Search Results (370)

Background: Hospitalized patients’ expectations about their treatment play a key role in therapeutic adherence, satisfaction with care, and clinical outcomes. However, there is a lack of brief, psychometrically validated instruments in Spanish-speaking contexts that adequately assess this construct. Objective: The objective of this study is to culturally adapt and validate the Hospitalized Patients’ Expectations for Treatment Scale-Patient Version (HOPE-P) in a Peruvian population. Methods: A methodological, cross-sectional study was conducted with 277 hospitalized patients aged 18 to 85 years (M = 45.87; SD = 17.09). The adaptation process included translation, back-translation, expert review, and pilot testing. Confirmatory factor analysis (CFA) was performed to assess the factor structure, and reliability and validity indices were calculated. Results: The bifactorial model showed good fit (CFI = 0.97, TLI = 0.94, RMSEA = 0.06). One item with a low factor loading was removed to improve the model. Convergent and discriminant validity were confirmed through acceptable values of Average Variance Extracted (0.60 and 0.55) and inter-factor correlation (φ² = 0.23). Internal consistency was strong for both dimensions (α = 0.76–0.77; ω = 0.76–0.77). Conclusions: The Spanish version of the HOPE-P is a valid, reliable, and culturally appropriate instrument for evaluating treatment expectations in hospitalized Peruvian patients. Its implementation in clinical settings could enhance physician–patient communication, support shared decision-making, and contribute to better therapeutic outcomes, especially in high-demand healthcare environments. Full article

Objectives: This study aimed to assess the knowledge, attitudes, and self-confidence of physicians and dentists in Croatia regarding the relationship between oral and systemic health, focusing on periodontal disease and oral manifestations of systemic diseases. Methods: A cross-sectional, web-based survey was conducted among physicians and dentists in Croatian primary healthcare. The questionnaire addressed six thematic domains, including demographic information, knowledge, self-assessment, and clinical practice. Descriptive and comparative statistical analyses were performed. Results: A total of 529 respondents were included (291 physicians and 238 dentists). The mean knowledge score for the association between periodontitis and systemic diseases was 6.8 ± 3.6 out of 15, indicating limited knowledge. For oral manifestations of systemic diseases, the mean score was 10.0 ± 3.8 out of 16, reflecting moderate proficiency. Dentists scored higher than physicians in both domains, though not significantly (p > 0.05). Routine oral mucosal examinations were reported by 89.5% of dentists and 43.0% of physicians (p ≤ 0.001). Only 21.3% of physicians correctly identified the link between periodontitis and adverse pregnancy outcomes, compared to 58.8% of dentists. The primary barriers to effective clinical management were a lack of experience (52.7%) and inadequate education. While 68.3% of dentists felt adequately educated on oral–systemic links, only 22.7% of physicians reported the same. Conclusions: Significant gaps in knowledge and confidence were observed, particularly among physicians. These findings underscore the need to integrate oral–systemic health topics into medical education and to promote interprofessional collaboration to improve patient outcomes. Full article

Large, high-quality patient datasets are essential for applications like economic modeling and patient simulation. However, real-world data is often inaccessible or incomplete. Synthetic patient data offers an alternative, and current methods often fail to preserve clinical plausibility, real-world correlations, and logical consistency. This study presents a patient cohort generator designed to produce realistic, statistically valid synthetic datasets. The generator uses predefined probability distributions and Cholesky decomposition to reflect real-world correlations. A dependency matrix handles variable relationships in the right order. Hard limits block unrealistic values, and binary variables are set using percentiles to match expected rates. Validation used two datasets, NHANES (2021–2023) and the Framingham Heart Study, evaluating cohort diversity (general, cardiac, low-dimensional), data sparsity (five correlation scenarios), and model performance (MSE, RMSE, R², SSE, correlation plots). Results demonstrated strong alignment with real-world data in central tendency, dispersion, and correlation structures. Scenario A (empirical correlations) performed best (R² = 86.8–99.6%, lowest SSE and MAE). Scenario B (physician-estimated correlations) also performed well, especially in a low-dimensions population (R² = 80.7%). Scenario E (no correlation) performed worst. Overall, the proposed model provides a scalable, customizable solution for generating synthetic patient cohorts, supporting reliable simulations and research when real-world data is limited. While deep learning approaches have been proposed for this task, they require access to large-scale real datasets and offer limited control over statistical dependencies or clinical logic. Our approach addresses this gap. Full article

