Search Results (979)

Background/Objectives: The accelerated digitalisation of dental practice is significantly influencing how patients perceive and accept modern treatments. This study uses a structured questionnaire to evaluate patients’ knowledge of, and attitudes towards, digital technologies in dentistry, adopting an original, patient-centred perspective within routine clinical settings. Methods: Non-parametric statistical methods (Mann–Whitney U test, Kruskal–Wallis H test and Spearman correlations) were employed to analyse the responses of 397 participants. To reduce selection bias, a systematic sampling technique was employed, and thorough validation ensured the consistency of the instrument. The questionnaire covered socio-demographic information, prior dental experience and opinions regarding specific digital applications (intraoral scanning (IOS), cone-beam computed tomography (CBCT), CAD-CAM workflows, 3D printing). Knowledge was operationalised as awareness; no keyed objective knowledge test was administered. Results: The findings show that patients generally accept digital technologies, with perceptions of costs, prior experience of digital dental procedures and educational level having a significant impact. The duration of the patient–clinician relationship, the patient’s dental health, and the history of orthodontic and prosthetic procedures also impacted the acceptance of digital technologies. Notably, clinical staff members were the main source of information, highlighting the importance of professional–patient communication. Conclusions: The results highlight the importance of patient-friendly communication in healthcare and provide a solid basis for the implementation of patient-centred digital dentistry. Future plans should focus on creating specialised educational materials, improving digital literacy, and promoting equal access to cutting-edge technologies in urban and disadvantaged communities. Full article

The proliferation of Digital Twins (DTs) across industries like manufacturing, healthcare, and logistics is leading to the formation of complex ecosystems where heterogeneous DTs must cooperate. In such environments, establishing trust becomes paramount. However, trust in DTs remains an under-investigated problem, with current research predominantly focused on security and privacy, which are prerequisites but not sole constituents of trust. This paper presents a comprehensive framework for analyzing and enhancing the trustworthiness of Digital Twins. First, we propose a novel five-layer symmetrical reference architecture (Asset, Synchronization, Data, Application, Integration) that models physical and digital twins as peers, improving reusability and maintainability. Using this architecture as a foundation, we then develop a multi-dimensional taxonomy to categorize DT trust issues from three critical perspectives: (1) an architectural perspective, which identifies and maps trust issues (e.g., model accuracy, data latency, application usability) to specific layers and behavioral attributes like conformance and dependability; (2) a massive twinning perspective, which explores emergent challenges in ecosystems of cooperating DTs, such as relationship complexity and data management; and (3) a stakeholder perspective, which addresses the need for both qualitative and quantitative trust assurances. Our analysis reveals that trust is a composite property requiring a holistic approach beyond conventional security. The paper concludes by synthesizing these perspectives into a unified view of DT trust and outlining critical open challenges and future research directions, providing a foundational roadmap for developing truly trustworthy Digital Twin systems. Full article

The root of metabolic disease lies in the gastrointestinal tract, where nutrient absorption occurs. Within this environment, a diverse community of microorganisms exerts effects that extend beyond the intestinal barrier. Akkermansia muciniphila (A. muciniphila), one such bacterium, has been associated with enhanced intestinal integrity, reduced intestinal inflammation, weight loss, and improved insulin sensitivity, mediated through mucus fermentation, production of short-chain fatty acids (SCFAs), bacterial proteins, and extracellular vesicles (EVs). Research in this field is promising, yet far from perfect. Its clinical applicability remains limited by factors such as strain variability, scarcity of human intervention studies, and the lack of established causality. While associations have been consistently observed in both rodent and human studies, causality has thus far been demonstrated only in animal models. This issue is of critical importance, as metabolic disease remains highly prevalent, carries systemic consequences, and imposes a substantial burden on healthcare systems, underscoring the urgent need for alternative therapeutic strategies. The aim of this narrative review is to synthesize current knowledge on A. muciniphila and to highlight the key limitations consistently reported in the literature. By addressing these factors, the review seeks to provide realistic perspectives on its therapeutic potential and to outline directions for future research. Full article

