Which shoulder functions correlate with patient satisfaction after primary shoulder arthroplasty?

Evaluation of care burden, psychological well-being and life satisfaction of informal caregivers caring of older people.

Limited research has examined psychological treatments for endometriosis-related chronic pain, despite its association with elevated disability, depression, and anxiety. Remotely delivered treatments have the potential to overcome barriers to access face-to-face psychological care, however, no studies have examined this format in endometriosis patients. The current study examined the efficacy and acceptability of an internet-delivered, psychological, pain management program for women with endometriosis-related pain. In this two-arm trial, 193 participants experiencing endometriosis-related pelvic pain were randomly assigned to the 8-week treatment or a waitlist control. The treatment was an adapted version of an established internet-delivered pain management program based on cognitive-behavior therapy principles. Relative to control, the treatment group reported significantly greater improvements (between groups Cohen's d ; average percentage change) in the primary outcomes of pain-related disability ( d = 0.35; 24%), depression ( d = 0.40; 17%), and anxiety ( d = 0.26; 17%) from pre- to post-treatment. Improvements were sustained at 3-month follow-up. No between-group difference was observed on the secondary outcome of average pain intensity ( d = 0.28; 17%, P = 0.054). High lesson completion and treatment satisfaction rates were observed. Mean clinician time per participant was 70 minutes (SD = 68). The current findings indicate the potential of a pain-focused psychological approach in supporting endometriosis-related pain, and the potential of the internet-delivered format in increasing access to care. Future research is needed to examine long-term outcomes and investigate factors associated with optimal treatment response.

This study explores user satisfaction with the coastal promenade in Yomra, Trabzon, completed in 2021, and how tourist presence affects that satisfaction. Survey data indicate that most users are local residents who are generally pleased with the new coastal area. However, the presence of tourists—particularly from culturally different backgrounds—lowers overall satisfaction. Yomra has become a major destination for Arab tourism over the past 20 years, contributing to rapid development but also creating challenges in the shared use of public spaces. The findings highlight the importance of coastal areas in the city–coast relationship, while also showing that cultural differences among users can weaken this connection. As a result, coastal planning should not only focus on user needs and participatory approaches but also consider the cultural and social dynamics of tourism to ensure inclusive and sustainable public space management.

Background — The incidence of thyroid nodules is increasing. Although most are benign and asymptomatic, some require treatment for compressive or cosmetic reasons. Radiofrequency ablation (RFA) is a minimally invasive alternative to surgery. To date, published studies focused on the technical aspects of RFA, while comparative analysis of patient satisfaction depending on nodule volume was limited. Methods — This prospective cohort study analyzed 101 patients who underwent RFA for benign thyroid nodules (from January 9, 2019, to October 15, 2024). Patients were distributed among two groups depending on nodule volume (<10 ml and ≥10 ml). Post-procedural satisfaction was assessed using questionnaires regarding physical and emotional well-being. Results — We observed high overall patient satisfaction. Although nodule volume did not significantly affect overall satisfaction, larger nodules were associated with higher rates of a full symptomatic satisfaction. Satisfaction with cosmetic outcome was similar across nodule volume groups. Significant volume reduction was observed at 24 months of follow-up. Conclusion — RFA results in high patient satisfaction for benign thyroid nodules. Nodule size influences several aspects of the experience, highlighting the need for further research examining factors affecting patient satisfaction beyond nodule volume.

