Search Results (85)

Background/Objectives: Complete denture rehabilitation in edentulous patients presents functional and biomechanical challenges. Mini-implant-supported overdentures improve retention, stability, function, and comfort, particularly in complex class II or class III mandibulo-maxillary relationships. However, mechanical complications such as ball abutment wear may compromise long-term success. This case report aims to describe the clinical context, methods employed to manage ball abutment wear, and related complications in a patient with a mandibular mini-implant overdenture. Methods: This retrospective case report presents two approaches to managing abutment wear and enhancing overdenture retention: silicone matrices (Retention.Sil, Bredent Medical GmbH & Co.KG, Senden, Germany) and abutment reconstruction using prefabricated cemented spheres (Concave Reconstructive Sphere, Rhein83, Bologna, Italy). Results: A significant mechanical complication associated with mini-implant overdentures is the wear of ball abutments, which may develop over time as a result of continuous interaction between the O-ring system and the abutment surfaces. Both techniques effectively preserved mini-implants while enhancing denture retention, function, and comfort. Conclusions: Mechanical complications, such as ball abutment wear, may compromise the retention and functional performance of mandibular overdentures. Alternatives like silicone matrices and reconstructive spheres address abutment wear in mandibular overdentures, ensuring long-term retention and sustainable, patient-centered care for the elderly. Full article

As immersive technologies increasingly permeate education and professional training, their cognitive implications for novice learners remain underexplored. This study examines the relative effectiveness of virtual reality (VR)-based instruction compared with conventional teaching modalities in a controlled experimental setting. A total of 106 undergraduate medical students with no prior technical experience were randomly assigned to one of three instructional conditions: (1) PowerPoint-based presentation, (2) real-person demonstration, or (3) immersive VR simulation of a five-axis CNC machine. Participants’ cognitive ability was assessed using Raven’s Progressive Matrices, and their learning styles were measured via the Honey and Mumford questionnaire. Immediate knowledge retention was evaluated through a 20-item multiple-choice test. Results revealed a significant main effect of instructional method on post-test performance (p < 0.001), with the real-person group achieving the highest mean score, followed by PowerPoint and VR groups. IQ was a significant predictor of performance across conditions but did not moderate the effect of instructional method. Gender and learning-style preferences showed no meaningful associations with learning outcomes. The findings suggest that, for novice learners engaging with complex technical content, immersive VR may impose additional cognitive demands that hinder immediate knowledge acquisition. These results contribute empirical support to Cognitive Load Theory and the Cognitive Affective Model of Immersive Learning, emphasizing the need for careful instructional design and cognitive scaffolding in VR-based education. Full article

Objective: To evaluate a 30 h educational program delivered to community health care workers (CHWs) involved in geriatric care within a primary care clinic, measure increase in knowledge, likelihood of using the education, and baseline results of geriatric screenings for patients 65 and older conducted by CHWs in their clinics. Methods: Design, Setting and Participants: This is an evaluation with a two-center, pre–post design study of a 30 h in-person educational program. The program used the Kirkpatrick model to evaluate the educational program. The study used quantitative and qualitative data collection with surveys measuring knowledge, feedback, content, and demographics of the participants and chart reviews to measure clinical implementation of 4Ms discussion. Qualitative data collection included a focus group and open-ended questions in the survey. Thematic analysis from focus groups explored the feedback from the educational program. Results: Twelve community health care workers (average age 40, 90% female) from two federally qualified health centers (FQHC) participated in the 30 h training program. Perceived knowledge improved after the completion of the training. Final exam scores after the training were also significant, indicating an improvement in content retention. Overall, 98% of participants described the training as “Excellent” and 96% rated excellent for the speakers who provided the training. Additionally, 83% suggested they would apply the training in their practice. Approximately 40% of chart reviews indicated the completion of the 4Ms (What Matters, Mentation, Medication, and Mobility) discussion with patients. Thematic analysis yielded two new practice dimensions: care provision and clinical documentation. The training resulted in organizational adaptation with the development of an intake form in the Electronic Health Record (EHR) to document the 4Ms. Conclusion: Results indicate improvement in all dimensions of the training with an emphasis on level 4, indicating wider organization adaptation of 4Ms discussion. Full article

