Recommendations For Interventions Research Articles

Geriatric assessment in older patients with non-small cell lung cancer: Insights from a cluster-randomized, phase III trial—ENSURE-GA study (NEJ041/CS-Lung001).

1502 Background: To determine optimal treatment in older cancer patients, it is recommended to conduct a geriatric assessment (GA) before chemotherapy. The ENSURE-GA study, which focused on patients aged 75 and older with non-small cell lung cancer (NSCLC), reported that the implementation of GA not only enhanced patient satisfaction with regards to communication with their physicians, but also improve the patients’ quality of life. Additionally, we assessed whether GA could improve overall survival and serve as a predictor for severe adverse events. Methods: Patients aged ≥75 with NSCLC who were unable undergo radical treatment were enrolled. All patients underwent a standardized GA before treatment. The participating institutions were cluster-randomized into either intervention group or control group. For the intervention group, GA summaries and recommendations for GA-guided interventions were provided to guide physicians in selecting treatments and interventions. The control group did not provide physicians with GA summaries. Geriatric 8 (G8) and CARG scores were calculated at enrollment, and we investigated whether adverse events during a 3-month follow-up could be predicted. Results: Between 2019 and 2022, 1,021 patients were enrolled from 78 institutions in Japan. No significant differences were observed in patient characteristics or for GA domains between intervention and control groups. Additionally, there were no significant differences seen in 1-year overall survival (20.7m vs 18.8m, p = 0.414), or the incidence of grade 3 or higher adverse events in patients treated with medical treatment (36.8% vs 38.1%, p = 0.732). The ROC curve for G8 regarding the occurrence of grade 3 or higher adverse events in cases receiving cytotoxic chemotherapy yielded an AUC of 0.525, indicating no discriminatory ability. Furthermore, there was no difference in the incidence of adverse events between low-risk and high-risk patients based on the CARG score. Conclusions: The implementation of GA and interventions based on its results enhances patient satisfaction. However, additional studies are needed before incorporating GA into an adverse event prediction system. Developing risk scoring tools specific to cancer types and races may prove useful. Clinical trial information: UMIN0000037590 .

AI-powered fertility assessment tool

The integration of artificial intelligence (AI) into fertility assessment and treatment presents a promising solution to the pervasive issue of infertility, offering individuals and couples personalized insights and recommendations on their reproductive health journey. By harnessing machine learning algorithms, an AI-powered fertility assessment tool analyzes diverse datasets encompassing demographic and clinical variables to generate comprehensive fertility profiles. These profiles provide predictions of fertility potential, identification of risk factors for infertility, and tailored recommendations for lifestyle modifications or medical interventions. The tool's adaptability and capacity for continuous improvement through user feedback and updated research ensure the relevance and effectiveness of its recommendations, while stringent privacy measures safeguard sensitive information. Preliminary testing demonstrates high accuracy and user satisfaction, highlighting the tool's potential to transform reproductive healthcare by streamlining assessments, reducing diagnostic uncertainties, and facilitating early interventions. However, the responsible implementation of AI-powered tools requires careful consideration of ethical, regulatory, and societal implications to ensure equitable access and mitigate algorithmic biases. Overall, AI-powered fertility assessment tools signify a significant advancement in reproductive medicine, offering hope and empowerment to individuals and couples navigating the complexities of fertility challenges.

Occurrence and Risk Factors for Cognitive Decline Shared by Couples: A Systematic Review and Meta-Analysis

