Conectar
The dynamic physiological and hormonal changes through the menopause transition predispose women to an increased risk of chronic diseases including cardiovascular disease, metabolic disease, depression and dementia. The underlying mechanisms remain unclear, yet it is thought that chronic systemic inflammation and changes to lifestyle behaviours play important roles. The LIfestyle risk Factors for chronic disease across the stagEs of reproductive ageing (LIFE study) is a cross-sectional study aimed to characterise how hormonal and lifestyle (physical activity, diet and sleep) differences across pre, peri and postmenopause influence chronic systemic inflammation, visceral adiposity, cognitive function and sleep health.
Women aged between 40 and 65 years were recruited and classified into pre, peri or postmenopausal groups. Body composition measures and blood samples were collected. Sleep and physical activity were objectively measured using activPAL4 and ActiGraph GT9X link accelerometer over 7 days. Participants were also provided with a sleep diary. Physical function was assessed using the Short Physical Performance Battery. Cognitive function was evaluated using Addenbrooke’s Cognitive Examination-III and Cambridge Neuropsychological Test Automated Battery. Participants completed a series of questionnaires: Depression, Anxiety and Stress Scale-21, RuSATED, Berlin Questionnaire, Insomnia Severity Index, Activities-specific Balance Confidence Scale and the Australian Eating Survey.
Ethical approval was received from the relevant University Human Research Ethics Committee (ethics approval number #S221718) prior to the commencement of the research project. Data collection is ongoing and expected to be completed by April 2026. Results are expected to be available from July 2026. Findings will be disseminated in national and international conferences and in peer-reviewed journals and expected to inform how differences in lifestyle behaviours across menopause influence chronic systemic inflammation, visceral adiposity and cognitive function. Understanding and characterising the links between lifestyle behaviours and menopausal symptoms will inform targeted strategies to improve long-term well-being, heart, brain and metabolic health.
by Jesús del Moral Preciado, David Gurpegui, Montserrat Royo, Bernardo Hontanilla
IntroductionRegenerative Peripheral Nerve Interface (RPNI) and Targeted Muscle Reinnervation (TMR) have demonstrated superior outcomes compared to classical amputation in prophylactic prevention of pain, primarily by reducing the incidence of symptomatic neuromas, residual limb pain, and phantom limb pain. However, direct comparisons between these two techniques remain limited. Furthermore, their comparative effectiveness across diverse patient demographics (including age, sex, and comorbidities) and surgical variables (amputation level, etiology, and nerve handling) has not been systematically evaluated. Therefore, the objective of this systematic review and meta-analysis is to synthesize the available evidence to determine the comparative safety and efficacy of primary TMR or RPNI.
Methods and designThis review will be conducted following the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive electronic search will be performed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, PubMed, and MedRxiv, without language restrictions. We will include randomized controlled trials, quasi-randomized trials, and observational studies. Study selection and data extraction will be managed using Covidence. Two reviewers will independently screen titles and abstracts, assess full-text eligibility, evaluate risk of bias, and extract data.
Ethics and disseminationAs this systematic review relies on the analysis of secondary data from published studies, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.
PROSPERO registration numberCRD42024617299
Workplace incivility is a pervasive challenge in healthcare. Few studies drew on theoretical concepts to simultaneously examine organisational correlates of incivility and its associations with nurses' work outcomes.
This study examined workplace incivility among nurses, focusing on job control, psychological job demands and workplace justice as workplace characteristics, and assessing its association with job satisfaction and intentions to leave.
A cross-sectional survey was conducted among 528 full-time nurses at a medical centre in Taiwan. Validated questionnaires assessed workplace incivility (the Workplace Incivility Scale), workplace characteristics, job satisfaction and intentions to leave. Multivariable linear regression examined associations of workplace characteristics with incivility, and associations of incivility with job satisfaction and intentions to leave, adjusting for demographic and workplace factors.
High workplace incivility was reported by 41.1% of nurses. In adjusted analyses, lower job control and lower workplace justice were associated with higher incivility scores. After adjustment for demographic and workplace factors, workplace incivility was negatively associated with job satisfaction and positively associated with leaving intentions. Among workplace characteristics, psychological job demands showed strong associations with both job satisfaction and leaving intentions.
