Embolization of the middle meningeal artery (EMMA) is an emerging neuroendovascular therapy for chronic subdural hematoma (CSDH). Recently, three landmark randomized trials (MAGIC-MT, EMBOLISE, STEM) were published. We performed a systematic review and meta-analysis of randomized trials for EMMA.

The authors systematically searched MEDLINE, EMBASE, Cochrane and ClinicalTrials.gov (National Library of Medicine) through March 6, 2025. Prospective randomized controlled trials comparing EMMA and standard care versus standard care alone were included. Primary (symptomatic recurrence, symptomatic progression, major adverse event, neurological deterioration, stroke, myocardial infarction and/or death) and secondary endpoints (serious adverse events, stroke, death from any cause and death from neurological causes) were analyzed. The review was registered on PROSPERO (CRD42024512049).

Four randomized trials (Lam et al., MAGIC-MT, EMBOLISE, STEM) were meta-analyzed. A total of 1468 patients were included. The primary endpoint was met in 50 patients (7.5%) in the EMMA group compared to 106 patients (15.5%) in the control group (RR 0.49 [95% CI, 0.36–0.67]; P < 0.001, I2 = 0.0%), with a number needed to treat of 13. There was no difference in serious adverse events (RR 0.88 [95% CI 0.68–1.13]; P = 0.31, I2 = 50.2%), stroke (RR 1.51 [95% CI 0.46–5.01]; P = 0.50, I2 = 0.0%), death from any cause (RR 1.03 [95% CI 0.37–2.85]; P = 0.95, I2 = 58.1%) or death from neurological causes (RR 1.29 [95% CI 0.53–3.09]; P = 0.58, I2 = 25.4%).

EMMA is effective in reducing symptomatic recurrence, progression and/or reoperation among patients with CSDH and is not associated with a greater incidence of serious adverse events, stroke or death.

While various delivery formats of cognitive–behavioural therapy (CBT) for obsessive–compulsive disorder (OCD) are available, comprehensive evidence on their comparative effectiveness and acceptability is lacking.

To examine the comparative effectiveness and acceptability of different CBT delivery formats for OCD.

An existing database of psychological interventions for OCD was utilised, with randomised controlled trials (RCTs) comparing CBT delivery formats with each other/control groups were included. Pairwise and network meta-analyses were conducted using a random-effects model. Comparative standard mean differences (SMDs) were calculated for effectiveness in reducing OCD symptom severity post-treatment. Relative risks were calculated for acceptability (conceptualised as any cause discontinuation in the acute treatment phase).

A total of 61 RCTs involving 3710 patients with OCD were included. All CBT treatment formats were significantly more effective than control groups (SMDs: −0.39 to −1.66). No significant differences were found among individual, remote-delivery, guided self-help, time-intensive and family-involved formats. However, individual, remote-delivery and family-involved formats were more effective than group (SMDs, −0.38 to −0.60), and most treatment formats were more effective than unguided self-help (SMDs, −0.58 to −0.80). Regarding acceptability, most CBT formats showed no significant differences among themselves, although they were generally more acceptable (relative risks: 1.11–1.18) than unguided self-help.

Most CBT delivery formats serve as potential alternatives to conventional individual CBT. Unguided self-help has lower but still moderate effects in reducing OCD symptom severity, and it holds important potential for assisting a larger number of individuals with OCD who face barriers to accessing treatments.

Respiratory virus transmission in healthcare settings is not well understood. To investigate the transmission dynamics of common healthcare-associated respiratory virus infections, we performed retrospective whole genome sequencing (WGS) surveillance at three teaching hospitals.

From January 2, 2018, to January 4, 2020, nasal swab specimens positive for rhinovirus, influenza virus, human metapneumovirus (HMPV), or respiratory syncytial virus (RSV) from patients hospitalized for ≥3 days were sequenced. High-quality genomes were assessed for genetic relatedness using ≤3 single nucleotide polymorphisms (SNPs) as a cutoff, except for rhinovirus (≤10 SNPs). Patient health records were reviewed for genetically related clusters to identify epidemiological connections.

We collected 436 viral specimens from 359 patients: rhinovirus (n = 291), influenza virus (n = 50), RSV (n = 48), and HMPV (n = 47). Of these, 42%% (152/359 patients) were from a pediatric hospital, and 58% were from adult hospitals. WGS was performed on 61.2% (178/291) rhinovirus, 78% (39/50) influenza virus, 90% (43/48) RSV, and all HMPV specimens. Among high-quality genomes, we identified 14 genetically related clusters involving 36 patients (range: 2–5 patients per cluster). We identified common epidemiological links for 53% (19/36) of clustered patients; 63% (12/19) of patients had same-unit stays, 26% (5/19) had overlapping hospital stays, and 11% (2/19) shared common providers. On average, genetically related clusters spanned 16 days (range: 0 − 55 days).

