Search Results (13,474)

Background/Objectives: Nurses’ engagement in research is essential to strengthen evidence-based practice, knowledge translation, and quality of care. However, individual, organisational, and cultural barriers may limit nurses’ participation in research activities. This study aimed to cross-culturally adapt and psychometrically test the Italian version of the Barriers to Nurses’ Participation in Research Questionnaire within the Italian cultural and healthcare organisational context, and to explore perceived obstacles to research engagement among nurses in Italy. Methods: A cross-sectional methodological study was conducted. The instrument was translated, back-translated, reviewed by the original instrument developer and an expert panel, and evaluated for content validity by 12 clinical research professionals. Data were collected online between September and October 2024 from 196 nurses working across Italian healthcare settings, including hospitals, university hospitals, IRCCS, primary care, and private hospitals. Exploratory Structural Equation Modelling was used to examine the factor structure. Results: A total of 196 nurses were enrolled in the study. A two-factor structure was identified, comprising Research Resources and Personal Relevance of Research, which explained 35.37% and 25.14% of the variance, respectively. Both factors demonstrated good reliability. The most prominent barrier was the lack of incentive or reward for nurses to engage in research, whereas the least relevant barrier was the perception that research was not interesting or valuable. Greater barriers were reported by younger nurses, those with fewer years of experience, and those without specific research training. Lack of time to conduct research emerged as a pervasive obstacle across the sample. Conclusions: The Italian version of the Barriers to Nurses’ Participation in Research Questionnaire provides preliminary evidence of validity and reliability for assessing perceived barriers to research participation among Italian nurses. Owing to the structural modifications introduced during adaptation, the instrument should be interpreted as a culturally adapted and modified Italian version rather than as a direct replication of the original structure. Its use may support organisational diagnosis, research mentorship, training planning, and future research-capacity-building initiatives, although further validation in larger and more heterogeneous samples is warranted. Full article

Background and Objectives: Quality of life (QoL) is an important issue for breast cancer (BC) survivors. The objective of this study was to assess health-related QoL (HRQoL) of BC patients and investigate the impact of different demographic and clinical factors on physical and social functioning and BC-related symptoms. Materials and Methods: In this cross-sectional study, 107 BC patients undergoing chemotherapy in Greece completed a questionnaire collecting sociodemographic and clinical information and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 (EORTC QLQ-C30) in order to assess HRQoL. Descriptive statistics and multiple linear regression analyses were used to identify factors linked to HRQoL outcomes. Results: Overall, participants reported moderate HRQoL, with high physical and social functioning and moderate emotional, cognitive, and role functioning. Fatigue was the most common symptom, whereas other symptoms were generally uncommon. Multiple regression analyses showed that marital status, place of residence, time since diagnosis, and type of surgery were significantly associated with the global QLQ-C30 score (R² = 0.337, p < 0.001). Physical functioning was associated with comorbidity burden, time since diagnosis, and employment status (R² = 0.155, p = 0.035), and social functioning with marital status and type of surgery (R² = 0.171, p = 0.011). Emotional functioning showed exploratory associations with place of residence and type of surgery; however, the overall regression model for emotional functioning did not reach statistical significance. No symptom model reached overall significance, but time since diagnosis, treatment type, and surgery were linked to distinct symptoms. Conclusions: BC patients undergoing chemotherapy in Greece report an overall moderate level of HRQoL, which is significantly influenced by a combination of demographic and clinical factors; physical and social functioning were high, with moderate emotional, cognitive, and role functioning. These findings highlight the importance of individualized supportive care strategies in order to improve QoL of BC patients. Full article

Gestational Diabetes Mellitus (GDM) represents a significant public health concern due to its association with adverse maternal and neonatal outcomes, as well as elevated long-term metabolic risks. Its prevalence varies substantially depending on the diagnostic criteria used and the population studied. Women with GDM frequently experience heightened stress, anxiety, and uncertainty, underscoring the need for accessible information, counseling, and ongoing support to navigate glucose monitoring, dietary adjustments, and treatment regimens. Although clinical management has been extensively studied, research has largely focused on metabolic monitoring and therapeutic interventions, often underemphasizing prevention strategies, women’s informational needs, and maternal psychological well-being. Emerging evidence and international guidelines increasingly advocate for integrating these components into structured, woman-centered GDM care plans that actively involve families. Such approaches empower women to engage in self-management, enhance health literacy, support adherence to lifestyle and pharmacological interventions, and promote sustainable behavioral changes. This narrative review presents a comprehensive, holistic model of care across the perinatal continuum, emphasizing early risk identification, preventive strategies, and multidisciplinary coordination. Core elements include individualized antenatal education, empathetic communication, and family engagement, fostering self-efficacy, continuity of care, and integration of medical, educational, and psychosocial interventions. Equipping healthcare professionals with the competencies to deliver this holistic, woman-centered framework is essential to optimize maternal and neonatal outcomes and mitigate the long-term health consequences of GDM. Full article

