Machine-learning-based ab initio gene finders have long been central to eukaryotic genome annotation, largely because gene expression data were historically expensive and limited. Modern sequencing technologies have transformed this landscape, making transcript evidence abundant and reliable, while proteins from many well-annotated genomes provide additional rich sources of evidence. Here we address the underutilization of these data by existing annotation tools by developing EviAnn (Evidence-based Annotator), an evidence-based eukaryotic gene annotation system. EviAnn takes a strongly data-driven approach, building exon-intron structures of protein coding and noncoding genes directly from transcript alignments or protein homology rather than relying primarily on ab initio predictions. Using identical input data, EviAnn consistently outperforms leading packages such as BRAKER3, MAKER2 and FINDER, while utilizing considerably less computer time. A mammalian genome can be annotated in under an hour on a single multicore server. EviAnn is open-source software available via GitHub at https://github.com/alekseyzimin/EviAnn_release and through Bioconda as 'eviann'.
Blood cultures (BC) are fundamental for diagnosing bloodstream infections (BSI), yet pre-analytical errors and inappropriate use undermine their value. Within the EU-JAMRAI 2 framework, we conducted a systematic review to formulate evidence-based diagnostic stewardship (DS) recommendations for optimizing BC practices across the entire testing pathway, aiming to strengthen antimicrobial stewardship (AMS) programs. Following a scoping review identifying existing documents through 2023, we systematically searched Medline, the Cochrane Library, and grey literature for 2023-2025. From 2,440 records, we included 14 clinical practice guidelines and 3 systematic reviews. Methodological quality was assessed using AGREE-II and AMSTAR-2, and key recommendations were synthesized across all BC phases. Strong consensus emerged on several DS interventions: testing guided by clinical suspicion of sepsis, avoiding routine use in low-yield scenarios; single-site collections sufficient for most cases except endovascular infections; optimal blood volumes (8-10 mL per bottle in adults); and skin antisepsis with 2% chlorhexidine in 70% alcohol. Rapid molecular assays expedite pathogen identification but have limited sensitivity directly from blood. Quality improvement, including contamination monitoring and mandatory training, is essential for sustainability. A key limitation was heterogeneous guideline reporting formats complicating direct comparison. Standardized, evidence-based DS protocols are crucial for accurate BSI diagnosis. This work provides harmonized recommendations applicable across Europe and underscores the urgent need for EU-wide guidelines ensuring consistent, high-quality BC practices that directly strengthen AMS efforts.
Malnutrition is among the leading modifiable risk factors for cardiovascular diseases worldwide. Current international guidelines consistently recommend predominantly plant-based dietary patterns rich in vegetables, fruits, whole grains, legumes and unsaturated fats. At the same time, the diet affects not only individual health but also the ecological foundations of future health. The nutrition system substantially contributes to greenhouse gas emissions, biodiversity loss, land-use change and freshwater consumption. This article argues that nutrition should therefore be understood as a dual lever for prevention: both for reducing cardiovascular disease and for stabilizing health-relevant ecological systems. While evidence supporting the cardiovascular benefits of high-quality plant-based diets continues to grow, implementation at the population level remains insufficient. The article discusses the limited long-term effectiveness of purely educational and individual responsibility-focused approaches and contrasts these with the more consistent evidence supporting structural interventions. In particular, fiscal policies, restrictions on unhealthy food marketing, healthy food standards in public institutions and modifications of food environments have demonstrated robust effects on dietary behavior and health outcomes. Against this background an expansion of cardiovascular prevention towards the active shaping of healthy and sustainable food environments is proposed. Physicians and medical societies could play a substantially stronger role in advocating evidence-based structural prevention policies. Fehlernährung zählt weltweit