Conectar
This study aimed to systematically delineate the clinical characteristics and identify the key risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) infections in burn patients, thereby informing targeted preventive measures and therapeutic strategies. This retrospective study included 270 burn patients with Staphylococcus aureus (S. aureus) infections at a Chinese centre (2019–2022), comprising 127 MRSA and 143 methicillin-susceptible S. aureus (MSSA) cases. Clinical data were analysed to assess infection profiles, resistance patterns and MRSA risk factors. Amongst the infections, 68.1% (184/270) were caused by multi-drug resistant S. aureus, specifically 47.0% (127/270) by MRSA and 21.1% (57/270) by MSSA. The predominant resistance pattern (penicillin, oxacillin, gentamicin, clindamycin, erythromycin, ciprofloxacin, levofloxacin, tetracycline) accounted for 23.9% (44/184) of multidrug-resistant cases. The overall MRSA detection rate was 47.0% (127/270). Univariate analysis identified multiple factors significantly associated with MRSA infection (p < 0.05). Multivariate analysis identified the use of ≥ 3 types of antibiotics as an independent risk factor for MRSA infection in burn wounds. The detection rate of multi-drug resistant S. aureus (including MRSA) infections in burn wounds is relatively high. A number of variables are the influencing factors for MRSA infections. Medical personnel should adopt infection control measures to block the transmission of multi-drug resistant bacteria (including MRSA).
This study aimed to investigate the incidence and characteristics of nursing-sensitive adverse events (NSAEs) in older adults (≥ 65 years) hospitalised with traumatic injuries, and to explore associations with frailty, demographic factors, injury characteristics and hospital-related factors.
NSAEs were identified through a retrospective medical record review of a prospectively collected cohort.
Patients ≥ 65 years admitted with physical trauma to a Swedish level I trauma centre between 2020 and 2024 were included. NSAEs were identified using a modified trigger tool chart review. Descriptive statistics were used to determine the incidence and characteristics of NSAEs in the whole cohort. Group differences, associations and predictors were examined using exact, non-parametric, or logistic regression methods.
A total of 270 trauma patients ≥ 65 years were included, of whom 25.6% had experienced at least one NSAE. The overall incidence was 38.2 events per 100 admissions, with hospital-acquired infections being the most common type of NSAE (16.7%), followed by overdistended bladder (6.3%) and pressure injuries (5.6%). Frailty and length of hospital stay were associated with an increased likelihood of NSAEs, with hospital length of stay emerging as the strongest predictor in multivariable analysis.
NSAEs are common among older trauma patients and are associated with frailty, injury characteristics and length of stay. Improving early risk identification and ensuring timely preventive nursing care may enhance patient safety in this vulnerable population.
The findings highlight the important role of nursing in the care of older trauma patients and the need for consistent delivery of fundamental nursing care. Strengthening clinical practices that support early identification of high-risk patients and the timely implementation of preventive interventions may improve patient safety and outcomes in this vulnerable population.
This study addresses the knowledge gap regarding NSAEs in older trauma patients, a population with increased vulnerability to adverse outcomes. The findings provide insights into the occurrence and risk factors of NSAEs in this group and highlight the importance of translating risk assessment into effective clinical action. These results may inform clinical practice and support the development of strategies to improve patient safety in trauma care for older adults.
This study was informed by the Standard Elements in Studies of Adverse Events and Medical Error (SESAME). The completed SESAME checklist is provided in the Supporting Information S1.
No patient or public contributions.
To identify the barriers and facilitators to implementing interventions for improving medication adherence in older patients with hypertension.
This review was designed according to the Arksey and O'Malley framework for scoping reviews.
Six electronic databases (PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO) were searched.
