Search Results (1,175)

Background and Objectives: The optimal timing of orthodontic intervention in children remains debated, particularly during the mixed dentition phase. Despite potential benefits, variability in clinical decision-making persists. This study explored orthodontists’ perceptions, clinical practices, and clinical decision-making regarding the timing of early orthodontic intervention in Saudi Arabia. Materials and Methods: An interpretive qualitative study was conducted using semi-structured interviews with nineteen licensed orthodontists practicing in Saudi Arabia. Participants were purposively sampled to ensure diversity in clinical experiences and practice settings. Interviews were conducted in English and Arabic, using detailed contemporaneous field notes that were subsequently expanded for analysis. Data were analyzed using thematic analysis following Braun and Clarke’s framework, with iterative coding supported by investigator triangulation, reflexive memoing, and participant validation. Data collection continued until thematic saturation was achieved. Results: Four major themes were identified. Early intervention was widely perceived as beneficial, particularly for functional problems, Class III malocclusions, and crossbites. However, decision-making was highly individualized, with many clinicians adopting a selective approach and deferring treatment in mild cases. Variation in clinical reasoning was observed across individual participant accounts, reflecting clinical judgment and contextual influences. Key barriers included limited parental awareness, financial constraints, and delayed referrals. System-level factors, such as variability in insurance coverage, referral pathways, and the lack of structured early screening programs, were identified as important influences on access to timely care. Conclusions: Early orthodontic intervention should be applied selectively, based on clinical indications and patient-specific factors. The context-specific findings highlight the need for appropriately tailored guidance, improved referral systems, structured early screening, and consideration of clinical, practitioner-related, and healthcare system factors to support consistent, patient-centered orthodontic care. Full article

Direct-acting antiviral (DAA) therapy has dramatically transformed the management of hepatitis C virus (HCV) infection in chronic kidney disease (CKD). Severe renal impairment and dialysis dependence are no longer considered major barriers to virologic cure. The main difficulties have shifted toward efficient diagnosis, choosing the regimen in the presence of cirrhosis and drug interactions, coordinating treatment with kidney transplantation, managing HCV-associated immune-complex kidney disease, and providing treatment in dialysis and resource-limited settings. This narrative review aims to discuss these issues in a decision-oriented manner, using verified guidelines, systematic reviews, important clinical trials, transplant cohorts, and studies of cryoglobulinemic disease, while explicitly comparing the strength and consistency of the underlying evidence and highlighting areas of genuine clinical uncertainty. Present evidence supports using the recommended DAA regimens without renal dose adjustment, while ribavirin needs dose modification when kidney function is reduced and can result in hemolytic anemia. Kidneys from HCV-viremic donors can be transplanted to recipients without HCV infection when proper informed consent, rapid access to DAA treatment, and organized post-transplant monitoring are available, although the minimum effective duration of peri-transplant antiviral prophylaxis remains unresolved. Antiviral therapy is the first-line treatment for HCV-associated glomerular disease, while rituximab-based immunosuppression is largely reserved for severe, rapidly progressive, or persistent cryoglobulinemic vasculitis. Future progress will depend less on proving antiviral efficacy and more on closing the gaps between screening, confirmatory testing, starting treatment, transplantation pathways, and long-term follow-up, gaps that stem from inequities in diagnostic infrastructure, drug reimbursement, and healthcare-system organization as much as from any remaining biomedical uncertainty. Full article

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse reactions to low-level environmental chemicals, often resulting in multisystem symptoms triggered by volatile organic compounds (VOCs) emitted from fragranced personal care and household products. The condition raises public health and accessibility concerns, as people with MCS may face barriers to accessing workplaces, healthcare settings, educational institutions, and other public environments. This descriptive cross-sectional study aimed to characterize the chemical exposures participants attributed to the onset of MCS and to subsequent symptom provocation, and to describe the associated symptom patterns. A cross-sectional survey was administered to Canadian residents aged 18 years or older, living with MCS for at least 1 year, with 18 questions assessing exposure history and onset of MCS and symptom provocation. A total of 119 participants completed the survey. Participants most frequently attributed the onset of MCS to the workplace (55%) or home (35%), with (61%) reporting ongoing exposures over time as the most frequently reported circumstance associated with onset. Fragranced products, including perfumes, air fresheners, cleaning products, disinfectants, construction materials, and laundry products, were the exposures most frequently reported in relation to both onset and subsequent symptom triggering. Symptoms involved multiple organ systems, with nearly one-third of participants reporting 11 or more symptoms; cognitive and respiratory symptoms were most prevalent. Nearly three-quarters of participants (74%) reported symptoms associated with third-hand exposure, and 51% reported discarding contaminated items, suggesting that third-hand exposure may represent an underrecognized pathway for symptom provocation. Full article

