Healthcare最新文献

{"title":"BAN Score and Distinct Early Cardiometabolic Risk Signatures in a Non-Diabetic Population: A Cross-Sectional Analysis.","authors":"Yazeed Alshuweishi, Noha A Alshuwayer, Lama Izziddeen, Arwa Abudawood, Dalal Alfayez, Ahmed M Basudan","doi":"10.3390/healthcare13182384","DOIUrl":"10.3390/healthcare13182384","url":null,"abstract":"<p><p><b>Background:</b> The BMI-albumin-neutrophil-to-lymphocyte (BAN) score integrates adiposity, nutritional status, and systemic inflammation, but its role in detecting early cardiometabolic changes remains unclear. This study examined associations of the BAN score with vascular, glycemic, and lipid markers in non-diabetic adults. <b>Methods:</b> This retrospective cross-sectional study included 162 non-diabetic subjects. Associations between the BAN score and vascular, glycemic, and lipid parameters were examined using Spearman's correlation, ROC analysis, and regression models adjusted for age, sex, smoking status, and medication use. <b>Results:</b> Patients had a median age of 37 years, 72.8% were female, with median BMI 33 kg/m², albumin 4.4 g/dL, and NLR 1.3. Higher BAN scores correlated with systolic blood pressure (SBP) (r = 0.23, <i>p</i> < 0.01), pulse pressure (PP) (r = 0.26, <i>p</i> < 0.001), and HbA1c (r = 0.22, <i>p</i> < 0.01). Compared with the lowest tertile, higher BAN tertiles showed significantly elevated SBP, PP, and HbA1c (<i>p</i> < 0.01). In adjusted models, each one-unit increase in BAN score was associated with higher SBP (β = 1.01, <i>p</i> = 0.037), PP (β = 0.66, <i>p</i> = 0.006), and HbA1c (β = 1.85, <i>p</i> = 0.008). No associations were found with the atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), or Castelli risk index II (CRI-II). ROC analysis showed moderate discriminative ability for hypertension (AUC = 0.66) and HbA1c (AUC = 0.65). <b>Conclusions:</b> The BAN score is associated with a distinctive early cardiometabolic risk, particularly elevated SBP, widened PP, and early glycemic alterations. Further research should define the BAN score's mechanisms and preventive utility.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Characteristics and Risk Factors for Severe Exacerbation in Never-Smokers with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study.","authors":"Josep Montserrat-Capdevila, Pilar Vaqué Castilla, Yoseba Cánovas Zaldúa, Francesc Alòs, Joan Deniel-Rosanas, Pere Simonet, Pau Olivares-Sanzo, Jennyfer Jiménez Díaz, Sandra Moreno Garcia, Araceli Fuentes, Eugeni Paredes, Pere Godoy","doi":"10.3390/healthcare13182374","DOIUrl":"10.3390/healthcare13182374","url":null,"abstract":"<p><p><b>Background:</b> Chronic obstructive pulmonary disease (COPD) in nonsmokers is increasingly recognized, yet its clinical profile and outcomes remain less well defined compared to smoking-related COPD. The aim of this study was to compare the clinical characteristics, comorbidities, and risk factors associated with severe exacerbations in nonsmoking COPD patients versus smokers. <b>Methods:</b> We conducted a prospective cohort study including 2376 patients with a diagnosis of COPD from the Lleida Health Region (Catalonia, Spain). Patients were followed for 2 years (2021-2022). Severe exacerbation was defined as hospital admission due to worsening COPD symptoms. Clinical variables were collected at baseline, and logistic regression analysis was performed to identify risk factors for severe exacerbation in the COPD-NS subgroup. <b>Results:</b> A total of 2376 COPD patients were included, of whom 966 (40.7%) were never-smokers. During the two-year follow-up, 165 patients (6.9%) required hospitalization for a severe exacerbation, nearly half of whom were never-smokers (48.5%). In multivariate analysis restricted to COPD never-smokers, the following independent predictors of hospitalization were identified: atrial fibrillation (OR: 2.35; 95% CI: 1.37-3.93), bronchiectasis (OR: 1.91; 95% CI: 1.08-3.28), and lower lung function measured by FVC (OR: 0.64; 95% CI: 0.45-0.89) and FEV1/FVC ratio (OR: 0.64; 95% CI: 0.45-0.89). Female gender was associated with a lower risk (OR: 0.44; 95% CI: 0.21-0.88). The predictive model demonstrated moderate discrimination (AUC = 0.71). <b>Conclusions:</b> COPD-NS patients represent a large proportion of the COPD population and present distinct clinical features. Although the incidence of severe exacerbation is similar to that of smokers/ex-smokers, risk factors such as atrial fibrillation and bronchiectasis have a stronger impact in this subgroup. Early identification of these factors may help guide more targeted clinical management strategies.