Intimate partner violence (IPV) is a major contributor to poor health outcomes, particularly for women in rural areas. Geographical and social isolation can impede access to support networks and limited availability of specialised services can further compound vulnerability. Within this context, rural emergency departments have become key access points for IPV support; presenting an opportunity to explore how identification and response are approached in these rural settings. This scoping review synthesises current research on clinician IPV identification and response practices in rural emergency departments (EDs) to inform future improvements in care and service delivery. This scoping review followed the Joanna Briggs methodology drawing on a search of four databases yielding ten peer-reviewed articles published between 2011 and 2025 that explored clinician IPV identification and response practices in rural EDs. Five themes emerged: (1) Training and preparedness for IPV Practice, (2) Clinician Attitudes & Readiness, (3) Structural Barriers in Rural EDs, (4) Identification & Documentation Practices (5) Organisational and System Supports. Rural EDs face complex barriers to effectively identifying and responding to IPV, including workforce limitations, confidentiality concerns, and systemic under-resourcing. Enhancing emergency clinicians' IPV practices requires greater focus on trauma-informed organisational approaches, supported by workforce training that reflects the realities of rural healthcare and the communities it serves.
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The retrospective component of this mixed method study leveraged implementation science to assess the execution of an acute-on-demand telehealth (AODTH) service pioneered in a Singapore public primary care institution using video consultation (VC) targeting the local multiethnic population. A study was conducted using electronic medical records and AODTH service data from 2023 to 2024. The data were computed to determine the implementation outcomes based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework: demographics of users (Reach); conversion to in-patient consultations (Effectiveness); AODTH uptake (Adoption); defaulters, post-VC referral to emergency or specialist outpatient services, medical certification (Implementation); purpose and service utility trend (Maintenance).Descriptive statistics, Pearson's χ2 test and regression analyses were executed to report implementation outcomes and associated factors. Data were obtained from a primary care clinic (polyclinic) in eastern Singapore. AODTH users aged ≥18 years who used the service between 2023 and 2024 were included. No exclusion criteria were applied. 39 811 AODTH VCs were completed by 17 603 unique users, including 44.4% males and Chinese (59%) and Malay (24%) ethnicity. Senior adults aged 65 years and older represented only 2.5% of users and 1.2% of VCs. Monthly VC volumes in 2024 exceeded those in 2023, with some months recording nearly double the consultation numbers and surpassing 2500 VCs in the second half of 2024. Mean default (6.6%) and conversion (2.2%) rates showed a decreasing trend from 2023 to 2024. Referrals to emergency or specialist outpatient services constituted 5.6% of VCs. Acute medical conditions accounted for 82.7% of VCs, chronic disease management 12.4% and other reasons 4.9%, with upper respiratory tract infections comprising almost half of acute cases. Over half (50.9%) of consultations were not prescribed medications, of which 72.3% were issued sick leave. 81.3% of users had two or fewer sick leave issuances, including those with none. Although AODTH outreach to older adults was low, the service was effective for acute medical management with low in-person consultation conversion despite the lack of physical examination. The rising trends of AODTH users and VCs over 2 years reflect gradual service adoption, while low defaulter and referral rates reflect an appropriate implementation framework. Prevalent medical certification is likely the cornerstone to maintain AODTH service as a means for recovery from acute illnesses.
Respiratory viral panels (RVP) are common, expensive tests that often do not change treatment, especially in children with suspected urinary tract infections. In children with abnormal urinalysis (UA) results, we hypothesize that RVP overuse existed before the COVID-19 pandemic and has risen further after. We conducted a single-center retrospective cohort study of children aged 0 to 24 months who presented to a quaternary care children's emergency department (ED) from March 2018 to May 2025 with abnormal UA results. Children with complex chronic conditions, required intensive care or respiratory support, or sepsis were excluded. The primary outcome was the proportion of children with RVP testing within periods of prepandemic (March 2018-February 2020), pandemic (March 2020-May 2023), and postpandemic (July 2023-May 2025). Secondary outcomes included ED revisits, antiviral use, and cost of testing. We assessed trends in RVP use across the periods using interrupted time series analysis. Cost was measured using Medicaid reimbursement fees. Our cohort included 7496 patients. The proportion of all children who received an RVP was 25.0% (95% CI, 23.1-27.0), 68.1% (95% CI, 66.5-69.7), and 66.1% (95% CI, 64.1-68.0) during prepandemic, pandemic, and postpandemic periods, respectively. There was an increase in viral testing during the pandemic compared with prepandemic period (P < .001) but without change between pandemic and postpandemic (P = .14). Viral testing was associated with no differences in ED revisits (P = .41). Only 134 patients (1.8%) received antivirals. The total cost of respiratory viral testing was $1 037 978. RVP testing increased during the COVID-19 pandemic in children with abnormal UA results and remained elevated postpandemic. RVP testing was costly and associated with low antiviral use. These results highlight opportunities for diagnostic stewardship.