Several treatments are available for actinic keratosis (AK), many of which are hampered by local inflammation, pain, long duration, and slow healing. Indoor daylight photodynamic therapy (idl-PDT) is an effective, well-tolerated, first-line treatment for both AK and field cancerization, but its feasibility is limited by the long time required for illumination (2h). The objective of our study was to evaluate the efficacy of idl-PDT with an illumination time of 1h versus 2h in the treatment of scalp AK. We conducted an intrapatient, comparative study of idl-PDT with two illumination durations, 1h versus 2h, using methyl aminolevulinate (MAL, Metvix®) and a white light-emitting diode (LED) light (Dermaris®) for the treatment of scalp AK. Patients were evaluated 3months and 6months after one session of idl-MAL-PDT for AK response rate, both overall and by AK grade, and tolerability. Physicians' and patients' satisfaction were also investigated. A total of 55 patients were enrolled with a total of 955 AK (grade I-II). The AK clearance rate was 72.9% in 1h-half and 71.1% in 2h-half after 3months, and 76.2% in 1h-half and 78.9% in 2h-half after 6months. No statistically significant difference in efficacy (overall, grade I and II AK) was observed between the two illumination times, both at 3 and 6months. The local skin reaction score and pain numeric rating scale (NRS) were very low, and comparable between the two treatment arms. Both physicians and patients expressed very good opinion on effectiveness and cosmetic outcome. Overall, 96.4% of patients would undergo idl-PDT again. The efficacy of idl-PDT in treating grade I and II AK of the scalp was comparable using 1h or 2h as illumination time. Both treatment schedules were well tolerated, with a very high rate of satisfaction from both physicians and patients. This trial was retrospectively registered on the 4th of December 2025. ClinicalTrials. gov identifier, NCT07290959.

Dementia increases the risk of individuals getting lost due to cognitive decline, impacting daily functioning and heightening caregiver worry. Traditional search methods are often time-consuming and stressful, whereas GPS-based technologies face limitations such as battery dependency. A crowdsourcing Internet of Things (IoT) technology using energy-efficient Bluetooth Low Energy (BLE) offers a potential solution to locate missing individuals with dementia more effectively by harnessing the power of the crowd and fostering a caring and inclusive community. This study aimed to evaluate the effectiveness of a BLE-based privacy-preserving crowdsourcing IoT system consisting of a BLE tag and an Android and iOS app in improving lost-related behavior and psychological well-being by facilitating searches, after-care arrangements, and reducing caregiver worry, as well as to assess its usability among caregivers of individuals with dementia in Hong Kong. A single-arm, prospective observational study was conducted from November 2020 to October 2023. Caregivers (N=1034) of individuals with dementia used a staff-assisted crowdsourcing IoT technology comprising a BLE tag, mobile app sensor, and location cloud server. Outcomes included search strategies, post-getting lost care arrangements, caregiver worry and distress (10-point scale), and usability (modified Quebec User Evaluation of Satisfaction with Assistive Technology 2.0 survey). Data were collected at 6- and 12-month follow-ups and analyzed using generalized estimating equations and linear mixed models. Of the 1034 participants, 143 (13.82%) reported lost episodes, with 51 (35.7%) using BLE tags for searches. Worry about future lost episodes decreased significantly over time (P=.008), especially among BLE tag users (P=.04). There was an association between BLE tag use and adoption of proactive search strategies (eg, going out to search: adjusted odds ratio 2.78, 95% CI 1.33-5.82; P=.007) and preventative measures (eg, IoT devices or CCTV: adjusted odds ratio 2.92, 95% CI 1.61-5.29; P<.001). Usability satisfaction was high for design and data security, whereas approximately half of the participants (309/707, 43.7%) were satisfied with accuracy. The BLE crowdsourcing system may reduce caregiver worry and encourage proactive search behaviors, although accuracy depends on broader community adoption. Integration into dementia care plans could enhance safety and autonomy. Further research with a randomized controlled trial design is needed to confirm these findings.

Abstract To address container loading problems with mixed fragile and regular cargo, an optimisation model is developed with the objective of maximising container volume utilisation under multiple constraints, including stacking requirements, centre of gravity balance, and corner casting limitations. Separate cargo block units for fragile and regular items are constructed, considering complete support requirements for all cargo and non-stacking properties of fragile items. A residual space update technique based on the maximum coverage method is proposed for corner casting constraint handling. Incorporating tree search algorithm principles, a heuristic algorithm is designed that demonstrates better overall performance on BR standard cases in terms of both container utilisation and constraint satisfaction rates when compared to several representative algorithms. In mixed cargo scenarios, the algorithm achieves 100% satisfaction of all constraints whilst maintaining high container utilisation rates, outperforming commercial loading tools by 4.77% in space efficiency. Experimental loading cases visually confirm that the algorithm effectively avoids corner casting restrictions and generates loading layouts that meet transportation safety requirements.

