Chronic dyspnoea is a prevalent and clinically significant symptom, often indicative of underlying cardiorespiratory disease. It is frequently under-reported by patients and under-recognised in primary care, with these challenges exacerbated in rural and remote communities where disease burden is greater and patients experience barriers to timely diagnosis and management. The BREATHE SMART trial aims to implement and evaluate an innovative, fully digital self-screening system for chronic dyspnoea, integrated into general practice workflows and information technology infrastructure. This approach seeks to enhance early detection and management of chronic cardiorespiratory conditions across diverse practice settings. This multisite proof-of-concept study will test a software platform delivering a preconsultation self-screening questionnaire across 40 general practices in urban, rural and remote Australia. The system identifies eligible patients (≥18 years, consenting to SMS communication with their practice), issues an automated SMS that administers a validated dyspnoea screening questionnaire, and summarises responses for integration into the electronic medical record. Process evaluation will assess acceptability and utility using deidentified audit data, software metrics and qualitative feedback from patients, staff and general practitioners (GPs) via surveys, interviews and focus groups. Approximately 12 000 patients will be screened over 12 months. Primary outcomes will include the proportion completing self-screening and prevalence of chronic dyspnoea and secondary outcomes will include the rate of newly diagnosed chronic dyspnoea-related conditions (ie, asthma, chronic obstructive pulmonary disease and heart failure) in the preceding 12 months and during the intervention period. Ethics approval was granted by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and the University of Notre Dame Australia HREC (2024-155). Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practices. ACTRN12624001451594.
Extreme heat, amplified by climate change, has become a predictable and escalating occupational hazard in Türkiye, increasing the burden of heat-related illnesses, traumatic workplace injuries, and productivity losses among both outdoor and indoor workers, particularly in labor-intensive sectors and among vulnerable populations. This Turkish Thoracic Society workshop report synthesizes interdisciplinary expert input and available evidence to propose a practical, prevention-focused framework for regulating working conditions in extreme temperatures. The recommendations were systematically developed through four thematic interdisciplinary working groups and finalized by plenary consensus. Key recommendations include explicitly defining employers' duties to assess, prevent, and manage extreme weather-related risks within Occupational Health and Safety Law No. 6331; establishing secondary regulations that operationalize temperature/Wet-Bulb Globe Temperature (WBGT)-triggered work-rest schedules, hydration and cooling requirements, and acclimatization protocols; and standardizing objective heat-stress monitoring using the WBGT index (aligned with ISO 7243). The report prioritizes engineering and administrative controls (shading, ventilation/cooling, shift adjustments, rest areas, and "buddy systems") over reliance on personal protective equipment, and calls for strengthened labor inspection capacity "through the lens of climate change." Additional policy actions include integrating heat-related outcomes into occupational disease and injury surveillance systems, enhancing inter-institutional coordination for rapid reporting and work-stoppage mechanisms during extreme heat events, and implementing multilingual, sector-specific training and emergency preparedness pathways. Protecting informal and migrant workers, seasonal agricultural laborers, and individuals with chronic cardiopulmonary disease is highlighted as a core priority for equity and climate justice.
Despite growing numbers of women entering medicine, female neurosurgeons and cardiothoracic surgeons continue to report persistent gender discrimination in their workplaces. While previous efforts to address these disparities have focused on individual-level interventions, less attention has been directed toward the cultural and structural dynamics that sustain inequity within these high-intensity surgical environments. This study explores female surgeons' perspectives on how neurosurgery and cardiothoracic surgery might become more equitable and inclusive. This qualitative study involved semi-structured interviews with 18 female neurosurgeons and 4 cardiothoracic surgeons in North America. The grounded theory method of data collection and analysis was used. Analysis involved line-by-line coding and was inductive, with codes and categories emerging from participants' narratives. Participants emphasized the need for a fundamental cultural shift within surgical practice. Six interrelated strategies were identified: (1) changing surgical training culture; (2) increasing female representation; (3) valuing surgeon differences; (4) supporting women through mentorship, advocacy, and sponsorship; (5) speaking up about bias and discrimination and pursuing legal action where necessary; and (6) implementing strategic policy changes and accountability mechanisms. Participants emphasized that policy reforms must be accompanied by cultural change and enforcement from leadership to produce meaningful impact. Female surgeons in neurosurgery and cardiothoracic surgery view gender inequity as embedded within the cultural and structural organization of surgical practice. Addressing these disparities requires coordinated reforms in training culture, representation, institutional policy, and accountability. Sustainable progress will depend on broader cultural transformation rather than isolated or symbolic interventions.
