Community nurses play a pivotal role in palliative care but face barriers in managing complex symptoms, such as fragmented knowledge and a lack of community-tailored evidence-based guidance, impairing clinical efficiency. The aim of this study was to develop and evaluate a knowledge graph-based question-answering system for symptom management in community palliative care. A three-phase codesign study guided by the Knowledge-to-Action framework was conducted. Phase 1 (Knowledge Creation): A Symptom Management Knowledge Base (Knowledge Product I) was developed through a codesign process involving a multidisciplinary expert panel. This panel adapted a knowledge base created by researchers through systematic evidence synthesis, employing FAME criteria for contextual adaptation. Phase 2 (Action Cycle: Implementation): A semantically structured knowledge graph (Knowledge Product II) was constructed via automated extraction by software developers, followed by manual verification by researchers. Based on this graph, a question-answering system was created and implemented as a WeChat mini-program, resulting in a practical KG-QA system (Knowledge Product III). Phase 3 (Action Cycle: Evaluation): The system's acceptability, usability, and perceived usefulness and ease of use were assessed among experts and community nurses during a two-week evaluation period using the Clinical Nursing Information System Effectiveness Evaluation Scale and the Post-Study System Usability Questionnaire, which is grounded in the Technology Acceptance Model. The knowledge base comprises 225 evidence items for nine symptoms; the knowledge graph integrates ten entity types, 11 relationship categories, 442 entities and 668 relationships, with the system supporting four query interfaces and three search methods. The evaluations demonstrated high perceived usefulness and ease of use, with strong scores for acceptability (102.25 ± 16.21; 110.56 ± 9.90) and usability (2.47 ± 1.98; 2.23 ± 1.93). The question-answering system bridges the evidence-practice gap via a nursing-process paradigm, offering a potentially scalable model that aligns with national policies pending further validation. However, these findings are based on a small‑scale, single‑region, short‑term evaluation relying largely on subjective measures. Future research should explore its long-term clinical outcomes and cross-setting scalability.
This study compared the relative effectiveness of different inspiratory muscle training (IMT) modalities within intensive care unit-acquired weakness (ICU-AW) prevention and rehabilitation strategies using network meta-analysis (NMA) and component network meta-analysis (CNMA). A systematic search of electronic databases in both Chinese and English was conducted to identify randomized controlled trials (RCTs) enrolling adult patients (≥ 18 years) admitted to the intensive care unit (ICU). Eligible studies evaluated strategies for the prevention and rehabilitation of ICU-AW, including inspiratory muscle training IMT-related interventions, systemic physical rehabilitation, and their combinations. The Cochrane Risk of Bias 2 (RoB2) tool was used to assess the risk of bias in the included RCTs, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was applied to evaluate the quality of the evidence. Heterogeneity was initially assessed using conventional pooled analyses and was not used as the sole criterion for model selection in the subsequent NMA. Outcomes with substantial heterogeneity were further analyzed using random-effects NMA, for which 95% prediction intervals (PIs) were additionally reported. For outcomes with low apparent heterogeneity, fixed-effect NMA was applied, with heterogeneity interpreted in light of clinical and methodological diversity across studies. Component network meta-analysis (CNMA) was additionally conducted to quantify the independent treatment effect of each intervention component. For continuous outcome measures (Medical Research Council [MRC] score, maximal inspiratory pressure [MIP], and duration of mechanical ventilation [MV]), results were presented as mean differences (MDs) and their 95% confidence intervals (CIs). For binary outcome measures (incidence of ICU-AW and weaning success rate), treatment effects were expressed as odds ratios (ORs) with 95% CIs. A total of 23 eligible randomized controlled trials (RCTs) were included in this analysis, which evaluated 11 distinct intervention strategies. These strategies were categorized into 5 multicomponent interventions and 6 single-component interventions. The 6 single-component interventions included 4 IMT modalities, a systemic physical rehabilitation intervention, and routine care, which was designated as the reference control group. Compared with the routine care reference group, mechanical threshold showed a non-statistically significant trend toward lower ICU-AW incidence (OR = 0.19, 95% CI [0.04, 1.01]); hence, the best-ranked results based on SUCRA should be interpreted as exploratory findings only. The combination of systemic physical rehabilitation and routine inspiratory muscle training was associated with improved MRC scores and higher weaning success rates. For MIP, the combination of systemic physical rehabilitation and mechanical threshold achieved the highest ranking. CNMA further indicated that the addition of systemic physical rehabilitation to mechanical threshold was associated with incremental therapeutic benefit. For duration of MV, combined strategies incorporating systemic physical rehabilitation and IMT also ranked favorably; however, this outcome was associated with a higher degree of uncertainty and should be interpreted with caution. According to the GRADE approach, the certainty of evidence was rated as low for the incidence of ICU-AW, moderate for the MRC score, weaning success rate, and MIP, and very low for the duration of mechanical ventilation. While combined interventions incorporating systemic physical rehabilitation and IMT ranked highest across multiple outcomes, evidence supporting the superiority of any specific IMT regimen over another remains limited. For MIP, CNMA further demonstrated that the addition of systemic physical rehabilitation to mechanical threshold was associated with a statistically significant incremental therapeutic benefit compared with mechanical threshold alone, although definitive isolation of the independent effects of most individual components was not possible. Overall, these findings provide a more differentiated assessment of IMT-related strategies within ICU-AW prevention and rehabilitation. However, the overall certainty of evidence ranged from moderate to very low across all outcomes according to the GRADE framework, highlighting the need for further high-quality randomized controlled trials to validate these findings. This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD420251208302.
