Future Need Research Articles

Long-term Clinical and Radiographic Results of Posteromedial Lateral Release for Neuromuscular Clubfoot Deformity.

Clubfoot occurs in up to 50% of patients with spina bifida (SB) and 90% with arthrogryposis (AR). Many of these patients with neuromuscular clubfoot deformity fail conservative casting and require surgery with posteromedial lateral release (PMLR). Limited data exist for the outcomes of PMLR in patients with SB and AR. Retrospective chart review was performed on PMLR in patients with SB and AR from January 2007 to June 2022, excluding those with follow-up <3 years or incomplete charts. Radiographic measurements were obtained pre-PMLR and post-PMLR when available. In total, 51 patients with 79 cases of clubfeet treated with PMLR at a tertiary children's hospital were identified. Of those, 35 patients with 54 cases of clubfeet treated with PMLR were analyzed, including 22 patients (29 feet) with SB and 13 patients (25 feet) with AR. In the SB cohort, 41% of feet required reoperation at an average of 4.6 years, and 76% of AR feet required reoperation at an average of 4.7 years post-PMLR. In addition, 21% of SB feet and 8% of AR feet required 2 or more reoperations. Talectomy was required post-PMLR in 24% of SB feet and 40% of AR feet at an average of 4.9 and 5.9 years, respectively. Younger age at time of PMLR was associated with significantly increased reoperation rates in AR (P=0.01). Greater change in calcaneus-fifth metatarsal angle after PMLR was associated with a future need for reoperation (P=0.047). Greater talo-first metatarsal angle after PMLR was associated with a future need for reoperations of any kind (P=0.040) in SB. Although PMLR remains a safe and successful treatment in the short term, many neuromuscular clubfeet will require additional procedures. Younger age and greater preoperative versus postoperative changes in calcaneus-fifth metatarsal and postoperative talo-first metatarsal angles were associated with increased reoperation rate. These results help orthopaedic surgeons counsel families about the long-term prognosis of clubfoot treatment in SB and AR. Level IV.

Epidemiology and Risk Determinants of Drug-Induced Liver Injury: Current Knowledge and Future Research Needs.

Drug-induced liver injury (DILI) is a major global health concern resulting from adverse reactions to medications, supplements or herbal medicines. The relevance of DILI has grown with an aging population, the rising prevalence of chronic diseases and the increased use of biologics, including checkpoint inhibitors. This article aims to summarise current knowledge on DILI epidemiology and risk factors. This review critically appraises available evidence on DILI frequency, outcomes and risk determinants, focusing on drug properties and non-genetic host factors that may influence susceptibility. DILI incidence varies across populations, with hospitalised patients experiencing notably higher rates than outpatients or the general population. Increased medication use, particularly among older adults and women, may partly explain age- and sex-based disparities in DILI incidence and reporting. Physiological changes associated with aging likely increase susceptibility to DILI in older adults, though further exposure-based studies are needed for definitive conclusions. Current evidence does not strongly support that women are inherently more susceptible to DILI than men; rather, susceptibility appears to depend on specific drugs. However, once DILI occurs, older age and female sex are associated with greater severity and poorer outcomes. Other less-studied host-related risk factors are also discussed based on available evidence. This article summarises existing data on DILI frequency, outcomes, drug properties affecting hepatotoxicity and non-genetic host risk factors while identifying critical knowledge gaps. Addressing these gaps through future research could enhance understanding and support preventive measures.

A novel operational protocol for the establishment of a medical facility for receiving returning hostages: structure, process and outcomes

BackgroundOn October 7, 2023, Hamas carried out an unprecedented attack on the State of Israel and kidnapped 251 people into captivity to the Gaza Strip. Several months later, as part of a humanitarian exchange deal, 105 hostages were released in five phases and admitted to one of six hospitals throughout the country for treatment. Shamir Medical Center (SMC) was one of these facilities. This study aims to describe the structure, process and outcomes of establishing a comprehensive, multi-step, operational protocol for receiving hostages returning from captivity.MethodThe process of preparing SMC as a receiving center, the establishment of procedures for implementation of the medical protocol, and the assessment of multi-disciplinary team preparedness and implementation and outcomes in an institutional protocol are described.Results24 returning hostages were received at SMC. Social workers, dietitians and translators were used by 100% of the majority group of returning hostages from the same country of origin and the sole individual from the other country of origin utilized a dietitian, social worker, ENT consultations, and a hearing test. Among the majority group, orthopedic and dermatological consultations were utilized by 17.4% and 13% received an ENT consultation. Of the administered imaging, 13% received a chest X-ray, 8.7% received a limb X-ray, 17.4% received a head CT scan, and 4.3% received an abdominal CT. In addition, 21.7% were provided antibiotic therapy. Protocol efficacy was measured by assessing time to various operational aspects of protocol implementation and medical procedures such as mean hours to room assignment, primary physician evaluation and social worker session. No correlation between age and operational variables was found.ConclusionThis novel operational protocol was successfully implemented and may serve as a framework for managing similar unpredictable sensitive events in the case of future need.

