The objective of this study was to identify risk factors for enema reduction failure and to establish a combined model that integrates deep learning (DL) features and clinical features for predicting surgical intervention in intussusception in children younger than 8 months of age.

A retrospective study with a prospective validation cohort of intussusception.

The retrospective data were collected from two hospitals in south east China between January 2017 and December 2022. The prospective data were collected between January 2023 and July 2024.

A total of 415 intussusception cases in patients younger than 8 months were included in the study.

280 cases collected from Centre 1 were randomly divided into two groups at a 7:3 ratio: the training cohort (n=196) and the internal validation cohort (n=84). 85 cases collected from Centre 2 were designed as external validation cohort. Pretrained DL networks were used to extract deep transfer learning features, with least absolute shrinkage and selection operator regression selecting the non-zero coefficient features. The clinical features were screened by univariate and multivariate logistic regression analyses. We constructed a combined model that integrated the selected two types of features, along with individual clinical and DL models for comparison. Additionally, the combined model was validated in a prospective cohort (n=50) collected from Centre 1.

In the internal and external validation cohorts, the combined model (area under curve (AUC): 0.911 and 0.871, respectively) demonstrated better performance for predicting surgical intervention in intussusception in children younger than 8 months of age than the clinical model (AUC: 0.776 and 0.740, respectively) and the DL model (AUC: 0.828 and 0.793, respectively). In the prospective validation cohort, the combined model also demonstrated impressive performance with an AUC of 0.890.

The combined model, integrating DL and clinical features, demonstrated stable predictive accuracy, suggesting its potential for improving clinical therapeutic strategies for intussusception.

Medication management is a demanding task for family caregivers of older adults, adding to their care burden. The aim was to identify the challenges family caregivers experience in managing medications of older care recipients to obtain caregiver-centred evidence for developing social and health services to meet their needs.

The qualitative data were collected during two consecutive home visits using thematic interviews with a narrative approach during the period of October 2017 to September 2018. The interview data were qualitatively analysed using the framework method with a combination of the inductive and deductive approaches. Human error theory with systems approach and prospective risk management was used as a theoretical framework.

Family caregiving of older adults.

21 officially contracted family caregivers and their older (≥65 years) care recipients using >1 prescription medicine from the capital region of Finland.

Three conceptual models were constructed: (1) to position family caregiving in the public social and healthcare system, (2) to identify challenges and (3) needs for development in medication management prioritised from challenges. Family caregivers were not well integrated as a part of the health system, but left alone to manage the care recipient’s medications. When urgent treatment-related matters arose, caregivers were not able to reach the physician. The major development needs concerned (1) identification of the caregivers as family caregivers in healthcare and community pharmacies, (2) making familiar healthcare professionals accessible, (3) ensuring sufficient customised support for managing medications at home (up-to-date medication list, monitoring and medicines information), (4) more active involvement and communication in the care process and (5) adopting compatible electronic health records between primary and secondary care, and pharmacies and social services.

Family caregiving practices and support services should be developed in cooperation with the caregivers to meet their needs and place the families at the centre of the medication use process. Strengthening the integration of family caregiving to the social and healthcare system is vital, for example, by making easy access to family physician and involving pharmacists more actively in supporting medication management.

Paediatric cervical spine injury (CSI) is uncommon but can have devastating consequences. Many children, however, present to emergency departments (EDs) for the assessment of possible CSI. While imaging can be used to determine the presence of injuries, these tests are not without risks and costs, including exposure to radiation and associated life-time cancer risks. Clinical decision rules (CDRs) to guide imaging decisions exist, although two of the existing rules, the National Emergency X-Radiography Low Risk Criteria and the Canadian C-Spine Rule (CCR), focus on adults and a newly developed paediatric rule from the Pediatric Emergency Care Applied Research Network (PECARN) is yet to be externally validated. This study aims to externally validate these three CDRs in children.

This is a multicentre prospective observational study of children younger than 16 years presenting with possible CSI following blunt trauma to 1 of 14 EDs across Australia, New Zealand and Singapore. Data will be collected on presenting features (history, injury mechanism, physical examination findings) and management (diagnostic imaging, admission, interventions, outcomes). The performance accuracy (sensitivity, specificity, negative and positive predictive values) of three existing CDRs in identifying children with study-defined CSIs and the specific CDR defined outcomes will be determined, along with multiple secondary outcomes including CSI epidemiology, investigations and management of possible CSI.

Ethics approval for the study was received from the Royal Children’s Hospital Melbourne Human Research Ethics Committee in Australia (HREC/69436/RCHM-2020) with additional approvals from the New Zealand Human and Disability Ethics Committee and the SingHealth Centralised Institutional Review Board. Findings will be disseminated through peer-reviewed publications and future management guidelines.

Registration with the Australian New Zealand Clinical Trials Registry prior to the commencement of participant recruitment (ACTRN12621001050842). 50% of expected patients have been enrolled to date.