Pediatric Health Care Research Articles

“Racism Happens Every Day, All the Time”: Black Families’ Outpatient Experiences of Racism Across a Large Pediatric System

ObjectiveTo qualitatively understand and characterize the experience of racism in outpatient pediatric healthcare settings from the perspectives of Black families. MethodsWe conducted focus groups with parents or guardians of Black children, recruited from academic primary care offices at a single pediatric institution. Focus groups were facilitated virtually by Black team members using an open-ended, semi-structured focus group guide. We analyzed focus group transcripts using iterative, thematic, inductive open coding performed independently by trained coders, with final codes reached by group consensus. ResultsWe conducted 6 focus groups of 3 to 5 participants each and 1 individual interview, with 24 total parents. We identified the following themes: 1) “I just felt like we was a number”: Black families perceived experiences that felt impersonal and lacked empathy; 2) “Why is the doctor treating me like I don’t matter?”: Black families perceived experiences with poor care and worse treatment; 3) Black families experience racism across socioecological levels when interacting with pediatric health systems; 4) Positive perceived experiences can guide improvement; and 5) Improvement will require antiracist efforts across the levels of racism. ConclusionsIn this qualitative study, we found that Black families have had many poor pediatric experiences, perceive racism as affecting child health broadly across socioecological levels, and recommend a multidimensional antiracist approach to improvement. Our findings underscore the importance of elevating Black family voices in developing policies that prioritize antiracism and work to eliminate the harmful impacts of racism on child health.

Enhancement of Immersive Technology Use in Pediatric Health Care With Accessible, Context-Specific Training: Descriptive Feasibility Study

Background Immersive technology provides adjuncts for pediatric care. However, accessibility and inadequate training limit implementation of this technology. Standardized instruction with no-cost software licensing may improve health care professionals’ facility with immersive technologies. Objective This descriptive feasibility study aimed to examine the applications of immersive technologies in pediatric health care, including virtual reality (VR) and projectors. Methods We developed immersive technology instructional guides for pediatric health care. The training guides were created for multiple software content and hardware types across several clinical scenarios. Content was available in print and digital versions. The primary outcome was technology use across sites with no-cost software agreements. The secondary outcome was the specific application types used at a single site, stratified by sessions and minutes. Data were analyzed using descriptive statistics. Results Data were collected from 19 licensed sites from January through June 2022. Among the 19 sites, 32% (n=6) used 10 or more VR units. Among the 6 sites that had projectors, half used 5 or more units. The mean minutes of use per month of all sites combined was 2199 (IQR 51-1058). Three sites had more than 10,000 minutes of total use during the 6-month review period. Secondary results indicated that active VR (977 total sessions) and passive projector streaming (1261 total sessions) were the most popular application types by session, while active projector (66,849 total minutes) and passive projector streaming (32,711 total minutes) were the most popular types when stratified by minutes of use. The active VR application with the most minutes of use was an application often used in physical therapy. Conclusions Context-specific technological instruction coupled to no-cost licenses may increase access to immersive technology in pediatric health care settings.

Effect of COVID-19 on paediatric TB service delivery and patients’ comfort receiving TB services in Cameroon and Kenya during COVID: a qualitative assessment

BackgroundThe outbreak of COVID-19 has caused a setback to the gains achieved in tuberculosis (TB) control by impairing TB diagnosis, delaying treatment initiation and aggravating TB deaths. This study explored...