Rapid Generation of Microplastics and Plastic-Derived Dissolved Organic Matter from Food Packaging Films under Simulated Aging Conditions.

In this study, we show that low-density polyethylene films, a prevalent choice for food packaging in everyday life, generated high numbers of microplastics (MPs) and hundreds to thousands of plastic-derived dissolved organic matter (DOM) substances under simulated food preparation and storage conditions. Specifically, the plastic film generated 66-2034 MPs/cm2 (size range 10-5000 μm) under simulated aging conditions involving microwave irradiation, heating, steaming, UV irradiation, refrigeration, freezing, and freeze-thaw cycling alongside contact with water, which were 15-453 times that of the control (plastic film immersed in water without aging). We also noticed a substantial release of plastic-derived DOM. Using ultrahigh-resolution mass spectrometry, we identified 321-1414 analytes with molecular weights ranging from 200 to 800 Da, representing plastic-derived DOM containing C, H, and O. The DOM substances included both degradation products of polyethylene (including oxidized forms of oligomers) and toxic plastic additives. Interestingly, although no apparent oxidation was observed for the plastic film under aging conditions, plastic-derived DOM was more oxidized (average O/C increased by 27-46%) following aging with a higher state of carbon saturation and higher polarity. These findings highlight the future need to assess risks associated with MP and DOM release from plastic wraps.

Scalability and Replicability Analysis in Smart Grid Demonstration Projects: Lessons Learned and Future Needs

This paper compares various approaches to the scalability and replicability analysis (SRA) of smart grid pilot projects, highlighting the need for a comprehensive SRA methodology as called for by the European Commission and International Energy Agency. This study addresses the need for a standardized SRA methodology and explores how three EU-funded projects—Platone, EUniversal, and IElectrix—adapted the general guidelines developed by the BRIDGE initiative. These guidelines provide recommendations for developing a comprehensive large-scale deployment analysis. The results show that while the guidelines are usable and flexible, project-specific conditions and data availability limitations—particularly in regulatory and technical analysis—can pose challenges. Some key recommendations to overcome these and facilitate future applications are identified. These include defining SRA methodologies and securing data-sharing agreements early. The lack of standardized approaches for presenting SRA results hampers cross-project comparison. Thus, creating an open-use case repository and updating the BRIDGE guidelines with more detailed examples, benchmarks, and reference networks is recommended. Additionally, linking SRA with cost–benefit analysis (CBA) is suggested in order to evaluate the commercial viability of smart grid solutions. The paper concludes that while the BRIDGE guidelines have proven to be fit for purpose, further developments are needed to facilitate their practical application in real-world projects.

Recommendations for permanent sleep telehealth: an American Academy of Sleep Medicine position statement.

Telehealth use greatly expanded under the Centers for Medicare and Medicaid Services (CMS) waivers at the start of the COVID-19 pandemic; however, the uncertainty and limitations of continued coverage risks loss of this momentum. Permanent coverage with adequate reimbursement is essential for the long-term acceptance and expansion of telehealth services. Telehealth supports both the current and future need for sleep health management by expanding patient access, increasing clinician efficiency, improving patient safety, and addressing health care equity. Sleep medicine is an ideal field for telehealth due to limited provider access, safety concerns with sleepy patients, availability of remote patient monitoring for treatment management, and the minimal need for repeated physical examinations. Telehealth is non-inferior for delivery of cognitive behavioral therapy for insomnia (CBT-I) and can enhance obstructive sleep apnea (OSA) treatment adherence. It is the position of the American Academy of Sleep Medicine (AASM) that telehealth is an essential tool for the provision of high quality, patient-centered care for patients with sleep disorders. We encourage all stakeholders including legislators, policymakers, clinicians, and patients to work together to address payment models, interstate care, technology access, prescribing practices, and ongoing research to ensure that sleep telehealth services are permanently available and accessible for all patients seeking sleep medicine care.

