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This article emphasizes the need to consider diverse identities and experiences when shaping health policies, research, and services for older Veterans in Canada. As the Veteran population ages, health needs become increasingly complex, influenced by military service and personal factors such as age, gender, culture, and social background. Veterans include individuals across a wide age range, many facing service-related health challenges. National reports highlight the importance of trauma-informed and culturally sensitive care, particularly for historically under-served groups such as women, Indigenous Peoples, racialized communities, and 2SLGBTQIA+ Veterans. Intersectionality helps explain how overlapping identities - like race, gender, income, and disability - affect access to care and health outcomes. Applying this lens ensures services are inclusive and responsive to all Veterans. Recent Veterans Affairs Canada assessments show progress in incorporating diverse perspectives but note persistent gaps in reaching marginalized groups. This article calls for inclusive research, informed policies, and provider training to guarantee equitable care. Recognizing the full range of Veteran identities is essential to building a health system that supports well-being throughout their lives. As Canada’s Veteran population gets older, its health needs are becoming more complex. These needs are shaped not only by military service but also by personal factors like age, gender, culture, and social background. Veterans are a diverse group, and some such as women, Indigenous Peoples, racialized communities, and 2SLGBTQIA+ individuals have historically faced barriers to care. Reports show that health services must be trauma-informed and culturally sensitive to meet these varied needs. One useful approach is intersectionality, which looks at how different parts of a person’s identity such as race, income, gender, and disability combine to affect health and access to care. Using this lens can help create services that are fair and inclusive for all Veterans. While Veterans Affairs Canada has made progress by including diverse perspectives in health planning, challenges remain in reaching marginalized groups. This article calls for more inclusive research, better-informed policies, and training for health care providers. By recognizing the full range of experiences among Veterans, Canada can build a health care system that supports their well-being as they age. Cet article fait ressortir la nécessité de tenir compte d’identités et d’expériences diversifiées pour façonner les politiques, la recherche et les services en matière de santé aux vétéran·e·s âgé·e·s du Canada. À mesure que la population de vétéran·e·s vieillit, les besoins de santé deviennent de plus en plus complexes, influencés par le service militaire et des facteurs personnels comme l’âge, le genre, la culture et le contexte social. Les vétéran·e·s incluent des personnes de tous les âges, dont bon nombre sont aux prises avec des problèmes de santé liés à leur service militaire. Les rapports nationaux font ressortir l’importance de soins tenant compte des traumatismes et reposant sur la sécurisation culturelle, particulièrement auprès des groupes qui ont toujours été mal desservis, comme les vétéran·e·s de sexe féminin, autochtones, racisé·e·s ou LGBTQIA2+. L’intersectionnalité contribue à expliquer les effets des identités multiples, telles que la race, le genre, le revenu et les handicaps, sur l’accès aux soins et les résultats en matière de santé. Cette perception permet d’offrir des services inclusifs, qui répondent aux besoins de l’ensemble des vétéran·e·s. Les récentes évaluations d’Anciens combattants Canada démontrent une évolution de l’intégration des diverses perspectives, mais également des lacunes persistantes pour l’atteinte des groupes marginalisés. Cet article réclame des recherches inclusives, des politiques éclairées et la formation des prestataires pour garantir des soins équitables. Il est essentiel de reconnaître le plein éventail des identités des vétéran·e·s pour construire un système de santé qui appuie le bien-être tout au long de leur vie. À mesure que la population de vétéran·e·s du Canada vieillit, ses besoins de santé deviennent plus complexes. Ces besoins sont façonnés non seulement par le service militaire, mais également par des facteurs personnels comme l’âge, le genre, la culture et le contexte social. Les vétéran·e·s forment un groupe diversifié, et certain·e·s, comme les femmes, les personnes autochtones, les communautés racisées et les personnes LGBTQIA2+, ont toujours affronté des obstacles aux soins. Les rapports démontrent que les services de santé doivent tenir compte des traumatismes et reposer sur la sécurisation culturelle pour répondre à ces besoins variés. L’intersectionnalité est une approche utile, qui examine les effets de la combinaison de divers aspects de l’identité individuelle, comme la race, le revenu, le genre et le handicap, sur la santé et l’accès aux soins. Cette perspective peut contribuer à la création de services justes et inclusifs pour l’ensemble des vétéran·e·s. Anciens combattants Canada a réalisé des progrès grâce à l’inclusion de points de vue diversifiés dans la planification de la santé, mais il reste difficile d’atteindre les groupes marginalisés. Cet article réclame des recherches plus inclusives, des politiques plus éclairées et une formation pour les prestataires de soins. S’il prend conscience du plein éventail d’expériences chez les vétéran·e·s, le Canada peut bâtir un système de santé qui appuie leur bien-être tout au long de leur vieillissement.