Substance use disorders (SUDs) remain a major public health concern and contribute substantially to compromised quality of life, mortality, and healthcare burden. In the United States alone, millions of individuals are affected by alcohol use disorder (AUD), tobacco use disorder (TUD), and opioid use disorder (OUD), with many cases complicated by co-existing anxiety and stress-related disorders. Piper methysticum G. Forst (kava), a traditional South Pacific plant preparation, has gained attention for its anxiolytic, sedative, and sleep-promoting properties. Its pharmacological effects are primarily attributed to a set of lipophilic compounds known as kavalactones, which have been reported to modulate GABA_A receptor activity, dopaminergic and adrenergic signaling pathways, monoamine oxidase-B activity, cannabinoid receptor type 1 activity, and voltage-gated ion channels. Peer-reviewed literature was identified through searches of PubMed, NIH resources, and other scientific databases using terms related to kava, kavalactones, addiction, anxiety, stress, insomnia, and SUDs. Both clinical and preclinical studies were reviewed, including investigations of neurotransmitter systems and addiction-related signaling pathways. The current literature suggests that the strongest rationale for kava use exists in AUD, where anxiety and stress are established contributors to relapse. Evidence supporting kava use in TUD and OUD is largely theoretical, while concerns regarding hepatotoxicity, cytochrome P450 interactions, product variability, and additive risk remain important barriers to its clinical application. In summary, current evidence does not support kava as a replacement for established therapies, while its unique pharmacological profile warrants further investigation as a potential adjunctive treatment for withdrawal and relapse in SUDs. Full article

Background: The Baby-Friendly Hospital Initiative (BFHI), developed by the World Health Organization (WHO) and UNICEF, provides an evidence-based framework to protect, promote, and support breastfeeding through implementation of the Ten Steps to Successful Breastfeeding. Despite its global adoption, implementation and scale-up of BFHI remain inconsistent across healthcare systems. In Saskatchewan, Canada, only one healthcare facility currently holds BFHI designation, highlighting the need to understand the health system factors influencing implementation. This study aimed to explore the barriers and facilitators influencing the implementation and scale-up of BFHI within Saskatchewan healthcare settings. Methods: A qualitative descriptive study was conducted using Bronfenbrenner’s socioecological model as a guiding theoretical framework. Semi-structured interviews were conducted with 26 mothers and healthcare professionals with breastfeeding-related experiences in Saskatchewan, including 11 mothers (42.3%), 6 mothers who were also healthcare professionals (23.1%), and 9 healthcare professionals without maternal experience (34.6%). Participants were recruited using purposive and maximum variation sampling. Guided by a socioecological framework, interview data were manually analyzed using an iterative thematic analysis approach. Themes were interpreted across individual, interpersonal, organizational, community, and health system levels. Results: Five interrelated themes characterized BFHI implementation and scale-up in Saskatchewan, including (1) leadership and governance as foundations for BFHI implementation; (2) workforce capacity, competency, and practice consistency as determinants of care delivery; (3) continuity of breastfeeding support across care settings; (4) breastfeeding as a psychosocially embedded maternal experience; and (5) structural and societal factors shaping BFHI scale-up. While supportive leadership, provincial breastfeeding guidelines, skilled healthcare providers, interdisciplinary collaboration, and community-based services facilitated BFHI-aligned care, implementation was challenged by workforce shortages, inconsistent clinical practices, limited access to specialized breastfeeding support, early postpartum discharge, geographic inequities, fragmented care pathways, and inadequate system-level monitoring. Conclusions: In Saskatchewan, BFHI implementation and scale-up are shaped by interconnected organizational, workforce, maternal, and structural factors. The findings provide context-specific qualitative evidence to inform future BFHI planning and implementation. Further research is needed to assess the feasibility, sustainability, and effectiveness of strategies to support BFHI scale-up across diverse healthcare and geographic settings. Full article

