To describe the use and appointment status of a nationally integrated telehealth pathway in a single-provider public developmental pediatrics clinic in Türkiye and to examine factors associated with telehealth appointment completion and cancellation. This retrospective single-center study included all telehealth appointments scheduled through Türkiye's national Central Physician Appointment System (Merkezi Hekim Randevu Sistemi: MHRS) using the Ministry of Health remote patient assessment module between 1 December 2023 and 1 December 2025. Telehealth appointments were physician-scheduled for selected clinical situations as a complement to prior in-person developmental assessment. Appointment indications, child and family characteristics, and telehealth appointment status categories (completed, cancelled, no-show) were described. Child-level multivariable binomial generalized linear models with logit link and robust standard errors were used to examine factors associated with telehealth completion and cancellation. A total of 526 telehealth appointments were scheduled for 380 children. Telehealth was most commonly used among children with prematurity or neonatal risk and for selected remote assessment purposes, including home-based naturalistic observation and caregiver-shared video review. Overall, 77.4% of telehealth appointments were completed, 20.5% were cancelled, and 2.1% were classified as no-show; among non-cancelled telehealth bookings, the no-show rate was 2.6% (11/418). In adjusted analyses, higher maternal education, paternal age 25-34 years, and travel distance ≥ 100 km were associated with higher cancellation and lower completion, whereas household income and rural residence were not independently associated. In this public developmental pediatrics clinic, a physician-scheduled telehealth pathway integrated within the national appointment system was used as a supplementary service for selected follow-up, counselling, and remote observational assessment needs. Telehealth appointment completion was generally high, but families living ≥ 100 km from the clinic had less favorable appointment status patterns. These findings support telehealth as a complementary service model in developmental pediatrics and highlight the need to address barriers affecting attendance. • Telehealth is increasingly used in developmental pediatrics, but evidence from routine public services, particularlyin low- and middle-income countries, remains limited. • Missed appointments can reduce usable clinical capacity in single-provider public subspecialty clinics. • This study describes a two-year, physician-scheduled telehealth pathway integrated into Türkiye's CentralPhysician Appointment System within a public developmental pediatrics clinic. • Within the telehealth cohort, maternal education, paternal age 25-34 years, and travel distance ≥ 100 km were associated with less favorable appointment status patterns.
Intracerebral hemorrhage (ICH) is associated with high early mortality. Guidelines recommend a rapid and sustained reduction of systolic blood pressure to <140 mmHg. Achieving and maintaining this target in refractory hypertension often requires prolonged intravenous therapy and complex escalation of oral antihypertensive regimens. Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), combines renin-angiotensin blockade with natriuretic peptide augmentation and has proven antihypertensive efficacy; however, data about its real-world use during the acute phase of ICH remain limited. We performed a single-center retrospective cohort study of consecutive patients with acute ICH and untreated refractory hypertension. Following the institutional introduction of ARNI in 2022, patients receiving ARNI as a scheduled second-line oral antihypertensive were compared with historical controls. The primary endpoint was time to antihypertensive regimen stabilization, defined as the time point at which escalation of scheduled oral antihypertensives was no longer required and intravenous or rescue short-acting antihypertensives were discontinued. Secondary outcomes included the number of scheduled oral antihypertensives at stabilization and the discharge modified Rankin Scale (mRS) scores. Thirty patients with ARNI (ARNI group: 2022-2024) and 30 consecutive historical controls (non-ARNI group: pre-2021) were included. Baseline characteristics were similar between groups. The mean time to antihypertensive regimen stabilization tended to be shorter in the ARNI group, i.e., 119.6 hours in the ARNI group and 143.3 hours in the non-ARNI group (unadjusted p = 0.275). In multivariable linear regression, ARNI use was independently associated with shorter stabilization time (partial regression coefficients (B) = -40.427 hours; 95% confidence interval (CI): -79.833 to -1.021; p = 0.045). At stabilization, the ARNI group required fewer scheduled oral antihypertensives compared to controls (median: 2.0 (interquartile range: 2.0-2.0) vs. 2.0 (2.0-3.0); p = 0.030; adjusted B = -0.483; 95% CI: -0.825 to -0.140; p = 0.006). The discharge mRS scores did not differ between the groups. In our routine clinical practice, early incorporation of ARNI as a second-line oral antihypertensive in acute ICH was associated with earlier completion of antihypertensive regimen adjustment processes and reduced treatment complexity. These results support the usefulness of ARNI as a practical second-line antihypertensive for goal-oriented blood pressure management and provide hypothesis-generating data for future prospective studies.