To describe Kangaroo Mother Care (KMC) practice in the community (cKMC) two months after discharge from the Neonatal Intensive Care Unit (NICU). in South Indian mother-LBW infants. A prospective study enrolling 420 dyads at discharge from the NICU with follow-up on cKMC practice two months after discharge. Factors associated with cKMC were explored using logistic regression. Among the 420 enrolled, 2 (0.5%) infants died, and 12 (2.9%) were lost to follow-up. Of the remaining families, 25% (101) never practiced cKMC, effective practice was done by 19% (77). Infant birth weight ≥ 1.5 kg (OR: 3.1, 95% CI 1.8, 5.3) was associated with higher odds of practicing cKMC, while being born at term (OR: 0.5, 95% CI 0.3, 0.8) and mothers' weight > 45 kg (OR: 0.3, 95% CI 0.1-0.7) was associated with lower odds of practicing cKMC. Continued KMC practice 48 h before discharge was associated with higher odds (OR: 3.4, 95% CI 1.8-6.2), while absence of father's support was associated with lower odds (OR: 0.6, 95% CI 0.3, 1.0) of effective cKMC. The continuum of cKMC after discharge from the NICU was inadequate. Factors associated with cKMC practice should be considered when planning interventions to improve cKMC practices.
The 2022 global mpox outbreak was the first to involve sustained community transmission outside endemic regions, disproportionately affecting gay, bisexual and other men who have sex with men (GBMSM). News media plays a critical role during outbreaks by disseminating information, shaping public perception and influencing health protection behaviours. This qualitative study examined how UK news media represented mpox during the 2022 outbreak, with a particular focus on public health messaging and the discursive framing of affected communities. Using the NexisUK® database, we retrieved UK print and online articles mentioning "mpox", "monkeypox", or "monkey pox" in headlines, published between May and December 2022. Five national newspapers were selected based on readership and political stance (The Times/Sunday Times, The Guardian, The Sun, The Daily Mail/Sunday Mail and the Daily Mirror/Sunday Mirror). Following deduplication and screening, we applied a rotating weekday sampling frame and analysed articles thematically in NVivo. We identified 746 articles in the five selected newspapers between May and December 2022. Coverage peaked in May 2022 (n = 223 articles) and then waned, despite incident cases rising in June (n = 1,185) and July (n = 1,453). We analysed 79 sampled articles. Key themes included communication of mpox characteristics, delivery of health promotion, and 'anchoring' mpox to other infectious diseases (e.g. COVID-19, chickenpox) to aid understanding. Articles described mpox's epidemiological origins in Africa, transmission routes, and epidemiological updates, often noting transmission during GBMSM events. Public health messaging focused on advice about transmission reduction, access to care/prevention services, and vaccine availability (including concerns over supply). GBMSM were frequently depicted as being at high risk, sometimes drawing upon stereotypes and language that potentially reinforced stigma. Notably, few articles included perspectives from individuals with lived experience of mpox. UK news media interest in mpox peaked early in the outbreak and waned despite rising cases. News media played a vital role in disseminating information and public health messaging (often drawing parallels with other familiar infections) but the framing of GBMSM may also have reinforced stigma. The absence of personal testimonies represents a missed opportunity for inclusive messaging. Future outbreak reporting should involve affected communities to co-produce and promote accurate, non-stigmatising communication.
Uptake of evidence-based medication for opioid use disorder (MOUD), including buprenorphine-naloxone, remains low despite the expanding US opioid crisis. This study examined participants' and staff perceptions of adopting and delivering buprenorphine-naloxone on a mobile unit providing integrated MOUD and HIV services for people with opioid use disorder who inject drugs in the HPTN 094 INTEGRA trial. We conducted semi-structured interviews with people with opioid use disorder who inject drugs in the intervention or control arm (n = 77) and mobile unit staff (n = 38) of HPTN 094 as part of an embedded qualitative implementation science evaluation across five US cities: Houston, Los Angeles, New York City, Philadelphia and Washington, DC. Interviews were transcribed and analysed using a pragmatic inductive and deductive thematic approach. Fear of precipitated withdrawal was a primary factor shaping perceptions of buprenorphine and other MOUD formulations. This fear was heightened by the widespread presence of fentanyl in the unregulated drug supply. Participants' MOUD preferences were influenced by their treatment goals and by misperceptions of the role of naloxone in buprenorphine and the risk of precipitated withdrawal. Additional barriers included stigma towards MOUD and infrastructure constraints that complicated buprenorphine-naloxone inductions on a mobile unit. Even with facilitated access, perceptions of evidence-based MOUD were strongly shaped by fear of precipitated withdrawal. Aligning MOUD formulations with the treatment goals of people who inject drugs, along with expanding flexibility in MOUD access, delivery and induction practices across formulations, may improve uptake of these life-saving treatments.
