Nutritional biomarkers are linked to body composition changes, but limited evidence has studied how nutritional biomarkers relate to low muscle mass, excess adiposity, and both coexisting conditions across different physical activity levels. This study aims to investigate associations between low muscle mass, obesity, and low muscle mass with obesity and nutritional biomarkers across physical activity levels among U.S. adults across physical activity levels. This cross-sectional study analyzed data from adults aged 20-59 years from the 2015-2018 cycles of the National Health and Nutrition Examination Survey (NHANES) 2015-2018. Low muscle mass was defined by low appendicular lean mass relative to body weight (LALM/W). Obesity was classified using body mass index (BMI1), waist circumference (WC2), and body fat percentage (FM%3), and low muscle mass with obesity was defined using three coexisting phenotypes (LALM/W-O1, LALM/W-O2, LALM/W-O3). Nutritional biomarkers included serum albumin, vitamin D, triglyceride, cholesterol, LDL cholesterol, iron, insulin resistance (HOMA IR), and high-sensitivity C-reactive protein (hs-CRP). Physical activity was categorized as inactive, insufficiently active, or sufficiently active based on MET minutes per week. Multivariable regression models accounted for the complex survey design and relevant covariates. After adjustment, LALM/W was significantly associated with low serum albumin, low vitamin D, high triglyceride, high HOMA-IR, and high CRP. Obesity was significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O in all phenotypes were significantly associated with low serum albumin, low vitamin D, high triglyceride, high LDL cholesterol, high HOMA-IR, and high CRP. LALM/W-O phenotypes demonstrated the strongest associations, particularly with high HOMA-IR and hs-CRP. Although the associations varied by physical activity level, sufficiently active group was associated with lower odds of adverse nutritional biomarkers compared with insufficient activity. Nutritional biomarkers are associated with LALM/W and obesity. Sufficient physical activity was associated with fewer adverse outcomes. This suggests that adequate physical activity may be associated with better nutritional status and body composition.
Soundscapes reflect interacting biological, physical, and sensor-driven processes; thus, passive acoustic monitoring (PAM) can provide a wealth of unique, multifaceted ecological information. Using coral reefs as an example, we outline how mechanistic, integrative interpretation is essential for reliable ecological inference and for realising PAM's growing potential in ecosystem monitoring.
The STRATA randomised-controlled trial (RCT) examined the antidepressant sertraline vs placebo for treating anxiety in autistic adults. Autistic people are often assumed to be reluctant to take part in RCTs due to intolerance of their inherent uncertainty. This study aimed to qualitatively examine autistic people's experiences of RCT participation, specifically regarding their random assignment to an antidepressant (sertraline) or placebo for their mental health, whilst blinded to treatment allocation. Semi-structured interviews were undertaken with a purposive sample of 62 STRATA participants. The interviews examined why they chose to take part, why they continued in the trial and/or discontinued medication, and their overall experience of participation. Interviews took place either during participation, or at participants' final trial appointment at 52-weeks post randomisation ('exit interviews'). Data were analysed thematically through a collaborative process, with multiple researchers independently coding, discussing, and refining themes. Interviewees often discussed improved anxiety, attributing changes to believing they were taking sertraline, experiencing the placebo effect, or external factors. Post-analysis unblinding revealed that improved anxiety was discussed equally by participants in both the sertraline and placebo groups. Some participants, including those taking placebo, experienced side effects, which mirrored the types, frequency, and severity seen in the general population. Many were able to manage these and continue, but some discontinued medication as a result. Aspects of trial design and delivery facilitated continuation with the study medication, including frequent appointments, shared control over medication dose, and meaningfully involving autistic people in trial design. Such non-pharmacological factors may enhance therapeutic benefits, and may improve RCT design and therapeutic alliances with autistic people.
