Conectar
by Daniel H. Nguyen, Debottama Das, Ali Bilgin, Dianne Patterson, Matthew Hook, Chris Butson, Alberto Cacciola, Vinod Kumar Jangir, Manojkumar Saranathan
Leveraging diffusion tractography, connectivity-based parcellation (CBP) is one of the oldest methods for thalamic nuclei segmentation. The goal of this work was to reassess CBP using higher spatial resolution diffusion MRI data and reconstruction algorithms, and to compare it with recent state-of-the-art methods for thalamic nuclei segmentation. Furthermore, these methods were systematically evaluated against three histological atlases and one functional MRI–based atlas to examine their relative anatomical similarities and differences. High resolution diffusion and T1-weighted MRI data from 67 healthy individuals in the Human Connectome Project Young Adult database were analyzed. CBP was performed using probabilistic tractography with cortical targets derived from combining labels of the Human Connectome Project Multi-Modal Parcellation 1.0 atlas into 8, 11, and 23 regions. Results were compared against three recent methods: orientation distribution function clustering (ODF), track density imaging (TDI), and structural MRI-based segmentation. Group level analyses were conducted in the Montreal Neurological Institute space, and Dice overlap coefficients were calculated using four atlases (three histological, one functional). CBP results using newer data and methods were still remarkably similar to the original CBP parcellation results. Across atlases, a consistent hierarchy was observed: HIPS-THOMAS performed best, followed by TDI, ODF, and CBP (Kendall’s W = 1.00, p = 0.007). Histological atlases showed strong mutual agreement (Pearson r = 0.71–0.85), whereas the Zhang atlas demonstrated lower concordance (Pearson r = 0.51–0.63). Despite methodological advances, CBP remains constrained in its ability to delineate thalamic nuclei with histological accuracy. By contrast, structural and diffusion microstructural approaches provided better nuclear localization. These findings highlight the need for hybrid workflows that integrate structural and diffusion-based information to enable more reliable thalamic segmentation for neuroscience research.by Linda Furness, Janani Pinidiyapathirage, Matthew French, James Ware, Liam Weber, Brendan Carrigan
IntroductionIn rural generalist clinical settings, medical trainees routinely assess patients and discuss their findings with supervisors to plan ongoing care. These interactions termed ‘learning conversations’, serve as important opportunities for workplace-based learning and clinical decision making. However, preliminary evidence and stakeholder feedback indicate a lack of shared understanding regarding how these conversations should be structured, facilitated, and optimised. This study aims to observe current practices, identify supervisor and trainee learning needs, and co-design a model of learning conversations that enhances educational value and supports safe, effective patient care.
Methods and analysisThis study will use an exploratory sequential mixed methods design structured around the 3Cs of co-design (Co-define, Co-design, Co-refine). Phase 1 (co-define) will involve qualitative observation and audio-recording of learning conversations across two rural hospitals to characterise current practice and inform a protype model. In Phase 2 (co-design), supervisor and trainee focus groups will explore perceived needs, expectations, and feedback on the prototype model. A national online survey of rural supervisors and trainees will further inform model refinement. Phase 3 (co-refine) will incorporate national stakeholder input through a workshop, followed by feasibility testing of the refined model during a pilot simulation at a Rural Clinical School. Outcome data will focus on model usability, perceived relevance, applicability across contexts, and users’ experiences of employing the model during simulated learning conversations.
DiscussionThis study will produce a stakeholder-informed model that responds to the specific learning and clinical needs of rural generalist practice. By embedding co-design throughout the research process, the resulting model is expected to strengthen learning conversations, optimise trainee learning, and enhance the quality and safety of patient care. The findings have potential applicability across broader health professional training contexts and can support workforce development in rural healthcare settings.
