Search Results (25)

Pediatric palliative care (PPC) aims to enhance the quality of life of children with life-limiting conditions and their families through individualized, interdisciplinary support. Among this population, children with neurological diseases represent a substantial and growing group, often facing prolonged disease courses, cognitive impairment, and high prognostic uncertainty. Effective communication is central to PPC; however, it remains deeply influenced by cultural, religious, and spiritual frameworks that shape family perceptions of illness, suffering, and decision-making. This narrative review explores communication strategies in PPC, with a specific focus on children with neurological conditions, highlighting conceptual foundations, cross-cultural variations, and emerging best practices. Key findings highlight the importance of culturally humble approaches, family-centered communication models, and structured tools, such as co-designed advance care planning and dignity therapy, to enhance communication. Additionally, the review highlights the presence of ethical and interdisciplinary challenges, particularly in neonatal and neurology settings, where misaligned team messaging and institutional hesitancy may compromise trust and timely referral to palliative care. Future research, policy, and clinical education priorities should advocate for models that are inclusive, ethically grounded, and tailored to the unique trajectories of neurologically ill children. Integrating cultural competence, team alignment, and family voices is essential for delivering equitable and compassionate PPC across diverse care settings. Full article

Background/Objectives: Radiotherapy for tumors of the central nervous system (CNS) could be improved by incorporating advanced imaging techniques into treatment planning and response assessment. The objective of this narrative review is to highlight the recent developments in magnetic resonance imaging (MRI) and positron emission tomography (PET) for applications in CNS radiotherapy. Methods: Recent articles were selected for discussion, covering the following topics: advanced imaging on MRI-linear accelerators for early response assessment in glioma; PET for guiding treatment planning and response assessment in glioma; and contrast-enhanced imaging and metabolic imaging for differentiating tumor progression and radiation necrosis for brain metastasis treatment. Where necessary, searches of scholarly databases (e.g., Google Scholar, PubMed) were used to find papers for each topic. The topics were chosen based on the perception of promise in advancing specific applications of CNS radiotherapy and not covered in detail elsewhere. This review is not intended to be comprehensive. Results: Advanced MRI sequences and PET could have a substantial impact on CNS radiotherapy. For gliomas, the tumor response to therapy could be assessed much earlier than using the conventional technique of measuring changes in tumor size. Using advanced imaging on combined imaging/therapy devices like MR-Linacs would enable response monitoring throughout radiotherapy. For brain metastases, radiation necrosis and tumor progression might be reliably differentiated with imaging techniques sensitive to perfusion or metabolism. However, the lack of level 1 evidence supporting specific uses for each imaging technique is an impediment to widespread use. Conclusions: Advanced MRI and PET have great promise to change the standard of care for CNS radiotherapy, but clinical trials validating specific applications are needed. Full article

Background/Objectives: Artificial Intelligence (AI) is transforming dentistry by offering advanced solutions to improve diagnostic accuracy, optimize treatment planning, and advance patient care. However, as AI becomes more prevalent in dental practice, patients may have concerns and skepticism about its implementation. Therefore, this study aims to explore the impact of the perceived risks and benefits on patients’ willingness to accept AI in dental treatment. Methods: This cross-sectional study was conducted in two public dental hospitals, and 586 patients were invited to complete a 28-item questionnaire. In total, 511 questionnaires were completed, resulting in a response rate of 87%. Multiple regression analysis was performed to assess the impact of perceived risks and benefits on patients’ willingness to accept AI in dental treatment. Results: All dimensions of perceived benefits had higher mean scores compared to the perceived risks. Additionally, three perceived benefit dimensions had a significant positive influence on the willingness to accept AI: patient-enhanced experience (β = 47.1, p < 0.001), personalized dental care (β = 22.2, p < 0.001), and cost efficiency (β = 15.3, p < 0.001). Conclusions: The perceived risks had little impact on patients’ willingness to accept AI, suggesting patients may be unaware of or unconcerned about AI’s potential risks in dentistry. Future research should investigate these perceptions and other dimensions influencing AI acceptance. Full article

