Delivery of geriatric oncology training to medical oncology residents - Is opportunistic learning good enough?

Skin side-effects of elexacaftor-tezacaftor-ivacaftor: a real-world view.

External compression of the outflow graft causing obstruction (eOGO) is a potentially lethal complication in patients on long-term mechanical circulatory support with the HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD). This complication results from the build-up of gelatinous substance between the bend relief and outflow graft and can be resolved by percutaneous intervention, surgery, or transplantation. This single-centre follow-up study evaluated the suitability of percutaneous intervention as a treatment strategy and long-term outcomes of eOGO patients in terms of laboratory, LVAD, and quality-of-life parameters. On October 31, 2024, a search of the implantation centre's electronic database identified HM3 patients diagnosed with eOGO. Individual patient data concerning 31 cases was analyzed. A quality-of-life survey was conducted using the short version of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12). The patient cohort had a median support time to eOGO diagnosis of 1219 days [976, 1917] and a post-treatment follow-up of 686 days [447, 1003]. 64.5% of patients (n = 20) underwent percutaneous intervention showing immediate LVAD flow improvement of 0.5 L/min post-intervention (p = 0.04). Of eight post-interventional survey respondents, 62.5% (n = 5) were assigned a fair-excellent health status according to the KCCQ-12. Percutaneous intervention is a suitable treatment strategy for eOGO, resolving low flow and providing satisfactory long-term quality of life outcomes. Given the increasing eOGO incidence after 1 year of support and overall mortality of 29.0%, clinicians should remain on high alert for this complication. We suggest computed tomography (CT) imaging be considered early on when eOGO is suspected.

ABSTRACT Objectives Communication barriers can hinder health promotion and healthcare services. Migrant and seasonal farmworkers face substantial challenges to healthcare access. We used a mixed-methods approach to assess access to phones and use of international numbers among agricultural workers, specifically migrant and seasonal farmworkers, and to explore potential implications for healthcare, emergency services, and public health outreach. Materials and Methods First, we surveyed migrant and seasonal farmworkers working in North Carolina, USA, about their ability to send text messages and make phone calls at their housing, including use of international phone numbers, in 2023. A total of 1,034 farmworkers participated in the survey, which used time-venue sampling. In 2023, we also interviewed farmworkers (n = 19) about their technology use and digital literacy skills. In 2024, as part of a statewide community assessment, we conducted listening sessions (n = 19) with farmworkers (n = 146), community health workers (n = 32), and healthcare team members (n = 34). Results Among survey respondents, 19% reported being unable to consistently make phone calls at their housing, and 10% reported using a phone with a number from another country. Interviews and listening sessions revealed three themes related to farmworkers’ cell phone use during the agricultural season, including use of international numbers, challenges with cell phones, and the utility of phones. Conclusions Healthcare providers, emergency services, and public health practitioners should be aware that farmworkers may face barriers to making and receiving phone calls as well as sending text messages. Healthcare systems should consider how to ensure access to care for farmworkers using phones with numbers from their country of origin. While most farmworkers have access to phones, a meaningful minority cannot consistently make a phone call to coordinate care, report an emergency, or access health promotion services.

The National Pension Scheme Authority (NAPSA) is Zambia’s central statutory body mandated to provide income security against retirement, invalidity, and death. Despite notable institutional growth, NAPSA continues to grapple with persistent structural and operational challenges that constrain its ability to deliver effective pension services. This study assessed the principal challenges affecting pension payments and coverage, examined their influence on pension system effectiveness, and identified actionable strategies to enhance service delivery. Using a mixed-methods design, data were collected from 307 survey respondents and three key informant interviews with NAPSA directors. Quantitative findings revealed pervasive challenges, including administrative delays (65.2%), payment delays that diminish confidence (88.6%), inadequate technological systems (51.1%), difficulties enrolling eligible contributors (67.4%), and weaknesses in management and coordination (77.2%). These challenges had a statistically significant negative influence on pension system effectiveness, confirmed by the Kruskal–Wallis test (X² = 133.7, p = 0.0001) and regression analysis (coefficients = 0.26–0.27, p = 0.001). Respondents strongly supported reforms such as digital system upgrades, staff capacity enhancement, improved monitoring and evaluation, expanded public awareness, and strengthened stakeholder partnerships. Qualitative insights underscored compliance challenges, reliance on manual processes, investment limitations, and the urgency of digitized national identification systems. The study concludes that NAPSA’s pension scheme effectiveness is compromised by systemic administrative and technological inefficiencies but can be substantially improved through targeted reforms centered on digital transformation, institutional strengthening, and inclusive coverage expansion.

