Effectiveness of Structured Communication Tools for Discussing Goals of Care in Cancer Care Settings: A Systematic Review

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Background and aim: Structured communication tools have been increasingly adopted in cancer care to support discussions on goals of care (GOC), symptom management, and psychosocial needs. However, evidence regarding their effectiveness across outcomes remains fragmented. The study aims to synthesize evidence on the effectiveness of structured communication tools used in cancer care settings for discussing goals of care, with a focus on patient, caregiver, and system-level outcomes.

Method: A comprehensive search was conducted in databases including PubMed, Google Scholar, Clinical Key, and Cochrane Library from January 2000 to July 2025. Eligible studies included quasi-experimental trials, Randomized controlled trials (RCTs), cluster randomized trials, and cohort studies evaluating structured communication interventions. Two reviewers independently screened articles, extracted data, and assessed the Risk of bias using the ROB-I, ROB-I (Cluster), ROBINS-I V2, and ROBINS-E tools. Outcomes of interest were broadly encompassed, including quality of life(QoL), psychological status, patient satisfaction, decisional conflict, hospice utilization, and advance care planning. Due to heterogeneity in study designs and outcomes, a narrative synthesis was performed.

Results: From an initial pool of 310 articles, 25 studies met the inclusion criteria. SCTs varied widely and included FLEX Care, end-of-life (EOL) care planning, communication training, Loop intervention, Serious Illness Care Program, PCAD pathway, GOC conversation, and an adapted end-of-life care module, etc. Studies reported improved QoL (n=10), psychological status (n=3), patient/staff/caregiver satisfaction (n=3), decisional conflict (n=2), hospice utilization, and advance care planning (n=7). Mean scores for psychological distress participants receiving FLEX Care®-enhanced psychosocial intervention experienced a significant reduction in psychological distress compared to participants in the control setting (p<0.001). EOL discussions were associated with lower rates of ventilation (AOR=0.26, 95%CI=0.08-0.83), resuscitation (AOR=0.16, 95%CI=0.03-0.80), ICU admission (AOR=0.35, 95%CI=0.14-0.90), and earlier hospice enrolment (AOR=1.58, 95% CI=1.04-2.63). while longer hospice stays were associated with better patient QoL (p=0.01)

Conclusion: SCTs appear effective in improving the goals-of-care discussions in cancer settings, with benefits in care alignment and patient satisfaction. Implementation strategies and clinician training remain critical components for success.

 

Comparison of Serum Vitamin D Levels Between Arthralgia and Non-Arthralgia Groups Among Indoor Workers with Suspected Knee Osteoarthritis in Kupang City, Indonesia

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Background: Osteoarthritis is a degenerative joint disease commonly affecting the knee and often begins with joint pain or arthralgia. Vitamin D deficiency has been suggested as a contributing factor to musculoskeletal pain and cartilage metabolism disorders. Indoor workers may be at increased risk due to limited sunlight exposure and prolonged sitting duration.

Objective: To compare serum vitamin D levels between arthralgia and non-arthralgia groups among indoor workers with suspected knee osteoarthritis in Kupang City.

Methods: An observational analytic study with a cross-sectional design was conducted among 46 indoor workers from several government institutions in Kupang City. Participants were assessed through anamnesis, body mass index measurement, and evaluation of knee pain using the Visual Analogue Scale (VAS). Serum 25-hydroxyvitamin D levels were measured using the electrochemiluminescence immunoassay (ECLIA) method. Subjects were classified into arthralgia and non-arthralgia groups. Data were analyzed using the independent t-test.

Results: All participants were female, aged 18–59 years. Of the 46 respondents, 22 were classified as having arthralgia and 24 as non-arthralgia. A significant difference in serum 25-hydroxyvitamin D levels was observed between the two groups (p < 0.05). The arthralgia group showed a lower mean serum vitamin D level (17.2 ± 2.94 ng/mL) with a mean VAS score of 5.83, indicating moderate pain. In contrast, the non-arthralgia group had a higher mean serum vitamin D level (24.1 ± 2.51 ng/mL) with a VAS score of 0.

Conclusion: There was a significant difference in serum vitamin D levels between arthralgia and non-arthralgia indoor workers with suspected knee osteoarthritis in Kupang City, with lower vitamin D levels observed in the arthralgia group.