Background: To date, the magnitude of association and the quality of evidence for cognitive decline (mild cognitive impairment, Alzheimer’s disease, and dementia) in couples and risk factors for outcomes have not been reviewed and analyzed systematically. Objective: The aim of this study was to investigate the concordance of cognitive impairment in unrelated spouses and to qualitatively describe potential risk factors. Methods: Eight databases were searched from inception to October 20, 2023. Eligible studies were independently screened and assessed for quality. Statistical analysis was conducted using Stata 15.1 software. The study was preregistered with PROSPERO (CRD42023488024). Results: Eleven studies involving couples were included, with moderate to high evidence quality. Compared to controls, spouses of individuals with cognitive impairment had lower cognitive scores (Cohen’s d: 0.18-0.62) and higher risk of cognitive decline (OR = 1.42, 95% CI: 1.15–1.76). The consistency of cognitive impairment between spouses was attributed to three theories: 1) the impact of caregiving stress experienced by the spouse; 2) assortative mating, which suggests that individuals select partners with similar characteristics; and 3) the influence of shared living environments and lifestyles. Conclusions: The cognitive status of one spouse can affect the cognitive function of the other spouse. It is important to consider shared lifestyle, environmental, and psychobehavioral factors, as they may contribute to the risk of cognitive decline by couples. Identifying these factors can inform the development of targeted recommendations for interventions and preventive measures.

Connecting the dots: a systematic review of explanatory factors linking contextual indicators, institutional culture and degree awarding gaps

PurposeThe primary aim of this paper is to illuminate the critical issue of the degree awarding gap in the UK, which significantly impacts students from lower socio-economic backgrounds and minority groups. By conducting a systematic review of existing literature following the PRISMA protocol, this study seeks to uncover the complex web of explanatory factors that mediate the relationship between contextual indicators, institutional culture, and degree awarding disparities. Addressing this gap is vital for promoting social justice, enhancing the economy, safeguarding the reputation of UK universities, and adhering to legal responsibilities. This paper endeavours to provide a comprehensive understanding of the underlying causes of degree awarding gaps and offer evidence-based recommendations for the higher education sector to mitigate these disparities.Design/methodology/approachThis study employs a systematic review design, adhering to the PRISMA protocol, to meticulously analyse the existing body of literature concerning the degree awarding gap in UK higher education. By systematically gathering, evaluating, and synthesizing relevant studies, the review aims to identify and understand the multifaceted factors mediating the link between contextual indicators, institutional culture, and the disparities observed in degree awarding. This methodological approach ensures a rigorous and transparent examination of the literature, enabling the identification of both the breadth and depth of research on the topic. Through this design, the paper aspires to uncover nuanced insights into the mechanisms driving degree awarding gaps.FindingsThe review’s findings reveal that degree awarding gaps in UK universities are influenced by a constellation of factors, highlighting the complexity of this issue. Key among these are unconscious bias, limited student engagement opportunities with academic staff, institutional racism, inadequate support systems, and a scarcity of social and cultural capital. These factors collectively contribute to significant disparities in degree outcomes, disproportionately disadvantaging students from lower socio-economic backgrounds and minority groups. The evidence suggests that institutional practices and culture play a pivotal role in either exacerbating or alleviating these disparities, indicating the need for targeted interventions to address the root causes of degree awarding gaps.Research limitations/implicationsOne strength of conducting a systematic review is its rigorous and meticulous nature, which ensures that the process is carefully planned and executed. This comprehensive approach allows for the elimination of biases, as the review systematically gathers and analyses existing literature on the topic. By adhering to a structured methodology, the systematic review enhances the validity and reliability of the findings, providing a robust and unbiased synthesis of the available evidence. This strength lends credibility to the research and reinforces the confidence in the conclusions drawn from the review.Practical implicationsThe practical implications arising from this information indicate that universities need to address the identified issues directly by implementing supportive strategies and interventions. By doing so, they can create a learning environment that is more inclusive and equitable, allowing all students to unlock their full potential. This may involve measures such as raising awareness about unconscious bias, promoting engagement between academic staff and students, implementing anti-racist policies, establishing comprehensive support systems, and actively fostering social and cultural capital. Such practical actions will contribute to reducing the degree awarding gaps and promoting equal opportunities for all students, ultimately leading to a more equitable and successful educational experience.Social implicationsThe social implications derived from this information are significant. By implementing supportive strategies and interventions to address the identified issues, universities can contribute to creating a more inclusive and equitable learning environment. This has the potential to have a transformative impact on society by providing equal opportunities for all students to unlock their full potential. By raising awareness about unconscious bias and implementing anti-racist policies, universities can foster a more diverse and inclusive community. Promoting engagement between academic staff and students and establishing comprehensive support systems can enhance social cohesion and create a sense of belonging. Ultimately, these efforts can lead to reduced degree awarding gaps and contribute to a more equitable and successful educational experience, positively influencing broader social equality and cohesion.Originality/valueThis paper contributes significantly to the literature by offering a comprehensive, systematic review of the factors contributing to the degree awarding gap in UK higher education, highlighting its originality and value. By focusing on the interplay between contextual indicators, institutional culture, and degree awarding disparities, the study provides novel insights into how these dynamics contribute to educational inequities. Furthermore, the evidence-based recommendations for institutional interventions presented in this paper furnish the higher education sector with actionable strategies to foster a more inclusive and equitable learning environment. This work not only advances academic understanding of degree awarding gaps but also offers practical value to policymakers and educational institutions aiming to enhance social justice in higher education.