To assess differences in incidence, patient characteristics, and survival outcomes by socioeconomic status [SES] in paediatric out-of-hospital cardiac arrest [pOHCA]. OHCA patients aged <15 years attended by emergency medical services [EMS] in Western Australia [WA] between 2015 and 2024 were identified. SES was classified using the Australian Bureau of Statistics Index of Relative Socio-Economic Disadvantage. SES was assigned based on each patient's residential address and categorised according to WA population-based tertiles (Low, Mid, High). Crude and age-standardised incidence rates per 100,000 population per year were calculated for all pOHCA. Incidence was modelled using negative binomial regression, stratified by SES tertile and paediatric age-group (infant, young child, older child). Survival outcomes (return of spontaneous circulation at hospital arrival [ROSC] and 30-day survival) were descriptively reported by SES tertile. A total of 411 pOHCAs attended by EMS were eligible for inclusion. The crude incidence of pOHCA was 9.03 per 100,000 population per year. Nearly half of all events (n = 201; 48.9%) occurred in children residing in low-SES areas (most disadvantaged). Incidence decreased with increasing socioeconomic advantage. The magnitude of the socioeconomic gradient differed by age (interaction p = 0.015) and was most pronounced in infancy. Overall, 11.7% of children achieved ROSC and 30-day survival was 7.8%, with no consistent socioeconomic differences observed. Socioeconomic disadvantage is strongly associated with higher pOHCA incidence, with the gradient most pronounced in early life. These findings highlight the need to better understand the mechanisms underpinning these disparities.
Technology is integrated into many children's daily lives, with parents' and health professionals' perspectives shaping children's technology use. Measuring and understanding these perspectives are essential for developing strategies for supporting adults in decision-making that help children thrive in a digital world. This systematic review aimed to investigate the psychometric properties of questionnaires used to assess parents' and health professionals' perspectives on young children's use of technology related to health, well-being, and development. The secondary aim was to synthesize findings on these perspectives. Peer-reviewed papers published between January 2010 and September 2024 were identified through searches in 7 electronic databases. Studies were included if they examined parental or health care professionals' perspectives on technology use among children aged birth to 5 years. Two reviewers (CLR and IPHA) independently conducted the data extraction and study quality assessment. Reported psychometric properties of the questionnaires were synthesized. Deductive thematic analysis was used to explore the content focus of the questionnaire used in the included studies and synthesize the reported perspectives. In total, 85 studies were included, all involving parents. No study investigated health professionals' perspectives. The methodological quality of the studies was generally low, with 62 studies scoring below the threshold for acceptable quality. In total, 52 studies reported psychometric properties of the questionnaires used, of which, only 15 studies reported more than 1 measure of validity or reliability. A total of 75 studies reported participants' perspectives on children's technology use. Findings revealed that parents generally supported the role of digital devices in enhancing learning but expressed concerns about potential negative impacts on children's physical health, emotions, and behaviors. Parents' perspectives on children's technology use were frequently assessed through questionnaires, though the validity of these questionnaires was often poor, with limited psychometric testing. Parental perspectives were mixed with educational benefits being recognized, while countered with concerns about the impact on children's physical health and development. High-quality questionnaires are needed to generate stronger evidence informing strategies to support families in technology use decision-making with and for children.
Home telemonitoring programs are increasingly used to support older adults living with chronic conditions such as heart failure (HF). While these interventions show promise for improving health outcomes and reducing care burden, their effectiveness depends largely on how patients and caregivers integrate digital technologies into everyday life and care relationships. However, relatively few studies have examined these experiences using conceptual frameworks that capture both functional and relational dimensions of care. This study aimed to explore the experiences of older adults and their informal caregivers participating in a home telemonitoring program for HF. Drawing on the Person-Based Approach and the Person-Centered Practice frameworks, we examined how participants engaged with both the technofunctional and relational aspects of the intervention. We conducted a qualitative study involving 34 patients, 28 informal caregivers, and 20 nurses across 3 primary care organizations in Quebec, Canada. The 6-month intervention included 4 connected devices used by patients (smartwatch, Bluetooth-enabled scale, voice-activated tablet, and a smart pill dispenser [xPill; Domedic]) and a mobile app for caregivers, complemented by remote nursing follow-up. Nurses reviewed patient data through a clinical dashboard at least once daily during weekday daytime shifts. Data were collected through semistructured interviews and field notes and analyzed using directed content analysis. Participants' experiences revealed both enabling and constraining factors across 2 key dimensions. Technofunctional engagement was shaped by digital literacy, emotional responses to the technology, alignment with daily routines, and access to technical or caregiver support. Relational aspects of care were influenced by perceived professional presence, opportunities for communication and shared decision-making, and the degree of emotional reassurance provided by remote monitoring. While many participants reported increased confidence and a sense of being supported, others experienced frustration, fatigue, or disengagement when the system disrupted routines or when feedback from clinicians was perceived as limited. Engagement with home telemonitoring technologies among older adults depends not only on usability but also on the relational context in which these technologies are embedded. Combining technofunctional and relational perspectives provides a more comprehensive understanding of how telemonitoring interventions are experienced and highlights the importance of personalized support, reliable technology, and sustained clinical engagement to promote meaningful adoption.
