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Nausea and vomiting in pregnancy is highly prevalent and can significantly impact pregnant women's quality of life. Despite this, access to effective pharmacotherapies can be constrained by stringent regulatory controls and socioeconomic barriers. The objective of this study was to examine the socioeconomic distribution of antiemetics (metoclopramide, ondansetron, and prochlorperazine) dispensed to pregnant women through Australia's publicly subsidized Pharmaceutical Benefits Scheme. We used the Maternity1000 linked administrative dataset to characterize antiemetics dispensed during 297&#x2009;630 pregnancies in Queensland, Australia (July 2013 to June 2018). Using a population-based historical cohort study design, we analyzed dispensing volume, prevalence, and government expenditure across socioeconomic quintiles, with socioeconomic disadvantage defined using the Australian Bureau of Statistics' Index of Relative Socioeconomic Disadvantage. Inequalities in medication access and public expenditure were assessed using concentration indices (C) and concentration curves. Off-label ondansetron dispensings for nausea and vomiting in pregnancy (i.e., use outside Therapeutic Goods Administration-approved indications and not subsidized under the Pharmaceutical Benefits Scheme) accounted for the largest share of public expenditure (53.5%), followed by metoclopramide (45.2%) and prochlorperazine (1.3%). Across all three antiemetics, prevalence was highest among women in the most socioeconomically disadvantaged quintiles and declined progressively across the two least disadvantaged groups. Small pro-poor inequalities in access (C&#x2009;<&#x2009;-0.10) and moderate pro-poor inequalities in public expenditure (C&#x2009;>&#x2009;-0.25) were observed across all antiemetics. (Medication access: Cmetoclopramide&#x2009;=&#x2009;-0.07, 95% CI (-0.080 to -0.068); Condansetron&#x2009;=&#x2009;-0.09, 95% CI (-0.114 to -0.075); Cprochlorperazine&#x2009;=&#x2009;-0.08, 95% CI (-0.109 to -0.045). Government expenditure: Cmetoclopramide&#x2009;=&#x2009;-0.30, 95% CI (-0.316 to -0.285); Condansetron&#x2009;=&#x2009;-0.25, 95% CI (-0.297 to -0.198); Cprochlorperazine&#x2009;=&#x2009;-0.28, 95% CI (-0.350 to -0.205)). Off-label ondansetron access accounted for the majority of public expenditure on antiemetics dispensed during pregnancy, revealing a disconnect between health policy, clinical practice, public expenditure, and pregnant women's needs. While pro-poor access and public subsidies for antiemetics align with the equity elements embedded in the design of the Pharmaceutical Benefits Scheme, they may also be reflective of inequitable access to other unsubsidized, guideline-recommended pharmacotherapies for nausea and vomiting in pregnancy.

The trade of illicit pharmaceutical products and cosmetics (IPCs) poses a significant public health threat, particularly in Malaysia where evolving online-to-offline supply chains facilitate their influx. The Pharmacy Enforcement Branch participates in INTERPOL's Operation Pangea to curb this trade at logistical entry points. This study aimed to determine the prevalence, detection-seizure ratios, and categories of IPCs detected and seized at Sarawak's entry points during Operation Pangea from 2020 to 2023. This retrospective cross-sectional study analysed data extracted from Operation Pangea reports (2020-2023). Universal sampling was applied to all entry-point screening cases, while records with missing data, West Malaysia imports, and passenger luggage imports were excluded. IPCs were defined as products or cosmetics not registered or notified with the Ministry of Health. Prevalence and detection-to-seizure ratios were calculated using descriptive statistics, and chi-square tests were used to determine associations between variables and enforcement outcomes. A total of 301 consignments (1006 individual items) were screened, mainly through courier services and at the Southern Zone (Kuching). Screening detected 281 IPCs, corresponding to a 27.9% detection rate, of which only 67 (23.8%) were seized. Products containing scheduled poisons and supplements were the most frequently seized categories. Significant associations were found between consignment type and both detection and seizure outcomes, with courier consignments showing higher rates. The Seizure Detection Ratio declined markedly from 1.00 in 2021 to 0.05 in 2023. Most seized items were intended for treatment purposes, including chronic disease medications and analgesics. This study demonstrates a high prevalence of IPCs in imported consignments in Sarawak, highlighting ongoing risks associated with IPC supply chains. The decline in seizure detection ratio suggests the need to review enforcement consistency and prioritization to strengthen regulatory effectiveness.

