Healthcare

BackgroundAdapted from the Navigational Health Literacy scale (HLS19 - NAV-HL), the 20-item Health System Literacy (HSL-CAN) was developed to measure health system literacy among Chinese Canadians. However, little is known about the functioning of its response categories. MethodThis study aimed to evaluate the proper functioning of the response categories using data from 681 adult Chinese Canadians aged 30 years or older who have resided in Canada for at least six months. Data were collected through a cross-sectional online survey. The partial credit model was utilized to evaluate the dimensionality of the scale, item- and category-level fit statistics, and the ordering of category thresholds. ResultsFindings supported the unidimensional construct of the scale. Most items met the item theory response (IRT) model requirements, demonstrating acceptable item fit statistics, except for three items with outfit-t statistics outside the acceptable range. Adjacent response category thresholds were increased monotonically, and threshold distances were within the recommended upper range, although relatively narrow distances were observed for several items. Person separation reliability and person separation index indicated good internal consistency and adequate discrimination among individuals with different level of health system literacy. ConclusionThis study provides evidence supporting the unidimensional construct and a proper functioning of the 5-point Likert response scale, suggesting that the HSL-CAN is a psychometrically appropriate instrument for evaluating health system literacy among Chinese Canadians. Future studies are needed to examine the scales applications across more diverse populations in Canada.

ImportanceLLMs have encoded a vast array of medical knowledge and are being integrated into clinical settings as decision-support tools to improve physician performance across various aspects of care. However, evidence of the impact of LLMs on the clinical reasoning of physicians remains limited. ObjectiveTo evaluate the impact of LLM on core aspects of physicians clinical reasoning: diagnostic reasoning, information gathering, and management reasoning in primary care scenarios. Design, Setting, and ParticipantsWe conducted three identical randomized controlled trials (RCTs) in 2024-2025 with 249 physicians in Indonesia, Kenya, and the Netherlands. Participants completed four or five clinical vignettes designed to simulate real-world primary care consultations, with half randomized to have access to ChatGPT-4o. Main Outcomes and MeasuresPhysician quality of care was evaluated using a rubric based on evidence-based clinical guidelines, scored across nine steps of the clinical reasoning process. Primary outcomes were quality scores for diagnostic reasoning, information gathering, and management. Secondary outcomes were quality per answer, number of answers, and less obvious answers. ResultsAccess to LLMs enhanced information gathering and management reasoning across all countries. Physicians who were assigned the LLM achieved significantly better quality-of-care scores in diagnostic steps in Indonesia (b=7.9%, CI: 4.0% to 11.8%, p<.001) and Kenya (b= 15.1%, CI: 10.2% to 19.9%, p<.001) but not the Netherlands (b=1.4%, CI: -1.6% to 4.4%, p=1.00). Physicians with LLM access also performed better in investigative steps, in Indonesia (b=10.7%, CI: 4.2% to 17.1%, p=.004), Kenya (b=17.1%, CI: 10.3% to 23.9%, p<.001), and the Netherlands (b=11.9%, CI: 7.7% to 16.1%, p<.001). We also found LLM access affected physicians scores in management steps (Indonesia: b=15.7%, CI: 8.6% to 22.9%, p<.001; Kenya: b=27.3%, CI: 19.9% to 34.7% p<.001; the Netherlands: b=12.3%, CI: 7.1% to 17.5%, p<.001). We found that LLM access was less useful in management reasoning for more cognitively demanding cases compared to standard patient cases in Indonesia (b=-14.1%, CI: -21.4% to -6.8%, p<.001) and Kenya (b=-12.1%, CI: -19.6% to -4.6%, p=.006). Conclusions and RelevanceIn this cross-country randomized control trial, we assessed that access to an LLM had significant positive effects on physicians clinical reasoning. The effects we found are promising for the further roll-out of LLMs to supplement physicians in their care tasks. They also suggest that the extent to which LLMs can supplement physicians is context dependent. Key PointsO_ST_ABSQuestionC_ST_ABSTo what extent do large language models (LLMs) increase physicians quality of diagnostic reasoning, information gathering and management reasoning? FindingsIn a randomized clinical trial including 249 physicians in Indonesia, Kenya, and the Netherlands, access to an LLM significantly enhanced clinical reasoning performance in information gathering and management reasoning across all countries, and diagnostic reasoning in Kenya and Indonesia. MeaningThis study shows that the use of an LLM can enhance clinical reasoning of physicians. Further research is needed to effectively understand the augmentation of physician clinical practice.

