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ورود به زیرشاخهنقشه موضوعی
جستوجوی دقیقمدیریت و آموزش پزشکی
مدیریت خدمات، آموزش علوم پزشکی و کیفیت مراقبت
زیرشاخهها
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مدیریت بیمارستان
مقالهها، منابع و پژوهشهای تازه حوزه مدیریت بیمارستان
ورود به زیرشاخهکیفیت و ایمنی بیمار
مقالهها، منابع و پژوهشهای تازه حوزه کیفیت و ایمنی بیمار
ورود به زیرشاخهآموزش پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه آموزش پزشکی
ورود به زیرشاخهبرنامهریزی درسی علوم پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه برنامهریزی درسی علوم پزشکی
ورود به زیرشاخهاخلاق پزشکی
مقالهها، منابع و پژوهشهای تازه حوزه اخلاق پزشکی
ورود به زیرشاخهحقوق سلامت
مقالهها، منابع و پژوهشهای تازه حوزه حقوق سلامت
ورود به زیرشاخهتازهترین رکوردها
شواهد مدیریت و آموزش پزشکی
PubMed2027
A New Combined Technique for Neophallus Elongation and Girth Enhancement for Metoidioplasty (Barroso Procedure): Total Corpora Mobilization with Martius Flap.
PURPOSE: Metoidioplasty is used in transmasculine gender-affirming surgery; however, limited neophallus length and girth remain significant challenges (1-4). We describe a combined technique using Total Corpora Mobilization (TCM) for elongation and a Martius flap for girth enhancement (5-9). MATERIALS AND METHODS: Fifteen transgender men underwent first-stage metoidioplasty with TCM and Martius flap between 2023 and 2026. The vestibular plate and urethra were mobilized, followed by circumferential clitoral degloving and suspensory ligament division. A pubic periosteal incision was made, and subperiosteal dissection was performed using bipolar cautery while preserving a portion of the periosteum attached to the corpora cavernosa. The urethra was further mobilized and the triangular ligament was divided, followed by lateral dissection of both corpora cavernosa and complete release from the crura. An oral mucosa graft was used to create the urethral plate. The preserved periosteum was fixed to the dorsal tunica albuginea, and a vascularized Martius flap harvested from the labia majora was secured over the corpora for girth augmentation. Scrotal flaps provided wound coverage. RESULTS: The index patient achieved a neophallus length of 6.4 cm, representing a 1.9 cm gain over the preoperative stretched clitoral length. Median length gain was 3.7 cm, and mean circumference increase was 1.6 cm. Glans perfusion and tactile sensitivity were preserved in all patients, with no vascular or sensory complications recorded. CONCLUSIONS: Combined TCM and Martius flap metoidioplasty is feasible and reproducible. By achieving corporal release beyond previously described techniques, TCM may meaningfully enhance neophallus projection while preserving perfusion and sensation. Larger cohorts and longer follow-up are required to confirm the durability and functional outcomes of this approach.
PubMed2027
Clinical Flow Cytometric Testing in Chronic Lymphocytic Leukemia.
Flow cytometry is the cornerstone for establishing the diagnosis of chronic lymphocytic leukemia (CLL), owing to its characteristic and well-defined immunophenotype that enables accurate distinction from other leukemias and lymphomas. Beyond diagnosis, flow cytometry provides essential prognostic information and allows sensitive detection of minimal residual disease (MRD), a strong predictor of clinical outcome. CLL MRD assessment is increasingly used to guide risk stratification, therapeutic decision-making, and treatment duration in the era of targeted therapies and immunotherapies. This chapter reviews best practices for specimen collection, processing, staining, and data analysis and summarizes the principles of flow cytometric MRD assessment in CLL.
PubMed2027
Extraperitoneal Single-Port Robotic-Assisted Radical Cystectomy with Orthotopic Ne-obladder: Technique and Surgical Considerations.
INTRODUCTION: Radical cystectomy (RC) is the standard therapy for muscle-invasive bladder cancer (MIBC) and refractory high-risk non-muscle-invasive bladder cancer (1-3). Single-port robot-assisted radical cystectomy (RARC) offers notable minimally invasive advantages (4-6), whereas conventional transperitoneal approaches are associated with intestinal and gastrointestinal complications (7). This study evaluated an optimized extraperitoneal single-port RARC with orthotopic neobladder reconstruction for improved surgical safety and clinical outcomes. MATERIALS AND METHODS: A 57-year-old male presented with three months of intermittent painless gross hematuria. Pelvic CT revealed a bladder mass. Preoperative biopsy confirmed high-grade urothelial carcinoma with muscularis propria invasion, and the patient received gemcitabine-cisplatin neoadjuvant chemotherapy before radical surgery. Preoperative MRI identified a 3.2×2.9×2.6 cm bladder lesion without extravesical invasion or lymphadenopathy. During the procedure, the patient was placed in a supine position with buttocks elevated. A 5-cm infraumbilical single incision was made for da Vinci Xi-assisted extraperitoneal RARC, and a single-port multichannel device was deployed through the incision. Robotic instruments including a 30° endoscope, monopolar scissors, bipolar forceps, and a robotic stapler were arranged in a chopstick configuration. Via the extraperitoneal approach, we mobilized the bilateral ureters, bilateral vas deferens, and umbilical artery, dissected the bladder lateral ligaments with vascular ligation, and established a sufficient extraperitoneal working space. Bladder and prostate dissection was performed along the perivesical avascular plane, with careful protection and precise hemostasis of the dorsal venous complex. Standard pelvic lymphadenectomy was concurrently conducted during radical resection of the bladder and prostate (8). A segment of ileum was then harvested to construct an orthotopic neobladder (9), followed by anastomosis with the bilateral ureters and urethral stump. RESULTS: Operative time was 400 minutes with 200 mL blood loss and no transfusion. No perioperative complications occurred, and the patient was discharged on postoperative day 6. Pathological diagnosis was pT2aN0M0 with negative surgical margins and negative lymph nodes. The 12-month follow-up showed no tumor recurrence, normal renal function, complete daytime continence, and mild nocturnal incontinence requiring one nightly pad. CONCLUSIONS: Extraperitoneal single-port RARC with orthotopic neobladder reconstruction is a feasible minimally invasive procedure for MIBC. The optimized infraumbilical single-incision technique preserves peritoneal integrity and avoids intestinal mobilization, effectively reducing abdominal complications. It achieves reliable oncological results and improves patients' postoperative continence and quality of life.