Nontraumatic low back pain is highly prevalent in Australia, affecting 79.2% of adults and accounting for up to 4% of emergency department (ED) presentations. This study examines the postdischarge outcomes of ED patients admitted to a short stay unit (SSU) for low back pain management. A cross-sectional observational study design was employed, comprising retrospective observational data and a follow-up cross-sectional survey. Data were collected between June 2023 and February 2024. Functional status was measured with the Modified Oswestry Low Back Pain Disability Questionnaire. Of the 422 participants invited, 21% (n = 89) completed questionnaires. Respondents were 58% female and 42% male, aged 20.3-96.1 years (mean 63.4, SD 19.4). Most respondents (71.2%) reported moderate-to-severe disability, with 19.1% reporting complete disability. Over 50% were still taking opioid analgesics at the time of survey completion. In the multivariable regression model, pharmacological treatments were significantly associated with disability scores (F (4, 84) = 5.34, p < 0.001). Use of short-acting opioids was associated with an average increase of 7.5 units in disability score and use of long-acting opioids with an average increase of 8.1 units, reflecting ongoing pain or greater disability among participants receiving opioid medications. Time spent in the SSU was associated with the severity of disability. Patients who later developed moderate or severe disability spent a mean of 31 h in SSU, compared to 17.5 h among those with no or mild disability (p = 0.012). Only 45% of patients sought ongoing physiotherapy care in the month following discharge. At one month postdischarge, most participants reported considerable ongoing disability and pain. A substantial proportion continued to use opioids, while physiotherapy services remained underutilised. Findings from this study informed a local business case to establish physiotherapy 'virtual hot clinics' for patients within 1 week of discharge.
Lumbar spondylolisthesis is a clinically important cause of chronic low back pain, activity limitation, and reduced functional capacity. Exercise-based physiotherapy is widely recommended for conservative management, yet uncertainty remains regarding the added value of targeted core stabilization and hip-related stretching strategies in this population. Abdominal hollowing is intended to improve deep trunk muscle activation and lumbopelvic control, whereas piriformis stretching may reduce posterior hip tightness and movement-related discomfort. This trial aims to evaluate whether adding abdominal hollowing and piriformis stretching exercises to a standardized conventional physiotherapy programme improves pain, functional disability, and kinesiophobia in adults with low-grade lumbar spondylolisthesis. This study is a two-arm, parallel group, assessor-blinded randomized controlled superiority trial. Seventy-two participants aged 18 to 65 years with radiologically confirmed lumbar spondylolisthesis of Meyerding grade I or II, chronic localized low back pain of more than 3 months, and a baseline pain intensity of more than 3 on a 10-point Visual Analogue Scale will be recruited from the Musculoskeletal Physiotherapy Unit of the Centre for the Rehabilitation of the Paralysed, Savar, Bangladesh. Recruitment is planned from April 2026 to June 2026. Participants will be allocated in a 1:1 ratio using a computer-generated block randomization sequence with concealed allocation. Both groups will receive a standardized conventional physiotherapy programme three times weekly for 6 weeks. The experimental group will additionally receive abdominal hollowing and piriformis stretching exercises. The primary outcome will be pain intensity measured by the 10-cm Visual Analogue Scale immediately after the 6-week intervention. Secondary outcomes will include functional disability measured by the Oswestry Disability Index, kinesiophobia measured by the Tampa Scale for Kinesiophobia, and all outcome measures assessed at 4-week follow-up. Data will be analysed according to the intention-to-treat principle using linear mixed effects models, with effect estimates reported alongside 95% confidence intervals. This trial will determine whether adding targeted core stabilization and piriformis stretching to a standardized physiotherapy programme produces superior short-term clinical outcomes in people with lumbar spondylolisthesis. The findings may inform conservative rehabilitation strategies for this population, particularly in resource-limited clinical settings. Clinical Trial Registry India (CTRI), CTRI/2025/07/089927. Registered prospectively on 01 July 2025.
Neurovasculoglial cross-talk underlying breakdown of the neurovascular unit is a central, yet poorly understood, component of many neurodegenerative disorders of the CNS, including retinal disease. Primary fatty acid amides have been identified to regulate this cross-talk between vasculature and neuronal tissues, but specific molecules and mechanisms remain unresolved. Here we show, using an unbiased high-resolution metabolomics screen, that erucamide, a 22:1 monounsaturated omega-9 fatty acid amide, is highly dysregulated during photoreceptor degeneration in mice. In vivo delivery of erucamide using organosilane-modified porous silicon nanoparticles activated retinal myeloid cells, leading to the upregulation of angiogenic and neurotrophic cytokines that limited vascular and neuronal degeneration. We identified TMEM19 as a binding protein for erucamide that is crucial for myeloid cell activation and subsequent neuroprotection. These findings reveal a previously unknown primary fatty acid amide pathway that modulates neuroimmune interactions during retinal degenerative diseases. We propose erucamide and analogs as candidate therapeutics.
