To explore the motivations, barriers and systemic challenges experienced by senior doctors' engagement with compassionate and inclusive medical leadership (CIML) within Somerset NHS Foundation Trust, and to identify evidence-based strategies to support sustainable leadership development. A sequential mixed-methods study integrating quantitative survey data with qualitative thematic analysis and postsurvey facilitated group discussions. Somerset NHS Foundation Trust, a large integrated healthcare organisation providing acute, community, mental health, learning disability and GP services across Somerset. Senior doctors including consultants and specialty associate specialist and specialist (SAS)-grade doctors. Participants included 156 survey respondents and 39 participants in postsurvey group discussions. Identifying leadership challenges, motivations, recruitment barriers and systemic facilitators of CIML engagement. Validation of survey findings through stakeholder discussions grounded in NHS leadership principles. Of the 692 eligible participants, 156 responded (22.5%) and 39 (5.64%) participated in the postsurvey group discussions. Key barriers to leadership engagement included time constraints (28%), lack of administrative support (20%), poor work-life balance (15%) and non-transparent recruitment practices (35%), echoing national concerns regarding clinician burnout and structural inequities. Qualitative themes reinforced these findings, highlighting cultural and systemic challenges, especially for women and ethnic minority doctors. Stakeholder discussions underscored the need for structured mentorship, protected time and inclusive leadership pathways. Systemic reforms, including mentorship programmes, transparent recruitment processes, leadership induction and protected time for leadership development, are essential to fostering sustainable and inclusive medical leadership. Engaging senior doctors in co-produced leadership strategies may help strengthen engagement and support more inclusive leadership cultures.
BackgroundSelf-management ability for patients with chronic obstructive pulmonary disease (COPD) in China urgently needs to be strengthened. The Health Action Process Approach (HAPA) promotes health-oriented behaviour change by tailoring interventions to each stage of the individual's disease. This approach has been applied across a wide range of fields. However, its application among patients with COPD remains relatively limited.ObjectiveTo construct a patient health management journey map based on the HAPA theory.MethodsUsing the HAPA theory as a framework, a patient health management patient journey map was developed through literature review, reference to standardised guidelines, phenomenological research and expert consultation.ResultsFrom the literature review, 12 relevant articles were included to form the preliminary framework. Semi-structured interviews with 5 respiratory medical staff identified the core stages of the patient journey. In a separate subsequent process, the 8 experts selected for consultation had an average work experience of 19.13 ± 3.27 years. Education levels included 2 with a bachelor's degree and 6 with a master's degree or above; professional titles included 3 associate senior doctors, 3 senior doctors and 2 intermediate doctors; and research specialties included 5 in respiratory medicine and 3 in internal medicine nursing. As for the consultation involvement, 3 experts participated once and 5 experts participated twice or more. The familiarity coefficient with consultation content was 0.851, the judgment basis coefficient was 0.916 and the authority coefficient of the experts was 0.889. The coordination of expert opinions was measured by Kendall's W and was 0.429 (χ2 = 42.452, P < 0.001). Finally, a proof-of-concept test with 5 patients refined the patient journey map's usability by simplifying terminology and adjusting adherence strategies.DiscussionThe patient health management journey map constructed in this study, based on the HAPA theory, is scientific, comprehensive and usable, covering key stages such as disease diagnosis, acute exacerbation management, stable period maintenance and rehabilitation support. It provides patients with comprehensive scientific guidance and promotes the establishment of healthy behaviours.
