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As recently as November 2024, the National Center for Health Workforce Analysis (NCHWA) of the Health Resources and Services Administration (HRSA) made note of the latest census data of U.S. physicians [1]. It was the conclusion of the NCHWA that the U.S. is presently home to a total of 933,788 "professionally active" physicians of whom 800,355 are "reported as patient care practicing physicians [1]." The NCHWA went on to project a "shortage of 187,130 full-time equivalent (FTE) physicians in 2037" as well as the possibility that "nonmetro areas will experience greater shortages of physicians than metro areas [1]." The NCHWA further estimates that "75 million people live in a primary care Health Professional Shortage Area (HPSA)" and that "a total of 122 million people live in a mental health HPSA [1]." Note was also made of the reality that "the maldistribution of the health care workforce results in severe shortages in rural communities [1]." Seeking to address the extant challenges, a bipartisan group of members of the Senate Committee on Finance stepped into the breach [2]. Led by Sen. Ron L. Wyden (D-OR), it was the intent of the Senators to introduce legislation that will assist teaching hospitals in the training of more physicians by reforming Medicare's Graduate Medical Education (GME) rules [2]. In this Commentary, we review the evolution of the aforementioned draft legislation as well as assess the likelihood of the materialization thereof.
In June 2025, the End Prescription Drug Ads Now Act, introduced by Senators Sanders and King, noted concerns regarding direct to consumer (DTC) advertising and called for its abolition. DTC advertising for pharmaceuticals adversely drives up costs for prescription medications and also leads to time wastage for busy physicians. However, the Act did not address the supplement market of which there are now over 95,000 products for which DTC ads are also common despite the fact that evidence suggests that the majority do not work, are of uncertain value, or do not have significant scientific support. Additionally, some have been sanctioned for making false claims; some have significant mislabeling; some have resulted in hospitalizations; and several have had contaminants. Supplements are approved by the FDA as foods, rather than as medications, an entirely different and less rigorous process. Yet many are not advertised as foods nor do patients treat them as such. We believe the supplement approval process as well as DTC advertising for all pharmaceuticals should be reevaluated. Our manuscript below provides more details.
A growing suite of neurotechnologies that capture brain activity, ranging from wearables to implanted devices, is rapidly transforming practice and research in the clinical neurosciences. States such as Colorado and California have incorporated "neural data" into their privacy laws. In addition, in September 2025, two senators introduced federal legislation, the Management of Individuals' Neural Data (MIND) Act of 2025, which defined "neural data," addressed ethical concerns about its collection and use, and directed the Federal Trade Commission to study how to regulate it. Legislative actions such as these recognize that neural data can potentially reveal unusually sensitive details about identity, cognition, and capacities that ordinary health information does not. In practice, however, neural data are heterogeneous, requiring careful consideration of their varying forms, degrees of sensitivity, and the clinical or nonclinical contexts in which they are generated. We describe the difficulties of using common tools, including data privacy and intellectual property, to regulate neural data and examine how clinicians can complement these efforts through deliberate, ethically informed safeguards in clinical practice even before regulatory frameworks are finalized.
Radiology reports serve as the primary communication tool between radiologists and referring clinicians. Dictation errors-textual inaccuracies in finalized reports-can compromise clarity and accuracy. This study evaluates the frequency and nature of dictation errors in resident-generated reports and explores associations with training level, gender, and time of year. This retrospective review examined 600 chest radiograph reports from a large academic medical center in the United States between January 2023 and December 2023. The sample included 500 resident-generated reports (dictated by residents and finalized by attendings) and 100 attending-only reports (dictated and finalized by attendings alone). Dictation errors-defined as inaccuracies introduced during dictation, editing, or proofreading-were categorized as nonsense, omission, redundancy, or internal inconsistency and assessed for clinical significance. Two PGY-2 radiology residents performed manual review, and a board-eligible cardiothoracic radiologist adjudicated all flagged errors. Dictation errors were more frequent in resident-generated reports (14.6% vs 3.0%; p<.0001). Reports dictated by male residents had borderline significantly higher error rates than reports dictated by female residents (16.6% vs 9.7%, p =.0495), a difference which was attenuated when accounting for report word count (OR = 1.56, p =.168). The frequency of errors increased by approximately 42% for each additional year of residency (p =.0016) or 29% for each additional year when corrected for word count (p =.0345), with the highest error rates in reports dictated by senior residents (20.6%). Dictation errors in finalized reports may arise from factors related to resident dictation, attending review, or shared workflow pressures. Differences by postgraduate year and gender may reflect resident performance, attending oversight, or both. Further study is needed to clarify these relationships. Targeted interventions, including ongoing supervision, feedback, and use of automated error detection tools, may help mitigate error risk, and improve documentation quality in radiology training programs.