Phase angle (PhA), derived from bioelectrical impedance analysis, reflects bioelectrical properties related to cellular mass and fluid distribution and has been proposed as a marker of malnutrition severity. However, its exploratory association with morphofunctional status and hospitalization-related outcomes in severe anorexia nervosa (AN) remains insufficiently characterized. This study aimed to explore whether baseline PhA is associated with morphofunctional status, length of stay, and inpatient costs in a specialized eating disorders unit. In this prospective cohort study, 42 female inpatients with severe AN or other specified feeding and eating disorder were assessed at admission. Patients were stratified into tertiles according to PhA. Anthropometry, body composition by bioelectrical impedance vector analysis (BIVA), intracellular and extracellular water distribution, handgrip strength, muscle and abdominal ultrasound parameters, biochemical markers, and length of stay were recorded. Hospitalization costs were estimated using standardized diagnosis-related group daily expenditure. Mean PhA values were 4.0°, 4.7°, and 5.5° in the low, mid, and high tertiles, respectively. Importantly, total body weight did not differ significantly across tertiles. In contrast, body cell mass index increased progressively (5.2, 6.1, and 6.9 kg/m²). Higher PhA was associated with greater rectus femoris cross-sectional area (2.3 vs. 3.7 cm²) and higher handgrip strength (20.3 vs. 24.9 kg), consistent with more favorable muscle structure and function in unadjusted comparisons. Hydration profiles also differed: extracellular water proportion decreased (52.7% to 40.3%), while intracellular water increased (44.1% to 53.3%) across tertiles. Median length of stay declined from 58.4 to 41.3 days, with corresponding reductions in estimated hospitalization costs (€36,523 to €25,829), which should be interpreted descriptively because cost estimates were largely driven by hospitalization duration. ROC analysis showed modest discriminatory performance for prolonged hospitalization (AUC = 0.65; exploratory threshold: 4.5-4.6°). Baseline PhA was associated with differences in morphofunctional profiles and hospitalization trajectories despite similar body weight, suggesting that it may capture morphofunctional variability not reflected by anthropometry alone. Its associations with cellular mass, hydration distribution, muscle function, and length of stay suggest that PhA may provide complementary descriptive information within a broader clinical assessment. However, given the modest discriminative performance, sample size, and lack of multivariable adjustment, PhA should not be considered a standalone prognostic tool. Larger multicenter studies are needed to validate thresholds and formally test whether PhA provides incremental information beyond conventional anthropometric, clinical, psychological, and organizational factors. Approved by the Provincial Research Ethics Committee of Granada (SICEIA-2024-003069). People with severe anorexia nervosa often need hospital treatment to restore their physical health safely. Healthcare professionals usually monitor recovery using body weight and body mass index (BMI), but these measures do not always reflect how well the body’s tissues, muscles, and cells are functioning. This study examined whether a measurement called phase angle could provide additional and more detailed information about the physical condition of the body. Phase angle is obtained from a painless body composition test that uses a very small electrical current. It gives information about cell mass, muscle condition, and body fluid balance. In particular, it reflects differences between water inside the cells and water outside the cells, which may be altered in severe malnutrition. Higher phase angle values are generally associated with more favorable cellular and muscle health. We studied 42 women admitted to hospital with severe anorexia nervosa or other specified feeding and eating disorder. Although patients had similar body weight, those with higher phase angle values showed stronger muscles, more favorable tissue-related measurements, and better body fluid balance at admission. They also had shorter hospital stays and lower treatment costs, although these lower costs were largely explained by shorter hospital stays. In contrast, patients with lower phase angle values tended to require longer inpatient care. These findings suggest that phase angle may help healthcare teams better understand the physical condition of patients beyond weight alone. Including phase angle in routine assessment may provide complementary information for clinical monitoring, but it should be used alongside broader medical, psychological, and organizational assessment during hospital treatment for anorexia nervosa, rather than as a standalone tool for predicting recovery, hospital stay, or discharge timing.
