Purpose This paper aims to conceptualize diasporic medication tourism and examine the factors influencing the revisit intention of diasporic medication tourists to the border city of Tijuana, Baja California. Design/methodology/approach Based on the push–pull model, four constructs were examined: medication availability (MA) and cultural proximity (CP) (push) and medication quality (MQ) and medication price (MP) (pull). An online survey was conducted with 384 diasporic medication tourists in Tijuana, Mexico, who reported repeated medication purchases from local pharmacies. Findings The results indicate that MA, CP and MQ significantly influence diasporic medication tourists’ revisit intention, while MP shows no significant effect. Practical implications The findings suggest that pharmacies and destination stakeholders in border regions can strengthen diasporic visitors’ loyalty by prioritizing consistent MA, culturally familiar service environments and credible quality assurance. At the policy level, enhanced binational coordination and regulatory clarity may support safe, efficient and culturally responsive pharmaceutical access for diasporic communities. Originality/value This study advances research on medication tourism by reframing diasporic medication travel as a trust-based and culturally embedded form of cross-border pharmaceutical mobility. It proposes a context-sensitive model suited to border regions where developed and developing pharmaceutical systems intersect.

The impact of digital self-management programmes on stroke survivors: a systematic review of randomised controlled trials.

Introduction: Bipolar Disorder (BD) is a complex psychiatric mood disorder. Despite its complexity, nearly half of the patients experience medication non adherence due to poor insight into the illness. Therefore, improving patient knowledge using a Patient Information Leaflet (PIL) regarding the disease and its treatment is crucial. Aim: To develop and validate a PIL and to assess knowledge levels among patients with BD. Materials and Methods: A prospective quasi-experimental study was conducted from June 2025 to November 2025 at Justice KS Hegde Charitable Hospital (JKSHCH), Dakshina Kannada, India. A total of 42 patients with BD aged 18 years or older were included. Demographic details, including age, gender, education, and domiciliary status were collected for analysis. The PIL was developed using information from relevant literature and translated into regional languages. Content validity was assessed using the Content Validity Index (CVI). Readability was evaluated using the Flesch Reading Ease (FRE) and FleschKincaid Grade Level (FKGL) formulas. The design quality was assessed using the Baker-Able Leaflet Design (BALD) criteria. The reliability of the Patient Knowledge Questionnaire (PKQ) was determined using the Intraclass Correlation Coefficient (ICC). A paired t-test was performed using Statistical Package for the Social Sciences (SPSS) version 29.0 to compare knowledge levels before and after reading the PIL. A p-value<0.05 was considered as statistically significant. Results: The PIL achieved CVI scores of 0.93 for relevance and 0.91 for clarity, indicating excellent content validity. Readability scores of 83.3 (FRE) and 2.8 (FKGL) suggest that the leaflet can be easily understood by individuals with education beyond grade three. BALD scores were 28 in English and 26 each in Kannada and Malayalam, indicating good leaflet design. ICC values ranged from 0.6 to 1 across questionnaire versions, demonstrating high reliability. The post-test results results showed a significant improvement in patient knowledge after reading the PIL. Conclusion: The systematically developed and validated PIL effectively improves patients’ understanding of BD and its treatment, which may enhance medication adherence and quality of life.

Background: Diabetes Mellitus is a chronic disease characterized by high blood sugar levels which can affect quality of life, instability of blood sugar levels and compliance with taking medication. Objective: The aim of this study was to determine the relationship between medication adherence and blood sugar levels with quality of life in type II diabetes mellitus patients at the Kassi-Kassi Community Health Center. Methods: This study uses a quantitative research method with a cross-sectional approach. The research location is at the Kassi-Kassi Community Health Center in Makassar City. Sampling used purposive sampling with a population of 190 and a sample of this study amounted to 65 respondents, data collection using the Morisky Medication Adherence Scale-8 questionnaire for medication adherence, the Quality of life-brief clinical inventory questionnaire for quality of life and observation sheets for Random Blood Glucose (RBG)examination. observation sheets and analyzed using the parametric Pearson/non-parametric Spearman rho test. Results: The results of the study showed that there was a relationship between the level of compliance in taking medication and quality of life with a p value of 0.001, there was no relationship between Random Blood Glucose (RBG)and quality of life with a p value of 0.010. Conclusion: The conclusion of this study is that there is a relationship between medication adherence and quality of life, but no relationship between blood sugar levels and quality of life. To lower blood sugar levels in diabetic patients, adherence to medication and maintaining a healthy lifestyle can help maintain a high quality of life.

