Emergency physicians care for diverse patients with undifferentiated and evolving conditions and often make clinical decisions with limited scientific evidence. Administrative barriers to effective pan-Canadian data collection from Emergency Departments (EDs) limit our ability to generate evidence in a timely manner, particularly in times of crisis. Informed by our prior COVID-19 collaboration ( https://ccedrrn.ca ), we created the Canadian ED Research Network (CEDRN, https://cedrn.ca ) to address these barriers. Our objective is to describe the Canadian ED Research Network's approach to enabling pan-Canadian, harmonized clinical ED data collection using established infrastructure and processes to accelerate research, quality improvement, and surveillance. The Canadian ED Research Network has executed data sharing and membership agreements, privacy approvals, and multi-stakeholder governance that can support the timely launch of national multi-center observational data collection for patients presenting to participating EDs, including rural and remote sites. The Canadian ED Research Network's standardized privacy-approved data collection platform, data flow, and data management processes facilitate the creation of nationally harmonized datasets including data cleaning and verification, permit linkages with administrative datasets, and secure access to data for research ethics board approved analyses within Canada. Outcomes and analytic methods for studies are determined by study-specific steering committees. By allowing the use of data for quality improvement and surveillance, Canadian ED Research Network data can be transferred to provincial health improvement networks to create metrics to monitor public health threats and track implementation of evidence-based interventions. The Canadian ED Research Network is a pan-Canadian research network that has the potential to facilitate and accelerate emergency medicine research and improve care. Its broad geographic and clinical scope will allow Canadian ED Research Network studies to expand to any research relevant to emergency medicine and enhance Canada's health emergencies and pandemic research preparedness. Use of data for research, quality improvement, and surveillance may facilitate implementation of learning health systems at participating sites. RéSUMé: OBJECTIF: les médecins urgentistes s’occupent de divers patients ayant des conditions non différenciées et évolutives, et prennent souvent des décisions cliniques avec des preuves scientifiques limitées. Les obstacles administratifs à la collecte efficace de données Pancanadiennes auprès des services d’urgence (su) limitent notre capacité à produire des données probantes en temps opportun, particulièrement en période de crise. Informes par notre précédente collaboration covid-19 ( https://ccedrrn.ca ), nous avons créé le réseau canadien de recherche sur les de (cèdre, https://cedrn.ca) pour surmonter ces obstacles. Notre objectif est de décrire l’approche du réseau canadien de recherche sur les de pour permettre la collecte pancanadienne harmonisée de données cliniques sur les de a l’aide d’une infrastructure et de processus établis afin d’accélérer la recherche, l’amélioration de la qualité et la surveillance . TRAVAUX PRéLIMINAIRES: le réseau canadien de recherche sur les de a exécuté des ententes de partage de données et d’adhésion, des approbations en matière de protection de la vie privée et une gouvernance multipartite qui peuvent appuyer le lancement opportun de la collecte de données observationnelles multicentriques nationales pour les patients se présentant aux ce participants, y compris les sites ruraux et éloignes. La plateforme de collecte de données normalisée et approuvée par le réseau canadien de recherche sur les de, le flux de données et les processus de gestion des données facilitent la création d’ensembles de données harmonises a l’échelle nationale, y compris le nettoyage et la vérification des données, permettre des liens avec les ensembles de données administratives et un accès sécurise aux données pour les analyses approuvées par le comité d’éthique de la recherche au canada. Les résultats et les méthodes analytiques des études sont déterminés par des comités de pilotage spécifiques à chaque étude. En permettant l’utilisation de données pour améliorer la qualité et la surveillance, les données du réseau canadien de recherche sur le dé peuvent être transférées aux réseaux provinciaux d’amélioration de la sante afin de créer des mesures pour surveiller les menaces a la sante publique et suivre la mise en œuvre d’interventions fondées sur des preuves. OBJECTIF: Le Réseau canadien de recherche sur les DE est un réseau de recherche pancanadien qui a le potentiel de faciliter et d’accélérer la recherche en médecine d’urgence et d’améliorer les soins. Sa vaste portée géographique et clinique permettra au Réseau canadien de recherche sur les DE d’élargir ses études à toute recherche pertinente en médecine d’urgence et d’améliorer la préparation du Canada aux urgences sanitaires et à la recherche pandémique. L’utilisation des données pour la recherche, l’amélioration de la qualité et la surveillance peut faciliter la mise en œuvre de systèmes de santé apprenants dans les sites participants.
