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Objective: This study evaluates the development and distribution of simple assistive devices designed to support individuals in managing their health conditions at home. The focus is on older adults from lower socio-economic groups in Stoke-on-Trent and Newcastle-under-Lyme, UK., Methods: Assistive kits were distributed to participants between December 2021 and April 2022, addressing weight management, diabetic foot care, mental wellbeing, and daily living independence. Each kit contained affordable and accessible assistive devices, including portion plates, exercise bands, and remote-operated plugs, alongside educational materials to promote self-care. Feedback was collected between March and June 2022 to assess user satisfaction and engagement. A qualitative analysis, informed by self-determination theory, explored how these kits supported autonomy, competence, and relatedness in self-management., Results: Over 90 % of recipients reported using the kits more than once weekly and an increased confidence in managing their health conditions independently. Qualitative analysis indicated that the kits facilitated motivation towards self-management by enhancing users' autonomy, competence, and social connectedness. However, barriers such as cost, availability, and lack of support were identified as limiting factors for broader adoption., Conclusions: This study highlights the potential of affordable, simple assistive devices to empower individuals in managing their health and wellbeing. The initiative demonstrates a promising approach to addressing health management challenges in lower socio-economic groups. Further research is needed to expand access and refine interventions to maximise impact and improve quality of life., (Copyright © 2025. Published by Elsevier Inc.)

The role of medical physics professionals (MPPs) (medical physicists and medical physics experts) in physiological measurement and related therapies (PM&T) applied in e.g., critical care, neurophysiology, neurology, physiology, audiology, and neurotology has long been acknowledged. Given that the exact role and medical specialty fields in which MPP are involved vary between countries, this policy statement aims to provide direction towards improved definition, harmonisation, and development of the role. This policy statement considers the surveyed experiences from several European countries, state-of-the-art of PM&T, and anticipated future developments. We also present an inventory of competences, and associated knowledge and skills expected of MPPs working in these areas., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

Background & Aim: Perinatal mental health disorders are common complications of pregnancy and the postpartum period. The value of screening for their early detection is well-recognized, but to-date, research-validated mental health measures for postpartum women in Malta are lacking. In this prospective cross-sectional study, we assessed the validity of the Edinburgh Postnatal Depression Scale (EPDS), an EPDS subscale (EPDS-3A), and the Generalised Anxiety Disorder-7 item (GAD-7) as screening measures for postpartum depression and anxiety. The optimal cut points were calculated., Methods: 243 randomly selected women from birth to 12 months postnatally self-completed the EPDS and the GAD-7. For women scoring ≥10 in at least one of the questionnaires, the Mini International Neuropsychiatric Interview (MINI) was applied to confirm or refute a diagnosis of depression and/or anxiety disorder based on DSM-5 criteria. Total EPDS, EPDS-3A and GAD-7 scores were analysed against MINI outcomes using receiver operator curve (ROC), and area under curves (AUCs) were determined. Sensitivity, specificity, positive and negative predictive values, likelihood ratios and Youden's indices were calculated across a range of cut-off values., Findings: Both the EPDS and GAD-7 had significant AUCs (>0.8) and Youden's indices (>0.6), contrary to the EPDS-3A. When screening for postnatal depression with the EPDS, the optimal cut-off is 11/12 (sensitivity 75 %; specificity 87.6 %). For postnatal anxiety, the recommended GAD-7 cut-off is 8/9 (sensitivity 79.2 %; specificity 85.3 %)., Conclusion: Both the EPDS and GAD-7 are valid screening measures for postpartum depression and anxiety, respectively. These findings can inform the implementation of postpartum screening programs to improve maternal healthcare in Malta., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: The FORCE initiative, funded by the EU, was created in response to the COVID-19 pandemic's impact on radiography education. It offers a virtual learning environment (VLE) filled with clinical simulation scenarios targeting Diagnostic Imaging, Nuclear Medicine, and Radiotherapy. These scenarios are designed to provide open-access, simulation-based learning (SBL) resources that help radiography undergraduates engage in problem-based learning across relevant clinical knowledge and professional awareness. This study presents the results of an online survey aimed at evaluating the FORCE VLE and SBL resources to guide future development., Methods: The survey targeted academic and clinical staff in Radiography and student Radiographers. It was based on the Course Experience Questionnaire (CEQ) and modified to include topics relevant to online learning, using a five-point Likert Scale (LS). The questionnaire consisted of four sections: research information and consent; socio-demographic data; LS-based questions on case structure, content, interactivity, technical aspects, multimedia quality, and overall experience; and open-text responses., Results: Of the 407 invited participants, 109 (27 %) responded, with 77 % being students and 23 % clinical or academic radiographers from 13 countries. English proficiency was reported by 76 % of respondents. The median LS was consistently 4 across all categories, indicating high satisfaction. Content analysis of 159 open-text comments revealed 139 positive opinions on the SBL resources., Conclusion: The FORCE VLE SBL resources were highly regarded for their interactivity, applicability, and support in consolidating knowledge and enhancing patient care. Suggestions for improvement were minor, mainly focusing on navigation and specific content preferences., Implications for Practice: Expanding the availability of online SBL cases could enhance Radiographer education and promote inclusivity across the field., (Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Importance: Variation in nicastrin (NCSTN) is associated with a monogenic subtype of hidradenitis suppurativa. Dysregulation of humoral immunity has been suggested as a potential mechanistic link between NCSTN variation and hidradenitis suppurativa. There is a paucity of biomarkers that can predict disease-associated variation., Objective: To investigate whether serum immunoglobulin levels, as a surrogate marker of humoral immunity, can identify individuals with hidradenitis suppurativa who have a specific disease-associated NCSTN variant., Design, Setting, and Participants: Maltese individuals with hidradenitis suppurativa genotyped for a disease-associated NCSTN in-frame deletion prevalent in the local patient cohort were invited to participate in this cross-sectional study from January to July 2023. Participation was restricted to adult individuals with hidradenitis suppurativa without known or suspected pathologies that would be associated with serum immunoglobulin levels. Data were analyzed between October 2023 and December 2023., Exposure: Serum immunoglobulin G levels and other hematological paraments were analyzed., Main Outcome and Measure: Main outcomes were the associations between serum immunoglobulin levels and an underlying NCSTN variation in individuals with hidradenitis suppurativa., Results: A total of 125 individuals (64 female individuals [51.2%]) with hidradenitis suppurativa of Maltese ethnicity were recruited in the study, of whom 17 (13.6%) who were from 7 genealogically unrelated families were heterozygous for the disease-associated NCSTN variant. Deletion carriers had a higher serum immunoglobulin G level (1370 mg/dL vs 1140 mg/dL [to convert to g/L, multiply by 0.01]; P < .001). The association between NCSTN variation and elevated immunoglobulin G levels retained significance despite adjusting for multiple confounders, including markers of disease severity, age of recruitment, age of disease onset, treatment with adalimumab, and liver transaminase levels. Serum immunoglobulin G demonstrated a strong discriminatory capacity in identifying patients who were heterozygous for the NCSTN variant., Conclusion and Relevance: The results of this cross-sectional study suggest an altered humoral immune state in patients harboring a specific NCSTN variant and support the role of serum immunoglobulin G levels as a potential predictive biomarker of monogenic hidradenitis suppurativa. This may aid in identifying and prioritizing individuals with monogenic hidradenitis suppurativa.

