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Medication adherence is critical to long-term graft and patient survival after liver transplantation (LT), yet the effectiveness of adherence-promoting interventions across the post-transplant survivorship continuum remains uncertain. We systematically reviewed interventions to improve medication adherence including immunosuppressive regimen simplification, pharmacist-led or counseling strategies, behavioral and multicomponent programs, and technology-based interventions. We identified 33 studies: immunosuppressive regimen simplification (n=8), pharmacist-led or counseling strategies (n=6), behavioral or multicomponent programs (n=3), virtual visits/remote monitoring (n=9) and mobile or text-based tools (n=7). In pooled analyses of randomized trials, active interventions improved adherence versus usual care (OR 4.04, 95% CI 1.94-8.41), although heterogeneity was substantial. A higher prevalence of alcohol-associated liver disease was associated with weaker intervention effects. Regimen simplification, especially conversion from twice-daily to once-daily tacrolimus, showed consistent improvement in adherence while maintaining acceptable graft outcomes. Pharmacist-led interventions improved medication knowledge, dosing compliance, and drug monitoring. Telehealth interventions reduced travel burden and, in some studies, early readmissions and hospital stay. Overall, regimen simplification and structured multidisciplinary support appear most effective, but larger longitudinal trials with standardized adherence measures are needed.
Nitrofurantoin is considered a first-line antimicrobial agent by the AUA/CUA/SUFU Guideline and Infectious Disease Society of America (IDSA) Guideline for the treatment of acute uncomplicated simple cystitis in women. Nitrofurantoin has good oral bioavailability, high concentration in urine, and low serum and tissue concentrations. These characteristics result in minimal collateral damage to the microbial composition of other niches within the human body, such as the gut, that are essential in maintaining homeostasis. In addition, resistance to nitrofurantoin is uncommon owing to its interference with multiple bacterial cellular functions critical to survival. Large systematic reviews and meta-analyses have demonstrated that nitrofurantoin is noninferior to other commonly prescribed antibiotics for treatment of urinary tract infection (UTI). Recent data from a randomized controlled trial suggest that a 5-day course of nitrofurantoin may be more effective than a single dose of fosfomycin in the treatment of UTI. Therefore, nitrofurantoin is an ideal first-line agent in the management of UTI.
Epstein-Barr virus (EBV) colonizes secondary lymphoid tissues to establish persistent infection and is strongly associated with malignancy and autoimmunity. Our understanding of EBV infection biology is hindered by a lack of models that capture infected B cell activity in the lymphoid tissue microenvironment. We therefore developed an EBV human tonsil organoid model to evaluate key B cell states and antiviral responses, including after primary infection. EBV promoted B cell differentiation into germinal center-like phenotypes and transcriptomic analyses highlighted numerous B cell transcriptional programs unique to EBV-infected cells. B cell receptor repertoire analysis revealed that most EBV+ B cells underwent class switching but only rarely participated in somatic hypermutation. CD4 T cells, highly activated by organoid infection, limited EBV+ B cell outgrowth in both primary and secondary EBV infection. Our findings demonstrate human tonsil organoids as a physiologically relevant model to investigate key aspects of EBV immunity and pathogenesis.
Laparoscopic nephrectomy for Wilms tumor remains controversial despite growing evidence supporting its feasibility. This study analyzed surgical and oncological outcomes according to the SIOP criteria and evaluated the hilar-to-central vessel distance as a potential selection parameter. Retrospective analysis of 50 children with unilateral Wilms tumor treated between 2014 and 2020. Patients underwent open (ON=38) or laparoscopic (LN=12) nephrectomy following SIOP protocols. Laparoscopic selection required: tumor confined to the kidney, not crossing vertebral border, no venous thrombus, volume ≤300 mL, and adequate chemotherapy response. CT/MRI measurements included tumor volume and the distance between the hilar vessels and the aorta/vena cava. Outcomes included operative time, complications (Clavien-Dindo classification), conversion rate, lymph node yield, recurrence, and survival. Groups differed significantly in staging (stage I: LN 83.3% vs. ON 26.3%, P=0.003). Mean tumor volume after chemotherapy was lower in the LN group (87.81 vs. 394.72 cm3, P<0.001). Hilar-to-central vessel distance after chemotherapy was greater in the LN group (10.83 vs. 5.42 mm, P=0.005). Conversion rate was 16.7% (2/12) due to bleeding. No intraoperative tumor spillage occurred in the LN group, compared with 3 in the ON group. Postoperative complications occurred only in the ON group (4/38, 10.5%). Average LOS was 2.42 days (LN) versus 4.53 days (ON). Five-year event-free survival was 91.7% (LN) and 84.2% (ON). Laparoscopic nephrectomy for carefully selected Wilms tumor patients treated according to SIOP protocols demonstrated favorable perioperative outcomes consistent with appropriate patient selection. The hilar-to-central vessel distance showed statistical association with surgical approach at the group level, but did not discriminate conversion risk at the individual level. Integration of this metric should be studied as a potential adjunct to comprehensive assessment by experienced surgical teams, with prospective multicenter validation required before clinical implementation.
