Search Results (795)

Background/Objectives: National guidelines include recommendations for cardiovascular disease (CVD) prevention, but gaps in prevention still exist. Clinical decision support (CDS) tools may be an avenue for delivering preventive care. The goal of this project was to understand how clinicians approach primary prevention of CVD and to determine barriers and facilitators in delivery of primary preventive care with and beyond a CDS tool. Methods: A user-centered design approach including a cross-sectional survey and qualitative interviews was deployed in a health system in Central and Northern California. Clinician responses to the survey in addition to clinician interviews about perspectives on CVD were analyzed. Results: A total of 62 primary care physicians, advanced practice clinicians, and nurse practitioners completed surveys, and 7 primary care clinicians participated in interviews. Primary care clinicians generally agree that preventive care would be more efficient with team-based care. Physician-centered care and CVD preventive care were constricted by limited time, the highly varied nature of primary care, and a lack of standardized and personalized CDS tools. Once patients at risk of CVD are identified, there is also a lack of clarity around resources available to support downstream care for patients. Conclusions: The results highlight the challenges in providing CVD prevention for primary care clinicians. A team-based approach, supported by digital CDS tools, can be more effective for ensuring the necessary CVD prevention communication and coordination takes place. Full article

Background/Objectives: Motivational interviewing (MI) is an established approach to addressing vaccine hesitancy, yet immediate changes following dedicated training for family physicians remain insufficiently documented in Romania. This study evaluated pre–post changes in physicians’ MI knowledge, self-reported communication behaviour, and self-perceived ability to counsel patients about vaccination, together with patient-level change following consultations delivered by trained physicians. Methods: This uncontrolled pre–post study used a voluntary, self-selected non-probability sample of 28 family physicians recruited through announcements distributed via county family medicine associations; participants completed paired assessments immediately before and after structured MI-based training. The three main physician-level outcomes were MI knowledge (MISI), corrected self-reported MI communication behaviour (MIBI), and self-perceived MI ability (SPMI). The linked component comprised 151 patients nested within 15 physicians. Patient changes were averaged within physician, and the physician-level mean patient composite change was used as the principal outcome of this component. Paired physician changes and physician-aggregated patient change were assessed using Wilcoxon tests, rank-biserial effect sizes, and bootstrap 95% confidence intervals (CIs), with Holm adjustment across the three physician outcomes. Results: Mean MISI increased by 39.80 percentage points (95% CI: 29.59–50.51), though the limited internal consistency of this seven-item composite requires item-level interpretation, and corrected MIBI by 0.44 points (95% CI: 0.20–0.68; r_rb = 0.75) and SPMI by 1.22 points (95% CI: 0.89–1.61; r_rb = 0.99); all Holm-adjusted p-values were <0.001. Across the 15 linked physicians, the mean patient composite change was 0.55 points (95% CI: 0.38–0.75; r_rb = 1.00; p < 0.001). No consistent association was observed between physician-level competency changes and mean patient change. Conclusions: Immediate post-training physician scores and post-consultation patient composite scores were higher. Controlled studies incorporating observed consultations and follow-up are required before causal or sustained effects can be inferred. Full article

Background/Objectives: Early residency is not only about building clinical knowledge. It also involves learning how to communicate, collaborate, and regulate one’s behavior throughout real-world pressure—skills that shape teamwork and everyday patient encounters. Describing the behavioral profiles of early-career physicians can therefore be useful for mapping strengths and developmental needs in training. Methods: A cross-sectional exploratory study was conducted between May and June 2023 among 83 medical residents from a major Romanian training centre. Participants completed the Harrison Assessment, which yields trait-level scores relevant to workplace functioning. Individual traits were summarized, and complementary characteristics were examined as trait pairs, using a balance/imbalance classification to describe configuration-level profiles. Results: Across five of the six trait pairs, non-balanced configurations represented 60.24–65.06% of the cohort; Delegation showed a larger balanced group (55.42%). These distributions describe heterogeneity within the participating cohort at one time point and do not establish developmental sequence, competence, or clinical consequence. Conclusions: Configuration-level profiling may offer a descriptive way to examine how complementary behavioral tendencies co-occur. Replication, population-specific psychometric evaluation, longitudinal follow-up, and validation against external outcomes are required before educational or clinical utility can be inferred. Full article

