Journal of Medical & Clinical Nursing is an open access peer-reviewed journal from the publishers of Scientific Research and Community (SRC) which publishes articles in the form of written, video and power-point presentations from the arena of Medical & Clinical Nursing. The journal focuses to build up accessing the complete content of articles freely from online for reader’s perusal. Article acceptance will be in the form of Research, Review, Case Reports, Analysis, Magazines, Editorials, Opinion, Communications, Mini-Review, Short Communications, Picturized, Book Review, Video Type and Power Point Presentations (PPTS). Articles can be submitted through online from https://srcpublishers.com/medical-clinical-nursing/user/register or can send through an Email with attachment for nursing@onlinescientificresearch.info 2.023 Impact Factor 84.5% Citations 90% Acceptance
Expanding the Framework: The Integral Role of Nurses inInformatics-Driven Telehealth for Addressing Social Determinantsof Health
As healthcare systems increasingly transition toward digitally mediated models of care, the role of nurses particularly registered nurses (RNs) has evolved beyond traditional bedside functions into dynamic, data-informed, and equity-driven practice. Within a telehealth framework grounded in health informatics, nurses emerge not merely as participants in care delivery but as central agents in identifying, interpreting, and responding to the social determinants of health (SDOH) that shape patient outcomes. Their position at the intersection of clinical care, patient advocacy, and care coordination uniquely situates them to operationalize equity within technologically advanced healthcare systems.
Copyright (c) 2026 Journal of Medical & Clinical Nursing
Active Drug-Free Prophylaxis of Hypotension Supine Syndrome in Pregnant Women for Safe Obstetric Surgical Interventions Under Local Anesthesia
Background: Due to the increase in the number of non-obstetric surgical interventions during pregnancy under local anesthesia, surgeons have encountered such a pathology as hypotension syndrome on the back during pregnancy (SHSP). This pathology was described by Howard R. et al. (1953). It only occurs in pregnant women, starting in the middle of the 11th trimester and throughout the 111th trimester. It manifests itself in a decrease in blood pressure (BPD) in pregnant women by 30-40% of baseline within 2-10 minutes, with corresponding clinical manifestations in both the pregnant woman and the fetus. Pathology occurs in patients who mainly lie on their backs, less often sitting. According to various authors, this pathology occurs in 20-70% of this group of patients - from latent forms to hypotonic shock. The task is to develop and actively implement safe surgical intervention under local anesthesia of the position of a pregnant woman on the operating table as one of the factors in the prevention of SHSP. Material and Methods: The analysis was carried out on the basis of 780 non-obstetric surgical interventions in pregnant women in the 11th and 111th trimesters under local anesthesia for primary symptomatic varicose veins of the lower extremities in saphenoid, non-saphene veins and in combination. All pregnant women during surgery were placed on the operating table in the initial position, lying on their backs, and the table top was turned 30 0 to the left, with both lower limbs bent at the hip and knee joints at 120 0, the head and chest raised by 30 0.In this position, for 2-3 minutes, we observe the dynamics of pressure on the brachial arteries, pulse rate and the presence of clinical manifestations of SHSP. Result: 98.3% of operated pregnant women showed no manifestations of SHSP. 1.7% showed mild manifestations of SHSP, requiring a change to 45 0, while the pressure stabilized to baseline without clinical symptoms in pregnant women with this pathology. Drug therapy support was not required. Conclusion: The proposed position of the pregnant woman on the operating table stabilized blood pressure, minimizing compression by the pregnant uterus of the terminal section of the abdominal aorta and/or the initial section of the inferior vena cava due to its mixing to the left, which improved hemodynamics in these areas. The postoperative period in the operated patients passed without signs of disruption pregnancy and intrauterine development of the fetus. This position of the pregnant woman may be recommended in bed to maintain pregnancy and prevent SHSP.
Scientific Substantiation of the Use of Leech Therapy in the Post-COVID Era
The COVID-19 pandemic and its long-term consequences, commonly referred to as Post-COVID Syndrome, have created significant challenges for healthcare systems worldwide. While acute COVID-19 infection has been extensively studied, the chronic post-infection phase is often associated with thrombotic complications, persistent inflammation, and disruptions in physiological homeostasis. Current therapeutic approaches primarily rely on anticoagulants and supportive treatments, which may have limitations and contraindications during prolonged use. This presentation examines the scientific basis for the application of leech therapy (hirudotherapy) as a complementary rehabilitation strategy in the post-COVID era. The approach is supported by a series of discoveries and investigations conducted between 1993 and 2016, including the identification of energy-information effects, neurite-stimulating effects, detoxification mechanisms, immunomodulatory actions, resonance-wave phenomena, and aquastructuring effects associated with medicinal leech therapy. Clinical observations suggest that the System Method of Leeching may contribute to reducing thrombotic risks, improving detoxification processes, restoring homeostasis, and supporting recovery in patients experiencing Post-COVID Syndrome and related complications. The method has also been applied in individuals affected by adverse reactions following COVID-19 vaccination. Given the growing need for safe and effective rehabilitation strategies, hirudotherapy represents a potential adjunctive approach that may complement conventional medical interventions. The presentation reviews the scientific evidence, theoretical foundations, and practical applications of leech therapy in addressing post-COVID health challenges and promoting patient recovery.
