Search Results (3,275)

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

Children with rare tumours and malformations may benefit from innovative imaging, including patient-specific 3D models that can enhance communication and surgical planning. The primary aim was to evaluate the impact of patient-specific 3D models on communication with families. The secondary aims were to assess their influence on medical management and to establish an efficient post-processing workflow. From 2021 to 2024, we prospectively included patients aged 3 months to 18 years with rare tumours or malformations. Families completed questionnaires before and after the presentation of a 3D model generated from MRI sequences, including peripheral nerve tractography. Treating physicians completed a separate questionnaire before surgical planning. Analyses were performed in R. Among 21 patients, diagnoses included 11 tumours, 8 malformations, 1 trauma, and 1 pancreatic pseudo-cyst. Likert scale responses showed improved family understanding after viewing the 3D model (mean score 3.94 to 4.67) and a high overall evaluation (mean 4.61). Physicians also rated the models positively. An efficient image post-processing workflow was defined. Although manual 3D reconstruction remains time-consuming, these preliminary results show that colourful, patient-specific 3D models substantially improve family communication and support clinical decision-making. They also highlight the need for supporting the development of MRI-based automated segmentation softwares using deep neural networks, which are clinically approved and usable in routine practice. Full article

Coronary artery disease (CAD) remains the leading cause of cardiovascular mortality worldwide. Accurate and non-invasive quantification of coronary hemodynamics, namely in the right coronary artery (RCA), is essential for clinical decision-making but remains challenging due to the complex interaction among vessel geometry, pulsatile flow, and blood rheology. This study presents and validates a transparent computational framework for non-invasive fractional flow reserve (FFR) estimation using patient-specific RCA geometries reconstructed from coronary computed tomography angiography (CCTA) using SimVascular 27-03-2023. The proposed workflow integrates realistic boundary conditions through a Womersley velocity profile and a three-element Windkessel outlet model, coupled with a viscoelastic blood rheology formulation (sPTT) implemented via user-defined functions (UDFs). This work integrates all clinically relevant conditions of invasive FFR assessment into a single patient-specific computational framework, while delivering results within a time frame compatible with clinical practice, representing a meaningful methodological advance. The methodology was applied to seven patient-specific cases, and the resulting non-invasive FFR values were compared with both invasive wire-based measurements and commercial HeartFlow^® outputs (Mountain View, CA, USA). Under hyperemic conditions, the computed FFR values showed strong agreement with invasive references, with a mean relative error of 8.4% ± 6.3%, showing diagnostic consistency similar to that of HeartFlow^® (8.3% ± 8.1%) for the selected dataset. These findings demonstrate the ability of the proposed CFD-based pipeline to accurately replicate physiological coronary behavior under hyperemia. This novel workflow provides a fully on-site, open-source, reproducible, and cost-effective framework. Ultimately, this study advances the clinical applicability of non-invasive CFD tools for the functional assessment of CAD, particularly in the RCA. Full article

Endometriosis affects one in seven women in Australia and is a significant public health concern. Access to appropriate health information is essential for informed decision-making and quality of life, especially for culturally and linguistically diverse (CALD) women who may face additional communication and health literacy barriers. This study explored the information-seeking behaviours and experiences of CALD women living with endometriosis using semi-structured interviews. Through convenience and snowball sampling via social media, eleven women were recruited. Data were analysed using thematic analysis. The results showed that although women often did not view their cultural background as influential, taboos and stigma can shape information-seeking behaviours. Women primarily relied on healthcare professionals, online resources, and other women with endometriosis as information resources. Healthcare professionals were appreciated for providing tailored information, but some were perceived to have limited knowledge of endometriosis, reducing their usefulness. Online information was abundant and easily accessible but often overwhelming and difficult to navigate. Information from other women with lived experience provided both practical insights and validation, though participants recognised its limited transferability to their own circumstances. These findings highlight the need for information pathways, including better patient education through healthcare providers, as well as accessible and evidence-based online resources. Full article

