Advanced Healthcare Research Articles

Laser-induced graphene (LIG) has driven significant advances in wearable electronics, advanced healthcare, and energy devices. However, achieving diverse functionalities and high-performance for practical use requires integrating functional materials, which remains challenging due to poor synthesis results or complex chemical treatments. Herein, direct, seedless growth of transition-metal-oxide (MO) crystalline nanorods on LIG is demonstrated, even under lattice-mismatch conditions, via a non-epitaxial process. Ultrafast laser pyrolysis during LIG formation introduces nitrogen- and oxygen-containing surface groups that facilitate the nucleation of MO during subsequent synthesis, enabling the selective growth of MO nanorods exclusively on LIG patterns without additional lattice-matching or patterning steps. Through this non-epitaxial growth, crystalline orthorhombic WO3·0.33 H2O and β-FeOOH nanorods are successfully synthesized on LIG micro-patterns. As a proof-of-concept, LIG electrodes integrated with these crystalline MO nanorods are employed in all-solid-state micro-supercapacitors, exhibiting significantly enhanced capacitive performance owing to the electrochemical reactivity of the MO nanorods, together with excellent mechanical and cyclic stability. Beyond this demonstration, the non-epitaxial strategy offers a versatile route for harnessing the diverse functionalities of MO nanostructures, unlocking new possibilities in graphene-based electronics.

Corporate Practice/Dental Service Organization.

Ultra-sensitive detection of mycobacterium cells on a smartphone through enhanced emission of autofluorescence signals.

Background: Internists formulate diagnostic hypotheses and personalized treatment plans by integrating data from a comprehensive clinical interview, reviewing a patient’s medical history, physical examination and findings from complementary tests. The patient treatment life cycle generates a significant volume of data points that can offer valuable insights to improve patient care by guiding clinical decision-making. Artificial Intelligence (AI) and, in particular, Generative AI (GAI), are promising tools in this regard, particularly after the introduction of Large Language Models. The European Federation of Internal Medicine (EFIM) recognizes the transformative impact of AI in leveraging clinical data and advancing the field of internal medicine. This position paper from the EFIM explores how AI can be applied to achieve the goals of P6 Medicine principles in internal medicine. P6 Medicine is an advanced healthcare model that extends the concept of Personalized Medicine toward a holistic, predictive, patient-centered approach that also integrates psycho-cognitive and socially responsible dimensions. An additional concept introduced is that of Digital Therapies (DTx), software applications designed to prevent and manage diseases and disorders through AI, which are used in the clinical setting if validated by rigorous research studies. Methods: The literature examining the relationship between AI and Internal Medicine was investigated through a bibliometric analysis. The themes identified in the literature review were further examined through the Delphi method. Thirty international AI and Internal Medicine experts constituted the Delphi panel. Results: Delphi results were summarized in a SWOT Analysis. The evidence is that through extensive data analysis, diagnostic capacity, drug development and patient tracking are increased. Conclusions: The panel unanimously considered AI in Internal Medicine as an opportunity, achieving a complete consensus on the matter. AI-driven solutions, including clinical applications of GAI and DTx, hold the potential to strongly change internal medicine by streamlining workflows, enhancing patient care and generating valuable data.

ABSTRACT Objective To develop and evaluate a scalable, multidrug-releasing intrauterine device (IUD) capable of treating common gynecological infections caused by viral, bacterial, and fungal pathogens. Significance Women's health encompasses both physical and emotional well-being and is impacted by inequitable access to advanced healthcare technologies. Conditions such as genital herpes, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) are prevalent and often managed with systemic oral drugs, which can reduce patient compliance and treatment efficacy due to side effects and dosing challenges. A localized, sustained-release IUD could improve adherence and therapeutic outcomes. Methods An IUD was manufactured using injection molding with high-density polyethylene (HDPE) due to its biocompatibility. Devices were loaded with acyclovir and silver sulfadiazine, with actual drug incorporation measured at ∼2–3% w/w for single or combination formulations. Physical-chemical, mechanical, and in vitro drug release tests were conducted to evaluate feasibility and performance. Results The injection molded HDPE-based IUD demonstrated sustained drug release and structural integrity. Initial in vitro results confirmed the capability to release multiple agents over time, although drug loading efficiency remains an area for improvement. Conclusions This approach presents a promising, scalable strategy for localized treatment of gynecological infections. Further optimization and in vivo studies are warranted to validate the device’s therapeutic effectiveness and regulatory readiness.

