Search Results (3,748)

Background/Objectives: Quality indicators are essential for evaluating and improving primary health care (PHC), but existing indicator sets differ considerably in their definitions, development methods, data requirements, and applicability across healthcare systems. This scoping review aimed to identify and synthesize quality indicators used to assess PHC services, describe the principal areas and methodological approaches represented, and identify persistent measurement gaps. Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. PubMed/MEDLINE, Embase, and CINAHL were searched from inception to December 2025, with an updated search conducted on 27 August 2026. Targeted grey-literature searches of World Health Organization, United Nations Children’s Fund, and Organisation for Economic Co-operation and Development sources were also undertaken. Two reviewers independently screened the records and assessed potentially eligible full texts. Data were synthesized narratively and interpreted using the Donabedian structure–process–outcome framework, the seven World Health Organization dimensions of healthcare quality, and PHC-specific functions and content areas. Results: Twenty-three sources were included, comprising empirical studies, indicator-development and consensus studies, methodological reviews, national quality-improvement programmes, and international performance-measurement frameworks. Recurring areas included chronic disease management, preventive care, medication safety, access, continuity, service delivery, patient safety, efficiency, and healthcare utilization. Patient-reported outcomes and experiences, equity, social determinants of health, structural capacity, and broader outcomes meaningful to patients and populations were less consistently represented. Substantial heterogeneity in indicator definitions, reporting levels, data sources, and methodological approaches limited direct comparison across frameworks. Conclusions: PHC quality measurement remains extensive but fragmented. Future frameworks should balance structure, process, and outcome indicators, incorporate outcomes that matter to people, and combine standardized core measures with context-specific, feasible, valid, and actionable indicators. Full article

Albuminuria is routinely used to assess kidney damage in diabetes, but it also conveys cardiovascular risk across the urinary albumin-to-creatinine ratio (UACR) distribution, including within A1. Whether sex modifies this relationship remains uncertain. This narrative review prioritizes longitudinal studies in type 2 diabetes mellitus (T2DM), analyses within A1 particularly, and distinguishes this direct evidence from the general population or chronic kidney disease cohorts, surrogate-endpoint studies, and experimental mechanisms. A few studies report formal sex-by-UACR interactions for selected outcomes, including mortality in broad kidney-disease populations and heart failure in diabetes. Many other apparent differences derive only from sex-stratified analyses and therefore do not establish effect modification. Differences in urinary creatinine excretion, body composition, hormonal exposure, kidney injury pathways, cardiovascular phenotype, and health-care ascertainment may alter the observed association, but most mechanistic evidence is indirect. Current evidence supports UACR as a continuous prognostic marker in both sexes but does not justify sex-specific diagnostic cut-offs, therapeutic thresholds, or response targets. UACR should be measured systematically, confirmed when abnormal or borderline, preferably repeated under standardized conditions, and interpreted with eGFR and the overall cardiovascular risk profile. Sex may provide additional clinical context; treatment should continue to follow guideline-based indications. Full article

Background/Objectives: The combined goal of achieving both clinical and endoscopic remission has highlighted the need for strategies that support a treat-to-target approach in inflammatory bowel disease (IBD). A proactive monitoring strategy involves scheduled assessments regardless of symptoms to detect subclinical disease activity and enable timely treatment adjustments, whereas a reactive approach initiates evaluation only in response to clinical deterioration or objective signs of active disease. This study investigated whether proactive monitoring improves the achievement of treatment goals compared with a reactive strategy. Methods: In this prospective cohort study carried out between September 2020 and July 2022, patients with IBD receiving biologic therapy were managed according to a predefined proactive monitoring schedule and prospectively followed for one year. A control group, matched for age, sex, diagnosis, and treatment, was enrolled from another tertiary IBD center using a reactive monitoring strategy; their clinical course over one year was reconstructed retrospectively from medical records. All patients underwent colonoscopy assessment at one year. The primary outcome was treatment failure, defined as inadequate mucosal healing or symptom control, the need for intestinal surgery, or discontinuation of biologic therapy due to insufficient efficacy. Results: A total of 162 patients were included (91 managed proactively and 71 managed reactively). In the intention-to-treat population, treatment failure occurred in 67 patients (74%, 95% confidence interval (CI) 63–84%) in the intervention group and 60 patients (85%, 95% CI 75% to 94%) in the control group (difference 11%, CI −3% to 25%, p = 0.13). In the per-protocol analysis, 44 of 69 patients (64%, CI 50% to 78%) in the intervention group experienced treatment failure compared with 43 of 53 patients (81%, CI 60% to 93%) in the control group (difference 17%, CI −1% to 36%, p = 0.06). Patients in the proactive monitoring group underwent significantly more disease-monitoring assessments than those managed reactively. Conclusions: Proactive monitoring numerically improved combined clinical and endoscopic outcomes compared with reactive management, but this did not reach statistical significance and resulted in substantially greater healthcare resource utilization. Full article