Awareness and Application of United States Food Allergy Prevention Guidelines Among Pediatricians and Other Clinicians

ObjectiveTo characterize the awareness of, adherence to, and barriers to the 2017 National Institute of Allergy and Infectious Diseases (NIAID) peanut allergy prevention guidelines among the pediatrics health care workforce Study designPediatricians, family physicians, advanced practice providers (APPs), and dermatologists who provide care for infants were solicited for a population-based online survey, administered from June 6, 2022, through July 3, 2022. The survey collected information about NIAID guideline awareness, implementation, and barriers as well as concerns related to the guidelines. ResultsA total of 250 pediatricians, 250 family physicians, 504 advanced practice practitioners (APPs), and 253 dermatologists met inclusion criteria. Self-reported guideline awareness was significantly higher for pediatricians (76%) compared with dermatologists (58%), family physicians (52%), and APPs (45%) (P < .05). Among participants who were aware of the guidelines, most reported using part or all of the guidelines in their clinical practices. Reported practice patterns for peanut introduction in 6-month-old infants were variable and did not always align with guidelines, particularly for infants with mild-to-moderate atopic dermatitis. ConclusionsAlthough pediatricians have the highest self-reported level of NIAID guideline awareness, awareness was suboptimal irrespective of provider type. Education for all pediatric clinicians is urgently needed to promote evidence-based peanut allergy prevention practices.

Risk of Pediatric Bipolar Disorder After General Anesthesia in Infants and Toddlers: A Propensity Score-Matched Population-Based Cohort Study.

The potential role of anesthesia as an independent risk factor for childhood bipolar disorder (BD) remains unclear. To address this, we conducted a population-based cohort study employing propensity score matching to compare BD incidence between pediatric patients undergoing surgery with and without general anesthesia. Our study included patients aged 0-3 years who received at least 1 episode of general anesthesia and were hospitalized for over 1 day in Taiwan between January 2004 and December 2014. They were matched 1:1 with a population not receiving general anesthesia to assess pediatric BD incidence. The study cohort comprised 15 070 patients, equally distributed between the general anesthesia and nongeneral anesthesia groups (7535 each). Multivariate Cox regression analysis revealed adjusted hazard ratios (aHRs; 95% CIs) for pediatric BD in the general anesthesia group as 1.26 (1.04-1.54; P = .021) compared to the nongeneral anesthesia group. Moreover, the incidence rate ratio (95% CI) for the general anesthesia group was 1.26 (1.03-1.53) compared to the nongeneral anesthesia group. Early childhood exposure to general anesthesia is significantly associated with an increased risk of pediatric BD. This expands understanding of pediatric BD's complex development, informing preventive strategies, and enhancing mental health outcomes for vulnerable young patients and global pediatric healthcare.

Burnout Profiles Among French Pediatric Health Care Professionals: A Cluster Analysis.

The aim of our study was to identify burnout profiles among pediatric nurses and physicians, and their specificities concerning sociodemographic characteristics, occupational stress, stress specific to pediatric caregivers, and coping. Conducted on a sample of 195 French pediatric health care professionals, a cluster analysis showed 2 endpoint profiles (Engagement, Burnout) and 3 intermediate profiles (Overextended, Disengaged, Ineffective). The Burnout profile showed the highest median scores on hours worked per week, occupational stress, stress related to working conditions, and relationships with colleagues and superiors. The Overextended profile reported more stress related to working conditions than did other intermediate profiles. The Disengaged profile showed the second lowest median score on stress related to relationships with colleagues and superiors and less social support-seeking than other profiles. The Ineffective profile used less problem-focused coping than the Engagement and intermediate profiles. Intervention for the well-being of these professionals should focus primarily on improving their working conditions.

Decision-making regarding accessing paediatric unscheduled healthcare during the COVID-19 pandemic: a mixed methods rapid review and thematic synthesis

ObjectiveReductions in paediatric unscheduled healthcare utilisation were seen during the COVID-19 pandemic, with concerns around their impact on children’s health. The reasons for these changes are not well described. This...

Reading for life-long health.

