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Sleep, a fundamental element of health, accounts for about one-third of our lives, and is as crucial as nutrition and exercise. Among university students, medical students are one subset that seems particularly susceptible to sleep problems, perhaps due to the length and complexity of their studies and being under a high level of stress. Yoga Nidra has been studied as a therapeutic intervention for various medical conditions. The aim of the study is to evaluate the efficacy of short-duration Yoga Nidra for improving sleep quality in students at a tertiary healthcare centre in Rishikesh, Uttarakhand.
A two-group parallel randomised controlled trial will be conducted among undergraduate medical students with a Pittsburgh Sleep Quality Index (PSQI) score >5. Efficacy of short-duration Yoga Nidra in comparison to sleep education will be evaluated for PSQI scores, heart rate variability, respiratory rate, pulse rate, body mass index, blood pressure, random blood sugar, lipid profile, interleukin 6, salivary cortisol, generalised anxiety disorder and depressive disorder. The intervention will be pre-recorded with the duration of 12 min. The intervention group participants will receive three sessions per week for 4 weeks. The sample size is 160 students. All analyses will follow the intention-to-treat approach using SPSS V.26. Descriptive statistics, test of associations, parametric and/or non-parametric methods (as appropriate) will be used to assess within and between group changes.
The Institutional Ethics Committee (All India Institute of Medical Sciences (AIIMS), Rishikesh) has approved the study (#AIIMS/ie,C/22/231) and the trial has been prospectively registered in Clinical Trials Registry-India: CTRI/2022/07/044426. The results will be published in a peer-reviewed journal.
CTRI/2022/07/044426.
This paper responds to the recently published article on nurses' turnover intentions and their lived experiences of disempowerment, moral distress and organisational neglect. While the study illuminates important workplace realities, it overlooks the perspectives of nurses who have left not only their institutions but also their countries of origin. From the vantage point of Filipino nurses in the diaspora, the decision to migrate mirrors the dynamic, cumulative processes described in the article. Migration is seldom the result of one critical incident; rather, it arises from entrenched systemic issues—understaffing, lack of respect and persistent undervaluing of nursing contributions—that transcend borders. Diaspora nurses bring with them narratives of resilience, yet their departure reflects health system fragility in their home countries and exposes new challenges in host nations. This commentary highlights the urgent need for global cooperation, stronger leadership and policy innovations that recognise migration as part of the retention equation, not apart from it.
To translate, cross-culturally adapt, validate and psychometrically test the MISSCARE Survey–Patient for assessing patients' perspectives on missed nursing care (MNC) in a Danish hospital setting.
A two-phase cross-cultural adaptation and psychometric validation study.
The study was conducted in two phases. First, the MISSCARE Survey–Patient was cross-culturally adapted to ensure its relevance in a Danish hospital context. This phase involved translation and back-translation, expert committee reviews and cognitive interviews with 18 inpatients to establish content validity. Second, a convenience sample of 284 patients from surgical and medical departments completed the adapted survey. Psychometric properties were evaluated using structural equation modelling to test a second-order formative model.
The cross-cultural adaptation phase led to minor and substantial revisions, including the addition of six new items to enhance content validity. These items addressed aspects of nursing care relevant to patients in the contemporary hospital setting that were not captured by the original survey. Structural equation modelling confirmed the second-order formative model and demonstrated robust psychometric properties.
The MISSCARE Survey–Patient was successfully adapted and validated for use in Danish hospitals, ensuring strong content validity and psychometric robustness.
The Danish version of the survey provides a valuable tool for assessing MNC from patients' perspectives in hospital settings. Its use can help identify specific areas where nursing care falls short, guiding targeted initiatives to enhance care quality and patient safety. By integrating patients' experiences into quality improvement initiatives, the survey supports the development of more person-centred care practices.
The study adhered to the COnsensus-based Standards for the selection of health Measurement INstruments reporting guideline for studies on measurement properties of patient-reported outcome measures.
Patients were not involved in the study's design, conduct, or reporting.
The Danish version of the survey facilitates data collection on patients' perspectives of MNC in contemporary hospital settings, providing valuable insights into care quality. By offering a validated tool to assess MNC from patients' perspectives, the survey helps hospitals identify care gaps, prioritise improvement efforts and enhance person-centred care.
