Beta-lactam antibiotics (beta-lactams) are first-line treatments for most major infectious syndromes in acutely ill patients, with in vitro activity against common pathogens, demonstrated efficacy in trials, and a perceived low risk of adverse effects. The current dosing approach, informed by population-level data, tends to be simplistically reduced to a "one size fits all" dosing method which only accounts for body weight (i.e., in pediatrics) and end organ function to estimate drug clearance (e.g., estimated glomerular filtration rate); this approach results in substantial variability in observed serum concentrations in acutely ill patients, which can compromise real-world effectiveness and safety. Beta-lactam dose individualization, therefore, defined as a dosing regimen for one patient informed by measured concentrations from that patient, has been recommended in international clinical guidelines. Comprehensive guidance on best practices for beta-lactam dose individualization is lacking. To address this knowledge gap and develop guidance, a multidisciplinary panel of international experts was assembled from the disciplines of infectious diseases, critical care, pharmacometrics, and laboratory medicine, representing both adults and pediatrics. The panel systematically evaluated the literature, using the GRADE approach where feasible, to address broad thematic questions pertaining to whether beta-lactam dose individualization should be pursued, for what indications beta-lactam dose individualization is warranted, and the most critical considerations and best practices for implementation of beta-lactam individualization. The resultant consensus recommendations will equip healthcare professionals caring for acutely ill patients treated with beta-lactam therapy with the evidence and tools necessary to guide optimal use of beta-lactam dose individualization.
How to define high quality end-of-life (EOL) care for children with advanced heart disease (AHD) is unknown. We sought to develop expert-panel endorsed quality measures (QM) for EOL for pediatric AHD. The Modified Delphi panel methodology was used to assess potential QM. Proposed QMs were derived from EOL QM in pediatric oncology, previously conducted bereaved parent interviews, and advisory board discussions. Panelists were nominated by professional organizations, research collaboratives, and national experts. The panel included thirteen experts from pediatric cardiology, pediatric palliative care, nursing, psychology, and bereavement services. Panelist received a literature review of thirty-five proposed QM. The panelist scored the importance of each measure on a 9-point scale (higher = 9) prior to discussion of the measures during a 4-hr video call, where 2 additional measures were added. Panelists then re-scored the measures. QM with median scores ≥7 and with at least 9 experts scoring it as ≥4 were endorsed. Twenty-eight of 37 QM were endorsed. They fell into 4 categories: symptom management (e.g., children receiving the help they wanted for pain), communication and information provided (e.g., prognostic communication), hospital policies and guidelines (e.g., less restrictive EOL environment), and supportive care services (e.g., subspecialty palliative care involvement). Unendorsed measures included measures related to transporting the child to the morgue and location of death. These QM are an important step in improving and standardizing the quality of EOL care for children with AHD. Next steps include validating the measures with a cohort of bereaved parents.
Wild mushroom poisoning represents a significant global public health challenge, with China experiencing particularly high incidence rates. Despite continuous prevention campaigns by government and health authorities, existing educational videos demonstrate variable effectiveness and lack culturally adapted strategies for diverse audiences. Specifically, evidence on which narrative strategies engage young audiences across high-tradition and low-tradition cultural contexts remains limited. This qualitative study aimed to identify effective narrative characteristics in wild mushroom poisoning prevention videos and explore how cultural backgrounds influence university students' reception of prevention messages, thereby providing evidence-based recommendations for targeted educational content development. We conducted four focus group discussions at a university in Fujian Province, recruiting 33 university students through purposive sampling stratified by geographic origin and sex, including students from Yunnan Province (n=9) and other provinces (n=24). Six prevention videos representing different narrative approaches were presented for discussion. Data were analysed using Braun and Clarke's thematic analysis framework. Two coders independently double-coded a 30% subsample (Cohen's κ=0.81; 95% CI 0.77 to 0.85), and findings were verified through a two-stage member-checking process. Three major themes emerged from the analysis: (1) authenticity and consequence visualisation as persuasion mechanisms-participants emphasised the impact of real cases and mortality data; (2) cultural traditions as moderators of risk perception-8 of 9 Yunnan participants rejected complete-avoidance messaging and endorsed harm-reduction strategies, whereas all 24 non-Yunnan participants endorsed regulatory and avoidance approaches; (3) digital media expectations and content preferences-participants expressed preferences for short-form, interactive content adapted to social media platforms. Cultural background significantly influenced acceptance of prevention strategies, with Yunnan participants favouring risk reduction over complete avoidance approaches. Effective wild mushroom poisoning prevention videos must consider audiences' cultural contexts, media consumption patterns and cognitive characteristics. We recommend differentiated narrative strategies: emphasising scientific foraging methods and risk identification for regions with strong mushroom traditions while highlighting severe consequences for regions without such traditions. Video production should integrate authentic cases, innovative formats and platform-specific characteristics for optimal engagement.
