搜索结果：Journal of CME

The concept of complete mesocolic excision (CME) with central vascular ligation (CVL) has been introduced as a surgical technique for colon cancer. Nonetheless, the precise significance of CME and CVL in improving outcomes remains a subject of ongoing debate. The objective of this systematic review and meta-analysis of prospective trials is to compare postoperative and oncological outcomes between CME with CVL and surgery without the concept of CME + CVL in patients with colon cancer. A systematic literature search and meta-analyses were performed to evaluate both postoperative and oncological outcomes. Postoperative outcomes included operative time, intraoperative blood loss, conversion rate to open surgery, intraoperative and postoperative morbidity and mortality, and length of postoperative hospital stay. Oncological outcomes included disease-free survival (DFS), overall survival (OS), and the cumulative incidence of recurrence and death. A total of 11 studies met the inclusion criteria, including six randomized controlled trials and five prospective clinical trials, comprising a total of 4575 patients (2244 in the CME + CVL group and 2331 in the non-CME + CVL group). Pooled analyses demonstrated significantly improved DFS and OS in the CME + CVL group, with no significant heterogeneity across studies. Additionally, there were no significant differences between the two groups in terms of postoperative outcomes, including morbidity and mortality. This systematic review and meta-analysis demonstrated that CME with CVL significantly improves long-term oncological outcomes in patients with colon cancer, without compromising short-term postoperative outcomes. CME with CVL may represent an optimal surgical strategy for the management of colon cancer.

Continuous medical education and continuing professional development (CME/CPD) have traditionally emphasised pedagogical effectiveness, yet the rapid digital transformation of health professions education now requires faculty to demonstrate advanced competencies in technology integration, digital resource management, accessibility, and online instruction. Faculty digital proficiency is increasingly essential for designing, delivering, and sustaining high-quality CME/CPD programmes that support workforce readiness and equitable access to learning opportunities. Evidence from resource-constrained settings remains limited. A cross-sectional survey was conducted among 498 faculty members across nine Ethiopian public higher education institutions offering six priority health programmes. Data were collected using the DigCompEdu framework (Area 2: Digital Resources). Descriptive statistics summarised participant characteristics and proficiency levels. Associations between categorical variables and expertise (Expert+ vs. Below Expert) were examined using Chi-square and Fisher's Exact tests. Multivariable logistic regression identified independent predictors of expert-level proficiency, reported as odds ratios (ORs) with 95% confidence intervals (CIs). Only 34 faculty (6.8%) reported expert-level digital proficiency, with most clustered at novice or explorer levels. Expertise was more common among faculty from research universities (12.9%), non-clinical units (13.3%), doctoral degree holders (33.3%), female faculty (23.1%), and those with &#x2265;10&#x2009;years of teaching experience (17.0%). Regression analysis revealed that male faculty had significantly higher odds of expertise (OR&#x2009;=&#x2009;2.45, 95% CI: 1.35-4.45, p&#x2009;=&#x2009;0.003), while higher academic rank was inversely associated (OR&#x2009;=&#x2009;0.32, 95% CI: 0.15-0.68, p&#x2009;=&#x2009;0.002). Institutional type was strongly predictive (OR&#x2009;=&#x2009;0.16, 95% CI: 0.06-0.35, p&#x2009;<&#x2009;0.001). Academic qualification and teaching experience were not significant predictors. Experts play a pivotal role in advancing educational practice by modelling innovation in teaching and learning. Yet, this study reveals a significant deficiency in faculty digital skills, with most lacking expertise in managing digital resources for student learning. Targeted, tiered faculty development is therefore essential to strengthen digital competence and enhance CME/CPD delivery in health professions education.

