Search Results (542)

Background: Regional anesthesia is a fundamental aspect of contemporary perioperative care. However, variability in practice, incomplete documentation, and inconsistent safety protocols continue to pose preventable risks. Although there are international checklist models for regional anesthesia and perioperative safety such as those developed by ASRA, ESAIC, and the WHO, Italy does not have a nationally endorsed checklist that is consensus-based and specifically tailored to local terminology, workflows, and legal requirements. Methods: To address this gap, we developed an evidence-based Locoregional Anesthesia Checklist (LRA Checklist) using established frameworks for healthcare checklist design. The development process included a needs assessment through a national survey of ESRA Italy members, a review of existing models, item drafting, expert consensus, and endorsement by the Board. We assessed content validity through a modified Delphi process involving 15 experts from the ESRA Italian Chapter Board. Additionally, we created a theoretical impact model to estimate the potential organizational and economic effects of implementing the checklist, using baseline institutional parameters. Results: Consensus was achieved for all checklist domains after two Delphi rounds, with minor edits to improve clarity, usability, and clinical relevance. The theoretical model indicates that adopting checklists may help reduce preventable complications, improve workflow, enhance documentation and traceability, and provide overall benefits to institutions in various scenarios. Conclusions: In conclusion, the LRA Checklist is a structured, consensus-based tool tailored for the Italian context, aimed at promoting safer and more standardized practices in regional anesthesia. To our knowledge, no prior Italian national consensus or checklist specifically dedicated to regional anesthesia has been formally published. Prospective multicenter studies are necessary to confirm its effectiveness in real-world settings and to quantify both clinical and economic outcomes. Full article

Background: Severe jaw atrophy limits traditional endosseous implantation, often necessitating complex regenerative procedures. Advances in digital planning and 3D printing have reintroduced custom-made subperiosteal (juxta-osseous) implants as a viable alternative. This study evaluates the clinical reliability and advantages of next-generation juxta-osseous implants. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines across the PubMed, Scopus, and Web of Science databases. The search focused on English-language studies reporting on custom-made titanium juxta-osseous implants in patients with severe maxillary or mandibular atrophy. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Additionally, a representative clinical case of a 60-year-old female treated via a fully digital workflow is presented to illustrate the protocol. Results: Twenty-six articles were included, accounting for 147 clinical cases. Most patients exhibited Cawood and Howell Class V–VI atrophy. All identified treatments utilized integrated digital workflows, including CBCT imaging, CAD/CAM design, and additive manufacturing (SLM/DMLS) of medical-grade titanium alloy. Reported success rates exceeded 90%, with high primary stability enabling immediate or early loading protocols and high patient satisfaction. Complications were primarily limited to manageable soft-tissue dehiscence. Conclusions: Modern juxta-osseous implants represent a promising, minimally invasive alternative to bone grafting for severe atrophy, enabling rapid functional restoration in the short-to-medium-term. However, because current evidence is limited to clinical studies, these findings should be interpreted with caution. Long-term prospective trials are essential to establish definitive clinical predictability and standardized protocols. Full article

Background/Objectives: The Diet Quality Questionnaire (DQQ) is a brief, food group–based instrument designed for globally comparable population surveillance of diet quality. We culturally adapted the DQQ for Poland and evaluated its internal structure and reliability in an adult cohort. Methods: Following forward–backward translation and expert review, the Polish DQQ was administered online to adult females. Internal structure was explored and test–retest reliability was assessed for total DQQ scores. Diet quality indicators (Dietary Diversity Score [DDS], NCD-protect, NCD-risk, and Global Dietary Recommendations score [GDR]) were summarized descriptively. Results: The average age in the cohort was 29.4 ± 13.6 years. A total of 296 respondents completed the survey; 100 completed the retest. Item-level test–retest reliability was good to excellent (Cohen’s kappa 0.72–1.00). Agreement for total scores was high with minimal bias (Bland–Altman bias 0.2, >95% of observations within limits of agreement) and there was no heteroscedasticity; Passing–Bablok regression indicated equivalence between the test and retest. Median (IQR) diet quality indicators were: DDS 6.0 (5.0; 7.0), NCD-protect 2.5 (1.5; 4.0), NCD-risk 2.5 (1.0; 4.0), and GDR 9.0 (7.5; 10.5). Eighty percent met DDS ≥ 5, while one-third consumed all five recommended food groups. Conclusions: DQQ-PL demonstrates high item-level stability and strong agreement for total scores, with structural findings aligning with its design as a non-latent, food group checklist for population monitoring. The Polish adaptation is feasible and reliable in the studied population (young adult women), supporting its potential use for rapid dietary surveillance pending broader validation. Full article