The Society for Vascular Surgery Vascular Quality Initiative (SVS-VQI) Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Registry represents the largest and most comprehensive prospectively maintained non-claims-based dataset of endoluminal repairs in North America. As part of the SVS-VQI benchmarking initiative, we sought to define national reference standards for patient selection, perioperative outcomes, and process-of-care metrics. All EVAR procedures from 2011 to 2024 were included and stratified by indication as elective, symptomatic (intact, non-ruptured), or ruptured. The primary endpoint was in-hospital mortality; secondary endpoints included in-hospital complications, adherence to SVS guideline-endorsed elective diameter treatment thresholds (men ≥5.5 cm; women ≥5.0 cm), discharge prescription of guideline-directed medical therapy, and one-year follow-up compliance. Risk-adjusted observed-to-expected (O:E) mortality ratios were derived from mixed-effects logistic regression models incorporating patient- and procedure-level covariates. Temporal trends were analyzed using linear and logistic regression across four periods: 2011-13, 2014-17, 2018-21, and 2022-24. Among 90,370 EVARs performed across >400 centers, 76,350 (85%) were elective, 8,349 (9%) symptomatic-intact, and 5,671 (6%) ruptured. Mean patient age was 73.5±8.8 years, and 17,531 (19%) were women. Adoption of percutaneous femoral access increased markedly after 2014, exceeding 80% of all cases across the study period (overall rate 81.1% [95%CI, 80.8-81.4]) and reaching a contemporary benchmark of 89.4% (95%CI, 89.1-89.8) in 2022-24. In-hospital mortality was 0.5% (95%CI, 0.42-0.52) for elective, 2.2% (1.91-2.56) for symptomatic-intact, and 21.5% (20.4-22.6) for ruptured repairs. Over time, mortality declined from 0.6% in 2011-13 to 0.4% in 2022-24 (p=.02) for elective cases, from 2.3% to 1.8% (p=.14) for symptomatic-intact, and from 24.0% to 20.6% (p=.09) for ruptures. Composite in-hospital complication rates decreased significantly across all indications (p<.001). Among elective repairs, adherence to diameter-based guidelines improved modestly, with male non-compliance decreasing from 46% to 40% and female non-compliance declining from 23% to 21%. In 2024, 87% of patients were discharged on an antiplatelet agent, 83% on a statin, and 74% on both. By 2022, one-year clinical follow-up reached 79%, while imaging surveillance was reported in 51%. EVAR outcomes within the SVS-VQI demonstrate persistently low in-hospital mortality and improving perioperative morbidity over time. Despite these gains, opportunities remain to improve adherence to societally endorsed diameter treatment thresholds, optimal medical therapy, and post-EVAR imaging surveillance. These findings establish contemporary national benchmarks for EVAR performance and provide reference standards for center-level comparison and quality improvement within the SVS-VQI.