Background: Pharmaceutical waste presents significant economic and environmental challenges, necessitating systemic interventions for sustainable healthcare. Community pharmacists are pivotal in mitigating this waste through optimized dispensing, patient education, and facilitating safe disposal. Methods: A nationwide cross-sectional survey was conducted to evaluate the perceptions, practices and perceived barriers of community pharmacists in Saudi Arabia. Data regarding barriers and mitigation strategies were collected using a five-point Likert scale. Results: A total of 275 pharmacists participated, with an average age of 33.86 ± 7.46 years. Pharmacists showed strong understanding of the economic impact of medication waste, with an average score of 4.41 ± 0.85. The lowest score, 2.80 ± 1.25, reflected poor public awareness about proper disposal practices. The most identified source of waste was the discarding of unopened medication packages, scoring 3.80 ± 1.05. The top barrier was the lack of national guidelines, with a score of 3.82 ± 1.01. Unified patient records and e-prescribing were viewed as the most effective strategies, scoring 4.17 ± 0.94. Practice gaps were clear, as 27.64% of pharmacies did not provide any disposal service. Conclusions: Saudi community pharmacists demonstrate high readiness but are hindered by logistical gaps and fragmented frameworks. Achieving sustainable pharmaceutical stewardship requires standardized national guidelines, formalized take-back pathways, and the expansion of digital tools like Wasfaty to align clinical practice with Saudi Vision 2030 sustainability goals. Full article

The global shift toward an aging population presents significant challenges for healthcare systems. This is compounded by rising disability rates, fragmented care models that struggle to meet complex needs, and a digital divide caused by the emergence of smart technologies. This work aims to evaluate how the digital divide affects the adoption, usability, and perceived benefits of smart home technologies designed to support activities of daily living and health monitoring. The influences of socioeconomic status and geographic location (urban versus rural) on the digital divide are considered. Four databases (Web of Science™, Scopus^®, PubMed^®, and IEEE Xplore^®) were searched between 2014 and 2026, resulting in 71 studies that examined older adults, smart home technologies for daily living or health monitoring, and factors related to the digital divide. Findings were synthesized using the Technology Acceptance Model, Van Dijk’s Digital Divide Framework, and Health Behavior Models. Three key barriers were identified—economic, technical, and social—which disproportionately affected vulnerable groups. Smart Home Health Technologies (SH2Techs) present adoption challenges distinct from standalone devices because they require integrated infrastructure and sustained engagement. Limited research addressing the usability of non-clinical SH2Techs has identified the need for co-design, simplified interfaces, targeted training, and policy reforms to support equitable aging in place. Full article

Artificial intelligence has emerged as a promising paradigm for advancing the screening, diagnosis support, and monitoring of autism spectrum disorder (ASD) through scalable and data-driven clinical augmentation. Recent advances in machine learning, multimodal sensing, and digital phenotyping have enabled AI systems to analyze behavioral, neurophysiological, speech, and clinical data to identify early markers of ASD. Despite encouraging experimental results, major barriers to clinical translation remain, including limited generalizability, fragmented datasets, insufficient evaluation rigor, lack of semantic interoperability, and unresolved ethical and regulatory concerns. This systematic review provides a comprehensive technical review of AI for ASD, covering data modalities, feature engineering, learning paradigms, evaluation protocols, deployment architectures, and knowledge representation frameworks. Particular emphasis is placed on system-level and translational considerations, including cloud–edge infrastructures, explainable clinical decision-support systems, privacy-aware deployment, and ontology-driven reasoning. Beyond summarizing existing work, this paper critically analyzes challenges related to reproducibility, dataset bias, interpretability, and clinical integration and derives design requirements for next-generation trustworthy ASD AI systems. We argue that meaningful clinical impact will require the integration of multimodal learning, semantic knowledge representation, explainable reasoning, and human-in-the-loop decision processes to support safe, interpretable, and clinically deployable AI systems in pediatric healthcare environments. Full article

This case report highlights how neglected tropical diseases (NTDs) may remain underdiagnosed in high-resource settings despite advanced healthcare systems. We describe an 18-year-old woman from Equatorial Guinea living in Spain who presented with chronic pruritus and episodic ocular symptoms and was ultimately diagnosed with ocular loiasis after the incidental extraction of a conjunctival filaria. Diagnostic evaluation included microscopy, serology, and molecular techniques, confirming Loa loa and Mansonella perstans co-infection alongside evidence of exposure to other parasitic infections. Management involved staged antiparasitic therapy with albendazole, ivermectin, praziquantel, and diethylcarbamazine, combined with corticosteroids to mitigate treatment-related reactions. The patient showed clinical improvement, although follow-up was irregular and microfilaremia persisted. This case illustrates key challenges in non-endemic settings, including low clinical suspicion, fragmented care pathways, and barriers to healthcare access among migrant populations. Despite the availability of sensitive diagnostic tools, delayed recognition remains common when tropical diseases are not considered in the differential diagnosis. Comprehensive, multidisciplinary approaches are essential, particularly in patients from endemic regions who may harbor multiple co-infections. Strengthening clinical awareness, referral pathways, and appropriate screening for NTDs may help reduce diagnostic delays and improve patient outcomes in increasingly globalized healthcare settings. Full article

