Respiratory syncytial virus (RSV) is highly prevalent as a cause of acute respiratory tract infection. Detection of RSV using nucleic acid amplification tests provides rapid results that can help physicians manage patients with acute respiratory symptoms and avoid unnecessary antibiotics. This study aimed to report the positivity rate of RSV among patients with acute respiratory symptoms.

Nasopharyngeal swab specimens were obtained from primary healthcare facilities and hospital outpatient clinics from January 2023 to June 2024. The specimens were processed using the multiplex QIAStat-Dx Respiratory SARS-CoV-2 Panel (QIAGEN GmbH, Hilden, Germany).

A total of 1339 tests were performed and RSV was positive in 10.3% of tested patients (138/1339). Regarding the monthly positivity rate, the highest rate of RSV positivity was in November 2023, followed by January 2023, and March 2023.

This study shows a moderate RSV positivity rate in outpatient settings and suggests a seasonal trend, with higher circulation during the rainy season. These findings highlight the value of RSV surveillance for guiding clinical and public health responses in tropical regions.

Adults with major lower limb amputation (LLA) due to dysvascular etiology often experience diverse health outcomes. However, the absence of standardized outcome reporting limits the ability to synthesize evidence, evaluate care models, and develop consistent clinical pathways. This review updates a systematic review on outcome measures and indicators reported in this population.

A systematic review update was conducted across six databases (MEDLINE, EMBASE, EBM Reviews, PsycINFO, Web of Science, and CINAHL) from 20 April 2017 to 1 December 2022. All study designs were eligible; however, the articles needed to report outcome measures and indicators on at least 50% of the adult population with major dysvascular LLAs. The extracted outcome measures and indicators were organized according to Dodd's framework and then reclassified alongside those reported in the study by Ambler and colleagues. The pilot phase of data extraction was carried out independently by multiple reviewers, after which a single reviewer completed the data extraction.

Of the 12,557 articles, 160 studies reporting data on 228,116 individuals with major dysvascular LLA met the inclusion criteria. Combining these with the 440 studies from the previous review, 2,466 outcome measures and indicators were categorized in five core areas: life impact (25.7%), physiological/clinical (23.4%), death (18.7%), resource use (17.6%), and adverse events (14.6%). In terms of the outcome domains, mortality/survival was the most commonly reported domain, followed by physical functioning (e.g. prosthesis fit, use), skin (e.g., stump wound healing), nervous system outcomes (e.g., residual limb pain), need for further interventions (e.g., prescription of medications), hospital outcomes (e.g., duration of stay, discharge), and adverse events.

This study builds on a previous review by identifying and categorizing outcome measures and indicators in adults with major dysvascular LLA, highlighting inconsistencies in outcome reporting across studies. The absence of a standardized set of outcome measures and indicators limits the ability to conduct meta-analyses or systematic reviews, evaluate the effectiveness of care models, and establish clinical pathways. Developing a core outcome set tailored to the needs of individuals with dysvascular LLA could help address these challenges by promoting consistency in outcome reporting and enabling meaningful comparisons across studies. Ultimately, this could contribute to improving the quality, efficiency, and person-centeredness of care.

PROSPERO (CRD42023388570).

The relationship between alcohol consumption and the incidence of myocardial infarction (MI), stroke and all-cause mortality exhibits significant regional variation.

This prospective study aimed to investigate this association analyzing data from a cohort of Swedish men aged 45-50 years at baseline, evaluating subgroups over various time intervals, and compiling data on cardiovascular endpoints.

The Coeur study, conducted between 1993 and 1995, included 973 middle-aged male employees out of a randomly selected sample of 1144 individuals from a Swedish automotive company. Participants were followed for 30 years using national health registers. The accumulated incidence of first-time stroke, first-time MI and all-cause mortality was calculated and adjusted for cardiovascular risk factors. Data analysis employed time-to-event methods (Kaplan-Meier's estimates and hazard ratios) and measures of association (odds ratios and correlation analysis).

No statistically significant association was observed between alcohol consumption and stroke (p > 0.05). However, alcohol consumption was associated with lower odds of MI (OR = 0.57, 95% CI: 0.41-0.79) and a slight increase in survival time (HR = 0.997, 95% CI: 0.995-1.000). Alcohol consumers had a median survival advantage of 1.3 years compared to non-consumers. All beverage types showed a negative association with all-cause mortality (total alcohol: OR = 0.57; beer: OR = 0.68, 95% CI: 0.50-0.92; wine: OR = 0.55, 95% CI: 0.41-0.75). Conversely, beer consumption was linked to higher odds of MI (OR = 1.70, 95% CI: 1.05-2.75).

