Search Results (257)

Background: The last decade has seen transformative changes in burn care, driven by advances in pharmacology, regenerative medicine, surgical techniques, and digital technologies. As management strategies evolve beyond survival to encompass functional and esthetic recovery, this review consolidates current evidence to inform best practice. Methods: A comprehensive narrative review was conducted using PubMed to identify peer-reviewed English-language articles from the past 10 years relevant to acute and long-term burn management. Selection focused on high-level evidence, including randomized controlled trials, systematic reviews, and meta-analyses, emphasizing novel and evolving clinical interventions. Results: Key advances include the integration of propranolol and oxandrolone for metabolic modulation; enzymatic debridement agents such as NexoBrid^®; regenerative approaches like epidermal cell sprays (e.g., RECELL^®) and dermal substitutes (e.g., Integra^®, MatriDerm^®, NovoSorb^® BTM); and innovations in scar modulation, notably fractional CO₂ laser therapy. The emergence of 3D bioprinting, and artificial intelligence further supports a shift toward precision burn medicine. Conclusions: Burn management is evolving from protocol-driven to patient-centred care, underpinned by high-quality evidence and technological innovation. The integration of systemic, local, and rehabilitative strategies is improving outcomes in survival, function, and quality of life. Ongoing challenges include cost, access, and translation of novel therapies into widespread clinical practice. Full article

Background: Dental patient-centred outcomes are essential in clinical practice and research. To enhance feasibility, Oral Health-Related Quality of Life (OHRQoL) instruments often need to reduce administration time. In Serbia, longer OHIP versions exist (OHIP-14, OHIP-EDENT), but the ultrashort OHIP-5 has not yet been available. Aim: This cross-sectional study aimed to translate, culturally adapt, and evaluate the psychometric properties of the five-item Serbian version of the Oral Health Impact Profile (OHIP5-Srb). Materials and Methods: The OHIP5-Srb was translated using a standard forward–backward procedure. Participants were recruited between June and September 2025 using a convenience sampling approach. Psychometric testing—including internal consistency, exploratory (EFA), confirmatory factor analysis (CFA), and convergent and known-groups validity—was conducted on 236 participants (mean age 47.4 years). Test–retest reliability was evaluated in 35 dental students, and responsiveness in 45 patients undergoing dental treatment. Results: Cronbach’s alpha was 0.784, indicating adequate internal consistency. Test–retest reliability was excellent (mean ICC = 0.96; all inter-item correlations > 0.20). Convergent validity was supported by a strong negative correlation between OHIP5-Srb summary scores and a single-item measure of overall oral/dental health (Spearman’s rho = −0.861, p < 0.01). Known-group validity was confirmed by significant differences between removable denture wearers and individuals with natural teeth (and/or fixed partial dentures), after adjusting for age, and between participants perceiving a need for dental treatment and those who did not. EFA indicated a one-factor structure explaining 55.1% of variance. The one-factor model was confirmed by CFA and showed good fit (χ² = 15.08, df = 5; CFI = 0.97; TLI = 0.94; RMSEA = 0.092; SRMR = 0.04). Responsiveness analysis demonstrated significant decreases in OHIP5-Srb scores following various dental treatments. Conclusions: The OHIP5-Srb is unidimensional, reliable, valid, and responsive. Its brevity and robust psychometric properties make it suitable for assessing self-perceived oral health-related quality of life in the Serbian urban population, particularly when minimizing respondent burden is critical. Full article

Background: Structured patient education (SPE) is a critical component of diabetes management, with the potential to reduce its physical, social, and economic burden. National and international guidelines emphasise the importance of raising awareness and equipping individuals with the knowledge and skills necessary for effective self-management. In the UK, practice nurses are central to this effort, playing a key role in identifying at-risk individuals and facilitating referrals to diabetes education programmes. However, non-attendance at these programmes remains a persistent challenge, undermining the impact of policy initiatives and service provision. Aim of the study: This study aimed to explore practice nurses’ perspectives on the factors contributing to non-attendance at diabetes education centres and to identify potential strategies to improve uptake. Methods: A qualitative approach was employed, involving semi-structured face-to-face interviews with eight practice nurses across six general practice (GP) surgeries in Southeast England. Data were analysed thematically to uncover key patterns and insights. Results: Findings reveal that barriers to attendance are multifaceted, encompassing personal, social, and systemic factors. These include limited patient understanding of the benefits of education, cultural and language differences, scheduling conflicts, and perceived relevance of the programmes. Conclusions: The results highlight the need for a coordinated, patient-centred approach that addresses these challenges through improved communication, flexibility in programme delivery, and enhanced interprofessional collaboration. Full article

