Involvement Of Healthcare Professionals Research Articles

Avertible filicide: a call to action for early intervention and mental health support in India.

Maternal filicide is a deeply distressing and potentially preventable phenomenon that demands priority attention. This study aims toshed light on the psychological, social and systemic factors contributing to maternal filicide. It calls for robust early intervention strategies and the establishment of comprehensive mental health support systems to mitigate the risk and prevent the occurence of such tragedies.. A detailed evaluation of a mother who committed filicide was undertaken The assessments included in-depth psychiatric evaluations, interviews with family members, review of the individual's medical history, prior social circumstances, and existing legal records. This comprehensive approach allowed for the identification of potential warning signs and gaps in intervention. Additionally, a review of existing literature and national frameworks related to maternal mental health was undertaken to contextualize the findings within the broader socio-cultural and healthcare landscape of India. The case highlights a complex interplay of untreated mental health disorders, social stigma, lack of accessible mental health services, and a failure to recognize warning signs by family members and professionals. The analysis reveals missed opportunities for intervention that might have prevented the act of filicide. Key contributing factors included postpartum mental health issues, socio-economic stressors, and inadequate social and legal support for the mother. This case underscores the need for systemic changes, including improved mental health screening during the perinatal period and the establishment of crisis intervention services. Maternal filicide is not solely a legal issue but also a multifaceted public health and social problem that warrants a multidisciplinary response. The findings emphasize the need for an integrated approach involving healthcare professionals, social workers, and law enforcement agencies to address the mental health challenges faced by mothers in distress. Early identification of at-risk individuals, destigmatization of mental health care, and the provision of timely interventions are pivotal in preventing such tragedies. This study underscores the urgency of implementing mental health policies that prioritize maternal mental health, enhance public awareness, and ensure the availability of accessible, culturally sensitive support systems for at-risk families.

Healthcare Professionals' Knowledge Level Regarding Forensic Cases in The Intensive Care and Operating Room

Purpose: Forensic cases are encountered in not only emergency units but also operating rooms, and intensive care units. It is believed that increasing the level of knowledge about forensic cases in these areas will improve the quality of healthcare services. This plays an important role in fulfilling ıntensive care professional responsibilities and contributes to the legal process. This study aims to assess the knowledge and practices of healthcare professionals in operating rooms and intensive care units regarding forensic cases. Material and Methods: A descriptive comparative design study was conducted, involving healthcare professionals from a university hospital in the Eastern Black Sea Region between March 17 and May 1, 2023 (n=116). Data were collected through a questionnaire developed by the researchers, and analysis was performed using descriptive statistics, t-tests, variance analysis, and correlation analysis. Results: Participants had a mean age of 30.6±7.7 years, with 56% working in operating rooms and 56.9% being nurses. While 53.4% had received training on forensic cases, 82.8% had encountered such cases. Education significantly influenced both knowledge level (p=0.00) and application (p=0.02), with a moderate positive correlation between knowledge and application (r=0.541, p=0.000). Conclusion: The study highlights a lack of knowledge and practices among healthcare professionals in operating rooms and intensive care units regarding forensic cases. It recommends providing detailed and regular training on forensic events and suggests further research with a larger sample size to address this issue comprehensively.

Applications of Artificial Intelligence for Non-Psychomotor Skills Training in Health Professions Education: A Scoping Review.

