Search Results (12,701)

The Internet of Medical Things (IoMT) is transforming healthcare through continuous patient monitoring, telemedicine, cloud–edge services, and Healthcare 5.0. However, the rapid growth of interconnected medical devices has expanded the healthcare cyberattack surface, making intelligent intrusion detection essential for protecting sensitive medical data and ensuring resilient clinical operations. Existing reviews examine specific aspects of AI-powered intrusion detection but rarely provide a deployment-oriented synthesis linking technical performance with operational and clinical requirements. This review critically examines Artificial Intelligence (AI)-powered Intrusion Detection Systems (IDSs) for IoMT across six analytical dimensions: detection performance, explainability, privacy preservation, computational efficiency, benchmarking practices, and cross-dataset generalization. This structured narrative review adopted the PRISMA 2020 framework to ensure transparent record identification, screening, and reporting, with evidence synthesized qualitatively rather than through quantitative meta-analysis. A total of 5127 records published between 2021 and 2026 were screened, resulting in 24 primary studies supported by 115 complementary studies. The findings show that machine learning, deep learning, hybrid AI, Explainable Artificial Intelligence (XAI), Federated Learning (FL), blockchain-assisted security, and edge intelligence have significantly advanced IoMT intrusion detection. However, despite benchmark accuracies often exceeding 95%, deployment remains constrained by dataset dependency, weak cross-dataset generalization, computational overhead, limited explainability, fragmented benchmarking, and insufficient operational validation. This review identifies deployment readiness, rather than predictive accuracy alone, as the principal challenge for next-generation healthcare cybersecurity and provides a practical framework for developing trustworthy, interoperable, privacy-preserving, and deployment-ready IoMT cybersecurity architectures supported by standardized evaluation protocols. Full article

Background: The purpose of this paper is to describe lessons learned from a clinical program that was developed to serve adolescents who experienced ABI in childhood during their transition to adulthood by providing insights to achieve good health and assessment of needs in both healthcare and educational/career areas. Methods: Participatory Action Research methods were utilized for program development by collaborating with focus groups of teen participants and stakeholders following each year. Activities were devised based on best practices for cognitive rehabilitation, direct instruction, and practice of cognitive and metacognitive strategies, technology use, peer coaches and incorporation of multiple stakeholders, including family members. Results: We learned the importance of technology utilization, completing surveys of vocational interests, peer coaches, and post program follow-up to better understand both healthcare and career needs of adolescents who experienced TBI and are transitioning to adulthood. Conclusions: Adolescents who experience a childhood ABI benefit from education about the injury effects, technology use for self-management, peer coaches and connection to both healthcare and career opportunities following high school graduation. Full article

Carbapenem-resistant Enterobacterales (CRE) represent one of the most important antimicrobial resistance threats in Europe, particularly in healthcare settings. Their increasing epidemiological significance is driven by the dissemination of carbapenem-resistant Klebsiella pneumoniae, the emergence of high-risk clones, horizontal transfer of mobile genetic elements, and the convergence of antimicrobial resistance and hypervirulence. Despite the growing epidemiological importance of CRE, surveillance and preparedness remain heterogeneous across European countries, creating a need for a continent-wide assessment of existing surveillance systems, implementation gaps, and emerging challenges. This narrative review summarizes the current epidemiology of CRE in Europe and critically discusses the role of European and global surveillance systems in monitoring their spread. Particular attention is given to the European Antimicrobial Resistance Surveillance Network (EARS-Net), European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net), Healthcare-Associated Infections Surveillance Network (HAI-Net), European Surveillance of Antimicrobial Consumption Network (ESAC-Net), Point Prevalence Survey (PPS), EpiPulse/TESSy, the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) programme, and the World Health Organization Global Antimicrobial Resistance and Use Surveillance System (WHO GLASS). Although Europe has well-established surveillance infrastructures, substantial heterogeneity persists among countries with respect to microbiological and genomic diagnostic capacity, reporting practices, infection prevention and control (IPC), antimicrobial stewardship, healthcare infrastructure, and implementation of national policies. These differences limit data comparability and may delay the detection of colonization, outbreaks, and cross-border transmission. The available evidence indicates that effective CRE control requires integrated surveillance combining microbiological, genomic, epidemiological, and antimicrobial consumption data within a coordinated One Health framework. Further expansion of genomic surveillance, harmonization of surveillance indicators, strengthening of healthcare system preparedness, and wider implementation of antimicrobial stewardship programmes are identified as priority areas for improve CRE prevention and control across Europe. By integrating evidence across surveillance, diagnostics, infection prevention and control, and antimicrobial stewardship, this review highlights key gaps in current European approaches and provides a framework for prioritizing future surveillance and preparedness efforts. Full article