Oral lichen planus is a chronic inflammatory disease of the oral mucosa characterised by immune dysregulation, but its pathogenesis remains incompletely understood and no curative treatment has been established. Our previous work showed that patients with oral lichen planus exhibit gut dysbiosis, including reduced microbial diversity and depletion of butyrate-producing bacteria. Because butyrate promotes regulatory T-cell differentiation and supports immune homeostasis, targeting this dysbiosis may represent a microbiota-directed approach for immune modulation in oral lichen planus. This study aims to investigate the effects of inulin supplementation on the gut microbiota and related immune markers in patients with oral lichen planus. This multicentre, double-blind, randomised, placebo-controlled parallel-group trial will enrol 80 patients with oral lichen planus. Participants will be randomly assigned in a 1:1 ratio to receive either inulin (8 g/day) or a maltose placebo for 4 weeks, in addition to standard care. The primary outcome is the change in the relative abundance of prespecified butyrate-producing gut bacteria from baseline to the end of intervention at Week 6. Secondary outcomes include changes in gut microbiota diversity, salivary microbiota composition, faecal short-chain fatty acid concentrations, peripheral blood regulatory T-cell counts, blood test parameters, and clinical symptoms of oral lichen planus. Analyses will follow the intention-to-treat principle, and between-group differences will be assessed using appropriate statistical methods. This trial is designed to evaluate, in a randomised placebo-controlled setting, whether a microbiota-directed intervention can modify gut microbial profiles and related immune markers in patients with oral lichen planus. The findings are expected to clarify whether inulin supplementation can modify gut microbial profiles and related immunological markers in patients with oral lichen planus. Trial registration: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000060840, registered on 1 April 2026 (https://rctportal.mhlw.go.jp/detail/um?trial_id=UMIN000060840#).
BACKGROUND Glaucoma is a progressive optic neuropathy often associated with elevated intraocular pressure (IOP). Implantation of an Ahmed glaucoma valve (AGV), a silicone or polypropylene shunt tube, can regulate aqueous humor drainage through a filtering bleb and lower IOP. A rare postoperative complication of AGV implantation is giant bleb formation, which typically occurs early in the postoperative period and can require surgical revision if IOP becomes uncontrolled or if the bleb causes discomfort/cosmetic concerns. We describe a case of bilateral refractory steroid-induced glaucoma and delayed-onset giant bleb formation after AGV implantation, temporally associated with coronavirus disease 2019 (COVID-19). CASE REPORT A 39-year-old man with bilateral steroid-induced glaucoma presented for an unscheduled visit 3 years after AGV implantation in the left eye with complaints of photophobia and foreign body sensation. He also reported recent COVID-19 onset. Tonometry revealed elevated IOP in the left eye (50 mm Hg). Examination showed an enlarged superotemporal bleb overlying the Ahmed valve plate. Treatment comprising topical glaucoma medications and oral acetazolamide improved bleb appearance and stabilized IOP within 3 months. At the last follow-up, the patient remained stable, with well-controlled IOP in both eyes on 4 topical glaucoma agents (6 medications total) and oral acetazolamide. CONCLUSIONS This report describes delayed-onset giant bleb formation and pronounced IOP elevation coincident with COVID-19 onset several years after AGV implantation. Conservative medical management improved bleb appearance and IOP; long-term pressure control required maximal medical therapy. Clinicians should remain vigilant for persistent IOP elevation despite favorable bleb appearance, including after COVID-19 onset.
