Search Results (12,807)

Despite longstanding vaccine availability, human papillomavirus (HPV) remains the most common sexually transmitted infection in the United States and a leading cause of preventable cancers. Additionally, HPV vaccination rates remain below other routinely recommended adolescent immunizations, particularly in rural populations. This study aimed to identify barriers related to healthcare access, socioeconomic conditions, cultural beliefs, and provider–patient communication in rural communities. A bibliographical review of articles published in English from 2020 to 2025 and an analysis of national datasets were conducted to establish trends in HPV vaccination rates. State-level HPV vaccination data for adolescents aged 13–17 years were obtained from America’s Health Rankings and the Centers for Disease Control and Prevention National Immunization Survey-Teen. States were classified as predominantly rural or urban using Rural–Urban Continuum Codes, and mean vaccination completion rates were compared. The mean HPV vaccination completion rate was lower in rural states (60.55%) compared to urban states (67.31%); however, this difference did not meet the selected threshold for statistical significance (p = 0.025). Barriers identified in the literature included reduced access to healthcare, differences in provider communication, socioeconomic constraints, and limited health literacy in rural communities. Of the identified barriers, healthcare provider recommendations emerged as one of the strongest predictors of vaccine acceptance. These findings highlight multilevel determinants contributing to differences in HPV vaccine uptake and underscore the need for targeted, evidence-based strategies to improve vaccine access and coverage in underserved adolescent populations. Full article

AI-driven smart healthcare platforms increasingly combine multimodal data acquisition, remote monitoring, predictive analytics, longitudinal dashboards, and role-specific information services. While these capabilities enable more continuous and personalized health monitoring, they also introduce accessibility challenges that extend beyond conventional user-interface design, particularly in how monitoring results and AI-generated outputs are structured, contextualized, and communicated. This paper addresses the gap in operationalizing accessibility at the system level by proposing a standards-mapped Accessibility-by-Design framework for AI-enabled smart healthcare platforms. Requirements derived from international accessibility, human-centred design, and software quality standards are translated into traceable architectural and component-level constraints and integrated into the development workflow. The methodology combines standards-to-requirement-to-component traceability mapping, architectural documentation analysis, component inspection, and controlled workflow walkthroughs. The framework is applied to the NeuroPredict platform, an AI-based environment for longitudinal and multimodal monitoring of neurodegenerative disorders. Accessibility is operationalized through cross-layer architectural mechanisms, including semantic interface components, predictable interaction workflows, accessible presentation mechanisms, and structured representation of monitoring and AI outputs. AI-generated results are presented in a structured form together with contextual, temporal, source-related, and explanatory information to support role adaptation; uncertainty-related fields are reserved for future validated user-facing integration. Implementation evidence from selected platform workflows demonstrates that the proposed mechanisms can be incorporated into the current platform architecture and provides preliminary support for their technical feasibility. The evidence remains limited to implemented and inspected mechanisms, without user-based accessibility validation, formal conformance auditing, clinical deployment, or regulatory certification. These results illustrate that, while maintaining the distinction between accessibility mechanisms and the underlying analytical computation, accessibility-by-design can offer an engineering foundation for integrating accessibility requirements into the architecture and development lifecycle of AI-driven smart healthcare platforms. Full article