There is a strong, positive relationship between childhood literacy and physical and mental health outcomes in adulthood. Through primary care-based literacy interventions, pediatricians reach children and their families long before they enter traditional education venues. In so doing, pediatricians play a key role in children's school readiness and in turn health outcomes. The current state of childhood literacy in United States defines an increasingly urgent platform for the healthcare profession generally, and pediatricians specifically, to embrace. Through reviewing the existing literature on the impact of childhood literacy on physical, mental, and social-emotional health outcomes, we hope to highlight the need for increased collaboration between the education and medical fields to further promote the literacy interventions in pediatric healthcare settings.

Risk factors for severe and fatal childhood unintentional injury: a systematic review protocol

BackgroundUnintentional injuries are a leading cause of death among children aged 1–19 years worldwide. Systematic reviews assessing various risk factors for different childhood injuries have been published previously. However, most of the related literature does not distinguish minor from severe or fatal injuries. This study aims to describe and summarize the current knowledge on the determinants of severe and fatal childhood unintentional injuries and to discuss the differences between risk factors for all injuries (including minor injuries) and severe and fatal injuries. The study also aims to quantify the reduction in childhood injuries associated with a reduction in exposure to some of the identified risk factors in the Canadian population.MethodsA systematic review and meta-analysis will be conducted by searching MEDLINE, Embase, CINAHL, and Web of Science. Observational and experimental cohort studies assessing children and adolescents aged ≤ 19 years old and determinants of severe and fatal unintentional injury, such as personal behaviors, family and environmental characteristics, and socioeconomic and geographic context, will be eligible. The main outcome will be a composite of any severe or fatal unintentional injuries (including burns, drowning, transport-related injuries, and falls). Any severity measurement scale will be accepted as long as severe cases require at least one hospital admission. Two authors will independently screen for inclusion, extract data, and assess the quality of the data using the Cochrane ROBINS-E tool. Meta-analysis will be performed using random effects models. Subgroup analyses will examine age subgroups and high- vs low-income countries. Sensitivity analysis will be conducted after restricting analyses to studies with a low risk of bias. Attributable fractions will be computed to assess the burden of identified risk factors in the Canadian population.DiscussionGiven the numerous determinants of childhood injuries and the challenges that may be involved in identifying which individuals should be prioritized for injury prevention efforts, this evidence may help to inform the identification of high-risk children and prevention interventions, considering the disproportionate consequences of severe and fatal injuries. This evidence may also help pediatric healthcare providers prioritize counseling messaging.Systematic review registrationPROSPERO CRD42023493322.

Epidemiology of carbapenemase-producing Enterobacterales carriage in a paediatric tertiary health care centre of Ontario, Canada

Introduction: The epidemiology of carbapenemase-producing Enterobacterales (CPE) in hospitalized children in low endemicity settings is not well known. We aim to describe it in a large tertiary paediatric health care centre in Canada. Methods: A repeated point-prevalence study including all inpatients was conducted at the Hospital for Sick Children, Toronto, for surveillance purposes over 3 days serially in April 2017, April 2019, and April 2022. Patients in the emergency department and medical day units were excluded. Stools or rectal swabs were analyzed for CPE identification, with confirmatory testing at the provincial reference laboratory. Results: We detected CPE colonization in 0.4% (1/242), 0.7% (2/278), and 0.9% (2/220) of inpatients in 2017, 2019, and 2022, respectively. Identified CPE included OXA-48-like and NDM beta-lactamases in Escherichia coli and Klebsiella pneumoniae. All patients with CPE colonization had a history of travel or hospitalization outside of Canada, including in the Middle East and Asia. Discussion: CPE colonization in children hospitalized in this Canadian hospital was detected. A history of prolonged travel or hospitalization outside of Canada are risk factors that should be considered in targeted screening programs.

Unmet care needs in psychiatric healthcare context: A systematized literature review.

