Conectar
by Guohui Wang, Lu Liu, Hanshu Zhang, Panpan Mao, Saijuan Lu, Xiaofang Zhang, Xingde Li, Cangsang Song
BackgroundLiver transplantation (LT) is an effective treatment for patients with end-stage liver disease. In recent years, more and more evidence has supported the association between gut microbiota dysbiosis and the pathogenesis and progression of liver diseases.
MethodsThe study included 36 patients who received tacrolimus treatment after liver transplantation. Patients were stratified into subgroups according to three key variables: tacrolimus treatment duration, whole-blood tacrolimus concentration, and tacrolimus concentration-to-dose (C/D) ratio. Fecal samples and whole-blood specimens were collected from all participants. The Illumina HiSeq X platform was used to detect the gut metagenome, analyzing the composition and characteristics of the gut microbiota. Liquid chromatography-tandem mass spectrometry (LC-MS/MS) technology was employed to detect metabolites of the gut microbiota, revealing their metabolic profiles.
ResultsAs the duration of tacrolimus use increased, the diversity of the gut microbiota also increased, and the abundance of Escherichia coli_D and Bacteroides stercoris rose. Additionally, the abundance of Brunovirus and Uetakevirus tended to decrease. The abundance of gene functions related to chemical carcinogenesis and bacterial invasion of epithelial cells significantly decreased. In the gut microbiota metabolites, 16 substances like Astragaloside A and Acetyl-L-carnitine significantly increased, while 108 substances like Capsaicin and TLK significantly decreased. Within a certain range, as the concentration of tacrolimus in whole blood increased, the diversity of the gut microbiota increased. The abundance of Phocaeicola and Klebsiella increased, and the abundance of Peduovirus among viruses also rose. However, excessively high concentrations may lead to a decrease in the diversity of the gut microbiota and a decrease in the abundance of Phocaeicola. With respect to the C/D ratio, increased ratios were linked to significantly higher levels of 57 fecal metabolites (e.g., PC 34:2, 5-Methyl-2’-deoxycytidine), whereas 13 metabolites (e.g., FAHFA 2:0/16:0) showed substantial declines.
ConclusionsTacrolimus treatment is associated with distinct alterations in gut microbiota and metabolites among LT recipients. These findings provide a preliminary framework for future investigations aimed at optimizing immunosuppressive regimens, although their clinical translational potential requires validation in larger-scale, prospective cohort studies.
To assess whether transgender women who have sex with men (TGWSM) sampled in men who have sex with men (MSM) biobehavioural surveys in Ukraine experience different levels of sexual risk, stigma, HIV prevalence and engagement in the HIV care than cisgender MSM (CMSM).
Analysis of secondary data from three population-level cross-sectional surveys.
The analysis was conducted on data from three rounds of integrated biobehavioural surveys of MSM in 27 cities of Ukraine from 2013 to 2018.
Data from n=18 621 MSM with n=18 102 CMSM and n=503 TGWSM.
The primary outcomes were differences in sexual risk behaviours, HIV testing and treatment uptake, and the secondary outcomes were differences in lifetime experiences of stigma, coercive sex and physical assault (in the 2018 survey only) between CMSM and TGWSM.
Compared with CMSM, TGWSM were more likely to be clients of non-governmental organisations (adjusted OR, aOR: 1.39, 95% CI 1.15 to 1.67), engage in commercial sex (last month; aOR: 1.28, 95% CI 1.01 to 1.61), have group sex (aOR: 1.31, 95% CI 1.06 to 1.61), more long-term sex partners (last month; adjusted incidence rate ratio: 1.14, 95% CI 1.03 to 1.27), history of imprisonment (aOR: 1.51, 95% CI 1.00 to 2.31) and engage in chemsex (last month, aOR: 1.58, 95% CI 1.12 to 2.23). We found no difference in HIV prevalence (5.17% in TGWSM vs 5.43% in CMSM, p=0.065). In 2018, more TGWSM reported lifetime experience of stigma from family and friends (aOR: 3.58, 95% CI 2.54 to 5.04), general social stigma (aOR: 3.13, 95% CI 2.22 to 4.41), anticipated healthcare stigma (aOR: 3.63, 95% CI 2.53 to 5.16), physical assault (aOR: 2.73, 95% CI 1.85 to 4.03) and coercive sex (aOR: 3.01, 95% CI 1.99 to 4.55) than CMSM.