Interventions to Reduce Intra-Operative and Post-Operative Pain Associated with Routine Dental Procedures in Children: A Systematic Review and Meta-Analysis.

implementing appropriate pharmacological and non-pharmacological interventions to alleviate pain related to routine dental procedures in paediatric patients could enhance children's ability to manage dental care. The aim of this review was to investigate the effectiveness of and provide recommendations for interventions that can be used to reduce intra-operative and post-operative pain associated with routine paediatric dental procedures. A systematic review of randomised controlled clinical trials (RCT) was conducted. Multiple electronic databases were systematically searched. The Cochrane risk-of-bias tool for RCTs was used to evaluate the quality of the included studies. A meta-analysis was performed to determine the effectiveness of the interventions using the Cohen's d standardised mean differences (SMD) and 95% confidence intervals (CIs) for continuous outcomes. The GRADE tool was used to assess the certainty of evidence to make recommendations. The review included forty-five RCTs comprising 3093 children. Thirty-seven RCTs were included in the meta-analysis, which showed the effectiveness of behavioural interventions (SMD = -0.50, 95% CI -0.83 to -0.18), mechanoreceptor and thermal receptor stimulation (SMD = -1.38, 95% CI -2.02 to -0.73) for intra-operative pain, and pre-emptive oral analgesics (SMD = -0.77, 95% CI -1.21 to -0.33) for reducing post-operative pain in children receiving routine dental care. The GRADE results for these interventions were strong recommendation (IB) for their use, based on moderate evidence and their benefits far outweighing the harm, and they can be delivered readily with minimal training to reduce the pain experience of paediatric patients.

Preparing Vulnerable Communities: Disaster Mitigation Strategies for Economically Depressed Areas in Oklahoma

When disasters strike, vulnerable areas that are economically disadvantaged are adversely affected economically, culturally, and healthily, as the lack of resources and vulnerabilities amplify their problems. This research focuses on the population specifics of disaster vulnerabilities and targeted policies for economically depressed neighborhoods in Oklahoma. Relative to less susceptible entities, poor people are likelier to take damage from tornados, winter storms, wildland fires, and flooding because they lack the resources required for preparation, response, and recovery. Through an equity-focused lens, the study examines four key factors amplifying disaster risk: those due to aging critical infrastructure, lack of insurance and savings, health disparities, or the failure to plan adequately. Collapsed stormwater drainage systems, roads, bridges, and water pipes in financially deprived communities experience cracks in a hurry during duresses. With little or no funds, families earning every paycheck cannot afford to purchase rescue insurance or, in the case of names, save money to build an emergency fund, including money to cover repair costs, temporary housing, and other costs. This is, of course, made even worse by any previously existing medical, disability, or mental health issues as well, with poorer health outcomes than might usually be expected since access to healthcare services, treatments, and medications is also disrupted. Lastly, language and education barriers lead to the lower development of disaster plans; the delays include access to early warning systems and a need for more awareness of risks among vulnerable groups. Given these weaknesses, the study offers policymakers, funders, and resilience practitioner’s implementable policy, investment, and community-oriented intervention recommendations. The hazards can be lessened by prioritizing infrastructure upgrades, insurance reduction, and commitment to spread-out shelters and relief supplies. Long-term recovery programs financed specifically by equal aid promote program equity of rebuilding. Regarding inclusive messaging on public preparation and early warnings, local trusted institutions should be appropriated to reach a diverse population. Collaborative networks among government agencies, relief organizations, businesses, and grassroots associations can bolster response capacity. Their unified efforts on localized resilience initiatives advance strategic plans for the state's most economically fragile neighborhoods. Implementation should focus on those with the highest vulnerability markers and the least ability to prepare, respond, and recover independently— metrics assessing community functionality, equity factors, and recovering spending offer evidence-based progress milestones. With climate change projected to increase disaster severity in Oklahoma, research-driven and equitable resilience policies for marginalized communities can reduce prolonged suffering. Tailored preparation, outreach, critical system backups, and financial support lessen acute shocks and accelerate recovery. However, sustainable policy change relies on addressing root socioeconomic inequalities through systemic interventions beyond immediate disaster management.

