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BACKGROUND:Psychological trauma, such as witnessing an untimely or gruesome death, commonly provokes intrusive memories that might persist for days to years with adverse effects on individual mental and physical health and functioning. Despite the global prevalence of trauma, scalable evidence-based interventions are absent. Reducing the impact of intrusive memories is crucial for people frequently exposed to trauma, such as health-care workers. This study aimed to determine whether a brief digital imagery-competing task intervention (ICTI) reduced intrusive memory frequency after 4 weeks. Harms were also assessed. METHODS:The GAINS-02 decentralised digital, parallel-group Bayesian adaptive randomised controlled trial tested a brief ICTI against an active control and treatment as usual to determine the effect on reducing intrusive memory frequency. Health-care workers in facilities that admitted patients with COVID-19 during the pandemic, who had experienced one or more traumatic events and reported at least three intrusive memories in the week before screening were randomised 2:2:1 (ICTI to active control to treatment as usual) via block randomisation (web-based). ICTI and active control participants were masked to treatment allocation, and both had one guided session then optional self-use. ICTI involved image-based memory retrieval then Tetris computer gameplay with mental rotation. The active control involved a music-listening task. Study statisticians were masked to ICTI and active control group. The primary outcome was the number of intrusive memories in week 4 (controlling for baseline), which was evaluated on an intention-to-treat basis. Treatment effects for the intervention group versus the comparator groups were assessed using Bayes regression analyses. Harms were assessed through adverse event reporting and interim analyses on primary outcome. People with lived experience were involved from study conception and throughout the research and writing process. The trial was pre-registered at clinicaltrials.gov (NCT05616676) and is completed. FINDINGS:Between Dec 8, 2022, and Sept 15, 2023, 176 participants were screened and 99 included (ICTI n=40, active control n=39, treatment as usual n=20) with mean age 41·2 years (SD 10·2; range 21-62). Of these 99 participants, 85 (86%) self-identified as women and 89 (90%) as White. Bayesian analyses gave robust evidence that ICTI reduced intrusive memories at week 4: ICTI participants reported fewer intrusive memories (median 0·5 [IQR 0·0-5·0]) compared with the active control (active control 5·0 [3·0-11·5]; Bayes factor [BF]active control>ICTI vs active control=ICTI 114·1; βactive control>ICTI 1·29 [95% CrI 0·64-2·00]) and treatment as usual (median 5·0 [IQR 2·5-8·0]; BFtreatment as usual>ICTI vs treatment as usual=ICTI=15·8; βtreatment as usual>ICTI 1·21 [95% CrI 0·49-1·98]) groups. No harms were detected for ICTI relative to the active control and treatment as usual. The most reported adverse event (n=7) was COVID-19. Two adverse events involved burden of diary recording. Serious adverse events were hospitalisations unrelated to study procedures (n=6). INTERPRETATION:This study shows that ICTI reduces intrusive memory frequency and post-traumatic stress disorder symptoms among health-care workers exposed to trauma. As a brief, scalable digital intervention, ICTI shows promise for mitigating consequences of trauma on mental health, an important and unmet need for health-care personnel and systems worldwide. FUNDING:Wellcome Trust, Swedish Research Council, UK Medical Research Council, and National Institute for Health and Care Research.
