Conectar
Ageing is associated with declines in physical and cognitive function that increase the risk of disability and dependence. Intrinsic capacity (IC), proposed by the WHO, provides a multidimensional framework to assess health in older adults. This study aims to evaluate whether a multicomponent recreational exercise programme (Fun Exercise for Older Adults (FEXO)) improves IC, motivation and adherence compared with a conventional programme (OTAGO).
A randomised controlled trial with two groups (2:1 ratio) will be conducted among 120 community-dwelling older adults (≥60 years). Participants will be randomly assigned to FEXO (intervention) or OTAGO (control). Both programmes will consist of 3 weekly sessions for 14 weeks. Primary outcomes: IC, assessed through validated measures (Short Physical Performance Battery, Mini Nutritional Assessment, Mini-Mental State Examination, Cornell Scale for Depression in Dementia and sensory evaluation), motivation (BREQ-3) and adherence rate. Secondary outcomes include body composition, cardiovascular parameters, frailty, cognition and resilience (PRIFOR). Data will be analysed using two-way ANOVA (groupxtime) under an intention-to-treat approach. Effect sizes (p²) and 95% CIs will be reported. Additional analyses (correlation, regression, mediation and moderation) will explore associations and intervention effects.
Approved by the Ethics Committee of Universidad CEU Cardenal Herrera (Ref. CEEI23/487 and CEEI25/639). Results will be disseminated through peer-reviewed journals and scientific conferences. The findings of this study will contribute to improving evidence-based strategies for promoting healthy ageing and will support the development of more engaging and effective exercise interventions for older adults.
This study has been prospectively registered at ClinicalTrials.gov (identifier: NCT07133568).
Type 2 diabetes (T2D) presents a global healthcare burden. Despite widespread use of non-insulin glucose lowering therapies, many individuals still require insulin to achieve recommended target glycated haemoglobin (HbA1c). Insulin injections improve HbA1c but can lead to problematic hypoglycaemia. The objective of this study is to determine whether fully closed-loop insulin delivery improves HbA1c at 26 weeks compared with standard insulin therapy with continuous glucose monitoring (CGM) in adults with T2D.
This study adopts an open-label, multinational, randomised, single-period parallel design and aims to randomise 224 adults with T2D to either standard insulin therapy with CGM (control group) or fully closed-loop insulin delivery (intervention group) for a period of 26 weeks. Participants will complete a run-in period of 2–3 weeks wearing a masked CGM followed by randomisation to either the control or intervention group. The primary endpoint is the between-group difference in HbA1c at 26 weeks. Key endpoints include time in target glucose range (3.9–10.0 mmol/L), mean sensor glucose, time above range (>10.0 mmol/L) and non-inferiority for time below target (
The study has received ethical approval from the East of England Cambridgeshire and Hertfordshire Research Ethics Committee (24/EE/0149) in the UK. Ethical approval for non-UK site has been obtained by local Research Ethics Committees.
Results will be disseminated by peer-reviewed publications and conference presentations, and findings will be shared with people living with diabetes, healthcare providers and relevant stakeholders.
To explore emergency nurses' experiences and perceptions of violence from patients and visitors in China, focusing on its nature, contributing factors, and consequences.
A qualitative descriptive design was employed.
Thirteen emergency nurses from eight tertiary public hospitals in a provincial capital city in northern China were recruited using purposive and snowball sampling; most were female and had several years of emergency nursing experience. Data were collected through semi-structured, face-to-face interviews conducted in Mandarin and analysed using latent content analysis.
Two overarching themes were identified. The first theme, Nurses as Healers or Targets: Confronting Misplaced Anger, described how violence from patients and visitors emerged in high-pressure emergency environments, often involving verbal abuse, threats, or physical aggression, and was shaped by situational stressors and perceived power imbalances. The second theme, Healing in Shackles: Maintaining Professional Composure and Emotional Desensitization, captured nurses' efforts to remain professional while experiencing fear, exhaustion, and emotional distancing following repeated exposure to violence.
