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Despite rapid advances in whole-genome sequencing (WGS), translating genomic findings into individualized insights remains challenging. We present GenRiskPro, a clinical decision-support and research platform, which automates WGS variant calling, annotation, prioritization, and reporting to deliver actionable findings and facilitate precision wellness. (To test the GenRiskPro platform, log on to https://www.phenomeportal.org/dashboard using the following credentials: Username: user@test.com; Password: test.) GenRiskPro integrates rare and common variant prioritization in a unified pipeline and in-house database, enabling both rare and complex disease and trait association analyses. Variant reporting is supported via LongevityCloud, which features a web portal for clinicians to review, adjust, and authorize the return of results in tabular and PDF formats, alongside a mobile app with artificial intelligence (AI) integration for sequenced individuals. Case studies using Turkish (TR, n = 275) and Swedish (SW, n = 101) WGS data assessed platform performance and variant prioritization: (a) predefined gene panels yielded a 1.82% positive rate for actionable findings per American College of Medical Genetics and Genomics (ACMG) secondary findings guidelines; (b) phenotype-driven support diagnosed cases including muscular dystrophy and microcephaly; (c) cohort-level ClinVar reassessment identified potentially misclassified pathogenic variants; (d) rare variant burden analysis revealed enrichment in ABCA4 for TR and SMPD1 in SW; and (e) population analysis highlighted carrier differences in trait-associated SNPs (rs12913832 and rs4988235) and PGx variants (CYP2B64 and CYP2B66). GenRiskPro unifies databases, literature, web development, and AI for rapid, user-friendly genomic analysis and reporting, which fosters collaboration among hospitals, researchers, clinicians, and patients.

Establishing the Korean Pediatric and Congenital Heart Surgery Database (KPCHSD) and linking it to the World Database for Pediatric and Congenital Heart Surgery (WDPCHS) is an important step toward creating a global network for quality care. Worldwide outcomes data are needed to support quality assurance and advocacy for necessary resources for pediatric and congenital cardiac care. The Korean Society for Thoracic and Cardiovascular Surgery collaborated with the World Society for Pediatric and Congenital Heart Surgery (WSPCHS) to develop and implement the KPCHSD. Variables selected for collection met the specific needs of Korean congenital heart surgery practice and were harmonized with the WDPCHS. Software was developed to link the databases in a secure environment, transfer data from KPCHSD to the WDPCHS, and produce outcomes reports. The initial data upload from the KPCHSD to the WDPCHS was successfully completed in 2023. Over 2,500 operations from a 2-year period were transferred from the KPCHSD into the WDPCHS. Comparisons of individual center data will be made with both national and international aggregates. These comparisons will be available to individual centers via a password-protected cloud-based dashboard. Working in collaboration with our Korean colleagues, the WSPCHS has taken the next step toward developing a global network to share knowledge and expertise and to promote quality improvement in the treatment of congenital heart disease. Using this platform, countries perform data validation and completeness checks while maintaining control over their data. This aggregated data can support quality assessment and help secure the necessary resources for all countries, regardless of economic status.

Implementing cryptographic primitives on resource-constrained IoT devices involves tight latency, code-size, and energy budgets. This work proposes a general LLVM backend instruction-selection strategy that recognizes single-bit update idioms-typically expressed as LOAD--(AND/OR)--STORE sequences in SHA-256 and similar bit-oriented code-and lowers them to the most efficient target-specific bit-manipulation primitive when legality and cost conditions are met. As a concrete instantiation, we implement the strategy for the Renesas RL78/G23 ISA by rewriting eligible patterns into SET1/CLR1 instructions when the constant mask targets exactly one bit. We evaluate the resulting backend on an RL78/G23 platform using cycle counts and code size (bytes) across SHA-256-driven workloads motivated by firmware integrity checking, Merkle-tree hashing, HMAC-based authentication, password-based key derivation (PBKDF2), and chunk-level update validation. The observed cycle reductions are also converted to absolute time across the device's supported on-chip oscillator frequencies to quantify latency impact under different clocking modes. The experimental validation in this work is limited to the RL78/G23 backend implementation. The underlying instruction-selection idea may be adaptable to other RL78-family devices or to other embedded architectures that provide equivalent single-bit set/clear or bitfield operations; however, such adaptations require target-specific legality checks, cost modeling, and separate experimental validation.