Listeners adjust their perception of sound categories when confronted with variations in speech. Previous research on speech recalibration has primarily focused on segmental variation, demonstrating that recalibration tends to be specific to individual speakers and situations and often persists over time. In this study, we present findings on the perceptual learning of lexical tone in Standard Chinese, a suprasegmental feature signaled primarily through pitch variations to distinguish morpheme/word meanings. Native speakers of Standard Chinese showed a recalibration of tone category boundaries immediately following exposure to ambiguous tonal pitch contours. However, this recalibration effect significantly weakened after 12 hours. Furthermore, participants trained at night did not exhibit delayed stabilization, a phenomenon commonly observed during sleep-induced consolidation. Our results replicate previous findings and provide new evidence suggesting that while our perceptual system can flexibly adapt to real-time sensory inputs, subsequent consolidation processes, such as those occurring during sleep, may exhibit selectivity and, under certain conditions, may be ineffective.

Introduction: Ovarian cancer remains a leading cause of mortality among gynecological malignancies, often diagnosed at advanced stages due to nonspecific symptoms and limited screening tools. Standard treatment, including cytoreductive surgery and chemotherapy, can cause fatigue, physical dysfunction, and psychological distress, impacting quality of life. Exercise interventions have shown potential to mitigate these effects, but inconsistent methodologies in randomized controlled trials (RCTs) limit reliable conclusions and clinical integration., Methods: A systematic review was conducted following PRISMA guidelines. RCTs assessing physical exercise effects on women with ovarian cancer were included, excluding pilot trials, reviews, and combined therapies. Data extraction and GRADE assessments were performed by two independent reviewers, and a narrative synthesis was conducted due to study heterogeneity., Results: Eleven RCTs were analyzed, covering aerobic, resistance, and yoga interventions. Findings indicated improvements in physical function, fatigue, and psychological outcomes, such as reduced depressive symptoms and cognitive enhancements. Patients adhering to ≥150 min of moderate-intensity exercise per week experienced the most consistent benefits. Preoperative walking expedited recovery, though significant heterogeneity in study protocols precluded meta-analysis., Discussion: Evidence supports the feasibility and benefits of exercise across ovarian cancer stages. However, inconsistency in exercise intensity, duration, and reporting hinders the development of standardized protocols. Compared to cardiological rehabilitation, ovarian cancer exercise guidelines remain underdeveloped, emphasizing the need for tailored, evidence-based interventions., Conclusion: Exercise interventions can improve physical and mental health in ovarian cancer patients. Standardized RCTs are urgently needed to establish robust exercise protocols and enable clinical implementation, enhancing survivorship outcomes and quality of life., Competing Interests: Declaration of conflict of interest We declare no conflicts of interest., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Hard-to-heal (chronic) wounds are a challenge to wound care professionals, a burden to the health service and negatively impact affected individuals' quality of life. They also consume a great deal of healthcare resources globally and are found in all settings, including prisons. Therefore, the evaluation of wound care services is essential in order to develop an awareness of where improvement can be made. The main aim of this point prevalence study was to gather data on wounds, wound aetiology and wound management in a Maltese correctional facility. A secondary aim was to compare current practice with the best evidence-based practice and clinical practice guidelines, in order to provide a set of recommendations which can be implemented to improve the service. A retrospective study was carried out, auditing the medical records of people with justice involvement. The results of the audit reported a low prevalence of wounds. While practice met existing standards, for example, no unnecessary wound swab was taken, several shortcomings in wound management were noted. To improve adherence to the clinical guidelines in conjunction with improving the quality of the current service offered in the wound clinic, a number of short- and long-term clinical recommendations were proposed including: the incorporation of pain assessment tools and C-reactive protein blood testing for identifying infection; early referral to specialised care for individuals with diabetic foot ulcers, as well as the necessity for proficient personnel specialising in wound management training.

