Search Results (200)

Antimicrobial resistance is a global threat to public health. The growing resistance of bacteria to commonly used antibiotics necessitates the search for and development of alternative treatments. Bacteriophage (or phage) therapy fits this trend perfectly. Phages that selectively infect and kill bacteria might represent, in some cases, the last therapeutic option. This overview provides case examples and discusses the potential development of phage therapy, examining its ethical and legal considerations in the context of current clinical practices. Additionally, it explores the advantages of utilizing phage products in patients for whom existing therapeutic options are limited or unavailable. Further clinical studies are necessary to broaden the understanding of phages, their dosage, and a standardised delivery system. These efforts are essential to ensure that phage-based therapy is not viewed as experimentation but as a routine medical treatment. Bacterial viruses are unlikely to become a miracle cure or a panacea for infections, but they may find an important role in medicine. Full legalisation of this treatment could help solve the problem of multidrug-resistant infectious diseases on a global scale. Full article

Background/Objectives: Historically, humankind has consistently regarded death as an uncomfortable topic. Although death and dying are unescapable, they are frequently overlooked in formal education, as discussing or acknowledging them is believed to provoke emotional or psychological discomfort. To the best of our knowledge, little is known about the influence of the fear of death on the lives of university students. To fill this gap, this study aimed to examine the relationship between the concept of a good death, fear of death and self-compassion among university students in Portugal. Methods: This cross-sectional study was conducted in Portugal between November 2024 and January 2025 with 310 university students using an e-survey. Personal questionnaire and the Portuguese versions of the Good Death Concept Scale, the Collett-Lester Fear of Death Scale, and the Self-Compassion Scale were used. JAMOVI statistical software (version 2.7.6.) was used for descriptive analysis, independent sample t-tests, one-way ANOVA with post hoc analysis, and Pearson correlation analysis. To identify the factors associated with fear of death, a multiple linear regression analysis was conducted. This study adhered to the STROBE checklist for reporting. Results: A total of 310 students were included. The average age was 25 ± 8.52 years, and 75.2% were female. The total mean score for fear of death was 99.22 ± 21.97, indicating relatively low fear levels. However, health sciences students presented higher fear of death rates compared with non-health counterparts. Age and gender differences were also found, with female and younger students reporting significantly higher levels of fear of death (p < 0.01). The Pearson correlation matrix indicated that fear of death is positively correlated with the concept of a good death, while negatively correlated with self-compassion (p < 0.01). Key factors influencing fear of death include age, gender, closure and control domains, and the overidentification subscale (adjusted R-Squared valued [R2] = 0.352). Conclusions: The results suggest that students are often poorly prepared to deal with death-related issues (revealing fear) and with negative thoughts and feelings about mortality. In this vein, it is necessary to implement curricular educational interventions focusing on death education as well as actively involving students in compassionate community initiatives, increasing their awareness and self-confidence about EoL care. Full article

Fecal microbiota transplantation (FMT) is a safe and effective treatment for recurrent Clostridiodes difficile infection (rCDI). However, experience with the oral biologic product MKB-01 remains limited. We describe a series of 13 patients with rCDI treated with FMT using MKB-01 capsules administered orally. Each patient received a single dose of 4 capsules (≥2.1–2.5 × 10¹¹ microorganisms) with water after a 2 h fasting period. Antibiotic therapy was discontinued pre FMT. Clinical evaluation was performed at weeks 8 and 12. The mean number of prior recurrences was 1.5 (range: 1–3 episodes). In 12 patients (92.3%), FMT was administered after resolution of the current episode; in one patient (7%), it was administered on day 3 of fidaxomicin therapy, prior to symptom resolution. At week 8, clinical cure (Absence of baseline symptoms for at least 72 h) was achieved in 11 patients (84.6%). An additional patient (7%) responded to a second FMT. One recurrence occurred at 8 weeks and was resolved with a second FMT. Therefore, the overall clinical response rate after one or more FMTs was 12 out of 13 patients (92.3%). The procedure was well tolerated; only one patient experienced self-limited diarrhea. These findings support oral FMT with MKB-01 capsules as a safe and effective option for treating rCDI. Full article

