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by Michael Kalinoski, Leah Bolden, Qi Wang, R. Adams Dudley, Nathan Mesfin, Nicholas E. Ingraham
IntroductionPersistent critical illness (PerCI) describes patients with prolonged intensive care unit (ICU) dependence after their acute phase of illness and affects 5–20% of the general ICU population. PerCI has been studied in the general ICU cohort, but prevalence and outcomes remain unclear among mechanically ventilated patients with acute hypoxic respiratory failure (AHRF), a high-risk cohort that is more prone to ICU-associated complications. The objective of this study is to quantify PerCI prevalence, identify risk factors for PerCI development, and describe one-year mortality in this population.
MethodsWe conducted a retrospective study of patients with AHRF (PaO2/FiO2 ratio < 300) requiring mechanical ventilation within 72 hours of ICU admission across a 12-hospital health system (2011–2022). PerCI was defined as ICU length of stay ≥ 10 days. The primary outcome was one-year mortality, modeled using a Cox proportional hazards model with PerCI as a time-varying exposure. To identify risk factors for PerCI while accounting for competing early mortality, we used a dual-model approach: logistic regression comparing PerCI to early death (≤ 10-day mortality) and PerCI to early ICU discharge, with factors associated with both models considered robust predictors.
ResultsAmong 10,626 eligible patients, 3,107 (29.2%) met criteria for PerCI. One-year survival was 64.2% in the PerCI group compared to 73.8% in the non-PerCI group. After PerCI onset, mortality risk increased threefold (hazard ratio 3.01; 95% CI 2.72–3.33). Factors consistently associated with PerCI across both models included ARDS, pneumonia, aspiration pneumonitis, heart failure, septic shock, weight loss, surgical admission, and postprocedural respiratory and circulatory failure.
ConclusionNearly one in three mechanically ventilated AHRF patients developed PerCI, far exceeding rates in the general ICU populations and was associated with worse one-year survival. Identifiable clinical risk factors may support earlier goals-of-care conversations and post-ICU care planning in this high-risk population.
by Yankuba Singhateh, Tshepiso Mechele Matoko, Mannini Shaabe, Selloane Amelia Maepe, Francis Dumobong Ngmenasong Abobo, Sarah Waithera Wanyoike
BackgroundLesotho, a lower middle-income country in southern Africa, has historically had relatively high routine immunization coverage over the last three decades. Since 1996, the country has been implementing measles elimination strategies. This manuscript evaluates Lesotho’s performance, from 2011 to 2025, against the World Health Organization’s criteria for measles and rubella elimination.
MethodsWe conducted a retrospective review of Lesotho’s immunization and surveillance data during 2011–2025. This included Lesotho’s annual WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) for routine measles-containing vaccine (MCV) doses; performance in the periodic measles rubella vaccination campaigns and case-based surveillance; and the trends of measles and rubella incidences.
ResultsDuring 2011–2025, MCV1 coverage generally remained ≥90% but failed to reach the 95% elimination target. MCV2 coverage reached 80% in 2011 and 2012 before declining in subsequent years. Lesotho has mostly attained the targets for surveillance performance according to the two principal performance indicators – non-measles febrile rash illness rate and the proportion of districts that report a minimum of one suspected case. From 2011 to 2015, measles incidence stayed below one per 1 million population in Lesotho. However rubella incidence ranged between 33.4 in 2012 to 142.3 in 2014, and declined significantly after MR introduction in 2017.
ConclusionLesotho has made significant progress in measles and rubella elimination efforts. To sustain the gains made, the country should work to strengthen vaccination in the second year of life, reinforce demand generation during preventive campaigns, address population denominator inaccuracies that hinder accurate coverage tracking, and systematically document measles and rubella virus genotypes.
by Thomas Muehlbauer, Reinhold Kliegl, Katharina Borgmann, Sam Limpach, Dirk Krombholz, Stefan Panzer
BackgroundThe effects of training interventions on interlimb balance performance have been recently investigated. However, no comparison was conducted between the impact of a single-mode versus combined training modality, whereby complementary adaptations are suggested for the latter.
ObjectiveThus, we investigated the effects of a single-mode versus combined training modality on interlimb static and dynamic balance performance in soccer players.
MethodsYoung male soccer players (N = 57, Tier level 3) were randomly allocated to a unilateral single-mode balance training (BT) group (n = 17, age: 13.8 ± 1.5 years), a unilateral combined balance and plyometric jump training (BT + PT) group (n = 20, age: 14.1 ± 1.5 years) or an active control (CON) group (n = 20, age: 14.2 ± 1.6 years). Training was conducted in-season for nine weeks (two sessions per week) using the non-dominant leg. Pre- and post-intervention, unipedal balance performance was assessed for both legs under static (unipedal stance only) and dynamic (unipedal stance with continuous leg swing) task conditions while increasing the difficulty level (i.e., gradual reduction of the base of support). Binary (success rate) and metric (center of pressure [CoP] indices, limb symmetry index [LSI]) parameters of postural control were calculated.
ResultsBoth training modalities yielded significant improvements in interlimb static and dynamic postural control, with greater effects in the single-mode BT group for the parameter success rate and in the combined BT + PT group for the CoP-based indices. Significant improvements in the LSI occurred irrespective of the training modality.
