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Background The cultivation of empathy for healthcare providers is an important issue in medical education. Narrative medicine (NM) has been shown to foster empathy. To our knowledge, there has been no research that examines whether a NM programme affects multi-professional healthcare providers’ empathy. Our study aims to fill this gap by investigating whether a NM programme effects multi-professional healthcare providers’ empathy. Methods A pre-post questionnaire method was used.142 participants ( n  = 122 females) who attended the NM programme were divided into single ( n  = 58) and team groups ( n  = 84) on the basis of inter-professional education during a period of 2 months. Perceptions of the NM programme were collected using our developed questionnaire. Empathy levels were measured using the Chinese version of Jefferson Scale of Empathy - Healthcare Providers Version (JSE-HP) – at three time points: prior to (Time 1), immediately after (T2), and 1.5 years (T3) after the programme. Results Participants’ perceptions about the NM programme ( n  = 116; n  = 96 females) suggested an in enhancement of empathy (90.5%). Empathy scores via the JSE-HP increased after the NM programme (T1 mean 111.05, T2 mean 116.19) and were sustainable for 1.5 years (T3 mean 116.04) for all participants ( F (2297) = 3.74, p  < .025). A main effect of gender on empathy scores was found ( F (1298) = 5.33, p  < .022). No significant effect of gender over time was found but there was a trend that showed females increasing empathy scores at T2, sustaining at T3, but males demonstrating a slow rise in empathy scores over time. Conclusions NM programme as an educational tool for empathy is feasible. However, further research is needed to examine gender difference as it might be that males and females respond differently to a NM programme intervention.

Background Clinical reasoning is a fundamental skill in healthcare education, crucial for diagnosing and managing patient care effectively. Traditional pedagogical techniques often fall short in fully engaging students or simulating real-life medical decision-making complexities. Gamification, which applies game-design elements in educational settings, has emerged as a promising strategy to enhance learning outcomes by making the educational process more interactive and engaging. This scoping review aims to comprehensively map the existing literature on gamification techniques used to enhance clinical reasoning education, identifying trends, gaps, and opportunities for future research. Methods The review followed the Joanna Briggs Institute (JBI) methodology and the Arksey and O’Malley framework for scoping reviews. A systematic search of Medline, Scopus, and Web of science, complemented by hand-searching reference lists. Studies published between 2014 and 2023, focusing on gamification applied to clinical reasoning education for healthcare professionals and trainees, were eligible for inclusion. Two independent reviewers screened and selected studies, and data were extracted using a pre-defined tool. Findings were synthesized using both quantitative summaries and qualitative thematic analysis. Results Fifty-three studies met the inclusion criteria, representing research from 20 countries, with the United States contributing the largest proportion (28.3%), followed by Germany (9.4%) and France (7.6%). The majority of studies were cross-sectional (28.3%) or pilot studies (22.6%). Gamification was most frequently applied in university and academic settings (37.7%), followed by clinical and hospital-based training (18.9%), and digital platforms and simulations (17.0%). Medicine (28.3%) and nursing (22.6%) were the most targeted disciplines, with pharmacy (13.2%) following. Serious games were the most common gamification technique (45.3%), with additional strategies including escape rooms (11.3%), board and card games (7.5%), and branching case-based games (5.7%). Most studies (88.7%) referenced at least one theoretical framework, predominantly game-based learning theories (34.0%), followed by constructivist learning (13.2%) and experiential learning theories (13.2%). However, cognitive theories, directly relevant to clinical reasoning, were referenced in only 11.3% of studies, highlighting a theoretical gap. Conclusions Gamification offers diverse and flexible strategies for enhancing clinical reasoning education across healthcare disciplines and settings. However, significant gaps remain, including limited longitudinal evidence, inconsistent use of validated reasoning assessments, underutilization of cognitive reasoning theories, and a lack of standardized design and reporting frameworks. Moreover, research predominantly focuses on medicine and nursing, with limited attention to interprofessional reasoning and underrepresented fields such as dentistry, rehabilitation, and allied health. Future research should prioritize theoretically informed gamification design, apply robust reasoning outcome measures, and explore emerging technologies such as AI-enhanced adaptive gamification and immersive virtual reality simulations to support clinical reasoning development. Addressing these gaps will ensure that gamification evolves from a promising innovation into a rigorously evidence-based strategy for enhancing clinical reasoning competence in healthcare education.