Theatre-based methodologies are increasingly recognized as complementary approaches that can enhance nurses’ empathy, communication, critical thinking, and person-centred care, all essential for managing chronic illnesses. This scoping review aimed to map and synthesize evidence on the application of theatre in continuing nursing education. A systematic literature search was conducted across five databases (PubMed, CINAHL, PsycINFO, Scopus, and Education Source) for publications in English and Italian up to 30 December 2024, supplemented by grey literature from ProQuest and reference screening via Google Scholar. Twenty-one studies met the inclusion criteria, identifying two main theatre methodologies, Forum Theatre and Drama, with four variations. These interactive methods were reported to foster reflective practice, enhance person-centred care, and improve interprofessional collaboration. Positive outcomes included improved nurse–patient relationships, quality of care, emotional engagement, cultural competence, teamwork, conflict management, and acceptance of diversity. Key facilitators were institutional support and active participation, while barriers included resistance to change and limited resources. These findings indicate that theatre-based education can serve as an effective complementary strategy to cultivate empathy, creativity, and reflective skills in continuing nursing education, supporting the development of holistic and patient-centred care practices. Further research is needed to explore the sustainability of acquired competencies in clinical practice. Full article

Background: Despite recent advances in new therapies for early-stage breast cancer (eBC), the impact of the current treatment landscape on patients’ quality of life remains poorly understood. This study explored the experiences and unmet needs of women with eBC, leading to the development of a patient-informed conceptual disease model (PI-CDM) that summarizes patient priorities. Methods: This qualitative study used a step-wise approach: (1) a targeted literature review; (2) draft CDM development; (3) interview guide development; (4) semi-structured interviews with women in the United States with a diagnosis of eBC; (5) thematic content analysis of interview transcripts; (6) patient steering committee insights; and (7) PI-CDM finalization. Results: Thirty-six women with eBC (stage I, n = 18; stage II, n = 11; stage III, n = 9) were interviewed between December 2023 and May 2024. Key health concepts included signs and symptoms leading to diagnosis and common treatment side effects. Emotional and psychological impacts were prominent, and 28 participants reported moderate to extremely severe anxiety or depression on the EQ-5D-5L. Other impacts included social life, body satisfaction, daily activities, physical functioning, sexual functioning, and finances. Needs for improved communication from healthcare providers about treatment options and better support were emphasized. These insights, combined with patient steering committee recommendations, resulted in a final PI-CDM. Conclusions: This study highlights the substantial burden women with eBC face and provides a framework for future patient-centric research. A CDM developed with patients summarizes the complexity of the eBC experience and can aid discussions between patients and physicians, facilitating shared decision-making to enhance care. Full article

Background/Objectives: Cancer remains a major public health concern in India, with the Northeast Region (NER) reporting the country’s highest incidence rates. In Meghalaya, a predominantly tribal state, cultural beliefs, financial hardship, and limited healthcare access significantly affect cancer diagnosis and treatment outcomes. This study explores the experiences and needs of cancer patients in Meghalaya, India, to inform culturally sensitive, patient-centred, and financially inclusive approaches to cancer care among tribal populations. Methods: A qualitative study was conducted among 19 participants (12 patients and 7 caregivers; in cases where patients were unable to communicate effectively due to physical weakness or treatment-related complications, their primary caregivers, those directly linked to the specific patients, were interviewed instead) receiving treatment at Civil Hospital, Shillong, between August and November 2023. In-depth interviews were conducted in Khasi, translated into English, and analysed thematically following COREQ guidelines. Results: Ten key themes emerged. Patients often attributed early symptoms to supernatural causes and sought traditional healers, delaying diagnosis. Many experienced fragmented care pathways, misinformation, and fear of treatment side effects. The financial burden was severe, with high out-of-pocket costs for travel, diagnostics, and medicines, despite partial relief through the Meghalaya Health Insurance Scheme. Communication about costs between patients and providers was limited, leaving families unprepared for the expenses. Emotional distress, loss of livelihood, and dependence on family support were common, while faith and spirituality served as major coping mechanisms. Conclusions: Cancer care in Meghalaya is shaped by intertwined cultural, economic, and systemic barriers. Strengthening culturally tailored health education, decentralised diagnostic services, structured financial counselling, and cost transparency can improve care delivery. Future research should adopt multi-centre, longitudinal approaches to guide equitable, patient-centred cancer policies in tribal and rural settings. Full article

