Artificial intelligence (AI)-assisted endoscopy represents a promising approach for lesion detection, yet frequent false-positive detections impair clinical utility by disrupting examinations and diminishing physician confidence. Linked-color imaging (LCI), an image-enhanced endoscopy technique that amplifies mucosal and vascular contrast, may address this limitation. This investigation evaluated whether LCI reduces false-positive AI detections compared with white-light imaging (WLI). This retrospective study analyzed consecutive AI-assisted upper endoscopies performed between March 2024 and June 2025. WLI and LCI were performed sequentially within the same endoscopic session in each patient. False-positive AI detections were compared between modalities using two computer-aided detection (CAD) versions. Propensity score adjustment was used as a sensitivity analysis for baseline differences between CAD Versions I and II. Of 66 initially screened cases, 63 remained after excluding patients with prior gastric surgery. LCI reduced false-positive AI detections compared with WLI (median 2 vs. 5; p < 0.001). In CAD version-stratified sensitivity analyses, LCI reduced false-positive AI detections in both Version I (5 to 2; p = 0.01) and Version II (2 to 0; p = 0.03). This reduction remained consistent across atrophic grades. Both imaging modalities identified all gastric lesions, achieving 100% detection sensitivity. LCI assessment performed after WLI observation yielded fewer false-positive CAD-EYE detections while maintaining lesion detection sensitivity. However, because the observation sequence was fixed, these findings should be interpreted cautiously and require confirmation in prospective or counterbalanced studies. Trial Registration: N/A (retrospective study).
PurposeThe study aims to assess the outcomes of introducing tissue plasminogen activator (t-PA) for massive subretinal hemorrhage (SRH) during pars plana vitrectomy (PPV).MethodsThis consecutive, retrospective, non-randomized study evaluated 11 eyes with massive SRH. The post-operative follow-up was assessed after 3- and 6 months from the surgery, evaluating the Best-corrected visual acuity (BCVA) and measured the central macular thickness (CMT). All eyes were undergoing a PPV in combination with t-PA introduction and retinal displacement, fluid-air exchange, and anti-VEGF injection.Results11 eyes were included. At baseline, the main BCVA before the surgery was very poor. At 3-month after the surgery 5 eyes (45.4%) gained two and three lines on the visual acuity chart (range 20/400-20/100), and it was remained stable at 6-month. Solely in 3 eyes the BCVA not improved in the follow-up time. Moreover, in 3 eyes (27.3%), the BCVA improved significantly (p < 0.05). Pre-surgical CMT was 596,4 ± 143,2 μm. Postoperative CMT was 288,7 ± 77,6 μm at 3-months follow-up (p < 0.05) and 263,3 ± 75,2 μm at 6-months follow-up (p < 0.05). Hemorrhage was displaced away from the fovea in all eyes. SRH recurred in only one eye.ConclusionWe suggest that timely intervention in massive-sized SRH may play a crucial role in limiting the extent of damage and preventing poor visual outcomes. It is also important to note that prompt treatment may help preserve foveal anatomy and limit the structural damage associated with this condition.