High demand for endoscopic procedures contributes to prolonged wait times and limited access to care, particularly in safety-net health systems. Missed appointments, including no-shows and late reschedules, further strain resources and delay diagnosis and treatment. Epic Systems provides a proprietary Risk of Patient No-Show Model, previously validated in primary care settings, but its performance in predicting attendance for endoscopy appointments has not been evaluated. A retrospective cohort study was conducted among adults scheduled for outpatient endoscopy at a single safety-net hospital between January 1, 2023, and August 1, 2024. Patients aged ≥ 18 years with at least one prior encounter in the electronic medical record (EMR) were included; inpatient procedures and early cancellations (> 2 days before the appointment) were excluded. The primary outcome was appointment completion versus no-show. Epic's predicted no-show risk, demographic characteristics, procedure type, and patient portal activation status were extracted. The relationship between predicted and observed no-show rates was assessed using the coefficient of determination (R²) and linear regression. Secondary analyses stratified results by patient portal activation. Among 4,658 unique patients, the median age was 59 years, 52.2% were male, and the cohort was racially and linguistically diverse. Overall, 1,493 patients (32.1%) did not attend their scheduled endoscopy. Epic's predicted no-show risk demonstrated a strong linear correlation with actual no-show rates (R² = 0.87). Observed missed appointment rates followed the equation: Missed Appointment Rate = 1.30 × (Epic Risk) + 0.16, indicating a baseline no-show rate of 16%. Each percentage-point increase in Epic's predicted risk corresponded to a 1.3-point increase in observed no-show rate. Patients without an activated patient portal (MyChart) had approximately 5-percentage-point higher no-show rates across the risk spectrum. Epic's Risk of Patient No-Show model shows strong correlation with real-world endoscopy attendance and may support predictive overbooking and targeted outreach to improve endoscopy unit efficiency. Given its integration within the EMR, this tool offers a practical framework for operational interventions, though further validation across diverse health systems is warranted.
Obesity is associated with an elevated risk of hypoxemia during endoscopic procedures performed under anesthesia. However, whether the sequence of drug administration - specifically the order of propofol and remifentanil - affects the incidence of hypoxemia remains unclear. This study was designed to evaluate whether a novel administration sequence, in which propofol precedes remifentanil, can decrease the incidence of hypoxemia in obese individuals during endoscopy. This prospective, single center, randomized controlled clinical trial recruited 296 obese patients scheduled for sedative/anesthesia gastroscopy prior to bariatric surgery. Patients were randomly assigned to either novel administration sequence with propofol-remifentanil (P-R) group or conventional administration of remifentanil-propofol (R-P) group. The primary outcome was the incidence of hypoxemia. Secondary outcomes included the lowest peripheral oxygen saturation (L-SpO2) during the procedure, hemodynamic parameters at six time points, and additional perioperative events. 284 patients were included in the analysis with 142 in each group. Hypoxemia occurred in 22 patients (15.5%) in the P-R group, and 42 patients (29.6%) in the R-P group (Relative Risk [RR], 1.44; 95% confidence interval [CI], 1.13 to 1.79; P = 0.007). The L-SpO2 during the procedure was significantly higher in the P-R group than in the R-P group (median [interquartile range, IQR], 94.0% [91.0 to 97.0] vs 93.0% [87.7 to 95.0]; P < 0.001). The P-R sequence technique was also associated with more stable hemodynamic profiles, shorter induction time, the start of drug administration to scope insertion and recovery time, improved patient's satisfaction. Particularly, minimal respiratory depression was observed in subgroups such as body mass index (BMI) ≥ 40 kg/m2. Propofol first and followed by remifentanil administration sequence significantly decreased the incidence of hypoxemia and increased the L-SpO2 in obese patients for their anesthesia/sedation gastroscopy. ChiCTR2400084998.