To assess the feasibility and parental acceptability of delayed consent for research involving blood samples collected from febrile infants aged 60 days or younger during emergent care. This was a substudy of a pilot trial at a tertiary pediatric ED to detect biomarkers of serious bacterial infections among febrile young infants. Families were provided an introductory letter indicating that, after clinically necessary blood tests, a small volume of additional blood would be collected and stored for research for which they could opt out at any time. After hospital discharge, all families received telephone follow-up for a delayed consent discussion, allowing them to accept or refuse participation in the main biomarker trial. A 6-month consecutive sample of parents was invited to complete a questionnaire regarding the acceptability of research blood collection with delayed telephone consent. Among 345 consecutive infants, 22 (6.4%) families opted out of research blood collection during ED care, and 136 (42.1%) had research blood collected after clinical sampling. Nearly all families (333/345; 96.5%) had telephone follow-up, and questionnaires were completed by 312/333 (90.4%). Most families found delayed consent for research blood collection acceptable (271/312; 86.9%) or somewhat acceptable (34/312; 10.9%), and 81.5% provided consent to use their infants' research blood samples. Delayed consent for research is feasible andhighly acceptable to parents of febrile infants in the ED. This methodology may minimize stress during emergent care, enhance inclusivity, and facilitate timely, ethical pediatric research when there are barriers to standard prospective consent. Broader implementation should consider study risk, context, and ethical oversight.
BACKGROUND: Following myocardial infarction (MI), therapies are recommended that reduce risk and prevent future cardiovascular events. Trends in the provision of guideline-directed medical therapies by sex, age, ethnicity and socioeconomic deprivation status may help identify opportunities to reduce inequalities in post-MI care. METHODS: This cohort study using linked routine healthcare data included patients with MI in South-East Scotland (1 April 2009 to 31st of July 2021). Multivariable logistic regression models with a generalized estimating equation approach were used to assess the association between each sociodemographic factor and the provision of three guideline-directed medical therapies (anti-platelet or anti-thrombotic agent, lipid-lowering therapy and renin-angiotensin system blocker) at 3-, 12-, and 18-months post-discharge. Multivariable cause-specific Cox proportional hazard models were used to evaluate medication status and risk of a composite of non-fatal myocardial infarction, non-fatal stroke, or cardiovascular death across sociodemographic subgroups. RESULTS: The study population comprised 7,926 patients (35% female, mean age 65 [SD 13] years). At 3 months, 5,393 (68%) patients were receiving all three guideline-directed medical therapies. Women (adjusted odds ratio at 3 months [aOR 0.69, 95% confidence interval 0.62 to 0.77]) and patients < 50 years (aOR 0.77, 95% confidence interval 0.65 to 0.89) and > 70 years (aOR 0.58, 95% confidence interval 0.51 to 0.65) were less likely to be receiving all three guideline-directed medical therapies at 3 months with similar observations at 12 and 18 months. No differences were observed by ethnicity and socioeconomic groups across the three time points. Patients receiving all three or one/two guideline-directed medical therapies had a lower risk of future cardiovascular events compared to those not receiving any, with this effect being consistent across all subgroups and time points. CONCLUSION: Women, and both younger and older patients are less likely to be receiving guideline-directed medical therapy following MI, despite its benefit in reducing future cardiovascular events. Targeted strategies to increase provision of secondary prevention in these groups are needed to reduce inequalities and improve post-MI care.
Applications of data science and artificial intelligence (AI) in global health are expanding, yet research remains fragmented and often misaligned with the needs of low-income and middle-income countries (LMICs). To address this misalignment, we conducted a global research priority-setting exercise using the Child Health and Nutrition Research Initiative (CHNRI) method. 155 research ideas were scored by 51 experts based on feasibility, potential impact on disease burden, paradigm shift potential, implementation potential, and equity. Top-ranked priorities focused on epidemic preparedness, including AI-based outbreak prediction, improved diagnostics for infectious diseases, and early-warning systems. Other highly ranked topics included AI-assisted resource allocation, telemedicine, culturally adapted mobile health services, and chronic disease management tools. Experts from LMICs prioritised infectious disease control and diagnostic equity, whereas experts from high-income countries emphasised infrastructure and climate-related analytics. The resulting agenda provides a roadmap for aligning AI and data science research with global health priorities, particularly in LMICs.
