Breast cancer patients' perspectives and needs about wed-based surgical decision aid: A qualitative study.

PURPOSE: Breast cancer diagnosis often presents patients with complex treatment decisions, particularly concerning surgical options. A patient decision aid can assist patients in making better decisions, and ultimately improving health outcomes positively. This study aims to explore the perceptions and needs of breast cancer patients regarding the utilization of wed-based surgical decision aids. METHODS: A descriptive qualitative study was conducted using semi-structured interviews with purposive sampling that were audio recorded and transcribed verbatim. A thematic analysis was conducted using NVivo 12 software. Participants were recruited from a tertiary general hospital in Shanghai, China. Inclusion criteria were being diagnosed with breast cancer, age over 18 years old, considering breast cancer surgery as a treatment option and able/willing to give informed consent. RESULTS: From March to May 2023, 16 patients consented to participate and completed the interviews. Three major themes were revealed, with corresponding sub-themes: (1) informative and useful content (need to know as much information as possible, easy to understand and presented in multiple ways and highly credible from reliable resource); (2) user-friendly on design (easy to operate, simple function and man-machine interaction); and (3) suggested timing of use. CONCLUSIONS: Patients' perspectives and needs about wed-based surgical decision aids are numerous and diverse. In designing wed-based surgical decision aids for breast cancer patients, content, design and timing are all factors that need to be taken into consideration to encourage informed surgical decisions. Further work will focus on developing a feasible and acceptable web-based surgical patient decision aid (PtDA), and test its usability in a clinical setting to understand if the PtDA can meet the decisional needs of breast cancer patients, thus to improve quality of decision-making.

Thermo-responsible PNIPAM-grafted polystyrene microspheres for mesenchymal stem cells culture and detachment.

The preparation of cells is a critical step in cell therapy. To ensure the effectiveness of cells used for clinical treatments, it is essential to harvest adherent cells from the culture media in a way that preserves their high viability and full functionality. In this study, we developed temperature-responsive PNIPAM-grafted polystyrene microspheres using reversible addition-fragmentation chain transfer polymerization. These microspheres allow for the non-destructive harvesting of cultured cells through temperature changes. The composition and physicochemical properties of the PNIPAM-grafted polystyrene microspheres were confirmed using infrared spectroscopy, elemental analysis, dynamic light scattering, and thermogravimetric analysis. In vitro experiments demonstrated that these microspheres exhibit excellent biocompatibility, supporting the adhesion and proliferation of various cells. Moreover, the microspheres showed good temperature responsiveness in thermosensitive detachment experiments with GFP-HepG2 cells and umbilical cord mesenchymal stem cells (UC-MSCs). Additionally, through orthogonal experiments, we identified a cell detachment aid mixture that significantly improved the dispersibility of cells detached from the microspheres, enhancing the efficiency of thermosensitive cell detachment by approximately 40%. The harvested UC-MSCs retained their capacity for re-proliferation and trilineage differentiation. Consequently, the temperature-responsive microspheres developed in this study, combined with the cell detachment aid mixtures, hold great potential for large-scale culture and harvesting of therapeutic cells in clinical applications.

Administration of Burns First Aid Treatment to Aboriginal and Torres Strait Islander children in community settings.

OBJECTIVE: This paper investigates Burn First Aid Treatment (BFAT) provided to Aboriginal and Torres Strait Islander children in Australia at the scene of injury using data from a population-based cohort study. STUDY DESIGN: The participants were 208 Aboriginal and Torres Strait Islander children aged < 16 years who sustained a burns injury between 2015-2018, and their carers. The primary outcome measure was gold standard BFAT, (defined as at least 20 min of cool, running water within 3 h of the injury); additional measures included type of first aid, length of first aid provided, and carer's knowledge of first aid. RESULTS: Of the 208 caregivers, 168 provided open-ended responses that indicated first aid was applied to their child; however, only 34 received gold standard BFAT at the scene of the injury, 110 did not receive correct BFAT, and 24 were unsure what first aid was applied. CONCLUSION: This study highlights an important need for communities to have access to appropriate evidence-based and co-designed BFAT education and training.

Implementation of Cellulose-Based Filtration Aids in Industrial Sunflower Oil Dewaxing (Winterization): Process Monitoring, Prediction, and Optimization.

