Healthcare, Volume 12, Issue 11 (June-1 2024) – 87 articles

The evolving landscape of opioid prescription practices necessitates a comprehensive understanding of emerging patterns, particularly among new opioid users discharged from emergency departments. This study delves into the intricate realm of opioid utilization by elucidating the prevalence of their prescriptions. A retrospective analysis of electronic health records was conducted, including a cohort of 71 patients who received opioid prescriptions upon discharge from emergency departments from 1 January 2022 to 30 June 2022. Demographic characteristics and prescription details were systematically examined. This study illuminates tramadol’s prominence, with 84% of prescriptions and a Defined Daily Dose (DDD) morphine equivalent of 60 mg, as the primary choice as a new opioid, a finding that draws attention due to the closely aligned dosages with morphine equivalents. This discovery prompts a critical reassessment of tramadol’s therapeutic role, considering its multifaceted nature encompassing serotonergic effects and heightened fall risks. This study advocates for a nuanced and vigilant approach to tramadol prescription, cognizant of its potential risks and therapeutic implications, and highlights the imperative of optimizing data quality and traceability within electronic health records to enhance patient care and facilitate future research endeavors. Full article

Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists’ role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination. Full article

This study investigated the association of exercise and dietary habits with defecatory dysfunction in patients living with colorectal cancer. We recruited 61 adult patients who had undergone surgery within the past 20 years and attended outpatient clinics at designated cancer hospitals in Japan. Defecatory dysfunction was defined as any symptom caused by issues with colon and anal function, including fecal incontinence, evacuation difficulties, frequent stools, diarrhea, and constipation. Exercise and dietary habits were assessed via a quantitative questionnaire survey. Postoperative defecatory dysfunction occurred in all the patients. Multivariate analysis revealed no association between exercise habits and defecatory dysfunction; however, dietary fiber intake ≥4 times a week was associated with frequent stools (adjusted odds ratio, 5.11; 95% confidence interval, 1.10, 23.70). These findings suggest a need to alleviate defecatory dysfunction by improving one’s dietary habits. Interventions aimed at alleviating defecatory dysfunction by improving the dietary habits in patients living with colorectal cancer are needed. Full article

Background: According to the World Health Organization, social isolation, particularly of older adults, is a public health issue endangering the well-being of individuals, families, and communities. Social isolation affects health through biological, behavioral, and psychological pathways and is associated with physical and psychological/emotional well-being, increases morbidity and mortality rates, and lowers quality of life. Purpose: This systematic review examined the relationship between social isolation and physical health, including subjective and objective dimensions, and factors that influence this relationship in adults. Methods: This systematic review examined six electronic databases covering the field of health and human services and included results from 1 January 2017 to 10 March 2023 with key terms including adult social connection or social isolation coupled with health, physical, psychological, emotional, mental, or behavioral. The initial search yielded 925 research articles across all databases and was narrowed to 710 when the decision was made to focus on social isolation and physical health. Covidence was used throughout the retrieval and appraisal process, as provided in a PRISMA flow diagram. Twenty-four studies that scored 90 or above in the appraisal process were included in the systematic review. Results: The studies represented included seven studies conducted in the United States and seventeen studies conducted internationally. Regarding study design, twenty-three studies were quantitative, one was qualitative, and one was mixed methods. The majority of quantitative studies were correlational in design with nine being longitudinal. The majority of studies were based on large national data sets representing in total 298,653 participants aged 50 and older. The results indicate that social isolation is related to increases in inflammatory biomarkers associated with diseases, all-cause mortality, lower expectations of longevity, and frailty. In addition, social isolation was associated with cognitive decline and disruptions in sleep. Poor oral health increased social isolation. The results further indicated that decreased physical performance/function and a decline in physical activity were associated with social isolation, as well as decreased overall physical health, poor health behaviors, and self-care, and decreased health-related quality of life. Further research is warranted to examine the possible bidirectionality of these relationships and possible mediating, moderating, or confounding variables. Implications: Future research is needed to explore the biological and behavioral pathways in which social isolation negatively impacts physical health. Going forward, studies are needed that move beyond descriptive, exploratory methods and integrate data from qualitative and mixed-method designs that will inform the development and testing of a conceptual framework related to social isolation and health. By advancing the science behind social isolation, comprehensive interventions can be identified and tested with implications at the individual, family, community, and societal levels to reduce social isolation, particularly among adults, and improve health and quality of life. Full article