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Virtual Reality on Pain and Anxiety During Epidural Steroid Injection in Patients with Lumbar Radicular Pain: An Open-Label Randomized Trial.","authors":"Marine Javelot, Clément Chopin, Loïs Bolko, Ambre Hittinger, Marion Geoffroy, Isabelle Charlot, Fanny Adeline, Claire Coutureau, Alice Duvivier, Jean-Hugues Salmon","doi":"10.3390/healthcare13182376","DOIUrl":"10.3390/healthcare13182376","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Virtual reality (VR) has been shown to reduce pain and anxiety in several specialties, but has not been investigated in the setting of steroid injections in rheumatology. We aimed to assess the impact of using a VR headset on pain and anxiety during epidural steroid injection via the sacral hiatus for lumbar radiculopathy. <b>Methods</b>: Patients received two injections via the sacral hiatus and were randomized into one of two groups: group 1 used the VR headset during the first injection and not during the second injection, while group 2 used the VR headset during the second injection but not the first. The primary endpoint was pain evaluated on a numeric rating scale. Secondary objectives were anxiety, measured using the STAI (State Trait Anxiety Inventory), and safety. These analyses were performed using the Mann-Whitney U test. <b>Results</b>: We included 116 patients over 18 years of age who were hospitalized in the Rheumatology department of the University Hospital of Reims and scheduled to receive at least two epidural steroid injections. We observed a significantly lower pain score during the first injection procedure (median 3 (IQ 1; 6) in group 1 vs. 5 (IQ 3; 7) in group 2, <i>p</i> = 0.045). The analysis for the second injection could not be performed by intention-to-treat due to the presence of a sequence effect. There was also a significant reduction in anxiety (<i>p</i> = 0.004 and <i>p</i> = 0.002 by per-protocol analysis). <b>Conclusions</b>: VR can significantly reduce pain and anxiety during epidural steroid injection via the sacral hiatus.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Breastfeeding Practices Pre- and During the COVID-19 Pandemic: A Retrospective Cohort Study.","authors":"Maryam Sharfi, Nasreen Hejres, Asma Ali, Noor Aldoseri, Badreya Malalla, Maria Tolentino, Wafa Hamad Almegewly, Khulud Ahmad Rezq","doi":"10.3390/healthcare13182379","DOIUrl":"10.3390/healthcare13182379","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Exclusive breastfeeding (EBF) during hospitalization is essential for infant health but remains suboptimal in many Gulf Cooperation Council (GCC) countries. Maternal factors and the COVID-19 pandemic may have influenced breastfeeding practices. Understanding these determinants is crucial for improving postnatal care. This study aimed to identify determinants of breastfeeding practices during hospitalization before and during the COVID-19 pandemic in Bahrain. <b>Methods:</b> This retrospective cohort study reviewed electronic records of 321 mothers and their newborns discharged between March 2019 and March 2021 from a larger pool of 4500 cases. A structured data collection form was used to capture maternal age, parity, nationality, mode of delivery, COVID-19 period of delivery (pre-pandemic vs. pandemic), breastfeeding method, and reasons for mixed feeding. Descriptive and inferential statistical analyses were conducted to identify associations between variables. <b>Results:</b> Multiparous mothers had significantly higher exclusive breastfeeding rates than primiparous mothers (<i>p</i> = 0.016). The mode of delivery showed a strong association with breastfeeding outcomes, with vaginal births linked to higher EBF rates (<i>p</i> < 0.01). A notable decline in EBF was observed during the COVID-19 pandemic period, from 40% pre-pandemic to 14% during the pandemic. <b>Conclusions:</b> Exclusive breastfeeding during hospitalization is significantly influenced by delivery method and maternal parity. Although the COVID-19 pandemic may have contributed to reduced EBF rates, further research is required to validate these trends. These findings emphasize the importance of supportive hospital policies, particularly for first-time and cesarean mothers, and stress the need to strengthen breastfeeding practices during public health emergencies.