Search Results (3)

Introduction: Robotic splenectomy has emerged as a promising alternative to laparoscopic surgery, offering potential advantages in precision, ergonomics, and individualized surgical planning. In the context of personalized medicine, robotic technology may enable tailoring of surgical strategies to patient-specific anatomy, spleen size, and comorbid hematologic conditions. However, its clinical superiority remains uncertain due to limited and heterogeneous evidence. Methods: We performed a systematic review and meta-analysis following PRISMA guidelines, utilizing PubMed, CINAHL, Web of Science, and EMBASE databases to locate studies on robotic splenectomies in children. This review was prospectively registered in PROSPERO (CRD420251104285). Risk of bias was assessed using the ROBINS-I tool for non-randomized studies. Random-effects models were fitted using restricted maximum likelihood (REML), and confidence intervals were adjusted using either Knapp–Hartung (HKSJ) or modified Knapp–Hartung (mKH) methods when appropriate. 95% prediction intervals were calculated, and the certainty of evidence for each outcome was assessed using the GRADE approach. Results: This review included 272 pediatric patients from 16 studies conducted between 2003 and 2025, of which five were included in the meta-analysis. No statistically significant differences were observed between robotic and laparoscopic splenectomy for operative time, intraoperative blood loss, conversion to open surgery, blood transfusions, or complications. However, the direction of effect estimates consistently favored the robotic approach. A statistically significant reduction in hospitalization days (−0.93 days; 95% CI: −1.61 to −0.24; p = 0.01) was found, though this became marginally significant after HKSJ adjustment (p = 0.06). Intraoperative blood loss showed significance in the primary model (−63.88 mL; 95% CI: −120.38 to −7.38; p = 0.03), but not after mKH correction (p = 0.16). Heterogeneity was substantial-to-extreme for several outcomes and was only partially accounted for by leave-one-out sensitivity analyses. All findings were rated as very low certainty according to the GRADE framework. Conclusions: Robotic-assisted splenectomy in pediatric patients has been reported as technically feasible and performed safely in selected cases. However, the small number of studies, their retrospective design, substantial methodological heterogeneity, and the resulting very low certainty of the evidence according to GRADE preclude any firm conclusions about its comparative safety or efficacy versus laparoscopy. Well-designed prospective studies are needed to clarify its clinical benefits. Full article

Background: The increasing demand for care in hospital settings, often at a high intensity, requires organizing work according to 24 h shifts. Nevertheless, shift work (SW), especially at night, alters the circadian rhythm, negatively affecting the psychophysical health of nurses, compromising their quality of life, and jeopardizing patient safety. Shift-work-related diseases (SWDs) can arise from these disruptions. Methods: This systematic review aims to evaluate the effects of several types of medical, psychotherapeutic, and educational interventions and strategies on shift-work-related diseases (SWDs). The databases PubMed, Embase, Web of Science, and Cochrane were searched using the MESH terms “shift work” and “nurses” from January 2015 to March 2025. A total of 43 articles were included in the final analysis. Results: Quantitative findings from the studies showed, for example, improvements in sleep quality scores ranging from 15% to 40% with optimized shift planning, reductions in fatigue scores by 20–35% through strategic napping, and moderate effect sizes for light therapy interventions. Physical activity and relaxation techniques were associated with a 10–25% improvement in subjective well-being indices, while meal timing interventions led to reductions in gastrointestinal symptom prevalence by up to 18%. The selected articles were discussed by dividing them according to the type of intervention applied to shift nurses, namely improvement of shift planning, light and temperature modulation, introduction of napping, supplementation, meal management, psychotherapy, sleep education, physical activity, relaxation techniques and yoga, music therapy, and aromatherapy. This categorization was performed to highlight the range of strategies tested and their relative quantitative impact. Conclusions: There is evidence that SWDs can be mitigated through targeted interventions and strategies. The limitations of the studies examined include small sample sizes, extreme heterogeneity of follow-up, the few numbers of randomized controlled trials, and the prevalence of female or Intensive Care Unit nurses in study samples. Further research should focus on large-scale randomized controlled trials, multicenter longitudinal studies, and the evaluation of the most promising interventions—particularly light therapy, optimized shift scheduling, and structured napping protocols—to assess their long-term efficacy and generalizability. Full article

China’s aging society has led to a major transformation of the healthcare model from traditional therapeutic medical care to life support healthcare. Med–small-sized hospitals (with 20–299 beds) are expected to play a major role in this transition compared to large hospitals. However, hospitals often take 3–5 years or more from design to construction. In order to guide architects in planning and designing for future needs, this study aims to identify the key points of planning and design that can enhance the value of med–small-sized hospitals in terms of functional configuration, spatial environment, etc. In this study, a questionnaire survey was conducted on the perceived value of 600 patients in Nanjing, China. The data were used to construct a structural equation model (SEM) of perceived value for med–small-sized hospitals in China. There are 24 observed variables in six dimensions, including cost value, functional value, social value, cognitive value, patient satisfaction, and patient loyalty. The final SEM indicates that optimizing functional configurations and spatial environment design can significantly increase the value of hospitals, while patients’ willingness to go to the inpatient department is quite low. Finally, based on the survey findings from Nanjing, we proposed four optimization strategies: (1) promoting diversified development and collaboration based on regional characteristics, (2) optimizing functional configurations, (3) maintaining an efficient and concise patient experience, and (4) optimizing the inpatient department. Full article