In the production of refined sunflower oil, waxes are removed during the winterization stage, and wax crystals are separated through filtration assisted by filtration aids. Commonly used filtration aids in oil refining include perlite and diatomaceous earth. After winterization, a significant amount of filter cake remains as a by-product and is treated as waste. Today, natural cellulose fibers are being promoted as filtration aids. Their advantages are numerous, both in the production process and from an environmental perspective. However, their only disadvantage is their higher cost. Therefore, in this study, 57 filtration cycles during the industrial sunflower oil winterization step using cellulose-based filtration aids were monitored. Different process parameters, including the pressure differential on the filter, the flow rate of filtered oil, constant pressure period, the quantity of filtered oil, filtration time, the quantity of pre-coating and dosing filtration aids, the volume of filtered oil, the concentration of dosing filtration aid, as well as the mass of separated waxes, were observed. Additionally, artificial neural networks were applied to predict process parameters, optimize the process, and, above all, determine the dosage of filtration aids, which will make the process more economical. The optimal filtration process is performed at a pressure differential of 3.3 bar, lasting a total of 39 h, with 32 h at constant pressure, resulting in 322,503 kg of filtered oil and 90.41 kg of waxes. The optimal quantity of cellulose-based filtration aids employed for pre-coat was 80 kg, and for dosing, 375 kg, with an optimal concentration of 0.12% w/w.

Association between compound extreme weather event types and the spectrum of emergency ambulance calls: A metropolitan study in Shenzhen.

BACKGROUND: Compound extreme weather events, a combination of weather and climate drivers that lead to potentially high-impact events, are becoming more frequent with climate change. The number of emergency ambulance calls (EACs) is expected to increase during compound extreme weather events. However, the extent of these increases and the trends over time have not been fully assessed. METHODS: We obtained 242,165 EAC records for Shenzhen from January 1, 2020, to June 30, 2023. A compound extreme weather event was defined as the occurrence of at least two extreme weather events on the same day. A distributed lag non-linear model was used to explore the exposure-response and lag-response relationships between various compound extreme weather events and all-cause and specific-cause EACs. FINDING: Compound Cold & Strong Monsoon events had more significant impacts on EACs for all causes and endocrine diseases, with the cumulative relative risk (CRR) of 1.401 (95% confidence interval (CI):1.290-1.522) and 1.641 (95% CI:1.279-2.105). Compound Heat Wave & Lightning events had more obvious impacts on digestive disease and endocrine disease EACs, with the CRRs of 1.185 (95% CI:1.041-1.348) and 1.278 (95% CI:0.954-1.711), respectively. Compound Rainstorm & Lightning & Heat Wave events also led to increased RRs of EACs for all causes (CRR: 1.168, 95% CI:1.012-1.348), cardiovascular diseases (CRR: 1.221, 95% CI:0.917-1.624), digestive diseases (CRR: 1.395, 95% CI:1.130-1.721), and endocrine diseases (CRR: 1.972, 95% CI:1.235-3.149). There was no increased RR in the compound Rainstorm & Lightning events for all types of EACs. INTERPRETATION: Our study explored the relationship between EACs and compound extreme weather events, suggesting that compound extreme weather events are associated with the acute onset of cardiovascular diseases, digestive diseases, and endocrine diseases, increasing the burden on emergency ambulance resources for both all causes and specific diseases mentioned above.

Comparative Analysis of Volatile Components in Chi-Nan and Ordinary Agarwood Aromatherapies: Implications for Sleep Improvement.

