Search Results (307)

Background and Objectives: The COVID-19 pandemic has led to an unprecedented mental health crisis among workers in the healthcare field, with average burnout rates increasing from about 32% before the pandemic to 46–52% during peak times and post-traumatic stress disorder (PTSD) affecting 24–34% of frontline staff. The primary objective of this article is to synthesize evidence on the prevalence of burnout and PTSD among healthcare workers before and during the COVID-19 pandemic. The secondary objectives are: (a) to examine the mechanisms and empirical evidence linking clinician mental health to medical errors and patient safety outcomes and (b) to analyze the medico-legal implications of this relationship, including malpractice liability, institutional responsibility, and opportunities for policy reform. Materials and Methods: We conducted a narrative review searching PubMed (November 2025–January 2026) using predefined keyword combinations. Inclusion criteria comprised original research, systematic reviews, and meta-analyses examining mental health outcomes or patient safety among clinical staff. Data were synthesized narratively across five thematic domains. Results: Burnout prevalence increased from approximately 32% pre-pandemic to 46–52% during peak periods, with emotional exhaustion reaching 67.5% in some settings. PTSD rates rose to 24–34% among frontline staff, exceeding pre-pandemic levels of 15–20%, with ICU staff particularly affected (27–40%). Substantial overlap exists between conditions (86–98% comorbidity). Physician burnout is associated with 2.72 times higher odds of self-reported errors (95% CI: 2.19–3.37), with each point increase in emotional exhaustion raising the error risk by 5–11%. Mechanisms include cognitive impairment (reduced executive function, g = −0.39; impaired working memory, g = −0.36) and sleep disturbance. Malpractice litigation compounds psychological harm, increasing depression and suicidal ideation. Conclusions: This review, synthesizing data from over 500,000 healthcare workers, demonstrates bidirectional relationships among burnout, PTSD, and medical errors with significant medico-legal ramifications. Addressing this crisis requires systemic interventions including workload management, psychological support, blame-free reporting cultures, and policy reforms balancing accountability with recognition of system-level contributors to error. Full article

High-risk benign breast lesions are histological abnormalities that present in breast tissue, typically identified by screening or diagnostic imaging. The presence of invasive or in situ breast cancer can be confirmed or ruled out within these lesions, and the risk of developing breast cancer can be reduced by their appropriate management. These potential high-risk lesions reviewed include atypical ductal hyperplasia, mucocele-like lesions, papillary lesions with or without atypia, radial scar/complex sclerosing lesion with or without atypia, atypical lobular hyperplasia, classical lobular carcinoma in situ, pleomorphic/florid lobular carcinoma in situ, flat epithelial atypia, columnar cell change, fibroepithelial lesions with stromal cellularity, spindle cell lesions/mesenchymal lesions, and microglandular adenosis. The lack of a clear consensus on the management of many of these lesions led the Ontario Health (Cancer Care Ontario) (OH-CCO) Breast Cancer Pathway Map Working Group and Breast Cancer Advisory Committee to identify the need for a recommendation document. A multidisciplinary working group was formed, with members representing surgical oncology, radiology, pathology, medical oncology, and genetic counselling. The working group developed a list of high-risk benign lesions to be included in this recommendation report. An updated literature review was completed, and these publications were reviewed by the working group, and recommendations were drafted. When evidence was lacking, the expert opinion was included. These draft recommendations were subjected to an extensive review by experts both within Cancer Care Ontario and across Canada. The recommendations included in this report are relevant to clinicians, primary care physicians, oncologists, radiologists, and pathologists who treat breast cancer and manage breast conditions. Full article