Violence from patients and visitors represents a persistent occupational challenge for emergency nurses, with cumulative effects on their emotional wellbeing and professional functioning. The findings highlight the need to shift responsibility for managing violence from individual nurses to organizational and systemic levels.
Strengthening organizational responses, such as emotional support mechanisms, clear visitor management policies, and accountability for violence prevention, may help create safer and more sustainable emergency care environments.
This study adhered to the COREQ reporting guidelines.
1. What problem did the study address? This study addressed the persistent problem of violence against emergency nurses in urban tertiary hospital emergency departments in northern China, particularly incidents perpetrated by patients and visitors. It explored how nurses perceive the nature of such violence, the factors contributing to its occurrence, and its consequences for their professional and personal well-being.
2. What were the main findings? Violence against nurses by patients and visitors in the ED was often driven by enabling factors, such as high-pressure environments, nurses' visibility, and perceived power imbalances, as well as by reward-based motivations. Nurses responded with professional composure but reported limited peer and managerial support. Over time, cumulative exposure led to physical harm, lingering emotional distress, heightened vigilance, and emotional detachment.
3. Where and on whom will the research have an impact? The findings will inform nurse leaders, policymakers, and hospital administrators by reframing resilience as an organizational responsibility. Embedding structured emotional support, transparent visitor management, and violence-prevention accountability within hospital governance can foster safer and more sustainable work environments.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Sandra S. Chaves, Valérie Bosch Castells, Ainara Mira-Iglesias, Joan Puig-Barberà, F. Xavier López-Labrador, Miguel Tortajada-Girbés, Mario Carballido-Fernández, Joan Mollar-Maseres, Germán Schwarz-Chávarri, Javier Díez-Domingo, Alejandro Orrico-Sánchez, Valencia Hospital Network for the Study of Influenza and other Respiratory Viruses (VAHNSI)
BackgroundUnderstanding the burden of acute viral respiratory infection-related hospitalizations is crucial for guiding research and development. Unlike influenza, respiratory syncytial virus (RSV), or severe acute respiratory syndrome coronavirus 2, no pharmaceutical interventions exist for other respiratory viruses; therefore, their impact remains poorly characterized. This study aimed to investigate the association of current non-vaccine-preventable respiratory viruses, especially rhinovirus/enterovirus (RV/EV), on hospitalizations during the respiratory seasons.
MethodsData from a prospective study that used multiplex polymerase chain reaction to conduct long-term surveillance on respiratory viruses in Valencia, Spain were analyzed. Patients aged ≥50 years hospitalized due to respiratory illness from 2014–15–2019–20 were included.
ResultsRespiratory viruses were detected in 35.2% (3,755/10,675) of hospitalized patients with acute respiratory illness. Influenza and RSV accounted for 22.1% of hospitalizations, RV/EV for 7.6%, and other non-vaccine-preventable viruses for 5.4%. Adults ≥75 years had average seasonal hospitalization incidence rates more than twice those aged 65–74 years and eight times those aged 50–64-year-olds. No significant differences in severity markers were observed among patients with or without virus identified, those aged ≥75 years had a 2–3 times higher mortality rate compared to younger age groups.
ConclusionsThe potential impact of respiratory viruses on hospitalization rates among older adults, particularly those aged ≥75 years, highlights the need for targeted interventions to reduce healthcare system burden. Enhanced diagnostic capabilities and the development of next-generation preventive strategies, including vaccines and therapeutics, could improve patient outcomes and strengthen the resilience of the healthcare system during respiratory virus seasons.
To determine whether a novel urine collection device (the ‘Pee-in-Pot (PiP)’) produces the same rates of reportable urine culture results as standard of care (SOC) urine collection. To determine whether the PiP produces comparable microscopy results to SOC urine collection. To estimate the carbon footprint of the PiP compared to SOC urine collection.
A prospectively designed, single-centre, paired comparison study.
