Search Results (2,524)

(1) Background: Ambulatory services are the main interface between populations and health systems, yet their benefits are unevenly distributed due to structural inequalities—systemic differences rooted in the social, economic, and political organisation of society. Inequities in access and quality are well documented, but patient safety remains the least examined. (2) Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, PubMed/MEDLINE and Scopus were searched for studies published from 2010 to 2026. In total, 44 studies were included, predominantly from the USA (n = 31), and synthesised narratively. (3) Results: Inequalities operated through geographic maldistribution, financial barriers, exclusionary institutional cultures, and market-driven practices. Access and quality were each addressed by 17 studies, whereas only four examined patient safety directly; the limited safety evidence indicated disproportionate diagnostic errors, medication-safety failures, and care-coordination breakdowns among vulnerable groups. Evidence was concentrated in the USA. (4) Conclusions: Structural inequalities are well documented for access and quality but are markedly under-studied for patient safety—the principal evidence gap identified. Patient safety warrants treatment as an equity outcome, measured with stratification by structural disadvantage and addressed through system-level interventions. Full article

Background/Objectives: Degenerative musculoskeletal diseases represent a major cause of chronic pain and disability worldwide and are increasingly associated with dysregulated oxidative stress and impaired redox signaling. Conventional therapeutic strategies are often limited to symptomatic management, prompting interest in adjunctive approaches that target underlying biological mechanisms. Among these, medical ozone therapy has been proposed as a redox-modulating intervention in various musculoskeletal conditions. Methods: A narrative clinical–mechanistic review of the literature was conducted using PubMed/MEDLINE, Scopus, and Google Scholar to identify experimental and clinical studies examining oxidative stress, redox signaling, and the application of medical ozone therapy in degenerative musculoskeletal disorders. Preclinical models published between 2000 and 2025 and randomized controlled trials published between 2020 and 2025 were critically evaluated and synthesized qualitatively, with attention to biological plausibility, clinical outcomes, and methodological limitations. A PRISMA-style flow diagram was used to document study selection. Results: Evidence from experimental studies supports a role for controlled oxidative stimuli in activating adaptive cellular defense pathways, including redox-sensitive signaling mechanisms involved in inflammation and tissue homeostasis. Clinical studies across conditions such as intervertebral disc disease, knee osteoarthritis, and other degenerative or overuse-related disorders report short- to mid-term improvements in pain and function following ozone therapy. However, substantial heterogeneity in study design, treatment protocols, and outcome measures limits comparability. Critically, many trials report statistically significant differences that do not consistently exceed the minimal clinically important difference (MCID) for pain and disability indices, and no trial has validated the proposed Nrf2-mediated mechanism in human tissue at clinically administered doses. Conclusions: Current evidence suggests that ozone therapy may exert biologically plausible effects through hormetic redox modulation and may provide symptomatic benefit in selected patients with degenerative musculoskeletal diseases. Nonetheless, the lack of standardized protocols, high-quality long-term data, and mechanistic biomarker validation warrants cautious interpretation. Ozone therapy should be regarded as an investigational adjunct rather than a disease-modifying or standalone standard of care. Further rigorous clinical trials integrating mechanistic biomarkers, sham-controlled designs, and standardized methodologies are needed to clarify the therapeutic role and safety profile of ozone therapy in musculoskeletal medicine. Full article

