Search Results (9,099)

Background/Objectives: Spiritual care is a core component of holistic paediatric palliative care, yet nurses often feel insufficiently prepared to address the spiritual and existential needs of seriously ill children and their families. This systematic review aimed to explore nurses’ experiences of providing spiritual care to seriously ill and dying children in paediatric palliative care settings and to identify the factors that facilitate or hinder its provision. Methods: A systematic review was conducted in accordance with PRISMA 2020. CINAHL, PubMed, Web of Science and SAGE were searched for English-language qualitative, quantitative and mixed-methods studies published up to November 2025. Study quality was assessed using JBI critical appraisal checklists, and the findings were synthesised thematically following Thomas and Harden. Results: A total of 228 records were identified, of which ten studies met the predefined inclusion criteria. The thematic synthesis identified one overarching theme—nurses’ engagement with spirituality while caring for seriously ill and dying children—supported by two sub-themes: managing emotional responses and maintaining professional, family-centred support. Conclusions: Nurses recognise spiritual care as essential in paediatric palliative care but often lack the competence and institutional support to provide it consistently. Education should prioritise spiritual assessment, developmentally appropriate communication, ethical boundaries, reflective practice and structured debriefing. Full article

Background: Telemedicine complements traditional healthcare delivery and may improve access, continuity of care, and patient engagement, particularly in chronic conditions requiring regular follow-up. Video consultation is a widely adopted telemedicine modality and is increasingly integrated into hybrid care models. Methods: This real-world implementation project describes scheduled video consultations embedded in a hybrid care model for children and adolescents with type 1 diabetes using continuous glucose monitoring (CGM) and integrated insulin delivery technologies as part of routine clinical care. A total of 38 families were offered video consultations as part of routine care; 18 adopted the hybrid model. Video consultations were used for routine follow-up, shared review of device data, treatment adjustment, and diabetes education. Family experience was assessed using a voluntary 5-point Likert-scale satisfaction questionnaire. Complete longitudinal CGM data were available for 13 participants, all of whom were established users of the same automated insulin delivery (AID) platform (MiniMed™ 780G (Medtronic MiniMed, Inc. Minneapolis, MN, USA) integrated with Guardian™ 4 (Medtronic MiniMed, Inc. Minneapolis, MN, USA) continuous glucose monitoring). Results: Between 2022 and 2024, 162 video consultations were conducted. Acceptability was high, with 95% (17/18) of respondents reporting high satisfaction (score ≥ 4 on the 5-point Likert scale). 89% (16/18) of families perceived the quality of care as comparable to face-to-face visits for routine follow-up. Families highlighted convenience, reduced travel burden, and flexibility, as well as the value of shared review of CGM and AID system data. Group-level CGM-derived metrics appeared descriptively similar across sequential face-to-face visits and video consultations. Individual patient trajectories showed expected variability but no consistent pattern of deterioration during periods of remote follow-up. Conclusions: Video consultation is a feasible and well-accepted complementary modality within hybrid care models for pediatric type 1 diabetes. When integrated with CGM and automated insulin delivery systems, it supports personalized, data-driven clinical decision-making and continuity of care. Structured implementation and systematic evaluation are essential for sustainable integration into routine practice. Full article

Universities increasingly compete through value propositions, service processes, and communication ecosystems rather than through program supply alone. Yet evidence remains limited on how students’ perceptions of the educational marketing mix are associated with satisfaction in non-metropolitan higher education settings in Latin America. This study examines a private university branch campus in a Latin American emerging economy using a quantitative, cross-sectional, non-experimental design and a probabilistic stratified sample of 287 complete student responses. Educational marketing was operationalized as students’ perceived evaluation of the educational marketing mix—product, price, place, and promotion—whereas satisfaction was measured with SERVQUAL-informed, performance-oriented service-evaluation items. The findings show a strong positive association between the perceived educational marketing mix and student satisfaction, with promotional communication emerging as the most closely related dimension. Descriptively, both constructs were concentrated at intermediate levels, indicating an acceptable but non-distinctive institutional experience and pointing to service weaknesses in security, empathy, and responsiveness. The article contributes by problematizing the use of marketing-mix logic in higher education, clarifying that satisfaction is not a proxy for educational quality or belonging, and showing how perceived value communication and service delivery are connected with students’ satisfaction judgments in an emerging-economy context. Full article

