Search Results (16,262)

Background: Waiting-room time is an important and neglected element of the outpatient experience in the field of oncology, which carries far-reaching consequences for overall patient satisfaction, perceptions of quality, and healthcare experience. Methods: We carried out a cross-sectional, mixed-methods study, conducted at the Juravinski Cancer Centre in Hamilton, Canada, from October to December 2024. Results: We studied 418 patients with a mean age of 61.6 years. Overall, 59.6% of respondents had spent less than 30 min in the waiting room, while 56.2% accepted a delay of 15–30 min. Waiting for more than 30–45 min was perceived as long by 61% of participants. In regards to physician choice, 59.8% of respondents preferred to be seen by their known provider, while 30.9% were ready to meet another one, particularly in terms of scheduled regular follow-up and urgent appointments followed by consultations. Interestingly, chemotherapy visits were the least common type of appointment where patients agreed to see different providers. A significant association was identified between appointment types and readiness to change physicians (p < 0.05). Although 78.7% agreed that delays were caused by complex conditions, only 29.2% received sufficient information about delays. Conclusions: Most gynecologic oncology patients want continuity of care, yet many are flexible with consultations, follow-up, and urgent visits. In outpatient clinics, patient-centered scheduling, balancing efficiency and patient satisfaction with better communication is an objective for system improvements. Full article

Background/Objectives: Cannabis use is prevalent in first-episode psychosis (FEP) and is associated with poor clinical outcomes. Cariprazine, a dopamine D3/D2 partial agonist with preferential D3 affinity, may offer clinical advantages for both psychotic symptoms and comorbid substance use; however, naturalistic data in FEP patients with active cannabis use are lacking. Methods: We conducted a retrospective naturalistic case series of eight FEP patients with active cannabis use treated with cariprazine for six months across two Greek Early Intervention Units (PNOES Athens and Thessaloniki, EPAPSY). Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) Five-Factor (Marder) model and cannabis use using the Cannabis Experience Questionnaire (CEQ) at baseline and six months. Analyses were descriptive, with exploratory Wilcoxon signed-rank tests. Results: At six months, lower mean PANSS scores were observed for positive symptoms (12.88 vs. 9.50), disorganization (11.38 vs. 9.13) and, to a lesser degree, anxiety/depression (9.38 vs. 8.50). Negative symptoms changed little (16.13 vs. 15.00), and hostility was essentially unchanged (10.63 vs. 11.63). Only the reduction in positive symptoms reached nominal significance (p = 0.047; d_z = −1.05), which did not survive correction for multiple comparisons. Cannabis-use frequency decreased in seven of eight participants, with two reporting complete cessation. Conclusions: These preliminary, hypothesis-generating observations suggest that cariprazine may warrant further study in FEP with comorbid cannabis use. The findings cannot be interpreted as evidence of efficacy given the small, uncontrolled, diagnostically heterogeneous sample. Full article

Background/Objectives: Robotic-assisted percutaneous coronary intervention (R-PCI) reduces occupational hazards, may enhance procedural precision and has demonstrated comparable efficacy to manually performed PCI (M-PCI). However, the switch from M-PCI to R-PCI represents a unique challenge and learning curve, which remains undefined. The purpose of this study was to evaluate patients’ profile and procedural outcomes over time after starting an R-PCI programme at a tertiary cardiac centre. Methods: All consecutive patients who underwent R-PCI with the second-generation CorPath GRX R-PCI system at our centre between March 2021 and January 2024 were included. The study cohort was divided into two equal groups representing the early and late experience. Clinical profile, lesion characteristics and procedural outcomes were compared between both groups. Angiographic success was defined as TIMI 3 flow and less than 30% stenosis, and R-PCI technical success as angiographic success without any unplanned manual input. Results: For 102 patients (mean age 68 years, 73% male) who underwent R-PCI, the angiographic success rate was 100%, and the R-PCI technical success rate was 83.33%, with 16.67% of patients requiring unplanned manual input. In the late (n = 51) versus early (n = 51) group, more bifurcations (52.94% vs. 33.33%, p = 0.046) and ACC/AHA (American College of Cardiology/American Heart Association) type C lesions (45.10% vs. 25.49%, p = 0.038) were treated with no significant differences in contrast volume, radiation dose, procedural time or peri-procedural complications between the two groups. Conclusions: R-PCI appears feasible with acceptable short-term results. In our experience, after ~50 cases, increasing complexity of lesions can be treated without significantly impacting procedural outcomes or safety. Full article