Missed, rationed or unfinished nursing care represents a global problem that jeopardizes the provision of quality and safe care. This phenomenon is frequently observed in adult, paediatric and child healthcare facilities and various care units. The findings of this review contribute valuable information to inform evidence-based practices, foster organizational improvements and ultimately optimize the overall quality of care in psychiatric healthcare settings. In addition, the review illuminates the far-reaching consequences of care on both patient and nurse outcomes, emphasizing the urgent need for tailored strategies to mitigate these effects. Based on the synthesis of the literature, a thorough and continuous assessment of patient care needs in the physical, psychological and social domains is needed, primarily utilizing standardized instruments designed for psychiatric settings to ensure a comprehensive understanding of unmet needs. Based on identified unmet needs, nurses should develop individualized care plans and tailor interventions to address them. In addition, nurse managers must adopt and implement regular monitoring mechanisms to track the prevalence of unmet care needs and at the same time establish reporting systems that capture the proportion of unmet needs, allowing timely interventions and adjustments to care delivery. Lastly, nurse managers must not only emphasize the importance of ethical care practices and dignity-focused interventions but also educate healthcare providers, especially nurses, on the potential threats to patient dignity arising from unmet care needs. INTRODUCTION: Despite frequent observations of unmet care needs in acute care adult settings, there are a limited number of studies that focus on investigating this phenomenon in the psychiatric setting. To synthesize the existing empirical research on unmet care needs in psychiatric healthcare settings. The search was carried out in August 2023 in four scientific databases, PubMed, ProQuest, Web of Science and OVID Nursing, based on their institutional availability. The search produced 1129 studies. The search and retrieval process reflected the recommendations of the Preferred Reporting Items for systematic reviews and meta-analyses. This review included 14 studies investigating unmet care needs in the psychiatric healthcare setting. Unmet care needs included three domains: physical, psychological and social. The analysis of the factors revealed factors related to the characteristics of the organization, nurse and patient. The classification of unmet needs provides a comprehensive understanding of the various challenges facing people in psychiatric healthcare settings. Identified factors that influence the occurrence of unmet care needs will help prevent the occurrence of unmet care needs and timely assessment. The resolution of needs helps to achieve patient and nurse outcomes, increase the quality of care provided and patient satisfaction in a psychiatric healthcare setting.

A Clinician's Guide To Effectively Transitioning and Transferring Care For Pediatric Patients With Inflammatory Bowel Diseases From The Pediatric To Adult Gastroenterologist.

Transition of care for pediatric patients with inflammatory bowel diseases (IBD) is a continuous, dynamic process that takes place over several years with a coordinated approach executed by a multidisciplinary team. We review the concepts, tools, and research in effective transitioning and transfer of care for adolescent/young adult patients with IBD. Given the constraints within the healthcare system, effective transitioning can be challenging to implement in everyday clinical practice. Different barriers include resources and expertise in effective transitioning by pediatric and adult gastroenterology healthcare providers and the impact of non-gastrointestinal issues facing young adult patients who are learning to manage and coordinate all aspects of their medical care and health maintenance. Factors that facilitate successful care transitioning and transfer include structured transitioning programs, utilization of validated transition checklists, and IBD medical summaries. Proactive transitioning by pediatric gastroenterologists in partnership with their emerging young adult patients with IBD leads to better clinical and psychosocial outcomes and ultimately, effective transfer of care to adult gastroenterology. By utilizing utilize comprehensive transition assessment tools and medical summaries in partnership with their patients, pediatric and adult gastroenterology teams can better prepare patients as they transfer to independent care and health maintenance.

Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity

BackgroundChildren with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC).MethodsThis mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.ResultsOverall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.ConclusionsFindings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers’ insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Moral Distress of Nurses Working in Paediatric Healthcare Settings.