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures. Full article

Background/Objectives: Emotional competence is a crucial skill in nursing education, yet it remains underdeveloped in academic curricula. This study aims to (1) propose and preliminarily apply the TRI-COM model as a conceptual and educational framework to operationalize the definition of emotions within nursing contexts, and (2) explore the multidimensional structure of emotional competence among nursing students. Methods: A cross-sectional study was conducted with 233 nursing students (M_age = 23.79, SD = 5.19) from various Italian universities, with 82.8% identifying as female. The participants completed an online questionnaire including the Toronto Alexithymia Scale (TAS-20) and the Jefferson Scale of Empathy—Health Profession Student (JSE-HPS) version. Descriptive statistics, t-test, ANOVA, and Pearson’s correlation analyses were performed. Results: The overall mean TAS-20 score was 60.36 (SD = 11.22), which is close to the clinical threshold (cut-off = 61). The EOT subscale showed the highest mean (M = 26.48, SD = 3.16), suggesting a tendency toward externally oriented thinking. The mean JSE-HPS total score was 87.05 (SD = 7.88), with higher scores for Perspective Taking (M = 60.95, SD = 7.42) than Compassionate Care (M = 18.92, SD = 6.40). A significant gender difference was found in Perspective Taking (female: M = 61.54, male: M = 58.10; p = 0.007). The ANOVA results showed no significant differences in empathy across academic years, but the DIF subscale of TAS-20 showed a trend near significance (p = 0.053). Significant negative correlations were observed between age and TAS-20 scores (e.g., age–TAS-20 total: r = −0.23, p < 0.001). Conclusions: The findings suggest a general tendency toward rationalization and emotional detachment among students, possibly as a coping strategy in emotionally demanding contexts. The TRI-COM model—an original pedagogical framework inspired by tripartite theories of emotion—was used as a conceptual lens, providing a preliminary framework to interpret emotional competence in nursing education. Further research is needed to validate its educational relevance and explore practical applications within curricula. Full article

Fear modulates intergroup dynamics by amplifying biases, yet prior work predominantly examines integrated emotions (e.g., fear tied to intergroup conflict), neglecting incidental fear—transient states unrelated to group contexts. Furthermore, the reliance on Western samples limits insights into cultural variability, particularly in collectivist societies where group boundaries differ. Here, we conducted two experimental studies that involved Chinese participants and examined the effect of incidental fear on empathy for in-group and out-group members’ pain (operationalized as self-focused empathy, reflecting personal distress when witnessing pain, and other-focused empathy, reflecting compassionate concern for the sufferer). In Experiment 1 (N = 54), using a pain observation paradigm, incidental fear was elicited by randomly showing frightening images, while the differentiation between the in-group and out-group was based on natural ethnic differences (same races and other races). Experiment 2 (N = 52) replicated this using artificial social categorization (university affiliation). Fear reduced other-focused empathy for racial out-groups and socially defined out-groups. Self-focused empathy remained unaffected, suggesting fear selectively disrupts mentalizing-dependent processes. The Inclusion of Other in Self (IOS) scale revealed heightened psychological distance toward out-groups under fear, mediating empathy reduction. Incidental fear universally diminishes empathy for out-group pain across natural and artificial group boundaries, extending social identity theory to transient affective states. These findings highlight fear’s role in intergroup bias and underscore cultural generalizability beyond WEIRD populations. Full article

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

Background/Objectives: Involuntary migration exposes individuals to multiple losses and ruptures that profoundly affect their physical, emotional, and social well-being. This study aimed to explore the vital losses experienced by Latin American women seeking international protection, identifying key dimensions of these losses and the coping strategies they employ to support their health and well-being. Methods: The study employed a qualitative phenomenological approach, with 17 international migrant women comprising the study subjects. Data were analysed using an inductive approach and interpretative phenomenological analysis, facilitated by Atlas.ti 23.0 software. The COREQ criteria were followed. Results: The analysis revealed two central themes: the multiplicity of losses associated with migration, including loss of identity, emotional deterioration, disruption of family and community ties, economic instability, and loss of sense of belonging; and hidden gains, encompassing processes of gratitude, spiritual strength, and personal transformation. Conclusions: The findings highlight the complexity of both the losses and the hidden gains associated with the migration experience, underscoring the need for compassionate and culturally competent healthcare. This study provides relevant evidence to improve professional support strategies for refugee women from a comprehensive and humanised perspective. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

