Search Results (441)

Background/Objectives: The transformation of nursing and midwifery education through digital technologies has gained momentum worldwide, with algorithm-based video instruction and virtual reality (VR) emerging as promising tools for improving clinical learning. This quasi-experimental study explores the impact of an enhanced flipped classroom model on Bulgarian nursing and midwifery students’ self-perceived competence. Methods: A total of 228 participants were divided into a control group receiving traditional instruction (lectures and simulations with manikins) and an experimental group engaged in a digitally enhanced preparatory phase. The latter included pre-class video algorithms, VR, and clinical problem-solving tasks for learning and improving nursing skills. A 25-item self-report questionnaire was administered before and after the intervention to measure perceived competence in injection techniques, hygiene care, midwifery skills, and digital readiness. Results: Statistical analysis using Welch’s t-test revealed significant improvements in the experimental group in all domains (p < 0.001). Qualitative data from focus group interviews further confirmed increased student engagement, motivation, and receptiveness to digital learning tools. Conclusions: The findings highlight the pedagogical value of integrating structured video learning, VR components, and case-based learning within flipped classrooms. The study advocates for the wider adoption of blended learning models to foster clinical confidence and digital competence in healthcare education. The results of the study may be useful for curriculum developers aiming to improve clinical readiness through technology-enhanced learning. Full article

Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is growing, many European countries—including Poland—still lack formal training programs for POCUS at both the undergraduate and postgraduate levels. Nevertheless, the number of pediatricians incorporating POCUS into their daily clinical practice in Poland is increasing. However, the extent of its use and perceived value among pediatricians remains largely unknown. This study aimed to evaluate the current level of POCUS utilization in pediatric care in Poland, focusing on pediatricians’ self-assessed competencies, perceptions of its clinical utility, and key barriers to its implementation in daily practice. Methods: This cross-sectional study was conducted between July and August 2024 using an anonymous online survey distributed to pediatricians throughout Poland via national professional networks, with a response rate of 7.3%. Categorical variables were analyzed using the chi-square test of independence to assess the associations between key variables. Quantitative data were analyzed using descriptive statistics, and qualitative data from open-ended responses were subjected to a thematic analysis. Results: A total of 210 pediatricians responded. Among them, 149 (71%) reported access to ultrasound equipment at their workplace, and 89 (42.4%) reported having participated in some form of POCUS training. Only 46 respondents (21.9%) reported frequently using POCUS in their clinical routine. The self-assessed POCUS competence was rated as low or very low by 136 respondents (64.8%). While POCUS was generally perceived as a helpful tool in facilitating and accelerating clinical decisions, the main barriers to implementation were a lack of formal training and limited institutional support. Conclusions: Although POCUS is perceived as clinically valuable by the surveyed pediatricians in Poland, its routine use remains limited due to training and systemic barriers. Future efforts should prioritize the development of a validated, competency-based training framework and the implementation of a larger, representative national study to guide the structured integration of POCUS into pediatric care. Full article

Background: High-intensity gait training (HIT) is an evidence-based intervention recommended for stroke rehabilitation; however, its implementation in routine practice is inconsistent. This study examined the real-world implementation of HIT in an inpatient rehabilitation setting in Norway, focusing on fidelity, barriers, and knowledge translation (KT) strategies. Methods: Using the Knowledge-to-Action (KTA) framework, HIT was implemented in three phases: pre-implementation, implementation, and competency. Fidelity metrics and coverage were assessed in 99 participants post-stroke. Barriers and facilitators were documented and categorized using the Consolidated Framework for Implementation Research. Results: HIT was delivered with improved fidelity during the implementation and competency phases, reflected by increased stepping and heart rate metrics. A coverage rate of 52% was achieved. Barriers evolved over time, beginning with logistical and knowledge challenges and shifting toward decision-making complexity. The KT interventions, developed collaboratively by clinicians and external facilitators, supported implementation. Conclusions: Structured pre-implementation planning, clinician engagement, and external facilitation enabled high-fidelity HIT implementation in a real-world setting. Pragmatic, context-sensitive strategies were critical to overcoming evolving barriers. Future research should examine scalable, adaptive KT strategies that balance theoretical guidance with clinical feasibility to sustain evidence-based practice in rehabilitation. Full article

