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Purpose: To retrospectively determine the cumulative survival rate (CSR) and marginal bone level change (ΔMBL) around novel hybrid design tissue-level (TL) dental implants that support multiple-screw-retained restorations. Materials and Methods: Implant CSRs were analyzed at the implant and patient level using Kaplan-Meier estimates. ΔMBL was measured by comparing the periapical loading and follow-up visit radiographs using an improved standardized digital methodology based on image gray levels. ΔMBL outcomes were subject to linear mixed regression to identify potential risk factors. Results: A total of 301 TL implants in 69 patients with an average age of 62.6 ± 11.7 years (range: 36 to 87 years) at the time of implant placement were considered for the analysis. All 301 implants were successfully restored and loaded. The 54-month CSRs at the implant and patient levels were 98.9% (95% CI: 96.7 to 99.6) and 95.3% (95% CI: 86.1 to 98.5), respectively. ΔMBL after a mean follow-up of 22 ± 10.7 months after loading was 0.00 ± 0.57 mm. None of the implant sites showed marginal bone loss exceeding 1.5 mm. Multivariate regression analysis revealed a significant association between ΔMBL and the loading protocol (P = .027) but not between ΔMBL and age or transgingival height. Conclusions: The high CSRs and stable peri-implant marginal bone levels support the use of recent TL implants, which have a hybrid design inherited from the bone-level implant-abutment connection, as a suitable treatment option for restoring partially or fully edentulous patients with a good mid-term prognosis. These results should be complemented by further prospective studies in a real-world multicenter private practice setup that represents the daily realities of implant treatment. [ABSTRACT FROM AUTHOR]

Purpose: One hundred years ago, Hill and Lupton introduced the concept of maximal oxygen uptake ( V ˙ O 2 max), which is regarded as "the principal progenitor of sports physiology." We provide a succinct overview of the evolvement of research on V ˙ O 2 max , from Hill and Lupton's initial findings to current debates on limiting factors for V ˙ O 2 max and the associated role of convective and diffusive components. Furthermore, we update the current use of V ˙ O 2 max in elite endurance sport and clinical settings. Practical Applications and Conclusions: V ˙ O 2 max is a healthy and active centenarian that remains a very important measure in elite endurance sports and additionally contributes as an important vital sign of cardiovascular function and fitness in clinical settings. Over the past 100 years, guidelines for the test protocols and exhaustion criteria, as well as the understanding of limiting factors for V ˙ O 2 max , have improved dramatically. Presently, possibilities of accurate and noninvasive determination of the convective versus diffusive components of V ˙ O 2 max by wearable sensors represent an important future application. V ˙ O 2 max is not only an indicator of cardiorespiratory function, fitness, and endurance performance but also represents an important biomarker of cardiovascular function and health to be included in routine assessment in clinical practice. [ABSTRACT FROM AUTHOR]

The purpose of this case series was to assess the application of a novel selfcutting, tapered implant (Straumann BLX) in combination with a digital integrated prosthetic workflow for immediate placement and restoration. Fourteen consecutive patients who required replacement of a single hopeless maxillary or mandibular tooth in the esthetic area and met the clinical and radiographic criteria for immediate implant placement were treated. All cases followed the same treatment procedure of extraction and immediate implant placement. Immediate temporization with full contoured screw-retained provisional restorations was performed using an integrated digital workflow. After implant placement and dual-zone bone and soft tissue augmentation, connecting geometries and emergence profiles were finalized. The average implant insertion torque was 53.2 ± 14.9 Ncm (range: 35 to 80 Ncm), allowing immediate provisional restoration in all cases. Final restorations were delivered 3 months after implant placement. An implant survival rate of 100% was observed at the 1-year postloading follow-up. The results of this case series suggest that immediate placement of novel tapered implants and immediate provisionalization using an integrated digital workflow can result in predictable and functional and esthetic results for the immediate transition of failing single teeth in the esthetic area. [ABSTRACT FROM AUTHOR]

Background: The personal qualities of health workers determine the way health services are provided to clients. Some key personal qualities (also called behavioural competencies) of physicians that contribute to quality healthcare delivery include ethical responsibility, empathy, patient-centeredness, diligence, good judgment, respectful, teamwork, team leadership/conflict management, ability to take correction and tolerance. In this study, we developed and validated clinical scenarios (dilemmas) for assessing priority behavioural competencies for medical practice in Nigeria. Methods: Drawing on prioritized competencies generated via a scoping review and nominal group technique (NGT) exercises in a previous study in the study series, Faculty members from the University of Nigeria Teaching Hospital were consulted to develop or adapt clinical scenarios that could be used to assess these competencies in a physician. The clinical scenarios and options were framed as situational judgement tests (SJTs) and these tests were administered to a random sample of 192 undergraduate and 111 postgraduate medical doctors in a tertiary hospital in Enugu State. Using Kane's validity argument framework, we assessed scoring and generalization inferences of situational judgment tests (SJT) based on the developed scenarios. Result: Scoring inference – difficulty and discrimination index – shows that most of the SJT items are good test items and can differentiate between high and low performers. The corrected point biserial correlations show positive correlation for most of the items. Generalization inference shows the items represent the domains of interest and are internally consistent. However, few items that show poor difficulty and discrimination index were subjected to re-evaluation and possible elimination. Conclusion: This study has produced a set of valid clinical scenarios that can be used to evaluate specific behavioural competencies among trainee medical doctors. It demonstrates that SJTs can be used to assess behavioural competencies for medical practice. However, further research is needed to establish the applicability of SJT beyond the immediate context, such as the medical school, in which it is developed. [ABSTRACT FROM AUTHOR]

Background and objectives: This study aimed to employ machine learning techniques to predict the clinical efficacy of acupuncture as an intervention for patients with upper limb motor dysfunction following ischemic stroke, as well as to assess its potential utility in clinical practice. Methods: Medical records and digital subtraction angiography (DSA) imaging data were collected from 735 ischemic stroke patients with upper limb motor dysfunction who were treated with standardized acupuncture at two hospitals. Following the initial screening, 314 patient datasets that met the inclusion criteria were selected. We applied three deep-learning algorithms (YOLOX, FasterRCNN, and TOOD) to develop the object detection model. Object detection results pertaining to the cerebral vessels were integrated into a clinical efficacy prediction model (random forest). This model aimed to classify patient responses to acupuncture treatment. Finally, the accuracies and discriminative capabilities of the prediction models were assessed. Results: The object detection model achieved an optimal recognition rate, The mean average precisions of YOLOX, TOOD, and FasterRCNN were 0.61, 0.7, and 0.68, respectively. The prediction accuracy of the clinical efficacy model reached 93.6%, with all three-treatment response classification area under the curves (AUCs) exceeding 0.95. Feature extraction using the prediction model highlighted the significant influence of various cerebral vascular stenosis sites within the internal carotid artery (ICA) on prediction outcomes. Specifically, the initial and C1 segments of the ICA had the highest predictive weights among all stenosis sites. Additionally, stenosis of the middle cerebral, anterior cerebral, and posterior cerebral arteries exerted a notable influence on the predictions. In contrast, the stenosis sites within the vertebral artery exhibited minimal impact on the model's predictive abilities. Conclusions: Results underscore the substantial predictive influence of each cerebral vascular stenosis site within the ICA, with the initial and C1 segments being pivotal predictors. [ABSTRACT FROM AUTHOR]