Correct plant identification becomes imperative in the conservation and application of ethnobotanical knowledge within the Indian subcontinent to facilitate evidence-based healthcare approaches. In this regard, to bridge the existing gap between plant identification technology and practical medical applications within the subcontinent, there is the need to present an end-to-end deep learning solution that combines the expertise of BiFPNet with an evidence-validated therapeutic databank. The designed BiFPNet deep learning architecture combines Compound Scaling and the BiFPN module from EfficientDet to ensure multi-scale features are derived from medical leaf images within the subcontinent. The network was tested and trained on a large set comprising 98 plant species and 12,813 images taken with high-resolution formats to present 97% accuracy above standard approaches presented by CNN, Resnet-50, and VGG models. Additionally, to ensure that herbal plant images are subjected to higher accuracy in terms of leaf features that can correlate with medical applications within the subcontinent, there is the use of Grad-CAM to present herbal leaf features that meet medical applications within the subcontinent. In this regard, these approaches resulted in 92% satisfaction rates during validation among medical experts who mainly relate to the application of Ayurvedic medical approaches within the subcontinent.

Strengthening Connections for Change: A Pilot Cluster-Randomized Trial of an Adolescent-Adult Social Network-Based Intervention.

BACKGROUNDEnhanced recovery after surgery (ERAS) guidelines have been established for multiple types of adult surgeries. However, ERAS guidelines tailored to pediatric surgeries remain to be developed.AIMTo evaluate the clinical outcomes of ERAS protocols in pediatric laparoscopic Meckel’s diverticulum resection.METHODSThis retrospective cohort study analyzed 78 consecutive pediatric cases treated between January 2017 and March 2025. Patients were divided into: Traditional care group (n = 38): January 2017-December 2020; ERAS protocol group (n = 40): January 2021-March 2025. We compared perioperative outcomes, including clinical recovery parameters and laboratory markers, to assess protocol efficacy.RESULTSAll procedures were completed laparoscopically by the same surgical team without conversion. Baseline characteristics, including demographics, diverticulum location, and intraoperative parameters (operative time, blood loss), were comparable between groups (all P > 0.05). The ERAS protocol demonstrated significantly shorter postoperative length of stay (7.55 ± 1.52 days vs 10.40 ± 3.59 days, P < 0.001) while complication rates were numerically lower in the ERAS group (17.50% vs 13.16%, P = 0.595). Additional benefits of ERAS implementation included: Reduced intravenous fluid requirements (5.00 mL/kg/hour vs 8.00 mL/kg/hour), accelerated gastrointestinal recovery (first flatus: 2.00 days vs 3.00 days), lower pain scores (P < 0.001), earlier total enteral nutrition achievement (5.00 days vs 6.50 days) and shorter intravenous therapy duration (6.00 days vs 8.00 days; all P < 0.001). ERAS patients also showed reduced drainage utilization (P < 0.05) and improved inflammatory marker profiles postoperatively [neutrophils: (5.98 ± 2.02) × 109/L vs (8.01 ± 3.98) × 109/L]; median C-reactive protein: 13.6 mg/L 7 vs 19.63 mg/L). Glycemic control was superior in the ERAS group despite higher induction levels (both P < 0.05). Parental satisfaction (92.50% vs 86.84%) and 30-day readmission rates (2.50% vs 2.63%) showed no significant differences.CONCLUSIONERAS protocols safely optimize recovery in children undergoing laparoscopic Meckel’s diverticulum resection, significantly reducing length of stay while improving pain management and overall clinical outcomes. These findings support the adoption of ERAS in pediatric intestinal surgery.

