Conectar
Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) is a promising respiratory support method for avoiding invasive mechanical ventilation in neonatal intensive care units (NICUs). However, its effectiveness and safety have not been widely established through clinical evidence. In this study, we aim to evaluate the feasibility of NIV-NAVA as a primary respiratory support method after birth and its effects on short-term clinical outcomes and long-term neurodevelopment in preterm infants.
In this prospective multicentre observational study, 230 preterm infants will be recruited after birth. This study will include preterm infants born between 27+0 and 31+6 weeks of gestation who require respiratory support within the first 48 hours after birth. NIV-NAVA will be initiated as primary respiratory support either immediately after birth or during the early NICU stay, with settings adjusted according to each infant’s clinical condition. Discontinuation of NIV-NAVA or transition to continuous positive airway pressure or high-flow nasal cannula will be performed based on clinical stability. A less invasive surfactant administration method will be used for infants with respiratory distress syndrome to avoid intubation whenever possible. Infants intubated at birth will be extubated to NIV-NAVA as early as is clinically feasible. Invasive ventilation may be applied if clinical deterioration occurs. The rate of NIV-NAVA failure, duration of non-invasive and invasive ventilation, rate of bronchopulmonary dysplasia and clinical outcomes, such as air leak, patent ductus arteriosus, intraventricular haemorrhage and retinopathy of prematurity, will be measured. The neurodevelopmental outcomes of infants will be assessed for up to 3 years.
The Institutional Review Board (IRB) of Korea University Anam Hospital (2024AN0554) and Seoul National University Bundang Hospital (IRB No. B-2507-984-304) approved this study. The results will be disseminated through scientific conferences and publications.
NCT06786039 registered on 14 January 2025.
Patient safety incidents involving hospitalized children can have significant impacts on both patients and their families. However, previous research has primarily focused on healthcare professionals' perspectives, and studies exploring parents' experiences of patient safety incidents in paediatric settings remain limited. This study aimed to identify parents' experiences of patient safety incidents during their child's hospitalization.
Qualitative study.
Data were collected through individual interviews conducted between August 15 and December 23, 2023. Participants were seven parents who had experienced patient safety incidents while their children were hospitalized in South Korea. Data were analysed using deductive content analysis.
Six themes were identified from parents' experiences, which were organized into three theme clusters: ‘the indelible pain of patient safety incidents,’ ‘limitations of the pediatric healthcare system’ and ‘the need for an integrated management system to strengthen pediatric patient safety.’
This study highlights the importance of healthcare environments that reflect the unique characteristics of paediatric patients and patient safety strategies based on parental engagement, as revealed by the experiences of parents whose children experienced patient safety incidents. Our findings underscore the need to develop and implement paediatric-centered healthcare services, as well as programs and policies aimed at creating safer care environments for hospitalized children.
Enhancing paediatric patient safety requires family-centered care that actively involves parents and promotes effective communication between healthcare professionals and parents. Additionally, transparent disclosure and support systems following patient safety incidents should be strengthened, and parent-engagement–based patient safety programs should be expanded in clinical practice.
The study adheres to the Consolidated criteria for Reporting Qualitative research (COREQ) guidelines.
Parents participated as interview respondents.
Large language model tools are increasingly used in higher education, offering opportunities to support self-directed learning. In nursing education, course-specific AI virtual tutors may provide contextualised support while addressing concerns about content accuracy and alignment; yet empirical evidence remains limited.
This study evaluated the use and perceived impact of a co-designed AI-powered virtual tutor embedded in a graduate-level Master of Nursing (MN) course. We explored how students used the tutor, their perceptions of benefits and limitations, and its influence on learning and engagement.
A pilot study using a mixed-methods explanatory sequential design was employed. The tutor was trained on course-specific materials and integrated into the institutional learning management system. Data included anonymised usage logs and user interactions coded using Bloom's Taxonomy of Educational Objectives, post-course surveys assessing AI self-efficacy, usability, and learning impact, and semi-structured interviews with students and teaching assistants (TAs). Quantitative and qualitative strands were integrated through a joint display.
