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Emerging evidence supports a role for interleukin 6 (IL-6), a pro-inflammatory cytokine, in the pathogenesis of treatment-resistant major depressive disorder (TRD). However, interventional studies targeting IL-6 in this population remain scarce. Tocilizumab is a humanised monoclonal antibody that inhibits IL-6 signalling and is approved for the treatment of autoimmune conditions such as rheumatoid arthritis. The primary objective of this study is to examine whether IL-6 inhibition via tocilizumab can impact depressive symptoms, inflammation-related biomarkers and cognition in patients with TRD. A secondary objective is to compare the biological profiles of patients with TRD with elevated inflammation to those of healthy controls.
This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.
The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.
School-aged children frequently experience psychological distress due to academic pressures, a challenge that is often more severe for those from underserved and minority communities. This study aims to evaluate the effectiveness of mental health interventions implemented in school and community settings for children aged 5 to 19. It also seeks to compare the outcomes between children from minority and underserved populations and their peers.
This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify relevant studies. Major databases will be searched using a structured search strategy developed by the research team. The review will include randomised controlled trials (RCTs) that assess the impact of interventions conducted in school or community settings to prevent psychological distress—specifically depression, anxiety and stress. To minimise bias, two reviewers will independently select studies and extract data at various stages. The quality of included studies will be assessed. A meta-analysis will be conducted to compare intervention outcomes between children from underserved/minority communities and other children. Pooled prevalence rates and subgroup analyses will be used to explore differences in effectiveness. Heterogeneity among studies and publication bias will also be assessed. Meta-analyses of proportions, ORs and relative risks will be conducted using a random-effects model to estimate effect sizes from multivariate analyses.
Ethical approval was not required, as this study involved secondary analysis of published literature and did not involve human participants. To date, no systematic review has comprehensively compared school-based and community-based interventions in terms of their effectiveness in addressing anxiety, depression and stress among school-aged children. This review aims to fill that gap by providing clinical insights into the comparative effectiveness of various intervention types and settings.
CRD42023479389.
by Robert Parisien, Alexander Drost, Amin Razi, Sina Ramtin, David Ring, Stein J. Janssen
ObjectivesTo inform efforts to promote regular and normalized Bayesian reasoning, we studied factors associated with the degree to which surgeons use Bayesian reasoning to navigate uncertainty across different clinical scenarios.
MethodsScience of Variation Group members (153; 58% North America, 30% Europe, 69% over 15 years of experience) completed an online survey reading 8 scenarios of test and treatment decisions and chose one of 4 answer options with higher scores indicating more Bayesian reasoning. Internal consistency of the survey was assessed using Cronbach alpha.
ResultsThe average Bayesian reasoning score across all scenarios was 3.0 (IQR 2.7–3.2) on a 4-point scale, indicating a relative context-dependent variability. Completely non-Bayesian reasoning was selected least often (8.6%, 90 of 1,044) and fully Bayesian reasoning represented 29% (301 of 1,044) of responses. Most surgeons showed mixed patterns (defined as reasoning in which prior probability is acknowledged but underweighted, without explicit probabilistic updating): 85% (121 of 142) used fully Bayesian reasoning at least once (121 of 142) while 42% (60 of 142) used completely non-Bayesian reasoning at least once. The Cronbach alpha was 0.43 suggesting the scenarios measured different aspects of clinical reasoning rather a unified construct.
ConclusionsThe finding that surgeons use relatively context-dependent reasoning suggests an opportunity for surgeons to develop and practice Bayesian reasoning strategies both in training programs and in practice.
by Rena Xu, David Pletta, Caitlynn Feng, Cassandra Morrow, Maya C. Clark, Badar Omar, Alex S. Keuroghlian, Sari L. Reisner
BackgroundDepression is highly prevalent among U.S. young adults and associated with long-term functional impairment and increased suicide risk. While delays in diagnosis and treatment of depression are well documented among older adults, the magnitude and predictors of such delays in the younger population are poorly understood.
ObjectiveTo characterize the time to diagnosis and treatment of depressive disorder and predictors of diagnostic and treatment delay among young adults.
