Publications by Year: 2026

IMPORTANCE: Restless legs syndrome (RLS) is a sleep-related movement disorder that affects approximately 3% of US adults to a clinically significant extent and can cause substantial sleep disturbance.

OBSERVATIONS: Restless legs syndrome is characterized by an overwhelming urge to move the limbs, typically the legs, often accompanied by unpleasant limb sensations (eg, achiness, tingling). Symptoms, provoked by immobility, are relieved while moving and are typically present or most severe in the evening or at night. Restless legs syndrome symptoms may lead to difficulty falling asleep, staying asleep, or returning to sleep. According to population-based studies, approximately 8% of US adults experience RLS symptoms of any frequency annually and 3% experience moderately or severely distressing symptoms at least twice weekly. Patients with RLS have impaired quality of life and elevated rates of cardiovascular disease (29.6% with coronary artery disease, stroke, or heart failure), depression (30.4%), and suicidal ideation or self-harm (0.35 cases/1000 person-years). Restless legs syndrome is common among patients with multiple sclerosis (27.5%), end-stage kidney disease (24%), and iron deficiency anemia (23.9%); during pregnancy and especially in the third trimester (22%); with peripheral neuropathy (eg, diabetic, idiopathic; 21.5%); and with Parkinson disease (20%). Other risk factors include family history of RLS, northern European descent, female sex (2:1 vs male sex), and older age (RLS prevalence of 10% in adults ≥65 years). Restless legs syndrome is diagnosed based on clinical history; polysomnography is not recommended for diagnosis. Iron supplementation with ferrous sulfate (325-650 mg daily or every other day) or intravenous iron (1000 mg) should be initiated for serum ferritin level less than or equal to 100 ng/mL or transferrin saturation less than 20%. If possible, medications associated with RLS, including serotonergic antidepressants, dopamine antagonists, and centrally acting H1 antihistamines (eg, diphenhydramine), should be discontinued. Gabapentinoids (eg, gabapentin, gabapentin enacarbil, pregabalin) are first-line pharmacologic therapy. In randomized clinical trials, approximately 70% of patients treated with gabapentinoids had much or very much improved RLS symptoms vs approximately 40% with placebo (P < .001). Dopamine agonists (eg, ropinirole, pramipexole, rotigotine) are no longer recommended as first-line medications due to the risk of augmentation, an iatrogenic worsening of RLS symptoms, which has an annual incidence of 7% to 10% with these medications. Patients who do not improve with first-line treatment or have augmented RLS often benefit from low-dose opioids (eg, methadone 5-10 mg daily).

CONCLUSIONS AND RELEVANCE: Restless legs syndrome affects approximately 3% of adults and can have negative effects on sleep and quality of life. Initial management includes cessation of exacerbating medications, as well as iron supplementation for patients with low-normal iron indices. If medication therapy is indicated, gabapentinoids are first-line treatment.

Cardiac magnetic resonance imaging (CMR) provides decisive advantages, particularly in coronary heart disease, myocarditis and cardiomyopathy. It accurately detects ischemia, scarring, edema and microvascular disorders, enables reliable risk stratification and supports treatment decisions such as revascularization or medication adjustments. Modern quantitative perfusion methods and artificial intelligence (AI)-based analyses further increase the diagnostic accuracy. In inflammatory myocardial and pericardial diseases, CMR using mapping techniques and late gadolinium enhancement (LGE) forms the basis for differentiated diagnostics and estimation of the prognosis. It also enables a precise etiological classification and provides prognostically relevant parameters in cases of hypertrophic, dilated, arrhythmogenic and restrictive cardiomyopathies. In the diagnostics of valvular diseases and the planning of interventional procedures and cardiac tumors, CMR provides essential additional information and demonstrates a high sensitivity and specificity. New techniques such as quantitative 4‑dimensional (4D) flow measurements, high-resolution 3D imaging and electrocardiograph (ECG)-independent scans will further increase its value. Due to the increasing number of CMR examinations, standardized procedures, qualified personnel and structured training programs are essential to ensure a high quality of care in the long term.

BACKGROUND: Central venous catheters (CVCs) are indispensable to contemporary critical care, perioperative management, and emergency resuscitation, yet their insertion remains fraught with preventable harm and inefficiency.

OBJECTIVE: This study aimed to identify all areas of CVC placement that can be improved through device design using human-centered design and qualitative research methods.