zu den wichtigsten modifizierbaren Risikofaktoren für kardiovaskuläre Erkrankungen. Internationale Leitlinien empfehlen konsistent überwiegend pflanzenbasierte Ernährungsmuster mit hohem Anteil an Gemüse, Obst, Vollkornprodukten, Hülsenfrüchten und ungesättigten Fettsäuren. Gleichzeitig beeinflusst Ernährung nicht nur die individuelle Gesundheit, sondern auch die ökologischen Grundlagen zukünftiger Gesundheit. Das Ernährungssystem trägt wesentlich zu Treibhausgasemissionen, Biodiversitätsverlust, Landnutzungsänderungen und Wasserverbrauch bei. Der Beitrag argumentiert, dass Ernährung deshalb als doppelter Hebel der Prävention verstanden werden sollte: sowohl zur Reduktion kardiovaskulärer Erkrankungen als auch zur Stabilisierung gesundheitsrelevanter ökologischer Systeme. Während die Evidenz zu gesundheitlichen Vorteilen qualitativ hochwertiger pflanzenbasierter Ernährung weiter zunimmt, bleibt die Umsetzung entsprechender Ernährungsmuster auf Bevölkerungsebene bislang unzureichend. Der Artikel diskutiert die begrenzte Wirksamkeit rein edukativer Strategien und stellt diesen die konsistentere Evidenz für verhältnispräventive Maßnahmen gegenüber. Insbesondere fiskalische Instrumente, Werbebeschränkungen, gesundheitsförderliche Standards in öffentlichen Einrichtungen und Veränderungen von Ernährungsumgebungen zeigen robuste Effekte auf Konsumverhalten und gesundheitliche Outcomes. Vor diesem Hintergrund wird eine Erweiterung der kardiovaskulären Prävention hin zur aktiven Mitgestaltung gesunder und nachhaltiger Ernährungsumgebungen vorgeschlagen. Ärztinnen und Ärzte sowie medizinische Fachgesellschaften könnten hierbei eine deutlich stärkere gesundheitspolitische Rolle einnehmen.
China's rural elderly face significant healthcare access barriers despite the national Digital Village initiative promoting Internet of Things (IoT) technologies. However, evidence on causal pathways to IoT adoption and cost-effective intervention strategies remains scarce. We surveyed 613 elderly residents (≥60 years) in rural Shanxi using multi-stage random sampling, collecting data on demographics, health status, IoT usage, barriers, and intervention preferences. Beyond descriptive analysis, we employed propensity score matching to identify causal effects, examined heterogeneous treatment responses, and simulated intervention scenarios with cost-effectiveness analysis. Results revealed high chronic disease burden (majority reporting 1-3 conditions) and moderate IoT usage (52.4%) despite low awareness (61.5% with little/no knowledge). Primary barriers were operationalmistouching (51.2%) and interface complexity (45.2%)rather than cost (35.7%). Having a caregiver increased adoption by 21.0 percentage points (95% CI: 8.0-33.0%, p = 0.001), a finding robust across multiple estimation methods (E-value = 4.1), with striking heterogeneity: low-education elderly showed 34.1pp improvement versus 10.1pp for high-education groups. Information-seeking behavior emerged as another modifiable factor (OR=1.25, p=0.02). Scenario-based cost comparison identified health information campaigns as the most efficient strategy, while combined caregiver-information interventions achieved the greatest impact (4.3pp increase). Based on these findings, we developed four evidence-based service modelsSelf-Management, Information-Enhanced, Community-Supported, and Intensive Risk Managementwith a decision pathway matching interventions to user segments. A phased implementation strategy could progressively increase adoption, with greatest gains among vulnerable populations. This study suggests that IoT adoption is fundamentally a social rather than technical challenge, requiring targeted interventions that address heterogeneous needs and optimize resource allocation in resource-constrained rural settings.
This article presents selected recommendations included in the 6th Edition of European Glaucoma Society (EGS) guidelines and highlights key differences compared to the previous (5th) and the latest revisions of Polish Ophthalmology Society (PTO) guidelines. The current edition is primarily an update to the earlier guidelines, incorporating the context of new technologies, the results of recent scientific research, and responses to important clinical questions - including those informed by input from the Experts by Experience (EbE-EGS) patient panel. These guidelines constitute a comprehensive, coherent, and evidence-based set of information and recommendations, useful both for making complex therapeutic decisions and in everyday clinical practice.