The Influence of Work Experience and Job Performance on Career Development Mediated by Career Training at the Ministry of Foreign Affairs and Cooperation of Timor-Leste in Indonesia.

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This study aims to analyze the influence of Work Experience (X1) and Job Performance (X2) on Career Development (Y), with Career Training (Z) as a mediating variable, at the Ministry of Foreign Affairs and Cooperation of Timor-Leste in Indonesia. Using a quantitative approach and a census method (saturated sampling) involving 62 employees, data were analyzed using Path Analysis (Partial Least Squares) based on Herzberg’s Two-Factor Theory. The results demonstrate that Work Experience (X1) has a significant positive effect on Career Development (Y), whereas Job Performance (X2) does not show a direct significant impact on Career Development (Y). Furthermore, while Career Training (Z) does not significantly mediate the relationship between Work Experience (X1) and Career Development (Y), it serves as a crucial mediating variable between Job Performance (X2) and Career Development (Y). These findings suggest that while practical experience naturally fosters career growth, high job performance requires structured training programs to effectively translate into professional advancement. Therefore, the organization should focus on enhancing training initiatives to bridge the gap between employee performance and career progression.

Quorum Quenching as an Ecological Modulator of Periodontal Biofilms

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Background: Periodontal disease is driven by dysbiotic biofilms characterized by altered microbial functions rather than mere pathogen overgrowth. Quorum sensing (QS) enables coordinated microbial behavior that sustains dysbiosis, while quorum quenching (QQ) has emerged as a strategy to disrupt microbial communication without bactericidal effects. Existing reviews primarily address QS inhibition broadly or focus on cariogenic biofilms, leaving a critical gap regarding the ecological implications of QQ in periodontal biofilms.

Objective: This scoping review aimed to map current evidence on quorum quenching strategies targeting periodontal bacteria, with a specific focus on their role in modulating biofilm ecology and restoring microbial balance.

Methods: A scoping review was conducted following PRISMA ScR guidelines. Searches were performed in PubMed, Scopus, and Web of Science for studies published between 2016 and 2025 investigating quorum quenching mechanisms in periodontal bacteria or periodontal biofilm models. Data were charted and synthesized descriptively.

Results: Five studies met the inclusion criteria. Quorum quenching strategies included enzymatic degradation of signaling molecules, inhibition of signal synthesis or reception, and natural compound based inhibitors. Most studies targeted interspecies signaling pathways and demonstrated reduced biofilm maturation, attenuation of virulence-associated functions, and partial restoration of symbiotic microbial behavior without eliminating commensals.

Conclusion: Quorum quenching represents a novel ecology based approach for periodontal biofilm management by reprogramming microbial communication rather than eradicating bacteria. This perspective highlights quorum quenching as a promising adjunctive strategy for restoring periodontal biofilm homeostasis

Analysis of Financial Performance on State-Owned Banks to Stock Prices on the Indonesian Stock Exchange

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This study analyzes the impact of the financial performance of State-Owned Banks (BUMN) on stock prices on the Indonesia Stock Exchange (IDX) during the 2020–2024 period, a dynamic timeframe influenced by the COVID-19 pandemic and economic fluctuations. Given the vital role of BUMN banks as a cornerstone of the economy, this research aims to examine how financial ratios, namely Capital Adequacy Ratio (CAR), Non-Performing Loan (NPL), Loan to Deposit Ratio (LDR), and Return on Assets (ROA), affect stock prices. Employing a quantitative approach with secondary data from the IDX and bank financial reports, the study sampled four prominent BUMN banks: PT Bank Mandiri, PT Bank Rakyat Indonesia, PT Bank Negara Indonesia, and PT Bank Tabungan Negara. The findings indicate that, partially NPL and ROA do not significantly influence stock prices, whereas CAR and LDR shows a significant partial influence. Importantly, simultaneously, all four ratios (CAR, NPL, LDR, and ROA) significantly affect BUMN bank stock prices, with the model explaining 69.1% of the stock price variation during the period, highlighting a strong relationship between financial performance and stock price movements.