Hereditary haemochromatosis is caused by pathogenic variants in the homoeostatic iron regulator gene HFE. Outcomes include liver cancer, cirrhosis and arthropathy, but penetrance is incomplete. Here, we use genetic data from >400,000 subjects to determine the genetic risk across 29 regions of the British Isles and Ireland. Northwest Irish and Outer Hebrideans are at the highest risk (1/54 - 1/62 carry the major risk genotype), Mainland Scots are also at increased risk (1/117), declining to 1/212 in Southern England. We also assessed the prevalence of clinically diagnosed haemochromatosis in >63 million people in NHS England and identified 70,365 cases. White Irish individuals have the highest prevalence (3.7x white British). Among white British, prevalence varied 11-fold from 1/1972 in parts of Kent to 1/177 in Liverpool. Discrepancies between genetic risks and prevalences of clinical diagnoses for Birmingham, Cumbria, Northumberland and Durham suggest under-diagnosis in these regions. We show heightened genetic risk of haemochromatosis in people of Northwest Irish and Hebridean ancestry and suggest health-economic modelling of community screening should be targeted to these priority areas.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for scoping reviews (ScRs) (PRISMA-ScR) was published in 2018 to provide reporting guidance. A substantial increase in published ScRs in recent years coupled with the omission or lack of engagement of interest-holders, including patients and public partners, as research partners throughout its development necessitate updating PRISMA-ScR. Important methodological advancements have emerged since PRISMA-ScR 2018, including automation and data extraction, which need to be incorporated into this update and reflected in new reporting items. Aligned with PRISMA 2020, this ScR underpins the update by identifying potential new reporting items for consideration from recent studies related to reporting guidance and the evaluation of reporting completeness in ScRs. The protocol for this review was published and registered with the Open Science Framework and in a peer-reviewed journal. We conducted database searches in MEDLINE, Embase, and Cochrane Methodology Register and gray literature searches guided by the Canada's Drug Agency Gray Matters tool. Retrieved sources were screened in duplicate to assess eligibility. Included studies underwent data extraction with one extractor and one verifier. We summarized results and proposed additional PRISMA-ScR reporting items. Of the 8265 records screened, 43 unique documents (13 overviews of ScRs and 30 guidance documents) were included and extracted. Thirty-seven potential reporting items for ScRs were identified; these will be evaluated in a subsequent Delphi survey to inform the PRISMA-ScR update. The most common additional items were related to objectives (67.4%), eligibility criteria (62.8%), search strategy (51.2%), data collection process (53.5%), and results of synthesis (51.2%). Newly identified items included reporting the inclusion criteria using a suitable framework (e.g., Population, Concept, and Context), reporting protocol deviations in the final ScR, and visually presenting results along with relevant text to support the visuals. This ScR highlights gaps in existing PRISMA-ScR reporting guidance and provides additional reporting items for consideration and potential inclusion in an updated guideline. When aligned with the latest methodological advancements and involving interest-holders, including patients and public partners, the updated guideline will enhance the transparency and robustness of ScRs. The goal of this project is to update the reporting guideline for ScRs. The reporting guideline is called PRISMA-ScR. ScRs collect and summarize information from many studies addressing a broad research question. They are useful because they help researchers see what is already known. They also find gaps in knowledge and inform what research should be conducted next. ScRs also help health-care workers, leaders, and policy makers make informed decisions. PRISMA-ScR is a guide to help researchers clearly explain the methods they used to conduct their ScR. Clear reporting of the methods used is important so readers can judge the quality of the review and know if they can be confident in the results. It allows other researchers to repeat the study to check if the results are reliable. Health professionals also use the information to guide patient care and healthcare planning. An update to PRISMA-ScR is needed for several reasons. 1. ScRs are not always reported in a clear or consistent way. This can make them hard to understand or use. 2. The original guideline from 2018 did not include patients or public partners. In this project, patients and public partners are involved throughout the entire process. Their experiences and perspectives help make the guideline more useful and relevant. 3. New methods for doing ScRs have been developed since 2018. The guideline needs to reflect these changes. To support the guidance update, researchers looked at current guidelines. They also completed a new ScR. They found 47 research papers that suggested 37 new reporting items. These items suggest there may be gaps in the existing guidelines. As a result, the new reporting items will be considered as part of the PRISMA-ScR update.
To assess feasibility of recruitment and compare clinical outcomes in a trial of early selective treatment of a moderate-severe patent ductus arteriosus (PDA) or no intervention in the first 7 postnatal days in extremely preterm infants. Multicentre, open-label, parallel-design pilot randomised controlled trial SETTING: Seven tertiary/quaternary neonatal intensive care units. Infants <26 weeks gestational age (GA) with a PDA diagnosed within 72 hours after birth. Participants were randomised to an early echocardiographic screening within the first 72 hours followed by selective medical treatment (SMART) strategy of a moderate-severe PDA shunt or no intervention in the first 7 days. The primary feasibility outcome was the proportion of eligible infants enrolled. Important secondary outcomes included a composite clinical endpoint of survival without major morbidity. 116 of 185 eligible infants were enrolled (63%, 95% CI 56% to 70%; SMART, n=51, Control, n=53). Of them, 104/116 (90%) (mean GA 24.3 weeks, birth weight 714 g) were randomised. Protocol deviation was 1.9%. Based on the treatment algorithm, 24% infants randomised to SMART never required treatment. Median treatment initiation age in the SMART arm was 2 days (IQR 1-2.5 days). The SMART strategy demonstrated an 85% probability of a better Win ratio (1.34, 95% CrIs 0.73 to 2.5) compared with control. A trial of selective early PDA pharmacotherapy based on clinical and echocardiography grading of PDA shunt volume in the smallest infants is feasible with minimal protocol deviation. Early echocardiography screening and selective pharmacotherapy using the SMART-PDA algorithm may enhance the probability of survival with less morbidities in infants born <26 weeks GA. NCT05011149.
