Pragmatic Strategy Research Articles

Evaluating small extracellular vesicle-based vaccination across heterologous Salmonella strains isolated from wastewater.

Salmonella infections pose significant public health challenges worldwide. The diversity of Salmonella strains, particularly those isolated from environmental and clinical sources, necessitates innovative approaches to prevention and treatment. Previous research has shown that small extracellular vesicles (sEVs) produced by macrophages during Salmonella Typhimurium infection can induce robust immune responses when used as a vaccine, offering complete protection in systemic infection models. In this study, we isolated 120 Salmonella strains from qPCR invA-positive wastewater samples collected in Gainesville, FL. These strains underwent enrichment, selection, and biochemical confirmation, followed by serotyping and whole genome sequencing. Two isolates, Salmonella enterica subsp. diarizonae (Diarizonae) and S. enterica serovar Enteritidis, were selected for further analysis based on community prevalence and clinical severity. We also assessed the ability of sEVs produced by S. Typhimurium-infected macrophages to induce immune responses against these heterologous and circulating strains in mice. Immunization with sEVs induced robust antigen-specific SIgA and IgG responses against S. Typhimurium, Enteritidis, and Diarizonae, with high titers observed in sera and fecal samples. Proteomic analysis revealed differential expression of proteins in these strains, including antigenic proteins present in sEVs such as OmpA, FliC, or OmpD. Moreover, this study highlights the role of wastewater-based epidemiology (WBE) as a tool for environmental surveillance, offering a complementary perspective on Salmonella dynamics within a population. Integrating WBE with traditional surveillance methods, along with the promising results of sEV-based vaccination, provides a pragmatic strategy for developing effective preventative measures against Salmonella infections, addressing the diversity of non-typhoidal Salmonella strains.

Navigating implementation strategies: insights from XPS programmes

PurposeThis study explores how industrial production companies adjust implementation strategies to deliver value with their company-specific production system (XPS) in a multi-site setting. Implementing an XPS is part of operations management and is supposed to mobilise employees resource-efficiently to increase operational performance.Design/methodology/approachBased on a multiple-case study, this study qualitatively explores the patterns of implementation decisions within and between five multi-site production companies. Conclusions were drawn on a mix of timely and retrospective data gathered through individual interviews with senior managers and joint workshops where they interacted and shared experiences.FindingsThis study identifies the fact that companies respond differently to non-unique implementation challenges, constituting various decision patterns when implementing their XPS. This paper identifies four implementation strategies (Education, Tool, Pragmatic and Culture Strategy) that explain various implementation setups. More experienced companies frequently shifted between strategies to return to previously de-prioritised implementation aspects.Originality/valueThis paper offers a dynamic model for XPS implementation in contrast to a simplified tool–system–culture sequence in literature today. Companies that deliberately shift implementation strategy by understanding the benefits and challenges of their decisions are more likely to keep momentum in the XPS implementation.

I’m telling you what’s best for you: A comparative study of the speech act of suggestion in e-commerce live streaming between male and female streamers

E-commerce live streaming has developed rapidly in recent years. The pragmatic strategy of e-commerce streamers is an important factor affecting sales. This study explores gender-specific pragmatic strategies in the speech act of suggestion by analyzing the discourse of the top ten male and female Taobao anchors during the Double Eleven Event, a promotional festival in China. With the help of corpus tools, based on Eden Sum-hung Li’s pragmatic strategy model of the speech act of suggestion, this study conducts a comparative analysis of the above discourse. The study finds that at the level of perspective, both male and female streamers use hearer-dominance suggestions most, followed by the speaker-dominance one. The difference is that male streamers use the speaker-dominance strategy more frequently than female streamers. At the level of directness, male and female streamers vary greatly in strategy distribution. Female streamers use the three strategies with similar frequency, while male streamers mainly use conventionally indirect suggestions and less non-conventionally indirect suggestions. At the level of politeness, both male and female streamers use more internal redressive actions and relatively fewer external ones. However, female streamers employ suggestions without redressive actions more frequently than male streamers in discourse. The above phenomenon can be explained by three reasons: features of the e-commerce live streaming format, gender of the streamers, and the audience. Specifically, the cross-screen communication method and fast pace of e-commerce live broadcasts raise requirements for the type of suggestions. The gender difference leads to different relationship positioning between the streamers and the audience, which affects the selection and use of male and female streamers’ pragmatic strategies of the speech act of suggestion.

