Conectar
by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEFThe aim of this study was to determine how family care is implemented in the care of women with gynaecological cancer from the perspective of health professionals in Finland.
Multiphase convergent mixed-methods research.
This study is based on two datasets collected from one Finnish university hospital. The first dataset was collected from health professionals (n = 20) in one Finnish university hospital inpatient unit in 2023. The second dataset is based on non-participant observational cases (n = 137) of health professionals in the spring of 2024. The quantitative data were analysed using both parametric and non-parametric tests. The qualitative data were analysed using thematic analysis.
The quantitative results of the first and second phases together confirm the gap between the lack of competence and the attitudes of health professionals towards their own communication skills. The qualitative results revealed two main themes: (1) increasing competence towards a more comprehensive patient care process and (2) increasing the sense of safety by sharing timely information between professionals, patients, and relatives.
Family-oriented working and communication between professionals is incidental and individual-dependent. Increased competence and more effective sharing and exchange of care information between professionals can improve the quality of care.
The study was able to identify important areas of family care for professionals to improve their clinical practice.
This study addressed clinical competence, as demonstrated by the family care perspective. Family care is recognised as an important part of the care of gynaecological cancer patients and requires increased competence. This study aims to raise awareness among health professionals and policymakers about the current state of family care in Finland.
This study was prepared and reported according to the STROBE checklist.
No patient or public contribution.
Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.
Multicentre, retrospective, observational, new-user, active-comparator cohort study.
Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.
Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.
Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.
The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.
SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.
We aimed to investigate the learning needs of general practitioners and their preferences as regards the most appropriate teaching session for continuing medical education in wound management. A survey targeting general practitioners at the public health centres in the City of Helsinki. Twenty-seven general practitioners participated in the study. The majority (74.1%) had received education in medical school, 40.7% from wound care nurses, and 40.7% from colleagues. Participants felt the most competent in wound diagnosis (59.3%) and etiological tests (55.6%) and requested training in these topics (74.1% and 74.1%). A peer-led lecture (88.9%) was the most preferred technique, followed by lectures by wound care nurses (55.6%), an educational video (44.4%), a specialist-led lecture (37.0%), an interactive wound product session (29.6%), and digital self-study (29.6%). Wound diagnostics and etiological tests are recognised as crucial topics for continuing medical education. Peer-led lectures were preferred over other techniques; however, we observed varying preferences regarding the most optimal technique. Based on our results, we propose a half-day training including lectures, interactive and hands-on activities, and reflection, led by a peer and a wound care nurse with supporting video materials. Future studies could assess its impact on learning outcomes and wound care quality.
Low anterior resection syndrome (LARS) is a common functional complication after sphincter-preserving surgery for rectal cancer that significantly impairs the quality of life. Current postoperative management strategies are suboptimal, and effective preventive approaches are lacking. This study aims to evaluate the impact of a mobile-based, knowledge-enhanced digital intervention for reducing the incidence of major LARS.
This is a multicentre, open-label, parallel-group, randomised controlled trial to be conducted across three academic medical centres in Korea.
A total of 300 adult patients who underwent low anterior resection or stoma reversal after rectal cancer surgery will be randomly assigned in a 1:1 ratio to the intervention group (mobile digital programme) or the control group (standard educational materials). The digital programme includes daily symptom monitoring, exercise suggestions, dietary recommendations and structured feedback from healthcare providers during clinical visits based on outcomes. The primary outcome is the incidence of major LARS (score ≥30) at 12 months postoperatively. Secondary outcomes include longitudinal changes in LARS score, quality of life (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-Core 30 (C30), EORTC QLQ-Colorectal Cancer 29 (CR29)), European Quality of Life 5 Dimensions Level Version (EQ-5D-5L), patient satisfaction and programme adherence. Statistical analyses will include stratified chi-squared tests and mixed-effects models based on the intention-to-treat principle.
The trial received ethical approval from the Institutional Review Board of the National Cancer Centre, Korea. Written informed consent will be obtained from all participants. The findings will be disseminated through peer-reviewed publications and conference presentations.
by Soha Albeitawi, Mohammad Talal Al-zubi, Anas Aljaiuossi, Murad Shatnawi, Ahlam Al-Kharabsheh, Fadi Sawaqed, Emad Aborajooh, Walid I. Wadi, Randa Mahasneh, Benjamin Rowland Colton, Mohammad AlQudah, Tamara Kufoof, Fida Asali, Ahmed Sheyyab, Monther A. Gharaibeh, Motasem Al-latayfeh, Enas Al-Zayadneh, Eman Badran, Yaser M. Rayyan, Kais Al Balbissi, Raed Al-Taher, Asma Basha, Rola Saqan, Ashraf Omar Oweis, Wafa Taher, Shadi Hamouri
BackgroundClinical preceptors serve as vital educators, so it is essential to enhance their effectiveness by developing a competency-based development program. In this study, we explored the challenges faced by preceptors and students, and measured the educational needs of preceptors, to inform the design of a syllabus for a preceptor development program.
