The integration of Artificial Intelligence (AI) in providing quality dental care to individuals with special needs has been scarcely explored and holds the potential to be transformative. This study aimed to map the current evidence and research gaps on the application of AI tools in special care dentistry. This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure transparency. A systematic search was carried out across PubMed, Google Scholar, Scopus and Web of Science, including studies on AI for dental care of special needs groups published from 2015 to 2025. The data were charted on an evidence map, and study characteristics were evaluated to identify existing evidence and gaps. Five studies were included in the review. Some of the major themes explored were AI tools used for diagnosis, treatment planning, behavior management, remote consultation and communication assistance for these groups, with one of the five studies assessing dentists' perceptions of their use. This study highlighted the lack of robust evidence and the narrow focus of the existing studies. This study highlighted the research gap in AI tools for special needs groups and noted the dearth of scientifically and conceptually rigorous studies on the topic. Thus, serving as the preliminary evidence for directing subsequent research on clinical translation of AI tools for special needs groups.
Since 2019, Dutch hospitals have been developing approaches aiming to bridge the gap between hospital care and community-based lifestyle support. This has led to the introduction of the so called 'Lifestyle Front Office" (LFO) in 2022. The LFO enables healthcare professionals to refer patients for lifestyle and (psycho)social support adjacent to medical treatment in the context of specialist medical care. After a consultation at the LFO, patients are referred to the appropriate community-based lifestyle interventions. LFOs have been quickly adopted in Dutch hospitals, leading to conceptual differences. This study aimed to evaluate similarities, differences and future needs of LFOs in the Netherlands, striving for a more unified concept. A cross-sectional survey was sent out between December 2023 and September 2024 to all Dutch hospitals with an operational LFO (n = 17 hospitals). The survey focused on referral processes, patient eligibility criteria, departmental involvement, screening methods, consultation practices, follow-up procedures, financing, and capacity. The collected data were analyzed quantitatively and qualitatively to identify common practice, challenges, and opportunities for improvement. The survey response rate was 82% (14/17). Primary referral groups were patients with lifestyle-related conditions such as obesity, type 2 diabetes mellitus and cardiovascular diseases. Most LFOs conducted pre-visit screenings by using questionnaires, employed lifestyle care coordinators with diverse professional backgrounds, utilized structured tools during consultations and used the electronic patient records for screening and communication. Future needs included the need for (long-term) funding, which was only secured in 21% of the LFOs. Furthermore, inconsistent eligibility criteria, limited capacity, and follow-up procedures were seen as priorities for future attention. This study highlights the similarities, differences and future needs of LFOs in the Netherlands. To achieve a more unified concept, LFOs need to better align patient-related eligibility criteria, use of structured tools, referral to community-based support, follow-up strategies and long-term funding. While the LFO concept emphasizes strong inter-organizational collaboration, further research is needed to assess its impact by investigating success rate of referrals and (long-term) health outcomes after referral. Additionally, for maintaining LFOs in the Dutch healthcare system, additional research is required to better understand the barriers and facilitators regarding structural implementation.
Older adults with complex needs (CN), commonly defined as the coexistence of multiple chronic conditions and functional limitations, are associated with high levels of medical and long-term care (LTC) utilization. However, evidence on real-world patterns of joint medical and LTC service use among this population in China remains limited. This cross-sectional study utilized data from 177,807 individuals aged ≥ 60 years who underwent LTC insurance assessment in Shanghai between January and May 2023. CN was defined as having three or more chronic conditions with at least one limitation in activities of daily living. Within an integrated care framework, latent class analysis (LCA) was applied to identify patterns of medical and LTC service utilization based on 10 indicators informed by the Andersen Behavioral Model of Health Services Use. Multinomial logistic regression was used to examine the association between CN status and class membership, adjusting for demographic, socioeconomic, and health-related factors. Older adults with CN (n = 42,277) differed significantly from those without CN (n = 135,530) across demographic, socioeconomic, health status, and service utilization. Six latent classes of medical and LTC service utilization were identified: Low Medical & Low Care, Moderate Medical & Low Care, High Medical & All Care, High Medical & Informal Care, High Medical & Formal Care, and High Inpatient & Formal Care. Compared to non-CN individuals, CN individuals had higher probabilities of belonging to high-utilization classes, particularly High Medical & All Care, High Medical & Informal Care, and High Medical & Formal Care classes, with the Low Medical & Low Care Class as the reference. These associations remained significant after adjusting for covariates. Older adults with CN in China showed heterogeneity in patterns of medical and LTC service utilization and were more frequently represented in intensive and multi-sector service use profiles. Early identification of CN individuals and the development of risk-stratified integrated care models may help inform more coordinated and people-centered service delivery approaches.