To investigate the independent risk factors of dysphagia after stroke, and to evaluate the clinical improvement of standardized swallowing function training. Three hundred stroke patients admitted from January 2023 to January 2025 were enrolled, of whom 142 presented with dysphagia. All patients underwent videofluoroscopic swallowing study (VFSS), Risk factors, including age, muscle strength, and National Institute of Health stroke scale (NIHSS) score, were assessed by univariate and multivariate logistic regression analysis. Patients with dysphagia received multimodal swallowing training (neuromuscular electrical stimulation, tongue muscle resistance training, and cold stimulation) once daily for 4 weeks. Swallowing improvement was evaluated using water swallowing test (WST). Patient compliance and satisfaction were recorded. VFSS score, upper esophageal sphincter (UES) openness, pharyngeal cavity constriction (PCR), age, muscle strength ≤ 3, and NIHSS ≥ 10 were identified as independent risk factors for dysphagia (P < 0.05). The overall effective rate of swallowing function training for dysphagia was 92.25%. Following intervention, the Standardized Swallowing Assessment (SSA) score decreased from 36.85 ± 5.67 to (24.56 ± 3.40), while WST grade reduced from (3.96 ± 0.83) to (1.74 ± 0.73), and VFSS parameters showed significant improvements in swallowing coordination. The overall compliance rate of the patients was 87.32%. Patient satisfaction rate was 92.96%, and the incidence of adverse reactions was 9.15%. The multimodal swallowing training can preliminarily improve swallowing function. However, given the single-center, uncontrolled design, and the potential influence of spontaneous recovery, large-scale randomized controlled trials are warranted to confirm these findings.

ABSTRACT Seven different cooking methods (pan-frying, oven-frying, microwave-frying, steaming, sous-vide, air-frying, and smoked) were used to examine the following parameters: moisture, ash, total protein, total fat, total antioxidant capacity (TAC), total phenolic content (TPC), color, texture, sensory quality, ∑MUFA, ∑PUFA, EPA, and DHA. Protein loss was minimal in air-frying samples. Antioxidants, which play an important role in combating free radicals, had the highest TAC values in the sample cooked in a cast iron pan without oil. Considering the total fat content, steaming clearly demonstrated better performance. Sous-vide preserved the ∑PUFA content more than pan-frying. From a sensory perspective, smoked samples were found to have the highest satisfaction ratings.

The signal-to-noise ratio (SNR) of the anterior talofibular ligament (ATFL) on preoperative magnetic resonance imaging (MRI) has been shown to influence outcomes after the modified Broström procedure in adults with chronic lateral ankle instability (CLAI). Its prognostic value in adolescents remains unclear. This study was to evaluate the relationship between preoperative ATFL-SNR and mid- to long-term clinical outcomes following modified Broström repair in adolescents with CLAI. This retrospective cohort study included adolescents who underwent modified Broström repair between July 2015 and June 2020. ATFL-SNR was measured on preoperative MRI and categorized into low (LSNR, SNR < 10.4) and high (HSNR, SNR ≥ 10.4) groups. Propensity score matching (1:1) was used to balance age, sex, body mass index, symptom duration, side, joint hypermobility, and preinjury Tegner score. Patient-reported outcomes (PROs) include visual analog scale (VAS) for pain, Karlsson score, Tegner score, and Foot and Ankle Outcome Score (FAOS, as the primary outcome). Secondary outcomes included time to return to sport, recurrent sprain, incision numbness, and subjective satisfaction. Linear regression and subgroup analysis were conducted. Seventy-eight patients (39 per group) were included, with a mean follow-up of 80.3 ± 17.7 and 80.1 ± 18.1 months in the LSNR and HSNR group (P = .950). Both groups showed significant improvements in all PROs (P < .05), but no significant differences were observed between the LSNR and HSNR groups (all P > .05). Return to sport time, recurrent sprain rate, numbness, and satisfaction rate were also comparable. No correlations were found between ATFL-SNR and postoperative PROs. Subgroup analyses showed no association between comorbidities and postoperative FAOS scores. Preoperative ATFL signal-to-noise ratio (SNR) on MRI was not associated with mid- to long-term outcomes after modified Broström repair in adolescents with chronic lateral ankle instability. These estimates should be interpreted with caution given the relatively small sample, potential residual confounding, and SNR variability. Within this cohort, favorable long-term outcomes were achieved across the range of preoperative SNR values.

