Tag: pubmed

Dermatol Online J. 2026 May 8;32(2). doi: 10.25251/4dmwat50.

ABSTRACT

BACKGROUND: Apalutamide is an androgen receptor antagonist used to treat patients with nonmetastatic castration-resistant prostate cancer (nmCRPC) or metastatic castration-sensitive prostate cancer (mCSPC). One of the most frequent adverse events associated with apalutamide is skin rash, particularly in Japanese patients. However, preventive skin care may reduce the frequency of apalutamide-induced skin rashes.

OBJECTIVE: We sought to compare the cumulative incidence of skin rashes in patients on apalutamide therapy with and without preventive skin care.

METHODS: This retrospective, real-world study included 27 patients in the control group (those who were not administered skin care) and 38 patients in the skin care group (those who were administered preventative skin care).

RESULTS: After a median follow-up of 7 months, grade 3 apalutamide-induced skin rashes occurred in 8.1% (3/37) of patients in the skin care group and 53.6% (15/28) of patients in the control group. Based on Gray’s test, the difference in incidence between groups was statistically significant (P = .002).

CONCLUSION: Preventive skin moisturization may reduce apalutamide-induced adverse skin events in patients with mCSPC or nmCRPC. Incorporating routine skin care may help patients experience the full efficacy of apalutamide while maintaining a good quality of life.

PMID:42522476 | DOI:10.25251/4dmwat50

J Nurs Manag. 2026;2026(1):e4905589. doi: 10.1155/jonm/4905589.

ABSTRACT

AIM(S): This study examined the association of moral injury and burnout with professional communication among operating room (OR) nurses in Southern Iran.

BACKGROUND: Effective professional communication is essential for surgical teamwork and patient safety. However, limited context-specific evidence is available on how moral injury and burnout are jointly associated with the quality of professional communication among OR nurses. Addressing this gap may help inform strategies to improve staff well-being, team functioning, and patient safety in high-stakes perioperative settings.

METHODS: A cross-sectional analytical study was conducted between March and May 2025. A total of 307 OR nurses were recruited from six tertiary referral hospitals in Shiraz, Iran. Data were collected using a demographic questionnaire, the Moral Injury Symptom Scale-Healthcare Professionals (MISS-HP), the Operating Room Nurses’ Burnout Questionnaire, and the Professional Communication Questionnaire for Operating Room Personnel. Data were analyzed using descriptive and inferential statistics.

RESULTS: Moral injury was significantly and positively correlated with burnout. In the multivariate regression model, moral injury was positively associated with professional communication, whereas burnout showed a negative association.

CONCLUSION: Moral injury and burnout were associated with professional communication among OR nurses. While burnout was negatively associated with communication, the unexpected positive adjusted association between moral injury and professional communication should be interpreted cautiously and may reflect ethically motivated communication, moral sensitivity, or professional advocacy rather than a beneficial effect of moral injury itself.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should consider integrated strategies to reduce burnout, support nurses facing morally challenging situations, and strengthen professional communication within surgical teams. Practical approaches may include workload monitoring, fair shift allocation, moral resilience training, ethics debriefing, supportive supervision, and team-based communication training. Such interventions may help promote nurses’ psychological well-being while supporting safer and more effective communication in OR settings.

PMID:42522470 | DOI:10.1155/jonm/4905589

Andrology. 2026 Jul 29. doi: 10.1111/andr.70336. Online ahead of print.

ABSTRACT

BACKGROUND: Infertility is a growing concern, which has led to an increase in the use of assisted reproductive techniques, involving in vitro sperm capacitation. Nonetheless, the optimal capacitation time remains a matter of debate, and it is unknown whether it has an impact on the localization of key membrane proteins.

OBJECTIVE: This study aimed to evaluate the distribution and dynamics of membrane protein domains zonadhesin (ZAN), izumo sperm-egg fusion 1 (IZUMO1), and transmembrane protein 95 (TMEM95) in sperm following 1 and 4 h of in vitro capacitation and subsequent induction of the acrosome reaction.

MATERIALS AND METHODS: Sperm from 16 humans under five physiological conditions were used: noncapacitation, 1- and 4 h in vitro capacitation, and acrosome reaction induction. Immunolocalization of ZAN, IZUMO1, and TMEM95 was assessed using confocal microscopy.

