International braz j urol : official journal of the Brazilian Society of UrologyEduardo Fagundes Muricy, Jahel Alves Estrela Lopes, Emanoel Nascimento Santos, Lucas Teixeira Aguiar Batista, Ubirajara Barroso
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.
Methods in molecular biology (Clifton, N.J.)Nadia Nasir, Maryalice Stetler-Stevenson, Hao-Wei Wang
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.
International braz j urol : official journal of the Brazilian Society of UrologyNaiwen Chen, Lichen Chen, Jinming Cai, Mingyue Tan, Dongliang Xu
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.
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.
International braz j urol : official journal of the Brazilian Society of UrologyMarcos Tobias-Machado, Ricardo C Brianson, John Eder Gamarra Bravo, Alcedir Raiser, Eliney Faria
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.
Methods in molecular biology (Clifton, N.J.)Pooja Bhardwaj, Gaurav Raj Dwivedi, Hari Shanker Joshi, Rajeev Singh
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.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyD V Vankov, O V Obukhova, I A Deev, M A Ivanova
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.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyV G Zilov, L V Kosmodemyansky
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.
Public health research & practiceSummer May Finlay, Anna Temby, Amohia Boulton, Jenni Judd, James A Smith, Yvette Roe, Bronwyn Fredericks
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.
Scandinavian journal of caring sciencesİlknur Özkan, Seçil Taylan
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.
Scandinavian journal of caring sciencesAnna Nivestam, Albert Westergren, Maria Haak, Gita Hedin
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.
Australasian journal on ageingRuttiya Bhula-Or, Chadatan Osatis, Orawan Prasitsiriphon, Man Thi Hue Vo, I-Chun Chen
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.
Journal of the peripheral nervous system : JPNSPeter Nørregaard Hansen, Lars Markvardsen, Hatice Tankisi, Henning Andersen, Thomas Krøigård, Søren Sindrup
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.
Musculoskeletal careYasser A Elmotaleb Gazar, Sherif Ismail, Saad Ghanem, Taha Ibrahim Aladrosy, Adel Ibrahim Azzam
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.
Nursing & health sciencesDimitrios Kosmidis, Georgios Vlachopoulos, Abdulqadir J Nashwan, Rafael Lima Rodrigues de Carvalho, Breno Santos Araujo, Dimitra Armeni, Eleni Sertaridou, Soti…
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.
Australasian journal on ageingJiwon Kim, Dong Hoon Lee, Kyeongtak Song
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.
The clinical teacherLachlan Dick, Despina Kimpizi, Elena Kirwan, Maggie Kerr Livingstone, Hannah Martin, Joseph E McKay, Elizabeth Ward, Andrew G Robertson
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.
Scandinavian journal of caring sciencesNoora Puusa, Eeva Harju, Maija-Liisa Kalliomäki, Elina Haavisto
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.
Pakistan journal of pharmaceutical sciencesOrcun Can
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.
Journal of foot and ankle researchKazuki Kanazawa, Shunsuke Akiho, Masahiko Sakai, Ken Ichikawa, Soshiro Goshima, Ryohei Haraguchi, Takuaki Yamamoto
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.
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.
Pakistan journal of pharmaceutical sciencesJiajia Ying
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.
The clinical teacherEmma Claire Phillips, Stephen Waite, Jocelyne Velupillai, Edward Mellanby, Victoria Ruth Tallentire
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.
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.
Journal of research on adolescence : the official journal of the Society for Research on AdolescenceMargaret Mackin, Roya Abbasi-Asl, Jonathan M Tirrell, Elizabeth M Dowling, Emma Armstrong-Carter, Alistair Sim, Richard M Lerner
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.
