Search Results (326)

Cell-free biosensors harness the selectivity of cellular machinery without living cells’ constraints, offering advantages in environmental monitoring, medical diagnostics, and biotechnological applications. This review examines recent advances in cell-free biosensor development, highlighting their ability to detect diverse analytes including heavy metals, organic pollutants, pathogens, and clinical biomarkers with high sensitivity and specificity. We analyze technological innovations in cell-free protein synthesis optimization, preservation strategies, and field deployment methods that have enhanced sensitivity, and practical applicability. The integration of synthetic biology approaches has enabled complex signal processing, multiplexed detection, and novel sensor designs including riboswitches, split reporter systems, and metabolic sensing modules. Emerging materials such as supported lipid bilayers, hydrogels, and artificial cells are expanding biosensor capabilities through microcompartmentalization and electronic integration. Despite significant progress, challenges remain in standardization, sample interference mitigation, and cost reduction. Future opportunities include smartphone integration, enhanced preservation methods, and hybrid sensing platforms. Cell-free biosensors hold particular promise for point-of-care diagnostics in resource-limited settings, environmental monitoring applications, and food safety testing, representing essential tools for addressing global challenges in healthcare, environmental protection, and biosecurity. Full article

Background: Artificial intelligence (AI) and machine learning (ML) have been reshaping maternal, fetal, neonatal, and reproductive healthcare by enhancing risk prediction, diagnostic accuracy, and operational efficiency across the perinatal continuum. However, no comprehensive synthesis has yet been published. Objective: To conduct a scoping review of reviews of AI/ML applications spanning reproductive, prenatal, postpartum, neonatal, and early child-development care. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, and Scopus through April 2025. Two reviewers independently screened records, extracted data, and assessed methodological quality using AMSTAR 2 for systematic reviews, ROBIS for bias assessment, SANRA for narrative reviews, and JBI guidance for scoping reviews. Results: Thirty-nine reviews met our inclusion criteria. In preconception and fertility treatment, convolutional neural network-based platforms can identify viable embryos and key sperm parameters with over 90 percent accuracy, and machine-learning models can personalize follicle-stimulating hormone regimens to boost mature oocyte yield while reducing overall medication use. Digital sexual-health chatbots have enhanced patient education, pre-exposure prophylaxis adherence, and safer sexual behaviors, although data-privacy safeguards and bias mitigation remain priorities. During pregnancy, advanced deep-learning models can segment fetal anatomy on ultrasound images with more than 90 percent overlap compared to expert annotations and can detect anomalies with sensitivity exceeding 93 percent. Predictive biometric tools can estimate gestational age within one week with accuracy and fetal weight within approximately 190 g. In the postpartum period, AI-driven decision-support systems and conversational agents can facilitate early screening for depression and can guide follow-up care. Wearable sensors enable remote monitoring of maternal blood pressure and heart rate to support timely clinical intervention. Within neonatal care, the Heart Rate Observation (HeRO) system has reduced mortality among very low-birth-weight infants by roughly 20 percent, and additional AI models can predict neonatal sepsis, retinopathy of prematurity, and necrotizing enterocolitis with area-under-the-curve values above 0.80. From an operational standpoint, automated ultrasound workflows deliver biometric measurements at about 14 milliseconds per frame, and dynamic scheduling in IVF laboratories lowers staff workload and per-cycle costs. Home-monitoring platforms for pregnant women are associated with 7–11 percent reductions in maternal mortality and preeclampsia incidence. Despite these advances, most evidence derives from retrospective, single-center studies with limited external validation. Low-resource settings, especially in Sub-Saharan Africa, remain under-represented, and few AI solutions are fully embedded in electronic health records. Conclusions: AI holds transformative promise for perinatal care but will require prospective multicenter validation, equity-centered design, robust governance, transparent fairness audits, and seamless electronic health record integration to translate these innovations into routine practice and improve maternal and neonatal outcomes. Full article