Digital health technologies are being used in healthcare more than ever, which has implications for the daily work of nurses. As the newest members of the nursing profession, new graduate nurses (NGNs) experience great change during the transition to practice experience. The experience of NGNs transitioning to practice while digital health technologies are being increasingly integrated is not well elucidated in the nursing literature. This proposed scoping review will address this gap and aims to explore and describe the literature involving NGNs and digital health technologies. This review will use the Joanna Briggs Institute (JBI) guidelines to search CINAHL, MEDLINE, Embase, and ERIC databases for keywords and subject headings related to the concepts of "digital health technology" and "new graduate nurses", published between 2020 and 2026. Included articles will involve new graduate nurses with 0-12 months of experience, use digital health technology in the clinical context of nursing, and be peer-reviewed primary research. Articles will be screened and extracted using Covidence and described in line with JBI guidance and presented narratively. The findings of this scoping review will be key in positioning the transition to practice experience for NGNs in an age of digital revolution. Results will be instrumental in enhancing nursing curriculum, ensuring transition policies and procedures are supportive of developing digital health competence and assuring the delivery of better care to patients when using digital health technologies. The contribution of this review will be unique and novel in exploring NGNs and digital health, providing context for the modern experience of transition to practice.
Acid sphingomyelinase deficiency (ASMD) is a rare debilitating lysosomal storage disease resulting in multisystemic disease manifestations, significant disease burden, and early mortality for some individuals. Enzyme replacement therapy (ERT) with olipudase alfa (Xenpozyme) is the first disease-specific treatment indicated for noncentral nervous system manifestations of ASMD in children and adults. During the 1-year primary analysis of the ASCEND placebo-controlled trial in 36 adults with ASMD, olipudase alfa treatment reduced sphingomyelin storage and was associated with clinically significant improvements relative to placebo in multiple endpoints. An open-label extension of the ASCEND trial followed 35 of 36 adults during olipudase alfa treatment for up to 5 years. Mean time on olipudase alfa was 4.2 ± 1.0 years; mean compliance was 90% ± 13%. During long-term olipudase alfa treatment, percent predicted diffusing capacity for carbon monoxide (DLCO) increased (mean 50.1% ± 10.8% at baseline vs. 66.5% ± 13.3% at final assessment; mean change from baseline of 35.9% ± 27.5% (p < 0.0001). Mean baseline spleen volume of 11.5 ± 4.6 multiples of normal (MN) decreased to 4.8 ± 2.1 MN at final assessment, mean change from baseline -57.5% ± 10.1% (p < 0.0001) and mean baseline liver volume (1.5 ± 0.4 MN) decreased to 0.95 ± 0.23 MN at final assessment, (mean change from baseline -36.8% ± 11.5%, p < 0.0001). Plasma lyso-sphingomyelin levels decreased by 72% from baseline to final assessment. Overall, improvements in clinical parameters occurred regardless of baseline severity. No new safety issues emerged during the trial extension and 98% of treatment emergent adverse events were mild/moderate. Improvements in visceral ASMD disease with olipudase alfa treatment will significantly impact the disease burden for those with this progressive multiorgan disorder.