Background/Objectives: A neonatal intensive care units (NICU) admission of a premature infant is lifesaving; however, it can also be emotionally devastating experiences for parents. Family-centered care (FCC) interventions are designed to support parents and infants in the NICUs by integrating families into care delivery through partnerships with healthcare professionals. Heterogeneity in outcome reporting across FCC studies limits comparability. Developing a core outcome set (COS) for FCC is essential to address this gap. Aim: The aim of this study was to explore the views of former neonatal patients, parents, and healthcare professionals who have experiences with FCC in neonatal settings and elucidate outcomes that are important to them. Methods: This study followed the Core Outcome Measures Effectiveness Trial Handbook, which suggests involving stakeholders in identifying outcomes to reflect what is important to them rather than to researchers. Nine focus group discussions were conducted with 27 international key stakeholders from multiple countries (former neonatal patient n = 1; parents n = 8; healthcare professionals n = 18), reflecting FCC experiences across different neonatal settings. Data were analyzed using a modified framework analysis. Findings: Five outcome domains were identified including 42 distinct outcomes: (1) Emotional functioning/wellbeing of parents, infants, and healthcare professionals, reflecting emotional responses to a NICU admission of an infant; (2) Role functioning of parents, healthcare professionals, and others, highlighting that FCC strengthens their roles; (3) Delivery of care, highlighting the role of staff attitudes and organizational factors in supporting FCC; (4) Physiological health, reflecting infant physical health; (5) Hospital environment and resource use, reflecting healthcare utilization outcomes. Conclusions: Participants’ experiences provide meaningful insights into outcomes that should be evaluated in neonatal research and practice. These findings will inform the development of a COS for FCC in neonatal settings. Full article

Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality worldwide, accounting for approximately 10% of all cancer cases. Despite the proven effectiveness of conventional screening modalities such as colonoscopy and fecal immunochemical testing (FIT), their invasive nature, high cost, and limited patient compliance hinder widespread adoption. Recent advancements in artificial intelligence (AI) and bowel sound-based signal processing have enabled non-invasive approaches for gastrointestinal diagnostics. Among these, bowel sound analysis—historically considered subjective—has reemerged as a promising biomarker using digital auscultation and machine learning. Objective: This review explores the potential of AI-powered bowel sound analytics for early detection, screening, and characterization of colorectal cancer. It aims to assess current methodologies, summarize reported performance metrics, and highlight translational opportunities and challenges in clinical implementation. Methods: A narrative review was conducted across PubMed, Scopus, Embase, and Cochrane databases using the terms colorectal cancer, bowel sounds, phonoenterography, artificial intelligence, and non-invasive diagnosis. Eligible studies involving human bowel sound-based recordings, AI-based sound analysis, or machine learning applications in gastrointestinal pathology were reviewed for study design, signal acquisition methods, AI model architecture, and diagnostic accuracy. Results: Across studies using convolutional neural networks (CNNs), gradient boosting, and transformer-based models, reported diagnostic accuracies ranged from 88% to 96%. Area under the curve (AUC) values were ≥0.83, with F1 scores between 0.71 and 0.85 for bowel sound classification. In CRC-specific frameworks such as BowelRCNN, AI models successfully differentiate abnormal bowel sound intervals and spectral patterns associated with tumor-related motility disturbances and partial obstruction. Distinct bowel sound-based signatures—such as prolonged sound-to-sound intervals and high-pitched “tinkling” proximal to lesions—demonstrate the physiological basis for CRC detection through bowel sound-based biomarkers. Conclusions: AI-driven bowel sound analysis represents an emerging, exploratory research direction rather than a validated colorectal cancer screening modality. While early studies demonstrate physiological plausibility and technical feasibility, no large-scale, CRC-specific validation studies currently establish sensitivity, specificity, PPV, or NPV for cancer detection. Accordingly, bowel sound analytics should be viewed as hypothesis-generating and potentially complementary to established screening tools, rather than a near-term alternative to validated modalities such as FIT, multitarget stool DNA testing, or colonoscopy. Full article

