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Kaizen initiatives are core organisational mechanisms in lean healthcare projects. Although they show specific peculiarities (e.g. a narrow goal and an accelerated timeframe), they can vary in the way they are planned and executed. This study investigates what types of configurations of kaizen initiatives (profiled as gestalts of specific characteristics) can exist in healthcare, if they differ for social and technical outcomes, and for their application context (here considered in terms of work area routineness and team composition). The study is based on data from 362 participants to 105 kaizen initiatives implemented in two public hospitals in Italy. It identifies three clusters (i.e. 'hard practices-oriented', 'soft practices-oriented' and 'full-lean adherent' kaizen initiatives) characterised by different social and technical outcomes. The original contribution to the lean healthcare literature is twofold: first, the simultaneous focus on performance improvement (technical outcome) and modification of operators' mindset (social outcome); second, the adoption of a configurational approach to understand how gestalts of many variables explain the dynamics that lead to social and technical outcomes. No significant differences were found among clusters in terms of work area routineness and team composition, which also opens interesting directions for future research. [ABSTRACT FROM AUTHOR]

This study proposed multiple revised variable neighborhood search (VNS) approaches applying the greedy concept to solve a nurse scheduling problem (NSP). In this paper, we developed three greedy-neighbourhood-swapping mechanisms (greedy-2-exchange, greedy-3-exchange, and greedy-4-exchange) to conduct local searches based on one-, two-, or three-neighbourhood structures that accounted for constraints imposed by government and hospital regulations. The greedy-neighbourhood-swapping mechanisms were used to identify medical staff members with the highest soft-constraint (e.g. nurses' preferences) violation weights on a given day who then swapped their shifts with others. To validate the proposed VNS approaches, we also conducted a case study. Based on the testing instances, all of the proposed VNS approaches generated optimal or near-optimal solutions, and the differences between them were small. The optimal number of the neighbourhood structures was determined to be two, confirming that a larger number of neighbourhoods in a neighbourhood structure would not necessarily be associated with more easily escaping local optima. Furthermore, the resulting outcomes supported the conclusion that the proposed modified VNS approaches generated better schedules for the medical staff members of hospitals than the compared meta-heuristic algorithms. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cancer is a leading cause of death in unhoused adults. We sought to examine the association between housing status, stage at diagnosis and all-cause survival following cancer diagnosis at a public hospital. DESIGN: Retrospective cohort study examining new cancer diagnoses between 1 July 2011 and 30 June 2021. SETTING: A public hospital in San Francisco. EXPOSURE: Housing status (housed, formerly unhoused, unhoused) was ascertained via a county-wide integrated dataset that tracks both observed and reported homelessness. METHODS: We reported univariate analyses to investigate differences in demographic and clinical characteristics by housing group. We then constructed Kaplan-Meier curves stratified by housing group to examine unadjusted all-cause mortality. Finally, we used multivariable Cox proportional hazards models to compare the hazard rate of mortality for each housing status group, adjusting for demographic and clinical factors. RESULTS: Our cohort included 5123 patients with new cancer diagnoses, with 4062 (79%) in housed patients, 623 (12%) in formerly unhoused patients and 438 (9%) in unhoused patients. Unhoused and formerly unhoused patients were more commonly diagnosed with stage 4 disease (28% and 27% of the time, respectively, vs 22% of housed patients). After adjusting for demographic and clinical characteristics, unhoused patients with stage 0-3 disease had a 50% increased hazard of death (adjusted HR (aHR) 1.5, 95% CI 1.1 to 1.9; p

The prime instrument used to measure Psychosocial Safety Climate (PSC) at the workplace is the PSC-12 scale questionnaire, which has been widely used by researchers worldwide. We set out to translate the PSC-12 scale into Malay and validate it among Malaysian healthcare workers, the first time this has ever been attempted. We carried out a cross-sectional study among 250 healthcare workers from 3 government health clinics and 15 identified clinical work units in a public hospital in the Klang Valley area, Malaysia. The English version of the PSC-12 scale was translated into the Malay language (Bahasa Malaysia) and back into English to check for content accuracy and validity. Psychometric properties of the questionnaire were assessed for internal consistency (Cronbach's alpha coefficient), temporal stability for test-retest reliability (intra-class correlation) and construct validity (confirmatory factor analysis). The translated questionnaire had a persistently high content validity-index (CV-I) of 0.916. The hypothesised four-factor-structure model displayed high goodness of fit indices (RMSEA = 0.081, SRMR = 0.032, GFI = 0.919, AGFI = 0.869, CFI = 0.961, and TLI = 0.946), demonstrating good questionnaire construct validity. Each item subscale in the PSC-12 scale showed satisfactory internal consistency with Cronbach's alpha (α) coefficient between 0.895 to 0.921. There was satisfactory temporal stability and test-retest reliability with ICC (2,1) for scores of 0.954 (total item score), 0.897 (Domain 1 score), 0.910 (Domain 2 score), 0.807 (Domain 3 score) and 0.806 (Domain 4 score) over the two-week interval. The Malay version of the PSC-12 scale is a valid and reliable instrument for use among healthcare workers in Malaysia as evidenced by its satisfactory psychometric measure and construct structure properties. [ABSTRACT FROM AUTHOR]

Hospital social workers rely on their professional judgement to make difficult decisions about allocating their time and prioritising referrals. The challenge of prioritising referrals lies within the fallibility of decision making and the conflict between social work and hospital goals for patient care. The resulting inconsistencies in clinical practice contrast with the profession's need for consistent, transparent, and justified decisions. Responding to this context, authors in this article detail the development of a prioritisation framework for social work referrals. Using the modified Delphi technique, 26 hospital social workers completed four survey rounds, and 13 hospital social workers participated in two meetings to gain a consensus about the factors that should be integral in a prioritising framework. We anticipate the framework will support hospital social workers in making transparent and consistent decisions, assessing patients promptly, and improving efficiency and patient outcomes.IMPLICATIONSA prioritisation framework allows hospital social workers to navigate challenging prioritisation decisions efficiently, consistently, and successfully.Improved articulation of clinical priorities by social workers will assist in accounting for the psychosocial needs of patients in the context of hospital requirements for timely discharge.A prioritisation framework allows hospital social workers to navigate challenging prioritisation decisions efficiently, consistently, and successfully.Improved articulation of clinical priorities by social workers will assist in accounting for the psychosocial needs of patients in the context of hospital requirements for timely discharge. [ABSTRACT FROM AUTHOR]