Rheumatology and immunology nursing involves complex, long-term patient care. However, the effectiveness of current training in supporting early-career nurses remains unclear. Therefore, this study aimed to explore stakeholders' perspectives on training experiences and perceived learning needs, and to identify key implications for competency-based continuing professional development, with a focus on enhancing sustained patient safety. This descriptive qualitative study employed semistructured interviews with 26 participants (15 trainees and 11 trainers) from six county-level hospitals in Ningxia, China. Data were analyzed using Braun and Clarke's reflexive thematic analysis, and reporting followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Three main themes emerged: (1) Trainees reported misalignment between training content and daily clinical demands, insufficient support for safe routine practice, and limited opportunities for supervised skill development; (2) Trainers highlighted gaps in preparation and educational resources, resulting in primarily didactic approaches and variable training quality, which may hinder the development of patient safety-related competencies; (3) Trainers emphasized the need for a structured, progressive training framework integrated with clinical practice. Shared priorities included clearly defined competency progression, contextually relevant content, experiential learning strategies such as case discussions and supervised practice, and the integration of psychological support, humanistic care, and lifelong learning awareness and methods. Faculty development and standardized teaching materials were considered essential to ensure consistent and safe practice standards. Strengthening specialist nursing capacity in resource-limited county hospitals requires not only structured, practice-integrated training curricula but also sustainable continuing professional development pathways that support progressive competency development. Embedding competency-based learning within routine clinical practice, alongside investment in trainer capability and standardized educational resources, may help reinforce patient safety competencies and promote sustained professional growth across the early stages of nursing careers.
Coping with prolonged periods of low availability of wind and solar power, also referred to as variable renewable energy droughts or "Dunkelflaute", emerges as a key challenge for realizing decarbonized energy systems based on renewable energy. Here we investigate the role of long-duration electricity storage and geographical balancing through transmission in dealing with such events in Europe, combining a time series analysis of renewable availability with power sector modeling of 35 historical weather years. We find that extreme droughts define long-duration storage operation and investment. Assuming policy-relevant interconnection, the least-cost system in our model capable of coping with the most extreme event requires 351 terawatt hours long-duration storage capacity, corresponding to 7% of yearly European electricity demand. While nuclear power can partially reduce storage needs, the storage-mitigating effect of fossil backup plants in combination with carbon removal is limited. Policymakers and system planners should prepare for a rapid expansion of long-duration storage to safeguard the renewable energy transition in Europe.
Good communication is vital to high-quality care for adults with learning disabilities in long-term care settings, influencing their health and well-being. Evidence on how best to support their communication needs is limited. To develop an initial programme theory that synthesises knowledge on how communication interventions work in these settings, how they can be best designed, implemented, and evaluated, and the resources needed. A realist review was conducted following RAMESES II standards, using seven databases (CINAHL, EMBASE, Medline, PsycINFO, Scopus, Web of Science, Cochrane Library). After screening, included studies were assessed for quality and relevance, with data extracted from those rated moderate to high. Context-mechanism-outcome configurations were developed and refined through consultation with experts and stakeholders, including in meetings with 53 adults with learning disabilities, carers, and professionals. The review was registered on PROSPERO [BLINDED FOR REVIEW]. Of 5576 studies screened, 29 were assessed as moderate or highly relevant, contributing to ten context-mechanism-outcome configurations describing changes in: staff knowledge and awareness of communication; ability to assess individuals' needs; and use of practices, techniques, tools, and support for choice-making. Organisational resources key to enabling staff skill development referred to changes in leadership, policies and procedures, environmental modifications, training and ongoing support. Outcome measures include those reflecting effective communication. Good communication is a complex process that requires systemic support prioritising communication and meaningful relationships between staff and individuals. This initial program theory offers a framework to guide the implementation and evaluation of such support.
