Conectar
by Hyun Ju Kim, Kyung-Ah Cho, So-Youn Woo
Skin inflammation arises from complex interactions among immune cells, particularly T cells and neutrophils. Mesenchymal stem cells (MSCs) exhibit potent immunomodulatory properties, but the specific roles of tonsil-derived MSCs (T-MSCs) in regulating neutrophil extracellular trap (NET) formation and cell death, as well as T cell migration in inflammatory skin conditions, remain poorly defined. In this study, the therapeutic effects and mechanisms of T-MSCs were investigated in a 2,4-dinitrochlorobenzene (DNCB)-induced skin inflammation model, with a focus on NET formation and T cell migration. T-MSCs were intravenously administered to mice with DNCB-induced skin inflammation; inflammation severity and immune cell dynamics were evaluated using histological analysis, flow cytometry, immunostaining, microarray profiling, NET assays, and T cell migration assays. T-MSC treatment reduced DNCB-induced skin inflammation, as demonstrated by decreased epidermal thickness and neutrophil infiltration. Although T-MSCs enhanced NET formation in vitro, they suppressed neutrophil accumulation in vivo. T-MSCs also modulated the distribution and activation of T cell subsets in the skin and secondary lymphoid organs. Gene expression profiling revealed that T-MSCs regulated pathways associated with inflammation and neutrophil activity, including those involved in immune cell trafficking and NET formation. Moreover, T-MSCs promoted T cell migration, although this effect was influenced by neutrophil presence, indicating complex interplay among immune cells. These findings demonstrate that T-MSCs exert anti-inflammatory effects in DNCB-induced skin inflammation by modulating NET formation and T cell migration, revealing a novel immunoregulatory mechanism and supporting their therapeutic potential for inflammatory skin diseases.There are approximately 700 000 autistic people in the UK, and autism is increasingly being diagnosed in adulthood. Diagnosis on its own does not provide adequate information to plan post-diagnostic support for autistic people, and clinicians often plan support without the use of validated standardised tools which may exacerbate inequities in care. This study will evaluate a novel strengths and needs assessment, based on the WHO’s International Classification of Functioning, Disability and Health CoreSet for Autism, for use in adult diagnostic services immediately on receipt of an autism diagnosis. Potential issues, including the length of the assessment, timing of delivery and selection bias, will be explored as part of the trial process evaluation.
A two-arm, multisite, randomised pilot trial design will be used to evaluate the ICF CoreSets for Autism Strengths and Needs Assessment in three diagnostic services in England. A total of 72 newly diagnosed autistic adults will be recruited across the three sites over a 6-month period and randomised into an assessment group (strengths and needs assessment plus standard care) and a treatment as usual group (standard care only). The assessment group will receive a summary report of their strengths and needs on completion of the assessment. Both groups will complete measures of mental health and quality of life at baseline and 3 months follow-up (Patient Health Questionnaire-9, Generalised Anxiety Disorder questionnaire-7, Recovering Quality of Life questionnaire-10, EuroQoL-5D). Acceptability and feasibility will be measured for the strengths and needs assessment and for trial procedures using standardised measures, progression criteria and qualitative data from clinician focus groups and interviews with a subsample of autistic participants. The study design and procedures are being co-produced with an autistic advisor/patient and public involvement lead and with a steering group of autistic adults.
This study was reviewed by the East Midlands—Nottingham 2 Research Ethics Committee and was given Health Research Authority approval on 18 March 2025 (REC reference:25/EM/0041). The results will be disseminated via reports to the funder (NIHR), a peer-reviewed journal paper and academic conferences. We will email a summary report of findings to study participants and will invite participants to an information dissemination event at the end of the study. Links to reports and a lay summary will be provided on the research group’s website: https://sharl.sites.sheffield.ac.uk/home
Clinical research in emergency and critical care is vital, but recruitment and consent are complex. Research may be conducted without prior consent when patients are critically ill, and interventions are time critical. Some patients may die before research participation can be discussed with relatives, leaving the bereaved unaware of their involvement. This study explored potential communication strategies for informing bereaved relatives when a patient has died following enrolment into an emergency or critical care study without prior consent.
