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The carbon footprint of end-to-end healthcare deliveries by the National Health Service in England totalled 25.0 megatons of carbon dioxide equivalent (CO2e) in 2019. Optimal and sustainable healthcare can lead to better health outcomes as well as a lower environmental footprint. To evaluate the potential impact of prevention and effective management of type 2 diabetes mellitus (T2DM) in adults on both the clinical outcomes and greenhouse gas (GHG) emissions in the UK healthcare setting. We incorporated an environmental module into the existing IQVIA core diabetes model to estimate the impact of improving clinical outcomes on GHG emissions over a lifetime horizon. We assessed two hypothetical scenarios: (1) preventing progression from pre-diabetes to T2DM through diet and exercise versus no intervention and natural disease progression to T2DM; and (2) well-controlled T2DM using interventions with clinical benefit on glycosylated haemoglobin (HbA1c), and renal and cardiovascular outcomes versus uncontrolled T2DM. Preventing progression to T2DM led to 6.357 additional undiscounted life years and 67% less kg CO2e emissions compared with subsequent natural progression to T2DM for a person with pre-diabetes over a lifetime (emissions of 9586 kg CO2e over 37.115 years vs 28 716 kg CO2e over 30.758 years, respectively). Well-controlled T2DM led to 1.947 additional undiscounted life years and 21% less kg CO2e emissions per patient over a lifetime compared with uncontrolled T2DM (emissions of 14 545 kg CO2e over 22.772 years vs 18 516 kg CO2e over 20.825 years, respectively). In both scenarios, the GHG emission savings were primarily due to reduced emissions related to avoidance of treating complications of T2DM including cardiovascular, renal and eye diseases. Effective prevention and management of T2DM through implementation of evidence-based clinical guidelines can improve patient outcomes while reducing the healthcare-related environmental impacts.

Symptoms are a central part of living with illness, and healthcare professionals play a crucial role in supporting patients in the managing of these. Symptom support is not only about alleviating physical discomfort but also about addressing the subjective and existential dimensions of illness. Understanding how patients experience such support is essential for strengthening communication, dignity, and person-centred care. This study aims to explore the meaning of patients' experience of support from HCP in managing symptoms, and how this meaning shapes their understanding of symptoms and subsequent strategies. A qualitative design was applied. In-depth interviews were conducted with 10 patients diagnosed with acute or chronic illness and receiving care in hospital and outpatient settings. Data were analysed using a phenomenological hermeneutic approach inspired by Ricoeur. Three themes were identified. Caught in the gaps of continuity in care describes how patients experienced symptom support as fragmented and inconsistent, shaped both by organisational structures and the professionals they encountered. Dialogue, relationship and professional knowledge as a vulnerable space highlights how encounters with healthcare professionals were perceived as fragile moments, where recognition, time, and competence could either foster trust or leave patients feeling exposed. Between silence and support in the healthcare encounter reflects how organisational structures and clinical routines often failed to address patients' concerns, creating silent spaces where symptoms and existential needs were overlooked. Patient experiences reveal how symptom support is shaped by both relational vulnerability and systemic fragmentation. When symptoms are overlooked, patients feel abandoned and burdened with coordinating their own care. Strengthening relational continuity, clarifying roles across professions explicitly to patients, and prioritising dialogue and empathy in clinical encounters are crucial steps toward ensuring person-centred symptom management that promotes dignity and well-being.