Objective: The rising occurrence of type 2 diabetes mellitus in Iraq, impacted by changes in lifestyle and strain on the healthcare system, is worsened by the significant issue of inadequate treatment adherence. As a result, this scenario leads to inadequate glycemic control and an increased risk of severe disease complications. The objective of this research was to assess medication adherence and quality of life (QOL) in indivduals with type 2 diabetes at the Al-Hilla Diabetic Center in 2023. Materials and Methods: A cross-sectional study was carried out at diabetic centers and outpatient clinics in Marjan Hospital and Imam Al-Sadiq Hospital in Al-Hilla City, Babylon Province, Iraq. A total of 355 patients with T2DM who were attending diabetic centers and hospitals in Al-Hilla, Babylon were included in the study using a convenience sampling method. Regression linear tests were utilized to explore the factors that may influence adherence. Results: The data analysis showed that the QOL was relatively good (47.32± 22.13) and medication adherence was 4.64± 1.42. This study indicated that age significantly influences the QOL of patients with T2DM (P≤ 0.001). Additionally, medication adherence was found to be significantly associated with age, work, educational level, income, and living condition (P≤ 0.001), while there was no statistical significance observed with marital status and gender (P≥ 0.001). Conclusion: Diabetes Nurse Specialists need to consider factors that impact QOL and develop strategies to enhance both QOL and medication adherence.

In-hospital medication changes are a key component of healthcare of older adults. It is important to employ strategies to ensure continuity of changes post-discharge. This systematic review aimed to summarise (i) strategies that have been investigated to facilitate post-discharge continuity of in-hospital medication changes in older adults and (ii) their impact on continuity of medication changes and clinical, health service utilisation and patient-reported outcomes. MEDLINE and EMBASE databases were searched (1946-20/03/2024) to identify strategies that facilitate post-discharge continuity of hospital medication changes and assess their impact on continuity, health service utilisation, and clinical and patient-reported outcomes post-discharge in older adults (mean/median age ≥60 years). After screening 800 articles, 49 met inclusion criteria, including 25 quasi-experimental studies, 14 randomised controlled trials, four cohort studies, four observational studies, one case series, and one retrospective case note review and audit. Strategies commonly involved providing discharge medication lists to patients and/or their general practitioners (36/49 studies, 73.5%), discharge counselling (28/49, 57.1%) and medication reconciliation (28/49, 57.1%). Most studies used multi-component strategies (39/49, 79.6%) by multi-disciplinary teams (28/49, 57.1%). Twenty-six of the 36 studies (68.4%) assessing the impact of strategies on continuity reported significant improvements in continuity-related outcomes. Thirteen out of the 21 studies (61.9%) that measured medication discrepancies (most common measure of continuity) reported significant reductions following strategy implementation. One out of 11 studies (9.1%) reported a significant improvement in clinical outcomes, while none of the 13 studies found significant improvements in health service utilisation outcomes. Two of three studies investigating patient-reported quality of life reported significant improvements. Strategies focus on communicating medication changes to patients, general practitioners and community pharmacists by multi-disciplinary hospital clinicians. There is evidence of a positive impact of multi-component strategies delivered by a multi-disciplinary team on continuity of medication changes and quality of life post-discharge. Future analyses investigating strategy complexity and cost effectiveness may inform their translation into practice.