Workplace incivility reflects underlying organisational conditions and is associated with lower job satisfaction and greater leaving intentions. Addressing job demands, autonomy and fairness may reduce incivility and sustain the nursing workforce.
Workplace incivility is associated with lower job satisfaction and greater leaving intentions, and may co-occur with lower job control and perceived organisational justice, highlighting the need for organisational strategies that foster fairness and supportive work environments to enhance nurse retention.
The authors adhered to the STROBE guidelines.
No patient or public involvement.
Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is a significant procedural adverse event (AE), occurring in 5–15% of cases and leading to substantial morbidity and mortality. Aggressive prolonged intravenous (IV) fluid regimens have demonstrated efficacy in reducing PEP in clinical trials. However, these regimens typically involve continuous infusion of IV fluids over 8–24 hours following ERCP, making them impractical for outpatient settings. Data on shorter hydration protocols are lacking. The STRIPE study aims to address this gap by evaluating short-term peri-procedural IV fluid regimens as a practical alternative for mitigating PEP.
This proof-of-concept, parallel-arm, randomised controlled trial will evaluate the impact of various short-term IV fluid regimens on post-ERCP serum amylase levels, a surrogate marker for PEP. Participants undergoing ERCP will be randomised into five groups, receiving 500 mL, 1000 mL, 1500 mL, 2000 mL or 2500 mL of IV Ringer’s lactate during the peri-procedural period. Patients, endoscopists and outcome assessors will be blinded to treatment allocation during the peri-procedural period. The primary outcome is the serum amylase level 24 hours post-ERCP. Secondary outcomes include PEP, 30-day AEs and unplanned healthcare encounters including those related to volume overload or cardiovascular AEs, duration of hospitalisation (for inpatients), death within 30 days and other relevant laboratory markers at 24 hours. A total of 505 participants (101 in each arm) will be enrolled to ensure adequate power after accounting for attrition and/or sample loss.
This trial was registered on clinicaltrials.gov on 7 February 2024. The study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB23-0625). On study completion, data will be made available on reasonable request to the corresponding author after completion of the study. Study dissemination and knowledge translation is planned via presentations at scholarly meetings, publications in peer-reviewed journals and, ideally, via adoption of results into clinical practice guidelines.
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.
One-third of patients operated for degenerative conditions in the lumbar spine do not report substantial improvement after 12 months. Most previous outcome prediction models are classifiers. This constrains nuances in prediction and use for decision support.
To develop and test models for the prediction of continuous outcome scores and retrieval of similar patients’ outcomes, and to evaluate the models’ fairness.
Norwegian public and private specialist healthcare.
All cases recorded with an elective operation for lumbar disc herniation (LDH, n=18 377) or lumbar spinal stenosis (LSS, n=24 540) in the Norwegian Registry for Spine Surgery from 1 January 2007 to 23 May 2023.
All outcomes were patient-reported 12 months after the operation. The primary outcome was the Oswestry disability index (ODI), modelled on a scale ranging from 0 to 100. Numeric Rating Scale scores (range 0–10) for back and leg pain were secondary outcomes.
We selected 22 predictors recorded preoperatively by patients and clinicians based on Shapley Additive Explanations values. Data were split into 80%/20% training/test samples for LDH and LSS. Six machine learning methods for regression, that is, with a continuous outcome (extreme gradient boosting (XGBoost), Gaussian process regression, gradient boosting regression, artificial neural networks and linear regression), were trained for both conditions using fivefold cross-validation. We report the magnitude and distribution of errors as mean absolute error (MAE) with 95% CIs, and explanatory power as the coefficient of determination (R2). Fairness and calibration were assessed with violin and calibration plots of error. We developed a patient-similarity function that uses a K-nearest neighbour model to retrieve the individual outcomes of the 50 most similar patients and evaluated it by calculating L1 distances (Manhattan distances) across subgroups.