MethodsThis cross-sectional study used a self-reported survey conducted via the online research platform Prolific in May 2025. Eligible participants were U.S. adults aged 18–35 years with a history of at least one depressive episode. Sociodemographic, clinical, and psychosocial characteristics, including age of depressive symptom onset, degree of social support, and frequency of social group engagement, were assessed. Primary outcomes were probability of not receiving a depressive disorder diagnosis despite symptoms, time from symptom onset to diagnosis, probability of not seeking treatment, and time from symptom onset to treatment. Secondary outcomes were perceived treatment effectiveness and current symptom control.
ResultsIn total, 871 respondents met inclusion criteria. Of those with one or more lifetime depressive episodes, 46.2% reported never receiving a depressive disorder diagnosis. Median time from symptom onset to diagnosis was 3 years (IQR: 0–7). Over a quarter (27.4%) never sought treatment; among those who did, 93.5% received care, but 31.4% experienced a delay of 1–4 years, and 28.8% experienced a delay of 5 + years. Symptom onset in childhood (ages 0–12) or adolescence (ages 13–17) was associated with longer time to diagnosis and treatment and lower perceived treatment effectiveness. Greater social support was associated with shorter time to diagnosis; lower probability of never receiving a diagnosis, never seeking treatment, or experiencing prolonged treatment delay; and higher perceived treatment effectiveness and current symptom control. Frequent engagement in social groups was also associated with greater perceived treatment effectiveness.
ConclusionsAmong U.S. young adults, prolonged delays in depression diagnosis and treatment are common. Early symptom onset is associated with longer delays and worse outcomes, whereas greater social support is associated with shorter delays and more favorable outcomes. These findings highlight the need for further research to clarify causal mechanisms and for interventions to promote timely diagnosis and treatment among young adults at risk for depression.
Stereotactic body radiotherapy (SBRT) delivered on an MRI-guided linear accelerator (MR-linac) enables highly conformal prostate cancer irradiation. The DESTINATION 2 trial is a federated, randomised phase II/R-IDEAL 2b study evaluating whether de-escalating the dose to prostate tissue, while maintaining a high dose to MRI-visible tumour(s) in two fractions, reduces genitourinary (GU) treatment-related adverse events (AE) without compromising disease control in men with localised prostate cancer.
200 men worldwide with localised, MRI-visible prostate cancer will be randomised 1:1 to receive either (1) prescribed uniform dose MR-linac SBRT (27 Gy in two fractions to the whole prostate and seminal vesicles with 0 mm CTV-PTV margin) or (2) de-escalated SBRT (20 Gy in two fractions to whole prostate with 0 mm CTV-PTV margin and 27 Gy in two fractions to MRI-visible tumour(s) with a 4 mm intraprostatic margin applied to the GTV. All treatments are delivered using MRI-guided adaptive Radiotherapy (MRIgRT). The primary endpoint is the absolute and relative risk reduction in acute grade 2+GU AE (CTCAE v5) within 12 weeks of completing radiotherapy. Secondary endpoints include late GU AE, acute and late gastrointestinal (GI) AE, sexual AE, patient-reported outcomes, dosimetry, technical feasibility and 2-year biochemical relapse-free survival.
This is a federated trial design in which each centre operates independently with its own sponsor, ethics committee approval and regulatory oversight. Each centre is responsible for obtaining and maintaining local ethics approval in accordance with their national and institutional requirements. The UK centre (The Royal Marsden NHS Foundation Trust) has received ethical approval from the East of England–Cambridge South Research Ethics Committee (REC reference: 24/EE/0163; IRAS: 338368). Results will be disseminated via peer-reviewed publications and conference presentations.
In sub-Saharan Africa, young women face disproportionate challenges transitioning from school to employment, with high rates of those not in education, employment or training (NEET). Structural barriers—including unequal gender norms, early marriage and unpaid labour—limit their economic participation. The Campaign for Female Education (CAMFED) Livelihoods programme supports young women’s transition from school to independent adulthood through mentoring, life skills, business and agricultural training and access to financial resources.
This study will evaluate the impact, process and mechanisms of change, and cost-benefit of CAMFED Livelihoods programme in Tanzania and Zimbabwe (2024–2027), focusing on outcomes related to economic activity, empowerment, leadership, mental health, subjective well-being and sexual and reproductive health among adolescent and young women (aged 15–24 years).