Background/Objectives: With the increasing incidence of drug counterfeiting and the emergence of personalized medicine, the need for unique marking of solid dosage forms, e.g., tablets, has attracted considerable interest in the current research and development landscape. Besides traditional printing methods, laser marking offers several advantages, as it eliminates the need for organic solvents and enables the generation of precise patterns. However, laser exposure may raise safety concerns regarding the stability of photosensitive drugs in the irradiated dosage forms. Therefore, the aim of the present study was to test the photoprotective effect of titanium dioxide (TiO₂) and its various alternatives, e.g., talc, calcium carbonate (CaCO₃), zinc oxide (ZnO), and black iron oxide (Fe₃O₄), alongside a ready-to-use reference formulation, Opadry^® Brown, which contains TiO₂ (titanium-containing, TC) on nifedipine, a light-sensitive model drug. Methods: Laser marking or short-term laser ablation at different wavelengths (193 nm, 248 nm, 532 nm, and 781 nm) was applied to different coating formulations. As a positive control, prolonged exposure to daylight was applied. The properties and photostability of these formulations were evaluated using several analytical methods (i.e., surface profilometry, Raman spectroscopy, and high-performance liquid chromatography (HPLC)). Results: The TiO₂, ZnO, Fe₃O₄, and Opadry^® TC Brown coatings maintained their color during the long-term study under all conditions. Furthermore, the prepared formulations exhibited different ablation depths and morphological changes depending on the coating and laser type. HPLC measurements confirmed significant differences in the protective ability of various pigments against sunlight and different types of lasers. Nevertheless, the obtained Raman spectra were not in complete agreement with HPLC results, which can be attributed to spectral overlap between key nifedipine degradation markers and excipient signals in the tablet core. Conclusions: Overall, laser treatment of tablets containing photosensitive drugs may induce API decomposition; however, this effect can be minimized or avoided by careful selection of the appropriate combination of laser type and photoprotective pigment. Under the applied experimental conditions, Ti:Sa laser treatment was associated with the lowest degree of nifedipine degradation among all formulations, while ZnO-containing coatings demonstrated the most consistent photoprotective performance against the majority of the tested laser types, while Fe₃O₄-containing coatings provided superior protection during prolonged sunlight exposure and Nd:YAG laser irradiation. Full article

Background/Objectives: Head and neck cancer (HNC) is associated with unique risks of catastrophic health events throughout the care continuum. This scoping review evaluated distinct domains of catastrophic health events in HNC and the associated risk factors to inform the development of risk prediction models. Methods: Five electronic databases were searched to identify peer-reviewed journal articles published from 2015 to 2025. Eligible studies were primary observational studies involving adults (≥18) with HNC that reported a catastrophic (or similar term) health event and assessed the associated risk factors using multivariable regression modelling. Results: Fifty-six studies involving 941,329 patients with HNC were included. Half (n = 28, 50.0%) of these studies were conducted in North America, followed by Asia and Europe (n = 13 each, 23.2%). Four domains of catastrophic health events were identified: sudden or premature deaths (n = 22, 39.3%), severe treatment-related complications (n = 19, 33.9%), unplanned acute care encounters (n = 22, 39.3%), and severe patient-reported symptoms (n = 6, 10.7%). Across all domains, comorbidity was the most repeatedly identified risk factor, followed by treatment characteristics (e.g., surgery duration), older age, and advanced cancer stage. Conclusions: Risk prediction models in HNC should always include variables of comorbidity. The varied measurability of risk factors requires strategic efforts when developing prediction algorithms for different domains of catastrophic health events. Full article