Stroke Impact Scale, a Clinical and Research Tool to Evaluate Outcomes after Stroke and to Evaluate Recovery Progression after Intervention
Stroke continues to be the second leading cause of death, and the third with regards to disability. The assessment of outcomes in individuals after stroke is important for both clinical practice and research. Unfortunately, there were no best measures of stroke outcome in either clinical practice or research until the Stroke Impact Scale (SIS) that was developed by our team in 1999. The SIS has 59 items in eight domains: strength, hand function, ADL/IADL, mobility, emotion, memory, communication, and social participation. The SIS was also validated for its Psychometric Properties including validity, reliability, and sensitivity/responsiveness. The SIS has been established not only for in-person interviews but is also validated for telephone and mail-mode of administrations. Our team also developed a Stroke Impact Scale 16 to evaluate stroke in physical functioning. These instruments have been used and translated worldwide on every continent.
Differences in Patient Satisfaction with Family Planning Care asa Result of the Modality of Delivery: In-Person Versus Telehealth
Family planning is known to be traditionally an in-person appointment; however, with the rise of telehealth services, many of these appointments can be conducted remotely or simultaneously with traditional in-person care. The ability to have both options for treatment methods, telehealth (video, phone, instant messaging) and in-person care, provides a well-rounded structure that can bridge gaps for patients. Therefore, the purpose of this research is to evaluate differences in patient satisfaction between individuals who received family planning services via telehealth and those who received them in person. Telehealth, also known as telemedicine, enables patients to access healthcare services remotely, often through phone or video platforms. Its adoption accelerated during the COVID-19 pandemic due to its convenience, flexibility, and reduced risk of disease exposure. While family planning services have traditionally required in-person visits, the shift toward hybrid and virtual models has broadened access, especially for underserved populations. This research explores the role of telehealth in family planning delivery within managed care organizations (MCOs), with a specific focus on satisfaction, access, and equity.
Digital Health for All: Ensuring Equity in Global Patient Carein Ghana-A Case Study of Student Perceptions at PresbyterianNursing and Midwifery Training College (PNMTC), Agogo
Background Digital health technologies, including telehealth, AI diagnostics, and mobile health applications, have transformed patient care allowing for accurate diagnostics, remote patient monitoring, reduced costs, and improved outcomes. However, these technologies risk exacerbating existing health disparities. At the same time, little is known about nursing students’ perceptions of these tools in Ghana. This study assessed awareness, perceived benefits, barriers, and equity concerns regarding digital health tools among nursing and midwifery students at Presbyterian Nursing and Midwifery Training College (PNMTC), Agogo. Methods A descriptive cross‑sectional survey of 99 students at their 2nd and 3rd year of learning was conducted using a structured questionnaire. Collected data was analyzed using SPSS v.23. Results The findings show that 63.6% of respondents had intermediate digital competence, but only 35.4% had received formal digital health training. 54.5% had grown in urban areas. The use of internet/AI to find health information was the highest among the students (mean=3.66/5). Advanced digital competence users scored significantly higher than beginners on using internet/AI for finding health information (p=0.034). Students agreed on benefits (means 3.38– 3.45) but identified lack of connectivity (mean=3.65) and privacy concerns (mean=3.46) as major barriers. The infrastructural disparities between urban and rural areas is strongly perceived among all students regardless of where they grew up (mean=3.66). Conclusions Nursing and midwifery students strongly acknowledge the benefits and barriers of digital health. However, there are significant educational and preparedness gaps and infrastructural barriers. It is highly recommended that formal digital health training be integrated into the nursing curriculum as policymakers work on addressing existing infrastructural gaps in rural regions of Ghana to achieve equitable digital health adoption.
Can Homeopathy Play a Role in the Treatment of Multimorbid Patients? A Prospective Outcome Study
Polypharmacy is one of the main problems in conventional treatment of multimorbid patients who have a combination of three or more concurrent complaints. They often receive a multitude of medicines with interactions that are difficult to overlook. In complementary medicine a holistic approach is one of the core-competences of homeopathy. Repeated single remedies or a staggered timing of different remedies can induce improvement in multimorbid patients without causing interactions. In a prospective homeopathic outcome study we followed 50 multimorbid patients over one year, aiming to answer the following questions: How many patients can be successfully treated and reach an subjective global improvement rating of 80% or more. And how do the estimated costs of conventional and homeopathic treatment compare, if conventional treatment can be reduced or phased out completely. Results: Fourtythree patients (86%) completed the observation reaching an average improvement of 91% of their initial symptoms. Six patients dropped out, and one did not reach an improvement of 80%, and was therefore also counted as a treatment failure. The cost of homeopathic treatment is estimated to be only 41% of an analogue conventional therapy. Conclusions: Homeopathy is able to cover a considerable part of the treatment of multimorbid patients, and it causes lower costs than conventional medicine.