Introduction: Pelvic exenteration is a radical operation for advanced or recurrent pelvic malignancies, requiring urinary and faecal diversion. The ileal conduit (IC) remains the standard urinary diversion, while the double-barrel uro-colostomy (DBUC) has re-emerged as an alternative that avoids small bowel anastomosis and consolidates diversion into a single stoma. Aims: To evaluate comparative outcomes of DBUC versus IC to clarify relative risks and potential benefits. Methods: A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD420251090885). PubMed, Scopus, EMBASE, and Medline were searched to March 2025 for studies directly comparing DBUC and IC following pelvic exenteration. Eligible studies reported perioperative or urological outcomes. Results: Four retrospective studies (164 patients; DBUC 88, IC 73) were included. Urinary leak was lower with DBUC (10.2% vs. 15.1%), with pooled analysis showing a higher risk in IC (RR 2.52, 95% CI 1.02–6.20, p = 0.04). Pyelonephritis (42.0% vs. 15.3%; RR 1.37, p = 0.24) and electrolyte derangements (20.6% vs. 15.6%; RR 1.21, p = 0.64) did not differ significantly. Rates of urinary and enteric fistulas were similar. Clavien–Dindo grade III (42.1% vs. 37.1%) and grade IV complications (17.1% vs. 24.2%) were also comparable between groups. Conclusion: DBUC is a feasible alternative to IC after pelvic exenteration, with reduced urinary leak rates and comparable morbidity. Its single-stoma approach may offer patient-centred advantages. Larger prospective studies incorporating long-term and quality-of-life outcomes are needed. Full article

Background and Clinical Significance: Tandem pathology at the dominant-hemisphere middle cerebral artery (MCA)—combining a wide-neck bifurcation aneurysm that shares the neck with both M2 origins and a short dorsal M1 fusiform dilation embedded in the lenticulostriate belt—compresses the therapeutic margin and complicates device-first pathways. We aimed to describe an anatomy-led, microscope-only sequence designed to secure an immediate branch-definitive result at the fork and to remodel dorsal M1 without perforator compromise, and to place these decisions within a pragmatic perioperative framework. Case Presentation: A 37-year-old right-handed man with reproducible, load-sensitive cortical association and capsulostriate signs underwent high-fidelity digital subtraction angiography (DSA) with 3D rotational reconstructions. Through a left pterional approach, vein-respecting Sylvian dissection achieved gravity relaxation. Reconstruction proceeded in sequence: a fenestrated straight clip across the bifurcation neck with the superior M2 encircled to preserve both M2 ostia, followed by a short longitudinal clip parallel to M1 to reshape the fusiform segment while keeping each lenticulostriate mouth visible and free. Temporary occlusion windows were brief (bifurcation 2 min 30 s; M1 < 2 min). No neuronavigation, intraoperative fluorescence, micro-Doppler, or intraoperative angiography was used. No perioperative antiplatelets or systemic anticoagulation were administered and venous thromboembolism prophylaxis followed institutional practice. The bifurcation dome collapsed immediately with round, mobile M2 orifices, and dorsal M1 regained near-cylindrical geometry with patent perforator ostia under direct inspection. Emergence was neurologically intact, headaches abated, and preoperative micro-asymmetries resolved without new deficits. The early course was uncomplicated. Non-contrast CT at three months showed structurally preserved dominant-hemisphere parenchyma without infarction or hemorrhage. Lumen confirmation was scheduled at 12 months. Conclusions: In dominant-hemisphere tandem MCA disease, staged, perforator-sparing clip reconstruction can restore physiologic branch and perforator behavior while avoiding prolonged antiplatelet exposure and device-related branch uncertainty. A future-facing pathway pairs subtle clinical latency metrics with high-fidelity angiography, reports outcomes in branch- and perforator-centric terms, and, where available, incorporates patient-specific hemodynamic simulation and noninvasive lumen surveillance to guide timing, technique, and follow-up. Full article

Healthcare 5.0 represents the next evolution in intelligent and interconnected healthcare systems, leveraging emerging technologies such as Artificial Intelligence (AI) and the Internet of Medical Things (IoMT) to enhance patient care and automation. While Intrusion Detection Systems (IDSs) are a critical component for securing these environments, the current literature lacks a systematic analysis that jointly evaluates the effectiveness of AI models, the suitability of datasets, and the role of Explainable Artificial Intelligence (XAI) in the Healthcare 5.0 landscape. To fill this gap, this survey provides a comprehensive review of IDSs for Healthcare 5.0, analyzing state-of-the-art approaches and available datasets. Furthermore, a practical case study is presented, demonstrating that the fusion of network and biomedical features significantly improves threat detection, with physiological signals proving crucial for identifying complex attacks like spoofing. The primary contribution is therefore an integrated analysis that bridges the gap between cybersecurity theory and clinical practice, offering a guide for researchers and practitioners aiming to develop more secure, transparent, and patient-centric systems. Full article

