Cladribine tablets (CladT) is a high-efficacy treatment (HET) for the management of relapsing multiple sclerosis (RMS) that acts as an immune reconstitution therapy (IRT). Administered as two short annual courses, CladT has been shown to provide durable disease control in responders for up to 11 years, extending well beyond the short treatment periods. Randomised trials do not offer evidence-based guidance on the therapeutic use of CladT beyond four years post-initiation, leading to variability in long-term management strategies in real-world practice, notably with respect to the possibility of additional treatment. We propose a pragmatic algorithm for long-term treatment with CladT, grounded in currently available data and our French collective clinical experience, intended to assist neurologists in therapeutic decision-making in year 5 and beyond. We suggest a practical classification of patients into two main profiles after the initial 4-year period: those who remain clinically and radiologically stable, and those who exhibit evidence of disease reactivation. A stable profile, which encompasses a large proportion of treated patients, may be managed through continued monitoring or additional treatment, depending on individual presentations and the presence or absence of factors associated with higher likelihood of RMS reactivation before CladT initiation. For patients demonstrating signs of disease activity, options include additional treatment with CladT or transitioning to another HET, according to the severity of inflammatory reactivation.
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The NeuPSIG diagnostic algorithm is regarded as the reference framework for the diagnosis of neuropathic pain. It is based on a hierarchical model in which diagnostic certainty increases with the presumed objectivity of the evidence, progressing from patient-reported symptoms to clinical examination and, ultimately, to confirmatory tests demonstrating a neurological lesion. In this position paper, we critically examine the conceptual foundations of this framework. We argue that the distinction between subjective and objective evidence is less clear-cut than assumed, as so-called objective biomarkers are themselves influenced by patient-related, examiner-dependent and methodological factors. Moreover, the identification of a neurological lesion does not establish a causal relationship with pain, raising fundamental questions about the validity of using lesion-based markers as surrogates for pain classification. Drawing on evidence from bedside examination, quantitative sensory testing, neurophysiology and structural biomarkers, we highlight the limitations of the current hierarchical approach. We show that clinical reasoning in neuropathic pain does not follow a linear progression from subjective to objective data, but rather relies on the integration of multiple, context-dependent sources of information. We propose an alternative framework based on converging evidence, in which patient history, pain characteristics and clinical examination are accorded equivalent weight, and diagnostic confidence emerges from their coherence rather than from a hierarchy of objectivity. Within this model, investigations aimed at identifying a neurological lesion are repositioned as tools for aetiological clarification rather than as determinants of pain classification. In our opinion, this approach offers a more conceptually coherent and clinically relevant framework for the diagnosis of neuropathic pain. While the NeuPSIG algorithm has been useful to standardize the diagnosis of neuropathic pain in the research setting, this algorithm is based on a hierarchical model in which objective measures (sensory deficits, complementary investigations) largely outweigh self-reported symptoms. We challenge this assumption by showing that 'objective' measures are also prone to variability and propose a model which gives equivalent weight to patient reported outcomes. This model may offer a more clinically relevant approach to the diagnosis of neuropathic pain.
Keratoconus is a common blinding corneal disease among young adults. A large number of atypical or early-stage patients are highly susceptible to missed diagnosis or misdiagnosis due to unremarkable clinical manifestations, leading to the loss of opportunities for early effective intervention and management, and ultimately resulting in irreversible blindness. In recent years, with the expansion of the population undergoing corneal refractive surgery, establishing an accurate screening and diagnostic system for keratoconus has important clinical significance for preventing postoperative complications. In view of this, the Refractive Surgery Group of the Ophthalmology Branch of the Chinese Medical Doctor Association, in collaboration with the Corneal Disease Group of the Ophthalmology Branch of the Chinese Medical Association, has developed consensus opinions on confusing concepts and terms related to early keratoconus, as well as the strategies, criteria, methods and systems for the early screening and diagnosis of keratoconus, based on relevant domestic and international consensus, evidence-based medicine evidence and expert clinical experience, using scientific and standardized methods. This consensus aims to continuously establish and improve the early screening and diagnostic pathway for keratoconus, which not only provides a scientific basis for the preoperative evaluation of corneal refractive surgery and enhances the safety of corneal refractive surgery, but also offers a reference for the early clinical diagnosis and treatment of keratoconus. 圆锥角膜为青年人常见的致盲性角膜疾病，大量非典型或早期患者因临床表现不明显，极易被漏诊或误诊，丧失早期有效干预和处理时机，导致不可逆盲。近年随着角膜屈光手术人群扩大，建立精准的圆锥角膜筛查诊断体系，对于预防术后并发症具有重要临床意义。鉴于此，中国医师协会眼科医师分会屈光手术学组联合中华医学会眼科学分会角膜病学组，基于国内外相关共识、循证医学证据及专家临床经验，采用规范的指南和共识制订方法，针对与早期圆锥角膜相关的易混淆概念和词语，以及圆锥角膜早期筛查诊断的策略、标准、方法、体系等，形成共识性意见，以期建立并不断完善圆锥角膜早期筛查诊断路径，不仅为角膜屈光手术的术前评估提供科学依据，提升角膜屈光手术的安全性，也为临床圆锥角膜的早期诊疗提供指导意见。.
