Experience-driven differences in acute ischemic stroke management: A nationwide study.

Real-world comparative effectiveness of atezolizumab versus durvalumab for extensive-stage small-cell lung cancer.

Influence of clinical characteristics and bronchodilator treatment on COPD exacerbations: BIFAP registry.

We report our initial cases of robotic left atrial appendage occlusion (LAAO) device deployment. From June 2021 to December 2024, all consecutive patients undergoing robotic-assisted LAAO (isolated or with robotic-assisted CABG) using an epicardial clip were enroled. The study protocol was approved by the Institutional Review Board (IRB 45CFR164.512). A total of 28 patients were included, 22 of which underwent a concomitant CABG. Transesophageal echocardiogram confirmed excellent exclusion of the LA appendage in all but one patient. There were no postoperative strokes, myocardial infarctions, reoperation for bleeding, unplanned revascularisation, or deaths. At a median of 1.4 [0.9-1.8] years, there was 1 non-cardiac mortality (cancer) and 1 stroke. Nine (32.1%) patients were off OAC, while 21 (75.0%) were off class I-III antiarrhythmic drugs. These early results show optimal stroke prevention outcomes, considering the high-risk level of the patients. Longer follow-up is warranted to confirm these outcomes.

Clinical outcomes of bromelain-based enzymatic debridement (NexoBrid®): evidence from the Italian National Burn Database.

To assess real-world canaloplasty outcomes in glaucoma management using standardized data from an international registry. The iTrack Global Data Registry (iTGDR) is an ongoing prospective real-world multicenter observational study on ab-interno canaloplasty with the iTrack or iTrack Advance (Nova Eye Medical), with or without concomitant cataract surgery. Patients diagnosed with ocular hypertension or glaucoma (excluding angle-closure glaucoma). Analysis included eyes with a minimum 12 months follow-up from the iTGDR. Both standalone canaloplasty and canaloplasty combined with cataract surgery were included. Intraocular pressure (IOP) and glaucoma medications were assessed at baseline and postoperative follow-ups. Surgical success was defined according to the 2024 American Academy of Ophthalmology (AAO) criteria. IOP, number of glaucoma medications, and success rate at last follow-up (LFU). Two hundred and fifty-four patients (344 eyes) were followed over a mean of 20.5 ± 7.9 months (LFU). Following combined canaloplasty and phacoemulsification (n = 313 eyes), mean IOP and medication usage reduced from 17.2 ± 5.3 mm Hg and 2.1 ± 1.1 preoperatively to 14.1 ± 3.9 mm Hg and 1.3 ± 1.4 at LFU (P < .001); 61.9% of all combined eyes achieved success (increasing to 83% in eyes with baseline IOP > 18 mm Hg), while 43% of eyes became medication-free (vs 7% preoperatively). Standalone canaloplasty (n = 24 eyes) reduced IOP and medication usage from 20.2 ± 7.1 mm Hg and 2.3 ± 0.9 to 15.3 ± 6.3 mm Hg and 1.5 ± 1.6 (P < .01); 35% of eyes achieved success, and 46% of eyes became medication-free (vs none preoperatively). IOP and medication reductions were significant across glaucoma subtypes (primary and secondary open-angle glaucoma, ocular hypertension) and severities (P < .01 for all). The rate of additional glaucoma procedures was 4.9%, including laser procedures; no canaloplasty-related sight-threatening complications were reported. A loss of ≥2 lines of corrected distance visual acuity occurred in 7.3% of eyes, most commonly in association with pre-existing advanced disease or unrelated ocular comorbidities. In real-world clinical practice, iTrack canaloplasty significantly reduced IOP and medication burden with a favorable safety profile when performed alone or with phacoemulsification and in diverse glaucoma populations.

Clinical ethics observation embedded in nursing ethics education: Nursing students' experiences.

Real-world effectiveness of oral semaglutide on body weight, composition, and metabolic parameters in patients with obesity without diabetes.