Background: Pain neuroscience education (PNE) can support understanding of low back pain and facilitate engagement with active care. Most PNE materials have been developed in English, and there is little culturally adapted content for Urdu-speaking populations. Locally relevant educational resources may help improve clarity, acceptability, and communication in clinical settings. Objective: To develop, culturally adapt, and content-validate Urdu PNE materials for individuals with LBP and for use by healthcare professionals in Pakistan. Methods: A four-stage adaptation process was used. Phase 1 involved drafting a ten-module English PNE booklet and clinician guide based on contemporary pain-science literature. Phase 2 included forward–backward translation into Urdu and cultural adaptation by translators and a bilingual pain researcher. In Phase 3, three focus-group sessions with clinicians and a person with LBP informed iterative revisions. In Phase 4, a multidisciplinary panel (clinicians and individuals with LBP, n = 32) assessed seven domains of the final Urdu materials for clarity, relevance, and cultural appropriateness using Lawshe’s content validity ratio (CVR). Results: Focus-group feedback led to simplification of Urdu phrasing, refinement of metaphors, and adjustments to illustrations. All seven domains exceeded the minimum CVR threshold (0.30) for n = 32, with a mean overall CVR of 0.69 ± 0.12. Cultural appropriateness (CVR = 0.88) and content accuracy (CVR = 0.86) showed the highest agreement. Conclusions: The adapted Urdu PNE materials were judged to be clear, relevant, and culturally appropriate by clinicians and individuals with LBP. These materials may be useful for supporting pain-related education in clinical and community settings. These findings establish preliminary content validity; further studies are needed to evaluate feasibility, implementation, and clinical outcomes. Full article

Background/Objectives: Given the critical role of vaccinations and venipunctures in disease prevention and health monitoring, it is concerning that over half of children ages 4 to 8 experience some level of needle fear. Higher levels of fear result in longer procedure times, ineffective pain management, distressing memories of needles, and ultimately, healthcare avoidance. Exposure-based therapy with a therapist is recommended for high levels of fear. However, access is limited due to cost, wait times, clinician shortages, system barriers, and social stigma. Thus, there is a need for an evidence-informed, caregiver-directed educational resource for management of moderate to high needle fear in young children. Methods: To address this gap, such a resource was drafted which included a caregiver guide and an illustrated children’s book. The current objective was to gather key user feedback on this initial version of the resource. Participants reported their perceptions of the content, coping strategies, design, organization, and accessibility of the resource through semi-structured interviews and limited quantitative ratings. Participants were children with moderate to high levels of needle fear (N = 6), their caregivers (N = 6), and healthcare professionals (N = 6; including needle providers, child life specialists, and mental health clinicians). Interviews were coded with inductive content analysis; descriptive statistics were calculated for quantitative ratings. Results: Participants reported satisfaction with the e-resource and highlighted strengths (e.g., CARD^TM system, children’s book) and improvement areas (e.g., length, language). Conclusion: Feedback informed revisions to the e-resource in preparation for further evaluation in a follow-up study. Full article

Objectives: This study explores the feasibility and value of integrating structured patient input into the PICOS (Population, Intervention, Comparator, Outcome, Study design) scoping process for Joint Clinical Assessments under the EU Health Technology Assessment Regulation. Methods: A modified Delphi panel, led by a steering committee composed of two clinicians, one patient expert, and one policy expert, engaged 12 individuals representing patient organizations across 12 European Member States to reach consensus on PICOS elements for CAR-T therapy in pediatric spinal muscular atrophy. Results: The Delphi process effectively facilitated PICOS consolidation and consensus among the 12 patient experts representing diverse EU contexts. Through 3 iterative rounds integrating quantitative rankings and qualitative feedback, the panel achieved strong agreement on key outcomes, intervention delivery, and study design elements, with population eligibility and comparator selection showing heterogeneity. Patient engagement was central: participants emphasized inclusive eligibility criteria, shared decision-making, and the inclusion of caregiver perspectives. The integration of qualitative insights allowed nuanced interpretation of dissent, distinguishing between genuine disagreement and framing effects, thereby enhancing transparency and scientific validity. Importantly, the process revealed patient priorities for outcomes, treatment burden, and evidence trade-offs, informing both PICOS refinement and future health technology assessment (HTA) strategies. This structured, participatory approach demonstrates the feasibility and value of incorporating patient voices systematically into early-stage EU HTA, fostering robust, credible, and context-sensitive consensus on complex rare-disease interventions. Conclusions: The study demonstrates the potential of consensus-building methodologies to enhance transparency, reduce heterogeneity, and support patient-centered evidence generation and decision-making in HTA. Full article

