Search Results (941)

Background: Candidozyma auris (C. auris) is an emerging multidrug-resistant yeast associated with healthcare-related transmission, difficult laboratory identification, antifungal resistance, and high mortality in critically ill patients. This study aimed to describe the clinical and microbiological characteristics of early institutional C. auris cases detected in a tertiary hospital in Istanbul, Türkiye. Methods: Adult patients hospitalized between January 2021 and December 2022 with C. auris isolation were retrospectively reviewed. Demographic data, underlying conditions, intensive care unit (ICU) exposure, invasive procedures, antimicrobial and antifungal use, culture sources, antifungal susceptibility testing (AFST) results, and clinical outcomes were evaluated. C. auris isolates were identified using VITEK MS v.3.2, and AFST was performed using C. auris isolates were identified using VITEK MS v.3.2, and AFST was performed using Sensititre YeastOne YO10 (Thermo Fisher Scientific, Waltham, MA, USA) panels. Results were interpreted according to CDC interim breakpoints. Multiple isolates from an individual patient were retained when they represented different specimen types or sampling events. Results: Thirty-three adult patients and 62 clinical isolates were included. The mean age was 67.8 years, and 20 patients (60.6%) were aged 65 years or older. Most patients had prior ICU admission (93.9%), urinary catheterization (97.0%), central venous catheterization (90.9%), mechanical ventilation (81.8%), and broad-spectrum antimicrobial exposure. Blood cultures represented the most frequent source of isolation (56.5%), followed by urine cultures (27.4%). Resistance rates were 98.4% for amphotericin B, 88.7% for fluconazole, 6.6% for micafungin, and 6.5% for caspofungin. Overall mortality was 72.7%. While mortality was numerically higher among patients aged 65 years or older and those requiring inotropic support, only the need for mechanical ventilation was statistically significantly associated with mortality. The cohort-level APACHE II-based expected mortality was 48.0%, whereas observed mortality was 72.7%; this comparison was descriptive and no formal calibration analysis was performed. Conclusions: Early institutional C. auris cases in this tertiary hospital occurred predominantly among elderly, critically ill patients with prolonged healthcare exposure, invasive devices, and extensive antimicrobial use. The findings support the need for early laboratory recognition, cautious interpretation of commercial AFST results, particularly given the propensity of Sensititre YeastOne to overestimate amphotericin B resistance, strengthened infection control practices, and multicenter studies incorporating molecular typing to clarify transmission dynamics and antifungal resistance patterns. Full article

Frailty syndrome and Alzheimer’s disease are prevalent conditions in the elderly that are associated with aging, decreased quality of life, and a significant healthcare burden. Evidence for a relationship between physical frailty and neurodegenerative decline is accumulating. This study analyzed two independent datasets, a frailty dataset based on gait and mobility parameters and an AD dataset with clinical, functional and lifestyle variables, in order to evaluate and compare their classification performance using machine learning. Features were optimized using dimensionality reduction techniques to keep predictors of clinical significance and hyperparameter optimized Random Forest models were built to develop the best model. Evaluation was performed with Accuracy, F1-score, Matthews Correlation Coefficient and Area Under the Curve. The results showed that the models constructed on the whole AD dataset achieved maximum predictive power with an accuracy of 0.946, which was slightly increased to an accuracy of 0.948 after the selection of significant features. Diagnostic models based on frailty were able to demonstrate an ACC predictive capacity of 0.6418, and in terms of feature selection, improvements appeared in all indicators. Regarding the features derived from Alzheimer’s disease associated with geriatric frailty, they managed to surpass the ACC frailty features of 0.741 alone, suggesting some intercalation mechanisms between neurodegeneration and physical vulnerability. These findings show that machine learning algorithms accompanied by feature selection improve clinical discrimination and prediction of frailty and neurodegenerative disorders, which offers a promising aspect for geriatric assessment. The frailty models analyzed demonstrated an ACC predictive capacity of 0.6418, even though feature selection improved all indicators. Alzheimer’s disease-derived features associated with frailty outperformed features in the frailty dataset with an ACC of 0.741, suggesting the mechanism of overlap between neurodegeneration and physical vulnerability. These results support the theory of a motor-cognitive aging continuum, indicating that algorithmic machine learning techniques coupled with feature selection mainly provide computational validation for the biological intersection of neurodegeneration and physical frailty, rather than forming an independent predictive clinical model. Using these algorithms the study highlights shared pathophysiological mechanisms, providing a significant insight into systemic geriatric deterioration. Full article

