Search Results (122)

Background: The recently published Thirst study showed that prolonged preoperative fasting for liquids remains an unresolved issue across multiple European countries despite clear guideline recommendations. In-depth analyses of national practices could help the development of targeted interventions. The aim of our study was to provide a national overview of fluid fasting in Romania, highlighting institutional factors that could prolong two distinct fasting times: true fluid fasting time and fasting time until the last sips. Methods: This was a secondary analysis of the recently published Thirst study, a prospective, observational, multicenter study. Twenty-one Romanian centers recruited a total of 2185 adult patients undergoing elective procedures between 25 and 29 November 2024. The main outcomes were: the median value of self-reported fasting time to the last sips (SIPS) and true fluid fasting time for larger amounts (NOT SIPS) across centers and procedures; SIPS and NOT SIPS times across hospital level of care and fluid fasting protocols; and the independent predictive value of hospital level of care, fluid fasting protocols and workload for prolonged fasting. The secondary outcomes were the frequency of prolonged fasting (>4 h) and fasting for 2–4 h across centers, procedures, level of care, protocol and afternoon scheduling. The Kruskal–Wallis test with pairwise comparisons was used to compare differences in median times depending on the studied subgroup. Results: The median fluid fasting times for SIPS and true fluid fasting were 8 h [3:30–13:00] and 12 h [10:00–14:55], respectively, and varied significantly across centers, specialties, levels of care and protocol in place (p < 0.001). Prolonged SIPS and true fluid fasting times were observed in 67.3% and 95% of the patients, respectively. Both times varied significantly across the procedure types (p < 0.05), with ophthalmology having the shortest fasting times. Reduced fluid fasting times were independently associated with moderate-competence centers, lower emergency case load and guideline-based fasting protocols. Conclusions: This secondary analysis shows that non-adherence to fluid fasting guidelines is frequent in most Romanian regions and centers. Further research is needed to develop individualized strategies based on institutional and geographical policies as well as on physiologic effects of fluid fasting. Full article

Background/Objectives: Patients awaiting total hip arthroplasty (THA) may have a preoperative period for home-based exercise. However, the benefit of prehabilitation may depend on programme completion. This study assessed the association between compliance with home-based prehabilitation and postoperative course after THA, particularly hospital stay and self-assessed health status at discharge, and explored associations between compliance and changes in clinical and functional outcomes. Methods: In this prospective single-centre observational cohort pilot study, 40 adults scheduled for elective THA were included in a planned 60-day home-based prehabilitation programme as standard preoperative care. Assessments were performed before prehabilitation, preoperatively, and at discharge. Compliance was recorded using a daily checklist and expressed as a compliance index. Associations were analysed using non-parametric tests and Spearman correlation. Results: Median compliance index was 32.41%. Higher compliance was observed in participants reporting improvement or marked improvement at discharge than in those reporting slight improvement or no improvement (p = 0.0076). Compliance was inversely correlated with postoperative length of stay, median 6 days (rho = −0.593, p < 0.001). Compliance was lower in participants who reported pain during exercise (p = 0.0127). No significant associations were found between compliance and postoperative symptoms or changes in hip muscle strength, mechanical muscle properties, pain intensity, or functional test performance between baseline and preoperative assessments. Conclusions: Greater compliance with home-based prehabilitation was associated with shorter postoperative hospitalization and more favorable self-assessed health status at discharge. These findings support strategies to improve programme completion and minimize exercise-related pain. Full article

This article examines how Sephardic Jewish delegations from Livorno and Senigallia framed their petitions to the Bourbon court during the negotiations for their resettlement in the Kingdom of Naples (1739–1740). Drawing on forty-four chapters presented by the Livornese representatives and complementary Senigallian requests, this study explores the legal and rhetorical strategies employed to secure corporate rights: judicial autonomy, exemption from corporation jurisdictions, commercial privileges, and the right to self-govern through elected Massari and rabbinical courts. While rooted in the contractual language of privileges and capitulations, these petitions also evoke a sacred lexicon, implicitly referencing biblical and halakhic categories such as the ger (resident foreigner), exile, divine providence, and covenantal continuity. This dual register—juridical and religious—allowed Jewish elites to legitimize their claims within a framework recognizable to Bourbon authorities while reinforcing a resilient communal identity. Analyzing the intersection of legal discourse and sacred rhetoric, this paper situates the Sephardic negotiations within the broader dynamics of eighteenth-century Catholic statecraft and minority governance. It argues that these petitions reveal not only pragmatic strategies to secure economic and legal stability but also a conscious use of covenantal and scriptural motifs to articulate endurance and justify corporate autonomy in a contested socio-political environment. These petitions, overall, must be situated within a longer continuum of forced displacement. The negotiations of 1739–1740 emerge not merely as administrative exchanges but as the latest chapter in a centuries-long history of expulsion, conditional return, and regulated residence. In this sense, the Sephardic petitions articulate a legal response to the structural precarity produced by forced migration. Full article