A district general hospital in Southwest England, including antenatal clinical, accident and emergency, medical and surgical ward environments.
Adults aged 18 or over.
Urine passed through the PiP device before being decanted into a 10 mL boric acid tube for microscopy and culture, compared with the same urine contained only in a sterile plastic vessel before being decanted into a boric acid tube for microscopy and culture.
The proportion of positive urine culture results.
The proportion of heavy mixed growth culture results. Comparison of particle counts: all small particles, bacteria, red blood cells and white blood cells.
Microscopy was performed for 1353 paired samples, of which 808 paired samples both underwent culture. Overall, urine cultures were positive in 9.3% (75/808) and 10.0% (81/808) of PiP and control cases, respectively. Overall matching between PiP and control arms for reportable positive culture results was 98.5% (796/808), with a Cohen’s Kappa test coefficient () of 0.9149 (almost perfect agreement). There was no significant difference in the rate of positive urine culture results between testing arms for any organisms (margin of non-inferiority prospectively defined as ±2.5% for Escherichia coli positive cultures). For microscopy, there was agreement in meeting culture thresholds for 1308 of 1353 paired samples with a difference in culturing rates of 0.00517 (95% CI –0.0045 to 0.015, ie, high level of agreement). The estimated base case carbon footprint of PiP testing was 95g CO2e compared to 270g CO2e for SOC testing.
This study found the PiP to be non-inferior for routine urine microscopy and culture testing and to have a lower carbon footprint compared with SOC urine testing.
Objetivo. Evaluar si existe asociación entre depresión y ansiedad con el rendimiento académico en estudiantes de enfermería de la Universidad Villasunción, Aguascalientes, México. Metodología. Estudio cuantitativo, observacional, descriptivo-correlacional y de corte transversal. La población estuvo conformada por 273 estudiantes de la Licenciatura en Enfermería. Se seleccionó una muestra de 161 participantes mediante muestreo estratificado. Para evaluar la depresión se utilizó el Inventario de Depresión de Beck II (BDI-II) y para ansiedad el Inventario de Ansiedad de Beck (BAI). El rendimiento académico se obtuvo a partir del promedio general acumulado. Los datos se analizaron mediante estadística descriptiva y prueba de chi-cuadrado de Pearson utilizando SPSS versión 27, con un nivel de significancia de p ≤ 0.05. Resultados. El 54.7% de los estudiantes presentó niveles mínimos de depresión, mientras que el 16.1% reportó niveles graves. En cuanto a la ansiedad, el 30.4% mostró niveles mínimos y el 20.5% niveles graves. El rendimiento académico predominante fue “Bueno” (59%). Mediante la prueba de chi-cuadrado de Pearson se identificó una asociación estadísticamente significativa entre depresión y rendimiento académico (p= 0.030). En contraste, la ansiedad no mostró una asociación significativa con el rendimiento académico (p= 0.506). Discusión. La depresión se asocia significativamente con el rendimiento académico en estudiantes de enfermería, lo que evidencia la importancia de considerar la salud mental como un factor relevante en el desempeño académico universitario.
ABSTRACT
Objective. To evaluate whether there is an association between depression and anxiety and academic performance among nursing students at Universidad Villasunción in Aguascalientes, Mexico. Methodology. A quantitative, observational, descriptive-correlational, cross-sectional study was conducted. The population consisted of 273 undergraduate nursing students. A sample of 161 participants was selected using stratified sampling. Depression was assessed using the Beck Depression Inventory II (BDI-II), and anxiety was measured using the Beck Anxiety Inventory (BAI). Academic performance was obtained from the students’ cumulative grade point average. Data were analyzed using descriptive statistics and Pearson’s chi-square test with SPSS version 27, considering a significance level of p ≤ 0.05. Results. A total of 54.7% of students presented minimal levels of depression, while 16.1% reported severe levels. Regarding anxiety, 30.4% showed minimal levels and 20.5% severe levels. The predominant academic performance category was “Good” (59%). Pearson’s chi-square test identified a statistically significant association between depression and academic performance (p = 0.030). In contrast, anxiety did not show a significant association with academic performance (p = 0.506). Discussion. Depression is significantly associated with academic performance among nursing students, highlighting the importance of considering mental health as a relevant factor in university academic outcomes.