BackgroundTreating drug-resistant tuberculosis (DR-TB) is clinically complex and economically burdensome compared to drug-susceptible tuberculosis (DS-TB). China’s diagnosis-intervention packet payment system initially omitted risk adjustment for drug resistance. In 2022, a diagnosis-intervention packet (DIP)-pilot city implemented such adjustment, establishing distinct reimbursement standards for DR-TB and DS-TB. This study aimed to assess the impact of this DR-type risk adjustment on medical expenditures, treatment efficiency, and care quality for TB patients.MethodsA quasi-experimental difference-in-differences design was employed, involving 8465 TB patients from June 2021 to December 2023. Linear regression was performed with time and treat fixed effects and the interaction term between time and treat. Subgroup analyses for DR-TB and DS-TB patients were conducted.ResultsUnder the DIP system, risk adjustment led to marginally significant reductions in inpatient expenditure per hospitalization [β = − 151.14, P = 0.065; 95% confidence interval (CI) for difference in proportions: − 311.66, 9.38] and in annual total inpatient expenditure per patient (β = − 200.58, P = 0.078, 95% CI − 423.26, 22.10) for all TB patients. It also resulted in significant reductions in inpatient out-of-pocket per hospitalization (β = − 257.51, P < 0.001, 95% CI − 316.20, − 198.81), annual total inpatient out-of-pocket per patient (β = − 266.78, P < 0.001, 95% CI − 342.02, − 191.53), inpatient length of stay per hospitalization (β = − 3.58, P < 0.001, 95% CI − 4.53, − 2.62), and annual total length of stay per patient (β = − 3.21, P < 0.001, 95% CI − 4.50, − 1.92). For DR-TB patients, all outcome measures in expenditures, efficiency, or care quality showed P > 0.1, indicating no significant changes. For DS-TB patients, measures of expenditures and efficiency showed P < 0.1, supporting significant or marginally significant reductions.ConclusionsThe DR-type risk adjustment policy under China’s diagnosis-intervention packet system proved effective in optimizing resource use and enhancing efficiency, particularly for DS-TB patients, while preserving care quality for DR-TB patients. These findings demonstrate the value of tailored risk adjustment within payment frameworks for heterogeneous diseases like tuberculosis, providing crucial evidence for optimizing TB care and implementing effective payment reforms in China and similar settings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40249-026-01423-y.

ABSTRACT Emergency services leaders have long recognized the importance of timely, high-quality care for critically ill and injured children. The establishment of the federal Emergency Medical Services for Children Program in 1985 has helped disseminate and promote the adoption of pediatric emergency care standards nationwide for the past four decades. Additional efforts were further driven by an impactful report by the Institute of Medicine in 2006: Emergency Care for Children: Growing Pains, which outlined key recommendations to improve pediatric emergency care. In response, the National Pediatric Readiness Project (NPRP) launched in 2011, providing a roadmap for emergency departments to improve pediatric care. Following the success of the NPRP, national organizations collaborated to address pediatric emergency care in the prehospital setting and published a set of recommendations in a 2020 joint policy statement, accompanied by a technical report that summarized the evidence behind the recommendations. Subsequently, the National Prehospital Pediatric Readiness Project (PPRP) was initiated to implement these recommendations. The work of this project has resulted in the development and dissemination of a comprehensive checklist, a corresponding toolkit, and a first-of-its-kind nationwide assessment of prehospital Pediatric Readiness. We describe here the scope of the PPRP, along with a description of future directions, including disseminating assessment results, supporting emergency medical services agency quality improvement efforts, research opportunities, and building a sustainable infrastructure to ensure all emergency medical service agencies are equipped to deliver high-quality emergency care to children.