Urban–rural public facility disparity is a systemic challenge that reflects dysfunctional feedback loops within and across social and technical subsystems. Traditional administrative-unit-based analyses cannot capture such systemic alignments. This study applies the marker-controlled watershed segmentation (MWS) algorithm, the Two-Step Floating Catchment Area (2SFCA) method, and spatial clustering methods sequentially to dynamically separate urban from rural areas and assess the urban–rural disparity in public facility provisions within the Chengdu–Chongqing economic circle (CCEC). The results indicate: (1) The distribution of public facilities in the CCEC is characterized by significant spatial inequity, predominantly manifested as a substantial disparity between urban and rural areas. (2) A significant misalignment exists between the supply of public facilities and the demands of vulnerable groups. Rural residents, low-income groups, and elderly people are at a disadvantage in accessing public facilities. (3) Rural residents are concentrated in low-income areas and have the most limited ability to obtain public facility services and resources, especially in terms of healthcare facilities. By replacing predefined administrative boundaries with image-derived functional urban–rural patches, the proposed framework enables a more spatially realistic assessment of urban–rural public facility disparities. This approach provides a transferable tool for system-level decision-making in regional planning, particularly for targeting resource allocation in underserved areas. Full article

Background/Objectives: Non-communicable diseases (NCDs), including cardiovascular disease and diabetes, present an increasing challenge in humanitarian settings. While healthcare services in refugee camps have traditionally prioritised acute and communicable diseases, the long-term management of chronic conditions remains difficult, particularly among older adults. This study explored healthcare providers’ perspectives on barriers to cardiovascular disease and diabetes care among elderly Rohingya refugees living in Cox’s Bazar, Bangladesh. Methods: A qualitative study was conducted using semi-structured interviews with six physicians working in Rohingya refugee camps in Cox’s Bazar, Bangladesh. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Three overarching categories of barriers were identified: service delivery barriers, physical and environmental barriers, and socio-cultural barriers. Healthcare providers described limited diagnostic capacity, restricted medication availability, fragmented continuity of care, transport difficulties, challenging camp terrain, language barriers, low health literacy, and reliance on informal healthcare providers as key challenges affecting long-term management of cardiovascular disease and diabetes. These interconnected barriers were perceived to reduce healthcare access and continuity of care for elderly Rohingya refugees. Conclusions: The findings suggest that humanitarian healthcare systems should strengthen long-term management of non-communicable diseases among ageing refugee populations. Improving diagnostic capacity, ensuring reliable access to essential medicines, enhancing continuity of care, and supporting culturally appropriate health education and outreach services may improve chronic disease management in humanitarian settings. Further research exploring the perspectives of elderly Rohingya refugees is needed to complement healthcare provider perspectives. Full article

