Search Results (3,489)

Background: Postpartum hemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide, accounting for approximately 27% of maternal deaths. In Spain, its incidence ranges from 2.5% to 5.2%. Clinical management has evolved toward a stepwise approach integrating pharmacological, mechanical, and surgical interventions. This study aims to analyze the evolution of these techniques during the 2020–2024 period to optimize decision-making and maternal outcomes. Methods: A systematic review was conducted following the PRISMA 2020 guidelines. Comprehensive searches were performed in PubMed, Scopus, and the Cochrane Library for studies published between 2020 and 2024 in English and Spanish. The PICO framework was utilized to evaluate interventions including intrauterine balloon tamponade (UBT), compression sutures, and arterial embolization, prioritizing outcomes such as bleeding control and fertility preservation. Out of 34 identified records, 13 studies met the final inclusion criteria. Results: The findings demonstrate a clear trend toward conservative management. Intrauterine balloon tamponade reported success rates of 80–90% in controlling refractory bleeding and significantly reduced the hysterectomy rates. B-Lynch compression sutures showed success rates between 68.4% and 100%, with generally favorable fertility outcomes. However, combining these sutures with devascularization increased the risk of uterine necrosis. Additionally, the early administration of tranexamic acid (TXA) within 3 h of birth was confirmed as a critical factor in reducing mortality. Conclusions: Acute PPH management has shifted toward protocol-based, sequential, and less invasive strategies. The implementation of standardized algorithms, care bundles, and simulation-based training is essential to reduce decision inertia and improve obstetric safety. While conservative mechanical and surgical techniques are effective, institutional protocols must be regularly updated to consolidate these technological and organizational advances. Full article

Background: Cardiac telemetry monitoring represents an important aspect of in-hospital patient safety in both telemetry and critical care settings. Despite technological advancements, telemetry effectiveness may be diminished due to systemic failures including operational processes, instructional policies, and human factors. Alarm fatigue, recognized by the Joint Commission as a leading contributor to serious patient harm, lies at the forefront of these failures. Objective: This narrative review utilized and synthesized sources indexed through PubMed, PubMed Central, MEDLINE, Web of Science, Google Scholar, Directory of Open Access Journals (DOAJ), and Scopus to illustrate the factors involved in hospital related monitoring failures. We purport that alarm fatigue and telemetry monitoring failures are the result of complex systemic failures comprising technological and human failures. Through this narrative, we propose an evidence-based framework known as the Safer Telemetry Architecture (STA) to pinpoint redundancies and promote closed-loop communication regarding alarm management. Conclusions: Monitored in-hospital environments represent a key area of preventable morbidity and mortality due to systemic design flaws. Our STA framework addresses such flaws via improvements in nurse-driven protocols, alarm routing, mandatory coverage standards for backup, and increased performance auditing. Systemic improvements via such a framework may represent an important institutional strategy for hospitals with cardiac monitoring, but requires further prospective validation. Managing redundancies in alerts and sounds, improving backup and nursing telemetry protocols, and promoting closed or continuous loops targeting alarm response times and telemetry utilization are key to effectively improving patient safety. Full article

Background/Objectives: Grief following the death of a partner is a complex psychosocial process associated with an increased risk of prolonged grief, depression and suicidal ideation. Among lesbian, gay, bisexual, transgender, intersex, and queer (LGBTIQ+) individuals, these risks are exacerbated by stigma, relational invisibility and family rejection, often resulting in unrecognized or disenfranchised grief. This scoping review aimed to map the available evidence on the experiences of bereavement following the death of a partner among LGBTIQ+ individuals between 2016 and 2026, identifying study types, recurring themes and knowledge gaps relevant to nursing practice. Methods: A scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension and the methodology of the Joanna Briggs Institute. Searches were planned in PubMed/MEDLINE, Scopus, CINAHL, PsycINFO and Web of Science (2016–March 2026) using combined terms for grief, partner and LGBTIQ+ populations. Primary qualitative, quantitative and mixed-methods studies, as well as selected grey literature that explicitly addressed grief following the death of a partner in LGBTIQ+ individuals were considered. Results: The search identified 1032 records; after removing duplicates (n = 356), 676 titles/abstracts were screened, and 94 full texts were assessed. Eighteen studies were included, mainly qualitative, and conducted in high-income countries. Key themes included invisibility and lack of recognition of the relationship, managing the disclosure of sexual orientation and gender identity, social isolation and the role of chosen families, and intersectional vulnerabilities in subgroups such as older adults, bisexual people and trans people. Conclusions: The available evidence reflects specific bereavement experiences among LGBTIQ+ individuals that are not adequately captured in traditional models of bereavement care. Significant gaps remain, particularly in Spanish-speaking contexts and in the design and evaluation of nurse-led interventions. This scoping review provides a conceptual basis for future research and for the development of culturally safe clinical practices in supporting LGBTIQ+ individuals through bereavement. Full article

