Search Results (242)

Background and Objectives: This study aimed to assess the week-by-week predictive value of Acute:Chronic Workload Ratios (ACWRs) for non-contact injury risk in professional soccer players. Materials and Methods: A cohort of 40 elite players was monitored using GPS over two competitive seasons. Binomial logistic regression and ROC curve analyses were performed on ACWR metrics—including total distance, moderate-to high-speed running, sprinting, acceleration, and deceleration—during the four weeks prior to injury (W4 to W1). p-values were further adjusted for multiple comparisons using the false discovery rate (FDR) correction (q < 0.05). Results: Significant predictive models emerged mainly for ACWR metrics related to moderate-speed running (15–20 km/h), sprinting (>25 km/h), and acceleration/deceleration. The ACWR for 15–20 km/h (DSR15–20) demonstrated the highest predictive accuracy, particularly in Week 3 (AUC = 0.811, p = 0.004). Sprinting (DSR>25) was also significantly associated with injury occurrence across Weeks 1–4 (AUC = 0.709–0.755, p = 0.011–0.024). Acceleration (ACC) and deceleration (DEC) metrics showed significant associations prior to correction—ACC in Weeks 3–4 (AUC = 0.737–0.755, p = 0.020–0.026) and DEC in Weeks 3–4 (AUC = 0.720–0.741, p = 0.029–0.043)—but these associations did not retain significance following FDR adjustment (q = 0.052–0.086). In contrast, total distance (ACWR TD) and high-speed running (20–25 km/h) were weaker predictors, reaching only marginal or nonsignificant levels (e.g., Week 3, AUC = 0.675, p = 0.054). After FDR correction, only DSR15–20 and DSR>25 remained statistically significant (q < 0.05), confirming them as robust predictors of non-contact injury risk. Multivariable models adjusted for age and playing position confirmed these findings, with DSR15–20 and DSR>25 retaining their predictive value independent of confounding factors. Injury risk thresholds were established through Estimated Marginal Means (EMMs), defining the “Sweet Spot” and “Danger Zone” for each metric, whereas the “Low Load” zone was treated as exploratory. Conclusions: This weekly ACWR monitoring approach enables practical injury risk profiling, helping training staff optimize load management and minimize non-contact injury risk in elite soccer. Full article

Artificial Intelligence (AI), particularly Generative AI (GenAI) and Large Language Models (LLMs), is rapidly reshaping higher education by transforming teaching, learning, assessment, research, and institutional management. This entry provides a state-of-the-art, comprehensive, evidence-based synthesis of established AI applications and their implications within the higher education landscape, emphasizing mature knowledge aimed at educators, researchers, and policymakers. AI technologies now support personalized learning pathways, enhance instructional efficiency, and improve academic productivity by facilitating tasks such as automated grading, adaptive feedback, and academic writing assistance. The widespread adoption of AI tools among students and faculty members has created a critical need for AI literacy—encompassing not only technical proficiency but also critical evaluation, ethical awareness, and metacognitive engagement with AI-generated content. Key opportunities include the deployment of adaptive tutoring and real-time feedback mechanisms that tailor instruction to individual learning trajectories; automated content generation, grading assistance, and administrative workflow optimization that reduce faculty workload; and AI-driven analytics that inform curriculum design and early intervention to improve student outcomes. At the same time, AI poses challenges related to academic integrity (e.g., plagiarism and misuse of generative content), algorithmic bias and data privacy, digital divides that exacerbate inequities, and risks of “cognitive debt” whereby over-reliance on AI tools may degrade working memory, creativity, and executive function. The lack of standardized AI policies and fragmented institutional governance highlight the urgent necessity for transparent frameworks that balance technological adoption with academic values. Anchored in several foundational pillars (such as a brief description of AI higher education, AI literacy, AI tools for educators and teaching staff, ethical use of AI, and institutional integration of AI in higher education), this entry emphasizes that AI is neither a panacea nor an intrinsic threat but a “technology of selection” whose impact depends on the deliberate choices of educators, institutions, and learners. When embraced with ethical discernment and educational accountability, AI holds the potential to foster a more inclusive, efficient, and democratic future for higher education; however, its success depends on purposeful integration, balancing innovation with academic values such as integrity, creativity, and inclusivity. Full article