Evaluating the impact of exercise on intermediate disease markers in overweight and obese individuals through a network meta-analysis of randomized controlled trials.

The aim of this study is to investigate the impact of exercise on intermediate disease markers in populations with overweight and obesity, providing evidence-based recommendations for clinicians to utilize these markers in developing exercise prescriptions for this group. The study was conducted by retrieving data from PubMed, Embase, Cochrane Library, Web of Science, and CNKI and only including Randomized Controlled Trials (RCTs) to examine the effect of different exercise interventions on intermediate disease markers in overweight and obese people. The quality of the included studies was evaluated using the Cochrane Bias Risk Assessment tool and the data was analyzed using Stata 15.1 data analysis software. The RCTs were collected from January 2017 to March 2024. A total of 56 RCTs were included and the results of 10 outcomes were analyzed using random effects meta-analysis. The total sample size used in the study was 3193 The results showed that resistance training significantly reduced total cholesterol (SUCRA: 99.9%), triglycerides (SUCRA: 100.0%), low-density lipoprotein (SUCRA: 100.0%), systolic pressure (SUCRA: 92.5%), and increased high-density lipoprotein (SUCRA: 100.0%). Aerobic exercise significantly reduced insulin (SUCRA: 89.1%) and HbA1c (SUCRA: 95.3%). Concurrent training significantly reduced HOMA-IR (SUCRA: 93.8%), diastolic blood pressure (SUCRA: 71.2%) and Glucose (SUCRA: 87.6%). Exercise has a significant impact on intermediate disease markers in populations with overweight and obese. Compared with no exercise, exercise lowers total cholesterol, triglycerides, LDL, systolic blood pressure, diastolic blood pressure, HOMA-IR, insulin, and HbA1c, and increases HDL in people with overweight and obese. These findings provide evidence-based recommendations for exercise interventions aimed at weight reduction and the prevention of chronic diseases in individuals with overweight and obese.

Reduced Student Life Satisfaction and Academic Performance: Unraveling the Dark Side of ChatGPT in the Higher Education Context

Little is known about the dark side of ChatGPT adoption in the higher education context; the current study, therefore, adopts the stressor-strain-outcome model to examine how compulsive use of ChatGPT and its consequences, such as loneliness and social avoidance (stressors), lead to the increased level of psychological distress (strain), which, in turn, negatively has the detrimental impacts on student life satisfaction and academic performance (outcomes). Moreover, the recent study also aims to test the moderating role of technostress in the strain-outcome relationship. Drawing on the sample of 2709 higher education students collected across 16 universities in Vietnam using a stratified random sampling approach, results reveal a positive correlation between compulsive use of ChatGPT, loneliness, social avoidance, and psychological distress. Furthermore, psychological distress mediates the relationship between compulsive ChatGPT use, diminished life satisfaction, and reduced academic performance. The study also shows a series of indirect effects of compulsive ChatGPT use on academic performance through sequential mediation pathways involving loneliness and social avoidance. Noticeably, the current research reveals that technostress not only reinforces the negative impacts of psychological distress on student life satisfaction and academic performance but also weakens the positive effect of student life satisfaction and academic performance. Based on the findings of this research, some practical and interventional recommendations are provided.

Promoting planting in front gardens: a systematic approach to intervention development.