Understanding and incorporating evidence‐based veterinary medicine (EBVM) into clinical practice and research continues to pose a challenge for our profession despite over 2 decades of increasing awareness of this concept. Reasons for this include a lack of understanding of its importance to the practice of medicine, veterinary literature that often fails to adhere to evidence‐based standards, inadequate attention to teaching EBVM at the university level, and the inherent reluctance of clinicians to alter historical practice styles. For many practitioners, EBVM continues to be an abstract concept they believe requires advanced training in statistics and epidemiology resulting in them relying on less robust sources for clinical guidance. This unfortunately results in suboptimal care for our patients and delayed medical advancements for our profession. As part of the 20th anniversary of the founding of the Evidence‐Based Veterinary Medicine Association (EBVMA), we are refocusing our efforts to highlight the need for dedicated teaching of EBVM at the university level, for rigorous adherence to established research reporting guidelines, for expansion of EBVM infrastructure, and for the provision of easily accessible tools that permit clinicians to incorporate EBVM into their daily practice. As the quality of veterinary literature improves, so too will development of more effective clinical practice guidelines that ultimately can be widely adopted if they are flexible enough to support the triadic relationship between veterinarians, our clients and our patients. Ultimately, EBVM is not an end unto itself, but rather a means to improve the quality of care we provide our patients. [ABSTRACT FROM AUTHOR]

Since nail psoriasis restricts the patient's daily activities, therapeutic intervention based on reliable and reproducible evaluation is critical. The Nail Psoriasis Severity Index (NAPSI) is a validated scoring tool, but its usefulness is limited by interobserver variability. This study aimed to develop a reliable and accurate NAPSI scoring tool using deep learning. The tool "NAPSI calculator" includes two parts: nail detection from images and NAPSI scoring. NAPSI was annotated by nine nail experts who are board-certified dermatologists with sufficient experience in a specialized clinic for nail diseases. In the final test set, the "NAPSI calculator" correctly located 137/138 nails and scored NAPSI with higher accuracy than the compared six non-board-certified residents: 83.9% vs 65.7%; P = 0.008 and four board-certified non-nail expert dermatologists: 83.9% vs 73.0%; P = 0.005. The "NAPSI calculator" can be readily used in a clinical situation, contributing to raising the medical practice level for nail psoriasis. [ABSTRACT FROM AUTHOR]

Background: Although second-generation antipsychotics (SGAs) have proven to be effective therapeutic options for patients with schizophrenia, there is a notable lack of evidence on patients' subjective perspectives regarding their well-being, quality of life, and satisfaction with these medications. This study aimed to evaluate the treatment satisfaction and effectiveness of lurasidone on quality of life and functioning in adult patients with schizophrenia in real-world Italian clinical practice. Methods: This was a multicentre, national, non-interventional, single-arm, 3-month prospective study. Patients who were naive to lurasidone treatment and whose treating physician had decided to start them on this medication were enrolled and evaluated over a 3-month period. Eligible patients were adults (≥ 18 years of age) with a primary diagnosis of schizophrenia who were being treated with lurasidone (for the first time [i.e., they were lurasidone naive]) as part of routine clinical practice. Efficacy endpoints were changes in patient/caregiver treatment satisfaction (seven-point Likert scale from the Treatment Satisfaction Questionnaire for Medication), patient quality of life and functioning (QLS), investigator-rated global assessment of functioning (CGI-S, IAQ) after 6 weeks and 3 months of lurasidone, and number of relapses and hospitalizations. Results: Sixty-one patients were enrolled and 59 completed the study. The median dosage of lurasidone at baseline was 37.00 mg/day. The median duration of titration was 86.0 days (Min 28; Max 115 days); the median number of dosage changes was 1.0. At the end of 3-month observation period, the median dose of lurasidone was 74.00 mg/day. QoL and Functioning Score showed a trend of improvement over time, reaching a mean change from baseline of 9.8 at the end of the study. According to the CGI-S, the percentage of patients who were "markedly or severely ill" showed a continuous decrease from baseline to 3 months, from 62.29% to 8.20%. Patient satisfaction increased over time, with 80.32% of patients reporting that they were somewhat, fairly, or very satisfied (including 63.93% who were completely or very satisfied) at the end of the study. No relapses/hospitalizations for psychiatric reasons were reported. Lurasidone was well tolerated with no safety concerns or discontinuations due to AEs. Conclusions: Lurasidone represents a valid option for the treatment of schizophrenia and positively affects subjective well-being, quality of life and satisfaction. Trial registration: NCT06527885 retrospectively registered (01/08/2024). [ABSTRACT FROM AUTHOR]

Nanoparticles are attractive therapeutic tools due to their distinctive characteristics, including more accurate drug delivery, improved bioavailability, and enhanced targeted therapy. This review offers a comprehensive analysis of the therapeutic potentials of cutting-edge nanoparticles as demonstrated in human clinical trials, based on empirical evidence. Through systematic searches of major scientific databases, relevant studies published up to March 2024 were included, focusing on clinical trials utilizing advanced nanoparticles for therapeutic purposes. The review discusses the diverse applications of nanoparticles in oncology, infectious diseases, neurology, and other medical fields. Additionally, it scrutinizes the safety profiles, efficacy outcomes, and challenges associated with nanoparticle-based therapies. The findings underscore significant progress in translating nanoparticle research into clinical practice and highlight the potential of these innovative platforms to revolutionize medical treatments. This review contributes valuable insights into the growing field of nanoparticle-based therapeutics, fostering a deeper understanding of their clinical applications and implications in medical practice. [ABSTRACT FROM AUTHOR]

Aim: Private practice is one of the most rapidly growing, but under‐researched employment sectors for graduate dietitians in Australia, limiting evidence‐based workforce development. This scoping review examines existing international literature to gain an understanding of the current private practice workforce size, distribution, demography and workforce development considerations, including competencies, supply and demand, remuneration and professional development activities. Methods: The databases MEDLINE, EMBASE, CINAHL, EMCARE, PsycInfo (Ovid) and grey literature were systematically searched in August 2023 using key search terms to identify studies for inclusion. Articles were included if they related to private practice dietetics and described an aspect of workforce. Original research, government and organisational reports, statements of practice and websites providing governmental or organisational statistics were included. A directed content analysis and qualitative constant comparison technique were used to deductively map intelligence sources against a workforce development framework. A gap analysis was also conducted to provide a focus for future workforce development research. Results: A total of 72 peer‐reviewed and grey literature sources were included, with 65% of the studies being Australian‐based publications. Private practice dietetics research interest has increased in the last decade. Despite a breadth of published sources, this review found little published data on workforce size, distribution, demography, supply, demand, continued professional development and remuneration, indicating a significant gap in the evidence base. Existing literature focuses on workforce challenges and barriers, the work of private practice dietitians, with limited exploration of competency requirements for graduate private practitioners. Conclusions: The literature on the private practice dietetics workforce is lacking worldwide, which constrains evidenced‐based workforce development initiatives. Workforce development research across all workforce aspects is warranted to address current evidence gaps. [ABSTRACT FROM AUTHOR]