Background: A substantial proportion of patients with chronic migraine (CM) with previous failures among oral standard-of-care migraine medications do not respond to monoclonal antibodies targeting the calcitonine gene related peptide pathway (CGRP-mAbs), leaving limited evidence-based options for subsequent preventive strategies. The present multicentre real-world study evaluated the effectiveness of onabotulinumtoxin-A (BoNT-A) in CM patients with previous CGRP-mAb failure and multiple prior oral preventive failures. Methods: This prospective, observational, non-randomized multicentre study enrolled patients with CM who had failed ≥3 classes of oral preventive treatments and ≥1 CGRP-mAb due to lack of efficacy or intolerance. Participants received BoNT-A according to the PREEMPT “follow-the-pain” paradigm every three months and were followed for 6 months. Co-primary outcomes were change in monthly headache days (MHD) after three and six months and ≥50% MHD responder rates at both time points. Results: Fifty-three patients were analysed (85% female, aged 48.5 ± 15.2 years, range 20–73). Compared to the baseline, at the third month and sixth month, MHD decreased from 22.83 (SD 6.74) to 15.38 (SD 7.91; p < 0.001) and 14.55 (SD 9.35; p < 0.001), respectively. The percentages of participants achieving the response status in MMD at the third month and sixth month were 30% and 45%, respectively. In the third and sixth months, 22 patients (41.5%) and 27 patients (50.9%), respectively, converted from chronic to episodic migraine, while the prevalence of medication-overuse headache decreased from 81.1% of patients at baseline to 45.3% and 43.4%, respectively. Migraine-related impact and disability scores improved over follow-up, alongside improvements in anxiety and depressive symptoms and in migraine-specific quality of life. Conclusions: The present findings support the use of BoNT-A in difficult-to-treat patients with CM following CGRP-mAb failure and provide further evidence that its therapeutic effects may rely on mechanisms that are at least partially distinct from, and potentially complementary to, those of CGRP-targeted therapies. Full article

Workplace violence (WPV) is a major occupational hazard for nurses in Thailand, negatively affecting psychological well-being, professional confidence, and patient care. In this quantitative cross-sectional analytic study involving 415 nurses, 43.61% reported experiencing at least one incident of WPV during the previous 12 months. Verbal abuse (41.20%) and physical violence (13.25%) were the most frequently reported forms, with a higher prevalence observed in urban hospitals than in rural hospitals (53.66% vs. 33.81%). Higher WPV risk was associated with working in medical wards (adjusted incidence rate ratio [Adj IRR] 3.33) and emergency departments (Adj IRR 2.47), caring for male-only patients (Adj IRR 1.87), younger age (Adj IRR 3.31), divorced or separated status (Adj IRR 3.05), rotating day and night shifts (Adj IRR 2.03), and extreme concern about WPV (Adj IRR 4.57). The psychological impact was considerable. Hypervigilance was the most common response (66.30%), especially following physical violence (76.36%). More than 41% of affected nurses reported intentions to resign or transfer and reduced professional confidence. Reporting incidents was often perceived as ineffective, contributing to underreporting. Nurses identified clear disciplinary measures, increased staffing, improved workplace environments, stronger security systems, and organizational support as key prevention priorities. These findings highlight the urgent need for context-specific interventions, targeted staff training, and organizational strategies to protect nurse well-being, strengthen workforce resilience, and maintain quality patient care. Full article

Background/Objectives: Prepectoral implant positioning has become an established option for implant-based breast reconstruction (IBBR) following a mastectomy. The impact of the implant position on the selected implant pocket thickness and the presence of residual fibroglandular breast tissue (RFGT) has yet to be determined. Methods: Patients following an IBBR between 2013 and 2017 at the Department of Obstetrics and Gynecology, Medical University of Vienna, Austria, and with an available archived breast MRI were identified through a retrospective chart review. Breast MRIs were reevaluated using Osirix. Results: A total of 14 patients (23 breasts) with prepectoral and 30 patients (45 breasts) with retropectoral breast implants were included. A reduction in the postoperative skin and subcutaneous tissue thickness compared to preoperative measurements was found in both cohorts, reaching statistical significance in the prepectoral subgroup (medially p = 0.001, laterally p = 0.044). Significantly higher RFGT volumes were present in the prepectoral compared to the retropectoral cohort (p = 0.026). This difference remained significant after accounting for unevenly distributed subgroup characteristics. In the retropectoral cohort, a significant reduction in the postoperative compared to preoperative thickness of the pectoralis major muscle (PMM) was observed (p < 0.001). The PMM only accounted for 30% of the implant pocket covering the breast implant. Conclusion: Prepectoral IBBR was associated with higher volumes of RFGT and a significant reduction in postoperative skin and subcutaneous tissue thickness compared with retropectoral reconstruction. These findings suggest that implant position may influence the quality of the implant pocket and underscore the importance of careful surgical planning and meticulous dissection. Further studies are warranted to determine the clinical significance of these findings with regard to oncologic and reconstructive outcomes. In retropectoral reconstruction, marked postoperative atrophy of the PMM was observed, raising questions about the long-term advantages of this reconstructive approach. Full article