Enhancing Sexuality Education to Prevent HIV Transmission Among Filipino Young Key Populations: A Policy Analysis
Background: Human Immunodeficiency Virus (HIV) is growing rampant among vulnerable populations in the Philippines. Projected estimates show that the Philippines experienced a 555% increase in new HIV infections between 2010 and 2024. Current projections reveal that 46% of new infections in 2024 were from the 15-24 age group, also referred to as the young key population (YKP). YKPs, especially those belonging to the adolescent age bracket, are more likely to engage in risky behavior and have difficulties in accessing HIV-related services. It is thus important to guide them toward safe sexual practices. While there are existing policies for education campaigns on HIV, there are no clear guidelines for their standardization and implementation. Comprehensive Sexuality Education (CSE) is already included in secondary and tertiary education curricula, as mandated by the HIV and AIDS Policy Act of 2018, yet it is not effectively delivered to the students due to censorship, hesitancy of teachers to convey messages, or inadequate knowledge among teachers in sexuality education. This analysis aims to examine policy alternatives which can improve the implementation of CSE among YKP attending schools. Methods: A policy analysis which adopted the 2013 US Center for Disease Prevention and Control Policy Analytical Framework was conducted in order to determine alternatives which could improve the coverage and effectiveness of CSE for YKP. Results: Review of secondary literature and insights from policy and programmatic informants yielded the following policy alternatives:(1) no change but reinforce implementation; (2) issue guidelines on prescribed modules and add feedback mechanisms; (3) regulate educators through certification requirements; and (4) build partnerships with institutions and organizations who can dispatch peer educators. The second and fourth alternative received the highest score based on five domains. Conclusions: Issuing national guidelines for the implementation of age-appropriate CSE, along with creating evaluation mechanisms to measure the effectiveness of education, can ensure that the youth are receiving quality health education which they can apply in their practice and behavior. Outsourcing peer educators through partnerships may be effective without exhausting internal manpower.
Human Immunodeficiency Virus, Reproductive Health, Sex Education, Youth
Evaluating the Impact of Respiratory Therapist–Led Case Management on Chronic Respiratory Disease Outcomes
Respiratory diseases, particularly asthma and chronic obstructive pulmonary disease (COPD), continue to present major public health and economic challenges in the United States. These chronic conditions contribute significantly to healthcare expenditures and are associated with elevated morbidity and mortality rates. As healthcare systems shift toward value-based care, there is growing emphasis on strategies that improve chronic disease outcomes while containing costs One promising solution is the expanded role of respiratory therapists (RTs) in case management. Given the burden of chronic respiratory diseases and the evidence supporting coordinated care, this paper examines the potential benefits of integrating RTs into case management positions. Through analysis of population-level data and a review of current care models, the goal is to assess whether RT-led case management can improve outcomes and reduce utilization in asthma and COPD populations. The purpose of this research is to evaluate the impact of integrating respiratory therapists (RTs) into case management positions, with particular emphasis on their impact on clinical outcomes, care coordination, and cost-effectiveness in the management of chronic respiratory diseases.
COPD, Respiratory Therapist, (RT), Chronic Disease Case Management, Chronic Respiratory Disease, RT Underutilized, Integrated Health Care
The Impact of Employee Engagement and Structured Rounding on Patient Satisfaction in a Post-Surgical Unit
Employee engagement and leadership presence are essential components of high-quality patient care, yet many acute care settings struggles to translate these concepts into measurable outcomes. This quality improvement initiative examined the impact of structured leadership rounding, interdisciplinary collaboration, and intentional staff engagement strategies on patient satisfaction within a high-acuity post-surgical unit. Over a 12-month period, interventions included implementation of a standardized rounding tool, Daily Interdisciplinary Rounds (IDR), and targeted employee engagement practices. Results demonstrated a significant increase in patient satisfaction scores from below 60% to above 90%, alongside improved staff accountability, communication, and interdisciplinary coordination. These findings reinforce the critical role of engaged leadership and structured processes in enhancing patient experience and achieving sustainable quality outcomes.
A Solid-State Liposomal Delivery System for Improving Oral Calcium Bioavailability: A Human Absorption Study
Calcium is an essential mineral for bone health; however, its oral bioavailability is often limited by gastrointestinal conditions and absorption mechanisms. Liposomal technology, particularly in solid-state formulations, has been proposed to enhance nutrient stability and bioavailability. This study aimed to evaluate the effects of solid state liposomal calcium on blood calcium response and absorption efficiency compared with non-liposomal calcium. A randomized crossover design was employed. Subjects received a single dose of either solid-state liposomal calcium or non-liposomal calcium, and blood calcium levels were measured over an 8-hour period. The area under the curve (AUC) was calculated to assess overall calcium exposure. Solid-state liposomal calcium significantly increased blood calcium levels at early time points (1–2 h; p < 0.05) and maintained elevated levels up to 8 h post-administration. The AUC was higher in the liposomal group (2.94 mg·h/dL) compared to the non-liposomal group (1.88 mg·h/dL), representing a 1.56-fold increase in systemic calcium exposure. Solid-state liposomal technology enhances both the rate and extent of calcium absorption, demonstrating its potential to improve calcium bioavailability.