Background: Stroke remains a significant cause of persistent long-term disability globally. Post-stroke neuroplasticity is critical for neurological functional recovery and reducing disability. Nevertheless, the existing scoping reviews rarely systematically integrate its intrinsic mechanisms, predictive biomarkers, and actionable intervention strategies. This scoping review aims to map the current research landscape, synthesize the core research findings, and identify existing research gaps in this field. Methods: This scoping review was conducted following the PRISMA-ScR guidelines. Eligible studies published between 31 January 2021, and 31 January 2026, were retrieved from three major mainstream electronic databases: PubMed, Scopus, and Web of Science. All retrieved evidence was synthesized via narrative approach, focusing on core research findings concerning post-stroke neuroplasticity mechanisms, biomarkers, and therapeutic interventions. Results: The existing research on neuroplastic mechanisms following ischemic stroke is predominantly derived from in vitro and animal studies, which have collectively demonstrated multiple core adaptive alterations, including enhanced synaptic plasticity, dendritic and axonal structural remodeling, restored interhemispheric connectivity, endogenous neurogenesis, and functional reorganization of neural networks. In contrast, mechanistic investigations in human stroke patients primarily highlight compensatory activation within peri-infarct tissues and functionally remote brain regions. The relevant clinical biomarkers are mainly imaging and electrophysiological indicators. Research on therapeutic interventions has mainly focused on rehabilitation treatments such as non-pharmacological magnetic stimulation. Conclusions: This scoping review synthesized the current body of evidence on post-ischemic stroke neuroplasticity and identified critical research gaps, particularly regarding multimodal biomarkers and their translational relevance. The present findings confirm that neuroplastic alterations after ischemic stroke are regulated by multiple pathways, among which those involved in synaptic structure, dendrites, and neural network connections exert pivotal effects. Nevertheless, most existing investigations remain confined to in vitro experiments and animal models. The identification of neuroplasticity biomarkers has opened up new avenues for the development of targeted stroke therapies and offers promising prospects for rehabilitative treatment of stroke patients. Full article

With the accelerating global population aging process, home health care (HHC) has emerged as a promising service mode to satisfy surging elderly medical care needs and alleviate the pressure of offline medical institutions. As a core operational optimization problem in the HHC service system, the home health care routing and scheduling problem (HHCRSP) has attracted extensive research attention in recent years. Different from traditional HHCRSP research, this work proposes a bi-objective mixed-integer programming model for HHC, which integrates facility location, caregiver allocation, route planning and skill-matching rules. The model simultaneously minimizes two competing objectives: total operational cost and total penalty incurred from time window violations. To tackle the high-complexity NP-hard characteristics of this integrated optimization problem, an enhanced non-dominated sorting genetic algorithm (E-NSGA) is designed by introducing dedicated local search operators to improve solution quality. Comparative numerical experiments are carried out on 12 test instances extended from the classic Vidal benchmark, covering four patient scales of 70, 80, 90 and 100 patients. Four state-of-the-art multi-objective metaheuristics, i.e., MOEA/D, MOGWO, NSGA-II and NSGAII-MLS, are selected as baseline comparison algorithms. Experimental results reveal prominent performance advantages of E-NSGA over all comparison methods. In terms of the IGD metric, E-NSGA achieves IGD reductions of 20.19%, 86.30%, 24.98% and 37.72% against MOEA/D, MOGWO, NSGA-II and NSGAII-MLS, respectively. In terms of the Hypervolume metric, E-NSGA obtains performance improvements of 6.22%, 2019.42%, 10.36% and 18.04% relative to the four baseline algorithms. Such quantitative evidence verifies the strong comprehensive optimization capacity of the proposed E-NSGA for addressing the investigated problem. Full article

