Search Results (432)

Background: Point-of-care ultrasound (POCUS) is gaining recognition as a valuable diagnostic tool in various fields of medicine, including pediatrics. Its application at the point of care enables real-time clinical decision-making, which is particularly advantageous in pediatric settings. Although global interest in POCUS is growing, many European countries—including Poland—still lack formal training programs for POCUS at both the undergraduate and postgraduate levels. Nevertheless, the number of pediatricians incorporating POCUS into their daily clinical practice in Poland is increasing. However, the extent of its use and perceived value among pediatricians remains largely unknown. This study aimed to evaluate the current level of POCUS utilization in pediatric care in Poland, focusing on pediatricians’ self-assessed competencies, perceptions of its clinical utility, and key barriers to its implementation in daily practice. Methods: This cross-sectional study was conducted between July and August 2024 using an anonymous online survey distributed to pediatricians throughout Poland via national professional networks, with a response rate of 7.3%. Categorical variables were analyzed using the chi-square test of independence to assess the associations between key variables. Quantitative data were analyzed using descriptive statistics, and qualitative data from open-ended responses were subjected to a thematic analysis. Results: A total of 210 pediatricians responded. Among them, 149 (71%) reported access to ultrasound equipment at their workplace, and 89 (42.4%) reported having participated in some form of POCUS training. Only 46 respondents (21.9%) reported frequently using POCUS in their clinical routine. The self-assessed POCUS competence was rated as low or very low by 136 respondents (64.8%). While POCUS was generally perceived as a helpful tool in facilitating and accelerating clinical decisions, the main barriers to implementation were a lack of formal training and limited institutional support. Conclusions: Although POCUS is perceived as clinically valuable by the surveyed pediatricians in Poland, its routine use remains limited due to training and systemic barriers. Future efforts should prioritize the development of a validated, competency-based training framework and the implementation of a larger, representative national study to guide the structured integration of POCUS into pediatric care. Full article

CareCoach seeks to enhance self-efficacy in family caregivers of people living with dementia and has been feasibility tested in a multicentre randomised controlled trial. The intervention offers two face-to-face sessions with a trained coach and access to an online platform with nine modules. This paper reports findings from an embedded qualitative process evaluation assessing implementation from the implementer’s (‘coach’s’) (n = 8) perspective using individual interviews and implementer group discussions. Qualitative data were transcribed verbatim, inductively coded and analysed using Normalisation Process Theory. Implementers demonstrated (1) ‘Coherence’ by seeking to understand how CareCoach compared to current practice, highlighting the importance of supporting coaches to differentiate and identify boundaries between their new ‘coach role’ and usual practice; (2) ‘Cognitive Participation’ by reviewing training and resources to understand their role own responsibilities and facilitate delivery of coaching sessions; group supervision and peer support were also emphasised; (3) ‘Collective Action’ through interactions with carers to deliver key behavioural aspects such as goal setting, problem solving, and providing feedback; and (4) ‘Reflexive Monitoring’ by appraising the intervention to gain useful insights that could facilitate refinement of CareCoach training and delivery. This study provides a theoretically informed understanding of the implementation of CareCoach for caregivers of people living with dementia and provides recommendations to enhance training for coaches, intervention delivery and carer engagement. Full article

Background/Objectives: Conventional blood collection can be challenging in a non-clinical or home-based setting. In response, vacuum-assisted lancing devices for capillary blood collection (typically from the upper arm) have gained popularity to broaden access to diagnostic testing. However, these devices are often costly relative to the reimbursement rate for common laboratory testing panels. This study describes the design and evaluation of Comfort Draw™, a simplified and economical vacuum-assisted capillary blood collection device. Methods: Comfort Draw™ was evaluated by 12 participants in a preliminary study and by 42 participants in a follow-up study. Metrics assessed included the following: vacuum pressure of the device, skin temperature generated by the Comfort Draw prep warmer, blood collection volume, and analytical accuracy (for 19 common serum-based analytes). Results: Acceptable blood volume (>400 µL) and serum volume (>100 µL) were collected by Comfort Draw in 85.5% and 95.1% of cases, respectively. Seventeen of the nineteen analytes examined were within CLIA acceptance limits compared to matched venous samples. Self-reported pain scores associated with Comfort Draw collection averaged 0.39 on a scale from 0 to 10. Conclusions: In this preliminary clinical study, Comfort Draw was found to be a valid and relatively painless method for collecting capillary blood specimens. The device’s simple design and lower cost could enable broader applications compared to more complex alternative capillary blood collection devices. Full article

