Conectar
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.
Care provided in people’s own homes (domiciliary care) is an increasingly important part of long-term care. There are various services, including home visits, live-in care and housing with care. Some people directly employ care staff, called personal assistants. Services vary in quality, price and availability, and there is currently little evidence of the value these services provide to the public purse and individuals. This study protocol presents planned research to fill this important gap.
This will be a cross-sectional study based on surveys of care recipients, their unpaid carers as well as formal care providers. In the first half of 2026, we will survey 1850 people accessing domiciliary care either through a homecare agency, a housing with care scheme or by directly employing personal assistants and 400 unpaid carers, all based in England. We will conduct a cost-effectiveness analysis taking a ‘production function’ approach and use quality of life as measured by the Adult Social Care Outcomes Toolkit as the main outcome of interest.
The study received ethical approval from the School of Social Sciences Staff Review Committee at the University of Kent on 20 May 2025 (reference 1195) and the Health Research Authority, London—Camberwell St Giles Research Ethics Committee on 28 October 2025 (reference 25/LO/0652). Implications around consent, data protection and confidentiality, risk and participant payment are discussed. In addition to academic outputs (eg, academic articles, conference presentations), we aim to coproduce news items and blogs with people with lived experience of accessing long-term care and jointly present findings at events aimed at the care sector. Moreover, we will offer participating care providers benchmarking briefs based on our findings.
(1) To explore community health nurses' experiences of implementing trauma-informed care in a general health context to individuals impacted by sexual assault or domestic violence; and (2) to identify essential components of implementing trauma-informed care in general health settings.
A naturalistic inquiry approach was used, incorporating a focus group (n = 4) and a semi-structured interview (n = 1) with community health nurses who implement trauma-informed care in general health services in Victoria, Australia. Data were inductively analysed using reflexive thematic analysis.
Nurse descriptions of implementing trauma-informed care are described across four main themes demonstrating competence in translating theory into trauma-informed care. These nurses recognised what trauma can look like in patients. They were able to identify the essential components of trauma-informed care, determine when trauma-informed care is working, and describe the benefits to clinicians. Themes demonstrate that implementation of trauma-informed care enables recognition of trauma, can help reduce the risk of re-traumatisation (through anticipating and planning interventions to support the unique needs of trauma survivors), can strengthen patient-centred care for trauma survivors, and enhance the experiences of clinicians and survivors alike.
Implementation of trauma-informed care into general health settings has the potential to enhance person-centred care with professionals trained to anticipate, recognise, and respond to trauma. Recommendations from this study include future research on building capacity for all healthcare providers to understand the importance of taking a trauma-informed approach to care, and large-scale evaluation of the impact of trauma-informed care approaches in mainstream health services on trauma responsiveness, patient satisfaction, and staff morale.
This study provides an understanding of the benefits associated with implementing trauma-informed care in generalist settings with important implications for training, practice and research.
There was no involvement of patients in this study; however, one of the authors is a lived-experience researcher in this topic area.
EQUATOR guidelines were followed, using the Standards for Reporting Qualitative Research (SRQR) checklist.
To synthesise evidence on the association between any diagnosed or self-reported mental health problems prior to pregnancy (pre-existing mental health problems) and birth outcomes including preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), neonatal unit (NNU) admission and mode of birth (instrumental birth, planned or unplanned caesarean section).
Systematic searches were conducted in MEDLINE, CINAHL, Embase and PsycINFO in December 2024 for studies examining the association between any pre-existing mental health problems and PTB, LBW, SGA, NNU admission and mode of birth. Only articles published in English were included with no restriction on year of publication. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklists. Random-effects meta-analyses were conducted to pool crude and adjusted ORs (aORs) and risk ratios (aRR) with 95% CIs. ORs and RRs were analysed separately. Between-study heterogeneity was quantified using the I2 statistic.
Of 15 467 records screened, 33 studies met the inclusion criteria. Women with any pre-existing mental health problems had higher odds and risks of adverse birth outcomes, including PTB (aOR 1.41, 95% CI 1.27 to 1.56) (aRR 1.36, 95% CI 1.21 to 1.51), LBW (aOR 1.28, 95% CI 1.22 to 1.33) (aRR 1.32, 95% CI 1.04 to 1.68), SGA (aOR 1.27, 95% CI 1.07 to 1.51) (aRR 1.34, 95% CI 1.19 to 1.51) and NNU admission (aOR 1.44, 95% CI 1.19 to 1.74). Adjusted estimates were based on multivariable models that commonly controlled for maternal age, parity and socio-demographic factors. No consistent associations were observed between pre-existing mental health problems and mode of birth.