Background: The United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services (MTaPS) program supported partner countries to implement infection prevention and control (IPC)-related programs. We evaluated the extent to which MTaPS-supported IPC programs fostered local ownership, such that members of local or national-level health systems had agency in developing and running programs. Methods: We surveyed three respondent groups involved in MTaPS IPC programs across eight African countries: (1) healthcare facility staff, (2) national-level stakeholders, and (3) MTaPS-contracted country implementers. Multiple-choice survey questions asked respondents to rate the quality of collaboration and capacity-building between their country and MTaPS, and the extent to which MTaPS fosters local ownership. Open-response questions inquired about factors that did or did not foster local ownership. We described the proportion of respondents reporting each multiple-choice response option, and conducted qualitative content analysis of open responses to generate themes about respondent perceptions of MTaPS support and local ownership. Results: We included 85 survey respondents: health facility staff (56%), MTaPS-contracted country implementers (29%) and national-level stakeholders (14%). Nearly all respondents rated the quality of MTaPS collaboration and capacity building "good" or "excellent." Overall, 75%-92% of respondents rated the quality of MTaPS collaboration and capacity strengthening as "mostly" supportive of local ownership and 8%-25% rated it "sometimes," supportive (0% selected "rarely/never"). Qualitatively, respondents described six activities as conducive to local ownership, including training, data collection/monitoring, stakeholder engagement, guideline/protocol standardization, creation/development of local committees, and supervision/mentorship/direct technical assistance. A reported barrier to MTaPS' support of local ownership was the inconsistent implementation of activities. Conclusions: IPC programs should continue to prioritize strategies for fostering local ownership, particularly as the funding landscape shifts. To increase IPC program sustainability in advance of future infectious disease threats, additional resources are needed to scale up activities perceived as conducive to local ownership.

Deprescribing guidelines support safe medication cessation and complement clinical practice guidelines. However, limited evidence exists on the strategies used by organisations and policy bodies to disseminate and implement such guidelines and their impact. The study aimed to identify dissemination and implementation practices of deprescribing guidelines across international organisations. An explanatory mixed-methods design was used, comprising (a) a content-validated 44-item survey comprising components based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and (b) qualitative interviews with survey respondents that provided deeper insights. Of the 75 unique visitors, 47 respondents from 14 countries provided analysable data (24 completed responses); five participated in a follow-up interview. Whereas 12 out of 27 respondents reported organisational tailoring of guidelines for local context, 18 out of 24 reported a lack of planning for implementation, dissemination and/or evaluation. Nineteen out of 24 respondents reported no monitoring of implementation outcomes. Although only three respondents reported provision of ongoing training and support, 25 out of 32 believed that guideline uptake could be improved. Although deprescribing guidelines have gained international attraction, organisations frequently overlook the need for implementation evaluation and the sustainment of implementation. Without attention to these aspects, organisations risk undermining their efforts to implement deprescribing guidelines.

ABSTRACT The Russia–Ukraine war generates fear, depression, loneliness, burnout, and the search for coping strategies that can alleviate the impact of war on mental health among civilians. In wartime, online gaming can become a coping strategy and/or a source of risk for internet gaming disorder (IGD). Our study examines the association of online gaming use and mental health among 1,170 Ukrainian university students in wartime conditions. Survey respondents were from six cities divided into two clusters. The first cluster included Kyiv, Kharkiv, and Chernihiv with much damage; and the second cluster of cities—Lviv, Rivne, and Ternopil with less damage. Respondent average age was 19.3 years, 30.4% secular and 31.7% married/partnered. Most respondents (66.2%) used online gaming during the past year. Statistical analysis does not show significant gaming disorder differences among university cluster students; however, first cluster students evidenced significant fear of war, depression, and burnout. Additional analysis shows a positive association between IGD, depression, burnout, and loneliness as well as a negative association with resilience and life satisfaction. Research findings confirm online game use as a resource that maintains or promotes resilience. Internet gaming, used as a therapeutic intervention for disaster conditions, calls for further research conducted over time with different groups of people and locations.