Background: Optical genome mapping (OGM) detects genome-wide structural variants (SVs), including balanced rearrangements and complex copy-number alterations beyond standard-of-care cytogenomic assays. In chronic lymphocytic leukemia (CLL), cytogenetic and genomic risk stratification is traditionally based on fluorescence in situ hybridization (FISH), karyotyping, targeted next-generation sequencing (NGS), and immunogenetic assessment of immunoglobulin heavy chain variable region (IGHV) somatic hypermutation status, each of which interrogates only a limited aspect of disease biology. Methods: We retrospectively evaluated fifty patients with CLL using OGM and integrated these findings with cytogenomics, targeted NGS, IGHV mutational status, and clinical time-to-first-treatment (TTFT) data. Structural variants were detected using OGM and pathogenic NGS variants were derived from a clinical heme malignancy panel. Clinical outcomes were extracted from the electronic medical record. Results: OGM identified reportable structural variants in 82% (41/50) of cases. The most frequent abnormality was del(13q), observed in 29/50 (58%) and comprising 73% (29/40) of all OGM-detected deletions with pathologic significance. Among these, 12/29 (42%) represented large RB1-spanning deletions, while 17/29 (58%) were focal deletions restricted to the miR15a/miR16-1 minimal region, mapping to the non-coding host gene DLEU2. Co-occurrence of adverse lesions, including deletion 11q/ATM, BIRC3 loss, trisomy 12, and deletion 17p/TP53, were recurrent and strongly associated with shorter TTFT. OGM also uncovered multiple cryptic rearrangements involving chromosomal loci that are not represented in the canonical CLL FISH probe panel, including IGL::CCND1, IGH::BCL2, IGH::BCL11A, IGH::BCL3, and multi-chromosomal copy-number complexity. IGHV data were available in 37/50 (74%) of patients; IGHV-unmutated status frequently co-segregated with OGM-defined high-risk profiles (del(11q), del(17p), trisomy 12 with secondary hits, and complex genomes whereas mutated IGHV predominated in OGM-negative or structurally simple del(13q) cases and aligned with indolent TTFT. Integration of OGM with NGS further improved genomic risk classification, particularly in cases with discordant or inconclusive routine testing. Conclusions: OGM provides a comprehensive, genome-wide view of structural variation in CLL, resolving deletion architecture, identifying cryptic translocations, and defining complex multi-hit genomic profiles that tracked closely with clinical behavior. Combining OGM and NGS analysis refined risk stratification beyond standard FISH panels and supports more precise, individualized management strategies in CLL. Prospective studies are warranted to evaluate the clinical utility of OGM-guided genomic profiling in contemporary treatment paradigms. Full article

Background/Objectives: Effective regurgitant orifice area (EROA) is a critical parameter in assessing mitral regurgitation (MR) severity. The Japanese Circulation Society recommends a volumetric method which uses mitral annular diameters from apical four-chamber (A4C) and two-chamber (A2C) views. However, given the elliptical shape of the mitral annulus, use of apical long-axis (A3C) and A2C views, which reflect the anatomical long and short axes, may improve measurement accuracy. This study aimed to determine the optimal echocardiographic view combination for precise EROA quantification in degenerative MR (DMR). Methods: We retrospectively analyzed 98 patients with DMR who underwent both transthoracic echocardiography (TTE) and three-dimensional transesophageal echocardiography (3D TEE) within three months between April 2018 and December 2023. EROA was calculated using volumetric methods based on two TTE view combinations, A4C-A2C (EROA 4/2) and A3C-A2C (EROA 3/2). These were compared with 3D TEE-derived vena contracta area (VCA), which served as reference standard. Results: Mean values of EROA were 0.57 ± 0.23 cm² for EROA 4/2, 0.50 ± 0.21 cm² for EROA 3/2, and 0.49 ± 0.18 cm² for 3D TEE VCA. EROA 4/2 was significantly larger than VCA (p < 0.01), whereas EROA 3/2 did not significantly differ from VCA (p = 0.41) and showed a stronger correlation with VCA than EROA 4/2 (r = 0.829 vs. r = 0.638, p < 0.01). Conclusions: Volumetric EROA assessment using A3C and A2C views provides more accurate quantification in DMR than the conventional A4C and A2C approach. Anatomically appropriate imaging planes should be prioritized to enhance the accuracy of MR severity evaluation. Full article