XGBoost regression performed best for both conditions. The models showed good calibration and predicted ODI with MAE 11.32 (95% CI 11.00 to 11.63) and R2 0.27 (95% CI 0.24 to 0.29) for LDH and MAE 12.05 (95% CI 11.76 to 12.32) and R2 0.31 (95% CI 0.28 to 0.34) for LSS. The MAEs for back and leg pain were 2.09 (95% CI 2.04 to 2.15) and 1.95 (95% CI 1.90 to 2.00) for LDH and 2.33 (95% CI 2.28 to 2.38) and 2.13 (95% CI 2.08 to 2.16) for LSS. All models were fair with differences in error between subgroups for sex, age, education level and native language. In the patient-similarity function, distances at baseline were evenly distributed across subgroups.
Our machine learning models predicted continuous outcomes with MAEs close to the SEs of measurements. The models were fair across sociodemographic subgroups. We succeeded in developing a patient-similarity function which supplements the predictions.
Intersectionality, as applied to health, provides a framework for understanding how overlapping social identities, such as ethnicity, gender and socioeconomic status, shape differential health outcomes and healthcare experiences. Individuals who occupy multiple marginalised identities often experience compounded disadvantages. Ethnic minority (EM) populations, defined here as social groups who are numerically smaller and/or socially marginalised within a given national or regional context based on ethnicity, race, culture, language, ancestry, or related heritage (often overlapping with racialised identities), frequently experience systemic exclusion, racism and structural barriers that also contribute to persistent disparities in morbidity, mortality and healthcare access. However, much health research relies on single-axis analyses, which can obscure within-group variation and may inadvertently reinforce inequities. Despite growing recognition of intersectionality, its empirical application to EM health remains limited. This systematic review aims to synthesise evidence on how intersectionality theory has been conceptualised and applied to understand health outcomes and healthcare utilisation among EM populations globally.
This systematic review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA-Equity Extension. Comprehensive searches of peer-reviewed databases and grey literature, including MEDLINE, EMBASE, CINAHL Plus, Scopus, Web of Science and ProQuest will identify quantitative, qualitative and mixed-method empirical studies published from 2000 to 2026. Eligible studies must implement intersectionality theory to EM health or healthcare utilisation outcomes. Two independent reviewers will screen titles, abstracts and full-text articles. Data extraction will also be conducted independently and discrepancies will be discussed with input from a third reviewer. Guided by the PROGRESS-Plus equity framework, findings will be synthesised thematically, implementing a mixed-method convergent integrated synthesis design.
This review only analyses previously published data, thus it does not require ethical approval. Findings will be presented at relevant academic or professional conferences and submitted for publication in a peer-reviewed journal.
CRD420251248887.
While exercise adherence is known to vary during cancer treatment, little is known about what predicts these changes during chemotherapy or within individual treatment cycles for breast cancer. We examined changes in adherence and its predictors (1) across chemotherapy treatment and (2) within treatment cycles in women undergoing (neo-)adjuvant chemotherapy for breast cancer.
This study is based on data from the Phys-Can multicentre parallel randomised trial.
The exercise intervention was conducted at public gyms in three Swedish university cities.
178 women undergoing (neo-)adjuvant chemotherapy without any chemotherapy treatment delays and had any adherence data were included in the analysis.
Participants in the Phys-Can trial were randomised to either high or low-to-moderate intensity combined endurance and resistance training.
The primary outcome variable for this secondary analysis of Phys-Can trial data was adherence to endurance and resistance training. Bayesian multilevel growth curve models were used to examine adherence to resistance and endurance training throughout the chemotherapy treatment period and within chemotherapy cycles. Potential predictors of adherence included exercise intensity, chemotherapy dose, muscle strength, body mass index, cardiorespiratory fitness, fatigue and age. Results are reported with 95% credibility intervals (CrIs).
Adherence to endurance and resistance training declined on average across the chemotherapy treatment by 1% (95% CrI –1.5, –0.5) and 5.2% (95% CrI –6.8, –3.6), respectively, per week. Adherence decreased within the chemotherapy treatment cycle by 2.4% for endurance (95% CrI –4.2, –0.7) and 6.1% (95% CrI –8.2, –4.1) for resistance training, respectively. Higher baseline fitness predicted better adherence to endurance exercise (β=1.2, 95% CrI 0.1, 2.3), while high-intensity training predicted a steeper decline (β=–1.2, 95% CrI –2.2, 0.2). No significant predictors were found for adherence to resistance training over time.