Cancer pain remains a significant challenge in oncology, profoundly affecting patients’ quality of life, function, and prognosis. Historically under-recognized and managed with a uniform, opioid-centric approach, cancer pain was often inadequately treated. Advances in pain assessment, multimodal analgesia, and supportive care have improved outcomes, yet traditional algorithms frequently fail to address the complex, heterogeneous nature of cancer pain. Contemporary management is shifting toward precision and personalized medicine, integrating genetic, molecular, and biomarker data with individual patient characteristics to inform treatment decisions. To address this complexity, we propose a five-domain framework encompassing biological, pharmacologic, psychological, sociocultural, and functional domains. This multidimensional approach enables clinicians to tailor pain management strategies to each patient’s unique profile, aiming for equitable and individualized care. However, challenges remain, including tumor and patient heterogeneity, limited biomarker validation, data integration, disparities in access, and the need for multidisciplinary coordination. This review traces the evolution of cancer pain management, highlights the promise of precision and personalized strategies, and presents a comprehensive framework for optimizing pain control in oncology. Full article

Background: The management of endometriosis-associated pain has traditionally focused on analgesic efficacy. However, with high-level evidence demonstrating therapeutic equivalence among principal hormonal classes, the paradigm has shifted towards a patient-centred approach prioritising long-term tolerability and shared decision-making. Objectives: This review critically synthesises the evidence for the three main hormonal therapies—gonadotropin-releasing hormone (GnRH) analogues, dienogest, and gestrinone—focusing on their distinct tolerability and safety profiles to inform this modern clinical framework. Methods: This narrative review followed the SANRA (Scale for the Assessment of Narrative Review Articles) guidelines. The literature search was performed in PubMed, Embase, and Web of Science in June 2025. Results: Our comparative analysis, based on a structured literature search adhering to SANRA guidelines, shows that while all three classes are effective, they present distinct benefit–risk profiles: GnRH analogues offer potent pain relief but induce a hypoestrogenic state requiring add-back therapy to mitigate bone loss and vasomotor symptoms; dienogest preserves bone mineral density but is associated with challenging bleeding patterns and potential mood disturbances; gestrinone provides robust efficacy with a favourable cardiovascular and skeletal safety profile, although its androgenic effects can significantly impact patient adherence. Conclusions: In the absence of a clear hierarchy of efficacy, the optimal therapeutic choice is not determined by potency, but by a collaborative process in which patient values and tolerance for specific adverse effects guide selection. This review provides a framework to facilitate this shared decision-making (SDM) in clinical practice. Full article

Background/Objectives: Antimicrobial stewardship (AMS) interventions are critical to reducing inappropriate antibiotic prescribing for acute respiratory infections (ARIs) in primary care and mitigating antimicrobial resistance (AMR). While interventions are routinely employed in hospitals, implementation in general practice is nascent. This qualitative study, part of the OPTIMAS-GP project, explored determinants influencing the implementation of evidence-based AMS strategies in Australian general practice. Methods: Using Experience-Based Co-Design, three rounds of online focus groups were conducted with ten healthcare professionals (GPs, pharmacists, microbiologist, practice staff) and ten adult patients who had experienced ARI management in primary care. Participants discussed the feasibility and acceptability of AMS interventions: shared decision-making (SDM) tools, delayed prescribing (DP) and point-of-care testing (PoCT) for C-reactive protein (CRP). Results: Thematic analysis of focus group transcriptions identified four interrelated themes: ‘Patient acceptance and engagement’, ‘Practising within a system’, ‘Prescribing stewardship’, and ‘Diagnostic stewardship’. Patient engagement was dependent upon expectations, trust, and personalised care, while systemic factors such as continuity of care, practice culture, and resource availability influenced implementation. DP was viewed as a pragmatic but potentially confusing strategy, requiring clear patient guidance and interprofessional collaboration. SDM tools were conceptually supported but challenged by time constraints and poor health literacy. PoCT-CRP was cautiously welcomed for selective use, with concerns expressed about workflow integration and overreliance on testing. Findings were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to identify behavioural determinants and inform future implementation strategies. Recommendations include co-designing patient-centred AMS tools with clear instructions and red flags, enhancing GP-pharmacist collaboration, and addressing barriers to PoCT integration. Conclusions: These insights highlight the complexity of implementing AMS interventions in general practice and underscore the need for tailored, system-supported approaches to optimise antibiotic use and reduce AMR. Full article