The study aimed to develop a computational fluid dynamics-based mobile wound irrigation education program and explore changes in irrigation pressure control, wound irrigation-related knowledge and performance confidence in syringe-based wound irrigation. This study used a single-group pre–post design. A computational fluid dynamics-based mobile wound irrigation program was developed following the Analysis, Design, Development, Implementation, and Evaluation model. The program enabled learners to manipulate irrigation variables and visualize pressure distribution in real time. Thirty-four participants were recruited. Irrigation pressure was measured using a load cell-based device, and knowledge and performance confidence were assessed pre- and post-intervention. Data were analysed using paired t-tests and content analysis. The mean irrigation pressure increased significantly, although the post-intervention mean remained below the recommended pressure range and the proportion of participants achieving the recommended range rose from 0% to 44%. Knowledge and performance confidence also improved significantly. Qualitative findings indicated enhanced understanding of performance standards, improved technical awareness and reduced uncertainty during skill execution. Participation in the computational fluid dynamics-based mobile education program was associated with improvements in irrigation pressure control, related knowledge and performance confidence in syringe-based wound irrigation. These findings should be interpreted as preliminary because of the single-group pre–post design. Numerical visualization and real-time feedback may be useful educational strategies for facilitating the transition from experience-based skill performance to data-driven practice.
Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea: KCT0011256.
Sexually transmitted infections (STIs) have emerged as significant public health concerns, imposing a substantial burden on both individuals and the healthcare system of the country. Additionally, STIs may also result in major extensive psychological consequences that profoundly affect individuals with STIs. Despite the government’s implementation of different initiatives aimed at addressing STI-related challenges, these conditions are associated with shame and stigma which act as barriers to the effective utilisation of healthcare services. The purpose of the present study is to generate evidence on barriers and facilitators to service utilisation and management of STIs in India.
Indian Council of Medical Research, New Delhi, is conducting a multi-centre study employing a mixed-method approach. The study involves different levels of healthcare systems, including both government and private healthcare facilities across seven sites in several states of India, including Maharashtra, Rajasthan, Punjab, Bihar, Uttar Pradesh and New Delhi. For the quantitative data, individuals seeking healthcare services related to STIs will be enrolled and assessed using a semi-structured pilot-tested questionnaire. In-depth interviews and focus group discussions will also be conducted with different stakeholders as per the standard guidelines of the qualitative method by the designated trained project staff. Descriptive and inferential statistics will be applied to the quantitative data, while the qualitative data will be analysed using a deductive approach with thematic content analysis.
The study protocol has been approved by the ethics review committees of all the participating sites individually. The findings from this study will be published in peer-reviewed journals and disseminated through scientific conferences and meetings among policy-makers and government agencies. AIIMS/IEC/2024/609; AIIMS/Pat/IEC/2024/1205; F. 7/BIOETHICS/AIIMS-RBL/APPROEM/2021/1; KIMSDU/IEC/11/2022; LHMC/IEC/2024/11; IEC/02/EX/2024; PGI/IEC/2024EIC000373.
Poststroke depression (PSD) affects approximately 33% of stroke survivors and is associated with worse outcomes, poor quality of life (QOL) and mortality. Despite its prevalence and consequences, there is no consensus on the most effective strategy for PSD prevention. Behavioural activation (BA) is an effective intervention for depression across diverse populations and is considered safer, better tolerated and a longer-lasting alternative to antidepressant medications. This study aims to test the effectiveness of a remotely delivered BA intervention to prevent PSD (Tele-BA-S).
We will conduct a randomised effectiveness trial of 350 low-income adults (≥ 55 years) within 3 months of ischaemic or haemorrhagic stroke and with subthreshold depression (Patient Health Questionnaire-9 score
Ethical approval was obtained by the University of Texas Health Science Center at Houston’s (UTHealth Houston) Committee for the Protection of Human Subjects Institutional Review Board. The trial protocol, statistical analysis plan and code, and deidentified participant data will be made available via the National Institute of Mental Health Data Archive. The results will be presented at academic conferences and submitted for publication. The authors declare that they have no conflicts of interest relevant to the content of this manuscript.
by Robert Parisien, Alexander Drost, Amin Razi, Sina Ramtin, David Ring, Stein J. Janssen
ObjectivesTo inform efforts to promote regular and normalized Bayesian reasoning, we studied factors associated with the degree to which surgeons use Bayesian reasoning to navigate uncertainty across different clinical scenarios.
MethodsScience of Variation Group members (153; 58% North America, 30% Europe, 69% over 15 years of experience) completed an online survey reading 8 scenarios of test and treatment decisions and chose one of 4 answer options with higher scores indicating more Bayesian reasoning. Internal consistency of the survey was assessed using Cronbach alpha.