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Background: Multiple chemical sensitivity (MCS), a recognized disability, is a chronic, multisystem condition in which exposure to common chemical substances provokes adverse health effects and functional impairment. Although population-level data and emerging clinical research support the pathophysiological basis of MCS, individuals living with the condition frequently encounter barriers to recognition and accommodation across employment, healthcare, and housing systems. This study examines patterns of accommodation requests, refusals, and associated socioeconomic impacts among adults living with MCS in Canada, with particular attention to how institutional recognition shapes access to supports. To our knowledge, this is the first national Canadian study to examine accommodation request outcomes across both employment and housing among adults with MCS, combining quantitative and qualitative data. A national cross-sectional survey of 119 Canadian adults living with MCS was conducted between January and February 2021. Quantitative data were analyzed descriptively to assess accommodation requests, outcomes, employment status, income, and housing stability. Qualitative responses were analyzed thematically to contextualize participants’ experiences of disclosure, and accommodation outcomes. Participants were predominantly female (87%) with post-secondary education (90%). Among participants who reported being unemployed (29%), 94% attributed it primarily to MCS-related limitations. Accommodation denial was common: 85% of respondents reported requesting accommodations, and 78% of those experienced refusals. On housing conditions, 52% reported living in unsafe housing (defined as housing with the presence of mould or symptom-triggering exposures), while 17% reported being homeless (e.g., moving frequently, personal vehicle, tent). Findings should be interpreted in light of the cross-sectional design, self-reported data, and community-based recruitment, which may limit generalizability. The findings suggest that inconsistent institutional recognition of MCS can function as a barrier to accommodation, contributing to health, economic, and social inequities. Addressing these barriers requires clarified guidance on the duty to accommodate multiple chemical sensitivity, proactive scent-free and lowest-emission policies in workplaces and housing, and improved healthcare provider education to support accommodation documentation. Full article

Background: Hospital-wide centralized bed allocation, known in China as the “one-bed-for-the-whole-hospital” model, aims to improve inpatient access by pooling beds across specialties. Existing studies have mainly examined operational outcomes, process risks, or staff competence. Less is known about how bed redistribution interacts with clinical responsibility, professional roles, functional support, and shared governance. Objectives: This study explored healthcare professionals’ perspectives on the barriers, facilitators, and strategies for sustaining the hospital-wide “One Bed” model. It also examined how bed integration and care integration aligned or diverged across the dimensions of the Rainbow Model of Integrated Care. Methods: A single-center descriptive qualitative study was conducted in a Grade A tertiary hospital in Shanghai, China, where the model had operated across 11 pilot wards for approximately 48 months. Between December 2024 and March 2025, 25 healthcare professionals, including 14 clinical nurses, eight head nurses, and three physicians, completed face-to-face semi-structured interviews. Data were analyzed using inductive qualitative content analysis. After themes and subthemes were developed from participants’ accounts, the Rainbow Model of Integrated Care was used as an interpretive framework to map the findings across clinical, professional, organizational, system, functional, and normative integration. Results: Five themes were generated. Participants perceived centralized bed allocation as shortening waiting time and improving bed use, but also as intensifying ward workload and making single efficiency indicators insufficient. Patients could move to available wards before medical response, responsibility, and physician visibility were fully aligned. Cross-specialty case mixes exceeded what nurses could manage through temporary learning alone. Information, logistics, space, equipment, and supplies did not always move with patients, leaving nurses to maintain workflow through manual and often invisible coordination. Sustained bed sharing also depended on clearer boundaries for patient selection, specialty fit, severity, nursing workload, leadership authority, resources, and incentives. Together, these themes showed that bed resources were integrated faster than care processes, professional capability, functional support, and shared governance. Conclusions: Hospital-wide centralized bed allocation should be understood as an uneven process of integration rather than only as a bed-management strategy. These findings primarily reflect the perceptions and experiences of nurses and nursing managers, supplemented by limited physician input. The distinctive finding of this study is that beds may be pooled, and patients may move rapidly, while medical response, nursing competence, functional support, workload recognition, and governance arrangements do not always move at the same pace. Safe and sustainable implementation therefore requires bounded flexibility: bed allocation should be guided not only by bed vacancy but also by clinical suitability, specialty fit, nursing workload, timely medical response, functional systems that move with patients, and shared accountability. Full article

