Skin cancer is a significant public health problem; it is one of the most commonly occurring cancers worldwide and imposes a high economic burden on society.
This study aimed to elucidate the key factors affecting the cost of skin cancer in patients residing in southern Iran.
A comprehensive list of cost-affecting factors for skin cancer was developed through a scoping review of relevant literature from multiple databases (PubMed, ProQuest, Scopus, ISI Web of Science, SID, and Magiran), supplemented by expert input from skin cancer specialists. Subsequently, the data about 216 skin cancer patients selected randomly were collected between March 2020 and March 2022. The factors affecting the costs of skin cancer were determined using SPSS 13.0 software through statistical tests and multiple regression analysis.
Multiple linear regression analysis identified mortality (p < 0.001), inpatient days (p < 0.001), and skin cancer type (p = 0.056) as key cost drivers. Mortality had the strongest impact, increasing costs by $78,249 per case (95% CI: ±$12,433), followed by each additional inpatient day ($4884 ± $845). Melanoma cases incurred $3727 higher costs than non-melanoma cases.
In conclusion, mortality, cancer type, and inpatient days were key cost drivers in skin cancer management. To mitigate these, we recommend nationwide high-risk screening, hospitalization reduction strategies, and prevention programs. Targeted mortality reduction requires early detection initiatives and public education on warning signs.
Nearly half of American adults live with high blood pressure, of whom three-quarters do not have their blood pressure under adequate control. Many challenges exist in assessing blood pressure control, including in-clinic measurement biases and physiologic variability, limiting the ability to appropriately guide therapeutic changes.
This study's objective was to compare blood pressure (BP) variability in-clinic and at-home using a BP monitoring app.
This retrospective, observational study compared in-clinic BP measurements to at-home BP measurements recorded via a mobile application from April 2024 to May 2025. BP variability was assessed, comparing standard deviations (SD), control status (adequately controlled: systolic BP < 140 mmHg and diastolic BP < 90 mmHg), and both within-day and within-week timeframe fluctuations.
Among 304 patients with sufficient in-clinic data, the mean SD value for in-clinic systolic BP was 12.6 mmHg. Comparing at-home readings 2, 4, and 6 weeks before an in-clinic appointment for 207, 229, and 243 patients with sufficient data, 71.5%, 72.1%, and 72.8% of in-clinic measurements differed by more than 5 mmHg from average at-home systolic BP, and 30.1%, 29.8%, and 29.8% indicated a different hypertension control status, respectively. For patients with at-home readings, the mean systolic BP SD for 288 patients within the same day was 8.8 mmHg. Over 2, 4, and 6 week timeframes, mean SD increased to 10.5, 10.9, and 11.1 mmHg for 322, 329, and 336 patients with sufficient readings, respectively.
Reliance on single in-clinic BP measurements for hypertension management can be inaccurate due to significant variability over time. In addition to impacting treatment decisions, this may impact HEDIS metrics and Medicare Advantage Star ratings, which heavily influence healthcare revenue and quality perception. Findings indicate at-home BP monitoring can result in a meaningfully different BP control rate, emphasizing a role for at-home monitoring to enhance BP measurement reliability.
With the rise of globalisation, the demand for reliable and valid measurement tools that can be applied across diverse languages and cultures has become increasingly crucial. This situation requires the translation and adaptation of assessment instruments before they can be effectively used in new contexts.
This umbrella review aimed to synthesise and critically evaluate existing methods for translating and culturally adapting self-report health instruments.
A comprehensive search was performed in PubMed, CINAHL, and the Cochrane Library for reviews published between January 2000 and April 2025. Two independent reviewers screened the titles, abstracts, and full texts using predefined inclusion and exclusion criteria. Data were extracted and categorised into translation and cultural adaptation processes. The methodological quality of included reviews was appraised using the AMSTAR tool.
Nineteen reviews were included, identifying 46 distinct methods for translation and cultural adaptation. Considerable variation was observed regarding the number of steps, use of forward and back translation, expert committee involvement, and pre-testing with target populations. Only 10 methods fully implemented all essential steps recommended by quality evaluation checklists such as DuBay & Watson.