This study explores uses of artificial intelligence (AI) in health professions education for non-psychomotor skills training at undergraduate, postgraduate, and continuing health professions education levels for education program development, delivery, and evaluation. This scoping review was conducted in 5 stages: (1) planning and research, (2) search strategy, (3) screening and selection, (4) review and recording data, and (5) synthesis. Seven bibliographic databases were searched using the main search terms artificial intelligence and continuing health professional education for articles that used AI for the purposes of non-psychomotor skills training for health professions education and involved health care professionals and/or trainees. Databases were searched for articles published from January 1, 2001, to March 26, 2024. The original searches were performed on July 26, 2021, and again on March 26, 2024. Two reviewers independently screened, reviewed, and extracted data. Data extraction was performed using Kern's 6-step curriculum development framework to guide analysis. In total, 9,914 studies related to AI in health professions education for non-psychomotor skills training were screened. Of these, 103 studies were identified that met inclusion criteria. Of these 103 studies, 52 (50%) were cohort studies. The most common learner population was health care professional students (67 studies [65%]). Most studies (76 [74%]) were set in nonclinical settings. Sixty-eight studies (66%) fit under step 6 of Kern's criteria (evaluation and assessment), illustrating that AI is predominantly being used for the purposes of evaluation and assessment of learners and programs. Most studies in the literature illustrate that AI is being applied in a non-psychomotor context to evaluate health professional education programs and assess learners. Additional opportunities to use AI in curriculum design and implementation could include identification of learning needs for training, personalizing learning with AI principles, and evaluating health care professional education programs.

Recommendations for Mental Health Chatbot Conversations: An Integrative Review.

To identify and synthesise recommendations and guidelines for mental health chatbot conversational design. Integrative review. Suitable publications presenting recommendations or guidelines for mental health conversational design were included. The quality of included publications was assessed using Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was conducted. Primary searches limited to last 10 years were conducted in PubMed, Scopus, ACM Digital Library and EBSCO databases including APA PsycINFO, CINAHL, APA PsycArticles and MEDLINE in February 2023 and updated in October 2023. A secondary search was conducted in Google Scholar in May 2023. Of 1684 articles screened, 16 publications were selected. Three overarching themes were developed: (1) explicit knowledge about chatbot design and domain, (2) knowing your audience and (3) creating a safe space to engage. Results highlight that creating pleasant and effective conversations with a mental health chatbot requires careful and professional planning in advance, defining the target group and working together with it to address its needs and preferences. It is essential to emphasise the pleasant user experience and safety from both technical and psychological perspectives. Recommendations for mental health chatbot conversational design have evolved and become more specific in recent years. Recommendations set high standards for mental health chatbots. To meet that, co-design, explicit knowledge of the user needs, domain and conversational design is needed. Mental health professionals participating in chatbot development can utilise this review. The results can also inform technical development teams not involving healthcare professionals directly. Knowledge of developing mental health chatbot conversations appears scattered. In mental health chatbots, features that enhance the chatbot's ability to meet users' needs and increase safety should be considered. This review is useful for developers of mental health chatbots and other health applications used independently. This integrative review was reported according to PRISMA guidelines, as applicable. No patient or public contribution.

Health Care Professionals and Data Scientists' Perspectives on a Machine Learning System to Anticipate and Manage the Risk of Decompensation From Patients With Heart Failure: Qualitative Interview Study.

Heart failure (HF) is a significant global health problem, affecting approximately 64.34 million people worldwide. The worsening of HF, also known as HF decompensation, is a major factor behind hospitalizations, contributing to substantial health care costs related to this condition. This study aimed to explore the perspectives of health care professionals and data scientists regarding the relevance, challenges, and potential benefits of using machine learning (ML) models to predict decompensation from patients with HF. A total of 13 individual, semistructured, qualitative interviews were conducted in Portugal between October 31, 2022, and June 23, 2023. Participants represented different health care specialties and were selected from different contexts and regions of the country to ensure a comprehensive understanding of the topic. Data saturation was determined as the point at which no new themes emerged from participants' perspectives, ensuring a sufficient sample size for analysis. The interviews were audio recorded, transcribed, and analyzed using MAXQDA (VERBI Software GmbH) through a reflexive thematic analysis. Two researchers (JS and AH) coded the interviews to ensure the consistency of the codes. Ethical approval was granted by the NOVA National School of Public Health ethics committee (CEENSP 14/2022), and informed consent was obtained from all participants. The participants recognized the potential benefits of ML models for early detection, risk stratification, and personalized care of patients with HF. The importance of selecting appropriate variables for model development, such as rapid weight gain and symptoms, was emphasized. The use of wearables for recording vital signs was considered necessary, although challenges related to adoption among older patients were identified. Risk stratification emerged as a crucial aspect, with the model needing to identify patients at high-, medium-, and low-risk levels. Participants emphasized the need for a response model involving health care professionals to validate ML-generated alerts and determine appropriate interventions. The study's findings highlight ML models' potential benefits and challenges for predicting HF decompensation. The relevance of ML models for improving patient outcomes, reducing health care costs, and promoting patient engagement in disease management is highlighted. Adequate variable selection, risk stratification, and response models were identified as essential components for the effective implementation of ML models in health care. In addition, the study identified technical, regulatory and ethical, and adoption and acceptance challenges that need to be overcome for the successful integration of ML models into clinical workflows. Interpretation of the findings suggests that future research should focus on more extensive and diverse samples, incorporate the patient perspective, and explore the impact of ML models on patient outcomes and personalized care in HF management. Incorporation of this study's findings into practice is expected to contribute to developing and implementing ML-based predictive models that positively impact HF management.

