Patient Welfare Research Articles

Associations Between Social Determinants of Health and Outcomes of Chronic Medical Conditions.

Social determinants of health, such as food insecurity, can significantly impact patient welfare, potentially increasing the prevalence of chronic illnesses while hindering their management, as shown in previous data collected by the National Health and Nutrition Examination Survey. This study aimed to investigate the association between food insecurity and other social determinants of health with hyperlipidemia, type 2 diabetes mellitus (T2DM), and hypertension. To that end, self-reported data on food security from clinical encounters and biological data from medical records were collected. This study utilized electronic medical record data from 349 patients aged between 18 and 85 years who answered two standard food insecurity screening questions. Each patient's current diagnoses and lab values, including blood pressure, fasting low-densitylipoprotein (LDL) cholesterol, and hemoglobin A1c (HbA1c), were then collected. Among patients facing food insecurity (n = 48), 55% were diagnosed with hypertension (p = 0.019), 45% with hyperlipidemia, and 27% with T2DM (p = 0.005). By comparison, these values for food-secure patients were 39%, 54%, and 13%, respectively (n = 301, p > 0.05). Regarding control of these chronic illnesses, hypertension (defined as blood pressure >135/85 mmHg per American Academy of Family Physicians (AAFP) guidelines) was observed in 12% of food-secure patients (n = 301, p > 0.05) and 42% of food-insecure patients (n = 48, p = 0.0204), whereas differences in control of hyperlipidemia and T2DM were insignificant. These results suggest that food-insecure patients are more likely to be diagnosed with hypertension and T2DM but are less likely than food-secure patients to be diagnosed with hyperlipidemia. Consistent with previous research, this study highlights the potentially increased health risks for patients experiencing food insecurity and calls for further efforts to screen patients for social determinants of health.

Equity Investment in Physician Practices: What's All This Brouhaha?

There have been two waves of equity-based investment in physician practices. Both used a combination of public and private sources but in different mixes. The first investment wave, in the 1990s, was led by public equity and physician practice management companies, with less involvement by private equity (PE). The second investment wave followed the Affordable Care Act and was led by PE firms. It has generated concerns of wasteful spending, less cost-effective care, and initiatives harmful to patient welfare. This article compares the two waves and asks if they are parallel in important ways. It describes the similarities in the players, driving forces, acquisition dynamics, spurs to consolidation, types of equity involved, models to organize physicians, and levels of market penetration achieved. The article then tackles three unresolved issues: Does PE investment differ from other investment vehicles in concerning ways? Does PE possess capabilities that other investment vehicles lack and confer competitive advantage? Does physician practice investment offer opportunities for supernormal profits? It then discusses ongoing trends that may disrupt PE and curtail its practice investment. It concludes that past may be prologue, that is, what happened during the 1990s may well repeat, suggesting the PE threat is overblown.

CONCEPTUAL, LEGAL, AND ETHICAL CONSIDERATIONS IN PHYSICIAN-ASSISTED SUICIDE: AN OVERVIEW

Physician-assisted suicide (PAS) remains a contentious and highly debated topic within medical, legal, and ethical spheres. The complex issue of (PAS) raises significant inquiries regarding patient autonomy and societal norms. Ambiguities in conceptual, legal, and ethical aspects impede policy formulation, leading to unequal access and apprehensions about patient welfare and confidence. This article provides a thorough examination of assisted suicide, exploring its legal, ethical, and medical dimensions. It aims to facilitate informed dialogue and stimulate further investigation into the legal framework and ethical considerations surrounding this contentious issue. Through a library-based research approach and qualitative analysis of existing literature, this study delves into the diverse facets of assisted suicide. The article begins with a definition and contextualisation of assisted suicide, distinguishing it from related end-of-life practices. It then delves into the legal landscape, discussing different legal frameworks and regulations across various jurisdictions, and significant legal cases that have shaped the current discourse. From an ethical standpoint, this article explores the ethical considerations involved in assisted suicide, including autonomy, dignity, and the sanctity of life, and presents the perspectives of different stakeholders. The medical perspective examines the role of healthcare professionals, the criteria for assisted suicide, and empirical research on its effectiveness and safety. Realworld case studies are presented to illustrate the complexities of assisted suicide. Furthermore, this article analyses public opinion and ongoing debates on the topic. Ultimately, this analysis aims to provide readers with a comprehensive understanding of assisted suicide, fostering informed discussions and encouraging further exploration of this contentious issue.