IntroductionStroke remains a leading cause of morbidity and mortality worldwide, with survivors often confronting significant physical, psychological, and social challenges. Quality of life (QoL) serves as a crucial indicator of recovery and long-term well-being among stroke survivors. However, little is known about the QoL of stroke survivors in Ethiopia. This study therefore aimed to assess QoL and associated factors among stroke survivors receiving care at specialized governmental hospitals in Addis Ababa, Ethiopia, in 2025. MethodsAn institution-based cross-sectional study was conducted from March 1 to May 1, 2025, among stroke survivors attending outpatient clinics and rehabilitation services at specialized governmental hospitals in Addis Ababa. A systematic random sampling technique was used to recruit 423 participants. Data were collected through interviewer-administered standardized questionnaires, coded, entered into EpiData version 4.7, and analyzed using SPSS version 21. Linear regression models were fitted, with unstandardized {beta} coefficients and 95% confidence intervals (CI) reported. Statistical significance was set at a p-value < 0.05. ResultThe overall mean QoL score was 11.5 (SD = 2.89), with 44.6% of survivors scoring above the mean across all domains. Domain-specific mean scores were highest for upper extremity function (M = 16.8, SD = 4.99), followed by self-care (M = 14.9, SD = 4.64), social role (M = 14.8, SD = 4.89), and mobility (M = 14.6, SD = 6.97). The lowest score was recorded in the energy domain (M = 6.0, SD = 0.81). In the adjusted model, older age ({beta} = -0.36, 95% CI: -0.51, -0.21), lower educational attainment ({beta} = -0.34, 95% CI: -1.55, -0.26), rural residence ({beta} = -0.57, 95% CI: -1.12, -0.33), depression ({beta} = -0.55, 95% CI: -1.16, -0.35), and the presence of comorbidities ({beta} = -0.67, 95% CI: -1.31, -0.11) were all significantly associated with lower QoL. ConclusionThe overall quality of life of stroke survivors in Addis Ababa was poor. The findings underscore the multifactorial nature of post-stroke QoL and point out the need for integrated, patient-centered care. Interventions should prioritize early mental health screening, management of comorbidities, educational support, and improved access to rehabilitation services, particularly for elderly and rural populations, to enhance survivor well-being.

PurposeThe objective of this study was to identify predictors of statin adherence in the primary and secondary prevention of CVD among patients in the first two years after the date of first prescription using real-world data. MethodsThe Electronic Practice Based Research Network Linked Dataset was used in this study. Statin adherence was calculated using a modified proportion of days covered (PDC) formula. Individuals with PDC [&ge;] 80% during the two years of observation period were considered as adherent. All analyses were performed with R software. Descriptive and multivariate logistic regression analyses were performed. Sensitivity analysis was performed using the Akaike Information Criterion model selection method. ResultsOverall, 3,432 patients accounting for 57,227 visits met the selection criteria. The mean PDC was 91.6% ({+/-}22.2%), and 72.0% of the patients were adherent to statins (PDC [&ge;] 80%) in the first two years after the date of first prescription. After adjusting for all other variables, statin adherence was positively associated with age (AOR 1.7, 95% CI 1.4 - 2.0), SEIFA index (AOR 1.8, 95% CI 1.2 - 2.6), polypharmacy (AOR 1.8, 95% CI 1.3 - 2.5) and comorbidities (AOR 1.4, 95% CI 1.1 - 1.7), and negatively associated with the number of statin types (AOR 0.6, 95% CI 0.5 - 0.9) and smoking status (AOR 0.7, 95% CI 0.6 - 0.9). The sensitivity analysis showed similar results as the regression model. ConclusionsStatin adherence is influenced by an aging, multimorbid population, who are exposed to polypharmacy, multiple statin options and socioeconomic diversity. Key pointsO_LIAdherence in the first two years after the first date of statin prescription was measured as proportion of days covered (PDC) C_LIO_LIThe mean PDC was 91.6% ({+/-}22.2%) C_LIO_LI72.0% of the patients were adherent to statins, with PDC [&ge;] 80% C_LIO_LIStatin adherence was positively associated with age, area-based social advantage and disadvantage index, polypharmacy and comorbidities C_LIO_LIStatin adherence was negatively associated with the number of statin types prescribed to the patients and the smoking status of patients C_LI Plain Language SummaryThe objective of this study was to identify predictors of statin adherence among patients in the first two years after the date of first prescription using real-world data. The dataset used was the Electronic Practice Based Research Network Linked Dataset. Statin adherence was calculated using proportion of days covered (PDC). A PDC [&ge;] 80% during the two years of observation period were considered as adherent. Overall, 3,432 patients were eligible for this study, and 72.0% of them were adherent to statins in the first two years after the date of first prescription. Statin adherence was positively associated with age, area-based social advantage and disadvantage index, number of medicines taken by the patient and number of chronic conditions that the patient suffered. Moreover, statin adherence was negatively associated with the number of statin types prescribed to the patients and smoking status of patients.