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 Inappropriate antibiotic prescribing contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) programs increasingly rely on electronic health record (EHR)-based clinical decision support (CDS) alerts to guide evidence-based care, yet poorly designed alerts can increase cognitive burden and contribute to burnout. Usability testing offers a structured approach to improving alert design and adoption.  To evaluate and iteratively refine interruptive CDS alerts developed to support appropriate antibiotic prescribing for pediatric acute respiratory tract infections (ARTIs) within an urban academic health system as part of a larger implementation project.  Twelve providers participated in four waves of virtual usability testing using scripted clinical scenarios reflecting common workflows. Participants interacted with three clinical alerts and one design focused scenario. Quantitative outcomes included task effectiveness, efficiency, satisfaction, and perceived difficulty. Qualitative feedback was gathered via think aloud techniques and synthesized using a "rainbow spreadsheet." Iterative modifications were implemented between waves until thematic saturation was achieved.  Task completion across scenarios was high (83.3%). Effectiveness and efficiency improved over waves, and satisfaction increased when alerts embedded actionable tasks such as ordering tests, adding diagnoses, or switching antibiotics. Participants emphasized the importance of clear, concise text, and intuitive defaults. Including links to evidence-based guidelines improved trust. Alert refinements reduced cognitive load and improved workflow alignment.  Rapid, iterative usability testing substantially improved the clarity and workflow integration of interruptive CDS alerts. Incorporating usability evaluation into CDS stewardship efforts can enhance adoption, reduce alert fatigue, and strengthen implementation of evidence-based practices.
Reporting guidelines for implementation strategies are important for transparency, measurement, and replicability. Yet, recent calls within implementation science highlight that foundational research commitments to advance minority health remain underspecified in current implementation strategy reporting guidelines. In response, our research team sought to expand Proctor and colleagues' guidelines for reporting and specifying implementation strategies to advance minority health. We first identified and synthesized key elements for specification from relevant literature. We then applied potential supplemental reporting criteria to our Literacy Promotion for Latinos (LPL) study as a case example to iterate and refine the suggested supplemental criteria. LPL implemented text messages and streamlined access to community resources as implementation strategies to enhance uptake of Reach Out and Read, an evidence-based pediatric clinic-based literacy promotion intervention specifically among Latino families. Our suggested supplemental reporting criteria integrate elements of community-engagement and health disparities research foundational for advancing minority health. We offer a new category, (1) Prioritize It, to describe processes of defining and prioritizing the (a) health outcome gap of interest and (b) performance gap of the evidence-based intervention. We add criteria to Proctor and colleagues' (2) Specify It category, which outlines the description of the implementation strategies, to describe processes of implementation strategy (a) selection, (b) development, and (c) tailoring. Lastly, we suggest a new category, (3) Evaluate It, to include community-engaged evaluation processes. In our case example, we explain the team's processes and engagement of relevant community members and partners in (a) prioritizing disparities in linguistic and socio-emotional development for Latino children related to school readiness and performance gaps in Reach Out and Read for families in local clinic communities; (b) specifying the selection, development, and tailoring of implementation strategies to focus on social and structural drivers of this health disparity; and (c) facilitating community partnerships to evaluate the strategies. Expansion of implementation strategy criteria for reporting can help ensure commitments to advancing minority health are fulfilled. Future efforts should convene researchers and community partners to create expert consensus on the specifications required for implementation strategies for addressing drivers of disparities and advancing minority health. ClinicalTrials.gov, Literacy Promotion for Latinos Study, NCT04609553, first posted October 30, 2020: https://clinicaltrials.gov/ct2/show/NCT04609553.