A total of 651 interactions by individuals within a group of ~120 MN students were logged. Interactions peaked in evenings and around assignment deadlines. Most interactions reflected lower-order education processes, with more application and analysis later in the course. Eleven participants completed surveys; students reported high AI self-efficacy and moderate tutor use. Perceived usefulness was mixed, but most reported the tutor enhanced both lower- and higher-level learning and recommended its future use. Interviews revealed that students valued the tutor's immediacy and course-specific accuracy, while TAs noted efficiency gains. Reported challenges included usability issues, scope limitations, privacy concerns, and risk of over-reliance on the tool.
A co-designed AI virtual tutor was feasible and valued for contextual relevance, though perceived usefulness was variable. Findings support responsible, pedagogically integrated use of AI tutors in graduate nursing education.
To investigate whether micronized acellular dermal matrix (mADM) can be used to treat diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. We retrospectively reviewed 52 patients who underwent bone or joint resection, followed by mADM-assisted reconstruction of diabetes-related or traumatic foot wounds between 2021 and 2024. mADM was applied using sheet-type, paste-type or combined formulations in one- or multi-stage procedures. Wound healing, contour preservation and radiological alignment were assessed. Among the 52 patients (43 with diabetes and 9 with trauma), complete epithelialization was achieved in 48 (mean follow-up: 14.8 months; mean time to wound closure: 5.6 weeks). Four cases showed recurrence or delayed healing and five developed mild early local infection; all were controlled with additional wound care or antibiotics, with no progressive osteomyelitis or graft loss. In 40 radiologically evaluable cases, the toe length and alignment were generally preserved (mean toe length ratio: 91.6% and no angular deformity > 10°). mADM-assisted reconstruction may be useful for treating diabetes-related and traumatic foot wounds with bone defects after bone or joint resection. Its role appears to lie in dead-space management, contour preservation and durable wound coverage, rather than bone replacement.
Balance impairment is a major contributor to falls, reduced mobility and loss of independence in individuals after stroke. Vibration therapy (VT) has been increasingly investigated as a non-invasive intervention to improve postural control and balance in individuals with stroke. However, the reported effects remain inconsistent, and a comprehensive synthesis focusing specifically on balance-related outcomes is lacking. This review aims to evaluate the effectiveness of VT on balance function and to explore the influence of intervention characteristics and outcome constructs.
This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Randomised and non-randomised controlled studies will be systematically identified from major electronic databases. Balance-related outcomes will be categorised using a predefined construct-based framework (eg, static postural control, dynamic balance, limits of stability, functional mobility and gait performance). Meta-analyses will be conducted only within conceptually homogeneous constructs; otherwise, findings will be synthesised narratively. Risk of bias will be assessed using Cochrane Risk of Bias 2 and Risk of Bias in Non-randomised Studies of Interventions. Random-effects models will be applied where appropriate, and meta-regression analyses will be exploratory.
Ethical approval is not required because this study will use only previously published data and will not involve individual-level human participant data. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences.
CRD420251110102.
by Jung-Bin Park, Youmin Shin, Jihun Kim, Yoon Jung Kim, Seung-Bo Lee, Eun-Hee Kim, Joo Whan Kim, Seung-Ki Kim, Hee-Soo Kim, Young-Gon Kim
BackgroundPostoperative cerebrovascular events, including transient ischemic attacks, infarctions, and hemorrhages, remain a significant concern in pediatric patients with Moyamoya disease (MMD)undergoing surgical revascularization. This study aimed to develop an explainable deep learning-based classification model using intraoperative arterial blood pressure (ABP) waveform analysis for postoperative cerebrovascular events in pediatric patients undergoing surgery for MMD, with exploratory analysis of associated waveform-derived physiologic features.
