Bridging the gap in implant dentistry education: Perspectives from Malaysia's graduating dental cohort.

In the ESPEN SIG meetings the similarities and differences between cachexia and disease-related malnutrition (DRM) were previously analyzed, as well as the role of inflammation in DRM. In the years 2023-2025, the SIG moving forward emphasized the relevance of the evolution of the cachexia definition and the advantage of considering DRM with chronic inflammation and cachexia as synonyms. We focused on the evidence regarding: i) the impact of DRM phenotypes and grade of inflammation on the efficacy of nutritional treatments, ii) the distinction between cachexia and end-of-life conditions, and iii) the identification of the barriers, facilitators and solutions for the implementation of the DRM definition among experts and non-experts in the field of nutrition. We underlined the importance of phenotyping those patients with DRM with inflammation to identify the most appropriate nutritional and metabolic interventions. Based on the role of inflammation in chronic and acute diseases, we discussed the impact of inflammation on the effectiveness of nutritional interventions. We discussed the differences between DRM with inflammation/cachexia and "end-of-life" conditions and the limited evidence on the efficacy of nutritional therapies in a palliative setting. Finally, the SIG discussed the barriers to the implementation of the concept of DRM, and suggested solutions. We emphasize the need for primary care training programs, to identify and address DRM early, and advocate for evidence-based interdisciplinary treatment strategies. The SIG recommends to enhance primary care nutritional and dietetic services, to support general practitioners and improve patient care through increased healthcare system engagement in clinical nutrition.

Prognostic implications of tumour number in intrahepatic cholangiocarcinoma.

The importance of young surgeons in surgical health policy advocacy engagement.

As the life expectancy of people with multiple sclerosis (PwMS) increases, the importance of recognizing and addressing specific needs and challenges faced by those undergoing age-related sex hormone changes and hypogonadism is becoming increasingly evident. We present expert-led, practical recommendations from a consensus program that address gaps in age-related sex hormone changes and hypogonadism in PwMS not sufficiently addressed in current literature and guidelines. A multidisciplinary steering committee (SC) of 15 international experts identified 18 key clinical questions across 6 themes: climacteric symptoms in women with MS; impact of MS on the climacteric stage; impact of menopause on MS disease activity and progression; treatment and management of climacteric symptoms in women with MS; late-onset hypogonadism (LOH) in men with MS; and patient-centered care. After thorough review of the evidence from a systematic literature review, the SC formulated 18 clinical recommendations to address the questions. These recommendations were voted on by the SC and an extended faculty of 23 health care professionals from 16 countries, including 2 nurses and 1 patient association representative. Consensus was reached when ≥75% of respondents expressed agreement, with a score of 7-9 on a 9-point scale. After a single voting round, all 18 recommendations reached consensus (14 reaching consensus at 90%-100% and 4 at 80%-90%). The clinical recommendations addressed the following: the potential overlap and exacerbation of MS symptoms during the climacteric stage; the need for preventive care and screening during the menopausal transition; the potential for, and a paucity of data on, differential efficacy and tolerability of MS medications in menopausal/postmenopausal women; the complex causal interplay between hormonal and/or immunologic changes and natural aging in PwMS switching to a more progressive phase of disease; consideration of behavioral/lifestyle interventions alongside pharmacologic treatments; effects of hormonal treatments on MS symptoms; and management of LOH in men with MS. These recommendations were based on a robust modified Delphi consensus approach and present a valuable framework for improved patient care. These results emphasize the need to address critical gaps in our understanding and management of PwMS undergoing age-related sex hormone changes and hypogonadism.

Development and validation of a workload prediction tool for nurses in pediatric intensive care units - The QuantI2S tool.

Radiographer research engagement: An international mixed methods study.