Background: The Processing of Positive Memories Technique (PPMT) is a brief, memory-based intervention designed to enhance access to detailed positive autobiographical memories (AMs) in individuals with posttraumatic stress disorder (PTSD). Although research suggests that PPMT is feasible and may reduce PTSD symptoms, little is known about client and therapist experiences with PPMT when delivered to individuals with diagnostic PTSD.Objective: In a pilot randomised controlled trial, PPMT was compared to Supportive Counseling. Seventy clients with PTSD were randomised in a 1:1 ratio to receive five weekly therapy sessions, and then clients in the PPMT arm and study therapists were invited to provide feedback on the format, content, feasibility and acceptability of PPMT.Method: Twenty-six clients with PPMT assigned to the PPMT condition and six therapists who delivered PPMT completed quantitative and qualitative feedback surveys one-week post-treatment.Results: Clients and therapists reported strong feasibility and acceptability of PPMT. Among clients, 52.3% reported that PPMT became easier with practice, 45.5% indicated they would participate in PPMT again, and 38.1% described it as helpful overall. Therapists uniformly endorsed PPMT as a valuable adjunct to trauma-focused treatments (100%) and viewed it as feasible for clinicians to implement due to its structured format (66.7%). Clients described emotional and cognitive benefits of narrating and positive AMs, including increased access to positive emotions, improved self-reflection, and greater present-oriented awareness. Several areas for protocol refinement were identified, including additional support to help retrieve positive AMs, clarifying the rationale for protocol elements such as using the present tense for narration, the exclusion of trauma content, and how recalling positive AMs can help in trauma recovery; as well as greater flexibility in number of sessions.Conclusion: Findings support PPMT as a feasible and acceptable intervention and provide guidance for optimising its clinical implementation.Trial registration: ClinicalTrials.gov identifier: NCT05523453.. Twenty-six clients who received the Processing of Positive Memories Technique (PPMT) and six therapists who delivered PPMT completed feedback surveys on their experiences with the intervention.Findings suggest that PPMT was acceptable and feasible to implement for stakeholders.Positive memory processing helped individuals access positive emotions and reflect on their positive experiences.To optimise PPMT, practitioners could provide structured support, including guidance to help clients retrieve detailed positive memories and clear explanations of protocol elements (e.g. present-tense narration and excluding trauma content).
The pet population is steadily increasing worldwide, and treats, which account for approximately 15% of the pet food market, are the fastest-growing segment of the pet food industry. However, the widespread use of antimicrobials in poultry farms may pose a direct risk to pets' health, leading to the emergence of antimicrobial resistance. For this reason, we sought to assess the possible presence of drug residues and antimicrobial-resistant bacteria in a limited cohort of 11 dehydrated chicken feet intended as dog treats purchased from the European market. Residues of nicarbazin (64%), 4-4' dinitrocarbanilide (64%), semicarbazide (91%), decoquinate (9%), cypermethrin (27%), dichlorvos (9%), pirimiphos-methyl (36%), piperonyl butoxide (18%), toltrazuril sulfone (9%), doxycycline (9%), lasalocid A (9%), monensin A (9%), and 37 bacterial strains belonging to the Staphylococcus genus (S. warneri, S. haemolyticus, S. pasteuri, and S. intermedius) were detected among all samples. S. warneri species was resistant to oxacillin, erythromycin, clindamycin, teicoplanin, and tetracycline (25%, 25%, 37.5%, 6.25%, and 6.25%, respectively), S. haemolyticus was also resistant to erythromycin, clindamycin, teicoplanin, and tetracycline (52.9%, 11.7%, 29.4%, and 35.2%, respectively), while S. pasteuri was resistant to both oxacillin and clindamycin (66.6% and 33.3%, respectively). No resistance was detected for S. intermedius. The detection of multiple residues further suggests the possibility of cumulative or synergistic toxic effects, especially with prolonged intake. In this sense, a One Health approach to mitigate risks associated with antimicrobial resistance and chemical exposure in pets and, in turn, in humans becomes mandatory.
Significant gaps in nutritional knowledge exist among haemodialysis patients, representing a critical opportunity for community nursing intervention. This study aimed to assess renal-specific nutrition knowledge among haemodialysis patients in Southern Iraq, with implications for community nursing practice. A cross-sectional study was conducted with 240 haemodialysis patients (median age 52 years) in Basrah, selected via Stratified random sampling. Knowledge was assessed using a piloted questionnaire, focusing on phosphorus, potassium and sodium intake. IBM SPSS Statistics 25 was used to analyse data. Data were summarised using means and percentages, and examined for group differences and correlations. Low knowledge levels were prevalent among haemodialysis patients (64.2%). Patients aged 40 years or older demonstrated significantly higher knowledge scores than their younger counterparts (P<0.001). Furthermore, higher income was positively correlated with greater knowledge (r=0.165, P=0.011), indicating the influence of socioeconomic status. Significant gaps in nutritional knowledge exist among haemodialysis patients, particularly younger individuals and those with lower incomes. These findings highlight a critical opportunity for community nurses and nutritionists to take a proactive role in dietary education and support. Community nurses can substantially improve dietary management and patient outcomes in renal failure by integrating routine nutritional assessments during home visits, developing tailored educational strategies for different age groups and advocating for resources to support patients with financial constraints.