The ultimate goal of integrating artificial intelligence into education is to ensure the long-term stability, quality, and sustainability of the educational process, turning it into a tool that consistently improves teaching and learning. Yet its sustainable and responsible integration depends largely on a positive mindset and the pedagogical willingness of future teachers. This study examines the attitudes and readiness of pre-service teachers, specializing in preschool, primary, and subject-specific science education, toward AI integration, with a specific focus on sustainable science education and Green Lab concepts. A mixed-methods study was conducted on a sample of 251 students from the University of Split. Data were analyzed using exploratory factor analysis, standard and Welch ANOVA with Tukey’s HSD and Games–Howell post hoc tests, and multiple linear regression in IBM SPSS 20, and qualitative content analysis. The findings reveal perceived usefulness as a primary driver of AI acceptance across all groups. Science students demonstrated the highest levels of ethical and critical sensitivity but provided the lowest ratings for AI’s practical application in sustainable science education, expressing cautious attitudes and distinct concerns about system reliability. However, no significant difference was found between students with and without a science background in regard to AI’s potential to facilitate sustainable scientific concepts. Furthermore, behavioral analysis demonstrated that even initial, occasional exposure to AI tools significantly boosted students’ perceptions of its utility and sustainable application compared to non-users, whereas increasing the frequency of use resulted in no additional gains. The transition toward sustainable science education requires moving beyond technical literacy toward a comprehensive framework that integrates pedagogical usefulness with ethical responsibility and sustainable scientific application. Future studies should explore potential models that combine the methodological creativity of pre-service educators and teachers with the analytical rigor of science students. Ultimately, this research underscores that an educational policy must integrate digital advancements while strictly maintaining ethical standards and the essential role of human supervision. Full article

Artificial intelligence is rapidly changing education. However, many learning chatbots are still reactive tools, which respond to arbitrary questions without leading learners through a meaningful pedagogical journey. This article presents a deterministic state-machine orchestrator coupled with a local large language model and a knowledge-graph-framed tutoring strategy for personalized education. The proposed virtual tutoring agent is designed to combine the flexibility of conversational AI with the reliability of explicit instructional states, key performance indicator (KPI) tracking, learner profiling, and controlled transitions between explanation, practice, feedback, assessment, and remediation. The system is not meant to replace the teacher, but rather to act as a teaching co-pilot that provides ongoing feedback, personalized learning paths, accessibility, and safer deployment by processing data locally. The study also presents a compact interview-based evaluation framework and statistical analysis of user perceptions across interactivity, individuality, proactivity, security, accessibility, gamification, and global preference for educational agents over classical chatbots. The findings show that learners appreciate personalized and interactive support and that proactivity is the key feature that distinguishes an educational agent from a regular chatbot. With this article we argue that deterministic orchestration can help make AI tutoring more transparent, controllable, and ethically fit for real learning contexts. Finally, it discusses privacy, educational value, limitations and future improvements to be made before the large-scale adoption of such systems. Full article

Background: Problematic smartphone use may threaten student well-being, especially among nursing students who rely on smartphones for academic and clinical activities. This study estimated potential problematic smartphone use among Greek nursing students, examined its association with quality of life (QoL), and explored whether contextual factors modified these associations. Methods: A cross-sectional study was conducted among 331 nursing students in Greece from September to November 2025. Participants completed an anonymous online questionnaire including sociodemographic data, the Smartphone Addiction Scale–Short Version (SAS-SV), and the World Health Organization Quality of Life–BREF (WHOQOL-BREF). Results: The mean SAS-SV score was 29.30 ± 9.69, and 18.9% of students screened positive for potential problematic smartphone use. Mean overall QoL and general health satisfaction were 3.80 ± 0.78 and 3.97 ± 0.88, respectively. Higher SAS-SV scores were associated with lower physical, psychological, and environmental QoL, but not with social QoL. Years of study moderated only the association with environmental QoL. Conclusions: Problematic smartphone use was associated with poorer physical, psychological, and environmental QoL among Greek nursing students. These domain-specific findings extend existing evidence and support integrating digital well-being, self-regulation, and sleep-hygiene strategies into nursing education and student-support services. Full article