ResultsThe average Bayesian reasoning score across all scenarios was 3.0 (IQR 2.7–3.2) on a 4-point scale, indicating a relative context-dependent variability. Completely non-Bayesian reasoning was selected least often (8.6%, 90 of 1,044) and fully Bayesian reasoning represented 29% (301 of 1,044) of responses. Most surgeons showed mixed patterns (defined as reasoning in which prior probability is acknowledged but underweighted, without explicit probabilistic updating): 85% (121 of 142) used fully Bayesian reasoning at least once (121 of 142) while 42% (60 of 142) used completely non-Bayesian reasoning at least once. The Cronbach alpha was 0.43 suggesting the scenarios measured different aspects of clinical reasoning rather a unified construct.
ConclusionsThe finding that surgeons use relatively context-dependent reasoning suggests an opportunity for surgeons to develop and practice Bayesian reasoning strategies both in training programs and in practice.
Chronic dyspnoea is a prevalent and clinically significant symptom, often indicative of underlying cardiorespiratory disease. It is frequently under-reported by patients and under-recognised in primary care, with these challenges exacerbated in rural and remote communities where disease burden is greater and patients experience barriers to timely diagnosis and management. The BREATHE SMART trial aims to implement and evaluate an innovative, fully digital self-screening system for chronic dyspnoea, integrated into general practice workflows and information technology infrastructure. This approach seeks to enhance early detection and management of chronic cardiorespiratory conditions across diverse practice settings.
This multisite proof-of-concept study will test a software platform delivering a preconsultation self-screening questionnaire across 40 general practices in urban, rural and remote Australia. The system identifies eligible patients (≥18 years, consenting to SMS communication with their practice), issues an automated SMS that administers a validated dyspnoea screening questionnaire, and summarises responses for integration into the electronic medical record. Process evaluation will assess acceptability and utility using deidentified audit data, software metrics and qualitative feedback from patients, staff and general practitioners (GPs) via surveys, interviews and focus groups. Approximately 12 000 patients will be screened over 12 months. Primary outcomes will include the proportion completing self-screening and prevalence of chronic dyspnoea and secondary outcomes will include the rate of newly diagnosed chronic dyspnoea-related conditions (ie, asthma, chronic obstructive pulmonary disease and heart failure) in the preceding 12 months and during the intervention period.
Ethics approval was granted by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and the University of Notre Dame Australia HREC (2024-155). Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practices.
ACTRN12624001451594.
This scoping review intended to map the existing literature on chronic stroke rehabilitation interventions in primary healthcare (PHC) settings, with a particular focus on intervention dosage—frequency, intensity, type and duration—as well as the mode of delivery, which encompasses intervention location, format and provider.
A scoping review was conducted following the guidelines outlined in the Joanna Briggs Institute Manual for Evidence Synthesis.
A comprehensive search of 16 databases was conducted on the EBSCOhost platform on 10 February 2022. A supplementary Google search was conducted to identify grey literature up to 19 November 2022.
Sources published in English between 2010 and 2022 with full-text availability, addressing interventions for chronic stroke survivors delivered by various stakeholders in PHC, community or home-based settings.
Two reviewers independently screened the identified sources to determine eligibility for inclusion. Data were extracted independently, compared between reviewers, analysed and synthesised narratively with descriptive statistics.
In total 34 sources are included in the review, with most (n=28) originating from high-income countries. Interventions predominantly targeted the body function and structure component of the International Classification of Functioning, Disability and Health framework (n=29) through physical exercise (n=21). However, few interventions addressed the activity (n=17) and participation (n=11) components. Contextual factors (n=9) were seldom considered in intervention design. Intervention dosage varied widely. Most interventions were delivered by the multidisciplinary team (n=9) and were provided either at home (n=16) or in the community (n=13). Individual sessions (n=18) were more commonly offered than group sessions (n=8).
The optimal dosage for chronic stroke interventions remains uncertain, and current interventions, along with their modes of delivery, are often misaligned with PHC settings. Further research is essential to establish best practices in both well-resourced and under-resourced environments to address the current evidence gap and to enable the development of effective rehabilitation protocols that meet the needs of chronic stroke survivors and their families in PHC settings.