Burnout among healthcare workers, especially in maternity units, is prevalent globally and exacerbated in resource-constrained contexts, contributing to decreased quality of care. Doctors in a maternity care unit (MCU) in a large Namibian public hospital complex were found to be at high risk of burnout, indicating need for intervention. Existing burnout interventions are predominantly individually-focused, created in a top-down manner and devised in high-resource settings. A dearth of research exists on burnout interventions that are contextually-fitted to low- and middle-resource settings in sub-Saharan Africa. This research aimed to explore how a burnout intervention could be co-created with local stakeholders in a Namibian public hospital MCU through an Interactive Learning and Action (ILA) approach. A research team comprising doctors of varying clinical levels was recruited and senior management figures were consulted throughout the ILA process. The iterative action-research process consisted of workshops with specific objectives, a training session, dialogue sessions and evaluative interviews. Based on a needs assessment, the research team devised ideas for six interventions. Priority setting of these interventions selected a mentorship programme to be fully developed and implemented. Outputs of each co-creation session created inputs for the next. After initial implementation of the intervention, adaptations were made based on input from end-users. End-evaluation showed the intervention's potential to prevent and mitigate burnout by stimulating increased feelings of support, strengthening social relationships, and building trust. Barriers to uptake included distant mentorship style, lack of accountability, and perception of the intervention as an increased workload. Facilitators encompassed enthusiastic and personal mentorship style and positive perceptions of the intervention as helpful with matters like case management. Co-creating and implementing a context-specific intervention to address healthcare worker burnout appeared feasible in a sub-Saharan African context without funding. By leveraging local knowledge and skills, co-researchers collaboratively devised solutions addressing the needs of various levels of staff, created ownership of the intervention, and proactively integrated accommodations to contextual constraints into its design and implementation. Embracing local- and user-led co-creation in intervention development offers a promising avenue for addressing complex challenges.
Virtual simulation constitutes a multidisciplinary field that integrates computer graphics, dynamic simulation modeling, human-computer interaction, and artificial intelligence. It has evolved from an auxiliary tool into a core teaching methodology, becoming indispensable to modern medical education. Through the establishment of a high-fidelity digital ecosystem, this technology achieves the accurate reproduction of real clinical scenarios. It provides a reliable support platform for evidence-based teaching and practical clinical competency training. Medical imaging education is a critical component of clinical training, and the integration of virtual simulation technology has emerged as a key strategic approach to optimizing clinical teaching outcomes, bridging the gap between theoretical knowledge and clinical practice. Furthermore, medical imaging education aims to cultivate competent clinical imaging professionals with comprehensive practical capabilities. This descriptive single-center study focuses on the development, implementation, and evaluation of a specialty-oriented virtual simulation teaching system for medical imaging technology. The effectiveness of the system was evaluated by comparing pre- and post-training outcomes among participants with three different levels of technical experience. The key components of an effective virtual simulation teaching system include clear identification of user needs, selection of appropriate technological approaches, sufficient granularity in system design, and implementation of engaging interaction modalities. For the training assessment of the magnetic resonance imaging (MRI) section, the comprehensive skills related to fetal scanning improved in all subjects (54.19 ± 18.03 vs. 66.62 ± 12.41, p < 0.001) after virtual simulation training. Among technicians with different experiences, residents (42.38 ± 15.41 vs. 59.95 ± 12.63) and junior technicians (63.4 ± 12.13 vs. 73.07 ± 8.34, all p < 0.05) showed the most significant improvement after retraining. In contrast, the improvement among senior technicians (72.50 ± 7.89 vs. 73.83 ± 7.41, p = 0.117) was not significant. These findings suggest the potential application of virtual simulation in fetal prenatal screening training.
Needle stick injuries (NSIs) represent a serious occupational hazard for healthcare workers (HCWs), particularly in surgical departments like orthopaedics. Beyond the risk of blood-borne infections, NSIs can cause significant psychological distress. To assess the incidence of NSIs and associated psychological outcomes such as stress, anxiety, and PTSD among doctors and nurses in the orthopaedics department. A cross-sectional survey of 337 HCWs was conducted using a structured online questionnaire. Data on demographics, NSI experience, reporting behavior, anxiety (GAD-7), PTSD (IES-R), and perceived stress were collected and analyzed using SPSS. Among 327 eligible participants, 103 (31.5%) reported NSIs in the past year. NSI rates were significantly higher among junior and senior resident doctors compared to consultants (p < 0.0001), and among female nurses compared to males (p = 0.0002). Mechanisms included suture needles (27.7%), braided sutures (23.5%), bony ends (21%), orthopaedic instruments (18.5%), and washing instruments (9.2%). Female nurses showed significantly higher anxiety and PTSD scores than males. Junior and senior residents reported more psychological distress compared to consultants. Needle stick injuries are common among orthopaedic HCWs and are associated with considerable psychological impact. Preventive training, proper reporting, and mental health support are essential.