Delirium is an acute neuropsychiatric syndrome of multifactorial etiology with a high incidence in people admitted to intensive care units. In addition to reversible impairment of cognitive processes, it may be associated with changes in thinking and perception. If, in the past, it was considered an expected complication of severe disease, nowadays, delirium is associated with a poor short-term and long-term prognosis. Knowing that its prevention and early identification can reduce morbidity, mortality, and health costs, it is vital to investigate nursing interventions focused on delirium in critically ill patients. This study aimed to identify nursing interventions in the prevention and management of delirium in critically ill adults. The method used to answer the research question was a scoping review. The literature search was performed in the Medline (via PubMed), CINAHL (via EBSCOhost), Scopus, Web of Science, and JBI databases. The final sample included 15 articles. Several categories of non-pharmacological interventions were identified, addressing the modifiable risk factors that contribute to the development of delirium, and for which nurses have a privileged position in their minimization. No drug agent can, by itself, prevent or treat delirium. However, psychoactive drugs are justified to control hyperactive behaviors through cautious use. Early diagnosis, prevention, or treatment can reduce symptoms and improve the individual’s quality of life. Therefore, nursing professionals must ensure harmonious coordination between non-pharmacological and pharmacological strategies. Full article

There is growing evidence on the prevalence and impact of loneliness, particularly among older people. However, much less is known about the personal origins of loneliness and how it persists, or not, over an individual’s life course. This study aimed to increase understanding of the personal experiences of loneliness among older adults across the life course. Central to this study was giving voice to the participants and allowing them to define loneliness, what it meant to them, and how it affected them throughout their lives. This qualitative study employed 18 life story interviews with older adults attending a mental health service. We explored their personal experiences of loneliness and the situations and factors associated with loneliness across the life course. We identified three distinct typologies of loneliness: those who experienced (1) chronic loneliness since childhood, (2) chronic loneliness after a life-changing event in midlife, and (3) loneliness which remained situational/transitional, never becoming chronic. This study found the seeds of chronic life course loneliness are often determined in childhood. Early detection and intervention may prevent situational loneliness from becoming chronic. More research is needed from a life course approach to help understand and address the causes and consequences of loneliness. Full article

Background: Globally, approximately 1.4% of people have celiac disease (CD), induced by gluten sensitivity. If left untreated, it causes small intestinal inflammation and villous atrophy, which can result in failure to thrive, anemia, osteoporosis, malabsorption, and even malignancy. The only treatment option available is a gluten-free diet (GFD). Few studies have looked at the role and perception of telehealth in relation to CD and selective nutrition both before and after the COVID-19 pandemic. Aim: Our goal was to screen and investigate the research conducted both before and after the COVID-19 pandemic concerning the utilization of telehealth applications and solutions in CD and other GFD-dependent circumstances. Methods: We employed a narrative review approach to explore articles that were published in scholarly journals or organizations between the years 2000 and 2024. Only English-language publications were included. PubMed and Google Scholar searches were mainly conducted using the following keywords: telemedicine, telehealth, telecare, eHealth, m-health, COVID-19, SARS-CoV-2, celiac disease, and gluten-free diet (GFD). Manual searches of the references in the acquired literature were also carried out, along with the authors’ own personal contributions of their knowledge and proficiency in this field. Results: Only a few studies conducted prior to the COVID-19 outbreak examined the viewpoints and experiences of adult patients with CD with relation to in-person clinic visits, as well as other options such as telehealth. The majority of patients believed that phone consultations were appropriate and beneficial. Video conferencing and telemedicine became more popular during the COVID-19 pandemic, demonstrating the effectiveness of using these technologies for CD on a global basis. In recent years, urine assays for gluten identification have become accessible for use at home. These tests could be helpful for CD monitoring with telemedicine assistance. Conclusions: The extended knowledge gathered from the COVID-19 pandemic is expected to complement pre-COVID-19 data supporting the usefulness of telemedicine even after the emergent pandemic, encouraging its wider adoption in standard clinical practice. The monitoring and follow-up of CD patients and other GFD-dependent conditions can greatly benefit from telemedicine. Full article

Primary care physicians (PCPs) should be active and reliable promoters of physical activity (PA), but there is no strong evidence that their knowledge and personal habits contribute to this. The aim of this study was to evaluate the frequency of PA recommendations provided by PCPs to patients in terms of their self-assessed PA knowledge and personal habits. This study used a cross-sectional design and data were collected through a self-reported online questionnaire. The study sample consisted of 202 PCPs from a large Lithuanian city, Kaunas, of which 122 were females (60.4%) and 80 were males (39.6%). The data were analyzed using SPSS version 29 (Statistical Package for the Social Sciences) for Windows. The findings show that the frequency of recommendations related to providing PA to patients is statistically significantly dependent on PCP health-friendly or partially favorable PA habits, their self-assessed level of knowledge about physical activity, and their self-assessed competence related to providing PA recommendations to patients, but this is not statistically dependent on objectively assessed level of knowledge related to PA. Full article