PubMed2027
Naked-Eye Visual Loop-Mediated Isothermal Amplification Method for the Rapid Detection of Chikungunya Virus.
Chikungunya virus (CHIKV) represents a significant global health threat due to its recent resurgence. This protocol highlights the use of capillary-modified visual loop-mediated isothermal amplification (LAMP) technology for the rapid detection of CHIKV. We employed Vero cells for virus propagation and utilized the MolPure Viral DNA/RNA Kit for nucleic acid extraction, successfully amplifying extracted viral RNA at 63°C for 25 min. The presence of CHIKV was indicated by a distinct yellowish-green color change, demonstrating the effectiveness and simplicity of this protocol. Our protocol underscores the potential of LAMP technology as a rapid diagnostic tool for CHIKV, enabling timely public health interventions.
PubMed2027
Robot-Assisted Partial Nephrectomy in a High-Complexity Renal Tumor in a Horseshoe Kidney.
INTRODUCTION: Horseshoe kidney is an uncommon congenital fusion anomaly that can make renal tumor surgery especially challenging because of altered rotation, limited mobility, variable vascular supply, and an unpredictable collecting system (1-7). This video presents a robot-assisted partial nephrectomy for a high-complexity renal tumor in this setting. CASE PRESENTATION: A 33-year-old man, with ECOG 0 and no relevant comorbidities, was diagnosed with a 7.5-cm solid renal mass in the central posterior portion of the left moiety of a horseshoe kidney. The lesion had a RENAL score of 10p. Contrast-enhanced computed tomography and three-dimensional reconstruction were used to understand the relationship between the tumor, aberrant vessels, renal hilum, and collecting system, supporting the decision to attempt nephron-sparing surgery (5, 8). Surgical technique and results: The procedure was performed through a transperitoneal robotic approach with the patient in right lateral decubitus using the Da Vinci Si platform. Port placement followed a standard renal robotic configuration, with a paramedian supraumbilical camera port, three robotic working ports along a craniocaudal lateral axis, a caudal fourth-arm port, and two medial assistant ports for suction, exposure, and support during renorrhaphy. After exposure of the horseshoe kidney and left hilar dissection, two arterial branches and one renal vein were identified. Tumor excision was performed under vascular control, with 20 minutes of warm ischemia and no collecting system opening, followed by two-layer absorbable renorrhaphy with adjunctive hemostatic agents. The operative time was 150 minutes. No transfusion, conversion, drain placement, or relevant immediate complication occurred. The urinary catheter was removed after 24 hours, and the patient was discharged 72 hours after surgery. Pathology showed clear cell renal cell carcinoma, Fuhrman grade 3, pT2N0M0, with negative surgical margins. During 12 months of oncologic follow-up, renal function remained stable and semiannual imaging showed no evidence of recurrence. Contemporary video reports have also emphasized the feasibility of advanced robotic renal surgery and complex partial nephrectomy strategies in selected patients (9, 10). CONCLUSION: In a carefully selected patient, robot-assisted partial nephrectomy supported by three-dimensional planning was feasible for a complex renal tumor in a horseshoe kidney, with negative surgical margins, preserved renal function, and no recurrence during 12 months of follow-up.
PubMed2027
RT-RPA-Assisted CRISPR/Cas12a-Based Isothermal Detection of Chikungunya Virus.
Chikungunya virus (CHIKV) is transmitted through the bite of Aedes mosquitoes, specifically A. aegypti and A. albopictus. CHIKV belongs to the alphavirus with a positive-sense ssRNA genome of 11-12 kb size. The virus has been reported from various geographical regions across the globe. Chikungunya fever is an acute febrile illness, which, if left untreated, may develop into chronic arthralgia that may persist for several months or acute encephalitis syndrome. Therefore, early diagnosis of CHIKV is crucial to initiate prompt supportive treatment. Laboratory diagnosis of CHIKV typically relies on serological tests such as IgM antigen capture ELISA and molecular methods including RT-PCR or qRT-PCR. However, both these methods are not viable in peripheral settings. This chapter highlights recent advancements in molecular detection techniques for CHIKV, specifically isothermal detection methods that eliminate the requirement for complex instruments. The detection is facilitated by RT-RPA and CRISPR/Cas12a endonuclease. The assay offers advantages over existing methods such as rapid and early detection, and eliminates cross-over contamination, ultra-sensitivity, high specificity, and ease of result interpretation.
PubMed2026
[THE ECONOMIC VIEW UPON MEDICAL CARE SUPPORT OF PATIENTS UNDER MYOCARDIUM INFARCTION IN MEDICAL ORGANIZATIONS OF VARIOUS LEVEL].
The diseases of circulatory system represent one of the main problems of the population health due to corresponding high morbidity and mortality and load on health care. The purpose of the study is to evaluate direct and indirect costs of medical care under acute coronary syndrome depending on level of medical organization. The study used content-analysis, statistical and analytical methods scientific publications on the research topic, copying of data from the medical documentation of the Vologda Regional Clinical Hospital for the period 2012-2021. The significant number of publications confirm that diseases of circulatory system develop due to multitude of risk factors. Also economic and medical effectiveness of timely applied medical care of diseases of the circulatory system is proved. It is demonstrated that medical care and cardiac rehabilitation under acute coronary syndrome are the most resource-wasteful types of medical care, while prevention of development of disease allows to save human, material and financial resources. In the medium perspective, economic damage under the worst scenario of development of disease when disability is set in makes up to about 400.000 rubles and in case of death of patient, more than five million rubles. Under acute coronary syndrome, medical, social and economic efficiency of emergency medical care is higher in medical organizations of the 3rd level. However, it is more economically advantageous to implement preventive measures.