Navigating the Future: A Review on Challenges and Innovations in Healthcare Network Technologies

Healthcare is a vital part of a healthcare system, which is governed by a set of responsibilities and responsibilities. This paper explores the evolution of healthcare systems through the use of the Internet of Things (IoT) and telemedicine. The paper aims to identify areas for improvement and explore strategies to leverage network technologies to enhance healthcare offerings and outcomes. The data analysis technique used was thematic analysis. Thematic analysis identified and categorized key themes related to challenges and innovations in the collected studies. Telemedicine, supported by cloud computing, offers significant potential for improving healthcare delivery but faces challenges related to high assurance, interoperability, and storage adaptability. The development and use of telecommunications technology in healthcare require careful policy considerations to address the significant challenges in healthcare delivery. The research also explores how technology influences the development of healthcare delivery systems known for its efficiency, accessibility, and improved patient welfare.

Disposition of health-care workers toward hospital patients during the COVID-19 pandemic in Nigeria

During the second wave of the COVID-19 pandemic, the World Health Organization declared health-care workers “the last line of defense against the COVID-19 pandemic.” Against this backdrop, this study investigated the state, responses, and attitudes of health-care workers toward hospital patients during the pandemic in Nigeria, alongside the attitudes of patients and the responsibilities of Nigerian social workers in ensuring adequate patient care. Employing a descriptive research design, the study sampled 17 respondents from Enugu State and utilized a qualitative research approach with an in-depth interview guide for data collection. The findings revealed that Nigerian healthcare workers exhibited a negative attitude toward hospital patients during the pandemic. Factors contributing to this negative attitude include fear of contracting the virus due to inadequate personal protective equipment, lack of incentives, insufficient hazard allowances, and inadequate hospital facilities. The death rate of patients with complications unrelated to COVID-19 was high because patients avoided hospital care even when critically ill due to fear of contracting the virus. Consequently, there was an increase in self-medication and reliance on alternative medicine among patients. Social workers played a significant role by advocating for improved hospital care and welfare for patients. They engaged in dialogue with hospital management to secure better attention and treatment for patients and advocated for adequate welfare provision for health-care workers. Social workers undertook educational initiatives to raise awareness among patients about the dangers of alternative medicine, self-medication, and the imperativeness of complying with the stipulated COVID-19 preventive protocol. In conclusion, this study recommends policy reforms aimed at enhancing budgetary allocations to the health-care sector and institutionalizing the social work profession in Nigeria through constitutional provisions.

Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship

Purpose We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship. Materials and Methods A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress. Results 357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress. Conclusion Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.

Improving Likert scale big data analysis in psychometric health economics: reliability of the new compositional data approach

Bipolar psychometric scales data are widely used in psychologic healthcare. Adequate psychological profiling benefits patients and saves time and costs. Grant funding depends on the quality of psychotherapeutic measures. Bipolar Likert scales yield compositional data because any order of magnitude of agreement towards an item assertion implies a complementary order of magnitude of disagreement. Using an isometric log-ratio (ilr) transformation the bivariate information can be transformed towards the real valued interval scale yielding unbiased statistical results increasing the statistical power of the Pearson correlation significance test if the Central Limit Theorem (CLT) of statistics is satisfied. In practice, however, the applicability of the CLT depends on the number of summands (i.e., the number of items) and the variance of the data generating process (DGP) of the ilr transformed data. Via simulation we provide evidence that the ilr approach also works satisfactory if the CLT is violated. That is, the ilr approach is robust towards extremely large or infinite variances of the underlying DGP increasing the statistical power of the correlation test. The study generalizes former results pointing out the universality and reliability of the ilr approach in psychometric big data analysis affecting psychometric health economics, patient welfare, grant funding, economic decision making and profits.