Can systemic antibiotics reduce the need for surgical intervention in treating peri-implantitis?

A retrospective cohort design was used to assess the long-term clinical effectiveness of systemic amoxicillin and metronidazole, used adjunctively with non-surgical peri-implantitis treatment (NST) and whether it prevents the need for further surgical interventions. Of the 57 peri-implantitis patients examined, 45 patients were included in this study. The participants were divided into two subgroups in accordance to who had received NST with or without systemic antibiotics. Selection was based on prior participation in a three-month randomised control trial, ensuring comparability of data regarding peri-implantitis severity and treatment history. Data were extracted pre-treatment, 3-months post-treatment and at a long-term follow-up interval of 36 months. The primary outcome was the need for additional surgical intervention and was analysed via Kaplan-Meier analysis and Cox regression. A multitude of secondary clinical outcomes were evaluated using parametric and non-parametric tests, including peri- implant probing depth, bleeding scores and treatment success. Overall, 62.2% of the 45 NST patients did not need surgical peri-implantitis treatment: 73.9% of the subgroup with antibiotics and 50% of the subgroup without antibiotics respectively. However, the difference between the two groups was not statistically significant (log-rank test, p = 0.110). The Cox regression analysis also displayed no significance over the first three years post-treatment (p = 0.115). Additionally, the study found that deeper peri- implant pockets at baseline significantly predicted the need for future surgical treatment (p = 0.031), highlighting the importance of initial disease severity in treatment outcomes. The study concludes that the adjunctive use of systemic amoxicillin and metronidazole with NST may delay but not statistically reduce or prevent a future surgical need. Although a short-term reduction in clinical inflammatory parameters was evident, the long-term effectiveness in altering the progression of peri-implantitis remains limited.

Comparative transcriptome of normal and cancer-associated fibroblasts

BackgroundThe characteristics of a tumor are largely determined by its interaction with the surrounding micro-environment (TME). TME consists of both cellular and non-cellular components. Cancer-associated fibroblasts (CAFs) are a major component of the TME. They are a source of many secreted factors that influence the survival and progression of tumors as well as their response to drugs. Identification of markers either overexpressed in CAFs or unique to CAFs would pave the way for novel therapeutic strategies that in combination with conventional chemotherapy are likely to have better patient outcome.MethodsFibroblasts have been derived from Benign Prostatic Hyperplasia (BPH) and prostate cancer. RNA from these has been used to perform a transcriptome analysis in order to get a comparative profile of normal and cancer-associated fibroblasts.ResultsThe study has identified 818 differentially expressed mRNAs and 17 lincRNAs between normal and cancer-associated fibroblasts. Also, 15 potential lincRNA-miRNA-mRNA combinations have been identified which may be potential biomarkers.ConclusionsThis study identified differentially expressed markers between normal and cancer-associated fibroblasts that would help in targeted therapy against CAFs/derived factors, in combination with conventional therapy. However, this would in future need more experimental validation.

Exploring acid mine drainage treatment through adsorption: a bibliometric analysis.

Discharge of acidic wastewater from mining activities (acid mine drainage (AMD)) is a major global environmental and public health issue. Although several approaches, including chemical precipitation and membrane technology, have been developed to treat AMD, adsorption has emerged as the most promising technology due to its cost-effectiveness and efficacy. Despite the wide adoption of adsorption in treating AMD, the evolution of research in this area remains poorly understood. To address this gap, a bibliometric analysis of the most recent literature involving the application of adsorption in AMD remediation was conducted by merging datasets of articles from Scopus (1127) and the Web of Science Core Collection (1422), over the past decade (2013-2022). This analysis revealed a yearly increase of 11% in research publications, primarily contributed by China, the United States, and South Africa. Keyword analysis revealed that natural schwertmannites and their transformations, activated carbon, zeolites, and clay minerals, are the most extensively employed adsorbents for the removal of common metals (arsenic, chromium, iron, manganese, among others). The findings underscore the need for future focuses on recovering rare earth elements, using nanoparticles and modified materials, pursuing low-cost, sustainable solutions, integrating hybrid technologies, pilot-scale studies, exploring circular economic applications of AMD sludges, and inter-continental collaborations. These insights hold significant future implications, serving as a valuable reference to stakeholders in the mining industry.