Critics often cite the lack of tactile feel as a major drawback of robotic surgery. Although robotic surgeons are believed to develop a sense of "visual haptics" through personal experience combined with the enhanced 3D vision, this phenomenon has not been formally scrutinized. Therefore, our objective was to determine whether surgeons' discernment of objects' physical properties using robotic technology was non-inferior to discernment via surgeons' hands. This was a non-randomized parallel group study using an inanimate model consisting of four identical balloons fixed to posterboard and containing substances meant to simulate physical properties encountered in surgery-namely air, water, petroleum jelly, or a firm substance. Two groups of board-certified surgeons discerned contents of each balloon by feeling with their hands or by manipulating them using robotic instruments. Using the Farrington-Manning test of binary non-inferiority, we expected 100% correct balloon discernment by hands-on surgeons and prospectively set 80% correct discernment by robotic surgeons as our definition of non-inferiority. A total of 76 board-certified surgeons made up our study group. There were 57 'hands-on surgeons' in Group A and 19 robotic surgeons in Group B. The mean number of years in practice, mean age, and proportion of females to males between&#xa0;Group A and Group B were similar (p values 0.17, 0.16, and 0.69, respectively). As expected, 100% of Group A discerned all four balloons correctly.&#xa0;Of the 19 robotic surgeons, one made two discernment errors (i.e., mixed up water and petroleum jelly-filled balloons). Therefore, the actual risk difference between groups was 2.6% which met our definition of non-inferiority (p&#x2009;=&#x2009;&#x2009;<&#x2009;0.0001). Object discernment via "visual haptics" provided by the robotic surgery system was non-inferior to actual haptic discernment by 'hands-on surgeons.'

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Diagnosis and classification of ovarian epithelial neoplasms in guinea pigs (Cavia porcellus) are challenging due to inconsistent terminology and few available diagnostic criteria. This study evaluated 23 ovarian epithelial neoplasms in 15 guinea pigs with the objectives of (1) differentiating ovarian surface epithelial (OSE) neoplasms from rete ovarii neoplasms using immunohistochemistry, (2) describing salient histologic features, and (3) classifying neoplasms according to canine, human, and rodent classification schemes. PAX-8 immunohistochemistry separated immunoreactive rete neoplasms from nonreactive OSE neoplasms. OSE neoplasms (n = 12) were well-differentiated and arose directly from the ovarian surface, rather than the primarily cortical location of OSE neoplasms in other species. Focal OSE neoplasms with papillary projections on a fibrous core or tubules within a fibrous stroma were classified as surface papilloma and surface adenoma, respectively. Generalized OSE neoplasms with tubules, papillae, and fibrous stroma were classified as surface borderline tumors. Neoplasms with invasion, 2-4 mitotic figures per 2.37 mm2, and/or peritoneal implantation were classified as surface carcinoma. The only carcinoma with follow-up had resolution of clinical signs and no radiologic evidence of recurrence 6 months after ovariohysterectomy. Rete neoplasms (n = 11) included rete cystadenomas and rete adenomas, and consisted of epithelial cells arranged in papillae and tubules within a rete tubule, with or without cysts, respectively. Further investigation is needed to correlate diagnoses with neoplasms' biologic behavior. We propose using "surface" and "rete" in the diagnosis to denote location, rather than "papillary," "cystic," or "serous," which are variably used in other ovarian neoplasia classification schemes, to standardize terminology.

Selecting eligible allogeneic haematopoietic stem cell transplantation (allo-HSCT) candidates with low-risk and intermediate-risk myelodysplastic syndrome (MDS) remains controversial. The International Working Group (IWG) for MDS prognosis identified a Revised International Prognostic Scoring System (IPSS-R) score >3.5 for benefits from early transplantation; the MDS-RIGHT group uses a broader set of poor risk features. We analysed 1145 lower risk MDS (lower risk and intermediate-risk IPSS-R) patients aged <75&#x2009;years, using real-world European Myelodysplastic Syndromes registry data and identifying those meeting IWG or MDS-RIGHT criteria for allo-HSCT at baseline and 6-month follow-up. Fit patients were characterised by Karnofsky score &#x2265;70 and Haematopoietic Cell Transplantation-specific Comorbidity Index <3. We evaluated clinical outcomes of transplant candidates, including survival, disease progression risk, new comorbidity risk and performance status decline. The IWG criterion, and not MDS-RIGHT criteria, identified patients with lower risk and intermediate-risk MDS with poorer baseline survival. Fit lower risk patients showed 2-year cumulative risks of incident comorbidity and performance status deterioration of 20% and 5% respectively. In summary, IWG and MDS-RIGHT features identify patients with lower or intermediate-risk MDS as candidates for early transplantation. Lower risk patients fit for transplantation have a cumulative incidence of adverse outcomes possibly jeopardising transplantation eligibility and should be carefully selected when planning delayed transplantation strategies.

