Search Results (32,394)

(1) Background: Completion of the full oral health course of care (CoC) is essential to prevent further deterioration of oral and overall health. Understanding these patterns, particularly in public oral healthcare services, is crucial for improving access to and the delivery of care. This study aims to identify the socio-demographic and clinical characteristics of adult patients who did not complete required dental treatments within a 12-month period at Monash Health Dental Services (MHDS), Melbourne, Victoria. (2) Methods: Data were collected on patients’ course of care (CoC), socio-demographic characteristics, and clinical information from the MHDS Titanium electronic database. This study represents a secondary data analysis from adult patients who attended MHDS between November 2022 and October 2023, excluding emergency dental care visits. Logistic regression analyzed the socio-demographic and clinical variables affecting CoC. (3) Results: Our findings identified several significant predictors of incomplete CoC; being a non-priority group, mental health clients, refugees, and identifying as Aboriginal or Torres Strait Islanders (OR = 1.41; 95% CI: 1.08–1.84). Conversely, speaking a language other than English increased the odds of completing treatment (OR = 0.85; 95% CI: 0.74–0.98). By age, patients in the 36-to-55- or the 56-to-75-year-old age groups were more likely to be in the incomplete group (OR = 1.65; 95% CI: 1.37–1.98; and OR = 1.43; 95% CI: 1.22–1.66, respectively). (4) Conclusions: This study identified predictors of discontinued care, emphasizing accessibility and equitable outcomes for users of public oral healthcare. The findings indicate that the predictors of course of care (CoC) completion differ from barriers to accessing care. This highlights key objectives in public health dentistry, focusing on improving accessibility and promoting equitable oral health outcomes for vulnerable populations. Full article

Background: The integration of artificial intelligence (AI), particularly large language models (LLMs) like ChatGPT-4, is transforming healthcare. ChatGPT’s potential to assist in decision-making for complex cases, such as spinal metastasis treatment, is promising but widely untested. Especially in cancer patients who develop spinal metastases, precise and personalized treatment is essential. This study examines ChatGPT-4’s performance in treatment planning for spinal metastasis cases compared to experienced spine surgeons. Materials and Methods: Five spine metastasis cases were randomly selected from recent literature. Consequently, five spine surgeons and ChatGPT-4 were tasked with providing treatment recommendations for each case in a standardized manner. Responses were analyzed for frequency distribution, agreement, and subjective rater opinions. Results: ChatGPT’s treatment recommendations aligned with the majority of human raters in 73% of treatment choices, with moderate to substantial agreement on systemic therapy, pain management, and supportive care. However, ChatGPT’s recommendations tended towards generalized statements, with raters noting its generalized answers. Agreement among raters improved in sensitivity analyses excluding ChatGPT, particularly for controversial areas like surgical intervention and palliative care. Conclusions: ChatGPT shows potential in aligning with experienced surgeons on certain treatment aspects of spinal metastasis. However, its generalized approach highlights limitations, suggesting that training with specific clinical guidelines could potentially enhance its utility in complex case management. Further studies are necessary to refine AI applications in personalized healthcare decision-making. Full article

Background/Objectives: New SARS-CoV-2 variants are continuously emerging, making it essential to assess the efficacy of vaccine-induced immune protection. Limited information is available regarding T cell responses to BA.2.86 and JN.1 variants, particularly in elderly individuals. Methods: We evaluated T cell and total IgG responses against the receptor-binding domain (RBD) of the ancestral SARS-CoV-2 strain, as well as BA.2.86 and JN.1 omicron subvariants, in two groups of subjects. One group consisted of SARS-CoV-2-exposed elderly individuals who were fully vaccinated with the BNT162B2 mRNA vaccine, with a booster dose of the updated 2023–2024 COVID-19 vaccine (XBB.1.5) at least 15 days after receiving a booster dose of the updated 2023–2024 COVID-19 vaccine. The second group consisted of healthcare workers who were unexposed to SARS-CoV-2 one month after the booster dose of the first-generation BNT162b2 mRNA vaccine. T cell activation-induced markers (AIM) and IFN-γ secretion were evaluated by flow cytometry and ELISpot assays, respectively. Results: Elderly subjects showed reduced IgG levels against JN.1 compared with the ancestral strain. BA.2.86 stimulation resulted in lower IFN-γ levels in the elderly versus the COVID-19-naïve group. AIM analysis showed that among T cells, CD4+ were the most responsive, with a reduced proportion of JN.1-reactive CD4+ T cells compared with the ancestral strain in the SARS-CoV-2-unexposed group. Despite receiving the updated booster, the elderly group showed reduced CD4+ T cell reactivity to BA.2.86. Conclusions: The XBB.1.5-containing vaccine induced lower CD4+ T cell responses against BA.2.86 in the elderly. CD4+ T cells from BNT16b2-vaccinated, COVID-19-naïve subjects recognized ancestral and BA.2.86 RBD strains while showing reduced responses to JN.1. These results emphasize the need for tailored vaccine strategies for emerging variants, particularly in vulnerable populations. Full article

