Background: Shared decision-making (SDM) is a collaborative process that integrates patients' values and preferences into health care decisions. In intensive care units, patients who are critically ill often lack the capacity to make decisions, necessitating surrogates to make complex choices regarding life-sustaining treatments (LSTs).
Objective: This scoping review aims to assess the range of research conducted on surrogate SDM for LSTs among patients who are critically ill over the past decade and highlight areas where current research remains limited.
Methods: This scoping review will follow the Joanna Briggs Institute methodology and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Studies will be included if they examine SDM involving surrogates of adult patients who are critically ill in relation to LST decisions within intensive care unit settings. SDM is defined using 4 criteria: participation of both health care professionals and surrogates, mutual information sharing, consensus building, and agreement on treatment based on the patient's values and preferences. A comprehensive search will be performed across PubMed, CINAHL, PsycInfo, CENTRAL, and Ichushi-Web for English- and Japanese-language studies published between 2016 and 2025. Eligible study designs will include quantitative, qualitative, and mixed methods research. Title and abstract screening, as well as full-text selection, will be conducted independently by 2 reviewers using Rayyan. Data will be extracted on study characteristics, SDM definitions, participant roles, and key findings. Results will be synthesized descriptively and presented in tables and narrative summaries to identify research gaps and inform future investigations.
Results: As of June 13, 2025, the literature search has been completed. A total of 2899 citations were identified through the specified database searches, and 527 (18.2%) duplicates were removed. Title and abstract screening are currently in progress, and full-text review is expected to be completed by September 2025.
Conclusions: This scoping review will systematically map recent evidence on surrogate SDM in the context of LST decisions for patients who are critically ill. By synthesizing diverse studies, it will identify challenges faced by surrogates and summarize existing interventions that aim to improve SDM processes. The findings are expected to inform future interventions and policies and advance patient- and family-centered care in critical care settings.
Background: Conventional amblyopia treatment involves the occlusion of the fellow eye using an eye patch. However, this approach imposes a substantial psychological and physical burden on pediatric patients with amblyopia, resulting in low adherence and suboptimal visual outcomes. As responsiveness to therapy declines beyond early childhood, treatments that can enhance adherence and improve efficacy are needed. We developed a virtual reality dichoptic training app (VR app) that integrates gamification and hand-eye coordination training in pediatric patients with amblyopia.
Objective: This study investigated the effect of a VR app on visual acuity improvement in pediatric patients with amblyopia compared with conventional occlusion therapy using an eye patch.
Methods: This is a multicenter, open-label, prospective, randomized controlled trial that will be conducted at 3 centers in Tokyo, Japan. Pediatric patients aged 3-10 years with anisometropic, strabismic, or refractive amblyopia will be enrolled. Participants will be assigned 1:1 to a VR app group or a control group. The VR app group will use the VR app at home for 1 hour per day for 6 months. The control group will undergo conventional occlusion therapy with an eye patch for 6 months. Each group will comprise 15 participants (30 participants in total). Ophthalmologic examinations will be performed at baseline and at weeks 4, 8, 12, 16, 20, and 24. The primary endpoint will be the change in the best-corrected visual acuity in the amblyopic eye from baseline to week 12. Secondary endpoints will include changes in best-corrected visual acuity, stereopsis, and ocular deviation through week 24. We will also assess treatment adherence, defined as the ratio of the cumulative actual treatment time to the cumulative prescribed time; record adverse events, and evaluate usability in the VR app group. Longitudinal changes in outcome measures will be analyzed using a mixed-effects model.
Results: Participant enrollment will start from January 1, 2026, to September 30, 2026. The data analysis will begin on October 1, 2026, and the results will be reported by March 31, 2027.
Conclusions: This study will clarify the effectiveness of the newly developed VR app in improving treatment outcomes and adherence among pediatric patients with amblyopia. By addressing the limitations of conventional occlusion therapy and providing a potentially more efficacious and acceptable treatment option, the VR app may enhance clinical outcomes and represent a paradigm shift in the treatment of pediatric amblyopia.