This scoping review aims to map the evidence on moral distress of nurses working in paediatric healthcare settings from homecare to hospital. It was conducted according to the Joanna Briggs Institute. International databases were searched according to the specific thesaurus and free search terms. Independent screening and analysis were conducted using Rayyan QCRI. This review considered a total of 54 studies, including quantitative and qualitative studies, systematic reviews, and grey literature; English and Portuguese languages were included. Moral distress is a phenomenon discussed in nursing literature and in the paediatric context but is considered absent from discussion in clinical practice. It is caused by disproportionate care associated with overtreatment. Nurses can present a variety of symptoms, characterising moral distress as a highly subjective experience. The paediatric contexts of practice should promote a healthy ethical climate and work towards a moral community built with peer support, education, communication, leadership, and management involvement. Moral distress is still a complex and challenging multidimensional concept, and the aim should be to promote a culture of prevention of the devastating consequences of moral distress and work towards moral resilience.

The imperative of the child life profession in KSA in transforming the quality of pediatric healthcare

Saudi Arabia has made substantial advancements in its pediatric healthcare infrastructure. However, substantial gaps persist in addressing hospitalized children's emotional safety, and psychosocial and developmental needs. Internationally, the child life profession has evolved over decades to specifically address these needs, through interventions such as therapeutic play, age-appropriate patient education, and family support.This article evaluates the imperative for integrating the child life profession into healthcare services in Saudi Arabia to transform the quality of pediatric healthcare. An analysis of the current landscape revealed gaps in pediatric psychosocial care. These gaps are listed as national priorities in the health transformation program aimed at improving healthcare quality and enhancing well-being. Integrating the child life profession can help achieve these objectives for children and families in Saudi Arabia.This article highlights the multifaceted benefits of the child life profession in improving patient experiences, healthcare delivery efficiency, pediatric healthcare quality, and the overall well-being of children and families. Strategies for phased implementation, involving healthcare institutions, academic partners, relevant non-profit partners, and policymakers, are proposed.

Transition between paediatric and adult diabetes healthcare services: An online global survey of healthcare professionals’ experiences and perceptions

IntroductionYouth with diabetes should transition from paediatric to adult diabetes services in a deliberate, organized and cooperative way. We sought to identify healthcare professionals’ (HCPs) experiences and perceptions around transition readiness planning, policies and procedures, and the actual transfer to adult services. MethodsData were collected via an online global survey (seven language options), broadly advertised by the International Society for Pediatric and Adolescent Diabetes (ISPAD), European Association for the Study of Diabetes (EASD), team members and partners, via newsletters, websites, e-mails and social media. ResultsRespondents (n = 372) were mainly physicians (74.5 %), practicing in government funded (59.4 %), paediatric (54.0 %), metropolitan settings (85.8 %) in Europe (44.9 %); 37.1 % in low and middle-income countries (LMICs). Few centers used a transition readiness checklist (32.8 %), provided written transition information (29.6 %), or had a dedicated staff member (23.7 %). Similarly, few involved a psychologist (25.8 %), had combined (35.2 %) or transition/young person-only clinics (34.9 %), or a structured transition education program (22.6 %); 49.8 % advised youth to use technology to assist the transfer.Most (91.9 %) respondents reported barriers in offering a good transition experience. Proportionally, more respondents from LMICs prioritised more funding (p = 0.01), a structured protocol (p < 0.001) and education (p < 0.001). ConclusionHCPs’ experiences and perceptions related to transition vary widely. There is a pressing need for an international consensus transition guideline.