Streak artifacts in non-contrast computed tomography (NCCT) can obscure anatomical details and even confuse radiologic signs. Existing methods for artifact reduction have limitations: specialized training data and high annotation costs hinder the performance scalability, inadequate anatomical constraints struggle to preserve fine details, and limited generative stability along with suboptimal artifact reduction compromises diagnostic applicability. Leveraging 96,641 CT slices (763 series) from four different CT scanners (100-140 kilovolt peak (kVp), 55-167 tube current-time product (mAs), 0.5-10mm thickness), we proposed a novel guided diffusion method using multi-level anatomical segmentations to optimize streak artifact reduction in chest NCCT scans. During training, the model integrates artifact-free CT slices with segmentation maps and anatomical regions of interest (ROIs) via channel-wise concatenation at each diffusion step. During inference, artifact-affected samples are fed into the trained model to generate artifact-free outputs with structural integrity. Statistical analysis revealed a significant (p < 0.05) difference in Signal-to-Noise Ratio (SNR) and Contrast-to-Noise Ratio (CNR) when comparing 47,032 artifact-affected samples to 49,609 artifact-free counterparts. Quantitative assessments demonstrated high consistency between generated outputs and reference standard artifact-free samples, with lung field SNR values of (26.67, standard deviation (SD) 2.01) vs. (26.11, SD 1.89) and lung-trachea CNR of (3.76, SD 0.77) vs. (3.78, SD 0.56) (both p > 0.05). Compared to four novel studies, our method achieved superior overall Peak Signal-to-Noise Ratio (PSNR) (36.952, SD 0.671), Structural Similarity Index (SSIM) (0.863, SD 0.013), and Dice Similarity Coefficient (DSC) (0.959, SD 0.031), with all p < 0.05. Moreover, ablation studies indicated that an appropriate segmentation guidance (Level-2) optimally balances anatomical structure constraints and artifact reduction efficiency, demonstrating superior performance in distinct organ or tissue regions compared to coarser and finer-grained guidance strategies. The proposed method has the potential to improve clinical analysis for chest NCCT by optimizing streak artifact reduction while enhancing medical image quality.

BackgroundSubstandard and falsified antimicrobials threaten public health due to their role in resistance development. Pharmacies, as key access points for antimicrobials, can play a crucial role in detecting these products. In this study, a visual assessment tool which incorporates a novel packaging quality index estimate, was developed and used in pharmacies to evaluate antimicrobial packaging and flag suspicious products.MethodsA cross-sectional study was conducted in 23 community pharmacies in the Ho Municipality between November 2023 and February 2024. The developed checklist contains indicators on registration compliance, language & medical information, batch information consistency, and product security of the antimicrobials. The tool was validated, and its use on randomly sampled antimicrobials informed the development of the packaging quality index from regression analysis involving weights determined from principal component analysis of the results. Statistical analyses were performed with SPSS (version 26.0) and OriginPro (version 2022).ResultsThe packages and labels of the 275 antimicrobials evaluated were antibacterials (41%), antiprotozoals (28%), antifungals (22%) and antivirals (9%). Most products were of foreign origin (58.5%) and labelled in English (98%). Significant variations were observed in the registration compliance and product security indicators by origin and antimicrobial class (p < 0.01). Batch information consistency varied significantly across the antimicrobial classes (p < 0.01), whereas language & medical information quality remained consistent. The packaging quality index scores followed a normal distribution, with majority (95.6%) referred to as moderate quality (Index: 1.81–5.34). High quality packages (2.2%; Index: 5.47–5.53) were mostly observed in antibacterials of local origin (66.7%) whereas the poor-quality packages observed (2.2%; Index: 1.48–1.78) were mostly antibacterials of foreign origin (66.7%).ConclusionThis study identified packaging quality issues among the antimicrobials investigated which may suggest potential risk to falsification. Routine antimicrobials packages assessment with developed tools like the packaging quality index could help pick up early signals of substandard and falsified antimicrobials for further regulatory investigations and action.