Estimation of potential social support requirement for tuberculosis patients in India.

Providing social support to tuberculosis (TB) patients is a recommended strategy as households having TB patients find themselves in a spiral of poverty because of high cost, huge income loss and several other economic consequences associated with TB treatment. However, there are few examples of social support globally. The Indian government introduced the 'Nikshay Poshan Yojana' scheme in 2018 to provide nutritional support for all registered TB patients. A financial incentive of 500 Indian Rupee (6 United States Dollars) per month was proposed to be transferred directly to the registered beneficiaries' validated bank accounts. We examined the reach, timing, amount of benefit receipt and the extent to which the benefit alleviated catastrophic costs (used as a proxy to measure the impact on permanent economic welfare as catastrophic cost is the level of cost that is likely to result in a permanent negative economic impact on households) by interviewing 1482 adult drug-susceptible TB patients from 16 districts of four states during 2019 to 2023, using the methods recommended by the World Health Organization for estimating household costs of TB nationally. We also estimated the potential amount of social support required to achieve a zero catastrophic cost target. At the end of treatment, 31-54% of study participants received the benefit. In all, 34-60% of TB patients experienced catastrophic costs using different estimation methods and the benefit helped 2% of study participants to remain below the catastrophic cost threshold. A uniform benefit amount of Indian Rupee 10 000 (127 United States Dollars) for 6 months of treatment could reduce the incidence of catastrophic costs by 43%. To improve the economic welfare of TB patients, levels of benefit need to be substantially increased, which will have considerable budgetary impact on the TB programme. Hence, a targeted rather than universal approach may be considered. To maximize impact, at least half of the revised amount should be given immediately after treatment registration.

A four-year assessment of the characteristics of Rwandan FDA drug recalls

BackgroundA drug recall is an act of removing products from the market and/or returning them to the manufacturer for disposal or correction when they violate safety laws. Action can be initiated by the manufacturing company or by the order of a regulatory body. This study aimed to assess the characteristics of Rwanda FDA drug recall and determine the association between classes of recall and recall characteristics.MethodologyThis was a retrospective descriptive cross-sectional study. Data about recalled drugs were collected from the official website of the Rwanda FDA in the section assigned to “Safety alerts”. The search included data reported between February 2019 and February 2023 covering four years. Data cleaning was conducted in Microsoft Excel to address missing data and inconsistencies, followed by importation into STATA/SE software version 17.0 for further cleaning and subsequent analysis. Descriptive statistics were computed for independent variables. Categorical variables were described in terms of counts and relative frequencies. Bivariate analyses used Pearson’s chi-square test to illustrate the associations between categorical independent variables and recall classes.ResultsThe study revealed that a large proportion (33.0%) of the recalled products belonged to Class I. Antibiotics constituted 35.8% of the recalled products, with contamination emerging as a leading cause and responsible for 26.4% of the recalls. India was the leading manufacturing country for the recalled products (29.2%), followed by France (17.9%), China (17.0%), Kenya (13.2%), and Russia (6.6%). An association was found between the class of recall and several recall characteristics, including the year of recall, drug category, safety issues, reporter, and manufacturing country.ConclusionThis study provides a comprehensive overview of the characteristics of drug recalls in Rwanda. The insights gained contribute to a nuanced understanding of recall dynamics and provide evidence-based strategies to enhance drug quality, safety, efficacy, regulatory compliance, and patient welfare.

Care of the Patient With an Artificial Airway.

