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Shoulder osteoarthritis most commonly affects older adults, causing pain, reduced function and quality of life. Total shoulder replacements (TSRs) are indicated once other non-surgical options no longer provide adequate pain relief. Two main types of TSRs are widely used: anatomic TSR (aTSR) and reverse TSR (rTSR). It is not clear whether one TSR type provides better short- or long-term outcomes for patients, and which, if either, is more cost-effective for the National Health Service (NHS).
RAPSODI-UK is a multi-centre, pragmatic, two-parallel arm, superiority randomised controlled trial comparing the clinical- and cost-effectiveness of aTSR versus rTSR for adults aged 60+ with a primary diagnosis of osteoarthritis, an intact rotator cuff and bone stock suitable for TSR. Participants in both arms of the trial will receive usual post-operative rehabilitation. We aim to recruit 430 participants from approximately 28 NHS sites across the UK. The primary outcome is the Shoulder Pain and Disability Index (SPADI) at 2 years post-randomisation. Outcomes will be collected at 3, 6, 12, 18 and 24 months after randomisation. Secondary outcomes include the pain and function subscales of the SPADI, the Oxford Shoulder Score, health-related quality of life (EQ-5D-5L), complications, range of movement and strength, revisions and mortality. The between-group difference in the primary outcome will be derived from a constrained longitudinal data analysis model. We will also undertake a full health economic evaluation and conduct qualitative interviews to explore perceptions of acceptability of the two types of TSR and experiences of recovery with a sample of participants.
Ethics committee approval for this trial was obtained (London - Queen Square Research Ethics Committee, Rec Reference 22/LO/0617) on 4 October 2022. The results of the main trial will be submitted for publication in a peer-reviewed journal and using other professional and media outlets.
Telerehabilitation (TR) programmes are increasingly recognised for their feasibility and potential benefits, such as eliminating travel time, reducing costs and providing a more comfortable rehabilitation experience at home. However, the comparative efficacy of remote physiotherapy compared with traditional in-person sessions for individuals with Parkinson’s disease (PD) remains uncertain. This study aims to evaluate the effects of TR compared with in-person physiotherapy in individuals with PD, focusing on both motor and non-motor outcomes.
This is a randomised, single-blind clinical trial with a mixed-methods approach. A total of 22 individuals diagnosed with PD will be randomly assigned to one of two groups. The experimental group will receive TR, consisting of remote physiotherapy sessions conducted once a week for 1 hour over a 4-month period. The control group will receive the same interventions in person. Interventions will include global muscle strengthening exercises, balance training, gait and motor coordination exercises, and cognitive training. The primary outcome will be motor function, measured using part III of the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale. Secondary outcomes will include cognition (Montreal Cognitive Assessment), gait (Functional Gait Assessment), mobility (Timed Up and Go Test) and quality of life (Parkinson’s Disease Questionnaire). Data will be analysed using repeated measures analysis of variance to compare outcomes between groups across four assessment points (baseline, midpoint, postintervention and 2 months follow-up). Additionally, a qualitative phase will explore participants’ perceptions and experiences regarding TR and in-person interventions, with assessments carried out 2 months after the completion of the 24-week interventions, through semistructured interviews that will be analysed using Bardin’s Content Analysis technique.
This protocol was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (approval number: 5.553.701). All participants will provide written informed consent before inclusion. Results will be disseminated through peer-reviewed publications, scientific conferences and communication with participants and healthcare professionals.
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To analyse the relationship between authentic nursing leadership and safety climates across hospital settings during the COVID-19 pandemic.
Authentic nursing leadership shapes the safety climate by fostering positive perceptions of workplace policies, processes, procedures and practices that influence how safety is prioritised and addressed within an organisation.
A cross-sectional study.
Our study was conducted from December 2021 to December 2022 in six Brazilian hospitals. Participants were nursing staff working in General Medicine Units, Intensive Care Units (ICU) and Emergency Departments (ED) who provided care to patients with COVID-19. The Authentic Leadership Questionnaire and the Safety Attitudes Questionnaire were used to measure nursing staff perceptions of authentic leadership and safety climates. Data were analysed using descriptive and inferential statistics.
391 nursing staff across six hospitals participated. Self-awareness significantly enhanced perceptions of the safety climates. Additionally, being a Registered Nurse and working in the ICU were positively associated with achieving safe climates in the working environment. In contrast, working in EDs was significantly negatively related to safety climates.
The COVID-19 pandemic underscored a lack of authentic nursing leadership and unsafe climates. Therefore, it is critical to implement educational strategies that foster authentic leadership, particularly focusing on self-awareness, to promote more positive safety climates. Ensuring that leadership and safety climates are relationship-focused is critical to enhancing patient outcomes.
Nursing staff's perceptions of authentic leadership and safety climates are important in making more informed decisions about patient management.
Since self-awareness increases positive perceptions of safety climates, nursing staff should exercise it to guide their actions in facing future health crises.
STROBE guidelines.
Higher self-awareness in relationships with others is a predictor of safety climates and can lead to enhanced patient outcomes.
Photobiomodulation therapy (PBMT), particularly when combined with a static magnetic field (PBMT-sMF), is a promising non-pharmacological approach for managing musculoskeletal disorders. However, high-quality evidence for its efficacy in lateral epicondylitis remains limited.
The study aims to investigate the effectiveness of PBMT-sMF vs placebo in reducing pain, improving function and modulating inflammatory markers in individuals with lateral epicondylitis.
Multicentre, randomised, triple-blinded, placebo-controlled trial.
Three outpatient physiotherapy clinics in Brazil.
50 adults (18–50 years) with unilateral lateral epicondylitis and baseline pain ≥50 on the visual analogue scale (VAS).