Double Nutri ® Solid, Liposomal Calcium, Calcium Bioavailability, Solid-State Formulation
The Power of Presence: How Leaders Can Transform Cultures, Break Barriers and Build Legacies
Sometimes it begins in a quiet moment—the one when you decide you will no longer sit silently when change is needed. I learned this early in my nursing career, long before “Director” was attached to my name. It happened the day I watched a brilliant nurse’s voice be dismissed in a meeting because she was “too passionate.” I spoke up. It wasn’t easy, but it was necessary. And that moment was a turning point, not just for her, but for me
Post Reperfusion Syndrome In Liver Transplant After NormothermicPerfusion
Introduction. Post reperfusion syndrome (PRS) is defined as severe haemodynamic instability, with a greater than 30% drop below the anhepatic mean arterial blood pressure (MAP) within 5 minutes of reperfusion sustained for at least 1 minute. It is an important factor in graft survival, recipient morbidity and mortality. The donor liver storage method may influence the incidence of PRS. Cooling the donor liver in cold storage (CS), is the conventional method. Normothermic Machine Perfusion (NMP) is a novel method that may reduce the incidence of PRS. Patients and Methods. Data from a previously published randomized trial comparing donor livers preserved with CS or NMP, using Organox machine (OX), was used to perform a retrospective analysis on 22 patients (11 CS, 11 OX). Recipient and donor demographics were evenly matched between patients. The primary outcome was the incidence of PRS with secondary outcomes being inotrope, blood product and fluid requirements. Data was examined for normality, and compared using Fisher exact test or Mann-Whitney. Results. PRS occurred in 54% (n=6) of the CS group compared to 18% (n=2) of the OX group, p=0.183. The percentage drop in MAP was significantly lower for the OX group (15.8%) compared with the CS group (40%) p= 0.007. Total amount of adrenaline used was lower in the OX group compared with the CS group, p=0.088. Total amount and number of patients on noradrenaline was similar between groups. Total fluids administered was less for the OX group (5090 mls) compared within the CS group (7419 mls) p=0.365. The OX group received less blood products in the post reperfusion phase compared to the CS group, however this was not statistically significant. Discussions and Conclusions: We observed a reduced incidence of PRS in patients receiving NMP compared to CS livers, with improved haemodynamics and lower adrenaline requirements.
An Innovative Nursing Management Solution to Improve Community-Based Health in Prisons: Modelling in Ireland for a Global Approach to Community-Based Health in Detention
People deprived of their liberty are often vulnerable due to poor health and living choices. These can include drug addiction and associated blood-borne virus risks, amongst people who Inject Drugs (PID). Prison populations also include people who have neglected their health, suffering chronic Non-Communicable Diseases (NCD) as well as being vulnerable to violence in prisons. The nature of prisons requires its organisation into regimes in order to manage the large populations whilst also providing safe and secure custody. As a result, clinical care, drug administration, nursing interventions and mealtimes for both prisoners and staff must be managed according to tight time windows. The role of nursing in Irish prisons needs to fit into the organisational regimes of the prison. Experience has indicated that the important nursing role in providing community-based health awareness is limited due to the existence of regimes. Following an audit of prison healthcare in Irish prisons, the need to provide an innovative solution to community health and wellbeing awareness within the community was apparent. A model originally developed within the Red Cross/Red Crescent Movement, using community members as peer educators was adapted, planned and implemented as action research in one prison and then extended to all prisons in Ireland over a five-year period. This innovative nursing management solution required the adoption of the WHO (2007)’ whole prison’ approach to health and the organisational changes to effect it. The theoretical underpinning of the project was based on systems theory, the fractal models of chaos theory and complex adaptive systems. Following fifteen years of successful operation in Irish Prisons, a Global Hub for community-based health in Detention was established in Ireland. Using the Irish model, Community-Based Health in Detention was piloted in Northern Ireland, Wales (UK), Australian and Norwegian Prisons. Evaluations in Ireland and internationally identified the important value of training prison inmates as peer health educator volunteers linked to prison healthcare units. This paper explores the development of a successful working model of peer health educators as an extension of nursing. It has resulted in reduced violence, increased health screening participation and increased self-esteem and mental health amongst prisoner peer educators. The use of the theoretical principles underpinning the Irish model in other jurisdictions is described.
Cardiology at a Crossroads: From Volume to Value in the IndianContext
Cardiovascular disease remains the leading cause of death in India, despite major advances in cardiology. This editorial highlight the growing disconnect between technological progress and equitable, outcome-driven care. Key challenges include early-onset coronary artery disease, gaps between guidelines and real-world practice, limited emphasis on prevention, and variability in access to evidence-based therapies. The need for context-sensitive guidelines, indigenous research, ethical practice, and strengthened training is emphasized. The potential of digital health to reduce care disparities is discussed, alongside the importance of patient-centered, value-based cardiology. A balanced approach integrating innovation, affordability, and prevention is essential for improving cardiovascular outcomes in India.