While alcohol consumption in middle-aged men after 30 years follow-up is associated with increased survival time, beer correlates with a higher likelihood of MI.

The Seattle Angina Questionnaire (SAQ) is widely used to measure disease-specific health status in coronary artery disease, but its psychometric properties have not been evaluated using multidimensional item response theory (MIRT). We evaluated the SAQ's dimensional structure, measurement precision, differential item functioning (DIF), and short form performance in a population-based cohort.

SAQ responses collected within two weeks of coronary angiography from 6,665 patients in the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry were analyzed using a confirmatory five-factor multidimensional graded response model. Item fit, local dependence, and conditional standard errors were evaluated. DIF by sex and age was examined using a two-step anchored multigroup approach. Short forms were derived based on discrimination, test information, and DIF magnitude.

The confirmatory five-factor model demonstrated good global fit (RMSEA = 0.031, CFI = 0.987, TLI = 0.982), supporting three distinct Physical Limitation dimensions: Basic, Moderate, and Strenuous. Empirical reliability ranged from 0.748 (Basic Physical Limitation) to 0.900 (Moderate Physical Limitation), with precision sufficient for individual-level interpretation in Moderate and Strenuous Physical Limitation. Moderate sex-related DIF was noted on Basic and Moderate Physical Limitation items, with females scoring lower than males. Age-related DIF was negligible to small. The 14-item short form preserved all five factors with theta correlations of 0.964 with the 18-item version.

MIRT revealed three distinct Physical Limitation dimensions, enabling targeted functional monitoring. Precision gradients and sex-related DIF inform interpretation, and the 14-item short form is supported as the preferred version.

Atrial fibrillation (AF), a common arrhythmia, is associated with impaired quality of life and increased stroke risk and mortality. Clinical guidelines recommend leveraging digital technologies to support patient education and AF self-management. Conversational artificial intelligence (AI) technologies may support patient engagement with self-management by enabling human-like conversations. This study aims to evaluate the effectiveness of a conversational AI intervention (Conversational artificial intelligence HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S)) in improving quality of life in patients with AF.

CHAT-AF-S is a 3-month randomised controlled trial with 1:1 allocation and embedded process evaluation. We will randomise 480 adults (aged 18 years and older) with documented AF to the CHAT-AF-S intervention or usual care. Primary outcome is the Atrial Fibrillation Effect on QualiTy-of-life overall score. We will follow the intention-to-treat principles and data analysts will be blinded. Intervention participants will be invited to complete a user experience survey and take part in an interview to explore the feasibility, acceptability, perceived use and barriers and enablers to implementing the intervention. Qualitative data will be analysed thematically.

Ethics approval was obtained from the Western Sydney Local Health District Human Ethics Research Committee (2023/ETH00765). Written and informed consent will be obtained from all study participants before commencing any study procedures. Results will be disseminated via peer-reviewed publications and presentations at international conferences.

Australian New Zealand Clinical Trials Registry (registration number: ACTRN12623000850673).

Lack of diversity in clinical trials reduces the generalizability of treatment efficacy across different demographic groups, thereby diminishing the relevance, quality, and equity of research findings.

This study aimed to evaluate the implementation of 4 recruitment strategies and their impact on clinical trial enrollment through the Trial of Sites to Increase Diversity in Clinical Trials (TOTAL) project, a collaboration between Stanford and Morehouse School of Medicine funded by the American Heart Association.

Clinical trials were randomized to 1 of 3 recruitment strategy intervention arms (community ambassador, social media ads, or registry and patient engagement platforms) or the control arm (usual recruitment). The Stanford Lightning Report, a rapid qualitative approach, was used to gather insights through interviews with principal investigators (PIs) and trial staff at baseline, 3 months, and trial completion.