This article addresses the problem of predicting the workload of the repair department in a company manufacturing electronic modules. The number of modules needing repair is called a repair stack. A deterministic algorithm and a machine learning-based algorithm are proposed to predict the repair stack for subsequent weeks based on historical data, current yield data, and planned production. These methods allow for estimation of the repair stack and appropriate selection of repair department staff to ensure the ongoing repair of defective products. The proposed algorithms are described and the results of their practical verification based on historical data from a large enterprise are presented. The practical utility of both algorithms is demonstrated and the impact of selected factors on their accuracy is analyzed. It is shown that using the proposed algorithms, it is possible to predict the repair stack for the coming week with a relative error not exceeding a few percentages on the basis of historical data from the previous 8 weeks. These algorithms were successfully implemented in industrial practice. Full article

Introduction: In-hospital cardiac arrest (IHCA) is still associated with high mortality. Introduction of multi-parameter early warning systems (EWS) could reduce the incidence of IHCA. However, data regarding prevention of IHCA remains conflicting. Moreover, an aging population and a shortage of healthcare workers strain Austrian acute care hospitals. Sicker patients and fewer staff could hinder the implementation of multi-parameter EWS in Austria. Therefore, we sought to identify such barriers by assessing local and national data. Furthermore, we investigated the incidence of in-hospital cardiac arrests at Medical University Innsbruck. Methods: In this perspective study, we retrospectively analyzed all patients experiencing an in-hospital cardiac arrest between 2017 and 2024. In the qualitative part, ten experts in in-hospital emergency medicine were interviewed using guided interviews. The main results from the interviews were identified using a structured content analysis according to Mayring. Quantitative and qualitative data were integrated through narrative. Using the Consolidated Framework for Implementation Research, we stratified our data into five domains. Finally, we applied the “eight steps for leading change” to develop a practice guideline. Results: In six years, 1356 patients were treated by an emergency medical team; 1317 emergencies were included, with 365 of them being resuscitated. Overall, 114 survived for 24 h. The incidence rate of in-hospital cardiac arrests was 0.86 cases/1000 admissions per year. The guided interviews demonstrated a nearly complete absence of EWS using multiple parameters in Austria. Strained human resources after the pandemic, the fear of an increased workload and the lack of robust data regarding the benefit of survival were mentioned as main reasons. The best practice tutorial considers the challenges identified and provides guidance for structured implementation in hospitals. Conclusions: Implementing NEWS2 can facilitate detection of critically ill patients despite decreased staffing. Identifying common barriers and facilitators in five domains described and applying this to the “eight steps for leading change” enabled us to provide a tutorial for implementation of an EWS. This could help master future challenges in in-hospital emergency medicine. Full article

Background: Patient education (PE) is an essential component of quality healthcare and chronic disease management. However, effective implementation often faces patient-, nurse-, and organization-related barriers. This is particularly relevant in multicultural healthcare settings such as Saudi Arabia, where a highly diverse nursing workforce may influence PE practices. Aim: To examine the barriers and facilitators influencing patient education practices among nurses working in multiple hospitals in Saudi Arabia. Methods: A descriptive cross-sectional study was conducted among 289 registered nurses recruited through convenience sampling from various hospitals in Saudi Arabia. Data were collected using a validated self-administered questionnaire consisting of demographic items and structured scales assessing PE barriers and facilitators. Descriptive statistics were used to analyze the data. Results: Language differences (64.3%) and cultural barriers (59.2%) were the most commonly reported patient-related obstacles. Among nurse-related barriers, staff shortages (72.4%), heavy workload (72.0%), and time constraints (59.9%) were prominent. Organizational barriers included limited educational resources (39.4%) and unsupportive environments (35.6%). Key facilitators identified by nurses included availability of policies and procedures (63.6%), provision of PE training (63.7%), and integration of PE into clinical workflow and nurse appraisals. Conclusions: Despite strong professional support for PE, multiple barriers hinder its implementation in Saudi hospitals. Addressing these challenges requires institutional strategies such as workforce reinforcement, policy integration, and resource allocation. Future efforts should also include integrating patient perspectives, developing culturally tailored education resources, and evaluating the impact of targeted interventions to strengthen PE delivery in diverse hospital settings. Full article

