Abstract Background Microaxial flow pumps (mAFP) are a well-established treatment modality for patients in cardiogenic shock, significantly improving hemodynamics and end-organ-function. In complex heart failure patients currently ineligible for advanced heart failure therapies, such as durable left ventricular assist device (dLVAD) implantation or heart transplantation (HTx), mAFP can serve as a preconditioning tool in a bridge-to-candidacy strategy. Case summary A 61-year-old male patient with known dilatative cardiomyopathy and multiple comorbidities presented in cardiogenic shock, accompanied by end-organ dysfunction, fluid overload, and the need for moderate catecholaminergic support. Bilateral lower limb stasis dermatitis with infected ulcers excluded advanced heart failure surgery. Initial management included high-dose diuretics, paracenteses and pleural drainage. To further improve microcirculation and optimize conditions for ulcer treatment, ongoing hemodynamic support was escalated through the implantation of a full-support transaxillary mAFP. Comprehensive wound care was initiated with successful split-thickness skin grafting during ongoing mAFP support. Given favorable wound healing, the patient underwent uncomplicated dLVAD implantation. Early postoperative right heart failure necessitated continued inotropic support. Following high-urgency HTx listing the patient was successfully transplanted eight months later. Conclusion Medium-term full support mAFP provided robust circulatory output, enabling effective decongestion and wound healing in a bridge-to-candidacy approach.

Background Acute promyelocytic leukemia (APL) has become a highly curable malignancy with the advent of targeted therapies. However, early death (ED), predominantly caused by severe hemorrhagic complications, continues to be the most significant obstacle to achieving high survival rates in real-world clinical practice, where outcomes often lag behind those reported in controlled trials. Aims This retrospective study aimed to identify the key clinical and laboratory factors associated with ED and overall survival (OS) in a cohort of newly diagnosed APL patients. The study also sought to evaluate the impact of current supportive care strategies and identify opportunities for improved management. Methods This single-center, retrospective analysis included 132 patients newly diagnosed with APL between June 2017 and January 2023. Data on demographics, baseline laboratory values, immunophenotyping, treatment, and outcomes were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of ED, while Kaplan-Meier and Cox regression models were used to assess survival outcomes. Results The ED rate was 12.88% (17 patients), with hemorrhage being the primary cause. Multivariate analysis identified three independent risk factors for ED: a high white blood cell (WBC) count (>201 × 10 9 /L), prolonged prothrombin time (PT), and CD2 positivity. While severe thrombocytopenia was common, it was not an independent predictor, likely due to an aggressive platelet transfusion policy. Elevated lactate dehydrogenase (LDH) levels were significantly associated with poorer OS. Furthermore, all relapses in the high-risk group involved the central nervous system (CNS). Conclusions This study found that high initial WBC count, prolonged PT, and CD2 positivity are critical independent predictors of ED in APL. The findings underscore the necessity of prompt diagnosis, risk-adapted therapy, and comprehensive multidisciplinary care, including aggressive management of coagulopathy. Enhanced CNS prophylaxis should be considered for high-risk patients to prevent relapse.

Obesity affects over 40% of US adults, with severe obesity on the rise. Despite recognition of obesity as a chronic disease, it remains underdiagnosed and undertreated. Access to evidence-based obesity treatment is limited, leading to increased obesity severity and related complications. Barriers to obesity treatment include socioeconomic disparities, limited clinician training, stigma, and restrictive or absent reimbursement policies. FDA-approved obesity medications offer significant health benefits, prompting the need for updated, evidence-based guidance. The Obesity Society (TOS), the Obesity Medicine Association (OMA), and the Obesity Action Coalition (OAC) convened a multidisciplinary panel, including patient representatives and obesity care providers, to develop a guidance statement using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Systematic evidence synthesis was conducted via Epistemonikos databases, with outcomes prioritized for clinical relevance, including weight reduction, quality of life, adverse events, and improvements in obesity complications. Recommendations were developed through consensus workshops and graded as strong or conditional based on evidence certainty, benefits, harms, equity, and feasibility using the GRADE Evidence-to-Decision framework. The panel issued recommendations on FDA-approved obesity medications including orlistat, bupropion-naltrexone, phentermine, phentermine-topiramate, liraglutide, semaglutide, tirzepatide, and setmelanotide. Strong recommendations were made for bupropion-naltrexone, semaglutide, tirzepatide, and setmelanotide, with moderate-certainty evidence. Conditional recommendations were made for other agents and specific obesity complications (obstructive sleep apnea, heart failure with preserved ejection fraction, metabolic dysfunction-associated steatotic liver disease/metabolic dysfunction-associated steatohepatitis, osteoarthritis, major adverse cardiovascular events, and type 2 diabetes). Continuing obesity medications during weight maintenance received a strong recommendation. Obesity is a chronic, often progressive, disease requiring comprehensive, long-term, and person-centered care. Effective obesity medications exist but remain underutilized due to systemic barriers. Expanding access, reducing stigma, and ensuring equitable coverage are essential to translating scientific advances into population health gains. Future priorities include access and integration of comprehensive obesity care in the primary care setting, improving affordability, addressing research gaps, conducting head-to-head trials, and updating guidance as evidence evolves.