Introduction: Home-based cardiac telerehabilitation (HBCTR) is a multidisciplinary intervention aimed at optimizing functional, psychological, and social recovery in patients undergoing percutaneous coronary intervention (PCI). This rehabilitation model serves as an effective alternative to traditional center-based rehabilitation, providing a cost-effective and clinically advantageous approach. Methods: Following PRISMA guidelines, we conducted a systematic literature search across multiple databases (PubMed, CINAHL, Cochrane, Scopus, Web of Science). We included randomized controlled trials (RCTs), cohort, and observational studies assessing telerehabilitation in post-PCI patients. Primary outcomes focused on health-related quality of life (HRQoL) and adherence, while secondary outcomes included functional capacity (6 min walk test, VO₂max), cardiovascular risk factor control, and psychological well-being. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. Results: A total of 3575 articles were identified after removing duplicates, of which 877 were selected based on title and abstract, and 17 met the inclusion criteria, with strong RCT representation ensuring robust evidence synthesis. HBCTR was associated with significant improvements in exercise capacity, with increases in VO₂max ranging from +1.6 to +3.5 mL/kg/min and in 6 min walk distance from +34.7 to +116.6 m. HRQoL scores improved significantly, with physical and mental component scores increasing by +6.75 to +14.18 and +4.27 to +11.39 points, respectively. Adherence to telerehabilitation programs was consistently high, often exceeding 80%, and some studies reported reductions in hospital readmissions of up to 40%. Wearable devices and smartphone applications facilitated self-monitoring, enhancing adherence and reducing readmissions. Several studies also highlighted improvements in anxiety and depression scores ranging from 10% to 35%. Conclusions: HBCTR is a promising strategy for rehabilitation and quality-of-life improvement after PCI. It offers a patient-centered solution that leverages technology to enhance long-term outcomes. By integrating structured telerehabilitation programs, healthcare systems can expand accessibility, promote adherence, and improve equity in cardiovascular care. Full article

Background/Objectives: Hard-to-heal wounds are resistant to standard treatments and significantly impact patients’ quality of life and healthcare costs. Photobiomodulation with blue light has shown potential in wound healing, but evidence in wounds persisting for extended periods is limited. This pilot study evaluated the effectiveness of an accelerated photobiomodulation protocol in patients with hard-to-heal wounds in a nurse-led outpatient setting. Methods: Eleven patients with venous, lymphatic, diabetic, or mixed etiology wounds, unhealed for at least two years, were recruited from two clinics in the North District of the ASL Città di Torino. Participants received twice-weekly sessions of blue light photobiomodulation (EmoLED™, 400–430 nm lasting 60–120 s) for four weeks, in addition to standard care. The wound area was measured at baseline, week 4, and week 12 using the CutiMed Wound Navigator^® Version 2.2.8. The secondary endpoints included pain, wound exudate quantity and quality, and the surrounding skin condition. Results: All participants (average wound duration 5.9 years; mean area 13.1 cm², SD ± 14.4) completed the treatment; two were lost at follow-up due to unrelated clinical events. No adverse reactions were reported. At week 4, an area reduction was shown in 9 of 11 wounds (mean: 9.5 cm², SD ± 11.4), though not statistically significant (p = 0.240). At week 12, a significant reduction was observed (mean: 7.2 cm², SD ± 13; p = 0.04), with a mean percentage area decrease of 40.5%. Significant improvements were also noted in pain levels, exudate characteristics, and surrounding skin conditions over time. Conclusions: Accelerated blue light photobiomodulation appears to support long-term wound healing and symptom improvement in patients with hard-to-heal wounds. These findings warrant confirmation in larger, controlled studies. Full article