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Medical Doctors' Confidence in Artificial Intelligence: The Role of Specialty, Experience, and Perceived Job Security.","authors":"Fahad Abdulaziz Alrashed, Tauseef Ahmad, Ahmad Othman Alsabih, Shimaa Mahmoud, Muneera M Almurdi, Hamza Mohammad Abdulghani","doi":"10.3390/healthcare13182377","DOIUrl":"10.3390/healthcare13182377","url":null,"abstract":"<p><p><b>Background:</b> Artificial intelligence (AI) is increasingly integrated into healthcare, offering transformative potential across diagnostics, treatment, and clinical decision-making. As its adoption grows, understanding how medical doctors perceive and respond to AI, particularly in relation to their specialty, experience, and job security, is critical for effective implementation and acceptance. This study investigates the confidence of medical doctors in AI technologies and their role in healthcare, focusing on the impact of specialty, experience, and perceived job security. <b>Method:</b> A cross-sectional survey was conducted among 187 medical doctors across various specialties in Riyadh, Saudi Arabia, with a final sample of 176 participants. The survey assessed awareness, confidence, and concerns regarding AI integration into clinical practice. The survey was conducted across multiple healthcare hospitals in Riyadh, Saudi Arabia. Hospitals from both public and private sectors were included to ensure a diverse sample of healthcare professionals from different organizational structures. <b>Results:</b> A statistically significant association was found between specialty and confidence level (χ² = 14.5, <i>p</i> = 0.001). Among specialists, the majority (80%) reported high confidence in AI use compared to 45% of general practitioners and 38% of surgeons. Conversely, moderate confidence was most common among surgeons (46%), followed by general practitioners (35%) and specialists (13%). Additionally, participants with 11-20 years of experience reported the highest confidence, whereas those aged 55+ years showed the lowest perceived impact of AI on patient outcomes. Multivariate regression analysis identified specialty as the strongest predictor of AI confidence, with specialists being four times more likely to express high confidence in AI use (β = 0.89, <i>p</i> = 0.001) compared to general practitioners. Job displacement concerns negatively influenced confidence in AI, while age and years of experience had less impactful effects. <b>Conclusions:</b> The study concludes that addressing barriers to AI adoption will be crucial for enhancing its integration into healthcare and improving patient care. These findings underscore the importance of specialty-specific training and highlight the need for targeted educational programs, particularly for lower confidence groups such as general practitioners and surgeons. Lower confidence levels in these groups may result in a hesitant or incorrect use of AI tools, potentially compromising patient safety. Therefore, equipping all healthcare professionals with the necessary knowledge and confidence is essential for the safe and effective use of AI in clinical practice.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine-Assisted Work-Related Injuries Among Seafarers on Italian-Flagged Ships: A 13-Year Retrospective Study.","authors":"Getu Gamo Sagaro, Francesco Amenta","doi":"10.3390/healthcare13182375","DOIUrl":"10.3390/healthcare13182375","url":null,"abstract":"<p><p><b>Background</b>: Seafarers are highly susceptible to work-related injuries, which can result in serious consequences or permanent disabilities. Understanding the frequency and characteristics of occupational injuries is crucial for developing effective prevention strategies and identifying their underlying patterns and causes. This study aimed to determine the frequency and characteristics of telemedicine-assisted work-related injuries among seafarers on board Italian-flagged vessels. <b>Methods</b>: A retrospective descriptive study was conducted to analyze occupational injuries using medical data recorded in the Centro