ConclusionBoth, single-mode BT (binary outcome) and combined BT + PT (metric outcome) appear to be effective in improving interlimb static and dynamic postural control in young male soccer players. Due to the floor and ceiling effects across outcome domains, it cannot be concluded that one training mode is superior to the other. However, the more in-depth analysis (i.e., CoP-based indices) yields findings in favor of the combined BT + PT and suggests that regulatory processes, in particular, benefit from this training modality.
by Sean Hartmann, Andrew Sharp, Heather Johnston, Michael S. Gee, Susie Y. Huang, Mukesh G. Harisinghani, Jens Gühring, Wei-Ching Lo, Vibhas Deshpande, Oleg S. Pianykh
PurposeHigh complexity of modern processes renders manual process optimization impossible. The main goal of our work was to formalize and to demonstrate the practical efficiency of explainable rule-learning AI in complex process optimization.
Materials and methodsProcess optimization methodology was based on globally-optimal Boolean rule-learning AI models, capable of identifying multiple inefficiency patterns, and supporting process-oriented optimization metrics. To illustrate this approach in real-word environment, the study used 3994 liver and prostate Magnetic Resonance Imaging (MRI) exams performed on five 3T scanners at three outpatient facilities from January 2019 to January 2024. Imaging exams longer than 25 minutes were labeled as requiring optimization, which applied to 35.4% of liver and 52.6% of prostate cases. Rule-learning AI was applied to the MRI scanner log data to discover short and interpretable process optimization rules. The selected Boolean rules were used to implement improved exam protocols, and a permutation test was used to measure the statistical significance of the resulting change in average exam duration.
ResultsN=1000 top rules, identifying the most significant processing delay patterns, were discovered by rule-learning AI from the scanner log data based on F1 score. A smaller set of 20 top rules was selected using the secondary operational impact metric, an estimate of each rule’s impact on average scan duration. A change in liver MRI protocols based on findings from the top rule resulted in a 10.9% reduction of median scan time. The proportion of long liver exams was reduced from 35.4% to 23.9% (p < 0.001). Similar optimizations in prostate protocols were used to add a new scanning sequence, improving exam quality.
ConclusionsGlobally optimal, multi-model rule-learning AI can transform feature-rich device logs into concise, interpretable, and operationally meaningful rules. When combined with domain expertise, this approach can support measurable and sustainable improvements in complex clinical workflows.
by Yeliz Yilmaz Bozok, Nihan Acar, Murat Kemal Atahan, Cem Karaali
BackgroundBreast cancer, the most common malignancy among women, remains a major global public health concern. With the rapid growth of artificial intelligence–based language models, it is essential to evaluate their potential roles in patient education. This study compared ChatGPT and Gemini in responding to patient-oriented questions about breast cancer and its surgical treatment regarding scientific accuracy, clarity, and unnecessary detail.
MethodsForty frequently asked questions were collected from Turkish online sources. Both models were queried under identical conditions on August 13, 2025, and the responses were anonymized for blinded evaluation. Four general surgeons experienced in breast surgery independently assessed each response using a five-point Likert scale across three domains: scientific accuracy, clarity, and unnecessary detail.
ResultsResponse lengths were recorded and compared. ChatGPT achieved significantly higher median scores than Gemini in scientific accuracy [4.75 (3.50–5.00) vs. 4.25 (3.50–5.00); p < 0.001], clarity [4.75 (3.50–5.00) vs. 4.25 (3.25–5.00); p = 0.005], and unnecessary detail [5.00 (5.00–5.00) vs. 4.50 (3.50–5.00); p < 0.001]. The overall median score was 4.83 (4.08–5.00) for ChatGPT and 4.33 (3.50–4.92) for Gemini (p < 0.001). Gemini’s responses were significantly longer (244 ± 84 vs. 170 ± 47 words; p < 0.001).
ConclusionBoth models demonstrated acceptable overall performance. However, ChatGPT’s higher scores and shorter, more focused responses indicate that it may be a more efficient tool for addressing breast cancer–related patient questions. In their current form, these models should not be used for diagnostic or clinical decision-making purposes. AI-generated health information should be used only under expert supervision and for educational or supportive purposes.
by Subhanwita Manna, Bijaya Kumar Mishra, Krishna Kant Yadav, Pratibha Dhiman, Smiteerekha Sahoo, Chiranjeet Mishra, Tanveer Rehman, Ranjan Kumar Prusty, Ragini Kulkarni, Mahadev Bhise, Ashok Kumar Pandey, Ravikumar B. S., Ipsita Pal Bhowmick, Subrata Kumar Palo, Narayana Swamy D. M., Neha Srivastava, Umaer Alam, Reeta Singh, Manish Barvaliya, Vani Kandpal, Barsha Gadapani Pathak, Reema Mukherjee, Sanghamitra Pati
BackgroundUnsafe abortion continues to be a significant cause of avoidable maternal morbidity and mortality especially in low- and middle-income countries. Despite India’s permissive Medical Termination of Pregnancy (MTP) Act, operational gaps continue to prevent women from accessing safe abortion services. There is still a dearth of multi-centric mixed-methods research from rural areas on women’s experiences, provider perspectives, and facility readiness. This study aims to assess the status of comprehensive abortion care (CAC) in rural India by evaluating public-sector facility preparedness, provider experiences, care-seeking pathways, and identifying key barriers and facilitators as per CAC guidelines (2023). The findings will guide the development of a preliminary implementation approach (Model 0+) as well as future phases focused on testing, adaptation, and scale up to strengthen CAC availability, quality, and uptake.