PubMed2026
[THE SECONDARY MEDICAL EDUCATION IN RUSSIA: CHALLENGES OF PRACTICAL TRAINING AND STRATEGIES ENHANCING COMPETITIVE ABILITIES OF GRADUATES AT LABOR MARKET].
The article analyzes current state of system of secondary vocational medical education in Russia. On the basis of data from government agencies and professional associations key issues are considered: record-breaking outflow of young professionals from industry, irregularity of practical training and low efficiency of existing mechanisms of employment. The particular attention is paid to strategies of increasing competitiveness of graduates, including implementation of tutorship, development of regional educational clusters and elaboration of system of medical training.
PubMed2026
[THE TRADITIONAL AND COMPLEMENTARY MEDICINE IN THE PUBLIC HEALTH SYSTEM OF THE RUSSIAN FEDERATION: ANALYSIS OF EVIDENCE BASE AND LEGAL ASPECTS OF INTEGRATION].
The article considers placement of methods of traditional and complementary medicine in the public health system of the Russian Federation, focusing on prevention and management of chronic non-communicable diseases. The analysis of the evidence base on key methods of traditional and complementary medicine (acupuncture, phytotherapy, homeopathy, manual therapy, osteopathy) was carried out, including differentiated estimate of level of evidence for forms of homeopathy based on the latest systematic review of meta-analyses. The legal framework of its application in Russia are explored. The corresponding collisions and barriers are identified. The following proposals concerning integrative health care model are formulated: differentiated register of methods, clinical guidelines, pilot integration into compulsory health insurance system and enhancement of research.
PubMed2026
Tokenistic co-design: participation without power in Indigenous health evaluations.
OBJECTIVES: Co-design evaluation methodology can be appropriate for Aboriginal and Torres Strait Islander health and wellbeing programs due to its principles of power-sharing and collaboration. We argue, however, that commissioners of evaluations use the term, co-design, uncritically to describe activities that are misaligned with contemporary co-design theory. METHODS: Through qualitative interview data with key stakeholders in the commissioning process (commissioners, evaluators and service providers), we examined perceptions and sentiments towards the use and misuse of co-design in the process of commissioning Indigenous health and wellbeing evaluations. RESULTS: A disconnect between the understanding of co-design theory and its use in practice is evident, with perceptions of what constitutes genuine co-design varying considerably across participants involved in the commissioning process. CONCLUSIONS: The misuse of co-design to describe commissioning and evaluation practices that do not genuinely adhere to co-design principles has a detrimental effect on the utility of program evaluations, the implementation of Indigenous ethical and research frameworks in a genuine way, and risks co-design becoming relegated to a meaningless buzzword.
PubMed2026
Caring Behaviours in Nursing: A Bibliometric Analysis of Global Research Trends and Knowledge Structure.
BACKGROUND: Caring behaviours constitute one of the most visible ways in which "caring" is translated into everyday nursing practice, yet the field has become increasingly heterogeneous across settings, outcomes, and conceptual traditions. A field-level map is therefore needed to clarify how the literature has evolved and where it is currently concentrating. OBJECTIVE: This study aimed to bibliometrically map the literature on caring behaviours in nursing, focusing on global research trends, thematic development, collaboration networks, citation performance, and the field's intellectual structure. METHODS: A bibliometric analysis was conducted on publications indexed in the Web of Science Core Collection between 1987 and 2025, following the SALSA framework. Analyses included performance indicators (publication growth; most productive journals and countries), Author Keyword-based frequency, trend-topic, co-occurrence, and thematic analyses following synonym merging and spelling harmonization, co-authorship network analysis (collaboration patterns), citation analyses, and co-citation mapping to examine the field's intellectual structure. RESULTS: A total of 351 documents from 158 sources (1987-2025) were included. The literature demonstrated steady growth, accelerating after 2016. Core source outlets included BMC Nursing, Journal of Nursing Administration, and Perspectives in Psychiatric Care. The USA, Iran, China, and Turkey were among the most productive countries, while international co-authorship remained limited (14.25%). Thematic signals suggested a shift from earlier emphases on patient satisfaction toward a more recent focus on nursing education, empathy, emotional intelligence, and, most recently, compassion fatigue. The thematic map positioned caring behaviours within the basic-themes quadrant, whereas work environment and related humanistic-care concepts showed greater thematic development. Foundational influences remained anchored in Watson and Swanson, and measurement-oriented works (notably Wu and Wolf) functioned as key intellectual bridges. CONCLUSIONS: Caring behaviours research appears to be a maturing but still expanding field with strong theoretical and measurement "anchors," yet comparatively constrained cross-national collaboration. Future work may benefit from more internationally coordinated programmes and greater attention to cross-cultural validation of measurement tools and to the emotional, organizational, and digitally mediated contexts in which caring behaviours are enacted.
PubMed2026
Clinical Teaching Fellow Practice Within Complex Clinical-Educational Systems: An Activity Theory-Informed Case Study.
