Late complications following surgical repair of aortic coarctation may include hypertension, aortic valve disease, coronary artery disease, aneurysm formation, and recoarctation. However, preprocedural aneurysmal dilatation is rarely reported.

We report the case of an 11-year-old male with severe aortic coarctation and a giant aneurysm identified prior to any surgical or interventional treatment. Takayasu’s arteritis was ruled out, and the patient underwent successful percutaneous placement of a covered stent. Post-procedure, he showed no residual gradient or aneurysmal lesion.

This case highlights a rare presentation of aneurysmal dilatation occurring prior to any intervention for aortic coarctation and supports the efficacy of covered stent placement as a safe and effective therapeutic option.

We aimed to evaluate the impact of transitioning from a conventional antimicrobial stewardship team (AST) to an interdisciplinary infectious disease support team (IDST) on patient mortality.

Single-center retrospective cohort study.

Yamanashi Prefectural Central Hospital.

We included patients with bacteremia during the AST and IDST periods.

We implemented an interdisciplinary IDST that provided comprehensive support beyond antimicrobial selection and treatment. We compared 28-day mortality outcomes in hospitalized patients with bacteremia during the AST-only period (April 2021–March 2022) and the IDST-intervention period (April 2022–March 2023). Cox proportional hazards modeling was used to assess 28-day mortality; multivariable logistic regression served as a prespecified sensitivity analysis. Between-group differences were tested using two-sided tests (P < .05), and 95% confidence intervals (CIs) were reported.

Among the 854 patients (413 in the AST group and 441 in the IDST group), AST interventions did not significantly decrease 28-day mortality compared with no-intervention cases (20.8% vs 23.3%, P = .630). However, intervention by the IDST significantly reduced 28-day mortality compared with the no-IDST group (16.1% vs 25.2%, P = .019). In the multivariate Cox proportional hazards model, IDST interventions remained independently associated with a reduced 28-day mortality (hazard ratio, 0.518; 95% CI, 0.325–0.826; P = .006).

Transitioning from an AST to an interdisciplinary IDST model was associated with lower 28-day mortality in bacteremia cases, possibly due to sustained diagnostic and therapeutic interventions. Our findings support stewardship as a team-based process and may significantly impact patient outcomes by maintaining involvement until treatment completion and clinical stabilization.

This research explores the legal and jurisdictional frameworks governing the deployment of Australian WHO-classified Emergency Medical Teams (EMTs) in Asia-Pacific disaster responses, focusing on how these factors influence authorization, timeliness, scope of practice, and legal risks.

A scoping review was conducted using thematic document analysis, comparative legal analysis, and case studies anchored in specific jurisdictions. Sixty-one publicly available sources were reviewed, including legal instruments, national disaster laws, bilateral agreements, and reports from recent EMT missions.

EMTs face fragmented legal environments. Host-country sovereignty primarily determines authorization, but the mechanisms for expedited licensure, customs clearance, and legal protection are often lacking. WHO classification provides no overarching legal standing during international deployments. Other barriers include immigration rules, drug regulations, and inconsistent data protection laws. Case studies highlight gaps in bilateral agreements and inconsistent credential recognition.

Despite improved technical standards, legal uncertainty hampers EMT effectiveness, including legal risk exposure. Countries should establish bilateral frameworks, regional licensing systems, embedded legal support, and standardized data governance. These steps are critical for ensuring timely, safe, and lawful EMT operations during international disasters.

The importance of palliative care in cancer care is underscored, yet there is a significant gap in research specifically focusing on the role of social workers in palliative cancer care. This qualitative study aims to better articulate the specific roles of social workers within palliative oncology settings.

Data were collected by semi-structured Zoom interviews with social workers in palliative cancer care between November 2023 and January 2024. Thematic analysis was used to identify unique themes.

Ten social workers in palliative cancer care were recruited for this study. Eight key themes related to social workers’ role emerged from the interviews. These were the following: (1) mapping out holistic needs through a biopsychosocial–spiritual assessment, (2) providing individual and family counseling, (3) patient and family psychoeducation, (4) resource identification and referral, (5) building communication bridges between patients, families, and oncology teams, (6) promoting patient and family engagement and voice in shared decision-making in cancer care, (7) providing anticipatory grief and bereavement counseling, and (8) strengthening team resilience and fostering well-being.