OBJECTIVES: Burnout can impair clinical judgment and is prevalent across all medical subspecialties. Neurology, in particular, is associated with high rates of burnout and low satisfaction with work-life balance. METHODS: A standardized survey using the abbreviated Maslach Burnout Inventory was administered from December 2020 to March 2022. Faculty from 19 academic neurology departments in the United States participated. Demographic, career, compensation, equity, domestic circumstances, parental leave, and burnout data were collected as part of the Women in Neurology Collaborative Study. Statistical analysis was performed using IBM SPSS version 30.0 and R version 4.4.4. RESULTS: Among the 311 neurology faculty participants, 185 (59.5%) identified as women and 277 (89.1%) were clinical faculty members. The mean reported duration of practice was 14.4 years (SD 11.3 years). Approximately 98.4% (n = 306/311) of respondents reported experiencing moderate-to-high levels of burnout. Burnout and depersonalization were consistently high across all career stages (>96.6%), while the subscale of emotional exhaustion (EE) rose significantly by the late-career stage (p < 0.001). Moderate-to-high EE among neurology faculty was associated with sex, academic rank, and career stage. In unadjusted analyses, leadership titles and research involvement were associated with higher rates of EE but were not statistically significant after adjustment for career stage and respective career advancement indicator. Participants in leadership positions had significantly higher observed rates of EE compared with those without leadership roles (p = 0.002). Participants who reported a history of involvement in funded research had significantly higher rates of EE compared with those with no history of funded research (p = 0.001). Among individuals in the mid-career stage, full professors had significantly higher odds of EE compared with assistant professors (OR = 6.00, 95% CI 1.34-26.81; p = 0.019). No significant differences in the rate of overall burnout were detected by sex, academic rank, career stage, or career advancement indicators. DISCUSSION: High burnout and EE rates among academic neurology faculty were common across career stages, with EE rising significantly among late-career faculty members. Higher EE rates were also seen among faculty with leadership roles and funded research involvement, although these associations were not significant after adjustment. Neurology departments may consider measures aimed at reducing burnout in the future, with particular attention to faculty in late-career stages.
Annals of medicineHong-Yu Long, Yong-Mei Wu, Xue Li, Bai-Qing Chen
BACKGROUND: To compare the predictive performance of computed tomography (CT) body composition indices, anthropometric indices, and laboratory indices for gallstones occurrence, and to construct machine-learning models to improve performance. METHODS: The dual-center retrospective cohort enrolled patients who underwent initial abdominal CT between January 2017 and January 2023, had no gallstones detected, and completed at least 3 years of follow-up. The data analysis was performed in April 2026. They were divided into gallstone group and non‑gallstone group by follow‑up findings. A deep-learning tool, Body and Organ Analysis (BOA), was used to quantify fat, muscle, and bone at the level of the third lumbar vertebra. The area under the receiver operating characteristic curve (AUC) of these indices was compared with that of anthropometric and laboratory indices. Predictive models were developed in the training cohort. Model performance was evaluated using fivefold cross-validation and an independent test cohort. RESULTS: 1,944 patients were evaluated, including 1,437 in the training cohort (Center 1; median age, 63 years [25th-75th percentile, 55-72]; 699 males) and 507 in the test cohort (Center 2; median age, 63 years [55-71]; 266 males). In univariate analysis, neutrophil-to-lymphocyte ratio (NLR) showed the highest AUC (0.627, 95% confidence interval [CI]: 0.586-0.668). The extreme trees (ET) model performed best, with a test-set AUC of 0.772 (95% CI: 0.714-0.822). SHapley Additive exPlanations (SHAP) analysis identified the area ratio of subcutaneous to total fat as the most important feature. CONCLUSIONS: NLR was the best single predictor but had limited standalone utility. Among models integrating the three indicator categories, the ET performed best.