Artificial airways are essential in various clinical settings to maintain a patient's airway and provide necessary support for ventilation and oxygenation. These devices are commonly temporary and come in several types, each serving specific purposes. Understanding the indications, types, and proper care of artificial airways is crucial for health care professionals to ensure patients receive optimal care and prevent complications. This article aims to review the indications for using artificial airways and discuss the most commonly used types, including supraglottic airway devices, endotracheal tubes, tracheostomy tubes, and laryngectomy tubes. It also provides insights into the procedures involved in intubation and percutaneous tracheostomy and offers guidance on patient management, emphasizing assessment, oral care, suctioning, and humidification for patients with these airway devices. This article underscores the significance of understanding artificial airways, not just as a set of skills but as a commitment to patient welfare. Health care professionals who master the knowledge and care of these devices can significantly contribute to their patients' well-being and quality of life.

Examination of Patient Safety and Experience in Ghanaian Healthcare Facilities

Objective: This paper analyzes Ghana’s healthcare quality challenges utilizing the Donabedian model covering structures, processes and outcomes to inform comprehensive systems improvement recommendations. Methods: A mixed methods approach compiles empirical findings from multiple clinical studies across Ghana assessing healthcare infrastructure, service delivery patterns, and resultant patient consequences. Qualitative case reports provide context while quantitative metrics spotlight nationwide deficiencies. An adapted Donabedian framework incorporated expanded quality domains for rigorous evaluation. Results: Significant infrastructure limitations, disjointed processes and alarming patient outcomes signify major quality gaps tied to wider health financing shortfalls. Specific issues include resource distribution inequities, medical supply unreliability, poor referral systems, limited staff accountability and infection control breaches—culminating in high preventable complications. Conclusions: Interdependencies exist between financing, tools, clinical workflows and patient experiences whereby strengthening isolated aspects risks continued quality issues without addressing root causes holistically. Sustainable reforms necessitate coordinated investments in infrastructure, oversight, coordination and worker training. Recommendations: A 10-step roadmap details structural upgrades, delivery protocols and monitoring mechanisms health authorities must institute in tandem to raise care standards for patient welfare and trust. Scientific Significance: This paper advances use of mixed, multi-level modeling to diagnose complex health sector challenges in resource-limited contexts. Practical Relevance: The blueprint formulated provides an evidence-based guide for policymakers to sequentially address identified healthcare deficiencies through coordinated quality assurance initiatives.

Examination of Patient Safety and Experience in Ghanaian Healthcare Facilities

Objective: This paper analyzes Ghana’s healthcare quality challenges utilizing the Donabedian model covering structures, processes and outcomes to inform comprehensive systems improvement recommendations. Methods: A mixed methods approach compiles empirical findings from multiple clinical studies across Ghana assessing healthcare infrastructure, service delivery patterns, and resultant patient consequences. Qualitative case reports provide context while quantitative metrics spotlight nationwide deficiencies. An adapted Donabedian framework incorporated expanded quality domains for rigorous evaluation. Results: Significant infrastructure limitations, disjointed processes and alarming patient outcomes signify major quality gaps tied to wider health financing shortfalls. Specific issues include resource distribution inequities, medical supply unreliability, poor referral systems, limited staff accountability and infection control breaches—culminating in high preventable complications. Conclusions: Interdependencies exist between financing, tools, clinical workflows and patient experiences whereby strengthening isolated aspects risks continued quality issues without addressing root causes holistically. Sustainable reforms necessitate coordinated investments in infrastructure, oversight, coordination and worker training. Recommendations: A 10-step roadmap details structural upgrades, delivery protocols and monitoring mechanisms health authorities must institute in tandem to raise care standards for patient welfare and trust. Scientific Significance: This paper advances use of mixed, multi-level modeling to diagnose complex health sector challenges in resource-limited contexts. Practical Relevance: The blueprint formulated provides an evidence-based guide for policymakers to sequentially address identified healthcare deficiencies through coordinated quality assurance initiatives.

