Search Results (643)

There is limited published guidance available to help less experienced practitioners assess and manage shoulder conditions, including spasticity, after acquired central nervous system (CNS) lesions. To address this gap, 11 spasticity and dystonia experts convened in a 2023 meeting to build on existing guidance, provide consensus on best treatment practice, and develop expert recommendations to guide the diagnosis and treatment of complications of shoulder conditions following CNS lesions. Presentations by each expert on diagnosis and management were followed by discussion; consensus on assessment and treatment practices was identified and recommendations developed. The expert panel recommended an assessment approach structured using the following components: patient history, including interpretation of reported symptoms; observation of postures and pain responses; clinical examination with targeted tests for specific signs; diagnostic tests; and assessment of upper limb impairment, activity limitations, and participation restrictions. This assessment process and the recommended measures recognize the importance of identifying shoulder involvement in upper limb spasticity as part of the diagnostic process in shoulder conditions following CNS lesions. These recommendations provide a practical approach to diagnosis and treatment for clinicians who are less experienced in evaluating and treating such conditions, simplifying otherwise complicated clinical scenarios. Full article

Background/Objectives: The consumption of opioids is a public health problem that significantly affects quality of life. In Spain, 7585 people are enrolled in the Methadone Maintenance Programme (MMP), which is an effective intervention with a low adherence rate. In this study, factors associated with the quality of life of MMP users, especially perceived social support and treatment adherence, were analysed. We hypothesised that low levels of adherence and social support would be associated with poorer quality of life. Methods: This was a cross-sectional observational study with an analytical approach. Quality of life (WHOQoL-BREF), perceived social support (DUKE-UNC-11), and treatment adherence (MMAS-8) among MMP users were studied, and data on sociodemographic and clinical characteristics were collected through ad hoc questionnaires and a review of electronic medical records. Linear and logistic regression models were used. Results: A total of 70 individuals were included in this study. The mean age was 56.9 years, and 83% of the participants were male. The perceived quality of life was low in the four domains evaluated (range of 47.4–48.2). A total of 38.57% of the participants had low perceived social support. Treatment adherence was low or moderate in 77.1% of the participants. Greater perceived social support was associated with better quality of life in all domains (p < 0.05). Quality of social life was negatively associated with the use of nonbenzodiazepine neuroleptics and HIV status. Treatment adherence was lower in insulin therapy users. Conclusions: Social support is a key determinant of the quality of life of MMP users. Health policies should promote social support networks as a strategy to improve the well-being of this population. Full article

This study analyses the conditions under which co-opetition improves the supply of healthcare services in Benin. Using non-centralised administrative data from a sample of public and private health centres, we apply network theory and negative binomial regression to assess the extent to which competition affects collaboration between public and private healthcare providers. We found that competition reduces the degree of collaboration between private and public health providers. However, the COVID-19 pandemic significantly mitigated this effect, highlighting the potential for competition within the healthcare system without compromising social welfare. Notwithstanding that, we show that these benefits are not sustained over time. These findings have policy implications for the sustainability of health system financing in Africa, particularly by promoting sustainable financial mechanisms for the private sector and more inclusive governance structures. Full article

Biophilic design has emerged as a multidimensional response to growing concerns about health, well-being, and ecological balance in the built environment. Despite its rising prominence, research on the topic remains fragmented across building typologies, user groups, and geographic contexts. This study presents a comprehensive review of the biophilic design literature, employing a hybrid methodology combining structured content analysis and bibliometric mapping. All peer-reviewed studies indexed in the Web of Science and Scopus were manually screened for architectural relevance and systematically coded. A total of 435 studies were analysed to identify key trends, thematic patterns, and research gaps in the biophilic design discipline. This review categorises the literature by methodological strategies, building typologies, spatial scales, population groups, and specific biophilic design parameters. It also examines geographic and cultural dimensions, including climate responsiveness, heritage buildings, policy frameworks, theory development, pedagogy, and COVID-19-related research. The findings show a strong emphasis on institutional contexts, particularly workplaces, schools, and healthcare, and a reliance on perception-based methods such as surveys and experiments. In contrast, advanced tools like artificial intelligence, simulation, and VR are notably underused. Few studies engage with neuroarchitecture or neuroscience-informed approaches, despite growing recognition of how spatial design can influence cognitive and emotional responses. Experimental and biometric methods remain scarce among the few relevant contributions, revealing a missed opportunity to connect biophilic strategies with empirical evidence. Regarding biophilic parameters, greenery, daylight, and sensory experience are the most studied parameters, while psychological parameters remain underexplored. Cultural and climate-specific considerations appear in relatively few studies, and many fail to define a user group or building typology. This review highlights the need for more inclusive, context-responsive, and methodologically diverse research. By bridging macro-scale bibliometric patterns with fine-grained thematic insights, this study provides a replicable review model and valuable reference for advancing biophilic design as an evidence-based, adaptable, and human-centred approach to sustainable architecture. Full article

