Local anesthetic systemic toxicity (LAST) is a rare but life-threatening complication of anesthetic administration. Nurses are often the first to observe subtle signs of toxicity, yet studies show gaps in knowledge and preparedness. This integrative review was conducted to evaluate effective educational strategies for clinicians to identify and manage LAST in the clinical setting. A total of 13 articles were selected for inclusion based on their relevance to LAST education. Thirteen studies met the inclusion criteria. Four primary educational strategies were identified: didactic instruction, simulation-based learning, web-based modules, and cognitive aids. All modalities showed significant short-term improvement in knowledge. Combined approaches, particularly simulation with didactic instruction, showed the strongest outcomes. Knowledge decay was identified as a persistent challenge, with only five studies assessing retention beyond 3 months. Preparing nurses and students for LAST requires integrated strategies that combine accessible content with experiential practice. Future research should emphasize long-term knowledge retention and innovative modalities to strengthen LAST education.

Frailty is a critical concern in the growing dialysis population. This study employs bibliometric analysis to map the knowledge landscape and identifyresearch hotspots regarding frailty in dialysis patients. We retrieved publications from the Web of Science Core Collection (January 1, 2007-February 8, 2025). After screening titles and abstracts, relevant articles were included for analysis. UsingCiteSpace software, we visually analyzedauthorship, institutions, countries, keywords, and burst keywords. A total of 243 articles were included.Annual publications showed a marked upward trend. TheUnited States was the leading country, with Johansen K.L. and the University of California System as the most influential author and institution, respectively. Keyword analysis revealed four central research hotspots:(1) frailty assessment, (2) interventions, (3) adverse outcomes, and (4) frailty in elderly dialysis patients.The analysis of burst keywords indicates thatfrailty assessment and its link to all-cause mortalityare the current research frontiers. This study conducted a comprehensive bibliometric analysis on research related to frailty in dialysis patients, revealing the research hotspots and trends in this field. It fills the gap in the panoramic view of frailty research in this high-risk subgroup and provides valuable references for future research in this area.

Sonodynamic therapy and combination strategies for cancer: a bibliometric analysis and knowledge mapping

Lifelong knowledge graph embedding via diffusion model.

Beyond technical skills: A scoping review on emotions in critical care in situ simulation Training.

Collaborative testing (CT) and its implementation into nurse practitioner (NP) programs is not well understood. Given the adoption of competency-based learning in nursing curricula, a pilot of CT in an NP program was implemented at a large, urban university. Over two years, CT was applied in three NP courses using integrated testing software. Students from two family NP cohorts (N2023 = 36 and N2024 = 34) who participated in the CT modality were evaluated for their feedback. The aim was to evaluate examination score outcomes and the student experience with the CT modality. Reported findings include examination scores from two NP courses and cross-sectional survey results with quantitative and qualitative findings. The mean examination score change from individual to weighted total was 6.3% in the 2023 cohort and 2.69% in the 2024 cohort. Students were surveyed with a questionnaire on their experience with CT at the completion of three courses. A means analysis shows high scores of student experience with CT and a paired t -test indicates a difference between the cohorts ( p < .0001). An analysis of one qualitative question through thematic analysis is presented, and findings show students have a positive experience in relation to knowledge retention, decreased test anxiety, and peer collaboration. Minimal barriers were identified in the execution or delivery of CT. Our findings indicate that CT may be efficiently implemented into NP courses, improve student outcomes and experience, and support competency based education.

Augmented and virtual reality training versus conventional teaching methods for geriatric oral care practices in nursing assistants: A randomized controlled trial.

Knowledge mapping of ecolinguistics research in China and abroad: a visual analysis using CiteSpace

Tropical medicine students often request testing preparation materials, but existing resources are limited. We conducted a pilot study of a gamification platform developed at the University of Alabama at Birmingham to build a formative question bank for examination preparation and to teach tropical medicine concepts in two courses: an American Society of Tropical Medicine and Hygiene diploma course and a condensed military-focused tropical medicine course. National Board of Medical Examiners-style questions were delivered as formative reinforcement of lecture material. A postcourse survey assessed user satisfaction, engagement with gamification elements, and the influence of peer competition on motivation. Forty-one learners participated, and 20 provided survey feedback. Learners reported high overall satisfaction, ease of use, and perceived knowledge retention. Most engaged primarily for examination preparation and to increase general tropical medicine knowledge. Our learners were less motivated by digital reward badges and peer competition than reported in prior gamification studies. We conclude that this gamified formative question bank is well regarded and could serve as a resource for other tropical medicine programs, although further study is needed.