MethodsThis study employs a convergent mixed-methods design across six geographically varied rural blocks in India (North, South, East, West, Central, and Northeast). There will be two participant groups: married women aged 18–49 years who are current, previous, or potential abortion service users, and public health system stakeholders involved in Comprehensive Abortion Care (CAC). A multistage cluster survey will enroll approximately 854 married women per site across 20 clusters. The qualitative component will comprise interviews with women who have had abortions in the last two years and healthcare practitioners, for a total of around 240 interviews. Additionally, 18 focus group discussions with Accredited Social Health Activists and Anganwadi Workers (three per site), will capture frontline worker’s perspectives. Quantitative data will be collected using KoboCollect and analysed using STATA (or an equivalent statistical software). Qualitative data will undergo combined phenomenological and thematic analysis using NVivo or equivalent software.
DiscussionThis study constitutes the first phase of a multi-stage implementation research programme. The study builds upon national CAC guidelines as a foundation of implementation of “Model 0” for abortion care and assesses their functioning in routine public-sector settings. Insights from women, frontline workers, and providers will inform development of a refined implementation strategy (“Model 0+”) grounded in real-world contexts. This evidence-driven approach is expected to yield a practical, acceptable, and scalable model for subsequent piloting, adaptation, and wider health system uptake.
by Kelly L. Penz, Erin Barker, Julie G. Kosteniuk, Norma J. Stewart, Steinunn Jónatansdóttir, Martha L. P. MacLeod
BackgroundThe availability of palliative health care professionals is considered a global concern, especially within rural/remote practice settings. Nurses across all domains of practice are expected to advocate for high-quality hospice, palliative, and end of life (H/P/EOL) care. However, within many rural/remote geographical areas, formal palliative care services are non-existent, leaving generalist nurses to take on this complex responsibility.
MethodsExamining results from a Pan-Canadian cross-sectional survey of rural and remote nurses (N = 3,822), this paper explores a subset (n = 295) of nurses who provided hospice, palliative and/or end of life care as part of their practice. Analyses examined job demands and job resources, predictors of work engagement, and a summary of open-ended responses.
ResultsThe rural and remote nurses who worked in hospice, palliative, and/or end of life care had significantly higher satisfaction with practice demands related to their safety, lower practice resources related to staffing and time, and higher levels of work engagement compared to nurses in other areas. Multiple regression analyses demonstrated that seven variables accounted for 40% of the variance in their work engagement, including: perceived mental health, job satisfaction, interprofessional collaboration, affective organizational commitment, continuance organizational commitment, normative organizational commitment, and lower job demands related to working conditions. Open-ended data revealed that rural nurses felt privileged to provide H/P/EOL care, however, faced barriers related to blurred personal/professional boundaries when dealing with death/dying and lack of access to palliative resources.
ConclusionsThis is the first Canadian national profile of rural and remote nurses who provide hospice, palliative and end of life care and highlights key areas related to their professional quality of life (e.g., work engagement, organizational commitment, job resources/demands). The results of this analysis may inform practice and policy development for health human resource planning and recruitment/retention in hospice, palliative and/or end of life care across rural and remote settings.
This single-centre, randomised, controlled study assessed the wound healing efficacy of adhesive bandages in eligible healthy adults (N = 36) aged 25–55 with Fitzpatrick skin types II and III using a model of laser-induced wounds. Here, we report data for wounds that were randomised to treatment with either a hydrocolloid bandage for multi-day use (BAND-AID Adhesive Bandage Hydroseal), standard of care (SoC) (BAND-AID Adhesive Bandage Tru-Stay Sheer) or an uncovered control. Primary endpoints included the time to complete healing and a composite wound healing score. Hydrocolloid bandage-treated wounds healed twice as fast as the uncovered control or SoC-treated wounds. Median time (days) to complete healing was significantly faster for the hydrocolloid bandage-treated wounds (6.9) versus SoC (11.9) and uncovered control (11.8). Hydrocolloid bandage-treated wounds had significantly better composite wound healing scores versus SoC and versus uncovered control over 2 weeks. At Day 28, cosmesis was better with hydrocolloid bandage treatment (0.3) versus SoC (0.6) and uncovered control (2.1) (change from baseline in a composite scar score; higher score = worse outcome). Multi-day wound occlusion with a hydrocolloid bandage promoted faster healing and improved cosmesis compared with daily SoC dressings or uncovered control.
La mayoría de los niños con dolor en los cartílagos de crecimiento (apofisitis) mejoran con el transcurso del tiempo. No está claro si el tratamiento de la apofisitis afecta a corto plazo al dolor, la capacidad funcional física ni a la participación en el deporte.
No está claro si algún tratamiento es mejor o peor que otro. Los estudios fueron en su mayoría pequeños y tuvieron problemas de diseño. Los estudios no siempre midieron los efectos no deseados del tratamiento, y ninguno midió si algún niño se retiró de los estudios debido a efectos no deseados.