We will conduct a mixed-method, longitudinal evaluation across five districts in Tanzania and three districts in Zimbabwe. The quantitative component includes a pre-post cohort with a comparison group in Tanzania (n=1520) and a single-cohort design in Zimbabwe (n=500), with data collected at baseline, midline and endline. Primary outcomes are NEET status and leadership, complemented by measures of well-being, empowerment and health. The qualitative component will explore mechanisms of change and programme delivery. A cost-benefit analysis will estimate social and economic returns using a provider perspective. Youth researchers will be engaged to enhance participatory learning.
We have received ethics approvals from the London School of Hygiene and Tropical Medicine (31266), the National Health Research Ethics Committee (6732) in Tanzania and the Medical Research Council of Zimbabwe (MRCZ/A/3239) in Zimbabwe. Results of this study will be published in peer-reviewed academic journals and shared with policymakers, study participants and the other stakeholders in Tanzania and Zimbabwe.
by Amma Aboagyewa Larbi, Moses Etsey, Obed Brew, Bismark Koduah, Rosemond Enam Mawuenyega, Emmanuel Kobla Atsu Amewu, Nehemiah Kweku Essilfie, Solomon Wireko, Alexander Kwarteng, Ben Adu Gyan
The human gut microbiome, consisting of bacteria, archaea, fungi, and viruses, influences various physiological processes of the body. The gut microbiome composition is shaped by factors such as diet, geography, and antibiotic use. Malaria has been a global health challenge over the years, especially in low- and middle-income countries. This study investigated how asymptomatic malaria infection altered gut microbial communities in Ghanaian children, offering insights for novel malaria control strategies. Standard aseptic phlebotomy procedures were employed to collect venous blood samples for Plasmodium species detection. The gut microbial community was profiled by sequencing the 16S rRNA V4 region, and sequence data were processed using the DADA2 pipeline in R. Asymptomatic malaria infections were predominantly mixed with P. falciparum and P. malariae. Microbiome analysis revealed that Firmicutes and Bacteroidetes comprised nearly 70% of the total microbial population. Asymptomatic individuals showed a decrease in Firmicutes abundance from 52.5% to 44.0% and an increase in Bacteroidetes from 34.7% to 45.6%. There was also a slight increase in the abundance of Proteobacteria from 3.0% to 4.8%. At the genus level, Prevotella_9 was the most abundant and exhibited the highest variability in the infected groups. The Alloprevotella and Streptococcus genera increased in both infected groups, but Escherichia-Shigella was significantly elevated in only those with mixed infections. Faecalibacterium significantly declined in asymptomatic malaria-infected individuals compared to healthy controls, with variability further reduced in mixed infections. Beta-diversity analysis indicated a significant effect of malaria status on microbial composition (PERMANOVA, pDeficient palliative care coverage and nursing training in Ecuador warrant examining self-efficacy to inform education strategies and strengthen equitable services.
To examine Ecuadorian nurses' self-efficacy in Palliative Care.
A sequential explanatory mixed-methods study was conducted. Convenience samples of nurses completed the Self-Efficacy in Palliative Care Questionnaire and participated in online semi-structured interviews. Descriptive statistics were used for quantitative data. A side-by-side joint display supported integration.
497 nurses completed the questionnaire (90.4% female; 11.47 years of experience). Teamwork scored highest, while communication scored lowest. Eighteen nurses were interviewed (88.8% female; 11.5 years of experience). Participants reported communication difficulties related to emotions, prognosis, denial, collusion of silence and paediatric cases. They expressed strong confidence in pain management but more difficulty with agitation and dyspnoea. Spiritual care was mainly understood as facilitating access to religious figures. Although teamwork was perceived positively, tensions with physicians and an excessive focus on physical aspects were noted.
Quantitative and qualitative findings aligned overall, with dissonances regarding psychological and social communication.
Strengthening communication and comprehensive patient management competencies, as well as addressing interdisciplinary tensions, is necessary to improve and consolidate Palliative Care in Ecuador.
This study adhered to EQUATOR guidelines and used COREQ for qualitative reporting.
No patient or public contribution.
To present the process of establishing a Doctor of Nursing Practice (DNP) policy analysis project option at one nursing school, offering examples of diverse student and graduate analyses to guide other institutions.
Nurses are skilled patient advocates, and their advocacy forms a crucial foundation for influencing health policy. This, in turn, enhances population health and addresses health disparities, particularly for vulnerable groups. DNP students are educated to use innovative methods to integrate current evidence to inform practice and policy, yet some nursing schools lack resources to support comprehensive DNP policy analysis projects.