Case-based learning (CBL) is a recent development in veterinary education, praised for enhancing clinical decision-making and preparing students for practice. This study explores the impact of supplementary online case-based learning (eCBL) self-assessment resources on student satisfaction, confidence, engagement, exam performance, and short-term knowledge retention. Findings were compared with other common study methods to enhance relevance to current UK veterinary cohorts. Fourth-year veterinary students at the University of Cambridge completed three multiple-choice exams over 3 weeks alongside anesthesia teaching. Students were randomly assigned one of three study methods-eCBL, flashcards, or lecture slide review-for the second and third exams. Exam score improvements were analyzed using the Mann-Whitney U test. Pre- and post-exam questionnaires were thematically analyzed using Clarke and Braun's method to assess student satisfaction and confidence. Students using eCBL reported higher satisfaction and engagement with the curriculum and felt more confident and prepared for exams and clinical placements. While exam score improvements did not significantly differ between groups, students in the eCBL group expressed greater perceived value of their study experience. eCBL resources improve student satisfaction and engagement, especially when aligned with clinical relevance and the "Day One Competencies" from the Royal College of Veterinary Surgeons. Students appreciated the self-assessment opportunities and context-rich scenarios offered by eCBL. Although no significant differences in exam performance were observed, eCBL aligns well with existing study practices and may enhance short- term knowledge retention with more sustained use.

To analyze the research dynamics of myopia management functional lenses (MMFL) in the field of vision health over the past decade, revealing cutting-edge hotspots and development trends. Relevant literature on MMFL from 2016 to 2025 in the Web of Science (WOS) core database was searched by computer. The bibliometrics software Bibliometrix, VOSviewer 1.6.20 and CiteSpace.V.6.3.R1 were used for bibliometric and knowledge graph visualisation analyses. A total of 1143 WOS core database documents were included, and the number of publications has gradually increased over time. China and the United States rank the top two in terms of the number of publications and citations. The leading authors in this field are Cho P, Sankaridurg P, and Chen H, who have made significant contributions to research in two distinct subfields: contact lenses and spectacle lenses. Most relevant sources are OPHTHALMIC AND PHYSIOLOGICAL OPTICS, CONTACT LENS & ANTERIOR EYE, and OPTOMETRY AND VISION SCIENCE, all of which are considered to be highly authoritative publications in this field. These journals have published a considerable number of articles on a wide range of topics, including the mechanism of spectacle lenses, physiological changes associated with contact lenses, variations in fitting parameters, and the effects of myopia control. The keywords co-occurrence, clustering, thematic map, timeline view and emergent analyses reveal that recent research has been focused on the following areas: axial length, defocusing mechanism, choroidal thickness, and orthokeratology. The knowledge map of research on MMFL is constructed through bibliometric analysis, systematically summarizing the current status and hotspots of research. The integration of material, optics and intelligence is a trend that is set to be reflected in future functional lenses for myopia management.

Problem-based learning (PBL) is an effective strategy for developing higher-order cognitive skills in biomedical education; however, structured exposure is often introduced late in postgraduate immunology curricula, leaving students insufficiently prepared for complex, independent learning tasks. Teaching immunity to COVID-19 presents additional challenges due to the need to integrate innate, adaptive, and cytokine-mediated immune pathways. The objective of this study was to quantitatively evaluate the effect of a pyramidal PBL intervention using structured mind mapping on academic performance, conceptual organization, and learner engagement among postgraduate immunology students. The intervention group (n = 18) replaced a scheduled didactic lecture with an intergroup pyramidal PBL activity involving domain-specific mind mapping, iterative peer and facilitator feedback, and whole-class synthesis, while a comparable control cohort (n = 20) received conventional lecture-based instruction. Knowledge retention was assessed using a delayed summative examination administered two weeks post-intervention, and student perceptions were measured using a structured Likert-scale questionnaire. The intervention group achieved significantly higher examination scores than controls (mean ± SD: 73.5 ± 4.4 vs. 66.2 ± 6.5), with a mean difference of 7.3 percentage points (95% CI: 3.8-10.7; p < 0.001) and a large effect size (Cohen's d = 1.30). Questionnaire findings demonstrated high acceptability and perceived effectiveness, with most participants reporting improved conceptual understanding, communication skills, and engagement with complex immunological content. These findings indicate that pyramidal mind-mapping-based PBL produces educationally meaningful improvements in learning outcomes and supports earlier scaffolding of problem-based learning within postgraduate immunology curricula.

