Search Results (202)

Background/Objectives: Patients with an ileoanal pouch change their diet to manage their symptoms and will often resort to the internet for nutrition advice. Currently, no evidence-based dietary guidelines exist to inform online resources. Hence, this study aims to assess the quality of online nutrition information directed towards patients with an ileoanal pouch. Methods: A systematic Google search was conducted to identify consumer websites including information on nutrition for those with ileoanal pouches. Quality was assessed using the DISCERN instrument, and the readability of written content was assessed using the Flesch–Kincaid score. A summative content analysis was used to identify the frequency of particular topics. Websites were also assessed against standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision-making support tools. Results: A total of 12 websites met the inclusion criteria. Mean total DISCERN scores across all websites are 33 out of 75, indicating that overall, the websites were of poor quality. The mean Flesch–Kincaid score was 57 out of 100, or “fairly difficult” in terms of readability. The main themes according to the content analysis were “general dietary advice for pouch”, “dietary strategies for symptom management”, “addressing risks associated with having a pouch”, and “optimisation of nutritional intake”. Overall, websites did not meet the standards for shared decision-making. Conclusions: Online nutrition information for patients with an ileoanal pouch is of poor quality and difficult to understand. There is a need for higher quality online resources for these patients, ideally co-produced with a multidisciplinary team and patient, to provide patients with good quality, understandable, and accessible nutrition information. Full article

Aims: To systematically review and synthesize qualitative research exploring the Breast Cancer Survivors (BCSs)’ perception of health promotion interventions and informing strategies to mitigate recurrence risk within five years post-treatment and improve clinical outcomes. Specifically, this study addresses the question: “How do women diagnosed with breast cancer perceive health promotion interventions for recurrence prevention?” Design: A systematic review and qualitative meta-synthesis were performed. Data Sources: A systematic search of scientific databases (CINAHL, MEDLINE, and Scopus) was undertaken in November 2024. The reference list was cross-referenced and hand-searched to identify additional articles. Review Methods: Studies were included if they met the following criteria: they were primary qualitative studies focusing on BCSs within five years post-treatment, involving participants who had completed surgery, radiotherapy, or chemotherapy in the same time frame, as this period is critical for monitoring recurrence and implementing health promotion interventions. Only studies published in peer-reviewed journals and written in Italian, English, French, or Spanish were considered, provided that an abstract and the full text were available. Moreover, eligible studies had to be conducted in high-income or middle-income countries. Studies were excluded if they focused exclusively on advanced or metastatic breast cancer, if they involved mixed cancer populations without reporting separate data for BCSs, or if they were non-qualitative studies or gray literature. The review study protocol was registered in the PROSPERO database (CRD42024626033). Results: The literature search identified 490 records, 13 articles from databases, and 3 articles identified via other methods (web and citation searching) that met inclusion criteria. A narrative synthesis approach allowed the emerging five themes: (I) Challenges, (II) Self-motivation and empowerment, (III) The relationships as a facilitator, (IV) Barriers to change, and (V) Proactive support strategies. Conclusions: Addressing internal and external factors that influence health behaviors is essential to improve adherence, reduce recurrence risk, and enhance quality of life. Tailored interventions, social support, and healthcare engagement are crucial in this effort. Impact: Our meta-synthesis highlighted significant challenges as well as valuable resources for health promotion among BCSs, suggesting practical and tailored approaches to improving the adoption of healthy behaviors, supported by relationships and targeted support strategies. Full article

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and to identify possible interventions to increase their use. Methods: Our research was conducted on Pubmed, Google Scholar, and the Trip Database. We selected articles written in English, Spanish, and Italian published since 2015. Results: Studies have shown that the health status of Roma and Sinti populations is generally worse than that of the rest of the population. Limited access to care is due to several specific factors, such as beliefs, traditions, and the lack of awareness of widespread direct and indirect discrimination against these groups by healthcare professionals. The studies reviewed have shown how mistrust can be broken down through multi-centered interventions linked to information, education, and communication through mediators able to interact with these populations, as well as through appropriate training of the health workers in charge. Conclusions: The health of the Roma and Sinti populations is commonly worse than that of the rest of the population. This is particularly true for the large proportion of people confined to suburban camps. However, the available evidence signals the low quality of life they experience and the need for interventions involving the communities and the establishment of ad hoc orientation or initial care contact points in the segregated areas. This could lead to an improvement in the integration of this population into the National Health Systems’ activities. Full article