MethodsThis retrospective study included 181 pediatric patients (≤18 years) who underwent revascularization surgery for MMD, with an independent temporal holdout cohort of 79 patients reserved for validation. ABP signals were preprocessed using detrending, pulse segmentation, and normalization, then converted into image representations for deep learning classification. Various convolutional neural network (CNN) models, including ResNet50, ResNet34, DenseNet121, VGG16, and VGG19, were evaluated against Vision Transformer (ViT) architectures. Multiple image transformation methods were tested, and Grad-CAM analysis and statistical comparisons of waveform-derived physiologic features were conducted between patients with and without postoperative cerebrovascular events.
ResultsThe optimal model configuration achieved the best performance using raw pulse waveforms with three consecutive pulses per image. CNN-based models outperformed ViT-based models, with the highest internal classification performance observed using raw pulse waveforms (AUROC = 0.772, SD = 0.070).In the independent temporal validation cohort, the model achieved an AUROC of 0.738 ± 0.011 at the patient level. Grad-CAM visualization highlighted the diastolic runoff phase as a region of interest for classification. Four waveform-derived features related to arterial compliance were significantly associated with postoperative cerebrovascular events (p Conclusions
In this study, CNN-based deep learning models demonstrated the feasibility of predicting postoperative cerebrovascular events from intraoperative ABP waveforms, with diastolic runoff dynamics emerging as a potentially relevant physiologic pattern. These findings are exploratory and require prospective multi-center validation before clinical application.
by Eui Jun Lee, Jae Yun Jung, Do Kyun Kim, Joong Wan Park, Young Ho Kwak
Pediatric emergency triage is a safety-critical task, and recent studies have explored whether artificial intelligence, including language models, can support triage decision-making; however, evidence on fine-tuned open-weight language models remains limited. We conducted a retrospective benchmark study using de-identified triage records from a tertiary pediatric emergency department in Korea collected from January 2020 to April 2025. After exclusions, 74,170 encounters were included. Each encounter was reconstructed into a case-level text sequence from triage-time structured variables and nurse-authored narratives. Qwen3-8B-Base was fine-tuned with Low-Rank Adaptation and Group Relative Policy Optimization using a safety-oriented reward design and was compared with a structured-data XGBoost model on a common evaluable test subset of 14,832 encounters. The fine-tuned model achieved an accuracy of 58.60%, a macro-F1 score of 0.417, and a quadratic weighted kappa of 0.535. Within-one-level agreement was 97.13%, and strict under-triage, defined as true Korean Triage and Acuity Scale levels 1 or 2 predicted as levels 4 or 5, occurred in 0.65% of cases. The structured-data comparator showed higher overall performance, with an accuracy of 69.40%, a macro-F1 score of 0.618, and a quadratic weighted kappa of 0.651. However, the fine-tuned model showed fewer extreme errors and lower strict under-triage in selected high-acuity groups, at the cost of higher over-triage. In this real-world pediatric benchmark, the fine-tuned language model did not surpass the structured-data comparator in overall performance but showed a distinct safety-oriented error profile. These findings support its potential role as a decision-support aid for human triage review rather than an autonomous triage system. External and prospective validation will be necessary before clinical implementation.To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:
A cross-sectional study.
Real time data were collected from an emergency department in a general hospital in Seoul, South Korea, between October 30, 2023 to October 24, 2024. Smartphones, beacons, and smartwatches were used to capture nursing time, physical activity, work-related characteristics, and location transitions across 238 shifts. A multiclass eXtreme Gradient Boosting model was developed and evaluated to classify working shifts (day, evening, night). Shapely Additive exPlanations were applied to identify key contributing features, and shift-specific differences were examined using analysis of variance with post hoc tests.
The model demonstrated strong performance in distinguishing shifts. Key features included the number of admissions, discharges, assigned patients, and both direct and indirect nursing time, all of which varied across shifts. In contrast, location transition patterns were relatively consistent.
Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.