Background: Preterm infants (PTIs) require hospitalization in different levels of neonatal care units (NCUs) for their survival and developmental needs. The quality of care provided at NCUs significantly influences infant outcomes and parents' experiences. Parents' experience of received support and care of PTIs is one of the indicators for determining the quality of care at NCUs. The study aims to investigate parents' perspectives on the PTIs care and support received from nurses in NCUs of Nepal. Methods: A descriptive phenomenological study was conducted within the NCUs of three public tertiary hospitals in Kathmandu, Nepal. In-depth interviews were conducted among 25 purposively selected parents, (both mothers and fathers) of low-birthweight PTIs admitted to the NCUs. Data was collected from November 2019 to February 2020. The data were meticulously analyzed using the Colaizzi method. Findings: The exploration of parents' experiences identified three main theme areas: (1) Care and support, (2) Initial involvement in PTI care, and (3) Outcome of care involvement. Parents appreciated competent and affectionate PTI care as well as informational support. However, they had varied experiences with communication, emotional support, and opportunities for infant-parent attachment. Guidance and support for PTI care from nurses and peer-parents proved instrumental in mitigating uncertainties related to initial care learning and involvement in PTI care. Parents' involvement in hands on care of their PTIs boosted infant-parent attachment, empowered for care giving, and provided emotional solace. Conclusion: Findings indicate that parents have positive experience with PTI care provided by nurses and their involvement in hands-on care of their PTIs. However, there are gaps in support expectations of parents including communication, emotional support, and care guidance. Findings have important implications for nurses, pediatricians, and policymakers for the enhancement of neonatal care practice by incorporating parental support and parents' involvement in hands on care of PTI across NCUs in Nepal. [ABSTRACT FROM AUTHOR]

Linear and volumetric analysis are the typical methods to measure tumor size. 3D volumetric analysis has risen in popularity; however, this is very time and labor intensive limiting its implementation in clinical practice. This study aims to show that an AI-led approach can shorten the length of time required to conduct 3D volumetric analysis of VS tumors and improve image processing accuracy. From Yale New Haven Hospital and public patient recruitment, 143 MRIs were included in the ground truth dataset. To create the tumor models for the ground truth dataset, an image processing software (Simpleware ScanIP, Synopsys) was used. The helper (DPP V1.0) was trained using proprietary AI- and ML-based algorithms and information. A proof-of-concept AI model achieved a mean DICE score of 0.76 (standard deviation 0.21). After the final testing stage, the model improved to a final mean DICE score of 0.88 (range 0.74–0.93, standard deviation 0.04). Our study has demonstrated an efficient, accurate AI for 3D volumetric analysis of vestibular schwannomas. The use of this AI will enable faster 3D volumetric analysis compared to manual segmentation. Additionally, the overlay function would allow visualization of growth patterns. The tool will be a method of assessing tumor growth and allow clinicians to make more informed decisions. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer (CC) is preventable, yet remains a significant public health threat, particularly in Sub-Saharan Africa. Despite considerable awareness, screening rates for CC in Kenya are low and loss to follow-up following treatment for premalignant cervical lesions remains high. This study investigates the efficacy of the Cancer Tracking System (CATSystem), a web-based intervention, to improve CC screening and treatment retention. Methods: A matched, cluster randomized controlled trial will be conducted in Kenyan government hospitals (n = 10) with five intervention and five standard-of-care (SOC) sites. The primary outcome is the proportion of women with a positive screen who receive appropriate treatment (onsite or referral). Secondary outcomes include CC screening uptake among all women and timeliness of treatment initiation. We will utilize mixed methods to assess intervention feasibility, acceptability, and cost-effectiveness. Discussion: The CATSystem has the potential to improve CC care in Kenya by leveraging existing technology to address known barriers in the screening and treatment cascade. This study will provide valuable evidence for potential scale-up of the intervention. [ABSTRACT FROM AUTHOR]

Background: The digitization of healthcare, through electronic medical records (EMRs), is recognized globally as a transformative initiative. Indonesia mandated all healthcare facilities to adopt EMRs by December 31, 2023. However, this transition is complicated by diverse technological, cultural, and infrastructural challenges, with little research addressing the recordkeeping culture's impact on EMR adoption. This study investigates the electronic recordkeeping culture in Indonesian hospitals following a government mandate to adopt Electronic Medical Records (EMRs). It aims to understand the readiness and challenges in implementing EMRs across hospitals on Java and Sulawesi islands, focusing on infrastructure, staff digital skills, and varied adoption approaches. Methods: A qualitative case study approach was utilized, involving focus groups and semi-structured interviews with 150 staff from 12 hospitals. Conducted between November 2023 and June 2024, the study applied thematic analysis based on Oliver and Foscarini's (2020) recordkeeping culture framework to explore organizational readiness, technological infrastructure, and healthcare professionals' skills in managing electronic records. Results: The findings reveal significant differences in EMR adoption between the islands. Hospitals on Java exhibited proactive engagement, supported by better technological infrastructure and staff training programs, while Sulawesi hospitals adopted EMRs primarily to meet regulatory requirements. Challenges included inconsistent internet connectivity, low digital literacy among staff, and ongoing reliance on paper records during the transition. Some Java hospitals have begun fostering a culture conducive to electronic recordkeeping by focusing on developing staff skills in EMR management. Conclusions: The effectiveness of EMR adoption in Indonesia relies on addressing technological infrastructure issues and enhancing staff digital literacy. While progress has been made, particularly in more developed regions, a cohesive national strategy emphasizing technological support and targeted training is essential to fully realize the benefits of EMRs in improving healthcare and recordkeeping standards across Indonesia. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of servant leadership features of managers of public hospitals on managerial effectiveness. The study population comprised executives from 353 public hospitals, including chief physicians, healthcare services directors, and administrative and financial affairs managers. Data were collected using the servant leadership and leadership effectiveness scales. In the data analysis, descriptive statistics such as the frequency, percentage, mean and standard deviation were considered, and the structural equation model was used for multivariate analysis. The study highlighted a significant positive correlation between health managers’ perceptions of sharing leadership, inspiring leadership and visionary leadership qualities, which constitute servant leadership, and their perceived leader effectiveness (p < 0.05). The perceptions of servant leadership characteristics are effective in the managerial success perceptions of public hospital managers. The criteria related to servant leadership characteristics should be included among the evaluation criteria in the appointments of managerial levels in these organizations. [ABSTRACT FROM AUTHOR]

