搜索结果：Medical education

The global prevalence of heart failure continues to increase, particularly in ageing populations. Many older patients receiving home-based medical care have limited access to standard diagnostic tools, such as chest radiography and echocardiography, which can delay the detection of disease progression. AMI-SSS01, an artificial intelligence (AI)-based portable phonocardiography device, enables rapid and reproducible analysis of heart sounds, potentially allowing earlier identification of heart failure exacerbations in home-based medical settings. This trial aims to evaluate the feasibility and safety of implementing the AMI-SSS01 phonocardiography system in patients receiving home-based medical care. This two-arm, parallel-group, randomised controlled feasibility trial is being conducted at two primary care clinics affiliated with the Research Organisation for Education and Network in Primary Care-Based Research Network in Nagasaki, Japan. Participants aged ≥65 years with symptomatic heart failure receiving home-based medical care are eligible for study inclusion. Participants are randomised in a 1:1 ratio to either the intervention group, in which AI-assisted phonocardiography using the AMI-SSS01 device is performed during physician home visits, or the control group receiving conventional home-based medical care without phonocardiography. Feasibility outcomes include recruitment rate, overall data completeness and completion and protocol-concordant completion rates for phonocardiography examinations. Safety outcomes include adverse events related to device use. The registered primary clinical outcome, collected as an exploratory clinical outcome, is the time from randomisation to hospitalisation for heart failure or cardiovascular death during the 24-week follow-up period. The registered secondary clinical outcome is the number of heart failure exacerbation events. Ethical approval was obtained from the Nagasaki University Hospital Clinical Research Ethics Committee (CRB24-028). The findings will be disseminated through peer-reviewed publications and scientific conferences. Japan Registry of Clinical Trials (jRCT1072240118).

Objectives. Gas station workers in low and middle-income countries face multiple occupational health and safety (OHS) hazards, yet the effectiveness of structured safety interventions remains underexplored. This study aimed to evaluate the impact of a structured OHS educational program on knowledge, attitudes and practices among gas station workers. Methods. A pre-post design was conducted with 120 workers. Validated tools were used to assess knowledge, attitude and practice (KAP) before and 4 weeks after a three-session training program. Results. Significant improvements were observed in all KAP domains (p&#x2009;<&#x2009;0.001). Mean knowledge scores increased from 15.4&#x2009;&#xb1;&#x2009;4.2 to 31.8&#x2009;&#xb1;&#x2009;3.6, attitude scores from 8.2&#x2009;&#xb1;&#x2009;2.1 to 13.5&#x2009;&#xb1;&#x2009;1.4 and practice scores from 4.1&#x2009;&#xb1;&#x2009;1.8 to 8.6&#x2009;&#xb1;&#x2009;1.2. Post intervention, 79.2% of workers demonstrated good knowledge, 81.7% showed positive attitudes and 78.3% exhibited satisfactory practices. Post-intervention attitude was strongly correlated with practice (r&#x2009;=&#x2009;0.615, p&#x2009;<&#x2009;0.01). Education level and pre-intervention knowledge were significant predictors of post-intervention practice scores (R2&#x2009;=&#x2009;0.45, p&#x2009;<&#x2009;0.001). Conclusion. The structured OHS educational program significantly enhanced workers' knowledge, attitudes and practices. Tailored training strategies targeting workers with lower educational levels are recommended.

Gastrointestinal (GI) cancer care requires coordination across specialties and is sensitive to non-medical barriers like insurance, transportation, and health literacy. Prior survey work at our institution identified these barriers as most prominent during initial treatment planning and as consuming substantial provider time. This qualitative study represents the second phase of a larger effort to inform the development of a transdisciplinary care model designed to address non-medical determinants of care. We conducted semi-structured interviews with purposively sampled multidisciplinary providers involved in GI cancer care at a large academic health system in the USA. Interviews explored patient- and system-level barriers and opportunities to improve care coordination. Transcripts underwent inductive thematic analysis with double coding. Pearson correlation coefficients assessed covariation among themes and informed the construction of a directed acyclic graph illustrating hypothesized causal relationships among barrier domains. We interviewed 30 providers, including physicians (n&#x2009;=&#x2009;7), advanced practice providers (n&#x2009;=&#x2009;2), nurses (n&#x2009;=&#x2009;5), dietitians (n&#x2009;=&#x2009;7), social workers (n&#x2009;=&#x2009;6), and a care coordinator (n&#x2009;=&#x2009;1). Seven interconnected themes emerged: health system, financial, access and logistics, provider capacity, patient knowledge and engagement, social and emotional, and communication and coordination. Structural and financial barriers operated as upstream drivers influencing workflow and access, while logistical and social barriers translated these pressures into downstream inefficiencies and provider strain. Providers consistently supported a transdisciplinary care model to centralize navigation and support. Non-medical barriers in GI cancer care undermine patient care, provider capacity, and health system efficiency. These findings provide an actionable framework for developing equitable, efficient, and sustainable cancer care models.

