搜索结果：List

Polypharmacy is increasingly common across all age groups and is often associated with the use of potentially inappropriate medications (PIMs), where harms may outweigh benefits, contributing to increased adverse drug events, reduced quality of life, and rising health care costs. However, existing deprescribing guidelines and PIM criteria, such as the Beers Criteria and STOPP/START (Screening Tool of Older Persons' Prescriptions/Screening Tool to Alert to Right Treatment), primarily target older adults, overlooking the risks faced by younger populations. This study aims to develop an international consensus-based list of PIMs for adults aged 18 to 65 years through a modified Delphi process, addressing a critical gap in medication safety and deprescribing guidance. A 14-member international steering committee developed a preliminary list of candidate PIMs through a literature review and expert input. An international, interdisciplinary Delphi panel of 30 to 40 participants will evaluate this list across 3 survey rounds. Panelists will rate the relevance of potential PIMs using predefined criteria, including the balance of benefits and harms, patient preferences, and the availability of alternatives. Consensus will be defined as a median rating of ≥4 (for inclusion) or ≤2 (for exclusion) on a 5-point Likert scale (1=not relevant to 5=extremely relevant), with an IQR width of ≤1 and at least 70% directional agreement. Items not meeting thresholds will be carried forward to subsequent rounds for reconsideration. Quantitative analyses will summarize ratings and agreement levels, while qualitative free-text responses will undergo content analysis to provide context and capture nuanced perspectives. The process will yield a prioritized list of PIMs for adults aged 18 to 65 years. Panel recruitment was completed between September and October 2025, with 36 participants. Three rounds of data collection were completed between October 2025 and January 2026. Interim analyses were conducted to inform structured feedback between rounds. Final data analysis is ongoing, and consensus results are expected to be reported in late 2026. This Delphi process will yield a consensus-based list of PIMs for adults aged 18 to 65 years, informing the development of an international guideline to support safer prescribing practices and to expand deprescribing efforts beyond geriatric care.