Hospital falls can be reduced through patient and staff education, yet limited evidence exists about how staff can systematically implement patient falls prevention education. Planning implementation with staff may enhance their acceptance, engagement, and delivery of falls education to hospital patients. The objective of the study was to design an implementation plan with hospital staff to guide the successful delivery of patient falls education. Three participatory workshops using a world café methodology were conducted in 1 Western Australian and 2 Victorian hospitals. Participants were presented with information about a patient falls education program called "Safe Recovery" and discussed program implementation strategies. Conversation topics were staff education and training needs, ward support, and organizational requirements. Table discussions were captured on paper and analyzed iteratively at the forum. Subsequently, workshop field notes were analyzed using inductive content analysis. Sixty-two hospital staff (n = 42 nurses, n = 12 allied health, n = 8 other) participated in the workshops. Participants considered the implementation process would be enabled at: (1) individual level, by providing accessible and flexible training to optimize staff engagement; (2) ward level, by establishing clear implementation protocols, engaging and supporting team leaders, and (3) ensuring clear communication between staff, patients, and families; and (4) organizational level, by leadership supporting sustained implementation. Group consensus was that it was important to have a single, agreed vision to implement the Safe Recovery Program. Staff engagement facilitated the development of a shared vision and structured plan to implement a patient falls prevention education program on hospital wards.
[This corrects the article DOI: 10.1016/j.isci.2023.107019.].
Unhealthy alcohol use is a preventable cause of morbidity and mortality, yet screening is hampered by inaccurate reporting. Phosphatidylethanol (PEth) is a biomarker that quantifies total drinking over the past 2-4 weeks, but PEth cutoffs for unhealthy drinking have not been well-examined. We pooled data from 22 studies (11,088 persons globally) that previously collected PEth and self-reported alcohol use. Within a 90% training set, we calculated PEth cutoffs per Youden's J in 1000 bootstrapped samples and explored differences by region, age, sex, race/ethnicity, body mass index (BMI), HIV status, hemoglobin level, and an indirect serum marker of liver fibrosis, FIB-4. For each cutoff, we estimated sensitivity, specificity, and positive and negative predictive values in a 10% validation dataset. We used two definitions for self-reported unhealthy drinking per Alcohol Use Disorders Identification Test Consumption (AUDIT-C) and National Institute on Alcohol Abuse and Alcoholism (NIAAA). Optimal PEth cutoffs using self-reported alcohol use as the reference standard differed substantially by region. The cutoff for AUDIT-C-measured unhealthy alcohol use in studies from the United States (US) was 14.0 ng/mL (95% CI: 12.3-18.6) with 73.0% sensitivity (95% CI: 67.3-79.1) and 77.4% specificity (95% CI: 73.2-81.4); and was 65.7 ng/mL (95% CI 19.3-90.7) in studies from Africa, with 71.7% sensitivity (95% CI: 64.4-78.7) and 65.2% specificity (95% CI: 58.1-72.7). Cutoffs for AUDIT-C did not differ between subgroups in the US, but within Africa, cutoffs were higher for men and lower for those with BMI ≥ 25 kg/m2. Cutoffs for NIAAA defined unhealthy alcohol use were similar to those using the AUDIT-C. Using self-report as the reference standard, PEth cutoffs differed substantially by region and by some other characteristics, which may be attributable to differences in PEth formation, elimination and/or reporting bias. Further work using objective gold-standard measures of alcohol consumption is needed for more definitive conclusions.
Current understanding of mental health problems among aviation pilots remains limited. Pilots are exposed to distinctive occupational stressors, and when psychological distress occurs, they may be reluctant to disclose symptoms or seek timely assistance because of concerns about stigma, loss of income, licensing restrictions, or medical disqualification from flying. Pilot mental health is therefore not only an occupational health issue, but also a critical component of aviation safety governance. Although the vast majority of mental health conditions do not lead to flight safety events, in rare circumstances, severe psychological crises that remain unidentified or unsupported may result in catastrophic outcomes, including aircraft-assisted pilot suicide. These tragic events underscore the potential safety implications of pilot mental health and highlight the urgent need for greater attention to this critical issue. This article argues that prevention should be centered on system-level measures, including confidential peer support, carefully governed digital tools, destigmatized safety cultures, and harmonized data infrastructures.