Language barriers in surgical care are linked to reduced patient satisfaction and care quality. Preoperative education improves patient understanding and postoperative outcomes, but its impact on disparities among non-English-speaking patients remains unclear. In January 2023, our institution implemented a Spanish-speaking nurse educator to provide language-concordant preoperative education to patients undergoing hip and knee arthroplasty. This study evaluated whether this intervention affected readmission rates compared to English-speaking patients. This retrospective, single-center cohort study included 1,381 total knee arthroplasty (TKA) surgeries between January 2022 and January 2024, including 221 among Spanish-speaking patients. Demographic data and 30- and 90-day emergency department and inpatient readmissions were obtained from the electronic medical record. Patients were categorized by self-reported primary language. Difference-in-differences (DiD) analyses assessed changes in readmission rates among Spanish-speaking patients after the nurse educator's implementation, compared to English-speaking patients over the same period. Multivariable logistic regressions adjusted for age, sex, body mass index, American Society of Anesthesiologists Physical Status Classification, and primary surgeon. Before the intervention, Spanish-speaking patients had higher odds of 30- and 90-day readmission than English-speaking patients (odds ratio (OR) = 12.6, 95% confidence interval (CI) [2.32 to 99.4], P = 0.006; and OR = 6.25, 95% CI [1.62 to 27.5], P = 0.010, respectively). After the intervention, 30- and 90-day readmissions decreased for Spanish-speaking patients relative to English-speaking patients (DiD OR = 0.11, 95% CI [0.01 to 0.62], P = 0.019; and DiD OR = 0.18, 95% CI [0.04 to 0.74], P = 0.021). Spanish-speaking patients also demonstrated improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain scores at one year (DiD Beta = -40 points, 95% CI [-76 to -5.2], P = 0.025). Implementation of a language-concordant nurse educator was associated with reduced readmissions and improved postoperative pain outcomes for Spanish-speaking patients undergoing TKA.

Asthma and chronic obstructive pulmonary disease (COPD) collectively affect an estimated 475&#x2009;million individuals worldwide, yet only 31% of patients achieve correct inhaler technique, a proportion that has not meaningfully improved over four decades of clinical practice. Critical technique errors are independently associated with poor disease control, increased exacerbation risk and greater healthcare utilisation. Although multiple educational modalities exist, no systematic review has applied network meta-analysis (NMA) to simultaneously compare and rank all six principal training approaches. This protocol describes a systematic review and NMA to generate comparative effectiveness evidence for inhaler technique training modality selection in adults with asthma or COPD. A Bayesian random-effects NMA will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols (PRISMA-P) 2015, PRISMA-NMA and PRISMA 2020, with prospective PROSPERO registration (systematic search: June 2026; completion anticipated: February 2027). Seven databases will be searched from inception to June 2026 without language restriction: PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, CINAHL, CNKI and Wanfang Data, supplemented by clinical trial registry searches. Eligible randomised controlled trials will enrol adults aged 18 years or older with confirmed asthma (Global Initiative for Asthma (GINA) criteria) or COPD (Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria). Six intervention nodes defined a priori using the Template for Intervention Description and Replication (TIDieR) framework will be compared against usual care and each other: face-to-face physical demonstration, video and digital training, teach-to-goal training, pharmacist-led training, nurse or clinician-led training and sensor-assisted technique feedback training. Primary analyses comprise two disease-specific NMAs (asthma: Asthma Control Test; COPD: COPD Assessment Test) with a pooled exploratory NMA as secondary analysis, a prespecified sparsity contingency and Bayesian meta-regression for transitivity (four covariates in disease-specific NMAs: device category, baseline severity, number of training sessions and participant age; disease type is added as a fifth in the pooled NMA). Risk of bias will be assessed using the Cochrane Risk of Bias 2; certainty of evidence will be evaluated using the Confidence in Network Meta-Analysis framework. Formal ethical approval is not required. Findings will be published in a peer-reviewed respiratory or evidence synthesis journal, presented at ERS and ATS annual congresses and communicated to GINA, GOLD and NICE guideline development groups. CRD420261347918.

