搜索结果：Leeds

This study assessed the feasibility and acceptability of a new theory- and evidence-based intervention designed to prevent return to pre-admission smoking behaviours after discharge from a smokefree mental health in-patient setting in the United Kingdom (UK). A multi-centre individually randomised controlled feasibility trial with follow-up at 3 and 4-6 months. Acute adult mental health wards of six National Health Service Mental Health Trusts in England. Thirty-eight (17 intervention, 21 usual care) adults who smoked on or after admission to an acute adult mental health in-patient ward and wished to continue reducing or quitting smoking after discharge, enrolled between February and November 2024. The intervention comprised usual care and a 12-week, theory- and evidence-informed support programme including a bespoke resource kit, personalised behavioural support including phone calls and text messages, and access to a digital smoking cessation app with 24/7 live support. It was delivered by trained mental health workers. The comparator group received usual care as per UK national guidance, typically involving brief behavioural support, offers of nicotine replacement therapy and sometimes electronic cigarettes. Primary outcomes included recruitment and retention, intervention acceptability and feasibility of collecting smoking, mental health and economic data. Success criteria for progression to trial were set a priori at a minimum of 60% of the n = 64 target for both recruitment and retention, i.e. at n = 38. Secondary outcomes included measures of smoking, quitting, reduction of cigarette consumption. Acceptability data were collected through exploratory interviews with participants, mental health staff and interventionists. We recruited n = 38 (60%) participants and retained n = 20 (52.6%) at 3 months, and n = 13 (34.2%) at second follow-up. As such, criteria agreed to determine progression to full trial were marginally met for recruitment and not met for retention. Two intervention participants reported maintaining abstinence. Motivation to quit remained higher in the intervention than the usual care group over time, and use of e-cigarettes was overall common (76.9% n = 10 across groups at 4-6 month follow up). Intervention group participants reported valuing the tailored and personalised behavioural support options but engaged little with tailored digital tools. Health economic data collection was feasible, though refinement is needed for future research. A new intervention delivering smoking cessation support to individuals discharged from smoke-free mental health settings was discontinued because key feasibility criteria were not met, highlighting the need for focused reconsideration of recruitment and retention strategies, intervention design and delivery in mental health in-patient populations. Design implications are discussed, taking into account individual patient-level and systemic challenges.

Perioperative abnormalities presenting in patients with inherited primary disorders of skeletal muscle can share similar characteristics to those in a malignant hyperthermia crisis. These patients are often referred to malignant hyperthermia units for perioperative advice as clinicians are accessing conflicting and non-current literature. To address this, the European Malignant Hyperthermia Group (EMHG) has conducted a review of the current literature and used a formal consensus process, with review at annual EMHG meetings and workshops, to provide guidelines for the perioperative management of patients with these myopathies. The guidelines include general recommendations and suggestions applicable to all patients with myopathy requiring anaesthesia or procedural sedation and additional specific recommendations, suggestions and main concerns for patients with specific primary myopathies (ICD-11-CM) with inheritable pathology distal to the neuromuscular junction, including congenital, mitochondrial and metabolic myopathies; muscular dystrophies; myotonias; and familial periodic paralyses.

Nigeria's uptake of digital health through electronic records, telemedicine and connected devices has expanded the cyber-attack surface of health facilities. Cybersecurity failures are not only data-governance problems; they can interrupt prescribing, diagnostics, referral pathways and emergency workflows, with downstream implications for patient safety and trust. Evidence from hospital incidents shows that ransomware and recovery efforts can disrupt services and degrade the timeliness of care when staff are unprepared, underscoring the need to treat cyber resilience as a clinical quality domain. This letter argues that the most scalable risk reduction in low-resource settings is workforce capability: many healthcare breaches exploit human and workflow weaknesses rather than novel technical exploits. We outline a minimum, role-based cybersecurity education package for medical students and practicing clinicians covering: (1) governance, policies and third-party risk management; (2) core technical controls clinicians encounter daily (access control, encryption, patching, segmentation and logging); (3) training and awareness focused on phishing, social engineering and safe downtime workarounds; (4) incident response and recovery integrated into clinical continuity planning; and (5) compliance and ethics aligned to Nigeria's data protection requirements. Embedding these competencies in curricula, accreditation and continuing professional development, reinforced through drills and monitoring, can protect sensitive information and keep essential services running during disruption.