BACKGROUND: Clinical teaching occurs where patient care and education coexist. Within the United Kingdom's National Health Service, workforce pressures constrain teaching and supervision. Clinical Teaching Fellow (CTF) roles have expanded in response but are often viewed as discrete posts rather than practices situated within complex clinical-educational systems. This study examined how tensions within and across these systems shaped CTF practice. METHODS: This theory-informed exploratory qualitative case study used third-generation Activity Theory. All 10 members of a hospital medical education team were invited to a semistructured group interview; eight participated. An Activity Theory-informed thematic approach was used to map the focal undergraduate clinical education activity system and examine tensions within it and at its intersections with adjacent systems. FINDINGS: Participants included three CTFs, two education facilitators and three administrators. CTF practice involved teaching, programme coordination and administrative work within a multiprofessional team. Differing understandings of the activity's purpose and outcomes shaped practice. Professional language, continuity, experience and blurred divisions of labour influenced participation and work organisation. Relationships with clinical services, the medical school, postgraduate medical education and university-based postgraduate study introduced competing demands. Participants negotiated tensions through communication, redistribution of responsibilities and closer working across professional roles. CONCLUSIONS: CTF roles are embedded within systems where educational, clinical and organisational priorities intersect. Third-generation Activity Theory makes visible how relationships within and across these systems shape practice. Supporting CTF roles requires attention to how educational work is organised, coordinated and prioritised.
PubMed2026
Collaboration for Healthy Ageing Through Preventive Home Visits: Identifying Home Visitors' Collaboration Partners.
BACKGROUND AND AIM: Intersectoral collaboration is essential for promoting healthy ageing. Preventive home visits provide an opportunity for home visitors to support healthy ageing among older adults. However, little is known about which collaboration partners the home visitors engage with. This study aimed to identify collaboration partners engaged by home visitors to achieve positive outcomes from preventive home visits. METHOD: This study was based on a re-analysis of data from five focus group discussions with a total of 16 professionals involved in preventive home visits across five Swedish municipalities. The data was analysed using conventional content analysis. Ethical approval was obtained from the Swedish ethical review authority (reference number 2022-06054-01). RESULTS: The analysis revealed that collaboration with influential entities, such as politicians and the media, was seen as critical for advancing healthy ageing initiatives. Other important partners included those involved in meaningful leisure activities, enabling participation, lifelong learning, and the health- and social care sectors. CONCLUSIONS: Home visitors collaborate with a broad range of sectors to promote healthy ageing. Support from leaders in key positions may enhance the effectiveness of these collaborations. The identified partners should be considered in the planning of preventive home visits within a whole-of-society approach to ageing.
PubMed2026
Comparative Barriers and Enablers in ASEAN Long-Term Care Systems: Insights From the 2025 Regional Policy Dialogue and Policy Recommendations for Equitable Active Ageing.
OBJECTIVE: To examine barriers and enablers to equitable long-term care (LTC) across ASEAN-Plus Three (APT) economies and to propose a framework for equitable active ageing, contributing to Sustainable Development Goals 3 and 10. METHODS: A qualitative participatory-observation study was conducted during the 2025 Regional Policy Dialogue on Inclusive and Equitable Care Systems. Reflexive thematic analysis, read through a life-course lens, was applied to three deliberation sessions involving 107 stakeholders from policy, academic, civil-society and provider sectors across diverse welfare regimes. RESULTS: Three themes were generated: institutional fragmentation converts earlier disadvantage into unequal access; communities absorb shortfalls in formal care without displacing public responsibility; and equity depends on redistributing voice and coordinating responsibility across levels. Costs fall heaviest on women and on rural and low-income older people. CONCLUSIONS: A critical participatory life-course framework can guide LTC redesign through inclusive governance; national coordination hubs are advanced as an author-generated proposal extending participants' calls for coordination.
PubMed2026
Fampridine for Symptomatic Treatment in Chronic Inflammatory Demyelinating Polyneuropathy: A Randomized, Double-Blinded, Placebo-Controlled Crossover Study.
BACKGROUND AND AIMS: Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an immune-mediated neuropathy that may cause persistent disability despite immunoglobulin treatment. Ion channel dysfunction has been demonstrated in CIDP, but no therapies specifically target this mechanism. We investigated whether fampridine improves clinical function and electrophysiological measures in CIDP patients with residual symptoms. METHODS: In this two-center, randomized, double-blind, placebo-controlled crossover trial, patients with CIDP receiving stable subcutaneous or intravenous immunoglobulin were assigned to 4 weeks of fampridine (10 mg twice daily) or placebo, separated by a washout period. Co-primary outcomes were changes in Six-Spot-Step Test (SSST) and Nine-Hole Peg Test (9-HPT). Secondary outcomes included clinical scores, patient-reported outcomes, nerve conduction studies, and nerve excitability testing. RESULTS: Twenty-eight patients were included in the study. No significant differences were observed between fampridine and placebo for SSST (p = 0.154) or 9-HPT (p = 0.857). Grip strength and R-ODS worsened during fampridine compared with placebo (Bonferroni-adjusted p = 0.007 for both), while other clinical outcomes showed no differences. Median nerve CMAP amplitude with proximal stimulation increased significantly during fampridine treatment (adjusted p = 0.040). No significant changes were observed in other electrophysiological variables, including nerve excitability testing. No serious adverse events occurred and adverse effects were predominantly mild. INTERPRETATION: Our study did not provide evidence that fampridine improves clinical function in CIDP patients with residual disability during stable immunoglobulin therapy. Targeting ion channel dysfunction in CIDP remains of interest, but alternative strategies may be required.
PubMed2026
Focused Extracorporeal Shock Wave Therapy Versus Therapeutic Ultrasound as Adjuncts to Exercise-Based Rehabilitation for Functional Limitation in Ankylosing Spondylitis: An Assessor-Blinded Randomized Comparative Trial.