Exploring the Realm of Physical Activity in Pregnant Indian Women: Understanding Their Knowledge, Practice, and Obstacles.

Background The study aimed to assess the knowledge of pregnant Indian women about antenatal exercises (ANEs), the challenges they face, and the motivating factors influencing their participation in physical activities. The main objective and practical implication of this research were to evaluate the prevalence of physical activity (PA) among pregnant women in Indian hospitalswhile also identifying the specific challenges that hinder physical activity among this demographic. Hypothesis or aim The hypothesis suggested that the lack of knowledge contributes to low physical activity levels, and healthcare professionals can address this through education. The research aimed to identify obstacles to physical activity among pregnant women in India. Methods This cross-sectional study was conducted at a tertiary healthcare facility, involving 400 pregnant women (24-36-weekgestational age {GA}) receiving prenatal care. The participants completed a detailed questionnaire and interviews to assess their knowledge, routines, challenges, and sources of motivation, aiming to understand the perspectives and experiences of pregnant women. Findings Findings revealed that 36% of the participants had good knowledge, while 64% had poor knowledge. Only 16.5% engaged in regular exercise, with most not prioritizing physical activity. Few exercisers met the recommended daily exercise duration, with walking being the most popular activity. Discussion Pregnant Indian women have poor knowledge and practice of antenatal exercise compared to their Western counterparts. By addressing barriers and involving healthcare professionals, positive changes can be made to enhance understanding in this area. Conclusion This investigation highlights a significant gap in knowledge and practice of antenatal exercise among the participants.

A Review of the Misuse of Isotretinoin in South Africa

Isotretinoin is a potent retinoid drug that is primarily used for the treatment of severe acne. Because of this, the drug has attracted attention and has the potential for abuse and misuse, including use without a prescription and overdose. This manuscript aims to explore the dimensions of isotretinoin misuse or abuse in South Africa. The epidemiological trends, underlying motivations, and associated health risks of Isotretinoin are discussed herein. Despite the strict regulatory control for access without a prescription and severe side effects, there is evidence of abuse of the drug for the effects it produces. The sociocultural and economic factors that contribute to this abuse are explored. Furthermore, Isotretinoin is rather perceived as a cosmetic enhancement tool, while it is indicated to treat severe cases of acne. Hence, the regulatory framework governing access to controlled scheduled substances such as isotretinoin in South Africa was analyzed and the gaps and enforcement challenges that allow for the misuse are described. Isotretinoin remains a valuable drug in the management of severe acne. However, its potential for misuse and abuse in South Africa requires a comprehensive approach involving healthcare professionals, policymakers, and the public to ensure safe and appropriate use through innovative rational medicine use (RMU) interventions to protect the public while providing access for those with sincere needs.

Strategies to reduce hyperglycemia-related anxiety in elite athletes with type 1 diabetes: A qualitative analysis.