Background/Objectives: Artificial intelligence (AI) is rapidly transitioning from a theoretical concept to an active clinical tool in dentistry and medicine. These are fields in which the current market-driven shift towards automation is observed. The aim of this study was to describe the possible applications of artificial intelligence particularly in oral surgery and maxillofacial surgery, fields that are deeply rooted in manual work with patients. Methods: A review of current literature was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Keywords like: “oral surgery”, “maxillofacial surgery”, “implantology”, “dentistry”, “artificial intelligence”, and “orthognathic surgery” and their combinations were applied. Non-English articles were excluded. Results: Based on the literature, current applications of artificial intelligence in oral surgery and maxillofacial surgery are presented. Results indicate high efficacy of convolutional neural networks (CNNs) in radiographic triage and large language models (LLMs) in postoperative patient communication. Conclusions: Artificial intelligence is a useful tool that can significantly improve the work of physicians. However, it should not be considered a “replacement” for physicians, especially in fields requiring manual work. It can provide important guidance for patients and be a form of support for physicians. Full article

Background: Community-acquired respiratory viruses (CARVs) cause significant morbidity and mortality in patients with haematological malignancies and those undergoing haematopoietic cell transplantation (HCT). Despite this, clinical management remains variable. This study evaluated clinicians’ awareness, diagnostic practices, and treatment approaches to major respiratory viruses in this high-risk population. Methods: An international electronic survey using non-probability convenience sampling was conducted among haematology, oncology, intensive care and emergency medicine physicians. Four real-life clinical cases were converted into standardised vignettes covering human metapneumovirus (HMPV), respiratory syncytial virus (RSV), human parainfluenza virus (HPIV) and influenza A virus (IAV). The questionnaire assessed reported testing strategies and intended management, including antiviral and immunoprophylactic interventions. Responses were analysed descriptively; no inferential between-group comparisons were performed. Results: Ninety-eight clinicians from 26 countries responded. Diagnostic approaches, including testing indications and panel selection, varied among respondents. For HMPV and HPIV, respondents mainly reported supportive care, immunoglobulin replacement, and infection-control measures in the absence of established pathogen-specific interventions. RSV practice was heterogeneous: systemic ribavirin was considered by 45/96 (46.9%) respondents, including 34/96 (35.4%) when guided by an immunodeficiency score. IAV management was more consistent, with reported availability of vaccination and antiviral therapy and frequent use of post-exposure prophylaxis. Conclusions: Within this international convenience sample, clinicians reported variation in respiratory viral testing and in how results informed intended management. Because sampling was non-probability-based and respondent groups were small and unevenly distributed, the findings should not be interpreted as representative estimates of international practice. IAV testing was most consistently linked to established treatment and prevention, RSV showed greater therapeutic and preventive heterogeneity, and HMPV/HPIV testing primarily informed infection control, monitoring and antimicrobial stewardship. Full article

Background: Borderline ovarian tumors (BOTs) represent a distinct group of rare epithelial ovarian neoplasms with excellent prognosis, but persistent uncertainty in patient understanding and clinical management. This study evaluated disease awareness, perceptions, and treatment patterns among affected women in Germany. Methods: The national multicenter Expression VIII survey was conducted across 34 centers by the North-Eastern German Society of Gynecologic Oncology (NOGGO). Using a standardized 46-item questionnaire, 286 patients with BOTs provided data on symptoms, treatment, fertility, follow-up, and illness perception. Descriptive analyses were performed. Results: Most participants (mean age 51 years) underwent surgery (94%), while systemic therapy was infrequent (chemotherapy 9%, bevacizumab 4%). Fertility-sparing surgery was performed in 14% overall, corresponding to 71% of those desiring future childbearing. Although 81% identified their physician as their main information source and rated information quality highly (mean 8.6/10), 29% believed they had ovarian cancer and 64% were unaware of their tumor stage. Nearly all patients (97%) received regular follow-up, though 18% were uncertain about the procedures performed. Disease severity was rated moderately high (mean 5.4/10), and recurrence risk and mortality were often overestimated. Conclusions: Despite good overall physician communication, substantial misconceptions persist among patients with BOTs, including the mistaken belief that they have been diagnosed with cancer, suggesting a need for clearer, structured education about its favorable prognosis and management of the disease. Improved guideline adherence and treatment centralization in specialized centers may reduce overtreatment and optimize fertility-preserving approaches. Full article