A mixed-methods study using a telephone survey and semi-structured interviews conducted simultaneously. The survey was conducted within a National Health Service Trust in North West England with relatives of deceased study participants. Semi-structured interviews were conducted with bereaved relatives and research and clinical staff across the UK, and medical examiner (ME)/ME officers based in England and Wales. Quantitative data were analysed descriptively, and qualitative data were analysed using reflexive thematic analysis. Data were synthesised using a constant comparison approach.
11 bereaved relatives completed the survey. 53 individuals (21 research and clinical staff, 18 relatives and 14 MEs/officers) participated in semi-structured interviews.
Although many trials do not include a process for notifying bereaved relatives about research participation, most relatives valued the opportunity to learn about their family member’s participation, emphasising the importance of transparency and trust. However, some raised concerns over the potential burden of automatic disclosure by the ME service. Offering bereaved relatives the option to receive sensitively worded information about research involvement at an appropriate time, soon after death, was recommended.
Bereaved relatives should have the choice to be informed about research participation without prior consent. Our findings support the need for transparent and sensitive communication and will contribute to future guidance for the design and conduct of adult emergency and critical care studies.
The Circle of Security-Parenting (COS-P) group intervention has demonstrated efficacy in reducing maternal perinatal mental health difficulty (PMHD) symptoms in some contexts. The Circle of Security Intervention (COSI) study, a multisite, individually randomised, single-blind, parallel-arm controlled trial, was conducted in England to assess the clinical effectiveness of COS-P in reducing perinatal psychopathology, parenting and infant development, as well as its acceptability among the National Health Service (NHS) participants and staff. The main aim of this work is to estimate the cost-utility of COS-P plus treatment as usual (TAU) relative to TAU among mothers and birthing parents receiving NHS perinatal mental health services (PMHS) in England.
A within-trial economic evaluation was performed comparing COS-P plus TAU with TAU alone, using data from the COSI trial, which employed a 2:1 randomisation ratio. Analyses were conducted from both NHS and personal social services (PSS) and societal perspectives. A 12-month time horizon was used, consistent with the final trial follow-up.
Secondary care NHS perinatal health services across multiple centres in England.
A total of 371 mothers and birthing parents with PMHD were randomised and had complete economic outcome data; 248 received COS-P plus TAU and 123 received TAU alone. Participants were eligible if they were receiving NHS PMHS; exclusion criteria were defined in the trial protocol.
Participants in the intervention arm received the COS-P group programme in addition to TAU. The control group received TAU alone.
The primary economic outcome was quality-adjusted life years (QALYs) over 12 months, derived from the 5-level EuroQol five-dimensional (EQ-5D-5L) questionnaire - responses. Costs were estimated from NHS and PSS as well as societal perspectives, including healthcare utilisation and productivity losses due to work absence.
Compared with TAU, COS-P was associated with higher costs from both NHS and PSS (£180.58; 95% CI –£1075 to £1436) and societal (£72.94; 95% CI –£1473 to £1619) perspectives. COS-P was marginally less effective in terms of QALYs (–0.01; 95% CI –0.06 to 0.05). Probabilistic sensitivity analyses indicated substantial uncertainty around cost and effectiveness estimates.
On average, COS-P was associated with higher costs and did not demonstrate improvements in health-related quality of life compared with TAU alone. Given the uncertainty surrounding the estimates, further research is warranted to explore potential longer term economic and clinical impacts of COS-P in perinatal mental health settings.
SRCTN18308962.
Intrahepatic cholangiocarcinoma (ICC) has a high recurrence rate after curative surgery, with no standard neoadjuvant therapy. Hepatic arterial infusion chemotherapy (HAIC) has shown efficacy in locally advanced ICC, while immune checkpoint inhibitors and anti-angiogenic agents have demonstrated promising response rates. The NEO-ERA-01 study evaluates the feasibility of neoadjuvant HAIC-GEMOX plus lenvatinib and Adebrelimab in high-risk resectable ICC.
NEO-ERA-01 is a prospective, multicentre, phase II trial using Simon’s two-stage design. Thirty patients with histologically confirmed resectable ICC and high-risk recurrence factors will be enrolled in China. Neoadjuvant therapy consists of HAIC-GEMOX (gemcitabine 800 mg/m², oxaliplatin 85 mg/m² every 3 weeks), lenvatinib (8 mg/day from Day 5) and Adebrelimab (1200 mg on Day 3, every 3 weeks) for 2–4 cycles. Surgery eligibility will be assessed post-treatment. Resected patients will receive adjuvant capecitabine (1250 mg/m² two times per day on Days 1–14, every 3 weeks) and Adebrelimab (1200 mg on Day 1, every 3 weeks) for 6 months.
