Hasil untuk "Nursing"

L. Ganong

J. Watson

J. Morris, C. Hawes, B. Fries et al.

L. Aiken, H. L. Smith, E. Lake

K. Schumacher, A. Meleis

M. Alligood

Hsiao-Yu Chen, J. Boore

Siedine Knobloch Coetzee, H. Klopper

C. Duffield, D. Diers, L. O'Brien-Pallas et al.

Enos Moyo, Hadrian Mangwana, Endalkachew Melese et al.

<b>Background:</b> Since the onset of the HIV epidemic, over 40 million individuals have died from AIDS-related illnesses, leading to nearly 14 million children aged 0–17 losing one or both parents to AIDS by 2022. In 2023, Namibia had 250,000 vulnerable children and 72,000 children aged 0–17 orphaned due to HIV and AIDS. Without parental support, orphaned and vulnerable children (OVC) face heightened risks, including neglect, distress, and compromised decision-making. These vulnerabilities can increase their susceptibility to risky behaviors, such as sexual experimentation. This study used data from the Project HOPE Namibia (PHN) OVC program to assess HIV testing rates and associated factors among OVC. <b>Methods:</b> This retrospective cross-sectional secondary analysis study used data from PHN’s OVC program implemented from 1 August 2023 to 30 November 2024. Data were analyzed using Chi-square tests and binomial and multinomial logistic regression. <b>Results:</b> Among the 16,995 participants included in this analysis, 15,014 (88.3%) participants had ever been tested for HIV (95% confidence interval (CI): 87.8–88.8%). Participants with an increased likelihood of having ever tested for HIV included those who had been in the program for 0–6 months (adjusted odds ratio (AOR) = 1.31, 95% CI (1.17–1.47)), and those from households experiencing little or moderate hunger (AOR = 1.29, 95% CI (1.12–1.50), AOR = 1.51, 95% CI (1.33–1.72), respectively. <b>Conclusions:</b> A multi-pronged approach involving all stakeholders is required to increase HIV testing among OVC. Such an approach should include community-based HIV testing, providing male-friendly healthcare services, and reducing household hunger through economically empowering vulnerable households.

Guy Tchuente

Many public services are produced in networked systems where quality depends on local effort and on how higher-level authorities monitor providers. We develop a simple model in which monitoring is a public good on a network with strategic complementarities. A regulator chooses between decentralized monitoring (cheaper, local oversight) and centralized monitoring (more costly, but internalizing spillovers). The model delivers an endogenous centralization threshold: for a given spillover strength, there exists a network size $n^\ast(λ)$ above which centralized monitoring strictly dominates; equivalently, for a given network size $n$, there is a critical complementarity $λ^\ast(n)$ beyond which decentralized oversight becomes fragile. A stochastic extension suggests that, above this region, idiosyncratic shocks are amplified, producing stronger peer correlations, higher variance, and more frequent deterioration in quality. We test these predictions in the U.S. nursing home sector, where facilities belong to overlapping organizational (chain) and geographic (county) networks. Using CMS facility data, We document strong within-chain and within-county peer effects and estimate network-size thresholds for severe regulatory failure (Special Focus Facility designations). We find sharp breakpoints at roughly 7 homes per county and 34 homes per chain, above which spillovers intensify and deficiency outcomes become more dispersed and prone to deterioration, especially in large counties.

Mohammad Abdullah Al Faisal

This paper examines the relationship between informal caregiving and both cognitive functioning and healthcare utilization among older adults with dementia. Using data from the RAND version of the Health and Retirement Study (HRS), a nationally representative longitudinal panel of U.S. adults over age 50, covering the years 2010 to 2022, I estimate Ordinary Least Squares (OLS) and Instrumental Variables (IV) models to address potential endogeneity in caregiving decisions. The number of children is employed as an instrument for informal care intensity. While OLS estimates suggest a negative association between informal caregiving and cognition, IV estimates show no significant causal effect after controlling for demographic, socioeconomic, and lagged cognition variables. In contrast, IV results indicate that informal care significantly reduces the likelihood of nursing home use, the number of institutional nights, and the probability of institutionalization. No robust causal effects are found for hospital use, doctor visits, or outpatient surgery, although there is some suggestive evidence of a complementary relationship between informal care and home health services. These findings highlight the role of informal caregiving in substituting for institutional care and underscore its importance in long-term care policy for dementia patients. Keywords: Informal Caregiving; Cognitive Decline; Instrumental Variables; Healthcare Utilization: Dementia Patients.