Claims data from statutory health insurance (SHI) funds are increasingly used in public health research. We evaluated the representativeness and external comparability of the InGef research database (RDB), which contains anonymized claims data from approximately 10&#xa0;million SHI-insured individuals in Germany, using selected disease-specific indicators. A retrospective cohort study combining cross-sectional and longitudinal analyses (2015-2023) was conducted. We assessed (1) follow-up duration, (2) demographic representativeness, and external comparability based on two complementary reference indications (3) incidence and mortality of lung cancer, and (4) prevalence and pharmaceutical treatment of bronchial asthma. All outcomes were compared with external reference data from the German Federal Statistical Office (DESTATIS), the German Centre for Cancer Registry Data (ZfKD), and the SHI Pharmaceutical Index (GKV-AI). Direct age and sex standardization was applied to ensure comparability. The InGef-RDB showed high concordance with the general German population in terms of age and sex distribution (maximum deviation&#x2009;<&#x2009;0.6 percentage points). 73% of all insured persons remained continuously observable over 9 years. 6.9% died and 19.5% left the database due to changes in their insurance provider, corresponding to an average annual attrition rate of approximately 2.4%. Overall mortality was slightly lower than national statistics (-&#x2009;0.3 to -&#x2009;0.4 percentage points). Between 2016 and 2022, the standardized asthma prevalence rose from 5,938 to 6,602 per 100,000 population, before decreasing to 5,977 per 100,000 in 2023. Monoclonal antibody prescription rates for asthma deviated by <&#x2009;0.01 percentage points from SHI benchmarks. Lung cancer incidence (2016-2022) averaged 41.8 cases per 100,000 persons, closely matching ZfKD data. The InGef-RDB demonstrates strong demographic alignment and good external comparability across distinct epidemiologic and health care use scenarios. Based on these evaluations, it represents a valid and reliable real-world data source for population-based epidemiological and health services research, provided that appropriate methodological adjustments are applied.

Long-term weight management drugs have the potential to reduce body weight and blood pressure in obese or overweight individuals. Being overweight or obese is often associated with hypertension, which is linked to an increased risk of cardiovascular mortality and morbidity. The effects of weight-reducing drugs on patient-relevant outcomes, especially in people with hypertension, are currently unclear. This review is the fourth update of one first published in July 2009. Primary objective To assess the effects of drugs approved for long-term weight management on all-cause mortality, cardiovascular morbidity and adverse events in adults with essential hypertension. Secondary objective To assess the effects of drugs approved for long-term weight management on changes in systolic and diastolic blood pressure and body weight in adults with essential hypertension. For this updated review, the Cochrane Hypertension Information Specialist searched the following databases to 22 April 2024: the Cochrane Hypertension Specialised Register, Cochrane CENTRAL, MEDLINE, Embase and trial registries, with no language restrictions. We also checked references, searched citations, and contacted manufacturers and authors of relevant papers. We included randomised controlled trials (RCTs) of at least 24 weeks' duration that compared approved long-term weight management drugs to placebo in non-pregnant adults with essential hypertension. Critical outcomes were all-cause mortality, cardiovascular morbidity and adverse events. Important outcomes were changes in systolic and diastolic blood pressure and changes in body weight. We assessed the risk of bias using the Cochrane RoB 1 tool. We used standard Cochrane methods. For meta-analyses, we used risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes. We undertook both fixed-effect and random-effects meta-analysis, presenting the random-effects results. We assessed the certainty of evidence using GRADE. We identified no additional trials of drugs included in the previous version of the review. We included two new RCTs evaluating the recently approved drugs semaglutide and tirzepatide. In total, eight RCTs reported results on different weight-reducing drugs compared to placebo in people with hypertension (approximately 13,000 hypertensive participants in total). The interventions evaluated were orlistat (4 trials, 3132 participants), phentermine/topiramate (1 trial, 1305 participants), naltrexone/bupropion (1 trial, 8283 participants), semaglutide (1 trial, 274 participants) and tirzepatide (1 trial, 153 participants with stage 2 hypertension and 635 participants taking antihypertensive medication). Study duration ranged from six to 48 months. Seven of the eight trials were funded by the pharmaceutical industry. We were unable to include any liraglutide results, as no RCTs have provided separate data for participants with hypertension. Rimonabant, sibutramine and lorcaserin are no longer considered relevant, since their marketing approval has been withdrawn. Orlistat versus placebo Orlistat may have little to no effect on all-cause mortality compared to placebo, but the evidence is very uncertain (3 versus 0 deaths; 3 trials, 1488 participants; very low certainty evidence). Orlistat may have little to no effect on cardiovascular morbidity compared to placebo, but the evidence is very uncertain (1.9% versus 0.7% in one trial and 17% versus 19% in another trial; 2 trials, 1721 participants; very low certainty evidence). Orlistat probably increases serious adverse events (SAEs) compared to placebo (RR 1.45, 95% CI 1.10 to 1.91; 3 trials, 1476 participants; moderate-certainty evidence). There may be little to no difference in all adverse events (AEs) between orlistat and placebo, but the evidence is very uncertain (RR 1.13, 95% CI 0.84 to 1.54; 2 trials, 1386 participants; very low-certainty evidence). Phentermine/topiramate versus placebo Phentermine/topiramate may have little to no effect on all-cause mortality compared to placebo, but the evidence is very uncertain (no deaths in either group; 1 trial, 1305 participants; very low-certainty evidence). Phentermine/topiramate may have little to no effect on cardiovascular morbidity compared to placebo, but the evidence is very uncertain (treatment-emergent cardiac events: high-dose versus placebo: RR 2.39, 95% CI 0.82 to 6.69; 1 trial, 1044 participants; low-dose versus placebo: RR 1.51, 95% CI 0.43 to 5.27; 1 trial, 785 participants; both very low-certainty evidence). Phentermine/topiramate may have little to no effect on SAEs compared to placebo, but the evidence is very uncertain (RR 0.85, 95% CI 0.49 to 1.48; 1 trial, 1305 participants; very low-certainty evidence). Phentermine/topiramate probably increases all AEs compared to placebo (RR 1.13, 95% CI 1.08 to 1.20; 1 trial, 1305 participants; moderate-certainty evidence). Naltrexone/bupropion versus placebo Naltrexone/bupropion may have little to no effect on all-cause mortality (RR 0.99, 95% CI 0.70 to 1.40; 1 trial, 8283 participants; very low-certainty evidence) and cardiovascular morbidity (RR 1.11, 95% CI 0.87 to 1.41; 1 trial, 8283 participants; very low-certainty evidence) compared to placebo, but the evidence is very uncertain. There is probably little to no difference between naltrexone/bupropion and placebo in SAEs (RR 1.05, 95% CI 0.96 to 1.14; 1 trial, 8283 participants; moderate-certainty evidence), but naltrexone/bupropion probably increases all AEs compared to placebo (RR 1.69, 95% CI 1.58 to 1.80; 1 trial, 8283 participants; moderate-certainty evidence). Semaglutide versus placebo No results were reported for all-cause mortality, cardiovascular morbidity, SAEs and AEs. Tirzepatide versus placebo No results were reported for all-cause mortality, cardiovascular morbidity, SAEs and AEs. There have been multiple developments in the domain of medications for long-term weight reduction in recent years. Several pharmaceutical products have been removed from the market due to safety concerns, whilst new drugs have been introduced. Our critical outcomes of death and cardiovascular complications were not the focus of the trials included in this review but were sometimes presented as part of an 'adverse events' outcome, with the resultant data providing only very low certainty evidence. Overall, the evidence for people with hypertension remains insufficient to draw conclusions regarding the benefits of pharmacological weight loss in terms of reducing the risk of mortality or cardiovascular morbidity. Further trials are needed. Moreover, separate results for participants with hypertension should be made available from any completed trials involving both normotensive and hypertensive people. This Cochrane review had no dedicated funding. Protocol and previous version DOIs: 10.1002/14651858.CD007654; 10.1002/14651858.CD007654.pub2; 10.1002/14651858.CD007654.pub3; 10.1002/14651858.CD007654.pub4; 10.1002/14651858.CD007654.pub5.