Although evidence suggests adiposity as a modifiable risk factor for postmenopausal breast cancer (BC), its association with premenopausal BC remains uncertain. This potential differential relationship for menopausal status has been insufficiently investigated in the Moroccan population due to limited data. This study aims to assess the relationship between various indicators of adiposity and the risk of BC among Moroccan women by menopausal status. A multicenter case-control study was conducted in Morocco between December 2019 and August 2023, including 1400 incident BC cases and 1400 matched controls. Detailed measures of adiposity and self-reported measures from different life stages were collected. Unconditional logistic regression analyses were conducted to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between body size indicators and the risk of BC, adjusting for a range of known risk factors for BC. Higher waist circumference (WC) and hip circumference (HC) were associated with an increased risk of BC in both pre- (p-trend < 0.001 for both WC and HC) and post-menopausal women (p-trend < 0.001 for WC, 0.002 for HC). Current body mass index (BMI) ≥30 kg/m² increased the risk of postmenopausal BC (p-trend = 0.012). Among postmenopausal women, higher weight at age 20 was positively associated with BC risk (p-trend < 0.001), while, weight at age 30 was significantly associated with increased BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend = 0.028). Interestingly, weight gain since age 20 was inversely associated with BC risk in postmenopausal women in the adjusted model (p-trend = 0.006). Young-adult BMI observed a significant increased trend with BC risk in both pre- (p-trend = 0.008) and post-menopausal women (p-trend < 0.001). In premenopausal women, larger body shape during childhood and early adulthood was positively associated with BC risk (p-trend = 0.01 and = 0.011, respectively). In postmenopausal women, larger childhood and adolescent body silhouettes were also associated with increased BC risk (p-trend = 0.045 and 0.047, respectively). These results suggest that anthropometric factors may have different associations with pre- and post-menopausal BC among Moroccan women. This underscores the importance of conducting large prospective studies to better understand these findings and explore their links to different molecular subtypes of BC. Full article

Background: Intermediate care units face growing complexity due to aging populations and chronic illnesses. Non-technical skills such as empathy and communication are crucial for quality care. We aimed to examine the relationship between communication skills, self-efficacy, and sense of coherence among intermediate care nurses. Methods: We conducted an observational, cross-sectional study with 60 intermediate care nurses from three units in a Catalan hospital, Spain. Participants engaged in high-fidelity simulation using geriatric end-of-life scenarios with an ultra-realistic manikin representing a geriatric patient at the end of life. NTSs were measured using validated tools: the Health Professionals Communication Skills Scale (HP-CSS), the General Self-Efficacy Scale, and the Sense of Coherence Questionnaire (OLQ-13). Sessions followed INACSL standards, including prebriefing, simulation, and debriefing phases. Results: Post-simulation outcomes revealed significant gains in interpersonal competencies, with men reporting higher assertiveness (p = 0.015) and greater satisfaction with both the simulation experience (p = 0.003) and the instructor (p = 0.008), underscoring gender-related perceptions in immersive training. Conclusions: Ultra-realistic clinical simulation is effective in enhancing NTS among intermediate care nurses, contributing to improved care quality and clearer professional profiles in geriatric nursing. Full article

This paper examines the importance of ‘education outside the classroom’ (EOtC) in an Australian secondary school. The primary aim was to develop a sense of belonging, build resilience, and enhance wellbeing in female students. This study investigated two cohorts of Year 9 students (aged 14–15 yrs) who participated in a four-week residential EOtC pilot program. The first cohort (Wave 1; N = 58) undertook the program alongside (N = 39) boys. The second cohort was single-sex girls (Wave 2; N = 28). A mixed-methods research design was implemented to inform experiences of students, parents, and staff and to triangulate inferences drawn from the data. Quantitative data was gained from pre- and post-program surveys with students and parents, whilst qualitative data was gathered from student focus groups, staff, and parents through semi-structured interviews to assess more nuanced impacts. School belonging was measured using the PISA six-item scale. Academic buoyancy was quantified using the four-item Academic Buoyancy Scale. Self-efficacy, peer relations, and resilience were evaluated by employing the 34-item Adolescent Girls’ Resilience Scale. The findings revealed significant improvements in students’ sense of belonging, including higher levels of school belonging than reported Australia-wide averages for 15-year-olds. Despite students’ mean academic buoyancy scores being more than a point lower than reported baseline scores for Australian high school students, it was promising to see a modest increase following the EOtC program. In conclusion, EOtC is a potent vehicle for developing a sense of belonging, enhancing resilience, and equipping students to deal with academic challenges. Full article