Planting in front gardens is associated with a range of human and environmental health benefits. Effective interventions aimed at cultivating this practice are, however, hampered by the paucity of theory- and evidence-based behavioural research in this context. This study aims to systematically determine a set of behaviour change interventions likely to be effective at promoting planting in front gardens amongst UK householders. The Behaviour Change Wheel framework was applied. Behavioural systems mapping was used to identify community actors relevant to front gardening. Potential behavioural influences on householders' front gardening were identified using the Capability, Opportunity, Motivation, Behaviour model. Using peer-reviewed scientific findings as evidence, behavioural influences were systematically linked to potential intervention strategies, behaviour change techniques and real-world implementation options. Finally, intervention recommendations were refined through expert evaluations and local councillor and public stakeholder feedback, evaluating them against the Acceptability, Practicability, Effectiveness, Affordability, Side effects and Equity criteria in a UK implementation context. This study formulated 12 intervention recommendations, implementable at a community level, to promote front gardening. Stakeholder feedback revealed a preference for educational and supportive (social and practical) strategies (e.g., community gardening workshops, front gardening 'starter kits') over persuasive and motivational approaches (e.g., social marketing, motivational letters from the council to householders). Householders' front gardening behaviour is complex and influenced by the behaviour of many other community actors. It also needs to be understood as a step in a continuum of other behaviours (e.g., clearing land, gardening, waste disposal). This study demonstrates the application of behavioural science to an understudied implementation context, that is, front gardening promotion, drawing on a rigorous development process promoting a transparent approach to intervention design. Stakeholder consultation allowed relevance, feasibility and practical issues to be considered. These improve the likely effectiveness of interventions in practice. The next steps include evaluating the proposed interventions in practice.

#1664 Assessing vascular access thrombectomy service adherence to GIRFT recommendations: single centre experience

Abstract Background and Aims Studies showed that early thrombectomy of dialysis vascular access (VA) is associated with better outcomes [1], especially for native VA [2]. Timely treatment of VA thrombosis within 24-48 hours is recommended by GIRFT to minimize access loss and requirement for dialysis line insertion [3]. Our centre has approximately 430 HD patients but has no on-site vascular surgery or vascular access interventional radiology (IR) service. Wait time for elective VA surgery or fistuloplasty is >8 weeks and VA surveillance is based on routine clinical monitoring. VA prevalence is 62% AV fistula (AVF), 2% AV graft (AVG), 36% central venous catheter (CVC). Fistula thrombectomy is provided at another centre, with increasing waiting times over recent years due to shortage of interventional radiologists. This study evaluates adherence to GIRFT recommendations for patients at our centre requiring thrombectomy and will identify potential local strategies to reduce fistula thrombosis and CVC use. Method In a 24-months’ retrospective cohort analysis of maintenance HD patients with permanent VA, we obtained data on: Results 44 patients with permanent VA developed VA thrombosis. The median waiting time for thrombectomy was 8 days (Fig. 1). Post-intervention primary patency rate was 71% at 3-months and 60% at 6-months (Fig. 2). 61% of patients required hospital admission with a 12-day median length of stay, with total inpatient admission days of 403 days over 2 years (2022-2023), and total cost of £246,065 (Figs. 3 and 4). The median CFD-extended was 356 days, i.e. 9 days/patient/year with VA-related complications (Fig. 5). Conclusion This study shows that our centre's VA thrombectomy service falls far outside the GIRFT recommendation of intervention within 24-48 hours. The high associated rates of CVC use, inpatient bed days and avoidable costs place a heavy burden on patient outcomes and NHS resources. The ideal solution of an on-site thrombectomy service is difficult to achieve due to lack of vascular IR support. In response to this study, we now aim to reduce thrombosis rates by training additional interventional nephrologists in elective fistuloplasty, implementing a robust VA surveillance to improve early detection of malfunctioning VA suitable for elective intervention and improving staff education on fistula care.