Background: The death of a child due to complex congenital heart disease (CCHD) in pediatric intensive care units profoundly affects families, often resulting in lasting grief and emotional distress. Despite advancements in pediatric palliative care (PPC), significant gaps persist in communication and end-of-life (EoL) planning. This study explores the experiences and perceptions of bereaved parents to identify areas for improvement in PPC delivery. Methods: A qualitative phenomenological design was used to analyze the lived experiences of 18 bereaved parents whose children died from CCHD at a tertiary cardiac center. Semi-structured telephone interviews were conducted, incorporating five open-ended questions. Data were analyzed inductively using Colaizzi’s method to identify recurring themes and subthemes. Results: Four key thematic areas emerged: communication issues, the parental role, child care, and bereavement support. Parents highlighted inconsistent communication, lack of preparedness for EoL decisions, and emotional isolation as major challenges. Positive experiences often involved compassionate healthcare providers and structured psychological support. A significant proportion of parents identified family support and faith as key coping mechanisms, while others expressed dissatisfaction with post-mortem follow-up and the absence of long-term bereavement care. Conclusions: Bereaved parents’ experiences underscore the need for improved communication strategies, greater parental involvement in care, and enhanced bereavement support. Integrating structured decision-making pathways early in the care trajectory may help mitigate parental distress and improve the quality of EoL experiences for children with CCHD. Full article

This paper focuses on the perspectives of passengers who were railway users and how railways as a service can be uplifted with technological advancements through the introduction of information and communication technologies (ICTs). For this purpose, a questionnaire was designed comprised of six sections related to information on socio-economic-demographics, travel, station facilities, train facilities, customer care, and familiarity with and benefits of ICTs. A total of 800 respondents were recruited on trains and in railway stations to collect data through a random sampling technique. Data were analyzed through descriptive statistics, factor analysis, bivariate correlation analysis, and ordered logistic regression analysis. The three hypotheses tested showed that (i) there is a correlation between socio-demographic factors, train frequency, and satisfaction levels, (ii) satisfaction with station and train facilities and customer care impacts users’ travel likelihood with the train service, and (iii) users’ familiarity with perceived benefits of ICTs influences passengers’ travel likelihood with the train service. The results indicate that the users’ satisfaction with attributes of station facilities, train facilities, and customer care and perceptions about ICTs significantly influences their travel frequency with the train service. This study is useful for multiple stakeholders, especially for railway management authorities, to provide inclusive services to passengers and to plan for future transportation, which should be well-equipped with ICTs, well-integrated with other transport modes, and well-connected with optimum stops. Full article

The robotics field of engineering has been witnessing rapid advancements and becoming widely engaged in our lives recently. Its application has pervaded various areas that range from household services to agriculture, industry, military, and health care. The humanoid robots are electro–mechanical devices that are constructed in the semblance of humans and have the ability to sense their environment and take actions accordingly. The control of humanoids is broken down to the following: sensing and perception, path planning, decision making, joint driving, stability and balance. In order to establish and develop control strategies for joint driving, stability and balance, the triple inverted pendulum is used as a benchmark. As the presence of uncertainty is inevitable in this system, the need to develop a robust controller arises. The robustness is often achieved at the expense of performance. Hence, the controller design has to be optimized based on the resultant control system’s performance and the required torque. Particle Swarm Optimization (PSO) is an excellent algorithm in finding global optima, and it can be of great help in automatic tuning of the controller design. This paper presents a hybrid H_∞/sliding mode controller optimized by the PSO algorithm to control the triple inverted pendulum system. The developed control system is tested by applying it to the nominal, perturbed by parameter variation, perturbed by external disturbance, and perturbed by measurement noise system. The average error in all cases is 0.053 deg and the steady controller effort range is from 0.13 to 0.621 N.m with respect to amplitude. The system’s robustness is provided by the hybrid H_∞/sliding mode controller and the system’s performance and efficiency enhancement are provided by optimization. Full article

