Search Results (12,265)

Introduction: Pain is one of the most common reasons why patients seek medical care, and chronic pain is now recognized as a major health problem worldwide. Better understanding of pain mechanisms has shown the importance of distinguishing nociceptive, neuropathic, and nociplastic pain in order to choose the most effective treatment. In recent years, topical analgesics have gained increasing attention because they can provide pain relief directly at the site of application while reducing systemic exposure and the risk of adverse effects. This is especially important in older adults, patients with multiple diseases, and those exposed to polypharmacy. Methods: This narrative review presents the current knowledge on the pharmacology, efficacy, and safety of topical drugs used in pain treatment. Particular attention is given to topical non-steroidal anti-inflammatory drugs (NSAIDs), lidocaine, capsaicin, menthol, and camphor. The review also discusses newer and less established therapies used mainly in neuropathic pain, including topical ketamine, amitriptyline, phenytoin, gabapentin, and clonidine. A structured, non-systematic literature search was conducted using the PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases to identify studies evaluating the efficacy and safety of topical analgesic therapies. Results: Current evidence supports topical NSAIDs as first-line therapy for localized musculoskeletal pain and osteoarthritis, while lidocaine and high-concentration capsaicin patches are effective options in focal neuropathic pain. Although several newer topical therapies show promising results, more high-quality clinical studies are still needed. Overall, topical analgesia is an important part of multimodal pain management because it combines analgesic efficacy with a better safety profile compared with many systemic therapies. Conclusions: Taking the aspects discussed in this paper into account, it seems justified to search for new drug combinations that would contribute to effective pain therapy with topical agents. It is recognized that a multimodal approach to pain management, which utilizes drugs with different mechanisms of action, can increase efficacy and reduce the systemic adverse events of the drugs used. The effective and safe treatment of patients with pain, especially neuropathic pain, despite emerging new clinical trials, remains a challenge for clinicians. Full article

Positive Leadership in Higher Education is a key process; however, its connection to the mental health and quality of life of women in leadership roles at universities has been explored only to a limited extent. This study aimed to analyze the structural relationships between positive leadership, positive mental health, and quality of life in women university leaders, and to explore the lived experiences and coping strategies that explain these associations. A mixed-methods explanatory sequential design (QUAN → qual) was employed. 45 women holding senior administrative positions in Peruvian universities completed three standardized scales. The quantitative results reveal that positive leadership significantly predicted positive mental health, which in turn strongly explained quality of life, confirming a partial mediation model. The qualitative results highlighted persistent psychosocial and structural challenges—gender bias, the glass ceiling, role overload, institutional pressure, impostor syndrome, and isolation—alongside coping strategies focused on self-care, emotional regulation, purpose-driven leadership, empowerment, sorority, and organizational transformation with a gender perspective. Positive leadership emerges as a key organizational resource that enhances women’s mental health and quality of life. Institutional cultures grounded in inclusion, care, and relational leadership are essential for sustainable and transformative women’s leadership in higher education. The WISE: Women Integrated for Sustainable Empowerment is presented as a practical action guide for positive female leadership. Full article

Maternal mortality is a serious public health problem and reflects social, ethnic, racial, and regional inequalities in access to and quality of obstetric care. Despite advances in the surveillance and investigation of maternal deaths in Brazil, late maternal deaths (occurring between 43 days and 1 year after birth) are still underestimated and underexplored. Therefore, the objective of this study was to analyze the distribution and factors associated with maternal deaths and late maternal deaths in Brazil between 2010 and 2023. This was a population-based, retrospective cohort study with a quantitative approach, using secondary data from the Mortality Information System. All maternal deaths (Chapter XV of ICD-10) and late deaths recorded during the period were included. Sociodemographic, clinical, and administrative variables were analyzed. Statistical tests of association (chi-square, test of proportions, and 95% CI) were used, with a significance level of 5%. A total of 26,953 deaths were identified, of which 24,387 were maternal and 2566 were late deaths. Most deaths occurred among single, mixed-race women with 8 to 11 years of schooling, and residing in the Southeast region. Late deaths were more frequent in the South and among women aged 40 to 49. The main causes were direct obstetric conditions. A statistically significant association was observed between the type of death and sociodemographic variables. The results highlight structural inequalities in maternal mortality in Brazil and reinforce the importance of expanding postpartum surveillance beyond 42 days, with a focus on equity and continuity of care. Full article