Emergency physicians frequently care for patients with serious or terminal illnesses, yet they often lack formal palliative care training. Our primary objective was to develop a structured, multimodal palliative care curriculum for emergency medicine (EM) residents and evaluate whether this curriculum improved residents' knowledge, comfort level, and perceived application of skills to care for patients with chronic or terminal illness in the emergency department (ED). Our secondary objective was to determine whether EM residents found palliative care education important and to identify which educational modalities are most effective for acquiring palliative care knowledge and skills. We implemented an eight-hour multimodal curriculum for EM residents at a single, large Level I trauma center (four hours of didactics, a three-hour simulated patient communication skills lab, and one hour of high-fidelity simulation). Our primary outcome was pre- and post-intervention surveys (12 questions) that assessed perceived knowledge, comfort, and skill application on five-point Likert scales. We analyzed paired responses using the Wilcoxon signed-rank test, with a P value of < .05 considered statistically significant. Effect size was calculated using Cohen d. Our secondary outcome measure was a post-intervention survey (six questions) that assessed participants' opinions on the effectiveness of the different educational methods. There was a 100% response rate among 41 residents from all postgraduate years 1-3. Significant improvements (P < .001) were observed in residents' self-reported abilities across all domains with large effect sizes. Median scores and interquartile ranges increased for conducting goals-of-care discussions (4 [3-4] vs 4 [4-5]), interpreting advance directives (3 [2-4] vs 4 [4-4]), managing end-of-life symptoms (3 [2-3] vs 4 [3-4]), communicating bad news (3 [2-4] vs 4 [4-4]), and coordinating with palliative or hospice teams (2 [2-3] v. 4 [4-4]). All educational modalities were rated effective, with simulation and small-group sessions preferred over lectures. A structured, multimodal palliative care curriculum significantly enhanced EM residents' perceived preparedness to manage patients with palliative care needs. Embedding didactic and simulation-based palliative training in EM residencies is both feasible and impactful, addressing critical gaps in palliative competencies and aligning with national best-practice guidelines.
Pregnancy in patients with Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) is uncommon but clinically challenging. Essential thrombocythemia (ET), polycythemia vera (PV), and primary myelofibrosis (PMF) are clonal hematopoietic stem cell disorders characterized by myeloid proliferation, JAK-STAT pathway activation, and an increased risk of thrombotic and hemorrhagic complications. Pregnancy itself is a hypercoagulable state, and when it occurs in patients with MPNs, maternal and fetal complications are more frequent than in the general population. The most common fetal complications are first trimester pregnancy loss, placental insufficiency, fetal growth restriction, preeclampsia, preterm delivery, and stillbirth. Maternal complications include venous and arterial thrombosis, bleeding, acquired von Willebrand syndrome, and postpartum thromboembolism. ET is the most frequently encountered MPN in pregnancy and generally carries the most favorable prognosis. PV is associated with higher thrombotic and placental risk, largely related to erythrocytosis and hyperviscosity. Pregnancy in PMF is rare, and available data are limited to small series and case reports, making management particularly dependent on expert opinion. The mainstay of treatment is risk-adapted therapy with low-dose aspirin, low-molecular-weight heparin, phlebotomy for PV, and interferon-based cytoreduction when needed. Hydroxyurea, anagrelide, and JAK inhibitors are generally avoided due to limited fetal safety data. Given the paucity of prospective evidence, management should be individualized and coordinated by hematology and maternal-fetal medicine specialists. This review summarizes current data on MPN pregnancy outcomes and provides a practical approach to preconception counseling, antepartum management, delivery planning, postpartum care, and future research priorities.