Mucormycosis (Black fungus): An Emerging Fatal Mycosis of21st Century- An Overview of History, Epidemiology, ClinicalSpectrum, Diagnostic Approaches and Treatment
Mucormycosis (zygomycosis, black fungus), is an emerging, noncontagious, opportunistic, life-threatening disease of sinuses, lungs, skin and brain of immunocompromised individuals, caused by the mucoraceous fungi. Friedrich Küchenmeister, a German physician, discovered the first case of mucormycosis in 1855. The fungal infections of humans, called mycoses, are a growing global health concern affecting more than one billion people causing over 3.75 million deaths each year. Due to the global surge in mucormycosis incidence with a marked increase in India and China especially among patients with uncontrolled diabetes mellitus (DM), it is designed as an emerging fatal mycosis of the 21st century. Globally, 39 fungal species belonging to 11 genera of Mucoromycetes (Mucoromycota) are involved in mucormycosis. Seventy-five percent incidences of mucormycosis are caused by the 3 genera Rhizopus, Mucor, Lichtheimia, and Rhizopus arrhizus (R. oryzae) alone is the main causative agent involved in 50 % of all cases of mucormycosis globally. The mortality rate is much higher in mucormycosis, considered to be an emerging mycosis, compared to aspergillosis and candidiasis, the two other fatal emerging mycoses. The infection mainly occurs when the fungal spores (sporangiospores) are inhaled by humans from the environment of the saprophytic mucoraceous fungi occurring in soil and decomposing plant residues. The inhalation is the most common mode of transmission compared to inoculation and ingestion. The epidemiology and mortality, despite antifungal therapy, has shown an exponential rise, the disease named as “black fungus” in 2021 following the second wave of COVID-19 pandemic. Prevalence of mucormycosis in India is nearly 80 times higher than global picture. Histopathological microscopic examination of stained biopsy samples for nonseptate wide hyphae and identification of fungi based on fungal culturing are often used in diagnosing mucormycosis. Molecular (PCR- based fungal DNA), qPCR kits, protein homolog in spore coating, serology, and imaging techniques are the other diagnostic techniques. Early diagnosis and prompt initiation of antifungal therapy along with surgery and control of risk factors are needed for successful management of mucormycosis. Antifungal drugs to treat mucormycosis include: amphotericin B, Isavuconazole, posaconazole and itraconazole, the former two recommended by the USFDA for the primary therapy. Amphotericin B, preferably liposomal amphotericin B (L- AMB), is the drug of choice globally for managing mucormycosis of various types: rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, renal, disseminated and COVID-19-associated mucormycosis.
Comparing USA and Mexico Response to COVID as well asIncidence and Death Toll for the First 6 Months from February2020 to August 2020 and the Pandemic on June 1st 2021
Both Mexico and United States share a border as well as Mexico being the country with the most American citizens living abroad and United States housing millions of individuals of Mexican descent, Covid 19 has impacted the world and both countries health system Mexico having to deal with the impact of a pandemic with a much lower budget and personnel compared to United States and aswell United States having to deal with a pandemic occurring in a country with more 330,000,000 persons of all type of ethnicities United states has being the country with the most cases confirmed of covid 19 in the World in this article we will compare the first 6 months of covid 19 in Mexico as well as in the United States and current data for nowadays of Covid 19.
Copyright (c) 2021 Journal of Medical & Clinical Nursing
The Experience of Separation and Grief Among Family Members of Hospitalized African American Patients Who Expired FromCOVID-19
The coronavirus disease (COVID-19) pandemic highlighted multiple consternations in our healthcare system, among which were the lack of preparedness of our federal public health response, impact on our frontline responders, recognition and contributions and burden on our essential workers, and disparity in health challenges and outcomes among minority patients diagnosed with the disease. However, little focus has been given to understanding the experience of abrupt separation and grief on the family members of COVID-19 patients. The purpose of this study was to understand, using a phenomenological design, the experience of separation and grief among family members of a group of African American patients who were hospitalized and subsequently expired from COVID-19 during the first surge of the pandemic. A purposive sample of 10 family members of patients who were hospitalized with and later expired from COVID-19 were recruited. Data collection was conducted using unstructured interviews. To capture the essences and meaning of this lived experience, the study was underpinned by Heidegger’s ( 1962) phenomenological perspective and was guided by van Manen’s ( 1990) methodological activities. The findings revealed that, for these participants, lived time was a marker of the rhythmic patterns of events during the experience, lived space was the confrontation of new limitations amid the dynamics of chaos and uncertainty, and lived relation (i.e., relationality) highlighted the caring/noncaring attributes of social and healthcare networks and their embrace of spirituality while coping with stigma and blame. Lived body emoted the parallel physical and emotional manifestation of the disease.