To compare visual and anatomic outcomes between primary laser photocoagulation and anti-vascular endothelial growth factor (VEGF) therapy with early or late deferred laser treatment (for reactivation or peripheral avascular retina [PAR]) in management of retinopathy of prematurity (ROP). In this retrospective cohort study, eyes were divided into three groups: primary laser, anti-VEGF with early (<4 months) deferred laser, and anti-VEGF with late (≥4 months) deferred laser (treated prophylactically for PAR per protocol or for reactivation if needed). A total of 260 eyes of 139 patients treated for ROP between 2013 and 2023 were included: 159 eyes in the primary group, 20 in the early-deferred group, and 81 in the late-deferred group. The primary laser group was older at first treatment (median postmenstrual age, 39.1 weeks vs 36.1 and 35.7 weeks for early- and late-deferred laser groups [P < 0.01]). Zone 1 disease was more common in anti-VEGF groups (43%-45% vs 1.9% [P < 0.01]). At median follow-up of 35 months, visual acuity was better in the early-deferred laser group (logMAR 0.14) than in the primary laser (0.18) and late-deferred laser (0.18) groups (P < 0.001; 162 eyes of 91 patients). Retinal detachment rates were not significantly different (3.1% primary laser vs 0.0% in anti-VEGF groups [P = 0.31] when excluding 2 eyes of 1 patient with numerous missed examinations and an atypical follow-up schedule due to medical instability in the early deferred laser group). At 2 years, the early-deferred laser group was more myopic (median, -1.50 D vs 0.0 D and 0.50 D [P = 0.031]). There were no differences in adverse events, strabismus, or amblyopia (P > 0.05 for all). Primary laser and anti-VEGF with deferred laser showed comparable anatomic outcomes. Refractive outcomes were comparable, though myopia was common in all groups. Anti-VEGF was more commonly used for posterior disease, reflecting contemporary practice patterns at this quaternary referral center.
Accurate, same-cycle assessment of endometrial readiness remains a major unmet need in assisted reproduction. Animal models have shown that spiral artery angiogenesis drives a midluteal rise in uterine oxygen tension, but direct, real-time measurements in humans have never been reported. We hypothesized that intrauterine dissolved O₂ profiling during the luteal phase could represent a potential functional, noninvasive biomarker of endometrial status. In this prospective, observational pilot feasibility study, eight healthy women aged 18-35 years with regular menstrual cycles and BMI < 30 underwent serial intrauterine pO₂ measurements across the luteal phase during a single natural cycle. Measurements were scheduled approximately every 48 h from the day of the LH surge (LH + 0) up to LH + 13/14, with minor variations due to scheduling constraints. Dissolved oxygen was recorded using a 1 mm fiber optic microsensor positioned 1 cm from the uterine fundus under ultrasound guidance. The primary outcome was intrauterine pO₂ (Torr) across the luteal phase. Two distinct intrauterine oxygenation profiles were identified. Four participants exhibited a "peak" pattern characterized by early luteal low pO₂ (< 15 Torr), followed by a sharp mid-luteal rise in pO₂ (40-45 Torr at LH + 4 to LH + 6, p < 0.0001), a short plateau, and a decline by LH + 8. One participant showed an earlier and abbreviated peak. The remaining four participants maintained pO₂ values < 35 Torr throughout the luteal phase ("no-peak" pattern). Post-hoc review of baseline screening data and follow-up participant interviews identified plausible physiological, pharmacological, or lifestyle-related factors that may influence endometrial vascular maturation in the no-peak subgroup. This study provides the first in vivo characterization of real-time intrauterine oxygen dynamics across the luteal phase in women. Intrauterine pO₂ profiling identified distinct temporal oxygenation patterns across the luteal phase and may reflect physiologically relevant changes in endometrial function. These preliminary findings support further evaluation of intrauterine oxygen profiling as a potential non-invasive, same-cycle functional biomarker of embryo-endometrium synchrony. Larger studies are required to validate its predictive value for implantation and live birth outcomes. ISRCTN85528745 (retrospectively registered on 30/01/2026).
Constipation is a common gastrointestinal disorder that negatively affects quality of life, work productivity, and long-term prognosis. To examine the associations between constipation severity and Short Form-8 Health Survey (SF-8) and Work Productivity and Activity Impairment Questionnaire (WPAI) scores, as well as treatment status and patient preferences, through a large-scale survey of the general population. A web-based questionnaire was administered to 2,300 Japanese adults with constipation symptoms using a large survey panel. The survey assessed the Constipation Scoring System (CSS), Bristol Stool Form Scale (BSFS), SF-8, WPAI, treatment status, and preferences for treatment methods. CSS scores showed significant negative correlations with the SF-8 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and significant positive correlations with WPAI scores (P < 0.05). Both SF-8 and WPAI scores differed significantly across BSFS categories, with normal stool forms associated with better outcomes (P < 0.05). Only 22.0% of participants received prescription medication for constipation. The most common reason for not seeking medical care was "inconvenience of visiting a medical institution" (65.6%). Regarding treatment preferences, 80.8% preferred tablet formulations, and once-daily administration at bedtime was the most favored dosing schedule (56.7%), followed by before breakfast (30.0%). Constipation severity and stool form are associated with quality of life and work productivity, underscoring the importance of appropriate treatment strategies. Patient preference should also be considered when selecting therapeutic options.