Background: Acinetobacter baumannii is an important opportunistic pathogen responsible for healthcare-associated infections, particularly among critically ill, intensive care unit (ICU), and post-surgical patients. The emergence of carbapenem-resistant A. baumannii (CRAB) has become a major therapeutic challenge worldwide because of its multidrug-resistant nature and limited treatment options. Despite the increasing prevalence of CRAB in Pakistan, information regarding the molecular characterization of carbapenem resistance genes among isolates recovered from surgical site infections (SSIs) remains limited. Methods: A cross-sectional study was conducted from November 2023 to February 2024 at Khalifa Gul Nawaz Hospital, Bannu, Khyber Pakhtunkhwa, Pakistan. A total of (n = 118) surgical wound specimens were collected from patients with clinically diagnosed SSIs. A. baumannii isolates were identified using standard biochemical tests and confirmed by 16S rRNA gene sequencing. In vitro antimicrobial susceptibility was determined by Kirby–Bauer disk diffusion according to CLSI 2024 guidelines. In addition, the concentration-dependent inhibition-zone response of imipenem and meropenem against carbapenem-resistant isolates was evaluated using an agar well diffusion assay. Molecular detection of blaNDM-1 and blaOXA-23 was performed by polymerase chain reaction (PCR), and representative amplicons were subjected to Sanger sequencing for further analysis. Results: In the current study, the total number of (n = 118) wound specimens from healthcare-associated patients were processed, in which A. baumannii-positive isolates (n = 23, 19.5%) were documented. Its prevalence was higher in males (69.6%) compared to females, and was strongly associated (78.2%) with elderly patients (aged 51–68 years). In vitro susceptibility testing revealed that 91.3% of isolates harbored multidrug-resistant (MDR) attributes. Antimicrobial susceptibility profiling revealed high levels of multidrug resistance, with 82.6% of isolates resistant to imipenem and meropenem, as well as 100% resistance to aztreonam and gentamicin. Colistin showed the highest activity, with 87.0% of isolates remaining susceptible. In the agar well diffusion assay, measurable inhibition of the carbapenem-resistant isolates by imipenem and meropenem occurred only at higher concentrations. Molecular screening of resistance genes identified blaOXA-23 in 60.9% and blaNDM-1 in 30.4% of isolates. Co-expression of both genes was detected in some (n = 4) isolates. Among the selected MDR isolates included in the gene resistance analysis, imipenem and meropenem resistance were recorded in 9/14 blaOXA-23-positive isolates and 5/7 blaNDM-1-positive isolates. Conclusions: This study substantiates an escalated incidence of carbapenem-resistant, MDR A. baumannii in post-surgical infections. blaOXA-23 were documented as the predominant carbapenemase gene, with co-expression of blaNDM-1 in a substantial proportion of isolates. These findings provide an important phenotypic and molecular characterization of selected carbapenemase genes in healthcare-associated infections, highlighting the exigency for strengthened antimicrobial stewardship and infection control strategies in the hospitals of the region. Full article

Objective: Varicella zoster virus (VZV), a member of the Herpesviridae family, is known as the causative agent of chickenpox (varicella). Following primary infection, VZV can remain latent for life and may reactivate over time to cause herpes zoster (shingles). Advanced age, immunodeficiency, and certain chronic illnesses are major risk factors for the development of herpes zoster. To prevent herpes zoster, a live zoster vaccine was licensed in 2006, followed by a recombinant zoster vaccine with higher efficacy in 2018. In Türkiye, the recombinant zoster vaccine was licensed in 2024. Raising awareness among healthcare workers is important both for their own health and the safety of vulnerable patients. This study aimed to evaluate healthcare workers’ knowledge and awareness of herpes zoster infection and zoster vaccines across the country, as well as to determine the prevalence of prior herpes zoster infection among them. Methods: After obtaining ethical approval, a nationwide multicenter survey was conducted. A questionnaire was distributed to healthcare workers via an online link. Participation was entirely voluntary. The survey collected demographic information (age, sex, profession, years of experience) and included questions on knowledge of herpes zoster, history of zoster infection, symptoms and severity (if applicable), awareness of the zoster vaccine, and vaccination attitudes. Results: A total of 5180 healthcare workers participated, of whom 3505 were female. The participants ranged in age from 18 to 79 years (mean age: 34.24 ± 11.52). Regarding professions: 47.9% were physicians, 21.3% were nurses or midwives, 0.8% were dentists or dental technicians, and 30% were from other healthcare professions. Among participants, 54.4% had ≤10 years of professional experience, 20% had comorbidities, and 10.5% were using immunosuppressive medications. It was found that 9.6% had previously had herpes zoster, 8.8% had no knowledge of the disease, 39.6% were aware of the vaccine, and 20.1% were unwilling to pay for vaccination. Multivariate binary logistic regression analysis revealed that being a physician significantly increased the likelihood of having correct knowledge by 1.961 times compared to other professions (p < 0.001, CI: 1.608–2.392). Similarly, those who had heard of herpes zoster were 3.191 times more likely to answer correctly than those who had not (p = 0.011, CI: 1.650–6.172). Male gender was significantly associated with a lower likelihood of having accurate knowledge compared to females (p = 0.001, OR = 0.720, CI: 0.594–0.874). Conclusions: This study revealed that healthcare workers’ knowledge and awareness regarding herpes zoster and its vaccines are generally insufficient. The recent licensing of the vaccine in Türkiye may explain this, but it is critical for healthcare professionals to be more informed about risk groups and vaccination indications in order to enhance the effectiveness of preventive healthcare services. Given the potential for serious complications of herpes zoster in elderly and immunocompromised individuals, the importance of vaccination should be emphasized more strongly to healthcare workers. Furthermore, the finding that 20.1% of those aware of the vaccine were deterred by its cost highlights the need to improve vaccine accessibility. Economic barriers preventing healthcare workers from being vaccinated emphasize the importance of making the vaccine widely available through public support to protect both healthcare workers and patient safety. Full article