Clinicians frequently encounter workplace verbal violence from patients and caregivers. We created Simulation Addressing Verbal Escalation (SAVE) training for hospital-based staff to practice managing verbal escalation in a safe learning environment while reinforcing available hospital resources. This curriculum included a 1-hour session with 2 scenarios, each involving interprofessional ad hoc teams simultaneously managing a pediatric patient (manikin) experiencing sepsis with decreased responsiveness, and a verbally escalating caregiver (standardized patient). A debriefing reinforced the BEAR (Bond, Engage, Assess, Reinforce) communication framework, sepsis management, and hospital resources for caregiver support. Training was evaluated using a checklist documenting team actions, and a learner feedback survey (4-point scale; 1 = nothing/not at all, 4 = quite a bit). From October 2024 to April 2025, 860 clinicians participated in SAVE training. There were significant increases from scenario 1 to scenario 2 in team implementation of the full BEAR communication tool (35% to 77%, p < .0001), the Bond (67% to 94%, p < .0001) and Reinforce (56% to 83%, p < .0001) components, and SWIFT (Social Work Intervention for Families and Teams) utilization (1% to 6%, p = .014). Among survey respondents (n = 610), mean ratings were 3.55/4, 3.73/4, and 3.88/4 for learning, engagement, and facilitator effectiveness, respectively. Relevant takeaways included supporting families, considering patient care team dynamics, applying communication strategies, and accessing hospital resources. SAVE training provided a meaningful experience for practice and discussion about emotional clinical situations. Hospital-wide training empowers staff to leverage resources to support patients' caregivers.

Mucinous tumours of the ovary can arise as either primary or metastatic tumours, especially from the appendix. Our study aimed to investigate the different terms used across Canada with respect to ovarian or omental involvement by an appendiceal primary tumour. Retrospective data from January 2010 to October 2022 were collected using an internal pathology database at a single centre for cases of ovarian or omental involvement by an appendiceal primary tumour. Reports were reviewed for terminology used. Subsequently a survey was sent to Canadian academic centres, asking pathologists about their use of diagnostic terminology in reporting these cases. Our study identified 39 local cases, corresponding to an average of 3.25 cases per year. A further 16 academic pathologists completed the survey. Second review by one or more pathologists was common in local cases with 62% of in-house cases being reviewed in internal consultation. All survey respondents indicated that they either sometimes (56%) or always (44%) reviewed these cases with a second pathologist. With regard to terminology, a variety of terms were used for the same pathologic process, including: "mucinous carcinomatosis ovarii", "metastatic mucinous adenocarcinoma", "low-grade appendiceal mucinous neoplasm (LAMN) involving the ovary", "mucinous neoplasia", as well as an older term, "adenomucinosis". Our study highlights these differences, with the potential to help understand and standardize diagnostic terminology.

BackgroundCurrent literature suggests young outdoor workers experience a higher risk for workplace exposures including elevated risk of sun related health risks for outdoor workers.ObjectiveThis study aimed to assess young workers' understanding of sun-related hazards and associated sun safety practices in the workplace.MethodsA survey targeted young workers ages 18 -25 years in Canada and the United Kingdom either currently or previously employed. The full survey was on a variety of workplace hazards, and we report here on the subset of respondents who reported working outdoors for at least part of their typical day, for which a sun safety-related module was also asked. A sample of survey respondents were also invited to participate in a focus group.ResultsNearly all (97%) of the 760 outdoor workers reported knowledge of skin cancer being a risk of sun exposure, but few workers (13.9%) reported receiving sun or heat safety training. Over half (65%) reported little concern about workplace sun exposure. Self-reporting of sun safe practices among respondents, such as often wearing UVR protective clothing (7.5%) was poor.ConclusionsFindings suggest that young workers have moderate awareness of workplace sun safety, but generally reported poor adherence with sun-safe practices at work.