Cesarean Section Is a Risk Factor That Prevents Organ Transplantation by Increasing the Development of Anti-HLA Antibodies in Women.

In this study, prenatal and postnatal blood samples were taken from pregnant women who had 35 or more gestational weeks and had not developed anti-HLA positivity yet. The aim of this study was to evaluate the factors that may be effective in the development of panel reactive antibody (PRA) positivity during pregnancy. PRA testing was studied by taking the blood of 86 pregnant women 1month before birth. Blood was taken again 1month after birth from these women with prenatal PRA negative and it was checked whether PRA positivity developed. As a control group, 40 women without pregnancy were selected for the study. Of the 86 pregnant, 42 (48.8%) had cesarean sections, 44 (51.2%) had normal births, and PRA positivity developed in 14 (32.5%) of cesarean deliveries and three (8.0%) of normal births. In the control group, there were three (7.5%) PRA positivity. A statistically significant difference was found between cesarean delivery, normal delivery, and control group. Moreover, when compared with the control group, it was found statistically significant that all deliveries increased the development of HLA Class II antibodies. Cesarean delivery was associated with increased PRA positivity compared to normal birth. The new information presented in this study will pave the way for further research and enable healthcare professionals to consider both the individual's potential future need for organ transplantation and the positive impact on public health and more effective management of healthcare costs when making decisions regarding cesarean section.

Alternative Scenarios for Projected Prevalence of Stroke and Post-Stroke Dementia to 2046 in Ireland: A Model-Based Analysis

Abstract Background Understanding future population need is key for informing stroke service planning. This study aims to evaluate alternative scenarios for future trends in stroke age-specific incidence and case-fatality and estimate impact on projected stroke and post-stroke dementia prevalence in Ireland. Methods We used a probabilistic Markov model to project and track incidence and prevalence of stroke and post-stroke dementia in the Irish population aged 40-89 years to 2046. Using systematic review and observational evidence, we extrapolated trends in stroke age-specific incidence and case-fatality from 1990-2019 to 2016-2046. We defined optimistic, realistic and pessimistic scenarios, including scenarios where trends decelerated over time. Results The stable (pessimistic) scenario indicates a projected 95,278 stroke survivors in 2046 (95% uncertainty interval, UI = 91,404-99,487) (30.1 per 1000 pop), an increase of 53% from 2022 to 2046. The most optimistic scenario would involve a 3.2% increase from 2022 to 2046, to a projected 61,000 survivors. More realistic scenarios based on lower rates of incidence/case-fatality decline, or rates of decline slowing over time, imply an increase ranging between 22.9% and 37.2%. There will be a projected 19,430 with post-stroke dementia in 2046 (95% UI 17,182-21,904), an increase of 69.2% from 2022. In the most optimistic scenario, the increase would be 22.6%, with realistic scenarios implying an increase ranging between 38.9% and 53.2%. Conclusion Future stroke healthcare needs will vary substantially depending on epidemiological trends. A large increase in post-stroke dementia is projected across scenarios. Further work is needed to identify optimal policies to promote continuing decline in stroke incidence.

Assessment of the Existing and Future Needs for River Water in the Kazakhstan Sector of the Ural River

Assessment of the Existing and Future Needs for River Water in the Kazakhstan Sector of the Ural River

Utilization of Plant based Nanoparticles Emerging in Nano-biomedical Science to Target Drug Deliveries for Breast Cancer Treatment: Existing Work and Future Need

Abstract: Cancer is a major global health concern and a hereditary disease brought on by alterations in the genetic code that controls how cells behave. In the United States and other countries, breast cancer is very common among females. Through the development of innovative biocompatible Nanocomposites for therapy, which demonstrate a highly appropriate manner of nanoparticles, Nanomedicine offers incredible potential to develop cancer treatment and diagnosis. More than 60% of anticancer medications on the market today are derived from natural sources. Historically, plants have been used to treat a wide range of illnesses, including cancer. This work aimed to treat breast cancer with plant-based nanoparticles. The information was gathered from research that has already been published on Google Scholar, PubMed, and Web of Science. Different nanoparticles have been shown to be effective drug delivery agents to treat breast cancer. These include gold, silver, platinum, iron, zinc oxide, copper nanoparticles, and other metals, such as nickel, manganese, silica, titanium, palladium, cerium, and platinum. It was discovered that all metal preparation nanoparticles have an effective function in the treatment of infectious diseases and cancer. In conclusion, the characteristics of biomolecules included in plant extracts may be connected to the greenproduced NPs. Because of their high effectiveness, plant based NPs synthesis will be necessary in the future to treat breast cancer.