This study aims to compare the clinical efficacy of transcutaneous photobiomodulation (PBMT) with an 808 nm infrared laser versus intraoral PBMT with a 660 nm red laser in the prevention of oral mucositis (OM). The study is designed to assess whether the transcutaneous approach is non-inferior to the intraoral standard, thereby contributing to the optimization and standardization of PBMT protocols in head and neck cancer (HNC) supportive care. A randomized pilot study is being conducted with 54 patients (n = 27 per group) undergoing radiotherapy (60-70 Gy) for HNC. Participants will be randomly assigned to receive either intraoral PBMT (660 nm, 100 mW, 1 J/point, fluence = 10.20 J/ cm², 10 s, 44 points) or transcutaneous PBMT (808 nm, 100 mW, 1 J/point, fluence = 34.5 J/ cm² (central) and 4.3 J/ cm² (lateral), 10 s, 32 points). Interventions occur three times weekly throughout treatment. The primary outcome is OM severity, graded by WHO scale. Secondary outcomes include OM severity (NCI-CTCAE), pain intensity (Numeric Rating Scale, NRS), ulcerated area extension, registered through digital images, treatment interruptions and unscheduled healthcare utilization. the primary hypothesis posits that transcutaneous infrared PBMT is as effective as intraoral red PBMT in mitigating OM severity. Additionally, the transcutaneous approach is expected to offer logistical advantages, including a reduction in application time (80 s vs. 440 s) and improved tolerability in patients with radiation-induced trismus or severe oral pain. This protocol is expected to provide robust evidence to support the most feasible and effective PBMT modality for OM prevention. By optimizing treatment delivery, the study may enhance adherence, preserve nutritional status, and improve the quality of life for patients undergoing oncological therapy.
MicroRNAs (miRNAs) are key components in the interaction between lifestyle-related risk factors and cancer development. In particular, miR-1303 expression is deregulated in breast cancer tissues, with elevated levels associated with poor prognosis. We have previously shown that regular exercise reduces the expression of this miRNA in skeletal muscle. The present pilot study aimed to evaluate the impact of lifelong football training on circulating miR-1303 expression and miR-1303 modulation on proliferation, migration, and invasion pathways in human breast cancer MCF-7 cells. Blood samples were collected from 17 veteran football players (VPG) and 17 healthy, untrained males (CG) of matching age (74.4 ± 4.3 years). Serum levels of testosterone, estradiol, IGF-1, insulin (ELISA), and miR-1303 (RT-qPCR) were measured. MCF-7 cells were treated with serum collected from VPG, CG or transfected with 25 μM miR-1303 mimic or inhibitor or miRNA mimic negative control. Cell proliferation and invasion were assessed using Wound healing assays and Transwell assay, respectively. Western blotting and RTqPCR were performed to evaluate the expression of key migration and invasion markers. We demonstrated, for the first time, that miR-1303 expression was lower in VPG serum than in CG and paralleled the lower expression previously found in skeletal muscle. Overexpression of miR-1303 increases the proliferation and motility of MCF-7 breast cancer cells and is correlated with increased expression of β-catenin, c-Myc, and MMP2 genes and decreased expression of p21 and p27 proteins, all key markers involved in migration and invasion pathways. These events were reversed by treatment with the miR-1303 inhibitor. Interestingly, treatment of MCF-7 cells with sera from VPG, with low level of c- miR-1303, parallels the effects mediated by miR-1303 inhibition. Our findings suggest that lifelong football training may counteract MCF-7 cell proliferation and invasion activities and that miR-1303 is one of the factors mediating the effects of long-term football training on breast cancer cells.