Introductory undergraduate science courses often aim to achieve two key goals: (i) build a foundation of knowledge and (ii) prime a deeper understanding of the natural world to help cultivate scientifically literate citizens. However, retention of knowledge and critical understanding of complex concepts in these foundational courses remains a challenge. While facts can fade from memory, content presented in the form of stories captures attention and is easier to recall. Narrative-based learning provides a powerful way to support STEM education, helping students grasp complex concepts, connect more meaningfully with the natural world, and view science as accessible and relevant. In this study, we evaluated how students engage with microbe-centered comic narratives designed around concepts students themselves identified as challenging in a foundational microbiology course. We started by collecting data around how students engage with an existing course resource, an open educational textbook designed specifically for the course, and identified key concepts that students indicated were still challenging. Comic narratives were created specifically to address these concepts. Student perception data showed that integrating the comics with the course reading helped to improve their understanding of the concepts using memorable examples of microbes and overall increased their curiosity about the microbial world. Here, we show that comic storytelling can be a powerful pedagogical tool in higher education, bridging abstract and complex scientific concepts with personal connection and curiosity.

Peer teaching is an established pedagogical approach in medical education; yet, traditional methods face challenges including inconsistent knowledge support, variable teaching quality, and limited scalability. Artificial intelligence (AI) large language models offer potential to augment peer teaching by providing on-demand access to medical knowledge and clinical reasoning support. However, AI integration within structured peer teaching has not been systematically evaluated in clinical education. This study aims to evaluate the effectiveness of AI-assisted peer teaching compared to traditional peer teaching in orthopedic clinical education, with respect to knowledge acquisition, clinical skills development (particularly clinical reasoning), student engagement, and 3-month knowledge retention. This historical cohort study compared 2 consecutive cohorts of medical students (aged 20-27 years, 108/190, 56.8% male) at the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China. All eligible students from each cohort were enrolled. The control group (2021 cohort, n=96, taught in 2024) received traditional peer teaching; the intervention group (2022 cohort, n=94, taught in 2025) received AI-assisted peer teaching with access to DeepSeek-V3. Primary outcomes were assessed using a validated 50-item multiple-choice examination (0-100 points) and a 4-station Objective Structured Clinical Examination (OSCE; 0-100 points) with standardized rubrics (intraclass correlation coefficient>0.85). Secondary outcomes included student engagement and satisfaction (5-point Likert scales) and AI usage metrics. Assessments were conducted at baseline, postintervention (8 weeks), and 3-month follow-up. Analysis of covariance adjusted for baseline knowledge, prior AI experience, and learning interest to address observed baseline imbalances. Using independent samples t tests (α=.05, 2-tailed), the AI-assisted group demonstrated significantly higher postintervention knowledge scores (mean 79.69, SD 8.41 vs mean 75.33, SD 9.26; mean difference=4.36, 95% CI 1.84-6.87; P<.001; Cohen d=0.49). OSCE total scores were significantly higher (mean 80.95, SD 7.57 vs mean 76.24, SD 9.23; mean difference=4.71, 95% CI 2.31-7.11; P<.001; d=0.56), with clinical reasoning showing the largest effect (mean difference=2.22, 95% CI 1.18-3.25; P<.001; d=0.61). Analysis of covariance adjusted results remained significant for all primary outcomes (adjusted knowledge difference=3.52, P=.002; adjusted OSCE difference=4.52, P<.001). At 3-month follow-up (174/190, 91.6%), the AI-assisted group maintained higher knowledge scores (mean 77.36, SD 8.60 vs mean 72.84, SD 10.42; mean difference=4.52, 95% CI 1.68-7.36; P=.002; d=0.47), with similar knowledge decay rates between groups. This study provides the first systematic evidence that integrating AI tools within structured peer teaching enhances orthopedic clinical education across multiple domains, including knowledge acquisition, OSCE performance, and student engagement. Unlike prior studies examining AI as a stand-alone learning tool, this work demonstrates the synergistic potential of combining AI knowledge support with peer teaching's social learning benefits, with particularly strong effects on clinical reasoning. These findings support scalable, cost-effective implementation of AI-augmented peer teaching, though randomized controlled trials are needed to confirm causality and determine optimal implementation strategies.

Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT) is a rare and highly aggressive malignancy with poor prognosis and no established standard therapy. This study aimed to map the research landscape of SMARCA4-UT through bibliometric analysis to guide clinical decision-making and research prioritization. Publications on thoracic SMARCA4-UT were retrieved from the Web of Science Core Collection and Scopus from 2000 to 2025. After screening, 132 articles and reviews were included. Bibliometrix and CiteSpace were used to analyze publication trends, geographic and institutional distribution, author productivity, collaboration networks, keyword evolution, thematic structure, and highly cited articles. SMARCA4-UT research expanded rapidly, with 31.95% annual growth rate and 32.25 average citations per article, reflecting rising academic impact. China (28.8%) and Japan (23.5%) led global output, forming a China-US dual-core collaboration network. Mechanistic studies on the SWI/SNF complex and BRG1 are mature, while clinical and therapeutic research remains underdeveloped. Temporal analysis revealed a shift toward diagnostic standardization after the 2021 WHO classification. SMARCA4-UT research is in a rapid growth phase, with a substantial gap between mechanistic advances and clinical translation. Immunochemotherapy is the current first-line backbone, while targeted and combinatorial strategies remain exploratory. These findings provide evidence-based guidance for clinical practice and research design, highlighting the urgent need for biomarker-driven therapy and large-scale international collaboration to improve patient outcomes.

Neuroanatomy is widely recognised as one of the most challenging subjects in health professions education due to its complex three-dimensional structures and spatial relationships. Technology-enhanced learning has increasingly been incorporated into neuroanatomy education to facilitate learning. This review aimed to evaluate the effectiveness of technology-enhanced learning interventions in teaching practical neuroanatomy skills. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomised controlled trials published between 2013 -2023 that evaluated technology-enhanced learning interventions in neuroanatomy education were included using a Rayann software. Nine studies met the eligibility criteria and were analysed using the modified Kirkpatrick model to assess educational outcomes. Learner's motivation and engagement (Kirkpatrick Level 1) were consistently high. for virtual reality,3D visualisation, and stereoscopic learning modules, with students reporting increased satisfaction, confidence, and perceived understanding. Augmented reality inventions demonstrated more valuable responses, often influenced by design, quality, and implementation. Improvements in objective learning outcomes (Kirkpatrick Level 2) were reported in several studies, particularly those employing 3D visualisation and virtual reality tools. However, these findings were not consistent across all interventions. Technology enhanced learning appeared particularly beneficial for supporting cognitive engagement and visuospatial understanding of complex neuroanatomical concepts. Considerable heterogeneity was observed across intervention types, pedagogical approaches, and outcome measures. Few studies evaluated behavioural changes (Kirkpatrick Level 3) or long term educational impact (Kirkpatrick level 4). Technology -enhanced learning, particularly 3D visualisation and virtual reality, shows promise as a complementary approach to neuroanatomy education by enhancing learner's engagement, motivation, confidence, and spatial understanding. While improvement in object knowledge, outcomes were reported in several studies, evidence of superiority over conventional teaching approaches remains inconsistent. The evidence base was restricted to randomised controlled trials and was driven from undergraduate medical student populations, which may limit the generalisability of the findings. Further high -quality longitudinal studies are needed to evaluate behavioural change, long-term knowledge retention, and educational impact.