A healthy man in his 40s presented with acute anterolateral ST-segment elevation myocardial infarction after sudden-onset chest pain during a coughing episode. Coronary angiography and intravascular ultrasound revealed extensive spontaneous coronary artery dissection (SCAD) of the left anterior descending artery with Thrombolysis in Myocardial Infarction II distal flow. He was managed conservatively, but his course was complicated by severe left ventricular systolic dysfunction, apical thrombus and a ventricular tachycardia storm leading to cardiogenic shock. He required repeated emergency direct-current cardioversions, intravenous amiodarone, lidocaine and intra-aortic balloon pump support. Cardiac magnetic resonance imaging confirmed extensive myocardial infarction. Clinical recovery was achieved without revascularisation, and an implantable cardioverter-defibrillator was implanted for secondary prevention alongside guideline-directed heart failure therapy. At follow-up, he remained clinically stable. This case highlights that SCAD, although uncommon in men, can present with life-threatening complications and that carefully tailored conservative management with multidisciplinary input may achieve favourable outcomes.
To evaluate the use of angiography in pediatric blunt abdominal trauma with hepatic and/or splenic injuries following the 2019 Updated APSA Blunt Liver/Spleen Injury Guidelines. The Trauma Quality Improvement Program (2020-2023) was queried for patients ≤18-years-old who sustained blunt abdominal trauma resulting in hepatic and/or splenic injury. Patient demographics, injury characteristics, interventions, and outcomes were analyzed. Trauma centers were categorized as adult, dual adult-pediatric, or pediatric trauma centers. Multivariable logistic regression was used to identify predictors of angioembolization and splenectomy. Patients with concomitant penetrating trauma and patients who died in the emergency room were excluded. A total of 13,788 pediatric patients were identified. Most (13,363; 97%) were managed without interventional radiology procedures, while 217 (1.6%) underwent diagnostic angiography only and 208 (1.5%) underwent angioembolization. Patients undergoing angiography or angioembolization had greater injury severity compared with those managed without interventional radiology (median ISS 29 and 35 vs 17, p < 0.001). Markers of hemorrhage were more common among patients undergoing angioembolization, including transfusion requirement (85% vs 18%, p < 0.001). Notably, only 47% of patients undergoing angiography without embolization required transfusion. Angioembolization utilization differed by trauma center type (2.0% adult, 1.7% dual, 0.8% pediatric; p < 0.001). In addition, angioembolization was not independently associated with decreased odds of splenectomy. Despite the updated 2019 APSA guidelines, angiography and angioembolization utilization continue to vary across trauma center types. While interventional radiology remains more common in patients with markers of severe injury, a subset of patients underwent angiography without transfusion requirement, suggesting potential continued overutilization and opportunities to further standardize guideline-based care.
Cycling-related injuries are a growing public health concern. Although bicycle helmets are intended to reduce head injury severity, evidence regarding traumatic brain injury and mortality remains limited in large emergency department (ED)-based datasets. This matched case-control study used South Korean ED-based Injury In-depth Surveillance data from 2011 to 2021. Cases were injured cyclists who died in the ED; controls were injured cyclists whose ED disposition was not coded as death. Controls were matched to cases at a 1:4 ratio by age, sex and year of visit. Conditional logistic regression assessed associations of recorded helmet use with traumatic brain injury, the primary outcome and ED mortality, the secondary outcome. Among 1394 injured cyclists, 282 were cases and 1112 were controls; 155 patients (11.1%) were recorded as wearing helmets. Recorded helmet use was associated with lower odds of traumatic brain injury, but the association was not statistically significant after adjustment (adjusted OR: 0.76, 95% CI 0.40 to 1.44). It was also associated with lower odds of ED mortality (adjusted OR: 0.30, 95% CI 0.14 to 0.65); however, only 11 helmeted patients died in the Evening crashes:ED arrival during evening hours (18:00-24:00) was associated with higher odds of ED mortality compared with daytime hours (06:00-18:00), and motor vehicle collisions were associated with higher odds of ED mortality. Recorded helmet use was not significantly associated with traumatic brain injury after adjustment. Its association with lower ED mortality was based on only 11 helmeted deaths and may reflect limited precision, residual confounding and unmeasured crash severity. This finding should be interpreted cautiously and confirmed in larger studies with detailed crash data.