Women with breast cancer may require additional support to maintain exercise adherence during the later stages of chemotherapy and during the second and third weeks of their chemotherapy cycles. Those with lower pretreatment fitness levels may benefit from more intensive support to sustain engagement in exercise.
The Phys-Can trial was registered in Clinical trials: ClinicalTrials.gov NCT02473003,
To map factors influencing nurses' engagement in clinical mentorship in nursing education and explore their interactions using network analysis.
Observational cross-sectional study employing an online survey from July 2024 to May 2025.
A total of 261 clinical mentors from healthcare institutions in Catalonia, Spain, completed the survey. Key variables included engagement in clinical mentorship (implication, motivation, satisfaction, compromise), perceived obstacles, ward manager support, emotional intelligence, emotional wellbeing, working and employment conditions. Data were analysed using regularized partial correlation network analyses. Centrality indices were calculated to determine the most influential variables within the network structure.
Motivation, ward manager support, and emotional intelligence emerged as the most central, interconnected drivers of engagement. Motivation showed positive associations with commitment and implication in the mentoring role and a negative association with perceived obstacles. Ward manager support was linked to emotional wellbeing and peer support, reflecting the importance of psychosocial resources. Emotional intelligence appeared to support motivation, work control, and satisfaction with the mentoring role. In contrast, professional experience and employment conditions showed limited influence within the network.
This study provides a comprehensive understanding of how multiple factors interact to shape nurses' engagement in clinical mentorship. Motivation, ward manager support, and emotional intelligence represent key leverage points for strengthening mentorship practices.
Sustainable, high-quality clinical practicums require supportive work environments that recognize and foster mentors' intrinsic motivation, leadership support, and emotional skills.
Clinical mentors are essential to student learning, and so is their engagement in the mentoring role. This study is the first to apply network analysis to this process, revealing that motivation, emotional intelligence, and ward manager support are central to engagement, while professional experience and employment conditions are less relevant. These findings can guide institutional strategies to promote supportive and nurturing clinical learning environments.
The manuscript is based on the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore how patients experience, interpret, and respond to missed nursing care during hospitalization in a Danish hospital context.
A qualitative design was employed.
Individual semi-structured interviews were conducted with fifteen patients who had been admitted to medical or surgical wards at a Danish university hospital. Data were analysed using reflexive thematic analysis.
The overarching theme, ‘Nursing care experienced through a filter of empathy and understanding’, captured how patients perceived omissions and delays as understandable responses to systemic pressures rather than neglect. Although they experienced missed nursing care, patients rationalized these omissions as inevitable, adapting to organizational constraints with empathy toward nurses, awareness of workload pressures, and a wish not to be a burden. Three subthemes illustrated this process: ‘Not wanting to be a burden: negotiating physical needs’, ‘Moderating expectations: the subtle importance of psychosocial care’ and ‘Waiting patiently: a sense of shared responsibility for timely care’.
Patients' empathy and adaptation sometimes obscured unmet needs and contributed to the normalization of missed nursing care. Missed nursing care thus emerged as a relational, co-constructed phenomenon shaped by both system pressures and patients' efforts to avoid burdening nursing staff.
Reducing missed nursing care requires action beyond staffing, addressing relational and cultural dimensions across clinical, organizational and policy levels through proactive, person-centered approaches.
By foregrounding patients' perspectives, this study reframes missed nursing care as co-constructed by both system constraints and patient adaptations, offering new insight to guide policy, leadership, and practice efforts toward more responsive and person-centered nursing care.
Reporting followed the consolidated criteria for reporting qualitative research.
Patients contributed as interview participants but were not involved in the design, conduct, or reporting of the study.