TGWSM in Ukraine may be at increased risk of HIV acquisition compared to CMSM due to many factors including elevated levels of stigma and violence. Services specifically tailored for transgender people are needed to help reduce these high-risk behaviours.
Mobile health (mHealth) technologies have become increasingly popular for monitoring mental health symptoms and lifestyle behaviours, and are largely reported to be feasible and acceptable to users. However, to date, the efficacy of such technologies to improve perinatal mental health outcomes has been mixed. Within the perinatal context, much of this work has been done in the context of postpartum depression, stemming from electronic health records as well as cohort studies. There is, however, a dearth of studies focusing on depression in pregnancy, and machine learning-based clinical decision support systems remain underexplored. The HappyMums application has been developed to meet this need, and its use across Europe will be tested in this study.
A total of 1000 pregnant people currently suffering from, or at risk of, antenatal depression will be recruited across six countries. All participants will be between 13 and 28 weeks’ gestation and will be given access to the new purposefully developed HappyMums mobile application, to use from enrolment until 2 months postpartum. The application leverages passively collected data from smartphone sensors relating to physical activity and behaviour, as well as requiring active engagement from the user to complete mental health questionnaires and ‘game-like’ activities. Digital data types will be combined with traditional mental health measurement methods, such as standardised questionnaires and interviews, to develop novel predictive models capable of identifying mental health trajectories in women at risk of developing antenatal depression and to test the app’s utility for use as personalised risk prediction and depression identification tool. The primary outcome of this study is to determine what proportion of users will continue to use the mobile application and engage with its tasks and activities at least weekly, while secondary exploratory outcomes include assessing usability of the app and testing the predictive ability of a novel machine learning-based model. These outcomes will, for the first time, be assessed by integrating active as well as passive data.
Ethical approval has been granted by local research ethics committees in each recruiting centre. At King’s College London (leading the clinical study), the study was reviewed by the East of England—Essex Research Ethics Committee and granted favourable opinion (REC reference 24/EE/0129). All other sites collecting participant data have the study approved for local delivery. Findings relating to the primary and secondary outcomes will be submitted for publication in open access, peer-reviewed journals, as well as presentations at conferences as symposia or posters. Findings will be made available to a non-specialist audience through open access digital mental health magazines and promotion on social media.
This study investigates how lean management (LM) practices align with and contribute to strategic objectives in healthcare using the congruence model as a conceptual framework.
This study employed a qualitative research design, integrating both inductive and deductive approaches. Data were collected from multiple hospital departments using primary and secondary sources. Primary data included semi-structured interviews, guided by a standardised interview protocol. Secondary data consisted of reports on courses of action, annual reports, policy documents and findings from exploratory meetings. The analysis involved iterative cycles of open coding, axial coding and selective coding to systematically identify and refine themes, supporting thematic analysis.
Six departments: Kidney and vascular surgery, Care core movement, Clinical department, Systemic diseases, Oncology, Care core Hepato-Pancreato-Biliary disease (HPB), which were part of one business unit within a tertiary care institution, a University Medical Centre in the Netherlands.
22 respondents aged 18 years or older were purposefully selected based on their organisational roles and LM experience. Respondents had to be involved in LM practices, which meant they had to understand LM and have passed at least one LM training programme, or they should be enrolled in a training course during the research.