➢ Open fractures are a critical global health challenge that disproportionately affect individuals in low- and middle-income countries (LMICs), primarily due to road traffic collisions. Surgical management of open fractures is 1 of the 3 essential bellwether procedures identified by The Lancet Commission on Global Surgery.➢ We developed and evaluated a novel hybrid course on open fracture management for surgical trainees and practicing surgeons in Rwanda, combining a self-directed, virtual, pre-course curriculum with a live, in-person workshop in Kigali in June 2025 that was simultaneously live-streamed for virtual attendees. Prerecorded multilingual lectures (English and French) and curated peer-reviewed articles provided foundational knowledge in advance and prepared learners for in-person didactics, case discussions, and skills training.➢ The in-person workshop included didactic sessions and discussions of local clinical cases from Rwanda related to open fracture management and other orthopaedic emergencies, along with hands-on practice in fracture external fixation and negative pressure wound therapy using affordable devices designed for resource-constrained practice.➢ The workshop engaged 160 active learners (37 in-person, 123 virtual) and demonstrated high overall satisfaction among 84 survey respondents, with an average rating of 4.6 out of 5.➢ Self-reported confidence in managing open fractures increased substantially following the course, from a mean rating of 3.83 to 4.69 on a 5-point scale (p < 0.001). Most survey respondents reported that the course moderately or significantly improved their knowledge (96.4%) and would change their clinical practice (96.5%).➢ Participant feedback highlighted opportunities for improvement, including extending the workshop duration to increase hands-on time, expanding the content on complex soft-tissue management, and improving the engagement of remote learners through mechanisms such as the provision of low-cost external fixation models for at-home practice.➢ Future directions include integrating the course into medical student and general practitioner education in Rwanda, adapting it for major surgical conferences regionally and internationally, and continuing to prioritize hands-on training modules. Iterative refinement of the course is planned on the basis of participant feedback.

Abstract Introduction In cardiac surgery, 25% of patients develop post-operative delirium (POD); significantly more than in general surgery.[1] POD leads to serious consequences, including falls, prolonged hospitalisation and increased healthcare costs.[1] When non-pharmacological management is ineffective, and the patient is at risk of harm, medication is used to treat symptoms.[2] Anecdotally, medication choices vary widely between UK cardiac centres. Comparing local prescribing guidelines and surveying existing practice will inform the direction of future research into effective pharmacological strategies for managing delirium after cardiac surgery. Aim To determine the extent of variation in drug choices for the management of POD at 32 UK cardiac centres. Methods All NHS adult cardiac centres listed on the Society for Cardiothoracic Surgery website were emailed a Freedom of Information (FOI) request. Centres were asked to provide their local POD guidelines and answer ten questions relating to prescribing practice. Questions covered the use of preventative agents, and preferred treatment options for symptomatic delirium. Reminders were emailed to non-respondents after three months. Responses were collated at six months. Descriptive statistics were used to analyse the data. Results The response rate was 91% (29/32). No two centres had the same treatment pathway. Two-thirds used haloperidol first line; the only product licensed for delirium.[2] Overall, responses showed no consensus on the prescribing sequence of drug classes, and variation was seen within each class (Fig. 1). At 12 centres, delirious patients with disrupted sleep were prescribed melatonin. In 17 centres, melatonin was unavailable (12 cited insufficient evidence of efficacy, five had not evaluated its use). Conclusion There is widespread prescribing variation for POD after cardiac surgery. In the absence of licensed medication options, further studies are needed to assess the efficacy and comparative effectiveness of ‘off label’ medicines, enabling the production of clear national guidance to inform practice at a local level. Study design strengths: NHS organisations have a legal obligation to respond to FOI requests which gives high survey response rates. Study design limitations: Relying on the FOI team at each cardiac centre to identify a suitable survey respondent may increase inter-respondent variation.