Background: To examine the prevalence of smoking among medical faculty students in Turkey, and to explore the associations between smoking, depression, and other factors. Methods: This cross-sectional study was carried out among medical students in Konya, Turkey, from November 2018 to February 2019. The first section included eight questions pertaining to sociodemographic details. The second comprised nine questions addressing smoking and other harmful habits. The third section involved the Fagerstrom Test for Nicotine Dependence while the fourth was the Beck Depression Inventory (BDI). Results: The study was completed with a total of 1117 participants (90.2% of all students). In regard to smoking, 813 (72.78%) were non-smokers, 98 (8.77%) were ex-smokers, and 222 (19.87%) were active smokers. Notably, 16.29% of students (n = 182) had a high BDI score (≥17). Male sex, good economic status, depression diagnosis at any time in life, and alcohol use were independently associated with active smoking. Being a senior student and regular exercise were independently associated with a low (<17) BDI score, whereas depression diagnosis at any time in life and drug use were independently associated with high (≥17) BDI. Conclusions: Almost 20% of medical school students were active smokers, with about a 2.5-fold higher prevalence among males compared to females. There is a significant association between smoking frequency and symptoms of depression. Policies targeting modifiable risk factors can reduce smoking and depression among future physicians, which can have a strong impact on population-wide smoking. Full article

Midwives’ self-efficacy can significantly affect the provided care and, therefore, maternal and neonatal outcomes. The aim of the present study was to investigate associations of perceived self-efficacy with emotional intelligence, personality, resilience, and attitudes towards death among midwives in Greece. From 2020 to 2022, a total of 348 midwives were recruited in this descriptive cross-sectional study. The participants were employed as independent professionals, in public hospitals or regional health authorities. Data collection involved five research instruments: the General Self-Efficacy Scale (GSES), the Trait Emotional Intelligence Questionnaire-Short Form (TEIQue-SF), the Eysenck Personality Questionnaire (EPQ), the Connor-Davidson Resilience scale (CD-RISC), and the Death Attitude Profile-Revised (DAP-R) scale. The mean score for the GSES was 29.1 (SD = 4.2), suggesting a moderately elevated level of self-efficacy among midwives. The results revealed that higher scores on the GSES were significantly associated with higher scores on the Extraversion subscale (p < 0.001) and lower scores on the Neuroticism (p < 0.001) and Lie (p = 0.002) subscales of the EPQ. Additionally, high self-efficacy was significantly correlated with high emotional intelligence (p < 0.001), high neutral acceptance of death (p = 0.009), and high resilience (p < 0.001). These findings highlight the relationship between the self-efficacy of Greek midwives and various psychological factors, as well as the multifaceted nature of self-efficacy and its importance for midwives’ psychological well-being and professional functioning. Full article

Developing valid and reliable measures of psychological responses to climate change is of high importance, as this facilitates our understanding of people’s psychological responses, including their pro-environmental behavior. Recently, the Climate Change Worry Scale (CCWS) was introduced. This study aimed to develop the first Polish version of the CCWS and explore its psychometric properties. Our sample comprised 420 Polish adults aged 18–70, with a mean age of 26.20 (standard deviation = 10.61) years. The CCWS’s factor structure was assessed with confirmatory factor analysis. McDonald’s omega and Cronbach’s alpha coefficients were computed to assess internal consistency reliability. Pearson correlations between climate change worry (CCW) and experience of climate change (i.e., an individual’s level of perception of being affected by climate change), pro-environmental behavior, ill-being (i.e., anxiety and depression symptoms), and well-being were calculated. Our results support the strong factorial validity of the CCWS, conforming to its intended one-factor solution, with excellent internal consistency reliability for the total scale score (i.e., McDonald’s omega and Cronbach’s alpha values of 0.93). We noted large positive correlations between CCW and experiences of climate change, as well as pro-environmental behavior, and medium positive correlations with psychopathology symptoms. CCW scores were not associated with well-being. As the CCWS represents a measure of a specific manifestation of worry, we also examined its discriminant validity against more general psychological distress markers, and it evidenced strong validity in this regard. Overall, the Polish version of the CCWS appears to have strong psychometric properties, and will therefore be a useful tool to use in research on psychological responses to climate change. Full article