Vitamin D is a pleiotropic secosteroid with established skeletal functions and proposed extraskeletal effects; however, its clinical application remains contentious. Despite extensive observational evidence linking low 25(OH)D concentrations to chronic diseases, randomized controlled trials (RCTs) have largely failed to confirm many of these associations. This review focuses on the practical clinical management of vitamin D, integrating determinants of vitamin D status, assay-related limitations, targeted testing, evidence-based supplementation, and decision-making within a precision-nutrition context. The discordance between observational and interventional evidence is partly explained by the inclusion of vitamin D-replete populations in major trials, background supplementation, non-linear dose-response relationships, and assay variability. For skeletal outcomes, clinically meaningful effects are mainly observed in deficiency, whereas selected benefits have been reported in specific populations, including mortality reduction in adults aged ≥ 75 years, a modest reduction in cancer mortality, and reduced progression to diabetes in adults with high-risk prediabetes. The 2024 Endocrine Society guideline recommends empiric supplementation for selected groups and discourages routine screening in healthy adults. Daily or weekly dosing is preferred to intermittent high-dose regimens, which may increase falls and fractures. Standardization initiatives have improved 25(OH)D measurement accuracy, but inter-method variability persists, complicating thresholds and cross-study comparisons. Genetic polymorphisms in GC, CYP2R1, CYP24A1, and VDR contribute to variability in supplementation response, although precision-nutrition approaches remain investigational. Vitamin D should be viewed as a context-dependent, threshold-driven nutrient rather than a universal preventive therapy. Clinically, priority should be given to preventing and correcting severe deficiency (< 12 ng/mL [< 30 nmol/L]), a threshold below which adverse skeletal outcomes are well documented. Supplementation should target evidence-based indications, and laboratory testing should be reserved for situations in which results inform management. Bridging evidence and practice requires trials in deficient populations, improved assay harmonization, and integration of individualized risk factors into clinical decision-making.
The problem of hearing impairment in children remains of high medical and social significance, as it negatively affects speech development, social adaptation, and quality of life. Early rehabilitation plays a crucial role, and parental involvement is a key factor in success. In the Russian Federation, ear diseases account for 5% of the structure of childhood disability, necessitating the development of accessible regional rehabilitation programs with active family involvement. To present a comprehensive regional rehabilitation program for children with hearing impairments in the Ivanovo region, developed with the support of the National Medical Research Center for Otorhinolaryngology of the FMBA of Russia, and to describe its main modules aimed at actively involving parents in the process of hearing restoration, speech development, and social adaptation of the child. This work is based on an analysis of the experience of implementing the regional program at the audiology department of the Ivanovo Regional Clinical Hospital with the participation of the Department of Otorhinolaryngology of Ivanovo State Medical University. The description is based on program documentation, session protocols, and interviews with participants (specialists and parents). A qualitative and descriptive analysis was conducted, identifying key modules, rehabilitation stages, and the roles of specialists. The program includes comprehensive diagnostics (audiological, speech therapy, psychological), an individualized rehabilitation plan, and a differentiated approach for users of hearing aids and cochlear implants. Educational modules for parents have been developed: psychological education, training in device handling, communication strategies, parental coaching, psychological support, social navigation, monitoring, and supervision. Innovative components include theater therapy and vocal lessons, which contribute to the development of prosody and strengthen parent-child relationships. The program is implemented by a multidisciplinary team (audiologist, ENT physician, speech-language pathologist, psychologist, social worker, coordinator) in accordance with a calendar model (0-1 month, 1-6 months, 6-24 months, preschool and school stages). Distance learning formats are provided for families from remote areas. The regional program of the Ivanovo region represents an example of a comprehensive family-centered approach that integrates modern evidence-based