Background/Objectives: 23-valent pneumococcal polysaccharide vaccine (PPV23) effectiveness against community-acquired pneumonia (CAP) remains controversial, with critical gaps in low-coverage settings and beyond 5 years post-vaccination. We estimated real-world PPV23 effectiveness against CAP hospitalization and characterized its duration among elderly adults in a low-coverage region. Methods: A multicenter matched case–control study was conducted across 14 hospitals in Eastern China (2018–2022). Cases were patients aged ≥60 years hospitalized with clinically diagnosed CAP. Up to three controls per case were matched on sex, age (±3 years), admission date (±5 days), hospital, and residential community. Conditional logistic regression estimated vaccine effectiveness (VE), adjusting for chronic comorbidities and healthcare utilization. Results: Among 6645 cases and 15,806 controls, 5-year PPV23 coverage was 2.14% (cases) and 2.76% (controls). PPV23 was associated with a 22.5% reduction in CAP hospitalization (adjusted VE = 22.5%, 95% CI: 4.1% to 37.3%). Protection was concentrated in non-severe CAP (adjusted VE = 25.7%, 95% CI: 7.0% to 40.7%), with no significant effect in severe CAP (adjusted VE = −11.7%, 95% CI: −115.1% to 42.0%). Extending the exposure window to 6 years yielded no significant VE (adjusted VE = 17.3%, 95% CI: −1.8% to 32.8%). Conclusions: PPV23 provides meaningful protection against CAP hospitalization in elderly adults in low-coverage settings, only for non-severe disease. Waning efficacy beyond 5 years supports revaccination at that interval. Full article

Background/Objective: With the rapid ageing of the global population, promoting mental health and well-being among older adults has become a key priority for healthcare systems. Social support is widely recognized as an important social determinant of health; however, the underlying psychological mechanisms through which it influences well-being in community-dwelling older adults remain insufficiently understood. This study aimed to examine the association between social support and subjective well-being among community-dwelling older adults in urban China and to determine whether psychological resilience mediates this relationship after adjusting for key sociodemographic factors. Methods: A cross-sectional study was conducted between May and July 2023 among 1227 older adults aged ≥ 65 years in three urban communities in Dongguan, China. Stratified cluster sampling was applied. Social support was assessed using the Lubben Social Network Scale (LSNS-6), psychological resilience using the Connor–Davidson Resilience Scale (CD-RISC-10), and well-being using the Elderly Well-Being Scale (EWBS). Pearson correlation and mediation analyses (PROCESS Model 4 with bootstrap resampling) were performed to examine the relationships among variables, adjusting for key sociodemographic factors. Results: A significant positive correlation emerged between social support and well-being (r = 0.410, p < 0.01), with psychological resilience exhibiting an even stronger correlation with well-being (r = 0.573, p < 0.01). Mediation analyses showed that psychological resilience partially mediated the social support–well-being relationship (indirect effect = 0.324, 95% CI: 0.262–0.391), explaining 38.5% of the total effect. Higher educational attainment and stable economic security (e.g., pension coverage) were significantly associated with better well-being outcomes. Conclusions: These findings suggest that social support is associated with better well-being both directly and indirectly through psychological resilience. From a healthcare perspective, community-based interventions that strengthen social networks and improve psychological resilience may represent effective strategies for promoting healthy ageing. Integrating psychosocial support and resilience-building programs into primary care and community health services could contribute to improving mental health and quality of life in ageing populations. Full article

