During the coronavirus disease 2019 (COVID-19) pandemic, emergency departments (EDs) faced unprecedented operational stress compounded by mandatory testing requirements that directly influenced patient flow and length-of-stay (LOS). Two testing modalities were central to pandemic ED operations: (1) rapid point-of-care lateral flow assays (LFAs), which return results in minutes but depend on frontline ED personnel and space, and (2) laboratory-based polymerase chain reaction (PCR), which requires sample transport and centralized processing but functions independently of ED capacity. Whether the relative performance of these modalities remains robust under varying ED operational pressures is unclear.

This retrospective observational study analyzed 31,737 COVID-19 testing encounters (11,098 LFA; 20,639 PCR) during the 11-month dual-testing period (May 2022–March 2023) at a high-volume tertiary ED, when both modalities were concurrently deployed. Propensity score matching (PSM; 1:1 nearest-neighbor, caliper 0.5 SD) generated 8,492 well-balanced LFA–PCR pairs. Turnaround time (TAT) was evaluated as an operational stress indicator modifying the association between testing modality and ED LOS. Variability analyses assessed performance stability under differing capacity levels.

Overall, LFA was associated with longer LOS than PCR (median 8.3 versus 5.8 hours; P < 0.001). Under low-stress conditions (TAT ≤30 minutes), this difference was modest (median difference 1.5 hours; 95% CI, 0.80 to 2.07). As TAT increased, modality performance diverged substantially. At TAT >90 minutes, LOS difference increased to 3.6 hours (95% CI, 2.85 to 4.42). Threshold inflection occurred between 60–90 minutes. Lateral flow assays exhibited higher operational variability (CV ratio 2.09; 95% CI, 1.25 to 3.12), with the greatest instability during high-volume periods, while PCR performance remained comparatively stable across stress levels. Stratified analyses were exploratory; confidence intervals were not adjusted for multiplicity.

Turnaround time and its variability serve as actionable, real-time indicators of ED system capacity. Lateral flow assay performance degrades progressively under operational strain due to its reliance on frontline ED resources, whereas PCR—supported by external laboratory infrastructure—maintains more stable throughput. Capacity-contingent, adaptive testing strategies that shift toward PCR as TAT rises may enhance ED resilience, reduce LOS, and support more predictable patient flow during future outbreaks and surge conditions.

The Hualien County Disaster Medical Team, established in 2018, aims to enhance disaster response efficiency. Experiences from several major earthquakes and a train derailment in 2021 revealed that personnel had spent much time locating supplies in complex disaster settings. Applying Lean Management principles, we developed “modular tactical medical belt bags” and “tactical belts” to facilitate the location of supplies, aiming to reduce time and improve operational efficiency by:

1. Regularly checking the inventory and expiration date.

2. Categorizing disaster supplies into modular tactical kits (Triage, Injection, Trauma, Immobilization, and Personal Items Kits). For saving time, tactical kits are fully replaced rather than restocked item-by-item when some items are exhausted.

3. Utilizing tactical belts. The belt, equipped with essentials like a radio and tape, allows responders to keep critical items readily accessible.

Modular kits effectively reduced the time spent retrieving supplies in disaster settings. Tactical belts saved an average of 2 minutes in locating items. Initially, tactical kits were restocked by logistics, taking an average of 5–7 minutes. Later, the process was changed from refilling bags to exchanging used bags for fully stocked ones, giving responders instant access to necessary supplies. This adjustment increased user satisfaction from 82% to 93%.

Every second counts. Applying lean management to DMAT logistics design - “Modular Tactical Medical Waist Bag” and “Tactical Belt” - reduces the time consumed in inventory management, enables faster acquisition of necessary items in unfamiliar environments, and improves the efficiency of disaster medical response.

In Hualien, Taiwan, the mountainous terrain covers 90% of the area, and medical resources are concentrated in urban centers, which makes emergency response in disaster situations challenging. Natural disasters occur frequently, and Hualien County urgently needs to establish and develop a disaster medical rescue team. In 2018, the Hualien County Health Bureau formed a disaster medical team to address local needs. However, accurately estimating logistical supply requirements remains a significant challenge, as insufficient supplies may delay response, while overstocking leads to resource waste.

