Maternal perception of reduced fetal movements is a frequent reason for referral to maternity services and may signal risk of adverse outcomes, particularly stillbirth. To identify contemporary maternal and pregnancy-related risk factors for RFM and to examine associations between RFM and perinatal outcomes. A prospective case-control study in a large urban maternity hospital in Ireland was conducted. Women with singleton pregnancies with RFM at ≥24 weeks' gestation between 1 January and 30 September 2020 (cases) were compared with randomly selected women without RFM during pregnancy (controls) from the same population and timeframe. Associations were assessed using univariate and multivariable logistic regression analyses. A total of 850 women with RFM were compared with 1743 controls. Women with RFM were younger (mean age [SD] 33.8 [5.04] vs 34.4 [4.93] years; p = 0.004), had a higher body mass index (BMI) (mean [SD] 26.6 [5.76] v 25.89 [5.10]; p < 0.05) and more likely nulliparous (68 % vs 43.8 %; p < 0.001). Multivariable analyses identified anterior placenta (OR 1.24 95 %CI 1.05-1.46; p = 0.01), a prior history of neonatal death (OR 4.65, 95 % CI 1.43-15.15; p = 0.01), and recurrent miscarriage (OR 1.64, 95 % CI 0.99-2.72; p = 0.05) as independent risk factors for RFM. RFM was not associated with stillbirth, preterm birth or neonatal death but was significantly associated with small for gestational age (SGA) infants (OR 1.48, 95 % CI 1.09-2.02). Women with RFM were more likely to undergo induction of labour (aOR 1.44 95 %CI 1.20-1.74) but not emergency caesarean section (aOR 1.20 95 % CI 0.80-1.80), or neonatal intensive care admission. RFM is influenced by maternal and pregnancy characteristics and is associated with SGA but not severe adverse perinatal outcomes. Careful assessment of women presenting with RFM, targeted growth surveillance, antenatal education and standardised care pathways are essential to optimise maternal and fetal well-being, inform clinical practice, and guide policy in contemporary maternity care.

Income is closely linked to morbidity and mortality in the United States, potentially due in part to differences in patient experience. However, existing studies on income and care experiences are outdated and have other important limitations. Using data from a recent national sample of adults (N=5016), we conducted a mixed-methods investigation of the relationship between income and primary care experiences. Patient experience was measured using the CAHPS Clinician and Group survey (CG-CAHPS) and its associated Narrative Item Set (NIS). Closed-ended responses were used to create 4 composite measures, for example, access to care, while open-ended NIS responses were coded for positive and negative mentions of 7 aspects of care: access, coordination, communication, office staff, efficiency, thoroughness, and emotional rapport. Contingent on mentioning an aspect of care in their narratives, low-income participants had lower unadjusted odds of making positive mentions of access, coordination, communication, office staff, efficiency, and emotional rapport (all P- values ≤0.02). Conversely, they had higher unadjusted odds of making negative mentions of coordination, communication, efficiency, and thoroughness (all P -values ≤0.006). Patterns were similar after controlling for education and other characteristics. Low-income participants also had scores on all CG-CAHPS composite measures that were 3-5 points lower than scores for higher-income participants (all P- values <0.001). Low-income patients report fewer positive and more negative health care experiences than higher-income patients across multiple aspects of care. These deficits may contribute to their higher morbidity and mortality. Further research is needed to uncover underlying causes and inform policies and practices to ensure high-quality care for all patients.

Characterise longitudinal patterns of chiropractic visits for neck pain or low back pain by using machine learning (ML) methods and explainable models. Using de-identified claims data from 2016 to 2023 for adults from the Optum Labs Data Warehouse, we applied spectral clustering (SC) to identify novel patient clusters. Then we used explainable boosting machines (EBM) for feature ranking followed by hierarchical group lasso regression for feature selection. A logistic regression model used for parameter estimates. SC identified 3 clusters-low, moderate and high dose-based on their pattern of chiropractic visits. An interesting finding was a small cluster where patients received persistently higher care for several months. Age, gender and number of prior visits to a chiropractor, primary care provider, or physical therapist emerged as strong indicators for provider type and frequency of visits. Patients receiving spinal manipulative therapy sorted into 3 markedly different trajectories of utilisation. This unexpected variation mandates further investigation to identify optimal dose based on patient and provider characteristics. We also present EBM, a robust alternative to computationally heavy feature selection methods, to identify features necessary for predictive models. This approach obviates the need for opaque feature selection methods. Results show the use of advanced, explainable methods to discover knowledge that can be missed by other methods. We present an approach to identify hidden patterns in large data that can guide hypothesis driven research. Our work can identify factors that drive high utilisation of services and inform practice guidelines.