This review is written in a consistent format in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
Fifteen studies were included in the final analysis. Barriers and facilitators were mapped to 14 constructs across the four CFIR domains. Barriers mapped to ‘intervention characteristics’ spanned multiple constructs, more than any other domain. Similarly, the most frequently mentioned facilitators were derived from the ‘intervention characteristics’ domain. Overall, the intervention content of the existing studies was not generalisable and accessible, whereas other factors such as family involvement in the ‘process’ were effective in facilitating interventions implementation.
This review identified barriers and facilitators to the implementation of interventions to improve medication adherence in older patients with hypertension. Future research should focus on reducing barriers and reinforcing facilitating factors to ensure improved medication adherence in the older population with hypertension.
This review provides a systematic overview of the barriers and facilitators to the implementation of interventions for improving medication adherence in older patients with hypertension. Whether as a barrier or a facilitator, the ‘intervention characteristics’ are predominant. This review will provide guidance for improving medication adherence in older patients with hypertension.
No Patient or Public Contribution.
To explore the facilitators and barriers to staff providing psychologically safe care in inpatient mental healthcare when restrictive practices are used.
Qualitative descriptive interview study.
Twenty semi-structured interviews were conducted with staff with experience working in inpatient mental healthcare in England. Analysis included principles of framework analysis, informed by the Theoretical Domains Framework.
Access to resources and a safe environment for both patients and staff were recognised as important (environmental context and resources) but access was impacted by competing organisational priorities and expectations (beliefs about capabilities). Participants recognised knowledge gaps in themselves and their colleagues (knowledge). Being able to confidently make decisions about risk was seen as central to the staff role (social/professional role and identity). Collaboration between staff is needed to make positive change and progression towards psychologically safe care (social influences). Empathy and compassion were driving factors in participants trying to use psychologically informed alternatives, but burnout hindered this (emotions).
Ensuring that staff feel supported in their role to implement psychosocial informed alternatives to restrictive practices, as well as providing safe environments for both patients and staff, could support the integration of psychologically safe care on inpatient mental health wards.
Key facilitators and barriers to staff providing psychologically safe care are identified to support practice and improvements to patient care.
Consolidated criteria for reporting qualitative studies (COREQ).
Former patients and members of the public were involved in the conceptualisation of key concepts and design of this study.
The integration of robots into clinical practice requires careful consideration of their alignment with nursing workflows, patient needs, and clinical contexts. This scoping review aimed to support effective technology adoption by systematically identifying and classifying how robots are used in hospital-based nursing practice using standardized nursing terminology.
A scoping review following Arksey and O'Malley's five-stage framework.
A structured search was conducted in five peer-reviewed databases (PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE) for studies published between January 2019 and July 24, 2025. The data were analyzed to classify the types of nursing tasks supported by the robots. Robotic functions were classified into direct care, indirect care, and associated work using standardized nursing terminology, Hurst's framework, and the Clinical Care Classification system to provide a codified and structured analysis of nursing tasks.
A total of 40 studies were included in the final review. Thirty-three focused on direct care with robots, primarily supporting psychological, physiological, and functional care. The key interventions included coping support, emotional support, infection control, and vital sign monitoring. Only one study involved indirect care, and nine focused on associated work, such as errands and cleaning.
Robots are primarily used for direct care, such as emotional support and monitoring, while their role in indirect care—requiring professional judgment including documentation—remains limited. This suggests that future development should prioritize user-centered designs and ethical guidelines aligned with actual clinical needs. Properly implemented robotic technology will serve as a strategic tool to enhance nursing efficiency and improve practice environments amidst chronic workforce shortages.
By categorizing robotic functions using standardized nursing terminology, this review offers a structured understanding of how robots can support nursing. These insights help identify tasks that can be delegated to robots during crises, such as pandemics or staffing shortages, allowing nurses to focus on essential patient care.
by Abdulmujeeb Opeyemi Muhammad-Olodo, Laura Asher
IntroductionHuman papillomavirus (HPV) vaccine prevents over 90% of cervical cancers. In October 2023, Nigeria launched a free HPV vaccination campaign targeting girls aged 9–14 years. Despite removing cost barriers, misinformation about fertility impacts and population control contributed to variable uptake across states. Understanding caregiver decision-making is crucial for improving coverage. This study aimed to explore factors influencing caregivers’ HPV vaccination decisions during Nigeria’s 2023 campaign in Ilorin East Local Government Area, Kwara State.