Global health actionAbdikerim Mohamed Moumin, Abdalle Ali Yusuf, Abdirizak Mohamed Moumin, Khadar Mowlid Abdi, Bishar Elmi Yey, Hibak Ahmed Nuh, Abdifatah Ahmed Osman
BACKGROUND: Postpartum depression (PPD) and fragmented maternal care are critical public health challenges in sub-Saharan Africa. OBJECTIVE: To examine the associations of psychosocial, structural, clinical, and health-system factors with self-reported postpartum depressive symptoms and maternal continuum-of-care (CoC) completion in Borama, Somaliland. METHODS: A community-based cross-sectional study analyzed 442 postnatal women. Postpartum depressive symptoms were assessed via binary self-report, and CoC was summarized using a 0-3 index (ANC4+, facility delivery, and postnatal care). Multivariable logistic regression estimated adjusted odds ratios (aORs) for depressive symptoms; robust multiple linear regression estimated adjusted CoC-score differences (N=442). RESULTS: Depressive symptoms were reported by 109/442 women (24.7%), and 152/442 (34.4%) completed all three CoC components. Higher adjusted odds of symptoms were observed among single mothers (aOR = 2.27, 95% CI 1.11-4.65), women with labor complications (aOR = 2.06, 95% CI 1.10-3.87), university/technical education (aOR = 2.49, 95% CI 1.16-5.33), and fair/poor self-rated health (aOR = 6.66, 95% CI 2.62-16.90). Among symptom-positive women, 37.6% spoke to no one about their distress. Adjusted symptom probabilities declined across increasing spousal-support categories, but the overall association was not statistically significant (p=.430). Early ANC initiation (B=0.345, 95% CI 0.205-0.486) and university/technical education (B=0.382, 95% CI 0.182-0.582) were positively associated with the CoC score. CONCLUSIONS: Postpartum depressive symptoms and incomplete continuity of care were prevalent in this sample. Maternal-health planning should consider integrating routine emotional symptom enquiry with strategies that strengthen early ANC engagement and postnatal follow-up.
The Journal of dermatological treatmentYanchen Liu, Haoran Hu, Linfeng Li
OBJECTIVES: Randomized evidence for systemic targeted therapies in prurigo nodularis (PN) has expanded, but cross-trial differences limit valid comparison. We mapped randomized evidence and assessed comparative effects using exact Week-16 ≥ 4-point itch numerical rating scale response (NRS4). METHODS: MEDLINE, Embase, CENTRAL, and Web of Science were searched through 14 August 2026. Studies with extractable randomized arm-level Week-16 NRS4 data were synthesized using a fixed-effect contrast-based network meta-analysis. Risk of bias was assessed with RoB 2 and confidence with CINeMA. RESULTS: Twenty-four randomized studies were represented by 117 reports, but only seven cohorts (1,435 participants; 19 arms; 10 active nodes) contributed to the aligned network. Dupilumab (OR 4.04, 95% CI 2.42-6.75; low confidence) and global phase III nemolizumab (OR 5.81, 95% CI 3.81-8.86; low confidence) were effective versus placebo. The indirect nemolizumab-versus-dupilumab comparison was imprecise (OR 1.44, 95% CI 0.74-2.79; low confidence). CONCLUSIONS: Indirect evidence did not establish superiority of either biologic. The randomized evidence bases substantially exceeded the quantitatively comparable network, reflecting incomplete results availability and cross-trial differences. REGISTRATION: PROSPERO CRD420261401106.