Abdominal fat distribution, particularly visceral fat, is commonly assessed as a marker of obesity-related and metabolic diseases in people. While this relationship may exist, few studies consider the factors related to the relative distribution of visceral and subcutaneous abdominal fat in dogs. This cross-sectional study evaluated associations between measures of abdominal adiposity, visceral and subcutaneous fat distribution (V/SQ), body condition score (BCS), age, sex, neuter status, and breed conformation in 205 dogs presenting to a tertiary veterinary hospital between March 2006 and March 2020. The influence of several disease states on abdominal adiposity and fat distribution was also evaluated. Additionally, the study aimed to assess the criterion validity of average computed tomography (CT) Hounsfield units, and linear and cross-sectional area measures of abdominal adiposity and fat distribution relative to CT-derived volumetric analysis and for intra-observer reliability. Greater total abdominal adiposity was seen in older dogs, with values highest around 10 years of age and lower after 10 years of age, and was lower in terrier breeds and dogs with neoplasia. Greater V/SQ was observed in older dogs, hounds, and terriers, but decreased with increasing BCS, total abdominal adiposity, and thoracic height-width ratio. Additionally, V/SQ was higher in dogs with hyperadrenocorticism. Body condition score was moderately correlated with total abdominal, visceral, and subcutaneous adiposity. Abdominal fat areas measured at L3 overestimated total abdominal and visceral fat percentages but underestimated subcutaneous fat percentages, with increasing bias at higher fat percentages. Linear fat measurements were moderately correlated with total abdominal adiposity, but only weakly correlated with abdominal fat distribution. This study supports the association between abdominal adiposity, age, breed category, and potentially certain diseases like neoplasia. Moreover, it highlights the correlation between V/SQ, age, and total adiposity, while emphasising the preferential distribution of fat to the visceral compartment in dogs with hyperadrenocorticism. The study also identified a novel association between V/SQ, specific breed categories, and body conformation (i.e., thoracic height-width ratio). Importantly, CT volumetric measures are more reliable in determining abdominal fat distribution than area and linear measures, supporting the use of CT volumetric measures in the study's methodology and its implications for future research and clinical practice.
Musculoskeletal disorders are the leading cause of disability in Canada, and chiropractic care is among the most commonly used healthcare services for their management. Despite this, little is known about the quality of care and adherence to clinical practice guidelines in chiropractic educational settings. This study aimed to describe the Université du Québec à Trois-Rivières university-based chiropractic clinic cohort (UQTRChiCo) and summarize its patient characteristics, care provided, and available outcome data. We conducted a retrospective cohort study of patients who first consulted at the Université du Québec à Trois-Rivières (UQTR) chiropractic clinic in 2017, with longitudinal follow-up through 2019. Reasons for clinical consultation (i.e., specific chief complaints) were treated as separate observations. Data were extracted from clinical records and included patient demographics, clinical presentations, care provided, and outcomes measured using validated questionnaires. Follow-up assessments were obtained from re-evaluations conducted at multiple time points between 1 January 2017 and 31 December 2019. The UQTRChiCo comprises 2,148 distinct reasons for consultation from 1,305 unique patients (59% female, mean age 31 ± 18 years). The most common presentations were lumbar spine (28%), cervical spine (18%), and thoracic spine complaints (10%). Multiple concurrent complaints were reported in 44% of patients, and 43% of conditions were chronic. Care commonly included spinal manipulative therapy (88%) and soft tissue treatments (93%). Patient education and exercise prescription were documented in 67% and 48% of consultations, respectively. Diagnostic imaging was performed in 19% of consultations. Follow-up outcome documentation was available for 58% of consultations at the first re-evaluation, decreasing to 16% by the third re-evaluation. The UQTRChiCo provides a comprehensive description of an academic chiropractic clinical population primarily seeking care for spinal musculoskeletal complaints. Care delivery reflected a multimodal approach with restrained use of diagnostic imaging. While short-term outcome monitoring proved feasible, substantial attrition over time underscores a key challenge for longitudinal practice-based research in educational clinics. The UQTRChiCo represents a valuable resource for advancing research on care quality, guideline adherence, and patient outcomes in chiropractic training environments.