La evidencia es limitada. La mayoría de los estudios incluyeron más niños que niñas e incluyeron niños más activos de media. Los niños a menudo sabían qué tratamiento recibían, lo que podría haber influido en los resultados.
Durante la pubertad, los niños a veces presentan dolor en los cartílagos de crecimiento de las caderas, las rodillas y los pies. Este dolor generalmente es causado por la irritación de los cartílagos de crecimiento debido a un estrés repetido a lo largo del tiempo, más que por un único episodio. El dolor suele ser a corto plazo y tiene un impacto limitado en la vida del niño. Sin embargo, a veces el dolor puede hacer que los niños cojeen, practiquen menos deporte o sean menos activos físicamente. Las afecciones reciben diferentes nombres según la localización del crecimiento, pero se conocen comúnmente como "apofisitis" o "lesiones apofisarias de las extremidades inferiores".
Muchos profesionales de distintas disciplinas sanitarias tratan la apofisitis, incluida la medicina general, la fisioterapia y la podología. Se utilizan muchos tratamientos, incluidos ejercicios, medicamentos, vendajes adhesivos, correctores posturales o dispositivos que se colocan en los zapatos, como ortesis plantar o elevadores de talón. Independientemente del tratamiento, la apofisitis generalmente mejora sola, pero en algunos casos, el dolor puede durar mucho tiempo.
Queríamos averiguar qué tratamientos alivian el dolor de forma efectiva y conocer si son seguros. Queríamos saber qué tratamientos mejoran la actividad física de los niños y su participación en el deporte. También queríamos saber si un tratamiento funcionaba mejor que otro.
Buscamos estudios que evaluaran los diferentes tipos de tratamientos para la apofisitis de las caderas, las rodillas y los pies. No buscamos tratamientos que implicaran cirugía.
Combinamos los resultados de los estudios que evaluaron los mismos tratamientos y utilizaron métodos similares para medir la efectividad. Calificamos el grado de certeza de esta evidencia.
Encontramos 10 estudios con 654 niños cuya edad promedio varió entre 10,3 y 13,3 años. Siete estudios se centraron en el dolor del talón (apofisitis calcánea) y 3 en el dolor frontal de la rodilla (apofisitis por tracción del tubérculo tibial).
Un estudio (23 niños) comparó un medicamento llamado dexametasona con placebo (tratamiento falso). No sabemos con certeza si la dexametasona alivia el dolor, mejora la capacidad funcional física o ayuda a los niños a retornar al deporte a corto plazo. Dos estudios (74 niños) informaron efectos no deseados de los medicamentos, pero la evidencia también fue muy incierta.
Un estudio (21 niños) comparó la dexametasona con la atención habitual. No sabemos con certeza si la dexametasona alivia el dolor, mejora la capacidad funcional física o ayuda a los niños a retornar al deporte a corto plazo. Un estudio (30 niños) informó sobre efectos no deseados, pero la evidencia también fue muy incierta.
Un estudio (22 niños) comparó la cinta kinesiológica con placebo. No sabemos con certeza si la cinta kinesiológica mejora el dolor o la capacidad funcional física a corto plazo. El estudio no informó sobre la participación en el deporte ni los efectos no deseados.
Un estudio (124 niños) comparó ortesis plantares con elevadores de talón. Encontró que probablemente hay poca o ninguna diferencia entre ellos en cuanto al dolor o la capacidad funcional física a corto plazo. El estudio no informó sobre la participación en el deporte. Un estudio (101 niños) informó que no hubo efectos no deseados.
Un estudio (43 niños) comparó la amortiguación del talón con una correa para el talón. No sabemos con certeza si la amortiguación del talón mejora la capacidad funcional física o causa algún efecto no deseado a corto plazo. El estudio no informó sobre la participación en el deporte.
Ninguno de los estudios informó si algún niño se retiró de los estudios debido a efectos no deseados.
En la mayoría de los estudios, los niños y los cuidadores sabían qué tratamientos recibían, lo que podría haber influido en la forma en que notificaron las mejorías. Lo anterior podría afectar la fiabilidad de los resultados.
La apofisitis suele mejorar por sí sola a medida que los niños crecen y se cierran los cartílagos de crecimiento, por lo que es difícil saber si cualquier mejoría se debe al tratamiento o a la recuperación natural por el paso del tiempo.
Hubo muchos más niños que niñas en los estudios, y la mayoría de los participantes eran muy activos físicamente. Es poco probable que la afección repercuta de manera diferente en los niños y las niñas, pero no sabemos con certeza si los hallazgos se pueden aplicar a los niños que son menos activos físicamente.
Finalmente, la mayoría de los estudios solo tuvieron un escaso número de participantes. Esto significa que no podemos confiar en los resultados ni podemos saber si los hallazgos se aplicarían a un grupo más amplio de niños con apofisitis.
La evidencia está actualizada hasta el 4 de enero de 2025.
- Si los dientes dañados se "empastan en bloque" (el material se coloca en una sola capa grande) o con un material de resina compuesta estándar (que se coloca en múltiples capas), es probable que haya poca o ninguna diferencia en el fracaso entre los materiales para empaste (también conocidos como materiales restauradores o para obturación).