Background/Objectives: This study assessed the feasibility and security of remote surgical wound monitoring using the RedScar© smartphone app, which employs automated diagnosis for early visual detection of infections without direct healthcare personnel involvement. Additionally, patient satisfaction with telematic care was evaluated as a secondary aim. Surgical site infection (SSI) is the second leading cause of healthcare-associated infections (HAIs), leading to prolonged hospital stays, heightened patient distress, and increased healthcare costs. Methods: The study employed a prospective paired-cohort and single-blinded design, with a sample size of 47 adult patients undergoing abdominal surgery. RedScar© was used for remote telematic monitoring, evaluating the feasibility and security of this approach. A satisfaction questionnaire assessed patient experience. The study protocol was registered at ClinicalTrials.gov under the identifier NCT05485233. Results: Out of 47 patients, 41 successfully completed both remote and in-person follow-ups. RedScar© demonstrated a sensitivity of 100% in detecting SSIs, with a specificity of 83.13%. The kappa coefficient of 0.8171 indicated substantial agreement between the application’s results and human observers. Patient satisfaction with telemonitoring was high: 97.6% believed telemonitoring reduces costs, 90.47% perceived it prevents work/school absenteeism, and 80.9% found telemonitoring comfortable. Conclusions: This is the first study to evaluate an automatic smartphone application on real patients for diagnosing postoperative wound infections. It establishes the safety and feasibility of telematic follow-up using the RedScar© application for surgical wound assessment. The high sensitivity suggests its utility in identifying true cases of infection, highlighting its potential role in clinical practice. Future studies are needed to address limitations and validate the efficacy of RedScar© in diverse patient populations. Full article

Background: Time-restricted eating (TRE) shows promise for managing weight and metabolic issues, yet its application in real-world healthcare settings remains underexplored. This study aims to assess the real-world utilisation and short-term outcomes of TRE in clinical practice. Methods: This observational study used a retrospective chart review of 271 adults who attended a metabolic specialist clinic between 2019 and 2023. Descriptive statistics and multivariable logistic regression were used to identify factors associated with TRE adoption, while paired sample t-tests evaluated changes in outcomes among those who received TRE advice. Results: Among the 271 patients, 76% were female, 90% Caucasian, and 94% overweight/obese. Of all patients, 47.2% received TRE advice, mainly using the 16:8 method, alongside additional dietary guidance for 60% of patients. Working status and baseline metabolic profiles were the only factors significantly associated with TRE adoption. Among those who followed TRE, 81% experienced modest but significant reductions in weight (−1.2 kg, p < 0.01), BMI (−0.4 kg/m², p < 0.01), and waist circumference (−3.7 cm, p < 0.01). Conclusions: This study highlights TRE as a feasible and practical dietary strategy for improving metabolic health in healthcare settings. However, further research and improved data capture are needed to explore long-term adherence, potential adverse effects, and the effectiveness of TRE across diverse patient populations. Full article

Background/Objectives: Digital twin technology, initially developed for engineering and manufacturing, has entered healthcare. In plastic surgery, digital twins (DTs) have the potential to enhance surgical precision, personalise treatment plans, and improve patient outcomes. This systematic review aims to explore the current use of DTs in plastic surgery and evaluate their effectiveness, challenges, and future potential. Methods: A systematic review was conducted by searching PubMed, Scopus, Web of Science, and Embase databases from their infinity to October 2024. The search included terms related to digital twins and plastic surgery. Studies were included if they focused on applying DTs in reconstructive or cosmetic plastic surgery. Data extraction focused on study characteristics, technological aspects, outcomes, and limitations. Results: After 110 studies were selected for screening, 9 studies met the inclusion criteria, covering various areas of plastic surgery, such as breast reconstruction, craniofacial surgery, and microsurgery. DTs were primarily used in preoperative planning and intraoperative guidance, with reported improvements in surgical precision, complication rates, and patient satisfaction. However, challenges such as high costs, technical complexity, and the need for advanced imaging and computational tools were frequently noted. Limited research exists on using DTs in postoperative care and real-time monitoring. Conclusions: This systematic review highlights the potential of digital twins to revolutionise plastic surgery by providing personalised and precise surgical approaches. However, barriers such as cost, complexity, and ethical concerns must be addressed. Future research should focus on validating clinical outcomes through large-scale studies and developing soft tissue modelling and real-time monitoring capabilities. Full article

