Enacting Person-Centred Care In Home Care Services For People With Dementia
In the person-centred care of people with dementia, familiarity had to be established and continuously fostered.
KEY FINDINGS: In the person-centred care of people with dementia, familiarity had to be established and continuously fostered. When familiarity was in place, the care recipient and the home care staff acted as a team to perform the care. The theoretical works of Goffman were used to interpret the results.
BACKGROUND: Objective of the study is to develop the theoretical understanding of the process of providing person-centred home care for people with dementia. People with dementia are increasingly cared for at home by family members and home care staff. Care of people with dementia should be person-centred; however, little is known about how home care staff understand and enact person-centred care in their daily work.
DETAILS: Home care staff (n = 29) were recruited from home care services specialised in providing care for people with dementia. Group interviews were conducted, and a tentative theoretical model for providing person-centred home care to people with dementia was outlined. Nine of the participants were then individually interviewed to further develop the model. The analysis was conducted parallel to the data collection, and hypotheses concerning the evolving theoretical model were continuously tested in the following interviews. The COREQ checklist for qualitative studies was used in reporting the study. Person-centred home care of people with dementia was conceptualised as a series of processes: Getting ready, getting in, giving care, getting out and finalising the story, each with subprocesses. Theatre metaphors were used to describe how the care was provided. A core process, Enacting and re-enacting familiarity, was at centre in all processes.
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Source: Hedman, R., Sandman, P., Edvardsson, D. (2022). Enacting Person-Centred Care In Home Care Services For People With Dementia. Journal of Clinical Nursing. 2022; 31(11-12): 1519-1530. Published: June, 2022. DOI: 10.1111/jocn.16004.
Obesity, Rather Than High Body Surface Area Alone, Predicts Clinically Significant Asparaginase Toxicity During Induction Therapy for Acute Lymphoblastic Leukemia
Among 4,925 children and young adults with ALL, obesity—not high BSA alone—was the strongest predictor of clinically significant asparaginase toxicity. Patients with obesity and high BSA had the highest risk of hepatic toxicity and thromboembolism, whereas induction toxicities were not associated with increased end-of-induction MRD positivity.
KEY FINDINGS: This large multicenter analysis demonstrates that obesity-not elevated BSA alone-is the principal patient-related risk factor for clinically significant asparaginase toxicity during induction therapy for ALL. The greatest excess risk occurred in patients with both obesity and high BSA, particularly for hepatic toxicity and thromboembolic events, while pancreatitis risk was unaffected. Older age independently increased toxicity risk, especially hyperbilirubinemia. Notably, induction-phase AAT did not compromise early treatment response, as measured by EOI MRD. These findings suggest that obesity should be prioritized when identifying patients for enhanced toxicity surveillance and future preventive strategies, whereas high BSA in the absence of obesity does not appear to justify dose modification based solely on body size.
BACKGROUND: Asparaginase remains a cornerstone of induction therapy for acute lymphoblastic leukemia (ALL), but treatment-limiting toxicities frequently interrupt therapy and may compromise long-term outcomes. Previous studies have produced conflicting evidence regarding whether older age, obesity, or high body surface area (BSA) independently increase the risk of asparaginase-associated toxicities (AAT). This large Children’s Oncology Group analysis evaluated the relative contributions of these risk factors and examined whether induction-phase AAT affected early treatment response measured by end-of-induction (EOI) minimal residual disease (MRD).
DETAILS: This retrospective analysis included 4,925 patients aged 1-30 years enrolled in the Children’s Oncology Group trials AALL0232 and AALL0434. All patients received a single induction dose of pegaspargase 2500 IU/m² without dose capping. Investigators assessed grade >=3 hyperbilirubinemia, grade >=4 alanine aminotransferase (ALT) elevation, grade >=2 thromboembolism, and grade >=3 acute pancreatitis. Multivariable analyses evaluated the independent effects of age, obesity, and BSA, while EOI MRD positivity (>=0.01%) was analyzed to determine whether AAT adversely influenced early leukemia response. Among 4,925 patients, 290 (6%) experienced at least one clinically significant AAT during induction. Toxicity rates increased with advancing age and obesity. After adjustment for confounding variables, obesity independently increased the likelihood of AAT (OR 2.5; 95% CI 1.88-3.24), whereas high BSA alone was not an independent predictor. Patients with both obesity and high BSA had the greatest risk of overall AAT (OR 3.3; 95% CI 2.22-4.77), while high BSA without obesity was not associated with increased risk (OR 1.4; 95% CI 0.94-2.04). Older patients (>=10 years) demonstrated more than a twofold increase in AAT risk compared with younger children.