Malnutrition is a highly prevalent chronic condition that contributes to higher morbidity and mortality in patients with multiple comorbidities. While positive effects of nutritional therapy in the in-hospital setting have recently been demonstrated, the benefits of long-term nutritional therapy after hospital discharge remain uncertain. Herein, we outline the design and rationale of the EFFORTII trial, the largest nutritional trial to date to assess the effects of continued nutritional support after hospital discharge in medical patients, with particular attention to key design decisions regarding nutritional strategy, patient selection criteria and study endpoints.
The Effect of Continued Nutritional Support at Hospital Discharge on Mortality, Frailty, Functional Outcomes and Recovery (EFFORTII) is an investigator-initiated, non-commercial randomised controlled trial designed to evaluate whether ongoing, individualised nutritional therapy after hospital discharge—targeted to meet specific energy and protein requirements—offers a cost-effective approach to lowering mortality, minimising complications and maintaining functional status compared with standard care. Eligible participants are adult, chronically ill medical inpatients at risk of malnutrition. Patients in the intervention group receive individualised nutritional therapy delivered by an experienced dietitian through a combination of telemedicine and in-person consultations. The intervention aims to meet personalised nutritional targets, supported by a trained dietitian. Control group patients receive nutritional counselling at discharge, but no structured nutritional management during follow-up. We designed the trial as an event-driven trial with a target of 247 mortality events (primary endpoint), which will be assessed over approximately 5 years until event-driven endpoint is met. The minimum total sample size is at least 802 participants, based on the assumed treatment HR of 0.70. The main trial is enrolling patients across multiple sites in Switzerland. During the trial, additional sites in Spain joined the study, and their data will be analysed using a patient-level pooled approach.
This study involves human participants and was first granted ethical approval by the Ethics Committee Northwest- and Central Switzerland and then by all participating local ethics committees. Written informed consent will be obtained from all participants. Findings will be disseminated in peer-reviewed journals and academic conferences.
To evaluate the safety, feasibility and acceptability of weighted blankets for patients with dementia who experience agitation in acute care.
Randomised controlled trial.
Patients with dementia experiencing agitation at a single hospital were recruited between May 2023 and January 2024. Participants were randomly assigned to the intervention (weighted blanket) or control (standard care) group. Agitation scores, vital signs, skin integrity, pharmacological interventions and general observations were recorded at baseline and at 15-, 30-, 60- and 75-min (or 15-min post-blanket removal) post-baseline. Nursing staff completed a survey on the intervention's acceptability, appropriateness and feasibility.
There was a recruitment rate of 86.7%, 70% of patients tolerated the intervention for the full duration. Nursing staff agreed the intervention was appropriate (100%), acceptable (100%) and feasible (92.9%). The intervention reduced patient heart and respiratory rates. No significant impact on patient temperature, oxygen saturations, skin integrity or risk of falls was found. The intervention reduced agitation scores, pharmacological and non-pharmacological interventions.
Weighted blankets in acute care settings are safe and have some effect on agitation and pharmacological use. Staff found the use of weighted blankets to be acceptable and most patients tolerated use of the blankets without increased risk of adverse events.
This study provides evidence that weighted blankets may be used safely with the acceptance of patients with dementia and staff in hospitals.
This study addressed the use of weighted blankets for persons with dementia who are experiencing agitation and found that they are safe and feasible for use in acute care. Future research is feasible and should focus on blanket weight dosing and the effect on agitation, pharmacological and non-pharmacological interventions.
Adheres to the CONSORT 2010 checklist for a feasibility trial.
Patients and public did not contribute to this study.