Chemical Control of Snail Vectors as an Integrated Part of a Strategy for the Elimination of Schistosomiasis-A Review of the State of Knowledge and Future Needs.

WHO promotes the implementation of a comprehensive strategy to control and eliminate schistosomiasis through preventive chemotherapy, snail control, clean water supply, improved sanitation, behaviour change interventions, and environmental management. The transmission of schistosomiasis involves infected definitive hosts (humans or animals) excreting eggs that hatch (miracidia), which infect freshwater snail vectors (also referred to as intermediate snail hosts) living in marshlands, ponds, lakes, rivers, or irrigation canals. Infective larvae (cercariae) develop within the snail, which, when released, may infect humans and/or animals in contact with the water. Snail control aims to interrupt the transmission cycle of the disease by removing the vector snails and, by so doing, indirectly improves the impact of the preventive chemotherapy by reducing reinfection. Snail control was, for many years, the only strategy for the prevention of schistosomiasis before preventive chemotherapy became the primary intervention. Snails can be controlled through various methods: environmental control, biological control, and chemical control. The chemical control of snails has proven to be the most effective method to interrupt the transmission of schistosomiasis. The current review aims to describe the vector snails of human schistosomiasis, present the chemicals and strategies for the control of snails, the challenges with the implementation, and the future needs. Snail control can play a key role in reducing schistosomiasis transmission and, thus, complements other interventions for disease control. There is a need to develop new molluscicide products or new formulations and methods of applications for existing molluscicides that would target snail vectors more specifically.

Picturing Better Materials: Normative Data on a Novel Illustration Set for Scientific and Clinical Use.

Picture stimuli are essential materials for language research and clinical practice. Here, we generated a modern, full-color set of 310 illustrations representing a carefully designed, culturally sensitive list of imageable nouns. We normed the images in a diverse sample of healthy adults, so the images can be used in various populations, including older adults. We recruited a diverse online sample of 200 adults ages 19-76 years. Participants typed a name for each picture and reported how familiar they were with the item (familiarity) and how well the illustration matched their mental image of the item (image agreement). We assessed relationships among these three measures, between these measures and word features (e.g., frequency, length), and between these measures and demographic characteristics of our sample. Two hundred ninety-seven of 310 items had 70% or higher name agreement among participants. Most items had good to excellent image agreement and familiarity. The image measures showed expected relationships with relevant word features (e.g., frequency, length). Older age was associated with higher image agreement and familiarity but not written naming accuracy. As a group, Black participants demonstrated lower written naming accuracy than White and mixed race participants. Education, sex, and self-reported multilingualism were not significantly related to image measures. We generated a novel set of illustrations with strong name agreement, familiarity, and image agreement, which are suitable for a variety of uses in research and clinical settings. Our normative data suggest a future need for item-level analysis to explore variability in performance across different racial groups. https://doi.org/10.23641/asha.26321926.

The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway

Objective Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

The Maternal and Child Health Workforce: A Snapshot of Current and Future Needs From Public Health WINS 2021.

To summarize and examine data collected from the first-ever Public Health Workforce Interests and Needs Survey Maternal and Child Health (MCH) module. Responses from MCH governmental public health employees in 47 state health departments and 288 local health departments (LHDs) in the United States. Demographic characteristics; 4 measures from the MCH module: the importance of and skill level in 5 MCH competencies in daily work, growth and leadership development opportunities, and additional workforce development needs. The MCH workforce predominantly self-identified as women (91.2%) and as White, non-Hispanic (55.2%). At least 70% of respondents reported MCH competencies as important in their daily work, but only 44% to 57% reported being proficient in those competencies. The MCH workforce in LHDs were less likely than those in state health departments to report being proficient in MCH competencies (adjusted prevalence rate ratio range: 0.83-0.92) or have growth and leadership development opportunities (adjusted prevalence rate ratio range 0.76-0.90). The MCH module highlights a need to further prioritize workforce development efforts for governmental public health staff, especially in LHDs. There is an ongoing need to meet public health professionals where they are and to tailor training models and workforce development plans to account for new and ongoing stressors faced by the workforce.