High-intensity interval exercise (HIIE) improves cardiorespiratory fitness through cardiac and skeletal muscle adaptations; however, the relationship between microvascular function and local skeletal muscle oxygenation during HIIE is unclear. Near-infrared spectroscopy at the vastus lateralis (∆ from baseline) was used to assess microvascular function pre- and post-HIIE and oxygenation throughout HIIE (n = 22 enrolled; n = 19 reported with complete oxygenation data, 27 ± 6 yrs., 42% female). HIIE consisted of twelve, 1-min intervals at 85% of peak power output while microvascular function was assessed using vascular occlusion-reperfusion. During HIIE, despite no change in the deoxygenation time constant tau (τ) (all p > 0.059), deoxygenation magnitude progressively increased at intervals 6 and 8 (both p < 0.011) and was greater at interval 11 compared to 1 (-49 ± 13 vs. -41 ± 19%, p = 0.033). Similarly, there was no change in the reoxygenation τ (all p > 0.753) while reoxygenation magnitude was immediately attenuated from interval 2 compared to 1 (-14 ± 18 vs. -6 ± 12%, p = 0.007) and was less at both intervals 6 and 11 compared to 1 (both p < 0.004). Microvascular function assessed as the 2-min hypersaturation area under the curve (AUC) was lower 15 min post- and 2 h post-HIIE compared to pre-exercise (both p ≤ 0.025), while the 10 s saturation upslope remained unchanged when controlling for the occlusion nadir (p = 0.212). The 2-min AUC (ρ = 0.659, p = 0.003) and 10 s upslope (r = 0.481, p = 0.043) correlated with peak cardiorespiratory fitness but were not related to reoxygenation outcomes (all p ≥ 0.113). These findings describe the acute oxygenation environment of HIIE while suggesting that sustained microvascular vasodilation may be lower post-HIIE.
Accumulation of brain amyloid beta (Aβ), a key pathological hallmark of Alzheimer's disease (AD), begins decades before cognitive symptoms. Being able to predict the risk of Aβ accumulation, or the age at which Aβ exceeds a critical threshold, may enable intervention to delay or prevent onset of AD. Using published genome-wide association studies (GWASs), we developed polygenic scores (PGS) for AD risk (PGSrisk) and resilience (PGSresilience), and tested whether these predicted (i) if an individual is an Aβ accumulator ('Accumulator Status'), and (ii) in accumulators, the age at which brain Aβ exceeds a 20 centiloid (CL) threshold ('Age at onset of Aβ'; AAO-Aβ) in 2175 participants (1158 with AAO-Aβ) from the Alzheimer's Dementia Onset and Progression in International Cohorts (ADOPIC) study. We also performed GWASs on these traits to develop phenotype-specific PGSs. Higher genetic risk of AD predicted increased odds of Aβ accumulation (OR = 1.16; 95% CI = 1.05-1.29; p = 0.003) and younger AAO-Aβ (β = -1.32; SE = 0.31; p = 1.63 × 10-5). Higher genetic resilience to AD predicted later AAO-Aβ (β = 0.91; SE = 0.29; p = 0.002) but did not predict Aβ accumulation. These associations were independent of APOE ε4 status, the strongest genetic risk factor for AD. Phenotype-specific PGSs were not significantly associated with either trait. Polygenic scores, alongside other risk factors, may help identify individuals at risk of accumulating Aβ, and predict the age at which this exceeds a critical threshold. This could provide a window for administering disease-modifying treatment or lifestyle interventions to prevent or delay the onset of AD. National Institutes of Health (R01-AG058676-01A1) and Australian National Health and Medical Research Council (GNT1161706; GNT2001320).