Background/Objectives: Staged resection with temporizing vacuum-assisted closure (VAC) has been adopted to facilitate margin assessment and local control of soft tissue sarcomas (STS). Accordingly, the objective of this study is to compare rates of local recurrence (LR) among superficial STS patients treated with and without temporizing VAC therapy. Methods: We conducted a multi-institutional retrospective cohort study of superficial STS patients treated at three tertiary care centers. Patients were matched by grade, and descriptive statistics and multivariate binary logistic regression were performed. Results: After matching, 314 superficial STS patients were included in analysis. VAC patients were more likely to present with a history of prior unplanned excision (p = 0.024), with recurrent disease (p = 0.004), harbor a diagnosis of myxofibrosarcoma (p < 0.001), and have positive initial surgical margins (p < 0.001). After multivariate analysis, VAC use remained independently associated with increased LR rates (OR = 4.117; p = 0.003). Conclusions: In this multi-institutional analysis of superficial STS patients, staged resection with temporizing VAC was not associated with improved LR rates. Rather, the VAC cohort represented distinctly higher-risk tumor biology and complex oncologic presentations, in whom the risk of LR may not be fully mitigated by surgical staging alone. Full article

Background/Objectives: Household food insecurity is a modifiable social determinant of health with important implications for diet quality and health outcomes. Dietitians are well positioned to identify and respond to food insecurity; however, little is known about how this is addressed in routine dietetic practice across Europe. This exploratory study examined food insecurity screening and response practices among dietitians practicing in Europe and examined associated correlates using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Methods: An online cross-sectional survey informed by the COM-B framework was distributed through the European Federation of Associations of Dietitians’ institutional communication channels between February and June 2024. Participants were recruited using a voluntary, convenience-based sampling strategy through professional networks and social media dissemination. A total of 148 dietitians practicing in European countries responded. The questionnaire assessed routine food insecurity screening practices, COM-B correlates, perceived barriers, actions taken following identification, and learning needs. Quantitative data were analysed descriptively, and open-ended responses were used illustratively to contextualise reported practices. Results: Food insecurity screening was not systematically embedded in routine dietetic practice, with 11.6% of respondents reporting routine screening and 30.2% not asking about food insecurity. Identification of food insecurity did not consistently translate into follow-up action, and responses were predominantly referral-based rather than involving direct material support. While capability and motivation to address food insecurity were generally high, opportunity-related factors—such as time constraints, limited organisational support, and unclear referral pathways—emerged as the main barriers shaping professional behaviour. Substantial heterogeneity was observed across practice settings. Conclusions: In this sample of dietitians practicing in Europe, food insecurity screening and response were variable and often constrained by organisational and contextual factors. These findings highlight the need for system-level support and practice-oriented training to facilitate the integration of food insecurity into routine dietetic care. Full article

Background: The integration of internationally educated nurses (IENs) into healthcare workforces is expanding globally, yet organization-led support models remain understudied. Successful IEN integration requires ethical recruitment, structured onboarding, workforce support, and stakeholder engagement in policy discussions related to transition and retention. Objective: To examine the conceptualization, implementation, and policy implications of the Philippine Nurses Association of America Cy Pres Task Force’s national initiative to support IEN onboarding and transition into U.S. healthcare. Methods: This descriptive program evaluation utilized governance documents, program planning records, policy summit materials, aggregated survey findings, PNAA Human Rights Committee resources, and the Handbook for Filipino Nurses Immigrating to the United States to examine initiative development, implementation processes, and program outputs. A descriptive narrative synthesis was used to characterize program structure, stakeholder engagement, and policy priorities. Findings: The PNAA Cy Pres governance model was built around ethical recruiting, workforce integration, and advocacy. The work began with policy summits with nurse leaders, health care organizations, recruitment agencies, and policy experts, focusing on hiring, onboarding, legal issues, and staff retention. Stakeholder engagement, interdisciplinary collaboration, and appreciative inquiry were used to identify best practices and goals. Key outputs included the establishment of a national governance structure, implementation of national and regional policy summits, and identification of policy priorities related to ethical recruitment, onboarding, workforce integration, and governance. Conclusions: The PNAA Cy Pres initiative provides an implementation-informed approach that may help guide future workforce integration efforts. The study illustrates how ethical recruitment, workforce integration, and stakeholder engagement can help translate workforce policy principles into practice. Policy & Practice Implications: Healthcare institutions, policymakers, and professional organizations need to work together to standardize onboarding, ethical recruitment, and support mechanisms to facilitate the integration and sustainability of the IEN workforce. Full article

