共找到 20 条结果
Some of the most daunting challenges facing health care today are complex (as opposed to complicated), and leadership approaches developed for merely complicated work (emphasizing measurement, efficiency, and standardized practices) have limited effectiveness. The decision-making processes honed by clinicians in medical school and residency, which emphasize teamwork, hypothesis-testing, and rapid adaptation, are better suited to complex problems than the processes typically taught in business and health administration programs, and organizations can benefit from harnessing their clinicians' skills to address complex operational problems.
Transcatheter aortic valve replacement (TAVR) in patients with a single coronary artery (SCA) is challenging because loss of coronary access may have catastrophic consequences. A 92-year-old woman with severe aortic stenosis underwent transfemoral TAVR. Preprocedural computed tomography revealed an SCA arising from the left coronary cusp with a small annulus. TAVR was performed using an Evolut FX+ valve with intentional commissural alignment guided by cusp-overlap and en face fluoroscopic views. Postprocedural imaging demonstrated preserved coronary access and flow, with a large stent-frame cell facing the coronary ostium. The patient recovered uneventfully. Intentional commissural alignment with imaging-guided deployment may preserve coronary access without coronary protection in patients with complex coronary anatomy. Intentional commissural alignment may facilitate safe TAVR while preserving coronary access in patients with SCA.
Preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is a highly effective tool, but it is underutilized, and significant inequities exist regarding which populations are able to access PrEP. Although most PrEP care occurs in specialty settings, such as sexual health and HIV clinics, most individuals eligible for PrEP are seen in primary care; this imbalance represents an opportunity to expand PrEP access. New York City Health and Hospitals (NYC H+H) is a municipal health care system that provides primary and specialty care across the five boroughs of New York City. To address the gap in PrEP access within primary care, a multidisciplinary working group within NYC H+H was convened in June 2023, and it included primary care providers, nursing staff, and administrative stakeholders within primary care, virology, quality, and data and analytics. The working group interfaced with facilities directly to listen to and engage with the care teams and patients to identify barriers and develop supports to facilitate implementing PrEP services within primary care. In response to care team and patient needs, electronic medical record tools were developed, and customized training and patient-facing educational materials were created to address identified gaps in care team knowledge regarding PrEP care services. Training and electronic medical record tool dissemination occurred, initially, as a proof of concept at one pilot site in East New York, Brooklyn, from June to December 2023, and resulted in a threefold increase in PrEP uptake among patients who had a documented PrEP discussion with their care team, at 20% (15/76), as compared with the NYC H+H system for PrEP uptake, at 6.8% (1207/17,724) (P<0.000). Moreover, the increase in PrEP uptake was seen across populations that traditionally face barriers to accessing PrEP. Through this patient- and care team-centered approach, PrEP care services were able to be implemented in an equitable way within a primary care clinic setting.
Occupational resilience has emerged as a construct that links the capacity to face adversity with the role of meaningful occupations in the adaptation and recovery of individuals, groups, and communities. However, its definition, theoretical frameworks, and applications remain heterogeneous and partial. This lack of systematisation hinders its integration into occupational therapy and occupational science. The objective of this study is to map and synthesise the scientific literature on occupational resilience, identifying how it is conceptualised and operationalised. Using established scoping review frameworks, publications from 2000 to 2025 were searched in databases and through manual searching, including empirical studies and conceptual literature that addressed occupational resilience and its relationship with occupational participation in contexts of adversity. There was no direct participation of consumers or community representatives in the design, conduct, or interpretation of the findings of this study. Thirty-seven studies were included that show diverse uses of the term occupational resilience and related concepts, tending to conceptualise it as a trait, an individual capacity, a dynamic process, and an adaptive outcome linked to occupational performance. The findings highlight the role of meaningful occupations in modulating suffering and emotional activation and in rebuilding purpose, agency, roles, routines, and identities after adversity. They also reveal marked differences in definitions, measures, and designs, with a predominance of approaches focussed on individual resilience, mainly in work-related contexts, and limited attention to structural dimensions and occupational justice. This review offers a structured view of occupational resilience and of the place that meaningful occupations occupy in resilience processes, proposing a process-oriented definition that articulates personal, contextual, and occupational dimensions. The results underscore the need to define integrated theoretical frameworks and occupational therapy interventions explicitly oriented towards the occupational effects of trauma, which validate pain, support the restoration and reinvention of occupational participation, and question the social conditions that make sustained resilience necessary. Occupational resilience is a concept that has gained importance in recent years. It refers to the capacity of individuals, groups, and communities to face adverse situations by engaging in occupations that are meaningful in their lives. However, there is no agreement on its definition or on how to apply it in practice. This study therefore reviewed and organised the scientific literature on occupational resilience through a scoping review that analysed 37 articles, including both theoretical papers and empirical research on the topic. The results show that occupational resilience is understood not only as an individual capacity but also as a process. Above all, they emphasise the importance of meaningful occupations for facing adversity and rebuilding life meaning and occupational identity.
