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The unprecedented expansion of approved oncology therapies has prolonged survival and transformed the prognosis for many patients diagnosed with cancer. However, cancer treatments may be associated with cardiovascular toxicities that manifest through vascular, myocardial, or metabolic pathways, potentially limiting the use of cancer therapeutics and adversely affecting outcomes. Oncology clinical trials provide an important opportunity to evaluate cardiovascular safety signals by generating data on the incidence, timing, and spectrum of toxicities. However, progress has been limited by inconsistent definitions and variable approaches to event characterization. This scientific statement aligns the advances in cardiovascular medicine and cardiovascular clinical trials to provide criteria for systematic selection, rigorous characterization, and adjudication of cardiovascular endpoints in contemporary oncology trials. The proposed framework links drug-specific mechanisms to endpoint selection and standardizes the approach to definitions of adverse cardiovascular events, including heart failure, arrhythmias, myocarditis, and thrombotic events. Definitions of major adverse cardiac events, clinical events, and surrogate endpoints are discussed, along with strategies for alignment with the Common Terminology Criteria for Adverse Events and patient-reported outcomes. Practical guidance is provided for prospective surveillance, decentralized and hybrid clinical trial designs, independent endpoint adjudication, and statistical approaches to competing risks and late-emerging toxicities. By harmonizing cardiovascular endpoint assessment across oncology trials, this scientific statement aims to enhance risk stratification, facilitate regulatory acceptance, and inform clinical decision-making, ultimately improving patient safety while supporting innovation in cancer therapeutics.

Immune checkpoint inhibitors and adoptive cell therapies have revolutionized cancer treatment, yet their success is accompanied by immune-related hepatotoxicity that can range from asymptomatic enzyme elevation to life-threatening liver failure. Unlike conventional drug-induced liver injury, immune-mediated hepatotoxicity arises from complex, therapy-specific mechanisms that remain incompletely understood, creating critical knowledge gaps in risk prediction and prevention. This review incorporates current evidence on the clinical presentation, mechanistic pathways, and risk factors underlying hepatotoxicity across major immune and cell therapy platforms, with emphasis on translating mechanistic insights into actionable management strategies. We systematically examine hepatotoxicity patterns for immune checkpoint inhibitors, CAR-T cell therapies, bispecific T-cell engagers, and tumor-infiltrating lymphocyte therapy, integrating clinical trial data, real-world evidence, and mechanistic studies. Our analysis shows distinct injury mechanisms: T-cell-mediated hepatocyte destruction following checkpoint blockade, cytokine-driven bystander injury during cytokine release syndrome, and emerging on-target/off-tumor toxicity from engineered lymphocytes. Critical risk modifiers include pre-existing liver disease, concomitant hepatotoxic medications, gut microbiome dysbiosis from antibiotic exposure, and host pharmacogenomic variation. We propose three priority research directions: development of predictive biomarkers enabling pretreatment risk stratification, microbiome-directed interventions to preserve hepatic immune tolerance, and implementation of Safety-by-Design engineering strategies that integrate hepatotoxicity prevention into therapeutic design. This review provides a mechanistic framework for transitioning from reactive toxicity management to predictive, personalized prevention, essential for maximizing the therapeutic potential of immune and cell therapies while protecting patient safety in this rapidly expanding treatment landscape.

Nurses contribute across the precision cancer care pathway, providing continuous, person-centred care and supporting genomic testing integration. However, the scope of nursing competencies required for precision cancer care and the extent to which current education prepares nurses for these roles remain unclear. This scoping review maps and synthesises evidence on nurses' roles and competencies in precision cancer care, and educational provision in this field. A JBI scoping review was conducted; MEDLINE, CINAHL, PsycINFO, Embase and Scopus were systematically searched on July 18th 2025. International postgraduate and continuing professional education programmes relevant to nurses were identified via a generative artificial intelligence grey literature search undertaken between July 25th and July 30th 2025. Data were synthesised using convergent integrated thematic synthesis. Fifty-two publications were included, addressing nursing roles and/or competencies (n = 44) and educational interventions (n = 23). Sixty-five education programmes were identified. Five themes captured nursing roles: 1) genomic risk assessment and stratification; 2) genomic communication and shared decision-making; 3) precision cancer care pathway coordination and clinical navigation; 4) interprofessional collaboration and genomic service integration; and 5) professional governance, quality assurance, and advanced practice roles. Educational provision predominantly addressed foundational competencies, with less explicit preparation for roles requiring professional autonomy, interpretive expertise, leadership, and governance. Alignment between nurses' competency expectations and educational preparation is uneven. We propose a three-level model of precision cancer nursing practice to differentiate foundational capabilities from advanced practice roles, distinguishing precision-informed, enhanced, and specialist precision cancer nursing practice. Explicit mapping of postgraduate curricula to stratified competency levels may support safe expansion of nursing scope within mainstreamed genomic cancer care. This research was supported with funding from the Dublin City University Undergraduate Summer Research Internship 2025, which supported AC's time on the project. The authors alone are responsible for the content of this presentation.