Renal anemia is a prevalent complication in patients undergoing peritoneal dialysis (PD). Roxadustat is an oral hypoxia-inducible factor prolyl hydroxylase inhibitor, but comparisons with erythropoiesis-stimulating agents (ESAs) require consideration of the specific regimens used. We systematically searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed from inception to December 2025 for randomized controlled studies comparing roxadustat-based regimens with ESA-based regimens in adults receiving PD. Eligible evidence was restricted to PD-only randomized studies after rechecking dialysis modality and study design. Nineteen studies involving 1,636 participants were included. The average post-treatment hemoglobin level was higher in the roxadustat-based groups than in the study-specific ESA comparator groups (mean difference = 7.30 g/L, 95% CI: 5.43 to 9.16; I2 = 62.6%). However, hemoglobin target-attainment data were not defined or reported consistently enough for quantitative synthesis. Post-treatment hematocrit and red blood cell count also differed between groups, with substantial heterogeneity. The pooled reported adverse-event rate yielded an RR of 0.45 (95% CI: 0.27 to 0.74), but definitions and ascertainment were not standardized. Effects on iron indices, inflammatory markers, lipid indices, and cardiovascular outcomes were exploratory. Grading of Recommendations Assessment, Development and Evaluation certainty was low for hemoglobin and low to very low for most secondary outcomes. Available evidence is insufficient to determine the comparative clinical superiority of roxadustat-based over ESA-based strategies in PD because final values were pooled and comparator regimens were heterogeneous. Evidence concerning hemoglobin target attainment, high-density lipoprotein cholesterol, and long-term safety remains insufficient.
Annals of medicineYang Xie, Peng Zhang, Jiajia Wang, Tao Chen, Jiansheng Li
BACKGROUND: Patient-reported outcomes (PROs) have become essential endpoints in clinical trials for bronchiectasis. However, no validated PRO instrument currently exists for the Chinese population. This study aimed to develop and validate a disease-specific Patient-Reported Outcome scale for Bronchiectasis (BE-PRO) tailored to Chinese patients. METHODS: A mixed-methods approach was used to develop the BE-PRO. The conceptual framework and initial item pool were developed primarily from semi-structured patient interviews and supplemented by literature and existing-instrument reviews and medical-record analysis. Items were refined through qualitative review by experts and patients. Two field surveys were then conducted, with items selected using classical test theory (CTT), item response theory (IRT), and structural equation modeling (SEM). Finally, a formal validation survey assessed the psychometric properties of the BE-PRO. RESULTS: The final BE-PRO consists of 16 items organized into five domains: physiology, psychology, environment, society, and treatment satisfaction. The scale demonstrated excellent internal consistency (Cronbach's α = 0.912), split-half reliability (0.856) and satisfactory structural validity (CFI = 0.961; RMSEA = 0.068). Strong correlations with the SF-36 and QOL-B supported criterion validity, while moderate correlations with the BSI and E-FACED supported its clinical relevance. The scale showed high feasibility, with 100% response and completion rates and a mean completion time of 9.07 min. CONCLUSION: The 16-item BE-PRO is a reliable, psychometrically validated and feasible instrument for assessing patient-reported outcomes in Chinese patients with bronchiectasis. Its strong psychometric properties support its use in both clinical trials and routine practice.
Global health actionFelix Ikenna Onunkwor, Rose Aguolu
BACKGROUND: Quality assessment in family planning (FP) and post-abortion care (PAC) programmes is shaped by workforce capability, programme context, and assessment modality. Longitudinal evaluations may misattribute quality-score differences if repeated measurements and temporal patterning are ignored. OBJECTIVE: To examine associations of workforce characteristics, calendar period, service-delivery channel, and assessment modality with Quality Technical Assessment (QTA) performance in Sierra Leone, 2019-2022. METHODS: We analysed 108 QTA records from 23 service delivery points using Gaussian generalised estimating equations with facility-level clustering and robust standard errors. Models included year, modality, channel, active staff count, and core-service competency coverage; full-time staffing and assessor identity were examined in sensitivity analyses. In 2021, all facilities received planned in-person and then remote assessments in a fixed programme-wide sequence. RESULTS: Mean QTA scores increased descriptively from 89.8% (SD 7.4) in 2019 to 94.2% (SD 4.7) in 2022. In the primary model, 2020 scores were lower than 2019 (B = -5.15; 95% CI -9.99 to -0.32). Active staff count was inversely associated with QTA scores (B = -2.86; 95% CI -4.47 to -1.26). Remote assessment was associated with higher adjusted scores, but this cannot be interpreted causally because modality was confounded with year and assessment order. CONCLUSIONS: QTA performance varied across calendar periods and workforce structure. Longitudinal evaluations should account for within-facility correlation and modality timing before attributing quality differences to the workforce or assessment approach.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyXufeng Gong, Qian Zhu, Linlin Wang
BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication. Although lipid parameters, the triglyceride-glucose (TyG) index, and TyG-body mass index (TyG-BMI) have been associated with GDM, their relative value within an integrated lipid-glycaemic prediction framework remains unclear. This study developed and internally validated an interpretable model for GDM risk estimation. METHODS: This single-centre retrospective study included 287 pregnant women who underwent 75 g oral glucose tolerance testing and fasting lipid assessment at 24-28 gestational weeks, including 72 with GDM and 215 without GDM. Candidate predictors comprised maternal characteristics, fasting plasma glucose (FPG), routine lipid fractions, apolipoproteins, the TyG index, and TyG-BMI. Forward stepwise likelihood-ratio logistic regression was used to develop the original combined model. A structured alternative model replaced pre-pregnancy BMI, FPG, and triglycerides with TyG-BMI. Model performance was evaluated using receiver operating characteristic analysis, calibration measures, threshold-dependent diagnostic metrics, 1,000-resample bootstrap internal validation, paired DeLong testing, a nomogram, and decision curve analysis. RESULTS: Eight variables were retained in the original combined model: maternal age, pre-pregnancy BMI, FPG, total cholesterol, triglycerides, non-high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B. Its apparent and optimism-corrected AUCs were 0.848 (95% CI: 0.786-0.909) and 0.830, respectively; the bootstrap-corrected calibration intercept was -0.03, calibration slope was 0.86, and Brier score was 0.147. The TyG-BMI alternative model had apparent and optimism-corrected AUCs of 0.831 (95% CI: 0.765-0.897) and 0.817. The AUC difference was 0.017 (95% CI: -0.011 to 0.045; P = 0.235). Decision curve analysis indicated potential net benefit for both models across clinically relevant thresholds. CONCLUSION: Both models showed good internally validated discrimination and acceptable calibration for GDM risk estimation at routine screening. The original model had a numerically higher AUC, but discrimination did not differ significantly between models. External validation is required before clinical implementation.
Human vaccines & immunotherapeuticsRong Jiang, May Z Gao, Vincent M D'Anniballe, Matthew Lu, Tammara L Watts, Gregory D Zimet, Darien J Weatherspoon, Erika L Thompson, Nosayaba Osazuwa-Peters
Human papillomavirus (HPV) infection contributes to rising incidence of HPV-related oropharyngeal cancer (OPC). After the U.S. expanded HPV vaccination to adults aged 27-45 y in 2018, COVID-19 caused preventive visits and routine immunizations to plunge. We analyzed 2019 and 2022 NHIS data among adults aged 27-45 (2019 n = 8,745; 2022 n = 7,303). The primary outcome was ever HPV vaccination (≥1 dose), regardless of age at first vaccination. We estimated age-adjusted, survey-weighted coverage and used multivariable logistic regression to estimate adjusted odds of vaccination by sociodemographic characteristics; secondary 2022 analyses assessed initiation between ages 27 and 45. Ever HPV vaccine uptake increased from 15.1% in 2019 to 20.7% in 2022 (difference 5.6 percentage points; 95% CI, 4.03-7.07). In both years, lower odds were observed with increasing age, men, non-Hispanic Asian adults, individuals with lower educational attainment, and those without a usual place for care. By 2022, lower income-to-poverty ratios and lack of insurance were associated with reduced odds, whereas LGB+ and unmarried adults had higher odds, and adults in the Northeast had higher odds than those in the South. Only 1.43% (95% CI, 1.07-1.80) initiated vaccination between ages 27 and 45 in 2022. Initiation was more common among females, LGB+ and non-Hispanic Asian adults, and unmarried adults, and less common among those with lower education and no usual place for care. The increase in lifetime HPV vaccine coverage likely reflects childhood and adolescent vaccination rather than initiation at ages 27-45, which remained uncommon, and persistent inequities highlight missed opportunities for equitable OPC prevention.