Monkeypox (Mpox) is a zoonotic disease caused by MPXV and remains a threat to global public health. MPXV Clade Ib has higher mortality, whereas Clade IIb exhibits widespread international transmission. WHO has twice designated mpox epidemics as a Public Health Emergency of International Concern (PHEIC). This highlights that the virus is not only pathogenic but also has the potential to cause a global pandemic, posing a challenge to the international public health system. The rapid transmission of MPXV between and within hosts is related to two key virus particles: IMV and EEV. Antigenic proteins (A29L, M1R, B6R, and A35R) on these particles mediate viral invasion, dissemination, and immune evasion. Clinical management of mpox remains supportive, and there is a lack of specific antiviral drugs. Although smallpox-related drugs (such as tecovirimat, cidofovir, and brincidofovir) show potential, their clinical efficacy needs to be verified. The existing vaccines recommended by the WHO are facing challenges, such as side effects or limited duration of immune protection in application, prompting the research and development of novel vaccines and antibody therapeutics. Research on the mechanism of invasion and surface proteins of viruses will continue to provide a scientific foundation for the development of medications and vaccines. Prevention and control rely on a stronger monitoring system, timely risk warnings, and public health education. This article reviews the recent progress in MPXV detection, vaccine development, and antibody-based therapy, providing new insights for mpox prevention and control.
To mark the 10th Anniversary of BJPsych Open, we explore the contributions of papers published in BJPsych Open to advance cultural psychiatry practice and policy. In our overview of papers published in BJPsych Open, we found examples of good practice where authors detailed the translation methods and interpretation models in the research. The task facing clinicians and public health practitioners is to evolve applied, locally relevant, culturally competent interventions in which specific adaptations are shaped by the potential beneficiaries, alongside theoretical and practical issues of cultural adaptation. Researchers and clinicians will need to provide evidence of acceptability and effectiveness of adapted interventions, alongside considering financial and implementation realities.
Children from low socioeconomic status (SES) backgrounds are at increased risk for delays in executive function (EF), particularly inhibitory control and attentional regulation. Orchestral string music training is a complex multisensory activity that repeatedly engages executive control systems, yet its neurophysiological mechanisms remain insufficiently understood. In this study we examined whether prolonged string training is associated with enhanced neural dynamics underlying inhibitory control in socioeconomically disadvantaged children. We re-analyzed 32-channel electroencephalography (EEG) data from an auditory Go/NoGo task in 20 children aged 9-12 years (11 with ≥4 years of orchestral string training; 9 controls). Event-related potentials (ERPs) were extracted using a data-driven vincentization pipeline. Group differences were assessed using mixed-model ANOVAs and topographic analyses. Musically trained children showed significantly larger NoGo-related ERP amplitudes across N1-N2, P300, N400, and late positive components, with maximal effects over right frontocentral and temporoparietal regions (median Cohen's f = 0.78, median p = 0.005, median upper bound Bayesian Factor = 24.17). These neural differences emerged despite comparable behavioral performance between groups. Findings suggest that orchestral string training is associated with more efficient recruitment of inhibitory-attentional networks in children facing socioeconomic adversity. These effects align with enhanced fronto-parietal integration and neural efficiency principles, consistent with Adaptive Resonance Theory and Parieto-Frontal Integration Theory frameworks, supporting its potential as a scalable intervention for executive function development.
