IntroductionPatients with colorectal cancer and other intestinal cancers often experience a high symptom burden and frequently require healthcare services near the end of life (EOL). Early involvement of specialist palliative care (SPC) has been shown to improve quality of life and reduce aggressive EOL care, but data on its timing in this population is limited. This study examined the association between timing of SPC contact and healthcare utilization at the EOL.Patients and MethodsThis nationwide retrospective cohort study included all patients who died from colorectal cancer and other intestinal cancers in Finland in 2019. Data on healthcare use were obtained from national registers. Patients were categorized based on the timing of their first SPC contact into early (>30 days before death) and late or no SPC contact (≤30 days or none). Healthcare utilization in the last month of life was compared between groups, and multivariable logistic regression was used to identify factors associated with acute care.ResultsA total of 1445 patients were included, of whom 339 (23%) received early SPC contact, with a median of 142 days before death. Early SPC contact was associated with fewer emergency department (ED) contacts (43% vs. 54%, p<0.001) and secondary care hospitalizations (21% vs. 49%, p<0.001) and with a lower likelihood of death in hospital (59% vs. 80%, p<0.001). In multivariable analyses, late or no SPC contact was associated with higher odds of ED contacts (odds ratio (OR) 1.613, 95% confidence interval (CI) 1.255-2.074) and hospitalizations (OR 4.029, 95% CI 2.998-5.415).ConclusionsSPC contact occurring more than 30 days before death was associated with lower acute care use and fewer hospital deaths among patients with colorectal cancer and other intestinal cancer. These findings support consideration of earlier integration of SPC in the disease trajectory and warrant further prospective studies evaluating its impact on EOL care and healthcare utilization.
This article explores the essential role of the Clinical Nurse Specialist (CNS) in military healthcare, particularly during the deployment of a U.S. Army Emergency Trauma CNS in support of Operation Spartan Shield in Kuwait. It highlights the gap in existing literature regarding the unique contributions of CNSs in military settings, emphasizing the need for advanced practice competencies to navigate the complexities of deployed healthcare provision. The CNS's multifaceted impact is demonstrated through their educational initiatives aimed at ensuring clinical staff readiness, where they trained 140 clinical personnel, providing 24-hour care to a diverse population at the U.S. Military Hospital-Kuwait. The article underscores the CNS's influence in promoting quality improvement, interdisciplinary collaboration, and adherence to established competencies such as those outlined in the 2022 AACN Scope and Standards. Additionally, the CNS advanced medical education throughout the Central Command (CENTCOM) region by initiating accredited continuing education courses, significantly enhancing the skill sets of healthcare providers and contributing to over 1,200 accredited educational hours. These initiatives not only exemplify the CNS's commitment to lifelong learning and evidence-based practice but also underscore their critical leadership role in improving healthcare delivery in military contexts. The article concludes by advocating for increased recognition of the indispensable contributions of CNSs in military medicine and the importance of ongoing education and competency development.
暂无摘要（点击查看详情）
Chronic venous disease (CVD) and varicose veins (VV) are highly prevalent yet remain inconsistently managed despite existing guidelines, with variability in treatment selection, patient stratification, and use of conservative therapies. This multinational initiative sought to establish expert consensus on key clinical questions in venous disease management. A Delphi-like process involved 38 phlebologists from 15 countries across Europe, North Africa, and Central Asia. Four thematic workshops addressed interventional and conservative approaches for both CVD and VV. Twenty predefined questions were discussed, and resulting statements were rated on a 5-point Likert scale, with consensus defined as ≥75% agreement. Of 34 proposed statements, 30 (88%) achieved consensus. The panel emphasized that treatment decisions should be driven primarily by symptoms and quality of life rather than anatomy alone. Endovenous procedures were supported for symptomatic disease, with endovenous laser ablation and radiofrequency ablation considered equivalent for VV. Diosmin-based venoactive drugs, often combined with compression, were endorsed across CEAP classes for symptom relief, although adherence to conservative therapy remains limited. This consensus provides practical guidance for individualized care and highlights unmet needs in risk stratification, adherence, and long-term comparative outcomes.
