Image-guided percutaneous osteosynthesis (IGPO) is an emerging minimally invasive technique for stabilizing metastatic, insufficiency-related, and selected traumatic skeletal lesions. Although technical feasibility and clinical outcomes are increasingly reported, guidance on launching and sustaining IGPO programs remains limited. This expert narrative review proposes an implementation framework based on the Practical, Robust Implementation and Sustainability Model (PRISM) and Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM). Key IGPO, musculoskeletal interventional radiology, and implementation-science publications were identified from PubMed and authors' reference libraries. Selected French and Canadian institutional experiences were synthesized through framework-guided author discussions. This approach was not a systematic review or formal qualitative study. The framework emphasizes institutional readiness, stakeholder engagement, patient selection, imaging and anesthesia access, staffing, radiation safety, adverse-event monitoring, follow-up, and progressive scale-up. Suggested metrics include technical success, procedure duration, radiation exposure, adverse-event grade, pain, mobility, length of stay, reintervention, and patient-reported outcomes.
This July, the US Centers for Medicare & Medicaid Services will launch its ACCESS program, a decade-long experiment in outcome-based payment expanded to digital care options. In this News and Perspectives article, JMIR Correspondent Delaney Rebernik reports on the players, promise, and potential pitfalls of this initiative.
Commercial human spaceflight has expanded markedly since 2021, with a growing cohort of civilian participants having undertaken suborbital, orbital free-flyer, and International Space Station visiting-crew missions. Pre-flight medical assessment of this population, however, continues to rely on regulatory guidance that predates the first civilian orbital flight by approximately fifteen years and stratifies eligibility on a single dimension of G-load exposure. The evidence accumulated since on spaceflight-associated neuro-ocular syndrome, on centrifuge-analog tolerance in participants with chronic comorbidities, on the integrated multi-omic findings of recent civilian orbital missions, and on the new mission profiles introduced by the Axiom and Polaris Dawn programs has not been incorporated into a unified evaluation framework. In this narrative review, the aerospace-medicine and clinical literature of the past two decades is synthesized within a framework that distinguishes mission-related background factors (including acceleration, microgravity, spaceflight-associated neuro-ocular syndrome, ionizing radiation, and cabin environment) from participant-related factors (comprising age, sex, reproductive status, and cardiopulmonary, metabolic, and oncological comorbidity). The documented cohort spans 18 to 90 years of age, with the extremes confined to suborbital flights. The orbital free-flyer subset (n=12 across Inspiration4, Polaris Dawn, and Fram2) ranges from approximately 29 to 63 years, and the International Space Station (ISS) visiting-crew subset (n=12 civilian participants across Axiom AX-1 through AX-4, excluding career-astronaut commanders) from 33 to 71 years. Documented comorbidities include treated coronary artery disease, paroxysmal atrial fibrillation, type 2 diabetes mellitus, obstructive sleep apnea, and prior oncological conditions. Based on the available evidence, a clinical routine is proposed, organized across three assessment tiers - a universal baseline (Tier 1), an indication-driven system-specific evaluation (Tier 2), and a mission-class-specific evaluation (Tier 3) - and distributed along a four-step pathway from 90 days before flight to the day of launch. The proposed workflow may serve as an operational starting point, although prospective validation will be required as the commercial era generates additional data on participants, mission profiles, and clinical outcomes.
The short communications.