Learning about conflicts of interest should be one of the core aspects aspect of clinical ethics in undergraduate and postgraduate training. However, the focus may direct more to external factors such as ties with, or inducements from, pharmaceutical interests rather than inherent fallibilities and motives of practitioners. At first sight it would appear that there is very limited concentration on the impact of income or private versus public practice on clinical practice in ethics textbooks. A list of clinical/medical ethics textbooks available on open shelves was established in the libraries of Trinity College Dublin, a deposit library alongside Oxford and Cambridge, each of which has rights to a copy of all publications originating in the British Isles. Two researchers independently established the presence and proportion of text relating to income or private practice in each textbook. In cases of disagreement, the senior author adjudicated. Descriptive statistics were used. Of 123 ethics textbooks examined, 304 out of 38,410 pages (mean 2.5 (0.89%), standard deviation 1.73, median 0) were dedicated to the issue of income and private practice. Leaders in clinical ethics should devote more emphasis to scrutiny and debate on the impact of income in addition to private and dual practice in education and research. There is significant opportunity to enhance such teaching by incorporating an informed approach to the wit and wisdom of the reflections on doctors and their income by Plautus, Moli&#xe8;re and GB Shaw.

The global transition toward Diagnosis-Related Groups (DRG) payment systems has fundamentally reshaped hospital reimbursement landscapes, yet obstetric departments present distinctive implementation challenges owing to the dual-patient paradigm and inherent clinical heterogeneity of maternal-fetal medicine. This study investigates whether strategically constituted DRG review teams can optimize both cost containment and care quality in obstetric settings through variance analysis methodology. We conducted a retrospective cohort analysis at Shenzhen Baoan Women's and Children's Hospital spanning June 2022 to June 2025, encompassing 120 obstetric cases stratified across major DRG categories. The analytical framework integrated Time Consumption Index (TCI), Cost Consumption Index (CCI), and Boston Matrix positioning analysis. Primary outcomes included cost variance patterns, length of stay trajectories, and composite quality indicators with statistical adjustment for patient complexity. Multidisciplinary DRG review team implementation yielded statistically significant improvements: TCI decreased from 1.15&#x2009;&#xb1;&#x2009;0.23 to 0.89&#x2009;&#xb1;&#x2009;0.18 (p&#x2009;<&#x2009;0.001), representing 22.61% efficiency gains; CCI improved from 1.08&#x2009;&#xb1;&#x2009;0.21 to 0.91&#x2009;&#xb1;&#x2009;0.16 (p&#x2009;<&#x2009;0.001), indicating 15.74% cost reduction. Average length of stay decreased from 6.21&#x2009;&#xb1;&#x2009;2.34 to 4.73&#x2009;&#xb1;&#x2009;1.87&#x2009;days (p&#x2009;<&#x2009;0.001), with mean cost savings of &#xa5;1333.33 per case. Pharmaceutical expenses demonstrated the strongest correlation with total cost variance (&#x3c1;&#x2009;=&#x2009;0.82, p&#x2009;<&#x2009;0.001). Critically, quality indicators remained stable throughout implementation, with 30-day readmission rates maintained at 2.50%&#x2009;&#xb1;&#x2009;1.20%. Structured multidisciplinary DRG review teams demonstrate substantial effectiveness in optimizing obstetric resource utilization while preserving care quality. Variance analysis provides a robust framework for identifying pharmaceutical cost management as the primary leverage point for system-wide optimization, informing targeted intervention strategies for DRG implementation within specialized obstetric contexts.