Non-technical skills, such as communication, teamwork, empathy, and emotional intelligence are critical for safe and effective nursing practice. While current nursing education tends to emphasize technical skills, the nuanced development of non-technical skills-particularly how they are shaped by personal experiences, low-fidelity simulation, and their interplay with technical skills-remains underexplored. To explore pre-registration nursing students' experiences in developing and applying non-technical skills within clinical and educational contexts. A qualitative descriptive study. A large Australian university offering pre-registration nursing programmes. Eight pre-registration nursing students (Bachelor and Master levels) with clinical placement experience. Data were collected through two focus groups (one face-to-face, one virtual) using a semi-structured interview guide. Reflexive thematic analysis was applied to identify patterns in non-technical skills development. Three key insights emerged: (1) Personal life experiences-including prior healthcare roles, volunteering, and non-clinical work-significantly shape how students understand and apply non-technical skills, suggesting a valuable but underrecognized learning pathway; (2) Low-fidelity simulations, while accessible, provide limited opportunities for developing the emotional and interpersonal dimensions of non-technical skills, raising concerns about their educational efficacy; (3) non-technical skills are not separate from technical skills but actively support their application, with strong communication and emotional regulation skills enhancing the effectiveness and safety of technical procedures. Nursing education should intentionally integrate students' lived experiences into the development of NTS, explicitly teach emotional intelligence as a core component of non-technical competency, and design simulations that foster emotional realism. Recognising the interdependence between NTS and TS will better prepare students for the emotional and relational complexity of real-world nursing practice, ultimately enhancing resilience, adaptability, and humanistic care.

The genetic counseling certification exam, or "oard exam," is a four-hour, 200-question multiple-choice exam. Recently reported first-time pass rates were 80% (August 2024) and 54% (February 2025). The purpose of our study was to explore the experiences of Black, Indigenous, and People of Color (BIPOC) Board exam candidates during these two exam cycles. In 2022, we enrolled 25 BIPOC genetic counseling students in a longitudinal constructivist grounded theory study. Here, we report the results of interviews conducted with this cohort before and after they took the August 2024 (n = 16) and/or the February 2025 (n = 13) Board exam. Interviews were transcribed and analyzed using a constant comparative approach. Among our participants, pass rates were 11/16 (69%) in August 2024, and 5/9 (56%) for first-time and 2/4 (50%) for repeat test-takers in February 2025. We constructed five themes and an overarching theory. Theme 1: The Board exam does not reflect real-world practice, where genetic counselors work with limited time and resources, and emphasizes memorization of information that is readily available online. Theme 2: The likelihood of passing the Board exam is influenced by socioeconomic disparities, particularly in the challenging 2024 job market. Theme 3: Anxiety negatively impacted exam performance. Theme 4: Testing accommodations, such as extended time, were challenging to access. Theme 5: Participants perceived that Board exam outcomes were influenced by luck, because the lack of a detailed content outline forces candidates to self-direct study across hundreds of topics. We theorize that the Board exam is a poor measure of readiness for entry-level genetic counseling as it fails to reflect real-world practice and is influenced by factors unrelated to competence, such as socioeconomic status, mental health, ability to access accommodations, and luck. We recommend changes to the exam format and the provision of official study materials to reduce inequities.

Access to veterinary care remains a significant barrier for many pet owners. Community-based learning opportunities are increasingly recognized as a way to address these gaps while fostering student development. This qualitative study aimed to understand more about the student learning experience through veterinary community engagement opportunities. Using a retrospective qualitative study design, we examined reflective journals from veterinary students following a shelter medicine rotation at the University of Pennsylvania between January 2015 and July 2019. The journals were analyzed with the use of collaborative qualitative content analysis. 53 veterinary students were included in the study. Eight major themes emerged from their journals, including student perspectives of owners, pets, neighborhoods, community outreach, and self; the learning process; the role of pets as social catalysts; and trust. Students frequently described shifts in their perceptions toward pet owners. Both the depth (time invested) and breadth (diversity of experiences) of community outreach experiences contributed uniquely to students' acquisition of soft skills critical to excellence in clinical practice, including social competence, cultural humility, and contextualized decision-making. These findings suggest that structured, reflective, ethical community-based experiential learning can challenge the hidden curriculum, foster emotional intelligence, and better prepare veterinary students for real-world practice. Incorporating sustained, diverse, and ethically grounded community engagement into veterinary curricula may empower future veterinarians to navigate complex social contexts and more effectively serve all types of populations.