The study aimed to identify the key methodological challenges and solutions related to recruitment and retention of rural-dwelling young adults into a randomized controlled trial that tests the feasibility of a digital healthy eating intervention (Veg4Me). Digital registration for a 12-week study was set up as a one-step process without researcher involvement. Participant registrations and recruitment rates were monitored daily using predetermined online preventative measures to identify fraudulent responses and to amend the digital registration process where necessary. Retention rates were monitored daily to identify any necessary amendments to the follow-up protocol. During data collection, n = 279 fraudulent responses were identified from n = 536 total responses (52%). One month into recruitment, amendments were made to the registration process to reduce fraudulent responses. To address bot attacks, Qualtrics passwords and a two-factor authentication process were added to the Veg4Me landing page. Targeted recruitment strategies, such as unpaid social media posts, corresponded to peaks in recruitment. In the final recruitment month, a question was embedded within follow-up correspondence to encourage completion of the post-intervention survey. This resulted in an additional n = 8 (7%) participants completing the intervention. Empirical observations made in this study suggest that digital recruitment protocols without direct researcher involvement should consider multiple in-built strategies for identifying and preventing fraudulent responses. This includes a two-factor authentication process and minimizing the over-promotion of financial incentives in recruitment strategies. Recruitment strategies should consider the use of social media posts in local community groups, while the use of reminders and notifications could support retention.

The rapid expansion of digital engagement has also exposed older adults to an increasing spectrum of cyber threats. Many older individuals encounter distinct challenges when navigating digital environments, including limited prior exposure to technology, lower levels of cybersecurity literacy, and heightened susceptibility to online misinformation. These vulnerabilities not only compromise their digital safety but also undermine their confidence in adopting and effectively using technology. This study aimed to examine the effect of cybersecurity awareness training on technology adoption, cybersecurity behaviors, and cybercrime awareness among older adults residing in assisted living facilities. A quasi-experimental pretest-posttest control group design was employed. A total of 160 older adults were recruited through convenience sampling. Participants were divided into intervention and control groups. The intervention group underwent a five-week cybersecurity training program, with weekly sessions of 60-90 min. Topics included password security, phishing awareness, social media safety, and secure browsing. Validated assessment tools were used to evaluate changes in cybersecurity awareness, technology acceptance, and security practices before and after the intervention. Post-intervention assessments showed that the intervention group experienced significant improvements in digital safety knowledge, attitudes toward technology use, control over digital tools, and awareness of cyber threats, especially on social media. Enhanced adoption of cybersecurity behaviors in daily life was also observed. Cybersecurity awareness training is effective in improving older adults' knowledge of digital threats, encouraging positive attitudes toward technology, and promoting safe online behavior. These findings underscore the potential of targeted interventions to reduce digital vulnerability and enhance inclusion among aging populations.

Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR. This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (≥18 years) with an LARS score >20, at least 6 months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3 months of daily TAI or conventional LARS care, followed by a 1 month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events. The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines. NCT05007015.