The dark triad, dating app use and online disinhibition positively predict technology-facilitated sexual violence perpetration

Technology-facilitated sexual violence (TFSV) describes the perpetration of a variety of sexual offences committed through digital communication technologies. The current study aims to investigate the similarity of risk factors between TFSV and in-person sexual offending. The sample consisted of 105 young adult, Australian males who responded to measures of sexual violence acceptance, dating app usage, online disinhibition, and the dark triad. Overall, 45.3% of the sample reported at least one instance of TFSV perpetration in the past 5 years. Standard and hierarchical linear regressions revealed dating app usage, the dark triad, and online disinhibition positively predicted TFSV perpetration. Neither measure of attitudes accepting of sexual violence predicted TFSV perpetration, but their positive correlation is indicative of cultural norms enabling sexual violence against women. As illuminated here, the congruence between TFSV and in-person violence extends beyond conceptual and prevalence trends to predictive risk factors. Recommendations for interventions and prevention include raising awareness of risk-generating app features that create vulnerability to sexual harm and identifying heterogenous groups of TFSV offenders based on key characteristics to develop optimal intervention strategies.

Assessing the Impact of Digital Transformation on Public Service Delivery in Zimbabwe

Governments worldwide increasingly recognize the need to accelerate digital transformation to enhance public service delivery, drive economic growth, and ensure societal resilience in an increasingly digital age. This study focuses on the impact of digital transformation on public service delivery in Zimbabwe, considering the country's unique socio-political and economic context. Through a comprehensive literature review, this research examines the challenges and opportunities presented by digital transformation, aiming to assess its effects on service quality, citizen engagement, and overall governance. The study contributes to the growing body of literature on digital transformation in developing countries, emphasizing best practices, key challenges, and recommendations for future interventions. Employing a quantitative methodology with stratified random sampling techniques, the research finds that the adoption of digital technologies in Zimbabwe has streamlined processes, improved resource utilization, and enhanced responsiveness to citizen inquiries and feedback. These findings underscore the importance of digital transformation in enhancing public service delivery and informing policy decisions in Zimbabwe.

Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Severe Ischemic Left Ventricular Systolic Dysfunction

Coronary artery disease is the most common cause of heart failure, which is the leading cause of cardiovascular-related death worldwide. There are insufficient data to make strong recommendations for percutaneous coronary intervention (PCI) in patients with severe ischemic left ventricular systolic dysfunction (LVSD). In that context, we performed a meta-analysis to compare the outcomes of PCI with those of optimal medical therapy alone in patients with severe ischemic LVSD. A systematic search was conducted in PubMed, EMBASE, and ClinicalTrials.gov from inception to December 2023. Our outcome of interest was all-cause mortality in patients undergoing PCI vs medical therapy. We used random effects models to aggregate data and to calculate pooled incidence and relative risk with 95% CIs. Four studies including 2 randomized controlled trials with 2080 patients (PCI, 1082; optimal medical therapy, 998) were included. All-cause mortality did not differ significantly between the groups: 168 patients (15.5%) in the PCI group vs 200 patients (20.0%) in the optimal medical therapy group (relative risk, 0.88; 95% CI, 0.75-1.09; P=.25). In conclusion, the available evidence indicates that PCI does not improve all-cause mortality in patients with severe LVSD without lifestyle-limiting anginal symptoms. Further data are needed to identify subgroups of patients better served by each modality.

Carotid Disease Classification: Impact of the 2021 Intersocietal Accreditation Commission Updated Recommendations vs 2003 Society of Radiologists in Ultrasound Consensus Conference Criteria