Prostate cancer is the most commonly diagnosed non-cutaneous malignancy among men in the United States and remains a leading cause of cancer-related mortality. Its marked biological, molecular, and histopathological heterogeneity creates a central diagnostic challenge: identifying clinically significant disease while limiting unnecessary biopsy and overdiagnosis of tumors unlikely to affect survival or quality of life. Although prostate-specific antigen (PSA) remains the foundation of early detection, its limited cancer specificity has driven the development of increasingly risk-adapted diagnostic pathways. Contemporary evaluation integrates clinical risk assessment and PSA-derived measures with selectively used blood- and urine-based biomarkers, multiparametric magnetic resonance imaging (mpMRI), image-guided biopsy, histopathological classification, genomic risk assessment, and molecular imaging. Biomarkers such as the Prostate Health Index, 4Kscore, IsoPSA, MiCheck, SelectMDx, and ExoDx may refine biopsy decisions in appropriately selected patients but should be interpreted according to the clinical setting, decision threshold, and surrounding diagnostic pathway. Prostate MRI and PI-RADS-based assessment have become central to pre-biopsy evaluation, while MRI-targeted biopsy improves detection of Grade Group ≥ 2 disease. Increasing use of the transperineal biopsy route offers comparable cancer detection with a lower infectious risk. Following diagnosis, Grade Group, adverse histological features, clinical risk models, and selected tissue-based genomic classifiers provide complementary prognostic information. PSMA PET/CT has further improved staging of selected patients with higher-risk disease and localization of biochemical recurrence. Precision diagnostics must also account for disease phenotypes that may not be adequately represented by conventional PSA- and imaging-based pathways, including intraductal carcinoma, cribriform architecture, ductal adenocarcinoma, and neuroendocrine prostate cancer. Emerging approaches, including artificial intelligence-assisted MRI interpretation, digital pathology, high-frequency micro-ultrasound, liquid biopsy, alternative molecular radiotracers, and multi-omic integration, show increasing potential but remain at different stages of validation and clinical adoption. This review critically examines contemporary prostate cancer diagnostics within United States clinical practice, distinguishing established guideline-supported approaches from selectively used adjuncts and emerging technologies. Particular emphasis is placed on diagnostic performance in context, clinical utility, external validation, healthcare equity, regulatory considerations, and the need to demonstrate that increasing diagnostic complexity translates into meaningful improvements in patient care. Full article

Actionable ALK, ROS1, RET, NTRK, and NRG1 fusions define biologically distinct subsets of advanced non-small cell lung cancer (NSCLC), yet real-world data across these rare populations remain limited. We retrospectively evaluated patients with advanced NSCLC treated at Memorial Healthcare System who received genotype-matched fusion-directed therapy; the first fusion-directed agent defined the index treatment, and survival was measured from its initiation. Progression was determined from radiographic reports and treating-oncologist documentation. After patient-level reconciliation, 59 unique patients were included: 29 ALK, 14 ROS1, 11 RET, 3 NTRK, and 2 NRG1. Median follow-up was 47.7 months (95% CI, 28.6–58.7), median progression-free survival was 44.8 months (95% CI, 17.1–not estimable), and median overall survival was not reached. No statistically significant survival differences were detected among ALK, ROS1, and RET subgroups, although limited sample sizes preclude exclusion of clinically meaningful differences. Later-line index therapy was not significantly associated with progression-free survival in exploratory unadjusted analysis. These findings provide descriptive real-world evidence of precision-oncology implementation across actionable fusion-defined NSCLC while underscoring that pooled outcomes should not be interpreted as evidence of equivalent efficacy across molecular subtypes or therapies. Full article

Background: Communication competence is essential for nurse managers because it facilitates team coordination, organizational alignment, shared decision-making, and the quality and safety of care. Despite its acknowledged importance, the key traits of this competence have not been systematically summarized. Objective: We aimed to identify and describe the traits of communication competence among nurse managers in healthcare settings, determine the most frequently reported traits, and explore the contextual, behavioral, and organizational factors associated with its expression. Methods: A systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO (CRD420261356065). Searches were performed in Web of Science, Scopus, PubMed, and CINAHL, covering 1 January 2016 to 1 February 2026. Peer-reviewed studies using quantitative, qualitative, or mixed methods that addressed communication competence from the perspective of nurse managers were included. Data analysis involved a structured narrative synthesis that combined frequency analysis of identified traits with contextual analysis of communication competence. Results: Fifteen studies met the inclusion criteria. After comparison, grouping, and conceptual refinement, 23 communication traits were identified. The most frequently reported traits were Active Listening and Verification of Understanding, along with Strategic and Multi-Channel Communication Planning (each 10.14%), followed by Building Trust-Based Professional Relationships (9.18%), Open and Transparent Communication (8.21%), and Clear, Consistent, and Effective Message Design (7.73%). The results also indicated that communication competence is context-dependent and linked to organizational factors such as structural empowerment, shared decision-making, and managerial visibility. Empowering communication behaviors correlated with psychological empowerment, team cohesion, staff retention, and perceived improvements in quality of care. Conversely, limiting behaviors were associated with declines in trust, dignity, and professional functioning. Conclusions: Communication competence among nurse managers is not merely a peripheral interpersonal trait but a core managerial skill with a well-defined foundation. Its key elements suggest that this competence is built on responsiveness, strategic intentionality, and relational credibility. Therefore, communication competence should be viewed as an organizationally significant capability that directly affects team performance, workforce sustainability, psychological safety, and the quality of care. Implications for Nursing Management: Recognizing a core set of communication traits provides a useful basis for leadership training, simulation exercises, and managerial evaluations. Improving this skill could strengthen team unity, boost staff involvement, and enhance the quality of care as healthcare settings become more complex. Full article