Investigation of Nursing Errors in Greek Pediatric Hospitals

Background: Adverse events are a prevalent occurrence across pediatric healthcare environments, and patient safety is intricately tied to nursing errors due to nurses’ consistent presence and interaction with patients, which surpasses that of any other healthcare professional. This research sought to explore the factors influencing errors as perceived by pediatric nurses in Greek hospital settings. Methods: Clinical pediatric nurses voluntarily and anonymously completed a specialized structured survey, utilizing the Taxonomy of Error, Root Cause Analysis, and Practice-responsibility (TERCAP) tool, which delineates the circumstances surrounding errors occurring during clinical practice. Results: Among the participants employed in the pediatric department, 80.8% (n = 84) reported experiencing an error at their workplace. Notably, in 48.7% (n = 38) of these instances, the error was attributed to themselves (personal responsibility), while in 78.9% (n = 56) of cases, it was linked to errors committed by other colleagues in the clinic. As reported by participants in pediatric departments, the primary factors contributing to potential error occurrence include the absence or inadequacy of orientation and training for new staff (43.2%), the absence of a standardized protocol for resolving disagreements (39%), insufficient ongoing training (38.3%), and breakdowns in interdisciplinary communication (21%). Conclusions: By classifying errors based on various criteria such as outcomes, processes, cognitive reasoning, ethical considerations, and importance, this study presents a holistic framework for examining pediatric nurses’ errors from diverse perspectives. Through this classification approach, the study establishes a foundation for tailored interventions targeting particular aspects of errors and their root causes in pediatric departments.

Exploring the Link Between Oral Health Factors and Hearing Impairments in Children: A Cross-Sectional Study.

Background Hearing-impaired children may face challenges in communication, social interaction, academic performance, and emotional well-being, which can have a notable impact on their overall quality of life. Beyond these challenges, oral health can also be significantly impacted. The relationship between hearing impairment and dental diseases is an intriguing and interconnected aspect of overall well-being that merits attention and exploration. This study aimed to assess the relationship between various oral health factors and hearing impairments. Methodology This cross-sectional study involved 90 hearing-impaired children aged 6-12 years. To evaluate the children's hearing abilities, diagnostic tools such as pure-tone audiometry were employed. To measure dental health, the decayed, missing, and filled teeth (DMFT) and decayed, missing, and filled primary teeth (dmft) indices, as well as plaque index (PI) and gingival index (GI) were calculated. The chi‑square test was used to identify significant differences between genders. Spearman's test was used to determine the correlation between variables. Results The severity of hearing impairment varied, with 5.6% having severe hearing loss, 8.9% having profound hearing loss, and 85.6% having complete hearing loss. The mean DMFT score was 2.5 ± 1.86, with no significant difference observed between males and females. The mean dmft score was 4.2 ± 3.12, with no significant difference between genders. However, there was a difference in the PI scores between males and females. Males presented a higher PI score of 2.6 ± 0.09 compared to 1.8 ± 0.08 for females. The overall mean PI was 2.1 ± 0.80. The mean GI was 1.5 ± 0.90, and no significant difference was observed between males and females. Spearman's test identified a significant positive correlation between the severity of hearing impairment and both PI scores (p = 0.000) and GI scores (p = 0.000). Conversely, the severity of hearing impairment showed a weak positive correlation with both DMFT scores (p = 0.487) and dmft scores (p = 0.229), but these correlations were not statistically significant. Conclusions The connection between oral health and severe hearing impairment in children is significant and has potential implications. Pediatric healthcare providers, including dentists and audiologists, need to work collaboratively to monitor the oral and aural health of young patients.

Scope-of-Practice Expansions Associated with Reduced Racial Disparities in Pediatric Mental Health Care.

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016-2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access.

Small patients, big challenges: navigating the complex world of pediatric reference intervals

Abstract With about 60%-70% of medical decisions based on laboratory investigations, modern medicine is increasingly more reliant on laboratory medicine. Pediatric healthcare particularly depends on laboratory testing, with reference intervals (RIs) serving as critical tools for accurate result interpretation. However, establishing pediatric RIs poses distinctive challenges due to developmental, growth, nutritional, and disease-related variations across age groups, along with technical, ethical, and logistical challenges. Despite these limitations, there are several ongoing initiatives for developing pediatric RIs globally, underscoring the importance of developing accurate pediatric RIs. This review outlines the particularities of pediatric laboratory medicine and the specific challenges in establishing pediatric RIs, highlighting the recent initiatives in this area. It also addresses biological and analytical variability issues and explores future perspectives aimed at enhancing diagnostic accuracy and elevating patient care standards.