Aims: Digital health transformation may enhance or impede person‐centred care and interprofessional practice, and thus the provision of high‐quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person‐centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science. Methods: Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science. Results: We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems. Conclusions: While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition‐related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person‐centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: Technical and immunological advancements have improved patient and graft survival rates in pediatric kidney transplantation (PKT). However, the landscape of PKT in India remains underexplored. We conducted a questionnaire-based survey among Indian pediatric surgeons to delineate contemporary trends in PKT. Methods: The online survey comprised 10 questions assessing pediatric surgeons' involvement in PKT, existing challenges, and educational needs. Results: Of 610 surveyed pediatric surgeons, 120 responded (19.67% response rate). Majority of the respondents were affiliated with teaching programs, either in the public sector (61.18%) or in corporate setups (25.21%). While 65.83% of respondents managed pediatric patients with chronic kidney disease, only 10% had PKT programs at their institutes. Most of the respondents (67.5%) believed that pediatric surgeons should perform PKTs. Despite this, only 15.83% were part of the renal transplantation team at their institute and only 2.5% routinely performed PKTs. Most of the respondents (63.33%) advocated for mandatory KT exposure during postdoctoral training. Conclusion: Despite enthusiasm among pediatric surgeons, actual involvement remains low. Dedicated PKT programs are necessary to address these challenges along with improved training by integrating transplantation sciences into the pediatric surgical curriculum. The study underscores the need for pediatric surgeons to specialize in transplantation and advocates for policy changes to address the prevailing challenges. [ABSTRACT FROM AUTHOR]

Since their inception in 1975, the Department of Veterans Affairs Geriatric Research, Education, and Clinical Centers (GRECCs) have served as incubators of innovation in geriatrics. Their contributions to the VA mission were last reviewed in 2012. Herein, we describe the continuing impact of GRECCs in research, clinical, and educational areas, focusing on the period between 2018 and 2022. GRECC research spans the continuum from bench to bedside, with a growing research portfolio notable for highly influential publications. GRECC education connects healthcare professions trainees and practicing clinicians, as well as Veterans and their caregivers, to engaging learning experiences. Clinical advancements, including age‐friendly care, span the continuum of care and leverage technology to link disparate geographical sites. GRECCs are uniquely positioned to serve older adults given their alignment with the largest integrated health system in the United States and their integration with academic health centers. As such, the GRECCs honor Veterans as they age by building VA capacity to care for the increasing number of aging Veterans seeking care from VA. GRECC advancements also benefit non‐VA healthcare systems, their academic affiliates, and non‐Veteran older adults. GRECCs make invaluable contributions to advancing geriatric and gerontological science, training healthcare professionals, and developing innovative models of geriatric care. [ABSTRACT FROM AUTHOR]

An introduction to articles in the issue is presented on topics including the scarcity of disordered speech samples for model training which is an obstacle to developing artificial intelligence (AI)-driven assistive technologies for individuals with speech disabilities, automatic speech recognition (ASR) systems that can be used in real-time conversations by these individuals, and challenges to advance ASR communication tools for those with speech impairments.

Anorexia nervosa is a complex and potentially devastating mental health (MH) diagnosis that is recognized as having high rates of non-response to treatment, pronounced medical as well as MH morbidity, and elevated mortality rates. Olanzapine is a second-generation atypical antipsychotic that has demonstrated benefit with weight gain in adults with anorexia nervosa (AN), although controlled research involving children and youth remains limited. In this commentary, the authors provide a brief history and review of research relating to olanzapine for the adjunctive treatment of children and adolescents with AN. Although the medication has been used for more than two decades, its mechanism of action remains incompletely understood and is likely multifactorial. Despite a paucity of research to guide clinical decision making, olanzapine prescription among youth with moderate to severe AN appears to be prevalent among eating disorder specialists in Canada. In addition to commenting on gaps and challenges related to controlled randomized research in this area, the authors reflect on factors likely contributing to olanzapine's adoption into clinical practice. Moving forward, it is critical that further research involving olanzapine for the adjunctive treatment of AN in youth be undertaken to better understand efficacy, appropriate indications for use, and safety profile. [ABSTRACT FROM AUTHOR]

Circumcision anesthesia, aimed at mitigating pain and distress during the procedure, has evolved, reflecting advancements in medical science and societal attitudes toward pain management. This study conducts a comprehensive bibliometric analysis of circumcision anesthesia research, from historical origins to contemporary trends. The Web of Science collection database was used to search for all articles on circumcision anesthesia between 1980 and 2024. All fields were searched using "circumcision anesthesia" or "circumcision anaesthesia" as keywords. Countries, authors, journals, institutions, citation frequency, and journal metrics were extracted. The results were analyzed bibliometrically using the VOSviewer program. A total of 683 relevant publications between 1980 and 2024 were analyzed. The results showed that the USA had the highest number of publications, followed by Turkey. Original articles were the most common publication type, and the main research topics included pain management strategies, anesthesia techniques, and clinical outcomes. The article by Taddio et al. was the most cited article, with 738 citations, while "circumcision" and "pain" were the most common keywords used. Despite cultural and regional differences, this study highlights the growing acceptance of circumcision anesthesia as a vital aspect of medical practice and offers insights to guide future research efforts and clinical interventions. The findings contribute to a better understanding of the role of circumcision anesthesia in enhancing patient comfort and well-being during this standard surgical procedure. [ABSTRACT FROM AUTHOR]

Objective This manuscript describes the uptake of the AIM-Back Pain Navigator Pathway (PNP) designed to encourage use of non-pharmacologic care options within the Veterans Health Administration (VHA). Design This manuscript describes the implementation of a telehealth intervention from one arm of a multisite, embedded, cluster-randomized pragmatic trial comparing the effectiveness of two novel clinical care pathways that provide access to non-pharmacologic care for Veterans with low back pain (LBP). Setting Ten VHA clinics Subjects 19 pain navigators, >200 primary care physicians, and over 1000 Veterans were involved in the PNP implementation Methods Data were generated within the VHA electronic health record (EHR) for the ongoing AIM-Back trial to describe PNP implementation for system-level findings in terms of number of visits, and type of care received Results Over a 3-year period, 9 of 10 clinics implemented the PNP within the context of the AIM-Back trial. The most frequent care recommended in the PNP included physical therapy, chiropractic, acupuncture, and yoga/tai chi. During follow-up at six-weeks, ∼50% of Veterans elected to receive a different care choice than what was initially prescribed. Notable variation across clinics was documented for PNP based on time to initiation of care and follow-up rates. Conclusions Implementation of the telehealth delivered PNP provides a nuanced understanding of the introduction of novel care programs within diverse clinical settings. These findings are most applicable to care programs that are delivered remotely and involve facilitation of existing care options. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Previous Pediatrician Life and Career Experience Study (PLACES) 2016 data revealed that female pediatricians reported earning ~94% of what male pediatricians reported, after adjusting for factors that might impact income. Has this disparity persisted? METHODS: Data from PLACES, a national longitudinal study, was used to examine pediatrician-reported income from 2017 to 2022. A regression analysis estimated the adjusted differences in female and male pediatricians' annual income for each survey year. Models included sex and other key personal and practice characteristics for which female and male pediatricians' careers might differ. A mixed effects regression for longitudinal analysis examined income across years for female and male pediatricians and if time-variant characteristics are associated with increased or decreased income. RESULTS: PLACES participation ranged from 83.6% in 2017% to 75.5% in 2022 (analytic n = 1251 in 2017 and 1077 in 2022). The unadjusted mean annual income in 2022 was $237 168, $220 374 for female pediatricians and $284 286 for male pediatricians. Adjusting for key characteristics, female pediatrician income was ~93% of male pediatrician income, a gap of ~$ 11 000 annually. Income increased across years (coefficient = 0.03, P < .001). The year--sex interaction was not significant, indicating that the female--male disparity did not change over time. Three time-variant characteristics associated with increased income over time included increased portion of continuous full-time work, work hours, and time in administrative work. CONCLUSIONS A national longitudinal study revealed that female pediatricians reported earning ~93% of what their male colleagues reported, with a consistent gap from 2017 to 2022. [ABSTRACT FROM AUTHOR]

