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Teclistamab, a B cell maturation antigen-targeting bispecific antibody, has demonstrated substantial activity in relapsed multiple myeloma (MM), particularly in earlier lines of therapy, and may have higher efficacy in high-risk smoldering MM (HR-SMM) with a more functional immune system. In the randomized phase 2 ImmunoPRISM trial, we compared fixed-duration teclistamab with lenalidomide-dexamethasone (Rd) in HR-SMM. After a six-patient safety run-in, patients were randomized 2:1 to teclistamab or Rd. The primary endpoint was complete response (CR) rate. As of 26 May 2026, 59 patients were treated-45 received teclistamab and 14 received Rd. Teclistamab treatment induced a CR in 77.8% patients versus 0% with Rd, and minimal residual disease negativity at 10-5 in 82.2% patients. At a median follow-up of 24.5 months, 2-year progression-free survival was 92% with teclistamab versus 49% with Rd. Overall, response rates, duration of response and time to progression (TTP) were significantly improved in teclistamab compared to Rd. Toxicities in the teclistamab arm included grades 1-2 cytokine release syndrome, no neurotoxicity and no increase in grade 3 infections compared to Rd (20% versus 21%). No deaths occurred in either arm. Teclistamab represents a highly active immune-interception strategy for HR-SMM. ClinicalTrials.gov registration: NCT05469893 .

Digital game-based learning (DGBL) is gaining traction in medical and nursing education, but its integration into public health and health sciences curricula remains limited. This study addresses this research gap by exploring student perspectives, use patterns, and expectations regarding DGBL within German public health study programs. The study investigated how public health and health sciences students perceive DGBL and identified conditions that promote or hinder its integration into academic training for public health professionals. A cross-sectional online survey was conducted from January 2021 to March 2024. A total of 444 students participated, with 326 completing the questionnaire. The instrument combined closed- and open-ended questions on sociodemographic characteristics, digital media use, attitudes toward DGBL, and structural and pedagogical requirements. Quantitative data were analyzed descriptively using SPSS; qualitative data were evaluated using MAXQDA and Kuckartz structured content analysis. The sample consisted predominantly of full-time students enrolled in bachelor's or master's programs in public health and health communication. Digital media are widely used for communication (n=320, 98.2%), information search (n=291, 89.3%), and entertainment (n=268, 82.2%) in daily student routines. In contrast, video gaming and online shopping play a minor role. Students expressed a generally positive attitude toward DGBL, particularly in practical learning contexts such as exam preparation, visualizing complex content, and knowledge checks. High agreement was found for using DGBL in modules such as Prevention and Health Promotion (n=277, 84.9%), Epidemiology and Statistics (n=271, 83.2%), and Population Medicine (n=251, 76.7%). Preferred devices include desktop PCs, tablets, and smartphones, while immersive technologies such as virtual reality or augmented reality glasses or consoles are less favored. Students highlighted specific prerequisites for DGBL integration: a functioning technical infrastructure (n=321, 98.5%), media-literate teaching staff (n=311, 95.4%), and compliance with data protection standards (n=303, 93%). Furthermore, students valued user-friendly design (n=255, 78.2%), technical reliability (n=299, 91.7%), clear feedback (n=236, 72.4%), and flexibility regarding the time and place of use (n=307, 94.2%). Game elements such as animations, multimedia, and reward systems were appreciated, whereas features such as 3D graphics, avatars, and multiplayer modes were considered less important. The findings show a high willingness among students to engage with DGBL, especially when its design emphasizes clarity, usability, and relevance to course content. Emotional safety, flexible access, and pedagogical integration are more decisive than immersive game features. To effectively implement DGBL in public health education, developers and educators should cocreate low-threshold, didactically sound applications that align with students' preferences and study realities. Future research should assess learning outcomes and emotional effects longitudinally and explore scalable implementation strategies.