Community-based physical and occupational therapy (PT/OT) are critical for stroke recovery but are underused. We conducted a secondary analysis of the COMPASS (Comprehensive Post-Acute Stroke Services) study, a pragmatic trial of comprehensive postacute transitional care (TC) to investigate whether TC programs increase PT/OT use. Forty hospitals were randomized to implement COMPASS-TC or maintain usual care for patients with stroke/transient ischemic attack. In a crossover phase, usual care hospitals implemented COMPASS-TC. We linked participants to administrative claims to assess PT/OT use after stroke. Adjusted generalized estimating equations compared COMPASS-TC to usual care within the trial and crossover cohorts on 30-/90-day PT/OT use, time to first visit, number of visits, and receipt of PT and OT versus single therapy. Per protocol analysis estimated complier average causal effects. COMPASS enrolled 8377 patients from July 2016 to March 2019; 5261 were linked to administrative claims. Thirty-day PT/OT ranged from 22.6% in usual care to 37.5% in COMPASS-TC. Therapy use was similar between groups in the trial cohort, and COMPASS-TC was associated with increased use in crossover analysis (9.4% [95% CI, 5.6-13.3%] at 30 days). COMPASS-TC was consistently associated with a shorter time to therapy (mean difference, -0.16 [95% CI, -0.03 to -0.29]). Per protocol results were larger for most outcomes. COMPASS-TC was associated with shorter time to PT/OT and with greater therapy receipt in the crossover, but not the trial, analysis. Inconsistencies may reflect confounding or differences in hospitals that chose to adopt the intervention in Phase 2. Implementation studies to improve care transitions after stroke are needed to enhance use of postacute rehabilitation.

Patients with implantable cardioverter-defibrillators (ICDs) are vulnerable to psychological distress, including posttraumatic stress disorder (PTSD). Impaired sleep is a hallmark of PTSD, and may also act as a risk factor that maintains or exacerbates PTSD, yet this relationship has not been examined in ICD recipients across different ages. We assessed 422 patients with ICD or cardiac resynchronisation therapy with defibrillator (CRT-D) who completed the Pittsburgh sleep quality index (PSQI) and post-traumatic diagnostic scale (PDS). 44.2% of patients showed impaired sleep (PSQI > 5). A multiple linear regression model showed that poorer sleep was associated with greater PTSD severity, and this association weakened with increasing age (interaction β = - 0.002, 95% CI [- 0.004, - 0.001], p = 0.008), indicating stronger effects in younger patients. Exploratory component analyses identified daytime dysfunction (β = 0.351, 95% CI [0.212, 0.490], p < 0.001) and sleep disturbance (β = 0.345, 95% CI [0.126, 0.564], p = 0.002) as the components most strongly linked to PTSD symptoms. These findings support that routine sleep screening is an important component of comprehensive ICD care, identifying clinically relevant sleep disturbance associated with PTSD symptom severity and underscoring sleep as a meaningful and modifiable treatment target.