Background/Objectives: Dental care is not routinely integrated into acute geriatric complex treatment, although older inpatients often present with substantial oral disease. This study assessed dental treatment needs, their relationship with patients’ expressed wish for dental treatment, and their association with oral health-related quality of life (OHRQoL). Methods: In this cross-sectional observational study, patients undergoing acute geriatric complex treatment at a university hospital in Germany (April 2023 to September 2024) were included if able to provide valid self-reported data. Standardized bedside dental examinations were performed by calibrated dentists without radiographs. Treatment needs were categorized as restorative, periodontal, surgical, and prosthodontic. General health and geriatric data were obtained from medical records. Patients reported their wish for dental treatment and completed the General Oral Health Assessment Index (GOHAI). Results: A total of 214 hospitalized older adults (mean age 82 ± 6 years; 58.4% female) were included. Overall, 94.9% showed clinically assessed dental treatment needs; however, most were elective or functionally relevant, while medically urgent needs (e.g., extraction indications) were identified in 26.7% of dentate patients. The most frequent categories were periodontal (93.2%) and prosthodontic (67.7%) treatment need. No significant association was found between clinically assessed treatment need and patient-reported wish for dental treatment. In exploratory analyses, surgical treatment need and supportive living environments were associated with treatment wish, although model fit was limited. Prosthodontic treatment need, lower functional oral intake, and institutional living were associated with lower OHRQoL. Conclusions: Dental treatment needs are highly prevalent in older adults undergoing acute geriatric complex treatment but are not consistently reflected by patient-reported wish for treatment during hospitalization. These findings indicate a mismatch between clinical assessment and patient-reported preferences. Interpretation is limited by the cross-sectional design and the use of a single dichotomous measure of treatment wish. Full article

In Ghana’s political landscape, actors from both ruling and opposition parties deploy a range of linguistic and rhetorical strategies in their pursuit of political power. Prominent among these is political labeling, a discursive practice used to construct favorable self-images while delegitimizing opponents through derogatory and face-threatening expressions. This study examines how political labeling functions as a strategic tool for identity construction and power negotiation in Ghana’s electoral landscape. Situated within the fields of political discourse and communication studies, the study demonstrates how labeling operates simultaneously as a rhetorical and framing device that reflects and reinforces underlying sociopolitical power dynamics. Drawing on empirical data from major Ghanaian news portals, the study adopts an integrated analytical framework combining Framing Theory and the Theory of Impoliteness. It analyzes public labeling directed at three prominent political figures across three election cycles (2016, 2020, and 2024). The findings show that politicians, activists, and their supporters strategically deploy labels to reconstruct rivals’ identities, inflict reputational damage, and provoke ridicule, thereby undermining their perceived competence and public credibility. Focusing on derogatory labels, we argue that political labeling serves primarily to generate emotional responses, shape public perception, and mobilize collective action, ultimately influencing the trajectory of national political discourse. By examining the interplay between language, identity construction, and power, this research offers a nuanced account of how political labeling shapes individual attitudes, group dynamics, and the broader political culture in Ghana. Full article

Background: Postoperative delirium (POD) is a common complication in geriatric patients. This prospective cohort study evaluated a possible influence of intraoperative positioning on the occurrence of POD, as intraoperative prone positioning could affect cerebral perfusion. Methods: We included 760 patients of ≥60 years scheduled for elective surgery in prone or supine positions. The primary outcome was POD incidence on the first five days after surgery, assessed via 3D-Confusion Assessment Method (3-D CAM) or Confusion Assessment Method for Intensive Care Units (CAM-ICU). Preoperative assessments included the American Society of Anesthesiologists (ASA) and New York Heart Association (NYHA) classifications as well as short screenings for the cognitive (modified Montreal Cognitive Assessment (MoCA)) and self-care status of the patient. Secondary outcomes were length of hospital stay (LOS) and mortality rates. Results: Postoperative delirium rates were similar in prone and supine patients (7.6% vs. 5.5%; p = 0.31), and logistic regression analysis revealed no association of intraoperative prone positioning with POD (odds ratio 1.42 (95% CI 0.68–2.92; p = 0.342)). The overall incidence of POD was 6.1% and was associated with older age (81.5 (CI 76.2–84.8) vs. 72.0 (CI 67.0–79.0) years; p < 0.01), higher ASA and NHYA classifications, lower preoperative modified MoCA, reduced independence in self-care (p < 0.001, respectively), and longer incision-to-suture times (107.0 (CI 73.0–173.0) vs. 85.0 (CI 60.0–130.0) minutes; p < 0.01). Postoperative delirium resulted in longer LOS (14.5 (CI 9.0–27.0) vs. 7.0 (CI 4.0–9.0) days; p < 0.001), and increased mortality (13.0% vs. 1.7%; p < 0.001). Conclusions: Intraoperative prone positioning was not associated with POD in patients aged 60 years or older (OR 1.42; CI 0.68–2.92; p < 0.340), and LOS and mortality as secondary outcome parameters were also similar in patients after prone and supine surgery. Future studies assessing additional and possible confounding factors and intraoperative systemic and regional hemodynamics and oxygenation are needed to verify this result and to evaluate cerebral hypoperfusion as a possible mechanism of POD. Full article