Background: Alcohol-induced blackouts (AIBs) are a serious consequence of alcohol use that are strongly associated with experiencing excess alcohol-related harms. AIBs are common and recurrent among young adults who drink. The risk factors for AIBs include dynamics of alcohol use (quantity, speed, duration), alcohol-related behaviors (eg, playing drinking games, not using protective behavioral strategies), and factors related to the subjective experience of alcohol intoxication (eg, expectancies, motivations).
Objective: This study seeks to examine 2 modifiable behaviors that have been shown to impact both alcohol consumption and subjective experiences of intoxication and may therefore be associated with AIB risk: (1) other substance use and (2) sleep.
Methods: Approximately 50 participants will be recruited to participate in this study. Interested individuals will complete an online screening assessment, and those who are eligible (young adults who report recent heavy episodic drinking and AIBs) will be invited to an in-person baseline visit. At the baseline visit, participants will complete a baseline assessment, be fitted with a wrist-worn alcohol sensor (BACtrack Skyn) and a sleep or activity ring sensor (Oura ring), and receive training on the study protocol. Participants will complete a 14-day intensive data collection period consisting of twice daily scheduled mobile surveys and participant-initiated drinking surveys with hourly follow-ups. Participants will also wear the alcohol and sleep or activity sensors continuously during this 14-day period. After the intensive data collection period ends, participants will complete an in-person return visit to return their sensors, complete a follow-up survey, and receive compensation. The data will be processed and cleaned, and analyses will include multi-level structural equation models.
Results: This study was funded in July 2025. Data collection is projected to span January 2026 through June 2026.
Conclusions: This study seeks to understand 2 key modifiable behaviors that may be associated with increased AIB risk by leveraging multiple forms of innovative measurement. The integration of ecological momentary assessments with 2 sensors to capture alcohol use and sleep also supports potential applications in future digital interventions. This study will further enhance our preliminary data on the feasibility and acceptability of these methods, providing opportunities for conducting future research on a larger scale.
Background: More than 20 million individuals worldwide, especially in the Vidarbha region of India, are affected by sickle cell anemia (SCA), a hereditary condition that results in aberrant hemoglobin S and red blood cell distortion. The condition leads to anemia, organ complications, and recurrent pain crises, making region-specific data necessary for efficient therapy and public health initiatives.
Objective: The goal of the study is to examine the clinical characteristics and unusual manifestations of SCA in the Vidarbha region, with an emphasis on dietary practices, clinical presentations, demographic distribution, and lifestyle factors such as alcohol consumption and smoking.
Methods: This observational cross-sectional study with random sampling will be conducted at Acharya Vinoba Bhave Rural Hospital in Wardha for 3 months. We will recruit 131 individuals aged 18 to 50 years with dominant hemoglobin S and a positive sickling test. A standardized questionnaire addressing clinical symptoms, nutrition, substance use, inheritance patterns, and demographic information will be used to gather data. SPSS (version 17; IBM Corp) will be used for statistical analysis. Data will be summarized using descriptive statistics. Group differences will be evaluated using inferential tests such as 1-way ANOVA, independent 2-tailed t tests, and chi-square tests. Associations between symptoms and lifestyle variables will be investigated by correlation analysis. Statistical significance is defined as a 2-tailed P value <.05.
Results: The anticipated findings may support the need for targeted regional public health initiatives and underscore the importance of comprehensive screening, detailed patient history, and tailored care strategies for individuals with SCA. As of January 2026, this observational study has not received external funding. Participant recruitment and data collection commenced in January 2026 and are currently ongoing. Data analysis will be undertaken following completion of data collection, and the final results are expected to be submitted for publication in April 2026.
