Eccentric phase duration in resistance training influences internal load and recovery dynamics, yet its specific neuromechanical effects remain unclear. This review aimed to synthesize experimental evidence from single-bout eccentric-only and eccentric-phase-tempo-manipulated resistance exercise protocols to determine how controlled eccentric-phase tempo affects acute neuromuscular fatigue, indirect markers of exercise-induced muscle damage, and short-term recovery outcomes measured from immediately post-exercise to 7 days after in healthy adults with clearly described physical activity or training status, including competitive athletes, resistance-trained individuals, and recreationally active adults when otherwise eligible. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched from inception without language or date limits. Eligible studies were experimental trials in healthy adults with clearly reported physical activity or training status performing either eccentric-only exercise or resistance exercise in which eccentric-phase duration was explicitly manipulated and measurable. Because coupled eccentric-concentric protocols may introduce concentric fatigue, contraction structure was extracted and used as an interpretive subgroup rather than assuming all studies represented eccentric-only exercise. Studies were required to report at least one prespecified single-bout acute neuromechanical, fatigue-related, muscle-damage, or recovery outcome within 0-168 h, corresponding to the immediate to 7-day post-exercise period, after the exercise bout. Primary outcomes were maximal voluntary contraction, muscle stiffness indices, reactive strength index, delayed-onset muscle soreness, biochemical markers of damage, and muscle oxygenation within 0-168 h post-exercise. Chronic adaptations to eccentric training, such as long-term hypertrophy, strength gain, or tendon remodeling, were outside the primary scope unless studies reported eligible acute or recovery outcomes attributable to a controlled eccentric-tempo manipulation. Risk of bias was evaluated using RoB 2 or ROBINS-I, and data were summarized descriptively by tempo and time frame. Seventeen studies met inclusion criteria. Explosive-to-fast eccentric conditions, corresponding to < 1 s and 1-2.9 s eccentric phases, were more often associated with greater immediate fatigue and transient performance loss, whereas moderate-to-slow eccentric conditions, corresponding to 3-5.9 s and 6-9.9 s eccentric phases, generally increased time under tension, metabolic stress, and perceived exertion. When total work or load was equalized, differences between tempos generally diminished. Overall risk of bias was moderate. Within the available bout-level evidence, eccentric tempo appears to modulate acute fatigue, mechanical performance, perceptual responses, and short-term recovery mainly through time-under-tension, total work, and protocol-context effects. osf.io/e2598 in 04-11-2025.
Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited. To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India. A quasi-experimental pre-post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner-a pictorial educational pamphlet-over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen's dz. Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (p < 0.001) with large to very large effect sizes (Cohen's dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training. Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre-post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.
This study aimed to investigate whether the probiotic Lactobacillus rhamnosus GG (LGG) (alone or combined with high-intensity interval training (HIIT)) could improve cognitive, electrophysiological changes, oxidative stress and metabolic parameters in HFD-fed rats. Rats were randomly divided into four groups (n = 8): HFD group, HFD + LGG group, HFD+ HIIT group, and HFD + LGG+ HIIT group. Rats were fed HFD daily for a period of 16 weeks, during which LGG (1 × 1010 colony forming unit (CFU)/ rats, orally), and HIIT protocol were administered four times a week on alternating days. At the end of study, assessment of social behavior, memory function, and Long-term potential (LTP) were performed using three-chambered apparatus, Y-maze task, and electrophysiology technique, respectively. Next, oxidative stress, lipid profiles, and liver enzymes were evaluated with routine kits. Both LGG and HIIT alone or in combination improved working memory, social memory, and LTP in HFD-fed rats. In addition, both LGG and HIIT alone or in combination increased the hippocampal levels of superoxide dismutase, catalase, and increased the serum levels of high-density lipoprotein (HDL), and decreased the serum levels of leptin, triglyceride, cholesterol, low-density lipoprotein (LDL), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) in HFD-fed rats. The combination of LGG and HIIT provides a multi-pathway intervention that improves HFD-induced memory impairments by concurrently targeting oxidative stress, dyslipidemia, and hippocampal synaptic function. This supports the potential of combined lifestyle and microbiome-based therapies for preventing metabolic and cognitive disorders.