- La evidencia más antigua encontró que la amalgama dental (empastes de color plata) podría presentar menos fallos del material que la resina compuesta. Pero este hallazgo se basó en los estudios más antiguos. La resina compuesta moderna es mejor, los dentistas tienen más experiencia en su uso y es probable que haya menos fracasos.
A veces el tejido dental se daña y se pueden formar agujeros (cavidades) en los dientes. Estas cavidades se producen por la caries dental, que es principalmente una enfermedad evitable si las personas mantienen una buena higiene bucodental y reducen el consumo de alimentos y bebidas azucaradas.
Cuando la caries dental provoca un daño permanente, los dentistas pueden rellenar (empastar) la cavidad para restaurar la forma y la función del diente.
Tradicionalmente, las cavidades se llenaban con amalgama. Este material de empaste de color plata (hecho principalmente de estaño, plata y cobre, y mezclado con mercurio líquido) es económico y fácil de usar. Pero ahora se sabe que el mercurio puede ser perjudicial para la salud de las personas y el medio ambiente. En una reunión internacional se acordó reducir (o eliminar) el uso del mercurio, incluso en los empastes dentales. Los materiales de empaste alternativos sin mercurio que se pueden colocar en una única cita dental incluyen:
- resina compuesta: material estándar blanco o del color del diente que se aplica en capas o en bloque.
- cemento de ionoméro de vidrio (GIC): a veces se utiliza como empaste temporal y no es tan resistente en algunas situaciones, por lo que no es adecuado para las superficies de masticación de los dientes.
- GIC modificado con resina (RMGIC): un GIC híbrido, más fuerte que los GIC pero no tan fuerte como el RBC.
- compómeros: alternativa al RMGIC pero más cercano al material de resina compuesta que a los GIC.
La resina compuesta, el RMGIC y los compómeros utilizan un sistema adhesivo para fijar el material a los dientes y necesitan fotocurado para endurecer el material. Con el GIC no son necesarios.
Quisimos averiguar lo siguiente:
- los beneficios de un material de empaste en comparación con otro para reducir la pérdida del diente (porque el empaste ha fallado), el fracaso (cuando el empaste no funciona según lo previsto), el tiempo transcurrido hasta la aparición de problemas y sensibilidad dental tras la intervención.
- si un material de empaste es más rentable que otro.
Buscamos revisiones sistemáticas que analizaran los materiales utilizados para los empastes dentales en las muelas permanentes de las personas. Estas revisiones recopilan toda la evidencia disponible a partir de los estudios publicados y analizan sus resultados. Resumimos los resultados de las revisiones y calificamos la confianza (según factores como los métodos y los tamaños las revisiones o los estudios) en la evidencia que proporcionaron.
También buscamos estudios económicos acerca de la relación entre el coste y la efectividad de estos materiales.
Encontramos 14 revisiones con 57 estudios. Los estudios se realizaron entre 1980 y 2023; 1 estudio tuvo un seguimiento de 10 años, pero en general el seguimiento fue mucho más corto. Algunas revisiones no informaron de los resultados de nuestros desenlaces clave, y a veces se incluyeron los mismos estudios en más de una revisión. Priorizamos la evidencia de 6 revisiones, con 25 estudios únicos.
Encontramos 7 estudios acerca de la relación entre el coste y la efectividad.
No encontramos revisiones con evidencia sobre la pérdida de dientes ni sobre el tiempo transcurrido hasta el fracaso.
- Aunque los empastes de amalgama podrían dar lugar a menos fracasos que los empastes con resina compuesta (8 estudios, 3486 empastes), los estudios comenzaron a finales de los años noventa. Las resinas compuestas y la experiencia de los dentistas al utilizarlas han mejorado desde entonces. Hoy en día la probabilidad de fracaso con la resina compuesta es del 5% (frente al 15% en los estudios más antiguos). Esto significa que la evidencia más antigua que compara la amalgama con la resina compuesta tiene una utilidad limitada en la práctica clínica actual.
- Probablemente no haya diferencias entre resina compuesta en bloque y resina compuesta estándar para reducir los fracasos (7 estudios, 511 empastes). Es probable que la mayoría de las personas no experimenten sensibilidad dental después del uso de cualquiera de los dos tipos de material de resina compuesta (5 estudios, 510 empastes).
- Es posible que no haya diferencias entre la resina compuesta estándar y el GIC en la reducción de los fracasos (1 estudio, 60 empastes) ni en la sensibilidad dental (4 estudios, 311 empastes). El RMGIC podría tener más probabilidades de reducir los fracasos que el GIC (1 estudio, 50 o 38 empastes). Encontramos revisiones que compararon el GIC con la amalgama y el compómero, pero no informaron sobre los fracasos ni la sensibilidad posoperatoria.
- La mayoría de los estudios económicos no establecieron conclusiones generales acerca de la relación coste-efectividad de ninguno de los materiales. Un estudio económico encontró que los empastes con amalgama probablemente duraran más y fueran más rentables que los empastes con resina compuesta, aunque esta conclusión se basó en un estudio más antiguo (de finales de los años noventa).