Autopsies play a critical role in elucidating the pathogenesis of emerging infectious diseases, particularly in cases involving high-consequence pathogens such as viral haemorrhagic fevers (VHFs). While biosafety concerns have restricted post-mortem examinations in such contexts, the COVID-19 pandemic has renewed interest in autopsy-based research and highlighted both the potential and the gaps in current biosafety protocols. This narrative review outlines autopsy practices in the context of high-consequence infectious diseases (HCIDs) with a focus on VHFs, summarizes reported autopsy cases, explores alternative post-mortem methods, and examines the evolution of legal and institutional frameworks in response to the pandemic. A comparison of official international guidelines shows that while detailed autopsy protocols have been published for pathogens requiring BSL-3 containment - particularly in the United States (US) and United Kingdom (UK) - no official procedural guidance seems to be available for performing autopsies under BSL-4 conditions. Instead, current recommendations at this level are limited to post-mortem handling and disposal of the deceased. This regulatory and procedural gap underscores the urgent need for harmonized, high-containment autopsy protocols that balance biosafety with scientific value. Developing such frameworks will be essential to improve outbreak preparedness and enable evidence-based responses to future pandemics globally. Accordingly, we propose a structured, system-based approach to BSL-4 autopsy practice as a foundation for discussion and future guideline development.
Data on age-specific outcomes in patients with atrial fibrillation (AF) treated with edoxaban in real-world settings are limited; this prespecified analysis of the ETAF-TR study aimed to investigate the influence of age on prespecified clinical outcomes, including overt bleeding, major bleeding, ischemic stroke, all-cause mortality, major adverse cardiovascular events (MACE), and net clinical benefit. The ETAF-TR study is a prospective, multicenter, observational registry conducted at 50 cardiology clinics across Türkiye. Patients with AF receiving edoxaban (60 mg standard dose or 30 mg reduced dose) were categorized into three age groups: < 65 years (n = 265), 65-74 years (n = 397), and ≥ 75 years (n = 391). Time-to-event outcomes were analyzed using the Kaplan-Meier method and unadjusted Cox proportional hazards models, with the < 65-year age group as the reference. Of 1053 enrolled patients, 25.1% were aged < 65 years, 37.7% were aged 65-74 years, and 37.1% were aged ≥ 75 years. Older patients had higher Congestive heart failure, Hypertension, Age ≥75, Diabetes, Stroke, Vascular disease, Age 65-74, Sex category (female) (CHA₂DS₂-VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding history, Labile INR, Elderly, Drugs or Alcohol (HAS-BLED) scores, lower creatinine clearance, and more frequent use of reduced-dose edoxaban. Appropriate edoxaban dosing was documented in 82.2% of patients; 8.0% received an inappropriately low dose and 9.8% an inappropriately high dose. Nonsteroidal antiinflammatory drug (NSAID) use was observed in 8.7%, 5.3%, and 10.2% of patients in the < 65, 65-74, and ≥ 75 groups, respectively, and approximately 12% received concomitant antiplatelet therapy without a documented indication. Major bleeding rates were 0.94, 1.20, and 1.13 per 100 patient-years in the < 65, 65-74, and ≥ 75 groups, respectively. Thromboembolic event rates were 0.38, 0.26, and 1.88 per 100 patient-years, respectively. All-cause mortality increased with age: 2.54, 4.34, and 10.84 per 100 patient-years, respectively; the unadjusted hazard ratio for ≥ 75 versus < 65 years was 4.04 (95% CI 1.69-9.65). Of 56 deaths, 10 (17.9%) were attributed to coronavirus disease 2019 (COVID-19) pneumonia, whereas one death was attributed to ischemic stroke and none to major bleeding. Prespecified descriptive secondary composites, including major adverse cardiovascular events and net clinical benefit, were also higher in the ≥ 75 group. In this real-world cohort of patients with AF treated with edoxaban, major bleeding rates remained consistent across age groups despite an increased comorbidity burden in older patients. Thromboembolic or hemorrhagic events could not account for the excess mortality observed in the ≥ 75 age group; instead, higher comorbidity burdens and the ongoing COVID-19 pandemic may have played contributory roles. Furthermore, beyond issues related to inappropriate dosing and concomitant NSAID or antiplatelet use, significant prescribing concerns persist in clinical practice.