This study aimed to investigate knowledge, attitudes, and practices (KAP) regarding occupational protection among Central Sterile Supply Department nurses. A cross-sectional online survey was conducted among a convenience sample of Central Sterile Supply Department nurses recruited through a province-level CSSD professional network in Zhejiang Province, China, between 4 January and 1 March 2026. A self-designed questionnaire with acceptable reliability (Cronbach's α = 0.725) was used to assess demographic characteristics and the three KAP dimensions. A total of 306 participants were included; most were female (95.8%), aged > 45 years (41.5%), and had a bachelor's degree or above (85.3%). Mean knowledge, attitude, and practice scores were 14.77 ± 1.73 (possible range: 0-18), 37.06 ± 2.87 (possible range: 8-40), and 45.90 ± 3.52 (possible range: 10-50), respectively. Path analysis revealed that attitudes showed the strongest direct association with practices (β = 0.542, P = 0.014). In multivariable analysis, higher attitude scores (β = 0.667, 95% CI: 0.549-0.784, P < 0.001) and ≥ 3 training sessions/year (β = 0.930, 95% CI: 0.062-1.798, P = 0.036) were associated with better practices, whereas 11-20 years (β=-1.249, P = 0.049) and > 30 years (β=-1.773, P = 0.009) of nursing experience were associated with lower practice scores, suggesting experience-related variations rather than a direct negative impact. Attitudes correlated strongly with practices (r = 0.584, P < 0.001), whereas knowledge showed no significant correlation with attitudes (r = 0.088, P = 0.125). In this convenience sample, CSSD nurses in Zhejiang Province showed favourable self-reported occupational protection attitudes and practices, but exhibited substantial and critical item-level deficits in knowledge regarding bloodborne exposure management and post-exposure prophylaxis timing. Implementing a mandatory, high-frequency (≥ 3 sessions per year), scenario-based occupational protection training programme linked to annual performance evaluation, alongside targeted modules for senior nurses, is recommended to improve protective practices. Not applicable.
Parental burnout has many negative effects on both parents and their children; however, research on the relation between parental burnout and children's digital media use remains limited. This study aims to examine the robustness of the relation between parental burnout and children's short-form video and online game use. The study also examined the cross-sectional statistical mediating role of parental phubbing in the association between parental burnout and children's digital media use. Using cluster sampling, 34 schools in northern China were surveyed in September 2025, including 6020 elementary school students (Sample 1) and 5456 junior and senior high school students (Sample 2), along with their fathers or mothers. Specification curve analysis, path analysis, and explainable deep learning models, combined with SHapley Additive exPlanations (SHAP) analysis, were used to examine variable robustness, statistical mediation effects, and nonlinear relations among variables. In the sample of junior and senior high school students, parental burnout showed robust positive associations with children's short-form video and online game use, whereas these associations were not consistently robust in the elementary school sample. In addition, the associations between parental burnout and children's short-form video and online game use were weak in both samples (Median β = 0.030-0.070). Parental phubbing showed a cross-sectional statistical mediation effect in the associations between parental burnout and children's short-form video and online game use (Sample 1: B = 0.016-0.020; Sample 2: B = 0.014-0.041). Interpretable deep learning analysis suggested exploratory nonlinear associations among the significant paths identified in the structural equation models. This study provides an empirical reference for the prevention and intervention of children's excessive or problematic digital media use from a family perspective.