Background/Objectives: Aneurysmal subarachnoid hemorrhage (aSAH) involves a sudden onset of a perfusion-pressure injury from the initial insult combined with a secondary injury phase produced by delayed cerebral ischemia, cerebrospinal fluid circulation disturbances, and generalized instability of the patient’s physiological state. The situation may be further complicated when there has been rupture of the aneurysm at the site of the carotid–posterior communicating (PCom) artery junction that occurs in conjunction with a fetal configuration of the posterior cerebral artery (fPCA), thereby making definitive treatment dependent on preserving the critical nature of the branches of the posterior circulation since the aneurysm’s neck plane coincides with the dominant posterior circulation conduit. Case Presentation: A 65-year-old female patient who was obese (Grade III BMI = 42), had chronic bronchial asthma, and arterial hypertension experienced a “thunderclap” type of headache in the right retro-orbital area followed by a syncopal episode and developed acute confusion with agitation. Upon admission to the hospital, her Glasgow Coma Scale (GCS) was 13, her FOUR score was 15, her Montreal Cognitive Assessment (MoCA) score was 12/30, her Hunt–Hess grade was 3, WFNS grade 2, and Fisher grade 4 SAH with intraventricular extension. Digital subtraction angiography (DSA) and three-dimensional rotational angiography revealed a posteriorly directed right carotid communicating aneurysm that had a relatively compact neck (approximately 2.5 mm) and sac size of approximately 7.7 × 6.6 mm, with the fPCA originating at the neck plane. Microsurgical treatment was performed with junction-preserving reconstruction with skull base refinement, temporary occlusion of the internal carotid artery for a few minutes, placement of clips reconstructing the carotid–PCom interface, and micro-Doppler verification of patent vessel. Postoperatively, the blood pressure was kept within the range of 110–130 mmHg with nimodipine and closely monitored. The neurological recovery was sequential (GCS of 15 by POD 2; MoCA of 22 by POD 5). By POD 5 CT scan, the clip remained positioned in a stable fashion without evidence of infarct, hemorrhage, or hydrocephalus; at three months she was neurologically intact (mRS 0; Barthel 100; MoCA 28/30), and CTA confirmed persistent exclusion of the aneurysm and preservation of fPCA flow. Conclusions: In cases where the ruptured aneurysm is located at the carotid communicating junction with the PCom artery in a configuration of the posterior cerebral artery that is described as fetal, clip treatment should be viewed as a form of branch-preserving junction reconstruction of the carotid–PCom junction supported by adherence to controlled postoperative physiology and close ppostoperativesurveillance. Full article