Type 1 diabetes is an autoimmune disease that targets and destroys insulin-producing beta cells in the pancreatic islets. The incidence of type 1 diabetes is rising globally. At the clinical diagnosis of type 1 diabetes, between 20% and 67% of children and adolescents present with diabetic ketoacidosis (DKA) requiring hospitalisation, and one-third of these require intensive care. Type 1 diabetes can be detected in early stages, prior to the insulin-requiring clinical diagnosis, through screening for islet autoantibodies (IAbs). Identifying individuals with early-stage type 1 diabetes, combined with monitoring of and education on disease progression, prevents DKA and results in a milder clinical onset. This allows for timely insulin initiation in outpatient settings and improved long-term glucose management. Early diagnosis also enables access to novel disease-modifying therapies that can delay the clinical onset of diabetes. In this international consensus, we provide guidance on the principles and practice of implementing general population screening for IAbs to diagnose early-stage type 1 diabetes. We also outline the minimum requirements for establishing effective population screening programmes to diagnose early-stage type 1 diabetes through IAb detection. This consensus statement has been endorsed by the following professional associations: Advanced Technologies & Treatments for Diabetes (ATTD); Association of Diabetes Care and Education Specialists (ADCES); Association Belge Du Diabète; Associazione Medici Diabetologi (AMD); Australian Diabetes Society (ADS); Belgian Diabetes Liga; Breakthrough T1D; Czech Diabetes Society (ČDS); EASD; Finnish Diabetes Association (FDS); Fondazione Italiana Diabete (FID); International Diabetes Federation (IDF)-Europe; International Society of Paediatric and Adolescent Diabetes (ISPAD); Paediatric Endocrinology Nursing Society (PENS); Polish Diabetes Society; Portuguese Diabetes Association (APDP); Sociedade Portuguesa de Diabetologia (SPD); Società Italiana di Diabetologia (SID); Société Francophone du Diabète (SFD) and Type 1 Diabetes Exchange (T1D Exchange).

Acute ischemic stroke (AIS) survivors are at high risk of major adverse cardiovascular events (MACE), highlighting the need to identify modifiable secondary prevention targets. We assessed whether postacute discharge destination is associated with 1-year MACE risk among AIS survivors. In this retrospective cohort study, adult AIS survivors were identified from the state inpatient and emergency department databases of 5 US states (2016-2019) and categorized by discharge destination: home, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). Other destinations were excluded. The primary outcome was 1-year MACE, defined as recurrent stroke, acute myocardial infarction, systemic embolism, or vascular death. Multivariable Cox models, adjusted for demographic and clinical factors, were used to evaluate the association between discharge disposition and MACE risk. Fine-Gray models were used for nonfatal secondary outcomes, and restricted mean survival time analyses were used to estimate absolute risk. Effect modification by age (<65 versus ≥65 years) was examined. Confounder-adjusted number-needed-to-be-exposed was estimated by marginal standardization. Among 213 511 AIS survivors (median age, 71 years), 16 237 (7.6%) experienced MACE within 1-year. MACE incidence was lowest after IRF discharge (6.6%) versus home (7.6%) or SNF (8.3%). In adjusted analyses, IRF discharge was associated with lower MACE risk versus home (adjusted hazard ratio, 0.88 [95% CI, 0.83-0.93]) and SNF (0.84 [95% CI, 0.79-0.89]). The association persisted across age strata but was more pronounced in patients <65 years (Pinteraction=0.014). Restricted mean survival time analyses indicated that IRF discharge was associated with 3.47 and 3.87 additional MACE-free days versus home and SNF discharge, respectively (both P<0.001). Adjusted number-needed-to-be-exposed were 115 (95% CI, 80-207) for IRF versus home and 87 (95% CI, 64-136) for IRF versus SNF. Postacute IRF discharge is associated with a lower 1-year MACE risk after AIS, highlighting the postacute care setting as a potentially modifiable system-level target for secondary prevention of long-term vascular outcomes.

Improved survival from critical illness has produced a growing population of intensive care unit (ICU) survivors with new or worsened physical, cognitive, and mental-health impairment, defined as post-intensive care syndrome (PICS), and frequent distress among families/caregivers (PICS-family, PICS-F). This narrative review synthesises the evidence in adults treated in high-resource settings. Rather than a formal guideline process, we used a structured descriptive approach: for each recommendation, we identified the predominant study design, assessed the consistency of findings, summarised uncertainties, and assigned an evidence-strength label (high, moderate, low, or insufficient). We summarise the definition of PICS and its overlap with related constructs (post-sepsis morbidity, chronic critical illness, post-COVID conditions, and frailty); the mechanisms linking acute injury to persistent disability, including skeletal-muscle pathobiology, neuroinflammation, mitochondrial and neuroendocrine dysfunction, and epigenetic change; and the instruments assessing the three PICS core domains (recommending a two-step assessment approach), as well as quality of life, across the care continuum. We describe preventive and rehabilitative interventions from the ICU (e.g., the ABCDEF bundle that includes light/no sedation, delirium prevention, early mobilisation and family participation) through the ward to the post-hospital phase, the heterogeneous organisation of post-ICU recovery services, PICS-F, the educational and cultural change needed, and the health-system and policy context. PICS-F affects 20-60% of relatives; nurse-led family interventions seem promising. The evidence base remains limited and heterogeneous, preventing firm recommendations. Research priorities include harmonised outcome measurement, phenotyping of recovery trajectories, the optimal dose and timing of rehabilitation, and rigorous comparison of follow-up models.