Awake functional-guided resection (AFGR) is the gold-standard approach in glioma surgery. The learning curve associated with mastering white matter tracts (WMT) identification using direct electrostimulation (DES) mapping remains poorly characterized. The goal of this study was to compare subcortical DES mapping performance between early-career and expert neurosurgeons. In this prospective, monocentric, case-matched study, patients undergoing AFGR (2022-2025) were operated on either by an early-career neurosurgeon during the first four years of independent practice (cohortA) or by a senior expert neurosurgeon with extensive experience in awake mapping procedures (cohortB). DES-elicited responses were compared using multivariable multinomial regression, adjusting for histology and anatomical location. WMT identification rates were analyzed using a benchmark-normalized Relative Detection Efficiency (RDE). Overall, 352 AFGR procedures were analyzed, including 101 in cohortA. Histology differed between cohorts, with fewer IDH-mutant grade 2 gliomas (46.5% vs 65.3%) and more glioblastomas (27.7% vs 6.4%) in cohortA. Postoperative tumor volume and functional outcomes were comparable. A total of 1,158 DES responses were recorded. Negative motor responses were more frequent in cohortA (+ 11.3%[95%CI:3.3-18.9], P = 0.006), whereas semantic paraphasia tended to be less frequent (- 15.4%[95%CI: - 32.3-0.6], P = 0.079). Identification of the inferior fronto-occipital fasciculus was reduced in cohortA, particularly in left frontal approaches (RDE:0.53[95%CI:0.31-0.81], P = 0.002), consistent with comparable overall extents of resection (EOR) except in frontal tumors. Benchmarking early-career practice of AFGR against expert practice reveals selective, tract- and functional system-specific differences in DES mapping strategies, with minimal impact on EOR and similar functional outcomes. These findings suggest that AFGR is reliably implementable during early independent practice and support a dynamic connectomic constraint framework to guide training.
Esophagogastroduodenoscopy (EGD) is an essential clinical procedure for diagnosing gastrointestinal (GI) diseases, while the subsequent EGD reports play a vital role in clinical decision-making and therapeutic interventions. This paper makes the first attempt to bootstrap Multimodal Large Language Models (MLLM) with medical knowledge for EGD diagnosis and reporting (EDR). We collected the largest multicentric EGD dataset so far, containing 4461 participants with 203,838 EGD images and 4461 corresponding EGD reports. Experimental results demonstrate that the proposed method, MLLM-EDR, achieves an average diagnostic accuracy of 0.882 for nineteen GI diseases, outperforming both state-of-the-art AI models (0.720) and junior endoscopists (0.784). The completeness and facticity scores of our generated reports match the quality of those created by senior endoscopists. Moreover, our method substantially reduces the endoscopists' workload from 7 minutes to 13.48 seconds. These results highlight the vigor and significance of MLLM-EDR for AI-assisted EGD diagnostic and reporting applications.
Five billion individuals worldwide lack access to safe and affordable surgical care, a deficit disproportionately skewed toward low- and middle-income countries. Global surgery may be defined as "an area of study, research, practice, and advocacy" aiming to improve health outcomes for surgical patients. Universities play an important role in global surgical work in high-income countries. We aimed to determine the relevant knowledge, attitudes, and perspectives of medical students in Australia and Aotearoa New Zealand (ANZ). We surveyed senior medical students in ANZ medical schools (n = 24) from August to October 2022. Participants were recruited through university channels, social media, and snowball sampling. Participants completed questionnaires examining attitudes, exposures, and content knowledge relating to global surgery. A total of 851 eligible responses were analyzed. This included 189 of 851 (22.2%) participants with prior global surgery exposure, most commonly through student organizations (10.9%), and 686 of 851 (80.6%) participants believed global surgery to be relevant to medical students. Few participants (72 of 851; 8.5%) reported timetabled teaching of global surgery content, despite 494 of 741 (66.7%) supporting mandatory inclusion in medical school curricula. Preferred methods of global surgery exposure did not align with the methods received, and global surgery was infrequently reported in university curricula. Global surgery knowledge was limited and lower than that of students overseas. Despite this, participants indicated significant interest in global surgery teaching. ANZ medical students lack global surgery education and knowledge. Most global surgery education is delivered through nonacademic methods, including student societies and social media. Educators should consider these findings when planning medical school curricula.