Arrhythmias and cerebrovascular disease commonly coexist in older adults and are associated with increased mortality risk. However, population-level trends and demographic disparities in related deaths remain insufficiently characterized, necessitating large-scale analyses to better inform prevention, risk stratification, and healthcare planning. Data from CDC WONDER (1999-2023) identified U.S. mortality rates in adults aged (≥ 65 years) with arrhythmia (ICD-10: I47-I49) and cerebrovascular disease (ICD-10: I60-I69) among U.S. adults aged 65 and older. Age-adjusted mortality rates (AAMRs) per 100,000 were stratified by sex, race, urbanization and regions. Trends were analyzed using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). Between 1999 and 2023, a total of 733,476 deaths among older adults (≥ 65 years) were attributed to arrhythmias and cerebrovascular disease. The AAMRs exhibited an upward trend from 72.14 in 1999 to 74.62 in 2023 (AAPC: 0.055, 95% CI - 0.62 to 0.74; p 0.87) with a significant rise in AAMR from 65.51 in 2018 to 80.44 in 2021 (APC: 6.65; p 0.01). Men had higher AAMR than women during 1999-2023 with (73.97 to 81.27 vs. 70.22 to 69.2). NH White individuals had the highest AAMR in 2021 (87.43) with a total (631,483 deaths). The South recorded the most deaths (251,478) with a significant decline in AAMR from (70.36) in 2002 to (58.54) in 2008 (APC: - 2.89, 95% CI - 3.85 to - 1.92; p 0.004). Non-metropolitan areas had higher AAMR compared to metropolitan areas (73.62 vs. 64.71). For the place of death, the majority occurred in inpatient medical facilities (38.73%, 284,079 deaths). Mortality related to arrhythmias and cerebrovascular disease has increased in recent years among older adults. While women accounted for more deaths, men consistently had higher AAMRs. Higher mortality burden was also observed among NH White individuals, residents of the South, and urban populations, with most deaths occurring in inpatient medical facilities, highlighting the need for targeted interventions.

Foundation models (FMs) and large language models (LLMs) are transforming cancer AI by integrating heterogeneous data sources, including medical imaging, electronic health records, and molecular profiles. By learning from large-scale, unstructured, and label-free inputs, these models may support diagnosis, biomarker discovery, prognostic assessment, treatment personalization, and workflow automation. In this narrative review, we propose the paradigm of "Leave No Data Behind" to describe the promise that broad oncology data integration may generate clinically meaningful outputs. We critically assess whether this paradigm is supported by current evidence and identify the key challenges that must be addressed to harness the full potential of FMs and LLMs for clinical implementation in oncology.

The reproductive division of labour is the defining feature of eusociality, in which reproduction is monopolised by one, or a small subset, of individuals within a colony. In the Western Honeybee Apis mellifera, workers are reproductively constrained by a suite of mechanisms, but primarily by queen mandibular pheromone (QMP). The adult developmental limits of QMP's ability to repress worker reproduction and its ability to suppress reproduction once ovaries have begun to activate remain unresolved. Here, we investigated the limits of plasticity of QMP mediated reproductive repression and compared it to Drosophila melanogaster. By manipulating the timing of QMP exposure and withdrawal in caged honeybee workers, we show that QMP inhibits ovary activation across early adult development, even when exposure is delayed for several days post-eclosion, and that this inhibition is reversible upon removal of QMP. We also show that QMP alone is unable to bring about repression of honeybee worker ovaries once they have activated, indicating that there is an intrinsic limit to QMP-mediated reproductive plasticity in honeybee workers. This contrasts with D. melanogaster where QMP exposure significantly reduced oogenesis even in active ovaries. These findings indicate that there are species differences in reproductive plasticity; and that in honeybees, QMP acts primarily as an inhibitor of adult reproductive development rather than as a reversible regulator of adult reproduction, with reproductive repression likely requiring other additional colony cues.