Referrals are the primary vessel for transferring patient information between primary care clinicians and specialists, providing a snapshot of the patient's condition and the question that ought to be addressed by the consultant. Despite their importance, no guideline currently exists outlining which components should be included in a quality referral for a cutaneous complaint. This scoping review summarizes the evidence outlining which components might be included in such referral. The review was conducted in accordance with PRISMA-ScR and Joanna Briggs Institute reporting guidelines. Sources from Embase, MEDLINE, Web of Science, and CADTH Grey Matters were screened independently and in duplicate. Data from 47 sources published between 1964 to 2023 was charted and synthesized. Results suggest cutaneous referrals should include referral information (e.g., reason for referral, urgency, and consultant details), referring clinician information (e.g., name, role, contact information), patient information (e.g., demographics, contact details) and clinical information. Clinical information emphasized the importance of characterizing the lesion or eruption (e.g., anatomical location, size, duration, evolution) and ABCDE criteria for suspected melanoma. If applicable, the referring clinician's impression of the lesion, explicit clinical suspicion of malignancy, and high-quality lesion photography was also noted. Relevant medical background, medications, psychosocial history, physical examination, and prior investigations and management were also highlighted and special considerations for inpatient referrals were noted. This scoping review provides a comprehensive list of components for high-quality referrals for cutaneous complaints, addressing a significant gap in medical communication. Standardizing components of referrals can enhance the quality and efficiency of referrals, ultimately improving patient care with more efficient and accurate triage.

Muslim patients may participate in religious and cultural practices that can affect their dermatologic health and influence their preferences regarding care and treatment. In this narrative review, we explore these topics and present culturally sensitive strategies for improving patient care for Muslim communities. We performed a literature review and identified articles published between 2005 and 2025 pertaining to the dermatological health and care of Muslim patients. We first discuss several key religious and cultural topics that can influence Muslim patients' perspectives on and participation with dermatological care, including views on contraception, modesty, divine will, and use of traditional medicines. Next, we summarize some specific religious and cultural prohibitions and observances than can affect dermatologic care, including tenets surrounding medications that contain animal products and the practice of fasting during the holy month of Ramadan. Lastly, we outline some key dermatoses associated with specific religious practices dermatologists should be aware of to enhance diagnostic accuracy and ensure timely, appropriate care. Importantly, we outline some key recommended clinical practices for providing evidence-based, culturally responsive dermatological care that respects patients' privacy, dignity, and spiritual values. Culturally competent dermatologic practice requires that clinicians understand health conditions and behaviors associated with religious and cultural practices and can employ clinical communication strategies that respect and incorporate patients' personal preferences. Enhanced awareness of the unique cultural and religious factors affecting dermatologic health in Muslim communities can help dermatologists foster trust and provide more effective, patient-centered care.

This article reviews the key concepts in pediatric headaches and provides a guide for neuroimaging assessment of children (≥ 2 years) and adolescents presenting with this chief complaint in both emergent and non-emergent settings. Contemporary imaging approaches (such as upfront utilization of abbreviated brain MR imaging) have been incorporated in the provided flow charts whenever appropriate. Our aim is to improve patient care and clinical outcomes by identifying the cases that need additional examinations and rapidly depicting any underlying serious disease (especially those requiring acute interventions) while at the same time reducing overuse of neuroimaging (especially irradiating CT) and associated risks and costs, thereby contributing to health system efficiency. KEY POINTS: Clinical history and physical/neurological exam are paramount in the initial evaluation/triage of children with headaches. Imaging should be avoided in children with primary headaches and low-risk mild traumatic brain injury. When imaging is required, prioritize ionization- and sedation-free techniques whenever feasible or minimize radiation dose.

