Head and neck (HN) radiotherapy contour quality directly impacts local control (LC) and survival; however, few departments peer review (PR) contours prior to radiotherapy planning (RTP). This study reports outcomes of a single institution’s formal HN contour PR process.

A formal HN contour PR process was implemented. Prior to RTP, HN radiation oncologists reviewed contours, provided feedback and assigned contour grades as follows: R0 (no change), R1 (minor revision, not high risk) or R2 (major revision; high risk). The PR task was completed and the contour grade was recorded. Cochran-Armitage trend test was performed.

Pilot PR process was performed over a 7-month period for 88 patients, followed by a maintenance phase. Contours were graded as follows: R0 (N = 51), R1 (N = 20) and R2 (N = 17). Over time, the number of R2 revisions decreased (p = 0.0001); month 1 (N = 7), month 2 (N = 3), month 3 (N = 5), month 4 (N = 2) and months 5–7 (N = 0). Conversely, the number of R0 revisions improved over time (p = 0.0203); month 1 (N = 5), months 2–3 (N = 9), month 4 (N = 5), month 5 (N = 8), month 6 (N = 12) and month 7 (N = 3). Each radiation oncologist demonstrated reduction in R2 revisions during the pilot. During maintenance, all 3 radiation oncologists demonstrated low rates of R2 revisions of less than 3 cases per year.

Incorporation of HN contour PR into routine clinical workflow is feasible. The collective experience of multiple high-volume HN radiation oncologists led to improved contour quality in the pilot for each radiation oncologist and continued to ensure high quality in the maintenance phase.

To develop an approach for creating facility-specific urinary antibiograms accounting for the low number of isolates recovered in nursing homes (NHs).

Retrospective analysis of urine culture data collected in NHs in five states.

Data on 5097 urine culture isolates collected across 59 study NHs from January 1, 2020 to December 31, 2021. Four consulting microbiology laboratories served the study homes.

We compared a Clinical and Laboratory Standards Institute (CLSI) standard antibiogram model to four weighted-incidence syndromic antibiogram (WISCA) models utilizing alternate formatting rules. Ability to produce a facility-specific antibiogram with at least 30 isolates and the impact on susceptibility predictions were compared.

Only one facility could generate a CLSI standard antibiogram for the three most commonly recovered Gram-negative isolates over a one-year period. Ability to generate an antibiogram increased with each of the four WISCA models trialed (36%, 54%, 85%, 85%) with the most successful models combining all Gram-negative isolates over a two-year period. Shortening the definition of duplicate isolates from 12 to 3 months did not improve performance. Using all Gram-negative isolates, rather than the three most recovered pathogens, resulted in meaningful changes in the predicted activity of ampicillin-sulbactam, cefazolin, ceftriaxone, and trimethoprim-sulfamethoxazole in several study NHs.

These results suggest that WISCAs using 2-years of urinary culture data including all gram-negative isolates and excluding duplicate isolates within twelve months maximizes the number of NHs able to create a valid antibiogram.

Assessing hospital preparedness for nuclear and radiological threats is one of the most effective methods for evaluating the condition of hospitals in relation to such incidents. This study aimed to review the tools used to assess hospital preparedness for nuclear and radiological threats and to analyze the strengths and weaknesses of these instruments.

In this systematic review, the full texts of 98 studies identified through database searches and 7 studies identified through manual searches were reviewed. Data were extracted from studies that addressed the measurement tools for assessing hospital preparedness for nuclear and radiological threats from 2000 to 2024, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The content quality of the tools was evaluated based on the World Health Organization (WHO) preparedness criteria, and the psychometric properties of the tools were examined using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) study criteria.

Among the studies reviewed, only 21 met the inclusion criteria, within which 9 tools for assessing hospital preparedness were identified. Eight tools directly assessed vulnerability in terms of physical space, related equipment, and hospital personnel, while one tool used a different criterion as an indicator of hospital preparedness for nuclear and radiological threats. The findings showed that most of the tools focused solely on evaluating a hospital’s vulnerability in terms of physical space, equipment, and personnel, with insufficient attention given to other critical aspects such as protocols, triage, and other important issues.