Generational shifts in scientific atheism: Ideology and strategy in 20th century Czechoslovakia

Abstract The paper delves into scientific atheism, distinguishing between atheist thought as mere opinion and its development into a comprehensive worldview under Marxist-Leninist influence. It explores scientific atheism’s role as both a philosophical discipline and an ideology that has significantly impacted philosophers from our region across generations. Initially, scientific atheism represented an ideological commitment to materialism and rationalism. However, for subsequent generations, it evolved into a pragmatic strategy for consolidating political power, fostering social unity, and enhancing state control. This study not only outlines the integration of dialectical and historical materialism into Czechoslovakia’s mid-20th-century scientific and education systems but also examines the shifting perception of scientific atheism through different philosophical generations, highlighting its practical significance in Marxist-Leninist-dominated regions.

Telehealth memory clinics in primary healthcare: real-world experiences from low-resource settings in Greece.

The role of primary healthcare is pivotal in the management of the surge of dementia prevalence particularly in low-resource areas. In this study, two telehealth-based memory clinics in primary healthcare operating within the frames of the INTegRated InterveNtion of pSychogerIatric Care (INTRINSIC) are presented. The first clinic, which is led by a general practitioner, operates at a primary healthcare center in a semi-mountainous area and closely collaborates with the geriatric psychiatry outpatient clinic of the Patras University General Hospital via a telehealth medicine platform. The second clinic is embedded at the General Hospital Center for Interconnected Psychiatric Support on the island of Syros, is led by registered nurses, and is interconnected with the geriatric psychiatry unit at the Eginition University Hospital in Athens. Both memory clinics are in their infancy. At the general practitioner-led memory clinic, 13 beneficiaries were assessed and treated during the first 6 months of its operation. Cognitive decline and depressive and/or anxiety symptoms were detected in 10 and eight individuals, respectively. In 9 of the 27 beneficiaries of the registered nurse-led memory clinic, either mild cognitive impairment or dementia was diagnosed, while affective and/or anxiety symptoms were detected in almost all of them. Of note, only 14 beneficiaries of both clinics had received a diagnosis of a mental or neurocognitive disorder prior to their assessment at the memory clinics. Developing memory clinics in primary healthcare may be a pragmatic strategy to improve access of older adults living in low-resource areas to cognitive healthcare services.

Advancing implementation science in community settings: the implementation strategies applied in communities (ISAC) compilation

BackgroundImplementation strategies have predominantly been operationalized and studied in clinical settings. Implementation strategies are also needed to improve evidence-based intervention (EBI) integration in community settings, but there is a lack of systematic characterization of their use, which limits generalizability of findings. The goals of this study were to determine which implementation strategies are most used to deliver primary prevention EBIs in community settings, develop a compilation and pragmatic strategy selection process with accompanying guidance tools, and understand practitioners’ preferences for dissemination.MethodsPurposive and snowball sampling was used to recruit community setting researchers and practitioners delivering primary prevention EBIs (nutrition, physical activity, tobacco prevention) in community settings: education, social services, city planning and transportation, workplaces, recreation/sport, faith-based, and other public health organizations. Semi-structured interviews were conducted using a guide based on the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework. Participants were asked to describe barriers experienced and strategies used to overcome them within each RE-AIM dimension. Practitioners were also asked about preferred dissemination strategies, prompted by Diffusion of Innovations theory concepts of sources (who provides information) and channels (how information is provided). A rapid deductive approach was used to analyze findings with a coding matrix aligned with the interview guide.ResultsResearchers (n = 10) and practitioners (n = 8) across all targeted settings and intervention outcomes completed interviews. Interviewees shared unique implementation strategies (N = 40) which were used to overcome barriers related to multiple RE-AIM dimensions, most commonly implementation (n = 29) and adoption (n = 27). Most frequently mentioned implementation strategies were conduct pragmatic evaluation (n = 31), provide training (n = 26), change adaptable program components (n = 26), and leverage funding sources (n = 21). Webinars (n = 6) and listservs/newsletters (n = 5) were the most mentioned dissemination channels; national public health organizations (n = 13) were the most mentioned sources.ConclusionsResults reflect commonly used implementation strategies in community settings (e.g., training, technical assistance) and add novel strategies not reflected in current taxonomies. Dissemination preferences suggest the need to involve broad-reaching public health organizations. The resultant compilation (Implementation Strategies Applied in Communities) and strategy selection process provide resources to assist researchers and practitioners in applying strategies and improving EBI delivery in community settings.