Understanding the regional blood group distribution is essential for safe transfusion practice and efficient blood bank inventory management, as local variations in the ABO and Rh blood group systems guide donor recruitment and minimise shortages and transfusion incompatibilities. This study aimed to determine the prevalence and distribution of ABO and Rh blood groups among individuals attending a tertiary care hospital in Lalitpur, Nepal. Retrospective cross-sectional study. Department of Transfusion Medicine and Blood Bank of KIST Medical College and Teaching Hospital. All individuals attending a tertiary care hospital between 17 July 2018 and 31 July 2023 who underwent ABO and Rh blood group testing were included in this study. Individuals younger than 4 months of age and those with discrepant blood group results were excluded. Frequency and distribution of ABO and Rh blood groups among different categories. A retrospective cross-sectional study was conducted among individuals attending a tertiary care hospital after obtaining ethical approval from the Institutional Review Committee (reference number: 2080/81/91) of KIST Medical College and Teaching Hospital. The blood grouping and sociodemographic data of individuals were analysed using SPSS V.17.0, and statistical significance was established at p<0.05. Out of 20 966 individuals, 12 956 (61.80% (95% CI 61.14% to 62.45%)) were female, and 8010 (38.20% (95% CI 37.55% to 38.86%)) were male. The most common blood group was A+ 6629 (31.62% (95% CI 30.99% to 32.25%)), while AB- was the least common blood group 49 (0.23% (95% CI 0.17% to 0.30%)). The RhD+ cases were 20 432 (97.45% (95% CI 97.24% to 97.67%)) and the RhD- cases were 534 (2.55% (95% CI 2.33% to 2.76%)). O+ blood (OR 1.25 (95% CI 1.18 to 1.32), p<0.001) was most common in the males, whereas A+ was common in the females (OR 1.22 (95% CI 1.15 to 1.30), p<0.001). Of the two major blood group systems, the ABO and RhD systems, A+ and RhD+ blood groups were the most prevalent among individuals attending a tertiary care hospital. Understanding the regional distribution of blood groups supports effective blood bank management and transfusion services, ultimately improving patient care.

Integrating neuroscience and NLP to improve patient care, team dynamics and dento-legal outcomes

Valid diagnostic criteria for classifying pain-related temporomandibular disorders (TMDs) exist and can be applied with high interexaminer reliability to patients. However, adoption in most clinical settings, generalist and specialist, remains limited due to the examination complexity and time constraints in clinics. To address this limitation, we created a simplified examination protocol, and we test it here against reference standards based on the Diagnostic Criteria for TMD (DC/TMD). DC/TMD assessments include multiple provocation tests, 5 range-of-motion tasks, and 40 palpation points, as well as imaging for definitive joint diagnoses. We tested the simplified protocol using data from 2 multicenter studies: the TMJ Impact Project (n = 401) and OPPERA (n = 547). Examiners were trained and assessed annually for reliability, supporting generalizability. Diagnostic validity was assessed by area under the curve, sensitivity, specificity, and likelihood ratios (positive and negative). By using 2-s palpation at the full muscle (bilateral temporalis, masseter) and TMJ lateral pole, results showed high diagnostic performance for identifying painful TMD: area under the curve = 0.93, sensitivity = 0.88, and specificity = 0.98. Targeted single-band palpation within each muscle yielded comparable results. Adding other joint pain provocation procedures to the index test did not improve diagnostic accuracy. For acute closed lock, other disc-based TMDs, and degenerative joint disease, sensitivity remained ≤0.12 while specificity was ≥0.92. For subluxation, sensitivity/specificity was 0.81/0.97. Based on the likelihood ratios, clinical decision-making guidelines were developed for brief DC diagnoses. In conclusion, a simplified and shortened version of the DC/TMD protocol demonstrates excellent validity for identifying painful TMDs and is feasible for clinical practice. This approach reduces examination time while maintaining diagnostic accuracy, potentially improving patient care across broader clinical settings.