Aims/Background: Polypharmacy, or the concurrent intake of five or more medications, is a significant issue in clinical practice, particularly in multimorbid elderly individuals. Despite its importance for patient safety, medical education often lacks systematic training in recognising and managing polypharmacy within the framework of patient-centred care. We investigated the impact of a structured learning intervention introducing polypharmacy as a chronic condition, assessing whether it enhances medical students’ diagnostic competence, confidence, and interprofessional collaboration. Methods: A prospective cohort study was conducted with 50 final-year medical students who received a three-phase educational intervention. Phase 1 was interactive workshops on the principles of polypharmacy, its dangers, and diagnostic tools. Phase 2 involved simulated patient consultations and medication review exercises with pharmacists. Phase 3 involved reflection through debriefing sessions, reflective diaries, and standardised patient feedback. Student knowledge, confidence, and attitudes towards polypharmacy management were assessed using pre- and post-intervention questionnaires. Quantitative data were analysed through paired t-tests, and qualitative data were analysed thematically from reflective diaries. Results: Students demonstrated considerable improvement after the intervention in identifying symptoms of polypharmacy, suggesting deprescribing strategies, and working in multidisciplinary teams. Confidence in prioritising polypharmacy as a primary diagnostic problem increased from 32% to 86% (p < 0.01), and knowledge of diagnostic tools increased from 3.1 ± 0.6 to 4.7 ± 0.3 (p < 0.01). Standardised patients felt communication and patient-centredness had improved, with satisfaction scores increasing from 3.5 ± 0.8 to 4.8 ± 0.4 (p < 0.01). Reflective diaries indicated a shift towards more holistic thinking regarding medication burden. The small sample size limits the generalisability of the results. Conclusions: Teaching polypharmacy as a chronic condition in medical school enhances diagnostic competence, interprofessional teamwork, and patient safety. Education is a structured way of integrating the management of polypharmacy into routine clinical practice. This model provides valuable insights for designing medical curricula. Future research must assess the impact of such training on patient outcomes and clinical decision-making in the long term. Full article

This concept paper outlines an implementation strategy for a mandatory training programme using the ADDIE instructional design model for delivery to nurses and other health professionals in an interprofessional education (IPE) environment). Background: Competence in Basic Life Support (BLS) is a lifesaving requirement for health professionals in clinical settings to ensure patient safety and accreditation outcomes. It is essential that health professionals are supported in attending mandatory training, including BLS. To inform learning and teaching strategies, it is useful to apply theoretical perspectives to the development of mandatory staff training methods. However, various training models exist, and few are grounded in instructional design theory to the unique environment for BLS in IPE. Method: A theory-based implementation strategy is outlined for a mandatory interprofessional training programme including BLS, using the ADDIE model to enhance patient outcomes. ADDIE is an instructional design framework comprising five elements: Assess, Design, Develop, Implement and Evaluate; describing a learning methodology that can be readily applied to mandatory training in IPE. Results: Through its iterative capability, the ADDIE model promotes learner needs and rapid acquisition of clinical skills that improve training accessibility. The strategy can equip educators with teaching skills based on a robust theoretical model, with potential to promote nursing and health professional attendance for mandatory training. Conclusions: Mandatory health professional training that addresses a theory informed strategy framed by the ADDIE model can support interprofessional collaboration and consistent competency across healthcare teams. This strategy has potential to contribute by demonstrating how instructional design can be operationalised to improve the effectiveness and engaging approach to BLS training and education to the unique dynamics of an interprofessional environment. Full article

Background: Despite growing interest in the literature on Parkinson’s disease (PD) on cognitive functioning, financial incompetence—a crucial aspect of daily living—and its modulation susceptibility by PD treatment regimens remains relatively understudied. Objective: This systematic review and meta-analysis aimed to synthesize existing evidence on how PD treatments affect financial capacity, assessing both direct financial competence and cognitive or behavioral proxies of financial decision-making. Methods: A comprehensive literature search according to PRISMA protocol was conducted across major biomedical databases, supplemented by gray literature and manual reference list checks. Eligible studies assessed financial capacity directly or indirectly through cognitive proxies (e.g., executive function, decision-making) or financial risk behaviors (e.g., impulse control disorders). Two separate meta-analyses were performed. Heterogeneity (I²), publication bias (Egger’s test), and sensitivity analyses were conducted to assess robustness. Results: Twenty-three studies met inclusion criteria. One study directly measured financial capacity and was analyzed narratively, reporting diminished competence in patients on levodopa therapy. A meta-analysis of cognitive proxies (10 studies) showed a moderate effect size (Hedges’ g = 0.70, 95% CI [0.45, 0.92], p < 0.001), indicating that PD treatments negatively affect executive function and financial decision-making. A second meta-analysis of impulse control and financial risk behaviors (12 studies) revealed a larger effect size (Hedges’ g = 0.98, 95% CI [0.75, 1.22], p < 0.001), strongly linking dopamine agonists to increased financial risk-taking. Moderate heterogeneity (I² = 45.8–60.5%) and potential publication bias (Egger’s test p = 0.027) were noted. Conclusions: These findings suggest that PD treatments negatively impact financial decision-making both directly and indirectly through cognitive and behavioral pathways. Integrating financial decision-making assessments into PD care, particularly for patients on dopamine agonists, is recommended. Future research should prioritize longitudinal studies and standardized neuropsychological measures to guide clinical practice and optimize patient outcomes. Full article