Abstract: This study explores the potential of digital storytelling as an innovative pedagogical tool in developing speaking skills in foreign language education. A case study design, a qualitative research method, was employed in order to investigate the experiences and perceptions of students. The research sample consisted of 9 students enrolled in the class of the Faculty of Medical in the speciality of Public Health. The findings revealed that the integration of digital storytelling contributed positively to students’ retention of knowledge, their motivation to participate actively, and their willingness to express themselves more freely compared to traditional classroom presentations. Many students reported that the use of digital stories made lessons more enjoyable, reduced speaking anxiety, and offered a more comfortable environment for self-expression. Moreover, the combination of images, music, and narration provided a multimodal learning experience that catered to different learner preferences. In addition, students highlighted that digital storytelling not only enhanced their speaking competence but also improved their self-confidence, technological skills, and preparedness for lessons. While some participants raised concerns that reliance on pre-prepared scripts could limit opportunities for improvisational speaking, the majority viewed the method as both pleasant and engaging. The study concludes that digital storytelling can serve as an effective alternative to conventional presentation methods in foreign language classes. It offers a dynamic, student-centered learning environment that fosters creativity and collaboration. Future research is recommended to expand the scope of digital storytelling applications into other language skill areas such as reading, listening, and writing, as well as to explore its impact across different age groups and educational contexts.

As educational priorities increasingly emphasize higher-order cognitive skills over rote memorization, it has become essential to clarify how these competencies interact in young learners. To address this, the current study examines how primary school students' problem-solving and decision-making skills mediate the relationship between their critical thinking dispositions and self-perceptions of success. The sample consisted of 285 third- and fourth-grade students in Türkiye, aged 8 to 10years, who were selected based on their enrollment status, absence of psychiatric diagnoses, and voluntary participation. Data were collected in person using paper-based surveys. Four instruments were administered: the Critical Thinking Dispositions Scale, the Problem-Solving Inventory for Children, the Decision-Making Skills Scale, and the Perception of Success Scale. Direct and indirect relationships between variables were assessed using path analysis. Bootstrapping procedures determined the statistical significance of the mediating effects. The indirect effects of decision-making and problem-solving skills on the relationship between critical thinking disposition and perception of success were statistically significant [β = .20, SE = .05 (95% CI = .095, .308)]. The results indicate that students with advanced critical thinking, problem-solving, and decision-making skills are more likely to perceive themselves as academically successful. The study confirms that critical thinking, problem-solving, and decision-making are interconnected competencies that significantly predict students' perceptions of success. These results support educational initiatives that prioritize higher-order cognitive abilities over basic knowledge retention. Ultimately, educators are encouraged to implement comprehensive curricula that simultaneously develop these skills to prepare students for real-world challenges.

Impact of quiz frequency on knowledge retention among high school students in Shenyang.

With the global prevalence of obesity, researches on metabolic bariatric surgery for patients with obesity and end-stage liver disease that require liver transplantation has gained increasing attention. This study aimed to perform a bibliometric analysis of metabolic bariatric surgery for patients with obesity and end-stage liver disease that require liver transplantation from 1900 to 2025 to identify major contributors and current research status, and to look forward to the research trends and future development prospects in this field. A total of 121 relevant articles from 1 January 1900 to 5 February 2025 were obtained from the Web of Science Core Collection database. VOS viewer and Cite Space were utilized as bibliometric tools to analyze and visualize knowledge mapping. A total of 121 publications were identified, 24 nations/regions participated in this field, with 695 scholars from 91 institutions. Mayo Clinic (USA) dominates with 13 publications and 516 citations; UC San Francisco (6 pubs, 416 cites) and the University of Toronto (2 pubs, 205 cites, over 100 cites per pub) excel in quality. The top 10 features 7 US institutions, plus ones from Canada, Europe, and South America, forming the field's high-impact core cluster. Our study analyzes 121 publications (1997-2025) on liver transplantation and metabolic bariatric surgery. The field is dominated by U.S. institutions, particularly the Mayo Clinic. Researches mainly focus on following areas: surgical timing (before, during, or after transplantation), management of post-transplant obesity, liver status, donor applications, and obesity-related liver diseases. Current evidence mainly limited to retrospective studies and case reports with small sample sizes. Future work requires prospective, multi-center trials and an international registry to establish standardized guidelines for this evolving field.