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Gordon Sammut reports was provided by University of Malta. Gordon Sammut reports a relationship with University of Malta that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Marine plastic pollution is a global issue affecting ecosystems and various aspects of human life. The scientific community is exploring new monitoring and containment approaches. Because in-situ sampling campaigns are time and resource demanding, there is a focus on integrating different approaches for marine litter monitoring. Data of two in-situ surveys (using a manta net) were compared to sea surface currents data and derived products with the aim to find a proxy variable of the plastic occurrence. Sea surface currents data were provided by the CALYPSO HF network (operating in the Sicily Channel since 2012). Notably, the occurrence of fragment items is inversely correlated with the total kinetic energy (r 2  ~ 0.85). This result was confirmed by a Lagrangian tracking model considering the deployment of virtual drifters around each in-situ measurement point. The proposed method applied to a wider domain using Copernicus Marine Service (CMS) data revealed that high plastic accumulation areas could be located at the centre of eddies often occurring in the winter period. However, uncertainties arise by the moderate-low correlation found between HF CALYPSO and CMS sea current data., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Stroke is a major cause of morbidity and mortality worldwide. Despite advances in acute treatments, timely intervention remains crucial. This study assessed stroke knowledge in Malta to identify gaps that could contribute to treatment delays., Methods: A mixed methods approach was used, starting with qualitative interviews of stroke patients, relatives, and bystanders, followed by a quantitative survey among the general Maltese population and healthcare workers. The online survey included demographics, stroke knowledge, and stroke response questions. Data were analysed using descriptive and inferential statistics to identify knowledge gaps and influencing factors., Results: The study surveyed 1872 participants, representing the Maltese population. Significant knowledge gaps were found in stroke symptoms, risk factors, and appropriate responses. Younger participants, males, non-Maltese, urban residents, those with higher education, and higher-income individuals showed better stroke knowledge and response. Healthcare workers scored higher than the general public. A strong positive correlation was found between stroke knowledge and appropriate response actions., Conclusions: The study highlights the need for targeted educational interventions to improve stroke awareness and response, especially among older adults, women, rural residents, and lower-income groups. Recommendations include comprehensive public education campaigns, culturally tailored materials, and ongoing professional development for healthcare workers. Addressing these gaps could enhance stroke prevention and management, reducing stroke-related morbidity and mortality., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Gynaecological cancer incidence in children and prepubertal girls is low but the risk of losing fertility potential is high due to the oncological treatments' toxicity. Consequently, fertility preservation is a top concern for survivors. This narrative review aims to summarize the best way of approaching each tumor treatment during prepubertal age with the goal of preserving fertility, and to discuss the latest methods used for fertility preservation for each gynaecological cancer. These procedures do not lack risks or uncertainities and offer a broad area of research., Competing Interests: Declaration of competing interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Progress in the management of critical care syndromes such as sepsis, Acute Respiratory Distress Syndrome (ARDS), and trauma has slowed over the last two decades, limited by the inherent heterogeneity within syndromic illnesses. Numerous immune endotypes have been proposed in sepsis and critical care, however the overlap of the endotypes is unclear, limiting clinical translation. The SUBSPACE consortium is an international consortium that aims to advance precision medicine through the sharing of transcriptomic data. By evaluating the overlap of existing immune endotypes in sepsis across over 6,000 samples, we developed cell-type specific signatures to quantify dysregulation in these immune compartments. Myeloid and lymphoid dysregulation were associated with disease severity and mortality across all cohorts. This dysregulation was not only observed in sepsis but also in ARDS, trauma, and burn patients, indicating a conserved mechanism across various critical illness syndromes. Moreover, analysis of randomized controlled trial data revealed that myeloid and lymphoid dysregulation is linked to differential mortality in patients treated with anakinra or corticosteroids, underscoring its prognostic and therapeutic significance. In conclusion, this novel immunology-based framework for quantifying cellular compartment dysregulation offers a valuable tool for prognosis and therapeutic decision-making in critical illness., Competing Interests: Conflicts of Interest NJM reports consulting fees from Novartis, Inc, AstraZeneca, Inc, and Endpoint Health, Inc (>2 years ago) YH is employed by Inflammatix, Inc. PK is co-founder, consultant to, and a scientific advisor to Inflammatix, Inc. TES is co-founder and CEO of Inflammatix, Inc. All other authors report no disclosures or conflicts of interest

A retrospective cohort study was conducted in Malta to assess the prevalence of threatened miscarriage. The study focuses on cases managed at a local state hospital over a 12-month period. Currently, data on pregnancies prior to 22 weeks' gestation are not publicly available, which hampers understanding of the frequency and impact of threatened miscarriage. This research provides the basis for a potential prospective study which analysis the epidemiology and outcomes of threatened miscarriage and advocates for early intervention and appropriate patient counselling. The study included females who visited the Accident and Emergency Department in a local state hospital in 2019 with first trimester vaginal bleeding. It excluded patients with incomplete medical records. Data from various hospital departments were collected, anonymised and analysed to track outcomes such as miscarriage, ongoing pregnancy, ectopic or molar pregnancy. The research aimed to create a comprehensive local registry of pregnancy outcomes following threatened miscarriage, reflecting the national situation. In 2019, 711 pregnant women in Malta experienced first-trimester vaginal bleeding. Of these, 241 had successful births beyond 22 weeks' gestation, while 412 experienced miscarriages, with other outcomes including ectopic and molar pregnancies and 58 women had an unknown pregnancy outcome. A significant association was found between maternal age and risk of miscarriage, particularly higher for women aged 35-46 and those under 19. Birthweight data revealed that threatened miscarriage complications likely led to low birthweights in a significant proportion of newborns. This study analysed pregnancy outcomes which were preceded by first trimester vaginal bleeding in pregnant women in Malta. Establishing a local register of pregnancy outcomes following first trimester vaginal bleeding provides clinicians with enhanced insights into the current local context. This resource may improve patient counselling and informed policy decisions and lay the groundwork for future research in the field., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier B.V.)

Background: In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce., Objective: This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning., Methods: A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined., Results: In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6%), of which 63 (36.4%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned., Conclusions: This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context., (©Irene Carrillo, Ivana Skoumalová, Ireen Bruus, Victoria Klemm, Sofia Guerra-Paiva, Bojana Knežević, Augustina Jankauskiene, Dragana Jocic, Susanna Tella, Sandra C Buttigieg, Einav Srulovici, Andrea Madarasová Gecková, Kaja Põlluste, Reinhard Strametz, Paulo Sousa, Marina Odalovic, José Joaquín Mira. Originally published in JMIR Medical Education (https://mededu.jmir.org), 07.10.2024.)

