Search Results (2,088)

Chronic constipation (CC) is one of the most common disorders of gut–brain interaction, affecting more than 11% of adults in Western countries, with higher prevalence in women and in the elderly. Despite its significant impact on quality of life, most patients self-manage their symptoms, while only a minority seek medical attention from general practitioners (GPs) or specialists. Proper assessment not only often requires a multidimensional approach but also accurate diagnostic and therapeutic pathways that define the exact role of GPs and specialists. This paper describes a comprehensive Diagnostic–Therapeutic Care Pathway (DTCP) for CC, focusing on the full spectrum of diagnostic and therapeutic methodologies required for accurate patient assessment and management. The pathway involves a primary care physician intervention phase, responsible for first-line diagnostic and therapeutic management and evaluation using objective parameters, as well as reassessment at appropriate time points to identify patients requiring further specialist evaluation. Advanced diagnostic methodologies are described as being performed in specialized gastroenterology or neurogastroenterology settings. These include colonic transit studies with radiopaque markers, high-resolution anorectal manometry, balloon expulsion testing, magnetic resonance imaging or conventional defecography, ultrasonography, and neurophysiological assessments such as anal sphincter EMG and pudendal nerve latency testing. Full article

Background/Objectives: Schizophrenia is a severe psychiatric disorder frequently characterised by sleep and circadian disturbances, which are closely linked to cognitive dysfunction, symptom exacerbation, and poor functional outcomes. A growing body of evidence implicates the orexin (hypocretin) system—an essential regulator of arousal, sleep–wake stability, metabolic processes, and motivated behaviour—in the pathophysiology and treatment response of psychotic disorders. We aimed to investigate the relationships between the orexinergic system and psychoses. Methods: On 3 March 2026, we searched the PubMed, Scopus, PsycInfo/Articles and Cinahl databases for studies dealing with the orexin system and psychotic disorders and treatment response. Results: We found 20 eligible studies reporting variable and inconsistent alterations in orexin signalling in patients with schizophrenia. Studies were mostly cross-sectional and heterogeneous in design. Antipsychotic medications interfere with orexin-dependent pathways, potentially contributing to both therapeutic effects and adverse outcomes such as sleep disruption and metabolic dysregulation. Conclusions: While evidence from preclinical studies could point to an influence of dopaminergic activity through orexinergic mechanisms, with possible attenuation of antipsychotic-induced motor side effects and improvement of attentional deficits associated with NMDA receptor hypofunction, the utility of dual orexin receptor antagonists (DORAs) in psychoses is unclear. Despite the high prevalence of insomnia in schizophrenia, its pharmacological management remains suboptimal, with current treatments often limited by reduced efficacy or tolerability concerns. DORAs, which are currently approved medications for the treatment of insomnia, represent a novel and mechanistically distinct therapeutic option that may improve sleep while modulating arousal- and cognition-related circuits relevant to psychosis. Full article

Parasitic diseases pose significant challenges to the success of mariculture. The health management strategies used in sea-cage aquaculture are not completely effective at preventing parasites from entering through interactions with wild fish. This study monitored the health status of greater amberjack (Seriola dumerili, Risso 1810) over a two-month period following their introduction to the farm in the Middle Eastern Adriatic Sea in July 2019. Zeuxapta seriolae was detected on the gills after 722 degree days (DD), with a 28% prevalence, a mean abundance of 1.00 parasite per fish (four examined arches), and a mean intensity of 3.57 parasites per infected fish. From 985 DD, prevalence was 100%; the parasite burden continued to rise, and by the final sampling at 1535 DD, the mean abundance reached 212.68 parasites per fish (53.17 per gill arch). At that point, fish express a sudden loss of appetite; no external symptoms were observed, except for mortality. This is the first report of Z. seriolae in cultured greater amberjack in the Adriatic Sea, and the study emphasises the difficulties in applying effective biosecurity measures in floating net cages. Full article

