Conectar
by Alaattin Ozen, Ilknur Harmankaya, Canan Ozdemır, Mehmet Halıcı, Oya Coskun, Ekin Baran Guler, Ozge Atılla, Sumeyra Can
BackgroundRadiotherapy (RT) is a cornerstone of cancer management, substantially improving local tumor control and overall survival. However, a subset of patients fail to complete the prescribed RT course. Identifying the factors associated with treatment termination is essential to enhancing cancer care delivery and patient outcomes.
MethodsThis retrospective, single-center analysis included 10039 patients who underwent RT between January 2020 and December 2024. Patients who terminated treatment before completion were identified in institutional RT records. Demographic and clinical characteristics, treatment intent, and reasons for termination were primarily evaluated using descriptive statistical analyses, with exploratory comparative analyses performed between curative- and palliative-intent groups.
ResultsBetween 01/01/2020 and 12/31/2024, RT was terminated in 297/10039 patients (2.96%). The most leading causes of termination was deterioration in performance status (143 patients, 48.1%). Of these, 170 patients (57.2%) had been treated with palliative intent. Lung cancer (96 patients, 32.3%) was the most frequent primary diagnosis, while the brain (92 patients, 31%) was the most commonly irradiated site. The median number of prescribed fractions was 13 (range: 2–44), and patients completed a median of 51.6% (range: 5–93%) of these fractions before termination. The most common reason was deterioration in performance status (48.1%). Treatment termination rates were significantly higher in palliative cases compared with curative cases (6.13% [170/2,772] vs. 1.75% [127/7,267]; χ² = 134.4; p Conclusion
Most RT terminations occurred among patients with poor performance status and advanced disease. These findings suggest that multidisciplinary supportive care may be relevant and should be evaluated in future prospective studies.
Oncology nurses are pivotal to delivering high-quality cancer care; yet, the uptake of evidence-based practices (EBPs) remains inconsistent. Though continuing professional education is widely used to support EBP uptake, persistent gaps remain, likely driven by the intricate and interrelated mechanisms that unfold differently across individual, organisational and system contexts.
To understand how, why, for whom and under what conditions continuing professional education interventions enhance (or fail to enhance) the uptake of EBPs among oncology nurses.
This realist review will adhere to the Realist and Meta-narrative Evidence Syntheses: Evolving Standards methodological standards. The Theoretical Domains Framework will guide the exploration of potential mechanisms. 33 initial programme theories, developed from the Theoretical Domains Framework, prior reviews, expert input and consultations with interested parties working in oncology (eg, oncology nurses, managers), will be refined through systematic searches (CINAHL, MEDLINE, EMBASE, PsycINFO and Google Scholar). These initial programme theories represent hypothesised Context-Mechanism-Outcomes Configurations that may influence the uptake of EBPs among oncology nurses. Eligible peer-reviewed and grey literature from high-income countries in English or French will be screened in duplicate. Data will be coded deductively and inductively in MaxQDA and synthesised into Context-Mechanism-Outcome Configurations. These configurations will be reviewed in collaboration with interested parties.
Findings will be disseminated through open-access, peer-reviewed publications and presentations at national and international conferences. Key stakeholders, including various professional associations (eg, the Canadian Association of Nurses in Oncology and the International Society of Nurses in Cancer Care), will be actively engaged to ensure the clinical relevance of the findings and to maximise their translation into nursing practice.
CRD420251133710.
Each year over 130 000 patients in the UK are discharged from an intensive care unit (ICU), with many experiencing poor outcomes such as in-hospital mortality, emergency ICU readmission and/or significant morbidity. Despite current national guidance and the availability of follow-up services, post-ICU care remains variable. Critical Care Outreach Teams (CCOTs) are key in supporting this patient group, yet practice differs considerably. Recovery pathways have been successfully employed in other patient populations and are a potential option to standardise post-ICU care. Understanding how care is currently delivered by CCOT throughout the UK is essential to inform future development of an evidence-based recovery pathway for this patient group. Our primary aim is to understand how post-ICU follow-up care is delivered within the wider remit of CCOT workloads.