Sustainable biomaterials are essential for advancing tissue engineering. This study investigates the in vivo biocompatibility and regenerative potential of seaweed cellulose (SC) scaffolds derived from Ulva sp. and Cladophora sp. as connective support matrices. SC scaffolds were fabricated using an optimized decellularization process that preserved their distinct porous (Ulva) and fibrous (Cladophora) architectures. Subcutaneous implantation in Sprague–Dawley rats demonstrated minimal foreign body response and successful integration over an eight-week period. Histological analysis revealed architecture-driven healing dynamics: Ulva sp. scaffolds promoted compartmentalized healing, characterized by distributed vascularized connective tissue, while Cladophora sp. scaffolds supported stratified tissue organization with aligned collagen deposition. Both scaffolds exhibited progressive vascularization and reduced foreign body response, with no adverse inflammatory reactions observed. These findings highlight the potential of SC scaffolds for regenerative applications that require tailored tissue responses, while their renewable, marine- origin underscores their potential as sustainable biomaterials in advanced healthcare solutions.

The rise of e-commerce has significantly broadened the marketplace, introducing greater convenience and accessibility to the desired products at the doorsteps of consumers. In recent years, even pharmacies have embraced the online platform. E-commerce plays a crucial role in providing technologically advanced healthcare services to all. While e-pharmacies provide numerous benefits, there are also inherent risks that can impact the health and well-being of patients. Since no legislation in India specifically deals with the e-pharmacy sector, they are governed by the existing legislation that regulates the pharmaceutical industry. This paper seeks to analyse challenges in regulating the e-pharmacy sector and to critically evaluate the applicability and effectiveness of the existing legislations in ensuring the safety and integrity of online pharmaceutical transactions in India.

BackgroundInflammatory bowel disease (IBD) is a chronic and relapsing gastrointestinal disorder whose global disease burden continues to rise, making it a significant public health issue. In recent years, rapid socioeconomic development in East Asia has led to notable changes in lifestyle and dietary patterns, accompanied by dynamic shifts in the epidemiological characteristics of IBD. However, there remains a lack of systematic comparison and analysis of the long-term disease burden and evolutionary trends of IBD across five East Asian countries and regions: China, Japan, South Korea, North Korea, and Mongolia. Based on data from The Global Burden of Disease Study 2021 (GBD 2021), this study aims to comprehensively describe the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of IBD in The region from 1990 to 2021, thereby providing a basis for differentiated prevention and control strategies.MethodsDescriptive analysis, Joinpoint regression, and age–period–cohort (APC) modeling were employed to examine epidemiological patterns and trends.ResultsSignificant variations in IBD burden were observed across the region. China and South Korea experienced the most rapid increases in incidence and prevalence, exhibiting a profile of “high morbidity and low disability.” Japan demonstrated a stabilizing disease burden alongside a continuing decline in standardized mortality rates, reflecting its advanced healthcare system. North Korea and Mongolia currently have a relatively low overall burden; however, a notable rise in incidence among young Mongolians suggests an emerging risk of early-onset IBD. APC analysis further indicated complex influences from environmental factors, healthcare resource allocation, and lifestyle changes such as Westernized diets. The study proposes tailored prevention strategies: high-SDI countries should optimize geriatric care systems, medium-SDI countries should enhance preventive interventions for adolescents, and low-SDI countries should prioritize the establishment of primary screening networks.ConclusionThese findings provide a scientific basis for differentiated IBD prevention and control in East Asia and contribute to a deeper understanding of the epidemiological transition of chronic diseases.