RESULTS: The univariate and multivariate statistical analysis revealed a clear relationship between physiological conditions and protein dynamics. In particular, noncapacitated spermatozoa were characterized by an absence of ZAN and TMEM95. Whereas, regardless of the capacitation time (1 h vs. 4 h), there was an increase in the key protein presence with ZAN and IZUMO1 in the acrosomal region and TMEM95 in the equatorial region. After induction of acrosome reaction, IZUMO1 was relocated to the equatorial region.

CONCLUSION: Here we illustrate the potential to quantify physiological differences among human spermatozoa by a multibiomarker approach. However, no evidence supports that capacitation time influences ZAN, IZUMO1, and TMEM95 distribution.

PMID:42522465 | DOI:10.1111/andr.70336

J Am Coll Clin Pharm. 2026 Aug;9(8):e70263. doi: 10.1002/jac5.70263.

ABSTRACT

BACKGROUND: Despite strong evidence supporting cardiovascular and kidney benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) in patients with type 2 diabetes, prescribing rates remain suboptimal. The aim of this study was to assess clinicians’ knowledge and comfort prescribing SGLT2i and GLP-1 RA in clinical practice and factors influencing prescribing of these agents.

METHODS: This multi-methods study used questionnaires to assess self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, and semi-structured interviews based on the Consolidated Framework for Implementation Research (CFIR) to assess factors affecting prescribing decisions among 21 clinicians (12 primary care physicians, 4 pharmacists, 5 nurse practitioners) at a large community-based health system in Virginia. Questionnaire results were analyzed using descriptive statistics, and interviews used a two-phase analytic approach combining inductive and deductive coding.

RESULTS: Clinicians self-reported high knowledge (7.9/10) and comfort (8.1 and 8.4/10) prescribing SGLT2i and GLP-1 RA but identified multiple implementation barriers. The most significant barriers were insurance coverage and out-of-pocket costs, with prior authorization requirements delaying therapy initiation. Medicare beneficiaries faced particularly challenging access due to coverage gaps and ineligibility for manufacturer assistance programs. Organizational factors, including high workload, limited appointment time, and the absence of automated patient identification systems, hindered consistent prescribing. Medication burden, side effects, and aversion to injectable medications emerged as patient-related barriers. Facilitators included strong clinical evidence supporting these agents, organizational culture supportive of innovation, and access to pharmacist support.

CONCLUSION: Despite high self-reported knowledge and comfort prescribing SGLT2i and GLP-1 RA, clinicians identified barriers to their use in clinical practice at the patient, clinician, organizational, and medication access levels. Future work should identify the best implementation strategies to address these barriers.

PMID:42522049 | DOI:10.1002/jac5.70263

Cardiovasc Diabetol Endocrinol Rep. 2026 Jul 29;12(1):49. doi: 10.1186/s40842-026-00315-2.

ABSTRACT

BACKGROUND: The cholesterol, high-density lipoprotein, and glucose (CHG) index has been linked to stroke risk. However, evidence is largely based on single-time-point measurements and has not been compared with cumulative exposure, nor evaluated in individuals with cardiovascular-kidney-metabolic syndrome (CKM) stages 0-3. This study aimed to compare the associations of baseline and cumulative CHG index with incident stroke risk in this population.

METHODS: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). The exposure measures were the baseline and cumulative levels of the CHG index. Multivariable logistic regression models were employed to examine the association between the baseline and cumulative CHG index and stroke risk. Restricted cubic spline (RCS) analysis was used to test potential dose-response relationships. The receiver operating characteristic (ROC) curve was used to compare the predictive performance of the two measures. Subgroup analyses were conducted to evaluate the consistency of these associations in different populations.