Given the limitations of existing tools in terms of psychometric evaluation, the lack of theoretical models, the reliance on empirical findings for tool design, and considering the critical importance of measuring and assessing hospital preparedness for nuclear and radiological threats, there is a pressing need in the health sector for the development of scientific tools based on the experiences of process owners and hospital specialists. These tools should adhere to rigorous processes of instrument development and validation.

Mild cognitive impairment (MCI) involves measurable cognitive decline that does not yet significantly disrupt daily functioning but may signal increased risk of dementia. Reliable prediction of dementia conversion in MCI is essential for early intervention and optimized clinical trial design. This study aimed to evaluate the predictive performance of various machine learning (ML) classification algorithms using clinical and neuropsychological data.

Data were drawn from the Gothenburg MCI Study and included 347 patients from a memory clinic, of whom 84 (24%) converted to dementia within two to six years. We applied 11 ML classification algorithms (logistic regression, linear discriminant analysis, naïve Bayes, k-nearest neighbors, LASSO, ridge regression, elastic net, decision tree, random forest, gradient boosting, and support vector machine (SVM)) to predict dementia conversion based on 54 clinical predictors (e.g., cerebrospinal fluid biomarkers, neuropsychological test scores, comorbidities, and demographics). In a second step, we included delta scores reflecting change in neuropsychological test performance from baseline to follow-up.

Without delta scores, LASSO, ridge, elastic net, random forest, and SVM performed best, achieving accuracy ≥0.87, kappa = 0.64, and AUC-ROC ≥0.90. These models demonstrated high specificity (0.94) but moderate sensitivity (0.68). Including delta scores improved performance, with ridge and elastic net achieving accuracy = 0.90, kappa = 0.73 and 0.72, AUC-ROC = 0.94, specificity = 0.96, and sensitivity = 0.73. The elastic net model yielded a positive predictive value of 0.85 and a negative predictive value of 0.92.

ML models incorporating clinical and cognitive change data can accurately predict dementia conversion in MCI, supporting their utility in clinical decision-making.

The aim of this research is to explore the experience of allocating scarce health resources in humanitarian response settings, specifically in relation to decision-making.

This research utilized an exploratory qualitative design. Participants were identified as clinicians with relevant first-hand experiences with scarce health resource allocation in humanitarian response settings. Participants were purposively recruited to include the broadest perspectives possible. Semi-structured interviews were hosted remotely. Transcripts capturing participant narratives were analyzed using inductive thematic analysis to allow themes to emerge.

Seventeen participants were recruited and interviewed as part of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) project. Inductive thematic analysis related to decision making revealed 5 key themes: devices; priorities; ideals; context-specific decision making; and weight of decision making. These themes informed the development of the SHARE-HRS Decision Making Model.

While health resource allocation decision-making is not unique to humanitarian settings, there are unique situational challenges faced by humanitarian health care workers. The SHARE-HRS Decision Making Model provides a new insight into how these challenges may be addressed or impact decision-making, and thus offers a structure and common nomenclature for future humanitarian health response operations and research.

Case study has been frequently conducted in disaster-related research, yet the trends and patterns of disaster-related case study are unclear. This large-scale analysis aimed at better understanding their thematic focus and reporting practices.

Based on systematic search strategy, publication metadata from 1901 to 2023 were obtained from Elsevier/Scopus and analyzed. Structural topic modeling was employed to identify the focus areas of the topics. The number of topics was determined based on content and diagnostic metrics such as held-out likelihood and semantic coherence. Hierarchical clustering was used to categorize the identified topics. The contents and reporting styles of the most-cited articles within each topic were further analyzed.

This large-scale analysis included 18,782 publications, showing an increase in number. The number of topics was determined as 12. They grouped into 2 overarching categories: public health and social medicine; and earth science and environmental technology. There were variabilities in reporting.

This study highlighted a growing trend in the publication of disaster-related case studies across diverse thematic areas. As variabilities in reporting exist, there is a need for standardization in reporting to enhance transparency in disaster-related case study.