Number needed to treat is a well-established concept in medicine that distils the benefit of a clinical intervention into a single, intuitive value. This paper discusses practical applications of number needed to teach (N2T2), a parallel metric for continuing medical education that quantifies the number of learners who must complete an activity and evaluation for one to achieve a meaningful educational benefit. While the concept has been considered in graduate education of future healthcare professionals, this paper describes the rationale and practical application of N2T2 using a hypothetical example focused on glycaemic status monitoring in type 2 diabetes for CE/CME professionals and participants. By applying pre- and post-activity assessment data to a prespecified improvement threshold, educators can calculate N2T2 to summarise learner gains in knowledge, competence, or performance. Methodological considerations such as paired versus unpaired responses, activity context, learner baseline proficiency and alignment with SMART, Link-SMART and TACT objectives are discussed. It is important to emphasise that N2T2 should be interpreted within the specific context of each activity's goals, audience and outcomes. In the absence of systematic use or established benchmarks for N2T2, early adoption and shared learning within the community are encouraged. N2T2 offers a complementary tool for expressing educational impact clearly and consistently, particularly when applied to longitudinal programmes or multi-activity outcomes. As with number needed to treat in medicine, N2T2&#xa0;has the potential to bring greater clarity and practicality to how we understand and communicate the value of education. N2T2 is a timely and accessible innovation as we continue to refine educational outcomes measurement together.

The Cologne Consensus Conference 2025 (CCC25), official meeting of the International Academy for CPD Accreditation (IACPDA), sought to explore opportunities for how accrediting bodies could ensure that the organisations or educational activities they accredit are demonstrating compliance with the IACPDA "Standards for Substantive Equivalency between CPD/CME Accreditation Systems", with a focus on how to align content selection with needs assessment to ensure that "content presented is relevant and responsive to the identified needs of the target audience". Based on the fact that it has become unmanageable for the individual doctor and/or faculty member to - get an unbiased overview over all evidence related to the clinical question in areas with exponential growth of evidence, or- find data relevant to the individual patient in the bulk of evidence without use of advanced search technologies, accrediting bodies recommend that providers, organizers of education, or even individual learners should consider evidence synthesis reports to be used in (accredited) CE, that are 1. independent2. publicly accessible and free of charge3. timely4. comprehensive and transparent, and5. user-friendly. As well, producers and/or publishers of evidence synthesis reports, ideally, might also offer opportunities for advanced searches, which, in the future, might increasingly be supported by artificial intelligence.

Interleukin-33 and its receptor, ST2, are implicated in neutrophilic and eosinophilic inflammation during chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to assess the efficacy and safety of astegolimab, an anti-ST2 human IgG2 monoclonal antibody, which were evaluated in two COPD pivotal trials. In two randomised, double-blind, placebo-controlled trials (phase 2b ALIENTO and phase 3 ARNASA), current or former smokers with COPD and a history of frequent exacerbations, irrespective of baseline blood eosinophils, were randomly assigned (1:1:1; stratification by smoking status and region) to receive subcutaneous astegolimab 476 mg every 2 weeks, every 4 weeks, or placebo, alongside optimised inhaled maintenance therapy over 52 weeks. The primary endpoint (analysed in participants receiving one or more doses) was annualised rate of moderate or severe exacerbations. Missing data were considered similar to data from other participants in the same treatment group with the same baseline characteristics. The trials were registered with ClinicalTrials.gov (NCT05037929 and NCT05595642). In ALIENTO, 1301 participants (astegolimab every 2 weeks, n=433; astegolimab every 4 weeks, n=437; and placebo, n=431) initiated treatment between Oct 5, 2021, and Feb 19, 2024. In ARNASA, 1375 participants (astegolimab every 2 weeks, n=459; astegolimab every 4 weeks, n=459; and placebo, n=457) initiated treatment between Jan 9, 2023, and June 25, 2024. Adjusted rate ratios versus placebo for the primary endpoint were 0&#xb7;85 (95% CI 0&#xb7;72-1&#xb7;00; p=0&#xb7;049) for astegolimab every 2 weeks and 0&#xb7;93 (0&#xb7;79-1&#xb7;10; p=0&#xb7;38) for astegolimab every 4 weeks in ALIENTO, and 0&#xb7;85 (0&#xb7;72-1&#xb7;01; p=0&#xb7;068) for astegolimab every 2 weeks and 0&#xb7;82 (0&#xb7;70-0&#xb7;98; p=0&#xb7;024) for astegolimab every 4 weeks in ARNASA. Adverse events were balanced between treatments, with most participants experiencing one or more adverse events (1093 [84&#xb7;0%] of 1301 participants in ALIENTO and 1176 [85&#xb7;5%] of 1375 in ARNASA). The most common non-COPD adverse event was nasopharyngitis in ALIENTO and upper respiratory chest infection in ARNASA. Deaths occurred in 40 (3&#xb7;1%) of 1301 participants in ALIENTO and in 44 (3&#xb7;2%) of 1375 participants in ARNASA, and were balanced across treatment groups. Across both trials, a total of three deaths (0&#xb7;1%) were considered to be related to treatment by investigators. In ALIENTO, astegolimab every 2 weeks was associated with a lower annual rate of exacerbations versus placebo in patients with COPD and a history of frequent exacerbations. In ARNASA, these findings did not meet statistical significance. Together, these findings suggest a role for targeting the ST2/IL-33 pathway to reduce the frequency of COPD exacerbations in patients with limited treatment options. Genentech, a member of the Roche Group, and F Hoffmann-La Roche.