In recent years, Transcranial Color Doppler (TCCD) has gained increasing recognition as a non-invasive neuromonitoring tool. However, there remains a strong tendency to view arterial TCCD as the ‘stethoscope for the brain,’ while the assessment of cerebral venous flow is still underrepresented in clinical protocols. This review aims to explore the emerging role of venous TCCD, particularly when combined with Internal Jugular Vein (IJV) ultrasound, in evaluating cerebral venous outflow in both critically ill and surgical patients. We conducted a narrative review of e-Pub articles from PubMed, MEDLINE, and Scopus, on the pathophysiological factors that impair cerebral venous drainage and their clinical implications in surgical and critical care settings. Based on this evidence, we developed two procedural algorithms that integrate established knowledge of cerebral venous hemodynamics with common clinical conditions affecting venous outflow, including internal jugular central venous catheter placement, mechanical ventilation, and pneumoperitoneum. The algorithms emphasize systematic monitoring of cerebral venous drainage, including assessment of internal jugular vein morphology and Rosenthal’s vein flow, to guide procedural optimization and minimize potential neurological complications. They were informed by validated frameworks, such as the RaCeVa protocol, and are illustrated through two representative clinical case scenarios. Cerebral venous congestion can be induced by multiple established risk factors, including mechanical ventilation, cardiovascular disease, elevated intra-abdominal pressure, the Trendelenburg position, and central venous catheterization. In selected patients, real-time venous TCCD monitoring, combined with IJV assessment, allows early detection of cerebral venous outflow impairment and guides timely hemodynamic and procedural adjustments in both surgical settings and critical care contexts. Venous TCCD neuromonitoring may help prevent intracranial hypertension and its consequent neurological complications. It can guide clinical decisions during procedures that may compromise cerebral venous drainage, such as mechanical ventilation, the placement of large-bore central venous catheters, or laparoscopic and robot-assisted surgeries. Further studies are warranted to validate this strategy and better define its role in specific high-risk clinical scenarios. Full article

Recognizing cervical cancer as a major public health concern, Romania was among the first EU countries to introduce human papilloma virus (HPV) vaccination in 2008. Despite multiple strategies implemented over the past 17 years, HPV vaccine coverage remains one of the lowest in the EU, while cervical cancer mortality rates are among the highest. To explore the underlying factors, we conducted a cross-sectional study involving 209 family physicians at the national level. The study assessed their attitudes, practice, knowledge, and training needs related to HPV vaccination. The majority of physicians (90%) reported that they provide HPV vaccination services, and 88.5% considered themselves to have good and very good knowledge about HPV, which they routinely share during consultations with patients. However, respondents noted that both physician and public attitudes toward HPV vaccination are only moderately positive, which limits vaccine uptake and the success of prevention efforts. Parental hesitation was the main barrier, mentioned by 81.8% of respondents. The majority (71.3%) of doctors indicated that they were able to adequately respond to patients’ questions, but 81.4% of respondents expressed the view that additional training is needed for healthcare professionals on HPV infection and vaccination. These findings highlight the need for coordinated efforts to increase demand and trust in HPV vaccination. Recommended strategies include targeted professional training, public information campaigns, and the development of strong cross-sector partnerships to support vaccination efforts. Full article

In the context of advanced BRAF-mutant melanoma, the treatment landscape has undergone a paradigm shift due to the impact of immune checkpoint inhibitors and BRAF/MEK inhibitors. This article presents three clinically illustrative melanoma cases that served as focal points for in-depth discussions during 12 expert meetings held across Spain. These include a treatment-naïve metastatic melanoma patient, a patient experiencing a recurrence while on anti-PD-1 adjuvant therapy, and a third patient whose melanoma relapsed ≥6 months after the end of adjuvant therapy. The discussions revolved around optimal treatment sequencing, emphasizing the challenges and alternatives discussed in each scenario. The common view aligned towards a nuanced approach that involves navigating the complexities of treatment choices. The conclusions underscore the need for personalized therapeutic strategies and highlight the ongoing challenge of refining real-life evidence-based algorithms for the management of metastatic BRAF-mutant melanoma. Full article