Background: Misinformation, disinformation, and a lack of information about abortion impede access. Mystery shopping designs are well-suited for evaluating the availability, accuracy, and quality of health services. However, we lack understanding of their use in abortion research. Methods: Our team conducted a scoping review to synthesize evidence of mystery shopping methods in abortion research internationally. We followed the JBI methodology for scoping reviews and engaged the expertise of a clinical research librarian. We included all English and French language studies of abortion using mystery shopping methods (phone, in person, or other). We did not limit the search by date range or jurisdiction. Results: We included 40 studies in our review, published between 2006 and 2025. Settings included 13 countries: USA (13), India (5), Canada (3), Mexico (3), Turkey (3), Bangladesh (2), Colombia (2), Ghana (2), Indonesia (2), and one each in Kenya, Nepal, Tanzania, Zambia, and Latin America. Methods included calls (20), in-person visits (18), texts/online messages (3), and combinations of mystery shopping with interviews/surveys (7) and systematic online searching (2). Themes included service availability and information quality, with seven subthemes, which we mapped to elements of the Levesque framework of patient-centred access: Approachability; acceptability; availability and accommodation; affordability; and appropriateness. Conclusions: Where abortion is decriminalized, efforts to improve abortion can prioritize Levesque’s concepts, such as ensuring care is affordable, culturally safe, and geographically proximal. Mystery shopping can proxy patient experience and be used as a validity check, such as comparing health professionals’ self-reported practice with that experienced by mystery shoppers. Full article

Introduction: As diabetes care becomes increasingly digitalized, stratified, and differentiated, psychosocial vulnerability risks becoming less visible within routine care and documentation. To ensure that differentiated care pathways meaningfully incorporate psychosocial stratification, vulnerability must be identifiable, documented, and revisited as part of routine clinical practice. Aim: The aim of this study is to explore how healthcare professionals identify psychosocial vulnerability in routine diabetes care and how such vulnerability is documented and followed up in the electronic medical record (EMR). Methods: This quality improvement audit with a descriptive analysis component was conducted at Steno Diabetes Center Copenhagen as part of the development of a new differentiated outpatient pathway. Healthcare professionals across disciplines submitted cases of persons with diabetes whom they considered psychosocially vulnerable. Documentation from the preceding six months was reviewed descriptively in order to find patterns of identification, documentation, care planning, and follow-up. Results: A total of 334 referrals representing 275 unique persons with diabetes were submitted. Psychosocial vulnerability extended beyond predefined high-risk categories, as 37% of identified cases did not align with any of the six vulnerability groups described in the Danish VIVE framework. Vulnerability often reflected cumulative everyday-life strain rather than formal diagnoses. While healthcare professionals demonstrated substantial relational attentiveness to psychosocial concerns, this knowledge was not consistently evident in formal documentation. Explicit care plans and longitudinal follow-up were uncommon, and psychosocial concerns were frequently documented as isolated observations rather than as part of structured ongoing care. Conclusions: Psychosocial vulnerability was frequently identified through clinical dialogue and professional judgement and often extended beyond predefined vulnerability categories. The findings highlight the importance of developing shared approaches and a shared understanding of psychosocial vulnerability across professional groups. If psychosocial stratification is to become an operational component of differentiated diabetes care, information about what burdens matter to the person must be identifiable, documented, and carried forward across encounters alongside biomedical information. Full article

The paradigm shift in early childhood education from custodial care to development-centered environments underscores the importance of kindergarten indoor activity spaces. However, how spatial configuration influences children’s embodied behaviors remains underexplored, particularly in cold-arid regions of western China, where prolonged indoor periods amplify the significance of interior spatial quality. Integrating embodied cognition and affordance theories, this study develops a coupling framework linking spatial metrics with behavioral outcomes. A mixed-methods approach combined 196 parent and 36 teacher questionnaires with space syntax analysis across three typical kindergartens in Lanzhou, China. Visual Integration [HH] was positively correlated with physical movement (r = 0.52, p < 0.01) and negatively correlated with solitude (r = −0.52, p < 0.01); Connectivity was positively associated with sensory exploration (r = 0.42, p < 0.05). Coupling coordination degrees ranged from 0.689 to 0.856, revealing a “high coupling, imbalanced development” pattern, with privacy affordance as a notable shortfall in the wide-corridor typology. The older courtyard-style kindergarten surpassed the newly built one (0.856 vs. 0.838) despite lower facility quality. Parent satisfaction depended more on spatial richness (r = 0.61) than on facility quality (r = 0.47). Spatial configuration shapes embodied behaviors through layout-specific affordances. An evidence-based optimization framework is proposed for kindergarten design in cold-arid climate zones. Full article