The article presents a case example of how one institution developed a pathway and instructional support to formally offer DNP students the option to perform a DNP policy analysis project.
Essential elements to support students' successful completion of a DNP policy analysis project include adequate faculty expertise in health policy and a structured institutional framework. Residency activities must deepen a student's understanding and knowledge about policy and the health problem trying to be solved with policy. Clear documentation of these unique residency activities is crucial. There is a strong emphasis on the need for clear communication and guidance between programme faculty, programme mentors and students. DNP policy analysis projects enrich students' knowledge, skills and networks, fostering future policy leaders and facilitating collaboration with clinical experts across diverse research fields.
Nurturing DNP students completing policy analysis projects is vital for translating evidence into practice, developing future nurse policy leaders and ensuring health equity and access to quality healthcare.
DNP policy projects can positively influence nursing practice and policy. Expanding upon previous DNP students' policy analysis projects also provides a unique opportunity to build and broaden nursing's impact on policy development.
Growing evidence exists about the pivotal role of immune mechanisms in the physiopathology of atrial fibrillation (AF). Drugs that modulate the immune system (immunomodulators) may contribute to the development of AF. We aimed to identify immunomodulators that are associated with AF to better define their safety profile, and elucidating their mechanisms of action could yield novel insights into AF’s immune physiopathology.
A descriptive and disproportionality analysis of claims data.
World pharmacovigilance database VigiBase until 1 March 2025.
First, we ascertained the association of immunomodulators with AF over-reporting with a disproportionality analysis evaluating the multivariable-adjusted reporting odds ratio (aROR) for AF reporting performed for 141 immunomodulators in VigiBase. Then, a literature review was done to explore the underlying mechanisms of AF through immunomodulator mechanisms.
A total of 6 148 556 reports encompassing at least one of the 141 immunomodulators were identified in Vigibase. Our primary analysis revealed 20 immunomodulators associated with AF over-reporting. The three immunomodulators with the greatest signal were: recombinant interleukin-11 with an aROR=20.91 (99.96% CI 12.08 to 36.17), efgartigimod alfa with an aROR=6.75 (99.96% CI 3.96 to 11.52) and recombinant interleukin-2 with an aROR=6.15 (99.96% CI 3.62 to 10.45). A derivative literature review posited a hypothetical immune ‘vicious circle’ promoting AF, involving T helper cells, macrophages and natural killer cells which could lead to electrophysiologic and histologic atrial remodelling.
Twenty Food and Drug Administration (FDA)-labelled immunomodulators are associated with AF overreporting in Vigibase with a substantial signal on recombinant IL-11. These data contribute substantively to the prevailing understanding of the safety profile of these immunomodulators. Moreover, these findings support a multidirectional interaction between the immune system and AF development and might lead to considering future therapeutic targets.
To examine triggers, responses, and outcomes for patient-related violence and/or aggression events during acute hospitalisation.
This was a descriptive observational study undertaken at two healthcare organisations.
Pre-existing data were extracted from organisational incident reports and individual medical records during a retrospective period (1/1/2023 to 30/6/2023) and a prospective period (7/6/2024 to 16/11/2024). Violence and/or aggression events requiring an organisational response that involved patients hospitalised in general ward areas at a metropolitan (Site A) and a regional (Site B) site were included. Data were analysed using descriptive statistics and content analysis.
The sample included 100 retrospective cases and 42 prospective cases. The most prevalent causes for hospitalisation related to a medical or mental health condition and dementia. Confusion and irritability were the most common forms of behaviour of concern prior to the event. Physical restraint was utilised more frequently in the prospective period compared with the retrospective period. Chemical restraint was used in approximately half of the cases in both study periods. A form of physical violence was the most prevalent behavioural symptom in both periods, followed by verbal aggression and inability to be re-directed.
Patients with a pre-existing medical condition, confusion and/or dementia are frequently involved in violent and/or aggressive events in ward settings. Physical and chemical restraints are commonly used to manage violence and aggression.
Alternative strategies are needed to manage occupational violence and aggression to minimise the need for physical and/or chemical restraint.