Agarwood, a precious traditional medicinal herb and fragrant material, is known for its sedative and sleep-improving properties. This study explores the mechanisms underlying the aromatherapy effects of Chi-Nan agarwood and ordinary agarwood in improving sleep. Using a combination of gas chromatography-mass spectrometry (GC-MS), network pharmacology, and molecular docking techniques, we identified and c ompared the chemical compositions and potential molecular targets of both types of agarwood. The GC-MS analysis detected 87 volatile components across six types of agarwood aromatherapy, with 51 shared between Chi-Nan and ordinary agarwood, while each type also had 18 unique components. Ordinary agarwood was found to be richer in sesquiterpenes and small aromatic molecules, whereas Chi-Nan agarwood contained higher levels of chromones. These differences in chemical composition are likely responsible for the distinct sleep-improving effects observed between the two types of agarwood. Through network pharmacology, 100, 65, and 47 non-repetitive target genes related to sleep improvement were identified for components shared by both types of agarwood (CSBTs), components unique to common agarwood (CUCMs), and components unique to Chi-Nan agarwood (CUCNs), respectively. The constructed protein-protein interaction (PPI) networks revealed that key targets such as MAOA, MAOB, SLC6A4, and ESR1 are involved in the sleep-improving mechanisms of agarwood aromatherapy. Molecular docking further confirmed the strong binding affinities of major active components, such as 5-Isopropylidene-6-methyldeca-369-trien-2-one and 2-(2-Phenylethyl)chromone, with these core targets. The results suggest that agarwood aromatherapy enhances sleep quality through both hormonal and neurotransmitter pathways, with ordinary agarwood more deeply mediating hormonal regulation, while Chi-Nan agarwood predominantly influences neurotransmitter pathways, particularly those involving serotonin and GABA. This study provides valuable insights into the distinct therapeutic potentials of Chi-Nan and ordinary agarwood, highlighting their roles in sleep improvement and offering a foundation for future research in the clinical application of agarwood-based aromatherapy.

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

BACKGROUND: Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. OBJECTIVE: This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. METHODS: We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. RESULTS: Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. CONCLUSIONS: Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

Clinical efficacy of a head-mounted device for central vision loss.

Central vision loss (CVL) is a major form of low vision that remains inadequately managed worldwide. This study evaluated the clinical efficacy of a novel head-mounted device (HMD), Onyx, designed to enhance visual function and vision-related quality of life for CVL patients. It employs a projection system that enables patients to leverage their residual peripheral vision for environmental awareness. It also integrates artificial intelligence to augment the automatic recognition of text, faces, and objects. In this single-center, prospective cohort study, 41 binocularly low vision patients with CVL were instructed to use Onyx for 4 to 6 h daily over a one-month period. Various metrics were assessed, including near and distance visual acuity (VA), recognition abilities for faces and objects, and the low vision quality-of-life (LVQOL) questionnaire scores, at the start and end of the study. The results showed significant improvements in near VA for 60.98% of the participants, distance VA for 80.49%, and recognition ability for 90.24%. 68.29% of the participants showed significant improvements in the LVQOL scores. Improvement in recognition ability was negatively correlated with baseline recognition ability. Additionally, improvement in the LVQOL scores was correlated with age and the baseline LVQOL score. Overall, the study found that the novel HMD significantly improved visual function and vision-related quality of life for low vision patients with CVL, highlighting the potential benefits and the need for further evaluation of such devices.

A Comparative Analysis of the Impact of Two Different Cognitive Aid Bundle Designs on Adherence to Best Clinical Practice in Simulated Perioperative Emergencies.

Background: Stress and human error during perioperative emergency situations can significantly impact patient morbidity and mortality. Previous research has shown that cognitive aid bundles (CABs) minimize critical misses by 75%. This study aimed to compare the effectiveness of two different CAB designs with the same content in reducing missed critical management steps for simulated perioperative emergencies. Methods: A multicenter randomized controlled simulation-based study was conducted including 27 teams, each consisting of three participants; each team performed four simulation scenarios. In the first scenario for each team (Scenario 1), no CAB was used. Scenarios 2 and 3 were randomly allocated to the groups, with either a branched, clustered design (CAB-1) or a linear, step-by-step design (CAB-2) of the cognitive aid. In Scenario 4, the groups used one of the previously mentioned CABs according to their own preference. The primary outcome was the difference in the percentage of missed critical management steps between the two different CABs. Secondary outcomes included user preference for one CAB design and the reduction in percentage of missed critical management steps using any CAB versus no CAB. Results: Twenty-seven teams simulated 108 perioperative emergency situations. The percentage of missed critical management steps was similar between CAB-1 and CAB-2 (27% [interquartile range (IQR) 20-29] versus 29% [IQR 20-35], p = 0.23). However, most participants favored the branched, clustered design CAB-1 (77.8%). Additionally, employing any CAB reduced the percentage of missed critical management steps by 36% (33% missed steps vs. 21% missed steps, p = 0.003). Conclusions: While the two CAB designs did not differ significantly in reducing missed critical management steps, the branched, clustered design was perceived as more user-friendly. Importantly, using any CAB significantly reduced the percentage of missed critical management steps compared to not using a cognitive aid, emphasizing the need for CAB use in the operating room.