暂无摘要（点击查看详情）

Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease in which symptoms are driven not simply by ventricular hypertrophy, but by a combination of dynamic left ventricular outflow tract obstruction (LVOTO), impaired diastolic filling and other factors.The therapy for HCM differs fundamentally from routine heart failure management and must be mechanism based. In obstructive HCM, the pharmacologic objective is to blunt hypercontractility, lengthen diastole, preserve loading conditions, and reduce the LVOT gradient. In non-obstructive HCM, management is focused on symptom control, heart-rate moderation, careful volume management, and treatment of arrhythmias and congestion. Non-vasodilating beta-blockers, non- dihydropyridine calcium-channel blockers, and disopyramide have constituted the foundation of medical therapy. The contemporary era has added sarcomere-directed treatment with cardiac myosin inhibitors, particularly mavacamten and aficamten, The present review provides a pragmatic algorithm for publication-level clinical use in contemporary practice.

Passing the American Society for Clinical Pathology Board of Certification (ASCP BOC) exam is a key milestone, and this study examined its association with academic performance at Qatar University. For 228 graduates attempting the ASCP BOC exam, use used &#x3c7;2 tests to assess relationships between (1) performance in ASCP domains and overall exam result (pass/fail) and (2) course grades (C or above vs below C) and ASCP BOC domain performance. The correlation between grade point average (GPA) and ASCP BOC exam score was assessed using the Pearson coefficient. Passing any ASCP BOC domain was statistically significantly associated with passing the overall exam (all P&#x2009;<&#x2009;.001). Students who passed the overall exam demonstrated high pass rates across domains, particularly in chemistry (95.5%), hematology (84.1%), microbiology (86.0%), and blood banking (73.9%). Achieving a grade of C or higher in courses at the university was statistically significantly associated with passing the corresponding ASCP BOC domains in most cases. Graduation GPA was positively correlated with total ASCP BOC score (r&#x2009;=&#x2009;0.652, P&#x2009;<&#x2009;.001). Academic performance at the university level is strongly associated with ASCP BOC certification success, along with other factors that influence student success. Higher graduation GPA and passing grades in core courses are strong predictors of improved ASCP BOC exam outcomes, providing early indicators by which to identify students who may benefit from targeted academic support.

A recent consensus report defined anaphylaxis as a serious allergic reaction that may involve the skin/mucosa, respiratory, cardiovascular, and/or gastrointestinal systems that can progress rapidly and may cause death. Epinephrine treatment is recommended in suspected anaphylaxis cases; however, numerous barriers exist to consistent, widespread epinephrine use, including difficulty identifying anaphylaxis signs and symptoms; challenges recognizing when to use epinephrine; low propensity of prescribing and filling prescriptions; low epinephrine carrying rates; knowledge gaps in epinephrine administration techniques; fears of contacting emergency medical services; use of antihistamines, inhaled bronchodilators, and other medications as first-line agents over epinephrine; and limited epinephrine device availability in community settings (e.g., schools, daycares, and restaurants). To address these challenges, healthcare providers should provide training and educational resources to caregivers on signs and symptoms of anaphylaxis that warrant epinephrine use, how to use epinephrine devices, and the importance of having epinephrine readily available at all times. System-level strategies, including measures to improve access, legislative efforts to stock epinephrine in childcare centers, and scalable digital education approaches, are also needed. Furthermore, healthcare providers should implement shared decision-making with caregivers to prepare and empower caregivers to make informed decisions when managing anaphylactic events. Understanding barriers to consistent, widespread epinephrine use when infants and toddlers experience anaphylaxis and providing actionable educational tools to caregivers alongside system-level strategies can improve outcomes in this vulnerable population. Anaphylaxis is a serious, possibly fatal event. The rate of anaphylaxis among young children has been increasing in the USA over the past decade. It is important to educate doctors and caregivers on the signs of anaphylaxis and when to give epinephrine to infants and toddlers during an anaphylactic event. Epinephrine is the standard treatment when someone has a possible anaphylactic event, but people can face challenges when giving epinephrine. These challenges include: correctly identifying the signs of anaphylaxis, knowing when to use epinephrine, low rates of prescribing epinephrine and filling those prescriptions, not carrying epinephrine, not knowing how to administer epinephrine, fears about calling emergency medical services, using other medicines instead of epinephrine, and lack of epinephrine availability in public spaces. To address these challenges, doctors should talk with caregivers and make plans together about how to best prepare for any anaphylactic event their infant or toddler could face. Doctors and caregivers can take steps together such as making an Anaphylaxis Action Plan, training with their epinephrine device, and discussing updated expert guidelines and how to implement them. Understanding the challenges that caregivers face when managing anaphylaxis in infants and toddlers can help improve outcomes in this vulnerable population.