MicroRNAs (miRNAs) regulate post-transcriptional gene expression and have emerged as important contributors to the pathogenesis of asthma, as well as potential biomarker candidates. In this study, we evaluated the serum miRNA-21 and miRNA-155 expression in bronchial asthma and its association with lung function and inflammatory markers. In this pilot case-control study, a total of 72 participants were enrolled, including 36 adults with spirometry-confirmed asthma and 36 healthy controls recruited from hospital staff and attendants without respiratory symptoms or history of allergic disease. Spirometry was also performed in controls to exclude occult airflow limitation. A predefined exploratory hypothesis was that circulating miRNA-21 and miRNA-155 expression would differ between asthma and controls and may correlate with inflammatory biomarkers and lung function. Serum miRNA-21 and miRNA-155 expression was quantified by quantitative real-time polymerase chain reaction. Between-group comparisons were performed using the Mann-Whitney U test, and correlations with serum IgE, absolute eosinophil count (AEC), forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were examined using Spearman's rank correlation coefficient. miRNA-21 expression was significantly higher in patients compared to controls with median values of 0.191 (IQR 0.114-0.312) vs 0.054 (IQR 0.027-0.195), P=0.006. In contrast, miRNA-155 expression did not differ significantly between the groups (median 0.159 (IQR 0.068-0.363) vs 0.220 (IQR 0.107-0.338), P=0.240). Among correlation analyses, only miRNA-155 showed a significant positive correlation with serum IgE (Spearman's ρ=0.654, P<0.001) and no significant association of miRNA-21 with the IgE level. Neither miRNA correlated significantly with AEC, FEV1 or FVC. Serum miRNA-21 was significantly upregulated in bronchial asthma, supporting its possible association with asthma-related immune dysregulation. Although miRNA-155 was not differentially expressed between groups, its positive association with serum IgE suggests a possible relationship with atopic inflammatory pathways. These findings suggest that circulating miRNAs may reflect asthma-related inflammatory activity; however, their clinical biomarker utility requires further validation.
To evaluate whether an ultrasound-guided lung recruitment manoeuvre (LRM) can identify a positive end-expiratory pressure (PEEP) associated with improved aeration compared with clinically set PEEP during non-invasive respiratory support. Feasibility study of 11 spontaneously breathing infants on continuous positive airway pressure or non-invasive ventilation. PEEP was increased stepwise by 2 cmH2O from 4 to 10 cmH2O. The PEEP with the lowest lung ultrasound score was recorded along with vital parameters. In 10 of 11 infants (91%; 95% confidence interval 62-99, p = 0.01), the LRM identified a PEEP with a lower lung ultrasound score than the clinically set level; five infants required a higher and five a lower PEEP. Clinical parameters were stable or improved. In this pilot cohort, lung ultrasound-guided PEEP adjustment appeared feasible and was associated with favourable short-term changes in lung aeration. Larger studies are required to validate these preliminary findings and determine clinical utility.
Young people with HIV experience disproportionately poor outcomes across the HIV care continuum, high levels of stigma, and elevated alcohol and other substance use. Healthy Choices is a 4-session intervention that integrates motivational interviewing with brief cognitive-behavioral strategies and has demonstrated a positive impact on HIV stigma, alcohol use, depression, and viral load in prior trials among young people with HIV. Interventions such as Healthy Choices have the potential to improve the HIV care continuum in Caribbean settings. However, no interventions have been adapted in Spanish and pilot-tested to concurrently address stigma, mental health, alcohol use, and viral burden among young people with HIV in the Dominican Republic. This study aims to adapt Healthy Choices for Spanish-speaking young people with HIV in the Dominican Republic and pilot-test the adapted intervention with implementation strategies to assess feasibility, acceptability, and a directional signal of its potential impact. Guided by the exploration, preparation, implementation, and sustainment framework and the health stigma and discrimination framework, this 36-month study has 3 specific aims. In aim 1, we will conduct focus groups with community representatives and in-depth interviews with young people with HIV to identify barriers, adaptation needs, and implementation strategies. In aim 2, we will use assessment, decision, adaptation, production, topical experts, integration, training, and testing and co-design workshops with community partners and a youth advisory board to contextually translate and adapt Healthy Choices for the Dominican Republic in Spanish, and we will train peer navigators. In aim 3, we will conduct a pilot randomized controlled trial with 45 young people with HIV using a 2:1 allocation to the adapted Healthy Choices intervention (n=30, 67%) or a time-attention control condition (n=15, 33%). Primary outcomes are feasibility and acceptability. Secondary and exploratory outcomes include antiretroviral adherence, viral load, alcohol and other substance use, social support, positive affect, coping, depression, and HIV-related stigma, which will be assessed from baseline to follow-up. The study period is from March 1, 2026, to February 28, 2029. At the time of manuscript preparation, formative partnership development and key-informant consultation had been completed. The study is positioned to proceed through qualitative exploration, intervention adaptation, peer navigator training, and pilot testing across the 36-month project period. Results from the pilot trial are expected after completion of follow-up assessments. This protocol describes an implementation science-guided approach to adapting and testing a promising intervention for young people with HIV in a high-priority global setting with translational potential for Spanish-speaking populations in the United States. If the intervention is feasible and acceptable, the study will yield preliminary data for a future full-scale hybrid type 1 effectiveness-implementation trial. ClinicalTrials.gov NCT07638618; https://tinyurl.com/5fsdn4fj. PRR1-10.2196/103611.
