Conectar
Postbiotics, non-viable microbial components or metabolites derived from probiotics, represent a promising new class of therapeutic agents in dermatological and wound-healing science. This review highlights the bioactive potential of postbiotics in modulating inflammation, enhancing tissue regeneration, and restoring microbiota balance in skin wounds. Through analysis of recent experimental and clinical studies, postbiotics were found to accelerate wound closure, stimulate collagen synthesis, and improve barrier integrity while providing antimicrobial and immunomodulatory benefits. Their incorporation into topical formulations and wound dressings has shown to regulate moisture, prevent infection, and support optimal healing conditions. In contrast to live probiotics, postbiotics are stable, safe, and free from viability-related limitations, making them ideal for cosmetic and medical use. Overall, postbiotics represent an innovative, next-generation strategy for skin regeneration and wound management.
To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.
Systematic review and meta-analysis.
The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.
In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.
A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.
Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.
To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.
No patient or public contribution.
The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)
The purpose of this scoping review is to map and summarise the current peer-reviewed literature on inequities in doctoral nursing education, with a specific focus on populations affected, barriers, facilitators and strategies to support equity in doctoral nursing education.
This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
A comprehensive search for empirical evidence was completed using four databases: CINAHL, Scopus, ERIC and Google Scholar. A systematic screening process was applied, and data were extracted and charted guided by the Population, Concept, Context (PCC) framework.
Databases were searched for peer-reviewed articles published between 2000 and 2025.
A total of 13 studies met the inclusion criteria. Most studies focused on racial/ethnic minoritized populations, and one focused on first-generation doctoral students. Common barriers included experiences of microaggression, systemic racism, lack of funding and feelings of isolation. Common facilitators were faculty mentorship, financial support, peer networks and targeted recruitment programs.
Inequities remain in doctoral nursing education, particularly for racial/ethnic minoritized populations. Although some effective interventions were identified, significant gaps exist in understanding how to support diverse doctoral nursing students, especially for those with intersecting identities.
Addressing inequities in doctoral nursing education can enhance the diversity of the nursing workforce and faculty, promote inclusive academic environments and contribute to health equity.
Persistent inequities in access and experience among underrepresented groups in doctoral nursing education. Main findings: Key structural and social barriers persist, though several promising strategies have emerged. Impact area: Academic institutions, doctoral program designers and nurse leaders.
This study adheres to the PRISMA-ScR reporting guidelines. This study did not involve patients or the public in its design, conduct or reporting.
This study aims to synthesise evidence on users' experiences of telephone cancer information and support services (CISS) to identify important service features and inform service development.
A qualitative evidence synthesis.
OVID MEDLINE, EMBASE, CINAHL, PsycINFO and SocINDEX databases were searched for peer-reviewed qualitative literature fitting the inclusion criteria from database inception to 30 March 2023. The included articles were double-screened, and quality appraised using the CASP checklist. GRADE-CERQual was used as a tool to assess the confidence of review findings. Content synthesis combined the qualitative data with the Loiselle cancer experience measurement framework guiding analysis. This paper is reported as per the equator network recommended SRQR checklist.
Of the 607 articles screened, seven studies were included. Four main themes and 14 sub-themes about CISS aspects were identified: psychological well-being (managing emotions/coping, hope/reassurance, supporting close others and a reluctance to call the CISS); knowledge is power (information seeking, the burden of knowledge and empowerment); truth and clarity (adjunct support, credible source and improved understanding and confidence); and service adequacy (operators' ability to connect with users, convenience, service provision and awareness, and the cancer journey).
Findings suggest people with cancer and their carers accessing a CISS value emotional support combined with trusted information, topic expertise and a connection with the service operator. future service provision should address the lack of awareness regarding the range of services and the convenience extended operating hours may offer.
The results add to our understanding of CISS service provision. However, knowledge gaps remain regarding preferences among service features and the hierarchy of CISS characteristics to be prioritised to enhance services.
Focused CISS awareness campaigns will inform communities and healthcare professionals of the available resources to improve the lives of those affected by cancer. Ongoing service review will enable resources to be tailored to callers' needs, potentially easing the burden on existing services that are overwhelmed and under-resourced.
This qualitative evidence synthesis did not directly involve patient or public contribution to the manuscript.