Background: Pre-travel health consultations require individualised risk assessment across itinerary, destination, traveller characteristics, vaccine and medication history, comorbidities, pregnancy and immune status, activities, and access to care. Artificial intelligence (AI), particularly large language models (LLMs), may support pre-consultation education, structured history collection, guideline retrieval, multilingual communication and post-consultation reinforcement, but unsafe use may introduce hallucinated, outdated or insufficiently personalised recommendations. Objectives: This scoping review maps the current evidence on AI tools relevant to pre-travel health consultations, characterises implementation gaps, identifies patient-safety risks and proposes a supervised implementation model for travel medicine clinics. Original contribution: Unlike previous reviews of clinical AI, patient-education LLMs or chatbots in chronic illness, this is the first scoping review focused specifically on AI in pre-travel consultations. It uniquely combines a five-tier evidence hierarchy that separates direct travel-medicine AI evidence from indirect clinical-AI safety and equity evidence, and provides a travel-medicine-specific clinical safety risk taxonomy and a supervised implementation framework anchored to authoritative travel-medicine guidance and current AI regulatory regimes. Methods: A scoping review was conducted following PRISMA-ScR reporting, using a Population–Concept–Context eligibility framework and a targeted retrieval in May 2026 covering January 2017 to May 2026. Sources were screened and charted by a single reviewer using a structured eligibility checklist. Quality and applicability were appraised conceptually using MMAT, AMSTAR 2 and JBI text-and-opinion criteria, with GRADE-informed certainty. Results: Of 70 records identified, 11 were included: four direct pre-travel AI sources, one adjacent travel-related decision-support study, four guideline and context sources and two clinical LLM safety sources. The only patient-level implementation involved 26 travellers using a GPT-4 Travel Clinic Assistant in Singapore, where physicians and travellers reported acceptability and workflow benefit but objective effectiveness outcomes were not measured. Broader clinical LLM evidence indicates heterogeneous evaluation methods, vulnerability to hallucinated guidelines, and accuracy that varies widely across model versions and specialties. Conclusions: Current evidence supports supervised AI augmentation of pre-travel consultations but does not support autonomous AI-led vaccine selection, malaria prophylaxis, contraindication screening or individualised travel-risk clearance. Near-term deployment should be restricted to clinician-supervised education, structured intake, source-grounded guideline retrieval, after-visit reinforcement and escalation-triggered workflow support. Priority research includes travel-medicine-specific hallucination audits; equity testing in visiting-friends-and-relatives, migrant, older-adult, First Nations Australian, and Pacific Islander travellers; and prospective trials reported under CONSORT-AI, SPIRIT-AI and TRIPOD + AI. Full article

Background: Nutritional deterioration and systemic inflammation frequently accompany gastrointestinal cancers and may negatively affect treatment tolerance, quality of life, and clinical outcomes. This study aimed to evaluate nutritional status, dietary behaviors, inflammatory biomarkers, and multidimensional nutritional–inflammatory profiles in patients with gastrointestinal cancers within the context of tertiary prevention. Methods: A cross-sectional study was conducted among 150 patients with gastrointestinal cancers. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), while dietary behaviors were evaluated using an original questionnaire. Biochemical markers, including albumin, hemoglobin, C-reactive protein (CRP), fibrinogen, and neutrophil-to-lymphocyte ratio (NLR), were evaluated in participants with available laboratory data. Exploratory hierarchical clustering analysis was performed to identify multidimensional nutritional–inflammatory profiles. Results: According to the MNA classification, 79.3% of participants were at risk of malnutrition and 2.0% were malnourished despite predominantly normal or excessive body weight. Nutritional risk was identified in 91.4% of patients with normal BMI and in 79.5% of overweight patients. Only 32.0% of patients reported receiving dietary counseling during treatment, while oral nutritional supplements and therapeutic diets were used by 40.7% and 41.3% of participants, respectively. Biochemical analyses revealed elevated inflammatory markers accompanied by reduced albumin concentration and anemia-related abnormalities. Exploratory clustering analysis suggested three distinct nutritional–inflammatory profiles (Stable/Supported, Hidden Malnutrition, and Inflammatory Deterioration), highlighting metabolic heterogeneity within the study population. Conclusions: Patients with gastrointestinal cancers frequently present nutritional risk accompanied by inflammatory activation despite preserved or excessive body weight. A multidimensional assessment integrating nutritional screening, dietary evaluation, inflammatory biomarkers, and exploratory profile-based clustering may improve understanding of nutritional heterogeneity in gastrointestinal cancer patients and may support future research on individualized nutritional assessment and supportive care. Full article