This study investigates and compares Food Safety Management System (FSMS) compliance in retail shops across Mazovia (Poland) and Kerala (India). A structured visual inspection checklist with 51 indicators across seven FSMS sections was used in 500 shops per country: design and layout, general food safety, food handling and storing practices, display, personnel hygiene practices, sanitation and cleanliness, and pest control. Each section was scored using a four-point ordinal scale. Compliance scores were analyzed using the Mann-Whitney U test, Kruskal–Wallis test, Principal Component Analysis (PCA), and Cluster analysis to identify influencing factors and compliance patterns. The results demonstrate significant differences between the two countries, with Polish retail shops showing notably higher compliance (p < 0.001). No significant difference was observed in the design and layout section (p = 0.103). None of the assessed shop categories in either country achieved full compliance with all food safety requirements. Retail format, location, and number of employees were significantly associated with compliance levels. This is the first comparative study to examine FSMS compliance in retail shops in Mazovia, Poland, and Kerala, India, using a standardized visual inspection method. The findings contribute to a better understanding of FSMS performance in retail environments under different economic and regulatory conditions. Identifying how variations in retail format, staffing, and operational practices influence FSMS compliance can support the development of context-specific strategies to improve food safety performance. Full article

Objectives: To systematically evaluate the efficacy and safety of intraovarian platelet-rich plasma (PRP) administration in women with diminished ovarian reserve (DOR) and related conditions, given the growing clinical interest and the conflicting evidence from uncontrolled and controlled studies. Methods: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches were performed in PubMed, Web of Science, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus up to January 2026. Eligible studies included randomized controlled trials (RCTs), prospective cohort studies, and before–after studies investigating PRP-based interventions in women diagnosed with DOR, premature ovarian insufficiency (POI), or poor ovarian response (POR). Given the limited availability of controlled data, these populations were analyzed together with cautious interpretation. Study quality was assessed using the Joanna Briggs Institute (JBI) checklists and the Critical Appraisal Skills Programme (CASP) tool for RCTs. Pooled estimates were calculated using random- or fixed-effects models depending on heterogeneity (I²). Results: Nineteen studies involving 1794 women were included, of which two were randomized controlled trials. In single-arm and before–after analyses, PRP administration was associated with increases in serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC), as well as a reduction in serum follicle-stimulating hormone (FSH). In addition, the number of metaphase II (MII) oocytes retrieved and transferable embryos increased following PRP treatment. However, pooled analyses of controlled studies, including RCTs, did not demonstrate consistent improvements in mature oocyte yield compared with control groups. In single-arm analyses, the pooled clinical pregnancy rate and live birth rate following PRP treatment were 15.5% (95% CI: 11.1–21.2%) and 10.7% (95% CI: 6.7–16.6%), respectively. No major procedure-related adverse events were reported across included studies. Conclusions: In conclusion, intraovarian PRP is associated with improvements in ovarian reserve markers such as AMH and AFC in uncontrolled studies. However, evidence from randomized controlled trials does not demonstrate a consistent benefit in pregnancy and live birth. Well-designed RCTs with standardized protocols are needed before clinical recommendation. Full article