Simultaneous operation of Fickian diffusion, swelling-mediated relaxation, and polymer erosion in polymeric nano- and microspheres produces release profiles whose mechanistic origins cannot be resolved by empirical models without system-specific refitting. I present the Modified Multicomponent Interactive Release for Spheres (MMIR-S) framework, a thermodynamically self-consistent mechanistic model for homogeneously loaded spherical particles that determines mechanism-specific release weights from tabulated molecular descriptors, without fitting to release data. The theoretical core is Thermodynamic Eigenrate Decomposition (TED), in which each mechanism is assigned a commensurable first-order depletion rate: the diffusion eigenrate (π2Deff,app/R2) from the dominant eigenvalue of Fick's second law in spherical coordinates; the swelling eigenrate governed by the Flory-Rehner criterion, closing when χPM > 0.5; and the erosion rate accommodating surface, first-order, or bulk erosion kinetics. Normalizing these rates yields mechanism weights summing to unity, connected to Hansen solubility parameters, Flory-Huggins interaction parameters, and partition coefficients without empirical intermediaries. The burst release term distinguishes physically adsorbed drug, governed by a first-order desorption rate constant, from chemically adsorbed drug governed by an Arrhenius rate constant parameterized by binding free energy, producing a biexponential burst profile. A polydispersity correction integrates the release function over a log-normal size distribution via Gauss-Hermite quadrature. Validation against the six-compound, two-pH, multi-polymer dataset of Stiepel et al. [1] demonstrates TED weight distributions consistent with effective diffusivity trends recovered by regression and machine learning. The framework recovers the Higuchi, Hopfenberg, and first-order models as limiting cases, providing a foundation for a priori prediction of release profiles from molecular structure alone.
Immune-mediated myocarditis is a rare and potentially fatal complication of oncologic immunotherapy. While most reported cases have been associated with the use of immune checkpoint inhibitors (ICIs), novel immunotherapy agents may also pose cardiac risks that warrant further attention. We report a case of fulminant, steroid-refractory myocarditis following initiation of talquetamab, a bispecific T-cell engager (BiTE) targeting CD3 and GPRC5D used for relapsed or refractory multiple myeloma (MM). A 69-year-old man with MM refractory to multiple lines of treatment presented to his outpatient cardio-oncologist with syncope and intermittent chest pain 4 weeks after starting talquetamab. He was found to have elevated high-sensitivity troponin and new inferior Q waves on EKG. He presented to the hospital, where he was admitted to the cardiac intensive care unit. New ST-segment elevations in the inferior leads were subsequently observed on serial EKGs. Transthoracic echocardiography showed a decreased left ventricular (LV) ejection fraction with new regional wall motion abnormalities. Left and right heart catheterization and endomyocardial biopsy were unremarkable. Cardiac magnetic resonance imaging (MRI) revealed segmental late gadolinium enhancement, myocardial edema, increased T1 time, and increased extracellular volume. Acute myocarditis due to talquetamab was presumed, and intravenous steroid therapy was initiated. His symptoms and biomarkers initially improved but later worsened despite steroid therapy. He received additional immunosuppressive therapies including tocilizumab, mycophenolate mofetil, intravenous immunoglobulin, and ruxolitinib. However, his biomarkers and LV systolic function continued to worsen, ultimately resulting in death. This case underscores the potential for immune-mediated myocarditis associated with talquetamab to follow a fulminant and treatment-refractory course despite guideline-directed escalation of immunosuppression, with important implications for clinical recognition and management. It also illustrates the diagnostic challenge of immune-mediated myocarditis presenting as an ST-segment elevation myocardial infarction (STEMI) mimic with non-obstructive coronary arteries. Finally, it emphasizes the complementary role of cardiac MRI in establishing the diagnosis when endomyocardial biopsy is non-diagnostic.
We hypothesized that a shorter preoperative leukocyte telomere length (TL) predicts the development of acute postoperative depression in elderly surgical patients. This single-center, prospective, observational study included 48 patients ≥ 65 years old requiring intensive care unit admission for ≥ 2 days after surgery. Acute postoperative depression was defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 on postoperative day 7. Multivariate logistic regression analyses were performed to determine whether the preoperative TL could be used to predict the development of acute postoperative depression. 48 patients who underwent esophagectomy, head and neck surgery, or off-pump coronary bypass grafting were included. 20 patients (41.7%) developed acute postoperative depression. The preoperative TL was not significantly different between the depression group and the non-depression group (n = 28) (303,902 ± 48,103 vs. 331,816 ± 48,984 RLU/µg DNA, p = 0.056). The multivariable logistic regression analysis showed that the surgical procedure type was the dominant predictor of acute postoperative depression, whereas preoperative TL was not independently associated (OR 1.585, 95%CI: 0.722-3.479, p = 0.251). In a post-hoc subgroup analysis excluding head & neck surgery patients, the preoperative TL was significantly shorter in the depression group (302,990 ± 38,881 vs. 336,426 ± 49,755 RLU/µg DNA, p = 0.042) and was independently associated with acute postoperative depression after adjustment for the surgical procedure type (OR 3.556, 95%CI: 1.121-11.282, p = 0.031). There was no significant association between the preoperative TL and acute postoperative depression. This result may be due to the small sample size and a cohort comprising multiple surgical procedure types. The exploratory post-hoc subgroup analysis excluding the patients who underwent head & neck surgery showed that shorter preoperative TL was significantly associated with an increased risk of acute postoperative depression. However, this preliminary finding is hypothesis-generating rather than confirmatory and should be interpreted with caution. jRCT1020220041.