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Obesity combined with high BSA significantly increased the risk of hyperbilirubinemia (OR 3.5; 95% CI 2.2-5.7), severe ALT elevation (OR 3.3; 95% CI 1.7-6.6), and thromboembolism (OR 3.1; 95% CI 1.5-6.5). Acute pancreatitis showed no significant association with obesity or BSA. Importantly, development of AAT did not increase the likelihood of EOI MRD positivity (36.6% vs 33.5%; Ps= .318), suggesting that induction toxicities did not adversely affect early disease response.
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Source: Orgel, E., Maese, L. D., Devidas, M., et al. Toxicity From Asparaginase During Acute Lymphoblastic Leukemia Induction: A Report From the Children's Oncology Group. Blood Advances. 2026; 10(14):4923-4930. Published: July 28, 2026. DOI: 10.1182/bloodadvances.2026019870
Suicide Risk Peaks During the First Year After Dementia Diagnosis in Older Adults
Among 2,667,987 older adults with newly diagnosed dementia, suicide risk during the first year was significantly higher than in the general population (SMR 1.53), peaking within 90 days of diagnosis. Adults aged 65–74 years, patients with frontotemporal dementia, and those with mental illness, substance use disorders, or chronic pain had the greatest risk.
KEY FINDINGS: Older adults experience a significantly elevated risk of suicide during the first year after receiving a dementia diagnosis, particularly within the first 90 days. Individuals aged 65-74 years and those diagnosed with frontotemporal dementia represent the highest-risk groups. Coexisting mental illness, substance use disorders, chronic pain, rural residence, and recent mental health service utilization further increase suicide risk. These findings support routine suicide risk assessment, early psychiatric evaluation when appropriate, caregiver support, and discussions regarding restriction of access to lethal means immediately after a dementia diagnosis.
BACKGROUND: A new diagnosis of Alzheimer's disease or related dementias (ADRD) can be psychologically distressing and may increase vulnerability to suicidal behavior. Previous studies have reported inconsistent findings regarding suicide risk after dementia diagnosis. This nationwide U.S. cohort study evaluated suicide mortality and non-fatal suicidal events during the first year following a new ADRD diagnosis and identified patient characteristics associated with increased risk.
DETAILS: This retrospective cohort study included 2,667,987 Medicare fee-for-service beneficiaries aged >=65 years with newly diagnosed ADRD identified between 2012 and 2015. Patients were followed for up to 12 months after the initial dementia diagnosis or until death. Suicide deaths were identified through linkage with the National Death Index, while non-fatal suicidal events were captured using hospital claims. Standardized mortality ratios (SMRs) compared suicide risk with that of the general U.S. older adult population. Adjusted hazard ratios (AHRs) were calculated after controlling for age, sex, and race/ethnicity. During the first year after diagnosis, 705 suicide deaths occurred, corresponding to a suicide rate of 26.42 per 100,000 person-years, with an overall SMR of 1.53 (95% CI 1.42-1.65) compared with the general older adult population. The highest relative risk was observed among adults aged 65-74 years (SMR 3.40; 95% CI 2.94-3.86), and approximately half of all suicides occurred within the first 90 days after diagnosis. Patients with frontotemporal dementia had the highest suicide rate (124.63 per 100,000 person-years) and a significantly increased risk of suicide compared with unspecified dementia (AHR 2.91; 95% CI 1.67-5.05). Rural residence, recent mental health disorders, substance use disorders, chronic pain, and recent mental health-related healthcare utilization were independently associated with higher suicide risk. Non-fatal suicidal events were more frequent among patients with vascular dementia, personality disorders, bipolar disorder, anxiety disorders, substance use disorders, and chronic pain.