Trial teams were supportive of increasing diversity and found the recruitment platforms generally user-friendly. External recruitment support was valued, and some trials reported improved access to participants outside their usual pool. Community ambassadors helped connect trials with community and physician networks and, in some cases, increased recruitment of Asian American participants. Registry and patient engagement platforms were easy to use and supported outreach, including direct emails to potential participants. Social media ads, particularly after the transition to BuildClinical (BuildClinical LLC), improved screening efficiency by prescreening candidates and producing a manageable number of eligible leads. Usual recruitment relied mainly on physician referrals and benefited from trusted clinician-patient relationships, but many trials exhausted their typical participant pools. Across strategies, major barriers included limited time, staff capacity, and financial resources; scarcity of diverse local populations; restrictive eligibility criteria; lack of language access; transportation burdens; and limitations of remote engagement. Additional operational barriers included institutional review board (IRB) delays, contract and vendor approval processes, and platform policy restrictions for digital advertising. Feedback from Lightning Reports led to several real-time changes, including a shift from in-house social media outreach to specialized digital recruitment support.

Increasing diversity in clinical trials requires sustained financial, human, and institutional support, as well as effective recruitment strategies. Rapid qualitative feedback can identify implementation problems early and support real-time improvements.

Readmission after chronic or subacute subdural hematoma (cSDH/sSDH) hospitalization is common, yet clinical attention and trial design have focused primarily on surgical recurrence. The full spectrum of readmission events, their clinical impact, and the heterogeneity of the affected patient population remain poorly understood. This study seeks to characterize the incidence, diversity, and outcomes of 90-day readmissions after cSDH/sSDH hospitalization and to identify patient phenotypes with distinct readmission risk profiles using machine learning-driven clustering.

This was a retrospective cohort study using the Nationwide Readmissions Database (2016-2022). Adults nonelectively hospitalized for cSDH/sSDH were included. The main outcome of interest was hospital readmission within 90 days, classified into readmission types. Readmission outcomes included length of stay, cost, in-hospital mortality, functional decline, new disability, and inability to return home. Machine learning-based phenotyping using Shapley Additive Explanations values from a multinomial gradient-boosted model and K-means clustering identified patient subgroups with divergent readmission patterns.

Of 22,387 patients (mean age 70.8 years; 29.6% female), 6,497 (29.0%) were readmitted within 90 days across diverse causes. Surgical SDH recurrence accounted for only 22.5% of readmissions, and fewer than half (44.0%) were primarily SDH-related. Non-SDH readmissions carried substantial clinical impact: infection readmissions had the highest mortality (9.6%), exceeding surgical SDH (2.9%) more than 3-fold, and the highest rate of new disability (45.5%) among patients initially discharged with routine self-care. Machine learning-driven phenotyping analysis identified 5 patient clusters with unique clinical characteristics and diverging readmission patterns: low acuity (39.8%), atrial fibrillation (16.9%), elderly/frail (16.6%), young/healthy (14.5%), and high acuity (12.1%). These phenotypes revealed marked patient heterogeneity, with each cluster exhibiting distinct readmission risk profiles.

Readmissions after cSDH/sSDH are diverse and predominantly nonsurgical, with non-SDH readmissions carrying equal or worse outcomes than surgical recurrence. Machine learning-based phenotyping uncovered substantial patient heterogeneity, highlighting the need for new therapeutic strategies, expanded clinical trial outcome targets beyond surgical recurrence, and comprehensive postdischarge care models tailored to distinct patient subgroups.

Brain natriuretic peptide (BNP) and global longitudinal strain (GLS) are emerging biomarkers used to risk-stratify patients with asymptomatic severe aortic regurgitation (AR) and preserved ejection fraction (EF). Although numerous clinical trials have investigated the efficacy of these biomarkers in patients with aortic stenosis, only a limited number have examined these biomarkers in patients with AR. Therefore, the proposed systematic review and meta-analysis seeks to assess the prognostic value of BNP and/or GLS in patients with severe asymptomatic AR and preserved EF.

This is a protocol for a systematic review and meta-analysis that will aggregate and synthesize high-quality clinical data on the usefulness of BNP and GLS as prognostic indicators for asymptomatic severe AR with preserved EF. By providing a comprehensive review, our study will have a significant impact in determining surgical candidacy in this patient population.

In accordance with the PRISMA-S (Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension), which is an extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting literature searches in systematic reviews, a comprehensive search of databases, including PubMed, Cochrane, and Embase, will be performed to retrieve peer-reviewed, English-language, observational, and experimental studies published from inception to November 2024. Studies that investigated patients aged ≥18 years with severe AR and preserved EF will be included. The National Heart, Lung, and Blood Institute tool will be used to assess the quality of the studies.