ACTRN12623000003673
The nursing workforce is central to healthcare delivery, yet racial and ethnic disparities persist. Systemic barriers such as implicit bias, institutional racism, and socioeconomic obstacles hinder the career progression of underrepresented nurses. Addressing these disparities is critical to fostering a diverse workforce that can effectively meet the needs of diverse patient populations.
This paper introduces the Equity-Centered Nursing Leadership Framework (ECNLF), a structured approach to advancing diversity in the nursing workforce. The framework provides strategies for dismantling systemic inequities and establishing sustainable leadership pathways.
Conceptual and theoretical analysis of nursing leadership and workforce equity.
A targeted literature synthesis of peer-reviewed research, policy reports, and theoretical frameworks was conducted. The ECNLF was conceptualised using an integrative approach that examines systemic inequities in nursing leadership and workforce diversity. This framework identifies structural barriers, proposes equity-driven interventions, and outlines strategies for mentorship, leadership development, and policy advocacy.
The ECNLF provides a structured approach for integrating equity-driven leadership development into nursing education and practice. Its implementation is guided by three key pillars: structured mentorship, leadership development, and policy advocacy. The framework supports the establishment of formal mentorship programmes, ensuring that underrepresented nurses have access to career advancement opportunities and leadership training.
Systemic change requires integrating equity frameworks into nursing curricula, adopting structured DEI initiatives in healthcare institutions, and expanding policy-driven funding for leadership development. The ECNLF provides a scalable model for reducing workforce disparities, improving retention, and fostering inclusive nursing leadership that reflects and serves diverse communities.
To assess the potential for microbial contamination of open-but-unused portions of wound dressings stored under real-life conditions in healthcare facilities, to inform safer and evidence-based wound care practices. Observational, descriptive, longitudinal, prospective study. Eleven types of non-adhesive wound dressings were sampled after opening and storage under usual clinical conditions in a hospital inpatient unit and a primary care centre in Andalusia, Spain. Samples were collected on six predefined sampling days (Days 0, 2, 3, 4, 5 and 6 after opening), cultured under standardised laboratory conditions and microorganisms were identified using mass spectrometry. Differences in contamination were examined by dressing type, healthcare setting, storage time and handling conditions. Microbial growth was frequently detected in open-but-unused dressings from the first day after opening, particularly after enrichment culture and increased with handling and time. The most frequent microorganisms were coagulase-negative staphylococci and Staphylococcus aureus. Contamination patterns were similar across settings, although microbial diversity was higher in the hospital. Silver-containing dressings showed slightly lower contamination, but not enough to indicate protection. Scissors used for cutting dressings had high microbial loads, suggesting a potential source of cross-contamination. Open-but-unused dressings may become contaminated shortly after opening under routine clinical practice conditions, across different healthcare settings and dressing types.
To assess the clinical patient exposure of residents over 20 years following the statutory introduction of a maximum working week of 50 hours in 2005.
Retrospective analysis of longitudinal cohorts of residents who worked on the medical wards between 2001 and 2023 or the emergency department (ED) between 2007 and 2023.
Cantonal Hospital of Baden, a representative, large Swiss teaching hospital affiliated with the University Hospital of Zurich.
Residents in training working on the internal medical wards and the ED.
Annual Patient Exposure (APEX) of residents, which is the ratio of annual patients to residents and describes the annual number of patients treated per resident.
We assessed time trends of the APEX in annual cohorts of residents in training on the internal medicine wards (2001–2023) and the ED (2007–2023). We analysed the annual case severity (Case Mix Index and Emergency Severity Index (ESI)), patient age and the length of hospital stay (LOS) as a proxy for changes in the patient population over time and the readmission rate as a quality indicator.
The medical ward APEX even increased by 5.2% from 325 patients to 342, despite the workhour restrictions and the increased number of residents (+90%). Inpatients increased by 100% (from 3250 to 6507). Their LOS decreased from 12.4 to 7.5 days and the readmission rate decreased from 4.2% to 3.3%.