Generative Artificial Intelligence (GenAI) has catalyzed a transformation in medical education. Understanding learners' perceptions is essential to guide their responsible integration into curricula. A cross-sectional survey was administered to 1039 undergraduate medical students across Saudi Arabia. A purpose-developed, pilot-tested instrument (Cronbach's α = 0.71 for dichotomous items) assessed students' familiarity with computational language models, perceptions of their educational utility, and attitudes toward technology-enhanced pedagogical approaches. Descriptive statistics, Kolmogorov-Smirnov testing for normality, and multivariable binary logistic regression (two-sided, α = 0.05) were performed using IBM SPSS Statistics v28.0. Among 1039 participants (64.3% male; median age 22 years [IQR 20-24]), 57.2% (595/1039) reported familiarity with computational language models in medical education, and 70.1% (728/1039; 95% CI: 67.2-72.9) supported curricular integration. A strong majority (86.4%; 898/1039; 95% CI: 84.2-88.4) anticipated impact on the future of medical education. While 73.4% (763/1039; 95% CI: 70.6-76.0) perceived benefit for basic science education, only 41.6% (432/1039; 95% CI: 38.6-44.6) recognized utility in clinical skills training. Only 29.8% (310/1039; 95% CI: 27.0-32.7) considered these tools superior to human instruction. Key concerns included distrust in output reliability (52.6%; 547/1039; 95% CI: 49.5-55.7) and awareness of reference fabrication (64.0%; 665/1039; 95% CI: 61.0-66.9). Saudi medical students express strong interest in GenAI-particularly for basic sciences and simulation-but perceive it as complementary rather than superior to human instruction. Findings reflect learner perceptions, not measured educational effectiveness. Implementation should prioritize reliability, ethical use, and preservation of humanistic competencies.
The incidence of cancer is rising in India, and radiotherapy plays a vital role in the management of most cancers. More radiotherapy centers are being set up across the country to cater to this need. Quality assurance (QA) of radiotherapy is crucial to minimize risks and ensure best outcomes for all patients receiving radiotherapy. We outline an effort to develop a standardized radiotherapy QA program implementable across India through a consensus process among stakeholders. The team structured a Standardised Unified Radiotherapy QA model (SURAQSA), a program of pan-India radiotherapy QA incorporating elements of radiotherapy trials QA, adapted for the Indian health care system. Engagement of a cross-section of radiation oncologists working across India to achieve consensus on the issue was essential. This paper describes the consensus development process among the diverse Indian centers/professionals in support of the SURAQSA program. The statement was introduced to clinicians through the vehicle of an abbreviated Delphi consensus process, with guidance from the Royal College of Radiologists (United Kingdom). We outline the elements of the SURAQSA program and describe the consensus adopted. Thirteen centers from across India were represented in the workshop. Three of the consensus statements on external QA of each center, prospective peer review of contours, plan quality measures, and protocol-driven management, as the basic requirements received unanimous support. Consensus was also achieved on the pilot subsite for this exercise with minor disagreement. This report showed feasibility of a wide stakeholder engagement to deliver focused outputs and is a huge step toward formulating site-specific radiotherapy QA programs. The process allowed oncologists to highlight the need to take essential steps for radiotherapy safety across centers with varying availability of trained manpower and infrastructure.