The primary endpoint is the completion rate of study treatment. Secondary endpoints include safety, R0 resection rate, response rate, event-free survival, disease-free survival and overall survival. Exploratory endpoints include immune microenvironment and biomarker analysis.
The study is approved by the ethics committee of all sites and follows the Declaration of Helsinki and good clinical practice guidelines. Results will be disseminated via peer-reviewed publications and conferences.
by Anas Ismail, Moatasem Salah, Mads Gilbert, Yousef H. Abu Alreesh, Craig Jones
BackgroundGaza has faced numerous military attacks that resulted in mass casualty incidents (MCIs). The ongoing genocide in Gaza has destroyed much of the health system, including killing and injuring of hundreds of health care workers (HCWs). Current thinking on the health system reconstruction lacks empirical data and local HCWs’ perspectives. The study analyses locally driven innovations and lessons learned by HCWs who responded to MCIs between 2018 and 2021 to guide current and future planning of the reconstruction of the health system in Gaza.
MethodsThis was a qualitative study using online and face-to-face interviews with HCWs who responded to the Great March of Return and the 2021 Israeli military attacks. Transcripts and extensive notes from the interviews were recorded and analyzed on NVivo using thematic content analysis. We used the health system building blocks as themes for deductive analysis with a seventh place-based theme (Gaza-specific) to account for the context of Gaza and the MCIs.
ResultsProblems faced by HCWs mostly related to the nature and complexity of traumatic injuries, shortages in HCWs, particularly specialist doctors, poor coordination among actors, duplication of services, and shortages of supplies and equipment. Locally driven innovations and solutions included establishing new services centers, opening and expanding training programs, starting new coordination bodies, and task shifting of staff and facilities. Lessons learned included strengthening training and employment opportunities for staff, enhancing emergency preparedness and capacities, maintaining coordination bodies, enhancing community engagement and strengthening the governance of the Ministry of Health.
ConclusionReconstruction of Gaza’s health system needs to be grounded in its political context and in the experiences of HCWs who have worked in and managed the system. Locally driven solutions and lessons learned can ensure that reconstruction serves as a vehicle for self-determination and sovereignty, rather than entrenching dependency.
by Chanseo Lee, Jaihyoung Lee, Kimon-Aristotelis Vogt, Muhammad Munshi
BackgroundAccurate intraoperative detection of nociceptive events is essential for optimizing analgesic administration and improving postoperative outcomes. Although deep learning approaches promise improved modeling of complex physiologic dynamics, their added computational and operational complexity may not translate into clinically meaningful benefit, particularly in small, high-resolution perioperative datasets.
MethodsWe performed a head-to-head evaluation of classical supervised models (L1-regularized logistic regression and 50-, 200-tree Random Forests, with and without drug dosing features) against a Temporal Convolutional Network (TCN) transfer-learning framework for intraoperative nociception detection. Using 101 adult surgical cases with 30 physiologic and 18 drug dosing features sampled in 5-second windows, models were assessed under leave-one-surgery-out cross-validation using AUROC and AUPRC. We further examined probability calibration, multiple ensemble strategies, permutation importance features, and computational cost in terms of inference operations and memory footprint.
ResultsDrug-aware Random Forests of various trees (50 trees vs. 200 trees) achieved the highest discrimination (AUROC 0.716; AUPRC 0.399), outperforming the TCN transfer-learning model (AUROC 0.649; AUPRC 0.311). However, increasing personalization windows in the TCN yielded inconsistent and modest gains (p > 0.05). Isotonic calibration substantially improved probability calibration but did not affect discrimination. No ensemble method surpassed the standalone Random Forest; the gated network consistently assigned >84% weight to the classical model. Computational analysis revealed that while the TCN was more compact in total memory footprint, the smaller, 50-tree Random Forest inference required two orders of magnitude fewer operations, with faster training and lower operational complexity.