Research education is fundamental to evidence-based practice in the allied health sciences; however, the progression of students from basic awareness to applied research competency remains poorly characterized. Understanding these progression patterns is essential for curriculum development and educational reform. We conducted a cross-sectional survey of 730 undergraduate students selected through stratified convenience sampling from 10 allied health science programs at Malla Reddy University, Hyderabad, India. Data were collected using a structured, self-administered questionnaire developed through literature review, expert consultation, and pilot testing. Research competencies were measured across four sequential domains research awareness, definitional knowledge, methodological familiarity, and practical experience using binary (Yes/No) items designed to capture progression from basic understanding to active research engagement. Data were analyzed using chi-square tests, correlation analysis, and multiple regression modeling. Key methodological limitations included the single-institution setting, self-reported responses, and the cross-sectional design, which may limit generalizability and preclude causal inferences. A progressive decline in competency was observed across learning domains: 74.9% demonstrated basic research awareness, 66.3% could define research concepts, 36.2% understood research methodology, and only 26.7% had practical research experience (p&#x2009;<&#x2009;0.001). This represents a 48.2 percentage point decline from awareness to application. Research aptitude scores remained consistent across all academic programs (&#x3c7;2&#x2009;=&#x2009;0.247, p&#x2009;=&#x2009;0.999). Students with formal research training demonstrated significantly higher participation rates (AOR&#x2009;=&#x2009;2.85, 95% CI: 1.98-4.11, p&#x2009;<&#x2009;0.001). While allied health curricula successfully establish foundational research awareness, they often fail to support progression to practical application. Educational interventions that incorporate active learning methodologies, structured mentorship, and experiential research opportunities are necessary to bridge the theory-practice gap.

Afghanistan has experienced decades of war, political instability, displacement, poverty and structural upheaval, all of which are likely to have contributed to the population's deteriorating mental health. Individual studies and reports describe depression, anxiety, trauma-related distress and a severe lack of access to care, especially among women. However, the evidence remains fragmented. There has been no recent synthesis of evidence on mental health conditions, determinants, coping strategies, services and interventions among people living in Afghanistan. This protocol describes a systematic review of the literature on the mental health of this population. This systematic review protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. The review will be conducted and reported in accordance with PRISMA 2020. MEDLINE, Embase, APA PsycINFO, Web of Science and WHO Global Index Medicus will be searched using subject headings and keywords related to Afghanistan and mental health, with searches updated before final analysis. Relevant grey literature will also be included. Eligible study designs include quantitative, qualitative and mixed-methods studies reporting mental health outcomes, determinants, coping strategies, access to mental healthcare or mental health interventions among people living in Afghanistan. No language restrictions will be applied. Title and abstract screening and full-text review will be conducted independently by two reviewers, with disagreements resolved through discussion or, if necessary, adjudicated by a third reviewer. Data will be extracted using a piloted structured template. Given the expected heterogeneity in study designs and outcome measures, quantitative findings will be reported as frequencies and qualitative data will be analysed using thematic approaches to support the synthesis. Where appropriate, findings will be grouped by population subgroup and study setting. Study quality will be appraised using the Mixed Methods Appraisal Tool. Ethical approval is not required for this study as it will involve the analysis of previously published literature and publicly available reports. The findings will be disseminated through peer-reviewed publication and conference presentations and may inform clinicians, researchers, humanitarian agencies and policymakers. CRD420261403755.

Digital health technologies are increasingly used across oncology services, but the available evidence remains concentrated on patient-facing and clinical applications. Organisational perspectives and the involvement of non-clinical professionals remain poorly represented. This scoping review mapped digital health technologies used in adult oncology care, examined their functions for healthcare professionals (HCPs), and assessed the extent and nature of evidence involving non-clinical professionals (NCPs). A scoping review was conducted to identify studies reporting the use of digital health technologies in adult cancer care. PubMed, Embase, CINAHL, and Web of Science were searched for studies published between 2015 and June 2025, and reference lists were hand-searched. Qualitative, quantitative, mixed-methods, pilot, feasibility, and implementation studies were eligible. Findings were synthesised narratively according to the primary function of each technology and the professional groups involved. Forty-one studies were included. The most frequently reported technologies were electronic patient-reported outcome systems, telehealth and telemonitoring platforms, mobile applications, and decision-support or AI-enabled systems. These technologies were used mainly for symptom monitoring, communication, follow-up, survivorship support, clinical decision support, and care coordination. Reported benefits included earlier symptom detection, improved communication, greater patient reassurance, and more structured clinical workflows. Common barriers included limited digital literacy, declining engagement over time, alert burden, workflow misalignment, poor interoperability, and inadequate technical infrastructure. Only three studies explicitly included non-clinical professionals, indicating that organisational and managerial applications remain substantially under-researched. Interoperability and workflow integration emerged as the most consistently supported implementation priorities. Equity, scalability, sustainability, and economic impact require further evaluation. Because evidence involving non-clinical professionals and AI-enabled implementation remains limited, recommendations concerning organisational adoption, AI governance, and workforce preparation should be treated as priorities for implementation research rather than established policy requirements.