Perovskite materials have emerged as versatile platforms for sustainable photocatalytic and photoelectrocatalytic applications, addressing critical challenges in environmental remediation and clean energy conversion. This Review comprehensively examines oxide perovskites (ABO3), lead-based and lead-free halide perovskites (ABX3, A3B2X9), layered architectures including Ruddlesden-Popper and Dion-Jacobson phases, and perovskite-derived catalysts for pollutant degradation, CO2 reduction, water splitting (HER/OER), and integrated waste-to-fuel conversion. Unlike previous reviews that separately focus on oxide or halide systems or isolated applications, this work establishes a unified environmental-energy catalysis framework that systematically compares diverse perovskite families while emphasizing the transition from Pb-based to Pb-free architectures. Particular attention is given to defect-mediated structure-function relationships, including A/B-site engineering, oxygen and halide vacancy regulation, and heterostructure design, which collectively enhance visible-light harvesting, charge separation, and multielectron redox kinetics. Side-by-side comparisons of lead-based and lead-free systems clarify the catalytic, environmental, and stability implications of Pb substitution. Although Pb-free perovskites offer significant sustainability advantages, challenges related to long-term durability, mechanistic understanding, and scalable synthesis remain unresolved. Future directions involving DFT- and machine learning-guided design, interface engineering, and pilot-scale implementation are highlighted to accelerate the development of next-generation sustainable perovskite catalysts.
This pilot study assesses HIV, syphilis and hepatitis point-of-care test (POCT) utility in men who have sex with men (MSM) attending a non-governmental organisation-led clinic in Beirut and evaluates knowledge, attitudes and practices in relation to sexual health. A cross-sectional study was conducted over 4 months. A physician offered sexual health consultations and sexually transmitted infection (STI)/HIV testing and administered an anonymous questionnaire assessing demographics, STI knowledge and practices, condom use, chemsex, experiences of sexual violence and perceived HIV-related stigma. The cohort consisted predominantly of young, highly educated, working-age men: 91.2% were male and 86.4% identified as MSM, with most participants aged 26-40 years. The majority were Lebanese (79.6%), while 18.4% were Syrian. Overall, 21.4% were persons living with HIV. High levels of STI/HIV awareness coexisted with condomless sex and recreational drug use. Perceived community beliefs and stigma emerged as notable barriers to testing. The use of POCT facilitated same-day counselling and linkage to care for individuals with positive results. This study highlights the substantial HIV-related stigma experienced by MSM, which is linked to risky behaviours. Incorporating POCT into sexual health services allows for rapid on-site diagnosis and immediate counselling as well as linkage to confirmatory testing and care.
Childhood cancer survival is improving in low-resource settings, but long-term outcomes remain poorly described. A cross-sectional survey of 172 survivors diagnosed before age 18 and treated between 2000 and 2020 at Mbingo Baptist Hospital was conducted. Questionnaires assessed education, stigma, disability, fertility, and perceived burden. A six-domain composite QoL index was analysed, and logistic regression identified predictors of poor outcomes. were predominantly Burkitt lymphoma survivors (82.6%), with a median age of 18.8 years and 9-year survivorship. While 68.6% resumed schooling, one-third did not. Disabilities affected 20.9%, and 38.4% felt like a burden. QoL was moderate in 61.6% and low in 7.6%. Older age at treatment predicted poorer QoL. Survivors face persistent educational and psychosocial challenges. Structured survivorship programmes integrating counselling, rehabilitation, and social reintegration are needed.