The rapid expansion of legalized sports betting and mobile gambling in the U.S. has transformed how gambling is accessed and experienced. Young adults are particularly vulnerable to these changes; however, limited research has examined how gambling behaviors are shifting across multiple modalities during periods of expanding gambling availability. We analyzed repeated cross-sectional data from the Rhode Island Young Adult Survey (RIYAS) collected in 2022 (n = 1,022) and 2024 (n = 1,008) among individuals aged 18-25 years. Outcomes included past-year participation in specific gambling behaviors, positive BBGS (Brief Biosocial Gambling Screen) screens, and overall gambling involvement measured as the number of gambling types endorsed. Multivariable logistic regression models estimated adjusted odds ratios for differences in individual gambling behaviors between survey waves, and Poisson/zero-inflated Poisson models estimated differences in gambling involvement. Gambling participation did not differ significantly between 2022 and 2024. However, among individuals reporting gambling, participation increased in several activities, including lottery tickets (AOR = 1.36, 95 % CI: 1.01-1.83), raffle gambling (AOR = 1.40, 95 % CI: 1.05-1.88), sports betting (AOR = 1.65, 95 % CI: 1.07-2.56), casino slot machines (AOR = 2.99, 95 % CI: 2.10-4.27), other slot machines (AOR = 2.30, 95 % CI: 1.23-4.33), and app-based gambling (AOR = 2.14, 95 % CI: 1.38-3.32). The number of gambling types endorsed increased (IRR = 1.28, 95 % CI: 1.16-1.41). Positive BBGS screens were more common in 2024 but not statistically significant after adjustment. Findings suggest while overall gambling participation remained stable, engagement across multiple and mobile-based gambling activities increased between survey waves, potentially signaling emerging risk. Increasing diversification and digitalization of gambling behaviors requires continued surveillance and public health strategies addressing emerging gambling environments.
Thoracic aortic aneurysm (TAA) presents significant medical and psychosocial challenges. Despite advances in medical care and outcomes, little is known about the psychosocial and behavioral supportive care needs and priorities of individuals living with TAA. Patients (N = 106) with a current or previous TAA completed a structured Needs Evaluation survey assessing perceived helpfulness, likelihood of attendance, and barriers across medical, psychological, behavioral, and exercise domains. Participants were categorized by treatment pathway (surgery vs. surveillance) and distress severity (high vs. low), using scores from the Depression Anxiety Stress Scales (DASS-21). Across groups, patients endorsed strong interest in physical activity education, sleep management, and stress/anxiety management programs (≥80%). Despite high perceived helpfulness, fewer patients indicated willingness to attend (e.g., 78% vs. 23% for depression programs). The most common barriers were distance (43%) and time (36%), while disinterest and health limitations were infrequent. Patients with elevated distress more frequently endorsed psychological and symptom-management services as helpful and were more likely to attend. Endorsement patterns were largely similar across surgical and surveillance groups. Patients with TAA express consistent interest in psychosocial and behavioral interventions, particularly those addressing stress, sleep, and activity. However, structural and motivational barriers limit participation. Embedding brief, accessible educational, psychosocial, and behavioral programs within routine TAA care may enhance patient engagement and quality of life.
Men experience poorer health outcomes than women and are less likely to engage with traditional healthcare services, highlighting the need for gender-responsive, community-based approaches. The Football Cooperative (FC) initiative in Ireland uses recreational football as a socially engaging setting to support men's health and wellbeing. Although football-based initiatives demonstrate strong acceptability and health benefits, translating locally successful models into sustainable systems capable of large-scale delivery remains challenging. This study aimed to identify multilevel determinants influencing implementation of the FC initiative and to develop a prioritised implementation strategy to support national scale-up. A two-part qualitative design was employed, comprising (1) multilevel data collection through semi-structured interviews, focus groups, and reflective logs with stakeholders across participant, provider, organisational, and community/system levels, and (2) strategy development and prioritisation through an adapted Delphi consensus process. Data were analysed using a framework-informed approach guided by the Consolidated Framework for Implementation Research (CFIR), and scalability was further examined using the Intervention Scalability Assessment Tool (ISAT). Findings indicate that implementation of the FC initiative is underpinned by relational facilitators supporting sustained engagement, including psychological safety, inclusive gameplay, and accessibility and operational practicality at participant level. However, while these support local delivery, they do not readily translate to scale. Critical determinants constraining scale-up were identified across ecological levels, including reliance on volunteer coordination and limited role clarity at provider level, informal administrative and digital systems and limited workforce capacity at organisational level, and the absence of formalised governance, cross-sector collaboration, and sustainable funding at system level. In response, seven implementation strategies were prioritised: maintaining psychological safety and accessibility (participant level); strengthening coordination systems and volunteer capacity and role support (provider level); developing monitoring and digital infrastructure and supporting governance transition and distributed leadership (organisational level); and establishing cross-sector collaboration and funding mechanisms to support scale (community/system level). This study provides a theory-informed, stakeholder-endorsed implementation strategy to support the transition of a community-based men's health initiative from local delivery to scalable systems. The findings contribute to implementation science by demonstrating how multilevel determinant analysis can be translated into prioritised strategies supporting scale-up of gender-responsive interventions.