Background: Chronic diseases such as human immunodeficiency virus (HIV) and chronic non-communicable diseases (CNCDs) are among the highest disease groups in Trinidad and Tobago. This study aimed to assess overall health for patients with chronic diseases at a hospital in Trinidad and Tobago. Methods: A cross-sectional study design was used to collect data over a six month period. A standard set of three patient reported outcome measures was used: WHO 5 Wellbeing Index, PROMIS Global Health 10 which comprised Global Physical Health (GPH) and Global Mental Health (GMH) and WHO Disability Assessment Schedule (WHO DAS). These questionnaires were self-administered to all patients attending two clinics. Results: Data from 401 participants were analysed, of which 73.1% (n = 312) had CNCDs and 22.2% (n = 89) were living with HIV. The median WHO 5 Wellbeing Index score was 60 for patients with CNCDs and 60 for patients living with HIV. The median GPH T score was significantly higher in patients living with HIV compared to the patients with CNCDs (39.2 versus 32.4, p = 0.003) while the median GMH T score was similar in both patient groups (MOPC 38.2 and ID 38.2, p = 0.329). The median WHO DAS score for patients with CNCDs was 23 compared to 17.5 for patients living with HIV. Conclusion: The study results indicated fair health, wellbeing and mild disability amongst chronic disease patients. These results can inform decisions on where improvement efforts should be targeted to improve patients' overall health. [ABSTRACT FROM AUTHOR]

Background: Dry mouth-related conditions adversely affect patients' well-being, as well as their oral and general health. There are indications that the quantitative and qualitative protein composition of saliva is disrupted in patients with xerostomia and Sjögren's syndrome. Salivary α-amylase levels positively correlate with the copy number (CN) of its coding gene, AMY1 (amylase alpha 1). This study aimed to investigate the association between intensity of xerostomia, Sjögren's syndrome, and AMY1 CN. Establishing such an association could position AMY1 CN as a potential genetic biomarker for dry mouth-related conditions, aiding in their early detection. Methods: This cross-sectional study utilized secondary data from the main dry mouth study conducted in five public hospitals in Vilnius, the capital city of Lithuania. Based on sample size calculations for the main study, 127 patients who met the inclusion criterion of dry mouth complaints (sometimes, often, and always) were recruited. The outcomes were xerostomia intensity, assessed using a visual analogue scale (VAS), and confirmed cases of Sjögren's syndrome, assessed using the 2016 ACR/EULAR classification criteria and classified as either primary or secondary. Sociodemographic information included age and sex; self-perceived stress levels were assessed using the Perceived Stress Scale (PSS-10). During clinical examinations, unstimulated whole sialometry was performed for 15 min, and oral mucosa swabs were collected. The swabs were used to quantify AMY1 CN via droplet digital PCR (ddPCR). Data were analyzed using both univariable and multivariable regression models. Results: In total, 112 patients with available AMY1 CN data and recorded xerostomia intensity VAS scores were included in this study. Of these, 26 (23%) were diagnosed with Sjögren's syndrome; 9 (8%) had primary and 17 (15%) had secondary Sjögren's syndrome. According to multivariable linear regression analyses, higher AMY1 CN was associated with 0.15 lower xerostomia intensity VAS score (β =-0.15, 95% CI -0.30, -0.01). Higher AMY1 CN reduced the odds for primary Sjögren's syndrome (OR 0.52, 95% CI 0.03–0.89). Conclusions: The present study indicated an inverse association between xerostomia, primary Sjögren's syndrome, and AMY1 CN. Studies validating these findings and exploring the underlying mechanisms are warranted. [ABSTRACT FROM AUTHOR]

Background: Electronic (e-)alerts for rising serum creatinine values are increasingly used as clinical indicators of acute kidney injury (AKI). The aim of this study was to investigate to what degree AKI episodes, as identified using e-alerts, correlated with coding for AKI in the hospital record for a national cohort of hospitalised children and examine whether coding corresponded with 30-day mortality after an AKI episode. Methods: A cross-section of AKI episodes based on alerts issued for children under 18 years in England during 2017 were linked to hospital records. Multivariable logistic regression was used to examine patient and clinical factors associated with AKI coding. Agreement between coding and 30-day mortality was examined at hospital level. Results: 6272 AKI episodes in 5582 hospitalised children were analysed. Overall, coding was poor (19.7%). Older age, living in the least deprived quintile (odds ratio (OR) 1.4, 95% Confidence Interval (CI) 1.1, 1.7) and higher peak AKI stage (stage 1 reference; stage 2 OR 2.0, 95% CI 1.7, 2.4; stage 3 OR 8.6, 95% CI 7.1, 10.6) were associated with higher likelihood of coding in the hospital record. AKI episodes during birth admissions were less likely to be coded (OR 0.4, 95% CI 0.3, 0.5). No correlation was seen between coding and 30-day mortality. Conclusions: The proportion of AKI alert-identified episodes coded in the hospital record is low, suggesting under-recognition and underestimation of AKI incidence. Understanding the reasons for inequalities in coding, variation in coding between hospitals and how alerts can enhance clinical recognition is needed. [ABSTRACT FROM AUTHOR]

Continuous access to electronic health records will fuel the digital transformation of medicine. For data-sharing initiatives, the challenge lies in ensuring data access aligns with the interests of data holders. Federated data access authorization, where data remains controlled locally, may offer a solution to balance these interests. This paper reports on a digital health implementation of the federated data access authorization system used in the German National Emergency Department Data Registry. Using data from 2017 to 2024, we analyzed the system's effectiveness in managing data access in a nationwide research network of 58 emergency departments. Facilitating access to more than 7.9 million records, 75% of data access queries were authorized within 15 days. The system also supports periodic queries, enabling recurring real-time access. Query volumes grew from 15 to over 23,000 by 2024, with completion rates of 86%. The system may thus serve as a blueprint for data-sharing initiatives worldwide. [ABSTRACT FROM AUTHOR]

