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This study aimed to examine the effect of an integrative cognitive training program by family caregivers on cognitive function among persons with traumatic brain injury.
A randomized controlled trial, repeated measures design was utilized.
The participants were adult persons diagnosed with mild-to-moderate TBI and their family caregivers. They were recruited from the neurology ward at a tertiary hospital in Thailand. One hundred participants were randomly assigned to the experimental group (n = 50) and the control group (n = 50). The experimental group received an integrative cognitive training program from family caregivers based on the theory of neural plasticity in combination with a systematic review, while the control group received usual care. Cognitive function was assessed at baseline and week 2, week 4, and week 6 follow-up using the Montreal Cognitive Assessment. Data were analyzed using descriptive statistics, Chi-square, Fisher's exact test, and repeated measures ANOVA.
The results showed a significant improvement in cognitive function scores in the experimental group over time (p < 0.001). Additionally, participants in the experimental group who received an integrative cognitive training program by family caregivers demonstrated significantly higher cognitive function scores compared to the control group at week 4 and week 6 follow-up assessments (p < 0.001). The effect sizes were large (η 2 = 0.14) with a test power of 90%.
An integrative cognitive training program can enhance neuroplasticity and improve cognitive function among persons with mild-to-moderate traumatic brain injury. Moreover, involving family caregivers in the rehabilitation process can improve community engagement and cognitive abilities in persons with traumatic brain injury.
Healthcare professionals in neurological settings should incorporate an integrative cognitive training program into their usual care and educate family caregivers to continue the intervention at home for improving cognitive function among persons with mild-to-moderate traumatic brain injury.
TCTR20230828002
Family caregivers of children receiving pediatric palliative care (PPC) play a crucial role in their care and wellbeing, especially during the early stages of life.
To explore the experience of family caregivers of children aged 1–23 months who are receiving pediatric palliative care (PPC).
A systematic review of qualitative studies was conducted using the databases PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Cuiden. The studies were appraised using the Critical Appraisal Skills Programme tool. The selected studies were synthesized using Noblit and Hare's meta-ethnographic method.
Eleven studies, 169 themes, 36 metaphors and four main themes were identified. Caregivers develop coping strategies related to meaning-making, faith, maintaining hope, and decision-making abilities. They perceive limited time with the child due to structural constraints and the child's deteriorating health, which sometimes prevents them from recognizing their child's identity. Caregivers strive to remain united and rebuild the daily family life they long for, but face challenges related to self-care, maintaining employment, and caring for siblings and their partner. In many cases, they are unsatisfied with the care they receive, attributed to a lack of technical training and understanding of the principles of pediatric palliative care (PPC) by healthcare staff, poor communication skills, and inadequate coordination. Caregivers highlight the role of nurses and the PPC team, advanced care planning, and post-mortem care as positive aspects.
Caregivers' experiences reveal coping strategies, active decision-making, constant challenges, healthcare interactions, and a need for improved comprehensive support.
This study underscores the importance of addressing the unique needs of family caregivers of children aged 1–23 months receiving pediatric palliative care (PPC), highlighting their struggles with social isolation, neglected self-care, and disrupted family life. Healthcare providers should prioritize age-specific approaches to PPC, focusing on improving communication, care coordination, and understanding of palliative care principles to better support these caregivers.
Caregivers make an essential contribution to the self-care of patients with multiple chronic conditions (MCCs), but no studies have described caregiver contribution (CC) and caregiver self-efficacy in contributing to patient self-care in low-/middle-income countries (LMICs). This study aimed to describe the CC to patient self-care and caregiver self-efficacy of patients affected by MCCs living in a low-middle-income country such as Albania.
A Multicenter cross-sectional study design was used.
A sample of 376 Albanian caregivers was enrolled if identified by the patient with MCCs as the primary unpaid informal caregiver in outpatient settings in Albania. The Caregiver Contribution to Self-Care of Chronic Illness Inventory (CC-SCCII) and the Caregiver Self-Efficacy in Contributing to Patient Self-Care Scale (CSE-CSC) were used to measure the CC to patient self-care maintenance, monitoring, and management and the caregiver's confidence in their ability to contribute to patient self-care, respectively.