BACKGROUND: The comparative effectiveness of adjunctive physical modalities alongside exercise for ankylosing spondylitis (AS) remains inadequately evaluated. OBJECTIVE: To compare the relative association of focused extracorporeal shock wave therapy (ESWT) versus therapeutic ultrasound, both added to identical exercise-based rehabilitation, with long-term functional outcomes in AS. METHODS: This assessor-blinded randomized comparative trial (conducted March 2024-August 2025) evaluated 106 AS patients with chronic lumbar stiffness (90 completed 12-month follow-up). Participants received either focused ESWT (weekly × 4 weeks, n = 45) or ultrasound (3 × /week × 4 weeks, n = 45), alongside identical 12-week supervised exercise and stable pharmacotherapy. The primary outcome was functional capacity (BASFI). Secondary outcomes included disease activity (BASDAI), pain, spinal mobility (modified Schober) and disability (DFI). This trial was not prospectively registered and lacked an exercise-only control arm; therefore, findings should be interpreted as exploratory. RESULTS: Both groups improved significantly across all outcomes (p < 0.001). At 12 months, the ESWT group was associated with lower BASFI scores (2.2 ± 1.8 vs. 3.7 ± 2.3; p = 0.001; Cohen's d = 0.72) and lower disability (DFI: p = 0.003; d = 0.63) than the ultrasound group. Lumbar mobility differed nominally (p = 0.030) but did not survive correction for multiple secondary comparisons. No significant between-group differences were observed for BASDAI (p = 0.424) or pain (p = 0.284). CONCLUSIONS: When added to identical exercise and pharmacotherapy, focused ESWT was associated with greater long-term functional improvement compared with therapeutic ultrasound. However, in the absence of an exercise-only control, the incremental benefit of either modality over exercise alone cannot be determined. Given the lack of prospective registration and other methodological limitations, these preliminary findings require confirmation through properly registered trials before any clinical recommendations can be made.
PubMed2026
Machine Learning in Causal Effect Estimation and Causal Evaluation of ML-Enabled Interventions in Nursing-Related Research: A Scoping Review.
Machine learning (ML) informs nursing practice, but prediction cannot establish intervention or workflow effects. Aim To map ML use within causal effect estimation and causal evaluations of ML-enabled interventions in nursing and midwifery. Eight electronic sources were searched for reports published January 2015-June 2026, followed by backward citation searching. Eligibility required a causal estimand, corresponding identification strategy, substantive ML role, and nursing or midwifery relevance. Two reviewers independently screened records and full texts. Fifteen studies (17 reports) were included. Five addressed acute deterioration or sepsis; others covered care prioritization, falls, post-discharge care, and nurse- or midwife-led services. Five used ML within causal effect estimation to examine longitudinal and spillover effects, treatment-effect heterogeneity, and targeting strategies. Ten evaluated ML-enabled interventions or workflows; reported favorable effects on mortality, care escalation, message-review time, and nursing processes, while several controlled estimates were null or imprecise. Evidence remains small and methodologically uneven. Future studies should align estimands, identification strategies, analytic methods, and workflows and evaluate model-plus-workflow effects on nursing processes and patient outcomes.
PubMed2026
Near-Peer Anatomy-Anchored Teaching.
BACKGROUND: The transition from pre-clinical to clinical medicine is challenging, particularly in applying anatomical knowledge to patient care. Reductions in dedicated anatomy teaching time have compounded this. Near-peer teaching may help address this gap by reducing hierarchy and enhancing psychological safety, though few programmes have explicitly targeted the pre-clinical to clinical transition through the integration of anatomy with clinical cases. APPROACH: A prospective educational evaluation examined a near-peer, case-based orthopaedic anatomy programme delivered to Year 4 medical students by Year 5 facilitators across four sessions. Knowledge acquisition was assessed using parallel pre- and post-session multiple-choice question (MCQ) sets compared using Wilcoxon signed-rank test and Cohen's dz. Student experience was evaluated using purpose-designed questionnaires. EVALUATION: Thirty-two matched pairs were available for analysis. Baseline anatomical confidence (mean 2.76/5) and ratings of placement-based anatomy teaching (mean 2.26/5) indicated clear unmet need. MCQ scores improved significantly from 5.0 to 7.0 out of 8 (mean 5.00 vs. 6.69, p < 0.001, Cohen's dz = 1.12). Post-session confidence improved to 4.03/5, facilitators were rated highly (mean 4.59/5), and 97% of students felt comfortable engaging with peer facilitators. IMPLICATIONS: This programme provides preliminary support for near-peer, case-based anatomy teaching as a promising approach to supporting the pre-clinical to clinical transition, demonstrating short-term improvements in MCQ performance, confidence and student satisfaction.
PubMed2026
Not All Pain Is Equal: Lower Extremity Pain and Longitudinal Fall Risk in Older Adults.
OBJECTIVES: To investigate the association between pain distribution patterns, particularly lower extremity involvement and multisite pain, and fall risk among older adults in Korea. METHODS: This was a secondary analysis of the Korean Longitudinal Study of Aging (KLoSA). We included participants aged 65 years or older who had experienced no fall during the 2 years prior to baseline. Pain status was assessed at the survey wave preceding a reported fall to capture pre-existing pain. Pain was classified according to its anatomical distribution and cumulative severity. Primary outcome was the incidence of the first fall event during follow-up. Cox proportional hazards models incorporating time-varying pain exposures were used to estimate hazard ratios (HRs) for the first reported fall over up to 16 years of follow-up. RESULTS: A total of 3199 participants (mean age, 72.52 years) were followed for up to 16 years, during which 445 (14%) experienced a fall. Compared to participants without pain, those with lower extremity pain had significantly higher fall risk (isolated lower extremity: HR = 1.38, 95% CI 1.01-1.90; multisite with lower extremity involvement: HR = 1.39, 95% CI 1.04-1.84). Higher lower extremity composite pain scores were associated with greater risk (HR = 1.47, 95% CI 1.10-1.97). Pain at non-lower extremity sites was not significantly associated with falls. CONCLUSION: Self-reported current lower extremity pain was associated with a higher hazard of subsequently reported falls among community-dwelling older adults. Further studies are needed to determine whether pain location improves fall-risk prediction and whether interventions targeting lower extremity pain can reduce falls.
PubMed2026
Nursing Students' Reports of Patient Safety Incidents and Reasons During Clinical Placements: A Secondary Analysis of the International Data.