Complete and high-quality photodocumentation in esophagoduodenogastroscopy (EGD) is essential for accurately diagnosing upper gastrointestinal diseases by reducing blind spot rates. Automated Photodocumentation Task (APT), an artificial intelligence-based system for real-time photodocumentation during EGD, was developed to assist endoscopists in focusing more on the observation rather than repetitive capturing tasks. This study aimed to evaluate the completeness and quality of APT's photodocumentation compared to endoscopists. The dataset comprised 37 EGD videos recorded at Seoul National University Hospital between March and June 2023. Virtual endoscopy was conducted by seven endoscopists and APT, capturing 11 anatomical landmarks from the videos. The primary endpoints were the completeness of capturing landmarks and the quality of the images. APT achieved an average accuracy of 98.16% in capturing landmarks. Compared to that of endoscopists, APT demonstrated similar completeness in photodocumentation (87.72% vs. 85.75%, P =.0.258), and the combined photodocumentation of endoscopists and APT reached higher completeness (91.89% vs. 85.75%, P <.0.001). APT captured images with higher mean opinion scores than those of endoscopists (3.88 vs. 3.41, P <.0.001). In conclusion, APT provides clear, high-quality endoscopic images while minimizing blind spots during EGD in real-time. [ABSTRACT FROM AUTHOR]

AbstractThe implementation of Standard Inpatient Classes (SIC) in hospitals presents a significant challenge for Indonesia in its efforts to achieve Universal Health Coverage (UHC). This study aims to strengthen the strategy of public hospitals in Indonesia to face the SIC policy. The study design is qualitative with a case study approach. Data were collected through in-depth interviews and observations were conducted in the 1st, 2nd, and 3rd inpatient rooms. Data analysis was carried out by using the Atlas-TI software and Strength, Weakness, Opportunity, and Threat (SWOT) analysis. Based on the results of this study, it was found that general hospitals are ready for the implementation of SIC. Public hospital is ready for SIC implementation. Hospitals must also consider a work plan for managing and observing the current condition of hospital infrastructure, a compatible hospital infrastructure management system, and an adequate budget for procuring hospital infrastructure. This study concluded that the main effort to deal with the SIC implementation is to strengthen the infrastructure of hospital inpatient rooms by optimizing funding from the Government. [ABSTRACT FROM AUTHOR]

AbstractHospitals are required to provide a social safety-net through charity care to indigent populations. This study aims to build upon previous research by examining the provision of charity care by hospitals using national, longitudinal data. We found no significant difference in the provision of charity care. However, we did find that hospital charity care ratio may be influenced by type of care, location, and market conditions. Policymakers need to determine the appropriate level of charity care to be provided by non-profit hospitals. Managers need to determine the appropriate cost management strategy to support their hospitals’ financial sustainability. [ABSTRACT FROM AUTHOR]

This study was conducted to determine the missed nursing care and to compare missed nursing care with descriptive characteristics of nurses during the COVID-19 period. The study was conducted with 182 nurses as a descriptive design working in seven public hospitals with a level III neonatal intensive care unit in Istanbul between April and July 2021. The study used an introductory information form for nurses and the Misscare survey-Pediatric version. Missed nursing care included “mouth care,” “full documentation of all necessary data,” and “communication of all relevant information during shift change or handover” in the first three ranks (n = 179, 98.35%). It was found that the highest score among reasons for missed nursing care was in the communication sub-dimension (2.50 ± 0.74). It was found that the reasons for missing care for nurses between the ages of 26–30 and with 6–10 years of professional experience (p < .05) were material resources-related, while the reasons for missing care for nurses with 11 years or more of professional experience (p < .05) and caring for 4 sick newborns in a shift (p < .01) were communication problems. It was concluded that nurses were unable to provide at least one nursing care in the last shift, and this was primarily due to communication-related problems. Training and policies for the development of communication skills can be suggested to reduce missed nursing care. [ABSTRACT FROM AUTHOR]

Background: Increasing quality and efficiency in health services can directly relate to nurses' innovative work behaviors. The happiness levels of nurses at the workplace can positively affect their innovative work behaviors and their willingness to make a positive difference in patient care. In this context, the study aims to examine the serial mediation role of these factors by associating the effect of nurse happiness on innovative work behaviors with transformational leadership and perception of artificial intelligence use. Methods: Nurses working in two medium-sized public hospitals in the Eastern Black Sea region of Turkey were selected as the study sample. Data were collected from 458 nurses by convenience sampling method. In this cross-sectional study, scales whose validity and reliability were supported by other studies were used. Results: When the findings of the study were evaluated, a significant positive relationship was found between nurses' happiness and innovative work behavior. In addition, it was found that transformational leadership and perception of AI usage had a mediating role separately in the relationship between nurses' happiness and innovative work behavior. Finally, when the research model was tested, it was also determined that transformational leadership and perception of AI use have a serial mediating role in the relationship between nurses' happiness and innovative work behavior. Conclusions: This study revealed that nurse happiness has a significant and positive effect on innovative work behaviors, and transformational leadership and perception of artificial intelligence use have a serial mediating role in this relationship. Ultimately, this research offers some theoretical and practical implications for practitioners by emphasizing the strategic importance of transformational leadership practices and the integration of artificial intelligence technologies, as well as increasing the happiness levels of nurses to promote innovation in healthcare services. [ABSTRACT FROM AUTHOR]

Leishmaniasis is a significant zoonotic infection with global health implications, particularly in regions where human and animal health are closely interconnected. This cross-sectional study assessed the knowledge, attitudes, and practices (KAP) of 5,074 participants regarding leishmaniasis and the One Health concept. The socio-demographic data revealed that most respondents were young (82.6%), male (82.3%), and from rural areas (50.8%), with a majority based in Khyber Pakhtunkhwa (57.4%). Veterinary professionals (42.1%) and students (27.4%) constituted the primary respondents, with 32.4% working in government hospitals. Knowledge about leishmaniasis was high, with 97.5% of participants recognizing Leishmania and 86% correctly identifying it as a protozoan disease. The majority (71.8%) believed in the zoonotic transmission of Leishmania from animals to humans. Attitudes toward the One Health concept were positive, with 90.2% of respondents aware of it, and 95.5% acknowledged the zoonotic nature of the disease. Practices for controlling sandfly populations were observed by 56.4% of participants, with bed nets (44.9%) being the most common preventive measure. Results showed that younger participants had significantly better knowledge, attitude, and perception regarding leishmaniasis and One Health compared to older individuals. Veterinarians and government hospital staff demonstrated better KAP toward VL. This study underscores the importance of educational interventions and community-based control measures to enhance understanding and prevention of leishmaniasis, with the One Health approach playing a crucial role. [ABSTRACT FROM AUTHOR]

