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Randomized controlled trials (RCTs) are foundational in evidence-based medicine but are often limited by their reliance on controlled conditions and highly selective patient populations, which may not reflect real-world healthcare outcomes. This commentary highlights the value of pragmatic controlled trials (PCTs) as a complementary method for evaluating real-world effectiveness (RWE). By employing Bayesian statistical approaches, PCTs enable comprehensive assessment of healthcare interventions under everyday conditions, bridging the gap between experimental efficacy and practical applicability. A three-dimensional strategy is proposed, addressing efficacy, effectiveness, and value to improve the relevance and generalizability of healthcare research. The commentary also emphasizes the need for endpoint-specific risk profiling to optimize patient outcomes and decision-making. Integrating PCTs into evidence-based medicine provides a robust framework for advancing healthcare efficiency and delivering patient-centered care in diverse populations.

Objectives: The Common Rule, the U.S. Basic Federal Policy for Protection of Human Research Subjects, was revised extensively in 2018 to modernize the regulations by enhancing protections for human research subjects and reducing unnecessary burden and ambiguity for researchers. It was implemented on January 21, 2019. The purpose of this study was to determine whether the revised Common Rule, in fact, enhanced human research subject protections and reduced burdens to researchers.Methods: Analysis of data collected on the performance of human research protection programs from 107-109 Department of Veterans Affairs research facilities between 2016 and 2024 was carried out to evaluate the impact of the revised Common Rule at five and a half years after its implementation.Results: At five and a half years after the implementation of the revised Common Rule, when 77% of all active human research protocols were under the revised Common Rule requirements, there was an increase of 259% in the number of exempt protocols and a reduction of 44% in the number of protocols requiring institutional review board (IRB) continuing reviews. However, analysis of human research subject protection performance metric data during the same period revealed that of the five human research subject protection performance metrics studied, two, i.e., unanticipated, serious, research-related adverse events, and research conducted without IRB approval, remained unchanged, while three, i.e., required informed consent and Health Insurance Portability and Accountability Act authorization not obtained, as well as continued research activities during a lapse in IRB continuing reviews, deteriorated.Conclusions: The revised Common Rule achieved its objective of reducing the burden of low-risk studies to researchers. However, it impaired, instead of enhancing, human research subject protections.

Background: Dementia is a growing public health concern in India, with an increasing prevalence among the elderly population. Early detection is crucial for effective intervention. Primary healthcare (PHC) centres play a vital role in identifying cognitive impairment; however, the effectiveness of cognitive screening tools in these settings is questionable.Objective: This scoping review explores the cognitive screening tools available for dementia detection in PHC centres in India, assesses their effectiveness, and identifies the need for their improvement and adaptation.Methods: A systematic search was conducted in PubMed, Scopus, and Google Scholar for studies published up to October 2024. A total of 29 studies were identified, indicating that tools such as the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are frequently used. However, these tools face significant challenges related to educational background and language comprehension, impacting their effectiveness.Conclusion: There is an urgent need for culturally and linguistically appropriate cognitive screening tools in PHC settings in India to enhance the early detection of dementia.

Background: Continuous renal replacement therapy (CRRT) requires effective anticoagulation to prevent circuit clotting. This study compared heparin and regional citrate anticoagulation (RCA) in an Intensive Care Unit (ICU), focusing on patient safety, cost-effectiveness, and nursing perspectives.Methods: This retrospective observational study included ICU patients undergoing CRRT with heparin (December 2021 - March 2022) and RCA (June 2022 - September 2022). Outcomes assessed were CRRT duration per patient, filter set cost, lifespan, and blood transfusion requirements. Data were extracted from electronic health records and analyzed using IBM SPSS Statistics Version 29.Results: RCA significantly increased CRRT duration per patient (198 vs. 101 hours, p = 0.037) and filter lifespan (67 vs. 24 hours, p < 0.001) compared to heparin. Filter cost per renal day decreased from £98.05 with heparin to £57.48 with RCA (p = 0.04). Blood transfusion requirements reduced from 0.59 to 0.27 transfusions per renal day, lowering daily transfusion costs from £84.96 to £39.58 with RCA.Conclusion: RCA demonstrated clinical and economic benefits in CRRT compared to heparin, including improved filter longevity, reduced transfusion requirements, and overall cost savings.Clinical significance: Implementation of RCA in CRRT can enhance treatment efficacy, reduce nursing interventions, and improve resource utilization in ICU settings.