Clinical placements expose nursing students to patient safety incidents and provide important opportunities for learning about safe care. This study explored how nursing students in four countries recognized and interpreted patient safety incidents encountered or witnessed during clinical practice, including perceived contributing factors. A secondary qualitative content analysis was conducted using narrative data from 1442 undergraduate nursing students in the Czech Republic, Italy, Slovakia, and Türkiye. In total, 287 incident descriptions and 263 explanations of perceived reasons were analyzed using an inductive-deductive approach supported by descriptive frequency counts. Medication safety incidents and patient falls were most frequently reported, alongside infection prevention breaches, missed or inadequate care, communication failures, adverse outcomes, and environmental hazards. Students described incidents as multifactorial, involving patient and contextual factors, organizational and system conditions, and human and professional factors. Cross-country differences reflected patterns within the analyzed narratives rather than differences in incident prevalence or quality of care. The findings support practice-integrated patient safety education, effective supervision, structured reflection and debriefing, clear reporting pathways, and psychologically and emotionally safe, nonpunitive learning environments.
PubMed2026
Operating Theatre-Based Video Interventions to Enhance Student Preparation: A Scoping Review.
INTRODUCTION: Operating theatre experience is central to surgical education, yet medical students often feel unprepared due to the environment's complexity. Video-based resources are increasingly used in surgical training, but their role in improving preparedness for the operating theatre is unclear. This scoping review examined how video-based interventions influence medical students' self-reported preparedness, including confidence, familiarity and anxiety. METHODS: PubMed, Web of Science and the Education Resources Information Centre were searched to 1 March 2026. Eligible studies included medical students, at least one operating room-based video intervention, and a self-reported preparedness outcome. Data were extracted using predefined criteria and synthesised thematically by intervention characteristics, delivery format and outcome domains. RESULTS: Eleven studies met the inclusion criteria, including 911 students. Interventions comprised operative footage, operating theatre environment overviews and perioperative practice demonstrations, predominantly delivered in two-dimensional format. Seven studies incorporated video into existing curricula. Preparedness was assessed through self-reported confidence, familiarity, comfort, anxiety and overall readiness. Ten studies reported improvements in at least one domain of preparedness, although only two assessed preintervention to postintervention change specific to preparation. Among comparative studies, one showed benefit over standard teaching and one found three-dimensional video superior to two-dimensional material. One study reported no effect on anxiety. CONCLUSION: Most studies indicated that operating theatre-based video can enhance medical students' perceived preparedness for theatre. Video represents a scalable approach to contextual familiarisation, but evidence remains constrained by heterogeneous designs and outcomes. Further controlled studies are needed to determine optimal formats and integration strategies.
PubMed2026
Opioid Use and Family Members' Experiences of Opioids in Paediatric Cancer Pain Management: An Integrative Review.
AIM: To analyse the use of opioids in children with cancer and the experiences of their family members regarding opioids used in pain management to improve family nursing. DESIGN: An integrative review. METHODS: A systematic literature search was carried out in four databases (CINAHL, MEDLINE, PsycInfo and Scopus) in August 2023, and was subsequently updated to include studies up to the end of 2024. Sixteen peer-reviewed research articles met the inclusion criteria and were included in a quality appraisal and analysis. RESULTS: Of the wide range of opioids used to treat pain in children with cancer, morphine and fentanyl stood out as the most used. The prevalent routes of opioid administration was intravenous and enteral. Limited research has been conducted on the experiences of family members of children with cancer in the context of opioids used for pain management. Furthermore, there is a scarcity of studies that describe the experiences of siblings from the same perspective. Parental experiences were particularly described as concerns about and a desire to refuse opioid use, although satisfaction with opioid use was also described. CONCLUSIONS: Opioids are particularly significant in managing pain among children with cancer. Therefore, the use of opioids in this patient group should be comprehensively studied, and healthcare professionals should receive sufficient training. The experiences of parents conclude that they require sufficient information and guidance on the management of their children's severe pain and the analgesics used to treat it. The notable lack of research regarding the experiences of siblings in connection with the use of opioids for the management of a child's pain addresses the need for further research from these perspectives. More research on experiences during the different phases of cancer treatment is needed. Further research employing qualitative methods will be essential for enhancing family nursing.
PubMed2026
PGR expression as a pharmacogenomic companion biomarker to GENE70-derived genomic risk in ER-positive/HER2-negative breast cancer.
BACKGROUND: The biology of the estrogen receptor-positive (ER+) and human epidermal growth factor receptor 2-negative (HER2-) breast cancers is heterogeneous even when they are categorized by their risk via genomics. Transcriptomic PGR expression reflects endocrine pathway activity and may provide complementary biological information within established GENE70-derived genomic-risk categories. Whether this molecular marker improves the biological interpretation of genomic-risk stratification beyond conventional clinicopathological assessment remains uncertain. OBJECTIVES: The aim of this study was to determine whether transcriptomic PGR expression provides complementary biological and prognostic information within reconstructed GENE70-derived genomic-risk categories and refines the characterization of endocrine-related tumour biology in ER-positive/HER2-negative breast cancer. METHODS: This study analysed publicly available transcriptomic and clinical data from three cohorts: METABRIC (discovery cohort), GSE96058/SCAN-B cohort (validation cohort) and TCGA-BRCA cohort (molecular validation cohort). The GENE70-derived genomic-risk score was reconstructed for each cohort using matched genes. Cox regression, Kaplan-Meier analysis and subgroup comparisons were used to assess relationships between PGR expression, clinicopathologic variables, molecular features and survival outcomes. RESULTS: Across the three independent cohorts, low transcriptomic PGR expression was consistently associated with higher GENE70-derived genomic risk, increased MKI67 expression, reduced ESR1 expression and enrichment of the Luminal B subtype. Survival findings differed between cohorts. In the discovery METABRIC cohort, transcriptomic PGR expression showed heterogeneous associations with survival, particularly within GENE70-derived high-risk subgroups, whereas the external GSE96058/SCAN-B validation cohort demonstrated consistent associations between low PGR expression and poorer overall survival in both the overall ER-positive/HER2-negative population and GENE70-derived high-risk subgroups. CONCLUSION: These findings suggest that transcriptomic PGR provides complementary biological and prognostic information within GENE70-derived genomic-risk categories. However, because treatment response was not evaluated in the present study, the findings should not be interpreted as evidence of predictive or pharmacogenomic utility and prospective studies incorporating treatment-response analyses are required before such applications can be established.