Despite advances in cancer care, disparities persist. The collection of the social determinants of health (SDOH) is fundamental to addressing disparities. However, SDOH are inconsistently collected in many regions of the world. This two-phase multiple methods study examined patient and community perspectives regarding SDOH data collection in Canada. In phase 1, a survey was administered to patients at a cancer centre (n = 549) to assess perspectives on an SDOH data collection tool. In phase 2, broader perspectives were sought through a community consultation with patient partners experiencing structural inequality (n = 15). Most participants were comfortable with SDOH data collection. Of survey respondents, 95% were comfortable with the collection of language, birthplace, sex, gender, education, and disability, and 82% to 94% were comfortable with SES, sexual orientation, social support, and race/ethnicity. Discomfort levels did not differ across subgroups, except women were more uncomfortable disclosing SES (OR: 2.00; 95%CI: 1.26, 3.19). Most (71%) preferred face-to-face data collection with a healthcare professional and only half were comfortable with storage of SDOH in electronic health records. Open-ended survey responses (n = 1533) and the community consultation revealed concerns about privacy, discrimination, relevance to care, and data accuracy. SDOH data collection efforts should include a clear rationale for patients, training for providers, strong data privacy and security measures, and actionable strategies to address needs. Full article

This paper presents a Self-Learning Robotic System (SLRS) for healthcare assistance using Deep Imitation Learning (DIL). The proposed SLRS solution can observe and replicate human demonstrations, thereby acquiring complex skills without the need for explicit task-specific programming. It incorporates modular components for perception (i.e., advanced computer vision methodologies), actuation (i.e., dynamic interaction with patients and healthcare professionals in real time), and learning. The innovative approach of implementing a hybrid model approach (i.e., deep imitation learning and pose estimation algorithms) facilitates autonomous learning and adaptive task execution. The environmental awareness and responsiveness were also enhanced using both a Convolutional Neural Network (CNN)-based object detection mechanism using YOLOv8 (i.e., with 94.3% accuracy and 18.7 ms latency) and pose estimation algorithms, alongside a MediaPipe and Long Short-Term Memory (LSTM) framework for human action recognition. The developed solution was tested and validated in healthcare, with the aim to overcome some of the current challenges, such as workforce shortages, ageing populations, and the rising prevalence of chronic diseases. The CAD simulation, validation, and verification tested functions (i.e., assistive functions, interactive scenarios, and object manipulation) of the system demonstrated the robot’s adaptability and operational efficiency, achieving an 87.3% task completion success rate and over 85% grasp success rate. This approach highlights the potential use of an SLRS for healthcare assistance. Further work will be undertaken in hospitals, care homes, and rehabilitation centre environments to generate complete holistic datasets to confirm the system’s reliability and efficiency. Full article