Human monkeypox (mpox) is a re-emerging zoonotic viral disease in Africa. Despite recent reports in Ethiopia, no studies have assessed healthcare workers' (HCWs) knowledge and attitudes in the Central Ethiopia Region. This study aimed to determine HCWs knowledge and attitudes toward the re-emergence of mpox in public health facilities. From June 16 to 28, 2025, 419 HCWs were chosen at random for an online cross-sectional study. The data were gathered using a self-administered questionnaire distributed through Google Forms. We used SPSS version 26 for the statistical analysis. Multivariable logistic regression was used to identify factors associated with knowledge and attitudes. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to determine statistical significance. Of the 419 participants, 46.8% (95% CI: 42.0-51.7) had good knowledge, while 43.4% (95% CI: 39.1-48.0) showed positive attitudes. Good knowledge were significantly positively associated with a master's degree or higher (AOR&#x2009;=&#x2009;3.46; 95% CI: 1.60-7.47), health officer (AOR&#x2009;=&#x2009;7.00; 95% CI: 3.20-15.32) and pharmacist (AOR&#x2009;=&#x2009;2.68; 95% CI: 1.17-6.13), low (AOR&#x2009;=&#x2009;5.15; 95% CI: 2.02-13.10) and medium monthly income (AOR&#x2009;=&#x2009;2.35; 95% CI: 1.32-4.20), and positive attitude (AOR&#x2009;=&#x2009;2.11; 95% CI: 1.25-3.59), in contrast significantly negatively associated with work experience (5-10 years) (AOR&#x2009;=&#x2009;0.13; 95% CI: 0.07-0.24). Positive attitudes were significantly positively associated with medical doctor (AOR&#x2009;=&#x2009;4.78; 95% CI: 2.39-9.55), and information about mpox during medical education (AOR&#x2009;=&#x2009;3.29; 95% CI: 1.91-5.67), in contrast significantly negatively associated with female sex (AOR&#x2009;=&#x2009;0.18; 95% CI: 0.08-0.41), age &#x2265;&#x2009;32 years (AOR&#x2009;=&#x2009;0.45; 95% CI: 0.28-0.73), and lack of current information access (AOR&#x2009;=&#x2009;0.47; 95% CI: 0.26-0.88). HCWs had low levels of knowledge and positive attitudes toward mpox. To get better at being ready for and responding to mpox in Ethiopia, it is important to strengthen continuing professional education, target training, and raise awareness.

Translating academic discoveries into clinical investigation remains a major barrier in translational science, particularly when investigators lack the regulatory infrastructure required to sponsor clinical trials. These challenges are especially pronounced for natural product therapeutics, which often lack commercial sponsorship despite promising preclinical evidence. The Penn State Cancer Institute established an Investigator-Initiated Trial Sponsor Support Unit (SSU) to facilitate investigator-initiated trials and support progression toward National Cancer Institute designation. We describe a translational science case study of a Sponsor-Proxy operational model in which a centralized institutional unit performs sponsor-level regulatory and trial infrastructure functions while investigators retain scientific and clinical leadership. Two National Institutes of Health-funded trials evaluating Angelica gigas Nakai extract (INM176) illustrate this framework. The SSU authored regulatory documentation including Investigator's Brochures, coordinated Investigational New Drug submissions, and supported trial infrastructure while clinical teams maintained participant oversight. Both trials achieved activation timelines of 112 and 105 days, shorter than previously reported activation times and within National Cancer Institute operational benchmarks. Sponsor-level oversight continued throughout trial conduct, including regulatory reporting, safety monitoring, and protocol amendment support. This case study demonstrates how centralized institutional expertise can overcome sponsor-level barriers and enable translation of basic science discoveries into investigator-initiated early-phase clinical trials.