Background: Port-a-catheter (PAC) placement is a common procedure in oncology that, despite local anaesthesia, can induce patient discomfort, procedural pain, and anxiety. Virtual reality hypnosis (VRH), combining immersive virtual reality with clinical hypnosis, has been proposed as a non-pharmacological adjunct to reduce peri-procedural distress. Objectives: This pilot study aimed to explore the suitability of VRH during PAC placement and its potential effects on pain, anxiety, and VRH-related experiences, while investigating psychological variables associated with VRH engagement. Methods: In this single-arm interventional monocentric prospective pilot study, twenty oncology patients undergoing first-time elective PAC placement received a VRH intervention delivered via a medical-grade head-mounted display throughout the procedure. Pain, anxiety, and VRH-related dimensions—including absorption, dissociation, automaticity, arousal, and sense of presence—were assessed pre- and post-procedure using self-reported numerical rating scales and questionnaires. Non-parametric Wilcoxon tests evaluated pre–post changes, and correlational analyses (Pearson’s and Spearman’s when necessary) explored associations between variables. Results: VRH was well tolerated by most participants, although three patients required additional pharmacological support, and four could not complete the session due to intolerance or technical issues. Anxiety scores decreased significantly following VRH, whereas pain showed a non-significant trend toward reduction. Post-procedural absorption and dissociation were positively associated with presence, and higher absorption traits were linked to greater immersive engagement and prior VR/hypnosis experience. Cybersickness was negatively associated with absorption. Older age was correlated with lower post-procedural pain, and females reported higher state anxiety. Conclusions: In this pilot, VRH was feasible, well tolerated, and associated with a significant exploratory reduction in procedural state anxiety. Given the single-arm design, these findings constitute directional evidence warranting controlled trial evaluation rather than proof of efficacy. These preliminary results support the rationale for randomised controlled trials to evaluate VRH efficacy, underlying mechanisms, and potential role as a non-pharmacological adjunct in oncology perioperative care. Full article

Large language model-based virtual patients (LLM-VPs) are an emerging simulation tool for health professions education, but their design and integration into curricula are not well characterized. This scoping review mapped how LLM-VPs are being used for simulated clinical learning across health professions. Following a protocol registered on OSF, we searched MEDLINE, EMBASE, CENTRAL, Scopus, and Web of Science to 11 April 2025, per PRISMA-ScR guidelines, and included 21 studies that used LLMs to generate virtual patients for simulated clinical encounters. Data were extracted on technical design, fidelity domains, curricular integration, human factors, and Technology Acceptance Model constructs, and synthesized narratively. Most studies (n = 11) were pilot or feasibility evaluations with small samples (median 21) and used GPT-based models with dynamic text chat. Integration was limited to 10 studies that operated as pilots, 7 as electives, and 3 as core curricular components. The outcomes focused on Level 2 learning (clinical reasoning and preclinical OSCE performance), with predominantly self-report assessments. No studies reported Level 3 or 4 outcomes. Fidelity was strongest in cognitive, socio-cultural, and emotional domains, and 11 studies reported hallucinations or inaccurate outputs. LLM-VPs appear feasible and well-received but remain early-stage, underscoring the need for fidelity-aligned design and more rigorous, longitudinal evaluations. Full article