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PARTNERS is a model of care that was co-designed with service users and carers to address the needs of people with severe mental illness to receive better support in primary care. Taking learning from a randomised controlled trial and process evaluation of this complex person-centred goal and coaching-based approach to care, our aim was to understand better the challenges of implementing PARTNERS in complex dynamic service delivery systems. We identified two Integrated Care Systems that were interested in adopting the PARTNERS model of care. We trained practitioners to adopt PARTNERS to their local settings and provided meta-supervision (supervision of supervisors). We examined the implementation period that covered site engagement, training of staff and initial delivery of the new PARTNERS model of care, undertaking a qualitative realist evaluation informed by the Consolidated Framework for Implementation Research (CFIR). Data collection involved semi-structured interviews with 10 System Change Leads, Supervisors, and trained intervention practitioners or 'Care Partners'; augmented by observations of supervision and practice within the systems and collation of documents. Analysis was qualitative informed by a realist approach and the CFIR. Analysis identified complex overlapping configurations of teams and roles within them, leadership, and individual characteristics influenced the systems' ability to implement the PARTNERS model of care. The presence or absence of leadership was instrumental in providing clarity regarding where the delivery of PARTNERS sat within newly emerging systems and was an important indicator of successful implementation. Collaborative leadership and supervision, alongside training tailored to the needs of individual practitioners, increased or decreased perceived self-efficacy amongst individual practitioners and their confidence in delivering the PARTNERS model of care. We identified that both internal and external supervision and system leadership are crucial to the implementation of PARTNERS, backed up by training delivered by a clinician and people with lived experience, to ensure that this new model of care is embedded in everyday practice. It is likely that the absence of any one of these mechanisms could make implementation and sustainability of the PARTNERS model challenging. Not applicable.
While deathcare services in developed countries are provided by well-trained, adequately resourced professionals, the industry in Sub-Saharan Africa (SSA) is characterized by minimal training, apprenticeship, and severe resource constraints. Consequently, workers in SSA often lack knowledge of industry policies, fail to adhere to proper personal protective equipment (PPE) protocols, and maintain poor personal and hand hygiene. Therefore, this study explored the knowledge, on-site safety practices, and experiences of deathcare workers in selected facilities within the Central and Western North regions of Ghana. Using a 10-item interview guide and observation checklists, we collected data from 35 participants selected using purposive sampling method. We employed a realistic phenomenological design and observational analysis to interpret the findings. Deathcare workers have limited knowledge of industry regulations designed to protect their health and safety. On-site practices are inconsistent with the Ministry of Health (MoH), Ghana, Occupational Health and Safety (OHS) and Infection Prevention and Control (IPC) guidelines. Specifically, workers fail to use PPE correctly, and their hand and personal hygiene practices do not conform to MoH standard operating procedures. These workers engaged in inappropriate handling of dead bodies risking exposure to infection. These deathcare workers have very limited knowledge required to provide safe deathcare services and were unable to advocate for their rights under existing policy guidelines. The MoH must develop a policy to standardize the recruitment of deathcare workers, while training current workers for protection.