Humanitarian Crises, A Roadblock to Global Health Vaccinationand Immunisation Initiatives
Background: Humanitarian crises have a significant negative impact on global health initiatives. Humanitarian crises, driven by conflict and natural disasters, result in population displacement, and significantly affect healthcare and routine immunisation services. Problem: Vaccination and immunisation efforts in crisis-affected areas are hindered by broken logistics and supply chain systems, resulting in delayed deliveries, and weakened health infrastructure. Population displacement leads to overcrowding, and increased transmission of Vaccine-Preventable Diseases (VPDs). The resultant fragile governance limits coordination between government and humanitarian partners, leading to an increase in zero-dose and under-immunised children. Aim: This article analyses the mechanisms by which humanitarian crises disrupt vaccines supply chains and coverage, using the Cameroon conflict as a case study, and proposes integrated response strategies. Method: We conducted a narrative review of peer-reviewed and institutional literature published between 2015 and 2025 on vaccination in humanitarian and conflict-affected settings. We complemented this review with a qualitative case study using routine immunisation reports, outbreak investigation summaries, program monitoring data, and stakeholder field experiences from the Northwest and Southwest regions of Cameroon between 2019 and 2025. We synthesized findings thematically, focusing on health system disruptions, supply chain constraints, service delivery barriers, and surveillance breakdowns. Results: We observe broken health systems from armed conflict, leading to compromised delivery of health commodities, a preponderance in unimmunised and under immunised children in conflict laden areas of the world. The direct result is outbreaks, and increased under-5 morbidity and mortality. Impact: In Cameroon, VPDs have resurged over the past four years, including poliomyelitis, measles, yellow fever, and neonatal tetanus, especially in the crisis-hit regions, such as the Wabane and Eyumodjock health districts in the Southwest Region. This resurgence is not unique to Cameroon. Other conflictaffected countries report similar findings regarding VPDs. These trends illustrate how insecurity and logistical challenges compromise vaccine delivery and handling, as well as vaccination coverage, thereby threatening immunisation goals. Conclusion: The interplay between humanitarian crises and immunisation underscores the urgent need to integrate resilience and emergency response into vaccination strategies. Strengthening these systems is critical to improving coverage, protecting vulnerable populations, and advancing progress toward Sustainable Development Goal 3, with vaccination remaining central to health equity.
Integrating Medical Outreach into Nurse Practitioner Education:Advancing Clinical Competence, Social Accountability, and HealthEquity
As healthcare systems confront widening health inequities, workforce shortages, and complex global health challenges, nurse practitioner (NP) education must evolve beyond traditional clinical training models. Medical outreach initiatives provide immersive, community-centered learning environments that align clinical skill development with social accountability and health equity. This article examines the importance of integrating structured medical outreach opportunities into NP curricula and training, emphasizing their role in enhancing clinical competence, cultural humility, interprofessional collaboration, and ethical practice. A narrative review of the literature was conducted, synthesizing evidence from global health education, service-learning, interprofessional practice, and competency-based NP education. A case exemplar from a long-standing academic community partnership is incorporated to illustrate best practices. Medical outreach experiences strengthen diagnostic reasoning, adaptability, leadership, and patient-centered care. When embedded longitudinally and ethically, outreach initiatives align with AACN Essentials, NP core competencies, and World Health Organization frameworks for social accountability and interprofessional education. Medical outreach is not supplemental but essential to preparing nurse practitioners capable of addressing health inequities in diverse settings. Academic leaders are encouraged to embed outreach within NP curricula through structured partnerships, reflective pedagogy, and competency-based assessment.
Treating Adolescent Sexual Victimization: A Concise Review ofEpidemiology, Neurobiological Consequences, and Evidence BasedInterventions
Sexual victimization of adolescents represents a critical public health concern with particularly elevated prevalence in low- and middle-income countries including Bangladesh. This narrative review synthesizes evidence on epidemiology, neurobiological mechanisms, and evidence-based treatments for adolescent sexual victimization. Global prevalence ranges from 3-41.5%, with girls disproportionately affected. The review covers Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) as primary evidence-based psychotherapies, neurobiological changes in posttraumatic stress disorder (PTSD), and contextual factors unique to Bangladesh including legal gaps, stigma, and limitedservice infrastructure. Recommendations address legal reforms, institutional strengthening, and community awareness programs essential for effective response in resource-limited settings.
PTSD, Trauma- Focused Cognitive Behavioral Therapy
Copyright (c) 2025 Journal of Medical & Clinical Nursing
Sling Gauze Technique for the Positioning of RAE Tube in InfantsUndergoing Head and Neck Surgeries
In order to maintain anaesthesia with minimal complications, one of the vital steps is securing a stable oral endotracheal tube. The endotracheal tube may be displaced and become unstable due to suctioning, change in the position of the head and patient care. Poor fixation of the endotracheal tube is one of the leading causes of accidental extubation. The ideal endotracheal tube stabilisation method must allow changes in position of the infant during care while simultaneously minimising movement of the tube. The relatively short tracheal length in small children and infants is a major reason why placing the endotracheal tube (ETT) in the proper position may be difficult. The endotracheal tube may migrate cephalad with neck extension and caudally with neck flexion due to changes in the position of the head, such as extension or flexion of the neck. Sometimes, a well secured tube may also cause abnormalities in ventilation due to the dynamic positioning during surgeries on the cranium. Here, we present to you a technique where the oral endotracheal tube fixation at the lips, can be manoeuvred to change its depth of insertion by millimetres by a simple easily available device in the operation theatre.