Research on the stress and burnout experienced by athletes in the esports field remains limited, necessitating an approach that considers the unique environment and circumstances of esports athletes. This study aims to explore the conceptualization of burnout experiences among professional esports athletes. The participants included 88 athletes from the League of Legends Championship Korea (LCK). Among these, in-depth interviews were conducted with 7 athletes who had experience in international tournaments (the World Championship), while an open-ended survey was completed by 81 athletes. Data collected through in-depth interviews and an open-ended survey were digitized and utilized for analysis. Through critical review by another author and inductive categorization, the conceptual components of esports athletes’ burnout were derived. Through the analysis of 251 raw datum, it was conceptualized into five conceptual factors: performance, overtraining, interpersonal relationships, physical and psychological exhaustion, and career and motivation. The results of this study confirm that esports athletes, like athletes in other conventional sports, experience burnout during their careers, highlighting issues in their unique environment, particularly in aspects of interpersonal relationships and training and rest conditions. This research can serve as a foundational resource for effective athletes’ psychological health management in the esports field and underscores the need for further research on burnout among esports athletes. Full article

Understanding healthcare avoidance among college students is critical. In this study, we consider two broad cognitive contributors to greater healthcare avoidance: specific early maladaptive schema and negative appraisals of students’ prior worst healthcare experiences. From schema theory, we proposed college students holding greater levels of two early maladaptive schema (disconnection/rejection and impaired autonomy/performance EMS) would be more likely to appraise their problematic healthcare experience as both containing healthcare institutional betrayal (HIB) behaviors and as traumatic and betrayal-inducing; both EMS and these appraisals would predict healthcare avoidance. Using a cross-sectional survey in a large, diverse college student sample (n = 1383, 61.1% female, 18.9% African American, 7.2% Asian, 6.4% Hispanic/Latino), as predicted, both EMS were significantly related to healthcare avoidance. Furthermore, a sequential mediation model was supported, indicating students holding greater EMS of disconnection/rejection or impaired autonomy/rejection reported more HIB in their worst healthcare experience, and appraised that experience as more betraying. Taken altogether, this model accounted for 23% of the variance in students’ reports of healthcare avoidance. Core beliefs formed early in life may be a foundational lens through which potentially traumatic healthcare experiences are processed in ways that can impact emerging adults’ future healthcare engagement. Findings also support the importance of addressing HIB actions and repairing trauma appraisals accrued during problematic healthcare experiences to prevent healthcare avoidance by emerging adults. Full article

The pandemic highlighted the need for alternative, more accessible access to mental health interventions that can be readily administered remotely. The purpose of this pre-post-interventional study was to evaluate the effectiveness of a virtual mind-body medicine training course on stress, anxiety, and depression levels. University employees and members of the Las Vegas community were recruited via self-selection and snowball sampling and subjected to online mind-body practice sessions in December of 2020. Stress, anxiety, depression, and quality of life were assessed pre- and post-intervention using standardized psychometric valid tools. The paired t-test and related samples marginal homogeneity tests were used for continuous and categorical outcomes, respectively. Depression and stress scores were significantly decreased (p < 0.001). Mean scores of professional quality of life improved post-intervention compared to pre-intervention (p = 0.03). A significantly larger proportion of participants reported no depression or stress post-intervention compared with pre-intervention (p < 0.001, p = 0.003, respectively.) This study suggests that virtual mind-body practices had a pronounced impact on stress and depression levels during the pandemic. These findings support virtual, online-guided mind-body medicine training as an effective intervention that can be administered virtually to reduce stress and depression symptoms. Full article

South Korea is a rapidly aging society with the lowest fertility rates among the OECD economies. It is projected to become a super-aged society in 2025, with the share of individuals older than 65 reaching twenty percent. These developments make it important to analyze the determinants of health outcomes in older individuals. In this study, we identified the determinants of subjective and objective health outcomes among senior individuals in South Korea. We used self-rated health and life satisfaction scores as the two subjective health status indicators, while the number of chronic diseases was the objective one. We ran Tobit multivariate regressions of all three indicators on a set of factors related to the older citizens’ physical, economic, and social characteristics. Active employment status and willingness to work in the future were positively related to self-rated health level but were not statistically related to life satisfaction, while income positively affected both subjective health status indicators. Age did not appear to affect satisfaction with life. Active leisure activities were positively related to both self-rated health and life satisfaction. In contrast, passive leisure, such as watching TV, was negatively related to both health status indicators while being associated with an increased number of chronic diseases. Our findings suggest that older South Koreans view employment primarily as a means of financial support rather than as an opportunity for active social engagement. Full article