Remediation is not uncommon in graduate medical education; however, the literature on this topic is limited. Existing literature focuses on supporting program directors (PDs) who encounter learners facing difficulty with performance competencies. We previously developed a stepwise framework to support pediatric PDs through the process of remediation based on a national survey. However, this model did not incorporate the perspective of residents who had undergone remediation. The goal of this national, qualitative study was to understand the experiences of residents who had undergone remediation to better inform a model of effective resident remediation. In 2024, we conducted semi-structured interviews with pediatric residents who had undergone remediation. De-identified transcripts were inductively analyzed using grounded theory. Themes were then compared to our theoretical framework of effective remediation from program director's perspectives. Thematic saturation was achieved after eight interviews; eleven total residents were interviewed as part of this study. The five main themes identified by residents focused on the inadequacy of feedback systems, the lack of transparency and personalization during the remediation process, and the impact this process has on a resident's emotional well-being and future career. Through interviewing residents who had undergone remediation, we learned that they prefer transparent and personalized remediation processes that promote psychological safety, and that these qualities are imperative to a successful remediation process. This informed an updated conceptual model for remediation, which proposes actionable steps for the remediation process across graduate medical education.

Aboriginal and Torres Strait Islander children are the future custodians of country, culture and community for the world's oldest living cultures. However, they continue to experience significant disadvantage as a legacy of British colonisation. Failure to address the systemic inequities experienced by Aboriginal and Torres Strait Islander children infringes on their rights to health, education, safety and cultural identity. Despite this, there has been limited focus on recognising and measuring the cultural and personal strengths that support their well-being. This study aims to co-design a culturally grounded, illustrated self-report well-being measure for Aboriginal and Torres Strait Islander children aged 5-11 years, focusing on the aspects of life that nurture their strength and well-being. The project will employ a five-phase mixed methods design, guided by principles of co-design and best practices to develop culturally and developmentally responsive measures with Aboriginal and Torres Strait Islander children. Extending existing methods, we will pioneer a new approach to develop measures enhanced with culturally-responsive pictures co-designed with Aboriginal and Torres Strait Islander communities. Ethics approvals have been obtained from the University of Queensland Human Research Ethics Committee (2023/HE000607), Western Australian Aboriginal Health Ethics Committee (WAHREC1260), Far North Queensland Human Research Ethics Committee (2023/QCH/99346), Aboriginal Health and Medical Research Council of New South Wales (2140/23), Aboriginal Health Council of South Australia (04-23-1063), Menzies School of Health Research and Northern Territory Department of Health Human Research Ethics Committee (HREC 2023-4608) and the Australian National University Human Research Ethics Committee (H/2024/0914), as well as relevant Departments of Education. The final WM2K (What Matters 2 Kids) results will be published in peer-reviewed journals, presented at conferences and disseminated to partner organisations and the broader sector via strategic networks with Aboriginal and Torres Strait Islander organisations, government bodies and non-government agencies. Children will receive study communications via partner organisations in age-appropriate formats.