RESULTS: Among 4,661 participants with CKM stages 0-3, 476 (10.2%) developed incident stroke during follow-up. After adjustment for demographic characteristics, lifestyle factors, anthropometric measurement, laboratory parameters, medication use and comorbidities, both the baseline CHG index (OR = 1.42, 95% CI: 1.12-1.81) and cumulative CHG index (OR = 1.14, 95% CI: 1.03-1.26) were positively associated with stroke risk. Participants in the highest tertile (T3) of the baseline CHG index had a 35% higher stroke risk than those in the lowest tertile (T1) (OR = 1.35, 95% CI: 1.03-1.76), and a 34% elevated risk was observed for the cumulative CHG index (OR = 1.34, 95% CI: 1.03-1.76). RCS analysis revealed linear relationships for both measures (p for non-linear = 0.331 and 0.817, respectively; overall p < 0.05 for both). ROC curve analysis showed no statistically significant difference in the area under the curve (AUC) between the two measures (0.672 vs. 0.671, p = 0.330). Subgroup analyses indicated that the associations might be modified by gender and drinking status.

CONCLUSIONS: Among individuals with CKM stages 0-3, both baseline and cumulative CHG indices were independently associated with incident stroke risk. Given its moderate discriminatory capacity, the CHG index-derived from routine blood tests-may serve as a preliminary screening tool to flag high-risk individuals, prompting more comprehensive stroke risk evaluation.

PMID:42522042 | DOI:10.1186/s40842-026-00315-2

BMC Med Educ. 2026 Jul 28;26(1):1216. doi: 10.1186/s12909-026-09978-y.

ABSTRACT

BACKGROUND: Student mistakes are common in bedside teaching (BST) and can serve as important learning opportunities. However, little is known about how frequently mistakes occur in authentic clinical settings, what types of learning content they involve, and how teacher and patient presence shape teachers’ handling of these mistakes. This study investigated (RQ1) the relevance of learning content during student mistakes, (RQ2) associations between mistake types and teachers’ reactions, and (RQ3) whether patient presence influences clinical teachers’ responses to mistakes.

METHODS: We conducted an observational study based on video recordings of 36 BST sessions across internal medicine, neurology, and orthopaedics (78.4 h). Using a hierarchical coding scheme, we identified mistakes, classified their learning content and mistake types, and coded teacher reactions as well as teacher and patient presence. Interrater reliability ranged from substantial to excellent. Descriptive statistics were used to determine the frequency of mistakes per hour and their distribution across the learning content. Associations between mistake types and teacher reactions were analysed via Spearman’s rank correlations (RQ2). Mann-Whitney U tests (RQ3) were used when examining whether teachers’ mistake-related behaviours differed depending on the presence or absence of the patient.

RESULTS: Across all BST sessions, the students made an average of 4.9 mistakes per hour. Mistakes occurred most often during theoretical knowledge and clinical reasoning, predominantly as reproduction mistakes, whereas an incorrect application of skills was most frequent during clinical examination and case presentations. Teacher presence was positively associated with the number of observed mistakes, particularly reproduction mistakes. During the physical examination, the students were supervised for only 72% of the active practice time. Teachers’ reactions – including elaboration, directness of feedback, and time provided for correction – did not differ significantly depending on patient presence.

CONCLUSIONS: Student mistakes are common in BST and hold considerable didactic value; however, this value is not fully realised when supervision is inconsistent or when feedback remains limited. Enhancing clinical teachers’ capacity to detect errors, providing structured and supportive feedback, and adapting their approach to the presence of patients may strengthen their ability to learn from mistakes. Interventions that cultivate psychological safety and promote effective error-management practices could further improve the pedagogical quality of BST.

PMID:42522036 | DOI:10.1186/s12909-026-09978-y

Trop Dis Travel Med Vaccines. 2026 Jul 28;12(1):27. doi: 10.1186/s40794-026-00311-5.

ABSTRACT

BACKGROUND: Hepatitis B virus (HBV) infection remains a major public health challenge in sub-Saharan Africa despite the availability of a safe and effective vaccine. In Nigeria, adult vaccination coverage and completion rates are not well characterized within hospital-based populations.

METHODS: A hospital-based cross-sectional study was conducted among 1,200 adults attending Federal Medical Centre (FMC) Keffi, Nasarawa State, Nigeria. Data on socio-demographics, HBV-related knowledge, attitudes, perceived barriers, vaccination uptake, and completion were collected using a structured questionnaire. Knowledge and attitude scores were categorized into poor, fair, and good levels. Associations between socio-demographic characteristics and vaccination uptake were examined using chi-square and Fisher’s exact tests, with statistical significance set at p < 0.05.