Background and Objectives: Healthcare-associated infections (HAIs) remain a major challenge in emergency hospital settings, where high patient turnover and empirical antibiotic use may contribute to the emergence and spread of multidrug-resistant organisms. Monitoring antibiotic consumption is essential for antimicrobial stewardship and infection prevention. This study evaluated antibiotic consumption patterns across multiple hospital units and explored their ecological relationship with HAI rates. Materials and Methods: A retrospective observational study was conducted in a tertiary-level emergency hospital in Romania between 1 January 2021 and 31 October 2025. Antibiotic consumption was quantified using Defined Daily Dose per 100 bed-days (DDD/100 bed-days) according to World Health Organization (WHO) methodology and categorized using the WHO Access, Watch, and Reserve (AWaRe) classification. HAI data were collected using standardized surveillance definitions. Statistical analyses were primarily descriptive and exploratory and included graphical trend assessment, simple linear regression for temporal trend description, and Spearman correlation analysis for exploratory ecological co-variation assessment. Results: Antibiotic consumption showed substantial variability across hospital units, without a consistent temporal trend over the study period. The Watch group predominated over the Access group from 2023 onward, while Access antibiotics remained below the WHO-recommended 60% threshold. The highest antibiotic consumption was observed in the Medical Wards, followed by Surgical Wards and the Intensive Care Unit. A total of 27 HAIs were identified (0.27 per 1000 patient-days), with the highest incidence observed in the ICU. The most frequent infections were Clostridioides difficile infections (33.3%) and catheter-associated urinary tract infections (29.6%). Exploratory ecological analyses did not identify robust associations between total antibiotic consumption and HAI rates across hospital units. A numerically elevated co-variation was observed between fluoroquinolone consumption and Clostridioides difficile infection incidence; however, this finding should be interpreted strictly as exploratory and hypothesis-generating. Conclusions: Antibiotic use varied across hospital units, with predominance of broad-spectrum agents and suboptimal adherence to WHO AWaRe targets. Reported HAI incidence remained low and should be interpreted within the limitations of routine surveillance systems and potential under-ascertainment. These findings support the value of continuous institutional surveillance of antibiotic use and HAIs while highlighting the limitations of aggregated ecological analyses. Full article

Background: Critical illness leads to profound metabolic, neuroendocrine and immune disorders that affect the prognosis of patients treated in intensive care units (ICUs). The ketogenic diet, a high-fat and low-carbohydrate eating model, is gaining increasing importance as a potential metabolic intervention in the ICU. Preliminary data suggest that the ketogenic diet (KD) may support the control of seizures in a super-refractive epileptic state (SRSE), stabilize glycemia, reduce insulin demand, and modulate the immune response in sepsis. The aim of this review was to present a synthetic presentation of the current state of knowledge regarding use of the KD in intensive care patients. Methods: The review was carried out in accordance with the guidelines of the Joanna Briggs Institute and PRISMA-ScR. PubMed, Scopus, EBSCO, Web of Science, Google Scholar and Cochrane Library databases were searched (10–19 April 2026) using the Population–Concept–Context model. Full-text observational studies, randomized trials and reviews of the use of KDs in ICU patients were included. Data extraction was performed independently by two reviewers. Results: Of the 42 publications identified, seven studies were included in the analysis. The KD was feasible and safe in both critically ill adults and children. In SRSE, most patients achieved stable ketosis within a few days, which often allowed for reduction or discontinuation of anesthetics. In sepsis, the KD led to glycemic stabilization, reduced insulin demand and reduced immune deregulation; in one study, “after day 4, none of the patients in the KD group required insulin treatment.” The KD also showed beneficial effects on cellular bioenergetics and mitochondrial function. The safety profile was acceptable and adverse reactions were manageable with appropriate monitoring. Conclusions: The KD represents a promising, non-pharmacological metabolic intervention in intensive care, particularly in the treatment of SRSE and in the stabilization of glucose metabolism in sepsis and other critical conditions. Despite the growing number of positive clinical observations, the available evidence remains limited due to small samples, heterogeneous protocols, and a lack of randomized trials. Further, well-designed prospective studies are needed to determine optimal KD implementation protocols and identify the patient populations that benefit most. Full article