To evaluate an online surgical skills course integrating structured video-based self-, peer-, and tutor feedback designed to enhance individualized feedback during early surgical training. Prospective observational study evaluating 4 course iterations following an iterative course development phase conducted between 2020 and 2023. Online surgical skills course delivered at the Department of General, Visceral, and Vascular Surgery, Universitätsklinikum Jena, Germany. Seventy-three undergraduate medical students participated in 4 course iterations between February 2024 and March 2025. Sixty-seven students who submitted more than 1 video recording met inclusion criteria and were included in the analysis. Submission compliance varied across tasks and appeared influenced by perceived clinical relevance and exercise complexity. Higher engagement was observed for authentic tissue-based exercises compared with synthetic training tasks. Students reported high satisfaction with the course structure and strongly endorsed structured video-based feedback. Recording and reviewing performances facilitated explicit error recognition, reflective practice, and peer-supported learning. Despite reliance on low-cost materials and student-owned devices, the online format enabled close visual supervision and individualized tutor feedback within small-group sessions. The educational value of this model lies not in digital delivery alone, but in the structured use of video analysis to support feedback-driven skill refinement. By integrating replay, annotation, and guided reflection, the approach enables precise and scalable feedback during early surgical skills training. This cost-effective model demonstrates that online instruction can maintain instructional depth while strengthening individualized feedback processes in undergraduate surgical education.
Mobile health (mHealth) applications can extend behavioral health care in integrated primary care (IPC), yet clinician adoption is inconsistent. This mixed-methods study examined IPC clinicians' attitudes toward mHealth apps, identified adopter profiles, and explored contextual factors shaping behavioral intention. We surveyed 69 clinicians using the technology acceptance model and the unified theory of acceptance and use of technology. Survey results analysis used k-means clustering to identify adopter profiles. Semistructured interviews with a purposive subsample (n = 10) explored perceived benefits, barriers, and implementation needs. We integrated quantitative and qualitative results using joint displays. Two clusters emerged: Enthusiasts (n = 25) and Skeptics (n = 44). Enthusiasts scored higher on behavioral intention and facilitating conditions. Interviews contextualized these differences: Enthusiasts emphasized clinical fit and workflow solutions (e.g., electronic health record integration and digital navigator roles), whereas Skeptics cited liability, relational concerns, and equity barriers (e.g., device access and digital literacy). Both groups endorsed apps as adjunctive rather than replacement tools. Mixed-methods integration highlighted actionable strategies: boundary-setting norms, curated app formularies, and equity-first implementation. Adoption of mHealth in IPC depends less on persuasion than on enabling technical, organizational, and ethical conditions that preserve relational care and promote equity. Findings identify Consolidated Framework for Implementation Research-aligned strategies that strengthen team coordination and family-centered equity in IPC. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
In Vietnam, limited empirical research on families in which parents have intellectual disabilities constrains understanding of their circumstances and effective support strategies. Meanwhile, professionals working with these families play a key role in informing policy, developing interventions and providing support. This study employed a survey based on a questionnaire developed by the authors and administered to 182 professionals, including researchers, intervention specialists, managers and teachers with experience working in special education. The main findings indicated that 54.4% of participants reported professional contact with such families and more than 80% endorsed the right of individuals with mild intellectual disabilities to marry. Reported forms of support primarily included counselling, parenting guidance and emotional or material assistance. The findings underscore the urgent need for in-depth research on parents with intellectual disabilities, their family circumstances and support needs to inform practical solutions and policy recommendations. This study explored professionals' experiences and perspectives on supporting families in which parents have intellectual disabilities in Vietnam, an area where research remains very limited. More than half of the professionals had worked with these families and most supported the right of individuals with mild intellectual disabilities to marry and have families. Professionals reported that the most common forms of support include psychological counselling, parenting guidance and emotional or practical assistance for families. The findings highlight the need for more research and better support services to help parents with intellectual disabilities raise their children successfully and to inform future policies and professional practice in Vietnam.