Genetics can inform biologically relevant drug development and repurposing, which may improve patient care. Here, we leverage the genetics of psychiatric disorders to prioritize potential drug targets and compounds. We used the genome-wide association studies of four psychiatric disorders [attention deficit hyperactivity disorder (ADHD), bipolar disorder, depression, and schizophrenia] and genes encoding drug targets. We conducted drug enrichment analyses incorporating the novel and biologically specific GSA-MiXeR tool. We conducted multiple molecular trait analyses using large-scale transcriptomic and proteomic datasets sampled from brain and blood tissue. This included the novel use of the UK Biobank proteomic data for a proteome-wide association study of psychiatric disorders. With the accumulated evidence, we prioritize potential drug targets and compounds for each disorder. We reveal candidate drug targets associated with a single or multiple disorders that implicate glutamate signaling. Drug prioritization indicated genetic support for psychotropic medications, including several top-ranked antipsychotics for schizophrenia. We also observed genetic support for commonly used psychotropics for psychiatric treatment (e.g., clozapine, duloxetine, and lithium). Revealed opportunities for drug repurposing included cholinergic drugs for ADHD, estrogen modulators for depression, and matrix metalloproteinases for ADHD and depression. Our findings indicate the genetic liability to schizophrenia is associated with reduced brain and blood expression of CYP2D6, a gene encoding a metabolizer of drugs and neurotransmitters, suggesting a genetic risk for poor drug response and altered neurotransmission. Our extensive analyses highlight the utility of genetics for informing drug development and repurposing for psychiatric disorders, providing novel opportunities for improving patient outcomes. Depicted is the series of analyses conducted to generate a list of prioritized drug targets and compounds. First pairings of genome-wide association study (GWAS) traits with drugs are generated using enrichment analyses. Next, a series of molecular trait analyses is conducted to generate and rank a list of potential drug targets for each GWAS trait. Finally, enrichment and molecular trait results are combined to generate a ranked list of prioritized drugs for each GWAS trait based on supporting genetic evidence. ADHD = Attention deficit hyperactivity disorder, BIP = Bipolar disorder, DEP = Depression, SCZ = Schizophrenia, DBP = Diastolic blood pressure, T2D = Type 2 diabetes, RNA = ribonucleic acid, XWAS = both transcriptome and proteome-wide association studies, MR = Mendelian randomization, coloc = colocalization.

To alleviate and prevent suffering, healthcare systems require collective action through organizational design and management. Therefore, healthcare organizations are appropriate contexts for studying the epidemiology of compassion – an emerging science that seeks to understand individual and systemic factors that foster compassion. Most research on compassion in healthcare settings has been conducted in high-income countries, focused on individual attributes that facilitate the giving of compassion. Less attention has focused on compassion in low- and middle-income country settings, or on organization- and system-level conditions that often determine whether compassion flourishes or falters. Epidemiology is a quantitative science, yet qualitative research can identify characteristics that warrant further testing and quantitative assessment. We conducted qualitative case studies of two primary healthcare organizations in Uganda and Kenya to examine how compassion is cultivated and sustained at the organizational level. Using the five components of the social architecture framework (network structures, organizational culture, roles, routines, and leaders) we discuss characteristics of these organizations that may enable compassionate responses to suffering among staff. Qualitative research in healthcare settings, framed by principles of organizational science, offers a pathway to sustaining healthcare workers and improving patient care. Increased attention to organizational and system-level compassion is needed, particularly in low- and middle-income countries where suffering is profound and complex.

We estimate age- and sex-specific reference intervals (RIs) for serum creatinine using indirect methods across multiple Romanian laboratories and evaluate their clinical relevance compared to manufacturer-provided RIs. Data were collected retrospectively from 6 laboratories representing a diverse patient population. Three indirect statistical independent methods, RefLim, the TML (truncated maximum likelihood), and refineR were applied. Data were preprocessed to exclude repeated measurements and high-risk patient samples. Results were stratified by age, sex, and clinical setting (outpatients vs inpatients). Clear age-related patterns were identified, with females showing a steady increase in creatinine and males a more complex pattern. In most female groups, the upper reference limits derived from indirect methods were 15% to 20% below manufacturer-provided RIs. Creatinine medians were 0.60 to 0.66 mg/dL (53.05 to 58.36 µmol/L) in women and 0.85 to 0.92 mg/dL (75.16 to 81.35 µmol/L) in men, diverging from European Kidney Function Consortium (EKFC) equation Q values. The use of indirect methods to establish RIs may capture population-specific differences that are not fully reflected by manufacturer-provided intervals. However, their results depend on rigorous preprocessing. Our results highlight that, while overall agreement exists among the TML and refineR approaches, careful consideration is needed for older patient groups where variability is higher. Ultimately, integrating locally derived RIs into clinical practice may improve patient care.