This study investigated how the DNACJ6 gene variation related to RMR alteration affects risk factors of obese environments in children with obesity aged 8–9. Methods: Over a three-year follow-up period, 63.3% of original students participated. Changes in the variables (anthropometrics, blood biochemistry, and dietary intakes) were analyzed and compared between those without obesity (non-OB) and with obesity (OB) classified at the study endpoint. Result: The average MAF of nine SNPs (D-1 to D-IX) was defined as 18.1%. The OB group showed greater increases in RMR, BMI, WC, and SBP, while the non-OB group had significantly greater increases in HDL and intakes of nutrients (e.g., total calories, vitamins B2, C, folate, A, retinol, iron, and zinc). Increased RMR, BMI, BW, and RMR/BW changes were observed with mutant allele of D-I SNP, which was also associated with a higher prevalence of obesity. Greater increases in animal fat intake, including saturated fatty acids and retinol, were noted in the minor alleles of D-VI, D-VII, D-VIII, and D-IX SNPs compared to those of the major alleles. The odds ratio for BMI risk was significantly higher in the mutant alleles of D-I (rs17127601), D-VII (rs1334880), and D-VIII (rs7354899) compared to the wild type, with increases of 2.59 times (CI; 1.068–6.274), 1.86 times (CI; 1.012–3.422), and 1.85 times (CI; 1.008–3.416), respectively. RMR was a mild risk factor in minors of the D-1, D-VII, and D-VIII; however, a higher RMR/BW ratio significantly correlated with decreased BMI risk, and this effect was found in only the major alleles of D-I, D-VII, and D-VIII SNPs, not in the minor alleles. High retinol intake appeared to reduce obesity risk in the minor alleles of the D-I, D-VII, and D-VIII SNPs, even though intake of animal fats and retinol remained higher among minors over the three years. Conclusions: These findings suggest that the RMR/BW ratio and dietary fat/retinol intake should be considered in DNACJ6-gene-based precision medicine approaches for pediatric obesity prevention, particularly for boys. Full article

Healthcare Waste Management (HCWM) is critical for public health and environmental sustainability. However, healthcare facilities face significant barriers to implementing sustainable HCWM practices, particularly in developing regions. Identifying and prioritizing these barriers is essential to developing practical solutions. This study aims to identify and rank barriers to sustainable HCWM using an integrated methodology. It seeks to provide actionable insights for policymakers and healthcare administrators to improve HCWM practices. The study employed a multi-method approach, combining a comprehensive literature review, expert consultations, and Grey Relational Analysis (GRA). The literature review identified 17 potential barriers across economic, social, technical, and regulatory dimensions. Eight experts from diverse sectors evaluated these barriers based on ten criteria. GRA was used to rank the barriers, and sensitivity analysis assessed the robustness of the rankings under varying parameters. The findings revealed that the most critical barriers include the lack of standardized guidelines and protocols, ineffective waste segregation, awareness and knowledge gaps, and inadequate training. Financial constraints and disposal infrastructure also ranked highly, highlighting systemic challenges in HCWM. Sensitivity analysis demonstrated that these rankings remained stable across varying conditions, affirming the robustness of the results. Addressing the prioritized barriers—mainly through policy standardization, enhanced training programs, and improved resource allocation—can significantly improve HCWM practices. This study underscores the need for a holistic approach integrating technical, social, and regulatory interventions to enhance sustainability in healthcare waste management. Full article

Background: Ministerial Decree (D.M.) 77/2022 aims to reform Italy’s primary care system by establishing community health centres and integrating digital tools to address healthcare access disparities and workforce shortages. This review focuses on frailty assessment tools, digital health innovations, and workforce challenges in the Autonomous Province of Bolzano, South Tyrol, emphasising interprofessional trust and collaboration issues. Methods: Using a narrative custom review approach guided by the SANRA checklist, this study synthesised findings from PubMed, official health websites, and regional surveys on frailty, workforce dynamics, interprofessional collaboration, and digital infrastructure in South Tyrol. Results: General practitioners (GPs) exhibited high professional motivation but expressed concerns about autonomy and administrative burdens in collaborative care models. Trust issues between GPs and specialists hinder workforce cohesion and care coordination, highlighting the need for structured inter-professional communication. Frailty assessments, such as the PRISMA-7 tool, identify over 33% of community-dwelling individuals aged 75 years and older as frail, necessitating targeted interventions. Digital health adoption, particularly electronic health records and telemedicine, is slow because of workforce shortages and infrastructure limitations. Conclusions: The successful implementation of D.M. 77/2022 in South Tyrol requires addressing workforce challenges, improving interprofessional trust, expanding digital infrastructure, and integrating frailty assessment findings into care strategies. These measures are critical for achieving a more resilient, equitable, and effective primary healthcare system. Full article