Injectable dermal fillers are widely used in aesthetic medicine; however, immunologically mediated hypersensitivity reactions may negatively influence clinical and aesthetic outcomes. Understanding their incidence, clinical presentation, and consequences is essential for improving patient safety and treatment effectiveness. To evaluate the incidence, clinical characteristics, and impact of hypersensitivity reactions on aesthetic outcomes after dermal filler injections. A prospective observational study included 92 patients aged 25-64 years who underwent cosmetic filler injections at an aesthetic clinic in Poland between November and December 2024. The fillers used included hyaluronic acid, calcium hydroxyapatite, and polycaprolactone-based preparations. Patients were monitored for 30 days with follow-up visits on days 3, 7, 14, and 30. Hypersensitivity reactions were classified according to the Gell-Coombs classification (types I and IV). Clinical manifestations, severity, and laboratory parameters (IgE, C-reactive protein, and procalcitonin) were evaluated in selected cases. Aesthetic outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) and a Visual Analogue Scale (VAS) of patient satisfaction. Hypersensitivity reactions occurred in 21 patients (22.8%). Delayed type IV reactions predominated (13.0%) and manifested with infiltrates, erythema, and pain occurring 5-14 days after injection, whereas immediate type I reactions were recorded in 9.8% of patients within the first 72 h. The highest reaction rates were observed with calcium hydroxyapatite and polycaprolactone fillers. Severe reactions required systemic therapy and were associated with elevated IgE levels in most cases. Patient satisfaction was significantly lower in the reaction group (VAS 5.9 ± 1.8 vs. 8.4 ± 1.1; p < 0.01). All reported aesthetic complications, including fibrosis and hyperpigmentation, occurred exclusively in patients with hypersensitivity reactions. Hypersensitivity reactions to dermal fillers occur relatively frequently and significantly affect aesthetic outcomes and patient satisfaction. Individual risk assessment, careful filler selection, and extended post-procedure monitoring are necessary to minimise complications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Thoracic and cardiac surgical procedures are associated with significant postoperative pain. Intercostal nerve cryoablation (INC) is a non-opioid adjunctive pain management strategy. The objective of this study was to comprehensively review published outcomes of INC during non-pectus repair thoracic and cardiac surgeries to inform clinical practice and guideline development. A literature search was conducted in PubMed, Embase, Google Scholar, and using manual approaches to identify comparative studies of patients undergoing non-pectus repair thoracic or cardiac procedures with INC versus standard of care (SOC) without INC. Meta-analyses were performed to quantitively evaluate opioid consumption and hospital length of stay (LOS). Secondary outcomes were summarized qualitatively. Twenty-four studies were included encompassing 18465 patients, of whom 10.6% (n = 1954) received INC. INC was applied during surgical stabilization of rib fractures, thoracotomy, pulmonary resections, lung transplants, aortic aneurysm repair, and cardiac procedures. Meta-analyses of adult studies demonstrated a significant reduction in inpatient opioid consumption by 102 morphine milligram equivalents (MME) (95% CI: -180.00, -23.87) and a non-significant reduction in opioid consumption after discharge by 89 MME (95% CI: -182.00, 4.56) with INC. Sub-group analysis demonstrated the largest effect size in inpatient opioid reduction for bilateral thoracotomy or thoracosternotomy for lung transplants. Meta-analysis demonstrated no significant difference in hospital stay for adult patients treated with INC. The results of this systematic review and meta-analysis provide evidence to support the association between INC and reduced inpatient opioid consumption in non-pectus repair thoracic and cardiac procedures.
Soft tissue metastases are rare lesions seen in the course of systemic malignancies and pose diagnostic challenges. Radiological findings are heterogeneous, and standardized criteria are needed for reliable differentiation from benign lesions. While the diagnostic importance of perilesional changes is emphasized in the current literature, comprehensive analyses considering the clustered data structure are lacking. In this study, we aimed to determine effective radiological parameters for distinguishing soft tissue metastases from benign soft tissue lesions and to reveal the independent predictive value of perilesional findings. Soft tissue lesions detected by computed tomography (CT) and magnetic resonance imaging (MRI) between January 2015 and December 2023 were retrospectively evaluated in this single-center study. The study included 57 benign lesions (55 patients) and 139 metastatic lesions (65 patients). Lesion size, contour characteristics, morphological shape, anatomical localization, perilesional edema, and perilesional vascularity were evaluated. Due to the clustered data structure, the Generalized Estimating Equations (GEE) methodology was used. Model performance was evaluated using ROC curve analysis, precision-recall curve, and Brier score. Statistical analyses were performed using Jamovi v2.6.44, JASP v0.19.3, and R v4.5.1 software. Metastatic lesions were significantly smaller than benign lesions (median 17.0 mm vs. 33.3 mm; p<0.001). In the GEE analysis, the presence of perilesional edema increased the likelihood of metastasis by 35 times (OR=35.25; 95% CI: 7.58-164.00; p<0.001), and perilesional vascularity increased the likelihood of metastasis by 45 times (OR=44.54; 95% CI: 1.86-1066.00; p = 0.016). Abdominal-pelvic localization showed a 133- fold (OR=133.00; 95% CI: 10.90-1622.00; p<0.001) higher likelihood of metastasis compared to the extremities, while thoracic-anterior chest wall localization showed a 35-fold (OR=35.22; 95% CI: 2.41-514.00; p = 0.007). Each unit increase in standardized size reduced the likelihood of metastasis by 90% (OR=0.10; 95% CI: 0.02-0.42; p = 0.001). The model demonstrated excellent discrimination (AUC-ROC=0.947) and calibration (Brier score=0.075) performance. Our results show that perilesional edema and perilesional vascularity are key diagnostic signs of metastatic lesions. The combined assessment of perilesional findings and anatomical localization can significantly enhance diagnostic accuracy in daily practice. Furthermore, the relationship between lesion size and the metastatic process emphasizes the need for more careful evaluation of smaller lesions. Perilesional edema, perilesional vascularity, and trunk region localization were associated with soft tissue metastasis. These findings may be helpful in the radiological differentiation of metastasis and benign soft tissue lesions.