The increasing integration of artificial intelligence as medical devices (AIaMDs) within diagnostic imaging necessitates a robust understanding of associated regulatory frameworks among clinical practitioners. Despite the growing commercial availability and adoption of AIaMD, a significant awareness gap persists among radiologists regarding pertinent European Union regulations, including the Medical Device Regulation (MDR) and the novel EU AI Act, both of which lack explicit provisions tailored to AI components. This regulatory ambiguity underscores a critical need for clarified guidelines concerning "high-risk" AI classification and best practices for safe deployment within the radiological workflow. Legal responsibility for AIaMD Post-Market Surveillance (PMS) primarily rests with software providers, yet radiologists are expected to contribute to the ongoing monitoring of safety and performance. Recognizing the need to raise awareness and provide practical guidance, the European Society of Radiology (ESR) eHealth and Informatics Subcommittee, supported by the ESR AI Working Group, conducted a modified Delphi procedure involving 16 domain experts (of which 14 acted as panelists) to establish a set of shared recommendations. These aim to establish essential practices for AIaMD PMS and post-market clinical feedback (PMCF), as stipulated by the MDR and partially updated by the AI Act. This paper also provides an overview of relevant regulations to enhance awareness among all stakeholders, particularly deployers (e.g., radiologists) and providers (e.g., vendors). These recommendations represent a foundational step towards improving consistency in AIaMD deployment, providing a critical reference standard for physicians navigating the unique challenges posed by these novel technologies. CRITICAL RELEVANCE STATEMENT: Radiologists need to familiarize themselves with AIaMD EU regulations due to shared PMS responsibilities and current ambiguities. ESR recommendations aim to bridge this awareness gap, standardizing safe AI deployment and enhancing clinical feedback within medical imaging. KEY POINTS: Radiologists need a clear understanding of EU regulations for AIaMDs, as current laws lack imaging-specific guidance. There is a shared responsibility for AIaMD safety, with radiologists contributing to PMS and clinical feedback systems. The ESR provides crucial recommendations to standardize AI deployment and improve clinical feedback in imaging.
Guidelines recommend structured self-reported functional capacity assessment for preoperative cardiac risk stratification, including the Duke Activity Status Index (DASI). However, evidence supporting its incremental prognostic value beyond established risk factors remains limited. We evaluated the prognostic performance of the DASI using pooled data from two prospective cohorts. We conducted a pooled cohort analysis of adults undergoing elective major non-cardiac surgery enrolled in the Measurement of Exercise Tolerance before Surgery (METS) and Functional Improvement Trajectories After Surgery (FIT After Surgery) studies, including data collected between March 2013 and April 2023. Before surgery, participants completed the Duke Activity Status Index (DASI), a structured 12-item questionnaire based on daily physical activities, and underwent routine preoperative biomarker measurement. The primary outcome was 30-day major cardiac complications (myocardial infarction or non-fatal cardiac arrest) or death. The secondary outcome was all-cause major complications. Hierarchical logistic regression assessed the incremental prognostic value of the DASI beyond age, Revised Cardiac Risk Index (RCRI), and natriuretic peptide concentration. Prognostic performance was evaluated using the likelihood ratio test (LRT), fraction of new predictive information, net reclassification improvement, c-index, calibration plots, and decision curve analysis. Among 3485 patients, 3.6% (n = 126) experienced the primary outcome and 19% (n = 647) experienced the secondary outcome. The DASI provided prognostic information beyond age, RCRI, and natriuretic peptide concentration for the primary outcome (LRT p = 0.009), and beyond age, sex, and surgery type for the secondary outcome (LRT p < 0.001). Inclusion of the DASI improved prognostic performance across multiple metrics, but overall discrimination of the final models remained modest (c-index 0.70-0.71), with limited net clinical benefit. Predicted risk associated with a given DASI score varied substantially by age, RCRI, and natriuretic peptide concentration, supporting interpretation of the DASI as a continuous prognostic marker rather than a dichotomous screening test. The DASI provides incremental prognostic information for preoperative cardiac risk assessment beyond guideline-recommended predictors. Its prognostic implications are modest, context-dependent, and best interpreted as a continuous prognostic marker alongside established risk factors, rather than as a stand-alone threshold-based tool. Canadian Institutes of Health Research; PSI Foundation; and the Elizabeth A. and Richard J. Currie, O.C. Chair in Translational Anesthesia Research at St. Michael's Hospital and the University of Toronto; The Ottawa Hospital Academic Medical Organization Innovation Fund; Heart and Stroke Foundation of Canada; Ontario Ministry of Health and Long-Term Care; Ontario Ministry of Research, Innovation and Science; UK National Institute of Academic Anaesthesia; UK Clinical Research Collaboration; Australian and New Zealand College of Anaesthetists; Monash University.
