Search Results (508)

Extracellular vesicles (EVs), particularly small extracellular vesicles (sEVs), are lipid bilayer-delimited particles involved in intercellular communication through the transfer of proteins, lipids, and nucleic acids; many products and studies in aesthetic medicine refer to these preparations as exosomes, although endosomal origin is not always demonstrated. This review examines current evidence on the mechanisms, clinical effectiveness, safety, therapeutic applications, and regulatory challenges of EV- and sEV-based interventions, complemented by an exploratory qualitative assessment of physicians’ perceptions regarding clinical implementation. A narrative review of studies indexed in Scopus and PubMed was conducted with emphasis on skin rejuvenation, hair restoration, wound healing, pigmentation disorders, and inflammatory dermatoses, and responses from 12 aesthetic physicians in Colombia were analyzed qualitatively. Available evidence suggests that EVs/sEVs may promote extracellular matrix remodeling, angiogenesis, immunomodulation, and tissue repair, with potential benefits across several aesthetic and regenerative indications. However, the literature remains heterogeneous and limited by variability in biologic sources, isolation and administration protocols, insufficient high-quality clinical trials, and unresolved regulatory issues. Reports of adverse reactions linked to unapproved products marketed as exosome-based formulations further highlight the need for stronger oversight. EVs, particularly sEVs, often referred to as exosomes in the aesthetic literature, remain a promising therapeutic platform, but safe clinical integration requires rigorous validation, technical standardization, and robust regulatory frameworks. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly used in clinical decision-support systems, yet its adoption in low- and middle-income countries, including Jordan, remains limited and underexplored. Understanding how healthcare professionals perceive AI-assisted clinical decision-making is essential for safe and contextually appropriate implementation. This study explored healthcare professionals’ perceptions of AI-assisted clinical decision-making in Jordan, with particular attention to trust, accuracy, accountability, professional judgement, digital literacy, and health-system readiness. Medication-related safety and prescribing concerns were examined as secondary cross-cutting issues where they emerged from participants’ accounts. Methods: A qualitative study was conducted using semi-structured, in-depth interviews with 22 purposively sampled healthcare professionals from public, private, and university-affiliated healthcare institutions in Amman, Irbid, and Zarqa. Participants included physicians, nurses, pharmacists, and allied health professionals with varied specialties and levels of seniority. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Member checking, peer debriefing, reflexive memos, and audit trails were used to enhance trustworthiness, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results: Eight overarching themes were identified: conditional trust in AI-assisted clinical decision-making; concerns regarding accuracy and confident algorithmic errors; accountability and professional responsibility; AI as an adjunct rather than a substitute for clinical judgement; the influence of experience, specialty, and digital literacy on AI acceptance; Jordanian health-system readiness; privacy, confidentiality, and algorithmic bias; and training requirements for safe AI use. Medication-related safety emerged as a cross-cutting concern, particularly in relation to dosing, polypharmacy, drug–drug and drug–herb interactions, and the risk of over-reliance on AI-generated recommendations. Conclusions: Healthcare professionals in Jordan expressed cautious but constructive views toward AI-assisted clinical decision-making. AI was perceived as potentially useful when used to support, rather than replace, professional judgement. Participants’ accounts suggest that safe implementation depends on local validation, clear accountability frameworks, ethical data governance, interprofessional training, and careful consideration of medication-safety expertise where AI tools influence prescribing or therapeutic decisions. These findings highlight the importance of context-sensitive AI governance strategies that support trustworthy, accountable, and professionally supervised AI adoption in healthcare. Full article