Healthcare accessibility is vital for sustainable urban development, ensuring timely diagnosis, chronic disease management, and emergency response. However, in many developing countries, the uneven distribution of advanced healthcare services exacerbates health disparities. Taking Tianjin in China as an example, this study aims to evaluate the spatial accessibility of tertiary hospitals and optimize hospital placement to improve healthcare coverage. Using the Gaussian Two-Step Floating Catchment Area (G2SFCA) method, the study integrated high-resolution spatial data on hospital locations, population density, and transportation networks, assessing the accessibility of higher-level healthcare services citywide. The results indicate that central urban districts exhibited high accessibility, where all demand points were within the 1-hour service range. In contrast, suburban districts had an average accessibility of 0.194, and outer suburban districts had the lowest citywide mean of 0.005, with less than 20% of the area covered. Despite its economic significance, Binhai New Area's healthcare accessibility remained inadequate, with a mean score of 0.010. The application of a location-allocation model to optimize the placement of 24 planned new hospitals, prioritizing areas with high population density and low accessibility resulted in an increased population coverage from 73.31% to 95.05%, significantly reducing non-accessible points. This study aligns with the United Nations' Sustainable Development Goals 3 and 11, advocating a hierarchical healthcare system, telemedicine, and improved transportation to minimize time costs and reduce inequities.

Fungal keratitis is a significant public health concern in rural areas, where access to advanced healthcare facilities is limited. This study aims to evaluate and compare the sensitivity and specificity of trypan blue (0.06%) with 10%potassium hydroxide (KOH) and Gram stain in the diagnosis of fungal keratitis in a resource-poor setting. Single-center, unmasked, comparative, cross-sectional study at a rural secondary center in south India from April to September 2023. All patients with clinically diagnosed microbial keratitis who presented to the clinic were enrolled, and the corneal scrapings from the infiltrate were collected on three slides and stained with Gram stain, 10% KOH, and 0.06% Trypan blue in a random sequence, and assessed for the presence of fungal filaments. Cases showing fungal filaments on any one of the 3 slides, were enrolled in the study, while the rest were excluded. A total 86 /108 patients with fungal keratitis were enrolled. Therate of detectionof fungal filaments was 96.5% with Gram stain, 83.7% with 10% KOH, and 85.9% with Trypan Blue. Sensitivity wasfound to be88%, specificity 66.67%, positive likelihood ratio 2.64 (95% C.I 0.53,13) and negative likelihood ratio was 0.18 (95% C.I. 0.07,0.49) for Trypan blue. The concordance between Trypan Blue and KOH stain was 77.3% (Cohen's kappa = 0.17), and between Trypan Blue and Gram stain was 87.21% (Cohen's kappa = 0.22). The Trypan blue staining technique seems to provide a reliable, easy to learn alternative for the detection of fungal filaments in the diagnosis of fungal keratitis, particularly in resource-poor settings.

The experience of pregnancy loss inflicts lasting psychological trauma on women, significantly impacting their subsequent pregnancies. This study aimed to understand the feelings and thoughts of pregnant women with a history of pregnancy loss. Between February and May 2023, participants were purposively sampled from three tertiary hospitals and one community hospital in Guangdong Province, China. Two interviewers conducted semi-structured, one-on-one interviews, which were transcribed verbatim and analyzed using Colaizzi's seven-step method. Thematic saturation was achieved after 15 interviews, with three additional interviews confirming no new emergent themes, resulting a total of 18 participants. Four main themes emerged: (1) Resilient yet hyper-vigilant emotional experiences; (2) Supportive yet burdensome family dynamics; (3) Advanced yet impersonal healthcare services; and (4) Abundant yet complex information resources. For pregnant women with a history of pregnancy loss, their unique experiences are deeply intertwined with family interactions, clinical encounters, and information-seeking behaviors. Developing personalized care models is essential to provide comprehensive support for this population.