Internazionale Radio Medico (C.I.R.M.) database from 1 January 2010 to 31 December 2022. Injuries in the database were coded according to the 10th revision of the International Classification of Diseases (ICD-10) by the World Health Organization (WHO). Variables extracted from the database included injury type, seafarers' age, rank, nationality, worksite, gender, date of injury, affected body region, clinical outcomes, and other demographic and occupational characteristics. Injury frequency and characteristics (e.g., location, type, and cause) were analyzed and stratified by seafarers' rank and worksite groups. <b>Results</b>: The analysis included 793 seafarers who sustained injuries. Their average age was 39.15 ± 10.49 years (range: 21 to 70 years). Deck ratings and engine officers accounted for 27.9% and 20% of those who claimed injuries, respectively. 39.2% of injured seafarers were aged between 30 and 40 years. In terms of affected body parts, the most reported injuries were to the hand/wrist (33.3%), followed by the knee/lower legs (21%), and the head/eye (19%). Open wounds (38%) and burns/abrasions (14%) were the most common types of injury. Slips/falls (32%), burns/explosions (16.6%), and overexertion while lifting or carrying (14.8%) were the leading causes of injury during the study period. Nearly 35% of injuries affected workers on the deck and were due mainly to slips/falls, 19% in the engine room were due to being caught in machinery or equipment, and 32.5% in the catering department were due to burns/explosions. <b>Conclusions</b>: One-third of seafarers who suffered work-related injuries sustained hand and/or wrist injuries, with slips/falls being a significant cause. The results of this study emphasize the need for preventative measures in the marine sector, particularly to reduce risks associated with slips and falls, overexertion, and other injury-causing factors. Campaigns for the larger use of protective equipment are desirable to reduce occupational accidents at sea and provide better health protection for seafarers.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Sleep, Beliefs About Sleep, and Executive Functioning in a College Student Sample: The Moderating Role of Dysfunctional Beliefs.","authors":"Kate Schneider, Gillian Falletta, D Erik Everhart","doi":"10.3390/healthcare13182373","DOIUrl":"10.3390/healthcare13182373","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Sleep is integral to cognitive functioning, yet many college students experience poor sleep, often influenced by dysfunctional beliefs about sleep. Dysfunctional beliefs can exacerbate sleep issues and negatively impact executive functioning (EF). Distinct EF facets, including inhibition, working memory, and cognitive flexibility, may differ in their sensitivity to sleep disruptions. While research suggests links between sleep and EF, less is known about how sleep-related beliefs may moderate this relationship and how sleep can affect the various EF facets. Utilizing an undergraduate population, this study examined how sleep quality/quantity affects the different EF facets, how this relationship differs between subjective and objective measurements, and whether dysfunctional beliefs about sleep moderate the relationship. <b>Methods:</b> Undergraduate students (N = 212, ages 18-23) completed self-report measures assessing dysfunctional beliefs about sleep (DBAS-16), sleep quality (ISI), and sleep quantity (self-reported sleep duration). Objective EF was measured using computerized CNS Vital Signs tasks targeting inhibition (Stroop Test), working memory (4-Part Continuous Performance Test), and cognitive flexibility (Shifting Attention). Subjective EF was measured using individual subscales on the Behavioral Rating Inventory of Executive Functioning-Adult Version (BRIEF-A). <b>Results:</b> Moderation analyses were conducted via linear regression. When measured objectively, neither sleep quantity nor insomnia severity (sleep quality) significantly affected any EF facets, and dysfunctional beliefs about sleep did not have any significant moderation effect. When measured subjectively, insomnia severity (sleep quality), but not sleep quantity, significantly predicted inhibition and cognitive flexibility; in contrast, neither predictor significantly predicted working memory. Regarding specific predictors, dysfunctional