This systematic review evaluates long-term outcomes after anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET), including patient-reported outcome measures (PROMs), failure rates, objective knee scores and radiographic osteoarthritis (OA). A search of MEDLINE, Embase and Emcare was conducted until April 2025. Studies were eligible if they reported ≥10-year outcomes following combined ACLR and LET in adults. Exclusion criteria included cadaveric, biomechanical, paediatric and non-English studies. Methodological quality was assessed using Risk of Bias 2.0 Tool (RoB 2) for randomized trials and methodological index for non-randomized studies (MINORS) for non-randomized studies. Narrative synthesis and descriptive statistics were performed. Eleven studies (n = 603) were included, with a mean follow-up of 15.8 years (standard deviation [SD] 5.9). Graft failure rates ranged from 0% to 19.5%, with lower rates in studies using stricter revision-based definitions. LET was associated with lower failure and instability rates compared to isolated ACLR in three studies. Radiographic OA findings were mixed: some reported increased lateral OA (notably with bone-patellar tendon-bone [BTB] grafts), while others suggested protective effects, especially in patients with hamstring grafts and prior meniscectomy. Lysholm scores consistently exceeded 85, while Tegner activity levels declined modestly. International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) scores were favourable, and most patients achieved IKDC objective Grade A or B. This review demonstrated that ACLR augmented with LET provided durable long-term outcomes, including high rates of subjective satisfaction and objective stability, without being consistently associated with increased radiographic OA or unacceptable failure rates. However, heterogeneity in study design, surgical technique and outcome reporting limits definitive conclusions. Level IV.

Augmentation mastopexy is complex due to the biomechanical conflict between lifting ptotic tissue and introducing volume with implants. In medium-to-large breasts or in patients with poor tissue quality, the imbalance between native parenchyma and implant weight may lead to recurrent ptosis, bottoming-out, and aesthetic dissatisfaction. Clinical outcomes and patient satisfaction following a septum-based parenchymal reduction technique combined with dual-plane augmentation were investigated. We conducted a retrospective review of a multicenter database including 238 patients who underwent bilateral septum-based augmentation mastopexy (January 2018 - May 2023). Inclusion criteria were age ≥18 years, Regnault grade II-III ptosis, and follow-up ≥12 months. The technique involved wide parenchymal resection on a vascularized medial pedicle including the internal septum, followed by dual-plane implant placement. Patient-reported outcomes were assessed (BREAST-Q Augmentation and Reduction/Mastopexy modules) preoperatively and at 30 days, 6 and 12 months. Rasch-transformed scores were analyzed using Wilcoxon signed-rank tests (p<0.05). Mean patient age was 35.2 years; mean BMI was 23.6kg/m2. Average implant volume was 345.1cc. Statistically significant improvements (p < 0.05) were observed in all BREAST-Q domains. Overall complication rate was 11.3% (reoperation rate 5.9%). Recurrent ptosis occurred in 1.3%. No BIA-ALCL cases were reported. Septum-based augmentation mastopexy appears safe and reliable in moderate to severe ptosis, especially in medium-to-large breasts. The technique allows controlled tissue reduction, maintains vascularity, and improves implant integration. Patient satisfaction and complication rates are favorable compared to the literature. However, further prospective studies are needed to confirm long-term stability and refine patient selection criteria.

Under-represented in medicine (URM) trainees experience higher discrimination and attrition rates, increased depression and burnout. This is the first mentorship program developed for URM medical students, residents and fellows in Canada in radiation oncology to try and improve trainee well-being and inclusion.The Canadian Association of Radiation Oncology - Underrepresented in Radiation Oncology Mentorship Program (CARO-UROMP) was developed through materials adapted from the Association of Residents in Radiation Oncology's Equity and Inclusion Subcommittee. Mentees and mentors were paired based on a pre-program needs assessment. The program was administered for an 8-month duration. Pre and post-program surveys were sent to participants.Between September 2024 and April 2025, 11 mentees and 11 mentors participated. All mentees and mentors were satisfied/very satisfied (100%) with the mentorship program overall. The majority of mentees (87.5%) felt that their mentors were approachable, timely, supportive and listened to their thoughts. Most (75%) were satisfied/very satisfied with career support including jobs and networking advice. For research support, most mentees (62.5%) were satisfied/very satisfied on guidance on research/grant applications and manuscript writing. All mentors agreed/strongly agreed that they were able to improve their mentees' confidence, sense of community and inclusion within RO and that they were able to motivate their mentee to reach their objectives. All mentor/mentee pairs wanted to continue their mentorship relationship.The inaugural year of the CARO-UROMP mentorship program was successful with very high rates of satisfaction. Given the positive impact of the program, the Canada-wide program will look to expand in the future.