This study examined why artificial intelligence (AI)-based clinical decision support tools have had limited clinical translation in the emergency department (ED) and identified barriers and facilitators to their development and implementation. We conducted a qualitative study involving semi-structured interviews with researchers who have expertise developing and implementing AI clinical decision support tools for use in the ED. We used purposive and snowball sampling to identify participants. We used platform-based AI transcription and anonymized transcripts manually. Using grounded theory framework, two coders iteratively analyzed transcripts in three stages (initial, focused, and theoretical) to identify barriers, facilitators, and themes. We adhered to SRQR and COREQ guidelines. We achieved data saturation after ten interviews conducted between October 15, 2024 and March 22, 2025. Participants ranged across a variety of medical and academic professions. We identified eight themes pertaining to developing and implementing AI clinical decision support in the ED, in descending frequency: team capacity; data infrastructure; defining the clinical problem and solution; research, ethics, and regulatory approval; legal and liability; model building and performance; time; and cost. We identified "engaging multiple healthcare end-users" and "sharing resources with other departments" as the highest yield facilitators. Successful implementation of AI clinical decision support tools in the ED requires a clear clinician- and patient-defined problem, robust data infrastructure, and a diverse research team able to navigate challenges with regulatory, legal, and financial challenges over a long timeline. Anticipating barriers and leveraging facilitators early in the development process may increase the likelihood of successful implementation. RéSUMé: OBJECTIFS: Cette étude a examiné pourquoi les outils d’aide à la décision clinique basés sur l’intelligence artificielle (IA) ont eu une traduction clinique limitée dans le service des urgences et a identifié des obstacles et des facilitateurs pour leur développement et leur mise en œuvre. MéTHODES: Nous avons mené une étude qualitative impliquant des entretiens semi-structurés avec des chercheurs ayant une expertise dans le développement et la mise en œuvre d’outils d’aide à la décision clinique par IA pour utilisation au service des urgences. Nous avons utilisé l’échantillonnage ciblé et en boule de neige pour identifier les participants. Nous avons utilisé manuellement la transcription IA basée sur la plateforme et les transcriptions anonymisées. En utilisant la théorie ancrée, deux codeurs ont analysé de manière itérative des transcriptions en trois étapes (initiale, ciblée et théorique) afin d’identifier les obstacles, les facilitateurs et les thèmes. Nous avons respecté les directives SRQR et COREQ. RéSULTATS: Nous avons atteint la saturation des données après dix entretiens menés entre le 15 octobre 2024 et le 22 mars 2025. Les participants exerçaient diverses professions médicales et universitaires. Nous avons identifié huit thèmes relatifs au développement et à la mise en œuvre de l’aide à la décision clinique en IA dans le service d’urgence, par ordre décroissant de fréquence : capacité de l’équipe ; infrastructure des données ; définition du problème clinique et de la solution ; recherche, éthique et approbation réglementaire ; juridique et responsabilité ; construction de modèles et performance ; temps ; et coût. Nous avons identifié « l’engagement de plusieurs utilisateurs finaux du secteur de la santé » et « le partage des ressources avec d’autres départements » comme les facilitateurs à plus haut rendement CONCLUSION: La mise en œuvre réussie des outils d’aide à la décision clinique de l’IA dans le service d’urgence nécessite un problème clairement défini par les cliniciens et les patients, une infrastructure de données robuste et une équipe de recherche diversifiée capable de surmonter les défis réglementaires, juridiques et financiers sur une longue période. Anticiper les obstacles et mobiliser des facilitateurs dès le début du processus de développement peut accroître la probabilité d’une mise en œuvre réussie.
To characterize spinal accessory nerve (SAN) related shoulder dysfunction under standardized, controlled conditions following anatomically nerve-preserving bilateral selective neck dissection, integrating objective functional, electromyographic, and patient-reported outcomes. Prospective cohort study. Single tertiary referral centre, [blinded institution], Spain. Twenty-six patients with head and neck squamous cell carcinoma requiring bilateral selective neck dissection of levels II-IV including level IIB. Shoulder range of motion (ROM) by digital inclinometry, electromyography (EMG) amplitude and latency of the trapezius muscle, muscle strength (British Medical Research Council scale), shoulder girdle examination, and patient-reported outcomes (Neck and Shoulder Disability Index), assessed preoperatively and at 1, 3, and 6 months postoperatively. Intraoperative neuromonitoring with compound muscle action potential recording was performed before and after dissection. Despite stable intraoperative neuromonitoring amplitudes, significant reductions in abduction (mean 30.5 °, p =  0.0003) and flexion ROM (mean 23.8°, p =  0.0008) persisted at 6 months. EMG amplitude decreased from 8.85 to 4.47 mV at 1 month (p =  0.0003), with partial recovery at 6 months. Latency increased transiently. Strength deficits (BMRC ≤4/5) were present in 19.2% of patients at 6 months. Neck Disability Index increased significantly (p =  0.004). Spinal accessory nerve dysfunction can occur despite anatomical preservation and stable intraoperative monitoring, suggesting neurapraxic changes arising from mechanisms not captured in real time such as possibly traction or perineural disruption at level IIB. These findings highlight the importance of postoperative surveillance and early targeted rehabilitation.