Idiopathic pulmonary fibrosis (IPF) is a progressive debilitating lung disease which affects physical and mental well-being. The IPF Patient-Reported Outcome Measure (IPF-PROM) scale is a validated and reliable tool for the self-report of physical and psychological well-being in IPF. This study aimed to validate a Greek version of the IPF-PROM scale and further investigate its correlation with clinical features of IPF patients and its interrelation with depressive symptoms and health-related quality of life (HRQoL). This was a two-centre, observational, cross-sectional study, in which IPF patients completed three scales: IPF-PROM, Patient Health Questionnaire-9 (PHQ-9), an index of depressive symptoms, and Health Survey Questionnaire Short Form-12 (SF-12), an index of HRQoL, at the IPF Outpatient Clinics of two University Hospitals in Greece during 2023-2024. Logistic regression analysis was conducted to assess severe status of IPF-PROM compared with mild/moderate status. The study involved 136 IPF patients (87.9% males) with a mean age of 73.5±7.9 years. Patients were classified overall with moderate disease according to IPF-PROM mean scores (41.7±31.3), particularly in the combined Breathlessness/Fatigue and the Psychological well-being components (40.1 and 43.8, respectively, p>0.050). Patients with severe symptoms, as measured by IPF-PROM, scored higher levels of depressive symptoms on PHQ-9 compared with those with moderate or mild symptoms (17.1, 12.3 and 1.4, respectively, p<0.001) and lower levels of HRQoL in physical (32.6, 34.7 and 47.9, p<0.001) and mental health on SF-12 (23.9, 34.5 and 50.3, p<0.001). Patients with incrementally higher levels of oxygen saturation had lower odds for severe health status according to IPF-PROM (OR=0.83, p=0.018). A significant percentage of IPF patients present with impaired health status and symptoms suggestive of depression. The IPF-PROM scale represents a useful tool that may predict impairment of mental health and HRQoL in IPF, with potential utility for clinical practice and research.
The recommended corridor length for the 6-minute walk test (6MWT) is 30 meters. However, it is not always feasible in clinical practice. The objective of this study was to compare walking distance and hemodynamic responses during 6MWTs performed in 10-, 20-, and 30-meter corridors in healthy young adults. Thirty-four healthy young adults (mean age: 21.2±1.5 years; female/male: 25/9) completed three randomized 6MWTs in 10-, 20-, and 30-meter corridors on separate days and with a crossover design. Walking distance, mean walking speed, and step counts were measured. Heart rate, blood pressure, respiratory rate, peripheral oxygen saturation, dyspnea, and fatigue were recorded at baseline (Pre), immediately post-test (Post), and at 3 (R3) and 5 (R5) minutes of recovery. Data were analyzed using the Friedman test with post-hoc Wilcoxon signed-rank tests and Bonferroni correction. Walking distance and speed were significantly lower in the 10-meter corridor than in the 20- and 30-meter corridors (P < 0.05), whereas step counts did not differ (P = 0.065). Hemodynamic responses were similar in all tests, except for increased post-test fatigue and dyspnea at R5 during the 10-meter corridor test (P < 0.05). Although hemodynamic responses were comparable across different corridor lengths, the 10-meter corridor led to an underestimation of walking distance by ~60 meters and to increased subjective fatigue and dyspnea. A 20-meter corridor may serve as a feasible alternative when the standard 30-meter corridor is unavailable in clinical practice, whereas a 10-meter corridor should be avoided.