Systematic Review Registration Number (PROSPERO): CRD42023413897
Stroke nurses must perform dysphagia screening on all suspected stroke patients, adhering to best practice guidelines. While comprehensive training is essential for safe and competent screening, the variability in dysphagia screening tools leads to significant differences in education.
This scoping review aims to collate and report what education is provided to stroke nurses on the use of dysphagia screening tools.
A scoping review guided by the PRISMA-ScR checklist.
A systematic review of three electronic databases identified 318 peer-reviewed studies. After screening and eligibility assessment in COVIDENCE, 10 studies were included. Data from these studies was analysed using Arksey and O'Malley's thematic framework.
MEDLINE, CINHAL, Scopus.
Ten studies were included in this review which yielded the following major themes: (1) comprehensive and structured training; (2) diversity of training methods; (3) ongoing education and competency assessment; and (4) standardised protocols and tools.
Offering comprehensive training programs to stroke nurses on dysphagia screening tools is associated with more timely interventions and improved outcomes; however inconsistent approaches to training make it difficult to benchmark outcomes of the education provided. Future research should explore stroke nurses' experiences with current training to guide future training program development.
This review highlights the importance of training stroke nurses to use dysphagia screening tools to improve patient outcomes.
No patient or public contribution.
Biofilms are a key driver of chronicity and treatment failure in diabetic foot ulcers (DFUs), yet clinical evidence quantifying their impact and management remains fragmented. This systematic narrative review synthesised recent evidence (2015–2025) on the prevalence, diagnostics, and management of biofilm in DFUs. A Systematic Review of the Literature (SRL) was conducted following PRISMA 2020 guidelines across PubMed/MEDLINE, Scopus, Cochrane Library and ScienceDirect. Eligible studies included adults with DFUs reporting biofilm/bioburden metrics or interventions aimed at biofilm disruption. Risk of bias was assessed using RoB 2 for randomised trials and ROBINS-I for non-randomised studies. Data were narratively synthesised by evidence tier (Tier 1 = clinical; Tier 2 = preclinical/mechanistic). Of 600 records screened, 25 studies met inclusion criteria (Tier 1 n = 9; Tier 2 n = 5; reviews n = 11). Over half of bacterial isolates in DFUs were biofilm producers, with multidrug resistance exceeding 90% in several cohorts. Fungi were detected in 31% of ulcers by qPCR but only 9% by culture. Tier 1 clinical evidence supports standard care components—debridement, antiseptics, and negative-pressure wound therapy—for improved healing, though direct antibiofilm outcomes remain limited. Emerging strategies (enzymatic agents, peptides, cold plasma, smart dressings) show promise in vitro but lack clinical translation. Evidence for direct antibiofilm efficacy in DFUs remains scarce. Current data justify maintaining guideline-based care while prioritising trials that integrate validated biofilm endpoints, standardised microbiological methods, and antifungal components. Distinguishing established from experimental approaches is essential to advancing safe, evidence-based biofilm management in DFUs.
To systematically examine how structural vulnerability has been defined and operationalised in United States-based health research, identify conceptual consistencies and methodological gaps, and propose core dimensions of structural vulnerability along with implications for future application in health research.
A systematic mixed-studies review using a parallel-results convergent synthesis design.
PubMed, Embase, Scopus and CINAHL were searched from first publication through 2024 using the terms ‘structural* vulnerab*’ AND health.
Peer-reviewed English-language empirical studies conducted in the United States that applied the concept of structural vulnerability were identified. The Mixed Methods Appraisal Tool was used to assess study quality. Study content was analysed to identify how structural vulnerability was defined and operationalised.
Thirty-seven predominantly high-quality studies published between 2011 and 2024 met inclusion criteria. Structural vulnerability was consistently defined through two interrelated dimensions: as a social positionality (characterised by constrained resilience, limited agency and imposed risks rooted in systemic discrimination and social hierarchies) and as a critical analytic framework for examining structural determinants of health. Quantitative studies predominantly used individual-level indicators (e.g., income, housing) and cross-sectional designs. Qualitative studies focused on experiences of structural vulnerability in relation to health outcomes and infrequently translated findings into structural interventions. The most frequently studied outcomes were infectious disease, substance use and mental health.