Deep learning, a subfield of artificial intelligence that uses neural networks with multiple layers, is rapidly changing healthcare. Its ability to analyze large datasets and extract relevant information makes it a powerful tool for improving diagnosis, treatment, and disease management. The integration of DL with pressure mats—which are devices that use pressure sensors to continuously and non-invasively monitor the interaction between patients and the contact surface—is a promising application. These pressure platforms generate data that can be very useful for detecting postural anomalies. In this paper we will discuss the application of deep learning algorithms in the analysis of pressure data for the detection of postural asymmetries in 139 patients aged 3 to 20 years. We investigated several main tasks: patient classification, hemibody segmentation, recognition of specific body parts, and generation of automated clinical reports. For this purpose, convolutional neural networks in their classification and regression modalities, the object detection algorithm YOLOv8, and the open language model LLaMa3 were used. Our results demonstrated high accuracy in all tasks: classification achieved 100% accuracy; hemibody division obtained an MAE of approximately 7; and object detection had an average accuracy of 70%. These results demonstrate the potential of this approach for monitoring postural and motor disabilities. By enabling personalized patient care, our methodology contributes to improved clinical outcomes and healthcare delivery. To our best knowledge, this is the first study that combines pressure images with multiple deep learning algorithms for the detection and assessment of postural disorders and motor disabilities in this group of patients. Full article

Objective: This systematic review aimed to identify the most prevalent conflict management styles and strategies employed by nurses in clinical settings and to examine the factors associated with their selection. Methods: A comprehensive literature search was conducted following the PRISMA guidelines. Databases searched included PUBMED, CINAHL, Medline, and ProQuest, focusing on articles published between 2014 and 2024. Inclusion criteria were primary data studies involving nurses, published in English. The search strategy utilized Boolean operators to combine keywords related to nursing, conflict management, and healthcare settings. A total of 174 articles were initially identified, with 22 meeting the inclusion criteria after screening. The quality of the included studies was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument Critical Appraisal Checklist. The results were synthesized using content analysis. Results: The main findings from the 22 articles reviewed indicate that accommodation and collaboration/integration are the most common conflict management styles and strategies among nurses, with compromising also frequently employed. Factors such as age, experience, educational level, and workplace culture significantly influence the choice of conflict management strategies. Discussion: Nurses employ a variety of conflict management strategies depending on the context, individual preferences, and situational factors. Effective conflict resolution is closely linked to collaboration and communication, with proactive strategies being more effective in preventing conflicts. The findings underscore the need for tailored conflict management training to enhance job satisfaction and work relations in nursing environments. We acknowledge several limitations that may affect the interpretation and generalizability of our findings such as the diversity of the tools and the methodologies used by the included studies. Full article

Traumatic brain injury (TBI) poses a major global health challenge, leading to serious repercussions for those affected and imposing considerable financial strains on families and healthcare systems. RNA methylation, especially 5-methylcytosine (m⁵C), plays a crucial role as an epigenetic modification in regulating RNA at the level of post-transcriptional regulation. However, the impact of TBI on the m⁵C methylation profile of long non-coding RNAs (lncRNAs) remains unexplored. In the present study, we conducted a thorough transcriptome-wide examination of m⁵C methylation in lncRNAs in a rat TBI model utilizing MeRIP-Seq. Our results revealed significant differences in the amount and distribution of m⁵C methylation in lncRNAs between TBI and control groups, indicating profound changes in m⁵C methylation following TBI. Bioinformatic analyses linked these specifically methylated transcripts to pathways involved in immune response, neural repair, and lipid metabolism, providing insight into possible mechanisms underlying TBI pathology. These findings offer novel perspectives on the post-transcriptional modifications in lncRNA m⁵C methylation following TBI, which may contribute to understanding the disease mechanisms and developing targeted therapeutic strategies. Full article