Chronic pain management relies on baseline prognostic models, although digital monitoring may better capture long-term patient trajectories. To describe 6-month chronic pain trajectories using weekly assessments and to evaluate the value of routinely collected baseline sociodemographic and clinical variables in estimating trajectories. This multicenter mobile health cohort study was conducted in French tertiary pain clinics between September 2019 and 2025. Adults with chronic noncancer pain initiating follow-up in a pain clinic and completing at least 6 months of follow-up were eligible. Participation in the eDOL digital health program with weekly assessments alongside routine care. The primary outcomes were weekly bodily comfort, sleep, and mood measured on 11-point numeric rating scale and aggregated into monthly medians. Trajectory stability, time spent in predefined clinical states, latent trajectory classes, and performance of baseline variables in estimating outcomes were assessed using linear mixed-effects models, time-in-state analyses, gaussian mixture models , and machine learning. Informative attrition was addressed using inverse probability of censoring weighting and joint longitudinal-survival modeling. Among 1477 participants (76.8% [95% CI, 74.6%-78.9%] aged 35-64 years; 82.1% [95% CI, 77.9%-86.3%] women; median pain duration >5 years), most were receiving multimodal treatment for multimorbid chronic pain. Average trajectories remained stable, with no clinically meaningful change in patient-reported outcomes. Three trajectory classes were identified: stable (1266 participants; 85.7% [95% CI, 83.9%-87.5%]), improving (61 participants; 4.1% [95% CI, 3.2%-5.2%]), and worsening (150 participants; 10.2% [95% CI, 8.6%-11.7%]). Baseline characteristics had limited value in estimating pain trajectories. In tertiary pain clinics patients, trajectories of bodily comfort, sleep, and mood were predominantly stable over 6 months. Baseline characteristics poorly estimated long-term trajectories, supporting continuous digital monitoring and individualized change detection rather than baseline-only prognostic stratification.

Effective postoperative pain management remains a significant clinical challenge in orthopaedic surgery, necessitating alternatives to systemic opioid administration. This study investigated an in-situ polymerizable hydrogel system for the simultaneous local delivery of the analgesic bupivacaine and the nonsteroidal anti-inflammatory drug (NSAID) ketorolac in a rat model of tibia fracture/osteotomy and plate fixation. Two hydrogel formulations, slow-degrading (MAPLAPEG) and fast-degrading (MAPGAPEG), were synthesized and characterized. Functional recovery was assessed via static weight-bearing, gait analysis, and mechanical sensitivity (Von Frey tests). Local inflammation was evaluated by measuring serum alpha-2 macroglobulin (α2M) levels and local matrix metalloproteinase-9 (MMP-9) activity, along with histological and immunofluorescence analyses. Static weight-bearing analysis demonstrated a ∼80% improvement toward symmetric hind-limb loading in the MAPGAPEG treatment group compared with control at postoperative day 42 (p < 0.05). At POD 3, 2-4 toe spread demonstrated ∼80% normalization toward symmetric limb use in the MAPGAPEG treatment group compared with control. Minimal inflammation and no negative impact on bone healing were observed. This dual drug-loaded hydrogel system offers a promising strategy for postoperative pain management in orthopaedics, potentially reducing reliance on systemic opioids and enhancing patient recovery.

The emergence of antibiotic resistance calls for the discovery of new compounds and materials that can stem the growth of microorganisms and promote wound healing. Metals have long been used for their antimicrobial properties. However, concerns about the potential side effects of non-physiological metals, such as silver, limit their use in medical applications. This review focuses on physiological metals that are classified as trace elements and more specifically on ultra-trace elements (TEs): cobalt (Co), manganese (Mn), molybdenum (Mo), and vanadium (V). They are essential for homeostasis in both human beings and microorganisms. Nanoparticles (NPs) based on these TEs exhibit superior properties, including antimicrobials and wound healing capabilities due to various mechanisms. This review presents recent advances on TE NPs and their formulation in hydrogels. Their incorporation into specific hydrogels allows for a controlled release and may achieve antibacterial, anti-fungal, and pro-wound healing synergistic effects, sometimes in a stimuli-responsive approach, without potential adverse effects. STATEMENT OF SIGNIFICANCE: Antibiotic resistance poses a global threat and requires innovative solutions that can combat infections and promote wound healing. This review explores the potential of ultra-trace metal nanoparticles (cobalt, manganese, molybdenum, and vanadium) as antimicrobial agents and wound-healing promoters. Unlike non-physiological metals, such as silver, these trace elements are essential for both human and microbial homeostasis, and reducing toxicity risks. The enhanced antimicrobial and regenerative properties of their nanoparticle forms are discussed here. Hydrogel formulations enable controlled release, thereby optimizing therapeutic effects. This work explores the impact of various factors at each stage of wound healing. It highlights a promising, multifunctional approach to advanced wound care that offers safer alternatives to conventional treatments.