Background: To compare photodynamic therapy and the use of probiotics in reducing halitosis assessed through gas chromatography and microbiome analysis. Methods: Participants aged from 18 to 25 years showing sulfide (SH2) ≥ 112 ppb on gas chromatography were selected. They were divided into four treatment groups: Group 1—Tongue Scraping; Group 2—Antimicrobial Photodynamic Therapy (aPDT); Group 3—Probiotics; and Group 4—Antimicrobial Photodynamic Therapy (aPDT) and Probiotics. The halimetry process was performed before, immediately after the treatments, and 7 days, 14 days, and 30 days after the initial collection. The collections for later microbiological analysis were made along with the halimetry for microbiome analysis. Results: Treatment with aPDT or probiotics under these experimental conditions was not able to change the bacteria present in the biofilm of the tongue. Conclusions: More research is needed to know the behavior of the oral microbiome in the presence of halitosis and the effectiveness of new treatments. Full article

Family caregivers are vital to enabling people with dementia to live longer in their own homes. For these caregivers, chatting with clinicians—being listened to empathetically and receiving reassurance—can be seen as not incidental but important to supporting them. This paper considers and identifies the significance of this relational work for family carers by re-examining data originally collected to document caregivers’ perspectives on quality in crisis response teams. This reveals that chatting, for family caregivers, comprises three related features: (i) that family caregivers by responding to a person’s changing and sometimes challenging needs and behaviors inhabit a precarious equilibrium; (ii) that caregivers greatly appreciate ‘chatting’ with visiting clinicians; and (iii) that while caregivers appreciate these chats, they can be highly critical of the institutionalized character of a crisis response team’s involvement with them. Full article

Abstract: Health and exercise technology may promote a healthy lifestyle during pregnancy. The objective of this cross-sectional study was to understand and involve the perspective of pregnant women as users in the design of a framework for future e-health and exercise interventions during pregnancy. Pregnant women replied to a questionnaire aimed at understanding their physical activity patterns, needs, and preferences regarding the use of mobile applications (apps). The main results showed that one-third of the women did not practice any type of exercise during pregnancy. Women preferred to exercise in a gym, outdoors, or at home. The majority already had or were currently using a fitness app, but never used any pregnancy-specific app. Most women agreed that it was important to have a specific app for pregnancy to improve knowledge about recommendations on lifestyle, have direct contact with health and exercise professionals, have social interaction with other mothers, and have guidance on preparation for childbirth and postpartum recovery. Understanding and involving the perspective of pregnant women as users will allow researchers to improve the design of a pregnancy-specific app and future e-health and exercise interventions during pregnancy. These preliminary results will lead to the development of the “active pregnancy app” focused on the promotion of an active and healthy lifestyle during pregnancy and postpartum. Full article

Introduction: A neighbourhood’s environmental characteristics can positively or negatively influence health and well-being. To date, no studies have examined this concept in the context of Saudi Arabian youth. Therefore, this study aimed to evaluate the association between a neighbourhood’s environmental characteristics and health risk factors among Saudi Arabian youth. Methods: A total of 335 secondary-school students (175 males, 160 females), aged 15–19 years old, participated. Body mass index (BMI) and waist circumference measurements were taken, and physical activity (steps) was measured via pedometer. The perceived neighbourhood environment was assessed using the International Physical Activity Questionnaire Environment Module (IPAQ-E). Results: Significant differences were found between the youths from urban, rural farm, and rural desert locations in terms of BMI, waist circumference, daily steps, accessibility, infrastructure, social environment, household vehicles, safety, and access to facilities (p < 0.001). Rural desert youths were less active, and males (26.43 + 8.13) and females (24.68 + 5.03) had higher BMIs compared to the youths from other areas. Chi-square analysis revealed a significant difference (χ²₁ = 12.664, p < 0.001) between the genders as to social-environment perceptions. Males perceived their neighbourhood as a social environment more than was reported by females (68.39% and 50.28%, respectively). Pearson’s correlation revealed negative significant relationships between steps and both safety of neighbourhood (r = −0.235, p < 0.001) and crime rate (r = −0.281, p < 0.001). Discussion: Geographical location, cultural attitudes, lack of facilities, and accessibility impact youth physical-activity engagement and weight status; this includes environmental variables such as residential density, neighbourhood safety, household motor vehicles, and social environment. Conclusions: This is the first study examining associations with neighbourhood environments in the youths of the Kingdom of Saudi Arabia. Significant associations and geographical differences were found. More research and policy interventions to address neighbourhoods’ environmental characteristics and health risk factors relative to Saudi Arabian youth are warranted. Full article