Lacunar stroke can cause cognitive decline and dependency. The LACI-2 (Lacunar Intervention Trial-2) trial showed that 12 months of treatment with isosorbide-mononitrate (ISMN) or cilostazol improved these outcomes. We tested whether this effect was present at 6 months. LACI-2 was a prospective randomized open-label blinded-end point 2×2-factorial phase-2b trial assessing feasibility, safety, and proof-of-concept of 1 year of ISMN (40-60 mg) or cilostazol (200 mg). Participants aged >30 years had clinical lacunar stroke, compatible neuroimaging, and capacity to consent. The primary clinical outcome was the composite of stroke, myocardial infarction, dependency (modified Rankin Scale score >2), cognitive impairment (Diagnostic and Statistical Manual version 5, 7-level >0) and death; key secondary outcomes included the composite components, mood and stroke impact scale. Global analysis of the stroke impact scale was analyzed using the Wei-Lachin test with result given as Mann-Whitney difference. Baseline characteristics were balanced across 363 participants: median age 64 (56-72) years, 31% female, and median onset to randomization 79 (27-244) days. At 6 months, participants allocated to ISMN versus control had fewer composite events (adjusted odds ratio [OR], 0.74 [95% CI, 0.55-0.99]) and improved stroke impact (Mann-Whitney difference, -0.15 [95% CI -0.25 to -0.05]). Cilostazol versus control improved cognition (Diagnostic and Statistical Manual version 5, 7-level scale, adjusted common OR, 0.64 [95% CI, 0.41-0.99]). ISMN/cilostazol versus control improved cognition (Diagnostic and Statistical Manual version 5, 7-level adjusted common OR, 0.40 [95% CI, 0.21-0.78]), mood (Zung adjusted mean difference, -6.94 [95% CI, -12.25 to -1.64]) and global stroke impact (Mann-Whitney difference, -0.23 [95% CI, -0.37 to -0.09]). A reduction in the composite outcome, cognitive impairment, dependency, and stroke impact was seen within 6 months of starting ISMN or cilostazol. URL: www.isrctn.com; Unique Identifier: ISRCTN14911850.

Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure (ICP) and typically affects young women with obesity. Patients are at risk of permanent visual loss due to papilloedema. Some require emergency intervention to rapidly reduce papilloedema and preserve vision. The international standard of care for patients with sight-threatening IIH is cerebrospinal fluid (CSF) shunting. However, dural venous sinus stenting (DVSS) is an emerging procedure that is offered at many neuroscience centres internationally as the primary intervention. Currently, there are no randomised controlled trial data supporting the efficacy of any interventional approach for preserving vision in sight-threatening IIH. IIH Intervention is a UK-based two-arm, open-label, multicentre, randomised controlled phase IIb clinical trial with integrated health economic evaluation to compare CSF shunting with DVSS in patients who have confirmed IIH and are at risk of permanent visual loss due to severe papilloedema. The primary outcome is the global thickness of the peripapillary retinal nerve fibre layer (RNFL), an indicator of papilloedema, measured by optical coherence tomography (OCT) over a 6-month period. Secondary outcomes are global thickness of the RNFL over 12 and 24 months, as well as macular ganglion cell layer volume, perimetric mean deviation, headache outcomes, intervention reporting measures (including complications and revisions) and patient-reported outcomes over 6, 12 and 24 months. The protocol was approved initially on 12 December 2022 by West Midlands-South Birmingham Research Ethics Committee (ref: 22/WM/0230). Participants will be required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications. ISRCTN57142415.

Consumer wearables have made atrial fibrillation (AF) detectable at population scale. Since 2019, smartwatch and smartphone studies enrolling thousands of participants have shown that photoplethysmography-based algorithms reliably generate AF notifications in real-world use, and that such a notification carries a high positive predictive value when benchmarked against a gold-standard electrocardiogram patch. This review follows the evidence along the clinical chain, from detection through notification and confirmation of diagnosis to treatment and outcome, and the strength of that evidence diminishes at each link. Population-scale studies established feasibility but did not measure sensitivity. Diagnostic accuracy is heterogeneous and conditional: it depends on the reference standard, the degree of supervision, the population studied, and the handling of inconclusive recordings. Randomised trials show that wearable-enabled pathways can accelerate diagnosis, a process outcome; yet none has shown that wearable-detected AF screening reduces stroke, systemic embolism or death. The treatment evidence that would justify acting on a detected arrhythmia comes from implanted-device populations, not consumer-wearable cohorts, and shows that anticoagulating device-detected AF trades a reduction in ischaemic stroke against an increase in major bleeding. Implementation raises further unresolved problems: confirmation-pathway heterogeneity, workflow burden, adherence, equity and overdiagnosis. Consumer wearables can detect AF at population scale, yet whether this improves hard clinical outcomes remains unresolved. Ongoing randomised trials must answer this critical question.