Background/Objectives: International nurse recruitment is increasingly important, but early integration depends on language, professional adaptation, organizational welcome, and retention support. Evidence from non-English-speaking healthcare systems and multi-stakeholder implementation evaluations remains limited. This study aimed to evaluate a structured onboarding pathway as an exploratory, response-level pilot and a feasibility platform. Methods: Anonymous five-point Likert questionnaires were administered to clinical coaches, ward teams, and newly hired international nurses at conceptual time points T0, T1, and T2. T0 was partly retrospective because the first survey wave, administered at approximately 3 months, asked respondents to rate both arrival status and current status. Analyses were response-level; T0–T1 ratings were summarized with a paired within-row sensitivity analysis when both ratings were available, whereas T2 could not be linked to the earlier wave. Results: The primary dataset contained 410 anonymous response-level observations, mostly from ward-team proxy ratings. Median language proficiency ratings were 3 (IQR 2–3) at T0, 3 (IQR 3–4) at T1, and 3 (IQR 3–4) at T2; the proportion of ratings at or above the pragmatic adequacy threshold (≥3) rose from 53.5% to 76.4% and 91.0%, respectively. For professional training/competence, median ratings were 3 (IQR 2–4), 3 (IQR 3–4), and 3 (IQR 3–4), with corresponding adequacy-threshold proportions of 53.5%, 78.0%, and 89.7%. However, stakeholder-specific patterns differed, and international nurses’ self-rated language proficiency followed a non-monotonic pattern. In the nurse-specific analytic subset (14 anonymous response rows), overall welcome was associated with intention to stay (Spearman rho = 0.73, FDR-adjusted p = 0.016) and willingness to recommend the experience (rho = 0.86, FDR-adjusted p = 0.002). Conclusions: The pilot generated hypotheses and, more importantly, mapped feasibility requirements for a future confirmatory study. Although the findings should not be interpreted causally or as paired longitudinal evidence, they provide an initial overview of issues related to the integration of international nurses in non-English-speaking healthcare settings. A future study should prospectively collect pseudonymized identifiers, objective and validated measures, and a pre-specified longitudinal analytic model. Full article

The incidence of neoplastic disorders worldwide has steadily increased, and Romania is no exception, showing a substantial rise in active oncologic surveillance cases. Family physicians are essential to the multidisciplinary team, providing screening, early diagnosis, care during and after cancer treatment, comorbidity management, and palliative care. Primary prevention through lifestyle behavioral changes and early detection in the asymptomatic phase remain the most effective strategies to reduce cancer morbidity and mortality. However, structural barriers within the Romanian primary healthcare system, specifically fragmented digital infrastructure, administrative workloads and limited patient health literacy, frequently restrict these preventive activities. The aim of this narrative review is to analyze cancer prevention and management within Romania’s current demographic and socio-economic context, comparing the national system to models from the UK, the Netherlands, and Spain. The analysis highlights operational gaps, including low breast, cervical, and colorectal screening uptake in Romania. We concluded that optimizing patient care requires transitioning to an integrated pathway, supported by practical reforms like digital fast-track scheduling modules managed directly by family physicians. Full article

Background/Objectives: Adherence to the Mediterranean diet has declined in recent decades, highlighting the need for practical, technology-enabled tools to support its adoption. This study developed and evaluated MAI-DIET, a clinician-supervised, data-driven, AI-assisted programmatic framework designed to generate Greek–Mediterranean recipe-based meal plans for apparently healthy community-dwelling adults. Methods: MAI-DIET is combined with standardized food-composition and recipe libraries and a rule-based module that performs meal-plan generation and nutrient calculations. Claude Opus 4.7 supported predefined operator-supervised transformation tasks, and provided the interface for launching the rule-based module. Six 28-day recipe-based dietary plans were generated for hypothetical adults with energy goals ranging from 1600 to 2600 kcal/day. The generated plans were not tested in the intended population. For each plan, detailed nutritional analysis was performed according to predefined criteria. The quality of the dietary plans was assessed using validated scores, i.e., MedDietScore, dietary phytochemical index (DPI), and GR-UPFAST. Early-stage acceptability was evaluated by 103 healthcare professionals using a five-point Likert questionnaire. Results: All plans met the predefined energy criteria, while most nutrient targets were achieved. Deviations were observed for sodium, particularly in the higher-energy plans (reaching +36.3%), and for calcium, which was 17.5% below the EFSA population reference intake in the 1600 kcal/day plan. MedDietScore ranged between 35 and 36/55, while DPI was 47.0–50.9% and GR-UPFAST was 2.0–4.5/70. Overall acceptability was favorable (3.84 ± 0.59), with Cronbach’s alpha values of 0.838–0.952. Conclusions: The findings support the technical feasibility of the MAI-DIET framework and its preliminary acceptability among healthcare professionals. Further evaluation is required before conclusions can be drawn regarding its practical effectiveness. Full article

