Search Results (5,451)

Viral hemorrhagic fevers (VHFs) are severe infectious diseases caused by RNA viruses of the families Arenaviridae, Filoviridae, Flaviviridae, and Hantaviridae, characterized by high morbidity, significant case fatality rates, and frequent diagnostic uncertainty in early disease stages. For military medical services, timely clinical recognition and laboratory confirmation are essential to guide patient management, prevent nosocomial transmission, and maintain operational continuity, particularly in endemic or resource-limited deployment settings. This review critically examines current diagnostic approaches to VHF-causative agents, emphasizing their use in clinical and field medical settings. The diagnostic process, from exposure through specimen collection, laboratory testing, and result interpretation is analyzed, including the use of molecular, serological, and antigen-based assays. Particular attention is given to deployable diagnostic platforms and their role in bridging the gap between frontline clinical suspicion and definitive laboratory confirmation. Biosafety requirements and infection prevention measures are discussed as integral components of clinical diagnostic workflows, aligned with guidance from the World Health Organization and the Centers for Disease Control and Prevention. Comparative analyses of virus-specific diagnostic timelines and laboratory requirements are presented to support differential diagnosis and clinical decision-making. Emerging technologies, including rapid molecular assays and genomic methods, are evaluated for their potential to improve early diagnosis and patient outcomes. This review highlights the central role of diagnostic readiness in clinical management of the VHFs and provides evidence-based considerations to support military clinicians facing high-risk febrile illnesses in operational environments. Full article

Background/Objectives: Medical social work is performed in hospital teams, but evidence remains limited on how medical social workers’ perceived communication and cooperation with physicians and nurses are associated with occupational outcomes. Methods: Using the medical social work module of the China Social Work Longitudinal Survey 2019 (CSWLS2019), this cross-sectional study examined job satisfaction, personal accomplishment, self-rated service quality, and emotional exhaustion. We constructed a four-item communication-and-cooperation index and estimated ordinary least squares (OLS) models with HC3 heteroskedasticity-robust standard errors and city fixed effects. Robustness and exploratory supplementary checks assessed sample definition, alternative specifications, single-item ordered logit models, decomposed components, moderation, and a supplementary seemingly unrelated regression (SUR) system. Results: The index was positively associated with job satisfaction (b = 0.260, p = 0.0010), personal accomplishment (b = 0.416, p = 0.0335), and self-rated service quality (b = 0.151, p = 0.0275). Its association with emotional exhaustion was negative but not statistically significant in the main model (b = −0.186, p = 0.1207), although it became significant in the stricter sample. Decomposed and moderation models provided limited evidence for stable component-specific or moderation patterns. Conclusions: The findings should be interpreted as exploratory associational evidence rather than causal effects. Perceived communication and cooperation with physicians and nurses appear more consistently linked to favorable occupational evaluations than to emotional exhaustion among medical social workers in China. Full article

Background/Objectives: Standardised institutional patient satisfaction surveys are the primary quality-monitoring tool in Romanian public hospitals, but their ability to capture the full range of patient experiences remains uncertain. This study quantifies the discrepancy between institutional patient satisfaction scores and an independent, unmediated national feedback instrument, the Patient Feedback Mechanism (MFP), at Targoviste County Emergency Hospital (SJUT) over a six-year period (2019–2024), and examines item-level MFP results across eight dimensions of the patient experience, including dimensions not captured by the institutional indicators routinely reported by SMCSP. Methods: A sequential design combined six years of institutional satisfaction data (2019–2024) from SJUT (N = 32,176 questionnaires) with item-level MFP results for the same period, covering eight questions on medical services, cleanliness, out-of-pocket medication costs, staff involvement, communication, recommendation intent, self-reported health outcome, and willingness to report requests for money from staff. Hypotheses were tested using two-proportion z-tests with Wilson confidence intervals, Mann–Kendall trend analysis, and Cohen’s h for effect sizes. Results: Institutional satisfaction remained consistently high (96.88–97.45%), while MFP satisfaction with medical services ranged from 70.7% to 88.9% across the same years, yielding gaps of 7.9 to 26.7 percentage points, significant in every year (p < 0.001; Cohen’s h ranging from 0.32 to 0.82). The gap did not follow a monotonic trend (Mann–Kendall p = 0.469); instead, it widened to a peak in 2021 and narrowed progressively through 2024. A parallel comparison between the Quality and Patient Safety Management Service (SMCSP) overall impression item (exceeding 99%) and the MFP recommendation item (69.9–76.3%) showed even larger gaps, of 23.3 to 29.6 percentage points. The MFP item on willingness to report requests for money from staff, which is not part of SMCSP’s reported institutional indicators, remained in a narrow 4.0–5.5% range between 2019 and 2023 with no significant trend (Mann–Kendall p = 0.82); a higher 2024 value (6.9%) coincides with a national redesign of this item and is not directly comparable to earlier years. Conclusions: Institutional surveys and an independent national feedback instrument offer structurally distinct perspectives on hospital performance, reflecting differences in administration rather than equivalent estimates of patient satisfaction. The discrepancy between sources is significant and persistent, though not monotonic, widening sharply during 2021 before narrowing. One item with no institutional equivalent documents a measurable, non-trivial proportion of patients willing to report informal payment requests every year, although the available data do not establish whether this proportion is rising over time. Systematic use of existing MFP data, already collected nationally, can complement institutional surveys at minimal additional cost, provided the two instruments are interpreted as structurally different rather than as alternative estimates of the same quantity. Full article