Background/Objectives: Primary healthcare in Hungary faces acute physician shortages; in the Heves district, eight general practices are permanently vacant, leaving 11,191 residents without continuous care. In September 2025, the Hungarian Charity Service of the Order of Malta launched the Heves Haziorvosi Pilot (HHP), combining on-site nurse triage with remote telemedicine consultations. This study qualitatively evaluated its implementation and early operation. Methods: Three focus group discussions were held in two rounds, before and after implementation, with all 19 professionals delivering the programme (10 practice nurses, 4 general practitioners, 5 degreed professionals). Verbatim Hungarian transcripts were analysed in NVivo 15 (Lumivero, Denver, CO, USA) using the thematic analysis framework of Braun and Clarke with hybrid deductive-inductive coding by three independent researchers until full consensus. Results: Daily physician availability rose from approximately 2 to 8 h, and one remote physician concurrently supported four practices. Participants reported reduced professional isolation among nurses, longer and more focused consultations, and perceived, though unquantified, decreases in non-urgent ambulance use. Implementation was constrained by duplicate paper and digital documentation, patients’ limited familiarity with triage, and unresolved software interoperability and IT ergonomic problems. Conclusions: The hybrid model was perceived as operationally feasible; national scaling would require nursing curriculum reform, administrative simplification, interoperable medical software, and community health literacy programmes. Full article

Background: Statins are among the most frequently prescribed medications worldwide, with proven benefits in reducing all-cause and cardiovascular mortality, preventing major adverse cardiovascular events (MACEs), and lowering healthcare costs. Despite their well-established safety and effectiveness, discontinuation of statin therapy remains a common problem in both primary and secondary prevention. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines and registered in the PROSPERO database (CRD420261295172). Original studies published since 1 January 2014 were identified through searches of PubMed (MEDLINE) and Google Scholar using predefined keywords. Methodological quality and risk of bias of the included observational studies were evaluated using the Newcastle-–Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) Critical Appraisal Tools. Results: Synthesized data from 29 included studies indicate that up to half of patients discontinue statin therapy within the first year (discontinuation rates ranging from 27.1% to 47.0% in primary prevention and 18.5% to 32.4% in secondary prevention), with rates increasing over time. Major factors contributing to non-adherence include fear of side effects, particularly statin-associated muscle symptoms (SAMSs), misinformation, limited patient–physician communication, socioeconomic barriers, and polypharmacy. Discontinuation is associated with significantly higher all-cause and cardiovascular mortality (Hazard Ratios ranging from 1.30 to 4.65), higher rates of cardiovascular and cerebrovascular events, worsening metabolic outcomes, reduced quality of life, and greater healthcare expenditures. Conclusions: Improving adherence requires better patient education, addressing misconceptions, strengthening patient–physician relationships, and optimising treatment regimens. A multidisciplinary approach is needed to prevent unjustified discontinuation and improve long-term clinical outcomes. Full article