PulmonologyCíntia Dias, Raquel Marinho, José Joaquim Alvarelhão, Eduarda Tinoco, Tiago Alfaro, Vânia Fernandes, Sérgio Campainha, Chris Burtin, Alda Marques
BACKGROUND: Measurement properties of patient-reported outcome measures assessing functional performance and activity limitations in interstitial lung disease (ILD) are often unknown. RESEARCH QUESTION: To evaluate the reliability and validity of the Canadian Occupational Performance Measure (COPM) and the Pulmonary Functional Status and Dyspnea Questionnaire-Modified version (PFSDQ-M) in European Portuguese among people with ILD, and to explore differences between fibrotic and non-fibrotic ILD. STUDY DESIGN AND METHODS: Cross-sectional study. Internal consistency (Cronbach's α), test-retest/intra-rater and inter-rater reliability assessed using intraclass correlation coefficients [ICC2,1[95%CI]], standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC95) and Bland-Altman analysis, and floor/ceiling effects were evaluated. Construct validity was explored with correlations: convergent validity with the LCADL, CIS-8, 6MWT and 1-minSTS, only for PFSDQ-M; divergent validity with age and lung function for both instruments. Subgroup analyses compared fibrotic and non-fibrotic ILD. RESULTS: A total of 334 participants were included. The COPM showed moderate test-retest/intra-rater and inter-rater reliability (ICC2,1 = 0.68[0.57-0.77]-0.72[0.63-0.80]), with SEM = 1.08-1.42 and MDC95 = 3.00-3.94, and no floor/ceiling effects. The PFSDQ-M demonstrated excellent internal consistency (α = 0.90-0.96) and good test-retest and inter-rater reliability (ICC2,1 = 0.80[0.74-0.85]-0.92[0.89-0.94]), with SEM = 15.80 and MDC95 = 43.80 for total score. Bland-Altman analysis showed no systematic bias for the COPM and a small bias for the PFSDQ-M test-retest. Moderate-to-strong correlations with LCADL/CIS-8 and weak-to-moderate with 6MWT/1-minSTS supported convergent validity for PFSDQ-M. Negligible-to-weak correlations with age and lung function for COPM and PFSDQ-M supported divergent validity. Subgroup results were similar. CONCLUSION: The European Portuguese COPM and PFSDQ-M demonstrated reliability. The COPM showed evidence of divergent validity, whereas the PFSDQ-M demonstrated both convergent and divergent validity. These findings support their use for assessing functional performance in people with ILD.
INTRODUCTION: Uncorrected refractive error (URE) is a primary cause of visual impairment (VI). Although URE causes VI and increases the risk of amblyopia in school-going children, no studies have examined barriers to uptake of refractive eye-care services among secondary school students in Uganda. This study reports the perceived reasons for the poor uptake of refractive eye care services among students at two secondary schools in Kampala, Uganda. METHODS: A cross-sectional study was conducted in two secondary schools in Kampala between March 2019 and April 2019. Students' presenting distance visual acuities (DVA) were measured. Participants with a DVA worse than 6/9 were reassessed using a pinhole. Those not using spectacles or contact lenses who had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error were administered a structured questionnaire. Descriptive statistics were used to analyze the data. Chi-square tests were performed to assess the association between sex and the proportion of screened students with pinhole-improvable, reduced distance visual acuity suggestive of uncorrected refractive error. RESULTS: 407 students were screened for refractive errors. In total, 10.81% (44/407, 95% CI:8.15% to 14.20%) of screened students had pinhole-improvable reduced distance visual acuity suggestive of uncorrected refractive error (URE). Perceived barriers towards refractive eye-care use reported included fear of surgery (52.27%, 95% CI: 37.94% to 66.25%), unawareness of the available eye care services (50.00%, 95% CI: 35.83% to 64.17%) and not feeling comfortable with the indigenous practitioner to whom they had access (19/44,43.18%, 95% CI: 29.68% to 57.78%). Financial limitations were stated as an important barrier by 20.00% (5/25, 20.00%, 95% CI:95% CI: 8.86% to 39.13%) of participants who stated the most important barrier. CONCLUSION: Among students who participated in screening at two secondary schools, a small subgroup had pinhole-improvable reduced distance visual acuity suggestive of an uncorrected refractive component. Exploratory questionnaire responses identified possible barriers related to awareness, perceptions of treatment, access, cost, and family or social influences. These findings require confirmation using refraction-based case definitions, probability sampling, and a culturally adapted and validated adolescent questionnaire.