The 340B program requires pharmaceutical manufacturers to provide discounts on drug purchases to hospitals caring for a large share of vulnerable populations. Recent concerns raised by legislators and regulators have highlighted potential misuse of revenue from the program. Thus, we explored changes in the financial performance of 340B-eligible hospitals. Focusing on 340B-eligible hospitals (excluding critical access hospitals), we used 2023 data from Medicare Cost Reports and the Office of Pharmacy Affairs Information System to identify changes in several measures of financial performance among 340B and non-340B hospitals. Descriptive statistics and linear regressions were used to estimate the magnitude of associations. The average 340B hospital was associated with 47.5% (95% CI: 36.7%-58.3%) greater total assets. The number of 340B sites was associated with higher real asset growth, with 10 additional 340B sites associated with a 0.15% (95% CI: 0.05%-0.25%) increase in the real asset growth rate. 340B hospitals also exhibited higher spending on administrative salaries than non-340B hospitals. These findings suggest that 340B-eligible hospitals have had consistently strong financial performance, surpassing non-340B-eligible hospitals. The results provide insight into the ongoing policy debates surrounding how 340B hospitals use proceeds from the program.

Occupational hygiene practices often treat compliance with occupational exposure limits (OEL) as an operational endpoint. However, OEL-compliant processes can still harbor preventable risks when hazard lists are incomplete or processes are upset. We evaluated a novel, pragmatic governance intervention workflow that repurposes routine gas chromatography-flame ionization detection (GC-FID) chromatograms as 'exposure-intelligence' early-warning signals that can trigger prioritized confirmation and preventive action. Decisions are thus reordered from 'assume hazards then quantify targets' toward 'detect anomalous fingerprints, triage by hazard priority, confirm selectively, act, and remonitor.' With explicit handling of unknowns via a precautionary principle that assigns highest hazard potential and maximum uncertainty by default. The workflow comprises Tier-1 screening, Tier-2 hazard-informed triage and confirmation screening, and Tier-3 confirmation and action. Accordingly, we applied standardized GC-FID analysis to thermal desorption and solvent desorption samples from across automotive, electronics, and pharmaceutical manufacturing, which we converted into retention-time-aligned fingerprints. Anomalies were flagged against site-by-task baselines (robust statistics) and prioritized by signal magnitude, recurrence, candidate hazard band, and quality control (QC) uncertainty, triggering targeted gas chromatography-mass spectrometry (GC-MS) confirmation and action logging. From 45,765 chromatograms (237 sites and 37 tasks), screening flagged anomalies in 16.4% (2.3% false alarms, primarily QC/background artifacts). Targeted confirmation averaged 57 GCMS- analyses per month. Implementation was associated with shorter time-to-action (median 28 to 11 days; Cox hazard ratio, 2.4), higher confirmation positive predictive value for actionable high-concern leads (47%vs 23%), and reduced unexplained peak burden after controls (median -22% peaks/windows; -17% unexplained area fraction). Routine GC-FID fingerprints can therefore operationalize scalable early warnings and risk-prioritized confirmation, complementing OEL-based compliance with faster, auditable preventive governance.

Background: The growing complexity and cost of oncohematological treatments has created an urgent need for standardized methodologies capable of enabling inter-institutional comparisons of healthcare expenditure within homogeneous patient groups. Cancer-related pharmaceutical costs vary substantially depending on tumour type, disease stage, and therapeutic approach, making cross-institutional benchmarking challenging due to heterogeneity in patient populations and clinical practice patterns. Therefore, integrating cost analysis with clinically meaningful patient stratification is essential to improve resource allocation and outcome evaluation. Methods: A multicentre working group comprising four tertiary hospitals in Madrid (Spain) was established to develop and preliminarily evaluate a novel classification system for adult oncohematological patients. A standardized methodology was designed to stratify patients into homogeneous groups (PATONCO categories) based on tumor location, therapeutic objective, and clinically relevant biomarkers. A cost indicator was defined as the average cost per patient per month for each PATONCO category. Data were extracted from pharmacy dispensing systems and analyzed using descriptive and inferential statistics, including Kruskal-Wallis and post hoc Dunn tests. Results: A total of 3659 patients were included (3168 oncology; 491 hematology), distributed across 62 programmes (54 oncology; 8 hematology). The PATONCOS tool enabled the identification and validation of a cost indicator (average cost/patient/month per category), allowing inter-hospital comparison. Significant differences in costs were observed across most high-prevalence categories, reflecting variability in drug selection within homogeneous patient groups, as documented by the differential use of specific therapeutic agents across centers. The model demonstrated its capacity to detect intra-group homogeneity and inter-group variability, improving the identification of high-cost patient subgroups and supporting benchmarking across centers. Conclusions: The PATONCOS tool provides a novel, clinically oriented stratification methodology that integrates pharmacotherapy, biomarkers, and disease stage with economic evaluation. This approach enables more accurate comparisons of oncology treatment costs between institutions and may support data-driven decision-making in resource allocation. Its implementation may contribute to more sustainable healthcare systems by aligning clinical practice with economic outcomes.