Diabetes mellitus arises from complex interactions between biological susceptibility and diverse environmental influences that extend beyond traditional "genes versus lifestyle" models. The exposome is defined as the aggregate of non-genetic environmental exposures and their biological consequences across the life course. It provides a systems-level framework to evaluate this interaction, spanning chemical, physical, social, and behavioral domains while integrating them with internal molecular responses to decode how environments shape metabolic health. Emerging assessment strategies, including exposome-wide association studies (ExWAS), high-resolution mass spectrometry-based biomonitoring, geospatial and remote-sensing platforms, and wearable exposure sensors, enable characterization of multi-exposure profiles rather than single agents in isolation. Within exposome domains, air pollution, endocrine-disrupting chemicals, food-borne contaminants, exposome characteristics of the built environment, and chronic psychosocial stress have each been shown to contribute to the development and progression of both type 1 and type 2 diabetes. These diverse exposures often share common pathogenic mechanisms of chronic low-grade inflammation, oxidative and nitrosative stress, alterations in the gut microbiome, and epigenetic changes that ultimately lead to glucose dysregulation. Recent progress in metabolomics, lipidomics, and epigenomics is elucidating the "internal exposome," providing molecular fingerprints that encode prior exposure and detect early metabolic disruption. This integrated approach argues for a paradigm adjustment in diabetes prevention from behavior-centered strategies to those that also target upstream environmental determinants. Exposomic information can improve risk prediction, inform precision public health and medical practice, and inform policy regarding air pollution, chemical use, urban planning, and food systems. This review summarizes the current state of knowledge of the exposome in diabetes, describing its conceptual underpinnings, major tools of assessment, major epidemiologic findings, and biological mechanisms, and identifying the key challenges and opportunities for exposomics to inform effective approaches to diabetes prevention and planetary health.

Persistent dietary restriction can result in people with eating disorders becoming so severely physically and mentally compromised that they are considered a risk to their own life. In these circumstances, individuals may be subjected to involuntary treatments, including nasogastric tube (NGT) feeding under restraint. This systematic scoping review identifies and assesses the evidence available to healthcare professionals to inform clinical practice decisions related to NGT feeding under restraint in eating disorder care, and highlights gaps in knowledge to be addressed in future research. Six electronic databases, six grey literature sites, 12 professional bodies, and four eating disorder conference websites were searched in May 2025. 36 sources met inclusion criteria, including: peer reviewed papers and practice guidelines. Peer-reviewed literature (22) included quantitative, qualitative, and mixed methods research studies, and systematic reviews. Grey literature (14) included practice guidance in the form of expert opinion, expert consensus, and practice standards. A narrative review was structured using deductive analysis focused on the following research questions in relation to eating disorders care: (1) where and how is NGT feeding under restraint happening? (2) how are healthcare professionals making decisions about when and how to use NGT feeding under restraint? (3) what are patients, parents/carers, and healthcare professionals' experiences of NGT feeding under restraint? And (4) what are the patient outcomes of NGT feeding under restraint? There is clear guidance that NGT feeding under restraint should be delivered minimally, as a lifesaving intervention in line with the legal principle of 'least restrictive practice'. No comprehensive, multi-disciplinary guidelines or frameworks were identified to support achieving this in practice. Further research is required to improve understanding of who is at risk of receiving NGT feeding under restraint, the long- and short-term risks associated with its use, and what care processes can improve patient outcomes. Future research should support development of multi-disciplinary guidance to improve clinical decision-making and patient outcomes.