The prevalence of e-cigarette use has recently increased globally amongst children and adolescents. In response to this increase and emerging evidence about the potential harms of e-cigarettes in children and adolescents, leading public health organisations have called for approaches to address e-cigarette use. Whilst evaluations of approaches to reduce uptake and use regularly appear in the literature, the collective long-term benefit of these is currently unclear. The co-primary objectives were to: (1) evaluate the effectiveness of interventions to prevent e-cigarette use in children and adolescents (aged 19 years and younger) with no prior use, relative to no intervention, waiting-list control, usual practice, or an alternative intervention; and (2) evaluate the effectiveness of interventions to cease e-cigarette use in children and adolescents (aged 19 years and younger) reporting current use, relative to no intervention, waiting-list control, usual practice, or an alternative intervention. Secondary objectives were to: (1) examine the effect of such interventions on child and adolescent use of other tobacco products (e.g. cigarettes, cigars, chewing tobacco and pouches); and (2) describe the unintended adverse effects of the intervention on individuals, or on organisations where such interventions were being implemented. We searched CENTRAL, Ovid MEDLINE, Ovid Embase, Ovid PsycINFO, EBSCO CINAHL and Europe PMC on 1st September 2025. Additionally, we searched two trial registry platforms (WHO International Clinical Trials Registry Platform; ClinicalTrials.gov), and reference lists of relevant systematic reviews. We contacted corresponding authors of articles identified as ongoing studies. We included randomised controlled trials (RCTs), including cluster-RCTs, factorial RCTs, and stepped-wedge RCTs. To be eligible, the primary targets of the interventions were children and adolescents aged 19 years or younger. Interventions could have been conducted in any setting, including the community, school, health services, or the home, and must have sought to influence children or adolescent (or both) e-cigarette use directly. Studies with a comparator of no intervention (i.e. control), waiting-list control, usual practice, or an alternative intervention not targeting e-cigarette use were eligible. Two review authors independently screened the titles and abstracts of references, with any discrepancies resolved through consensus or a third reviewer. The critical review outcome was e-cigarette use in children and adolescents aged 19 years or younger. We included measures to assess the effectiveness of interventions to: prevent child and adolescent e-cigarette use (including measures of e-cigarette use amongst those who were never-users); and cease e-cigarette use (including measures of e-cigarette use amongst children and adolescents who were current e-cigarette users at baseline). We included data measured at least six months post-baseline. Outcomes were current use (defined as use in the past 30 days), ever use (defined as any lifetime use) and adverse effects. Risk of bias for all included studies was assessed using the Cochrane RoB 2 tool. We applied this tool to the critical and important review outcomes from each included study to assess and rate each outcome as low, some concerns or high for all relevant domains. Pairs of review authors independently extracted information from the included studies, with any discrepancies resolved through consensus or a third reviewer when required. Meta-analyses were conducted using a random-effects model where data were suitable for pooling, with two prevention studies measuring e-cigarette use pooled. Studies and outcomes unsuitable for pooling in meta-analyses were instead summarised narratively. We identified three studies with 10,510 participants as eligible for inclusion. A further 30 studies were identified as ongoing and five are awaiting classification and likely to be eligible for a future update. Two studies employed a cluster-RCT design to test the effectiveness of school-based interventions to prevent adolescent e-cigarette use, with one study judged to have 'some concerns' for the overall risk of bias for the e-cigarette ever-use outcome and the other study judged as 'high risk'. The remaining study employed an RCT design to test the effectiveness of a community-based intervention (delivered via text-messages) to support adolescents to cease e-cigarette use. We judged the overall risk of bias as low for this study which reported an e-cigarette current-use outcome. Included studies were conducted in the United States, Australia and Sweden. For the critical outcome of e-cigarette ever use, a meta-analysis of two studies (one high risk of bias, one some concerns) found that prevention interventions may prevent ever use, relative to usual care, although evidence is very uncertain (RR 0.94, 95% CI 0.89 to 0.99; 2 studies; 5306 participants; random-effects model; very-low certainty evidence). The certainty of evidence in this effect was downgraded due to risk of bias, indirectness and imprecision. One study reporting a prevention intervention reported no adverse effects. For the critical outcome of e-cigarette current use, one study reported that a cessation-focused intervention is likely to reduce adolescent current use of e-cigarettes (RR 0.73, 95% CI 0.65 to 0.82; 1 study, 1064 participants; moderate-certainty evidence). The certainty of evidence in this effect was downgraded due to indirectness. The cessation intervention did not report on adverse effects of the intervention. Given only three randomised studies were included in the review, there is limited evidence, of very low-to-moderate-certainty, that interventions may be effective in preventing or ceasing adolescent e-cigarette use. As findings of the 30 ongoing studies are published, certainty of evidence of effects may improve. Until then, the findings of this review should be considered together with evidence from studies employing other trial designs not eligible for inclusion in this review to guide actions to prevent or cease e-cigarette use. This is a living systematic review. We search for new evidence every month and update the review when we identify relevant new evidence. This review was supported by the NHMRC Centre for Research Excellence (No. APP1153479) - 'the National Centre of Implementation Science'. NHMRC also provides support for the editorial and author support function of Cochrane Public Health. This review is registered in the Cochrane Database of Systematic Reviews. The protocol (https://doi.org/10.1002/14651858.CD015511) and previous version of the review (https://doi.org/10.1002/14651858.CD015511.pub2) are published in the Cochrane Library.

To examine the use of real-world evidence (RWE) in health technology assessment (HTA) for postlisting reimbursement decisions across 4 Asian healthcare systems-China, Japan, South Korea, and Taiwan-between 2015 and 2024. We conducted a policy analysis and narrative literature review of HTA submissions, agency guidance documents, and published case examples from 2015 to 2024. Evidence on RWE use by country/region and therapeutic area was extracted from peer-reviewed literature, HTA reports, and official policy sources. Postlaunch evidence-generation mechanisms were summarized and qualitatively compared with practices in Europe (National Institute for Health and Care Excellence, Haute Autorité de Santé) and the United States (Centers for Medicare and Medicaid Services/Medicare). Use of RWE in Asian HTA increased steadily over the study period. In China, RWE is frequently used to inform epidemiology and economic parameters in National Reimbursement Drug List submissions. Japan applies RWE mainly for postlaunch price reassessment, particularly for oncology and orphan drugs. South Korea incorporates RWE into risk-sharing agreements and reassessment processes. Taiwan's Conditional Reimbursement Listing provides temporary coverage linked to real-world outcome generation. RWE use is most prominent in oncology and rare diseases. RWE is increasingly used to address postlisting uncertainty in Asian HTA. Structured, indication-specific RWE requirements following reimbursement are likely to expand, aligning Asian HTA systems more closely with international practice.