America is facing a primary care provider shortage. Enhanced primary care RNs (EPC‐RNs), registered nurses working at the top of their practice scope, can be an important part of community‐based primary care provision. Typically, community health nursing education has not included primary care‐based clinical experiences, and there is a clinical site shortage. Teaching students about EPC‐RN roles can be an important domain of community/public health nursing education. Simulation is a creative pedagogical approach to learning about the EPC‐RN role. The purpose of this manuscript is to 1) describe EPC‐RN Telehealth Simulation development; and 2) describe student simulation feedback. Nursing faculty and simulation experts designed five simulations for community health students to teach about the EPC‐RN role, incorporating recommendations from the Quad Council Coalition of Public Health Nursing Organizations community/public health nursing competencies and the National Competencies for Registered Nurses in Primary Care. Retrospective, descriptive quantitative, and qualitative student feedback data (n = 519) was collected through QuestionPro over multiple semesters. Student feedback data demonstrated support of the use of the simulations in community/public health nursing education. The EPC‐RN Telehealth Simulations prepared pre‐licensure nursing students to practice in community‐based primary care settings. Innovative, sustainable experiences such as this can improve community/public health nursing education. [ABSTRACT FROM AUTHOR]

COP‐28, the United Nations' Climate Change Conference, hosted by the United Arab Emirates, ended on 12 December 2023. At the convention, Australia released its National Health and Climate Strategy, committing to low‐carbon, climate‐responsive care. The Strategy will need new policies, projects and investments and a fit‐for‐purpose health workforce. This is a tall order considering healthcare's challenges. Everyone has a role, including clinicians, healthcare agencies, policymakers, politicians, patients and the providers and manufacturers in the supply chain. Clinicians' groups, policymakers and federal and state departments of health have an opportunity to lead climate change reform by considering climate change impacts across clinical practice and health policy. [ABSTRACT FROM AUTHOR]

Purpose: Therapeutic alliance (TA) is critical to rehabilitation outcomes for adults with acquired brain injuries (ABIs). The purpose of this viewpoint article is to review factors that contribute to TA and to suggest ways speechlanguage pathologists (SLPs) can integrate these factors into their ABI rehabilitation practice. Method: We evaluated literature describing client and clinician factors shown to affect—or not affect—TA in ABI rehabilitation and mapped findings onto suggested practices that SLPs may use to actively promote TA with their clients. Informed by our findings and TA frameworks, we integrated findings into a novel clinician self-reflection tool: the Therapeutic Alliance Reflection Checklist. Conclusions: TA is a key ingredient in ABI rehabilitation. We contend that SLPs can, and should, actively facilitate TA with clients; the self-reflection checklist can assist. We advocate for continued TA research and improved measurement across rehabilitation settings. We further contend that training in active TA-promoting skills is a critical component of speech-language pathology education. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopy is an essential skill for all surgeons. However, endoscopic competency, training, and practice may vary widely among them. The EAES Flexible Endoscopy Subcommittee is working towards a standardized set of fundamental endoscopic knowledge and skills. To best advise on current practice patterns of flexible endoscopy among surgeons worldwide, a snapshot audit was conducted on the training, use, and limitations of flexible endoscopy in practice. Methods: An online survey was distributed via email distribution and social media platforms for EAES, SAGES, and WebSurg members. Respondent demographics, training, and practice patterns were assessed. The main outcome measure was the annual endoscopic volume. Multivariate regression and machine learning models analyzed relationships between outcomes and independent variables of age, geographic region, laparoscopic surgery practice, and surgical specialization. Results: A total of 1486 surgeons from 195 countries completed the survey. Respondents were mainly general (n = 894/1486, 60.2%), colorectal (n = 189/1486, 12.7%), bariatric (n = 117/1486, 7.9%), upper gastrointestinal (GI)/foregut (n = 108, 7.3%), hepatobiliopancreatic/HPB (n = 59/1486, 4%), and endocrine surgeons (n = 11/1486, 0.7%) in active practice. Eighty-two percent (n = 1,204) mentioned having used endoscopy in their practice, and 64.7% (n = 961/1486) received formal flexible endoscopy training. Of those performing endoscopy annually, 64.2% (n = 660/1486) performed between 0 and 20 endoscopies, 15.2% (n = 156/1486) performed between 20 and 50 endoscopies, 10.1% (n = 104/1486) performed between 50 and 100 endoscopies, and 10.5% (n = 108/1486) performed over 100 endoscopies. From the regression analysis, there was no statistical correlation between the annual endoscopy volume and age, geographic region, laparoscopic surgery practice, or surgical specialization. Performing advanced endoscopy was directly related to the bariatric subspecialty and to performing over 50% of cases in a minimally invasive fashion. Conclusions: This international snapshot audit revealed significant heterogeneity in endoscopic practices among surgeons worldwide. There was a nonindependent relationship between endoscopy volumes and other variables tested. Barriers to practicing and receiving endoscopy training were common among respondents. The EAES Flexible Endoscopy Subcommittee will consider such results when developing an equitable and effective standardized flexible endoscopy curriculum. [ABSTRACT FROM AUTHOR]

This series of six articles is inspired by themes arising from the Royal College of Midwives' state of midwifery education report. The series explores the current landscape and challenges in educating the future midwifery workforce, particularly those that relate to the higher education workforce. This penultimate article examines the interplay between the practice and academic environments and the impact this has on both students and staff alike, particularly in the wake of changing standards for student supervision. The article explores whether the nature of being an educator in a health field such as midwifery is unique because of the need to support students through placement challenges when there are limitations on what higher education institutions can realistically influence. It also examines the 'extra' responsibilities put on midwifery education staff to support students by way of 'academic assessor' roles. [ABSTRACT FROM AUTHOR]

The article discusses a study on laparoscopic cholecystectomy performed by a surgical care practitioner, which sparked debate and received over 15,000 downloads. Questions were raised regarding ethical approval, training opportunities, and the role of surgeons in training. The Royal College of Surgeons of England does not support surgical care practitioners undertaking laparoscopic cholecystectomies. The study authors responded to questions about the necessity of training the practitioner, the impact on trainees, and the responsibility in case of complications. The authors emphasized the SCP's extensive training and experience, as well as the supervision provided during the procedures. [Extracted from the article]

This paper demonstrates the essential nature of oncology social work and the critical role that oncology social workers (OSWs) play in the achievement of high-quality cancer care that improves patient outcomes, contains cost, advances population health, reduces provider burn-out among healthcare providers, and does it in a manner that addresses disparities and achieves equity. To this end, this paper's purpose is two-fold: (1) to review and demonstrate OSW contributions to the advancement of comprehensive cancer care over the last 15 years, and (2) to consider next steps for the Association of Oncology Social Work (AOSW) and the Oncology Social Work profession to achieve its mission and calling. To enhance the viability and security of OSWs and the professional organizations that support them, this report summarizes a breadth and depth of work and includes recommendations for the profession. [ABSTRACT FROM AUTHOR]