의사의 미성년 환자에 대한 설명의무

Medical treatment is based on a contract between the doctor and the patient, and the doctor must obtain the patient's consent to the medical treatment. This is to protect the patient's right to self-determination, and as a prerequisite for consent, the doctor is obligated to explain the medical treatment. However, there is no explicit regulation and no case law has directly addressed the duty of explanation for minor patients, but the recent Target Judgment has for the first time suggested that doctors have a direct duty to explain to minor patients and the requirements for determining that the duty of explanation has been violated. As a prerequisite to discussing the validity of the target judgment, we examined the general theory of a physician's duty of explanation, the legal basis for a minor patient's capacity to consent, and the difference between a minor patient's capacity to consent to medical treatment and civil law capacity. We also confirmed that the term decision-making capacity, as used in the target judgment and the statute, has virtually the same meaning as consent. After concluding that the duty of explanation to a minor patient is generally fulfilled by indirect explanation, but only by direct explanation, the case law sets out two requirements for recognizing a breach of a doctor's duty of explanation to a minor patient. There are several problems with the logic of the target judgment, first of all, considering that the other party to the duty of explanation, the minor patient, has decision-making capacity, adopting the direct explanation method is consistent with the protection and welfare of the minor patient's right to self-determination; secondly, even according to the logic of the target judgment, the criteria for determining decision-making capacity is still ambiguous; and thirdly, the indirect explanation method may be preferable in some cases, such as when a minor patient refuses medical treatment, which is an example of a situation where the target judgment requires the direct explanation method. Considering the problems with the subject judgment, it is recommended that the direct explanation method, in which the physician directly explains the medical procedure to the minor patient, should be the principle for the physician's duty to explain the medical procedure to the minor patient, and that specific practice guidelines should be developed to allow indirect explanations to minimize the confusion that may arise in the medical field.

Evolution of the Surgical Net.

The surgical net technique, originally conceptualized to mitigate postoperative hematomas, has evolved into a versatile tool, transcending its initial purpose, and signaling a new era of surgical innovation. This article provides a comprehensive overview of the surgical net's journey from a targeted solution to a multifaceted surgical asset and explores its burgeoning applications, challenges, and future trajectories. Despite early reluctance due to anatomical concerns and unfamiliarity with the novel technique, the surgical net's consistent success in various surgical contexts from facial surgeries to gynecological applications has catalyzed its widespread global adoption. The technique's integration of the progressive tension method and enhanced skin redraping capabilities underscores its contribution to optimal aesthetic outcomes and improved surgical control. Noteworthy is its role in the innovative concept of gliding surgery, marked by procedures like the gliding brow lift and Glidelift, demonstrating the surgical net's adaptability and effectiveness in diverse surgical environments.Contributions from international surgeons have expanded its applications to areas like axillary space obliteration after breast implant, postmastectomy closure, and the management of postpartum hemorrhage, showcasing the surgical net's global impact and universal commitment to optimizing surgical outcomes. The article delves into the anatomical considerations essential for adapting the surgical net technique to various surgical contexts, emphasizing the need for continuous research, clinical trials, and multidisciplinary collaboration to navigate emerging challenges and ensure its sustained efficacy and safety.In conclusion, the article highlights the surgical net technique's unwavering potential for further advancements, greater procedural efficiency, and the continued elevation of patient care standards. The consistent evolution of its applications, paired with a dedicated approach to addressing emergent challenges, reinforces the surgical net's enduring contribution to surgical innovation and global patient welfare.

Learning and achieving basic mental health competence in placement studies with the support of a tool: A qualitative study of student nurses’ experiences