Background/Objectives: Oropharyngeal dysphagia (OD) is a frequent condition among older adults in long-term care facilities, often leading to malnutrition, dehydration, and increased mortality. Modified-texture diets (MTDs) are used to address these risks, though traditional preparation methods often compromise nutritional density and standardization. The WeanCare protocol with Dysphameal^® technology introduces an innovative solution by offering IDDSI-compliant, high-density, freeze-dried meals. This study assesses its clinical effectiveness and economic impact. Methods: A six-month quasi-experimental pre–post study was conducted in two Italian nursing homes involving 13 older participants with diagnosed OD. Participants received all meals and hydration through Dysphameal^®, and data were collected on anthropometry, biochemical markers, care workload, and economic parameters. Statistical analyses included regression, correlations, and pre–post comparisons. Results: Improvements were noted in fat-free mass (FFM), skeletal muscle mass (ASMM), and basal metabolic rate (BMR) in all participants. Albumin and lymphocyte counts improved, as did participant autonomy at mealtime. Operational time per participant dropped by 44% in kitchen and by 7 min/day in wards. Supplement use decreased, leading to significant cost savings and improved staff allocation. Conclusions: The WeanCare–Dysphameal^® system improves nutritional status, reduces caregiver workload, and enhances economic efficiency in institutional settings. It represents a scalable solution for OD management, ensuring consistency, safety, and sustainability in dysphagic care. Full article

Cystic fibrosis (CF) is an autosomal recessive genetic condition affecting nearly 1 in 4000 newborns. Early diagnosis and treatment have been shown to improve the care of individuals with CF, which is enhanced through newborn screening (NBS). The state of Florida has been performing CF NBS since 2007, and in 2022, Florida implemented enhanced next generation sequencing (NGS). The goal of this change was to identify individuals from under-represented racial and ethnic groups, who may have rare or de novo variants. NBS screening for CF involved a first tier with immunoreactive trypsinogen (IRT) ≥ 50 or the top 4% of daily specimens, whichever is lower, reflexing to a second tier. As of 2022, the second tier has evolved to an expanded sequence with an Agena 74-variant panel. Single variants would then reflex to the third tier utilizing NGS. NGS is able to confirm what is detected in second-tier testing, adding variants not included in the Agena panel, and refining the TG replications for Poly-T variants to determine pathogenicity of 5T results. When there is a variant of varying clinical consequence between the two databases, the most conservative classification is selected. Individuals with variants would then be referred to one of the contracted CF NBS referral centers for confirmatory sweat chloride testing (sweat). With implementation of NGS, referrals nearly tripled in 2022–2024, with 538 referrals in 2019; 485 in 2020; and 805 in 2021; followed by 1223 referrals made in 2022; 1146 in 2023; and 1294 in 2024. In 2022–2024, 71% of referrals to the contracted NBS CF referral centers were for single variant results, and no cases of CF were identified from these referrals. The number of CF cases remained about the same, ranging from 23 to 40 through the years 2019–2024. The number of CRMS/CFSPID cases, however, tripled going from 10 to 12 in 2019–2022 to over 100 in 2024. The reason for this change seems to be related to complex heterozygous genetic variants as opposed to abnormal sweat. Implementation of NGS for CF in Florida led to a significant increase in the identification of CFTR variants which affected all aspects of the NBS CF process, from an increased workload on the NBS laboratory and follow-up staff, to an increase in referrals to the NBS CF referral centers. The majority of referrals were for single-variant results, which meant the infants had a very low likelihood of having CF. It is recommended that when an algorithm involving NGS is utilized, one should verify that there are appropriate processes for sweat, including the manner in which single-variant CF results are handled, avoiding unnecessary healthcare utilization. Full article

Latvia faces one of the lowest nurse-to-population ratios in the EU, resulting in critical staff shortages in intensive care units (ICUs). Nurses frequently care for more patients than recommended, which not only compromises patient safety but also places heavy psycho-emotional burdens on staff. The aim of this study was to examine organizational-level relationships between objectively measured ICU nursing workload and subjectively reported psycho-emotional outcomes, including moral distress, burnout, and intention to leave one’s job. A secondary analysis combined data from two cross-sectional studies conducted in 2025. Workload was measured using 3420 Nursing Activities Score (NAS) protocols from three hospitals, while 155 ICU nurses from 16 units completed validated instruments assessing moral distress, burnout, and turnover intentions. The findings revealed persistent nurse shortages, with one ICU showing deficits exceeding 70% and mean NASs above 100 points per nurse per shift. Nurses reported moderate moral distress, particularly in situations of unsafe patient ratios and aggressive treatment, while burnout levels were moderate to high, especially in personal and work-related dimensions. About one-quarter of respondents were actively considering leaving their jobs. Moral distress significantly correlated with burnout (r = 0.357, p < 0.001), and organizational-level comparison indicated that higher workload was associated with greater emotional strain. These results not only highlight urgent national challenges but also resonate with international evidence on the link between unsafe staffing, moral distress, and workforce sustainability. Implementing systematic workload monitoring, safe staffing ratios, and structured support mechanisms is essential to safeguard ICU nurses’ well-being, reduce turnover, and protect patient safety in both Latvian and global contexts. Full article