The management of end-stage kidney disease (ESKD) poses a substantial clinical and economic challenge, characterized by a growing patient burden, rising healthcare costs, and persistent unmet needs to enhance survival outcomes and quality of life. Background/Objectives: Conventional high-flux hemodialysis (HD) remains the dominant form of renal replacement therapy for ESKD but is still associated with substantial morbidity and mortality. High-volume post-dilution online hemodiafiltration (HVHDF) offers a promising alternative by enhancing the convective removal of uremic toxins. Methods: We conducted a narrative review of randomized controlled trials, meta-analyses, real-world cohort studies, and registry analyses published between 2010 and 2024. Evidence was categorized into short-term, medium-term, and long-term outcomes, including hemodynamic stability, inflammation, anemia, infection risk, cardiovascular events, cognitive decline, quality of life, and survival. Results: HVHDF improves short-term outcomes by enhancing toxin clearance, stabilizing blood pressure, reducing inflammation and oxidative stress, and improving anemia management. Medium-term benefits include improved nutritional status, reduced hospitalizations related to infections, and improved neurological and immune function. Long-term data from major trials (e.g., ESHOL, CONVINCE) and large real-world studies show consistent reductions in all-cause and cardiovascular mortality, particularly with convection volumes ≥ 23 L/session. A clear dose–response relationship supports the clinical relevance of convection volume targets. HVHDF has also shown benefits in preserving cognitive function and enhancing health-related quality of life. Conclusions: Strong and converging evidence supports HVHDF as a superior dialysis modality. Given its survival benefits, better tolerance, and broader impact on patient outcomes, HVHDF should be considered the new standard of care in dialysis, especially in light of the recent regulatory approval of the machine that provides the ability to perform HDF in the United States. Full article

The COVID-19 pandemic exposed the urgent need for scalable, reliable telemedicine tools to manage mild cases remotely and avoid overburdening healthcare systems. This study evaluates StepCare, a remote monitoring medical device, during the first pandemic wave at a single center in Spain. Among 35 patients monitored, StepCare showed high clinical reliability, aligning with physician assessments in 90.4% of cases. Patients and clinicians reported excellent usability and satisfaction. The system improved workflow efficiency, reducing triage time by 25% and associated costs by 84%. These results highlight StepCare’s value as a scalable, patient-centered solution for remote care during health crises. Full article

Background/Objectives: European healthcare systems are increasingly adopting automation technologies to improve efficiency. This study evaluates the economic viability of hospital automation and medication management digitalization. Methods: An economic evaluation was based on a standardized hospital model comprising 561 beds, representative of an average acute care hospital across EU27 + UK. For each technology, several cost items were estimated using country-specific parameters such as labor costs, medication error rates, healthcare expenditure, and money discount rate. The financial metrics (Return On Investment—ROI, Net Present Value—NPV, Payback Time—PBT) were first calculated at the hospital level. These results were then extrapolated to the national level by scaling the per-hospital estimates according to the total number of hospital beds reported in each country. Finally, national results were aggregated to derive the overall European impact. Results: The analysis estimated a total European investment of EUR 3.55 billion, with an average PBT of 4.46 years and annual savings of 1,96 billion. ROI averaged 167%, and the total NPV was 8.21 billion. A major saving driver was the reduction in Medication Administration Errors that has an impact of 37.2% on the total savings. Payback times ranged from 3 years in high-GDP countries, to 7 years in lower-GDP nations. Conclusions: These findings demonstrate how providing structured data on hospital automation benefits could support decision-making processes, highlighting the organizational and economic feasibility of the investment across different European national contexts. Full article