sleep beliefs were found to exert significant effect over all three facets; this effect was diminished when insomnia severity was included in the model. Regarding moderation, dysfunctional beliefs about sleep moderated the relationship between sleep quantity and all three EF facets. <b>Conclusions:</b> The impact of sleep quality, sleep quantity, and dysfunctional beliefs about sleep varies depending on whether the facets of EF are measured subjectively or objectively. Dysfunctional beliefs about sleep may exacerbate the perceived effect of short sleep duration on daytime cognitive functioning. In addition, insomnia severity may account for the effects of dysfunctional sleep beliefs on perceived inhibitory control and cognitive flexibility; however, working memory may be more resistant to the effects of sleep disturbances and dysfunctional sleep beliefs. Clinical implications of these results and future directions are discussed.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12470137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selenoprotein S and the Causal Risk of Hypertension in Pregnancy: A Mendelian Randomization Study.","authors":"Mengqi Cai, Wenrui Lv, Yan He, Weili Liu, Yuzhen Gao","doi":"10.3390/healthcare13182383","DOIUrl":"10.3390/healthcare13182383","url":null,"abstract":"<p><p><b>Background:</b> Pregnancy-induced hypertension (PIH) affects approximately 10% of pregnancies worldwide, representing a leading cause of maternal and perinatal morbidity and mortality. The relationship between plasma selenium levels and PIH remains controversial, with observational studies limited by confounding factors. Selenoprotein S (SELENOS) has emerged as a potential biomarker for PIH risk. As one of the carrier proteins for dietary selenium, SELENOS plays a crucial role in oxidative stress and inflammatory pathways. However, the causal relationship between the plasma levels of the SELENOS and PIH development remains unclear. This study employed Mendelian randomization (MR) to investigate the causal link between the plasma levels of the SELENOS and PIH risk, providing evidence for preventive strategies. <b>Methods:</b> We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from the INTERVAL study and FinnGen consortium. The analysis included individuals of European ancestry, utilizing the inverse-variance weighted (IVW) method as the primary approach. Comprehensive sensitivity analyses were performed to address potential pleiotropy and strengthen causal inference. <b>Results:</b> The analysis encompassed 3301 samples for the plasma levels of the SELENOS and 7686 PIH cases, 1109 pre-existing hypertension (PEH) cases, 4255 gestational hypertension (GH) cases, and 83 preeclampsia (PE) cases superimposed on chronic hypertension, alongside approximately 115,000 controls. Genetic variabilities that have been found to be accompanied by elevated levels of plasma selenioprotein levels showed significant associations with increased risk of PIH [odds ratio (OR) 1.078, 95% confidence interval (CI) 1.031-1.126, <i>p</i> = 0.001], PEH (OR 1.232, 95% CI 1.105-1.373, <i>p</i> < 0.001), and GH (OR 1.111, 95% CI 1.047-1.180, <i>p</i> = 0.001), with suggestive associations for preeclampsia superimposed on chronic hypertension (OR 1.590, 95% CI 1.078-2.344, <i>p</i> = 0.019). <b>Conclusions:</b> This study provides robust genetic evidence for a causal relationship between the plasma levels of the SELENOS and PIH risk, establishing SELENOS as a potential modifiable risk factor with significant clinical implications. These findings support the development of personalized selenium management strategies during pregnancy and highlight the potential for early screening and targeted interventions to improve maternal and fetal outcomes.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on A1c Management and Telehealth Use Among a Type 2 Diabetes Mellitus Population in the Outpatient Setting.","authors":"Megan Jodray, Annesha White, Kimberly G Fulda, Haley McKeefer, Fan Zhang, Chinemerem Opara, Yan Xiao","doi":"10.3390/healthcare13182372","DOIUrl":"10.3390/healthcare13182372","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic disrupted routine healthcare delivery, raising concerns about chronic disease management, particularly for individuals with type 2 diabetes mellitus (T2DM). This study evaluated the pandemic's impact on glycemic control and telehealth utilization in an underserved outpatient population.