Pre-existing mental health problems were associated with increased risks and odds of several adverse birth outcomes. These findings highlight the importance of early identification and targeted support for women with mental health problems before pregnancy to strengthen preconception and maternity care planning.
CRD42023485834.
Growing numbers of clinicians are dealing with mental and behavioral health issues, including burnout, depression, and suicidal ideation. Prevalence of these conditions in pediatric critical-care (PCC) nurses is reported to be as high as 42%–77%.
The purpose of this evidence-based quality improvement project was to implement a cognitive behavioral skills-building (CBSB) program to improve well-being and resiliency in PCC nurses.
The 7-week MINDBODYSTRONG (MBS) program was implemented with two cohorts of neonatal/PCC nurses in a 222-bed academic, tertiary care pediatric hospital, using a virtual platform and offering 1 sequential session per week. Each participant was asked to complete an anonymous baseline and post-program survey that included the following measures: Generalized Anxiety Disorder (GAD-2), Perceived Stress Scale (PSS4), Patient Health Questionnaire (PHQ-2), and a Single Item Measure of Burnout. Post-program surveys also included a MBS program evaluation.
Fifteen RNs registered for and completed the MBS program. 93.3% completed both the baseline and post-program survey. Results demonstrated positive clinical effects across all four mental health measures with large effects noted in the GAD-2 and PSS-4, and small effects noted in the PHQ-2 and the Single Item Measure of Burnout. 100% of participants found MBS helpful and recommended that it be offered to a wider audience.
Implementation of the MBS CBSB program demonstrated clinical effectiveness on measures of anxiety, perceived stress, depression, and burnout in PCC nurses. The program was well received by participants. Strategies for broader implementation should be explored.
To examine trends in the frequency and costs of emergency hospital admissions in acute wards for mental health conditions among children and young people in England between 2012 and 2022 and to assess socioeconomic and geographic disparities in these costs.
Retrospective observational cohort study using routinely collected administrative data.
Secondary care acute wards; analysis includes all National Health Service (NHS) hospital admissions in England.
All emergency hospital admissions in acute wards for individuals aged 5–18 years with a primary or secondary mental health diagnosis recorded between 2012 and 2022. Exclusion criteria included admissions without a mental health diagnosis or outside the defined age range.
Primary outcomes were the annual number and total cost of mental health-related emergency admissions. Secondary outcomes included length of stay, diagnostic categories contributing to cost, and variation by socioeconomic deprivation and geographic location.
Between 2012 and 2022, the total cost of emergency admissions for mental health among children and young people rose markedly, driven by increases in both admission rates and length of stay. Children from the most socioeconomically deprived areas experienced higher admission rates and greater associated costs. Substantial regional variation in the financial burden was also observed. Eating disorders and self-harm were the main diagnostic categories contributing to the rise in costs. Following the COVID-19 pandemic, total admission numbers declined, but overall costs remained high due to a shift in diagnostic mix towards conditions associated with longer hospital stays and higher per-admission costs.
The increasing financial burden of paediatric mental health crises highlights the urgency of addressing upstream drivers of poor mental health. Policies should prioritise early intervention, reduce regional and socioeconomic disparities, and ensure equitable allocation of mental health resources. Further research should explore the effectiveness of community-based alternatives to hospital care.
Remote consultations (video, telephone, text) have become integral to the delivery of primary care and are promoted by government initiatives. While many find these more convenient, they may also discriminate against those with lower digital literacy and present a barrier to empathy by removing some non-verbal communication. The aim of this realist review is to understand how therapeutic empathy can be effectively expressed during remote consultations in general practice across different situations and for different people.
This realist review will follow the methodological framework proposed by Pawson and colleagues, which includes the following five steps: (1) identify existing theories to develop an initial programme theory; (2) systematically search bibliographic databases to identify relevant literature; (3) select, extract and organise data; (4) synthesise evidence to develop context-mechanism-outcome configurations; (5) refine and finalise programme theory. This iterative process will be guided by a Content Expert Group consisting of patients, carers, clinical staff working in general practice and representatives from national stakeholder groups. The final programme theory will inform the development of evidence-based recommendations to help clinical staff working in general practice express empathy during remote consultations.
This review does not require ethics approval. Findings will be disseminated through peer-reviewed journals, national and international conferences and through relevant professional associations and primary care networks in the UK.
CRD420261306014.