Everyday services are increasingly being digitalised, while the proportion of older adults continues to grow. Ensuring that digital services are accessible to this population is essential to prevent digital exclusion and support autonomy. This study aimed to explore older adults' perspectives, experiences, and needs regarding digital services, identify perceived barriers to accessibility, and examine associated ethical and societal concerns. This qualitative descriptive study recruited 48 French community-dwelling older adults in France (28 women, 20 men; mean age = 76.06 years, SD = 9.21; 42 urban, 6 rural). Semi-structured interviews were conducted using an 18-item guide developed from a review of the literature on digital accessibility. The study design and reporting were informed by the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Interviews were audio-recorded, transcribed verbatim, pseudonymised, and analysed using inductive thematic analysis. Coding was performed independently by two researchers, and discrepancies were resolved through discussion. All participants reported using at least one digital technology, primarily for communication, information-seeking, administrative procedures, entertainment, and, more rarely, for professional or obligatory tasks. Participants described both advantages (e.g., convenience, ergonomic interfaces) and difficulties (e.g., lack of support, interface complexity, technical failures), leading to diverse coping strategies such as seeking help, self-learning, delegation, or avoiding digital tools when possible. Feelings toward digitalisation were ambivalent, combining perceived benefits with frustration, concerns about data security, and reflections on the impact of digitalisation on autonomy and human relationships. Participants also identified barriers to accessibility (e.g., lack of digital literacy, financial constraints, poor design, insufficient support) and proposed concrete solutions, emphasising the importance of accessible design, non-digital alternatives, adapted training, and human assistance. Digitalisation offers opportunities for older adults but also raises accessibility, ethical, and societal challenges. While many participants recognised the usefulness of digital services, they also highlighted risks related to autonomy, perceived choice, and reduced human contact. These findings underscore the need for digital services that are inclusive, intuitive, and supported by continuous human assistance to avoid reinforcing existing inequalities.
Previous editions of the International Glossary on Infertility and Fertility Care (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many other changes, expanded the definition of infertility to include not only its recognition as a disease causing disability, but also as resulting from an impairment of a person's capacity to reproduce either as an individual or with his/her partner. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders, including policy makers. Updates are now required to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains OBJECTIVE: To update the latest International Glossary on Infertility and Fertility Care, 2017 to reflect current scientific knowledge, evolving social contexts, and inclusive terminology, thereby promoting harmonized international communication across clinical, research, policy, and public domains. Under guidance of the organizing committee, 21 professionals from across the world representing expertise in different sub-specialties formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives. Following several virtual discussions and a one-day in-person meeting, most terms and definitions were agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-thirds majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors. The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms were modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. This updated glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy. Periodic updates will be required as scientific and societal contexts evolve.
Community Health Centres (CHCs) are community-governed organizations often located in communities facing significant challenges with social determinants of health. To date, no review has summarized the evidence on the effects of team-based models of care on patient outcomes. The objective of this systematic review was to synthesize the evidence on the characteristics of interprofessional teams practicing in CHCs and their associations with patient outcomes. A systematic review was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. In October 2024, an electronic search was performed in five databases and the grey literature using a combination of descriptors and keywords. No restrictions were applied regarding language or year of publication. Screening and data extraction were independently conducted by two reviewers. The included papers focused on interprofessional teams composed of at least three different types of providers (e.g., physician, nurse, and nutritionist) practicing in CHCs and addressing at least one patient outcome (e.g., satisfaction, diabetes management). The risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute checklist. From 6,309 identified papers, 36 papers were included. Most papers focused on team composition (n = 18) and staffing patterns (n = 8). Adjustments to staffing patterns-such as increasing full-time equivalents, expanding team size, and diversifying skill mixes-were associated with improved patient satisfaction and increased number of visits. Adding a chiropractor reduced opioid prescriptions and patient pain, while including a pharmacist improved hepatitis management and patient satisfaction. Inconsistent findings were observed regarding the inclusion of nurse practitioners and physician assistants in interprofessional teams and their impact on the number of patients seen in CHCs. Specialized interprofessional teams addressing diabetes, pain management, and childhood obesity had better health outcomes and care management compared to standard care, highlighting the value of tailored interprofessional collaboration in achieving improved health outcomes for specific populations. Specific team compositions are associated with improved health outcomes for the populations served by CHCs. Future research is needed to deepen the understanding of the associations between team composition, the type of care provided, and patients' clinical and psychosocial needs.