</p><p><strong>Methods: </strong>A retrospective cohort analysis used de-identified electronic health record and claims data from a family medicine clinic in central Texas. The study included 387 adults with T2DM who had at least one A1c measurement in both the pre-pandemic period (1 March 2019-13 March 2020) and COVID-19 era (14 March 2020-31 March 2021). Outcomes included A1c control (<8.0%), prescription trends, and telehealth use. A case series examined individual-level patterns.</p><p><strong>Results: </strong>A significantly higher percentage of patients achieved A1c control during the COVID-19 era (75.2%) compared to the pre-pandemic period (68.7%, <i>p</i> < 0.05), despite a decline in prescriptions for diabetes medications and supplies. Telehealth visits increased substantially. Patients who maintained or improved glycemic control often had uninterrupted access to medications and telehealth.</p><p><strong>Conclusion: </strong>This study is novel in its focus on a safety-net outpatient clinic serving a predominantly low-income, diverse population in central Texas, an underserved group often underrepresented in diabetes research. By combining a retrospective cohort analysis with a descriptive case series, the study offers both population-level trends and individual-level insights into how medication access and telehealth engagement influenced glycemic control during the pandemic. These findings highlight the potential of telehealth to support diabetes management during healthcare disruptions and underscore the importance of maintaining medication access in vulnerable populations.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Palliative Care in Patients with Glioblastoma: Co-Design of an Integrated Care Pathway.","authors":"Esmée K J van der Poort, Monique C M Baas-Thijssen, Marleen Oomes, Maaike J Vos, Robin M Pieterman, Martin J B Taphoorn, Inge de Vries, Carla Juffermans, Eline F de Vries, Yvette M van der Linden, Johan A F Koekkoek","doi":"10.3390/healthcare13182378","DOIUrl":"10.3390/healthcare13182378","url":null,"abstract":"<p><p><b>Background:</b> Glioblastoma is an incurable form of brain cancer with a median overall survival of 1.5 years. Despite its progressive nature and high symptom burden, palliative care is not consistently integrated in routine glioblastoma care. Early integration of palliative care better addresses the needs of patients and caregivers, improves quality of life, and reduces inappropriate care in the end-of-life phase. This study aims to design an integrated care pathway to support the early integration of palliative care for patients with glioblastoma. <b>Methods:</b> We used a design thinking approach, engaging stakeholders from neuro-oncology, specialist palliative care, primary care, district nursing, healthcare administration, health insurance, health economics, and patient advocacy. The process consisted of thirteen informal interviews (with healthcare professionals, patients, and caregivers), six expert meetings, and two workshops. <b>Results:</b> First, we mapped existing routine glioblastoma care and identified perceived barriers to early palliative care integration, including variations in advance care planning (ACP) timing, clinicians' hesitation, unclear referral criteria to specialist palliative care, suboptimal care coordination, and limited experience with glioblastoma in the primary care setting. Second, iterative prototyping led to the development of a care pathway with key components: initiation of ACP by the lead clinician within six weeks of diagnosis, integrated multidisciplinary team meetings for complex cases, ongoing coordination, clear referral triggers for specialist palliative care, and structured caregiver care. <b>Conclusions:</b> The co-designed pathway provides a feasible model for integrating early palliative care into routine care for patients with glioblastoma. Future steps include implementation and evaluation of the care pathway and development of a payment model.</p>","PeriodicalId":12977,"journal":{"name":"Healthcare","volume":"13 18","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12469345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145174503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}