Managing blood glucose levels is challenging for elite athletes with type 1 diabetes (T1D) as competition can cause unpredictable fluctuations. While fear of hypoglycemia during physical activity is well documented, research on hyperglycemia-related anxiety (HRA) is limited. HRA refers to the heightened fear that hyperglycemia-related symptoms will impair functioning. This study investigates current strategies employed to mitigate HRA during competition and the development of alternative approaches. Elite athletes with TID, aged >14 who self-reported HRA during competition were recruited. Elite athletes were defined as individuals exercising >10 hours per week whose athletic performance has achieved the highest competition level. 60 to 90-minute virtual semi-structured interviews were analyzed using an Interpretative Phenomenological Analysis. Ten elite athletes with T1D (average age 25 ± 3 years; T1D duration 12 ± 8 years; number of competitions per year 27 ± 19; training time per week 12 ± 6 hours) reported the strategies they currently use to mitigate HRA. These strategies include managing insulin and nutrition intake, embracing social support networks, using technology, practicing relaxation techniques, establishing routines, performing pre-competition aerobic exercise, and maintaining adequate sleep hygiene. Several additional approaches that could be implemented were identified including establishing targeted support networks, developing peer-reviewed resources on HRA, ensuring support teams have sufficient tools, and improving existing technology. Elite athletes with T1D use physiological and psychological strategies to mitigate HRA during competition. This finding highlights the need for increased support and education for these athletes, and advancements in technology. A multidisciplinary approach involving healthcare professionals, athletic staff, and peer mentors could help integrate personalized anxiety management and diabetes care strategies into training regimens, enhancing both mental resilience and performance outcomes for athletes with T1D.

Instruments for assessing healthcare professionals’ knowledge, attitudes and practices regarding deprescribing: a scoping review protocol

ObjectiveTo map instruments for assessing healthcare professionals’ knowledge, attitudes and practices regarding deprescribing.IntroductionDeprescribing is essential for improving patient outcomes by managing polypharmacy, reducing fall risks and decreasing medication costs. However,...

Empowerment among breast cancer survivors using an online peer support community

ObjectivesBreast cancer (BC) impacts the patients’ quality of life. Peer support can provide emotional understanding and enhances access to information, social support, coping strategies, and empowerment. Comunitats is an online peer support community app for BC survivors that involves healthcare professionals. This study aims to explore how participation in Comunitats promotes empowerment, and to identify the variables related to it.MethodsA prospective, cross-sectional approach was applied. One hundred twenty-one women diagnosed with BC were included in Comunitats. Sociodemographic and clinical variables, along with measures of emotional distress (HADS), post-traumatic growth (PTGI), and empowerment (Van Uden-Kraan’s Empowerment Questionnaire), were collected through an online questionnaire completed by the participants. Additionally, data on participation in the online community were obtained directly from the app. Assessments were conducted at inclusion and again 3 months later. Correlations were used to guide linear regression analysis to identify the variables predicting greater empowerment outcomes.ResultsEmpowerment assessment indicated that participants felt empowered by their involvement in Comunitats. The most commonly experienced empowerment outcomes were “being better informed” and “improved acceptance of the illness.” “Exchanging information” and “finding recognition” were the most strongly experienced empowerment processes and the strongest predictors of empowerment outcomes in the regression analysis.ConclusionInvolvement in Comunitats enhances empowerment in BC survivors. Empowering processes within the community partially predict overall empowerment outcomes.Practical implicationsEmpowerment positively impacts self-care autonomy, self-efficacy, and treatment adherence, promoting healthier lifestyles and enhanced treatment outcomes. Therefore, we recommend encouraging participation in online peer support communities, as it might enhance empowerment.

Beyond pain relief: the unseen consequences of NSAIDs misuse in pregnancy.