Electronic health records are crucial medical informatics elements increasingly utilized in industrialized nations to enhance health care services. Given the significance of electronic health records in improving monitoring and evaluation, along with the necessity to deliver quality, cost-effective, and patient-centered services, this study aims to examine the strengths, limitations, challenges, facilitators, and prerequisites for the implementation and utilization of electronic health records. This study was a systematic scoping review conducted in 2023. The protocol of the Joanna Briggs Institute (2015) was employed to design and execute this scoping review, while the model by Levak et al. (2010) served as a guide for its execution. Articles were searched across six major databases, including IS Web of Sciences, PubMed, Scopus, EMBASE, Cochrane, and ProQuest, using a predefined search strategy. Google Scholar was also utilized for supplementary searches. The search period spanned from 2002 to 2022. A total of 37,694 studies were identified across six primary databases. Following evaluation in three stages-title, abstract, and full-text-71 articles were deemed eligible for inclusion in this scoping review. Qualitative analysis and data classification of the selected studies identified four main themes and 31 sub-themes related to the strengths of setting up and utilizing electronic health records. Challenges associated with the launch and implementation of electronic health records were categorized into five main themes and 47 sub-themes, while facilitators and prerequisites for launching and utilizing EHRs were classified into five main themes and 30 sub-themes. It should be noted that some sub-themes were reported in only a single study; therefore, their weight should be interpreted with caution. Finally, a five-stage process was recommended to guide the successful launch and implementation of EHRs. Healthcare managers and policymakers should comprehensively consider the strengths, limitations, challenges, facilitators, and prerequisites for launching and using electronic health records. Given the relatively limited effectiveness of government incentive policies and financial support, there is a need to assess and revise these policies to enhance the implementation of EHR. Addressing user resistance requires a greater focus on organizational culture.
In response to the development demand for miniaturized portable and lightweight of UAV ejection system, a new technological approach for UAV ejection based on CO2 phase transition is proposed. A thermodynamic model for CO2 phase transition ejection system was established and solved, a 115 mL CO2 phase transition catapult was trial-produced and the ejection experimental system was built. The 8.8 kg UAV was accelerated to a exit velocity of 25 m/s and the peak acceleration was 1077.7 m/s2, the simulation and experimental results showed that the maximum error of exit velocity and peak acceleration were 2.35%, 3.68%, which effectively verifying the accuracy of simulation model. To further reduce the launch overload of UAV, the effects of ejection system's CO2 working fluid filling parameters, valve diameter, and initial volume of launch tube on the interior ballistic performance during ejection process were simulated and studied under the condition of constant total system energy. The research results indicate that the filling density of CO2 which inside catapult has the greatest impact on the exit velocity, and the valve diameter has the greatest impact on the peak acceleration. Reducing the valve diameter, increasing the filling density of CO2 and the initial volume of launch tube are beneficial for reducing the projectile overload while ensuring the exit velocity. By adopting key parameter optimization design, the UAV achieves an exit velocity of 25.5 m/s and a peak acceleration of 733 m/s2, the peak acceleration can be reduced by 31.98%, which can significantly improve the safety of ejection process.
Subspecialty recognition and certification in Pediatric Nephrology remain heterogeneous across Europe and globally, resulting in variations in training standards and professional mobility. To address this gap, the European Society for Paediatric Nephrology (ESPN) launched the European Board Certification in 2020 as a pan-European and curriculum-based assessment of knowledge and clinical reasoning in Pediatric Nephrology. We performed a descriptive and analytical evaluation of candidates who applied for the ESPN Board Certification in Pediatric Nephrology between 2020 and 2025. Candidate characteristics, examination performance, and factors associated with success were analyzed. The exam consisted of 100 case-based multiple-choice questions developed according to a predefined blueprint. Multivariable logistic regression was used to identify factors independently associated with passing. Additionally, a cross-sectional survey assessed candidates' perceptions of the examination and its professional impact. A total of 349 pediatric nephrologists from 52 countries and four continents completed the examination. Median age was 38.2 years (IQR 34.7-43.5), and 59.9% were female. The overall pass rate was 54.7%, with significant variation by continent (p = 0.014). Attendance at the International Pediatric Nephrology Association (IPNA)-ESPN Junior Master Class was associated with higher odds of success (OR 3.76, 95% CI 1.65-5.87, p < 0.001), whereas increasing age was associated with lower odds of success (OR 0.66 per additional year, 95% CI 0.55-0.78, p = 0.002). Among 74 survey respondents, perceptions regarding the examination were highly positive: 93.2% considered the content clinically relevant, 89.2% reported increased self-confidence, and 75.6% perceived a positive professional impact. Since its launch, the ESPN Board Examination has emerged as an internationally acknowledged benchmark of key knowledge and clinical reasoning in Pediatric Nephrology. Structured preparatory education enhances examination success, and certification is widely perceived as professionally meaningful. The examination plays a vital role in standardizing subspecialty criteria and reinforcing the professional identity within Pediatric Nephrology.