Traditional uvulectomy (TU) is a culturally rooted practice performed on neonates in parts of Ethiopia despite its associated health risks. Evidence on its prevalence and determinants in Gondar City remains limited. This study assessed the prevalence, practices, and determinants of TU among neonates aged&#x2009;<&#x2009;28 days in selected communities of Gondar City, Ethiopia. A community-based cross-sectional study using quantitative and qualitative approaches was conducted in 12 kebeles of Gondar City (5 rural and 7 urban). A total of 633 neonates aged&#x2009;<&#x2009;28 days and their mothers or caregivers were included. Quantitative data were collected using structured interviewer-administered questionnaires, and qualitative data through focus group discussions with mothers and traditional healers. TU prevalence was summarized using descriptive statistics. Binary logistic regression identified determinants, reported as crude and adjusted odds ratios (COR and AOR) with 95% confidence intervals. Among the 633 neonates, the prevalence of traditional uvulectomy among was 84.5%. The procedure was mainly performed at home by traditional healers and was strongly influenced by family and community advice, beliefs about safety, and lower cost than formal healthcare. Multiparity was associated with lower odds of TU (AOR&#x2009;=&#x2009;0.40; 95% CI: 0.26-0.61). Mothers who did not receive antenatal counselling had higher odds of practicing TU, while ANC counselling was protective (AOR&#x2009;=&#x2009;0.15; 95% CI: 0.09-0.24). Home delivery increased the likelihood of TU (AOR&#x2009;=&#x2009;5.86; 95% CI: 2.51-13.68). Qualitative findings showed that TU was viewed as a safe cultural practice in the community. Traditional uvulectomy in neonates remains highly prevalent in Gondar City, driven by cultural norms, family influence, and access to traditional healers. Strengthening antenatal counselling, promoting institutional delivery, and implementing culturally sensitive community interventions are essential to reduce TU and improve neonatal health outcomes. Not applicable as this study did not involve a clinical trial.

A large measles outbreak occurred in Yakusu Health Zone, Democratic Republic of the Congo, between January 2018 and June 2019. We aimed to estimate the magnitude, mortality burden, and vaccination coverage of this epidemic, and to evaluate whether the reactive mass vaccination campaign reached previously unvaccinated children. We conducted a retrospective two-stage cluster household survey to estimate the attack rate (AR), case fatality ratio (CFR), mortality rates, and vaccination coverage. We extrapolated survey-weighted estimates to the population of Yakusu to estimate true outbreak size. Kaplan-Meier survival analysis characterised the temporal distribution of post-measles mortality. Geospatial analyses described the spatial distribution of vaccination coverage and attack rates, and Spearman rank correlation quantified the spatial relationship between routine and campaign coverage at the cluster level. Among 8,968 individuals surveyed, 1,390 (15.5%, 95% CI: 13.2-17.8) reported measles during the recall period. The estimated true outbreak size was 22,068 cases (95% CI: 18,785-25,351), suggesting routine surveillance detected only 27.9% of cases. Among children under 5 years, the AR was 45.7% (95% CI: 39.6-51.9) and the 31-day CFR was 4.9% (95% CI: 3.4-6.3). Among infants under 1 year, survival at 31 days post-onset was only 78.7%, with deaths continuing to accrue beyond this point, reflecting a distribution of onset-to-death intervals that extends beyond the standard attribution cutoff. Routine EPI and campaign vaccination coverage were each approximately two-thirds of the target population (68.2% and 67.7%, respectively). Over half of the target age group (53.5%, 95% CI: 46.8-60.3) had received both EPI and campaign vaccination, while 19.2% had received neither. Among children vaccinated during the campaign, 81.6% had already received routine EPI vaccination, while only 39.8% of previously unvaccinated children were reached. EPI and campaign coverage were strongly spatially correlated at the cluster level (Spearman &#x3c1; = 0.59, p < 0.001). This was a severe epidemic with high attack rates and case fatality, particularly among infants. The reactive vaccination campaign, implemented more than one year into the outbreak, overwhelmingly reached children already vaccinated through routine services while failing to reach the majority of unvaccinated children. Reactive campaigns in similar settings should prioritise identifying and reaching unvaccinated populations through improved microplanning and spatial targeting, rather than maximising total doses administered.