Homecare aides (HCAs) are professional non-family caregivers, who support dependent individuals to live at home with dignity; yet in Spain they remain understudied and vulnerable, often facing precarious working conditions. We aimed to characterize HCAs' employment, living conditions, health, and exposure to workplace violence and harassment, considering migrant background as a key axis of inequality. We conducted a sequential explanatory mixed-methods study. Quantitative data came from an online respondent-driven sampling survey of 324 HCAs across Spain, with stratified analyses by migrant background. Qualitative data were obtained through three focus groups and analyzed using qualitative content analysis. Findings were triangulated during interpretation. The findings suggest that precariousness extends beyond the workplace, affecting everyday life, social relationships, and health. Quantitative results showed poorer health, higher exposure to workplace violence, and greater drug use among migrant HCAs. While the qualitative data did not fully account for these differences, they offered insight into possible underlying mechanisms, such as physically demanding work and lack of resources. Qualitative findings also confirmed greater exposure to different forms of violence and sexual harassment among migrant HCAs, while revealing broader gendered patterns of violence affecting the occupation as a whole. A vicious circle of poverty, poor health, and workplace violence/discrimination emerges, described by HCAs as their being "poor and enslaved." Migration background influences inequalities, but widespread structural precariousness tends to homogenize experiences, while gender dynamics further shape vulnerability. Urgent intersectional policies are needed to ensure decent work and protect HCAs' health and rights.
The use of health systems data (HSD) such as patient records and prescriptions is expanding within clinical trials to improve efficiency, reduce participant burden, and enhance real‑world relevance. However, challenges remain around governance, data quality, transparency and public trust, echoed through discussions in this project. While Patient and Public Involvement and Engagement is increasingly embedded in trial design, involvement in methodological and data‑focused areas remains limited. Ensuring that HSD trial training for researchers and public reflects public perspectives is therefore important. This work was conducted within HDR UK's Transforming Data for Trials programme. A Participatory Health Research (PHR) approach was used to develop training resources for the HDR UK Futures online learning platform. A UK‑wide Public Advisory Group (PAG) was recruited through national involvement networks. Engagement took place through virtual full-PAG and small-working‑group meetings. PAG members were involved in identifying priorities, shaping content, reviewing materials and recording videos. Two case studies illustrate different approaches to involvement: co‑production throughout development of a public‑facing module and consultative input to a researcher‑focused module. The PAG comprised 25 members with diverse geographical and experiential backgrounds. Case Study 1: members helped develop eight short videos for public partners. They influenced topic selection, tone, language and accessibility of scripts; six members also participated in filming. Their input led to clearer explanations of topics including data governance, consent and trust, with content presented in plain English and modular formats. Case Study 2: PAG members provided feedback on a technical training module on Data Utility Comparison Studies which compare the usefulness of different data sources. Their feedback highlighted concerns about data accuracy, transparency and potential equity implications, prompting refinements to the framing and examples used within the module. Co‑production supported the development of accessible resources for public research partners, while consultative input helped ensure researcher‑focused training addressed issues relevant to public trust and accountability. These approaches demonstrate how public perspectives can strengthen training related to HSD trial methodology. Embedding public perspectives in HSD training development could enhance relevance, accessibility and trust. This work provides a practical model for involving public contributors in methodological training within trials.
Kidney transplantation greatly improves survival and quality of life for children and adolescents with kidney failure. However, it also brings psychological and social challenges, including anxiety, depression, and difficulties with adaptation. Families often face ongoing stress even after successful transplantation. Although qualitative studies have explored these issues, no systematic review has synthesized their findings. This study aims to fill that gap by reviewing qualitative research on the post-transplant experiences of children and adolescents, providing insights to support their psychosocial well-being. This was a systematic review of qualitative studies. Literature searches were conducted in PubMed, Web of Science, CINAHL, Embase, Scopus, ProQuest, China National Knowledge Infrastructure (CNKI), and Wanfang database. The search period was from the inception of the databases up to January 2025. This review was conducted in accordance with the Joanna Briggs Institute Manual for Evidence Synthesis for qualitative research. Two reviewers independently carried out the screening process and data extraction. Studies meeting the inclusion criteria were evaluated using the Joanna Briggs Institute's critical appraisal tool for qualitative studies. Thematic synthesis was performed following the approach outlined by Thomas and Harden. A total of ten descriptive themes were extracted from the included qualitative studies. Through a process of thematic synthesis, these were consolidated into three overarching analytical themes: (1) Rebirth and Transformation - capturing the personal growth, psychological adaptation, and evolving identity experienced by children and adolescents following kidney transplantation; (2) Facing Challenges - reflecting the physical, emotional, and social difficulties encountered during recovery and reintegration into daily life; and (3) Future Uncertainty and Lack of Support - highlighting ongoing concerns related to long-term health outcomes, fear of graft failure, and the perceived inadequacy of informational, and systemic support. Kidney transplantation offers children and adolescents a renewed chance at life, boosting their self-esteem and overall well-being. However, they often face considerable psychological stress, including anxiety about the future and limited support. To address these challenges, healthcare providers and social organizations must focus on their unique needs through comprehensive psychological assessments, identification of unmet needs, and strengthened collaboration among medical teams, families, and communities. PROSPERO: (CRD420250654624).