Aim of the Study: To assess how virtual reality (VR) patient-specific simulations can support decision-making processes and improve care in pediatric urology, ultimately improving patient outcomes. Patients and Methods: Children diagnosed with urological conditions necessitating complex procedures were retrospectively reviewed and enrolled in the study. Patient-specific VR simulations were developed with medical imaging specialists and VR technology experts. Routine CT images were utilized to create a VR environment using advanced software platforms. The accuracy and fidelity of the VR simulations was validated through a multi-step process. This involved comparing the virtual anatomical models to the original medical imaging data and conducting feedback sessions with pediatric urology experts to assess VR simulations’ realism and clinical relevance. Results: A total of six pediatric patients were reviewed. The median age of the participants was 5.5 years (IQR: 3.5–8.5 years), with an equal distribution of males and females across both groups. A minimally invasive laparoscopic approach was performed for adrenal lesions (n = 3), Wilms’ tumor (n = 1), bilateral nephroblastomatosis (n = 1), and abdominal trauma in complex vascular and renal malformation (ptotic and hypoplastic kidney) (n = 1). Key benefits included enhanced visualization of the segmental arteries and the deep vascularization of the kidney and adrenal glands in all cases. The high depth perception and precision in the orientation of the arteries and veins to the parenchyma changed the intraoperative decision-making process in five patients. Preoperative VR patient-specific simulation did not offer accuracy in studying the pelvic and calyceal anatomy. Conclusions: VR patient-specific simulations represent an empowering tool in pediatric urology. By leveraging the immersive capabilities of VR technology, preoperative planning and intraoperative navigation can greatly impact surgical decision-making. As we continue to advance in medical simulation, VR holds promise in educational programs to include even surgical treatment of more complex urogenital malformations. Full article

(1) Background: This observational cohort study describes the frequency, content, and satisfaction with advance care planning (ACP) conversations with healthcare providers (HCPs), as reported by patients with advanced colorectal cancer. (2) Methods: The patients were recruited from two tertiary cancer centers in Alberta, Canada. Using the My Conversations survey with previously validated questions, the patients were asked about specific ACP elements discussed, with which HCPs these elements were discussed, their satisfaction with these conversations, and whether they had a goals of care designation (GCD) order. We surveyed and analyzed data from the following four time points: enrollment, months 1, 2, and 3. (3) Results: In total, 131 patients were recruited. At enrollment, 24% of patients reported discussing at least one ACP topic. From enrollment to month 3, patients reported a high frequency of discussions (80.2% discussed fears, 71.0% discussed prognosis, 54.2% discussed treatment preferences at least once); however, only 44.3% of patients reported discussing what is important to them in considering health care preferences. Patients reported having ACP conversations most often with their oncologists (84.7%) and cancer clinic nurses (61.8%). Patients reported a high level of satisfaction with their ACP conversations, with over 80% of patients reported feeling heard and understood. From enrollment to month 3, there was an increase in the number of patients with a GCD order from 53% to 74%. (4) Conclusions: Patients reported more frequent conversations compared to the literature and clinical documentation. While the satisfaction with these conversations is high, there is room for quality improvement, particularly in eliciting patients’ personal goals for their treatment. Full article

This paper reviews the robotic manipulation of deformable objects in caregiving scenarios. Deformable objects like clothing, food, and medical supplies are ubiquitous in care tasks, yet pose modeling, control, and sensing challenges. This paper categorises caregiving deformable objects and analyses their distinct properties influencing manipulation. Key sections examine progress in simulation, perception, planning, control, and system designs for deformable object manipulation, along with end-to-end deep learning’s potential. Hybrid analytical data-driven modeling shows promise. While laboratory successes have been achieved, real-world caregiving applications lag behind. Enhancing safety, speed, generalisation, and human compatibility is crucial for adoption. The review synthesises critical technologies, capabilities, and limitations, while also pointing to open challenges in deformable object manipulation for robotic caregiving. It provides a comprehensive reference for researchers tackling this socially valuable domain. In conclusion, multi-disciplinary innovations combining analytical and data-driven methods are needed to advance real-world robot performance and safety in deformable object manipulation for patient care. Full article

(1) Background: Advance directives are an expression of a person’s autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalised is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population’s perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: “advance care directives”, “advance care planning”, “perceptions”, “attitudes”, and “knowledge”. Two hundred and twenty-four (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures. Full article