Gastrostomy tube placement is the preferred modality for long-term nutritional management in individuals with oral feeding disorders. However, acceptance of this intervention is often impeded by reluctance to discontinue oral feeding, concerns about increased caregiver burden, and apprehension regarding life prolongation with diminished quality of life. These factors may generate decisional conflict, negatively affecting patients' physical and psychological well-being and treatment outcomes. In this study, we aimed to explore the facilitators and barriers influencing gastrostomy-related decision-making among patients with cancer and dysphagia, providing a theoretical and empirical basis for developing culturally tailored decision aids and structured communication pathways. A qualitative descriptive design was employed. In-depth one-on-one interviews were conducted with 18 patients with cancer and dysphagia who had engaged in gastrostomy decision-making at two tertiary hospitals in Fujian Province, China. The transcripts were coded using NVivo and analyzed using conventional content analysis. Three overarching themes with seven subthemes were identified. Theme 1 included decision-making motivation, which comprised three subthemes: disease perception and survival needs, supportive communication from healthcare providers, and support from family members and peers. Theme 2 included decision-making challenges, which included two subthemes: emotional-rational dissonance and insufficient decision-making information. Theme 3 comprised decision-making optimization and included two subthemes: enhancing the transparency of gastrostomy-related information and improving the efficacy of healthcare provider-patient communication. Effective healthcare provider-patient communication and support from family members and peers emerged as key facilitators of decision-making regarding gastrostomy tube placement, whereas emotional-rational conflicts and informational deficits constituted major barriers. Future efforts should focus on developing culturally tailored, multimodal decision aids integrating paper and digital formats, establishing structured communication pathways that integrate these tools, and strengthening family-peer support while ensuring that autonomous decisions are aligned with patient values. Not applicable.

Lip reading technology has potential use across various fields, significantly enhancing communication for the deaf, aiding in noisy settings, and supporting information security through silent password entry. Although, notable progress has been made in constructing datasets of different types like digits, alphabets, words, phrases, and sentences levels for lip reading in various languages. However, developing a robust Urdu lip reading model remains a challenge due to the lack of a suitable dataset. Moreover, difficulties in adapting previous models, such as the LipNet model to Urdu. To address these barriers, we present the ULRA (Urdu lip reading alphabets) dataset, leverage advanced data augmentation techniques, and evaluate three cutting-edge DNN models: a LipNet-based 2D-CNN model, a Hybrid 2D_3D-CNN model, and a baseline 3D-CNN model. Each model undergoes rigorous testing in diverse environments, with both familiar and unfamiliar data. The results reveal that the LipNet-based 2D-CNN model achieves an impressive 81.97% accuracy on unknown data across diverse environments, while the Hybrid model excels in generalization, reaching 69.45% accuracy on unfamiliar data, thanks to its superior spatiotemporal feature extraction capabilities. Additionally, precision, recall, and F1-Score values of LipNet-Based 2D CNN are 0.83, 0.82, and 0.82 respectively. All three values of this model are also higher than the other two models. These findings underscore the strengths of various DNN architectures and the critical advancements made possible by the ULRA dataset, paving the way for future breakthroughs in Urdu lip reading research.

Genomic data sharing enhances efficiency in medical practice by facilitating faster data access and collaboration across settings. However, the same arrangements that enable efficiency could also raise legal inequalities, especially concerning data ownership and access. Yet these inequities are intensified in cross-border collaborations where power dynamics disadvantage low and middle income (LMIC) researchers. A qualitative phenomenological study was conducted in Uganda. Key informant interviews (KIIs) were conducted with 49 stakeholders working at different points across the genomic research landscape and four focus group discussions (FGDs) were conducted with people currently or previously enrolled in genomic studies, or their caretakers. The stakeholders who took part in the KIIs included genomic researchers (16), research ethics committee (REC) members (14), practicing lawyers (3), community advisory board (CAB) members (8) and national research regulators (8). A theory of decolonization was used to clarify rooted power imbalances and unfairness. Through thematic analysis six concerns were identified: (1) inadequate regulatory frameworks, (2) limited access to the shared data, (3) unclear data ownership (4) absence of benefit sharing frameworks, (5) contested intellectual property rights and (6) rethinking power asymmetries and struggles. The wide spread perception by research participants that the Global North collaborators owned the data, eroded community trust. There was limited clarity on data ownership, with Ugandan researchers expressing differing views, on ownership, custodianship, and shared ownership leading to calls for co-ownership. In the absence of benefit-sharing frameworks to regulate the distribution of commercial value, data commercialization disadvantaged Ugandan researchers and participants, reinforcing colonial-like inequalities. Current governance systems mirror colonial patterns in the control and sharing of genomic data in Uganda. These patterns are reinforced not only by cross-border power asymmetries but also by internal power dynamics within the country, including institutional hierarchies and regulatory gaps that limit local decision-making authority. Addressing this requires rethinking governance structures and promoting local or co-ownership models that reflect African interests and support decolonized approaches to data governance. Not applicable. This study did not involve a clinical trial.