BACKGROUND:Factor Xa inhibitor-associated major gastrointestinal bleeding is life-threatening and requires rapid anticoagulation reversal. Andexanet alfa, a recombinant factor Xa decoy protein, is approved for reversal but is limited by high cost, restricted availability, and reported thromboembolic risk. Consequently, four-factor prothrombin complex concentrate (4F-PCC) is frequently used in clinical practice, although real-world data remain limited. METHODS:We conducted a single-center retrospective study at Meir Medical Center evaluating patients who received 4F-PCC for reversal of factor Xa inhibitor-associated major gastrointestinal bleeding between August 2016 and May 2025. The primary outcome was 12-hour hemostatic efficacy, assessed using methodology similar to the ANNEXA-4 trial. Safety outcomes included 30-day thromboembolic events and in-hospital mortality. RESULTS:Of 72 screened patients, 62 were included in the final analysis. Median age was 80 years (interquartile range 76-88), and 33 patients (53.2%) were male. Apixaban was the most commonly used factor Xa inhibitor (74.2%). Hemostatic efficacy was achieved in 72.6% (45/62; 95% CI 60.4-82.1), including excellent responses in 51.6% and good responses in 21.0%. Efficacy was 70.2% in upper gastrointestinal bleeding and 80.0% in lower gastrointestinal bleeding (relative risk 1.14, 95% CI 0.83-1.56; P = 0.53). Thromboembolic events occurred in 4 patients (6.5%; 95% CI 2.5-15.4), and in-hospital mortality occurred in 8 patients (12.9%; 95% CI 6.7-23.4). CONCLUSION:Prothrombin complex concentrate achieved 73% hemostatic efficacy in factor Xa inhibitor-associated gastrointestinal bleeding, with low thromboembolic rates and mortality similar to published data, supporting current guideline recommendations for reversal.
This study aimed to investigate the latent profiles of clinical nurse preceptors (CNPs)’ compassion fatigue (CF), identify the influencing factors, and examine their association with work alienation. Between July and August 2025, 340 nurse preceptors from a tertiary grade A general hospital in Zhejiang Province were recruited as participants using convenience sampling. The Chinese version of the Professional Quality of Life Scale Version 5 (ProQOL-5) and the Work Alienation Scale (WAS) were used to assess compassion fatigue and work alienation, respectively. Demographic information was also collected from the participants. Latent Profile Analysis (LPA) was employed to identify potential profiles of compassion fatigue. After screening variables through univariate analysis and multicollinearity tests, multinomial logistic regression was used to assess the influencing factors. Furthermore, a one-way ANOVA was conducted to examine differences in work alienation among different potential profiles, and the results were interpreted based on the job demands-resources (JD-R) model theoretical framework. A total of 320 CNPs were included in the final analysis. The findings of the latent profile analysis indicated that three latent profiles of CNPs’ compassion fatigue were identified: high-satisfaction-low-exhaustion group (n = 56, 17.5%), moderate compassion fatigue group (n = 160, 50%), and severe exhaustion group (n = 104, 32.5%). Multinomial logistic regression analysis showed that age, marital status, education, years of preceptorship, experience, employment type, and professional title were significant predictors of compassion fatigue among CNPs. There were statistically significant differences in the work alienation scores among the three latent profiles (P < 0.001). CNPs’ compassion fatigue can be categorised into three types, with significant heterogeneity observed among them. Notable differences exist in work alienation among CNPs with different compassion fatigue types. These findings suggest that clinical managers and educators should develop targeted interventions and support systems based on these circumstances. Therefore, formulating such management strategies is crucial for alleviating work alienation among CNPs and will help improve nurse retention rates and the quality of clinical education.
