METHODS: A qualitative, phenomenological design was employed to explore the experiences of 12 gynecological nurses working in early pregnancy units. Semi-structured interviews investigated nurses' perceptions of emotional labor, the coping strategies they utilized, and the influence of organizational factors on their well-being. Thematic analysis guided by Braun and Clarke's framework illuminated emerging patterns, with member checking and peer debriefing ensuring analytical rigor.
RESULTS: Four key themes emerged. First, The Emotional Burden of Recurrent Loss highlighted nurses' cumulative grief and sense of "compounding sorrow" as they supported patients through multiple losses. Second, Balancing Empathy and Professional Boundaries underscored the tension between offering genuine compassion and guarding personal emotional reserves. Third, Coping Strategies and Resilience-Building revealed a multilayered approach comprising reflective practices, peer debriefing, and self-care. Finally, Organizational Support and Gaps emphasized how institutional resources, staffing levels, and specialized training significantly shaped nurses' capacity to sustain empathetic care.
CONCLUSION: Nurses caring for RPL patients experience heightened emotional labor due to repetitive, distressing encounters with loss. While individual and peer-based coping mechanisms foster resilience, organizational support-such as formal debriefing sessions and RPL-focused training-amplifies nurses' well-being and ensures sustainable, high-quality care. These findings underscore the need for targeted interventions that address both the individual and systemic dimensions of emotional labor in RPL settings.
MATERIALS AND METHODS: A total of 303 unvaccinated COVID-19 patients (151 severe cases and 152 asymptomatic/moderate cases) and 150 individuals from a SARS-CoV-2-negative group were included in the analysis. Genotyping was performed using TaqMan SNP assays. SARS-CoV-2 antibodies targeting the nucleocapsid protein and IgG antibodies specific to the receptor-binding domain (RBD) were quantified using chemiluminescence microparticles immunoassay. Complete blood counts and C-reactive protein levels were evaluated using an automated platform.
RESULTS: Our analysis revealed that the A/A genotype of rs12603708 significantly increased the risk of SARS-CoV-2 infection in both codominant (p = 0.0055; OR = 3.74; adjusted p value = 0.022) and recessive (p = 0.0049; OR = 3.17; adjusted p value = 0.022) models, as well as the risk of severe disease (p = 0.014; OR = 3.43; adjusted p value = 0.049). For rs3751987, the G/G genotype was linked to higher susceptibility to infection (p = 0.0011; OR = 2.91; adjusted p value = 0.008), while the G/A genotype appeared protective (p = 0.0007; OR = 0.45; adjusted p value = 0.008). No association was found between rs3751987 and disease severity. Analysis of IgG anti-N and anti-RBD levels revealed no significant associations with either polymorphism (p > 0.05).
CONCLUSION: These findings highlight the role of TNFRSF13B polymorphisms in SARS-CoV-2 susceptibility and severity, while their impact on humoral immune responses appears limited.
AIMS: We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants' knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.
METHODS: A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).
DISCUSSION: We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.Trial registration: ClinicalTrials.gov (NCT06408493).
METHODS: Drawing on social constructivism, the study employed a qualitative methodology to explore perspectives of medical students, examiners and SPs across metropolitan Melbourne, rural Victoria and Malaysia. Data included individual interviews with nine examiners, eleven SPs, and three focus groups with students. Data were transcribed and thematically analysed using framework analysis.
RESULTS: Analysis demonstrated overlapping perspectives with five themes - fit for purpose assessment, focus on dynamics of online discourse, perceiving realism, readiness for practice and implications for future, with ongoing role in Telehealth. Readiness or preparation for practice was acknowledged through impact on student performance for progression, examiners' focus on assessment rigour replicating chaos and complexity of real life and SPs drew analogy with real-life clinical consultations.
CONCLUSIONS: MONSCE assessments appear to be useful for student assessment of skills like history taking and clinical counselling. Their role was considered complementary to in-person clinical skills assessment but not replace the complexity of real life or replicate skills assessment of empathy, physical examination, and difficult communication, where in-person assessment may be preferred.
METHODS: This study collected time-series incidence data from the literature and hPIV surveillance programs worldwide (47 locations). Wavelet analysis and circular statistics were used to detect the seasonality and the months of peak incidence for each hPIV type. Relationships between climatic drivers and incidence peaks were assessed using a generalized estimating equation.
RESULTS: The average positive rate of hPIV among patients with respiratory symptoms was 5.6% and ranged between 0.69-3.48% for different types. In the northern temperate region, the median peak incidence months for hPIV1, hPIV2, and hPIV4 were from September to October, while for hPIV3, it was in late May. Seasonal peaks of hPIV3 were associated with higher monthly temperatures and lower diurnal temperatures range throughout the year; hPIV4 peaks appeared to correlate with lower monthly temperatures and higher precipitation throughout the year. Different hPIV types exhibit different patterns of global epidemiology and transmission.
CONCLUSIONS: Climate drivers may play a role in hPIV transmission. More comprehensive and coherent surveillance of hPIV types would enable more in-depth analyses and inform the timing of preventive measures.
PURPOSE: This study aims to assess the precision of ultrasound in identifying upper limb peripheral nerves by comparing ultrasonographic findings with direct human cadaveric dissection.