Use of in-home video telehealth rapidly expanded in response to the COVID-19 pandemic, including at Veterans Affairs (VA), a forerunner in telehealth. Despite this uptick, differences in use by patient age and rurality created a digital divide that persists to this day. While clinicians frequently cite patients' older age and lack of technical skills as barriers to in-home video telehealth, it remains unclear how clinicians decide whether to offer video visits to patients and to what extent these beliefs may hinder offering video visits to older adults. Gathering perspectives from clinician users of in-home video telehealth may illuminate opportunities to ensure continued access to care through solutions such as telehealth. This study aimed to examine clinician decision-making around the offer of in-home video telehealth to understand how interprofessional clinicians determine to whom they offer in-home video telehealth and what factors (organizational, personal, or attitudinal) influence their decision. We conducted a qualitative study by using semistructured interviews. Participants were interprofessional clinicians (N=16) employed by 11 different VA hospitals and included 1 clinical pharmacist, 6 medical doctors, 2 nurse practitioners, 1 occupational therapist, 3 psychologists, 1 physical therapist, 1 speech-language pathologist, and 1 social worker. All the participants had at least some experience using in-home video telehealth from locations across VA (the largest integrated health care system in the United States) and were interviewed over a 6-month period. Interviews focused on clinicians' use of video telehealth and the decision-making process involved in offering in-home video telehealth. We used directed content analysis with a rapid analytic approach, given the time-pressured nature of our project. This study revealed that clinician decision-making around offering in-home video visits is complex and influenced by several domains, namely, (1) clinician factors, including experience with video and perceived benefits of video; (2) appointment factors, including the visit's clinical goal; (3) clinician-reported patient factors, including age and willingness to try video; (4) patient social context, including caregiver availability; (5) geographical factors, such as availability of reliable high-speed internet and patient distance from the medical center; and (6) health system factors, including technical support and clinician ability to work from home. Access to in-home video telehealth may be facilitated by clinician familiarity and confidence with telehealth technology, strategies to improve patients' technical skills, and support for caregivers. Infrastructure also plays an important role, including device availability, broadband reliability, and clear protocols for matching services to video visits. Findings highlight the importance of clinician competency in telehealth, patient and caregiver digital readiness, and a supportive technology infrastructure to equitable in-home video care. In addition, improved guidance for specific clinical services and awareness of potential biases may enable consistent, accessible telehealth delivery for older adults and medically complex populations.

Short-form video platforms are increasingly used to obtain information about chronic obstructive pulmonary disease (COPD), but the quality and reliability of COPD-related content across Chinese platforms remain unclear. We evaluated 228 COPD-related videos from Douyin, Kwai, and Bilibili using the Journal of the American Medical Association (JAMA) benchmark criteria, Global Quality Scale, modified DISCERN (mDISCERN), and Patient Education Materials Assessment Tool. Video characteristics, creator identity, verification status, content theme, presentation format, and visible engagement metrics were also analyzed. Video quality differed significantly across platforms. Douyin showed the highest transparency, reliability, and overall quality scores. Kwai showed the highest visible engagement but had lower overall quality and actionability scores. Bilibili had the longest videos and the highest understandability scores. Organization verified accounts generally achieved higher quality scores than individual verified or unverified accounts, although this finding should be interpreted cautiously because of the small number of such accounts. Visible engagement metrics, including likes, comments, saves, and shares, were not significantly correlated with medical quality scores. Together, these findings suggest that visible popularity is a poor proxy for medical quality. COPD-related digital health communication may benefit from more accessible evidence-based content, clearer source identification, and closer oversight of high-risk therapeutic claims.

Professional voice users, particularly singers, are at increased risk of developing voice disorders due to intensive vocal demands. Structural and inflammatory laryngeal pathologies may impair vocal performance and quality of life. However, data on vocal health among singers in the country of Georgia remain limited. This study aimed to examine the clinical characteristics, symptoms, and potential risk factors associated with voice disorders among singers. A clinic-based cross-sectional study was conducted among 47 singers presenting with voice complaints at a specialized medical facility in the country of Georgia. Data were collected using a structured questionnaire covering demographic characteristics, vocal habits, lifestyle factors, and medical conditions. All participants underwent laryngeal examination, including videostroboscopy, to establish clinical diagnoses. Descriptive statistics were used to summarize participant characteristics and clinical findings, and cross-tabulation analyses were performed to explore associations between vocal load and diagnosis groups. The mean age of participants was 33.2 &#xb1; 10.0 years, and 68.1% were female. Most singers (76.6%) reported professional singing activity and high vocal load exceeding 20&#xa0;hours per week. The most frequently reported symptoms were variable voice quality (40.4%) and hoarseness (38.3%), while 40.4% also reported difficulties with conversational voice. Clinical examination revealed that acute laryngitis (40.4%) and vocal fold nodules (36.2%) were the most common diagnoses. Gastroesophageal reflux symptoms and other gastrointestinal conditions were reported by approximately one-third of participants, and upper respiratory conditions such as rhinitis and pharyngitis were also observed. Although singers with vocal fold lesions tended to report higher vocal load, no statistically significant association was found between the diagnosis group and reflux symptoms. Voice disorders are common among singers and are primarily associated with intensive vocal use and inflammatory or structural laryngeal conditions. Preventive strategies, including vocal hygiene education, appropriate vocal rest, and regular clinical evaluation, are essential for maintaining vocal health among professional voice users.

