Search Results (1,529)

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients. Full article

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success. Full article

Background/Objectives: Schizophrenia Spectrum Disorder (SSD) represents a major challenge for healthcare systems due to its chronic nature, comorbid conditions, and high socioeconomic impact. Ensuring high-quality care for patients with SSD requires well-defined quality criteria based on consensus from healthcare professionals, patients, and caregivers. This study aims to identify and prioritize quality criteria for SSD care. Methods: A qualitative research approach was applied, including incorporating two focus groups—one with patients and caregivers (n = 7) and another with healthcare professionals (n = 8)—alongside the Delphi technique. The Delphi panel included 32 participants from psychiatry, primary care, mental health nursing, social work, and patient associations. The first round had an 88.9% response rate, while the second round achieved full participation (100%). The Delphi process was conducted and reported according to recommended guidelines for consensus methods (ACCORD checklist), specifying panel composition, rounds, predefined consensus thresholds, and controlled feedback between rounds. Results: A total of 26 quality criteria were ultimately selected, categorized into 16 identified barriers to effective care. Key priorities included early diagnosis protocols, coordinated multidisciplinary care, and improved access to specialized mental health services. Conclusions: The findings underscore the necessity of integrating patient experience into healthcare evaluation and highlight the potential for implementing a certification system to standardize SSD care across healthcare settings. Full article

First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention service model and care pathway for young people aged 16–25 with a recent-onset eating disorder. This multi-site study aimed to evaluate the feasibility of a newly developed implementation fidelity tool and observe patterns of fidelity to FREED. Six eating disorder services across England took part in an assessment. Data were collected from 242 patient referrals between January and June 2025 and via semi-structured interviews with FREED staff. Total fidelity scores were calculated alongside two component scores (rapid access to the service and early intervention care package), and inter-rater agreement was assessed. The tool was feasible to use across multiple services, time efficient, aligned with existing workflows, and demonstrated high inter-rater agreement. The average fidelity score across services was 72% (‘medium fidelity’). The average component scores were 57% for rapid access targets (‘not satisfactory’) and 77% for early intervention care package (‘medium fidelity’). Rapid access target scores were highly variable across services (20–87%), whereas care package scores were more consistent (72–82%). Additional sustained resource augmentation is needed to improve model adherence and facilitate consistent access to high-quality early intervention for eating disorders, including support to meet rapid access targets. Full article

Background/Objectives: Pediatric asthma is the most prevalent chronic respiratory condition in children and adolescents worldwide and remains a major contributor to morbidity, school absenteeism, and the use of integrated healthcare services. The main goal of this systematic review is to synthesize the available evidence about the impact of biologic therapies on the quality of life in the pediatric population (children and adolescents) with asthma. Methods: This systematic review followed the PRISMA guidelines. A comprehensive search was performed across PubMed, Scopus, and Web of Science for articles published between 2015 and 2025 in English, Portuguese, or Spanish. Studies were eligible if they included pediatric patients (<18 years) with asthma receiving biologic therapies (e.g., omalizumab, mepolizumab, dupilumab) and reported health-related quality of life (HRQoL) outcomes using validated instruments. Article selection followed PICOS criteria and excluded reviews, case reports, and editorials. Risk of bias was assessed using the Mixed Methods Appraisal Tool. Results: A total of 576 articles were found and screened, and 8 studies were selected. The characteristics of the studies highlighted the involved countries, study design, number of participants, conditions, type of biologic intervention, duration, and follow-up. In addition, the importance of biologic therapies in patients’ HRQoL was presented. All eight included studies reported statistically significant improvements in HRQoL using appropriate scales. Conclusions: The studies reinforced the importance of biologic therapies to improve HRQoL in both patients and families/caregivers. Implications for health promotion, in particular, greater involvement of integrated healthcare comprising health professionals, family, school contexts, and the community, are discussed. Full article

Lithium is the first-line treatment for bipolar disorders and a first-line augmentation option for treatment-resistant unipolar depression. Due to its narrow therapeutic window and risk of toxicity, people taking lithium require regular blood testing to monitor lithium levels in the body. However, studies have reported that only half of lithium-treated patients receive adequate lithium monitoring. This protocol describes a trial that will test the feasibility and acceptability of a point-of-care (POC) lithium blood testing programme in patients with unipolar or bipolar affective disorders taking lithium as a maintenance treatment. The primary objectives are to establish whether testing the effectiveness of POC testing is feasible, by assessing recruitment, attrition, and adherence to monitoring guidelines compared to participants randomised to testing as usual; to test whether the programme is acceptable to patients; and to measure potential contamination bias. The secondary objectives are to examine changes in health-related quality of life, the use of healthcare services, and depressive and manic symptoms to inform the design of a larger multi-site randomised controlled trial (RCT). This feasibility RCT will recruit 80 participants with affective disorders who are taking lithium. Participants will be 1:1 randomised to either POC monitoring or monitoring as usual where they will be followed up at three research visits over 30 weeks. The proportion of patients meeting guidelines for lithium monitoring will be examined, alongside measures of acceptability, wellbeing, and health economic data. POC testing has the potential to significantly improve patient safety and satisfaction with lithium treatment. Full article

