Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review

Unraveling the nutritional challenges in epilepsy: Risks, deficiencies, and management strategies: A systematic review

BACKGROUND

Malnutrition and epilepsy share a complex bidirectional relationship, with malnutrition serving as a potential risk factor for epilepsy development, while epilepsy, in turn, often exerts profound effects on nutritional status. Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.

AIM

To explore the multifaceted associations between malnutrition and epilepsy, structured into three primary sections: (1) Elucidating the impact of malnutrition as a risk factor for epilepsy onset; (2) Examining the reciprocal influence of epilepsy on nutritional status, and (3) Evaluating diverse nutritional interventions in the management of epilepsy.

METHODS

A systematic search was conducted across PubMed, Scopus, and Web of Science databases utilizing defined keywords related to malnutrition, epilepsy, and nutritional interventions. Inclusion criteria encompassed various study types, including clinical trials, animal models, cohort studies, case reports, meta-analyses, systematic reviews, guidelines, editorials, and review articles. Four hundred sixteen pertinent references were identified, with 198 review articles, 153 research studies, 21 case reports, 24 meta-analyses, 14 systematic reviews, 4 guidelines, and 2 editorials meeting the predefined criteria.

RESULTS

The review revealed the intricate interplay between malnutrition and epilepsy, highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies. Findings underscored the importance of nutritional interventions in managing epilepsy, showing their impact on seizure frequency, neuronal function, and overall brain health.

CONCLUSION

This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment. The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.

Garcia Adaptive Equilibrium Theory (GAET): A New Nursing Theory for Mental Health Nursing

Mental health nursing demands a dynamic, patient-centered approach that goes beyond crisis intervention and symptom management. Traditional models like the Roy Adaptation Model and Tidal Model emphasize adaptation and recovery but fall short in capturing the fluid, nonlinear nature of mental health. The Garcia Adaptive Equilibrium Theory (GAET) introduces a new framework viewing mental health as a continuous balancing process. In this model, nurses serve as Equilibrium Facilitators, identifying points of instability and intervening early to prevent crises.Central to GAET is the Equilibrium Spectrum, which conceptualizes mental health as a fluctuating continuum-from stability to severe distress. Unlike traditional psychiatric approaches focused on reactive treatment, GAET incorporates Equilibrium Forecasting, a proactive assessment strategy that integrates subjective tools (scales, narratives) and objective data (biomarkers, physiologic signs) to anticipate deterioration.By reframing mental health care around real-time stabilization, GAET promotes early intervention, sustained well-being, and a shift toward preventive, holistic care. This theory redefines psychiatric nursing as an active, interdisciplinary practice focused on maintaining equilibrium rather than responding to disruption-empowering nurses to lead in mental health stabilization and prevention.

Macroergonomic factors, coping style, and satisfaction analysis for nursing career pursuance: A perspective from the Philippines

Nurse turnover is a continuous problem in the Philippines, a social phenomenon evident in due to change in career and nurse migration. The purpose of this study was to comprehensively assess the willingness of Filipino nurses to pursue nursing careers using an extended and modified macroergonomic factor framework. This study collected 314 valid responses from nurses in the Philippines. An in-depth investigation was performed by analyzing factors under self-efficacy, function, opportunity, organizational behavior, coping style, occupational commitment, career satisfaction, and life satisfaction influencing the career pursuance of Filipino nurses beyond the scope of their initial entry into the profession. Using higher-order structural equation modeling analysis, results showed the direct influence of self-efficacy, function, opportunity, organizational behavior, coping style, reflective style, suppressive style, reactive style, while occupational commitment and career satisfaction directly influenced the pursuance of nursing career. The results of this study have provided actionable insights and strategies, thus mitigating the issues the Philippines faces regarding the reduced pursuance of a nursing career. The study highlighted the urgent need to deal with systematic challenges and establish favorable regulations to provide an intricate environment formed by a variety of institutional, social, and economic factors. Lastly, the framework used in this study could be implemented and extended in other service industries to assess pursuit willingness, enhancing the retention of local and domestic nurses in the country.

Transformational Nurse Leaders and Nurse Well-Being: Examining Mediating Influences of Organizational Justice and Quality of Work Life Mixed Methods Study

Background: Transformational leadership is recognized as a crucial factor influencing nurses' work experiences and well-being. However, the mechanisms through which transformational leadership affects nurse well-being, especially concerning organizational justice and quality of work life, are not fully understood. Aim: This study investigates the direct and indirect effects of transformational leadership on nurse well-being, focusing on the mediating roles of organizational justice and quality of work life. Methods: Using a sequential explanatory mixed methods design, quantitative data were collected from 580 nurses across five hospitals in Saudi Arabia with validated tools: the Global Transformational Leadership Scale, Organizational Justice Scale, Quality of Nursing Work-Life Scale, Emotional Exhaustion Subscale of the Maslach Burnout Inventory, Job Satisfaction Scale, and Perceived Stress Scale. Qualitative data were obtained from 25 focus group discussions using a validated semistructured discussion guide. Quantitative analyses included hierarchical multiple regression and mediation analyses, while qualitative data wereanalyzed thematically. Results: Transformational leadership significantly reduced emotional exhaustion (β = -0.48, p < 0.001), increased job satisfaction (β = 0.53, p < 0.001), and lowered perceived stress (β = -0.46, p < 0.001). Mediation analyses showed significant indirect effects through organizational justice and quality of work life (indirect effects: -0.34 to 0.38, p < 0.001). Qualitative findings highlighted the importance of inspirational motivation, individualized consideration, intellectual stimulation, and idealized influence. Conclusions: Transformational leadership directly and indirectly enhances nurses' well-being through improved organizational justice and quality of work life. These findings emphasize the need for healthcare organizations to foster transformational leadership and promote fair, supportive work environments to enhance nurse well-being.