rehabilitation methods. This experience can serve as a model for the development of similar programs in other regions. Further research will be aimed at quantitative evaluation of the effectiveness of the described modules. Нарушения слуха у детей имеют большое социально-медицинское значение, поскольку негативно влияют на речевое развитие, социальную адаптацию и качество жизни. Ранняя реабилитация играет решающую роль, а участие родителей является ключевым фактором успеха. В Российской Федерации заболевания уха составляют 5% в структуре детской инвалидности, что обусловливает необходимость создания доступных региональных программ реабилитации с активным вовлечением семьи. Представить комплексную региональную программу реабилитации детей с нарушениями слуха в Ивановской области, разработанную при поддержке НМИЦО ФМБА России, и описать ее основные модули, направленные на активное вовлечение родителей в процесс восстановления слуха, развития речи и социальной адаптации ребенка. В основу работы положен анализ опыта реализации региональной программы на базе сурдологического кабинета Ивановской областной клинической больницы при участии кафедры оториноларингологии ФГБОУ ВО «Ивановский ГМУ» Минздрава России. Описание основано на документации программы, протоколах занятий и интервью с участниками (специалистами и родителями). Проведен качественный и описательный анализ с выделением ключевых модулей, этапов реабилитации и роли специалистов. Программа включает комплексную диагностику (аудиологическую, логопедическую, психологическую), индивидуальный план реабилитации и дифференцированный подход для пользователей слуховых аппаратов и кохлеарных имплантов. Разработаны образовательные модули для родителей: психологическое образование, обучение обращению с техникой, коммуникативные стратегии, родительский коучинг, психологическая поддержка, социальная навигация, мониторинг и супервизия. Инновационными компонентами выступают театральная терапия и вокальные занятия, способствующие развитию просодики и укреплению детско-родительских отношений. Программа реализуется мультидисциплинарной командой (аудиолог, врач-оториноларинголог, логопед-дефектолог, психолог, социальный работник, координатор) в соответствии с календарной моделью (0—1 мес, 1—6 мес, 6—24 мес, дошкольный и школьный этапы). Предусмотрены дистанционные формы работы для семей из отдаленных районов. Региональная программа Ивановской области представляет собой пример комплексного семейно-центрированного подхода, интегрирующего современные научно обоснованные методы реабилитации. Опыт может служить моделью для создания аналогичных программ в других регионах. Дальнейшие исследования будут направлены на количественную оценку эффективности описанных модулей.
Oral diseases, including periodontal disease, salivary gland dysfunction and oral squamous cell carcinoma, are characterized by chronic inflammation and metabolic dysregulation. Dietary interventions have demonstrated systemic anti-inflammatory and metabolic benefits; however, their effects on the oral cavity remain insufficiently explored. A systematic review was conducted in PubMed and Web of Science to identify relevant studies published up to September 2025 assessing the effects of fasting, caloric restriction, and ketogenic diet on oral conditions. The search strategy combined MeSH terms and keywords related to these dietary interventions and oral health conditions. Data on study characteristics, interventions, outcomes, and limitations were extracted and synthesized. Fourteen studies were included, comprising preclinical in vitro and in vivo studies as well as a limited number of clinical trials. Caloric restriction and intermittent fasting were generally associated with improvements in periodontal inflammation and metabolic parameters, without significant effects on oral microbiota composition. Alternate-day fasting demonstrated beneficial effects on salivary gland function and inflammatory responses in preclinical models. In oral squamous cell carcinoma, fasting-related interventions enhanced treatment sensitivity and reduced tumor growth in experimental studies; however, clinical evidence remains scarce, and feasibility, particularly for ketogenic diet, is limited and mainly derived from small pilot studies with methodological constraints. Caloric restriction and intermittent fasting may exert potential beneficial effects in oral health by modulating inflammation, tissue regeneration, and metabolic pathways. However, current evidence remains largely preclinical and heterogeneous. Well-designed clinical trials and mechanistic studies in humans are required to establish their clinical relevance and to support their integration into evidence-based oral health practice. This review was registered in PROSPERO (Registration ID: 1085293) and conducted in accordance with PRISMA 2020 guidelines [1].