Intensive care units (ICUs) are among the most resource-intensive areas within health care and generate more waste and greenhouse gas emissions. Critical care nurses (CCNs) are well positioned to influence environmentally sustainable practices. To assess CCNs' attitudes and climate-health engagement related to healthcare sustainability, to explore perceived challenges and identify other factors affecting sustainable practice in critical care settings. A quantitative descriptive cross-sectional study was conducted using convenience sampling of CCNs working in adult ICUs, emergency departments and cardiac care units in the Eastern Region of Saudi Arabia. Data were collected using the Sustainability Attitudes in Nursing Survey (SANS-2), Climate, Health and Nursing Tool (CHANT) and a self-developed checklist to assess perceived challenges to practising healthcare sustainability, which were distributed electronically. Descriptive and inferential statistics, correlation analysis and multivariate linear regression were performed. A total of 216 CCNs participated, yielding a response rate of 90%; the respondents demonstrated generally positive attitudes towards sustainability and climate change (mean SANS-2 score = 23.87 ± 8.69). Concern about the health impacts of climate change ranked highest among CHANT domains (76.0%), while sustainability-related behaviours at work were lowest (49.1%). Awareness, concern and motivation were positively associated with sustainability behaviours, whereas attitudes showed weak associations with behaviour. Key challenges included lack of organisational support (45.8%), staff shortages and workload (41.2%) and inadequate policies or infrastructure (36.1%). Leadership role and lack of previous training independently predicted higher attitude scores, whereas prior education predicted greater climate-health engagement. Although CCNs express strong concern and positive attitudes towards sustainability, organisational and workload constraints limit translation into practice. Strengthening leadership engagement, targeted education and institutional support is essential to embed sustainable practices in critical care. The study highlights sustainability attitudes, climate-health engagement, perceived challenges and persistent behavioural gaps, while identifying the central roles of education, leadership, and organisational support.
A structured, system-level quality improvement (QI) initiative at Singapore General Hospital was undertaken to reduce postoperative length of stay (LOS) after uncomplicated lower segment caesarean section (LSCS) and improve performance on the national Value-Driven Care clinical quality index. This project specifically targeted an increase in postoperative day 3 (POD3) discharge rates towards the 88% internal benchmark without compromising safety or increasing readmissions.Uncomplicated LSCS cases between October 2023 and September 2025 were included, with complicated caesarean sections and severe neonatal morbidity excluded. A single-centre pre-post design was used, with October 2023-September 2024 as the baseline period and October 2024-September 2025 as the intervention period. Root causes of delayed discharge were identified using a fishbone (Ishikawa) analysis, informing a three-phase, system-level intervention: department-wide performance sharing, a bundled intervention (standardised patient education, multidisciplinary discharge coordination via Microsoft Teams and coding support) and clinician-specific feedback.Baseline POD3 discharge performance was 80.0% (n=352) after correction of coding inaccuracies. Following phased implementation, the postoperative LOS ≤3 days rate increased to 84.5% (n=241) overall, with a more marked improvement from 83.3% to 92.5% after introduction of the bundled system-level intervention. Run charts showed an upward shift and reduced monthly variation in POD3 discharge rates, indicating more consistent practice. There was no clinically significant increase in 30-day readmissions, emergency attendances or postoperative complications, and a simple cost analysis estimated savings of SGD 70 884 from reduced LOS.This multidisciplinary, enhanced recovery after surgery-aligned QI project successfully shortened postoperative LOS for uncomplicated LSCS without evidence of harm. Core components-clear discharge expectations, coordinated mother-baby discharge planning, accurate coding and non-punitive clinician feedback-are conceptually transferable to similar obstetric units seeking to optimise postcaesarean LOS within value-based care frameworks.
