Objective To examine how adults with epilepsy in Uganda experienced epilepsy self-management, stigma, and care following participation in a peer-led intervention (SMART-U) compared to enhanced treatment as usual (ETAU). Methods This qualitative study was embedded within an ongoing randomized controlled trial at two university neurology clinics. A purposive subsample from both study arms completed semi-structured interviews at 13 (n = 16) and 24 weeks post-intervention (n = 16). Interviews explored perceived benefits and challenges of care, self-management behaviors, stigma and recommendations for improvement. Transcripts were analyzed using thematic analysis. Results Four themes emerged: barriers to self-management, self-management behaviors and attitudes, participant perspectives on care, and facilitators of self-management. Participants in both groups described significant structural and social barriers, including stigma, limited support, and challenges accessing care. However, SMART-U participants more frequently reported increased confidence, engagement in proactive self-management (e.g., stress management, planning around seizures), improved communication with providers, and greater ability to cope with stigma. In contrast, ETAU participants more often characterized epilepsy care as provider-driven, with fewer changes in attitudes or behaviors. Over time, SMART-U participants demonstrated clearer shifts toward self-efficacy and a more reflective understanding of epilepsy. Conclusions Peer-led self-management support may enhance engagement, coping, and self-efficacy among people with epilepsy in resource-limited settings. Addressing stigma and strengthening social and healthcare support may be critical for improving outcomes in low-middle income countries.
This manuscript reviews the clinical spectrum and management of Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE), examining how chronic venous hypertension leads to multisystem injury. Liver fibrosis is now recognized as an early and nearly universal complication after the Fontan procedure, with cirrhosis affecting approximately 43
Introduction: Despite growing interest in the nature and impact of cognitive disengagement syndrome (CDS), few studies have examined environmental factors associated with CDS such as the possible role of trauma exposure. The current study used a community sample of young adolescents and a multi-informant, multi-method design to examine the association between type of trauma exposure and symptoms of CDS and attention-deficit/hyperactivity disorder (ADHD). Methods: Youth ages 10—12 (N = 341, 52.7
Acute kidney injury is common among critically ill children and independently associated with morbidity and mortality, particularly in those receiving kidney replacement therapy (KRT). As KRT is not innocuous, standardizing its delivery is critical for accurate outcome tracking. Establishing key performance indicators (KPIs) is essential to guide quality improvement and support decision-making through ongoing monitoring of KRT processes. This systematic review evaluated existing evidence on KPIs related to KRT delivery in critically ill pediatric populations. A comprehensive search of Ovid MEDLINE, Ovid Embase, CINAHL, and the Cochrane Library was conducted for studies published from inception to February 2025. Eligible studies reported KPIs related to dialysis processes in critically ill children receiving KRT. Critically ill children receiving all KRT modalities were assessed for KPIs according to the Donabedian framework, with each KPI stratified based on whether it measured a process related to KRT care. Six reviewers independently screened, selected, and appraised studies using the risk-of-bias tool appropriate for each study design. Data were summarized narratively. Of 7,111 citations screened, 107 studies met inclusion criteria, comprising 57 retrospective cohorts, 27 case series, 16 prospective cohorts, 4 case reports, 2 randomized controlled trials, and 1 audit. Most studies (66.7
Pulmonary MRI in neonates can be performed with quality comparable to radial 3D ultrashort echo time (UTE) MRI in significantly less time using a FLORET trajectory. Eighteen NICU patients with severe bronchopulmonary dysplasia (BPD), age 40.9 ± 3.0 weeks at time of imaging, underwent MRI using Radial and FLORET UTE at 1.5 T. Pulmonary signal-to-noise ratio (SNR), lung density, and radiologist scoring of motion artifacts and image quality were compared across sequence types. FLORET UTE reduced scan time by 75
