Objectives: This scoping review aimed to map European and Romanian pharmaceutical legislation and policy-related evidence and to examine how legislative harmonization translates into access outcomes in Romania. Eligibility criteria: Legislative documents, institutional reports, market analyses, and peer-reviewed studies addressing pharmaceutical regulation, pricing, reimbursement, and access to medicines (2000–2024). Sources of evidence: EUR-Lex, the Romanian Legislative Portal, PubMed, Scopus, Google Scholar, and institutional sources (European Commission, OECD, WHO, EFPIA, NAMMDR, CNAS). Charting methods: Data were extracted using a standardized charting form and synthesized narratively across thematic domains (regulatory harmonization, pricing and reimbursement, medicine shortages, comparative EU indicators, and health system implications). Results: Fifty sources were included. The mapped evidence consistently identified three dominant patterns: (1) prolonged time-to-availability for centrally authorized medicines, with mean delays exceeding 800 days in Romania compared with approximately 578 days at EU level; (2) limited availability of innovative therapies, particularly in oncology (approximately 20% availability in Romania versus around 50% EU average); and (3) recurrent medicine shortages associated with low-price regulation and parallel export dynamics. Evidence gaps include limited Romania-specific empirical evaluation of the causal effects of individual policy levers (e.g., external reference pricing, reimbursement timelines, clawback mechanisms). Conclusions: Legislative harmonization alone has not ensured equitable or timely access to medicines in Romania. The evidence suggests that national pricing, reimbursement, and supply governance mechanisms mediate the relationship between EU regulation and real-world patient access, highlighting the need for targeted policy reforms and further empirical investigation.

Background: Medicine shortages present a critical challenge for health systems worldwide, impacting patient care and health outcomes. This study investigated healthcare professionals’ perceptions of the impact of medicine shortages in public health facilities of the Eastern Cape, South Africa. Methods: A quantitative, cross-sectional design was employed, using a self-administered questionnaire distributed to 394 healthcare professionals (professional nurses, pharmacists, and medical officers). Results: The findings revealed a strong consensus that shortages negatively affect all stakeholders, with 96.7% of respondents agreeing that they increase provider stress and reduce patient trust. A significant majority also reported that shortages lead to delayed treatment (70.6%) and compromised health outcomes (67%). However, perceptions varied significantly by profession. Pharmacists were significantly more likely than nurses and medical officers to perceive that shortages result in increased out-of-pocket costs for patients, treatment errors, and compromised health outcomes. Conclusions: The study concludes that medicine shortages severely impact patient safety, clinical outcomes, and healthcare providers’ well-being in this setting. The pronounced concerns among pharmacists highlight their strained role in managing the crisis and underscore the urgent need for strengthened pharmaceutical supply chain governance, interprofessional collaboration, and targeted policies to mitigate the effects of shortages and protect patients from financial hardship.

Background: Enhanced Recovery After Surgery (ERAS) protocols improve postoperative outcomes and promote multidisciplinary, evidence-based perioperative care. However, ERAS adoption in gynecological departments remains inconsistent, and the underlying implementation challenges are poorly understood. Objective: To identify key barriers, facilitators, and preferred implementation strategies influencing ERAS adoption in German gynecological departments, and to assess whether clinicians’ ERAS knowledge or institutional certification shapes these perceptions. Methods: We conducted a nationwide, web-based cross-sectional survey of gynecologic clinicians in Germany. The questionnaire assessed ERAS-related knowledge, current implementation status, and perceived barriers, facilitators, and strategies. Statistical analyses included equality of proportions tests, logistic regression, and internal consistency measurement. Results: A total of 116 clinicians participated; 66 provided data on barriers and 64 on facilitators and strategies. Only 37.9% reported routine ERAS use. The most frequently identified barriers were limited ERAS knowledge (40.9% “very important”) and insufficient personnel resources (40.9%). The strongest facilitators were improved patient well-being, reduced morbidity, and higher patient satisfaction (each >60% “very important”). High-impact implementation strategies included informational materials, workshops, and online training. Well-informed clinicians had significantly higher odds of reporting a positive professional impact of ERAS (OR = 9.0, p = 0.001). Conclusions: ERAS implementation in gynecological settings remains restricted by staff knowledge gaps and personnel limitations. Patient-centered benefits and interactive educational strategies serve as powerful facilitators. Enhanced staff education and multidisciplinary support structures may substantially improve ERAS uptake and contribute to greater professional satisfaction among clinicians.