Targeted alpha therapy (TAT) has recently emerged as a highly promising approach for the management of metastatic castration-resistant prostate cancer (mCRPC), especially in patients with disease progression despite standard treatments. Among alpha-emitter radiopharmaceuticals, actinium-225-labelled prostate-specific membrane antigen ([225Ac]Ac-PSMA) has shown remarkable potential due to its high linear energy transfer (LET), short path length, and ability to induce potent, localised cytotoxic effects. This review summarises current clinical evidence regarding [225Ac]Ac-PSMA radioligand therapy (RLT), emphasising its efficacy, safety profile, and position relative to beta-emitter therapy with lutetium-177 ([177Lu]Lu-PSMA). Data from compassionate-use programs and small clinical trials demonstrate that [225Ac]Ac-PSMA produces significant biochemical and imaging responses, including > 50% declines in prostate-specific antigen (PSA) and lesion regression on [68Ga]Ga-PSMA PET/CT, even in heavily pre-treated mCRPC cohorts. Xerostomia, renal toxicity, and haematological adverse effects remain the main safety challenges, necessitating optimisation of patient selection, dosing strategies, and salivary gland protection protocols. Compared with [177Lu]Lu-PSMA, [225Ac]Ac-PSMA appears effective even in cases of beta-refractory disease, highlighting its complementary role rather than a competitive alternative. However, limited availability, high production costs, and the lack of large-scale, randomised trials hinder widespread clinical adoption. Future directions include combination protocols, improved radiopharmaceutical design, and trials evaluating its use in earlier disease stages. This review provides a comprehensive overview of the clinical aspects of [225Ac]Ac-PSMA RLT and its evolving role in advanced prostate cancer management. Full article

The growing number of older adults with cancer confront practical and organizational limitations that hinder their ability to obtain care that is adapted to their health status, needs, expectations, and life choices. The integration into practice of evidence-based and institutional recommendations for a geriatric approach and person-centered high-quality care remains incomplete. This study uses an action research design to explore stakeholders’ perspectives of the challenges involved in translating the established care priorities into a compassionate geriatric approach in oncology and identify promising pathways to improvement. Fifty-three stakeholders participated in focus groups to create cognitive maps representing perceived relationships between concepts related to compassionate care of older adults with cancer. Combining maps results in a single model constructed in Mental Modeler software to weigh relationships and calculate concept centrality (importance in the model). The model represents stakeholders’ collective perspective of the determinants of compassionate care that need to be addressed at different decision-making levels. The results reveal pathways to improvement at systemic, organizational, practice, and societal levels. These include connecting policies on ageing and national cancer programs, addressing fragmented care through interdisciplinary teamwork, promoting person-centered care, cultivating relational proximity, and combatting ageism. Translating evidence-based practices and priority orientations into compassionate care rests on collective capacities across multiple providers to address the whole person and their unique trajectory. Full article

This study aims to understand the meaning nursing professionals attribute to their lived experiences of providing humanized care within a public hospital setting. Grounded in Jean Watson’s theory of human caring, the research adopts a qualitative, descriptive phenomenological design to capture the perceptions and emotions of nurses regarding humanized care. Data were collected through semi-structured interviews with nine experienced nurses, selected through purposive sampling. The interviews, conducted virtually between July and December 2024, were analyzed using Colaizzi’s method and supported by Atlas.ti software. Four main thematic categories emerged: institutional health policies, professional image and identity, strengths and challenges in care, and essential competencies for humanized care. The findings highlight the critical role of empathy, cultural sensitivity, ethical commitment, and emotional presence in delivering compassionate care. Participants emphasized that, beyond clinical procedures, humanized care requires relational and contextual sensitivity, often hindered by institutional limitations and excessive administrative burdens. The study concludes that nursing professionals are key agents in promoting ethical, empathetic, and culturally respectful practices that humanize health services. These insights offer valuable contributions for designing policies and training strategies aimed at strengthening humanized care as a cornerstone of quality healthcare systems. Full article

This review addresses the urgent need for alternative strategies to combat drug-resistant mycobacterial infections, including multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis, as well as non-tuberculous mycobacterial (NTM) diseases. Traditional antibiotics are increasingly limited by resistance, toxicity, and poor efficacy, particularly in immunocompromised patients. A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar, covering publications primarily from 2000 to 2025. Only articles published in English were included to ensure consistency in data interpretation. Search terms included “mycobacteriophages,” “phage therapy,” “drug-resistant mycobacteria, “diagnostic phages,” and “phage engineering.” The review examines the therapeutic and diagnostic potential of mycobacteriophages—viruses that specifically infect mycobacteria—focusing on their molecular biology, engineering advances, delivery systems, and clinical applications. Evidence suggests that mycobacteriophages offer high specificity, potent bactericidal activity, and adaptability, positioning them as promising candidates for targeted therapy. Although significant obstacles remain—including immune interactions, limited host range, and regulatory challenges—rapid progress in synthetic biology and delivery platforms continues to expand their clinical potential. As research advances and clinical frameworks evolve, mycobacteriophages are poised to become a valuable asset in the fight against drug-resistant mycobacterial diseases, offering new precision-based solutions where conventional therapies fail. Full article