In the era of digital healthcare, electronic health records generate vast amounts of data, much of which is unstructured, and therefore, not in a usable format for conventional machine learning and artificial intelligence applications. This study investigates how to extract meaningful insights from unstructured radiology reports written in Finnish, a minority language, using machine learning techniques for text analysis. With this approach, unstructured information could be transformed into a structured format. The results of this research show that relevant information can be effectively extracted from Finnish medical reports using classification algorithms with default parameter values. For the detection of breast tumour mentions from medical texts, classifiers achieved high accuracy, almost 90%. Detection of metastasis mentions, however, proved more challenging, with the best-performing models Support Vector Machine (SVM) and logistic regression achieving an F1-score of 81%. The lower performance in metastasis detection is likely due to the more complex problem, ambiguous labeling, and the smaller dataset size. The results of classical classifiers were also compared with FinBERT, a domain-adapted Finnish BERT model. However, classical classifiers outperformed FinBERT. This highlights the challenge of medical language processing when working with minority languages. Moreover, it was noted that parameter tuning based on translated English reports did not significantly improve the detection rates, likely due to linguistic differences between the datasets. This larger translated dataset used for tuning comes from a different clinical domain and employs noticeably simpler, less nuanced language than the Finnish breast cancer reports, which are written by native Finnish-speaking medical experts. This underscores the need for localised datasets and models, particularly for minority languages with unique grammatical structures. Full article

Psychedelic plants and fungi have been traditionally used in many cultures as part of ritual ceremonies and ancient medicinal treatments. In some regions, these psychoactive plants have already entered mainstream discourse through popular literature and art. Today, numerous academic and medical institutions are establishing dedicated departments to examine the benefits and risks of psychedelic-assisted treatments. Entheogens in healing practices and herbal medicine are part of Slavic cultural heritage. However, due to the predominantly oral transmission of this knowledge, there is a significant lack of written sources and a profound gap in documentation regarding entheogen use on the Balkan Peninsula, where many psychoactive plants and mushrooms grow in their natural habitat. Our work aims to bridge indigenous knowledge systems with contemporary therapeutic discourse, while advocating for sustainable, inclusive, and culturally respectful research practices. This review manuscript presents information on Slavic ancient entheogens, and calls for further multidisciplinary, integrative approaches in researching psychoactive plants and mushrooms of the Balkans. Our paper includes the ethnobotanical uses of native Balkan entheogens, outlines the pharmacological mechanisms of their main active compounds, and discusses their impacts on social behavior, mental health, and overall well-being. We also examine their therapeutic potential and risks, contributing to the contemporary understanding of psychoactive and psychedelic use in mental health treatment and beyond, as tools for life enhancement to improve quality of life and well-being. Full article

Clinical documentation, particularly the hospital discharge report (HDR), is essential for ensuring continuity of care, yet its preparation is time-consuming and places a considerable clinical and administrative burden on healthcare professionals. Recent advancements in Generative Artificial Intelligence (GenAI) and the use of prompt engineering in large language models (LLMs) offer opportunities to automate parts of this process, improving efficiency and documentation quality while reducing administrative workload. This study aims to design a digital system based on LLMs capable of automatically generating HDRs using information from clinical course notes and emergency care reports. The system was developed through iterative cycles, integrating various instruction flows and evaluating five different LLMs combined with prompt engineering strategies and agent-based architectures. Throughout the development, more than 60 discharge reports were generated and assessed, leading to continuous system refinement. In the production phase, 40 pneumology discharge reports were produced, receiving positive feedback from physicians, with an average score of 2.9 out of 4, indicating the system’s usefulness, with only minor edits needed in most cases. The ongoing expansion of the system to additional services and its integration within a hospital electronic system highlights the potential of LLMs, when combined with effective prompt engineering and agent-based architectures, to generate high-quality medical content and provide meaningful support to healthcare professionals. Hospital discharge reports (HDRs) are pivotal for continuity of care but consume substantial clinician time. Generative AI systems based on large language models (LLMs) could streamline this process, provided they deliver accurate, multilingual, and workflow-compatible outputs. We pursued a three-stage, design-science approach. Proof-of-concept: five state-of-the-art LLMs were benchmarked with multi-agent prompting to produce sample HDRs and define the optimal agent structure. Prototype: 60 HDRs spanning six specialties were generated and compared with clinician originals using ROUGE with average scores compatible with specialized news summarizing models in Spanish and Catalan (lower scores). A qualitative audit of 27 HDR pairs showed recurrent divergences in medication dose (56%) and social context (52%). Pilot deployment: The AI-HDR service was embedded in the hospital’s electronic health record. In the pilot, 47 HDRs were autogenerated in real-world settings and reviewed by attending physicians. Missing information and factual errors were flagged in 53% and 47% of drafts, respectively, while written assessments diminished the importance of these errors. An LLM-driven, agent-orchestrated pipeline can safely draft real-world HDRs, cutting administrative overhead while achieving clinician-acceptable quality, not without errors that require human supervision. Future work should refine specialty-specific prompts to curb omissions, add temporal consistency checks to prevent outdated data propagation, and validate time savings and clinical impact in multi-center trials. Full article