Healthcare-associated bloodstream infections caused by bacterial and fungal contamination of intravenous fluids and medicines in healthcare facilities in low- and middle-income countries: a scoping review

INTRODUCTION

We reviewed culture-confirmed healthcare-associated outbreaks linked to bacterial and fungal contamination of intravenous fluids and medicines (further "infusates") in low-income countries and lower and upper middle-income countries (LIC, Lower-MIC and Upper-MIC). We assessed the scope, impact, risks, and gaps in knowledge.

METHODOLOGY

Literature search including PubMed, Web of Science, Worldwide Database for Nosocomial Outbreaks, Global Health, and Google Scholar. National essential medicine lists (NEMLs) of sub-Saharan countries were searched for listing of pediatric infusates.

RESULTS

Between 1975 and 2023, 50 articles were retrieved. Median (range) number of patients affected was 12 (3-185); 74.2% (761/1025) of all patients affected were children. All patients presented with bloodstream infections; median case fatality ratio was 21.1% (0.0-87.5%). Upper-MIC, Lower-MIC and LIC accounted for 21, 25 and 4 articles, respectively. Most frequently affected wards were neonatal and adult intensive care units (19 and 6 articles). The 50 articles revealed 59 contaminated infusates: IV fluids (n = 37), including TPN (n = 10, of which 8 were from Upper-MIC), and IV medicines (n = 22), comprising amongst others propofol (n = 4) and Water for Injection (n = 3). The 63 isolates included Enterobacterales (46.0% (29/63) of isolates), non-fermentative Gram-negative bacteria (NFGNB, 47.6% (30/63)), fungi (4.8%, 3/63)) and Bacillus circulans (1.6% (1/63)). Among the Enterobacterales, the genera Serratia, Klebsiella, and Enterobacter represented 82.8% (24/29) of isolates. Burkholderia cepacia was the most frequent NFGNB (53.3% (16/30) isolates). Excluding TPN, 18 IV fluids and 7 IV medicines (representing half (51.0%, (25/49) of these infusates) were incorrectly used as multidose vial. A third (33.9%, 20/59) of infusates in 40.0% (20/50) of articles was intrinsically contaminated. In LIC and LMIC, staff in neonatology units turned to in-ward preparation of infusates because of lack of access to pediatric IV formulations and sizes. Less than a third (31.8%, 18/44) of the NEMLs listed neonatal IV premixtures.

CONCLUSION

Infusate contamination is a serious, underreported risk especially for children in LICs and Lower-MIC. Outstanding issues are access to pediatric infusates and preventing in-ward preparation of IV medicines in LIC and Lower-MIC, and safe preparation and administration of TPN in Upper-MIC.

A web-based platform for optimizing healthcare resource allocation and workload management using agile methodology and WISN theory

BACKGROUND

Effective healthcare workforce management is critical for ensuring quality care delivery, particularly in resource-constrained settings. The World Health Organization's (WHO) Workload Indicators of Staffing Need (WISN) methodology provides an evidence-based framework for optimizing staffing levels. However, manual implementation of the WISN methodology is labour-intensive, error-prone, and time-consuming. To address these challenges, the Platform for Resource Allocation and Optimization for Healthcare Facilities (PRAYOJN) platform was developed as a web-based tool to automate WISN calculations, streamline data analysis, and improve workforce planning.

OBJECTIVE

To develop and validate a web-based system that automates the WISN methodology for healthcare workforce planning.

METHODS

The PRAYOJN platform was developed using an agile methodology, structured over five iterative sprints. These sprints incorporated stakeholder feedback to refine system functionalities, ensuring adaptability to real-world healthcare needs. The platform integrates data for principal, supporting, and ancillary tasks to calculate staffing requirements. Key functionalities include automated computation of Available Work Time (AWT), Standard Workload (SW), Category Allowance Factor (CAF), and Individual Allowance Factor (IAF). Alpha testing validated usability and accuracy, while beta testing in a clinical phlebotomy department assessed real-world performance.

RESULTS

The platform calculated an ideal staffing requirement of 15.53 Full-Time Equivalent (FTE) for the phlebotomy department, aligning closely with the current staff strength of 15 FTE. Agile development ensured iterative improvements, enhancing user interface (UI) and user experience (UX). Feedback highlighted the platform's user-friendly design, with dynamic visualizations such as pie charts and bar graphs aiding workload interpretation. Users praised its efficiency, adaptability, and role in reducing calculation complexity.