by Htay-Wah Saw, Arie Kapteyn
An extensive literature studies the relation between demographic and socio-economic characteristics and attrition in longitudinal studies. In this study, we analyze the independent effects of non-demographic variables—respondent personality traits, panel tenure, and survey topics, using unique datasets from two recently completed high-frequency online longitudinal studies conducted in the U.S. We used latent class analysis to group respondents into various classes based on similarities in their nonresponse patterns across all survey waves, which revealed substantial variations in patterns of nonresponse. Our results indicate that respondent personality traits were strong predictors of nonresponse patterns. Specifically, conscientiousness is positively associated with a lower likelihood of wave nonresponses. In contrast, more open, extroverted, neurotic, and agreeable respondents are more likely to exhibit higher wave nonresponses, but with effect sizes smaller than that of conscientiousness. We found no significant demographic effects on wave nonresponse in one of the studies focused on aging and well-being. However, in the study primarily focused on COVID-19-related topics conducted during the pandemic, we found a few significant demographic effects. Collectively, our findings suggest that personality traits may play a more significant role than conventional demographic and household variables in predicting nonresponse patterns in high frequency (at least one survey per month) online surveys.Electrical burns are among the most severe burn injuries, often leading to deep tissue damage, systemic complications, and prolonged hospitalisation. In Lebanon, limited national data on electrical burn injuries limits the understanding of their epidemiology and management. This study aims to assess the prevalence and characteristics of electrical burns in patients admitted to the specialised burn care unit in Geitaoui Hospital in Lebanon. A retrospective observational study was conducted by reviewing the medical records of patients admitted from 1st January 2011 to 31st December 2024. Data on demographics, burn characteristics, hospitalisation outcomes, infections, surgical interventions, and laboratory findings were extracted and analysed using SPSS version 26. Thirty patients were included, with a male predominance (96.7%) and the mean age was 29.6 years. Third-degree burns were observed in 70.0% of cases, and 66.7% of patients had burns affecting 10%–30% of their total body surface area. High-voltage injuries accounted for 50.0% of cases. Upper extremities were the most commonly affected site (93.3%). The mean hospital stay was 25.69 days, and the mortality rate was 10.0%. Infection was documented in 43.3% of cases. The most frequently isolated pathogens were Acinetobacter (20.0%) and Pseudomonas aeruginosa (16.7%). Surgical intervention was required in 63.3% of patients, most frequently skin grafting (36.7%). This study contributes national data on electrical burns and emphasises the importance of preventive and multidisciplinary care strategies.
En el presente artículo se presenta la ciencia como un producto cultural occidental que ha evolucionado desde la modernidad. Debido a ello se obtuvo su forma actual, la cual logró imponerse, por su efectividad, a nivel global. Se reflexiona también sobre el origen y la evolución de lo que se conoce como “método científico” y se problematiza la naturaleza de la hipótesis y su corroboración empírica. El objetivo de este trabajo es reflexionar epistemológicamente sobre la práctica social de la ciencia, el método y la hipótesis científica. El escrito está estructurado en tres apartados. El primero, presenta la ciencia y el método científico desde sus orígenes hasta la actualidad. El segundo, se centra en los supuestos epistemológicos del método científico, profundizando en el inductivismo y las diversas alternativas que Bunge, Popper y Hempel plantean. Por último, se analiza la hipótesis científica, estudiando su naturaleza y los requisitos obligatorios que esta exige. Concluye sosteniendo que la “ciencia” es un producto occidental con tendencias empiristas y en muchos casos experimentales. Además, se logró determinar los componentes fundamentales del método científico, el cual no es estático, pues varía cada vez que cambia la concepción o la práctica social de la ciencia. Asimismo, se estableció que la contrastación empírica es fundamental para confrontar la hipótesis con la realidad.
by Grant L. Austin, Feng Wang, Steven Q. Le, Alexander Sorensen, Shan Li, Lai C. Foong, Srikanth Singamsetty, Jill Wood, Tsui-Fen Chou, Patricia I. Dickson
Mucopolysaccharidosis type IIID (MPS IIID; Sanfilippo D) is caused by biallelic pathogenic variants in N-acetylglucosamine-6-sulfatase (GNS), which participates in catabolism of heparan sulfate (HS) glycosaminoglycans. Characterization of MPS IIID disease at a cellular level has not been robustly achieved. We used unbiased quantitative proteomics to establish a cellular phenotype for MPS IIID mice. Recombinant human GNS (rhGNS), a variant of which previously demonstrated single dose efficacy in MPS IIID human fibroblasts and in MPS IIID neonatal mice, was used to establish a repeat dosing schedule to treat MPS IIID mice. Adult Gns KO mice or heterozygous carriers were treated via intracerebroventricular (ICV) injections and received 3, 30, or 200 μg rhGNS in 4 doses over 2 weeks or vehicle. Twenty-four hours after the final dose, HS in brain and CSF showed dose-dependent reductions, reaching carrier levels in the higher dose groups. Furthermore, the proteomic perturbations that we described were corrected by rhGNS treatment. Next, Gns KO or carrier adult mice were treated via ICV and received 3, 30 or 200 μg rhGNS or vehicle once every two weeks (Day 1, 15, 29, 43, 57, 71, 85) and were euthanized on day 91. Following treatment, total HS and MPS IIID-specific HS (GlcNAc6S) showed dose-dependent reductions in brain and CSF and markers of neuroinflammation were substantially reduced. ICV enzyme replacement therapy with rhGNS restores CNS pathology of adult MPS IIID mice even with treatment at 14-day intervals, demonstrating preclinical efficacy for MPS IIID.by Chayanee Noosak, Pavarish Jantorn, Suvimol Surassmo, Sittichat Chukaew, Jirut Meesane, Dennapa Saeloh Sotthibandhu