Retinal angiogenesis is the process of new blood vessel formation within the retina, the light-sensitive tissue located at the back of the eye. It is a tightly regulated physiologic process essential for supplying oxygen and nutrients to retinal cells, supporting their metabolic needs, and maintaining overall retinal function. During retinal angiogenesis, new blood vessels sprout from pre-existing vessels in response to specific signals and cues within the retinal microenvironment. The process involves a series of coordinated events, including endothelial cell proliferation, migration, tube formation, and vessel maturation. The process of retinal angiogenesis is tightly regulated by a complex interplay of proangiogenic and antiangiogenic factors, including growth factors, cytokines, extracellular matrix components, and cell-cell signaling pathways. In addition to its role in normal retinal development, angiogenesis in the retina can also occur under pathologic conditions, leading to the formation of abnormal blood vessels. Conditions such as diabetic retinopathy, retinopathy of prematurity, and age-related macular degeneration are characterized by aberrant retinal angiogenesis, which can result in vision-threatening complications. Understanding the mechanisms that regulate retinal angiogenesis is essential for developing novel therapeutic strategies aimed at promoting normal vascular development, inhibiting pathologic angiogenesis, and preserving vision in patients with retinal vascular disorders.
Diabetes mellitus type 2 (T2D) is a growing burden in Switzerland, where general practitioners (GPs) face increasing workload. To evaluate the quality of T2D care, the Swiss Society of Endocrinology and Diabetology (SGED) developed the SGED score to help GPs overview aggregated patient parameters at the practice level. However, the practical use of the SGED score is hampered by paper-based workflows and fragmented documentation. Currently, no dashboard exists to specifically visualize the SGED score, which overviews aggregated population parameters such as HbA1c or blood pressure. To address this gap, this study examined: (1) what functional requirements healthcare professionals consider essential for such a potential SGED dashboard, and (2) how do healthcare professionals evaluate the usability and clinical relevance of an iteratively developed dashboard prototype. We employed an iterative, user-centered three-step approach involving 10 semi-structured interviews with 14 Swiss T2D healthcare professionals. Step 1 involved defining the project scope, identifying predefined functional requirements, and developing an initial SGED score dashboard prototype. Step 2 collected user-generated requirements and prioritized all requirements using the "Must Have", "Should Have", "Could Have", "Won't Have" (MoSCoW) method. In step 3, the high-fidelity Figma dashboard prototype was iteratively refined based on the requirements and interviewee feedback. Key functional requirements of the digital SGED score included reminder and alert functions for missing or overdue SGED-relevant assessments, color-coded critical values such as low nephropathy screening rates, demographic overviews, trend analyses of SGED indicators at practice level, benchmarking within practice networks, and exportable reports. Additional needs emerged for patient-level views, integrated checklists, inclusion of comorbidities, and personal or practice-specific goal-setting features. Iterative refinements based on user feedback improved clarity, usability, and visual appeal. Some participants highlighted the dashboard's intuitive design, clear and diverse visualizations, and benchmarking functionalities, describing it as both engaging and efficient. Others raised concerns about limited suitability for daily clinical workflows, potential integration challenges with existing systems, and the need for interactive, patient-centered features to support routine care. The proposed SGED score dashboard could enhance T2D care through features like population overviews, long-term visualizations, and anonymized benchmarking, meaning the ability to compare a practice's SGED performance with those of other practices. Successful clinical adoption will heavily depend on interoperability and seamless integration into existing workflows. The identified requirements provide a foundation for future digital T2D management systems.
In the rapidly evolving landscape of Natural Language Processing (NLP), transfer learning has emerged as a game-changing methodology, fundamentally altering how machine learning models are trained and deployed. The study at hand dives deep into the intricacies of transfer learning techniques, specifically focusing on their application in complex deep learning architectures within the NLP domain. By exploring a variety of architectural designs, fine-tuning methodologies, and alternative training paradigms, we aim to demystify the optimal strategies for harnessing the power of pre-trained models. To quantify the effectiveness of these approaches, we conducted a comprehensive series of experiments targeting key NLP tasks, such as text classification and language generation. Transfer learning significantly accelerated training and improved model accuracy, highlighting its practical advantages in NLP tasks. This dual benefit underscores the immense potential of advanced transfer learning techniques, making them an indispensable tool for future NLP applications. By implementing state-of-the-art transfer learning methodologies, companies can offer faster and more accurate NLP solutions, aligning perfectly with the ethos of "Business Digitalized" and catering to a broad spectrum of client needs in the market.