Giant cell arteritis (GCA) is the most common type of systemic vasculitis and predominantly affects women over the age of 50 years. Clinical presentation includes cranial and ocular involvement, joint and systemic features. Diagnosis is confirmed by positive temporal artery biopsy or ultrasound or large vessel vasculitis on positron emission tomography. Treatment includes high-dose glucocorticoids (GC) and immunosuppressants. Health-related quality of life (HRQoL) can be impacted by pain, fatigue, and sight loss; glucocorticoid therapy adds further physical, psychological, and social burdens. Patient-reported outcome measures (PROMs) aim to capture the impact of disease from the patient's perspective. A range of PROMs have been used to highlight the impact of GCA. The generic 36-Item Short Form Health Survey (SF-36) has demonstrated the effectiveness of novel treatments including Tocilizumab in clinical trials, the symptom-specific Hospital Anxiety and Depression scale has demonstrated 50% of people with GCA suffer with anxiety and a third depression, and condition-specific (GCA PRO) and treatment-specific (Steroid PRO) PROMs have been developed and validated in people with GCA for clinical practice and trials. Shared decision-making (SDM) is essential in GCA management, ensuring patients understand treatment options and decisions reflect their preferences and "what matters to them." PROMs support SDM and enhance the patient-clinician dialogue. Early evidence from use of the GCAPRO demonstrated that PROMs have helped patients explain their symptoms, providing clinicians with clearer insights into the patient's health. There is a growing role for electronic PROMs (E-PROMs) to support patient and clinician communication and facilitate effective clinical triage. Considerations about E-PROMs include potential for digital exclusion in older patients, data governance with online apps, and clinical safety (i.e., for people reporting active disease). To fully implement E-PROMS in clinical practice and gain the maximum benefit, full integration into intuitive clinical and patient systems will be required. Measuring the impact of giant cell arteritis and steroids from the patients’ perspective Giant cell arteritis (GCA) is the most common type of vasculitis. It is most common in women and those over 50 years old. GCA causes the blood vessels of the head and neck to become inflamed and narrowed. People can have headaches and pain and it can affect chewing and cause loss of vision. Some people can also get internal inflammation of the blood vessels around the aorta. A type of steroid called glucocorticoids are used to treat GCA. GCA and treatment with steroids can cause side effects and reduce quality of life. Fifty percent of people can feel anxious and a third have depressive symptoms. Patient reported outcome measures (PROMs) are questionnaires that ask people about their quality of life. They have been used in GCA in clinical trials to show the benefit of new treatments that do not have the side effects of steroids. They can also be used in clinic to improve understanding between patients and doctors and nurses. They do this by raising awareness of what is important to patients–e.g fatigue or pain or how the condition is affecting peoples’ life. A plan can then be made together to help with this. Electronic PROM questionnaires are now being used to help patients and their clinical team. These can help communication and efficiency. It is however important to think about people who may not be confident with digital questionnaires, e.g because of visual problems or older age.

The objective of this study was to evaluate the effect of both cognitive and visual distraction on drivers' gaze behaviour and takeover performance during an SAE Level 2 automated drive. A driving simulator study was conducted where drivers needed to take over control during a safety critical scenario i) while engaged in an auditory version of the 2-back task (cognitive distraction), ii) during ambient occlusion of the driving scene (visual distraction) or iii) a combination of both. In line with previous studies, results showed that, under the 2-back task, drivers showed a lower horizontal dispersion of gaze for scanning the environment. In the ambient occlusion condition, drivers compensated for the temporary absence of the driving scene by dispersing their gaze vertically and towards offroad areas of the environment. In terms of their takeover performance, the results found no significant differences between cognitive and visual distraction manipulations alone. However, drivers' performance was significantly worse, when both manipulations were combined. The findings suggest that both visual and cognitive distraction may tax drivers' cognitive resources and consequently impact their takeover performance. This finding is relevant for future development of driver monitoring systems, which should consider the impact of cognitive load on drivers' performance, even if their eyes are facing towards the road.