Health coaching is the process of using conversation, clinical strategies and interventions to engage clients in setting goals and identifying strategies to facilitate behaviour changes that allow clients to better self-manage their health. Health coaching is a new and growing industry in the USA. With increasing budgetary strain and limited resources, understanding the financial outcomes of adding health coaching is critical. The objective of this review was to examine what is known in the literature about health coaching and cost analyses since 2017, building and expanding on the findings of a prior review. This review seeks to identify existing and persisting gaps in the literature and suggest future directions for cost analyses in health coaching interventions. Full-text publications, excluding editorials and opinion pieces, included in this scoping review were published in 2017 or later. Included publications had to be written in English and align with the definition of health coaching described by the National Board for Health and Wellness Coaching. They also had to contain some measurement of cost or cost analysis, indicated by the mention of cost or a related synonym in the methods section. PubMed, Embase and the Health Medicine Collection were searched from 1 January 2017 to 7 January 2025 for peer-reviewed research, with an additional search on 5 May 2026 to reflect any additions to the literature since the initial submission. The scoping review was structured according to the enhancement by Levac et al to Arksey and O'Malley's framework for conducting scoping reviews.Information related to the cost analysis methodology and results was extracted from each of the included articles. Trends across articles were summarised based on key characteristics of the study and the main questions being addressed in the review. Only two studies found statistically significant effects on healthcare costs from health coaching: one found an increase in costs and the other found a decrease. Only one study found health coaching to be cost-effective, with another two studies finding it to be not cost-effective or cost-effective only if the coaching costs less than a certain amount or has an assumed efficacy threshold. Overall, the cost analyses for health coaching lacked transparency in methodology reporting and had a wide variety of methodology and costs included. Synthesis of results was not possible due to inter-study heterogeneity. As there is a move towards standardisation and credentialing of health coaches, there needs to be a similar move towards the standardisation of their cost analyses. This scoping review found mixed, limited evidence regarding the cost outcomes and cost-effectiveness of health coaching. Future research should conduct cost analyses of health coaching interventions according to the structured framework listed in the Consolidated Health Economic Evaluation Reporting Standards, with greater transparency of methods, longer-term results and greater generalisability of results to other geographic locations and health conditions. Cost analysis of health coaching remains an urgent area for standardised and rigorous analysis to better understand the financial implications of adding health coaching to an institution.
Primary healthcare is facing unprecedented complexity, driven by multimorbidity, social vulnerability, health inequities, rapid digitalisation, and shifting professional roles. This opinion paper argues that strengthening primary care requires a fundamental reorientation of both research agendas and professional education. We propose a shift towards innovative, theory-informed methodologies capable of capturing how care works in practice, for whom, and under which conditions. Priority research domains include integrated care, interprofessional teamwork, the biopsychosocial health interface, care for vulnerable and superdiverse populations, and the responsible implementation of digital and AI-supported tools. To capture these dynamics, we advocate for innovative methodologies including longitudinal mixed-methods designs, pragmatic cluster trials, realist evaluation, implementation science, network analysis, and complexity science approaches. Participatory and practice-based research models are essential to ensure relevance and reduce research waste. Finally, we emphasise the need to embed research literacy, interprofessional learning, and digital competence within transformative education for future family physicians. Strengthening primary healthcare requires renewed research agendas and professional education.Priority domains include integrated and interprofessional care, the mental–physical health interface, vulnerable populations, and digital and AI-supported care.This requires investment in innovative methodologies such as longitudinal mixed-methods, implementation science and complexity science approaches.
Although in the minority, outdoor pig farming systems are experiencing a resurgence of interest in several countries such as France, systems that could contribute to the transition towards sustainable agriculture. Understanding farmers' motivations for adopting sustainable practices is crucial for transforming agricultural systems. Hence, this study aimed at identifying the motivational profiles of French farmers who chose to raise pigs on farms offering outdoor access to their animals. A total of 20 semi-structured interviews, lasting 1.25-2.25 h, were conducted among French farmers who raised pigs with various modalities of outdoor access (from simple courtyards to free-range farms). The topics addressed during the interviews included a historical overview, a description of the farm and practices, as well as opinions about the impact of outdoor access on farmers, animals, production and economic performance, environment, and society. Following a thematic analysis, farmers' motivational profiles were elaborated using multiple correspondence analysis and hierarchical clustering analysis. The study revealed three motivational profiles guiding farm management and system choices: The "Tradition" profile concerned farmers mainly motivated by relational values, emphasizing cultural heritage, landscape, and preservation of local breeds, and adopting free-range systems. The "Entrepreneurship" profile concerned farmers mainly driven by instrumental values, combining economic opportunities, innovation, and societal expectations, typically favouring indoor farms with outdoor courtyards. The "Naturalness" profile concerned farmers mainly animated by intrinsic and relational values, focusing on animal welfare, natural behaviours, environmental sustainability, and strong human-animal relationships, often expressed in full outdoor or mixed systems. These profiles demonstrate that outdoor access is not a single technical choice but an expression of diverse moral, cultural, and economic logics. Values and motivations shaped concrete farm decisions, influencing system type, management practices, and adoption of agroecological or innovative approaches. These findings highlight the importance of recognizing the diversity of farmers' motivations when designing support programmes across different agricultural contexts. Overall, tailored advisory services and training that align with underlying values could support diverse pathways while facilitating the adoption of outdoor pig farming systems viewed as more sustainable and acceptable agricultural systems.