WGS offered new insights into respiratory virus transmission dynamics. These advancements could potentially improve infection prevention and control strategies, leading to enhanced patient safety and healthcare outcomes.

To assess preparedness for Candida auris in Canadian hospitals.

Cross-sectional survey.

Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.

In June 2024, surveys were e-mailed to the infection prevention and control departments of 109 CNISP hospitals and their 33 microbiology laboratories. The surveys assessed policies for patient screening/management and laboratory processes supporting C. auris transmission prevention. Results were compared to a similar 2018 survey.

All 109 hospitals and 32/33 laboratories responded. Most hospitals had policies for admission screening (80%, 87/109) and policies/defined plans for post-exposure screening (95%, 104/109). Policy presence increased from 18% to 73% in 56 hospitals completing both 2018 and 2024 surveys (P < 0.001). Among hospitals with admission screening policies, 69% (60/87) screened for recent out-of-country hospitalization. All but one hospital implemented transmission-based precautions for cases; 70% (76/109) continued precautions indefinitely. Overall, 94% (99/105; excluding hospitals with exclusively private rooms) and 55% (60/109) of hospitals screened roommates and wardmates, respectively. Frequency and timing of screening and policies regarding precautions for exposed patients varied. All hospitals used axilla and groin swabs, at minimum, for screening. Most (81%, 26/32) laboratories identified all clinically significant Candida isolates to species level, increasing from 48% to 85% (P < 0.001) in the 27 laboratories completing both 2018 and 2024 surveys. Twenty-four laboratories (75%) had standard operating procedures for processing screening specimens; 96% (23/24) used direct plating onto chromogenic agar.

Despite progress in C. auris preparedness, areas for improvement remain. Variability in practice may be related to evidence gaps and resource constraints.

Significant changes in Taiwan’s psychiatric services over recent decades include expansion of community-based clinics and implementation of the Schizophrenia Pay-for-Performance programme.

This study aimed to assess the trend of the quality of healthcare for individuals with schizophrenia, using various indicators of the treatment process and outcomes between 2010 and 2019.

Individuals with schizophrenia were identified using Taiwan’s National Health Insurance claims database. The quality of healthcare for individuals with schizophrenia was assessed using treatment process and outcome indicators, including antipsychotic types, medication adherence, daily dose for antipsychotics and concurrent use of other psychotropic agents. Outcome indicators included all-cause mortality, suicide deaths, psychiatric hospitalisation, emergency department visits and employment status.

Antipsychotic medication usage has shifted towards second-generation antipsychotics (SGAs) and long-acting injectable antipsychotics (LAIs), with declines in first-generation antipsychotics. The percentage of medication adherence declined, while that of individuals with an adequate daily dose increased. Concurrently, anticholinergic and benzodiazepine use decreased while antidepressant and mood stabiliser use increased. Outcome indicators showed no significant change in all-cause mortality or suicide rates over time, but there were reductions in psychiatric hospitalisations and emergency department visits. Employment rates increased overall, particularly in urban areas.

The quality of healthcare for individuals with schizophrenia, as measured by treatment process and outcome indicators, improved alongside changes in Taiwan’s psychiatric services; however, causality cannot be inferred from our findings. Future research should evaluate the effectiveness of psychiatric service policies and continuously monitor healthcare quality to further enhance the lives of individuals with schizophrenia.

Non-ventilator hospital-acquired pneumonia (NV-HAP) is common and deadly. Guidelines recommend improving oral care and mobility performance to prevent NV-HAP but data on their impact are limited. We therefore evaluated associations between oral care and mobility performance with NV-HAP and mortality rates in a large hospital network.

Retrospective cohort study

144 acute care hospitals

Adults hospitalized for ≥4 days between May 2021 and July 2023

We extracted daily data on oral care performance (yes, no) and patient mobility (bed-bound, upright, walking) and used time-varying Cox proportional hazards models to evaluate associations between oral care and mobility performance with NV-HAP and in-hospital mortality risk, adjusting for patients’ demographics, comorbidities, hospital service, daily vital signs, and daily laboratory measures.

Among 1,744,811 hospitalizations (9.6 million hospital-days), median patient age was 68 (IQR 55–78) and 50.6% were female. Persistent oral care for ≥3 days was associated with 16% less NV-HAP (hazard ratio (HR) 0.84; 95% CI: 0.82–0.86) and 6% lower mortality (HR 0.94; 95% CI: 0.92–0.96), with stronger effects in the ICU than outside the ICU. Persistent walking for ≥3 days was associated with 18% less NV-HAP (HR 0.82; 95% CI: 0.79–0.85) and 80% lower hospital-mortality (HR 0.20; 95% CI: 0.19–0.21), with stronger effects outside the ICU than in the ICU.