RESULTS: The mean age of respondents was predominantly 36-40 years (32.5%), with males constituting 72.3%. Most respondents had tertiary education (91.8%) and were civil servants (83.4%). Overall awareness of HBV was high (95.5%), with a mean knowledge score of 12.37 ± 1.42. Good knowledge was observed in 74.2% of respondents, while 57.2% demonstrated good attitudes toward HBV prevention. Vaccination uptake was high, with 93.5% reporting receipt of at least one vaccine dose. However, only 22.3% had completed the recommended three-dose schedule, while 48.2% and 23.1% had received one and two doses, respectively. Willingness to complete vaccination was reported by 81.6% of respondents. Perceived barriers included high vaccine cost (72.4%), inadequate access to health facilities (96.9%), fear of side effects (71.9%), and insufficient information (73.5%). No significant associations were found between socio-demographic variables and vaccination uptake (p > 0.05 for all).

CONCLUSION: Despite high HBV vaccination initiation and knowledge levels, substantial gaps in vaccine completion persist. Addressing financial, informational, and access-related barriers is essential to improve full vaccination coverage among Nigerian adults.

PMID:42522034 | DOI:10.1186/s40794-026-00311-5

Isr J Health Policy Res. 2026 Jul 29;15(1):30. doi: 10.1186/s13584-026-00773-0.

ABSTRACT

BACKGROUND: Suicide is a leading cause of death among young people worldwide and remains a significant cause of mortality across all age groups, especially in older adults. The underlying causes of suicide span various disciplines and are deeply influenced by societal attitudes, which fluctuate between glorification and severe condemnation of suicide. This study aims to evaluate the role of court rulings on suicidal behavior, with particular attention to implications for healthcare policy in Israel.

METHODS: We searched the national court rulings databases for alleged psychiatry malpractice in suicide-related cases and of pre-trial settlements from 1985 to 2023. For court decisions, we collected patients’ socio-demographic and clinical characteristics, lawsuit characteristics, and the quality of medical documentation and decision-making processes. For pre-trial settlements, we collected data about lawsuit characteristics. Two researchers reviewed the qualitative data, while the quantitative data was analyzed with descriptive statistics.

RESULTS: Over the 38-year period, there were 20 psychiatry malpractice court lawsuits related to patient suicides, including 17 deaths and 3 life threatening attempts. Of these, 12 (60%) of cases were won by the plaintiff, and eight (40%) by the defendant. In 14 cases, the suicides occurred in inpatient units and in six cases in community settings. The number of lawsuits notably increased over time for suicide events, with 17 pre-court settlements between 1985 and 1997, and 56 cases in each of the subsequent periods (1998-2010 and 2011-2023).

CONCLUSIONS: The number of malpractice lawsuits related to suicide in Israel is increasing over time. Our findings, which show a rise in both litigation and pre-trial settlements, may put pressure on psychiatrists to avoid certain kinds of work, especially in the public sector. Such a shift could have broader effects on the quality of suicide prevention efforts and overall mental health care. The study highlights the structural tension between retrospective legal accountability and prospective clinical and public-health approaches to suicide prevention. Addressing this challenge requires balanced policy responses, including strengthening patient-safety and risk-management systems, improving clinical documentation and decision transparency, fostering constructive collaboration between legal and mental health systems, and considering alternative compensation mechanisms that reduce adversarial pressures while supporting affected families.

PMID:42522033 | DOI:10.1186/s13584-026-00773-0

Cardiovasc Diabetol. 2026 Jul 28;25(1):212. doi: 10.1186/s12933-026-03312-y.

ABSTRACT

BACKGROUND: Copeptin, a surrogate marker for vasopressin secretion, is associated with cardiovascular disease, insulin resistance and dysglycaemia. The cardioprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) may involve vasopressin modulation through fluid redistribution, but whether this effect persists long-term in high-cardiovascular-risk patients with newly detected dysglycaemia remains unknown.