MethodsA qualitative study using focus group discussions (FGDs) was conducted using purposive and snowball sampling. We recruited 41 caregivers (mean age 47 years; 71% female) of eligible girls from urban and rural communities. Five FGDs were conducted: four with vaccine acceptors (n = 35) and one with decliners (n = 6). Discussions were conducted in Yoruba, audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s reflexive thematic analysis. Ethical approval was obtained from two institutional review boards.
ResultsFour themes emerged from the analysis. Trust operated at multiple levels: institutional (government programmes), interpersonal (healthcare worker competence), and community (religious/traditional leader endorsement). Historical medical mistrust, intensified by COVID-19 experiences, may have manifested as fertility and population control fears. Personal cancer experiences strongly motivated acceptance, whilst concerns about childhood sexuality influenced timing preferences. Despite free provision, barriers included geographic inequities (remote Fulani-Hausa communities were excluded), language barriers (no Hausa translators), school-based delivery gaps, and indirect costs (transport, time). Caregivers recommended house-to-house campaigns, multilingual services, traditional leader engagement, and permanent vaccination centres.
ConclusionFree vaccine provision is necessary but not sufficient to ensure uptake. Successful HPV vaccination requires rebuilding trust through community engagement, addressing historical medical exploitation concerns, and ensuring equitable access. Integrating these findings into Nigeria’s National Programme on Immunisation could improve coverage from current estimates of 54% to targeted 90%, protecting more girls from cervical cancer whilst respecting community values.
by Sevilay Gülesen, Victoria Most, Clara T. Schoeder, Jens Meiler
Viruses such as coronaviruses or filoviruses use their surface glycoproteins (GPs) to attach to the host cell, triggering the fusion of the viral membrane with the endosome membrane. Epitopes on the viral GP are major targets for antibody-mediated recognition and neutralization. During the fusion process, the GP undergoes conformational changes triggered by fluctuations in environmental pH. Structural states are typically classified into three distinct conformations: prefusion, intermediate, and postfusion. These conformations serve as essential templates for prediction of conformational epitopes and structure-based vaccine design. Despite their importance, many viral GP structures remain absent from the Protein Data Bank (PDB). Fortunately, recent breakthroughs in computational structure prediction have greatly enhanced the accuracy and accessibility of protein modeling. In this study, we utilized AlphaFold2-Multimer (AF2-M), version 2.3, to predict various GP structural conformations and observed that the overall frequency of predictions in the postfusion conformation is low. Therefore, we hypothesized that adapting the AF2-M protocol is necessary to enrich for specific conformations, thereby enabling the prediction of both pre- and postfusion conformations. AF2-M requires only the input sequence and internally generates multiple sequence alignments (MSAs) and optional templates before applying its pretrained model weights. We tested the use of template data to enrich pre- or postfusion conformations and demonstrated that our approach significantly increases the prediction frequency of class I fusion protein structures in both conformations, with the template dataset playing a crucial role in guiding modeling towards the intended state. Furthermore, we showed that the lack of correlation between pLDDT and TM-scores suggests that low pLDDT values may obscure the presence of valid alternative conformations.by Jing-le Zhuge, Xi-yong Li, Yong-le Wang, Juan-fen Ma
ObjectiveThis study aimed to comprehensively analyze differentially expressed genes (DEGs) in chondrocytes from patients with knee osteoarthritis (OA) by integrating multiple machine learning algorithms and bioinformatics techniques, to unravel the underlying molecular mechanisms associated with OA chondrocytes, and to provide novel insights for the innovation of clinical therapeutic strategies.