Despite advances in precision medicine for non-small cell lung cancer (NSCLC), biomarker testing for these therapies remains frequently underused, delayed, and inequitable. Pulmonologists often play a critical role in the initial diagnostic steps for patients with lung cancer, and previous data show variability in their knowledge and practices regarding biomarker testing. The purpose of this study is to better understand how pulmonologists view their role in lung cancer care. With the increasing importance of biomarker testing and precision medicine, how do pulmonologists view their role in lung cancer care? An electronic survey consisting of 31 items focused on attitudes and practices regarding diagnostic steps for NSCLC was randomly distributed to a sample of practicing pulmonologists in the American College of Chest Physicians (CHEST) analytics database. Inferential statistics were performed using χ2 tests and multivariable logistic regression models. A total of 401 pulmonologists responded to the survey. Most (92%) were general pulmonologists, and more than one-half (62%) indicated they order biomarker testing. Longer practice tenure, higher case volumes, and participation in a multidisciplinary tumor board were associated with ordering biomarkers (P <.05). Pulmonology was identified to have the leading responsibility for the initial diagnostic biopsy by most respondents (83%) and less often for staging (45%), leading discussions about biomarker testing with patients (28%), and for ordering biomarkers (22%). The most common reasons for not ordering biomarkers included the following: oncology was responsible (84%), it was not within their scope of practice (46%), or lack of the necessary knowledge (51%). This study shows that pulmonologists vary in their practices for ordering biomarkers, and many defer this responsibility to oncology. Despite the role of bronchoscopy and pulmonology societal guidelines for staging, many defer leadership of this process. Many pulmonologists lack the necessary resources and multidisciplinary infrastructure likely required to efficiently accomplish biomarker testing. [Display omitted] [ABSTRACT FROM AUTHOR]

In this professional theoretical article, the authors argue that patient care should be centered on connection and that authentically turning toward suffering necessitates an approach to care that transcends medicine's traditional focus on cure and physical restoration and differentiates between pathology and disability. The meaning of illness and suffering for those who have experienced life-changing injuries or illness is explored. Strategies for approaching the lifeworld of these individuals are discussed using the concepts of phenomenology and embodiment, rooted in the work of philosophers from the phenomenological tradition. The authors also propose an approach to patient care offering a case-based example based on postmodernist concepts that elevate connection, relationship, and interdependency above the traditional focus of restoring normality and physical independence for individuals with disabilities. Traditional assumptions about quality of life, illness, and disability are called into question by focusing on the fluidity of being and disability identity, which serves to destabilize static, binary conceptions of individuals as either healthy or ill, disabled, or able-bodied. A postmodern lens invites healthcare practitioners to envision themselves as part of an assemblage that may promote a more expansive view of the relationship between patient and healthcare practitioner. [ABSTRACT FROM AUTHOR]

In this topical review, we integrate 3 concepts—public health practice, community engagement, and cross-sector governance—to consider the following question: What is the underlying relationship between public health and cross-sector governance according to which the field can understand the role of community engagement in achieving health equity? We begin with an overview of public health practice and the practice of community engagement. Next, we position these practices in the broader turn toward cross-sector governance. The integration of these themes reveals that common tools for community engagement fail to address questions about how services should be funded, how resources should be distributed, and which members of the community have a claim to services. We therefore suggest that distinguishing between community engagement for equity and equitable community engagement is a first step toward deepening dialogue about the role of public health in achieving health equity. [ABSTRACT FROM AUTHOR]

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing—the largest healthcare workforce with diverse roles—operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health. [ABSTRACT FROM AUTHOR]

We developed an ethical decision-making tool to assist in training clinical psychologists that had four goals: (a) to mirror the way psychologists naturally think about ethical dilemmas; (b) to facilitate thorough analysis by using a simple, guided checklist format; (c) to provide quick access to intuitively organized explanations and examples of each major domain of ethical challenges and principles; and (d) to facilitate good documentation and record-keeping of the decision-making process. Study 1 surveyed clinical psychologists and asked them to list the top 10–15 ethical considerations they encounter in practice, and then used those categories to help develop the tool. In Study 2, having access to two different versions of the tool significantly improved the quality of analysis of a standardized clinical vignette, particularly for individuals still in training. In Study 3, a streamlined version of the tool significantly improved the quality of graduate trainees' analysis of the standardized clinical vignette and was faster to use. In Study 4, we demonstrated the efficacy of the tool in helping trainees analyze ethical dilemmas they had actually experienced. In Study 5, faculty at doctoral programs who teach graduate ethics courses provided dilemmas and then graded the responses of trainees who analyzed them either with or without the tool. Analyses completed with the tool received far better grades on average than those completed without the tool. This work is the first that we know of to develop an evidence-based, empirically supported tool for training future psychologists in ethical practice. Public Significance Statement: This study describes the development of a novel ethical decision-making tool for use in training clinical psychology graduate students. The study shows that the tool helps trainees improve their analysis of complex ethical dilemmas that arise in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Nasal obstruction in humans leads to mouth breathing and subsequent hypoxia in the entire body. Furthermore, nasal obstruction in growing children affects craniofacial growth and development. Objective: To investigate the effects of unilateral nasal obstruction (UNO) on craniofacial growth in mice of different ages, particularly on the morphology of the nasomaxillary complex and mandible. Methods: Mice aged 3, 6 and 12 weeks were selected as representatives of juvenile, adolescent and adult stages, respectively. A total of 30 male C57BL/6J mice (10 mice each at the ages of 3, 6 and 12 weeks) were used in this study for a 3‐week experiment. The mice in each age stage were randomly and evenly assigned to either the control group (C3+3, C6+3 and C12+3) or the experimental group (E3+3, E6+3 and E12+3). The UNO model in experimental group was constructed by plugging the mouse's left nostril, thereby disrupting its normal nasal breathing pattern and inducing hypoxia. The control group underwent the sham procedure. After 3 weeks, the length, width and height of the cranium, nasomaxillary complex and mandible of each group were measured on two‐dimensional images constructed by micro‐computed tomography. Furthermore, the impact of UNO on mouse growth was evaluated through the measurement of femoral length. Results: In juvenile mice, UNO inhibited the growth of cranial width, cranial height and mandibular length. In adolescent mice, UNO impeded the growth of the femoral length, cranial length, nasomaxillary length and mandibular length. In adult mice, no significant negative effects of UNO on craniofacial growth were found. Conclusion: Referring to the experimental results, in addition to actively treating nasal obstruction in patients, it is important to monitor the growth of the mandible in juveniles, as well as the nasomaxillary and mandibular growth in adolescents during orthodontic clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To describe the current state of the literature on nurses' and midwives' knowledge, perceptions and experiences of managing parental postnatal depression (PPND). Design: The Joanna Briggs Institute scoping review method and the PRISMA extension for Scoping Reviews guided the work. Data Sources: A systematic search of PubMed, CINAHL, Embase, MEDLINE, PsycINFO and Scopus databases was conducted in January and February 2023. Review Methods: Peer‐reviewed primary research articles published in English between 2012 and 2023 that involved nurses or midwives managing PPND were included. Rayyan was used to screen titles, abstracts and full‐text articles. A spreadsheet was used to organize extracted data and synthesize results. Results: Twenty‐nine articles met the inclusion criteria. Most study samples were of mothers, and few were from middle‐ and lower‐income countries. Nurses and midwives lacked knowledge about PPND, yet they felt responsible for its management. Nurses and midwives faced significant organizational and systems‐level challenges in managing PPND. However, nurses and midwives facilitated PPND care in collaboration with other healthcare providers. Conclusion: The review highlights significant gaps in the nurses' and midwives' care of PPND. Educational programmes are necessary to increase nurse and midwife knowledge of PPND and strategies for its management, including facilitating collaboration across the healthcare system and eliminating organizational and systemic‐related barriers. Additional focused research is needed on nurses' and midwives' knowledge, perception of and experience with PPND beyond mothers, such as with fathers, sexually and gender‐minoritized parents and surrogate mothers. Finally, additional research is needed in middle‐ and lower‐income countries where nurses and midwives may face a higher burden of and unique cultural considerations in managing PPND. Impact: PPND can affect the parent's mental and physical health and relationship with their child. If left untreated, PPND can lead to long‐term consequences, including child developmental delays, behavioural problems and difficulties with parental–child attachment. Reporting Method: This scoping review adheres to PRISMA Extension for Scoping Review guidelines and the Joanna Briggs Institute scoping review method. Patient or Public Contribution: This research is a scoping review of published peer‐reviewed studies. [ABSTRACT FROM AUTHOR]