Following a request from the European Commission, EFSA was asked to deliver a scientific opinion on the safety and efficacy of a feed additive consisting of nicarbazin (NICACOX®) as a coccidiostat for chickens for fattening and chickens reared for laying. The FEEDAP Panel concluded that NICACOX® is safe for chickens for fattening and chickens reared for laying when used at concentrations up to 80 mg nicarbazin/kg complete feed during the first 21 days of life. The use of the additive under the proposed conditions (maximum use level of 80 mg/kg complete feed for 21 days) is considered safe for the consumer, provided that a withdrawal period of 5 days is ensured. Nicarbazin is not a skin nor eye irritant and is not a dermal sensitiser. In the absence of specific data on the final additive, the FEEDAP Panel cannot conclude on the safety of NICACOX® for the users. The use of nicarbazin (DNC and HDP) from NICACOX® in complete feed for chickens for fattening does not pose a risk for the terrestrial and aquatic compartments nor to sediment under the proposed condition of use. No concern for groundwater is expected, and no risk of secondary poisoning is identified. Nicarbazin from NICACOX®, given at a level of 75 mg/kg complete feed for the first 21 days of life is effective in preventing coccidiosis of chickens for fattening and chickens reared for laying in the corresponding time period.
Effective management of Whiplash-Associated Disorders (WAD) requires adherence to evidence-based guidelines. While educational interventions and e-resources improved guideline knowledge among healthcare professionals, their implementation in physiotherapy education remains unexplored. To evaluate the feasibility and acceptability of a multifaceted implementation strategy, including an integrated e-resource, within physiotherapy education. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, this single-group pre-post pilot implementation study evaluated a blended learning strategy that included: (i) interactive education, with integration of an e-resource into existing curricula, (ii) opinion leaders, and (iii) student champions. Feasibility outcomes included participation in educational intervention, access to e-resources, research recruitment and retention rates. Acceptability of e-resource and exploratory knowledge change outcomes were assessed using baseline and six-week follow-up questionnaires. Of 229 students, 171 attended the educational tutorial (75% participation rate). E-resource access was reported by 55% of enrolled students and 74% of tutorial attendees. Recruitment and retention rates were 59% and 32%, respectively. E-resource acceptability was high (>80%). Exploratory pre-post analyses suggested higher levels of knowledge at follow-up for WAD classification (42%), prognostic factors (44%), and when to refer (48%). No differences were observed in knowledge of the Canadian C-Spine Rule or risk-stratified matched-care principles. The multifaceted implementation strategy was feasible to integrate within an existing physiotherapy curriculum and demonstrated high acceptability of e-resources. Exploratory findings suggested a change in knowledge of WAD classification, prognosis, and referral pathways; however, these should be interpreted with caution given the single-group design and the modest follow-up retention rate.
Glioblastoma (GBM) is an aggressive primary brain tumor that rarely metastasizes outside the central nervous system, with reported rates of extracranial dissemination below 2%. Increasing survival and improved diagnostic capabilities may contribute to more frequent detection of this phenomenon. We describe a retrospective case series of 3 consecutive patients with histopathologically confirmed IDH-wild-type GBM who developed extracranial metastases at our institution. Clinical, radiological, pathological, and molecular data were extracted from medical records. Histopathological confirmation of metastatic disease was achieved in 2 of three patients, and an independent second-opinion pathology review was obtained for 1 case. Patient 1 (55-year-old man) developed cervical lymph node metastasis within 6 months of initial resection despite MGMT promoter methylation; the recurrent tumor contained a primitive neuroectodermal tumor-like component, immunophenotypically supported by diffuse Ki-67 positivity (∼100%) and expression of synaptophysin, chromogranin, CD56, and NSE. Patient 2 (56-year-old man) developed rapid systemic dissemination to bone, lung, liver, and the interatrial septum approximately 18 months after diagnosis; the metastatic tumor displayed mesenchymal (gliosarcoma-like) differentiation with co-expression of GFAP, SMA, and h-caldesmon, PD-L1 SP263 CPS 10/TPS 10%, retained mismatch-repair proteins, and a clinically significant TP53 c.833C>G (p.Pro278Arg) mutation identified by NGS. Patient 3 (48-year-old woman) survived 61 months despite unfavorable molecular markers, with late leptomeningeal and multiorgan dissemination. Overall survival was 8, 22, and 61 months for patients 1, 2 and 3, respectively. This series illustrates three distinct biological trajectories of extracranial GBM dissemination and supports the concept that prolonged survival, repeated surgical interventions, and specific molecular features (mesenchymal differentiation, PD-L1 expression, TP53 mutation) may unmask systemic metastatic potential in IDH-wild-type GBM. Clinicians should maintain a high index of suspicion for extracranial dissemination in long-term GBM survivors and in patients with atypical systemic symptoms; targeted use of whole-body 18F-FDG PET/CT and histopathological confirmation of suspicious lesions are essential for accurate diagnosis.