Background: The development of lung cancer is strongly influenced by oxidative stress (OS), which results when the balance between oxidants and antioxidants is disturbed. Evaluation of both specific redox markers such as thiol/disulfide homeostasis (TDH) and overall indicators including total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) may provide a more comprehensive view of oxidative imbalance in lung cancer. We examined OS indices and TDH in patients with lung cancer versus healthy controls. Methods: Eighty participants were enrolled, consisting of 40 patients with newly diagnosed lung cancer and 40 age- and sex-matched healthy controls. Serum levels of native thiol (NT), total thiol (TT), and disulfide were determined using an automated spectrophotometric method. Additionally, TAS, TOS, and the OSI were evaluated to provide an overall assessment of oxidative balance. Routine hematological and biochemical parameters were compared between groups. Results: White blood cell and neutrophil counts were notably higher in lung cancer patients compared with controls (p < 0.05). NT and TT levels were remarkably decreased, whereas disulfide levels, TOS, and OSI were significantly elevated in the lung cancer group (p < 0.05). TAS levels tended to be lower in patients, although not reaching statistical significance. No significant association was observed between oxidative parameters and tumor stage or localization. Conclusions: Patients with lung cancer exhibited a marked oxidative imbalance, characterized by elevated oxidant burden and impaired TDH. Combined assessment of TAS, TOS, OSI, and thiol/disulfide parameters may provide valuable insight into the oxidative pathophysiology of lung cancer and hold potential as complementary biomarkers for disease evaluation. Further large scale studies are needed to confirm these findings. Full article

Juvenile dermatomyositis (JDM) is a rare, idiopathic autoimmune disorder characterized by inflammation of both muscle and skin, with a significant contribution from the interferon (IFN) pathway in its pathogenesis. Here, we present the case of a 4-year-old boy with JDM who tested positive for Mi2-α and MDA5 antibodies and showed combined muscle and skin involvement. In view of his markedly elevated IFN signature, the Janus kinase (JAK) inhibitor baricitinib was introduced very early as a targeted steroid-sparing agent in addition to standard immunosuppressive therapy. The patient experienced marked clinical improvement, with resolution of skin lesions, normalization of MDA5 antibodies, and a pronounced reduction in the IFN signature. This case highlights the potential efficacy of JAK inhibition in managing JDM with a high IFN signature and supports a mechanism-based, interferon-targeted treatment approach, in line with emerging evidence in refractory JDM. Further studies are warranted to define the role of JAK inhibitors in the treatment of JDM. Full article

Background/Objectives: Epicardial fat thickness (EFT) is an echocardiographic marker of epicardial adipose tissue that has been linked to coronary atherosclerosis, but its relationship with both coronary artery disease (CAD) severity and myocardial ischemia remains incompletely assessed. This study evaluated the association between EFT, angiographic CAD severity, and stress-induced myocardial ischemia. Methods: In a prospective study, 125 consecutive patients with suspected stable angina underwent transthoracic echocardiography with EFT measurement, dobutamine stress echocardiography, and coronary angiography. EFT was measured at end-systole in the parasternal long-axis view. Significant CAD was defined as ≥50% stenosis in at least one major epicardial coronary artery. Myocardial ischemia was assessed using peak-stress wall motion score index (WMSI). Results: Significant CAD was present in 56% of patients. Mean EFT was significantly higher in patients with significant CAD compared with those without (7.8 ± 2.0 mm vs. 5.5 ± 1.5 mm; p < 0.001). EFT increased progressively with angiographic CAD severity (non-significant CAD: 5.5 ± 1.5 mm; one-vessel disease: 6.5 ± 1.8 mm; two-vessel disease: 7.5 ± 2.0 mm; three-vessel disease: 8.5 ± 1.9 mm; p < 0.001). Patients with EFT > 5 mm had a significantly higher prevalence of significant CAD (68.8% vs. 33.3%; p < 0.001) and were older, with higher body mass index and a greater prevalence of hypertension and obesity. Additionally, peak-stress WMSI was significantly higher in patients with elevated EFT (1.08 ± 0.07 vs. 1.04 ± 0.05; p = 0.005), indicating a greater ischemic burden. Conclusions: EFT is associated with both the anatomical severity of CAD and the extent of stress-induced myocardial ischemia, supporting its potential role in non-invasive risk stratification of patients with suspected CAD. Full article