Interviewees identified several barriers to LM implementation, including insufficient management support for a culture of continuous improvement, limited time for LM projects, inadequate recognition from management and poor communication of strategic objectives. Despite positive individual experiences with LM projects, their contribution to strategic objectives was deemed limited due to these barriers. Specific challenges included an experienced lack of leadership commitment, inadequate follow-up on projects, insufficient resource allocation, limited access to training and leaders failing to acknowledge employee value. Facilitators of success were fostering a culture of continuous improvement, committed managers and providing training.
LM practices have the potential to contribute to strategic objectives in healthcare organisations by reducing waste, improving patient care quality and optimising processes. However, their impact is constrained by organisational barriers and misalignments. Challenges such as insufficient resources, poor project follow-up, lack of management support and the absence of a continuous improvement culture minimise LM’s effectiveness.
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
To synthesise the application, construction methods, challenges, and optimisation strategies of Patient Journey Maps (PJMs) in care transitions.
A scoping review guided by Arksey and O'Malley's framework and PRISMA-ScR.
Nine databases, including PubMed, Embase, CINAHL, Cochrane Library, Web of Science, CNKI, etc., searched from January 2015 to March 2025.
Two reviewers independently screened studies, extracting data from 23 studies across 12 countries, synthesised via descriptive and thematic analyses informed by nursing theories.
PJMs targeted elderly, children/adolescents, and special-needs populations across in-hospital referrals, inter-hospital transitions, and community adaptation. PJMs development integrated qualitative (interviews, co-design) and quantitative (process mining, EHR analysis) methods to map stages, touchpoints, and emotional curves. Challenges included collaboration breakdowns (78.3%), information fragmentation (74.0%), and psychosocial barriers (47.8%). Optimization strategies emphasised interdisciplinary collaboration, standardised processes, technology enablement, and patient-centred interventions.
PJMs enhance care transitions by visualising patient experiences and systemic gaps, improving continuity and safety. Scalability requires addressing technological adaptation, policy alignment and resource equity. Future research should prioritise dynamic, digitally driven PJM tools and cross-regional collaboration for health equity.
This review informs clinical practice and policy by bridging theoretical and practical gaps in transitional care via interdisciplinary strategies and technology integration.
Advances global nursing practice with patient-centered strategies, promotes health equity through collaboration, and informs policy and digital innovation for dynamic care transitions.
None.
Not registered.
This study aimed to describe the types of psychological and physical symptoms experienced by healthcare professionals who became second victims after a patient safety incident and the impact of the incident on their social and professional lives.
Scoping review.
JBI methodology for scoping reviews and PRISMA-ScR for reporting were followed.
The search was conducted on June 13, 2024, using the CINAHL (EBSCO), Scopus, PubMed (Medline), Medic and PsycInfo (EBSCO) databases. A grey literature search was also conducted.
A total of 96 papers were included. Healthcare professionals experienced psychological symptoms such as anger, sadness and guilt after a safety incident. Physical symptoms were reported, including symptoms related to sleep and gastrointestinal symptoms. At the professional and social levels, the incident affected their work, relationships and well-being. Positive impacts were also noted.
This study provides a comprehensive overview of healthcare professionals' experiences after safety incidents. In addition, this study also captured the positive impacts of safety incidents, such as learning from mistakes.
By recognising the symptoms and impacts associated with the second victim syndrome, appropriate support can be provided for healthcare professionals.
The findings of this study can be used to identify the relevant harm to professionals after a safety incident, which could help to improve the well-being of these workers.
No patient or public contribution.
Open Science Framework, https://archive.org/details/osf-registrations-5cdmu-v1
Anxiety and depression are among the top contributors to disability in the Kingdom of Saudi Arabia (KSA), but little is known about their economic impact. This study estimates the economic burden of moderate to severe symptoms of anxiety and depression among adults in KSA.
A cross-sectional survey was administered via a web panel. Participants were asked to fill out the Patient Health Questionnaire-4 (PHQ-4) for themselves and on behalf of other household members to capture prevalence rates. Those who reported at least moderate symptoms of anxiety or depression filled out a longer survey with questions on healthcare utilisation and productivity losses due to symptoms. These responses were monetised using prevalence rates and population estimates to calculate per-person and total annual costs.