In a recent commentary, Alcalay argues that the concept of epistemic disadvantage provides a useful framework for understanding forms of epistemic harm that may arise even in the absence of epistemic injustice. We agree that this concept identifies an important category of harms associated with warranted asymmetries of expertise and offers valuable insights into both clinical and nosological practices. However, we suggest that, in some clinical situations, clinicians may intentionally maintain interpretative distance from a patient's explicit narrative while fully recognizing its sincerity, meaning, and experiential value. We argue that psychiatric care frequently involves what we call therapeutic asymmetry, i.e., situations in which interpretative distance forms part of the therapeutic process itself. Using examples based on suicidality, loyalty conflicts, mania and AI sycophancy, we aim to show that clinicians may sometimes refrain from accepting patient narratives at face value because suffering can affect capacities for self-understanding, self-deliberation and decision-making. Therapeutic asymmetry highlights the role of alterity, interpretation, and clinical judgment in situations where patients seek assistance precisely because they struggle to understand, interpret, or transform aspects of their own experience.
Type 2 diabetes mellitus (T2DM) is a well-established risk factor for acute coronary syndrome (ACS). However, the association between prediabetes and ACS remains less clearly characterized, particularly regarding sex-based differences in this association. This study aimed to examine how specific glycemic disorders distinctly influence the risk of plaque erosion and rupture, and to explore sex-based variations in the association. In this cross-sectional study, participants with coronary artery disease (CAD), including ACS and chronic coronary syndrome (CCS), who underwent percutaneous coronary intervention (PCI) with recorded glycemic measurement between 2016 and 2020 were enrolled. Using patients with CCS undergoing PCI as the controls, multivariable logistic regression models were designed to evaluate the association between different glycemic disorders and the risk of ACS manifested as either plaque erosion or rupture. ACS patients with prediabetes and diabetes were respectively matched 1:1 using propensity score matching. The heterogeneity of age, sex and body mass index (BMI) in the association was also investigated. Among 1806 screened participants, 1525 participants with recorded glycemic measurement were enrolled in the analysis, consisting of 1158 (75.9%) males with an average age of 65.8 years. With CCS patients undergoing PCI as the controls, compared to participants without diabetes, the associations between prediabetes and diabetes and the risk of ACS were attenuated toward the null after 1:1 propensity score matching. The association between glycemic disorders and ACS was modified by sex (p for interaction = 0.005), rather than age and BMI. Among female participants, 93.7% of whom were over 55 years of age, diabetes was associated with a two-fold higher risk of ACS compared to non-diabetic controls (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.02-4.15, p = 0.042). The general association between prediabetes and ACS is similar to that in individuals with normal glycemic status. Perimenopausal and post-menopausal women with diabetes may face an elevated risk of plaque erosion or rupture compared to their non-diabetic counterparts, implicating a potential loss of estrogen's plaque-stabilizing effect in the context of glycemic disorders.
This study aims to evaluate the effects of preoperative stoma simulation on preoperative state anxiety and postoperative stoma adaptation among individuals scheduled for stoma surgery. This study is designed as a two-arm, parallel-group randomized controlled trial. A total of 52 patients scheduled for stoma surgery will be randomly allocated to either the intervention group (n = 26) or the control group (n = 26). The intervention group will receive a structured preoperative stoma simulation in addition to standard care, whereas the control group will receive standard preoperative care alone. The primary outcome is preoperative state anxiety, which will be measured using the Spielberger State Anxiety Inventory 24 h before surgery and on the morning of surgery. The secondary outcome is postoperative stoma adaptation, which will be assessed at discharge and 1 month after surgery using the Ostomy Adjustment Inventory. Data will be collected through face-to-face interviews. Outcome assessments will be conducted by a blinded assessor, and statistical analyses will be performed by a blinded statistician. As this manuscript presents the study protocol, the results are not yet available. The findings are expected to provide evidence regarding the effectiveness of preoperative stoma simulation in reducing anxiety and improving postoperative adaptation. This trial is expected to provide evidence regarding the effectiveness of preoperative stoma simulation on preoperative state anxiety and postoperative stoma adaptation and may contribute to the development of evidence-based nursing interventions for individuals undergoing stoma surgery. Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of this research. ClinicalTrials.gov Identifier: NCT06737887. Registered on December 11, 2024.