Burnout among nurses is an important occupational and public health concern because it is associated with nurses’ well-being, workforce retention, and the quality and safety of patient care. This explanatory sequential mixed-methods study examined levels of work stress, quality of work life, and burnout among registered nurses in public hospitals in Samut Songkhram Province, Thailand, and explored nurses’ experiences regarding workplace factors related to burnout. The target quantitative sample was 217 registered nurses, and 186 completed questionnaires were included in the final analysis. Structured questionnaires assessed work stress, quality of work life, and burnout. Multiple regression analysis was used to identify factors associated with burnout. Qualitative data were collected through in-depth interviews with 10 registered nurses and analyzed using content analysis. Most nurses were classified as having high work stress and being at risk of burnout. Work stress and quality of work life jointly explained 35.0% of the variance in burnout. Work–life balance, fair and adequate compensation, professional development, workplace safety, organizational justice, and social integration in the workplace were associated with lower burnout scores. Organizational structure, policy, and climate showed a positive coefficient in relation to burnout and should be interpreted cautiously because the p-value was close to the conventional threshold for statistical significance. Qualitative findings supported the quantitative results and highlighted workload, staffing shortages, limited resources, insufficient recovery time, and workplace support as important workplace concerns. Full article

Background/Objectives: Individualized nursing care is a fundamental component of high-quality healthcare, particularly in geriatric populations. However, its consistent implementation remains challenging, a situation further exacerbated by the COVID-19 pandemic due to increased workloads and resource constraints. This study aimed to assess nurses’ perceptions of individualized care for older adults in Spain and to examine the influence of the workplace ethical climate on these perceptions. Methods: A cross-sectional observational study was conducted using two validated instruments: the Individualized Care Scale–Nurse version (ICS-Nurse) and the Hospital Ethical Climate Survey (HECS). Descriptive and inferential analyses were performed to assess individualized care, ethical workplace climate, and the associations between both constructs. Results: A total of 96 nursing professionals participated in the study. Participants reported an overall favorable perception of individualized care. The highest scores were observed in the clinical situation dimension, whereas lower scores were reported for aspects related to hygiene organization and the incorporation of patients’ preferences. A moderate, positive, and statistically significant association was observed between ethical workplace climate and individualized care, particularly in dimensions related to patients and physicians. Participants working in hospital settings reported higher recent-experience individualized care scores than those working in nursing homes. Conclusions: These results highlight the critical role of an ethical workplace climate in supporting nurses’ capacity to deliver individualized care. They also underscore the need for targeted strategies to strengthen organizational support, enhance interprofessional collaboration—particularly with physicians—and promote training in individualized care practices. Addressing these factors may facilitate more consistent and comprehensive individualized care, especially in long-term care settings where structural challenges persist. Full article

Romania’s Mecanismul de Feedback al Pacientului (MFP; Patient Feedback Mechanism) has collected post-discharge patient experience feedback from public hospitals since 2016 and publishes monthly aggregate workbooks through official channels, but the files are heterogeneous in layout, inconsistently granular, and have never been consolidated into a documented, reusable resource. This data descriptor presents a harmonized, reproducible open dataset built from 117 original workbooks. A Python pipeline integrates them into three analysis-ready artifacts: a national monthly series (113 observed releases over the December 2016–May 2026 span, 6004 tidy answer rows, an 18-row question legend spanning a 2024 instrument revision); a provider release panel (493,450 rows, 466 county plus exact-name provider identities, 42 counties, 39 releases); and a structurally separate legacy 2016 paper-based instrument. Provenance was verified by re-downloading sampled sources and confirming byte-for-byte identity, and national totals reconstructed by hospital summation reconcile exactly with an independent re-aggregation of the published hospital-level details. The release adds SHA-256 source checksums, a machine-readable data dictionary, and a provenance log. The descriptor documents reuse hazards (a ten-to-eight-item instrument break, uneven granularity, aggregate-only records, and string-defined provider identity) and a reuse opportunity: provider- and county-level integrity (informal-payment solicitation) items, usable for rare-event analysis under explicit shrinkage caveats. Full article