CONCLUSION

PRAYOJN modernizes and enhances WISN-based workforce planning by automating workload calculations, improving data visualization, and supporting real-time decision-making. Its scalability and intuitive interface position it as a valuable tool for optimizing staffing efficiency across diverse healthcare environments.

Enhancing Occupational Health and Safety Through Strategic Leadership: The Mediating Role of Total Quality Management in Hodeida Hospitals, Yemen

Background

Occupational Health and Safety (OHS) is a critical concern in healthcare settings, particularly in resource-constrained environments where safety challenges often compromise staff well-being and patient care. Effective leadership and quality management are increasingly recognized as essential for addressing these challenges.

Objective

This study investigates the impact of Strategic Leadership (SL) on the Occupational Health and Safety System (OHS) in hospitals, with Total Quality Management (TQM) serving as a mediating factor. Utilizing a cross-sectional survey design.

Methodology

Data were collected from 323 healthcare professionals across six hospitals in Hodeida, Yemen, covering both medical and administrative roles. Partial Least-Squares Structural Equation Modeling (PLS-SEM) was employed to analyze the data, examining both direct and indirect relationships among the study variables.

Results

The findings reveal that SL positively influences OHS directly and indirectly through TQM. Specifically, leadership practices that emphasize strategic direction, ethical conduct, and organizational control contribute to fostering a safer work environment. TQM enhances this effect by strengthening operational efficiencies and standardizing safety protocols. These results underscore the critical role of integrated leadership and quality management in advancing OHS practices in resource-constrained healthcare settings.

Conclusion

The study offers practical implications for hospital administrators seeking to improve safety and performance through a combined focus on leadership and quality management. Future research should explore these dynamics in different sectors and geographical contexts to validate and extend these findings.

Enhancing Trauma Care in Tertiary Hospitals: Addressing Gaps and Pathways to Improvement

Background: Trauma is a major cause of morbidity and mortality globally, with road traffic accidents projected to be the leading cause of death by 2030. In developing countries like Pakistan, trauma patients face significant challenges in receiving timely and effective care. This study aimed to evaluate trauma centers in tertiary care hospitals in the twin cities of Pakistan to highlight gaps and pitfalls in trauma patient management. Methods: A descriptive cross-sectional study was conducted using the World Health Organization's Hospital Emergency Unit Assessment Tool (HEAT) at five major public sector hospitals in Islamabad and Rawalpindi. Data collection involved collaboration between the Violence, Injury Prevention and Disability Unit and key informants, including Emergency Room in-charges and Heads of Departments. Information on trauma protocols and guidelines was gathered. Results: All hospitals provided 24/7 emergency services with access to operating rooms and laboratories. However, significant disparities were found in equipment availability, particularly portable X-rays (40% availability) and RDT/HIV testing (20% availability). Protocol adherence varied, with 80% of hospitals having clinical management protocols but only 20% having specific protocols for conditions like asthma exacerbation and maternal hemorrhage. This study identifies infrastructural deficiencies and highlights systemic barriers that contribute to inadequate trauma care delivery, underscoring the need for targeted reforms. Conclusion: The study highlights significant gaps in trauma care management in Pakistani tertiary care hospitals, including shortages of personnel, infrastructure deficiencies, and lack of standardized protocols. These findings underscore the urgent need for systemic improvements in trauma care delivery. Recommendations include increased investment in medical infrastructure, addressing staffing and training deficiencies, and standardizing clinical management protocols to enhance trauma care outcomes and reduce morbidity and mortality rates in Pakistan. This research contributes novel insights into the specific barriers faced by trauma care systems in Pakistan, which have not been previously addressed in existing literature.

Mentorship for Non-academic, Mid-Career Hospitalist Physicians: The Journey Taken Less Often

Mentorship plays a crucial role in the professional development of hospitalists by offering guidance, support, and opportunities for career advancement. Multiple studies have reported that mentorship significantly contributes to improving job performance and cultivating happiness in medicine. Further, mentorship also leads to increased confidence in decision-making, and enhanced work-life balance. Additionally, mentees have reported greater engagement, reduced burnout, and commitment to their organizations. Most of these studies were performed on academic hospitalists and very little has been written about the foundation of non-academic organizations: mid-career hospitalists. Academic organizations have invested in mentorship programs, but little focus is given to mentorship of hospitalists, specifically mid-career hospitalists, outside of these settings. The lack of mentorship contributes to lack of professional development, burnout, low job satisfaction, worse patient outcomes, and increased turnover. By fostering a culture of mentorship, healthcare institutions can better retain talent, improve patient care, and ensure sustained career satisfaction among hospitalists. This article delves into the importance of mentorship, its empowering benefits, and strategies tailored to the specific needs of mid-career hospitalists working in non-academic institutions. Further, we advocate for integrating robust mentorship as a strategic initiative to bolster the professional trajectory of this vital group within the healthcare system.