Findings support the development of staffing strategies that account for variation in workload across shifts, with potential to improve efficiency and maintain quality of care.
This study addresses the lack of objective evidence for shift-specific workload differences in emergency nursing. It demonstrates that multidimensional activity data can distinguish workload patterns across shifts. The findings may inform staffing decisions for emergency department nurses and support improvements in workforce management and patient care.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.
People living with concurrent cancer and mental health disorders face heightened vulnerability within healthcare systems that are predominantly organised around biomedical treatment pathways. Although cancer care has advanced substantially, less is known about how these patients experience recognition of their psychological vulnerability, continuity of care, communication and opportunities to participate meaningfully in decisions about treatment.
To explore patients' experiences of living with concurrent cancer and mental health disorders, with particular focus on how they experience being met in their individual needs within oncology care.
This qualitative study used individual semi-structured interviews with 11 adult patients receiving current or recent cancer treatment and living with an existing mental health or neurodevelopmental condition. Participants were recruited purposively from oncology and haematology departments at two Danish hospitals between September 2024 and December 2025. Data were analysed using interpretive qualitative content analysis.
Six interrelated themes were identified: (1) being treated for cancer while mental illness was left outside the room; (2) the hidden work of self-coordination in a fragmented system; (3) communication as care: the need for predictability and adaptation; (4) cancer treatment as a trigger for mental health deterioration; (5) stigma, legitimacy and self-silencing; and (6) relational continuity and being remembered as protective factors. Across themes, participants described a persistent tension between technically competent somatic treatment and insufficient recognition of psychological vulnerability, support needs and relational needs.
Patient-centred oncology care for people living with co-morbidity depends not only on clinical expertise, but on recognition, adapted communication, shared responsibility and relational continuity. The findings suggest that vulnerability is shaped not only by illness itself, but also by how care systems and professional practices are organised.
Small but meaningful changes in everyday oncology practice including psychologically informed communication, continuity of contact persons, explicit recognition of mental health needs and shared coordination of care—may substantially improve safety, participation and patient experience for this population.
Patients living with concurrent cancer and mental health disorders contributed to this study through individual qualitative interviews. Their lived experiences formed the empirical foundation of the study and informed the analysis and interpretation of findings. Patients were not involved in the design of the study or the preparation of the manuscript.
Tanzania carries a dual burden of communicable and non-communicable diseases while remaining vulnerable to emerging pandemics of public health concern. Since its independence in 1961, Tanzania has implemented successive health reforms aimed at expanding access and moving towards universal health coverage (UHC). Despite notable progress, inequities in access, quality and financial protection persist. This review examined how policy evolution (1961–2025) addressed or reinforced inequities and the lessons for building resilience and equity in UHC.
We conducted a scoping review of national health policies, strategies, legislation and the related literature (1961–2025), following Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligible sources included government reports, strategic plans, evaluation reports and peer-reviewed or grey literature. Data were analysed using the Walt and Gilson Policy Triangle and mapped against the WHO Health Systems Building Blocks.
Out of 10 435 records identified, 60 documents met the inclusion criteria. Policy evolution reflected five broad reform episodes, ranging from postindependence centralisation to primary healthcare, structural adjustment and cost-sharing, sector-wide reforms and recent UHC-focused financing strategies. Reforms shifted from politically driven, top-down policies to participatory and evidence-informed approaches. Mapping showed progressive but uneven gains across service delivery, workforce, financing, governance, medicines and information systems. Six thematic shifts towards UHC were identified: fragmented to pooled financing, routine delivery to resilient systems, paper to digital systems, workforce numbers to distribution and skills-mix, state-only to mixed providers and expansion to effective coverage.
Tanzania’s reform trajectory illustrates adaptive progress, but persistent inequities in financing, workforce distribution and service access remain. Achieving equitable and resilient UHC will require stronger domestic financing, governance and primary care, with transferable lessons for other low- and middle-income countries.