The science of learning (learning science) is an interprofessional field that concerns itself with how the brain learns and remembers important information. Learning science has compiled a set of evidence-based strategies, such as distributed practice, retrieval practice, interleaving, elaboration, and contextual learning, which are quite relevant to continuing professional development (CPD). Spreading out study and practice separated by cognitive breaks (distributed practice), testing oneself to check mastery and memory of previously learned information (retrieval practice), mixing the learning of separate but associated information (interleaving), making connections between concepts one is trying to learn and other known concepts (elaboration), and leveraging cues to remember important information (contextual learning) represent strategies that are underutilized in CPD. Participants and planners alike can benefit from learning science recommendations to inform their decisions. Managing cognitive load, the subject of this article, is another evidence-based strategy that supports the study and practice of important information. By better understanding cognitive load to avoid unnecessary and excessive mental strain, CPD participants and planners can make more informed educational decisions.

The aim of this study was to investigate the prevalence of vestibular and/or postural balance alterations in children with congenital cytomegalovirus (cCMV) and to determine the association between the infection and these impairments compared to a control group. This systematic review was registered with Prospective Register of Systematic Reviews (CRD42024549387) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines consulted five databases (Embase, LILACS, PubMed/MEDLINE, Scopus, and Web of Science) and gray literature (Google Scholar and ProQuest). It included studies with children aged 0-12 years diagnosed with cCMV by laboratory tests performed in the first 21 days of life. Eligible studies assessed vestibular function and/or postural balance and compared children with cCMV with a control group of children without the infection. Only observational studies were included. A meta-analysis was performed to estimate the association between cCMV and vestibular changes, using a random-effects model and subgroup analysis. The risk of bias was assessed using the Joanna Briggs Institute checklist, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. The qualitative synthesis included eight observational studies of the 2,840 studies identified. All reported vestibular and/or postural balance changes in children with cCMV. The meta-analysis demonstrated an approximately 10-fold increased risk of vestibular changes in this group, especially in symptomatic children. Although the pooled risk ratio suggested a strong association, the certainty of the evidence was rated very low according to GRADE, which considers study quality, consistency, precision, and risk of bias. Children with cCMV, especially those with symptoms, have a significantly increased risk of vestibular and postural balance changes. However, given the very low certainty of the evidence, these results should be interpreted with caution. Future well-designed research should prioritize pediatric vestibular screening to confirm these associations and inform clinical practice.

ObjectiveFew studies examine how therapists adapt their approaches when providing psychological therapy to children seeking refuge and asylum and how therapists experience the unique challenges of this work. This study aims to explore therapists' experiences in delivering therapy to children seeking refuge and asylum, specifically focusing on how they conceptualise their work and provide care to this population.MethodNine mental health therapists working in the United Kingdom took part in semi-structured interviews and data was analysed qualitatively using thematic analysis.ResultsData from the interviews were organised into three superordinate themes: the importance of remaining flexible in therapy; stepping into different roles; navigating therapeutic instability. These themes covered the kinds of adaptations that therapists make in their work with this population - both in technique and therapeutic stance - as well as the struggles therapists face.ConclusionsThis study explored therapists' experiences of delivering therapy to CSRA. Findings highlight the centrality of cultural adaptations in this work, alongside therapists' roles in supporting patients with non-clinical needs. Therapists also reported emotional distress related to the significant challenges and instability CSRA face during the asylum process in the UK. Further research could examine these areas in greater depth to strengthen the understanding of clinical work with CSRA and inform practice and policy.