Background: Artificial intelligence (AI) is being increasingly promoted as a means to enhance diagnostic accuracy, to streamline workflows, and to improve overall care quality in primary care. However, empirical evidence on how primary care physicians (PCPs) perceive, engage with, and emotionally respond to AI technologies in everyday clinical settings remains limited. Concerns persist regarding AI’s usability, transparency, and potential impact on professional identity, workload, and the physician–patient relationship. Methods: This qualitative study investigated the lived experiences and perceptions of 28 PCPs practicing in diverse outpatient settings across Germany. Participants were purposively sampled to ensure variation in age, practice characteristics, and digital proficiency. Data were collected through in-depth, semi-structured interviews, which were audio-recorded, transcribed verbatim, and subjected to rigorous thematic analysis employing Mayring’s qualitative content analysis framework. Results: Participants demonstrated a fundamentally ambivalent stance toward AI integration in primary care. Perceived advantages included enhanced diagnostic support, relief from administrative burdens, and facilitation of preventive care. Conversely, physicians reported concerns about workflow disruption due to excessive system prompts, lack of algorithmic transparency, increased cognitive and emotional strain, and perceived threats to clinical autonomy and accountability. The implications for the physician–patient relationship were seen as double-edged: while some believed AI could foster trust through transparent use, others feared depersonalization of care. Crucial prerequisites for successful implementation included transparent and explainable systems, structured training opportunities, clinician involvement in design processes, and seamless integration into clinical routines. Conclusions: Primary care physicians’ engagement with AI is marked by cautious optimism, shaped by both perceived utility and significant concerns. Effective and ethically sound implementation requires co-design approaches that embed clinical expertise, ensure algorithmic transparency, and align AI applications with the realities of primary care workflows. Moreover, foundational AI literacy should be incorporated into undergraduate health professional curricula to equip future clinicians with the competencies necessary for responsible and confident use. These strategies are essential to safeguard professional integrity, support clinician well-being, and maintain the humanistic core of primary care. Full article

Background: The outbreak of the COVID-19 pandemic has highlighted the importance of online health consultations, as they can help reduce the risk of contagion and infection. However, due to limited trust, these services have not yet gained widespread adoption and usage among patients. Objective: This research aims to examine the impact of perceived quality on patients’ adoption and usage of online health consultations from three perspectives: emotional support, responsiveness, and service continuity. Additionally, this research further explores the moderating effects of online service prices on these relationships. Methods: Based on trust theory, this research constructs theoretical models and empirically tests them by using a panel dataset that comprises 1255 physicians and 65,314 physician–patient communication records. Results: The empirical results confirm that emotional support, responsiveness, and service continuity positively influence patients’ adoption and usage behaviors. Additionally, higher online service prices negatively moderate the impact of emotional support and responsiveness on adoption behavior. Moreover, increased online service prices weaken the positive relationship between emotional support and usage behavior while strengthening the positive relationship between service continuity and usage behavior. Conclusions: This research extends the existing literature on online health services and provides practical guidance for platform managers, physicians, and policymakers to improve overall service acceptance. Full article

Physician burnout is a multifaceted syndrome characterized by emotional exhaustion, depersonalization and a diminished sense of personal accomplishment. It affects physicians at various stages of their medical training more prevalently than their peers in the general population. This article aims to explore the systemic challenges contributing to physician burnout and the role of individual resilience as a mitigating factor. The article highlights that burnout not only impacts physician well-being but also patient care, organizational performance and healthcare costs. Factors such as heavy workload, long hours and poor interpersonal relationships significantly contribute to burnout, while personal characteristics and coping mechanisms can influence its prevalence. By examining the interplay between systemic challenges and individual resilience, this article contributes to a deeper understanding of physician burnout. It offers insights into potential strategies for mitigation, highlighting the importance of both organizational and personal interventions in addressing this escalating crisis. Full article