‘Spin’ refers to reporting practices that distort the interpretation of results and mislead readers’ impression of the research findings so that the results are viewed in a more favourable light. This systematic review aims to assess the impact of spin on the impressions and/or interpretation of research findings among healthcare professionals and decision makers involved in health-related decision-making and to evaluate interventions/strategies designed to reduce the influence of spin.
This systematic review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE (via Ovid), EMBASE, the Cochrane Library (CENTRAL) and the Education Resources Information Center (ERIC) will be searched from their inceptions to 27 January 2026. Randomised controlled trials evaluating the impact of spin on participants’ impressions and/or interpretation of research findings, as well as trials assessing the effect of interventions/strategies on the recognition and interpretation of spin, will be considered. Study selection, data extraction and risk of bias (RoB) assessment with the Cochrane RoB2 tool will be performed independently by multiple reviewers. Where sufficient data are available, meta-analyses will be conducted.
As this study is based on a review of publicly available literature, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals, presentations at international conferences and press releases.
INPLASY202620006.
Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. In East Asia, the prevalence of macrolide-resistant MP (MRMP) has surged, leading to treatment failures and prolonged illness. While doxycycline is an effective alternative, its use in young children has historically been limited due to concerns about tooth discolouration. This study aims to evaluate the efficacy and safety of doxycycline compared with azithromycin as a first-line treatment for children with pneumonia suspected of MRMP infection.
This is a multicentre, randomised, open-label, parallel-group superiority trial conducted at 14 tertiary hospitals in South Korea. A total of 208 children (aged 3–17 years) with pneumonia and confirmed or suspected MP infection will be randomised 1:1 to receive either doxycycline (4 mg/kg/day in two divided doses for 7–14 days) or azithromycin (10 mg/kg on day 1, then 5 mg/kg on days 2–5) (). Randomisation will be stratified by age (3–7 years vs 8–17 years). A standardised ‘rescue therapy’ protocol ensures patient safety by allowing control group patients to switch to doxycycline if no clinical improvement is observed within 48–72 hours. The primary outcome is the defervescence rate within 72 hours after randomisation. Secondary outcomes include treatment failure rate, length of hospital stay, symptom duration and adverse events. Safety assessment will specifically include tooth discolouration evaluation at Day 28, focused on children aged
This study has been approved by the Institutional Review Boards (IRB) of all participating centres. Written informed consent will be obtained from parents or legal guardians, and assent will be obtained from children aged 7 years and older. Results will be disseminated through peer-reviewed publications and conference presentations.
Management of cryptoglandular anal fistula is characterised by wide variation in diagnostic strategies, surgical techniques and outcome reporting, limiting comparison between studies and hindering evidence-based guideline development. This study aims to implement a standardised core outcome measurement set within a large international observational framework and to evaluate the feasibility of a scalable digitally supported model for global collaborative surgical research.
Cryptoglandular anal fistula treatment is a prospective, international, multicentre observational study comprising two components: a short-term audit capturing clinician-reported outcomes at 3 months and a long-term cohort capturing clinician- and patient-reported outcomes over twelve months. Adults undergoing surgery for primary or recurrent cryptoglandular anal fistula are eligible, excluding non-cryptoglandular aetiologies. Data are collected using secure electronic case report forms and digitally administered patient-reported outcome measures, with paper alternatives available where required. Outcomes are defined according to the Anal Fistula Core Outcome Measurement Set and include clinical and radiological healing, recurrence, complications, reintervention, development of additional fistulas, symptoms, psychological impact of treatment, continence, quality of life and additionally work productivity. The study was designed around a predefined nine-step framework, including multidisciplinary coordination, central ethical approval to support local submissions, artificial intelligence-assisted translation of study materials with native review and implementation of secure digital data capture systems. Based on previous European Society of Coloproctology studies and expected centre volumes, the audit arm aims to include approximately 1000 patients and the cohort arm 500 to 750 patients.