This study aimed to conduct the first national survey to characterize the current practice, training and perceived barriers associated with robotic-assisted thoracic surgery (RATS) among thoracic surgeons in Spain. Between February and March 2025, a nationwide electronic survey was distributed to thoracic surgeons through a scientific society. The questionnaire assessed institutional demographic variables, the volume and types of robotic procedures, perceived benefits and barriers, training models and access to the technology. A total of 120 responses from thoracic surgeons representing 55 hospitals were analyzed. Among these, 103 respondents (85.8%) worked in centers with an active RATS program and were included in analyses related to robotic activity. Most respondents practiced within the public healthcare system (87.4%). Although more than 63% of RATS programs had been established for at least 2 years, only 27.2% of survey participants reported that most surgeons in their department were trained as console surgeons. At the institutional level, 69.9% indicated that all types of thoracic procedures were performed using RATS, and 31.1% reported more than 200 accumulated robotic cases. However, in over half of the hospitals, robotic surgery accounted for less than 25% of total thoracic surgical activity. This study provides the first national overview of the status of RATS in Spain, highlighting its potential as well as the challenges limiting broader clinical consolidation. Standardized training, particularly among residents, and equitable access to robotic platforms have emerged as key priorities for the nationwide consolidation of RATS.
With the development of new technologies, surgical treatment options for lung cancer have become increasingly diverse, providing patients with more choices before surgery, which may lead to hesitation, uncertainty, and decisional conflict. Decisional conflict can affect psychological well-being and may reduce treatment adherence. Facilitating patient involvement has been proposed as a potential strategy to reduce decisional conflict; however, the underlying mechanisms remain unclear. This study aimed to examine the association between facilitating patient involvement and decisional conflict among patients undergoing surgical treatment for lung cancer and to explore the mediating and serial mediating roles of hope level and social support. A cross-sectional study was conducted among 321 patients undergoing surgical treatment for lung cancer using a convenience sampling method. Data were collected using a self-developed sociodemographic questionnaire, the Facilitating Patient Involvement Scale, the Herth Hope Index, the Perceived Social Support Scale, and the Decisional Conflict Scale. Mediation and serial mediation analyses were performed using Model 6 of the PROCESS macro (version 4.1) for SPSS, with 5,000 bootstrap resamples to estimate indirect effects and their 95% confidence intervals. The median decisional conflict score was 25.00 (IQR:6.25-28.13). Overall, Overall, 51.4% of patients had decisional conflict, and 13.7% reported high levels of conflict. Facilitating patient involvement (r = - 0.394), hope level (r = - 0.504), and social support (r = - 0.677) were all negatively correlated with decisional conflict (all P < 0.05). Facilitating patient involvement was associated with decisional conflict through both direct and indirect pathways. The total effect was - 0.744, with an indirect effect of - 0.337, accounting for 45.3% of the total effect. The serial mediation model involving hope level and social support was statistically significant (indirect effect = - 0.069). Facilitating patient involvement was associated with lower levels of decisional conflict through both direct and indirect pathways, including indirect pathways involving hope level and social support. These findings provide new perspectives for the development of multi-level decision-support systems. Clinical nursing practice may benefit from greater attention to the integration of psychological and social resources to better address decisional challenges among patients undergoing treatment for lung cancer.
Ultrasound-guided transthoracic lung biopsy is a well-established, minimally invasive technique for evaluating peripheral and pleural-based lung lesions. Its use by trained pulmonologists has expanded in recent years; however, evidence from tuberculosis-endemic regions remains limited. This study aimed to assess the diagnostic yield and safety profile of pulmonologist-performed ultrasound-guided transthoracic biopsy of pleural-based lung masses. This retrospective study included patients who underwent ultrasound-guided transthoracic biopsy of pleural-based lung lesions. Of 129 eligible patients, 6 did not undergo the procedure, and 7 were excluded because histopathology was unavailable, resulting in 116 patients included in the final analysis. All biopsies were performed by pulmonologists who had formal interventional pulmonology training or who were under direct supervision. Diagnostic yield, histopathological findings, and procedure-related complications were evaluated. The overall diagnostic yield was 97.4% (113/116). Malignancy was identified in 72.4% of patients, with adenocarcinoma (39.7%) as the most frequent subtype, followed by squamous cell carcinoma (15.5%). Tuberculosis was diagnosed in 9.5% of cases, while 2.6% remained inconclusive. Notably, 29.3% of patients were already receiving anti-tuberculosis therapy at presentation. The overall complication rate was 10.3%. Pneumothorax occurred in 3.4% of patients, and minor hemoptysis occurred in 2.6%; all events were managed conservatively. No procedure-related mortality was recorded. Pulmonologist-performed ultrasound-guided transthoracic biopsy of pleural-based lung lesions yields high diagnostic yield with a low complication rate when conducted by formally trained operators. In tuberculosis-endemic settings, histopathological confirmation is critical to differentiate malignancy from infectious etiologies. Structured interventional pulmonology training may further optimize procedural outcomes and enhance patient safety.