The UK trauma and orthopaedic (T&O) workforce increasingly relies on non-deanery doctors, including international medical graduates (IMGs), Specialist and Associate Specialist (SAS) doctors, and locally employed doctors, who contribute substantially to service delivery across elective and trauma care. Despite their important role, there remains no nationally standardised training pathway to support competency development and progression through the Portfolio Pathway towards specialist registration. This technical report proposes a structured, curriculum-aligned framework for non-deanery T&O registrars that integrates educational supervision, workplace-based assessments, mentorship, operative competency monitoring, portfolio development, leadership activities, and protected educational time within existing NHS infrastructure. The proposed model aims to convert routine clinical service into documented educational progression while providing a framework that may support greater consistency in training, improve educational equity, and strengthen workforce retention. Further evaluation is required to determine its impact on educational and patient outcomes. A phased implementation strategy incorporating national governance, local supervision, and quality assurance mechanisms is described. Adoption of such a framework could provide a practical and scalable solution to support consultant-level competency development and strengthen the long-term sustainability of the UK T&O workforce.
As part of a quality improvement initiative focused on medical educator faculty development, we sought to explore the perspectives of clinician-educators based at a large urban Veterans Affairs Medical Center (VAMC) who navigate the workplace communities of both their VAMC and academic medical center (AMC). Informed by the conceptual framework of Communities of Practice proposed by Lave and Wenger, we conducted semistructured interviews from 2023-2024 with 20 VAMC-based clinician-educators holding faculty appointments at the affiliated AMC. We used purposive sampling to recruit a wide range of participants capturing differences in factors such as academic rank, subspecialist versus internal medicine specialist, and formal educational positions at the AMC. We identified three themes from the interviews: professional fulfilment from mission-driven care and mentoring of trainees; facilitation of the clinician-educator role by the VAMC environment; and the impact of geographic distance on faculty integration. In the last theme, several participants highlighted how working closely within the VAMC promoted strong collegial relationships within the facility, and physical separation from the AMC led to perceptions of professional distance from medical school faculty colleagues. Educating the next generation of healthcare professionals remains one of the core missions of the VA and supporting VA-based clinician-educators is critical to fulfilling this mission. Our study reveals the importance of the geographic distance between AMC and VAMC and its translation to perceptions of collegiate distance among individual VA faculty. We discuss strategies to foster connectivity between AMCs and VA facilities alongside strengthening VA-specific faculty development as potential solutions.
Prior international studies indicate that 9-36% of people with cerebral palsy (CP) have a monogenic condition. However, the utility of whole genome sequencing (WGS) as a diagnostic tool for United Kingdom (UK) National Health Service (NHS) patients has not been evaluated. This prospective pilot study recruited 86 individuals with CP from specialist clinics in Bedford, Cambridge, Colchester, Newcastle, and Luton NHS Foundation Trusts. Gene-agnostic trio WGS was performed using AI-based variant prioritisation, with subsequent application of a CP gene list. Candidate diagnostic pathogenic (P) or likely pathogenic (LP) variants were reviewed at multidisciplinary meetings and confirmed in an NHS Genomic Laboratory Hub prior to issuing a clinical report. The use of human phenotype ontology (HPO) terms was evaluated to estimate probability of a diagnostic variant using a supervised linear discriminant analysis (PCA + LDA) model. 86/157 (54.7%) individuals approached consented to the study. Variants meeting P/LP diagnostic criteria were identified in 11/86 cases (12.8%). 8/86 participants (9.3%) carried variants strongly suggestive of disease causation. Variants of uncertain significance were identified in 27/86 cases (31.4%). In all cases with P/LP variants, findings informed patient prognosis, specialist care, clinical management, and familial recurrence risk. Machine learning approaches were used to segregate the probability of diagnosis for participants based on HPO terms. WGS is clinically useful for diagnosis and management of genetic conditions associated with CP in the UK. Validation of these findings in a larger cohort is warranted. Rosetrees Charitable Trust, Isaac Newton Trust, NIHR Cambridge Biomedical Research Centre, and the Wellcome Trust.