Background/Objectives: Intraoperative hypotension (IOHs) affects up to 87% of patients under general anesthesia and is consistently associated with acute kidney injury, myocardial damage, stroke, and mortality. The intermittent unavailability of ephedrine across healthcare systems underscores the need for evidence-based alternatives. This review critically evaluates pharmacological options for IOH when ephedrine is unavailable, focusing on receptor pharmacodynamics, population-specific evidence, and clinical consequences of inadequately managed hypotension. Methods: A narrative, evidence-based review was conducted examining mechanisms of action, dosing strategies, adverse effect profiles, and clinical applicability of key vasoactive agents: ephedrine, phenylephrine, norepinephrine, and epinephrine. Population-specific evidence across obstetric, pediatric, and elderly cohorts was synthesized from randomized controlled trials, meta-analyses, and observational studies. The clinical impact of IOH on neurological, cardiovascular, and renal outcomes was reviewed. Results: Each vasopressor exhibits a distinct receptor-selectivity profile that determines its hemodynamic effect and optimal clinical context. Norepinephrine’s favorable α1/β1 balance tends to preserve cardiac output better than pure α1-agonists and has emerged as a promising alternative in obstetric and elderly populations, although the optimal agent ultimately depends on the underlying mechanism of hypotension and individual patient characteristics. Epinephrine provides combined vasopressor and inotropic support for hypotension with myocardial depression. IOH is associated with a greater than twofold increase in postoperative AKI and significantly elevated risks of myocardial infarction and stroke, with outcomes driven by cumulative hypotensive exposure rather than isolated pressure nadirs. Conclusions: Effective management of IOH requires individualized vasopressor selection guided by underlying pathophysiology, cardiovascular profile, and surgical context. A physiology-based strategy—rather than protocol-driven drug substitution—enables anesthesiologists to achieve precise hemodynamic control and preserve end-organ perfusion even when ephedrine is unavailable. Full article

The association of atrial fibrillation (AF) and neck of femur fractures (NOF) are common in old people, creating a complex clinical scenario with significant implications for morbidity, mortality, and healthcare systems. This narrative review explores the bidirectional relationship between AF and NOF, focusing on shared risk factors, pathophysiological links, and challenges in clinical management, and also reviews the benefit of an orthogeriatric model. Advanced age, frailty, osteoporosis, polypharmacy, and cardiovascular comorbidities predispose patients to both conditions, while AF itself increases fall risk through haemodynamic instability, syncope, and adverse effects of rate- or rhythm-controlling medications. Importantly, the physiological stress of hip fracture and subsequent surgery can precipitate new-onset or worsening AF via inflammatory, neurohormonal, and metabolic mechanisms. The main challenge for ortho-geriatricians lies in anticoagulation management and preoperative and postoperative management. While anticoagulation reduces thromboembolic risk in AF, it increases perioperative bleeding risk in patients with NOF, often leading to delays in surgery that are independently associated with poorer outcomes. This review examines the current evidence regarding perioperative anticoagulation strategies, timing of surgery, and postoperative resumption of therapy. In addition, the review examines important outcome parameters such as mortality, stroke, bleeding, length of hospital stay, and functional recovery. This highlights the importance of not only improving multidisciplinary care involving orthopaedics, cardiology, geriatrics, and anaesthesia to optimise outcomes, but also enhancing risk stratification. Standardised perioperative pathways and integrated geriatric–cardiac assessment may help mitigate complications. Therefore, understanding how AF and NOF interact is key to delivering holistic, patient-centred care for an increasingly elderly population in orthogeriatric wards. Full article