ABSTRACT Millions of children in the United States attend residential summer camp each year. Within these settings, healthcare providers are tasked with complex workflows that include medication management, chronic and acute disease management, and support for camper and staff MESH concerns, yet lack quality metrics and benchmarking of traditional healthcare settings. The aim of this study was to identify a core set of priority quality metrics for pediatric residential summer camp health services to guide quality improvement, inform practice, and establish a foundation for future research. Using e-Delphi methodology, camp experts participated in iterative survey rounds, evaluating the importance of proposed metrics on a Likert scale. Survey rounds continued until consensus was reached on a finalized list of core quality metrics. Experts were then asked to rank each metric on four qualities to establish a priority ranking of the list. Eleven core quality metrics were identified based on expert consensus. In the final ranking survey, mean scores ranged from 2.23 to 2.55, with pre-camp health form completion, documentation reliability, and illness-related health center visits identified as the highest priority metrics. The finalized list highlighted the importance of health service processes over clinically driven outcomes. This perspective suggests experts view reliable systems and support as foundational to quality care in the residential camp setting.

Children and adolescents are disadvantaged when it comes to drug therapy, as drugs are frequently used off-label for this age group. Despite regulatory measures such as the EU Paediatric Regulation, off-label use in paediatrics remains widespread. Since 2021, the online platform "Kinderformularium.DE" has been providing evidence-based dosing recommendations for on- and off-label drug use in Germany, establishing itself as reliable source of information in paediatric practice. This study aims to analyse the scope of age-appropriate (off-label) dosage recommendations provided and to evaluate usage patterns and user satisfaction. Drug monographs were examined to determine the availability and licensing status of age-specific dosing recommendations, taking into account different indications and routes of administration. Auser survey was conducted between November 2024 and February 2025 and analysed using amixed-methods approach. Kinderformularium.DE contains 637 monographs with 5536 individual age-specific dosage recommendations. Both the number of dosage recommendations and the licensing status vary by age: there is less dosage information available for preterm and newborn infants, and this information is more frequently classified as off-label. The survey confirms the platform's high level of acceptance-it is used frequently, particularly by doctors-and highlights its importance in the care of paediatric patients. With its age-specific (off-label) dosage recommendations, Kinderformularium.DE is an important tool for ensuring medication safety in paediatric clinical practice in Germany. The platform must continue to be updated and expanded on an ongoing basis.

Gastric and gastroesophageal junction adenocarcinoma (GC/GEJC) poses a substantial clinical burden in China. This updated guideline introduces a refined human epidermal growth factor receptor 2 (HER2) classification system (high, intermediate, low, absent) to redefine patient stratification for targeted therapy. It integrates cutting-edge evidence on standardized detection-including immunohistochemistry, in situ hybridization, and liquid biopsy-to overcome spatial-temporal heterogeneity. Recent progress in the use of HER2-targeted agents, including monoclonal antibodies, antibody-drug conjugates, tyrosine kinase inhibitors, and bispecific antibodies, is systematically reviewed and presented to inform evidence-based clinical practice. These updates aim to optimize personalized HER2-targeted therapy and improve outcomes in GC/GEJC patients.

While a substantial proportion of Turkish PICUs allow 24-h family presence for non-intubated patients, restrictive policies remain common for visitors and siblings. The prohibition on family presence during procedures represents an important gap in the implementation of family-centered care. These findings highlight opportunities for policy development and staff education. • Restrictive visitation policies in pediatric ICUs increase family stress and may prolong patient recovery. • Family-centered care with 24-hour family presence improves patient and family outcomes. • Visitation and family information practices vary widely between countries and institutions. • This is the first national survey evaluating visitation policies and family information practices in Turkish pediatric ICUs. • Most Turkish PICUs allow 24-hour family presence but maintain some visitation restrictions. • Significant differences exist between isolation-room-only and mixed-room units regarding visitation and family information provision.