A decision coach (DC) is a trained healthcare professional who provides non-directive support to patients in health-related decision-making. The decision coach role can be integrated into shared decision-making (SDM) processes, but is not an inherent component of SDM, as both may be applied independently depending on the clinical context. Numerous trained DCs are nurses who have transitioned from their roles as patient educators to knowledgeable, skilled decision facilitators. Thus, developing core competencies has become increasingly crucial for DC training, especially patient-centered care in nursing education. This study aimed to evaluate DC competencies in SDM by examining accessibility, performance, and perceived directional relationships among competency domains. This mixed-methods study combined a narrative literature review and expert consultations to identify key DC competency criteria. Subsequently, a cross-sectional questionnaire survey was administered to healthcare professionals at two hospitals in Taiwan between April 2023 and February 2024. Accessibility-performance analysis (APA) and the decision-making trial and evaluation laboratory (DEMATEL)-based network relation map (NRM) approach were applied to evaluate competency accessibility, performance, and perceived directional relationships across domains. A total of 149 healthcare professionals, including physicians, nurses, and other clinical staff, completed the valid questionnaires. The reliability of the overall criteria was measured at 0.965. The findings suggest that the professional knowledge (PK) aspect demonstrated perceived directional associations with the outcome evaluation (OE), process management (PM), and guidance skills (GS) aspects within the network structure, whereas the GS aspect was more likely to be associated with other competency domains. Each of the four aspects has a criterion critical to improving DCs' competencies: value (PK1), listening skill (GS2), shared decision-making resources (PM3), and practical decision-making results (OE3). From healthcare professionals' perspectives, professional knowledge was the competency domain most closely associated with perceived directional relationships among other competency aspects within the network structure. The integrated APA-NRM approach delivers evidence-based prioritization and practical pathways for developing DC competencies and guiding training strategies. Not applicable.
Mentorship is considered essential in residency training, yet its structure and quality in Japan remain unclear. We conducted a nationwide, multi-center descriptive study of postgraduate year (PGY) 1-2 residents who completed both the General Medicine In-Training Examination (GM-ITE) and a formal mentorship survey in 2024. Residents who declined participation, provided no response to the survey, had incomplete survey responses, or did not have a formal mentor were excluded. Of 9,179 residents who took the GM-ITE, 3,877 from 570 hospitals were analyzed. Most reported having one mentor (71.6%), and mentors were predominantly male (72.9%). Only 61.0% of programs offered lectures on mentorship. Overall, 46.1% of residents did not perceive feedback as specific or actionable, whereas 69.3% reported trusting their mentors. Mentoring interactions were relatively limited, with 60.4% of residents reporting meeting less than once a month. Among residents with formally assigned mentors, important gaps remained in mentor diversity, feedback quality, and mentoring engagement. Efforts to strengthen mentor training, improve feedback practices, and promote more structured mentoring interactions may help optimize residents' educational and professional development.
Institutional maternal and perinatal outcomes are highly specific to local contextualized conditions and are suited to inform local policy. As institutional delivery increases, maternal health events are more likely to occur in facilities than at home. This was a before-after impact evaluation study through the implementation of a 3-year quality improvement project undertaken in Central Region. The goal was to reduce institutional maternal mortality ratio and perinatal mortality rate over a 3-year period from 2021 to 2023 with 2020 as a baseline year. Baseline assessment was conducted by reviewing 2020 maternal death audit reports to identify key challenges associated with maternal deaths. Interventions were drawn to address identified challenges by key stakeholders. Sensitization meetings were held with stakeholders, health managers and health staff to discuss the interventions and solicited their support. Interventions implemented were life-saving skills and safe motherhood trainings for health staff across the region, introduction of maternal death tracker to improve surveillance on maternal death, clinical supervision of health staff at the peripheral level by specialist through telemedicine using WhatsApp platforms from 2021 to 2023. Baseline indicators were collected from the District Health Information Management System-2 (DHIM2) in 2020. The outcome indicators were improved family planning coverages, increased skilled delivery rates and reduction in maternal mortality ratio and perinatal mortality rates. Process indicators were proportion of practicing midwives and clinicians trained in life saving skills, number of health centers conducting basic emergency obstetric care signal functions, percentage of audited maternal deaths entered DHIMS2. Over the course of the project, 4,800 health staff were trained, skilled birth rate improved from 61.6 to 63.9%, family planning acceptor rate from 28.5 to 45.1% and reported maternal deaths audited improved from 78.7 to 100%. The implementation of institutional audit recommendations also improved from 20 to 72%. Institutional maternal mortality ratio declined by 25.3% and neonatal deaths by 45.2%. Quality improvement methods using the project approach to strengthen maternal health services can lead to improve mother and baby health outcomes. This approach when scaled up nationally may help increase the chances of meeting the sustainable development goal three, I recommend the implementation of the interventions to policymakers such as the Ministry of Health to support in reducing institutional maternal and perinatal mortalities.
