This study provides an analytical investigation of the thermomechanical behavior of biological skin tissue subjected to harmonic thermal loading within the framework of four thermoelastic theories. The four employed thermoelastic theories, namely the classical dynamic coupled theory (CDC), the Lord-Shulman (LS) theory, the dual-phase-lag (DPL) theory, and the nonlocal dual-phase-lag (NLDPL) theory, are utilised to represent various heat conduction mechanisms. The governing equations are derived for skin tissues and solved using the normal mode technique in conjunction with an eigenvalue approach. Numerical simulations are conducted to analyze the distributions of temperature, displacement, and stress fields, with the results illustrated through two- and three-dimensional graphical representations. The effects of angular frequency and the nonlocal parameter on the thermomechanical response are examined in detail. A comparative evaluation of the four thermoelastic theories (CDC, LS, DPL, and NLDPL) highlights their respective capabilities under harmonic heating conditions. The findings offer valuable insights into the behavior of skin tissues under varying conditions. These results may significantly contribute to the advancement of treatments such as hyperthermia therapy and laser surgery, thereby potentially improving patient care.

Personalized 3D-printed bone models are becoming increasingly popular in clinical care. Common applications include the visualization of idiopathic deformities or complex joint fractures. Functionalizing such printed replicas in terms of individual mechanical properties holds great potential for clinical training and research but is challenging due to the complexity of the bone structure. This study aims at developing a parametrizable structure as a substitute for spongious bone by simplifying 3D reconstruction and printing. 43 vertebrae from 6 body donors aged 86.8 ± 7.8 years were examined. Each spine underwent a clinical computed tomography scan. Cylindrical samples (Ø6 × 12 mm) were randomly taken from the left or right side of the vertebral body using a core drill in the superior-inferior direction. Specific software was used for determining the volumetric Hounsfield units of the spongious bone in each vertebral hemisphere. In parallel, a parametric hexagonal grid structure was designed using engineering software. All rods within the lattice have a variable length L and a fixed diameter of t = 0.4 mm. By varying the ratio t/L, six different porosities were defined. For each of these, five cylindrical lattice samples (diameter/length = 1/2) from two different synthetic resins were manufactured using the stereolithography printing process. All samples were mechanically characterized by uniaxial compressive testing. Curve fitting based on power functions (y = axb) allowed the determination of correlations between mechanical parameters and Hounsfield units (bone) as well as the lattice parameter t/L (3D-printed lattice). Finally, three vertebrae with varying bone quality were printed with their respected parameterized lattice and evaluated by comparing the axial screw pullout forces of the human and the respective printed bones. There is a significant correlation between the mechanical properties of the bone specimens and the determined Hounsfield units. Furthermore, the mechanical properties of the lattice can be excellently described by the ratio t/L. The printed vertebrae showed pull-out forces similar to those of osteoporotic bone. The mechanical behavior of vertebral human spongious bone can be well reproduced by a 3D-printed generic lattice structure. Patient-specific bone models can be generated by integrating the parameterizable lattice structure into the specific bone contours. These models can help in improving patient care, for instance by enabling highly realistic surgical approaches for particularly complex anatomies.

Surgical site infections (SSIs) are a serious complication of spinal surgery, leading to prolonged hospital stays, increased healthcare costs, and worse patient outcomes. This review aimed to synthesise current evidence on modifiable risk factors for SSIs in spinal surgery to identify targets for intervention, perioperative optimisation, and improve patient care. A systematic search of MEDLINE, Embase, Scopus, Academic Search Ultimate, and CINAHL was conducted on 10 March 2024. Risk of bias was assessed using the Newcastle-Ottawa Scale, ROBINS-E, and the Oxford Centre for Evidence-Based Medicine: Levels of Evidence. A random-effects meta-analysis generated pooled odds ratios (ORs) with 95% confidence intervals (CI). Heterogeneity was assessed using I², Cochran’s Q, and associated p-values. Sensitivity and influence analyses evaluated the robustness. Forty-four studies were included, comprising 637,032 patients and 9,745 SSIs. Modifiable risk factors associated with increased SSI risk included body mass index, diabetes mellitus (including insulin-dependent), smoking, low preoperative haematocrit (< 33–39%), and chronic steroid use. Subcutaneous fat thickness > 30 mm and operative time > 2 h were also considered partially modifiable. Intraoperative vancomycin powder significantly reduced SSI risk. Non-modifiable risk factors included (American Society of Anaesthesiologists) ASA ≥ 3, female sex, coronary artery disease, revision surgery and procedures involving ≥ 3 vertebral levels. Age, alcohol use, albumin levels, instrumentation and blood transfusion were not significantly associated. High heterogeneity was noted for several variables, particularly BMI and diabetes. Several modifiable risk factors for SSIs were identified. Intraoperative vancomycin powder showed a protective effect. These findings offer perioperative strategies including glycaemic control, smoking cessation, anaemia management, and steroid dose adjustments to reduce SSI incidence and improve outcomes.