Promising stabs in the Dark: theory virtues and pursuit-worthiness in the Dark Energy problem

This paper argues that we ought to conceive of the Dark Energy problem—the question of how to account for observational data, naturally interpreted as accelerated expansion of the universe—as a crisis of underdetermined pursuit-worthiness. Not only are the various approaches to the Dark Energy problem evidentially underdetermined; at present, no compelling reasons single out any of them as more likely to be true than the other. More vexingly for working scientists, none of the approaches stands out as uncontroversially preferable over its rivals in terms of its rationally warranted promise, i.e. the reasons to further work on, explore, and develop it. We demonstrate this claim by applying a Peircean economic model of pursuit-worthiness in terms of a cognitive cost/benefit estimate—with the instantiation of theory virtues as key indicators of cognitive gains—to the four main Dark Energy proposals (the cosmological constant approach, modified gravity, quintessence, and inhomogeneous cosmologies). According to our analysis, these approaches do not admit of an unambiguous, or uncontroversial, ranking with respect to which ansatz deserves distinguished attention and research efforts. The overall methodological counsel that our analysis underwrites recommends a pragmatic double research strategy forward: to encourage and foster theory pluralism and the search for tests—with the goal of enhancing the testability of the \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\Lambda $$\\end{document}CDM model and “testing it to destruction".

The Strategy of the Muslim Brotherhood in Egypt Facing Historical Cycles of Oppression and Legitimation

This study analyzes the strategy of the Muslim Brotherhood (MB) in Egypt facing cycles of repression and legitimation throughout its history. The analysis suggests that the strategic shift into a political activity has proved to be effective, but only for a short period of time. President Morsi must have assumed that the MB in Egypt was closer than ever to achieving its strategic political goals, since for the first time in its history it founded a legitimate political party and won the elections. Reviewing the strategy of the MB in Egypt may lead to describe it as pragmatic. However, the unique nature of the MB as a political movement with a religious affiliation - an Islamic political movement, may challenge the pragmatic nature of its strategy. Thus, the alleged pragmatic strategy of the movement may eventually serve a strategic radical goal rather than lead to moderation.

Balancing Powers: Azerbaijan’s National Role Conceptions Amidst Regional And Global Challenges

This study explores Azerbaijan's National Role Conceptions (NRCs) since its independence in 1991, analyzing how these evolving conceptions have shaped its foreign policy. Situated in the geopolitically sensitive South Caucasus, Azerbaijan has adopted various NRCs—including "regional stabilizer," "energy provider," and "bridge between East and West"—to address complex regional dynamics. Through a case study approach focusing on the leadership of Heydar and Ilham Aliyev, this paper examines the interplay between role perceptions, leadership transitions, and external pressures. The findings highlight Azerbaijan’s pragmatic strategy in balancing regional powers like Russia and Turkey while simultaneously engaging Western entities. This research sheds light on the inherent contradictions in Azerbaijan's NRCs, particularly its claims as a regional stabilizer amidst ongoing tensions. Ultimately, the study contributes to the broader understanding of NRCs as tools of both influence and adaptability in foreign policy decision-making.

Introducing chaos theory in the classroom: A life sciences students’ perception.

This article details a concise in-class workshop to introduce life science students to basic chaos theory concepts, which is a modern subject and has high potential for applications in life sciences and other fields, justifying its knowledge. The teaching approach is based on a pragmatic strategy that uses only the essential mathematical and computing concepts required to reach the learning outcome, which this article explains step-by-step and, therefore, at least in expectation, even students or professors with no previous software knowledge could understand them. The proposed educational approach uses a meaningful learning approach, and population growth models as an educational anchor subject, which is a common subject for life science students and may be intuitive for students from other areas. Feedback from 70 students surveyed after the workshop yielded positive results, and 72.9% of the students expressed confidence in explaining basic chaos theory concepts following the session, and 94.7% stated they would recommend it to their peers, which underscores the present proposal feasibility.

Effects of different orthokeratology lens designs on slowing axial length elongation in children with myopia.

