Search Results (45,508)

Background/Objectives: As population ageing accelerates, integrated care has become an important strategy for addressing the complex care needs of older adults. Although gerontological nurse specialists (GNSs) are expected to contribute to integrated care, their roles remain inconsistently defined and insufficiently synthesized across healthcare systems and professional role titles. This scoping review aims to systematically map the roles of GNSs in supporting integrated care for older adults within hospital-based settings. Methods: This scoping review protocol will follow the JBI methodology for scoping reviews and will be reported in accordance with the PRISMA-ScR guidelines. Searches will be conducted in PubMed, CINAHL, Web of Science, China National Knowledge Infrastructure, and Ichushi-Web, with no date restrictions. Studies published in English, Chinese, and Japanese will be included. The review will consider studies involving nurses with recognized specialist or advanced nursing practice competence in gerontological or older-adult care and will focus on their roles in supporting integrated care for older adults within hospital-based settings and hospital-linked transitional care services. Two independent reviewers will conduct study selection and data extraction. The findings will be synthesized descriptively and presented using tabular, narrative, and diagrammatic formats. Conclusions: This review is expected to contribute to a clearer understanding of the roles of GNSs in integrated care for older adults and provide evidence to inform future nursing practice, workforce development, education, and research in gerontological integrated care. Registration: This protocol was registered within the OSF database on 19 May 2026. Full article

Background: Carbapenem-resistant Acinetobacter baumannii is a critical priority pathogen of the Acinetobacter calcoaceticus-Acinetobacter baumannii Complex (Acb Complex) characterized by extensive multidrug resistance, leading to increased reliance on last-line polymyxins and widespread use of cationic disinfectants in healthcare settings. However, shared membrane-targeting mechanisms raise concerns regarding potential cross-resistance between disinfectants, polymyxins, and cationic antimicrobial peptides. Methods: A diverse panel of clinical A. baumannii isolates from Australia (n = 9), Pakistan (n = 15), and Switzerland (n = 3), and standard strains (n = 3), including polymyxin-resistant laboratory and clinical mutant strains (n = 4), was used. Minimum inhibitory concentrations (MICs) of polymyxin B, colistin, three cationic disinfectants (polyquaternium-1; PQ-1), polyhexamethylene biguanide (PHMB), and chlorhexidine (CHX), and four Antimicrobial peptides (AMPS: LL-37, melimine, Mel4, and lactoferricin) were determined using broth microdilution. Correlations between MICs were assessed using Spearman analysis, and differences between polymyxin-resistant and -susceptible isolates were analyzed statistically. Results: Most isolates were susceptible to polymyxins. The MIC data confirmed that one mutant strain, A. baumannii 19606 (R), and three clinical isolates displayed high-level polymyxin B and colistin resistance. PQ-1 exhibited the greatest antibacterial activity among disinfectants, while LL-37 showed the lowest and most consistent MICs among AMPs; lactoferricin was largely inactive. Within this exploratory strain collection, polymyxin-resistant isolates exhibited lower MICs to PQ-1 and PHMB, indicating collateral susceptibility. Correlation analysis revealed significant negative correlations between polymyxin susceptibility and disinfectant MICs (colistin–PQ-1 (r = −0.67 and p = 0.0001), colistin–PHMB (r = −0.44 and p = 0.05), and polymyxin B–PHMB (r = −0.48 and p = 0.005), whereas no consistent correlation was observed between polymyxins and AMPs, including LL-37. A moderate positive correlation was identified between colistin and Mel4 activity (r = 0.45 and p = 0.05). Conclusions: These findings indicate diverse susceptibility patterns of A. baumannii to cationic antimicrobials. Within this exploratory strain collection, polymyxin resistance was not associated with reduced susceptibility to disinfectants or most antimicrobial peptides and was instead associated with lower MICs to certain disinfectants. No evidence of cross-resistance between polymyxins and LL-37 was observed under the conditions tested, suggesting that polymyxin resistance does not necessarily confer reduced in vitro susceptibility to this host defense peptide. Given the small number of polymyxin-resistant isolates, these findings should be considered hypothesis-generating and require confirmation in larger collections of genetically characterized strains. Further mechanistic studies are needed to determine the biological basis and generalizability of these observed susceptibility patterns. Full article