(1) Background: In routine clinical practice, CHDs are occasionally diagnosed in adulthood, mostly relatively minor defects that become symptomatic later in life. Less frequently, adults may present with complex CHDs that, due to anatomical variations, remain undiagnosed until adulthood. Another important group comprises patients with previously unrecognized CHDs, particularly those from socioeconomically disadvantaged settings with limited access to healthcare. (2) Body: In adulthood, CHDs often present with nonspecific symptoms suggestive of other cardiovascular conditions (cardiomyopathy or coronary artery disease), including dyspnea, chest discomfort, signs of HF, syncope, palpitations, and paradoxical embolism. The initial manifestation may also be a malignant arrhythmia or sudden cardiac death; therefore, early recognition and diagnosis are crucial. TTE represents the first-line diagnostic modality. Reduced LVEF in young patients, particularly when accompanied by left atrial and right-sided cardiac chamber dilatation, should raise suspicion of an underlying CHD. The diagnostic evaluation may be supplemented by TEE, CMR imaging, and right heart catheterization. Familial forms of CHD and the risk of transmission to offspring have been extensively investigated, particularly for conditions with a strong genetic component, such as BAV. (3) Conclusions: In adult patients with newly diagnosed CHD, accurate recognition of clinical symptoms and completion of an appropriate diagnostic workup are essential for establishing the diagnosis and initiating timely treatment. Furthermore, identification of families at increased genetic risk is important to facilitate targeted genetic panel screening. Future research should focus on developing and validating appropriate screening strategies for the early detection of CHDs in resource-limited regions. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Background: Recently, artificial intelligence-based tools such as large language models (LLMs) have further transformed health information-seeking practices. This study aimed to assess digital health information-seeking behaviors among healthcare professionals working in İzmir, Türkiye, and to examine individual and environmental factors associated with these behaviors. Methods: A cross-sectional study was conducted among 380 healthcare professionals in İzmir. Data were collected using an online questionnaire comprising sociodemographic and health information-seeking items and the eight-item e-health literacy scale (eHEALS). Descriptive statistics and non-parametric tests were used for unadjusted comparisons. Multivariable binary logistic regression was performed to identify factors independently associated with LLM use, while multivariable linear regression with HC3-robust standard errors was used to identify factors independently associated with e-health literacy. To reduce sparse-data instability, conceptually compatible small categories were collapsed before refitting the multivariable models. Statistical significance was set at p < 0.05. Results: Overall, 73.2% of participants reported using LLMs (e.g., ChatGPT) for health-related information seeking. After multivariable adjustment, daily internet use of 3–6 h was associated with higher odds of LLM use compared with ≤3 h/day (adjusted OR = 2.0437, 95% CI: 1.1467–3.6423, p = 0.0153). E-health literacy was not independently associated with LLM use (adjusted OR = 0.9875, 95% CI: 0.9599–1.0158, p = 0.3825). In the e-health literacy model, the combined divorced/widowed group had lower adjusted scores than married participants (B = −4.4087, 95% CI: −7.4003 to −1.4171, p = 0.0039). Uncertainty about institutional scientific database access was also associated with lower e-health literacy (B = −6.1805, 95% CI: −8.9255 to −3.4356, p < 0.0001), whereas often/always reading online health information was associated with higher scores compared with never/rarely reading it (B = 2.6264, 95% CI: 0.5112–4.7416, p = 0.0149). Conclusion: LLM use was common among healthcare professionals, but it was not independently associated with e-health literacy. Patterns of internet use, marital status, institutional database awareness, and frequency of reading online health information showed independent associations with the study outcomes. These findings support targeted digital health and AI-literacy initiatives. Full article