Young adults in South Korea experience high stress from academic and economic pressures, but help-seeking and service use remain low. Mobile-based interventions have emerged as promising strategies to improve access to mental health support; however, empirical evidence for non-clinical young adult populations remains limited. The objective of this study was to evaluate the effectiveness of DodaMe, a mobile-based self-management program integrating positive psychology and behavioral activation, in improving mental health outcomes among community-dwelling young adults with elevated stress. This randomized controlled trial with a wait-list control group evaluated DodaMe, a 4-week mobile self-management program integrating Positive Psychology and Behavioral Activation, followed by a 4-week self-directed phase. Participants were recruited nationwide in South Korea from community-based youth and mental health service settings. A total of 179 young adults (aged 19-34) with elevated stress were randomized to the intervention (n = 92) or wait-list control group (n = 87). Stress (primary outcome) and depression, anxiety, and resilience (secondary outcomes) were assessed at baseline, 2, 4, and 8 weeks, and analyzed using generalized estimating equations. Week 8 program quality and app usage data were analyzed to assess acceptability and engagement. The intervention showed a small, non-significant reduction in stress compared with the wait-list control group [B = -0.21, 95% CI (-0.41, 0.00)]. Resilience improved significantly, although the effect was small [B = 0.23, 95% CI (0.09, 0.37)]. No significant effects were found for depression or anxiety, with small effect sizes at 8 weeks. Participants evaluated the program positively, particularly its functionality and usefulness, while engagement data revealed frequent use of emotional check-ins and gratitude journaling. DodaMe did not significantly reduce stress but showed a small significant improvement in resilience among Korean young adults. The intervention may be a usable and potentially scalable approach for supporting mental health in community-dwelling young adults, but further refinement and adequately powered trials are needed to evaluate its effectiveness. ClinicalTrials.gov (NCT07174544).

Preoperative anaemia is a common finding in patients with colorectal cancer (CRC) and is significantly associated with morbidity and mortality. Patient Blood Management Programs (PBM), have been developed to improve patient outcomes. This study aimed to evaluate the effectiveness of the Outpatient Blood Management Program (OBMP) in a tertiary hospital in Spain. The primary endpoint was to determine the percentage of patients who recover from anaemia after treatment at the OBMP. Additionally, correlations between preoperative anaemia, administered treatments, and surgical waiting times were analyzed. A retrospective observational study was conducted including 537 patients who underwent surgical intervention for CRC. Demographic data, haemoglobin values at three time points (inclusion on the surgical waiting list, preoperative, and postoperative), as well as the time intervals between inclusion on the waiting list and the performance of surgery, were collected. The prevalence of anaemia was 43.3% at the time of inclusion on the surgical waiting list. Of the total anaemic patients, 42% received specific treatment. Treatment at the OBMP was associated with a higher recovery rate (37%) and a more significant increase in haemoglobin (1,35 g/dl IC95% (0,7-2,1) vs 0,4 IC95% (0-1,6) g/dl )). Preoperative anaemia was associated with longer surgical waiting times, higher incidence of transfusions, higher prevalence of postoperative anaemia, and prolonged hospital stays. The OBMP offers an opportunity to improve the management of anemia in patients undergoing surgery for colorectal cancer (CRC); however, it requires interdisciplinary coordination to minimize its impact on surgical waiting times.

Among young adults (20-39), cancer is the fifth leading cause of death. Delayed diagnoses in this population are frequent, contributing to reduced survival and higher morbidity. Delays may be driven by individuals attributing symptoms as nonserious and failing to seek timely medical care. Google search is commonly used for health information seeking, but we do not know the current online symptom content quality that young adults may encounter. We aimed to answer 1. What is the content quality of top-ranked webpages for common young adult cancer symptom searches? 2. Does quality differ by website type (e.g., academic/health care vs. for profit)? Using 18 young adult cancer symptoms as input into the SEMRush Keyword Magic Tool, we generated a list of the most common keyword searches and the top-ranked webpages (i.e., first three pages listed in Google output). We evaluated 162 pages on 9 quality metrics, including the JAMA benchmark criteria. Two-thirds of pages (66.7%, n = 108) were written at less than a 9th-grade reading level, and three-quarters (72.8%, n = 118) provided actionable content about when to seek medical care for symptoms. However, only 13.6% (n = 22) of pages included content framed for young adults. On average, pages met about half (2.33) of four JAMA criteria (authorship, disclosures, currency/up-to-date, and references). Academic/health and government organizations should devote resources to improving information about young adult cancer symptoms on their webpages and optimize these pages to appear higher in search result rankings.