To elucidate whether differences exist in the impact on retarding the elongation of axial length (AL) among children with myopia when utilizing orthokeratology (ortho-k) lenses employing the corneal refractive therapy (CRT) design versus those employing the vision shaping treatment (VST) design. This retrospective clinical trial aimed to collect and analyze AL data from individuals who wore ortho-k lenses for three years. A total of 654 subjects were enrolled and prescribed one of the three specific brands of ortho-k lenses: CRT, Euclid, and Mouldway. The study's primary focus was to compare the rates of AL elongation and myopic progression across these three brands of ortho-k lenses. In the 3-year follow-up, the AL elongation exhibited variations of 0.73±0.36 mm in the CRT lens group, 0.59±0.37 mm in the Euclid lens group, and 0.63±0.38 mm in the Mouldway lens group. A noteworthy disparity emerged between the CRT and Mouldway groups (P<0.01), as well as between the CRT and Euclid groups (P<0.001). Additionally, it was observed that 32.1% of participants who wore CRT lenses experienced a decelerated progression of myopia, in contrast to 47.2% in the Euclid group and 44.4% in the Mouldway group. Statistical analyses revealed a statistically significant distinction between the CRT and Euclid groups (P<0.01), and similarly, the CRT group demonstrated a statistically significant difference when compared to the Mouldway group (P<0.05). Ortho-k lenses represent a pragmatic strategy for mitigating the advancement of myopia. In contradistinction to ortho-k lenses utilizing the CRT design, those employing the VST design exhibited a more favorable impact regarding retarding AL elongation.

Introgression and Mapping of Cotton Leaf Curl Disease (CLCuD) Resistance from Wild Gossypium armourianum Kearney into Upland Cotton (G. hirsutum L.).

Cotton leaf curl disease (CLCuD), caused by the whitefly transmitted geminivirus complex (Cotton leaf curl virus - CLCuV and their satellite molecules), is a serious threat to successful upland cotton production in northwest India, Pakistan, and China. The disease causes significant losses in fibre yield and the quality of cotton. Owing to the regular emergence of resistance breaking strains of CLCuV, all the previously available CLCuD resistant germplasms of upland cotton have become compromised and none of the extant upland cotton cultivars is resistant to this disease. Therefore, alternate sources of CLCuD resistance need to be explored, as genetic resistance is the only pragmatic and tenable management strategy to combat this malady. Here, we report for the first time the introgression and mapping of CLCuD resistance from a related non-progenitor wild diploid D-genome cotton species, G. armourianum into upland cotton. A backcross population (G. hirsutum/G. armourianum/G. hirsutum) was developed for this purpose. A single major QTL was found to be associated with resistance to CLCuD and was located on chromosome D01 through the genotyping-by-sequencing technique.

The Androgen Deprivation Therapy Landscape in 2024 – Co-navigating the Available Options with Prostate Cancer Patients

This symposium convened during the 2024 European Association of Urology (EAU) Congress in Paris, France, focusing on the multifaceted aspects of prostate cancer (PCa) treatment from the patient’s perspective. The session delved into the nuanced needs, expectations, and treatment experiences encountered by individuals diagnosed with this condition. A pivotal aspect of the discussion centred on the imperative of ensuring patient awareness and informed consent, particularly concerning androgen deprivation therapy (ADT), given its array of potential side effects. ADT, a cornerstone in advanced PCa management, encompasses a spectrum of side effects including both physical and psychological dimensions. These include, but are not limited to, body hair loss, weight fluctuations, mood alterations, decreased libido, cognitive impairments, muscle atrophy, and bone density loss. Effective management of these side effects requires comprehensive support to be provided to patients to mitigate complications and optimise quality of life. The options for ADT were discussed, with their comparative strengths and challenges. ADT strategies take effect over different time periods (from 12 hours up to 4 weeks), exert varying effects on testosterone levels, and carry different side effect profiles. Selecting the optimal course of treatment for localised or locally advanced PCa requires consideration of whether the patient is at intermediate-, high-, or very high-risk of biochemical recurrence, and whether the intermediate-risk disease is classified as favourable intermediate-risk (FIR) or unfavourable intermediate-risk (UIR). While continuous ADT is the standard of care, intermittent ADT has been associated with significantly better quality of life scores for hot flushes, desire for sexual activity, and urinary symptoms, with a trend toward improvement in the level of fatigue. Furthermore, the interplay between PCa, ADT, and cardiovascular disease (CVD) was discussed to underscore the imperative for clinicians to assess the cardiovascular risks associated with ADT, particularly in patients with heightened cardiovascular vulnerability. Mitigating the adverse skeletal effects of ADT mandates a multifaceted approach encompassing nutritional supplementation, exercise regimens, and lifestyle modifications including alcohol cessation and smoking cessation. Integrating a prehabilitation checklist into clinical practice emerges as a pragmatic strategy to facilitate informed discussions regarding the potential adverse effects of ADT, enabling proactive support provision to optimise patient outcomes.