In a large hospital network, both oral care and mobility were associated with lower risk of NV-HAP and hospital mortality, with differential effects inside and outside of the ICU. Prospective trials are needed to confirm these potential benefits.

Background: Lifestyle factors are linked to differences in brain aging and risk for Alzheimer’s disease, underscored by concepts like ‘cognitive reserve’ and ‘brain maintenance’. The Resilience Index (RI), a composite of 6 factors (cognitive reserve, physical and cognitive activities, social engagement, diet, and mindfulness) provides such a holistic measure.

This study aims to examine the association of RI scores with cognitive function and assess the mediating role of cortical atrophy.

Baseline data from 113 participants (aged 45+, 68% female) from the Healthy Brain Initiative were included. Life course resilience was estimated with the RI, cognitive performance with Cognivue®, and brain health using a machine learning derived Cortical Atrophy Score (CAS). Mediation analysis probed the relationship between RI, cognitive outcomes, and cortical atrophy.

In age and sex adjusted models, the RI was significantly associated with CAS (β= -0.25, p = 0.006) and Cognivue® scores (β= 0.32, p < 0.001). The RI-Cognivue® association was partially mediated by CAS (β= 0.07; 95% CI [0.02, 0.14]).

Findings revealed that the collective effect of early and late-life lifestyle resilience factors on cognition are partially explained by their association with less brain atrophy. These findings underscore the value of comprehensive lifestyle assessments in understanding the risk and progression of cognitive decline and Alzheimer’s disease in an aging population.

R. Ezzeddine: None Declared, D. Oshea: None Declared, S. Camacho: None Declared, L. Besser: None Declared, M. Tolea: None Declared, J. Galvin Employee of: Cognivue (Chief Scientific Officer of Cognivue). Cognivue devices are used for research conducted at the center., C. Galvin: None Declared, L. Wang: None Declared, G. Gibbs: None Declared

Stigma not only influences the willingness to disclose mental health conditions and self-esteem but may also diminish the overall quality of life in individuals with mental illnesses. However, limited research has examined the potential mechanisms underlying this complex relationship.

This study aims to explore the mediating roles of disclosure and self-esteem in the association between mental illness stigma and quality of life.

We utilized the meta-analytic structural equation modeling (MASEM) approach and conducted a comprehensive literature search across various electronic databases to identify relevant publications up to July 2023. MASEM was employed to derive bivariate correlation matrices for stigma, disclosure, self-esteem, and quality of life. Additionally, two simple mediation models and one serial mediation model were tested to examine the relationships between these variables.

The analysis included 181 articles reporting 195 independent samples (N = 33,162) and 278 effect sizes. The single mediator model indicated that self-esteem (β = −0.155, 95% CI [−0.276, −0.070], p < .001), rather than disclosure (β = −0.019, 95% CI [−0.094, 0.031], p > .05), served as a mediator. In the multiple mediator model, disclosure and self-esteem were found to have serial mediating roles between stigma and quality of life (β = −0.016, 95% CI [−0.0546, −0.0003], p < .05).

This study makes a significant contribution to understanding how stigma attitudes impact the quality of life in individuals with mental health problems, providing a strong empirical foundation for the development of mental health interventions. Future research directions and practical implications are also explored.

None Declared

Electronic Health Record (EHR) data are critical for advancing translational research and AI technologies. The ENACT network offers access to structured EHR data across 57 CTSA hubs. However, substantial information is contained in clinical narratives, requiring natural language processing (NLP) for research. The ENACT NLP Working Group was formed to make NLP-derived clinical information accessible and queryable across the network.

We established the ENACT NLP Working Group with 13 sites selected based on criteria including clinical notes access, IT infrastructure, NLP expertise, and institutional support. We divided sites into five focus groups targeting clinical tasks within disease contexts. Each focus group consisted of two development sites and two validation sites. We extended the ENACT ontology to standardize NLP-derived data and conducted multisite evaluations using the Open Health Natural Language Processing (OHNLP) Toolkit.

The working group achieved 100% site retention and deployed NLP infrastructure across all sites. We developed and validated NLP algorithms for rare disease phenotyping, social determinants of health, opioid use disorder, sleep phenotyping, and delirium phenotyping. Performance varied across sites (F1 scores 0.53–0.96), highlighting data heterogeneity impacts. We extended the ENACT common data model and ontology to incorporate NLP-derived data while maintaining Shared Health Research Informatics NEtwork (SHRINE) compatibility.

This demonstrates feasibility of deploying NLP infrastructure across large, federated networks. The focus group approach proved more practical than general-purpose approaches. Key lessons include the challenge of data heterogeneity and importance of collaborative governance. This work also provides a foundation that other networks can build on to implement NLP capabilities for translational research.

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.