Background: Rare diseases collectively affect millions of children worldwide and are a major cause of pediatric morbidity, mortality, and lifelong disability. Although most have a genetic basis, obtaining a timely molecular diagnosis remains challenging because of substantial clinical and genetic heterogeneity. Advances in genomic medicine are transforming rare disease diagnosis and establishing genomics as the center of precision medicine. Methods: This review summarizes current evidence on genomic approaches for pediatric rare diseases, including established and emerging sequencing technologies, their clinical applications, implementation challenges, and future directions. Results: Whole-genome sequencing is increasingly being adopted as a first-line genomic test for suspected rare genetic disorders, particularly when the phenotype is heterogeneous or does not point to a specific diagnosis. Conventional cytogenetic and targeted molecular techniques remain important complementary approaches for selected phenotypes, variant classes, and orthogonal confirmation. Gene panels are effective for well-defined phenotypes, whereas whole-exome sequencing remains a high-yield approach for genetically heterogeneous disorders, particularly when whole-genome sequencing is not available or is not clinically indicated. Long-read whole-genome sequencing expands diagnostic capacity by detecting structural variants, repeat expansions, complex rearrangements, and non-coding pathogenic variants that frequently escape short-read technologies. Emerging multi-omics approaches further improve variant interpretation and help resolve previously unsolved cases. Beyond diagnosis, molecular findings guide personalized clinical management, genetic counselling, reproductive planning, and access to targeted therapies and genotype-driven clinical trials. However, broad implementation is constrained by challenges in variant interpretation, ethical and legal considerations, data governance, workforce capacity, cost, and inequitable access to genomic services. Artificial intelligence, international data-sharing initiatives, and coordinated healthcare networks are helping overcome these barriers and improve diagnostic equity. Conclusions: Whole-genome sequencing is increasingly emerging as a first-line genomic strategy for pediatric rare diseases, while complementary technologies, expert phenotyping, and iterative data interpretation remain essential for comprehensive and accurate diagnosis and equitable access to genomic medicine. Full article

Helicobacter pylori infection is a major cause of gastric cancer, and eradication before advanced precancerous gastric changes develop provides a biologically plausible opportunity for primary prevention. Adolescence represents a strategically favorable, although not universally established, window for intervention in Japan because persistent childhood-acquired infection can be identified before extensive mucosal damage while school-based programs provide organized access to defined birth cohorts. This narrative review evaluates the evidence supporting population-based adolescent H. pylori screening, its potential harms and uncertainties, and the lessons derived from Japanese implementation. Representative programs demonstrate that organized screening is feasible but show substantial heterogeneity in participation, diagnostic pathways, antimicrobial resistance, eradication outcomes, and retention across the care cascade. Direct evidence that adolescent screening reduces future gastric cancer incidence or mortality is not yet available. As H. pylori prevalence declines, the balance among screening yield, diagnostic performance, antimicrobial exposure, cost, and equity will continue to change. International experience further indicates that prevention strategies should be matched to local epidemiology and healthcare systems. Adolescent screening should therefore be viewed as an adaptive prevention strategy whose target population, diagnostic pathway, and treatment approach require periodic reassessment. Full article

Diabetes-related hypoglycemia contributes substantially to increased morbidity, mortality, health-care utilization, and reduced quality of life. Older adults with diabetes represent a heterogeneous group of patients who need individualized blood glucose targets to avoid hypoglycemia. Since the elderly present with varying degrees of functional and cognitive status and individualized health needs, their management varies among individuals. Complicating this, the hypoglycemia risk in older adults treated with insulin also varies due to aging, renal dysfunction, cognitive impairment, and other comorbidities. The challenge for healthcare providers is in considering all aspects of care in order to avoid hypoglycemia in elderly individuals. In this review, we introduce a Patient and Function Centric Approach to the assessment and management of hypoglycemia in older adults. This holistic framework extends beyond blood glucose values to systematically evaluate the other domains of patients’ health that influence hypoglycemia risk, including biochemical, medication, timing, autonomic, cognitive, mood, renal, pancreatic, hepatic, social, and physical function. The management of hypoglycemia in older adults should also include strategies to address both fear of hypoglycemia and hypoglycemia unawareness. In addition to physical limitations, the psychosocial barriers to self-care in older individuals with hypoglycemia are also of paramount importance. Using tools that measure diabetes burden, diabetes distress, and fear of hypoglycemia provides valuable insights into patient wellbeing. The use of newer anti-hyperglycemic medications, sensor-augmented insulin pump therapy, intranasal glucagon, and continuous glucose monitoring (CGM) has significantly contributed to reduced hypoglycemia incidence in individuals with diabetes. Overall, successful management requires a collaborative approach that empowers patients, respects their individual needs and preferences and helps them face the challenges associated with diabetes management with confidence rather than fear or anxiety. Adopting a patient- and function-centric approach to hypoglycemia management allows clinicians to move beyond a one-size-fits-all model and adopt individualized glycemic targets that improve overall diabetes control and mental well-being. Full article