Mild cognitive impairment (MCI) is characterized by a decline in cognitive functions while the ability to perform daily activities remains intact. This pathological condition is a recognized as risk factor for dementia-related disorders, and the current lack of therapies is the critical issue. Our preclinical studies indicated that a formulation (named GeNeurofil™) exhibited a synergistic neuroprotective effect in an animal model of amyloid beta toxicity. Therefore, the present study aimed to evaluate the efficacy of GeNeurofil™ in patients with mild cognitive impairment. A six-months, randomized, double-blind, placebo-controlled pilot trial (retrospectively registered on ISRCTN registry-number ISRCTN11405046-01/07/2026) was performed enrolling 54 patients with mild to moderate MCI (Clinical Dementia Rating Scale ranging from 0.5 to 2). Patients, concurrently maintained under their usual medications, received either the GeNeurofil™ (0.7 mL × 3/day) or an identical placebo (0.7 mL × 3/day) for six months. The psychometric assessments were performed using the Mini Mental State Examination (MMSE) tests and depressive symptoms were evaluated with the Zung Test. Plasma samples were analyzed for NfL and p-TAU. After six months of treatment, GeNeurofil™ supplementation improved CDR, MMSE, and Zung scores. Furthermore, the treatment reduced plasmatic levels of light neurofilaments (NfL) and phosphorylated Tau protein (p-TAU) compared to placebo. Our findings indicate that six months of supplementation with GeNeurofilTM might represent a helpful adjuvant strategy for cognitive impairment. GeNeurofil™ nutraceutical supplementation demonstrates a favorable safety profile, however given the exploratory nature of this pilot feasibility trial, these preliminary findings will further followed by confirming definitive clinical efficacy in larger clinical trials.
Substance use disorder (SUD) represents a significant public health concern in the United States. SUD recovery is complex and individualized, and support provided by peer recovery coaches (PRCs) can improve outcomes. The PRC-client relationship requires bidirectional mediated communication that is often informal but should be trackable, efficient, and aligned with health care privacy and security regulations. Current workflows and available apps do not meet these needs, illustrating the opportunity for client-centered technology tools. We have developed Peer PLUS (People Leveraging Urgent Support; Parkview Health System, Inc), a HIPAA (Health Insurance Portability and Accountability Act)-compliant mobile app and client management system, to address this need; however, the platform has not yet been tested in a clinical setting. We describe the protocol for the evaluation of our digital health platform to identify its perceived usability, potential sustained use, and potential impact on treatment-related outcomes, as well as to assess its feasibility for a future randomized controlled trial and develop an implementation tool kit to facilitate use by other organizations. Our evaluation leveraged user-centered design (UCD) and implementation science frameworks (Reach, Effectiveness, Adoption, Implementation, and Maintenance [RE-AIM]). We conducted prelaunch ethnographic observations of 3 PRCs' workflows for an understanding of user needs. During subsequent in-the-wild testing, PRC-client dyads will use the platform for asynchronous communication within their standard support relationship. We will deploy periodic electronic surveys, including the System Usability Scale (SUS) to assess perceived usability during beta testing, and additional validated measures assessing specific treatment-related outcomes (ie, recovery, quality of care, and therapeutic alliance) during pilot testing. App use log data will be leveraged to assess the likelihood of sustained use. After each test, UCD-focused stakeholder engagements will further elucidate opportunities for platform refinement and implementation tool kit development. Feasibility targets include SUS scores of 68 or more, 25% client eligibility and enrollment rate, and 20% increased contacts between PRCs and enrolled vs nonenrolled clients. This project was funded in March 2023. Beta test recruitment began in January 2024, with 3 tests completed by November 2024 (3 PRCs and 7 clients). Pilot recruitment began in August 2025. Pilot testing and analyses will continue in 2026. If feasibility metrics are met, the platform will be tested in a later study phase that will include a randomized controlled trial and a second pilot trial to test implementation at a different organization. Our evaluation assesses whether Peer PLUS is an efficient and usable tool that meets identified communication and documentation needs of clients and PRCs while fostering increased connection, which could suggest the likelihood of sustained use and improved treatment outcomes. This project contributes to the UCD and implementation science fields by demonstrating the importance of merging these frameworks during the design and evaluation of novel digital health solutions.