Introduction: Streptococcus pneumoniae severely affects adults over 65, especially those with comorbidities. Since vaccination coverage among healthcare workers (HCWs) is unknown despite free availability, this study evaluates knowledge, behaviours, hesitancy and accessibility among employees of an Italian hospital. Methods: A prospective cross-sectional survey was administered via “SurveyMonkey.” From February 22 to June 15, 2024, healthcare and administrative staff aged ≥ 18 at the Fondazione Policlinico Universitario Gemelli were recruited by email. Descriptive and inferential analyses used Stata 16.1. Results: Among HCWs, 72% are women, with an average age of 48. Pneumococcal vaccination coverage is 20%, with 82.7% vaccinated in-hospital. Preferred information sources include courses, webinars, and institutional websites. For management staff, vaccine safety and effectiveness were significant determinants. Among administrative employees, 65% are women (average age 51); 19% are vaccinated, 24% are unsure, and 43% prefer in-hospital vaccination. Physicians cited trust in vaccines (25.3%) and self-protection (23.2%) as key motivators, compared with 12.4% among nursing, technical and rehabilitative staff. Recommendation to family members was higher among medical and specialist professionals (90%) than in other groups (77% in nursing/technical/rehabilitative; <50% in assistants and auxiliary staff). About half of the groups rated their knowledge at level 2 (scale 1–4). Multivariable regression analysis showed that medical professionals and specialists exhibited a higher perception of the importance and safety of vaccines compared with other categories. Conclusions: HCWs showed greater knowledge of pneumococcal vaccination, while administrative staff had lower awareness and more hesitancy. Both groups preferred in-hospital vaccination and expressed interest in structured educational initiatives. Full article

Background/Objectives: Antimicrobial resistance (AMR) represents one of the most pressing global public health challenges, with inappropriate antibiotic prescribing being a major contributor. In Hungary, general practitioners (GPs) account for over 70% of all antibiotic prescriptions, yet limited research has examined the complex relationship between patient expectations and physician prescribing behavior. This study explores general practitioners’ antibiotic prescribing practices and their perceptions of patient expectations. Methods: A cross-sectional study was conducted among 181 GPs in Hungary from March 2024 to April 2025. The sample is representative of the northeastern region of Hungary. Participants completed anonymous paper-based questionnaires assessing their self-reported professional knowledge, perceived patient expectations, prescribing behavior, and antibiotic stewardship practices. Results: Most respondents recognized antimicrobial resistance as a significant public health issue (81.7%, n = 147); however, only 52.2% (n = 94) felt capable of effectively taking action against it. While 80.6% (n = 145) reported that patients expect antibiotic prescriptions and 71.1% (n = 128) experienced conflicts over prescribing refusals at least once within the previous six months, 87.2% (n = 157) stated they do not yield to patient pressure. Concerning patterns emerged: 56.1% (n = 101) reported completing patient-initiated antibiotic courses, 36.1% (n = 65) admitted to “just-in-case” prescribing at least once within the past six months, and 38.9% (n = 70) encountered self-medication despite regulations restricting antibiotics to prescription-only use. Only 17.8% (n = 32) regularly monitored their antibiotic prescribing indicators. Physicians with multiple specialty qualifications reported less frequent patient education and more conflicts (p = 0.010). Conclusions: General practitioners demonstrate resilience despite substantial patient pressure; however, self-medication and defensive prescribing practices reveal important gaps in antimicrobial stewardship. Targeted, multifaceted interventions addressing both prescriber behavior and systemic vulnerabilities are needed to strengthen stewardship efforts. Full article

Background/Objectives: Artificial intelligence (AI) is integrated into diagnostic, therapeutic, administrative, and communicative healthcare domains in Italy under regulations requiring human oversight. Empirical evidence on AI attitudes, acceptance, and perceptions in Italian healthcare is rapidly accumulating but not systematically mapped. This scoping review aimed to (i) map empirical evidence on AI attitudes, acceptance, and perceptions in Italy by population and domain; (ii) identify measurement instruments used in studies and their origins; and (iii) characterize determinants, themes, and methodological gaps in the Italian evidence base. Methods: This review used Joanna Briggs Institute methodology, reported via PRISMA-ScR (protocol Open Science Framework doi: 10.17605/OSF.IO/TZRVF). PubMed and Embase were searched on 27 April 2026 from January 2018 in English, Italian, or German, combining controlled vocabulary and free-text terms across AI, attitudes-acceptance, and healthcare delivery, with an Italian-context qualifier; a complementary AI-assisted semantic search (Consensus Pro) was conducted to validate retrieval completeness. Eligibility criteria used the Population–Concept–Context mnemonic. Results: Of 1510 unique records screened, 35 empirical studies were retained, comprising 7 studies of Italian patients and the general population, 22 studies of healthcare professionals, 3 psychometric validation studies of AI-acceptance instruments, 1 mixed-population study, and 2 international comparator studies with substantial Italian sub-samples. Acceptance was consistently positive but conditional on physician oversight, training, and regulatory clarity. A recurrent optimism–knowledge gap and an absence of probabilistic, population-representative evidence were identified as principal gaps. Conclusions: Italian evidence on AI attitudes is expanding but methodologically narrow. Three Italian-validated acceptance instruments are now available. Population-representative, multilingual, and longitudinal evidence is required. Full article