Participants' mean age was 48.10 (15.14) years. Most of the caregivers were women (67.9%), adult children (53.2%) or spouses (46.8%) of the patient. Regarding the CC to self-care maintenance, inadequate behaviors were observed in caregiver recommendations for physical activity (41%) and stress management (33%). In the CC to patient self-care monitoring, inadequate behaviors in recognition of symptoms were reported (20%) by caregivers. In the CC to patient self-care management, inadequate behaviors were found in caregiver ability to recognize reflecting on the effectiveness of the remedy used to manage signs and symptoms of the patient's illness (60%) and in alerting the healthcare provider (25%). Caregiver self-efficacy was lower in the ability to persist in finding a remedy for symptoms of the person for whom they care (27%) and to evaluate the effectiveness of a remedy they used (27%).
We found, on average, adequate CC to patient self-care maintenance, monitoring, management behaviors, and caregiver self-efficacy in contributing to patient self-care of MCCs, but specific CC behaviors were found to be insufficient.
This study described CC and caregiver self-efficacy in contributing to patient self-care in a low-middle-income country. This knowledge will enable healthcare professionals to identify inadequate caregiver contributions to self-care and strengthen them through targeted educational interventions, thus optimizing the scarce resources available in these contexts.
Drinking is the most problematic health behavior among adolescents. Adolescent drinking behavior is likely to continue into adulthood and can lead to various social problems, development of multiple diseases, and even death. Grit is defined as the ability to persist in the face of a struggle. While grit can be a protective factor against risky health behaviors, there is a lack of information on how grit is related to adolescent drinking behavior. Based on the integrative model of adolescent health risk behavior, this study aimed to examine how intrapersonal, interpersonal, and cultural/environmental factors were related to adolescent drinking behaviors. Especially, this study aimed to examine the relationship between grit and adolescent drinking behavior by adding grit as a psychosocial maturity factor.
A cross-sectional study using a nationally representative sample of Korean adolescents.
A secondary data analysis of the 5th wave of the Korean children and youth panel survey (N = 2252) was conducted. The study sample comprised 11th-grade high school students. Descriptive statistics and logistic regression analyses were performed
Model 1 included intrapersonal, interpersonal, and cultural/environmental factors associated with adolescent drinking behavior. Model 2 added grit to the factors in model 1 to examine how grit is related to adolescent drinking behavior. After controlling for intrapersonal, interpersonal, and cultural/environmental factors, a higher level of grit was associated with lower odds of drinking behavior among adolescents (OR = 0.413, 95% CI = 0.257–0.662, p < 0.001)
A higher level of grit was associated with lower odds of drinking behavior among adolescents after adjusting for intrapersonal, interpersonal, and cultural/environmental factors
As grit can help deter risky health behaviors, guardians, teachers, and school nurses should focus on fostering grit among adolescents through education, mentorship, and intervention programs
The diverse cultural landscape of Europe underscores the importance of culturally safe healthcare. There is a necessity to assess cultural competence among European nursing faculty to provide an international perspective on cultural competence.
A descriptive, cross-sectional study.
An assessment of cultural competencies was conducted using the Cultural Competence Assessment scale, either in its original language (English) or in its translated and validated versions in Spanish, Italian, Portuguese, and Turkish. An online questionnaire was used to collect data.
The study was conducted in 71 higher institutions, distributed across 17 countries through a consecutive sample of 1364 nursing faculty.
The ethical principles of biomedical research were respected during the study, and the confidentiality of the data was guaranteed.
The mean level of cultural competence of the European nursing faculty was at the level of ‘good’. They showed greater cultural awareness and sensitivity than cultural competence behaviors. Significant associations were found between cultural competence level and the language of the questionnaire, level of education, having a nursing degree, leisure stays abroad, having friends from other countries or cultures, and international experiences abroad and at home. The better levels of cultural competence were found in profiles with the categories of: women with a Nursing Degree, a higher level of education, and with an ERASMUS+ stay experience.
This study offers an international overview of the cultural competence of nursing faculty. While the overall level of cultural competence was good, there is a need to reinforce the behaviors and factors that influence it.
Delay in detecting acute deterioration in older adults in care homes is associated with avoidable hospitalizations and adverse outcomes, including premature death.
Underpinned by the Knowledge to Action Framework, this study aimed to understand the barriers and enablers to direct care staff detecting and responding to the early signs of acute deterioration in care home residents.
Online focus groups or interviews with regulated (registered and enrolled nurses) and unregulated (assistants in nursing and personal care workers) direct care staff from participating care homes were conducted. Homes were recruited using disproportionate stratified random sampling to include metropolitan, inner regional, and outer regional care homes. Interview and focus group recordings were transcribed verbatim and analyzed using inductive thematic analysis.