Weight Loss with Acarbose and Metformin May be Curative in Early Phases of Diabetes Mellitus
Background: Atherosclerosis may be the main cause of diabetes mellitus (DM). Methods: All patients with sickle cell diseases (SCD) were included. Results: We studied 222 males and 212 females with similar ages (30.8 vs 30.3 years, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused red blood cells (RBC) in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), stroke (12.1% vs 7.5%, p<0.05), chronic renal disease (CRD) (9.9% vs 6.1%, p<0.05), cirrhosis (8.1% vs 1.8%, p<0.001), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), leg ulcers (19.8% vs 7.0%, p<0.001), and clubbing (14.8% vs 6.6%, p<0.001) were all higher in males. Conclusion: As an accelerated atherosclerotic process, hardened RBC-induced capillary endothelial damage terminates with multiorgan insufficiencies in early decades in the SCD. Although atherosclerotic endpoints are common, we detected no case of DM probably due to lower body mass indexes. As the most common cause of CRD, DM may be an atherosclerotic endpoint, too. Increased blood and insulin needs of excess fat tissue in contrast to decreased blood supply of the excess tissue and pancreas both due to excess pressure on vasculature, externally and atherosclerosis, internally may be significant in the development of DM. Acarbose and metformin are safe, cheap, oral, long-term used, and effective drugs for loss of excess fat which may even be curative in early phases of DM before development of fibrotic changes on vasculature.
Variability, Severity, Preventability, and Outcomes of Adverse DrugReactions to HIF-PHIs in CKD Case Reports: A Systematic Review
Background: Underdiagnosed and undertreated renal anaemia remains an issue among individuals with chronic kidney disease (CKD). Hypoxiainducible factor prolyl-hydroxylase inhibitors (HIF-PHIs) offer significant options. However, there are unmapped areas regarding adverse drug reactions (ADRs) to HIF-PHIs. Thus, this systematic review aims to find ADRs to HIF-PHIs and analyse their variability, severity, preventability, and outcomes in individual CKD patients reported as case reports. Methods: A literature search of published case reports was conducted between 2018 and 2024 across various electronic sources. Of the total identified studies (N=2123), only 8 case reports (13 patients) were included after applying inclusion and exclusion criteria. Results: ADRs to roxadustat (8/13;61.5%) and daprodustat (5/13;38.5%) included retinal haemorrhage (7.7%), hypertension (15.4%), stroke (23.1%), hypothyroidism (7.7%), rhabdomyolysis (7.7%), and elevation of serum copper (38.4%). The mean ADRs time-to-onset was 6.5 months. Specific causality and non-preventability of ADRs to HIF-PHIs were confirmed in one report (1/8;12.5%), and definite probability and severity in two reports (2/8;25%) due to HIF-PHIs ADRs. Conclusion: This review suggests HIF-PHIs could be safe for patients to treat CKD anaemia. Thanks to personalised dosages that maintain the recommended Hb value and sufficient management of comorbidities, the probability and severity of ADRs could be decreased.
Copyright (c) 2024 Journal of Medical & Clinical Nursing
Predictive Values of CSF Ferritin in Cognitive Assessment ofPatients after Acute Central Nervous System Infections
CNS infections represent a unique challenge to clinicians due to significant morbidity and mortality. The role of ferritin as a reactant of various pathological conditions is currently being intensively investigated. The pathogenesis of cognitive impairment after acute neuroinfectious disease is not yet fully understood. It is believed to be a direct consequence of neuronal damage by the infection, but also by the activation of immunocompetent brain cells, with consequent disruption of signal conduction in a varying period of time after the infection has resolved. The aim of the study is to examine the prediction of ferritin on the degree of cognitive impairment in patients who have suffered from a CNS infection. The values of CSF ferritin were evaluated in three analyzed groups of subjects (bacterial, viral and group with normal CSF findings - meningism). The analyzed clinical data were correlated with the degree of neurocognitive impairment, and the relationship between CSF ferritin and the degree of cognitive impairment was analyzed. The conducted research is a retrospective-prospective analytical and clinical study that was conducted in the period from 01.01.2017 to 01.01.2020. The research includes 90 patients according to previously nominated criteria, divided into three groups, two “examined” and one “control”. The assessment of the cognitive status of the subjects was performed using the MMSE test. The SPSS for Windows software package (version 20.0, SPSS INC, Chicago, Illinois, USA) was used for statistical analysis of the obtained data. We confirmed that the CSF protein ferritin is a good predictor of distinguishing purulent from viral meningitis / meningoencephalitis. The obtained results did not confirm the hypothesis that elevated CSF ferritin values have a negative impact on cognition. Impairment of individual domains of cognition measured by MMSE I, such as “attention”, “calculation” and “memory” are more pronounced in purulent CNS infections. Impairment of individual domain MMSE II “calculation” is more pronounced in the purulent CNS infection category
Financing for Universal Health Coverage, A Myth or a Realityin Low- and Middle- Income Countries (LMICs): The Case ofCameroon
The 17 Global Sustainable Development Goals were conceived and adopted by the United Nations in 2015, with an overall purpose to end poverty while protecting the planet and ensuring global peace and prosperity by 2030. One of the goals, Goal 3, directly relates to health by proclaiming good Health and wellbeing. Target 3.8 focuses on Universal Health Coverage (UHC). Universal Health Coverage is enshrined in the concept that all people have access to the full range of quality health services they need, when and where they need them, without suffering financial hardship. Therefore, UHC encourages financial risk protection including access to safe, effective, quality affordable essential medicines and vaccines to all. The achievement of target 3.8 of the Global Goals entails Government engagement and good political will in healthcare financing to limit out-of-pocket financing of healthcare. This can be achieved through dedicated government budgets to finance various aspects of the healthcare delivery system including essential medicines and health commodities, as well as health facilities within the rural communities. To realise this dedicated government funding, a structured questionnaire shall be administered to commercial directors of Brasseries du Cameroun, Guinness Cameroun, Kadji Beer Company, and Tobacco factories in Cameroon. The current rate of out-of-pocket financing of healthcare in Cameroon is approximately 70%. Thousands of families still suffer financial hardship. Besides, long travel distances to the nearest health facility, with no road networks are real obstacles to access to healthcare. This in turn affects targets 3.1 to 3.4 of the global goals. The current healthcare expenditure in Cameroon is 3.82% of GDP as of 2021, below the African average of 5.76%, the Sub-Saharan Africa average of 5.10% and the global average of 7.02% GDP. Considering the low political will, the low current healthcare spending, and the current crisis that are almost paralysing the economy, as recommendation, dedicated taxes on some commodities consumed within the country as source of finance to exclusively finance healthcare in enclaved areas of the country so that all people can indeed have access to the healthcare they need and where they need without suffering financial hardship.