Resistance to thyroid hormone (RTH) syndrome is an uncommon disorder of thyroid function that is frequently misdiagnosed or overlooked clinically. We identified a heterozygous mutation in the THRβ gene (c.1357C > A [p.Pro453Thr]) in a patient with resistance to thyroid hormone beta. This locus variation has rarely been reported domestically or internationally. The patient, a 13-year-old female presenting with goiter, was found to have persistent high free triiodothyronine and free thyroxine levels with a non-suppressed thyroid-stimulating hormone in the absence of classic hyperthyroid symptoms. Based on the patient's history, physical examination, imaging studies, and genetic testing, the diagnosis of resistance to thyroid hormone was definitively established. The medication was discontinued based on the patient's clinical status. The management plan was transitioned to a strategy of watchful waiting, with scheduled follow-ups to monitor the patient's status. Following a genetic diagnosis, the patient has been followed for 24 months under an active surveillance strategy, which includes annual thyroid function tests. Enhanced clinical vigilance is imperative to mitigate diagnostic bias and errors associated with this condition, thereby ensuring timely and accurate diagnosis and appropriate therapeutic intervention.
Psychiatric nurses in China face high psychological and occupational strain. Understanding the factors influencing their mental health is essential. This study aimed to determine the positive rate of psychological distress among Chinese psychiatric nurses and to examine the associations of psychological resilience and other psychosocial factors with psychological distress. A cross-sectional study was conducted from October 2024 to January 2025. Using an online survey, 436 psychiatric nurses from six hospitals in Jiangsu Province, China, were recruited. Data were collected using a general information questionnaire, the 12-item General Health Questionnaire (GHQ-12), and the Connor-Davidson Resilience Scale (CD-RISC). Chi-square tests, Spearman correlation, and multivariate logistic regression were employed for analysis. Of 436 nurses invited, 412 provided valid responses (response rate: 94.5%). The positive screening rate for psychological distress (GHQ-12 score ≥ 3) was 38.38%. Multivariate logistic regression analysis showed that among Chinese psychiatric nurses, higher psychological resilience (OR = 0.948, 95% CI: 0.931-0.965, p < 0.001) was associated with lower odds of psychological distress. In contrast, more frequent weekly night shifts (≥ 3 vs. ≤ 2; OR = 2.452, 95% CI: 1.212-4.959, p = 0.013) and poorer self-rated health status (per level increase; OR = 1.711, 95% CI: 1.274-2.299, p < 0.001) were associated with a greater odds of psychological distress. Psychological resilience, night shift frequency, and self-rated health status are significantly associated with psychological distress among Chinese psychiatric nurses. Interventions aimed at building resilience, optimizing work schedules, and promoting health may help protect their mental well-being. Not applicable.
Patients with breast cancer often experience health-related quality of life (HRQoL) impairments that remain difficult to predict on an individual level. Prediction models can aid in understanding individual survivorship trajectories. However, current prognostic models are based on fixed intervals, limiting their utility in clinical follow-up schedules. This study aimed to develop and externally validate time-dynamic machine learning (ML) models that predict clinically relevant HRQoL impairments in nonmetastatic patients with breast cancer. Using the pooled multicohort EORTC (European Organisation for Research and Treatment of Cancer) BALANCE (big data in patients with breast cancer) dataset (n=6316) containing repeated HRQoL measurements (EORTC QLQ [Quality of Life Core Questionnaire]-C30), we constructed over 70,000 patient assessment pairs. ML algorithms were trained using the earlier HRQoL assessment and clinical data to predict dichotomized impairments in QLQ-C30 domains at the later assessment between 2 weeks and 5 years ahead, reflecting the range of follow-up intervals available in the dataset. The best performing model was determined via the area under the receiver operating characteristic curve in the internal validation, and externally validated in an independent cohort of the BALANCE dataset, in which the calibration and predictive performance in risk groups (patients: postmenopause, with financial difficulties, with obesity, with 2 or more comorbidities, with lower educational status, and with frailty) were also evaluated. ML models showed good discrimination (area under the receiver operating characteristic curve 0.64-0.84) across most domains, especially for persistent symptoms such as fatigue, financial difficulties, or functioning scales. Gradient boosting models performed best, but tended to be overconfident, with poor calibration for low-prevalence symptoms such as diarrhea or constipation. Model performance varied by risk group (eg, lower education and frailty), though no group consistently performed poorly. Performance remained stable across time windows, with prior HRQoL being the strongest predictor at the respective scale level, while clinical variables such as the type of treatment were less important for prediction. Time-dynamic ML models can support personalized HRQoL prediction in breast cancer care. Future improvements should focus on calibration and fairness to enable equitable, clinically meaningful implementation.
Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination in pregnancy is recommended to provide passive immunity to newborns. Few studies have assessed how pregnancy modifies vaccinated individuals' immune response to Tdap vaccination, with most focused on short-term responses (i.e., within 1 month). Here, we assessed anti-pertussis toxin (PT) immunoglobulin G (IgG) levels 9-15 months following Tdap vaccination in pregnant and non-pregnant active duty service members (ADSMs). This observational cohort study included 240 ADSMs pregnant at Tdap vaccination, 1:1 matched with 240 non-pregnant ADSMs on age, time between vaccine and serum collection, and receipt of other same-day vaccines (2011-2016). Serum samples (0-6 weeks before and 9-15 months after vaccination) were obtained from the Department of Defense Serum Repository. Anti-PT IgG levels were assessed using geometric mean concentrations (GMCs), and associations between pregnancy status at vaccination and anti-PT IgG levels were estimated through multivariable linear regression models. Pregnant vs. non-pregnant ADSMs had higher anti-PT IgG GMCs in both pre- (9.01 vs. 5.81, P < .01) and post-vaccine (27.71 vs. 22.33, P = .02) serums. Post-vaccine multivariable models adjusting for pre-vaccine levels were not significantly different between pregnant vs. non-pregnant ADSMs (b = -0.05, P = .42). Associations were modified by time since prior Tdap booster, and statistically different for pregnant individuals who received a booster <2 years prior (b = -0.22, P = .02). Tdap vaccination in pregnancy yielded a similar long-term anti-PT IgG response to vaccination outside of pregnancy; findings substantiate the current recommended vaccine schedule.
The Big Baby Trial found that early induction in patients with suspected large-for-gestational-age (LGA) fetuses reduced shoulder dystocia and prelabor cesarean rates. However, it excluded patients with pregestational diabetes mellitus (PGDM), who are at increased risk of adverse outcomes. We sought to evaluate delivery outcomes by gestational week in patients with PGDM and LGA fetuses. This was a population-based cohort study of nulliparous, nonanomalous, singleton, live births complicated by PGDM and LGA between 360/7 and 416/7 weeks using the U.S. Natality Vital Statistics Database from 2015 to 2023. Births following a prior cesarean delivery were excluded. Planned delivery group included births at each completed week from 36 to 40 weeks that underwent labor induction or scheduled cesarean delivery, excluding spontaneous labor. Expectant management group included all births that delivered in subsequent weeks (e.g., planned birth 360/7-366/7 compared with all births ≥370/7 weeks). The primary outcome was cesarean delivery rate and the secondary outcome was a composite of adverse neonatal outcomes (5-min Apgar score < 7, assisted neonatal ventilation > 6 hours, neonatal seizures, 10-min Apgar score of 0, and neonatal death). Outcomes were compared between groups at each week using multivariable logistic regression. There were 9,805 births analyzed. Cesarean delivery rate ranged from 77 to 87%. After adjusting for baseline differences between groups, planned delivery at 39 weeks was associated with decreased odds of cesarean delivery than expectantly managed pregnancies. After 38 weeks, planned delivery and expectant management had similar odds of cesarean delivery and neonatal morbidity. In pregnancies complicated by PGDM and LGA, planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management. Planned delivery at 38 weeks had similar odds of cesarean delivery and neonatal morbidity. These data suggest that providers should be cautious expectantly managing these pregnancies past 38 weeks. · Pregnancies complicated by PGDM and LGA are associated with higher risk of cesarean delivery.. · Across all gestational ages, planned delivery group was more likely to deliver by cesarean delivery than those expectantly managed.. · Planned delivery after 39 weeks was associated with lower odds of cesarean delivery compared with expectant management.. · Planned delivery prior to 38 weeks (36-37 weeks) is associated with increased cesarean delivery rates and higher neonatal morbidity..