Background: Healthy lifestyle guidance is an important component of outpatient preventive care, yet evidence is limited on whether outpatients receive satisfactory guidance across multiple lifestyle domains. This study examined receipt of satisfactory healthy lifestyle guidance and its associated factors among outpatients in China. Methods: This national multicenter cross-sectional study used data from the outpatient component of the fifth National Third-Party Evaluation of the Action Plan for Further Improving Healthcare Services. A total of 31,599 outpatients from 143 tertiary public hospitals across all 31 provincial-level administrative regions of mainland China were included. The primary outcome was receipt of satisfactory healthy lifestyle guidance, defined as receiving at least one type of guidance and reporting satisfaction or high satisfaction. Mixed-effects logistic regression models with hospital-level random intercepts were used to identify associated factors. Results: Dietary guidance was the most frequently reported domain, followed by physical activity, weight management, and smoking cessation and alcohol reduction guidance. Overall, most outpatients were classified as having received satisfactory healthy lifestyle guidance. In the fully adjusted model, male sex and hypertension were associated with higher odds of satisfactory guidance, whereas a greater number of chronic conditions and unclear physician type were associated with lower odds. Satisfaction with history taking and disease communication and perceived respect and comfort from healthcare professionals were strongly associated with satisfactory healthy lifestyle guidance. However, these contemporaneously measured patient-reported indicators may reflect overlapping dimensions of patients’ overall outpatient care experience. Sensitivity analyses yielded broadly consistent findings. Conclusions: Satisfactory healthy lifestyle guidance was common among outpatients in China’s tertiary public hospitals, but guidance was unevenly distributed across lifestyle domains. Patients’ evaluations of satisfactory healthy lifestyle guidance were closely associated with their broader communication and interpersonal care experiences. However, because these measures were self-reported and assessed contemporaneously, the observed associations should not be interpreted causally. Full article

Background: Current evidence on diabetes care interventions is either fragmented or focused on specific interventions targeting healthcare professionals or patients. This study aims to categorize diabetes care interventions involving physicians or nurses and their impact on health outcomes for individuals with diabetes. Additionally, it aimed to determine the proportion of favorable findings across healthcare intervention categories. Methods: This scoping review was conducted in primary care settings and guided by a health system framework. We searched articles from inception to June 2022 in databases including CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. The classification of healthcare interventions was guided by the Cochrane Effective Practice and Organization of Care taxonomy and health system framework. Results: Results were reported following the PRISMA Extension for Scoping Reviews. From the initial pool of 13,406 articles, 116 met the eligibility criteria and reported interventions conducted across 119 countries or regions, of which 94 were high-level economies. Five healthcare intervention categories were identified: transforming the workforce; service content; re-designing the service delivery system; information and communication technology; and multifaceted. Patient health outcomes were classified into 3 overarching categories with 11 subcategories: clinical outcomes, behavioral outcomes, and psychosocial outcomes. The proportion of statistically significant favorable findings differed across intervention categories and outcome domains. Multifaceted interventions showed relatively higher proportions of favorable findings for clinical outcomes, whereas re-designing the service delivery system interventions showed relatively higher proportions for behavioral outcomes. ICT interventions frequently reported favorable findings related to blood glucose indicators. Conclusions: This study provides a comprehensive overview of healthcare interventions and health outcomes for diabetes in primary care settings. It emphasizes the importance of tailored interventions, delivery methods, and technology integration for effective diabetes management, advocating for a comprehensive approach from individual to societal levels. Full article

Background/Objectives: Patient-centered antimicrobial stewardship depends not only on restricting non-prescription antibiotic access, but also on how people interpret professional advice when an antibiotic request is declined. This study explored how adults in Jordan interpreted antibiotic refusal and distinguished personally reported experiences from anticipated vignette responses and perceptions of other people’s behavior. Methods: Semi-structured interviews were conducted between November 2025 and March 2026 with 32 adults purposively recruited for variation in age, gender, region, education, caregiving status, healthcare access, and antibiotic-use experience. Thirteen participants reported a previous refusal encounter—seven involving a pharmacist and six involving a physician—whereas 19 discussed refusal primarily through vignettes. Data were analyzed using an experiential, contextualist form of reflexive thematic analysis. Results: Three themes were developed: (1) antibiotics as active and responsible care under uncertainty; (2) refusal as a negotiation of credibility and care; and (3) continued antibiotic seeking after refusal as a set of reported, anticipated, or socially attributed possibilities. Antibiotics could symbolize strength, rapid recovery, and responsible caregiving. Refusal was more readily interpreted as care when participants described or anticipated acknowledgement, a reasoned explanation, symptom-relief options, and safety-netting. Responses after refusal included acceptance and monitoring, uncertainty or clinical reassessment, and continued antibiotic seeking, but these were not equivalent forms of evidence. Conclusions: Antibiotic refusal is a trust-sensitive and context-dependent patient–provider interaction rather than a uniform behavioral pathway. The findings identify communication and access conditions that merit prospective evaluation; they do not establish that communication causes acceptance or that vignette intentions predict behavior. Full article