Background/Objectives: Clinical stability within 24 h prior to discharge is a key metric for safe care transitions in hospitalised patients with community-acquired pneumonia (CAP). However, its association with post-discharge outcomes, particularly readmissions, remains underexplored. This study assessed whether clinical instability before discharge is associated with 30-day mortality, readmissions, or a composite of both in hospitalised CAP patients. Methods: This retrospective cohort study included adults (≥18 years) admitted with CAP to two tertiary Australian hospitals between 1 January 2020 and 31 December 2023. Clinical instability was defined as abnormal vital signs (temperature, heart rate, respiratory rate, blood pressure, or oxygen saturation) within 24 h before discharge. Pneumonia severity was assessed using the CURB-65 score and frailty using the Hospital Frailty Risk Score. Multilevel logistic regression models were used to evaluate associations with outcomes, adjusting for age, sex, comorbidities, frailty, disease severity, microbiological aetiology, antibiotics prescribed during admission, and prior healthcare use. Competing risk regression accounted for death when analysing readmissions. Results: Of 3984 patients, 20.4% had clinical instability within 24 h before discharge. The composite outcome occurred in 21.9% patients, with 15.8% readmitted and 6.1% dying within 30 days. Clinical instability was significantly associated with the composite outcome (adjusted odds ratio [aOR] 1.73, 95% CI 1.42–2.09, p < 0.001), primarily driven by increased mortality risk (aOR 3.70, 95% CI 2.73–5.00, p < 0.001). However, no significant association was found between clinical instability and readmissions (aOR 1.16, 95% CI 0.93–1.44, p > 0.05). Conclusions: Clinical instability within 24 h before discharge predicts worse outcomes in CAP patients, driven by increased mortality risk rather than readmissions. Full article

Background: Boiling histotripsy (BH) uses high-amplitude, short-pulse focused ultrasound to disrupt tissue mechanically. Oncolytic virotherapy using reovirus has shown modest clinical benefit in pancreatic cancer patients. Here, reovirus and BH were used to treat pancreatic tumours, and their effects on the immune transcriptome of these tumours were characterised. Methods: Orthotopic syngeneic murine pancreatic KPC tumours grown in immune-competent subjects, were allocated to control, reovirus, BH and combined BH and reovirus treatment groups. Acoustic cavitation was monitored using a passive broadband cavitation sensor. Treatment effects were assessed histologically with hematoxylin and eosin staining. Single-cell multi-omics combining whole-transcriptome analysis with the expression of surface-expressed immune proteins was used to assess the effects of treatments on tumoural leukocytes. Results: Acoustic cavitation was detected in all subjects exposed to BH, causing cellular disruption in tumours 6 h after treatment. Distinct cell clusters were identified in the pancreatic tumours 24 h post-treatment. These included neutrophils and cytotoxic T cells overexpressing genes associated with an N2-like and an exhaustion phenotype, respectively. Reovirus decreased macrophages, and BH decreased regulatory T cells compared to controls. The combined treatments increased neutrophils and the ratio of various immune cells to Treg. All treatments overexpressed genes associated with an innate immune response, while ultrasound treatments downregulated genes associated with the transporter associated with antigen processing (TAP) complex. Conclusions: Our results show that the combined BH and reovirus treatments maximise the overexpression of genes associated with the innate immune response compared to that seen with each individual treatment, and illustrate the anti-immune phenotype of key immune cells in the pancreatic tumour microenvironment. Full article