Severe mental illness (SMI) is associated with high cardiovascular disease (CVD) risk. Important contributors are poor diet quality, physical inactivity, and metabolic side effects of antipsychotic medication entailing significant weight gain. Evidence implies that dietary counseling delivered by clinical dietitians leads to greater improvements in diet quality, weight management, and cardiometabolic health than counseling delivered by non-specialist health personnel, especially when combined with increased physical activity. However, randomized controlled trials (RCTs) testing clinical dietitian-led nutrition counseling integrated with structured exercise across diverse treatment modalities in psychiatric care remain scarce. The Norwegian Mental Illness Heart Health (NORMI-Heart) study will evaluate the efficacy and applicability of a 6-month lifestyle program, combining individualized, clinical dietitian-led nutrition counseling focused on weight reduction and improved dietary quality, and moderate-to-vigorous exercise training, on CVD risk in adults with SMI in Oslo, Norway. This parallel-group RCT will recruit 70 overweight adults with SMI. Participants will be randomized to a 6-month diet and lifestyle intervention, or control. The intervention is individualized and includes monthly one-to-one sessions with a clinical dietitian focusing on heart-healthy eating and weight reduction, monthly supervised group exercise, and support to follow an individual exercise program. Control participants will receive treatment as usual (TAU). The NORMI-Heart Trial aims to evaluate the effect of the intervention on estimated CVD risk. This trial aims to provide evidence on the effectiveness, feasibility, and real-world applicability of clinical dietitian-led nutrition counseling combined with structured exercise for reducing CVD risk in individuals with SMI. Findings may strengthen the scientific and policy rationale for integrating clinical dietitians as a standard part of multidisciplinary mental health care. Results will also inform scalable, integrated lifestyle care models in mental health services. ClinicalTrials.gov Identifier: [NCT07085923].

The Pedagogic Surveys (IPUP) were validated and introduced in 2004 at the University of Porto to monitor and improve teaching quality. Despite the advancements and implementation of several revisions, the use of these tools for longitudinal analysis, and particularly in medical education, remains underexplored. This study seeks to address this gap by conducting a longitudinal analysis of medical students' feedback over consecutive academic years. This study analysed student responses to the IPUP questionnaire collected between the academic years of 2020 and 2023, aiming to characterise trends and patterns in the evaluation of the undergraduate curriculum of the Integrated Master's in Medicine at the School of Medicine and Biomedical Sciences of the University of Porto (ICBAS). The IPUP is designed to assess nine subdomains of teaching and learning: appreciation and clarity, difficulty, support for autonomy, consistency and help, structure, relationship, effects of the unit course (UC), engagement, and assessment. A total of 221 observations from 74 curricular units across three academic years were included. The overall IPUP response rate ranged from 49.77% to 42.55% in the first semester and from 36.15% to 35.18% in the second semester across the analysed years. To assess temporal trends in the evaluation of each subdomain, linear mixed-effects models were employed. To facilitate interpretation and longitudinal analysis, three summary domains (Teacher, Unit Course and Difficulty) were created through principal component analysis (PCA), aggregating the original nine subdomains into broader dimensions. Student evaluation scores were overall positive across all subdomains (mean scores > 5 on a 7-point scale). Differences were found between curriculum years, with the 3rd year consistently presenting the lowest scores and the 4th year showing the highest (e.g., the assessment subdomain ranged from a mean of 4.98 ± 0.89 in the 3rd year to 5.76 ± 0.69 in the 4th year; p < 0.001). When analysed by scientific domain, Pathology was the one with the highest scores, while Semiology and Pharmacology received the lowest scores (e.g., the assessment subdomain ranged from a mean of 6.57 ± 0.17 in Pathology to 4.15 ± 0.35 in Pharmacology; p < 0.001). A positive correlation was observed between average final grade and subdomain evaluations (ranging from r = 0.108 to r = 0.260 across subdomains), except for difficulty, which showed a negative correlation (r = -0.57, p < 0.001). A higher number of credits of the European Credit Transfer System (ECTS) was also positively associated with student perceptions. During the evaluation period, a significant decline was observed in the Teacher domain (β = -0.147, CI95%: -0.260, -0.034), whereas the UC and Difficulty domains remained stable. Intraclass Correlation Coefficient (ICC) values ranged from 0.45 (Teacher) to 0.86 (Difficulty), indicating a high level of consistency in student perceptions. This study provides important insights into the potential use of the IPUP as a tool for longitudinal assessment of the student perspectives on undergraduate medical education quality. The study showed that student evaluation of the course were overall very positive and highlights the stability of the scores' trends over the three academic years analysed, with only a slight decline observed in the Teacher Domain. The overall consistency of results over the years suggests, on one hand, strong reliability and, on the other, that the opportunities for improvement were not taken into account nor led to the implementation of significant changes, denoting the missed opportunity provided by these tools for the refinement of teaching and learning processes.