Efficient oral feeding is a key functional milestone in neonatal and early childhood care, reflecting neuromuscular maturation, physiological stability, and readiness for hospital discharge. Infants and young children, particularly those born preterm, frequently experience feeding difficulties due to immature oral motor coordination. Structured oral motor interventions have been proposed to enhance feeding-related outcomes; however, their effectiveness remains variably reported. This systematic review and meta-analysis aimed to evaluate the effectiveness of oral motor interventions in improving feeding and oral motor outcomes in infants and young children compared with routine care. A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials published between 2014 and 2024 were identified through PubMed, Cochrane Library, and Google Scholar. Eligible studies involved infants and young children with feeding difficulties or underdeveloped oral motor function and evaluated structured oral motor interventions compared with routine care or standard feeding support. Study selection was performed using Rayyan. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2.0. Where appropriate, random-effects meta-analyses were performed, and effect estimates were presented as mean differences or standardized mean differences with 95% confidence intervals. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Ten randomized controlled trials were included. All included studies involved preterm infants receiving neonatal clinical care. Oral motor interventions were associated with improvements in feeding readiness, sucking-swallowing coordination, feeding efficiency, and earlier achievement of full oral feeding compared with routine care. Interventions incorporating Premature Infant Oral Motor Intervention demonstrated the most consistent benefits, particularly in reducing the time required to achieve independent oral feeding. The certainty of evidence ranged from low to moderate, with methodological heterogeneity and limited blinding representing the main sources of bias. Oral motor interventions were associated with clinically relevant improvements in feeding-related outcomes among preterm infants compared with routine care. Overall, the findings support oral motor interventions as a clinically relevant adjunct to routine care for preterm infants with feeding difficulties associated with underdeveloped oral motor function. However, the certainty of evidence ranged from low to moderate, highlighting the need for further well-designed randomized controlled trials to clarify long-term developmental implications and inform evidence-based clinical practice. PROSPERO CRD420251270705.

This study aimed to evaluate the knowledge, attitudes, and lived experiences during the peri and postmenopausal phases among women slum dwellers in Kanpur, Uttar Pradesh, India. This qualitative study comprised 35 women slum dwellers aged between 40 and 64 years who had experienced menopause in the previous 5 years. Data were collected using semi-structured interviews and analyzed using reflexive thematic analysis after an iterative approach to understand the knowledge, attitudes, and lived experiences of women. The identified themes were further compared and discussed with the help of available literature to draw significant conclusions. This study unveiled the misery of women slum dwellers during the perimenopausal and postmenopausal stages in terms of sociocultural constraints, accessibility of services, information, and health-seeking behaviors. Attitudinal variations were also observed; the majority of women enjoyed this phase and viewed it as a sign of freedom from pain and mental liberation. In contrast, women also felt upset by viewing it as an end to their femininity and womanhood. Medical implications are generally ignored by these women despite experiencing a range of physical, emotional, and psychological changes. Those seeking medical support are vulnerable in terms of receiving the right information and guidance, making them further stigmatized for adopting traditional unsafe practices. Government policies also neglect women's health during menopause. All these factors lead to the creation of a vicious circle during menopause. Breaking the culture of silence surrounding menopause empowers women to make their own decisions. If they are treated inappropriately, it may lead to severe health consequences. The findings underscore the critical need to design culturally appropriate, gender-sensitive, and community-oriented health education programs, along with improved access to menopausal health services, especially for women belonging to marginalized groups. A focused intervention with an integrated approach is substantially needed to improve menopausal health, along with providing the right information and encouraging healthy behavioral practices.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are currently recommended as one of the four pillars of treatment in heart failure (HF) with reduced ejection fraction (HFrEF). Following the approval of dapagliflozin in 2020, real-world data are relevant for the medical community and payers. This study aimed to characterize the patient population with dapagliflozin initiated for HFrEF in clinical practice in 9 countries from Central Eastern Europe and the Baltic Area (CEE-BA). EVOLUTION-HF CEE-BA is a multicentre, multi-country, observational, longitudinal study conducted in 102 centres in Bulgaria, Croatia, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, and Slovenia. All treatment decisions were at the discretion of the patient's healthcare providers, based on the locally approved product information and routine clinical practice. Patients with type 1 diabetes, prior treatment with dapagliflozin or other SGLT2i, and initiation of dapagliflozin outside the approved HFrEF indication were excluded. The baseline period covered 12 months prior to dapagliflozin initiation, with prospective follow-up continuing up to 12 months or until loss to follow-up, death, or study discontinuation, whichever occurred first. Descriptive statistics and Kaplan-Meier methods were used. A total of 1131 patients with HFrEF were included in the full analysis set. Ischaemic aetiology was present in 52% of patients. The mean left ventricular ejection fraction was 32%. The most frequent comorbidities were atrial fibrillation (46%), type 2 diabetes (37%), and chronic kidney disease (29%). At the time of dapagliflozin initiation, 93% of patients received any combination of a renin-angiotensin-aldosterone system inhibitor (RAASi), beta-blocker (BB), or mineralocorticoid receptor antagonists (MRA). Of all patients, 60% received concomitantly all three classes plus dapagliflozin for their HFrEF. Except for dapagliflozin, which was administered as 10 mg/day, optimal doses were recorded for 14% for any RAASi, 17% for BB, and 25% for MRA. At 6- and 12-month follow-up, maintenance of dapagliflozin treatment was recorded in 95% and 96% of patients, respectively. The real-world median time to discontinuation of dapagliflozin has not been reached. The percentage of patients receiving all four classes recommended in HFrEF remained stable over the study period. Adverse events were reported spontaneously, as in routine clinical practice in each centre. This large non-interventional study provides a contemporary perspective of the treatments used in HFrEF over 1-year follow-up. Despite high dapagliflozin persistence rates, a low proportion of patients received complete guideline-directed medical therapy in optimal doses. Improvement of HF management decisions across the CEE-BA region is warranted.