Achieving health equity for people with disabilities requires addressing the barriers that they face when accessing healthcare. Older adults with disabilities may experience compounded disparities, yet little research has explored their satisfaction with health facility personnel, including non-healthcare staff. This study examines differences in satisfaction with health facility personnel between younger (18–59 years) and older (60+) adults with disabilities in Chile. Data from the 2024 Disability and Citizenship (DISCA) survey were analysed using chi-square tests to examine differences between younger and older people with disabilities with regard to their satisfaction with health facility personnel. Ordered logistic regressions were employed to predict high satisfaction, given socioeconomic and health-related variables. Findings indicated that a higher percentage of older adults with disabilities reported high satisfaction with health facility personnel compared to younger adults. Ordered logistic regressions confirmed that older adults had greater odds of reporting high satisfaction with doctors (OR: 3.83), other health professionals (OR: 4.66), paramedical technicians (OR: 4.31), and administrative staff (OR: 3.13). These results suggest that age influences satisfaction levels among people with disabilities, potentially due to varying expectations, experiences, or interactions with health facility personnel. Understanding the underlying reasons for these age-related differences is essential to inform policies and practices that ensure equitable, person-centred care for people with disabilities across the life course. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Background: Patients with ST-elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) who undergo complete revascularization (CR) have a more favorable prognosis than those who receive incomplete revascularization (IR), as evidenced by recent randomized controlled trials. Despite the absence of a survival benefit associated with CR in these trials, positive outcomes were ascribed to combined endpoints, such as repeat revascularization, myocardial infarction, or ischemia-driven rehospitalization. In light of the significant burden that rehospitalization from STEMI imposes on healthcare systems, we examined the long-term effects of CR on ischemia-driven rehospitalization and cardiovascular (CV) mortality in STEMI patients with MVD. Methods: In our retrospective study, we included patients with STEMI and MVD who underwent successful primary percutaneous coronary intervention (PCI) at the University Medical Centre Ljubljana between 1 January 2009, and 11 April 2011. The combined endpoint was ischemia-driven rehospitalization and CV mortality, with a minimum follow-up period of six years. Results: We included 235 participants who underwent CR (N = 70) or IR (N = 165) at index hospitalization, with a median follow-up time of 7 years (interquartile range 6.0–8.2). The primary endpoint was significantly higher in the IR group than in the CR group (47.3% vs. 32.9%, log-rank p = 0.025), driven by CV mortality (23.6% vs. 12.9%, log-rank p = 0.047), as there was no difference in ischemia-driven rehospitalization rate (log-rank p = 0.206). Ischemia-driven rehospitalization did not influence CV mortality in the CR group (p = 0.49), while it significantly impacted CV mortality in the IR group (p = 0.03). After adjusting for confounders, there were no differences in CV mortality between CR and IR groups (p = 0.622). Predictors of the combined endpoint included age (p = 0.014), diabetes (p = 0.006), chronic kidney disease (CKD) (p = 0.001), cardiogenic shock at presentation (p = 0.003), chronic total occlusion (CTO) (p = 0.046), and ischemia-driven rehospitalization (p = 0.0001). Significant risk factors for the combined endpoint were cardiogenic shock at presentation (p < 0.001), stage 4 kidney failure (p = 0.001), age over 70 years (p = 0.004), female gender (p = 0.008), and residual SYNTAX I score > 5.5 (p = 0.017). Conclusions: Patients with STEMI and MVD who underwent CR had a lower combined endpoint of ischemia-driven rehospitalizations and CV mortality than IR patients, but after adjustments for confounders, the true determinants of the combined endpoint and risk factors for the combined endpoint were independent of the revascularization method. Full article

Ventilator-associated pneumonia (VAP) develops in patients who stay on mechanical ventilation for more than 48 h. In the presence of causative pathogens, the patient develops clinical signs such as purulent tracheal discharge, fever, and respiratory distress. A prospective observational study was carried out in the Intensive Care Unit (ICU) of Max Healthcare Centre, New Delhi, from 2020 to 2023. The study comprised 70 samples from patients diagnosed with VAP. This study thoroughly examined VAP-associated microorganisms and resistance in the hospital ICU. Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa were the most commonly reported pathogens. Significant drug resistance was seen in P. aeruginosa, K. pneumoniae, A. baumannii and Staphylococcus aureus. The heatmap also supported the antibiotic resistance data patterns obtained from conventional and automated systems of determination. Notably, Serratia marcescens, Escherichia coli, Klebsiella pneumoniae, Ralstonia insidiosa, and Ralstonia mannitolilytica, showed 60 to 100% of resistance to a number of antibiotics. Among all VAP patients, 31.42% early-onset and 68.57% late-onset VAP cases were detected. Out of 70 patients, 43 patients died (mortality rate 61.4%); majority of them suffered from late-onset VAP. The study goal was to describe the antibiotic resistance patterns and microbial ecology of the pathogens that were isolated from VAP patients. According to the heatmap analysis, a varied VAP microbiome with high prevalences of MDR in A. baumannii, P. aeruginosa, K. pneumoniae, and S. aureus was identified. To address the increasing prevalence of MDR VAP, the study highlights the critical need for improved VAP monitoring, strong infection control, and appropriate antibiotic usage. Full article