Background/Objectives: The aim of this study was to investigate the relationship between the PRIMARY score derived from [⁶⁸Ga]Ga-PSMA PET/CT and key clinical and pathological parameters of prostate cancer aggressiveness, including the PSA level, ISUP Grade Group, and D’Amico risk classification, in patients with biopsy-proven prostate cancer. A secondary aim was to evaluate the interobserver agreement of the PRIMARY score in routine clinical practice. Methods: This retrospective analysis included 51 patients with histopathologically confirmed prostate adenocarcinoma who underwent [⁶⁸Ga]Ga-PSMA PET/CT imaging for staging. PRIMARY scores were determined based on the intraprostatic uptake pattern, intensity, and zonal localization. These scores were compared with PSA levels, ISUP GG, D’Amico risk classification, and histopathological features such as the cribriform pattern, intraductal carcinoma, perineural invasion, extraprostatic extension, and lymphovascular invasion. The PRIMARY scores were independently assigned by a total of three nuclear medicine physicians, and interobserver agreement was calculated using Fleiss’ kappa analysis. Results: Significant associations were found between the PRIMARY scores and the PSA level, ISUP Grade Group, and D’Amico risk classification. The most prevalent score was PRIMARY 5 (54.9%), which was significantly associated with ISUP GG 5 and the high-risk category in D’Amico classification. Among patients with PRIMARY Score 2, a substantial proportion (64.7%) had ISUP GG ≥ 3, and 58.8% were in the high-risk group, highlighting the limitations of binary PRIMARY classification. No statistically significant correlations were found between the PRIMARY scores and specific histopathologic features. Interobserver agreement was excellent (κ = 0.833). Conclusions: The PRIMARY score demonstrates high reproducibility and clinical relevance in stratifying prostate cancer aggressiveness. However, the findings challenge the reliability of binary classifications, particularly for patients with Score 2, who may still harbor high-grade disease. Integrating imaging-based scores with clinical and histopathological data is essential, particularly for accurate staging and decision-making regarding active surveillance. Full article

Background/Objectives: This study evaluates the adherence to guidelines for the management of asthma exacerbations in the ED, recommendations at discharge, and impact at a 1-year of follow-up. Methods: An observational study of 87 asthma patients who attended the ED during 2022 and were discharged within 24 h was carried out. Data before the ED admission, care in the ED, and discharge reports, as well as the clinical characteristics at follow-up, were recorded. The relationship between complete ED discharge reports and outcome at 1 year, and factors associated with new exacerbations were analyzed. Results: The mean age was 51 years, 80% of the patients were women, and 50% had severe asthma. Prior to ED admission, 58.8% of patients used ICS-LABA, 26.2% triple therapy, 31.8% had not been treated, and 51.2% had presented at least one exacerbation. On ED admission, PEF was measured in 21% of patients only, decreasing to 6.8% at 3 h. In the ED discharge reports, the use of systemic corticosteroids was recommended in 76.5% of the cases and ICS-LABA in 46.9%. However, complete ED discharge reports were recorded for only 18.2% of patients. A total of 6.7% of patients were referred to a primary care physician and 29.9% to a pneumologist. Complete ED discharge forms did not improve asthma control at follow-up or reduce new exacerbations. Exacerbations before ED admission (OR 2.49, 95% CI 1.47–4.22, p = 0.001) and the use of any asthma controller treatment (OR 1.84, 95% CI 1.84–507, p = 0.017) were associated with ≥2 exacerbations at follow-up. Conclusions: Contact with ED did not improve disease control or reduce exacerbations. It is necessary to optimize care before, during, and after exacerbations by developing integrated programs with primary care to improve asthma management. Full article

Background: DLco remains one of the most commonly performed tests in the pulmonary lab. An isolated reduction in DLco is a unique abnormality with specific differentials when evaluating a patient with dyspnea. There remains a significant misunderstanding amongst young pulmonologists and pulmonary trainees regarding DLco and its relationship with alveolar volume and kco. Objective: This review aims to provide a physiological basis for the DLco test and bust the myth of “DLco corrected for lung volume.” Method: A systematic review of the available literature regarding alveolar gas-exchange physiology, measurement methods of DLco, the interplay of different variables associated with it, and the causes of its reduction was performed. Focused physiological data were used to put together a comprehensive review of isolated reductions in DLco. The second part of this review addresses the critical and interdependent relationship between DLco and alveolar volume (VA). Results: DLco has a unique relationship with lung volume that needs to be considered while interpreting its value. Diffusion capacity per unit volume (kco) is an independent factor that, when combined with DLco and VA, helps accurately interpret the test and narrow down differentials. Conclusion: DLco is an extremely valuable test and an important prognostic tool in many patients with dyspnea. An isolated reduction in DLco is increasingly recognized these days as an early marker of detection for various pulmonary parenchymal and vascular diseases. A detailed physiopathological explanation, followed by the proposed algorithm, should help pulmonary physicians and trainees understand and implement DLco’s relationships in their daily patient care. Full article