La mayoría de revisiones no cumplieron con los estándares más altos. Consideramos que solo 2 revisiones estaban bien realizadas. Sin embargo, la mayoría de las revisiones presentaron resultados muy similares, incluso cuando incluyeron estudios diferentes.
Tenemos menos confianza en la evidencia sobre el GIC y el RMGIC ya que los estudios fueron, por lo general, de pequeño tamaño y con pocos participantes.
La evidencia está actualizada hasta abril de 2025.
Osteoporosis is a chronic skeletal condition that significantly affects daily life and may benefit from adequate self-care. The Middle-Range Theory of Self-Care of Chronic Illness conceptualizes self-care as a naturalistic process encompassing maintenance, monitoring, and management, also shaped by contextual and cultural factors. Despite this theoretical framework, limited evidence exists on how people with osteoporosis conceptualize and enact self-care in different cultural contexts. Italy and Spain provide comparable yet distinct settings for exploring cultural influences on self-care practices. This study aims to explore and compare self-care behaviors among Italian and Spanish people with osteoporosis.
A cross-national qualitative study was conducted using an Automatic Analysis of Textual Data approach within the Exploratory Multidimensional Data Analysis framework.
Forty people with osteoporosis (38 women and 2 men; mean age 68.6 years, SD = 5.74) were recruited, equally distributed between Italy (n = 20) and Spain (n = 20). Data were analyzed using Labbé's intertextual distance and correspondence analysis to examine lexical similarities, differences, and semantic structures of self-care narratives.
Although moderate intra-national lexical similarity was observed within each national group, substantial inter-national differences emerged between Italian and Spanish participants in the discursive construction of self-care. Italian participants described self-care as a medically mediated and system-oriented process, closely linked to professional guidance, diagnostic procedures, and prescribed treatments. In contrast, Spanish participants framed self-care as embodied, routine-based, and emotionally expressive, grounded in daily practices and bodily awareness. These findings indicate that participants relied on distinct cultural and epistemic models when interpreting and organizing self-care experiences.
This study highlights clear cross-cultural differences in how people with osteoporosis narrate and conceptualize self-care. Methodologically, it illustrates the potential of multidimensional analysis to support systematic and transparent comparison of qualitative datasets. The findings are consistent with the Middle-Range Theory of Self-Care and suggest that greater attention to cultural contexts may inform the development of self-care interventions that are more responsive to individuals' lived experiences.
Recognizing how cultural contexts influence how people with osteoporosis understand and practise self-care may help nurses tailor communication and educational support to individuals' everyday experiences, supporting more responsive and culturally sensitive care.
Due to the increased survival and stable prevalence rates of preterm birth, every clinician, regardless of the patient population or practice setting, has cared for someone born preterm. Unfortunately, most healthcare teams fail to consider preterm birth as a risk factor to adult health, missing a critical opportunity to mitigate risk in this vulnerable population. The purpose of the study was to explore the health status and health experience of adults born preterm with comparisons between birth year cohorts and gestational age categories.
The study utilized a cross-sectional, quantitative descriptive comparative design, augmented by qualitative analysis of open-ended questions.
The health status and health experience survey was developed in collaboration with leaders of an advocacy group for adults born preterm and based on the available research. Convenience, snowball sampling among members of the advocacy network and other preterm birth groups provided an international sample of participants (N = 80).
Chronic conditions or symptoms, representing health status, were reported by 85.7% of participants, with 75% of those participants taking medications for the condition. Participants born less than 32 weeks of gestation reported experiencing health conditions significantly more than those born at later gestations (91.8% vs. 62.5%, p = 0.008); there was no difference in birth year cohort. The most commonly reported conditions were respiratory, mental health, neurodevelopmental, and musculoskeletal. Two-thirds of participants reported never being asked about preterm birth history by healthcare teams. Healthcare experiences were described as ambivalent or dismissive among those who chose to disclose preterm birth status to providers.
Chronic and comorbid conditions associated with preterm birth are common among adults born preterm. These conditions are responsive to prevention and mitigation strategies and, as such, failure to identify adults born preterm as a population susceptible to chronic health conditions results in unidentified, unmanaged risk.
Risk screening for pre-eclampsia relies on accurate gestational age assessment, but routine access to ultrasound-based gestational dating remains challenging in many low- and middle-income countries. As part of the formative work for the ‘Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening’ (PEARLS) platform, we aim to validate and implement an artificial intelligence (AI)-based algorithm for estimation of gestational age, using blind sweeps done with a handheld ultrasound device. This study protocol outlines the accuracy cohort for AI-based gestational age estimation in participating facilities in Ghana, Kenya and South Africa.
This multicountry prospective cohort study will recruit 969 pregnant women at 13 health facilities across Kenya, Ghana and South Africa. The eligible population is pregnant women presenting for antenatal visits from 11+0 to 13+6 weeks’ gestation. Eligible women will have a gestational age assessment by a trained sonographer using fetal biometry (reference standard), followed by gestational age estimation conducted by a trained midwife using the AI-based Intelligent Ultrasound ScanNav FetalCheck system (experimental). Both conventional and AI-based gestational age scans will be conducted with the General Electric VScan Air platform. Women will return for a second visit between 14+0 and 27+6 weeks’ gestation (week of visit is randomly selected) for an assessment with both conventional and AI-based ultrasound. The primary objective is to determine the accuracy and precision of gestational age estimation using an AI ultrasound system in first and second trimesters, as compared with gestational age estimation using crown-rump length measurement by conventional ultrasound in first trimester (11+0 to 13+6 weeks’).