Chronic osteomyelitis, often accompanied by bone loss, requires an adequate angiogenic response for bone regeneration. Loading growth factors into a drug vehicle to promote angiogenesis can address this challenge. In a previous study, we demonstrated the potential of sericin/polyvinyl alcohol (PVA) hydrogel as a functional biomaterial carrier for osteomyelitis treatment. In this study, we optimized sericin/PVA hydrogel for enhanced angiogenesis by supplementing sericin nanoparticles as vascular endothelial growth factor (VEGF) nanocarriers. Sericin nanoparticles, 284.20 ± 13.20 nm in size, exhibited a spherical morphology with 86% VEGF encapsulation efficiency. After integrating VEGF-loaded sericin nanoparticles, the hydrogel was coated with 0.1% and 1% gelatin, and its physical and mechanical properties were assessed. Coating the hydrogel with gelatin enhanced its swelling properties, providing an appropriate degradation rate to support bone regeneration and angiogenesis, and improve mechanical properties. The uncoated hydrogel and hydrogels coated with 0.1% and 1% gelatin exhibited burst release rates of 70%, 60%, and 45% with cumulative release rates on day 14 measured at 76%, 67%, and 57%, respectively. The hydrogels were biocompatible with MC3T3-E1 osteoblastic cell lines and human umbilical vein endothelial cells (HUVEC). The gelatin-coated hydrogels also promoted cell attachment of HUVEC cells. Gelatin-coated hydrogels containing VEGF-loaded sericin nanoparticles were evaluated for their bioactivity on HUVEC cell proliferation. After a 14-day treatment, cell proliferation in 0.1% gelatin-coated hydrogel was significantly higher than in 1% gelatin-coated hydrogel, with over a 160% increase. The expression levels of genes related to angiogenesis were quantitatively examined and results suggested that the hydrogels affected the eNOS pathway to promote angiogenesis. Despite optimization efforts, the sericin/PVA hydrogel maintained effective antibacterial activity against Gram-positive and Gram-negative bacteria. The enhanced sericin/PVA hydrogel showed promise as a novel implant biomaterial for treating chronic osteomyelitis, particularly by promoting angiogenesis.To explore the experiences of new graduate registered nurses in caring for the deteriorating patient in rural areas.
New graduate registered nurses often feel unprepared to care for the deteriorating patient. Whilst literature has recognised new graduate registered nurses working within metropolitan areas feel ill-equipped to care for deteriorating patients, there is a paucity of literature focused on experiences within the rural context.
Qualitative, descriptive phenomenological approach.
In-depth interviews were undertaken with 7 participants in rural Eastern Australia with collected data being subject to thematic analysis.
Three themes were identified that shares the lived experiences of the participants as they transitioned into the rural team: First encounters—Transition to the rural team; Practice support for managing deterioration; and The road to confidence.
New graduate registered nurses are unprepared to care for the deteriorating patient in rural areas. Practice support and barriers to ongoing education are influential on their experience with findings from this study supporting focused rural healthcare preparation from tertiary education providers, plus structured practice support from senior rural nurses and health facility orientation programs. Preparation should include the use of digital technologies and escalation and management of the deteriorating patient alongside rural policies and procedures to enhance patient safety and support new graduate rural nurses.
The findings have implications for tertiary undergraduate nursing education and those supporting New Graduate Registered Nurses in their transition to practice in rural areas. Enhancement of new graduate nurses' skills and abilities in recognition and responding to patient deterioration through both technological and personnel support will enhance patient safety within rural health care.
Standards for Reporting Qualitative Research (SRQR).
7 participants were involved in the study.
This study investigates the knowledge, attitudes, and practices of the Lebanese population regarding thermal burns to inform targeted interventions. Using a cross-sectional design, data was collected from 1090 participants though a structured questionnaire. Key findings revealed a mean knowledge score of 14.89/20, indicating moderate understanding, with gaps in identifying third-degree burns and optimal cooling durations. Attitudes scores averaged 36.97/50, reflecting a strong support for burn prevention but low confidence in first aid. Practices scored 12.37/20, with many participants adhering to safety measures but relying on unverified remedies and lacking emergency preparedness. Significant correlations were found between the three domains, particularly between knowledge and practices (r = 0.328, p < 0.001), emphasising the role of education and attitudes in shaping behaviours. Multivariate analysis identified formal first aid training, education, and urban residency as strong predictors across all three domains, while older age negatively influenced knowledge. These results underscore the need for culturally tailored education and enhanced training to address gaps in burn prevention and management among the Lebanese population.