Infected diabetic wounds face a dual therapeutic challenge of rapid biomaterial degradation under combined oxidative-osmotic stress, and mechanical collapse of conventional redox-active polysaccharide gels upon prolonged wet-state exposure. To address these challenges, we engineered a tri-domain phyto-cryogel integrating oxidized lignin, gum Arabic, and Aloe vera into an interpenetrating architecture. A covalently crosslinked poly (N-vinylpyrrolidone-co-N,N'-methylenebisacrylamide) [poly(NVP-co-MBAM)] backbone provides wet-state persistence. At the same time, hydrogen-bond-rich polysaccharide domains maintain hydration under hyperosmotic challenge, and lignin-derived phenolic motifs contribute radical-scavenging capacity. The tri-domain cryogel retained consistent antioxidant activity across seven 2,2-diphenyl-1-picrylhydrazyl (DPPH) cycles (82.4 ± 0.6% to 81.0 ± 0.2%, p > 0.05), whereas binary preparations showed significant decay. In an infected diabetic animal model, the lignin-gum Arabic-Aloe vera (LGA) 0.2% tri-domain cryogel accelerated early-stage wound closure compared to a medical-grade bandage control (38.6% vs. 19.3% by Day 3, p < 0.01), accompanied by reduced cluster of differentiation 68 (CD68) macrophage infiltration, normalized redox ratios, and enhanced angiogenesis. These findings demonstrate that polymer architecture-driven microenvironment buffering, through integrated mitigation of oxidative stress, osmotic stress, and infection, can accelerate diabetic wound healing without relying on drug delivery.
Cortical interneurons are essential for the formation, maturation and functional balance of mammalian brain circuits. Originating in the ventral telencephalon, they migrate into the cortex through organized streams and diversify into multiple inhibitory subtypes. Advances in molecular biology, imaging and single-cell transcriptomics have revealed the remarkable heterogeneity in their development. Understanding their molecular and functional complexity is a gateway to understanding in full their critical roles in neural synchronization, cognitive processes, sleep regulation and their potential links to the emergence of human-specific brain functions. These findings aim to inspire future studies focused on deciphering the origins of human interneuron, the diversity of interneuron functions and their implications for understanding neurodevelopmental disorders.
The integration of metal organic frameworks (MOFs) with sustainable polymer matrices has emerged as an effective strategy for developing multifunctional composites with improved stability and practical applicability. Among biomass-derived polymers, carboxymethyl cellulose (CMC) has attracted increasing attention due to its low cost, excellent processability, water solubility, and abundant functional groups, making it an ideal platform for constructing MOF-based composites. This review provides a comprehensive overview of recent advances in CMC-MOF composites, with particular emphasis on their design principles and functional applications. The fundamental characteristics of CMC and MOFs relevant to composite formation are first introduced. Subsequently, fabrication strategies, including in-situ growth and ex-situ assembly, are systematically discussed, with emphasis on interfacial interactions and structural regulation. The diverse structural forms of these composites, such as hydrogels, membranes, aerogels, and beads, are also summarized. Importantly, the relationships between material structure, physicochemical properties, and application performance are highlighted to guide rational design. Emerging applications in environmental remediation, biomedicine, sensing, and energy are discussed, along with current challenges and future perspectives.
Mechanical adaptation underlies mechanical homeostasis by enabling living systems to maintain characteristic mechanical states under sustained perturbations. Turnover-mediated remodeling contributes to this process by renewing or reorganizing internal structures under load across biological scales. While substantial advances have been made in understanding remodeling mechanisms, reduced-order system-level interpretations that relate feedback structure to characteristic timescales remain limited. Here, we develop a systems-based reduced-order formulation that provides a feedback representation for turnover-mediated mechanical adaptation processes. We first formulate a minimal actin-based model as a concrete starting point for linking turnover-mediated remodeling with mechanical response and identifying three system-level elements: a disturbance input, a remodeling state, and a regulated mechanical quantity. In the resulting local linearized representation, turnover-mediated remodeling dynamics can be represented in an integral-equivalent closed-loop form, yielding a local characteristic timescale determined by the local turnover and mechanical gains. A literature-based descriptive comparison shows that reported adaptation times lie near or above the corresponding turnover-related timescale ranges in representative multiscale systems. The present formulation provides a reduced-order system-level representation that relates turnover-mediated mechanical adaptation to feedback structure and characteristic timescales.