Purpose: Despite the unique service models and educational opportunities they provide, student-led clinics remain scarce in social work. This evaluation study reports client outcomes and service experience feedback from a social work student-led mental health counseling clinic. Methods: The evaluation used chart reviews and a client experience survey. Results: A total of 236 clients (67.2% women; mean age = 37.72 years; 63.1% non-white) were seen over a 3-year period. Among clients with a planned termination ( n = 144, 61.0%), significant and clinically meaningful reductions in anxiety and depression symptoms were observed. The proportion screening positive declined from 68.0% to 36.1% on the GAD-2 and from 54.1% to 26.2% on the PHQ-2 (both p &lt; .001), with medium-to-large effect sizes. Over 90% of survey respondents agreed that services were client-centered, safe, timely, efficient, and effective. Conclusions: These findings support the effectiveness and acceptability of a student-led clinic in social work.

Cybercrime remains a persistent and evolving challenge in Nigeria despite increased government efforts through legal frameworks and enforcement activities. This study examines government responses to cybercrime with particular focus on the balance between prosecution-based and preventive approaches. Adopting a mixed-method design, data were collected from 400 survey respondents and 20 key informants in Sokoto State to assess public perceptions of enforcement effectiveness, awareness of cybercrime laws, and institutional capacity. The findings indicate that government response is predominantly enforcement-driven, with arrest and prosecution identified as the most visible intervention. However, awareness of cybercrime laws is generally low, and public sensitisation efforts are widely perceived as ineffective. Respondents also reported weak institutional capacity, including limited training, inadequate technological tools, and systemic challenges such as judicial delays and poor coordination. Overall, the results show that government response is largely reactive, focusing on addressing cybercrime after it occurs rather than preventing it. The study concludes that the persistence of cybercrime in Nigeria is linked not to the absence of intervention, but to an imbalance between corrective and preventive strategies. It recommends strengthening public awareness, improving institutional capacity, and adopting a more prevention-oriented approach to enhance the effectiveness of cybercrime governance.

This study addresses a critical gap in Egyptian independent theatre research concerning the lack of empirically grounded evaluation of scenic background limitations and the applied potential of projection mapping as a digital scenography strategy. The study investigates three core dimensions: cost efficiency, scene transition time, and audience engagement. It asks: (1) What are the primary operational challenges of traditional scenic backgrounds in Egyptian independent theatre? (2) To what extent can projection mapping improve production efficiency and audience immersion? (3) How does digital scenography align with contemporary scenic design theory? A convergent mixed-methods design was employed (n = 600 survey respondents; 15 expert interviews). Statistical analysis showed significant positive correlations between cost constraints and support for projection mapping (r = .66, p &lt; .001) and between transition inefficiency and digital adoption preference (r = .71, p &lt; .001). Comparative production modeling indicated mean cost reductions of 66% and transition time reduction of 80%. The study contributes theoretically by operationalizing Gillette’s Scenic Design framework within digital scenography and empirically by providing large-sample stakeholder data from an under-researched theatre ecosystem. Findings position projection mapping as a structurally transformative scenographic model rather than a merely technical enhancement.

The consumption of spring water contributes to meeting population demands and is essential in the context of water scarcity, as well as the proper maintenance of human well-being and environmental sustainability. Given the importance of information availability for the adoption of effective water resource management actions, this study aimed to analyse the water quality of public springs in the municipality of Pinheiral, RJ, based on potability standards and the perception of the local population. Water potability was determined through the analysis of the following parameters: pH, turbidity, colour, total Mn, total Fe, NO₃-, and thermotolerant coliforms, in water samples collected at four time points: summer (March 2021), autumn (June 2021), winter (September 2021), and spring (December 2021). To capture the perception of spring users, interviews were conducted using a questionnaire consisting of closed-ended questions. The results showed that all five springs evaluated failed to comply with legislative standards in at least one sampling period and for at least one of the following parameters: pH, turbidity, colour, total Mn, total Fe, NO₃⁻, and thermotolerant coliforms. Regarding consumption, 83% of respondents reported consuming spring water, motivated by their perception of good water quality and favourable organoleptic characteristics. This perception of quality leads to the non-adoption of hygiene practices during water collection, storage, and consumption. Out of the overall survey respondents, 28.1% reported that they do not wash the container where they collect the water, and 30.2% wash it only with water. Regarding consumption practices, none of the respondents reported boiling the water, and only 45.8% reported always filtering it prior to consumption. Based on the study results, it can be concluded that water from the analysed springs does not meet the limits established by potability standards and may therefore pose health risks to consumers.