Each year, suicide claims approximately 700 000 lives worldwide and generates a significant financial burden. Integrating genomic data, exposomic factors and digital phenotypes can enhance the development of short-term predictive models. Current knowledge and available tools provide the basis for designing personalised treatment strategies that incorporate real-time interventions to prevent suicide attempt recurrence cost-effectively. This study aims to develop a predictive algorithm for suicidal behaviour integrating psychiatric assessments, genetic risk markers, digital phenotypes and exposomic data.
This protocol describes a retrospective multicentre study that will recruit participants with a clinical history of suicide across 25 hospitals across Spain with a catchment area of 8.6 million people (17.8% of Spain’s population). Our sample target is over 5000 participants, aged over 12 years old, ensuring 93.5% statistical power for genetic analysis. Eligible participants must be over 12 years old. Data collection will include psychiatric assessments, biospecimen collections (DNA, RNA, plasma and serum), Google Takeout data for digital phenotyping, and a standardised set of administrative and clinical data registered for each patient. Genotyping will be performed with the Axiom Spanish array (>750 000 markers), and genome-wide association studies (GWAS) will be performed after genetic imputation in a whole sample of >10 000 individuals (5000 suicide attempters; 5000 controls). Prescription and clinical history will also be retrospectively integrated, and codified data statistics forms will periodically be sent to the Government. Statistical analyses will combine traditional regression models and AI-based algorithms to identify predictive behavioural, genomic profiles, and digital markers of suicidal behaviour. Cost-effectiveness analyses of pharmacogenomic markers for antidepressant response will also be conducted.
By successfully implementing this project, we aim to help reduce suicide reattempts and lessen the emotional and economic burden on families and the healthcare system.
This study has been approved by the Ethics Committee of the Fundación Jiménez Díaz (PIC301-24_FJD) and complies with the Declaration of Helsinki. It adheres to the GDPR (EU Regulation 2016/679), Spain’s Organic Law 3/2018 on Personal Data Protection and Digital Rights, and Law 41/2002 on patient autonomy. All required data protection measures will be implemented, including those under Real Decreto 1718/2010 on prescriptions and treatment adherence. Underaged participants will require parental consent for participation. The results will be disseminated through publication in peer-reviewed scientific journals and presentations at psychiatric conferences.
Midwives/nurse midwives are the healthcare professionals most often present on the birth scene. However, they have been the professionals who are most justified to defend their legally established position by arguing their competence and autonomy. Thus, it is important to show their reality through experiences, particularly when autonomy does not
align with regulations. This meta-synthesis aims to bring together scientific evidence regarding midwife/nurse midwife’s autonomy experience in caring for labouring women in health facilities.
The meta-aggregation will be used to conduct a systematic review of qualitative studies. In January 2025, a search was carried out in scientific databases: EBSCOhost (CINAHL Ultimate, MEDLINE Ultimate and Academic Search Complete), LILACS, PubMed, Wiley Online Library, Scopus and Web of Science. The articles will be independently reviewed by two authors who will assess data quality, extraction and synthesis. Studies will be assessed for rigour using critical appraisal tools provided by the Joanna Briggs Institute. Data extraction and synthesis will be carried out using software, and results will be presented in tables. The results of the qualitative research will, where possible, be grouped according to the meta-aggregation approach proposed by the Joanna Briggs Institute.
Ethical approval to analyse secondary data is not required. The results will be published in peer-reviewed journals and presented at international and national conferences.
CRD42024572542
Despite limited evidence of efficacy, opioid analgesics are frequently used by patients for chronic pain while awaiting total hip or knee arthroplasty (THA or TKA). Preoperative use of opioids is problematic as it increases the likelihood of postoperative opioid-related adverse drug events and postoperative complications and is the strongest predictor of persistent opioid use post surgery. Opioid tapering prior to elective surgery has been proposed as a strategy for mitigating harms and improving postoperative outcomes. This protocol describes a randomised clinical trial, which aims to determine the effectiveness of a preoperative pharmacist-partnered opioid tapering programme compared with standard care for patients awaiting elective THA or TKA on postoperative outcomes including persistent opioid use.