Chronic diabetic wounds remain a major clinical burden due to persistent oxidative stress, microbial infection and impaired vascularization. Composite seaweed-derived hydrogels engineered from sulfated polysaccharides such as alginate, fucoidan, laminarin, carrageenan, agarose and ulvan offer a promising biomaterial platform that integrates mechanical robustness with bioactivity. The unique chemistry of marine polysaccharides, featuring carboxyl and sulfate groups, provides intrinsic antioxidant, anti-inflammatory and angiogenic functions while enabling facile chemical modification and crosslinking. Through hybridization with biopolymers, nanoparticles and therapeutic agents, these composites achieve tunable viscoelasticity, controlled degradation and sustained release of bioactives. Their multifunctional mechanisms include ROS scavenging, cytokine suppression, macrophage polarization, VEGF stabilization and antibacterial action, collectively restoring the wound microenvironment. Advanced fabrication techniques such as 3D bioprinting, microfluidic gelation and stimuli-responsive design further enhance spatial control and therapeutic precision. Despite promising preclinical outcomes, translational challenges remain regarding standardization, structural reproducibility and clinical validation. This review consolidates recent progress in the chemistry, engineering and biological performance of seaweed-based composite hydrogels, highlighting their emerging role as intelligent, bioinstructive platforms for diabetic wound regeneration and next-generation wound-care technology.

Universal decolonization and enhanced cleaning are strategies to prevent multidrug-resistant organism (MDRO) transmission. Whether their associations with MDRO burden are overlapping, additive, or synergistic remains unknown. To evaluate independent and combined associations of decolonization and enhanced cleaning with MDRO carriage and environmental contamination. This quality improvement study was conducted in 2 Southern California nursing homes from March 2019 to April 2021. This 4-phase study implemented (1) universal decolonization only, (2) routine care (control), (3) enhanced cleaning only, and (4) universal decolonization plus enhanced cleaning sequentially and compared them to determine their associations with MDRO body-site carriage and environmental contamination. Analyses were performed from 2024 to 2025. Universal decolonization involved chlorhexidine bathing and nasal iodophor for all residents. Enhanced daily cleaning included staff education and ultraviolet-marker feedback. The main outcomes were serial point-prevalence assessments (n = 6 per phase) of MDRO carriage (nares, skin), as well as MDRO contamination of high-touch objects in bedrooms and common areas. Differences in the odds of any MDRO and MDRO-specific carriage and contamination during each intervention phase compared with the control were assessed using generalized linear mixed models. Point-prevalence sampling generated 5856 swabs to evaluate MDRO carriage (n = 3840 swabs) and environmental contamination (n = 2016 swabs). For MDRO carriage, prevalence during the control phase was 50.0% (n = 240 of 480 objects). Decolonization alone was associated with markedly lower carriage compared with either the control (adjusted odds ratio [AOR], 0.41 [95% CI, 0.27-0.61]) or enhanced cleaning (AOR, 0.36 [95% CI, 0.24-0.55]). Enhanced cleaning alone did not reduce carriage (AOR, 1.14 [95% CI, 0.77-1.69]) and provided no additional benefit when combined with decolonization compared with decolonization alone (AOR, 1.37 [95% CI, 0.88-2.14]). For environmental contamination, 62.5% of bedroom objects (n = 225 of 360) and 72.9% of common area objects (n = 105 of 144) were contaminated during the control phase. In bedrooms, decolonization alone was associated with markedly lower contamination compared with either the control (AOR, 0.16 [95% CI, 0.08-0.32]) or enhanced cleaning (AOR, 0.26 [95% CI, 0.12-0.54]). Enhanced cleaning alone did not reduce bedroom contamination (AOR, 0.63 [95% CI, 0.32-1.24]) and provided no additional benefit when combined with decolonization compared with decolonization alone (AOR, 1.35 [95% CI, 0.66-2.75]). In contrast, MDRO contamination in common areas was significantly reduced by both decolonization (AOR, 0.19 [95% CI, 0.08-0.45]) and enhanced cleaning (AOR, 0.15 [95% CI, 0.07-0.35]) compared with the control. The combined intervention was associated with markedly lower common area contamination than either enhanced cleaning (AOR, 0.39 [95% CI, 0.16-0.91]) or decolonization alone (AOR, 0.30 [95% CI, 0.11-0.82]). In this quality improvement study, only decolonization was associated with reduced MDRO carriage and bedroom contamination, and only common area contamination appeared to be further reduced by adding once-daily enhanced cleaning.