Introduction Endometrial cancer is a common gynecologic malignancy, and surgical resection remains the mainstay of treatment. Perioperative complications such as malnutrition and venous thrombosis highlight the importance of comprehensive nursing care. Stroke sequelae, including hemiplegia, dysphagia, and impaired language function, further complicate management, especially when occurring simultaneously. However, reports addressing perioperative care in such patients are scarce. This study summarizes the perioperative nursing experience of a patient with endometrial cancer complicated by post-stroke hemiplegia, dysphagia, and impaired language deficits. Case presentation A 62-year-old postmenopausal female (gravida 2, para 2) with a history of sterilization and a 7-year hemorrhagic stroke (with sequelae of hemiplegia, dysphagia, and impaired language function) presented with 3-month vaginal bleeding. Following admission, she underwent an endometrial segmented diagnostic curettage. Postoperative pathology revealed endometrioid adenocarcinoma, International Federation of Gynecology and Obstetrics (FIGO) Stage I. The patient subsequently underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node mapping. Postoperatively, she was transferred to the intensive care unit (ICU) for mechanical ventilation, antimicrobial therapy, and supportive care. On postoperative day (POD) 2, extubation failed, and reintubation was performed. Given the high extubation risk due to her prior tracheostomy history, a tracheostomy was conducted on POD 4. During ICU stay, enteral nutrition was administered via NG tube and discontinued due to intolerance. POD 8, she was weaned off mechanical ventilation and transferred back to the ward. Results Proactive interventions via multidisciplinary team (MDT) discussions and nursing consultations ensured postoperative airway patency for maintaining oxygenation. Key focus areas included emphasizing the importance of nutrition, addressing the patient’s needs, protecting the patient’s skin, and preventing pressure injuries. POD 17, the patient was discharged home with a tracheostomy tube, which was removed 1 week post-discharge. The patient was able to tolerate pureed food. Conclusion This case highlights that for patients with endometrial cancer and post-stroke sequelae undergoing Category IV procedures (laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node mapping), MDT collaboration and specialist nursing consultations are critical to addressing complex perioperative care needs (airway, nutrition, skin) and achieving favorable outcomes.

Congenital syphilis remains a public health issue in Mexico. Timely screening during pregnancy is key to its prevention. To evaluate the implementation of the dual HIV/Syphilis rapid test in pregnant women at the General Zone Hospital with Family Medicine No. 2 and its feasibility to meet the national goal of performing three tests per pregnancy. A total of 8672 tests (2020 - 2024) were analyzed using MATLAB to identify trends by age, trimester, and test number. Linear regressions were applied, using the root mean square error as a measure of confidence, to project the fulfillment of the goal. Most pregnant women (74%) underwent only one test, mainly in the first trimester. An increase in second and third tests was observed in 2024. Projections suggest the goal may be reached between 2029 and 2030. The dual HIV/Syphilis screening strategy at this hospital shows significant progress toward universal testing during pregnancy. The trend suggests comprehensive care for all pregnant women, contributing to the reduction of congenital syphilis and improved maternal-neonatal health. Strengthening early detection, follow-up, and sexual health education remains essential.

This study aimed to explore the earthquake-related experiences of older adults relocated from nursing homes in earthquake-affected regions, the difficulties they faced in adapting to their new environments, and the post-earthquake support they received. This phenomenological research was conducted through face-to-face semi-structured interviews with 26 participants who had to relocate to a nursing home in southern Turkiye after the earthquake. Qualitative content analysis was based on a deductive and inductive approach. After the 2023 earthquake in Turkiye, participants experienced a range of emotions and attitudes, including trust, satisfaction, and happiness, as well as fear and anxiety. They experienced social isolation and difficulty adapting to the new nursing home's dietary habits, climate, and living environment. Although participants received psychosocial and health support services after the earthquake, they recommended organizing more sociocultural activities and providing training on earthquake preparedness. The findings revealed that emotional distress, adaptation difficulties, and social isolation were prominent challenges during the post-earthquake relocation process. Comprehensive post-earthquake care models are required, which should address older catastrophe survivors' emotional and social well-being in addition to their physical health.

Sexual assault affects an estimated 0.5-12% of athletes and can seriously affect athlete health. Concerted efforts are needed to support survivors in receiving timely and appropriate care. Despite recognition from leading sports organisations about the need to prevent and respond effectively to sexual assault, many sports medicine physicians feel inadequately prepared to handle sexual assault disclosures. Emergency action plans (EAPs) offer a promising strategy to support adequate responses and ensure competent and consistent care. This modified Delphi study aimed to identify consensus-based components of a sexual assault EAP designed for sports medicine clinicians responding to sexual assault disclosures. A diverse panel of 24 individuals with lived and practical experience related to sexual violence in sport participated in one anonymous open-ended round and three anonymous voting rounds. The open-ended round generated important components in eight key domains: General Guidance; Mandatory Reporting, Confidentiality and Consent; Initial Evaluation; Follow-up Planning; Athlete Safety and Trauma-Informed Care; Legal Considerations; Established Contacts and Resources and Implementation. Overall, 90/130 proposed items (69%) achieved consensus (≥80% agreement for non-ranking items). The sexual assault EAP framework may improve clinician competency and support adequate responses, addressing common barriers such as low disclosure rates, personnel turnover and confidentiality concerns. Adoption of such plans has the potential to increase athlete trust in reporting mechanisms and foster more comprehensive care for athlete-survivors of sexual violence in sport. Example EAP templates are provided to assist sports organisations in implementing protocols that enhance self-efficacy among clinicians and support survivors throughout the reporting and recovery process.

