In recent years, multiple clinical and translational studies have investigated the application and mechanisms of transcutaneous auricular vagus nerve stimulation (taVNS) in gastrointestinal disorders (GIDs), with consideration given to pathophysiology, stimulation parameters, and patient-specific factors. In this review, we systematically synthesize recent evidence from clinical trials and preclinical models published in leading gastroenterology and neurology journals. Our focus is on taVNS-mediated modulation of the brain–gut axis, particularly its role in improving autonomic balance, reducing visceral sensitivity, and attenuating inflammatory responses, with the aim of enhancing therapeutic outcomes in functional and inflammatory GIDs. There is a need to optimize stimulation protocols through mechanistic insights and to promote the use of this non-invasive, well-tolerated neuromodulation approach. These advances are essential for expanding taVNS accessibility in clinical practice, especially for patients with refractory symptoms, comorbid psychological conditions, and in settings where conventional treatments are limited or contraindicated. Personalized taVNS strategies and biomarker-guided dosing represent emerging trends in neuromodulation therapy. However, standardized protocols and predictive models have yet to be established for widespread clinical implementation.
Cognitive-attitudinal factors predict CBT-I enrollment willingness in Chinese sleep clinic patients: a knowledge-attitudes-practices survey
BackgroundDespite strong evidence for cognitive behavioral therapy for insomnia (CBT-I), uptake remains constrained by poorly understood cognitive, attitudinal, and practical barriers. This study examined determinants of willingness to enroll in sleep improvement programs among adults at risk of sleep disorders—including insomnia, obstructive sleep apnea, and comorbid psychological distress—attending a tertiary sleep clinic in China.MethodsA cross-sectional knowledge-attitudes-practices survey was conducted among 2,661 adults attending the sleep and behavioral medicine outpatient clinic at Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou, Jiangxi, China, between February 2022 and June 2025. Willingness to enroll in a structured sleep improvement program was assessed alongside sleep health knowledge, perceived need, CBT-I versus medication effectiveness beliefs, telehealth acceptability, clinical severity (Insomnia Severity Index, Epworth Sleepiness Scale, STOP-Bang), psychological symptoms (PHQ-2, GAD-2), perceived barriers, and sociodemographic characteristics. Multivariable logistic regression identified independent predictors of willingness to enrollment, with secondary analyses evaluating model discrimination and testing prespecified interactions.ResultsAmong 2,661 participants (median age 45 years, 56.5% female, median ISI = 13), 1,386 (52.1%) expressed willingness to enroll. Univariable comparisons showed no significant differences between willing and not-willing groups across demographics, clinical characteristics, or barriers (all p>0.05). However, multivariable modeling revealed that when considered simultaneously, cognitive-attitudinal factors emerged as significant independent predictors, suggesting complex interactions rather than simple bivariate associations. In multivariable models, perceived need (OR = 1.20, 95% CI: 1.16–1.25, p<0.001), beliefs that CBT-I is more effective and durable than sleep medication (OR = 1.12, 95% CI: 1.08–1.16, p<0.001), sleep health and treatment knowledge (assessed by a six-item knowledge score) (OR = 1.09, 95% CI: 1.05–1.13, p<0.001), and anxiety symptoms (OR = 1.07, p=0.005) positively predicted willingness. Paradoxically, depression symptoms (OR = 0.94, p<0.001) and insomnia severity (OR = 0.93, p<0.001) inversely predicted willingness. Model discrimination was modest (AUC = 0.543, 95% CI: 0.504–0.590). Time (mean 3.54) and cost (3.44) were most severe barriers but showed no independent association with willingness (p>0.05).ConclusionCognitive-attitudinal factors (perceived need, CBT-I beliefs, knowledge) independently predicted enrollment willingness, whereas demographics and practical barriers did not. Depression and insomnia severity paradoxically reduced willingness, creating an inverse care law. However, poor model discrimination and measurement of stated willingness rather than actual enrollment limit conclusions. Prospective validation and motivational enhancement strategies for patients with depression are needed.
Can preoperative spino-cranial angle predict cervical sagittal imbalance after laminoplasty?