Background: Clinical guidelines highlight the challenge of distinguishing CT-negative ultra-early mild acute ischemic stroke (AIS) from transient ischemic attack (TIA) based solely on clinical manifestations. MRI-DWI, the gold standard for differentiation, is often inaccessible in primary hospitals due to cost and time constraints, leading to widespread CT use-with a false-negative rate in mild AIS, risking delayed thrombolysis.This study aims to establish a clinical prediction model for CT-negative ultra-early mild acute ischemic stroke (AIS) by comparing the clinical data and laboratory test results of patients with CT-negative early mild ischemic stroke and transient ischemic attack (TIA), in order to promote early diagnosis and early treatment of AIS, thereby improving patient prognosis. Methods: This study compared and analyzed the clinical data of gender, age, history of hypertension, history of diabetes, National Institutes of Health Stroke Scale (NIHSS) score, and laboratory test results such as homocysteine, neutrophil count, lymphocyte count, monocyte count, platelet count (PLT), C-reactive protein (CRP), fibrinogen (FIG), D-dimer, Random Blood glucose (GIU), total cholesterol (TCHO), triglycerides (TG), high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol (LDL), neutrophil count, lymphocyte count, and platelet count to calculate the neutrophil to lymphocyte ratio(NLR) and platelet to lymphocyte ratio (PLR) in CT-negative ultra-early mild AIS and TIA patients, variables showing significant differences in difference analysis were included in a multivariate logistic regression model to identify independent predictors of AIS,and the independent predictors were used to established a clinical prediction model for the diagnosis of early AIS with negative CT based on the statistical results. Results: Multivariate analysis revealed that the NIHSS score, C-reactive protein (CRP), random blood glucose (GLU), total cholesterol (TCHO), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) are independent predictors of computed tomography (CT)-negative mild acute ischemic stroke (AIS), with odds ratios (ORs) and 95% confidence intervals (CIs) as follows: NIHSS score (OR = 5.497, 95% CI: 3.599- 8.395; p < 0.001), CRP (OR = 1.128, 95% CI: 1.005- 1.295; p = 0.038), random blood glucose (OR = 1.103, 95% CI: 1.013- 1.268; p = 0.043), total cholesterol (OR = 1.626, 95% CI: 1.022- 2.931; p = 0.023), triglycerides (OR = 1.337, 95% CI: 1.025- 1.721; p = 0.031), and LDL-C (OR = 1.542, 95% CI: 1.142- 1.959; p = 0.025). A clinical prediction model that included these factors showed a strong ability to discriminate between outcomes, achieving area under the curve (AUC) values of 0.830 in the training set and 0.804 in the validation set. Additionally, the model demonstrated good calibration and clinical utility across various threshold probabilities, indicating its effectiveness in practical applications. Conclusion: Our study demonstrated that The developed clinical prediction model can assist in diagnosing CT-negative ultra-early mild AIS, thereby potentially improving patient outcomes through timely intervention.
Purpose:Primary amoebic meningoencephalitis (PAM) is a rapidly fatal infection caused by Naegleria fowleri (N. fowleri) with a mortality rate exceeding 95%. This study presented the clinical course, diagnosis, treatment, and outcome of a confirmed PAM case in an adult female. Additionally, we analyzed the epidemiology of PAM in China and review the therapeutic regimens of surviving cases worldwide, aiming to enhance disease awareness and improve clinical outcomes. Case Presentation:The patient was a 50-year-old immunocompetent woman with a history of hot spring bathing before symptom onset, which was not initially disclosed. Moreover, her early infectious symptoms, particularly fever following a tick bite in an orchard, directed clinical suspicion toward tick-borne disease. Four days later, she was hospitalized with generalized convulsions and coma. Clinical examination suggested a bacterial intracranial infection, and treatment with meropenem and vancomycin was initiated. However, her condition deteriorated rapidly. The presence of N. fowleri was identified by cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) and smear. The etiology was clarified only after retrospective confirmation of hot spring contact, which was later confirmed by blood mNGS. Despite intensive therapy with amphotericin B (AmB), the patient unfortunately died. To provide insights into PAM management in China, we also conducted a systematic analysis of 15 domestic cases and 18 global survivors. Conclusion:PAM is characterized by rapid progression, underscoring the importance of early diagnosis. In cases of rapidly advancing meningoencephalitis, clinicians should maintain a high index of suspicion for rare pathogens such as N. fowleri, with thorough and repeated assessment of recent environmental exposures such as hot spring immersion or freshwater swimming. Early application of mNGS is essential for timely pathogen identification. While AmB remains the first-line therapy, its dosing and duration should be tailored to individual patient factors, and combination therapy should be considered to enhance efficacy. Overall, improved clinical vigilance, advanced pathogen diagnostics, and standardized anti-amoebic therapy form the cornerstone of enhancing outcomes in PAM. As the first documented PAM case in Shandong Province, China, this report highlights the need for heightened awareness in coastal regions while contributing valuable epidemiological insights into this devastating disease.