The intensification of the global ecosocial crisis has exposed the structural incompatibility between continuous economic growth and the biophysical limits of the planet, prompting increasing interest in degrowth as a framework for ecological sustainability and social justice. Despite the growing development of degrowth theory within ecological economics and political ecology, its educational implications remain underexplored. This article examines the role of education in the transition toward post-growth societies through a critical review of the literature and a conceptual analysis informed by critical pedagogy, ecofeminism, environmental education, and degrowth scholarship. The study identifies how contemporary educational systems reproduce growth-oriented subjectivities through human capital theory, neoliberal governance, competitiveness, and productivist curricular frameworks. The analysis demonstrates that dominant models of sustainability education frequently remain embedded within the assumptions of green growth and fail to address the structural drivers of ecological degradation and social inequality. As a result, the article develops an integrated framework for a pedagogy of degrowth structured around ecosocial literacy, democratic participation, care ethics, cooperation, critical civic engagement, curriculum transformation, technological sovereignty, and commitment to the commons. The main contribution of the study lies in articulating a comprehensive educational model that connects pedagogical transformation with broader processes of post-growth social change, positioning education not merely as a tool for environmental awareness but as a strategic arena for cultivating the values, capacities, and collective agency required for ecosocial justice. The findings suggest that a transition toward sustainable and equitable societies requires a profound reorientation of educational aims, contents, institutions, and practices beyond the paradigm of economic growth. Full article

Intimate partner violence (IPV) affects individuals of all genders and can result in adverse physical, psychological, and social outcomes. Experiences of IPV in men remain understudied when compared with those of cisgender women, leading to considerable gaps in understanding of prevalence, experiences, disclosure, and outcomes. The Male Experiences of Intimate Partner Violence Study (ME-IPV Study) was designed to explore: nature of IPV experiences, physical and psychological impacts, barriers to reporting/disclosing, experiences of disclosure, experiences of support, and support needs in a Northern Ireland (NI) context. This mixed-method study utilised data from N = 10 qualitative interview participants (quantitative results reported separately), analysed using an Interpretative Phenomenological Analysis (IPA) framework. Participants described experiencing multiple forms of IPV, with coercive control, psychological and institutional abuse being highly prevalent. Detrimental effects of their experiences included diagnoses of anxiety, depression, and PTSD, physical symptomology, the advent/exacerbation of multiple health conditions, and suicidal ideation. Barriers to care were primarily a lack of dedicated care pathway, concerns over being believed, and stigmatic barriers. Experiences of disclosure were mixed: positive with family/friends and negative with police and institutions of state. Male experiences of IPV in NI are a significant public health issue and it is evident that the impacts of IPV on men’s physical/mental health and wellbeing are profound. Full article

Background/Objectives: Digital technologies and data-driven approaches are rapidly transforming healthcare practice and enabling more personalized and preventive care. As personal health data becomes increasingly embedded in healthcare systems, understanding how future healthcare professionals interpret these developments is essential for shaping responsive health education. This study aims to identify the factors that students in health-related programs consider important regarding the increasing use of personal health data in healthcare. Methods: An exploratory qualitative focus group study was conducted between March 2024 and July 2025 across five higher education institutions in Australia, Canada, and the Netherlands. Seven focus groups were conducted with forty students from health-related programs, including nursing, public health, occupational therapy, and social work. Participants discussed the use of personal health data in healthcare and reflected on short fictional future scenarios designed to stimulate discussion about possible developments in data-driven healthcare. Data were analyzed using reflexive thematic analysis using ATLAS.ti. Results: Three overarching domains were identified: (1) personalization and prevention, (2) data quality and ethical considerations, and (3) organizational implications and conditions. Students described personal health data as a powerful tool for personalization, prevention, and informed decision-making. At the same time, they raised concerns about data reliability, overreliance on automated systems, patient anxiety, potential dehumanization of care, privacy risks, and emerging inequalities related to access to and representation within data systems. Overall, students appeared neither purely techno-optimistic nor technophobic, but articulated nuanced ethical, cultural, and professional tensions surrounding data-driven care. Conclusions: Preparing future healthcare professionals for data-driven healthcare requires integrating critical data literacy, ethical reflection, interdisciplinary collaboration and opportunities to critically engage with the societal and professional implications of data-driven technologies into health professional education, while ensuring that organizational conditions support the responsible use of personal health data. Full article