IntroductionAs the field of radiation oncology continues to evolve with rapidly advancing technologies, the need for innovative educational methods is critical. Extended reality (XR) technologies—including virtual reality, augmented reality and mixed reality—have emerged as transformative tools in medical education. While the potential of XR in healthcare education is recognised, there is a lack of comprehensive exploration specifically in the context of radiation oncology education. This scoping review aims to map the existing literature on XR technologies in radiation oncology training and education, identify barriers to their adoption and highlight opportunities for broader integration into curricula.MethodsThis scoping review will follow the Arksey and O'Malley framework with enhancements by Levac et al and will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A comprehensive search will be conducted across databases, including MEDLINE, Scopus and Web of Science, to identify relevant studies on the use of XR technologies in radiation oncology education. Studies will be selected based on predetermined inclusion criteria using the population, concept, context framework. Data extraction will focus on the types of XR technologies used, educational settings, learning outcomes, barriers to adoption and methodologies for evaluating XR effectiveness. The results will be synthesised through descriptive statistics and qualitative thematic analysis. A consultation phase will engage experts to refine findings and ensure the practical relevance of the review.Ethics and disseminationThis protocol does not require ethics approval at the current stage as it involves a scoping review of publicly available literature. Ethics approval will be obtained prior to initiating the consultation phase involving experts. Written informed consent will be obtained from all individual participants included in the study. The study will be conducted in accordance with relevant guidelines and regulations and was approved by the Chang Gung Medical Foundation Institutional Review Board on 13 May 2025 (ref.: 202500731B0). The findings of this review will be disseminated through peer-reviewed publications, conference presentations and tailored executive summaries aimed at educators, policymakers and stakeholders in radiation oncology education.

IntroductionIn the rapidly evolving field of medical education, gamification has emerged as a promising strategy to enhance clinical reasoning skills among healthcare professionals. By incorporating game-like elements into the learning environment, gamification strives to enhance engagement, motivation and knowledge retention. Given the importance of clinical reasoning in medical decision-making and patient care, this scoping review protocol aims to systematically explore developments, implementations and outcomes of gamification in clinical reasoning education.Methods and analysisThe scoping review will follow the Arksey and O'Malley methodological framework, enhanced by guidelines from the Joanna Briggs Institute. We will search four major databases: OVID Medline, Scopus and Web of Science using key terms such as “gamification,” “clinical reasoning,” and “medical education”. Studies will be selected based on the participants, concepts and contexts (PCC) framework, focusing on literature published in English. Two independent reviewers will screen studies and extract data on gamification elements used in clinical reasoning education. Any disagreement between the reviewers will be resolved by consulting a third person. We will provide a narrative synthesis of the findings, highlighting the variety of gamified strategies and their effects on clinical reasoning skills. This review will also map out gaps in the current literature and provide direction for future research.Ethics and disseminationThe scoping review, which aggregates and synthesises publicly available studies, does not require ethics approval due to its nature as a compilation of existing research. The reporting of findings will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist, promoting both thoroughness and transparency in our analysis. Our dissemination plan encompasses publication in a peer-reviewed journal and presentations at academic conferences focused on medical education. This strategy is designed to engage educators, curriculum designers and policymakers within the sector, ensuring our insights reach those who can apply them most effectively.