The role of the commercial sector in driving population health outcomes is gaining attention; yet the influence of commercial entities and practices on Indigenous health is underexplored. This case study examined the separate legal disputes between Clothing The Gaps (an Aboriginal business, social enterprise and B-Corp) and two for-profit commercial clothing companies, investigating their potential impact on Aboriginal health and wellbeing, and how Aboriginal business and advocacy can overcome powerful commercial interests. This qualitative case study combined data from interviews with key informants (n = 3) and data extracted from media articles and stakeholder submissions (n = 74) to the Senate Select Committee on the Aboriginal Flag. Data were analysed for key themes with Aboriginal researchers central to the analysis process. Findings suggest that the legal avenues taken by two non-Indigenous companies were enabled by Australia's existing legal and regulatory systems, coupled with notable resource disparities. WAM Clothing and GAP Inc. asserted their legal rights against Clothing The Gaps to protect their respective branding and profits. The 'Free The Flag' campaign demonstrated how Aboriginal business advocacy can garner public and political support to counter profit-focused commercial interests. This case study underscores the importance of recognising the impact of the commercial sector's lawful pursuit of their intellectual property on Indigenous peoples' rights, culture, health and wellbeing, and on the transformative potential of Aboriginal-led advocacy campaigns. Further work is needed to safeguard Indigenous cultural and intellectual property rights, and to investigate the diverse industries influencing Indigenous peoples' health and wellbeing. Not applicable.
Pelvic mesh complication clinics (PMCCs) were established in each Australian state following a senate enquiry into the use of artificial mesh implants for the management of pelvic organ prolapse and stress urinary incontinence. This study aimed to describe the characteristics and clinical care pathways of women presenting to a PMCC at a tertiary hospital in Western Australia. The relationships between neuropathic pain symptoms and depression anxiety stress scale (DASS) scores with referral to pain medicine and psychology, respectively, were investigated. A retrospective cohort study utilising clinical files of 74 women who attended a mesh complications clinic between 2017 and 2024. The mean age of women presenting to the PMCC was 60.6 years, with concerns including urinary leakage (82.4%), bowel symptoms (78.6%), pelvic pain (98.6%), possible/highly likely neuropathic pain (56.8%) and dyspareunia (78.7%). The median wait from referral acceptance to urogynaecologist consultation was 185 days (quartile one, quartile three; 116, 367). Management included topical oestrogen (83.8%), referral to physiotherapy (87.8%) and pain medicine (87.4%) with median (quartile one, quartile three) wait to referral of 0 (0,0) and 0 (0,14) days, respectively. A greater proportion of those categorised as possibly/highly likely to have neuropathic pain were referred to pain medicine (p = 0.005). Only 13.5% were referred to psychology, with no association between those referred and higher combined score on the DASS (p = 0.205). Most women attending a PMCC reported a variety of urogynaecological and pain symptoms, requiring an evidence-based, timely, individualised and multidisciplinary management approach.
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Bills to prevent transgender youth from participating in school sports have passed in many states, including Missouri Senate Bill 39. In response, past St. Louis Mayor Tishaura Jones signed an executive order (No. 77) to support and protect transgender residents in the City of St. Louis, Missouri; this executive order addressed numerous public spaces, including the city's seven recreation centers. In this Practice Note, we describe a pilot initiative, Free to Flex, with the goal of supporting the safety and inclusion of transgender members within the St. Louis recreation centers. This initiative utilized a participatory action research framework and was guided by a community advisory group. Key elements included: Gender-neutral bathrooms and locker rooms; staff training on gender-affirming communication and care; gender-inclusive signage; updated policies; and revised registration procedures. Implications for policy, practice, and next steps are discussed.
Cardiac implantable device procedures in patients with congenital heart defects often pose a major challenge due to the often very complex anatomy and should be planned and performed by an interdisciplinary team in centers suitable for this. This review article gives a practical guide on how a pacemaker or defibrillator implantation can be successfully performed in patients with complex congenital heart defects based on representative case examples. Device-Implantationen bei Patienten mit angeborenen Herzfehlern stellen aufgrund der häufig sehr komplexen Anatomie eine große Herausforderung dar, die im interdisziplinären Team an hierfür geeigneten Zentren geplant und durchgeführt werden sollten. Die vorliegende Übersichtsarbeit soll eine praxisnahe Hilfestellung anhand von repräsentativen Fallbeispielen geben, wie eine Herzschrittmacher- oder Defibrillatortherapie bei Menschen mit komplexen Herzfehlern erfolgreich durchgeführt werden kann.