BackgroundIncreasing understanding of MCI has been identified as a public health priority1, however MCI, as a concept, is difficult for professionals, patients, and the public to grasp2. There is a need for holistic, person‐centered education to support health and wellbeing of persons with MCI and their families3 (Mpofu 2024). In response to the need for community education the Wisconsin ADRC launched the Healthy Living with Mild Cognitive Impairment (HLMCI) education series to support persons with MCi and their care partners and promote health behaviors known to reduce dementia risk.MethodHLMCI is a quarterly series offering guidance and science‐backed strategies for living and coping with a diagnosis of MCI for communities across Wisconsin. Each session is led by the WADRC Medical Director and Clinical Core Co‐Leader together with a subject matter expert. Ample time for questions and answers are included in each event. Session topics are selected, guided by the Lancet Commission report on brain health risk factors with preference given to requests from program participants. The program is offered in 7 locations across the state. Including rural communities.ResultsIn 2024, the most popular topic was “You are More than Your Diagnosis” with 160 registrants. We averaged 112 registrants per session, 28% report a diagnosis of MCI, 35% were care partners and 35% were health or social service professionals. The majority of attendees are women, 45% are URGs. Although the median age of registrants was 55, the programs attract individuals ranging in age from under 35 to over 75; 52 % reported they were interested in finding out if they have amyloid or tau proteins in their brain. Approximately 40% attended 2 or more sessions last year. Satisfaction ratings of the topics and presenters are high ranging from 92 to 94 % across 2024 sessions.OutcomeHealthy Living with MCI is meeting an unmet need for information and guidance regarding lifestyle changes and activities to support brain health. While the program is designed to support individuals living with mild cognitive impairment, it also provides reliable and unbiased education and support to care partners and health professionals.

The purpose of this study was to analyse the impact of users’ pre-use expectations and attitudes towards products and apps and long-term post-use satisfaction evaluations as factors related to anticipatory UX. The author conducted a survey on users’ expectations and attitudes prior to use and their satisfaction with the service immediately after use and one, two, and three months after use. The multiple regression analysis used the level of satisfaction at each time point as the dependent variable and the variables related to expectations and attitudes before use as the explanatory variables. Significant multiple regression models were obtained at each time point (immediately after use and 1, 2, and 3 months later), revealing that users’ prior expectations and attitudes had a certain influence on satisfaction ratings even three months later.

During kidney transplantation, the use of a ureteral stent reduces the risk of major urological complications (MUC). However, it is associated with infectious complications and usually requires a second procedure to be removed. The goal of this pilot study was to evaluate the impact of early ureteral stent removal at bedside. We prospectively included all consecutive kidney transplant recipients at our center between May 2020 and May 2021. During the first 6 months, all consecutive patients had routine removal of the ureteral stent as an outpatient procedure (Group 1). During the last 6 months, all patients had early removal of the ureteral stent at bedside before leaving the hospital, using a grasper-integrated single-use flexible cystoscope (Group 2). The primary endpoint was feasibility and patient satisfaction. Secondary endpoints were rate of urinary tract infections (UTI) and major complications. Overall, 151 patients were included, 84 in Group 1 and 67 in Group 2. The characteristics of the two groups were similar. There was no failure of the bedside early stent removal procedure, with a mean overall satisfaction score of 9/10 (rank: 4-10). The rate of MUC was similar in the two groups. In multivariate analysis, early removal of the ureteral stent was a significant predictor of a lower risk of UTI (OR=0.49; IC95% [0.23; 0.98]; p=0.047). Early bedside ureteral stent removal was feasible, with a high satisfaction rate and a lower risk of UTI without a significant increase of MUC.