Using the most recent US population projections data, we sought to update the estimated number of women who will undergo surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in the United States from 2025 through 2060. We hypothesize that the number of pelvic floor surgeries will increase in the upcoming decades. We used the 2017 National Population Projections from the US Census Bureau, which provides age-specific estimates on the number of women in the US from 2025 to 2060. We used previously published age-specific rates of surgery for women undergoing SUI-only surgery, POP-only surgery, and either SUI or POP surgery. These rates were applied to the population estimates of women aged 18 to 89 years to determine the projected surgeries from 2025 to 2060 in 5-year increments. From 2025 to 2060, the population of women in the United Sates ages 18 to 89 years is projected to increase 17%, from 136.0 million to 158.5 million. Correspondingly, the total number of either SUI or POP surgeries will increase from 469,460 in 2025 to 553,858 in 2060. From 2025 to 2060, there will be an 18% increase in the projected number of surgeries for SUI or POP, from 469,460 to 553,858. Our field should be proactive in ensuring that enough specialists and fellowship-trained subspecialists are available to meet the future surgical demands of women with pelvic floor disorders.
Artificial intelligence (AI) models can create radiological images. We aimed to determine whether radiologists could distinguish AI-generated from real images, and factors associated with correct classification. AI-generated images were made using an implementation of the Dreambooth fine-tuning approach applied to Stable Diffusion v2.1. Radiologists were asked to classify images as real (n = 10) or AI-generated (n = 20) and their confidence in this decision (1 least, 5 most) in an online form. 182 radiologists completed the survey. The median proportion of correctly identified images per respondent was 77.8% (interquartile range, IQR 70.0, 86.7%), with no difference between AI-generated (75.0%, IQR 70.5, 87.1%) and real images (83.4%, IQR 74.2, 92.6%, p = 0.19). Ultrasound and X-ray were more likely to be correctly identified than cross-sectional images like CT or MRI (88%, 91%, 70% and 77% respectively, p = 0.015). Mean confidence was similar for AI-generated and real images (3.50 ± 0.23 versus 3.56 ± 0.23, p = 0.49). There was no difference in classification based on number of years of experience (p = 0.57) or familiarity with AI (p = 0.37). However, radiologists with relevant specialist interests were more likely to correctly classify images (80.7 ± 1.3% versus 76.9 ± 0.8%, p = 0.012). Radiologists were only able to correctly identify three-quarters of AI-generated images. This was impacted by sub-specialist expertise but not the number of years of experience or familiarity with AI.
Tuberculosis (TB) remains a major global health concern, with poor post-discharge adherence driving relapse and drug resistance. While China's 2024 guidelines advocate for "intelligent post-discharge management," the role of Large Language Models (LLMs) in this specialized care remains unexplored. To explore the feasibility of LLMs as auxiliary tools to complement TB specialists in post-discharge medication counseling, patient education, and follow-up planning. This exploratory study compared two LLMs (ChatGPT-4o, DeepSeek-R1) with TB physicians using 17 standardized clinical cases. Responses were assessed by three blinded specialists using objective metrics (precision, recall, F1) and subjective ratings across seven domains. Linear mixed models (LMMs) were employed to analyze the fixed effects of participant type while controlling for the random effects of clinical cases. In patient education, LLM-generated responses exhibited higher objective completeness and accuracy than those of physicians (precision: 0.86 vs 0.50, P < .001; recall: 0.53 vs 0.14, P= .026; F1: 0.65 vs 0.22, P= .018). Conversely, no statistically significant differences were observed in objective metrics for medication counseling and follow-up planning (all P > .050), although LLMs demonstrated a tendency toward broader but more discordant coverage. Subjectively, LLMs were rated significantly higher in suitability, understandability, and empathy across all tasks (all P < .050). No significant differences were found regarding perceived safety or text readability (P > .050). This study suggests the potential of LLMs as auxiliary tools in TB post-discharge management. While quantitative performance in high-stakes tasks was comparable to physicians, the complementary qualitative patterns support a hybrid human-AI approach. These preliminary findings provide a basis for integrating LLMs into clinical workflows under professional supervision to enhance efficiency in resource-limited settings.