Introduction: Cervical cancer (CC) is a type of cancer with poor prognosis when diagnosed in advanced stage with a big socioeconomic burden. The incidence rates have wide variations among European countries depending on the implementation or not of screening, vaccination programs and the human development index (HDI). Most studies on cost-effectiveness of CC screening programs are carried out in countries with a high HDI, however more recent reviews of screening approaches are coming from countries with lower HDI aiming to identify the best screening strategies. Our study aims to identify which are the currently applied and most cost-effective strategies of CC screening in Europe., Materials and Methods: This is a systematic review conducted in three different databases (PubMed, Scopus and ScienceDirect) and reported following the PRISMA guidelines. General key terms for all databases were the following: cost-effectiveness, cervical cancer, screening, Europe. We included studies in English, Italian, Spanish and Bulgarian, published in the last 25 years, reporting data on cost-effectiveness of CC screening, costs and outcome measures. The methodological quality of the articles was evaluated with a standardized tool., Results: A total of 262 studies were identified and 22 studies were included in the final analysis. In 90.1 % of the economic studies, the new screening strategy was shown to be more cost-effective compared to the current one or compared to no screening. The optimal strategy mostly involved primary HPV testing, combined with cytology or as stand-alone screening technique. Several scenarios differing on starting age and periodicities for CC screening, combination of techniques and triage, were found to be cost-effective and below the willingness to pay (WTP) threshold. The methodology of all included studies was assessed from 10 to 11 on the JBI standardized tool and Drummond 11-point checklist., Conclusion: Numerous cost-effective options for CC screening in different European countries were identified in this systematic review. HPV testing, with or without cytology, mainly starting at 30 years of age and repeated every 5 years or more was the most cost-effective technique. Future studies should focus on the most appropriate CC screening approach for each context and setting, also considering HPV vaccination in Europe., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Gestational trophoblastic disease (GTD) is a group of diseases associated with pregnancies that demonstrate abnormal development of trophoblastic cells. GTD includes hydatidiform moles (HM) that may continue to further develop into gestational trophoblastic neoplasms (GTN), such as choriocarcinoma (CC). Gestational CC is a malignant mass development that may arise from HM, from other (normal) pregnancies or from other gestational events (such as ectopic pregnancies). The aim of this review is to outline current understating of the genetics and epigenetics of GTD and gestational CC and the link between the two diseases., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: As the global healthcare system evolves, diagnostic radiographers (DRs) are taking on advanced roles, constituting advanced radiography practice. This study explored the definition of ARP tasks among DRs, radiology department managers (RDMs), and National Society Officers (NSOs) on a global scale., Methods: Data collection was obtained via a self-developed online survey administered via email and social media to DRs, RDMs, and NSOs. The survey sought to collect demographic data, insights into definition of ARP tasks, and perceptions regarding global practice., Results: 206 respondents from 25 countries participated, predominantly from Norway (n = 77), Australia (n = 34), and Portugal (n = 20). 71.7 % of DR respondents defined teaching as ARP task, while RDMs (74.2) and NSOs (88.8 %) identified approving image quality independently as ARP. 53.4 % of DRs perceived their practice as ARP-aligned, with awareness reported by 44.8 % of DRs, 66.7 % of RDMs, and 77.8 % of NSOs., Conclusion: This study provides a clearer understanding of the task respondents consider ARP and the extent to which it is practiced, whereas DRs are increasingly performing advanced tasks globally. Clarifying ARP tasks in the workplace will promote a common understanding of the role and foster support for its establishment in diagnostic radiography. Further research is required to gather a more comprehensive international perspective on ARP tasks, especially given the limitations of this study, as well as the limited responses from the Americas and African regions., Implications for Practice: Clear definitions of ARP tasks are necessary for seamless integration of ARP into current practices. Additionally, advocating for official recognition, and global acknowledgement by the profession and key stakeholders are imperative for DRs to fully develop in these areas., Competing Interests: Conflict of interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Effective fluid management is critical in patients undergoing damage control laparotomy (DCL) for trauma and sepsis. Hypertonic saline (HTS) has been proposed as an alternative to isotonic fluids to enhance primary fascial closure rates and optimize fluid balance. This systematic review and meta-analysis aims to evaluate the efficacy and safety of HTS compared to isotonic fluids in patients undergoing DCL. A comprehensive literature search was conducted across multiple databases up to the 14 th  of June 2024, identifying studies that compared HTS to isotonic fluids in adult patients undergoing DCL for trauma or sepsis. Eligible studies included randomized controlled trials and observational studies reporting outcomes such as early primary fascial closure (EPFC) rates, time to fascial closure, fluid requirements, electrolyte imbalances, renal function, and mortality. Data extraction and quality assessment were performed independently by two reviewers, and pooled analyses were conducted using fixed-effect models where appropriate. Four studies encompassing 375 patients met the inclusion criteria, with 100 patients receiving HTS and 275 receiving isotonic fluids. HTS administration was associated with a significantly higher EPFC rate compared to isotonic fluids (odds ratio (OR): 0.314; 95% confidence interval (CI): 0.142-0.696; p=0.004). The mean time to fascial closure was also significantly reduced in the HTS group by approximately eight hours (mean difference (MD): 8.007 hours; 95% CI: 5.558-10.596; p<0.001). Patients receiving HTS required significantly less total fluid over 48 hours (MD: 1.055 liters; 95% CI: 0.713-1.398; p<0.001). While HTS use led to higher peak sodium levels (MD: -4.318 mEq/L; 95% CI: -4.702 to -3.934; p<0.001), there were no significant differences in peak creatinine levels, need for inpatient renal replacement therapy, or 28-day mortality between the groups. HTS appears to be effective in improving EPFC rates and reducing both time to closure and overall fluid requirements in patients undergoing DCL for trauma and sepsis. Although associated with higher serum sodium levels, HTS did not increase the risk of renal dysfunction or mortality. These findings suggest that HTS is a safe and efficacious alternative to isotonic fluids in the management of critically ill patients requiring DCL. Further large-scale, randomized controlled trials are warranted to confirm these results and inform clinical guidelines., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Muscat et al.)