Рharmaceutical practice of advanced regulatory healthcare systems places high demands on the quality and safety of medicines, especially on compounding drugs by pharmacies. The United Kingdom is one of the countries with a developed system of legal regulation of drug treatment, which is based on the principles of effective management and is aimed not only at following formal procedures, but also at ensuring the ultimate goals, namely patient safety, quality of manufactured drugs and effectiveness of pharmaceutical processes.The aim. To identify the key elements of the British system of regulation of drugs compounding by pharmacies, to assess their applicability in other legal systems and to form promising directions for improving Russian legislation.Materials and methods. The study based on analysis of the UK regulatory framework governing circulation of medicines, as well as documents from government agencies and regulatory agencies. Comparative legal, content analysis, a systematic approach, analytical and empirical methods were used.Results. Pharmaceutical activity is regulated by the General Pharmaceutical Council, which develops standards and guidelines that are binding. The production of medicines is carried out within the framework of a licensing system and is subject to the principles of good practices. The British system is based on a model of effective regulation, where the emphasis is on achieving targeted results rather than strictly following procedures. There is a separate license for the production of special drugs designed for a specific patient.Conclusion. Legal and regulatory systems for manufacturing of medicines in the UK demonstrates high degree of harmonization with international standards, including GMP and PIC/S recommendations. It can serve as a model for improving legislation in other countries, including the Russian Federation, in terms of developing and implementing a unified system of regulatory support for manufacturing of medicines, including introduction of adapted GMP requirements into of pharmaceutical medicine manufacturing practice — good practices for the preparation of medicinal products.

The rapid expansion of miniature biomedical devices has attracted considerable global attention, driven by the growing demand for advanced healthcare solutions. Despite significant progress in materials, fabrication techniques, and device architectures that have propelled the development of wearable and implantable technologies, a critical challenge remains: mimicking the structure and function of human skin. This challenge contrasts advancements in power efficiency, design miniaturization, precision, and device integration. Recent breakthroughs in manufacturing techniques and the development of high-performance organic and inorganic piezoelectric materials with tunable mechanical properties offer transformative potential to overcome these limitations. This review systematically examines the evolution of piezoelectric materials for health monitoring applications, focusing on their historical development, underlying mechanisms, fabrication strategies, and characterization techniques. We critically evaluate their integration into wearable and implantable systems, emphasizing their potential to address power autonomy, device adaptability, and sensing accuracy issues. Additionally, the article highlights emerging interdisciplinary research frontiers in bioengineering, highlighting pioneering contributions from global research teams. By synthesizing key advancements and identifying unresolved challenges, this review aims to provide a comprehensive guide for future innovations in smart biomedical devices, fostering collaborative efforts across the materials science, electronics, and healthcare fields.

BackgroundWhile protocol-based psychological treatments have significantly advanced mental health care, real-world accessibility remains a challenge. Primary care, the main provider of mental health services, faces barriers such as limited resources and a diverse patient population with varying needs, making it difficult to rely solely on time-intensive, protocolized treatments. The Primary Care Behavioral Health (PCBH) model promotes brief, flexible interventions that may better accommodate these needs. However, limited research on these interventions raises concerns about potential undertreatment. To align with Universal Health Coverage principles, it is essential to identify which patient groups benefit most from resource-efficient protocol-based versus brief, flexible, and individualized treatments. Our main aim is to evaluate whether a integrating guided self-help into PCBH improves outcomes compared to the core PCBH model, as well as to assess whether patients identified as suitable for protocol-based interventions benefit more from the combined model.MethodsPatients seeking help for mental or behavioral health problems at PCBH primary care centers will be randomized to one of two arms: core PCBH, where patients receive a contextual assessment and brief interventions tailored to their needs, or an extended PCBH model, where a diagnostic assessment determines whether patients receive brief interventions or guided self-help. The primary outcome is functional impairment, assessed at baseline and followed up at 4, 8, and 12 weeks (primary endpoint), as well as at 1 year. Secondary outcomes include symptom change, cost-effectiveness, and care process factors.DiscussionThe study design allows for comparisons of patient outcomes between the two care models, with a primary focus on evaluating superiority and a secondary focus on non-inferiority, cost-effectiveness, and care process factors. Overall, the project seeks to advance understanding of effective mental health interventions in primary care settings and inform decision-making regarding treatment approaches.Trial registrationClinicalTrials.gov: NCT04900064. Registered on May 25th, 2021. Registered with the Swedish Ethical Review Board (2020–04198) on October 12th, 2020. This protocol was submitted for publication on March 18th, 2025, prior to the inclusion of the final participant, and will shortly thereafter, without any changes, be made publicly available as a preprint in an open-access repository.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13232-4.