Background: The study aims to adapt the validity and reliability of the Pregnancy Quality of Life Scale in Turkish society. Methods: The study was carried out methodologically between April 2021 and April 2022 at Bayburt State Hospital, the only public hospital operating in the city center of Bayburt. In the study, a total of 355 pregnant women who met the research criteria and volunteered to participate were examined without selecting a sample. Validity and reliability analysis of language and content validity, explanatory and confirmatory factor analysis, and Cronbach- α coefficient were used. Results: The factor structure of the Turkish form of the scale was consistent with the original form. As a result of the explanatory appropriate. The internal consistency coefficient was calculated as the total Cronbach-α coefficient of the scale was 0.628 for the first trimester, and 0.628 for the II. trimester 0.727 for trimester, III. Trimester it is 0.698 for a trimester. Conclusion: As a result of the validity and reliability study, the Turkish version of the Pregnancy Quality of Life Scale can be used as a valid and reliable measurement tool. [ABSTRACT FROM AUTHOR]

Background: Achieving optimal glycemic control is vital for managing diabetes mellitus and preventing its complications, yet it is particularly challenging for individuals with diabetes and concurrent chronic kidney disease. Chronic kidney disease disrupts glucose metabolism and excretion, leading to pronounced and variable blood glucose fluctuations, thereby complicating diabetes management. So far, the intricate impact of chronic kidney disease on the glycemic control status of diabetic patients remains obscure, especially in Sub-Saharan Africa where both diseases pose an escalating burden. Objective: This study aimed to assess prescription patterns, glycemic control status, and the contributing factors to poor glycemic control among diabetic patients with comorbid chronic kidney disease at Tikur Anbessa Specialized Hospital, Ethiopia. Methods: A facility-based cross-sectional study was conducted from March 15 to May 15, 2024, from the electronic medical records of diabetic patients with comorbid chronic kidney disease who had received regular treatment and follow-up at the adult diabetes mellitus clinic of Tikur Anbessa Specialized Hospital. The sample size was calculated by using a single population proportion formula and accordingly, a total of 384 patients were recruited randomly and enrolled in this study. Descriptive statistics was employed for analyzing quantitative variables. Logistic regression analysis was performed to identify predictors of poor glycemic control status. Statistical significance was established at p-value < 0.05. Results: This study found that 98.2% of patients had type 2 diabetes, with a mean diabetes duration of 16.36 years. Only 4.4% achieved good glycemic control (glycated hemoglobin [HbA1c] < 7%), while 95.6% had poor glycemic control (HbA1c ≥ 7%). Insulin, metformin, and sodium glucose cotransporter-2 (SGLT-2) inhibitors were the most frequently prescribed anti-diabetic drug classes which accounted for 80.2%, 59.1%, and 41.4%, respectively. Presence of hypertension (AOR: 3.70, 95% CI: 1.08–12.71, P = 0.038) and regimen change in the past 01year (AOR: 0.34, 95% CI: 0.11–1.01, P = 0.050) were predictors of poor glycemic control status. Conclusion: This study reveals significant challenges in glycemic control among diabetic patients with comorbid chronic kidney disease (CKD). With only 4.4% of participants achieving optimal HbA1c levels, the findings underscore a critical public health concern regarding the management of diabetes in this vulnerable population. Clinical trial number: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Both climate change and intentional injuries (suicide attempts and violence) are recognized as crucial factors that affect human health. Previous studies revealed the association between ambient temperatures and deaths due to intentional injuries but mostly about the consequences of severe events. Our study aimed to examine suicide attempts and violence incidence including mild and moderate cases with future projections, using each injury's burden about climate change scenarios. Methods: We collected nationally representative cases of suicide attempts (8,512 cases) and violence (9,742 cases) from the Korea National Hospital Discharge In-depth Injury Survey from 2005 to 2019. We performed a two-stage analysis with a time-stratified case-crossover design to evaluate the associations of outdoor temperatures with suicide attempts and violence using historical data (2005–2019). Based on the estimated associations in the historical period, we projected the excess suicide attempts and violence attributable to ambient temperatures in the future (2020–2099) using the three shared socioeconomic pathway (SSP) scenarios. Results: We found positive associations between outdoor temperatures with suicide attempts and violence individually, and the association with violence was more linear. The excess suicide attempts attributable to temperatures in the historical period were around 11%, and it was expected to increase in all SSP scenarios (up to 14.35%). For violence, the excess risk of violence attributable to temperatures in the historical period was around 3.5%, and it was also estimated to increase in the future (up to 7.92%). Conclusions: The nationwide study about South Korea shows that there are associations between an increase in outdoor temperatures and increased risks of suicide attempts and violence, and each excess injury related to temperature is projected to grow under the SSP scenarios. Our findings might provide informative evidence for relevant action plans against climate change and intentional injuries. [ABSTRACT FROM AUTHOR]

Background: Low- and middle-income countries experience higher burn-related morbidity and mortality compared to high-income countries. Prehospital Burn First Aid (BFA) improves outcomes. We assessed BFA knowledge and water lavage practices and their associated factors among burn victims, caregivers, and visitors at a tertiary health facility in Uganda. Methods: A cross-sectional study was conducted at the Burns Unit of Kiruddu National Referral Hospital in Kampala between 1st April 2022 and 30th November 2022. Participants included burn patients, caregivers, and hospital visitors. Data on BFA knowledge and practices were collected using an interviewer-administered questionnaire. BFA knowledge was evaluated using 13 questions, with a ≥80% score considered adequate. Logistic regression was used to assess for associations. Results: We enrolled 404 participants, comprising 68 (16.8%) burn victims, 161(39.9%) primary caregivers, and 175 (43.3%) hospital visitors. Overall, 339 (83.9%) participants had never received BFA information, and 392 (97.0%) had no first aid training. The mean BFA knowledge score was 56±13.9%, with only 5.4% of the participants demonstrating adequate knowledge. Only 26 (27.7%) of current and former burn victims used water lavage as BFA. No statistically significant associations were found between BFA knowledge, water lavage usage, and demographic variables at univariable and multivariable binary logistic regression analyses. Conclusion: We highlight inadequate BFA knowledge and practices among victims of burns, their caregivers, and the general population. Addressing these deficiencies through community-based initiatives is crucial to improving burn care in Uganda. [ABSTRACT FROM AUTHOR]