Eighty direct care staff (n = 48 regulated; n = 32 unregulated) from eight care homes participated. Fifteen focus groups (n = 7 unregulated staff, n = 8 regulated staff) and two interviews (n = 1 regulated staff, n = 1 unregulated staff) were conducted between July 2021 and October 2022. Four themes related to the barriers and enablers of detecting and responding to acute deterioration were generated: decision-making within the scope of practice; resource availability; streamlined communication; and teamwork.
Findings highlight the challenges direct care staff encounter in being able to detect early signs of acute deterioration and implement appropriate care pathways. Perceived barriers and enablers highlighted in this study need to be considered when developing and implementing programs to optimize the timely detection of, and response to, acute deterioration in care homes.
Workforce knowledge, experience, and confidence deficits are significant barriers to detecting acute deterioration, while the unique workforce mix in care homes poses additional challenges for the accurate detection of early signs of acute deterioration. Knowing the resident, working as a team, and valuing the contribution of aged care staff and families in managing acute deterioration are enablers to achieving better outcomes for residents experiencing acute deterioration.
Menopause is associated with significant physical, psychosocial, and emotional changes that can negatively affect women's quality of life (QoL). In response to this, psychological interventions like mindfulness-based interventions have shown promise in alleviating menopausal symptoms and improving psychological well-being.
A comprehensive randomized controlled trial was conducted from May to August 2024 at Damanhour University, Egypt. One hundred and twenty menopausal women were randomly assigned to either the intervention group (n = 60), which participated in seven mindfulness sessions, or the control group (n = 60), which received general health education. Pre and postintervention data were collected using the Menopause-Specific QoL questionnaire, the Depression Anxiety Stress Scale-21, and the Mindful Attention Awareness Scale. Independent samples t-tests were performed to compare groups, while paired t-tests assessed within-group changes post-intervention. Effect sizes were calculated using Cohen's d, ensuring a robust and reliable data analysis.
The intervention group showed significant improvements across all domains of menopause-specific QoL, including vasomotor (d = 0.788, p < 0.01), psychosocial (d = 1.042, p < 0.01), physical (d = 0.809, p < 0.01), and sexual (d = 0.794, p < 0.01). Additionally, significant reductions were observed in anxiety (d = 1.221, p < 0.01), stress (d = 1.030, p < 0.01), and depression (d = 0.880, p < 0.01), along with a significant increase in mindfulness (d = 1.335, p < 0.01) postintervention.
The MBIS significantly improved menopause-specific QoL and reduced anxiety, stress, and depression while enhancing mindfulness in menopausal women. These findings suggest that mindfulness-based interventions could be game changers in managing menopausal symptoms and improving overall psychological well-being, offering hope for a better QoL for menopausal women.
The research will primarily impact healthcare providers working with menopausal women, particularly those offering psychological support or nonpharmacological treatments. It also impacts menopausal women themselves by providing evidence-based intervention options that could alleviate menopausal symptoms. Furthermore, researchers and policymakers focusing on women's health and mental well-being may use these findings to inform future studies and healthcare strategies.
Women from Damanhur University.
This trial was registered with the ClinicalTrials.gov database under the registration number NCT06421909
To determine the correlation between preoperative health education and the emotions of lung cancer patients, artificial intelligence software was used.
This was a cross-sectional study.
This study included 210 lung cancer patients from Sun Yat-sen University Cancer Center and examined the impact of health education on patient emotions using an AI-based emotion analysis tool.
This study indicated a significant relationship between the tone and emotional content of health education materials and patient emotions. Specifically, educational materials with an explanatory tone and negative sentiment appeared to impact patients' emotional states.
Quality improvements in health education can potentially benefit lung cancer patients' emotional well-being by minimizing the use of both explanatory tone and negative sentiment in educational content.
This research suggests that the careful crafting of health education materials, taking into consideration tone and emotional expressions, can have a tangible positive effect on the emotional state of lung cancer patients.
The study was reported in accordance with the STROBE guidelines.
No patients, service users, caregivers, or members of the public were involved in the design, conduct, collection, analysis, or interpretation of the data for this study, nor were they involved in writing the manuscript.