Surgeon-scientists have played a critical role in advancing understanding of human disease and improving patient care. Despite this legacy, the surgeon-scientist pathway in oral and maxillofacial surgery (OMFS) is increasingly vulnerable. For example, among 163 dentist-scientists funded as National Institutes of Health (NIH) principal investigators between 2003 and 2011, only a small fraction were OMFS faculty. This article discusses contemporary challenges facing OMFS surgeon-scientists and proposes a mentorship-based framework to support trainees across the career continuum. Drawing on published literature, workforce data, and the authors' collective experiences as mentors and trainees, we examine barriers encountered by clinician- and surgeon-scientists in the United States. These perspectives are integrated with an illustrative example of an OMFS surgeon-scientist training pathway to highlight practical considerations and potential solutions. Major challenges include inadequate financial support, limited protected research time, inconsistent access to high-quality mentorship, and increasing trainee disillusionment. These factors contribute to attrition at multiple transition points. In response, we outline a longitudinal mentorship model designed to support OMFS surgeon-scientists from early exposure in dental training through residency, postdoctoral training, and early- to mid-career faculty development. Financial pressures, structural constraints, and mentorship gaps continue to threaten the sustainability of the OMFS surgeon-scientist workforce. Early recruitment, combined with coordinated and longitudinal mentorship, is essential. Effective mentors must advocate for trainees within their institutions, facilitate access to diverse funding mechanisms, and engage national organizations to help stabilize and grow the OMFS surgeon-scientist pipeline.

High-flow nasal cannula (HFNC) therapy is widely used for respiratory support in critically ill patients, offering benefits such as improved oxygenation and reduced respiratory rate. However, HFNC failure can lead to adverse outcomes, including increased mortality. This narrative review examines predictive factors and indices for HFNC failure, including respiratory rate, P/F and S/F ratios, the ROX index, HACOR score, and emerging indices, such as VOX and FOX. Among these, the ROX index and HACOR score currently provide the most robust predictive value, whereas newer tools such as VOX and FOX require further validation. The ROX index, combining oxygenation and respiratory rate, has shown significant predictive value, particularly in COVID-19 patients, though its thresholds and timing for assessment remain variable. Modified versions of the ROX index, incorporating heart rate and PaO2, have improved predictive accuracy. The HACOR score, initially developed for non-invasive ventilation, also predicts HFNC failure but may be less discriminative in emergency settings. Emerging indices such as VOX and FOX offer novel approaches but face clinical application challenges due to measurement complexities. Risk stratification models, scoring systems, ultrasound techniques, and machine learning methods show promise but require further validation. This review highlights the importance of integrating multiple predictive tools and tailoring assessments to individual patient conditions. Future strategies must also account for nursing quality variables to enhance prediction accuracy in real-world settings. Comprehensive training for healthcare professionals and future multicenter, large-scale studies is essential to refine these predictive strategies and improve patient care quality.

The annual Brazilian Dialysis Survey (BDS) plays an important role in informing and shaping national health policies. To present the 2024 epidemiological findings from the BDS conducted by the Brazilian Society of Nephrology (BSN) and compare them with previous years. A survey was conducted among Brazilian chronic dialysis centers through voluntary participation, utilizing an online questionnaire to assess clinical and epidemiological characteristics of dialysis patients, as well as dialysis center attributes. For specific estimates of prevalence, incidence, and funding source, a nationally representative random sample of dialysis centers stratified by geographic region was selected (n = 258). A total of 386 dialysis centers (42.7%) voluntarily responded to the online questionnaire, and 162 centers from the randomly selected centers provided data. On July 1st, 2024, the estimated number of dialysis patients was 172,585, with 52,944 new patients starting dialysis in 2024. The estimated prevalence and incidence rates per million population (pmp) were 812 and 249, respectively. Among prevalent patients, 87.3% were undergoing hemodialysis, 7.1% hemodiafiltration, and 5.6% peritoneal dialysis. Compared to the previous year, there was an increase in catheter use for hemodialysis vascular access, along with higher prevalence rates of anemia, hyperphosphatemia, hyper-kalemia, and low Kt/V. The estimated crude annual mortality rate was 16.5%. Data from a random sample of dialysis centers indicate a continued rise in the number and prevalence of chronic dialysis patients in Brazil. Worsening trends in permanent vascular access, dialysis adequacy, and metabolic control underscore the need for targeted improvements in patient care.

Evidence-based quality indicators of soft tissue sarcomas in Germany 2015-2021: An analysis of the German Cancer Registry Group.