The coordination of school- and community-based mental health services is a promising strategy to respond to the rising mental health needs of youth. Out-of-school time (OST) programs are an under-utilized community-based resource that may be leveraged to help meet this need. We conducted a scoping review to (a) identify practices that facilitate the coordination of care between schools and OST programs and (b) examine whether such practices align with those used in existing models of expanded school mental health (ESMH). EBSCOhost, PsycINFO, PubMed, Google Scholar, ERIC Scopus, MedLine, ScienceDirect, and national organization websites were used to identify articles, including peer-reviewed (n = 2) and grey literature (n = 7) published from 2004 to 2024 that were written in English and described U.S.-based schools and programs. Coordination practices were coded inductively and categorized as a school/program, district/community, or state-level practice. Practices within the vision/mission alignment, coordinating daily operations, training, and resource/information sharing domains were identified at the highest frequency. Many of the strategies identified are included in existing models of ESMH. Thus, expanding coordination models to include OST may be a feasible direction for increasing the capacity of communities to meet the mental health needs of youth. Given the paucity of research in this area, further empirical research is needed. Full article

Background and clinical significance: Polymorphous adenocarcinoma of the oral cavity is predominantly located in the palate. It is characterized by a slow rate of growth and thus may be misdiagnosed as a benign tumor. Its histology is intricate with other salivary malignancies, thus necessitating specific immunohistochemical stains. Our case report illustrates an adenocarcinoma localized in the palate of a 61-year-old female patient. Case presentation: The patient came to the postgraduate clinic of Oral Medicine and Pathology, Department of Oral Medicine and Pathology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece and provided written informed consent for the subsequent examination. The patient complained about the presence of a mass on the palate, which was otherwise asymptomatic, without being able to pinpoint when the tumor initially emerged. The lesion was biopsied and the histology suggested the immunophenotype p63+/p40- which constitutes an important diagnostic clue for polymorphous adenocarcinoma. The patient was referred to the Department of Oral and Maxillofacial Surgery. Conclusions: The standard therapeutic approach primarily involves surgical excision. The goal is to achieve optimal patient outcome while minimizing unnecessary morbidity. As surgical techniques and understanding of the disease continue to advance, it is crucial for healthcare providers to stay informed and integrate these developments into practice to improve treatment outcomes for patients. Full article

Background/Objectives: The digital transformation in healthcare is reshaping care delivery by enhancing patient care and flexibility. However, it also poses potential challenges to healthcare professionals’ wellbeing and work practices. To date, research on the implications of telemedicine for healthcare professionals remains limited and inconclusive. This study aims to provide a comprehensive overview of this research field using a quantitative, bibliometric approach. Methods: Articles were systematically selected from Web of Science and Scopus databases, focusing on empirical, peer-reviewed articles written in English, involving healthcare professionals and focusing on telemedicine. Results: The dataset consists of 160 papers. The analysis reveals a significant increase in publications starting from 2012, with a notable surge in 2020, reflecting the impact of the COVID-19 pandemic. The University of New Mexico and the Cleveland Clinic Foundation, both in the United States, were identified as the institutions with the highest number of published articles. Most studies were published in clinical-focused journals (e.g., Journal of Medical Internet Research and BMC Health Services Research), emphasizing the field’s dominant orientation. The intellectual structure reveals that wellbeing, work practices, and communications between patients and professionals are central themes. Conclusions: This bibliometric analysis provides scholars with a clearer understanding of the intellectual structure of research on the implications of telemedicine for healthcare professionals, addressing key gaps left by previous reviews. While telemedicine offers numerous advantages, such as enhanced access to care and greater flexibility, it also raises challenges related to healthcare professionals’ wellbeing, work practices, and communication with patients. Both contextual factors (e.g., digital skills training) and individual characteristics (e.g., attitudes toward telemedicine) play a significant role in shaping healthcare professionals’ experiences with telemedicine. By identifying influential contributors and thematic patterns, this study offers a foundation for future research and informs the development of targeted interventions to sustain healthcare professionals in digitally mediated care environments. Full article