Background: Febrile neutropenia is a critical complication in patients with hematological malignancies; immediate initiation of empirical treatment with a broad-spectrum agent is the standard of care. In this study, we aimed to evaluate the cost-effectiveness of long- and short-term antibiotic treatments. Methods: We conducted a retrospective cohort study. We collected data on admissions between 1 January 2018 and 31 December 2022. Adult patients treated with meropenem were included and treatment duration was categorized. Short-term treatment (STT) was defined as a period of 7 days or less, and long-term treatment (LTT) was defined as longer than 7 days. To comparatively estimate costs in both groups, it was hypothesized where STT patients were assumed to receive LTT. Three scenarios were modeled to calculate potential cost reductions. Results: In total, 151 high-risk patients were eligible, with 93 and 58 in the STT and LTT groups, respectively. Both groups exhibited similar clinical characteristics and statistically no significant differences in outcomes. The average costs for the STT and LTT groups were statistically significantly different at USD 9294.01 and USD 13,515.27, respectively. From the regression analysis, cost reductions per patient of USD 164, 527, and 690 were estimated for the three intervention scenarios. Conclusions: Notably, even though the clinical outcomes of STT were not statistically different from those of LTT, the cost of the STT group were statistically significantly lower than that of the LTT group. The early discontinuation of empirical meropenem treatment may offer financial advantages to healthcare systems. Full article

Background: Asthma is the most common chronic respiratory disease in children and adolescents, associated with high morbidity and healthcare costs. Telemedicine has emerged as a strategy to improve access to care, adherence to treatment and symptom control. However, its effectiveness in the pediatric population has not been clearly studied. Objective: To assess the clinical effectiveness of telemedicine interventions in asthma control and health-related quality of life in asthmatic children and adolescents. Methodology: A systematic review and meta-analysis were performed following PRISMA-2020 guidelines, with previous registration in PROSPERO (CRD42025251000837). Sixteen randomized clinical trials (n = 2642) with patients aged 2–18 years were included. The interventions included videoconferencing, mobile applications, web systems, interactive voice response and mobile units in schools. The outcomes were measured using validated quality-of-life (PAQLQ) and asthma control (ACT/c-ACT) questionnaires. Results: Seven studies were incorporated into the PAQLQ meta-analysis, whose overall effect was non-significant (mean difference = 0.06; 95% CI: −0.06 to 0.18; I² = 5.7%). Five studies provided ACT/c-ACT data, showing a significant effect in favor of telemedicine (mean difference = 0.61; 95% CI: 0.32 to 0.90; I² = 73%). Complementary qualitative analysis revealed improvements in adherence, reduction in exacerbations, emergency department visits and use of rescue medication. Conclusions: Telemedicine improves the clinical control of pediatric asthma, although its impact on the quality of life is limited. Multicenter trials with long-term follow-up and cost-effectiveness evaluation are required. Full article

Background: The nursing practice environment significantly influences nurses’ job satisfaction, turnover, and burnout; therefore, it is essential to promote favorable environments to ensure the retention of qualified professionals. Improving the nursing practice environment is a low-cost organizational strategy associated with satisfaction, retaining professionals, and reducing burnout. The aim of this study was to assess the relationship between the nursing practice environment and job satisfaction, turnover, and burnout among primary healthcare nurses in Portugal. Methods: A descriptive, cross-sectional, and correlational study was carried out based on data from the RN4CAST Portugal Project. The Nurse Survey Instrument (Core Nurse Survey) of the RN4Cast Project (2018) was used for data collection. The sample consisted of 1059 nurses from fifty-five health center groups in mainland Portugal, fifteen health centers in the Autonomous Region of Madeira, and six health centers in the Autonomous Region of the Azores. Results: Primary healthcare nurses in Portugal rated the nursing practice environment as unfavorable or mixed, with an average ($\overline{\mathrm{x}}$) of 2.5 (standard deviation (SD) = 0.4), which is associated with lower job satisfaction, with an average of 2.0 (SD = 0.4), moderate intention to leave, with 40.3%, and low levels of burnout, with an average of 1.6 (SD = 0.8). There was also a negative correlation between the nursing practice environment and burnout (r = −0.28) and its dimensions. Emotional exhaustion (r = −0.35) represents the individual dimension of stress and physical exhaustion, corresponding to feelings regarding the depletion of emotional and physical resources, depersonalization (r = −0.18) represents the interpersonal context dimension of burnout, and a lack of personal accomplishment (r = −0.15) represents the self-assessment dimension of burnout and refers to feelings of incompetence and a lack of confidence and self-efficacy at work. Conclusions: The quality of the work environment is associated with greater job satisfaction and a reduction in burnout. For this reason, improving the work environment has therefore been associated with increased job satisfaction and reduced burnout among primary healthcare nurses, promoting nurse retention and the well-being of healthcare teams. Full article