Ornamental aquarium keeping collectively involves millions of freshwater, marine, and reef systems in which fish, corals, invertebrates, biofilters, microbial communities, and human husbandry practices are closely interconnected. In these domestic aquatic animal systems, preventive and curative treatments may include antimicrobials, antiparasitics, antiseptics, oxidizing agents, copper-based products, dips, and commercial formulations targeting microbial proliferations or visible system deterioration. Many interventions occur without veterinary diagnosis, microbiological confirmation, standardized dosing, active-ingredient transparency, or post-treatment monitoring. This raises concerns for aquatic animal health and welfare, as whole-system treatments may affect not only the intended pathogen or pest but also non-target organisms, biofilter communities, animal-associated microbiota, and water quality stability. Digital communities and online platforms can rapidly circulate empirical treatment protocols, although they may also provide opportunities for stewardship education and improved husbandry guidance. Current evidence does not support interpreting ornamental aquaria as major independent drivers of antimicrobial resistance. The more defensible concern is stewardship: biologically active compounds may be used repeatedly and empirically in animal systems without diagnosis, professional guidance, or systematic monitoring. This Perspective argues that ornamental aquaria should be recognized as an overlooked interface between aquatic animal health, welfare, antimicrobial stewardship, and One Health. It proposes a research and communication agenda focused on treatment transparency, diagnosis, prevention, biofilter protection, and responsible care practices. Full article

This study examines university students’ perceptions of how artificial intelligence (AI) tools influence creativity in Digital Media coursework at an Egyptian university, addressing the underrepresentation of non-Western and non-STEM contexts in AI-in-education research. A convergent mixed-methods design was used with 103 undergraduate students enrolled in a Visual Communication course. Data were collected through an online questionnaire comprising a 24-item Likert-scale battery (Cronbach’s α = 0.94) and four open-ended prompts. Because creativity was measured through perception rather than objective performance, the findings are interpreted as students’ subjective appraisals rather than as evidence about the originality or quality of their creative products. A four-item Perceived Creative Support subscale (α = 0.82) was positively associated with overall learning satisfaction (r = 0.33, p < 0.001), while remaining independent of prior AI familiarity. However, it was significantly related to comfort with new technology (r = 0.35, p < 0.001) and moderate AI use intensity. Reflexive thematic analysis identified five themes: task efficiency, academic support, creative stimulation, information access, and concerns about overreliance and authenticity. Students mainly framed creativity in functional terms, including ideation structure, speed, and organization. The study positions AI as a perceived cognitive scaffold and discusses implications for pedagogy, assessment design, and academic integrity in creative disciplines. Full article

This systematic narrative review synthesizes 42 distinct sources including peer-reviewed journal articles, selected conference papers, and policy documents to examine the role of knowledge management (KM) processes in Saudi higher education accreditation, with specific focus on the National Center for Academic Accreditation and Evaluation (NCAAA) standards. Drawing on literature published between 2005 and 2025, the review investigates how KM frameworks, including Nonaka and Takeuchi’s SECI model (socialization, externalization, combination, and internalization), may be associated with accreditation outcomes in Saudi universities. The reviewed literature suggests an association between systematic KM approaches and more effective accreditation processes; causal conclusions are not warranted given the observational and case study nature of the evidence base. Certainty of the overall evidence body is rated as low to moderate. The study reveals significant challenges, including information decentralization, inadequate training, resistance to change, and the absence of dedicated governance structures that appear to impede effective knowledge transfer during accreditation processes. A secondary sustainability coding pass identified associations between KM-driven accreditation practices and institutional sustainability, environmental sustainability, and alignment with SDG 4 (Quality Education) and SDG 16 (Strong Institutions); these findings are hypothesis-generating rather than confirmatory. It should be noted that all screening and data extraction were conducted by a sole reviewer; a post hoc validation exercise achieved Cohen’s kappa = 0.81 (95% CI: 0.72–0.90) for inclusion/exclusion decisions, providing retrospective assurance of acceptable consistency. This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Full article