Toolbox training or toolbox talks is short-term training to improve occupational health and safety practices in various sectors. These on-the-job trainings provide employees with opportunities to ask questions and share experiences, facilitating the enhancement of workplace safety practices. The aim of this study is to determine the impact of toolbox trainings provided to nurses on nursing-sensitive quality indicators (pain management, pressure ulcer, patient falls, peripheral venous catheter complications, and adverse event reporting) in the workplace.
Randomized controlled, pre-test, post-test, and control group design.
Before the toolbox training, pretest measurement instruments were used for the nurses in both the experimental and control groups, and the nursing-sensitive quality indicators were monitored by two independent observers. Toolbox training was provided to nurses in the intervention group on their shift in the respective units. Both groups were followed up at the 8th and 12th weeks after the training. Descriptive tests, independent sample t-tests for intergroup comparisons, and repeated and mixed ANOVA for intragroup comparisons were utilized in data analysis.
Significant differences were found between pre-test and post-test scores of the nurses in the group who received toolbox training in terms of falls, pressure ulcers, pain management, peripheral venous catheter, and adverse event reporting (p < 0.01). It was observed that the application scores significantly differed among all nurses who received toolbox training according to the findings of both observers, generally increasing in the second follow-up compared to the first, but decreasing in the third follow-up (p < 0.05). Evaluated according to unit quality indicators, it was determined that the number of patient falls (mean 4.04, 2.32, and 1.95 respectively), pressure ulcer occurrences (mean 4.48, 2.69, and 2.45 respectively), and the number of patients experiencing peripheral venous catheter complications decreased (mean 26.79, 16.46, and 15.42 respectively) in the units where nurses who received toolbox training worked. The average number of correctly managed pain patients (mean 37.82, 71.61, 69.07 respectively) and the number of reported adverse events (mean 2.79, 6.60, 6.42 respectively) were observed to increase in the second follow-up but decrease in the third follow-up.
As a result, it was determined that on-the-job trainings increased nurses' knowledge level regarding nursing-sensitive quality indicators, improved their practices, and enhanced unit quality indicators. According to the findings of this study, on-the-job trainings provided to nurses were found to be an effective method, and it is recommended to use them in addition to traditional training methods in nurses' in-service education.
There is a growing demand for shorter and different training methods in nurses' education. In addition to classical in-service training methods, this training method, which was applied for the first time in the field of nursing, contributed to the improvement of quality indicators sensitive to nursing. Our findings emphasize that it will be useful to use this training method in future studies on improving and developing nursing-sensitive quality indicators.
The study has been registered with ClinicalTrials.gov (NCT05853588)
Adverse childhood experiences (ACEs) are associated with an increased risk of developing chronic health conditions, including Alzheimer's disease and related dementias (ADRD) and subjective cognitive decline (SCD), self-reported confusion/memory loss, and an early clinical manifestation of ADRD. While ACEs and SCD have both been individually studied in transgender and nonbinary (TGN) adults, no study has examined the relationship between the two among this population. This study sought to establish the prevalence of ACEs and their association with SCD among TGN adults.
Cross-sectional, secondary analysis of publicly available data.
2019–2021 Behavioral Risk Factor Surveillance System data, representing 16 US states that assessed ACEs, SCD, and self-reported gender identity were used to determine the association between ACEs and SCD among TGN adults aged 45+ (N = 206). Pearson's chi-squared/Fisher's exact tests assessed the association between ACEs (individual, categorical, sum score) and SCD. Crude and adjusted odds ratios (aORs) along with 95% confidence intervals (CIs) were calculated to investigate the associations between ACEs and SCD.
18% (n = 38) of TGN adults in the sample endorsed SCD, 60% (n = 120) experienced any ACE, 20% (n = 41) 1 ACE, and 18% (n = 37) experienced > 4 ACEs. Nearly 50% experienced childhood abuse (n = 94) or household dysfunction (n = 92). Among those with SCD, 34% (n = 13) reported > 4 ACEs, and 73% (n = 26) reported childhood abuse or household dysfunction (n = 27). Most ACES were associated with and increased the risk of SCD, even after adjusting for BRFSS year, age, race, education, and employment. The odds of SCD increased 40% as the number of ACEs increased (aOR = 1.4, 95% CI: 1.2–1.6, p < 0.0001). The odds of SCD were higher with childhood abuse (aOR = 4.3, 95% CI: 1.88–10.02, p < 0.01) or household dysfunction (aOR = 4.7, 95% CI: 2.00–11.07, p < 0.01).
