Physiotherapist-led care for musculoskeletal conditions in the emergency department (RESHAP-ED): a randomised controlled trial with economic evaluation.

August 27, 2026| Source: Lancet (London, England)

Long stays in the emergency department compromise patient safety and health system performance. Physiotherapist-led models of care may improve care and emergency department performance, but their effects have not been rigorously evaluated in randomised trials. We compared the effectiveness, safety, and cost-effectiveness of physiotherapist-led care with usual care for patients presenting to the emergency department with musculoskeletal conditions. RESHAP-ED was an open-label, pragmatic, randomised trial that recruited adults aged 18 years and older at five emergency departments in New South Wales, Australia, with uncomplicated musculoskeletal conditions (eg, soft tissue conditions, neck and back pain, and fractures or dislocations not requiring orthopaedic review or surgery). Participants were randomly assigned (1:1), using statistician-generated randomly permuted blocks, to either physiotherapist-led care (intervention) or usual physician-led or nurse practitioner-led care (control). The primary outcome was length of stay in the emergency department, calculated as time from arrival to discharge, analysed in the intention-to-treat population using a linear mixed-effects model. The trial was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12623000782639) and is completed. Between Nov 22, 2023 and March 29, 2025, 4219 patients were screened, 2728 were deemed ineligible for inclusion, and 1491 participants were randomly assigned (746 assigned to the physiotherapy-led intervention group and 745 assigned to the physician-led or nurse-led practitioner control group). Following the exclusion of 16 participants after randomisation, 1475 were included in the analysis (737 in the intervention group and 738 in the control group). The mean age of participants was 40·1 years (SD 16·5). 719 (48·7%) participants were male, 755 (51·2%) were female, and one (0·1%) participant had unreported sex data. Follow-up for the primary outcome was 100% complete. The mean length of stay in the emergency department was 2·4 h in the intervention group and 3·4 h in the control group (-1·0 h [95% CI -1·2 to -0·8]). Adverse events were reported by 39 (6·6%) of 591 participants in the intervention group versus 33 (5·9%) of 555 in the control group (p=0·72). The intervention group had lower costs (-$35·1 [95% CI -69·0 to -1·7]) and a high probability (98·1%) of being cost-effective. A physiotherapist-led model of care in the emergency department reduced length of stay among patients presenting with uncomplicated musculoskeletal conditions, without compromising health outcomes or safety, and was cost-effective. Medical Research Future Fund.

Read the original source →

The honey bee stinger: An unusual pump with collapsible double pistons.

Most stinging animals deliver venom by contracting muscles around a venom reservoir, but honey bees employ a fundamentally different strategy. The stingers of worker bees have the unique ability to autotomize, separating from the body, to continue to sting independently. Despite more than a century of anatomical descriptions, the mechanics of venom pumping have remained unresolved due to the challenges of observing them in action. We recorded high-speed videos of active, autotomized stingers, co

Chronic cigarette smoke exposure induces distinct stem cell states driving genetic driver-specific non-small cell lung cancer subtypes.

Cigarette smoke-induced chronic inflammation (CI) potentiates development of non-small cell lung cancer (NSCLC) by mediating genetic and epigenetic events. Using normal lung organoids (LOs), we define how chronic cigarette smoke condensate (CSC) exposure drives two separate stem cell populations to evolve premalignant states harboring progressive epigenetic and linked transcriptomic abnormalities in the absence of major driver mutations. These dynamics facilitate evolution of an immune evasive s

Cell identity competes with surface tension to determine stromal organization in tumor spheroids beyond the CAF shell paradigm.

Cancer-associated fibroblasts (CAFs) are often found forming a peripheral stromal barrier around tumors. Here, this paradigm is challenged using microfabricated 3D cancer-CAF spheroid models combined with quantitative magnetic force tensiometry. A surface tension atlas is established for eight cancer cell lines, three CAF populations, and heterotypic tumor-CAF assemblies, spanning nearly two orders of magnitude. Surface tension is first shown to govern spheroid morphology and modulate drug respo

A phenome-wide structural variant map from 467,152 UK Biobank genomes.

Structural variants (SVs) are large (>50 base pairs) genomic rearrangements that can significantly influence human phenotypes, yet their contribution to health and disease remains undercharacterized. We conducted a phenome-wide association study (PheWAS) of 1.6 million SVs identified in whole-genome sequencing data from 467,152 UK Biobank participants, across 13,322 binary, 2,018 quantitative, and 2,923 plasma protein traits. Of these, 82.25% of SVs were outside the detectable range of prior

Mitochondria-targeted tetraoxanes initiate lipid peroxidation to drive ferroptosis and tumor suppression.

Ferroptosis is implicated as a vulnerability in multiple cancers, yet approaches for effectively inducing ferroptosis in vivo are limited. Bypassing conventional strategies targeting the antiferroptotic glutathione peroxidase 4 (GPX4) and ferroptosis suppressor protein 1 (FSP1) proteins, we designed metabolic initiators of lipid peroxidation (MILPOs) and developed the compounds WMK-1/2, which contain tetraoxane radical-generating and mitochondria-targeting groups, as de novo ferroptosis inducers