To introduce a new service delivery intervention to improve equity of access to home dialysis therapy and describe the process of intervention development. Despite strong evidence in favour of home dialysis, its uptake remains stubbornly low in England and elsewhere. Furthermore, uptake levels vary between kidney services and between population groups. The Inter-CEPt study identified several enablers of access to home dialysis, including: receptive organisational cultures; adoption of reflective practice; engagement in quality improvement, and shared belief in the benefit of home dialysis. Drawing on the Inter-CEPt study, and using established intervention development frameworks, we developed 'Location of Dialysis Care in Kidney Life' as a targeted intervention for improving the uptake of home dialysis. In this paper, the intervention and the processes involved in its design are described. This involved co-design workshops with professional stakeholders and people with lived experience. The Location of Dialysis Care in Kidney Life intervention consists of two principal components: (1) quality improvement activities focussed on supporting dialysis care in the home, and (2) dedicated home therapies leadership roles and activities in kidney services. The rationale of the intervention is to develop and sustain a culture that improves equitable access to home dialysis. We report a staged process of intervention development that combines the principles of evidence-based intervention development and user co-design. The resulting intervention proposal can be adapted by kidney services to meet their specific needs and challenges. The study identifies organisational culture as one of the biggest determinants of uptake in home dialysis. No other study to our knowledge has fully investigated this as a barrier to home dialysis, nor indeed how to begin to change it. The Location of Dialysis Care in Kidney Life intervention requires future piloting and evaluation.
The foundation and core value of the nursing profession is caring. Worldwide, it is expected that nursing education will cultivate caring behavior amongst nurses to fulfill the health needs of a patient. Three earlier reviews related to caring behavior were identified. However, these reviews were conducted over ten years ago and other literature has since been published. Therefore, it is timely to synthesise the most recent evidence related to the perceptions of patients, nurses, and nursing students of caring behaviours exhibited by nurses. A mixed methods systematic review was conducted in accordance with Joanna Briggs Institute (JBI) guidelines. MEDLINE, Web of Science, Scopus, and Cumulative Index of Nursing in Allied Health Literature (CINAHL), PsycINFO, and Embase were searched to identify original peer reviewed studies published from January 2009 onwards. All records were systematically screened for eligibility based on their title, abstract, and full text by all three authors. Eligible studies were critically appraised for methodological quality using the Mixed Methods Appraisal Tool. Both qualitative and quantitative studies were reviewed and data separately extracted for each type of study. The findings were narratively synthesised using a convergent integrated approach. The thematic synthesis of qualitative data and narrative summary of quantitative data was integrated to provide the overall findings of the review. From 4130 records identified, 44 studies were included (19 qualitative, 23 quantitative, and two mixed methods study). The studies covered several hospital specialty areas. Two themes, physical care with sub-themes of knowledge and skills; comfort; and assurance, and expressive care with sub-themes of connectedness; being respectful; trusting relationships, and teaching and learning emerged from the analysis. In this review, deficits in knowledge and training requirements of both nurses and student nurses have been identified. For nurse leaders, the review findings will bring insight to those who develop nursing policies to ensure that caring behaviours are incorporated into guidelines and job descriptions for registered nurses. Not applicable.