Female surgeons more commonly delay childbearing and experience higher rates of infertility than women in the general population. More women are entering orthopaedic surgery but face unique challenges in family building. The accessibility of fertility preservation strategies among female orthopaedic surgeons remains underexplored. We aimed to investigate facilitators of and barriers to oocyte cryopreservation, especially during orthopaedic residency. A survey regarding family planning and experiences surrounding oocyte cryopreservation was designed and distributed via residency program directors, regional orthopaedic societies, and the Ruth Jackson Orthopaedic Society. Female orthopaedic surgery residents, fellows, and attending physicians were invited to participate. Of 169 participants, 107 (63%) reported intentionally delaying childbearing and 58 (34%) reported delaying or planning to delay for ≥4 years. Although 91 respondents (54%) had considered oocyte cryopreservation, only 36 (21%) had undergone or planned to undergo at least 1 cycle and 55 (33%) ultimately decided not to undergo it. Inflexible scheduling of work, lack of insurance coverage, and restrictive leave policy were the most important barriers to oocyte cryopreservation during residency. Among current residents and fellows, 30 (38%) would not have been comfortable telling program leadership that they were planning to undergo oocyte cryopreservation and 25 (32%) reported that they would not have been provided adequate scheduling flexibility. When given 5 multiple-choice questions about female fertility and the oocyte cryopreservation process, respondents answered a mean of 1.46 questions correctly. This study revealed a high degree of interest in oocyte cryopreservation among survey respondents but identified persistent barriers of financial burden, inflexible scheduling, institutional stigma, and limited fertility knowledge. Residency programs should prioritize schedule flexibility, proactive leadership support, and privacy-conscious accommodations for fertility-related care as well as structured reproductive health education for trainees. Barriers to fertility preservation during orthopaedic training directly affect physician well-being and the ability to recruit and retain women in this specialty, which, in turn, impact patient access to quality care from a diverse physician workforce.

Purpose The purpose of this study was to explore health-care access, experiences and barriers among people with learning disabilities from ethnic minority backgrounds and their informal carers within an NHS mental health trust in the East of England. The evaluation aimed to understand experiences of health-care access, and to generate practical, service-user- and carer-informed priorities for improving equity, coordination and reasonable adjustments across the local pathways. Design/methodology/approach Multi-method service evaluation. .An easy-read questionnaire was mailed to 64 eligible service users, where 13 responded (descriptive analysis). A focus group with six carers was conducted online and transcripts were analysed using reflexive thematic analysis. The design sought feedback on service use, satisfaction and reasonable adjustments, alongside carer experiences of access, information, coordination and support. Findings “Not knowing where to find help” was the most frequent barrier, alongside language barriers, stigma and insufficient reasonable adjustments. Carers reported high weekly caregiving hours and limited respite; coordination and signposting were inconsistent, with fewer than half of survey respondents (46.15%) reporting yearly specialist input. While 69.2% of people with learning disabilities had an annual GP health check and many felt involved in their care, information gaps undermined satisfaction. Desired adjustments included earlier/later appointments and easy-read materials. Carers advocated for stronger multidisciplinary working. Research limitations/implications As this evaluation did not set out to isolate the role of ethnicity, findings reflect general experiences of health-care access rather than providing an in-depth account of how ethnicity specifically shapes these experiences. Originality/value This evaluation contributes empirical evidence to the limited research on health-care access for people with learning disabilities from ethnic minority backgrounds and their carers, bringing together both service user and carer perspectives. It highlights actionable levers, such as clearer signposting, proactive communication, staff training in learning disability and better multidisciplinary coordination – to reduce avoidable burden on families and carers and improve equitable access, experiences and outcomes for people with learning disabilities.

As health sciences libraries look to the future, one area of focus should be onboarding new hires. This project investigates the onboarding experiences of newly hired health sciences librarians. This study used a mixed method design to quantitatively and qualitatively analyze the attitudes and perceptions of new health sciences librarians toward their most recent onboarding experiences. A survey was designed focusing on onboarding experiences of health sciences librarians and how these experiences have affected their career. Individual interviews were arranged with 14 survey respondents. Libraries need to explore more connections for new hires both inside and outside of the library.