ConclusionsIn this clinically realistic benchmark, interpretable classical models operating on well-engineered features without personalization matched or exceeded the performance of a personalized deep learning approach while remaining computationally cheaper and simpler to deploy. These findings underscore the importance of rigorously justifying model complexity in perioperative machine learning and suggest that, for intraoperative nociception monitoring, classical approaches may offer a more favorable balance of accuracy, interpretability, and operational efficiency.
by Riham M. Hamadouk, Esra D. Albashair, Einass M. Alshareif, Ali Awadallah Saeed, Bashir A. Yousef
BackgroundToday, community pharmacists’ responsibilities have expanded beyond the traditional role to include the management of minor ailments. Acute uncomplicated cystitis is one of the most prevalent medical conditions seen in primary healthcare and can be managed by community pharmacists (CPs).
ObjectivesTo evaluate community pharmacists’ history-taking practice when responding to patients with acute uncomplicated cystitis.
MethodsA cross-sectional simulated patient study was conducted from November 2022 to January 2023 in Khartoum locality targeting only pharmacists. Six trained female students played the simulation in which they pretended to have the clinical symptoms of acute uncomplicated cystitis and requested treatment for their condition. The Interactions during the simulation were documented immediately in a data collection form after each visit. Descriptive statistics were used to report the study outcomes.
ResultsA total of 238 community pharmacies were visited. The majority of the pharmacists were female. The mean of the number of questions that were asked by the pharmacists was 1 (SD = 1.6) questions. Among the studied pharmacists, 45.4% asked at least one question during patient assessment. The most asked question was if the patient has a fever, representing 61 (25.6%) CPs, followed by if there is vaginal discharge, representing 38 (16%) CPs. In response to scenario 47 (19.7%) CPs decided to refer the patient to a physician, and 45 (18.9%) of the CPs advised the patient to increase water intake.
ConclusionsThe study has revealed a poor history-taking practice towards acute uncomplicated cystitis during patient assessment. Further studies exploring pharmacists’ involvement in patient assessment are required. Strategies to improve community pharmacists’ practice, like continuing pharmacy education and providing a national guideline regarding patient assessment should be considered seriously.
To identify and synthesise qualitative and quantitative evidence of nurse managers' qualities, practices and styles related to leading nurses' interprofessional collaboration.
Mixed-methods systematic review.
Two authors independently selected studies based on predefined inclusion criteria, assessed quality and extracted data. A thematic synthesis with a convergent qualitative design was used.
CINAHL, PubMed and Scopus were searched from January 1, 2010, to September 7, 2025. Citations of relevant articles were screened.
A total of 32 articles were included. The analysis revealed two leadership core qualities, five core practices, and three core styles of nurse managers that promote nurses' interprofessional collaboration. Core qualities were proficiency and mindset. Core practices comprised empowering, communicating and informing, commitment to interprofessional collaboration, creating possibilities, and establishing an enhancing atmosphere. Core styles included authentic, transformational, and transactional leadership styles.
The results reflect the situational nature of nursing leadership related to interprofessional collaboration. Successful leadership requires managers to adopt primarily a transformational leadership style, yet more traditional leadership is required occasionally. Results indicate that nursing leadership is foremost a process that evolves within its context.
Greater clarity on how leadership influences nurses' interprofessional collaboration supports leaders, organisations, and educational institutions in developing and sustaining effective leadership.
This review demonstrates that the quality of nursing leadership is a central factor for successful interprofessional collaboration.
The PRISMA guidelines for Systematic Reviews and Meta-Analysis were used.
This study did not include patient or public involvement in its design, conduct or reporting.
(1) To determine the mediating effects of children's transition readiness, which reflects self-management skill acquisition, and family resilience on the relationship between parenting stress and the quality of life (QOL) of parents and children with spina bifida (SB). (2) To conduct an exploratory analysis of the differences in the mediating pathways based on the presence of SB-related clinical characteristics.
A cross-sectional study.
Data were collected from a single centre in South Korea between October 2022 and July 2024. Participants included children aged 7–13 years diagnosed with myelomeningocele, lipomyelomeningocele or tethered cord syndrome, along with their parents. Statistical analysis was conducted using SPSS and the MEDYAD macro for actor–partner interdependence mediation model analysis.