This is a pragmatic multicentre qualitative study of post-ICU follow-up care. The study will be split into two sub-studies: semi-structured interviews and ethnographic observations. Semi-structured interviews will be conducted with three groups of individuals: multi-professional staff members involved in the care of patients discharged from ICU to the wards, patients discharged from ICU to the wards and their family members. Direct participant observations alongside ad hoc informal discussions will be undertaken with members of the CCOT at participating sites focusing on their workflow to generate an understanding of the CCOT role and how post-ICU support fits within this. An overarching thematic analysis approach will be taken to analyse data from both sub-studies to clearly identify the barriers and facilitators to providing post-ICU support within the CCOT role.
Ethical approval has been obtained through the London—Chelsea Research Ethics Committee (25/PR/0773). We aim to disseminate the findings to local teams, at regional and international conferences, in peer-reviewed journals and through social media.
To describe nurses' experiences in managing malnutrition in hospitalized adults and providing support along an interprofessional nutritional standard.
A qualitative study using focus group discussions and an inductive approach to data analysis based on Braun and Clarke's reflexive thematic analysis.
Three focus groups were conducted with nurses from a large tertiary hospital with experience in general and specialized medical care.
The overarching theme of ‘Malnutrition receives high priority’ highlighted the strong influence of the nutritional standard. With the adoption of tasks, malnutrition was becoming an important topic in clinical practice and nursing activities could be further described in three interacting sub-themes: (1) Exploration of an individual patient situation to identify possible causes of malnutrition (‘malnutrition is considered individually’); (2) development of individual care plans depending on identified problems, causes and symptoms (‘malnutrition comes into focus’); and (3) recognizing challenges when interventions sometimes were unsuccessful (‘malnutrition is not a uniform label’).
The results indicate that nurses are well positioned to improve nutritional support for patients, even in the context of emerging trends in healthcare such as digitalization. Achieving this requires a person-centred approach with individualized goals, structured interprofessional collaboration, and shared decision-making with patients and healthcare professionals.
The study highlights the importance of adherence to nutritional standards, further integration of artificial intelligence–based technologies into clinical practice, regular training in early detection of malnutrition, and support for shared decision-making and individualized nutritional care planning.
No patient or public contribution.
The Consolidated criteria for Reporting Qualitative research (COREQ) checklist were used according to the recommendations of the EQUATOR guidelines.
To explore relatives' experiences of the circulatory death of a family member following out-of-hospital cardiac arrest and to explore their hypothetical perspectives on being asked to decide about organ donation in this situation. This study forms part of a broader initiative undertaken to assess the prerequisites for implementing uncontrolled donation after circulatory death in Sweden with a focus on ethical issues.
A qualitative design, using semi-structured interviews with open-ended questions.
Data were collected in Sweden between March 2024 and September 2024 and analysed using reflexive thematic analysis with an inductive, descriptive approach. Included were 13 bereaved relatives, four men and nine women.
The analysis generated three themes: ‘Fluctuating between hope and despair’, which describes relatives' experiences of their family member's sudden cardiac arrest; ‘Exposed to vulnerability’, concerning their experiences of death and their perspectives on reasoning about the deceased person's wishes regarding donation; and ‘Balancing a major life change’, which involves experiences of facilitators and barriers to dealing with the loss.
Awareness of the deceased family member's wishes regarding organ donation facilitates relatives' ability to support the deceased's known or presumed wishes. Compassionate and communicatively competent healthcare professionals influence relatives' capacity to reason about the deceased's wishes and cope with their experience of loss. Ensuring sufficient time for goodbyes and providing follow-up may facilitate emotional processing and should be considered when implementing uncontrolled donation after circulatory death.
Policies and clinical practice should ensure that relatives are adequately informed and supported in reasoning on their family members' wishes regarding organ donation. To achieve this, nurses and other healthcare professionals require training in compassionate and empathetic communication strategies. Such training is essential both for guiding relatives through reasoning about their family preferences and for providing emotional support during the grieving process.
What is already known? ○
Organ donation after sudden death in out-of-hospital cardiac arrest is a complex process that raises ethical issues concerning both the timing and the content of conversation with the deceased's relatives, as well as the relatives' capacity to reason about the deceased's wishes in the context of sudden death.
