Since Russia's full-scale invasion of Ukraine in 2022, casualties have frequently sustained extensive soft tissue injury and contamination requiring complex wound care and prolonged hospitalization. To characterize in-country care, we conducted a retrospective case series of adult patients with conflict-related traumatic wounds to describe wound characteristics, microbiologic testing, antibiotic use, and resistance patterns during active conflict in Ukraine. We conducted a retrospective case series to identify a consecutive population of adult patients treated at a single, referral hospital in western Ukraine for wounds management. Structured medical record abstraction was performed. The primary outcome was prevalence of complex traumatic wounds. Secondary outcomes included prevalence of antibiotic resistance among cultured wounds, surgical amputation associated with the wound, and length of hospital stay. Descriptive statistics were calculated for all variables. One hundred patients with conflict-related traumatic wounds were included. All were male with injuries occurring on the eastern frontlines from blast-related mechanisms. Median time from injury to hospitalization at study facility was 25.5 days. Overall, 95% of wounds met the case definition of a complex wound, predominantly due to presence of wound necrosis (90%). Wound cultures were obtained in half of patients (51%) with 24% (n=12) showing significant positive bacterial growth. Antibiotic resistance was identified in 9 of the 12 cultures. Nearly all patients received intravenous antibiotics (98%) for a mean duration of 7.3 days. Surgical debridement was performed in 99% of patients, while 2% underwent amputation during hospitalization. Hospital length of stay was a median of 14 days. In this cohort of conflict-related traumatic wounds in Ukraine, intravenous antibiotics were used extensively in a manner consistent with cautious, risk-averse combat trauma care. These findings primarily reflect the challenges of clinical decision-making in austere, high-risk environments and underscore the need for supportive, wartime-adapted stewardship frameworks. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved). Level V - Case Series / Epidemiological.
Cervical cancer screening is difficult to initiate and sustain during war due to disrupted health services, population displacement and limited clinical capacity. Evidence on whether human papillomavirus (HPV)-based screening using self-sampling can function as a screening pathway during armed conflict is unknown. This study evaluated the feasibility, acceptability and operational performance of HPV self-sampling for cervical cancer screening in a war-affected region of Ukraine. Women aged 30-60 years living in Zaporizhzhia Oblast, Ukraine, were offered HPV testing using self-collected cervicovaginal samples distributed through outpatient clinics, community outreach activities and refugee centres. Samples were analysed locally using PCR-based HPV assays with external laboratory quality assurance. Women positive for HPV16/18 were referred directly for colposcopic evaluation. Primary outcomes included screening uptake, kit return rate, HPV positivity and follow-up completion among HPV16/18-positive women. Secondary outcomes included turnaround times, HPV positivity by age and sampling setting, and participant feedback. Between April and December 2025, 593 women were offered HPV self-sampling; only 4 (0.67%) declined participation. Of 589 distributed kits, 572 samples were returned and analysed (attendance rate 96.46%, 572/596), with non-return occurring only in refugee centres. Overall, 52/572 women (9.1%) tested positive for targeted HPV types, including 22 (3.8%) positive for HPV16/18 and 30 (5.2%) positive for HPV31/33/35/45/52/58. All women testing positive for HPV16/18 were contacted and referred for specialist follow-up; among those completing follow-up, all were assessed within 2 months. Median turnaround time from self-sampling to results was 6.3 days. All recorded participant feedback was positive. HPV self-sampling-based cervical cancer screening can be initiated and maintained during active war with high uptake, timely laboratory processing and effective referral of women at highest risk. Simplified, low-contact screening pathways may support cervical cancer prevention under wartime conditions. NCT07275333.