The substantial underrepresentation of American Indian, Alaskan Native, and Native Hawai'ian (AI/AN/NH) students in Science, Technology, Engineering and Mathematics (STEM) majors at United States colleges and universities results from systemic barriers in higher education. Efforts to address inequities have thus far not led to increases in AI/AN/NH student participation in STEM at the national level. In fact, while the AI/AN/NH population in the United States is increasing, there was a 17.0% decrease in the number of bachelor's degrees awarded to Indigenous students in STEM during the period 2012-2021. This work reports on steps that can be taken in a variety of types of institutions of higher education to serve our Native students in STEM more effectively. These steps are reported as a series of rationales, followed by practical descriptions of implementations. Ideas for enhancing the Indigenous experience in the academy, together with examples of successful programs, are detailed. These include raising faculty and institutional cultural competency, addressing inequities in college preparation within the K-12 system, making college STEM courses more inclusive, improving one-on-one advising and mentoring, engaging students in research, helping students overcome isolation, and providing physical spaces to build community. Implementation of these strategies will bring vast new talent to the STEM workforce, contributing to increased technical innovation and economic growth.

Physical inactivity is highly prevalent in older adults living in deprived communities, with many living with long-term health conditions. Community-based and tailored physical activity behaviour change programmes are needed to support increased physical activity in this population. This project aims to conduct a pragmatic pre-post mixed-methods evaluation of a community-based physical activity intervention (Move Together Buckinghamshire). Move Together Buckinghamshire is a 3-year community-based physical activity programme for inactive adults aged over 50 years with at least one long-term health condition living in deprived areas of Buckinghamshire, England. Across the 12-week programme, users will receive: (i) one 45-minute in-person one-to-one consultation with a Physical Activity Referral Specialist (PARS), (ii) three check-in contacts with their allocated PARS taking place by email, phone or text and (iii) access to an online platform to identify and book physical activity opportunities in their local area. The programme's recruitment target is 3000 service users over the 3-year programme. This pragmatic evaluation will assess the first 18&#x2009;months of programme delivery using a mixed-methods design. A quantitative outcome evaluation will be conducted for secondary data routinely collected within the programme to assess the primary outcome of physical activity (using the single-item physical activity measure), and secondary outcomes of health-related quality of life, loneliness and confidence to engage in physical activity (assessed at baseline, during and at the end of the 12-week programme and at 6-month and 12-month follow-up). A qualitative process evaluation will use focus groups and interviews with service users and interviews with PARS staff delivering the programme and strategic decision-makers. An economic analysis will be undertaken to estimate the resources and costs required to design, set up and deliver the Move Together Buckinghamshire. This study has been approved by the College of Health, Medicine and Life Sciences Research Ethics Committee at Brunel University of London. Informed written consent will be obtained from all participants of the evaluation. Results will be disseminated in peer-reviewed publications, scientific conferences, reports, webinars and through local community outlets. This study has been preregistered on Open Science Framework: https://doi.org/10.17605/OSF.IO/EV24C.

Eye diseases constitute a major public health challenge globally, with a disproportionate burden borne by populations in low- and middle-income countries (LMICs), including Sub-Saharan Africa (SSA). Prison populations represent a uniquely vulnerable group characterized by restricted access to healthcare, overcrowding, poor nutrition, and high-risk environmental conditions - all of which substantially elevate the risk of eye diseases. Despite individual country-level reports documenting elevated rates of eye disease among incarcerated persons in SSA, no synthesis of the evidence has been conducted. This systematic review and meta-analysis protocol aims to consolidate existing evidence on the prevalence of eye diseases among prison inmates across SSA. The protocol has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines to ensure rigor, transparency, and reproducibility. We will search major databases, including PubMed, Scopus, Web of Science, Embase, CINAHL (via EBSCO), PsycINFO, Google Scholar, and African Journals Online, using controlled vocabularies without date or language restrictions. Risk of bias and study quality will be assessed using standard critical appraisal tools. The completed review will follow the PRISMA reporting checklist and where appropriate, a meta-analysis will be conducted to generate pooled estimates, with subgroup analyses to explore sources of heterogeneity and country-level variations. Given the eye's role as a non-invasive window into systemic and overall health, findings from this review may inform evidence-based screening strategies and support policy reforms aimed at improving ocular and general health care in prison settings. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261389357, identifier (CRD420261389357).

Bloodstream infections (BSIs) pose a significant global health challenge, particularly in developing countries. Neonates are highly vulnerable due to underdeveloped immune systems and immature physical barriers, a risk amplified by poor hygiene and limited healthcare access in low- and middle-income countries (LMICs), leading to an estimated incidence of 5.5 cases per 1000 live births. This review aims to provide insight into the diagnostic and therapeutic challenges of neonatal BSIs in developing countries and to identify prospects for improving their diagnosis and treatment. This review employed a nonsystematic narrative approach. A comprehensive literature search was conducted using multiple electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and ScienceDirect. The search prioritized peer-reviewed articles, clinical trials, and systematic reviews published within the past decade (2015-2025). Diagnosis is severely hampered by nonspecific symptoms and limitations of conventional methods like blood culture, especially in resource-constrained settings lacking advanced molecular diagnostics. This often necessitates empirical antibiotic treatment, which intensifies antimicrobial resistance (AMR), complicates therapy, and leads to adverse outcomes. Promising solutions include rapid diagnostic technologies, artificial intelligence (AI), clinical decision support systems (CDSS), novel antimicrobial agents, alternative therapies like maternal immunization, and robust public health strategies, such as antimicrobial stewardship and stringent infection prevention. Addressing this complex issue requires concerted global efforts, substantial investment in local laboratory infrastructure, enhanced healthcare provider training, and the development of context-appropriate, affordable solutions to improve neonatal outcomes in LMICs.