Maternal mortality remains a major public health concern globally despite significant progress over the past two decades. Nigeria is among the countries with the highest maternal mortality rates. Within the country, marked regional disparities persist, with northern Nigeria experiencing a significantly higher burden. These disparities are shaped by a complex interaction of sociocultural norms, household power relations, geographic constraints, and health system limitations that influence women's access to skilled birth attendance and facility-based delivery. The study explored skilled birth attendants' perceived barriers to the provision of maternal healthcare services that prevent pregnant women from seeking appropriate care in government-based facilities. This study employed a qualitative research design to explore skilled birth attendants' perspectives on barriers preventing women from accessing maternal healthcare services. Twenty-four skilled birth attendants were purposively selected from primary healthcare facilities across six high-burden northern Nigerian states: Bauchi, Kaduna, Katsina, Kano, Jigawa, and Niger. Data were collected through in-depth interviews using a semi-structured and pretested interview guide. The Three Delay Model guided the study to examine factors affecting women's decisions to seek care, their ability to reach healthcare facilities, and their experiences receiving care within facilities. The findings revealed multiple barriers across the three phases of delay. At the household level, cultural expectations, generational beliefs, and patriarchal decision-making structures limited women's autonomy to seek skilled care. Mothers-in-law and husbands often influenced or determined childbirth decisions, sometimes discouraging facility delivery. Structural barriers also affected women's ability to reach health facilities, including long travel distances, poor road infrastructure, and limited transportation options. Even when women arrived at health facilities, systemic challenges such as shortages of skilled health workers, inadequate medical supplies, insufficient delivery beds, financial constraints, and weak referral systems contributed to delays in receiving appropriate care. In conclusion, maternal healthcare service utilization in northern Nigeria is shaped by interconnected sociocultural, economic, and health system factors that contribute to delays in seeking, reaching, and receiving care. Therefore, addressing maternal mortality in this context requires comprehensive strategies that strengthen health system capacity, improve transportation and referral systems, reduce financial barriers, and promote gender-equitable decision-making within households and communities. Such integrated efforts are essential for improving access to skilled birth attendance and advancing progress toward global maternal health targets.

Malaria remains a major public health challenge in Papua New Guinea (PNG) and accounted for most malaria cases and deaths in the Western Pacific Region in 2023. Despite current national efforts centred on insecticide treated nets (ITNs), there is a pressing need to explore supplementary vector control tools, given the resurgence of malaria in PNG since 2015, partly driven by declining insecticidal efficacy of ITNs. The Newly Adapted Tools and Network Against Mosquito Borne Disease Transmission (NATNAT) project is assessing the feasibility and acceptability of complementary vector control approaches in PNG communities and the health system. These tools include residual spraying, spatial emanators, and larval source management. We conducted an exploratory qualitative study to examine community acceptability, readiness and perceptions of current vector control tools such as ITNs and the potential reintroduction of supplementary vector control approaches, like residual spraying. Using in-depth interviews and focus group discussions, data were collected from four villages along the north coast of Madang Province: Megiar, Bulal, Mirap, and Wasab. Transcripts were analyzed thematically using inductive techniques, with collaborative review to refine key themes by study team. The current malaria control practices and contextual factors shaped community perceptions and the prospective acceptability of residual spraying. Community members demonstrated a strong understanding of malaria risk, including seasonal transmission patterns and breeding sites, and reported both traditional and program-implemented vector control approaches used in their village. Engagement for vector control activities was motivated by strong leadership, personal values, and a comprehensive understanding of malaria risk factors. Community support for supplementary vector control measures, alongside a strong desire to address existing gaps in mosquito protection, were key drivers of acceptability. Addressing insecticide safety concerns informed in part by historical DDT spraying campaigns experiences through tailored, context-specific communication strategies will be critical for the successful adoption of residual spraying. Affordability and uptake of new vector control tools into existing programs are essential for sustainable uptake into policy and practice. Findings demonstrate the prospective acceptability of new vector control tools in PNG and underscores the importance of sustained, in-depth community engagement. To ensure effective implementation, policy development must consider community norms and practices, societal attitudes, and resource availability.