Purpose: The aim of this retrospective study was to analyse the compensation procedures concerning patients presenting with work-related lung cancer (LC), hospitalised in a French university hospital, and to assess the benefit of systematic specialised occupational disease (OD) consultations in improving procedures for reporting and recognising OD. Methods: Patient exposure to occupational lung carcinogens was assessed via an analysis of a standardised questionnaire, completed between 1 January 2009 and 24 April 2023. Among the 2024 patients who completed the questionnaire, 621 patients with probable exposure to occupational lung carcinogens were included. Among these patients, two groups were compiled: group 1, consisting of the 392 subjects who did not benefit from specialised OD consultations, and group 2, consisting of the 229 subjects who benefited from such consultations since 2014 and to whom a medical certificate to claim for compensation was issued by a physician. During the second phase of our study, we determined the outcome of the compensation procedure for OD. Uni- and multivariate logistic regressions were performed according to descending logistic regression methods. Results: Multivariate analyses, including smoking status, sex, age and claim for compensation, confirm the significant relationship between specialised OD consultation and claim for compensation (OR 18.13, 95% CI [11.47–28.64]). Furthermore, the rate of occupational disease recognition has multiplied by 1.5 since 2014. Conclusion: This study confirms the importance of specialised OD consultations in helping patients with LC to obtain compensation and to reduce under-recognition. Full article

Background: Physician attributes significantly impact patient outcomes, satisfaction, and trust. Various attribute frameworks have been developed to help structure and guide undergraduate medical education and subsequent clinician practice; however, prioritization of these attributes vary by stakeholder (patients, physicians, medical students). Based on findings from two previous studies completed by the research team, we sought to understand the context in which individuals in these stakeholder groups prioritize particular physician attributes. We adopted a qualitative approach, conducting semi-structured interviews with patients (N = 11), doctors (N = 11), and medical students (N = 12), for a total sample of 34. Results: Thematic analysis of data resulted in the following five themes: caring, communicator, expert, professional, curiosity and open-mindedness. Central to our findings was the need for a positive, trusting provider–patient relationship, which was framed as the conduit to quality patient care (both receiving and providing). The attributes believed to support this central finding differed, noting that “caring”, “curiosity and open-mindedness” are not typical in physician attribute frameworks. Findings suggest there is a central guiding philosophy shaping what medical students, physicians and patients alike, need in the context of the provider–patient relationship, which transcends particular attributes. The guiding philosophy of relational inquiry is used to further situate study findings. Conclusions: Integrating a central guiding philosophy can add additional depth and nuance to attribute frameworks, ensuring considerations for qualities that transcend particular attribute characteristics, such as “caring” and “curiosity and open-mindedness” are also explicitly used to help structure and guide undergraduate medical education and subsequent clinician practice. Full article

This study examined 112 CKD patients’ adherence to and satisfaction with treatment, and their quality of life, as mediated by the level of psychological stress experienced as well as their working alliance, resilience, and social support. The patients were receiving care at a public teaching hospital in the northeast region of the U.S. The results indicated a significant moderate negative correlation between psychological distress and quality of life (r = −0.34, p < 0.01). The results also indicated significant positive moderate to strong correlations between the physician–patient working alliance and adherence (r = 0.42, p < 0.001), satisfaction (r = 0.55, p < 0.001), and quality of life (r = 0.51, p < 0.001), between social support and quality of life (r = 0.39, p < 0.001), and significant moderate positive correlations between resilience and adherence (r = 0.35, p < 0.001) and satisfaction (r = 0.26, p < 0.01). Regression analyses indicated that the following predictors were significant: patient adherence was positively predicted by the working alliance (β = 0.42, p < 0.001); patient satisfaction was positively predicted by the working alliance (β = 0.51, p < 0.001) and negatively predicted by psychological distress (β = −18, p < 0.048); and quality of life was positively predicted by the working alliance (β = 0.38, p < 0.001) and social support (β = 0.28, p < 0.016) and negatively predicted by psychological distress (β = −0.34, p < 0.002). Moderation analyses indicated that the working alliance moderated the relationship between COVID impact and adherence (R² = 0.27, F(df1, df2) = 8.36, p < 0.001, 95% CI = 0.29–2.74), social support moderated the relationship between COVID impact and adherence (R² = 0.19, F(df1, df2) = 5.77, p < 0.001, 95% CI = 0.47–2.77), and resilient coping moderated the relationship between COVID impact and satisfaction (R² = 0.20, F(df1, df2) = 7.89, p < 0.001, 95% CI = 0.94–2.81). The present study provides evidence of the significant role of psychological stressors and social support in influencing CKD patients’ adherence to and satisfaction with treatment, as well as their quality of life. Full article

