B. Braun (Netherlands)

Abstract Background and Aims Patients with chronic kidney disease (CKD) undergoing hemodialysis (HD) experience a significant reduction in muscle mass and strength, which decreases physical and functional capacity increasing morbidity and mortality rates. Although the importance and safety of exercise during maintenance HD are well-documented in the literature, the impact of such programs on the daily workflow of the multidisciplinary healthcare team remains unclear. Objective To evaluate the opinion of a hemodialysis center's healthcare team regarding the implementation of an intradialytic exercise program supported by audiovisual resources. Method A qualitative study was conducted with the healthcare team at the B. Braun Avitum Renal Care Center in Massamagrell, Valencia, Spain. A 12-question questionnaire was used as part of the feasibility study for an audiovisual-supported intradialytic exercise program (GRexID). In this program, patients performed 12 sessions of upper and lower limb exercises guided by a 20-minute video, shown either individually or in groups during HD sessions. After the intervention period, the healthcare team was invited to complete the questionnaire anonymously and virtually. The questionnaire included questions about the importance of implementing exercise programs during HD, perceived benefits, and potential barriers. Additionally, it assessed the team's interest in engaging in an exercise program during their work hours. The questionnaire included open-ended, multiple-choice, and Likert-scale questions (ranging from 1 “strongly disagree” to 5 “strongly agree”). Results A total of 19 professionals (79% women) completed the questionnaire, comprising 21% doctors, 58% nurses, and 21% nursing assistants. The median age of professionals was 38 (18) years and the median time working with CKD patients on HD was 10 (12) years. Regarding program implementation, 89.5% of respondents agreed with its implementation. When asked about the importance of exercise, 42.1% agreed, and 57.9% strongly agreed that patients with CKD on HD should increase their physical activity levels. Additionally, 73.7% agreed that exercise should be performed during HD sessions. The primary benefits identified by the professionals included promoting physical activity (89.4%), maintaining muscle and joint function (84.2%), improving health-related quality of life (78.9%), enhancing cardiovascular function (68.4%), and supporting mental health (63.1%). The main barriers to patient participation in the program were identified as low motivation (78.9%), preexisting health conditions (73.6%), and poor physical conditioning (63.1%). The presence of a physiotherapist (84.2%) and adequate training for both patients (68.4%) and healthcare staff (52.6%) were highlighted as essential resources for the program's success. Regarding the healthcare team, 79% reported experiencing physical pain, particularly lower back pain (68.4%) and neck pain (57.8%), and 57.9% agreed with engaging in an exercise program during working hours to address these health issues. Conclusion The healthcare professionals at a hemodialysis clinic expressed strong support for the implementation of an audiovisual-supported intradialytic exercise program.

This study was conducted to determine the relationship between the anti-Streptolysin O (ASO) titer and patients with history of recurrent tonsillar infection of different age and sex groups. To evaluate the validity of serum ASO in assessing cases of recurrent tonsillar infection. A cross-sectional study done on 50 patients of different ages and sex groups who were clinically diagnosed with recurrent tonsillitis and wishing to undergo a tonsillectomy at Basra Teaching Hospital over a period of 10 months from October 2023 to July 2024. Surface swabs were obtained for cultures. ASO titer was performed to estimate its relation to tonsillar infection. The percentage of patients who had high ASO titer among patients who had positive GABHS cultures is nearly similar to those who had negative cultures. Although ASO titer is used commonly to determine streptococcal infection, it seems that it is not a decent indicator for recurrent tonsillar infections.

ObjectiveStatus epilepticus (SE) represents one of the most common neurological emergencies. The International League Against Epilepsy (ILAE) redefined SE duration thresholds from 30 to 5 min for convulsive SE in 2015. We conducted a prospective population‐based study to determine SE incidence and outcomes under the revised criteria and compared findings with historical data using the 30‐min definition.MethodsA prospective, population‐based cohort study was conducted over a period of 18 months to determine the incidence of SE in Germany, replicating the methodology of a first study conducted in this region in 1999. The study included all adults residing within the 35‐postcode area, with participation from all regional hospitals and emergency departments. SE cases were prospectively identified and reported. To ensure comparability with the historical data, the analysis focused on the Primary Service Area (PS‐Area)—the direct catchment region of the University Hospital Marburg.ResultsA total of 180 adults with SE (96 men, mean age 66.47 years, SD ± 18.5 years, range: 20–94 years). The crude annual incidence in the PS‐Area increased from 15.8/100 000 (95% confidence interval [CI] 11.2–21.6) in 1999 to 29.4/100 000 adults (95% CI 20.5–40.0). It was higher in men than in women (30.9 vs 28.1/100 000, p = .11) and in patients ≥60 years (68.5 vs 13.5/100 000; p < .0001). The calculated age‐ and gender‐adjusted incidence was 32.5/100 000 in the PS‐Area. The case–fatality rate was 5.77% (95% CI 1.2%–12.7%) and the crude annual cause‐specific mortality rate per 100 000 is 1.70 (95% CI 0.21–4.73). In 53% SE was the first seizure episode; only 47% had a history of epilepsy. When extrapolating these findings to the entire German population, there were at least 20 000 cases of SE with 1000 associated deaths annually.SignificanceThese findings provide new epidemiologic evidence that the incidence of SE has increased by ~12% with the adoption of the ILAE 2015 definition, underscoring the impact of updated diagnostic criteria on epidemiological estimates.