To assess patient trust in AI-generated medication information, examine associated behavioral safety risks, and evaluate patient expectations regarding the role of clinical pharmacists in preventing medication-related harm. A cross-sectional survey was conducted among adult patients attending outpatient clinics and community pharmacies in Abha, Saudi Arabia. Data were collected across 3 sites (King Khalid University Hospital outpatient department and 2 affiliated community pharmacies) over a 10-week period (December 2025-January 2026), after ethical approval (KKU-147-2025-31). A structured questionnaire assessed demographic characteristics, AI use patterns, trust in AI-generated medication information, verification behaviors, and perceptions of pharmacist involvement. Psychometric evaluation demonstrated good internal consistency of the trust in AI scale. Data were analyzed using descriptive statistics, nonparametric tests, exploratory factor analysis, and ordinal logistic regression. Among 167 participants, trust in AI-generated medication information varied significantly across demographic groups and AI platforms, with higher trust reported for large language model-based tools. Participants without health care backgrounds demonstrated higher trust than health care professionals. Increasing trust was associated with higher behavioral risk, including acting on AI-generated medication advice without verification (P=0.002). Factor analysis identified distinct cognitive trust and behavioral engagement dimensions. Strong support was observed for pharmacist involvement in verifying AI-generated medication information. Patient trust in AI-generated medication information is closely linked to behaviors that may increase medication-related safety risks. Clinical pharmacists play a critical role as a safety barrier, underscoring the need to integrate pharmacist-led verification into AI-informed medication counseling to enhance patient safety.

Hospitalized medical patients are at increased risk of venous thromboembolism (VTE). Current VTE-risk assessment models do not adequately identify which patients would benefit most from prophylaxis, with some low-risk individuals receiving unnecessary anticoagulation and some high-risk patients receiving inadequate protection. A clearer understanding of the risk factors most strongly associated with VTE in this population is needed. A systematic review and meta-analysis were conducted to identify risk factors associated with VTE in acutely ill medical patients. The review was registered on the PROSPERO international prospective register of systematic reviews (CRD42024584005). We searched electronic databases from inception to April 2025 for studies that analyzed risk factors associated with VTE in hospitalized medical patients or within 90 days of discharge. Methodological quality was assessed using the Risk of Bias in Nonrandomized Studies-of Interventions tool, and the certainty of evidence for each risk factor was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Findings were summarized narratively and by performing a random-effects meta-analysis. Of 3804 studies identified, 18 met the inclusion criteria. Risk factor associations were reported using regression analyses, nonparametric tests, and descriptive statistics. A history of cancer or current cancer diagnosis; a history of VTE; acute infection; and comorbidities, including diabetes, atrial fibrillation, ischemic stroke, and hypertension, were the most frequently reported risk factors positively associated with VTE. All studies were assessed as having moderate or serious risk of bias. Using the GRADE approach, a history of VTE was the only risk factor graded as having moderate-certainty evidence. Further work is needed to improve our understanding of which VTE-risk factors are most relevant to medical inpatients.

Human leukocyte antigen (HLA) loci are highly polymorphic genome regions, with allele frequencies varying significantly across different populations. Population HLA frequency databases may contain biases and make cross-study comparison complicated due to varying data curation protocols, genotyping methodologies, resolution, and inconsistencies in the selection criteria for population samples. This study presents HLA allele frequencies of class I (HLA-A, -B, -C) and class II (HLA-DRB1, -DQB1, -DQA1), as well as their combined haplotypes obtained from over 18,000 whole genome sequencing samples of the Russian population. The cohort was stratified based on PCA and admixture components, providing frequencies for 14 different ethnic groups. For 12 groups cohort size allowed us to reach average saturation of 96% of allele frequencies in groups. Moreover, we demonstrated the utility of composed statistics for disease population study using type 1 diabetes (T1D) as an example. Genetically defined population clusters with similar aggregated genetic risk for T1D demonstrated substantial differences in frequencies of risk and protective HLA alleles. Obtained frequency data were made publicly available through the Allele Frequency Net Database improving previously sparse coverage in HLA frequencies data for the East Europe and North Asia regions.