Background/Objectives: Perinatal care is essential for the health and well-being of women and adolescent girls from conception through the first year postpartum. The World Health Organization (WHO) provides evidence-based recommendations aimed at improving the quality of antenatal, intrapartum, and postnatal care. This study mapped 51 WHO perinatal care recommendations against Zambian guidelines to identify areas of alignment, as well as gaps and challenges related to their implementation. Methods: The review was conducted following Joanna Briggs Institute (JBI) guidance. Published recommendations and relevant documents issued from 2016 onwards were included. National guidelines, policy documents, professional standards, and literature related to perinatal care in Zambia were identified through searches of PubMed, Google Scholar, WHO resources, and relevant institutional websites. WHO recommendations were mapped against Zambian guidelines and classified according to their level of alignment. Results: The findings demonstrated significant alignment between WHO recommendations and Zambian guidelines in perinatal healthcare. However, important implementation gaps remain; for example, only 4.7% of pregnant women attended all eight recommended antenatal care visits. Intrapartum care largely aligns with WHO standards, though there are differences in pain-relief choices. Furthermore, difficulties in adopting WHO recommendations are mostly due to health system constraints. Conclusions: Most of the Zambian guidelines align with the WHO recommendations. However, ten were classified as partly aligned, and one did not align. This small proportion of non-alignment may reflect adaptation for a national context and require further evidence-based evaluation. In addition, consolidating existing recommendations, strengthening health-system capacity, and addressing implementation gaps may support the delivery of standardized, high-quality perinatal care and contribute to improved maternal and newborn health outcomes. Full article

Invasive aspergillosis and mucormycosis are life-threatening fungal infections characterized by high early mortality, substantial toxicity, and intensive healthcare resource utilization. While multiple antifungal therapies are recommended in international guidelines, their comparative clinical and economic value remains uncertain, particularly in resource-limited settings. We developed a hybrid decision tree and Markov model to evaluate antifungal strategies, including liposomal amphotericin B, isavuconazole, voriconazole, posaconazole, and caspofungin, from the perspective of the Colombian healthcare system over a 6-month horizon. Health states included clinical response, treatment failure, toxicity, and death. Outcomes included quality-adjusted life-years (QALYs), costs, incremental cost-effectiveness ratios (ICERs), and net monetary benefit (NMB). Deterministic and probabilistic sensitivity analyses were performed. In invasive aspergillosis, isavuconazole provided a modest incremental benefit over voriconazole (+0.022 QALYs), driven primarily by improved tolerability, at an incremental cost of COP 3.4 million, yielding an ICER of COP 154.5 million/QALY. In mucormycosis, liposomal amphotericin B yielded greater survival benefits (+0.035 QALYs) but at substantially higher costs (ICER: COP 494.3 million/QALY). Across willingness-to-pay thresholds, isavuconazole and voriconazole demonstrated more favorable economic profiles, owing to lower toxicity and reduced hospitalizations. These findings highlight that the clinical–economic value of antifungal therapy is primarily determined by early survival gains, toxicity burden, and front-loaded costs. Strategies minimizing toxicity and hospitalization appear more efficient in constrained health systems, whereas survival-maximizing approaches may be justified in severe disease. This integrated analysis supports context-specific antifungal decision-making in the management of invasive fungal infections. Full article

Healthcare delivery fragmentation can be understood as a structural coordination problem within a socio-technical System of Systems, where autonomous but interdependent providers, insurers, suppliers, information systems, support services, and care recipients interact through uneven incentives, information flows, and dependencies. This paper develops a graph-theoretic structural assessment method for examining how an external governance influence may alter the modeled coordination conditions of such a system before empirical evaluation. A synthetic network is constructed to compare a status quo healthcare SoS with a proposed governance-augmented configuration in which an external governing entity introduces governance interfaces among constituent systems while preserving their operational autonomy. The two configurations are assessed using eigenvector centrality, PageRank, Katz centrality, clustering coefficient, HITS hubs and authorities, anchored structural-priority scenarios, and Monte Carlo sensitivity analysis. Results show that the governance-augmented configuration redistributes modeled structural priority rather than uniformly improving or suppressing any category. Providers and Care Recipients gain prominence and inbound recognition, Insurance and Information Communication Technology retain routing roles despite lower inbound prominence, and reduced clustering indicates lower modeled local closure. Scenario scoring and Monte Carlo analysis show that these interpretations depend on policy-weighting assumptions: Providers and Care Recipients have high probabilities of higher structural-priority scores, Insurance remains near neutral, and Information Communication Technology is slightly lower on average. These findings show that external governance can be modeled as an interface-setting mechanism that reshapes coordination structures while preserving constituent autonomy, without claiming that governance alone would resolve healthcare fragmentation or improve outcomes. Full article