Background/Objectives: Studies on the satisfaction of patients’ relatives in intensive care units are quite limited both in our country and worldwide. In intensive care units, particularly in adult settings, communication is known to be one of the most important factors influencing patient and family satisfaction. From a communication theory perspective, there are very few qualitative descriptive studies that reveal how this issue is perceived. This research aims to examine the information needs of relatives of patients receiving treatment in intensive care units and their satisfaction levels with regard to regular information provision practices carried out by healthcare professionals working in intensive care units in Turkey. Methods: Semi-structured interviews were conducted with 23 patients’ family members in two adult ICUs at a university-affiliated training and research hospital in Turkey. In the data collection process, the ‘Critical Care Family Needs Inventory’ was used to establish the family needs, as well as a sociodemographic questionnaire that included: age, gender, educational level, patient relationship and previous ICU experience. The unstructured texts obtained from the interviews were analyzed using the Atlas.ti qualitative data analysis software for the thematic analysis method. Results: The findings revealed that while face-to-face information provided by healthcare professionals is generally perceived as comprehensive, regular, and confidence-building, the experience of obtaining information by telephone varies greatly depending on hospital and family circumstances. Inconsistencies in telephone-based information access can create significant communication barriers for some families, yet in certain situations (e.g., chronic illnesses), it can serve as a vital adaptation and information flow tool. Conclusions: The ‘Uncertainty Management Theory’ and the ‘Information Management Theory’ are critical for understanding the effects of communication quality in the intensive care unit (ICU) environment on the psychological state of family members and their decision-making processes. Healthcare professionals should recognize that their communication serves not only an informative function but also has profound effects on family members’ psychological well-being and participation in the healthcare process. Full article

Background/Objectives: Early diagnosis of periodontal disease is vital for preventing disease progression and improving patient outcomes. This study explored healthcare professionals’ perspectives on a novel minimally invasive biofluid sampling device intended for periodontal disease diagnosis. Methods: A co-design approach was used to engage end users during early device development. Two focus group discussions were conducted with dentists, followed by an online questionnaire completed by dentists and other oral healthcare professionals. The aim was to gather opinions, preferences, and suggestions regarding the proposed device’s design and clinical application. Results: The innovation was well received by survey respondents (n = 54) and participants of the focus group discussions, who also provided insightful comments on aspects including physical features, diagnostic value, usability, and integration with clinical workflow. Conclusions: The co-design process revealed that there is a need for the novel biofluid sampling device. Suggestions from the participants helped improve an early internal Target Product Profile and bring the device closer to clinical requirements and expectations. Full article

Background/Objectives: Neck pain is a complex biopsychosocial condition that affects a significant proportion of the global population. Projections indicate that over the next 30 years, cervical pain will impact approximately 269 million individuals, positioning it as one of the primary drivers of healthcare expenditure and system burden worldwide. While exercise is a key approach for neck pain, the effectiveness and cost-effectiveness of treatments delivered remotely remain underexplored. The aim of this study is to analyse the cost-effectiveness and cost-utility of the treatment of non-specific neck pain through a telerehabilitation programme based on cervical exercise and analgesic electrotherapy. Methods: This is a study protocol for an economic evaluation based on a randomised controlled trial (RCT) with a sample size of 210 participants (N = 210). The sample will be evenly divided into two groups to perform the same cervical exercise programme combined with electroanalgesia: one group will receive the intervention via telerehabilitation, and the other will receive the intervention face-to-face. Three sessions will be held per week for eight weeks for a total of 24 sessions. Demographic and clinical data of the participants, healthcare resource utilisation, and associated costs will be collected. Assessments will be carried out throughout the study: before the first session (baseline), at 8 weeks (post-intervention), and 6 months after completion of the treatment (follow-up). Discussion: This study will make a significant contribution to reducing costs and improving the treatment of patients with non-specific chronic neck pain. The social perspective associated with economic evaluation will enable the investigation of indirect costs such as work absenteeism or expenses borne by the patient, providing useful data to optimise planning and decision-making in the healthcare sector. Full article