Despite growing interest in AI-driven Heating, Ventilation, and Air Conditioning (HVAC) systems, existing approaches often rely on static control strategies or offline simulations that fail to adapt to real-time environmental changes, especially in high-risk healthcare settings. There remains a critical gap in integrating dynamic, physics-informed control with human-centric design to simultaneously address infection control, energy efficiency, and occupant comfort in hospital environments. This study presents an AI-driven ventilation system integrating BIM, adaptive control, and computational fluid dynamics (CFD) to optimize hospital environments dynamically. The framework features (1) HVAC control using real-time sensor datasets; (2) CFD-validated architectural interventions (1.8 m partitions and the pressure range at a return vent); and (3) patient flow prediction for spatial efficiency. The system reduces airborne pathogen exposure by 61.96% (159 s vs. 418 s residence time) and achieves 51.85% energy savings (0.19 m/s airflow) while maintaining thermal comfort. Key innovations include adaptive energy management, pandemic-resilient design, and human-centric spatial planning. This work establishes a scalable model for sustainable hospitals that manages infection risk, energy use, and occupant comfort. Future directions include waste heat recovery and lifecycle analysis to further enhance dynamic system performance. Full article

Background/Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disorder marked by persistent synovial inflammation, progressive joint destruction, and systemic complications. Despite significant progress in targeted therapies, major clinical challenges persist, including heterogeneous treatment responses and therapeutic resistance. This review aims to critically evaluate emerging immunomodulatory strategies—focusing on immune checkpoints, microRNAs (miRNAs), and cell-based therapies—as potential diagnostic and therapeutic tools. Methods: This non-systematic literature review involved a comprehensive analysis of recent studies to investigate emerging immunomodulatory strategies in RA. Special attention was given to immune checkpoint pathways—cytotoxic T-lymphocyte antigen 4 (CTLA-4); programmed death-1 (PD-1) and its ligand, PD-L1; and inducible T-cell costimulator (ICOS)—as well as cell-based therapies. Additionally, miRNA-based interventions were examined for their diagnostic and therapeutic potential. Results: Immune checkpoint modulation has demonstrated preclinical efficacy in attenuating inflammatory responses and restoring immune tolerance. Concurrently, miRNAs have emerged as both biomarkers and therapeutic agents, with exosome-based delivery systems enhancing their function. Cell-based therapies have shown robust immunoregulatory effects with acceptable safety profiles. Notably, integrative strategies that combine checkpoint inhibitors, cell-based interventions, and miRNA delivery exhibit synergistic effects and offer a promising avenue for personalised treatment, when guided by molecular and transcriptomic profiling. The majority of these approaches remain at the preclinical or early translational stage. Conclusions: Targeted immunomodulation is poised to transform RA management. The integration of cell therapies, checkpoint inhibition, and miRNA manipulation with omics technologies holds promise for enhancing therapeutic precision and safety. Advancing towards personalised immunotherapy will necessitate a multidisciplinary and patient-centred effort. Full article

We aimed to compare the proportion of tuberculosis infection among social contacts of male tuberculosis Index case with and without alcohol use in the Puducherry district. A cross-sectional study using ego-centric approach was conducted between November 2023 and May 2024. A total of 713 social contacts of 106 male pulmonary tuberculosis index cases were enrolled, stratified by alcohol-use (AUDIT ≥ 8): 358 contacts from 45 alcohol-using cases and 355 from 61 non-alcohol-use cases. Social contacts were defined based on the frequency and duration of shared indoor exposure with index cases within the past three months. Tuberculosis infection was screened with Cy-Tb skin test (≥5 mm induration) at the third month of index case treatment. Univariate and multivariable analysis were conducted to identify factors associated with tuberculosis transmission. Among the 358 social contacts of alcohol-use index cases, 33.8% (n = 121; 95% CI, 29.1–38.8%) tested positive for tuberculosis infection, significantly higher than 21.7% (n = 77; 95% CI, 17.7–26.3%) among 355 contacts of non-alcohol-use cases. Regression analysis revealed that contacts of alcohol-using index cases (aOR = 1.6, p < 0.05), were significantly associated with tuberculosis infection. Alcohol-use among tuberculosis patients significantly increases the risk of tuberculosis infection in their social networks. Full article