Objective: Patient safety culture (PSC) is a critical determinant of healthcare quality. This study aimed to assess the current status of PSC among healthcare workers at Kien An Hospital, Hai Phong, Vietnam, and identify associated factors. Methods: A cross-sectional survey was conducted using the 12-dimension hospital survey on patient safety culture (HSOPSC). A total of 324 healthcare professionals (physicians, nurses, and allied staff) participated. Data were analyzed using descriptive statistics and multivariable logistic regression. Results: The positive response rate (PRR) across the 12 dimensions of patient safety culture (PSC) varied widely. The highest positive perceptions were observed in “Teamwork within units” (98.5%) and “Teamwork across units” (98.1%). Conversely, severe vulnerabilities in psychological safety were identified, with “Communication Openness” recording the absolute lowest PRR at 25.9%, closely followed by “Non-punitive response to error” at 29.0%. Comparative analysis between professional strata revealed broad alignment across 11 dimensions, with the sole significant divergence occurring in “Feedback and communication about error”, where physicians reported a significantly higher PRR than nurses & allied staff (85.8% vs. 75.2%; p = 0.04). In the multivariable logistic regression model, age emerged as the single independent predictor of overall positive PSC; compared to early-career staff (<30 years), healthcare workers aged 30–40 years (AOR = 4.17, p = 0.02) and 40–50 years (AOR = 5.03, p = 0.02) had significantly higher odds of favorable safety perceptions. Conclusions: Healthcare workers at the study hospital exhibit exceptionally strong collaborative teamwork, yet low communication openness and the fear of a punitive environment remain critical systemic barriers to safety. Because safety culture challenges are macro-institutional and disproportionately impact junior personnel, interventions should shift away from role-specific policies. Instead, hospital leadership must prioritize establishing non-punitive reporting mechanisms, enhancing open dialogue, and designing targeted safety culture onboarding initiatives tailored specifically to the needs of early-career healthcare workers to foster continuous organizational learning. Full article

Introduction: Improving adult pneumococcal vaccination is a public-health priority in Romania, and evidence regarding patient-level outcomes following different approaches to physician training remains limited. Materials and methods: This non-randomised, multicentre, quasi-experimental implementation study examined patient-level changes across three geographically distinct Romanian settings between August and November 2025. Physicians in Iași and Dolj counties received in-person training combining medical content with communication techniques based on motivational interviewing, whereas physicians in the webinar group received online medical training without a dedicated communication module. Eligible adult patients completed questionnaires before and after counselling and reported whether they had been vaccinated or had scheduled a vaccination appointment. Results: The analysis included 295 questionnaire pairs from patients nested within 29 physicians. Baseline attitudes differed markedly across settings (composite score of 5.64 in the webinar group, 5.29 in Dolj County, and 4.09 in Iași County; p < 0.001), as did strong baseline vaccination intention (75.6%, 48.1%, and 27.2%, respectively). Using a composite score comprising all seven attitude items, with item 7 reverse-coded and vaccination intention analysed separately, the cluster-robust group-by-time model indicated different mean changes between settings (global p = 0.001): +0.28 in the webinar group, +1.02 in Iași, and +0.60 in Dolj. Strong vaccination intention increased within each setting, but the magnitude of change did not differ between settings (group-by-time p = 0.929). The combined self-reported vaccination-or-scheduling outcome was observed in 81.5% of patients in the webinar group, 49.4% in Iași, and 73.3% in Dolj; after adjustment for baseline intention, there was no longer evidence of an overall group difference (p = 0.651). Discussion and conclusions: Because training approach, delivery modality, geographical setting, physician cohort, and patient population were not independently allocated, and because baseline levels differed markedly between settings, the findings should be interpreted as exploratory implementation patterns rather than causal comparative effects. Full article