Family resilience significantly mediated the relationship between parenting stress and both child and parent QOL. However, transition readiness was not a significant mediator in the overall sample. Among children with SB-related clinical characteristics, transition readiness significantly mediated the association between parenting stress and child QOL. In contrast, family resilience mediated the relationship between parenting stress and parent QOL. No significant mediators were found in children without SB-related clinical characteristics.
This study highlights the mediating role of family resilience and transition readiness in improving the QOL of children with SB, particularly those with clinical characteristics. The findings suggest that interventions should be tailored to address both family resilience and transition readiness, especially for children with SB-related clinical challenges.
These findings are valuable for nurses supporting children with SB, as the results highlight the importance of transition education tailored to SB-related clinical characteristics. In particular, nurse-led transition education may play a key role in enhancing transition readiness and improving the QOL of children with SB who have clinical characteristics.
None.
STROBE Checklist for cross-sectional studies.
To comprehensively understand the meaning of person inclusive care and the care expectations of transgender individuals from health care professionals.
An integrative review was conducted.
Literature was searched in four databases (CINAHL, PubMed, Web of Science and Scopus) and 25 qualitative, quantitative and mixed methods studies published during January 2019–October 2024 were included.
All articles were critically appraised using validated critical appraisal tools. Deductive and constant comparative analyses were used to develop themes and sub-themes.
Person inclusive care was described as: (a) recognition and respect of identity, (b) holistic and individualised care and (c) creating safe and affirming healthcare environments. Care expectations included: (a) empowerment through shared decision-making, (b) person-centred communication, (c) advocacy as a supportive gesture and (d) intersectionality-informed care.
This review highlights the critical importance of person-inclusive care for transgender individuals, emphasising the need for healthcare practices that respect and affirm their identities, provide holistic care, and foster safe and supportive environments.
Transgender individuals experience persistent stigma and discrimination in healthcare settings and beyond. Understanding how to provide person-inclusive care and their care expectations from healthcare professionals is crucial to improving the delivery of quality care. The current body of evidence underscores significant disparities in healthcare for transgender individuals. While advancements in inclusive practices and affirming care models are evident in specific settings, these practices are not universally adopted. Inclusive care equips healthcare professionals with the necessary competencies to deliver high-quality, sensitive care that meets the unique needs of transgender individuals, ultimately fostering trust and equitable health outcomes. Nurses must ensure the delivery of person-inclusive care by demonstrating respect, advocacy, holistic assessment and care and genuine involvement of transgender individuals in decision-making for their care.
No direct patient or public contribution.
by Boyoung Jeon, Boyoung Jung, Yun-Kyung Song
BackgroundMusculoskeletal surgery imposes extended recovery periods and significant financial burdens that can undermine individual and system-level health security. Patients undergoing musculoskeletal surgery often face prolonged recovery and substantial post-discharge costs, yet longitudinal evidence on their healthcare use remains limited.
MethodsThis study quantified two-year post-discharge utilization and identified predictors of high expenditure among Korean musculoskeletal surgery patients. A retrospective cohort was constructed from the 2019–2021 Korea Health Panel. Adults (n = 182) hospitalized for spinal, knee, shoulder or other musculoskeletal disorders between July 2019 and June 2020 were followed for 24 months. Outcomes were total healthcare expenditure (log-transformed) and in the top 25% cost group (“high-expenditure”) in the second post-discharge year.
ResultsAmong 182 adults hospitalized for musculoskeletal surgery, first-year post-discharge spending averaged US $848 but fell to US $487 in the second year. Readmission fell from 19.2% to 7.1%, and Western-medicine outpatient visits declined from 18.3 ± 25.9 to 13.6 ± 22.9 per person. By contrast, Traditional Korean Medicine (TKM) visits rose from 2.3 ± 6.5 to 3.3 ± 10.0. In multivariable models, metropolitan residence, obesity, additional chronic conditions, and heavier first-year inpatient and outpatient use independently predicted higher second-year costs. Lower household income was associated with lower spending. Index diagnoses were pivotal: spinal disorders and shoulder disorders markedly increased the odds of falling into the top-cost quartile. Among the first-year TKM, frequent chuna/manual therapy sessions were marginally associated with higher costs, suggesting these rehabilitative modalities may serve as proxies for underlying health complexity during the stabilization phase.