This umbrella review provides the first quantitative critique of translation and cultural adaptation methods for self-report instruments. Findings highlight the absence of a single ‘gold standard’ but support the adoption of structured, multistep approaches that integrate expert committee review and cognitive testing to ensure linguistic accuracy and cultural appropriateness.
This study aimed to investigate the metaphorical perceptions of the students of the Department of Physiotherapy and Rehabilitation regarding exercise.
The study was designed as a phenomenological case study, following the qualitative research method; it included 180 students from the Department of Physiotherapy and Rehabilitation. The students were asked to complete the sentence, “Exercise is like…; because…” to gain insight into their perception of exercise.
Students produced 180 metaphors, which were grouped into 13 different categories. Students most frequently compared exercise to the notions of water, reading, therapy, air, and medicine. The categories with the highest number of metaphors included “happiness and soothing,” “psychological impact,” “labour, care, and continuity,” and “valuable.” The metaphors suggested by the students of the Department of Physiotherapy and Rehabilitation toward exercise were positive; however, they defined exercise as a challenging activity that requires effort and continuity.
Most students included in the study used positive metaphors about exercise. A few students expressed negative sentiments. Investigating the perceptions of physiotherapy students on exercise beginning from their school years can provide a reference for adopting a better quality and holistic exercise approach, including teaching about and training on exercise, thereby enhancing their future role in developing exercise prescriptions and improving exercise adherence.
This cross-sectional study aims to compare the accuracy, precision and clarity of responses to dental implant questions from three artificial intelligence (AI) models: ChatGPT (OpenAI, GPT-4), Gemini (Google) and MedGebra.
56 questions from an EAO patient guide were used and responses from each AI system were evaluated independently by two oral surgery specialists using a four-point Likert scale for correctness, precision and clarity.
ChatGPT consistently scored highest especially in clarity with perfect marks from both evaluators. Gemini ranked lower in accuracy and precision but exhibited similar clarity. MedGebra received the lowest ratings on all criteria. Though consistency generally remained excellent, the inter-rater reliability study revealed some variance in agreement levels between two examiners.
ChatGPT and Gemini provided more accurate and informative responses on dental implants questions compared to MedGebra. According to the findings of the present study AI chatbots have potential for enhancing patient education on dental implants but professional oversight is crucial for ensuring accuracy and reliability. The study highlights the promising and potential benefits of large language models (LLMs) in dental patient education.
In the early weeks of the pandemic year 2020, health agencies were slow to warn of the potential for a global health emergency while scientists waited for ‘sufficient’ evidence of human-to-human transmission of the new coronavirus. There were further delays and confusion in issuing guidance because of uncertainty about the most important routes of exposure. A 2021 international expert panel review of COVID-19 pandemic response concluded: ‘The bias of the current system of pandemic alert is towards inaction—steps may only be taken if the weight of evidence requires them. This bias should be reversed—precautionary action should be taken on a presumptive basis, unless evidence shows it is not necessary’. To implement this recommendation, health agencies should incorporate the concept of precaution into their methods for rapidly and transparently reaching policy decisions. In this article, we summarise the historical development of precautionary policy frameworks, and present 4 key components. First, take action if potential risks are large, even when the science is uncertain. This corresponds to the common sense idea of ‘better safe than sorry’. Second, consider the burden of proof required before choosing among alternative actions. Third, ensure that the full range of potential solutions is considered by broadly defining the problem and consulting all relevant scientific fields. Finally, increase public participation so that all relevant perspectives are included, and the chances of public buy-in are increased. Drawing lessons from past applications and missed opportunities, we propose steps that health agencies could take to incorporate precaution into a pragmatic approach to using science for pandemic preparedness and response. The risk of another pandemic from the highly pathogenic avian influenza A (H5N1) virus underscores the urgency of this new approach.
To explore the role of the traditional Chinese medicine (TCM) health management model in improving the quality of clinical nursing services.