Objectives: To study the predictive and prognostic values of serum erythropoietin levels (sEPO) measured at diagnosis in lower-risk myelodysplastic syndromes. Methods: We analyzed clinical associations and prognosis with sEPO in 672/1610 patients with at least one year of follow-up data in the prospective EUMDS study. Results: sEPO levels increase with WHO subtypes associated with erythroid hypoplasia and poorer risk IPSS-R scores. sEPO is an independent predictor of transfusion free survival and levels <&#xa0;200 IU/L predict response to ESA. sEPO is not an independent predictor of overall survival. Conclusions: sEPO predicts transfusion free survival and response to ESA. Trial Registration: The EUMDS Registry (ClinicalTrials.gov: Identifier NCT00600860).

The immunosuppressive tumor microenvironment reduces immune response effectiveness in stromal-rich tumors, including consensus molecular subtype 4 colorectal cancer (CRC). Mesenchymal stromal cells (MSCs), precursors to cancer-associated fibroblasts (CAFs), promote cancer progression by suppressing anti-tumor immune responses. Hypersialylation of glycans on tumors engages Siglec receptors on immune cells, driving immune dysfunction, but its role in stromal-mediated suppression of innate immunity remains unclear. Sialylation, Sialic acids and Siglec ligands were measured on CRC tissue, primary human normal-associated fibroblasts (NAFs), CAFs, and tumor-conditioned MSCs (MSCTCS) using transcriptional profiles, immunohistochemistry and flow cytometry, respectively. The effect of stromal cell sialylation on macrophages and NK cells was assessed in ex vivo human primary stromal and immune cell co-cultures, and expression of Siglec-10 and immune cell phenotype markers and function was measured by flow cytometry and real-time imaging. Using an immunocompetent Balb/c CT26 mouse model, we induced tumors with/without conditioned stromal cells, with/without pretreatment of stromal cells with sialyltransferase inhibitor (3FAX) or sialidase (E610). We assessed the effect of stromal cell sialylation on macrophages and NK cells in the tumor and secondary lymphoid tissues by flow cytometry. Stromal cells, including CAFs, in CRC tumors are highly sialylated compared with epithelial cancer cells and are associated with high expression of the sialyltransferase ST6GALNAC6. Genetic knockdown of ST6GALNAC6 reduced the expression of stromal cell Siglec-10 ligands in MSCs. CAFs and MSCTCS induced Siglec-10 on macrophages and NK cells and impaired macrophage phagocytosis and NK cell cytotoxicity. Sialidase treatment reduced Siglec-10 expression, restoring macrophage and NK cell antitumor functions. In vivo and ex vivo, desialylation of stromal cells increased macrophage activation (CD11b+CD80+) and reduced immunosuppressive marker expression (CD206, PD-L1, Siglec-G) in lymphoid tissues, indicating sustained systemic anti-tumor immunity. Intratumoral NK cells exhibited high Siglec-G expression and impaired cytotoxicity, and granzyme B expression significantly increased with sialidase treatment of stromal cells. In an inflammatory tumor model, inflammatory tumor-conditioned MSCs (MSCiTCS) promoted metastasis and Siglec-G induction on NK cells and macrophages, both reversed by sialyltransferase inhibition, underscoring the effects of stromal modulation of innate immune cell function in inflammatory tumors. Stromal cell sialylation modulates innate immune suppression in CRC via the sialic acid/Siglec axis. Targeting stromal sialylation restores NK cytotoxicity and macrophage activation, offering novel insights that may shape therapeutic strategies for reversing immunosuppression in stromal-rich tumors.