Although awareness of abortion legality has been associated with reproductive health service utilization, little is known about whether legal awareness influences safe abortion uptake in Ghana or whether educational attainment modifies this relationship. This study examined the association between awareness of abortion legality and safe abortion uptake and assessed the moderating role of education among women in Ghana. Data were drawn from 1282 women aged 15-49 years who reported an induced abortion in the 5 years preceding the 2017 Ghana Maternal Health Survey. Abortions were classified as safe if they involved a recommended abortion method, were performed by a trained provider, and occurred in a recognized health facility. Awareness of abortion legality was assessed by asking respondents whether they knew abortion was legally permitted in Ghana under specific circumstances. Responses were categorized as aware or unaware. Covariates were selected based on existing literature relevant to abortion care-seeking behavior. Multivariable logistic regression models were used to estimate adjusted associations between legal awareness, education, and safe abortion uptake. Overall, 39.39% of abortions were classified as safe, while only 12.09% of women were aware of Ghana's abortion law. Legal awareness was strongly associated with safe abortion uptake (aOR&#x2009;=&#x2009;2.09; 95% CI: 1.42-3.08; p&#x2009;<&#x2009;0.001). Educational attainment was also positively associated with safety, with women with secondary (aOR&#x2009;=&#x2009;1.98; 95% CI: 1.22-3.22; p&#x2009;=&#x2009;0.006) and higher education (aOR&#x2009;=&#x2009;3.06; 95% CI: 1.57-5.96; p&#x2009;=&#x2009;0.001) more likely to obtain safe abortions compared with those with no education. However, education did not significantly moderate the association between legal awareness and abortion safety. Predicted probabilities indicated the highest likelihood of safe abortion among legally aware women with higher education (69%). These findings highlight the importance of improving women's awareness of abortion legality and strengthening women's educational attainment to enhance reproductive health autonomy and reduce unsafe abortion in Ghana.

ChatGPT, an AI-powered conversational tool, has shown potential to transform healthcare education. However, its integration poses challenges regarding usability, ethics, and critical thinking. Understanding students' attitudes and usage patterns is vital for successful adoption. The aim of this study was to translate and psychometrically validate the TAME-ChatGPT (Technology Acceptance Model Edited to Assess ChatGPT Adoption) tool into Persian and to evaluate the attitudes and usage of this technology among medical and paramedical students at Mashhad University of Medical Sciences (MUMS). This cross-sectional study was conducted over 2 months (December 21, 2024-February 21, 2025) at MUMS. A TAM-based questionnaire was administered to 246 students. The instrument was validated through forward-backward translation, content validity (CVI&#x2009;=&#x2009;0.90), exploratory factor analysis, and reliability testing (Cronbach's alpha&#x2009;=&#x2009;0.82-0.88). Data analysis, performed using SPSS 27, included Chi-square, Mann-Whitney U, and regression analyses. Thematic analysis was applied to qualitative responses. A total of 246 students participated (response rate: 100%). Among participants, 86.6% were aware of ChatGPT, and 65.5% reported prior usage. Awareness and usage were both significantly higher among male students (p&#x2009;=&#x2009;0.002 and p&#x2009;=&#x2009;0.007, respectively). Positive attitudes were observed toward ease of use (mean&#x2009;=&#x2009;4.06, SD&#x2009;=&#x2009;0.80) and usefulness (mean&#x2009;=&#x2009;4.03, SD&#x2009;=&#x2009;0.77), though concerns persisted about critical thinking (mean&#x2009;=&#x2009;3.38, SD&#x2009;=&#x2009;1.11) and perceived risks. Regression analysis showed academic discipline as a key predictor, with health information technology students having the highest acceptance (&#x3b2;&#x2009;=&#x2009;0.28, p&#x2009;<&#x2009;0.01). Key challenges included access issues, response quality, and training needs. Students had positive attitudes toward ChatGPT's usability and potential. Addressing ethical concerns and critical thinking is essential. Tailored training and policies are required for responsible integration in healthcare education.