Low Back Pain (LBP) is a prevalent musculoskeletal condition among office professionals, particularly bankers, who often experience prolonged sitting and poor ergonomic conditions. Globally, LBP is the leading cause of disability for both sexes and across all age groups. However, research on occupational and psychosocial determinants among banking professionals in Nepal remains limited. This study aims to assess the prevalence and associated risk factors of LBP among bankers in Pokhara, Nepal. A cross-sectional study was conducted from January to February 2023 among 334 systematically selected bank workers from 27 banks within Pokhara Metropolitan, Kaski District. Participants with at least three months of work experience were included in the study. Data were collected through face-to-face interviews using a semi-structured questionnaire. LBP-related information was assessed using the Extended Nordic Musculoskeletal Questionnaire (NMQ-E). Stepwise logistic regression modeling was employed to identify the associated factors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated, and p-values&#x2009;<&#x2009;0.05 were considered statistically significant. Furthermore, the random forest technique was employed to identify the major variables. Of the 334 employees, on average, they were 31 years old, and more than half (55.1%) were female. The one-year prevalence of LBP was found to be 56.3% (95% CI: 51.2-61.7). LBP was positively associated with female employees (AOR: 2.62, 95% CI: 1.61-4.27), employees having higher education (AOR: 3.91, 95% CI: 1.22-12.45), and employees experiencing work-related stress (AOR: 3.68, 95% CI: 3.68, 95% CI: 2.16-6.29). While married employees (AOR: 0.36, 95% CI: 0.21-0.59) and private bank employees (AOR: 0.31, 95% CI: 0.15-0.65) were less likely to have LBP. The major variables explaining LBP, as identified by the random forest technique, in order, are: work-related stress, marital status, gender, type of bank, and education level. The prevalence of LBP among bank workers in Pokhara was 56.3%, indicating a substantial burden of musculoskeletal conditions among bank workers. Preventive measures to address work-related stress, along with consideration of gender and marital status while designing ergonomic interventions, are crucial for lowering LBP among bank employees.

This study aimed to examine in depth the spiritual care experiences of nurses working in hemodialysis units in T&#xfc;rkiye. A qualitative phenomenological design was employed, and data were collected through in-depth, face-to-face, semi-structured interviews with 10 hemodialysis nurses working in public hospitals in western T&#xfc;rkiye. A total of 12 eligible nurses were invited, and 10 participated in the study, resulting in a response rate of 83.3%. The data were analyzed using Colaizzi's seven-step phenomenological analysis method with MAXQDA 2022 software. The findings were grouped under four main themes: definition of spiritual care, effects of spiritual care, barriers to spiritual care, and suggestions for improving spiritual care. The results showed that nurses perceive spiritual care as a holistic approach involving empathy, respect for privacy, therapeutic communication, and emotional support. However, excessive workload, lack of time, and insufficient organizational support were identified as key barriers. Strengthening institutional support and training programs is recommended to improve the integration of spiritual care into clinical practice.