Background: Micronutrient deficiencies (MD) are highly prevalent among candidates for bariatric surgery (BS) and are associated with adverse perioperative and postoperative outcomes. Although guidelines recommend systematic preoperative screening and correction, conventional targeted supplementation (CTS) often requires multiple products, potentially limiting adherence and delaying surgical readiness. Bariatric-specific multivitamins (BSM) may simplify nutritional management, but their real-world effectiveness for preoperative correction of multiple MD remains insufficiently investigated. Objective: To compare the effectiveness, efficiency, and adherence of a BSM versus CTS for preoperative correction of multiple MD in BS candidates. Methods: This retrospective multicenter cohort study included 1560 adults with obesity evaluated for BS between 2020 and 2024 across three Italian bariatric centers. The primary efficacy analysis was restricted to patients presenting with ≥3 laboratory-confirmed MD at baseline. Patients treated between 2020 and 2022 received individualized CTS using multiple products, whereas those treated between 2023 and 2024 received a single BSM. Biochemical follow-up was scheduled at 4 and 8 weeks. The primary outcome was the achievement of complete biochemical correction of all baseline deficiencies at the predefined 4-week follow-up assessment (composite endpoint). Secondary outcomes included supplementation burden and self-reported adherence. Early correction rates were compared using absolute risk differences and risk ratios; adjusted associations were evaluated using multivariable regression models including center and baseline deficiency burden. As a supplementary analysis, the patient-level proportion of baseline deficiencies corrected at 4 weeks was also evaluated. Results: Among patients with ≥3 baseline deficiencies (n = 216), complete biochemical correction at 4 weeks was achieved in 55/134 patients (41.0%) in the BSM group and in 13/82 patients (15.9%) in the CTS group, corresponding to an absolute risk difference of 25.2 percentage points (95% CI 7.8–40.0) and a risk ratio of 2.59 (95% CI 1.51–4.44). In adjusted analyses accounting for center and baseline deficiency pattern, BSM use remained independently associated with early complete correction (adjusted absolute risk difference 26.3 percentage points; adjusted risk ratio 2.69). Sensitivity analyses restricting follow-up timing and excluding early calendar periods yielded consistent results. The mean proportion of baseline deficiencies corrected per patient at 4 weeks was higher in the BSM group compared with CTS (0.74 ± 0.25 vs. 0.54 ± 0.30). Compared with CTS, BSM was associated with lower supplementation burden (1 vs. 3.5 supplements on average) and higher adherence (92% vs. 70%). Conclusions: In a real-world multicenter cohort of BS candidates with ≥3 baseline MD, a simplified preoperative supplementation strategy based on a BSM was associated with a significantly higher probability of complete biochemical correction at 4 weeks, lower supplementation burden, and higher reported adherence compared with CTS. Although complete correction was not universal at 4 weeks, BSM significantly increased the likelihood of achieving early multi-deficiency normalization. Given the non-concurrent observational design, these findings should be interpreted as hypothesis-generating and warrant confirmation in prospective studies with concurrent cohorts. Full article

Background: Hypertension is an important target for primordial prevention of complex, noncommunicable diseases, and its prevalence remains high across populations. The urban population in India is at a high risk of hypertension, but the genetic basis of hypertension in this population remains poorly understood. Methods: We conducted a pooled whole-blood genome-wide association study of 28 pools representing 1402 participants of the Diabetes In Sindhi Families In Nagpur (DISFIN) study, which enrolled families of probands with type 2 diabetes (T2D). Genotyping was done using Illumina’s Global Screening Array. Results: From a total of 608,550 single-nucleotide variants, 191 were found to be significantly associated with hypertension even after adjusting for metabolic comorbidities, batch effects, pooling error, kinship status, and pooling variation. These variants mapped to 180 well-characterized genes comprising 55 (31%) genes, and encode long noncoding RNAs (lncRNAs). Many of the genes significantly associated with hypertension (including 35% of the lncRNAs) have also been reported by other studies. However, we identified novel genes (SBF2, ARHGAP12, EPAS1, CLEC16A, and LRPPRC) to be associated with hypertension. The most significantly associated lncRNA gene was FLYWCH-AS1. Bioinformatic analyses indicated that these novel genes are likely to have functional importance in hypertension. Conclusions: Our study thus points to the potential candidate genes associated with hypertension in endogamous Sindhi families with T2D patients. The replicable and functional role of these candidate genes should be investigated in future studies. Full article