Randomised clinical trials (RCTs) are gold standard in evidence-based medicine, but follow-up typically relies on clinic visits and trial-specific data collection. Much of this information overlaps with routinely collected healthcare systems data (HSD), such as electronic health records and national registries. Leveraging HSD for trial follow-up has the potential to reduce cost, time and resource burden. However, concerns remain about data quality and evidence is needed to show that HSD-based outcomes are reported to an equivalent standard to trial-specific data.
The Blood Cancer Clinical Trials Long-term Follow-up Using Integrated Healthcare Systems platform will link data collected from multiple myeloma clinical trials with HSD to create a research database supporting extended follow-up and further methodological and clinical research.
This data-linkage study includes participants from multiple myeloma RCTs conducted by the University of Leeds between 2008 and 2021. NHS (National Health Service) England will link these participants to HSD, including deaths and cancer registrations, systemic anticancer therapy, radiotherapy and Hospital Episode Statistics.
We will compare trial-collected outcomes with those derived from HSD, including mortality, treatment, second cancer incidence and major adverse events. Long-term overall survival will be estimated using national mortality data. HSD-derived demographic and clinical variables will be used to assess population representativeness relative to the wider myeloma population. Time to next treatment will be derived and evaluated as a surrogate for progression-free survival. HSD-derived frailty measures will be examined for prognostic utility, and radiotherapy and hospital records will be analysed to characterise bone-related treatments and skeletal complications.
Ethical approval has been obtained from the East of England–Cambridge Central Research Ethics Committee, with Section251 support from the Health Research Authority on advice from the Confidentiality Advisory Group. Findings will be disseminated through publications, conference presentations and engagement with stakeholders and patient groups.
To explore the long-term communicative experiences of tracheostomised ICU survivors 12 months after discharge; to identify facilitators and barriers to communication with caregivers, family members, and healthcare professionals; to describe coping and communicative adaptation strategies; and to assess perceived quality of life and self-esteem.
This is a qualitative-dominant mixed methods study based on a multicentre Italian sample.
Twenty-three adult patients from several Italian hospitals were interviewed using a semi-structured guide 12 months after discharge. Qualitative data were analysed using reflexive thematic analysis. Quantitative data were collected through the EQ-5D-5L, EQ-VAS, and Visual Analogue Self-Esteem Scale (VASES), and analysed using descriptive statistics to explore patterns of QoL and self-esteem.
Four major themes emerged: (1) A body that speaks no more, reflecting the initial experience of voicelessness and emotional isolation; (2) Finding new ways to be heard, describing adaptive communicative strategies and the supportive role of family; (3) When the voice returns, so does life, highlighting the transformative meaning of regaining one's voice; and (4) Living differently, capturing long-term psychological and social adjustments. Quantitative data confirmed reduced self-esteem and QoL (mean EQ-5D index = 0.61; EQ-VAS = 58.4; VASES = 54.2). Integrated findings revealed that communication impairment remained a determinant of reduced well-being 1 year after discharge.
This is the first Italian study to investigate in depth the communicative trajectories of tracheostomised ICU survivors. Findings highlight the crucial role of voice recovery in emotional adjustment and quality of life, supporting the need for structured, multidisciplinary post-ICU follow-up focused on communication and psychosocial rehabilitation.
These findings support health professionals in developing individualised post-ICU interventions to restore communication, improve QoL, and enhance social reintegration.
COREQ checklist was followed.
No patient or public contribution.
Medical malpractice imposes a substantial clinical and economic burden worldwide. Pressure injuries (PIs) are amongst the most frequently litigated adverse events and represent a major source of preventable patient harm. To characterise the medicolegal landscape of PI-related malpractice, the Westlaw legal database was queried for cases litigated between 1990 and 2024. A total of 590 cases met inclusion criteria, with data extracted from court documents. The mean patient age was 71 years; 53.4% were female and 46.6% male. Nursing homes were the most commonly named defendants (59.8%), followed by hospitals and outpatient surgical practices (37.3%) and individual physicians (14.1%). The mean settlement was $383 099, compared with a mean jury award of $2 100 787. Adverse legal outcomes were strongly associated with allegations of inadequate care, poor clinical outcomes and gross provider negligence. When prevention and timely management fail, the consequences extend beyond patient harm to substantial legal and financial liability. Targeted interventions such as standardised risk assessment, rigorous documentation, staff education, appropriate staffing ratios and institutional accountability may mitigate both PI incidence and litigation risk. Strengthening these measures represents a critical opportunity to improve patient safety whilst reducing medicolegal exposure.