The mental well-being benefits and challenges of pet ownership have been explored in many populations, including clinical populations such as individuals with depression, anxiety, and posttraumatic stress disorder. Critically, there are currently no published studies focusing specifically on pet ownership for individuals with eating disorders. The present work aimed to explore pet ownership experiences of adults experiencing eating disorders. Semi-structured interviews were conducted with 17 cat- and dog-owning British adults (eight cat owners, six dog owners, three participants with both cats and dogs) with diagnosed or suspected eating disorders. Reflexive thematic analysis was utilized to identify two overarching themes and seven subthemes relating to the role of the human-pet bond in eating disorder symptoms and treatment. Data-driven themes include personal recovery experiences, the dual role of pets in eating behaviors, exercise experiences, pets' influence on cognitions, body image perceptions, and self-identity, as well as pets' roles in personal recovery motivations. Furthermore, pets were found to impact treatment experiences, represented by themes that discuss pets as catalysts for change and partners during treatment, while also creating challenges around separation during treatment. The present study found that pets can be largely beneficial for individuals with eating disorders, especially for those in later stages of personal recovery; however, pets can also create challenges, especially for individuals in earlier stages of personal recovery. The present work also provides a foundation for future work related to pet ownership for individuals with eating disorders, such as further exploration on incorporating pets into eating disorder treatment, how to utilize the human-pet relationship to support symptom reduction, and how to mitigate challenges posed by pets related to treatment, with the results having key relevance for the development of clinical interventions for this population. The study examined the relationships that people with eating disorders have with their pets. Semi-structured interviews were conducted with 17 participants who owned cats or dogs. Two overarching themes and seven subthemes were identified. These themes included the role pets play in personal recovery experiences and personal recovery motivation, the dual function of pets in eating behaviors and exercise experiences, how pets influence thought patterns, perceptions of body image, and self-identity, and how pets provide motivation and support, but also challenges related to treatment. The findings of this study provide a better understanding of the support, but also challenges, related to pet ownership for people with eating disorders, and provide a foundation for future research in this area. Future work building on the present study may focus on incorporating pets into eating disorder treatment, how to utilize pets to support symptom reduction, and how to mitigate challenges posed by pets related to treatment.
BACKGROUND: The maternal cardiovascular system undergoes a profound transformation during pregnancy. Disordered cardiovascular adaptation is associated with pre-eclampsia and fetal growth restriction; however, these complications remain challenging to predict and manage. Computational modelling presents an opportunity to study the maternal circulation with unprecedented flexibility. We conducted a scoping review to assess the potential utility of computational models for studying maternal cardiovascular adaptation to pregnancy and providing insights into disease. We aimed to identify research gaps and barriers to translating this emerging field into clinical practice. METHODS: Medline, Embase, and Web of Science Core Collection were searched from 01/01/2013 to 01/09/2025, for articles related to computational haemodynamic models of pregnancy. English-language studies describing models of the maternal circulation in human pregnancy were identified. Information on system modelled, study design, participant or clinical specimen details, and key findings were extracted from original research studies and presented in a narrative synthesis. RESULTS: Of 662 citations, 37 met inclusion criteria, comprising 28 original research studies, two conference abstracts, and seven reviews. Amongst the original research studies, 27 were basic experimental papers and one was a retrospective cohort study. Nine experimental articles incorporated data from pregnant participants or clinical specimens into personalised models, with sample sizes between one and 21. Four of these included participants or specimens affected by hypertensive disorders of pregnancy or fetal growth restriction. The retrospective cohort study employed haemodynamic modelling to investigate blood loss in 480 patients with abnormally invasive placentas. Modelling approaches described included those simulating the entire maternal circulation, maternal cardiac remodelling, maternal renal autoregulation, the maternal pelvic circulation in isolation, uterine vascular adaptation, spiral artery remodelling, and blood flows within the placental intervillous space. CONCLUSIONS: Computational modelling could represent a powerful tool to advance understanding of maternal cardiovascular adaptation to pregnancy and guide future approaches to risk stratification, diagnosis, and management of pregnancy complications. Realising this promise will require cardiovascular models to be parameterised with scalable metrics, validated in large pregnancy cohorts, developed alongside robust computational processing pipelines, and integrated into existing clinical workflows. PROTOCOL REGISTRATION: The review protocol was registered prospectively with the Open Science Framework (osf.io/v3968).
Occupational eyelid dermatitis (ED) is a much-neglected issue in public health, with important ramifications for patients' quality of life, employment and facial aesthetics. Patients with occupational ED are often younger, male and with an atopic background compared with those with non-occupational ED. Common contact allergens include rubber additives, acrylates, isothiazolinones, fragrances, epoxy resins, potassium dichromate, colophonium, metals and topical medications. Contact allergens and irritants may cause occupational ED by direct or indirect exposure, for example, through transfer by hands, airborne exposure or connubial contact. At-risk occupations include healthcare workers, hairdressers, industrial workers, electricians, cleaning staff, gardeners and florists as well as artists and craftsmen. The diagnostic work-up should include medical and employment history and exposure analysis in addition to clinical manifestations according to Mathias' diagnostic criteria. Patch testing with standardized series as well as consideration of semi-open or use tests with the patient's own work-related materials are essential. The differential diagnosis requires a multidisciplinary approach to exclude ED of other aetiologies. Occupational ED is an important issue in public health meriting better reporting, medical surveillance and public health policies to ensure the safety and well-being of the employees.