Background: Turner syndrome is a genotypic disorder in females characterized by the total or partial absence of an X chromosome. While cardiovascular issues and sensorineural hearing loss are well-documented, vestibular system involvement remains understudied. This study aims to examine vestibular system involvement in patients with Turner syndrome and assess if they exhibit a higher prevalence of peripheral vestibular pathology compared to the general population. Methods: A retrospective longitudinal study was conducted with 21 Turner syndrome patients and 21 age-matched controls. Evaluations included clinical history, otoscopy, pure tone audiometry, the Video Head Impulse Test (vHIT) to measure vestibulo-ocular reflex gain, and computerized dynamic posturography, specifically the Sensory Organization Test (SOT) and Stability Limits Analysis. Results: Turner syndrome patients showed significantly higher hearing thresholds across all frequencies compared to controls (p < 0.001). In the vHIT, 30% of the Turner group presented pathological results, with significant gain reductions in the right horizontal and left posterior semicircular canals. Posturography revealed a significant reduction in overall stability (p = 0.006) and a significantly lower vestibular index (p = 0.011) in the Turner group. Additionally, patients with Turner syndrome demonstrated significant impairments in directional control, reaction time, and excursion points during Stability Limits Analysis. Conclusions: Patients with Turner syndrome are more likely to experience vestibular disorders, a finding likely associated with estrogen deficiency and the loss of its protective effect on the inner ear. These results highlight the necessity of including vestibular and posturographic assessments in the routine clinical follow-up of these patients to facilitate early detection and rehabilitation, even in the absence of overt symptoms like vertigo. Full article

Major depressive disorder (MDD) is a highly prevalent psychiatric illness for which rapid-acting antidepressants such as ketamine provide only transient benefit. Because κ-opioid receptor (KOR) signaling contributes to stress-related dysphoria and impaired neuroplasticity, we examined whether KOR antagonism could prolong ketamine’s antidepressant-like effects in a mouse model of adolescent chronic unpredictable stress (CUS). Male C57BL/6J mice (n = 10 per group for behavioral analyses) were exposed to CUS during adolescence and developed persistent depression-like behavior in adulthood. Mice with depressive-like behavior received a single injection of ketamine, the selective KOR antagonist norbinaltorphimine (nBNI), or their combination. Behavioral testing showed that all treatments reduced immobility in the tail suspension test (TST) 24 h post-administration; however, only the combined ketamine/nBNI treatment maintained antidepressant-like effects one week post-treatment. Molecular analyses (n = 4–8 per group) were conducted at this single time point, one week post-treatment, to characterize region-specific signaling states in the prefrontal cortex, hippocampus, and striatum, focusing on ERK, AKT, JNK, mTOR, and BDNF pathways. These molecular findings represent correlates of sustained behavioral effects rather than evidence of causal mechanisms. Together, the data indicate that concurrent KOR antagonism is associated with prolonged antidepressant response to ketamine in stress-exposed male mice and with distinct region-dependent signaling profiles at one week post-treatment. Further studies are needed to establish mechanistic causality and confirm the possible applicability of these findings. Full article

Background: Changes in body composition, such as decreased muscle mass and increased adipose tissue, are significant in older adults, impacting health, functional capacity, and increasing the risk of metabolic diseases, functional decline, and frailty. Bioelectrical Impedance Analysis (BIA) is a non-invasive tool for assessing body composition, including fat-free mass (FFM), skeletal muscle mass (SMM), and fluid distribution (e.g., ECW/TBW ratio). Complementing BIA, the Mini Nutritional Assessment (MNA) serves as a validated tool for identifying malnutrition risk in the elderly. This study aimed to understand the correlation between BIA-derived parameters, MNA scores and clinical outcomes. Methods: This cross-sectional study involved 195 older adults (mean age 72.8 ± 5.4 years), divided into two groups based on body composition profiles determined by cluster analysis. Data collected included demographics, comprehensive BIA parameters (BMI, fat mass, FFM, SMM, ECW/TBW, phase angle), MNA scores, self-assessed health, chronic disease prevalence, frailty index (TFI), and functional limitations (EQ-5D). Statistical analyses included descriptive statistics, t-tests/ANOVA, chi-square tests, Pearson’s/Spearman’s correlations, point-biserial correlations, regression analyses, and ROC curve analysis to compare groups, explore variable relationships, and assess predictive abilities for malnutrition risk. Results: The first group had significantly higher BMI, AFM (AFM), FFM, and SMM, but a lower ECW/TBW ratio compared to Group 2 (N = 115), which was predominantly female and had higher frailty scores. MNA scores showed significant positive correlations with FFM (rho = 0.165, p = 0.021) and SMM (rho = 0.182, p = 0.011), and a negative correlation with ECW/TBW (rho = −0.188, p = 0.008). Higher adiposity (BMI, fat mass) correlated positively with arterial hypertension and obesity. Lower FFM and SMM were negatively correlated with gastroesophageal reflux disease. Skeletal muscle mass (AUC = 0.634, cut-off ≤ 17.3 kg) and ECW/TBW ratio (AUC = 0.626, cut-off ≥ 49.7%) showed modest discriminatory capacity to identify malnutrition risk. Individuals at risk of malnutrition reported greater functional limitations and lower self-assessed health. Numerous BIA parameters, including segmental muscle mass, total body water, phase angle, and impedance values, significantly correlated with MNA scores. Conclusions: The study highlights the importance of body composition analysis, particularly BIA, in correlation with MNA, for assessing nutritional status, functional limitations, and chronic disease associations in older adults. Integrating BIA and MNA into geriatric assessments provides a complementary profile of nutritional and functional vulnerability. Full article