While mechanical alignment (MA) has long been the gold standard in total knee arthroplasty (TKA), functional alignment (FA) has recently emerged as a promising alternative, particularly with the advent of robotic-assisted techniques. Despite its growing adoption in clinical practice, comparative evidence between functional and mechanical alignment remains limited, especially for postero-stabilized (PS) TKA. The present study means to compare mechanical and functional alignment in TKA in terms of patient-reported and functional outcomes at a minimum of one year follow-up. Functional alignment would result in superior functional outcomes compared to mechanical alignment in total knee arthroplasty, without compromising perioperative safety. This single-center, retrospective cohort study included 172 patients undergoing primary TKA performed by the same surgeon between 2016 and 2024. Following a 1:1 propensity score matching, patients receiving MA-TKA with navigation (n = 86) were compared with those receiving FA-TKA with robotic assistance (n = 86). The primary outcome was the rate of persistent pain (VAS ≥ 4/10) at six months. Secondary outcomes included validated patient-reported outcomes (PROs), operative time, hospital stay, and complications. At six months, the prevalence of persistent pain was comparable between groups (MA: 15.1%, FA: 19.8%; p = 0.55). At one-year, PROs were similar across all metrics (p > 0.05), although the FA group consistently demonstrated numerically superior scores. Two isolated WOMAC items (pain and difficulty walking on a flat surface; both p = 0.02) favored the FA group. Operative time (101.7 ± 16.7 vs 119.6 ± 16.0 min; p < 0.01) and hospital stay (7.7 ± 2.0 vs 9.2 ± 3.8 days; p < 0.01) were significantly shorter in the FA group. Complication and revision rates were low and not significantly different between groups. As the two cohorts also differed in surgical technology and treatment era, these perioperative findings should be interpreted as exploratory and not necessarily attributable to alignment strategy alone. Functional alignment in robotic-assisted TKA resulted in pain and functional outcomes comparable to mechanical alignment with computer navigation, without demonstrating clinical superiority. Perioperative differences (operative time and hospital stay) were observed but may reflect differences in technology and treatment era rather than alignment strategy alone. These findings support the safety of functional alignment as an individualized alternative to mechanical alignment in contemporary TKA. III; comparative retrospective investigation.
Bacterial translocation and gut dysbiosis are key drivers of systemic immune activation in decompensated cirrhosis, precipitating inflammatory complications such as acute-on-chronic liver failure (ACLF). Currently, no licensed therapies effectively restore intestinal barrier function or reverse dysbiosis in this vulnerable population. While previous studies have suggested benefits of faecal microbiota transfer (FMT) in hepatic encephalopathy or alcohol-associated hepatitis, data on its safety and immunomodulatory effects in decompensated cirrhosis with ascites are lacking. This Phase IIa trial (TransImmune) aims to evaluate the safety and tolerability of encapsulated FMT. Furthermore, it will assess feasibility, microbial engraftment and downstream effects on intestinal barrier integrity, as well as systemic and peritoneal inflammation. This is a prospective, single-centre, randomised, double-blind, placebo-controlled Phase IIa pilot study. A total of 24 patients with decompensated cirrhosis and ascites will be randomised in a 1:1 ratio to receive either encapsulated FMT or placebo over three consecutive days. The investigational product, INTESTIFIX 001, is an encapsulated FMT preparation derived from rigorously screened healthy donors and manufactured under Good Manufacturing Practice (GMP) conditions with predefined release specifications, including minimum alpha-diversity QC criteria, manufactured by the Cologne Microbiota Bank (CMB). The primary endpoints are the occurrence of serious adverse events (SAE) up to the end of study (EOS) and the occurrence and severity of treatment-emergent adverse events (TEAE). Secondary endpoints evaluate signals of clinical efficacy, specifically: (1) systemic inflammation (white blood cell count, C-reactive protein, procalcitonin and IL-6); (2) gut inflammation (faecal calprotectin); (3) organ dysfunction (Child-Pugh, MELD and CLIF-SOFA scores); (4) quality of life (EQ-5D-5L and CLDQ) and (5) the number of antibiotic-free days. Patients will be monitored across five study visits up to 90 days. The study was approved by ethics committee review and the German Federal Institute for Drugs and Medical Devices (BfArM). The trial is registered under EU CT no. 2023-5 07 790-18-00. The results of the study will be disseminated via peer-reviewed publications and at international conferences. EU Clinical Trials Register: 2023-507790-18-00. Registered on 8 August 2024.