Background: Autism Spectrum Disorder (ASD) is a multifactorial neurodevelopmental condition in which genetic predisposition interacts with environmental factors. Among these, the gut microbiota has emerged as a crucial modulator of the microbiota–gut–brain axis (MGBA), influencing neuroinflammation, neurotransmission, and behavior. This review aims to provide an updated and integrative overview of the relationship between gut microbiota, diet, and neurodevelopment in ASD. Methods: A comprehensive search was conducted in PubMed, Scopus, and Web of Science for articles published between 2010 and 2025. Original studies, systematic reviews, and meta-analyses in English were included. Results: Evidence from human and animal studies supports a strong association between gut dysbiosis and ASD-related behaviors. Alterations in microbial composition, characterized by reduced Bifidobacterium and Prevotella and increased Clostridium spp., have been linked to impaired intestinal barrier function, chronic inflammation, and altered production of microbial metabolites such as short-chain fatty acids and tryptophan derivatives. Discussion: Maternal dysbiosis, nutritional imbalances, and perinatal stressors may further modulate fetal neurodevelopment through immune and epigenetic pathways. Emerging data suggest that dietary modulation, targeted nutritional interventions, functional foods, prebiotics, probiotics, and postbiotics could help restore microbial balance and improve neurobehavioral outcomes. Conclusions: The gut microbiota represents a key biological interface between environment, metabolism, and neurodevelopment. It is, therefore, necessary to transform current knowledge about the microbiota and neurodevelopment into clinical, social, and health actions that offer real solutions to people with ASD and their families. From this perspective, focusing on prevention, promoting healthy lifestyles, and integrating new technologies represent the true tools for building a more sustainable and inclusive healthcare system. Full article

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients. Full article

This Perspective presents a framework for US hospitals treating foreign patients to reconceptualize international healthcare trade by leveraging all four modes of trade in health services under the General Agreement on Trade in Services (GATS), which include information exchange (Mode 1), patient travel/medical tourism (Mode 2), commercial presence (Mode 3), and temporary movement of healthcare personnel (Mode 4). This framework illustrates how hospitals could adopt multi-modal approaches and describes the strategic implications for hospitals and their international patient programs. Historically, US hospitals have focused primarily on international patient travel (Mode 2), but this narrow approach creates vulnerability to disruption. Mode 2 exports by US hospitals have not recovered to pre-pandemic levels, making expansion into other modes essential for maintaining competitive advantages while mitigating systemic risks. Diversification into other modes, such as digital health and telemedicine (Mode 1), co-branding and managing facilities (Mode 3) and visiting professorships (Mode 4) are single-mode approaches for diversification. Multi-country clinical trials are an example of cross-border trade that addresses all four modes of GATS. Overall, this perspective provides a new framework for US providers engaged in or considering entry into international markets that does not solely rely on Mode 2 medical tourism but instead adopts a multi-modal, cross-border health service paradigm. Full article