To determine the percentage of female adolescent patients (13-26 years old) who had HIV testing ordered within 90 days of incident sexually transmitted infection (STI) diagnosis during an outpatient clinic visit. This was a retrospective chart review study evaluating 830 visits among 589 female patients 13 to 26 years who had an incident STI diagnosed in outpatient Adolescent Medicine or Pediatric Practices in an urban, nonprofit, academic, free-standing children's hospital at the main campus and a community site in the Northeast United States. Odds of HIV screening was greater at the community-based adolescent medicine practice (odds ratio [OR] = 3.17; 95% confidence interval [CI]: [1.92, 5.24]) and when seen by an adolescent medicine provider (OR = 1.44; 95% CI: [1.02, 2.03]). Only 33.5% (n = 283) of 844 clinical encounters had HIV screening obtained within 90 days of incident STI diagnosis. Overall, HIV screening rates within 90 days of STI diagnosis was low, and there is much room for improvement. [ABSTRACT FROM AUTHOR]

Introduction: The growing popularity of dietary supplements in Poland raises the need to verify the knowledge and practices of healthcare workers who have a key role in recommending their use. Understanding these issues is important to ensure patient safety and the correct use of dietary supplements. Therefore, the aim of the study was to examine the level of knowledge, practices, and sources of information on dietary supplements among various professional groups of healthcare workers. Material and Methods: The study conducted from September 2023 to June 2024 involved 743 healthcare professionals, including doctors, pharmacists, and nurses. Data were collected online using an original questionnaire. The questionnaire was placed in portals associated with target groups. Results: A total of 73.49% of respondents declared knowledge of dietary supplements. The most common source of information was scientific articles (42.8%), and only 7.00% of respondents used official sources such as the Chief Sanitary Inspectorate. Advertisements had a smaller impact on doctors (p < 0.001), with 46.97% of respondents stating that they did not pay attention to them. In addition, 84.52% of respondents considered the composition of the dietary supplement to be a key factor in their recommendation. Conclusions: Knowledge of dietary supplements among healthcare professionals varies, particularly between different professional groups. The results indicate a need for further education and standardization of information to ensure safe and responsible recommendation of supplements to consumers. [ABSTRACT FROM AUTHOR]

Background/Objectives: Cesarean section (C-section) scars can lead to chronic pain due to changes in tissue properties. Combining elastography and algometry can assess these scars comprehensively by identifying areas of increased rigidity and quantifying pain sensitivity. This study aims to evaluate the efficacy of using elastography and algometry together to assess cesarean scar tissue, correlating tissue stiffness with pain thresholds for targeted pain management. Methods: Thirty-one non-pregnant women who had undergone a C-section between six months and two years prior participated. Elastography measured tissue stiffness, while algometry provided quantitative measures of pain sensitivity on and around the scar. The correlation between tissue stiffness and pain thresholds was analyzed. Results: Elastography identified areas of increased rigidity within the scar tissue, which corresponded with lower pain thresholds measured by algometry, indicating higher pain sensitivity. A significant correlation was found between increased tissue stiffness and reduced pain thresholds (p < 0.05). Conclusions: Combining elastography and algometry offers a powerful diagnostic tool for evaluating C-section scars. This approach identifies areas that may benefit from targeted pain management interventions, enhancing understanding and treatment of pain associated with cesarean scars. Incorporating these techniques into clinical practice could improve patient outcomes and quality of life. [ABSTRACT FROM AUTHOR]

As more family physicians choose employment over private practice, more are also wrestling with the question of whether to join a union. Here's what to consider. As more family physicians choose employment over private practice, more are also wrestling with the question of whether to join a union. Here's what to consider. [ABSTRACT FROM AUTHOR]

The article provides readers with a detailed overview of the AutoMedPrint technology, its advantages and opportunities, based on a number of studies and case examples. The AutoMedPrint system represents a significant advancement in the field of orthopedics, offering a comprehensive solution for the automated design and rapid production of personalized orthopedic and prosthetic devices through 3D printing technology. This paper details the system’s capabilities and methodologies behind it, which include the design and manufacturing of various devices such as wrist hand orthoses (WHO) and ankle foot orthoses (AFO), among others. These devices are crafted using data obtained from precise anthropometric measurements, allowing for high customization to meet individual patient needs. The AutoMedPrint system enhances the quality of life for patients by providing devices that are not only functional and cost-effective but also rapidly produced, ensuring timely intervention. Case studies demonstrate the system’s effectiveness in practical scenarios, highlighting its potential to revolutionize orthopedic care by integrating new materials and technologies that adapt to changing medical and patient requirements. The discussion extends to the lifecycle of the produced devices, emphasizing sustainability and continuous improvement, ensuring the system’s relevance and efficacy in modern medical practice. [ABSTRACT FROM AUTHOR]

Objective: Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, posttraumatic stress disorder, and early mortality. Low screening and older adult self-reporting, especially within emergency departments, represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors' perspectives on EM screening and response practices in emergency departments. Methods: Semi-structured interviews with 19 EM survivors of those with Adult Protective Services validated EM were completed in older adults' homes. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses. Results: The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response. Conclusions: Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized. [ABSTRACT FROM AUTHOR]

The American Institute of Ultrasound in Medicine (AIUM) revised the Practice Parameter for the Performance of Vascular Ultrasound for Postoperative Assessment of Hemodialysis Access in collaboration with other organizations. The document provides recommendations for personnel requirements, documentation, quality assurance, and safety for ultrasound examinations. It addresses the importance of monitoring hemodialysis access to detect complications and ensure proper function, with specific guidelines for evaluating AVFs and grafts. The parameter emphasizes the need for accurate documentation, equipment specifications, and adherence to quality and safety standards in ultrasound practices. [Extracted from the article]