Background/Objectives: Emergence agitation (EA) is common after rhinologic surgery and may cause self-injury, bleeding, and prolonged post-anesthesia care unit (PACU) stay. Remimazolam is an ultra-short-acting benzodiazepine that may reduce EA without delaying recovery. The objective of this study was to evaluate the effect of a single dose of remimazolam administered at the end of surgery on the incidence of EA in adult patients undergoing nasal surgery. Methods: In this prospective, randomized, triple-blind, placebo-controlled trial, 62 adults undergoing elective rhinologic surgery under sevoflurane anesthesia received either remimazolam 0.1 mg/kg or saline immediately after sevoflurane discontinuation and before extubation. EA was assessed using the Richmond Agitation–Sedation Scale (RASS) at extubation and every 5 min for 30 min in the PACU. The primary outcome was presence of EA (RASS ≥ 2) at extubation. Secondary outcomes included Aldrete recovery scores, VAS, PONV incidence and safety outcomes. The study was registered at ClinicalTrials.gov (NCT06398275; 3 May 2024). Results: EA occurred in 12/32 patients (37.5%) in the control group and 0/30 (0%) in the remimazolam group (p < 0.001). Extubation time and operative durations were similar between groups. More patients in the remimazolam group achieved an Aldrete score ≥ 9 at extubation (76.7% vs. 50.0%, p = 0.030). Severe agitation (RASS ≥ 3) requiring rescue sedation occurred in 6/32 control-group patients and in 0/30 patients in the remimazolam group (p = 0.025). Pain scores were low (no VAS > 2). PONV occurred in one patient per group. Clinically relevant postoperative nasal bleeding requiring intervention occurred in 2/32 control-group patients and in 0/30 remimazolam-group patients. No laryngospasm or respiratory complications within 24 h were observed. Conclusions: A single remimazolam bolus given at the end of surgery prevented clinically relevant EA after rhinologic surgery without delaying early recovery. Full article

Casta Meretrix articulates the Church’s paradoxical identity as simultaneously holy and sinful, a motif profoundly reconfigured by Hans Urs von Balthasar. Drawing on biblical typology, patristic interpretation, and historical allegory—from Rahab and Hosea to Tamar and the Shulamite—Balthasar constructs a nuanced ecclesiology that honors divine grace while acknowledging human frailty. This essay examines his method, showing how Casta Meretrix offers a critical framework for engaging ecclesial sin, historical failings, and the Church’s redemptive vocation, emphasizing vigilance, penitential self-awareness, and the transformative power of divine love within a flawed yet elect community. Full article

(1) Background: In response to the educational challenges brought on by the COVID-19 pandemic, APPE preceptors implemented the Intention/Reflection (I/R) practice as a structured engagement tool. I/R is designed to promote engagement, motivation, metacognitive growth, and self-awareness among student pharmacists with the goal of enhancing learning experiences in diverse APPE settings. This project aimed to assess the impact of I/R strategies on student pharmacist engagement during APPEs in the post-pandemic landscape, with the overarching goal of identifying and advancing best practices in experiential pharmacy education. (2) Methods: This retrospective qualitative study included 20 student pharmacists from two U.S. colleges who participated in APPE elective rotations featuring I/R activities. Student pharmacists’ responses to five structured I/R prompts were collected and thematically analyzed by two independent researchers using qualitative data analysis software. (3) Results: Four themes were identified in the I/R responses: two themes each from the intention and reflection responses. The intention themes “Embracing Discomfort as a Catalyst for Confidence, Engagement, and Leadership Growth” and “Purposeful Precision: Growing into Adaptive Leadership” both illustrate the students’ journeys as they develop greater confidence and resilience in overcoming challenges. The reflection themes “Reflection as a Catalyst for Professional Learning and Engagement” and “Reflection as a Tool for Focused Growth and Self-Awareness” synthesized the evolution of the student pharmacist and forward thinking for future career. (4) Conclusion: Overall, participants perceived the I/R practice as transformative, citing benefits such as sustained learning, increased confidence, and continued professional development. These findings suggest that integrating I/R into experiential pharmacy education can significantly enhance student engagement and contribute to best practices for post-pandemic pharmacy training. Full article

While fostering an informed understanding of science is a key educational aim, students often hold simplified, fact-based views of science due to limitations in traditional pedagogy, materials, and resources. Out-of-school learning environments, such as natural history museums (NHMs) and citizen science projects, offer opportunities to deepen scientific understanding by providing authentic insights into scientific work. This study examines how participation in a short-term citizen science project on micrometeorites, conducted in collaboration with a NHM, contributes to students’ understanding of science. Two cohorts of 10th-grade students in an elective STEM course combined classroom learning with museum-based lab experiences to identify and analyze real micrometeorites. Qualitative interviews with students and their teacher revealed that participants gained insight into real scientific work, viewed science as a participatory process, and benefited from self-directed, hands-on learning, including innovative remote access to research instruments. The teacher also emphasized access to lab equipment and authentic research as key benefits, but noted organizational and structural challenges to its implementation, as well as format-specific considerations. The findings highlight the value of school–museum collaboration for promoting citizen science approaches for young people and call for greater institutional support to enable such initiatives more frequently and at a larger scale. Full article