The non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drug with analgesic, anti-inflammatory, and antipyretic effects. Their primary mechanism of action is the inhibition of the cyclooxygenase (COX) enzyme and a consequent reduction in prostaglandin levels. There is a high global prevalence of NSAIDs used by pregnant females for pain management because of the abundance and ease of access to these compounds. In Pakistan, the most commonly used OTC analgesic medications during pregnancy include acetaminophen, ibuprofen and aspirin.1 A study by Bohio et al discovered that 77.4% of women taking these medications have no knowledge about their dosage and potential adverse effects.2 A recent systematic review by Ambrosio et al. established that the use of NSAIDs during pregnancy can cause oligohydramnios by blocking the synthesis of prostaglandins responsible for normal foetal renal perfusion.3 Oligohydramnios is a serious condition characterised by abnormally low volume (< 500 ml) of amniotic fluid between the 32nd and 36th weeks of pregnancy.4 It is associated with unfavourable maternal and foetal health outcomes, including a 5-fold increase in stillbirths and a 3-fold increase in deaths among neonates.5 The weight of babies from pregnancies complicated by oligohydramnios is, on average, 162 g less than those without oligohydramnios.5 It is a cause of concern since Pakistan has the highest incidence of oligohydramnios during the third trimester of pregnancy among low-middle-income countries.5 One of the reasons is the self-administration of NSAIDs by pregnant females due to a lack of proper medical supervision. Hence, a multifaceted approach involving healthcare professionals, policymakers, and general population is required to address this issue of NSAIDs misuse in Pakistan. This includes education of pregnant women regarding the safe and appropriate management of pain, existing alternate treatment options and consequences of non-prescribed OTC analgesic use during pregnancy. Secondly, the use of NSAIDs should be limited to lowest effective dose for the shortest duration and only in situations where maternal benefits outweigh the potential foetal risk. Lastly, ultrasound monitoring of amniotic fluid should be considered beyond 48 h of NSAIDs treatment and if a decline Amniotic Fluid Index (AFI) is present, therapy should be discontinued. Furthermore, government authorities and community stakeholders should implement regulatory policies to restrict the sale of NSAIDs without a prescription and conduct public awareness campaigns regarding their potential adverse effects. Continued...

The impact of using simulation-based learning to further develop communication skills of pharmacy students and pharmacists: a systematic review

BackgroundEffective communication in healthcare, among professionals and between professionals and patients is crucial for delivering high-quality care. While simulation effectively translates technical skills to clinical practice, its impact on communication, particularly in pharmacies, is less well documented.AimThis systematic review examined the impact of simulation-based education on communication skills among pharmacy students and pharmacists. It aims to identify the types of simulations used, the outcomes obtained, and the effectiveness of these simulations in enhancing communication skills, perception and confidence.MethodWe conducted searches in MEDLINE, LISSA, EMBASE, and PsycINFO for articles on communication training through simulation for pharmacy students and pharmacists. The search covered the period from inception to August 31, 2022. To be included, studies had to meet the following criteria: (i) target pharmacy student or graduate pharmacists; (ii) use simulation in the field of clinical pharmacy; (iii) provide a complete description of the outcome measure. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. Three investigators independently evaluated each title and abstract. If each investigator considered the citation eligible, six authors progressed to full-text review. The outcomes related to communication were categorized into three groups: perception of the importance of communication in delivering high-quality patient care, confidence in communication skills, and assessed communication proficiency. The quality of studies included in this review was assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsThe total number of participants was 3337. Among the 20 articles reviewed, which were primarily published in the United States over the last decade, only one focused on community pharmacists. Quasi experimental designs were predominant, and studies often relied on learners' self-assessments with non-validated questionnaires. Simulation-based learning aimed to enhance communication skills and attitudes across interprofessional contexts (involving nursing and medical students), patients, and families, frequently utilizing simulated patients. Studies evaluating outcomes have emphasized communication skills with patients and families, while those involving healthcare professionals often focused on perception of the importance of communication in delivering high-quality patient care.ConclusionDespite study heterogeneity, this systematic review concluded that simulation-based training significantly enhances perception, confidence, and communication skills. The development of clear guidelines and standardized assessment tools to evaluate communication would significantly improve the validity and reliability of future research efforts (PROSPERO registration: n°CRD42022371915).

NAFLD to MAFLD: collaboration, not confusion - rethinking the naming of fatty liver disease

The recent shift from “non-alcoholic fatty liver disease” (NAFLD) and “metabolic associated fatty liver disease” (MAFLD) to “metabolic dysfunction-associated steatotic liver disease” (MASLD) has raised questions about its scientific basis and impact on patient understanding. This renaming may create confusion rather than clarity. A collaborative approach involving healthcare professionals, researchers, and patients to establish terminology that balances scientific accuracy with accessibility is needed. Effective disease naming should be accurate, unique, consistent, objective, and accessible - qualities essential for clear communication in healthcare. Disease name is more than scientific correctness because naming conventions for public use, especially anything related to health, must be a matter of convenience, ethics, and cultural and social acceptance. Education and straightforward communication should take precedence over renaming, helping patients and healthcare providers fully understand the complexities and implications of liver disease for treatment. After all, from a scientific and public health perspective, MAFLD has clear advantages over MASLD.