MethodsWe downloaded the GSE117999, GSE114007, GSE169077, GSE246425, and GSE178557 datasets from the public Gene Expression Omnibus (GEO) database as the training set, while GSE57218 served as an independent validation set. To ensure data consistency and comparability, the training set was normalized, and the ComBat algorithm was applied to eliminate batch effects, yielding a merged gene expression dataset. Subsequent differential expression analysis was performed to identify genes with significant changes under disease conditions, followed by enrichment analysis. To more accurately identify genes closely linked to disease characteristics, we independently analyzed the merged dataset using three machine learning algorithms: Lasso regression, random forest, and support vector machine (SVM). The intersection of results from these three methods was used to construct a robust list of disease-related feature genes. These prominent feature genes were validated in the training set and further externally confirmed using the GSE57218 dataset. Additionally, the CIBERSORT algorithm was employed to quantify immune cell infiltration in the normalized gene expression data, selecting infiltration results with high reliability (P Results
DDIT3 and PFKFB3 were significantly downregulated in OA patients. DDIT3 was specifically associated with lipid metabolism, apoptosis, and inflammatory genes (e.g., TNFRSF12A), whereas PFKFB3 was linked to phospholipid synthesis and cell cycle genes (e.g., CHKA). Both genes were associated with core OA-related pathways, including PI3K-Akt and AGE-RAGE. Immune infiltration analysis revealed that DDIT3 was positively correlated with pro-inflammatory mast cells and M1 macrophages, while PFKFB3 was negatively correlated with activated dendritic cells. Collectively, these two genes were associated with immune cell infiltration patterns. The competing endogenous RNA (ceRNA) network analysis indicated that DDIT3 was associated with axes such as LINC00689-miR-769-5p, and PFKFB3 was associated with complex networks like GAS6-AS1-miR-146a-5p.
ConclusionDDIT3 and PFKFB3 are key candidate genes associated with the pathological progression of OA. Their downregulation is correlated with inflammatory and metabolic disturbances in chondrocytes, supporting their potential use as diagnostic biomarkers and therapeutic targets for OA.
by Ying Fei, Ming-Yi Gao, Nan Qiao, Jia Hu, Ling He, Jiao-Li Zhou, Ning-Ning Zheng, Ting-Ting Liu
BackgroundThe effect of fecal microbiota transplantation (FMT) in treating irritable bowel syndrome (IBS) may be attributed to the modulation of CD8 + T cells. This study aims to identify FMT-mediated key genes to explore the underlying mechanism.
MethodsTranscriptomic datasets GSE138297 (colonic biopsies from 8 IBS patients pre- and post-FMT) and GSE134649 (single-cell data from 3 healthy colon tissues) were obtained from GEO during December 2023–December 2024. Key genes were identified by intersecting differentially expressed genes (DEGs) and the most relevant co-expression module derived from weighted correlation network analysis. Functional enrichment, gene set enrichment analysis, immune infiltration profiling via TIMER 2.0, single-cell annotation using PanglaoDB and Seurat, and drug–gene interaction screening from DrugBank were conducted to decipher the regulatory mechanisms.
ResultsTen key genes were identified through integration of DEGs and the MEgreen module. Functional analyses revealed significant involvement in the positive regulation of CD8 + T cells activation. Immune infiltration assessment demonstrated a marked increase in CD8 + T cells abundance post-FMT. Single-cell data indicated predominant expression of LILRB1, P2RY13, CLEC10A, and CLEC12A in dendritic cells, and LILRB1, PIPOX, and CLEC11A were annotated within CD8 + T cells clusters in healthy colonic tissue. Nine (database-derived and speculative) drugs targeting seven key genes were identified, most implicated in the management of IBS symptoms or immunomodulation.