It has been well established that racial discrimination has detrimental consequences for well-being. However, less is known about this relationship in non-Western settings, and there is limited research examining factors that may moderate it. This study investigates the association between perceived racial discrimination and life satisfaction across four non-Western countries, as well as the role of migration as a potential moderator. A total of 3,600 respondents living in Ghana, Indonesia, Kenya, and Ukraine participated in an online survey on racial discrimination and its association with life satisfaction. Participants also reported their migration status, including whether they had migrated and the duration of their residence outside their country of origin. We found a negative association between perceived racial discrimination and life satisfaction across the four countries, although the strength of this relationship varied by context. Importantly, we found that years since migration attenuate the negative association between perceived racial discrimination and life satisfaction, potentially reflecting coping strategies and adaptation processes developed over time. While a negative association between perceived racial discrimination and life satisfaction is observed in these non-Western contexts, the strength of this relationship varies across countries and is moderated by individuals' migration experiences. These findings open new avenues for research on how discrimination and migration jointly shape well-being across diverse national and individual contexts.
The global ban on antibiotic growth promoters (AGPs) in livestock production has increased the search for safe and effective natural alternatives that can maintain productivity and support animal health. Phytogenic feed additives from medicinal plants are gaining more attention because of their antimicrobial, antioxidant, and immunomodulatory properties. Garlic (Allium sativum) and caraway (Carum carvi) contain bioactive compounds that can enhance digestive function and intestinal health in monogastric animals. Replacement gilts are a critical group in pig production, as their growth and intestinal development during rearing influence their reproductive longevity and herd productivity. However, limited information is available on how phytogenic additives affect intestinal structure and performance in replacement gilts. Therefore, this study aimed to assess the effects of a garlic-based phytogenic additive, "Imunochasnyk," on growth performance, feed efficiency, survival rate, and small intestine histomorphology of replacement gilts under commercial production conditions. A controlled feeding trial was conducted on 160 clinically healthy crossbred replacement gilts (Large White × Landrace) aged 11-28 weeks under commercial conditions in southern Ukraine. Animals were randomly assigned to two groups: a control group receiving a basal diet (BD) and an experimental group receiving BD supplemented with 0.10% phytogenic additive "Imunochasnyk," which contains A. sativum and C. carvi (1000 g/ton). Each group included 80 animals. Growth performance parameters, including live weight, average daily gain (ADG), feed conversion ratio (FCR), and survival rate, were monitored throughout the experimental period. At 190 days of age, five representative gilts from each group were selected for histological examination of the jejunum. Morphometric analyses of enterocyte dimensions, nucleus-to-cytoplasm (N:C) ratio, and structural characteristics of villi, crypts, goblet cells, and Paneth cells were performed. Data were expressed as mean ± standard error of the mean and analyzed statistically, with significance set at p < 0.05. Dietary supplementation with the phytogenic additive significantly enhanced the productive performance of replacement gilts. Starting from week 17, the experimental group showed greater live weight and higher ADG than the control group. At 28 weeks of age, the final live weight reached 128.52 kg in the supplemented group compared to 118.64 kg in the control group (p < 0.001). The FCR decreased by 8%-11% during intensive growth phases, indicating improved feed utilization efficiency. The survival rate increased to 95.0% in the supplemented group compared to 85.0% in the control group. Histological analysis revealed notable intestinal adaptations in supplemented gilts, including a 19.6% increase in enterocyte area and a 31.0% increase in nuclear area, leading to a higher N:C ratio (p < 0.01). Additionally, increased villus tortuosity, enlarged crypt lumina, higher goblet cell density, and activation of Paneth cells were observed, suggesting enhanced absorptive capacity and strengthened mucosal defense mechanisms. Including the garlic-based phytogenic additive "Imunochasnyk" at 0.10% in the diet significantly enhanced growth performance, feed efficiency, and intestinal structure in replacement gilts. The additive stimulated epithelial metabolic activity, boosted mucosal defenses, and improved nutrient absorption, ultimately increasing productivity and survivability. These results support the use of garlic-based phytogenic additives as sustainable alternatives to antibiotics in intensive pig production systems.