Chronic obstructive pulmonary disease (COPD) is a progressive condition and a leading cause of morbidity and mortality in the UK. Characterised by persistent airflow limitation, breathlessness, cough and frequent exacerbations, it is often linked to smoking and other environmental exposures. This article reviews COPD from a nursing perspective, outlining definition, pathophysiology and evidence-based management. Pharmacological and non-pharmacological strategies are discussed, with emphasis on smoking cessation, inhaler technique, pulmonary rehabilitation and holistic care. The central role of nurses in supporting self-management, co-ordinating multidisciplinary care and addressing comorbidities is highlighted. Aligning practice with National Institute for Health and Care Excellence guidance can improve outcomes and reduce avoidable admissions.
To evaluate the evidence supporting preventive pelvic floor muscle therapy (PFMT) in reducing pregnancy associated pelvic floor dysfunction (PFD) and assess the alignment of insurance coverage, clinical guidelines, and legislative initiatives with current evidence in the United States (U.S.). Despite growing evidence supporting PFMT, U.S. insurers restrict coverage to treatment of dysfunction rather than its prevention. We review the pathophysiologic mechanisms linking childbirth to PFD, summarize the evidence supporting preventive PFMT, and evaluate U.S. insurance coverage practices, PFMT implementation guidelines, and relevant legislation. International approaches to pelvic floor health promotion are also examined. Vaginal birth places significant mechanical strain on the pelvic floor, frequently injuring the structures responsible for maintaining continence and preventing pelvic organ prolapse (POP). Evidence from a 2020 Cochrane review, RCTs, and other meta-analyses demonstrates that antenatal PFMT significantly reduces the risk of urinary incontinence (UI) during pregnancy and postpartum. The preventive efficacy of postpartum PFMT remains less clearly defined, as many studies evaluate mixed populations of continent and incontinent patients vs strictly continent. U.S. insurance does not cover preventive PFMT, resulting in significant out-of-pocket costs. Clinical and public health guidelines inconsistently address preventive PFMT, and legislative efforts remain limited. Preventive PFMT represents an evidence-based strategy for reducing pregnancy associated PFD. Aligning clinical guidelines, insurance coverage, and legislative initiatives with current evidence may improve access to preventive pelvic floor care and strengthen maternal health outcomes.
Thrombotic diseases remain a leading cause of global mortality and a significant public health burden. While conventional antiplatelet and anticoagulant therapies are cornerstone strategies, their clinical application is frequently hindered by a significant risk of hemorrhagic complications and limited efficacy in certain patient populations. Consequently, there is an urgent need for safer and more effective antithrombotic agents. Flavonoids, a diverse class of plant-derived polyphenols, have garnered considerable attention due to their potent antiplatelet and antithrombotic activities coupled with a favorable safety profile. This review systematically examines the latest advancements in the therapeutic effects of flavonoids on thromboembolic disorders and elucidates their underlying molecular mechanisms. Evidence suggests that flavonoids function as multi-target inhibitors. They exert antithrombotic effects by regulating platelet activation through interfering with multiple signaling pathways, including the ADP-mediated P2Y1/P2Y12 cascade, cyclic nucleotide (cAMP/cGMP) signaling, and the collagen pathway. Additionally, these compounds inhibit the coagulation cascade by targeting key proteases including thrombin. This review provides an evidence-based roadmap for the development of flavonoid-derived therapies, aiming to facilitate their translation into clinical interventions for the effective management of thrombotic diseases.