Background/Objectives: Parental mental health challenges are associated with parenting difficulties and child mental health issues. Parenting interventions can support families; however, parents with mental health challenges face barriers to accessing parenting support, which is not consistently offered within adult mental health settings. Embedding technology-assisted parenting programs into these settings could provide accessible, holistic support. Partners in Parenting Kids (PiP Kids) is a digital parenting program designed to prevent child anxiety and depression, yet its suitability for parents with mental health challenges and fit within mental health services remains unclear. This study aimed to co-design and adapt PiP Kids for future implementation in an Australian adult mental health service. Methods: Parents who recently sought mental health support (n = 8) and service providers (n = 7) participated in co-design workshops to explore needs and preferences for a technology-assisted parenting program and iteratively develop a prototype. Parents (n = 3) trialled the online component of the prototype and participated in qualitative interviews to assess acceptability. Results: The adapted clinician-supported program was designed to facilitate (1) parent and clinician readiness for parenting support; (2) emotional and social support for parents and clinicians; (3) practical, personalised parenting knowledge; (4) parent-led empowerment; and (5) accessible, integrated support. Prototype clinician training was developed to strengthen the clinician-support component. Parents indicated initial acceptability of the online prototype while reiterating the value of including face-to-face support. Conclusions: This study co-designed an online, clinician-supported parenting program for future embedding within adult mental health settings. The findings highlight key considerations for developing and implementing technology-assisted interventions that promote family-focused care for parents seeking mental health support. Full article

Artificial intelligence (AI) and machine learning (ML) are reshaping cancer research and care. In pediatric oncology, early evidence—most robust in imaging—suggests value for diagnosis, risk stratification, and assessment of treatment response. Pediatric endocrine tumors are rare and heterogeneous, including intra- and extra-adrenal paraganglioma (PGL), adrenocortical tumors (ACT), differentiated and medullary thyroid carcinoma (DTC/MTC), and gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Here, we provide a pediatric-first, entity-structured synthesis of AI/ML applications in endocrine tumors, paired with a methods-for-clinicians primer and a pediatric endocrine tumor guardrails checklist mapped to contemporary reporting/evaluation standards. We also outline a realistic EU-anchored roadmap for translation that leverages existing infrastructures (EXPeRT, ERN PaedCan). We find promising—yet preliminary—signals for early non-remission/recurrence modeling in pediatric DTC and interpretable survival prediction in pediatric ACT. For PGL and GEP-NEN, evidence remains adult-led (biochemical ML screening scores; CT/PET radiomics for metastatic risk or peptide receptor radionuclide therapy response) and serves primarily as methodological scaffolding for pediatrics. Cross-cutting insights include the centrality of calibration and validation hierarchy and the current limits of explainability (radiomics texture semantics; saliency ≠ mechanism). Translation is constrained by small datasets, domain shift across age groups and sites, limited external validation, and evolving regulatory expectations. We close with pragmatic, clinically anchored steps—benchmarks, multi-site pediatric validation, genotype-aware evaluation, and equity monitoring—to accelerate safe, equitable adoption in pediatric endocrine oncology. Full article

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

Objective: This study aimed to provide a reliable estimate of early childhood autism spectrum disorder (ASD) prevalence in Türkiye and to examine diagnostic stability and developmental trajectories through a ten-year longitudinal follow-up incorporating systematic early screening, structured parent-child observations, and repeated diagnostic assessments. Methods: A total of 1981 children aged 18-48 months were screened using the M-CHAT-R/F. Children who screened positive underwent an initial clinical assessment, including a family interview and structured parent-child observation. Those identified as at risk were referred for DSM-5-TR-based diagnostic evaluation by expert clinicians. Children diagnosed with ASD or classified as at risk were enrolled in a structured ten-year follow-up program. Results: Of the 1981 screened children, 27 (1.4%) were identified as at risk. Nine children (33.3% of at-risk; 0.45% of the total sample) received an ASD diagnosis following comprehensive evaluation. All retained their diagnosis during the 18-month follow-up. By the tenth year, two additional children from the at-risk group were diagnosed, bringing the total number of ASD cases to 11. Conclusions: These findings demonstrate that structured, multi-stage screening and diagnostic procedures are feasible and effective for early ASD identification in Türkiye. High diagnostic stability supports the reliability of early clinician-led assessments, while later-emerging cases highlight the importance of long-term monitoring of at-risk children. Full article