Exploring the interplay of clinical, ethical and societal dynamics: two decades of Medical Assistance in Dying (MAID) on psychiatric grounds in the Netherlands and Belgium.

This paper explores recently emerging challenges in Medical Assistance in Dying on Psychiatric Grounds (MAID-PG), focusing on ethical, clinical, and societal perspectives. Two themes are explored. First, the growing number of young MAID-PG requestors and the public platform given to MAID-PG requests. Ethically, media portrayal, particularly of young patients' testimonials, requires scrutiny for oversimplification, acknowledging the potential for a Werther effect alongside the absence of a Papageno effect. This highlights the need for better communication policies for media purposes. Second, cautionary considerations regarding psychiatric care adequacy are addressed. In MAID-PG this includes reasons underlying psychiatrist reluctance to engage in MAID-PG trajectories, leading to growing waiting lists at end-of-life-care centers. Addressing current shortages in psychiatric care adequacy is crucial, necessitating less narrow focus on short-term care trajectories and recovery beside transdiagnostic treatment approaches, expanded palliative care strategies, and integrated MAID-PG care.

Assessing the Feasibility of Using Parents' Social Media Conversations to Inform Burn First Aid Interventions: Mixed Methods Study.

BACKGROUND: Burns are common childhood injuries, which can lead to serious physical and psychological outcomes. Appropriate first aid is essential in managing the pain and severity of these injuries; hence, parents who need timely access to such information often seek it from the web. In particular, social media allow them to reach other parents, hence these conversations may provide insight to aid the design and evaluation of burn first aid interventions for parents. OBJECTIVE: This study aims to determine the feasibility of finding, accessing, and analyzing parent burn first aid conversations on social media to inform intervention research. METHODS: The initial choice of the relevant social media was made based on the results of a parent focus group and survey. We considered Facebook (Meta Platforms, Inc), Mumsnet (Mumsnet Limited), Netmums (Aufeminin Group), Twitter (subsequently rebranded as "X"; X Corp), Reddit (Reddit, Inc), and YouTube (Google LLC). To locate the relevant data on these platforms, we collated a taxonomy of search terms and designed a search strategy. A combination of natural language processing and manual inspection was used to filter out irrelevant data. The remaining data were analyzed manually to determine the length of conversations, the number of participants, the purpose of the initial post (eg, asking for or offering advice), burn types, and distribution of relevant keywords. RESULTS: Facebook parenting groups were not accessed due to privacy, and public influencer pages yielded scant data. No relevant data were found on Reddit. Data were collected from Mumsnet, Netmums, YouTube, and Twitter. The amount of available data varied across these platforms and through time. Sunburn was identified as a topic across all 4 platforms. Conversations on the parenting forums Mumsnet and Netmums were started predominantly to seek advice (112/116, 96.6% and 25/25, 100%, respectively). Conversely, YouTube and Twitter were used mainly to provide advice (362/328, 94.8% and 126/197, 64%, respectively). Contact burns and sunburn were the most frequent burn types discussed on Mumsnet (30/94, 32% and 23/94, 25%, respectively) and Netmums (2/25, 8% and 14/26, 56%, respectively). CONCLUSIONS: This study provides a suite of bespoke search strategies, tailored to a range of social media platforms, for the extraction and analysis of burn first aid conversation data. Our methodology provides a template for other topics not readily accessible via a specific search term or hashtag. YouTube and Twitter show potential utility in measuring advice offered before and after interventions and extending the reach of messaging. Mumsnet and Netmums present the best opportunity for informing burn first aid intervention design via an in-depth qualitative investigation into parents' knowledge, attitudes, and behaviors.

Development and acceptability of a decision-aid for food allergy Oral immunotherapy in children.