Prevalence estimates are based on responses from 1164 participants on behalf of 3202 Saudi adults. Of these, 269 individuals with symptoms completed the longer survey.
Prevalence of anxiety and depression; healthcare utilisation (medications, outpatient, inpatient) and productivity losses due to absenteeism and presenteeism.
In total, 26.2% reported at least moderate symptoms consistent with anxiety and/or depression. Among those with symptoms, direct healthcare costs due to anxiety and depression averaged Saudi riyal (SAR) 3431.95 per person annually. Indirect costs via absenteeism and presenteeism averaged SAR 9702.87 and SAR 24 577.28 per person assuming that anxiety and/or depression episodes last for 6 months. Summing up the healthcare costs and productivity losses yields a total annual economic burden of SAR 163.3 billion. Absenteeism accounts for 24.8% of this total (SAR 40.5 billion), presenteeism accounts for 62.8% (SAR 102.5 billion) and healthcare resource utilisation accounts for 12.4%(SAR 20.3 billion).
The overall prevalence of anxiety and depression in KSA is estimated at 26.2%. The economic burden associated with these symptoms amounts to SAR 163.3 billion or 4.1% of GDP. Absenteeism and presenteeism costs account for the vast majority of the total, but a large percentage (nearly 60%) also report emergency department visits and unplanned hospital admissions. Evidence-based interventions should be considered to address the health and economic burden of these conditions in KSA.
To (1) analyse managers' experiences with handling patient safety incident reports in an incident reporting software, identifying key challenges; (2) analyse the incident report processes from the managers' perspective; (3) examine managers' perceptions of ways to support and improve health professionals' experiences of report-handling processes; and (4) investigate how, from their point of view, incident reporting software should be developed in the future.
A descriptive qualitative study.
Interviews and focus group discussions on Microsoft Teams from 11/2024 to 3/2025, including 16 participants, analysis with deductive and inductive content analysis.
Of 16 participants, 15 were managers and one was a patient safety expert. Most were nurse managers (n = 9). Four discussion themes were divided into 30 categories. Participants highlighted the need to improve the reporting software's terminology, classification and analysis tools. The use of artificial intelligence was desired but not currently integrated into the software. Participants were unsure of their skills to use all the software features. Clear and transparent handling processes, feedback, managers' behaviour and communication methods were seen as key to improving staff's experience with report processes. A real-time warning system was considered beneficial for various incident types. Specific questions must be answered before further developing such systems.
This study deepened the understanding of reporting software's challenges regarding its handling features. The handling processes of incident reports had multiple shortcomings, which may negatively affect health professionals' experiences in report handling. Real-time warning systems could assist healthcare managers in processing reports.
Organisational-level guidance for incident report processing is needed. Improvements to report processing and reporting software can improve shared learning and understanding of the status of patient safety.
No patient or public contribution.
COnsolidated criteria for REporting Qualitative research Checklist.
Empathy is significant in nursing, and showing empathy toward a patient positively impacts a patient's health. Learning empathy through immersive simulations is effective. Immersion is an essential factor in virtual reality. This study aimed to describe nursing students' experiences of empathy in a virtual reality simulation game. Data were collected from nursing students (n = 20) from May 2021 to January 2022. Data collection included individual semistructured interviews; before the interviews, the virtual reality gaming procedure was conducted. Inductive content analysis was used. Nursing students experienced compassion and a feeling of concern in the virtual reality simulation game. Students were willing to help the virtual patient, and they recognized the virtual patient's emotions using methods such as listening and imagining. Students felt the need to improve the patient's condition, and they responded to the virtual patient's emotions with the help of nonverbal and verbal communication and helping methods. Empathy is possible to experience by playing virtual reality simulation games, but it demands technique practicing before entering the virtual reality simulation game. 
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