Critical Time Intervention (CTI) is an evidence-based, time-limited case management practice that improves housing outcomes among homeless-experienced adults. While CTI's effect on housing outcomes has been well-studied, its impacts on health services utilization are less clear. In the context of a U.S Department of Veterans Affairs (VA) CTI implementation effort, we assessed relationships between CTI implementation, including fidelity, and Veterans' VA health services utilization. We conducted a retrospective observational study of 9,051 Veterans who received services, 10/1/2019 to 5/1/2025, from one of 156 case management sites that worked with VA; 32 of these sites implemented CTI. Within the 18 implementing CTI sites that completed fidelity ratings, we compared health services utilization for Veterans (n = 2,022) at sites with adequate (n = 12 sites) vs. inadequate (n = 6 sites) fidelity. We performed multivariate regression using generalized estimating equations with clustering by site, adjusting for Veterans' demographics and diagnoses, and VA facility complexity. Regression models identified the impacts of CTI (versus non-CTI), and fidelity (adequate versus inadequate), on health service utilization; we used negative binomial regression for count outcomes (number of primary care, emergency department [ED], behavioral health, homeless services, outpatient medical-surgical visits) and logistic regression for binary outcomes (presence of inpatient mental health, or medical-surgical hospitalizations). CTI Veterans had lower rates of utilization across all service types compared to non-CTI, including primary care (IRR = 0.98, 95% CI: 0.97-0.98), ED (IRR = 0.93, 95% CI: 0.90-0.95), homeless services (IRR = 0.91, 95%CI: 0.89-0.93) and hospitalizations (AOR = 0.79, 95%CI: 0.68-0.91). Among CTI Veterans, Veterans at sites with adequate fidelity had more primary care use (IRR = 1.04, 95% CI: 1.02-1.07), less ED use (IRR = 0.84, 95% CI: 0.80-0.90) and more homeless service use (IRR = 1.10, 95% CI: 1.05-1.15). CTI Veterans had lower service utilization rates compared to non-CTI Veterans. However, adequate CTI fidelity is associated with increased primary care use and decreased ED use; this finding may be due to high-quality CTI implementation and/or site-level characteristics that enabled better CTI fidelity. Ensuring fidelity to CTI implementation may hold value in promoting optimal care linkages for homeless-experienced Veterans and other clients with high needs.
The COVID-19 pandemic exposed critical gaps in healthcare systems and underscored the need for effective strategies to mitigate its burden. Understanding lessons learned from local experiences can inform future pandemic preparedness. This study aimed to explore context-specific strategies implemented in Iran to reduce the impact of COVID-19 and provide insights applicable to future health emergencies. A qualitative study was conducted between July 2023 and February 2024 in five major Iranian cities (Tehran, Shiraz, Isfahan, Mashhad, and Kerman). Data were collected through 28 semi-structured interviews with healthcare managers, hospital administrators, frontline workers, policymakers, and infectious disease specialists, recruited using purposive sampling with maximum variation. Interviews were audio-recorded, transcribed verbatim, and analyzed using conventional content analysis based on Graneheim and Lundman. MAXQDA 2022 software supported data management and coding. Trustworthiness was ensured through credibility, transferability, dependability, and confirmability criteria. Analysis revealed eight main themes and 38 subthemes encompassing a broad range of pandemic mitigation strategies. These included preparedness planning (e.g., early risk assessment, vaccination readiness), organizational coordination (e.g., interdepartmental collaboration, crisis task forces), resource management (e.g., ICU optimization, supply chain efficiency), communication strategies (e.g., transparent reporting, public awareness campaigns), workforce support (e.g., mental health interventions, recognition programs), community engagement (e.g., volunteer mobilization, home care support), policy adaptation (e.g., flexible regulations, cross-sector collaboration), and innovation (e.g., telemedicine, mobile testing, digital health tools). Illustrative participant quotes highlighted both successes and challenges in implementation. Findings demonstrate that a multifaceted, coordinated approach, integrating preparedness, effective communication, community participation, and innovation, is essential to mitigate pandemic burden. Insights from this study can inform evidence-based policy, strengthen health system resilience, and guide strategic planning for future public health emergencies.