BackgroundArtificial intelligence chatbots (AICs) are increasingly being integrated into scholarly publishing, with the potential to automate routine editorial tasks and streamline workflows. In traditional, complementary, and integrative medicine (TCIM) publishing, editorial and peer review processes can be particularly complex due to diverse methodologies and culturally embedded knowledge systems, presenting unique opportunities and challenges for AIC adoption. MethodsAn anonymous, online cross-sectional survey was distributed to the editorial board members of 115 TCIM journals. The survey assessed familiarity and current use of AICs, perceived benefits and challenges, ethical concerns, and anticipated future roles in editorial workflows. ResultsOf 5119 invitations, 217 eligible participants completed the survey. While approximately 70% of respondents reported familiarity with AI tools, over 60% had never used AICs for editorial tasks. Editors expressed strongest support for text-focused applications, such as grammar and language checks (81.0%) and plagiarism/ethical screening (67.4%). Most respondents (82.8%) believed that AICs would be important or very important to the future of scholarly publishing; however, the majority (65.3%) reported that their journals lacked AI-specific policies and training programs to guide editors and peer reviewers. ConclusionsMost TCIM editors believe that AICs have potential to support routine editorial functions but also have limited adoption into editorial and peer review processes due to practical, ethical, and institutional barriers. Additional training and guidance are warranted by journals to direct responsible and ethical use if AICs are to be adopted in TCIM academic publishing.

ObjectiveThe objective of this study was to explore the predictors of statin intolerance in the primary and secondary prevention of CVD among patients in the first two years after the date of first prescription using real-world data. MethodsThis study used the Electronic Practice Based Research Network Linked Dataset. An algorithm, which considered the muscle symptoms and creatinine kinase of patients, was used to identify statin intolerant patients. The R software was used for all analyses. Descriptive and multivariate logistic regression analyses were performed along with sensitivity analysis which was done using the Akaike Information Criterion model selection method. ResultsOverall, 4,016 patients accounting for 60,873 visits met the selection criteria. About 3.5% of the patients were statin intolerant. After adjusting for all other variables, statin intolerance was positively associated with gender (AOR 1.5, 95% CI 1.0 - 2.2), SEIFA index (AOR 3.8, 95% CI 2.3 - 6.7), employment status (AOR 2.4, 95% CI 1.1 - 5.7), and comorbidities (AOR 7.0, 95% CI 2.2 - 19.0). A similar direction of associations was seen for the exposures of the model from the sensitivity analysis and the regression model. However, since the unrecorded employment status showed a positive association, the sensitivity analysis suggests that the relationship may be influenced by residual confounding or information bias, indicating that this finding should be interpreted with caution. ConclusionStatin intolerance within the diverse community represented in the dataset is driven by gender, employment status, area-based social advantage and disadvantage index, and comorbidities.