This study builds upon prior work by focusing specifically on the roles of palliative care social workers in oncology. The findings highlight the multifaceted roles of social workers, demonstrating their capacity to deliver holistic care to cancer patients, families, and healthcare providers to enhance quality of care. The findings may help inform the development of training curricula and practice standards for the subspecialty of oncology-focused palliative social work.

This qualitative study explored nurses’ experiences of facing death while caring for bedridden patients in palliative and long-term care settings. Nurses are the primary witnesses to the final phase of life, where technical competence and emotional endurance coexist. Understanding how nurses perceive death and how knowledge, time, and communication affect their caregiving can provide insights into improving end-of-life nursing practices.

The study was conducted with 70 primary nurse-caregivers of bedridden patients who were hospitalized in the palliative clinic of a university and an educational research hospital in Istanbul between April and August 2024. The research data were obtained through face-to-face interviews using a semi-structured interview form. The interviews were recorded on a voice recorder. The data obtained from the interviews were analysed thematically.

Three main themes were identified: Deficits in Knowledge and Education, Time Management, and Communication and Coordination. Nurses expressed uncertainty and emotional tension when providing care for dying patients. Inadequate end-of-life education heightened their fear of making mistakes. Heavy workload and limited time constrained emotional presence at the bedside. Fragmented communication among healthcare professionals increased feelings of isolation and moral distress. Across these themes, nurses experienced a silent but persistent awareness of death that shaped their professional identity and coping strategies.

Nurses caring for bedridden patients constantly face death, balancing medical duties with human vulnerability. Including death education, emotional support, and effective interdisciplinary communication in nursing practice can improve nurses’ resilience and the quality of end-of-life care.

Zinc is a micronutrient essential for taste perception and may be prescribed for dysgeusia in cancer patients undergoing treatment. However, overconsumption of zinc can lead to copper deficiency, which is likely under-recognized and can present as fatigue, nausea, anemia, and myelopathy.

A patient in his 70s with multiple myeloma and gastroparesis taking zinc supplementation to treat dysgeusia for the past 2 years presented with generalized fatigue, lightheadedness, nausea, neutropenia, anemia, gait disturbance, and worsening numbness and tingling in the bilateral lower extremities and hands. He was found to have hypocupremia in the setting of prolonged zinc supplementation and admitted for inpatient treatment with IV cupric chloride. His symptoms gradually improved over the course of approximately 5–6 weeks.

Clinicians should be vigilant about screening for copper deficiency symptoms in patients taking zinc supplementation and avoid prolonged courses or overprescribing of zinc. Hypocupremia should be promptly diagnosed and treated to prevent permanent neurological deficits.

To examine the accuracy of pulse oximetry in neonates by race and ethnicity.

We performed a single-centre retrospective cross-sectional study in neonates aged ≤ 7 days at Children’s Healthcare of Atlanta in the neonatal and cardiac ICU between 2010 and 2022. Eligible patients had pulse oximetry with arterial oxygen saturation measurements taken within 10 minutes. We evaluated the mean saturation bias, accuracy root mean square, and the frequency of occult hypoxaemia by race and ethnicity.

Of 1645 infants, there were 639 non-Hispanic Black infants (38.8%), 651 non-Hispanic White infants (39.6%), and 215 Hispanic infants (13.1%). The majority had no CHD (71.4%), required respiratory support (81.1%), and had oxygen saturation levels = > 90% (87.6%). The mean pulse oximetry and arterial oxygen measurement time difference was 0.8 minutes. The mean bias and accuracy root mean square were 8.7% and 13.7%, respectively, with no significant difference between the groups (p = 0.91). Occult hypoxaemia was found in 20.5% of infants. Compared to White infants, there were no differences in likelihood of occult hypoxaemia for either Black (adjusted prevalence ratio 1.13 (0.92–1.4), p = 0.24) or Hispanic (1.06 (0.77–1.45, p = 0.72) infants.

There was not a systemic discrepancy in pulse oximetry between racial and ethnic groups as previously described in older children and adults. However, pulse oximetry significantly overestimated arterial oxygen saturation. Future prospective studies that objectively measure skin pigmentation may be able to overcome some of the limitations of our study.

Catheter ablation is now the preferred early treatment option in children due to its high success rate and low complication rate. The aim of this study was to evaluate the outcomes of patients who underwent electrophysiology studies and a catheter ablation procedure in our centre.