Background/Objectives: Limited access to mental health services contributes to poorer outcomes among individuals with mental health conditions, including major depressive disorder (MDD). Nurse-led interventions serve as a strategic model of care to improve mental health service delivery and enhance patient outcomes. This project aims to co-design a nurse-led telehealth family psychoeducation (FPE) for MDD and primarily assess its feasibility by evaluating the recruitment and retention rates. Methods: A multi-methods study encompassing a co-design phase (Study Phase 1) and a feasibility study (Study Phase 2). Study Phase 1 will involve semi-structured interviews with individuals with MDD and their families or significant others, as well as surveys and focus groups with mental health professionals to develop telehealth FPE for MDD. Study Phase 2 will evaluate the feasibility and acceptability of the intervention, which comprises three biweekly FPE sessions and a six-week follow-up with patient–family dyads using a single-group pre-post design. The primary outcomes comprise the feasibility and acceptability of intervention. Exploratory secondary outcomes include personal recovery, medication necessity beliefs and concerns, antidepressant adherence, and depression severity, measured at baseline, immediately post-intervention, and at 6-week follow-up using validated measures. Data analysis will primarily involve descriptive statistics and thematic analysis. The TIDieR checklist will be followed in reporting the intervention development. Conclusions: Findings from the proposed study will inform the design and protocol for a future randomised trial of telehealth FPE for improving clinical and non-clinical outcomes in MDD. The feasibility study was prospectively registered with the ClinicalTrial.gov on 8 June 2025 (NCT07014241). Full article

Emergency medical services confront significant challenges in delivering timely patient assessments within geographically isolated or disaster-impacted regions. While drones (unmanned aircraft systems, UAS) show transformative potential in healthcare, standardized protocols for drone-assisted patient evaluations remain underdeveloped. This study introduces the ABCD-IN-BARS protocol, a 9-step telemedicine checklist integrating patient-assisted maneuvers and drone technology to systematize remote emergency assessments. A wait-list randomized controlled trial with 68 first-aid-trained volunteers evaluated the protocol’s feasibility. Participants underwent web-based modules and in-person simulations and were randomized into immediate training or waitlist control groups. The ABCD-IN-BARS protocol was developed via a content validity approach, incorporating expert-rated items from the telemedicine literature. Outcomes included time-to-assessment, provider confidence (Modified Cooper–Harper Scale), measured at baseline, post-training, and 3-month follow-up. Ethical approval and informed consent were obtained. Most of the participants can complete the assessment with a cue card within 4 min. A mixed-design repeated measures ANOVA assessed the effects of Time (baseline, post-test, 3-month follow-up within subject) on assessment durations. Assessment times improved significantly over three time points (p = 0.008), improving with standardized protocols, while patterns were similar across groups (p = 0.101), reflecting skill retention at 3 months and not affected by injury or not. Protocol adherence in simulated injury identification increased from 63.3% pre-training to 100% post-training. Provider confidence remained high (MCH scores: 2.4–2.7/10), and Technology Acceptance Model (TAM) ratings emphasized strong Perceived Usefulness (PU2: M = 4.48) despite moderate ease-of-use challenges (EU2: M = 4.03). Qualitative feedback highlighted workflow benefits but noted challenges in drone maneuvering. The ABCD-IN-BARS protocol effectively standardizes drone-assisted emergency assessments, demonstrating retained proficiency and high usability. While sensory limitations persist, its modular design and alignment with ABCDE principles offer a scalable solution for prehospital care in underserved regions. Further multicenter validation is needed to generalize findings. Full article

The vein of Galen malformations (VoGMs) is mainly correlated with the retention of an embryonic pattern of vascularity, inducer of vein of Galen dilation, and formation of arteriovenous communications that give rise to the risk of systemic shunting, causing cardiac dysfunction, vascular steal, and venous hypertension. This is a rare cerebral vascular malformation in the newborn, accounting for 1% of all cerebral arteriovenous malformations and occurring in approximately 1 in 25,000–50,000 live births. We review nine cases of newborns diagnosed with vein of Galen malformations (VoGMs) to assess whether this pathology demonstrates a marked improvement over the past 13 years in diagnostic accuracy, treatment approaches, and patient survival rates within our clinic. Medical treatment was focused on providing inotropic support and tightly controlled peripheral and pulmonary vasodilation with the aim of overriding the effects of high output heart failure. Most of the patients underwent liver failure and flow-mediated pulmonary hypertension, while half of the newborns expressed anomalies of the nervous system due to impaired cerebral hemodynamics. Given the unavailability of endovascular treatment in our unit, which predisposes the newborns to a higher vital risk, we recognize the importance of delivering tailored intensive care aimed at maintaining cardiorespiratory and hemodynamic stability until a curative intervention can be performed in a specialized center. Full article

Background: The European Doctoral Conference in Nursing Science provides a unique platform for doctoral students in nursing and health sciences to present their research in a supportive environment. Celebrating its 20th anniversary, the 2024 conference embraced the motto “looking back and looking forward,” offering an opportunity to reflect on the development of nursing science and future challenges. Results: Held at the Medical University of Graz, Austria, the conference hosted 90 participants from 13 countries. It featured two keynote lectures, three workshops, 48 presentations, and a science slam. Abstract submissions underwent peer review to ensure the quality of presentations. The presentations highlighted key challenges and opportunities across nursing practice, healthcare work environments, education and digitalization in nursing, and health perspectives. Topics included, for example, workforce retention, artificial intelligence in nursing practice, leadership in error management, and culturally sensitive care. The keynotes emphasized the importance of patient and public involvement in research and the benefits of survey data in nursing science. Workshops imparted knowledge and skills regarding funding acquisition, guideline development, and effective research presentation. A science slam introduced innovative and creative ways to present research. Conclusions: The conference showcased the evolving landscape of nursing science, emphasizing the importance of evidence-based practice, supportive working conditions, and constructive collaboration. It demonstrated the enthusiasm and readiness of a new generation of researchers to advance nursing science in a rapidly changing healthcare environment. Full article