ConclusionsSpinal and shoulder disorders, metropolitan residence, obesity, multimorbidity, heavy inpatient and outpatient use during the first post-discharge year, and frequent TKM sessions, albeit marginally, jointly predicted the highest second-year expenditures. These findings highlight the value of early risk stratification and tightly coordinated Western-and-traditional care pathways that facilitate the shift from structural repair to functional restoration. From a policy perspective, these results suggest the need for integrated post-discharge care models and targeted financial support strategies to reduce avoidable costs and enhance equity in musculoskeletal rehabilitation.
by Hongfei Yang, Chao Sun, Ya Li, You Zhou, Rui Wang, Yingxue Li
ObjectiveThe triglyceride-glucose index and estimated glucose disposal rate serve as notable surrogate markers of insulin resistance, demonstrating established links to cardio-cerebrovascular disease. However, their combined prognostic value in predicting cardio-cerebrovascular disease outcomes remains unexplored. The current investigation examined the interaction between the TyG (triglyceride–glucose index) index and eGDR (estimated glucose disposal rate) concerning the danger of cardiovascular disease within a clinical population.
MethodsThis investigation employed data sourced from the China Health and Retirement Longitudinal Study (CHARLS). The median TyG index and eGDR scores were used to stratify the participants into 4 categories: low TyG/high eGDR, high TyG/high eGDR, low TyG/low eGDR, and high TyG/low eGDR. Clinical characteristics across groups were systematically compared. Cox proportional hazards regression models evaluated the distinct and interconnected associations of the TyG index and eGDR with the risk of cardio-cerebrovascular disease, with multiplicative and additive interaction effects subsequently assessed through formal interaction analysis.
ResultsThe final study cohort comprised 7,330 participants, with 1,336 individuals (18.2%) developing cardio-cerebrovascular disease during the 9-year follow-up. Stratification using median thresholds (TyG: 8.59; eGDR: 10.55 mg/kg/min) yielded four groups: low TyG/high eGDR (n = 2,991), high TyG/high eGDR (n = 1,375), low TyG/low eGDR (n = 1,372), and high TyG/low eGDR (n = 2,292). Multivariable-adjusted Cox regression analyses revealed markedly increased risks of cardio-cerebrovascular disease among the various exposure groups when contrasted with the low TyG/high eGDR reference: high TyG/high eGDR (HR: 1.31, 95%CI: 1.10–1.57, ppp Conclusion
The TyG index and eGDR demonstrate independent associations with cardio-cerebrovascular disease risk, while their combined assessment reveals synergistic predictive capacity. Combined assessment of the two allows for further accurate stratification of the population based on insulin resistance and improved prediction of cardio-cerebrovascular disease.
Poverty can have profound negative impacts on parent, child and family health. Primary care providers are in a unique position to address child poverty. Some team-based models have integrated community support workers (CSWs) for social service system navigation assistance. The overall aim of this study is to rigorously test a poverty reduction intervention (navigation of financial supports) embedded in primary care. The primary objective is to compare parenting stress between CSW-supported, structured review of financial supports and social system navigation (intervention) and receipt of written summary of local resources (usual care).
This is a multisite pragmatic superiority randomised controlled trial with a 1:1 allocation to the CSW-supported social system navigation versus no navigation. Parent–child dyads (80 parents of children aged Do you ever have difficulty making ends meet at the end of the month?’) will be recruited during a scheduled health supervision visit from primary care practices in Kingston, Ontario. Intervention group participants will have a structured review of financial supports with a trained CSW and will meet up to 6 times over 6 months. Outcomes are measured at baseline, 6 months and 12 months after randomisation. The primary outcome is the Parenting Stress Index Fourth Edition Short Form (PSI-4-SF) total score at 6 months. Secondary outcomes include household income, food insecurity, parent mental health (depression and anxiety) and child health. An internal pilot study was used to obtain more reliable estimates of the SD of PSI-4-SF at 6 months to recalculate the sample size (if needed) and assess randomisation and completion rates. Qualitative interviews conducted 9 months after enrolment explore parent experiences with the CSW intervention.
Research ethics approval by Queen’s University Health Sciences REB. Results will be shared with the College of Family Physicians of Canada, the Ontario SPOR SUPPORT Unit and academic forums.
