Search Results (293)

Background and Aim: Type 2 diabetes (T2D) continues to pose a significant public health challenge worldwide. Among therapeutic options, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have proven effective in optimizing glycemic control and improving cardiometabolic profiles. Semaglutide, now available in an oral formulation, represents a modern strategy to improve patient adherence while supporting glucose and weight regulation. This study primarily investigated the effects of oral semaglutide on key metabolic indicators and secondary endpoints included cardiovascular risk markers (blood pressure and lipid profile) and patient-reported quality of life (QoL). Study Design and Methods: A longitudinal, prospective observational study was conducted involving patients with T2D across two Italian healthcare facilities. Participants were assessed at baseline (T0) and at three subsequent intervals—6 months (T1), 12 months (T2), and 18 months (T3)—following the initiation of oral semaglutide use. Key Findings: Out of 116 participants enrolled, 97 had complete and analyzable data. Across the 18-month follow-up, significant improvements were observed in glycemic parameters, with a notable reduction in HbA1c levels (T0 vs. T3, p = 0.0028; p ≤ 0.05, statistically significant). Self-reported outcomes showed enhanced quality of life, especially in treatment satisfaction and perceived flexibility (T0 vs. T3, p < 0.001). Conclusions: Daily administration of 14 mg oral semaglutide in individuals with T2D resulted in substantial benefits in glycemic regulation, weight reduction, cardiovascular risk management, and overall patient satisfaction. These findings reinforce its potential role as a sustainable and effective option in long-term diabetes care from both a clinical and public health perspective. Full article

Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines. While this principle applies globally, practices vary between countries. In the Netherlands, the preparation of medicines in pharmacies is well-established and integrated into routine healthcare. This narrative review explores the role and significance of extemporaneous compounding, pharmacy preparations and related product care in the Netherlands. Methods: Pharmacists involved in pharmacy preparations across various professional sectors, including community and hospital pharmacies, central compounding facilities, academia, and the professional pharmacists’ organisation, provided detailed and expert insights based on the literature and policy documents while also sharing their critical perspectives. Results: We present arguments supporting the need for pharmacy preparations and examine their position and role in community and hospital pharmacies in the Netherlands. Additional topics are discussed, including the regulatory and legal framework, outsourcing, quality assurance, standardisation, education, and international context. Specific pharmacy preparation topics, often with a research component and a strong focus on product care, are highlighted, including paediatric dosage forms, swallowing difficulties and feeding tubes, hospital-at-home care, reconstitution of oncolytic drugs and biologicals, total parenteral nutrition (TPN), advanced therapy medicinal products (ATMPs), radiopharmaceuticals and optical tracers, clinical trial medication, robotisation in reconstitution, and patient-centric solid oral dosage forms. Conclusions: The widespread acceptance of pharmacy preparations in the Netherlands is the result of a unique combination of strict adherence to tailored regulations that ensure quality and safety, and patient-oriented flexibility in design, formulation, and production. This approach is further reinforced by the standardisation of a broad range of formulations and procedures across primary, secondary and tertiary care, as well as by continuous research-driven innovation to develop new medicines, formulations, and production methods. Full article

The global rise in urban-related health issues poses significant challenges to public health, particularly in cities facing socio-economic crises. In Lebanon, 70% of the population is experiencing financial hardship, and healthcare costs have surged by 172%, exacerbating the strain on medical services. Given these conditions, improving the quality and accessibility of green spaces offers a promising avenue for alleviating mental health issues in urban areas. This study investigates the psychological impact of nine urban public spaces in Beirut through a comprehensive survey methodology, involving 297 participants (locals and tourists) who rated these spaces using Likert-scale measures. The findings reveal location-specific barriers, with Saanayeh Park rated highest in quality and Martyr’s Square rated lowest. The analysis identifies facility quality as the most significant factor influencing space quality, contributing 73.6% to the overall assessment, while activity factors have a lesser impact. The study further highlights a moderate positive association (Spearman’s rho = 0.30) between public space quality and mental well-being in Beirut. This study employs a hybrid methodology combining Research for Design (RfD) and Research Through Designing (RTD). Empirical data informed spatial strategies, while iterative design served as a tool for generating context-specific knowledge. Design enhancements—such as sensory plantings, shading systems, and social nodes—aim to improve well-being through better public space quality. The proposed interventions support mental health, life satisfaction, climate resilience, and urban inclusivity. The findings offer actionable insights for cities facing public health and spatial equity challenges in crisis contexts. Full article