Exploring health literacy development through co-design: understanding the expectations for health literacy mediators

Health promotion efforts that enhance health literacy among individuals, organizations, and communities are gaining attention globally. Additionally, co-designed and community-led health promotion interventions have gained recognition as an effective strategy for addressing health issues through more effective and sustainable health outcomes. This qualitative study conducted in Tasmania, Australia, aimed to co-design the emerging Health Literacy Mediator (HLM) and to assess the support, expectations, and need for such a role. Following an Ophelia approach, data for this research were collected via focus group discussions within an online workshop, enabling diverse perspectives to emerge and be analysed via thematic analysis. Discussions around how the role could impact the individuals and families presented in the short case scenarios (vignettes) produced four strong expectations: that they are solution-focused, that they have a duty to facilitate change, that the role is based in community, and that the role targets those in the community who need them most to ensure the greatest impact. Participants also shared other recommendations and supporting ideas for the role. The potential role of HLM holds substantial promise in addressing health inequities for all individuals, regardless of background or socioeconomic status, by optimizing time management, simplifying navigation, ensuring the right care, and building community trust. By creating connections and advocating for individuals, HLMs could effectively break down barriers to healthcare access. This proactive approach not only addresses immediate health concerns but could also lay the groundwork for sustained improvements in public health outcomes in the future.

Exploring the Relationship Between Ejection Fraction, Arterial Stiffness, NT-proBNP, and Hospitalization Risk in Heart Failure Patients

Background/Objectives: Heart failure (HF) remains a leading cause of hospitalization and morbidity. Arterial stiffness, measured by pulse wave velocity (PWV) and the augmentation index (AIx), has been linked to HF severity and prognosis. This study investigates the relationship between clinical parameters, biochemical indicators, and arterial stiffness in hospitalized patients with HF, aiming to identify predictors of hospitalization and improve patient management. Methods: This cross-sectional study included 98 patients admitted with HF: 53 with acutely decompensated HF (sudden worsening of symptoms) and 45 with chronic HF (stable symptoms of HF). Clinical and biochemical parameters, including ejection fraction (EF), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, and arterial stiffness indicators (PWV and AIx), were measured at admission. During follow-up, 59 patients required re-hospitalization due to acutely decompensated HF, while 39 remained outpatients without further hospitalization. The relationship between these parameters was analyzed using Pearson correlation coefficients, and multiple Cox regression analysis was conducted to identify independent predictors of re-hospitalization. Results: A significant negative correlation between EF and PWV was found (r = -0.853, 95% CI [-0.910, -0.764]), suggesting an association between improved heart function (higher EF) and reduced arterial stiffness (lower PWV). A moderate positive correlation between EF and AIx (r = 0.626, 95% CI [0.473, 0.805]) suggests that, while higher EF is associated with increased AIx, the relationship is weaker compared to EF and PWV. This may reflect differing contributions of vascular and myocardial factors to HF severity. Hospitalized patients exhibited significantly poorer clinical and biochemical profiles, including higher NT-proBNP levels (p < 0.001) and worse blood pressure (BP) measurements (systolic and diastolic, p < 0.01). Multiple Cox regression analysis identified PWV, Aix, and NT-proBNP as independent predictors of re-hospitalization in HF patients, with significant hazard ratios: PWV (HR = 1.15, p = 0.02), AIx (HR = 1.03, p = 0.02), and NT-proBNP (HR = 1.0001, p < 0.01). Conclusions: Arterial stiffness indices (PWV and AIx), EF, and NT-proBNP were identified as significant predictors of re-hospitalization in HF patients. These findings suggest that integrating arterial stiffness measurements into routine clinical assessments may enhance the risk stratification and inform targeted interventions to reduce hospitalizations and improve outcomes.

Updated WHO list of emerging pathogens for a potential future pandemic: Implications for public health and global preparedness

Historically, pandemics constitute a major nuisance to public health. They have a debilitating impact on global health with previous occurrences causing major mortalities worldwide. The adverse outcomes are not limited to health outcomes but ravage the social, economic, and political landscapes. The World Health Organization (WHO) stands at the front of the pandemic response, strategizing to contain and mitigate the impacts on humans and the environment. It also intervenes in regional disease outbreaks that pose a threat to global health through strategic technical guidance, resource allocations, and expert support. With emerging pathogens, and in the aftermath of the COVID-19 pandemic, discussions are currently underway on global preparedness for a potential future pandemic. The effects of previous pandemics underscore the need to improve global health preparedness for upcoming pandemics. The WHO's July 2024 updated list of emerging pathogens serves as a potential tool to foster global health readiness for a future pandemic. It represents a change in the world's approach to emerging and re-emerging pathogens, shifting focus from specific pathogens to adopting a broader family-focused approach. This new list recognizes the shortcomings of previous lists and adopts a more forward-thinking, proactive, and flexible approach to dealing with familiar and unfamiliar pandemic risks, now incorporating 'Prototype Pathogens' and 'Pathogen X' into its risk classification. The WHO has set the pace, developing tools and guidelines for practice. This updated list of high-priority pathogens seeks to gear research and development toward combating and neutralizing the virulence of these pathogens. Recent outbreaks of Cholera, Mpox, and Dengue fever in Africa, Avian influenza (H5N2) in Mexico, Nipah virus disease in Bangladesh, and Oropouche virus in the Americas necessitate intensifying regional disease surveillance Research organizations and institutions must prioritize incorporating these tools and approaches for shared learning and collective action established during the COVID-19 pandemic and other recent public health emergencies in the Preparedness and Resilience for Emerging Threats (PRET) Initiative as outlined by WHO.