Background and Objectives: Persistent human papillomavirus (HPV) infection is associated with the development of cervical intraepithelial neoplasia and cervical cancer. In women with low-grade cervical lesions, a conservative management approach is commonly recommended. However, a subset of patients may experience lesion progression, which can also be accompanied by psychological distress. Adjuvant therapies during the surveillance period have gained increasing clinical interest. This consensus aims to provide multidisciplinary, expert-based recommendations on the use of a Coriolus versicolor-based vaginal gel in HPV-positive women with low-grade cervical lesions. Materials and Methods: A rapid systematic review was conducted in accordance with PRISMA guidelines, and the level of evidence was assessed using SIGN criteria. Subsequently, a multidisciplinary panel of experts formulated and evaluated consensus statements and recommendations using the nominal group technique and a voting process. Results: All statements reached consensus, with agreement levels exceeding 80%. Experts concluded that available evidence reports potential benefits of a Coriolus versicolor-based vaginal gel in HPV-positive women with low-grade cervical lesions, since it has demonstrated increased lesion regression and viral clearance rates. These benefits may be more pronounced in specific subgroups, particularly women over 40 years of age. Limited studies also suggest a positive effect on vaginal microbiota, which may contribute to both vaginal health and HPV clearance, as well as a reduction in perceived stress. The experts emphasized the importance of patient education, shared decision-making, and addressing psychosocial aspects, including emotional well-being and sexual health. Conclusions: This consensus provides a multidisciplinary perspective on the management of HPV-positive women with low-grade cervical lesions, highlighting the adjuvant role of a Coriolus versicolor-based vaginal gel during surveillance. Although current evidence suggests potential clinical benefits, further high-quality, independent studies are needed to corroborate these findings. Full article

Background/Objectives: Oral diseases affect around 3.5 billion people worldwide and remain a major public health burden. Adolescence represents a critical stage for establishing lifelong oral health behaviours, particularly given the widespread use of smartphones in this age group. This review aimed to synthesise available evidence on the use of mobile health (mHealth) applications to promote oral health among adolescents, identify app features, evaluate their efficacy in improving oral health outcomes and behaviours, and explore barriers and challenges to their use. Methods: A comprehensive review was conducted across PubMed, Scopus, the Cochrane Library, and Web of Science. Studies published between 2010 and 2025 in English, Portuguese, or Spanish that evaluated oral health apps targeting adolescents were included. Data were extracted regarding study design, sample characteristics, app features, clinical and behavioural outcomes, and barriers to app use. Methodological quality was assessed using RoB 2, ROBINS-I, and the JBI checklist, as appropriate. Results: Twenty-five studies met the inclusion criteria, comprising 19 randomised controlled trials, 3 qualitative studies, and 3 non-randomised trials. Common app features included educational content, brushing timers, reminders, gamification, and communication with professionals. Most studies demonstrated improvements in plaque and gingival indices, brushing frequency, and oral health knowledge, particularly when apps incorporated behaviour change techniques. However, long-term adherence, usability issues, and lack of regulation remain major limitations. Conclusions: mHealth applications show promise as complementary tools for promoting oral health in adolescents. Their success depends on sustained engagement, evidence-based content, user-centred design, and integration with traditional preventive approaches. Full article

Background: In-hospital falls are common adverse events associated with injuries, functional decline, prolonged length of stay, and increased healthcare costs, which require effective and sustained nursing interventions. Objective: To identify, through a Systematic Literature Review, which nursing care interventions are effective in reducing the incidence/rate of falls among inpatients in hospital settings. Methods: A systematic literature review was conducted using the JBI methodology. The review was guided by the PICO framework (P: inpatients; I: nursing care interventions; C: usual care; O: incidence of accidental falls). A comprehensive search was performed in the MEDLINE, CINAHL, and Scopus databases. Studies were included if they evaluated nursing-led or nursing-related interventions aimed at fall prevention and reported fall-related results. Eligible study designs included randomized controlled trials, quasi-experimental studies, observational studies, and quality improvement initiatives. Study selection, data extraction, and critical appraisal were conducted according to JBI recommendations. Results: Six studies were included (quasi-experimental, cohort, prospective/observational, and quality improvement projects). Two main themes emerged: (1) structured multifactorial and educational interventions and (2) technology-based interventions. Multifactorial approaches that combine risk assessment, education, communication, and environmental measures have been shown to improve adherence and reduce falls. Technology-based interventions, especially video monitoring, showed the most consistent reductions in fall rates, including fewer nighttime falls and decreased need for one-to-one observation. The included studies were methodologically heterogeneous in design, clinical setting, and outcome definitions, which precluded statistical pooling and warrants caution in the interpretation of the findings. Conclusions: Structured, standardized, multifactorial, and nursing-led approaches can contribute to reducing inpatient falls. However, more robust and comparable studies are required to consolidate practice-relevant recommendations. Full article