Individuals suffering from psychotic disorders have increased comorbidity with chronic organic disorders and reduced life expectancy compared to their healthy peers. Particularly, individuals diagnosed with schizophrenia have a life expectancy 10-20 years shorter than average.1 The main factor contributing to this increased comorbidity and mortality from natural causes is cardiovascular diseases resulting from higher rates of metabolic syndrome (MetS), obesity, diabetes mellitus, sedentary lifestyle, poor diet, and smoking.2 MetS, specifically, is defined by the coexistence of a combination of risk factors such as high blood pressure, high blood glucose levels, excessive fat around the waist, high levels of triglycerides, and low levels of high-density lipoprotein (HDL). These aggravating factors occur more frequently in individuals with psychosis than in control groups from the very onset of symptoms. For example, the prevalence of MetS was found to be 13.2% higher than in the general population in patients who had never taken antipsychotic drugs and presented with first episode psychosis (FEP).3 Similarly, blood pressure, waist circumference, and fasting glucose have been reported to be slightly higher in antipsychotic-naive ultra high risk (UHR) individuals, while lower HDL levels have been demonstrated in FEP adolescents who have never taken medication.4 Moreover, initiating treatment with second-generation antipsychotics is associated with rapid and significant weight gain, depending on the specific drug, within the first three months of treatment.5 This indicates that between 33% and 61% of individuals with FEP experience clinically significant weight gain, defined as an increase of ≥7% of initial body weight within the first 12 weeks of treatment, and certain parameters of MetS progressively deteriorate over the first year of treatment.6,7 The above findings have prompted the implementation of various interventions, both pharmaceutical and non-pharmaceutical, in individuals with FEP, aiming at reducing the burden associated with antipsychotic use, which remains the therapeutic standard despite its side-effect profile. These interventions are extended beyond medication-related adverse effects and target other parameters that increase cardiometabolic risk, such as poor diet, lack of physical activity, tobacco and alcohol use, and inadequate physical care.8 The effectiveness of these interventions varies, but combining them and implementing them in an organized framework with a holistic approach appears to be the optimal choice. In Greece, this type of comprehensive care is delivered through Early Intervention Services (EIP), where the physical health of patients with FEP is prioritized as a core treatment objective. This is achieved through detailed and systematic recording of medical data, monitoring the key parameters in accordance with international guidelines, and collaborating with primary care services. International guidelines suggest best practices for recording and treating MetS, and attempts are now underway to estimate the likelihood of MetS emerging from the early stages of psychosis.9 One example of such best practice guidelines is the "Lester positive cardiometabolic resource" algorithm, which is the version used in the UK by the iphys initiative, summarizing key indicators and target values for young individuals with psychosis.10 Tables of the algorithm list the parameters for lifestyle habits (smoking, diet, activity), obesity (weight, BMI, waist circumference), hypertension, glucose levels, and lipid markers. Baseline measurements for each parameter are categorized into three levels: high risk, medium risk, and a target range to be achieved. In this way and with guidance on recommended monitoring frequency (i.e., blood pressure measured at baseline and every three months thereafter), the tool constitutes a practical resource for assessing physical health problems and planning appropriate interventions. Enhancing the physical health of individuals with FEP requires adopting best practices and providing information and cooperation with primary health care providers within the framework of EIP, as well as with all mental health professionals involved in patient care. Coordinated practice is essential, as physical health outcomes substantially influence both the course of the illness and patients' functional recovery.

Access to affordable medications is an important determinant of treatment adherence and continuity of care. High out-of-pocket expenditure and cost disparities pose barriers and contribute to poor treatment adherence. We aimed to (1) analyze cost variation among different brands of essential psychiatric medications listed in the National List of Essential Medications (NLEM) 2022, and (2) compare market prices with corresponding generic drugs from the Janaushadhi Scheme. A cross-sectional price analysis was conducted using the current index of medical specialties (CIMS) and the Janaushadhi database. There was high variation in market costs, ranging from 20.8% (Carbamazepine liquid) to 1604.4% (Clonazepam 0.5 mg). Median branded costs were higher than generic Janaushadhi prices. The cost ratio (branded price/generic price) was highest for Escitalopram 10 mg tablet (>7). Substantial price variation exists even among essential psychiatric medications, potentially undermining equitable access, particularly for economically disadvantaged groups.