Since the initial clearance of the da Vinci Surgical System, there have been multiple design evolutions. The da Vinci Surgical System Model IS5000 (da Vinci 5) is a modification to the predicate da Vinci Xi Surgical System with the same core features and significant enhancements to system electronics, Surgeon Surgical Console, integrated electrosurgical generator and carbon dioxide insufflator, and Force Feedback surgical instruments. To confirm the safety, effectiveness, and usability of the da Vinci 5 in performing robotic-assisted surgical procedures. This study is a nonrandomized, prospective clinical trial. Subjects scheduled to undergo robotically assisted surgical procedures in one of four surgical specialties were enrolled in this IRB approved Investigational Device Exemption (IDE) study from December 2022 through May 2023. The primary effectiveness endpoint was the ability to complete the procedure without conversion to open. The primary safety endpoint was the incidence of adverse events through 30 days. Usability was assessed with observational data collected by Human Factors assessment during actual use across various surgeon experiences. Data were collected from 53 subjects across four United States clinical sites who underwent one of eight procedures using the da Vinci 5 robotic system. There were no intraoperative conversions to open, and no device-related adverse events or unanticipated adverse device effects reported through 30 days. The da Vinci 5 demonstrated excellent usability by Human Factors assessment. The study confirms that the da Vinci 5 surgical system is safe, effective, and usable, and does not pose new risks. The Human Factors data further confirmed the safety, effectiveness, and ease of use of the system. Trial Registration: This study is registered on Clinicaltrials.gov. Trial ID is NCT05682742.

Surgicel (oxidised regenerated cellulose) is a commonly used haemostatic agent in various surgical procedures. While it is generally safe and bio-absorbable, it may cause foreign body reactions that mimic malignancy on imaging. This case report presents a woman in her late 70s who underwent laparoscopic right hemicolectomy for a hepatic flexure mucinous carcinoma. During follow-up, imaging revealed a soft tissue nodule in the mesentery highly suspicious for a local metastatic deposit/lymph node recurrence. Subsequent positron emission tomography scan showed no avidity in the area and ensuing biopsy reported presence of foreign body reaction. Thus, this reaction was secondary to the presence of Surgicel placed at the time of initial procedure. This case emphasises the diagnostic challenges posed by foreign body granulomas and highlights the importance of integrating clinical, radiological and histopathological findings to avoid unnecessary interventions.

The human microbiome plays a crucial role in metabolism and thereby influences health and disease. Constraint-based reconstruction and analysis (COBRA) has proven an attractive framework to generate mechanism-derived hypotheses along the nutrition-host-microbiome-disease axis within the computational systems biology community. Unlike for human, no large-scale visualisation resource for microbiome metabolism has been available to date. To address this gap, we created the MicroMap, a manually curated microbiome metabolic network visualisation, which captures the metabolic content of over a quarter million microbial genome-scale metabolic reconstructions. The MicroMap contains 5,064 unique reactions and 3,499 unique metabolites, including for 98 drugs. The MicroMap allows users to intuitively explore microbiome metabolism, inspect microbial metabolic capabilities, and visualise computational modelling results. Further, the MicroMap shall serve as an educational tool to make microbiome metabolism accessible to broader audiences beyond computational modellers. For example, we utilised the MicroMap to generate a comprehensive collection of 257,429 visualisations, corresponding to the entire scope of our current microbiome reconstruction resources, to enable users to visually compare and contrast the metabolic capabilities for diaerent microbes. The MicroMap seamlessly integrates with the Virtual Metabolic Human (VMH, www.vmh.life) and the COBRA Toolbox (opencobra.github.io), and is freely accessible at the MicroMap dataverse (https://dataverse.harvard.edu/dataverse/micromap), in addition to all the generated reconstruction visualisations.