METHOD: Fourteen fresh-frozen upper limb specimens were examined in February 2023. Ultrasound assessments were performed by two experienced musculoskeletal radiologists using three linear probes (15 MHz, 24 MHz, and a 22 MHz hockey stick probe). Seven peripheral nerves were identified and marked using dye injections. Subsequent dissections were conducted under loupe magnification by hand surgeons.
RESULT: The recurrent motor branch of the median nerve exhibited the lowest discrepancy (mean 1.014 ± 1.459 mm) and the highest accuracy (64.29% of specimens). The greatest discrepancy was observed in the branch of the musculocutaneous nerve to the brachialis (mean 5.114 ± 3.758 mm). The interrater correlation coefficient (ICC) varied across nerve sites, ranging from - 6.298 to 0.795, with the highest ICC observed in the superficial branch of the ulnar nerve (0.795, 0.066).
CONCLUSION: These findings suggest that ultrasound is a valid and effective tool for identifying peripheral nerve branches in the upper limb, particularly for superficial nerves. Improved accuracy in ultrasound-guided nerve identification may enhance surgical precision and reduce complications in nerve-related procedures.
MATERIALS AND METHODS: CT imaging data from twenty patients with breast or chest wall cancer, either right or left-sided, and with supraclavicular and internal mammary chain lymph nodes were retrieved. The CT data planned with a hybrid VMAT of three different weighting proportions: 30 % using 3DCRT and 70 % using VMAT, 50 % using 3DCRT and 50 % using VMAT, and 70% using 3DCRT and 30 % using VMAT and compared with full 3DCRT and full VMAT plan (classic and five arc design).
RESULTS: The homogeneity and conformity indices were better in the hybrid VMAT plans than in plans using VMAT or 3DCRT alone (P<0.005). Results of all hybrid VMAT plans showed a considerable drop of volumes receiving more than 4Gy, 8Gy or 16Gy in the ipsilateral lung compared to the full VMAT plan (P<0.001). There was a noticeable decrease in the mean dose to the heart and the dose in 5% of the contralateral breast in the plan using 70 % 3DCRT and 30 % VMAT compared to full VMAT (P<0.001). The plan using 70 % 3DCRT and 30% VMAT achieved a balance between the target and surrounding areas, compared to using only 3DCRT or VMAT.
CONCLUSION: A hybrid plan using 70 % 3DCRT contribution achieved a balanced outcome for breast or chest wall irradiation, considering both planning target volume and organs at risk. Utilizing our VMAT arc design, incorporating one shortened arc can significantly reduce doses to organs at risk further. It is important to consider the patient's anatomy when making this decision.
OBJECTIVE: To investigate the relative curve correction of Proximal Thoracic (PT) and Main Thoracic (MT) scoliosis curves and their relationship with post-operative UIV tilt angle as well as post-operative shoulder imbalance.
METHODS: 151 AIS patients with Lenke type 1 and 2 curves who underwent PSF were reviewed. Relative PT/MT Correction Rate (RCR), Relative PT/MT Residual Cobb angle (RRCA) and Post-operative UIV Tilt Angle were investigated for their association with post-operative T1 tilt (medial shoulder balance), Cervical Axis (neck balance) and Clavicle Angle (Lateral Shoulder Balance).
RESULTS: There were 107 patients with Lenke 1 curves and 44 patients with Lenke 2 curves. Overall, the prevalence of medial shoulder, neck and lateral shoulder imbalance was 27.8%, 23.2% and 9.9%, respectively. There was a significant association between RRCA and medial shoulder, lateral shoulder and neck balance but RCR had a significant association with lateral shoulder and neck balance. There was a significant and strong correlation (r = 0.708) between post-operative UIV tilt angle and post-operative T1 Tilt. Unlike RCR, RRCA had shown a statistically significant correlation to post-operative UIV tilt angle with an r-value of 0.406.
CONCLUSIONS: RRCA had shown a statistically significant correlation with the post-operative UIV tilt angle, and post-operative T1 tilt ie, medial shoulder balance. However, the post-operative UIV tilt angle showed the strongest strength of correlation with the post-operative T1 tilt (r = 0.708).
METHODS: Thirty-four donor nephrectomy and 64 cholecystectomy patients received intraoperative IV lidocaine. Plasma samples were collected perioperatively and analysed in NONMEM. Covariate effects and alternative dosing regimens were investigated.
RESULTS: 1,520 concentration-timepoints were analysed. Lidocaine PK was best fitted with a 3-compartment model, while MEGX and GX used a 2-compartment model. All parameters were scaled allometrically with total body mass and fat-free mass (FFM). Lidocaine had a typical clearance of 45.9 L/h, decreasing by 60% postoperatively, and a central volume of 25.2 L. Peripheral compartments 1 and 2 exhibited intercompartmental clearances of 142 L/h and 5.81 L/h, with volumes of 44.4 L and 29.3 L, respectively. Peripheral compartment 1's volume expanded with intraoperative fluid administration. Simulations suggested an FFM-based dosing regimen (bolus: 2.5 mg/kg over 30 min, single infusion: 2 mg/kg over 1 h, maintenance infusion: 1.5 mg/kg/h) quickly achieved and maintained a lidocaine target plasma concentration of 1.5 mg/L.
CONCLUSIONS: The joint parent-metabolites model adequately describes the disposition of lidocaine and its metabolites, incorporating allometric scaling and key covariates. It provides a foundation for optimising lidocaine dosing and guiding investigations to establish target plasma concentrations for safe and effective use in the general surgical population. Further research is warranted to refine and evaluate the model's utility in other surgical populations.