Scandinavian journal of primary health careTuva Sandsdalen, Reidun Hov, Harald Sanaker, Liv Skomakerstuen Ødbehr
BACKGROUND: Since physicians have primary responsibility for medical treatment, their perspectives of palliative care quality in nursing homes can provide important knowledge for service evaluation and enhancement in this context. However, few studies exist that include their perspectives. OBJECTIVES: The aim was to investigate physicians' perspectives of the quality of palliative care in Norwegian nursing homes. METHODS: A cross-sectional study conducted between November 2022 and December 2023, which included 77 nursing home physicians (response rate 43.5%) in Norway. Data were collected using a questionnaire comprising questions about demographic variables and perceptions of quality of care, as measured by the short form of the instrument Quality from the Patients' Perspective for Palliative Care (QPP-PC), adapted for healthcare personnel. Descriptive analyses and Wilcoxon signed rank tests were performed. RESULTS: Nursing home physicians scored subjective importance of the care significantly higher than their perception of the quality of actual care received in the two dimensions; medical-technical competence and sociocultural atmosphere and for nine out of the 24 items and three out of seven additional symptom-specific questions. A need for improvement was identified in care areas such as symptom relief for pain, depression and anxiety, existential care, understanding patients' perspective, waiting time, individualized care, cooperation, and continuity. CONCLUSION: The results show that provision of high-quality palliative care in nursing homes can be challenging and that the physicians identified several areas for improvement. The results can provide direction for future quality improvement. However, the findings need to be confirmed in a larger sample.
Annals of medicineElif Esma Bayraktar, Nuray Alaca, Irmak Çavuşoğlu, Yağmur İldeniz, Asiye Koçak
BACKGROUND: The longitudinal interpretability of Turkish pain-related psychological measures in chronic non-specific low back pain (NSLBP) remains uncertain. This study evaluated the responsiveness and minimal important change (MIC) of the Turkish Fear-Avoidance Beliefs Questionnaire (FABQ), Tampa Scale of Kinesiophobia (TSK) and Pain Catastrophizing Scale (PCS). METHODS: In this prospective, single-arm measurement-property study, 110 adults with chronic NSLBP completed baseline and 4-week assessments during a standardized rehabilitation program. Distribution-based responsiveness was assessed using effect size and standardized response mean. Associations with Global Rating of Change (GRC)-defined improvement were examined using correlations and receiver operating characteristic analysis. MIC uncertainty was estimated by stratified bootstrap resampling with 20,000 iterations. RESULTS: Fifty-two participants were classified as improved and 58 as not improved. FABQ change scores were strongly correlated with GRC and showed excellent discrimination (area under the curve (AUC) = 0.943-0.977). GRC-defined MIC estimates (95% bootstrap confidence interval (CI)) were 5 (5-5) for FABQ-Physical Activity and 7 (6-8) for FABQ-Work. PCS correlations and discrimination were more modest (AUC = 0.647-0.700); MIC estimates ranged from 2 to 6 points, with the widest interval for PCS-Total [6 (3-11)]. TSK change was unrelated to GRC (rho = 0.014; AUC = 0.508), and no MIC was estimated. CONCLUSIONS: In this rehabilitation context, FABQ change scores corresponded most strongly to GRC-defined improvement. PCS MIC estimates were less precise, whereas TSK change did not distinguish global improvement. These estimates are context-specific and require external validation.