Despite longstanding vaccine availability, human papillomavirus (HPV) remains the most common sexually transmitted infection in the United States and a leading cause of preventable cancers. Additionally, HPV vaccination rates remain below other routinely recommended adolescent immunizations, particularly in rural populations. This study aimed to identify barriers related to healthcare access, socioeconomic conditions, cultural beliefs, and provider–patient communication in rural communities. A bibliographical review of articles published in English from 2020 to 2025 and an analysis of national datasets were conducted to establish trends in HPV vaccination rates. State-level HPV vaccination data for adolescents aged 13–17 years were obtained from America’s Health Rankings and the Centers for Disease Control and Prevention National Immunization Survey-Teen. States were classified as predominantly rural or urban using Rural–Urban Continuum Codes, and mean vaccination completion rates were compared. The mean HPV vaccination completion rate was lower in rural states (60.55%) compared to urban states (67.31%); however, this difference did not meet the selected threshold for statistical significance (p = 0.025). Barriers identified in the literature included reduced access to healthcare, differences in provider communication, socioeconomic constraints, and limited health literacy in rural communities. Of the identified barriers, healthcare provider recommendations emerged as one of the strongest predictors of vaccine acceptance. These findings highlight multilevel determinants contributing to differences in HPV vaccine uptake and underscore the need for targeted, evidence-based strategies to improve vaccine access and coverage in underserved adolescent populations. Full article

Prostate cancer is the most commonly diagnosed non-cutaneous malignancy among men in the United States and remains a leading cause of cancer-related mortality. Its marked biological, molecular, and histopathological heterogeneity creates a central diagnostic challenge: identifying clinically significant disease while limiting unnecessary biopsy and overdiagnosis of tumors unlikely to affect survival or quality of life. Although prostate-specific antigen (PSA) remains the foundation of early detection, its limited cancer specificity has driven the development of increasingly risk-adapted diagnostic pathways. Contemporary evaluation integrates clinical risk assessment and PSA-derived measures with selectively used blood- and urine-based biomarkers, multiparametric magnetic resonance imaging (mpMRI), image-guided biopsy, histopathological classification, genomic risk assessment, and molecular imaging. Biomarkers such as the Prostate Health Index, 4Kscore, IsoPSA, MiCheck, SelectMDx, and ExoDx may refine biopsy decisions in appropriately selected patients but should be interpreted according to the clinical setting, decision threshold, and surrounding diagnostic pathway. Prostate MRI and PI-RADS-based assessment have become central to pre-biopsy evaluation, while MRI-targeted biopsy improves detection of Grade Group ≥ 2 disease. Increasing use of the transperineal biopsy route offers comparable cancer detection with a lower infectious risk. Following diagnosis, Grade Group, adverse histological features, clinical risk models, and selected tissue-based genomic classifiers provide complementary prognostic information. PSMA PET/CT has further improved staging of selected patients with higher-risk disease and localization of biochemical recurrence. Precision diagnostics must also account for disease phenotypes that may not be adequately represented by conventional PSA- and imaging-based pathways, including intraductal carcinoma, cribriform architecture, ductal adenocarcinoma, and neuroendocrine prostate cancer. Emerging approaches, including artificial intelligence-assisted MRI interpretation, digital pathology, high-frequency micro-ultrasound, liquid biopsy, alternative molecular radiotracers, and multi-omic integration, show increasing potential but remain at different stages of validation and clinical adoption. This review critically examines contemporary prostate cancer diagnostics within United States clinical practice, distinguishing established guideline-supported approaches from selectively used adjuncts and emerging technologies. Particular emphasis is placed on diagnostic performance in context, clinical utility, external validation, healthcare equity, regulatory considerations, and the need to demonstrate that increasing diagnostic complexity translates into meaningful improvements in patient care. Full article

Mood disorder symptoms represent an important but understudied mental health concern among physicians in Romania, with potential implications for quality of life and suicide risk. This cross-sectional study included 104 medical doctors. Validated self-report instruments were used to assess depressive symptoms, manic and cyclothymic symptoms, bipolar risk, suicidal behaviour, and quality of life. Pearson correlation analyses and multiple linear regression models were conducted to examine associations and identify predictors of quality of life and suicide risk. Overall, 33% of participants screened positive for depressive symptoms, 21% for manic symptoms, 71% for cyclothymic symptoms, 12% for suicide risk, and 2% for bipolar risk. Depression, cyclothymia, and suicide risk were negatively correlated with quality of life, whereas manic symptoms showed a positive association. In multivariate analyses, cyclothymia predicted poorer quality of life (β = −0.43, p < 0.001) and manic symptoms seemed to predict better quality of life (β = 0.26, p = 0.008), while depressive symptoms uniquely predicted greater suicide risk (β = 0.24, p = 0.048). These findings indicate a high prevalence of mood disorders among Romanian physicians and suggest distinct patterns linking mood symptoms to quality of life and suicide risk. The results highlight the importance of early identification, stigma reduction, and targeted mental health interventions to support physician well-being and healthcare system sustainability. Full article