The Daniel K. Inouye Graduate School of Nursing (GSN) at the Uniformed Services University (USU) is dedicated to preparing advanced practice nurses (APRNs) and nurse scientists for the federal health system, with a distinct focus on military readiness. As a joint-service program, the GSN educates a diverse student body from all military branches to serve those in harm's way, offering Doctor of Nursing Practice (DNP) and PhD degrees across specialties like Family Nurse Practitioner (FNP), Women's Health Nurse Practitioner (WHNP), Psychiatric-Mental Health Nurse Practitioner (PMHNP), Registered Nurse Anesthetist (RNA), and Clinical Nurse Specialist (CNS). For Army nurses, this education is uniquely tailored to operational demands. The rigorous curriculum requires 1,800-3,000 clinical hours, specialized training in battlefield medicine and advanced trauma care, and interprofessional field exercises simulating large-scale combat operations. Strategic partnerships with entities such as the National Institutes of Health (NIH), Department of Veterans Affairs (VA), and U.S. Immigration and Customs Enforcement (ICE) provide unique clinical experiences in diverse and resource-limited settings. Consistently ranked in the nation's top 5%, the GSN leverages a strong partnership with Army Nurse Corps leadership to generate a ready medical force, ensuring its graduates are prepared to lead and provide expert care from stateside hospitals to austere operational environments. Through its dedication to excellence, leadership, and operational relevance, the GSN produces highly skilled Army Nurse clinicians and scientists, prepared to lead and transform military healthcare for the nation.
Patient satisfaction is a key indicator of healthcare quality, particularly in resource-constrained public health systems. Despite growing evidence on healthcare service quality in Bangladesh, comprehensive assessments incorporating both patients and attendants remain limited. This study evaluated satisfaction with healthcare services at Sylhet MAG Osmani Medical College Hospital using the SERVQUAL framework. A cross-sectional survey was conducted among 400 respondents, including 167 patients and 233 attendants, selected through multi-stage cluster sampling. Data were collected using a structured questionnaire measuring five SERVQUAL dimensions: tangibility, reliability, responsiveness, assurance, and empathy. Descriptive statistics, independent-samples t-tests, chi-square tests, and binary logistic regression were employed for data analysis. Reliability and assurance received the highest ratings, particularly accurate diagnosis (mean = 3.96), reliable test results (mean = 3.99), and confidence in specialist doctors (mean = 4.07). In contrast, tangibility recorded the lowest ratings, with 74.6% dissatisfied with bed availability and 70.3% dissatisfied with seating arrangements. Empathy scores revealed concerns regarding equitable care, especially for poor patients (mean = 2.22). Independent-samples t-tests showed no significant differences between patients' and attendants' perceptions across SERVQUAL dimensions or overall satisfaction. Logistic regression identified assurance (OR = 6.86), empathy (OR = 4.64), tangibility (OR = 2.47), and responsiveness (OR = 2.08) as significant predictors of overall satisfaction, whereas reliability was not significant. Age, education, profession, and frequency of hospital visits were associated with satisfaction, while gender and income were not. Interpersonal aspects of care, particularly assurance and empathy, are the strongest determinants of satisfaction in a public medical college hospital in Bangladesh. Although respondents expressed confidence in healthcare providers, substantial deficiencies in infrastructure and perceived inequities in care for vulnerable populations remain. Addressing these gaps is essential for improving patient-centered service delivery and healthcare quality in public hospitals.