Surveillance of methicillin-resistant Staphylococcus aureus (MRSA) in the environment is crucial for reducing its transmission, particularly in hospitals, nursing homes, and high-contact public areas. Rapid Point-of-Need (PON) tools at healthcare facilities, without involving prolonged bacterial culture in sophisticated laboratories, are needed for environmental surveillance of MRSA. We have developed a gold nanoparticle (AuNP)-based “Swab-and-Stain” assay for rapid and on-site detection of PBP2a-expressing MRSA from environmental surfaces. The assay utilizes anti-PBP2a antibody immobilized on cotton swabs to specifically capture PBP2a-expressing MRSA and anti-MRSA antibody conjugated on AuNPs to detect the captured MRSA on the swabs via sandwiched complex formation. In the presence of PBP2a-expressing MRSA, the swabs were stained in red, as seen with the naked eye. The color intensity of the stain can be quantified by smartphone image analysis for MRSA quantification. Using PBP2a-expressing MRSA samples spiked in real hospital sink and drain matrices, this pilot study demonstrated a “Swab-and-Stain” assay as a proof-of-concept method for detecting MRSA at a concentration as low as 12 CFU/mL. The assay was validated to specifically detect MRSA spiked in real hospital sink and drain matrices. This “Swab-and-Stain” assay provides a rapid, portable, and easy-to-use platform with potential application for PON environmental surveillance of MRSA. Full article

Digital transformation (DT) is a strategic priority for healthcare systems seeking to improve the quality of care, patient safety, and operational efficiency. In Saudi Arabia, DT is central to Vision 2030; however, evidence regarding its effects on healthcare quality and safety remains dispersed across technologies and healthcare settings. This narrative review aimed to examine the impact of digital transformation on healthcare quality and patient safety in Saudi Arabia and to identify the principal implementation facilitators, barriers, and policy implications. A structured narrative literature search was conducted for publications from January 2010 to March 2026 using PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, the Saudi Digital Library, and relevant Saudi governmental and policy documents. In total, 64 peer-reviewed studies, reviews, reports, and policy documents addressing digital health initiatives and outcomes related to quality, safety, efficiency, or patient experience were included. Evidence was synthesized thematically, focusing on electronic health records, digital prescribing, online appointment systems, clinical and pharmacy automation, claims and financial analytics, telemedicine, governance, and workforce factors. The reviewed evidence indicates that Electronic Health Record (EHRs), computerized provider order entry, e-prescribing, barcode-supported medication systems, telemedicine, digital appointment platforms, and automated workflows can improve access to care, documentation, care coordination, medication safety, workflow efficiency, and patient experience. However, the benefits of DT are constrained by fragmented infrastructure, limited interoperability, workforce resistance, insufficient digital literacy, funding limitations, and unclear or fragmented governance and regulatory arrangements. In conclusion, digital transformation has substantial potential to enhance healthcare quality and patient safety in Saudi Arabia. Achieving these benefits requires context-sensitive implementation, interoperable systems, strong governance, sustained investment in infrastructure and workforce capacity, and effective leadership and change-management strategies aligned with Vision 2030. Full article