Congenital cytomegalovirus (cCMV) is characterized by highly variable outcomes; how diagnostic information is communicated to families is critical, yet parent experiences of communication following a cCMV diagnosis are not well described. The objective was to examine parent experiences of communication following a cCMV diagnosis and identify opportunities to improve communication in the setting of clinical uncertainty. The method used was semi-structured interviews with 41 mothers of children with cCMV explored communication of diagnostic results, interactions with healthcare providers, and perceptions of information clarity, timing, and adequacy. Transcripts were analyzed using thematic analysis. Participants described variability in diagnostic communication, including differences in timing, modality, and content. Some received in-person counseling, whereas others learned of the diagnosis through phone calls, written communication, or electronic health portals prior to provider contact. Many reported limited explanation, insufficient anticipatory guidance, and inconsistent or incomplete information across providers. These communication gaps contributed to confusion, increased reliance on external information sources, and diminished trust in the healthcare system. Participants emphasized the importance of clear, compassionate communication that acknowledges uncertainty while providing actionable guidance. Communication surrounding cCMV diagnosis is inconsistent and often does not meet family needs. Diagnostic disclosure should function as a clinical intervention requiring clear, patient-centered, longitudinal communication to support families navigating uncertainty. Full article

Background: Smith–Magenis syndrome (SMS) is a rare neurodevelopmental disorder characterized by severe sleep disturbances, circadian rhythm dysregulation, and prominent behavioral difficulties. Objective: To examine associations between subjective and objective sleep and circadian characteristics and behavioral difficulties in children with SMS in real life. Methods: Children aged 5–13 years with genetically confirmed SMS were included in a prospective single-center cohort study. Sleep and circadian rhythms were assessed using parent-reported questionnaires (Sleep Disturbance Scale for Children (SDSC), Horne and Östberg Morningness–Eveningness Questionnaire (H&O)) and 15-day home-based wrist actigraphy. Behavioral difficulties were evaluated using the Aberrant Behavior Checklist-Community (ABC-C). Associations between subjective and objective sleep and circadian measures with behavioral difficulties were studied using Spearman correlations for each ABC-C subscale. Results: Among the 20 children included (55% female, mean age 10 ± 2.5 years), 75% were carriers of a 17p11.2 microdeletion and 25% had an RAI1 mutation. Overall, 95% of children were treated with melatonin, 55% with psychostimulants and 20% with beta-blockers. According to the SDSC results, pathological sleep disturbances were present in 14/20 (70%) children and concerned mainly complaints of insomnia (10/20, 50%) and excessive daytime sleepiness (8/20, 40%). The H&O chronotypes confirmed the morning type in 70% of patients. Sleep and circadian measures obtained by actigraphy showed reduced total sleep time in 71% of the children, reduced sleep efficiency in 88%, long wake after sleep onset (WASO > 60 min) in 59%, as well as an early L5 onset (5 h period with the least movements < 23:38) and M10 onset (10 h period with the highest activity levels < 09:12) in 92% and 62% of children, respectively. The behavioral domains of the ABC-C with the highest scores were hyperactivity (mean 52.1, range 2.1–97.9) and irritability, agitation, and crying (mean 46.9, range 17.8–82.2). In the analysis of the relationship between behavior and sleep, a positive correlation was found between sleep disorders and stereotyped behaviors (r = 0.472, p = 0.048), insomnia and irritability, social withdrawal and stereotyped behaviors (r = 0.472, p = 0.048; r = 0.701, p = 0.001; and r = 0.648, p = 0.004, respectively), and non-restorative sleep and inappropriate speech (r = 0.476, p = 0.046). No significant association was found between objective sleep measures and behaviors. While subjective assessments suggested that a stronger morning chronotype was associated with lower irritability (r = −0.565, p = 0.015), actigraphy-derived circadian rhythm analyses revealed that an earlier L5 onset was associated with greater social withdrawal and hyperactivity (r = −0.556, p = 0.048 and r = −0.560, p = 0.049, respectively). Conclusions: The present cohort study of children with SMS studied in real-life conditions, using both objective and subjective measures, shows that patients continued to experience sleep and behavioral disturbances despite treatment. Exploratory analyses identified distinct associations between subjective sleep disturbances, circadian rhythm characteristics, and specific behavioral domains. While subjective sleep disturbances were associated with irritability, stereotypic behavior, and inappropriate speech, circadian rhythm parameters are specifically associated with hyperactivity. Both were also associated with social withdrawal. As these findings arise from an exploratory observational secondary analysis, they should be considered hypothesis-generating and require confirmation in larger prospective studies. If confirmed, they may help identify sleep and circadian rhythm characteristics as potential targets for future interventions in children with SMS. Full article