Introduction: In 2021, the Intersocietal Accreditation Commission (IAC) introduced modified criteria for carotid duplex interpretation based on peak systolic velocity (PSV) and PSV ratio. The most significant change compared to the 2003 Society of Radiologists in Ultrasound (SRU) criteria involved re-defining the thresholds for <50 and 50% to 69% stenosis ranges. Patients identified in <50% vs 50% to 69% ranges may face different disease severity assignments, variable surveillance protocols, medical management approaches, and recommendations for intervention. Facilities may experience altered payment coverage, issues of staff re-training, and questions from referring physicians regarding patient treatment and disease management expectations. The objective of this study was to assess the impact of re-defining these stenosis ranges using the 2021 IAC criteria vs the SRU criteria. Methods: Anonymized patient data from carotid duplex examinations were collected as part of an internal laboratory quality improvement strategy. These data were analyzed in an electronic database using the IAC and SRU threshold criteria to determine the degree of carotid stenosis. Patients with normal arteries, unilateral studies, or complete occlusions were excluded. Results: Of the 1000 patients considered, 850 met the eligibility criteria. Using PSV: for the right carotid, 242 (28.5%) showed a change and 608 (71.5%) showed no change in stenosis classification; for the left carotid, 228 (27%) showed a change and 622 (73%) showed no change. All changes were a downgrading of disease to <50% stenosis. Using PSV ratio: for the right carotid, re-assignment of 53 (22% of changed, 6% of total cohort); for the left carotid, re-assignment of 48 (21% of changed, 5.6% of total cohort). All changes resulted in re-assignment to the 50% to 69% stenosis category. Conclusions: Implementation of the IAC criteria resulted in patients being re-assigned to lower stenosis categories (27% for PSV and 21% for PSV ratio). The impact of these changes on patient care and facility logistics needs careful consideration.

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax.

The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading, Recommendation, Assessment, Development and Evaluation). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made. This update of an ERS Task Force statement from 2015 provides a concise comprehensive update of the literature base. 24 evidence-based recommendations were made for management of pneumothorax, balancing clinical priorities and patient views.https://bit.ly/3TKGp9e.

The Impact of Gaokao High-Stakes Testing on Student Mental Health in China: An Analysis of Stress Levels and Coping Mechanisms Among Senior High School Students

The Gaokao, China’s National College Entrance Examination, is a high-stakes test that significantly impacts students’ academic futures and career opportunities. This paper examines the mental health implications of the Gaokao, focusing on stress levels and coping mechanisms among senior high school students. It explores the societal and educational significance of the Gaokao, identifies specific stressors related to its preparation and performance, and analyzes the correlation between stress levels and academic performance. Additionally, the paper discusses the short-term and long-term effects of stress on students’ overall well-being and offers recommendations for immediate and long-term interventions. These strategies aim to reduce the adverse effects of stress, enhance students’ mental health, and improve academic outcomes. The findings highlight the need for a balanced approach to stress management and support systems to ensure students’ success and well-being in the face of high-stakes examinations.

Joint ERS/EACTS/ESTS clinical practice guidelines on adults with spontaneous pneumothorax.

The optimal management for spontaneous pneumothorax (SP) remains contentious, with various proposed approaches. This joint clinical practice guideline from the ERS, EACTS and ESTS societies provides evidence-based recommendations for the management of SP. This multidisciplinary Task Force addressed 12 key clinical questions on the management of pneumothorax, using ERS methodology for guideline development. Systematic searches were performed in MEDLINE and Embase. Evidence was synthesised by conducting meta-analyses, if possible, or narratively. Certainty of evidence was rated with GRADE (Grading of Recommendations, Assessment, Development and Evaluations). The Evidence to Decision framework was used to decide on the direction and strength of the recommendations. The panel makes a conditional recommendation for conservative care of minimally symptomatic patients with primary spontaneous pneumothorax (PSP) who are clinically stable. We make a strong recommendation for needle aspiration over chest tube drain for initial PSP treatment. We make a conditional recommendation for ambulatory management for initial PSP treatment. We make a conditional recommendation for early surgical intervention for the initial treatment of PSP in patients who prioritise recurrence prevention. The panel makes a conditional recommendation for autologous blood patch in secondary SP patients with persistent air leak (PAL). The panel could not make recommendations for other interventions, including bronchial valves, suction, pleurodesis in addition to surgical resection or type of surgical pleurodesis. With this international guideline, the ERS, EACTS and ESTS societies provide clinical practice recommendations for SP management. We highlight evidence gaps for the management of PAL and recurrence prevention, with research recommendations made.