Idiopathic pulmonary fibrosis (IPF) and lung cancer (LC) are distinct pathological entities; however, growing evidence indicates that they share convergent cellular and molecular mechanisms. As central post-transcriptional regulators microRNAs (miRNAs) orchestrate critical pathogenetic processes including epithelial-mesenchymal transition (EMT), TGF-β signaling, fibroblast activation, and extracellular matrix remodeling. Circulating miRNA signatures represents a promising class of minimally invasive biomarkers for early detection, risk stratification, and disease monitoring, while emerging therapeutic strategies based on miRNA mimics or inhibitors have shown encouraging results in preclinical models. Understanding the complex interplay of miRNAs at the interface between fibrogenesis and oncogenesis may facilitate the development of novel translational approaches, ultimately improving patient outcomes in both IPF and LC. Dysregulation of specific miRNAs has been implicated in both IPF and LC, some of which with concordant expression patterns, such as miR-21,miR-155, and miR-200 promoting fibrosis and tumor progression, and others exhibiting divergent roles, including miR-204 5-p and members of the miR-20a e miR-425, exerting opposing effects in fibrotic and neoplastic contexts. By systematically integrating mechanistic and regulatory evidence, this review provides a framework for understanding miRNA dysregulation in IPF and LC, with direct implications for biomarker validation and therapeutic targeting.
To evaluate postoperative disposition and resource use among patients admitted to the inpatient unit or pediatric intensive care unit (PICU) following tonsillectomy, adenoidectomy, and tonsillectomy/adenoidectomy (T/A). This retrospective cohort study featured patients aged 18 years or less after T/A procedures in 38 children's hospitals in the Pediatric Health Information System database (2016-2023). Patients were categorized by postoperative disposition: ambulatory, inpatient unit, inpatient unit with subsequent PICU transfer, or PICU; inpatient admissions were analyzed. Primary outcomes were the frequency of urgent interventions (racemic epinephrine administration and noninvasive ventilation) and emergent interventions or outcomes (invasive mechanical ventilation, cardiopulmonary resuscitation, hemorrhage, blood transfusion, or return to operating room). The secondary outcome was median daily hospital cost. A total of 388 071 T/A procedures were identified, including 316 323 ambulatory and 71 748 inpatient. Among the patients in the inpatient unit and PICU, 2% and 16% received an urgent intervention, and, in both locations, 2% received an emergent intervention or outcome. For patients without interventions, the median daily cost difference between PICU and inpatient unit admissions was $1774. Based on the difference between PICU and inpatient costs for patients with no interventions, we estimate that $2.6 million could be saved if 50% of these patients in the PICU were admitted to the inpatient unit. A minority of PICU admissions following T/A procedures require urgent or emergent interventions. This suggests that deimplementation of routine T/A PICU admissions may facilitate transitioning patients to the inpatient unit, reducing costs and optimizing PICU use.
Biventricular pacing (BiVP) is the gold standard for cardiac resynchronization therapy (CRT) in heart failure with reduced ejection fraction (HFrEF), yet up to 30% of patients fail to respond. Conduction system pacing (CSP) has emerged as an alternative with potential for physiological superiority. Multiple 2026 multicentre randomized controlled trials (RCTs) reported contradictory results, necessitating an updated meta-analysis. This analysis aims to compare the safety and efficacy of CSP vs. BiVP for CRT in patients with HFrEF. PubMed, Cochrane CENTRAL, and Embase were searched (January 2010-May 2026) for RCTs and observational studies. Pooled risk ratios (RRs) and mean differences (MDs) were estimated using random-effects restricted maximum likelihood models. Twenty-five studies (11 RCTs, n = 1201; 14 observational, n = 3376) involving 4577 participants were included. In the RCT-only analysis, no significant differences were found in all-cause mortality (RR 0.96; P = 0.91), heart failure (HF) hospitalization (RR 0.67; P = 0.12), or procedural complications (RR 0.83; P = 0.44). Conduction system pacing significantly shortened paced QRS duration (MD -19.52 ms, P < 0.001) and improved New York Heart Association (NYHA) class (MD -0.19, P = 0.05). Combined analysis showed larger effect sizes, including lower all-cause mortality (RR 0.74; P = 0.004) and HF hospitalization (RR 0.64; P < 0.001) in the CSP group. Randomized evidence demonstrates no significant difference between CSP and BiVP in hard clinical endpoints, despite superior electrical resynchronization and modest functional improvement with CSP. Confirmation of any clinical superiority of CSP awaits adequately powered trials reporting objective outcomes.