Background: Dry eye disease (DED), a prevalent condition with a multifactorial etiology, significantly impacts global health by causing discomfort and visual disturbance. This historical cohort study evaluates the efficacy of Intense Pulsed Light (IPL) therapy on meibomian gland dysfunction (MGD)-related evaporative DED. Methods: The study involved 110 patients (220 eyes) who underwent IPL therapy. Ethical approval was secured, and informed consent was obtained from all participants. A Tearcheck^® (ESWvision, Houdan, France) device was used for ocular surface evaluation, measuring tear film stability (NIFBUT, NIABUT), tear film quantity (CTMH, TTMH), and inflammation (OSIE). The study assessed tear film and ocular surface health across multiple IPL sessions. Results: Significant improvements were observed in subjective symptoms (EFT score increased from 29.10 ± 8.87 to 35.91 ± 7.03, p < 0.01), tear film stability (NIFBUT increased from 9.37 ± 6.04 to 10.78 ± 5.83 s, p < 0.01; NIABUT increased from 11.07 ± 4.98 to 12.34 ± 4.66 s, p < 0.01), and tear film surface evaluation (TFSE score decreased from 337.78 ± 414.08 to 206.02 ± 240.44, p < 0.01). Tear film quantity remained unchanged (CTMH and TTMH, p > 0.05). Conclusions: IPL therapy is a promising treatment for DED, improving symptoms and ocular surface health. Further research is warranted to explore long-term efficacy and optimization. Full article

Several studies suggested the efficacy of dispositional mindfulness and mindfulness-based interventions in reducing anxiety and depression in cardiovascular diseases. However, data on the impact of mindfulness on the psychological well-being of patients with an implantable cardioverter–defibrillator (ICD) are scarce. In this study, 422 patients with an ICD were prospectively recruited. Logistic regression was applied to determine associations between dispositional mindfulness (Freiburg Mindfulness Inventory), depression (Patient Health Questionnaire-8), anxiety (Generalized Anxiety Disorder-7 scale), and post-traumatic stress disorder (PTSD) symptoms (Post-Traumatic Stress Diagnostic Scale), adjusting for age, sex, educational status, number of ICD shocks after ICD implantation, and physical activity. The PROCESS regression path analysis modelling tool was used to identify indirect mediating effects of dispositional mindfulness on depression, anxiety, and PTSD symptoms and quality of life (QoL; EuroQol group 5-dimension questionnaire). Participants presented high baseline QoL (mean 1.06 to 1.72) and medium–high mindfulness scores (mean 40.85 points). Higher mindfulness scores were associated with lower levels of anxiety (OR 0.90, 95% CI 0.86 to 0.95, 0.001), depression (OR 0.93, 95% CI 0.88 to 0.98, p = 0.006), and PTSD symptoms (OR 0.94, 95% CI 0.89 to 0.98, p = 0.011). Furthermore, greater mindfulness partially mediated the relationship between anxiety (indirect effect 0.10, 95% CI 0.02 to 0.21), depression (indirect effect 0.08, 95% CI 0.01 to 0.17), or PTSD (indirect effect 0.04, 95% CI 0.01 to 0.17) as independent variables and the QoL as the dependent variable. This study suggests that greater dispositional mindfulness is associated with less anxiety, depression, and PTSD symptoms. Mindfulness might also increase the QoL in ICD patients by mitigating the impact of those with psychological distress. Full article

Background: Cancer disproportionately affects Hispanic populations, yet the preparedness of Hispanic caregiver–patient dyads facing cancer remains understudied. This study aims to identify essential components of preparedness needs and inform future psychosocial interventions for this demographic. Methods: Secondary analyses were conducted utilizing focus groups to develop a communication intervention for Hispanic patients and caregivers. Transcripts were qualitatively analyzed using NVivo v12 (2020). Results: Analysis revealed symptom management and treatment comprehension as pivotal aspects of preparation. Additionally, preparedness among our sample emerged by addressing the multifaceted dimensions of preparedness, including psychological, emotional, educational, familial, practical, financial, and spiritual aspects. Conclusions: Tailoring interventions encompassing diverse dimensions of preparedness can foster inclusivity and maximize their impact on supportive measures. This underscores the necessity for culturally sensitive approaches when delivering interventions supporting Hispanic individuals navigating the challenges of cancer. Full article