Iterative decision making is deeply embedded in the design process of healthcare facilities. A significant body of literature and practices, most notably Evidence-based Design, explicitly seeks to better inform decisions as a key pathway to achieving improved outcomes. The objective of this systematic review is to explore multiple dimensions of decision making in the healthcare design literature, including interprofessional stakeholder engagement, decision flow elements, and multidisciplinary methodologies aimed at improving decision quality during healthcare facility design processes. This review offers a comprehensive review of 114 papers from the Web of Science, CINAHL, MEDLINE, and Art and Architecture Source. Decisions made during healthcare facility design processes are characterized as complex, highly interdependent, and difficult to reverse with significant implications for human and operational outcomes. The published literature emphasizes decision support generated from ex ante or ex post research. Despite numerous references to the importance of decision making, there are considerable gaps in the study of interprofessional group decision-making dynamics. The adoption and application of decision analysis tools and integrated decision flows are emerging. This review synthesizes current perspectives and methods aimed at improving decision making during the design of healthcare facilities and proposes a potential framework for future investigations of design decision quality. Full article

Radiotherapy, a critical component of cancer treatment, faces significant challenges in Gauteng, South Africa. These disparities hinder the achievement of Sustainable Development Goal 3, primarily due to systemic issues, socioeconomic barriers, and limitations within the health system. This article presents the House framework, designed to enhance access to radiotherapy services by integrating the WHO Health Systems framework with the dimensions of access proposed by Penchansky and Thomas. The framework is visually represented as a house, with Policy & Governance as the foundation, WHO building blocks as pillars, and Equitable Cancer Care and Improved Outcomes as the roof. A mixed-methods approach was utilized, combining quantitative data from radiotherapy facilities and qualitative insights from healthcare professionals to identify barriers and potential solutions. Findings indicate significant disparities in resource distribution and accessibility between public and private institutions, compounded by socioeconomic factors like transport costs and lack of awareness. The article discusses innovative proposed framework using the 5As of access as potential solutions. The House framework serves as a valuable tool for policymakers and healthcare providers aiming to improve radiotherapy access and promote equitable cancer care in Gauteng, ultimately working towards reducing disparities in cancer outcomes. Full article

Background: Antimicrobial resistance (AMR) poses a critical global health challenge, particularly in resource-limited settings. A hub-and-spoke model, decentralising expertise and distributing resources to peripheral facilities, has been proposed as a strategy to enhance the antimicrobial stewardship (AMS) capacity in low- and middle-income countries. Aim: This study sought to understand healthcare professionals’ experiences of a hub-and-spoke AMS model in the Volta Region of Ghana and its influence on clinical practice, leadership, and collaborative endeavours to address AMR. Methods: A qualitative descriptive design was adopted. In-depth interviews were conducted with 11 healthcare professionals who participated in the AMS program. Thematic analysis was used to identify key themes related to the knowledge and skills that were gained, clinical and leadership practice changes, capacity building, and challenges. Results: Participants reported an increased awareness of AMR, particularly regarding the scale and clinical implications of antimicrobial misuse. The clinical practice improvements included more judicious prescribing and enhanced adherence to infection prevention and control measures. Many respondents highlighted stronger leadership skills and a commitment to capacity building through AMS committees, multidisciplinary collaboration, and cross-organisational knowledge exchange. Despite resource constraints and logistical hurdles, participants expressed optimism, citing data-driven approaches such as point prevalence surveys to track progress and inform policy. Engagement with hospital management and public outreach were viewed as essential to sustaining AMS efforts and curbing over-the-counter antibiotic misuse. Conclusions: The hub-and-spoke model caused observable improvements in AMS knowledge, clinical practice, and leadership capacity among healthcare professionals in Ghana. While challenges remain, particularly in securing sustainable resources and shifting community behaviours, these findings underscore the potential of network-based programs to catalyse systemic changes in tackling AMR. Future research should explore long-term outcomes and strategies for embedding AMS practices more deeply within healthcare systems and communities. Full article