Background: Belantamab mafodotin (belamaf) is a BCMA-targeting antibody–drug conjugate used in triple-class refractory multiple myeloma. Despite its efficacy, keratopathy remains a significant dose-limiting toxicity. Following its withdrawal from the U.S. market in 2022, its use in Austria is limited to clinical trials or compassionate use. Methods: In this real-world, retrospective study, we analyzed 36 relapsed/refractory, BCMA-naïve multiple myeloma patients treated at the University Hospital of Vienna (January 2020–June 2024); 42% received a reduced dose (1.9 mg/kg) throughout all treatment cycles. The primary objective was to assess adverse events, particularly keratopathy, and the impact of dose modifications on toxicity and efficacy. Results: The overall response rate was 64%, with responders having significantly fewer prior therapy lines (median 3 vs. 4.5, p = 0.015). Median PFS was 7.3 months, significantly longer in responders (11.1 vs. 1.6 months, p < 0.0001); median OS was 20.1 months, also longer in responders (not reached vs. 18 months, p = 0.031). Keratopathy occurred in 75% of patients; 33% experienced grade 3–4 events. Dose reduction significantly decreased grade 3–4 keratopathy (7% vs. 52%, p = 0.004) and thrombocytopenia (33% vs. 67%, p = 0.048) without compromising efficacy. Conclusions: Belamaf dose reductions improved tolerability without loss of efficacy, supporting reduced dosing in practice. Full article

Background: It is generally well-known that narration of care is critically important to high-quality nursing care. Narration of care is loosely defined as a nurse’s ability to describe to patients and families the clinical purpose behind nursing practice, what is hoped to be achieved, and the “why” (or clinical rationale) behind nursing activities. Despite the importance of narration of care, there is little practical guidance given to nurses about how to narrate care—what makes for effective or ineffective narration of care. Objective: Our aim was to develop a framework for teaching nurses and patient care assistants (PCAs) on how to effectively narrate care. In this article, we provide a practical framework for teaching nurses and PCAs how to narrate care. We describe the process of developing the framework as part of quality improvement efforts and implementing a course for eight hospitals based on the framework. Methods: Consistent with a Plan-Do-Study Act (PDSA) quality improvement approach, we developed the framework by first conducting a data and literature review, then convening a taskforce, discussing with patients on our existing committees, and finally formulating a framework. We then drafted supplementary cases and course material and implemented a course to teach nurses and PCAs how to narrate care. Results: The narration of care framework (NOC) that we developed and implemented consisted of the following five principles, which can be called RECAP as an acronym: 1. The “R” in RECAP stands for removing uncertainty. 2. The “E” in RECAP stands for explaining the environment. 3. The “C” in RECAP stands for being calm and sincere. 4. The “A” in RECAP stands for assume nothing. 5. The “P” in RECAP stands for personal connection. As for the course developed based on the RECAP principles, there was a total of 276 course offerings conducted by 30 facilitators, and 7341 nurses and PCAs completed the course. The evaluations reflected that 99% of learners believed their learning was improved by the course. Discussion: There are several multifaceted benefits to NOC: nurses’ and PCAs’ capability to narrate care well shows empathy and compassion to patients; it strengthens patient understanding and education that can lead to improved patient outcomes; and it helps allay patients’ uncertainties and anxieties. In essence, narrating care in an effective manner cultivates a strong nurse–patient therapeutic relationship. Yet, in the absence of any practical guidance, nurses and PCAs are left to develop narration skills on their own, learning by trial and error, and, in doing so, perhaps failing to meet patients’ needs and failing to fully derive the many benefits that the NOC is designed to achieve. Our hope is that, if hospital systems adopt our work, nurses and PCAs can comfortably and confidently enter the profession knowing the purpose or narrating care, its many benefits, and how to practically conduct sufficient narration, and what would constitute insufficient narration. Hospitals, in turn, can specify and clearly articulate their expectations for nurses and PCAs narrating with patients—what would make for a strong, compassionate process and what would be inadequate. For more experienced nurses, they can use the RECAP framework to reflect on their own practices and perhaps strengthen or refreshen existing skills. Conclusions: NOC is acknowledged, somewhat implicitly, as being critical to nursing and PCA practice, yet practical instruction and specified principles are lacking. We aimed to fill this gap by developing, implementing, and teaching a practical framework, armed with many tools nurses can use. Full article