BackgroundAlzheimers disease (AD) is a major public health issue with rising prevalence due to global aging. In France, official estimates report a societal cost of {euro}2.3 billion, however likely underestimating the true economic burden. MethodsA comprehensive economic model was developed to estimate the ADs societal cost in France. The model incorporated diagnosis timings (early, average, late), disease stages (MCI, mild, severe AD), direct and indirect costs, and different payors. ResultsTotal annual costs ranged from {euro}32.5B (late diagnosis) to {euro}36.5B (early). Early diagnosis increased total costs but reduced indirect burdens on patients. Key cost included medical expenses and home-based medical-social support. Per-patient costs varied between {euro}62,000 (early MCI) and {euro}175,000 (late sAD). ConclusionEarlier diagnosis increases total expenditures but improves care and cost allocation. Current and future medications focusing on the early stages of the disease, we need to invest in early diagnosis, which will reduce future expenditure.

BackgroundStroke is a leading cause of death and disability, particularly in underserved populations with limited healthcare access, where poor health literacy and low stroke awareness contribute to delayed symptom recognition and worse outcomes. Student-run free clinics serve high-risk patients with hypertension, diabetes, and dyslipidemia, which are key stroke risk factors, yet stroke awareness remains inadequate. This study aims to identify stroke knowledge gaps and develop a culturally relevant educational intervention. MethodsThe three-phase study includes baseline surveys, educational material development, and post-education evaluation. ResultsAfter participation in stroke education, significant improvements in stroke sign recognition were observed, with Spanish speakers showing gains in knowledge about balance and vision loss, and English speakers in balance, vision loss, and face drooping (p <0.01). Emergency response knowledge improved less consistently; calling 911 significantly increased among English speakers (p <0.01) but decreased significantly (p <0.01) among Spanish speakers. The intervention effectively closed specific risk factor gaps, such as alcohol recognition among Spanish speakers (p <0.01). ConclusionBy addressing knowledge gaps and empowering patients to act quickly, this intervention may reduce stroke-related morbidity and mortality in high-risk populations. The model could also serve as a framework for other student-run clinics to address health literacy gaps in underserved communities.

IntroductionLarge Language Models (LLMs) in healthcare practice and education have been evaluated using medical question-answering (QA) datasets, with excellent performance. However, multiple-choice questions fall short when assessing more complex language interactions. ObjectiveTo evaluate the time invested and validity of medical students responses to clinical questions using ArkangelAI, compared to traditional search methods. MethodsRandomized, double-blind trial with clinical medical students assigned to two groups. Each group answered four clinical questions from each of four clinical cases, one using ArkangelAI, the other using traditional research methods: Google, PubMed, etc. Field specialists evaluated the responses using six pre-established criteria to define the answers validity. Total average validity (the mean of individual scores) was compared by groups with hypothesis testing and 95% CI. The time to respond was also compared. ResultsEighty-three medical students were randomized to groups A (43) and B (40). Average differences responded in half the time (three minutes faster) than the control group, with 98% fewer searches needed. The models answers were valid (accurate, non-biased, aligned with consensus, and safe) with a total validity score of 2.84 (group A) and 2.69 (group B). Most Arkangel AI users found it helpful for daily practice and would recommend it to colleagues. Conclusion: LLM-supported methods appear to have a positive influence on effective clinical search without sacrificing, and even augmenting, the quality of answers. This is applicable at the clinical medical student level and for non-critical clinical reasoning. Validations, including graduated physicians and specialists, are needed to further understand the effect of LLMs in education and clinical practice.

BackgroundAlthough ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) are very similar regarding pathophysiology and clinical treatments, especially NSTEMI comprises a much more heterogenic group of patients and underlying diseases. We therefore aimed to assess the treatments and outcomes of both entities in a large contemporary cohort. MethodsPatients with STEMI and NSTEMI between 01/2010 to 12/2018 were identified from the largest German Health Insurance (AOK, {approx}26 million members). Patient demographics, their hospital course, adherence to guideline-directed drug therapy and overall survival were assessed. ResultsIn total 544,529 patients (mean age 74, IQR 62-82), one third of whom had a STEMI. Chronic kidney disease, peripheral arterial disease, and heart failure were more common in patients with NSTEMI. Patients with STEMI were more likely to get coronary angiograms and percutaneous coronary interventions. Although STEMI more frequently led to cardiogenic shock, the rate of serious cardiac events was lower. Mortality was higher for STEMI only within the first 30 days, whereas long-term survival rates were better. The combination of statins, angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, and oral anticoagulants or antiplatelet agents was associated with higher overall survival in patients with STEMI (hazard ratio [HR] 0.20; 95% confidence interval [95%CI] 0.18 - 0.24; p<0.001) or NSTEMI (HR 0.30; 95%CI 0.28 - 0.33; p<0.001). Nevertheless, the prescription rates decreased over time, particular in patients with NSTEMI. ConclusionClear differences between STEMI and NSTEMI were observed regarding short-and long-term survival. Guideline-recommended therapy improved long-term survival, but decreased during the follow-up period.