Review of Manpower Management in Healthcare System: Strategies, Challenges, and Innovations

Hospital manpower management (HRM) is vital for effective healthcare delivery. Unique challenges, such as managing diverse staff, ensuring clear communication, and optimizing resources, complicate HRM. Rising operational costs, workforce shortages, and employee burnout necessitate strategic approaches to manpower management. This review aims to provide a comprehensive understanding of manpower management in hospitals, focusing on identifying core components and discussing innovative strategies to address current challenges, particularly those related to workforce shortages. A literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key terms included "hospital manpower management", "HRM challenges in healthcare", and "workforce shortages", selected for their relevance to the core focus of this review. Relevant articles published from 2019 to 2023 were selected for analysis. The review identified core components of manpower management: recruitment and staffing, workforce planning, training and development, performance management, and compensation and benefits. Strategies to address workforce shortages included strategic hiring and enhancing employee engagement. The integration of technology and ongoing training emerged as critical for maintaining high-quality patient care. Effective manpower management is essential for the sustainability of healthcare systems. This review highlighted the importance of innovative HRM strategies to tackle workforce shortages and improve employee satisfaction. By focusing on comprehensive HRM practices, healthcare organizations could enhance workforce efficiency and provide better patient care. Future research should explore the long-term impacts of these strategies on healthcare.

Technologies and decision-support tools for health systems management: a scoping review of features and use cases

INTRODUCTION

In the face of growing patient volumes, health requirements, and economic constraints, modern healthcare systems are in dire need of innovative management solutions. Despite a range of tools available to tackle these challenges, there's a gap in the understanding of how these tools are tailored for health systems management.

AREAS COVERED

This review, conducted in October 2023 across key health administration and technology databases Medline, Embase, IEEE Xplore, and ACM Digital Library, aims to examine the applications, characteristics, and real-world impacts of health systems management tools. From a total of 2,048 records, 12 studies were selected that span a variety of technologies, including decision analysis tools, machine learning algorithms, and data dashboards, all of which have proven critical in optimizing resource allocation, financial management, and patient care.

EXPERT OPINION

These technologies have shown substantial promise in improving decision-making processes, operational efficiency, and overall healthcare outcomes. This review highlights the role these technologies and tools play in enhancing the manageability and sustainability of complex healthcare systems. It also underscores the need for ongoing research to further align technological developments with the evolving needs of the healthcare sector, ultimately aiming to boost system efficiency and improve patient care.

The interactive effect of the application of accreditation standards (JCIs) and the practice of administrative control in improving the quality of health services: a study on Yemeni hospitals

BACKGROUND

This study aimed to examine the interactive effect of applying JCI accreditation standards and administrative control in improving the quality of health services in Yemeni hospitals. By examining the synergistic relationship between these two components, this study sought to shed light on how hospitals can improve their performance and achieve sustainable advancements in healthcare quality.

METHODS

This study utilized a quantitative research design and collected data from Yemeni hospitals. The sample size was determined via the Krejcie and Morgan table, which provides a recommended sample size on the basis of the population. A total of 310 healthcare professionals were selected through a random sampling technique. Hypotheses were formulated to examine the impact of JCI accreditation standards and administrative control on healthcare quality. Statistical analyses were also conducted to test these hypotheses and determine the interaction effect between the two variables.

RESULTS

The results confirmed that applying JCI accreditation standards has a statistically significant positive effect on improving the quality of health services in hospitals. Additionally, the practice of administrative control had a statistically significant effect on healthcare quality. Furthermore, there was an interactive effect between the application of JCI accreditation standards and administrative control, indicating that their combined implementation led to even greater improvements in healthcare quality.

CONCLUSION

The significance of this study lies in its potential to inform healthcare policymakers, administrators, and practitioners about the importance of integrating accreditation standards with robust administrative control measures. The findings emphasize the need for hospitals to prioritize both the implementation of accreditation standards and the establishment of effective administrative control systems to ensure the delivery of high-quality healthcare services. This study contributes to the literature by highlighting the interactive impact of these factors and providing insights into their synergistic relationship.

Exploring Early Complications in Paraumbilical Hernia Mesh Repair: A Rigorous Six-Month Prospective Study and In-Depth Analysis

Introduction When an organ, such as the colon, pushes through the wall of the abdominal cavity, a hernia results. After femoral and inguinal hernias, umbilical hernias account for the third most common kind of abdominal hernia in adults precipitated by conditions such as obesity, ascites, and repeated pregnancies. A subtype of umbilical hernias called paraumbilical hernias is more likely to cause problems such as rupture, skin ulceration, and obstruction. Seroma, hematoma, and infection are the reported post-repair consequences but data regarding early complications is limited. High-quality data assessing early complications is necessary to improve mesh repair outcomes. Materials and methods This cross-sectional study was carried out in the Department of General Surgery at Medical Teaching Institute (MTI) Lady Reading Hospital, Peshawar over one year, from January to December 2022. A total of 167 patients were selected using simple random sequential selection. Patients aged 20-60 years of both genders who were diagnosed with paraumbilical hernia in the emergency department were included. To prevent bias, those with uncontrolled diabetes or existing complications from hernia were excluded. Following informed consent, data were gathered using pre-designed proformas. Patients underwent open mesh repair during each surgery, and they were monitored at one and three months following the procedure. Complications such as seroma, hematoma, and wound infection were documented. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY) with chi-square tests for categorical variables and a significance level of p < 0.05. Results The study included a total of 167 patients, with a mean age of 42 years (SD ±8.77). The majority of patients (40%) ranged in age from 41 to 50 years old, with 33% aged 31 to 40. Gender distribution revealed that 63 (38%) of the patients were male and 104 (62%) were female. Early complications included 25 (15%) wound infections, 32 (19%) seromas, and 63 (38%) hematomas. The occurrence of wound infections, seromas, and hematomas did not differ significantly by age or gender (p > 0.05). Conclusion Early complications from paraumbilical hernia mesh repair include wound infections (15%), seromas (19%), and hematomas (38%). Postoperative monitoring is critical to reducing these complications.