Background/Objectives: Prehospital advanced airway management significantly affects patient outcomes. The King Laryngeal Tube (King LT) has been a standard method for managing compromised airways in various emergency medical services (EMSs). However, in-depth analyses of first-attempt success and influencing factors are limited. This study explores the use of the King LT in Saudi Arabia to assess the first-attempt success rate and predictors of successful management. Methods: This retrospective cross-sectional study was conducted to analyze cases requiring the King LT in the main EMS provider in Saudi Arabia between October 2021 and September 2022. A descriptive analysis was employed for categorical data, and Chi-square test, Fisher’s exact test, and a regression analysis were applied to assess the significance of the association. Results: Of the 239 analyzed cases, adults (58.6%) and males (70.7%) were predominant. The highest proportions of cases were medical cases (36.8%) and indoor incidents (69.9%), with a significant association of indoor incidents with female and elderly patients (p = 0.001). The first-attempt success rate reached 82.4%, with significant success likelihood in afternoon incidents (adjusted odds ratio [OR] = 2.92, 95% confidence interval [CI] [0.53–3.57]; p = 0.03). Conclusions: This first nationwide study of King LT outlines advanced airway management characteristics in Saudi Arabia. The high use rates in adults, males, medical cases, and indoor incidents could suggest tailored training strategies. Noted temporal variations may provide insights for policy improvements. While first-attempt success rates are high, reflecting literature findings; performance could improve with further training. Full article

Background/Objectives: Chronic diseases account for 74% of global deaths, with multimorbidity (existence of more than one chronic condition) increasing disability risk and treatment burden, leading to poor adherence, disease progression, and reduced quality of life. Nursing-led proactive care models that focus on patient engagement, education, and self-care can help mitigate these challenges. The study aims to evaluate the effectiveness of a nurse-led proactive health intervention in improving care for individuals with chronic diseases in general practice. Methods: A quasi-experimental pre–post study will be conducted in a Community Health Home in Northern Italy. Family and community nurses will deliver the intervention, which includes assessments, educational sessions, and follow-ups for patients aged 65+ with at least one chronic condition. Recruitment will occur over three months. Results: Primary outcomes include emergency department visits and hospitalizations, while secondary outcomes focus on medication adherence, self-care, and service utilization. Data will be collected at 6 and 12 months, and statistical analysis will use descriptive methods and generalized estimating equations (GEEs). Conclusions: This study will improve the understanding of the value of nurse-led proactive intervention, filling the gap in the literature by testing evidence-based approaches on a realistic frail population. Moreover, delivering a complex but structured intervention will provide evidence for future interventions to reduce treatment burden and improve health outcomes. Full article

Background/Objectives: Prediabetes significantly increases the risk of type 2 diabetes and related complications. Limited data exist for prediabetes among minority groups in Israel, particularly Bedouins. In the Negev region, Jewish and Bedouin populations differ markedly in culture and socioeconomic status. This study aimed to identify gender- and ethnicity-specific predictors of prediabetes. Methods: This retrospective, population-based observational exploratory study used data from 28,754 adults aged 20–65 years insured by Clalit Health Services in Southern Israel (2010–2020). Individuals with prediabetes were matched 1:1 with controls by age, gender, ethnicity, and year of diagnosis. Multivariate logistic regression models stratified by gender and ethnicity identified independent predictors. Results: Prediabetes was identified at significantly younger ages among Bedouins than Jews (6.8 years in men, 11.3 in women). The strongest predictor across all subgroups was metabolic syndrome (OR 2.0–4.0). Gestational diabetes was a major risk factor in women, particularly Jewish (OR 3.6). Cardiovascular disease and the use of statins or thiazide diuretics were independently associated with increased odds of prediabetes. Triglyceride-to-HDL cholesterol ratio was consistently elevated among prediabetes patients. Conclusions: Metabolic and medication-related factors contribute significantly to prediabetes-associated risk, with distinct gender and ethnic patterns. Culturally tailored early interventions and individualized risk profiling may enhance diabetes prevention in Southern Israel. Full article