BackgroundLearning basic mental health care competence is often challenging for the bachelor of science student nurses, and many lack basic mental health care competence to ensure safe and confident mental health care practice. Mental health assessment is an integrated part of this competence. ObjectiveThe objective of this study was to explore and describe in depth how student nurses experience learning and achieving basic mental health competence while on mental health placement with the support of a learning tool. DesignAn explorative and descriptive qualitative design was conducted to gain insight on how student nurses experienced learning basic mental health competence when on placement. SettingA diversity of mental health placement settings in which student nurses were involved with patient care or welfare were approached; general psychiatric wards (n = 2), psychiatric ward for elderly people (n = 1), community mental health in-patient facilities (n = 2) and unconventional placements in the community (n = 9). Unconventional placements are a diversity of non-clinical service contexts. ParticipantsThe participants comprised student nurses in their 3rd and final year while on mental health placement. Potential participants received information from course coordinators, the online learning platform, and from teachers in plenary. Using purposive sampling, 14 student nurses were recruited. MethodsIndividual semi-structured interviews were conducted online and in person at two campuses of one university in Norway between August 2020 and December 2021. The interviews were transcribed and thematically analysed as described by Braun and Clarke. ResultsStudents expressed insecurity in a new clinical context. They engaged in new learning situations and realized the diversity of nursing practice. Unconventional placements were described as challenging contexts for learning basic mental health care competence. ConclusionsThis qualitative study provided insight into how student nurses experience learning mental health assessment, and gaining relational, communicative, and ethical competence while on placement. Students revealed their insecurities and challenges in learning in a new context. Awareness of clinical learning opportunities on placement when preparing student nurses to learn basic mental health competence may help improve their confidence.

With a little help from my (neighbouring) friends. ‘Border region patient mobility’ in the European Union: A policy analysis

Increased disparities in income and health care expenditure across EU countries may lead to an increase in patient mobility, which may, in turn, call for more action by the EU and its Member States. At present, patient mobility (or cross-border healthcare) is still a marginal phenomenon but is deemed to increase in the future. In this paper we examine border region patient mobility, defined as patients receiving care in a neighbouring country within a certain proximity. We examine, with the use of a spatial competition model, the options used to regulate such a patient flow and their welfare implications, both for patients and Governments. We show that marginal price costing would lead to an increase in patient welfare, whilst reducing the risk of increasing cost for the exporting country.At present there seems to be an East/West difference in the way these flows are regulated. In order to increase equity, we suggest that a ‘joint implementation’ of EU Directives by neighbouring Member States, especially in the field of cross-border healthcare, would allow Member States to define target populations (in terms of type of care and distance travelled) that could allow more freedom in terms of border care, without increasing health care expenditure. A future combination of the two existing legal frameworks in this field would also be more user- or patient-friendly.

Ethical Considerations in the Use of Artificial Intelligence and Machine Learning in Health Care: A Comprehensive Review.

Artificial intelligence (AI) and machine learning (ML) technologies are revolutionizing health care by offering unprecedented opportunities to enhance patient care, optimize clinical workflows, and advance medical research. However, the integration of AI and ML into healthcare systems raises significant ethical considerations that must be carefully addressed to ensure responsible and equitable deployment. This comprehensive review explored the multifaceted ethical considerations surrounding the use of AI and ML in health care, including privacy and data security, algorithmic bias, transparency, clinical validation, and professional responsibility. By critically examining these ethical dimensions, stakeholders can navigate the ethical complexities of AI and ML integration in health care, while safeguarding patient welfare and upholding ethical principles. By embracing ethical best practices and fostering collaboration across interdisciplinary teams, the healthcare community can harness the full potential of AI and ML technologies to usher in a new era of personalized data-driven health care that prioritizes patient well-being and equity.

Bridging technology and care: integrating web-based PROMs in mental health services for refugees: a study on clinician training and technology adoption.

This study explores the integration of a web-based electronic database technology containing patient-reported outcome measures (PROMs) with electronic health records for refugees with PTSD, emphasizing the systematic inclusion of patient perspectives in clinical decision-making. Our research addresses the notable gap in literature regarding training clinicians for the competent integration of health information technology in healthcare. The training program developed aimed at equipping clinicians, particularly inexperienced with technology, to effectively utilize an electronic PROM system for collecting systematic patient information. Our study is set in the context of the Mental Health Services (MHS) in Denmark, focusing on a specialized clinic for treating trauma-affected refugees. The multidisciplinary team involved in this project reflects a wide range of healthcare professionals. The training program employed a variety of activities over nearly 2 years, adapting to feedback and aiming to engage clinicians in continuous improvement processes. Analyzing qualitative data with thematic analysis we interpreted that the training's extended focus on discussion of the implementation process, with limited hands-on experience, potentially reinforced clinicians' hesitations toward new technology, rather than reducing them. Clinicians prioritized immediate concerns over potential long-term benefits. Despite this, their approach reflects a strong commitment to patient welfare and careful evaluation of new practices. Notably, there were also positive engagements with the technology, highlighting its potential in patient care. This study concludes that the successful integration of technology in clinical settings hinges on its alignment with clinicians' workflows, respect for their professional judgment, and clear benefits to patient care.