Neurological health score (NHS), indicating the health of brain and nervous system, helps in identifying high risk individuals, and in recommending lifestyle modifications. In the present study, we developed NHS based on genetic, lifestyle and biochemical variables associated with eight neurological disorders - dementia, stroke, Parkinsons disease, amyotrophic lateral sclerosis, schizophrenia, bipolar disorder, multiple sclerosis and migraine. UK Biobank data from Caucasian individuals was used to develop the model, and the data from individuals of Indian ethnicity was used to validate the model. Logistic regression and XGBoost algorithms were used in selecting the significant variables for the disorders. NHS developed from the selected variables was found to be very significant after adjusting for age and sex (AUC:0.6, OR: 0.95). Higher NHS was associated with a lower risk of neurological disorders and better social well-being. Highest NHS group (top 25%) showed 1.3 times lower risk compared to the rest of the individuals. Results of our study help in developing a framework for quantifying the neurological health in clinical setting.

ObjectiveThere is no validated questionnaire in Japan to measure the culture of safety in ambulatory care clinics. Therefore, we developed the Japanese version of the Medical Office Survey on Patient Safety Culture (MOSPSC) of the Agency of Healthcare Research and Quality (AHRQ) in the United States with the aim to establish a tool for evaluating and benchmarking the safety culture of outpatient clinics in Japan. Materials and methodsThis research uses both qualitative and quantitative approaches to translate, adapt and validate the MOSPSC questionnaire which consists of 62 questions. The process involved seven steps such as translation by two independent bilingual physicians, drafting and reviewing, backtranslation by two separate translation companies, semantic equivalence assessment by AHRQ and revision, pretest, focused discussion, and finalizing the questionnaire after expert review and proofreading. An actual safety culture survey was conducted with mainly online and paper versions at four clinics in Tokyo. The survey results were then evaluated for patient safety dimensions, reliability and construct validity. ResultsEfforts are made to select appropriate terminology during tool adaptation processes due to different language and medical system between Japan and the United States. The response rate in the actual survey was 66.4% (242/364). Confirmatory factor analysis showed that factor loading and goodness of fit indices were better when 3 items were removed from the original 10-composite model with 38 items. The Cronbachs alpha coefficients of composite measures ranged from 0.62 to 0.78 in the original model and 0.62 to 0.85 in the new model, indicating good internal consistencies. ConclusionsConsidering the differences in medical systems, culture, and language between the United States and Japan, the instrumented was adapted with a satisfactory content validity and reliability.

ObjectivesCase reports and case series comprise a significant portion of the biomedical literature, yet unlike case reports, the National Library of Medicine does not index case series as a Publication Type. This hurts clinicians and researchers ability to retrieve, identify and analyze evidence from this type of study. Materials and MethodsPubMed articles mentioning "case series" in title or abstract were characterized to learn what are considered to be case series by the authors themselves. We then set aside articles better indexed as other standard publication types - case reports, cohort studies, reviews and clinical trials -- as well as those that discuss (rather than report the results of) case series studies, to create a corpus of typical case series articles. A random sample of these articles was evaluated by two annotators who confirmed that the great majority satisfy a formal definition of "case series". ResultsThe corpus was utilized in an automated transformer-based machine learning indexing model. Case series performance of this model on hold-out data was excellent (precision = 0.887, recall = 0.952, F1 = 0.918, PR-AUC = 0.941) and manual evaluation of 100 articles tagged as "case series" revealed that 88% satisfied a formal definition of case series. Discussion and ConclusionThis study demonstrates the feasibility of automatically indexing case series articles. Indexing should enhance their discoverability, and hence their medical value, for evidence synthesis groups as well as general users of the biomedical literature.