Driving simulators offer a safe and controlled way to study fatigue in truck drivers, but variation in scenario design and incomplete reporting limit reproducibility and cross-study comparison. This systematic review synthesized scenario parameters used in truck-driving simulators to induce fatigue-related reductions in alertness and identified recurring protocol patterns associated with interpretable fatigue-related change. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and a prospectively registered protocol (PROSPERO CRD420261302272), systematic searches were conducted in February 2026 in Scopus, Web of Science, IEEE Xplore, PubMed, and ScienceDirect. Peer-reviewed original studies published in English were eligible if they involved truck drivers, used a driving simulator, reported fatigue-relevant scenario parameters, and measured at least one fatigue-related outcome; no restriction was applied to publication year. Twenty-three studies comprising 419 participants met the eligibility criteria and were synthesized narratively. Risk of bias was appraised using an adapted 11-item checklist for driving simulator experiments, developed with the National Heart, Lung, and Blood Institute (NHLBI) quality assessment tools as a reference framework. Across the qualitative evidence base, fatigue-related change was reported more consistently in protocols combining sustained time on task with low-variability driving demands, typically implemented through monotonous road environments and reduced traffic complexity. Effects were more readily interpretable when sessions were scheduled at night or after work shifts and when outcomes were assessed repeatedly during the drive. However, incomplete control or reporting of baseline sleep pressure, stimulant intake, counterbalancing, familiarization, simulator sickness, and outlier handling limited causal interpretation and confidence in cross-study comparison. Overall, the evidence supports recurring design patterns rather than a single optimal protocol and highlights the need for standardized scenario descriptions and minimum reporting requirements. Full article

Background/Objectives: Adequate cardiopulmonary resuscitation (CPR), defibrillation, and treatment of reversible causes are essential for improving the survival of patients suffering from out-of-hospital cardiac arrests (OHCAs). The Advanced Life Support (ALS) algorithm includes reversible causes for cardiac arrest. This study aimed to develop an interactive mobile checklist to identify reversible causes of OHCA (REBECCA) and evaluate their usability and usefulness among emergency physicians. Methods: This mixed-methods study was conducted at the Emergency Medical Service Vienna, Austria. All participants were emergency physicians from the Medical University of Vienna. An interactive mobile checklist was developed using a participatory design approach involving a focus group of 10 emergency physicians. Usability and applicability were assessed using structured questionnaires. Descriptive statistics were used to summarize participant characteristics and evaluation outcomes. Results: Among the included participants, 70% were specialists with a median prehospital experience of 2.0 (1.0–4.3) years. Although most participants were confident about their level of professional experience with OHCA, 85% still found the checklist to be helpful. The majority of the participants preferred the digital checklist over the paper-based checklist and appreciated its integration with the point-of-care ultrasound (POCUS) application. Although the participants did not communicate a significant need for further details on most causes, a small majority favored more information on intoxication and electrolyte disorders. Conclusions: The majority of the included emergency physicians found the REBECCA checklist helpful regardless of training level, whereas almost no physician needed further detailed information on the reversible causes. Our findings underscore the potential importance of future investigations aiming to reduce the cognitive load of emergency physicians during OHCA scenarios. Full article

Mechanical complications after acute myocardial infarction (MI)—ventricular septal rupture (VSR), free-wall rupture (FWR), and papillary muscle rupture (PMR)—have become uncommon in the primary percutaneous coronary intervention (PCI) era, yet remain among the most lethal cardiovascular emergencies, with contemporary mortality largely driven by cardiogenic shock and delays to definitive treatment. Although major society documents agree on urgent imaging, early mechanical circulatory support when shock is present, and multidisciplinary decision-making, important transatlantic differences persist, particularly regarding timing of intervention in ventricular septal rupture. This review synthesises current surgical and transcatheter evidence and proposes a unified, physiology-centred framework integrating shock staging, anatomical feasibility, and response to mechanical support. We also introduce STABLE, a structured bedside checklist designed to support consistent daily triage across all three lesions and to align timing decisions with haemodynamic stabilisation rather than centre-specific habit. Full article