Eligible participants must be aged ≥18 years; awaiting elective unilateral or bilateral THA or TKA; speak and read English; use prescription opioid analgesics at least 4 days a week and have access to internet or telephone. The participants will be excluded if they are undergoing a repeat surgery (same procedure within 6 months), are using opioids for cancer, palliative care or substance use disorder; have previously or are currently undergoing an opioid tapering programme or active medication review or have cognitive impairment. Enrolled participants will be randomised in a 1:1 ratio in permuted blocks of two and four to: (1) intervention or (2) standard care. A total of 314 participants will be recruited into the study. The intervention will include a pharmacist-partnered opioid tapering programme in which a pharmacist will work with participants to reduce their opioid dose over a 3-month period before surgery. Standard care will involve review by the hospital preadmission clinic multidisciplinary team to assess medical, physical and psychological health prior to surgery and education sessions for preoperative and postoperative care. The primary outcome assessed is persistent opioid use 3 months post surgery. The key secondary outcome is total Western Ontario and McMaster Universities Arthritis Index score. Data analysis will be performed using an estimand framework, with a generalised estimating equation model for the primary outcome from 1 day to 3 days presurgery to 3 months post surgery and a multilevel model for the main secondary outcome from baseline to 3 months after surgery. Cost-effectiveness and cost-utility analyses will be conducted to determine whether the intervention is cost-effective from the healthcare system perspective.
Ethics approval for this study was granted by a Human Research Ethics Committee (approval number: 2023/ETH01042). Results will be disseminated in peer reviewed journals, at international scientific meetings as well as meetings with key stakeholders and via the media.
ACTRN12623000685617.
Weight loss through combined lifestyle interventions (CLIs) can slow down knee osteoarthritis (OA) progression. However, gender-related factors may influence both the implementation of and participation in CLIs. Therefore, the aims were to identify gender-related facilitators and barriers to CLI implementation among healthcare professionals (HCPs) and uptake and adherence among individuals with early-stage knee OA and overweight or obesity.
Semi-structured interviews were conducted in this qualitative study. Thematic analysis, combining inductive and deductive approaches, was performed according to the Consolidated Framework for Implementation Research (CFIR) domains.
HCPs and individuals with knee OA and overweight or obesity were interviewed in Dutch between December 2023 and May 2024.
16 HCPs who referred or delivered a CLI and 23 individuals with knee OA and overweight or obesity who participated in a CLI were purposively recruited. 16 participants identified themselves as women and 7 as men; no other gender identities were reported.
HCPs experienced resistance to CLIs of both men and women. Additionally, HCPs perceived that women were more open and available to participate in CLIs, tended to prioritise others over themselves and often lacked familial support compared with men. Women valued trust, preferred female HCPs and struggled with self-prioritisation. Men were motivated by female HCPs and participants due to their empathy and interaction. Across men and women, barriers included conflicting HCP advice, work stress, caregiving tasks and lack of discipline, while social environment support was a key facilitator.
Addressing gender-related facilitators and barriers in the design and implementation of the CLI may improve long-term engagement and efficacy in individuals with knee OA and overweight or obesity.
Overview of Medical Research in the Netherlands (OMON), managed by the CCMO: NL75367.078.20
This study was designed to investigate the mistreatment of women during childbirth and its determining factors in a selected maternity hospital in Mazandaran/Iran.
This cross-sectional study was designed in 2024.
Maternal and child clinics in the cities of Amol and Babol in Mazandaran/Iran.
The study population consisted of 215 women who were selected via convenience sampling and were at least 8 weeks postpartum.
All participants in the study reported experiencing at least one form of mistreatment. 42% of cases experienced three types of mistreatment. The highest reported level of mistreatment was related to the poor relationship between women and service providers (88.1%) and physical abuse (80.9%), respectively. The overall satisfaction score for care was 33.96±9.17. Multivariate logistic regression analysis demonstrated that higher maternal age was significantly associated with lower odds of physical mistreatment (OR=0.923, 95% CI 0.865 to 0.985, p=0.016). Women without doula accompaniment during childbirth had higher odds of experiencing a lack of privacy compared with those who had a doula (OR=2.77, 95% CI 1.41 to 5.42, p=0.003), and failure to meet needs (OR=2.2; 95% CI 1.13 to 4.28; p=0.020), but significantly lower odds of experiencing poor communication (OR=0.128; 95% CI 0.043 to 0.337; p
The results of this study indicated that the prevalence of mistreatment in participants in the selected hospitals was notable. The most reported mistreatment was the lack of effective communication between staff and the patient, followed by physical mistreatment and the lack of respect for privacy. Factors related to mistreatment included the mother’s age and the presence of a companion (doula) during delivery.