Background: Complex chronic patients (CCPs) frequently experience fragmented care and high healthcare utilization. Integrated multidisciplinary care may improve care coordination and reduce reliance on acute healthcare services, although evidence regarding its impact on healthcare utilization and costs remains inconsistent. This study evaluated the real-world impact of a multidisciplinary integrated care program on healthcare utilization and provider costs among CCPs. Methods: This retrospective before-and-after study included CCPs enrolled in a multidisciplinary integrated care program between 2016 and 2023. Healthcare utilization and provider costs from the provider perspective were compared for up to two years before and after enrollment. Results: The study included 473 patients with a median age of 82 years, 56.7% of whom were women. Significant reductions in acute and ambulatory healthcare utilization and overall provider costs were observed following enrollment and were sustained over two years (p < 0.001). Exploratory economic analyses showed that lower provider costs occurred alongside reductions in acute healthcare utilization. Conclusions: A multidisciplinary integrated care program for CCPs was associated with sustained reductions in healthcare utilization and provider costs over two years. These findings support the potential value of integrated multidisciplinary care for CCPs. Full article

Background/Objectives: Emergency medical care is a critical component of the healthcare system. The aim of the study was to forecast the number of general practitioner and paramedic teams, the number of ambulance stations, and the number of calls per 1000 population in Kazakhstan until 2030. Methods: We conducted a retrospective longitudinal ecological time-series study of the staffing and structure of the emergency medical service in Kazakhstan for 2000–2023. Data were provided by emergency medical stations in 16 regions of Kazakhstan. We also used data from the statistical digest “Health of the Population of the Republic of Kazakhstan and the Activities of Healthcare Organizations”. Results: A progressive decrease in the absolute number of emergency medical system (EMS) stations by an average of 4.19% (95% CI: [−5.00%, −3.37%]) was found. In the period from 2000 to 2023, a relative average annual decrease was found in the number of medical teams by 7.94% [CI −10.14%, 5.69%] and pediatric teams by 7.73% [CI −10.36%, 5.02%]. An analysis showed an average annual growth rate of paramedic teams of 1.62% [CI 0.19%, 3.46%]. The construction of a predictive model for the number of medical and pediatric teams and EMS stations in the country for the coming years demonstrates a further gradual decrease in their number. Conclusions: A predictive model for the number of physician teams predicts a further decline through 2030, while the forecast for the number of paramedic teams remains relatively stable. Full article

The COVID-19 pandemic led to a dramatic increase in healthcare-associated infections and antimicrobial resistance, particularly in intensive care units (ICUs). The aim of this study was to provide a comprehensive genomic characterisation of all clinically significant opportunistic pathogens (OPs) isolated from patients and the hospital environment in COVID-19 ICUs, and to use these data to reconstruct transmission pathways, identify reservoirs, and assess the molecular mechanisms of antimicrobial resistance and virulence. Whole-genome sequencing (WGS) was performed on 175 isolates isolated from patients and the hospital environment (including personal protective equipment, PPE) between 2021 and 2023. The species collection included nine OP species. Bioinformatic analysis included multilocus sequence typing, core genome single-nucleotide polymorphism analysis, phylogenetic reconstruction, and in silico detection of resistance and virulence genes and plasmid replicons. High-risk multidrug-resistant (MDR) clones were identified among Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus. Core genome SNP analysis confirmed direct transmission of K. pneumoniae between patients and healthcare worker medical gloves. PPE was identified as a major reservoir, accounting for 68.4% of environmental isolates. The study demonstrates the power of WGS for high-resolution epidemiological surveillance, confirms the critical role of contaminated PPE in nosocomial transmission, and highlights the dominance of internationally spreading MDR clones in COVID-19 ICUs. Full article