Pandemic impacts on rural general practice: Trainees and supervision team working and learning together.

To explore the impact of COVID-19 pandemic disruptions on general practice trainees interdependent learning, from the perspectives of trainees and the whole of the practice team. Four rural general practices in Queensland that continued to supervise registrars, junior doctors and medical students through the pandemic. Twenty-three members of the general practice teams, including general practitioners, practice managers, receptionists, practice nurses, registrars, junior doctors and medical students. Audio-recorded semi-structured interviews were conducted with all participants following an initial survey. Thematic analysis and the theory of interdependent learning were used to understand how supervision and training was both disrupted and sustained during the pandemic period. Reporting is informed by the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Learning affordances were transformed by the rapid implementation of physical distancing and other infection control measures. Telehealth consultations and remote working impacted on the interdependent relationship between the work environment, supervision team and trainees. Practice staff identified new ways of working that arose through this period, including changes to practice team roles and the supervisory dynamic that enabled patient care and trainee learning to continue. Social connectedness was important to the trainees and the implications for future training need to be further evaluated.

Clinical Utility of Serum C-peptide Concentration for Hospitalized Patients with Hyperglycemia.

Serum C-peptide concentration is often utilized for diagnostic, prognostic, or therapeutic assessment in diabetes mellitus. However, there is limited clinical data regarding diagnostic and predictive value of C-peptide measured during hospitalizations for hyperglycemia. Adults admitted to Mayo Clinic inpatient facilities due to an acute hyperglycemic emergency between January 2017 and November 2022 were included in our study. Predictive capacity of C-peptide for discontinuation of therapeutic insulin was examined in the entire cohort and the subgroup of non-autoimmune non-pancreatitis diabetes (NANP-DM). We included 187 patients (63 women) in our study. During hospitalization, patients with type 1 diabetes antibodies displayed diminished serum C-peptide concentration (p=0.014), correlating inversely with subsequent HbA1c% [r= (-0.22), p=0.005]. Initial C-peptide concentrations did not differ between patients requiring insulin therapy during follow-up and those who did not (p=0.16). C-peptide concentrations showed limited predictive capacity for achieving glycemic control. Subgroup analyses in NANP-DM exhibited similar limited capacity for anticipating therapeutic insulin needs and achieving glycemic controls. C-peptide concentration did not exhibit a robust predictive capability for future need of insulin therapy and achieving glycemic control, limiting its utility in clinical practice within inpatient settings.

Pengaruh Citra Perusahaan Dan Persepsi Harga Terhadap Loyalitas Nasabah Dengan Mediasi Kepercayaan Nasabah (Studi Pada Nasabah Bni Life Regional Office Semarang)

The research is a literature review that analyzes the influence model of corporate image and influencer endorsement on customer loyalty through customer trust. The focus of research on customer loyalty BNI Life Regional Office Semarang is based on research gaps that arise from previous research, namely: Budiyanti's research, (2023) concluded, there is a positive influence between customer trust on customer loyalty, but Tandiwijaya and Pusparini, (2022) did not show a significant effect of customer trust on customer loyalty. Based on this research gap, this research on BNI Life Regional Office Semarang tends to support Budiyanti's research, (2023) which states that customer trust has a positive effect on customer loyalty. The phenomenon gap in this study is that there was a decrease in both the number of policies and the number of agents in 2016-2018 and the 2019-2022 period due to reduced agents and customer loyalty to BNI - Life. The results of this study indicate that company image has a positive effect on customer trust and customer loyalty, price perceptions have a positive effect on customer trust and customer loyalty, and customer trust has a positive effect on customer loyalty. Customer trust is able to mediate the effect of company image and price perception on customer loyalty. Suggestions for future research need to add other variables that affect customer loyalty. Suggested variables are: customer experience, brand equity and so on. Future research suggestions need to use comparisons to find out the position of PT BNI Life Insurance Regional Office Semarang with its competitors in increasing customer loyalty, by examining Axa Mandiri, BCA Life and so on.