Nationwide survey on the current clinical practice of the first atrial fibrillation episode.

The implementation gap between evidence-based SGLT2 inhibitor therapy and real-world practice remains substantial in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Protocolized care delivery bundles incorporating frequent follow-up, systematic monitoring and adherence support may bridge this implementation gap. To evaluate the impact of a a structured, nurse-delivered multi component pathway (frequent contact, protocolized monitoring, and adherence reminders) on kidney function progression and clinical outcomes in patients with T2DM and CKD. This single-center, retrospective cohort study included 450 patients with T2DM and CKD who initiated SGLT2 inhibitors between February 2024 and February 2025. Patients were categorized into structured nurse-delivered multi component pathway management (n = 225) or conventional care (n = 225) groups. Primary outcomes included annualized eGFR decline rate and composite kidney endpoint (≥ 40% eGFR decline, end-stage kidney disease, or kidney-related death). Propensity score weighting was applied to balance baseline characteristics. The structured nurse-delivered multi component group demonstrated a slower annualized eGFR decline compared to conventional care. The composite kidney endpoint occurred less frequently in the structured nurse-delivered multi component group (HR 0.68, 95% CI 0.52-0.89, P = 0.004). Laboratory follow-up compliance was significantly higher in the structured nurse group (82.3% vs. 64.7%, P < 0.001). Adverse event-related drug discontinuation was lower with structured nurse-delivered multi component group (8.4% vs. 15.2%, P = 0.012). A structured SGLT2 inhibitor management bundle delivered through a nurse-coordinated pathway reflecting greater care intensity and standardized follow-up was associated with improved kidney function trajectories and fewer adverse kidney outcomes in routine practice. The clinical trial was registered in the Chinese Clinical Trial Registry (ChiNHSMU20231015).

The rapid rise of artificial intelligence (AI) and digital health technologies presents new opportunities for personalized care in multiple sclerosis (MS). However, implementation in routine practice is limited by regulatory hurdles, fragmented infrastructure and a lack of agile real-world evaluation methods. Living Labs (LLs) emerge as dynamic environments for advancing MS care and research, supporting early testing and iterative development of digital tools, while fostering structured collaboration among patients, clinicians, researchers and regulators. In this review, we conceptually frame LLs in MS and provide a concrete, clinic-ready implementation framework for AI-enabled application in real-world practice. Using a digital-based voice task as an exemplar with automated feature extraction, we detail integration patterns and define key performance indicators for feasibility, data quality, usability and clinical utility. We show how this co-designed model can generate decision-relevant evidence, may help shorten time-to-action and embed innovation seamlessly into clinical workflows. Finally, we align LL operations with ethical and regulatory standards and outline strategies to responsibly scale across centres.