One-lung ventilation (OLV) is used to isolate one lung during thoracic surgery, but manipulation and positioning can affect heart-lung interaction. Cardiomegaly may exacerbate these changes, especially in the left lateral decubitus (LLD) position. To investigate the effect of cardiomegaly on heart-lung interaction during OLV, particularly in the LLD position. A 20-year-old male with recurrent spontaneous pneumothorax was scheduled for right-sided bronchopleural fistula repair via thoracotomy. The patient presented with cardiomegaly (cardiothoracic ratio 75%) and echocardiographic evidence of right ventricular and atrial dilation. In the LLD position, OLV led to desaturation when both lungs were ventilated, but oxygenation improved when only the left lung was ventilated. Cardiomegaly alters heart-lung interaction during OLV, particularly in the LLD position. The enlarged heart exerts pressure on the left lung, impairing ventilation. When both lungs are ventilated in this position, ventilation is directed toward the right lung, reducing oxygenation and causing desaturation. However, restricting ventilation to the left lung improved oxygenation due to better lung compliance and less interference from the enlarged heart. Cardiomegaly affects heart-lung interaction during OLV in the LLD position. Oxygenation improves when only the left lung is ventilated, likely due to less compression of the left lung. The supine position may further enhance oxygenation even with bilateral ventilation. This case highlights the importance of considering cardiomegaly in OLV management. This section should be written as per the CARE checklist item 3.
The COVID-19 pandemic and associated school closures presented unprecedented challenges to university students' well-being, highlighting an urgent need to understand the factors influencing their health-related quality of life. This study aimed to explore the association between psychological distress, lifestyle, and career planning on the health-related quality of life of university students during the school closure period in China. A cross-sectional study was conducted, collecting data from 1965 Chinese college students locked down in campus during COVID-19 using a snowball sampling method via an online questionnaire platform (Wenjuan.com). Psychological distress and the health-related quality of life were measured by scales. Descriptive analysis, Chi-squared test and logistic regression analysis were employed to analyze the data. The mean physical component summary score was 47.5, while the mean mental component summary score was 36.8. Students who were women (OR=1.444, P = 0.003), having a boy or girl friend (OR=1.379, P = 0.008), with rural hukou (OR=1.446, P = 0.004), with low psychological distress (OR=4.589, P < 0.001), high physical activity intensity (OR=3.909, P < 0.001), a regular studying schedule arrangement (OR=2.553, P = 0.008), clear career planning (OR=1.570, P = 0.001) during COVID-19 were more likely to report a good physical component summary. For mental component summary, lower psychological distress (OR=8.330, P < 0.001), a regular studying schedule arrangement (OR=2.892, P = 0.001) and keeping same job-hunting pressure (OR=1.852, P = 0.003) were positive influencing factors, whereas having a boy or girl friend (OR=0.774, P = 0.032) and having no clear career planning (OR=0.752, P = 0.020) during COVID-19 were negative influencing factors. In conclusion, while health-related quality of life was generally good, lower psychological distress, healthier lifestyle habits, and clearer career planning were significantly associated with better health-related quality of life among university students during the pandemic-related school closure. These findings underscore the importance of integrating mental health support, lifestyle guidance, and career planning services into student support systems during public health crises. Future studies should develop and evaluate interventions targeting these modifiable factors.
In both the U.S. and Wisconsin, Black women and infants experience significantly higher rates of morbidity and mortality than their white counterparts. Our research team set out to explore how a community-based and culturally informed perinatal support model could address the needs of Black mothers and their families. We developed and implemented the Today Not Tomorrow Pregnancy and Infant Support Program (TNT-PISP), a community-based, culturally informed perinatal support model integrated with traditional obstetrical care. From October 2019 to August 2022, we held monthly support group sessions facilitated by Black community-based doulas, Black physicians, and community partners. Twenty-five participants engaged in topic-focused and freeform sessions to discuss mental health, breastfeeding, peripartum care, and medical racism. Data were collected through semi-structured interviews and focus groups and analyzed using the Daughtering Method and reflexive thematic analysis. Participants emphasized the importance of shared Black identity and culture in fostering connection and trust. The group's open, judgment-free environment allowed for meaningful conversations and emotional support. Participants valued the exchange of parenting knowledge and community resources. The program's flexible structure and child-friendly setting were key strengths, enabling consistent participation despite busy schedules. This study highlights the potential of community-based, culturally informed perinatal support programs to promote health equity for Black women and infants. Future research should explore such programs' long-term impacts and scalability in diverse settings. Continued efforts to integrate culturally relevant care models into traditional healthcare systems may help promote health inequities in Black communities.