Significant disparities in cystic fibrosis (CF) care persist across Europe. To address these inequalities, the European CF Society (ECFS) has launched the Twinning Project in collaboration with CF Europe. The project promotes structured partnerships between well-established and developing CF centres. Mentor centres from the ECFS Clinical Trials Network (ECFS-CTN) are paired with mentee centres, primarily from Eastern European countries, with the aim of strengthening CF care. Launched in 2020 with eight partnerships, the programme has grown in 2024 to encompass an additional 19 twinning pairs and national patient organisations. Twinning activities include onsite visits, virtual meetings, educational initiatives and translation of learning resources into local languages. Programme evaluation is based on annual progress reports assessing collaboration, training, multidisciplinary team development at the mentee site, and the frequency and mode of communication. Of the 25 twinning pairs that submitted their reports in March 2025, 24 had established regular online communication and 19 had conducted at least one onsite visit. Based on reports received from 23 pairs in March 2026, we identified that the proportion of pairs completing reciprocal onsite visits rose from 24% (6/25) in 2025 to 65% (15/23) in 2026, and the proportion reporting regular clinical case consultations increased from 24% (6/25) to 83% (19/23). One mentee centre was approved as a new ECFS-CTN site. As of 2026, the network comprised 26 mentor centres and 28 mentee sites. The Twinning Project has fostered sustainable collaborations between CF centres and patient communities, contributing to the harmonisation of CF standards across Europe.
"Patient-focused drug development" emphasizes multi-stakeholder collaboration and advocates for in-depth listening to patients' opinions to facilitate all stages of drug development. In the field of rare disease drug development, implementing the concept of "patient-centered" drug development, focusing on patients' perspectives, and heeding patients' voices will serve as an effective approach for pharmaceutical companies, researchers, and regulatory authorities to gain a deeper understanding of rare diseases and patients' needs, thereby enhancing the precision and efficiency of rare disease drug development. The "Care Program" is a pilot program launched by the Center for Drug Evaluation, NMPA focusing on rare diseases. Its aim is to guide pharmaceutical companies to incorporate the perspectives of rare disease patients throughout the entire drug development process and improve the scientific rigor and standardization of integrating patients' voices into the clinical development of rare disease drugs. The launch of the "Care Program" is expected to accumulate valuable experience for future regulatory work and drug development efforts.
Neural tube defects (NTDs) are severe congenital malformations that cause significant foetal mortality and lifelong disability. Preconception folic acid supplementation has been proven effective in reducing the risk of NTDs. In 2009, China launched a national folic acid supplementation programme, which was further strengthened in Guangxi, China, by the implementation of a free premarital medical check-up policy in 2010. In this study, we analysed NTDs incidence trends in Guangxi (2009-2023) to evaluate the impact of these integrated interventions. We conducted a descriptive epidemiological study utilising surveillance data from Guangxi on premarital medical check-up (PMC) rate, folic acid supplementation rate, compliance rate, awareness rate, and the number of NTDs cases from 2009 to 2023. We used the Cochran-Armitage trend test to assess temporal trends, and Spearman's rank correlation and linear regression analyses to examine associations between PMC rate, folic acid-related indicators, and the NTDs incidence rate. We observed significant increasing trends in the PMC rate, folic acid supplementation rate, compliance rate, and awareness rate (P < 0.001, respectively) from 2009 to 2023. Conversely, the NTDs incidence rate demonstrated a significant decreasing trend (χ2 = 365.556, P < 0.001). Spearman correlation analysis showed significant negative correlations between the NTDs incidence rate and the PMC rate (r = -0.986, P < 0.001), folic acid supplementation rate (r = -0.932, P < 0.001), and folic acid awareness rate (r = -0.976, P < 0.001). Linear regression models indicated that increases in the PMC rate (β = -0.063, P < 0.001) and the folic acid supplementation rate (β = -0.090, P < 0.001) were significant predictors of a decrease in the NTDs incidence rate. The findings highlight the pivotal role of premarital medical check-ups and folic acid supplementation in preventing NTDs. The sustained promotion and reinforcement of these public health interventions are essential for further reducing the burden of birth defects and improving population health outcomes. The 'Guangxi model' of integrated premarital and reproductive health services offers valuable insights in this context.