To protect older adults and their rights, social distancing, isolation and quarantine were the key measures put in place to slow down the spread of COVID-19. Yet several studies have highlighted the importance of contact and emotional support from families for residents of long-term care facilities. The purpose of the study was to elicit the experiences and perceptions on the COVID-19 epidemic preventive measures and gain insights into the perspective of people who had family members in Slovenian nursing homes during the pandemic. A qualitative descriptive research paradigm with social constructivist approach was employed. Due to COVID-related restrictions, the method of formal natural group interview was used to conduct a single group interview. The interview guide comprised five open-ended questions with prompts. A purposive sample of relatives was invited to participate, with 25 out of 34 invited relatives confirming participation. Participants were 50–85 years old and had relatives in nursing homes—most often their parents or, alternatively, their spouses/partners. Three experts facilitated the group interview which was recorded. Transcripts were coded using thematic analysis. Ethical approval was obtained by the lead investigator’s home institution. Data synthesis yielded seven sub-themes and three themes: “Paternalism of authorities and health professionals” (medicine, nursing) towards residents and their relatives; “Negative impact on the health of residents and relatives”; and “The ethics of triage in relation to residents’ hospital access”. Overall, the approaches of those in charge of long-term care facilities were perceived as paternalistic and detrimental to the health and quality of life of nursing home residents during the pandemic. Our findings corroborate other international studies on the issues experienced in long-term care facilities for older adults during the pandemic. Relatives should not be a burden for the nursing home residents and should not feel like a controlling authority, but should be an important factor for the vitality and quality of residents’ lives. Our findings highlight the key role of health professionals in nursing care homes, particularly in terms of taking responsibility for protecting the autonomy and rights of residents and their relatives. Not applicable.
Potential etiologies of hip pain, especially in younger patients with acetabular dysplasia and various impingement syndromes, or in older patients following arthroplasty can be subtle radiographically, and quantitative assessment on standardized imaging is often performed to confirm the diagnosis and help clinicians choose between conservative or surgical management. As hip preservation and joint replacement surgical techniques have become more sophisticated and widespread, the number of measurements reported in the literature to detect subtle abnormalities has greatly increased, and measurement techniques may vary between institutions. As a result, musculoskeletal radiologists may be less familiar with particular measurements requested by clinicians. This article is the first of a three-part series describing measurements of the lower extremity and focuses on the most common measurements used by hip preservationists and hip replacement surgeons, including the proper study on which to perform each measurement, the proper measurement technique and the normal value(s) based on current literature. Finally, the implications of abnormal values for each measurement are briefly discussed. The measurements are grouped by anatomy and pathology; those that are more commonly used clinically and reported in the literature are discussed in greater depth, while those that are less common or may be primarily used for research are described more briefly with imaging examples.
The ankle and foot rely on a complex, coordinated interaction of numerous small bones and supporting soft tissues to produce efficient locomotion and weight bearing. Subtle osseous malalignments or insufficiency of tendons and ligaments can result in pain, instability and arthropathy. Although gross malalignment can be seen qualitatively, detecting subtle malalignment often requires standardized measurement on imaging studies with prescribed techniques. Moreover, stress imaging techniques, such as weightbearing or angular stress, are more often used in ankle/foot imaging compared with other lower extremity joints, which results in an added layer of complexity when performing measurements. In the ankle/hindfoot, quantitative assessment is most commonly used to detect and/or characterize ankle instability, calcaneal fractures and posterior tibialis tendon dysfunction. Furthermore, quantitative assessments of ankle arthroplasties may help diagnose device failure. In the midfoot, assessment of the tarsometatarsal joints can help detect subtle Lisfranc instability, while in the forefoot, quantitative characterization of hallux valgus is often used to guide surgical management. This review article is the last of a three-part series discussing measurements of the lower extremities and focuses on common measurements used in the foot and ankle, grouped by pathology, with attention to the imaging study of choice for each measurement, as well as the appropriate technique of measurement.