Music is the synthesis of a multitude of components: the combination of spectrotemporal structures emerging from different acoustic or electronic instruments, carefully orchestrated to form a connected whole. From these complex textures, our auditory system groups components through a process called musical scene analysis (MSA). In this review, we aim to address several questions about MSA. What are the perceptual principles underpinning musical scene perception? How are these principles being probed with different experimental paradigms? What stimulus and listener factors shape MSA? And what are future perspectives that further drive this field of research? We will find that Gestalt principles from psychology help us organize a musical scene through primitive and schema-based grouping cues. Such principles are being investigated through both minimalist and ecological experimental designs that give rise to several factors affecting MSA. We will present studies that have investigated blend and segregation, salience, and complexity, as stimulus-based aspects, and both peripheral and cognitive factors, which explain inter-individual differences among listeners. We conclude by exploring different perspectives on how music is attuned to MSA and the aesthetic affordances of multi-source music - perspectives that might inform future research in the field.

Quantitative EEG (qEEG) provides objective, millisecond-resolution measures of brain dynamics. Despite decades of methodological advances, clinically relevant derived indices-spectral power ratios, cognitive-emotional state markers, and physiological parameters-are typically reported as raw values without the normative context required for individualized clinical inference. To develop the first systematic age-dependent normative models for this family of derived qEEG indices using a multinational database, enabling probabilistic Z-score interpretation at the individual level with potential applications in objective therapeutic monitoring. Normative modeling was applied to the HarMNqEEG database (n = 1,564 neurologically healthy participants, ages 5-97, 9 countries, eyes-closed resting state). Electrode-level Spectral Normalization (ESN) removed inter-individual and inter-device amplitude variability while preserving the neurophysiological interpretability of each index. Age-dependent normative trajectories were estimated using Generalized Additive Models for Location, Scale, and Shape (GAMLSS) with P-splines on log(age), allowing conditional mean and variance to vary non-linearly across the lifespan. GAMLSS modeling revealed significant non-linear age-dependent trajectories for all indices. Slow-wave-dominated ratios showed steep decreases from childhood to early adulthood, consistent with cortical maturation; alpha-dominated indices increased during adolescence before stabilizing. ESN normalization yielded well-calibrated normative residuals across the full age range for all indices, except Valence. For the Valence index, a quantile regression model is provided as the recommended normative reference due to its spike-and-slab marginal distribution. These normative models provide a principled, age-adjusted probabilistic framework for individual-level qEEG interpretation, based on eyes closed resting state recordings, laying the methodological groundwork for future clinical validation in diagnostic and therapeutic monitoring applications. The ESN strategy requires no knowledge of recording equipment, ensuring broad applicability across clinical and research settings.

We investigated factors associated with delayed diagnosis of childhood onset uveitis. Prospective Cohort: United Kingdom Uveitis in Childhood National Inception Cohort (UNICORN) Study SUBJECTS: Children (aged <18 years) newly diagnosed with non-infectious uveitis between 1st March 2020 and 28th February 2023. Descriptive analysis of disease onset and presentation, with linear and logistic regression modelling to identify factors independently associated with increased time from onset to diagnosis (symptomatic disease) and structural complications at diagnosis (all cases). Among 221 children (median age, 10.9 years; 52% girls), the majority, 69%, were diagnosed following symptomatic onset, most commonly with redness, pain, or photophobia. Median time from symptom onset to diagnosis was 9 days (range, 0-568), with 50% having at least one complication at presentation with symptomatic onset. Independent predictors of increased time to diagnosis, following adjustment for the COVID-19 pandemic 'lockdown' period were bilateral disease (adjusted coefficient 38.1 days, 95% confidence 8.7 to 67.6, p=0.01) and initial presentation to primary care versus eye services (62.6, 13.7 to 111.5, p=0.01). Structural complications at diagnosis were independently associated with younger age (odds ratio 1.4, 1.3 to 1.7, p<0.001) and socioeconomic deprivation (4.5 for lowest quintile, 1.5 to 13.2, p<0.01). Delays in diagnosis occur in childhood uveitis of symptomatic onset, with symptoms being prevalent in disease. Improved awareness of this blinding disorder among primary-care practitioners, standardized referral pathways for childhood eye complaints, and equitable access to eye services are needed to prevent childhood onset, life-long visual disability.