Background: Thyroid eye disease (TED), or Graves’ orbitopathy, is the most common extra-thyroidal manifestation of Graves’ disease, but it has only rarely been reported after SARS-CoV-2 vaccination. Autoimmune thyroid disease, including subacute thyroiditis and Graves’ disease, has been described following COVID-19 vaccination; we present a case series of TED occurring shortly after different COVID-19 vaccines to provide clinical data on this potential safety signal. Case presentation: We describe five women (mean age 47 years; range 27–69) who developed TED 3–20 days after COVID-19 vaccination with mRNA or adenoviral vector vaccines, three of whom had pre-existing thyroid disease. Presentations included ocular and retro-orbital pain, exophthalmos, headache, goiter, tremor, depressive symptoms, and, in one case, anterior neck pain and fever. TED severity (ETA/EUGOGO) ranged from mild to severe, with frequent findings of suppressed TSH, elevated thyroid autoantibodies, and inflammatory markers, as well as imaging evidence of exophthalmos, extraocular muscle enlargement, and diffuse or multinodular goiter. Management with intravenous corticosteroids, selenium, levothyroxine adjustment, and/or intramuscular corticosteroids led to improvement in thyroid function and inflammation by 3 months, although mild TED often persisted. Conclusions: This case series supports a temporal association between COVID-19 vaccination and new-onset or exacerbated TED in individuals with autoimmune thyroid disease. Although vaccination benefits outweigh potential risks, clinicians should remain alert to ocular and thyroid symptoms after immunization to ensure timely diagnosis and management. Full article

Background: Hospital-acquired influenza remains a persistent threat that amplifies morbidity, mortality, length of stay, and operational strain, particularly among older and immunocompromised inpatients. The COVID-19 era reshaped control norms—normalizing N95 use during surges, ventilation improvements, and routine multiplex PCR—creating an opportunity to strengthen hospital outbreak management. Methods: We conducted a targeted narrative review of WHO/CDC/Infectious Diseases Society of America (IDSA) guidance and peer-reviewed studies (January 2015–August 2025), emphasizing adult inpatient care. This narrative review synthesizes recent evidence and discusses theoretical implications for practice, rather than establishing formal guidelines. Evidence was synthesized into pragmatic practice statements on detection, diagnostics, isolation/cohorting, antivirals, chemoprophylaxis, vaccination, surveillance, and communication. Results: Early recognition and test-based confirmation are pivotal. For inpatients, nucleic-acid amplification tests are preferred; negative antigen tests warrant PCR confirmation, and lower-respiratory specimens improve yield in severe disease. A practical outbreak threshold is ≥2 epidemiologically linked, laboratory-confirmed cases within 72 h on the same ward. Effective control may require immediate isolation or cohorting with dedicated staff, strict droplet/respiratory protection, and daily active surveillance. Early oseltamivir (≤48 h from onset or on admission) reduces mortality and length of stay; short-course post-exposure prophylaxis for exposed patients or staff lowers secondary attack rates. Integrated vaccination efforts for healthcare personnel and high-risk patients reinforce workforce resilience and reduce transmission. Conclusions: A standardized, clinician-led bundle—early molecular testing, do-not-delay antivirals, decisive cohorting and Personal protective equipment (PPE), targeted chemoprophylaxis, vaccination, and disciplined communication— could help curb transmission, protect vulnerable patients and staff, and preserve capacity. Hospitals should codify COVID-era layered controls for seasonal influenza and rehearse unit-level outbreak playbooks to accelerate response and recovery. These recommendations target clinicians and infection-prevention leaders in acute-care hospitals. Full article

Aberrant activation of the RAS signaling pathway is a halmark of various cancers. This activation, is often caused by mutations in RAS genes or other pathway components and, drivesi uncontrolled cell growth and proliferation. Studies have demonstrated that certain codon mutations can significantly influence the clinical outcomes of cancer patients. Historically, KRAS was considered “undruggable”; however, recent advancements in drug discovery have led to the development of promising KRAS inhibitors. Accurately identifying the specific type of KRAS mutation in a patient is essential for making optimal treatment decisions. Several methods have been developed for detecting KRAS mutations to address this need, focusing on creating robust, rapid, sensitive, accurate, and cost-effective approaches, particularly for point-of-care applications. Starting with the Ras family and RASopathies, this review provides a comprehensive overview of KRAS mutation detection methods, ranging from research-use-only techniques to in vitro diagnostic-certified tests. Published results are critically evaluated in terms of accuracy, sensitivity, cost, throughput, and suitability for various sample types and clinical settings. This, offers researchers and clinicians an up-to-date resource for. Full article