Smartphone delivery of contingency management (CM) could overcome barriers to dissemination of this effective treatment for methamphetamine use. We quantified help-seeking intentions for CM and preferences for smartphone versus in-person delivery of CM amongst people who used methamphetamine. An open web-based cross-sectional survey of 220 Australian residents who had used methamphetamine weekly or more often in the past year was conducted. Help-seeking intentions for CM were compared to other available treatment options using the General Help Seeking Questionnaire. Preferences for three CM models: in-person voucher-based CM, in-person prize-based CM and a smartphone-delivered model of CM, were sought, along with preferences for other aspects of CM delivery. Help-seeking intentions were similar for CM and other treatment options (82% vs. 76%-81% likely to seek help). Smartphone delivery of CM was preferred by 43% of participants (cf. 27% for in-person voucher CM and 30% for in-person prize draw CM). Overall, other preferences were for a fixed (predictable) reinforcement schedule (78%), cash (53%) or gift card (40%) rewards rather than merchandise (7%), and adjunctive support (78%) - mostly counselling (50%) and withdrawal management (43%). Participants wanted a median minimum payment of $69 (interquartile range $58-$77) to start CM, and a minimal median potential earnings of $4000 (interquartile range $3600-$4500) over a 12-week program. We found strong potential demand for smartphone-delivered CM, although adjunctive counselling and withdrawal management would be needed and incentives may need to be larger than those used in conventional CM models.
Objective: To evaluate the changes of binocular visual function and patient satisfaction after small-incision lenticule extraction (SMILE) with micro-monovision in myopic patients with presbyopia. Methods: This was a single-arm clinical trial. Myopic patients with presbyopia who underwent micro-monovision SMILE at Beijing Tongren Hospital, Capital Medical University, from January 2019 to March 2021 were enrolled. The surgical design principle was full correction of the dominant eye for distance vision, with the non-dominant eye undercorrected by -1.50 D to -0.50 D for near vision. Best corrected distance visual acuity and best corrected near visual acuity (CNVA) for the dominant eye, non-dominant eye, and both eyes were measured before surgery. Uncorrected distance and near visual acuity (UDVA, UNVA), CDVA, and CNVA for the dominant eye, non-dominant eye, and both eyes were measured at 1, 3, 6 months, 3 years, and 5 years after surgery. Accommodative function parameters were measured preoperatively and at each postoperative follow-up visit, including binocular accommodative amplitude (AMP) measured by the push-up method, accommodative response (BCC) measured by the binocular cross-cylinder method, negative relative accommodation (NRA), and positive relative accommodation (PRA), as well as distance and near stereopsis and Worth 4-dot tests. A visual satisfaction questionnaire was administered after surgery. Results: A total of 51 patients (102 eyes) with myopia and presbyopia were included, comprising 19 males and 32 females, aged (41.68±2.47) years. Sixteen patients (32 eyes) completed the 5-year follow-up. The binocular UDVA and UNVA were (-0.02±0.06) logMAR and (0.01±0.09) logMAR at 5 years after surgery, respectively. The spherical equivalent of the dominant and non-dominant eyes was (-0.24±0.22) D and (-0.80±0.37) D, respectively. The binocular AMP decreased from (5.66±0.28) D before surgery to (4.36±0.19) D at 1 month after surgery, and returned to the preoperative level at 3 months after surgery; The PRA decreased from (-1.93±0.17) D before surgery to (-1.33±0.13) D at 1 month after surgery, and returned to the preoperative level at 6 months after surgery. The BCC increased at 1 month after surgery and returned to the preoperative level at 6 months after surgery (differences across time points were all statistically significant, P<0.05). These indicators slightly decreased at 3 and 5 years postoperatively compared with their respective recovered levels. There were no statistically significant differences in NRA and near stereopsis at any postoperative follow-up time point compared with preoperative values. All patients achieved 60″ distance and near stereopsis at each postoperative follow-up visit point, and the Worth 4-dot tests showed both central and peripheral fusion function in both eyes. The subjective satisfaction score was (9.06±1.18) (out of 10) at 5 years after surgery, with a satisfaction rate of 15/16. Conclusions: SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage. The AMP, PRA, and BCC returned to preoperative levels at 3 and 6 months postoperatively, with a slight decrease at 3 to 5 years. The procedure did not affect binocular visual functions such as fusion and stereopsis. At 5 years after surgery, patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction. 