Spinal cord injury (SCI) predisposes patients to pressure injuries (PIs) often requiring surgery. Multiple factors influence postoperative complications and recurrence, though their associations remain unclear. We performed a PRISMA-guided systematic review and meta-analysis to assess predictors of acute postoperative complications and PI recurrence in SCI patients undergoing surgery. PubMed, Scopus and Embase were searched. Studies with ≥ 15 participants were eligible; 24 (n = 2566 subjects) were included, with 15 (n = 1976 subjects) quantitatively synthesized. Risk of bias was assessed with the Newcastle-Ottawa Scale. A random-effects model meta-analysis was performed, and odds ratios (OR) were pooled when > 2 studies were available; otherwise, findings were narratively synthesized. Moderate-quality evidence showed prior flap reconstruction increased complication risk (aOR = 4.98). Low-quality evidence linked diabetes (OR = 1.39) and smoking (OR = 1.35) with complications. Higher recurrence risk was associated with prior flap reconstruction (OR = 1.80) and thoracic injury (OR = 2.21), while cervical injury was protective (OR = 0.37). Prior flap reconstruction resulted as the strongest predictor of complications and significantly increased the odds of recurrence. These findings underscore the importance of a multidisciplinary approach for preventing the first occurrence of flap reconstruction and subsequent procedures.
Psychiatric settings are high-risk environments for violence. Coercive measures (CMs) and security technologies (STs) can be used to ensure safety. However, limited evidence exists on how Italian mental health nurses (MHNs) perceive the appropriateness of such practices and the influencing factors. This study aimed to fill this gap.
Cross-sectional study.
An online survey collected sociodemographic data and validated measures of depression, anxiety, stress, stigma toward mental illness, and humanization of care. The perceived appropriateness of various CMs and STs was rated on a 5-point Likert scale using a validated item set. Data were analyzed using descriptive statistics, bivariate tests, and multilevel mixed-effects linear regression.
A total of 707 MHNs participated in the study. CMs were considered moderately appropriate (mean = 3.56 ± 0.92), with pharmacological restraint and locked-door policies rated as more appropriate than physical restraint. STs were evaluated better (mean = 3.74 ± 0.95), with alarms and closed-circuit television judged more appropriate than body-worn cameras and metal detectors. CMs were considered less appropriate by non-believers (p = 0.009), head nurses (p < 0.001), and those in non-acute settings (p = 0.004), and more appropriate by those in Central Italy (p = 0.036), on daytime shifts (p = 0.042), and with higher stigma (p = 0.012). STs were considered less appropriate by males (p = 0.004), head nurses (p = 0.040), and more experienced MHNs (p < 0.001), and more appropriate by those in Southern Italy (p < 0.001) and in non-acute settings (p < 0.001).
MHNs consider CMs and STs moderately appropriate. Perceptions are influenced by both individual and contextual factors. Targeted training, anti-stigma education, and inclusive policies are needed to ensure ethical and evidence-based safety practices in psychiatric care.
Targeted education and training in mental health nursing, both continuing and post-graduate, are essential to support cultural change among MHNs and ensure the appropriate use of CMs and STs. Integrating anti-stigma initiatives and involving MHNs in policy development can strengthen clinical decision-making and foster safer, more ethical, and person-centred psychiatric care.
To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences.
With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation.
Cross-sectional study.
Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist.
Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences.
Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke.
Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
No patient or public contribution.
by Yaa Abrafi Ankomah, Bright Anneh Awaitey, Moses Monday Omoniyi, Benjamin Asamoah, Obed Kwame Numadzi, Kwofie Robert Amoah, Joel Innocent Goli
BackgroundPregnancy and childbirth increase the risk of pelvic floor muscle damage, leading to conditions such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This makes it imperative to adopt strategies such as pelvic floor muscle exercises (PFMEs) to ensure positive antenatal and postnatal experiences for women. Hence, the study aimed to assess the awareness, knowledge, practices, and beliefs of PFMEs among pregnant women in a Ghanaian setting.
ObjectiveWe assessed the awareness, knowledge, practices and beliefs of PFMEs among pregnant women in a Ghanaian setting.
DesignA cross-sectional descriptive research was conducted, recruiting 134 pregnant women through convenient sampling in selected antenatal clinics in Kumasi metropolis, Ashanti Region.
MethodsThe study adopted the questionnaire regarding pelvic floor muscle training among pregnant women used by Teerayut Temtanakitpaisan, Suvit Bunyavejchevin, Pranom Buppasiri and Chompilas Chongsomcha. Data on the socio-demographic characteristics of the women, their awareness, knowledge, beliefs and practices about PFMEs were recorded.