Objectives: Neurosarcoidosis (NS) is a severe and infrequent complication of sarcoidosis. Available data on NS are variable. We aimed to characterize NS epidemiology, clinical and therapeutic characteristics in a well-defined cohort of NS patients. Methods: Observational population-based cohort study of 342 patients diagnosed with sarcoidosis in Northern Spain, between 1999 and 2019. Among them, those patients who fulfilled the Consortium Consensus Group diagnosis criteria for NS were included. The annual incidence between 1999 and 2019 was estimated by gender, age, and year of diagnosis. Additionally, a literature review was performed. Therapeutic efficacy was evaluated using the neurological-related extra-pulmonary physician organ severity tool (ePOST). Results: NS was diagnosed in 29 out of 342 patients with sarcoidosis (8.5%; 18 women/11 men) with a mean age of 42.3 ± 15.1 years. Most NS patients have associated systemic sarcoidosis (93.4%) mainly consisting of lung (n = 22; 75.9%), articular (n = 15; 51.7%) and/or ocular (n = 12; 40%) involvement. The annual incidence of NS during the study period was 1.1 per 1,000,000 people. There is a linear relationship with a weak decrease in age at diagnosis over time. NS was subdivided into chronic headache (n = 11; 36.7%), cranial neuropathy (n = 7; 24.1%), myelitis (n = 4; 13.8%), peripheral neuropathy (n = 3; 10.3%), cranial neuropathy with chronic headache (n = 3; 10.3%) and aseptic meningitis (n = 2; 6.9%). Twenty-five patients (86.2%) received oral glucocorticoids (mean ± SD maximum prednisone dose 49.6 ± 19.4 mg/day). In addition, conventional immunosuppressive drugs were administered to 17 (58.6%) patients and biological therapy to 12 (41.4%) patients. After 12 months of initiating biological therapy, 14 out of 17 patients (82.4%) achieved complete remission, defined as an ePOST score of 0. Severe allergic reaction was observed in only one patient who had received treatment with both Infliximab and Adalimumab. Conclusions: The epidemiological, clinical and treatment characteristics of NS in Northern Spain are similar to that of other countries. Full article

Tuberculosis is an infectious condition caused by Mycobacterium tuberculosis, primarily targeting the pulmonary system, with the potential to disseminate to various other organs via the haematogenous pathway, ranking among the top ten causes of global mortality. Tuberculosis remains a serious public health problem worldwide. This narrative review aims to emphasise the clinical importance of the inter-relationships between nutrition, pharmacotherapy, and the most common drug–nutrient interactions in the context of tuberculosis and multi-drug-resistant tuberculosis management. Nowadays, pharmacologic approaches utilise polytherapeutic regimens that, although showing increased efficacy, prominently affect the nutritional status of patients and modify multiple metabolic pathways, thus influencing both the effectiveness of therapy and the patient outcomes. There is much evidence that antituberculosis drugs are associated with deficiencies in essential vitamins and various micronutrients, leading to serious adverse consequences. Moreover, poor nutrition exacerbates TB outcomes, and TB further exacerbates nutritional status, a vicious cycle that is particularly prevalent in low-resource environments. Nutritional support is necessary, and clinicians ought to evaluate it on a patient-by-patient basis, as empirical evidence has shown that it can improve immune recovery, decrease tuberculosis-associated morbidity, and increase adherence to therapy. However, drug–food interactions are increasingly prevalent, and patients with tuberculosis require personalised dietary and pharmacological regimens. In this context, antituberculosis treatment requires a holistic approach, based on the collaboration of the prescribing physician, pharmacist, and nutritionist, to assess the patient’s needs from a nutritional and pharmacological perspective, with the ultimate goal of decreasing mortality and improving the prognosis of patients through personalised therapies. Full article

Background and Objectives: Shift work and night work are common among emergency physicians. It is necessary to provide continuous care to patients, especially with acute diseases, including throughout the night. Literature studies show that shift and night workers have an altered light exposure, timing of sleep and intake of food. The consequence of this desynchronization with the biological clock can lead these workers to be more exposed to developing some acute and chronic health conditions. In particular, the alteration of the sleep–wake cycle, fatigue, the shortened sleep duration and the misalignment of the body’s hormone production is a codified risk factor of gut dysbiosis that can lead to acute and chronic diseases, also gastrointestinal ones. the aim of this narrative review is to collect and summarize evidence about the association between the disruption of the circadian rhythm, sleep and food timing alterations, gut dysbiosis and the risk of gastrointestinal diseases among shift and night workers. Materials and Methods: we searched for evidence about the association of shift and night work, dysbiosis, gut microbiota and gastrointestinal diseases among shift workers in healthcare settings. Results: shift work and night work are associated with a higher risk of diseases, an inflammatory state and the alteration of the gut microbiota composition; but definitive data are still inconsistent. Conclusions: Until now, obtaining conclusive results in regard to the relationship between shift work, the gut microbiota and the increased risk of gastrointestinal disorders has been particularly complex and not yet feasible. More confirmatory studies are needed to better characterize risk factors and realize preventive measures. Full article