Background and Objectives: Uterine cancer is the most common gynaecologic malignancy in developed countries, yet the psychosocial sequelae of treatment are incompletely described. This prospective, single-centre study quantified six-month changes in the quality of life (QoL) and perceived stress in women with newly diagnosed uterine cancer and explored clinical moderators of change. Methods: Participants completed four validated self-report questionnaires: the 36-item Short-Form Health Survey (SF-36), the 26-item World Health Organization Quality-of-Life-BREF (WHOQOL-BREF), the 30-item EORTC QLQ-C30 and the 10-item Perceived Stress Scale (PSS-10) before therapy and again six months after surgery ± adjuvant chemoradiation. Subgroup analyses were performed for stage (FIGO I–II vs. III–IV). Results: Mean SF-36 Physical Functioning improved from 58.7 ± 12.1 to 63.1 ± 12.6 (Δ = +4.4 ± 7.3; p = 0.000, d = 0.36). PSS declined from 24.1 ± 5.6 to 20.8 ± 5.4 (Δ = −3.3 ± 5.0; p < 0.001, d = 0.66). The WHOQOL-BREF Physical and Psychological domains rose by 4.4 ± 6.9 and 3.5 ± 7.3 points, respectively (both p < 0.01). EORTC QLQ-C30 Global Health increased 5.1 ± 7.6 points (p < 0.001) with parallel reductions in fatigue (−5.4 ± 9.0) and pain (−4.8 ± 8.6). Advanced-stage patients showed larger reductions in stress (ΔPSS −3.5 ± 2.5 vs. −2.3 ± 2.3; p = 0.036) but similar QoL gains. ΔPSS correlated inversely with ΔWHOQOL Psychological (r = −0.53) and ΔSF-36 Mental Health (r = −0.49) and positively with ΔEORTC Global Health (r = −0.42) (all p < 0.001). Conclusions: Over six months, multimodal uterine cancer treatment was associated with clinically meaningful QoL improvements and moderate stress reduction. Greater stress relief paralleled superior gains in psychological and global health indices, highlighting the importance of integrative survivorship care. Full article

Background: To assess the accuracy of ChatGPT-4o and OpenAI-o1 in answering refractive surgery questions from the AAO BCSC Self-Assessment Program and to evaluate whether their performance could meaningfully support clinical decision making, we compared the models with 1983 ophthalmology residents and clinicians. Methods: A randomized, questionnaire-based study was conducted with 228 text-only questions from the Refractive Surgery section of the BCSC Self-Assessment Program. Each model received the prompt, “Please provide an answer to the following questions.” Accuracy was measured as the proportion of correct answers and reported with 95 percent confidence intervals. Differences between groups were assessed with the chi-squared test for independence and pairwise comparisons. Results: OpenAI-o1 achieved the highest score (91.2%, 95% CI 87.6–95.0%), followed by ChatGPT-4o (86.4%, 95% CI 81.9–90.9%) and the average score from 1983 users of the Refractive Surgery section of the BCSC Self-Assessment Program (77%, 95% CI 75.2–78.8%). Both language models significantly outperformed human users. The five-point margin of OpenAI-o1 over ChatGPT-4o did not reach statistical significance (p = 0.1045) but could represent one additional correct decision in twenty clinically relevant scenarios. Conclusions: Both ChatGPT-4o and OpenAI-o1 significantly outperformed BCSC Program users, demonstrating a level of accuracy that could augment medical decision making. Although OpenAI-o1 scored higher than ChatGPT-4o, the difference did not reach statistical significance. These findings indicate that the “advanced reasoning” architecture of OpenAI-o1 offers only incremental gains and underscores the need for prospective studies linking LLM recommendations to concrete clinical outcomes before routine deployment in refractive-surgery practice. Full article