Objectives: The primary objective was to compare the usage of Hazardous Materials (HazMat) Protective Personal Equipment (PPE) and ordinary PPE when performing basic and advanced health care support maneuvers in a prehospital setting, evaluating the effectiveness of several procedures, defined as the mean success rate of each. The secondary objective was to evaluate the presence of a learning effect, with improvements in the success rate and/or procedure timing. Methods: This was a prospective within-subjects (repeated-measures) study conducted on Emergency Medical Services (EMS) responders within their Chemical-Biological-Radiological-Nuclear-Explosive (CBRNe) training institutional programme. Volunteers performed a trial sequence of eight lifesaving procedures four times. During the first trial sequence, they wore standard clothing; during the three successive trials, they wore full HazMat PPE equipment. The primary outcomes were changes in success rate and time interval across the four trials. Results: A total of 146 EMS responders volunteered for the experiment. Procedure success rates remained high overall, with the most notable initial drop observed for video-assisted intubation (≈−10%). The only statistically significant delay in the first HazMat trial compared with baseline was for intravenous access (median +30 s; p < 0.001). In the two successive HazMat trials, success rates and timings improved, with median values coming close to baseline. However, only 61% of participants completed the entire drill due to tolerance limits of the equipment. Conclusions: HazMat PPE, while physically and ergonomically demanding, has minimal impact on most lifesaving procedures, though it may reduce intubation success and delay intravenous access. Tolerance to prolonged use is a key limitation, but dexterity improves rapidly with brief practice. EMS responders can benefit from continuous training practice, while manufacturers could explore ergonomic and tolerance improvements in their PPE equipment.

Background: The research explores the advancements and implications of e-prescribing systems within modern healthcare.Objective: The primary objective is to assess the growing body of literature, examining global trends, effectiveness, and challenges associated with e-prescribing implementation.Methods: Using a comprehensive literature review methodology, data were sourced from the Scopus database, revealing many publications from 1980 to 2024.Results: A notable increase in scholarly interest was observed, particularly from 2015 to 2024, highlighting e-prescribing as a mature research subject. The results indicate a high concentration of research activity in advanced healthcare systems, contrasting with the limited contribution from developing contexts such as Indonesia.Conclusion: The study identifies that while e-prescribing improves medication safety and efficiency, gaps in understanding its long-term impacts on patient outcomes persist. Additionally, disparities in technology adoption among demographic groups emerge as significant barriers. This research contributes to existing knowledge by underscoring the need for localized studies and international collaboration to enhance e-prescribing practices. Future research directions should focus on evaluating long-term outcomes, improving digital literacy, and assessing training impacts on healthcare professionals.