Artificial intelligence (AI) is increasingly being integrated into healthcare systems; however, nurses' knowledge, attitudes, and perceived challenges play a crucial role in its adoption in patient care. This study aimed to assess nurses' knowledge, attitudes, and perceived challenges toward AI, examine the relationships among these variables, and explore their associations with demographic characteristics and prior AI training. A descriptive analytical cross-sectional study was conducted among 107 nurses working in intensive care, medical, and surgical units at Zagazig University Hospital. A purposive sampling technique was used. Data were collected over two months using structured instruments during morning shifts. Most participants were aged 25-34 years (55.1%), male (65.4%; reflecting the accessible sample composition), and held bachelor's degrees (68.2%), with nearly half (49.5%) having 5-10 years of clinical experience. Overall, 68.2% of nurses achieved satisfactory knowledge scores, whereas 88.8% demonstrated positive attitudes toward AI applications. Perceived challenges were mainly related to technical and ethical concerns, particularly the need for continuous system updates, cybersecurity risks, and implementation costs. A statistically significant weak negative correlation was found between nurses' knowledge and attitudes toward AI (r = -0.195, p = 0.044). No significant correlations were observed between knowledge and perceived challenges (r = -0.162, p = 0.095) or between attitudes and perceived challenges (r = 0.142, p = 0.145). Previous AI-related training was significantly associated with more positive attitudes toward AI (p = 0.019), whereas no significant associations were found with knowledge or perceived challenges. Educational level, workplace, and years of experience were not significantly associated with nurses' knowledge, attitudes, or perceived challenges. Nurses demonstrated a satisfactory knowledge and generally positive attitudes toward AI applications in patient care, while perceiving moderate implementation challenges. Although previous AI-related training was associated with more positive attitudes, no significant associations were found with knowledge or perceived challenges. The weak negative correlation between knowledge and attitudes suggests that greater awareness of AI may be accompanied by increased concerns regarding its use. Further educational initiatives are needed to enhance nurses' preparedness for AI integration in clinical practice.
Palliative care integration into primary healthcare is essential to improving access for patients with life‑limiting illnesses in low‑ and middle‑income countries. Frontline health workers require targeted capacity‑building to strengthen symptom management and community‑based care. To evaluate the effectiveness of a structured capacity‑building program on the knowledge and attitudes of ASHA workers and ANMs/Staff Nurses regarding palliative care. A quasi‑experimental design was used among 984 ASHA workers and 335 ANMs/Staff Nurses in southern India. Participants received structured training on symptom assessment, communication, and home‑based palliative care. Pre‑test and post‑test data were collected using validated knowledge and attitude scales. Data were analysed with Wilcoxon Signed‑Rank tests. The TREND (Transparent Reporting of Evaluations with Nonrandomized Designs) checklist has been completed. ASHA workers demonstrated significant improvement in knowledge (r = .714) and attitude (r = .312) scores. Likewise, ANMs/Staff Nurses showed large gains in knowledge (r = .973) and substantial improvements in attitude (r = .682). The proportion of participants with strong knowledge increased from 9% to 35.2% among ASHAs and from 1.2% to 14% among ANMs/Staff Nurses. Capacity‑building interventions significantly strengthen primary healthcare workers' competencies in palliative care. Integrating structured palliative care training into national primary healthcare systems enhances awareness and positive attitudes toward palliative care, thereby strengthening their preparedness to provide supportive care. Patient or Public Contribution: No Patient or Public Contribution was sought for this research.