Adults discharged from the hospital with poorly controlled diabetes face elevated readmission risk, yet health systems lack practical models for integrating remote glucose monitoring into post-discharge care. Existing approaches often exclude patients at the highest risk who have limited English proficiency, adverse social determinants of health or limited smartphone access. At a 292-bed community hospital in White Plains New York, patients discharged with haemoglobin A1c ≥8% showed higher rates of hospital utilisation. Local mortality data revealed disparities affecting Black/African American and Hispanic/Latino residents, prompting a programme design with equity as a core objective. We integrated remote patient monitoring (RPM) into our nurse-led transitional care programme through five Plan-Do-Study-Act (PDSA) cycles from April 2024- to January 2025. Patients received RPM services and care coordination for 90 days. Enrolment, appointment attendance, A1c completion and demographic representation were evaluated through each cycle. Among 442 screened patients, 46 were enrolled (enrolment grew from 10.5% to 39.7%, p<0.001). Enrolled patients closely matched the eligible population across targeted demographic groups. Follow-up appointment attendance reached 78.3% for primary care and 69.6% for endocrinology. A1c testing completion improved to 48% in the final cycle. The most substantial gains in feasibility occurred after redistributing monitoring to a team-based model. Iterative PDSA cycles enabled the development of an equitable RPM-enabled transitional care pathway for diabetes, achieving proportional enrolment across all targeted demographic groups. Key implementation insights included workforce capacity as the primary constraint to enrolment, workflow simplification through continuous glucose monitoring standardisation and the importance of pre-arranged ambulatory follow-up. Health systems implementing RPM for transitional care should prioritise adequate monitoring workforce, streamline device protocols and coordinate ambulatory integration from programme inception to enable scalable, equitable implementation.
Surgery constitutes the only curative treatment of primary hyperparathyroidism (PHPT). The difficulty in localizing all hyperfunctioning parathyroid glands can lead to the persistence of the disease and require a surgical reintervention. Complementary intraoperative tools for the localization of hyperfunctioning parathyroid glands remain, however, limited. The objective of this review is to evaluate the role of near-infrared autofluorescence (NIRAF) and fluorescence with indocyanine green (ICG) injection in the surgery of PHPT. NIRAF allows real-time visualization of the parathyroid glands without dye injection and has shown promising results for improving intraoperative detection of the parathyroids. Parathyroid adenomas appear to present specific autofluorescence characteristics. The impact of NIRAF on the cure rate, complication rate, and reduction of operative time in PHPT surgery remains currently uncertain. As the use of NIRAF in PHPT is still in its early stages, only a few studies have analyzed its impact on surgical outcomes. ICG shows promising results for the identification of parathyroid glands and could allow rapid detection of parathyroid adenomas, although this still needs to be validated in larger series. Its most established and relevant use currently remains the evaluation of vascularization and viability of the parathyroid remnant during a subtotal parathyroidectomy. Prospective studies evaluating the use of ICG in PHPT surgery still need to be conducted. The limitations of NIRAF and ICG techniques are the lack of standardized protocols and the additional cost. In conclusion, fluorescence imaging can facilitate the identification of normal and pathological parathyroid glands, increase the surgeon's confidence, and reduce the need for frozen section pathological examination, with a probably greater benefit for less experienced surgeons. Due to the recent emergence of fluorescence in PHPT and therefore an early stage of use, its main current limitations include the absence of standardized protocols and limited evidence regarding its impact on surgical performance and outcomes.