Conclusions: The findings will support the need for focused regional public health initiatives and emphasize the need for thorough screening, patient history, and customized care techniques for SCA.
Background: Cisplatin-induced nephrotoxicity (CIN) is a major dose-limiting adverse event that can lead to both acute and chronic kidney injury. The formation of thiol-cisplatin conjugates within renal tubular cells has been implicated as a key mechanism underlying CIN. Flopropione is an inhibitor of cysteine conjugate β-lyase 1, an enzyme that catalyzes the formation of the thiol-cisplatin conjugate, which might prevent CIN.
Objective: We designed a clinical trial to evaluate the safety of flopropione in patients receiving cisplatin-based chemotherapy and explore its efficacy in preventing CIN.
Methods: This is a phase I/IIa, single-center, randomized, open-label trial conducted in patients undergoing cisplatin therapy. Participants are randomized at a 5:2 ratio per cohort to receive either flopropione or no treatment. On the day of cisplatin administration, the flopropione group receives oral flopropione twice daily (80 mg in Cohort 1, 160 mg in Cohort 2, and 240 mg in Cohort 3). On the following day, all cohorts receive three doses of 80 mg of oral flopropione. A step-up dose escalation design is adopted, progressing from Cohort 1 to 3 after confirming safety at each level. The primary endpoint is the safety of flopropione use in combination with cisplatin; the secondary endpoints include changes in the levels of urinary biomarkers of nephrotoxicity, such as neutrophil gelatinase-associated lipocalin, liver-type fatty acid-binding protein, and kidney injury molecule-1. Blood and urine samples are collected within 48 h before cisplatin administration and at 24 h, 48 h, and 1 week after its initiation for safety and efficacy assessments.
Results: The first participant was registered in July 2024. As of the date of manuscript submission in November 2025, participant registration is ongoing. The final participant will complete the study by March 2026. Publication of results is expected by March 2027.
Conclusions: This study is expected to contribute to advances in preventive strategies for CIN by providing evidence that inhibition of cysteine conjugate β-lyase 1 by flopropione may attenuate CIN.
Clinicaltrial: Japan Registry of Clinical Trials jRCTs041220021; https://jrct.mhlw.go.jp/en-latest-detail/jRCTs041220021.
Background: Several factors come into consideration when medical students choose their future specialty. Among these factors, the desire to start a family and planning the best timing for pregnancy may interfere with career advancement in certain specialties.
Objective: To the best of our knowledge, this is the first scoping review aimed at understanding medical students' career choice and parental expectations without restriction of the specialty chosen. This protocol describes a scoping review aiming to understand how representations regarding specialties and parenthood influence medical students' career choice., This protocol describes a scoping review aiming to understand how representations regarding specialties and parenthood influence medical students' career choice.
Methods: We will search PubMed, Embase, Web of Science, ERIC, and PsycInfo for literature. Additionally, the reference lists of included articles will be screened for further inclusion. Rayyan and Endnote will be used to organize data screening and extraction. The database selection will allow us to extract and analyze data from various disciplines. This diversity will increase our understanding of medical students' career and personal life decisions. This protocol and the upcoming scoping review have been designed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines to ensure the quality of the searching process, the data screening, and the data extraction.
Results: This study will conduct a thematic synthesis of how the concepts of representations and perceptions of parenthood are used by medical students in the selected literature, comparing them to theoretical frameworks to clarify their meanings. We also plan to identify key themes related to parenthood and medical specialty choice when planning a career. As of December 2025, we proceeded to data screening. We anticipate publishing our results in the second quarter of 2026.
Conclusions: This scoping review aims to better understand medical students' representations of medical specialties and parenthood, and how these perceptions influence their specialty preferences and career choices. By mapping existing evidence across various disciplines, the review will identify research gaps and provide a foundation for future studies. The findings will offer valuable insights into the challenges of balancing career aspirations and family life, particularly in the context of physician shortages and the growing feminization of the medical profession.
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