Background/Objectives: InterRAI is a globally validated platform aimed at improving care for individuals with disabilities and complex medical needs, particularly in long-term care settings. This study explores the experiences of interRAI coordinators in New Brunswick, Canada, and their perceptions of an educational intervention designed to enhance their ability to effectively use interRAI data for quality care. Methods: The study recruited interRAI coordinators from 73 New Brunswick long-term care homes for an educational intervention. Nine coordinators participated in interviews about their experiences. A qualitative descriptive approach was used to analyze field notes and interview transcripts with thematic analysis. Results: Nine interviews and six sets of field notes were collected over one year, focusing on the roles of interRAI coordinators. Participants (all female, averaging 54 years old) expressed positive perceptions of the intervention, noting increased knowledge and collaboration. Key themes included the context of the interRAI coordinator role, the use of interRAI data for quality indicators, and recommendations for future educational initiatives. Conclusions: The findings emphasize the critical role of interRAI coordinators in improving quality care in long-term care settings through effective data use and collaboration. Participants reported that the educational intervention significantly improved their understanding and application of interRAI data. Recommendations for ongoing training and broader engagement stress the importance of continuous support to advance care quality in long-term care homes. Full article

Background: Rotator cuff-related shoulder pain (RCRSP) is a common musculoskeletal condition characterized by pain, functional disability, reduced mobility, and weakness. There is a need for valid functional tests that can measure shoulder strength and power without exacerbating pain. The Seated Medicine Ball Throw (SMBT) and Unilateral Shot-Put Test (ULSPT) are throwing tests that use a weighted ball in a seated position, measuring throwing distance (m). This study aimed to evaluate the feasibility, discriminative validity, and convergent validity of these tests in individuals with RCRSP. Methods: This cross-sectional study included 64 participants: 30 with RCRSP and 34 asymptomatic controls. Participants completed the QuickDASH and Fear-Avoidance Beliefs Questionnaire (FABQ). Pain was assessed using a 10 cm visual analog scale (VAS) at multiple time points. The SMBT and ULSPT were performed using a 2 kg ball, with throwing distance calculated as the average of three trials. Active shoulder range of motion (AROM) and grip strength were also measured. A two-way mixed-model repeated-measures ANOVA was conducted to examine group effects, with post hoc analyses performed where relevant. Pearson correlations explored associations among outcome measures. Results: The RCRSP group presented with persistent moderate shoulder pain (mean duration = 6.33 ± 5.7 months, VAS = 5.03 ± 1.99 cm, QuickDASH = 26.2 ± 10.54). Pain did not significantly increase after throwing (VAS change = 0.5 ± 1.6 cm, P = 0.4), supporting the tests’ feasibility. ULSPT demonstrated significant differences between the RCRSP and control groups for both symptomatic (2.03 ± 0.81 m) and asymptomatic shoulders (2.04 ± 0.8 m) compared with controls (2.51 ± 0.93 m, P < 0.01). SMBT showed a trend toward group differences (P = 0.05). RCRSP participants showed reduced AROM (166.2 ± 10° vs. 175.1 ± 8.2°) but similar grip strength compared to controls. ULSPT strongly correlated with SMBT (r = 0.92–0.94, P < 0.0001). Both throwing tests correlated moderately with grip strength (r = 0.61–0.81, P < 0.05) and showed mild to moderate correlations with disability, pain, and fear-avoidance measures (r = 0.26–0.48, P < 0.05). Conclusions: The ULSPT demonstrated good discriminative validity in differentiating individuals with RCRSP from controls, while the SMBT showed a trend toward discrimination. Both tests were feasible to administer without significantly exacerbating pain. The strong correlation between ULSPT and SMBT, along with their associations with established measures, supports their potential as functional assessments of upper extremity performance in RCRSP. Full article

Objective: This study aims to investigate the trends in otology, rhinology, and head and neck (H&N) operations over the past decade in England. These trends will allow for predictive modelling to forecast the demand over the coming years to aid workforce and resource planning in ENT. Methods: Hospital Episode Statistics data were extracted between April 2012 and April 2023. A total of 121 otology, 114 rhinology, and 122 H&N procedure codes were included. Correlation and linear regression analyses were conducted to examine trends and produce a forecast model for the volume of operations. Results: A gradual upward trend in the volume of operations was observed in rhinology, with a positive correlation coefficient (R = 0.74). In contrast, otology (R = −0.67) and H&N (R= −0.75) showed negative trends, indicating a moderate decline in operational volumes over time. The COVID-19 pandemic significantly disrupted operating activity in rhinology and otology. To address the backlog and reach the pre-pandemic forecasted levels within the next five years, surgical capacity must increase by an additional 33,807 rhinology 25,486 otology, and 10,300 head procedures per year in England. Conclusions: This analysis highlights a need for prioritization and expansion of the ENT workforce and resources to manage the current backlog and anticipated increase in demand over the next five years. Full article