Body mass index (BMI) confers a higher risk of colorectal cancer (CRC) and may influence cancer diagnostic pathways. We investigated variations in diagnostic pathways by BMI category among patients with symptomatic CRC.
Retrospective cohort study using linked cancer registry, primary, and secondary care data.
England
5571 patients with symptomatic CRC diagnosed in England between 2011 and 2015.
Route to CRC diagnosis (emergency presentation and fast-track referrals among patients with new-onset red flag symptoms), presenting symptoms and pre-diagnostic endoscopy use.
Red-flag symptoms (change in bowel habit, rectal bleeding) were more frequently recorded among patients with rectal cancer with obesity and overweight versus normal weight (65.2% and 65.5% vs 56.8%, respectively). Among colon cancer patients endoscopy during the year pre-diagnosis was used in a greater proportion of patients with obesity versus normal weight (72.8% vs 64.4%, p
Patients with CRC with higher BMI are more likely to be referred urgently and less likely to experience emergency cancer diagnosis than normal weight patients.
by Seo-Yun Choi, Yuri Jang
Perceived neighborhood danger poses significant risks to mental health in later life, yet the underlying psychological mechanisms remain unclear. Given that environmental stressors can compromise sleep health, we conceptualize insomnia symptoms as a potential mediator in the association between perceived neighborhood danger and depressive symptoms. Data from 2,240 adults aged 65 or older from Wave 3 of the National Social Life, Health, and Aging Project (NSHAP) were analyzed. Multivariate analyses showed significant associations of both perceived neighborhood danger and insomnia symptoms with depressive symptoms after controlling for sociodemographic and health covariates. Bootstrap mediation analysis provided supportive evidence for the indirect effect of perceived neighborhood danger on depressive symptoms through insomnia symptoms (B = .04, SE = .01, bias-corrected 95% CI = [.02, .07]), accounting for 25.8% of the total effect. Insomnia symptoms were identified as an important pathway through which perceived neighborhood danger undermines mental health in older adults.by Parya Jangipour Afshar, Vahid Yazdi-Feyzabadi, Zahra Abdolahinia, AliAkbar Haghdoost, Jaason M. Geerts, Reza Goudarzi, Katayoun Tayeri, Babak Eshrati, Hamid Sharifi
BackgroundIntegrating clinical programs and services is a cost-effective approach that can improve health and system outcomes. This review aimed to provide an overview of the benefits and challenges of integrated programs for HIV, hepatitis B and C, and STI services worldwide and provide recommendations for research and practice.
MethodsThis scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched electronic databases PubMed, Scopus, and Web of Science until May 2025 to extract relevant studies. Additionally, we reviewed reputable grey literature sources, such as WHO and UNAIDS, and references from included publications for further relevant articles. Studies that had eligible criteria were included. We applied a narrative approach to report the findings through an inductive approach.
ResultsOut of 19,516 initially identified studies, 118 were selected. The benefits and challenges of integration were classified into six categories: integrated service delivery, medical information and technology, human resources, health outcomes, collaboration and partnerships, and financial/physical resources. The significant benefits of these classifications include improved health outcomes, cost-effectiveness, enhanced efficiency, prevention of transmission, use of comprehensive care, reduction of time for receiving necessary services, increased knowledge and awareness, and improved cooperation. However, integration has some challenges, including the need for sufficient infrastructure, budget, human resources, and the potential for increased stress and work pressure on employees.
ConclusionsPrioritizing health is key to national development, requiring policies and resources for cost-effective patient and community benefits. This scoping review highlights the feasibility and advantages of integrating services for HIV, hepatitis B and C, and STIs. Our findings strongly support policymakers in prioritizing the planning and implementation of these integrated programs. An evidence-informed integration framework is needed to guide these actions effectively.