Human Papillomavirus Vaccination in Saudi Arabia: A Narrative Review of Current Evidence

ABSTRACT Human papillomavirus (HPV) represents the most common sexually transmitted infection globally, exerting a substantial impact on sexual and reproductive health, with a high oncogenic potential leading to various malignancies. The prevalence of HPV in Saudi Arabia ranges from 9% to 43%, with types 16, 18, and 45 being the most common high-risk strains. Despite the availability of effective vaccines such as Gardasil 9, Gardasil, and Cervarix, proper awareness and vaccination rates remain low in Saudi Arabia. Only 4% of the population has received the HPV vaccine. The Saudi Ministry of Health has integrated HPV vaccines into the national immunization schedule, offering them free of charge and ensuring their availability for adolescent girls and women. However, challenges persist, including cultural and religious beliefs, inadequate healthcare infrastructure, and insufficient public awareness. To effectively increase HPV vaccination coverage, it is crucial to implement comprehensive public education campaigns, actively involve healthcare professionals, and address cultural and religious concerns with sensitivity and respect. International collaboration, such as initiatives by the Gavi alliance and sustained research efforts, is critical to optimizing HPV vaccine efficacy, accessibility, and uptake. Through coordinated efforts, the global burden of HPV-related diseases can be significantly reduced, ultimately leading to improved public health outcomes.

Healthy ageing in long-term care? Lessons learned from the COVID-19 pandemic: a position paper.

This position paper focuses on healthy ageing for the frailest and institutionalized older adults in the context of the recent pandemic. The paper aims to identify and discuss hindering and promoting factors for healthy ageing in this context, taking both health safety and a meaningful social life into account, in a pandemic situation and beyond. The recent COVID-19 pandemic has highlighted the vulnerability of frail older adults residing in long-term care institutions. This is a segment of the older population that does not seem to align well with the recent policy trend of healthy and active ageing. The need for healthy ageing in this population has been voiced by professionals and interest organizations alike, alluding to inadequate support systems during the pandemic, conditioned by both previous and newly emerging contextual factors. Supporting healthy ageing in older adults in nursing homes and other residential care settings calls for attending to meaningful social life as well as to disease control. Findings and early conclusions leading up to the position paper were presented with peer discussions involving healthcare professionals and researchers at two joint EFPC PRIMORE workshops 2021 and 2022, as well as other international research seminars on long-term care. The following aspects of long-term care and COVID-19 were systematically discussed in those events, with reference to relevant research literature: 1. Long-term care policies, 2. pre-COVID state of long-term care facilities and vulnerability to the pandemic, 3. factors influencing the extent of spread of infection in long-term care facilities, and 4. the challenge of balancing between strict measures for infection control and maintaining a meaningful social life for residents and their significant others. A policy shift towards ageing at home and supporting the healthiest of older adults seems to have had unwarranted effects both for frail older adults, their significant others, and professional care staff attending to their needs. Resulting insufficient investment in primary health care staff and in the built environment for frail older adults in nursing homes were detrimental both for the older adults living in nursing homes, their significant others, and staff. More investment in staff and in physical surroundings might improve the quality of care and the social life of older adults in nursing homes in a non-pandemic situation and be a resource for primary health care staff ensuring both protection from health hazards and a meaningful social life for frail older adults in a pandemic or epidemic situation. As for investing in the physical surroundings, smaller nursing homes are advantageous, with singular resident rooms and for developing out-and indoor spaces for socializing and for meeting with families and other visitors. Regarding investment in staff, there is a documented need for educated staff in full-time positions. Use of part-time or temporary staff should be limited.