Background: The global number of operatively treated proximal femoral fractures is steadily growing, driven by the demographic shift toward an increasingly elderly, frail, and comorbid population. This clinical condition profoundly impacts not only patient health but also the finances of healthcare systems. The aim of this economic analysis was to investigate the impact on direct costs of orthogeriatric co-management (OGCM) compared to standard of care (SOC). Methods: A retrospective analysis was conducted investigating two comparable cohorts of patients aged 75 and above, originating from the exact same geographic area, who underwent surgical treatment for proximal femoral fractures in 2023. The two cohorts differed in their perioperative care protocols: one followed an OGCM (n = 143) protocol, while the other adhered to a SOC protocol (n = 141). Economic data were retrieved from the centralised finance department managing the two hospital sites under investigation. Results: The findings revealed that the OGCM protocol was associated with direct costs that were not higher (CHF 16,019 vs. CHF 16,713, p = 0.78) compared to SOC, despite higher daily costs in the OGCM cohort (CHF 2504 vs. CHF 2202, p < 0.0001). This difference was largely driven by a significantly shorter length of stay in the OGCM group (6 days vs. 7 days, p = 0.002). Conclusions: Optimising resource allocation through tailored geriatric care protocols suggests not only an improvement in clinical outcomes but also a reduction in economic burden, thereby alleviating pressure on the healthcare system. Full article

Background: Acute appendicitis (AA) is a common surgical emergency worldwide. Over the past few decades, diagnostic imaging has become a cornerstone in the identification of acute appendicitis, significantly contributing to the reduction in unnecessary laparotomies and associated healthcare costs. This study aimed to investigate the influence of serum and spot urine 5-hydroxyindoleacetic acid (5-HIAA) levels, as well as other established clinical and biochemical parameters on the diagnosis of acute appendicitis. Methods: This prospective study was conducted between January and November 2023, evaluating 97 patients diagnosed with acute appendicitis. Serum and spot urine 5-HIAA levels, level of white blood cell (WBC), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), and Alvarado score were analyzed. Patients were further allocated to subgroups based on their Alvarado scores, the onset time of the symptoms, and pathological findings to statistically assess the relationship between the parameters. Results: The mean age of the patients was 34.6 ± 14.8 years. Of the patients, 57 (58.8%) were male, and 40 (41.2%) were female. Spot urine 5-HIAA levels exhibited statistically significant variation among different symptom onset time groups, with elevated levels observed in patients presenting within the first 12 h of symptom onset (p < 0.001). Neutrophil counts were significantly different among Alvarado score groups (p < 0.001), whereas CRP levels significantly increased with the onset time of the symptoms (p < 0.001). Conclusions: Increased spot urine 5-HIAA is supportive of the diagnosis of AA in patients presenting within the first 12 h of symptom onset. Hematological parameters, especially CRP, may provide more reliable information regarding disease severity and progression. Full article