Cladribine tablets are an oral immune reconstitution therapy with demonstrated efficacy and durable disease control in relapsing-remitting multiple sclerosis (RRMS). While global evidence supports their use, region-specific guidance adapted to healthcare variability, access constraints, and real-world practice in North-West Africa (NWA) remains limited. To develop expert-based, region-specific consensus recommendations on the optimal use of cladribine tablets in RRMS in the NWA region. A modified Delphi methodology was conducted during a face-to-face advisory board meeting in May 2025 in Tunisia. Senior neurologists with expertise in multiple sclerosis from across NWA reviewed available evidence, discussed key clinical questions, and voted on consensus statements addressing treatment positioning, early use, switching strategies, long-term management, safety, and special populations. Consensus was predefined as agreement by ≥75% of voting experts. All consensus statements met the predefined threshold after discussion and refinement, achieving high to unanimous agreement. Experts endorsed cladribine tablets as a high-efficacy option for treatment-naïve patients with moderate-to-high disease activity and as a switch option following suboptimal response to platform therapies and in selected patients previously treated with high-efficacy therapies. Benefits include early initiation, durable disease control without continuous immunosuppression, and suitability for patients with limited access to hospital-based care. Expert consensus recommendations also addressed long-term management beyond Year 4, retreatment strategies, safety monitoring, pregnancy planning, and use in older patients, recognizing that some areas are supported mainly by emerging real-world evidence and expert clinical experience. This Delphi consensus provides practical, region-specific guidance to optimize the use of cladribine tablets in RRMS across NWA, aiming to harmonize treatment practices and improve long-term outcomes.
General-purpose large language model (LLM)-based systems are increasingly accessible to clinicians and are being explored for applications in clinical microbiology and infectious diseases (ID). However, rapid adoption has outpaced the development of specialty-specific guidance, raising concerns related to safety, reliability, accountability, and antimicrobial stewardship. The project aims to develop consensus-based statements, endorsed by Study Group for Artificial Intelligence and Digitalisation of the European Society of Clinical Microbiology and Infectious Diseases (ESGAID), that describe principles, opportunities, and limitations in the interactions of clinical microbiologists and ID specialists with general-purpose LLM-based systems. Secondary objectives are to quantify expert agreement and identify areas of uncertainty and disagreement. The project follows a structured expert consensus design using the RAND/UCLA Appropriateness Method. A multidisciplinary panel of 15 experts will be selected through ESGAID using predefined criteria to ensure balanced expertise across clinical microbiology, infectious diseases, ethics, legal aspects, and patient safety. Ten draft statements, each supported by a structured literature review, will be developed by project coordinators. Statements will be evaluated through iterative rounds of anonymous rating on a 1-9 scale, combined with moderated remote discussions. Median scores will classify statements as supported, uncertain, or unsupported. Consensus will be defined as ⩾70% agreement with <15% disagreement during final anonymous voting. This protocol provides a transparent and reproducible framework to generate interim, specialty-specific statements on principles, opportunities, and limitations in the interactions of clinical microbiologists and ID specialists with general-purpose LLM-based systems. By combining structured evidence review with expert judgment, the resulting statements aim to delineate guidance on principles for interacting with these systems, highlight the nature of both existing risks and excessive skepticism, and identify research priorities in a rapidly evolving technological and regulatory landscape. Interactions with AI systems in microbiology and infectious diseases: an expert consensus project. Artificial intelligence systems such as ChatGPT, Gemini, or Claude are increasingly accessed by clinical microbiologists and infectious diseases specialists to explore medical questions or summarize information. However, clear understanding and deep knowledge about key principles, opportunities, limitations, and safeguards in the interaction with these tools may still be uncommon. For example, these systems can sometimes produce convincing but incorrect answers or lead users to rely too heavily on automated outputs. This project brings together experts to develop agreed statements on the principles guiding how clinicians can interact with these systems responsibly.