Life cycle assessment is increasingly applied in healthcare, yet the healthcare-specific standardisation landscape and its relation to current practice remain unclear. This study maps existing frameworks and analyses their alignment with published healthcare LCA to identify standardisation gaps. Healthcare-specific standards and product category rules were identified through grey literature searches. Published healthcare LCA studies were quantitatively analysed and compared with the identified frameworks to assess methodological convergence and divergence. Six healthcare-specific frameworks were identified: five address medical products, one addresses services, and none cover organisational assessment. Product-level applications showed strong alignment in structural modelling elements including system boundaries and life cycle stages, while substantial heterogeneity persisted in functional unit definitions and impact assessment approaches. Service and organisational assessments showed broader variability in modelling approaches, functional units, and system boundary conceptualisations, indicating distinct modelling logics of healthcare delivery across assessment levels. Healthcare LCA practice is consistent with ISO-based principles but lacks a shared conceptual modelling logic for healthcare delivery systems. Rather than reflecting a single methodological paradigm, healthcare LCA combines product-, intervention-, pathway-, and organisational-oriented approaches. Standardisation efforts should therefore focus not only on harmonising calculation methods but also on developing healthcare-specific modelling conventions for products, services, and organisational structures. Full article

Most airline passengers and crew assume that the air in the cabin is free from harmful or hazardous substances, as is mandated by airworthiness regulations. While fresh air entering the cabin is sterile (and if recirculated is usually efficiently filtered to remove microorganisms), if the fresh air is bled off the turbine compressors (as is the case in about 95% of airliners currently in service), it may be contaminated with traces of engine oil and ultrafine particles abraded from the turbine blades, and possibly traces of hydraulic fluid leaking from servo systems. Engine oil contains tricresyl phosphate (TCP) as an essential antiwear agent, but it is also a well-known neurotoxin, and it has been suggested that there may be no safe lower limit of exposure, not least because of considerable variation among individuals in sensitivity to tri-ortho-cresyl phosphate (ToCP) and other isomers with at least one ortho constituent. This paper reviews current knowledge about these hazards and discusses the medical and economic motivations for diminishing them. A calculation based on maintaining the life quality index shows that eliminating xenobiotic hazards in aircraft cabin air is likely to be affordable. Full article

Background: Research on nursing interventions for breast cancer patients undergoing radiotherapy is increasing. However, comprehensive mapping and synthesis regarding the field’s overall knowledge structure and development remain limited. This study aims to utilize bibliometric methods to analyze the current status, research hotspots, and emerging trends in this field. Methods: We conducted a bibliometric analysis of 256 publications from the Web of Science Core Collection and PubMed. Results: Publication volume showed a notable increase after 2020 (16–25 articles per year). The United States leads in output (82 articles, 32.0%), followed by China (25 articles). At the institutional level, the University of California, San Francisco (10 articles) is the most productive, while George Washington University leads in total citations (1759). Oncology Nursing Forum is the leading journal both in publication volume (20 articles) and h-index (13). Twelve major research clusters were identified, primarily focusing on symptom management (specifically pain) and psychosocial support. Keyword burst analysis suggests that current frontiers have shifted from acute symptom control toward systematic management approaches and psychological symptom interventions. Conclusions: Based on the analysis of 256 publications and 12 research clusters, this study indicates that the focus of nursing research appears to be expanding from acute symptom control toward comprehensive case management and targeted psychological research. These findings may provide useful directions for future research and clinical practice, particularly regarding the integration of psychosocial care into nursing management. Full article

Burdur Lake is a saline lake in southwestern Türkiye that has undergone significant hydrological changes in recent decades. Water levels dropped by about 18 m, and the surface area became 75 km² smaller between 1980 and 2022. Trend analyses showed a strong downward trend in lake levels (p < 0.01), while air temperatures increased significantly. Wind speed and relative humidity decreased, and no significant trend in precipitation was detected. Analysis of the normalized difference vegetation index (NDVI) values showed that the vegetation density increased during the same period. Correlation results indicated no link with precipitation and water levels, but a strong negative relationship of water levels with temperature and NDVI was found. Overall, the decline in lake level cannot be explained solely by climatic changes; anthropogenic effects are also highly influential. Full article