This study has received or sought ethics approval from the following entities: Australia: University of Melbourne, Office of Research Ethics and Integrity (Reference Number: 2024–28489-49438-3) and the Alfred Hospital Ethics Committee (Reference: Project 727/23); Ghana: Ghana Health Service Ethics Review Committee (GHS-ERC Number 002/01/24); Kenya: Kenyatta National Hospital, University of Nairobi ERC (Ref: KNH-ERC/01/MISC/20); South Africa: University of Cape Town, Faculty of Health Science, Human Research Ethics Committee (HREC Ref: 138/2024). Key findings will be disseminated to research teams to inform future scale-up of AI-based pregnancy dating and pre-eclampsia risk screening. Findings from this pilot work will be published in peer-reviewed open-access journals, conferences and meetings to maximise reach of our findings.
To describe antibacterial consumption (ABC) in four paediatric inpatient facilities in Sri Lanka in 2023.
Descriptive cross-sectional study, adapted from the WHO Global Antimicrobial Resistance and Use Surveillance System methodology.
Paediatric inpatient facilities in two tertiary and two secondary care government hospitals located across three provinces.
Data on antibacterials for systemic use, J01 in the Anatomical Therapeutic Chemical (ATC) classification issued to these paediatric inpatient facilities in 2023 by their respective hospital pharmacies.
(1) ABC at ATC third and fifth levels expressed as defined daily doses (DDDs)/100 admissions, (2) ABC as per WHO ‘Access, Watch and Reserve’ category, (3) choice of antibacterials within a class, (4) DU 75% for oral and parenteral dosage forms, (5) quality indicators such as amoxicillin index and broad:narrow spectrum ratio.
In 2023, total antibacterial (J01) consumption across the four paediatric inpatient facilities was 94.49 DDDs/100 admissions. Together, non-penicillin beta-lactams, penicillins and macrolides/lincosamides/streptogramins accounted for 90–98%. Co-amoxiclav was the most consumed antibacterial, and six agents (co-amoxiclav, cefotaxime, clarithromycin, azithromycin, cefuroxime and meropenem) collectively accounted for 70–90%. Aminoglycosides, tetracyclines, sulfonamides and trimethoprim, and quinolones contributed minimally. Access and Watch group antibacterials accounted for 34 and 65%. Quality indicators demonstrated disproportionately higher use of broad-spectrum and Watch group antibacterials.
High use of broad-spectrum and Watch-group antibacterials was observed across the four paediatric inpatient facilities. The findings highlight targets for antibacterial stewardship programmes and demonstrate the feasibility of ABC surveillance in Sri Lanka.
This study examined social determinants and structural barriers to lung cancer outcomes in Kern and Fresno counties, California, and co-developed a multilevel intervention strategy informed by community perspectives.
Engaging stakeholders through group model building (GMB) to elicit their knowledge to build a system dynamics (SD) simulation model for intervention strategy design.
We identified and trained four community members from two community-based organisations in Central Valley, California, to help recruit GMB participants. 14 community members representing patient advocacy organisations, cancer survivors, clinicians, caregivers, public health professionals, medical interpreters, housing, agriculture, sanitation, healthcare payer organisations and local policymaking sectors were recruited.
The GMB protocol consisted of two in-person and four virtual workshops from 22 August to 11 November 2024. The SD simulation model was built with iSee System’s Stella Architect SD modelling software (V.4.0).
The 181 variables suggested by the GMB workshop participants were categorised into 3 themes and 13 subthemes, which shaped the system boundary and model structure. 7 of the 16 intervention scenarios tested showed a cumulative reduction in the at-risk population and increases in screening, diagnoses, treatment and cancer-free survival. Participants selected a multilevel strategy focused on expanding public health and insurance education and advocating for air pollution-related screening within existing protocols.
Community engagement is essential for understanding lung cancer disparities and designing practical multilevel interventions. Scenario testing enables informed planning to improve long-term population health outcomes.
Type 2 diabetes (T2DM) and cognitive impairment are common long-term chronic conditions affecting older people in hospital. Cognitive impairment can complicate glucose monitoring and lead to diabetes-related emergencies in T2DM. Traditionally, point of care test measurements of capillary blood glucose are conducted in-hospital for T2DM while continuous glucose monitoring (CGM) is not widely used.
To understand the feasibility, acceptability and tolerability of using CGM in older inpatients with T2DM and cognitive impairment.
32 older people (mean age=78.7±6.7 years) with comorbid T2DM and cognitive impairment (Abbreviated Mini-Mental Test ≤8/10 and Mini-Addenbrooke’s Cognitive Examination ≤22/30) were recruited within a tertiary care hospital in the UK. All participants were naive to CGM and were asked to wear blinded Dexcom G7 sensors for up to 10 days. Participants were asked about feasibility, acceptability and tolerability questions at the point of sensor removal.