Background: Liver transplantation is the most effective curative treatment for patients with hepatocellular carcinoma. Due to the scarcity of cadaveric donor livers, several selection criteria have been established; however, these criteria are highly restrictive. In this study, we compare alternative selection tools with the standard selection criterion, the Milan Criteria. We conducted a cost-effectiveness analysis from the perspective of the U.S. healthcare system to determine which criterion provides the greatest benefit to the health system. Methods: An innovative non-homogeneous Markov model was developed to simulate the health trajectories of patients with hepatocellular carcinoma who underwent liver transplantation over five years. The model incorporated time-dependent transition probabilities, enabling the simulation to capture the evolving risks of recurrence and mortality. Transition probabilities, costs, and QALYs were obtained from published studies, while recurrence probabilities were estimated using the Kaplan–Meier method based on a cohort of 149 patients. We evaluated mean recurrence-free survival, life years gained, quality of life, and the incremental cost-effectiveness ratio (ICER) relative to the Milan Criteria. Results: HepatoPredict yielded the most significant benefits but incurred higher total costs than the other criteria. The ICERs of HepatoPredict Class I and Class II relative to the MC were $14,689.58/QALY and $39,542.98/QALY, respectively. Both values were below the cost-effectiveness threshold (U.S. GDP per capita: $81,632.25/QALY), indicating that HepatoPredict is cost-effective in the U.S. healthcare system. Conclusions: HepatoPredict stands out as the most cost-effective criterion and optimises organ allocation, an especially important consideration given the scarcity of donor livers. This represents a substantial advantage for healthcare institutions. Full article

Background/Objectives: This study explores the concept of dignity in care for older patients with cancer in Korea using the hybrid model. Methods: A three-phase hybrid model approach was employed for concept analysis. In the theoretical phase, a literature review was conducted to determine the attributes and definition of dignity in care. In the fieldwork phase, the practicability of the defined concept was assessed through practical observations. In the final analysis phase, findings from the theoretical and fieldwork phases were compared and synthesized to validate the attributes and definition of the concept. Results: Four dimensions of dignity in care were found identified: intrinsic, relational, social, and illness-related. Professional dimension was added based on nurses’ perspective. Attributes of dignity in care for older cancer patients include eight key elements: personal identity, a deepened sense of value and meaning of life, respect, relationships (with medical staff, family, and fellow patients), support for society’s care policies, systemic support from healthcare systems, free will and choice, and proactive coping strategies. For nurses, dignity in care involves seven attributes: understanding and respecting human values, ethical and moral attitudes, interaction-based communication through the cultivation of rapport, systemic support from healthcare systems, protection of dignity, activities promoting dignity, and professional competency. Conclusions: This study provides concept definitions and attributes for dignity in care, equipping clinical nurses with assessment tools to better understand and enhance the dignity of older cancer patients. Full article

Background/Objectives: COPD is a leading cause of death in the US, with higher morbidity and mortality in rural areas that lack specialized pulmonary care. Mobile health (mHealth) tools, including remote spirometry, may fill this gap, yet healthcare provider (HCP) perspectives on utility and implementation of remote spirometry and mHealth for COPD management in these settings remain unexplored. This study aimed to examine HCPs’ perspectives of mHealth with remote spirometry to inform future implementation in rural and low medical access settings. Methods: Five HCPs working in rural or medically limited settings in South Carolina participated in a deliberative discussion focus group. A semi-structured interview guide was used to explore insights into feasibility, clinical utility, and implementation needs. Transcripts were analyzed using thematic analysis to identify facilitators, barriers, and implementation considerations. Results: Participants reported that remote spirometry and mHealth had potential to support COPD treatment, increase healthcare access, and support self-management. Key facilitators identified were access to smartphones, potential for individualized COPD care, and visual tools for patient engagement. Barriers included risk of time and workload burden, data information overload, and technological limitations. Participants emphasized the need for team training, thoughtful integration into existing workflows, customizable data displays, and robust support for patient onboarding. Conclusions: Providers viewed mHealth applications with remote spirometry as a valuable tool with potential to improve COPD care but identified critical implementation needs. Participants emphasized that successful integration would require structured support, user-centered design, and attention to reimbursement and workflow alignment to enhance sustainability and patient/provider engagement. Full article