Background/Objectives: Lavandula cariensis species is cultivated uncommonly in the western region of Turkey. The colloquial appellations avayianos, karabasi, and myra are used to refer to the L. cariensis plant. The essential oil of L. cariensis was studied for its potential antiglaucoma, antioxidant, antidiabetic, and acetylcholinesterase inhibitory effects. Methods: The inhibitory effect of the essential oil of L. cariensis on the acetylcholinesterase (AChE), carbonic anhydrase II (CA II), and α-amylase enzymes was determined. Therefore, chemical profiles of L. cariensis’ essential oil were identified using Gas Chromatography Mass Spectrometry (GC-MS) and as Chromatography with Flame Ionization Detection (GC-FID) analyses. Results: Camphor (39.73%), fenchone (19.49%), exobornyl acetate (6.81%), camphene (5.49%), and eucalyptol (5.49%) were the most abundant compounds in L. cariensis essential oil. Radical scavenging effect of the essential oil of L. cariensis was examined using 1,1-diphenyl-2-picrylhydrazyl (DPPH) (IC₅₀: 231.0 ± 0.094 μg/mL) and 2,2′-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid) (ABTS) (IC₅₀: 7.45 ± 0.013 μg/mL) radicals. Also, the ferric ions (Fe³⁺), cupric ions (Cu²⁺), and Fe³⁺-2,4,6-tri(2-pyridyl)-S-triazine (TPTZ) complex reducing capabilities were studied. Additionally, essential oil of L. cariensis indicated a comparable level of inhibition towards hCA II (IC₅₀: 276.42 μg/mL), AChE (IC₅₀: 14.22 μg/mL), and α-amylase (IC₅₀: 475.63 μg/mL) enzymes. Conclusions: The evaluation of the antioxidant capabilities and enzyme inhibition profiling of the essential oil of L. cariensis will be made possible by this comprehensive study, which serves as a springboard for further research. The essential oil of L. cariensis demonstrated enzyme-inhibitory activities against target enzymes associated with Alzheimer’s disease, diabetes, and glaucoma. Also, this study’s in vitro inhibition suggests promising prospects. Full article

Background: Meralgia paresthetica (MP) of the lateral femoral cutaneous is a rare, nerve-entrapment condition, often related to an inflammatory and fibrotic pathological component. Although most cases resolve with conservative management, refractory presentations may require interventional or surgical treatment. Platelet-rich plasma (PRP) has demonstrated emerging potential in peripheral neuropathies through anti-inflammatory, neurotrophic, and antifibrotic mechanisms. Case Presentation: We report the case of a 64-year-old professional scuba diving instructor with occupational MP related to repetitive compression from a tight lead weight belt. Symptoms persisted for six months despite conservative therapies. Clinical examination supported lateral femoral cutaneous nerve (LFCN) entrapment. The patient underwent three serial perineural PRP injections prepared from autologous blood and administered along the inguinal course of the nerve. Progressive symptom reduction was observed after each session, reaching approximately 90% improvement at two months. At six months, the patient was pain-free and had returned to full professional activity without limitations. Discussion: Occupational microcompression may induce intraneural edema, ischemia, and perineural fibrosis, creating a biological substrate amenable to regenerative intervention. PRP delivers concentrated growth factors capable of promoting axonal regeneration, angiogenesis, and modulation of the neuroinflammatory microenvironment. Preclinical and clinical evidence in other compressive neuropathies supports this translational rationale. Conclusions: Perineural PRP infiltration may represent a safe and promising regenerative strategy for refractory occupational MP. Controlled clinical studies are needed to define optimal protocols, patient selection criteria, and long-term efficacy in peripheral compressive neuropathies. Full article