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, pParenting concerns, stemming from cancer's projected impact on children, are a common and significant source of emotional distress for parents. A quantitative synthesis of existing data is critically absent, and the role of modulating factors (e.g., male sex, single parenthood, and the number of children) remains unclear.
This meta-analysis aims to quantify the association between parenting concerns and emotional distress in cancer patients, examining male sex, single parenthood, and number of children as key moderators.
This systematic review and meta-analysis followed PRISMA guidelines. Searches (PubMed, Embase, PsycINFO, Airiti Library; inception-November 2025) identified observational studies of adult cancer patients with minor children. Data on parenting concerns, anxiety, and depression were extracted and appraised using a modified JBI Checklist. Correlations were synthesized. Meta-regression addressed the quantitative void, examining male sex, single parenthood, and number of children as key moderators. Publication bias and sensitivity were assessed.
We included 12 studies (N = 3895). Our meta-analysis found significant positive associations (r = 0.50, p < 0.001) between parenting concerns and both anxiety and depression. Meta-regression, controlling for time since diagnosis, identified male sex, single parenthood, and fewer children as significant moderators for anxiety (p < 0.001), with similar trends for depression.
This meta-analysis highlights parenting concerns linked to distress in cancer patients, with fathers, single parents, and those with fewer children particularly vulnerable. Routine assessment and tailored, family-centered psychosocial interventions are urgently needed.
This systematic review was registered with the International Prospective Register of Systematic Reviews and Meta-analysis (PROSPERO; Registration No. CRD42024592899).
To explore the narrated experiences of adult children during the initial phase of their transition process when their elderly parent transfers from home to a nursing home.
The article describes part of a qualitative study with a narrative, longitudinal, prospective design.
Narrative interviews were conducted with a sample comprising eight adult children at three time points between February and July 2022. Narratives from the first interviews obtained during the initial transition phase are presented. This article explores the narratives of one woman and one man. The data were analysed using a thematic narrative approach. A constructed timeline gave a narrative chronology and facilitated the generation of three storylines and a unifying plot.
The narratives provide insight into a complex, emotionally demanding, and morally challenging initial transition phase. This generated the following three storylines: doubting the decisions, a shift in the filial responsibilities and an emotional roller coaster. These storylines were closely intertwined, and they shaped the unifying plot of experiencing persistent ambivalence.
Adult children encounter significant burdens due to shifting roles and experiences of intergenerational ambivalence during the initial transition phase when their elderly parent transfers from home to a nursing home. Informal caregivers are crucial for maintaining and developing a sustainable health-care service, which makes it necessary to allocate resources and provide systematic support to enable adult children to continue their care responsibilities.
Nurses and other health-care personnel need to acknowledge the challenges and heavy burdens experienced by adult children when their elderly parent transfers from home to a nursing home. This should be addressed through systematic follow-up and dialogue with adult children.
This study provides knowledge that will enable health-care personnel to recognise adult children in this situation and support them during this phase.
Reporting was performed in accordance with the consolidated criteria for reporting qualitative research (COREQ). There were no patient or public contributions.
To gain insight into healthcare professionals' perceptions and needs regarding hospital-to-home transitions.
Qualitative phenomenological study.
Hospital and primary care professionals participated in focus groups and interviews. Participants were recruited from a Dutch University hospital and from our networks between May and September 2023. Data were analysed using thematic analysis.
We conducted seven focus groups and twelve interviews. Three themes emerged: “Collaboration and information exchange between professionals”, “Coordination and continuity of care”, and “Interaction between professionals, patients, and families”.
This study suggests that professionals would benefit from clear guidelines and arrangements for communication with colleagues to support care coordination and continuity. Collaboration and information sharing are essential for providing integrated, patient-centred care. Additionally, involving patients and families in decision-making regarding hospital-to-home transitions, in a way that considers their needs, is important for effective care.
This study highlights the importance of clear communication and collaboration between professionals to ensure continuity of care. It emphasises the need for integrated care, where patients and families are actively involved without being overwhelmed.
Transitions from hospital-to-home are often hindered by fragmented, non-individualised care. Improved collaboration, clear coordination, and patient-family involvement can address this. This research can positively impact professionals across different settings, policymakers, and advocacy groups aiming to improve integrated patient-centred care.