When a child dies in a pediatric intensive care unit (PICU) from a sudden or unexpected cause such as trauma or sepsis, intense grief felt by the child's family can cause sustained psychosocial impacts. Supporting unexpectedly bereaved families with evidence-based bereavement care is key to improving grief outcomes, and understanding their specific needs is essential to inform the delivery of bereavement care in PICUs. To understand what is known about (1) bereavement care needs of families who have experienced the unexpected death of a child in a PICU, and (2) approaches to address families' needs. An integrative review was systematically conducted with the protocol registered a priori on the Open Science Framework. Original peer-reviewed research articles relating to relatives of children who died an unexpected death in a PICU were included from OVID Medline, PsycINFO, CINAHL, SCOPUS, and ProQuest, along with guidelines from Google© searching. Articles were critically appraised using Critical Appraisal Skill Program, Mixed Methods Appraisal Tool, and Appraisal of Guidelines, Research and Evaluation II checklists, and data were synthesized using the constant comparison method. Twenty-nine original research articles (15 qualitative, 11 quantitative, 1 mixed method, and 2 secondary analyses) and five guidelines were included in this review. Three original articles focused on unexpected child death exclusively. From the findings of all 34 articles, four linked themes were identified: (1) connection and (2) communication with PICU clinicians, (3) awareness of the impacts of unexpected death, and (4) emotional and physical support for family members. Unexpectedly bereaved family members' needs included close relationships with clinicians and caring support before and after their child's death, including ongoing follow-up from the PICU. Further targeted research is needed to better understand the specific needs of unexpectedly bereaved families, gain diverse and representative evidence in this area, and develop innovative, evidence-based interventions to improve bereavement outcomes for the whole family.
To evaluate health care utilization in veterans with Alzheimer disease (AD) in the Veterans Affairs health system (VAHS). This retrospective analysis identified veterans with AD using clinical notes extracted from the VAHS electronic health record from fiscal years 2010 to 2019. The first note identifying AD was the index date. Health care utilization in veterans with AD and a 1:1 matched comparison group without AD was evaluated at 2 years preindex, 1 year preindex, 1 year post index, and 2 years post index. From clinical notes, we identified 571,671 veterans with AD and 571,671 for the comparison group (overall: mean age, 74 years; 96% male; 75% White). In those with AD, outpatient visits per patient per year peaked 1 year post index at 67 and remained elevated 2 years post index at 57; without AD, the rate was approximately 19 at all time points. Hospitalization rates peaked at 1 year post index with AD but were lower and generally stable without AD. Nursing home utilization was relatively low overall. Veterans meeting the 2-code criteria (n = 56,305), defined as having 2 diagnostic codes for AD recorded at least 30 days apart, had consistently higher utilization than veterans without AD (especially post index). Veterans with AD have higher health care utilization than veterans without AD, especially around the time of AD diagnosis.
Cancer staging data is vital for treatment planning, outcome prediction, clinical research, and healthcare resource allocation. Collection at the population level can improve insights, however existing manual methods are resource intensive. This study aimed to develop rules-based natural language processing (NLP) systems to: (1) extract explicit tumour, node, and metastasis (TNM) entities from data reported to the Western Australian Cancer Registry; (2) extract implicit entities translatable to individual TNM values; and (3) translate these values into cancer stages for melanoma, breast, and colorectal cancers based on the AJCC 8th edition TNM staging system. Rules-based NLP systems were developed with extensive consultation from knowledge experts to extract staging information and stage colorectal, breast, and melanoma cancers using pathology reports and a hospital inpatient morbidity dataset. Their performance was evaluated against manual collections (ground truth) created by cancer staging project officers using recall, precision, and F1-scores. After an iterative development process, the rules-based NLP systems correctly staged 87%-90% of cases compared to manual collections created by cancer staging officers. The melanoma NLP system had a weighted average precision of 0.96, recall of 0.94, and F1-score of 0.94. The colorectal and breast models had weighted average precision, recall, and F1-scores of 0.89, 0.89, 0.89; and 0.90, 0.89, and 0.89, respectively. The rules-based NLP systems demonstrated strong performance, with potential for improved accuracy using additional data sources. A rules-based NLP architecture can accurately derive TNM components and cancer stage from routinely collected clinical text. Whilst dependent on domain-expert input rather than data-driven training, the methods described demonstrate a way to support partial automation of cancer staging workflows in a setting with limited training datasets.