Message

Greetings! Warm congratulations to the Editorial Board of the Philippine Journal of Otolaryngology – Head and Neck Surgery (PJO-HNS), headed by Dr. Jose Florencio Lapeña, on the publication of this issue. The Philippine Society of Otolaryngology-Head and Neck Surgery (PSO-HNS) is proud to have such an eminent team curating and reviewing research articles from specialists from all over the world in order to provide the PSO-HNS Fellows and the wider medical community with information essential to the practice of ORL-HNS. The primary purpose of the PSO-HNS is to engage in the promotion of the welfare, training, and scientific advancement of ORL-HNS in the Philippines; in particular (among many other objectives): to develop programs to promote the exchange of scientific information among members, and to encourage, support and institute publication of scientific ORL-HNS literature for national and international consumption. Considering the journal that you are currently reading, I declare success in achieving these objectives. Our Society has been growing and evolving through the years, and the PJO-HNS is proof that PSO-HNS is now more than just a social organization. We are a force for good of ORL-HNS practice and optimum patient welfare. If we are to continue taking the best care of our patients, we must practice evidence-based medicine, and research will be the bedrock on which we build. I leave you with my life verse for this year. From Galatians 6:9 (NIV): “Let us not become weary in doing good, for at the proper time we will reap a harvest if we do not give up.” Let us continue doing good for each Fellow, for the PSO-HNS as a whole, and for the Filipino people who need our care. May you be inspired to do good, to do research, and to do good research as you read this issue. His Blessings!

Descriptive Study of the Clinical and Molecular Features of Epidermolysis Bullosa Patients in a Romanian European Reference Network-Skin Affiliated Reference Center.

During the last 10 years, in Romania, progress has been made for the welfare of patients suffering from epidermolysis bullosa (EB). In five university hospitals, affiliated with the National Program for the Treatment of Rare Diseases, highly trained specialists diagnose and treat patients with this rare condition. Regarding diagnosis, limitations still exist as immunofluorescence mapping and molecular genetic analysis are not accessible, and generally not reimbursed. Our objective is to present the experience in diagnosing EB patients at Colentina Clinical Hospital, highlighting genotype-phenotype correlations observed in our cohort of patients. The records of the patients enrolled between 2012 and 2024 were analyzed considering clinical aspects, and, when available, immunofluorescence mapping, transmission electron microscopy, and genetic molecular analysis. Fifty-six patients were identified, of whom 31 cases were of dystrophic EB, threewere of junctional EB, and 11 were of simplex EB. For 11 cases, the EB type could not be determined. Regarding EB simplex, two patients with KRT5 mutations and three patients with KRT14 mutations with various clinical expressions, from mild phenotype to severe forms, were identified. Three severe junctional EB patients were registered in our database and for one of the patients, two previously unreported mutations in the LAMA3 gene were identified. Regarding dystrophic EB, 31 cases were identified, of which 25 were recessive dystrophic casesand six were dominant dystrophic cases. Molecular genetic testing was performed for 15 patients, and the most common variant was c.425A>G, identified in six cases. Two previously unreported mutations were identified, namely,COL7A1 c.5416G>C, a heterozygous missense variant in a patient with a mild phenotype, mainly with nail involvement, and COL7A1 c.5960del, a variant that generates a frameshift in exon 72 resulting in a premature stop codon; this variant was identified in two siblings with a severe recessive dystrophic. Important steps have been made in identifying the correct and complete diagnosis, as well as the characterization of EB patients addressing our reference center. The findings underscore the pivotal role of molecular genetic testing in confirming diagnoses and elucidating inheritance patterns, especially in cases with atypical presentations or de novo mutations.