BackgroundStroke is a leading cause of public health burden in China, particularly among the elderly. This study aims to examine long-term trends in stroke incidence and the impact of population aging. MethodsUsing the Global Burden of Disease (GBD) Study 2021, we analyzed the incidence, mortality, and disability-adjusted life years (DALYs) for ischemic stroke (IS), cerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) from 1990 to 2021. We applied the estimated annual percentage change (EAPC) and decomposition analysis to assess trends and the influence of population aging. FindingsFrom 1990 to 2021, the age-standardized incidence rate (ASIR) of IS rose from 110.05 to 135.79, with an EAPC of 0.94. The EAPCs for ICH and SAH were -2.24 and -3.70, respectively. Population aging significantly contributed to the stroke burden, with 800,000 IS-related deaths from 1980 to 2021. In 2021, the proportion of IS deaths due to aging was 279.4% for men and 204.8% for women. ConclusionsStroke incidence and mortality continue to rise, especially among the elderly. Aging exacerbates the stroke burden, highlighting the need for targeted policies to improve the quality of life for the aging population.

Natural language processing was applied to 3,586 Australian health practitioner tribunal decisions (1999-2026) to identify patterns in professional misconduct, outcomes, and temporal trends at a scale impractical through manual analysis. A text classification approach categorised 2,428 disciplinary decisions across seven misconduct types with acceptable accuracy for the major categories (per-class F1 0.47-0.82). Boundary violations were the most prevalent misconduct type (30.2%), followed by dishonesty/fraud (29.7%) and professional conduct breaches (28.0%). Reprimand was the most common outcome (53.0%), followed by cancellation (40.2%). Significant increasing trends were identified for boundary violations, dishonesty/fraud, professional conduct breaches, and communication failures. Boundary violations were associated with higher cancellation odds (OR = 1.36, p < 0.001). Opioid medications appeared in 67% of prescribing misconduct decisions. Significant jurisdictional variation in both misconduct types and outcomes was observed, with large effect sizes between major jurisdictions. The findings provide an empirical foundation for monitoring disciplinary trends under the National Law.

BackgroundAcute type A aortic dissection (AAAD) complicated by cardiopulmonary arrest is characterized by high mortality rates, rendering the selection of surgical candidates a subject of intense debate. Despite the necessity for cardiopulmonary resuscitation (CPR) prior to the completion of a definitive intervention, the prognostic impact of CPR duration on postoperative survival and neurological outcomes remains insufficiently elucidated. This study sought to evaluate the association between pre- and intra-operative CPR duration and the incidence of early mortality and central nervous system (CNS) complications in patients undergoing emergent surgical repair for AAAD. MethodsThis retrospective, cohort study was conducted at two tertiary community hospitals in Japan. All the patients who underwent emergency surgery for AAAD between January 2014 and December 2024 were enrolled. A multilevel Cox proportional hazards model, with each patient as level 1 and institutions as level 2, was used to evaluate the association between pre-or intra-operative CPR events and early postoperative mortality and CNS complications. ResultsOf the 880 patients enrolled, 785 (89.2%), 13 (1.5%), and 82 (9.3%) were without CPR, with CPR <15 min, and with CPR [&ge;]15 min, respectively. Among them, death within 30 days post-surgery occurred in 76/785 (9.7%), 3/13 (23.1%), and 47/82 (57.3%), respectively. CNS complications within 30 days post-surgery occurred in 141/785 (18.0%), 5/13 (38.5%), and 38/82 (46.3%) without CPR, CPR <15 min, and [&ge;]15 min, respectively. In multivariable analysis, CPR lasting [&ge;]15 min was associated with mortality within 30 days post-surgery (adjusted hazard ratio, 7.66; 95% confidence interval [CI], 3.56-16.5; P<0.001). Both CPR <15 min and [&ge;]15 min were associated with an increase in the sub-hazard ratio of CNS complications within 30 days post-surgery (adjusted sub-hazard ratios, 4.49; 95% CI, 3.92-5.11; P<0.001, and 3.62; 95% CI, 2.73-4.81; P<0.001, respectively). ConclusionA preoperative CPR duration of [&ge;]15 min prior to the initiation of cardiopulmonary bypass or extracorporeal membrane oxygenation was associated with a substantial escalation in 30-day mortality compared with patients without CPR. These findings suggest that CPR duration might serve as a pivotal prognostic indicator, necessitating careful consideration for surgical indication in patients with AAAD complicated by CPR. CLINICAL PERSPECTIVEO_ST_ABSWhat is new?C_ST_ABSO_LIPre- or intra-operative cardiopulmonary resuscitation lasting [&ge;]15 min in patients with acute type A dissection is associated with a nearly seven-fold increase in 30-day postoperative mortality. C_LIO_LIBoth short (<15 min) and prolonged ([&ge;]15 min) cardiopulmonary resuscitation are associated with a higher risk of early postoperative complications in the central nervous system. C_LI What are the clinical implications?O_LIPatients with acute type A dissection who require pre- or intra-operative cardiopulmonary resuscitation [&ge;]15 min should undergo careful multidisciplinary evaluation, as the risk of early mortality is substantially elevated. C_LIO_LIEven brief cardiopulmonary resuscitation is associated with increased neurological complications, highlighting the need for early neurological monitoring and supportive care postoperatively. C_LI