Structural vulnerability, as a conceptual and empirical lens, reveals how systems produce—and can potentially reduce—health risks. Findings underscore the need for geographically diverse and longitudinal studies, as well as multidimensional measures. Advancing health equity demands critiquing systemic causes of inequities and pursuing justice-oriented interventions.
Nursing, positioned at the intersection of public health, social sciences and policy, is uniquely equipped to engage structural vulnerability as a critical analytic tool to address health inequities, design interventions and advocate for policy reform.
What problem did the study address? This study addressed a lack of clarity in the definition and operationalization of structural vulnerability in health research.
What were the main findings? The definition of structural vulnerability is consistent across quantitative and qualitative studies, but there are marked variations in its operationalization. Quantitative studies predominantly rely on individual-level indicators, while qualitative studies use it as a theoretical framework to guide analysis, interpret findings and examine structural determinants of health.
Where and on whom will the research have an impact? This review offers a clear framing for integrating structural vulnerability in health research in efforts to advance health equity.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
The aim of this integrative review is to critically appraise and synthesise empirical evidence on the clinical applications, outcomes, and implications of generative artificial intelligence in nursing practice.
Integrative review following Whittemore and Knafl's five-stage framework.
Systematic searches were performed for peer-reviewed articles and book chapters published between 1 January 2018 and 30 June 2025. Two reviewers independently screened titles/abstracts and full texts against predefined inclusion/exclusion criteria focused on generative artificial intelligence tools embedded in nursing clinical workflow (excluding nursing education-only applications). Data were extracted into a standardised matrix and appraised for quality using design-appropriate checklists. Guided by Whittemore and Knafl's integrative review framework, a constant comparative analysis was applied to derive the main themes and subthemes.
CINAHL, MEDLINE, and Embase.
Included literature was a representative mix of single-group quality improvement pilots, mixed-method usability and feasibility studies, randomised controlled trials, qualitative descriptive and phenomenological studies, as well as preliminary and proof-of-concept observational research. Four overarching themes emerged: (1) Workflow Integration and Efficiency, (2) AI-Augmented Clinical Reasoning, (3) Patient-Facing Communication and Education, and (4) Role Boundaries, Ethics and Trust.
Generative artificial intelligence holds promise for enhancing nursing efficiency, supporting clinical decision making, and extending patient communication. However, consistent human validation, ethical boundary setting, and more rigorous, longitudinal outcome and equity evaluations are essential before widespread clinical adoption.
Although generative artificial intelligence could reduce nurses' documentation workload and routine decision-making burden, these gains cannot be assumed. Safe and effective integration will require rigorous nurse training, robust governance, transparent labelling of AI-generated content, and ongoing evaluation of both clinical outcomes and equity impacts. Without these safeguards, generative artificial intelligence risks introducing new errors and undermining patient safety and trust.
PRISMA 2020.
The use of technology to support nurses' decision-making is increasing in response to growing healthcare demands. AI, a global trend, holds great potential to enhance nurses' daily work if implemented systematically, paving the way for a promising future in healthcare.
To identify and describe AI technologies for nurses' clinical decision-making in healthcare settings.
A systematic literature review.
CINAHL, PubMed, Scopus, ProQuest, and Medic were searched for studies with experimental design published between 2005 and 2024.
JBI guidelines guided the review. At least two researchers independently assessed the eligibility of the studies based on title, abstract, and full text, as well as the methodological quality of the studies. Narrative analysis of the study findings was performed.
Eight studies showed AI tools improved decision-making, patient care, and staff performance. A discharge support system reduced 30-day readmissions from 22.2% to 9.4% (p = 0.015); a deterioration algorithm cut time to contact senior staff (p = 0.040) and order tests (p = 0.049). Neonatal resuscitation accuracy rose to 94%–95% versus 55%–80% (p < 0.001); seizure assessment confidence improved (p = 0.01); pressure ulcer prevention (p = 0.002) and visual differentiation (p < 0.001) improved. Documentation quality increased (p < 0.001).
AI integration in nursing has the potential to optimise decision-making, improve patient care quality, and enhance workflow efficiency. Ethical considerations must address transparency, bias mitigation, data privacy, and accountability in AI-driven decisions, ensuring patient safety and trust while supporting equitable, evidence-based care delivery.