A Prospective Clinical Audit of Sterile Surgical Glove-Donning Practices Among Young Surgeons at a Tertiary Care Hospital in Sudan

Background Adherence to aseptic protocols and proper sterilization is critical for optimal patient recovery post-surgery. The standard procedure for donning sterile surgical gloves helps manage infection risk and maintain surgical site cleanliness by following aseptic principles. This study evaluates adherence to these protocols among young surgeons at a tertiary care hospital in Sudan. Methods This prospective audit included 42 young residents and house officers at a tertiary care hospital in Sudan, following ethical clearance. Compliance with sterile surgical glove-donning practices was assessed using the World Health Organization (WHO) pre- and post-intervention criteria. Participants were observed in the operating room without prior notice. The intervention comprised a video presentation and a live demonstration. Results Pre-intervention adherence to standard criteria for donning sterile surgical gloves was 73.4% (n= 31). This rate increased significantly to 91.4% (n= 38) following the intervention and showed marked improvement. Conclusion The audit demonstrated a significant improvement in adherence to donning sterile surgical gloves practices after the intervention. Implementing WHO guidelines effectively enhances compliance, reduces infection risks, and increases awareness of aseptic practices.

The Power of Thought: The Role of Psychological Attentiveness and Emotional Support in Patient Trajectories

In modern healthcare, the influence of a patient's mindset on health outcomes is an often neglected yet vital component of holistic care. This review explores the significant impact of positive and negative mindsets on disease progression and recovery, emphasizing the need to integrate mental wellness practices into conventional medical care. Drawing from a wide array of studies, it demonstrates how fostering a positive mindset can enhance patient trajectories across various medical specialties. The article advocates for training healthcare providers to adopt a more empathetic and patient-centered approach, bridging the gap between mind and body. By presenting compelling evidence on the correlation between patient mindset and health outcomes, this review highlights the potential benefits of incorporating psychological support and holistic strategies into standard care protocols. Practical strategies for implementing mindset-focused interventions are also proposed, including training programs for healthcare professionals and the development of interdisciplinary treatment plans. Ultimately, this article underscores the need for a paradigm shift in medical practice, advocating for a comprehensive approach that recognizes the power of thought in promoting patient wellness.

Optimizing Pain Management in Emergency Departments: A Comprehensive Review of Current Analgesic Practices

Effective pain management in Emergency Departments (EDs) is vital for improving patient comfort and clinical outcomes. This review provides a comprehensive analysis of current pain management practices in ED settings, focusing on the challenges and opportunities for optimization. The review examines pharmacologic and non-pharmacologic pain management strategies, evaluating their effectiveness and identifying inconsistencies and gaps in current practices. Key challenges in the ED environment include time constraints, variability in clinical protocols, and the need to address diverse patient needs, including those of paediatric, geriatric, and chronic pain patients. The review highlights the importance of standardized pain assessment tools and protocols to improve consistency in pain management. Innovations, such as technological advances and multimodal approaches, are explored for their potential to enhance pain management practices. Recommendations address identified challenges, including improved training for ED staff, the development of evidence-based protocols, and the integration of multimodal pain management strategies. By addressing these areas, the review aims to contribute to the development of more effective and uniform pain management practices in emergency care, ultimately leading to better patient outcomes and experiences. This review emphasizes the need for ongoing research and adaptation of best practices to meet the evolving needs of patients in emergency settings.

Balancing confidentiality and care coordination: challenges in patient privacy

BACKGROUND

In the digital age, maintaining patient confidentiality while ensuring effective care coordination poses significant challenges for healthcare providers, particularly nurses.

AIM

To investigate the challenges and strategies associated with balancing patient confidentiality and effective care coordination in the digital age.

METHODS

A cross-sectional study was conducted in a general hospital in Egypt to collect data from 150 nurses across various departments with at least six months of experience in patient care. Data were collected using six tools: Demographic Form, HIPAA Compliance Checklist, Privacy Impact Assessment (PIA) Tool, Data Sharing Agreement (DSA) Framework, EHR Privacy and Security Assessment Tool, and NIST Cybersecurity Framework. Validity and Reliability were ensured through pilot testing and factor analysis.