The interview guide was developed with professionals who reviewed it and provided feedback. Professionals provided us with their lived experiences by participating in interviews and focus groups.
This study adhered to the COREQ guidelines.
N.A
To examine the conceptual ambiguity of nursing leadership, particularly in relation to management roles, and to propose a multilevel competency framework that redefines leadership as a core dimension of nursing practice. The paper introduces an innovative hybrid Iceberg–Alles model that integrates observable competencies with deeper motivational, ethical and personality-based attributes.
Integrative review.
Two-stage evidence identification process informed by theoretical reflection and existing evidence on nursing leadership and management.
A literature search was conducted in targeted databases such as PubMed, Scopus, Web of Science, CINAHL and extended to Google Scholar and grey literature.
Current understandings of nursing leadership are fragmented and often limited to managerial skills, overlooking crucial aspects such as ethical commitment, personal values, interpersonal skills and relational capacities. The hybrid Iceberg–Alles model reconceptualizes leadership as a multidimensional construct that balances visible skills with underlying drivers such as motivation, self-awareness and value alignment, offering a more comprehensive basis for leadership development.
Nursing leadership should be understood as a relational and value-based process embedded across all levels of practice, not confined to formal administrative positions. The proposed model enhances conceptual clarity and provides a transferable framework that can be adapted across diverse health systems, roles and organisational structures.
Broadening the scope of nursing leadership can reduce role ambiguity, highlight the unique contribution of nurses to healthcare systems, and strengthen the profession's influence in policy and decision-making. The hybrid model provides concrete guidance for educational programmes, competency-based curricula and organisational strategies aimed at preparing future nurse leaders to manage complexity, promote collaboration and improve patient care.
This manuscript followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR).
This study did not include patient or public involvement in its design, conduct or reporting.
To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion.
An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022).
Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression.
Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables.
There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision.
Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety.
This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain.
This study adheres to the STROBE guidelines for reporting observational studies.
In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.
Hand burns, although often limited in surface area, have a major impact on function and quality of life. Debridement—surgical or enzymatic—is a key component of treatment, with enzymatic debridement increasingly used for its selectivity and potential to preserve viable dermis. To evaluate and compare the functional outcomes of hand burns treated with surgical versus enzymatic debridement, using the DASH/Quick-DASH and Michigan Hand Questionnaire (MHQ) assessment tools. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251034408). Searches were performed in PubMed, Scopus, and Web of Science without date restrictions. Inclusion criteria focused on studies evaluating hand burn function using DASH, Quick-DASH, or MHQ after enzymatic or surgical debridement in patients aged 16 or older. Methodological quality was assessed using the ROBINS-I tool. Of 547 studies identified, 7 met inclusion criteria: 4 surgical and 3 enzymatic. Functional recovery was generally better in cases where enzymatic debridement preserved viable dermis and avoided grafting. DASH and MHQ scores favoured enzymatic approaches, especially when conservative management followed debridement. However, methodological limitations and clinical heterogeneity limited direct comparison. Enzymatic debridement, through preservation of viable dermis and reduced grafting need, appears associated with improved functional outcomes in hand burns. Whilst surgical debridement remains essential for deeper burns, enzymatic methods may offer functional advantages and support early rehabilitation in appropriate cases.
To clarify the concept of disempowerment in adults with chronic illness.
The Walker and Avant approach to concept analysis was used.
A systematic literature search was performed on 14 February 2024, using the following databases: CINHAL, PubMed, PsycINFO, Sociological Abstracts and ProQuest Dissertations & Theses Global A&I: The Humanities and Social Sciences Collection. Studies examining adults' experience of individual disempowerment stemming from chronic illness were included. Definitions and descriptions of the concept in the included studies were extracted and synthesised into defining attributes, antecedents, and consequences.
Forty-five articles were included. Two defining attributes were identified: (1) diminishing opportunities to take control and (2) clients' dissatisfaction with diminishing control. Antecedents were changes in health status related to chronic illness and expectation mismatch within the client, or between clients and their care partners. The consequence of disempowerment was disengagement in the context of disempowerment.