Long term respiratory symptoms are reported following recovery of acute COVID-19 infection and residual lung abnormalities (RLA) on follow-up thoracic computed tomography (CT) after COVID-19 hospitalisation have been observed. It is unknown whether RLA are associated with epithelial lung injury. Plasma was sampled from the observational Post HOSPitalisation-COVID cohort at five months post-hospitalisation. Epithelial injury biomarkers Krebs von den Lungen-6 (KL-6), matrix metalloproteinase 7 (MMP-7), surfactant protein-D (SP-D) and surfactant protein-A (SP-A) were assayed. In those without follow-up CT, RLA at-risk was defined by percent predicted DLCO <80% and/or abnormal chest X-ray, otherwise they were considered low-risk. Follow-up CT RLA was defined as combined involvement of ground glass opacity and reticulation ≥10%. A total of 957 people were included, 846 people with no CT (at-risk n = 103; 12.2%), 111 people with follow-up CT (RLA ≥10% n = 85; 76.6%). All epithelial injury biomarkers were significantly elevated in people at-risk of RLA compared with low-risk. KL-6 and MMP-7 were significantly higher in people with ≥10% RLA than those with <10%, SP-D and SP-A did not reach significance. SP-D and SP-A were associated with percent involvement of reticulation (3.22%, 95% CI 1.19-5.24; 3.03%, 95% CI 0.76-5.30, respectively). RLA after acute COVID-19 infection were consistent with elevated epithelial injury biomarkers and pro-fibrotic signalling. Future studies should address the temporal association between fibrotic biomarkers and resolution or progression of radiological involvement. MRC-UK Research and Innovation and National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (MR/V027859/1; COV0319; MR/W006111/1).
Redirection of non-urgent patient visits from the pediatric emergency department (ED) to community healthcare professionals may reduce crowding. As there is no consensus about who should be eligible for redirection, this qualitative study explored how health professionals conceptualize eligibility for pediatric redirection. We completed one-on-one semi-structured interviews with pediatric ED triage nurses and physicians, office-based pediatricians and family physicians, and healthcare leaders who oversee pediatric and ED operations. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis within an interpretive description framework to generate clinically relevant insights. From our 24 interviews (6 community professionals, 11 pediatric ED professionals, and 7 healthcare leaders), we identified three guiding principles that are important to consider when developing eligibility criteria: 1. assessing the impact of presenting condition on the patient and caregivers; 2. medical complexity of the clinical condition, patient, and health system; and 3. process-related considerations. This study captures referring and receiving healthcare professional perspectives about eligibility for pediatric ED redirection. The resulting guiding principles support prior work that focuses on patient characteristics and medical complexity, and also emphasizes the importance of considering family capacity, patient history, and shared decision making when creating pediatric redirection eligibility criteria. Through interviews with referring and receiving healthcare professionals and health leaders, we identified guiding principles that can support identifying patients suitable for redirection from the pediatric ED. The guiding principles we developed provide a structured, healthcare professional-informed foundation to determine which children may be suitable for ED redirection and highlight the importance of caregiver, health system, and process factors often overlooked in prior approaches. Our guiding principles reflect health professionals' values surrounding redirection and if applied can enhance the acceptability and sustainability of pediatric ED redirection programs.
The Scottish Travellers are a traditionally nomadic community in Scotland that has historically been marginalised, and remained socially isolated from the settled Scottish population until recently. Little, however, is known about their genetic origins, population structure and risks of Mendelian disease. After an approach from the community to address this gap and increase representation, we analyzed array genotypes and whole-exome sequencing data from up to 125 Gypsy/Traveller individuals, alongside settled British and Irish references. We demonstrate that Scottish Travellers are genetically distinct from Irish Travellers, English Gypsies and European Roma, as well as the settled British and Irish populations. However, they do share autosomal and mitochondrial genetic ancestry with settled Scots. Two genetic subgroups are detectable: one which is more drifted and one more admixed. High levels of autozygosity are apparent, consistent with consanguinity. We detect signals of bottlenecks in autosomal and mitochondrial data. Importantly, we identified an enrichment of rare, pathogenic variants, including at least five putative founder variants associated with recessive Mendelian disorders. These findings provide insights into the genetic history of the Scottish Traveller population and highlight the opportunity and need for community-driven clinical genetics screening initiatives to decrease the scope for further health disparities.