IntroductionDigital technologies have become integral to everyday life; however, older adults' engagement remains uneven. This study aimed to explore how older adults interpret digital technologies and make sense of their digital experiences, with particular attention to how these experiences relate to well-being in later life.MethodsThis qualitative study adopted a phenomenological orientation. Semi-structured, face-to-face interviews were conducted with 22 adults aged 65 and over in Türkiye. Participants were selected using maximum variation and snowball sampling strategies to ensure diversity. Data were analyzed using an inductive thematic approach.ResultsFive interrelated themes were identified: meanings attributed to digital, digital experiences (facilitators and barriers), impacts on well-being, coping and adaptation strategies, and needs in digital processes. Digital engagement was experienced as both enabling and constraining. Facilitating experiences supported social connection, daily functioning, and health-related practices, while barriers included limited digital literacy, economic constraints, and experiences of ageism. These experiences generated cognitive, behavioral, and emotional impacts, ranging from autonomy, engagement, and satisfaction to fear, withdrawal, dependence, and reduced confidence. Importantly, emotional responses functioned as mechanisms shaping patterns of engagement or avoidance. Participants adopted both self-directed and support-seeking coping strategies and emphasized educational, technical, and social needs for meaningful digital participation.ConclusionDigital engagement in later life is a dynamic process shaped by structural, emotional, and social factors. Digital inclusion should be addressed as a determinant of well-being, requiring integrated approaches that combine digital literacy training, age-friendly design, and socially supportive environments.
Risk-reducing salpingo-oophorectomy (RRSO) is an effective option to prevent ovarian cancer in high-risk individuals, but adverse effects from premature menopause are a barrier to uptake. Interval salpingectomy with delayed oophorectomy (ISDO) may be an effective alternative. To evaluate the association of ISDO vs RRSO and sexual function and menopausal symptoms. This prospective, multicenter, nonrandomized (patient preference) clinical trial was performed among Women Choosing Surgical Prevention participants with a pathogenic or likely pathogenic germline variant conferring an increased risk for ovarian cancer. Patients from 9 US centers were enrolled from June 2, 2016, to October 28, 2020; chose ISDO or RRSO; and were followed up for 24 months. The analysis was performed on November 13, 2024. Participant-selected RRSO or ISDO. Changes in sexual function and menopausal symptoms from baseline to 6, 12, and 24 months. Inverse probability weighting was applied to achieve covariate balance across groups. The analytic sample included 334 female participants (mean [95% CI] age at consent, 39.2 [38.7-.9.7] years) who underwent RRSO (n = 165) or ISDO (n = 169) and completed 6-month questionnaires. Significantly more participants experienced clinically meaningful worsening of sexual function at 6 months compared with baseline after RRSO vs ISDO (33.1% [39 of 118] vs 16.8% [17 of 101], respectively; odds ratio, 2.00 [95% CI, 1.20-3.35]) and at 12 months (39.2% [38 of 97] vs 18.3% [17 of 93], respectively; odds ratio, 1.69 [95% CI, 1.09-2.63]). This finding was no longer significant at 24 months. When restricted to the RRSO group who took hormone replacement therapy, there was no significant worsening of total sexual function scores or menopausal symptoms compared with baseline. No interval ovarian cancers were reported. This nonrandomized clinical trial comparing RRSO with ISDO found that ISDO was less likely to impair sexual function, which addresses an important barrier to surgical prevention in high-risk patients in premenopause. After RRSO, use of hormone replacement therapy mitigated menopausal symptoms and prevented decline in sexual function. More information is needed about the safety of ISDO. ClinicalTrials.gov Identifier: NCT02760849.