The decision-making process for a patient to undergo breast reconstruction after mastectomy is complex and dependent on personal, cultural, and religious values. This systematic review explores the cultural influences on the patient's decision to undergo breast reconstruction that have been reported in the literature. A systematic search was conducted on March 14, 2025, using Embase, PubMed, Medline, Web of Science, and CINAHL. Inclusion criteria required the focus on cultural preferences and values regarding breast reconstruction during patient clinical experiences. Two investigators independently conducted the screening, extraction, and synthesis of results. Of the 1419 reports identified, eight articles were selected for analysis. The total number of patients across the review was 1,733. The average study sample size was 217 patients, with a range from 8 to 715 patients. The patient groups represented women from distinct ethnic or racial backgrounds as well as speakers of various languages: Chinese women, Hispanic women, African American women, women of Belgian nationality, Vietnamese-speaking women, Arabic-speaking women, and English-speaking women. Despite various measures and scales being used, all included studies depicted the patients' experiences, challenges, and strategies to navigate decision-making regarding breast reconstruction, which included these core factors: empowered and informed choices, self-advocacy, community, and maintaining physical as well as mental health. Of the studies that reported, 85 (5%) of patients decided to undergo breast reconstruction. Understanding the preferences of women of various cultural backgrounds regarding breast reconstruction is essential to ensure culturally relevant and informed patient-centered care. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Recent advances in large language models (LLMs) such as GPT-3/4 have spurred the development of artificial intelligence (AI) chatbots and advisory tools in medicine. These systems are posited to assist or augment physician-patient communication, potentially improving empathy, clarity, and responsiveness. However, their actual impact on communication outcomes remains uncertain. This study aimed to systematically review and meta-analyze peer-reviewed studies (2020-2025) evaluating how LLM-based interventions affect physician-patient communication, including empathy, clarity, trust, and patient understanding. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched PubMed/MEDLINE, Embase, Scopus, and Web of Science for studies published from 2020 to 2025 examining LLM or chatbot applications in clinical communication contexts. Eligible designs included randomized, observational, cross-sectional, and qualitative studies. Two reviewers (WHP and SR) independently screened titles or abstracts, assessed full texts, and extracted data on study design, population, LLM type, communication measures, and outcomes. We conducted a qualitative synthesis and random-effects meta-analysis, reporting pooled standardized mean differences or odds ratios with 95% CIs. From 312 records, 10 studies were included, all quantitative and predominantly cross-sectional. Populations ranged from patients with chronic conditions to health care professionals and laypersons. Outcomes assessed included empathy (8 studies), clarity or information quality (6 studies), satisfaction or usefulness (4 studies), and trust perceptions (2 studies). In 6 direct comparisons of AI- versus physician-generated responses, LLMs were rated significantly higher in empathy in 5 studies. One large study found that chatbot replies were judged empathetic in 45.1% of cases versus 4.6% for physician replies (odds ratio approximately 9.8, P<.001). Similarly, ChatGPT-4 answers scored higher in empathy on a 5-point scale than human-written responses (mean 4.18 vs 2.70, P<.001). One neurology study showed higher empathy scores (Consultation and Relational Empathy Scale +1.38, P<.01) for ChatGPT answers. Only 1 study found no significant empathy difference. LLM content was also longer and more information-rich, improving patient-perceived clarity and understanding. On the other hand, GPT-4 simplified pathology reports, increasing patient comprehension scores (7.98 vs 5.23/10, P<.001) and reducing consultation time by 70%. However, AI replies were sometimes less concise or less readable for low-literacy patients. In pooled analyses (k=4 studies; total evaluations N=2604), LLM assistance showed a large positive effect on empathy (standardized mean difference 1.02, 95% CI 0.44-1.60; random-effects model). Patient satisfaction results were mixed. No study directly assessed long-term trust. Current evidence suggests that LLM-based chatbots can enhance physician-patient communication by producing more empathetic, detailed, and understandable responses. These improvements may positively influence patient experience and engagement. However, LLMs may also generate overly lengthy or occasionally inaccurate advice, emphasizing the need for physician oversight. While meta-analytic findings are promising, robust randomized controlled trials, real-world and longitudinal studies are needed to confirm benefits, assess trust outcomes, and define optimal clinical integration strategies.