The special issue collects recent contributions from Ukrainian researchers, both from academia and industry, in the field of chemoinformatics. It contains 6 publications from leading Ukrainian scientists in the field. These articles representatively demonstrated a wide landscape of chemoinformatics in Ukraine and its deep integration into the global one.
Allexiviruses (family Alphaflexiviridae) are widespread pathogens of vegetatively propagated allium crops, but their occurrence has not previously been documented in Ukraine. We surveyed cultivated allium plants collected in eight Ukrainian regions (2022-2025) and screened their samples for garlic virus B (GarV-B), garlic virus C (GarV-C) and shallot virus X (ShVX) using enzyme-linked immunosorbent assay (ELISA). GarV-B, GarV-C and ShVX were detected in 39/108 (36.1%), 23/108 (21.3%) and 21/108 (19.4%) plants, respectively, with infections which were strongly host-associated: garlic (n = 63) had high frequencies of indicated viruses (GarV-B-61.9%; GarV-C-36.5%; ShVX-28.6%), whereas onion samples (n = 33) were largely negative (ShVX-3.0%; GarV-B and GarV-C-not detected). Co-occurrence analysis within garlic revealed a nested allexivirus module in which GarV-C and ShVX occurred only in GarV-B-positive plants. RT-PCR and Sanger sequencing generated 11 partial genomes representing GarV-B, GarV-C, ShVX, GarV-A and GarV-D. Maximum-likelihood phylogenies placed Ukrainian allexivirus isolates within established global diversity and indicated both European- and Asian-affiliated lineages. These findings provide the first evidence of allexiviruses in Ukrainian allium crops, and support their inclusion in plant health surveillance and planting-material certification.
This study investigates how civilians who remained in war-affected suburbs of Kyiv following the 2022 outbreak of war in Ukraine cope with trauma and build resilience under conditions of prolonged insecurity. Using a mixed-methods design, we combine standardized assessments of post-traumatic stress symptoms (PCL-5) with in-depth qualitative interviews conducted in suburbs of Kyiv, a region largely neglected in empirical research. Nineteen interviews were analyzed using qualitative content analysis. Two contrasting case vignettes, one with the highest and one with the lowest PTSD symptom load, were selected to show variations in resilience strategies and resources. Guided by Michael Ungar's multisystemic social-ecological framework, the analysis explores how resilience unfolds across micro, meso, macro, and transnational dimensions and complements psychological assessments of trauma with a sociological perspective. Rather than viewing resilience as an individual trait, we highlight its relational, structural, and symbolic dimensions. The findings show how civilians sustain meaning and everyday stability under conditions of ongoing conflict, contributing to research on trauma recovery and resilience in active conflict settings.
International guidelines recommend rapid-start antiretroviral therapy (RS-ART) for people with HIV. Guidance for implementing RS-ART among people who inject drugs (PWID), a population often denied equitable treatment due to stigma and rights violations, remains limited. Using human-centered design, barriers and facilitators to combined RS-ART and opioid agonist therapy initiation in Ukraine were explored, where HIV is concentrated among PWID with opioid use disorder. Using nominal group technique, a human-centered design method involving client input, five focus groups (6-12 participants each and 42 participants total) with PWID with HIV in four Ukrainian cities most affected by HIV were conducted. Responses were rank-ordered and grouped using NVivo along the socioecological model. The most common barriers were organizational, including nonintegration of ART and opioid agonist therapy services (45%), followed by individual (22%), such as fear of withdrawal symptoms, policy/regulatory (20%), including the national addiction registry, and relationship (13%) barriers, including pervasive stigma. Solutions focused on equity, promoting behavioral design interventions like choice architecture, nudging, and message framing.