Exploring how patients with acute and/or chronic illnesses experience symptoms. Using a phenomenological approach, interviews were conducted with patients to gain insights into their lived experiences and the meanings they attribute to symptoms. Phenomenological concepts of lifeworld, body and embodiment, intentionality, and existential anxiety provide lenses for examining the realities of patients' experiences. Three central themes emerged from the Ricoeur inspired analysis: Perception of an altered body presence, which highlights how illness transforms the perception of the body from a "silent" part of the self to an intrusive presence; Symptoms as a threat to existence, illuminating how symptoms confront patients with vulnerability, mortality, and existential uncertainty; and Loss and reclaiming of control, describing the ongoing struggle patients face between feelings of helplessness and efforts to regain autonomy in daily life.Symptoms are not merely indicators of illness but are intertwined with patients' identities and their sense of meaning in life. Insights emphasize the importance of addressing both the biological and existential dimensions of symptoms. Face-to-face clinical encounters offer a shared opportunity to create reflective spacesValidating coping strategies and supporting patients in reclaiming control, clinicians can nurture resilience, dignity, and a comprehensive approach to symptom (self)management.

We analyzed 217 patients with KMT2A-rearranged acute myeloid leukemia (AML) in 2 large sequential randomized trials. Those randomized to FLAG-Ida (fludarabine, cytarabine, granulocyte colony-stimulating factor, idarubucin) had markedly lower rates of relapse than other chemotherapy regimens. Molecular measurable residual disease assessment after cycle 2 was strongly prognostic for relapse and death. The trials were registered at the ISRCTN Registry as AML17 ISRCTN55675535 and AML19 ISRCTN78449203.

We report the case of a 95-year-old female cadaver with a documented history of Alzheimer's disease (AD) and an anteroinferior kinking of the right internal carotid artery (ICA). On dissection, the right ICA bifurcated at the superior one-third of C3 and demonstrated a marked kink with an inferior deviation of 45&#xb0; followed by superior redirection of 60&#xb0;, consistent with morphologic criteria for kinking. A digital caliper was used to obtain vessel measurements. The right ICA lumen measured 4.2 mm in diameter with a focal wall thickness of 2.5 mm, exceeding the Mannheim consensus plaque threshold of 1.5 mm and consistent with advanced atherosclerosis. No histologic sections were available to confirm carotid plaque composition, and the diagnosis of AD was based on past medical history without neuropathologic staging. Nevertheless, the coexistence of severe ICA kinking and extensive plaque formation raises the possibility that chronic vascular insufficiency contributed to the decedent's cognitive decline. This interpretation remains speculative, particularly in the context of advanced age and likely coexisting vascular risk factors. This case underscores the importance of recognizing congenital and acquired ICA anomalies during morphologic and clinical evaluation. Quantitative assessment of ICA variation may help refine diagnostic considerations in dementia and support further investigation into the vascular contributions to neurodegeneration.