The findings underline the transformative role of AI in addressing pressing nursing challenges such as staffing shortages, workload management, and error reduction. By supporting clinical decision-making and workflow efficiency, AI can enhance patient safety, care quality, and nurses' capacity to focus on direct patient care. A stronger emphasis on research and implementation will help bridge usability and scalability gaps, ensuring sustainable integration of AI across diverse healthcare settings.
Psychosocial interventions are recognized as effective nonpharmacological treatments that can enhance the mental well-being of women dealing with perinatal loss. However, as these interventions vary widely, there is currently no review that systematically evaluates and ranks their effects on the mental health of women affected by perinatal loss.
The aim of this study is to integrate the existing evidence, assess and compare the effects of psychosocial interventions on negative emotions among women experiencing perinatal loss, rank the effect sizes of various interventions, and identify the most effective intervention on the basis of different outcome measures.
Seven English-language databases were systematically searched for randomized controlled trials (RCTs) focusing on women experiencing perinatal loss, with publications up to August 20, 2024. Traditional pairwise meta-analyses were performed using Review Manager 5.4.1, while Stata 18.0 was employed for network meta-analysis and evidence synthesis. The surface under the cumulative ranking curve (SUCRA) was used to assess the efficacy of the interventions. The protocol was registered with PROSPERO under number CRD42024530312.
A total of 30 RCTs encompassing 6181 participants were included in the analysis. On the basis of the SUCRA rankings, problem-solving therapy was identified as an effective treatment for alleviating depression and anxiety among women experiencing perinatal loss (depression: SUCRA = 82.55%, SMD = −1.34, 95% CI [−2.41, −0.27]; anxiety: SUCRA = 97.7%, SMD = −2.83, 95% CI [−4.26, −1.40]). Additionally, bereavement intervention emerged as the most effective approach for improving grief symptoms (SUCRA = 81.60%, SMD = −1.11, 95% CI [−2.14, −0.09]).
Compared with traditional treatment, psychosocial intervention can improve the psychological state of women with perinatal loss, and the differences in the effects of face-to-face and technology-assisted interventions should be further explored. Moreover, problem-solving therapy has proven to be effective and appears to be the most effective method for alleviating depressive and anxiety symptoms among women experiencing perinatal loss, while bereavement support is the most effective method for grief due to perinatal loss. Nursing and health policymakers can develop various intervention strategies according to the varied psychological states of women experiencing perinatal loss.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
The global prevalence of chronic kidney disease (CKD) has continued to rise over time. Pharmacological therapy is the mainstay of conventional CKD treatment; however, many CKD patients find it difficult to adhere to their medication regimen.
To systematically evaluate and compare the effects of various self-management support strategies for patients with CKD.
We searched PubMed, Embase, The Cochrane Library, Web of Science, and Scopus to identify quasi-randomized and RCTs comparing the effectiveness of different self-management support strategies in CKD patients, The search spanned from database inception to June 24, 2025. Two reviewers independently screened the literature, extracted information, assessed the quality of studies, and we performed analysis using RevMan 5.0 and STATA 14.0 software.
Eighty-one studies were included, examining 10 strategies. Compared to conventional interventions, face-to-face combined tele-guidance, group visits, tele-guidance, and multi-component structured interventions significantly improved patients' self-efficacy. Surface under the cumulative ranking curve (SUCRA) of different self-management support strategies influencing self-efficacy ranked in the top three were face-to-face combined tele-guidance, group visits and tele-guidance. Empowerment interventions, cognitive behavioral therapy (CBT) and tele-guidance enhanced quality of life compared to conventional interventions. The SUCRA for quality of life ranked highest for empowerment, CBT and face-to-face combined tele-guidance. Additionally, we found that these strategies were beneficial in improving patients' blood pressure, IDWG, renal disease knowledge, and self-management.
The study offers evidence on effective self-management support strategies for CKD patients, highlighting face-to-face combined tele-guidance might be the most effective intervention for increasing self-efficacy, while empowerment might be the most effective intervention for increasing quality of life in CKD patients. These findings can help healthcare providers design better programs to improve patient outcomes. However, more high-quality RCTs are needed to confirm findings.