Empowering nurses to discuss clinical trials with patients can increase recruitment rates. Clinical trials are essential for improving lung cancer patient outcomes; in the short term, they provide individuals access to new treatments and care regimens which, longer term, have the potential to advance clinical care. However, recruitment into lung cancer clinical trials is as low as 5%, and lung cancer nurses feel ill-equipped to signpost clinical trial opportunities to patients. This study aimed to pilot and assess the acceptability and utility of the 'Lung I-ACT tool': a newly developed resource comprising a patient-facing leaflet and a nurse-facing poster, designed to help lung cancer nurses initiate clinical trial discussions with patients. A 6-month, mixed methods, pilot study was conducted at seven NHS hospital sites in the UK; four were intervention sites, three were control sites. Data on self-efficacy, knowledge, confidence, awareness and current practice were collected using online surveys for nurses at baseline, 3 and 6 months, and online interviews with lung cancer nurses and patients from intervention sites. Survey data were analysed using descriptive and inferential statistics, and interview data were thematically analysed via Framework Method. Thirty-four nurse respondents were recruited to the survey. Survey findings indicated increased frequency of clinical trial discussions at the intervention sites, and increased nurse awareness, confidence and knowledge to navigate these discussions. Eleven nurses and four patients were interviewed; these data comprised five themes regarding lung cancer nurses' and patients' views of the Lung I-ACT tool: (1) content and format of the tool, (2) application and utility of the tool in practice, (3) perceived changes to practice, (4) knowledge, awareness and confidence to discuss clinical trials, (5) contextual and situational factors impacting the presentation of clinical trials. The Lung I-ACT tool improves nurses' confidence in discussing trials with patients through increasing their awareness of clinical trial opportunities and helping them to structure conversations.
Recent advances in surgical robotic systems, high-speed communication networks, and information processing technologies have made the clinical implementation of remote surgery increasingly feasible. Although pilot clinical applications have been initiated worldwide, the safe, ethical, and sustainable adoption of remote surgery requires comprehensive guidance that addresses not only technical considerations, but also clinical practice, legal responsibility, and organizational frameworks. In response to these needs, the Japan Surgical Society has developed the second edition of the Clinical Practice Guidelines for Telesurgery through a multidisciplinary, consensus-based process involving multiple surgical societies. This updated edition builds on validation and verification studies conducted since the publication of the first edition and places particular emphasis on practical implementation in real-world clinical settings, including telesurgical support and telementoring. The guidelines provide expanded, implementation-oriented recommendations covering surgeon and support staff qualifications, institutional requirements, communication network performance and cybersecurity standards, registry-based governance, and structured approaches to remote surgical mentoring. In addition, legal and ethical considerations are strengthened through the inclusion of representative informed consent documents and contractual frameworks. To enhance international applicability, content that is broadly relevant across jurisdictions is presented separately from elements specific to the Japanese regulatory environment. These guidelines aim to support the responsible global dissemination of telesurgery by promoting safety, transparency, and clinical effectiveness.