29 participants (96%) reported no pain during CGM fitting. All participants (100%) agreed that they did not notice wearing the sensor, and it did not affect their day-to-day hospital activities. All participants (100%) found it ‘very easy’ or ‘easy’ to have the sensor fitted and wearing it for 10 days, with 27 participants (90%) finding CGM convenient. 17 participants (57%) reported favourable perceptions of the subcutaneous sensor sensation.
CGM use in older inpatients with T2DM and cognitive impairment is highly feasible and acceptable for patients. Future studies and trials are now needed to evaluate the clinical use of CGM for glucose monitoring in hospitalised or community-dwelling older individuals with T2DM and cognitive impairment.
Life expectancy for people with type 1 diabetes has increased due to improved treatment of diabetes and its comorbidities, allowing many to reach old age. Still, we lack knowledge of how individuals with type 1 diabetes age. On one hand, those who reach older age can be considered survivors, but on the other hand their long-standing diabetes might still exhibit negative impacts on their health and functional ability. Healthy ageing is the WHO’s priority for this decade. The focus has shifted from chronological age to functional ability, which reflects the ability of individuals to perform meaningful activities. Functional ability is shaped by intrinsic capacity, the environment and their interaction. Intrinsic capacity encompasses five main domains: cognition, vitality, sensory function, locomotion and psychological domain. This observational study aims to assess how this vulnerable group of individuals with type 1 diabetes age and to identify factors that contribute to their healthy ageing, intrinsic capacity and its domains.
The FinnDiane LifeOne Study is a prospective observational cohort study. We aim to recruit a minimum of 300 individuals with type 1 diabetes from the FinnDiane Study, aged >65 and a minimum of 100 matched controls without insulin-dependent diabetes. The cohort will be comprehensively characterised, including clinical assessment, laboratory tests, questionnaires and a geriatric assessment of different aspects of functioning ability, with 5 years intervals. We will compare the individuals with type 1 diabetes to their matched controls. For those with type 1 diabetes, we will further assess which factors from the FinnDiane baseline and trajectories during follow-up predict healthy ageing in above 65-year-olds.
The LifeOne Study protocol is approved by the Ethics Committee of HUS Helsinki University Hospital (HUS/4387/2023) and the study adheres to the Declaration of Helsinki. Written informed consent is obtained from each participant. Findings will be published in international peer-reviewed journals with an open access choice.
Floods and heatwaves are becoming more frequent and intense and can disrupt routine maternal and child health (MCH) services. Previous reviews have not systematically examined how context and mechanisms may shape adaptation outcomes. This realist-informed systematic review examines how, why and under what conditions interventions support access to, utilisation of and continuity of routine MCH services during flood and heat events.
The search strategy was developed by integrating terms from 17 related reviews, refined with the author team and checked by an experienced London School of Hygiene & Tropical Medicine librarian. The initial database search was conducted on 16 May 2025 and the search was updated on 30 April 2026. Eight databases were searched: Web of Science, Ovid MEDLINE, EMBASE, Global Health, EconLit, GreenFILE, CINAHL and ProQuest Environmental Science & Public Policy. Records published between January 2000 and April 2026 were eligible. Search results were imported into EndNote and deduplicated. Title-and-abstract screening and full-text assessment were conducted independently by two reviewers for the initial search and are ongoing for the updated search, with ASReview being used to prioritise records during title-and-abstract screening. Data extraction across the full review evidence base remains ongoing using a structured template covering study context, intervention characteristics, mechanisms, outcomes, costs and implementation conditions. Study settings will be classified by country income group, health system context and Köppen–Geiger climate zone to compare evidence across settings and, where appropriate, to identify possible climate analogues for exploratory, context-specific assessment. Climate-zone similarity will not be used to infer intervention transferability or future effectiveness. The synthesis will be guided by the WHO Climate-Resilient Health Systems framework, Meadows’ leverage-points framework and realist-informed C–M–O reasoning. Interventions will be grouped to identify where they operate within the health system and which health system components and vulnerabilities they address. Findings will be reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance.
Ethical approval is not required because the review uses published literature and does not involve human participants. The findings will be disseminated through a peer-reviewed systematic review publication. They will inform the design, improvement and scaling of interventions intended to maintain routine MCH services and strengthen health system resilience to floods and heatwaves across diverse settings.
The review was not prospectively registered with PROSPERO.
To evaluate the accuracy of the Emergency Severity Index (ESI) assignments by GPT-4, a large language model (LLM), compared to senior emergency department (ED) nurses and physicians.
An observational study of 100 consecutive adult ED patients was conducted. ESI scores assigned by GPT-4, triage nurses, and by a senior clinician. Both model and human experts were provided the same patient data.
GPT-4 assigned a lower median ESI score (2.0) compared to human evaluators (median 3.0; p < 0.001), suggesting a potential overestimation of patient severity by the LLM. The results showed differences in the triage assessment approaches between GPT-4 and the human evaluators, including variations in how patient age and vital signs were considered in the ESI assignments.
While GPT-4 offers a novel methodology for patient triage, its propensity to overestimate patient severity highlights the necessity for further development and calibration of LLM tools in clinical environments. The findings underscore the potential and limitations of LLM in clinical decision-making, advocating for cautious integration of LLMs in healthcare settings.
This study adhered to relevant EQUATOR guidelines for reporting observational studies.
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