The growing demands for sanitary regulations in medical facilities, particularly operating rooms, highlight the importance of ensuring high air quality and minimizing airborne hospital-acquired infections. Improperly designed ventilation systems may lead to contamination of up to 90–95% of patients, especially in light of evolving threats, such as COVID-19. This study focuses on enhancing the energy efficiency and performance of air conditioning and ventilation systems for cleanrooms, where air recirculation is not permissible. A novel energy-efficient direct-flow air treatment scheme is proposed, integrating a heat pump system with adjustable thermal output. A computational fluid dynamics CFD model of a clean operating room was developed to assess the impact of inlet air velocity on aerosol particle removal and airflow stabilization time. The model also considers the effect of personnel movement. The results supported optimized air distribution, reducing microbial contamination risks, with less than 10 CFU/m³, and improved thermal performance. The proposed system was evaluated for energy and cost efficiency compared to conventional setups. Findings can inform the design and operation of cleanroom ventilation in surgical environments and other high-tech applications. This research contributes to improving indoor air quality and reducing infection risks while enhancing sustainability in healthcare infrastructure. Full article

Background/Objectives: Despite ongoing national interventions, pockets of acute malnutrition persist in rural settings of South Africa, contributing to disproportionate rates of child morbidity and mortality. This study aimed to identify risk factors associated with acute malnutrition among under-five children attending primary healthcare facilities in Msinga, KwaZulu-Natal Province, with a specific focus on dietary diversity and selected infant and young child feeding indicators. Methods: A cross-sectional, facility-based study was conducted among 415 mother–child pairs attending five randomly selected PHC facilities in the Msinga sub-district. Participants were selected using a multistage sampling design from a sampling frame of 18,797 under-five children. Of the 551 mother–child pairs approached; the final analytic sample comprised 415 observations. Data were collected through structured interviews, anthropometric assessments, and dietary diversity scores (DDS). Data were analyzed using Stata 18, and Poisson regression was applied to identify risk factors. Results: The prevalence of acute malnutrition was 29% based on weight-for-height/length z-scores (WHZ/WLZ) and 27% based on mid–upper-arm circumference z-scores (MUACZ). Children aged ≥36 months had significantly higher prevalence of acute malnutrition (aPR = 1.62; 95% CI: 1.15–2.10). Children from households with five or more members had reduced risk (aPR = 0.66; 95% CI: 0.45–0.74), and those born full-term showed a strong protective association (aPR = 0.39; 95% CI: 0.23–0.64). Maternal age was associated with reduced risk, with children of mothers aged 25–34 years (aPR = 0.67; 95% CI: 0.48–0.93) and ≥35 years (aPR = 0.58; 95% CI: 0.35–0.84) experiencing significantly lower prevalence. Mixed feeding was significantly associated with reduced risk (aPR = 0.86; 95% CI: 0.55–1.17), while a DDS ≥4 was protective (aPR = 0.41; 95% CI: 0.04–0.84). Consumption of protein-rich foods was notably low, with only 21% consuming flesh foods and 10% consuming eggs. Conclusions: Acute malnutrition in under-five children was significantly associated with poor diet quality, older age, low household income, and mixed feeding practices. Protective factors included full-term pregnancy, larger households, older maternal age, and adequate dietary diversity, highlighting the importance of targeted, multisectoral interventions. Full article

Background/Objectives: This study investigates the evolution of hospital capacity and utilization in California between 2003 and 2023, focusing on emergency departments (EDs) and trauma centers (TCs). We seek to document structural changes in the healthcare delivery system with respect to hospital-based emergency and trauma services. Methods: This analysis examines changes in population demographics, hospital resources, and patient utilization patterns across facility types. Given the significant increase in the proportion of the population aged 65+ and the documented higher use of emergency and trauma services by this population, we expected to observe an expansion in ED and trauma service capacity and utilization. Results: Utilizing a comprehensive dataset of California general acute care hospitals over this 20+ year period, our descriptive analysis reveals major shifts in the healthcare delivery system, notably the increased prominence of hospitals with EDs, particularly those designated as trauma centers. Findings indicate that, while the overall number of hospitals and licensed beds has slightly decreased, facilities with EDs, especially trauma centers, have increased their capacity and manage a greater proportion of inpatient admissions and ED visits. Conclusions: The increase in ED visits and inpatient admissions at trauma centers, contrasted with decreases in both capacity and utilization at non-trauma hospitals, indicates a significant restructuring of the health delivery system with significant implications for healthcare policy, financing, operations, and affordability. The high and increasing percentage of inpatient admissions originating from hospital EDs and from hospitals with trauma centers suggests a need for policies that foster integration between ED and inpatient care and the broader healthcare delivery system, while at the same time managing the increase in prices and costs associated with growing emergency services utilization. Further research is needed to explore the implications of these trends, particularly concerning their impact on the affordability of healthcare in the US. Full article