Nursing quackery; the unlicensed practice of nursing by unqualified individuals poses a major threat to patient safety and nursing integrity in Nigeria. Despite a regulatory council, systemic enforcement failures continue to enable imposters to operate countrywide. To examine perceptions of nursing quackery in Nigeria, assess registered nurses' professional values, professionalism, trust, and ethical practice, and identify predictors of quackery awareness. A cross-sectional survey of 618 registered nurses recruited across all six Nigerian geopolitical zones used multistage sampling. Data were collected using the Nigerian Nursing Professionalism and Quackery Assessment Tool (NNPQAT), adapted from the Nurses' Professional Values Scale-Revised (NPVS-R), Hall's Professionalism Scale, the Trust in Nurses Scale, and the Ethical Behaviour Rating Scale. Chi-square tests, Spearman's rho correlations, and multiple linear regression were performed using SPSS version 29. Participants demonstrated high professional values (M = 4.76, SD = 0.44), professionalism (M = 4.76, SD = 0.58), ethical practice (M = 4.84, SD = 0.59), and trust (M = 4.53, SD = 0.59). Quackery awareness was widespread (M = 4.53, SD = 0.58); 96.1% agreed quackery threatens patient safety and 97.1% agreed it damages public trust. Awareness did not vary by region (χ2 = 2.25, p = 0.814) or facility type (χ2 = 0.18, p = 0.915). Ethical practice (ρ = 0.421, p < 0.001) and trust (ρ = 0.361, p < 0.001) were the strongest correlates. Regression identified ethical practice (β = 0.541, p < 0.001) and trust (β = 0.215, p < 0.001) as the only significant predictors (R2 = 0.511); years of experience, professionalism, region, and facility type were non-significant. Nigerian registered nurses exhibit strong professional values, yet quackery persists as a system-level failure rooted in regulatory weakness rather than individual professional deficit. Ethical practice functions as professional vigilance, heightening sensitivity to quackery. Strengthening Nursing and Midwifery Council of Nigeria (NMCN) enforcement, investing in ethics education, and developing public awareness campaigns are essential to protect patients and preserve professional integrity. These findings call for heightened regulatory vigilance among registered nurses, nurse educators, and healthcare administrators in identifying and reporting suspected nursing quackery. Pre-registration and continuing professional development curricula should embed ethics education that develops professional vigilance, recognising that ethical orientation, not seniority or years of experience, is the strongest driver of quackery awareness. Clinical and educational leaders should establish routine credential verification practices at ward and facility level, supported by safe, protected reporting mechanisms for nurses who identify unqualified colleagues. Nurse educators are encouraged to incorporate public awareness content into community health teaching, equipping the public to verify nursing credentials and recognise warning signs of fraudulent practice. These actions are relevant across all facility types and regions, given the uniform national distribution of quackery awareness identified in this study. This study did not involve patients, service users, caregivers, or members of the public in its design, conduct, data analysis, or manuscript preparation. The study population comprised registered nursing professionals only, recruited as expert informants on the phenomenon of nursing quackery in Nigeria. Patient and public involvement was not applicable to this study.
Scientific writing (SW) is an essential component of academic development in cytopathology; however, many professionals face difficulties when attempting to initiate the writing process. This series arises from a commonly shared challenge: not knowing where or how to begin. To introduce a practical educational framework for SW in cytopathology, developed in response to the need for structured guidance among both early-career and experienced cytopathologists. This article aims to encourage structured scientific publication, strengthen mentorship, and promote academic continuity within the specialty. A narrative review of the literature was performed using major biomedical databases and leading cytopathology journals to identify publications addressing SW, medical education, mentorship, research training, and publication practices relevant to cytopathology. Educational initiatives from scientific societies and current resources supporting academic writing, including digital technologies and artificial intelligence, were also reviewed. Based on the available literature and the authors' educational experience, a practical framework was developed to describe the scientific writing pathway from idea generation to manuscript submission. The literature specifically addressing scientific writing in cytopathology was found to be limited, and existing educational resources are fragmented. This article introduces a practical and accessible framework for both junior and senior cytopathologists, cytotechnologists, and other biomedical professionals working in cytopathology, addressing key aspects such as how to begin writing, identifying publishable ideas, the fundamental elements of successful publication, the role of mentorship, responsible use of artificial intelligence and digital tools, and the importance of disseminating both positive and negative research findings. The framework is intended to guide readers from their first research idea through manuscript preparation and publication. SW is a learnable competency that should be incorporated into cytopathology education throughout professional life. Developing structured educational pathways, strengthening mentorship, and promoting the responsible use of modern digital resources may facilitate greater academic participation. Encouraging a culture of SW is essential to develop the next generation of authors, improve international collaboration, and ensure the long-term academic growth of cytopathology.