Background: Training has been shown to be associated with competence improvement among healthcare providers. This study aimed to evaluate the relationship between external training and self-reported competence improvement among county hospital healthcare providers in the context of China’s “Thousand-County Project” policy. Methods: A multi-center cross-sectional survey was conducted from June to September 2025, involving 605 healthcare providers from 30 county hospitals across six provinces in China. Propensity score matching was used to control for observed confounding, and multivariable ordinal logistic regression was applied to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between post-policy external training and self-reported competence improvement, using 5-point Likert scale as the ordered outcome. Interaction tests and a series of sensitivity analyses were conducted to assess robustness and explore potential effect modification. Results: Matching effectively balanced the distribution of covariates between the two groups. Ordinal logistic regression showed that participants who received post-policy external training reported significantly higher self-reported competence improvement than those who did not (OR = 3.36, 95%CI: 1.74–6.48, p < 0.001). Policy awareness was also strongly associated with self-reported competence improvement (OR = 4.50, 95%CI: 2.53–7.99, p < 0.001), and a significant interaction indicated that this association was substantially stronger among those who were aware of the policy (p for interaction = 0.043). Sensitivity analyses, including cluster-robust standard errors and alternative propensity score specifications, yielded consistent results, supporting the robustness of the findings. Conclusions: Post-policy external training was significantly associated with higher self-reported competence improvement among county hospital healthcare providers, and this association appeared stronger among those with greater policy awareness. To better support such initiatives, policymakers could consider strengthening financial support for external training, while hospitals might optimize staffing arrangements to facilitate training participation. Additionally, improving policy dissemination may help raise healthcare providers’ awareness of relevant policies. Full article

Background: The psychological health of healthcare workers is a critical global public health concern. Identifying associated risk factors and their interrelationships is key to informing the development of effective interventions. This study aimed to construct a risk factor model for psychological health among healthcare workers and to examine the strength and patterns of associations between various factors and psychological health outcomes using structural equation modeling. Methods: A cross-sectional survey was conducted among 930 healthcare professionals. Structural equation modelling (SEM) was used to test the theoretical hypotheses, with bootstrapping used for path significance and multiple indicators multiple causes (MIMIC) models used for robustness validation. Results: The social environment and job demand risks were greater than the negative events and psychological adjustment risks. The final model explained 62.2% of the variance in psychological health. The social environment and organizational management functioned as distal risk factors, exerting indirect effects. Job demands, negative events, and job resource risks were associated with psychological health through psychological adjustment. Most of the hypothesized direct associations with the outcomes–burnout, anxiety, depression, suicidal ideation, and turnover intentions—were significant, except for the direct effects of job resource risk on anxiety and job demand/resource risk on suicidal ideation. MIMIC analysis confirmed the stability of the model. Conclusions: The proposed model clarifies how multilevel risk factors interact to affect healthcare workers’ psychological health. The findings support the development of comprehensive, prioritized interventions, including strengthened legal protections, dynamic staffing schemes in high-pressure departments, and routine psychological resilience training for staff. Full article