To compare postoperative platelet counts in patients in whom intraoperative cell salvage (ICS) was performed using either a centrifugation-based device (ICS-centrifugation) or a filtration-based device (ICS-filtration; Same) for red blood cell recovery from shed blood, as well as to compare the transfusion requirements and outcomes of the patients in both groups. Observational, retrospective, single-center study. Academic hospital, June 2021 to May 2024. All patients admitted for scheduled cardiac surgery who had an anticipated duration of cardiopulmonary bypass ≥ 2 hours or underwent aortic arch surgery, redo or combined surgery, or multiple aorto-coronary bypasses, who had expressed their non-opposition to the use of their personal data for research purposes and for whom data collection was performed. Red blood cell recovery from shed blood with either the ICS-centrifugation device (n = 208) or the ICS-filtration device (n = 85) according to device availability. The primary outcome was the decrease in platelet count between the preoperative and postoperative assessments. Secondary outcomes included transfusion rate, postoperative morbidity, and length of hospital stay. A total of 293 patients were included, predominantly male (81.6%); the mean age was 66.2 years. Postoperatively, the platelet count decrease was greater in the ICS-centrifugation group than in the ICS-filtration group (74.9 × 109/L v 65.0 × 109/L; mean difference, 9.94 [95% confidence interval, 1.99-18.58]; p = 0.02). This difference was consistent in the multivariable analysis. The number of patients receiving intraoperative or postoperative transfusion by day 28 was higher in the ICS-centrifugation group than in the ICS-filtration group (49% v 34.1%, p = 0.03). Finally, the ICS-centrifugation group presented higher overall postoperative morbidity rates than the ICS-filtration group on day 28 (16.3% v 5.9%; odds ratio, 0.32 [95% confidence interval, 0.11-0.78]; p = 0.03). Compared with ICS-centrifugation, ICS-filtration may offer advantages in platelet salvage for shed blood, thereby reducing transfusion requirements and related morbidity in cardiac surgery patients. These results need to be confirmed by larger randomized studies with a special focus on clinical outcomes.
Streptozotocin (STZ) remains a potentially effective chemotherapeutic agent for pancreatic neuroendocrine tumours, more than five decades after its initial use. Despite its longstanding clinical application, STZ dosing regimens have traditionally been driven by empirical practice rather than by pharmacokinetic or pharmacodynamic rationale. Recent advances in understanding its molecular mechanism of action, selective uptake via the glucose transporter type 2 transporter, and DNA-methylating properties provide a solid foundation for revisiting its therapeutic role and optimising its scheduling. This review outlines the key pharmacological features of STZ, including its rapid systemic clearance, narrow volume of distribution, and renal elimination, all of which support the use of short intravenous infusions and fractionated schedules to minimise nephrotoxicity while maintaining efficacy. Comparative insights with temozolomide highlight the unique delivery and tissue tropism advantages of STZ, particularly in pancreatic neuroendocrine tumours. In addition, emerging biomarkers, such as O⁶-methylguanine-DNA methyltransferase deficiency and mismatch repair status, may help refine patient selection for STZ-based chemotherapy. Clinical data from classical and modern regimens, such as those combining STZ with 5-fluorouracil or capecitabine, suggest sustained disease control in well-selected patients. The potential for biomarker-guided strategies and pharmacology-informed protocols supports a contemporary repositioning of STZ in neuroendocrine oncology. Rational redesign of dosing, improved toxicity management, and integration with personalised medicine may revitalise the clinical utility of this historically valuable agent.