Obesity is highly prevalent among patients with chronic musculoskeletal pain and is associated with low back pain, knee osteoarthritis, reduced mobility, and poorer functional outcomes. Glucagon-like peptide-1 (GLP-1) receptor agonists and related therapies have transformed obesity medicine and may become more relevant to pain medicine specialists. This narrative review examines whether GLP-1-based medications should be considered within pain practice, particularly for obesity-associated low back pain and knee osteoarthritis. Chronic pain impacts a substantial portion of adults, while low back pain and osteoarthritis remain leading causes of disability worldwide. Obesity is associated with low back pain and knee osteoarthritis, and weight reduction has been shown to improve pain and function in these conditions. GLP-1-based therapies can produce clinically meaningful weight loss in patients with obesity and chronic pain. Literature also suggests possible anti-inflammatory and chondroprotective effects relevant to pain. GLP-1-based medications should not be viewed as primary analgesics or replacements for standard pain evaluation, rehabilitation, pharmacologic care, or interventional treatment. However, they are reasonable to consider as part of comprehensive pain management in patients with obesity when excess weight plausibly contributes to chronic pain, impaired mobility, or reduced rehabilitation tolerance. Pain physicians familiar and comfortable with obesity pharmacotherapy may consider prescribing within appropriate indications and safety parameters. Alternatively, referral to obesity medicine, endocrinology, primary care, or another experienced clinician is appropriate.
This case study details a U.S. Army perinatal clinical nurse specialist's (66G7T) experience providing advanced obstetric care, including an unexpected twin delivery, in a resource-constrained environment at Kamenge Military Hospital in Bujumbura, Burundi, during a Medical Readiness Exercise (MEDREX). It illustrates the practical application of the U.S. Army Medical Department's dual mission of military readiness and global humanitarian engagement. The narrative highlights the critical need for adaptability, resourcefulness, and cultural humility when working in austere settings. This experience goes beyond standard combat-focused medical training, emphasizing that nurses must be prepared to deliver specialized care, such as perinatal nursing, in environments with severe resource limitations and differing cultural norms. It suggests that future military medical education should explicitly integrate training for these complex scenarios, fostering the skills necessary for effective global health engagement and humanitarian missions. The case study also underscores the mutual learning and strengthened partnerships fostered by international medical collaboration for impactful global health outcomes.
Bone age (BA) is the gold standard for skeletal maturity assessment but is not routinely incorporated into pediatric growth evaluation workflow because it requires dedicated hand radiographs and specialist interpretation. To develop an estimation model for BA from chest radiographs using deep neural networks. We retrospectively analyzed children aged 3-15 years who underwent both chest and hand radiography at a tertiary center over 20 years. Patients with skeletal dysplasia or chest wall abnormalities were excluded. Reference BA was determined from hand radiographs by pediatric endocrinologists using the Tanner-Whitehouse 2 radius-ulna-short bones (TW2-RUS) method. Three pretrained deep neural networks were fine-tuned to estimate BA from chest radiographs using sex-non-considering models and sex-considering models. Model performance was evaluated using the intraclass correlation coefficient (ICC), root mean squared error (RMSE), and related metrics. Of 180 screened patients, 101 were included, yielding 237 chest radiographs. Estimated BA showed good concordance with the reference standard, with ICCs up to 0.81 (95% CI 0.48-0.97) for sex-non-considering models and 0.87 (95% CI 0.63-0.99) for sex-considering models. Corresponding RMSEs were 1.52 (95% CI 0.67-2.20) and 1.30 (95% CI 0.56-1.95), respectively. This proof-of-concept study demonstrates the feasibility of estimating BA from pediatric chest radiographs using deep neural networks. These findings suggest potential opportunistic use when dedicated hand radiographs are unavailable.