PROSPERO: CRD42024596581
Nurses are pivotal in EBHC implementation; however, its adoption remains limited, highlighting the need to investigate nurses' experiences and perceptions of their EBHC competence.
To critically appraise and synthesise qualitative evidence of nurses' experiences and perceptions of EBHC competence.
A qualitative systematic review.
The review followed the JBI methodology for qualitative systematic reviews. Inclusion criteria were qualitative studies published in Finnish, Swedish or English that explored nurses' experiences and perceptions of EBHC competence. Data were synthesised using JBI's meta-aggregation method and the findings were graded with the ConQual approach.
CINAHL, Medic, PubMed, Scopus and grey literature from EBSCO Open Dissertations and MedNar, searched in December 2023.
Seventeen qualitative studies were included. The study findings were generated from four synthesised findings with low confidence scores. The synthesised findings were: (1) Nurses' competence in Global Health, (2) Nurses' competence in enhancing Evidence generation, (3) Nurses' competence in optimising Evidence Transfer and (4) Nurses' competence in effective implementation of evidence. A new finding of this systematic review was that nurses did not express their experiences or perceptions on evidence synthesis.
Nurses' experiences of EBHC competence focus mainly on evidence implementation and global health. The lack of findings to evidence synthesis suggests that core principles of the EBHC model are not yet fully embedded in nursing practice. Nurses emphasised the need for greater support for developing EBHC competence.
Integration of EBHC into education, mentoring and adequate resources enhances nurses' competence, motivation and commitment to EBHC sub-dimensions, while also strengthening their professional confidence and development.
Strengthening nurses' EBHC competencies contributes to supporting the delivery of high-quality, effective and sustainable healthcare services.
PRISMA guidelines followed.
None.
PROSPERO-registered: CRD42021285179
There is an increased focus on healthcare workers' bullying due to various individual, organisational, and social factors that may elevate the risk of bullying among healthcare employees. This scoping review aims to identify knowledge gaps regarding the theorising of bullying and the prevention and management of bullying in healthcare settings.
A scoping review of systematic reviews and meta-analyses was conducted using PRISMA guidelines.
Systematic reviews and meta-analyses (N = 18) involving healthcare workers (i.e., doctors, nurses, and allied health professionals) were identified through a vigorous search of ProQuest Central, PubMed, PubMed Central, Google Scholar, Scopus, PsycINFO (PsycNet), and Web of Science databases.
The included reviews were explored to identify theoretical explanations of bullying and strategies for bullying prevention and management. Thematic analysis was applied to synthesise findings.
The results indicated that workplace culture, hierarchy within healthcare organisations, inactive institutional power, and conflict are key theoretical constructs that may explain bullying among healthcare workers. Further, a comprehensive approach of individual and organisational-level factors, involving organisational policies and procedures, creating awareness to promote effective reporting of bullying, and the role of leaders and managers, was identified as critical for preventing and managing bullying.
The scoping review emphasises the need for integrating theoretical frameworks that consider both individual and systemic aspects of bullying in healthcare organisations. Addressing these aspects can improve the effectiveness of strategies for bullying prevention and management.
Understanding the theoretical approaches to explain bullying of healthcare employees can provide a concrete foundation for targeted interventions and organisational policies that address bullying at multiple levels, therefore improving healthcare workers' wellbeing and workplace culture.
No direct patient or public contribution was related to the scoping review.
To summarise current research that defines cardiopulmonary resuscitation and to provide a succinct conceptual definition of cardiopulmonary resuscitation.
Scoping review using JBI guidelines to develop the study protocol.
The most recent (2024) research papers on cardiopulmonary resuscitation were evaluated for inclusion. Individual definitions of cardiopulmonary resuscitation extracted from 25 papers were summarised and then analysed to conceptualise a single definition for cardiopulmonary resuscitation.
CINAHL, Medline and Scopus databases were evaluated for inclusion.
Definitions of cardiopulmonary resuscitation focused on interventions, mainly chest compressions and ventilation. Defibrillation was inconsistently included. There was less emphasis on criteria for initiating cardiopulmonary resuscitation and desired outcomes.
This scoping review found limited consensus between definitions of cardiopulmonary resuscitation. Analysis of the range of perspectives found in the review enabled the researchers to propose definitions in three areas: cardiopulmonary resuscitation, basic life support and advanced life support.