This study aimed to evaluate the clinical efficacy and potential immunomodulatory effects of autologous platelet concentrates in promoting tissue regeneration and enhancing post-operative recovery in otorhinolaryngology.

A systematic search of PubMed, Scopus and the Cochrane Library was conducted through November 2025, focusing on randomised controlled trials and prospective studies using autologous platelet concentrates in otological, rhinological and laryngological surgery.

Twelve studies met the inclusion criteria. Autologous platelet concentrates improved tissue healing, most notably by increasing graft uptake rates in myringoplasty. Recent trials (2024–2025) also reported reduced post-operative pain and mucosal oedema following tonsillectomy and tympanoplasty.

Autologous platelet concentrates appear to be effective adjuncts for enhancing regeneration and reducing post-operative morbidity in ear, nose, and throat procedures. These benefits likely involve downregulation of pro-inflammatory cytokines (e.g., interleukin-6) and modulation of matrix metalloproteinases (e.g., matrix metalloproteinase-9). Standardised biomarker-based studies are needed to confirm these mechanisms.

This study compared endoscopic butterfly inlay and microscopic over-underlay cartilage tympanoplasty regarding graft success and hearing outcomes.

A retrospective analysis was performed on patients who underwent tympanoplasty between January 2022 and December 2024. Patients with additional otologic procedures, cholesteatoma or revision surgery were excluded. Patients were assigned to Group 1 (endoscopic butterfly inlay) or Group 2 (microscopic over-underlay). Demographic characteristics, perforation size, operative time, graft success and audiometric outcomes were evaluated using air–bone gap (ABG).

Sixty-four patients were included (33 in Group 1, 31 in Group 2). Operative time was significantly longer in the microscopic group, while perforation size and graft success rates were similar. Both techniques resulted in significant post-operative hearing improvement without inter-group differences.

Both techniques provided comparable graft success and hearing outcomes. The endoscopic butterfly inlay technique achieved similar results with shorter operative time, supporting its use as a minimally invasive alternative.

To examine the effects of age and hearing loss on travelling wave delay by comparing frequency-specific action potential latencies obtained with electrocochleography.

A cross-sectional design was applied. Tympanic membrane electrocochleography recordings at 0.5 and 4 kHz were analysed in 85 ears from 49 adults. Participants were divided into four groups: older adults with hearing loss (n = 22), older adults with normal hearing (n = 18), younger adults with hearing loss (n = 19) and younger adults with normal hearing (n = 26).

Age and hearing loss significantly influenced action potential latencies. At 0.5 kHz, the older adults with hearing loss showed the longest latencies (p < 0.001). At 4 kHz, older adults with hearing loss differed from older adults with normal hearing (p = 0.027). Travelling wave delay varied across groups (p < 0.001), with the shortest travelling wave delay in younger adults with normal hearing and the longest travelling wave delay in older adults with hearing loss.

Ageing and hearing loss slow travelling wave velocity, providing an indirect but sensitive marker of early cochlear transmission deficits.

Patients in the re-entry phase (that is, the first 18 months after curative cancer treatment) may use meaning-making to deal with existential concerns imposed by cancer and related changes in life. The purpose of the current study was to conduct a formative evaluation of an intervention aimed at supporting patients’ meaning-making process and motivating them to pick up life during the re-entry phase.

Patients were included after finishing systemic treatment for breast cancer or melanoma. The intervention comprised a single one-hour conversation guided by a spiritual counselor who explored patients’ sources of meaning, in order to support them in dealing with existential concerns and changes in life in the re-entry phase. The evaluation included semi-structured interviews concerning the intervention and questionnaires assessing mental adjustment to cancer, psycho-spiritual wellbeing and meaning in life.

Qualitative interviews with 14 participants demonstrated an overall positive experience and appreciation of the intervention. Patients reported several benefits: reflection on existential concerns and sources of meaning, validation of sources of meaning, insights regarding the use of sources of meaning, and motivation to pick up life; and to a lesser extent: prioritizing, identifying meaningful goals, or undertaking specific action. Patients made suggestions on how to tailor the intervention more to their needs. Quantitative data showed increases on the subscales autonomy, goal-orientedness, and fairness of life with small effect sizes.