Daily witnessed ingestion in community-based pharmacies is standard practice for methadone maintenance treatment for opioid use disorder in British Columbia, Canada. Whether this practice, compared with take-home methadone, may pose a barrier to sustained retention in treatment and its lifesaving benefits is not known. To assess the different initiation times of methadone take-home doses in terms of time to all-cause mortality and methadone discontinuation, defined as a gap in prescribed doses lasting 5 or more days. This cohort study using principles of target trial emulation used observational data from British Columbia, Canada, 2010-2022. Both incident (no history of opioid agonist treatment [OAT]) and prevalent new-user (no OAT within the past month) designs were used. The study included individuals aged 18 years or older who completed OAT induction, were not pregnant or incarcerated, and had no history of cancer treatment or palliative care. Data analyses were conducted from March 5, 2025, to May 29, 2026. Exposure strategies were (1) no take-home dosing, (2) take-home dose initiation within 0 to 4 weeks after completing induction, (3) take-home dose initiation within 5 to 12 weeks after completing induction, (4) take-home dose initiation within 13 to 24 weeks after completing induction, and (5) take-home dose initiation within 25 to 52 weeks after completing induction. Outcomes were time to all-cause mortality and methadone discontinuation. A clone-censor-weight approach was used to estimate the 78-week adjusted risk difference (ARD). A total of 9788 incident users (median age, 34.1 [IQR, 27.2-44.1] years; 32.8% female) and 31 658 prevalent new users (median age, 36.9 [IQR, 29.7-46.2] years; 33.3% female) were included. Compared with no take-home dosing in prevalent new-user analysis, ARDs for the mortality outcome were -0.87 (95% CI, -1.51 to -0.23) for take-home dose initiation within 0 to 4 weeks after completing induction, -0.98 (95% CI, -1.62 to -0.33) for take-home dose initiation within 5 to 12 weeks after completing induction, -0.82 (95% CI, -1.59 to -0.06) for take-home dose initiation within 13 to 24 weeks after completing induction, and -0.31 (95% CI, -1.05 to 0.44) for take-home dose initiation within 25 to 52 weeks after completing induction. Compared with no take-home dosing in prevalent new-user analysis, the discontinuation outcome ARDs were -2.04 (95% CI, -3.99 to -0.10) for take-home dose initiation within 0 to 4 weeks after completing induction, -5.29 (95% CI, -6.82 to -3.76) for take-home dose initiation within 5 to 12 weeks after completing induction, -5.97 (95% CI, -7.16 to -4.78) for take-home dose initiation within 13 to 24 weeks after completing induction, and -4.39 (95% CI, -5.37 to -3.42) for take-home dose initiation within 25 to 52 weeks after completing induction. Similar patterns were observed among incident users. Multiple sensitivity analyses with sample restrictions, time-0 classifications, timeline restrictions, and addressing residual confounding bias supported the primary results. Results of this study suggest that initiating take-home methadone within 5 to 12 weeks and 13 to 24 weeks after completing induction resulted in the greatest benefits in reducing mortality and treatment discontinuation, although any take-home dosing was consistently better than no take-home dosing. These client-level benefits warrant consideration when refining clinical guidelines on take-home dosing.

Skin wound management poses a critical clinical challenge, as conventional dressings and systemic therapies fail to adapt to the dynamically evolving, complex wound microenvironment. Herein, we develop a breathable, self-adhesive, multifunctional wound dressing built on a gradient-wettable Janus trilayer fibrous membrane. This platform integrates in-situ biochemical sensing with combined antibacterial drug delivery and electrical-stimulation therapy. The vertically stacked trilayer architecture separately incorporates a multiplexed electrochemical sensor array (glucose, lactate, pH), a silver sulfadiazine drug reservoir, and stimulation electrodes. Benefiting from gradient wettability, the membrane achieves directional exudate transport, sequentially triggering passive drug release and enabling in-situ wound biomarker tracking. The integrated stimulation electrodes further facilitate wound healing. The dressing is thin, breathable, stretchable, self-adhesive and biocompatible. It conforms to deformable skin and stably captures biochemical signals without additional adhesives, ensuring wear comfort and a favorable wound microenvironment. Preclinical evaluations confirm the dressing achieves accelerated infected wound healing and reliable in-situ wound monitoring. This integrated platform offers a promising strategy for next-generation wound care and regenerative medicine.