MethodsThis was a sequential multi method study utilizing a structured questionnaire survey and focus group discussions among a representative sample of medical students in their fourth, fifth, and sixth years in addition to preceptors from the six public medical schools in Jordan.
ResultsThematic analysis of focus group discussions revealed six themes: admission policy, training environment, curriculum gaps, trainers and mentorship, learners, and dissemination. The most important training needs documented by preceptors were teaching in the clinical setting, mentoring skills, simulation, assessment in the clinical setting, and providing feedback. Accordingly, a competency-based preliminary syllabus was developed.
ConclusionIt is essential to enrich the skills of preceptors regularly based on a needs assessment. Further long term studies are required to investigate the effectiveness of the proposed syllabus after implementation.
To explore the challenges and opportunities in clinical skills teaching and learning among faculty, final-year medical students and patients at a private medical university in Pakistan, within the context of a low- and middle-income country (LMIC) medical education system.
An exploratory descriptive qualitative design using inductive thematic analysis utilising in-depth interviews and focus group discussions, framed within a metaphorical lens.
A single private-sector tertiary care teaching hospital and affiliated undergraduate medical college in an urban setting in Pakistan.
A total of 48 participants were included in the study: 12 clinical faculty members representing various disciplines and levels of experience, 16 final-year medical students and 10 house officers and 10 patients from adult inpatient wards. Participants were purposively selected to ensure maximum variation in perspectives.
Six key metaphorical themes emerged, each reflecting both the challenges and opportunities within the clinical learning journey: (1) The Safety Harness—simulation as an opportunity for structured, risk-free skill development, yet limited by authenticity; (2) The Underwater Life—the irreplaceable but unpredictable nature of bedside learning in fostering empathy and communication; (3) The Stormy Seas—systemic and cultural barriers such as patient availability, gender constraints and limited faculty resources; (4) The Ship—students navigating self-development amid evolving expectations, digital distractions and shifting motivations; (5) The Engine Room Tools—balancing diverse teaching modalities while seeking optimal time distribution between simulation and bedside learning; and (6) The Guiding Compass—the pivotal role of clinical teachers as mentors and professional exemplars. Triangulated perspectives revealed that while structured simulation and bedside experiences complement one another, significant institutional, ethical and pedagogical challenges persist, many amplified by the realities of resource-limited LMIC settings.
This study underscores the complexities of clinical teaching and learning in an LMIC context, highlighting the need for a balanced, context-sensitive model that integrates simulation with authentic bedside exposure, supported by mentorship and reflective practice. Addressing structural and faculty-related barriers is essential to advancing equitable, patient-centred clinical education in resource-constrained environments.
Prediabetes (PD), defined by impaired glucose tolerance or impaired fasting glucose, represents a growing global health challenge, with a prevalence projected to increase substantially. PD is a critical intervention target because of its high annual progression rate (5–10%) to type 2 diabetes mellitus (T2DM) and elevated cardiovascular disease (CVD) risk. Non-surgical interventions (NSIs), particularly lifestyle modifications (LMs) and pharmacological therapies, are the cornerstone of PD management, demonstrating efficacy and cost efficiency over surgical options. However, despite LM’s ability to reduce T2DM incidence by 40–70% in trials such as the Diabetes Prevention Program, real-world implementation faces barriers, including resource intensity and complex delivery requirements, which increase upfront costs. We aim to review scientific literature reporting on the effectiveness and cost-effectiveness of NSIs for preventing the progression of PD to T2DM among adults.
A comprehensive systematic search will be conducted across major biomedical databases (PubMed, Scopus, Cochrane Library, Web of Science) for records published up to July 2024. We will include studies involving adults diagnosed with PD according to the American Diabetes Association (ADA) or WHO criteria, focusing on LM and pharmacological treatments. Observational and interventional study designs, including economic evaluations, will be considered. Primary outcome: diabetes incidence (ADA or WHO glycaemic criteria). Secondary outcomes: (1) CVD risk factors, (2) health utilities and (3) healthcare cost analyses. The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 guidelines and is registered with PROSPERO (CRD42024561294). Data extraction and quality assessment will be performed by two reviewers, with discrepancies resolved by the consensus of a third reviewer. Data will be narratively synthesised; if the data allow, a meta-analysis will be conducted.
This systematic review was exempt from ethical approval as it involved no collection of individual patient data and posed no confidentiality risks. The findings will be shared via publication in a peer-reviewed journal or presentation at relevant conferences.
CRD42024561294.
FreshRSS 