Global development relies on vast and expanding road networks, yet the global distribution of the wildlife mortality they cause remains poorly quantified. Here we show, using researcher-led surveys, global citizen-science records and a high-resolution national dataset for China, that wildlife-vehicle collisions disproportionately burden biodiversity in low- and middle-income countries. After standardising for species pools and sampling effort, low- and middle-income countries bear a heavier roadkill burden than high-income countries, with the strongest disparities reaching 2-4-fold for threatened vertebrates but much weaker contrasts for non-threatened species. This reflects elevated collision rates among threatened fauna rather than a broader list of affected species. In China, the same pattern unfolds along a land-use intensity gradient: transformed landscapes elevate risk for common generalists while progressively filtering threatened taxa from the roadscape. Overall, expanding transport networks concentrate contemporary collision burden on threatened biodiversity in low- and middle-income countries.

The Vertebrate Genomes Project (VGP) aims to produce complete and near-error-free reference genomes for all ∼70,000 extant vertebrate species. Organized in four phases, it progressively targets all vertebrate orders, families, genera, and eventually all species. Here we present the completion of VGP Phase I, delivering reference genomes for ∼97% of vertebrate orders, along with additional lineages within those orders, totaling 815 species and 1.6 trillion base pairs of main haplotype sequence. These genomes were assembled and annotated over an 8-year period (2018-2026) of rapid advances in genome sequencing, assembly, and annotation methods, alongside the growth of associated consortium initiatives and international collaborations. They represent some of the highest-quality vertebrate genomes currently available, and most have become the primary reference for their respective species in public databases. Comparative analyses across a subset of 579 species when we reached a threshold of 85% of orders allowed us to reconstruct the genome of the last common ancestor of all vertebrates 500 million years ago, identify diverse modes of sex chromosome evolution, reveal clade-specific three-dimensional genome architecture, discover methylated epigenetic landscapes across vertebrates, and provide a framework for studying gene and pseudogene evolution, immune loci, cancer-associated genes, and other trait-associated loci. Approximately a quarter of this subset are listed as Vulnerable to Critically Endangered by the IUCN Red List of Threatened Species, and have enabled more advanced genomic investigations of extinction risk. VGP Phase I delivers the reference backbone for vertebrate genomics, enabling discoveries that would otherwise remain out of reach across evolution, conservation, and medicine.

A wide range of methods for speech audiometry to evaluate the outcome after cochlear implant (CI) fitting exist in German-speaking countries. Various procedures are used to determine the speech recognition threshold in noise (SRT). As an adaptive test with a simple lexical structure, the digits-in-noise (DiN) test offers an alternative to list-based speech tests or matrix tests. The aim of this study was to evaluate the clinical relevance of DiN in postoperative follow-up, particularly in comparison to the Freiburg speech test (FBS) and the Oldenburg sentence test (OlSa), as well as for supporting individualized CI settings. In a prospective study, 73 adult CI users were examined. Speech comprehension was assessed monaurally in a free field using the FBS, OlSa, and DiN. The participants were divided into three groups based on their hearing loss for numbers (HVZ). The OlSa in noise was only performed if speech comprehension was sufficient. The evaluation was carried out using descriptive statistics, the Kruskal-Wallis test, and Bland-Altman analysis. The test-retest reliability of the DiN was high and independent of the time of measurement. The SRTs differed significantly between groups, with better audibility showing lower thresholds. Speech tests in quiet and noise confirmed these differences. The DiN could be performed in all participants. The DiN can be used in all phases of audiological CI follow-up care and enables early differentiation and progress monitoring, provides information on audibility, complements the FBS, and may be used in future studies on optimal fitting of CI systems. HINTERGRUND: Im deutschsprachigen Raum steht zur sprachaudiometrischen Kontrolle nach Cochlea-Implantat(CI)-Versorgung ein breites Methodenspektrum zur Verfügung. Zur Ermittlung der Sprachverständlichkeitsschwelle im Rauschen (SRT) kommen verschiedene Verfahren zum Einsatz. Der Digits-in-Noise-Test (DiN) bietet als adaptiver Test mit einfacher lexikalischer Struktur eine Alternative zu listenbasierten Sprachtests oder Matrixtests. Ziel der Arbeit ist die Bewertung der klinischen Relevanz des DiN in der postoperativen Verlaufskontrolle, insbesondere im Vergleich zum Freiburger Sprachtest (FBS) und Oldenburger Satztest (OlSa) sowie zur Unterstützung individualisierter CI-Einstellungen. In einer prospektiven Studie wurden 73 erwachsene CI-Tragende untersucht. Das Sprachverstehen wurde monaural im Freifeld mit dem FBS, OlSa und DiN erhoben. Die Teilnehmenden wurden anhand des Hörverlusts für Zahlen (HVZ) in drei Gruppen eingeteilt. Der OlSa im Störgeräusch wurde nur bei ausreichendem Sprachverständnis durchgeführt. Die Auswertung erfolgte mit deskriptiver Statistik, Kruskal-Wallis-Test und Bland-Altman-Analyse. Die Test-Retest-Reliabilität des DiN war hoch und unabhängig vom Messzeitpunkt. Die SRT unterschieden sich signifikant zwischen den Gruppen. Bessere Hörbarkeit resultierte in niedrigeren (besseren) SRT und höherem Score für die durchgeführten Sprachtests in Ruhe. Der DiN konnte bei allen Teilnehmenden durchgeführt werden. Der DiN ist in allen Phasen der audiologischen CI-Nachsorge anwendbar, ermöglicht eine frühe Differenzierung und Verlaufskontrolle, liefert Hinweise auf Hörbarkeit, ergänzt den FBS und kann in zukünftigen Studien zur optimalen Einstellung der CI-Systeme verwendet werden.