Surgical resection for drug-resistant focal epilepsy relies on the precise presurgical localization of the epileptogenic zone (EZ). Although [1⁸F]FDG-PET has historically served as a diagnostic cornerstone, its clinical utility is often constrained by anatomy-metabolism decoupling. This non-specific glucose hypometabolism frequently extends beyond the true EZ due to the bystander effect, complicating surgical margin delineation in MRI-negative patients and those with focal cortical dysplasia (FCD). While [1⁸F]FDG-PET and ictal SPECT remain the guideline-endorsed cornerstones of routine clinical care, this review explores the emerging investigational transition toward advanced multimodal molecular-structural fusion strategies. We evaluate novel PET radiotracers designed to target proximal pathophysiological mechanisms of epileptogenesis, including synaptic density degradation (SV2A), microglial-mediated neuroinflammation (TSPO), neurotransmitter system imbalances (GABA_A, mGluR5), and dysregulated amino acid metabolism (AMT). Furthermore, we outline the integration of these mechanism-based molecular probes with high-resolution isotropic 3D MRI frameworks and artificial intelligence-driven coregistration pipelines. Clinical evidence across various epilepsy subtypes demonstrates that this multimodal approach enhances the detection of subtle histopathological lesions, refines surgical boundaries, and optimizes invasive stereoelectroencephalography (SEEG) trajectories. Ultimately, transitioning to molecular-structural coupling provides a robust framework to advance precision epilepsy surgery and improve postoperative outcomes.
Two new studies now make the most substantial case yet that the framework of the International System for Reporting Serous Fluid Cytopathology can be carried across the biologic boundary to include cerebrospinal fluid, and current work on the second edition of the system will address cerebrospinal fluid for the first time as a special category of body fluid-an expansion the international community has explicitly endorsed. The contributions of these authors will stand among the empirical foundations on which a coherent, cerebrospinal fluid-specific-and, ultimately, fluid-agnostic-reporting standard can be built.
This case report details the perioperative management of a 5-year-old girl with biliary atresia (BA) and Alagille syndrome (ALGS) undergoing liver transplantation. Our transplant center emphasizes preoperative optimization, targeted management of high-risk complications, and family-centered support throughout the care process. This report was prepared in strict accordance with the Case Report (CARE) Guidelines, an official clinical reporting guideline endorsed by the EQUATOR Network, to ensure standardized and transparent case reporting. This case report details the perioperative management of a 5-year-old girl with BA and ALGS undergoing liver transplantation. The clinical strategy highlights preoperative optimization, targeted intervention for high-risk complications, and family-centered care throughout the treatment course. The patient underwent orthotopic liver transplantation on the second hospital day. Postoperative complications included chylous ascites and biliary anastomotic stricture. The total length of hospital stay was 78 days. During 3 months of remote follow-up, her graft function remained stable. The percutaneous transhepatic cholangiography (PTCD) catheter was temporarily clamped at 1 month postoperatively, and anxiety in the patient's caregiver was significantly alleviated. This case report presents a novel integrated strategy encompassing multidisciplinary team evaluation, stepwise nutritional optimization, and remote digital follow-up.This approach effectively supported postoperative recovery in this case study, consistently maintained the function of the allograft, and facilitated a successful transition to home care. Nursing care for complex pediatric liver transplantation should incorporate a multidisciplinary team (MDT)-led, stepwise nutritional protocol for the management of lymphatic complications, standardized symptom assessment instruments, and a patient empowerment model integrated with digital telemedicine to support safe and effective transition to home care.