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.

Introduction: Since the founding of the first Physician Assistant (PA) program in 1965, the role of PAs has shifted dramatically. Their scope of practice has broadened and includes provision of care for critically ill patients. For over 30 years, the Society of Critical Care Medicine has delivered the Fundamental Critical Care Support (FCCS) Course to provide multidisciplinary education for diagnosis and management of patients with critical illness. Our goal was to assess changes in PA confidence in management of critical illness after exposure to the FCCS course. Methods: Between May 2018 and November 2019, PAs (both practicing and students) enrolled in our institution’s FCCS course were asked to participate in a study exploring the effects of FCCS education. Using 5-point Likert scales, critical care confidence was assessed in 11 domains pre-course, post-course, and after a 3-month follow-up period. Statistical analysis was performed using a combination of parametric and non-parametric methods. Demographics and opinions on the effectiveness of course participation were also collected. Results: Overall, a total of 38 PAs participated in the course during the study period and enrolled in the study. Thirty (78.9%) completed the post-course survey with demographic information and 24 (63.2% of total) completed the 3-month follow-up. Characteristics of the 30 participants included: 24 females (80%) with a mean age of 30 years; 17 students (56.7%); 4 post-graduate PA fellows (13.3%); and 9 practicing PAs with a mean of 2.4 years of experience (30%). Participant total confidence in critical care assessment and management increased by a mean of 8.41, p< 0.0001 after course completion. The increases were significant over all 11 domains of course content. Analysis at 3 months post-course demonstrated the increased confidence persisted in all domains. Overall, 25 participants completing the post-course evaluation (86.2%) rated the course content as helpful in their practice and 26 (89.7%) would recommend the course to others. Conclusions: Physician Assistant confidence in the assessment and management of critical illness increased significantly after FCCS participation. Further study is needed to investigate if this increased confidence translates to improvement in patient care and outcomes.

Introduction: Since the late 1960s, paramedics have been tasked at providing care to unstable pre-hospital patients. With the advent of advanced flight and critical care paramedic training, transport paramedics are increasingly called upon to provide scene and interfacility care to the sickest cohorts of patients. Pre-hospital critical care has been associated with lower rates of mortality in some populations. The Fundamental Critical Care Support course (FCCS) has been used to provide standardized critical care education to an interprofessional audience. Our goal was the evaluation of the effect of FCCS participation on paramedic confidence with management of critically ill patients. Methods: Between May 2018 and November 2019, paramedics taking part in our institutions multidisciplinary FCCS course were invited to participate in a study assessing the impact of FCCS participation. Across 11 critical care domains, 5-point Likert scales were used to assess critical care confidence along with a summed total. Students were surveyed in the pre-course, post-course, and 3-months follow-up periods. A combination of parametric and non-parametric methods were used for statistical analysis. Results: A total of 28 paramedics enrolled in the study and completed the pre-course survey. Three participants (10.7%) dropped out after initial enrollment and 25 (89.3%) completed the post-course survey (which included demographic information). An additional 3 participants dropped out in the follow-up period for total 3-month follow-up participation of 22 (78.6% of initial enrollment). The majority of participants were male (17/25, 68%) and the mean age was 37.7. Average time in practice was 11.8 years. Total confidence in critical care assessment and management improved after course participation (p< 0.0001) and was significant in 7 of the 11 domains. In the 3-month follow-up period, confidence levels were maintained in all domains, but continued to improve for respiratory failure (p=0.0156). Conclusions: Paramedics’ overall confidence with critically ill patient management significantly increased after FCCS participation. FCCS is now an institutional requirement for our critical care paramedics. However, further study is needed to evaluate if paramedic FCCS involvement results in direct improvements in patient care.

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.