RESULTS

Participants were primarily aged 31-40 years (45%), with 75% female and 60% staff nurses. High compliance was observed in the HIPAA Compliance Checklist, especially in Administrative Safeguards (3.8 ± 0.5), indicating strong management and training processes, with an overall score of 85 ± 10. The PIA Tool showed robust privacy management, with Project Descriptions scoring 4.5 ± 0.3 and a total score of 30 ± 3. The DSA Framework had a mean total score of 20 ± 2, with Data Protection Measures scoring highest at 4.0 ± 0.4. The EHR assessments revealed high scores in Access Controls (4.4 ± 0.3) and Data Integrity Measures (4.3 ± 0.3), with an overall score of 22 ± 1.5. The NIST Cybersecurity Framework had a total score of 18 ± 2, with the highest scores in Protect (3.8) and lower in Detect (3.6). Strong positive correlations were found between HIPAA Compliance and EHR Privacy (r = 0.70, p < 0.05) and NIST Cybersecurity (r = 0.55, p < 0.05), reflecting effective data protection practices.

CONCLUSION

The study suggests that continuous improvement in privacy practices among healthcare providers, through ongoing training and comprehensive privacy frameworks, is vital for enhancing patient confidentiality and supporting effective care coordination.

Development and Validation of a Malay Version Questionnaire to Evaluate Remote Health Monitoring of COVID-19 via Telehealth Applications: Navigating Telehealth Evolution

Introduction The rapid adoption of telehealth services due to the COVID-19 pandemic has highlighted the necessity for effective tools to evaluate patient experiences. This study developed and validated the Telehealth Usability, Acceptability, and Satisfaction Questionnaire (TUASQ) for virtual COVID-19 Assessment Centres (CACs) in Malaysia, aiming to comprehensively measure usability, acceptability, and satisfaction. Methodology The TUASQ was developed in two phases. Initially, the questionnaire development phase included item generation guided by the Technology Acceptance Model (TAM) and the Health Belief Model (HBM), with feedback from a panel of six experts. Items were refined through Content Validity Index (CVI) - Item-Level Content Validity Index (I-CVI) ≥ 0.82, Scale-Level Content Validity Index (S-CVI) ≥ 0.82, and Content Validity Ratio (CVR ≥ 0.78); and Face Validity Index (FVI) by 10 respondents - Item-Level Face Validity Index (I-FVI) ≥ 0.82 and Scale-Level Face Validity Index (S-FVI ≥ 0.82). The psychometric validation phase involved a cross-sectional study of 705 respondents, recruited through convenience sampling from March to July 2024, to perform Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), followed by reliability testing using Cronbach's alpha, Composite Reliability (CR), and Average Variance Extracted (AVE). Results Content validation showed that most items' I-CVI exceeded 0.82, indicating significant expert consensus on relevance and clarity. The CVR also surpassed the 0.78 threshold, affirming their essential role. Face validation indices generally exceeded 0.80, confirming the questionnaire's clarity and comprehensiveness from the users' perspective. EFA with 250 participants indicated a high Kaiser-Meyer-Olkin Measure of Sampling Adequacy (KMO) of 0.933 and significant Bartlett's test (χ² (136) = 3752.698, p < 0.001), supporting the factorability of the data and extracting three distinct factors. CFA with 455 participants initially showed a poor fit, prompting model adjustments that subsequently improved the fit indices (Root Mean Square Error of Approximation (RMSEA) = 0.076, Standardized Root Mean Square Residual (SRMR) = 0.045, Goodness of Fit Index (GFI) = 0.94, Tucker-Lewis Index (TLI) = 0.96, Comparative Fit Index (CFI) = 0.97). Reliability testing revealed a high internal consistency with Cronbach's alpha of 0.975. CR for each factor exceeded the 0.70 threshold, and the AVE for each factor was above 0.50, indicating good convergent validity. Conclusion The validated TUASQ is a reliable and effective instrument for assessing the experiences of Malaysian patients using virtual CAC. Demonstrating robust psychometric properties through comprehensive validation processes, the TUASQ accurately measures usability, acceptability, and satisfaction, identifying strengths and areas for improvement in telehealth services. This contributes to enhanced care quality and patient satisfaction in the evolving healthcare landscape.

The Mediating Role of Students' Health Information Literacy Skills: Exploring the Relationship Between Web Resource Utilization and Health Information Evaluation Proficiency

BACKGROUND

In an increasingly digital age, students rely heavily on web resources to access health information. However, evaluating the reliability and relevance of such information is crucial for informed decision-making. This study examines the importance of students' health information literacy skills (HILS) as mediators, particularly their ability to utilize web resources and successfully evaluate health information.

OBJECTIVES

This research investigates the mediating role of students' HILS in the relationship between their utilization of web resources and their proficiency in evaluating health information.

METHOD

An online survey was distributed to current students at a public university in Bangladesh as part of the data collection process for this study. Using Google Forms, the authors created a structured questionnaire. The survey was distributed through Messenger groups, Facebook pages and email invitations to reach the target audience effectively. The researchers thoroughly analysed the gathered data using structural equation modelling (SEM) techniques and SmartPLS-4 software to look for correlations between the variables.