Background: The nursing process provides a structured framework for delivering safe, holistic, and patient-centered care; however, its implementation in primary healthcare settings, particularly in low-resource systems, remains inconsistent due to limited training and institutional support. Objectives: This study aimed to evaluate the effectiveness of a structured educational intervention in improving nurses’ knowledge and practical competencies in applying the nursing process in primary healthcare centers in Vlora, Albania. Methods: A quasi-experimental study was conducted with 32 nurses from five public primary healthcare centers. Sixteen nurses received a structured training program consisting of theoretical instruction and case-based practice, while sixteen nurses served as a control group. Pre- and post-intervention assessments were performed using standardized questionnaires and skill evaluation tools, and differences were analyzed using nonparametric statistical tests. Results: The results showed clear improvements in the intervention group across all domains, after the training. The reported use of the nursing process increased from 62.5% to 100%, while the use of Gordon’s Functional Health Patterns increased from 6.3% to 93.7%. The use of NANDA nursing diagnosis increased from 62.5% to 100%. The proportion of nurses reporting written nursing care plans increased from 62.5% to 93.7%, and the implementation and evaluation of care plans increased from 62.5% to 100%. The control group showed no comparable progress. Nurses who participated in the training also reported increased confidence and consistency in applying the nursing process in daily practice. Conclusions: These findings suggest that structured, competency-based training programs may improve immediate nurses’ theoretical knowledge and practical skills. Such training may contribute to improving the quality of nursing care, but further studies and longer follow-up and patient-related results are needed. Full article

Background: Total knee arthroplasty (TKA) is a common procedure to relieve pain and restore function in osteoarthritis patients. Postoperative rehabilitation is essential to address pain, swelling, reduced range of motion, and functional limitations. Hydrotherapy, using water buoyancy and resistance, may enhance recovery, but evidence on its effectiveness after these surgeries remains limited. Methods: A systematic literature search was conducted across six databases: PubMed, ProQuest, Science Direct, Google Scholar, Scopus, the Cochrane Library, and PEDro, covering studies published up to 30 November 2025. Only prospective randomized controlled trials were considered for inclusion. Studies such as case reports, uncontrolled case series, and those focused on outcomes other than postoperative pain and decreased muscle strength in patients undergoing total knee arthroplasty were excluded. This review was registered in PROSPERO (CRD420251164054). Results: Pooled analysis showed no statistically significant difference between hydrotherapy and land-based or usual-care rehabilitation in Visual Analogue Scale (VAS)-measured pain (MD ≈ −0.35; 95% CI $[-1.06, 0.36]$; $p=0.34$) or in WOMAC pain (MD ≈ −0.46; 95% CI $[-8.50, 7.58]$; $p=0.89$). In contrast, hydrotherapy produced a moderate, statistically significant improvement in lower-limb muscle strength (Hedges’ $g=0.46$; 95% CI $[0.23, 0.69]$), particularly in knee extensor and hip abductor strength. Heterogeneity was low for VAS pain and muscle strength but substantial for WOMAC pain ($I^2\approx 71\%$), and no evidence of publication bias was identified. Conclusions: Hydrotherapy did not reduce postoperative pain more than land-based exercise or usual care; pain relief was comparable between approaches, whereas hydrotherapy yielded greater gains in muscle strength. Heterogeneity in treatment parameters and the limited number of high-quality trials preclude definitive conclusions; future research should standardize hydrotherapy protocols and investigate long-term outcomes. Full article