Ultra-short-acting insulin analogues have the potential to achieve clinical benefits for people with type 1 diabetes, but their relative effects in relation to regular human insulin remain unclear. Primary objective: To compare the effects of long-term treatment with (ultra-)short-acting insulin analogues to regular human insulin or another (ultra-)short-acting insulin analogue in people with type 1 diabetes on multiple daily injections through a network meta-analysis. To obtain an estimate of the relative ranking of these (ultra-)short-acting insulin analogues compared to regular human insulin. We searched CENTRAL, MEDLINE, Web of Science, the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov from inception to 14 May 2025, without language restrictions. We included all randomised controlled trials (RCTs) with an intervention duration of at least 24 weeks that compared (ultra-)short-acting insulin analogues with regular human insulins in non-pregnant adults with type 1 diabetes on multiple daily injections. Critical outcomes included glycaemic control, hypoglycaemia, diabetic ketoacidosis, quality of life and adherence to treatment. We evaluated studies with the Cochrane risk of bias tool (RoB 2). We performed statistical analyses using a frequentist network meta-analysis to compare estimates for the critical outcomes, with regular human insulin as the reference treatment, and a random-effects model for other outcomes and pairwise comparisons. We rated the certainty of the evidence using the CINeMA framework. We included 15 RCTs with 6335 participants evaluating insulin aspart, lispro, glulisine, ultra-rapid lispro (URLi) and fast-acting insulin aspart (FIAsp). The duration of interventions ranged from 24 to 52 weeks. Participants had a mean age of 36.4 years and a mean HbA1c of 8.1%. Participants had different basal insulin regimens. Thirteen studies were funded by the pharmaceutical industry. Network meta-analysis: (Ultra-)short-acting insulin analogues versus regular human insulin (RHI) Glycaemic control: haemoglobin A1c (HbA1c) Based on low-certainty evidence from 14 studies with 6039 participants, all five (ultra-)short-acting insulin analogues may result in little to no difference in HbA1c compared to RHI (mean difference (MD): URLi -0.25%, 95% confidence interval (CI) -0.51% to 0.00%; lispro -0.22%, 95% CI -0.46% to 0.02%; glulisine -0.21%, 95% CI -0.48% to 0.06%; FIAsp -0.17%, 95% CI -0.28% to -0.05%; aspart -0.14%, 95% CI -0.21% to -0.06%). Glycaemic control: fasting blood glucose (FBG) Based on extremely low-certainty evidence from four studies with 2737 participants, we are uncertain about the effects of aspart and FIAsp compared to RHI (MD: FIAsp 0.69 mmol/L, 95% CI -0.31 mmol/L to 1.69 mmol/L; aspart 0.80 mmol/L, 95% CI -0.01 mmol/L to 1.61 mmol/L). Lispro, glulisine and URLi could not be assessed in relation to RHI. Mild/moderate (non-severe) hypoglycaemia Based on very low-certainty evidence from six studies with 3967 participants, we are uncertain about the effects of aspart and FIAsp compared to RHI (risk ratio (RR): aspart 1.05, 95% CI 0.97 to 1.13; FIAsp 1.04, 95% CI 0.96 to 1.12). Lispro, glulisine and URLi could not be assessed in relation to RHI. Severe/serious hypoglycaemia Based on low- to very low-certainty evidence from 11 studies with 5390 participants, URLi may result in a reduction in severe/serious hypoglycaemia compared to RHI (RR: URLi 0.80, 95% CI 0.36 to 1.77), but the evidence is very uncertain for aspart and FIAsp (RR: aspart 0.89, 95% CI 0.73 to 1.09; FIAsp 0.79, 95% CI 0.55 to 1.15). Glulisine may result in an increase in severe/serious hypoglycaemia compared to RHI (RR glulisine 1.54, 95% CI 0.46 to 5.19). In contrast, lispro may result in little to no difference compared to RHI (RR: lispro 1.01, 95% CI 0.51 to 1.98). Mild/moderate nocturnal hypoglycaemia This outcome could not be evaluated with network meta-analysis. Severe/serious nocturnal hypoglycaemia Based on very low-certainty evidence from four studies with 3229 participants, we are uncertain about the effects of aspart and FIAsp compared to RHI (RR: aspart 0.63, 95% CI 0.46 to 0.88; FIAsp 0.52, 95% CI 0.26 to 1.04). Lispro, glulisine and URLi could not be assessed in relation to RHI. Diabetic ketoacidosis (DKA) Based on low- to very low-certainty evidence from nine studies with 4599 participants, lispro and URLi may result in a reduction in DKA compared to RHI (odds ratio (OR): lispro 0.74, 95% CI 0.10 to 5.39; URLi 0.74, 95% CI 0.03 to 16.64), whereas FIAsp may result in an increase compared to RHI (OR: FIAsp 1.18, 95% CI 0.12 to 11.24), but the evidence is very uncertain for aspart (OR: aspart 0.80, 95% CI 0.20 to 3.11). Glulisine could not be assessed in relation to RHI. Quality of life This outcome could not be evaluated with network meta-analysis. Adherence to treatment Based on very low-certainty evidence from five studies with 3579 participants, we are uncertain about the effects of aspart and FIAsp compared to RHI (RR: aspart 1.01, 95% CI 0.95 to 1.07; FIAsp 1.01, 95% CI 0.94 to 1.08). Lispro, glulisine and URLi could not be assessed in relation to RHI. (Ultra-)short-acting insulin analogues may result in little to no difference in glycaemic control, non-severe hypoglycaemia and treatment adherence at short-term follow-up, but some agents may reduce severe/serious hypoglycaemia and DKA. We are uncertain about the effects of these insulins on mild to moderate nocturnal hypoglycaemia and quality of life. There were no long-term follow-up data. World Health Organization (WHO). Protocol for this update: PROSPERO CRD42024599817 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024599817); DOI of the previous review: 10.1002/14651858.CD012161.