Olfactory dysfunction has emerged as a potential early marker of neurodegenerative diseases. Despite growing interest, population-based evidence on its association with cognitive domains remains limited, particularly in low- and middle-income countries. This study examined the association between olfactory impairment and multidomain cognitive performance in older Indonesian adults. We conducted a cross-sectional study among 205 community-dwelling adults aged&#x2009;&#x2265;&#x2009;60 years in West Jakarta. The cognitive assessments included the Indonesian version of the Montreal Cognitive Assessment (MoCA-Ina), verbal fluency, a modified Boston Naming Test (BNT), constructional praxis, word list recall, delayed memory, and word list recognition. Multivariable logistic and linear regression analyses were used to examine associations between olfactory function and cognitive performance, adjusting for demographic factors and chronic illnesses. Probable dementia as assessed by the MoCA-Ina was significantly associated with increased odds of olfactory impairment (OR [95% CI]&#x2009;=&#x2009;4.29 [1.87-9.85]), as were verbal fluency impairment (2.25 [1.15-4.39]) and the BNT (2.21 [1.12-4.38]). In linear regression models with continuous olfactory scores, cognitive impairment as assessed by the MoCA-Ina, verbal fluency, and the BNT was associated with lower olfactory scores, indicating poorer olfactory function (MoCA-Ina: &#x3b2;= -1.51, p&#x2009;<&#x2009;0.001; verbal fluency: &#x3b2;= -0.87, p&#x2009;=&#x2009;0.001; BNT: &#x3b2;= -1.00, p&#x2009;<&#x2009;0.001). Olfactory impairment is independently associated with both global cognitive function and specific deficits in verbal fluency and naming. These tasks primarily reflect language processing but may also involve executive control. These findings suggest that olfactory assessment may be useful in community-based cognitive screening, especially in resource-limited settings.

The equine veterinary profession is frequently considered inaccessible to veterinary students who have had limited exposure to the equine industry. One of the perceived reasons for this inaccessibility is the use of what is often coined "horsey" language within the industry. If a student has limited experience of the equine industry, there is a potential language barrier to teaching, which may result in poor engagement with equine teaching and placements. The aim of this Teaching Tip is to describe the development and evaluation of a new teaching resource designed to demystify equine industry-specific language. An online anonymous survey based on the Twenty Statements Test was shared via social media and used to generate a list of terms that equine veterinary surgeons, horse owners, and paraprofessionals believed essential for a new graduate veterinary surgeon to understand in the equine industry. The list of terms and their definitions was then developed into an e-book glossary resource that students could download and access offline, ensuring they could access it during placement in remote locations. The eGlossary was presented to fourth-year veterinary students at the University of Surrey. Students were surveyed on their perceptions of the resource in terms of usefulness and whether it improved their confidence in using and understanding equine industry-specific language. This Teaching Tip provides evidence that language can be a barrier to learning and that with the development of an easily navigable eGlossary resource, this barrier can be mitigated. By increasing student engagement and enabling students to feel less like outsiders during clinical placements, this teaching resource could have a direct effect on the proportion of graduates considering a career in equine practice, thereby helping address the current recruitment and retention crisis within the field of equine veterinary medicine.