Understanding the meaningfulness of clinical trial outcomes is essential for people living with Alzheimer disease (AD) and their clinicians to make evidence-based shared treatment decisions in real-world clinical care. Donanemab, a monoclonal antibody targeting the insoluble form of &#x3b2;-amyloid found in plaques, significantly slows cognitive and functional decline of AD in participants with mild cognitive impairment (MCI) or mild AD-related dementia. This analysis reviews the efficacy of donanemab across various clinical outcome assessments, using both published data and new complementary analyses to provide context on its potential benefits for patients and caregivers. We present findings from prespecified and post hoc analyses from the TRAILBLAZER-ALZ 2 trial. Clinical outcomes assessed were Integrated AD Rating Scale (iADRS), comprising the 13-item AD Assessment Scale-Cognitive Subscale (ADAS-Cog13) and AD Cooperative Study-Instrumental Activities of Daily Living (ADCS-iADL); Clinical Dementia Rating (CDR)-Sum of Boxes (CDR-SB) for clinical severity and individual cognitive and functional domains; CDR-Global for clinical severity stage progression; meaningful within-patient change (MWPC); and ADCS-Activities of Daily Living dependence score. Donanemab reduced the risk of progression from MCI to mild AD by 33% (hazard ratio [HR] = 0.67; 95% CI 0.52-0.87; p = 0.003) and from mild to moderate AD by 50% (HR = 0.50; 95% CI 0.33-0.78; p = 0.002). In addition, donanemab reduced MWPC risk over 76 weeks by 38% for CDR-SB (HR = 0.62; 95% CI 0.52-0.75; p < 0.001) and 30% for iADRS (HR = 0.70; 95% CI 0.58-0.84; p < 0.001). Donanemab-treated participants exhibited significant slowing of clinical progression across multiple ADAS-Cog13 and ADCS-iADL items and all CDR-SB cognitive and functional domains. Donanemab also slowed progression of dependence least-squares mean change difference, -0.14 [95% CI -0.24 to -0.04; p = 0.007]), representing 23% slowing of progression (95% CI 6.17%-40.32%), and reduced risk of progression to requiring in-home support by 27% (HR = 0.74; 95% CI 0.59-0.91; p = 0.005). These results add to the evidence and further support clinically meaningful donanemab-mediated effects on cognition and function for patients and their caregivers and may aid communication of realistic treatment expectations and informed decision-making. ClinicalTrials.gov NCT04437511. Submitted: June 17, 2020; First patient enrolled: June 19, 2020. clinicaltrials.gov/study/NCT04437511 EudraCT Number 2020-000077-25. Start date of recruitment: June 19, 2020. clinicaltrialsregister.eu/ctr-search/trial/2020-000077-25/results.