Background/Objectives: Oral healthcare succeeds not only when treatment is biologically sound but when its outcome meets patient expectations, making expectation management a measurable component of care quality. Patient satisfaction in dental implant therapy is strongly influenced by pre-treatment expectations, yet differences between patient expectations and dentists’ perceptions of those expectations remain poorly characterized. This study compared the two using a mirror-design survey. Methods: A cross-sectional survey was administered to adult patients (n = 250) and dentists involved in implant therapy (n = 200). A 16-item questionnaire was developed in two parallel versions covering two domains, outcome expectations and surgical process apprehension, rated on a 5-point Likert scale. Internal consistency, item- and subscale-level differences, and signed and absolute between-group difference scores were analyzed. Results: Significant between-group differences were identified in 13 of the 16 items, while total scale scores did not differ between groups, producing a cancel-out effect at the aggregate level. Within the surgical process apprehension domain, patients were more optimistic than dentists perceived, with procedural pain showing the largest between-group difference (Cliff’s δ = 0.437). The opposite pattern emerged for long-term outcomes, where concern about implant loss yielded the largest difference across the entire instrument (δ = 0.645). Dentists’ clinical experience was negatively correlated with the signed total gap score (ρ = −0.342, p < 0.001), indicating reduced directional bias among more experienced clinicians. Conclusion: Patients’ expectations differed systematically from dentists’ perceptions of those expectations across both domains, but these opposing differences offset at the aggregate level. Aggregate summary scores may therefore obscure clinically relevant item-level differences, and directional item-level analyses may better capture expectation patterns in implant dentistry. Full article

The adsorption behavior of selected volatile sulfur compounds on graphene was examined using density functional theory. The analytes of interest are hydrogen sulfide, methyl mercaptan and dimethyl sulfide, which are found in the exhaled breath of halitosis patients. The human breath contains several volatile compounds that act as chemical fingerprints of what is happening inside the body. This study employs first-principles calculations to investigate the structural, electronic, and adsorption properties of pristine and transition-metal-doped graphene (Fe, Ru, and Os) for the detection of key volatile sulfur compounds relevant to breath analysis and halitosis screening. According to our findings, when a single carbon atom is substituted with an iron, ruthenium or osmium atom in the optimized graphene sheet, which is equivalent to a dopant concentration of 2 mol% in experiments, the adsorption behavior of the system is altered significantly. Based on the resultant adsorption behavior and electronic structure alterations, important sensor properties were examined. This work presents a non-invasive approach for halitosis detection, therapeutic monitoring, and metabolic status observation by analyzing the volatile sulfur compounds present in exhaled breath. Additionally, this study demonstrates how computational modeling can be used as a decision support tool. Full article