Paediatric patients who underwent catheter ablation in our hospital between 2017 and 2024 and were followed up or referred for ablation from another centre were retrospectively screened. Patients who had an intracardiac defibrillator, pacemaker, or ventricular arrhythmia were excluded from the study. The data were screened from a total of 586 patients (M/F = 300/286). The procedure was applied to 288 (49 %) patients with atrioventricular re-entry tachycardia (Wolf Parkinson White 86.4%-n:249; occult accessory pathway 13.9%- n:39), and to 270 (45%) with atrioventricular nodal re-entry tachycardia. Eleven (1.8%) patients with focal atrial tachycardia, 11 (1.8%) with frequent extrasystole or ventricular tachycardia, 6 (1%) with supraventricular premature beat (SVE), and 2 patients with a Mahaim diagnosis underwent the procedure. Fluoroscopy was used during the procedure in 75 (12.8%) patients, and the mean duration of fluoroscopy was 5.2 ± 3.2 mins (range 0.2–19.6 mins). Of these 75 patients, trans-septal punction was performed on the left side for the procedure to be applied in 71 patients. Of the patients diagnosed with atrioventricular re-entry tachycardia, fluoroscopy was used in 4.

The results of this study of catheter ablation performed at our institution have shown acute success and recurrence rates similar to those of previously published studies.

Disinvesting from rare disease therapies with persistent clinical uncertainties following a managed entry agreement (MEA) may be necessary to ensure an equitable and sustainable healthcare system. To minimize public controversy, communication surrounding such disinvestment decisions must be timely, transparent, and tailored to stakeholder needs. This study develops a structured communication roadmap for disinvestment decisions in the Belgian context, addressing the clinical, financial, ethical, psychological, and social implications.

Three advisory board meetings were conducted with nine experts from academia, clinical practice, health insurance funds, patient organizations, and the Belgian Drug Reimbursement Committee. A targeted review of peer-reviewed literature, legal texts, and policy documents informed the discussion guide. Meetings were transcribed verbatim and analyzed using NVivo 14, following grounded theory principles.

Disinvestment decisions should be evidence-based and communicated clearly and pragmatically in a context-specific manner. The proposed five-step roadmap defines the roles, responsibilities, and timelines of key stakeholders and provides guidance for public-facing documents, including a lay summary of the health technology reassessment report and written communications for patients and the public. Effective and timely communication with patients requires close collaboration among stakeholders. Moreover, regular engagement with healthcare providers and patients throughout the MEA period can enhance understanding and acceptance of the final decision.

Transparent, collaborative, and adaptable communication strategies can facilitate the implementation of disinvestment decisions and help maintain trust among patients and the public. Although developed for rare disease therapies in Belgium, the proposed principles and roadmap are applicable to disinvestment processes in other healthcare systems.

Right atrial appendage aneurysm, or giant right atrial appendage, is extremely rare, with very few cases reported in scientific literature. We sought to systematically review the published cases of right atrial appendage aneurysm in terms of age, sex, clinical presentation, electrocardiography, imaging (chest X-ray, echocardiography, CT/cardiac magnetic resonance), and outcome.

An electronic search for case reports, case series, and related articles published until March 2025 was carried out, and clinical data were extracted and analysed.

Forty-four cases of right atrial appendage aneurysm were identified with a clear male prevalence (68.2%) and commonly presenting in the third decade of life. Palpitation (27.3%) and dyspnoea (18.2%) were the most common clinical presentations, whereas 40.9% of right atrial appendage aneurysm patients were asymptomatic. Electrocardiography was done in 77.3% of the sample. It displayed an atrial arrhythmia (atrial fibrillation or flutter, atrial tachycardia, supraventricular tachycardia) in 31.8%. A chest X-ray was done in 65.9%. Echocardiography was the most common diagnostic modality (93.2%). Right atrial appendage aneurysm diagnosis was confirmed on CT and/or MRI in 79.5%. The mean size of the right atrial appendage aneurysm was 93 × 70 mm. In 12 patients (27.3%), an associated congenital cardiac abnormality was found, mostly in the form of an atrial septal defect/patent foramen ovale (22.7%). Half of the patients (50.0%) were treated surgically, whilst 47.8% were treated medically with close follow-up. One patient experienced right atrial appendage aneurysm reduction in size after atrial septal defect device closure. One death (2.3%) was reported also.

Although very uncommon, right atrial appendage aneurysm can be linked to considerable morbidity. Surgical removal is recommended for patients who are symptomatic.