Adolescence is a critical period for the development of dietary patterns that significantly impact long-term health. This study explores the perspectives of adolescent girls, their parents, and educational staff regarding the factors shaping dietary behaviors in female school students. A qualitative content analysis was conducted between February and August 2024 in various regions of Khuzestan, Iran. Data were collected through semistructured interviews guided by social cognitive theory (SCT) and analyzed via a directed content analysis approach. The study took place in school and home environments in Khuzestan, Iran. Twenty-eight participants, including 17 female school students (aged 13-17 years), 8 parents, and 3 health educational stakeholders, were interviewed for 28-55&#xa0;min (average: 40&#xa0;min). The analysis identified 208 thematic codes categorized into six main categories and 15 subcategories. The key categories include (1) self-efficacy, which addresses challenges in nutrition management during stress and positive eating habits; (2) outcome expectations, which highlight the role of physical consequences and social approval/disapproval in food choices; (3) environmental factors, which reflect the influence of physical and social contexts; (4) self-regulation, which emphasizes goal-setting and self-monitoring; (5) knowledge, which reveals gaps in general and specialized nutritional understanding; and (6) attitudes, which highlight various perceptions of local foods. The dietary behaviors of female school students are shaped by a dynamic interplay of individual, social, and environmental factors. Promoting healthy eating requires a multifaceted approach, incorporating education, environmental adjustments, and social support to create sustainable changes.

Understanding whether socioeconomic and ethnic backgrounds influence help-seeking and communication with emergency medical services (EMS) is essential to mitigate disparities. We explored how public housing residents seek help and communicate with EMS, focusing on barriers and enablers to out-of-hospital cardiac arrest (OHCA) recognition and swift EMS responses. Explorative qualitative analysis of audio recordings of emergency service calls regarding non-EMS witnessed OHCAs. Audio recordings were screened and selected to ensure call variety-then transcribed and analysed using thematic analysis inspired by the concepts of social wrongs and social orders. We also analysed the dispatch protocol, a tool for managing emergency service calls. Four public housing areas with >50% ethnic minority residents in Copenhagen, Denmark. Non-EMS witnessed OHCAs from 2017 to 2022. We included 17 calls regarding 13 OHCAs and defined two themes. The effective call aligned with the dispatch protocol, leading to swift OHCA recognition and dispatcher-assisted cardiopulmonary resuscitation (CPR). In contrast, the challenging call, which did not match the framework of the dispatch protocol, entailed one or more of the following characteristics, leading to delayed or missed OHCA recognition: (1) multiple people involved (multiple callers, third-party caller or bystanders communicating with caller), (2) language barriers, (3) emotionally unstable callers and (4) lack of emergency medical competencies. Across themes, witnesses contacted someone in their network instead of calling emergency services immediately. This was a barrier to OHCA recognition in the challenging calls, which some dispatchers managed using calm intonation and simple inquiries. We identified two themes concerning communication in emergency service calls from public housing areas: the effective call and the challenging call, resulting in swift or delayed/missed OHCA recognition, respectively. The dispatch protocol enabled swift recognition in the effective calls but was a barrier in the challenging calls. Across themes, witnesses used network-based help-seeking before calling emergency services, delaying EMS responses and dispatcher-assisted CPR.