A Pragmatic Approach to Fetal Monitoring via Cardiotocography Using Feature Elimination and Hyperparameter Optimization.

Cardiotocography (CTG) is used to assess the health of the fetus during birth or antenatally in the third trimester. It concurrently detects the maternal uterine contractions (UC) and fetal heart rate (FHR). Fetal distress, which may require therapeutic intervention, can be diagnosed using baseline FHR and its reaction to uterine contractions. Using CTG, a pragmatic machine learning strategy based on feature reduction and hyperparameter optimization was suggested in this study to classify the various fetal states (Normal, Suspect, Pathological). An application of this strategy can be a decision support tool to manage pregnancies. On a public dataset of 2126 CTG recordings, the model was assessed using various standard CTG dataset specific and relevant classifiers. The classifiers' accuracy was improved by the proposed method. The model accuracy was increased to 97.20% while using Random Forest (best classifier). Practically speaking, the model was able to correctly predict 100% of all pathological cases and 98.8% of all normal cases in the dataset. The proposed model was also implemented on another public CTG dataset having 552 CTG signals, resulting in a 97.34% accuracy. If integrated with telemedicine, this proposed model could also be used for long-distance "stay at home" fetal monitoring in high-risk pregnancies.

New RPC gas mixtures for sustainable operation in the CMS experiment

The current operation of the Resistive Plate Chamber (RPC) system within the CMS experiment involves approximately 95% tetrafluoroethane (C2H2F4, TFE). However, in response to climate change concerns, the European Union has instituted a ban on TFE owing to its elevated Global Warming Potential (GWP), resulting in an associated increase in market prices. In this framework, shared endeavors within the RPC EcoGas@GIF++ Collaboration, have been dedicated to investigating novel ecological gaseous mixtures based on tetrafluoropropene (C3H2F4, HFO-1234ze) to ensure the sustainable functionality of RPCs. This presentation will delve into the performance outcomes derived from improved RPC gas gaps operating on HFO/CO2-based mixtures as ecologically viable alternatives, particularly in anticipation of the High Luminosity LHC phase (HL-LHC). Additionally, the utilization of TFE/CO2 mixtures will be explored as a pragmatic strategy to swiftly alleviate gas-related operational costs.

Türkiye’s Security Policy in Sub-Saharan Africa: A Constructivist Analysis

Türkiye’s comprehensive, pragmatic, multi-dimensional, and multi-stakeholder strategy towards Africa is commendable for adopting a collaborative approach that aligns well with the region’s needs. This study aims to explore Türkiye’s security relations in Sub-Saharan Africa through a constructivist perspective, focusing on the sub-regions of East Africa, West Africa, and the Sahel Belt. The research employs a qualitative methodology, drawing on official documents, academic literature, reports from international organizations, and discourse analysis to examine Türkiye’s security policy in the region. Türkiye’s security cooperation in Sub-Saharan Africa extends beyond mere military ties, encompassing a holistic strategy that supports regional peace and stability. By enhancing and strengthening these efforts, Türkiye significantly bolsters its standing in Sub-Saharan Africa and contributes to regional security architecture.

SUNDIALS time integrators for exascale applications with many independent systems of ordinary differential equations

Many complex systems can be accurately modeled as a set of coupled time-dependent partial differential equations (PDEs). However, solving such equations can be prohibitively expensive, easily taxing the world’s largest supercomputers. One pragmatic strategy for attacking such problems is to split the PDEs into components that can more easily be solved in isolation. This operator splitting approach is used ubiquitously across scientific domains, and in many cases leads to a set of ordinary differential equations (ODEs) that need to be solved as part of a larger “outer-loop” time-stepping approach. The SUNDIALS library provides a plethora of robust time integration algorithms for solving ODEs, and the U.S. Department of Energy Exascale Computing Project (ECP) has supported its extension to applications on exascale-capable computing hardware. In this paper, we highlight some SUNDIALS capabilities and its deployment in combustion and cosmology application codes (Pele and Nyx, respectively) where operator splitting gives rise to numerous, small ODE systems that must be solved concurrently.