Nursing students encounter several challenges as they progress through their educational journey, particularly in integrating theoretical knowledge with practical applications using simulation-based learning (SBL). This study aimed to comprehensively assess the effects of SBL on nursing competence, self-efficacy, and overall satisfaction among undergraduate nursing students at Tabuk University, Saudi Arabia. A total of 136 students participated in this study, which employed a mixed-methods sequential explanatory design including a quantitative cross-sectional survey complemented by qualitative interviews to capture a holistic view of their experiences with SBL. The findings revealed high levels of satisfaction and self-confidence among students participating in SBL, indicating its effectiveness as an academic tool for enhancing learning outcomes. Significant positive correlations were observed among nursing competence, satisfaction, and self-confidence in the SBL context. This suggests that successful engagement in this educational approach can lead to improved clinical skills and preparedness for real-world challenges. The qualitative findings further illuminated the emotional and cognitive engagement experienced by students during the SBL sessions. The participants emphasized the importance of skill mastery in a safe and controlled environment and the positive impact of advanced technologies, such as virtual simulations, on their learning experiences. Full article

Objectives: This study aimed to analyze the critical and reflective self-assessment capacity of dentistry students based on two clinical courses that employ self-assessment processes as a strategy to foster autonomy in health care. Materials and Methods: Reflections from third- and fifth-year students were evaluated over a three-year period. The methodology sought to identify the presence of critical reflections, perceptions of strengths and weaknesses, and the formulation of improvement plans. Results: The results revealed low levels of continuous reflection, with only 20.0% of third-year students and 24.1% of fifth-year students engaging in reflection in at least half of their clinical activities. However, 78.7% of third-year students and 90.8% of fifth-year students completed at least one reflection during the academic year. The ability to sustain continuous critical reflection was observed in only 22.1% of the 453 students evaluated. These findings present a concerning scenario, as critical reflection is directly linked to competence in health care and informed decision-making. Conclusions: The study concludes that formative assessment processes requiring critical and reflective self-assessment must be broadly integrated into the curriculum to foster significant gains in the development of professional competencies. Full article

The development of new diagnostic technologies is accelerating, and budgetary constraints in the health sector necessitate a systematic decision-making process to acquire emerging technologies. Health Technology Assessment methodologies integrate technology, clinical efficacy, patient safety, and organizational and financial factors in this context. However, these methodologies do not include the learning curve, a critical factor in operator-dependent technologies. This study presents an evaluation model incorporating the learning curve, developed from the domains of the AdHopHTA project. Using System Dynamics (SD), the model was validated and calibrated as a case study to evaluate the use of Point-of-Care Ultrasound (POCUS) in identifying dengue. This approach allowed for the analysis of the impact of the learning curve and patient demand on the revenues and costs of the healthcare system and the cost–benefit indicator associated with dengue detection. The model assesses physician competency and how different training strategies and frequencies of use affect POCUS adoption. The findings underscore the importance of integrating the learning curve into decision-making. This study highlights the need for further investigation into the barriers that limit the effective use of POCUS, particularly in resource-limited settings. It proposes a framework to improve the integration of this technology into clinical practice for early dengue detection. Full article

Background/Objectives: Mobile healthcare units (MHUs) comprise flexible, ambulatory healthcare teams that deliver community care services, particularly in underserved or remote areas. In Greece, MHUs were pivotal in epidemiological surveillance during the COVID-19 pandemic and are now evolving into a sustainable and integrated service for much-needed community-based healthcare. To support this expanded role, targeted, competency-based training is essential; however, this can pose challenges, especially in coordinating synchronous learning across geographically dispersed teams and in ensuring engagement using an online format. Methods: A nationwide, online training program was developed to improve the knowledge of the personnel members of the Hellenic National Public Health Organization’s MHUs. This program was structured focusing on four core themes: (i) prevention–health promotion; (ii) provision of care; (iii) social welfare and solidarity initiatives; and (iv) digital health skill enhancement. The program was implemented by the University of Crete’s Center for Training and Lifelong Learning from 16 January to 24 February 2025. A multidisciplinary team of 64 experts delivered 250 h of live and on-demand educational content, including health screenings, vaccination protocols, biomarker monitoring, chronic disease management, treatment adherence, organ donation awareness, counseling on social violence, and eHealth applications. Knowledge acquisition was assessed through a pre- and post-training multiple-choice test related to the core themes. Trainees’ and trainers’ qualitative feedback was evaluated using a 0–10 numerical rating scale (Likert-type). Results: A total of 873 MHU members participated in the study, including both healthcare professionals and administrative staff. The attendance rate was consistently above 90% on a daily basis. The average assessment score increased from 52.8% (pre-training) to 69.8% (post-training), indicating 17% knowledge acquisition. The paired t-test analysis demonstrated that this improvement was statistically significant (t = −8.52, p < 0.001), confirming the program’s effectiveness in enhancing knowledge. As part of the evaluation of qualitative feedback, the program was positively evaluated, with 75–80% of trainees rating key components such as content, structure, and trainer effectiveness as “Very Good” or “Excellent.” In addition, using a 0–10 scale, trainers rated the program relative to organization (9.4/10), content (8.8), and trainee engagement (8.9), confirming the program’s strength and scalability in primary care education. Conclusions: This initiative highlights the effectiveness of a structured, online training program in enhancing MHU knowledge, ensuring standardized, high-quality education that supports current primary healthcare needs. Future studies evaluating whether the increase in knowledge acquisition may also result in an improvement in the personnel’s competencies, and clinical practice will further contribute to assessing whether additional training programs may be helpful. Full article