ACEs increase the risk of SCD among TGN adults. Gender-affirming and trauma-informed nursing care are important, and screening and interventions for ACEs and SCD are needed to help reduce the risk of SCD and ADRD.
Examining how adverse childhood experiences impact different aspects of health, including brain health, is important to nursing practice as it can provide clinical care strategies and identify interventions to specifically address ways to improve the health and well-being of transgender and nonbinary people.
To describe the development and implementation of evidence-based teaching strategies for assessing and classifying pressure injuries in older nursing home individuals ≥ 60 years old with darker skin tones.
Pressure injury assessment learning interventions based on pre- and post-test assessments.
The learning interventions were developed by experts in pressure injury education and were based on empirical evidence, international clinical practice guidelines, and underpinned by social constructivism theory and the integrated interactive teaching model. The teaching strategy was developed to educate research assistants in the assessment of pressure injuries in darker skin tone individuals. The content included requisite knowledge and skills for pressure injury assessment and classification in darker skinned individuals. Using evidence-based teaching strategies, the content was delivered through face-to-face lectures, small group discussions, and practical application sessions delivered using classroom and practical-based activities. Photographic images were used to assess their knowledge and skills in classifying pressure injuries. Four Bachelor of Nursing-qualified registered nurses in Sri Lanka were recruited as research assistants using the new education resource. Using scores from 1 to 20 points, mastery of the theory and practice components was assessed.
The mean pre-test score was 9 ± 1.6 (95% confidence interval 6.4–11.6), demonstrating that assessment and classification of pressure injury knowledge were lacking. The mean post-test score was 16 ± 0.8 (95% confidence interval 14.7–17.3) indicating an improvement in the participants' ability to assess and staging pressure injuries.
Early pressure injury detection among older individuals with darker skin tones is challenging. This evidence-based teaching approach can be used to educate clinical nurses and research assistants in assessing pressure injuries in individuals with darker skin tones.
This study contributes to the body of knowledge by improving the early detection and accurate classification of pressure injuries in older nursing home residents with darker skin tones, addressing a significant gap in current nursing practice.
Ensuring an appropriate length of stay (LOS) is a primary goal for hospitals, as prolonged LOS poses clinical risks and organizational challenges. Children and adolescents are particularly susceptible to prolonged LOS due to frequent hospitalizations and unique vulnerabilities, including developmental disabilities that may necessitate additional care and monitoring. This study aims to describe the LOS of children and adolescent patients and identify the sociodemographic, organizational, clinical, and nursing care factors contributing to prolonged LOS in this population.
Observational, retrospective, monocentric study.
A sequential sampling approach was used to select the clinical records of 1538 children and adolescent patients admitted to an Italian university hospital in 2022. The study included all children and adolescents aged 3–18 who were hospitalized for a minimum of 2 days. Patients from outpatient units and those with LOS shorter than 2 days were excluded. The Neonatal Pediatric Professional Assessment Instrument (PAIped) and the Hospital Discharge Register were used to collect sociodemographic, organizational, clinical, and nursing care patient data, including nursing diagnoses (NDs) and nursing actions (NAs). A forward stepwise regression approach was used to identify predictors of LOS among the selected variables. A mediation analysis was conducted to explore the role of nursing predictors, identified in the stepwise regression, as mediators between the number of medical diagnoses and LOS.
Positive correlations between the number of medical diagnoses, NDs, NAs, and LOS were discovered (r s = 0.262, p = < 0.001; r s = 0.114, p = < 0.001; r s = 0.384, p = < 0.001, respectively). Longer hospital stays were associated with an increased number of medical diagnoses, NDs, and NAs. The number of NAs emerged as an independent predictor of LOS (β = 0.516; p < 0.001). Other significant determinants of LOS included a higher number of NAs and medical diagnoses, the presence of a medical DRG category, increased DRG weight, emergency admissions, residency in rural areas, and older age (F = 122.222, p < 0.001, R 2 = 0.361, adjusted R 2 = 0.358). The mediation analysis showed that the number of medical diagnoses positively predicted the number of NAs (β = 2.774, p < 0.001), which, in turn, positively affected LOS (β = 0.162, p < 0.001). A significant indirect effect of the number of medical diagnoses on LOS through NAs was observed (β = 0.448, 95% CI [0.34, 0.55]), along with a significant direct effect of medical diagnoses on LOS, even with the mediator in the model (β = 0.633, p < 0.001), indicating partial mediation (F = 321.6892; R 2 = 0.295; p < 0.001). These results highlight the influence of medical diagnoses on LOS through the mediating role of NAs.