To explore barriers and enablers to the implementation of the Global Initiative for Asthma (GINA) recommendations in Jordan, building on prior quantitative survey findings. We aimed to examine healthcare professionals' experiences, perceptions and contextual challenges in translating guideline awareness into practice. Qualitative descriptive study using semi-structured interviews. Analysis was inductive thematic, guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Healthcare services in Jordan, including public hospitals, private hospitals, outpatient clinics and community pharmacies, spanning both urban and semi-urban areas. 28 healthcare professionals were purposively sampled to capture diverse roles, sectors and levels of experience. The sample included physicians (general practitioners and pulmonologists), pharmacists (community and hospital), nurses and Doctor of Pharmacy (PharmD) graduates. Eligibility required direct involvement in the management and counselling of adult patients with asthma within the preceding 12 months. Perceptions of and experiences with implementing GINA recommendations in clinical practice, focusing on provider-level, system-level and patient-level barriers and enablers. Eight interrelated themes were identified. A consistent 'know-do gap' emerged, whereby clinicians were aware of guidelines but reverted to habitual practice due to insufficient training, scepticism or lack of support systems. Limited diagnostic capacity, particularly the absence of spirometry in public settings, led to symptom-based management. Pharmacotherapy decisions were shaped by patient demand, entrenched short-acting &#x3b2;&#x2082;-agonist use and affordability concerns. Inhaler technique counselling and written action plans were infrequently provided, largely due to workload and unclear interprofessional roles. Patients' beliefs (eg, steroid fears, avoidance of inhalers during Ramadan, low health literacy) further impeded adherence. Despite these barriers, participants proposed pragmatic solutions, including concise locally adapted tools, structured Continuing Medical Education (CME), digital decision support, pharmacy-based inhaler technique clinics and public awareness campaigns. Asthma care in Jordan reflects a gap between GINA awareness and consistent application, driven by resource, organisational and cultural barriers. Improving outcomes will require system-level investment in diagnostic infrastructure, sustainable access to controller medications, interprofessional care models and culturally tailored patient education. These findings highlight the need for a coordinated national strategy to strengthen guideline implementation and provide a basis for developing policy and practice interventions across similar middle-income settings.

Interprofessional continuing education (IPCE) has become essential to advancing collaborative practice, improving patient outcomes, and achieving system-level changes in healthcare. As healthcare delivery evolves towards integrated, team-based models, accrediting bodies such as Joint Accreditation for Interprofessional Continuing EducationTM (Joint Accreditation) are redefining standards that promote learning developed by the team, for the team, across professions. This is a descriptive study of the advancement of Joint Accreditation, followed by a discussion of the impact of IPCE developed by providers that have achieved Joint Accreditation and the value of IPCE for patients, learners, and IPCE providers. The article concludes by describing next steps, as outlined in the Joint Accreditation strategic plan, to continue to evaluate and promote the value of IPCE. Through the inclusion of emerging health professions and community partners, strengthening of patient-centeredness in interprofessional learning, enhancing the measurement of outcomes to capture true team and system impact, and leveraging technology to support scalable and accessible learning models, Joint Accreditation and IPCE will continue to impact patients, learners, and our organisations for years to come.

Medical societies shape clinical standards, develop practice guidelines, and provide continuing education to physicians. Many receive funding from pharmaceutical and medical device companies, creating conflicts of interest (COI); however, organizational-level COI governance in medical societies remains largely unexamined. We developed what is, to our knowledge, the first comprehensive tool to assess medical society COI policies and applied it to Canadian medical societies. We identified 68 Canadian medical societies meeting our inclusion criteria and systematically searched the publicly accessible sections of their websites for COI policies. Two researchers independently analyzed policies using our 51-item tool covering nine domains: continuing medical education/continuing professional development (CME/CPD), leadership COI, clinical practice guidelines, industry relationships, research funding, external funding, annual general meetings, staff COI, and society journals. Only 33 societies (48.5%) had any publicly available COI policy, and those with policies addressed an average of only 1.85 domains (20.5% of possible domain coverage). The most frequently addressed domain was CME/CPD (22 societies, 32.4%), followed by leadership COI (12 societies, 17.6%). Within domains where policies existed, societies covered an average of only 32.5% of relevant items. The most common policy item was speakers' declaration of COI in CME/CPD activities (16 societies, 23.5%). Policies addressing research funding, external funding, annual meetings, and staff COI were rare (1.5-5.9% of societies). Where present, policies were generally restrictive but narrow in scope. Most Canadian medical societies lack comprehensive COI governance, and existing policies are fragmented and reactive. More transparent, comprehensive, and enforceable frameworks are needed to protect institutional independence and public trust. The assessment tool may be adaptable for use in other jurisdictions to support international standardization and best-practice development.