Background/Objectives: Family meetings (FMs) are clinical encounters in a structured space between the patient, family members, and care teams. Healthcare professionals (HPs) often lack formal training in conducting FMs. The scoping review aims to provide an overview of the available research evidence on FMs’ education for HPs. Methods: We searched MEDLINE, Embase, CINAHL, PsycINFO, and Scopus. The PCC (Population-Concept-Context) framework was used to define inclusion criteria: educational intervention on FMs aimed at HPs in all settings of care and students of medicine and nursing sciences treating adult patients with oncological and non-oncological diseases. Results: The search retrieved 1017 articles, of which 26 were eligible. The training had as its primary aims the development of communication skills and curriculum development/evaluation. For the most part, palliative care physicians served as trainers, while medical students and residents represented a major part of trainees, underscoring a focus on early-career learners. FM training is mainly provided in the American countries and intensive care settings. Role-play or simulation was the most common teaching method. Pre- and post-interventional designs were the most common, with few studies incorporating longitudinal follow-up to assess skill retention. Quantitative and qualitative methodologies were used to evaluate interventions. Conclusions: The training topics are related to advanced communication, but there is a lack of an interprofessional perspective and long-term assessment of the skills learned. It is necessary to consider different family types as subjects of communication. Full article

General practitioners play a crucial role in the early detection and prevention of cutaneous melanoma. However, structured training on skin cancer diagnosis and management is often lacking. This narrative review aims to map the current educational interventions for general practitioners focused on melanoma, assess their methodological approaches and outcomes, and explore the contribution of e-learning and telemedicine in medical education. A comprehensive literature search identified 54 relevant studies published between 1 January 1995 and 31 December 2024. Data were extracted and categorized by topics covered, training methodology, interactivity, and clinical outcomes. Training programs varied widely in duration, delivery, and content. Interventions that integrated dermoscopy and interactive methodologies demonstrated improved diagnostic accuracy and clinical impact. E-learning, particularly asynchronous models, emerged as a flexible and effective modality, although few studies evaluated long-term retention or clinical practice changes. Educational programs tailored to general practitioners and enriched with dermoscopy and telemedicine tools show promise in improving melanoma detection and care. Structured, interactive, and blended/hybrid learning models should be prioritized to support effective primary and secondary prevention. Full article

Background: Key populations (KPs), particularly female sex workers (FSWs), continue to face significant barriers in accessing HIV-related healthcare services in South Africa. Structural challenges have historically hindered equitable HIV treatment access, worsened by the COVID-19 pandemic. Overburdened clinics, staff shortages, and travel constraints disrupted HIV services and ART adherence. In response, the Differentiated Service Delivery (DSD) model was rapidly scaled up to decentralise care and improve treatment continuity. Objective: To solicit the views of stakeholders regarding their interests, roles and experiences in the implementation of the HIV treatment DSD model among FSWs in South Africa, as well as associated successes and barriers thereof. Methods: We purposively selected and interviewed eight stakeholders, comprising government officials, implementers and sex workers’ advocacy organizations. Thematic analysis was used to explore the perceived impact of DSD models and associated successes and barriers in the current service delivery landscape. Results: The study found that decentralization of DSD models improved access to services for FSWs. However, the criminalization of sex work perpetuates fear and marginalization, while stigma and discrimination within healthcare settings remain significant deterrents to HIV treatment uptake. High mobility among FSWs also disrupts continuity of care, contributing to treatment interruptions and lack of data on loss to follow-up. Participants highlighted the need for legal reform, increased healthcare provider sensitization, and the integration of mental health and psychosocial support in HIV services. Peer-led interventions and digital health innovations, such as biometric systems and electronic medical records, emerged as promising strategies for enhancing patient tracking and retention. Nonetheless, the sustainability of DSD models is threatened by an overreliance on external donor funding and insufficient government ownership. Conclusions: To achieve equitable healthcare access and improved HIV outcomes for KPs, especially FSWs, a multi-pronged, rights-based approach is essential. This must include community engagement, structural and legal reforms, integrated support services, and sustainable financing mechanisms to ensure the long-term impact and scalability of DSD models. Full article