Background/Objectives: In Australia, attrition rates in undergraduate nursing degrees have been increasing nationally. The aim of this study was to explore if and how clinical laboratory-based peer-assisted learning (PAL) improved the first-year nursing student learning experience and retention at a regional university. A further aim was to explore any perceived benefits for third-year student participants. Methods: This is a descriptive study design. The study recruited eight third-year nursing students (named ‘LabPALs’) offering support to 42 first-year nursing students during their self-directed laboratory practice sessions. The first-year students included a high percentage of mature aged and ‘first in family’ students. Over an eight-week period, LabPALs provided peer support for up to four students per one-hour practice session. Unit grade outcomes were compared with students not exposed to the PAL sessions. Both the LabPAL mentors and first-year participants were asked to evaluate their experience. Results: It was found that PAL project participation was associated with higher completion rates when compared with non-participation. When combined with exposure to their experienced peers’ perspectives and support, participation was associated with academic success. Thematic analysis found that first-year nursing students reported developing both ‘confidence’ and ‘competence’ in their laboratory learning spaces. The third-year LabPAL students reported skills gained in facilitating peer learning and perceived their experience as very rewarding. Conclusions: This research suggests that PAL enhances clinical laboratory learning among undergraduate nursing students. Full article

Background and Objectives: The associations between body appreciation, weight status, and weight management practices are influenced by societal, cultural, and psychological factors. Studies indicated that a higher level of body appreciation is linked to lower engagement in unhealthy weight management practices. The transition from high school to university is a significant life event, often accompanied by substantial lifestyle changes that can affect students’ body image and weight-related behaviours. This study aimed to assess the associations between body appreciation, weight status, and weight management behaviours among first-year students at four universities of applied sciences in Lithuania. Materials and Methods: A cross-sectional online survey was conducted in 2022 among 709 first-year students (216 males and 493 females) at the four largest universities of applied sciences in Vilnius, Kaunas, Klaipėda, and Šiauliai. Body appreciation was assessed using the Body Appreciation Scale-2 (BAS-2), whilst BMI was calculated from self-reported height and weight. Students were asked about their weight management practices. Logistic regression analysis was applied to evaluate associations between weight management behaviours, body appreciation, and weight status. Results: Female students had a significantly lower median BMI (21.1 kg/m²) than males (23.3 kg/m²) but were more likely to perceive themselves as overweight (34.5% vs. 17.1%), worry about gaining weight (40.6% vs. 11.6%), and attempt weight loss (52.5% vs. 23.6%) (all p < 0.001). Higher BAS scores were associated with greater accuracy in weight perception, higher satisfaction with body weight, and fewer concerns about weight gain. Students with lower BAS scores were more likely to engage in harmful weight-control behaviours such as smoking (OR = 0.07; 95% CI: 0.02–0.25 for high vs. low BAS) and were more strongly influenced by media beauty standards and dissatisfaction with appearance. Conclusions: Body appreciation is linked to healthier weight perceptions and behaviours. Interventions that enhance body appreciation may help reduce body dissatisfaction and prevent unhealthy weight control practices, especially among female students. Full article

Optically pumped semiconductor disk lasers—known as vertical-external-cavity surface-emitting lasers (VECSELs)—are promising devices for ultrashort pulse formation. For it, a “SESAM-free” approach labeled “self-mode-locking” received considerable attention in the past decade, relying solely on a chip-related nonlinear optical property which can establish adequate pulsing conditions—thereby suggesting a reduced reliance on a semiconductor saturable-absorber mirror (the SESAM) in the cavity. Self-mode-locked (SML) VECSELs with sub-ps pulse durations were reported repeatedly. This motivated investigations on a Kerr-lensing type effect acting as an artificial saturable absorber. So-called Z-scan and ultrafast beam-deflection experiments were conducted to emphasize the role of nonlinear lensing in the chip for pulse formation. Recently, in addition to allowing stable ultrashort pulsed operation, self-starting mode-locked operation gave rise to another emission regime related to frequency comb formation. While amplitude-modulated combs relate to signal peaks in time, providing a so-called pulse train, a frequency-modulated comb is understood to cause quasi continuous-wave output with its sweep of instantaneous frequency over the range of phase-locked modes. With gain-bandwidth-enhanced chips, as well as with an improved understanding of the impacts of dispersion and nonlinear lensing properties and cavity configurations on the device output, an enhanced employment of SML VECSELs is to be expected. Full article