To improve the accuracy of advanced preparation of logistical supplies, Hualien’s major disaster data in the past ten years were reviewed. A major disaster is an incident involving more than 30 injured people. The two most significant incidents were the 2018 earthquake (293 injuries) and the 2021 train accident (220 injuries), of which over 90% were trauma victims. Based on these data, supply and demand are estimated using the Historical Data Projection method adapted to local conditions. Emergency nurse practitioners experienced in responding to these disasters completed a questionnaire about supply types and quantities.

Through this analysis, the four most in-demand supplies were identified: 4x4 gauze pads (221 packs), cotton swabs (222 packs), 4-inch elastic bandages (43 packs), and 6-inch elastic bandages (28 packs).

This study demonstrates that the high demand for gauze and swabs underscores the critical need for wound cleaning and dressing in trauma-heavy scenarios. Literature suggests that precise pre-arrangement of logistical supplies reduces resource waste and improves cost-effectiveness. The Historical Data Projection aligns with Hualien’s needs, providing reliable guidelines for resource allocation. Ongoing data collection and AI integration will further enhance the accuracy of supply forecasting, ensuring efficient disaster response.

To pilot a registry to evaluate the use and effectiveness of interventional cancer pain management.

Upon interventional pain procedure scheduling, patient demographics, cancer, and pain information were entered into the longitudinal clinical registry in 2 tertiary hospitals in Sydney, Australia (Royal Prince Alfred Hospital and Chris O’Brien Lifehouse). Details of the procedure (including proceduralist, nature of the intervention, and site of treatment), post-procedure patient-reported outcomes and quality of life surveys, adverse events, and mortality data (when known) were collected longitudinally.

Between October 2021 and March 2023, 48 patients underwent 55 procedures. Procedures included treatment targeting autonomic plexuses, peripheral nerves, fascial planes, and neuraxial structures. Celiac plexus neurolysis was the most frequently reported procedure (33.3%). Post-procedure, there was a trend in reduction in pain intensity on the Patient-Reported Outcome Measurement Information System (p < 0.01), reduction in opioid consumption, and improvement in quality of life on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core-15-Palliative Care.

This is a vital first step in creating a more widely applicable registry evaluating cancer pain intervention. It provided valuable information on the range of available pain intervention procedures and data on patient-reported outcome measures using validated instruments. This will facilitate a timely review of clinical practice to improve future patient care. An Australian-wide database of cancer pain will be a valuable next step in the improvement of cancer pain management.

Clinical trial number: not applicable.

This study aimed to explore the end-of-life decision-making experiences of bereaved family caregivers of Alzheimer’s disease (AD) patients, focusing on do-not-resuscitate orders. Given the high emotional and ethical burden on caregivers, understanding their challenges and needs is crucial to enhancing palliative care for AD patients.

A qualitative, exploratory study was conducted using semi-structured interviews with 22 family caregivers recruited through purposive sampling in central Taiwan. Participants were primary caregivers for AD patients who had been bedridden for at least a year before death. Analysis employed inductive thematic coding to identify key themes, with rigor ensured through multiple coding, member checking, and reflective journaling.

Three major themes emerged: (1) Decision-making difficulties, where caregivers felt pressure and conflict when making urgent decisions; (2) Willingness to let go, which involved accepting the inevitability of death when recovery was no longer possible; and (3) Embracing the consequences of the decision, reflecting caregivers’ sense of relief and acceptance post-decision. Cultural factors, such as filial piety, were found to influence decision-making processes, often intensifying emotional conflicts.

Findings underscore the importance of early, culturally sensitive discussions around end-of-life care in palliative settings for AD patients. Healthcare providers are encouraged to initiate these discussions, offering clear explanations and emotional support to assist caregivers through decision-making. This study highlights the need for a family-centered approach that respects cultural nuances, helping to reduce caregiver stress and enhance the quality of palliative care in AD contexts.

Major depressive episodes (MDEs) are highly recurrent in clinical samples. However, the course of MDEs and predictors of their endurance are unclear in the general youth population.

We investigated prospective factors associated with enduring MDE (the presence of 12-month DSM-IV MDE at baseline and 1 year using the Composite International Diagnostic Interview–Screening Scales) in 1,833 participants of a 1-year epidemiological youth cohort study in Hong Kong. Multivariable logistic regression models were used to examine the influences of a range of personal and environmental factors.