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Aim: To characterise Ukrainian PhD students' research management skills, the difficulties experienced in Ukrainian medical PhD education, and to provide insights into potential directions for improving medical education. Materials and Methods: The authors conducted a cross-sectional study using a convenience sample. In 2025, the authors surveyed 118 medical PhD students of Bogomolets National Medical University to evaluate their research management competence and attitudes towards it. The authors offered a 17-item questionnaire on research management. To process the data, the authors used descriptive and thematic analysis. Results: This study shows that medical PhD students at Bogomolets National Medical University generally recognise the importance of research management skills for successful doctoral training. However, attitudes towards these skills remain fragmented, and recognition of their value does not translate into confidence or effective practice. The findings reveal significant gaps in strategic planning, adaptability to change, bureaucratic communication, self-discipline, and the ethical use of digital tools such as artificial intelligence. Research management effectiveness relies mainly on external control and personal self-regulation rather than structured curricular support. Conclusions: The research management skills of Ukrainian medical PhD students should be conceptualised not as their individual psychological capacity but as a competence shaped by educational design, mentoring structures, ethical training, and career support. The results support the need for curricular integration of research management as a structured competence area, including training in planning, adaptability, communication, academic integrity, and the responsible use of digital tools.
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Large-scale combat operations will generate casualty volumes and injury patterns that fundamentally differ from routine civilian trauma, yet contingency planning increasingly relies on civilian surgeons and hospitals to deploy, absorb, and definitively treat combat-injured patients through frameworks such as the National Disaster Medical System and Health Care Personnel Delivery System. Decades of experience, from World War II and the Global War on Terrorism to the current war in Ukraine, demonstrate that civilian surgical volume alone does not reliably translate into readiness for combat casualty care. Contemporary warfare produces blast and high-velocity fragment trauma, severe polytrauma, extensive contamination, complex extremity and vascular injuries, burns, and prolonged evacuation delays, requiring serial operative management and decision making under resource constraints. In contrast, civilian trauma systems are predominantly blunt injury-based with rapid access to definitive resources and subspecialty support. The Military Health System mitigates this readiness gap through the Clinical Readiness Program (CRP), a Knowledge, Skills, and Abilities (KSA) based framework that standardizes combat-relevant education, procedural training, and experience validation. No comparable readiness requirement exists for civilian surgeons despite their anticipated wartime role, creating a mismatch between assumed capacity and validated capability. This opinion argues that civilian clinicians expected to support combat casualty care should be incorporated into a civilian combat casualty care readiness framework modeled on the CRP. Key elements include specialty-specific curricula, knowledge assessments, periodic skills-based training aligned to deployment requirements, and KSA scoring using case log review to enable role assignment across echelons of care. Before activation, clinicians would undergo standardized education, skills verification, and team-based training. A scalable civilian readiness framework would enable rapid, effective, and safe integration of civilian surgeons into large-scale combat operations and responses, ensuring that providers are objectively prepared and ready before the call. (J Trauma Acute Care Surg. 2026;000: 000-000. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.).
Disturbances in memory following trauma exposure are central to the development of posttraumatic stress disorders. Whether traumatic memories directly or indirectly affect symptoms of other disorders like depression and generalized anxiety disorder (GAD) remains unclear. This study tested the hypothesis that traumatic memories are directly related to depression and GAD symptoms, independent of posttraumatic stress symptoms. Cross-sectional data from quasi-representative samples from Ukraine (N = 2050) and the United Kingdom (N = 975) were analysed. Posttraumatic distress was measured according to the ICD-11 description (i.e., posttraumatic stress disorder [PTSD] and disturbances in self-organization [DSO] symptoms). Traumatic memories were strongly, positively, and significantly correlated with PTSD, DSO, depression, and GAD symptoms. Controlling for PTSD symptoms, traumatic memories remained positively (p < 0.001) associated with depression (β = 0.37- 0.41) and GAD (β = 0.35- 0.36) symptoms. Controlling for PTSD and DSO symptoms, associations remained positive and significant (β = 0.11-.21, p < 0.001). Traumatic memories were associated with depression and GAD symptoms, independent of the effects of posttraumatic stress symptoms. These findings are consistent with the proposition that traumatic memories are directly related to depression and GAD symptoms, as well as posttraumatic stress symptoms. Theoretical and clinical implications are discussed.