ABSTRACT As rapid demographic ageing reshapes the region, cross-border retirement in the Guangdong-Hong Kong-Macao Greater Bay Area has emerged as a strategic priority. Adopting a ‘retirement mobilities’ framework, this scoping review synthesises 18 studies (2006–2024) to examine this transition. Our analysis reveals a critical paradigm shift: While financial portability barriers have been largely resolved, challenges have migrated towards care system compatibility, specifically impacting frail older adults concerned with medical quality. A gap persists between policy incentives and retiree uptake. Notably, the GBA case illuminates four key non-monetary challenges – digital exclusion, social isolation, cultural dissonance, and institutional mistrust – that carry vital lessons for ASEAN and the broader Asia-Pacific as they seek to support cross-border retirees. Ultimately, sustainable ‘ageing across places’ requires service integration beyond mere monetary transfers.

ObjectiveThis study aims to systematically assess the content characteristics and information quality of knee arthroplasty-related videos on TikTok and Bilibili, in order to provide evidence to support the optimization of health science communication.MethodsOn February 13, 2025, we searched for “膝关节置换” (knee arthroplasty in Chinese) on TikTok and Bilibili, and initially collected 100 videos from each platform according to the default sorting order, which were then subjected to further screening. Videos containing irrelevant content, lacking audio, being non-original reposts, or intended for advertising and marketing purposes were excluded. The quality and reliability of the included videos were assessed by applying four validated instruments: the modified version of DISCERN (mDISCERN), the Global Quality Score (GQS), the Video Information and Quality Index (VIQI), and the Patient Education Materials Assessment Tool (PEMAT). Interplatform variations and correlations between quality and user interactions were analyzed via Mann‒Whitney U and chi-square tests.ResultsA total of 162 knee arthroplasty related videos were analyzed, including 88 from TikTok and 74 from Bilibili. TikTok videos demonstrated higher engagement and more certified uploaders, whereas Bilibili featured more diverse professional backgrounds. Bilibili emphasizing anatomy using PPT/class based, animation/ motion and television program/documentary styles. TikTok focusing on examination/diagnosis, and treatment delivered through solo narrative and Questions and Answers (Q&A). TikTok videos achieved higher scores across all quality assessment tools. Professionally generated content consistently outperformed nonprofessional content across most quality metrics, whereas no significant difference was observed for mDISCERN. Correlation analysis showed that engagement was strongly associated with VIQI on both platforms, with additional moderate associations for GQS and PEMAT only on TikTok, while mDISCERN showed no significant correlation.ConclusionsTikTok favors high user engagement, whereas Bilibili provides more structured educational content. Professional involvement is essential to ensure information quality and effective medical communication.