Embedded implementation research (EIR) integrates research within health programmes to address delivery bottlenecks and improve uptake of evidence. While widely promoted, its influence on policy, programme delivery, and service outcomes in low- and middle-income countries (LMICs) remains under-documented. We examined how EIR has influenced policy adaptation, programme design, and service delivery outcomes across LMICs where UNICEF has supported EIR initiatives. We conducted a mixed-methods cross-sectional synthesis drawing on survey data, document review, and case analyses of UNICEF-supported EIR projects conducted between 2015 and 2022. The analysis was guided by Proctor's implementation outcomes framework (adaptation, fidelity, sustainability) and the Consolidated Framework for Implementation Research to explore how contextual mechanisms shaped observed outcomes. We included 33 researchers and implementers representing 24 completed EIR projects from 11 countries who participated in an online structured survey (69% response rate). Their responses were triangulated with project reports and UNICEF monitoring documentation. Two-thirds (67%) of projects reported that their findings informed policy or programme adjustments, most commonly through revised immunisation strategies, integration of digital tools, and strengthened community engagement. Half (50%) documented measurable service-delivery improvements, such as increased vaccination coverage and improved routine child health indicators, reflecting greater fidelity to evidence-informed practices. Examples from Pakistan, Malawi, and Ethiopia demonstrated policy adaptation and scaling of interventions derived from EIR evidence. Across projects, early engagement of decision-makers, alignment with programme cycles, and participatory dissemination were key enablers of uptake. Persistent barriers included limited political commitment, competing priorities, and inadequate post-research financing. When co-led by decision-makers, integrated into programme cycles and national coordination structures, embedded implementation research can accelerate the use of evidence and strengthen programme performance. To maximise its potential, future EIR efforts should prioritise sustained political commitment, dedicated financing, and mechanisms for ongoing follow-up and learning to ensure that research findings translate into policy and service-delivery improvements.

Radiology impressions guide clinical care. Large Language Models (LLMs)-drafted impressions can drift into generic, off-style text. Retrieval-augmented generation (RAG) enables context-aware few-shot prompting during inference. This retrospective IRB-approved study included 11,998 CT pulmonary angiography (CTPA) reports. We built a retrieval bank from 11,399 reports and reserved 599 reports for testing. GPT-4o and LLaMA 3.1-70B generated impressions from the "findings" section using three setups: zero-shot, fixed random few-shot, and dynamic retrieval-selected few-shot (top-k semantic matches; k&#x2009;=&#x2009;3/5/10). We ran temperatures 0, 0.7, 1. We scored outputs against the original impressions with ROUGE and BERTScore F1, report mean scores with 95% confidence intervals, and tested for statistical significance using Wilcoxon signed-rank test. Dynamic retrieval-based few-shot prompting outperformed zero-shot and fixed few-shot prompting across all configurations (all p&#x2009;<&#x2009;0.05). The highest scores were observed at temperature 0 and k&#x2009;=&#x2009;10. ROUGE-1 F1 increased to 0.44-0.47 for GPT-4o and 0.37-0.50 for LLaMA, versus 0.35-0.37 and 0.25-0.37, respectively, in zero-shot prompting. Lower temperature and larger k were associated with higher similarity scores. Dynamic, case-matched retrieval improved alignment of LLM-generated CTPA impressions with reference impressions on automated text-similarity metrics. Scores remained moderate, and radiologists' verification is still required before clinical deployment.

Disasters pose a significant concern for healthcare systems. Dentists, as essential members of healthcare teams, possess skills and capabilities valuable for disaster risk management. However, little is known about the knowledge, attitudes, and practices (KAP) of natural disaster risk management among dentists in Iran. This study was conducted to evaluate dentists' KAP of natural disaster risk management and to determine the correlation between these variables. This cross-sectional study involved 403 general and specialist dentists from Kerman city in southeastern Iran. We evaluated dentists' KAP of natural disaster risk management using a researcher-designed questionnaire and convenience sampling. The results showed that dentists had high knowledge (12.96&#x2009;&#xb1;&#x2009;1.54, 92.6%), desirable attitudes (46.42&#x2009;&#xb1;&#x2009;2.45, 99.3%), and desirable practices (17.63&#x2009;&#xb1;&#x2009;1.89, 94%). Higher knowledge was observed among dentists aged over 46 years, married participants, those working in private and public clinics, and those with more than 21 years of experience. Positive attitudes were more common among married dentists, those employed in both private and public clinics, and those with less than 10 years of work experience. Multivariate analysis further showed that age and working in both private and public clinics were significant predictors of higher knowledge, while employment in both settings was associated with a more positive attitude. Given the high levels of knowledge, positive attitudes, and effective practices among Iranian dentists in disaster risk management, they can play a pivotal role in emergency response. To utilize this capacity, it is essential to formally recognize and integrate the participation of dentists into the national disaster management system. This integration requires establishing standardized protocols and interdisciplinary training programs to better incorporate the dental profession into Iran's emergency response structure.