Central ethical approval has been obtained from the Medical Ethics Review Committee of the Maastricht University Medical Centre+ under METC 2024-0374 (audit arm) and METC 2024-0361 (cohort arm) with local approvals or waivers secured in participating countries according to national regulations. Written informed consent is obtained for cohort participation. Results will be disseminated through peer-reviewed publications and international conferences, with the aim of informing future guideline development and supporting patient-centred care in cryptoglandular anal fistula management.
Tinnitus is the perception of sound without an external source, often considered a phantom percept similar to phantom limb sensations, resulting from maladaptive plasticity in the brain. The condition lacks an established biomarker for diagnosis but recent studies have linked it to neural changes. The Tinnitus Detection consortium aims to identify and validate potential biomarkers for tinnitus presence and intensity.
This multicentre prospective case–control study will recruit 560 adults (280 chronic tinnitus; 280 controls). Participants will complete standardised audiological and questionnaire assessments and then undergo 64-channel electroencephalography (and magnetoencephalography at one site) to record event-related potentials during (1) a cortical gap prepulse inhibition of the acoustic startle (GPIAS) paradigm assessing gap-related inhibition of the N1 response and (2) an omission auditory oddball paradigm quantifying mismatch negativity and P300 as candidate biomarkers of tinnitus presence and loudness.
The identification of a biomarker for tinnitus is crucial for developing personalised diagnosis and treatment: There is a need for updated guidelines and more effective tinnitus treatments, as existing interventions often rely on subjective measures. The success of biomarkers like GPIAS and oddball paradigms could significantly improve the reliability of tinnitus diagnosis and treatment, marking a transformative step in the field.
One-third of patients operated for degenerative conditions in the lumbar spine do not report substantial improvement after 12 months. Most previous outcome prediction models are classifiers. This constrains nuances in prediction and use for decision support.
To develop and test models for the prediction of continuous outcome scores and retrieval of similar patients’ outcomes, and to evaluate the models’ fairness.
Norwegian public and private specialist healthcare.
All cases recorded with an elective operation for lumbar disc herniation (LDH, n=18 377) or lumbar spinal stenosis (LSS, n=24 540) in the Norwegian Registry for Spine Surgery from 1 January 2007 to 23 May 2023.
All outcomes were patient-reported 12 months after the operation. The primary outcome was the Oswestry disability index (ODI), modelled on a scale ranging from 0 to 100. Numeric Rating Scale scores (range 0–10) for back and leg pain were secondary outcomes.
We selected 22 predictors recorded preoperatively by patients and clinicians based on Shapley Additive Explanations values. Data were split into 80%/20% training/test samples for LDH and LSS. Six machine learning methods for regression, that is, with a continuous outcome (extreme gradient boosting (XGBoost), Gaussian process regression, gradient boosting regression, artificial neural networks and linear regression), were trained for both conditions using fivefold cross-validation. We report the magnitude and distribution of errors as mean absolute error (MAE) with 95% CIs, and explanatory power as the coefficient of determination (R2). Fairness and calibration were assessed with violin and calibration plots of error. We developed a patient-similarity function that uses a K-nearest neighbour model to retrieve the individual outcomes of the 50 most similar patients and evaluated it by calculating L1 distances (Manhattan distances) across subgroups.
XGBoost regression performed best for both conditions. The models showed good calibration and predicted ODI with MAE 11.32 (95% CI 11.00 to 11.63) and R2 0.27 (95% CI 0.24 to 0.29) for LDH and MAE 12.05 (95% CI 11.76 to 12.32) and R2 0.31 (95% CI 0.28 to 0.34) for LSS. The MAEs for back and leg pain were 2.09 (95% CI 2.04 to 2.15) and 1.95 (95% CI 1.90 to 2.00) for LDH and 2.33 (95% CI 2.28 to 2.38) and 2.13 (95% CI 2.08 to 2.16) for LSS. All models were fair with differences in error between subgroups for sex, age, education level and native language. In the patient-similarity function, distances at baseline were evenly distributed across subgroups.