Despite the increasing availability of IV analgesics, perioperative pain management remains a challenge, especially in pediatric care where most IV NSAIDs do not have labelled indications. NSAIDs are consistently identified as essential for multimodal analgesia protocols. This document summarizes key discussions of a 2023 Medical Advisory Board Meeting (Frankfurt, Germany) on Ready-to-use (RTU) IV Ibuprofen, complemented by follow-up clinician questionnaires describing institutional clinical protocols, perceived benefits and safety considerations. Ready-to-use IV ibuprofen has become available in Europe in the last few years, prior to its worldwide launching. This paper aims to provide valuable insights and serve as a reference point for the introduction of this new formulation by colleagues in other countries. Ibuprofen inhibits COX-1 and COX-2 enzymes with a favorable COX-1/COX-2 ratio, reducing side effects. Its pharmacokinetics are consistent across age groups, and it is considered safe for pediatric and elderly populations. Experts reported broad adoption of RTU IV Ibuprofen across multiple surgical settings, with consistent analgesic efficacy and evident opioid-sparing effects. Protocols referred by the authors included mainly preemptive analgesia and multimodal strategies tailored to patient needs. Reported advantages for IV Ibuprofen included rapid onset of action, accurate dosing, faster recovery, and workflow benefits from a premixed preparation, making it suitable for hospitalized patients. Contraindications include allergies, active bleeding, and severe renal failure. Board members reported no increased bleeding risk in their experience with IV Ibuprofen.
During the critical life transition of higher education, academic performance and mental health are two key factors that influence college students' personal growth and future career development. Notably, there is ongoing debate regarding whether a bidirectional relationship exists between academic performance and mental health, and existing research lacks longitudinal evidence from students in China's elite universities. As key indicators of mental health, the dynamic relationship between depression, subjective well-being, and academic performance warrants further investigation. This study utilizes data from two waves of the Beijing College Students Panel Survey, a large-scale longitudinal study of university students in Beijing that was launched in 2009. Using a sample of 874 students from five elite universities in Beijing, China, the study employed a cross-lagged model to examine the longitudinal bidirectional relationship between depression, subjective well-being and academic performance. The results show that academic performance is negatively correlated with depression and positively correlated with subjective well-being. Cross-lagged analysis further indicates that prior academic performance can predict subsequent depression (β = -0.066, p < 0.1) and subjective well-being (β = 0.082, p < 0.05), but there is insufficient evidence for the reverse predictive relationship (p > 0.1). These findings suggest that, for students in China's elite universities, academic performance is a significant antecedent of subsequent mental health status. The conclusions emphasize the importance of enhancing academic support in elite universities to promote mental health and provide empirical evidence for constructing a collaborative support system that integrates academic and psychological aspects, as well as health communication strategies for behavioral change.
The Adult Chronic Pancreatitis (CP) Working Group, formed at inception of the Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC), has developed a robust framework and infrastructure to conduct clinical, translational, and mechanistic studies of CP. At its core is PROspective Evaluation of Chronic Pancreatitis for EpidEmiologic and Translational StuDies (PROCEED), the first longitudinal cohort study of CP in US adults, launched in 2017. PROCEED has developed a well annotated clinical dataset of over 2,000 deeply-phenotyped participants, a biorepository and an imaging repository. Investigators have published promising data on blood- and imaging- based biomarkers of CP diagnosis and pain, which are awaiting validation. Clinical observations include classification of patients into mechanism-based pain phenotypes using responses to PROMIS questionnaires, prevalence and predictors of opioid use, prevalence of psychological comorbidity, and osteopathy in CP patients. Pilot clinical trials have evaluated the effect of oral indomethacin on pancreas fluid prostaglandin E2 levels, and Internet-based cognitive behavioral therapy (CBT) for chronic pain. Results of pilot trials have led to an ongoing definitive randomized clinical trial for CBT. The rich environment and resources have facilitated mentorship and academic development of many early-stage investigators. Investigators outside of the consortium have opportunities for collaboration. In the next 5 years, the Working Group plans to further strengthen the research platform, complete primary and key secondary analyses of PROCEED and ancillary studies, continue efforts to develop biomarkers for diagnosis and prognosis of CP, and complete ongoing clinical trials to address unanswered questions in the field.