Background Clinical reasoning is a critical skill for healthcare professionals, vital for making accurate diagnoses and effective treatment decisions. This study focuses on enhancing collaborative clinical reasoning (CCR) among multidisciplinary healthcare teams in a neurosurgery intensive care unit (NICU) in Taiwan. The study utilizes video-reflexive ethnography (VRE) to examine the factors influencing CCR, the cognitive processes involved, and the efficacy of VRE in promoting CCR. Methods The study employed a qualitative research design, utilizing VRE. Participants included 17 healthcare professionals from a NICU, comprising attending physicians, residents, nurses, and respiratory therapists. Data collection involved video recordings of daily ward rounds, field observations, and reflexive interviews where participants reviewed video clips of their interactions. Thematic analysis was conducted on the transcripts of video recordings and interview. Results Thematic analysis revealed seven key themes in CCR: information sharing, active verbal and behavioral information gathering, information processing and recall, modification and discussion, short-term indications, and management plans and goals. Information sharing was fundamental, with team members frequently exchanging patient data to ensure a common understanding. Active information gathering, both verbal and behavioral, was crucial for obtaining real-time patient insights. Cognitive processing involved synthesizing data to form initial hypotheses, while modification and discussion highlighted the iterative nature of CCR. Conclusions This study underscores the importance of effective communication, active information gathering, and iterative discussions in enhancing CCR. VRE proved to be a valuable tool for promoting self-awareness and continuous improvement among healthcare teams. The findings suggest that education programs should focus on developing teamwork and communication skills, and interventions should aim to optimize information flow and foster a culture of open communication. By enhancing CCR, healthcare teams can improve patient outcomes and ensure safer healthcare delivery. Clinical trial number Not required, as this is not a clinical trial and does not involve any healthcare interventions with human participants.

Background Unresectable esophageal cancer harbors high mortality despite chemoradiotherapy. Better patient selection for more personalized management may result in better treatment outcomes. We presume the ratio of maximum standardized uptake value (SUV) of metastatic lymph nodes to primary tumor (NTR) in 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG PET/CT) may provide prognostic information and further stratification of these patients. Methods The patients with non-metastatic and unresectable esophageal squamous cell carcinoma (SCC) receiving FDG PET/CT staging and treated by chemoradiotherapy were retrospectively reviewed. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cut-off value for NTR. Kaplan-Meier method and Cox regression model were used for survival analyses and multivariable analyses, respectively. Results From 2010 to 2016, 96 eligible patients were analyzed. The median follow-up time was 10.2 months (range 1.6 to 83.6 months). Using ROC analysis, the best NTR cut-off value was 0.46 for prediction of distant metastasis. The median distant metastasis-free survival (DMFS) was significantly lower in the high-NTR group (9.5 vs. 22.2 months, p  = 0.002) and median overall survival (OS) (9.5 vs. 11.6 months, p  = 0.013) was also significantly worse. Multivariable analysis revealed that NTR was an independent prognostic factor for DMFS (hazard ratio [HR] 1.81, p  = 0.023) and OS (HR 1.77, p  = 0.014). Conclusions High pretreatment NTR predicts worse treatment outcomes and could be an easy-to-use and helpful prognostic factor to provide more personalized treatment for patients with non-metastatic and unresectable esophageal SCC.

Prion diseases, including Creutzfeldt–Jakob disease, are mediated by transmissible proteinaceous pathogens. Pathological changes indicative of neuro-degeneration have been observed in the brains of affected patients. Simultaneously, microglial activation, along with the upregulation of pro-inflammatory cytokines, including IL-1 or TNF-α, have also been observed in brain tissue of these patients. Consequently, pro-inflammatory cytokines are thought to be involved in the pathogenesis of these diseases. Accelerated prion infections have been seen in interleukin-10 knockout mice, and type 1 interferons have been found to be protective against these diseases. Since interleukin-10 and type 1 interferons are key mediators of the antiviral THαβ immunological pathway, protective host immunity against prion diseases may be regulated via THαβ immunity. Currently no effective treatment strategies exist for prion disease; however, drugs that target the regulation of IL-10, IFN-alpha, or IFN-β, and consequently modulate the THαβ immunological pathway, may prove to be effective therapeutic options.