In the ED, the APEX decreased by 21% (from 3261 to 2576), but the case complexity (ESI) and the LOS increased substantially.
In contrast to the general belief, work hour restrictions and the increased number of residents did not reduce the inpatient APEX over 20 years. The reduced APEX in the ED may be compensated by the increase in case complexity and the LOS.
Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.
The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping—outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis—quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies—up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,
Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.
Research Registry (researchregistry11126).
To describe the clinical profile, comorbidity burden, follow-up and healthcare utilisation in patients labelled as having Chronic Obstructive Pulmonary Disease (COPD) in Primary Care (PC) nursing consultations.
Real-world data COPD, retrospective, observational study using routinely collected data in electronic health records (EHR). This study adheres to the STROBE reporting guidelines for cross-sectional studies.
Three Primary Care centres in Catalonia, Spain, belong to the Catalan Health Service.
All patients aged ≥ 15 years with a recorded diagnosis of COPD in their EHR, excluding institutionalised individuals and those deceased before study onset. Final sample: 474 patients (105 women, 369 men; mean age 70 years) from a reference population of 28,000 individuals.
Data included socio-demographics, smoking/alcohol, mMRC dyspnea, inhaled therapy/adherence, spirometry, comorbidities, Adjusted Morbidity Groups (GMA), active COPD care plans and 12-month healthcare use.
EHR showed a high rate of missing data in follow-up variables (inhaler adherence 28.5%; dyspnea 17%–20%). Despite that, all participants were ‘labelled’ as COPD, most of them lacked spirometric confirmation. Active smoking was highly prevalent (52.3% women, 45.0% men). Hypertension, obesity and osteoarthritis were the most common comorbidities; anxiety, depression, osteoporosis and thyroid disorders were more frequent in women. Higher GMA complexity correlated with more Primary Care visits, especially nursing consultations, particularly in patients with cardiovascular disease and diabetes (p < 0.001) for 12 months follow-up. No significant differences between groups were found in urgent or hospital care use.
EHR-labelled COPD patients with cardiometabolic comorbidity received more structured nursing follow-up and more annual visits than without. Improving EHR recording, integrating spirometry with the EHR, and prioritising high-complexity profiles could enhance monitoring, treatment optimisation and equity—nursing consultations are a key lever.
No patients or members of the public were directly engaged in the study design or data analysis. Nevertheless, the research was motivated by patient needs and aims to improve healthcare services.
This systematic review and meta-analysis evaluated the efficacy of infrared (IR) devices versus the traditional palpation technique for first-attempt success of peripheral intravenous catheter (PIVC) insertion in adults.
Systematic review and meta-analysis of randomised controlled trials (RCTs).
A comprehensive search of PubMed, Embase, Cochrane Library, Scopus and CINAHL was conducted on 28 May 2024 and included articles in English or French published from 1st January 2000 onwards.
Eligible studies included RCTs comparing IR devices with the traditional palpation method for PIVC insertion in adults. The primary outcome was first-attempt success. Secondary outcomes included overall success, number of attempts, cannulation time and patient pain. The risk of bias was assessed using the RoB2 tool, and a random-effects model was applied for meta-analysis.
Five RCTs were included, involving 690 patients and 704 catheters, including 289 PIVCs in patients with Difficult Intravascular Access (DIVA) criteria. First attempt insertion success was similar when using infrared devices (139/331, 42%) and traditional palpation (143/373, 38%) with Risk Ratio (RR) 1.08 (95% CI, 0.69 to 1.70). No significant statistical differences were noted in secondary outcomes: overall insertion success, number of attempts, time to cannulate and patient pain. Clinical and statistical heterogeneity were substantial (primary analysis I 2 = 83%).
Current evidence does not support the systematic use of infrared devices to improve PIVC insertion success, reduce the number of attempts or alleviate patient pain compared with traditional palpation in adults. Further high-quality studies with suitable sample sizes and varied populations are needed to better establish the potential place of infrared devices.