Background and Objectives: Advances in digital dentistry, particularly CAD-CAM, have improved the efficiency and precision of crown design and fabrication. Recently, artificial intelligence (AI)-integrated CAD-CAM systems have enabled automated tooth morphology generation, margin detection, and occlusal analysis, enhancing consistency and accuracy. This systematic review evaluates the accuracy of AI-assisted crown design compared with conventional and CAD-CAM workflows. Materials and Methods: A systematic search was conducted across PubMed/MEDLINE, Scopus, Web of Science, Cochrane, and LILACS for studies published between January 2010 and December 2025 that assessed the marginal fit, internal adaptation, and occlusal contact accuracy of single crowns. Screening, full-text assessment, and data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality and risk of bias were evaluated using the Modified CONSORT checklist for in vitro studies and the Joanna Briggs Institute tools for clinical studies. Results: Of 887 records identified, 12 studies met the inclusion criteria. Nine studies showed a moderate risk of bias, two moderate-to-high, and one low-to-moderate. AI-assisted crown design demonstrated clinically acceptable internal fit and marginal adaptation, comparable or superior to CAD-CAM systems. Occlusal contact accuracy was generally comparable to CAD-CAM and technician-designed crowns, though variability was observed across AI models. Conclusions: AI-assisted crown design provides a reliable fit and marginal adaptation, with occlusal accuracy approaching conventional CAD-CAM and technician workflows. While not a replacement for clinical expertise, AI serves as a valuable adjunct, enhancing reproducibility, precision, and overall quality in restorative dentistry. Further standardized clinical studies are needed to validate long-term outcomes and optimize occlusal performance. Full article

Background: The effectiveness of prostate-specific antigen (PSA)-based early detection of prostate cancer remains controversial and implementation-dependent. Screening policy changes have substantially altered PSA testing behavior in the United States, yet longitudinal evidence from non-organized European settings is limited. We assessed 12-year changes in awareness and utilization of PSA-based early detection and identified subgroups requiring targeted counseling. Methods: Two cross-sectional survey waves were conducted in 2009 (Study Phase 1) and 2021 (Study Phase 2) among men recruited via general practitioner practices in urban and rural regions of Germany. The survey was developed and reported according to the Consensus-Based Checklist for Reporting of Survey Studies (CROSS). Identical questionnaires were used across phases. Endpoints were awareness of PSA-based early detection and prior PSA testing. Univariable and multivariable logistic regression evaluated independent associations with sociodemographic and behavioral factors. To assess sensitivity to compositional differences between survey waves, post-stratified weighted analyses re-aligning Study Phase 2 to the Study Phase 1 distribution of age category, educational attainment, and smoking status were conducted. Results: The analytic cohort comprised 890 men (Study Phase 1, n = 755; Study Phase 2, n = 135). Compared with Study Phase 1, Study Phase 2 participants more frequently were non-smokers (63.0% vs. 48.5%, p < 0.001) and had a university degree (38.5% vs. 30.5%, p = 0.002). In primary multivariable analyses, higher educational attainment (OR 1.71, 95% CI 1.24–2.36) and paternity (OR 1.94, 95% CI 1.25–3.01) were independently associated with greater awareness, whereas increasing age (OR 1.39, 95% CI 1.29–1.50) and higher educational attainment (OR 1.63, 95% CI 1.19–2.24) were independently associated with utilization. Study phase was not independently associated with either endpoint in primary models. In post-stratified sensitivity analyses, study phase was positively associated with utilization, indicating sensitivity of temporal contrasts to population composition. Conclusions: In primary multivariable analyses, we did not detect statistically significant temporal differences in awareness or utilization of PSA-based early detection within this German non-organized setting. The emergence of a study phase effect in weighted sensitivity analyses suggests that apparent time trends may be influenced by compositional differences between survey waves. Persistent social gradients, particularly related to educational attainment, underscore the importance of targeted, evidence-based counseling in opportunistic early detection systems. Larger, prospectively designed studies are needed to distinguish true temporal change from sampling-related effects. Full article