The aims of this study were to evaluate sickness compensation before and after transsphenoidal surgery (TSS) for pituitary adenoma compared to the general population and to identify factors associated with return to work (RTW) after TSS. This study included working-age patients who had undergone TSS for a pituitary adenoma at Sahlgrenska University Hospital and matched controls (1:5) from the general population in Sweden. Data for sickness compensation from 1 year before TSS (index) to up to 2 years after was obtained from national registers. Demographic factors, cognition, and fatigue were evaluated based on impact on number of days to RTW or by comparing the groups of patients with and without RTW 1-year post-surgery. Sixty-six patients and 329 matched controls were included. The proportion of patients with sickness compensation was approximately twice that of controls 1 year prior to TSS. The proportion of patients with sickness compensation continued to increase until TSS and decreased thereafter but did not return to the level observed 1 year prior to TSS. Prior sickness compensation and Cushing's disease, albeit this subgroup was small, were predictive of more days to RTW after TSS. Patients without RTW 1-year post-surgery reported more fatigue and more often had adrenal insufficiency compared to the group of patients with RTW. Sickness compensation for patients with pituitary adenoma is mainly limited to the surgical period and the months thereafter. Sustained higher levels 1-year post-surgery suggest that work disability remains a long-term issue for a subgroup of patients.
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Fibrous osseous dysplasia (FOD) and ossifying fibroma (OF) are craniofacial fibroosseous lesions with overlapping features but distinct biology and surgical needs, particularly when orbital involvement impairs function. This study described long-term outcomes after resection and reconstruction for ossifying fibroma compared with fibrous osseous dysplasia patients. Patients undergoing orbital fibrous osseous dysplasia or ossifying fibroma surgery between 2008 and 2019 were reviewed, excluding those lacking ≥3 years of follow-up. Demographic, symptom-to-surgery-related data and outcome data were compared. Patients were divided into 2 groups (fibrous osseous dysplasia and ossifying fibroma), and statistical comparisons were performed using the Mann-Whitney test. Twenty-seven patients were included (21 for fibrous osseous dysplasia and 6 for ossifying fibroma). Ossifying fibroma required radical excision with bony reconstruction (coronal/Weber-Ferguson approaches, pericranial flaps, parietal/rib grafts), while fibrous osseous dysplasia was treated with debulking or resection based on symptoms; orbital box osteotomy was performed in 4 patients. The mean age at the time of the first surgical intervention was 16.7±11.9 years for patients with ossifying fibroma and 14.8±6.9 years for those with fibrous osseous dysplasia. Average timing for new operation in months was 16.3±12.8 months for ossifying fibroma and 50.4±53.3 months for fibrous osseous dysplasia (P=0.08). Among 6 patients with amblyopia-related visual loss, 3 improved. Optic nerve decompression in 2 FOD patients did not halt visual deterioration, leading to blindness. Our data indicate that ossifying fibroma is more likely to necessitate a secondary surgical intervention at an earlier stage compared with fibrous dysplasia.
Hair loss is a common, multifactorial condition caused by traumatic, autoimmune, hormonal, and iatrogenic factors. Despite its prevalence, it is associated with significant psychological distress. Hair transplantation is an increasingly utilized treatment; however, postoperative complications remain an important consideration. A scoping review was conducted using PubMed, Embase, and Scopus from database inception through February 2026. Studies published in English reporting complications following hair transplantation were included, while those focused solely on medical management were excluded. Complications were categorized by timing (early <30 d; late >30 d) and severity (minor: self-resolving/minimally impactful; major: requiring surgical intervention). The review began with 3119 identified records; duplicates were removed, and title/abstract screening yielded 253 studies for full-text review. After full-text screening, 117 studies met the inclusion criteria. Of the included studies, 47 reported late complications, 42 early complications, and 28 both. Fifty-nine studies reported minor complications, 39 major, and 19 both minor and major. Common adverse events included pain, infection, folliculitis, and edema. Minor infection rates ranged from 1.4% to 2.0%, and folliculitis from 1.1% to 12.1%. Necrosis was rare (0.03% in 1 study). Serious complications most frequently included arteriovenous fistula (n=16), necrosis (n=6), and graft failure (n=6). Interpretation was limited by heterogeneity in definitions and reporting, necessitating qualitative synthesis. Identified risk factors included smoking, chronic sun damage, diabetes, dense graft packing, epinephrine use, vascular injury, and excessive graft depth. Hair transplantation carries the risk of both minor and major complications. While common complications are generally self-limited, they may negatively impact outcomes. Rare but serious complications can occur. Emphasis on patient optimization, surgical technique, and early recognition is essential, and standardized reporting is needed to better define incidence and risk factors.