The American Cancer Society predicts 158,850 new cases of colorectal cancer and 52,230 deaths in 2026. Rates have declined for both men and women since 2011, particularly among those over age 65. This decline is likely due to reduced smoking and increased uptake of screening. Unfortunately, there has been an increase among those younger than age 55 years since the mid-1990s, likely due to the lifestyle of those born after 1950. Early-onset colorectal cancer is defined as a diagnosis before the age of 50 years. Guidelines now recommend screening for average-risk patients begin at age 45 years (formerly 50 years). High-risk patients should start screening at age 40 years, and possibly earlier. Patients need to learn about this recent change. A high index of suspicion is helpful when any patient presents with complaints of unexplained weight loss, abdominal pain, bloating, change in bowel habits, or rectal bleeding. These patients should be referred, regardless of age, for a diagnostic colonoscopy. Primary care providers can improve their practice's screening rates using evidence-based strategies. The gastroenterology nurse is in a key position to implement lead-time messaging with tailored messages to promote on-time screening and primary prevention through diet and lifestyle.
Optimal corticosteroid treatment duration for immune checkpoint inhibitor-related pneumonitis remains uncertain. No randomized trials have addressed this issue. To determine whether a 3-week corticosteroid taper is noninferior to the guideline-recommended 6-week taper for short-term treatment success in patients with mild (Common Terminology Criteria for Adverse Events Grade 1-2) immune-related pneumonitis. Patients with mild immune-related pneumonitis were assigned to either a 3-week or 6-week corticosteroid regimen. The primary endpoint was the treatment success rate at 8 weeks, defined as resting room-air SpO2 ≥ 90% without steroid escalation or prolongation due to pneumonitis worsening. Overall, 106 patients were randomized (median age, 72 years; Grade 2, 73%). Treatment success rates were 66.7% and 85.2% in the 3- and 6-week groups, respectively, which did not demonstrate noninferiority (difference: -18.5 percentage points [80% confidence interval: -29.0% to - 7.9%] P = .621) of the 3-week regimen. A predefined exploratory analysis indicated superiority of the 6-week regimen (P = .013). Grade ≥ 3 adverse events occurred in 12% and 24% of the 3- and 6-week groups, respectively; however, all were manageable with clinical interventions. The total quality of life mean change using the King's Brief Interstitial Lung Disease score from baseline was 4.78 and 6.28 in the 3- and 6-week groups, respectively (between-group difference: -1.50 percentage points; 95% confidence interval: -5.91 to 2.91). Overall survival was comparable between the groups (hazard ratio: 1.03; 95% confidence interval: 0.46-2.29; P = .95). This study establishes the 6-week corticosteroid regimen as an evidence-based standard for treating ICI-related pneumonitis.
Childhood vaccinations are among the most successful public health strategies for preventing infectious diseases. However, rising parental vaccine hesitancy and refusal pose a significant threat to immunization coverage in Türkiye. This systematic review aimed to synthesize current evidence on the factors influencing parental hesitancy and refusal to childhood vaccinations in Türkiye. This review followed PRISMA guidelines and was registered in PROSPERO. A comprehensive search of six databases (Scopus, Web of Science, PubMed, Cochrane Library, Medline and TR Dizin (ULAKBIM) was conducted up to March 2025. Quantitative studies evaluating parental attitudes toward routine childhood and pandemic vaccinations in Türkiye were included. Factors influencing vaccine hesitancy were categorized into individual, familial, social, and structural domains. Of 412 records identified, 26 met the inclusion criteria across diverse regions and samples in Türkiye. Factors including social media misinformation, distrust in healthcare professionals, low health literacy, prior negative vaccine experiences, and religious or cultural beliefs shaped vaccine hesitancy. Education, income, and gender showed mixed associations. Hesitancy was also linked to limited postpartum follow-up and pandemic-related vaccine experiences. Several studies highlighted the protective role of health literacy, digital competence, and accurate information from trusted healthcare providers. Parental vaccine hesitancy and refusal in Türkiye are shaped by personal beliefs, trust in the health system, and information sources. Healthcare professionals, policymakers, and public health authorities should implement coordinated, evidence-based strategies to strengthen parental health literacy, address misinformation, build trust, and improve childhood vaccination uptake in Türkiye through targeted education and communication.