Background: Substantial weaknesses and omissions of surgical informed consent are evident and the current elements of the surgical informed consent process are largely neglected in daily practice. This study aimed to assess surgical informed consent practice and associated factors among adult postoperative patients in public hospitals of Mekelle, Tigray, Ethiopia. Methods: Institution based cross-sectional study was conducted among 314 adult postoperative patients in public hospitals of Mekelle, Tigray, Ethiopia. Participants were selected using systematic random sampling. A pretested interviewer-administered questionnaire was used to collect data. Descriptive, Descriptive, bivariate and multivariable logistic regression analyses were performed using statistical package for social science version 27. Result: Only 35.8% (CI 95%, 30.6, 41) of the respondents were identified to have received the recommended (6 or more) components of surgical informed consent. Educational level [AOR 5.76 (1.02, 32.6)], timing of surgical informed consent delivery [AOR 3.27 (1.5, 7.11)], qualification of counselor who took surgical informed consent them [AOR3.185 (1.21, 8.38)], hospital type [AOR 2.85 (1.26, 6.46)], and duration of counseling [AOR 6.9 (3.33, 14.3)] were statistically significant at P<0.05. Conclusion: Majority of participants did not receive comprehensive information during the surgical informed consent process in the study hospitals. To improve the delivery it is suggested that health professionals; create rapport with patient, spend more time during counseling. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women (AGYW) seeking post-abortal care (PAC) remain at risk of unintended pregnancies and HIV due to infrequent condom use. Integrating HIV prevention services, such as PrEP, into PAC services offers an opportunity to enhance reach, uptake, and efficiency, particularly in high-burden settings like Kenya. However, data on acceptability, feasibility, and sustainability of PAC clinics as entry points for PrEP is limited. A cross-sectional qualitative study, part of a cluster-randomized trial in 14 Kenyan public and private facilities, explored the integration of PrEP delivery for AGYW aged 15–30 within PAC clinics. Using in-depth interviews, focus group discussions, and key informant interviews, the study gathered perspectives from AGYW, providers, and implementing partners. Guided by the theoretical framework of acceptability, findings revealed receptiveness for the integration as a timely and effective intervention to expand PrEP reach, enhance access , and reduce stigma. Provider competence, their attitudes towards the integration, and AGYWs' confidence in using PrEP were identified as critical influencers. Essentail operational considerations were staffing, availability of safe spaces, commodity management, and efficient reporting systems. The study highlights the acceptability and scalability of integrating PrEP services into PAC while emphasizing the need for strategies to enhance operational efficiency. [ABSTRACT FROM AUTHOR]

Objective: Infertile people undergoing assisted reproductive technology (ART) treatment in China may experience severe infertility-related stress and illness anxiety (IA). However, little relevant research has been conducted until now. Design: This study investigated the IA of 340 infertile people undergoing ART treatment, including 43 males, 292 females and 5 who preferred not to answer, in 2 tertiary general public hospitals in Wen Zhou, China. Main Outcome Measures: Blood samples for thyroid-stimulating hormone (TSH) levels were obtained from 107 women to explore the relationship between IA and TSH. The questionnaire contained the Mandarin version of the Fertility Problem Inventory, the Resilient Trait Scale for Chinese Adults and the Whiteley Index, measuring infertility stress, resilience and IA, respectively. Results: An incidence rate of 44.1% of IA among infertile people undergoing ART treatment in China was determined, and 30.2% of men and 46.6% of women had severe IA (χ2 = 4.05, p < 0.05). The risk of severe IA in women was around twice that in men (OR = 2.01, 95% CI: 1.01–4.01). Women's IA level was significantly associated with their TSH level (β = 0.27, p < 0.01). Resilience played a moderating role in the relationship between parenthood importance and illness anxiety. Conclusion: This study highlighted the importance and urgency of providing holistic care for illness anxiety of infertile people undergoing ART treatment in China, especially women. The findings of this study indicated that mind-body therapies and resilience empowerment workshops could be conducive to infertile people's holistic health. [ABSTRACT FROM AUTHOR]

In this qualitative study conducted at a public mental health outpatient clinic in Norway, the integration of patients' social network in treatment was examined. The aim was to explore the experiences of patients and their network during dialogical network meetings and discuss any similarities and differences between the two participant groups. Reflexive thematic analysis was performed on data obtained from fifty-three meetings, resulting in the development of five themes. For patients, there were two themes: "Enhanced trust within our relationships" and "Providing us a safe space to talk openly," and for network members there were three: "Empowered through participation," Being welcomed and taken seriously," and "Provide more clarity to enhance our ability to contribute." Mattering was employed as a conceptual framework to discuss the similarities and differences between the themes of the two participant groups. Both patients and network members placed strong emphasis on the freedom of expression and acknowledged the crucial role of the meeting leaders in facilitating discussions on important and challenging topics. Differences included network members' emphasis on feeling welcome and their need to add value, while patients emphasized strengthened relationships and feeling valued and empowered by being trusted to control the discussion content. Overall, mattering appears to be a valuable tool for understanding the relational dynamics within network meetings.\. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study is to determine the levels of nurses' fear of compassion for others, fear of compassion from others, and fear of self-compassion and to examine the effect of fear of compassion on caring behaviors. Design: A cross-sectional, quantitative design was used. Participants and research context: The study was conducted between October 2022 and April 2023 with 304 nurses working in two public hospitals. Data collection tools were the "Fears of Compassion Scales" and the "Caring Behaviors Inventory." Data were analyzed using a t test, one-way ANOVA, Pearson correlation analysis, and stepwise multiple regression model. Ethical considerations: Ethics committee approval of the research was obtained from the non-invasive ethics committee of Kütahya Health Sciences University (Reference No: 25.05.2022/2022/06-19). The principles of the Declaration of Helsinki were followed in the study. The purpose of the research was explained to all participants, and their verbal/written informed consent was obtained. Results: The mean scores of nurses on fear of compassion for others and from others were at a moderate level, and their scores on fear of self-compassion were close to a moderate level. It was found that the level of nurses' fear of compassion was related to their sociodemographic and professional variables. Fear of self-compassion, fear of compassion for others, and fear of compassion from others explained 33.5% of the total variance in caring behaviors. Conclusions: Nurses' caring behaviors were shown to be more associated with fear of self-compassion than fear of compassion for others. Fear of compassion may be one of the barriers to compassionate care. Interventions that will reduce nurses' fear of compassion may be one way to provide compassionate care. It is recommended to conduct awareness studies on self-compassion and accepting compassion from others in nurses. [ABSTRACT FROM AUTHOR]