Background: Hypotonic–hyporesponsive episode (HHE) is a recognised adverse event following immunisation (AEFI) in infants, characterised by sudden hypotonia, hyporesponsiveness, and pallor or cyanosis. Although considered benign, its abrupt and often dramatic presentation often leads to acute medical evaluation. Contemporary data on HHE are limited, and awareness among healthcare professionals needs attention. Methods: We conducted a retrospective analysis of all spontaneous reports of HHE submitted to the national pharmacovigilance centre Lareb between 1 January 2012 and 22 July 2025. Cases were included only when meeting Brighton Collaboration (BC) Level 1 criteria, requiring clear documentation of hypotonia, hyporesponsiveness, and pallor or cyanosis in children younger than 24 months. Demographic and clinical characteristics, vaccine combinations, latency, duration, seriousness, and medical care utilisation were described. Results: A total of 294 Level 1 HHE cases were identified. Most episodes followed combinations of hexavalent vaccines with pneumococcal conjugate vaccines. The median age at onset was 9 weeks, with slightly more reports involving boys. The median latency to onset was 5 h (range 4–8 h), and the median episode duration was 10 min (range 3–30 min), aligning with the historical literature. All children recovered fully, and no long-term sequelae were reported. Although HHE is clinically benign, 27% of cases were classified as serious, primarily due to hospital admission. Among non-serious cases, one third involved medical assessment or emergency services. Healthcare professionals submitted 44% of reports, notably community child health physicians. Conclusions: Contemporary Dutch pharmacovigilance data confirm that the clinical characteristics of HHE remain highly consistent with long-standig evidence. Despite its benign and self-limiting nature, HHE frequently triggers substantial medical care consumption. Improved awareness of the typical presentation, course, and prognosis, supported by the Brighton Collaboration criteria, may help clinicians recognise HHE more readily, reduce unnecessary medical consumption, and provide reassurance to caregivers. Full article

Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake County, a large (~1 million inhabitants), diverse county in North Carolina. We screened and adjudicated victims of sudden, unexpected, out-of-hospital deaths in adults aged 18–64 years reported by emergency medical services between 2013 and 2015. We randomly selected sex- and age-matched control patients from a university health system from the same county and time period. Characteristics of sudden death victims and controls were ascertained via standardized chart reviews. Unhealthy alcohol use was identified via chart review and was defined as any evidence of excessive alcohol use, such as it being stated in the social history or medical history, alcohol abuse being listed as a possible contributor to death, or alcohol-related diagnoses. We used logistic regression to estimate odds ratios (ORs) for the association of unhealthy alcohol use and sudden death, adjusting for age, sex, race, and other psychiatric diagnoses, including depression, anxiety, schizophrenia, bipolar disorder, and substance use disorders other than tobacco and alcohol. We also calculated the E-value to estimate the impact of any unmeasured confounders. Results: We identified 399 sudden death victims, of whom 374 (94%) had alcohol use data available. Among these 374 included victims, 256 (68%) were male, and 239 (62%) were White, with a median age at death of 55 years (IQR 48, 60). The demographic characteristics of the 1114 matched controls were similar to those of sudden death victims. Unhealthy alcohol use was present in 115 (31%) sudden death victims and 27 (2%) controls. In analyses adjusted for demographics only, unhealthy alcohol use was associated with a higher incidence of sudden death, with an OR of 17.5 (95% CI 11.4, 27.8). When further adjusted for other psychiatric diagnoses, the OR was 11.2 (95% CI 7.1, 18.0). The calculated E-value was 21.8, meaning an unmeasured confounder would need to be associated with both unhealthy alcohol use and sudden death by 21.8-fold to explain away the observed OR. Conclusions: Unhealthy alcohol use was strongly associated with higher sudden death risk in working-age adults. Our calculated E-value indicates it is unlikely that any unmeasured confounders alone would account for the observed association. Our findings suggest that interventions to reduce unhealthy alcohol use may be an effective strategy to prevent sudden death in working-age adults. Full article

Background/Objectives: Medication-related harm is a leading global patient safety challenge, yet patients’ lived experiences of medication safety remain underexplored in Central and Eastern European healthcare systems, where structural constraints significantly shape everyday medication use. Methods: This study provides an in-depth qualitative analysis of Hungarian patients’ online narratives, building on a prior netnographic mixed-methods study. Using grounded theory-informed principles and a patient-centred medication safety framework, we inductively analysed 5174 publicly accessible Hungarian-language comments posted on health forums and social media platforms between August 2020 and August 2023. The COM-B model was applied as a secondary lens to map findings onto modifiable behavioural determinants. Results: Access to services and communication emerged as the dominant medication safety concerns. Patients reported long waiting times, limited rural emergency services, and brief consultations leading to delayed or inadequate treatment. Communication gaps included insufficient information on medication duration, side effects, and follow-up, as well as conflicting advice from multiple sources, all of which eroded trust and prompted treatment discontinuation or reliance on informal online communities. Community pharmacists were largely absent from patients’ mental models of care, representing a significant missed opportunity given their accessibility. Less frequently mentioned were medication shortages, healthcare professional workload, and systemic safety culture. Conclusions: Clear, respectful communication and timely access to care are central to medication safety from the patient perspective. Netnography combined with a grounded theory-informed methodology offers a valuable approach for capturing authentic patient perspectives in structurally burdened healthcare systems, with findings relevant beyond the Hungarian context. Full article