Background: Immersive technologies are increasingly used to support interprofessional education and team training in healthcare. Holographic display technology (HDT) offers a novel approach for delivering distributed, simulation-based TeamSTEPPS training; however, evidence regarding its short-term feasibility remains limited. Methods: This mixed-methods pilot feasibility study examined the acceptability and limited efficacy (defined as learning satisfaction and self-reported gains) of HDT for interprofessional TeamSTEPPS-based team training across two geographically distributed campuses. Quantitative measures assessed changes in UTAUT-informed constructs, including attitude toward technology use (ATU) and behavioral intention (BI), while qualitative focus groups explored learner experiences and perceptions. Results: Of 64 participants, 47 consented to analysis. Quantitative analyses demonstrated post-training improvements in key technology-acceptance constructs, including significant gains in ATU and strengthened alignment between BI and UTAUT predictors. Qualitative findings reflected high learner engagement and perceived educational value, alongside practical considerations related to technical and instructional coordination. Conclusions: HDT was feasible for assessment of short-term foci of acceptability and perceived limited efficacy through the delivery of interprofessional TeamSTEPPS training, with observed gains in ATU and BI. These findings inform future assessment of long-term feasibility foci, including implementation studies examining the role of holographic simulation in advancing interprofessional education, healthcare workforce development, and the quality of healthcare delivery.

Background and Objectives: Sepsis and septic shock remain leading causes of morbidity and mortality in intensive care settings worldwide. While substantial epidemiological data exist from Western countries, the clinical profile of sepsis in regions with exceptionally high diabetes prevalence remains inadequately characterized. Saudi Arabia, with one of the highest diabetes mellitus prevalence rates globally, may exhibit distinct sepsis epidemiology, infection patterns, and outcomes. This study aimed to characterize the clinical profiles, antimicrobial management, and outcomes of sepsis and septic shock in a tertiary intensive care unit (ICU) in the Aseer region of southwestern Saudi Arabia. Materials and Methods: A retrospective observational study was conducted including 263 adults meeting Sepsis-3 criteria (232 sepsis, 31 septic shock) admitted to a tertiary ICU between January 2020 and December 2024. Demographics, comorbidities, laboratory parameters, microbiological data, antibiotic timing, interventions, and in-hospital mortality were analyzed. Logistic regression identified independent mortality predictors. This study adhered to the STROBE reporting guidelines. Results: The median age was 73 years with male predominance (58.4%). Diabetes mellitus (71.5%) and hypertension (65.8%) were highly prevalent. Urinary tract infections (UTIs) predominated (79.8%), with Escherichia coli as the most common pathogen (26.2%). The median time to antibiotic administration was 1.8 h; piperacillin–tazobactam was the most frequent empiric regimen (43.7%). Septic shock patients exhibited higher creatinine (1.65 vs. 1.08 mg/dL, p = 0.026) and lower platelets (194 vs. 271 × 103/μL, p = 0.030). Mortality was 38.7% in septic shock versus 8.2% in sepsis (p < 0.001). Multivariate analysis confirmed septic shock (aOR: 5.23; 95% CI: 1.89–14.48) and mechanical ventilation (aOR: 15.42; 95% CI: 5.67–41.95) as independent mortality predictors. Conclusions: High diabetes prevalence shapes regional sepsis epidemiology with UTI predominance. Early antibiotic administration and recognition of septic shock remain critical for improving outcomes in this population.

Background: Exercise during pregnancy is known to benefit physical and mental health. However, pregnant women’s lived experiences of its psychological impact remain insufficiently explored. This study aimed to explore pregnant women’s experiences and perceptions of how exercise influences mental health during pregnancy. Methods: A qualitative study design was employed. Pregnant women were recruited using purposive sampling from a clinical hospital setting between March and September 2025. Eligible participants met predefined inclusion and exclusion criteria. Data saturation guided sample size (N = 38). Data were collected through semi-structured online interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Four major participant-derived themes emerged: emotional regulation and mood stabilization, reduction of anxiety and depressive symptoms, enhanced self-confidence and body acceptance, and increased self-efficacy and sense of control. These themes illustrate the range of psychological benefits associated with maintaining exercise during pregnancy. Conclusions: This study highlights the psychological meanings pregnant women attribute to exercise, extending beyond its established physical benefits. These insights underscore the importance of integrating mental health perspective into prenatal physical activity counselling and support the development of more individualized, patient-centered prenatal care strategies.