Ibrutinib, a Bruton tyrosine kinase inhibitor, prolongs progression-free survival when added to immunochemotherapy as first line treatment. The ENRICH trial compared the chemotherapy-free combination of ibrutinib and the anti-CD20 antibody rituximab (ibrutinib-rituximab) with standard immunochemotherapy (R-CHOP [rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisolone] or bendamustine-rituximab) in patients 60 years and older with untreated mantle-cell lymphoma. This randomised, open-label, phase 2/3 superiority trial was performed at 66 sites in the UK, Sweden, Norway, Finland, and Denmark. Patients 60 years and older with untreated mantle-cell lymphoma (Ann-Arbor stage II-IV disease, an Eastern Cooperative Oncology Group performance-status score of 0-2) were randomly assigned to receive either rituximab plus immunochemotherapy or ibrutinib-rituximab in a 1:1 ratio, stratified by investigator choice of immunochemotherapy. Patients randomly allocated to the ibrutinib-rituximab (intervention) group received 560 mg oral ibrutinib daily in combination with six to eight cycles of 375 mg/m2 intravenous rituximab on day 1 of each cycle in the matched schedule of the pre-randomisation choice of immunochemotherapy (every 21 days for R-CHOP or every 28 days for rituximab-bendamustine). R-CHOP comprised 750 mg/m2 of cyclophosphamide, 50 mg/m2 of doxorubicin, and 1&#xb7;4 mg/m2 vincristine on day 1 of each 21-day cycle, with 100 mg prednisolone on days 1-5 of each cycle. Rituximab-bendamustine comprised 90 mg/m2 of bendamustine on days 1 and 2 of each cycle, in combination with 375 mg/m2 rituximab on day 1 of each cycle. All responding patients in both groups at the end of induction received maintenance rituximab administered every 8 weeks for 2 years, and patients allocated to the intervention group continued ibrutinib until disease progression or unacceptable toxicity. The primary outcome was investigator-assessed progression-free survival, stratified by immunochemotherapy choice and analysed in the intention-to-treat population. The trial was registered with EudraCT (2015-000832-13) and is closed for recruitment. Between Feb 15, 2016, and June 30, 2021, 397 patients were randomly allocated to immunochemotherapy (control) or ibrutinib-rituximab (intervention). Of the 397, 107 (27%) were pre-allocated to the immunochemotherapy choice of R-CHOP and 290 (73%) were pre-allocated to rituximab-bendamustine. In total, 198 were allocated to the control group (53 to R-CHOP and 145 to bendamustine-rituximab) and 199 were allocated to intervention. The median age was 74 years (IQR 70-77) for the intervention group and 74 years (70-78) in the control group. 296 patients (75%) were male and 101 patients (25%) were female; ethnicity data were not collected. At a median follow-up of 47&#xb7;9 months, the median progression-free survival of ibrutinib-rituximab was superior to immunochemotherapy, with an adjusted hazard ratio (HR) of 0&#xb7;69 (95% CI 0&#xb7;52-0&#xb7;90); p=0&#xb7;0034. For those with pre-randomisation choice R-CHOP, the HR was 0&#xb7;37 (0&#xb7;22-0&#xb7;62), and with bendamustine-rituximab, the HR was 0&#xb7;91 (0&#xb7;66-1&#xb7;25). Across induction and maintenance, 67% of patients assigned to ibrutinib-rituximab and 70% of patients receiving immunotherapy reported grade 3 or above adverse events. To our knowledge, this is the first randomised trial in untreated mantle-cell lymphoma to demonstrate significant improvement in progression-free survival for ibrutinib-rituximab compared to immunochemotherapy. This study suggests that ibrutinib-rituximab should be considered a new standard of care option for first-line treatment of older patients with mantle-cell lymphoma. Cancer Research UK (C7627/A17938) and Johnson and Johnson Pharmaceuticals.

The human microbiome critically influences metabolism and thereby our health. Constraint-based reconstruction and analysis (COBRA) is a proven framework for generating mechanism-derived hypotheses along the nutrition-host-microbiome-disease axis. However, no large-scale microbiome metabolism visualisation has been available. Therefore, we created the MicroMap, a manually curated network visualisation, which captures the metabolism of over a quarter million microbial genome-scale metabolic reconstructions. The MicroMap contains 5064 unique reactions and 3499 unique metabolites, including for 98 drugs. Users can intuitively explore microbiome metabolism, inspect metabolic capabilities, and visualise computational modelling results. Further, the MicroMap may serve as an educational tool to help diversify the computational modelling community. We generated 257,429 visualisations, covering all our current microbiome reconstructions, to visually compare metabolic capabilities between microbes. The MicroMap integrates with the Virtual Metabolic Human (VMH, www.vmh.life ), the COBRA Toolbox (https://opencobra.github.io ), and is freely accessible at the MicroMap dataverse ( https://dataverse.harvard.edu/dataverse/micromap ), along with all the generated reconstruction visualisations.