目的： 评估近视伴老视患者行微单眼视设计的飞秒激光小切口角膜基质透镜取出术（SMILE）后双眼视功能变化及患者满意度。 方法： 单臂临床试验。纳入2019年1月至2021年3月在首都医科大学附属北京同仁医院接受微单眼视设计的SMILE矫正近视伴老视的患者。手术设计原则为优势眼足矫看远，非优势眼预留-1.50~-0.50 D看近。术前测量优势眼、非优势眼、双眼最佳矫正远视力（CDVA）、最佳矫正近视力（CNVA）；分别于术后1个月、3个月、6个月、3年、5年时测量优势眼、非优势眼、双眼的裸眼远视力（UDVA）、裸眼近视力（UNVA）及CDVA、CNVA；分别于术前及术后各时间点测量调节功能参数，包括移近法测量双眼调节幅度（AMP）、交叉柱镜法测量双眼调节反应（BCC）、负相对调节（NRA）及正相对调节（PRA），以及远、近立体视和Worth四点灯检查；术后进行视觉满意度问卷调查。 结果： 共纳入近视伴老视患者51例（102只眼），其中男性19例、女性32例，年龄（41.68±2.47）岁，术后5年完成随访16例（32只眼）。术后5年双眼UDVA和UNVA分别为-0.02±0.06和0.01±0.09，优势眼和非优势眼等效球镜度数分别为（-0.24±0.22）D和（-0.80±0.37）D。双眼调节幅度由术前（5.66±0.28）D降至术后1个月（4.36±0.19）D，术后3个月恢复至术前水平；PRA由术前（-1.93±0.17）D降至术后1个月（-1.33±0.13）D，术后6个月恢复至术前水平；调节反应术后1个月升高，术后6个月恢复至术前水平（不同时间点间差异均有统计学意义，均P<0.05）；术后3年和5年上述指标较恢复期略有下降。NRA和近立体视在术后各时间点与术前比较差异均无统计学意义；所有患者术后各时间点远、近立体视均可达到60″，Worth四点灯检查均显示双眼中心及周边融合功能。术后5年主观满意度评分为（9.06±1.18）分，满意率为15/16。 结论： 微单眼视设计的SMILE术后早期对调节功能有影响，调节幅度、PRA和调节反应分别于术后3个月和6个月恢复到术前水平，术后3~5年略有下降。微单眼视设计的SMILE不影响融合和立体视等双眼视功能。术后5年表现出较好的远近视力、双眼视功能维持和较高的主观满意度。.
Purpose Feedback literacy is a pivotal concept in education. Students with well-developed feedback literacy are able to understand, interpret, and implement feedback effectively to improve learning and performance. The purpose of the study was to evaluate the effectiveness of a feedback literacy course for dental hygiene students.Methods This study utilized a quantitative randomized control trial comprising a convenience sample of 42 dental hygiene students over two consecutive semesters. The control group received no formal feedback education, while the experimental group completed a feedback literacy module with an in-person feedback workshop, a follow-up in-person reflection activity, and online feedback literacy resources. Feedback Literacy was measured using the Feedback Literacy Scale, where participants self-rated their abilities on a Likert scale. A pre/posttest design was used, paired with supplemental open-ended questions for the experimental group to determine perceived program impact. Descriptive statistics were used to analyze the data.Results Overall Feedback Literacy posttest mean scores of the experimental group (n = 21) were significantly higher (p < 0.001) when compared to controls (n = 21). The experimental group demonstrated statistically significant improvements in Appreciation of Feedback (p < .001), Positive Attitude toward Feedback (p = .001), and Openness to Feedback (p < .001). Four key concepts emerged from open-ended questions posed to experimental group, namely: valuing feedback, seeking feedback, managing emotions, and enhancing self-assessment.Conclusion Students may benefit from feedback literacy training delivered early in their education. The feedback literacy module helped students value feedback, use self-assessment to identify learning gaps, actively seek feedback, and regulate emotions during feedback.
The real-world effectiveness and tolerability of prescription glucosamine sulfate (pGS) in reducing knee osteoarthritis (KOA) symptoms in a Filipino cohort was evaluated. This 8-week, pragmatic, open-label, multicenter study enrolled 281 Filipino adults with mild-to-moderate (Kellgren-Lawrence grade 2-3) KOA. Participants received pGS 1,500 mg once daily. Outcomes included changes from baseline assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Visual Analog Scale (VAS) for pain at Weeks 4, 6, and 8. Tolerability was evaluated through adverse event monitoring. Among 281 treated patients, 277 (98.6%) completed the study, and 245 (~88.0%) received pGS alone for the full period. These patients demonstrated rapid, sustained symptom improvement, with knee pain decreasing by Week 4 and continuing through Week 8. After 4 weeks, 132 patients (~47.0%) had already achieved ≥50.0% pain reduction. By Week 8, WOMAC pain showed a least squares (LS) mean change of -11.96 (95% CI: -12.26 to -11.67), with marked improvements in stiffness, physical function, and total score. VAS pain decreased from 68.4 mm at baseline to 11.9 mm at Week 8, consistent with meaningful clinical benefit. Treatment satisfaction was high, with 98.78% satisfied at Week 8 and a mean psychometric VAS score of 9.0. Patients with more advanced KOA requiring add-on therapy (n = 34) also demonstrated pain improvement, with an LS mean change in WOMAC pain of -8.81 (95% CI: -9.62 to -7.99). Overall, adverse events occurred in 4.6% of patients, were mostly mild, and led to only one withdrawal, confirming good tolerability of pGS as monotherapy and in multimodal treatment. Prescription glucosamine sulfate improved pain, stiffness, and function in Filipino patients with mild-to-moderate KOA as early as Week 4, sustained through Week 8. Treatment was well tolerated, with high satisfaction and one discontinuation. Most patients (~88%) were effectively managed with pGS monotherapy, while add-on celecoxib benefited those with insufficient response, supporting a multimodal approach for KOA symptom control in routine care.