Optimizing Antibiotic Use: Addressing Resistance Through Effective Strategies and Health Policies.

Background: Antimicrobial resistance (AMR) has emerged as a significant challenge to public health, posing a considerable threat to effective disease management on a global scale. The increasing incidence of infections caused by resistant bacteria has led to heightened morbidity and mortality rates, particularly among vulnerable populations. Main text: This review analyzes current strategies and health policies adopted in the European Union (EU) and Italy to manage AMR, presenting an in-depth examination of approaches for containment and mitigation. Factors such as excessive prescriptions, self-medication, and the misuse of antibiotics in livestock contribute to the selection and spread of resistant strains. Furthermore, this review provides a detailed overview of resistance mechanisms, including enzymatic inactivation, reduced permeability, efflux pump activity, and target site protection, with specific examples provided. The review underscores the urgent need to develop new antibiotics and implement diagnostic testing to ensure targeted prescriptions and effectively combat resistant infections. Current estimates indicate that AMR-related infections cause over 60,000 deaths annually in Europe and the United States, with projections suggesting a potential rise to 10 million deaths per year by 2050 if current trends are not reversed. The review also examines existing public health policies in Europe and Italy, focusing on national and regional strategies to combat AMR. These include promoting responsible antibiotic use, improving surveillance systems, and encouraging research and development of new therapeutic options. Conclusions: Finally, the review presents short- and long-term perspectives from the authors, suggesting actionable steps for policymakers and healthcare providers. Ultimately, a coordinated and multidisciplinary approach involving healthcare professionals, policymakers, and the public is essential to mitigate the impact of AMR and ensure the effectiveness of antibiotics for future generations.

Evaluating the Effectiveness of Trauma Care and Emergency Preparedness Training Programs on Prehospital Primary Survey Skills: A Systematic Review.

This systematic review evaluates the impact of trauma care and emergency preparedness training programs on prehospital primary survey effectiveness. A comprehensive search strategy was employed across multiple databases, including PubMed, Cochrane Library, Embase, and the Cumulated Index to Nursing and Allied Health Literature (CINAHL), focusing on studies involving healthcare professionals such as paramedics, nurses, and emergency medical technicians (EMTs). The review included randomized controlled trials (RCTs), clinical trials, and cohort studies that assessed various training modalities like virtual reality (VR) simulations, case-based learning (CBL), and hands-on workshops. Quality assessment was performed using the Cochrane risk-of-bias (RoB) tool for randomized trials and the Newcastle-Ottawa Scale (NOS) for clinical trials, ensuring methodological rigor and consistency. The findings suggest that CBL significantly improves knowledge retention and prehospital primary survey skills, outperforming other methods such as simulation exercises, which showed mixed results. VR training increased confidence levels but did not demonstrate significant improvements in objective skills compared to traditional methods. The use of supplementary triage assistance teams (physician-nurse supplementary triage team (MDRNSTAT)) was found to be effective during high patient volume hours, though not cost-effective as a daytime strategy. While the review highlights the importance of interactive and scenario-based training programs, limitations such as variability in study designs, publication bias, and language bias were noted, suggesting that caution should be exercised in generalizing the results. Future research should focus on long-term effectiveness, the integration of emerging technologies, and larger, well-designed trials across diverse healthcare settings to strengthen the evidence base.

Navigating shared decision-making after the Life-Sustaining Treatment Decision Act: a qualitative study of in-depth interviews with terminal cancer patients, families, and healthcare professionals

PurposeEnd-of-life decision-making, particularly relating to withholding life-sustaining treatment (LST), is a complex and emotionally charged process involving healthcare professionals, patients, and caregivers.MethodsThis qualitative study explored the decision-making process in South Korea, where cultural norms and ethical considerations influence the dynamics of shared decision-making (SDM). In-depth interviews were conducted with healthcare professionals, patients, and caregivers using a grounded theory approach to elucidate the themes and processes underlying SDM for LST. This study used the “6C” framework, which could reflect the intricacies of the SDM process.ResultsThe results suggest that healthcare professionals face emotional challenges and an ethical dilemma in disclosing prognoses and discussing LST withholding, often deferring such discussions until the condition of patients worsens. Cultural factors, such as collectivist values and societal taboos surrounding death, influence decision-making dynamics, highlighting the need for tailored interventions and cultural competence in healthcare settings.ConclusionThe proposed “6C” framework provides insights into addressing current challenges in SDM and emphasizes the importance of cultural norms and ethical obligations in end-of-life decision-making. Further research is warranted to examine the SDM process in diverse cultural contexts and develop interventions to enhance patient and family involvement in the decision-making process for LST.

