The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.

A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4–5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8–9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.

Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8–9: odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.14–1.07) but higher odds of ACP engagement (CFS: 6: OR = 3.38, 95% CI = 1.40–8.17; CFS: 7: OR = 2.52, 95% CI = 1.08–5.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8–10.0%) and was not significantly associated with frailty status.

Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.

Paediatric cardiac catheterization in children with CHD requires anaesthetic techniques that balance procedural conditions with physiological risk. We evaluated anaesthesia management at a tertiary centre and examined associations between anaesthesia strategy and peri-procedural outcomes.

This single-centre retrospective cohort included 307 catheterization procedures after exclusions. Anaesthesia was categorized as general anaesthesia or sedation. The primary outcome was any recorded complication.

Median age was 7.0 years (interquartile range 2.0–13.0), and 155/307 (50.5%) procedures were performed under general anaesthesia and 152/307 (49.5%) under sedation. Overall, 49/307 (16.0%) procedures were associated with at least one recorded complication; complications were more frequent with general anaesthesia than with sedation (20.6% versus 11.2%, p = 0.024). In diagnostic catheterization/angiography (n = 175), general anaesthesia was independently associated with higher odds of any complication compared with sedation (adjusted odds ratio 2.78, 95% confidence interval 1.12–6.91; p = 0.028).

In this cohort, general anaesthesia was associated with higher recorded complication rates than sedation, and this association persisted after adjustment within diagnostic catheterizations. Comparisons within interventional procedures were limited by sparse sedation data. These findings support procedure-specific, risk-adjusted evaluation when selecting anaesthesia strategy in the paediatric catheterization laboratory.

The COVID-19 pandemic disrupted education and training which led academia to revise well-established instructional content and strategies. This report described and evaluated the curricular response of public health preparedness at Penn State to the COVID-19 pandemic.

We describe an online, hybrid course focused on the development, approval, and dissemination of the SARS-CoV-2 vaccines. The course was offered in the spring of 2021 and covered real-time laboratory, public health, emergency management, homeland security, medical, and policy aspects of the vaccines. Additionally, we report the student evaluation results of those who completed the course.

The median and mode scores for student evaluations were 7, on a scale of 1 (lowest) to 7 (highest). Students enjoyed the instructors because they were employed in strategic positions and explained real-world challenges. Students reported the course as “timely” and “breaking down complex concepts into simple understanding.”

Penn State responded to the COVID-19 pandemic with an innovative course that developed students’ real-time understanding of pandemic response. Students gained knowledge and skills relevant to the practice of public health. Based on the positive student feedback, the course will serve as a model for future classes on public health and emergency management.

The Emergency Paramedic Act (EPA; Notfallsanitätergesetz), implemented in 2014, expanded the legal authority of German paramedics to independently perform defined invasive and pharmacological interventions under specific conditions. However, real-world implementation of these competencies within the physician-based German Emergency Medical Services (EMS) system remains insufficiently described.

The aim of this study was to evaluate the frequency, type, temporal development, and regional variation of invasive and pharmacological/therapeutic interventions performed independently by paramedics over a six-year period.

A retrospective, descriptive multicenter analysis of digital EMS documentation was conducted across three districts in Saxony, Germany, from January 1, 2019 through December 31, 2024. All missions were screened (n = 197,842). Paramedic-led missions without physician presence were included; physician-attended missions and non-emergency interfacility transports were excluded. Interventions were classified according to the 2024 Federal Association of Medical Directors of EMS competency catalogue. Frequencies were analyzed by year and district. Temporal trends were assessed using the Mann–Kendall test, and regional differences were explored using one-way ANOVA with Tukey HSD post hoc testing. All inferential analyses were exploratory.

Of 197,842 missions, 156,417 (79.1%) were paramedic-led without physician presence. Invasive procedures occurred in 7.6% of missions and were predominantly peripheral intravenous (IV) access (5.7%). Advanced airway management and intraosseous (IO) access were rare (<0.1%). Pharmacological/therapeutic administrations occurred in 11.3% of missions and increased from 9.4% in 2019 to 12.1% in 2024 (Mann–Kendall test), whereas overall invasive procedure rates remained stable.

Ten years after implementation of the EPA, invasive and pharmacological interventions performed independently by German paramedics remain relatively infrequent and largely confined to basic measures. Advanced procedures are rarely applied, reflecting continued structural characteristics of the physician-based EMS model.

To assess the impact of ethnicity on survival following paediatric cardiac surgery.

Observational study of a regional tertiary paediatric cardiac surgical centre in Yorkshire, UK. All children (age 0–15 years) undergoing their first cardiac surgical procedure from January 2005 to December 2021 inclusive. The primary outcome was 5-year survival. Secondary outcomes included 30-day, 1-year, and pre-discharge survival.

3,508 children (46% female) underwent their first cardiac surgical procedure during the study period. Within the study cohort 2,578 (73%) children were White, 634 (18%) were South Asian, 95 (3%) were Black and 201 (6%) were from other ethnic groups. South Asian children were more likely to have a functionally single-ventricle (10% vs. 7% White; relative risk 1.41, 95% confidence interval 1.15–1.69).

Mortality after surgery, adjusted for deprivation, was higher for South Asian (hazard ratio 1.50, 1.12–2.01) and Black children (hazard ratio 1.69, 0.93–3.06), compared to White children. Survival differences were not present at discharge or 30 days post-procedure, but widened progressively at 90 days, 1 year and 5 years. This was not influenced by diagnosis or pre-operative risk factors. One-year survival improved for South Asian children across the study period and was similar to that of White children from 2017–2021 (94.7% (89.8–97.3%) vs. 96.8% (94.9–97.9%) White).

Black and South Asian children have a greater risk of death following cardiac surgery compared to White children, independent of pre-operative risk. The majority of excess deaths occurred after hospital discharge. Although inequities have steadily reduced over the past two decades, the explanation for this effect remains unclear.