Eye-tracking methodology represents a young but rapidly growing approach in tourism research, offering a direct window into the cognitive processes driving tourism stakeholders’ behaviour. However, a critical gap remains between the rapid adoption of this tool and the methodological rigour required to interpret its neurophysiological data. This critical review synthesizes 23 empirical studies (2020–2025) from the destination marketing and branding domain to diagnose eye-tracking’s state-of-the-art application. Adopting the SALSA framework (Search, Appraisal, Synthesis, Analysis) augmented by PRISMA 2020 guidelines, this study systematically searched Web of Science and Scopus databases. Studies were appraised using an eight-dimensional quality rubric, assessing from theoretical grounding to experimental design to statistical rigour. Findings revealed a “tool-first” exploratory phenomenon, where the majority of studies relied on basic fixation metrics to infer complex psychological states such as “interest”, when they could imply other cognitive states. Furthermore, most reviewed studies failed to control for stimulus-level confounds (e.g., luminance, AOI size) and utilized inappropriate data-handling procedures and methods, such as the absence of data cleaning and treating count and binary data as continuous data. These, coupled with transparency deficits, undermined the validity of their conclusions. Hence, a Checklist for Eye-Tracking Rigour (CETR) and a methodological decision tree were developed to guide researchers towards confirmatory and neurobiologically grounded research. Findings also provided a framework for managers/practitioners to more accurately interpret eye-tracking studies. Full article

Background and Objectives: Corneal allogeneic intrastromal ring segments (CAIRS) are designed to decrease and stabilize the extent of corneal ectasia in keratoconus patients. This systematic review and meta-analysis evaluate the effectiveness of different surgical techniques for CAIRS preparation and the adjunctive use of corneal cross-linking. Materials and Methods: Following the PRISMA statement and checklist, a comprehensive search was conducted in Embase, Medline, and the Cochrane Controlled Trials Register, through the use of a systematic search approach in accordance with the Cochrane Collaboration guidelines. Results: Eighteen studies, involving 567 eyes of 459 patients, met the inclusion criteria. At one month postoperatively, CAIRS implantation significantly improved uncorrected visual acuity (UCVA) (−0.45 logMAR, 95% CI [−0.59 to −0.31], p < 0.001) and best corrected visual acuity (BCVA) (−0.36 logMAR, 95% CI [−0.46 to −0.25], p < 0.001). These improvements remained significant after one year (UCVA: −0.39 logMAR, 95% CI [−0.48 to −0.30], p < 0.001; BCVA: −0.34 logMAR, 95% CI [−0.50 to −0.18], p < 0.001). Similarly, mean simulated keratometry (Kmean) decreased by −4.42 D (95% CI [−5.94 to −2.90], p < 0.001) and maximum keratometry (Kmax) by −3.88 D (95% CI [−6.71 to −1.05], p < 0.001) at one month, with sustained reductions at one year (−3.59 D, 95% CI [−4.35 to −2.84], p < 0.001 and −3.73 D, 95% CI [−4.91 to −2.55], p < 0.001). No significant differences in surgical outcome have been observed between the different surgical techniques. Conclusions: CAIRS implantation appears to be an effective treatment option for keratoconus, regardless of the technique used for segment preparation or the addition of corneal cross-linking. No approach demonstrated clear clinical superiority over others in the first year after surgery. Full article