Background and Objectives: Individuals with Parkinson’s disease (PD) experience deficits in working memory (WM) and sustained attention (ATTN), but diagnosing and monitoring these deficits remains challenging. This study compares machine learning (ML) classification models trained on EEG and pupillometry data from WM and ATTN tasks to identify task-specific and shared cognitive biomarkers of PD. Methods: EEG and pupillometry were recorded from PD patients and healthy controls (HC) during a visual change detection WM task and a continuous performance ATTN task. A standardized toolbox extracted 108 features, reduced via PCA and recursive elimination (RE) and classified using an SVM-RBF within a nested, 5-fold cross-validated pipeline, with class balancing (SMOTE) and feature selection performed strictly within training folds to prevent leakage. Results: On internal test folds, WM achieved 71% accuracy (F1 = 0.701) and ATTN achieved 73% (F1 = 0.699); on an independent hold-out set, WM achieved 63% accuracy (F1 = 0.626) and ATTN achieved 70% (F1 = 0.623). ATTN showed higher accuracy and precision, WM showed higher recall, and univariate analyses independently supported several top-ranked features (e.g., theta/beta and alpha/theta ratios); PAI and FAA, though top features in both tasks, reached univariate significance only in ATTN. These results indicate WM and ATTN yield complementary, task-linked neurophysiological signatures relevant to PD classification. Conclusion: At its current stage, this pipeline functions as a research tool for biomarker discovery rather than a clinical diagnostic, though larger, externally validated samples could support future screening and monitoring applications. Full article

Background/Objectives: Endometriosis affects around 10% of women of reproductive age and is commonly associated with pelvic pain, fatigue and infertility. Beyond physical symptoms, the condition can substantially affect psychosocial well-being. However, self-esteem has typically been considered only indirectly in this context. This study examines how women with medically diagnosed endometriosis describe self-esteem in relation to the condition and the contexts in which it appears to be weakened or strengthened. Methods: Nine women with medically diagnosed endometriosis participated in semi-structured interviews (in person or online) between March and May 2025. Data were analyzed using Focused Interview Analysis with MAXQDA. Results: Self-esteem emerged as a recurring theme across everyday functioning, body-related experiences and, in some cases, fertility-related concerns. Self-esteem-related difficulties were described across different levels of symptom burden and were often discussed in relation to functional limitations, perceived reliability, loss of control, and high internal performance standards. Experiences of social and medical invalidation were frequently linked to self-doubt, withdrawal and self-invalidation. At the same time, participants described acceptance, self-compassion, boundary-setting, and the re-evaluation of femininity as experiences associated with a more stable sense of self-esteem. Conclusions: The findings suggest that self-esteem-related experiences were discussed in relation to functional limitations, experiences of being taken seriously, and available psychosocial resources. Self-esteem-related dynamics may represent a clinically relevant dimension to consider in psychosocial support for patients with endometriosis. Full article

Background/Objectives: The homeostatic imbalance between tumor metastasis-promoting genes and metastasis-suppressing genes determines the metastatic potential of lung adenocarcinoma (LUAD) cells. However, the post-transcriptional regulation mechanism mediated by RNA-binding proteins (RBPs) in maintaining the expression balance of tumor metastasis-related genes remains unclear. Methods: The expression of MCPIP3 and IGF2BP3 in human lung cancer tissues was analyzed using bioinformatics methods and validated using qRT-PCR, immunohistochemistry, and immunoblotting. In vitro cellular experiments and in vivo animal examinations were used to evaluate the effects of MCPIP3 and IGF2BP3 on metastasis. RNA sequencing, PCRarray, RNA pull-down and mass spectrometry, RNA-EMSA, RNA immunoprecipitation (RIP), mRNA stability, and luciferase assays were performed to elucidate the mechanism. Results: MCPIP3 is expressed at low levels, while IGF2BP3 is highly expressed in LUAD tissues. Lower MCPIP3 expression and higher IGF2BP3 expression in lung cancer tissues were significantly associated with poor prognosis in LUAD patients. MCPIP3 significantly inhibited the metastasis of lung cancer cells both in vitro and in vivo, whereas IGF2BP3 promoted metastasis. Mechanistically, MCPIP3 specifically bound to the stem–loop structure in the 3′UTR (untranslated region) of the METAP2 transcript and degraded its mRNA via its RNase domain. In contrast, by interacting with the common stem–loop structure, IGF2BP3 could stabilize METAP2 mRNA and promote its expression. Notably, inverse correlations were observed between the expression of MCPIP3 and IGF2BP3 and the expression of METAP2 in LUAD tissues. Conclusions: MCPIP3 and IGF2BP3 antagonistically control lung cancer cell metastasis by balancing the expression of metastasis-promoting genes through mediating mRNA stability, thereby providing potential targets for lung cancer treatment. Full article