Physicians routinely operate in environments that require the rapid processing of complex and dynamic visual information to diagnose patient conditions, communicate effectively, and make informed decisions. Despite the central role of visual attention in clinical practice, these processes are rarely conceptualized or systematically measured in medical education research. In other professional domains, such abilities are described as professional vision (PV)—the situated capacity to selectively attend to relevant cues and interpret them considering domain-specific knowledge. Although the term professional vision foregrounds visual attention, we use it here to cover the multimodal clinical perception in which visual cues are typically embedded—predominantly visual, but in many tasks also auditory and verbal—with visual attention as the analytic anchor. This paper introduces a cognitive process model of professional vision for medical education (PV-CP) that specifies the perceptual and cognitive subprocesses underlying how physicians perceive and interpret clinically relevant information. Building on this model, we propose a theory-driven framework for the measurement of professional vision using multimodal indicators. Central to our argument is the assumption that professional vision represents a latent, temporally unfolding construct that cannot be validly captured through single behavioral metrics or outcome measures. Instead, robust measurement requires the coordinated analysis of gaze-based indicators of visual attention and cognitive indicators of reasoning, each reflecting distinct subprocesses of professional vision. By systematically linking families of indicators to specific subprocesses and clarifying their respective inferential strengths and limitations, the PV-CP model advances a process-oriented approach to studying professional vision in medical education. The framework provides a conceptual basis for integrating multimodal data sources and supports more precise interpretations of gaze and reasoning data in expertise research. In doing so, the model contributes to the theoretical refinement of professional vision and offers a structured foundation for future empirical research and the design of learning environments aimed at fostering clinically relevant perceptual–cognitive skills. Full article

Background: This study fills a gap in the literature by examining how perceptions of health news are associated with interpersonal trust in physicians and institutional distrust in the healthcare systems, particularly in the Türkiye context. While previous studies have examined trust in physicians and distrust in healthcare systems separately using different independent variables, evidence remains limited on the simultaneous association between health news perception and both trust in physicians and distrust in the healthcare system, particularly in the Türkiye context and using validated measurement tools. Therefore, the main objective of this study is to examine the association between health news perception, trust in physicians, and distrust in the healthcare system. Methods: The population of this cross-sectional study consisted of individuals aged 18–60 residing in the central district of Kutahya. The study data were collected face-to-face using a two-part questionnaire. A total of 719 completed questionnaires were analyzed. Results: 58% of the participants in the study were aged 41 and above. Commercial concerns and advertising, consumption promotion, behavioral change, health behavior exploitation, and trust in health news were positively associated with distrust in the healthcare system (β = 0.119, β = 0.196, β = 0.054, β = 0.061, β = 0.046; p < 0.01, p < 0.05). The model explained 22.4% of the variance (R² = 0.224). Commercial concerns and advertising, consumption promotion, behavioral change, health behavior exploitation, and trust in health news were negatively associated with trust in physicians (β = −0.221, β = −0.014, β = −0.014, β = −0.127, β = −0.211; p < 0.05, p < 0.01). The model explained 25.3% of the variance (R² = 0.253). Conclusions: The study found that health news perception was associated with trust in physicians and distrust in the healthcare system. Therefore, understanding the associations between health news perception, trust in physicians, and distrust in the healthcare system is important for improving individual and public health. For this reason, it is of great importance to raise the level of health and digital health literacy in society through policies developed under the leadership of public health experts. Full article

