Search Results (1,633)

Background/Objectives: Heat waves are increasingly frequent and intense climate events with significant implications for public health, particularly among frail older adults. While most evidence has focused on mortality and morbidity, healthcare service utilization represents an additional and potentially more sensitive indicator of heat-related health burden. Methods: A systematic review and meta-analysis was conducted following the PRISMA guidelines and prospectively registered in PROSPERO (CRD420251107598). PubMed/MEDLINE, Scopus, and Web of Science were searched up to August 2025. This study aimed to systematically review and quantitatively synthesize the evidence on the association between heat wave exposure and healthcare utilization—including hospitalizations, emergency department (ED) visits, and outpatient care—among frail older adults. Pooled effect estimates (RRs, IRRs, and ORs) were calculated using random-effects models. Heterogeneity was assessed using the I² statistic, and sensitivity analyses were performed by outcome type, effect measure, and risk of bias. Results: Fifty-five studies met the inclusion criteria. Heat wave exposure was consistently associated with increased healthcare utilization. Both hospitalizations and ED visits showed significant increases during heat wave periods, with results remaining robust across sensitivity analyses. Evidence on outpatient care was limited but suggested a similar pattern. Substantial heterogeneity was observed across studies, reflecting variability in exposure definitions, populations, and study designs. Overall, the methodological quality of the included studies was acceptable, with most presenting a low-to-moderate risk of bias. Conclusions: Heat waves are associated with increased healthcare utilization among frail older adults, indicating a relevant burden on healthcare systems. Healthcare utilization may represent a sensitive indicator of heat wave impact, complementing traditional clinical outcomes. Full article

With the continued rise in outpatient surgical procedures, modern medicine requires more advanced tools for pain and anxiety monitoring and management. The current standard of care requires patient responses on visual analog scales, which may be subjective and are difficult to assess when a subject is unresponsive. Electrodermal activity (EDA) and pulse rate variability (PRV), two non-invasive, wearable, and objective measurements of sympathetic nervous system activity, can help provide insight into a patient’s psychological or emotional state without user input, allowing for continued monitoring even when a patient is unable to respond. However, methods based on these measurements have largely been relegated to longer duration (>60 s) or post hoc analysis, which does not suit the needs of medical care environments. Here we propose new methods for handling ultra-short (<10 s) signals to allow rapid evaluation of pain and anxiety state. We show how machine learning models trained on these signals can obtain high degrees of classification performance (AUC > 0.88) between no pain or anxiety and medium or higher pain and anxiety on signals obtained during two different forms of painful stimulation. We also show how these signals can measure the degree of stimulation irrespective of perceived pain from the patient. Further development of these algorithms will allow for greater monitoring and control of patient comfort in a clinical setting. Full article

Background: Family caregivers are essential partners in the outpatient care of older adults with cancer, yet the knowledge, skills, and confidence, collectively, of caregiver activation are not well characterized in Asian settings. Understanding activation can inform tailored support to sustain effective caregiving. Accordingly, this study assessed the overall activation levels among cancer caregivers in the three most common cancer diagnoses in Singapore by using the Caregiver-Patient Activation Measure (CG-PAM). Methods: A total of 103 informal caregivers of patients ≥60 years (lung, GI, or myeloma) at Singapore’s largest public cancer hospitals completed the 13-item CG-PAM, scored 0–100 and classified into four activation levels. Descriptive statistics summarized characteristics and CG-PAM responses, and logistic regression analyses assessed the degree of activation for individual demographic and other characteristics (p < 0.05). Results: Caregivers showed moderate–high activation (mean 65.9 ± 16.1) and the following levels: L1, 4.9%; L2, 23.3%; L3, 38.8%; L4, 31.1%. They strongly endorsed personal responsibility and active engagement, reporting confidence in key self-management tasks, but struggled to sustain behaviors under stress. Activation was not significantly associated with demographic factors or any other measured characteristics. Conclusion: Caregivers of older adults with cancer in Singapore included in this study showed moderate–high activation and strong self-management confidence but struggled to sustain behaviors under stress. Routine activation assessment and tailored support (education, coaching) could strengthen outpatient care. Longitudinal and interventional research, alongside follow-up interviews, is needed to identify unmet needs, existing support systems, and inform scalable, sustainable models. Full article

Background: Drug shortages represent a growing challenge to healthcare systems worldwide, affecting treatment continuity and patient outcomes. This study assessed the burden and perceived impact of drug shortages from both healthcare professionals’ and patients’ perspectives in a Saudi tertiary hospital. Methods: A cross-sectional survey was conducted in April 2025 at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Convenience sampling was used to recruit healthcare professionals with at least two years of experience and adult outpatients. Structured questionnaires assessed shortage frequency, affected drug classes, perceived impacts, and management practices. The findings were descriptively analyzed and compared with the Saudi Food and Drug Authority (SFDA) national shortage data for the corresponding 12-month period. Results: A total of 230 healthcare professionals and 243 patients participated. Among healthcare professionals, 89.1% reported experiencing at least one drug shortage, with 38.3% encountering shortages more than ten times annually. Anti-infectives (36.5%) and analgesics (35.7%) were the most frequently reported classes. The most common response was prescribing alternative medications (77.4%), with 55.3% perceived as adequately effective and 30.8% as less effective. Delayed care was the most frequently reported consequence (44.0%). Among patients, 30.9% reported experiencing shortages, 46.7% reported some degree of health impact, and 28.1% incurred additional costs. Awareness and utilization of the SFDA reporting system were low in both groups. Comparison with SFDA data revealed discrepancies between hospital-reported and nationally reported shortages. Conclusions: Drug shortages were frequently reported and associated with perceived clinical and economic consequences. Gaps between hospital experiences and national reporting highlight limitations in current surveillance systems. Strengthening reporting mechanisms, communication, and supply chain coordination may improve the management of drug shortages. Full article

Background: Neurological disorders are a leading cause of disability worldwide, placing increasing strain on healthcare systems. In Eastern Europe, and specifically Bulgaria, there is a significant lack of granular data regarding how ambulatory neurology services are utilized and how clinical workloads are distributed across different diagnostic groups. Objective: In this study, we aimed to analyze the clinical workload, demographic patterns, and diagnostic distribution within a single-center ambulatory neurology setting in Bulgaria, while identifying the primary determinants of patient age stratification. Methods: We conducted a retrospective observational study of 518 consecutive clinical encounters recorded over a one-year period in a specialized outpatient neurology clinic. Data on age, gender, visit type (ambulatory vs. dispensary), and ICD-10 diagnostic groups were analyzed. Inferential analyses included a one-way ANOVA for age differences and multivariable linear regression to identify independent predictors of age patterns, with age modeled as a continuous variable. Results: The clinical workload was highly concentrated, with spine-related disorders accounting for over 40% of all visits, and primary consultative examinations were the predominant service type (65.4%). Statistical analysis revealed significant age differences across diagnostic categories (p < 0.001), with neurodegenerative and cerebrovascular diseases associated with the highest mean age, while spine and headache syndromes involved significantly younger populations. Multivariable modeling confirmed that diagnostic category is the sole independent determinant of age distribution (p < 0.001), whereas gender and visit type showed no significant independent associations. Conclusions: Ambulatory neurology utilization in this setting is characterized by a high-turnover primary consultation model and a heavy concentration of musculoskeletal neurological conditions. These findings suggest that outpatient neurology functions as a critical diagnostic filter and pain management hub. The study underscores the need for diagnosis-specific clinical pathways and targeted resource allocation to optimize service efficiency and improve long-term management of chronic neurological morbidity in a public insurance-driven framework. Full article

Background and Objectives: Hepatic encephalopathy (HE) management becomes particularly challenging in older patients. This study aimed to evaluate the physician-reported diagnostic approaches, therapeutic strategies, and specific challenges in managing HE in older cirrhotic patients across Italy. Methods: A nationwide survey was conducted under the aegis of the Italian Association for the Study of the Liver (AISF). Forty-three hepatology centres participated. Data were analyzed using descriptive statistics. Results: Participating centers followed over 6000 older patients with cirrhosis, nearly one-third of whom experienced overt HE and/or minimal HE episodes in the previous year. Physicians reported that infections were the most frequently reported precipitating factor, followed by constipation and electrolyte disturbances for OHE. Half of patients with HE (50%; IQR 30.0–50.0%) experienced recurrent episodes, while 22% (IQR 10.0–30.0%) were reported to have persistent HE. In this setting, the diagnosis of HE was often complicated by cognitive decline. Treatment primarily consisted of a combination of lactulose and rifaximin, but adherence was often limited. Caregiver support emerged as a critical element in patient management. The management of comorbidities such as diabetes and chronic kidney disease was a major challenge, and nutritional screening was not routinely implemented across centres. Conclusions: This study highlights the need for better multidisciplinary management, improved caregiver support, and more consistent approaches to the diagnosis and treatment of HE in the elderly. The survey also explored how centres approach the differential diagnosis between HE and age-related cognitive disorders, the practical role of caregivers in outpatient management, and the impact of comorbidities, polypharmacy, and nutritional issues on everyday care. Marked heterogeneity emerged in psychometric assessment, multidisciplinary collaboration, and nutritional screening, indicating that several relevant aspects of care remain insufficiently standardized. Overall, the findings suggest that older patients with HE should be regarded as a distinct high-risk subgroup requiring tailored diagnostic pathways and integrated management models. Full article

Invasive fungal respiratory infections (IFRIs) remain a major cause of morbidity and mortality among immunocompromised patients, yet diagnosis continues to be hindered by nonspecific clinical features, limited sample accessibility, and the poor sensitivity or specificity of conventional tests. Microfluidic and microelectromechanical systems (MEMS)-based biosensing platforms have emerged as promising alternatives, enabling rapid, minimally invasive, and highly specific detection of fungal pathogens and host responses. Microfluidic nucleic acid and antigen assays allow on-chip amplification and immunodetection with reduced sample volumes and turnaround times, while CRISPR-enhanced systems further improve analytical sensitivity. Parallel advances in host response profiling—including transcriptomic, proteomic, and cytokine-based signatures—have demonstrated feasibility for integration into lab-on-a-chip platforms. MEMS-based technologies extend this potential by facilitating real-time analysis of exhaled volatile organic compounds, mechanical biosensing of fungal DNA and antigens, and in situ monitoring of device-associated biofilms. Translational studies highlight potential applications across intensive care, hematology–oncology, and transplant settings, as well as in outpatient monitoring of high-risk populations. However, several challenges remain, including limited multicenter validation, matrix-related biofouling effects, and a lack of standardization in fungal biomarker panels. Future directions include AI-driven interpretation of multianalyte data, multiplexed integration of host and pathogen markers, and development of fully cartridge-based systems for near-patient deployment. Collectively, these innovations may shift fungal diagnostics toward earlier, more precise, and patient-tailored interventions, improving outcomes in vulnerable populations. Full article

Pediatric psychiatric emergency department (ED) visits have increased globally, yet many children do not receive timely outpatient follow-up. Although South Korea provides universal health coverage through its National Health Insurance (NHI), additional financial barriers may impede the continuity of mental health care. This study examined whether supplemental private insurance is associated with improved outpatient mental health follow-up after pediatric psychiatric ED visits within a universal coverage system. A retrospective cohort study was conducted at a tertiary children’s hospital in South Korea including 520 psychiatric ED visits (480 unique patients aged <18 years) from 2016 to 2024. The primary outcome was attendance at an outpatient mental health visit within 30 days of ED discharge. Multivariable logistic regression was used to assess the association between insurance type (NHI-only versus NHI plus supplemental private insurance) and follow-up, adjusting for age, sex, clinical presentation, and prior mental health care. Overall, 53.7% of patients attended a 30-day follow-up visit. Patients with supplemental private insurance had significantly higher follow-up rates than those with NHI alone (58.8% vs. 45.5%, p = 0.019). In adjusted analysis, supplemental private insurance was independently associated with increased follow-up (adjusted odds ratio 1.50, 95% confidence interval 1.10–2.05, p = 0.02). A significant interaction was observed between insurance type and prior mental health care (p_interaction = 0.03): the insurance effect was pronounced among patients without prior outpatient mental health treatment (45.6% vs. 38.8%) but negligible among those with prior treatment (71.9% vs. 72.5%). Prior outpatient mental health treatment (adjusted odds ratio 2.00, 95% confidence interval 1.30–3.10) and suicidal presentation were also significant predictors. Even within a universal health coverage system, supplemental private insurance is associated with better outpatient follow-up after pediatric psychiatric emergencies, particularly among patients new to the mental health system. Reducing financial barriers, expanding community-based mental health services, and strengthening care coordination are essential to ensure equitable continuity of care for all children. Full article

Background: Antibiotic misuse and prescribing errors are significant concerns in clinical practice, contributing to unnecessary antibiotic exposure, increased adverse effects, rising healthcare costs, and the escalation of antibiotic resistance. Understanding the prevalence, patterns, and risk factors of these prescription errors is essential for improving patient safety and healthcare efficiency in the future. Aim: Our aim was to evaluate the prevalence, patterns, and risk factors of antibiotic prescription errors in Saudi Arabia. Methods: A comprehensive search of three databases (PubMed, Scopus and ProQuest) was conducted to identify eligible cohort and cross-sectional studies in Saudi Arabia published up to January 2025. Studies that reported on error rates of antibiotic prescription errors and those that did not provide quantitative data were excluded. The primary outcome was the prevalence and patterns of inappropriate antibiotic use, while the secondary outcomes included the pooled prevalence of specific errors (i.e., selection, dose, duration, etc.). The quality of the studies was assessed using the Newcastle–Ottawa scale. This review was registered in PROSPERO (CRD42024611747). Results: Fourteen eligible cohort (n = 2) and cross-sectional (n = 12) studies conducted in Saudi Arabia were included in the review. Two studies reviewed medical records and orders of patients. Patient selection varied from emergency department to intensive care units and outpatients. The pooled prevalence of antibiotic prescription errors was 42.7% [95% CI: 37.5–47.8], with common errors including dosage (29.3%), duration (24.3%), selection (15%) and frequency (11.1%) errors. However, there was a high heterogeneity among the results. Overall, the quality assessment revealed a low risk of bias, except for one study with a high risk of bias. Conclusion: These findings highlight the high prevalence of antibiotic prescription errors. Future efforts should strengthen antibiotic stewardship, enhance clinician training, and ensure adherence to evidence-based guidelines to reduce prescription errors and combat antibiotic resistance. Full article

Background and Objectives: Artificial intelligence (AI) and extended reality (XR) are increasingly being integrated into telemedicine, yet clinician adoption depends not only on perceived utility but also on digital preparedness and technology-related burden. This study compared clinician acceptance of AI-only, XR-only, and combined AI+XR telemedicine scenarios and examined whether AI literacy, health literacy, technostress, age, and sex explained variability in acceptance. Materials and Methods: We conducted a cross-sectional, anonymous online vignette survey among 117 resident physicians and nurses from a tertiary-care hospital and affiliated outpatient clinics in Western Romania. Participants evaluated three randomized telemedicine scenarios (AI-only, XR-only, and AI+XR) using a 3-item Acceptance Index scored from 1 to 4. Additional measures included a study-developed AI literacy quiz, the Romanian-validated HLS-EU-Q16, an adapted brief technostress scale, prior AI/XR exposure, perceived accessibility, perceived value, privacy concern, and demographic variables. Results: Acceptance was highest for the combined AI+XR scenario (3.74 ± 0.49), followed by AI-only (3.64 ± 0.56) and XR-only (3.49 ± 0.64). AI+XR acceptance was significantly higher than AI-only and XR-only acceptance (both p < 0.001), although the absolute between-scenario differences were modest. Residents reported consistently higher acceptance than nurses across all scenarios, whereas sex differences were small and non-significant; younger age showed only weak inverse associations with acceptance. AI+XR acceptance correlated positively with AI literacy (ρ = 0.60) and health literacy (ρ = 0.23), and negatively with technostress (ρ = −0.47). In multivariable analysis, higher AI literacy (β = 0.603, p < 0.001) and health literacy (β = 0.241, p < 0.001) independently predicted higher AI+XR acceptance, whereas technostress was inversely associated (β = −0.212, p < 0.001). Conclusions: In this sample, clinicians rated the integrated AI+XR vignette most favorably, but the observed differences between scenarios should be interpreted cautiously and as hypothesis-generating rather than definitive evidence of superiority. Acceptance appeared to depend more on digital readiness and technostress than on age or sex, supporting implementation strategies focused on literacy-building, workflow fit, and burden reduction. Full article

Background: Outpatient palliative care effectively alleviates symptom burden in advanced cancer patients, yet data from Central–Eastern Europe remain scarce. This retrospective study examined changes in revised Edmonton Symptom Assessment Scale (ESAS) scores from initial outpatient palliative consultation to first follow-up in Hungarian cancer patients, assessing clinically meaningful improvement and inter-symptom associations. Methods: Revised ESAS scores from 119 patients attending an outpatient palliative care clinic (2017–2020) were analyzed using paired baseline and first follow-up assessments (7–30 days). Symptom changes (Time 2–Time 1) were evaluated using Wilcoxon signed-rank tests. Clinically meaningful improvement was assessed with minimal clinically important difference thresholds (0.5× baseline SD). Sankey diagrams visualized symptom transitions, and multivariable linear regression examined inter-symptom associations. Results: Baseline pain was highest (mean 6.29, median 7), followed by fatigue, sleep disorder, and impaired well-being. At follow-up, significant reductions were observed in pain (mean 4.52, p = 0.001), nausea, dyspnea, constipation, sleep disorder, depression, and anxiety (all p < 0.05). Sankey diagrams showed shifts from severe to mild/moderate pain (50% to 24%) and constipation. Clinically meaningful improvement occurred in pain, nausea, and constipation, with 59–65% achieving ≥1-point pain reduction. Regression analyses showed that pain reduction was associated with concurrent improvements in sleep disorder (β = 0.31), depression (β = 0.20), fatigue (β = 0.20), and anxiety (β = 0.14), while dyspnea reduction was associated with concurrent improvements in depression (β = 0.22) and anxiety (β = 0.14). Conclusions: Outpatient palliative care in Hungarian cancer patients resulted in clinically meaningful symptom reductions, particularly pain and dyspnea. Improvements in these core symptoms were associated with concurrent improvements in other symptom domains, underscoring the clinical relevance of inter-symptom associations and supporting early, integrated outpatient palliative care and symptom cluster-based management. Full article

Background and Objectives: Idiopathic pulmonary fibrosis (IPF) is frequently accompanied by chronic cough, which may negatively affect sleep quality. However, the relationship between cough burden and sleep disturbances in patients undergoing antifibrotic therapy remains inadequately defined. This study aimed to investigate the association between cough and sleep quality in patients with IPF and to evaluate the potential effects of antifibrotic treatment on these outcomes. Materials and Methods: This cross-sectional analytical study was conducted at a tertiary care center in Türkiye between January 2019 and December 2024. Patients with a diagnosis of IPF who were receiving antifibrotic therapy (nintedanib or pirfenidone) were consecutively recruited from the pulmonology outpatient clinic. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and cough-related quality of life was evaluated with the Leicester Cough Questionnaire (LCQ). Pre-treatment data were obtained retrospectively based on patient recall, and follow-up assessments were conducted during ongoing therapy. Correlation analyses and multivariable linear regression models were used to identify factors associated with sleep quality. Results: The study included 74 patients, with a mean age of 68.6 ± 6.8 years. At baseline, 87.8% of patients had poor sleep quality (PSQI ≥ 5). During antifibrotic therapy, PSQI scores significantly improved (median 9 [IQR: 6–12] vs. 6 [IQR: 5–8], p < 0.001), accompanied by a clinically meaningful increase in LCQ total score (13.28 ± 2.86 vs. 16.06 ± 2.58, p < 0.001). Significant inverse correlations were observed between PSQI and LCQ scores at both baseline and follow-up. In multivariable analysis, LCQ score was an independent predictor of sleep quality during treatment (β = −0.453, p < 0.001), whereas demographic and physiological parameters showed no significant independent associations. No significant differences were detected between nintedanib and pirfenidone in terms of PSQI or LCQ outcomes. Conclusions: Cough-related quality of life is independently associated with sleep quality in patients with IPF receiving antifibrotic therapy. These findings highlight cough burden as a key determinant of patient-centered outcomes beyond traditional physiological measures. Targeted assessment and management of cough may represent an important strategy to improve sleep quality and overall quality of life in this population. Full article

Background: Central sensitization (CS) has been held responsible for both persistent pain and high disease activity scores in Spondyloarthritis (SpA). The Central Sensitization Inventory (CSI) is a questionnaire used to determine CS frequency: a score of at least 40 is associated with a high likelihood of CS. Objectives: To investigate the prevalence of CS in our cohort and its association with clinical characteristics of patients and their quality of life. Methods: Adult patients with a diagnosis of Psoriatic Arthritis (PsA) or Axial Spondyloarthritis (AxSpA) who were also classifiable according to ClASsification criteria for Psoriatic Arthritis (CASPAR) and Assessment of SpondyloArthritis international Society (ASAS) criteria respectively, and regularly followed at the SpA outpatient clinic of our Unit were consecutively enrolled from April to November 2023. Their epidemiologic, clinical and clinimetric data were collected, as well as patient-reported outcome measures (PROMs) [CSI, Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), and Hospital Anxiety and Depression Scale (HADS)]. Considering the definition of “difficult-to-treat” rheumatoid arthritis, we defined as “multi-failure” those patients who were treated with more than two biologic disease-modifying anti-rheumatic drugs (bDMARDs) with different mechanisms of action. Intergroup comparisons were assessed by using Chi-square, t-test and ANOVA. p-values < 0.05 were considered significant. Results: A total of 100 patients were enrolled, 46 male (46.0%) and 54 female (54.0%), with a mean age of 59.4 ± 9.8 years and a mean disease duration of 14.8 ± 10.1 years; 79 patients (79%) had a diagnosis of PsA and 21 (21%) of AS. Forty-two patients (42.0%) had a CSI score ≥ 40. Significant correlations were found between a CSI score ≥ 40 and female sex (p = 0.004), the occurrence of enthesitis (p = 0.05), DAPSA-CRP (p = 0.02) and ASDAS scores (p = 0.03), a multi-failure condition (p = 0.01), fibromyalgia (FM) (p = 0.004), thyroid disease (p = 0.016) and obesity (p = 0.047). Regarding PROMs, significant correlations were found between CSI and values of HADS (both anxiety and depression), FACIT-F, HAQ and all the domains of SF-36 (p-value < 0.0001). Conclusions: Our data confirmed that more than 40% of SpA patients had CSI values ≥ 40 and underlined how CS could widely impair their disease burden. A routinary evaluation of CS and a multifactorial biopsychosocial perspective in the diagnosis and management of chronic pain in patients with SpA could help rheumatologists in improving their quality of care. Full article