Background: Myosteatosis—fat infiltration within skeletal muscle—is emerging as a critical yet underappreciated determinant of cancer outcomes. Although historically overshadowed by sarcopenia and cachexia, myosteatosis is now recognized as a distinct and early muscle phenotype that carries significant prognostic implications across multiple tumor types. Despite its relevance, foundational gaps remain in our understanding of its mechanisms, clinical significance, and therapeutic potential. The goal of this manuscript is to review the current literature to identify the unique characteristics, prevalence, biological and other etiological mechanisms of myosteatosis and its role as an early biomarker in cancer treatment, recurrence, and prognosis. Methods: A review of the evidence from epidemiological, laboratory and other observational studies with regard to the definition of the biomarker, its biological mechanism, its prevalence in cancer patient populations and the gaps in the research was conducted. Results: Retrospective studies utilizing CT imaging reveal that myosteatosis is highly prevalent in cancer populations and independently associated with mortality, treatment toxicity, postoperative complications, functional decline, and survivorship outcomes. Unlike sarcopenia, which primarily reflects loss of muscle mass, myosteatosis reflects impaired muscle quality, metabolic dysfunction, and lipid derangements. Importantly, it appears early in the trajectory of muscle deterioration—well before irreversible cachexia develops—making it a strategic point for intervention. Conclusions: Despite strong associations with clinical outcomes, the biological underpinnings, clinical applications, and modifiability of myosteatosis remain poorly defined. A coordinated research agenda focused on mechanistic discovery, biomarker standardization, and targeted interventions is essential to improving survival, treatment tolerance, and quality of life for patients across the cancer continuum. Full article

While the digital transformation is predominantly framed as a catalyst for efficiency, the structural shifts induced by digitalization seem to generate a hidden erosion of working conditions that challenges the broader vision of sustainable work. Focusing on four Central European countries, this research explores how contemporary labor environments conceal declines in job quality. Drawing on original survey data, the study identifies several critical sources of this deterioration, including uncompensated workload expansion, the erosion of the right to disconnect, and the increasing pressure of digital presenteeism. The analysis reveals that these hidden shifts are most prevalent among workers in remote or hybrid models, as well as those in the first decade of their professional careers. Younger workers appear especially vulnerable to the blurring of work–life boundaries and the compulsion to maintain availability during illness. The research questions were addressed using appropriate statistical tests and by constructing working conditions due to digitalization index (WCDI). These findings point toward a need for a broader understanding of how digital transformation impacts the sustainability of work in practice. Full article