Background/Objectives: CAR T-cell therapy is a highly efficacious therapy option for relapsed/refractory (R/R) large B-cell lymphoma (LBCL), but its widespread use is currently limited by safety concerns and high healthcare costs. Methods: We evaluated 66 patients with R/R LBCL treated with tisagenlecleucel or axicabtagene ciloleucel between 2016 and 2022 at a single institution to identify factors associated with increased healthcare utilization. Results: The median age of our cohort was 59.5 years, with 22.7% over the age of 70. The median length of stay (LOS) during the initial hospitalization was 12 days (range, 7–62 days). Longer initial hospital LOS was linked to higher age-adjusted HCT-CI score (IRR 1.08; 95% CI, 1.01 to 1.15; p = 0.0203), thrombocytopenia grade 3–4 (IRR 1.32; 95% CI, 1.07 to 1.63; p = 0.0091), and first ICU admission (IRR 1.81; 95% CI, 1.37 to 2.38; p < 0.00001). Thirty- and 90-day readmission rates post-discharge after receiving CAR T-cell therapy were 21.2% and 28.8%, respectively. Multiple readmissions within 90 days after initial hospital discharge were observed in 15% of patients. Longer 30-day readmission LOS was linked to initial hospital LOS (IRR 1.23; 95% CI, 1.11 to 1.35; p < 0.0001) but outpatient follow-up was associated with shorter 30-day readmission LOS (IRR 0.43; 95% CI, 0.26–0.69; p = 0.0005). Factors associated with longer 90-day readmission LOS included a greater number of ER visits within 60 days of CAR T-cell therapy (IRR 3.10; 95% CI, 2.15–4.46), prior 30-day readmission LOS (IRR 1.35; 95% CI, 1.14–1.60), and SUVmax at Day 30 (IRR 1.06; 95% CI, 1.03–1.09) (all p-values < 0.0001). Conclusions: Our findings identify key clinical and utilization variables associated with initial and repeat hospitalizations post-CAR T-cell therapy, emphasizing the need for targeted interventions to reduce readmissions and optimize post-discharge care. Full article

Background: Diffuse large B-cell lymphoma (DLBCL) with TP53 abnormalities, corresponding to the LymphGen A53 molecular subtype, represents a biologically high-risk group associated with primary resistance to standard R-CHOP therapy. Epigenetic sensitization using hypomethylating agents may enhance chemosensitivity in this setting. We prospectively evaluated the clinical activity and safety of a molecularly adapted DAC-R-CHOP regimen in newly diagnosed A53-DLBCL. Methods: In this single-center prospective pilot cohort study, 70 consecutive patients with newly diagnosed DLBCL underwent targeted next-generation sequencing using a 60-gene panel with integrated copy number variation analysis. Six patients (8.5%) were classified as the A53 subtype. All patients received one cycle of standard R-CHOP. From cycle 2 onward, A53 patients received decitabine (10 mg/m² IV, days 1–5) prior to R-CHOP (DAC-R-CHOP), for a total of six cycles. The primary endpoint was complete metabolic response (CMR) according to Lugano 2014 criteria. Exact 95% confidence intervals (CI) were calculated. Results: The median age of the A53 cohort was 65 years. CMR was achieved in all six patients (100%; 95% CI, 54–100%). At a median follow-up of 6 months, all patients remained alive in confirmed CMR. Grade III–IV hematologic toxicity occurred in all cases. Febrile neutropenia developed in 100% of patients, requiring mandatory G-CSF support and anti-infective therapy; no treatment-related mortality or permanent dose reductions were observed. Two patients (33%) experienced gastrointestinal bleeding related to local tumor lysis, which was managed conservatively without protocol discontinuation. Conclusions: In this prospective molecularly stratified pilot cohort, integration of decitabine into front-line immunochemotherapy showed promising clinical activity in A53-DLBCL, albeit at the cost of substantial hematologic toxicity requiring intensive supportive care. Given the small sample size, short follow-up, and absence of a comparator arm, these findings should be considered hypothesis-generating and warrant validation in larger multicenter phase II studies with integrated translational biomarker analyses. Full article

In 2025, Rome hosted the Catholic Jubilee, recording over 33 million cumulative pilgrim attendances while simultaneously facing the death of Pope Francis, the election of Pope Leo XIV, and a regional West Nile Virus (WNV) outbreak. This commentary describes the Lazio Region’s preparedness strategy, based on adapting an existing Hub-and-Spoke infectious diseases network integrating surveillance with Regional Service for Epidemiology, Surveillance and Control of Infectious Diseases (SERESMI) laboratory support, telemedicine, and clinical management. Preparatory measures included an additional Hub, updated syndromic pathways, multidisciplinary coordination, and enhanced surveillance. Emergency department visits increased by 14.8%, while the proportion of infectious syndromes remained stable. This experience highlights the potential value of strengthening existing healthcare networks for mass gathering preparedness. Full article