At baseline, 13.7% participants had MDEs, among whom 21.1% presented enduring MDEs. More severe symptoms of post-traumatic stress disorder (adjusted odds ratio [aOR] = 5.54, confidence interval [CI] = 2.14–14.38), depression (aOR = 3.92, CI = 1.79–8.62), and generalized anxiety (aOR = 2.27, CI = 1.21–4.25) at baseline were among the strongest associated factors for enduring MDE, with trends of associations observed for psychotic-like experiences (aOR = 1.98, CI = 0.98–4.02) and eating disorder symptoms (aOR = 1.88, CI = 0.90–3.95). Among various types of stressors, only dependent stressors at follow-up showed a clear association with enduring MDE (aOR = 4.22, CI = 1.81–9.83). Those with enduring MDE showed poorer functioning and mental health-related quality of life at follow-up, with only 35.6% having sought any psychiatric/psychological help during the past year.

Detecting comorbid symptoms in those with prior MDEs and reducing the impact of dependent stressors may help reduce their long-term implications. Enhancing the accessibility and acceptability of youth-targeted mental health services would also be crucial to improve help-seeking.

To analyze the correlation between scale of Candida auris clustering and extent of environmental contamination, exploring its implications for improving infection control measures in healthcare settings.

Retrospective observational study.

An acute hospital and a convalescent hospital in Hong Kong.

Laboratory confirmed C. auris carriers diagnosed in two hospitals between March and October 2023.

C. auris screening was conducted on patients with defined risk factors and through regular surveillance. Environmental samples were collected from high-touch surfaces and air grilles in corresponding wards.

One-hundred-seventy new C. auris patients were identified, including 65 from nine outbreaks and 105 sporadic cases. Environmental screening from eight outbreaks and 46 sporadic isolated cases was analyzed. The environmental contamination rate was significantly higher in the outbreak group (15.1% vs 2.6%, P < 0.05). Longer outbreak duration (34 vs 7 days, P < 0.05) and a higher median number of affected patients per outbreak (9 vs 5, P = 0.05) were associated with higher contamination rates. Notably, air grille samples had a significantly higher contamination rate than high-touch surfaces in both the outbreak (31.6% vs 10.2%, P < 0.05) and sporadic groups (4.6% vs 1.5%, P < 0.05).

Prolonged and sizeable C. auris clusterings were linked with more extensive environmental contamination, particularly in air grilles, which are often overlooked during decontamination

These findings underscore the need for enhanced infection control measures, including thorough environmental decontamination of air ventilation systems, to mitigate transmission risks in healthcare settings.

Trauma exposure has been associated with the development of psychotic disorders in adolescence and young adulthood. Trauma can compromise the sense of agency, a predictor of psychosis. Symptoms of post-traumatic stress disorder (PTSD) after trauma may also imply significant cognitive impairments that predispose young people to psychotic-like experiences (PLEs). This study investigates whether the two senses of agency subtypes – positive and negative agency, and PTSD symptoms mediated PLEs in youths after trauma.

The study aimed to explore the mediation of the sense of agency and post-traumatic stress symptoms in the development of psychotic-like experiences after trauma.

Participants were Hong Kong youths aged 12 to 25 who completed surveys online from May 2022 to May 2024. Self-report sense of agency, PLEs and related distress, potentially traumatic life events and PTSD symptoms from 517 youths with a mean age of 20.22 and 72.0% female were analysed. 283 participants (54.7%) experienced at least one potentially traumatic event.

A series of regression analyses revealed that a positive sense of agency mediated the effect of trauma on PLEs and related distress in the full sample. In the subgroup of 283 trauma-exposed youths, PTSD symptoms but not sense of agency mediated the effect of trauma on PLEs and related distress.

The presence of traumatic experiences can increase PLEs by reducing positive agency in community youths. Among trauma-exposed youths, the effect of various traumatic experiences on PLEs may be better explained by PTSD symptoms. Limitations of the study and future directions are discussed.

Transoral robotic surgery has gained much recognition in the surgical management of obstructive sleep apnoea, allowing for improved surgical access and precise dissection around the narrow surgical field. However, it is associated with a steeper learning curve and may give rise to significant morbidity especially amongst less experienced surgeons.

Through a comprehensive literature search, this review summarises patient selection for transoral robotic surgery as well as peri-operative considerations and management.

Apart from technical mastery, successful transoral robotic surgery require for the surgeon to be proficient with navigating the entire care continuum beginning with patient selection to management of post-operative complications.

Transoral robotic surgery remains a promising tool for surgical treatment of patients with obstructive sleep apnoea. This review provides an overview of the surgical application of transoral robotic surgery in obstructive sleep apnoea, together with practical guidance for the sleep surgeon.