This study highlights the limited benefit of IR devices in routine clinical practice and underscores the need for further research into their use in specialised settings.
No Patient or Public Involvement. This study did not include patient or public involvement in its design, conduct or reporting.
To test the feasibility and acceptability of a newly developed model of neonatal nurse-controlled analgesia to manage pain in the post-operative infant.
The study utilised a single-centre two-arm parallel, unblinded randomised controlled external pilot trial design.
The pilot trial was conducted in a surgical neonatal tertiary intensive care unit in Brisbane, Australia. Eligible infants were randomised to receive either post-operative pain management care via a model of neonatal nurse-controlled analgesia or standard care. Feasibility and acceptability were the primary outcomes. Seven feasibility outcomes were assessed by a traffic light system to delineate progression to a larger trial. Acceptability and clinical utility of the model of care by staff were assessed by feedback from an anonymous questionnaire that was administered at the completion of the trial period. Secondary outcomes included parental attitudes and perceptions of post-operative pain management to help establish primary outcomes for a larger randomised controlled trial.
Overall staff found the formalised model beneficial for managing post-operative pain but found the complexity of the model and ability to titrate analgesia based only on documented pain scores barriers requiring further consideration. Three of the seven feasibility outcomes failed to reach ‘greenlight’ targets to progress to a larger trial with adherence to the model, and the proportion of eligible infants not recruited was allocated a ‘redlight’. Secondary outcomes were comparable and support future study.
This pilot feasibility study has shown that a model of neonatal nurse-controlled analgesia can be safely implemented and utilised in the post-operative care of the surgical neonate. Further exploration of the barriers to model adherence and recruitment is warranted before a future larger trial is undertaken.
Though not all primary outcomes reached an acceptable range for further progression, this pilot feasibility study provided invaluable learning and has provided direction for future research into the provision of a family integrated and responsive model of analgesia.
This study is reported in line with the Consolidated Standards of Reporting Trials (CONSORT): Extension to randomised pilot and feasibility trial and the TIDieR Checklist (Template for Intervention, Description and Replication).
No patient or public contribution was utilised for this study.
Trial Registration: ACTRN12623000643673—the trial was prospectively registered
by Patricia Quintero-Rincón, Karina Caballero-Gallardo, Elkin Galeano, Oscar Flórez-Acosta
This study investigated the chemical and biological potential of Bidens pilosa and Croton sp., plants from megadiverse ecosystems in Colombia, collected in Santander de Quilichao (Cauca) and San Basilio de Palenque (Bolivar). The chemical profile was analyzed by UHPLC-ESI-Orbitrap-HRMS, and the total phenolic and flavonoid content was quantified using colorimetric methods. Antioxidant capacity was assessed using methods that evaluate reducing power and electron transfer mechanisms. The inhibition of key enzymes in skin aging, such as tyrosinase, hyaluronidase, and collagenase, was evaluated, as well as cytotoxicity in keratinocytes and human melanoma cells. Chemical characterization revealed distinctive phytochemical profiles: B. pilosa contained 21.1 mg GAE/g DT of phenolics and 64.6 mg RE/g DT of flavonoids, dominated by p-coumaric acid and rosmarinic acid, while Croton sp. exhibited higher levels of phenolics (169.4 mg GAE/g DT) and 54.1 mg RE/g DT of flavonoids, highlighting rosmarinic acid, p-coumaric acid and quercetin. Both extracts showed significant antioxidant capacity and enzyme modulation, including moderate collagenase inhibition (53.9–55.0%), high hyaluronidase inhibition (64.5–76.5%), and low tyrosinase inhibition (11.1–12.7%), suggesting protection of extracellular matrix and hyaluronic acid during skin aging. Sun protection factor was limited (SPF: 14.5 for B. pilosa and 11.6 for Croton sp.), with low ultraviolet absorption, consistent with low antityrosinase activity. Cytotoxicity assays demonstrated that B. pilosa was not toxic to HaCaT keratinocytes (IC₅₀ > 500 µg/mL) and displayed antimelanoma activity on A375 cells (IC₅₀ = 398.6 µg/mL), whereas Croton sp. showed moderate selectivity towards melanoma cells (IC₅₀ HaCaT = 329.5 µg/mL; IC₅₀ A375 = 189.0 µg/mL). The results suggest that both plants have potential in dermatological applications such as anti-melanoma agents, antioxidants, and modulators of skin aging enzymes, although highlight the importance of improving strategies to maximize their efficacy and safety.To explore the barriers and facilitators in adherence to the guidelines in the management of benign paroxysmal positional vertigo from the perspective of primary care physicians.