Effective cardiopulmonary resuscitation (CPR) extends beyond technical proficiency and is influenced by team dynamics, environmental conditions, and clinicians' emotional responses. Although previous studies have examined barriers and facilitators of resuscitation, these factors have often been investigated separately, providing limited understanding of how they interact during real-time resuscitation practice in emergency departments. Exploring these interrelated domains is essential for improving team performance and patient safety in high-acuity emergency settings. This study aimed to explore emergency nurses' perspectives on how team dynamics, environmental conditions, and emotional experiences interact during resuscitation practice in emergency departments. A qualitative descriptive study was conducted with emergency nurses working in adult emergency departments across university, state, training and research, and private hospitals. Data were collected through focus group interviews using purposive criterion sampling and analyzed using inductive content analysis. Thirty-one emergency nurses participated in the study. Analysis identified three interrelated themes encompassing nine subthemes: team dynamics (leadership, staffing adequacy, role clarity), environmental safety (equipment availability, overcrowding, patient transfer, violence risk), and emotional regulation (traumatic exposure and crisis management). These themes illustrate how these domains interact to influence resuscitation practice in high-acuity settings. Resuscitation effectiveness reflects the interaction of team coordination, environmental safety, and emotional regulation within emergency settings. Findings highlight the need for team-based training, environmental organization, and emotional support strategies to strengthen resuscitation practice in emergency departments.
Healthcare professionals' knowledge and training are important contributors to adequate medical care for headache disorders. Since most headaches are treated in primary care, undergraduate medical education represents an important stage for strengthening headache-related knowledge and clinical preparedness. This study aimed to evaluate headache education among final-year medical students in Türkiye. This cross-sectional, web-based survey study was conducted among final-year medical students from ten medical faculties in Türkiye between June and December 2022. A 32-item questionnaire developed by the authors was used to assess headache-related educational exposure, self-reported preparedness, and theoretical knowledge. Thirteen knowledge-based questions were used to calculate the total knowledge score. Descriptive statistics, group comparisons, and Spearman correlation analysis were performed. A total of 523 final-year medical students participated. The mean knowledge score was 9.14 ± 1.87 out of 13. Although 94.8% reported receiving headache education, only 46.5% had received outpatient clinic-based training, 11.7% had attended a headache subspecialty clinic, and 9.6% were familiar with the national headache guideline. Participants who had received didactic headache education scored higher than those who had not (9.18 vs. 8.37; mean difference 0.81, 95% CI 0.09 to 1.54; p = 0.019), as did those who had received outpatient clinic-based training (9.38 vs. 8.93; mean difference 0.45, 95% CI 0.13 to 0.77; p = 0.009) and those who had received structured instruction on headache history-taking (9.30 vs. 8.58; mean difference 0.72, 95% CI 0.34 to 1.11; p = 0.001). Higher total headache-related lesson time was weakly but significantly correlated with higher knowledge scores (Spearman's rho = 0.12, 95% CI 0.04 to 0.21; p = 0.005). Most participants reported feeling insufficiently prepared to treat pregnant women with migraine, as well as pediatric and geriatric patients with migraine. The findings suggest that undergraduate headache education in Türkiye may benefit from further curricular strengthening, particularly through structured teaching, clinical exposure, and improved familiarity with headache management guidelines. Further studies using validated tools and longitudinal designs are needed to evaluate the educational and clinical impact of such interventions.
To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings. Systematic review. Preferred Reporting Items for Systematic Reviews and Meta-analysis informed design, conduct and management. A systematic approach was taken, utilising multiple reviewers and consensus methods. Mixed Methods Appraisal Tool informed quality appraisal. Qualitative findings were analysed using Reflexive Thematic Analysis. Quantitative results are presented as a narrative summary. CINAHL; MEDLINE; PubMed; Scopus; ScienceDirect; Nursing and Allied Health; Cochrane Library; Internurse.com; The Kings Fund; GOV.UK and Trip Database were searched between 1st January 1980 to 5th January 2026. Twenty-nine studies were included. Eighteen studies met all quality assessment criteria. Limited quantitative data was available, and inconsistent outcome measures constrained quantitative analysis. Qualitative analysis generated three themes: (1) Shaping Practice: the interplay of organisational context, culture, and structure, (2) Enablers and constraints in Practice Development, (3) Collective empowerment. Across diverse study designs, the majority of studies indicate that PD contributes positively to staff working environments and the contexts in which patient care is delivered. However, current findings do not demonstrate consistent improvements in clinical outcomes or quality of life. Practice Development may contribute to improvements in care environments for patients and staff, respectively. This review highlights knowledge gaps in the generalisability and transferability of Practice Development that would benefit from further exploration. Practice Development may enhance healthcare environments, but further research is needed to determine if these benefits impact upon clinical outcomes. Preferred Reporting Items for Systematic reviews and Meta-Analyses. No patient or public contribution. PROSPERO registration number: CRD42024557949.