Background/Objectives: This study aims to understand gaps and strategies in Chinese Americans’ utilization of SDOH services in the pediatric primary care context in Sunset Park, Brooklyn, from a patient–provider partnership perspective. Methods: The study was guided by an integrated Patient–Provider Partnership, Engagement, and Collaboration (PEC) framework that influenced patient–provider interaction during the provision of SDOH services. A qualitative study design was applied, and eight quality improvement interviews with healthcare providers were conducted to understand the existing community and health service system context. Six in-depth interviews were conducted with Mandarin-speaking Chinese American caregivers. Interviews were transcribed and coded in Mandarin and then translated into English. Results: Consistent with the PEC framework, we identified cognitive, affective, and communication gaps from both the patient and provider. Caregivers reported unaddressed needs in food, financial security, and mental health. Providers identified gaps in patient workflow, staffing, and the intake form process. Conclusions: Addressing social determinants of health among Chinese American immigrant populations is crucial for mitigating poor health outcomes in children and families. Multi-level community-engaged strategies are needed to alleviate the challenges facing this community. Recommendations for future research should consider the importance of language and cultural affinity, digital intake forms translated into the patient’s language, and regular on-site staffing during SDOH screenings. Full article

Background: Diabetes and mental health conditions frequently co-occur, with depression and anxiety affecting up to 20–30% of people with diabetes. These comorbidities worsen glycemic control, adherence, and quality of life, yet mental health is often neglected in diabetes care. Integrating mental health services into diabetes management is recommended by international organizations to improve patient outcomes. Objectives: To systematically review the evidence on integrated mental health interventions in diabetes care, compared to usual diabetes care, in improving patient outcomes (glycemic control, mental health, adherence, quality of life). Methods: We searched PubMed/MEDLINE, Embase, PsycINFO, and Scopus (2000 through July 2024) for studies of diabetes care integrating mental health support (e.g., collaborative care, co-location, stepped care, or digital interventions). Inclusion criteria were controlled trials or cohort studies involving individuals with type 1 or type 2 diabetes receiving an integrated mental health intervention, with outcomes on glycemic control and/or mental health. Two reviewers independently screened titles/abstracts and full texts, with disagreements resolved by consensus. Data on study design, population, intervention components, and outcomes were extracted. Risk of bias was assessed using Cochrane or appropriate tools. Results: Out of records identified, 64 studies met inclusion criteria (primarily randomized controlled trials). Integrated care models consistently improved depression and anxiety outcomes and diabetes-specific distress, and yielded modest but significant reductions in glycated hemoglobin (HbA1c) compared to usual care. Many interventions also enhanced treatment adherence and self-management behaviors. For example, collaborative care trials showed greater depression remission rates and small HbA1c improvements (~0.3–0.5% absolute reduction) relative to standard care. Co-located care in diabetes clinics was associated with reduced diabetes distress, depression scores, and HbA1c over 12 months. Digital health integrations (telepsychiatry, online cognitive-behavioral therapy) improved psychological outcomes and adherence, with some reporting slight improvements in glycemic control. Integrated approaches often increased uptake of mental health services (e.g., higher referral completion rates) and showed high patient satisfaction. A subset of studies reported fewer emergency visits and hospitalizations with integrated care, and one economic analysis found collaborative care cost-effective in primary care settings. Conclusions: Integrating mental health into diabetes care leads to better mental health outcomes and modest improvements in glycemic control, without adverse effects. Heterogeneity across studies is noted, but the overall evidence supports multidisciplinary, patient-centered care models to address the psychosocial needs of people with diabetes. Healthcare systems should prioritize implementing and scaling integrated care, accompanied by provider training and policy support, to improve outcomes and bridge the persistent treatment gap. Future research should focus on long-term effectiveness, cost-effectiveness, and strategies to reach diverse populations. Full article