This research analyzes the wavy, axisymmetric flow of a Ree–Eyring non-Newtonian nanofluid, infused with motile microorganisms, within a porous, tapered cylindrical channel under a transverse magnetic field. This investigation presents a theoretical framework that may inform the improvement of energy efficiency and thermal management in biomedical engineering applications, such as drug delivery systems and microfluidic biosensors. The work provides an extended insight by a contribution to the evaluation of entropy generation, explicitly considering the influence of motile microorganisms, thereby bridging a gap in the existing literature. The comprehensive physical model further incorporates the combined effects of Joule heating, viscous dissipation, nonlinear thermal radiation, and chemical reactions. Methodologically, the governing nonlinear equations of the system were rendered tractable under long-wavelength and low-Reynolds-number assumptions and subsequently solved using the numerical Runge–Kutta–Fehlberg technique. The key conclusion is that, based on the present numerical model, careful selection of magnetic field strength and microorganism motility parameters may reduce irreversible energy losses, potentially improving the net usable work in advanced nanofluid transport systems for biomedical applications, subject to experimental validation. The most significant finding reveals that the magnetic field serves as a dual-purpose control parameter: increasing its strength boosts total entropy generation by 20–30% while simultaneously raising the Bejan number, confirming heat transfer as the dominant irreversibility mechanism in the system. Additionally, nanoparticle concentration diminishes substantially with elevated chemical reaction rates and Schmidt numbers, while microorganism density is highly sensitive to the Péclet number, which causes flow disruptions. Full article

Developing critical thinking is a central aim of contemporary higher education, yet conventional instructional approaches often underuse authentic, real-world materials that stimulate higher-order reasoning and reflective judgment. The study examines the effectiveness of case-based socio-legal pedagogy in fostering critical thinking within contexts of legal pluralism and social complexity. A quasi-experimental mixed-methods pre–post design was conducted with 62 undergraduate students enrolled in a course on Islamic law and society. Over a four-week intervention, students engaged with six socio-legal cases drawn from Muslim women’s legal experiences in Israel, focusing on divorce, maintenance (nafaka), and child custody. Quantitative data were collected using a validated Critical Thinking Rubric assessing argumentation, evaluation of multiple perspectives, and legal reasoning. Results showed significant improvement in overall critical thinking, with gains across all measured dimensions. Qualitative analysis of written assignments and student reflections revealed greater recognition of legal ambiguity, more structured and evidence-based argumentation, and deeper engagement with competing normative and social frameworks. Overall, the findings highlight the pedagogical value of integrating socio-legal complexity into case-based learning as an adaptable model for strengthening critical thinking across disciplines involving interpretive, contested, and context-dependent knowledge in higher education and other fields requiring careful judgment under conditions of uncertainty and change. Full article

Background/Objectives: Ventilator-associated pneumonia (VAP) remains a major complication in patients requiring prolonged mechanical ventilation. The effect of tracheostomy on VAP risk remains controversial, particularly when differences in duration of mechanical ventilation are considered. This study evaluated the association between tracheostomy, VAP occurrence, and clinical outcomes in mechanically ventilated ICU patients. Methods: We conducted a retrospective matched exposed–unexposed cohort study in a tertiary-care ICU in Mexico City. Patients undergoing tracheostomy were compared with an age- and sex-matched subcohort of intubated patients receiving invasive mechanical ventilation for ≥48 h. VAP incidence was assessed using cumulative incidence, incidence density, and multivariable generalized linear models. Results: A total of 218 patients were included (55 tracheostomized and 163 intubated). VAP incidence density was similar between groups (31.5 vs. 30.3 per 1000 ventilator-days; RR 1.04, 95% CI 0.7–1.7), whereas cumulative incidence was higher among tracheostomized patients (61.8% vs. 22.7%; RR 2.7, 95% CI 1.9–3.9). Broad-spectrum antibiotics, mechanical ventilation ≥ 5 days, chronic pulmonary disease, and ICU stay remained associated with VAP occurrence in an exploratory multivariable model. Gram-negative microorganisms predominated, and antimicrobial resistance was more frequent among tracheostomized patients. Conclusions: Tracheostomy was associated with higher cumulative incidence of VAP, but a similar incidence density compared with endotracheal intubation. The crude association between tracheostomy and VAP disappeared after adjustment for confounding factors, suggesting that prolonged mechanical ventilation and ICU exposure are more important determinants of VAP risk than tracheostomy itself. Full article

Objectives: To evaluate the impact of Point-of-Care Ultrasound (POCUS) performed by family physicians on the management of abdominal pain in the emergency department, assessing its effect on length of stay, performance of complementary diagnostic tests, diagnostic concordance, and patient satisfaction. Methods: Quasi-experimental pilot study with a control group conducted in a hospital emergency department. A total of 222 adult patients with abdominal pain were included and allocated according to the attending professional (with or without ultrasound training). Clinical, care-related, and patient-satisfaction variables (SERVPERF questionnaire) were analyzed. Non-parametric statistical tests were used, and multiple linear regression analyses were performed. Results: The POCUS group showed a shorter length of stay (3.46 vs. 4.41 h; p = 0.022) and a lower number of plain radiographies (16.8% vs. 69.9%; p < 0.001) and CT scans (p = 0.034). Diagnostic concordance was significantly higher in the experimental group (99.2% vs. 75.7%; p < 0.001). Overall satisfaction with received care was also higher in the intervention group (p < 0.001), with significant differences observed across all evaluated dimensions. The multivariate model explained 26.6% of the variability, with patient satisfaction emerging as a positive predictor. Conclusions: POCUS improves the quality of care in emergency departments by reducing length of stay and the use of complementary diagnostic tests while increasing diagnostic accuracy and patient satisfaction. Its implementation can be considered an effective and potentially cost-effective strategy; however, further studies with greater methodological robustness are required to validate the development of standardized composite indexes. Full article