Interleukin-1β–Mediated Orofacial Bone Defects and Alveolar Bone Loss in Periodontal Disease: A Scoping Review

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Orofacial bone defects, particularly alveolar bone loss, are hallmark features of periodontal disease and represent a significant clinical challenge affecting oral function and quality of life. Interleukin-1β (IL-1β) has emerged as a key pro-inflammatory cytokine mediating the link between periodontal inflammation and osteoclastic bone resorption. This scoping review using keywords related to orofacial bone defects, alveolar bone loss, and IL-1β, published between 2016 and 2026. The studies included experimental models, animal studies, and clinical observations. Results consistently indicate that ligature induced periodontitis and microbial dysbiosis upregulate IL-1β expression, correlating with enhanced alveolar bone resorption. Interventions such as desipramine, epigallocatechin-3-gallate (EGCG), curcumin, and four-day fermented milk kefir demonstrated reductions in IL-1β levels alongside attenuated alveolar bone loss, highlighting the functional role of IL-1β in periodontal bone destruction. Immune modulation studies, including TLR-activated B10 cell transfer and Ifi204-deficient mouse models, further suggest that IL-1β–mediated osteoclast activity contributes directly to alveolar bone resorption independently of certain bone marrow–derived immune cell responses. Mechanistically, IL-1β promotes osteoclastogenesis via upregulation of RANKL and matrix metalloproteinases while downregulating tissue inhibitors of metalloproteinases. Collectively, the findings underscore IL-1β as a pivotal mediator in periodontitis-related bone loss and as a promising therapeutic target. Understanding these IL-1β mediated pathways informs the development of novel anti-inflammatory and regenerative strategies to improve oral and dental health outcomes.

The Relationship Between Agility Score and Ankle Flexibility and the Risk of Ankle Injury Among Basketball Players at Giovanni Catholic Senior High School Kupang

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Background: Ankle injuries are the most common type of injury experienced by basketball players, mainly due to pressure or rapid twisting forces upon landing after jumping. Agility scores and ankle flexibility are frequently associated with ankle injury risk, however research focused on high school students in Indonesia remains limited.

Objective: This study aimed to investigate the relationship between agility scores and ankle flexibility with ankle injury risk among basketball players at SMA Katolik Giovanni Kupang.

Methods: This analytical observational study used a cross-sectional design involving 43 active basketball players. Agility score was assessed using the Illinois Agility Run Test, ankle flexibility using the Weight Bearing Lunge Test (WBLT), and ankle injury risk using the Foot and Ankle Outcome Score (FAOS). Data were analyzed using Spearman Rank correlation.

Results: Most participants demonstrated poor agility scores (60.5%) and normal ankle flexibility ≥10 cm (88.4%). The mean FAOS was 80.03, indicating low injury risk. No significant relationship was found between agility score and ankle injury risk (p = 0.954; r = 0.009) or between ankle flexibility and injury risk (p = 0.794; r = −0.041).

Conclusion: Agility score and ankle flexibility were not associated with ankle injury risk in this population. Further research is recommended to assess proprioception and prior injury history.

Institutional Capacity and the Productivity of R&D: Evidence from Patent Outcomes Across Countries

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Innovation is a key driver of economic growth. However, countries with similar research and development spending show very different patent outputs. This raises questions about what makes innovation efficient. This study examines whether government effectiveness affects the relationship between R&D spending and patent production in different countries. Using panel data from 111 countries from 2000 to 2020, we use two-way fixed effects models and System Generalized Method of Moments estimation to address potential issues of innovation persistence and reverse causality. The main variable we are looking at is the natural logarithm of one plus resident patent applications. The main independent variables are R&D expenditure as a percentage of GDP and the government effectiveness index, both measured two years earlier. The results show that R&D investment significantly increases patent activity. Specifically, a one percentage point increase in R&D intensity is associated with about a 39% increase in patent output. Conversely, the relationship between research and development (R&D) and governmental efficacy is both negative and statistically significant, suggesting that the incremental impact of R&D on patent output decreases as the quality of governance improves. This unexpected result probably reflects technological catch-up processes; nations with less robust institutions tend to experience swift patent expansion during periods of capacity building, whereas advanced economies characterized by strong governance increasingly prioritize quality over sheer volume. Dynamic models demonstrate considerable persistence in patenting behavior, as evidenced by a lagged dependent variable coefficient of 0.623, thereby validating path-dependent innovation processes. These observations imply that effective innovation policy requires aligning research investments with institutional capacities and the prevailing developmental context, rather than prioritizing either independently. This research provides empirical support for the influence of governance capacity on national innovation systems.