Postgraduate medical education increasingly requires learners to develop clinical reasoning, manage uncertainty, integrate heterogeneous clinical information and collaborate across disciplines. Multidisciplinary team (MDT) teaching may provide a clinically situated learning environment in which trainees can observe and participate in complex decision-making. However, evidence on the use of remote MDT teaching in urology postgraduate education remains limited. This randomized controlled study included 76 professional master's students rotating through a surgical standardized residency training base. Students were assigned to a remote MDT teaching group or a conventional teaching group, with 38 students in each group. The remote MDT intervention was delivered as a structured teaching package that included pre-session case preparation, remote multidisciplinary case discussion, expert-guided case analysis, post-session reflection and iterative feedback. Outcomes included theoretical knowledge, clinical decision-making, practical skills, questionnaire-based evaluation of the teaching model and overall competency. Students in the remote MDT group achieved higher scores than those in the conventional teaching group in theoretical knowledge, clinical decision-making, questionnaire-based evaluation and overall competency. No significant between-group difference was observed in practical skills. The pattern of findings suggested that the remote MDT model had a stronger effect on outcomes requiring information integration, clinical reasoning and collaborative decision-making than on procedural performance. Remote MDT teaching may be a useful component of urology postgraduate education, particularly for learning outcomes related to clinical reasoning and knowledge integration. Its value appears to derive not only from remote delivery, but also from the structured organization of preparation, multidisciplinary discussion, reflection and feedback. Procedural skill development remains dependent on supervised hands-on practice. Future multicentre studies are needed to confirm these findings and to examine which components of the intervention contribute most to learning. Not applicable.
To identify independent risk and protective factors for acupuncture response in community-dwelling patients with chronic low back pain, and to develop and validate a clinical prediction model incorporating traditional Chinese medicine (TCM) diagnostic components, thereby providing a tool for individualized clinical decision-making and risk stratification in community acupuncture practice. A total of 500 patients with chronic non-specific low back pain who received acupuncture treatment at the Ningbo Jiangbei Zhuangqiao Community Health Service Center between January 2023 and November 2025 were retrospectively enrolled. Patients were randomly split into a training cohort (n = 350) for model development and a test cohort (n = 150) for internal validation using a 7:3 ratio. Predictors were selected via LASSO regression, and a multivariable logistic regression model was constructed and presented as a clinical nomogram. SHapley Additive exPlanations (SHAP) analysis was employed to quantify the global importance of features and their directional association with the outcome. Model performance was comprehensively evaluated by assessing discrimination (receiver operating characteristic curve), calibration (calibration curve), clinical utility (decision curve analysis), and generalizability (performance in the internal/external validation sets). Multivariable analysis identified longer disease duration (OR = 1.170), radiating leg pain (OR = 1.998), and the Qi-Stagnation-Blood-Stasis syndrome pattern (OR = 3.701) as independent risk factors for poor acupuncture response (all p < 0.05), while acupoint Weizhong (BL40) selection (OR = 0.267) and combined therapy (OR = 0.214) were independent protective factors. SHAP analysis confirmed disease duration and the Qi-Stagnation-Blood-Stasis pattern as the top contributors to the prediction. The developed nomogram demonstrated excellent discrimination in the training (AUC = 0.819), test (AUC = 0.828), and external validation (AUC = 0.788) cohorts. The model showed good calibration (Hosmer-Lemeshow test p > 0.05) and provided a clear clinical net benefit across a wide threshold probability range (25%-90%). This study identifies a TCM syndrome pattern (Qi-Stagnation-Blood-Stasis) and acupoint selection as independent predictors for acupuncture response in community-based low back pain management. The developed nomogram, integrating TCM and clinical features, demonstrates good predictive performance and clinical utility upon internal and preliminary external validation. Its broader implementation requires further confirmation through larger, multicenter prospective studies and could be enhanced by the future integration of objective biomarkers.