Aim: This study aims to provide a comprehensive analysis of the administrative-legal assurance of the reliability and ethics of medical decision-making in wartime conditions, combining normative analysis with empirical data from a frontline Ukrainian hospital. Materials and Methods: The normative framework includes international standards of the World Health Organization, the International Committee of the Red Cross, professional medical associations, the European Charter of Patients' Rights (2002), European Union legislation, and the national healthcare and wartime legislation of Ukraine. The empirical component comprised a cross-sectional anonymous survey conducted between May and September 2025 among 40 healthcare workers at a rural hospital located near the active frontline in the Dnipropetrovsk region. The questionnaire assessed decision-making complexity, perceived probability of errors, stress impact, resource availability, preparedness, and willingness to report incidents. Results: Wartime conditions significantly increase the perceived complexity of clinical decision-making, particularly in resource allocation, evacuation prioritization, and surgical interventions. Respondents reported elevated stress levels and increased risk of errors, primarily associated with limited resources, disrupted logistics, and administrative constraints. The reliability and ethical integrity of medical decisions were found to depend on the availability of updated clinical protocols, state monitoring mechanisms, organized evacuation systems, and guaranteed minimum healthcare services. Conclusions: Effective administrative-legal support is a prerequisite for ensuring both the reliability and ethical soundness of medical decisions in wartime. Strengthening institutional safeguards, resource allocation mechanisms, and clear regulatory guidance is essential to maintain medical standards under extreme conditions.
Background/Objectives: Antimicrobial resistance (AMR) is one of the greatest health threats affecting humans, animals and the environment. Antimicrobial use (AMU) in the livestock sector contributes to the development and spread of AMR, highlighting the need to understand the current situation, to target knowledge gaps and non-prudent practices with tailored interventions, and improve antimicrobial stewardship. This is especially important in low- and middle-income countries (LMICs), where data on AMU and AMR are currently limited. This study assessed knowledge, attitudes and practices (KAP) among farmers, veterinarians, veterinary pharmacy personnel and feed mill personnel related to AMU (particularly considering the use of antibiotics) and AMR in seven former Soviet countries, Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine. Methods: Face-to-face interviews were conducted between 2020 and 2025 with 3012 participants, with results analyzed using an aggregated regional approach. Results: The interviews revealed common regional knowledge gaps and practices among livestock sector stakeholders related to antimicrobials, AMR, antimicrobial residues, and prudent AMU. Non-prudent practices, such as the purchase of antimicrobials without a prescription, the use of antimicrobials as growth promoters, the inappropriate disposal of antimicrobials, and the frequent use of highest priority critically important antimicrobials (HPCIAs) were reported. Another factor that may hinder prudent AMU was the limited access of veterinarians to diagnostic laboratories. Conclusions: Despite significant global efforts to tackle AMR, there is an ongoing need to address knowledge gaps and non-prudent practices of livestock sector stakeholders in former Soviet countries. The findings highlight the importance of antimicrobial stewardship interventions that address system-level drivers of improper AMU beyond stakeholder trainings.