Background: Hip fractures are a major cause of morbidity and healthcare utilization among elderly patients. Early surgical intervention has been associated with improved postoperative outcomes; however, the effect of surgical timing on hospital length of stay (LOS) remains debated, especially in the Middle Eastern region. This study aimed to evaluate the impact of surgical timing on LOS and postoperative outcomes among elderly patients undergoing hip fracture surgery. Methods: A retrospective cohort study was conducted at King Abdulaziz Medical City in Jeddah, Saudi Arabia. Patients aged ≥ 60 years who underwent surgical management for proximal femur fractures between May 2019 and May 2025 were included. Surgical timing was categorized as early (<48 h from admission) or delayed (≥48 h). The primary outcome was hospital LOS. Secondary outcomes included ICU admission, venous thromboembolism (VTE), respiratory infection, periprosthetic infection, and one-year mortality. Kaplan–Meier survival analysis and Cox proportional hazards modeling were used to assess time to hospital discharge. Relative risks (RR) with 95% confidence intervals (CI) were calculated for postoperative outcomes. Results: A total of 179 patients were included, of whom 100 (55.9%) underwent early surgery, and 79 (44.1%) underwent delayed surgery. The median LOS was significantly shorter in the early surgery group compared with the delayed surgery group (7 days [95% CI: 6–7] vs. 11.5 days [95% CI: 9–14]; log-rank p < 0.001). After adjustment for comorbidities, surgical factors, and pre-hospital delay, early surgery remained independently associated with earlier discharge (hazard ratio 2.17, 95% CI 1.55–3.04; p < 0.001). ICU admission occurred less frequently in the early surgery group (6.0%) compared with the delayed surgery group (17.7%) (RR 0.34, 95% CI 0.14–0.83; p = 0.013). No significant differences were observed in VTE, respiratory infection, periprosthetic infection, or one-year mortality between groups. Conclusions: Surgery performed within 48 h of admission was associated with significantly shorter hospital LOS and lower ICU admission rates among elderly patients undergoing hip fracture surgery. These findings highlight the importance of timely surgical intervention to improve perioperative efficiency and hospital resource utilization. Full article

Extreme temperatures are an emerging public health concern due to their significant impact on humans, yet the evidence remains limited in tropical countries. This study examined the non-linear relationship between ambient temperature and non-accidental and cause-specific mortality in two northern parts of Peninsular Malaysia, from 2011 to 2019. Daily mortality and meteorological data were analyzed using a quasi-Poisson Generalized Linear Model with a Distributed Lag-Non-Linear model to estimate the relationship between temperature and mortality. A U-shaped and J-shaped relationship was observed for the cumulative effects of 21-day lag periods for Kedah and Penang, respectively. The minimum mortality temperature (MMT) at 27.4 °C in Kedah and 28.2 °C in Penang was observed. Extremely high temperatures were associated with an increased non-accidental mortality, with a 16% increase at cumulative lag days 0–3 in Kedah and a 21% increase at cumulative lag days 0–7 in Penang. Vulnerable groups included individuals with respiratory diseases, the elderly, both genders and those residing in both urban and rural areas. These findings highlight the acute impact of heat on mortality in Malaysia and underscore the need for targeted public health interventions. Strengthening heat-health warning systems, improving healthcare preparedness, and prioritizing vulnerable populations are essential to mitigate the health impacts of rising temperatures in tropical regions. Full article