DNA methylation plays a crucial role in gene regulation and has been implicated in various neuropsychiatric disorders, including alcohol use disorder (AUD). The rs27072 polymorphism within the SLC6A3 gene has been studied in addictive disorders; however, its role in epigenetic modifications remains unclear. This study investigates the methylation levels of CpG sites near rs27072 and their potential associations with AUD, personality traits, and environmental stressors.

One hundred twenty-four male participants (66 patients with AUD and 58 controls) were analyzed for DNA methylation at CpG islands proximal to the rs27072 locus. The personality traits and life stress events were assessed in all participants.

AUD patients had a lower methylation level than healthy controls (p = 0.003 for total average). However, the results changed to borderline significance after adjusting for clinical covariates in the analysis (p = 0.042), and the genotype at rs27072 did not modulate the methylation levels. There is high novelty seeking (p < 0.001), and more bad life events in patients with AUD than healthy controls (p < 0.001). Additionally, no significant correlations were found between methylation levels and personality traits or life stress scores (p > 0.05).

The methylation of the SLC6A3 gene may be marginally associated with AUD; however, the rs27072 genotype, personality, and life stress may not be directly linked to epigenetic modifications. Cross-sectional epigenetic studies may not establish causality; future studies with larger, more diverse cohorts and longitudinal designs are warranted to elucidate the complex interplay in AUD pathophysiology.

There are few economic evaluations of adjunctive psychosocial therapies for bipolar disorder.

Estimate the cost–utility of in-person psychosocial therapies for adults with bipolar disorder added to treatment as usual (TAU), from an Australian Government perspective.

We developed an economic model, estimating costs in 2021 Australian dollars (A$) and outcomes using quality-adjusted life-years (QALYs) gained and disability-adjusted life-years (DALYs) averted. The model compared psychoeducation, brief psychoeducation, carer psychoeducation, cognitive–behavioural therapy (CBT) and family therapy when added to TAU (i.e. pharmacotherapy) over a year for adults (18–65 years) with bipolar disorder. The relative risk of relapse was sourced from two network meta-analyses and applied to the depressive phase in the base case. Probabilistic sensitivity analysis and one-way sensitivity analyses were conducted, assessing robustness of results.

Carer psychoeducation was preferred in the base case when the willingness-to-pay (WTP) threshold is below A$1000 per QALY gained and A$1500 per DALY averted. Brief psychoeducation was preferred when WTP is between A$1000 and A$300 000 per QALY gained and A$1500 and A$450 000 per DALY averted. Family therapy was only preferred at WTP thresholds above A$300 000 per QALY gained or A$450 000 per DALY averted. In sensitivity analyses, brief psychoeducation was the preferred therapy. Psychoeducation and CBT were dominated (more costly and less effective) in base-case and sensitivity analyses.

Carer and brief psychoeducation were found to be the most cost-effective psychosocial therapies, supporting use as adjunctive treatments for adults with bipolar disorder and their families in Australia.

Chronic pain and depression are common in older people, and creative activities may lower the perceived impact and distress related to the symptoms.

This study describes the co-development of a creative arts and crafts protocol for older people with chronic pain and depressive symptoms, and investigates its feasibility and potential effects.

This study had two phases. In phase 1, a multidisciplinary expert panel (n = 10), consisting of professionals, patients and researchers, underwent iterative rounds to co-develop the protocol. In phase 2, a pilot study was conducted among 12 older adults (mean age 71.4 years). Mixed methods were used, including questionnaires at baseline, post-intervention and 3-month follow-up, assessing pain intensity and interference, depressive symptoms and quality of life; observational notes and focus groups. Descriptive and Wilcoxon signed-rank tests were applied to analyse quantitative data, and thematic analysis was used for qualitative data.

Qualitative findings supported the programme’s feasibility. Participants reflected that the process was engaging and empowering and brought them a sense of achievement and recognition. The quantitative findings evidenced the programme’s potential effects in reducing depressive symptoms (Z = −2.60, P < 0.01) and improving mental health-related quality of life (Z = −2.67, P < 0.01) at 3-month follow-up.

Our results support the feasibility of a creative arts and crafts programme and provide preliminary evidence of its impact on reducing depressive symptoms and improving mental health-related quality of life. Given the promising results, a definitive trial is needed to reveal the effectiveness of creative activities in pain management.