To evaluate bone mineral density (BMD) in young adults with inflammatory arthritis. Low BMD was detected in 42% of patients, associated with male sex, lower BMI, slower gait speed, higher ESR, and prolonged glucocorticoids. This population requires early, comprehensive bone health screening to prevent long-term complications. Bone loss and consequent fractures significantly reduce quality of life, causing disability and premature mortality. These issues, common in elderly patients, are also linked to inflammatory arthritis (IA). The impact of IA on bone health in young adults (20-40 years) is poorly documented. This study investigated the prevalence of low bone mineral density (BMD) and potential risk factors in young adults with IA in Ukraine. Patients aged 18-40 with IA (juvenile idiopathic arthritis (JIA), spondyloarthritis (SpA), rheumatoid arthritis (RA)) and disease duration > 2 years, observed between November 2020 and December 2022, were included in this mono-centric study. Exclusion criteria are as follows: diabetes mellitus, endoprosthesis, systemic JIA, and pregnancy. BMD was measured using dual-energy X-ray absorptiometry. Low BMD was defined as a Z-score ≤ -2.0 at the lumbar spine, total hip, or femoral neck. Multivariable logistic regression, adjusted for sex, body mass index (BMI), erythrocyte sedimentation rate (ESR), gait speed, and duration of glucocorticoid use, was performed to evaluate associated factors, calculating odds ratios (OR) with confidence intervals. Among 144 patients (81 females, 63 males; median age 29 years), the prevalence of low BMD was 42% (61/144): 42% in JIA, 31% in SpA, and 26% in RA. In the adjusted multivariable model, low BMD was associated with male sex (OR = 11.5, p < 0.001), lower BMI (OR = 0.74, p < 0.001), higher ESR (OR = 1.10, p < 0.001), slower gait speed (OR = 0.02, p < 0.001), and longer duration of glucocorticoid use (OR = 1.03, p = 0.003). Our study revealed a high prevalence of low BMD among young patients with IA in Ukraine, closely linked to disease-related factors. This condition is multifactorial and associated with a specific clinical profile, including male sex, lower BMI, reduced physical performance, higher inflammation, and prolonged glucocorticoid use, highlighting the need for comprehensive screening and care.
To analyze the dynamics of antimicrobial consumption and evaluate the clinical and economic outcomes of a comprehensive antimicrobial stewardship (AMS) program in a Ukrainian maternity hospital. Retrospective observational study. The study was conducted at a tertiary referral maternity hospital in Kyiv, Ukraine, using two datasets. First, a longitudinal analysis of pharmacy dispensing records (2020-2024) was performed to assess consumption trends. Second, a comparative cohort analysis of 320 women undergoing gynecological surgery (preAMS [2018] vs postAMS [2023]; n = 160 per group) was conducted to evaluate the impact of stewardship interventions. The AMS program, implemented in 2020, utilized administrative "stop-orders" for postoperative prophylaxis and pharmacy gatekeeping for broad-spectrum agents. Economic outcomes were assessed using a patient-level micro-costing approach. A profound structural shift occurred: consumption of ceftriaxone decreased from 72.4% of total prophylactic units in 2020 to 1.4% in 2024, replaced by cefazolin (0% to 44.0%). In the clinical cohorts, unjustified postoperative antibiotic use was eliminated (46.3% in 2018 to 0% in 2023; P < .001). The transition to single-dose prophylaxis reduced the mean direct antibiotic cost by 78.4% and coincided with a decrease in the mean length of stay from 9.85 to 4.68 days (P < .001). The program generated an estimated net saving of approximately $1,040 per surgical case. Institution-level stewardship interventions successfully shifted prescribing toward guideline-concordant use and generated substantial cost savings. This study demonstrates the resilience and feasibility of low-cost stewardship models in high-pressure, transitional healthcare environments.
Gastric cancer is one of the leading causes of cancer-related mortality worldwide. While perioperative chemotherapy with the fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) regimen improves survival in resectable gastric and gastroesophageal junction (GEJ) cancer, postoperative treatment is frequently poorly tolerated. Total neoadjuvant chemotherapy (TNT), in which all chemotherapy is delivered prior to surgery, has emerged as a promising alternative. The present study aimed to investigate the safety and feasibility of TNT with FLOT in patients with resectable gastric and GEJ cancer. The study retrospectively analyzed patients who received TNT with FLOT followed by curative surgery at the National Cancer Institute in Kyiv (Ukraine), between October 2017 and October 2021. Primary endpoints included safety and feasibility, assessed by chemotherapy-related adverse events, dose reductions, treatment discontinuation and completion rate. Secondary endpoints included pathological response, R0 resection rate, postoperative morbidity and mortality, and surgical outcomes. A total of 76 patients were included in the study. Of these, 71 patients proceeded to curative-intent surgery after the neoadjuvant stage. Among all included patients, 42 (55.26%) patients completed all eight FLOT cycles, 14 (18.42%) patients completed seven cycles, 10 (13.16%) patients completed six cycles and 5 (6.58%) patients completed five cycles. Common toxicities included leukopenia (76.32% grade 1-2; 21.05% grade 3-4) and nausea (76.32% grade 1-2; 10.53% grade 3-4). An R0 resection was achieved in 66 patients (92.96%) and a complete pathological response in 2 patients (2.82%). In conclusion, TNT with FLOT is a safe and feasible option for resectable gastric and GEJ cancer. It is not associated with an increased rate of severe adverse events and mortality. However, the findings of the present study are not conclusive and further prospective studies should assess its long-term efficacy and integration with targeted therapies.