Anthracycline induced cardiomyopathy (AIC) is an important complication of cancer management. Recent findings showed that with early identification and intervention, AIC may be fully or partially reversible. European society of cardiology (ESC) guidelines recommend a risk-stratified monitoring approach, including transthoracic echocardiogram (TTE) for all patients within 12 months post-treatment. Investigate the impact of a survivorship clinic on TTE follow up for AIC. Over a 5 year span, 235 patients with haematological malignancies received anthracycline chemotherapy&#x2009;&#x2265;&#x2009;250mg/m2. The electronic medical records of these patients were reviewed. TTE outcomes were compared between survivorship and non-survivorship patients. Survivorship patients received TTE in 88.6% of cases, whereas non-survivorship patients received TTE in 30.9% of cases. In survivorship patients, TTE was indicated for asymptomatic screening in 92.3% of cases. In non-survivorship patients the majority of TTE were for symptom investigation (78.0%). Chi-squared analysis found these results to be statistically significant (p value&#x2009;<&#x2009;0.05). Survivorship patients are nearly three times more likely to receive TTE monitoring for AIC. However, due to delayed clinic referral/attendance, only 36.4% received TTE within 1 year of treatment completion, in line with ESC guidelines. Survivorship clinics improve TTE monitoring for AIC, allowing early identification and potential intervention. However, reliance on this model alone may risk inadequate surveillance for patients who do not attend and delays in referral/attendance may impact monitoring timeliness.

Infections are an important cause of morbidity and mortality in patients with lower-risk myelodysplastic syndromes (LR-MDS). Studies regarding risk factors for infections are, however, limited in this population. This study aimed to investigate the prevalence and risk factors for infections and infection-related death in patients with LR-MDS. The study included 2,552 patients from the European MDS (EUMDS) Registry, which prospectively collects observational data on newly diagnosed MDS patients from 17 countries. The prevalence of infections and infection-related death was determined. Risk factors for infections and infection-related death occurring within 1 year from diagnosis were analyzed in separate multivariable logistic regression models. A third model that only included LR-MDS patients who experienced an infectious episode within the first year after diagnosis was used to analyze risk factors associated with infection-related death in patients with an infectious episode. The prevalence of infections was 7.6%, and 24.6% of all deaths were due to infections. In multivariable analysis, an independent association with increased risk for infections was found for hemoglobin level <8 g/dL, platelet count <50x109/L, absolute neutrophil count <0.8x109/L, intermediate/poor/very poor cytogenetics, and having received red blood cell transfusions at baseline. An independent association with increased risk of infection-related death was found for older age at diagnosis, hemoglobin level <8 g/dL, and platelet count <50x109/L. Patients with an increased risk of infections could benefit from close monitoring, especially in the first months after diagnosis. Future research should focus on the causality and severity of infections and risk factors over time, to provide more guidance for monitoring.

BackgroundThe COVID-19 pandemic has significantly impacted how healthcare practitioners operate and provide care. Dentists are at an increasing risk of contracting the disease; working in mouths and constantly exposed to patient respiratory droplets and aerosols.ObjectiveWe explored the experiences of Nova Scotian dentists including motivation to work and perceived organizational support during a global public health crisis.MethodsThis was a mixed-methods study utilizing a sequential exploratory design. Phase 1 involved qualitative interviews with eight Nova Scotian dentists regarding their pandemic experiences. In Phase 2, a cross-sectional survey informed by Phase 1 focused on motivation to work and perceived organizational support. Descriptive statistics summarized the study sample, while Chi-square and t-tests explored associations and differences between subgroups.ResultsPhase 1 revealed logistical and physical challenges, including difficulty obtaining and working in personal protective equipment. Barriers to motivation included financial stresses and concern about patients without care. A key recommendation was against complete practice shut down in future pandemics. Clear return to work plans provided by the Nova Scotia Dental Association (NSDA) were identified as important support. Phase 2 revealed a high level of perceived organizational and regulatory body support among respondents (n&#x2009;=&#x2009;19). Men exhibited slightly higher intrinsic motivation compared to women. Changes in patient needs included clenching and grinding, (the "Covid clench"), as top observations by dentists.ConclusionsThis study's insights into dentists' occupational challenges suggest that regulatory guidelines helped streamline return-to-work, and future improvements in crisis preparedness and business management would be beneficial.