Search Results (8,637)

Intensive care units (ICUs) are among the most resource-intensive healthcare settings and represent a strategic priority for environmental sustainability policies. While technological solutions are increasingly promoted, sustainable practice in ICUs also depends on nurses’ knowledge, attitudes, and behaviors, which remain insufficiently studied using validated, context-specific tools and longitudinal designs. This research protocol describes a multi-phase, theory-driven study aimed at developing and validating the Knowledge, Attitudes, and Behaviors Questionnaire on Environmental Sustainability in Intensive Care Units (KABQES-ICU) and at evaluating the longitudinal impact of a structured sustainability training program. Phase 1 focuses on instrument development and psychometric validation, grounded in a conceptual framework integrating individual, psychological, and organizational determinants and informed by qualitative evidence from ICU nurses. Phase 2 consists of a longitudinal intervention study assessing changes in sustainability-related competencies and their effects on nurse, patient, caregiver, organizational, and environmental outcomes. This protocol is designed to generate robust evidence to support the integration of sustainability into ICU quality improvement strategies and health policy frameworks without compromising patient safety. Full article

Background: Head and neck squamous cell carcinoma (HNSCC) remains a major global health concern, with cervical lymph node metastasis being one of the most important determinants of prognosis. Level II (2A/2B) lymph nodes, in particular, play a key role in disease spread and survival outcomes. This study aimed to assess the prognostic impact of level II lymph node metastasis and evaluate the concordance between clinical and pathological staging in patients undergoing neck dissection. Methods: We retrospectively analyzed 138 non-metastatic HNSCC patients treated between 2007 and 2015. Clinical staging was standardized according to the AJCC 8th edition. Level II lymph nodes were dissected and evaluated separately by two independent pathologists. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards models. Correlation between clinical and pathological staging was examined using Pearson correlation analysis. Results: The median follow-up was 55.6 months. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 62.4% and 60.1%, respectively. There was a strong correlation between clinical and pathological staging (r = 0.871, p < 0.001). Patients with level II metastasis had significantly worse outcomes, with median OS of 27 months versus an estimated 128 months among those without involvement (p = 0.008), and median DFS of 17.3 versus 114 months (p = 0.004). Age was identified as an independent predictor of mortality in multivariate analysis. Conclusions: Metastasis to level II lymph nodes is a strong adverse prognostic factor in HNSCC. These findings highlight the importance of detailed nodal evaluation in guiding neck dissection strategy, risk stratification, and subsequent adjuvant treatment decisions. Full article

Background and Aims: Changes in hepatitis delta virus (HDV) epidemiology have been highlighted recently in the context of increasing worldwide migrations. The lack of comprehensive real-world data on HDV in the Valencia region highlights the need for a structured registry to accurately estimate disease prevalence and burden and to generate robust real-world evidence on clinical outcomes and therapeutic effectiveness. We aimed to better understand the barriers for successful HDV patient care in our region by establishing a registry as well as linking previously under-recognized or lost to follow-up (FU)cases to care. Methods: After a search of all possible HDV cases in a Spanish region, attempts were made (through letters and phone calls) to relink to care those lost to FU. Two approaches were undertaken: (i) search of the Microbiology Labs Database, and (ii) clinical chart review from adult patients attending the Hepatology or Infectious Disease (ID) Units outpatient clinics of the three participant hospitals between January 2011 and June 2021. Results: Only one third of anti-HDV positive patients without adequate clinical management could be successfully linked or re-linked to care, highlighting a substantial gap in follow-up. Among 243 HDV cases detected (7.5% of HBsAg-positive patients), 111 belonged to the hospitals’ health department, and after excluding deceased or transplanted individuals, the final study cohort consisted of 84 patients. Of these, 27.4% were adequately followed in Hepatology or Infectious Disease Clinics, 11.9% had been inadequately followed recently, 45.2% had been lost to follow-up for several years, and 15.5% had never been evaluated in outpatient clinics. Overall, only a third of the patients without adequate clinical management could be successfully linked/relinked to care. Conclusions: In our setting, only a minority of anti-HDV positive patients are adequately managed in specialized outpatient clinics, with unsuccessful attempts to link many patients to care, particularly among young migrant men. These findings underscore the need for alternative strategies, such as decentralized testing, reflex testing, and the involvement of patient navigators or social workers, to strengthen linkage to care and improve retention. Full article