This cross-sectional study assessed bulk-tank raw milk quality, subclinical mastitis burden, and farmers’ health management practices across 83 sheep and goat farms in the Epirus Region of northwestern Greece (October 2022–April 2023). Bulk-tank milk composition (fat 5.82%, protein 5.35%, lactose 4.82%) was consistent with Mediterranean small-ruminant norms. Mean somatic cell count (SCC) was 1123 ± 913 × 10³ cells/mL (median 883 × 10³); only 10.0% of farms met the healthy threshold (SCC ≤ 200 × 10³ cells/mL) and 26.2% exceeded the EU limit of 1500 × 10³ cells/mL (Regulation EC No 853/2004). SCC correlated positively with total bacterial count (Spearman ρ = 0.549, p < 0.001). Farmers were predominantly middle-aged (50.0 ± 11.8 years), exclusively male, and had low levels of formal education (9.0% university-educated); only 14.3% had regular veterinary support, and 34.9% practised post-milking teat dipping. Despite 51.3% self-reporting mastitis, no management or demographic variable was significantly associated with SCC after Bonferroni correction; education showed the strongest trend (Kruskal–Wallis H = 9.13, p = 0.058). The findings reveal widespread, largely undiagnosed subclinical mastitis driven by structural gaps in veterinary support, education, and hygiene practice, with direct implications for animal health and targeted advisory intervention. Full article

Background: In older adults, multimorbidity and polypharmacy complicate medication regimens and often lead to poor adherence. Mobile health (mHealth) has been suggested as a solution to enhance medication adherence in chronic conditions. Despite the increase in smartphone usage among people aged 65 and over, there is still a lack of evidence of mHealth in this age group. Objectives: To evaluate the impact of mHealth interventions on medication adherence in older adults (≥65 years) with chronic diseases, compared with standard care or other interventions. Methods: The review was conducted in accordance with PRISMA 2020 guidelines and the Cochrane Handbook for Systematic Reviews. Randomized controlled trials published from 2000 onwards were considered with no linguistic or geographical restrictions. The databases searched included PubMed, Scopus, Cochrane Library, and CINAHL. Methodological quality was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. Results: 551 records were initially identified, from which 8 randomized controlled trials published between 2014 and 2025 were included. Six of eight studies showed that medication adherence in mHealth groups was significantly higher than in controls. However, one study found benefits only in specific drug classes rather than a general improvement. Conclusions: The results of this review suggest that mHealth has the potential to improve medication adherence among older adults with chronic diseases, especially when interventions go beyond simple reminders and incorporate educational and relational components. Nevertheless, higher quality studies with larger samples and longer follow-up are needed to clarify mHealth’s role in the care of this population. Full article

The cultivation of high-quality talents relies on the synergistic interaction of various educational stakeholders, including schools, families, and society, within the educational system. With the rapid advancement of artificial intelligence (AI) technology, new opportunities have emerged for constructing and optimizing collaborative education mechanisms. Based on a feature-rich and large-scale real dataset, this paper conducts a case study to explore novel approaches for leveraging AI to empower a cooperative education system. Specifically, correlation and association analysis methods from traditional statistics are first employed to quantify pairwise feature relationships, providing a basis for identifying key factors influencing student development. Subsequently, principal component analysis (PCA) is applied to extract dominant components from the dataset, assess the intrinsic information carried by each feature, and uncover latent relationships among features. Finally, leveraging the multi-source and heterogeneous nature of the cooperative education system, a novel multi-branch neural network model (MBDNN) is proposed to achieve accurate prediction of student academic performance. This study can provide reference and methodological support for effectiveness evaluation and decision-making within the cooperative education system. Full article