Search strategy development for this systematic review began in November 2024. A Peer Review of Electronic Search Strategies review of the search strategy with 2 academic librarians occurred in December 2024, and the final search strategy was finalized by the team of investigators in January 2025. Database queries and screening of studies began in January 2025 with title screening, followed by abstract screening in January and February 2025. Full-text screening took place from February to April 2025. Data extraction occurred between April and May 2025. Synthesis and risk of bias assessment occurred between April and May 2026, followed by data analysis between June and July 2026. Manuscript drafting will begin between June 2026 and July 2026, with manuscript writing and data dissemination continuing from May 2026 to August 2026. Findings will be submitted to a peer-reviewed journal by August 2026.

This systematic review will synthesize the existing evidence to determine the prognostic value of BNP and GLS in patients with asymptomatic severe AR and preserved EF, which could inform future clinical guidelines for the management of this population.

Evidence regarding the optimal timing of rehabilitation after aneurysmal subarachnoid haemorrhage (aSAH) remains limited. In this study, we aimed to evaluate clinical outcomes associated with initiating rehabilitation within 48 h after aneurysm securing.

We conducted a retrospective cohort study emulating a target trial using the Diagnosis Procedure Combination claims database (651 acute-care hospitals), which contains administrative data with limited clinical granularity. We included adults (≥18 years) with aSAH who underwent endovascular coiling or surgical clipping on hospital day 1 and had prestroke mRS scores of 0-2. Early rehabilitation was defined as initiation within 48 h after aneurysm securing; the comparator was initiation after 48 h. Using a clone-censoring-weighting approach, we estimated per-protocol hazard ratios for 30-day mortality and poor functional outcome (mRS scores of 3-6). Sensitivity analyses were conducted using alternative initiation thresholds (72, 96 and 120 h).

Among 7544 patients (mean age, 62.6 years; 69.7% women), crude 30-day mortality was 2.6% in the early initiation group and 1.5% in the deferred initiation group. In the per-protocol analysis, early rehabilitation was associated with higher 30-day mortality (hazard ratio [HR], 1.82; 95% CI, 1.21-2.63) and a higher risk of poor functional outcome (HR, 1.31; 95% CI, 1.08-1.55). This association was attenuated when "early" was defined after 72 h (mortality HR, 1.34; 95% CI, 0.87-2.07).

Initiating rehabilitation within 48 h after aneurysm securing was associated with worse short-term outcomes, whereas deferring initiation until after 72 h attenuated the excess risk.

These findings suggest that the first 48 h may represent a higher-risk window for routine rehabilitation initiation in acute aSAH care.

Of the 3 published trials, only 1 showed possible efficacy of endovascular treatment (EVT) compared to best medical treatment (BMT) alone for medium or distal vessel occlusions (MDVO), whereas the others were neutral. Procedural conditions may affect the outcome.

This is a post-hoc analysis of the randomised, controlled DISTAL trial, conducted in 55 centers between 12/2021 and 7/2024. Patients with isolated MDVO within 24 hours of last seen well randomised to EVT plus BMT were treated under general anaesthesia (GA), conscious sedation (CS) or local anaesthesia (LA) at investigators' discretion. Endovascular treatment under different anaesthesia modalities was compared head-to-head, and to BMT alone.

Among 491 patients included in the analysis, 224 received EVT plus BMT (108 GA, 64 LA, 52 CS) and 267 received BMT alone. Compared to BMT alone, EVT under CS was associated with worse 90-day modified Rankin Scale (median 2.5 vs 2.0; adjusted odds ratio [aOR] 0.51 [95% CI 0.29-0.90]), whereas no difference was observed between EVT under other anaesthesia modalities and BMT alone. Symptomatic intracranial haemorrhage occurred more frequently after EVT under GA compared to BMT alone (8.3% vs 2.6%; aOR 3.37 [95% CI, 1.22-9.66]). LA was associated with higher odds of better functional outcome (aOR 2.11 [95% CI, 1.09-4.12]) and lower mortality (aOR 0.28 [95% CI, 0.08-0.95]) compared to CS, whereas there was no difference to GA.

The lack of superiority of EVT plus BMT over BMT alone in DISTAL may not have been driven by anaesthesia modality.