Participants received either active PBMT-sMF (n=25) or placebo (n=25), 2 times per week for 3 weeks. PBMT-sMF involved multi-wavelength irradiation at 4 epicondyle sites (60 s; 27.1 J/site). The placebo group underwent the same procedure without active irradiation.
The primary outcome was degree of pain rating (VAS). Secondary outcomes included forearm disability (Patient-Rated Tennis Elbow Evaluation, PRTEE), grip strength, serum tumour necrosis factor-alpha (TNF-α) levels and treatment satisfaction. Assessments were conducted at baseline, post-treatment (3 weeks) and at 4-week follow-up.
PBMT-sMF yielded a higher responder rate (defined as the proportion of participants achieving at least a 30% reduction in pain intensity relative to baseline) than placebo (72% vs 40%, p=0.045), with a clinically and statistically significant between-group difference. Compared with placebo, the PBMT-sMF group showed significantly greater reductions in pain intensity both at the end of treatment (51.4±19.8 vs 36.9±22.6; p=0.0223) and at follow-up (37.4±24.1 vs 20.3±21.2; p=0.0049). TNF-α levels also decreased significantly in the PBMT-sMF group compared with placebo at both time points (p
PBMT-sMF significantly reduced pain intensity and TNF-α levels, suggesting an anti-inflammatory mechanism. Although functional outcomes were not improved, PBMT-sMF may be a valuable short-term, non-invasive option for lateral epicondylitis pain management.
NCT04829734 on ClinicalTrials.gov
Objetivo: Actualizar la evidencia de investigación cualitativa primaria respecto de las percepciones y significados del impacto de la espiritualidad en el proceso de afrontar el tratamiento oncológico en las personas adultas y sus familiares. Metodología: Se realizó una metasíntesis, respondiendo a la pregunta en estructura SPICE y basada en el marco de trabajo para revisiones SALSA. Se recuperaron 149 artículos en las bases de datos, Scielo, BVS, PubMed, Scopus, CUIDEN, con los descriptores DeCS, espiritualidad y oncología, unidos con el booleano AND. Se aplicaron criterios de selección, se realizó lectura crítica con plantilla CASPe para estudios cualitativos, quedando finalmente incluidos en la revisión cinco estudios. Resultados: Los hallazgos de los estudios analizados se densificaron en tres categorías temáticas; la espiritualidad como una forma de resignificar las experiencias, como una forma de alivio del sufrimiento y finalmente como una estrategia de afrontamiento para lograr la resiliencia. Conclusión: La pregunta de investigación fue respondida en torno a tres principales subcategorías; resignificación de la experiencia del cuidar, como un alivio del sufrimiento físico/ emocional y como una estrategia de afrontamiento para lograr la resiliencia.
Objetivo: investigar en la literatura científica el conocimiento producido sobre la influencia de las relaciones interpersonales para la salud del trabajador de la enfermería. Método: revisión integradora que ocurrió a partir de cuatro bases de datos, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE), repositório Scientific Electronic Library Online (SciELO) y Cumulative Index to Nursing and Allied Health Literature (CINAHL).Fue utilizado el operador booleano and para las combinaciones de los descriptores: ʽʽRelaciones interpersonales y Enfermería, ʽʽRelaciones interpersonales y Equipo de Enfermeríaʼʼ, ʽʽRelaciones interpersonales y Salud del Trabajadorʼʼ. Resultados: Fue evidenciado un bajo números de estudios publicados con esa temática. Sin embargo, los estudios desarrollados abordan los aspectos negativos de las relaciones interpersonales como responsables y contribuyentes para la aparición del estrés, Síndrome de Burnout y agotamiento emocional. Conclusión: Las relaciones interpersonales pueden interferir en la salud de los trabajadores de enfermería, frente a relaciones conflictivas en el ambiente de trabajo y la insatisfacción en el trabajo.
Objetivos: determinar los indicadores de morbilidad de la tuberculosis en una ciudad del nordeste brasileño prioritaria para el control de la enfermedad y describir características sociodemográficas y clínicas-epidemiológicas de los casos notificados. Método: se trata de un estudio epidemiológico descriptivo con enfoque cuantitativo, considerando todos los casos notificados mediante el Sistema Nacional de Información y Agravios de Notificación en 2015 y expresando los coeficientes de incidencia y prevalencia. Las variables relacionadas con la caracterización sociodemográfica tales como género, edad, raza/color, nivel de educación y zona de residencia, así como las de investigación clínica-epidemiológica, tipo de ingreso, forma clínica, realización de baciloscopía, cultivo, realización de tratamiento supervisado y desenlace de tratamiento fueron analizadas por medio de la estadística descriptiva. Resultados: las tasas de prevalencia e incidencia fueron respectivamente 26,0 y 24,5 casos/100.000 habitantes, donde la mayoría de los casos notificados pertenecían a la zona urbana (98,48%), haciendo hincapié en hombres (68,18%), con edades ≤ 40 años (60%), raza/color pardo (78,79%) y con el predominio de la enseñanza primaria completa (34,85%). En lo que atañe a las características clínicas y epidemiológicas, la mayoría presentaba la forma clínica pulmonar (89,39%), resaltando la baciloscopía de esputo positivo (40,91%), cultivo de esputo no realizada (92,42%), rayos-x torácicos sospechosos para tuberculosis (54,55%), enfermedades y agravios – SIDA (10,61%), y la situación de desenlace predominante fue la cura (86,36%). Conclusiones: a pesar del panorama epidemiológico evidenciado con indicadores de morbilidad por debajo del promedio nacional, la identificación del perfil clínico-epidemiológico de la población afectada señaló aspectos importantes que deben ser observados relacionados con la organización de los sistemas y servicios sanitarios para el control y vigilancia de esta enfermedad.
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