European journal of psychotraumatologyIrada Meoon, Aungsana Khlaisuk, Siriyupa Nansunanon, Teerapon Dhippayom
Background: Post-traumatic stress disorder (PTSD) is prevalent among children and adolescents, with cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) widely used treatment options. This study compared the effects of CBT and EMDR in children and adolescents using a meta-analysis approach.Methods: PubMed, EMBASE, CENTRAL, CINAHL, ProQuest Dissertations & Theses, and PsycInfo were searched in March 2025. Randomized controlled trials that compared the effectiveness of CBT and EMDR on PTSD symptoms in children and adolescents aged 6-18 years who had been exposed to traumatic events were included. The Cochrane Risk of Bias version 2 was used to assess the methodological quality of the included studies. A random-effects model was applied to calculate the standardized mean difference (SMD) along with 95% confidence interval (CI), and the I2 statistic was used to quantify statistical heterogeneity.Results: Five trials (248 participants) were included. There was no statistically significant difference in PTSD symptoms between the CBT and EMDR groups, whether reported by children (SMD: 0.18; 95% CI: -0.07-0.43; I2 = 0%) or by parents (SMD: 0.23; 95% CI: -0.02-0.48; I2 = 0%). For anxiety, the pooled estimate did not reach statistical significance (SMD: 0.44; 95% CI: -0.19-1.07; I2 = 69%). Depression symptoms were higher in the CBT group than in the EMDR group (SMD: 0.44; 95% CI: 0.13-0.76; I2 = 0%).Conclusion: The comparative effects of CBT and EMDR in reducing PTSD and anxiety symptoms remain inconclusive. Although CBT was associated with higher depression symptoms compared with EMDR, the current evidence is based on a small number of trials, and the pooled estimates should be interpreted with caution.
BACKGROUND: Older adults represent a rapidly growing segment of the hemodialysis (HD) patient population. However, the specific clinical variations and dialysis management strategies employed for geriatric patients in Thailand remain poorly characterized. METHODS: We analyzed baseline data from 839 hemodialysis patients enrolled in the Thai-HDcohort, a prospective multicenter study across 13 clinical sites in Thailand. Patients were stratified into a geriatric group (≥ 65 years of age, n = 412) and a younger control cohort (< 65 years of age, n = 427). Demographics, vascular access modalities, baseline laboratory markers, pharmacotherapy, and dialysis prescriptions were compared between the two groups. RESULTS: Geriatric patients were more frequently treated in hospital-based facilities (75.0% vs. 67.4%, p = .002). The geriatric group exhibited lower body weight (57.7 vs. 63.0 kg, p < .001) and lower serum albumin (hypoalbuminemia prevalence: 11.6% vs. 5.1%, p = .001). Regarding practice patterns, geriatric patients relied more heavily on tunneled cuffed catheters at enrollment (38.1% vs. 27.7%, p = .005) and were likely to initiate HD using a catheter (41.0% vs. 27.1%, p < .001). Geriatric prescriptions also favored a higher utilization of a 3.0 mmol/L dialysate potassium bath (40.0% vs. 23.7%, p < .001), and a higher dialysate calcium bath of 3.0 mmol/L (19.9% vs. 12.9%, p = .011). CONCLUSIONS: In this cross-sectional study, geriatric hemodialysis patients showed distinct variations in prescriptions and vascular access. Longitudinal follow- up is essential to determine whether these conservative, individualized strategies improve clinical and survival outcomes.