Clinicians face challenges in implementing evidence-based practices due to limited resources and tools that can support their efforts in translating evidence into practice. To address this, JBI developed PACES (Practical Application of Clinical Evidence System), an online tool designed to streamline and support evidence implementation and quality improvement projects.
This paper reports the development of JBI-PACES and presents an evaluation of its usability (usefulness, satisfaction, ease of use) and user recommendations for improvements.
PACES was developed based on the integration of the Donabedian perspective on quality improvement and JBI's process model for evidence implementation, which incorporates context evaluation, facilitation of change, and the evaluation of both process and outcomes. Initially launched in 2004, the system underwent multiple enhancements based on informal user feedback from 2007 to 2017. A significant update, version 0.0.23 Build 1, was re-launched in late 2018. To evaluate its usability, we conducted a cross-sectional study using the Post-Study System Usability Questionnaire (PSSUQ), which also gathered qualitative feedback.
PACES supports evidence implementation by allowing users to conduct audits across multiple sites and over time, enabling data comparisons and insights into clinical practices. Findings from the usability evaluation showed high levels of satisfaction with the system's usefulness and ease of use. However, qualitative data indicated areas where further enhancements could optimize user experience and functionality.
The current study suggests clear benefits of PACES in terms of its utility and value for supporting evidence-based practices. Although the system performs well in usability, ongoing refinements are necessary to optimize user experience and ensure the tool continues to meet the evolving needs of healthcare professionals.
Burnout and mental health concerns are prevalent among healthcare workers. Female physicians, nurses, and healthcare staff are at a higher risk of suicide than the general population. Burnout and depression have been known to coexist with suicidal ideation and behaviors.
To identify what is known about the relationship between burnout and depression in the context of suicide among healthcare workers.
Registered scoping review of English language articles indexed to CINAHL, PubMed, and PsychInfo databases with date of publication prior to March 5, 2024.
The review yielded nine eligible studies, all employing observational or descriptive methodologies. Depression was found to be a predictor of suicidal ideation. While burnout was associated with depressive symptoms and found to coexist with suicidal ideation, it was not predictive of ideation. Emotional exhaustion and depersonalization were key components of burnout linked to depression. No studies were found exploring survivorship factors in healthcare professionals. Suggested prevention strategies that need to be tested include mindfulness and cognitive-behavioral skills training, improved workplace conditions, addressing loneliness, and fostering resilience.
Interventional studies are needed to test strategies addressing burnout, depression, suicidal behaviors, and survivorship of suicide attempts. Depression should be considered and evaluated when healthcare workers exhibit symptoms of burnout. Moreover, the Socio-economic Model of Suicide Prevention (i.e., SESM) can be used to categorize suicide prevention measures in healthcare. Burnout and depression interact to influence mental health outcomes among healthcare professionals, with depression playing a more significant role in predicting suicidal ideation. Despite the demonstrated relationships, critical gaps in knowledge exist in understanding survivorship and in the development and testing of effective interventions. Future interventional multisite research is needed using validated tools to identify best practices in suicide prevention for healthcare professionals.
Trauma and orthopaedic surgery (TOS) can result in surgical site infections (SSIs), and the repercussions include prolonged and increased cost of treatment. This study investigated the incidence and risk factors of SSI following TOS. A prospective cohort study was conducted at the Tamale Teaching Hospital from September 2023 to May 2024. Data on demographics, comorbidities, preoperative, intra-operative and postoperative parameters were collected from patients, medical records and the operation report. SSI was defined following the Centers for Disease Control and Prevention criteria. The incidence of SSI during the study period was determined, and univariate and multivariate logistic regression analyses were used to identify the independent risk factors of SSI. A total of 210 patients were enrolled of which 6.7% (14) developed SSIs, including 1.0% (2) deep and 5.7% (12) superficial SSIs. The incidence of open fractures and closed fractures in this study was 3.3% (7) and 2.9% (6), respectively. According to multivariate regression analysis, blood transfusion before surgery (p = 0.034; OR = 3.53; 1.10–11.33) was identified as an independent risk factor of SSI following TOS. However, there was a significant association between the type of dressing used on the surgical site after surgery (p = 0.035; OR = 4.08; 1.10–15.08) and SSI. The study reported the overall incidence rate of SSI after TOS to be 6.7% (67 per 1000 surgical operations). Blood transfusion before surgery was an independent risk factor of SSI following TOS. Local and global measures that limit the rates of SSI after TOS should be adopted especially in managing high-risk patients such as those who require pre-operative blood transfusion.
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