This paper examines male characters in Nilakshi Chaliha Gogoi’s Assamese novel Oiya Mor Dibru-Saikhowa (Oh, My Dibru-Saikhowa) through the lens of Eco Masculinity, drawing primarily on Hultman and Pulé’s tripartite typology of industrial, eco-modern, and ecological masculinities. The study reads the novel’s two principal male characters—Bakul Bora and Seuj—as contrasting masculine trajectories shaped, respectively, by socio-economic deprivation, displacement, patriarchal conditioning, and legal criminalization on the one hand, and by maternal ecological ethics, generational mentorship, and affective formation on the other. The analysis proceeds through three connected registers. First, it attends to the novel’s narrative form, arguing that its principal focalizing consciousness is Dr. Irina Baruah, a physician through whose perception the male characters are largely presented. Second, it develops the political ecology of the Dibru-Saikhowa region—its colonial and postcolonial conservation history, the institutional gap between the Wildlife (Protection) Act 1972 and the Forest Rights Act 2006, and the slow violence visited on the Mising villagers of Laika and Dadhiya. Third, it engages intersectional critiques of eco-masculinity and confronts the structural tension of applying a male-centered framework to a female-focalized novel. The paper argues that Eco Masculinity, applied with due attention to narrative form, historical specificity, and eco-feminine agency, offers a productive tool for South Asian ecocritical scholarship, and it suggests two modifications to the framework that follow from this application. Full article

Purpose: Virtual reality (VR) and augmented reality (AR) are increasingly being explored as tools with potential applications in radiation oncology, with applications in education, patient care, and workflow optimization. This review evaluates the current landscape and future potential of immersive technologies in clinical practice. Methods: A comprehensive literature review was conducted via PubMed and Scopus (search date: January 2026) using a Boolean search strategy combining terms for virtual/augmented/mixed reality, radiotherapy, and education/anxiety/training; articles published between 2010 and 2026 were screened independently by two reviewers. An online survey assessed experience with and perceptions of VR among Canadian radiation oncologists. Semi-structured interviews with physicians, residents, therapists, physicists, and a staff psychologist at a large academic tertiary-care center in Canada explored qualitative insights into current use and attitudes toward immersive technologies. Results: VR and AR show utility across multiple domains. In education, platforms such as the Virtual Environment for Radiotherapy Training (VERT) enable therapists to practice in simulated treatment environments, while VR-based contouring tools reduce segmentation time by 41–58% and improve spatial understanding. For patient care, immersive VR interventions reduce pre-treatment anxiety by 26–56%, enhance understanding of procedures, and may decrease sedation in pediatric populations. AR-guided positioning systems demonstrate feasibility with acceptable accuracy, offering radiation-free setup verification. Survey findings revealed limited adoption (>80% reported no use), though 40% believed VR could enhance patient education and 39% desired expanded integration over the next decade. Barriers included cost, limited institutional awareness, and lack of training infrastructure. Conclusions: VR and AR show early potential for improving education, reducing patient anxiety, and enhancing positioning accuracy in radiation oncology. Despite implementation barriers, ongoing trials and technological advances are gradually building the evidence needed to clarify the role of immersive technologies in clinical practice. Full article

Background/Objectives: Artificial Nutrition and Hydration (ANH) at the end of life remains a clinically and ethically complex intervention. Although international guidelines exist, data regarding the awareness of them and their perceived applicability across different population groups remain limited. This study aimed to evaluate and compare perceptions and attitudes regarding ANH among healthcare professionals, medical students, and lay respondents. Methods: A cross-sectional, questionnaire-based comparative survey was conducted between July 2025 and March 2026, including 470 respondents (338 healthcare professionals, 46 medical students, and 86 lay respondents). The survey assessed perceptions of ANH, factors influencing decision-making, and familiarity with clinical guidelines and legislation. Results: General perceptions regarding ANH were broadly similar across groups. Significant differences were observed for the importance assigned to estimated life expectancy (p < 0.001) and family opinion (p = 0.017). Associations were identified between study group and opinions on clinical guidelines (χ²(6) = 16.366, p = 0.012) and legislation (χ²(6) = 14.712, p = 0.023), with lack of knowledge more frequent among lay respondents and students. Within healthcare professionals, physicians and nurses showed significantly different responses regarding guidelines (p < 0.001). Conclusions: In this cross-sectional survey, perceptions of ANH at the end of life were largely shared, but differed in relation to prognostic factors, family involvement, and awareness of guidelines and legislation, suggesting the presence of relevant knowledge gaps in end-of-life decision-making. Full article