Although most imaging assessments are made qualitatively, quantitative measurements in orthopedic imaging are becoming more important in detecting subtle findings and assessing degrees of abnormality, which can help direct surgical management. In the knee, patellofemoral maltracking is a common cause of anterior pain, particularly in younger patients. Failure to recognize this pathophysiology may result in accelerated chondral loss and osteoarthritis (OA), and the imaging findings may be subtle. As a result, clinicians and radiologists have developed numerous measurements to detect and quantify patellofemoral alignment. Additional entities, such as femorotibial subluxation or angular abnormalities, may only be detected by using standardized measurements and can help detect ligamentous insufficiency or developmental malalignment, which can lead to instability and OA in the medial and lateral femorotibial compartments. Finally, the proper positioning and hardware selection for knee arthroplasty are critical to preventing early hardware failure and postsurgical pain. This review, which focuses on the knee, is the second in a three-part series discussing the appropriate imaging modalities on which to obtain specific lower extremity measurements as well as proper measurement techniques, grouped by pathology. Furthermore, the normal value or range of values according to current literature is reported, along with the significance of abnormal measurements.
Rosai-Dorfman syndrome is a rare disease that belongs to the group of non-Langerhans cell histiocytosis. Affected patients can exhibit a wide variety of symptoms, which can be divided into nodal and extranodal manifestations. The syndrome primarily presents with fever, enlarged lymph nodes, and weight loss. Extranodal findings may include pancreatic cysts, hypergammaglobulinemia, and infiltration of testicular tissue. Skin involvement occurs in approximately one-third of cases. In addition to routine beside histopathology, immunohistochemistry with positivity for S100 and CD68 and negativity for CD 1a is particularly decisive for diagnosis. Topical and/or systemic steroids are used as first-line treatment for skin manifestations. In individual case studies, other systemic therapies have been used. Other treatment options include methotrexate (MTX), sirolimus, or rituximab. If KRAS/MAP2K1 mutation is detected, treatment with MEK inhibitors may be considered. Das Rosai-Dorfman-Syndrom ist eine seltene Erkrankung, welche zu den Non-Langerhans-Zell-Histiozytosen zählt. Betroffene Patienten können verschiedenste Symptome aufweisen, die sich in nodale und extranodale Manifestationen aufteilen lassen. Primär präsentiert sich das Syndrom mit Fieber, Lymphknotenschwellungen und Gewichtsverlust. Zu den extranodalen Befunden können Pankreaszysten, eine Hypergammaglobulinämie und eine Infiltration des Hodengewebes zählen. Eine Hautbeteiligung tritt bei ca. einem Drittel der Fälle auf. Bei der Diagnostik ist neben der Histologie die Immunhistochemie mit Positivität von S100 und CD68 und Negativität von CD 1a von besonderer Bedeutung. Als Therapie der Hautmanifestation werden zunächst meist topische und/oder systemische Steroide angewandt. Weitere Systemtherapien sind überwiegend kasuistisch beschrieben. Weitere Therapiemöglichkeiten sind Methotrexat (MTX), Sirolimus oder Rituximab. Bei Nachweis einer KRAS/MAP2K1-Mutation kann auch eine Therapie mittels MEK-Inhibitoren diskutiert werden.