Nurses working in hospitals and responding to cardiac arrests are guided by Advanced Resuscitation Plans and Do Not Resuscitate orders. In turn, these documents should communicate a clear definition of cardiopulmonary resuscitation in policies, procedures and standards. This is important for clinical nurses to ensure patients' consent for cardiopulmonary resuscitation and defibrillation is informed.
Currently cardiopulmonary resuscitation is inconsistently defined. Cardiopulmonary resuscitation includes compressions and ventilation. A standardised definition of cardiopulmonary resuscitation supports professional nursing practice and has wider implications for patient consent and research practice.
This scoping review adheres to and is reported according to PRISMA-ScR.
No patient or public contribution.
Diabetic foot ulcers (DFUs) are a major cause of infection, hospitalisation, and amputation. Collagen-based dressings—especially collagen combined with oxidised regenerated cellulose (ORC)—are proposed to improve healing by modulating matrix metalloproteinases (MMPs), stabilising the extracellular matrix (ECM), and tempering inflammation; some formulations also include antimicrobial or bioactive adjuncts. We conducted a systematic review of randomised controlled trials (RCTs) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Adults with DFUs were eligible. Interventions included collagen-alone or collagen-combination dressings (e.g., collagen–oxidised regenerated cellulose [collagen–ORC]/silver, collagen–chitosan) versus standard of care (SOC) or alternative dressings. To ensure comparable outcomes, the quantitative synthesis was pre-specified and restricted to complete wound closure (yes/no, intention-to-treat [ITT]) from collagen-combination RCTs with aligned constructs; other outcomes were synthesised narratively. Meta-analyses were performed in Microsoft Excel using Mantel–Haenszel methods for risk ratios (RR) with a fixed-effect primary model and DerSimonian–Laird random-effects sensitivity analysis; heterogeneity was summarised with Cochran's Q, between-study variance (τ 2), and Higgins' I 2 statistic (I 2), and a 95% prediction interval was reported for random-effects. (Protocol not registered). Six studies (five randomized controlled trials and one single-blinded non-randomized comparative study; total n = 314) met inclusion. In a focused meta-analysis of the two collagen-combination RCTs, treatment was associated with a higher probability of complete wound closure versus control (RR 1.69, 95% confidence interval [CI] 1.05–2.72; I 2 = 0%). One assessor-blinded RCT of collagen alone reported higher 12-week closure versus a placebo dressing and was not pooled due to heterogeneity. Across studies, signals also favored collagen-based care for earlier area reduction and, in one trial, fewer infection-related withdrawals; mechanistic work showed reductions in MMP-9/TIMP-2. However, most trials were small and single-centre, comparators and adjuncts varied, follow-up was short (~8 days–24 weeks, clinical endpoints typically 4–20 weeks), outcome definitions were non-standardised, and key confounders (off-loading, infection management, vascular status, glycaemic control) were inconsistently addressed. Collagen-based dressings—particularly collagen-combination formulations—appear to improve complete closure when added to the standard of care (SOC) for diabetic foot ulcers (DFUs), but the evidence is limited by study size, heterogeneity, and risk of bias. Larger, prospectively registered, multicentre RCTs with standardised outcomes and longer follow-up are needed to define clinical and cost-effectiveness and to identify which patients benefit most. Collagen–ORC dressings show promise as an adjunctive treatment for DFUs by influencing the inflammatory microenvironment and supporting tissue repair. However, the certainty of the current evidence remains limited, highlighting the need for further high-quality randomised studies.
The utilisation of artificial intelligence in the context of nursing education has become increasingly extensive. However, various studies show differing perspectives and attitudes among nursing students, and the findings have not been systematically synthesised.
To systematically review the perceptions and attitudes of nursing students on the application of artificial intelligence in nursing education.
Mixed-methods systematic review.
A comprehensive literature search was conducted across 10 databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, Scopus, China Science and Technology Journal Database, SinoMed, China National Knowledge Internet, and WanFang database, the inclusive years of articles searched were from 1969 to 2025. Two researchers independently screened the literature and extracted the data. The mixed methods assessment tool was used to evaluate the risk of bias in the included literature. The relevant data were extracted and synthesised according to the Joanna Briggs Institute's convergence synthesis method, ensuring the comprehensive integration of qualitative and quantitative results. These results were then integrated into the Technology Acceptance Model.