Background: With the worldwide resurgence of Mpox in 2022, understanding its regional features is important. This systematic review aimed to provide an overview of the epidemiology, risk factors, clinical features, and outcomes of Mpox in Saudi Arabia to fill the knowledge gaps in this area. Methods: Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic search was performed on PubMed, MEDLINE (via Ovid), Scopus and Wiley Online Library for case reports and series published on Mpox in Saudi Arabia after 2022. Results: Analysis included eight studies comprising a total of 410 patients with confirmatory data. The cohort was predominantly male (91%), with a mean age of 32.8 years. Extramarital sexual contact was the most frequently identified risk factor (28.8%), whereas most patients (63.4%) had unknown or denied exposure routes. The most common clinical manifestations were fever (97.1%) and rash (96.8%). Dermatological findings were usually pleomorphic. These included umbilicated pustules, crusted papules, and vesiculopustular lesions. Although management was primarily supportive, rare complications, such as keratitis and neurological deficits, were observed. Conclusions: In Saudi Arabia, Mpox primarily affects young adult males, particularly individuals with high-risk sexual behaviors. Much of this transmission remains undetermined, and better contact tracing and focused public health efforts are urgently required. Full article

Cardiometabolic diseases, including hypertension, type 2 diabetes, dyslipidemia, and obesity, along with their cardiovascular complications, remain leading causes of morbidity and mortality worldwide, imposing significant public health, economic, and societal burdens. Conventional pharmacological therapies often show limited efficacy and increased adverse effects because they do not account for the body’s intrinsic circadian rhythms, which regulate organ function, drug absorption, and metabolism. Chronopharmacology, which aligns treatment timing with these biological rhythms, offers a strategy to enhance therapeutic outcomes. This review presents a comprehensive analysis of chronopharmacology principles applied to cardiometabolic disease management, integrating molecular, physiological, and clinical perspectives. It examines how core clock genes and tissue-specific circadian patterns influence drug action and absorption and summarizes evidence-based time-optimized interventions for hypertension, diabetes, dyslipidemia, obesity, and multimorbid patients. Furthermore, the review highlights emerging innovations, including artificial intelligence-guided dosing, circadian-biomarker-informed therapy selection, and wearable digital devices for real-time monitoring of biological rhythms. By synthesizing mechanistic and clinical insights, circadian-aligned treatment strategies are shown to improve drug efficacy, reduce adverse effects, and support the development of precision, rhythm-based therapeutics, offering a practical framework for personalized cardiometabolic disease care. Full article