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Genetic Analysis Identifies Vitamin B1 Metabolism as a Potential Therapeutic Target for Gut Motility Disorders
A multiancestry GWAS of 268,606 individuals identified 21 stool frequency loci, including 10 novel signals, and implicated vitamin B1 metabolism as a regulator of gut motility. Higher dietary thiamine intake correlated with increased stool frequency (p less than 0.0001), with effects modified by SLC35F3/XPR1 genotypes, highlighting a potential therapeutic target for IBS and dysmotility disorders.
KEY FINDINGS: This large multiancestry GWAS substantially expands the genetic architecture of gut motility by identifying 21 stool frequency-associated loci and uncovering vitamin B1 metabolism as a previously unrecognized regulator of intestinal transit. The convergence of genetic evidence on SLC35F3 and XPR1, together with the observed association between higher dietary thiamine intake and increased stool frequency, suggests that thiamine metabolism may represent a modifiable pathway for personalized nutritional or pharmacologic interventions. The findings also reinforce the importance of bile acid and cholinergic signaling in gut motility and provide a foundation for future mechanistic studies and therapeutic development for IBS and other dysmotility disorders.
BACKGROUND: Altered gastrointestinal motility is a central feature of irritable bowel syndrome (IBS) and other disorders of gut–brain interaction, yet the molecular mechanisms regulating intestinal transit remain incompletely understood. Stool frequency serves as a practical population-based surrogate for gut motility and enables large-scale genetic studies aimed at identifying biologically relevant pathways and potential therapeutic targets.
DETAILS: Investigators conducted a multiancestry genome-wide association study (GWAS) meta-analysis of stool frequency in 268,606 individuals of European (167,966) and East Asian (100,640) ancestry. Heritability, genetic correlations, Mendelian randomization, fine-mapping, and functional annotation analyses were performed to identify genes influencing gut motility. Dietary interaction analyses evaluating vitamin B1 (thiamine) intake were subsequently conducted in 98,449 UK Biobank participants to examine gene–nutrient interactions. Stool frequency demonstrated modest but consistent heritability across populations (7.0% in Europeans and 5.6% in East Asians). The analysis identified 21 independent genetic loci, including 10 novel loci, with significant genetic correlations observed between stool frequency and gastrointestinal, psychiatric, and cardiovascular traits (rg=0.12–0.47). Mendelian randomization supported a causal effect of stool frequency on IBS.
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Fine-mapping highlighted two genes involved in thiamine metabolism-SLC35F3, encoding a thiamine transporter, and XPR1, which facilitates phosphate export required for activation of thiamine into thiamine pyrophosphate. Among 98,449 UK Biobank participants, higher dietary thiamine intake was associated with increased stool frequency (p<0.0001), and a combined SLC35F3/XPR1 genotype score significantly modified this relationship (p<0.0001). Additional candidate pathways implicated bile acid synthesis through KLB and cholinergic signaling through COLQ, supporting multiple biologically actionable mechanisms regulating intestinal transit. Drug-signature analyses further identified compounds targeting calcium channels, cholinergic pathways, histamine signaling, and bile acid regulation as potential candidates for therapeutic exploration.
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Source: Díaz-Muñoz, C., Bozzarelli, I., Lopera-Maya, E. A., et al. Genetic Dissection of Stool Frequency Implicates Vitamin B1 Metabolism and Other Actionable Pathways in the Modulation of Gut Motility. Gut. 2026; 75:1480-1490 Published: June 22, 2026. DOI: 10.1136/gutjnl-2025-337059.
Promising Drug Candidates and Emerging Therapeutic Strategies Against Candida auris
Emerging therapies for Candida auris extend beyond conventional antifungal agents and include repurposed drugs, novel antifungal compounds, vaccines, antimicrobial peptides, and nanotechnology-based approaches. While further clinical validation is needed, these strategies may help address the growing challenge of multidrug-resistant C. auris infections.