Clinical trials often assess multiple end points; however, many do not consider the value of composite end points. Although some evaluations of composite end points consider each outcome to be of equal importance, win ratio analysis ranks outcomes by clinical severity, prioritizing more serious events that have the biggest impact on patients. Does win ratio analysis, incorporating multiple clinician- and patient-relevant outcomes, show benefits for dupilumab over placebo in patients with COPD and type 2 inflammation? BOREAS and NOTUS (Two Pivotal Studies to Assess the Efficacy, Safety, and Tolerability of Dupilumab in Patients With Moderate-to-Severe COPD With Type 2 Inflammation)-phase 3, randomized, double-masked, placebo-controlled trials-enrolled patients with COPD, moderate-to-severe airflow limitation, and type 2 inflammation (screening blood eosinophil count &#x2265; 300 cells/&#x3bc;L) receiving inhaled triple or dual therapy (where inhaled corticosteroids were contraindicated). Patients were randomized to add-on dupilumab 300 mg (n = 938) every 2 weeks or matched placebo (n = 934) for 52 weeks. Win ratio analysis evaluated the relative efficacy of dupilumab vs placebo using data from the pooled intention-to-treat safety population. Hierarchical composite end points were occurrence of death, hospitalization, emergency department visits, exacerbations, lung function decline, symptoms, and quality of life. Win ratios were calculated to quantify treatment effects and to assess differences in event occurrence and timing between treatment arms. Dupilumab showed a higher win ratio than placebo after consideration of key end points, reinforcing its clinical benefits. Dupilumab increased the likelihood of improved clinically significant outcomes by 31% (win ratio, 1.31; 95% CI, 1.15-1.48). For any given untied pair of dupilumab vs placebo recipients, the estimated probability of a better outcome for dupilumab recipients was 57%. Our results show that dupilumab improved patient- and clinician-important outcomes by reducing the risks of clinically significant severe outcomes, together with improving symptoms and lung function. This analysis provides meaningful insights into the value of composite end points and win ratio analysis that could guide future phase 3 trial designs. ClinicalTrials.gov; No.: NCT03930732 and NCT04456673; URL: www. gov.

Cognitive reserve (CR) is a protective factor in first-episode psychosis (FEP), influencing cognitive, clinical, and functional outcomes. CR is shaped by a combination of genetic, clinical, and environmental factors, yet the extent of their respective contributions remains unclear. This study investigates the influence of polygenic risk scores (PRS), clinical and environmental variables on CR in FEP. A cohort of 174 individuals with non-affective FEP, aged 25.5 (SD=5.3), was analyzed. CR was assessed using a socio-behavioral proxy. PRS for educational attainment (PRSEA), intelligence (PRSIQ), cognitive performance (PRSCP), occupational attainment (PRSOA), physical activity (PRSPA), and schizophrenia (PRSSZ) were calculated. Age at onset, socioeconomic status, birth weight, and family history of psychosis were considered. Multiple regression models were employed to evaluate the impact of the different predictors on CR. PRSEA (p=0.002), age at onset (p=5.32x10-5), and family history of psychosis (p=0.001) emerged as the strongest contributors to CR. Higher PRSEA was associated with higher levels of CR, while earlier age at onset and positive family history were associated with lower CR. The model incorporating environmental, clinical, and genetic variables explained 17.7% of the variance in CR, and the one without PRS explained 13.5%. The inclusion of PRSEA in the model improved the explanatory power (&#x394;adj.R2=0.042) and predictive accuracy (&#x394;RMSE=-0.288). These findings highlight the role of precision psychiatry in better understanding CR. Early identification of individuals with earlier onset, family history of psychosis, and lower genetic predisposition to educational attainment may help characterize those with lower CR.

Blood is increasingly used as a biological matrix in the doping control field; however, the limited volume typically available for analysis poses a significant challenge, particularly when multiple tests must be carried out on the same sample. This study proposes a simple and efficient microextraction protocol based on the use of unmodified cellulose for the extraction of 25 steroid esters from just 20 &#xb5;L of serum or plasma. Sample preparation consisted of spotting 20 &#xb5;L of serum or plasma on a cellulose card, followed by a double extraction of the target analytes with 500 &#xb5;L of methanol and subsequent derivatization using Girard's Reagent P. The analysis was carried out using liquid chromatography coupled with tandem mass spectrometry. The analytical workflow was qualitatively validated according to the UNI CEI EN ISO/IEC 17025 standard and the WADA technical rules and notes in terms of selectivity (target analytes were distinguishable from the matrix interferences), sensitivity (limits of detection in the range of 0.05-0.70 ng/mL), carry-over (no signals were detected in the negative sample injected after the positive sample), intra and inter-day stability of the retention times (&#x2264;0.5%), matrix effect (13-32%), extract stability (the target analytes were stable for at least 72 h in the autosampler at 10 &#xb0;C), and extraction yield (43-88%). Plasma samples collected after testosterone undecanoate injection were finally analyzed: the compound was detectable in all three volunteers evaluated for at least 1 month after administration, demonstrating the effectiveness of the newly developed method for doping control purposes.