Background: Nurse leaders increasingly need effective tools that facilitate the prioritisation of ethics and help staff navigate ethical challenges and prevent moral distress. This study examined experiences with a new digital tool for ethical reflection, tailored to improve the capabilities of both leaders and employees in the context of municipal long-term care. Aim: The aim was to explore the experiences of nurse leaders and nurses in using Digital Ethical Reflection as a tool for ethics work in home nursing care. Research design: The study employed a qualitative design, incorporating individual and focus group interviews for data collection. Qualitative content analysis was used to analyse the data. Participants and research context: The participants comprised six nurse leaders and 13 nurses, representing six home care zones across two Norwegian municipalities. Ethical considerations: The study involved informed, voluntary participation and was approved by the Norwegian Agency for Shared Services in Education and Research. Findings: Four themes were developed: a constant walk on the edge between engagement and discouragement and lost in translation describe the process, while tuning in to the ethical dimension and navigating ethical uncertainties illuminate the experienced significance of Digital Ethical Reflection. Conclusion: Success with Digital Ethical Reflection in home nursing care depends on clear leadership planning, nurses' understanding of the tool's purpose, and active use of digital registrations. Support from ethically interested nurses enhances overall engagement. Further research is needed to explore the potential of Digital Ethical Reflection as an additional tool in long-term care ethics work. [ABSTRACT FROM AUTHOR]

Elevated serum soluble alpha Klotho (s-αKlotho) levels are early biomarkers for overwork-related health risks, allowing timely intervention. This finding supports healthcare policies to limit work hours and promote a healthy work-life balance, reducing overwork-related diseases. Further research is needed for validation and intervention development. Objective: This study evaluates the utility of serum s-αKlotho levels as a quantifiable biomarker for overwork. Methods: Frontline medical workers aged 20–55 years from Yiling People's Hospital of Yichang were recruited. Criteria included nonsmokers, non-heavy drinkers, no chronic medication use, and no acute illnesses recently. Participants worked over 10 hours per day, 60 hours weekly, and had at least 3 years of experience. A control group was matched except for work conditions. Data were collected through surveys, and serum levels were measured. Results: Significant differences in serum Klotho were found between overwork and control groups. The overwork group had higher median s-αKlotho levels (49.99 pg/mL) compared to controls (27.88 pg/mL). Conclusion: Overworked medical workers exhibited elevated serum s-αKlotho, suggesting s-αKlotho as a potential biomarker for overwork. Future research should use multicenter designs with larger samples to validate findings. [ABSTRACT FROM AUTHOR]

Objective: We present an evaluation of antipsychotic prescribing in an inpatient psychiatry ward in Hobart, Tasmania, to establish pattern of use, alignment with other psychiatric wards or centres and the recommendations in the Royal Australian and New Zealand College of Psychiatry Clinical Practice Guidelines, and to determine predictors of polypharmacy. Methods: A descriptive cross-sectional survey design was used. Data from 118 patients discharged from the Royal Hobart Hospital (RHH) Mental Health Inpatient Unit between 01/02/2021 to 01/08/2021 were evaluated. Results: Antipsychotic polypharmacy (APP) was observed in 40% of patients. When low doses of adjunctive ('PRN') use of olanzapine and quetiapine were excluded, the APP proportion was 35%. APP was predicted by age and by a schizophrenia diagnosis. Long-acting injections (LAIs) were used in 46% of the patients. The most common LAI was risperidone (52%). Average daily dose of antipsychotic at the time of discharge was 529 mg chlorpromazine (CPZ) equivalents. High dose antipsychotics (more than 1000 mg CPZ equivalents per day) was observed in 13% of the patients. Conclusions: The observed prescribing practice is consistent with other clinical settings. Antipsychotic prescribing practice should, however, continue to be monitored to ensure adherence to best practice guidelines. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to conduct an in-depth survey of psychiatric care provided for children and young people (CYP) in general hospital settings in New Zealand (NZ). Method: As part of a larger national survey of Consultation-Liaison Psychiatry (CLP) services across the lifespan, a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for CYP at each of the 24 public general hospitals with specialist paediatric services. Results: Responses were obtained from all four paediatric CLP teams that cover the four specialist children's hospitals, and 16 of the 23 child and adolescent community mental health services that provide hospital inreach. These services were found to be under-resourced, utilise variable service models, and rely heavily on inreach. Conclusion: Escalating presentation rates for young people and increasingly complex paediatric presentations pose major challenges for the psychiatric care of CYP in general hospital settings. Utilising international staffing standards and service models, proposals are made to evolve more consistent and effective paediatric CLP services in NZ. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the effect of mothers' knowledge about asthma management on quality of life and asthma control among children with asthma in Palestine. Methods: This cross-sectional study was carried out by mothers of children with asthma in Palestine in four major public hospitals. Mothers of a total of 220 were selected randomly via a computerized system. Data were collected using Pediatric Asthma Quality of Life (PAQLQ), an Asthma Control Test (ACT), and the mothers' Self-Practices and Knowledge (SPK) of asthma management questionnaire. Statistical analysis was performed using SPSS (V25). Results: A total of 220 mothers of children with asthma were randomly selected and invited to participate but 182 agreed to participate, with a response rate of 83%. The mean age of participant children was 9.7 ± 2.72 years, and the mean age of mothers was 34.5 ± 9.6 years. The mean score of the QoL was 3.91(SD ± 1.61) out of 7. Most participant children had uncontrolled asthma with a total mean score of 14.13(SD ± 5.23) on the ACT. The mean score of mothers' SPK level was 2.12(SD ± 0.83) with a total mean score of 42.13 ± 3.68 out of 68, which indicated a moderate level of knowledge and there was a strong correlation between mothers' SPK and children's QoL. Conclusions: The investigation showed that mothers of children with asthma had moderate SPK, and the children had uncontrolled asthma with poor QoL. These findings suggest developing educational initiatives to enhance parents' asthma-related knowledge and skills to improve their children's asthma-related quality of life and asthma control. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility and acceptability of outpatient medical induction at 13-18 weeks' gestation to limit overnight hospital stays. Methods: In this prospective cohort study, participants with 13-18-week pregnancies seeking abortions at two government hospitals swallowed mifepristone 200 mg and self-administered misoprostol 400 mcg buccally 24-48 h later, 1-2 h before returning to the outpatient clinic (OPD). Repeat misoprostol was dosed every 3 h until expulsion. Participants requiring care beyond OPD hours were admitted as inpatients. Acceptability was evaluated by exit interview before discharge. Participants were contacted two weeks later to assess any subsequent issues. Results: Ninety-eight (82%) of 120 participants had successful outpatient abortions using a median two (IQR 2, 3) misoprostol doses. The median induction-to-abortion time was five hours (IQR 4, 7.5). Eleven (9%) participants expelled before clinic arrival. Twenty-two (18%) participants were transferred as inpatients at OPD closing. Transferred participants remained inpatient for a median 18 h (IQR 18, 21.25). There were no serious adverse events and satisfaction with the abortion process was high. Conclusions: Although the outpatient model did not meet statistical expectations, it is clinically feasible, acceptable, and improves efficiency, expands access, and reduces burdens for women and providers. Operational adjustments may facilitate higher outpatient success. SHORT CONDENSATION: Outpatient medical induction at 13-18 weeks' gestation is feasible, improves efficiency, expands access, reduces staff and patient burdens, and aligns guidelines and practice with evidence. [ABSTRACT FROM AUTHOR]