Lung cancer in never-smokers represents a distinct clinical and biologic entity. However, its epidemiologic characteristics remain incompletely described in the Middle East. To characterize lung cancer in never-smokers and compare it with ever-smokers in a multicenter Saudi cohort. Retrospective multicenter cohort study. Three tertiary-care centers of King Faisal Specialist Hospital & Research Centre system in Saudi Arabia. Adults with histologically confirmed primary lung cancer diagnosed between January 2020 and December 2024 were classified as never- or ever-smokers. Carcinoid tumors were excluded from the comparative analysis. Demographic, histologic, stage, and molecular characteristics were compared. Multivariable logistic regression identified factors independently associated with never-smoker status. Clinical, histologic, stage, and molecular differences between never-smokers and ever-smokers expressed as crude and adjusted odds ratios (95% confidence interval). 301 patients reviewed; 253 in the primary analytic cohort (92 never-smokers, 161 ever-smokers). Among 280 patients with available smoking history, 253 were included after excluding 27 carcinoid tumors (92 never-smokers [36%] and 161 ever-smokers [63.6%]). Never-smokers were mostly females (64/92 (70%) vs 12/161 (7.5%); P<.001) and younger than ever-smokers [mean age 59.2 (standard deviation 13.5) vs 62.3 (11.1) years; P=.065]. Adenocarcinoma predominated among never-smokers (81/92 (88%) vs 108/161 (67.1%); P<.001). Among patients tested, Epidermal growth factor receptor (EGFR) mutations(34/86 (39.5%) vs 12/128 (9.4%); P<.001) and Anaplastic lymphoma kinase (ALK) rearrangements [17/86 (20%) vs 9/128 (7.0%); P=.01] were significantly more frequent in never-smokers, whereas KRAS alterations were more common in ever-smokers [6/86 (7%) vs 21/128 (16.4%); P=.068]. Stage III-IV disease was common in both groups (70% vs 72%; P=.783). In multivariable analysis, female sex [adjusted odds ratio (OR) 31.9, 95% CI 14.2-71.6; P<.001] and adenocarcinoma histology (adjusted OR 5.3, 95% CI 2.0-14.2; P<.001) were independently associated with never-smoker status. In this multi-center Saudi cohort, more than one-third of lung cancers occurred in never-smokers, characterized by female predominance, adenocarcinoma histology, and frequent EGFR and ALK alterations. These findings support comprehensive molecular testing regardless of smoking history and underscore the need for strategies to improve early recognition of lung cancer in never-smokers. Retrospective design, incomplete molecular testing, tertiary-referral setting, and potential misclassification of smoking exposure, including unrecorded waterpipe and electronic-cigarette use.
The U.S. Army perioperative nurse (66E) plays a pivotal role in delivering surgical care that directly influences battlefield survivability, operational readiness, and overall force health. Rooted in a legacy dating back to the American Revolutionary War, Army perioperative nurses embody a unique blend of clinical precision, operational agility, and leadership excellence. These nurses serve as circulating or scrub personnel in operating rooms, managing sterile technique, surgical equipment, implants, and intraoperative imaging, while coordinating preoperative and postoperative care in both domestic and deployed settings. Their responsibilities extend beyond the surgical suite, encompassing trauma response, setting up field hospitals, managing mass casualties, and providing surgical logistics in austere environments. Specialization in perioperative nursing offers distinct career advancement opportunities and aligns with the Military Health System's goals of maintaining a medically ready force. Through training, mentorship, research dissemination, and advanced academic programs such as the Doctor of Nursing Practice Adult-Gerontology Clinical Nurse Specialist with a perioperative focus at USUHS, 66Es contribute to surgical innovation and quality improvement across the continuum of care. In 2024, 66Es demonstrated significant impact through leadership roles, global deployments, scholarly achievements, and clinical education initiatives. Looking forward, strategic efforts to reintegrate 66Es into forward surgical units and expand CNS authorizations will further strengthen the specialty's influence. Army perioperative nurses remain essential to military surgical capability, shaping the future of combat care and enhancing patient outcomes across operational and humanitarian missions.