Cerebral MRI after severe traumatic brain injury (sTBI) may refine lesion characterization and support prognosis, but the optimal timing within the early course remains uncertain. We retrospectively analyzed 17 adult sTBI patients (GCS ≤ 8) who underwent two clinically indicated 3 T MRI examinations: an early scan (≤ 72 h) and a subacute scan (day 12-14). Three board-certified neurointensivists, blinded to scan timing, independently rated lesion burden across standard sequences (T1, T2/FLAIR, SWI, DWI) and evaluated (i) comparative clinical utility of early vs subacute MRI, (ii) imaging-only prognosis (expected favorable vs unfavorable functional outcome, dichotomized by Glasgow Outcome Scale), and (iii) whether imaging findings would be expected to prompt a management change. Inter-rater agreement was quantified by ICC (lesion counts) and Fleiss' kappa (categorical ratings). The patient (MRI-pair) was the statistical unit; rater-level ratings were used for reliability estimation, not as independent observations. At the patient level, early and subacute MRI were judged equally useful in 12/17 (70.6%) cases (Fleiss' kappa for pairwise utility rating: 0.33). Lesion burden demonstrated substantial overlap between time points; paired comparisons of rater-averaged lesion counts did not indicate a systematic difference between early and subacute MRI across T1, T2/FLAIR, SWI, or DWI (all p > 0.05). Monitoring-related artifacts were frequent but rarely reduced overall interpretability. In this selected cohort able to undergo two MRIs within the early course of sTBI, early and subacute MRI provided largely concordant information. MRI timing should be individualized based on clinical stability and the specific diagnostic question; routine repetition within the first two weeks may not be necessary.
The prognostic nutritional index (PNI), a composite marker derived from serum albumin and total lymphocyte count, has been associated with adverse outcomes in several cardiovascular and critical care settings. However, its prognostic value in critically ill patients with atrial fibrillation (AF) remains unclear. This study aimed to evaluate the association between PNI and mortality in this high-risk population. This retrospective cohort study included critically ill patients with AF from the Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1). The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, 90- and 365-day mortality. Multivariable Cox proportional hazards and logistic regression models were used to assess the associations between PNI and outcomes. Kaplan-Meier survival analyses and restricted cubic spline (RCS) analyses were performed to further characterize these associations. The association between PNI and in-hospital mortality was further examined in an independent cohort from the eICU Collaborative Research Database (eICU-CRD). A total of 3,007 critically ill patients with AF were included in the MIMIC-IV cohort, and 2,741 patients were included in the independent eICU-CRD cohort. In the primary model (Model 2), each 10-unit increase in PNI was associated with a lower risk of 30-day mortality (HR, 0.63; 95% CI, 0.57-0.70; P < 0.001), 90-day mortality (HR, 0.64; 95% CI, 0.58-0.70; P < 0.001), and 365-day mortality (HR, 0.68; 95% CI, 0.63-0.74; P < 0.001) in the MIMIC-IV cohort. Higher PNI was also associated with lower in-hospital mortality in the MIMIC-IV cohort (OR, 0.58; 95% CI, 0.50-0.66; P < 0.001). In the independent eICU-CRD cohort, higher PNI remained significantly associated with lower in-hospital mortality (OR, 0.66; 95% CI, 0.57-0.76; P < 0.001). Kaplan-Meier analyses showed progressively better survival across increasing PNI quartiles, whereas RCS analyses demonstrated a nonlinear inverse relationship between PNI and mortality. Lower PNI was independently associated with increased short- and long-term mortality in critically ill patients with AF. As a readily available laboratory-based index, PNI may provide simple adjunctive prognostic information in this high-risk population.
Social determinants of health influence maternal and perinatal outcomes, yet tools to operationalize these risks in clinical care remain scarce. We aimed to study social determinants in Brazilian pregnant women and develop a social vulnerability index (SVI) that could correlate with pregnancy and perinatal outcomes. The present study was a secondary analysis of 1565 low-risk nulliparous women enrolled in two Brazilian cohort studies. We selected vulnerability indicators from sociodemographic data and tested the performance and risk association of multiple SVI models with any adverse outcome (preterm birth, gestational diabetes mellitus, pre-eclampsia, small or large for gestational age, low 5-min Apgar score, neonatal intubation, neonatal intensive care unit admission, fetal or neonatal death) using chi-square tests, logistic regression, and receiver operating characteristic analysis. Advanced maternal age, non-white ethnicity, and exclusive publicly funded antenatal care were the most consistent vulnerability predictors of adverse outcomes. The final three-variable SVI demonstrated a significant dose-response gradient, with maternal adverse outcomes increasing from 16.4% (no vulnerabilities) to 43.8% (3 vulnerabilities) and perinatal adverse outcomes rising from 22.1% to 35.6%. The model presented a sensitivity of 64.71%, a specificity of 42.56%, a positive predictive value of 47.46% and a negative predictive value of 60.07% for any adverse outcome. The three-variable SVI offers a simple, reproducible, and context-adapted screening tool for primary care. Either for individual or population screening, it can be easily combined with clinical risk assessment, targeting those who may benefit from equity-oriented maternal health strategies.