Maintaining the availability of blood components remains a major challenge for transfusion services and healthcare institutions. Blood shortages can disrupt clinical care, complicate prioritization decisions, and place substantial operational pressure on transfusion services. Limited attention has been given to the perspectives of transfusion service personnel directly involved in shortage management, particularly within tertiary healthcare settings in Riyadh, Saudi Arabia. A cross-sectional questionnaire-based study was conducted using a structured survey designed to assess respondent and institutional characteristics, perception of blood component shortage, practices implemented during shortage, barriers affecting shortage management, and perceived strategies to improve blood component availability. A total of 94 responses were collected from transfusion service personnel working in healthcare institutions in Riyadh. Of these, 64 respondents who were directly involved in shortage management were included in the principal analytical sample. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, United States). Descriptive statistics were used to summarize demographic, institutional, and item-level response patterns. Composite domain scores were calculated, and reliability was assessed using Cronbach's alpha. Subgroup analyses were conducted according to age, years of experience, academic qualification, and role in shortage management. Blood component shortage was perceived as a meaningful and recurrent operational challenge. The mean composite scores were 3.68±0.90 for shortage perception, 4.03±0.52 for practices during shortage, 3.69±1.06 for barriers and constraints, and 4.44±0.73 for improvement strategies. The most strongly endorsed shortage-related experiences were the need for regular coordination with clinical departments and hospital leadership and the prioritization of patients or procedures during shortage periods. The most frequently reported practices included intensification of donor recruitment, close monitoring of blood inventory, and recall of repeat donors. Major perceived barriers included limited donor availability, high workload, insufficient staffing, high transfusion demand, and limited decision-making authority. Respondents showed the strongest agreement regarding improvement strategies, particularly increasing public awareness of blood donation, implementation of patient blood management programs, and establishment of a national blood service system. Postgraduate-qualified respondents demonstrated significantly higher shortage perception and stronger recognition of selected barriers. Blood component shortage in tertiary healthcare settings in Riyadh is perceived not merely as a donor supply issue but as a broader system-level challenge shaped by operational demands, workforce capacity, governance limitations, and institutional coordination requirements. These findings support the need for integrated interventions combining donor awareness, patient blood management, workforce strengthening, and system-level coordination to improve the resilience and sustainability of blood component availability.
South Africa has one of the highest rates of gender-based violence (GBV) globally, disproportionately affecting women, girls, and the elderly. Despite numerous intervention efforts, GBV persists as a major social and public health concern. Prevention campaigns are central to awareness-raising, behavioural change, survivor support, and justice advocacy. Lately, attention is being given to the inclusion of men in GBV prevention efforts. To explored university students' perceptions of GBV and the inclusion of men in GBV prevention campaigns. To determine the perceptions of university students regarding the inclusion of men in GBV prevention campaigns, to determine their understanding of GBV and the importance of GBV prevention campaigns and the role of multi-gender approach (MGA) in the GBV prevention campaigns. The study used a qualitative exploratory design guided by Social Learning Theory and Feminist Theory. Twelve third-year Psychology and Criminology students (7 females, 5 males), aged 22-29 years, were selected through purposive sampling. Data were collected using semi-structured interviews and analysed using thematic analysis. Participants demonstrated a strong understanding of GBV and prevention campaigns, which shaped their perceptions of intervention strategies. Furthermore, participants supported the inclusion of men in GBV prevention campaigns and endorsed a multi-gender approach (MGA) as important in strengthening GBV prevention. However, inclusion was viewed as conditional, requiring careful structuring to ensure safety, trust, and the protection of women's voices. Government-led campaigns were largely perceived as ineffective, inconsistent, and inaccessible, while civil society and community-based organisations were viewed as more responsive and impactful. Participants highlighted weak enforcement and limited accountability as key factors sustaining GBV. Students recognised the importance of GBV prevention campaigns but questioned their effectiveness due to implementation gaps, limited reach, and institutional weaknesses. The inclusion of men was seen as critical for transfiguring harmful gender norms and strengthening prevention efforts. The results emphasise the need for inclusive, multi-sectoral, and community-driven approaches that balance male engagement with survivor-centred safety and empowerment.
To assess the work-related quality of life (WRQoL) of anesthesiologists and various health issues that may have an impact on it. We conducted a cross-sectional, anonymous electronic survey of active American Society of Anesthesiologists (ASA) members to evaluate sex-specific health conditions and WRQoL. The WRQoL included validated domains of job satisfaction, stress at work, home-work interface, control at work, and working conditions, along with demographic and professional characteristics. Descriptive statistics and multivariable analyses were used to identify factors independently associated with lower WRQoL scores. The survey was distributed to approximately 37,000 ASA members from September 2024 to December 2024, yielding 2292 responses. About 45.9% of respondents were women, slightly overrepresenting female anesthesiologists compared with the ASA population. Occupational and psychosocial exposures were common: 78.8% reported lifetime exposure to occupational hazards, 49.7% to harassment, and 74.6% to burnout, all of which significantly correlated with lower WRQoL (P<.001). Multivariable analysis identified occupational hazards, harassment, and burnout as independent predictors of lower WRQoL. Female anesthesiologists had higher odds of burnout and occupational hazard exposure impacting their quality of life, whereas older physicians reported lower burnout risk. Commonly endorsed workplace improvements included consistent schedules, reduced call burden, and flexible leave policies. This national survey represents the first large-scale assessment of WRQoL among US anesthesiologists. Findings highlight the multidimensional nature of professional well-being and underscore the importance of organizational culture, workload management, and targeted strategies to support high-risk subgroups. Addressing these factors may improve workforce sustainability.