Burnout is a critical problem among healthcare professionals worldwide, but nationally representative data on psychosocial factors associated with burnout are lacking for Latvia’s hospital system. This study investigated twofold aims: first, it examined the association between job-related demands, psychosocial resources, and burnout in a representative sample of Latvian hospital staff; and second, it tested whether specific resources buffer or amplify the impact of excessive workload. A cross-sectional survey was conducted among 4756 healthcare workers across 30 inpatient institutions in Latvia. Participants completed the Copenhagen Psychosocial Questionnaire III and the Burnout Assessment Tool; regression and moderation analyses were used. Burnout was positively associated with longer working hours, multiple job-holding, and psychosocial demands such as emotional strain, time pressure, and work–life conflict. Several resources, including support from colleagues, supervisor support, recognition, sense of belonging, supervisor evaluation, and especially resources for quality work, were associated with lower burnout and weakened the relationship between workload and burnout. In contrast, high autonomy, meaning at work, organizational justice, and role conflict amplified this association. These findings suggest that in resource-constrained healthcare systems, some job resources may be associated with increased risk of burnout. Effective interventions should address both structural and relational factors to mitigate burnout among healthcare workers. Full article

In 2024, a significant pertussis surge in Queensland, Australia, strained public health resources. To improve investigation efficiency, the Wide Bay Public Health Unit introduced an online survey for pertussis cases on 1 August 2024, which collected data and provided automated health advice. This retrospective evaluation assessed survey acceptance and staff workload. A controlled interrupted time series (ITS) analysis compared pertussis incidence in the intervention region against a control group of four other de-identified regional hospital and health services in Queensland where the survey was not implemented. Of the 298 eligible cases, 140 responded (47.0%); a total of 67.9% of these required no further staff follow-up, a subgroup for whom time savings were statistically significant (p < 0.01). The ITS analysis for the total population revealed a significant 4.9% weekly reduction in the notification trend compared to the control group (Rate Ratio: 0.95, p = 0.001), with a non-significant immediate level change. The online survey is a practical and effective tool for pertussis investigation in a regional setting. It is associated with significant workload efficiencies and a favourable, statistically significant impact on community disease transmission trends. Full article

Background: The Nursing Work Environment (NWE) plays a critical role in determining the quality of care, staff well-being, and organizational performance, particularly in oncology settings. Despite increasing attention, a comprehensive synthesis of organizational factors shaping oncology NWEs has been lacking. This scoping review aimed to describe the key features of oncology NWEs and to explore the outcomes associated with these characteristics. Methods: A scoping review was conducted following the Joanna Briggs Institute guidelines. Peer-reviewed studies published in English or Italian were included without time restrictions. Literature searches were performed in MEDLINE via PubMed, CINAHL, and Scopus between January and April 2025. Results: Twenty studies met the inclusion criteria. Key organizational characteristics of oncology NWEs were grouped into the following four domains: leadership and organizational support; workload and resource availability; ethical climate and collegial relationships; and physical and structural conditions of care settings. Across the studies, a positive NWE was frequently reported to be associated with improved nurse-related outcomes and, to a lesser extent, with patient-related outcomes. However, these associations should be interpreted with caution due to the heterogeneity of contexts and the predominance of cross-sectional designs. Conclusions: The NWE is a strategic element in delivering effective, safe, and sustainable oncology care. Practical actions for nurse managers and healthcare leaders include implementing leadership training programs, ensuring adequate staffing and resource allocation, fostering open communication, and promoting interdisciplinary collaboration. These measures are essential to protect staff well-being and guarantee high-quality, patient-centered care. Full article

Healthcare systems worldwide face growing challenges related to staff shortages, excessive workload, and deteriorating working conditions, which compromise both staff well-being and care quality. Despite these issues, there is a lack of validated tools that capture healthcare professionals’ subjective perceptions of resource adequacy. This study presents the development and initial validation of the Staff Resource Adequacy Questionnaire for Healthcare Professionals (SRAQ-HP), a multidimensional tool designed to assess staffing adequacy and workload, quality of care, and working conditions and support. The development process followed a mixed-methods design, incorporating theoretical foundations from Kanter’s empowerment theory, role enactment models, and professional competence frameworks. The initial item pool of 32 statements was reduced to 26 through expert reviews, focus groups, and pilot testing (n = 35). Content validity index (CVI = 0.931) and face validity index (FVI = 0.976) demonstrated high content relevance and clarity. Cronbach’s alpha for the full scale was 0.841, confirming internal consistency. Expert re-review confirmed strong content (S-CVI/Ave = 0.931) and face validity (FVI = 0.976) for the final 26-item version. Three core dimensions were retained: Staffing Adequacy and Workload, Quality of Care, and Working Conditions and Support. The SRAQ-HP provides a novel, evidence-based approach to systematically assess workforce sufficiency and support structures in clinical settings. It can guide decision-making in healthcare institutions and inform national workforce policies. Further research with larger and more diverse samples is needed to confirm its factorial validity and practical applicability. Full article