To construct gestational age-specific P3-P97 percentile curves for amniotic fluid index (AFI) and single deepest pocket (SDP) in healthy singleton pregnancies between 14 and 28 weeks in a Turkish cohort, and compare them with international references. A prospective cross-sectional study at Haseki Training and Research Hospital, Istanbul, between February 2025 and February 2026. We included 507 healthy singleton pregnancies (14-28 weeks), each with one measurement. AFI and SDP were obtained during routine ultrasonography by two perinatologists under senior supervision, all using a shared written protocol. P3-P97 percentiles were generated empirically per gestational age and smoothed with polynomial regression. LMS modeling served as secondary verification. AFI rose from 105 mm at 14 weeks to 163 mm at 28 weeks (r = 0.609, p < 0.001), and SDP rose from 38 mm to 55 mm (r = 0.581, p < 0.001). AFI P50 values were up to 2.3 cm (median 1.7 cm) greater than the classic Moore-Cayle reference (weeks 16-28). Neither BMI nor placental location was significantly associated with AFI (p = 0.099 and p = 0.771, respectively). Inter-observer reliability was very good for both AFI (ICC[A,1] = 0.976) and SDP (ICC[A,1] = 0.920). This study provides second-trimester AFI and SDP P3-P97 reference curves in a Turkish cohort. AFI values were higher than those in classic international nomograms, suggesting that older reference charts may not be applicable to contemporary clinical settings and may influence classification in borderline cases.
Elderspeak is a collection of prosodic, lexical, and syntactic adaptations adopted for communicating with older adults. Often rejected as ageist and patronizing, it actually has mixed effects: some features hinder comprehension and well-being, while others aid understanding, social connection, or care. Considering seniors with and without dementia, this perspective addresses motivations, forms, and impacts of elderspeak, advancing a personalized, science-first agenda to preserve benefits despite flaws.
Decreased incidence of neonatal intubation combined with an increase in advanced practice providers performing the skill limits intubation opportunities for neonatal fellows. Fellows must now achieve intubation competency in an environment of increased competition for intubations. Little is known about the impact of this new environment on neonatal fellows' and attending neonatologists' perceptions of intubation. The objective of this study is to qualitatively explore neonatal fellows' and attending neonatologists' unique perceptions of and experiences with intubation. A qualitative study of neonatal fellows and attending neonatologists recruited from a single neonatal division that covers a level III and a level IV neonatal intensive care unit (NICU). Participants completed one-on-one semistructured interviews exploring their perceptions of and experiences with neonatal intubation. A qualitative researcher analyzed interview transcripts using coding and analytical memos in ATLAS.ti V7. We generated salient themes using the constant comparative method. Interviews continued until thematic saturation was achieved. A total of 15 neonatal fellows (5 from each year) and 11 attending neonatologists completed interviews. Qualitative analysis revealed four major topics with 12 themes. Perceived importance of neonatal intubation differed significantly between fellows and attendings, with fellows placing immense emphasis on the skill. Attendings both empathized with and were frustrated by fellows' preoccupation with intubation. Provider relationships with intubation failure varied greatly by training level. Third-year fellows expressed more difficulty recovering from unsuccessful intubations and fear of future failures as attendings. This qualitative study highlights differences in fellow perceptions of intubation by training level and suggests that this relationship evolves throughout fellowship and into attendinghood. With fewer intubation opportunities during fellowship training, neonatal educators should incorporate these distinct perceptions to develop training-level-specific intubation curricula. · Neonatal fellows' perceptions of intubation vary by training level.. · Intubation perceptions continue to evolve among attendings.. · Senior fellows have increased fear of intubation failure.. · Educators can use the distinct perceptions to develop training-level-specific intubation curricula..