KEY FINDINGS: This review underscores the expanding pipeline of therapeutic strategies targeting Candida auris, ranging from repurposed medications and next-generation antifungal agents to vaccines, antimicrobial peptides, nanoparticle formulations, and innovative environmental control measures. Although no single therapy has emerged as a definitive solution, compounds such as ibrexafungerp (SCY-078), ATI-2307, and fosmanogepix, together with drug repurposing and bioinspired approaches, represent promising avenues for addressing multidrug-resistant C. auris infections. Continued translational research and clinical evaluation remain essential to establish safe and effective treatment options for this increasingly important fungal pathogen.
BACKGROUND: Candida auris has rapidly emerged as a multidrug-resistant fungal pathogen of global concern since its first identification in 2009. The organism is associated with healthcare-associated outbreaks, high transmissibility, frequent misidentification, and severe invasive infections, with reported mortality rates ranging from 35% to 72%. Resistance to currently available antifungal agents further complicates treatment, with approximately 90% of isolates resistant to fluconazole, around 30% resistant to amphotericin B, and fewer than 5% resistant to echinocandins. These challenges have accelerated efforts to identify novel antifungal therapies and alternative treatment strategies.
DETAILS: This publication is a comprehensive narrative review that summarizes advances in antifungal research targeting C. auris over the preceding decade. The authors evaluated emerging therapeutic approaches from a medicinal chemistry perspective, including drug repurposing, combination therapy, novel antifungal agents, natural products, metal-based compounds, nanoparticles, vaccines, antimicrobial peptides, and environmental decontamination strategies. The review also examined chemical and physicochemical characteristics of promising compounds, including lipophilicity and topological polar surface area, to identify structural features that may facilitate future antifungal drug development. The review highlights several promising therapeutic candidates with activity against multidrug-resistant C. auris. Drug repurposing identified multiple agents with antifungal or antibiofilm activity, including sertraline, miltefosine, iodoquinol, octenidine dihydrochloride, taurolidine, and bensulfuron methyl. Miltefosine demonstrated fungicidal and antibiofilm activity, while encapsulation within alginate nanoparticles reduced toxicity and improved survival in an infected Galleria mellonella model. The NDV-3A vaccine generated cross-reactive antibodies against C. auris and protected neutropenic mice, with additive efficacy when combined with micafungin.
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Among novel antifungal agents, SCY-078 (ibrexafungerp), an orally available 1,3-ß-D-glucan synthesis inhibitor, demonstrated potent activity against C. auris, with an MIC90 of 1 mg/L and MIC50 and MIC90 values of 0.5 µg/mL and 1 µg/mL, respectively, across 100 isolates representing the four major clades. More than 150 strains with diverse resistance profiles were subsequently shown to be uniformly susceptible to SCY-078, and the agent remained active against pan-resistant isolates while also exhibiting antibiofilm activity.
Additional investigational therapies also demonstrated encouraging preclinical activity. The arylamidine T-2307 (ATI-2307) exhibited in vitro MIC values ranging from 0.125 to 4 µg/mL and improved survival while reducing kidney fungal burden in murine infection models following 3 mg/kg once-daily subcutaneous treatment. Other experimental approaches included antimicrobial peptides, ceragenins, fluorinated hydrazone derivatives, and novel chemical scaffolds designed to overcome existing resistance mechanisms.
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Source: Billamboz, M., Fatima, Z., Hameed, S., et al. Promising Drug Candidates and New Strategies for Fighting against the Emerging Superbug Candida auris. Microorganisms. 2021; 9(3): 634. Published: March 18, 2021. DOI: 10.3390/microorganisms9030634.