Objective: Despite concerted and directed efforts to increase organ donation, the gap between the need for organs for transplantation and the lack of donors has been increasing globally. Studies have shown that donor rates in countries in the Middle East, such as Saudi Arabia, are particularly low despite a relatively advanced healthcare system and supportive government policies. There are multiple psychosocial, cultural, religious, and structural factors, that influence the increase in the organ donation rate, and some of them may be unique to a country such as Saudi Arabia. The theory of planned behaviour (TPB) is an important theory utilised to study how various types of attitudes, beliefs, and norms, influence organ donation intention and practice. In this study, we aimed to explore the normative, behavioural, and control beliefs, among residents of Saudi Arabia. Methods: The current study was a cross-sectional online survey performed from 6 June 2021 to 31 December 2021, using a questionnaire prepared in GoogleTM form among the residents of Saudi Arabia. The questionnaire asked demographic factors and questions to explore the normative, behavioural, and control beliefs, regarding organ donation. Results: This study received 1245 valid responses. Among the study participants, only 19.6% were willing to register as an Organ/Tissue donors. The intention for organ donation showed a statistically significant positive association with beliefs that organ donation is a good thing (123.51, df 4, p < 0.001), could save somebody’s life (81.38, df 4, p < 0.001), could have a positive impact on life after death (114, df 4, p < 0.001), and provision of better social support to family (of the deceased) can increase organ donation (68.43, df 4, p < 0.001). Those who expressed normative beliefs that their intention to donate organs strongly depend upon their family’s lack of objection to allowing the donation of organs at the time of death (190.76, df 4, p < 0.001), their knowledge about the organ transplantation process (179.35, df 4, p < 0.001), their knowledge about the viewpoint of their religion regarding organ donation (120.345, df 4, p < 0.001), and their knowledge about the registration facilities (241.64, df 4, p < 0.001), were more willing for donating their organs. Perception of worry about the likelihood of getting lesser care from doctors in an emergency if registered as an organ donor (OR = 4.25, 95% CI 1.57–11.51), beliefs that provision of better social support to family (of the deceased) can increase organ donation (OR = 10.49, 95% CI 1.56–70.43), and concern for the emotions of their family members while organ are being taken (OR = 4.37, CI 1.57–12.23), were the strongest predictors influencing a definite intention for organ donation. Conclusion: This study found that most of the components under normative and behavioural beliefs showed positive correlation with a definite intention for organ donation, whereas most of the components under control beliefs showed negative correlation with a definite intention for organ donation, among Saudi population. Based on the study results, there is a need to promote awareness regarding the organ donation process, especially the religious permissibility of organ donation, among general public in order to promote organ donation. Full article

The objective of this systematic review is to present older individuals’ views on the advance care planning (ACP) process and the factors affecting those opinions. The review contains search terms predetermined in the databases of CINAHL, MEDLINE (via PubMed), Academic Search Ultimate, Web of Science, Master FILE, and TR Dizin over the last 10 years (1 January 2012–31 December 2021) in English and Turkish. The studies were included in the research using inclusion (sample age ≥ 50, focusing on individuals’ opinions on ACP) and exclusion (articles whose samples consisted of individuals with a specific disease, non-research articles) criteria. Quality assessment was conducted using the Mixed Methods Appraisal Tool. A narrative synthesis was used to collate findings. The most striking results are the positive perspectives increasing in parallel with the individuals’ level of knowledge and experience about ACP. Variables affecting their views are advanced age, marital status, socioeconomic status, perception of remaining life expectancy, self-perceived health, number and stage of chronic diseases, religion, and cultural characteristics. This study offers guidance on the application and dissemination of ACP, empowering the use of this practice given the perspectives of older adults on ACP and the factors that affect them that the data show. Full article