Despite the dramatic achievements in malaria control, Bangladesh continues to face persistent transmission in high-endemic regions such as Bandarban in the Chittagong Hill Tracts. One important strategy to close surveillance and case management gaps is to involve the for-profit private sector that serves marginalized populations including high-risk occupational groups and communities facing geographical obstacles. The objectives of this study were to determine the practicality and the effects of involving the private healthcare providers in the national malaria surveillance system in Alikadam Upazila, Bandarban. A One-month pilot study was conducted in March 2023 in 10 for-profit private healthcare facilities in Alikadam Upazila, Bandarban. The providers were trained to do rapid diagnostic tests on suspected malaria patients and to refer positive cases to government or partner NGO facilities. Data on adherence to diagnostic protocols, the detection of malaria cases, the reporting, the referral and patient satisfaction were collected using standard registers, reporting forms and supervision checklists. These data were entered into an electronic database and analysed descriptively. Quality assurance was taken care of by monitoring and evaluation mechanisms, including regular supervisory visits. Rapid diagnostic tests were done on 440 patients in the pilot, and 1.8% were positive of malaria (Plasmodium falciparum and P. vivax were equally distributed). The study period has shown that the private sector has a share of 20% in all the reported cases of malaria in Alikadam. Most of the participants were males (54.6%), and 4.0 percent of the women were pregnant. The level of patient satisfaction was also good as 100 percent of the people who were surveyed claimed that they were confident in the private providers and the referral process. The accuracy of data recording rose as the providers performed better over time with a rate of 37.5 in week one but in the fifth week, it was 87.5. Although these successes have been achieved, referral gaps and lack of financial incentives to the private providers were a challenge. The research highlighted private healthcare providers' potential in malaria surveillance and case detection in remote, vulnerable populations. Integrating them into national programs could strengthen health systems and eradication efforts, but scaling requires addressing challenges like sustained training, financial incentives, and adequate service coverage.
Medical dramas are widely consumed by medical students globally and may constitute an informal or hidden curriculum influencing professional identity, empathy, and ethical reasoning. Palestinian medical students represent an understudied population navigating a resource-constrained and geopolitically complex healthcare context. To investigate the perceptions of Palestinian medical students regarding medical dramas, including viewing habits, assessments of clinical and ethical realism, psychological and behavioural impacts, and the potential role of such media as an informal educational resource. A cross-sectional study was conducted among 638 undergraduate medical students from five universities in the West Bank, Palestine, using convenience and snowball sampling. Data were collected via an online structured questionnaire adapted and culturally validated from the Czarny et al. (2008) instrument, incorporating forward-back translation, pilot testing (n = 15), and internal consistency assessment (Cronbach's alpha = 0.81). Descriptive statistics and Chi-square tests were applied. Mean age was 21.1 ± 1.65 years; 66.8% were female. Most participants (73.4%) had watched medical dramas, primarily via digital streaming platforms. While 77.3% perceived clinical scenes as only slightly or moderately realistic, 41.9% considered ethical content to be moderately accurately depicted. Approximately 46.6% reported increased empathy and 47.2% reported increased study motivation. Drama viewers were significantly more likely to rate informal sources-family (p < 0.001), friends (p = 0.021), and online news (p = 0.037)-as important for ethical guidance, compared with non-viewers. Palestinian medical students engage substantially with medical dramas and appraise their content critically. Associations between drama viewing and increased empathy, study motivation, and reliance on informal ethical guidance sources suggest a potential hidden-curriculum effect. Given the cross-sectional design and convenience sampling, causal inferences cannot be drawn. These findings support cautious integration of medical dramas into bioethics and professionalism curricula as supplementary teaching tools.