Colorectal cancer (CRC) is a leading global malignancy, and surgery is frequently followed by complications, functional decline, and reduced quality of life. Multimodal prehabilitation and rehabilitation can improve physical recovery and psychosocial outcomes, but uptake is often limited by logistical and mobility barriers. Asynchronous telerehabilitation offers a flexible, patient-centered, and scalable approach; however, its effectiveness across the perioperative CRC pathway has not been rigorously evaluated. This trial will evaluate a multimodal asynchronous program delivered in prehabilitation and postoperative phases, against a booklet-based usual-care approach reflecting the pre-existing perioperative pathway in the study setting before trial initiation. This single-blind, parallel-group randomized controlled trial will compare an asynchronous multimodal telerehabilitation program with a booklet-based usual-care program in adults scheduled for elective CRC resection. Fifty-six participants will be randomized 1:1 to the telerehabilitation group (HEFORA platform) or the usual-care control group. The intervention includes a 2-week prehabilitation phase and a 4-week postoperative rehabilitation phase. Assessments will be performed at five time points: baseline (pre-prehabilitation), post-prehabilitation (pre-surgery), post-surgery (pre-rehabilitation), post-rehabilitation, and 3-month follow-up. The primary outcome is functional capacity, measured by the Six-Minute Walk Test distance. Secondary outcomes include muscle strength, body composition, pulmonary function, physical activity, sleep quality, psychosocial variables, health-related quality of life, treatment expectancy, usability, satisfaction, and adherence. Analyses will follow the intention-to-treat principle using longitudinal models and sensitivity analyses for missing data and adherence. Conclusions: This study will provide evidence on the role of asynchronous telerehabilitation in perioperative colorectal cancer care. Positive results could inform clinical guidelines, promote wider adoption of digital rehabilitation strategies, and support a more accessible, patient-centered, and cost-effective approach to oncologic recovery. ClinicalTrials.gov identifier: NCT06593678.
Patients with Medicaid compared with private insurance have increased difficulty gaining access to orthopedic care. How insurance status affects access to care for young athletes (football; from here, all "young athletes" are football players) with hip labrum tears has yet to be assessed. The purpose of this study was to determine whether there is a difference in insurance acceptance rates for Medicaid versus Blue Cross Blue Shield (BCBS) for young athletes with a hip labral tear. Fifty orthopedic clinics across 10 states were contacted using a standardized script. Each clinic was called twice: once as a young athlete with BCBS and once with a young athlete with Medicaid, requesting an appointment for a hip labral tear. The primary outcome was appointment success. Secondary outcomes included barriers to scheduling and wait times. Statistical analysis was performed using chi-squared and Mann-Whitney U tests. All clinics accepted BCBS insurance, whereas only 16 (32%) accepted Medicaid (P<0.0001). Young athletes with BCBS successfully scheduled an appointment 100% of the time compared with only 24% for young athletes with Medicaid (P<0.0001). Of the 34 clinics that did not accept Medicaid, 22 (65%) cited not accepting the insurance, and 11 (32%) required a referral. Among clinics that accepted both insurance types, there was no significant difference in median wait time (13 vs 14 days, P=0.44). For young athletes with hip labrum tears, it is more difficult to schedule appointments with Medicaid insurance compared with BCBS insurance. The main barrier to care with Medicaid for young athletes is requiring a primary care physician referral.
Esophageal squamous cell carcinoma (ESCC) has high risks of postoperative recurrence, complications, and prolonged nutritional and functional recovery, while conventional follow-up (scheduled visits with imaging, endoscopy, and laboratory testing) is often limited by delays and resource constraints. This review summarizes recent applications of artificial intelligence (AI) across perioperative ESCC care, with emphasis on postoperative surveillance and management. Following PubMed/MEDLINE, etc. were searched (inception-2025) for English-language studies using machine learning, deep learning, radiomics, natural language processing (NLP), and digital health algorithms in postoperative monitoring, recurrence prediction, complication warning, and remote follow-up. Evidence indicates that AI-enabled multimodal models integrating electronic health records, imaging radiomics, and biomarkers can predict major complications (e.g., anastomotic leak and pneumonia) with improved timeliness, enabling earlier intervention compared with symptom-triggered workflows. Imaging-driven radiomics combined with machine learning demonstrates robust performance for recurrence risk and recurrence-pattern prediction, supporting refined risk stratification beyond TNM staging and informing individualized surveillance intensity and adjuvant decision-making. Explainable approaches (e.g., SHAP) enhance clinical interpretability by identifying key predictors such as nutritional and inflammatory indices. Intelligent follow-up systems incorporating NLP, wearable sensors, and electronic patient-reported outcomes (ePROs) facilitate closed-loop monitoring, improve early issue detection, and strengthen patient-clinician communication.