The healthcare sector has undergone a transformation driven by the adoption of digital technology. Digital strategies have become the principal mechanism for delivering high-quality, cost-effective healthcare at scale. The Indian Government is also rapidly deploying the Ayushman Bharat Digital Mission (ABDM), launched in September 2021. ABDM is the flagship programme of the Indian Government, which has become the standard platform for healthcare delivery and allied services, including insurance management. The COVID-19 pandemic further accelerated digital adoption, making dependence on digital infrastructure both pervasive and unavoidable. Ensuring cybersecurity and resilience is therefore fundamental to uninterrupted healthcare delivery. This paper examines cyber resilience and cybersecurity within ABDM, with specific reference to its architecture and governing policies. A rigorous assessment of cyber resilience and cybersecurity, encompassing potential threats and attack vectors, is essential to the programme&#×2019;s long-term success. We conclude that ABDM&#×2019;s success is intrinsically linked to robust cybersecurity and resilience. Further work is required to develop a comprehensive framework for ABDM cyber resilience and security that is applicable across all ecosystem partners.
Introduction Healthy eating supports diabetes management and may reduce colorectal cancer risk, yet patients in underserved clinic settings often face structural barriers that limit dietary behavior change. This study examined patient-care-team and health-system factors influencing diet counseling, nutrition referral, and food-resource linkage in two community clinics. Methods Before launching a patient-facing colorectal cancer and colon-healthy nutrition education intervention, we conducted an exploratory study to inform the intervention design with 23 patient-care-team members from two community-based clinics serving medically underserved populations. Participants completed semi-structured interviews supplemented by a brief descriptive survey. Interviews examined diabetes-related diet counseling, colorectal cancer risk-reduction nutrition, nutrition referral, food access, cultural food practices, and clinic workflow barriers. Survey items assessed knowledge of diets to prevent colorectal cancer, familiarity with diet-related risks and benefits, counseling practices, resources, and perceived patient barriers. Transcripts were analyzed using deductive codes based on interview domains and inductive refinement based on recurring patterns. Survey data were summarized descriptively. Results Participants described diet counseling as important, particularly for patients with diabetes, but often constrained by limited time, competing visit priorities, referral availability, and patient social needs. Themes included routine but variably structured counseling; diabetes-focused counseling that created opportunities to reinforce colorectal cancer risk-reduction nutrition; barriers related to affordability, food access, housing, cooking resources, and competing priorities; the need for culturally responsive counseling; inconsistent availability or use of nutrition referrals and food-resource linkages; and variable patient-care-team knowledge, training, and confidence. Among all participants, 61% rated their knowledge of diets to prevent colorectal cancer as low, very low, or "don't know." Among role-applicable participants, 23% reported counseling patients about dietary changes to prevent colorectal cancer at every visit. Conclusion In underserved clinics, healthy eating support should move beyond brief advice toward resource-linked, culturally responsive care pathways that connect counseling, referral, food access support, and follow-up.
This pilot study used Charmaz's constructivist grounded theory and Watson's theory of human caring to develop the Trinitas Mentorship Model with 11 new nurse faculty. Data from 10 monthly focus groups and pre-/post-questionnaires were analyzed. Four constructivist grounded theory categories-belonging, competency, empowerment, and work/life balance-persisted and deepened within the structured mentorship experience, with no new categories emerging. These categories shaped a three-pronged framework: Launch/Onboarding, Mentorship, and Sponsorship, with intentional mentor pairing and caring science principles embedded throughout. Findings from year 1 indicate the model strengthened recruitment, development, and retention; only 1 of 11 faculty resigned to date.