Connecting Families (Registered 12 October 2021 at www.clinicaltrials.gov;
To determine the safety and efficacy of ruxolitinib (RUX) and fostamatinib (FOS) compared with standard of care (SOC) in patients requiring hospital admission for the treatment of COVID-19 pneumonia.
Adaptive multiarm, multistage, randomised, open-label trial (three arm, two stage).
Five hospitals in England between October 2020 and September 2022.
Hospitalised patients (≥18 years) with COVID-19 pneumonia defined by a modified WHO COVID-19 severity grade of 3 or 4.
Participants were randomly assigned 1:1:1 to receive RUX (10 mg two times per day for 7 days then 5 mg two times per day for 7 days), FOS (150 mg two times per day for 7 days then 100 mg two times per day for 7 days) or SOC.
Primary outcome was development of severe COVID-19 pneumonia (modified WHO severity grade≥5) within 14 days of randomisation. Secondary outcomes included mortality, invasive and non-invasive ventilation, venous thromboembolism, duration of hospital stay, readmissions, inflammatory markers and serious adverse events (SAEs).
At stage 1, 181 patients were randomised, with 4 assessed as ineligible post randomisation. FOS was stopped early for futility with 16 participants (27.6%, n=58) developing severe COVID-19 pneumonia compared with 15 (25.0%, n=60) in the SOC arm (adjusted odds ratio (aOR) compared with SOC: 1.12; 95% CI 0.49 to 2.58; p=0.608). RUX progressed to stage 2 but the trial was stopped early due to slow recruitment. At the final analysis, 10 participants (16.1%, n=62) developed severe COVID-19 pneumonia in the RUX arm compared with 15 (24.6%, n=61) in the SOC arm (aOR: 0.63; 95% CI 0.25 to 1.57; p=0.161). Four (7.4%) participants in the FOS arm, none in the RUX arm and three (5.5%) in the SOC arm died within 14 days of randomisation. Infections were the most frequently reported SAE and were numerically higher in the FOS (10, 17.2%) and RUX (10, 16.1%) arms compared with SOC (7, 11.5%). Two unexpected serious adverse reactions occurred in the RUX arm only.
We found no evidence that FOS was superior to SOC for the treatment of COVID-19 pneumonia in patients requiring hospital admission. Due to early stopping, the trial was underpowered to establish RUX’s effect in this population. Further study is needed.
NCT04581954; EUDRA-CT:
This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles.
This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework.
Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities.
Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes.
We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted.
Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD.
The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.
by Farhan R. Chowdhury, M. Ismail Hossain, Tangerul A. Jepu, Nusrat U. A. Saleh, Fatema T. Zohora, Tasmim A. Saleh, Mrinmoy Sarker, Al Numan, Zainab Yousuf, M. Aftab Uddin, Muktadir S. Hossain
Pneumococcal diseases caused by the human pathogenic bacterium Streptococcus pneumoniae are a major public health concern worldwide. In this study, we examined the pathogenicity of a clinical isolate of S. pneumoniae in the silk moth, Bombyx mori, larvae infection model. The whole genome sequencing of a clinical isolate of S. pneumoniae, Spn1 identified the presence of genes responsible for its virulence and antibiotic resistance. Spn1 infection of Bombyx larvae resulted in death within 24 h concomitant with an increase of phenoloxidase activity in the hemolymph. The bacterial load increased in the hemolymph within 9 h post-infection (p.i.) Ampicillin, ceftriaxone, tetracycline, imipenem, and erythromycin showed therapeutic effect in infected larvae, although the bacterial strain was resistant to erythromycin in vitro. The Bombyx homologs of mammalian TLR2 and TLR4, known as BmToll2 and BmToll9 (BmToll9−1 and BmToll9−2 isoforms), were upregulated in both the fat body and trachea. The antimicrobial peptide (AMP) genes, BmdefensinA and BmdefensinB, known to be regulated by the Toll signaling pathway, were significantly upregulated in both fat body and trachea after S. pneumoniae infection through hemolymph. Our data indicate that the Bombyx larvae can be a suitable infection model to study the pathogenicity of S. pneumoniae.The timing of a woman’s first birth is significantly associated with maternal and child health outcomes and socioeconomic opportunities. Delaying the first birth is associated with reduced risks of adolescent pregnancy complications, improved birth outcomes and enhanced interpregnancy intervals, all of which contribute to better maternal and child health. In Somaliland, early childbearing is prevalent, necessitating an understanding of its associated factors. Early childbearing, defined as a first birth before age 20, is prevalent in Somaliland, with 47.02% of women having their first birth by this age, significantly higher than the average for sub-Saharan Africa (approximately 30%) and global figures.