ConclusionAn association between key gene regulation and CD8 + T cell-related immunoregulation is correlated with the therapeutic effect of FMT in IBS.
by Su-jin Kim, Jinhee Kim
BackgroundPost-Acute Sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is characterized by persistent and heterogeneous symptoms that impair health-related quality of life (HRQoL). Although several studies have identified symptom subgroups in Western populations using person-centered approaches, data on Asian populations remain limited.
ObjectivesIn this study, we aimed to classify the symptom profiles of Korean adults with PASC using latent profile analysis (LPA) and examine the differences in HRQoL and associated factors between the identified profiles.
MethodsWe conducted an online survey of 629 adults in Korea who experienced persistent symptoms ≥12 weeks after coronavirus disease (COVID-19) diagnosis. Symptom burden was assessed using the Long COVID Symptom Tool (26 items), and HRQoL was measured using the SF-36 v2®. LPA was performed to identify the symptom subgroups. One-way analysis of variance (ANOVA) and multiple linear regression were used to compare HRQoL across profiles and explore predictors.
ResultsA four-class model provided the best fit: Class 1 (Low symptom, 23.3%), Class 2 (Moderate multisystem, 44.1%), Class 3 (Fatigue/post-exertional malaise dominant, 15.9%), and Class 4 (High multisystem burden, 16.7%). HRQoL differed significantly between classes (p Conclusions
Korean adults with PASC exhibit heterogeneous symptom patterns that substantially affect their HRQoL. The identification of distinct symptom profiles supports the need for tailored interventions, including rehabilitation, cognitive training, and psychological support. Our findings provide crucial evidence for developing Korean population-specific screening tools and management guidelines for PASC.
by Gunnhild Helmsdal, Marnar Fríðheim Kristiansen, Eyðbjørg Klemmentsen Gaard, Barbara Joensen Eysturoy, Pál Weihe, Eina Hansen Eliasen, Maria Skaalum Petersen
BackgroundSix years since the emergence of SARS-CoV-2, the newer variants of the virus continue to have long-term health effects.
ObjectivesThe aim of the study was to investigate persistent symptoms, cognitive impairment, and clinical and paraclinical predictors of long COVID in individuals infected during the Omicron wave.
MethodsWe conducted a clinical case-control study including participants with persistent symptoms up to 13 months after confirmed SARS-CoV-2 Omicron infection (long COVID or LC group) and antibody-verified never-infected controls (NI group).
ResultsA total symptom score based on a 24-item questionnaire was strongly associated with increased odds of long COVID (adjusted odds ratio (aOR) 1.21, 95% CI 1.13–1.30, p Conclusions
One year after Omicron infection, a subset of people continue to experience a substantial symptom burden, particularly fatigue, cognitive impairment, and mental well-being, and a higher frequency of intercurrent infections.
by Natsuhiro Takahashi, Akihiko Fujita, Yuki Azetsu, Akiko Karakawa, Mie Myers, Masamichi Takami, Masahiro Chatani
Bone loss occurs in astronauts during prolonged spaceflight, thus indicating the sensitivity of skeletal homeostasis to altered gravitational environments. Previous studies have shown that microgravity affects osteoclast differentiation and bone resorption, which suggests that osteoclasts possess mechanisms to sense and respond to gravity-generated mechanical forces. For testing of the related mechanisms, hypergravity can be experimentally reproduced with use of a centrifuge. In the present study, osteoclasts derived from mouse bone marrow were subjected to hypergravity under three conditions: 30G exposure using a non-CO2 centrifuge system, and short- or long-term exposure to 3G or 5G using an incubator-compatible centrifuge system. Cytoskeletal organization and resorptive function were assessed using TRAP (tartrate-resistant acid phosphatase) staining, F-actin visualization, and dentin pit assays. In addition, phosphoproteomic analysis was performed after short-term exposure to 5G hypergravity. Hypergravity exposure for as brief as 30 minutes compromised F-actin ring integrity, reduced fluorescence intensity, and promoted nuclear repositioning toward actin rings, whereas tubulin and vinculin localization remained unchanged, and the structural alterations corresponded to attenuated resorption pit formation. Quantitative phosphoproteomic profiling revealed coordinated hypergravity-dependent changes in phosphorylation across multiple cellular modules, including cytoskeletal organization, membrane trafficking, intracellular signaling, and nuclear regulatory pathways. Together, these results indicate that osteoclasts are sensitive to gravity-generated mechanical loading, with hypergravity rapidly modifying F-actin-associated cytoskeleton properties and reprogramming phosphorylation-dependent signaling networks, ultimately attenuating bone-resorptive activity. These findings provide mechanistic insight into how osteoclasts respond to altered gravitational loading conditions and have implications for skeletal adaptation during spaceflight and under altered mechanical loading conditions on Earth.by Sneha Vidyasagar, Kanakamani Jeyaraman, Syeda Farah Zahir, Paul Varghese
ObjectiveThis retrospective study evaluated calcitonin as an adjunct therapy for reducing phantom limb pain (PLP) following lower limb amputation.