Background: During the coronavirus disease 2019 (COVID-19) pandemic, changes in healthcare organisation may have affected the management of patients with chronic conditions, such as those with type 2 diabetes (T2D), who require close monitoring. Although there are studies that have analysed the access and management of patients with T2D in primary care (PC) during the pandemic, there is no synthesis of the results that inform us about the care provided and their effect. The aim of this study is to summarise the existing evidence on the care provided in PC settings to patients with T2D during the COVID-19 pandemic, as well as their follow-up care and outcomes, in order to understand the impact of the pandemic on their management. Methods: A scoping review was conducted according to the approach described by Arksey and O’Malley. Structured search strategies were developed for each of the selected databases (PubMed, EMBASE and Web of Science). We included articles published in English and Spanish up to 24 March 2026 on access to care for patients with T2D in PC during the pandemic. Two independent reviewers screened titles and abstracts to select studies related to the population, intervention, and outcomes of interest. In cases of disagreement, a third reviewer resolved the discrepancy. One of the reviewers extracted data and summarised them. Results: After duplicate removal, 535 records were identified, with 116 articles screened in full text and 26 included. Most studies were conducted in Europe and North America using retrospective designs and electronic health records. During the pandemic period, face-to-face visits and routine screenings generally declined, while telemedicine expanded and may have partially mitigated disruptions in patient contact, although inequalities in access were reported. Disease monitoring and complication screening also declined in several settings. Clinical outcomes such as HbA1c and blood pressure (BP) showed heterogeneous trends, with some studies reporting deterioration and others reporting stability. Some studies also highlighted increased adverse events and greater attention to mental health during care. Conclusions: Although telemedicine helped maintain patient follow-up, it could not fully replace face-to-face assessments and was implemented alongside some gaps in clinical monitoring, patient safety, and health equity. These findings underscore the need to maintain structured chronic disease management and to develop safe and inclusive telehealth models. Full article

Background: Geriatric dentistry prepares dentists to care for an aging population. Yet, its integration into undergraduate curricula remains inconsistent. Objectives: To map evidence on the barriers to and facilitators of the implementation and development of undergraduate geriatric dental education. Methods: A scoping review was conducted using systematic searches of PubMed, Scopus, and Embase for English-language original research articles published from 1 January 2016 onward. Two reviewers screened titles, abstracts, and full texts independently against eligibility criteria. Studies were included if they examined barriers and/or facilitators related to undergraduate geriatric dental education. Data were extracted independently and synthesized descriptively to identify themes and evidence gaps. No critical appraisal was performed. Results: This review identified 1376 studies and included 11 studies, including seven cross-sectional and four cohort studies. Barriers clustered into three themes: structural and workforce-related barriers (resource constraints and a lack of equipped/trained staff), curricular and regulatory barriers (overcrowded curricula and a lack of curriculum guidelines), and interprofessional and attitudinal barriers (limited interprofessional collaboration and negative attitudes among students and teaching staff towards older adults). Facilitators were grouped into three themes: pedagogical and experiential learning strategies (didactic teaching, clinical training, extramural exposure, simulation-based training, and communication training), curricular and policy enablers (integrated curricula and national guidelines), and institutional and faculty support (staff support). Conclusions: This review identifies the multifaceted, modifiable educational, institutional, and policy factors that influence the implementation and development of geriatric dental education. By consolidating the existing evidence, this review provides a foundation for curriculum development and policy planning to prepare graduates to deliver age-responsive oral healthcare. Full article