Opioid overdoses have surged among United States (US) youth, who face high risk of morbidity and mortality. Opioid antagonists (OAs), like naloxone, are life-saving medications that can reverse overdoses. For youth, schools can be key venues for harm reduction. As states enact laws governing OAs in schools, it is important to understand how states permit schools to manage and respond to emergencies with this medication. This study's objective was to examine statutes on OAs in Kindergarten-12th grade schools to identify and compare key legislative components across states. This national review analyzed US state laws on OAs in K-12 schools enacted by December 31, 2024. A search of statutes was conducted using Nexis Uni. Team members iteratively reviewed each statute to identify components and extract relevant language. Discrepancies were resolved through discussion. Findings were summarized and reviewed with experts in school health, addiction, and harm reduction for validity. Thirty-eight states have laws on OAs in K-12 schools. Nine states (24%) mandate a supply of OAs to be available in schools, while eight states (21%) require policies to be adopted for school systems to have OAs. State laws vary in terms of components. State laws commonly define OA (n = 24, 63%) and specify school types and/or levels (n = 35, 92%). Most states detail individual(s) who may administer OAs in school settings (n = 34, 89%) and training on OAs (n = 25, 66%). More than half of states detail acquisition (n = 22, 58%) and inventory logistics (n = 21, 55%). Few state laws include incident response post-administration (n = 9, 24%), reporting of administration (n = 8, 21%), and parental involvement (n = 5, 13%). Lastly, most states include immunity (n = 32, 84%) protecting school systems and/or individuals who provide or administer OAs. This study found most states have laws on OAs in K-12 schools with variation in specific language. Such variability in state legislation contributes to varied implementation in school, which may affect accessibility to OAs and response to overdose emergencies in schools. If implemented effectively, such legislation has potential to promote harm reduction and reduce opioid overdoses among youth.
Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder worldwide, with projections exceeding 25 million people by 2050. Its burden, however, is unevenly distributed. Many low- and middle-income countries face rapidly rising prevalence alongside profound shortages in neurological workforce, infrastructure, and access to specialised care and essential therapies. This global "Parkinson's divide" reflects not merely a funding gap, but a structural mismatch between disease burden and health-system capacity. Traditional clinic-centred models cannot scale to meet this expanding demand.This article argues that technology, when responsibly implemented, offers a structural response to this capacity gap. Telemedicine expands access by decoupling specialist expertise from geography. Wearable and domestic sensor-based technologies extend clinical visibility beyond episodic encounters, capturing real-world fluctuations, mobility changes, falls, and sleep disturbances. Artificial intelligence, positioned as augmented rather than autonomous intelligence, can transform high-volume longitudinal data into actionable insights that support triage, task-sharing, and continuity across distributed care networks. Mobile health platforms further strengthen patient agency through structured self-management and co-designed digital ecosystems.Yet innovation alone is not sufficient. Impact depends on feasibility, interoperability, workforce development, governance, and equity-first design, particularly in resource-constrained settings. Embedded within hybrid care models and life-course brain health frameworks, digital technologies can shift PD management from episodic symptom control toward longitudinal stewardship of function and resilience, helping to convert scarcity into distributed capability and narrow global inequities in Parkinson's care for our future generations. Closing the global gap in Parkinson's care: How technology can helpPlain language summaryParkinson's disease (PD) is increasing rapidly worldwide. However, access to diagnosis, treatment, and specialist care is not evenly distributed. Many low- and middle-income countries face rising numbers of people with PD but have very few neurologists, limited infrastructure, and barriers to long-term follow-up. This imbalance creates a “Parkinson's divide” between those who can access high-quality care and those who cannot.This article explains how technology, when carefully and responsibly implemented, can help reduce this gap. Telemedicine can connect patients to specialists without requiring travel. Wearable devices and smartphone-based tools can monitor symptoms in daily life rather than relying only on brief clinic visits. Artificial intelligence can help clinicians interpret large amounts of health data and prioritise patients who need attention most urgently. Mobile health applications can also support self-management, education, and communication between patients and care teams.However, technology alone is not enough. Digital tools must be affordable, usable, and adapted to local contexts. They must also avoid increasing inequalities, especially in communities with limited internet access or digital literacy. When integrated into hybrid models that combine in-person and remote care, and aligned with broader brain health strategies, digital innovations can expand specialist reach and strengthen care systems.Closing the global Parkinson's divide requires thoughtful system redesign. With careful implementation, technology can help convert limited resources into broader, more equitable access to Parkinson's care worldwide.