People living with chronic kidney disease (CKD), individuals receiving dialysis therapies, and those with both native and transplant kidneys undergo routine blood testing for regular follow-up and monitoring of CKD and its complications. There is a lack of evidence supporting the established frequency and utility of testing, which is largely based on historical practice and expert consensus. While early identification and correction of critical laboratory values can lead to improved clinical outcomes, surveillance bloodwork does not always lead to changes or improvements in patient care. As with all investigations, bloodwork has implications for patients, health care providers and our health care system, impacting costs and the environment. Frequent monitoring of highly variable laboratory values may also lead to overtreatment or undertreatment. The purpose of this review is to synthesize the existing evidence pertaining to current blood testing frequencies across the spectrum of patients with CKD to fully inform the appropriateness of care. The sources included published studies and available guidelines regarding the frequency of routine surveillance bloodwork in patients with CKD G3-5, including those receiving all types of dialysis therapies, and recipients of a kidney transplant. Information was gathered from database searches using a search strategy that included keywords related to bloodwork, lab work, frequency, chronic kidney disease, kidney transplant, and dialysis modalities. Reference lists of relevant studies were also screened. There is a paucity of evidence underpinning monthly routine lab testing across the spectrum of patients with CKD. Five observational studies compared outcomes between in-center hemodialysis patients undergoing monthly bloodwork and those receiving less frequent bloodwork (every six weeks). Of those five studies, four demonstrated that it is safe to undergo less frequent testing. The totality of current data, while limited, suggests that for in-center hemodialysis patients, less frequent testing is a safe strategy. No such data exist for other dialysis or non-dialysis CKD populations. Evidence is needed to inform an appropriate testing frequency across the spectrum of patients with CKD to optimize care at the patient, provider, system, and planetary levels. A formal systematic review was not undertaken, and therefore, there is a possibility of bias in the included studies.

Crohn's disease is a transmural inflammatory bowel disease, which can progress to stricturing and internal penetrating complications. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are utilized with endoscopy to detect and stage small bowel Crohn's disease. Small bowel strictures and associated penetrating complications are commonly missed complications of fibrostenosing Crohn's disease at CTE/MRE. This educational review focuses on factors contributing to unreported or overcalled strictures including disease location, postoperative anatomy, erroneous understanding of threshold dilation for stricture diagnosis, and underappreciation for how stricture diagnosis can improve patient care, emphasizing current understanding of Crohn's small bowel strictures using illustrative cases. In addition, we explain emerging consensus for how strictures and their associated obstruction can be consistently measured and described. We also review frequently missed complications of fibrostenosing Crohn's disease such as chronic mesenteric venous occlusion and penetrating complications, including blind-ending sinus tracts, and ileoappendiceal and complex enteroenteric fistulas. Finally, common mimics of fibrostenosing Crohn's disease including NSAID enteropathy, radiation enteritis, and other entities are discussed, highlighting key distinguishing imaging and clinical features. Radiologists must be proactive in identifying strictures to improve patient outcomes and prevent unnecessary delay in surgical intervention or access to targeted biologic therapies.

285th ENMC international workshop: SMN-associated neurodevelopmental disorder: type 1 spinal muscular atrophy and the brain, 31st January - 2nd February 2025, Hoofddorp, The Netherlands.

Though specialty pharmacies collect and report a myriad of measures to internal and external stakeholders, these data are infrequently used for evaluating specialty pharmacy performance or clinical decision-making. Establishing standardized specialty pharmacy measures could enable benchmarking, performance-based contracting, and high-cost drug utilization management while improving patient care and specialty medication management. To determine consensus among specialty pharmacy stakeholders on important and usable measures for specialty pharmacies managing patients with rheumatoid arthritis (RA). A modified Delphi study was conducted with a multisite study group (n = 25 sites). Expert panelists from diverse RA-related backgrounds participated in up to 3 survey rounds. An environmental scan informed an initial list of 10 generalized measures. In rounds 1 and 2, panelists rated each measure's importance and usability on an 11-point Likert scale. Measures were categorized to be included, excluded, or rescored based on mean scores. Panelists received group scores and feedback between rounds. In round 3, specialty pharmacy-affiliated panelists assessed the feasibility of measures that reached consensus. Final study group voting categorized measures as core (should be collected and reported by all specialty pharmacies without exception), reach (important and actionable but not yet essential for specialty pharmacies to collect and report), or neither. Of 315 recruited panelists, 118 participated; response rates were 83% (round 1), 76% (round 2), and 73% (round 3). In round 1, 4 measures met consensus; 3 measures moved forward to be rescored in round 2, and 2 general measures were delineated to more specific measures for feasibility scoring. Feasibility consensus varied. Final study group voting identified 7 specific core measures: adherence, serious adverse effects, patient response to therapy, medication discontinuation, medication switching, and tuberculosis and hepatitis B screening (if applicable). Six reach measures included immunization screening, drug-specific laboratory screening, common AEs, patient functional status, patient disease activity, and medication persistence. There was a high survey response rate within each round. Consensus was reached for 13 measures deemed important and usable by specialty pharmacy stakeholders, with most considered moderately/very feasible by specialty pharmacists.