Chronic hepatitis C virus (HCV) infection constitutes a substantial healthcare concern in Türkiye. The clinical application of direct-acting antiviral medications (DAAs) has transformed its management. The goal is to assess the efficacy and safety of DAAs in the real-world setting in Turkish patients with chronic HCV. Thirty-seven centers from Türkiye recorded 1807 patients to the database. Patients aged >18 years were enrolled to the study. Their demographics, clinical information, DAAs used, efficacy, and safety information were evaluated. Efficacy and safety results were reported for patients with 12-week post-treatment (SVR12) data. Among the patients, 919 (50.9%) were female with a mean of age 56 ± 15 years (range:18-97 years) and 238 (13%) were cirrhotic. Liver biopsy was performed in 296 patients. Mean histologic activity index score was 7.68 and fibrosis score was 2.58. Baseline mean viral load was 4.11×106 copies/mL. Patients received the following treatments: Paritaprevir+Ritonavir+Ombitasvir+Dasabuvir (PrOD):706, Ledipasvir+Sofosbuvir:490, Sofosbuvir+Ribavirin:176, PrOD+Ribavirin:175, Ledipasvir+Sofosbuvir+Ribavirin:156, PrO+Ribavirin:32, and PrO:10. Response at the end of treatment was 99.2% (1454/1465) and SVR12 was 97.8% (1289/1318). The DAAs were generally well tolerated. Ten and 13 patients discontinued therapy because of drug-related and unrelated adverse side effects, respectively. This real-world study demonstrated that DAA treatment for HCV is both safe and highly effective. In two-thirds of the patients, the hepatic inflammation is moderate to severe, and fibrosis is moderate to advanced in half of them. Patients' characteristics suggest that HCV infection is often not diagnosed or treated until patients present with moderate-to-severe stage, indicating that diagnostic and therapeutic approaches should be used more effectively.
The aim of this study was to: (a) compare potentiation effect of three eccentric phase duration on countermovement jump (CMJ); (b) evaluate approaches for verification of post activation performance enhancement (PAPE); (c) verify whether muscle saturation and time of reoxygenation are relevant to explain PAPE. Eighteen men with experience in strength training completed four sessions. The first one included one repetition maximum testing (1RM) and familiarization. The remaining focused on potentiation protocol which was four repetitions with 80% 1RM at given tempo, 2/0/X/0 (FAST), 4/0/X/0 (MED), 6/0/X/0 (SLOW) respectively. Before and after conditioning activity (CA) CMJ was conducted. During CA barbell velocity and muscle saturation was monitored, There were no changes in CMJ height at 1, 4 and 8 min (F(3153) = 0.65, p = 0.58) in each condition. However, for an approach with changes between pre-post analysis showed significant increases in the CMJ height for SLOW (3.5%, p < 0.05) and MED (4.2%, p < 0.01) The smallest worthwhile change analysis showed the highest proportion of participants exhibiting a PAPE effect. Muscle saturation did not differ tempo and time of reoxygenation has not any relationship on magnitude of PAPE. Methodological approach has a large influence on the examination PAPE. Muscle saturation does not provide explanation of PAPE.
In order to assess the pain phenomenon, a pilot cross-sectional study was conducted. The aim of this study was to determine the correlation between segmental body composition and cervical spine mobility in individuals with nonspecific neck pain (NSNP). Forty-six individuals aged 18-75 were recruited for the study. After completing the cervical spine safety test, participants completed a socio-medical survey, assessed their pain level using a 10-point VAS scale, quality of life using the SF-36, assessed their total and segmental body mass (upper limbs) using a Tanita BC-418 body composition analyzer, and assessed their active range of motion (AROM) using the CROM system (Performance Attainment Associates, Roseville, MN, USA). Descriptive statistics (median and quartiles) were used to evaluate the obtained results, and nonparametric tests (no normal distribution of the studied variables) were used to compare the results between groups. The results showed that NSNP was associated with job type, stress level, and time spent using a smartphone. Pain severity increased with age, BMI, and increased fat mass. AROM was within the normal range (SFTR system for measuring angles in human joints according to the International Standards for Orthopaedic Measurements) for flexion-extension, right and left rotation, and was slightly lower for right and left lateral flexion. No statistically significant differences in AROM were observed depending on pain levels (p = 0.628-p = 0.869). Based on the conducted research, it can be concluded that NSNP is associated with lifestyle. Pain intensity was observed to be accompanied by a decrease in AROM in all areas examined. Cervical spine pain levels also increased with age, BMI, and total and segmental fat content. It was noted that AROM does not always correlate with pain intensity, warranting further research. The results indicate that patients consult a physiotherapist with long-term pain. At the same time, lifestyle factors exacerbate pain symptoms, ambiguously affecting AROM, which requires further investigation.