Delayed union and nonunion remain clinically important complications after tibial and femoral shaft fractures. Although traditional risk factors such as smoking and diabetes have been widely investigated, the association between visceral adiposity-related metabolic dysfunction and impaired fracture healing remains unclear. This study aimed to examine the association between the visceral adiposity index (VAI) and delayed union/nonunion after tibial or femoral shaft fractures and to explore whether VAI could improve internally validated prediction models. We conducted a single-center retrospective cohort study of 485 adults who underwent intramedullary fixation for isolated tibial or femoral shaft fractures between January 2022 and June 2025. VAI was calculated using sex-specific equations incorporating waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol. The primary endpoint was delayed union/nonunion at 6 months after surgery. The association between VAI and delayed union/nonunion was assessed using multivariable logistic regression and restricted cubic spline analysis. Discriminative performance was compared using receiver operating characteristic analysis, and exploratory machine learning models were evaluated using internal validation. Delayed union/nonunion occurred in 60/485 patients (12.4%). The median VAI was higher in patients with delayed union/nonunion than in those who achieved fracture union [3.1 (IQR, 2.2-4.5) vs. 1.9 (IQR, 1.3-2.8), P < 0.001]. After full adjustment for demographic, lifestyle, metabolic, and fracture-related covariates, each 1-unit increase in VAI was associated with higher odds of delayed union/nonunion (OR 1.61, 95% CI 1.31-1.98; P < 0.001). Restricted cubic spline analysis suggested an approximately linear association, without significant evidence of nonlinearity. VAI showed higher discrimination than body mass index and waist circumference (AUC 0.785 vs. 0.655 and 0.712, respectively). In exploratory internal validation, L1/Elastic Net-regularized logistic regression showed the highest AUC among the evaluated machine learning models (AUC 0.914, 95% CI 0.864-0.963). In this single-center retrospective cohort, higher VAI was associated with an increased risk of delayed union/nonunion after tibial or femoral shaft fractures treated with intramedullary fixation. VAI showed better discrimination than conventional anthropometric measures in internal analyses and may provide additional information for early risk stratification. However, these findings do not establish causality, and external prospective validation is required before clinical implementation.
The 2024 international pediatric sepsis consensus definition has undergone a paradigm shift from a systemic inflammatory response syndrome (SIRS)-based framework to the organ dysfunction-centered Phoenix Sepsis Criteria (PSC). We aimed to evaluate the diagnostic concordance, predictive performance for 28-day pediatric intensive care unit (PICU) mortality, and phenotypic overlap between these two pediatric sepsis definitions. This single-center retrospective cohort study included 1034 children aged > 1 month to < 18 years with confirmed or suspected infection who were directly admitted to the PICU of Children's Hospital of Chongqing Medical University between January 1, 2020, and November 21, 2023. All patients were independently evaluated for sepsis using both the 2005 International Pediatric Sepsis Consensus Conference (IPSCC) SIRS criteria and the 2024 PSC. Diagnostic agreement was assessed using the Kappa coefficient. Binary logistic regression was employed to establish association models between factors and phenotypes, as well as between factors and PICU 28-day mortality. Predictive performance was compared using the C-statistic. Among 1034 patients, 613 (59.3%) met the Sepsis-SIRS criteria with a 28-day PICU mortality of 15.2% (93/613), 744 (72.0%) met the Sepsis-Phoenix criteria with a mortality of 16.3% (121/744), 489 (47.3%) met both criteria with a mortality of 18.6% (91/489), and 166 (16.1%) met neither criterion with a mortality of 2.4% (4/166). Agreement between the two criteria was poor (kappa = 0.202, 95% CI: 0.143-0.261). After adjusting for clinically relevant confounders, the PSC remained a strong independent predictor of 28-day mortality (adjusted OR = 5.123, 95% CI: 2.128-12.333, p < 0.001), whereas the SIRS criteria showed no independent predictive value (adjusted OR = 0.937, 95% CI: 0.523-1.678, p = 0.827). The PSC demonstrated significantly superior discriminatory ability compared with the SIRS criteria (C-statistic = 0.809 vs. 0.589, p < 0.001). Notably, 20.2% of SIRS-positive patients were not classified as sepsis by the Phoenix Criteria, and this subgroup had an extremely low mortality of 1.6%, reflecting higher specificity of the PSC. The SIRS and PSC identify partially overlapping populations with distinct risk stratification, showing poor diagnostic concordance. The PSC has superior independent predictive performance for PICU 28-day mortality and may be considered for prognostic assessment of infected children in the PICU setting. Importantly, historical study results based on the SIRS criteria should be extrapolated cautiously to PSC-defined populations.