Background: Systems thinking (ST) is an approach to problem-solving that views systems through a holistic perspective, focusing on the interconnections and relationships between various elements. In healthcare, the World Health Organization’s 2009 report marked a paradigm shift toward ST, prompting the development and use of ST tools to address complex challenges. Despite this, limited attention has been given to ST’s application in healthcare human resource management (HRM). This paper aims to provide a scoping review of ST application in healthcare HRM to explore its value in workforce management. Methods: Following Arksey and O’Malley’s framework, a scoping review was conducted to map how ST has been applied in healthcare HRM. Peer-reviewed articles published between 1999 and December 2024 were identified through Scopus and PubMed, using search terms such as systems thinking, human resources, and workforce. Data were extracted using a structured tool, and findings were analyzed through the lens of the system level of application. Results: The review identified 19 studies from 15 countries, with the majority using qualitative or mixed methods approaches across diverse settings. Core applications were applied at the macro, meso, and micro system levels to address workforce challenges, map feedback loops, identify leverage points, and strengthen stakeholder collaboration. ST was commonly applied at regional and national levels and supported improved workforce planning, policy development, and service coordination. Most studies employed soft systems modeling. Conclusions: This review highlights ST’s potential to enhance HRM by recognizing interdependencies across workforce functions. Findings suggest that ST enables more integrated strategies, promotes collaboration, and supports systemic decision-making. The adoption of ST in healthcare HRM may address persistent workforce challenges, though implementation remains limited by reductionist perspectives and unfamiliarity with ST tools. Full article

Fatigue is a multidimensional phenomenon with profound implications for performance, health, and wellbeing. Its complexity means that no single discipline can adequately explain its causes or management, highlighting the need for integrative approaches. This article introduces the F.L.A.M.E.S. framework, a psychological model that integrates self-report, physiological, emotional, and contextual perspectives on fatigue. The framework combines validated assessment tools with evidence-based management strategies including goal setting, motivational self-talk, attentional control, and emotion regulation and embeds these within proactive, reactive, and preventative approaches. Applications are illustrated through case studies in sport, healthcare, and education, showing how the model can be co-constructed with practitioners to ensure ecological validity and uptake. By linking mechanisms to management and scaling solutions across domains, the F.L.A.M.E.S. framework provides a roadmap for enhancing performance, resilience, and sustainable wellbeing. Full article

This study addresses the common challenges in medical image segmentation and recognition, including boundary ambiguity, scale variation, and the difficulty of modeling long-range dependencies, by proposing a unified framework based on a hierarchical attention mechanism. The framework consists of a local detail attention module, a global context attention module, and a cross-scale consistency constraint module, which collectively enable adaptive weighting and collaborative optimization across different feature levels, thereby achieving a balance between detail preservation and global modeling. The framework was systematically validated on multiple public datasets, and the results demonstrated that the proposed method achieved Dice, IoU, Precision, Recall, and F1 scores of 0.886, 0.781, 0.898, 0.875, and 0.886, respectively, on the combined dataset, outperforming traditional models such as U-Net, Mask R-CNN, DeepLabV3+, SegNet, and TransUNet. On the BraTS dataset, the proposed method achieved a Dice score of 0.922, Precision of 0.930, and Recall of 0.915, exhibiting superior boundary modeling capability in complex brain MRI images. On the LIDC-IDRI dataset, the Dice score and Recall were improved from 0.751 and 0.732 to 0.822 and 0.807, respectively, effectively reducing the missed detection rate of small nodules compared to traditional convolutional models. On the ISIC dermoscopy dataset, the proposed framework achieved a Dice score of 0.914 and a Precision of 0.922, significantly improving the accuracy of skin lesion recognition. The ablation study further revealed that local detail attention significantly enhanced boundary and texture modeling, global context attention strengthened long-range dependency capture, and cross-scale consistency constraints ensured the stability and coherence of prediction results. From a medical economics perspective, the proposed framework has the potential to reduce diagnostic costs and improve healthcare efficiency by enabling faster and more accurate image-based clinical decision-making. In summary, the hierarchical attention mechanism presented in this work not only provides an innovative breakthrough in mathematical modeling but also demonstrates outstanding performance and generalization ability in experiments, offering new perspectives and technical pathways for intelligent segmentation and recognition in medical imaging. Full article