Zoi Lygizou, Dimitris Kalles

Background/Objectives: Efficient task allocation in hospital emergency departments (EDs) is critical for operational efficiency and patient care quality, yet the complexity of staff coordination poses significant challenges. This study proposes a simulation-based framework for modeling doctors and nurses as intelligent agents guided by computational trust mechanisms. The objective is to explore how trust-informed coordination can support decision making in ED management. Methods: The framework was implemented in Unity, a 3D graphics platform, where agents assess their competence before undertaking tasks and adaptively coordinate with colleagues. The simulation environment enables real-time observation of workflow dynamics, resource utilization, and patient outcomes. We examined three scenarios - Baseline, Replacement, and Training - reflecting alternative staff management strategies. Results: Trust-informed task allocation balanced patient safety and efficiency by adapting to nurse performance levels. In the Baseline scenario, prioritizing safety reduced errors but increased patient delays compared to a FIFO policy. The Replacement scenario improved throughput and reduced delays, though at additional staffing cost. The training scenario forstered long-term skill development among low-performing nurses, despite short-term delays and risks. These results highlight the trade-off between immediate efficiency gains and sustainable capacity building in ED staffing. Conclusions: The proposed framework demonstrates the potential of computational trust for evidence-based decision support in emergency medicine. By linking staff coordination with adaptive decision making, it provides hospital managers with a tool to evaluate alternative policies under controlled and repeatable conditions, while also laying a foundation for future AI-driven personalized decision support.

Andrew Maranhão Ventura D'addario

The evaluation of Large Language Models (LLMs) in healthcare has been dominated by physician-centric, English-language benchmarks, creating a dangerous illusion of competence that ignores the interprofessional nature of patient care. To provide a more holistic and realistic assessment, we introduce HealthQA-BR, the first large-scale, system-wide benchmark for Portuguese-speaking healthcare. Comprising 5,632 questions from Brazil's national licensing and residency exams, it uniquely assesses knowledge not only in medicine and its specialties but also in nursing, dentistry, psychology, social work, and other allied health professions. We conducted a rigorous zero-shot evaluation of over 20 leading LLMs. Our results reveal that while state-of-the-art models like GPT 4.1 achieve high overall accuracy (86.6%), this top-line score masks alarming, previously unmeasured deficiencies. A granular analysis shows performance plummets from near-perfect in specialties like Ophthalmology (98.7%) to barely passing in Neurosurgery (60.0%) and, most notably, Social Work (68.4%). This "spiky" knowledge profile is a systemic issue observed across all models, demonstrating that high-level scores are insufficient for safety validation. By publicly releasing HealthQA-BR and our evaluation suite, we provide a crucial tool to move beyond single-score evaluations and toward a more honest, granular audit of AI readiness for the entire healthcare team.

Yueqiao Jin, Kaixun Yang, Roberto Martinez-Maldonado et al.

Generative AI (GenAI) tools are rapidly transforming higher education, yet little is known about how students' GenAI literacy shapes their ability to perform independently once such support is removed. This study investigates what we term the agency gap, introduced as the extent to which GenAI literacy predicts student writing performance in contexts that require self-initiation and regulation. Seventy-nine medical and nursing students completed multimodal academic writing tasks based on visual data, supported either by a reactive or proactive GenAI chatbot, followed by a parallel task without AI support. Writing was evaluated across insightfulness, visual data integration, organisation, linguistic quality, and critical thinking. Results showed that GenAI literacy predicted independent writing performance only in the reactive condition, where students had to actively mobilise their own strategies. Mediation analyses revealed no indirect effect via in-task performance, indicating that GenAI literacy acts as a direct, task-general competence rather than a proxy for domain knowledge or other literacies. By contrast, proactive scaffolding equalised outcomes across literacy levels, reducing reliance on learners' GenAI literacy. The agency gap highlights when GenAI literacy matters most, with implications for designing equitable AI-supported learning environments that both leverage and mitigate differences in students' GenAI literacy.

Junyu Liu, Kaiqi Yan, Tianyang Wang et al.

Recent advances in large language models (LLMs) have demonstrated notable performance in medical licensing exams. However, comprehensive evaluation of LLMs across various healthcare roles, particularly in high-stakes clinical scenarios, remains a challenge. Existing benchmarks are typically text-based, English-centric, and focus primarily on medicines, which limits their ability to assess broader healthcare knowledge and multimodal reasoning. To address these gaps, we introduce KokushiMD-10, the first multimodal benchmark constructed from ten Japanese national healthcare licensing exams. This benchmark spans multiple fields, including Medicine, Dentistry, Nursing, Pharmacy, and allied health professions. It contains over 11588 real exam questions, incorporating clinical images and expert-annotated rationales to evaluate both textual and visual reasoning. We benchmark over 30 state-of-the-art LLMs, including GPT-4o, Claude 3.5, and Gemini, across both text and image-based settings. Despite promising results, no model consistently meets passing thresholds across domains, highlighting the ongoing challenges in medical AI. KokushiMD-10 provides a comprehensive and linguistically grounded resource for evaluating and advancing reasoning-centric medical AI across multilingual and multimodal clinical tasks.

Lincy Koodaly, Erika Friedmann, Nancy R. Gee et al.