Congenital nasolacrimal duct obstruction (CNLDO) is a common condition in infants. While observation and surgical probing are commonly used in clinical practice, evidence to guide the choice between these approaches is lacking, and the efficacy of lacrimal sac massage remains controversial. To assess whether lacrimal sac massage is noninferior to lacrimal duct probing for treating CNLDO in infants. This noninferiority randomized clinical trial took place at an outpatient clinic in Guangzhou, China, from April to September 2025 and included 160 infants younger than 1 year with CNLDO, presenting with epiphora or discharge in 1 or both eyes since birth. Children with bilateral eye disease were only analyzed for the right eye. Patients were excluded if they had previously undergone surgery for CNLDO or had another systemic disease or ocular infection. Patients were randomly assigned to receive lacrimal duct probing in the consultation room (n = 80) or standardized, regular lacrimal sac massage performed by parents (n = 80). The primary outcome was the resolution rate at 3 months, defined as complete or substantial resolution of epiphora, alongside the complete resolution of purulent discharge. The prespecified noninferiority margin was -10 percentage points. The mean (SD) age of the participants was 6.2 (2.5) months, and 98 (61.3%) were male. Resolution occurred in 69 of 80 participants (86.2%) in the massage group compared with 67 of 80 (83.7%) in the probe group (difference, 2.5 percentage points; 95% CI, -8.78 to 13.76). No serious complications occurred. The mean (SD) symptom resolution time was 1.1 (0.5) weeks in the probe group and 3.8 (2.8) weeks in the massage group (difference, 2.7 weeks; 95% CI, 1.96 to 3.38; P < .001). For infants younger than 1 year with CNLDO, lacrimal sac massage for 3 months was noninferior to lacrimal duct probing in efficacy, with no serious complications in either group. These findings support lacrimal sac massage as an alternative to surgical probing for CNLDO in infants younger than 1 year similar to those enrolled in this trial. ClinicalTrials.gov Identifier: NCT06924723.
Spinal stenosis most commonly occurs at L4-5, with 91% of patients experiencing nerve compression at this location. It results from a degenerative process that begins in the intervertebral disc, as viable cell counts, water, and proteoglycan content decrease in the nucleus pulposus. The disc height decreases as the nucleolus pulposus degenerates and the annulus fibrosus bulges. Stenosis is generally classified by descriptive elements, such as etiology (i.e., degenerative or congenital), location (i.e., central, lateral recess, foraminal, or extraforaminal), and severity of narrowing on advanced imaging (mild, moderate, or severe). The primary case study in this case report is LSCS, where the researchers explored the patient's problems and nursing care. Mr. A (68 years old) was admitted to the 6th floor (Surgery) ward with complaints of low back pain that had been felt for the past 7 months. Pain scale 6-7 (NRS), felt intermittent, sometimes disturbing sleep during the day or night. The pain radiates from the waist to the left leg. The patient is bedridden and cannot walk, and only gets up to a body elevation position of 30 ° for 7 months. The client experienced a decrease in extremity muscle strength. The results of the MRI examination showed the patient had lumbar spinal canal stenosis. The nursing problems experienced by Mr. A were resolved after 6 days of nursing intervention. The patient showed a decrease in pain to a scale of 2-3 (mild pain), improved physical mobility, decreased falls, and decreased knowledge deficit. RésuméLa sténose spinale survient le plus souvent au niveau L4-L5, 91 % des patients présentent une compression nerveuse à ce niveau. Elle résulte d’un processus dégénératif débutant au niveau du disque intervertébral, caractérisé par une diminution du nombre de cellules viables, de la teneur en eau et en protéoglycanes du noyau pulpeux. La hauteur du disque diminue à mesure que le noyau pulpeux dégénère et que l’anneau fibreux se bombe. La sténose est généralement classée selon des critères descriptifs, tels que l’étiologie (dégénérative ou congénitale), la localisation (centrale, du récessus latéral, foraminale ou extraforaminale) et la sévérité du rétrécissement observé en imagerie avancée (légère, modérée ou sévère). Le cas clinique principal présenté dans ce rapport est celui de M. A., dont les chercheurs ont analysé les problèmes et les soins infirmiers prodigués. M. A., âgé de 68 ans, a été admis au service de chirurgie (6e étage) pour des lombalgies évoluant depuis 7 mois. Douleur d’intensité 6 à 7 (échelle numérique de la douleur), ressentie de façon intermittente et perturbant parfois le sommeil, de jour comme de nuit. La douleur irradie de la taille à la jambe gauche. Le patient est alité et ne peut pas marcher ; il ne peut se tenir debout qu’à une élévation du corps de 30° depuis 7 mois. Il présente une diminution de la force musculaire des membres. L’IRM a révélé une sténose du canal lombaire. Les problèmes de soins rencontrés par M. A. ont été résolus au bout de 6 jours d’intervention infirmière. Le patient a présenté une diminution de la douleur (d’une intensité de 2 à 3 sur l’échelle numérique de la douleur), une amélioration de sa mobilité, une réduction des chutes et une amélioration de ses connaissances.