Background: Post-traumatic stress disorder (PTSD) affects millions globally, with 40–50% of patients not responding adequately to first-line treatments. Prism neurofeedback, an FDA-cleared electroencephalography (EEG)-based system targeting amygdala-derived biomarkers, has demonstrated efficacy in randomized controlled trials (RCTs) and multicenter studies. Real-world implementation data from community clinical practice remain limited. Objective: To evaluate clinical outcomes and patient-developed self-regulation strategies of Prism neurofeedback in patients with PTSD in community clinical practice. Methods: Retrospective case series of 28 consecutive patients with PTSD treated with Prism neurofeedback in a community psychiatry practice. The primary outcome was change in PTSD Checklist for DSM-5 (PCL-5) from baseline to end of treatment. Results: Twenty-one of 28 patients (75.0%) completed treatment. Mean PCL-5 reduction was 37.0 ± 18.2 points (Cohen’s d = 2.03). Response rates were 100% for any improvement and 90.5% for clinically significant improvement (≥10-point reduction). Five patients (23.8%) achieved excellent response with ≥50-point reduction. Limited follow-up data (1–3 months post-treatment) were available for three patients; two of three (67%) exceeded their end-of-treatment gains. Four patients receiving booster sessions showed continued improvement. Limitations: The uncontrolled, retrospective design precludes causal attribution of improvements to the intervention versus placebo effects or regression to the mean. The 25% early discontinuation rate may introduce attrition bias. Durability data are available for only three patients. Conclusions: This case series provides real-world evidence supporting the feasibility and potential clinical utility of Prism neurofeedback in community practice, with outcomes comparable to controlled studies and preliminary evidence of durable treatment effects. These findings complement existing RCT evidence by demonstrating successful implementation outside research settings. Full article

Hygienic design of food processing equipment is essential for maintaining food safety by minimizing contamination risks and ensuring that equipment can be cleaned and sanitized effectively. This comprehensive cross-industry review summarizes currently available standards and guidelines for the hygienic design of food processing equipment and discusses how their qualitative requirements can be translated into practical assessment tools, such as checklists or risk-based approaches to prioritize nonconformities. Differences between wet and low-moisture operations, as well as the particular challenges of packaging and end-of-line equipment, are summarized to illustrate that practical implementation of hygienic design principles must be adapted to sector-specific hazards, processing conditions and cleaning strategies. Outbreaks and product recalls linked to equipment that is difficult to clean or poorly designed are included to show how design limitations can contribute to persistent contamination and food safety incidents. Full article

Background/Objective: Nursing students commonly use social networking sites during clinical practicums, and excessive use may interfere with their attention, performance, and training during clinical placements. However, the relationship between problematic social networking use, perceived stress, distraction, and self-management of activities during clinical practice among nursing students has not been explored in depth. The aim of this study was to analyze the relationship between problematic use of social networking sites, perceived stress, smartphone-related distraction, and self-management among nursing students during clinical practicums. Methods: A cross-sectional design was carried out. The sample consisted of 340 nursing students. Data were collected between September and November 2025 using a sociodemographic form, the WhatsApp Negative Impact Scale, Perceived Stress Scale, Distraction Smartphone Use during Clinical Practice Scale, and Self-Control and Self-Management Scale. The data were analyzed using SPSS 28. Regression analysis was performed to define the factor of the problematic use of social networks and the relationship between the scales. The STROBE Checklist was used when preparing the manuscript. Results: A positive relationship was found between problematic social networks use and perceived stress (p < 0.001) and distraction (p < 0.001), and there was a negative relationship with self-management (p < 0.001). A negative relationship was found between perceived stress and self-management (p < 0.001). After regression analysis, more problematic social network use consisted of those who spent more time daily using the smartphone (p < 0.001), had more distraction associated with smartphone use during clinical practicum (p < 0.001), had more perceived stress (p < 0.001), those whose last place performing the practicum was the hospital (p = 0.006), and those whose sex was male (p = 0.026). Conclusions: The results obtained from this study indicated an association between problematic Social networksuse and increased perceived stress and distraction, as well as decreased self-management activities during clinical practicum. In line with these findings, perceived stress was negatively associated with self-management; nursing students reporting lower perceived stress also reported a greater capacity for self-management of clinical activities. Full article