Hospitals serve as a public space for medical practice. They also serve as an educational space. Effective, transparent, and timely delivery of health information is important at all times but especially in times of pan/epidemics. A crucial part of the necessary information dissemination is language-in-use for multiple purposes (medical practice, education, research) among stakeholders. This study investigated the linguistic landscapes of hospitals in the People's Republic of China (China) in the COVID (post)pandemic period, roughly 2019–2022, to consider health information as language-in-use. Specifically, we examine the linguistic landscapes of three Grade A Class 3 hospitals in a multilingual, ethnic minority region by analysing 2354 signs for multilingual combinations, functionality and the way translations were used. We consider the role of language awareness in the experiential dimension to understand the linguistic medical landscapes. Our findings detect potentially biases linked to translation and language awareness and leading to potentially misleading information. The analysis also suggests the importance of a socio-cognitive perspective of the experiential dimension for future LL studies. PLAIN SUMMARY: Patients, families, and caregivers often make medical choices based on the prestige of the institution. Therefore, medical institutions engage in both informational and promotional efforts to attract stakeholders. This study considered how three top-level hospitals in one multilingual--multiethnic geographic area potentially shaped stakeholders experiences through the linguistic medical landscape (LML). The analysis showed that multilingualism was prevalent with bilingual Chinese-English signs close in number to monolingual Chinese signs. However, signs including the officially recognised ethnic language, Zhuang, were relatively fewer despite policies encouraging use of the language. The low visibility of Zhuang language (including lack of translations in Zhuang) suggested some tension in the extent to which the representational space could align with local minority stakeholders. The finding on multilingualism in signs suggested different functionalities for the different languages. The prevalence of Chinese with English translation also suggested the hospitals placed importance on internationalisation as well as local stakeholders. Further analysis considered cognitive schema as represented in the signs (e.g. representations of information as RULE, WARNING, OFFER). The analysis showed that Chinese and English were not always used in parallel. In some cases, this suggested dissonance in language awareness, evidence of translation faultlines, and potentially different meaning for different stakeholders. [ABSTRACT FROM AUTHOR]

This study was to determine risk assessment associated with bed bugs (Insecta: Hemiptera: Cimicidae) using participatory epidemiological tools in the selected public hospitals of district Faisalabad, Punjab, Pakistan. Bed bugs were collected and morphologically identified through a standard taxonomic key. A descriptive cross-sectional survey of patients using a pre-designed questionnaire containing open-ended and closed-ended questions was conducted for six months between January 2023 and June 2023. Of the 384 participants, 113 (29.43%) had experienced itching or skin irritation presumably from the bed bug feeding activity. The study further revealed patients above age 40 (35.43%) and males (30.57%) experienced greater skin irritation responses compared to other participants. Among administrative divisions (tehsils) in the city of Faisalabad, Tehsil Sadar had the highest number of participants with itching or skin irritation (35.48%), while Tehsil Chak Jhumra had the lowest number (24.62%). Most observations of bed bugs by patients were in their beds (10.42%), with chairs (3.91%) being the second most reported location. However, we found bed bugs from only 17 (4.42%) beds and 5 (1.30%) from chairs. A majority of patients (60.9%) reported daily change of bedding; however, a significant proportion (29.9%) reported infrequent changes. About 25.5% of the patients shared beds with others and about 77.1% of patients brought their own bedding or clothing to the hospitals. The current study concluded that the bed bug infestation is a problem in the public hospitals of Faisalabad, Punjab, Pakistan. Risk factors such as sharing a bed, infrequent change of bedding, and bringing personal bedding to hospital while having medical treatment pose a concern. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The insecure attachment styles are associated with mental health problems and can influence reality perception, particularly in individuals with schizophrenia. What the paper adds to existing knowledge?: The paper provides empirical evidence for the correlation between insecure attachment styles and reality‐testing impairment in clients with schizophrenia.Higher reality testing impairment scores were observed in specific demographics: males who were unmarried and aged between 40 and 50 years old, as well as those with a duration of illness of less than 5 years. What are the implications for practice?: The findings underscore the importance for nurses to understand insecure attachment styles, particularly anxious and avoidant styles, in clients with schizophrenia.Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships.A secure, structured and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation.Secure Attachment Style Psycho‐Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality‐testing impairment.Imply early intervention through educating mothers on fostering secure bonds can potentially prevent future occurrences of schizophrenia. What are the implications for future research?: Conducting empirical studies to explore the associations between insecure attachment style, social functioning, and poor service engagement is essential.Research is needed to investigate specific techniques for managing insecure attachment styles, particularly the avoidant ones, and reality testing impairments within the therapeutic setting. Introduction: Insecure attachment styles are associated with mental health problems and may influence reality perception. Aim: This study investigated the link between attachment styles and reality‐testing impairment in individuals with schizophrenia. Methods: A cross‐sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality‐testing abilities (Bell Reality Testing Inventory). Results: A significant positive correlation emerged between insecure attachment and poorer reality testing (r =.394, p <.001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality‐testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40–50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61). Discussion: Insecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains. Implication for Practice: Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho‐Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality‐testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers‐to‐be) and their children to promote healthy attachment styles as a preventive measure. [ABSTRACT FROM AUTHOR]

The article discusses the discontinuation of SGLT2 inhibitors (SGLT2i) in people with type 2 diabetes following hospitalization for heart failure. A study conducted in New South Wales, Australia, found that nearly 30% of SGLT2i users discontinued therapy within 90 days of discharge, with one in five remaining off treatment at 365 days. Factors such as age, hospitalization duration, number of prior hospitalizations, and chronic kidney disease were associated with higher discontinuation rates. The study highlights the importance of minimizing SGLT2i discontinuation to reduce mortality and readmission risks in this population. [Extracted from the article]