The 28-item Coping Orientation to Problems Experienced Inventory (Brief COPE) is widely used to assess coping strategies, but reported factor structures range from 2 to 15 factors, raising concerns about structural stability. Only one study has applied Rasch analysis to examine unidimensionality and overall model fit of a four-factor French Brief COPE among cancer patients and caregivers. However, item fit and response categories were not evaluated. This study examined the psychometric properties of the Brief COPE among parents of preschoolers from low-income backgrounds. Specifically, we evaluated reliability using internal consistency and composite reliability; construct validity through structural validity, convergent validity, discriminant validity, and hypothesis testing with stress, anxiety, depression, and hair cortisol; and item- and response-option performance using item response theory analysis. We analyzed baseline data from three clinical trials conducted between 2021 and 2024. Participants were parents of preschoolers enrolled in Head Start programs in the Midwestern United States. Participants completed online surveys assessing coping, stress, anxiety, depression, and demographics, and provided hair samples for cortisol analysis. The sample included 348 parents (Mage =30.89 years), randomly divided for exploratory and confirmatory factor analysis. Exploratory factor analysis suggested a four-factor structure after removing four items due to high inter-item correlations or cross-loadings: adaptive coping, support coping, avoidant coping, and religious coping. Confirmatory factor analysis demonstrated good fit: CFI=0.92, TLI=0.91, RMSEA=0.06 (90% CI: 0.05-0.07), and SRMR=0.08. Convergent validity was adequate for support coping (average variance extracted=0.64) and religious coping (0.71), borderline for adaptive coping (0.49), and low for avoidant coping (0.38). Discriminant validity was supported by inter-construct correlations (r=0.10-0.59) and square roots of the average variance extracted values exceeding corresponding inter-construct correlations. Construct validity was partially supported by significant associations between coping dimensions and stress, anxiety, and depression, but not hair cortisol. Internal consistency (α=0.81-0.88) and composite reliability (0.83-0.90) were strong. Most items showed adequate difficulty and discrimination, while several appeared redundant. Information curves were unimodal. Response option "3″ was under-endorsed across multiple items, and several items had sparsely used options, indicating a need to collapse or revise response options. Findings support the reliability and validity of a four-factor, 24-item Brief COPE in parents of preschoolers with low-income. However, variability in item- and response-option performance indicates opportunities for targeted item consolidation and response-option refinement. Future efforts should implement these revisions and cross-validate the refined scale.
Acne and hirsutism are among the most distressing features of polycystic ovary syndrome (PCOS), yet current guidelines largely emphasize metabolic and reproductive aspects, offering limited guidance for dermatologic management. Myo-inositol (MI), an insulin-sensitizing agent with endocrine benefits, has emerged as a promising nonhormonal option; however, its role in managing cutaneous symptoms remains unclear. The purpose of this study was to develop expert consensus on the use of MI alone and in combination with folic acid and vitamin D₃ for PCOS-related dermatologic manifestations. Eleven statements were generated through a rigorous literature review and subsequently evaluated by 133 experts through a two-round online Delphi process. Consensus was defined as ≥70% agreement; statements with 50% to <70% agreement were revised and reassessed. Consensus endorsed MI as an effective and well-tolerated intervention for acne and hirsutism. Continuous MI supplementation at 4 g/day for ≥6 months was recommended. MI + folic acid + vitamin D₃ and MI + D-chiro-inositol were favored for metabolic dysfunction and hyperandrogenism. MI-based therapy, particularly early initiation and strategic combinations, should be integrated into multimodal management of PCOS-related cutaneous manifestations.