<b>Background:</b> The growth of the older adult population calls for innovative and cost-effective ways of promoting their physical, psychological, and cognitive health. Human–animal interaction, including pet ownership, is related to positive and negative aspects of human health. Not all pet owners respond in the same way. The levels of pet attachment and pets’ influence on their owners’ lives could moderate the relationship between psychological status and health outcomes. <b>Purpose:</b> We examined the moderating role of pet attachment in the relationships of psychological status (mental wellbeing, happiness, anxiety, depression) to physical function (physical wellbeing, usual- and rapid-gait speeds, physical performance battery) in community-residing older adult pet owners. <b>Methods:</b> A cross-sectional, secondary analysis of pet-owning older adult participants in the Baltimore Longitudinal Study of Aging (n = 178). <b>Results:</b> In regression analyses, controlling for age, gender, and comorbidities, pet attachment and pet influence moderated the relationships of physical wellbeing to mental wellbeing and anxiety (<i>p</i> < 0.05). Pet influence also moderated the relationship between anxiety and usual gait speed (<i>p</i> < 0.05). <b>Conclusions:</b> Greater attachment and influence buffer the relationship of perceptions of poor mental function with perceptions of poor physical wellbeing suggesting one mechanism for health benefits of human-animal interaction.

Igbayilola Yusuff Dimeji, Adekola Saheed Ayodeji

Central obesity, atherogenic dyslipidemia, insulin resistance, and hypertension are among the metabolic dysregulations associated with metabolic syndrome (MetS). Insulin resistance and chronic low-grade inflammation are 2 of the many acquired and genetic components that make up the pathophysiology of MetS. MetS is strongly linked to a greater risk of diabetes and cardiovascular disease in the absence of effective treatment. To create effective intervention strategies and preventative techniques, the MetS process needs to be thoroughly examined. Recent research has emphasized the critical roles that metabolic endotoxemia and the gut microbiota play in the pathophysiology of MetS. The manipulation of gut microbiota‒host metabolism interactions has been linked to several factors, including bile acid metabolism, short-chain fatty acid metabolism, and inflammation caused by malfunction of the gut barrier. Pharmacological treatments for the gut microbiota are becoming increasingly popular as treatment alternatives. This brief message highlights some of the most recent developments in pharmaceutical strategies for preventing both gut dysbiosis and systemic low-grade inflammation caused by endotoxemia. Antibiotics, prebiotics, probiotics, synbiotics, postbiotics, and metabolite modulators produced from the microbiota are all used in these tactics. Particular focus is placed on next-generation treatments such as small chemical inhibitors of microbial‒host interactions, bacteriophage therapy, and tailored probiotics. Significance Statement: Pharmacologic alteration of the gut microbiota to target endotoxemia, a major cause of systemic inflammation, is a viable next-generation treatment for metabolic syndrome. These treatments help stop lipopolysaccharide translocation, restore metabolic balance, and improve insulin sensitivity by strengthening the gut barrier and changing the makeup of microbes. This method improves lipid metabolism, decreases chronic inflammation, and targets the underlying causes of disease. As a result, to improve results, treatment is moving from just managing symptoms to changing the disease itself.

Keila do Carmo Neves, Gabriel Nivaldo Brito Constantino, Ana Carolina Fernandes de Souza Gusmão et al.

Introdução: A Segurança do paciente visa reduzir o risco de dano desnecessário associado ao cuidado de saúde a um mínimo aceitável, sendo abordada constantemente nos diversos níveis de atenção à saúde. Objetivo: Assim, buscou-se verificar a percepção do acadêmico de enfermagem frente a segurança do paciente na Unidade de pediatria. Material e Métodos: Trata-se de um estudo exploratório descritivo, de abordagem mista (quantitativo + qualitativo), apresentando diferentes perspectivas dos graduandos de Enfermagem relacionadas a segurança do paciente nas unidades de pronto atendimento pediátrico por meio da pesquisa de campo. Resultados e Discussão: Analisando os dados, das 51 pessoas que responderam ao formulário, 100% descreveram que é de suma importância a segurança do paciente dentro do ambiente hospitalar, sendo o serviço de enfermagem fundamental para a recuperação do paciente. Em relação às facilidades e dificuldades encontradas para manter a segurança do paciente pediátrico, 1,9% não souberam responder, enquanto 98,1% narram a facilidade pelo contato diário com o paciente e a dificuldade ser a grande demanda que os profissionais têm. Ressalta-se que das 100% das pessoas que responderam a pesquisa 31,37% não fizeram nenhum curso complementar ou assistiu palestra sobre o tema segurança do paciente Conclusão: É de conhecimento geral que a segurança do paciente é de extrema importância, sobretudo a do paciente pediátrico, que é a temática abordada no artigo. Também é notável que cada vez mais os acadêmicos buscam conscientizar e se informar sobre o tema. Palavras-Chave: Enfermagem; Pediatria; Segurança do Paciente.

J. Por, Louise Barriball, J. Fitzpatrick et al.