Women constitute the majority in Argentine rheumatology research, but their participation in rheumatology guidelines and recommendations (RGRs) has not been evaluated. To analyze women's representation in RGRs published between 2010 and 2024 that included at least one Argentine rheumatologist. Cross-sectional bibliometric study of rheumatology guidelines and recommendations published between January 1, 2010, and December 31, 2024, including at least one rheumatologist affiliated with an Argentine center. Publications were identified through searches in PubMed, the Revista Argentina de Reumatolog&#xed;a, and Google Scholar using predefined affiliation-based keywords. The main study variables were author gender, first and corresponding authorship, guideline classification national (NAC) or international (INT), and declared conflicts of interest with the pharmaceutical industry. Descriptive analyses were performed, and group comparisons were conducted using the Mann-Whitney U test and chi-square test. Eighty-seven RGRs were analyzed (79% INT), with a median publication year of 2021. Of 526 authors, 274 (52%) were women. In NAC RGRs, 57% of authors were women versus 43% in INT (p=0.003). Among 25 first authors based in Argentina, 11 (44%) were women; among 12 corresponding authors, 5 (42%) were women. COIs were reported in 24 RGRs, totaling 59 declarations, 37 (63%) from men. Although women are the majority among Argentine rheumatology researchers, their representation decreases in international publications and leadership roles. Conflicts of interest show a gender bias favoring men.

IntroductionArtificial intelligence (AI) is increasingly applied in prostate cancer screening and diagnostic evaluation; however, the structure, methodological characteristics, and clinical positioning of AI-focused trials remain incompletely characterized. This study aimed to map the clinical trial landscape of AI applications in prostate cancer diagnosis using registry-based evidence mapping.MethodsA registry-based evidence-mapping analysis was conducted using ClinicalTrials.gov. Trials registered up to 15 November 2025 were systematically identified using search terms related to prostate cancer and AI-based methodologies. Eligible studies included interventional and observational trials evaluating AI applications for diagnostic purposes. Data were extracted on study design, diagnostic modality, functional role of AI, comparator framework, and validation strategy. Descriptive statistics and cross-tabulation analyses were used to characterize patterns across studies. The study selection process was presented using a PRISMA-style flow diagram.ResultsA total of 84 trials met the inclusion criteria. Imaging-based AI applications predominated, accounting for 52.4% of studies, with magnetic resonance imaging (MRI) representing the most frequently investigated modality (34.5%). Biomarker-based (16.7%), multimodal (15.5%), and computational pathology (7.1%) approaches were less frequently reported. The most common functional applications were classification and risk prediction (48.8%) and lesion detection and segmentation (29.8%). Most studies employed prospective observational designs (84.5%) and frequently relied on stand-alone AI evaluation frameworks (39.2%). Histopathology or biopsy confirmation was the most commonly reported reference standard (56.0%). Only a limited number of trials incorporated workflow integration or clinical decision-support evaluation.ConclusionAI research in prostate cancer diagnostics appears to be primarily centered on imaging-based, early-phase, and performance-oriented studies. Current evidence suggests that AI systems are predominantly positioned as decision-support tools rather than fully integrated clinical solutions. Greater emphasis on multicenter validation, standardized reporting, and clinically relevant outcome evaluation may be required to support broader clinical implementation.

IntroductionEast Java ranked second among Indonesian provinces for HIV/AIDS cases in June 2022. Barriers to prevention include limited knowledge, negative attitudes, and risky practices. This study assessed knowledge, attitudes, and practices (KAP) toward HIV/AIDS and examined their relationships with sexual activity status and preventive sexual behaviors among health faculty students at a University in East Java, Indonesia.MethodsA cross-sectional study was conducted from May to June 2024 using a validated questionnaire. Descriptive statistics summarized participant characteristics and KAP levels. Path analysis using a partial least square examined relationships among variables, with sexual activity status in the full sample and preventive sexual behaviors in the sexually active sub-sample as outcomes.ResultsA total of 441 students were included. Most participants demonstrated high HIV/AIDS knowledge (75.3%), positive attitudes toward people living with HIV/AIDS (PLWHA) (61%), and safe practices (91.6%). In model 1, knowledge had a significant positive relationship with attitudes (&#x3b2; = 0.165; p = 0.000) and sexual activity status (&#x3b2; = 0.038; p = 0.048), while attitudes showed a significant negative relationship with sexual activity status (&#x3b2; = -0.065; p = 0.019). In model 2, knowledge had a significant positive relationship with attitudes (&#x3b2; = 0.615; p = 0.000). However, both knowledge and attitudes showed a non-significant relationship with preventive sexual behaviors.ConclusionsHealth faculty students exhibited high KAP levels. Knowledge consistently was related to attitudes across models, emphasizing the importance of strengthening information-based curricula to improve HIV/AIDS knowledge, including transmission, prevention, and treatment.