Physician burnout represents a major occupational health concern associated with impaired wellbeing, reduced job satisfaction, and decreased quality of patient care. Although burnout is frequently examined using variable-centered approaches, less is known about distinct burnout profiles among physicians and their associations with professional identification and intellectual humility. The present study investigated relationships between burnout, job satisfaction, professional social identification, and intellectual humility among physicians using both variable-centered and person-centered approaches. A sample of 100 physicians completed measures assessing burnout dimensions, job satisfaction, professional identification, and intellectual humility. Cluster analysis identified four distinct burnout profiles characterized by different combinations of exhaustion, distancing, cognitive dysfunction, and emotional dysfunction. Significant differences between profiles emerged regarding job satisfaction and professional identification, with higher burnout generally associated with lower occupational wellbeing and weaker professional identification. Correlational analyses also indicated negative associations between burnout, job satisfaction, and professional identification. Although global intellectual humility was not significantly associated with burnout severity, exploratory analyses revealed that openness to correction and engagement in debate were negatively associated with cognitive and emotional dysfunction. These findings support the heterogeneous nature of physician burnout and suggest that professional identification and humility-related cognitive openness represent relevant psychological resources in demanding healthcare environments. Full article

Background/Objectives: Germany’s 2019 Digital Healthcare Act allows manufacturers to integrate digital health applications (DiGAs) into statutory health insurance if they demonstrate a medical benefit or patient-relevant structural or procedural improvement, substantiated by comparative studies. However, existing reviews indicate that the quality of evidence in these studies is inconsistent. Methods: A scoping review following the PRISMA-ScR guidelines was conducted using MEDLINE on 16 December 2024, via PubMed, Scopus, EMBASE, and Cochrane Library. Studies published between 2020 and 2024 assessing DiGA evaluation tools, study quality, and the strength of evidence were included, while non-DiGA studies, telemedicine research, and register-based studies were excluded. Results: Out of the 4628 publications screened, 16 met the inclusion criteria. Across the nine dimensions of evidence quality, deficits were most frequently identified in relation to validity (nine publications), transparency (seven), objectivity (six), consistency (five), and reliability (five), followed by relevance, generalizability, and accuracy (four each) and timeliness (two). Conclusions: The findings highlight substantial limitations in the quality of DiGA studies, including high dropout rates, a lack of blinding, gender imbalance, a high risk of bias, small sample sizes, and biased control-group designs. Additionally, DiGA usage durations were often shorter than recommended. Strengthening the evidence base for DiGAs requires balancing methodological rigor with the practical realities of digital health development. Sustainable integration into routine care depends on feasible evaluation pathways that enable continuous, real-world evidence generation and address the financial and operational challenges of high-quality evaluations. Full article

Background/Objectives: Satisfaction with health and psychosocial services is a key indicator of perceived quality and acceptability, but it does not show whether services improve parenting, family functioning or youth outcomes. It is rarely assessed systematically in community-based addiction prevention and psychosocial health promotion services. This primarily descriptive cross-sectional survey assessed parent-reported satisfaction with family-based addiction prevention and psychosocial health promotion services delivered by a Greek community prevention center. Methods: An anonymous cross-sectional online survey was completed by 110 of 250 invited parents (44%) who had participated in family-based programs delivered by the Prevention Center of the Regional Unit of Achaia (“Kallipolis”) during the 3 years immediately preceding data collection. Satisfaction was measured with a licensed Greek-language version of the Client Satisfaction Questionnaire (CSQ-8). The primary analyses were descriptive, and sample-specific internal consistency was assessed. Because only six respondents had scores below the upper descriptive range, a two-predictor Firth penalized logistic regression was fitted solely for exploratory, hypothesis-generating purposes. Results: The mean CSQ-8 score was 29.35 (SD = 2.84), the median was 30 (interquartile range = 28–31.75), and 104 respondents (94.5%) scored 25–32. Internal consistency was good (Cronbach’s alpha = 0.82), although the distribution showed a pronounced ceiling effect. The exploratory model suggested an association between complete attendance and an upper-range score; however, the reference attendance group contained only three participants, producing an extremely imprecise estimate and precluding reliable interpretation of the magnitude of the association. Conclusions: Respondents reported very high perceived satisfaction and acceptability. The findings are primarily descriptive, may be affected by nonresponse, selection, and recall bias, and do not demonstrate an improvement in parenting, family functioning or youth outcomes. Satisfaction monitoring should be combined with measures of reach, retention, implementation fidelity, and participant, family and youth outcomes. Full article