Early intervention for eating disorders (EDs) models and services is not formalized in Canada, despite increasing demand for care and well-established clinical, social, and economic benefits of intervening early. FREEDcan (First Episode Rapid Early Intervention for Eating Disorders-Canada) introduces a community-based model to improve early identification, initial response, and access to evidence-based interventions for young people aged 8-25 years with early-stage EDs. FREEDcan was co-adapted from the United Kingdom's evidence-based FREED model for the Canadian context with a multi-partner advisory group of clinicians, community organizations, youth and family advisors, researchers, and an implementation science team. It has three pillars: early identification, initial response, and evidence-based interventions for early-stage EDs. Implementation is supported by intersectoral partnerships, community-driven adaptation, and integrated workforce expansion to build capacity and facilitate sustainable, integrated early intervention. From a service perspective, FREEDcan aims to improve early detection of EDs, reduce duration of untreated illness through rapid, low-barrier responses, and increase access to stage-appropriate interventions. Additional implementation-based outcomes are anticipated, including evidence for core components, costs, and adaptations relevant to scaling this model in diverse regions across Canada. FREEDcan has the potential to provide an accessible, youth-centered, developmentally appropriate approach to early ED care within a collaborative, community-driven, integrated care framework. Using a learning health systems approach, it strives for continuous evaluation to support real-time learning, opportunities for model improvement, and evidence-generation for a new integrated model of care for early-stage ED care for young people in Canada. FREEDcan is a new early intervention model in Canada aimed at helping young people aged 8–25 years receive support for eating disorders (EDs) as early as possible. Although the need for ED care is increasing, early intervention has not been widely available in Canada. FREEDcan, adapted from the UK’s FREED model, seeks to address this gap by identifying EDs early, responding quickly, and providing treatments that are proven to work in the early stages. The model was developed through a collaborative process that integrates research, clinical expertise, and lived expertise. FREEDcan involves partnerships across different sectors including community and primary care so that early intervention can be built into existing care systems. FREEDcan also works to raise awareness about EDs, expand and strengthen the workforce, and make early support more accessible. FREEDcan’s community-driven strategy helps young people and their families receive timely and appropriate support no matter where they live. The model is continuously evaluated, allowing for real-time learning and adaptation for real-time learning and adaptation. By fostering collaboration and integrated care, FREEDcan has the potential to significantly improve early intervention for EDs in Canada, making care more accessible, equitable, and effective.
Adolescent blood pressure guidelines rely on expert consensus because evidence on cardiovascular outcomes is limited. This study aimed to examine the link between adolescent blood pressure indices and early cardiovascular events. We conducted a cohort study among 902 741 adolescents aged 16 to 19 years who were evaluated for mandatory service from 1979 to 2019, excluding those with preexisting cardiometabolic conditions. Individuals were followed until 50 or death or insurance loss or December 31, 2021, whichever occurred first. Exposures included baseline blood pressure and American Academy of Pediatrics categories: normal (<120/<80 mm Hg), elevated (120/<80-129/<80 mm Hg), stage 1 (130/80-139/89 mm Hg), stage 2 (≥140/90 mm Hg), and hypertension (clinical diagnosis). The primary outcome was incident cardiovascular events (ischemic heart disease or cerebrovascular disease). Hazard ratios were estimated using Cox models adjusted for demographic, socioeconomic, and clinical confounders. During over 18 million person-years of follow-up, 6305 cardiovascular disease events were recorded, yielding an incidence rate of 0.35 per 1000 person-years. Increased diastolic, systolic, and mean arterial blood pressure were significantly associated with increased risk. Compared with the Normal group, adjusted hazard ratios for cardiovascular disease were 1.14 (95% CI, 1.08-1.22) for stage 1, 1.31 (1.20-1.44) for stage 2, and 2.42 (1.87-3.12) for hypertension. Risk in the stage 1 category was particularly sensitive to diastolic blood pressure. Higher blood pressure indices during adolescence were strongly associated with an elevated risk of early cardiovascular disease, highlighting the potential need to refine current guidelines to better reflect cardiovascular risk.
Poor cardiopulmonary fitness is an important risk factor for postoperative complications, yet a feasible, objective and prognostically accurate method to assess preoperative fitness has not been established. The 6 min walk test (6MWT) is a simple, inexpensive and widely applicable measure that shows promise for predicting postoperative risk. However, robust data are lacking on whether the 6MWT accurately predicts complications, provides incremental prognostic value beyond routinely collected clinical factors or outperforms simpler alternatives such as questionnaires, cardiac biomarkers or grip strength testing. The Functional Assessment for Surgery by a Timed Walk (FAST Walk) study is designed to address these knowledge gaps by evaluating whether the 6MWT improves prediction of key postoperative outcomes compared with clinical factors and simpler measures of fitness. The FAST Walk study is an international multicentre prospective cohort study of 1672 adults (≥40 years) undergoing major elective non-cardiac surgery at centres in Canada, Hong Kong, Australia, Spain and the Netherlands. Participants complete a preoperative 6MWT and baseline assessments of comorbidities, self-reported cardiopulmonary fitness (MET: Re-evaluation for Perioperative Cardiac Risk questionnaire), biomarkers (N-terminal pro-B-type natriuretic peptide) and grip strength. The primary outcome is 30-day death or major postoperative complication, defined as Clavien-Dindo grade II or higher. Secondary outcomes are (1) death or new significant disability at 90 days after surgery and (2) days alive and out of hospital at 30 days after surgery. Disability is measured using the short-form WHO Disability Assessment Schedule 2.0 instrument. Multivariable regression models and complementary metrics of prediction performance will be used to determine whether 6MWT distance adds prognostic value beyond routinely collected clinical factors and simpler measures of fitness. The FAST Walk study has received research ethics board approval at all participating sites. Recruitment commenced in June 2024, with completion of participant follow-up expected in 2026. Findings will be disseminated through peer-reviewed publications and conference presentations, with the primary results anticipated in 2027. NCT06412367.