The healthcare system faces significant challenges rooted in its fee-for-service model, which incentivizes interventions for the sick rather than prioritizing preventive measures, predictive health assessments, and early detection.Resistance to systemic reform results from the complex agendas of stakeholders, including clinicians, hospitals, insurers, policymakers, and technology providers. Patients, the core stakeholders, are rarely involved in shaping their health futures, however.Transitioning to a prevention-based model demands systemic change, emphasizing early stakeholder engagement, evidence-based solutions, training, and fostering innovation.Digital transformation and value-based care are essential to overcoming the "healthcare innovator's dilemma,” but they also require new business models, initial funding, and progress/value metrics to be accepted and adopted. The article discusses that while a health delivery transformation and disruption are needed, a business model for prevention will need to be developed and established in parallel.Investments in preventive technologies promise long-term cost reductions and improved health outcomes; they also require substantial upfront funding, which is unlikely to be provided through private investments without a future business model. To convince individuals and other stakeholders to spend more personal money, the value must be demonstrated and respective metrics developed.The article will also talk about the value of prevention for lower-income health environments and present opportunities in the context of reverse innovation.

Introduction: Schizophrenia is a complex syndrome with numerous risk factors, one of which is the season or month of birth. Therefore, the principal objective of this study was to test the relationship between summer birth and clinical features in schizophrenia.Methodology: Study design: We conducted a cross-sectional analytic study with retrospective data collection. Sample: Were included in this study all the patients having met the DSM-IV criteria for schizophrenia during their first psychotic episode requiring hospital admission spanning from January,1, 2013 to December,31,2022. in the psychiatry department of Fattouma Bourguiba teaching Hospital Monastir, and who kept the same diagnosis of schizophrenia according to their medical files and the follow-ups. Variables and instruments: The recruitment was conducted through the patients’ medical files using a questionnaire including socio-demographic, clinical, and therapeutic characteristics, as well as the month of birth and season of birth for each patient. Data analysis: Data entry and analyses were carried out using the software package IBM SPSS Statistics 25.0. To look for an association between the qualitative variables, we used the chi-square test, and if needed, Fisher’s exact test.Results: Our study included 333 patients with a mean age of 31.6 years. Several clinical features were associated with season of birth. Regarding types of schizophrenia, the paranoid type was significantly associated with the summer season of birth(p=0.005). We also found a significant association between delusional themes like influence theme being significantly associated with the summer birth (p=0.02). As for the mechanisms of delusion only intrapsychic hallucinations had an association with summer birth (p=0.039).Conclusions: The season of birth is one of the most consistently identified risk factors in the epidemiology of schizophrenia, although the underlying causes remain unclear. This underscores the importance of additional research in this field to enhance our understanding of schizophrenia and explore potential preventive measures.

Climate change, the need to save raw materials and energy, the development of information and communication technologies that will enable the automation of construction sites, but also change the administrative management of these sites, etc. All these changes are opportunities to improve working conditions in a sector which, even if significant progress has been made in recent decades, is still too often lagging behind when it comes to occupational risk prevention. As part of an overall forward-looking analysis of changes in the building industry in France over the next 30 years, specific work has been devoted to the question of working conditions and the possibilities for improving them (or avoiding their deterioration). As techniques and professions are bound to evolve, what are the main levers we can use to ensure safer, more fulfilling working conditions?

Child malnutrition remains a significant public health concern in Karamoja, Uganda. This study investigated the prevalence and determinants of simultaneous wasting, stunting, and anaemia (collectively termed WaStAn) among children aged 6-59 months in Karamoja. Secondary data from the Food Security and Nutrition Assessment (FSNA) collected by the World Food Program, UNICEF, and the Uganda Bureau of Statistics in February 2022 were used. The participants included women aged 15-49 years and children aged 0-59 months living with their mothers. The analysis revealed a high prevalence of wasting (13.0%), stunting (41.4%), and anaemia (55.1%), with younger children (12-23 months) disproportionately affected. A worrying 4.6% of children presented with WaStAn, highlighting the need for comprehensive approaches targeting multiple forms of undernutrition. Factors associated with WaStAn included age, sex (males more affected), geographical location, socioeconomic status, maternal education, food consumption score (wasting), and residence type (stunting). The study underscores the urgency for multisectoral interventions addressing these risk factors across various levels. Recommendations include improved screening and treatment, promotion of optimal feeding practices, micronutrient supplementation, deworming, hygiene improvements, women's empowerment, enhanced food security, and strengthened district-level capacity for nutrition management.