The aging trend in the population, the high rate of hospitalization, the affliction by multiple chronic illnesses, and the increased vulnerability of older people when hospitalized undoubtedly require a person-centered approach to healthcare—an approach that values a person’s participation in the healthcare relationship, supports shared decision making and mutual understanding, and respects a person’s values, preferences, and beliefs. However, despite widespread recognition that the adoption of such a clinical practice paradigm is paramount, its implementation and development are still challenging for various health systems and professionals worldwide. The implementation strategy for such a healthcare paradigm must be based on each country’s health system organization and practice contexts, as well as the professionals involved. The present work aims to provide guidelines for the understanding of the state of development of person-centered practice in the daily care of hospitalized older adults with chronic illnesses within the internal medicine department of a secondary hospital in an urban area of Portugal. We focus on the characterization of (i) the perceptions of a multidisciplinary team working at an inpatient hospital department of person-centered practice, (ii) the perceptions of hospitalized older adults with chronic illnesses about person-centered practice, (iii) the work culture of an inpatient hospital department with a high prevalence of older adults with chronic illnesses, (iv) the Person-Centred Practice Framework at the organizational and structural levels of the healthcare system, and (v) the elements that influence the implementation of person-centered practice at the individual, organizational, and structural levels in this specific hospital context. To this end, a mixed-methods analysis with a convergent design was planned to use questionnaire instruments to collect data in parallel and independently from distinct samples of health professionals and older inpatient adults within this department. Furthermore, health policies and strategic plans will be analyzed to identify and evaluate references and guidelines for the practice of person-centered care. Studying the dimensions of clinical practice in this specific healthcare context following the Person-Centred Practice Framework can allow us to understand the extent of its development in terms of prerequisites, care environment, care processes, and the macro-context of the healthcare system. Therefore, it is possible to identify and characterize the dimensions achieved and those that need to be improved and, thus, establish a starting point for the definition of new strategies to advance practice towards person-centeredness and monitor changes in healthcare practice. Full article

The coronavirus disease 2019 pandemic created a major shift in learning modalities in the Advanced Pharmacy Practice Experience program. This descriptive study aimed to evaluate preceptor and student perceptions of remote learning experiences and student practice readiness upon completion of remote rotations. Preceptors and students who participated in partial to full remote experiential rotations between 17 August 2020 and 26 March 2021 were invited to complete an on-line survey. A cross-sectional survey consisted of closed-ended questions using a 5-point Likert scale assessing perception on adaptability, effectiveness of remote learning in advancing practice knowledge and skills, and confidence in students’ practice readiness. A total of 29 preceptors and 43 students completed the survey (response rates of 67% and 57%, respectively). Approximately 70% of the remote rotations were practice-based, with ambulatory care representing the most frequently reported rotation by preceptors (38%) and students (28%). A high level of confidence in preceptor perception of their ability to adapt and provide effective remote experiences (average 4.28) matched with the students’ high level of confidence with their preceptors’ abilities (86% agree or strongly agree). Upon the completion of remote rotations, both preceptors and students felt confident in student practice readiness based on student ability to design and initiate individualized patient care plans or complete projects using evidence-based resources (79% and 86%, respectively). Most preceptors (69%) reported that students achieved the rotation objectives at the same level as students engaged in-person experiences. The limitations of remote learning included the absence of direct interactions. Overall, both preceptors and students reported achieving practice readiness with remote experiential learning experiences and felt the remote activities should be continued post-pandemic. Full article

Studies related to the competencies of clinical nurse leaders as an advanced practice demonstrate that they are an asset to health organizations. However, it is pertinent to use an instrument to measure the self-efficacy of clinical nurse leaders in Portugal to facilitate managers’ decision-making. In this study, we aimed to translate, adapt, and validate the Clinical Nurse Leader Self-Efficacy Scale for the Portuguese cultural context. This is a quantitative, observational, and descriptive cross-sectional study. The sample of this study was non-probabilistic and intentional, consisting of 329 nurses responsible for shift and specialist nurses. The translation and validation process followed the internationally recognized guidelines on the psychometric properties of measurement instruments. The factor analysis explained 62.1% of the variance and had a seven-dimensional structure. The seven factors were: Patient-Centred Care; Unit Management; Clinical Leadership; Strategic Leadership; Team Management; Cost Reduction; and Care Planning. The confirmatory analysis showed that the seven-factor model achieved a suitable adjustment in the Portuguese context. The self-efficacy scale for clinical nurse leaders can be considered a valid and reliable instrument for application in Portugal in any care context. This scale allows the assessment of the nurse’s perception of their ability to intervene effectively as a clinical leader in their care team. Full article