Objectives: To theorize the work-related dimension involved in the process of reconciling work and personal roles among nurses working in Intensive Care Units. Methods: Constructivist grounded theory was employed to conceptualize the phenomenon of interest from the perspectives of nurses, their families, and administrative staff. Data were derived from 202 h of non-participant observation in two high-complexity hospitals in Chile (one public and one private), 57 institutional documents, and 51 in-depth interviews. Data analysis followed the constant comparative method and multilevel coding. To ensure methodological rigor, the study adhered to the 13 criteria for constructivist grounded theory research proposed by Charmaz and Thornberg and was approved by a scientific ethics committee. Results: Work-related roles are defined as the set of behaviors associated with the professional context, which are shaped by nine sources of interaction: (1) Job content; (2) Workload and pace; (3) Work schedule; (4) Control; (5) Environment and equipment; (6) Organizational culture; (7) Interpersonal relationships; (8) Function within the organization; and (9) Career development. Conclusions: The study presents the theorization process of the work-related dimension involved in the reconciliation of work and personal roles among nurses in Intensive Care Units. Work-related roles are essential to understanding this reconciliation process. The findings provide evidence for the existence of nine sources of interaction, which are influenced by institutional strategic planning and, in turn, by national and international public policies. Full article

Background: The management of older diabetic patients in the Southern Africa Development Community (SADC) has been described by several authors as poor due to several constraints and lack of a team care approach. This systematic review aimed to investigate the facilitators and barriers to the effective implementation of interprofessional care (IPC) of the elderly with type 2 diabetes mellitus (T2D) in the SADC region. Methods: A comprehensive literature search was conducted using the Population–Concept–Context (PCC) framework in the search for relevant articles. Out of a total of 155 relevant articles, only 8 articles matched the set criteria and were selected for the final review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in the review. Results: The identified facilitators include providing decision support to healthcare workers, training of healthcare workers, use of local languages during the training sessions, and use of certified guidelines in the management of not only T2D but also all the other disease conditions. Barriers like ill-equipped patients with limited opportunities for education and counseling, enormous workload due to staff shortages, and loss to follow-up, among others, were equally identified. Conclusions: This systematic review identifies key facilitators and barriers to implementing effective interprofessional care for type 2 diabetes management in the elderly population of the SADC. Understanding these factors can help healthcare professionals optimize their collaborative efforts, ultimately enhancing the quality of care and improving health outcomes for elderly patients with T2D in the region. Full article

The integration of Artificial Intelligence and Robotics (AI/R) in healthcare presents both opportunities and challenges, especially in developing countries. This study assessed the attitudes and perceptions of Vietnamese healthcare undergraduates towards AI/R applications in healthcare and elderly care. In 2023, a cross-sectional survey was conducted among 1221 Vietnamese healthcare undergraduates. The questionnaire covered demographic, academic, social, and mental factors, as well as attitudes towards AI/R applications measured by a five-level Likert scale. Key findings revealed that respondents were primarily majoring in medicine (60.9%) and pharmacy (29.4%). Awareness and interest in AI/R were high (89.9% and 88.3%, respectively), but formal training was significantly lacking (5.9%). A substantial majority (89.9%) expressed a need for AI/R training. Respondents perceived considerable benefits of AI/R, particularly in data synchronization (mean [M] = 3.83), workload reduction for medical staff (M = 3.79), and delivering multiple healthcare benefits (M = 3.82). Moderate concerns were noted regarding security and privacy (M = 3.46), potential over-reliance on technology (M = 3.43), and AI/R potentially replacing medical staff (M = 3.38). Overall, perceived benefits (M = 3.67) outweighed concerns (M = 3.38), (p < 0.001). Additionally, participants aware of AI/R and those planning to study abroad showed greater interest and training needs in AI/R. Higher GPA and self-esteem were associated with a greater interest in AI/R research. The study highlights a significant gap in formal AI/R training, not only in availability but also in the absence of structured, outcome-based curricula, despite the strong interest among healthcare students in acquiring knowledge and skills in this area. These findings suggest the need for enhanced educational programs to train healthcare students with the necessary competencies to apply AI/R technologies effectively. Full article