Background: Cholangiocarcinoma (CCA) is a highly heterogeneous malignancy with limited therapeutic options and poor prognosis. The increasing complexity of molecular stratification and treatment selection has stimulated interest in computational and biological modeling approaches for precision oncology. Objective. This narrative review aims to provide a comprehensive overview of digital twins (DTs), DT-enabling computational models, and biological twins (BTs) in CCA, discussing their applications, limitations, and potential integration within hybrid precision medicine frameworks. Methods: A narrative literature review was conducted. To inform the twin-focused sections, a structured PubMed search was performed using predefined keywords related to CCA and twin-related technologies, including organoids, xenografts, organ-on-chip systems. Particular attention was devoted to recent studies addressing computational modeling, patient-derived experimental systems, and translational applications. Results: DT development in CCA is supported by an ecosystem of DT-enabling technologies, including radiomics, artificial intelligence, multi-omics integration, and simulation-based models. However, fully realized medical DTs remain unavailable. BTs, including patient-derived organoids, xenografts, and microfluidic platforms, enable functional validation of therapeutic hypotheses but face challenges related to scalability, standardization, and clinical feasibility. Emerging hybrid DT-BT frameworks seek to combine computational prediction with biological validation through iterative feedback loops, potentially improving patient stratification and treatment personalization. Conclusions: DTs and BTs represent complementary components of an evolving precision oncology ecosystem in CCA. Although technical, biological, regulatory, and implementation challenges remain, the convergence of computational models, longitudinal molecular monitoring, and patient-derived systems may facilitate clinically actionable hybrid twin frameworks. Successful translation will require both technological innovation and healthcare-system improvements to precision medicine access. Full article

Background: Sustainable leadership has emerged as a critical approach for promoting long-term organizational effectiveness and workforce well-being in healthcare settings. However, empirical evidence linking sustainable leadership to workplace integration and resilience among nurses remains limited. Objective: This study aimed to examine the association between sustainable leadership and both workplace integration and resilience among staff nurses. Methods: A descriptive cross-sectional correlational design was used. Data were collected from 200 staff nurses working in intensive and intermediate care units at a tertiary healthcare institution. Standardized instruments were used to measure sustainable leadership, workplace integration, and resilience. Data were analyzed using descriptive statistics, Pearson correlation, and linear regression analysis. Results: Sustainable leadership was positively associated with workplace integration (r = 0.43, p < 0.001) and resilience (r = 0.24, p < 0.001). Regression analysis indicated that sustainable leadership was associated with workplace integration (β = 0.43, R² = 0.18, p < 0.001) and resilience (β = 0.24, R² = 0.10, p < 0.001), explaining a modest proportion of variance in both outcomes. Conclusions: Sustainable leadership is significantly associated with improved workplace integration and resilience among nurses. Healthcare organizations should adopt sustainable leadership practices such as providing consistent mentorship and professional development chances to improve workplace integration, and implementing supportive supervision and wellness initiatives to improve nurse resilience. However, the relatively low explained variance suggests that additional individual and organizational factors contribute to these outcomes. Therefore, sustainable leadership should be integrated with complementary strategies, including peer support programs and workload management interventions, to comprehensively strengthen workforce integration and resilience. Full article

Background/Objectives: Proactively informing the patient prior to initiating medication and implementing preventive strategies are essential for mitigating the risk of developing medication-related osteonecrosis of the jaw (MRONJ). This study evaluated the awareness of MRONJ among a group of dental faculty patients who were scheduled to use, were using, or had previously utilized bisphosphonate and/or denosumab. Methods: A structured questionnaire-based survey was used as the survey tool to evaluate the patients’ awareness of MRONJ. A non-probability convenience sampling method was employed throughout a one-year period. Results: Throughout the study period, 202 participants were included, with a response rate of 97.58%. Only 35 (17.3%) of the patients had awareness of the risk of MRONJ, and 23 (11.4%) reported that their prescribing physicians had informed them about the potential side effects of their medication before the commencement of treatment. Univariate logistic regression, which was performed to elucidate the elements affecting awareness, revealed a significant odds ratio for healthcare professionals as a source of knowledge (29.229, p < 0.001), information of side effects given by a prescribing physician (25.343, p < 0.001), dental consultation (2.592, p = 0.018), and regular dental visits (3.205, p = 0.004). In the multivariate logistic regression analysis, “Healthcare professional as source of knowledge” was significantly associated with awareness (OR = 21.956, p < 0.001). “Information of side effects given by a prescribing physician” was also a significant predictor (OR = 11.450, p < 0.001), indicating that participants informed by prescribing physicians about the side effects were more likely to have awareness. Conclusions: This study revealed that despite patients’ limited awareness of MRONJ, the dissemination of information by healthcare professionals positively influenced their awareness and understanding of the risk factors associated with MRONJ. In particular, receiving information from healthcare professionals and prescribing physician-provided information about side effects appeared to be the strongest predictors of awareness. Full article