RESULT

The study revealed that among the 122 participants, a significant number (N = 47) accessed internet health information on an occasional basis, whereas 30 individuals reported using it infrequently. The data revealed that 58 individuals, accounting for 47.5% of the sample, possessed the necessary abilities to access and assess online health information. Additionally, 57 participants, representing 46.7% of the sample, demonstrated proficiency in conducting online health information searches. The measurement model demonstrated good convergent validity, as evidenced by composite reliability (CR) scores and Cronbach's ⍺ values over 0.700 and an average extracted variance (AVE) of 0.500. The structural model demonstrated R2 values exceeding 0.1, thus validating its dependable forecasting capability. Notable effects were seen, with f2 values of 0.335 and 0.317 for the challenges in accessing and evaluating health information (CAEHI) to health information evaluation (HIE) and CAEHI to HILS relationships, respectively. The mediation analysis found that HILS act as a mediator between types of web resources (TWRs) and HIE, with TWR having an indirect impact on HIE through HILS.

DISCUSSION

The result supports all hypotheses. Therefore, it is evident that students' HILS mediate the relationship between utilization of web resources and their proficiency in evaluating health information.

CONCLUSION

This study's findings could significantly impact instructional practices meant to raise students' health information literacy. This initiative seeks to enable students to make informed decisions about their health by providing them with the necessary tools to analyse and evaluate health-related information.

PATIENT OR PUBLIC CONTRIBUTION

Research on health information literacy can assist patients and the general public by instructing them on how to assess trustworthy online health resources. Students gave insightful feedback that assisted in shaping the study and guaranteeing its relevancy. If they better comprehend health information literacy, patients and the general public can use web-based resources and critically evaluate health information more accurately.

Evaluating Modern Therapeutic Interventions for Migraine Management: A Systematic Review

This systematic review evaluates the efficacy and safety of contemporary migraine treatments, synthesizing evidence from recent randomized controlled trials (RCTs). The focus is on both pharmacological interventions, such as calcitonin gene-related peptide (CGRP) monoclonal antibodies and non-specific oral migraine preventives, and non-pharmacological approaches like myofascial release. Through a detailed examination of the studies, this review identifies superior strategies for acute and preventive migraine management, assessing their impact on patient-reported outcomes and determining the prevalence of associated adverse events. Findings suggest that while CGRP monoclonal antibodies show promise as first-line treatments due to their efficacy and safety, myofascial release offers considerable benefits for pain and disability in tension-type and cervicogenic headaches. Challenges such as the variability in individual response and potential side effects emphasize the need for personalized treatment plans. This review underscores the importance of integrating new therapeutic discoveries into clinical practice to enhance the quality of care for migraine sufferers.

Natural Language Processing for Digital Health in the Era of Large Language Models

OBJECTIVES

Large language models (LLMs) are revolutionizing the natural language pro-cessing (NLP) landscape within healthcare, prompting the need to synthesize the latest ad-vancements and their diverse medical applications. We attempt to summarize the current state of research in this rapidly evolving space.

METHODS

We conducted a review of the most recent studies on biomedical NLP facilitated by LLMs, sourcing literature from PubMed, the Association for Computational Linguistics Anthology, IEEE Explore, and Google Scholar (the latter particularly for preprints). Given the ongoing exponential growth in LLM-related publications, our survey was inherently selective. We attempted to abstract key findings in terms of (i) LLMs customized for medical texts, and (ii) the type of medical text being leveraged by LLMs, namely medical literature, electronic health records (EHRs), and social media. In addition to technical details, we touch upon topics such as privacy, bias, interpretability, and equitability.

RESULTS

We observed that while general-purpose LLMs (e.g., GPT-4) are most popular, there is a growing trend in training or customizing open-source LLMs for specific biomedi-cal texts and tasks. Several promising open-source LLMs are currently available, and appli-cations involving EHRs and biomedical literature are more prominent relative to noisier data sources such as social media. For supervised classification and named entity recogni-tion tasks, traditional (encoder only) transformer-based models still outperform new-age LLMs, and the latter are typically suited for few-shot settings and generative tasks such as summarization. There is still a paucity of research on evaluation, bias, privacy, reproduci-bility, and equitability of LLMs.

CONCLUSIONS

LLMs have the potential to transform NLP tasks within the broader medical domain. While technical progress continues, biomedical application focused research must prioritize aspects not necessarily related to performance such as task-oriented evaluation, bias, and equitable use.

Navigating the Future: The Transformative Impact of Artificial Intelligence on Hospital Management- A Comprehensive Review

This comprehensive review explores the transformative impact of artificial intelligence (AI) on hospital management, delving into its applications, challenges, and future trends. Integrating AI in administrative functions, clinical operations, and patient engagement holds significant promise for enhancing efficiency, optimizing resource allocation, and revolutionizing patient care. However, this evolution is accompanied by ethical, legal, and operational considerations that necessitate careful navigation. The review underscores key findings, emphasizing the implications for the future of hospital management. It calls for a proactive approach, urging stakeholders to invest in education, prioritize ethical guidelines, foster collaboration, advocate for thoughtful regulation, and embrace a culture of innovation. The healthcare industry can successfully navigate this transformative era through collective action, ensuring that AI contributes to more effective, accessible, and patient-centered healthcare delivery.