Rationale, Aims and Objectives Method Results Conclusion This research aims to develop an effective algorithm for diagnosing COVID‐19 in chest X‐rays using the transfer learning method and support vector machines.In total, data was collected from 10 clinics, including both large city hospitals and smaller medical institutions. This ensured a diverse range of geographical and demographic information in the sample. An extensive data set was collected, including 10,000 chest X‐ray images. 5000 images represent normal cases, 3993 images represent pneumonia cases, and 1007 images represent COVID‐19 cases. Machine learning methods were applied to develop a classification model, and the results were compared with seven state‐of‐the‐art models and a lightweight CNN architecture.The results showed that the proposed method achieves high accuracy values (Accuracy): 0.95 for COVID‐19, 0.89 for pneumonia, and 0.92 for normal images (p < 0.05). Comparison with other models demonstrates statistically significant superiority of our method in accuracy across all three classes. The EfficientNet‐B0 model surpasses our method only in accuracy for normal images with p < 0.01, confirming the advantages of our method. Our method demonstrates high sensitivity values (Sensitivity): 0.96 for COVID‐19, 0.88 for pneumonia, and 0.93 for normal images (p < 0.05), outperforming most of the compared models. Correlation analysis showed Pearson coefficients of 0.92, 0.89, and 0.94 for COVID‐19, pneumonia, and normal images, respectively, confirming a high degree of consistency between predicted and true class labels. In addition, the model was validated on external datasets to assess its generalizability. This validation confirmed its high level of effectiveness in a variety of clinical settings.This study confirms the importance of applying machine learning methods in medical applications and opens new perspectives for early diagnosis of infectious diseases. The practical application of the obtained results can enhance the efficiency of diagnosis and control the spread of COVID‐19, as well as contribute to the development of innovative methods in medical practice. [ABSTRACT FROM AUTHOR]

Background: Reference intervals, which define an interval in which a specific proportion of measurements from a healthy population are expected to fall, are commonly used in medical practice. Synthesizing information from multiple studies through meta-analysis can provide a more precise and representative reference interval than one derived from a single study. However, the current approaches for estimating the reference interval from a meta-analysis mainly rely on aggregate data and require parametric distributional assumptions that cannot always be checked. Methods: With the availability of individual participant data (IPD), non-parametric methods can be used to estimate reference intervals without any distributional assumptions. Furthermore, patient-level covariates can be introduced to estimate personalized reference intervals that may be more applicable to specific patients. This paper introduces quantile regression as a method to estimate the reference interval from an IPD meta-analysis under the fixed effects model. Results: We compared several non-parametric bootstrap methods through simulation studies to account for within-study correlation. Under fixed effects model, we recommend keeping the studies fixed and only randomly sampling subjects with replacement within each study. Conclusion: We proposed to use the quantile regression in the IPD meta-analysis to estimate the reference interval. Based on the simulation results, we identify an optimal bootstrap strategy for estimating the uncertainty of the estimated reference interval. An example of liver stiffness measurements, a clinically important diagnostic test without explicitly established reference range in children, is provided to demonstrate the use of quantile regression in estimating both overall and subject-specific reference intervals. [ABSTRACT FROM AUTHOR]

Background: At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level. Methods: A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed. Results: A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37–61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. Conclusions: GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions The clinical management of partial bone defects in lower limbs, particularly those resulting from osteomyelitis, remains a significant challenge. This study aimed to systematically evaluate the effectiveness of 3D‐printed porous Ti6Al4V prostheses in addressing osteomyelitis‐induced partial bone defects.We established a comprehensive protocol for utilizing 3D‐printed prostheses for bone defect repair, encompassing 3D simulation of prosthesis implantation and internal fixation, finite element analysis (FEA), and clinical implementation. Mimics software facilitated simulation of fixation patterns and screw lengths. FEA modeled bone defects in the distal metaphyseal femur and distal diaphyseal tibia to assess changes in stress conduction pre‐ and post‐prosthesis implantation. The clinical study involved eight patients (average age: 56.3 years) with an average defect length of 14.9 cm. Postoperative outcomes were evaluated using X‐rays and the Lower Extremity Functional Scale (LEFS).FEA demonstrated that the implanted prostheses effectively shared stress and reduced the load on residual bone in both models, thus lowering the risk of fractures under external forces. The average follow‐up period was 24.5 months, with patients initiating weight‐bearing activities on average 7.8 days post‐surgery. Serial postoperative X‐rays demonstrated long‐term stability of the prostheses, with progressive bone regeneration around and integration with the prostheses. While two patients experienced infection recurrence requiring prosthesis removal and debridement, the remaining six showed significant improvement in LEFS scores, increasing from 31.5 preoperatively to 61.0 at the last follow‐up.3D‐printed porous Ti6Al4V prostheses effectively restore anatomical integrity and optimize stress conduction in lower limbs, resulting in substantial functional recovery. This innovative approach shows promise for wider clinical adoption and warrants further investigation in medical practice. [ABSTRACT FROM AUTHOR]

Large language models (LLMs) have broad medical knowledge and can reason about medical information across many domains, holding promising potential for diverse medical applications in the near future. In this study, we demonstrate a concerning vulnerability of LLMs in medicine. Through targeted manipulation of just 1.1% of the weights of the LLM, we can deliberately inject incorrect biomedical facts. The erroneous information is then propagated in the model's output while maintaining performance on other biomedical tasks. We validate our findings in a set of 1025 incorrect biomedical facts. This peculiar susceptibility raises serious security and trustworthiness concerns for the application of LLMs in healthcare settings. It accentuates the need for robust protective measures, thorough verification mechanisms, and stringent management of access to these models, ensuring their reliable and safe use in medical practice. [ABSTRACT FROM AUTHOR]

Simple Summary: This review paper explores advanced imaging technologies for prostate cancer because traditional methods often miss or misclassify cancers. The aim of this study is to provide a comprehensive overview of three key technologies, MRI, micro-ultrasound, and prostate-specific membrane antigen (PSMA) PET scans, and how they can improve prostate cancer detection and management. The findings showed that these techniques have improved our ability to detect prostate cancer; however, further studies are needed to determine each imaging technique's specific role in the diagnosis of prostate cancer. Background/Objectives: Prostate cancer is a prevalent malignancy often presenting without early symptoms. Advanced imaging technologies have revolutionized its diagnosis and management. This review discusses the principles, benefits, and clinical applications of multiparametric magnetic resonance imaging (mpMRI), micro-ultrasound (microUS), and prostate-specific membrane antigen positron emission tomography–computed tomography (PSMA PET/CT) in localized prostate cancer. Methods: We conducted a comprehensive literature review of recent studies and guidelines on mpMRI, microUS, and PSMA PET/CT in prostate cancer diagnosis, focusing on their applications in biopsy-naïve patients, those with previous negative biopsies, and patients under active surveillance. Results: MpMRI has demonstrated high sensitivity and negative predictive value in detecting clinically significant prostate cancer (csPCa). MicroUS, a newer technology, has shown promising results in early studies, with sensitivity and specificity comparable to mpMRI. PSMA PET/CT has emerged as a highly sensitive and specific imaging modality, particularly valuable for staging and detecting metastatic disease. All three technologies have been incorporated into urologic practice for prostate cancer diagnosis and management, with each offering unique advantages in different clinical scenarios. Conclusions: Advanced imaging techniques, including mpMRI, microUS, and PSMA PET/CT, have significantly improved the accuracy of prostate cancer diagnosis, staging, and management. These technologies enable more precise targeting of suspicious lesions during biopsy and therapy planning. However, further research, especially randomized controlled trials, is needed to fully establish the optimal use and inclusion of these imaging modalities in various stages of prostate cancer care. [ABSTRACT FROM AUTHOR]