Background/Objectives: Adolescents with intellectual disabilities may experience inequities in preventive healthcare, including HPV vaccination. This review aimed to synthesize evidence on HPV vaccination-related knowledge, attitudes and perceptions among adolescents with intellectual disabilities, parents/caregivers, educators, healthcare professionals and other stakeholders. Methods: A systematic search was conducted in PubMed, Embase and Scopus on 29 October 2025. Eligible studies reported original data on knowledge, attitudes or perceptions regarding HPV vaccination for adolescents with intellectual disabilities or relevant stakeholders. The protocol was registered on PROSPERO (CRD420251015183). Quantitative, qualitative and mixed-methods studies were considered. Results: Seven studies were included. They were conducted in the USA, Australia and the UK and involved parents/caregivers, healthcare providers, school staff, immunization staff and adolescents or young people with disabilities. Direct evidence from adolescents was limited. HPV-related knowledge was often limited or uneven, and standard information materials were perceived as insufficiently accessible. Parents/caregivers were often broadly supportive of vaccination, but HPV-specific acceptance was affected by perceived low susceptibility, assumptions about sexual inactivity, safety concerns, procedure-related distress and lack of provider recommendation. Healthcare providers generally supported HPV vaccination; however, recommendations were sometimes influenced by perceived sexual activity, age or consent. School-based vaccination was considered useful but required tailored information, preparation, individual adjustments and follow-up. Conclusions: Evidence on HPV vaccination-related knowledge, attitudes and perceptions among adolescents with intellectual disabilities and their stakeholders remains limited and geographically restricted. Improving equitable access may require interventions that should be further investigated, such as accessible communication, systematic provider recommendation, flexible vaccination pathways and greater involvement of adolescents in decision-making. Full article

Human Activity Recognition (HAR) using wearable sensor data is widely applied in healthcare, smart environments, and mobile systems. Support Vector Machines (SVMs) are commonly used for HAR due to their strong generalization ability. However, traditional approaches often rely on single kernels and may not fully capture complex motion patterns. This research presents a comparative analysis of seven SVM-based methods, including Multiclass SVMs, Radial Basis Function (RBF) SVMs, Kernel Engineering SVMs, Multiple Kernel Learning (MKL) SVMs, Class-Weighted SVMs, Least Squares SVM approximation, and Online Incremental SVMs. A unified experimental framework with consistent preprocessing and hyperparameter tuning using Grid Search with cross-validation is employed to ensure fair evaluation. Results show that kernel-based methods outperform linear and approximate models. The MKL SVM achieves the highest accuracy, slightly surpassing the RBF baseline, by combining multiple kernels to capture diverse data characteristics. Kernel Engineering SVM also improves performance, while Fuzzy and LS-SVM provide competitive results with enhanced robustness. In contrast, Multiclass and Online SVM exhibit lower accuracy. Thes results demonstrate that improving feature representation through advanced kernel design is key to enhancing HAR performance. Full article

Determining appropriate nurse and midwife staffing levels in neonatal units is essential to provide safe, effective, and high-quality care to premature and critically ill infants. Ratio-based staffing methods currently utilized to guide staffing decisions consider factors such as infant acuity, specific illnesses, and treatment needs. However, these approaches may not adequately reflect contemporary neonatal care and are supported by limited empirical evidence. This study aims to generate robust evidence on the time required to provide care for infants with varying acuity levels and to develop a novel neonatal staffing model based on observed workload. This multi-site time-motion study will use one-to-one continuous observations of nurses and midwives providing care to infants across different acuity levels in South Australian neonatal units. Independent observers will record all activities performed and their duration. Descriptive statistics will be used to summarize activity characteristics, time allocation across care tasks, and infant acuity distributions. Regression modelling, including quantile and generalized linear models, will examine relationships between staffing, infant acuity, and time required for care activities. Model development will incorporate infant characteristics and nurse/midwife qualifications to estimate staffing requirements under different acuity scenarios. Sensitivity analyses and validation procedures will be undertaken to assess model reliability and generalizability. Continuous-observation time-motion studies are considered the gold standard for measuring healthcare activity duration and quantifying nursing and midwifery workload. This study will contribute to the development of an empirically informed neonatal staffing model in Australia, providing contemporary evidence to support workforce planning and to better align staffing requirements with infant care needs and acuity. Full article