This policy insight outlines Latvia’s national strategy for integrating simulation-based education into all levels of medical and healthcare education by 2027. It is framed as a direct response to the 2024 Global Consensus Statement on Simulation-Based Practice in Healthcare, operationalizing its recomme ndations within a national policy context for Latvia. Grounded in international and national standards—including WHO guidance, EU directives, and principles of healthcare safety and education quality—the strategy promotes simulation as a transitional and indispensable phase between theoretical instruction and clinical practice. The strategy emphasises structured collaboration among universities, professional associations, healthcare providers, and government bodies. It sets out a governance and resource model for simulation-based learning environments, ensuring quality, sustainability, and alignment with ethical and professional standards. By embedding simulation-based education into undergraduate, postgraduate, and continuing medical education, Latvia aims to enhance healthcare professionals’ clinical competence, reduce preventable medical errors, and improve patient outcomes. The approach supports deliberate practice, facilitates safe and realistic training conditions, and strengthens the preparedness of healthcare workers for both routine and complex clinical scenarios. The strategy also calls for standardised quality-assurance mechanisms, accreditation procedures, and integration into national regulatory frameworks. This national roadmap aims to establish Latvia as a regional leader in simulation-based healthcare education, improving not only the safety and efficiency of healthcare services but also public trust and professional development. As such, the strategy serves both as a practical implementation plan and a model for countries pursuing similar goals. Full article

Background/Objectives: Pancreatic cancer remains highly fatal, often diagnosed late with poor prognoses and worse psychological quality of life compared to other cancers. Globally, it is the twelfth most common cancer but the sixth leading cause of cancer-related deaths, with actual 5-year survival rates below 5%. Northern Ireland’s outcomes are among the worst, yet research on people’s experiences across the illness trajectory is scarce. Consequently, the unique needs of people with pancreatic cancer are poorly understood. It is crucial we develop deeper understanding of the entire pancreatic cancer journey to address this. This study aims to explore the lived experiences of people diagnosed with pancreatic cancer in Northern Ireland and generate a theory that explains their journeys, from pre-diagnosis through to survivorship or end of life. Methods: This study will adopt a grounded theory approach, incorporating multiple qualitative data generation methods: semi-structured interviews with patients and care partners, and focus groups with professionals. An optional photovoice (participatory photography) method will be offered to participants. Theoretical sampling principles and constant comparative analysis will guide recruitment, data collection, and analysis to ensure the explanatory theory is rooted in participants’ lived experiences. Conclusions: Establishing a holistic, in-depth understanding of people’s pancreatic cancer journeys will enable us to better comprehend, anticipate, and meet their needs. A theory grounded in empirical data about lived experiences can inform priorities for future care, support services, policy, and research, and contribute to the development of support interventions that help people to maintain the best possible quality of life, whether during a short-term, terminal illness; treatment journey; long-term symptom management; or survivorship. Full article

Background: Psoriasis has a huge impact on a patient’s life. Treatment dissatisfaction and non-adherence are common among patients with psoriasis, partly due to discordance between individual preferences and recommended treatments. The modern strategy for psoriasis should be focused on human-centric treatment that recognizes the needs and preferences of patients with a goal for safe, effective, quality and acceptable health services for a lifetime. The aim of this analysis was to capture patients’ preferences with moderate-to-severe psoriasis regarding various treatment attributes. Methods: A specialized questionnaire containing four attributes with three levels, each, was used, followed by an orthogonal plan based on conjoint analysis. Nine combinations of therapeutic scenarios were produced as a result, to investigate participants’ preferences. Respondents were asked to rank alternatives from best to worst. Results: The risk of developing pneumonia or other serious infections within a decade seems to be higher in patients with an implied assigned value of 37. The second attribute was the type and frequency of the administration with a value of 27, followed by the treatment effectiveness with great improvement of body surface with a value of 25. The lowest utility (11) was the sustainability of early remission of psoriasis. Conclusions: Psoriasis patients want safe, effective and easy to administer treatments. Full article

Nuclear medicine is a highly specialized field that combines advanced technology and multidisciplinary collaboration. Despite its complexity, the role of nurses in this context remains underexplored, especially regarding their clinical and administrative activities. This is a scoping review protocol developed according to the Joanna Briggs Institute (JBI) methodology and reported in accordance with the PRISMA-ScR guidelines, as recommended by the EQUATOR Network. The research question was structured using the PCC mnemonic (Population, Concept, and Context): What are the clinical and administrative activities performed by nurses in nuclear medicine services? A comprehensive search will be conducted in Web of Science, PubMed, Embase, Cochrane, SciELO, LILACS, Scopus, and CINAHL, complemented by grey literature sources such as Google Scholar and ProQuest Dissertations & Theses Global. No restrictions on language or publication date will be applied. Study selection and data extraction will be performed independently by two reviewers. This protocol is registered on the Open Science Framework (OSF) and is publicly accessible. The selection process will be detailed in a PRISMA-ScR flow diagram. A descriptive table will summarize the characteristics of the included studies, including the authors, year, country, study type, objectives, population, main nursing activities, and key findings. The anticipated results are expected to clarify nurses’ contributions to patient safety and service quality in nuclear medicine. This review may also support the development of an assessment tool for nursing activities, guide professional training, and inform policies to strengthen nursing practice in this specialized field. Full article