This study addresses a gap in evidence regarding triggers, responses and outcomes for patients exhibiting violence and aggression in ward settings during hospitalisation. Patients with dementia, confusion and irritability frequently exhibit behaviours of concern, exposing healthcare workers to potential physical and psychological harm.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Navdeep Kaur, Marcus V. Merfa, Alexandra K. Kahn, Rodrigo P. P. Almeida, Leonardo De La Fuente
Xylella fastidiosa (Xf) is an insect-transmitted, xylem-limited bacterial plant pathogen that infects hundreds of plant species. This pathogen causes bacterial leaf scorch in southern highbush blueberry (Vaccinium corymbosum interspecific hybrids) in the southeastern United States, a disease that has not yet been reported elsewhere. Previously, a comparative genomic analysis of Xf and ancestral host species identified evolutionary events of gene gain and loss related to host range specificity. Here, by using a similar workflow, we identified two loci that are significantly found in blueberry-infecting strains. Locus_1088 included a hypothetical protein and a small part of the N-terminus of an orphan RelE toxin, while Locus_2741 was annotated as a hypothetical protein. Using a protocol based on natural competence, mutants were generated in three Xf subsp. multiplex strains from blueberry. Less biofilm, more planktonic growth, and increased twitching motility as compared to its wild-type (WT) were observed for the strain LA-Y3C_1088 mutant. In blueberry virulence assays, the LA-Y3C_1088 mutant caused significantly more severe symptoms than LA-Y3C_WT, whereas no significant differences were observed for other mutated strains. Interestingly the mutation of Locus_1088 additionally disrupted a toxin (part of a toxin-antitoxin system) that is likely responsible for the phenotypic changes observed. However, because the two independent mutants were not generated, we could not determine whether the phenotype resulted from disruption of hypothetical protein or the toxin. Additionally, since the coffee-isolated but never tested in blueberry Xf subsp. fastidiosa strain CFBP8073 was found to encode the two blueberry-associated loci studied here, its virulence was assessed in blueberry. This strain caused severe symptoms comparable to the control strain AlmaEm3 from blueberry. Due to the complexity of understanding host specificity in Xf, any advance in identifying genetic markers for host specificity in this devastating pathogen could greatly improve management of Xf worldwide.To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.
Systematic review of qualitative studies.
AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.
Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.
Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.
Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.
This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.
The review was undertaken and reported using the PRISMA guidelines.
None.
PROSPERO (CRD42023425752)
The aim of this study was to explore the digital health technology readiness of nurses, nursing students, nurse-academics, and nurses in leadership roles. Workforce digital readiness impacts the adoption of digital health technologies and quality and safety outcomes. This study sought to identify key factors affecting nurses' readiness for specific digital health technologies and provide recommendations to accelerate readiness levels in alignment with rapidly advancing digital health technologies.
Cross-sectional multi-method study.
An online survey was followed by semi-structured interviews. Survey data (N = 160) were analysed using descriptive and inferential statistics, whereas qualitative responses (N = 8 interviews, 43 open-ended responses) were thematically analysed.
Participants were confident regarding openness to innovation, reporting highest confidence Levels around telehealth, wearable devices, and information technology. The lowest confidence scores were seen in health smart homes technology, followed by health applications, social media, patient online resources, and EHRs. Four themes were developed from the qualitative interviews including ‘opportunities for efficient ways of working’, ‘digital technology turning experts into novices’, ‘disillusionment between expectation and reality’ and ‘shared responsibility for development of digital expertise’. Open-ended data was focused on the need for comprehensive education, ongoing support, and infrastructure improvements to prepare healthcare professionals for digital health environments.
Notable findings include age-related differences, the need for shared responsibility in workforce preparation, and a link between problem-solving ability and help-seeking.
Low confidence among nurses around the use of digital health technologies such as electronic health records, in-home monitoring technology, and other wearable technologies could impact adoption readiness. Because patient safety is increasingly and inextricably linked to digital health technologies, nurses must not only be digital health literate but also included in the design and implementation process of these technologies.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for the reporting of cross-sectional survey research, and the Consolidated Criteria for Reporting Qualitative (COREQ) research guidelines.
Limited patient and public involvement was incorporated, focusing on feedback from digital health researchers and practitioner-academics during the academic peer review process. Their insights informed the clarity and relevance of the survey design and data interpretation, ensuring alignment with real-world workforce development priorities in nursing.
To explore key stakeholders' experiences and perceptions of end-of-life communication in acute care settings.
A qualitative descriptive study.