The optimal surgical strategy after failed midurethral sling (MUS) surgery remains controversial, and robust comparative data are needed to guide the choice between repeating the same sling type and converting to an alternative approach. The objectives of this study were to compare the effectiveness and safety of 4 redo MUS strategies and to assess whether sling-type conversion offers clinical advantages over same-type repetition. In this multicenter retrospective cohort study (2015-2025), 256 women undergoing redo MUS surgery for persistent or recurrent stress urinary incontinence (SUI) were included. Patients were categorized into 4 groups according to redo sling type: (1) tension-free vaginal tape-retropubic sling (RP)→transobturator sling (TO) (n=33), (2) RP→RP (n=38), (3) TO→ RP (n=92), and (4) TO→TO (n=93). The primary outcome was objective cure at final follow-up. Secondary outcomes included repeat failure, change in International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) severity category, and mesh-related complications. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences. Baseline characteristics were comparable across groups. In IPTW-adjusted analyses, sling-type conversion was associated with significantly higher objective cure rates compared with same-type repetition (83.2% vs 61.8%; OR, 3.44; 95% CI, 1.86-6.37; P=0.001) and lower repeat failure (16.8% vs 38.2%; OR, 0.29; 95% CI, 0.16-0.54; P<0.001). Symptom improvement favored switch strategies, with mild postoperative ICIQ-SF scores observed in more than 80% of conversion groups. Mesh-related complications were also reduced with switching (OR, 0.63; 95% CI, 0.40-0.98), particularly in early redo procedures. In recurrent SUI, the switch strategy continued to show benefit in early recurrence, while in late recurrence (≥36 mo), no clear advantage was demonstrated. Sling-type conversion after failed MUS surgery is associated with superior efficacy and improved safety, supporting an individualized, strategy-driven approach to redo surgery.
Systematic review and meta-analysis. To identify patient-related, operative, radiographic, and bone quality predictive risk factors associated with proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery and evaluate diagnostic performance of opportunistic CT-derived bone quality metrics. PJF is a severe complication of ASD correction associated with pain, deformity progression, and reoperation. While numerous risk factors have been proposed, reported associations are inconsistent, and clinical utility of opportunistic bone quality assessment remains uncertain. PubMed, Embase, and CENTRAL were searched from inception to January 2026. Observational studies reporting PJF after ASD surgery with extractable comparative data were included. Random-effects meta-analyses were used. Diagnostic accuracy of Hounsfield unit measurements was summarized using pooled sensitivity, specificity, and area under curve (AUC). Twenty-eight studies encompassing 4560 patients were included, of whom 1064 (23.3%) developed PJF. Patients with PJF were older (MD 2.59 y, P <0.001) and had worse baseline disability and pain. Binary osteoporosis status was not consistently associated with PJF, though continuous bone measures were predictive, including lower DEXA T-scores (MD -0.55, P <0.001), and CT attenuation at upper instrumented vertebra (MD -28.97 units, P <0.0001) and immediately cranial adjacent vertebra (MD -32.67 units, P <0.0001). Radiographically, PJF was associated with greater preoperative sagittal misalignment, including higher pelvic tilt and sagittal vertical axis, lower lumbar lordosis, and greater pelvic incidence-lumbar lordosis mismatch. Fusion length and upper instrumented level (dichotomized at T10) were not significantly associated with failure. Hounsfield units demonstrated good diagnostic performance (pooled AUC 0.86). PJF after ASD surgery reflects the interaction between sagittal misalignment, correction strategy, and junctional structural capacity. Continuous bone quality measures, particularly opportunistic Hounsfield unit assessment, show potential for risk stratification and may inform targeted preventive strategies in biologically vulnerable patients, pending prospective validation.