Qualitative study using focus groups.
L’Hospitalet del Llobregat (Barcelona), Spain.
Qualitative study using focus groups. Structured 90 min focus groups were conducted until data saturation was reached. Each session included a moderator and an observer from the research team. Sessions were transcribed and thematically analysed by three independent researchers.
Purposeful sampling was used to form four groups of 4–10 participants, selected by sex, age, years of experience and primary care team (PCT). Participants were recruited between January and February 2023.
A total of 34 family physicians belonging to four PCTs participated in the study. The main barriers identified were a lack of time, negative initial experiences, a fear of harming patients (especially older adults), difficulty in nystagmus visualisation and challenges in managing patient expectations, as many preferred medication over physical manoeuvres. Facilitators included potential time savings from effective early management, the value of initial practical training with periodic refreshers, access to expert consultants for case discussions and the availability of digital tools, such as tutorials, videos and aids for nystagmus interpretation.
Health systems should invest in protected time for history-taking and physical examination, and in regular, updated training for primary care professionals. This could improve vertigo management and reduce unnecessary investigations and medications, ultimately benefiting both patients and the healthcare system.
by Andy Domínguez-Monterroza, Alfonso Mateos Caballero, Antonio Jiménez-Martín
Heart rate variability (HRV) is a well-established marker of autonomic regulation and undergoes profound maturation during early human development. In this study, topological data analysis (TDA) is applied to investigate the evolving geometric complexity of HRV across pediatric developmental stages. Using persistent homology in homological dimension 1, we extracted topological descriptors from time-delay embedded RR interval series of 127 individuals aged 1 month to 17 years. We identified statistically significant, age-dependent transformations in the topological structure of HRV signals. Neonates and infants exhibited a greater number and strength of persistent features, reflecting highly heterogeneous cardiac control dynamics during early autonomic maturation. In contrast, adolescents displayed reduced topological complexity and increased entropy, suggesting a shift toward more uniform and structured physiological control. Topological measures correlated with conventional HRV indices, confirming their physiological relevance. Furthermore, pairwise distances between persistence landscapes revealed an inverse relationship between intra-group topological variability and classical HRV measures. Collectively, our findings demonstrate that persistent homology provides a powerful, multiscale-aware framework to capture developmental trajectories in cardiac autonomic regulation, with potential applications in pediatric monitoring, developmental physiology, and early detection of dysautonomia.Phasix mesh is a fully resorbable synthetic mesh for use in clean and contaminated ventral incisional hernia repairs. Long-term absorbable Phasix mesh appears to be a safe and promising device in incisional hernia repair, with low recurrence rates; however, data on long-term complications after surgery, particularly after the resorption period of the mesh, are scarce.
This protocol describes a study of several European registries on the use of a Phasix mesh in incisional hernia repair. The primary endpoint of the study is long-term complications at 2–5 year follow-up after mesh implantation, with secondary endpoints including hernia recurrence and complications during short-term follow-up.
Ethical approval was not required for this protocol as the study is based on anonymised registry data collected with prior patient consent in each registry. Each participating registry has its own ethical approval process, and this study will adhere to those regulations. The results will be disseminated through peer-reviewed publications and conference presentations.
FreshRSS 