Background: The impact of social media on adolescent mental health has become a critical area of research as social media usage has surged among youth. Despite extensive research, findings on this relationship remain inconsistent, with various studies reporting both negative and positive effects. This scoping review aims to clarify the multifaceted nature of this relationship by analyzing the recent literature. Objective: This review aims to analyze the current evidence regarding the effects of social media use on adolescent mental health, identify consistent patterns and discrepancies in the findings, identify gaps in our knowledge, and highlight opportunities for further research. Methods: A scoping review was conducted following Arksey and O’Malley’s five-stage approach. Searches were performed in PubMed, MEDLINE, Web of Science, and Scopus for articles published between July 2020 and July 2024. Inclusion criteria were systematic reviews, umbrella reviews, narrative reviews, and meta-analyses written in English focusing on youth/adolescents’ mental health and social media. The search strategy identified 1005 articles, of which 43 relevant articles survived the reviewer selection process, from which data were extracted and analyzed to inform this review. Results: The majority of studies linked social media use to adverse mental health outcomes, particularly depression and anxiety. However, the relationship was complex, with evidence suggesting that problematic use and passive consumption of social media were most strongly associated with adverse effects. In contrast, some studies highlighted positive aspects, including enhanced social support and reduced isolation. The mental health impact of social media use, specifically during the COVID-19 pandemic, was mixed, with the full range of neutral, negative, and positive effects reported. Conclusions: The nature of social media’s impact on adolescent mental health is highly individualistic and influenced by moderating factors. This review supports the notion that social media’s effects on adolescent mental health can be context specific and may be shaped by patterns of usage. A focus on longitudinal studies in future research will be useful for us to understand long-term effects and develop targeted interventions in this context. Enhancing digital literacy and creating supportive online environments are essential to maximizing the benefits of social media while mitigating its risks. Full article

Low health literacy is a known contributing factor to poorer patient outcomes. Health information is often presented through materials written at high reading levels and thus may be an ineffective education tool for patients of diverse socioeconomic backgrounds, age ranges, and education levels. Graphic medicine (i.e., healthcare concepts presented through illustrations, such as comics or cartoons) may be a more equitable and efficacious format for many patients. The purpose of this review was to describe the efficacy and use of graphic medicine interventions regarding health outcomes, behavior changes, and engagement with health services. Nine databases were searched for studies that were randomized controlled trials in the English language, published before 4 December 2023. The searches identified 34 research articles that met the inclusion/exclusion criteria. This review revealed four key takeaways: (1) graphic medicine interventions are used globally; (2) graphic medicine interventions may be efficacious for a wide variety of health topics; (3) graphic medicine can be equitably delivered in many formats; and (4) graphic medicine can be applied broadly across the lifespan. The findings suggest that graphic medicine enhances patient engagement, empowers individuals with knowledge, and ultimately contributes to improved health outcomes across various populations; however, more effectiveness trials are needed. Additionally, an expanded definition of graphic medicine is presented. Full article

Background: Sepsis is a major global health issue and the leading cause of death in critically ill patients, with rising incidence and associated healthcare costs. Early administration of antibiotic therapy is crucial, but increasing antibiotic resistance poses a threat. Beta-lactam antibiotics, commonly used as a first-line therapy option against sepsis, often demonstrate unpredictable concentrations due to pharmacokinetic and pharmacodynamic changes in critically ill patients. Acute kidney injury (AKI) affects a significant portion of septic patients, and continuous renal replacement therapy can further complicate treatment by reducing antibiotic levels and, consequently, increasing antibiotic resistance risk. Objectives: To develop pharmacokinetic/pharmacodynamic models for beta-lactam antibiotics in septic shock patients undergoing continuous renal replacement therapy (CRRT), with the goal of optimizing antibiotic dosing and then improving treatment outcomes. Methods: Septic shock Caucasian adult patients treated with beta-lactams and who have undergone major surgery in AKI failure that requires CRRT will be eligible with previous informed written consent. CRRT will be performed exclusively using Continuous Venovenous Hemodiafiltration (CVVHDF) modality. Antimicrobial determination analyses will be carried out with LC-MS/MS. Further calculation of pharmacokinetic parameters and determination of PK/PD breakpoints will be made using Monte Carlo simulation. Conclusions: The expected results from this study will lead to a better understanding of the pharmacokinetics of beta-lactam antibiotics in critically ill patients with AKI and septic shock undergoing CVVHDF, allowing for improved therapeutic strategies. Full article