Importance: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the paranasal sinuses with significant quality of life impairments. There is a need to implement outcome-based metrics to evaluate the outcomes of CRS treatment with endoscopic sinus surgery or biologics. Objective: We aimed to understand Canadian otolaryngologists' opinions on patient-related outcome measures (PROM) for CRS and identify potential barriers to implementation. Design: Qualitative research. Setting and Participants: A cross-sectional survey was distributed via the Canadian Society of Otolaryngology-Head and Neck Surgery and direct emailing. Measures: Participants' demographics, practice information, and opinions on PROM were collected. Results: Of 346 (23%) Canadian otolaryngologists, 78 responded to the survey (26 rhinology fellowship–trained, 51 non-fellowship-trained, and 1 missing data). Thirty-eight responded that they collect PROM (69% with fellowship-trained, 39% non-fellowship-trained, P =.029). Regarding opinions on PROM, 74% of respondents agreed that it helps patients report their symptoms, 42% agreed that it improves the efficiency of the patient encounter, 54% agreed that it is easy for patients to understand, 62% agreed that it improves management and monitoring of clinical outcomes, and 71% disagreed that PROM is not helpful. Fellowship-trained otolaryngologists were 4 times more likely to agree that PROM improves management and monitoring of clinical outcomes (P =.014), and no other differences in opinions were significant. The most-frequently-identified barriers to PROM usage were lack of time for 67% of respondents, difficulty integrating into clinical workflow for 64%, and lack of integration into the electronic medical record for 47%. If these barriers were addressed, 86% of respondents said they would use PROM in their practice. Conclusions and Relevance: Despite the low uptake of PROM among otolaryngologists without rhinology fellowship, opinions were generally favorable. We identified barriers that, if addressed, may increase their use in clinical practice. As resource-limited therapies such as biologics become more prevalent in CRS management, PROM may find more applications in shared clinical decision making. [ABSTRACT FROM AUTHOR]

Triple‐negative breast cancer (TNBC), a highly aggressive form of breast cancer, currently lacks targeted therapies and is associated with high recurrence rates in medical practice. In this study, the effectiveness of a specially developed magnetic nanodrug, namely doxorubicin (DOX)‐loaded Fe3O4 vortex magnetic nanoannulars coated with a cancer cell membrane (DOX‐VMAs@CM), against cancer under a varying low‐frequency magnetic field (MF), is investigated. This advanced nanodrug can specifically target and accumulate in tumors. Additionally, it considerably improves tumor suppression compared with that of DOX chemotherapy alone, indicating the possibility of homologous targeting of the cancer cell membrane and the vibrating effect of the MF. The DOX‐VMAs@CM nanoparticles (NPs) exhibit exceptional safety characteristics because of their ability to specifically target tumors. The results of RNA sequencing suggest that the potential mechanisms may involve cellular respiration, cell cycle, and ferroptosis regulation. Altogether, chemotherapy is successfully optimized by implementing a delivery system and MF intervention, and the developed DOX‐VMAs@CM NPs hold significant potential for use in the clinical treatment of TNBC. [ABSTRACT FROM AUTHOR]

Background: This correlative study aimed to examine how the different primary care models (physicians in solo practice, physicians in collaborative practice, physicians and nurse practitioners in collaborative practice, after-hours clinics, community centers, or emergency rooms) were associated with their capability to offer timely access to their patients. The data collected from the primary care provider's perspective was to complete the New Brunswick Health Council results on patients' perspective. Methods: A convenience sample of 120 primary care providers (33 physicians in solo practice, 33 physicians in collaborative practice, 27 providers in collaborative practice with nurse practitioners, 2 providers working in after-hours clinics, and 10 providers in Emergency departments) responded to an online survey about their primary care models and accessibility. We used the Statistical Package for Social Sciences software to run correlations, independent t-tests and Fisher's exact tests to compare timely access to care between variable groups. Results: A positive correlation was observed between patient load (or the number of patients under a primary care provider's practice), age and years of experience. However, the patient load did not translate to more timely access to care. However, a statistically significant difference (p = 0.032) was observed when primary care providers kept appointment slots available for daily urgent requests. When a primary care provider booked all available appointment slots, only 85% of them could offer timely appointments (in 5 days or less), compared to 97% who could deliver it when appointment slots were left open in their daily schedule. The primary care model (solo vs. collaboration), the use of health technologies and the type of provider did not significantly influence timely access to care. In contrast, the primary care providers who reported teleworking (or working remotely) were less likely to offer timely access to care. Conclusion: Timely access to care is not always available to patients, even those with a primary care provider. Certain organizational practices may improve access to care and should be integrated into primary care in New Brunswick and elsewhere in Canada. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) profoundly affects an individual's ability to move. Fortunately, recent advancements in neuromodulation, particularly the spatio-temporal epidural electrical stimulation (EES) targeting the spinal nerve roots, promoted rapid rehabilitation of SCI patients. Such neuromodulation techniques require precise anatomical modelling of spinal cord. However, the lack of spine imaging datasets, especially high-quality magnetic resonance imaging (MRI) datasets highlighting nerve roots, hinders the translation of EES into medical practice. To address this problem, we introduce an open-access lumbosacral spine MRI dataset acquired in 14 healthy adults, using constructive interference in steady state (CISS) sequence, double echo steady state (DESS) sequence, and T2-weight turbo spin echo (T2-TSE) sequence, with enhanced nerve root resolution. The dataset also includes the corresponding anatomical annotations of nerve roots and the final reconstructed 3D spinal cord models. The quality of our dataset is assessed using image quality metrics implemented in MRI quality control tool (MRIQC). Our dataset provides a valuable platform to promote a wide range of spinal cord neuromodulation research and collaboration among neurorehabilitation engineers. [ABSTRACT FROM AUTHOR]

There is an abundance of outcomes research for clinical hypnosis showing promising results. Nonetheless, hypnosis is still underutilized in clinical care. For a behavioral intervention to enter mainstream clinical care, efficacy needs to be demonstrated with exceptionally high quality of evidence, and its reporting needs to be complete and sufficiently clear to enable replication and clinical use. The present article provides best practice guidelines formulated by the Task Force for Establishing Efficacy Standards for Clinical Hypnosis for conducting and reporting clinical hypnosis research.The recommendations are presented in two tiers. Tier I recommendations include essential best practices, such as a call for the use of detailed research and intervention manuals, plans for and reporting of participant-education about hypnosis, the use of hypnotizability scales with good psychometric properties, and clear reporting of the hypnotizability measurement. Tier I also includes the sharing of intervention manuals, the reporting of the induction procedure, the labeling of the intervention for participants, and the definition of hypnosis used. Tier II includes preferred recommendations, calling for measurement of adherence to home practice, measurement of hypnotizability using scales with both subjective and behavioral measures of responsiveness, and the involvement of participants from the full hypnotizability spectrum. Tier II also includes the assessment of variables related to proposed mechanisms of action, the reporting of participants prior hypnosis experiences, and the relationship of expectancies and treatment outcomes.This list of recommendations will be useful for researchers, reviewers, and journal editors alike when conducting, reporting, or evaluating studies involving clinical hypnosis. [ABSTRACT FROM AUTHOR]