Background and Objectives: International guidelines differ on short-term (4-week) oral anticoagulation (OAC) indication after acute cardioversion for recent-onset atrial fibrillation (AF < 12–48 h) in low-risk patients (CHA₂DS₂-VA = 0). While Canadian and Chinese guidelines recommend OAC for all, European, Australian and New Zealand, and American guidelines state that such treatment is optional due to the absence of high-quality evidence supporting its indication in this specific scenario. This study aimed to assess physicians’ management of a simple clinical case at an international level, focusing on how they balance ischemic and bleeding risks in a setting lacking any strong evidence-based recommendations. Materials and Methods: Six different AF guidelines were evaluated regarding the recommendation for and scientific evidence justifying short-term OAC in this specific setting. Following review, an international questionnaire was developed with Google Forms 2024 (Mountain View, CA, USA) and circulated among physicians working in the fields of cardiology, internal medicine, intensive care unit, geriatrics, and emergency medicine at 17 centres in Italy, France, and Canada. Results: A total of 78 responses were obtained. Younger physicians and cardiologists appeared to administer OAC more frequently compared to older physicians or those working in other specialties (95% CI Fisher’s Exact Test p = 0.049 and 0.029, respectively). Significant differences were observed in the use of periprocedural imaging, with transoesophageal echocardiogram (TOE) prior to cardioversion being performed more often in Europe vs. Canada (p = 0.006) and in long-term rhythm control, with first-line pulmonary vein isolation (PVI) being offered more frequently by European cardiologists (p = 0.013). No statistically significant association was found regarding guideline adherence for OAC administration (p = 0.120). Conclusions: The real-world antithrombotic management of low-risk (CHA₂DS₂-VA = 0), acutely cardioverted AF patients varies significantly among different healthcare systems. Particularly in cardiology departments, reducing the time limit for safely not prescribing OAC to < 12 h, ensuring local access to direct oral anticoagulants (DOACs) and considering regional stroke risk profiles, as well as actively preventing haemorrhage in patients receiving short-term OAC could all limit cardioversion-related complications in this low-risk population. Full article

To explore Indigenous patients’ use of a primary urgent care centre (PUCC) at a co-located general medical practitioner (GP)-led primary healthcare service (GP service) in regional Queensland, Australia, secondary data analysis was conducted using the 65,420 deidentified PUCC patients from 1 July 2020 to 30 June 2021, including Indigenous status. A Mann–Whitney U test and Chi-Square test were used to analyse patients’ arrival times, reasons to attend PUCC, and frequency of attendance. The proportion of Indigenous patients from the communities attending the PUCC was 9.8% while the proportion of Indigenous people in the general population was only 3.8%. Indigenous patients were more likely to be new patients to the GP service (13.6% never visited the GP service prior to PUCC) compared to non-Indigenous (9.6%) patients. The peak hours of attendance for Indigenous people were 11 a.m.–12 p.m. and 2 p.m.–3 p.m. while it was 10 a.m.–12 p.m. for non-Indigenous patients. The most common reason for attending PUCC for both patient groups was superficial injuries. The second most common reason was digestive issues for Indigenous patients and musculoskeletal issues for non-Indigenous patients. These findings provide insights for enhancing future PUCC models to better meet the community needs, especially the underserved Indigenous population in regional areas. Full article

Background and objectives: As part of Vision 2030, Saudi Arabia aims to strengthen its healthcare system by enhancing efficiency, reducing medical errors, and ensuring drug safety. Evidence on pharmacists’ experiences with adverse drug reactions (ADRs) in daily practice remains limited. Gaining insight into their perspectives is essential for improving patient safety and optimizing pharmaceutical care. Therefore, we aimed to assess pharmacists’ ability to identify ADRs in daily practice and the subsequent actions taken upon identification. Methods: Between July and August 2024, an email-based invitation was sent to randomly selected registered community and hospital pharmacists in Saudi Arabia to participate in the study, which employed a piloted questionnaire. Results: The study involved 305 pharmacists, including 169 hospital/clinical pharmacists (HCPs, 55.4%) and 136 community pharmacists (CPs, 44.6%). A majority (n = 251, 82.3%) indicated direct patient encounters, while 67.2% (n = 205) reported observing suspected ADRs in the preceding 12 months. Most respondents filed ADR reports to the Saudi Food and Drug Administration/National Pharmacovigilance Centre (HCP = 103, CP = 60) and hospital drug information centers (HCP = 89, CP = 64), with online forms being the favored mode (HCP = 122, CP = 96). Awareness of ADR reporting procedures was reported by 128 HCPs and 80 CPs. Conclusions: More than two-thirds of participants reported having participated in ADR reporting, with greater adherence observed in hospital settings. Pharmacists predominantly depend on the Saudi Food and Drug Administration/National Pharmacovigilance Centre and hospital drug information centers for reporting, with a preference for online submission methods. Targeted educational interventions addressing gaps in knowledge, reporting procedures, and form complexity could improve ADR reporting practices. These findings support the need for structured training and policy measures to strengthen pharmacovigilance system. Full article