Artificial intelligence (AI) tools are being used in pharmacy practice in a variety of ways, such as enhancing the safety and efficiency of dispensing, compounding medications and helping pharmacists identify drug–drug interactions. The further development and use of these innovative technologies will be necessary to ensure patients can continue to access high-quality care amidst a growing health human resource crisis. However, in the field of pharmacy practice, little is known about actual or potential risks these tools pose to patients. A scoping review was conducted to map these risks. A database search of Ovid Medline, Ovid Embase, Ebsco CINAHL, and Web of Science, and a grey literature search were conducted. Three major potential risks were described in the literature: inaccuracies associated with AI outputs, privacy and data security concerns, and risks associated with algorithmic bias. Despite these potential risks, there is still a large gap in the literature regarding the study of risks of AI in pharmacy practice. While characterizing all risks associated with this rapidly changing technology may be impossible, further exploration of risk, perhaps using novel approaches to understanding risk itself, is warranted if these technologies are to be adopted responsibly and used safely. Full article

The NHS-funded Common Ailments Service (CAS) in Wales enables community pharmacists to manage 28 common ailments by providing advice and/or medication free of charge without the need for patients to book an appointment. The aim of this study was to evaluate the patient experience of the CAS using patient reported experience measures (PREMs) and determine the feasibility of digital data capture collected directly from patients through a pharmacist-led manual recruitment model. The study used prospective, primary data collected through an online survey accessible via a Quick Response code and census recruitment. A total of 3660 surveys were included in the analysis, completed between 27 October 2025 and 31 March 2026. Overall experience was rated as excellent by 95.1% of participants. A theory-based framework analysis of 1499 free-text comments across the six domains of healthcare quality confirmed the high standard of care provision, primarily influenced by consultation quality, convenience, accessibility, and short waiting times. It also identified targeted areas for improvement, such as the need for seamless referrals from other areas of primary care and consistent availability of the service across all pharmacies. While digital PREMs captured high-quality insights, the pharmacist-led recruitment model reached a “feasibility ceiling”, with an overall response rate of 3.2%. Full article

Objectives: Alopecia areata (AA) is a widespread autoimmune condition causing non-scarring hair loss, significantly affecting the quality of life. Despite its prevalence, data on diagnostic and treatment efficacy and the quality of patient care in Poland remain unstudied. The aim of this study was to assess the current clinical approaches to the diagnosis and management of alopecia areata by dermatologists in Poland and to highlight the challenges encountered by Polish patients. Methods: A cross-sectional study was conducted regarding dermatologists and AA patients in Poland. The data were gathered from distinct proprietary surveys: an original questionnaire for doctors, and DLQI, CDLQI, AAPPO, WPAI+CIQ:AS, and SF-36 questionnaires for patients. Results: The study included 100 dermatologists and 252 patients from Poland. The study revealed that the care provided to patients with alopecia areata is inadequate and lacks a comprehensive approach, despite the negative disease impact on patients’ quality of life. A number of physicians do not follow the diagnostic and treatment guidelines. Despite the registration of next-generation treatments like Janus kinase inhibitors, access to these medications remained limited until recently. Conclusions: Alopecia areata in Poland poses significant diagnostic, therapeutic, and psychosocial challenges. While clinical practice largely aligns with international recommendations, notable gaps remain in the use of validated severity tools, psychosocial assessment, and access to advanced therapies. The recent reimbursement of ritlecitinib represents a breakthrough, bringing Polish care in line with global standards. However, optimal management requires not only pharmacological advances but also interdisciplinary strategies integrating psychological support, patient advocacy, and public education to reduce stigma and improve overall quality of life for affected individuals. Full article