Hernias are a frequent cause of acute surgical admission, yet optimal management remains uncertain. Watchful waiting (WW) and waiting-list delays may increase symptom recurrence and surgical crossover, creating uncertainty about when timely elective repair is indicated. This study evaluates acute hernia presentations and how different management pathways may influence outcomes. A retrospective cohort study was conducted on 105 patients presenting with symptomatic hernias to the University Hospitals of Leicester from period of September 2024 to January 2025 with patient follow-up in September 2025. Outcomes analysed included length of hospital stay, complications, surgical crossover rates, and re-presentations. A total of 105 patients met the inclusion criteria. 51(49%) patients were conservatively managed with WW, and 43(41%) listed for elective repair, and 11(10%) underwent emergency surgery at presentation. WW patients had higher re-presentation rates (35.3 vs. 14%, p&#x2009;=&#x2009;0.0172) and surgical crossover rates (33.3 vs. 2.3%, p&#x2009;<&#x2009;0.001) relative to those awaiting elective surgery. In the WW cohort, crossover occurred in 50% of inguinal hernias (9.1% to emergency; 40.9% to elective) and approximately 20.7% of ventral hernias (10.3% to emergency; 10.3% to elective). Emergency hernia repair was associated with increased length of stay compared to elective repair for both ventral (median 4 vs. 0.5 days, p&#x2009;=&#x2009;0.0079) and inguinal hernias (median 1.5 vs. 0 days, p&#x2009;<&#x2009;0.001). Observed surgical crossover and re-presentation among patients managed with watchful waiting may indicate the importance of identifying patients who are less suitable for prolonged non-operative management. Structured follow-up and reassessment may improve watchful waiting pathways and support shared decision-making regarding the appropriateness of surgical repair. Further studies are needed to validate these findings.

A thematic review that identifies and summarises available evidence for people with Type 1 diabetes (T1D) continuing automated insulin delivery (AID) systems in the hospital setting, primarily with a focus on assessing the in-hospital safety and efficacy of AID use. A thematic review was conducted searching Embase, MEDLINE and EBSCO for English language publications from 2014 to 2025 using keywords including AID system brands and terms related to insulin pumps and to inpatients. Eligible studies included original research, retrospective observational studies and case reports and series. Of 1043 articles identified, 1037 did not meet the inclusion criteria. Six articles were reviewed in detail, and a further two papers were identified by screening the reference list of the six papers. There is a paucity of evidence, with heterogeneous methodology regarding the safety and efficacy of continuing AID in hospitalised people with T1D. Results support the feasibility of continuing AID use from the ambulatory to the inpatient setting in hospitalised people with T1D. There is a trend towards improved time in recommended glucose ranges or mean glucose levels without increased hypoglycaemia. There were no adverse glucose outcomes or diabetic ketoacidosis reported. Whilst continuing AID in the inpatient setting appears promising, our review identified significant heterogeneity in patient populations, device types, as well as limited data on healthcare professional perspectives and person-reported outcomes. Further studies and guidelines are merited. Until then, inpatient use of AID should be guided by specialist diabetes healthcare teams with expertise in diabetes technology.

To explore potential neuroimaging features derived from [18F]FDG PET/MRI imaging that may help characterize differences between adolescent with bipolar disorder (BD) and those with major depressive disorder (MDD). Patients were grouped based on the Hamilton Depression Scale (HAMD) and Hypomania Check List (HCL), and the severity of suicidal ideation and behavior was assessed. 14 BD and 14 MDD adolescent patients were enrolled. Simultaneous PET and MRI data (including 3D T1-weighted imaging, Diffusion Tensor Imaging (DTI), and resting-state functional MRI (fMRI)) were acquired. Functional connectivity (FC) and structural connectivity (SC) were derived from fMRI and DTI respectively. A multiple linear regression model was employed to predict FC from SC. SC-FC coupling was defined as Pearson correlation coefficient between predicted FC and original FC. Using cerebellar gray matter uptake as reference region, standardized uptake value ratio (SUVr) of each brain region was calculated as metabolic parameter. Compared with the MDD group, the BD group showed significantly decreased SC-FC coupling and glucose metabolism in the thalamus. &#x200c;In the BD group, SC-FC coupling in the paracentral lobule showed a significant positive correlation with metabolism (r&#x2009;=&#x2009;0.70). In the MDD group, SC-FC coupling in cingulate gyrus showed a significant negative correlation with metabolism (r=-0.73). &#x200c;In the BD group, SC-FC coupling in superior parietal lobule, postcentral gyrus, and precentral gyrus correlated significantly with HAMD, HCL, and suicide scores, respectively. In the MDD group, SC-FC coupling in precentral gyrus, orbital gyrus, and hippocampus showed the highest correlations with these clinical indicators. The middle temporal gyrus and parahippocampal gyrus were specifically associated with suicide scores in the BD group. &#x200c;Notable intergroup differences between BD and MDD were thalamus (AUC&#x2009;=&#x2009;0.86) and inferior temporal gyrus (AUC&#x2009;=&#x2009;0.76), with SC-FC coupling features in these regions showing more prominent differences than metabolic features. This study identifies the thalamus as a key region in adolescent BD. Differences in SC-FC coupling in thalamus and inferior temporal gyrus reflect notable exploratory features between adolescent BD and MDD patients, suggesting that SC-FC coupling parameters may represent potential neuroimaging signatures for differential diagnosis. The differences in correlations among SC-FC coupling, metabolism, and clinical parameters between the groups indicate distinct pathogenic mechanisms for BD and MDD.