Chemical burns are a significant concern in Ukraine, with a growing interest in new treatments. Nanohybrids based on Ag nanoparticles and carbon dots (Ag/C NHs) due to their anti-inflammatory, antioxidant, and antibacterial properties, have shown promise for wound healing. This study aimed to evaluate the efficacy of Ag/C NHs in promoting healing of both acidic- and alkali-induced burns in a rat model. The results indicated that rats with acid- and alkali-induced skin burns exhibited distinct healing patterns and systemic responses, with Ag/C197 sample accelerating early wound closure in acidic burns despite a mild proinflammatory profile, while Ag/C195 sample promoted later-stage healing and demonstrated anti-inflammatory effects, particularly in alkali burns. Systemic inflammation was evident in both burn types, characterized by neutrophilia and lymphocyte suppression, which was mitigated by Ag/C195. Both Ag-based formulations increased monocyte counts, suggesting enhanced tissue repair. Additionally, burns induced mild anemia that was not fully prevented by treatment with Ag/C NHs, although partial hemoglobin recovery was observed by day 14. Overall, our findings support the therapeutic potential of Ag/C NHs (particularly Ag/C195 version), in managing chemical burn injuries.
Continuing professional development (CPD) is essential for maintaining competency and quality in healthcare practice, yet low- and middle-income countries (LMICs) often lack practical guidance to design, implement, and sustain CPD programs. While implementation science frameworks provide theoretical structure, accessible tools to operationalize these frameworks for rehabilitation workforce development remain limited. This study describes the development and pilot testing of the Clinical Skills Training Tool (CSTT); a theory-informed, planning and evaluation tool to support contextually relevant CPD development for rehabilitation professionals. The CSTT was developed using implementation science frameworks, including the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework and the Consolidated Framework for Implementation Research (CFIR), and incorporated the Kirkpatrick model to guide CPD evaluation. The tool was piloted between 2021 and 2024 with multidisciplinary rehabilitation stakeholders in Myanmar, Ukraine, Uganda, and Pakistan. Data were collected through stakeholder workshops, structured planning activities, guided reflections, and evaluation of CPD programs developed using the tool. Qualitative framework-informed analysis was used to assess usability, feasibility, contextual adaptation, and implementation factors influencing tool use. A total of 191 stakeholders participated in CSTT pilot implementation across 4 countries. The tool supported systematic identification of workforce training priorities, structured CPD program design, and development of evaluation strategies. CSTT-supported programs demonstrated improvements in stakeholder knowledge, clinical confidence, and adoption of structured evaluation practices. Stakeholders successfully adapted the tool across diverse health system contexts while maintaining fidelity to core planning processes. Iterative refinement improved usability, clarity, and sustainability guidance. The CSTT operationalizes implementation science frameworks into a practical, adaptable tool to support CPD planning and evaluation in LMIC rehabilitation settings. By bridging the gap between implementation theory and workforce development practice, the CSTT provides a scalable approach to strengthening rehabilitation workforce capacity and supporting sustainable CPD systems across diverse global contexts.