Rates of self-harm among young women have been increasing in recent years across multiple high-income nations. Given the negative outcomes associated with self-harm, it is essential that young women who engage in self-harm receive the support that best addresses their specific needs. The aim of the current study is to explore support preferences among Australian young women with a history of self-harm. Semi-structured interviews were conducted with 27 young women (M = 20.9, SD = 2.1) with a history of self-harm, recruited through social media posts. Interviews were audio-recorded and transcribed verbatim. Data were analysed using a Reflexive Thematic Analysis approach. Thematic analysis of the data identified themes pertaining to the following: (1) the types of support young women want around self-harm, and (2) how young women would like to receive support for self-harm. Regarding the former, participants expressed wanting information about self-harm and self-harm interventions, education about self-harm for those around them, age-specific mental health education, and alternative coping strategies. Some participants expressed not wanting any support. Regarding the latter, participants wanted self-harm information to be provided by health professionals and in school settings, and preferred for information to be provided in written or digital forms. The findings highlight the need to improve access to formal mental health support among young women, the importance of young people being able to access support confidentially, and the need for young peoples’ caregivers and health professionals to be educated about self-harm. Additionally, the findings support a role for schools in providing information about mental health and available support. Full article

The objective of this scoping review was to map out the cultural themes related to oral health practices, beliefs, and experiences in Nigeria; explore mythologies about oral health in Nigeria; identify the perceived cultural significance of oral health within the Nigerian communities; and determine the implications of study findings for oral health promotion and intervention strategies. This was a scoping review. A systematic literature search was conducted in PubMed, Cochrane Library, Web of Science, Google Scholar, and CINAHL. Published studies in peer-reviewed journals written in English that investigated culture and oral health were included. All forms of literature reviews, editorials, or opinion pieces were excluded. Information on the study characteristics and population characteristics, cultural determinants of oral health, oral health outcomes, and the methods used to assess cultural factors and oral health outcomes was extracted. A narrative synthesis of the findings was conducted to identify key themes in the literature. The 37 articles, published between 1998 and 2024, that met the eligibility criteria wrote on the prevalence of a culture of self-medication and self-care, myths that affect utilization of oral health services, cultures that expose people to increased risk of poor oral health, and cultural norms, beliefs, and practices that facilitate oral health. The findings emphasize the need for culturally tailored strategies to improve oral health literacy and reduce disparities. This review underscores the potential to foster community engagement, trust, and sustainable improvements in oral health outcomes by aligning oral health promotion efforts with Nigeria’s culture. In conclusion, cultural norms, beliefs, and practices can be barriers and facilitate oral health in Nigeria. Identifying and understanding the norms, beliefs, and practices that affect oral health can help improve oral health education and promotion so that they are culturally relevant and effective. Full article

Background/Objectives: Globally, there has been an increase in the prevalence of anxiety and depression among university students, and medical students are no exception. Medical students are especially susceptible to these mental health challenges, primarily due to multifaceted stressors, which can significantly impact their academic achievements and future career. There is a pressing need for comprehensive research that not only investigates the prevalence of anxiety and depression among medical students but also explores strategies for developing effective mental health interventions and support systems that can enhance the well-being of medical students. Therefore, this study aimed to identify the prevalence and severity of anxiety and depression among medical students at a university in South Africa, evaluating the association of socio-demographic, student, and clinical variables with total general anxiety disorder (GAD-7) and patient health questionnaire (PHQ-9) scores. Methods: A survey-based quantitative cross-sectional study was conducted with 208 medical undergraduate students at a South African university. Participants who provided written consent completed GAD-7 and PHQ-9 questionnaires together with socio-demographic, student, and clinical variable information. The relationship between socio-demographic, student, and clinical variables and total GAD-7 and PHQ-9 scores was determined using the Mann–Whitney U test and Kruskal–Wallis H test. Correlation analysis was used to establish the relationship between total anxiety and depression scores. The threshold for statistical significance was set at p ≤ 0.05. Results: More than half of the participants were female (n = 130; 62.5%), single (n = 123; 59.1%), and belonged to the Pedi ethnic group. A majority of the students were Christian (n = 183; 88.0%), received a bursary (n = 183; 88.0%), and had a rural background (n = 155; 74.5%). However, a small percentage of students reported a history of psychiatric and chronic illnesses (n = 26; 12.5%) and previously received professional psychological support (n = 38; 18.3%). In this study, 38% (n = 79) of the participants reported GAD and 67.8% (n = 141) reported symptoms of depression. Significant associations (p <0.05) were observed between variables such as year of study, repeating a module, and history of psychiatric illness with total GAD-7 and PHQ-9 scores. Correlation analysis revealed a moderate positive correlation (r_s = 0.400, df = 206, p < 0.001) between total GAD-7 and PHQ-9 scores. Conclusions: This study identified a high level of depression and anxiety among medical students and found a positive correlation between anxiety and depression scores. Addressing these mental health challenges is crucial not only for the well-being of the students but also for the future of healthcare, as the mental health of medical professionals directly impacts patient care. Full article