Background: High attrition rates among nursing students, particularly during the sophomore year, threaten the sustainability of the nursing workforce. Objectives: This study assessed structured assessment methods implemented at a School of Nursing located in northern Virginia to improve student success and reduce attrition. Methods: Interventions included a three-tier grading system (Mastery, Intermediate, and Novice), standardized rubrics, detailed instructor guidelines, remediation sessions, and medication competency practice materials. Results: Data from student and instructor feedback surveys and attrition rate comparisons between Spring 2024 and Spring 2025 revealed a reduction in overall attrition of sophomores from 23.5% to 17.3% and from 20% to 12% in the Fundamentals courses. Students reported increased engagement and confidence in foundational core skills, though complex nursing skills care posed challenges. Instructors valued the structure but questioned the suitability of certain skills for sophomores. Conclusions: These findings underscore the value of structured assessments in enhancing retention, with implications for revision of curriculum design in students’ early years of nursing education. Full article

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

Background: Pediatric mitochondrial cytopathies (MCs) are rare, multisystemic, and heterogeneous disorders that require harmonized collection of clinical, biochemical, and genetic data to better understand their natural history, optimize patient care, and support translational research. In this context, developing a regionally adapted Minimum Data Set (MDS) is a critical step toward establishing a structured registry. Methods: A two-round Delphi study was conducted involving 16 Moroccan–Tunisian experts from diverse specialties to assess the relevance of 382 initially proposed variables. Robust statistical analyses were applied to all composite questions using Content Validity Index (CVI), Kappa coefficient, and Content Validity Ratio (CVR), alongside retention rate assessments. Results: The overall relevance score assigned by the experts was high (4.5 ± 0.41), with a final retention rate of 90.1% (347 variables retained out of 382). Section-wise S-CVI/Ave scores ranged from 0.91 to 0.99, with the paraclinical section achieving the highest value (0.99) and the evolutive section the lowest (0.91). The more stringent S-CVI/UA revealed greater variability (from 0.36 in clinical data to 0.83 in paraclinical data). Kappa index calculations led to the exclusion of a subclass of five therapeutic variables due to insufficient inter-rater agreement. The CVR further supported the content validity of the 46 retained subclasses. The results demonstrated strong consensus, particularly across the neurological, biochemical, molecular, and medical follow-up domains. Additionally, the registry design survey revealed strong expert support for a secure and interoperable digital platform incorporating longitudinal follow-up and advanced search and reporting functionalities. Conclusions: This validated Moroccan–Tunisian pediatric MDS offers a solid foundation for a regional mitochondrial cytopathy registry. It standardizes data collection, strengthens clinical research, and improves diagnosis and care for affected children in the Maghreb. Moreover, it lays the groundwork for future interoperability with international registries, contributing to a more inclusive and collaborative precision medicine landscape. Full article

Despite medical advances having made HIV a survivable condition, HIV persists as the 11th leading cause of death among young Black women. Enhancing the quality of care engagement through beneficial patient–provider relationships can close gaps in retention and adherence, enabling long, healthy lives. Using constructivist grounded theory informed by an established framework for patient-centered care in complex cancer settings and insight from local HIV advocates, this work identifies what provider actions retain women in care and why. Through focus groups and interviews, eleven Black women in the Southwestern United States, an understudied population, express that providers who engage them as co-creators in maintaining good health are more likely to retain them. Concurrently, when women are attuned to their own health care and interpersonal needs, they discern which providers are equally committed to their health based upon observed provider actions. These actions, such as listening attentively, taking time, and paying attention to the whole person, in conjunction with women’s motivation and active involvement, create a reciprocal dynamic that increases the likelihood these women will remain virally suppressed. The ideal relationship is one in which the provider empowers and champions women as drivers of their own care. Full article

This article describes the design, methods, and baseline characteristics of the social needs assessment (SNA) of participants enrolled in an ongoing randomized clinical trial implementing a comprehensive approach to improving diabetes self-management and providing an intensive Diabetes Self-Management Education and Support (iDSMES) Program at St. Vincent’s House Clinic, a primary care practice serving resource-challenged diverse populations in Galveston, Texas. Standardized SNA was conducted to collect information on financial needs, psychosocial well-being, and other chronic health conditions. Based on their identified needs, participants were referred to non-medical existing community resources. A series of in-depth interviews were conducted with a subset of participants. A team member independently categorized these SNA narratives and aggregated them into two overarching groups: medical and social needs. Fifty-nine participants (with a mean age of 53 years and equal representation of men and women) completed an SNA. Most (71%) did not have health insurance. Among 12 potential social needs surveyed, the most frequently requested resources were occupational therapy (78%), utility assistance (73%), and food pantry services (71%). SNA provided data with the potential to address barriers that may hinder participation, retention, and outcomes in diabetes self-management. SNA findings may serve as tertiary prevention to mitigate diabetes-related complications and disparities. Full article