This study aims to evaluate the real-life efficacy and safety of a biosimilar to reference product (RP) ustekinumab for the treatment of plaque psoriasis in different patient scenarios. The cohort included ustekinumab-switched patients, who switched from the RP to the biosimilar, and ustekinumab-naïve patients, never treated with ustekinumab. Ustekinumab-naïve patients were subdivided into bio-naïve (no prior biologic therapy) and bio-experienced (previous non-ustekinumab biologic therapy). Adult patients with chronic plaque psoriasis treated with AVT04 were followed up to 28weeks. Efficacy of the biosimilar was assessed by improvement of the Psoriasis Area Severity Index (PASI) 75, 90, and 100 responses from baseline to weeks16 and 28. A cost-minimisation analysis over a 1-year time horizon was performed to estimate costs and potential savings with AVT04 versus RP across the Italian National Health Service (NHS). Throughout the observation period, a sustained improvement in PASI was observed in the overall cohort of 183 patients, encompassing both the ustekinumab-switched and ustekinumab-naïve groups. Within the ustekinumab-naïve group, a trend toward more favourable PASI75/90/100 responses was observed in bio-naïve patients compared to bio-experienced patients. By 28weeks of treatment, a higher proportion of bio-naïve patients compared to the bio-experienced group achieved PASI75 (72.7% vs. 56.2%), PASI90 (72.7% vs. 50.0%), and PASI100 (54.5% vs. 37.5%), respectively (p > 0.05). No adverse events were reported during the study. Furthermore, the cost-minimisation analysis suggested that compared to the RP, AVT04has the potential to generate approximately €5200 in annual savings per patient for the Italian NHS, representing around €20million in nationwide savings. AVT04 biosimilar shows consistent efficacy results in both ustekinumab-switching and ustekinumab-naïve patients, supporting its integration into real-world practice as an effective and cost-saving therapeutic option. Further studies are warranted to confirm and expand these preliminary findings across a broader bio-naïve cohort.

Dosing interval optimization and persistence with faricimab in age-related macular degeneration: An observational study in real-world clinical practice.

We evaluated the alterations of applying artificial intelligence (AI) diagnostic system for diabetic retinopathy (DR) screening in real-world practice. This retrospective study included 11,713 diabetic patients from the government-led Diabetes Shared Care Network. The AI system Verisee was integrated into the clinical workflow to identify referable diabetic retinopathy (RDR). Its performance was compared with ophthalmologist grading at the patient level using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). Subgroup analysis was performed by age and gender, with additional referral diseases identified by ophthalmologists. Verisee achieved a sensitivity of 0.88, specificity of 0.86, accuracy of 0.86, PPV of 0.58, NPV of 0.97, and AUC of 0.87 in detecting RDR. Performance declined with increasing age, whereas sex distribution remained consistent across age groups. The AI system identified a higher proportion of RDR than ophthalmologists (27.45% vs. 18.15%). In addition to 1,818 patients with RDR, ophthalmologists identified other referral-warranted ocular conditions in 4.5% of cases. The AI system referred age-related macular degeneration (grades 2-4), whereas referral decisions for macular hole and macular edema (grades 1-2) varied; however, glaucoma (grades 0-1) identified by clinicians was not consistently referred. Verisee demonstrated high accuracy in detecting RDR but exhibited reduced performance in older patients. It had a higher referral rate than ophthalmologists yet missed certain conditions such as glaucoma. Despite effectiveness in DR screening, further refinement is required to support broader ophthalmic disease detection.

Initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients hospitalised for heart failure (HF) is crucial for improving long-term outcomes. However, in real-world practice, a considerable proportion of patients are discharged without initiation. This study aimed to evaluate the initiation rate of SGLT2i, identify clinical factors associated with non-initiation, and examine the impact on long-term prognosis in patients hospitalised for HF. This single-centre, retrospective, observational analysis of a prospective registry included 781 consecutive patients who were hospitalised for HF between 2021 and 2024. The primary endpoint was the in-hospital initiation rate of SGLT2i. Secondary endpoints included clinical factors associated with non-initiation, assessed using multivariable logistic regression, and the incidence of the composite endpoint of all-cause mortality or HF rehospitalisation at 1 year according to SGLT2i prescription status at discharge, evaluated by log-rank test and Cox proportional hazards analysis. A total of 467 patients (median age 81 [74-87] years, 50.3% male) were included in the final analysis. The initiation rate of SGLT2i during hospitalisation was 37.3% (174/467), and treatment discontinuation after initiation occurred in 8.6% (15/174). Multivariable analysis revealed that older age, non-diabetes, impaired renal function, higher left ventricular ejection fraction, malnutrition, impaired mobility, and cognitive dysfunction were independently associated with non-initiation. Among 346 patients with available follow-up data, the incidence of the composite endpoint at 1 year was significantly higher in the non-initiation group than in the initiation group (37.5% vs 21.3%, log-rank p = 0.001). In multivariable Cox analysis, not prescribed SGLT2i at discharge remained independently associated with worse long-term outcomes (hazard ratio 1.70, 95% confidence interval 1.07-2.69, p = 0.02). Both conventional clinical factors (e.g., diabetes, left ventricular ejection fraction) and aging-related factors (e.g., nutritional status, mobility, cognitive function) were independently associated with non-initiation of SGLT2i in hospitalised patients with HF. Importantly, non-initiation at discharge was significantly associated with worse long-term outcomes, underscoring the need to promote active initiation of SGLT2i in this population.