"T-Junction" or distal musculotendinous junction (DMTJ) hamstring injuries have become a true enigma for clinicians as demonstrated by the high recurrence rate. Magnetic Resonance Imaging (MRI) can sometimes fail to provide an accurate assessment of these injuries, probably because of the dynamic function that this structure provides to offer stability at the synchronous movement of the two heads of biceps femoris. The aim of the present case report was to describe a novel method for dynamic ultrasound evaluation of the DMTJ performed during functional loading exercises and to explore its potential role in return-to-play (RTP) decision-making. Case Report. A 23-year-old male elite football player sustained a DMTJ injury. MRI revealed a complete rupture of the superficial portion (myotendinous) and the deep portion (myoaponeurotic) of the T-Junction. The injury occurred initially during high speed non-linear running action.The initial diagnosis was made using a 3T MRI scan. Subsequently, three dynamic ultrasound evaluations were performed at weeks 3, 6 and 9 during two different gym-based exercises: the single-leg barbell Romanian deadlift and the single-leg hamstrings slider with ipsilateral trunk rotation. Additional 3Tesla MRIs were conducted to assess healing and structural changes at weeks 5,8 and 14. The player returned to competitive activity 10 weeks after the injury and experienced no re-injury during the subsequent 4-month follow-up period. Improvements in the synchronous movement between BFlh and BFsh were seen on the progressive evaluations as well as the scar healing progression. Dynamic ultrasound assessment during the SL-RDL appeared to provide clearer visualization of interhead hamstring movement than during the slider exercise. Further investigation in larger cohorts is warranted to establish the reliability, validity, and prognostic utility of this novel assessment modality for athletes with this injury. In this single case, dynamic ultrasound of the DMTJ provided valuable information regarding interhead synchrony of the biceps femoris. This approach may complement MRI and support informed return to play decision-making following T-Junction hamstring injuries. 5.

Finite therapy resulting in sustained hepatitis B surface antigen (HBsAg) loss for patients with chronic HBV infection (CHB) is an important therapeutic goal. In patients with HBeAg-negative infection, nucleos(t)ide analogue (NA) withdrawal may achieve HBsAg loss in 5-20% of patients after 3 years. Pegylated interferon (PEG-IFNa) is a recognised treatment for CHB. NUC-B was a randomised, multi-centre trial in NA-treated non-cirrhotic HBeAg negative patients with CHB. Patients were allocated to either NA withdrawal alone (control) or NA withdrawal followed by a 16 week course of PEG-IFNa 180ug weekly commencing 4 weeks after NA cessation (PEG-IFNa). The primary endpoint was HBsAg loss at 3 years. The target recruitment of 240 patients was not achieved. 156 patients, 82 to control arm , 74 to PEG-IFNa arm , were recruited between 2017 and 2021; median age 45 years, 24% female, HBV Genotypes -A 16%, B 6%, C 4%, D 24%, E 22%, other 1%, unknown 26%. At 3 years 3% of patients in the contol arm and 14% of patients in the PEG-IFNa arm lost HBsAg (odds ratio 5.39; 95% confidence interval, (1.11, 26.19); p=0.037). In the control arm 34.9% of patients returned to NA therapy compared to 28.4% in the PEG_IFNa- arm. Exaggerated flares occurred in 27.9% of patients in the control arm compared with 13.4% in the PEG-IFNa arm. The use of adjuvant PEG-IFNa therapy after withdrawal of NA therapy increases the rate of HBsAg loss whilst simultaneously reducing the number of exaggerated flares.