Background: Herpes zoster (HZ) poses significant risks to immunocompromised individuals, particularly cancer patients receiving systemic therapies. The recombinant zoster vaccine (RZV, Shingrix^®) provides strong and durable protection against HZ and its complications. Nevertheless, vaccination coverage remains low, mainly due to limited awareness among patients and healthcare providers and logistical barriers to vaccine access and delivery. Materials and Methods: We conducted a single-center quality improvement (QI) project to enhance RZV uptake among oncology outpatients receiving systemic therapy. Following the Plan–Do–Study–Act (PDSA) model, baseline HZ vaccination coverage was assessed, and an in-house vaccination campaign was implemented. Vaccination rates were monitored every two months over a 14-month period. Results: At baseline, only 5.4% (24/446) of patients had received RZV. After 14 months, 365 patients were evaluated for vaccination: 200 (55%) were vaccinated, 134 (37%) were ineligible, and 31 (8%) refused RZV. The overall vaccination rate increased from 5.4% to 44%. Reported adverse events were mild and primarily local reactions, confirming the vaccine’s favorable safety profile in this population. Conclusions: This real-world QI initiative demonstrates that an in-house vaccination strategy embedded within oncology services can substantially improve RZV coverage and patient engagement. The approach highlights the key role of oncology teams in leading preventive interventions for immunocompromised patients. By integrating vaccination into routine cancer care, institutions can overcome traditional organizational barriers and align with current ASCO and ESMO recommendations for comprehensive patient protection. Full article

Super-utilization, defined as frequent and often avoidable use of emergency departments and hospital admissions, has attracted significant policy and research attention due to its impact on healthcare costs. Over the past decade, care management and integrated care interventions have been promoted as solutions to reduce per capita expenditure and service use. However, systematic reviews and primary studies consistently report limited success in shifting utilization patterns or improving care experiences. This narrative review based upon critical systems heuristics explores the conceptual evolution of super-utilization and examines whether current approaches reflect the underlying complexity of the health system and patient needs. The three-phase narrative and complexity-informed review aimed to identify the evolution of Super-utilization as an issue and its key drivers, in relation to the dynamic systems in which it occurs. The findings reveal a predominant emphasis on cost containment and acute care metrics, with minimal incorporation of person-centered outcomes, lived experience, or local system dynamics. Even when addressing social determinants, interventions remain narrowly focused on utilization and/or costs as the key outcome. Super-utilization or High-Need/High-Cost trajectories reflect multi-level dynamics—biological, psychological, social, and political—yet these are rarely integrated into program design or evaluation. Centralized policy frameworks such as the Triple Aim risk reinforce inequities unless they actively address under-resourced populations and the complexity of chronic illness and ageing. Radical transformation of policy is required to make the nature of care of high-cost/high-need super-utilizers central to quality metrics that may improve outcomes rather than inappropriate utilization metrics which make little impact on healthcare costs. This review concludes that super-utilization requires a shift in paradigm toward systems-informed, needs-based approaches that integrate complexity theory and distributive justice to guide future research and interventions. Full article

Background/Objectives: Patient satisfaction is increasingly recognized as a key indicator of the effectiveness of substance use disorder (SUD) treatment. While some studies suggest disparities in satisfaction across treatment settings, there remains limited research examining these differences, particularly among vulnerable populations. This study aimed to assess patient perceptions of satisfaction with opioid use treatment services and explore how demographic and socioeconomic factors influence these experiences. Methods: Conducted between 1 February and 31 March 2025, the study took place at a longstanding Opioid Treatment Program in Philadelphia. A total of 217 participants receiving treatment were recruited through convenience sampling during routine clinic visits. Data collection involved an electronically administered survey using the validated Client Satisfaction Questionnaire-8, with both quantitative and qualitative components. Quantitative data were analyzed using SAS 9.4, while qualitative responses underwent thematic analysis in Excel. Results: Findings revealed an average satisfaction score of 27.16, with employment status emerging as a significant predictor; employed individuals reported lower satisfaction (β = −1.118, p = 0.040), and race showed a marginal association. Qualitative analysis highlighted themes such as supportive staff, financial struggles, and personal growth. Conclusion: The results emphasize the need for equitable, culturally responsive treatment approaches that account for socioeconomic disparities in patient experience and care quality. Full article