Our study highlights the significant interplay between determinants of LOS in children and adolescent patients, emphasizing the need for targeted interventions, resource planning, and the integration of clinical nursing information systems to enhance care quality and support evidence-based practices.
Optimizing resource distribution and implementing specific interventions for patients at risk of prolonged LOS could help mitigate this negative outcome and enhance the quality of care. Incorporating nursing data into DRG systems could improve reimbursement accuracy and benefit the nursing profession, which may result in better patient outcomes and lower hospital expanses.
Depressive symptoms are common, worsening heart failure (HF) progression and reducing quality of life. While supervised structured exercise training is effective for managing depressive symptoms, it often demands a substantial time commitment or intensive activity that may discourage participation.
Evaluate the impacts of reducing sedentary time with short bouts of light physical activities or greater intensity levels on depressive symptoms after HF patients' enrollment in a home-based intervention.
A total of 127 HF patients participated in an experimental two-group design, randomly allocated to either delayed or immediate decreasing sedentary time intervention. The immediate group started the intervention immediately, while the delayed group began after the first group finished their intervention. The 8-week intervention, guided by the Theory of Planned Behavior, focused on interrupting 30 min of sedentary behavior with short bouts of light- or greater intensity physical activities. Demographic and clinical variables were collected at baseline. Depressive symptoms were assessed at baseline, pre-intervention, and post-intervention. Physical activity (daily steps) was monitored daily during the study period using the Samsung mobile health app.
Both groups demonstrated reduced sedentary time during the intervention, with improvements in HF symptom burden. Repeated measures analysis of variance revealed a significant reduction in depressive symptoms in both groups post-intervention, with a greater reduction seen in the immediate group before the delayed group began the intervention.
The study highlights the effectiveness of interrupting sedentary behavior with light- or greater intensity activities in managing depressive symptoms among HF patients. The home-based intervention, facilitated by mobile technology, provides a feasible and accessible approach to improving mental well-being.
The findings support the broader implementation of home-based interventions addressing sedentary time reduction as a valuable strategy for enhancing the mental health of HF patients, particularly those facing challenges with traditional rehabilitation programs or intense exercise.
Attention-deficit hyperactivity disorder (ADHD), affecting 5% of global children, presents inattention, hyperactivity, and impulsivity. Sleep problems, prevalent in 70% of cases, exacerbate long-term psychosocial challenges.
This study aimed to assess the efficacy of behavioral sleep intervention in alleviating sleep problems, enhancing quality of life (QoL), and reducing ADHD symptom severity among children diagnosed with ADHD.
A randomized controlled trial was conducted from June 2022 to April 2023. The intervention group (n = 47) engaged in a hybrid approach, participating in both face-to-face and Zoom sessions, while the control group (n = 45) received standard care. Data collection involved administering the Children's Sleep Habits Questionnaire (CSHQ), Pediatric Quality of Life Inventory (PedsQL), and ADHD Rating Scale IV (ADHD-RS-IV).
Significant enhancements were observed in CSHQ (p ≤ 0.001, effect size = 1.913), PedsQL (p ≤ 0.001, effect size = 1.862), and a notable reduction in ADHD-RS-IV (p ≤ 0.001, effect size = 1.548). These findings highlight the intervention's efficacy in improving sleep quality, QoL, and reducing ADHD symptomatology.
This trial contributes substantially to understanding behavioral sleep interventions' impact on ADHD-affected children, enhancing quality of life and ADHD symptomatology. The study highlights the importance of individualized care for optimal outcomes in children with ADHD.
The study's findings underscore the potential for integrating behavioral sleep interventions into routine nursing practices, offering a valuable approach to address sleep-related challenges in children with ADHD. By focusing on sleep improvement, nurses can contribute to enhancing overall well-being and emotional regulation in these children within the context of comprehensive healthcare.
The aim of this study was to evaluate and compare artificial intelligence (AI)-based large language models (LLMs) (ChatGPT-3.5, Bing, and Bard) with human-based formulations in generating relevant clinical queries, using comprehensive methodological evaluations.