PubMed2026
Prevalence of Hallux Valgus in Patients With Femoral Neck Fracture and Its Association With Postoperative Functional Outcomes.
BACKGROUND: Hallux valgus is a frequent forefoot deformity in older adults and has been linked to impaired balance, gait dysfunction, and increased fall risk. However, its prevalence among patients with femoral neck fracture and its association with postoperative functional outcomes remain unclear. METHODS: This single-center retrospective study included 235 patients aged ≥ 65 years with available radiographic data who underwent surgery for femoral neck fracture between 2022 and 2024. Hallux valgus was defined on weight-bearing radiographs as a hallux valgus angle (HVA) ≥ 20°. Functional outcomes were evaluated using the Functional Independence Measure (FIM) at 3 months postoperatively. Multivariable linear regression analysis was performed to determine whether hallux valgus was independently associated with motor FIM scores after adjustment for age, sex, surgical procedure, and cognitive function. RESULTS: Among the 235 patients with radiographic data, 178 (76%) were women, with a median age of 85 (77-90) years; 86% of patients underwent bipolar hemiarthroplasty. Hallux valgus was present in 55% (130/235), including 20% (47/235) with moderate-to-severe deformity (HVA ≥ 30°). Patients with hallux valgus had significantly lower motor FIM scores at 3 months than those without the deformity (p = 0.044), whereas cognitive and total FIM scores did not differ. In multivariable analysis, hallux valgus (HVA ≥ 20°) was independently associated with lower motor FIM scores (B = -5.92, 95% CI -10.95 to -0.89; p = 0.021). CONCLUSIONS: Hallux valgus is highly prevalent in patients with femoral neck fracture and is independently associated with lower postoperative motor function. Assessment of hallux valgus may provide additional insight into postoperative functional prognosis in this population.
PubMed2026
Synthesising Generative Artificial Intelligence Competency Domains for Medical Education Faculty.
BACKGROUND: Artificial intelligence (AI), including generative AI (GenAI), is reshaping clinical care and medical education, requiring medical education faculty to develop new competencies. As GenAI becomes integrated into clinical and teaching workflows, faculty must guide learners in AI-enabled environments. Although existing frameworks outline AI competencies for clinicians or learners, few synthesise competencies specifically for faculty roles. This review addresses that gap by synthesising AI and GenAI competency frameworks to identify GenAI domains relevant to medical education faculty. METHODS: The authors conducted a narrative review of 24 articles published between January 2020 and February 2025 on AI and GenAI competencies for clinicians, educators and learners. Structured database searches identified articles. Existing AI competency frameworks guided comparison of faculty-relevant GenAI competencies. Through iterative synthesis, the authors identified competency domains consistently represented across frameworks and aligned with educator responsibilities. FINDINGS: Using Russell et al.'s framework as an organising anchor, six competency domains were identified: (1) Foundational AI Knowledge and Literacy; (2) Ethical, Social, and Legal Policies and Implications; (3) AI-Enhanced Clinical Interactions; (4) Practice-Based Learning, Instructional Design, and Pedagogy; (5) Evidence-Based Evaluation and Assessment; and (6) Systems-Level Workflow and Integration. Existing frameworks differed in emphasis across domains, with clinical and systems-level competencies less consistently represented. IMPLICATIONS: These domains provide a foundational structure to guide faculty development, curricular decision-making and responsible integration of GenAI into medical education. Future work should translate these domains into observable indicators and assessment strategies while examining how faculty competencies support learner development and responsible GenAI use.
PubMed2026
Therapeutic drug monitoring-guided individualized caffeine dosing for apnea of prematurity: Clinical efficacy and association with early neurobehavioral outcomes in preterm infants.
BACKGROUND: Given the high incidence of apnea of prematurity (AOP) and the repeated hypoxia-induced nerve damage, treatment optimization from the dosing perspective is critical. Caffeine is the current first-line therapeutic drug for AOP. However, the conventional dose results in low blood concentration compliance, with significant variation among individuals. OBJECTIVES: To explore the clinical efficacy and safety of a therapeutic drug monitoring (TDM)-guided individualized caffeine dosage regimen and its association with early neurobehavioral development and weight gain in preterm infants (PTIs). METHODS: In this retrospective propensity score-matched cohort study, 130 PTIs with AOP were included after 1:1 matching, with 65 infants in the TDM-guided individualized dosing group and 65 in the conventional fixed-dose group. Inter-group comparative assessments were conducted from the perspectives of blood drug concentration compliance rates, apnea control, adverse reactions, neurobehavioral development scores, clinical outcomes and weight gain rates. RESULTS: Compared with the conventional fixed-dose group, the TDM-guided individualized dosing group had a significantly higher target attainment rate of blood caffeine concentration (92.31% vs 70.77%; OR=5.22, 95% CI 1.68-12.74, P=0.002), lower apnea episode frequency at 4 weeks (MD -1.40 times/day, 95% CI -2.13 to -0.67, P<0.001), lower overall incidence of adverse reactions (6.15% vs 20.00%; OR=0.26, 95% CI 0.09-0.87, P=0.035), higher NBNA score at 40 weeks of corrected gestational age (MD 1.74, 95% CI 1.23-2.25, P<0.001), shorter hospital stay (MD -4.11 days, 95% CI -6.51 to -1.71, P=0.001) and faster weight gain rate (MD 7.88 g/day, 95% CI 3.21-12.55, P=0.001). CONCLUSION: The TDM-guided individualized caffeine dosing regimen was associated with improved precision of AOP treatment, better short-term therapeutic efficacy and safety, and higher early neurobehavioral assessment scores and weight gain in preterm infants within 6 months of corrected gestational age. Multicenter studies with longer follow-up are needed to further verify its long-term clinical benefits.