Background: Spondyloarthritis (SpA) typically develops before 40 years of age, but increasing life expectancy has led to a growing number of cases in older adults. It is well known that age at onset may influence disease presentation, comorbidities, and patient outcomes. Objectives: To assess whether age at onset influences SpA clinical presentation. Methods: We analyzed clinical, demographic, clinimetric, and imaging data in 272 SpA patients, grouped by onset age: early (≤40, n = 119), intermediate (41–59, n = 127), and late (≥60, n = 26). All patients had a minimum follow-up duration of 12 months. Their epidemiologic, clinic, and clinimetric data were collected, as well as patient-reported outcome measures (PROs) [Patient Global Assessment (PGA), Health Assessment Questionnaire (HAQ), FACIT-Fatigue (FACIT-F), SHORT-FORM 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Work Productivity and Activity Impairment Questionnaire (WPAI), CSI (Central Sensitization Inventory), and Psoriatic Arthritis Impact of Disease (PsAID) questionnaire]. In univariate analyses, differences in categorical variables across onset groups were assessed using Fisher’s exact test; for continuous variables, between-group comparisons were performed using the Mann–Whitney U test (two-tailed) or the Kruskal–Wallis test, as appropriate, with Bonferroni correction for post hoc analyses. Multivariable regression models were subsequently fitted, adjusting for sex, diagnosis, and disease duration. For binary outcomes, multivariable logistic regression models were used, while multivariable linear regression models (ANCOVA) were applied for continuous outcomes. The overall association between onset group and each outcome was formally tested using likelihood ratio tests, comparing models including the onset variable with nested models excluding it. A p-value < 0.05 was considered statistically significant. Results: Patients’ mean age was 60.0 ± 13.7 years; 55.9% of them were males; and there were 188 cases (69.1%) of psoriatic arthritis (PsA) and 84 cases (30.9%) of ankylosing spondylitis (AS). In early-onset patients, inflammatory back pain (IBP) was more frequent, whereas late-onset patients more often presented with joint swelling. A family history of SpA and psoriasis was less common in late-onset forms. Comorbidities, including osteoporosis, osteoarthritis, hypertension, hyperuricemia, and diabetes, were more prevalent in older-onset patients, resulting in a higher overall comorbidity burden in Groups 2 and 3. Patient-reported outcomes were largely similar across age groups, although work activity limitation was more pronounced in younger patients. Conclusions: Age at onset seems to influence SpA phenotypes: early-onset could favor axial involvement, while late-onset may associate with peripheral arthritis. Late-onset forms are associated with a more severe comorbidity burden, in particular for cardiovascular risk factors. Lung involvement proved to be more prevalent with respect to the general population, so it should be checked in the routinary assessment of SpA patients. These findings suggest that rheumatologists could tailor their routine assessments based on patients’ age at disease onset. Interestingly, work productivity seems more impacted in early-onset patients. All these points highlight the importance of age at disease onset in SpA, guiding toward personalized medicine in terms of follow-up, therapy, and more holistic patient management. Full article

Background and Objectives: The aim of this study was to compare the clinical and radiological outcomes of the nail-plate combination (NPC) and double-plate (DP) fixation techniques in revision surgery performed after fixation failure of periprosthetic distal femur fractures. Materials and Methods: Patients who underwent revision surgery for periprosthetic distal femur fractures following fixation failure between 2018 and 2023 at a tertiary referral center were retrospectively reviewed. Based on the surgical technique, patients were divided into two groups: NPC group (n = 27) and DP group (n = 45). Demographic characteristics, operative time, intraoperative blood loss, and fluoroscopy time were recorded. Radiological evaluation included union time, while clinical outcomes were assessed with the Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Short Form-36 (SF-36) health survey. Complications (infection, thromboembolism, implant failure, nonunion, malalignment), reoperation, and 1-year mortality rates were also analyzed. Results: The NPC group had significantly shorter operative time (107 vs. 134 min, p < 0.001) and lower intraoperative blood loss (412 vs. 634 mL, p < 0.001). Hospital stay was shorter in the NPC group (6.9 ± 1.5 vs. 10.2 ± 3.3 days, p < 0.001). Mean union time was approximately three weeks shorter in the NPC group (15.4 vs. 18.8 weeks, p < 0.001). Functional outcomes (KSS, WOMAC, SF-36) did not differ significantly between groups. Complication rates were comparable; implant failure was the most frequent complication (NPC: 3.7% vs. DP: 13.3%). One-year mortality did not differ significantly (NPC: 7.4% vs. DP: 11.1%). Conclusions: Compared with DP fixation, the NPC technique offers clear perioperative advantages in revision surgery performed after fixation failure of periprosthetic distal femur fractures, including shorter operative time, reduced blood loss, and faster union. Functional outcomes and complication rates were similar between techniques. These findings suggest that the NPC may represent a safer and more feasible alternative. Full article

Generative Adversarial Networks (GANs) have emerged as powerful tools for medical image synthesis and clinical outcome prediction. In ophthalmology, accurate forecasting of Optical Coherence Tomography (OCT) images and best-corrected visual acuity (BCVA) values can significantly enhance patient monitoring and personalized treatment planning. We introduce a multimodal GAN inspired by the StyleGAN architecture, featuring super-resolution modules, a multi-scale patch discriminator, and temporal attention mechanisms. To predict logMAR values, a hybrid deep–shallow LSTM model was jointly trained alongside the image pipeline. Synthesized scans were processed through an EfficientNet-based classifier to predict 16 retinal biomarkers. To ensure subject independence, we employed a 3-fold patient-level cross-validation strategy. The proposed multimodal GAN achieved an SSIM of 0.9264, an FID of 11.9, and a PSNR of 38.1 dB for OCT forecasting. The logMAR module delivered an MAE of 0.052, while the biomarker classifier attained a macro-F1 score of 0.81. Based on logMAR change forecasting, patients were further categorized into Winner, Stabilizer, and Loser outcome groups using a threshold of $\Delta =0.05$, achieving an overall F1 score of 0.84. Our approach effectively forecasts retinal morphology and functional outcomes, providing valuable predictive insights for proactive clinical decision-making in retinal health management. Full article