Breast cancer constitutes one of the oncological diagnoses with the greatest impact on women’s lives, with consequences that extend beyond active treatment into a survivorship period marked by profound transformations in identity, relationships, and well-being. This study aimed to explore the impacts that breast cancer produces on the everyday lives of survivor women in the municipality of Villarrica, La Araucanía Region. A qualitative methodology with a phenomenological orientation was employed, based on discourse analysis of three focus groups with 20 female breast cancer survivors between 35 and 70 years old. The analysis identified five categories: impact on everyday life and work, management of uncertainty and fear, transformation of self-care and life priorities, support networks and community, and barriers to accessing the healthcare system. The findings demonstrate the coexistence of posttraumatic growth and persistent psychological distress, together with structural inequities that limit access to comprehensive care during the survivorship period. It is concluded that cancer survivorship demands public policy responses that are continuous, multilevel, and integrative of a gender perspective, articulating individual, family, and community interventions from primary healthcare. Full article

Background/Objectives: Psychological safety is increasingly recognized as a key factor in promoting communication, learning, and teamwork in healthcare, with implications for patient safety culture. Although psychological safety and patient safety culture have been reviewed separately, evidence on how nurse managers contribute to both constructs within nursing teams remains fragmented. This scoping review aimed to map the available evidence on the role of nurse managers in promoting psychological safety and patient safety culture in nursing teams, identify leadership behaviors, strategies, and competencies, and highlight facilitating factors and barriers. This review provides an integrated synthesis of evidence on how nurse managers contribute to fostering both psychological safety and patient safety culture within nursing teams, addressing a gap in the existing literature. Methods: A scoping review was conducted following established methodological frameworks and prospectively registered in the Open Science Framework. Systematic searches were conducted in MEDLINE (PubMed), CINAHL, Psychology and Behavioral Sciences Collection, Scopus, BVS, and WorldCat for gray literature, with the final search performed on 11 May 2026. A total of 229 records were identified, with 112 duplicates removed. The remaining 117 records were screened, resulting in 25 studies included for analysis. Data were extracted and synthesized using thematic analysis. Results: Twenty-five sources were included, comprising predominantly quantitative (mainly cross-sectional) studies, together with qualitative studies, systematic reviews, conceptual papers, expert opinion papers, and gray literature. The findings highlight a close and interdependent relationship between psychological safety and patient safety culture. Nurse managers’ relational leadership behaviors—such as visible presence, active listening, emotional support, and constructive feedback—emerged as key strategies for fostering psychologically safe environments. The reviewed evidence suggests that psychological safety may mediate the relationship between leadership practices and communication, speaking up, incident reporting, and organizational learning. Facilitators include supportive leadership and a just culture, while barriers encompass punitive environments, hierarchical structures, workload pressures, and resource constraints. Conclusions: The findings suggest that psychological safety may be an important mechanism through which nurse managers contribute to patient safety culture. However, leadership alone is insufficient, requiring alignment with organizational conditions and system-level support. These findings support strategies to strengthen safety culture and guide leadership development. Full article

Objective: Patient safety culture (PSC) is a critical determinant of healthcare quality. This study aimed to assess the current status of PSC among healthcare workers at Kien An Hospital, Hai Phong, Vietnam, and identify associated factors. Methods: A cross-sectional survey was conducted using the 12-dimension hospital survey on patient safety culture (HSOPSC). A total of 324 healthcare professionals (physicians, nurses, and allied staff) participated. Data were analyzed using descriptive statistics and multivariable logistic regression. Results: The positive response rate (PRR) across the 12 dimensions of patient safety culture (PSC) varied widely. The highest positive perceptions were observed in “Teamwork within units” (98.5%) and “Teamwork across units” (98.1%). Conversely, severe vulnerabilities in psychological safety were identified, with “Communication Openness” recording the absolute lowest PRR at 25.9%, closely followed by “Non-punitive response to error” at 29.0%. Comparative analysis between professional strata revealed broad alignment across 11 dimensions, with the sole significant divergence occurring in “Feedback and communication about error”, where physicians reported a significantly higher PRR than nurses & allied staff (85.8% vs. 75.2%; p = 0.04). In the multivariable logistic regression model, age emerged as the single independent predictor of overall positive PSC; compared to early-career staff (<30 years), healthcare workers aged 30–40 years (AOR = 4.17, p = 0.02) and 40–50 years (AOR = 5.03, p = 0.02) had significantly higher odds of favorable safety perceptions. Conclusions: Healthcare workers at the study hospital exhibit exceptionally strong collaborative teamwork, yet low communication openness and the fear of a punitive environment remain critical systemic barriers to safety. Because safety culture challenges are macro-institutional and disproportionately impact junior personnel, interventions should shift away from role-specific policies. Instead, hospital leadership must prioritize establishing non-punitive reporting mechanisms, enhancing open dialogue, and designing targeted safety culture onboarding initiatives tailored specifically to the needs of early-career healthcare workers to foster continuous organizational learning. Full article