In recent years, increasing aesthetic expectations have led to a growing demand for porcelain laminate veneer treatments. This study aims to address a gap in the literature by evaluating the knowledge, attitudes, and practices of undergraduate dental students regarding porcelain laminate veneers, within the context of updated dental curricula, thereby providing insight into their current level of theoretical understanding and clinical preparedness. This study employed a descriptive cross-sectional design. The sample consisted of final-year students from the Faculty of Dentistry at Atatürk University. A total of 150 students were invited to participate; those who agreed and completed the questionnaire in full were administered a KAP-based survey adapted for porcelain laminate veneer applications. A total of 134 dental interns participated in the study, of whom 61.9% were female and 38.1% were male. Based on objective assessments, the level of theoretical knowledge was found to be high, with correct response rates ranging between 85% and 94% for many items; however, lower success rates were observed in technically demanding aspects, such as cement thickness effects on shade selection (28.4%) and preparation classifications (45.5%). Subjective evaluations revealed limited clinical experience and self-confidence; notably, only 32.1% of participants had encountered a laminate veneer case in clinical practice. While no significant difference was found in theoretical knowledge levels by gender (p = 0.083), male participants demonstrated significantly higher self-perceived clinical confidence scores compared to females (p = 0.024). A weak negative correlation was observed between objective knowledge scores and self-perceived clinical confidence scores (r = -0.201, p = 0.020). Despite a high level of theoretical knowledge among dental interns, this theoretical knowledge was not reflected in students' self-perceived clinical preparedness and confidence. Furthermore, a weak negative correlation was identified between objective knowledge and self-perceived clinical confidence scores, suggesting these constructs are related but distinct. These findings highlight the need to strengthen simulation-based training, clinical case exposure, and complication management within undergraduate prosthodontic education.
The prevalence of type 2 diabetes mellitus (T2DM) varies significantly among Tuberculosis (TB) patients from 25.3 to 44% in India. Correct knowledge regarding TB symptoms is a determinant for health-seeking behaviour among T2DM patients. However, there is limited literature regarding TB knowledge and risk perception among patients with T2DM in rural communities of coastal Karnataka, India. To determine the association of correct knowledge regarding TB among patients with T2DM and their TB risk perception in a rural community in coastal Karnataka. A cross-sectional study was conducted over 18 months in the rural villages under the rural health training centre of a tertiary care private medical college at Dakshina Kannada District, Karnataka, involving 202 T2DM patients. Data were collected via pretested semi-structured questionnaires administered through interviews. Descriptive statistics and chi-square tests were used to analyse demographic variables, TB knowledge and TB risk perception. Among the 202 participants, 116 (57.4%) demonstrated overall correct knowledge regarding TB. Participants with high risk perception showed significantly better recognition of specific TB knowledge components, including airborne transmission (p = 0.013), key symptoms such as cough (p = 0.029), fever (p = 0.049), and weight loss (p = 0.019), as well as awareness of asymptomatic disease (p = 0.003) and extrapulmonary involvement (p = 0.046). They were also more likely to correctly reject misconceptions related to TB transmission.However, overall correct TB knowledge was not significantly associated with perceived risk (χ² = 0.008, p = 0.927). High risk perception was significantly associated with being single/widowed (p = 0.003), higher education (p < 0.001), higher socio-economic status (p < 0.001), skilled occupation (p < 0.001), and a family history of DM (p = 0.008). Age, sex, and duration of DM were not significantly associated with risk perception. Although more than half of the participants demonstrated correct TB knowledge, this did not translate into higher perceived risk, highlighting a critical knowledge-perception gap among patients with T2DM. While specific and clinically relevant knowledge components were associated with higher risk perception, general awareness alone was insufficient to evoke a sense of personal vulnerability. Educational strategies should therefore move beyond general information dissemination and focus on personalised risk communication that explicitly links DM with increased susceptibility to TB. Such interventions should emphasise the possibility of asymptomatic disease and promote timely screening and care-seeking behaviour.