To interact with the major LLMs ChatGPT-3.5, Bing Chat, and Google Bard, scripts and prompts were designed to formulate PICOT (population, intervention, comparison, outcome, time) clinical questions and search strategies. Quality of the LLMs responses was assessed using a descriptive approach and independent assessment by two researchers. To determine the number of hits, PubMed, Web of Science, Cochrane Library, and CINAHL Ultimate search results were imported separately, without search restrictions, with the search strings generated by the three LLMs and an additional one by the expert. Hits from one of the scenarios were also exported for relevance evaluation. The use of a single scenario was chosen to provide a focused analysis. Cronbach's alpha and intraclass correlation coefficient (ICC) were also calculated.
In five different scenarios, ChatGPT-3.5 generated 11,859 hits, Bing 1,376,854, Bard 16,583, and an expert 5919 hits. We then used the first scenario to assess the relevance of the obtained results. The human expert search approach resulted in 65.22% (56/105) relevant articles. Bing was the most accurate AI-based LLM with 70.79% (63/89), followed by ChatGPT-3.5 with 21.05% (12/45), and Bard with 13.29% (42/316) relevant hits. Based on the assessment of two evaluators, ChatGPT-3.5 received the highest score (M = 48.50; SD = 0.71). Results showed a high level of agreement between the two evaluators. Although ChatGPT-3.5 showed a lower percentage of relevant hits compared to Bing, this reflects the nuanced evaluation criteria, where the subjective evaluation prioritized contextual accuracy and quality over mere relevance.
This study provides valuable insights into the ability of LLMs to formulate PICOT clinical questions and search strategies. AI-based LLMs, such as ChatGPT-3.5, demonstrate significant potential for augmenting clinical workflows, improving clinical query development, and supporting search strategies. However, the findings also highlight limitations that necessitate further refinement and continued human oversight.
AI could assist nurses in formulating PICOT clinical questions and search strategies. AI-based LLMs offer valuable support to healthcare professionals by improving the structure of clinical questions and enhancing search strategies, thereby significantly increasing the efficiency of information retrieval.
Postoperative nausea and vomiting (PONV) is a common adverse event after general surgery. This study aimed to examine the effectiveness and safety of transcutaneous electrical acupoint stimulation (TEAS) for the prevention of nausea and vomiting after laparoscopic surgery.
The Cochrane Library, Pubmed, Embase, and Web of Science databases were accessed from inception to 23 January 2024. The incidence of PONV was the primary outcome measure. The required information size (RIS) of each outcome was estimated by Trial sequential analysis (TSA). The RoB 2.0 tool was used to assess the risk of bias and GRADE to assess the quality of evidence.
Seventeen RCTs including 3698 participants were included. In comparison to the control group, TEAS reduced the incidence of PONV (13 trials, n = 3310; RR, 0.56; 95% CI, 0.46–0.67; I 2 = 64%; p < 0.01; RIS = 1100), with the level of evidence graded as low. TEAS reduced the incidence of PON (9 trials, n = 2762; RR, 0.64; 95% CI, 0.52–0.79; I 2 = 57%, p < 0.01; RIS = 1595), and was also associated with a lower incidence of POV (9 trials, n = 2797; RR, 0.53; 95% CI, 0.45–0.63; I 2 = 0%, p < 0.01; RIS = 773).
The current meta-analysis and TSA provide reliable evidence that TEAS is an effective and safe method to prevent PONV. It may reduce the workload of nursing professionals, alleviate emotional stress, and decrease exposure risk. Adverse events related to TEAS were mild.
Nurses can incorporate TEAS into the rehabilitation nursing of patients experiencing PONV.
Pain is a frequent post-stroke health concern, and several non-pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post-stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non-pharmacological interventions and evaluate the significant factors associated with post-stroke pain through subgroup analysis.
Systematic review and meta-analysis.
Relevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB-2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I 2) were obtained using a random-effects model. The stability of the pooled result was then assessed using the leave-one-out approach. STATA 17.0 was used to run the meta-analysis.
Non-pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: −0.79; 95% confidence interval [CI]: −1.06 to −0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post-stroke hemiplegic shoulder pain. A pooled analysis of non-pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients.
Non-pharmacological approaches appear to be beneficial for reducing post-stroke pain. The outcomes based on the modalities merit further research.
Further studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.
Accurate and rapid triage can reduce undertriage and overtriage, which may improve emergency department flow. This study aimed to identify the effects of a prospective study applying artificial intelligence-based triage in the clinical field.