This study aimed to develop and evaluate an AI-assisted teaching platform to enhance diagnostic competency in breast ultrasound. The goal was to assess whether AI integration improves diagnostic accuracy, learning efficiency, and participant satisfaction within a residency training program. We conducted a cohort-based study at our hospital. Twelve junior residents (experimental group) underwent AI-assisted training via a newly implemented platform, while twelve senior residents (control group) completed conventional training. Diagnostic performance was evaluated before and after the one-month intervention using consistent assessments. Participant satisfaction was surveyed across domains including learning engagement, skill development, and confidence. In the experimental group, post-intervention diagnostic scores (90.50 ± 9.82) were significantly higher than pre-intervention diagnostic scores(70.00 ± 17.55, P = 0.003,95%CI[-32.54,-8.46], Cohen's d=-1.44). Survey results indicated high satisfaction: 83.33% strongly agreed the platform facilitated learning, 66.67% reported improved pattern recognition, and 66.67% noted increased engagement in self-learning. A majority also reported gains in clinical reasoning and confidence when facing a real patient. We integrated an AI-assisted platform into ultrasound residency training, creating an educational tool. In this single-center exploratory study, the AI-assisted platform shows potential to improve residents' diagnostic skills for breast ultrasound.
Dorsal preservation rhinoplasty (DPR) has attracted significant attention in recent years. However, the rapid dissemination of diverse techniques and terminology has generated confusion regarding definition, indications, methodology, and outcomes. A unified conceptual framework remains lacking. We retrospectively reviewed 1,191 consecutive primary rhinoplasties performed by a single senior surgeon between 2010 and 2024. Three chronological series were analyzed. Series 1 (2010-2014; n = 320) introduced push-down and let-down osteotomies in selected cases. Series 2 (2015-2019; n = 352) expanded indications to more complex morphologies, exposing limitations. Series 3 (2020-2024; n = 519) applied a unified framework developed from the previous series. Revision rates and clinical lessons were compared. : Series 1 reported 11 revisions (3.4%), confirming feasibility in favorable cases. Series 2 recorded 35 revisions (9.9%) during the uncontrolled expansion of indications. Series 3 demonstrated 17 revisions (3.3%) after refinement of patient selection and operative decision-making informed by earlier experience, with revision rates differing significantly across the three series (χ²(2) = 21.61, p < 0.001). The third series validated that systematic application of a dorsal preservation framework produced reliable outcomes, minimized revisions, and helped formulate a pyramidal classification with named septoplasty modulators. The evolution of DP rhinoplasty follows a U-shaped learning curve, characterized by initial proof-of-concept, uncontrolled expansion, and subsequent consolidation through classification. Integration of the pyramidal framework with W-point septoplasty clarifies terminology, standardizes methodology, and establishes DP rhinoplasty as a reproducible and mature approach in contemporary practice.
This study aimed to explore latent categories of nursing and medical students' knowledge, attitude and practice intentions regarding advance care planning (ACP), and to identify the factors influencing these categories. It sought to provide an evidence base for developing personalized, precision-targeted advance care planning educational interventions. From October to December 2023, a stratified cluster random sampling method was employed to select a sample of 1006 undergraduate students in clinical medicine and nursing (Years 1-4) from a medical university in eastern China. A total of 935 valid questionnaires were recovered. Research instruments included a self-developed demographic questionnaire, the advance care planning knowledge, attitude and practice intentions Questionnaire, the Death Attitude Profile-Revised, and the Meaning in Life Questionnaire. Latent profile analysis determined the optimal number of categories; logistic regression identified factors influencing different advance care planning knowledge, attitude and practice intentions categories; a nomogram was constructed using R software, and predictive performance was evaluated using area under the curve (AUC), Hosmer-Lemeshow test, and 1000-bootstrap calibration curves. Latent profile analysis identified two latent categories: a "collaborative" group (33.6% of the sample) and a "lagging" group (66.4% of the sample). The collaborative group scored higher than the lagging group across all dimensions of advance care planning knowledge, attitude and practice intentions questionnaire. Logistic regression analysis indicated: palliative care training (OR = 1.5, 1.028-2.190), resuscitation experience (OR = 0.64, 0.424-0.966), clinical medicine student (OR = 0.537, 0.376-0.766), urban student (OR = 0.626, 0.419-0.935), high death escape scores, low natural acceptance scores, and low meaning in life questionnaire scores were more likely to be classified as "lagging type". Senior students (OR = 7.217, 4.089-12.737) and those with positive major attitude (OR = 3.572, 1.228-10.386) were more likely to be classified as "collaborative type". The nomogram demonstrated good discriminatory ability (AUC = 0.864; 95% CI 0.841-0.887; Brier score = 0.14) and high calibration (χ2 = 13.845, p = 0.086; calibration slope = 0.97). The established nomogram model identified the influencing factors of the knowledge, attitude and practice Intentions level of advance care planning among medical undergraduates, providing empirical evidence for the educational intervention of advance care planning for nursing and medical undergraduates. Universities needed to carry out refined advance care planning education in a targeted manner based on the different characteristics of students. To strengthen the validity of the research, it was planned, conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. All participants contributed to the conducting of this study by completing self-reported questionnaires.