The development of new technologies enabling rapid, frequent, and reagent-free monitoring of kidney function is recognized as being of paramount importance. In this work, mid-(MIR) and near-infrared (NIR) spectroscopy were compared for the prediction of key renal biomarkers—creatinine, urea and albumin—using 54 serum solutions mimicking the biochemical profiles of five stages of chronic kidney disease (CKD). MIR spectra were acquired in a high-throughput microplate platform after a simple dehydration step, while the NIR spectra were obtained directly from liquid serum using a fiber optic probe. After evaluating several spectral pre-processing methods and targeted spectral regions, excellent regression models (R² > 0.9 for the best models) were obtained for the three biomarkers. MIR provided highly accurate urea predictions, whereas optimized NIR sub-regions enabled excellent estimation of creatinine and albumin. Both MIR and NIR, associated with supervised classification methods, enabled us to successfully distinguish healthy from diseased profiles and to identify the diseases state with AUC > 0.93. These findings highlight the complementary value of MIR and NIR spectroscopy for kidney disease assessment and their potential integration into point-of-care diagnostic systems. Full article

Radiation-induced oral mucositis (RIOM) frequently causes severe pain and treatment interruptions in patients with head and neck cancer. While earlier guidelines suggested zinc supplementation, updated MASCC/ISOO guidelines downgraded it to ‘No Guideline Possible’ due to highly conflicting evidence. This study aims to resolve these inconsistencies by evaluating zinc’s prophylactic efficacy and investigating whether the route of administration determines its clinical benefit. Following PRISMA guidelines and INPLASY registration (INPLASY202620063), we searched PubMed, Embase, and the Cochrane Library through February 2026. We included randomized controlled trials (RCTs) comparing prophylactic zinc versus placebo or standard care in head and neck cancer patients receiving radiotherapy. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The primary outcome was severe (Grade 3–4) RIOM incidence. Data from five RCTs (332 patients) were pooled using a random-effects model. Overall, zinc significantly reduced severe mucositis risk (RR = 0.35, 95% CI: 0.17–0.73, p = 0.005). Crucially, an exploratory subgroup analysis revealed a striking divergence based on delivery route. Topical zinc mouthwash demonstrated encouraging protection (RR = 0.16, 95% CI: 0.05–0.49, p = 0.001) with zero heterogeneity (I² = 0%). In contrast, systemic zinc yielded borderline, inconsistent benefits (RR = 0.52, 95% CI: 0.27–1.01, p = 0.055, I² = 37%). In conclusion, the localized pool of contemporary evidence clearly demonstrates that the systemic oral ingestion of zinc supplements does not provide a reliable prophylactic benefit against severe radiation-induced oral mucositis in head and neck cancer care. Conversely, topical zinc mouthwashes exhibit an encouraging protective trend; however, the severe paucity of available randomized trials and low cumulative patient volume preclude definitive clinical verification. While these exploratory findings suggest that topical administration may provide a more consistent protective trend compared to systemic routes, they should be interpreted as hypothesis-generating rather than definitive. Future large-scale, multi-center RCTs are strictly warranted to validate these promising route-specific benefits before formal guideline integration. Full article