Data were collected from 4 May to 31 October 2023. Patients with terminal illness, family caregivers and healthcare providers were recruited from two Chinese hospitals via purposive sampling. Individual interviews were conducted with patients and family caregivers, whereas healthcare providers participated in focus group discussions. Thematic analysis was conducted.
Nineteen patients, 22 family caregivers and 25 healthcare providers participated. Five themes emerged: (1) protective end-of-life communication, characterised by dominant family involvement, truth concealment and restricted end-of-life topics; (2) open end-of-life communication, characterised by dominant patient involvement, truth disclosure and diverse end-of-life topics; (3) patient-related factors, including comfort level in talking about end-of-life, burden and treatment engagement; (4) family-related factors, including comfort, burden, expectations, values and trust in healthcare providers and (5) healthcare provider-related factors, including comfort, time availability and clinical priorities, end-of-life communication awareness and skills and end-of-life care knowledge.
End-of-life communication in Chinese acute care settings oscillates between protective and open approaches, influenced by several individual factors.
Healthcare providers must overcome stereotypes rooted in cultural values and adopt a proactive approach to end-of-life communication. Enhanced training and institutional procedures are needed to improve end-of-life communication in acute care settings.
The study provides nuanced insights into end-of-life communication dynamics in Chinese acute care settings, complementing global evidence. Coexisting protective and open communication approaches highlight the need for context-sensitive approaches to end-of-life communication. Multifocal interventions addressing patient-, family- and healthcare provider-related factors are warranted.
Standards for Reporting Qualitative Research.
No patient or public contribution was involved in the design or conduct of the study.
To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, national differences, and demographic associations.
Cross-sectional study using a survey design.
Study conducted between January 2021 and April 2022, using a convenience sample of intensive care unit nurses across Cyprus, Spain, Croatia, and Poland, Romania. The Critical Elements of a Healthy Work Environment Scale (CEHWES) developed by the American Association of Critical Care Nurses and cross-culturally adapted by the authors was used, which included four sections, including sociodemographic data and a total of 50 questions. The core section of the tool comprised 16 questions using Likert-type response (1—strongly disagree—4 strongly agree). Perception of fulfilment of healthy work environment standards was calculated using the aforementioned Likert-type scale.
A total of 1183 nurses participated reporting moderate perception of fulfilment of the standards, with mean scores ranging from 2.6 to 2.8. Skilled communication and effective decision making were the highest rated. 56% (n = 662) reported awareness of some standards and while 25.8% (n = 305) reported full or significant implementation in their unit. Significant differences related to the perception of all standards were observed across countries. Implementation of the standards was significantly associated with higher quality of care having better perception when standards were fully implemented.
This study shows moderate perception of healthy work environment standards among intensive care nurses. Country differences highlight the need for more awareness, training, and further implementation of the standards, which is linked to better care quality.
Work environment still need to improve and needs to be prioritised by organisations, considering local and national particularities. Having a measuring tool available in multiple languages facilitates comparisons and getting a global picture.
The questionnaire used is validated in different languages, allowing results to be compared with other countries. Novel data from countries that were poorly investigated is now available. More evidence points out the need to prioritise work environment for maintaining quality in patient care.
The study has been reported following the STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Social media is a significant source of information for post-secondary students, who are usually at the age at which many common mental disorders first express themselves. Social media can have a role in the way post-secondary students identify and act on mental health issues.
Explore how the use of social media influences post-secondary students’ adoption of mental health labels.
We included empirical studies on mental health labelling in the context of social media use among post-secondary students published in English between January 1995 and April 2025.
The review includes references from five databases: Scopus, PubMed, Ovid MEDLINE (to access APA PsycINFO), Web of Science and ProQuest Global Dissertations and Theses. Based on the included studies from the initial search, we built a complementary search strategy using Research Rabbit artificial intelligence.
We present a table listing characteristics of the studies and brief summaries of their findings. A narrative synthesis compiled the information from each study to answer the research questions.
The search identified 7551 references and 1099 additional records from Research Rabbit. 11 studies published since 2011 met the inclusion criteria with qualitative, mixed methods and quantitative designs, without major quality concerns. Approaches to measuring social media exposure varied, including platform reports of user activity and self-reported indicators. Individuals adopted labels themselves or received labels from peers or researchers. Most research focused on self-presentation and symptom disclosure rather than labelling itself. The accuracy of self-diagnosis was higher for common disorders and lower for complex conditions such as mania or panic disorders. Labelling varied across social media platforms. Online interaction revealed issues that students were reluctant to share face-to-face. Label use appeared to influence help-seeking and peer support, with effects shaped by social stigma.