This bibliometric study focuses on the publication activity of senior staff, consisting of chief physicians, senior physicians, department heads, and division heads at German university hospitals specializing in cardiology. The aim is to identify topics, focal points, study types, and impact factors (IFs) achieved. No studies on this topic have been conducted to date. However, Millenaar et al. [1] provided an overview of the cardiovascular research landscape in Germany, highlighting publication activities by federal state, the gender distribution among first authors, and the most important areas of cardiological research. In a subsequent global scientometric analysis, Millenaar et al. [2] examined gender differences in authorship in cardiovascular research between 2010 and 2019. They found that the number of publications in cardiovascular research has increased over the last ten years, particularly among female authors. However, a detailed analysis of the associated IFs revealed that articles by female authors achieved a lower average IF compared to their male counterparts. Similarly, publications by female authors were cited less frequently. The aim of this study was to provide an overview of the publishing activities of senior staff in the cardiology departments of all 39 university hospitals. The hierarchy, academic rank, and gender of the authors were taken into account. The aim was to determine which specialist areas and topics are emphasized in cardiology publications and which impact factors were assigned to the respective areas. Furthermore, the composition of the hierarchical levels according to gender and academic rank of the management staff and the respective publication performance (number; impact factor) were determined. For comparison purposes, the methodological approach was adapted to previous bibliometric analyses in other medical fields such as visceral surgery [3], trauma surgery [4], and oral and maxillofacial surgery [5]. The aim was to investigate whether the pronounced gender-specific differences in publication output and academic leadership roles observed in these fields can also be observed in cardiology. This work can serve as a basis and reference for the effectiveness and implementation of measures to promote women.

BackgroundClinical placements are a vital element of physiotherapy education, where students must demonstrate competence across a range of professional attributes. Although core competencies such as clinical knowledge, ethical conduct, and communication are universally valued, clinical educators (CEs) from different cultural contexts may emphasize these attributes in different ways. Gaining insight into how Hong Kong CEs evaluate students is important for aligning academic expectations with clinical practice. ObjectiveThis study identifies the key student attributes prioritized by Hong Kong CEs and summarizes the behavioral examples they use to distinguish performance levels on the Assessment of Physiotherapy Practice (APP) Global Rating Scale. MethodsA secondary qualitative analysis was conducted on 456 qualitative feedback comments from APP forms completed by 45 CEs assessing physiotherapy students across two cohorts. The data were analyzed using AI-assisted thematic analysis combined with human expert interpretation, followed by deductive validation across performance levels (Excellent, Good, Adequate, Not Adequate). ResultsSix core attributes emerged from the analysis: (1) communication and interpersonal skills, (2) clinical reasoning and decision-making, (3) practical knowledge and technical competence, (4) learning attitudes and reflective practice, (5) professionalism and work ethics, and (6) safety and risk management, and patient-centered care. Behavioral examples were mapped across performance levels, revealing clear distinctions between competent and underperforming behaviors. Among these attributes, learning attitudes and reflective practice were consistently emphasized, reflecting cultural values within the Hong Kong clinical education context. ConclusionHong Kong CEs prioritize not only technical and cognitive competence, but also reflective and affective attributes rooted in professional and cultural values. The identified attributes and behavioral descriptors may provide actionable guidance for curriculum design, educator training, and student preparation, fostering coherent, transparent, and culturally informed clinical assessment practices.