Background/Objectives: Collaboration between physicians and community pharmacists (CPs) is important for ensuring high-quality healthcare delivery. However, evidence on physician–CP collaboration in Jordan remains limited, and no studies have specifically examined physicians’ perspectives on collaboration with CPs. This study aimed to explore physicians’ experiences and attitudes towards collaboration with CPs, their views on the impact of such collaboration on patient care, and their perceptions of CPs’ professional roles. Methods: Between January and March 2025, a cross-sectional survey was conducted among 380 physicians in Amman, Jordan, using convenience sampling. A five-section self-administered questionnaire was used to collect the data. Data were analysed using descriptive and inferential methods in SPSS version 28. Results: Of the 380 physicians directly invited to participate, 209 completed the questionnaire. All participants reported previous collaboration with CPs, although the frequency varied. Nearly half of the participants reported that collaboration occurred sometimes (47.4%, n = 99). Physicians perceived that CPs only sometimes had adequate clinical skills (59.3%, n = 124), confidence (61.2%, n = 128), or knowledge (65.6%, n = 137) to deliver effective patient care. Most physicians (>74%) demonstrated positive attitudes towards collaboration with CPs, particularly regarding communication, mutual respect, and shared goals in patient care. Nevertheless, neutral attitudes were reported towards trust in CPs’ professional decisions (42.1%, n = 88), meeting professional expectations (33.0%, n = 69), and therapeutic expertise (46.9%, n = 98). Almost all physicians agreed that collaboration with CPs could improve patient outcomes (98.1%, n = 205) and continuity of care (89.0%, n = 186). Physicians also expressed positive perceptions of CPs’ professional roles, mainly in improving medication adherence (91.9%, n = 192). Significant overall differences in attitude (p = 0.035) and perception (p = 0.025) scores were observed according to physicians’ job description; however, post hoc analysis identified a significant pairwise difference only for perception scores between general practitioners and specialists. Conclusions: This study found that the majority of physicians reported previous collaboration with CPs and generally held positive views and attitudes towards collaborative practice. However, uncertainty regarding CPs’ expertise and decision-making abilities suggests the necessity of professional role clarification and trust-building. These findings should be interpreted in the context of a convenience sample of physicians practising in Amman, predominantly in the private sector, and should not be generalised to all physicians in Jordan. Future research exploring CPs’ perspectives on collaboration with physicians is needed to support the findings of this study. Full article

Background/Objectives: Long COVID is characterised by persistent symptoms such as fatigue, pain, cognitive impairment, sleep disturbances, and reduced quality of life (QoL) following SARS-CoV-2 infection. Proposed mechanisms include persistent immune activation, chronic inflammation, oxidative stress, endothelial dysfunction, mitochondrial disturbances, and virus-induced cellular senescence. Current management is largely supportive, highlighting the need for complementary strategies targeting these pathways. Natural polyphenols such as quercetin and curcumin possess anti-inflammatory, antioxidant, immunomodulatory, and potential senolytic properties that may modulate multiple pathways implicated in Long COVID. This study aimed to explore the potential complementary effects of oral quercetin–curcumin co-supplementation, administered alongside usual symptomatic management, in adults with persistent Long COVID symptoms. Methods: This single-centre, open-label, single-arm, pragmatic exploratory study enrolled 15 adults with Long COVID in an outpatient real-life clinical practice setting. Participants received a nutraceutical formulation containing quercetin (65 mg) and Curcuma longa extract standardised to provide 42 mg curcumin (Nasafytol^®), administered as two capsules twice daily for 8 weeks in addition to standard care. The primary endpoint was change in overall symptom burden assessed using the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS). Secondary outcomes included fatigue (Fatigue Severity Scale, FSS), pain (Brief Pain Inventory—Short Form, BPI-SF), cognitive function (Patient-Reported Outcomes Measurement Information System Cognitive Function Short Form 8a, PROMIS-CF-8a), mood (Hospital Anxiety and Depression Scale, HADS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), autonomic symptoms (Composite Autonomic Symptom Score-31, COMPASS-31), and health-related QoL (Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36). Results: After 8 weeks, overall symptom burden significantly decreased (C19-YRS median 50 to 32; q = 0.018). Significant reductions were observed in patient-reported fatigue (q = 0.006), pain severity and interference (q = 0.006), and improved physical health-related QoL (SF-36 PCS; q = 0.025). Numerically favourable changes were also observed in cognitive function, anxiety, sleep quality, and autonomic symptoms, although these did not reach statistical significance. The supplementation was generally well tolerated with no serious adverse events. Conclusions: Quercetin–curcumin co-supplementation was associated with lower patient-reported symptom burden, fatigue, and pain and better physical health-related QoL after 8 weeks of supplementation in adults with Long COVID. These observed findings represent treatment-associated changes within this uncontrolled exploratory study and should be interpreted cautiously. Further evaluation in adequately powered randomised placebo-controlled trials is warranted. Trial registration: ClinicalTrials.gov (ID NCT06974058). Full article