Studies evaluating cellular phenotypes by cytometry techniques are increasingly facing analytical challenges due to the multitudes of samples and parameters that are evaluated concurrently. Spurious technical effects resulting from a lack of standardization can affect marker distributions and further complicate multi-sample analyses. User-friendly tools for exploratory data analysis to identify such technical effects in large datasets are lacking. To fill this gap, we present a novel R package, CytoScan, that evaluates inter-measurement variation in cytometry datasets and allows for detecting anomalous measurements after data acquisition. CytoScan can detect two types of anomalies: files with limited similarity to others within a dataset (outliers) and files with limited similarity to previously acquired high-quality reference data (novelties). Using simulations of skewed marker distributions and real-life technical effects, we demonstrate that CytoScan can accurately detect such anomalies. CytoScan can be applied to large cytometry datasets on consumer-grade hardware with informative visualizations, providing accessible quality control for more reliable analyses.
To gain insight into the experiences of nurses in outpatient paediatric asthma care regarding how their profession changed, with an emphasis on workload, nurse-patient relationship, and task shifting, after the implementation of a remote patient care platform (called Airbridge (Luchtbrug)). A descriptive qualitative study. Semi-structured face-to-face interviews were conducted from February 2023 to May 2023, with nurses who were working with Airbridge. Nurses were recruited using a purposive sampling method. An interview guide was developed partly based on the Technology Acceptance Model. Interviews were audio recorded, transcribed, and analysed according to Braun and Clarke's six phases of Thematic Analysis. Eleven nurses participated in the interviews. Patient centred care and changes of professional practice due to working with remote patient care were identified as the main themes in relation to experiences of nurses after the introduction of a remote patient care platform. Nurses are pivotal in the successful implementation and sustainability of remote patient care (RPC) platforms, yet they require adequate time and organisational support. As primary users alongside patients, nurses should actively be involved in remote patient care (RPC) practices and take leadership in defining their responsibilities. This study enhances understanding of nurses' experiences with remote patient care (RPC), emphasizing the importance of their role in maintaining the nurse-patient relationship in an advanced professional nursing practice. These findings contribute to the understanding of the experience of nurses when working with a remote patient care (RPC) platform regarding effective implementation. This study adhered to the COREQ guideline. No paper or public contribution.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized in patients with primary biliary cholangitis (PBC). While metabolic comorbidities are expected to worsen outcomes, the clinical impact of MASLD in PBC remains uncertain. We investigated whether concomitant MASLD modifies hepatic and cardiovascular outcomes in patients with PBC. We conducted a retrospective international cohort study using de-identified electronic health records from the TriNetX global research network, including 172 healthcare organizations between 2010 and 2025. Adult patients with PBC with and without MASLD were matched using propensity score matching (1:1) to balance baseline characteristics. The primary outcomes were all-cause mortality. Major adverse cardiovascular events (MACE) and hepatic decompensation were evaluated as secondary outcomes. Additional outcomes included hepatocellular carcinoma, liver transplantation, and one-year biochemical response (ALP normalization). Among 30 934 patients with PBC (78.9% female; mean age 68 years), 5955 (19.2%) had concomitant MASLD. After matching, 10 856 patients (5428 per group) were included. Over a mean follow-up of 4 years, patients with PBC-MASLD had a lower risk of all-cause mortality (HR 0.60; 95% CI 0.54-0.67) and hepatic decompensation (HR 0.82; 95% CI 0.71-0.93), but higher risk of MACE (hazard ratio [HR] 1.30; 95% CI 1.14-1.48). One-year biochemical response rates were comparable between groups. Findings remained consistent across multiple sensitivity analyses. MASLD identifies a distinct metabolic phenotype of PBC characterized by increased cardiovascular risk but paradoxically lower mortality and hepatic decompensation. These findings highlight the need to integrate cardiovascular risk assessment into the management of patients with PBC. Patients with primary biliary cholangitis who also have metabolic fatty liver disease face a higher risk of serious heart problems. In this large study of 30,934 patients, this added hepatic steatosis was linked to more cardiovascular events, but not worse liver outcomes or survival. These findings highlight the need to actively screen for and manage heart risk in patients with both conditions.