This paper presents a novel, low-cost, portable impedance analyzer system designed for biopotential electrode evaluation and skin/electrode impedance measurement, critical for enhancing bioelectrical signal quality in healthcare applications. In contrast with conventional systems that depend on external PCs or host devices for data acquisition, visualization, and analysis, this design integrates all functionalities into a single, compact platform powered by the Analog Devices AD5933 impedance converter and a Raspberry Pi 4. The design incorporates custom analog circuitry to extend the measurement range from 10 Hz to 100 kHz and supports a wide impedance spectrum through switchable feedback resistors. Validated against a benchtop impedance analyzer, the system demonstrates high accuracy with normalized root-mean-square errors (NRMSEs) of 1.41% and 3.77% for the impedance magnitude and phase of passive components, respectively, and 1.43% and 1.29% for the biopotential electrode evaluation and skin/electrode impedance measurement. This cost-effective solution, with a total cost of USD 159, addresses the accessibility challenges faced by smaller research labs and healthcare facilities, offering a compact, low-power platform for reliable impedance analysis in biomedical applications. Full article

Aim: This study aimed to explore the relationships between burnout, emotional intelligence (EI), and work engagement (WE) among hospital nurses. Specifically, it examined the mediating role of burnout in the relationship between EI and WE. Background: Nurses are frequently exposed to emotionally and physically demanding environments, which may lead to sustained occupational stress. Prolonged exposure to such conditions can contribute to burnout, adversely affecting both personal well-being and professional performance. EI is increasingly recognised as a protective factor that may alleviate burnout and enhance WE. Methods: A quantitative, cross-sectional correlational design was employed. A quota sampling technique was used to select 336 nurses working in public healthcare facilities in Ha’il, Saudi Arabia. Data were collected using standardised self-report instruments: the 14-item Shirom–Melamed Burnout Questionnaire (SMBM), the short-form Genos Emotional Intelligence Inventory (Genos EI), and the 9-item Utrecht Work Engagement Scale (UWES-9). Structural equation modelling examined associations and the mediating role of burnout between EI and WE. Results: EI was positively associated with WE and negatively with burnout. Burnout, in turn, was negatively associated with WE. Mediation analysis confirmed that burnout partially mediated the effect of EI on WE, indicating that EI nurses were less likely to experience burnout and more likely to remain engaged in their roles. Discussion: The results emphasise the role of EI in reducing burnout and enhancing WE among nurses. Burnout partially mediates this relationship, suggesting that EI influences WE both directly and indirectly. Conclusions and Implications for Nursing: Integrating EI training into professional development and implementing measures to reduce burnout may improve WE and retention. Policy efforts should ensure supportive work environments and adequate staffing to sustain nurse well-being. Full article

Background: Rural communities in the United States experience significant barriers in accessing healthcare, including inadequate numbers of providers and local healthcare facilities. These barriers are exacerbated during seasons with high rates of respiratory diseases when rural clinics and providers may be overwhelmed. When mild, many of these respiratory diseases may be managed effectively in alternate settings, including community pharmacies. Investigators interviewed pharmacists in Washington State to explore the capacity of pharmacists and pharmacies to provide test-to-treat services for COVID-19, influenza, and strep throat. Methods: A qualitative study design was used to conduct key informant interviews with pharmacists who precepted student pharmacists from a local university. Twenty interviews were conducted, transcribed, and qualitatively evaluated to identify themes. The 5 A’s of Access were utilized as a theoretical framework. This framework describes five domains of access, including affordability, availability, accessibility, accommodation, and acceptability. Results: Qualitative analysis identified several themes that described the benefits of offering test-to-treat services in rural communities, such as reducing geographical barriers to accessing care, reducing wait times for patients, and reducing the number of patients seeking higher levels of care for basic treatments. Barriers to offering test-to-treat services identified by pharmacist participants included difficulties with receiving payment for services, challenges with adequate staffing, and the lack of awareness among many people in rural communities that pharmacies offer test-to-treat services. Conclusions: Rural communities experience challenges with the limited capacity of healthcare providers to meet the needs of patients in their communities. The results of this qualitative analysis may be useful to pharmacists in U.S. states where collaborative drug therapy agreements or collaborative practice agreements allow the provision of test-to-treat services. By providing test-to-treat services, pharmacists can increase access to care for rural patients and alleviate the burden of offering these services from other healthcare providers. Full article