Evidence suggests that criteria based clinical audit is improving the quality of emergency obstetric care services. Therefore, this criteria based clinical audit was conducted to assess the emergency obstetric standard of care and their feto-maternal outcomes in public hospitals of West Shoa Zone, Central Ethiopia. An institutional based retrospective cross-sectional study design was conducted using criteria-based clinical audit from September 01 to December 30, 2023. The medical records of women admitted with selected obstetric emergencies were selected through systematic sampling technique from maternity logbook registor and reviewed using stardarized check list. The data were collected through a kobo tool and exported to SPSS software version 27 for analysis. First, descriptive statistics were conducted. Additionally, a chi-square test was applied to test the differences in feto-maternal outcomes by study variables. A total of 438 medical records of women admitted with selected obstetric emergencies were reviewed. The quality of care that the mother received was 83.2% for severe preclapsia/eclampsia, 82% for antepartum hemorrhage, 82.8% for obstructed labor and 78.4% for post partum hemorrhage as per the standards. Related to feto-maternal adverse outcomes, the maternal mortality rate was 684.9/100,000LB and the perinatal mortality rate was 114.2/1000LB. Variables; such as type of hospital, type of obstetric emergencies, history of ANC service follow up and women hospital stay were significantly associated with both severe maternal outcomes and perinatal mortality in the chi-square analysis. Additionally, rural residences, severe maternal outcomes, referral from another facility and coming from more than 10 KM were also significantly associated with the perinatal mortality. The standards of emergency obstetric care provided were acceptable but not optimal to fully meet the established clinical standards. Additionally, significant proportions of study participants were incountered adverse feto-maternal outcomes. Thus, this criteria-based clinical audit of obstetric emergency treatment is an excellent and applicable tool to evaluate health facilities clinical services and feto-maternal outcomes in poor resource settings. Therefore, authors urge all healthcare facilities to apply regular criteria based clinical audit to improve quality of emergency obstetric care and its documentation.

To clarify how Ikigai and closely related meaning constructs are described in literature relevant to older people in Korea and to propose a provisional, context-informed conceptual framework for gerontological nursing. Ikigai, often glossed as "a life worth living," has been associated with well-being in later life, yet its meaning and operationalisation vary across settings. Greater conceptual clarity is needed to support culturally responsive nursing assessment and care planning. Rodgers' evolutionary method of concept analysis (Rodgers, 2000) was used to examine contemporary scholarly use of Ikigai and related concepts in 13 peer-reviewed studies (published 2002-2024; searched January 2000-June 2025), of which 10 were conducted outside Korea and three in Korea. Data were analysed to identify defining attributes, antecedent contexts, consequences and related concepts. Six defining attributes were identified: psychological equanimity, purposefulness in life, self-worth and personal value, social connectedness, cultural belonging, and reflective wisdom and self-integration. Four antecedent contexts were identified: family and intergenerational change, cultural and value transformation, health and functional challenges, and existential and social disconnection. Four consequence domains were identified: emotional stability and psychological balance, active health orientation and functional preservation, life fulfilment and satisfaction, and community integration and social engagement. In literature relevant to older people in Korea, Ikigai was not presented simply as a list of valued sources, but was provisionally interpreted as a process through which relational sources such as family roles, intergenerational continuity and everyday responsibilities may be internalised as an enduring sense of life's worth. Ikigai may be understood as a dynamic and context-dependent meaning process in later life that includes both valued sources of worth and a sense of life's worth. This review offers a provisional conceptual framework for gerontological nursing and supports further qualitative and measurement research in Korea. This framework can support gerontological nurses in assessing meaning, dignity, purpose and relational continuity alongside physical and functional indicators. Nurses may use open-ended questions and observable indicators to identify valued roles, relationships and routines that sustain older people's sense that life is worth living. Meaning-centred and culturally responsive care planning may help support participation, autonomy and continuity during later-life transitions.