The ADAPT phase 3 trial (NCT03669588) showed efgartigimod was well tolerated and efficacious in acetylcholine receptor antibody-positive (AChR-Ab&#x2009;+) patients with generalized myasthenia gravis (gMG). This analysis utilized data from the ADAPT trial to investigate the efficacy and safety of efgartigimod in different patient subgroups. ADAPT included a broad population of AChR-Ab&#x2009;+&#x2009;participants who received a stable dose of&#x2009;&#x2265;&#x2009;1 (any) treatment for gMG and were randomized 1:1 to efgartigimod (10&#xa0;mg/kg) or placebo (administered as four once-weekly infusions per cycle) for 26&#xa0;weeks. Myasthenia Gravis Activities of Daily Living (MG-ADL) and Quantitative Myasthenia Gravis (QMG) responder rates in cycles 1 and 2, and rates of treatment-emergent adverse events (TEAEs) were analyzed in the following patient subgroups: history of nonsteroidal immunosuppressive treatment (NSIST), concomitant use of gMG treatments throughout the study, and baseline patient and disease characteristics, including time since diagnosis, age, baseline MG-ADL score, body mass index (BMI), sex, and prior thymectomy. In total, 129 AChR-Ab&#x2009;+&#x2009;participants were included (efgartigimod, n&#x2009;=&#x2009;65; placebo, n&#x2009;=&#x2009;64). Across all subgroups, higher MG-ADL and QMG responder rates were observed in participants treated with efgartigimod versus placebo during cycles 1 and 2. Rates of TEAEs were similar between participants treated with efgartigimod and placebo, regardless of concomitant gMG treatment type. Similar to outcomes observed in the ADAPT overall population, efgartigimod was well tolerated and efficacious across a broad range of patients, regardless of NSIST treatment history, concomitant use of gMG treatments, or baseline patient and disease characteristics. ClinicalTrials.gov: NCT03669588 (registered September 13, 2018).

Monoclonal gammopathy of clinical significance (MGCS) is a general term that encompasses a spectrum of non-malignant clinical disorders that are directly caused by monoclonal immunoglobulins (monoclonal proteins) produced by clonal plasma cell proliferative disorders. It is best considered as a collection of specific disorders that represent non-malignant progression of monoclonal gammopathy of undetermined significance (MGUS). This review provides a comprehensive overview of MGCS, highlighting its pathophysiology, diagnostic approach, clinical manifestations, and current management strategies across multiple organ systems. The spectrum of MGCS includes specific renal, neurological, cutaneous, hematological, and ocular diseases, as well as multisystem disorders such as POEMS syndrome, Schnitzler syndrome, cryoglobulinemia, and TEMPI syndrome. The diagnosis of MGCS is often challenging as it requires establishing a causal link between a monoclonal protein and the specific disease entity or clinical manifestation. Treatment strategies vary by disease and target the underlying monoclonal protein-producing clone or are directed to limit the effects of the monoclonal protein. As clinical trials remain limited, current management relies on mechanistic insights and observational studies. Increased awareness of MGCS and its organ-specific clinical features is crucial for providing timely diagnosis and delivering targeted interventions that may reverse or halt disease progression.