Several studies have demonstrated superior outcomes with endovascular aortic repair (EVAR) compared to open aortic repair (OAR) in patients with infrarenal ruptured abdominal aortic aneurysms (rAAA). However, in emergent settings, aortic neck suitability for EVAR and adherence to IFU criteria are often not met in a significant proportion of patients. We aimed to compare EVAR and OAR in patients with rAAA using a recent national database, incorporating favorable neck (FN) versus hostile neck (HN) anatomy. We analyzed VQI data for rAAA from 2018-2024. Two analyses were performed: first, a comparison between OAR and EVAR; second, a comparison among three cohorts: OAR, EVAR with FN (EVAR-FN), and EVAR with HN (EVAR-HN). HN anatomy was defined as neck length <15 mm, neck diameter >30 mm, or infrarenal angle >60°. The primary outcomes were 30-day and one-year mortality. Secondary outcomes included postoperative complications, ICU stay >3 days, RBC transfusion >4 units, and postoperative reintervention. Logistic and Cox regressions were used for the analyses. A total of 4,578 rAAA repairs were performed, of which 3,275 (71.5%) were EVAR. Among EVAR cases, 2,452 (74.9%) had HN anatomy. Thirty-day mortality was 35.5% for OAR and 21.5% for EVAR (P< 0.001). One-year mortality was 42.5% for OAR, 31.7% for all EVARs, 26.1% for EVAR-FN, and 33.5% for EVAR-HN. After adjusting for confounders, EVAR was associated with reduced 30-day and one-year mortality (aOR= 0.66, 95% CI 0.52-0.84, P= 0.001; and aHR= 0.79, 95% CI 0.67-0.93, P =0.005). EVAR was also associated with reduced risk of postoperative complications. When stratified by neck anatomy, EVAR-FN was associated with more pronounced reduced 30-day (aOR= 0.46, 95% CI 0.33-0.65; P< 0.001) and one-year mortality (aHR= 0.66, 95% CI 0.53-0.82; P< 0.001) compared with OAR. EVAR-HN was associated with reduced 30-day mortality (aOR= 0.74, 95% CI 0.58-0.94; P= 0.013) but not one-year mortality (aHR= 0.84, 95% CI 0.71-1.00; P= 0.052) compared with OAR. EVAR-HN was also associated with increased 30-day and one-year mortality compared with EVAR-FN. The majority of rAAAs are treated today with EVAR, and 75% of these patients present with HN anatomy. EVAR was associated with reduced postoperative mortality and complications compared with OAR, regardless of neck anatomy. However, EVAR maintained a one-year survival advantage over OAR only in patients with FN anatomy. While EVAR-HN demonstrated similar one-year mortality to OAR, it remains the preferred option due to better perioperative outcomes and lower 30-day mortality. Longer-term follow-up is needed to evaluate reintervention, rupture, and aneurysm-related mortality, particularly in patients with HN anatomy.
To assess Egyptian nursing students' level of AI knowledge, perceptions of AI benefits, and fears regarding AI in nursing education and practice, and to examine associated sociodemographic factors. The rapid integration of artificial intelligence (AI) into healthcare has generated both enthusiasm and apprehension among nursing professionals and students. While AI offers substantial potential benefits in clinical efficiency, decision support, and educational innovation, important concerns remain regarding individualised care, professional displacement, and data privacy. This combination of promise and concern suggests a cautiously receptive context in which nursing students may recognise AI's value while remaining uncertain about its implications for practice and education. Therefore, evidence-based assessment of nursing students' knowledge and perceptions is needed. A cross-sectional descriptive design was utilised in this study. A convenience sample of 2412 nursing students was drawn from two nursing faculties between May 2024 and January 2025. Data were collected using a structured three-part questionnaire covering individual sociodemographic characteristics, a dichotomous AI knowledge test, and an attitude scale measuring perceived benefits and fears regarding AI. Approximately 46.4% of students demonstrated good AI knowledge (mean score 3.2 ± 1.3 out of 5). The mean perceived benefits score was 10.9 ± 3.5 (maximum 14), indicating generally favourable views of AI's educational and clinical support applications. The mean fear score was 5.0 ± 1.6. Notably, 72.2% of students expressed concern that AI may replace nurses in the future, and 57.8% reported discomfort with using AI in educational settings. Statistically significant differences were observed across academic years for knowledge, perceived benefits, and fears, and across age groups for perceived benefits and fears; age-related differences in knowledge were smaller but remained statistically significant. No significant differences were found by gender or university. Egyptian nursing students demonstrated a foundational understanding of AI and broadly recognised its benefits for education and clinical support. Nevertheless, substantial gaps in formal AI training and pronounced fears about professional displacement were identified. Structured, ethically grounded AI educational programs are urgently needed to enhance students' digital competencies and ensure the safe and effective use of AI in nursing practice. Not applicable.