Reduced skeletal muscle mass may impair outcomes of immune checkpoint inhibitors in recurrent or metastatic head and neck squamous cell carcinoma. We evaluated whether temporal muscle thickness (TMT) on routine head computed tomography was associated with treatment response and survival. We retrospectively analyzed 109 patients treated with nivolumab or pembrolizumab between 2017 and 2023 (89 men [81.7%], 20 women [18.3%]; median age 69 years [range 21-88]). TMT was measured on CT images at the level where the Sylvian fissure was most clearly visualized, perpendicular to the temporalis muscle long axis, on both sides, and the mean of the bilateral values was used. Sex-specific cutoffs were defined by time-dependent receiver operating characteristic analysis for 12-month overall survival (5.53 mm for men; 3.92 mm for women). Associations with objective response and survival were assessed using logistic regression and Cox proportional hazards models. Objective response was evaluable in 105 patients (complete response 12, partial response 30, stable disease 18, progressive disease 45), yielding a response rate of 40.0% and a disease control rate of 57.1%. High temporal muscle thickness was associated with response (univariable odds ratio 2.64, 95% confidence interval 1.18-5.90; p = 0.018) and remained significant after adjustment for chemotherapy (adjusted odds ratio 2.42, 95% confidence interval 1.05-5.58; p = 0.038). One-year progression-free survival was 36.5% in the high group versus 15.8% in the low group (absolute difference 20.7%; p = 0.010; adjusted hazard ratio 0.57, 95% confidence interval 0.36-0.90; p = 0.017). One-year overall survival was 73.1% versus 47.4% (absolute difference 25.7%; p = 0.001; adjusted hazard ratio 0.54, 95% confidence interval 0.34-0.86; p = 0.010). Temporal muscle thickness, obtainable from routine head computed tomography, was independently associated with response and survival in patients receiving immune checkpoint inhibitors and may serve as a practical host-related imaging marker for prognostic risk stratification.
Pain that develops after cardiac surgery can negatively affect early recovery. In this study, we aimed to investigate the effect of sternal retractor opening on post-sternotomy pain in cardiac surgeries performed with median sternotomy. Patients who underwent open cardiac surgery with median sternotomy in our clinic between September 2023 and March 2025 were included in this retrospective study. Postoperative pain assessments were performed using the Visual Analogue Scale (VAS) at the 2nd hour (VAS0), 6th hour (VAS1), first day (postoperative 24th hour) (VAS2), and second day (postoperative 48th hour) (VAS3) after extubation. Patients were divided into two groups: those with sternum retractor opening less than 9 cm (Group 1) and those with 9 cm or more (Group 2). A total of 124 patients were included in the study. The mean age of the patients was 59.8 ± 14.2 (Range: 19-81), and 67 (54%) patients were female. As a result of the analysis, a statistically significant difference was found between the groups only in VAS0 values. While the median VAS0 value was four (range: 0-10) in Group 1, it was found to be six (range: 0-10) in Group 2 (P = 0.033). Although VAS1, VAS2, and VAS3 values were higher in Group 2, there was no statistically significant difference (P values: P = 0.132, P = 0.421, P = 0.267, respectively). Although there was no statistically significant difference in the pain evaluations at the sixth postoperative hour, on the first day, and on the second day, we found that patients with smaller retractor openings had lower pain scores.
The prevalence of frailty is high among older patients receiving hemodialysis and there is a widespread agreement that frailty may be alleviated by interventions, yet frailty assessment and management are not consistently conducted among these patients. The objective of this study was to assess perceptions and attitudes regarding frailty assessment and physical activity interventions among patients receiving hemodialysis and their clinicians in a large dialysis unit. Focus groups or interviews were conducted with patients (n= 9) and dialysis unit staff and providers (n= 26) from the Hines Veterans Affairs dialysis unit. Recordings from the focus groups and interviews were transcribed verbatim. Deductive and inductive qualitative analyses were used to identify emergent themes. Emerging themes were organized into; 1) Perspectives and current practices about frailty testing reported by clinicians; 2) perspectives and current practices about physical activity reported by patients and clinicians, and 3) practical suggestions to increase frailty testing and physical activity interventions also reported by patients and clinicians. The clinicians in our study were supportive about frailty assessments in the dialysis unit. However, they were skeptical about the implications of the assessment to inform patient care and additional burden in an already constraint dialysis unit. Patients and clinicians also noted that at the health center, physical activity was mostly supported in the context for rehabilitation from acute illnesses. They spoke about the relevance for individualized exercise routines based on patients' preferences, capabilities and situation, as well as convenience. Clinicians also spoke about the importance of multidisciplinary approach for designing frailty reduction interventions including aspects of physical, mental and social wellbeing. While there is broad stakeholder acceptability and interest in frailty assessment and frailty reduction interventions, significant operational, educational, and patient-, clinician- and systemic-level barriers must be addressed before implementation is feasible in routine dialysis unit care.