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

People living with and beyond cancer often face ongoing challenges related to nutrition, wellbeing, and long-term health. Many individuals express a need for evidence-based, tailored dietary support, yet practical approaches to sustaining healthy eating behaviours remain limited. Culinary nutrition interventions, which integrate nutrition education with hands-on culinary skills, may help address these needs; however, their effects have not been systematically synthesised. This systematic review evaluates the impact of culinary nutrition interventions, delivered alone or in combination with physical activity or mental health components, on dietary intake, psychosocial and health-related outcomes, anthropometric measures, clinical and metabolic markers, and feasibility among individuals living with or beyond cancer. Following PRISMA guidelines, 18 studies were identified across PubMed, Scopus, EMBASE, CINAHL, and Web of Science (last searched in April 2025) and narratively synthesised. A total of 1173 participants were included, with sample sizes ranging from 4 to 190 participants per intervention. Interventions were well received and rated as highly acceptable, with strong engagement and minimal adverse effects. Across studies, statistically significant improvements were reported in dietary intake (7/13 studies), quality of life (4/5), mental health (5/6), self-efficacy (2/3), symptom management (3/4), self-reported cognitive health (1/1), food-related behaviours (2/2), selected anthropometric measures (4/8), and selected metabolic biomarkers (4/6). The evidence suggests that culinary nutrition interventions hold promise as supportive, behaviour-focused strategies aligned with oncology nutrition guidelines and responsive to patient needs. However, due to heterogeneity across interventions and outcomes, and variability in methodological quality as assessed using the Cochrane risk of bias tool, quantification of effects was not possible, limiting interpretation of the evidence. Further high-quality studies using comparable outcome measures and longer-term follow-up are needed to quantify the magnitude of effects, assess their durability over time, and inform the integration of culinary nutrition programmes into cancer care. This systematic review is registered under the PROSPERO ID CRD42024567041 and was funded by the RCSI Research Summer School Fund. Full article

The thoracolumbar region affects 60 to 80% of the 4 million spine fractures occurring annually, making them a global health threat. Management has evolved from early fixation systems to minimally invasive techniques, reducing muscle trauma and recovery time. Fractures are classified into compression, distraction, and translation types, with stability guiding treatment decisions. Surgical options include open and minimally invasive procedures, each with benefits and drawbacks. The choice of treatment depends on fracture type, neurological deficits, and patient factors. Advances in technology continue to improve outcomes, but further research is needed to determine optimal management 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

High-need populations face substantive barriers to accessing primary care, leading to disproportionately poor health outcomes. This descriptive, observational study details the implementation of a Federally Qualified Health Center (FQHC) program designed to improve engagement in care and enabling services by leveraging mobile health units (MHUs) to provide comprehensive, low-barrier primary care services to residents who were previously unable or unwilling to engage with the traditional healthcare system. The program sought to overcome common access challenges such as lack of transportation, lack of insurance, and mistrust of healthcare institutions. We describe the operational framework of this program, examine the types of care delivered, and offer recommendations from the perspective of a large multi-site FQHC experienced in reengaging people back to the healthcare system but new to providing mobile health care. We describe our program’s focus on prioritizing patient engagement and access and its consideration of operational and technical infrastructure. Based on our FQHC’s experience, we provide recommendations on how to address patients’ health and social needs. FQHCs have the potential to implement MHUs, drawing on their existing infrastructure and community relationships. Our MHU program is well-aligned with our FQHC’s commitment and priority to deliver essential care and foster continuity within hard-to-reach communities, strengthening the local healthcare safety net and improving healthcare for high-need populations. Full article