Rosacea is a chronic inflammatory dermatosis characterized by persistent erythema and episodic flushing, often associated with suboptimal treatment outcomes and frequent recurrence. Botulinum toxin has recently been proposed as a novel therapeutic modality in its management. This systematic review evaluates the current evidence regarding the efficacy and safety of botulinum toxin in patients with rosacea. A comprehensive search of major electronic databases was conducted to identify relevant studies assessing its clinical application. Overall, the available literature suggests that botulinum toxin is associated with improvements in clinical signs and symptoms, particularly erythema, with effects sustained for a variable duration. Reported adverse events were predominantly mild and self-limiting. However, interpretation of these findings is limited by small sample sizes, heterogeneity in study design, and relatively short follow-up periods. Further high-quality, standardized studies are required to better define its role in routine clinical practice.

To investigate the effect of surgical delay on radiographic and patient outcomes following canine humeral condylar fracture stabilization. Retrospective observational cohort study. A total of 211humeral condylar fractures (204 dogs). Time to surgery and clinical data were collected from the medical record. Immediate postoperative radiographs were reviewed for an intracondylar gap or articular step defect. Postoperative complications and short-term outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis modeled radiographic and patient outcomes. Fracture events occurring on Friday or Saturday were systematically associated with longer delays to surgery (p&#x2009;<&#x2009;.001). Increasing delays to surgery were associated with an increased risk of an intracondylar gap or articular step defect on immediate postoperative radiographs (adjusted OR&#x2009;=&#x2009;3.86 per additional day, 95% CI:&#x2009;2.04-7.29, p&#x2009;<&#x2009;.001). Presence of an intracondylar gap or articular step defect was associated with an increased risk of postoperative complications (adjusted OR&#x2009;=&#x2009;5.92, 95% CI:&#x2009;1.44-24.36, p&#x2009;=&#x2009;.01). Presence of an intracondylar gap or articular step defect was associated with an increased risk of a poorer short-term outcome (adjusted OR&#x2009;=&#x2009;0.13, 95% CI:&#x2009;0.04-0.42, p&#x2009;=&#x2009;.001). The presence of postoperative complications increased the risk of a poorer short-term outcome (adjusted OR&#x2009;=&#x2009;0.38, 95% CI:&#x2009;0.17-0.87, p&#x2009;=&#x2009;.02). Delays to surgery are an important system-level factor influencing the accuracy of fracture reduction, postoperative complications, and short-term outcomes in canine humeral condylar fracture repair. System-level optimization may be an avenue for quality improvement in this patient population.

To determine whether perioperative management guided by conditional computed tomography-myelography (C-CTM) is non-inferior to magnetic resonance imaging (MRI) regarding functional outcome for acute thoracolumbar intervertebral disc extrusion (IVDE) in non-ambulatory chondrodystrophic dogs. Quasi-randomized natural experiment utilizing unscheduled MRI downtime as an exogenous instrument. A total of 560 client-owned dogs (MRI, 518 dogs; C-CTM, 42 dogs). A retrospective cohort study was conducted. The primary outcome was recovery of ambulation, analyzed with intention-to-treat (ITT) and per-protocol (PP) principles with a prespecified non-inferiority margin of -12%. Secondary outcomes included safety events (postoperative neurologic deterioration, progressive myelomalacia, major complications) and time-adjusted treatment costs. C-CTM was non-inferior to MRI for recovery of ambulation in both ITT (risk difference&#x2009;+&#x2009;6.5%, 95% CI: -2.7%-15.7%, one-sided p&#x2009;<&#x2009;.001) and PP analyses (risk difference&#x2009;+&#x2009;2.5%, 95% CI: -7.3%-12.2%, one-sided p&#x2009;<&#x2009;.001). There was no difference in rates of postoperative neurologic deterioration, progressive myelomalacia, or major complications. Total treatment costs and imaging costs were significantly lower for C-CTM (p&#x2009;<&#x2009;.01). There was no difference in non-imaging costs between groups. In non-ambulatory chondrodystrophic dogs with acute thoracolumbar IVDE, C-CTM is non-inferior to MRI for recovery of ambulation with a similar safety profile, at significantly lower cost. In dogs with a high pretest probability of acute thoracolumbar IVDE, routine use of MRI may not be justified given the comparable clinical outcomes and lower treatment costs achieved with C-CTM.