○Knowing the wishes of the deceased person, personal beliefs, and receiving clear, direct, and honest information from nurses and other healthcare professionals prepares relatives to reason about the deceased's known or presumed wishes regarding organ donation.
What were the main findings? ○
The quality of nurses' and healthcare professionals' communicative competence and their behaviours influence relatives' ability to reason and reflect on organ donation.
○Factors that facilitate family members' experiences of donation following out-of-hospital cardiac arrest and death include awareness of the deceased's wishes regarding organ donation, being able to see with their own eyes that their family member is dead, and having sufficient time to say farewell.
○Follow-up from health care services could have an impact on relatives' experiences and their processing of loss.
Where and on whom will the research have an impact? ○
This research has an impact on organ donation services, pre-hospital emergency care, and emergency department operations. It can assist nurses and physicians in planning ethical and family-centred care in cases of out-of-hospital sudden death and uncontrolled donation after circulatory death.
COREQ-checklist.
No patient or public involvement in design, conduct or reporting.
by Peesit Leelasawatsuk, Pasawat Supanimitjaroenporn, Nattida Rodsom, Theepat Wongkittithaworn, Manupol Tangthongkum
Nasopharyngeal carcinoma is prevalent in Thailand, with a substantial proportion of cases diagnosed at advanced stages. The standard treatment, concurrent chemoradiotherapy, is associated with considerable adverse effects, which may compromise therapeutic efficacy and diminish patients’ quality of life. While vitamin C has shown potential in reducing chemotherapy-induced toxicities in some cancers, its effects in nasopharyngeal carcinoma remain unclear. In this randomized, double-blind, placebo-controlled trial, patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy were assigned to receive either 2 g of intravenous vitamin C or placebo prior to chemotherapy. The incidence of gastrointestinal adverse effects—including nausea, anorexia, mucositis, diarrhea, and dysphagia—did not differ significantly between groups. However, longitudinal analysis demonstrated a significantly attenuated decline in platelet counts in the vitamin C group compared with placebo. Although intravenous vitamin C did not reduce gastrointestinal toxicities, the observed platelet preservation suggests a potential supportive effect that warrants further investigation. Trial registration The study was registered with the Thai Clinical Trial Registry (TCTR20190316003) on March 16, 2019.Organizational culture and readiness are critical determinants of evidence-based practice (EBP) implementation. The Organizational Culture and Readiness Scale for System-Wide Integration of EBP (OCRSIEP), developed within the ARCC framework, is a validated tool to assess these dimensions, but no Italian version currently exists.
To translate, culturally adapt, and psychometrically validate the OCRSIEP and its short form in Italian.
A validation study was conducted, using exploratory and confirmatory factor analyses to derive and test the underlying model, followed by reliability testing with multiple indices and measurement invariance analyses.
Data were collected from 405 Italian nurses. Factor analyses supported a 19-item, six-factor structure explaining 59.5% of the variance, with a second-order factor indicating an overarching construct. The three-item short form showed strong model fit and explained 67% of the variance. Subscales demonstrated acceptable-to-excellent reliability, and partial scalar invariance was established across public and private facilities.
The Italian OCRSIEP scales are valid and reliable tools to assess organizational readiness for EBP implementation. They can guide leaders, educators, and researchers in monitoring, benchmarking, and advancing EBP–oriented system transformation within the Italian healthcare context.