BACKGROUND: Limited decision-support tools are available to help shared decision-making (SDM) regarding food oral immunotherapy (OIT) initiation. No current tool covers all foods, forms, and pediatric ages for which OIT is offered. METHODS: In compliance with International Patient Decision Aid Standards criteria, this pediatric decision-aid comparing OIT versus avoidance was developed in three stages. Nested qualitative data assessing OIT decisional needs were supplemented with evidence-synthesis from the OIT literature to create the prototype decision-aid content. This underwent iterative development with food allergy experts and patient advocacy stakeholders until unanimous consensus was reached regarding content, bias, readability, and utility in making a choice. Lastly, the tool underwent validated assessment of decisional acceptability, decisional conflict, and decisional self-efficacy. RESULTS: The decision-aid underwent 5 iterations, resulting in a 4-page written aid (Flesch-Kincaid reading level 6.1) explaining therapy choices, risks and benefits, providing self-rating for attribute importance for the options and self-assessment regarding how adequate the information was in decision-making. A total of n = 135 caregivers of food-allergic children assessed the decision-aid, noting good acceptability, high decisional self-efficacy (mean score 85.9/100) and low decisional conflict (mean score 20.9/100). Information content was rated adequate and sufficient, the therapy choices wording balanced, and presented without bias for a "best choice." Lower decisional conflict was associated with caregiver-reported anaphylaxis. CONCLUSIONS: This first pediatric OIT decision-aid, agnostic to product, allergen, and age has good acceptability, limited bias, and is associated with low decisional conflict and high decisional self-efficacy. It supports SDM in navigating the decision to start OIT or continue allergen avoidance.

The Comparative Performance of Large Language Models on the Hand Surgery Self-Assessment Examination.

BACKGROUND: Generative artificial intelligence (AI) models have emerged as capable of producing human-like responses and have showcased their potential in general medical specialties. This study explores the performance of AI systems on the American Society for Surgery of the Hand (ASSH) Self-Assessment Exams (SAE). METHODS: ChatGPT 4.0 and Bing AI were evaluated on a set of multiple-choice questions drawn from the ASSH SAE online question bank spanning 5 years (2019-2023). Each system was evaluated with 999 questions. Images and video links were inserted into question prompts to allow for complete AI interpretation. The performance of both systems was standardized using the May 2023 version of ChatGPT 4.0 and Microsoft Bing AI, both of which had web browsing and image capabilities. RESULTS: ChatGPT 4.0 scored an average of 66.5% on the ASSH questions. Bing AI scored higher, with an average of 75.3%. Bing AI outperformed ChatGPT 4.0 by an average of 8.8%. As a benchmark, a minimum passing score of 50% was required for continuing medical education credit. Both ChatGPT 4.0 and Bing AI had poorer performance on video-type and image-type questions on analysis of variance testing. Responses from both models contained elements from sources such as PubMed, Journal of Hand Surgery, and American Academy of Orthopedic Surgeons. CONCLUSIONS: ChatGPT 4.0 with browsing and Bing AI can both be anticipated to achieve passing scores on the ASSH SAE. Generative AI, with its ability to provide logical responses and literature citations, presents a convincing argument for use as an interactive learning aid and educational tool.

Is in-kind kinder than cash? The impact of money vs. food aid on social emotions and aid take-up.

Over the past decade, there has been a shift in the way charities deliver humanitarian aid. Historically, the most prevalent way to help the global poor was by providing in-kind asset transfers. Recently, alternatives to in-kind aid, such as cash aid, have been increasing in prevalence. Although there has been widespread endorsement from the academic community and the public on the popularizing model of giving cash aid, one perspective remains untouched: the recipient's perspective. Thus, the present research explores how food-insecure individuals feel when receiving money vs. in-kind food aid to help meet their hunger and nutrition needs. Specifically, we explore the degree of positive (e.g., feeling cared for) and negative (e.g., feeling ashamed) social emotions felt when receiving the aid opportunity and how willing recipients are to accept monetary (vs. food) aid. Results from five preregistered experiments (N = 3,110)-a field experiment in Kenya and four online experiments in the United States-find that monetary (vs. food) aid elicits comparatively more of a market-pricing relationship and less of a communal sharing relationship and, hence, makes people feel less positive and more negative social emotions when receiving the help. Subsequently, recipients are less likely to take up monetary (vs. food) aid from a charity. However, we find that this effect does not persist when receiving government aid: Recipients are similarly willing to accept money and in-kind food aid from the government. This research suggests that future scholarship ought to examine ways to improve psychological experiences when receiving money from charity.