Background/Objectives: This study compared medication safety gaps across outpatient and inpatient care among older adults using explicit prescribing-quality criteria. Methods: We conducted an analytical cross-sectional study based on a retrospective review of 157 medical records from adults aged ≥ 60 years treated at Hospital Carlos Monge Medrano, a public referral hospital in Juliaca, Peru, in 2024. Stratified probability sampling included 73 outpatient and 84 inpatient records. Primary outcomes were Beers-defined potentially inappropriate medications, Screening Tool of Older Persons’ Prescriptions (STOPP)-defined potentially inappropriate prescribing, and Screening Tool to Alert to Right Treatment (START)-defined potential prescribing omissions. Overall medication safety gaps were assessed as a secondary exploratory composite outcome. Crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) were estimated using modified Poisson regression with robust variance. Results: Overall medication safety gaps were identified in 79.0% of participants. START-defined omissions occurred in 52.9%, STOPP-defined inappropriate prescribing in 49.7%, and Beers-defined potentially inappropriate medications in 46.5%. Compared with outpatient care, hospitalization was associated with a lower prevalence of STOPP-defined inappropriate prescribing (adjusted PR = 0.74; 95% CI: 0.55–0.99) and a higher prevalence of START-defined omissions (adjusted PR = 1.39; 95% CI: 1.04–1.86). Polypharmacy and multimorbidity were independently associated with the composite outcome. Conclusions: Medication safety gaps were common but differed by care setting. Outpatient care showed more high-risk or insufficiently reviewed prescribing, whereas inpatient care showed more therapeutic omissions. These findings support prospective evaluation of medication review, reconciliation, deprescribing, and reassessment of omitted therapies in similar public referral settings. Full article

Low back pain (LBP) is the leading cause of years lived with disability globally, and a major rehabilitation priority, yet nursing education often does not translate burden evidence into first-contact actions across care settings. This article aimed to develop a nursing education and practice framework that converts global LBP evidence into competencies for assessment, education, medication safety, referral, follow-up and occupational prevention. A focused, Global Burden of Disease-informed narrative review and practice-oriented educational synthesis was conducted. PubMed/MEDLINE, CINAHL, Scopus, Google Scholar, and organisational sources were searched for burden estimates, clinical guidelines, pain education scholarship, nursing occupational health evidence and nurse-led self-management literature. Sources were selected for relevance to nurse-deliverable actions and curriculum assessment; systematic-review methods, meta-analysis and formal risk-of-bias appraisal were not used. Evidence was mapped iteratively to six nursing practice domains: red-flag triage and escalation; functional, psychosocial and contextual assessment; brief therapeutic education; medication safety and low-value-care reduction; follow-up and referral; and occupational prevention. The revised framework adds an explicit evidence-to-competency map, implementation guidance and evaluation indicators for undergraduate education, postgraduate training, continuing professional development, clinical supervision and quality improvement. LBP should be taught as a nursing-sensitive disability and rehabilitation priority, supporting nurses to screen for danger, validate pain, reduce threat, promote graded activity, monitor medicines, coordinate continuity and prevent occupational harm. Full article