Self-compassion is a core professional value in nursing and is positively associated with nursing students' psychological well-being, academic performance, and caring behaviors. However, heterogeneity and influencing factors in self-compassion among nursing undergraduates remain underexplored. This cross-sectional study investigated latent profiles of self-compassion and their associated factors among Chinese undergraduate nursing students. A total of 2004 participants completed a sociodemographic questionnaire and the self-compassion scale-short form. Latent profile analysis identified three distinct self-compassion profiles: medium self-compassion (42.71%), high self-compassion (30.59%), and an imbalanced profile characterized by higher positive self-compassion but lower reverse-scored negative self-compassion (26.70%). Multinomial logistic regression showed that gender, academic grade, professional attitude, and whether nursing was the first-choice major were significant predictors of profile membership. These findings highlight substantial heterogeneity in self-compassion among nursing undergraduates, with most students demonstrating moderate levels and potential for improvement. Tailored educational and psychological interventions based on self-compassion profiles may help enhance nursing students' self-compassion, professional identity, and mental well-being.
Lesbian, gay, bisexual, transgender or non-binary and intersex (LGBTI) populations experience persistent health inequities, including poorer mental and physical health outcomes and higher unmet healthcare needs compared with non-LGBTI populations. These inequities are partly attributable to insufficient training of primary care physicians (PCPs) in LGBTI health. However, evidence on effective and scalable training interventions for PCPs remains limited, particularly outside North America. This study evaluates the effectiveness of a self-directed e-learning programme-Improving Care and Access for Rainbow Equity (I-CARE)-designed to improve PCPs' knowledge, attitudes, skills and behaviours related to LGBTI health. We will conduct a type I effectiveness-implementation hybrid, two-arm, parallel-group, superiority randomised controlled trial among PCPs practising in French-speaking Switzerland. Eligible physicians will be randomly assigned (1:1) to either the I-CARE programme (intervention) or an e-learning programme on motivational interviewing (control) matched for format and duration. Outcomes will be measured at baseline, immediately postintervention and at the 3-month follow-up. The primary outcomes are knowledge and attitudes towards LGBTI patients assessed at the postintervention time point using validated scales. Superiority will be declared if the intervention group is statistically significantly superior to the control group on at least one primary outcome and statistically significantly inferior on neither primary outcome. Secondary outcomes include skills, self-reported behaviours and the presence of LGBTI-inclusive environmental cues. Effectiveness will be analysed using generalised estimating equations. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Participants will provide electronic informed consent. All study data will be managed and stored on secure servers hosted by the Lausanne University Hospital (CHUV). All information will be handled in strict accordance with the Swiss Federal Act on Data Protection. The project was approved by the Central Ethics Commission of the University of Lausanne on 7 July 2025 (C_Services centraux_052025_00018). Study findings will be disseminated through peer-reviewed scientific publications and lay summaries intended for the public, Swiss PCPs and LGBTI communities. ISRCTN93781961 (11 March 2026, updated 14 July 2026).
 In sub-Saharan Africa (SSA), men are more likely than women to experience numerous treatment interruptions after receiving a human immunodeficiency virus (HIV) diagnosis and starting treatment. As this can lead to poor adherence and retention in care, there is a need to address it to achieve epidemic control.  This scoping review aimed to synthesise current evidence on the factors influencing improved adherence and retention to care among men living with HIV in SSA.  A comprehensive literature search was performed across multiple electronic databases to identify studies published from 2019 to 2024. The authors independently analysed the titles and abstracts before exporting the articles to Endnote. Of the 550 studies identified in the peer-reviewed literature, 474 remained after removing 76 duplicates, with only nine being included after reading the full article.  The findings revealed three themes and six sub-themes related to improving adherence and retention: support for men (improve men's HIV knowledge and peer support), digitalisation of antiretroviral therapy (ART) programme (appointment reminders) and improving access to ART services (community-centred services, differentiated model of care and flexible accessible services).  Improving adherence and retention in care for men living with HIV requires a multifaceted approach that addresses the unique social, structural, family challenges and psychological barriers they face. Strategies should include targeted health education, stigma reduction and the integration of gender-sensitive services that resonate with men's health-seeking behaviours.Contribution: This study summarised the strategies that can be put in place to improve adherence and retention in care among men living with HIV.