This paper explores the complex nature of ethical leadership and decision-making in educational settings by reviewing the learning content of a master’s subject in an educational leadership course. The paper focuses on how effective ethical leadership requires a multidimensional, context-sensitive approach rather than simple rules or linear paradigms. Drawing on foundational and contemporary scholarship, the paper discusses how leaders address “wicked problems” such as equity gaps, data ethics, and conflicting stakeholder values. It emphasises moral reasoning rooted in dialogue, role theory, and political literacy, acknowledging that institutional cultures, power dynamics, and norms influence decision-making. The article discusses how practical tools, such as ethical decision-making staircases, dilemma mapping, and reflection protocols, help leaders balance values and foster inclusive, morally resilient communities. A discussion of the increasing ethical challenges of data analytics and surveillance, and an advocacy for transparency, dignity, and data minimalism, is presented. The paper concludes that preparing ethical leaders involves immersive experiences such as case studies and simulations, alongside the development of moral courage and networks to support systemic change. By integrating theory, context, and transformative practices, this paper offers a comprehensive framework for nurturing leaders who navigate ambiguity and advance justice, care, and integrity across diverse educational environments. Full article

Persons with Disabilities (PWDs) face persistent barriers to healthcare access, welfare services, and timely medical assistance, particularly where hospital information is fragmented across institutions. In Thailand, these challenges are exacerbated by heterogeneous Hospital Information Systems (HISs) across provincial, district, and sub-district hospitals. This study presents the design, implementation, and evaluation of an integrated mobile application and a hybrid Hospital Information Exchange (HIE) system to enhance healthcare accessibility and service coordination for PWDs. The platform integrates a user-centered mobile application (iOS and Android) with a hybrid data exchange architecture (MedEx Hybrid) combining an application programming interface (API) and Message Queuing Telemetry Transport (MQTT). This enables real-time and on-demand data exchange while accommodating hospitals with limited infrastructure. Key functionalities include disability registration, emergency medical service (1669) integration, appointment management, rights notification, service location mapping, teleconsultation, and peer communication. Deployment across 159 hospitals nationwide demonstrates system scalability and interoperability. The system supports secure access to electronic medical records and enables emergency responders to retrieve patient information during SOS events, improving continuity of care. Findings confirm the feasibility of the proposed system and its potential to support inclusive digital health and national healthcare interoperability. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in clinical decision-support systems, yet its adoption in low- and middle-income countries, including Jordan, remains limited and underexplored. Understanding how healthcare professionals perceive AI-assisted clinical decision-making is essential for safe and contextually appropriate implementation. This study explored healthcare professionals’ perceptions of AI-assisted clinical decision-making in Jordan, with particular attention to trust, accuracy, accountability, professional judgement, digital literacy, and health-system readiness. Medication-related safety and prescribing concerns were examined as secondary cross-cutting issues where they emerged from participants’ accounts. Methods: A qualitative study was conducted using semi-structured, in-depth interviews with 22 purposively sampled healthcare professionals from public, private, and university-affiliated healthcare institutions in Amman, Irbid, and Zarqa. Participants included physicians, nurses, pharmacists, and allied health professionals with varied specialties and levels of seniority. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Member checking, peer debriefing, reflexive memos, and audit trails were used to enhance trustworthiness, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Eight overarching themes were identified: conditional trust in AI-assisted clinical decision-making; concerns regarding accuracy and confident algorithmic errors; accountability and professional responsibility; AI as an adjunct rather than a substitute for clinical judgement; the influence of experience, specialty, and digital literacy on AI acceptance; Jordanian health-system readiness; privacy, confidentiality, and algorithmic bias; and training requirements for safe AI use. Medication-related safety emerged as a cross-cutting concern, particularly in relation to dosing, polypharmacy, drug–drug and drug–herb interactions, and the risk of over-reliance on AI-generated recommendations. Conclusions: Healthcare professionals in Jordan expressed cautious but constructive views toward AI-assisted clinical decision-making. AI was perceived as potentially useful when used to support, rather than replace, professional judgement. Participants’ accounts suggest that safe implementation depends on local validation, clear accountability frameworks, ethical data governance, interprofessional training, and careful consideration of medication-safety expertise where AI tools influence prescribing or therapeutic decisions. These findings highlight the importance of context-sensitive AI governance strategies that support trustworthy, accountable, and professionally supervised AI adoption in healthcare. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article