The respiratory department of a tertiary hospital began constructing and applying the TCM health management model in 2020. Taking this as the time node, the study was divided into two stages: between February and October 2019 (pre-implementation phase) and between April and December 2020 (post-implementation phase). A total of 300 patients were selected from those admitted during the post-implementation phase as the post-implementation group; another 300 patients were selected from those admitted during the pre-implementation phase as the pre-implementation group. Nursing management quality indicators, nursing service quality scores and patient satisfaction were compared and analysed between the two groups. Sensitivity analyses were conducted to adjust for potential time-related confounders.
Compared with the pre-implementation group, the incidence of adverse events in the post-implementation group was significantly reduced (3.33% vs. 8.67%, p < 0.05), the qualified rate of nursing documents increased to 98.33% (vs. 89.33%, p < 0.05) and the service response time was shortened to 5.2 ± 1.3 min (vs. 9.8 ± 2.1, p < 0.05). Regarding nursing service quality, the scores for guidance service, health education, triage nursing, medication management and risk control increased to 90.55 ± 4.18, 91.48 ± 4.29, 90.82 ± 3.97, 90.17 ± 4.49 and 91.65 ± 4.50 points, respectively (all p < 0.05). For patient satisfaction scores, service situation, treatment environment and treatment experience increased to 90.51 ± 4.71, 90.69 ± 4.78 and 90.29 ± 4.12 points, respectively (all p < 0.05).
Within the context of this single-centre quasi-experimental study, the TCM health management model showed potential in optimising nursing processes and improving selected quality indicators in the respiratory department. However, these findings require validation through multicentre randomised controlled trials before broader implementation can be recommended.
This study offers preliminary insights into integrating traditional medicine approaches with modern nursing practices, although further research is needed to establish broader applicability, particula
Paolinelli, J.P.V., de Alencar, T., Rocha, K.S.S., Pereira, M.L. and dos Santos Júnior, G.A. (2025), Implementation of Clinical Pharmacy Services in Primary Health Care: A Scoping Review. Journal of Evaluation in Clinical Practice, 31: e70285. https://doi.org/10.1111/jep.70285.
The graduate program in the affiliation for Kérilin Stancine Santos Rocha is incorrect:
2Laboratory of Innovation for Healthcare (Linc). Postgraduate Program in Pharmaceutical Assistance (PPGASFAR), Federal University of Espírito Santo, Vitória, ES, Brazil
The correct affiliation should be:
2Laboratory of Innovation for Healthcare (Linc). Graduate Program in Pharmaceutical Services and Policies (PPGASFAR), Federal University of Espírito Santo, Vitória, ES, Brazil
We apologize for this error.
This study aims to systematically retrieve, evaluate and synthesize the best evidence for medication adherence management in adult tuberculosis (TB) patients, providing an evidence-based foundation for optimizing clinical practice.
Evidence-based questions were formulated using the PIPOST model. Following the ‘6S’ model, 19 Chinese and international databases (BMJ Best Practice, WHO, Cochrane Library, etc.), guidelines and professional association websites were searched from their inception to March 2025, using keywords such as tuberculosis, TB, medication adherence and drug adherence. Clinical guidelines, systematic reviews and manuals were included. Four researchers independently assessed the quality of the literature using AGREE II, AMSTAR and the Johns Hopkins Nursing Evidence-Based Practice Manual tools. Extracted evidence was classified, summarized and graded using the JBI Evidence-Based Healthcare Center's evidence hierarchy system (2014).
Fourteen publications were included (five systematic reviews, six guidelines, three manuals), yielding 25 pieces of evidence across four dimensions: healthcare services, medication adherence supervision, adverse drug reaction management and patient social support. Key evidence included: Providing patient-centred care (Level 1 evidence); delivering health education and counselling throughout treatment (Level 1); implementing directly observed therapy (DOT) and digital health technologies (Level 1); prioritizing adverse drug reaction management (Level 4); strengthening social support systems (Level 1).
This study integrates a multidimensional intervention framework to systematize adherence management in adult TB patients. However, clinical implementation must consider regional resources, cultural differences and individual patient needs. Future research should focus on three priorities: (1) scaling digital technologies; (2) developing adverse reaction early-warning systems; and (3) exploring cost-effective interventions.
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