Acute, chronic, and hard-to-heal wounds pose a growing challenge due to reduced patient quality-of-life, higher cost and increased hospital admissions. Although there is no gold standard for wound care, there is a trend toward simple, outpatient-compatible treatment options. Acellular dermal fish skin derived from Gadus morhua (Atlantic cod) is a promising alternative. This retrospective study evaluated the surgical procedures and outcomes associated with fish-skin graft transplantation for difficult-to-treat wounds. Forty-four patients (33 male and 11 female; mean age: 72.4 years; mean wound area: 84.5 cm2) were treated with acellular fish skin graft. Wound healing was assessed by photographic documentation, confocal microscopy and clinical evaluation. Patient satisfaction was assessed using a structured questionnaire. A positive effect on wound healing, defined as a reduction in wound size, was observed in 88.6% of cases, with complete wound closure in 45.45% of cases. Most patients reported that the procedure was neither painful nor time-intensive; 95% stated that they would opt for treatment again. Fish skin grafting has also shown beneficial outcomes in complex cases, such as in wounds secondary to pyoderma gangrenosum and wounds with exposed bone. Fish skin graft transplantation represents a safe, well-tolerated and effective option for managing chronic wounds as well as challenging postoperative wounds, such as those at anatomically challenging sites.
To explore the lived experiences of children with type 1 diabetes (T1D) and their caregivers in Armenia, a post-Soviet country, and to identify system-level barriers to care from the community perspective.
Qualitative study using a phenomenological design with inductive thematic analysis.
Muratsan Hospital Complex, the primary national referral centre for paediatric endocrinology, Yerevan, Armenia.
12 children aged 13–17 years with T1D and their caregivers, recruited through purposive sampling across 7 of Armenia’s 10 administrative regions.
Five themes emerged from the data: (1) barriers to care, (2) quality of care, (3) perceived control of T1D, (4) knowledge of T1D and (5) government and non-governmental organisation (NGO) support. Participants described unreliable government-supplied glucose strips, geographical barriers rooted in the centralisation of specialist care in the capital, abrupt withdrawal of state support at age 18, reliance on the KATIL NGO to fill gaps in both clinical and psychosocial support and pervasive stigma encountered across family, school and clinical settings.
Children with T1D in Armenia navigate a post-Soviet health system where provisions exist but remain fragmented, limited by centralised care, geographical barriers and variable support. This unique context shapes the relationship and expectations patients have of the healthcare system. Community perspectives are indispensable in these settings, surfacing system-level gaps that conventional data cannot capture. These findings have relevance for other health systems navigating similar structural transitions.
To synthesise existing qualitative and conceptual literature on the implementation, ethical considerations and policy implications of Medical Assistance in Dying for Mental Disorder as a Sole Underlying Medical Condition (MAiD MD-SUMC) in Canada and internationally.
A qualitative evidence synthesis using a thematic analysis approach. Empirical, conceptual and policy papers addressing MAiD for mental disorders were identified through major databases and grey literature. Studies were thematically analysed to identify recurring ethical, clinical and policy themes related to eligibility, assessment and implementation.
Data was extracted from a systematic search of Medline and Embase for peer-reviewed studies published from 1974 onwards, supplemented by relevant policy documents and legal cases.
Studies were included if they examined MAiD MD-SUMC and explored ethical, legal or clinical considerations or provided stakeholder perspectives. Exclusion criteria included studies focusing solely on non-psychiatric conditions or not published in English.
Two independent reviewers screened, extracted and analysed data using an iterative thematic synthesis approach. Key themes were identified through consensus discussions.
The synthesis identified four major themes: (1) Irremediability and treatment resistance—persistent uncertainty regarding when mental disorders can be considered irremediable. (2) Capacity and vulnerability—ongoing debate about assessing capacity amid fluctuating symptoms and social influences. (3) Ethical and policy considerations—divergent interpretations of autonomy, justice and safeguards highlighting the need for standardised criteria. (4) Public and professional perspectives—public and family support for inclusion, although clinician hesitancy exists.
The evidence supports a thoughtful, structured approach to potential implementation of MAiD MD-SUMC in Canada. Future priorities include refining criteria for irremediability, standardising capacity assessments, addressing disorder-specific complexities and strengthening mental health infrastructure. Continued research, engagement and transparent policy dialogue will be essential to ensure that any expansion of MAiD upholds ethical integrity, protects vulnerable persons and maintains public trust.
FreshRSS 