ResultsMore than half (64.9%) of the respondents were not aware of PFMEs. Subsequent analysis for this work was therefore done for participants who reported being aware (35.1%). Also, the principal sources of information from which the subjects acquired the knowledge of PFME were health-care providers (42.6%) and media outside the hospital (36.2%). With reference to beliefs 80.3% believed that PFME could reduce vaginal trauma and 83.0% believe PFME aids vaginal birth. In terms of PFME practice, 36.2% of the aware women performed PFME regularly.
ConclusionTo ensure pregnant women are well-informed about PFMEs, physiotherapists should work with antenatal care providers to develop comprehensive courses that include detailed information on PFME’s.
Organizational culture and readiness are critical determinants of evidence-based practice (EBP) implementation. The Organizational Culture and Readiness Scale for System-Wide Integration of EBP (OCRSIEP), developed within the ARCC framework, is a validated tool to assess these dimensions, but no Italian version currently exists.
To translate, culturally adapt, and psychometrically validate the OCRSIEP and its short form in Italian.
A validation study was conducted, using exploratory and confirmatory factor analyses to derive and test the underlying model, followed by reliability testing with multiple indices and measurement invariance analyses.
Data were collected from 405 Italian nurses. Factor analyses supported a 19-item, six-factor structure explaining 59.5% of the variance, with a second-order factor indicating an overarching construct. The three-item short form showed strong model fit and explained 67% of the variance. Subscales demonstrated acceptable-to-excellent reliability, and partial scalar invariance was established across public and private facilities.
The Italian OCRSIEP scales are valid and reliable tools to assess organizational readiness for EBP implementation. They can guide leaders, educators, and researchers in monitoring, benchmarking, and advancing EBP–oriented system transformation within the Italian healthcare context.
Kidney transplant recipients are at increased risk of surgical site infections (SSIs) due to procedural complexity and immunosuppression. This retrospective single-centre study examines the influence of BMI on SSI risk and identifies common pathogens. A total of 230 renal transplant patients were included in this analysis 2017 and 2019. All patients received a cephalosporin for prophylaxis, and wound swabs were taken from those who developed SSIs. SSIs occurred in 45 patients (19.6%) and were not significantly associated with age, sex or donor type. The most common organisms were coagulase-negative staphylococci (26.7%), Staphylococcus epidermidis (24.4%), Enterococcus faecalis (22.2%) and Candida albicans (22.2%). SSIs were significantly linked to surgical revision (p < 0.001) and higher BMI (p = 0.027). A BMI ≥ 28.1 was associated with threefold higher odds of SSIs (OR = 3.0; p = 0.001). Each one-unit increase in BMI was associated with a 7.2% increase in the odds of SSI occurrence (OR = 1.072; p = 0.020). Staphylococcus (p = 0.019) and Enterococcus (p = 0.048) infections were more common in patients with BMI > 28.1. Therefore, SSIs are a frequent complication posttransplant and are strongly associated with high BMI. Standard antibiotic regimens may not cover all relevant pathogens in obese patients, underscoring the need for tailored prophylactic strategies.
Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.
Scar outcomes are known to vary by skin tone and race, yet few studies have systematically evaluated these differences using validated tools. To evaluate differences in scar maturation across Fitzpatrick skin types and racial groups from 3 to 12 months postoperatively using the modified Patient and Observer Scar Assessment Scale (POSAS) scale. We conducted a prospective observational study of 40 patients undergoing breast surgery at a single academic centre. All scars were assessed at 3 and 12 months postoperatively using the modified POSAS. Fitzpatrick skin types were categorized into I–II, III–IV, and V–VI, and racial groups included Caucasian, Black, and Hispanic patients. Fitzpatrick Types I–II had the greatest vascularity reduction (–2.06 ± 2.10), while Types V–VI showed the least improvement (–0.80 ± 1.61). Pigmentation increased in Types V–VI (+0.35 ± 1.89) and improved in lighter skin tones. Black and Hispanic patients had significantly lower odds of favourable pigmentation outcomes (p < 0.07). Fitzpatrick Types V–VI also had lower odds of improved scar relief (OR = 0.125, p = 0.034). This study highlights differences in scar maturation across skin tone and racial categories using a standardized scale. These trends underscore the importance of tailoring postoperative scar counselling and interventions to individual patients’ skin types and racial backgrounds.
FreshRSS 