Purpose: Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching. Methods: This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups. Results: A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016). Conclusions: VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA. Trial registration: ClinicalTrials.gov Identifier: NCT05807828

Purpose: Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II–IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II–IV JARs must be created to effectively assess and categorize these data. Methods: Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II–IV JARs worldwide. The secondary aim was to record their lifetime, publications’ number and frequency and recognise differences with national JARs. Results: One hundred five Level II–IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case–control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. Conclusions: This is the first study mapping all Level II–IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.

Mobile vaccination units administered COVID-19 vaccines to homebound populations in Greece. This study explores the perspectives of public healthcare providers involved in the COVID-19 home vaccination program, aiming to identify challenges and propose improvements in the delivery of healthcare services at home. This study employed a cross-sectional mixed-methods design and was conducted within public Primary Health Care (PHC) facilities. It utilized a questionnaire consisting of both closed- and open-ended questions. The study population included healthcare professionals and administrative staff involved in vaccination units. Data were collected from April to July 2022 and analyzed using descriptive statistics for quantitative data and thematic analysis for qualitative data. The integration of both data types enhanced the depth and reliability of the findings. Ethical approval for the study was granted by the Bioethics Committee of the Aristotle University of Thessaloniki. Twelve hundred participants from 168 facilities across six Health Districts responded. The majority were nurses (34.1%) and general practitioners (24.7%). Participants overwhelmingly praised the concept of home-based care, aligning it with PHC, and expressed readiness for future involvement, despite time constraints. Four main themes emerged from the thematic analysis of 1,072 text responses. Challenges in providing such services included difficulties in balancing home care with existing workload, addressing understaffing, and achieving effective time management to prevent staff burnout and service disruptions. Participants’ experiences in the national COVID-19 home vaccination project highlight their positive attitudes toward home care while also underscoring several potential challenges in organizing similar home-based services.

Background and Objectives: The triglyceride–glucose (TyG) index is an accessible surrogate marker of insulin resistance and has been increasingly investigated for its prognostic relevance in cardiovascular disease. However, evidence regarding its predictive value for major adverse cardiovascular events (MACEs) in patients with acute coronary syndromes (ACSs) remains inconsistent. This study systematically assessed the association between TyG index and the risk of MACEs in individuals with ACS. Materials and Methods: Following PRISMA 2020 guidelines, PubMed, ScienceDirect, and ClinicalTrials.gov were searched through October 2025. Ten observational cohort studies including 32,751 ACS patients were analyzed. Studies reporting fully adjusted hazard ratios (HRs) for the association between TyG index and MACEs were eligible. A random-effects model was used to pool effect sizes expressed as adjusted HRs per 1-unit increase in the TyG index. Heterogeneity, sensitivity analyses, publication bias assessment, and meta-regression were conducted. Results: Higher TyG index values were significantly associated with increased MACE risk (pooled adjusted HR 1.45, 95% CI 1.25–1.68, I² = 80%). Leave-one-out analysis confirmed robustness. Meta-regression analysis suggested a stronger association in cohorts consisting exclusively of patients with type 2 diabetes mellitus, with a trend toward larger effect estimates in smaller studies, potentially contributing to the observed heterogeneity. Despite small-study effects, trim-and-fill-adjusted estimates remained significant (HR 1.26, 95% CI 1.05–1.52). Conclusions: An elevated TyG index is independently associated with higher MACE risk in ACS patients and may be considered as an additive metabolic risk marker in combination with established risk stratification tools, pending further prospective validation.

Background: Cardiac arrest is a time-critical medical emergency during which prompt and effective drug delivery plays a key role in patient outcomes. Current resuscitation guidelines recommend intravenous (IV) access as the first-line route, with intraosseous (IO) access recommended as an alternative when IV access is delayed or not feasible. Although the endotracheal (ET) route was previously included in resuscitation protocols, it is no longer recommended. This study aims to evaluate the pharmacokinetic (PK) and pharmacodynamic (PD) effects of resuscitation drugs administered through different injection sites and under varying hemodynamic conditions in in vivo animal models. Methods: PubMed, CENTRAL and ClinicalTrials.gov were searched up to August 2025 for studies comparing different injection sites for the same drug (adrenaline/epinephrine, amiodarone, lidocaine and vasopressin) during CPR. Study selection, data extraction, and quality assessments were performed independently by two reviewers. Frequentist random-effects models were used to calculate mean differences and odds ratios (ORs) with 95% confidence intervals (CIs). Results: Fourteen prospective experimental studies (sample sizes ranging from 15 to 49 animals) conducted on swine were included. For epinephrine under normovolemia, humeral IO (HIO) access achieved significantly higher maximum concentrations (C_max; p = 0.0238) and a shorter time to the maximum concentration (T_max; p < 0.01) compared to IV, translating into faster return of spontaneous circulation (ROSC) (p = 0.0681). Under hypovolemia, IV access proved superiority over IO for epinephrine administration (MD = +382.80 ng/mL; p = 0.0022). The time to ROSC was significantly shorter with sternal IO (SIO) compared to tibial IO (TIO) (p = 0.0109). For amiodarone and vasopressin, no consistent or statistically significant differences were observed between administration routes, and in several cases, the findings were based on a single study. Conclusions: The injection site significantly influences the PK and PD of epinephrine during cardiac arrest. Proximal IO routes may offer advantages under normovolemic conditions, while IV access appears superior in cases of hypovolemic shock. Further research is needed to guide optimal drug delivery in varying hemodynamic conditions during cardiac arrest.

During the pandemic, mobile vaccination units administered COVID‐19 shots to homebound populations. This study explores the perspectives of public healthcare providers involved in Greece's COVID‐19 home vaccination program, aiming to identify challenges and inform improvements in delivering healthcare services at home. This is a cross‐sectional mixed‐methods survey with convergent design, conducted in public Primary Health Care facilities, using a questionnaire. Facilities from all Health Districts were invited. The study population included healthcare professionals and administrative staff engaged in vaccination units. Data were collected from April to July 2022. Quantitative data were analyzed using descriptive statistics and univariate linear regression analysis, while qualitative data underwent thematic analysis. Integration at the analysis phase enhanced understanding and reliability. The study was approved by the Bioethics Committee of the Aristotle University of Thessaloniki. A total of 1200 participants from 168 facilities across six Health Districts responded. The majority were nurses (34.1%) and general practitioners (24.7%). Participants unanimously praised the program's concept, aligning it with Primary Health Care and expressed readiness for future involvement, but reported time constraints. Those in larger groups found time management easier (1.68, 95% CI [1.28, 2.20], p < 0.001). Thematic analysis of 1070 text responses identified five themes, including guidance for implementation, resource availability, field challenges, professionals' skillsets, and public engagement. Collaboration with colleagues and authorities to address transportation problems proved vital for success. Understaffing and time constraints were evident. Integrating a new service into busy settings poses challenges, underscoring the need for problem‐solving and empowering healthcare personnel to address shortcomings.