Systematic review of prospective studies.
CINAHL, Cochrane, Embase, PubMed, ProQuest, KISS, and RISS were searched from March 9 to April 18, 2023. All the data were screened independently by three researchers. The review included prospective studies that measured outcomes related to AI-based triage. Three researchers extracted data and independently assessed the study's quality using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) protocol.
Of 1633 studies, seven met the inclusion criteria for this review. Most studies applied machine learning to triage, and only one was based on fuzzy logic. All studies, except one, utilized a five-level triage classification system. Regarding model performance, the feed-forward neural network achieved a precision of 33% in the level 1 classification, whereas the fuzzy clip model achieved a specificity and sensitivity of 99%. The accuracy of the model's triage prediction ranged from 80.5% to 99.1%. Other outcomes included time reduction, overtriage and undertriage checks, mistriage factors, and patient care and prognosis outcomes.
Triage nurses in the emergency department can use artificial intelligence as a supportive means for triage. Ultimately, we hope to be a resource that can reduce undertriage and positively affect patient health.
We have registered our review in PROSPERO (registration number: CRD 42023415232).
A whole person approach to healthy aging can provide insight into social factors that may be critical. Digital technologies, such as mobile health (mHealth) applications, hold promise to provide novel insights for healthy aging and the ability to collect data between clinical care visits. Machine learning/artificial intelligence methods have the potential to uncover insights into healthy aging. Nurses and nurse informaticians have a unique lens to shape the future use of this technology.
The purpose of this research was to apply machine learning methods to MyStrengths+MyHealth de-identified data (N = 988) for adults 45 years of age and older. An exploratory data analysis process guided this work.
Overall (n = 988), the average Strength was 66.1% (SD = 5.1), average Challenges 66.5% (SD = 7.5), and average Needs 60.06% (SD = 3.1). There was a significant difference between Strengths and Needs (p < 0.001), between Challenges and Needs (p < 0.001), and no significant differences between average Strengths and Challenges. Four concept groups were identified from the data (Thinking, Moving, Emotions, and Sleeping). The Thinking group had the most statistically significant challenges (11) associated with having at least one Thinking Challenge and the highest average Strengths (66.5%) and Needs (83.6%) compared to the other groups.
This retrospective analysis applied machine learning methods to de-identified whole person health resilience data from the MSMH application. Adults 45 and older had many Strengths despite numerous Challenges and Needs. The Thinking group had the highest Strengths, Challenges, and Needs, which aligns with the literature and highlights the co-occurring health challenges experienced by this group. Machine learning methods applied to consumer health data identify unique insights applicable to specific conditions (e.g., cognitive) and healthy aging. The next steps involve testing personalized interventions with nurses leading artificial intelligence integration into clinical care.
The effectiveness of health interventions delivered via a combination of in-person and electronic social networking services for caregivers of stroke survivors remains uncertain. This study evaluates the feasibility of implementing educational and peer support programs for these caregivers through such platforms.
Quasi-experimental design.
This study included 105 caregiver–survivor dyads, with 54 dyads allocated to the intervention group and the remaining 51 to the control group. The LINE intervention comprised a combination of in-person and electronic social networking services including stroke and rehabilitation education, problem-solving skills training, long-term care information support, and 24-h peer and professional support for caregivers. The outcomes were assessed at baseline, after 1 month, and after 3 months, and encompassed caregivers' care burden, depressive symptoms, perceived social support, and quality of life, as well as the rehabilitation adherence and depressive symptoms of stroke survivors. Generalized estimating equations were used to examine group differences. The data were collected between August 2021 and October 2022.
The average age of the caregivers was 48.3 years. Caregivers in the intervention group reported reduced care burdens and enhanced perceptions of social support and quality of life as compared to those in the control group. Additionally, stroke survivors in the intervention group were less likely to exhibit high-risk depressive symptoms.
Delivering a stroke caregiver support intervention via in-person and electronic social networking services, such as LINE, effectively reduced the care burden for caregivers of stroke survivors. Additionally, it enhanced caregivers' perceived social support and quality of life.
This study demonstrated that caregiver education and peer support programs administered through a combination of in-person and electronic social networking services can serve as an effective support system for the psychosocial health of stroke caregivers. These findings support the integration of such interventions into standard clinical practice by healthcare providers or governmental bodies.
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