MethodThe study included 35 patients who received at least 3 days of calcitonin treatment between January 1, 2017, and December 31, 2023. We collected demographic data and pain ratings (intensity, distress, and interference with activity) before and after calcitonin treatment. Descriptive statistics and paired t-tests analysed the data, with a two-way repeated measures ANOVA used to compare outcomes between patients with and without diabetes. Raw and Standardized mean differences (Cohen’s d) are presented for each measure.
ResultsThe average age of participants was 57.09 years (SD = 13.66), with 40% female. Amputation types were below-knee (65.7%), above-knee (25.7%), and other (8.6%). The main causes of amputation included diabetic foot infection (25.7%), peripheral vascular disease (34.3%), trauma (25.7%), and other (14.3%). Ten participants had diabetes, and 20% had depression.Calcitonin was associated with significant reductions in pain outcomes from pre- to post-intervention (Day 0 to Day 7), with calcitonin given from day 1–3. Mean pain intensity decreased from 6.41 to 5.24 (Cohen’s d = 0.66); p = 0.02), and pain-related distress decreased from 5.85 to 4.81 (Cohen’s d = 0.71; p = 0.014). Perceived pain relief scores increased from 33.69 to 58.21, indicating greater patient-reported pain relief following treatment (Cohen’s d = 0.53; p = 0.035). No significant differences in pain intensity or distress were observed between patients with and without diabetes. Additionally, there was no significant change in the Oral Morphine Equivalent Daily Dose (p = 0.94).
ConclusionIn conclusion, calcitonin significantly reduced perceived pain intensity and pain-related distress scores while increasing perceived pain relief scores (i.e., patients’ reported degree of pain reduction), with similar effects observed in both patients with and without diabetes.
by Wen Lin, Qiong-zhi Shi, Xiang-ru Liao, Yuan Zeng, Xiang-yang Xie, Gang-jian Ji, Yin-ke Li
Burn wound infections are frequently complicated by biofilm-forming and multidrug-resistant pathogens, particularly methicillin-resistant Staphylococcus aureus (MRSA), posing major therapeutic challenges. Antimicrobial peptides (AMPs) such as PL-5 (peceleganan) exhibit broad-spectrum activity but are limited by instability, poor biofilm penetration, and reduced efficacy in complex wound environments. Here, a red-light-responsive, porphyrin-phospholipid (PoP)-containing cationic liposomal system for PL-5, aiming to enhance its antibacterial and antibiofilm performance was developed. Optimized liposomes achieved high encapsulation efficiency (~73%), uniform nanoscale size (~50 nm), narrow polydispersity, and positive surface charge. They demonstrated good storage stability and controlled peptide release under red-light irradiation (635 nm). In vitro, red-light activation significantly enhanced antimicrobial activity against MRSA and methicillin-susceptible S. aureus (MSSA), reducing minimum inhibitory concentration (MIC) values fourfold and accelerating bactericidal kinetics compared with free PL-5 and non-irradiated liposomes. Additionally, red-light-activated liposomes markedly inhibited biofilm formation. These results indicate that light-responsive liposomal delivery enables spatiotemporally controlled release of PL-5, significantly potentiating its antibacterial and antibiofilm efficacy. This approach offers a promising localized treatment strategy for biofilm-associated burn wound infections and a foundation for future translational studies.To develop predictive models for early and overall tuberculosis (TB) deaths for prospective use at TB diagnosis in resource-constrained TB programme settings.