Background/Objectives: Chronic dermatological conditions increasingly require complex and patient-centered therapeutic management, including biologic therapies, injectable treatments, and multidisciplinary care. In this context, patient-reported experience measures (PREMs) may provide valuable insight into the quality and effectiveness of pharmacist-delivered care. This study aims to translate, culturally adapt, and evaluate the psychometric performance of the Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0) as a patient-reported experience measure in Romanian patients with chronic dermatological conditions. Methods: A cross-sectional validation study was conducted in community pharmacies across Romania (N = 220). The questionnaire was translated using a structured forward-translation and expert review process, in accordance with ISPOR and COSMIN recommendations. Internal consistency was assessed using Cronbach’s alpha and item-level statistics. Construct validity was examined using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and bifactor modeling. Known-groups validity and floor and ceiling effects were also evaluated. Results: The Romanian PSPSQ 2.0 demonstrated excellent internal consistency (α = 0.978; subscales α = 0.961–0.969). EFA indicated a dominant single-factor structure, explaining 84.0% of the variance. In CFA, the original three-factor model showed excellent relative fit (CFI = 0.999, TLI = 0.999), although RMSEA indicated some model misfit (0.109). Bifactor analysis revealed a strong general satisfaction factor, with consistently high loadings (0.80–0.99), suggesting that most item variance is attributable to a global patient satisfaction construct. These findings support the use of the instrument as a global measure of patient experience within contemporary dermatologic care pathways. Conclusions: The Romanian version of the PSPSQ 2.0 demonstrates excellent reliability and acceptable construct validity as a PREM for assessing patient satisfaction with pharmacist services. The findings support the use of total scores as a robust indicator of patient experience, while domain-level interpretation should be approached with caution due to substantial overlap between dimensions. This instrument may support the integration of patient-reported measures into routine evaluation of pharmaceutical care. Full article

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women’s nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women’s experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women’s experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating “good motherhood”; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support. Full article

Background/Objectives: Chronic heart failure (CHF) is a leading cause of global morbidity and mortality, particularly among older adults, significantly impacting their quality of life and imposing a substantial economic burden. While pharmacological and surgical treatments remain essential, non-pharmacological interventions led by nurses are gaining prominence due to their comprehensive approach and biopsychosocial impact. The objective of this study was to synthesise and integrate such interventions for community-dwelling older adults with CHF. Methods: An integrative review was conducted in accordance with the Joanna Briggs Institute protocols and the PRISMA statement, utilising a systematic search across databases including PubMed and Cochrane. Qualitative, quantitative, and mixed-methods studies evaluating non-pharmacological interventions in the home setting were included, whilst those targeting non-specific populations were excluded. Following a rigorous screening process, 12 studies were selected, and their methodological quality was appraised based on study design. Results: The 12 included studies involved a total of 2466 participants and addressed interventions across the domains of education, physical activity, telehealth, and nutrition, with programme durations ranging from 4 weeks to 16 months. Notable improvements were observed in physical capacity, cognitive function, quality of life, and self-care capabilities, alongside potential reductions in hospitalisations reported in some studies. However, considerable methodological variability was identified across the literature. Conclusions: This review synthesises non-pharmacological nursing interventions for older adults with CHF, demonstrating varied benefits across multiple biopsychosocial domains. The findings emphasise the critical need for further research to evaluate the economic viability of these programmes and to adapt interventions to enhance the delivery of community-based care. Full article

While total knee arthroplasty (TKA) is highly successful, wear, primary fixation stability and structural failure remain significant challenges, particularly in patients with diverse kinetic profiles and compromised bone. This study evaluates a fixed-bearing cruciate-retaining TKA prosthesis under extreme load variability in healthy and osteoporotic bone. Finite element simulations utilized ISO-standardized baseline gait cycle, scaling independently axial forces, antero-posterior forces, and rotational torque to 50% and 200%. Polyethylene insert stress, tibial stress, and bone–implant micromotion were evaluated to assess structural safety, load transfer, and primary stability. Kinetic variability directly influenced the stress magnitude and load transfer. Insert load distribution revealed a compartmental split (medial side bearing 47.6% to 60.9%) sensitive to force orientation and translational load magnitudes (axial and shear), but totally independent of rotational torque magnitude. While reduced bone quality did not significantly affect overall polyethylene stresses, it directly impacted primary stability. Osteoporotic conditions nearly doubled the total baseline interface micromotion (from 19 µm to 37 µm) and exhibited an absolute maximum of 63 µm under 200% axial load scaling. These findings highlight the necessity of definition of model parameters for careful preclinical planning for patients with compromised bone quality regarding prosthesis selection, fixation method and alignment. Full article