Prediction models that accurately predict patient prognosis and treatment response enable the development of personalized treatment plans in dermatology as well as outside dermatology. This can improve patient care and reduce the use of ineffective, potentially harmful treatments. Developing representative models for all patients can be a significant challenge, particularly in cases involving rare outcomes or expensive molecular biomarkers. The former requires large cohorts, whereas the latter requires a significant budget to measure these in a large volume of samples. Nested case-control and case-cohort designs are cost-effective designs that enable the development and validation of prediction models using only a proportion of samples of the source cohort, without compromising their applicability to the total population. These epidemiological designs are relatively unknown, and there is a lack of clear guidance on how to develop and validate models using these studies. We aim to inspire other researchers to apply these designs to their (skin) disease of interest and facilitate the development of prediction models that can have a high clinical impact on patient care.

Prominent 19th-century anatomist Josef Hyrtl (1810-1894) made contributions to anatomy that continue to influence contemporary medical practice. Highlighting his discovery of the foramen of Hyrtl and its relevance in neuroradiology and neurosurgery, the authors explore Hyrtl's life, career, and lasting impact. Dr. Hyrtl transformed anatomical education through innovative teaching strategies, emphasizing practical dissection and observation. His comprehensive research into comparative anatomy, the vascular system of the head and neck, and ear anatomy advanced our understanding across various medical fields. One focus of Hyrtl was a landmark feature in the superolateral bony orbit, where a small arterial connection exists between the middle meningeal artery of the external carotid artery and the ophthalmic artery. Attention to the small, superior orbital bony aperture-the foramen of Hyrtl, which contains this collateral branch-is necessary for the safety of modern interventional techniques to avoid blindness and stroke. The legacy of Hyrtl underscores the importance of fundamental anatomical knowledge in medical advancement, despite a career marked by both controversy and acclaim. This review highlights the interconnectedness of anatomical observations throughout history and their ongoing value in enhancing medical knowledge and improving patient care by examining Hyrtl's contributions in both historical and contemporary contexts.

The purpose of this study was to enhance access to medication assistance programs (MAPs), which are crucial for providing free medications to patients who cannot afford them. These programs are particularly beneficial for the management of chronic conditions such as diabetes, heart failure, and cancer, for which medication adherence is vital for positive patient outcomes, and cost is a common barrier. This quality improvement project aimed at optimizing the MAP enrollment process. Interventions included the development of frequently asked questions documents, standardized templates for documentation, establishment of MAP technician office spaces, and standardization of patient referrals. A Mann-Whitney U test and a chi-square test were used to summarize the data in this study. The project resulted in a 56% increase in new patient enrollments (p < .01) and a 33% increase in medications provided, with a significant reduction in the average time from patient referral to application approval. The project improved patient access to MAPs, optimized pharmacy technician resources, and significantly reduced processing times, an important factor in preventing treatment delays and improving patient care. Future plans include expanding the new enrollment process to annual reenrollments, formally establishing the MAP technician within departments, and considering additional pharmacy technician support in response to increasing demand for MAPs.

Medical Apps for Physicians: Leveraging MHealth to Enhance Healthcare.

IntroductionInterprofessional collaboration (IPC) and interprofessional education (IPE) are widely recognised as essential for improving teamwork and reducing medical errors. However, despite their importance, implementing IPC and IPE in hospital settings remains challenging, and little is known about how they are understood and enacted in everyday clinical practice. This study explores how healthcare professionals perceive IPC and IPE within a diverse hospital environment and how these practices unfold in routine clinical work.MethodsAn ethnographic design was employed, incorporating field observations, shadowing of healthcare staff, and semi-structured interviews with a range of healthcare professionals. The data were analysed collaboratively and iteratively to identify key themes relating to IPC and IPE in daily clinical work.ResultsThe data analysis revealed three interrelated themes directly affecting IPC and IPE: commitment, skills and competencies, and environmental factors. Commitment was strongly influenced by shared professional experiences, which led to improved team cohesion, a better working atmosphere, and enhanced motivation. Competencies such as communication, respect, leadership, and emotional/moral qualities, such as humility, were identified as critical in translating commitment into practice. Environmental factors, including financial constraints, workload, and inadequate resources can hinder IPC, while IPE programs, empowering nurses, and small, cohesive units were identified as facilitators.ConclusionsThe study contributes to a deeper understanding of IPC and IPE in everyday healthcare clinical settings, highlighting the critical role that both human and structural factors play in improving patient care.