Statewide cohort study using routinely captured secondary data.
With the majority of TB deaths being early (within 2 months), India’s TB programme’s information management system (Ni-kshay)-dependent death prediction models (using age, gender, TB site, previous treatment, microbiological confirmation, HIV, diabetes and bank account availability) are not feasible for prospective use, as few variables are captured at diagnosis. Utilising routinely captured triage variables for severe illness at diagnosis (body mass index, pedal oedema, respiratory rate, oxygen saturation and ability to stand without support) from an ongoing statewide and state-specific differentiated TB care initiative to reduce TB deaths in Tamil Nadu state (southern India, 80 million population with 0.1 million annual notifications), robust models for prospective use were developed.
Adults (aged ≥15 years) with TB (not known to be drug-resistant at diagnosis) that were notified from public facilities of Tamil Nadu from July 2022 to June 2023.
Early and overall (within 12 months of notification) TB deaths. Area under the receiver operating characteristic curve (AUC) was used to assess accuracy of models built using modified Poisson regression.
Among 55 971 adults, the overall death rate was 7.4%, and 67.9% of the deaths were early. In predicting overall deaths, accuracy of the model using all Ni-kshay variables (AUC 0.716 (95% CI 0.707 to 0.725)) was as good as the model using triage variables for severe illness only (AUC 0.701 (95% CI 0.691 to 0.711)). To the latter, adding potentially capturable Ni-kshay variables at diagnosis (age, gender, TB site, previous treatment and microbiological confirmation) significantly improved model accuracy (AUC 0.754 (95% CI 0.745 to 0.763)). Further addition of remaining Ni-kshay variables did not improve accuracy significantly. Death prediction equations were generated for these models.
Simple and easily measurable triage variables for severe illness should be routinely captured at TB diagnosis. A death prediction calculator (http://44.208.93.99/) based on these variables (specifically triage variables for severe illness combined with age, gender, TB site, previous treatment and microbiological confirmation) may be used by Indian states and high TB burden countries seeking scalable, data-driven interventions to reduce TB deaths.
After resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear.
This protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.
Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.
Data collected in the STEPCARE trial that will be analysed include patients’ prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes.
The STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved.
Active learning strategies, including case-based learning (CBL), problem-based learning (PBL) and team-based learning (TBL), have been extensively studied in clinical and basic science education; however, their application in public health programmes remains under-explored. Public health professionals address population-level challenges that differ substantially from clinical practice, making it necessary to evaluate whether these pedagogies are effective in this field. This review examines how CBL, PBL and TBL have been used in public health education and what outcomes have been reported.
Scoping review was conducted using the Levac and Colquhoun framework, an adaptation of Arksey and O’Malley’s approach.
PubMed, Scopus and Google Scholar were searched for studies published between 2000 and 2025. Eligible studies included those involving students enrolled in undergraduate or postgraduate public health programmes, such as bachelor’s or master’s programmes in public health, epidemiology and biostatistics, global health, community medicine or health policy as well as employees working in public health-related fields. Data were extracted using a predefined template capturing study characteristics, population characteristics, student satisfaction and study objectives. All articles were thematically analysed.