Patients with young-onset Parkinson disease (YOPD) commonly experience early motor complications necessitating deep brain stimulation (DBS), and the subthalamic nucleus (STN) and globus pallidus interna (GPi) are the primary DBS targets used for reducing medication use and addressing dyskinesias. This study leveraged both the University of Florida Fixel Institute high volume of DBS operations and the INFORM database to evaluate motor outcomes in a large cohort of patients with YOPD treated with STN or GPi DBS, and addressed the limited available evidence and paucity of data on the long-term effects of these targets applied to YOPD. A single-center retrospective chart review was conducted on a nonrandomized cohort of adult patients with a diagnosis of YOPD treated with STN or GPi DBS between January 1999 and October 2023. Multidisciplinary evaluation was used to choose the anatomical target for each patient. Disease onset, lead location, medications, and mortality were collected and compared between cohorts. Preoperative, 6-month, and 1-, 3-, and 5-year Unified Parkinson's Disease Rating Scale (UPDRS) scores were used to compare motor outcomes. There were 405 patients, and 61.3% received GPi DBS and 37.7% STN DBS. Mean disease duration at surgery was 12.3 (4.2) years for GPi and 11.5 (6.3) years for STN. GPi DBS improved ON UPDRS part 3 scores at 1 year (26.5 [11.84] vs 20.94 [9.09], p = 0.0024), and these scores worsened slightly by 5-year follow-up (20.94 [9.09] vs 24.72 [10.28], p = 0.0491). Unilateral STN DBS showed greater 6-month motor improvement vs unilateral GPi (p < 0.001) and remained stable from 6 months to 3 years (p = 0.3). GPi DBS improved ON UPDRS part 4 scores from baseline to 5 years (8.34 [3.15] vs 4.21 [2.25], p < 0.0001), whereas STN DBS showed no significant change (6.16 [4.21] vs 5.0 [2.98], p = 0.328). Although statistically significant, the changes did not meet the threshold for clinical relevance. This large cohort study assessed long-term outcomes of STN vs GPi DBS when used in the setting of YOPD. Both targets improved motor symptoms at 1 and 5 years. STN offered modest motor benefits and greater medication reduction, while GPi DBS better addressed dyskinesia and motor fluctuations. These findings inform preoperative decision-making, although selection bias based on baseline symptoms remains a limitation of the data set.

A major barrier to hepatitis C virus (HCV) elimination in the United States is the lack of a point-of-care test to confirm the presence of HCV RNA. The purpose of this clinical trial was to evaluate the performance of the Xpert&#xae; HCV test at CLIA-waived sites in the United States. Participants at risk and/or with signs/symptoms of HCV infection provided fingerstick blood that was tested on the Xpert&#xae; HCV test and venous blood tested using the cobas&#xae; HCV and Elecsys&#xae; Anti-HCV II tests. Fingerstick blood was collected at CLIA-waived sites by individuals self-trained on collection procedures. Participants (N = 1279) were enrolled across 15 sites; 1015 (79.3%) were deemed eligible for further evaluation. Specimens from 985 (97.0%) participants with valid results for Xpert&#xae;, cobas and Elecsys were included in the performance analysis. The prevalence of HCV antibodies and HCV RNA was 34.6% and 12.4%, respectively. The Xpert&#xae; HCV test demonstrated a positive percent agreement of 93.4% (95% CI: 87.6-96.6) and a negative percent agreement of 99.8% (95% CI: 99.2-99.9) relative to the patient infected status. Data from this clinical trial showed that the Xpert&#xae; HCV test was sensitive, specific, and acceptable for use to detect HCV RNA in human EDTA fingerstick blood from individuals at risk and/or with signs/symptoms of HCV infection. Clinical Trials Registration. This study, Pro0075996, was approved by Advarra IRB (Columbia, Maryland, 21044) and registered on ClinicalTrials.gov (NCT06508996).

Lower urinary tract symptoms (LUTS) affect the majority of men over&#xa0;60 years old in Germany to varying degrees. These symptoms include issues with bladder storage and bladder emptying. The most common cause of such disorders by far is prostate enlargement (benign prostatic hyperplasia, BPH), which leads to urethral narrowing (benign prostatic obstruction, BPO). Due to the aging population, the prevalence of BPH is steadily increasing and a&#xa0;good understanding of individualized patient treatment is of major importance. Treatment options range from watchful waiting and behavioral therapy to phytotherapy and pharmacotherapy up to surgical procedures. While the range of surgical and interventional therapeutic options is rapidly expanding, innovations in conservative treatment procedures have lagged behind in recent years; however, new drugs and combination treatment with existing medications offer promising possibilities to improve the quality of life and slow progression of the disease in patients. Beschwerden des unteren Harntrakts (&#x201e;lower urinary tract symptoms&#x201c;, LUTS) betreffen in Deutschland die Mehrheit der M&#xe4;nner nach dem 60.&#xa0;Lebensjahr in unterschiedlichem Auspr&#xe4;gungsgrad. Die Symptome umfassen Probleme bei der Blasenspeicherung und Blasenentleerung. Die mit Abstand h&#xe4;ufigste Ursache f&#xfc;r St&#xf6;rungen dieser Art ist die Vergr&#xf6;&#xdf;erung der Prostata (benigne Prostatahyperplasie, BPH), welche zu einer Verengung der Harnr&#xf6;hre f&#xfc;hrt (benigne Prostataobstruktion, BPO). Aufgrund der alternden Bev&#xf6;lkerung nimmt die Pr&#xe4;valenz der BPH stetig zu, und gute Kenntnis &#xfc;ber eine patientenindividualisierte Therapie ist von zentraler Bedeutung. Behandlungsm&#xf6;glichkeiten reichen von kontrolliertem Zuwarten und Verhaltenstherapie &#xfc;ber Phytotherapie und medikament&#xf6;se Therapie bis hin zu operativen Verfahren. W&#xe4;hrend sich die Facetten der operativen und interventionellen therapeutischen M&#xf6;glichkeiten rasant vermehren, hinken die Innovationen der konservativen Therapieverfahren in den letzten Jahren hinterher. Allerdings bieten neue Wirkstoffe und die Kombinationstherapien bestehender Medikamente interessante M&#xf6;glichkeiten der Verbesserung der Lebensqualit&#xe4;t und zur Verlangsamung der Krankheitsprogression der Patienten.