Background: Orthorexic eating reflects a rigid preoccupation with healthy eating that often co-occurs with health-oriented lifestyles, yet the affective experience of physical activity has received little attention. This study examined whether enjoyment of physical activity is associated with orthorexic tendencies in adults and whether it explains variance beyond age, body mass index (BMI), physical activity status, and self-rated diet. Methods: Adults (N = 434; M_age = 27.55) recruited online in Türkiye completed a survey including the Physical Activity Enjoyment Scale (PACES), the Orthorexia Nervosa Inventory (ONI), and sociodemographic, BMI, physical activity, and diet items. Pearson correlations and one-way ANOVAs assessed bivariate associations, and hierarchical regressions tested whether PACES added incremental variance to ONI total and domain scores beyond covariates. Results: PACES scores showed a near-zero correlation with ONI total (r ≈ 0.02) and did not add variance in regression models (ΔR2 ≈ 0.00). Higher BMI and identifying one’s diet as “healthy and balanced” were linked to modestly higher ONI total and Impairments/Emotions scores, while differences in physical activity status were small and mainly limited to the Behavioural domain. Conclusions: In this non-clinical sample of Turkish adults, enjoyment of physical activity was not meaningfully associated with orthorexic tendencies. These findings suggest that enjoyment-focused physical activity promotion can be encouraged without increasing orthorexic symptoms, while replication in clinical/high-risk groups (e.g., elite/professional athletes and clinical eating disorder patients) and longitudinal designs is warranted.

Background/Objectives: Breast cancer (BC) represents a major public health problem that is influenced by social and systemic factors. This study evaluates disparities in the BC care continuum based on health insurance type and determines whether these patterns differ according to neighborhood-level deprivation. Methods: Using the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we conducted a retrospective cohort study of women aged ≥18 years and diagnosed with BC in Puerto Rico between 2012 and 2016. The main outcomes were diagnostic delay (>60 days) and six-year mortality. Insurance type (private, Medicare, Medicaid, and dual enrollment in Medicare and Medicaid) was the main predictor, with neighborhood deprivation as a modifier. Logistic and Cox models assessed delay and survival, adjusting for key covariates. Results: Disparities in diagnostic delays and risk of death across insurance types were most evident in areas with low to average deprivation, whereas, in neighborhoods with above-average to highest deprivation, these differences diminished for diagnostic delay and disappeared for risk of death. Conclusions: These findings reveal that neighborhood environment, an intermediary social determinant of health, may affect the timeliness and quality of care provided to women diagnosed with BC.

Background: This pilot study examined the feasibility, acceptability, usability, and preliminary outcomes of apt.mind, a mobile app-based mindfulness intervention with an exploratory smartwatch component, among healthcare worker families during the COVID-19 pandemic. Methods: Using a micro-randomized trial (MRT) design, 102 healthcare workers and co-parents of children aged 4–13 years were randomized once per day over 30 days to one of three conditions: (1) an audio-guided mindfulness exercise delivered via the apt.mind mobile app, (2) an in-app push notification prompting a brief mindfulness activity, or (3) no intervention. Feasibility was assessed through participant enrollment, retention, and daily engagement rates, while acceptability and usability were evaluated through qualitative and quantitative feedback. Exploratory multilevel analyses examined proximal effects of intervention conditions on momentary stress. Results: Retention was high, with all participants completing the 30-day protocol, and 80% of participants completed at least one daily survey. Participants reported moderate-to-high acceptability and usability. However, smartwatch battery life and sensor reliability limited the collection of usable physiological data. Multilevel analyses did not identify any significant main effects of intervention condition on momentary stress, but age moderated the association between the audio exercise condition and stress, benefiting older participants. Conclusions: Mobile-based mindfulness interventions appear feasible and acceptable for healthcare worker families in high-stress contexts. Although proximal stress effects were limited and exploratory, the findings inform future optimization of just-in-time adaptive interventions. Improvements in wearable technology and MRT implementation strategies are needed to enhance physiological data quality and reduce assessment-related anxiety.

Aims: This study aims to assess the effect of a structured universal self-care practices module on improving self-care compliance and health maintenance behaviors among women with endometriosis, and to determine if it reduces pain severity. Design: A quasi-experimental design was used. Methods: A total of 90 women confirmed a diagnosis of endometriosis, who were free from any chronic medical or gynecological comorbidities, and who had not received any pain relief pharmacological interventions. Results: The study and control groups were comparable at baseline regarding socio-demographic and clinical characteristics (p > 0.05). Following the intervention, the study group demonstrated significant improvements in universal self-care practices compared to the control group at one month (M = 69.2 ± 11.6 vs. 58.3 ± 8.83; t = −4.93, p = 0.001) and three months (M = 76.4 ± 16.5 vs. 61.5 ± 12.2; t = −4.89, p = 0.001). A strong negative correlation was found between self-care and symptom severity at one month (r = −0.70, p < 0.001) and three months (r = −0.83, p < 0.001), indicating that improved self-care was associated with reduced symptoms. Conclusions: This study highlights the vital role of nursing-led, WHO-based self-care interventions in improving compliance and reducing pain among women with endometriosis. Integrating such programs into routine care can enhance self-management and overall quality of life. Patient or Public Contribution: Integrating individualized, nursing-led self-care programs into routine endometriosis management can improve symptom control through ongoing education and follow-up. Nurses play a pivotal role in empowering women’s self-management, while adopting the WHO Universal Self-Care Framework can strengthen gynecological care policies and practices.