Despite clinical guidelines emphasising coordinated, person-centred care for pregnant women with epilepsy, preventable maternal deaths and suboptimal care continue. To explore the perspectives of women with epilepsy on pregnancy-related care and their views on how to improve it. We conducted semi-structured interviews with eleven women aged 27-39 years who were currently pregnant or had given birth within the last two years. We recruited participants from across the UK. Data were analysed using reflexive thematic analysis. Three main themes were identified. Enabling and supportive care was characterised by supportive healthcare professionals as anchors, proactive preconception counselling, collaboration between providers, a single coordinator of care, and access to specialist expertise. Fragmented and inadequate care included absence of informed decision-making, poor coordination, women being left to correct errors in their own care, encounters lacking empathy, limited epilepsy knowledge among non-specialist staff, and over-reliance on remote contact. Priorities for service improvement included early and direct conversations about risks (including SUDEP), respectful and balanced communication, partnership-based adult-to-adult dialogue, in-person consultations, and coordinated, holistic care that includes mental health support. Despite longstanding guidelines, women with epilepsy continue to experience significant gaps between recommended standards of pregnancy care and service realities. Women describe deficits in early, proactive discussions about medication and risks, informed decision-making, and joined-up care, leaving some to perform unsupported "safety work", correcting errors and mediating between neurology, obstetric and midwifery teams. Improving care requires a commitment to holistic, person-centred support that embeds clear, respectful, two-way communication with women and across services as a core safety practice.
Despite the important role of Geriatricians in our society, there is a shortage of Geriatric Medicine specialists. This study surveyed fellows enrolled in ACGME approved Geriatric Medicine fellowships in the United States for insight into why they joined a Geriatric Medicine fellowship. Survey links were sent to all Geriatric Medicine Program Directors from July-Sept in 2019 and 2020 and we asked them to share the surveys with their fellows. Survey responses were summarized using descriptive statistics. The Likert-scaled dataset was analyzed with percentage of responses for each item related to "influence" and "barrier" domains. We examined the associations between variables using the Chi-Square test. The free-text fields were analyzed using inductive thematic analysis. There were 149 respondents (80% female) and approximately half of the respondents were from foreign medical schools (52%). Geriatric Medicine was the first fellowship choice for 75% of respondents. Among respondents who were US medical graduates, 89% chose Geriatric Medicine as first-choice specialty for fellowship, in contrast to 61.5% among the Foreign Medical Graduates (FMGs) (p < 0.001). Major reasons why fellows chose Geriatric Medicine were unique career opportunities and care of complex patients. The largest barrier/concern for pursuing Geriatric Medicine fellowship was the low salary associated with the field. As the first national survey of Geriatric Medicine fellows evaluating their reasons for pursuing a Geriatric Medicine fellowship, these results can be used by Geriatric Medicine fellowship programs and health care systems to improve recruitment into Geriatric Medicine fellowships.
The Open Data Commons for Traumatic Brain Injury (ODC-TBI.org) was launched in 2018 to support data sharing in pre-clinical TBI. As data science and artificial intelligence continue to advance, open sharing of high-quality, FAIR (Findable, Accessible, Interoperable, and Reusable) data has assumed critical importance to propel discovery science and as a countermeasure to some of the rigor and reproducibility problems plaguing translational research across biomedicine. Researcher-led specialist repositories such as ODC-TBI serve as important hubs through which biomedical communities come together to define data sharing requirements for their respective domains in support of new requirements by funders and journals for routine data sharing. ODC-TBI is now the recognized data repository for pre-clinical TBI research, listed on the National Library of Medicine-recommended repository listing, and is supported by the National Institute on Neurological Disorders and Stroke. ODC-TBI forms one of the critical infrastructure components of the PRE Clinical Interagency reSearch resourcE-TBI (PRECISE-TBI) project, an interagency effort to promote and support data sharing, rigor, and reproducibility in pre-clinical TBI research. Through PRECISE-TBI, the ODC-TBI has conducted broad outreach, starting in 2022, resulting in a significant increase in the number of users, datasets uploaded and public data releases. PRECISE-TBI has facilitated the establishment of an Editorial Board providing community oversight of ODC-TBI policies and recommendations, for example, the use of standards such as common data elements (CDEs). Here we describe the current state of the ODC-TBI, including its organization, operation, and governance. We perform a detailed overview of public datasets to provide insight into data sharing practices, including the use of CDEs and ancillary practices such as providing links to publications and citing data. We examine the impact of the ODC-TBI by providing statistics on downloads per datasets and reuse of ODC-TBI data in published studies. The results not only provide insight into the growth trajectory of ODC-TBI and data sharing behaviors in pre-clinical TBI, but also point to areas where increased outreach, communication, and training are needed to firmly establish a culture of data sharing.