Introduction: Anastomotic leak is a relatively common and debilitating complication. Colorectal leak rates vary widely in the literature, ranging from 1% to 20%. In modern surgical practice, there is much emphasis on the use of indocyanine green (ICG). This is a fluorescent dye administered intravenously to locate and predict an adequate line of anastomosis. We sought to analyse the current literature and supporting evidence behind the use of ICG in the context of elective colorectal surgery., Methods: A literature search was conducted for papers published between January 1991 and December 2022 concerning the use of ICG in colorectal surgery. Data on anastomotic leak, overall complication rate, operative time and involvement of artificial intelligence (AI) were compared., Results: A total of 24 studies were selected, including 3 randomised controlled trials. There was an anastomotic leak rate of 4.3% in cases with ICG administration compared with 9.5% in the control group ( p <0.00001). Seven studies mentioned overall complication rates. These were lower in the ICG cohort than in the control group (15.5% vs 24.5%). There was no significant correlation between ICG use and operative time ( p =0.78). Five studies looked at AI, with results suggesting that use of AI leads to much better accuracy in ICG metric analysis. However, the current literature is still inconclusive., Conclusions: While there is strong evidence behind ICG use in the existing literature, more randomised controlled trials are required for better recommendations. AI in ICG metric interpretation has proved to be difficult owing to interpatient variability. Nevertheless, new data suggest better understanding and standardisation.

Childhood obesity is a growing public health concern worldwide, with significant implications for long-term health outcomes. Thus, the aim of this study is to highlight the prevalence and trend of obesity among children and adolescents in Saudi Arabia over the last 24 years. This systematic review included participants aged 2 to 19 years without systemic disease, reporting the prevalence of obesity using the Centers for Disease Control and Prevention (CDC) classification and BMI calculation, from studies in English or Arabic published between January 2000 and April 2024. We conducted a comprehensive search across multiple databases including ProQuest, Google Scholar, ISI Web of Science, Embase via Ovid, and MEDLINE via Ovid, and reviewed references of included studies. Data were extracted and quality assessed independently by two authors, with any disagreements resolved through discussion with a third reviewer, using the Newcastle-Ottawa Scale modified for this study. This systematic review included 21 studies from Saudi Arabia, published between 2006 and 2023, with participants aged 2 to 19 years. The studies involved a total of 63,512 subjects. Among children, the prevalence of overweight ranged from 5% to 29%, while obesity ranged from 3.8% to 49.7%, classified using CDC criteria. Quality assessment rated 10 studies as Very Good, 10 as Good, and one as Unsatisfactory. The systematic review of childhood obesity prevalence in Saudi Arabia over the past 24 years highlights alarming trends and significant public health implications. Our analysis emphasizes an increase in obesity rates among children and adolescents, revealing a complex link of socioeconomic, cultural, and lifestyle factors contributing to this epidemic., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Adam et al.)

Aims: Sudden cardiac death (SCD) in young individuals is often unexpected, provoking substantial emotional stress for family and friends of the deceased. Cardiac screening may identify individuals who harbour disorders linked to SCD. The feasibility and diagnostic yield of a nationwide cardiac screening programme in adolescents has never been explored., Methods: All individuals eligible for cardiac screening (students aged 15 years) were systematically invited to enrol. Students were provided with a health questionnaire. ECGs were acquired at school. A physician led consultation was carried out on site. Participants with an abnormal screen were then referred for secondary evaluation to the nation's tertiary centre. Feasibility criteria included a) participation rate >60%, b) adherence to secondary evaluation >80%, and c) cost per individual screened equating to <€100. The diagnostic yield was also evaluated., Results: At the end of enrolment, 2708 students gave consent (mean 15 years, 50.4% male), equating to 67.9% of the eligible cohort. Overall, 109 participants (4.0%) were referred for further evaluation. An abnormal electrocardiogram (ECG) was the most common reason for referral (3.7%). Fifteen individuals (0.6%) were diagnosed with a cardiac condition. Nine (0.3%) had a condition linked to SCD (n = 1 Long-QT syndrome, n = 1 Hypertrophic Cardiomyopathy, n = 5 Wolff-Parkinson White, n = 2 coronary anomalies). The yield was similar in athletes and non-athletes (p = 0.324). The cost per cardiac individual screened equated to €51.15., Conclusion: A nationwide systematic cardiac screening programme for adolescent athletes and non-athletes is feasible and cost-efficient, provided that responsible centres have the appropriate infrastructure., Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare., (Copyright © 2023 Hellenic Society of Cardiology. All rights reserved.)

Objective: Technology and advances in clinical care have changed the management of abdominal aortic aneurysms (AAAs) but the clinical effectiveness of continuing advances needs to be assessed. To facilitate rapid synthesis of new evidence and improve stakeholder representation, including patients, the concept of core outcome sets (COS) has been developed. COS, reflecting the needs of all stakeholders, have been established across several surgical specialties. This study aimed to develop an international core outcome set for intact AAA repair., Methods: Following COMET methodology, potential outcomes were identified from a systematic review of published outcomes and focus groups involving patients, carers, and nurses. A 38 question Delphi consensus survey in lay language was developed (with translation to local languages); this included 35 themes identified from the findings of the systematic review and three themes from the focus groups. All three of the themes identified by the focus groups (cognitive, physical, and social functioning) can be evaluated from quality of life instruments, with overall quality of life being identified from the systematic review. The survey was completed by patients, carers or family members, vascular nurses, vascular surgeons, trainees, interventional radiologists, anaesthetists, and industry partners from six European countries. After two rounds of the survey, the top outcomes were discussed at a face to face multistakeholder consensus meeting., Results: The 38 item questionnaire was amended after piloting among all stakeholder groups. After the first round of the Delphi survey (98 respondents) 15 questions were eliminated, and 11 further questions were eliminated after round 2 (90 respondents). This left two outcome questions for discussion at the consensus meeting, where the top six outcomes were unanimously endorsed: death at 30 days (or in hospital if longer), secondary AAA rupture, overall quality of life and retention of cognitive functioning after recovery, five year survival, and continued sac growth., Conclusion: Six core outcomes are recommended for use as a minimum framework in all future studies and registries of intact open and endovascular AAA repair. Further work to select instruments for quality of life and to define instruments for cognitive functioning is needed., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs' well-being and ultimately improve the quality of care and patient safety., Objective: This study aims to describe and evaluate a multimodal training organized by the European Researchers' Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs., Methods: We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities., Results: Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants' satisfaction increased, particularly when adjusting the allocated time for the case studies' discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team., Conclusions: This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts., (©Sofia Guerra-Paiva, José Joaquín Mira, Reinhard Strametz, Joana Fernandes, Victoria Klemm, Andrea Madarasova Geckova, Bojana Knezevic, Eva Potura, Sandra Buttigieg, Irene Carrillo, Paulo Sousa. Originally published in JMIR Formative Research (https://formative.jmir.org), 30.08.2024.)