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Whether admission timing influences outcomes after surgery for acute Stanford type A aortic dissection (TAAD) remains uncertain. This study examined the association between off-hour admission and in-hospital mortality in a nationwide cohort, including seasonal, weekday, and time-of-day variation. All surgically or hybrid-treated TAAD cases were identified in the German Diagnosis Related Groups database from 2010 to 2023. Multilevel logistic regression was used to evaluate factors associated with in-hospital mortality, adjusting for age, sex, comorbidity burden (Elixhauser score), annual hospital volume, and temporal variables (season, weekday, and time of admission). Among 25,608 patients (median age 65 years; 62.4% male), overall in-hospital mortality was 19.0%. Mortality showed no seasonal variation after adjustment. In contrast, significant off-hour effects were observed. Weekend admissions were associated with greater mortality compared with Monday (Saturday: adjusted odds ratio [aOR], 1.20; 95% CI ,1.05-1.36; P = .006; Sunday: aOR, 1.25; 95% CI, 1.10-1.42; P < .001). Nighttime admissions (12:00 to 8:00 am) also had greater mortality than daytime admissions (aOR, 1.11; 95% CI, 1.01-1.22; P = .04). Greater annual hospital TAAD case volume was associated with reduced mortality (aOR, 0.93; 95% CI, 0.86-0.99; P = .038). Seasonal patterns are not related with outcomes, but weekend and nighttime admissions were independently associated with increased in-hospital mortality after TAAD repair, adding further population-level evidence to an ongoing debate. These findings support centralized 24/7 aortic emergency care, consistent team availability, and optimized regional transfer pathways to mitigate temporal disparities and improve survival.
Musicians demonstrate advantages in acquiring motor sequences, showing faster learning and better explicit sequence knowledge than non-musicians. However, it is unclear whether this advantage extends beyond acquisition to the consolidation phase, which is when newly learned skills stabilize and become resistant to interference. Additionally, while interference from executing competing motor tasks is well-established, less is known about whether purely sensory information presented after learning can disrupt consolidation of a bimodal motor sequence. We investigated how post-acquisition sensory interference affects performance of a learned audio-visual sequence, and whether musical training moderates this vulnerability. Participants first learned an explicit sequence in a serial reaction time task using synchronous, informative audio-visual cues. After a brief consolidation period, they were randomly assigned to one of four observational conditions that manipulated the relationship between auditory and visual streams. Motor performance was then reassessed. Post-acquisition sensory interference impaired subsequent motor performance, but this effect was modality-specific: it was driven primarily by manipulations to the task-relevant visual stream, while auditory interference alone had no credible effect. Distributional analysis revealed that learning involved a strategic shift from reactive to anticipatory responding. Critically, participants with musical training showed a consistently higher reliance on anticipatory responses than those without throughout acquisition, indicating stronger predictive motor control. These findings demonstrate that newly formed sensorimotor memories are selectively vulnerable to interference in task-relevant modalities. Furthermore, our work provides a candidate mechanistic account for the musician advantage in sequence learning, linking it to greater reliance on predictive motor strategies during acquisition.
Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation. Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process. Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training. Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain. When a patient is about to have surgery, they talk with their doctor about what to expect. Then they must agree to have the surgery and agree to the anesthesia needed for the surgery. This is known as the informed consent process. Patients who are about to have surgery may have a lot of questions for their doctor. It is important for the doctor to ask the patient if they have any questions. This study looked at videos of a training session for anesthesiology residents, who are doctors in advanced training to give anesthesia. In this training session, the anesthesiology residents were asked to get informed consent from a patient. The patient was an actor pretending to be in a lot of pain. This study looked at whether the anesthesiology resident ever asked the patient if he had any questions. Our results show that sometimes the doctors did not ask if the patient had questions. Sometimes the doctors ask after the consent form has been signed. We need to train anesthesiology residents to always ask if the patient has questions before the patient agrees to the surgery and the anesthesia.
Many people with major depressive disorder (MDD) undergo a lengthy process of trial-and-error before finding a medication that works well for them. Pharmacogenomic (PGx) testing for MDD can help find a suitable antidepressant faster. However, concerns about health equity, and data privacy and security need to be considered before implementing the test. In Fall 2024, 30 individuals attended a four-day public deliberation in Vancouver, British Columbia (BC) to provide direction on implementing PGx testing for MDD in BC's publicly funded healthcare system. Participants were recruited to represent a diversity of perspectives and experiences of British Columbians. Information supports included expert speakers and a background booklet. Event transcripts were analyzed using thematic analysis (both inductive and reflexive), while also accounting for participants' knowledge gains over time. Participants adopted four policy-relevant positions on implementation: 1) PGx test results should be treated like other lab results; 2) stored in electronic medical records; 3) shared with patients and healthcare professionals in the circle of care; and 4) education about the test will facilitate its widespread use. Participants' positions represent informed, civic-minded, and policy-relevant priorities for the acceptable adoption of PGx testing for MDD in the BC healthcare system and elsewhere.