Background/Objectives: Healthcare-associated infections (HAIs) are a major global public health concern, significantly impacting patient safety and healthcare quality. These infections are associated with high morbidity and mortality rates, prolonged hospital stays, and increased healthcare costs. Nurses play a critical role in infection prevention, implementing evidence-based interventions to reduce infection risks. This systematic review aims to identify and synthesize the most effective nursing interventions to prevent HAIs in hospitalized adults, analyzing their variability across different clinical settings and populations. Methods: This systematic review follows the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and is reported according to PRISMA guidelines. The protocol is registered in the PROSPERO database (CRD42024582820). This review includes randomized controlled trials, quasi-experimental studies, and observational studies (cohort, case-control, and cross-sectional) assessing the effectiveness of nursing interventions in reducing HAIs. A comprehensive search is conducted in the PubMed, CINAHL, Scopus, Web of Science, and Cochrane databases. Study selection, data extraction, and quality assessment are performed by two independent reviewers, with disagreements resolved by a third reviewer. Results: The primary outcomes include reductions in HAI incidence rate, increased adherence to preventive interventions, decreased hospital length of stay, reduced readmission rates due to infections, and overall patient safety improvements. A meta-analysis is conducted when feasible; otherwise, results are synthesized narratively. Conclusions: The findings of this review contribute to the standardization of evidence-based nursing practices for HAI prevention, promoting safer healthcare environments. By identifying the most effective interventions, this study aims to support healthcare professionals and policymakers in implementing targeted infection control strategies. Full article

Managed competition is a key driver in healthcare systems in countries like Germany, Switzerland, and The Netherlands. Trust in health insurers is vital but currently low in The Netherlands. This may be due to perceptions regarding profit motives, negative experiences, media coverage, and a lack of understanding of insurers’ roles. This study explores how enrollees perceive health insurers and how the aforementioned factors contribute to these perceptions. Semi-structured interviews were conducted with 17 participants from the Nivel Dutch Health Care Consumer Panel in March and April 2023. Data were analysed using Braun and Clarke’s six-step method for inductive thematic analysis. Participants generally view health insurers positively in terms of managing finances and ensuring care accessibility. However, some perceive insurers as profit-driven and prioritising cost reduction over individual needs, leading to dissatisfaction. Negative experiences and media coverage also shape these perceptions. Participants believe that insurers should ensure care accessibility and quality, distribute costs fairly, provide guidance, and prioritise preventive measures. To foster trust, insurers should communicate their non-profit status and use of benefits, increase transparency in purchasing decisions, and maintain clear communication about payment obligations. Enhancing communication about their contributions to healthcare and raising awareness of their broader roles may also help build trust. Full article

Healthcare providers performing aerosol-generating procedures (AGPs) face significant infection risks, emphasizing the critical need for effective aerosol containment systems. In this study, we developed and validated a negative pressure chamber enhanced with an innovative aerodynamic cap structure designed to optimize aerosol containment. Initially, computational fluid dynamics (CFD) simulations were performed to evaluate multiple structural improvement ideas, including air curtains, bidirectional suction, and aerodynamic cap structures. Among these, the aerodynamic cap was selected due to its superior predicted containment performance, practical feasibility, and cost-effectiveness. The CFD analyses employed realistic transient boundary conditions, precise turbulence modeling using the shear stress transport (SST) k–ω model, and detailed droplet evaporation dynamics under realistic humidity conditions. A full-scale prototype incorporating the selected aerodynamic cap was fabricated and evaluated using physical polyalphaolefin (PAO) particle leakage tests and biological aerosol validation with aerosolized Bacillus subtilis. For the physical leakage tests, the chamber opening was divided into nine sections, and the aerosol dispersion was tested in three distinct directions: ceiling-directed, toward the suction hole, and opposite the suction hole. These tests demonstrated significantly stabilized airflow and substantial reductions in aerosol leakage, consistently maintaining containment levels below the critical threshold of 0.3%, especially under transient coughing conditions. The biological aerosol experiments, conducted in a simulated emergency department environment, involved aerosolizing bacteria continuously for one hour. The results confirmed the effectiveness of the aerodynamic cap structure in achieving at least a one millionth (10⁻⁶) reduction in the aerosolized bacterial leakage compared to the control conditions. These findings highlight the importance and effectiveness of advanced CFD modeling methodologies in accurately predicting aerosol dispersion and improving containment strategies. Although further studies assessing the structural durability, long-term operational ease, and effectiveness against pathogenic microorganisms are required, the aerodynamic cap structure presents a promising, clinically practical infection control solution for widespread implementation during aerosol-generating medical procedures. Full article