by Ayesha Bibi, Muhammad Hamza Afandi, Azra Mehmood, Usman Ali Ashfaq, Muhammad Shareef Masoud, Mohsin Ahmad Khan, Rashid Bhatti
Hepatocellular carcinoma (HCC) has a very significant mortality rate and is one of the most common cancers worldwide. Jacaranda mimosifolia is reported to have potential antitumor activities against various human cancers. However, the effects of J. mimosifolia on HCC are yet elusive. This study aimed to investigate the anti-HCC potential of methanolic extract of J. mimosifolia leaves using in vitro and in vivo studies and a network pharmacology approach. The effect of J. mimosifolia extract was assessed on Huh-7.5 cells using MTT assay, wound healing assay, and DNA fragmentation assay. These experiments found that J. mimosifolia extract significantly suppressed Huh-7.5 cell proliferation, impaired cell migration, and induced cell apoptosis. The real-time PCR validated the upregulation of p53 and Bax, alongside the downregulation of AFP and GPC3 in Huh-7.5 cells after treatment with J. mimosifolia extract. In vivo experiments confirmed the hepatoprotective effects of J. mimosifolia extract in mice models with CCl4-induced hepatic injury. In addition, through network pharmacological analysis, J. mimosifolia was found to play a critical role against HCC via targeting multiple potential targets and pathways. Docking analysis identified apigenin and kaempferol with the lowest binding energy against PTGS2 and EGFR, respectively, while flavonol glycoside showed the lowest binding energy against MMP9. However, detailed research is needed to isolate the potential phytochemicals from J. mimosifolia against HCC.by Maria Grazia De Iorio, Michele Polli, Sara Ghilardi, Stefano Frattini, Mara Bagardi, Alessandra Paganelli, Maria Cristina Cozzi, Kenza Seghrouchni, Paola Giuseppina Brambilla, Giulietta Minozzi
Non-epidermolytic ichthyosis (NEI) is a hereditary skin disorder affecting several dog breeds, most notably the Golden Retriever. It is primarily caused by a loss-of-function variant in the PNPLA1 gene, while a second, less common form is associated with a deletion in the ABHD5 gene. This retrospective study aimed to assess the prevalence and temporal trends of both mutations in Golden Retrievers tested in Italy between 2017 and September 2025. A total of 508 genetic tests were analyzed, including 463 dogs tested for the PNPLA1 mutation, 42 for the ABHD5 deletion, and 3 for both variants. DNA was extracted from blood or buccal samples and analyzed by real-time PCR followed by confirmatory Sanger sequencing. Among the PNPLA1 tested dogs, 42% were clears (wt/wt), 37% carriers (wt/mut), and 21% affected (mut/mut), with calculated allele frequencies of 60% wild-type and 40% mutant. A significant temporal decline in mutant allele frequency was observed, accompanied by an increasing number of animals tested over time, suggesting growing interest in genetic screening and its impact on selective breeding. Conversely, all dogs tested for the ABHD5 deletion were wild-type, supporting its rarity in the breed. Overall, these findings confirm that PNPLA1-related ichthyosis remains one of the most prevalent hereditary disorders in Golden Retrievers, although its frequency is decreasing. The results emphasize the effectiveness of genetic testing in disease prevention and highlight the importance of continued monitoring to maintain genetic health within the breed.Cancer in adolescents and young adults (AYAs; ages 15–39 years) is a rising global epidemic. Yet, AYAs remain an understudied population, and little is known about what research topics should be prioritised according to those with lived experience. The AYA Cancer Priority Setting Partnership (PSP) was established to identify the top 10 research priorities for AYA cancer in Canada according to patients, caregivers, and clinicians.
This project followed the James Lind Alliance (JLA) Priority Setting Partnership (PSP) methodology that included two national cross-sectional surveys and a final priority setting workshop following an adapted nominal group technique.
A national sample was recruited to participate from across Canada.
Participants were patients, caregivers, and clinicians with lived personal and/or professional experience of AYA cancer in Canada.
In the first survey, open-ended responses were collected from participants about questions they would like answered by research. Responses were collated into overarching summary questions and a literature search was undertaken to verify if questions were true uncertainties and not fully answered by existing evidence. Unanswered questions were ranked by participants in a second survey. The top-ranked questions were prioritised through consensus at the final priority setting workshop. The final outcome was the top 10 priorities for AYA cancer research in Canada.
In the initial survey, 1916 potential research questions were submitted by 275 patients, caregivers, and clinicians. Following data processing, summary question formation, and the evidence check, 58 questions were put forward for interim prioritisation in a second survey (n=285 patients, caregivers, and clinicians). The top 20 questions from the interim prioritisation were ranked at the final priority setting workshop attended by a diverse group of 23 patients, caregivers and clinicians from across Canada. The resulting top 10 priorities reflect topics across the cancer continuum including: diagnostic delays, screening and early detection, novel therapies, psychosocial impacts, end-of-life concerns, and survivorship issues.
This patient-directed research agenda will guide researchers, funding agencies, and policymakers to ensure that future research is aligned with what matters most to the AYA cancer community.
The ