Search Results (10,970)

Introduction: Nursing informatics aims to improve patient care through rapid access to patient data, systematic assessment, a reduction in clinical errors, evidence-based practice, cost-effectiveness, and improved patient outcomes and safety. Background: Despite being the largest workforce in healthcare, nurses are not being adequately prepared to use nursing informatics, and this has been attributed to poor digital literacy, limited professional development, and a lack of undergraduate informatics education. Objectives: This scoping review aims to review contemporary published literature on the benefits, barriers, and enablers for embedding nursing informatics into undergraduate nursing education with a focus on the Australian healthcare context. Methods: A scoping review was conducted using the PRISMA-ScR checklist and the JBI Manual for evidence synthesis in adherence with an a priori scoping review protocol. A comprehensive search of JBI, Cochrane, CINAHL, Ovid, ProQuest, PubMed, and Scopus databases was performed. Two reviewers independently screened the results via Covidence, with discrepancies resolved via a third reviewer. Results: Two searches were conducted for this scoping review. In the first search, a total of 3227 articles were identified through database searches, with an additional 76 articles identified through bibliographic and grey literature searches. Following duplicate removal and screening, 46 articles met the inclusion criteria. In the second search, a total of 1555 articles were identified, and after duplicate removal and screening, 16 articles met the inclusion criteria. Duplicate removal during the second search round included those articles identified in the first search. The combined searches resulted in a total of 62 sources for this review. Conclusions: Despite the early adoption of nursing informatics in Australia in the 1980s, barriers remain to effective nursing informatics engagement and proficiency, including a lack of understanding of nursing informatics, limited infrastructure and resources, inadequate digital literacy of students and faculty, and the evolving nature of nursing informatics. Definitions of nursing informatics and associated fields, development of university faculty competency, access to digital health technologies, competency standards, digital literacy of the student cohort, faculty digital proficiency, and leadership from professional nursing bodies are all viewed as integral foundations for the development of student competency in nursing informatics. Full article

Obstructive sleep apnea (OSA) is a common disorder caused by recurrent upper airway obstruction during sleep, affecting individuals across the lifespan. In children, OSA commonly results from adenotonsillar hypertrophy and may resolve spontaneously or following surgical intervention. Among adolescents and adults, OSA is more frequently associated with modifiable lifestyle factors, particularly obesity. The natural history of OSA may evolve from intermittent snoring and mild disease to moderate or severe forms if left untreated, leading to reduced health-related quality of life and overall health deterioration. Early identification of OSA, especially in mild and moderate cases, allows timely interventions to improve OSA-associated indices and may prevent progression to severe disease. Continuous positive airway pressure therapy remains the treatment of choice for adults, providing effective symptom control and reducing long-term complications, although adherence rates vary. In obese patients, sustained weight reduction represents the most effective disease-modifying strategy: a ≥5% weight loss is associated with an approximately 80% reduction in progression risk, while bariatric surgery achieves remission in up to 60–65% of cases at one year. Emerging anti-obesity pharmacotherapies have also demonstrated clinically meaningful reductions in the apnea–hypopnea index. Comorbid conditions such as hypertension, type 2 diabetes, and depression exacerbate OSA severity, impair treatment response, and complicate overall disease management. This review uniquely integrates pediatric and adult longitudinal data, treatment-modified trajectories, and emerging therapeutic approaches to provide a life-course perspective on OSA natural history, highlighting opportunities for early, phenotype-directed intervention to possibly alter disease course and long-term outcomes. Full article

Background/Objectives: Adequate hydration is essential for health; however, water consumption behaviors are influenced not only by physiological needs but also by hydration knowledge and perceptions of drinking water quality. Empirical evidence examining these factors in Eastern European populations remains limited. This study aimed to assess hydration knowledge, water consumption patterns, and attitudes toward drinking water quality among adults in Romania, and to examine their associations with daily water intake and water source preferences. Methods: A cross-sectional study was conducted between November 2024 and November 2025 among adults residing in Romania. Data were collected from 165 participants using an anonymous, self-developed, paper-based questionnaire administered in person to adult patients attending routine visits in four primary care clinics in Arad, Romania, using a convenience sampling approach. The questionnaire assessed sociodemographic characteristics, hydration knowledge, water consumption behaviors, and attitudes toward drinking water quality. Descriptive statistics, chi-square tests, correlation analyses, and multivariable linear and logistic regression models were applied to identify factors associated with daily water intake, adequate hydration (≥2 L/day), and bottled water consumption. Results: Hydration knowledge was moderate overall and was significantly associated with education level and gender. Higher hydration knowledge was positively correlated with daily water intake (r = 0.21, p = 0.006) and was independently associated with higher intake and adequate hydration (OR = 1.28, 95% CI: 1.10–1.49; p = 0.002). Greater trust in tap water was also positively associated with daily intake (r = 0.27, p = 0.001) and adequate hydration (OR = 1.31, 95% CI: 1.12–1.54; p < 0.001). Lower trust in tap water and stronger beliefs regarding bottled water were significant predictors of bottled water use as the primary drinking water source. Education level emerged as a consistent predictor across multiple hydration-related outcomes. Conclusions: Hydration knowledge and perceptions of drinking water quality are key, modifiable factors associated with water consumption behaviors. Educational strategies integrated into primary care and transparent communication regarding tap water safety may support adequate and sustainable hydration among adults. Full article

Objectives: This study aimed to develop and validate an explainable machine learning (ML) model to predict the risk of sarcopenia in older European adults with arthritis, providing a practical tool for early and precise screening in clinical settings. Methods: We analyzed data from the English Longitudinal Study of Aging (ELSA) and the Survey of Health, Aging and Retirement in Europe (SHARE). The final analysis included 1959 participants aged ≥65 years. The ELSA dataset was divided into a training set (n = 1371) and an internal validation set (n = 588), while the SHARE dataset (n = 1001) served as an independent external test cohort. From an initial pool of 33 variables, nine core predictors were identified using ensemble feature selection techniques. Six ML algorithms were compared, with model performance evaluated using the Area Under the Curve (AUC) and calibration analysis. Model interpretability was enhanced via SHapley Additive exPlanations (SHAP). Results: The Decision Tree model demonstrated the optimal balance between performance and interpretability. It achieved an AUC of 0.921 (95% CI: 0.848–0.988) in the internal validation set and maintained robust generalizability in the external SHARE cohort with an AUC of 0.958 (95% CI: 0.931–0.985). The nine key predictors identified were stroke history, BMI, HDL, loneliness, walking speed, disease duration, age, recall summary score, and total cholesterol. SHAP analysis visualized the specific contribution of these features to individual risk. Conclusions: This study successfully developed a high-performance, explainable, lightweight ML model for sarcopenia risk prediction. By inputting only nine readily available clinical indicators via an online tool, individualized risk assessment can be generated. This facilitates early identification and risk stratification of sarcopenia in older European arthritis patients, thereby providing valuable decision support for implementing precision interventions. Full article

Background/Objectives: Nurses working in closed psychiatric wards experience substantial psychosocial and spiritual burdens, emotional strain, and ethical tension due to continuous exposure to patients in crisis. As formal caregivers, nurses’ health and multidimensional well-being are essential for sustaining compassionate, dignity-preserving practice. However, the lived meaning of self-care within highly restrictive psychiatric environments remains insufficiently understood. This study explores how psychiatric nurses in South Korea experience and interpret self-care. Methods: A qualitative phenomenological design was used. Eight psychiatric nurses with more than three years of experience in closed psychiatric wards participated in in-depth, face-to-face interviews conducted between August 2018 and January 2019. Data were analysed using Colaizzi’s method to identify and synthesise essential themes. Results: Five categories captured the essence of nurses’ self-care experiences: (1) struggling to establish therapeutic roles as a psychiatric nurse; (2) conflating professional identity with ideals of good nursing; (3) recognising a gradual loss of motivation and hope to continue psychiatric nursing; (4) acknowledging the need to care for oneself and refocus on inner vitality; and (5) engaging in self-care through interactions with patients. Self-care was understood as a reflective, relational, and transformative process rather than as a set of stress-relief activities. Conclusions: Psychiatric nurses perceived self-care as an existential journey involving vulnerability, self-reflection, and renewal, which fostered both personal and professional growth. By framing self-care as an ethically grounded, relational practice that sustains therapeutic presence and safeguards moral and professional integrity, this study extends existing self-care literature beyond behavioural strategies. Full article

Background/Objectives: With the global rise in chronic diseases among older adults, rehabilitation services have become essential, particularly for those with cerebrovascular and central nervous system (CNS) disorders, which lead to significant long-term disabilities. To determine the impact of designated rehabilitation medical institutions on the readmission rates of older patients with CNS disorders who receive surgical interventions. Methods: This was a population-based cohort study. Data was obtained from the National Health Insurance Service database (2002–2019). Fifteen designated institutions participated in the pilot project for convalescent rehabilitation. We analyzed the data of 1019 patients before and after the implementation of the designated rehabilitation institution. The study sample included (1) patients admitted to 15 designated institutions participating in the pilot project for convalescent rehabilitation and (2) patients diagnosed with conditions classified under the rehabilitation patient group, Rehabilitation Impairment Category 1 to 7. The intervention was the pilot project for designated rehabilitation institutions, launched in October 2017. The primary outcome of interest was the readmission rate of older patients with CNS disorders who received surgical interventions. Interrupted time series analysis with segmented regression was used to assess changes in the 30-day readmission rates. Results: Post-intervention, an 8% reduction in 30-day readmission rates (estimate, 0.9225; 95% confidence interval: 0.9129–0.9322, p < 0.0001) was observed. Subgroup analysis showed a significant decline in readmission rates across various patient groups, including those with disabilities, high Charlson Comorbidity Index scores, and extended hospital stays. The regions outside Seoul (capital city), particularly Gyeonggi/Incheon (areas around Seoul) and other areas (i.e., rural), also showed a significant decrease in readmission trends after the intervention. Conclusions: Designated rehabilitation medical institutions led to a significant reduction in readmission rates of older patients with CNS disorders, suggesting that these institutions effectively support recovery and reduce the burden of readmission for patients with severe conditions and those residing in non-capital cities. Full article

Age-related neurodegenerative disorders, including Alzheimer’s disease, Parkinson’s disease, and mild cognitive impairment, represent a growing global health challenge. The present medicines offer only symptomatic alleviation with poor disease-modifying efficacy. Increasing data suggests that the gut–brain axis and dietary health are measurable contributions to cognitive impairment as we age. This review first focused on the mechanistic link between gut dysbiosis and neurodegeneration. Furthermore, the review discusses preclinical and clinical research that show how probiotics and dietary supplements improve brain function in the elderly using supplemental therapy methods. It also indicates that randomized clinical studies and meta-analyses suggest that probiotics and particular nutritional supplements provide modest but consistent cognitive advantages, which are most noticeable when patients receive therapy at the initial stage of their disease development. These advantages might originate from the combined impact of gut microbiota, immunological signaling, and neuroprotective pathways, rather than specific targeted approaches. Thus, the current review highlights the reports, suggesting that probiotics and dietary supplements might be effective and safe therapies for age-related neurodegeneration. Full article

Bone conduction hearing implant systems (BCHIs) are established treatments for patients with conductive or mixed hearing loss or single-sided deafness when conventional hearing aids are unsuitable. This study evaluated the cost-effectiveness of the active transcutaneous system Sentio versus a similar system, i.e., Osia in an Australian setting. Scenario analyses also compared Sentio to other systems, i.e., Ponto and Baha Attract. A Markov cohort model was adapted from a previously published source to reflect Australian practice, incorporating device acquisition, surgery, maintenance, battery replacement and adverse event management over a 15-year horizon from a healthcare perspective. Effectiveness inputs were derived from published evidence using a naïve indirect comparison. Extensive sensitivity analyses and external validation tested robustness. In the base case, Sentio was associated with lower costs and a small modelled incremental quality-adjusted life years (QALYs) gain versus Osia. Scenario analyses confirmed cost-effectiveness relative to Ponto and Baha Attract, with outcomes below the Australian willingness-to-pay threshold. Health state utility, device price and reimplantation assumptions were the most influential drivers, yet Sentio remained cost-effective in over 95% of simulations. These findings support Sentio as a clinically and economically efficient BCHI in Australia and highlight the need for direct utility and long-term durability data. Full article

Subarachnoid hemorrhage (SAH) is a devastating form of stroke that disproportionately affects younger individuals and often results in long-term disability, even among those who achieve favorable outcomes on traditional clinical scales. This scoping review uses the PRISMA-ScR protocol to evaluate independent studies from 1980 to 2025 and synthesizes current evidence on sleep and cognitive dysfunction in SAH survivors, highlighting their prevalence, impact, and gaps in assessment and management. A total of 2243 publications were screened across three databases (PubMed, EMBASE, and Web of Science), which resulted in 115 studies analyzed for review. Sleep disturbances—including insomnia, hypersomnia, and sleep apnea—are common across all phases of recovery and are closely linked to fatigue, mood disorders, and impaired cognitive function. Cognitive deficits, particularly in memory, executive function, and attention, persist in most survivors and are significant barriers to return to work and reintegration. Despite their clinical relevance, these domains are underrepresented in SAH research and inadequately captured by standard outcome measures such as the modified Rankin Scale. Compared to moderate-to-severe traumatic brain injury (TBI), the SAH literature lacks standardized assessment tools, longitudinal data, and interventional studies. Neuroinflammation may underlie both sleep and cognitive sequelae, offering a potential therapeutic target. This review underscores the need for patient-centered outcome measures, integrated sleep and cognitive assessments, and targeted interventions to improve long-term brain health in SAH survivors. Full article

Objective: Homeless individuals are vulnerable, and a high burden of mental health problems is suspected. We aim to identify the prevalence and key predictors of probable depression and anxiety among homeless individuals in Germany during the Coronavirus disease-2019 (COVID-19) pandemic. Study Design: Nationwide multicentre cross-sectional study including clinical, laboratory, and questionnaire-based data on the health of homeless individuals in Germany. Methods: Data were used from the National Survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic. Probable depression and anxiety were determined using the Patient Health Questionnaire 9 and the General Anxiety Disorder 2 questionnaire. Logistic regression analysis was used to identify key predictors of probable depression and anxiety. Results: A high prevalence of probable depression (26.8% [95% CI: 23.2–30.3]) and anxiety (27.2% [95% CI: 23.7–30.7]) was found. Logistic regressions showed both probable depression and anxiety associated with being female (depression: OR 1.80 [95% CI: 1.06–3.03]; anxiety: OR: 1.69 [95% CI: 1.03–2.76]), daily use of any illegal substances (depression: OR 3.20 [95% CI: 1.87–5.49]; anxiety: OR 2.04 [95% CI: 1.21–3.45]), and fear of contracting COVID-19 (little fear, depression: OR: 1.81 [95% CI 1.01–3.23], some fear, anxiety: OR: 2.52 [95% CI: 1.31–4.83]). Probable depression was associated with longer durations of homelessness (OR: 1.004, [95% CI: 1.001–1.007]. Conclusions: Probable depression and anxiety are highly prevalent in homeless individuals throughout. Key predictors may help to identify individuals in need and design targeted interventions. Full article

Background/Objectives: Federated learning (FL) offers a way for healthcare institutions to collaboratively train machine learning models without sharing sensitive patient data. This systematic review aims to comprehensively synthesize the ethical dimensions of FL in healthcare, integrating privacy preservation, algorithmic fairness, governance, and equitable access into a unified analytical framework. The application of FL in healthcare between January 2020 and December 2024 is examined, with a focus on ethical issues such as algorithmic fairness, privacy preservation, governance, and equitable access. Methods: Following PRISMA guidelines, six databases (PubMed, IEEE Xplore, Web of Science, Scopus, ACM Digital Library, and arXiv) were searched. The PROSPERO registration is CRD420251274110. Studies were selected if they described FL implementations in healthcare settings and explicitly discussed ethical considerations. Key data extracted included FL architectures, privacy-preserving mechanisms, such as differential privacy, secure multiparty computation, and encryption, as well as fairness metrics, governance models, and clinical application domains. Results: Out of 3047 records, 38 met the inclusion criteria. The most popular applications were found in medical imaging and electronic health records, especially in radiology and oncology. Through thematic analysis, four key ethical themes emerged: algorithmic fairness, which addresses differences between clients and attributes; privacy protection through formal guarantees and cryptographic techniques; governance models, which emphasize accountability, transparency, and stakeholder engagement; and equitable distribution of computing resources for institutions with limited resources. Considerable variation was observed in how fairness and privacy trade-offs were evaluated, and only a few studies reported real-world clinical deployment. Conclusions: FL has significant potential to promote ethical AI in healthcare, but advancement will require the development of common fairness standards, workable governance plans, and systems to guarantee fair benefit sharing. Future studies should develop standardized fairness metrics, implement multi-stakeholder governance frameworks, and prioritize real-world clinical validation beyond proof-of-concept implementations. Full article

Objective: Visceral adipose tissue is a primary driver of insulin resistance and dysglycemia in type 2 diabetes (T2D), yet its clinical assessment remains challenging. This study aimed to validate neck circumference (NC) as a novel, practical anthropometric biomarker for estimating visceral fat area (VFA) and identifying metabolic risk in a T2D cohort, facilitating its integration into public health and primary care screening strategies. Methods: In a cross-sectional study of 1139 T2D patients, we collected data on NC, biochemical parameters (fasting plasma glucose, hemoglobin A1c, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides), and precisely measured VFA and subcutaneous fat area (SFA) via bioelectrical impedance analysis (Omron HDS-2000). We employed Pearson’s correlation and multivariate logistic regression to analyze the relationship between NC and metabolic indicators. Receiver operating characteristic (ROC) curve analysis was used to establish sex-specific NC cut-off values for predicting abnormal VFA. Results: The cohort comprised 687 (60.3%) males and 452 (39.7%) females. NC demonstrated strong positive correlations with VFA (p < 0.001), as did body mass index (BMI), waist–hip ratio (WHR), and SFA. In males, NC was further positively correlated with key metabolic biomarkers including fasting insulin, Insulin Resistance Index, triglycerides, and creatinine. ROC analysis identified NC > 39.5 cm for males and >35.5 cm for females as the optimal cut-off points for detecting abnormal visceral adiposity, highlighting its diagnostic utility. Conclusions: NC serves as a highly accessible and effective biomarker for visceral adiposity and associated metabolic dysfunction in patients with T2D. The established sex-specific cut-off values provide a simple, non-invasive tool for risk stratification in clinical and public health settings, enabling early intervention and improved management of metabolic disease. Full article