Indoor localization systems are gaining increasing relevance due to the limitations of traditional Global Positioning System (GPS) technology in enclosed environments. While the GPS remains widely used for navigation, its efficacy is significantly reduced indoors or in confined spaces. Given the growing societal and technological demand for precise localization and movement tracking within such environments, the development of indoor positioning systems (IPSs) has become a critical area of research. Among the available technologies, Bluetooth Low Energy (BLE) beacons have emerged as one of the most promising solutions for indoor positioning applications. This paper presents an indoor positioning system leveraging BLE beacons, specifically designed for deployment in confined environments. The system employed the Fingerprinting method for localization, and its prototype was experimentally tested within a selected healthcare facility. A series of systematic tests confirmed both the functional reliability of the proposed system and its capability to provide precise localization tailored to the spatial characteristics of the given environment. This research offers a novel application of BLE beacon technology, as it extends beyond simple presence detection to enable accurate position determination at defined time intervals and the relative positioning of multiple entities within the monitored space. Full article

Background: This study examines the role of the built environment in mitigating risk in healthcare facilities, with a particular focus on how the design of hospital infrastructures can influence and improve the safety of patients, staff, and visitors. Methods: A two-phase mixed-methods approach was adopted. First, a scoping literature review was conducted to identify design-based strategies targeting five categories of risk: healthcare-associated infections (HAIs), indoor air quality (IAQ), safety, falls, and emergency resilience. Based on this review, a structured questionnaire was developed and administered to a sample of hospital facilities in Northern Italy to assess the implementation of the strategies emerged. Results: The literature review identifies recurring specific design solutions and strategies that have proven effective in mitigating risks in healthcare infrastructures in the following dimensions: infection mitigation, indoor air quality, falls reduction, safety, emergency preparedness. At the same time, survey data from (n = 9) hospitals indicate a significant implementation gap. Key shortcomings included a lack of spatial flexibility, limited environmental monitoring (especially for IAQ and acoustic conditions), and underutilization of antibacterial surfaces. Antibacterial flooring and wall finishes were absent in (n = 4/9) and (n = 6/9) of the facilities, respectively. IAQ monitoring was mostly confined to surgical areas, with (n = 0/9) facility reporting comprehensive building-wide monitoring. Only two (n = 2) facilities reported adaptable spaces suitable for emergency conversion and accessible green areas. Conclusions: This study provides a comprehensive overview of risk mitigation strategies in hospital design. The results reveal critical gaps in implementation, particularly in spatial flexibility, environmental monitoring, and antimicrobial surfaces. Future research should focus on developing adaptable design models that are context-sensitive, scalable, and capable of enhancing healthcare resilience in response to emerging global health threats. Full article

Over the past three decades, the biodegradable polymer known as poly(propylene fumarate) (PPF) has been the subject of numerous research due to its unique properties. Its biocompatibility and controllable mechanical properties have encouraged numerous scientists to manufacture and produce a wide range of PPF-based materials for biomedical purposes. Additionally, the ability to tailor the degradation rate of the scaffold material to match the rate of new bone tissue formation is particularly relevant in bone tissue engineering, where synchronized degradation and tissue regeneration are critical for effective healing. This review thoroughly summarizes the advancements in different approaches for PPF and PPF-based composite scaffold preparation for bone tissue engineering. Additionally, the challenges faced by each approach, such as biocompatibility, degradation, mechanical features, and crosslinking, were emphasized, and the noteworthy benefits of the most pertinent synthesis strategies were highlighted. Furthermore, the synergistic outcome between tissue engineering and artificial intelligence (AI) was addressed, along with the advantages brought by the implication of machine learning (ML) as well as the revolutionary impact on regenerative medicines. Future advances in bone tissue engineering could be facilitated by the enormous potential for individualized and successful regenerative treatments that arise from the combination of tissue engineering and artificial intelligence. By assessing a patient’s reaction to a certain drug and choosing the best course of action depending on the patient’s genetic and clinical characteristics, AI can also assist in the treatment of illnesses. AI is also used in drug research and discovery, target identification, clinical trial design, and predicting the safety and effectiveness of novel medications. Still, there are ethical issues including data protection and the requirement for reliable data management systems. AI adoption in the healthcare sector is expensive, involving staff and facility investments as well as training healthcare professionals on its application. Full article