To explore the implementation of England's high volume, low complexity (HVLC) surgical hubs programme from the perspective of senior leaders involved in its development and rollout. A qualitative design using semistructured interviews with service leaders. Following the postponement of elective surgical care in England after the outbreak of COVID-19, NHS England and the 'Getting it Right First Time' (GIRFT) programme developed an elective recovery plan for the NHS, with surgical hubs as the chief innovation for building elective surgical capacity. 12 service leaders, directly involved in the development and/or implementation of the HVLC surgical hubs programme. From the service leader interviews, four interrelated themes explained the rapid diffusion of surgical hubs: a 'window of opportunity' created by COVID-19, which accelerated adoption by reframing elective backlog as an acute crisis and enabling targeted investment; leadership by respected clinicians and the use of peer-generated, data-driven protocols which built trust and engagement; an iterative, locally adaptive approach to implementation, framing oversight as supportive rather than punitive; and peer-to-peer accreditation, allowing for the showcasing of best practice and fostering a growing network for continued shared learning. The implementation of high-volume, low-complexity surgical hubs in England demonstrates how large-scale service reconfiguration can be accelerated under crisis conditions but sustained through clinical credibility, trusted data and improvement-focused oversight. Our findings highlight the importance of hybrid governance models that combine national direction with local adaptability, supported by peer networks and accreditation mechanisms. These features align with wider evidence on health system change, underscoring the need for organisational readiness, relational work, and supportive infrastructures to ensure long-term impact beyond initial investment and leadership momentum. Future research should explore how these hubs function in practice, and whether the views of surgical hub staff align with those given by service leaders.
Patients with obesity who are admitted to an ICU bring specific challenges for rehabilitation during and after critical illness. This narrative review explores impact of differences in body compositions and pathophysiology on outcomes to summarise interprofessional, patient-centred rehabilitation strategies across the trajectory of recovery. The interprofessional expert panel reviewed major trials and guidelines, integrating their clinical expertise with the current evidence. Three distinct phenotypes potentially influence outcomes for survivors. Whilst patients with preserved muscle mass may have a survival advantage, the phenotypes characterised by ectopic visceral fat or sarcopenia are frequently complicated by multimorbidity and polypharmacy, likely increasing the risk of adverse effects such as suboptimal sedation, prolonged ventilation and immobilisation, malnutrition, and impaired recovery. Targeted respiratory interventions, including secretion-clearance techniques and appropriate patient positioning to prevent atelectasis, reduce the work of breathing. Optimisation of communication and swallowing function is an essential component for facilitating safe oral intake and promoting active patient participation in rehabilitation. Concurrently, targeted nutrition strategies combined with early, targeted, progressive mobilisation might mitigate ICU acquired weakness and support functional recovery. The availability of appropriate weight‑based equipment is fundamental to ensuring safe mobilisation for both patients and healthcare professionals. Interprofessional collaboration is central to optimising outcomes and should extend beyond the ICU to structured post-ICU follow-up to address persistent, worsening, or newly emerging health impairments. Early rehabilitation in critically ill patients with obesity should integrate physiological, logistical, and psychosocial considerations to support equitable and functional recovery.