Sexual hyperactivity, often linked with substantial psychological and social disturbances, remains under-researched, particularly in contexts like Iran where cultural and social norms may influence the reporting and treatment of such conditions. This study explores the therapeutic potential of cognitive rehabilitation (CR) and binaural beats (BB) in addressing this issue. The primary objective was to compare the effectiveness of CR and BB in reducing symptoms of sexual hyperactivity and associated comorbid conditions, with a focus on fluctuations in sexual desire and overall mental health. Utilizing a quasi-experimental design, the study involved pretest, posttest, and follow-up assessments to evaluate the interventions’ impacts. Recruitment through social media yielded 45 participants from a larger pool, who were then assigned to either the CR group, the BB group, or a control group. The CR and BB interventions were administered over a period of 10 sessions, each lasting 20 min, 3 times a week. Significant improvements were observed in both intervention groups compared to the control group. The CR group showed a marked reduction in Sexual Addiction Screening Test (SAST) scores from an initial average of 24.87 to 6.80 at follow-up, indicating a reduction in symptoms of sexual hyperactivity. The BB group also showed improvement, with SAST scores decreasing from 19.93 to 9.57. In terms of mental health comorbidities, the Depression, Anxiety, and Stress Scale (DASS-21) scores decreased notably in the CR group from a baseline of 8.53 to 3.07 post-intervention, and in the BB group from 10.33 to 5.80. Both interventions showed similar effectiveness in reducing anxiety and stress, with no statistically significant differences between the groups for most of the outcomes studied, affirming their potential for clinical application. Full article

Volunteer interventions play a vital role in supporting families by offering accessible and community-based resources outside the formal professional sector. This study examines the impact of the volunteer intervention known as Family Club Denmark (FCD) on the well-being of parents and children. FCD aims to provide families with positive experiences and support relationship building. The intervention, open to families from diverse social backgrounds, comprises volunteer-led family clubs where parents and children aged 2–12 years engage in activities and meals. We allocated 510 families (363 vulnerable families) to FCD or placed them on a waiting list based on a first-come, first-served principle. We conducted baseline, post-intervention, and follow-up assessments through questionnaires, observations, and interviews. On average, families participated in 5.8 sessions, with both families and volunteers reporting high satisfaction. When compared to control families, we find that vulnerable FCD parents feel more confident playing with their children (p = 0.04, [0.01; 0.40], d = 0.25), require less assistance in playing with their children (p = 0.01, [−0.34; −0.05], d = 0.33), and report that their children have a more challenging time forming friendships (p = 0.01, [−0.51; −0.09], d = 0.29). However, we did not find significant effects on mental health, parenting stress, self-efficacy, self-worth, family routines, or child well-being. We observed similar results for the full sample. The discovery that parents feel more confident playing with their children after participating in FCD highlights the vital role of volunteer-based interventions in enhancing parental engagement and fostering positive parent–child interactions. Trial registration: ClinicalTrials.gov NCT03657888 (registered 29 August 2018). Full article

3D printing has been adopted into routine use for certain medical applications, but more widespread usage has been hindered by, among other things, unclear legislation. We performed an analysis, using legal doctrinal study and legal informatics, of relevant EU legislation and case law in four issues relevant to medical 3D printing (excluding bioprinting or pharmacoprinting): pre-market approval, post-market liability, intellectual property rights, and data protection. Several gaps and uncertainties in the current legislation and interpretations were identified. In particular, we regard the current EU regulatory framework to be quite limiting and inflexible, exemplifying a cautionary approach common in EU law. Though the need to establish high safety standards in order to protect patients as a disadvantaged population is understood, both legal uncertainties and overregulation are seen as harmful to innovation. Hence, more adaptive legislation is called for to ensure continuous innovation efforts and enhanced patient outcomes. Full article

Online medical teams (OMTs), a new mode of online healthcare service, have emerged in online health communities (OHCs) in China. This study attempts to explore the underlying mechanism of how OMTs’ engagement influences patient satisfaction through the lens of semantic features. This study also scrutinizes the moderating effect of multiple specializations on the link between OMTs’ engagement and semantic features. We utilized a linear model that had fixed effects controlled at the team level for analysis. A bootstrapping approach using 5000 samples was employed to test the mediation effects. The findings reveal that OMTs’ engagement significantly improves language concreteness in online team consultations, which subsequently enhances patient satisfaction. OMT engagement has a negative impact on emotional intensity, ultimately decreasing patient satisfaction. Multiple specializations strengthen the impact of OMT engagement on both language concreteness and emotional intensity. This study contributes to the literature on OMTs and patient satisfaction, providing insights into patients’ perceptions of OMTs’ engagement during online team consultation. This study also generates several implications for the practice of OHCs and OMTs. Full article

Background: Open surgery relies heavily on the surgeon’s visual acuity and spatial awareness to track instruments within a dynamic and often cluttered surgical field. Methods: This system utilizes a head-mounted depth camera to monitor surgical scenes, providing both image data and depth information. The video captured from this camera is scaled down, compressed using MPEG, and transmitted to a high-performance workstation via the RTSP (Real-Time Streaming Protocol), a reliable protocol designed for real-time media transmission. To segment surgical instruments, we utilize the enhanced U-Net with GridMask (EUGNet) for its proven effectiveness in surgical tool segmentation. Results: For rigorous validation, the system’s performance reliability and accuracy are evaluated using prerecorded RGB-D surgical videos. This work demonstrates the potential of this system to improve situational awareness, surgical efficiency, and generate data-driven insights within the operating room. In a simulated surgical environment, the system achieves a high accuracy of 85.5% in identifying and segmenting surgical instruments. Furthermore, the wireless video transmission proves reliable with a latency of 200 ms, suitable for real-time processing. Conclusions: These findings represent a promising step towards the development of assistive technologies with the potential to significantly enhance surgical practice. Full article