Background/Objectives: As a key health information and communication technology, mobile health information services (MHISs) play a critical role in delivering health information, enabling remote monitoring, and supporting patient well-being. However, widespread resistance among older adults hinders their access to these information services and undermines these benefits. Employing the technology–personal–environment (TPE) framework, this study constructed and verified a comprehensive model to explain older adults’ resistance to MHIS use. Methods: Quantitative data from 430 elderly individuals aged 65 and above from China who participated in the free health check-up basic public health program were analyzed using structural equation modeling. Results: Technology access barriers, technology usage barriers, declining physiological conditions, and resistance to change were positively related to technology anxiety. Declining physiological conditions, resistance to change, social legitimacy power, and perceived institutional effort were negatively related to perceived autonomy. Additionally, technology anxiety was positively related to resistance to MHIS use, while perceived autonomy was negatively related to resistance to MHIS use. Conclusions: The findings clarify the mechanisms linking technological barriers, individual characteristics, and environmental factors to older adults’ resistance to MHIS use. Therefore, relevant health information service providers should adopt systematic actions that simultaneously alleviate technology anxiety through user-centric design and supportive training while fostering perceived autonomy by respecting older adults’ choices and enabling meaningful participation. These findings offer actionable insights for healthcare information system designers and providers to reduce older adults’ exclusion from digital health information ecosystems, thereby enhancing patient well-being among aging populations. Full article

Background/Objectives: Telemedicine offers significant potential to improve the quality and accessibility of geriatric care, particularly in resource-constrained settings. However, its effective implementation depends largely on healthcare professionals’ acceptance and willingness to use such systems. Drawing on an extended Technology Acceptance Model (TAM), this study examines the determinants of doctors’ and nurses’ intentions to adopt telemedicine for elderly care in Algeria, with particular emphasis on self-efficacy and institutional support. Methods: This cross-sectional study employed a structured questionnaire administered to 130 healthcare professionals, including physicians and nurses, in Algeria. Hierarchical multiple regression analysis was conducted to test the proposed hypotheses and assess the incremental explanatory power of the extended model. Results: The extended TAM accounted for 48.7% of the variance in intention to use telemedicine. Institutional support (β = 0.432, p < 0.001) and self-efficacy (β = 0.264, p = 0.001) emerged as the strongest predictors. Perceived ease of use (β = 0.178, p = 0.038) and perceived usefulness (β = 0.139, p = 0.021) also had significant positive effects. The inclusion of self-efficacy and institutional support increased the model’s explanatory power by 23.5%. Conclusions: The findings highlight the critical role of organizational support mechanisms, digital competencies, and system usability in fostering telemedicine adoption among healthcare professionals. The study provides practical implications for policymakers and healthcare institutions, emphasizing the need for targeted training programs, supportive infrastructure, and institutional policies that enhance confidence and facilitate the integration of telemedicine into clinical workflows. Full article

Virtual reality (VR) has shown promising potential for upper-extremity rehabilitation; however, its successful integration into clinical practice depends not only on therapeutic effectiveness but also on the acceptance of the technology by patients and healthcare professionals alike. Despite growing international research in this area, there is limited evidence on clinical attitudes toward VR rehabilitation in Thailand and other middle-income settings. This study investigates Thai patients’ and clinicians’ perceptions of VR for upper-extremity rehabilitation through two complementary studies focusing on perceived usability and usefulness. The first study evaluated the perceived usability of a VR rehabilitation game using the System Usability Scale (SUS) among 40 first-time VR users divided into younger and senior groups. The younger group reported a higher average SUS score (64.6) than the senior group (55.4). While both groups generally perceived VR rehabilitation positively, senior participants expressed greater concern regarding system complexity, consistency, and the need for technical assistance. Nevertheless, the findings indicate that VR remained an acceptable rehabilitation approach even among elderly first-time users in a population with relatively lower technological readiness. The second study explored clinicians’ perceptions of utilizing VR-generated movement data to support rehabilitation decision-making. Five rehabilitation professionals evaluated the potential usefulness of VR data visualizations for diagnosis and treatment monitoring. Clinicians generally perceived VR data as valuable, particularly for tracking rehabilitation progress rather than diagnostic decision-making. Feedback from interviews also highlighted practical considerations for future implementation, including the importance of normative data, simplified visualization formats, and the feasibility of clinical workflows. By combining patient usability perspectives with clinicians’ evaluations of clinical usefulness, this research provides a broader understanding of the factors influencing VR adoption for upper-extremity rehabilitation in Thailand. The findings contribute contextual evidence from an underrepresented healthcare environment and offer insights relevant to the future deployment of VR-assisted rehabilitation systems in similar socio-economic settings. Full article