Background: Syphilis can present with diverse clinical manifestations, earning the name “great imitator.” Malignant syphilis (MS) is a rare, severe form of secondary syphilis, typically reported in immunocompromised patients, particularly those living with HIV. However, MS can occasionally occur in immunocompetent individuals, posing diagnostic challenges due to its atypical presentation. Methods: A case report is presented alongside a PubMed literature search using the terms “(malignant syphilis OR lues maligna) AND (immunocompetent) AND (case report OR case series).” No language or temporal restrictions were applied, yielding 18 relevant publications. Results: A 60-year-old HIV-negative man presented with fever, weight loss, papular lesions, and a single ulcer on the sternum. Serology was positive for syphilis, and PCR confirmed T. pallidum DNA in the lesion. Treatment with a single intramuscular dose of benzathine penicillin G led to prompt clinical and serological improvement. Literature review (n = 18) showed that MS in immunocompetent patients affects both sexes (55% male; mean age 37.1 years), often presents with ulceronodular or rupioid crusted lesions, and frequently involves systemic symptoms. Molecular diagnostics were rarely reported, with most diagnoses relying on histopathology and serology. Treatment with benzathine penicillin G was effective in all cases, and full recovery was achieved. Conclusions: MS can occur in immunocompetent, HIV-negative individuals without obvious risk factors. Clinicians should maintain a high index of suspicion in cases of systemic, cutaneous, or ocular manifestations suggestive of MS. Molecular assays can facilitate diagnosis and prevent unnecessary invasive procedures. Benzathine penicillin G remains the treatment of choice, demonstrating high therapeutic effectiveness. MS should be considered in the differential diagnosis of ulcerative or nodular dermatoses, regardless of immune status. Full article

We report a rare case of isolated bilateral pedicle fractures in the lumbar spine that occurred without any identifiable risk factors. Such fractures are uncommon, as they are typically accompanied by multiple other fractures. This type of fracture is commonly associated with widely acknowledged predisposing factors, including high-energy trauma, degenerative spine disease, previous spinal surgery, stress-related activities, or osteoporosis. Additionally, some reports suggest these fractures can result from low-energy trauma when underlying conditions such as osteoporosis are present. This report describes a 43-year-old female who presented with gradually aggravating low back pain in the absence of any significant trauma history. Initially, she denied any preceding injury, considering the event too trivial to mention. However, upon detailed history taking, she later recalled minor contact with the edge of her bed two days prior to symptom onset. Conservative management, consisting of administration of painkillers, adequate rest, the use of a brace, and rehabilitation exercises, led to significant improvement, with marked relief of clinical symptoms and fracture healing observed in follow-up imaging. Early identification and appropriate management of isolated pedicle fractures are essential, as delayed diagnosis may lead to chronic pain or long-term sequelae. Furthermore, unilateral fracture can increase mechanical loading on the contralateral pedicle, making it vulnerable to secondary stress injury. Therefore, clinicians must remain alert to the possibility of isolated pedicle fractures even in patients without risk factors. Thorough history taking is also essential, as unrecognized minor trauma may hinder timely diagnosis and optimal outcomes. Full article

Background/Objectives: We studied the feasibility of incorporating a play-based bimanual ride-on-toy navigation training (RNT) program into an intensive hybrid training camp based on principles of modified constraint induced movement therapy and bimanual training for children with unilateral cerebral palsy (UCP). The bimanual RNT sessions included theme-based play involving navigational exploration and object-based tasks. Methods: We employed a pretest-posttest, mixed methods design. Ten children between 3 and 11 years participated. Camp was 6 h/day and 5 days/week for 3 weeks. Researchers trained camp staff to provide RNT every day. The feasibility of clinician delivery of RNT was assessed using training logs and staff exit questionnaires. The combined effects of the camp programming, inclusive of bimanual RNT, was measured through a combination of standardized tests (Quality of Upper Extremity Skills Test (QUEST), Shriner’s Hospital Upper Extremity Evaluation (SHUEE), and Box and Blocks Test) and video-coding measures. We report on means (M), standard errors (SE), and effect sizes (ES) with 95% confidence intervals for outcome measures. Results: The average session adherence was 90.7%, and staff were able to successfully deliver RNT, despite initial logistical challenges. In combination with camp programming, RNT led to improvements in the total QUEST score (pretest M (SE): 77.54 (5.11), posttest M (SE): 81.46 (5.22)) and SHUEE spontaneous functional analysis score (pretest M (SE): 41.33 (7.48), posttest M (SE): 50.22 (7.88)). Children increased the use of their affected upper extremity (UE) during late RNT sessions and improved in their navigational abilities. Conclusions: RNT is a fun and easily adaptable therapy adjunct that can complement traditional therapies to incentivize spontaneous use of the affected UE in children with UCP. Full article