The global transition from non-alcoholic fatty liver disease (NAFLD) to steatotic liver disease (SLD), encompassing metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated steatohepatitis (MASH), and metabolic dysfunction-associated alcohol-related liver disease (Met-ALD), aims to improve pathophysiologic accuracy and reduce stigma. Asia-Pacific countries have been early adopters of metabolic dysfunction-associated fatty liver disease (MAFLD), which has demonstrated strong prognostic performance and operational simplicity. How MASLD implementation aligns with existing MAFLD-oriented clinical practice in the region remains unclear. A 27-item cross-sectional survey was distributed to clinicians across 19 Asia-Pacific regions to assess readiness to adopt SLD terminology. Respondents evaluated willingness across clinical practice, research, patient education, and stigma-reduction domains. Additional items explored metabolic syndrome (MetS) definitions, alcohol-assessment practices, and access to fibrosis testing. Multivariable ordered logistic regression identified predictors of adoption. Among 462 respondents, gastroenterology and hepatology specialists demonstrated greater willingness to adopt MASLD across clinical management (p=0.0194), research (p=0.0208), and patient education (p=0.0157). Alcohol assessment showed operational gaps, with lower effort among non-specialists (&#x2265;1 minute: 35.6% vs 26.5%), potentially complicating Met-ALD classification. Definitions of MetS were heterogeneous, and access to fibrosis assessment differed, with specialists reporting higher use of vibration-controlled transient elastography, magnetic resonance elastography, and corrected T1 imaging (adjusted odds ratio 2.18-2.41). Successful regional implementation of MASLD will require alignment with MAFLD-informed practice, improved exposure to evolving nomenclature, operationally feasible workflows, strengthened alcohol assessment, and enhanced access to fibrosis testing to ensure coherent SLD adoption across primary care and specialist settings.

Obesity is a chronic, relapsing disease that increasingly spans generations within households, yet contemporary metabolic and bariatric surgery (MBS) models remain oriented toward individuals or single-generation patients. A growing body of evidence demonstrates that obesity risk, behaviors, and treatment responses cluster within family systems, and that MBS produces measurable metabolic and behavioral effects among untreated spouses, partners, and children. Concurrently, decades of pediatric research confirm that caregiver engagement and integration is one of the strongest determinants of successful obesity treatment. Together, these observations support a paradigm shift toward an intergenerational, family-centered model of MBS, in which the household becomes the unit of care. This perspective synthesizes evidence supporting the biological, behavioral, and environmental interdependence of obesity within families and outlines a comprehensive framework for implementing household-level bariatric care. Core components include integrated pediatric-adult clinical infrastructure; combined multidisciplinary teams trained across the age spectrum; harmonized protocols for evaluation, education, and follow-up; coordinated scheduling and workflow alignment; and family-based behavioral strategies that promote shared goals, consistent routines, and mutual accountability. Operational and policy innovations, such as cross-departmental agreements, unified electronic health records, and coordinated billing can facilitate sustainable implementation. We further identify research priorities, including quantifying metabolic ripple effects among untreated family members, evaluating bundled household-level interventions, and developing validated metrics to assess changes in the home environment. Treating the household as the patient offers a promising strategy to enhance medical obesity treatment, surgical durability, improve adherence, and disrupt intergenerational transmission of obesity. As obesity increasingly presents as a family condition, an intergenerational MBS model may help realign treatment with the realities of lived experience and improve outcomes across generations.

Understanding factors influencing nurses' knowledge of peripherally inserted central catheter (PICC) care is crucial for developing interventions to improve knowledge and ensure care quality. However, evidence remains limited in low-resource areas. This study aimed to examine factors influencing nurses' PICC care knowledge in Guizhou Province of China, and to explore potential differences across hospital levels. A cross-sectional study was conducted among 3528 nurses from 18 hospitals across nine cities in Guizhou, China. PICC care knowledge was assessed using a standardized questionnaire, and multiple linear regressions were used to identify influencing factors. The mean knowledge score was 48.67&#x2009;&#xb1;&#x2009;12.94, with 17.2% achieving a passing score (&#x2265;&#x2009;60). Higher scores were associated with higher professional titles, higher education, PICC care experience, workplace guidelines, prior training, self-reported training needs, and tertiary hospital employment (all p&#x2009;<&#x2009;0.05). In secondary/primary hospitals, nurses' knowledge was significantly associated with professional title, educational level, PICC care experience, and prior training (all p&#x2009;<&#x2009;0.05). In tertiary hospitals, nurses' knowledge was significantly associated with professional title, PICC care experience, workplace guidelines, and self-reported training needs (all p&#x2009;<&#x2009;0.05). Nurses in Guizhou have suboptimal PICC care knowledge, with different factors associated with knowledge observed across hospital levels. Interventions are needed to improve nurses' PICC care knowledge and enhance care quality, with tailored strategies for tertiary versus secondary/primary hospitals.