To translate, revise and evaluate the Chinese-version Nursing Leaders' Readiness for Artificial Intelligence Scale and assess Chinese nursing leaders' AI readiness. Cross-sectional survey. The research team conducted translation, cognitive interviews, a pilot survey and psychometric evaluation. Survey participants were 762 nursing managers. The reliability and validity of the Chinese-version scale were examined. The status and influencing factors of AI readiness among Chinese nursing managers were investigated. The translated scale comprises 20 items. Cronbach's α was 0.824. Regarding validity, the three-factor model demonstrated a good fit. The square roots of the average variance extracted, absolute values of correlation coefficients among dimensions and content validity index values were acceptable. The mean AI readiness score was 65.27 ± 9.78. Of the participants, 624 scored above 60 points, 136 scored 40-60 points and 2 scored below 40 points. Scores differed significantly by hospital type, hospital level, department, training participation, prior AI tool or system use and frequency of AI usage. The Chinese-version scale demonstrated good reliability and validity and can effectively assess AI readiness among Chinese nursing managers. Nursing leaders generally demonstrated a favourable level of AI readiness; however, factors such as hospital type and level remain significant determinants influencing nursing leaders' AI readiness. This study provides a standard measurement tool for Chinese hospitals to check how ready their nursing managers are for AI. These findings help us understand the current state of AI readiness among nursing managers in China. The results can help improve AI use strategies. In addition, they can help bring AI into nursing practice more smoothly. This study has important value for moving forward with digital change and smart nursing in China.
Infections caused by carbapenem-resistant Enterobacterales (CRE) pose significant challenges in clinical practice. In practical work, laboratory detection of CRE, as well as the diagnosis, treatment, and prevention of related clinical diseases, still face numerous difficulties due to a lack of consensus and standardization. To better guide clinical practice related to CRE in China, Clinical Microbiology Society of China International Exchange and Promotive Association for Medical and Health Care and Chinese Thoracic society, Chinese Medical Association invited experts in clinical microbiology, respiratory medicine, infectious diseases, critical care medicine, clinical pharmacy, epidemiology, and other relevant clinical fields to jointly discuss and formulate this consensus, and finally formed 15 recommendations. The consensus systematically summarizes information related to CRE, including terminology, mechanisms of formation, resistance mechanisms, transmission mechanisms, epidemiology, laboratory testing, clinical diagnosis, treatment, infection prevention and control, with the aim of standardizing laboratory and clinical aspects of CRE-related work. 碳青霉烯类耐药肠杆菌目（CRE）感染对临床造成严重挑战。实际工作中，CRE的实验室检测和所致临床疾病的诊治及防控仍然面临诸多难题，缺乏共识和标准。为了更好地指导我国CRE相关的临床实践，中国医疗保健国际交流促进会临床微生物学分会和中华医学会呼吸病学分会邀请微生物学、呼吸病学、感染病学、重症医学、药学、流行病学等领域的专家共同研讨和制订本共识，最终形成了15条推荐意见。本共识系统归纳了CRE相关术语、形成机制、耐药机制、传播机制、流行病学、实验室检测、临床诊断、治疗、感染预防和控制等内容，以期规范CRE相关的实验室诊断和临床防治工作。.
The balance between thromboembolic complications and bleeding risk in anticoagulated patients with atrial fibrillation remains challenging, with left atrial appendage occlusion (LAAO) representing a potential alternative. Our prospective multicenter study aimed to evaluate the feasibility, safety, technical, and procedural outcomes of the contemporary practice of stand-alone LAAO. The SALAMANDER (Stand-Alone Left Atrial Appendage Occlusion for Thromboembolism Prevention in Nonvalvular Atrial Fibrillation Disease) registry is a real-world, multicenter, observational cohort study conducted at 16 cardiac centers in Europe between 2010 and 2024, evaluating the safety and efficacy of LAAO using contemporary devices. A total of 1660 patients were enrolled, with a median age of 76 (interquartile range, 70-81) years and 38% being women. The median CHA2DS2-VASc score was 4 (interquartile range, 3-5). The most common indication for LAAO was significant bleeding (83.7% of patients), most frequently during treatment with direct oral anticoagulants (68.8%) more than vitamin K antagonists (24.9%). The predominant bleeding sites were the lower (27.9%) and upper (21.7%) gastrointestinal tracts, with 17.4% having a history of hemorrhagic stroke. The most common antithrombotic regimen before the procedure was direct oral anticoagulants (48.9%), while postprocedural therapy most often included dual antiplatelet therapy (50%). The technical success rate was 95.5%, with residual leak (2.2%) and tamponade (1.4%) as the main causes of failure. Procedural success was 90.5%, most often limited by vascular complications (3.7%), periprocedural death (1.1%), and major bleeding (0.7%). Technical and procedural success rates did not differ significantly between the devices used. In this large prospective cohort, technical and procedural success rates were similar across all LAAO devices, suggesting comparable safety and efficacy. Postprocedural therapy typically involves dual antiplatelet therapy, with all patients requiring some pharmacological treatment. URL: https://www.clinicaltrials.gov; Unique identifier: NCT05144958.