The growing urgency of the climate crisis has heightened the importance of integrating sustainability into health education. Allied health professionals are well positioned to lead sustainable healthcare efforts, yet evidence suggests a persistent gap between student awareness and formal training. This study explored the perspectives, knowledge, and attitudes of Portuguese allied health students regarding sustainability. An online and anonymous cross-sectional survey was conducted among undergraduate and graduate students across multiple allied health disciplines. The questionnaire assessed general knowledge, perceptions of curricular integration, and attitudes toward sustainable clinical practice. A total of 247 (response rate of 8.23%) students participated, with the majority expressing high concern about climate change and strong support for environmentally responsible healthcare. However, the results revealed inconsistent awareness of healthcare’s environmental footprint and a limited exposure to structured sustainability education. Friedman tests indicated significant variability in students’ knowledge, perceived responsibility, and curricular experiences. Students identified priority themes for curricular inclusion—such as the environmental impact of the health system—and recognized their alignment with the UN Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health) and SDG 13 (Climate Action). The findings highlight the need for the systematic, competency-based integration of sustainability into allied health curricula to support a climate-resilient and ecologically responsible future healthcare workforce. Full article

This article describes the design and implementation of a Specialized Mental Health Clinical Pastoral Education (CPE) program for clergy and theological students of all spiritual, religious, and cultural backgrounds. Addressing the need for mental health competencies in religious leaders and chaplains, this training equips participants with specialized skills in individual and group mental health spiritual assessment and spiritual care. Program participants become effective members of a multiprofessional team, gain knowledge of mental health philosophies of concordant and discordant spiritual orienting systems, and gain greater relational capacity. The Mental Health CPE Program includes traditional and novel CPE elements: (1) clinical practice, (2) group and individual supervision, (3) didactic presentations and journal clubs, (4) verbatim (Protocols of patient encounters) and case presentations, (5) group leadership training and practica, and (6) experience of faith reflections. This article provides insights into the origins of CPE, a description of the implementation in a free-standing psychiatric hospital, and observed developmental changes of program participants. We include graduates’ anecdotal feedback about their learning experience and its impact on their leadership in chaplaincy and in religious communities. Additionally, we report on areas for future development and further study of the effectiveness of Mental Health CPE. Full article

Physiotherapy is challenged to be a profession with competencies in humanized skills and aptitudes. The need to integrate the learning of sustainable soft skills and humanistic education into higher education curricula has recently been emphasized to improve the capabilities of future healthcare professionals. Our objective was to psychometrically evaluate the Invisible Care, Well-being, Security, and Autonomy (CIBISA) scale in the context of physiotherapy through a pilot study involving students undertaking a degree in physiotherapy. The Delphi method was used over two rounds, and a focus group was convened to achieve a consensus on the adaptation of the CIBISA nursing scale to assess physiotherapy (CIBISA-F). For the psychometric validation of the CIBISA-F scale, the data-collection instruments used were the adapted CIBISA-F scale and two more validated scales related to soft skills. The scales were answered by 25 students at three different times, twice before the start of the clinical placements and once after. The results showed high internal consistency (α = 0.911), adequate reliability according to a Brand–Altman plot, and an adequate construct validity and sensitivity in comparison to other tools. The results of the present study suggest that this version of the CIBISA-F scale is a useful and reliable tool for measuring humanization skills in healthcare and physiotherapy students during their clinical placements, ensuring high-quality education. Full article