This study evaluated the outcomes of hepatocellular carcinoma (HCC) patients with small normal liver volume (NLV) treated with proton beam therapy (PBT) and introduced estimated standard liver volume (eSLV) as a new constraint. HCC patients with NLV < 800 cm3 and no distant metastasis who received treatment in our proton center were included. The doses of PBT were mainly 72.6 Gray equivalents (GyE) in 22 fractions and 66 GyE in 10 fractions according to tumor locations. The Urata equation was used to calculate eSLV. Twenty-two patients were treated between November 2015 and December 2016. The 1-year progression-free and overall survival rates were 40.4% and 81.8%, respectively. The 1-year in-field failure-free rate was 95.5%. NLV ranged from 483.9 to 795.8 cm3 (median = 673.8 cm3), eSLV ranged from 889.3 to 1290.0 cm3 (median = 1104.5 cm3), and the resulting NLV/eSLV ratio ranged from 44.3 to 81.2% (median = 57.7%). Non-irradiated liver volume (NILV) ranged from 232.9 to 531.6 cm3 (median = 391.2 cm3). The NILV/eSLV ratio ranged from 21.2 to 48.0% (median = 33.3%). NLV in the patients who received <30 GyE (rV30) ranged from 319.1 to 633.3 cm3 (median = 488.2 cm3), and their rV30/eSLV ratio ranged from 30.7 to 58.0%. None of our patients developed liver failure. One patient with initial abnormal liver enzyme levels developed non-classic radiation-induced liver disease (RILD). From the viewpoint of minimal liver toxicity occurring in our patients with NLV < 800 cm3, conventional liver constraints involving the use of absolute volume could not accurately predict the risk of RILD. It is reasonable to start using individualized constraints with eSLV for HCC patients undergoing PBT. According to the study results, an NILV/eSLV ratio of >20% and an rV30/eSLV ratio of >30% are acceptable.

Objectives To investigate the prognostic value of the preoperative systemic immune‐inflammation index (SII) in patients with oral cavity squamous cell carcinoma (OC‐SCC) treated with curative surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CCRT). Materials and Methods We retrospectively reviewed the clinical records of patients with OC‐SCC who received surgery and postoperative adjuvant RT/CCRT between January 2005 and December 2012. Blood samples were drawn in the 2 weeks preceding surgery. SII was calculated by multiplying the absolute neutrophil and platelet counts, and then, divided by the absolute lymphocyte count, and its optimal cutoff value was identified using the Youden’s index. The study endpoints included overall survival (OS), local control (LC), regional control (RC), and distant control (DC). Results The study sample consisted of 993 patients (58.8% of them treated with CCRT). The optimal cutoff value for SII was 810.6. A total of 347 (34.9%) study participants had high preoperative SII values. After allowance for potential confounders in multivariable analysis, high SII values were independently associated with less favorable DC (adjusted hazard ratio [HR] = 1.683, p = 0.001) and OS (adjusted HR = 1.466, p < 0.001). No independent association between SII and LC/RC was observed. Conclusion Increased SII values predict poor DC and OS in patients with OC‐SCC treated with curative resection and adjuvant RT/CCRT. Owing to the higher risk of systemic failure in this patient group, a thorough follow‐up surveillance schedule may be advisable pending independent confirmation of our data. The SII is defined as platelet × neutrophil/lymphocyte counts. Increased SII values predict poor distant control and overall survival in patients with oral cancer treated with curative resection and adjuvant RT/CCRT. Owing to the higher risk of systemic failure in this patient group, a tight follow‐up surveillance schedule or adjuvant systemic treatment may be advisable pending independent confirmation of our data.

Due to the COVID-19 pandemic, numerous vaccines have been developed for the disease. However, with large-scale vaccination has come the gradual emergence of immunological phenomena caused by these new vaccines. Herein, we report a 48-year-old female with a sudden onset of inferior visual field defects in the left eye following her first dose of the ChAdOx1 vaccine. Dilated fundus examination combined with optical coherence tomography and fluorescein angiography confirmed the diagnosis of branch retinal artery occlusion. Within 4 weeks following vaccination, symptoms associated with hearing impairment developed, and magnetic resonance imaging revealed leptomeningeal enhancement. The diagnosis of Susac syndrome (SS) was confirmed. The development of SS may be caused by endotheliopathy resulting from the molecular mimicry of the ChAdOx1 vaccine. Clinicians should be aware of the symptoms of SS, which may develop after COVID-19 vaccination. Further experimental surveillance and case–control studies are required to confirm this relationship.