Our machine learning models predicted continuous outcomes with MAEs close to the SEs of measurements. The models were fair across sociodemographic subgroups. We succeeded in developing a patient-similarity function which supplements the predictions.
Active patient involvement is a core principle of patient-centred care, yet public experiences of medical decision-making in non-Western settings remain underexamined. In South Korea, nationwide evidence on how adults experience, perceive and prefer medical decision-making is limited. This study, therefore, examined Korean adults’ experiences, perceptions and preferences regarding medical decision-making.
A cross-sectional study was conducted between March and April 2025 using online data collection for adults aged 19–59 years and face-to-face interviews for those aged 60 years or older.
This nationwide survey was conducted in South Korea.
A total of 1081 Korean adults were recruited using proportional quotas for sex, age group and region. After excluding withdrawals and invalid responses, 1000 were included (response rate 92.5%).
Overall, 70.4% of respondents reported at least one significant health-related decision in the past 2 years. Although 34.1% reported making their most recent decision independently, a larger proportion preferred collaborative decision-making involving clinicians and/or family members. The clinician’s explanation was the most influential factor (77.4%). Preferences for primary decision-maker varied by clinical context: patient-led decisions were favoured for low-risk interventions such as vaccination (78.5%), whereas physician involvement was preferred for life-threatening illness (86.2%). Communication ratings were highest for presentation of treatment options (mean score 3.56±0.79 on a 5-point scale) and lowest for explanation of potential treatment risks (mean score 3.20±0.89). Participants satisfied with decision outcomes reported higher communication quality (p
Medical decision-making was common, but respondents’ experiences did not always match their preference for collaborative involvement. The findings suggest that strengthening patient-centred care in South Korea will require not only improvements in patient–clinician communication, but also attention to family involvement and structural conditions such as limited consultation time and current reimbursement arrangements.
The use of CT has increased markedly over recent decades, and this trend is also observed among pregnant women. According to current clinical guidelines, fetal radiation exposure below a threshold of 100 to 200 mGy does not appear to increase the risk of congenital malformations. Although the estimated fetal dose from a maternal abdominopelvic CT examination is generally lower than this range, evidence regarding the risks associated with such relatively low-dose diagnostic exposures during pregnancy remains scarce. This study aims to evaluate the association between abdominopelvic CT exposure during the first trimester of pregnancy and the risk of congenital malformations in infants.
We will conduct a nationwide population-based cohort study using the National Health Insurance Service (NHIS) database of South Korea. All live births from 2011 through 2023 will be identified and linked to their mothers. Exposure will be defined as maternal abdominopelvic CT during the first trimester of pregnancy. The primary outcome is major congenital malformations in infants, defined according to the standardised classification system of the European Surveillance of Congenital Anomalies. Secondary outcomes include organ-specific malformations and congenital malformations requiring neonatal intensive care unit admission or corrective surgery. A propensity score-based fine stratification weighting approach will be used to adjust for covariates as potential confounders, and relative risks will be estimated. Prespecified sensitivity analyses will be conducted to assess robustness of the findings.
This study has been approved by the Institutional Review Board of Seoul National University Bundang Hospital (Institutional Review Board No. X-2508-993-902). Informed consent was waived because only anonymised administrative claims data will be used. All analyses will be conducted within the secure NHIS research environment, and no individually identifiable data will be released. The study findings will be disseminated through peer-reviewed publications, scientific conference presentations and communication with regulatory authorities, clinicians and policymakers.
Burn injuries constitute a significant health concern, requiring immediate first aid to mitigate further tissue damage and complications. Most countries worldwide recommend application of 20 min of cool running water (20CRW) within 3 hours of the burn as the cornerstone in burn first aid management. Despite its widespread acceptance and proven benefits in reducing the severity of burns and subsequent interventions, concerns regarding the risk of hypothermia following this intervention persist, representing at least a perceived barrier to the delivery of 20CRW. When it does occur, hypothermia in patients with burns has been associated with higher mortality rates, even after controlling for burn injury severity. Developing an understanding of the incidence of post-burn hypothermia following 20CRW, with a specific focus on potential predictive and/or causative factors, is quintessential.