The adoption of mental health labels via social media among post-secondary students remains largely unexplored. The concept of labelling and its operationalisation vary across research. Future studies should provide more formal definitions, investigate mechanisms driving labelling and assess its potential effects on human health.
This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles.
This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework.
Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities.
Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes.
We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted.
Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD.
The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.
In response to global outcries of poor healthcare, organisational interventions have been implemented with the aim of promoting compassionate care. An overall synthesis of qualitative data, including the perspectives of healthcare staff who have attended interventions, can establish ‘what works’ and inform future interventions.
To synthesise existing research exploring how healthcare staff experience organisational interventions for compassionate care.
Qualitative evidence synthesis.
A qualitative evidence synthesis was conducted in August 2023. Five databases were searched: MEDLINE, Academic Search Premier, CINAHL, APA PsycInfo and APA PsycArticles. Articles met the following criteria: (a) reported on the experiences of healthcare staff who had participated in organisational interventions for compassionate care, (b) taken place in a healthcare setting, (c) use of a qualitative or mixed-methods methodology, (d) published in English and (e) published since 2010. A thematic synthesis was conducted using NVivo software to synthesise findings. Data from the complete ‘findings/results’ sections were included in the synthesis. The final search protocol and search strategy were registered on PROSPERO (ID: CRD42023472404) and are reported using the PRISMA guidelines.
Eighteen qualitative or mixed-methods studies were included in the review, encapsulating the experiences of healthcare staff across eight countries. Four themes were identified: (1) holding back, (2) humanising healthcare, (3) values are instilled and (4) sustainability is important.
Organisational interventions for compassionate health care are valued and appreciated by healthcare staff and foster reflection and connection. Interventions facilitate clinical creativity, improve staff well-being and strengthen communication between staff.
The implementation of organisational interventions for compassionate care should be encouraged in healthcare settings. Interventions that consider organisational cultures are driven by organisational values and are embedded with sustainability in mind can improve staff well-being and positively impact the provision of patient care.
PRISMA guidelines were followed in the reporting of this review.
by Ernest V. Boiko, Elena V. Samkovich, Irina E. Panova, Alexander A. Ivanov, Sergey B. Shevchenko, Sergey L. Vorobyev, Elizaveta S. Kalashnikova, Victoria G. Gvazava, Elizaveta A. Masian, Alexandra E. Kim
PurposeTo define optimal exposure parameters and the therapeutic window for transscleral photodynamic therapy (TSPDT) with chlorin e6 by evaluating clinical, histological, and thermal effects of subthreshold, therapeutic, and suprathreshold settings in rabbit eyes.
MethodsThe study was conducted on 21 healthy rabbits. TSPDT was performed using a 660 nm laser and chlorin e6 (2.5 mg/kg). Transscleral probes (5 mm: 0.1 W, 0.17 W, 0.3 W; 10 mm: 0.3 W, 0.6 W) with integrated thermosensors were used. Enucleation and histological analysis were performed 14 days post-irradiation.
ResultsFundus examination on day 14 revealed distinct treatment zones correlating with laser settings. The therapeutic window was defined as 0.14–0.17 W (5 mm probe; power density: 0.693–0.866 W/cm²; energy density: 415.8–519.6 J/cm²) and 0.48–0.6 W (10 mm probe; 0.611–0.764 W/cm²; 366.6–458.4 J/cm²) with 600 s exposure time, achieving selective choroidal damage without scleral or retinal injury (ΔT ≤ 4.5°C). Suprathreshold settings (≥0.3 W for 5 mm; ≥ 0.6 W for 10 mm) induced retinal necrosis (up to 50%) and scleral coagulation (ΔT ≥ 8°C) with power densities exceeding 0.866 W/cm² (5 mm) and 0.764 W/cm² (10 mm).
ConclusionTSPDT with chlorin e6 enables selective targeting of intraocular pathological tissues while preserving scleral and retinal integrity. Defining the therapeutic window and using real-time thermal monitoring enhances treatment safety. These findings lay a foundation for clinical protocols for uveal melanoma and other intraocular tumors.
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