Advanced practice providers (APPs) are increasingly involved in surgical care delivery. This study analyzed Medicare data for total joint arthroplasty services delivered by APPs and explored their geographic distribution and practice characteristics. A retrospective analysis was conducted using Medicare data from 2014 to 2023. Providers submitting claims for arthroplasty-related services were identified and classified by provider type. Demographic characteristics, practice locations, billing trends, and payment ratios were analyzed over the study period. Monetary values were adjusted for inflation to 2023 dollars. There were 187,481 unique providers providing arthroplasty-related services over the study period. Most were orthopaedic surgeons (n = 121,087, 65%), and fewer were APPs (n = 66,394, 35%). The number of APPs increased 87% over the study period compared with a 17% increase observed among surgeons. The APPs were more likely to practice in rural areas (11 versus 7%), be newer in practice (11 versus 23 years), and have fewer office visits (32 versus 43) (all P < 0.001). The mean payment ratios were lower for APPs than surgeons (0.14 versus 0.22; P < 0.001) and decreased for both provider groups over the study period. Projections to 2030 demonstrated 15,782 orthopaedic surgeons (56%), 9,752 physician assistants (34%), and 2,884 nurse practitioners (10%) providing arthroplasty-related services. The proportion of APPs providing arthroplasty-related services increased significantly from 2014 to 2023. Further work is needed to delineate APP responsibilities in total joint arthroplasty, including the development of standardized training pathways and evidence-based guidelines to support multidisciplinary care delivery.
There are currently two opposing hypotheses regarding the risk factors for acquisition, colonisation and infection with multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in the intensive care unit (ICU). Acquisition could be either endogenous or exogenous or both. It is of great interest to estimate pooled prevalence and describe individual and environmental factors associated with the colonisation and infection with MDR Pseudomonas aeruginosa in intensive care units. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol of this review has been registered under CRD42021233832 in the International Prospective Register of Systematic Reviews (PROSPERO) and has been published on Systematic review on November 2022All types of studies carried out in intensive care units (ICUs) were included. MEDLINE (Pubmed), EMBASE (OVID), the Cochrane Library (Wiley), Web of Science, CINAHL (EBSCOHost), LILACS (BIREME), Google Scholar and Open Grey were searched from 1983 to 2023 and the results of electronic searches were uploaded to Rayyan software. The methodological quality of the studies was assessed using the National Heart, Lung, and Blood Institute Critical Appraisal Tools. The I2 test was performed to assess the statistical heterogeneity among the included studies. The publication bias was assessed by using the funnel plot and Egger's test. Descriptive analysis and meta-analysis were performed. Fixed effect model were used to calculate the surveyed prevalence and odds ratio (OR) with their respective 95% confidence intervals (95% CI). A total of 10,791 articles were identified, of which 13 were retained for descriptive analysis and 8 for meta-analysis. The majority of these 13 studies were conducted in Western countries. Methods were heterogeneous and few studies addressed environmental factors. The pooled prevalence of MDR-PA in the ICU was 4% (95% CI: 0%-11%). Identified risk factors were: length of stay in ICU (> 8 days), mechanical ventilation with OR: 3.19; 95% CI: 2.25-4.53, use of invasive devices with OR: 2.97; 95% CI: 2.40-3.68 (use of central venous catheter with OR: 3.16 95% CI: 1.87-5.33, the use of urinary catheters with OR: 2.65; 95% CI: 2.05-3.44, the use of parenteral nutrition with OR: 2.43; 95% CI: 1.15-5.16 and the use of arterial catheters with OR: 7.00; 95% CI: 2.77-17.68) and the use of antibiotics with OR: 3.69; 95% CI: 3.16-4.27 (carbapenem with OR: 4.12; 95% CI: 3.29-5.16, quinolones with OR: 3.31; 95% CI: 2.45-4.47, bectalactam with OR: 3.58; 95% CI: 2.4-5.24, and aminoglycosides with OR: 3.32; 95% CI: 2.33-4.73) and environmental factors. All this suggest that acquisition or infection by MDR-PA in ICU could be due to endogenous and exogenous transmission. Due to the few numbers of studies analysed, further investigation with more studies is needed to draw definitive conclusions. The protocol of this review has been registered under CRD42021233832 in PROSPERO and has been published on Systematic review on November 2022. Eyebe et al. (Syst Rev 11:270, 2022).