Background/Objectives: Pelvic floor dysfunctions (PFDs) are highly prevalent chronic conditions associated with substantial functional and psychosocial burden. Although multidisciplinary pelvic floor rehabilitation is recommended as first-line management, its effectiveness depends not only on intervention efficacy but also on care delivery, communication, patient engagement, and long-term adherence. This study applied the Delphi-Dialogue Patients–Professionals (DDPP) framework to quantify patient–professional alignment and translate identified patient–professional perceptual differences into candidate service-improvement strategies. Methods: A two-phase observational study incorporating parallel stakeholder surveys and a modified Real-Time Delphi feasibility-assessment process was conducted under the auspices of the Spanish Society of Physical Medicine and Rehabilitation (SERMEF). In Phase 1, parallel online questionnaires were completed by 225 patients with PFD and 164 rehabilitation professionals. Shared items were rated on a six-point Likert scale, and patient–professional divergence was quantified using an operational composite index integrating standardized differences in mean ratings and high-agreement responses. In Phase 2, the implementation feasibility of 10 improvement recommendations was evaluated by a Delphi panel comprising 35 PM&R physicians and two representatives of the Spanish Incontinence Association (ASIA). Results: Patient–professional agreement was domain-specific. The greatest divergences concerned digital competence, timing of patient education, bladder and bowel diary use, and adherence to prescribed rehabilitation programmes. Professionals attributed greater value to bladder and bowel diaries and selected group-based interventions, whereas patients reported higher digital competence, more timely information delivery, and better adherence. Comparatively similar response patterns were observed regarding hybrid rehabilitation models, educational resources, app-supported follow-up, and overall satisfaction with rehabilitation care. The Delphi process identified structured home exercise programmes, adherence-monitoring strategies, and improved visibility of rehabilitation pathways as the recommendations with the highest perceived implementation feasibility. Conclusions: The findings suggest that important challenges in pelvic floor rehabilitation may arise from implementation-related factors in addition to the effectiveness of available interventions. The DDPP framework provides a structured, stakeholder-informed methodology for translating patient–professional divergence into candidate organizational recommendations with comparatively higher perceived implementation feasibility. Full article

Background: Deprescribing is a supervised, patient-centred process for reducing or stopping medicines when their burden, harm, or lack of continuing indication outweighs expected benefits. This study assessed attitudes toward deprescribing, examined the exploratory psychometric performance of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire, and identified factors associated with stated willingness to deprescribe among adults using prescribed medicines in western Saudi Arabia. Methods: An analytical cross-sectional survey was conducted from 15 February to 30 April 2025 in six community pharmacies and three outpatient clinics in Taif, Makkah, and Jeddah. Adults taking at least one prescribed medicine completed a paper-based Arabic rPATD questionnaire. Internal consistency, exploratory factor analysis, Spearman correlations, Mann–Whitney U tests, ordinal logistic regression, and a fully adjusted binary logistic regression sensitivity analysis were used. Results: Of 362 adults assessed, 320 were included in the final analysis. Overall, 254/320 (79.4%) agreed or strongly agreed that they would stop one or more medicines if their physician recommended it. Cronbach’s alpha ranged from 0.77 to 0.84, and McDonald’s omega ranged from 0.79 to 0.85. The four-factor exploration solution explained 61.4% of the variance. Greater involvement (adjusted odds ratio [aOR] 2.84, 95% confidence interval [CI] 1.98–4.06) and greater perceived medication inappropriateness (aOR 2.31, 95% CI 1.67–3.20) were associated with higher willingness, whereas concerns about stopping were associated with lower willingness (aOR 0.54, 95% CI 0.39–0.75). Medication burden was correlated with willingness but was not independently associated after adjustment (aOR 1.28, 95% CI 0.94–1.75; p = 0.112). Conclusions: Participants reported generally favourable stated willingness to deprescribe when advised by a physician. Involvement, perceived medication inappropriateness, and concerns about stopping were independently associated with willingness. These cross-sectional findings concern intention rather than actual deprescribing behaviour or clinical outcomes. Full article