Analyze and compare the characteristics of nonconformities (NCs), root causes, and corrective actions generated from internal assessments and ISO 15189 external assessments in a medical laboratory, identify high-risk points and evaluate the role and contribution of different assessments to the medical laboratory's quality performance. A total of 35 NCs from internal assessments and 67 NCs from external assessments were documented in a medical laboratory between 2021 and 2024. The NCs were categorized according to clause requirements, while root causes and corrective actions were classified based on their content. The recurrence rate of NCs, effectiveness of corrective actions and characteristics of recurring NCs were statistically analyzed. The flow relationships were shown by Sankey diagrams. The laboratory quality monitoring model was illustrated by a double-helix diagram. In internal assessments, the top three NC categories were Examination processes (n = 8, 22. 86%), Personnel management (n = 7, 20. 00%), Document and record control (n = 6, 17. 14%);in external assessments the top categories were were Examination processes (n = 19, 28. 36%), Document and record control (n = 10, 14. 93%), Others(Evaluation, Complaints, Information system, Risk Management)(n = 8, 11. 94%), Personnel management (n = 6, 8. 96%). Regarding root causes, the most frequent in internal assessments were Personnel Negligence (n = 14, 40. 00%), Training deficiencies (n = 11, 31. 43%);in external assessments, the tops were Training deficiencies (n = 27, 40. 30%), Document and Record Deficiencies(n = 15, 22. 39%). The The most frequently implemented corrective action across both assessment types was Personnel training(internal [n = 35, 47. 29%] and external [n = 67, 41. 36%]). The numbers of Managment NCs, Technical NCs, total NCs, and Corrective Actions in external assessments were significantly higher than in internal assessments. The high-risk points primarily lie in Examination processes, Document/record and Personnel management during the initial implementation of the ISO 15189. External assessments help identify deviations, contributing to quality performance improvement. Internal assessments enable continuous monitoring of quality issue corrections, supporting the ongoing enhancement of the QMS. The 'Double Helix' Model of Quality Monitoring ensures the stability and accelerated advancement of the quality management system in the medical laboratory.

Workplace violence is prevalent in settings where health care practitioners are responsible for managing agitated patients and visitors. First-line management of agitation within health care is verbal deescalation. However, formal training in verbal deescalation is not standardized across health professions education (HPE), and consensus about best practices is lacking. This systematic review examines the characteristics of existing curricula within HPE that teach deescalation skills, assesses the research quality and strength of evidence of these studies, and outlines consequent best practices for teaching the skill of deescalation to health professionals. PubMed, EMBASE, ERIC (EBSCOhost), and Google Scholar were searched using terms related to HPE, aggression, and deescalation for work published from database inception to July 22, 2025. Studies on empirical outcomes from curricula designed to teach deescalation to health professionals were included. Included studies were assigned scores on the Medical Education Research Study Quality Instrument (MERSQI) and an adapted version of the Best Evidence Medical Education (BEME) strength of evidence scale. A narrative synthesis approach was adopted. Of 4,312 unique records identified, 56 studies met the inclusion criteria. Twelve had BEME scores of 4 or 5, indicating strong evidence. MERSQI scores ranged from 5.5 to 16.0, with a mean (SD) of 10.4 (2.5). Learning interventions were targeted to nurses, physicians, students, and hospital staff. The interventions with strong evidence all incorporated both didactic education as well as role-play and/or simulation for active practice. The Ten Domains of De-escalation by the American Association for Emergency Psychiatry and the De-escalating Violence in Healthcare Settings curriculum by the International Committee of the Red Cross were referenced by multiple studies. Available literature suggests that the most evidence-supported way to teach deescalation within HPE is through a combination of didactic lessons and active skills practice.

Sonography phantoms are an educational tool for training student sonographers and acquainting health science students to the conventions of sonography, which employs high frequency sound waves for soft tissue imaging. Phantoms are objects that mimic human anatomy and their appearance on sonography, enabling the practical application of theoretical skills in a simulated environment. As such, sonography phantoms are essential in providing an interactive experience for medical imaging students by consolidating theoretical knowledge and facilitating collaborative learning. This research study aims to analyse the experiences of diagnostic radiography students' use of four new sonography phantoms recently integrated into their curricula to examine the implementation of the phantoms in this environment which has not yet been researched. A mixed methods study was performed using an online Qualtrics survey composed of open and closed-ended questions as well as focus groups. Twenty-three students completed the survey, of whom thirteen participated in focus groups. Most students indicated strong engagement with these learning tools, found them easy to use, and demonstrated an improved understanding of sonography. Key themes generated from the focus groups and open-ended survey questions included active phantom engagement, appreciation of sonography, and its role in medical imaging and quality improvement. Students indicated a substantial level of enjoyment from phantom engagement and learning, describing a greater appreciation of sonography.