A total of 28 articles were included, including 13 qualitative studies, 13 quantitative studies, and 2 mixed-method studies. According to the Technology Acceptance Model, the perceptions and attitudes of nursing students on the nursing education's adoption of artificial intelligence were integrated into 10 categories of three comprehensive themes: (i) Nursing students' perceptions and attitudes of the ease of use of artificial intelligence in nursing education, including 3 categories; (ii) nursing students' perceptions and attitudes on the usefulness of artificial intelligence in nursing education, including 4 categories; (iii) nursing students' behavioural intention, including 3 categories.
Overall, our study demonstrated that nursing students had an active willingness to utilise artificial intelligence. However, they acknowledged that certain issues persist regarding the ease and practicality of artificial intelligence in nursing education.
No patients or members of the public were directly involved in this systematic review, as the study synthesised existing literature.
To synthesise literature about horizontal violence or workplace bullying among Intensive Care Unit nurses, exploring its awareness, factors, impacts, and strategies.
Following PRISMA standards, a mixed systematic review using a narrative synthesis approach and thematic analysis design of the Joanna Briggs Institute.
Four electronic databases from 2013 to 2023 studies published were searched.
Eight studies were included: three qualitative and five quantitative. Four key themes emerged: (i) awareness and understanding of horizontal violence or workplace bullying, (ii) factors affecting horizontal violence or workplace bullying, (iii) impacts of horizontal violence or workplace bullying, and (iv) strategies to address horizontal violence or workplace bullying.
Addressing horizontal violence or workplace bullying requires hospitals should adopt conflict resolution policies, stress management programs, and supportive supervision to improve nurse retention. Nurse management should establish confidential reporting mechanisms, provide training on interpersonal respect, and implement supportive structures to promote psychological safety. Intensive care unit nurses are encouraged to take proactive steps to address workplace bullying, ensuring improved staff well-being and care quality.
This paper addresses a significant gap in the literature regarding horizontal violence or workplace bullying among Intensive Care Unit nurses.
The findings will impact on healthcare administrators, policymakers, and educators. By understanding horizontal violence or workplace bullying, strategies can be implemented to improve workplace environment, support nurses' well-being, increase nurse retention, and improve the quality of patient care.
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review methodology, including data selection, extraction, and synthesis, follows PRISMA standards to ensure clarity, transparency, and reproducibility.
This study did not include patient or public involvement in its design, conduct, or reporting.
There is a protocol that does not require registration, it made accessible at: https://doi.org/10.17605/OSF.IO/CFNEJ.
Climate change has serious consequences for the morbidity and mortality of older adults.
To identify the effects of climate change on older people's health.
A scoping review was conducted following the Joanna Briggs Institute guidelines and the PRISMA-ScR checklist. Quantitative research and reports from organizations describing the effects of climate change on older people were selected.
Sixty-three full-text documents were selected. Heat and air pollution were the two factors that had the most negative effects on cardiovascular and respiratory morbidity and mortality in older people. Mental health and cognitive function were also affected.
Climate change affects several health problems in older individuals, especially high temperatures and air pollution. Nursing professionals must have the necessary skills to respond to the climate risks in older adults. More instruments are required to determine nursing competencies on climate change and the health of this population group.
No patient or public contribution.
Codes of ethics are, for many, important documents that define the key values and behaviours expected of healthcare professionals. They are also documents that have been widely criticised. These criticisms range from being vague to failing to provide guidance on many important issues. Codes, however, vary substantially in their scope, content and the guidance they provide.
This scoping review sought, in the context of comparative studies of codes, to examine the form (i.e., the structure of the code, its contents, principles or rules for example) and function (what the code says it does, either explicitly or implicitly) of codes, along with their points of con/divergence.
A systematic search was carried out using Scopus, PsycInfo, CINAHL and Medline.
Thirty-one papers met inclusion criteria and were included in this review. Results suggest that while there were a number of similarities seen across codes, there were also substantial points of divergence related to the content of codes and structure. These differences were seen across professions, countries and time, suggesting that culture, history, politics and perhaps even geography influence the content of codes.
These findings are discussed in light of the broader literature that examines and critiques codes.
FreshRSS 