Artificial Intelligence-Assisted Colonoscopy Improves Polyp Detection in a Prospective Randomized Tandem Colonoscopy Study
This prospective randomized tandem study demonstrates that AI-assisted colonoscopy significantly improves overall polyp detection, with the greatest benefit observed for diminutive and Paris type 0-IIa lesions. The enhanced detection was achieved without increasing procedure withdrawal time, supporting the feasibility of real-time AI integration into routine colonoscopic practice. Although false-positive alerts occurred, they were infrequent and readily distinguishable by experienced endoscopists. Given the single-center design, relatively small sample size, and absence of adenoma detection rate analysis, larger multicenter studies are warranted to confirm the clinical impact of AI-assisted colonoscopy on colorectal cancer prevention.
KEY FINDINGS: This prospective randomized tandem study demonstrates that AI-assisted colonoscopy significantly improves overall polyp detection, with the greatest benefit observed for diminutive and Paris type 0-IIa lesions. The enhanced detection was achieved without increasing procedure withdrawal time, supporting the feasibility of real-time AI integration into routine colonoscopic practice. Although false-positive alerts occurred, they were infrequent and readily distinguishable by experienced endoscopists. Given the single-center design, relatively small sample size, and absence of adenoma detection rate analysis, larger multicenter studies are warranted to confirm the clinical impact of AI-assisted colonoscopy on colorectal cancer prevention.
BACKGROUND: Colonoscopy remains the standard procedure for detecting and removing colorectal polyps, thereby reducing the incidence of colorectal cancer (CRC). However, lesions may be overlooked because of operator-dependent factors and the subtle appearance of small or flat polyps. Artificial intelligence (AI)-based computer-aided detection systems have been developed to provide real-time assistance during colonoscopy, but clinical evidence supporting their effectiveness in routine practice remains limited. This prospective randomized study evaluated whether AI-assisted colonoscopy improves polyp detection compared with conventional colonoscopy in a real-world clinical setting.
DETAILS: This prospective, randomized tandem cohort study was conducted at the Endoscopy Center of Nanfang Hospital, China, between April 2019 and September 2019. A total of 150 patients aged 18-70 years underwent same-day back-to-back colonoscopies performed by two experienced endoscopists, each with experience exceeding 3,000 colonoscopies. Participants were randomly assigned to undergo either conventional colonoscopy or AI-assisted colonoscopy first, followed immediately by the alternate procedure. The AI system employed a convolutional neural network based on the YOLO architecture and operated during withdrawal to identify suspected polyps in real time. The primary endpoint was the polyp detection rate (PDR), while secondary outcomes included the total number of detected polyps, detection of diminutive polyps (<6 mm), detection according to Paris classification, withdrawal time, and false-positive findings. Baseline demographic characteristics, bowel preparation quality, and withdrawal times were comparable between study groups. Mean withdrawal time was 370.15 ± 31.44 seconds with conventional colonoscopy and 373.17 ± 33.37 seconds with AI-assisted colonoscopy (p = 0.102). AI assistance significantly improved the PDR from 34.0% to 38.7% (p < 0.001). The total number of detected polyps increased from 80 with conventional colonoscopy to 105 with AI-assisted colonoscopy (p = 0.020). The benefit was primarily attributable to enhanced detection of diminutive polyps, with 91 lesions identified using AI compared with 69 during conventional examination (p < 0.001). Detection rates for patients with at least one diminutive polyp also increased from 30.0% to 34.7% (p < 0.001). In contrast, detection of polyps measuring >=6 mm did not differ significantly (11 vs 14; p = 0.319). AI-assisted colonoscopy also improved detection of Paris type 0-IIa polyps, increasing the number detected from 61 to 87 (p = 0.010) and the proportion of patients with at least one such lesion from 26.0% to 32.0% (p < 0.001). The AI system generated 52 false-positive alerts, averaging 0.35 false positives per colonoscopy, most commonly due to feces and mucosal folds, without prolonging withdrawal time.
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Source: Luo, Y., Zhang, Y., Liu, M., et al. Artificial Intelligence-Assisted Colonoscopy for Detection of Colon Polyps: a Prospective, Randomized Cohort Study. Journal of Gastrointestinal Surgery. Journal of Gastrointestinal Surgery. 2021; 25(8): 2011-2018. Published: June 22, 2026. DOI: 10.1007/s11605-020-04802-4.
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