Few medical schools, particularly those without dedicated pathology departments, offer preclinical pathology electives. To address this gap, faculty at Michigan State University College of Osteopathic Medicine and the Michigan State University College of Human Medicine-College of Osteopathic Medicine Pathology Interest Group launched a student-faculty elective in 2025. The elective comprised eight sessions: seven microscope sign-outs and one grossing workshop. Each began with one hour of independent slide preview, followed by a 2-h sign-out led by a practicing pathologist and delivered in person and via Zoom. Across approximately 30 contact hours, students engaged in microscopic and macroscopic pathology. Twenty-three learners attended at least one session. Anonymous pre- and post-class surveys assessed prior exposure, self-rated confidence, specialty interest, and perceptions of curricular adequacy. Thirteen medical students completed the precourse survey, and fourteen completed the postcourse survey; eleven responses were paired. Baseline experience was limited: 54% had never grossed a specimen or attended a sign-out, and no learner reported high confidence in histology, gross pathology, or laboratory report interpretation. Among paired respondents, mean confidence increased by +1.1 to +1.3 points on a five-point scale, with 82% improving across domains. Post-survey data showed 93% reported the elective reshaped their perception of pathology, 93% planned a pathology rotation, and all respondents recommended the course. In the absence of a pathology department, this student-led, faculty-mentored elective provided rare early exposure. Beyond measurable confidence gains, the program offers a scalable model for institutions seeking to strengthen pathology exposure and the specialty pipeline.
To provide hearing care professionals (HCPs) with an overview of the NAL-NL3 fitting system and to guide its use in clinical practice. The aim is to translate the research underpinning NAL-NL3 into practical guidance. This Clinical Note outlines the rationale and clinical application of the NAL-NL3 fitting system, which at launch comprises the NAL-NL3 Prescription, the Comfort in Noise (CIN) Module, and the Minimal Hearing Loss (MHL) Module. The NAL-NL3 fitting system was developed through laboratory and field testing and feedback from hearing care professionals. The NAL-NL3 Prescription provides amplification that aligns more closely with clinical needs, improving first-fit satisfaction and clinical efficiency for a wider range of cases. The Comfort in Noise Module offers a comfort-focused amplification profile adapted for noisy environments, improving comfort and reducing listening fatigue while maintaining speech intelligibility. The Minimal Hearing Loss Module extends hearing aid fitting to adults with normal or near-normal hearing thresholds who experience hearing difficulties, providing safe access to hearing aid technologies. NAL-NL3 is the next generation of NAL's evidence-based philosophy towards prescribing hearing aid amplification. Its modular design enables hearing care professionals to better personalise fittings to patients' communication needs, supporting patient-centred care.
In alignment with the Ending the HIV Epidemic (EHE) Initiative, the Los Angeles County Department of Public Health launched TelePrEP in May 2023 to expand access to HIV prevention services. This study aimed to examine predictors of engagement in care, including demographic characteristics, and insurance status. This retrospective cohort study used de-identified data from 412 clients during the program's operation from May 2023 through May 2025. Engagement was measured as completion of three or more quarterly visits versus fewer than three visits. Bivariate analysis and Logistic regression assessed associations between engagement and client demographics. The cohort was predominantly male (91.70%), Hispanic/Latino (48.10%), and aged 18-39 years (72.60%). Majority of clients disenrolled (53.80%) were attributed to adherence/compliance challenges. Completion of three or more quarterly visits was not significantly associated with gender, age, race/ethnicity, or insurance status in either bivariate or adjusted analyses. In this large urban TelePrEP program, no statistically significant associations were detected between the measured variables and completion of three or more quarterly visits. Small subgroup sizes and wide confidence intervals limit interpretation. Findings support strengthening early engagement and reengagement strategies, although interpretation is limited by small subgroup sizes.