Artificial intelligence, including large language models (LLMs) such as GPT-4, can generate responses to clinical queries using predictive algorithms trained on large online datasets. Current literature lacks a comprehensive assessment of the medical quality and accuracy of dermatologic GPT-4-generated outputs. A standardized query was used to ask GPT-4 models (Copilot and ChatGPT-4) to generate summaries and treatment recommendations for 33 dermatologic conditions, which were then compared to corresponding sections of UpToDate (UTD) excerpts. DISCERN scores were calculated for each source by two authors (AN and PV). Concordance between GPT-4-generated treatments and UTD was evaluated by a certified dermatologist. Word count and Flesch Kincaid reading score were generated in R. Paired t-tests and one-way and weighted ANOVA were conducted in R. The DISCERN instrument classified UTD content as being of "fair" medical quality (mean [SD], 3.08 [0.34]), while both ChatGPT-4 and Copilot produced content of "poor" medical quality (mean [SD], 2.28 [0.22] and mean [SD], 2.31 [0.35], respectively). ChatGPT-4's treatment recommendations demonstrated 33.5% greater average concordance with UTD treatment recommendations (mean [SD], 64.89% [29.29]), in comparison to Copilot (mean [SD], 31.38% [31.08%]); (95% CI, 22.3%-44.7%, p < 0.001). Overall, GPT-4 models produced dermatological content with few harmful recommendations. However, GPT-4-generated content performed poorly on the DISCERN instrument, and validation of LLM-generated responses remains challenging. Results suggest LLM parameters and query structures may be optimizable for dermatologic applications. If implemented alongside the professional judgement of certified dermatologists, future LLMs may serve as time-saving dermatologic tools, enhancing patient care.

We assessed the availability, price, and affordability of commonly used chemotherapy medications in Cameroon, Ethiopia, Kenya, and Malawi. We also examined the characteristics that could predict chemotherapy medication quality. Samples of seven commonly used chemotherapy medications were collected: cisplatin, cyclophosphamide, doxorubicin, ifosfamide, leucovorin, methotrexate, and oxaliplatin. Stockouts and medicine prices were recorded at public national hospitals and community pharmacies. Using the National Comprehensive Cancer Network's harmonized guidelines for sub-Saharan Africa, we estimated the costs of medications to treat early-stage breast cancer, colorectal cancer (CRC), and head and neck cancer. Every sample was tested for quality using high-performance liquid chromatography against USP standards. We ran logistic regressions to assess medicine characteristics that could predict substandard and falsified chemotherapy medications. Stockouts of chemotherapy medications in public hospitals were observed in three of four countries. Other than in Malawi where medications are free when available in the public sector, chemotherapy medications were unaffordable, costing government worker salary equivalents of 47-242 days, 233-869 days, and 22-196 days to treat early-stage breast cancer, CRC, and head and neck cancer, respectively. On average across the population, $36 US dollars (USD) (95% CI, $50 USD to $134 USD, 9%-25% of medication cost) was spent on poor-quality medicines for treatment of breast cancer, $32 USD (95% CI, $6 USD to $214 USD, 0.5%-17%) for CRC, and $15 USD (95% CI, $4 USD to $49 USD, 2%-21%) for head and neck cancer. Price of the medication, public/private source, and medicine registration status were poor predictors of medicine quality. We found that medicines for cancer treatment are unaffordable without government subsidies. Moreover, poor-quality chemotherapy medicines are hard to detect without chemical testing. Government policies and supply chain practice changes are needed to improve the availability, affordability, and quality of chemotherapy medications in sub-Saharan Africa.

Training and assessment of competencies in hysteroscopy - A systematic review.