Background/Objectives: Psoriasis is a chronic, systemic, and multifactorial disease affecting approximately 1–2% of the Caucasian population. It is characterized by distinct histopathological features, including epidermal hyperplasia and infiltration of immune cells into the skin. Despite its high prevalence, the underlying mechanisms driving psoriasis remain incompletely understood. Heat shock proteins (HSPs), particularly HSP70, are known to play key roles in modulating immune responses and inflammation. Although previous studies have examined the involvement of HSPs in dermatological conditions such as psoriasis, current evidence remains inconclusive. In this study, we aimed to elucidate the role of Hsp70 deficiency in the pathogenesis of psoriasis using an in vivo model. Methods: We used male mice that were either genetically normal (Hsp70+/+) or lacked the Hsp70 gene (Hsp70−/−) at 8–12 weeks of age. Psoriasis was induced by applying imiquimod cream daily for 7 days. At the end of this period mice were sacrificed and blood and tissue collected for further analysis. The severity of the psoriasis was evaluated daily using the PASI Score. Results: Hsp70 depletion was accompanied by significantly decreased psoriatic-like skin inflammation, fewer histological abnormalities, and lower PASI scores. Flow cytometry analysis revealed a decrease in LY6C⁺ monocytes and an increase in LY6G⁺ neutrophils infiltration in Hsp70-deficient mice. In addition, HSP60 expression was lower in the absence of HSP70, while HSP90 expression was markedly elevated. Conclusions: These results point to a significant regulatory function of HSP70 in psoriatic inflammation and raise the possibility that it could be a therapeutic target. Full article

Background/Objectives: Bariatric surgery has emerged as an effective intervention for severe obesity; however, post-operative dizziness remains poorly characterized in the literature. This study aimed to determine the prevalence of dizziness, imbalance, and hearing problems following bariatric surgery and to identify associated risk factors. Methods: A cross-sectional study was conducted among 156 patients who underwent bariatric surgery at multiple centers in Saudi Arabia. Data were collected through structured questionnaires assessing demographic characteristics, surgical details, and post-operative vestibular symptoms. Bivariate and multivariate logistic regression analyses were performed to identify predictors of dizziness. Results: The prevalence of post-operative dizziness was 77.3% (95% CI: 70.0–83.3%), imbalance was 38.0% (95% CI: 30.6–46.0%), and hearing problems were 10.7% (95% CI: 6.7–16.6%). Bivariate logistic regression identified weight loss was significantly associated with dizziness (OR = 1.063, 95% CI: 1.024–1.103, p = 0.001). In the multivariate model, each percentage point increase in weight loss was associated with a 6.1% increased dizziness (adjusted OR = 1.061, 95% CI: 1.017–1.107, p = 0.006). Dizziness was strongly associated with imbalance (chi-square = 14.325, p < 0.001) and falls (chi-square = 7.085, p = 0.008). Conclusions: Vestibular complications, particularly dizziness, are highly prevalent following bariatric surgery and demonstrate a significant dose–response relationship with the magnitude of weight loss. Enhanced awareness and systematic screening for dizziness in post-bariatric patients are warranted. Full article

Background: Early diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM) remains challenging. Although ECG and morphological abnormalities at diagnosis are well-described, their temporal evolution has not been systematically evaluated. This study characterized the prevalence and longitudinal progression of electrical and structural cardiac abnormalities preceding ATTR-CM diagnosis. Methods: We retrospectively analyzed patients with confirmed ATTR-CM evaluated at a specialist amyloidosis center between 2006 and 2023. Diagnosis was established by grade 2–3 myocardial uptake on 99mTc-DPD scintigraphy. Standard 12-lead ECGs and transthoracic echocardiograms were reviewed at diagnosis and at baseline, 3–5 years earlier. Results: Sixty-three patients (79% men; mean age 77 ± 8 years) were studied, including 33 (52%) with hereditary ATTR (ATTRv) and 30 (48%) with wild-type ATTR (ATTRwt). Overall, 95% had a NAC score ≤ 2, consistent with less advanced disease at diagnosis. During the prediagnostic phase, 79% of patients exhibited pathological ECGs. Non-specific ST–T abnormalities (40%), prolonged QTc (38%), left-axis deviation (35%), first-degree AV block (33%) and anterior infarction pattern (33%) were each observed in at least one-third of patients. From baseline to diagnosis, significant prolongation was observed in the PR interval (+26 ms), QRS duration (+11 ms), and QTc interval (+22 ms) (p < 0.001 for all), and a leftward shift observed in the electrical axis (−12.03°, p = 0.011). Low voltage was uncommon at both time points. Although interventricular septal thickness increased significantly (+3.42 mm; p < 0.001), left ventricular ejection fraction and dimensions were relatively stable. Conclusions: In this proof-of-concept study, electrical remodeling precedes functional changes and outperforms low voltages to raise clinical suspicion of ATTR-CM. Full article