Background/Objectives: Colorectal cancer (CRC) is a major public health challenge in Brazil, characterized by marked regional disparities. Although national legislation mandates that treatment begin within 60 days after diagnosis, compliance remains inconsistent, particularly within the Unified Health System (SUS). This study aimed to analyze the time to treatment initiation for colon (C18) and rectal (C20) cancer in Brazil from 2013 to 2024, assessing regional inequalities, temporal trends, and factors associated with treatment delays. Methods: We conducted an ecological study using secondary data from the Ministry of Health’s PAINEL-Oncologia platform, which integrates information from SIA/SUS, SIH/SUS, and SISCAN. Records of patients diagnosed with colon and rectal cancer (ICD-10 C18–C20) were evaluated. Temporal trends were analyzed using Joinpoint regression, and factors associated with delayed treatment initiation (>60 days) were identified through multiple logistic regression models. Results: Persistent discrepancies were observed between diagnostic and treatment trends from 2013 to 2024, with the Annual Percent Change (APC) for diagnosis exceeding that for treatment, particularly among adults aged 55–69 years. The Southeast and South regions accounted for over 70% of all diagnosed cases, starkly contrasting with the less than 25% in the North and Northeast. More than 50% of patients across all clinical stages initiated treatment after the legally mandated 60-day period. Women with rectal cancer had a 28% higher risk (RR = 1.28) of being diagnosed at stage IV. Chemotherapy was the predominant initial therapeutic modality, while the need for combined chemo-radiotherapy was associated with markedly elevated risk ratios for delay (e.g., RR = 26.53 for stage IV rectal cancer). Treatment initiation delays (>60 days) were significantly associated with residence in the North/Northeast regions, female sex (for rectal cancer), advanced-stage disease, and complex therapeutic regimens. Conclusions: The study demonstrates persistent regional inequalities and highlights a substantial mismatch between diagnostic capacity and therapeutic availability in Brazil. These gaps contribute to treatment delays and reinforce the need to strengthen and expand oncological care networks to ensure equitable access and improve outcomes, particularly in underserved regions. Full article

Background: Large language models (LLMs) are becoming progressively integrated into clinical practice; however, their role in cardiovascular (CV) prevention remains unclear. This review synthesizes current evidence on LLM applications in preventive cardiology and proposes a governance framework for their safe translation into practice. Methods: We conducted a comprehensive narrative review of literature published between January 2015 and November 2025. Evidence was synthesized across three functional domains: (1) patient applications for health literacy and behavior change; (2) clinician applications for decision support and workflow efficiency; and (3) system applications for automated data extraction, registry construction, and quality surveillance. Results: Evidence suggests that while LLMs generate empathetic, guideline-concordant patient education, they lack the nuance required for unsupervised, personalized advice. For clinicians, LLMs effectively summarize clinical notes and draft documentation but remain unreliable for deterministic risk calculations and autonomous decision-making. System-facing applications demonstrate potential for automated phenotyping and multimodal risk prediction. However, safe deployment is constrained by hallucinations, temporal obsolescence, automation bias, and data privacy concerns. Conclusions: LLMs could help mitigate structural barriers in CV prevention but should presently be deployed only as supervised “reasoning engines” that augment, rather than replace, clinician judgment. To guide the transition from in silico performance to bedside practice, we propose the C.A.R.D.I.O. framework (Clinical validation, Auditability, Risk stratification, Data privacy, Integration, and Ongoing vigilance) as a roadmap for responsible integration. Full article

Background: Beyond the direct COVID-19 effects, the pandemic’s broader impact on vulnerable groups, such as patients with systemic sclerosis (SSc), is particularly concerning, especially regarding any resulting increase in overall mortality due to healthcare access disruptions. We aimed to determine excess all-cause mortality in SSc patients before and during the pandemic. Methods: We examined mortality data from Thailand’s Ministry of Public Health database for adults with SSc (ICD-10: M34). According to the WHO methodology, a negative binomial distribution model was used to estimate the expected number of deaths using pre-pandemic data (1 January 2015–31 December 2019). We evaluated actual versus expected deaths during the pandemic (1 January 2020 to 31 December 2022), defining excess mortality as the difference between observed and projected deaths under normal conditions. Results: The total number of all-cause deaths in Thailand was 2,325,384 in the pre-pandemic period and 1,634,121 during the pandemic period. The mortality rate among patients with SSc was 3693 before and 3107 during the pandemic. Of those with SSc, 1785 of the deceased were female, and the observed mortality was significantly lower than expected, with an excess death count of −368 (95% CI: −459 to −277), as well as in males with an excess death count of −123 (95% CI: −198 to −48). However, younger SSc patients (aged 18–29 years) experienced significantly higher excess mortality, with an excess death count of 11 (95% CI: 4–18). Conclusions: During the COVID-19 pandemic, neither sex had significantly higher SSc mortality; however, mortality in younger SSc patients increased significantly compared to pre-pandemic levels, underscoring the need for tailored therapies. Full article