced as next-generation carriers combining the benefits of both systems. Future research should aim to develop scalable, biomimetic, and stimuli-responsive nanostructures through advanced surface engineering. Collaborative interdisciplinary efforts and regulatory harmonization are essential to translate these lipid-based carriers into clinically viable platforms for anticancer phytochemical delivery. Full article

SCALENEo (Smart ClinicAL rEasoning iN physiothErapy) is an innovative online serious game designed to improve clinical reasoning in musculoskeletal physiotherapy education. Adapted from the “Happy Families” card game, it provides an interactive, structured approach to developing students/learners’ ability to categorize clinical information into families of hypotheses. This digital platform supports both self-directed and collaborative learning, eliminating the need for continuous instructor supervision while ensuring meaningful engagement. SCALENEo features a unique feedback and scoring system that not only assesses students/learners’ decision-making processes but also promotes cautious and reflective reasoning over random guessing. By aligning with evidence-based pedagogical strategies, such as serious games and formative assessment, SCALENEo offers educators a powerful tool to reinforce critical thinking, improve student/learner engagement, and facilitate deeper learning in clinical reasoning education. Full article

Virtual Reality (VR) is a useful educational tool in healthcare, allowing students to practise and improve practical skills. In speech therapy (ST), the need to revise academic curricula to adapt them to university contexts and integrate them into advanced clinical practices has highlighted the need to analyse the use of VR in this sector. The objective of this scoping review was to investigate whether research has considered using VR to support ST students’ training and highlight potential gaps in the literature. The study followed the JBI methodology for scoping reviews and was reported according to PRISMA-ScR guidelines. A protocol to conduct the current review was developed and registered on the Open Science Framework. The articles considered were retrieved from databases specialising in healthcare, computer science, and education, and were enhanced by results found with the help of AI-based tools. No constraints were applied and all study types were considered. Fourteen studies were included in the review and analysed under four core subjects: VR technology, ST context, training purposes, and main outcomes and assessment methods. The VR types identified in the studies were grouped into four categories, i.e., non-immersive VR (6/14, 42.9%), immersive VR (5/14, 35.7%), non-specified VR type (2/14, 14.3%), and semi-immersive VR (1/14, 7.1%). Most studies (5/14, 35.7%) focused on clinical skills acquisition, others addressed communication and interpersonal collaborative skills (3/14, 21.4%), while the remaining focused on person-centred care and awareness, clinical interviewing or reasoning skills, and performance knowledge (2/14 each, 14.3%). VR is still in its early stages in ST education. Some recent studies suggest VR supports students’ communication, interdisciplinary, and clinical skills. Although still limited in the context of ST education, the increasing affordability and ease of development of VR, along with its growing use in other healthcare fields, suggest that its underuse might be due to institutional barriers and lack of standardised frameworks. Overall, the findings suggest that VR offers promising support for experiential and skills-based learning. Full article

The concerning increase in respiratory infections that are resistant to multiple drugs has led to a growing interest in bacteriophage therapy as a potential alternative to conventional antibiotics. Effective phage delivery to the lungs, however, presents several formulation and stability issues, particularly for inhalation-based methods. This review highlights current developments in the creation of dry powder formulations that can be inhaled for pulmonary phage therapy, with a focus on encapsulation methods based on nanoparticles, such as solid lipid nanoparticles (SLNs) and polymer-based nanoparticles. These carriers enhance the aerodynamic characteristics of phages, making them suitable for deep lung deposition, while also protecting them during processing and storage. Several drying methods have been investigated to create powders with optimal morphologies, porosity, and dispersibility, including spray drying and spray freeze drying. The review also emphasizes how the phage morphotype affects stability, especially when nebulization stress is present. Furthermore, the advantages of nanoparticle matrices are confirmed by the reduced viability loss (usually< 0.5 log PFU) of encapsulated phages. Standardizing production processes, scaling up, and ensuring regulatory compliance remain challenging despite encouraging preclinical results. The combination of phage therapy with nanotechnology creates new avenues for the utilization of inhalable delivery methods to treat multidrug-resistant pulmonary infections. To translate these novel formulations from preclinical development to clinical application, sustained multidisciplinary collaboration across pharmaceutical sciences, microbiology, and clinical pharmacology is essential. Full article