Diets are increasingly dominated by ultra-processed foods, which have been linked to several chronic diseases. Emerging evidence suggests an association between ultra-processed food consumption and inflammatory diseases, including multiple sclerosis (MS). To assess associations between consumption of ultra-processed foods and paediatric-onset MS (PoMS). We used data from the microbiome sub-study of the Canadian Pediatric Demyelinating Disease Network Study for PoMS cases (symptom onset aged <18 years) and unaffected controls. Data on consumption of ultra-processed foods (defined within the Nova system) were derived from dietary intake data collected using the Block Kids Food Screener. Dietary contribution of ultra-processed foods (% of total grams consumed per day) was estimated. Logistic regression models were used to examine associations between ultra-processed food consumption (continuous and tertiles) and likelihood of PoMS. Models were adjusted for age at dietary data collection, sex, race, region of residence, and total energy intake. Dietary data were collected from PoMS participants (females=57, males=23) aged 5-28 years and controls (females=30, males=16) aged 8-26 years. Each additional 10% in ultra-processed food consumption was associated with a 35% higher odds of being a PoMS participant (adjusted odds ratio [aOR]=1.35, 95% CI 1.05, 1.73). Participants in the highest (versus lowest) tertile for ultra-processed food consumption had over five times higher odds of being a PoMS participant (aOR=5.30, 95% CI 1.36, 20.70). Participants with PoMS reported greater consumption of ultra-processed foods compared to unaffected peers. More comprehensive longitudinal dietary histories are required to better understand this observation.

This study evaluated the impact of a comprehensive, curriculum-based continuing education (CE) programme on the adoption of second-generation intravitreal anti-VEGF therapies among ophthalmologists treating patients with diabetic macular oedema (DME) or neovascular age-related macular degeneration (nAMD). A multimodal educational curriculum was developed for eye care providers, incorporating principles of adult learning and marketing strategies. The curriculum included 14 CE activities (didactic content, case scenarios, live meetings, interprofessional activities, and downloadable resources) delivered from July 2024 through April 2026. Surveys, assessing knowledge, attitudes, and clinical decision-making, were administered before, during, and after participation. Participants were categorised as single-activity learners (one activity) or multiple-activity learners (three or more activities). Statistical analyses compared knowledge acquisition, comfort, and adoption of second-generation anti-VEGF agents between groups. As of September 2025, 5,975 providers completed at least one activity; 398 providers, with complete data, were analysed (289 single-activity, 109 multiple-activity learners). Both groups, post education, demonstrated improved knowledge and comfort with second-generation anti-VEGF agents. Multiple-activity learners had higher baseline knowledge and consistently selected second-generation agents more frequently in case scenarios. Single-activity learners showed greater knowledge gains, while multiple-activity learners maintained higher overall knowledge. The curriculum increased preparedness for future use of new therapies, particularly among low-frequency injectors (<9 injections/week), though some barriers to adoption persisted. A curriculum-based, multimodal CE programme can accelerate the adoption of innovative therapies by improving clinician knowledge, comfort, and clinical decision-making. Iterative, data-driven education is effective in bridging gaps between emerging science and real-world practice, ultimately supporting better patient outcomes in nAMD and DME care.