Peritoneal dialysis is a widely used treatment for kidney failure; however, peritoneal dialysis-related infections (exit-site, tunnel infection, peritonitis) occur frequently. The effect of standardised nurse and patient training on peritoneal dialysis infections is uncertain. The aim of this study was to determine whether implementing an international guideline-based standardised training curriculum for nurse trainers and new peritoneal dialysis patients reduces the risk of peritoneal dialysis-related infections compared with existing local training practices. Targeted Education ApproaCH to improve Peritoneal Dialysis (TEACH-PD) was a pragmatic, investigator-initiated, cluster-randomised controlled trial conducted in Australia and New Zealand. Adult patients 18 years of age or older with kidney failure who required training for incident peritoneal dialysis treatment and who were able to provide written informed consent were eligible. Clusters were randomised 1:1 to either the standardised training curriculum or usual care. Participant data and infection outcomes were routinely collected in national patient registries. The primary outcome was time to first peritoneal dialysis-related infection (exit site infection, tunnel infection, or peritonitis). Secondary outcomes were the first of each individual infection type in the primary composite outcome, catheter removal, haemodialysis transfer, all-cause death and quality of life. This trial was registered with ClinicalTrials.gov, number NCT03816111. Between 22 July 2019 and 29 September 2023, 42 clusters were randomised: 21 to the standardised training group and 21 to the usual care group. Overall, 1462 incident peritoneal dialysis patients were included; 667 were assigned to the standardised training group and 795 to the usual care group. A peritoneal dialysis-related infection occurred in 296 of 667 patients in the standardised training group and 297 of 795 patients in the usual care group (sub-hazard ratio 1.230, 95% confidence interval [CI] 1.004-1.507, p = 0.0457). Secondary outcomes were similar in the two groups. Among patients commencing peritoneal dialysis, the use of a standardised training curriculum for nurses and patients based on the International Society for Peritoneal Dialysis guidelines increased peritoneal dialysis-related infection. Implementation-focused research is needed to identify which elements of training require standardisation and where individualisation is most beneficial to support safe, sustainable and patient-centred peritoneal dialysis care. The TEACH-PD trial is funded by MRFF Clinical Trials Activity: Rare Cancers, Rare Diseases and Unmet Need Grant Opportunity; National Health & Medical Research Council BEAT-CKD Program Grant; Health Research Council of New Zealand grant; Metro South Health Research Support Scheme Research Fund-Health System and Health Economics Project Grant; Queensland Health; South Western Sydney Research Small Grant Scheme; International Society for Peritoneal Dialysis; Translational Research Institute Australia; Amgen and Baxter Healthcare (Vantive).

US healthcare systems are struggling to meet the growing demand for neurological care, particularly in Alzheimer's disease and related dementias. Generative artificial intelligence (AI) built on large language models now enables agentic AI systems that can streamline clinical workflows, integrate multimodal data and learn from practicing specialists. We envision an agentic AI system that scales specialist-level care to nonspecialist clinical settings through a continuously learning healthcare system. We describe this destination and outline a phased roadmap for responsible design and integration into care of Alzheimer's disease and related dementias: (1) high-quality standardized data collection across modalities; (2) decision support; (3) clinical integration enhancing workflows; (4) rigorous validation and monitoring protocols; (5) continuous learning through clinical feedback; and (6) robust ethics and risk management frameworks. This human-centered approach optimizes clinicians' capabilities in comprehensive data collection, interpretation of complex clinical information and timely application of relevant medical knowledge while prioritizing patient safety, healthcare equity and transparency.

The WHO International Nonproprietary Names (INN) system for monoclonal antibodies underwent its most fundamental revision in 2021-2022, retiring the universal -mab suffix and replacing it with four structure-based stems (-tug, -bart, -ment, -mig). Simultaneously, new stems for JAK inhibitors (-citinib), BTK inhibitors (-brutinib), and oral peptide receptor antagonists (-kinra) have entered dermatological practice. These changes are not yet systematically addressed in dermatology education. Dermatologists prescribe the broadest range of biologic drug classes of any specialty, spanning anti-TNF, anti-interleukin, checkpoint inhibitor, JAK/TYK2/BTK inhibitor, and oral peptide antagonist therapies. This review provides a practical, disease-organized framework for decoding biological drug names, with a three-step algorithm, reference tables covering 26 approved agents, and guidance on biosimilar naming across FDA, EMA, and CDSCO systems. The post-2022 structural stems carry direct pharmacokinetic implications, and two currently used agents (sonelokimab and certolizumab pegol) are structurally misclassified under their legacy -mab names. Nomenclature literacy directly affects adverse event attribution, biosimilar substitution decisions, and pipeline evaluation. Understanding this evolving system is a patient safety competency for practicing dermatologists.