Despite federal mandates requiring qualified interpreter use, ad hoc interpreters, untrained individuals such as family members or bilingual staff, continue to be used in clinical care for patients with non-English language preference (NELP). Prior studies rely primarily on self-report or administrative data, leaving gaps in our understanding of how and when ad hoc interpretation is documented in real-world practice. To characterize the frequency, documentation, and contextual factors associated with untrained ad hoc interpreter use in inpatient medicine settings. We conducted a retrospective cohort study of adults with NELP admitted to a general medicine service at a large academic medical center between 2019 and 2023. We analyzed clinical notes using a large language model-based approach to identify documentation of interpreter use. Ad hoc interpretation cases were manually validated and categorized by interpretive role and documented rationale. Among 23,245 clinical notes from 2176 admissions involving 1379 patients with NELP, professional interpreter services were documented in 5921 notes (25.5% of notes). Ad hoc interpreter use was explicitly documented in 600 notes (2.6% of notes), across 324 admissions (14.9% of admissions) and 223 patients (16.2% of patients). Most ad hoc interpreter documentation involved family members (64.7%), and 7.7% occurred in conjunction with professional interpreters. Admissions with documented ad hoc interpreter use involved older patients, longer hospital stays, and higher comorbidity burden. Documented ad hoc interpreter use was more prevalent among non-Spanish language groups and increased with length of stay; nearly 75% of ad hoc interpreter notes lacked a documented rationale. Ad hoc interpreter use was relatively common among inpatients with NELP, particularly for less common languages and longer lengths of stay, and was most often provided by family members. Gaps in documented rationales for ad hoc interpreter use reveal systemic issues in language access workflows and underscore the need for improved access to professional interpretation, standardized documentation, and greater use of qualified bilingual staff to ensure equitable, policy-compliant communication for all language groups.

To evaluate the real-world efficacy and safety of adalimumab (ADA) combined with conventional therapy in patients with chronic non-infectious anterior uveitis (NIAU). This retrospective cohort study included 114 patients with chronic NIAU treated at a single tertiary center between May 2022 and May 2025. Patients were divided into a study group receiving ADA plus conventional therapy (n = 58) and a control group receiving conventional therapy alone (n = 56). Anterior chamber (AC) cell count, best-corrected visual acuity (BCVA), treatment response, adjunctive therapy use, complications and adverse events were compared over 6months. Multivariate logistic regression was performed to identify factors associated with complete remission. At 3 and 6months, the ADA group showed significantly lower AC cell counts and greater BCVA improvement than controls (all P < 0.05). At 6months, complete remission was achieved in 84.5% of the ADA group versus 64.3% of controls, with lower relapse rates (13.8% vs. 28.6%, both P < 0.05). After adjustment, ADA use was independently associated with complete remission (adjusted OR = 2.85, 95% CI 1.15-7.05). The ADA group required less adjunctive corticosteroid and immunosuppressive therapy and had lower rates of cataract and ocular hypertension. Most adverse events were mild, with one serious infection leading to discontinuation. In real-world practice, adalimumab combined with conventional therapy is associated with improved inflammation control, visual outcomes and reduced relapse in chronic NIAU, with an acceptable safety profile.