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, impulsivity, emotion dysregulation, and executive dysfunction. Current treatment guidelines recommend a multimodal approach. Cognitive Behavioral Therapy (CBT) has proven effective for alleviating core symptoms, improving executive functioning, and reducing emotional comorbidities, with benefits sustained for up to one year. Dialectical Behavior Therapy (DBT), an adaptation of CBT that integrates mindfulness and emotion regulation components, has also shown potential benefits in adult ADHD populations. However, no prior studies have directly compared CBT and DBT in Chinese adults with ADHD. This trial aimed to compare the efficacy of group DBT and group CBT in adults with ADHD across multiple dimensions, with follow-up assessments extending to six months post-treatment. Ninety-eight adults with ADHD were randomly assigned to either the DBT (n = 49) or CBT (n = 49) group, and received 12 weeks of group-based intervention. Assessments were conducted at baseline (T0), weeks 4 (T1) and 8 (T2), post-treatment (T3), and at 3-month (T4) and 6-month (T5) follow-ups. Outcome measures included core symptoms (ADHD-RS), emotional symptoms (SAS and SDS), emotion regulation (DERS and ERQ), quality of life (WHOQOL-BREF), global functioning (GSES and SDS), and executive function assessed via both self-report (BRIEF-A) and laboratory-based tasks (TMT, SCWT, SST, and CPT-IP). Linear mixed models (LMM) were employed to examine group-by-time interaction effects. Both the DBT and CBT groups showed improvement over time in core ADHD symptoms and several secondary outcomes at post-treatment and follow-up. No significant group-by-time interactions were observed for core ADHD symptoms and the between-group effect sizes were small at post-treatment (d = 0.06, 95% CI [-0.33, 0.46]) and at 6-month follow-up (d = 0.17, 95% CI [-0.27, 0.61]). However, the confidence intervals were not fully contained within the prespecified non-inferiority margin (d = 0.40), and formal non-inferiority of DBT relative to CBT was therefore not established. Across secondary outcomes, most between-group differences were generally small, time-specific, and not consistently maintained over follow-up. For laboratory-based executive function measures, CBT showed a relative advantage on a spatial working memory task, whereas no stable between-group differences were observed for most other measures. This is the first randomized controlled trial in China to directly compare DBT and CBT for adults with ADHD. The findings indicate that both interventions were associated with improvement across multiple symptom and functional domains, with generally small between-group differences over 6 months of follow-up. DBT may represent a potentially useful psychotherapeutic option for adults with ADHD. However, formal non-inferiority relative to CBT was not established, and the present findings do not support a conclusion of equivalence between the two treatments. Further studies with larger and more diverse samples are needed to obtain more precise estimates of treatment effects and to evaluate the generalizability of the present findings. ChiCTR2300072075, registered 2023.6.1.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have transformed the management of obesity by producing substantial and durable weight loss. However, gastrointestinal adverse effects, including nausea, vomiting, and constipation, are a common, dose-dependent, and frequent cause of discontinuation. Furthermore, weight regain is typical after drug withdrawal, reflecting the chronic and relapsing nature of obesity. Long-term adherence is essential but often constrained by high cost, injection burden, and patient preference. Moreover, the consequences of chronic GLP-1 receptor activation on gut physiology, microbiota composition, and immune tolerance remain incompletely defined. In parallel, dietary fibers offer a physiological means of engaging the same gut-brain axis through microbial fermentation and the stimulation of endogenous GLP-1. Fibers deliver broad benefits as they strengthen gut barrier function, enrich short chain fatty acid, and recalibrate immunity toward an anti-inflammatory state. Nevertheless, weight loss with fiber alone is typically more modest than with GLP-1RAs and depends on the type, dose, and duration of use. Tolerability can be limited by bloating or gas, particularly if intake is increased too rapidly. This review critically examines the convergence and divergence between GLP-1RAs and dietary fibers. We discuss their mechanistic overlaps in appetite control, metabolism and immune modulation, and highlight potential interactions, such as altered fermentation dynamics during pharmacological slowing of gastric emptying and the potential for GLP-1R desensitization. We explore opportunities for fibers to mitigate GLP-1RA-related adverse effects, support bowel regularity, and stabilize the microbiota during treatment or after discontinuation. A pragmatic framework is raised to place dietary fiber and lifestyle measures as the foundation of care, reserves GLP-1RA therapy for highest-risk individuals, and plans for fiber supplements once pharmacotherapy is reduced. Well-designed trials that combine GLP-1RAs with well-characterized fibers, include microbiome end points, and assess long-term outcomes are needed to optimize efficacy and reduce dependence on costly pharmacotherapy.