The construction industry is one of the major contributors to global environmental degradation due to its high carbon emissions, excessive resource consumption, and large volumes of construction and demolition waste. In response to this issue, this study explores the integration of Building Information Modeling (BIM) with Life Cycle Assessment (LCA) to assess the environmental performance of green concrete incorporating recycled coarse aggregate (RCA). A systematic literature review was conducted to explore the convergence of BIM, LCA, circular economy (CE) principles, and green concrete technologies. Based on the identified research gaps, a BIM-integrated LCA framework was developed to assess environmental indicators—such as global warming potential, water footprint, and resource depletion—under different RCA alternative scenarios. The model was applied to a real administrative building project in Vietnam, where concrete mixes with different RCA contents (0, 30, 60, and 100%) were evaluated using the Tally plugin and the Ecoinvent v3.8 database. The results showed that while the use of RCA can reduce water consumption and some toxicity indicators, it can increase carbon emissions due to the higher cement demand required to maintain compressive strength. These trade-offs highlight the need for cement reduction and material optimization strategies to be incorporated early in the design phase. By embedding environmental indicators into the BIM environment, the approach supports scenario-based, data-driven decision-making in line with CE objectives. These findings demonstrate the potential of accessible and low-cost BIM-LCA tools to increase transparency, enable circular material tracking, and inform sustainable design practices. The model provides a replicable approach to integrating digital workflows and green material choices in construction, contributing to broader carbon reduction and zero waste goals.

The Effectiveness of Tranexamic Acid in Pediatric Posttonsillectomy Hemorrhage (A Systematic Review and Meta-Analysis).

The purpose of the study is to identify priority areas for the modernization of university education in the field of digital skills development based on a comparison of international approaches to measuring digital competencies, data of official Rosstat statistics for 2025, and modern online learning models. Special attention is paid to identifying the gap between normative models of digital competencies and actual practices of their use by the population, as well as finding effective educational mechanisms to bridge this gap. Methods of research. The methodological basis of the study includes the analysis and comparison of international frameworks for digital competencies (DigComp 2.2, ITU Digital Skills Toolkit, PIAAC), which make it possible to structure digital skills by levels, as well as official statistical data from the Federal State Statistics Service (Rosstat) for 2022–2025, reflecting the prevalence of various types of online activities among the population aged 15 years and older. Additionally, a systematic review of modern online education models as an environment for developing applied digital competencies was conducted. The study employs methods of comparative analysis, systematization, generalization, and interpretation of empirical data. Results. The structure of the population’s digital skills is found to be markedly heterogeneous: despite the widespread adoption of basic communication and information practices (calls, video calls – 80.5%; file sharing via messaging – 75.9%), more complex and professionally significant competencies remain poorly represented (use of neural networks – 6.4%; programming – 1.5%). A steady increase has been recorded in the use of cloud technologies (from 16.5% in 2022 to 20.5% in 2025) and information verification skills (from 12.3% to 15.0%). It is shown that international models of digital competencies cover a wide range of skills, including data processing, digital content and artificial intelligence technologies; however, the actual level of these skills among the population lags significantly behind. It is argued that online education, characterized by high adaptability, a modular structure, project-based orientation, and a close connection with practical labor market needs, serves as an effective environment for developing in-demand digital skills and can be considered a reference model for updating university curricula. Conclusion. The study concludes that systemic modernization of university education is necessary, considering the identified imbalances in the structure of the population’s digital skills. Key priorities include integrating universal modules on generative artificial intelligence (prompt engineering, generation of analytical materials, automation of routine tasks), developing cloud-related competencies (collaborative work, data processing in digital environments, the use of BI systems), and implementing project-based learning methods. Mechanisms for improving the assessment of educational outcomes are proposed, including the use of digital portfolios and the recognition of online learning outcomes through crediting the results of mastering individual disciplines and the recognition of learning outcomes, as well as a phased roadmap has been developed for integrating digital modules into bachelor’s degree programs.