Background/Objectives: This paper synthesizes and evaluates the potential origins of ectopic salivary gland pathologies in the human nasopharynx. By combining historical reports with an original comparative analysis, this study aims to clarify the precise anatomical and functional status of the proposed tubarial salivary-type glands. Methods: A literature search through December 2025 across major electronic databases identified 84 relevant publications on nasopharyngeal glandular pathologies. The methodological quality in the histomorphological literature was evaluated using the AQUA tool. Concurrently, histological samples were harvested from the inner Eustachian tube opening/torus tubarius region of human, canine, and rodent cadavers and analyzed using histomorphological and immunohistochemical protocols. Results: Most of the literature addressing histologically indicated nasopharyngeal glandular pathology described these findings as controversial, largely overlooking salivary gland origins. The AQUA appraisal identified significant vulnerabilities, showing a high risk of bias in the Study Design domain and yielding moderate inter-rater agreement (κ = 0.435). The empirical morphological study revealed mixed glands with strong mucous predominance in the torus tubarius region of humans and dogs, whereas rodents displayed exclusive PAS positivity within a trabecular stroma. Human samples uniquely demonstrated distinct compartmentalization, duct- and capsule-like formations, and negative α-amylase immunoreactivity. Conclusions: Our pilot empirical evidence, combined with the literature data, suggests a possible pathogenetic link between specific nasopharyngeal neoplasms and the baseline glandular structures of the human torus tubarius. Exhibiting traits of both major and minor salivary systems, the tubarial glands may represent an intermediate structural entity. Furthermore, the animal models utilized do not provide a completely reliable translational framework, highlighting the need for standardized research using fresh human biopsies. Full article

Background: Waiting-room time is an important and neglected element of the outpatient experience in the field of oncology, which carries far-reaching consequences for overall patient satisfaction, perceptions of quality, and healthcare experience. Methods: We carried out a cross-sectional, mixed-methods study, conducted at the Juravinski Cancer Centre in Hamilton, Canada, from October to December 2024. Results: We studied 418 patients with a mean age of 61.6 years. Overall, 59.6% of respondents had spent less than 30 min in the waiting room, while 56.2% accepted a delay of 15–30 min. Waiting for more than 30–45 min was perceived as long by 61% of participants. In regards to physician choice, 59.8% of respondents preferred to be seen by their known provider, while 30.9% were ready to meet another one, particularly in terms of scheduled regular follow-up and urgent appointments followed by consultations. Interestingly, chemotherapy visits were the least common type of appointment where patients agreed to see different providers. A significant association was identified between appointment types and readiness to change physicians (p < 0.05). Although 78.7% agreed that delays were caused by complex conditions, only 29.2% received sufficient information about delays. Conclusions: Most gynecologic oncology patients want continuity of care, yet many are flexible with consultations, follow-up, and urgent visits. In outpatient clinics, patient-centered scheduling, balancing efficiency and patient satisfaction with better communication is an objective for system improvements. Full article

Background: Rotator cuff tendinopathy is a common musculoskeletal disorder associated with shoulder pain, functional limitations, and reduced quality of life. A wide range of non-surgical interventions have been investigated, and uncertainty remains regarding their comparative effectiveness. Objective: This study aimed to summarize recent evidence on non-surgical treatments for rotator cuff tendinopathy and evaluate their reported clinical outcomes. Methods: A structured narrative review was conducted using Google Scholar to identify studies published between 2020 and 2025 involving adult patients with rotator cuff tendinopathy. Studies investigating exercise therapy, platelet-rich plasma (PRP), extracorporeal shockwave therapy (ESWT), laser therapy, kinesiotaping, and percutaneous electrolysis were considered. Following screening and eligibility assessment, 21 studies met the inclusion criteria. Results: Exercise therapy was the most extensively investigated intervention and consistently improved pain, function, and shoulder mobility. PRP injections were associated with favorable effects on pain and functional outcomes, although treatment protocols varied substantially. Several studies reported improvements following ESWT in pain reduction and functional recovery. Evidence from a limited number of studies suggests that high-power laser therapy may improve clinical outcomes, whereas evidence supporting low-level laser therapy remained inconclusive. Kinesiotaping and percutaneous electrolysis demonstrated potential benefits, although the available evidence remains limited. Conclusions: Exercise therapy remains the cornerstone of conservative management for rotator cuff tendinopathy. Adjunctive interventions, including PRP, extracorporeal shockwave therapy, and high-power laser therapy, may provide additional benefits in appropriately selected patients. However, methodological heterogeneity and differences in treatment mechanisms limit direct comparisons between modalities. Full article