Understanding the economic cost of self-harm is essential for evaluating intervention cost-effectiveness and guiding funding allocation and service planning. To estimate the cost associated with self-harm presentations to hospital emergency departments and investigate key predictors of cost. Data on presentations to hospital for self-harm in all Irish emergency departments were analysed for 2018 and 2019. Costs of hospital treatment following self-harm were identified (in 2019 euros) using top-down and bottom-up approaches. The perspective taken was that of the health service. Factors associated with costs were investigated using generalised linear models. There were 25 053 self-harm presentations from 2018 to 2019. The average annual cost of self-harm was approximately €26.5 million; almost half of the total cost was due to repeat self-harm presentations (47.3%). The mean cost per presentation was €2117 (s.d. €1845), which incorporates acute hospital costs (mean €2067, s.d. €2127) and those of initial aftercare (mean €50, s.d. €69). Psychiatric and medical admissions were associated with highest costs, three times that of presentations resulting in emergency department discharge (incidence rate ratio (IRR) 3.01, 95% CI 2.72-3.36 and IRR 2.88, 95% CI 2.72-3.36, respectively). Other factors associated with higher costs included older age, emergency department medical assessment unit admission, receiving a psychosocial assessment and self-harm involving a firearm. Demographic and clinical predictors of cost varied according to care pathway. Significant costs associated with repeat attendances and hospital admission provide evidence for investment in emergency department services providing comprehensive care for those presenting with self-harm, as well as in community-based mental health services.

From endorsement of the WHO Acceleration Plan to Stop Obesity to national implementation: country progress on health system preparedness to scale up a comprehensive obesity chronic care programme

Cumulative diabetes-related metabolic burden and the risk of hearing loss: A population-based study.

Needs of pregnant women with epilepsy-a mixed methods study.

The article presents a clinical case of a 65-year-old female patient with stage IV adenocarcinoma of the right lung harboring an EGFR-mutated (L858R). The key feature of this case is the sequential modification of targeted therapy: initial stabilization with osimertinib, transient progression with associate complications during Gefitinib therapy, and subsequent restoration of disease control following reintroduction of osimertinib. A comprehensive palliative care approach is described in detail, including repeated thoracenteses, long-term pleural drainage, and supportive therapy aimed at symptom control and maintenance of the patient’s functional status. This case highlights the importance of integrating palliative interventions into oncological practice from the early stages of treatment, as well as the advantages of original targeted agents in overcoming tumor resistance.

P0163 Barriers to care and individual expenditures among patients with Von Hippel–Lindau syndrome: Insights from a patient-reported outcomes study in a large comprehensive care center

Financial Toxicity Among Patients with Peripheral Artery Disease.

Impact of nurse-led comprehensive care on compliance, image quality, and family satisfaction during pediatric MRI sedation: A retrospective study

Nursing leadership in Housing First implementation: A comparative analysis of care coordination approaches across four U.S. states.

Nurses often face high workloads, limited supervision, and challenging conditions. This study was conducted to assess the competence of clinical nurses and explore driving forces for nursing competence in a mountainous area of Vietnam. A cross-sectional survey was conducted among 356 clinical nurses working at nine district health centers, using a structured self-administered questionnaire. Logistic regression was used to examine factors associated with higher competence. Of the nurses, 67.4% reported good overall competence. The highest rated domains were comprehensive care practice and collaboration with colleagues in patient care. However, notable gaps were noted in patient-centered competencies, especially patient communication and education (62.4%), prioritization of care based on patient needs (70.2%), and medication guidance communication (71.9%). Nurses who reported higher job motivation (odds ratio = 7.9, p < .001) and recent training (odds ratio = 3.6, p < .001) showed notably better competence. These findings highlight critical areas for improvement, particularly in patient-centered communication skills. Targeted training initiatives and strategies to enhance professional motivation are essential interventions to address these competence gaps, thereby improving health care quality and workforce retention in underserved mountainous areas.

P0078 Multidisciplinary management of Von Hippel–Lindau disease throughout the patient's lifetime: Observational analysis from a large comprehensive care center