Disempowerment was found as the state of dissatisfaction with diminishing opportunities to control personal lives, which stems from changes in health status and expectation mismatch and leads to disengagement in the context of disempowerment. Contrary to prior studies, where disempowerment was often considered an outcome of an imbalanced relationship between clients and care partners, the present findings showcased disempowerment as a holistic illness experience, involving changes in health status. The understanding of disempowerment as the dissatisfaction with the situation of diminishing opportunities to take control differentiates this concept from the opposite of empowerment, which is conceptualised as clients' ability to make decisions or manage diseases. Findings further highlight the importance of understanding clients' illness experience comprehensively and providing care in a manner that is matched with clients' abilities, expectations and needs. It is suggested that operationalising the concept based on this understanding is necessary in order to understand correlations between disempowerment, its causes and consequences.
Disempowerment has been applied to describe interruptions in their states of being, perceived role performances, and independence in adults with chronic illness from diverse perspectives in the extant literature, such as the opposite of empowerment, action to take away control over personal lives and a state of diminishing ability to tackle problems. Through clarifying the concept, this article will guide the communication, measurement tool development and response in clinical practice.
No patient or public contribution.
Adults living with chronic conditions may need to access health programmes to mitigate health-related challenges that persist long after discharge from the hospital. Community physical activity programmes represent critical opportunities for health promotion and chronic disease self-management that can extend beyond hospital-based services. However, navigating the healthcare system and connecting to much-needed physical activity programmes can be challenging due to fragmentation of the health and social care system, especially for those who are transitioning between different healthcare providers, settings, stages of recovery and funding sources (eg, public, private). Patient navigation services can assist with this fragmentation by providing tailored support to individuals with chronic conditions. However, our understanding of patient navigation services in Canada is limited. This rapid review seeks to explore the landscape of patient navigation services supporting Canadians with chronic conditions in connecting to physical activity programmes in the community.
The rapid review will follow the recommendations published by Garritty et al in 2024. Integrated Knowledge Translation will be employed to facilitate meaningful engagement of people with lived experience of chronic conditions throughout the entire research process. Studies published in English that examine patient navigation services in physical activity for community-dwelling Canadians with chronic conditions will be included. Ovid MEDLINE, Embase, Emcare, CINAHL and Google Canada will be searched for articles published from 1990 to May 2025 to identify the characteristics, strengths and limitations, and prioritised features of patient navigation services for community physical activity programmes. The Mixed Methods Appraisal Tool will be used to assess the quality of included studies.
This protocol is a rapid review of published literature and does not require ethical approval. Review findings will be disseminated to various key interest groups through publications, presentations, infographics, social media posts and/or videos.
Selective fetal growth restriction (sFGR) is a major cause of perinatal morbidity and mortality in monochorionic diamniotic (MCDA) twin pregnancies. Current management relies on umbilical artery Doppler patterns in the smaller twin. These patterns are, however, inconsistent and do not represent a reliable severity scale, complicating clinical decision-making and parental counselling. This study aims to improve risk stratification by identifying predictors of adverse outcomes, while also evaluating the pathophysiology and multi-organ impact of sFGR in early childhood.
This is a prospective, international, multicentre cohort study conducted in six tertiary fetal medicine centres with expertise in complicated twin pregnancies. Recruitment began in March 2023 and will continue until December 2026, targeting 274 MCDA twin pairs with complete follow-up to develop a prediction model for adverse perinatal outcomes in sFGR at the time of diagnosis. Standardised data collection includes serial ultrasound examinations, advanced fetal imaging (cardiac, cerebral and 3D volumetric), fetal brain MRI and detailed placental phenotyping. Maternal and parental well-being are assessed during pregnancy and after birth. Neurodevelopmental outcome is evaluated up to 2 years after birth using validated tools. The statistical analysis plan includes predictive modelling with internal validation.
The study has been approved by the ethical review boards of all participating centres. Findings will be disseminated through peer-reviewed publications, international conferences and engagement with clinical guideline committees.
FreshRSS 