This study aimed to identify the sociodemographic factors associated with age at first birth among married women in Somaliland.
The median duration from marriage to first birth was 3 years, with a median age at first birth of 21 years. Women residing in the Sool (adjusted HR: 1.318, 95% CI 1.138 to 1.527) and Sanaag (adjusted HR: 1.265, 95% CI 1.095 to 1.462) regions had a significantly higher hazard of first birth compared with those in Awdal (reference). Conversely, women in the middle (adjusted HR: 0.821, 95% CI 0.685 to 0.985) and highest (Adjusted HR: 0.799, 95% CI 0.663 to 0.964) wealth quintiles had a significantly lower hazard of first birth compared with the lowest wealth quintile. Age at first marriage was a strong factor associated with the outcome; marrying at age 20 or older (adjusted HR: 0.699, 95% CI 0.644 to 0.759) was associated with a significantly lower hazard of first birth compared with those who married before age 20. After adjustment, other factors including residence, media exposure and husband’s employment status were not significantly associated with the timing of first birth.
Region, wealth quintile and age at first marriage are critical factors associated with first birth timing in Somaliland. Interventions should focus on addressing regional disparities and promoting delayed marriage to improve maternal and child health outcomes. Further research is needed to explore the complex social and cultural drivers of these findings.
China has a high disease burden of low bone mass, and elderly men with excessive alcohol consumption may be underdiagnosed and undertreated given the adverse effects on skeletal health. This study implemented an economic evaluation to assess the screening plus receiving anti-osteoporotic medication for low bone mass prevention in older men with excessive alcohol intake.
A patient-level Markov model.
Chinese men aged over 60 years with excessive alcohol consumption.
Receiving screening plus medication considered with two eligibility strategies for therapy: osteoporosis and osteopenia.
The quality-adjusted life-years (QALYs), lifetime cost and the incremental cost-effectiveness ratio (ICER) were calculated for different strategies relative to no screening. Scenario analyses were conducted to evaluate the cost-effectiveness associated with risk factors, study perspectives and selection of medication.
From the healthcare perspective, the prevention strategies for men aged over 70 years were cost-effective with the ICER of $28 403/QALY for osteoporosis and $24 560/QALY for osteopenia. Scenario analyses revealed screening strategies were cost-effective in men with risk factors aged over 60 years. In the selection of medication, denosumab might be dominant. From the societal perspective, prevention for osteopenia aged from 60 years was cost-effective at the ICER of $36 524/QALY.
These findings suggest that prevention strategies for Chinese older men with excessive alcohol consumption would be cost-effective. Early screening initiation will aid efforts in improving skeletal health for men with excessive alcohol intake in China and reducing humanistic and economic burdens.
Obstructive sleep apnoea–hypopnoea syndrome (OSAHS) is a sleep-related breathing disorder characterised by partial or complete obstruction of the upper respiratory tract. Owing to their relevant physiological anatomy, patients with OSAHS often experience severe respiratory complications, such as airway obstruction and hypoxaemia, during painless gastroscopy. In addition, the use of the shared airway approach increases the difficulty of airway management. At present, simple and effective tools for airway management for use during gastroscopy in clinical practice are lacking. Therefore, the aim of this study is to investigate whether a novel oropharyngeal airway designed for use in endoscopy can effectively relieve airway obstruction and prevent hypoxaemia.
In this prospective, randomised, controlled clinical study, 130 patients with OSAHS diagnosed via polysomnography monitoring will be randomly divided into two groups. The experimental group will receive the novel oropharyngeal airway, whereas the control group will receive a conventional bite block. The primary outcome will be the incidence of hypoxia (75%≤SpO2 (pulse oxygen saturation)22
The Institutional Review Committee of the First Affiliated Hospital of Shandong First Medical University (Shandong Qianfoshan Hospital) approved the experimental protocol on 22 August 2024 (ethics number: YXLL-KY-2024(084)). The results of this study will be reported in peer-reviewed journals and relevant academic conferences or related research platforms.
FreshRSS 