Maternal mortality data and review are important indicators of the effectiveness of maternity healthcare systems and an impetus for action. Recently, a rising incidence of maternal mortality in high income countries has been reported. Various publications have raised concern about data collection methods at country level, as this usually relies mainly on national vital statistics. It is therefore essential that the collected data are complete and accurate and conform to international definitions and disease classification. Accurate data and review can only be truly available when an Enhanced Obstetric Surveillance System is in place. EBCOG calls for action by national societies to work closely with their respective ministries of health to ensure that high quality surveillance systems are in place., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Introduction: Vaginal bleeding in the first trimester of pregnancy generates anxiety and uncertainty for expecting parents. The ability to determine pregnancy outcome through a first trimester ultrasound scan remains a challenge in obstetrics. Several first trimester ultrasound markers used individually or in combination, as well as ultrasound markers used in combination with biochemical markers, have been studied to determine their predictive value in pregnancy outcome. This scoping review was performed to determine which markers have already been investigated for this purpose., Methods: An extensive and systematic database search was performed using four different categories of keywords which were combined using Boolean terms. A total of 14 variables were included on the final data charting forms. Data was synthesised collectively for each variable and then separately for the studies analysing only one marker. For the studies which analysed multiple markers, data was synthesised based on the number of markers per study., Results: The search yielded 3608 studies, of which 128 were ultimately used for this review. Data extraction, based on predetermined eligibility criteria, was performed by two authors independently. Seventy-seven (62.6%) studies investigated the predictive value of a single ultrasound marker. The remaining 46 (37.4%) studies explored multiple markers, of which at least one was an ultrasound marker., Conclusion: This review identified several discrepancies among different studies. This highlights the need for better consensus among researchers to allow for the design of a predictive model which enables extrapolation of findings to all pregnant women., Implications for Practice: Through the study of ultrasound and biochemical markers in the first trimester of pregnancy, clinicians may provide a more accurate prediction of pregnancy outcome following threatened miscarriage., Competing Interests: Conflict of interest statement No conflicts of interest identified., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Autosomal dominant polycystic kidney disease (ADPKD) is characterized by the development of multiple renal cysts causing kidney enlargement and end-stage renal disease (ESRD) in half the patients by 60 years of age. The aim of the study was to determine the genetic aetiology in Maltese patients clinically diagnosed with ADPKD and correlate the clinical features., Methods: A total of 60 patients over 18 years of age clinically diagnosed with ADPKD were studied using a customized panel of genes that had sufficient evidence of disease diagnosis using next generation sequencing (NGS). The genes studied were PKD1, PKD2, GANAB, DNAJB11, PKHD1 and DZIP1L. Selected variants were confirmed by bidirectional Sanger sequencing with specifically designed primers. Cases where no clinically significant variant was identified by the customized gene panel were then studied by Whole Exome Sequencing (WES). Microsatellite analysis was performed to determine the origin of an identified recurrent variant in the PKD2 gene. Clinical features were studied for statistical correlation with genetic results., Results: Genetic diagnosis was reached in 49 (82%) of cases studied. Pathogenic/likely pathogenic variants PKD1 and PKD2 gene were found in 25 and in 23 cases respectively. The relative proportion of genetically diagnosed PKD1:PKD2 cases was 42:38. A pathogenic variant in the GANAB gene was identified in 1 (2%) case. A potentially significant heterozygous likely pathogenic variant was identified in PKHD1 in 1 (2%) case. Potentially significant variants of uncertain significance were seen in 4 (7%) cases of the study cohort. No variants in DNAJB11 and DZIP1L were observed. Whole exome sequencing (WES) added the diagnostic yield by 10% over the gene panel analysis. Overall no clinically significant variant was detected in 6 (10%) cases of the study population by a customized gene panel and WES. One recurrent variant the PKD2 c.709+1G > A was observed in 19 (32%) cases. Microsatellite analysis showed that all variant cases shared the same haplotype indicating that their families may have originated from a common ancestor and confirmed it to be a founder variant in the Maltese population. The rate of decline in eGFR was steeper and progression to ESRD was earlier in cases with PKD1 variants when compared to cases with PKD2 variants. Cases segregating truncating variants in PKD1 showed a significantly earlier onset of ESRD and this was significantly worse in cases with frameshift variants. Overall extrarenal manifestations were commoner in cases segregating truncating variants in PKD1., Conclusions: This study helps to show that a customized gene panel is the first-line method of choice for studying patients with ADPKD followed by WES which increased the detection of variants present in the PKD1 pseudogene region. A founder variant in the PKD2 gene was identified in our Maltese cohort with ADPKD. Phenotype of patients with ADPKD is significantly related to the genotype confirming the important role of molecular investigations in the diagnosis and prognosis of polycystic kidney disease. Moreover, the findings also highlight the variability in the clinical phenotype and indicate that other factors including epigenetic and environmental maybe be important determinants in Autosomal Dominant Polycystic Kidney Disease., Competing Interests: Declaration of competing interest The authors declared that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP)., Methods: From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo)., Results: Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning., Conclusion: Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership., Implications for Practice: This study highlights a policy gap in the education and practice of APs in radiotherapy., Competing Interests: Conflict of interest statement This work was co-funded by the SAFE EUROPE project under the Erasmus Sector Skill Alliances programme [grant agreement 2018-2993/001-001]. The European Commission support for the production of this publication does not constitute an endorsement of the contents which reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein. Helen Anne McNair is funded by a National Institute for Health Research and Health Education England (HEE/NIHR), Senior Clinical Lectureship and supported by the NIHR Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Pre-term birth is associated with significant neonatal morbidity and mortality. Pre-term births are associated with significant health and neuro-developmental risks in childhood and adulthood. Women with multiple pregnancies are at much higher risks. Low levels of omega-3 long-chain polyunsaturated fatty acids (PUFAs), such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are associated with higher risk of pre-term labour and increased consumption of foods rich in omega-3 PUFA or supplements are associated with a 11 % and 42 % risk reduction of early and late preterm births, respectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Liquid biopsies have emerged as a promising and minimally invasive alternative to traditional tissue biopsies for detecting and monitoring cancer. Liquid biopsies offer a comprehensive analysis of cancer genetics and tumor burden by examining circulating cells and cell-derived analytes using a variety of assays, including conventional PCR methods and cutting-edge tools like long-read sequencing and nanotechnology. However, there are still some limitations and challenges that need to be overcome for their implementation in clinical routine, including the need for further research on their sensitivity and specificity, cost-effectiveness, standardization, and regulatory approval. Despite these challenges, liquid biopsies have the potential to become widely used tools in oncology. Here we provide an overview of the current state of liquid biopsies, highlighting recent advancements in the field and their potential benefits in clinical settings for cancer patients. The article further discusses the challenges that need to be addressed in order to facilitate their application worldwide. Prompt resolution of these challenges can be achieved by fostering international research collaborations and establishing standardized guidelines for liquid biopsy sample management and studies., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