PubMed2026
Training for Change: Developing Clinical Debriefing Champions in a Maternity Unit.
BACKGROUND: Clinical debriefing (CD) is a structured reflective conversation that supports experiential learning, enhances teamwork and contributes to patient safety. Despite established evidence for its benefits, implementation of CD within clinical environments remains challenging, with cultural barriers frequently cited as problematic. As part of a wider programme to embed CD within a busy maternity unit, a 1-day course in CD facilitation was delivered to an interprofessional group to develop debriefing skills and empower a group of staff to commit to CD practice. APPROACH: Course design was informed by self-determination theory (SDT) and relational coordination theory (RCT), integrating principles of motivation, psychological safety and interprofessional learning into teaching and learning activities. Sessions combined didactic teaching, small-group discussion, scaffolded skills practice using structured debriefing tools, clinical and nonclinical scenarios and immersive simulation. EVALUATION: Fifteen staff members from the maternity unit participated. Participants represented a diverse interprofessional group, many of whom held formal leadership roles. Feedback indicated an improved perceived ability of participants to undertake aspects of CD. Free-text feedback highlighted the value of psychological safety, interactive methods and opportunities to practise facilitation skills. Participants expressed strong intentions to implement CD within their teams. IMPLICATIONS: This theory-driven, interactive course showed promise for building capability and motivation for CD facilitation while supporting the cultural conditions required for sustained implementation. The design is transferable to other specialties and settings: Educators can adapt the theoretical mapping and scaffolded skills practice to develop local 'champions' to accelerate cultural change in healthcare contexts.
PubMed2026
Ultrasound-guided high-voltage vs conventional pulsed radiofrequency in elderly cervical radiculopathy: A randomized controlled trial.
BACKGROUND: Elderly patients with cervical radiculopathy present therapeutic challenges owing to comorbidities and medication-related risks. Long-term pharmacotherapy and surgical interventions are often suboptimal, necessitating evaluation of optimized pulsed radiofrequency strategies under image guidance. OBJECTIVES: This superiority trial compared the efficacy and safety of ultrasound-guided cervical nerve root high-voltage pulsed radiofrequency (HVP-PRF) versus conventional pulsed radiofrequency (C-PRF) for pain management in elderly patients with cervical radiculopathy. METHODS: This single-center, parallel-group, assessor-blinded randomized controlled trial enrolled patients aged 60-85 years with cervical radiculopathy, randomly assigned (1:1) to HVP-PRF (70 V) or C-PRF (45 V). Procedures were performed under ultrasound guidance with sensory/motor stimulation confirmation and temperature ≤42°C. The primary outcome was change in upper-limb radiating pain on the Numeric Rating Scale (ΔNRS) from baseline to 3 months. Secondary outcomes included Neck Disability Index (NDI), neck pain NRS, Patient Global Impression of Change, responder rates, rescue analgesia use, and adverse events. Follow-up occurred at 1 week, 1, and 3 months. RESULTS: A total of 104 patients were randomized and 101 received treatment. At 3 months, HVP-PRF demonstrated significantly greater radiating pain improvement versus C-PRF (adjusted mean difference 1.24, 95% CI 0.46-2.02, P=0.002). Functional improvement (NDI) was superior in the HVP-PRF group at 3 months (AMD 6.47, 95% CI 2.11-10.83, P=0.004). Responder rates (≥50% pain reduction) were higher with HVP-PRF at 3 months (68.75% vs. 42.22%, OR 3.01, P=0.011) and 6 months (65.22% vs. 43.18%, OR 2.52, P=0.035). Rescue analgesic use was lower in the HVP-PRF group during 1-3 months intervals (both P<0.05). Adverse event rates were comparable (27.45% vs. 32.00%). CONCLUSION: Under ultrasound visualization and electrical stimulation-based target confirmation with temperature control ≤42°C, HVP-PRF provided greater and more durable relief of upper limb radiating pain compared with C-PRF in elderly patients with cervical radiculopathy, with a comparable safety profile.
PubMed2026
Youth development programming in El Salvador: Interrogating program duration and youth perceptions of program quality.
Youth development programs can equip young people with the skills and competencies they need to thrive, and thus, are ecological assets supporting youth, particularly those living in Majority World countries, such as El Salvador, where young people are exposed to high rates of poverty and violence. The programs of Compassion International (CI), an international faith-based youth organization, serve more than 2.4 million youth across Majority World countries. Although past research established the positive impact of CI programming on Salvadoran youth, the role of specific program doses involved in CI programs and youth perceptions of program quality are unknown. Using a sample of 564 Salvadoran youth (ages 10 to 16) involved in CI programs in El Salvador, we investigated: (1) Do program duration (i.e., years of enrollment) and youth perceptions of program quality (i.e., positive and sustained youth-adult relationships, life-skill-building activities, and opportunities for leadership/contribution) directly account for variation in positive youth development (PYD)? and (2) Are youth perceptions of program quality associated with program duration? Results from structural equation modeling indicated that there was no significant association between youth perceptions of program quality and program duration. Both variables significantly accounted for variation in PYD, with distinct effects: program duration negatively predicted PYD, whereas perceived program quality positively predicted PYD. These findings highlight the critical role of youth perceptions of program quality in promoting PYD.
PubMed2026
All You Need to Know to Better Implement Quality Improvement into Your Practice.
This article uses a hypothetical quality improvement project to discuss the process of the Model for Improvement and ways to incorporate this into allergy practice.