Post-donation care is variable in Canada. A virtual workshop including donors and health providers was conducted to advance recommendations for a new national standard of living donor follow-up. Attendees participated in facilitated breakout groups to deliberate pre-set questions on a draft care model informed by a survey of 685 previous donors. Deliberations were audio-recorded, transcribed, and imported into HyperRESEARCH software to facilitate inductive, systematic and auditable coding of the data. Final meeting recommendations were approved by attendees and then presented for consideration of endorsement by all Canadian programs. We identified four themes: (1) Establishing a donor centric long-term follow-up plan; (2) Generating data to optimize donor outcomes; (3) Safeguarding donors and (4) Partnership to strengthen care (transplant centers enacting duty of care, setting expectations with donors for follow up, supporting a collaborative model with primary care doctors, harnessing technology, ensuring consistency, regularity, and feasibility). Post-donation care should be donor-centric, flexible and based on a strong collaboration between primary care providers and transplant programs. The new model should include a "safety net" to provide specialist care when needed, as well as donor consent for capture of long-term health outcomes in a national registry. The recommendations are endorsed by all Canadian living donor programs. Although necessary, the provision of universal health care coverage alone is insufficient to ensure long-term donor health and inform future practice. A new national model of long-term donor follow-up informed by the lived experience of past donors and input from primary care and transplant providers was proposed.

Adolescents and young adults are rarely included alongside parents and clinicians in codesign of interventions in pediatric oncology, particularly for sensitive communication topics such as prognosis. We examined the feasibility of mixed-participant codesign, including pediatric patients, parents, bereaved parents, and multidisciplinary clinicians, within the RIGHTime study. We conducted eight longitudinal virtual mixed-participant codesign sessions across four sequential blocks spanning 5months. Eligible participants included patients aged ≥12years with advanced cancer, parents of children with advanced cancer, bereaved parents, oncologists, and psychosocial clinicians. Feasibility outcomes included enrollment and attendance. To characterize participants' experiences, we analyzed structured reflections from each session, eliciting perspectives on the benefits and challenges of the mixed-participant codesign approach. Twenty-one participants contributed: patients (n = 4), parents (n = 5), bereaved parents (n = 4), oncologists (n = 5), and psychosocial clinicians (n = 3). Among invited patients and parents, 13/19 enrolled, and the mean attendance across four blocks was 92.5%. Reflections highlighted the value of shared dialogue, including learning across perspectives, connection, and attention to individualized communication. Patients and parents described gratitude and legacy-oriented motivations; clinicians described perspective-taking and incorporation of insights into communication practices. Across groups, reflections suggested that shared dialogue informed both intervention development and clinician communication practices. Mixed-participant codesign that includes adolescents and young adults alongside parents and clinicians was feasible in pediatric oncology communication research. Participant reflections suggest this approach may support the development of patient-centered communication interventions and inform clinician communication practices. This model may be transferable to pediatric oncology settings where patient perspectives are essential to intervention design. ClinicalTrials.Gov Identifier: NCT05116566.