Heart Failure (HF) represents a critical challenge for the National Health Service (SSN) in terms of mortality and costs, often fueled by fragmented management between hospital and community care. The objective of this study is to analyze the current care pathway and related direct costs (hospitalizations, medications, outpatient services) to identify inefficiencies and propose an improvement model based on Lean and Value-Based Healthcare (VBHC) methodologies. A retrospective analysis was conducted from January 2022 to December 2023 on a sample of 689 patients with heart failure, utilizing administrative data flows (SDO, SPA, SPF, and SIAD). Lean tools, specifically "As-Is" and "To-Be" Swim Lane maps, were applied to map processes and evaluate hospital-community integration. The total costs generated by the 689 monitored patients amounted to &#x20ac;2,451,475.60. This is broken down as follows: &#x20ac;1,312,227.66 from hospital discharge records (SDO), &#x20ac;169,716.38 from Emergency Department (PS) services, &#x20ac;82,908.64 from outpatient services (SPA), &#x20ac;114,472.92 from pharmaceutical records (SPF), and &#x20ac;772,150 from home care services (SIAD). Significant critical issues emerged in the "As-Is" pathway, revealing analysis biases such as 32.5% of patients not undergoing outpatient visits and 4.7% not receiving specific medications. The "To-Be" model proposes value-centered management through the activation of the Territorial Operations Center (COT), the assignment of a lead physician (tutor), the use of telemedicine, and the integration of the Electronic Health Record (FSE) to overcome the observed biases. Shifting to an integrated and digitalized model is essential to ensure continuity of care and therapeutic adherence, thereby reducing exacerbations and optimizing the use of public resources.

Many essential inhaled medicines recommended in guidelines are delivered to the lung via pressurized metered-dose inhalers (pMDIs). Global environmental legislation will lead to phasing out of hydrofluoroalkane propellants currently used in pMDIs, owing to their global warming potential (GWP). Furthermore, the European Chemicals Agency is reviewing proposed legislation to ban per- and polyfluoroalkyl substances (PFAS) on the basis of chemical structure, which could also impact pMDI availability. Here, we estimated pMDI use as a proportion of all inhaler use in 60 countries, spanning six geographical regions, to understand the relevance of any pMDI restrictions to patients and prescribers. pMDI use as a percentage of total inhaler use during 2022 was calculated by country and geographical region using inhaler sales data (a surrogate of use) from the IQVIA Quarterly MIDAS database; inhaler use for the 10-year period from 2013 to 2022 was also evaluated for these regions. Data were compared by individual inhalations. The total patient population living with asthma and/or chronic lower respiratory disease was calculated on the basis of Eurostat (the statistical office of the European Union [EU]) 2019 data and available disease prevalence statistics. Maintenance pMDI utilization was estimated by adjusting for ratio of maintenance pMDI use to total inhaler use. Across all countries analyzed, pMDIs accounted for the largest proportion of inhaler use in 2022 (77.3%). In 51 out of 55 countries with available country-level data, pMDIs represented&#x2009;>&#x2009;50% of total inhaler use. After adjusting for pMDI usage, an estimated 8.1 million EU patients received a maintenance pMDI in 2022, with the greatest proportion in Germany and France. pMDIs are vital inhalers for most patients in Europe and around the world. While transitioning to near-zero or low-GWP inhalers, it is essential to avoid unintended consequences from the proposed PFAS ban by safeguarding patient access to this essential device option.

To assess factors associated with methotrexate-induced oral mucositis and its impact on the quality of life of pediatric patients with acute lymphoblastic leukemia, considering chemotherapy dose and mucositis severity within a clinical context where photobiomodulation is routinely used as part of the institutional care protocol. A cross-sectional study was conducted with 113 pediatric patients aged 5 to 18 years undergoing methotrexate-based chemotherapy between 2020 and 2024 in a university hospital in Northeastern Brazil. Data were collected using the Children's International Mucositis Evaluation Scale (ChIMES; self-report and proxy), the Child Oral Impacts on Daily Performances (C-OIDP), the WHO Oral Mucositis Grading Scale, photobiomodulation records, and chemotherapy regimen data. Descriptive statistics, Spearman correlation, and multiple linear regression analyses were performed (&#x3b1;&#x2009;=&#x2009;0.05). Among the participants, 85% reported a high impact on quality of life. The mean age was 10.8 years (SD&#x2009;=&#x2009;3.49), and most participants were boys. Higher mucositis severity, older age, higher methotrexate doses, and longer wound healing time were associated with worse quality of life. A strong positive correlation was observed between C-OIDP and ChIMES scores (p&#x2009;<&#x2009;0.001). In the regression analysis, mucositis severity (&#x3b2;&#x2009;=&#x2009;0.304; p&#x2009;=&#x2009;0.021) and wound healing time (&#x3b2;&#x2009;=&#x2009;0.492; p&#x2009;<&#x2009;0.001) remained significantly associated with higher impact scores. Methotrexate-induced oral mucositis was associated with a substantial negative impact on quality of life in pediatric patients with acute lymphoblastic leukemia. Greater mucositis severity and longer wound healing time were the main factors associated with worse outcomes. Although photobiomodulation was systematically applied as a preventive and therapeutic intervention, no causal inference regarding its independent effect can be established.