Objective: To evaluate the visual acuity, refractive predictability, and vision-related quality of life in patients with myopia and presbyopia 3 months after laser blended vision (LBV) surgery, and to analyze factors associated with postoperative dissatisfaction. Methods: This was a retrospective case series study. Clinical data were collected from 43 patients (86 eyes) who underwent LBV surgery for presbyopia correction at Zhongshan Ophthalmic Center, Sun Yat-sen University, from February 2025 to November 2025 and completed the postoperative 3-month follow-up. There were 21 males (48.8%) and 22 females (51.2%), with a mean age of (44.21±2.20) years. Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (both converted to the logarithm of the minimum angle of resolution, logMAR), manifest refraction, postoperative satisfaction scores, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) scores were recorded before and after surgery. Postoperative visual acuity, refractive predictability, and vision-related quality of life were analyzed. Patients were divided into a satisfied group and a dissatisfied group according to satisfaction scores. The logistic regression was used to identify factors associated with postoperative dissatisfaction, with results expressed as odds ratio (OR) and 95% confidence interval (CI). Results: At 3 months postoperatively, binocular UDVA and UNVA were -0.07±0.08 and 0.07±0.10, respectively. The postoperative spherical equivalent was (-0.13±0.34) D in dominant eyes and (-1.06±0.39) D in non-dominant eyes. All patients reported no need for regular presbyopia-correcting spectacles, and 32 patients (74.4%) were in the satisfied group. The scores of general vision, ocular discomfort, near activities, mental health, role difficulties, and driving in the satisfied group were significantly higher than those in the dissatisfied group (all P<0.05). Multivariate Firth-corrected logistic regression analysis showed that each 1-mm increase in axial length was associated with 3.31-fold higher odds of postoperative dissatisfaction (OR=3.31, 95%CI: 1.11-16.18, P=0.029). By contrast, elevated tear film break-up time (OR=0.74, 95%CI: 0.47-0.98, P=0.034) and elevated negative relative accommodation (OR=0.10, 95%CI: 0.01-0.51, P=0.003) were both associated with lower odds of postoperative dissatisfaction. Conclusions: LBV surgery provided favorable UNVA and UDVA and good refractive predictability, with a high level of spectacle independence and overall satisfaction in patients with myopia and presbyopia. The dissatisfied patients had lower vision-related quality of life scores in near activities and role difficulties. Longer axial length was associated with an increased risk of postoperative dissatisfaction, whereas better tear film stability and greater negative relative accommodation were associated with a reduced risk, suggesting that preoperative assessment of the ocular surface status and accommodative function may be useful for patient selection and perioperative management. 目的： 评价近视合并老视患者接受激光融合视觉（LBV）方案矫正老视后3个月的视力、屈光可预测性及视觉相关生活质量，并分析术后不满意的相关因素。 方法： 回顾性病例系列研究。收集2025年2月至11月在中山大学中山眼科中心接受LBV方案矫正老视并完成术后3个月随访的患者资料43例（86只眼），其中男性21例（48.8%），女性22例（51.2%），年龄（44.21±2.20）岁。记录术前及术后裸眼远视力（UDVA）和裸眼近视力（UNVA）（均转化为最小分辨角的对数）、显然验光结果、术后满意度及美国国家眼科研究所视觉功能问卷（NEI VFQ-25）评分，分析术后视力、屈光可预测性及视觉相关生活质量。根据满意度评分将患者分为满意组和不满意组，并采用Logistic回归分析术后不满意的相关因素，结果以比值比（OR）及95%置信区间（CI）表示。 结果： 术后3个月，双眼UDVA和UNVA分别为-0.07±0.08和0.07±0.10。优势眼和非优势眼术后等效球镜度数分别为（-0.13±0.34）和（-1.06±0.39）D。所有患者均报告无需常规配戴老视矫正眼镜，满意组32例（74.4%）。满意组在总体视力、眼部不适、近距离活动、心理健康、角色困难及驾驶维度评分均高于不满意组（均P<0.05）。Logistic回归分析显示，眼轴长度每增加1 mm，术后不满意的发生比升至原来的3.31倍（OR=3.31，95%CI：1.11~16.18，P=0.029）；泪膜破裂时间增加（OR=0.74，95%CI：0.47~0.98，P=0.034）和负相对调节增加（OR=0.10，95%CI：0.01~0.51，P=0.003），术后不满意的发生比降低。 结论： LBV手术可使近视合并老视患者获得较好的远、近裸眼视力和屈光可预测性，并具有较高的脱镜率和总体满意度。不满意者在近距离活动和角色困难等视觉相关生活质量维度评分较低。眼轴长度增加与术后不满意风险升高相关，泪膜稳定性较好和负相对调节能力较强与不满意风险降低相关，提示术前眼表状态及调节功能评估对患者筛选和围手术期管理具有一定参考价值。.