Over the past decade, the digitalization of health and telemedicine solutions has accelerated. Optimized digital infrastructure enables telemedicine as a complementary health care service, reducing organizational pressures and increasing accessibility. Tele medicine (TM) is well suited for chronic wound care, particularly diabetes-related foot ulcers, owing to its photo documentation and data exchange capabilities. This study aimed to explore health care professionals' (HCPs') cross-sectoral use of TM technology for the treatment and care of patients with diabetic foot ulcers (DFUs). The study used a realistic evaluation design. From 2023 to 2024, we conducted 68 h of participant observation of healthcare professionals in hospital and primary care during DFU treatment within a Danish cross-sectoral setting. The Standards for Reporting Qualitative Research (SRQR) were applied. We generated three key themes: (1) Time matters: navigating allocated and limited time in person-centred care and treatment. (2) Tech hurdles: adapting/aligning perceptions and mastering digital tools. (3) Building bridges: the power of relationships in sustaining telemedicine use. Our study led to a refined program theory allowing us to propose an answer to the problem of "what works, for whom, and under what circumstances": HCPs' cross-sectoral collaboration using the TM communication solution Pleje.net© enhances the treatment and care of patients with DFUs. This improvement is achieved in a cross-sectoral setting when care management addresses organizational challenges, such as managing time constraints, overcoming technological hurdles, and fostering strong relationships among HCPs. When robust relationships are present, the TM solution facilitates timely and coordinated care across different sectors, ultimately improving patient outcomes in a multidisciplinary setting. Findings are limited to a Danish cross-sectoral healthcare context and may not be directly transferable to other health systems.
This study aims to design, develop, and evaluate the feasibility of a mobile chemotherapy drug guide (ChemoNurse) tailored for oncology nurses. The evaluation focused on feasibility, usability, and acceptability outcomes. ChemoNurse includes drug preparation, storage methods, administration routes, administration duration, dosage calculation, side effects, patient education, and symptom management. This feasibility study was conducted between August 1, 2023, and August 1, 2024, with 34 oncology nurses from the Turkish Oncology Nursing Society. The Standard Protocol Items: Recommendations for Interventional Trials checklist was utilized. The RE-AIM framework was used to guide the evaluation of early implementation outcomes, particularly feasibility, usability, and acceptability. The evaluation framework integrates usability, perceived usefulness, acceptability, and feasibility. The Information Form, ChemoNurse Evaluation Form, Mobile Application Usability Scale, Satisfaction Scale, and semi-structured interview form were used for data collection. The nurses' mean age was 32.79 ± 6.55 years, 91.2% female, and most had over ten years of professional experience. The evaluation of ChemoNurse's usability demonstrated high acceptance and perceived usefulness among oncology nurses. 94.1% of participants rated the application as easy to use, and 100% of participants reported that the content was understandable and clinically relevant. Additionally, 85.3% of participants considered the drug guide content clinically sufficient, and 91.2% confirmed that the application met their clinical needs. The application was perceived as cost-effective by all participants, and 97.1% of participants indicated they would continue using ChemoNurse in clinical practice. The Mobile Application Usability Scale results further supported these findings, with 91.2% of nurses scoring above 200 and a mean usability score of 246.76 ± 38.13. Preliminary evidence suggests that ChemoNurse is usable and acceptable for supporting oncology nurses' point-of-care access to chemotherapy information within this pilot sample; larger studies are needed to confirm its clinical impact. ChemoNurse demonstrated promising feasibility, usability, and acceptability within this pilot sample. Future studies with objective outcome measures are needed to evaluate its potential perceived usefulness and implementation feasibility in clinical practice.
Population ageing is a growing public health concern. Despite the Ugandan Government's efforts, like the Social Assistance Grant for Empowerment (SAGE) programme, malnutrition and poor Quality of Life (QoL) are still older persons' challenges. This study assessed the nutritional status and QoL of older persons on the SAGE programme in Kampala City, Central Uganda. A cross-sectional study with a quantitative research approach was conducted. Data was collected in 2025 among 159 persons aged 80 years and above using a 24-hour recall, the 26-item World Health Organisation BREF, and anthropometric assessments. Data analysis involved descriptive statistics, chi-square, analysis of variance, and regression. Statistical significance was read at p < 0.05. The mean (SD) meal frequency was 1.95 ± 0.81, dietary diversity score (DDS) was 6.69 ± 2.77 in the past 24 h, and Body Mass Index (BMI) was 22.8 ± 4.5 kg/m². Intake of meat (16.7%), fruits (14.6%) and eggs (10.2%) was low. Underweight, overweight, and obesity prevalence were 18.9%, 22.6%, and 8.2%, respectively. Underweight odds were lower in males (AOR = 0.36, CI: 0.14-0.92, p = 0.032) and persons who consumed ≥ 3 meals (AOR = 0.04, CI: 0.01-0.34, p = 0.003). The odds of overweight/obesity were higher among males (AOR = 2.01, CI: 1.36-2.69, p = 0.041). The mean (SD) overall QoL score was 52.27 ± 15.75, with 23.3% of respondents having a good QoL. Males had higher odds of a poor QoL (AOR = 2.45, CI: 1.53-3.04, p = 0.021), while having secondary or higher education (AOR = 0.25, CI: 0.11-0.57, p < 0.001) and other income sources (AOR = 0.32, CI: 0.28-1.38, p = 0.027) protected against a poor QoL. The study highlights a double burden of malnutrition and poor QoL linked to sex, socioeconomic and dietary factors among older persons on the SAGE programme. This points to challenges emanating from gender and policy disparities among older persons in Uganda.