The Exploration of Youth School Refusal Problem: Causes, Intervention, and Case Study from Ecological Perspective

兒童青少年拒學問題一直以來都是複雜和難解的課題。研究者基於生態系統觀點探討拒學原因與介入方法，並認為若能分別主要與次要影響因素，先針對主要影響因素進行介入，將更能在有限的時間和資源內改善出席率，故提出三個層次的原因與介入模式。此模式中不同層次差別在主要影響因素的數量不同，層次一包含兩個因素的相互影響，如：個人與家庭。層次二包含三個因素的相互影響，如：個人、家庭與學校。層次三包含四個因素的相互影響。原因部分，個人因素包含身體狀況、心理狀況和特質；家庭因素包含五點，即家長特質與身心健康、家庭功能與動力、家庭期待與參與度...等；學校因素包含六點，即轉換學校、學校氛圍、管教與出席...等；社會因素包含五點，即經濟拉力、文化價值觀、政策或法規...等。介入部分，個人因素包含醫療介入、提升行為技巧、增進認知技巧、提供專業資源；家庭因素包含五點，即進行意外或風險管理訓練、提供諮詢或家訪、提供認知訓練...等；學校因素包含七點，即辨識和轉介高風險學生、推動反霸凌政策、鼓勵學習社群與生涯活動...等；社會因素包含社區資源、警政與司法、社會機構與媒體、教育、諮商與醫療。最後提出中年級拒學案例說明如何改善拒學。Problematic school refusal in youth has long been a complex and vexatious issue. This article reviews the literature that affect school refusal based on ecological perspective. It is believed that if we can differentiate between primary and secondary influencing factors and first intervene with the primary influencing factors, we can better improve school attendance within limited time and resources. Furthermore, a three-level model that emphasizes on comprehensive causes and user-friendly systematic intervention recommendations is proposed. Level one includes the interaction of two factors, such as the individual and the family. Level two includes the interaction of three factors, namely the individual, family, and school. Level three includes the interaction of four factors. Among the causes, personal factors can be addressed through physical condition, mental condition and trait. Family factors include five points, such as parents’ trait, mental and physical health, family function and family dynamic, family expectations and involvement... etc... School factors include six points, namely transferring schools, school atmosphere, discipline and attendance policies...etc.. Social factors include five points, such as economic pressures, cultural values, policies or regulations...etc.. Regarding interventions, personal factors can be addressed through medical treatment, enhancing behavioral skills, increasing cognitive skills, and providing professional resources. Family factors include five points, namely conducting accident or risk training, consultation and home visits, providing cognitive training...etc.. School factors include seven points, such as identifying and referring high-risk students, promoting an anti-bullying policy, encouraging learning groups and career activities...etc... Social factors include community resources, policing and Justice, social organizations and media, education, counseling and medical services. In the end, there is a case example of a fourth-grade child, explains how to address school refusal.

Need to Change, Want to Change, or Hard to Change? Targeting three dinner food waste profiles with regard to attitudes and personality traits

In 2015, the United Nations’ sustainable development sub-goal 12.3 called for halving food waste per capita by 2030. In Norway, dinner leftovers are the largest consumer food waste category, particularly in households with children. To reduce household food waste, we hypothesised that different strategies for different consumer profiles are necessary and aimed to document self-reported food waste in relation to consumers' attitudes and personalities. In a survey, 333 consumers with children reported their perceived dinner waste (PDW). In addition, we collected the respondents’ attitudes towards food waste, as well as their environmental awareness and personality traits in order to classify them into three previously identified personality-environmental awareness segments. Our results show that Need to Change consumers (30%), characterized by Emotional Control and Openness to Experience, reported the highest PDW and showed reluctance to reduce food waste, making them a key target for interventions. Want to Change consumers (54%) reported the lowest PDW and showed high motivation to reduce food waste, but a further reduction from this segment would have less societal impact. Hard to Change consumers (15%), characterized by Conscientiousness, Agreeableness, and low Openness to Experiences, reported medium PDW. Engaging this segment could have a moderate impact, but they might be harder to reach. Our findings support the idea that environmental awareness and personality traits should be taken into consideration when developing strategies to reduce household food waste. Targeted intervention recommendations to reach each profile are derived.

Prehabilitation: The underutilised weapon for chronic pain management

Objective Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to ‘prehabilitate’ patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.