The increasing global nursing shortage has led to a rise in the migration of African-educated nurses (AENs) to the United States. Despite being essential to the U.S. healthcare workforce, AENs face significant challenges during their transition, including cultural, professional, and emotional adjustments. This study aimed to explore the lived experiences of AENs transitioning into the American healthcare system and to identify the specific support needs required for their successful integration. A phenomenological approach guided by Ricoeur's interpretive phenomenology framework and Afaf Meleis's transitions theory was used. A combination of purposive and convenience sampling was employed to select 19 AENs who were trained in Africa but are currently working in various U.S. health institutions, and they participated in in-depth, unstructured interviews. Data were analyzed thematically to capture the essence of participants' experiences. Five main themes emerged: (1) Navigating an Unfamiliar Ground, including culture shock, language barriers, and differences in patient care standards; (2) Developing a Thriving Mindset, highlighting resilience, determination, and the importance of social support; (3) Institutional Factors Affecting Transitioning, such as the role of mentorship programs and perceived racial biases; (4) Heavy Performance Demands, reflecting the need for constant skill demonstration and managing high workloads; and (5) Leveraging Opportunities for Growth, focusing on career progression, financial benefits, and access to advanced healthcare technologies. AENs experience a complex transition into the U.S. healthcare system characterized by significant challenges and growth opportunities. Targeted support interventions, including cultural competence training, mentorship, and institutional support systems, are essential to facilitate their successful integration and enhance their contributions to patient care.

The increasing demand on healthcare services, coupled with financial pressures and the need to optimise patient outcomes, has driven the exploration of innovative care models. This abstract outlines the launch of a surgical virtual ward in the United Kingdom. The virtual ward aims to provide continuous care for surgical patients following hospital discharge, allowing them to recover effectively at home under remote monitoring. This new approach aims to reduce hospital readmissions, and lower healthcare costs. The virtual ward uses advanced wearable devices and remote monitoring systems to continuously track patients' vital signs 24h a day. This allows healthcare providers to detect early signs of clinical deterioration and intervene promptly. Secure video consultations are used to visually assess patients, including monitoring wounds for signs of infection or poor healing. The primary objectives of the virtual ward are to reduce the length of hospital stays, promote faster recovery by managing complications early, and reduce healthcare costs through remote care. From January 2024-February 2025, a total of 46 patients were enrolled to the surgical virtual ward. Early outcomes demonstrate the feasibility and effectiveness of this model. The financial impact has been substantial; with an average hospital bed costing £589 per day, the virtual ward has saved approximately £91,295 in bed costs alone, underscoring the cost-efficiency of the approach. The surgical virtual ward initiative represents a significant shift in the delivery of surgical care, offering patients the benefits of home-based recovery while maintaining high levels of clinical oversight. The model not only alleviates pressure on hospital resources but also enhances patient satisfaction and provides a cost-effective solution for healthcare systems. As the program expands, it is expected to set new standards for surgical care, with the potential to redefine patient-centred, technologically advanced healthcare in the UK.

Deep neural hashing for content-based medical image retrieval: A survey.

Indonesia comprises 16,771 islands, including 111 small islands and atolls. The Indonesian government has established community health centres, known as puskesmas in Indonesian, to provide health services to the entire populations of the country, including those in remote areas. In 2014, the Indonesian government introduced a national health insurance system with the goal of providing equitable access to health care for all citizens. However, not all health issues can be managed by these community health centres, necessitating a referral system to more advanced healthcare facilities. This study aims to evaluate the implementation of the referral system by community health centres in small island areas, with a view to addressing a research gap on this topic. This implementation research explores the challenges associated with the referral system using the intervention mapping approach. This approach involves six stages: (1) needs assessment, (2) change matrix development, (3) devising strategies to optimise referrals based on practical theories, (4) program preparation, (5) adoption and implementation planning, and (6) evaluation planning. The target population will comprise patients, healthcare workers at community health centres and various other stakeholders. The study is to be conducted on three small islands in Sangihe Islands Regency, North Sulawesi Province: Nusa Tabukan, Marore and Kahakitang. The evaluation of the referral program addresses the gap in the implementation of referrals from community health centres on small islands, providing valuable information for the government and policymakers regarding healthcare delivery in hard-to-reach and remote areas. The study's results are expected to offer valuable insights into systematic research processes and provide recommendations for interventions designed to improve the referral system from community health centres to regional hospitals.