Background/Objectives: The COVID-19 pandemic disproportionately impacted rural areas across the United States, including rural North Carolina (NC). Consistent with national patterns, COVID-19 vaccination coverage as of December 2022 was higher for non-rural (72%) than rural (58%) NC counties. The role of trusted sources of vaccine information used by rural and non-rural residents is unknown. Methods: Using data from two surveys distributed by the COVID-19 Community Research Partnership from 8 June 2021 through 21 December 2021, we compared self-reported sources of trusted COVID-19 vaccine information by non-rural and rural counties and by county-level predominant political vote in the 2020 Presidential election. Results: While NC respondents were highly vaccinated (94%), fewer residents from rural counties self-reported COVID-19 vaccination than those from non-rural counties (91% versus 95%). The most common reported source of trusted vaccine information was federal health agencies. The proportion citing a federal health agency was higher for respondents from non-rural (80%) than rural (72%) counties and was higher for vaccinated (75%) than unvaccinated (42%) rural respondents. The next two most trusted sources of vaccine information were state/local health officials (48%) and health care providers (42%). Among trusted resources reported by 10–15% of respondents, those from rural counties were less likely to use hospital websites, employers, or news sources than those from non-rural counties. More respondents from counties with >60% vote for the 2020 Democratic Presidential candidate cited federal health agencies, state and local officials, and new sources than respondents from counties with >60% vote for the 2020 Republican Presidential candidate. Conclusions: By identifying the trusted sources of vaccine information for residents in non-rural and rural NC counties, future vaccine implementation efforts can tailor communication efforts to increase vaccine uptake and potentially reduce the rates of hospitalizations and death from vaccine-preventable diseases such as COVID-19 or other future pandemics. Full article

Deviance poses a fundamental challenge for groups: while it can threaten cohesion and invite moral condemnation, it can also express deep commitment to shared principles. The present research examines how loyalty shapes perceptions of constructive deviance through the case of Republicans for Harris (RHs) during the 2024 U.S. presidential election. Across three time points, we compared how deviants (RHs, N = 89) perceived themselves to how they were viewed by mainstream ingroup members (Republicans for Trump; RTs, N = 340) and outgroup members (Democrats; N = 294). Results revealed marked asymmetries: RTs viewed RHs as less loyal, less prototypical, and more likely to defect than RHs saw themselves. All groups, including mainstream ingroup members, outgroup members, and deviants themselves, felt warmer toward deviants they perceived as more loyal and prototypical. These findings suggest that constructive deviants maintain positive self-views by construing their actions as expressions of fidelity to, rather than rejection of, the group. Full article

Medical students experience fluctuations in their motivation, influenced by various factors, including curricular rigor, mental health, and institutional factors. Based on Self-Determination Theory (SDT) and the Four Pillars of Academic Engagement (HPEE), this study, conducted at a private Mexican university, examined motivational variation according to academic year, curricular impact, gender differences, and its relationship with mental health. Methods: A quantitative, cross-sectional, descriptive study was conducted using qualitative tools for contextualization (n = 1326). Mann–Whitney U tests, Kruskal–Wallis tests, logistic regression, and psychological network analysis were performed. Results: Motivation showed cross-sectional variation: high in preclinical years 1 and 2, decreasing in clinical years 3 and 4 (p < 0.001), and rebounding in year 6. The reformed curriculum (elective subjects, student-centered active learning) resulted in greater motivation (OR = 10.68, p < 0.001). Women tended to have slightly higher motivation (p = 0.050), higher grade point averages (p < 0.001), but also greater stress (p < 0.001). Network analysis revealed that intrinsic achievement (centrality = 1.11) and curiosity about knowledge (predictability = 84.5%) are the main drivers, while demotivation was linked to the later years. The qualitative part of the study showed altruism/curiosity as the main motivators; mistreatment/workload (demotivators). Conclusions: Motivation is context-sensitive, peaks in the preclinical stage, and recovers with autonomy but is vulnerable during clinical immersion. Autonomy in course selection, active student-centered pedagogies, and gender-sensitive support foster sustained participation. The centrality of intrinsic factors in the network highlights that achievement motivation and knowledge are general and independent motivators. Qualitative data reveal systemic barriers. Stage-specific interventions, such as mentoring, student support programs, and reporting mistreatment, can be crucial for strengthening resilience and performance. Longitudinal and multi-institutional studies are needed to validate the causality and generalizability of this study. Full article