Results
Overall, 22 studies were included. Of these, 11 focused on PBL, 2 on CBL, 3 on both CBL and PBL and 6 on TBL. Public health topics addressed included general public health practice (n=5), global health (n=3), health literacy or education (n=3) and occupational health or medicine (n=2); remaining studies covered leadership, nutrition, health behaviour, climate and health, ageing and mental health. Six themes emerged: skill development, real-world relevance, diversity and inclusion, blended learning, innovative approaches and challenges. Key challenges for PBL included cognitive overload and implementation constraints; for CBL, inequitable participation and resource-intensive implementation; and for TBL, increased student time burden and difficulty adapting to complex simulations.
Active learning methods enhance critical thinking and problem-solving in public health education but face implementation barriers, including faculty training requirements and resource constraints. Future research should examine long-term outcomes and the integration of emerging technologies.
To evaluate the feasibility, safety and acceptability of arm crank ergometry cardiopulmonary exercise testing (CPETarm) in patients with chronic limb threatening ischaemia (CLTI).
Prospective feasibility single-arm cohort study.
A tertiary vascular surgery referral centre in Greater Manchester, UK.
Adult inpatients admitted with CLTI and scheduled for non-elective vascular intervention.
Participants underwent bedside CPETarm using an incremental ramp protocol. Cardiopulmonary parameters measured included peak oxygen uptake, anaerobic threshold (AT), ventilatory equivalent for carbon dioxide at AT, peak work rate, oxygen pulse, maximum heart rate and respiratory exchange ratio.
Primary outcomes were feasibility domains including eligibility, recruitment, test completion, safety, practicality, implementation and patient acceptability. Secondary outcomes included the ability to obtain clinically relevant CPET variables for perioperative risk stratification.
60 patients underwent CPETarm. 74% of CLTI inpatients met eligibility criteria and 71% of eligible patients consented to testing. CPETarm was completed to volitional exhaustion by 95% of participants, with anaerobic threshold identified in 68%. No major adverse events occurred during testing or within 24 hours post-test. 90% of CPETarm assessments were completed within 48 hours of the decision to proceed with intervention, without delaying surgery. The procedure was well tolerated and acceptable to patients.
CPETarm is a feasible, safe and acceptable method for preoperative assessment in patients with CLTI who are unsuitable for conventional lower-limb CPET. Further research is required to establish modality-specific thresholds, evaluate prognostic value for postoperative outcomes and evaluate integration into perioperative care pathways.
To examine whether exposure to anti-herpetic drugs (AHDs: acyclovir, valacyclovir, famciclovir) is associated with reduced risk of Alzheimer’s disease (AD) treatment initiation.
Population-based retrospective matched cohort study.
University Groningen community pharmacy database IADB.nl, covering approximately 125 Dutch pharmacies (1994–2024).
262 757 adults aged 50–80 years without prior dementia or AD treatment. Exposed individuals with antiherpetic prescriptions (n=23 887) were matched 1:10 to unexposed controls (n=238 870) by age, sex and calendar time.
AHDs: acyclovir, valacyclovir, famciclovir.
Initiation of AD drug treatment, defined as at least two prescriptions for rivastigmine, donepezil, galantamine or memantine within 1 year. Cox proportional hazards models estimated HRs with 95% CIs, adjusted for comorbidities and medications. Analyses were stratified by period (1994–2018 vs 2019–2024) and drug type.
During follow-up, 2495 participants initiated AD treatment. The age of the participants was 65 (SD 9), and 59% were female. Any AHD exposure was associated with 90% reduced hazard of AD treatment (HR 0.09, 95% CI 0.07 to 0.13, p
AHD exposure was consistently associated with markedly lower risk of AD treatment initiation, with similar findings observed in recent years. These findings support the hypothesis that herpesvirus reactivation may contribute to AD pathogenesis and suggest antiviral therapy could have preventive implications. Confirmation through prospective studies and randomised trials is needed.
FreshRSS 