Background: Socioeconomic deprivation is a well-established determinant of participation in colorectal cancer (CRC) screening. However, less is known about the geographic clustering of screening adherence and whether spatial inequalities mirror regional patterns of socioeconomic disadvantage. This study investigated the association between socioeconomic deprivation and adherence to CRC screening across Italian regions and explored the presence of spatial autocorrelation using geographic analytical methods. Methods: We conducted a nationwide ecological cross-sectional study including 21 Italian regional units. Pearson correlation analysis was performed to explore associations between colorectal cancer (CRC) screening adherence, primary care physician (PCP) workload and socioeconomic deprivation. Multivariable linear regression was used after assessment of multicollinearity using variance inflation factors (VIFs). Sensitivity analyses included alternative deprivation indicators and leave-one-region-out analyses. Spatial dependence was evaluated using Global Moran’s I and Local Indicators of Spatial Association (LISA). Results: CRC screening adherence showed substantial geographic variability across Italy, with higher participation in northern regions and lower participation in southern areas. Screening adherence was inversely associated with socioeconomic deprivation. Sensitivity analyses confirmed the robustness of the association across alternative deprivation measures and sequential exclusion of each regional unit. Spatial analysis demonstrated significant positive spatial autocorrelation (Moran’s I = 0.275; p = 0.039), indicating that neighbouring regions tended to exhibit similar screening behaviours. LISA analysis identified significant High–High clusters in northern Italy, Low–Low clusters in southern and insular regions, and isolated spatial outliers, highlighting persistent territorial inequalities in preventive healthcare utilisation. Conclusions: Regional disparities in CRC screening participation were associated with socioeconomic deprivation and modest but significant spatial clustering. These findings provide a regional-level description of inequalities in screening participation and may help inform future public health strategies aimed at reducing disparities in organised colorectal cancer screening. Full article

In the healthcare and clinical domain, artificial intelligence (AI) is evolving from earlier models that primarily predicted outcomes or generated content toward agentic AI systems that demonstrate the capability to make decisions and complete tasks autonomously. Previous research on AI has contributed significantly to disease identification, deep learning applications, large language models (LLMs), and generative AI. These systems primarily function as assistive tools, as they generate text or predictions without directly interacting with clinical infrastructures. Therefore, recent research trends are increasingly oriented toward agentic AI systems that extend beyond traditional predictive and generative model performance. This manuscript provides a detailed review of the current state of agentic AI, starting with the evolution of AI and the concept of a medical agent. A medical agent refers to an intelligent AI system designed to assist in clinical or administrative tasks by analyzing data, supporting decision making, and interacting with healthcare environments. Its underlying agentic AI architecture integrates planning, memory, reasoning, and environmental interaction to enable autonomous tool use, multi-agent collaboration, and continuous perception decision action loops across diverse healthcare applications and clinical workflows. The review further examines safety mechanisms, including human-in-the-loop oversight, self-verification strategies, and regulatory alignment frameworks, which are designed to ensure reliability, accountability, compliance, and safe deployment in regulated healthcare environments. Our findings indicate that a large number of AI agents have been introduced in various manuscripts for healthcare applications; however, fully autonomous systems remain challenging to achieve, as AI still faces several limitations related to reliability, interpretability, data dependency, and integration within complex clinical workflows. In response to these challenges, this survey shifts the focus from task-specific model performance to system-level autonomy and workflow orchestration, providing a structured foundation for understanding the design, deployment, governance, and limitations of agentic AI systems in modern healthcare ecosystems. Full article