Background: Fibromyalgia is a chronic pain syndrome in which treatment effectiveness may be influenced by biological, psychological, social, and nutritional factors. This study aimed to identify clinical, psychosocial, nutritional, and selected individual factors associated with patients’ perceived overall treatment effectiveness among women with fibromyalgia. Specifically, we examined whether fibromyalgia symptom severity, psychological and social quality of life, diet quality, vitamin D₃ supplementation, treatment duration, and selected individual characteristics were associated with patients’ perceptions of treatment effectiveness. Methods: A cross-sectional online study included 195 women with physician-diagnosed fibromyalgia who reported using medications and/or supplements. Fibromyalgia severity (FAS, FIQR), quality of life in psychological and social domains (WHOQOL-BREF), diet quality (pHDI, nHDI, DQI), vitamin D₃ supplementation, and treatment duration were assessed. Cluster analysis and hierarchical linear regression were performed to identify factors associated with self-perceived treatment effects. Results: Women reporting lower treatment effects presented greater symptom severity, higher FIQR scores, and lower quality of life in psychological and social domains. No significant differences were observed according to age, BMI, diet quality, or self-reported daily vitamin D₃ supplementation. In the final regression model, treatment duration (β = 0.246; p < 0.001), quality of life in the psychological domain (β = 0.173; p = 0.035) and social domain (β = 0.158; p = 0.039), and symptom severity (β = −0.196; p = 0.041) independently predicted self-perceived treatment effects. Conclusions: Better psychological and social well-being, lower symptom severity, and longer treatment duration were associated with higher perceived treatment effectiveness, whereas neither diet quality nor self-reported daily vitamin D₃ supplementation was associated with this outcome. These findings support a multidisciplinary biopsychosocial model of care integrating nutritional, medical, psychological, and social interventions. Full article

Care transition comprises integrated actions that ensure individualized, multidimensional care and became especially relevant after COVID-19 due to complications, readmissions, and fragmented healthcare delivery. The aim this study was to assess care transition care quality for post-COVID-19 patients using the Care Transition Measure (CTM-15) and its association with sociodemographic and clinical variables. This cross-sectional quantitative study included 176 post-COVID-19 patients or caregivers from a Brazilian public hospital (2020–2021). Data were collected by telephone within 30 days after discharge using a sociodemographic/clinical questionnaire and the CTM-15. The results demonstrated that care transition quality was rated as satisfactory. The highest scores were observed in health management preparation and the lowest in understanding medications. Better evaluations were associated with younger age, higher income, influenza diagnosis, and non-smoking status, whereas diabetes and chronic obstructive pulmonary disease negatively influenced care plan scores. In conclusion, care transition quality was satisfactory and influenced by sociodemographic and clinical factors, highlighting the importance of individualized discharge planning. Full article

Walking recovery is a central goal of geriatric rehabilitation, but it is shaped by multiple interacting factors rather than by muscle impairment alone. This mini-review examines whether sarcopenia-related weakness, low muscle quality, and reduced physical reserve identify a clinically important vulnerability phenotype relevant to delayed gait recovery in older adults after hospitalization, hip fracture, surgery, or cardiac procedures. We summarize current consensus definitions of sarcopenia, explain why muscle strength and physical performance are often more clinically informative than muscle mass alone, and review the mechanistic pathways that may connect sarcopenia with impaired walking, including anabolic resistance, inflammation, disuse, neuromuscular remodeling, trunk weakness, and cognitive–emotional modifiers. Across community, orthogeriatric, post-acute, and cardiac rehabilitation settings, sarcopenia markers are generally associated with slower gait or poorer attained mobility; however, findings for change in mobility are inconsistent, and most available studies are observational, heterogeneous, or indirect. Sarcopenia should therefore be interpreted as one potential marker of reduced reserve and mobility risk rather than as a determinant of walking recovery or evidence that sarcopenia-aware rehabilitation improves outcomes. Future work should use more consistent diagnostic frameworks and test whether a sarcopenia-aware rehabilitation integrating early strength assessment, individualized nutrition care, and multicomponent gait rehabilitation improve walking outcomes in medically complex older adults beyond current standards of care. Full article