A Systematic Review of Surgical Characteristics and Adverse Events of an Active, Transcutaneous Bone Conduction Device.

OBJECTIVE: A new, active transcutaneous bone conduction device (BCD) was FDA-approved in 2019 in the USA. This systematic review sought to evaluate early outcomes associated with Osia implantation. METHODS: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Four databases were reviewed: PubMed, Scopus, Cochrane CENTRAL, and CINAHL. Studies were included if they described audiometric, surgical characteristics/complications, or adverse events associated with the Osia BCD. Exclusion criteria: non-English language studies, animal investigations, reviews/meta-analyses, case reports, database studies. RESULTS: Eighteen studies with 336 patients were included. Mean age at implantation was 37.9 years. About 79.5% of patients had MHL/CHL and 19.5% had SSD/SHL. Mean operative time was 71.6 minutes. Mean PTA gain from unaided conditions was 35.4 dB. Mean functional gain at high frequency (6 kHz and above) from aided conditions was 16.1 dB. Mean improvement in speech recognition thresholds was 19.1 dB from unaided conditions. Adverse events (all types) were reported in 20.1% of cases. Across all studies, the postoperative infection rate was 5%. About 2% of patients reported magnet retention issues. About 1.65% of cases were complicated by hematomas. CONCLUSIONS: Under systematic literature review, the Osia BCD has been associated with low complication rates, relatively short operative times, and good audiometric and speech outcomes, notably high frequency gain >6 kHz. More advanced audiometric outcome reporting remains limited and audiometric data and patient reported outcome measures were reported heterogeneously.

Edward K. Barsky (1897-1975): Surgery, activism, and the Spanish Civil War.

Edward K. Barsky (1897-1975) was born and raised in New York City and became a surgeon at Beth Israel Hospital. During the political upheaval of the 1930s, Barsky became passionate about the cause of the Spanish Republic during the Spanish Civil War, as the democratically elected government came under siege by insurrectionists led by General Francisco Franco. Barsky transformed his beliefs into action as a founder of the American Medical Bureau to Aid Spanish Democracy, where he led a medical mission to the Spanish frontlines from 1937 to 1939. In Spain, Barsky organized American hospitals and operated under fire, contributing to significant advances in battlefield medicine. After the fall of the Republic in 1939, Barsky returned to the United States and his career as a surgeon in New York while also dedicating himself to the cause of Spanish refugees. His political activities, however, made him a target of political persecution by the House Un-American Activities Committee, and he ultimately lost both his freedom and his medical licence. Barsky was a surgeon, scientist, humanitarian, and activist, and his life illustrates the often complicated ties between politics and the practice of medicine.

A novel intervention for acute stress reaction: exploring the feasibility of ReSTART among Norwegian soldiers.

Background: Soldiers in combat may experience acute stress reactions (ASRs) in response to trauma. This can disrupt function, increasing both immediate physical danger and the risk for post-trauma mental health sequelae. There are few reported strategies for managing ASRs; however, recent studies suggest a novel peer-based intervention as a promising approach.Objectives: This study assesses the feasibility of ReSTART training, a peer-based course designed to prepare soldiers to manage ASRs. ReSTART builds on programmes established by US and Israeli militaries. The current study evaluates the ReSTART programme in a Norwegian setting, across distinct groups of soldiers, professionals and conscripts.Methods: Participants included professional soldiers deploying to Mali and conscripts with 6 months of service, who completed the ReSTART training course and surveys administered pre- and post-training. These surveys assessed attitudes and programme acceptability. Analyses included 74 soldiers who provided complete survey responses.Results: ReSTART training received high ratings in terms of usefulness, relevance, and importance in managing ASRs. From pre- to post-training, respondents had significant increases in positive attitudes towards ASR management and confidence in handling ASRs personally, and at the unit level; decreases in stigma-related attitudes associated with ASRs; and increased perception of leadership emphasizing ASR management.Conclusions: ReSTART training shows potential as an effective tool when preparing soldiers to manage ASRs in high-risk environments, enhancing military units' capacity to support each other and effectively respond to stress-induced functional disruptions. This study adds evidence supporting the utility of peer-based ASR management in operational settings and highlights the need for broader implementation and systematic evaluation.