Gill Brabner of Resound Learning &amp; Development outlines the damage caused by unresolved conflict in small practice teams and offers evidence-based solutions

Male pattern baldness (MPB) also known as androgenetic alopecia (AA) affects approximately half of men by the fifth decade, and significantly influences both psychological well-being and quality of life. Existing pharmacotherapies include oral finasteride, which reduces dihydrotestosterone (DHT) levels and slows follicular miniaturization, and topical minoxidil, which enhances follicular blood flow and extends the anagen phase. However, adherence to topical regimens can be suboptimal. A combined oral low-dose minoxidil (2.5 mg)-finasteride (1 mg) "All-in-One" regimen could improve convenience, adherence, and possibly efficacy. This retrospective study sought to (i) assess the efficacy of a combined oral minoxidil-finasteride therapy over 12 months in a real-world AA cohort; (ii) determine inter-rater reliability of hair loss scoring metrics; and (iii) examine how baseline Norwood severity influences outcomes and effect sizes. Data were collected from a UK-based digital health service between January 2020 and December 2023. Eligible men, aged ≥18, with Norwood stages 2-7 AA, initiated combined oral therapy. All had baseline and 12-month follow-up images. The primary outcome was the mean change in hair density according to a clinician-rated 7-point scale. A one-sample t-test compared the mean change to zero (no change). Cohen's d and Hedge's g estimated effect sizes, and Cohen's kappa assessed inter-rater reliability. Out of 502 men, 92.4% (N = 464) achieved stable or improved outcomes (≥0), and 57.4% (N = 288) showed marked improvements (>0). The inverse-variance weighted mean 7-point change was 0.58 (95% CI: 0.51-0.65; p<0.001; N = 502), indicating significant improvement relative to no change. More severe baseline categories achieved equal or greater gains, with effect sizes up to d≈1.0. Kappa values were modest (Norwood: κ=0.33; 7-point: κ=0.20), indicating fair to slight agreement. The combined oral minoxidil-finasteride regimen produced statistically significant and clinically meaningful improvements (p<0.001; N = 502) in AA over 12 months. The substantial proportion of stable/improved patients(92.4%, N = 464) and large effect sizes in severe stages highlight its potential. However, modest inter-rater reliability underscores the need for refined protocols or potential AI-driven evaluations. Future prospective trials should confirm these findings and explore optimal dosing, patient selection, and long-term durability.

Regulators play a pivotal role in cybersecurity, tasked with significant responsibilities while facing diverse opportunities and challenges. They are vital in maintaining industry standards, necessitating continuous learning, adaptation, and fruitful business collaboration. Regulation occupies an exceptionally critical role within cybersecurity's intricate and multifaceted realm. As a regulator in the field of cybersecurity, pinpointing key focus areas is not only instrumental for steering practices and sustaining industry standards but also for shaping a robust cybersecurity ecosystem. In the hands of regulators, the Federal Financial Institutions Examination Council work papers are indispensable in ensuring consistent and comprehensive evaluations of cybersecurity practices in businesses. Regulators in the cybersecurity arena are entrusted with developing and maintaining robust communication and interaction strategies with businesses. A key aspect of continuous improvement and adaptation is the regular revision and updating of regulatory guidelines. International collaboration and standards development also offer a strategy for continuous improvement.

Program and project management play pivotal roles in cybersecurity, dictating how security efforts are structured and implemented. Every organization presents a distinct array of cybersecurity challenges, which can originate from several fronts. The domain of cybersecurity primarily focuses on the implementation and maintenance of robust protective measures designed to safeguard both physical and digital assets. Network security enhancements are critical to improving an organization's resilience against cyber threats. Within cybersecurity, a communication plan is pivotal to ensure all stakeholders, including team members, senior management, customers, and more, are duly informed about the project's progress, imminent risks, and other pertinent details. A project manager in cybersecurity often acts as the liaison between the technical team and nontechnical stakeholders. Program and project management is the backbone that provides structure to cybersecurity initiatives. A wealth of knowledge can be found in cybersecurity and project management publications.

The Federal Financial Institutions Examination Council (FFIEC) is a government interagency body that sets the tone for cybersecurity within financial institutions across the United States. The FFIEC has a significant role in cybersecurity for financial institutions. The Office of the Comptroller of the Currency, a central entity in the regulatory framework of financial cybersecurity, is an independent bureau within the US Department of the Treasury. The Board of Governors of the Federal Reserve System, also known as the Federal Reserve Board, plays a significant role in the governance of US financial institutions. The Federal Deposit Insurance Corporation has played a substantial role in addressing cybersecurity risks by introducing a cybersecurity framework to protect consumers and the integrity of financial systems. The Securities and Exchange Commission is an independent federal government regulatory agency responsible for protecting investors, maintaining fair and orderly functioning of the securities markets, and facilitating capital formation.

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