The European Trauma Course (ETC) exemplifies an innovative approach to multispecialty trauma education. This initiative was started as a collaborative effort among the European Society for Emergency Medicine, the European Society for Trauma and Emergency Surgery, and the European Society of Anaesthesiology under the auspices of the European Resuscitation Council. With the robust support of these societies, the project has evolved into the independent European Trauma Course Organisation. Over the past 15 years, the ETC has transcended traditional training by integrating team dynamics and non-technical skills into a scenario-based simulation course, helping to shape trauma care practice and education. A distinctive feature of the ETC is its training of doctors and allied healthcare professionals, fostering a collaborative and holistic approach to trauma care. The ETC stands out for its unique team-teaching approach, which has gained widespread recognition as the standard for in-hospital trauma care training not only in Europe but also beyond. Since its inception ETC has expanded geographically from Finland to Sudan and from Brazil to the Emirates, training nearly 20,000 healthcare professionals and shaping trauma care practice and education across 25 countries. Experiencing exponential growth, the ETC continues to evolve, reflecting its unmet demand in trauma team education. This review examines the evolution of the ETC, its innovative team-teaching methodology, national implementation strategies, current status, and future challenges. It highlights its impact on trauma care, team training, and the effect on other life support courses in various countries., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Instrumented gait analysis is an established procedure in biomechanical assessment, requiring specially-trained analysts to interpret the complex graphical output generated., Research Question: Does a new method of visual representation of lower limb kinematic gait analysis data provide a reliable and valid method of interpretation of biomechanical data for healthcare professionals?, Methods: An innovative system based on the Traffic Lights System (TLS) was developed. Simulated abnormal gait was captured using a 16-camera optoelectronic motion capture system, and the results were presented in both the Traditional Graphical System (TGS) format and the new TLS. An online form was filled by health professionals who attempted to interpret normal and abnormal motion in the joints presented in the 2 output formats., Results: Out of 26 raters, 18 preferred the new system because of its user-friendliness and its ease of interpretation. 2 raters preferred the TGS, with one of these raters clarifying that the preference is due to colour blindness. For intra-rater reliability, 2 trained raters provided a second response for the TGS (Cronbach's Alpha ranging between 0.733 and 0.918), whilst the TLS resulted in Cronbach's Alpha between 0.817 and 1.00 amongst 3 untrained raters. The Fleiss Multi-rater Kappa Test demonstrated low inter-rater reliability amongst raters in the TGS, whereas the overall Fleiss Multi-rater Kappa values of the TLS surpassed the TGS in all 3 studies., Significance: This study showed that whilst trained health professionals have high intra-rater reliability in interpreting traditional gait analysis results, those professionals inexperienced in the system, do not always comprehend the complex graphs generated by the system when presenting gait analysis data. When these graphs are transformed into coloured outputs representing the extent of the movement, the TLS has demonstrated high validity and high intra- and inter-rater reliability, significantly exceeding those of the TGS, especially in untrained health professionals., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Ovarian carcinosarcoma, also referred as malignant mixed Mullerian tumour, is an uncommon, highly aggressive and malignant neoplasm which makes up 1 to 4% of all ovarian tumours. It is biphasic involving both malignant sarcomatous (mesenchymal) and carcinomatous (epithelial) cells. There are various subtypes such as serous and endometrioid. However, the mesenchymal part is sarcomatous. About 90% of cases of ovarian carcinosarcoma spread outside the ovary. The two most accepted theories of origin for carcinosarcoma of the ovary are the collision and conversion theories. A third theory is the combination theory. Prognosis remains poor even when still localised in the ovary. In the last few years, there has been no change in the survival rate. The median survival rate is lower than 2 years. Clinical features mainly include lower abdominal pain and a palpable abdominal mass. Ovarian carcinosarcoma remains poorly understood and understudied. Being a rare tumour, elaborate therapeutic consensus is not available for ovarian carcinosarcoma. The main treatment involves cytoreductive surgery and then chemotherapy. The type of chemotherapy, role of radiotherapy and novel therapies need to be further studied. The main objective of this article is to review the current literature on carcinosarcoma of the ovary.