METHODS: In this post-hoc analysis of the SOCOGAMI double-blind, placebo-controlled trial, 42 patients (mean age 67.5 years, 19% females) with impaired glucose tolerance or newly detected type 2 diabetes following an ACS and no heart failure were randomized to empagliflozin 25 mg/day (n = 20) or placebo (n = 22) for 7 months. Copeptin was measured during oral glucose tolerance tests (OGTT) at baseline, after 7 months on-treatment, and 3 months after treatment withdrawal. Treatment effects were assessed by repeated-measures ANOVA with treatment × time interaction and linear mixed-effects models.

RESULTS: Haematocrit, but not copeptin, showed a significant between-group difference at 7 months (p = 0.03 and p = 0.63, respectively). Both markers returned toward baseline after treatment withdrawal, but the overall treatment × time interaction was not significant for either (p = 0.72 and p = 0.64 respectively). Results were unchanged after accounting for a baseline imbalance in diuretic use (35% vs. 14%). Copeptin was not associated with the glucose-lowering effect of empagliflozin and no differential copeptin response during the OGTT across groups or visits was observed. In exploratory analyses, copeptin correlated with arterial pulse wave velocity at baseline (rs = 0.40, unadjusted p = 0.03).

CONCLUSIONS: In this post-hoc analysis, empagliflozin treatment was not associated with statistically significant sustained vasopressin secretion in post-ACS patients with newly detected dysglycaemia and preserved cardiac function. Due to the limited power and the absence of early on-treatment sampling these findings cannot exclude AVP modulation and warrant confirmation in adequately powered studies.

TRIAL REGISTRATION: EudraCT number 2015-004571-73.

PMID:42522027 | DOI:10.1186/s12933-026-03312-y

Infect Dis Poverty. 2026 Jul 28;15(1):84. doi: 10.1186/s40249-026-01484-z.

ABSTRACT

BACKGROUND: The Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) scheme, supported by the World Bank, is establishing four zonal National Institutes of Virology (NIVs) in India. It is essential to identify the zonal disease and research priorities so as to focus research at zonal levels. This study reports a zonal viral disease prioritisation exercise to support outbreak response and collaborative research. It describes zonal-prioritised viral diseases, assesses concordance and differences in zonal priority lists and, and identifies cross‑cutting research themes and preparedness gaps using an multicriteria decision analysis (MCDA)‑based consensus process.

METHODS: We conducted a cross-sectional, multi-stakeholder consultative study across four geographical zones of India in March 2024. The zonal-level consultative workshops employed a systematic consensus-building approach using the modified One Health Zoonotic Disease Prioritisation (OHZDP) tool, adapted for emerging viral diseases and applied via MCDA. We identified zonal-level stakeholders, listed 40 viral diseases and categorised them into three groups: common occurrence (Group A), limited occurrence (Group B), and rare occurrences with a chance of emergence, evolution or importation (Group C). The stakeholders from state health departments, medical colleges, research institutes and the Virus Research and Diagnostic Laboratory (VRDL) network ranked the viral diseases and research themes in each zone. Spearman rank correlation was used to assess concordance of priority rankings between zones.

RESULTS: A total of 186 participants (42-48 per zone) contributed to the four zonal workshops including collaborators from VRDL laboratories (26%), public health stakeholders from Integrated Disease Surveillance programme(IDSP) (28%), invited experts (21%), organisers (19%) and Indian Council of Medical Research (ICMR) representatives (6%). The key outcomes included the zone-specific lists of priority viral diseases in Groups A, B and C. There were zonal variations in viral disease prioritisation, reflecting local epidemiological patterns. Spearman rank correlation analysis showed moderate positive correlation between the Central and East zones (rho = 0.697, P = 0.031), whereas other pairwise comparisons were not statistically significant, which indicated both shared and distinct priority patterns within the zones. The top five priority viral diseases across zones included dengue, influenza, measles, Japanese encephalitis and hepatitis A. The research themes and subthemes were then decided for collaborative research.

CONCLUSIONS: These multistakeholder consultations provided a novel, replicable template for prioritising viral diseases to develop strategies for mitigating the impact of future outbreaks through collaborative research. These zonal priorities may guide similar exercises at national, regional and global levels in future.

PMID:42522023 | DOI:10.1186/s40249-026-01484-z