ObjectiveThis study aimed to determine whether the preoperative spino-cranial angle (SCA) predicts cervical sagittal imbalance (CSI) after laminoplasty (LP).MethodsWe retrospectively screened 298 consecutive patients with degenerative cervical myelopathy (DCM) who underwent LP at our hospital from January 2018 to June 2021. Of these, 116 met the inclusion criteria and were analyzed. Radiographic and clinical parameters were collected preoperatively and at the last follow-up. Patients were stratified based on the change in cervical sagittal vertical axis (cSVA), calculated as ΔcSVA = postoperative−preoperative, into three categories: improvement (ΔcSVA≤ − 10 mm), stability (−10 mm < ΔcSVA≤10 mm), and deterioration (ΔcSVA>10 mm). Group comparisons were conducted using the χ2 test, t-test, analysis of variance, or non-parametric equivalents, as appropriate. Multivariable logistic regression was used to identify factors associated with postoperative CSI (ΔcSVA>10 mm). Receiver operating characteristic (ROC) analysis was performed to determine the SCA cutoff.ResultsPatients in the deterioration group exhibited the lowest preoperative SCA, along with poorer JOA recovery and worse postoperative neck pain compared to the improvement group. In the adjusted model, a lower SCA independently predicted postoperative cSVA deterioration (OR = 0.575, 95%CI: 0.372–0.808, p = 0.012), while other preoperative variables were not significant. The ROC analysis showed fair discrimination (AUC = 0.662), and an SCA threshold of 81.8° yielded 62.6% sensitivity and 96.0% specificity.ConclusionThe preoperative SCA influences postoperative cervical alignment after LP. Patients with a low SCA are at increased risk for CSI and may benefit from enhanced preoperative counseling and strategies that preserve alignment during LP.
Essex Partnership digital tool improves leg wound and ulcer care
Essex Partnership University NHS Foundation Trust has introduced a digital tool to improve care for patients with leg ulcers and wounds.
Burnout and perceived health in medical residents after the COVID-19 pandemic: a single-center cross-sectional study
IntroductionResidents have a high risk of burnout during the training period. The COVID-19 pandemic has had a great impact on work conditions and health of medical residents. We therefore estimated the prevalence of post-pandemic burnout and perceived health, and their relationship with psychosocial factors, stress profile, and job satisfaction, as well as the pre-post pandemic changes.MethodsWe carried out a retrospective cross-sectional, online, anonymous survey using the validated FPSICO-4.0 questionnaire in a teaching hospital after the COVID-19 pandemic (2023). We also studied the pre-post changes from an independent pre-pandemic online survey (2018) with the same tool.ResultsOne hundred ninety-seven residents, 64% females, answered the questionnaire (43.5%); 28% had post-pandemic burnout without gender differences, being higher in surgical specialties (p=0.017) and along residency years (p=0.041). Role performance, behavior stress, job satisfaction and residency years were associated with an increase in odds of burnout (p<0.05). Supervision, conflict of role/cognitive stress explained 35% of the variation in perceived general health (adjusted-R2 = 0.356); temporary autonomy, supervision, information/training/promotion, behavior/somatic stress, and job satisfaction did 68% of mental health (adjusted-R2 = 0.683); and take decisions, conflict of role, behavior/somatic/cognitive stress, and male gender did 62% of vitality (adjusted-R2 = 0.624). Pre/post pandemic mean differences, adjusted by gender and residency year, showed deterioration of variety sense of work (p<0.001), effort of attention (p=0.026), behavior stress (p=0.022), and improvement of temporary autonomy (p=0.045).ConclusionsThe identification after pandemic of high prevalence of burnout, stress levels and certain psychosocial risk factors (role performance and supervision), highlights the need of specific health promotion plan.
Opinion: Maternity deserts aren’t accidents. They’re the result of a design flaw
A pregnant woman in rural America may have to drive two hours — sometimes more — to reach a hospital that can deliver her baby. If labor comes early or complications arise, that distance becomes dangerous.
This is happening in the United States in 2026 — not because we lack medical knowledge or technology, but because we have failed to train and place the physicians where they are most needed.
West Midlands NHS imaging programme enters procurement
An NHS imaging transformation programme serving 6.6 million people across the West Midlands has entered procurement.