Background: Ulcerative Colitis and Crohn’s Disease are the most common forms of inflammatory bowel disease (IBD), with increasing prevalence both globally and in Poland. Many aspects of a patients’ everyday functioning and treatment remain underexplored. Methods: This study recruited adult patients with IBD hospitalized in the Department of Digestive Tract Diseases of the Medical University of Lodz, Poland. The data were collected between June and July 2025 using an author-developed questionnaire assessing patients’ opinions on therapy, their expectations, and overall life satisfaction. Results: A total of 87 patients with IBD were included in the analysis. Overall, 59 patients (67.82%) reported strong satisfaction with their current treatment, indicating a generally positive perception of disease management. Higher treatment satisfaction was associated with patients’ perception that their preferences were respected by the gastroenterologist. Further analysis revealed significant associations between different types of treatment, disease activity, and patient-reported outcomes. Those patients who were treated with biological agents more frequently reported complete satisfaction with the treatment (41/52 vs. 18/35; p = 0.014), low-to-moderate disease activity (42/52 vs. 19/35; p = 0.016), and fewer limitations in their social lives (16/52 vs. 20/35; p = 0.026) compared to the remaining group. Furthermore, the study demonstrated that those patients who reported remission were less likely to have their physical activity limited (27/55 vs. 27/32; p = 0.002). There were significantly more patients under 50 years of age than older patients getting biological therapy (48/74 vs. 4/13; p = 0.045). Additionally, women in the studied group had a higher rate of IBD-related surgical interventions compared to men (15/36 vs. 9/51; p = 0.026). Despite the high overall satisfaction with treatment and physician communication, 20 patients (22.99%) admitted to taking additional, non-prescribed medication or dietary supplements. Similarly, 21 (24.14%) patients modified treatment regimens by discontinuing the medication intake or changing the prescribed dose. Furthermore, 57 patients (65.52%) reported that they feared the possibility of surgical intervention. Nonetheless, the majority of patients who underwent surgical treatment (22/24; 91.67%) were satisfied with the results. Reported rates of undergoing regular colorectal cancer screening were also unsatisfactory—4/37 (10.81%) patients with disease duration > 8 years, suggesting inadequate awareness. Conclusions: Biological treatment can positively impact multiple aspects of patients’ lives by lowering the disease’s activity. Gastroenterologists should spend more time discussing patients’ preferences and concerns, as well as explaining the colorectal cancer screening rules. Full article

Background/Objectives: The multiple benefits of physical activity and exercise (PAE) for non-communicable diseases (NCDs) and, thus, for public health underscore the importance of their multidisciplinary implementation in clinical practice. However, there is a lack of validated instruments that comprehensively assess physicians’ knowledge, attitudes, intentions, abilities, and behaviour (KAIAB) regarding PAE promotion in NCD management. Methods: This study aimed to develop and validate a new questionnaire to assess physicians’ KAIAB towards PAE and to evaluate their KAIAB levels. A two-stage design, including an e-Delphi method and a cross-sectional study, was conducted in Greece from January 2022 to May 2022. Results: In the first stage, after achieving consensus and stability within a purposive sample of 16 physician–experts (response rate 100%), the questionnaire was effectively developed and validated (Content Validity Ratio: 0.5–1) using a two-round e-Delphi method. In the second stage, a cross-sectional study was conducted in two physician populations from 12 medical specialities (response rate: 18.2%) and demonstrated that the new questionnaire had sufficient face validity and high reliability (Cronbach’s alpha: 0.805– 0.931). The three original Bloom levels’ cut-off points were also used to classify physicians’ KAIAB levels in the second stage. KAIAB levels were assessed using median and interquartile range (Mdn/IQR) and were found to be low (13/6), moderate (128/79), high (35/9), moderate (21/8), and moderate (33/8), respectively. Conclusions: The new questionnaire is reliable and valid. It is recommended that the questionnaire be applied in larger studies to further verify its validity and applicability. Additionally, it was found that although physicians reported high intentions and moderately positive attitudes toward PAE promotion, their knowledge in these domains and their exercise prescription practices remained limited. This underscores the need to enhance policies and initiatives in medical education and the healthcare system. Full article