Background/Objectives: This study examines the continued use of smart healthcare applications among older adults by integrating the Health Belief Model (HBM) with the Unified Theory of Acceptance and Use of Technology (UTAUT). Perceived health threat and health management self-efficacy were considered health-related antecedents, while technology anxiety was examined as a moderator. Methods: Data were collected from 224 South Korean adults aged 60 years or older with prior experience using smart healthcare applications. Confirmatory factor analysis and structural equation modeling were used to assess the measurement and structural models. Indirect effects were tested using 5000 bootstrap resamples, and moderation was examined through hierarchical regression and simple slope analysis. Results: Perceived health threat was positively associated with performance expectancy but not with effort expectancy. Health management self-efficacy was positively associated with both performance and effort expectancy. Performance expectancy, effort expectancy, social influence, and facilitating conditions were all positively associated with behavioral intention, which showed the strongest relationship with actual use behavior. Technology anxiety significantly weakened the relationship between social influence and behavioral intention, whereas its moderating effects on performance expectancy and effort expectancy were not significant. Conclusions: The findings provide an integrated explanation of continued smart healthcare application use among older adults by linking health-related beliefs, UTAUT factors, and technology anxiety. Sustained use may be promoted by strengthening self-efficacy, improving usability, and reducing technology-related anxiety through accessible design and appropriate support. Full article

Background: Saudi Arabia’s healthcare system serves an increasingly diverse patient population, yet limited qualitative evidence exists regarding how pediatric nurses navigate cultural complexity in their daily practice. Understanding nurses’ day-to-day experiences of cross-cultural care is essential for strengthening culturally sensitive pediatric services. Purpose: This study explored the experiences of pediatric nurses in providing culturally sensitive care to children and their families in Riyadh, Saudi Arabia. Methods: A qualitative descriptive study was conducted in pediatric units of tertiary hospitals in Riyadh City, Saudi Arabia. Eighteen pediatric nurses participated in semi-structured interviews. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Results: Four themes emerged: navigating cultural landscapes, describing nurses’ encounters with diverse cultural beliefs and health practices; communication as a bridge and a barrier, reflecting language challenges and strategies for meaningful engagement; balancing professional standards with cultural respect, highlighting the tension between evidence-based care and cultural accommodation; and the emotional labor of cross-cultural caregiving, capturing the personal toll and resilience involved in culturally diverse practice. Conclusions: Pediatric nurses engage in complex interpretive, relational, and emotional work when providing culturally sensitive care. Institutional support through cultural competence training, multilingual resources, and organizational policies is essential for enhancing culturally responsive pediatric nursing practice in diverse healthcare settings. Full article

The U.S. healthcare delivery infrastructure functions as a complex socio-technical system-of-systems (SoS). In this environment, autonomous, interdependent entities (providers, insurers, and IT networks) must balance local efficiency with system-wide coordination. Existing governance mechanisms frequently fail to prevent operational fragmentation, yet the conditions under which governance pressure generates or inhibits coordination remain poorly understood. This study introduces a three-parameter cost framework. The framework comprises default operational costs, incoherence penalties for structural misalignment, and switching costs associated with modernization. This framework enables the examination of how governance structures shape emergent alignment in healthcare SoS. The three cost components are grounded in the Confluence Interoperability Covenant (CIC), a governance framework that codifies standards for interaction among autonomous healthcare systems and extends it into a computationally tractable form for simulation-based analysis. The contribution lies in jointly operationalizing these three cost components interacting with each other within a healthcare SoS governance framework using agent-based modeling and simulation (ABMS) and examining how their interaction shapes coordination under decentralized, periodic adaptation. Using a stylized exploratory ABMS framework implemented on a network, we analyze how these parameters influence coordination dynamics across a range of simulated governance conditions. The results reveal three emergent patterns. First, higher incoherence costs accelerate the transition from fragmented legacy configurations toward greater alignment. Second, high switching costs can create lock-in dynamics in which inefficient arrangements persist because transition burdens suppress adaptation. Third, the relationship between governance pressure and speed of coordination is non-monotonic: at early review horizons, moderate incoherence costs can produce faster coordination than maximal pressure, whereas stronger pressure eventually produces lower entropy as the simulation progresses. This finding reflects a transient finite-horizon coordination advantage rather than a fixed optimal governance level. This last finding suggests that governance effectiveness is horizon-dependent rather than a simple linear function of regulatory intensity. These findings contribute to a complexity-informed understanding of healthcare governance by showing that alignment in adaptive SoS depends not only on the intensity of interoperability pressure but on its interaction with institutional transition burdens. The model is designed as a mechanism-exploration framework to support future empirically grounded policy analysis and data collection. Full article