Venom-induced compartment syndrome (VICS) is a rare but severe complication of snakebite which poses unique challenges in diagnosis and treatment. Published literature largely focuses on VICS in the North American context, while information on clinical presentations, diagnostic and treatment approaches, clinical outcomes and associated challenges from the world's most snakebite endemic regions remain fragmented and scarce. A scoping review using PRIMSA-ScR methodology of the global literature on VICS was performed by searching the PubMed, Embase, and Cochrane databases. Literature was divided into 1) Case reports on VICS and 2) General literature. Clinical data from eligible case reports was extracted to describe management of VICS and associated challenges. Available evidence on diagnostic and treatment strategies was extracted from the general literature. Of 115 cases of VICS analyzed, most were from Europe (40%); Only 13% and 6% were reported from South-East Asia and Africa respectively. Viperids caused 73% of bites and upper extremities were most frequently affected (63%). Compartment pressure was measured in 38% of patients. Compartment pressure was more commonly measured in the 12% of non-surgically treated patients, none of whom developed ischaemic contracture or required amputation. Coagulopathy was the most common systemic toxicity, present in 40% of patients at admission. Results from eight animal studies support the use of antivenom for treating VICS. Analysis of 17 human observational studies suggests an overdiagnosis of VICS using clinical symptoms alone, highlighting the need to investigate diagnostic tools, such as ultrasound, for diagnosing compartment swelling. Antivenom as first-line treatment for VICS is supported by animal and human observational studies. However, additional data is needed to inform decision-making on when fasciotomy is indicated as a rescue therapy. Improved evidence generation will depend on the collection of high-quality clinical and diagnostic observational data from patients treated with antivenom in snakebite-endemic regions.

Cognitive impairment is an inclusive term used to describe the impairment of different domains of cognition. It is a growing public health concern and it can be influenced by hyperthyroidism. While the association between hyperthyroidism and cognitive impairment had been documented in other settings, evidence from Ethiopia remains limited. The aim of this study was to determine the prevalence of cognitive impairment and the associated factors among hyperthyroid patients attending Bale zone hospitals, Southeast Ethiopia. An institution-based cross-sectional study was conducted from February to May 2024 among 406 hyperthyroid patients selected using a systematic random sampling technique. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE) tool. Data were entered into EpiData Manager version 4.6.0.0 and exported to STATA version 17 for statistical analysis. The analysis began with descriptive statistics, followed by binary logistic regression. Variables with a p value&#x2009;<&#x2009;0.25 in bivariable analysis were entered into multivariable binary logistic regression. The strength of association was determined by the adjusted odds ratio with a 95% confidence level. The prevalence of cognitive impairment was 29.06% (95% CI: 24.84-33.68). The odds of cognitive impairment were higher in females, rural residents, and those with primary education. Older age (AOR&#x2009;=&#x2009;1.09), higher free triiodothyronine levels (FT3) (AOR&#x2009;=&#x2009;1.03), poor sleep quality (AOR&#x2009;=&#x2009;2.24), and lower wealth (middle: AOR&#x2009;=&#x2009;0.18; rich: AOR&#x2009;=&#x2009;0.19) were linked to higher odds of cognitive impairment. Avoiding alcohol consumption (AOR&#x2009;=&#x2009;0.16) helped lower the odds of cognitive impairment. Cognitive impairment is a significant health problem among hyperthyroid patients in southeast Ethiopia. Old age, higher FT3 levels, poor sleep quality, and low socioeconomic status are the key associated factors.

Continuous antipsychotic treatment is crucial for relapse prevention in schizophrenia. This article reviews the literature comparing long-acting injectable antipsychotics (LAIs) with oral formulations in various outcomes, including relapse prevention, recovery, and mortality reduction. LAIs ensure consistent medication delivery and are increasingly valued especially for patients in the early phase of schizophrenia, in which they help prevent the irreversible consequences of relapse. The reconceptualization of LAIs underscores their role as proactive rather than as last-resort interventions, which positions them as essential tools in early treatment stages. It is vital for clinicians to communicate effectively with patients and their families about the benefits and practicalities of LAIs. Conversations should begin early in treatment to normalize LAI use by addressing potential misconceptions and emphasizing the role of LAIs in maintaining psychiatric stability and reducing hospitalizations. Engaging family members in discussions enhances support networks, which can then aid the patient's adherence to treatment. Clinicians should provide detailed comparisons between available pharmacologic treatment options, including their dosing intervals, administration methods, and side-effect profiles, that are tailored to patient needs and health care settings. Practical considerations such as storage requirements, insurance coverage, and administration logistics must be addressed. By framing LAIs as valuable components of schizophrenia management, particularly in early phases, clinicians can optimize patient adherence and outcomes. This review highlights the growing recognition of the role of LAIs in contemporary mental health care and advocates for their strategic implementation to enhance patient quality of life.