A retrospective cohort study of all adult and paediatric patients with thermal burn injuries presenting to one of 11 participating Australian or New Zealand hospitals between 1 January 2024 and 31 December 2024 will be conducted. The primary outcome is the incidence of hypothermia in patients with burns following their arrival at the emergency department (ED). Secondary outcomes include influence of burn first aid cooling, risk factors influencing hypothermia, impact of hypothermia on clinical patient outcomes and incidence of hypothermia in patients with burns in non-ED settings.
Ethical approval was granted by the Children’s Health Queensland Human Research Ethics Committee (CHQHREC; HREC Ref No: HREC/25/QCHQ/114285) as well as Health and Disability Ethics Committees, New Zealand (HDEC; Ref No: 2026 EXP 23892). The study findings will be formally disseminated through peer-reviewed journals and conference presentations.
HIV is a major health challenge in Kenya, where prevalence exceeds global averages. Achieving viral suppression depends on consistent adherence to antiretroviral therapy (ART), but individuals in neighbourhoods perceived as disorderly often show low self-efficacy for ART adherence. Despite the importance of neighbourhood dynamics in shaping health behaviours, this area is under-explored in low- and middle-income countries (LMICs), especially regarding transportation barriers. Grounded in Social-Ecological Theory (SET) and the ‘Broken Windows’ Theory (BWT), SET suggests that health outcomes are influenced by environmental factors, while BWT posits visible signs of neighbourhood disorder, such as neglect and decay, can lead to a decline in healthy behaviours, creating an environment conducive to negative health outcomes. This protocol describes a multimodal qualitative study designed to examine how transportation challenges and perceived neighbourhood dynamics influence HIV care among people living with HIV (PLWH). This intersection of structural barriers, neighbourhood dynamics and HIV outcomes in LMIC settings remains under-researched.
This theory-informed multimodal qualitative study, grounded in a Community-Based Participatory Research framework, integrates individual in-depth interviews (IDIs) and community-based photovoice focus group discussions (FGDs). 20 PLWH participated in IDIs accompanied by a survey with validated scales (~ 10 min) assessing perceived neighbourhood disorder, defined as visible physical and social signs of neglect such as crime, vandalism and deteriorated infrastructure, ART adherence self-efficacy, transportation, access to HIV care and fear of crime. An additional 20 PLWH took part in four photovoice FGD sessions. Photovoice FGD sessions were guided by the SHOWeD questioning technique, a structured reflection method that prompts participants to discuss what they see, what is happening, how it relates to their lives, why it exists and what can be done. In each component, participants were purposively sampled and stratified to ensure approximately equal representation by viral suppression status (10 suppressed, 10 unsuppressed), gender (10 women, 10 men) and age group (10 aged 18–24, 10 older than 24). Interviews and photovoice discussions were transcribed and are being analysed thematically using MAXQDA qualitative analysis software. Participant-generated photographs will be analysed alongside accompanying narratives using an integrated visual and textual coding approach combining inductive and theory-informed deductive analysis. Triangulation across interviews and validated survey measures will be conducted.
This study has received ethical approval from the KNH-UoN Ethics and Research Committee (P635/08/2024) and the Stanford University Institutional Review Board (eProtocol #: 77260). Written informed consent was obtained from all participants. Findings will be disseminated through peer-reviewed publications, conference presentations and a photo exhibition.
This study will contribute to an understudied body of research on how socio-environmental conditions influence HIV care engagement in LMICs. Through the integration of individual-focused in-depth interviews and community-centred photovoice FGD sessions, the study captures both personal perceptions and shared neighbourhood realities. Findings will inform interventions and policy adjustments to improve support for PLHIV in disordered environments.
FreshRSS 