A Complex Case of Febrile Illness in an Elderly Male withNeurological Symptoms and Negative Csf Cytopathology: ADiagnostic and Management Challenge
An elderly male in his eighties presented with persistent high-grade fever, altered mental status, and features suggesting central nervous system (CNS) involvement. The clinical picture was concerning for infectious or inflammatory encephalopathy. The diagnostic workup included cerebrospinal fluid (CSF) analysis, cartridge-based nucleic acid amplification test (CBNAAT), line probe assay (LPA), cytopathology, fungal microscopy, and aerobic culture. Despite significant systemic symptoms, CSF analyses returned negative for tuberculosis, fungal infection, and malignant cytology. MRI and MR spectroscopy findings revealed pontine hyperintensities and metabolic abnormalities suggestive of neuronal dysfunction. The imaging also showed decreased N-acetylaspartate (NAA) and elevated choline, with a lactate peak—findings supportive of encephalopathy or inflammatory pathology. Treatment was initiated empirically with broad-spectrum antibiotics, antifungals, and supportive neurological and systemic care. Electrolyte imbalance and hypertension were addressed promptly. Despite extensive diagnostics, no specific pathogen was identified, and the patient’s clinical course required close multidisciplinary monitoring. The case exemplifies the diagnostic and therapeutic challenges posed by febrile encephalopathy in the elderly, where overlapping features of metabolic, infectious, and vascular etiologies complicate definitive diagnosis. This report highlights the role of advanced imaging and CSF analysis in guiding management when primary infectious markers are inconclusive. Further follow-up, especially with culture data and clinical evolution, remains essential for ongoing care.
Novel Emerging Inflammatory Biomarkers Predict the Coronary Artery Diseases-Related Complications: An Integrative Review
This integrative Review aims to evaluate the utility of novel emerging inflammatory biomarkers in predicting major adverse cardiac events (MACEs) in patients with acute coronary artery disease (CAD). Cardiovascular diseases (CVDs), primarily driven by myocardial ischemia due to atherosclerosis, are the leading cause of global morbidity and mortality. Traditional biomarkers have offered mixed prognostic capabilities, necessitating the exploration of new markers that encompass complete blood count (CBC) parameters and CBC-derived indices. We conducted a comprehensive review, following PRISMA guidelines, and searched databases such as PubMed, Web of Science, ERIC, and Science Direct up to May 2023, focusing on inflammatory indices and their correlation with cardiovascular outcomes. The selected studies, published within the last five years and meeting our inclusion criteria, provided data on various biomarkers including Platelet Distribution Width (PDW), Mean Reticulocyte Volume, and systemic inflammatory indices such as Neutrophil-to- Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR). Emerging indices like the Systemic Inflammatory Index (SII) demonstrated significant predictive power for both short-term and long-term cardiovascular complications. Our findings suggest that these novel biomarkers, particularly CBCderived indices, offer valuable prognostic information that could enhance clinical decision-making in managing coronary artery disease. Further research and standardization are required to fully integrate these biomarkers into routine clinical practice.
Nursing informatics plays an essential role in modern healthcare by merging the disciplines of nursing, computer science, and information technology. It involves the use of technology to enhance nursing practice and improve patient care outcomes. This paper explores the evolving role of nursing informatics, particularly in the context of artificial intelligence, and highlights its significance in clinical decision-making. Additionally, it discusses the growing need for nursing informatics education and competencies to meet the demands of today’s healthcare systems. As healthcare becomes increasingly data-driven, the ability of nurses to effectively use technology and information systems is paramount. By integrating electronic health records (EHRs), decision support systems, and artificial intelligence, nursing informatics enables more efficient workflows, better clinical outcomes, and enhanced patient safety. The future of nursing is inextricably linked to the continued advancement and adoption of informatics tools that will help shape both patient care and the nursing profession itself.
The Challenge of Post-Acute Compliance with Infection Preventionand Control
Healthcare-acquired infections (HAIs), also known as nosocomial infections, are infections that patients acquire while receiving treatment for other conditions within a healthcare setting. These infections pose a significant challenge to healthcare systems worldwide, affecting millions of patients each year and leading to substantial economic burdens and adverse health outcomes.