Background/Objectives: Screening for carriage of antibiotic-resistant bacteria (ARB) upon hospital admission and isolating carriers can prevent nosocomial spread of ARB. Screening typically targets patients at high risk of ARB carriage because of recent hospitalization or travel. For ARB with community spread among non-high-risk patients, screening only high-risk patients may be insufficient to control nosocomial transmission. We used an agent-based model to examine the impact of screening patients without recognized risk factors for ARB carriage on the acquisition and prevalence of ARB carriage in hospitals. Methods: The agents in our model of an 800-bed hospital were patients and healthcare workers (HCW). Contacts between HCW and patients or between patients may result in ARB transmission. We modelled scenarios of 1%, 5% or 20% ARB carriage prevalence upon admission among high-risk patients and ARB carriage prevalence ratios between high-risk and non-high-risk patients of 1.11, 2, 5 and 10. At baseline, screening test sensitivity was 85%, compliance with screening of high-risk patients was 80%, and isolation effectiveness was 70%. Results: Expanding screening to non-high-risk patients decreased the incidence of nosocomial ARB acquisitions. The impact of this screening on nosocomial acquisitions increased as greater community spread occurred. Carriage prevalence in the hospital was mainly influenced by imported cases; nosocomial transmission accounted for a minority of prevalent cases. Improving isolation effectiveness to 95% had a greater impact on ARB acquisitions than expanded screening when carriage prevalence among non-high-risk patients was low. Conclusions: The impact of expanded screening was small when carriage prevalence among high-risk patients was low or when the carriage prevalence ratio was high. In the scenarios modelled here, improving isolation effectiveness prevented more acquisitions than expanded screening. Full article

Background: Cutaneous wound repair requires rapid re-epithelialization to restore barrier function and protect against infection. This process depends on coordinated keratinocyte migration and proliferation, and its impairment contributes to slow wound healing and increased healthcare burden. Current extracellular matrix (ECM)-based therapies largely target the dermis, while the therapeutic potential of epidermal basement membrane (BM) components remains underexplored. BM protein laminin-332 (LN332) is upregulated after injury and promotes keratinocyte migration. It functions as a key ligand for integrin α3β1, which is highly expressed by basal keratinocytes and further induced after wounding. Objectives: We aimed to investigate whether topical application of recombinant full-length LN332 could enhance wound repair in vivo and we examined the requirement for integrin α3β1 in this process. Methods: We used a full-thickness murine wound model with topical treatments of LN332 or a vehicle control, combined with a murine model of epidermis-specific integrin α3β1 deletion. Results: LN332 treatment accelerates re-epithelialization, and α3β1 is required for this effect. In addition to its direct effects on re-epithelialization, exogenous LN332 modulates several α3β1-dependent genes, including nerve growth factor (NGF). Our current study identifies NGF as an α3β1-dependent and LN332-responsive mediator of keratinocyte migration during wound healing. Conclusions: These findings identify the LN332–integrin α3β1-NGF axis as a promising therapeutic target for promoting re-epithelialization and improving healing outcomes. Full article

Background/Objectives: Celiac disease (CD) is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals with higher prevalence among first-degree relatives. Despite its hereditary risk, little is known about how parents with at least one child with CD perceive this risk in unaffected children. This study examined parental perceptions and dietary practices regarding CD prevention in unaffected children. Methods: A cross-sectional mixed-methods study was conducted in Greek parents using an online questionnaire for the quantitative component and semi-structured interviews for the qualitative. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression analysis, while qualitative data were analyzed using framework analysis. Results: Although parents demonstrated high awareness of genetic risk, this was not translated into preventive dietary modifications. Belief in the role of diet as a preventive CD strategy emerged as the only significant predictor of dietary change. Diet was widely recognized as important for overall health or as a therapeutic regimen for children living with CD; however, it was not perceived as a preventive strategy for CD. Reported family barriers to adopting a healthy diet included financial constraints and limited guidance, whereas advice from healthcare professionals emerged as a key facilitator of dietary change. Conclusions: Although parents recognize the genetic risk of CD, they rarely implement dietary changes as CD preventive behavior for their unaffected children. These findings highlight the potential value of clearer dietary guidance and targeted professional support for families with children with CD and unaffected siblings. Full article