BackgroundSex disparities in the delivery of care and in-hospital outcomes following ST-segment elevation myocardial infarction (STEMI) remain a global concern. We performed an updated global meta-analysis comparing clinical outcomes between males and females with STEMI. MethodsThis study was conducted according to PRISMA guidelines (PROSPERO CRD42024612510). We searched major electronic databases from 1st January 2000 to 7th November 2024. Pairwise meta-analysis was performed on outcomes related to time-to-therapy, in-hospital outcomes, and optimal therapy, with subgroup analyses of geographic regions. Meta-regression was performed to evaluate heterogeneity. ResultsA total of 69 studies, involving 891,585 patients (262,773 females; 628,401 males) were included. Males were younger (MD -7.387 years), less likely to have diabetes, hypertension, and prior stroke, had significantly lower risk of in-hospital mortality (RR 0.56, 95%CI 0.53 to 0.61, P<0.05) and major bleeding (RR 0.59, 95%CI 0.50 to 0.71, P<0.05). Males had significantly shorter time to first medical contact (MD - 32.42mins), door-to-balloon (MD -6.17mins) and door-to-needle (MD -5.53mins) times, more likely to undergo PCI (OR 1.34, 95%CI 1.20 to 1.48, P<0.05), receive P2Y12 inhibitors (OR 1,52, 95%CI 1.04 to 2.23, P=0.03), GP IIb/IIIa inhibitors (OR 1.30, 95%CI 1.14 to 1.49, P<0.05), and ACE inhibitors (OR 1.41, 95%CI 0.92 to 2.17, P=0.11). No differences were observed for aspirin and beta-blocker use. Meta-regression showed female sex ({beta} = 1.40) and DM ({beta} = 0.78) were positively correlated with mortality. ConclusionFemales with STEMI experience longer treatment delays, worse in-hospital outcomes, and suboptimal care. There is an urgent need to address sex disparities in STEMI care.

BackgroundCombination therapy with atherectomy and intravascular lithotripsy (IVL) has emerged as a promising strategy for the treatment of severely calcified occlusive coronary lesions, which potentially enhances procedural efficacy without increasing complication risk. MethodsThe Dual-Prep Registry is a multicenter, prospective registry designed to evaluate the safety and efficacy of IVL after atherectomy in severely calcified lesions. Combined use was selectively applied when the risk of complications was anticipated to be high with a larger atherectomy burr size, or when it was deemed non-beneficial due to unfavorable guidewire bias. All adverse events were adjudicated by a clinical events committee. Kaplan-Meier analysis was performed to evaluate the primary endpoint of major adverse cardiovascular events (MACE; composite endpoint of cardiac death, myocardial infarction, and target vessel revascularization [TVR]) at 1 year. ResultsA total of 118 cases (120 lesions) were enrolled across 20 facilities. Significant comorbidities included diabetes in 56.8% of patients and hemodialysis-dependence in 25.4%. Calcification score after atherectomy was 4.0 in all cases, and calcified nodules were present in 56.4% (core-lab analysis) of cases. One-year follow-up was complete in 99.2% patients. MACE occurred in 7.6% patients at one year (cardiac death 2.5%, myocardial infarction 5.1%, TVR 5.1%) and stent thrombosis was observed in 1 case. ConclusionsAtherectomy followed by IVL resulted in low 1-year rates of MACE, TVR, and stent thrombosis in patients with severely calcified coronary lesions. This approach may be considered for lesions where an "IVL-first" strategy is difficult to apply. Japan Registry of Clinical Trials: jRCT1032230384. URL: https://jrct.mhlw.go.jp A Clinical Perspective1) What Is New? O_LIElective combined use of IVL and atherectomy resulted in low 1 year MACE and TLR. C_LIO_LIThe incidence of MACE was higher in cases with greater residual stenosis after the procedure and a larger baseline reference vessel diameter. C_LI 2) What Are the Clinical Implications? O_LICombining IVL with atherectomy may serve as an effective treatment strategy in cases where IVL-first approaches are difficult to apply. C_LIO_LISevere calcified lesions that are presumed to be unresponsive to RA/OA treatment or carry a high risk of RA/OA complications may be good candidates for this strategy. C_LI