Background/Objectives: CKD-associated pruritus (CKD-aP) is a serious systemic comorbidity occurring in patients with CKD. Despite the burden of CKD-aP, there are limited efficacious treatments available for its management; difelikefalin is the only approved treatment based on its efficacy and safety demonstrated in two clinical studies, namely KALM-1 and KALM-2. This study aimed to evaluate the cost-effectiveness of difelikefalin plus best supportive care (BSC) versus BSC alone when treating moderate-to-severe CKD-aP in patients receiving in-centre haemodialysis, from the perspective of the UK healthcare system. Methods: A de novo lifetime Markov health economic model was built to assess the cost-effectiveness of difelikefalin. The modelled efficacy of difelikefalin was based on data from KALM-1 and KALM-2 pooled at the patient level. The main efficacy driver was the total 5-D Itch scale score. Per-cycle probabilities of changing health states defined by CKD-aP severity were used to derive transition matrices; the model also estimated time-dependent annual probabilities of death and transplant for people on haemodialysis. An increased risk of mortality for modelled patients with very severe, severe, or moderate CKD-aP was applied. Health state utilities and management costs were based on published evidence. Results: Modelled patients treated with difelikefalin were estimated to have a reduced severity of CKD-aP. Consequently, difelikefalin plus BSC was associated with an increased life expectancy of 0.11 years per person and improved HRQoL compared with BSC alone. This translated to higher quality-adjusted life years, at 0.26 per person gained compared to BSC alone. Improved patient outcomes were achieved at an incremental cost of £7814 per person. Conclusions: Overall, at a price of £31.90/vial, difelikefalin was estimated to be a cost-effective treatment for moderate-to-severe CKD-aP at a willingness-to-pay threshold of £30,000/QALY, with conclusions robust to sensitivity analysis. Full article

Background: Influenza poses a significant threat to the health of Malaysians, particularly among the elderly population. It results in high levels of illness and mortality, becoming a financial burden on the government. Vaccination is widely recognised as the most effective measure for controlling the spread and impact of influenza. Objectives: This study sought to assess the knowledge, attitudes, and practices (KAP) regarding influenza and influenza vaccination among older adults attending primary healthcare centres in different states of Malaysia. Additionally, the study assessed the level of acceptance for a proposed free annual influenza vaccination program. Methods: A nationwide survey was conducted involving 672 older people aged 60 and above who visited nine primary healthcare centres in Malaysia. These centres were selected using proportionate to population size (PPS) sampling to ensure representation from each zone. Participants completed a validated self-reported questionnaire. Descriptive statistics were used to determine the levels of KAP, and a binomial logistic regression model was used to determine the predictors of acceptance for the proposed free annual vaccination program. Results: Most participants displayed a strong understanding of influenza illness (74.0%) and the vaccine (65.9%). Moreover, 76.4% of respondents exhibited a positive attitude towards influenza vaccination. However, the prevalence of good vaccination practices was relatively low, with only 29.2% of participants having a history of previous vaccination, and just 55.2% of these consistently practicing annual vaccination. The group acceptance rate for the proposed free annual influenza vaccination was 62.3%. Significant predictors of acceptance included a history of previous vaccination (good practice) (OR = 6.438, 95% CI = 1.16–35.71, p < 0.001), a positive attitude towards vaccines (OR = 21.98, 95% CI = 5.44–88.87, p = 0.033), and a good level of knowledge about the influenza vaccine (OR = 0.149, 95% CI = 0.03–0.79, p = 0.026). Conclusions: Increasing the uptake of influenza vaccination among the older population in Malaysia remains a significant challenge. It is recommended that a targeted, free annual influenza vaccination program be implemented for high-risk populations, particularly those with comorbidities and those who have shown greater receptiveness. In addition, health education strategies aimed at raising awareness and understanding of influenza should be prioritised. Strengthening epidemiological data collection and establishing systematic monitoring mechanisms are also essential to support these efforts. Full article