Establishing intervention effectiveness is an important component of a broader knowledge translation (KT) process. However, mobilizing the implementation of these interventions into practice is perhaps the most important aspect of the KT cycle. The purpose of the current study was to conduct an umbrella review to (a) identify promising interventions for SI&L in older adults, (b) interpret (translate) the findings to inform clinical knowledge and practice interventions in different settings and contexts, and (c) highlight research gaps that may hinder the uptake of these interventions in practice. The broader purpose of this study was to inform evidence-based clinical practice guidelines on SI&L for HCSSPs. In line with other reviews, our study noted variations in methods and intervention designs that prohibit definitive statements about intervention effectiveness. Perhaps, the most significant contribution of the current review was in identifying knowledge-to-practice gaps that inhibit the implementation of interventions into practice-based realities. Full article

Efficient management of hospital resources is essential for providing high-quality healthcare while ensuring sustainability. Length of stay (LOS), measuring the duration from admission to discharge, directly impacts patient outcomes and resource utilization. Accurate LOS prediction offers numerous benefits, including reducing re-admissions, ensuring appropriate staffing, and facilitating informed discharge planning. While conventional methods rely on statistical models and clinical expertise, recent advances in machine learning (ML) present promising avenues for enhancing LOS prediction. This research focuses on developing an ML-based LOS prediction model trained on a comprehensive real-world dataset and discussing the important factors towards practical deployment of trained ML models in clinical settings. This research involves the development of a comprehensive adult cardiac patient dataset (SaudiCardioStay (SCS)) from the King Faisal Specialist Hospital & Research Centre (KFSH&RC) hospital in Saudi Arabia, comprising 4930 patient encounters for 3611 unique patients collected from 2019 to 2022 (excluding 2020). A diverse range of classical ML models (i.e., Random Forest (RF), Extreme Gradient Boosting (XGBoost), Light Gradient Boosting Machine (LGBM), artificial neural networks (ANNs), Average Voting Regression (AvgVotReg)) are implemented for the SCS dataset to explore the potential of existing ML models in LOS prediction. In addition, this study introduces a novel approach for LOS prediction by incorporating a dedicated LOS classifier within a sophisticated ensemble methodology (i.e., Two-Level Sequential Cascade Generalization (2LSCG), Three-Level Sequential Cascade Generalization (3LSCG), Parallel Cascade Generalization (PCG)), aiming to enhance prediction accuracy and capture nuanced patterns in healthcare data. The experimental results indicate the best mean absolute error (MAE) of 0.1700 for the 3LSCG model. Relatively comparable performance was observed for the AvgVotReg model, with a MAE of 0.1703. In the end, a detailed analysis of the practical implications, limitations, and recommendations concerning the deployment of ML approaches in actual clinical settings is presented. Full article

Core nursing skills are emphasized in nursing education, given their vital role in nurses’ competence; however, invasive nursing procedures like catheterization and enemas are infrequently performed in actual clinical practice, primarily being observed rather than executed. Virtual reality simulation training involves performing core nursing skills on virtual patients in a three-dimensional virtual reality environment, following the correct procedures. The purpose of this study is to examine the effects of VR simulation on nursing students’ confidence, proficiency, task engagement, and satisfaction. The study participants included 76 second-year nursing students, with 37 in the VR group and 39 in the control group. The VR group engaged in immersive VR (IVR) training sessions including enemas, nasogastric feeding, and nelaton catheterization. Conversely, the control group practiced these skills using mannequins. Assessments evaluated confidence, proficiency, learning satisfaction, and task engagement before and after the intervention. The average age of the study participants was 21.07 years, with 78.95% being female and 21.05% being male. The study findings revealed no significant differences between the VR and control groups regarding confidence (F = 3.878, p = 0.053), task engagement (F = 0.164, p = 0.687), and learning satisfaction (F = 0.668, p = 0.416). However, the VR group demonstrated significantly higher proficiency in the overall assessment of nasogastric feeding (F = 5.389, p = 0.023) and core components of nelaton catheterization (F = 4.046, p = 0.048). The IVR program emerged as an effective and valuable teaching tool, particularly well-suited for second-year nursing students, significantly enhancing proficiency. Full article