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Health literacy concerns the ability to access, appraise and use information to maintain good health. The purpose of this study was to explore the health literacy of older adults and their experiences after cardiac surgery. A purposive sample of eight patients (aged ≥65 years) who had undergone cardiac surgery participated in this qualitative study. A validated health literacy assessment instrument was used to gather data on their health literacy levels. Two semi-structured interviews were conducted with each participant to explore the experiences of recovery in the immediate and medium-term post-discharge period. The data from the assessment instrument and the interviews were analysed and collated. Data analysis gave rise to seven themes: aftermath of cardiac surgery; settling in; whirlwind of emotions; shifting perspective; faith and hope; sense of community; and COVID-19 experience. The findings suggest health literacy plays a part in a patient's cardiac surgical discharge experience, along with other factors. As patients' responses and experiences vary, health professionals need to adopt a context-sensitive approach when discharging patients after surgery.

Source apportionment (SA) for indoor air pollution is challenging due to the multiplicity and high variability of indoor sources, the complex physical and chemical processes that act as primary sources, sinks and sources of precursors that lead to secondary formation, and the interconnection with the outdoor environment. While the major indoor sources have been recognized, there is still a need for understanding the contribution of indoor versus outdoor-generated pollutants penetrating indoors, and how SA is influenced by the complex processes that occur in indoor environments. This paper reviews our current understanding of SA, through reviewing information on the SA techniques used, the targeted pollutants that have been studied to date, and their source apportionment, along with limitations or knowledge gaps in this research field. The majority (78 %) of SA studies to date focused on PM chemical composition/size distribution, with fewer studies covering organic compounds such as ketones, carbonyls and aldehydes. Regarding the SA method used, the majority of studies have used Positive Matrix Factorization (31 %), Principal Component Analysis (26 %) and Chemical Mass Balance (7 %) receptor models. The indoor PM sources identified to date include building materials and furniture emissions, indoor combustion-related sources, cooking-related sources, resuspension, cleaning and consumer products emissions, secondary-generated pollutants indoors and other products and activity-related emissions. The outdoor environment contribution to the measured pollutant indoors varies considerably (<10 %- 90 %) among the studies. Future challenges for this research area include the need for optimization of indoor air quality monitoring and data selection as well as the incorporation of physical and chemical processes in indoor air into source apportionment methodology., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Interprofessional education (IPE) has been highly promoted as a means of enhancing interprofessional practice and thereby having a positive impact on healthcare systems and patient outcomes. Various documents mention that sufficient evidence has been accumulated to demonstrate the effectiveness of IPE, yet it is not completely clear what type of evidence is being alluded to. The objective of this review was to gather evidence about IPE programs that resulted in effective long-term outcomes in healthcare. Secondary outcomes included identification of the types of models that met the success criteria, barriers and facilitators of such successful programs if any., Design/methodology/approach: A systematic search was conducted in PubMed, Web of Science, CINAHL and Scopus. The review considered studies that targeted undergraduate and postgraduate students among more than one health profession and included those in the English language published between 2010 and end of 2020., Findings: Five studies have been identified and described in this review. These papers evaluated different IPE programs and models., Research Limitations/implications: 1. This systematic review investigated the evidence of the existence of IPE programs and the findings show there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. 2. The conclusion from this review is that it is still unclear what format constitutes a successful and efficient program. 3. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes., Originality/value: Overall, the studies show that although there is an emphasis on practice-based learning, there is no robust specific evidence of long-term impact on healthcare and on patients' outcomes. Appropriate longitudinal studies need to be designed to identify the impact of IPE on long-term health outcomes., (© Emerald Publishing Limited.)

Gynaecological cancers, namely breast and cervical cancer represent a high burden in women's health. It is well established that cervical and breast cancer screening programmes are effective in reducing morbidity and mortality. It is of the most importance to define strategies to provide a universal access to screening. In European countries, significant progress has been made over the past years concerning screening strategies, namely the choice of screening test, its frequency as well as the age to start and stop the screening. Introduction of Human Papillomavirus vaccination programmes is also making a measurable impact to reduce cervical cancer prevalence and mortality. Our survey has shown a variation among European countries in delivery of cervical and breast cancer screening programmes. These variations can be due to organizational, economic or cultural reasons. The European Board and College of Obstetrics and Gynaecology calls for an implementation of a unified policy of prevention, screening and early detection of cervical and breast cancer across Europe to optimize clinical outcomes and reduce variations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Cancer screening can play an important role in early detection, improving treatment outcomes and reducing morbidity and mortality. Breast and cervical cancers belong to the most common gynaecological cancers group. Countries provide different screening programmes on its eligible population basis centred on different health care policies. This scientific study aims to assess and understand the health inequalities in the member countries of the European Board & College of Obstetrics and Gynaecology (EBCOG) as regards screening programmes of gynaecological cancer, with a special focus on breast and cervical cancers' screening strategies., Study Design: A descriptive questionnaire-based study was conducted, addressed to EBCOG member countries., Results: Ninety-one percent of the countries have an organized national or regional screening programme for cervical cancer. Of these, 45% of countries use both cytology and testing for Human Papilloma Virus (HPV) as screening test, 31% use cytology exclusively and 17% only perform HPV testing. Considerable differences were found regarding the interval of screening test: there are countries performing HPV detection triennially, while others perform only conventional cytology every 5 years. Sixty-nine percent of countries included in this study begin screening for cervical cancer in women aged 25 to 29 years, four of them using HPV detection as the screening test. Six countries begin cervical cancer screening before the age of 25. As regards vaccination against HPV, almost all countries have implemented national HPV vaccination programme, except in Poland and Turkey. The 9-valent HPV vaccine is the most frequently offered (77% of countries) and the majority vaccination programmes include both girls and boys. As regards breast cancer screening, all thirty-two countries have an implemented screening programme. All countries perform mammography as the screening test, 62.5% of them begin in women aged 50 to 54, with a 2-yearly interval in the majority. In five countries, screening programmes are performed biennially, starting between 45 and 49 years old. Seven countries start in women aged 41 to 44., Conclusions: There are discrepancies around gynaecological cancer screenings provision among EBCOG member countries. It is important to establish European recommendations about screening for gynaecological cancers, in order to standardize the access to equitable better health care in gynaecological cancers within Europe., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed., Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories., Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians., Main Outcome: The OHNS workforce per capita, stratified by income and region., Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally., Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.