METHODS: This qualitative study was a contextual inquiry of CVC placement, which included observation alongside brief face-to-face interviews with physicians. It was aimed at providing a depth of understanding using evidence to demonstrate causality. This study was conducted at 3 hospitals in the emergency department, the intensive care unit, and the operating rooms. Where possible and with additional consent, sessions were recorded in video or still photography, or at times both. This study included 19 observations and 24 interviews.

RESULTS: In this study, the approach to CVC insertion was consistent across hospitals and care environments, with moderate variability spanning a few sections, such as suture and dressing use or lack thereof in specific care environments. The described and observed difficulties leave room for improvement in device design. The results of this study indicated that there are 34 discrete steps to placing a CVC line, with most time spent during sterile preparation. As a result of the device or kit design, challenges were observed. These included missing essential materials from kits, difficulty distinguishing between nonsterile and sterile items, challenges with lidocaine ampules, patient claustrophobia from draping, and a lack of user preference for kit contents. Additional challenges included obscured ultrasound views, kinked guidewires, overall procedural untidiness, and considerable waste management issues.

CONCLUSIONS: An intuitive kit that aligns with predictable human behavior and eliminates unnecessary multistep detours can reduce novice failure rates, cognitive load, and practice inconsistency, and it could also curb nonrecyclable waste from "backup" kits opened for a single missing item. By reframing CVC systems as sociotechnical solutions rather than static assortments of parts, the same design moves that minimize improvisation and coordination errors for physicians may also reduce dwell time and manipulation events for patients, thereby advancing the core triad of safety, procedural efficacy, and everyday usability. By examining how clinicians place central lines, this study reveals modifiable design flaws that perpetuate risk despite decades of procedural standardization. Contextual inquiry provides the evidentiary bridge between clinical imperatives to reduce complications and the practical realities of device use. Embedding such investigations at the outset of design and iteratively throughout product life cycles offers a path toward safer, more efficient, and more humane central venous access for both patients and providers.

BACKGROUND/OBJECTIVE: The rising prevalence of Type 2 Diabetes Mellitus (T2DM), coupled with sedentary behavior and an increase in obesity rates in South Asian countries, calls for effective management strategies. We aimed to assess the efficacy of lifestyle interventions on glycemic control among adults with T2DM in South Asian countries.

METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to assess the effectiveness of lifestyle interventions on glycemic control in adults diagnosed with T2DM in South Asia. We conducted a comprehensive search in CINAHL, Embase, PubMed, Cochrane Library, Web of Science (WoS), and Scopus to identify related studies published from 2000 to 13 June 2024. We assessed the risk of bias using the ROB 2.0 tool and calculated the pooled mean differences in HbA1c and FBG levels under a random-effects model. We conducted subgroup and leave-one-out sensitivity analyses to assess and explore sources of heterogeneity. PROSPERO Registration: CRD42024552286.

RESULTS: We included 16 RCTs with a total of 1499 participants. Lifestyle interventions reduced HbA1c levels by 0.86% (95% CI: -1.30 to -0.42, p < 0.01) and FBG levels by 22.49 mg/dL (95% CI: -32.88 to -12.10, p < 0.01). We observed substantial heterogeneity (I2 = 98% for HbA1c and I2 = 87% for FBG). Subgroup analyses indicated larger HbA1c reductions in long-term (-1.44%) than short-term trials (-0.62%), and greater FBG decreases in long-term (-23.7 mg/dL) versus short-term studies (-22.5 mg/dL). Physical activity interventions had the largest improvements (HbA1c -0.99%; FBG -26.1 mg/dL), followed by dietary (HbA1c -0.59%; FBG -15.8 mg/dL) and combined programs (HbA1c -0.55%). Participants aged >50 years achieved greater glycemic improvements (HbA1c -0.92%; FBG -24.0 mg/dL) compared to younger adults (HbA1c -0.60%; FBG -21.3 mg/dL). Despite high heterogeneity, sensitivity analyses confirmed the robustness of the overall findings.

CONCLUSIONS: Lifestyle modifications yielded a clinically significant reduction in HbA1c and FBG in adults with T2DM in South Asia. Although heterogeneity of the included studies was substantial, the direction of the effects was uniformly consistent across subgroups. To further validate these findings and assess their long-term effects, large-scale and standardized RCTs conducted for longer durations are necessary.