Phytocompounds and lipid-based drug delivery system for neurodegenerative diseases

Across the annals of time, organic molecules sourced from nature have found innumerable uses within the realms of healthcare, pharmaceuticals, and the study of living organisms. This abundant source of natural compounds has exhibited immense promise in the cure of diverse ailments, mainly neurodegenerative diseases owing to their minimum toxic and adverse effects. However, different challenges exist with phytocompounds from plants such as poor permeation, poor solubility (water/lipid), unsteadiness under extremely acidic pH conditions, and lack of targeting specificity. Furthermore, as a result of the existence of blood-brain barrier membrane and inconvenient pharmacokinetics characteristics of phytocompounds, their passage into the brain is constrained. In order to address this issue and augment the transportation of medications into the brain at a therapeutically effective level, it is imperative to formulate an innovative and pragmatic strategy. Many papers have shown that nanoformulations containing phytocompounds (resveratrol, quercetin, ferulic acid, curcumin, berberine, etc.) effectively improved many neurodegenerative diseases such as Parkinson’s, Alzheimer’s and Huntington’s diseases. This study provides an overview of phytocompounds that are used in nanosized lipid drug delivery systems. These systems are categorized according to lipid types and preparation techniques used in the formulation. Some studies regarding these systems and phytocompounds are also summarized.

Pro-Ictal EEG Scheduling Improves the Yield of Epilepsy Monitoring: Validating the Use of Multiday Seizure Cycles to Optimize Video-EEG Timing.

A significant challenge of video-electroencephalography (vEEG) in epilepsy diagnosis is timing monitoring sessions to capture epileptiform activity. In this study, we introduce and validate "pro-ictal EEG scheduling", a method to schedule vEEG monitoring to coincide with periods of increased seizure likelihood as a low-risk approach to enhance the diagnostic yield. A database of long-term ambulatory vEEG monitoring sessions (n = 5,038) of adults and children was examined. Data from linked electronic seizure diaries were extracted (minimum 10 self-reported events) to generate cycle-based estimates of seizure risk. In adults, vEEG monitoring sessions coinciding with periods of estimated high-risk were allocated to the high-risk group (n = 305) and compared to remaining studies (baseline: n = 3,586). Test of proportions and risk-ratios (RR) were applied to index differences in proportions and likelihood of capturing outcome measures (abnormal report, confirmed seizure, and diary event) during monitoring. The impact of clinical and demographic factors (age, sex, epilepsy-type, and medication) was also explored. During vEEG monitoring, the high-risk group was significantly more likely to have an abnormal vEEG report (190/305:62% vs 1,790/3,586:50% [%change = 12%], RR = 1.25, 95% confidence interval [CI] = [1.137-1.370], p < 0.001), present with a confirmed seizure (56/305:18% vs 424/3,586:11% [%change = 7%], RR = 1.63, 95% CI = [1.265-2.101], p < 0.001) and report an event (153/305:50% vs 1,267/3,586:35% (%change = 15%), RR = 1.420, 95% CI = [1.259:1.602], p < 0.001). Similar effects were observed across clinical and demographic features. This study provides the first large-scale validation of pro-ictal EEG scheduling in improving the yield of vEEG. This innovative approach offers a pragmatic and low-risk strategy to enhance the diagnostic capabilities of vEEG monitoring, significantly impacting epilepsy management. ANN NEUROL 2024;96:1148-1159.

Exploring Patients' Perceptions of One-step Surgery for Primary Cutaneous Melanoma: A Qualitative Study.

High-frequency ultrasonography (> 20 MHz) has allowed for preoperative measurement of melanoma thickness and thus a one-step surgery strategy. The potential benefits of one-step surgery to patients remain unexplored. From June 2022 to August 2023, 2 dermatologists conducted semi-structured individual interviews with patients who had undergone HFUS examination allowing the choice for one-step surgery (group A) and with patients who had had standard two-step surgery (group B). Analysis of interviews with 21 patients (age range 31-81 years) revealed 5 main themes: (a) understanding the diagnosis, highlighting the significance of clear and comprehensive medical explanations; (b) personal factors considered in treatment decisions, including preferences for minimizing surgical procedures; (c) making choices, bearing responsibility, thus showcasing different levels of patient involvement in decision-making; (d) high- frequency ultrasonography reassurance emphasizing the role of medical reassurance, and (e) patient satisfaction, discussing surgical outcomes and the decision-making process. The majority of participants expressed a clear preference for one-step surgery, perceived as a pragmatic and fast surgical strategy while minimizing interventions. In conclusion, the results emphasize the importance of patient-centred care. These insights can guide improved preoperative consultations and enhance shared decision-making between healthcare professionals and patients regarding melanoma treatment strategies.