Research on how patients and family carers experience their relationships with physicians and healthcare staff is limited, particularly regarding the gap between ideal expectations and actual care. This study explored patients’ and carers’ perceptions of the ideal care relationship, their lived experiences, and factors shaping discrepancies between expectations and reality. A total of 143 individual, face-to-face semi-structured interviews (mean age = 56.7 ± 13.2; 61.4% women) were conducted with 57 cancer patients and 86 family carers in outpatient oncology clinics in Southern Italy. Participants were recruited through purposive sampling and interviewed separately, with carers recruited as an independent group. Transcripts were analysed using Thematic Analysis of Elementary Contexts (TAEC), a mixed-methods approach combining qualitative and quantitative techniques. Methodological rigor and trustworthiness were ensured in line with COREQ reporting guidelines. Four thematic clusters emerged: “Variability in the experience,” “The ideal care relationship,” “Waiting times and delays in care,” and “The luck of being cared for by a good physician.” Oncology care experiences emerge as inherently ambivalent: supportive in interactions with clinicians, yet tension-laden due to systemic and organizational constraints. These findings suggest that strengthening patient- and family-centered care requires both relational improvements and organizational interventions aimed at reducing waiting times, enhancing care integration across fragmented pathways, and improving continuity of care. Full article

Background/Objectives: The use of personal smartphones by healthcare professionals in clinical settings has become a growing area of concern as practice may not consistently align with policy guidance. This study enhances our understanding of how and why medical residents are using smartphones to communicate patient healthcare information with other physicians in daily practice and provides insights into the role that institutional governance, policies, and structures play in the use of smartphones. Methods: This study used qualitative techniques to examine medical residents’ use of smartphones to communicate healthcare-related information with colleagues. Additionally, a neo-institutional theory lens was applied to assess the role that regulative (guidelines/policies), normative (what peers/staff are doing), and cultural-cognitive (beliefs/perceptions) factors play in smartphone use by medical residents. Results: The results suggest that behaviour related to smartphone use is based primarily on normative and cultural-cognitive factors rather than regulative factors. Regulative elements around smartphone use play a smaller role in shaping behaviour, particularly when they: (1) lack clarity; (2) are not seen as credible/legitimate; or (3) are viewed as cumbersome and do not align with workflow needs. Conclusions: The implementation of future guidelines/policies should consider the use of mentorships throughout postgraduate medical training whereby staff physicians educate, model, and promote behaviour in accordance with the associated policies/guidelines. Full article

Background/Objectives: The guideline targets for blood pressure (BP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) are frequently unmet, and physicians often misjudge control. This study aimed to characterize the real-world control of BP, HbA1c, and LDL-C in patients with type 2 diabetes (T2D) and hypertension, herein called cardiometabolic multimorbidity (CMM), and to compare guideline-based versus physician-perceived disease control. Methods: We conducted SNAPSHOT–Brazil, a nationwide, multicenter, cross-sectional study to gather real-world data on patients with CMM. The ESC guidelines defined the cardiovascular (CV) risk and control targets. Results: We included 451 patients with hypertension and T2D (median age 65 years; 60% female; 54% White). Most patients (98%) were on pharmacotherapy and reported high adherence (according to the Hill–Bone Medication Adherence Scale). A very high CV risk predominated (78%); 22% of the patients were at a high risk. The guideline-defined control was achieved in 27% for BP, 34% for HbA1c, 13% for LDL-C, and 6% for both BP and LDL-C; only 3% met all three targets simultaneously. The physicians accurately stratified the CV risk in 49% of patients, while 50% had their CV risk underestimated. They systematically overestimated control in 29% of cases for BP, 35% for LDL-C, and 25% for both. The sensitivity ranged from 0.88 to 0.98; the positive predictive values ranged from 0.19 to 0.48, and the positive likelihood ratios ranged from 2.16 to 3.65. Conclusions: The SNAPSHOT–Brazil study revealed a low attainment of BP, HbA1c, and LDL-C targets, despite the widespread pharmacotherapy and the high self-reported adherence. The physicians consistently overestimated disease control and underestimated the CV risk. Full article