Medical decision-making is characterized by rapidly evolving evidence being represented by national and international guidelines that form the decision basis for treatment recommendations. Large language model-based clinical decision support systems (LLM-CDSS) have shown promising potential to serve as a support tool, e.g., in gynecologic oncology. Nevertheless, physicians' acceptance of this technology in gynecologic oncology is currently not backed by evidence. Therefore, we present a pilot study evaluating the clinical technology acceptance of LLM-CDSS in gynecologic oncology. We designed a questionnaire based on the existing technology acceptance model (TAM) and the unified theory of acceptance and use of technology (UTAUT) characteristics, which was sent to clinicians employed at a clinic of gynecology and obstetrics of a large tertiary hospital. A total of 29 physicians spanning the complete range of clinical experience answered the survey. For identifying factors influencing the willingness to use a LLM-CDSS, Ordinary Least Squares (OLS) regression was applied based on answers grouped by question categories. Further, descriptive analysis was performed by measures of central tendency and correlation. OLS regression did not identify any question categories significantly influencing willingness to use LLM-CDSS. Answer distribution was left skewed for the primary endpoint, indicating an acquiescence bias in the survey population. Still, descriptive findings indicate a generally positive but cautious attitude toward LLM-based therapy recommendation systems in gynecologic oncology. Acceptance appeared to depend strongly on transparency, integration of evidence, clinical validation, and the preservation of physician oversight and accountability. The participants agreed on a possible positive influence of LLM-CDSS for clinical practice. However, the results emphasize that such tools should support rather than replace physicians to leave the final medical decision to the human. Participants were divided on whether patients must be informed about the usage of such tools whereas some participants reported concerns about their clinical autonomy and patients' trust. The survey needs to be validated in a larger multicentered cohort in a shortened version.
Residual congestion is the principal driver of heart failure readmission, and reliable serial assessment of volume status remains an unmet clinical need. This study asked whether a wrist-worn, machine-learning-based device for non-invasive venous waveform analysis in heart failure (the NIVA HF device), which produces an integer-scaled estimate of pulmonary capillary wedge pressure termed the NIVA Score, responds to acute changes in volume status. Agreement between the NIVA Score and invasively measured pulmonary capillary wedge pressure at single time points has been established in a separate prospective, multi-site study; however, such static agreement does not establish whether the measure tracks dynamic decongestion. We therefore evaluated the directional responsiveness of the locked NIVA Score in two prespecified cohorts: hospitalized adults with acute decompensated heart failure undergoing routine intravenous diuresis, and a controlled porcine model of volume overload followed by diuresis. In eleven patients contributing thirteen paired measurements (mean net fluid balance -2.1 ± 1.0 L), NIVA Scores decreased significantly after diuresis (paired t-test, P = 0.04). In five pigs contributing twenty-four paired measurements, NIVA Scores decreased significantly after intravenous furosemide following crystalloid loading (P <0.01), and the direction of change was concordant with measured urine output in every animal. Statistical significance was reached in both cohorts despite modest sample sizes, indicating a measurable NIVA Score reduction with volume removal. In an exploratory analysis, the discharge NIVA Score yielded an area under the receiver-operating-characteristic curve of 0.85 (95% confidence interval 0.575-1.00; P = 0.04) for thirty-day readmission. Together, the significant, directionally concordant NIVA Score reductions across independent clinical and preclinical cohorts demonstrate that the device tracks acute decongestion and support its use for serial, non-invasive congestion monitoring; an adequately powered prospective study is the planned next step.
Final-year student nurses were offered aspirant nurse roles to support busy clinical teams within district nursing services as part of the response to the COVID-19 pandemic. Student nurses in their final year of training had the opportunity to work as an aspirant nurse (paid band 4 position) for a 12-week period, as per the emergency education standards delivered by the Nursing and Midwifery Council in an effort to help out during the pandemic. This gave the students additional responsibilities to allow them to work autonomously but still under the supervision of the registered nurse. This role was separate to their student nurse role, becoming part of the clinical team where they were placed. Building on this concept, a collaboration between higher education institutions and the Essex Partnership University Trust resulted in the development of a structured pilot student autonomous visit programme, at the time referred to as non-direct supervision students. This initiative aimed at improving student learning and enhancing professional identity and confidence, while addressing challenges in recruitment and retention in community nursing roles. This article outlines the development and implementation of the pilot programme, evaluates its impact and discusses its implications for nurse education and workforce planning. Results indicate enhanced student preparedness and improved staff retention in district nursing, strengthening interprofessional collaboration between universities and NHS teams.