This study is the first study outside the US and Israeli context to systematically evaluate the feasibility of peer-based interventions for Acute Stress Reactions (ASRs) during combat.Results show that a novel Norwegian Armed Forces training programme, called ReSTART, is strongly endorsed as a means to prepare soldiers for managing ASRs.The study also demonstrates that completing ReSTART training positively impacts changes in self-confidence in ASR management, confidence in others' ability to manage ASRs, perceptions of leadership emphasis of ASR management, and stigma related to ASRs.This investigation represents the first investigation of how suitable training for peer-based ASR interventions is for inexperienced conscripted soldiers. Findings show that overall, ReSTART training has high suitability for both professional soldiers and conscripts with less than 6 months of service.Findings demonstrate the utility of peer-based interventions like ReSTART in European militaries. Moreover, the study has implications for preparing inexperienced recruits such as newly mobilized Ukrainian soldiers currently being trained by NATO partners.

Descriptive analysis of road traffic crashes encountered by Tanzanian motorcycle taxi drivers trained in first aid.

Introduction: In Dar es Salaam, Tanzania, death from road traffic crashes (RTC) occurs at roughly double the global rate. In this study, we sought to understand the locations and types of vehicles involved in RTC in Dar es Salaam encountered by a cohort of motorcycle taxi drivers previously trained in first aid. Methods: This was a quasi-non-randomized interventional study, cohort subtype, with three-month follow-up. Some 186 motorcycle taxi drivers were selected by convenience sampling from 16 heavily populated, central wards and trained in a basic hemorrhage control course. Participants reported the location and types of vehicles involved in RTCs they encountered and intervened upon through performing bleeding control interventions. Surveys were designed on KoboToolbox and administered via phone call at monthly intervals over a three-month period. The main outcome measures were the location of crash encounters and types of vehicles involved. Results: In all 62 unique participants (33.3 %) encountered and provided bleeding control interventions to 83 injured individuals following 69 RTC in at least 31 distinct city wards, despite training only having occurred in 16 wards. Eight crash locations were not recorded. Crashes in distant wards typically contained major roads. Most commonly, crashes involved a motorcycle without the involvement of another vehicle (n=20), followed by motorcycle vs. car/three-wheeled vehicle (n=15), motorcycle vs. bus/van (n=10), motorcycle vs. motorcycle (n=9), motorcycle vs. pedestrian (n=7), pedestrian vs. bus/van (n=2), pedestrian vs. car/three-wheeled vehicle (n=1), motorcycle vs. bicycle (n=1), multi vehicle (n=1), and other (n=3). Conclusions: Motorcycle taxi drivers trained in hemorrhage control frequently encounter and intervene upon RTC in wards where they are based as well as in distant locations, commonly in wards containing major roads. Expanding first aid training for motorcycle taxi drivers could improve timely access to emergency care for RTC victims. Since most crashes involved motorcycles, road safety training should be integrated into future courses.

Evaluating the Impact of a Shared Decision-making Intervention for Patients with Renal Cell Carcinoma: The SDM-RCC Study Protocol.

The aim of the SDM-RCC study is to evaluate the impact of a comprehensive shared decision-making (SDM) intervention for patients with renal cell carcinoma (RCC) on the decision-making process and outcomes. The intervention includes online patient decision aids (PtDAs) and training of health care professionals (HCPs) in the use of PtDAs and SDM. The study is a multicenter, prospective pretest-posttest cohort in six Dutch hospitals, focusing on patients with localized or metastatic RCC. The primary outcome is the observed quality of the decision-making process, measured using OPTION-5 scores. Secondary outcomes include perceived quality of the decision-making process, decision quality, and implementation of the intervention (user statistics and interviews). Quantitative analysis will be performed on questionnaire data, while qualitative analysis will be performed on interviews using coding based on established frameworks. The study results could improve understanding of the decision-making process for RCC patients from patient, HCP, and observer perspectives. The SDM tool implemented is expected to support the decision-making process. PATIENT SUMMARY: We are conducting a trial on the effects of a tool to support shared decision-making by patients with kidney cancer who are facing treatment decisions. This paper outlines the protocol that will be used for the trial.