Precision oncology implementation in a regional-based health care system: A professional consensus to define the pathway

Precision Oncology requires deep changes in organizational settings but little evidence has been identified about the best strategy to guarantee the delivery of this innovation to patients. In the Italian health care system, high heterogeneity could jeopardize equal access opportunity for patients. Following a consensus method, we aim to define shared solutions to address these issues in clinical practice. A Delphi RAND method was chosen to record the consensus among involved health care professionals in the Italian region of Friuli Venezia Giulia. The item generation phase was conducted following a bottom-up approach. Ten statements were defined on the main topics that emerged from the direct observation of the current practice, focusing on Molecular Tumor Board organization, massive parallel sequencing technology application, laboratory report content and informed consensus submission. All the statements reached a strong consensus and have been shared with the health care government authorities of our region. The direct observation of the current practice in different health care authorities allowed to define ten statements as solution proposals to solve the identified complexities. This methodological approach could be applied in different organizational models but aiming to achieve a homogeneous clinical outcome for patients.

Smartphone Apps for Pulmonary Hypertension: Systematic Search and Content Evaluation.

Pulmonary hypertension (PH) is a chronic and complex condition, requiring consistent management and education. The widespread use of smartphones has opened possibilities for mobile health apps to support both patients and health care professionals in monitoring and managing PH more effectively. This study aimed to identify and assess the quality of free smartphone apps for PH targeted at either patients or health care professionals. A systematic search was conducted on freely available apps for patients with PH and health care professionals, accessed from a Spanish IP address, on Android (Google Play) and iOS (App Store) platforms. Searches were performed in October 2022 and 2023. Apps were independently analyzed by two reviewers, focusing on general characteristics. Quality assessment was based on the Mobile Application Rating Scale (MARS) framework, and Mann-Whitney U tests compared mean MARS scores against specific variables. In the overall study, 21 apps were identified. In the 2022 search, 19 apps were listed (9 iOS, 7 Android, 3 available on both platforms). In the subsequent 2023 search, 16 apps were identified (6 Android, 7 iOS, 3 available on both platforms). Of those identified in 2022, 14 remained available in 2023, with only 7 updated since 2022. In addition, 12 apps targeted patients or the general population, while 9 targeted health care professionals; none involved patients in the development or design. Conversely, 13 apps involving health care professionals were identified. There were 10 apps that received pharmaceutical industry funding. The primary goal for 81% (17/21) of the apps was to disseminate general information about PH. The overall mean MARS quality was acceptable in 2022 and 2023, with mean ratings of 3.1 (SD 0.6) and 3.3 (SD 0.5), respectively. The functionality category achieved the highest scores in both years, indicating ease of use and intuitive navigation. In contrast, the subjective quality domain consistently received the lowest ratings in the MARS assessment across both years. None of the apps underwent clinical testing themselves; however, 2 incorporated tools or algorithms derived from trials. The overall quality of iOS apps statistically outperformed that of Android apps in both years (P<.05). Furthermore, the involvement of health care professionals in app development was associated with enhanced quality, a trend observed in both years (P=.003 for both years). This review of mobile health apps for PH reveals their emergent development stage, with generally acceptable quality but lacking refinement. It highlights the critical role of health care professionals in app development, as they contribute significantly to quality and reliability. Despite this, a notable stagnation in app quality and functionality improvement over 2 years points to a need for continuous innovation and clinical validation for effective clinical integration. This research advocates for future app developers to actively engage with health care professionals, integrate patient insights, and mandate rigorous clinical validation for PH management.