Pulmonary embolism (PE) remains a frequent and potentially fatal condition, with early mortality largely driven by (RV) failure and hemodynamic collapse. Rapid and accurate prognostic assessment is therefore central to management. Current European Society of Cardiology (ESC) strategies rely first on hemodynamic status to identify high-risk patients requiring urgent reperfusion consideration, and then—when patients are normotensive—on a stepwise approach combining clinical risk scores, RV imaging, and circulating biomarkers. Clinical tools such as HESTIA and the Pulmonary Embolism Severity Index (PESI)/simplified PESI (sPESI) enable early identification of low-risk patients suitable for outpatient pathways and stratify 30-day mortality risk, but do not integrate biological data. Consequently, biomarkers have an expanding role in refining prognosis, particularly within the heterogeneous intermediate-risk group. This review provides a practical overview of established and emerging biomarkers for PE risk stratification. Conventional cardiac biomarkers—troponins and natriuretic peptides (BNP/NT-proBNP)—reflect RV myocardial injury and strain and, when combined with imaging evidence of RV dysfunction, allow discrimination between intermediate–low- and intermediate–high-risk PE, guiding monitoring intensity and escalation strategies. D-dimer, while essential in diagnostic algorithms because of its high negative predictive value, has only an adjunctive and indirect prognostic role. Beyond these markers, growing evidence supports additional biomarkers capturing complementary pathways: neurohormonal stress (copeptin), early myocardial injury (H-FABP), inflammation and hypoxia (GDF-15), tissue hypoperfusion (lactate), and molecular regulation (circulating microRNAs). Readily available inflammatory indices derived from blood counts (NLR, PLR, LMR), red cell distribution width, and hs-CRP may further contribute within multimarker models, although specificity and validation remain limitations. Future directions include multimodal and omics-driven biomarker profiling integrated with advanced imaging to enable more precise, dynamic, and personalized PE care, from acute risk prediction to long-term follow-up and prevention of chronic thromboembolic complications. Full article

Background/Objectives: Sickle cell disease (SCD) is the most prevalent inherited pediatric hematologic disease. Pain is the most common complaint and primary reason for emergency care. Effective coping is critical to improved quality of life for individuals with SCD and other chronic illnesses. Hope, engendered by provision of comprehensive care, may explain the positive impact of effective coping and improved health outcomes. The relevance of effective coping skills and hope’s impact on repeated hospitalizations and/or length of hospitalization stay (LOS) among adolescents with SCD is considered. A regional, comprehensive pediatric sickle cell center (RCPSCC) provided the services. Methods: Patients with SCD, ages 13 through 21 years seen in a university RCPSCC (URCPCC-SCD), completed surveys: a general scale providing a broad range of positive and maladaptive coping-related issues, and KIDCOPE, a standardized scale measuring pediatric coping strategies. Medical records were reviewed for frequency of hospitalization and length of stay (LOS) for the eight months before study entry. Results: Thirty-four URCPCC-SCD outpatients, mean/median age of 16 years, entered the study, and data were analyzed for 33. All reported some sense of future hopefulness, and almost half reported feeling “tense or wound up” most of the time. Use of avoidant or negative coping strategies in response to daily stress correlated positively with increased LOS. Conclusions: Youths with SCD require effective coping strategies to improve self-efficacy and related hope for brighter futures. Individualized, comprehensive treatment and support to families and individuals at risk for sickle cell crisis are uniquely offered in a URCPCC-SCD. Their contributions to service delivery and clinical outcome are expected to enhance hope, mitigate prolonged hospitalizations, and improve adherence to treatment (N = 268). Full article