This study showed that an intervention to support patients with breast cancer or melanoma in the process of meaning-making in the re-entry phase after systemic treatment was positively experienced and well appreciated. It supported meaning-making, particularly through reflection on, validation and utilization of sources of meaning, and supporting motivation to pick up life. The results of the current study can be used to optimize the intervention, which can be further evaluated in a multicenter study.

A longer duration of untreated illness (DUI) has been associated with poorer outcomes across several mental disorders; however, few studies have investigated DUI in anxiety disorders, particularly in generalized anxiety disorder (GAD). This study aimed to identify sociodemographic and clinical factors associated with a longer DUI in GAD.

We conducted a cross-sectional, multicenter study, retrospectively reviewing the medical records of GAD patients from three mental health services. Sociodemographic and clinical variables were extracted for analysis. One-way analyses of variance and Pearson’s correlations were used to examine the relationship between DUI and categorical and quantitative variables, respectively. A multivariate linear regression model was then conducted to identify variables independently associated with DUI.

The total sample included 243 patients; the mean DUI was 30.92 (±65.25) months. In the final model, a longer DUI was associated with an earlier age at onset (B = −0.428; p = 0.023), a longer duration of illness (B = −0.431; p < 0.001), and the presence of multiple side effects (B = 55.778; p < 0.001). There was a trend toward statistical significance for the association between a longer DUI and multiple medical comorbidities (B = 13.122; p = 0.076).

Our findings suggest that reducing the time between the onset of GAD and the initiation of appropriate pharmacological treatment may improve clinical outcomes, mitigating the risk of a chronic course of illness. Further studies are needed to elucidate the role of DUI as a prognostic factor in GAD.

Exercises are an essential component of preparedness and should be used to enhance capability and contribute to continuous improvement. An exercise can be as simple as a planning group discussing an emergency plan or as complex as a major multi-agency event involving several organizations and participants. This study aims to identify and conceptualize quality indicators (QIs) influencing prehospital disaster exercises across structure, conduct, and outcome.

This research was conducted through a systematic review and searching of the databases of PubMed, Scopus, Web of Science, and Google Scholar. Thematic content analysis was used for data analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for systematic search, and the Critical Appraisal Skills Program (CASP) was used for quality assessment of the final extracted articles.

From an initial set of 3,083 articles, 10 high-quality studies were included for analysis. The quality indicators influencing prehospital disaster exercises were analyzed into 3 themes, 8 categories, and 21 subcategories. The primary themes and related main categories included: Exercise structure QIs (knowledge promotion and cognitive skills, supply of exercise hardware and software requirements and resources desirable management), Exercise conduct QIs (practical proficiency in essential skills and decision-making capacity), and Exercise outcome QIs (evaluation and reporting of exercise, promotion of managerial capabilities and competencies, and development of psychological capabilities).

The findings of this research present a knowledge framework that can help exercise planners in prehospital settings in designing scientifically sound and standardized exercises aimed at enhancing disaster response processes. Furthermore, the implementation and evaluation of both discussion-based and operation-based disaster exercises informed by these identified quality indicators can foster the development of knowledge and promote behavioral change among prehospital staff, and facilitate a standardized response to emergencies and disasters.

Frailty is associated with adverse outcomes among patients with head and neck cancers. We evaluated the awareness of frailty among Irish head and neck healthcare professionals.

A cross-sectional survey was distributed to Irish multidisciplinary head and neck healthcare professionals.

Eighty responses were received with varying clinical experience. Seventy-nine (99 per cent) participants believed frailty could influence: post-treatment functional outcomes (77 [96 per cent]), overall survival (72 [90 per cent]) and treatment related toxicity among head and neck cancer patients. Eighteen (23 per cent) participants had used frailty in practice. A lack of awareness / training (68 [85 per cent]) and time / practical constraints (62 [78 per cent]) were the main barriers identified to the utilisation of frailty in practice.

Irish head and neck healthcare professionals are aware of frailty and believe it may be of benefit in clinical practice. Barriers to incorporation of frailty in head and neck care included a lack of training, time or resources.