Background/Objectives: Weight loss following bariatric surgery can improve fertility. Current guidelines recommend delaying pregnancy for at least 12 months post-surgery for weight stabilization and to support healthy gestational weight gain (GWG). However, evidence supporting this recommendation is limited. This study investigated the impact of preconception weight stability and the surgery-to-conception interval on GWG and examined risk factors for GWG above or below recommendations. Methods: Women aged 18–45 years with singleton pregnancies post-bariatric surgery were recruited before 23 weeks’ gestation and followed until delivery. Participants self-reported their weight for the 6 months preceding conception and again at 36 weeks’ gestation via an online survey. Weight change (as a percentage of pre-pregnancy weight) was analyzed using stepwise linear and multivariate logistic regression. Results: Sixty-nine participants completed the study. The percentage of body weight change in the 6 months before conception ranged from −34% to +21%, with significantly greater preconception weight loss observed in those who conceived within 12 months of surgery (p < 0.001). The pre-pregnancy BMI and preconception weight change together explained 24% of the variation in GWG (p < 0.001), while the surgery-to-conception interval was not a significant predictor (p = 0.502). While 70% (34/49) of participants experienced weight gain outside of recommendations, no significant risk factors could be identified. Conclusions: Weight trajectory prior to conception is a key factor to predict GWG rather than the surgery–conception interval. These findings have important implications for family planning and clinical guidance following bariatric surgery. Full article

The stigma associated with food assistance can be a barrier to resolving food insecurity. Self-reliance expectations likely contribute to this stigma. Aim: This cross-sectional study identified factors that predict perceptions of food assistance stigma. Demographics (age, sex, race, and ethnicity) were collected, and food assistance stigma (Food Resource Acceptability) and self-reliance (Self-Reliance Scale) were measured via REDCap questionnaires from 531 online participants. The research volunteer repository, Research Match, was used for recruitment. Multiple regression was conducted to determine food assistance stigma predictors. Older age, being male, and reporting higher self-reliance significantly predicted the likelihood of stigmatizing food assistance. The social expectation of self-reliance in adulthood contributes to an assigned and anticipated stigma associated with accepting food assistance. This stigma permeates many regions, particularly the United States, and likely contributes to unresolved food insecurity despite the availability of multiple food assistance resources. Future qualitative research should be conducted among older individuals and males with high levels of self-reliance to gain a deeper understanding of how food assistance stigma could be lessened so that appropriate stigma reduction interventions could be tested among this target group. Full article

Background/Objectives: Early care and education programs promote children’s social–emotional development, predicting later school success. The COVID-19 pandemic worsened an existing youth mental health crisis and increased teacher stress. Therefore, we applied an infant and early childhood mental health consultation model, Jump Start Plus COVID Support (JS+CS), aiming to decrease behavioral problems in children post-pandemic. Methods: A cluster randomized controlled trial compared JS+CS to an active control, Healthy Caregivers–Healthy Children (HC2), at 30 ECE centers in low-income areas in South Florida. Participants were not blinded to group assignment. Teachers reported on children’s social–emotional development at baseline and post-intervention using the Devereux Early Childhood Assessment and Strengths and Difficulties Questionnaire. We assessed whether teacher stress, classroom practices, and self-efficacy mediated the relationship between JS+CS and child outcomes. We also explored whether baseline behavior problems moderated JS+CS effects on child protective factors, relative to HC2. Results: Direct group-by-time differences between JS+CS and HC2 were limited. However, JS+CS demonstrated significant within-group improvements in teacher-reported child protective factors, behavior support practices, and classroom safety practices. Classroom safety practices consistently mediated positive changes in child behaviors, including the DECA total protective factor score and subdomains of initiative and self-regulation. Additionally, teacher perceptions of behavior support mediated gains in child attachment. Conclusions: JS+CS shows promise in building protective systems around children through intentional support for teachers, underscoring the value of whole-child, whole-environment approaches in early intervention. Full article

Background: Undergraduate research is vital for developing critical thinking and academic identity in medical students, yet traditional models often fail to overcome institutional and personal barriers. Peer-led approaches may offer more accessible, supportive environments that promote deeper engagement and leadership in research. Methods: This study evaluated medical students’ experiences in a peer-led research initiative from 2022 to 2024. Students were then invited to complete a qualitative questionnaire reflecting on their perceptions towards research, development in research skills, confidence, and academic identity. Results: Code saturation was achieved after 9 responses (N = 15). Participants reported intrinsic interest, peer encouragement, and opportunities to publish as motivating factors. The peer-led model made research feel more approachable, fostering technical growth and academic confidence. Peer mentorship and a gradual learning structure were especially valued. While challenges such as workload and team dynamics emerged, students reported growth in resilience and self-reflection. Conclusions: Peer-led research initiatives can effectively support academic identity formation by integrating motivation, support, and skill development. Despite obstacles, students gained competence and confidence. Full article