Clinician Decision-Making Around Offering Home Video Telehealth Visits: Qualitative Study
<strong>Background:</strong> Use of in-home video telehealth rapidly expanded in response to the COVID-19 pandemic, including at Veterans Affairs (VA), a forerunner in telehealth. Despite this uptick, differences in use by patient age and rurality created a digital divide that persists to this day. While clinicians frequently cite patients’ older age and lack of technical skills as barriers to in-home video telehealth, it remains unclear how clinicians decide whether to offer video visits to patients and to what extent these beliefs may hinder offering video visits to older adults. Gathering perspectives from clinician users of in-home video telehealth may illuminate opportunities to ensure continued access to care through solutions such as telehealth. <strong>Objective:</strong> This study aimed to examine clinician decision-making around the offer of in-home video telehealth to understand how interprofessional clinicians determine to whom they offer in-home video telehealth and what factors (organizational, personal, or attitudinal) influence their decision. <strong>Methods:</strong> We conducted a qualitative study by using semistructured interviews. Participants were interprofessional clinicians (N=16) employed by 11 different VA hospitals and included 1 clinical pharmacist, 6 medical doctors, 2 nurse practitioners, 1 occupational therapist, 3 psychologists, 1 physical therapist, 1 speech-language pathologist, and 1 social worker. All the participants had at least some experience using in-home video telehealth from locations across VA (the largest integrated health care system in the United States) and were interviewed over a 6-month period. Interviews focused on clinicians’ use of video telehealth and the decision-making process involved in offering in-home video telehealth. We used directed content analysis with a rapid analytic approach, given the time-pressured nature of our project. <strong>Results:</strong> This study revealed that clinician decision-making around offering in-home video visits is complex and influenced by several domains, namely, (1) clinician factors, including experience with video and perceived benefits of video; (2) appointment factors, including the visit’s clinical goal; (3) clinician-reported patient factors, including age and willingness to try video; (4) patient social context, including caregiver availability; (5) geographical factors, such as availability of reliable high-speed internet and patient distance from the medical center; and (6) health system factors, including technical support and clinician ability to work from home. Access to in-home video telehealth may be facilitated by clinician familiarity and confidence with telehealth technology, strategies to improve patients’ technical skills, and support for caregivers. Infrastructure also plays an important role, including device availability, broadband reliability, and clear protocols for matching services to video visits. <strong>Conclusions:</strong> Findings highlight the importance of clinician competency in telehealth, patient and caregiver digital readiness, and a supportive technology infrastructure to equitable in-home video care. In addition, improved guidance for specific clinical services and awareness of potential biases may enable consistent, accessible telehealth delivery for older adults and medically complex populations. <strong>Trial Registration:</strong>
University Hospitals Sussex EDs switch to digital observations
University Hospitals Sussex NHS Foundation Trust has now rolled out digital observations and prescribing in two of its emergency departments.
The Feasibility of an App-Based Worksite Health Promotion Program to Improve Mental Well-Being and Work-Related Vitality in University Hospital Workers: Process and Preliminary Effect Evaluation Study
Background: University hospital employees face role-specific stressors that can impair mental well-being and work-related vitality. While worksite health promotion programs show potential for improving mental well-being by targeting lifestyle behaviors, most target single professions or hospital subunits, and evidence for mental well-being and work-related vitality remains mixed. Mobile apps offer unique advantages for delivering such worksite health promotion programs hospital-wide. However, accessible interventions tailored to a diverse workforce are lacking. Objective: This study aimed to investigate the feasibility of an app-based worksite health promotion program (the Recharge360 program [The Recharge Company]) targeting multiple lifestyle behaviors, including a team-based competition element, for improving mental well-being and work-related vitality of hospital employees over a 5-month follow-up period by evaluating two objectives: (1) the implementation process of the program, and (2) the preliminary effects of the program on mental well-being and work-related vitality. Methods: We included 532 employees (mean age 43, SD 12 y; n=482, 91% women; n=480, 90% highly educated) from a university hospital in Amsterdam, the Netherlands. The study had a single-arm, longitudinal pretest-posttest design lasting 5 months, during which employees participated in the 5-day Recharge360 program (Recharge week) 3 times—in weeks 1, 9, and 17. At baseline (T0) and after each Recharge week (T1-T3), we assessed mental well-being, work ability, need for recovery, and task performance. The process was evaluated by assessing recruitment, attrition, and survey completion rates, and the degree of participation. Preliminary effects were evaluated by linear mixed model regression analyses to assess changes in mental well-being and work-related vitality between baseline and follow-up. Results: Recruitment appeared feasible, but attrition rates were high (up to 70% in the final Recharge week), and the degree of participation decreased over time. We showed statistically significant, albeit small, increases in well-being at T3 (unstandardized β coefficient=2.08, 95% CI 0.33-3.84), with progressively larger improvements in the analyses among those who started at least 1, 2, and all 3 Recharge weeks (unstandardized β coefficient=3.27, 95% CI 1.09-5.45). Results for work-related vitality were mixed. The need for recovery remained unchanged, task performance increased slightly at T3 (unstandardized β coefficient=0.16, 95% CI 0.07-0.24). Work ability showed a small, but statistically significant, decline across follow-up (unstandardized β coefficient=−0.46, 95% CI −0.64 to −0.29). Conclusions: This app-based worksite health promotion program might be feasible to implement in a university hospital setting and shows potential to slightly improve mental well-being, but primarily for a selective group of highly educated, health-conscious women. While these findings support further investigation in a randomized controlled trial in similar university hospital settings, they also highlight the need for more participatory study designs to improve the tailoring of program components and engagement of underrepresented groups, as well as for a supportive culture and population-based approaches at the organizational level.
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