Background: Patients undergoing open-heart surgery (OHS) are at risk of postoperative morbidity and mortality. Physical performance has been increasingly recognized as an important factor influencing postoperative outcomes. Therefore, the study aimed to investigate the associations and predictive value of physical performance on postoperative complications and duration of hospital stay. Methods: A prospective cohort study was conducted in 116 patients who were admitted to OHS. Preoperative assessment of physical performance, i.e., Short Physical Performance Battery (SPPB), Five Times Sit to Stand Test (5STS), gait speed (5 m walk test: 5MWT), Timed Up and Go (TUG), and handgrip strength. Duration of hospital stay and incidence of post-operative complications were recorded. Differences between participants with and without postoperative complications were analyzed using independent samples t-tests for continuous variables and chi-square tests for categorical variables. The associations between physical performance and postoperative outcomes were assessed using Spearman’s rank correlation coefficient. Hierarchical regression analysis was conducted to determine the predictive contribution of physical performance. Results: A total of 116 participants were submitted for OHS in two medical school hospitals; however, 108 individuals completed the pre-operative physical performance. The most common procedures were coronary artery bypass grafting and valve surgery. Fifty-one participants (47.22%) experienced postoperative complications, including five deaths, corresponding to 4.63% mortality. For the length of hospital stay analysis, five participants who died postoperatively were excluded, resulting in a final sample of 103 participants. Physical performance was significantly associated with the length of hospital stay (p < 0.05). Hierarchical regression analysis showed that the final prediction model explained 13.4% of the variance in length of hospital stay, with SPPB independently contributing an additional 6.0% to the model, followed by 5STS, 5MWT, handgrip strength, and TUG, which accounted for an additional 5.1%, 4.6%, 4.4%, and 3.7%, respectively. Conclusions: Preoperative physical performance was associated with length of hospital stay. While each measure explained a relatively small proportion of the variance in hospital stay, these assessments offer a simple, non-invasive, and clinically feasible approach to evaluating functional reserve before surgery. These findings highlight the importance of incorporating functional assessment into perioperative care to support risk stratification and guide rehabilitation strategies. Full article

Artificial intelligence (AI) is reshaping the field of diagnostic radiology; however, its applications in interventional radiology and pediatric interventional radiology (PIR) remain limited despite clear clinical needs and the rich multimodal data environment characteristic of pediatric procedural care. In this narrative review, I summarize the current state of AI technologies relevant to PIR and outline future perspectives for their clinical integration. Peer-reviewed literature and position statements identified through MEDLINE/PubMed, Embase, Scopus, and major society publications up to the first quarter of 2026 are synthesized, focusing on AI applications across the PIR care pathway, including dose-sparing image acquisition and reconstruction, automated image interpretation and computer-aided diagnosis, data-driven procedural planning and navigation, and post-procedural risk prediction and monitoring. After briefly introducing core machine learning and deep learning concepts, pediatric-specific challenges are discussed, including radiation sensitivity, growth-related anatomical variability, regulatory constraints, and the scarcity of large, annotated datasets, as well as existing and emerging applications along the PIR care pathway: AI-assisted dose reduction and image reconstruction, automated image interpretation, segmentation, and computer-aided diagnosis; data-driven procedural planning, including three-dimensional modelling, augmented reality, AI-enabled/AI-adjacent robotics, and AI-directed procedural navigation; and post-procedural risk prediction and outcome monitoring. Finally, emerging paradigms, including explainable AI, federated learning, and multimodal integration, are highlighted, and research priorities, collaborative frameworks, and governance principles required to ensure safe, equitable, and effective AI deployment in PIR are outlined. In doing so, this review delineates the current evidence gaps and priority directions for clinically meaningful AI adoption in PIR. Although AI has the potential to improve patient care, it has not yet been specifically designed, validated, or deployed in children. Existing work demonstrates feasibility across the PIR workflow, but most tools remain weakly linked to pediatric clinical endpoints. 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

Objectives: To determine the prognostic value of the triglyceride-glucose (TyG) index, which serves as a surrogate for insulin resistance, for heart failure rehospitalization and all-cause mortality in older adults with chronic heart failure, and to evaluate its clinical utility in risk stratification and nursing care. Methods: In this single-center retrospective cohort study, 786 patients aged ≥65 years with chronic heart failure hospitalized at a tertiary referral hospital in Central China (January 2022–January 2025) were included and divided into low vs. high TyG index groups based on the median. Baseline data were extracted from medical records. Follow-up ended in December 2025. Associations between TyG index and adverse outcomes were examined using Kaplan–Meier curves, restricted cubic spline (RCS) regression, and multivariable Cox proportional hazards models. Results: The median TyG index was 8.35. In unadjusted analyses, the high-TyG group had significantly greater cumulative risks of heart failure rehospitalization (p < 0.001) and all-cause mortality (p = 0.028). After multivariable adjustment, the TyG index remained independently associated with heart failure rehospitalization (hazard ratio [HR]= 1.63), whereas its association with all-cause mortality was attenuated and no longer significant. Restricted cubic spline analysis revealed a nonlinear dose–response relationship between the TyG index and heart failure rehospitalization, and a linear relationship with all-cause mortality. Conclusions: In elderly patients with chronic heart failure, the TyG index independently predicted heart failure rehospitalization and demonstrated a nonlinear dose–response relationship; its independent association with all-cause mortality was not significant after full adjustment. The index may nonetheless aid in risk stratification and individualized nursing in this population. Full article