Introduction: Major depressive disorder (MDD) is a leading cause of disability worldwide and contributes significantly to the global burden of disease. Recent data show an increasing prevalence of treatment-resistant depression (TRD). Patients with autism spectrum disorder (ASD) often exhibit MDD as a comorbidity and it is often resistant to conventional treatments. ASD determines emotional dysregulation and a reduced ability to understand mental states (mentalization). These features can lead to suicidal ideation and/or behavior. Intranasal esketamine may offer a novel therapeutic option for this population. Methods: This case series focuses on the clinical response to intranasal esketamine in patients with autism and TRD; esketamine is approved in Italy as an add-on therapy in TRD, so our case study is based on an in-label treatment. Three young patients (n = 3, F/M 2:1, age range 20–25 y) with light to moderate autism (Level 1 or 2) were treated. Esketamine was administered in augmentation with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) in accordance with EMA/AIFA guidelines. A structured follow-up protocol was set to monitor depressive symptoms, social cognition, and mentalization. Follow-up during treatment was maintained for six months, and psychometric evaluations were performed at six time points: baseline (T0), 1 week (T1), 1 month (T2), 2 months (T3), 3 months (T4), and 6 months (T5). Also, subjective quality of life was investigated before and after the observation period. Results: Despite differences in clinical profile, all patients showed good efficacy of esketamine in reducing depressive symptoms: two patients experienced clinical remission at T5 (MADRS < 10), one patient showed partial response (dMADRS = 43.24%). No major side effects were reported. Significant improvements were observed after the first week of treatment (P1: MADRS_T0 = 37, MADRS_T1 = 12; P2: MADRS_T0 = 32, MADRS_T1 = 21; P3: MADRS_T0 = 25, MADRS_T1 = 12). Depressive relapses occurred (e.g., P1, T3–T4), but they were not associated with hospitalizations and/or suicidal attempts. Suicidal ideation, when present, decreased by the end of the follow-up period. Lack of mentalization and in social cognition was noted, with just mild improvements during therapy. Subjective quality of life improved significantly for all patients (P1: 28% at T0, 73% at T5. P2: 25% at T0, 71% at T5. P3: 35% at T0, 80% at T5). Conclusions: Intranasal esketamine showed a favorable efficacy and safety in these three cases of TRD in comorbidity with ASD (at six months: total remission = 66.66%, partial remission = 33.33%, inefficacy = 0%, drop-out = 0, severe adverse events = 0). Besides improvements in depressive symptoms, esketamine was associated with a constant decrease in suicidal thoughts. A case series is unfit to form statistical conclusions; preliminary data warrant further investigation in randomized controlled studies to validate the therapeutic potential of esketamine in this population. Full article

Background/Objectives: Pain is highly prevalent among hospitalized patients, and suboptimal pain assessment and management remain common in clinical practice. Nurses are central to timely pain recognition and intervention, yet knowledge and attitudinal gaps can hinder evidence-based pain care. Therefore, this study aimed to evaluate the impact of an evidence-based instructional program on nurses’ knowledge and attitudes toward pain management at a tertiary hospital in Saudi Arabia. Methods: A one-group pretest–posttest quasi-experimental study was conducted at King Fahad Military Medical Complex, Dhahran, Saudi Arabia (January–July 2025). Registered nurses providing direct patient care (N = 226) completed a researcher-developed questionnaire assessing pain management knowledge (30 items) and attitudes (10 items, 5-point Likert scale) immediately before and one week after a structured three-hour evidence-based educational program. Data were analyzed using descriptive statistics, paired-sample t-tests, and Pearson correlation coefficients (SPSS v30), with p < 0.05 considered statistically significant. Results: Baseline findings indicated moderate knowledge (mean of total scores = 15.54 ± 4.32) and generally positive attitudes toward pain management (mean = 3.83 ± 0.60). Knowledge scores increased significantly after the intervention to become moderate to high (pretest: 15.54 ± 4.32 vs. posttest: 18.65 ± 3.83; p < 0.001). Attitude scores also improved significantly following the program (p < 0.001). Knowledge and attitudes showed a significant positive correlation both preintervention (r = 0.241, p < 0.001) and postintervention (r = 0.435, p < 0.001). Conclusions: A brief evidence-based educational program yielded measurable improvements in nurses’ pain management knowledge and attitudes. Integrating structured pain education into continuing professional development may strengthen patient-centered pain care and support more consistent evidence-based practice in tertiary settings. Full article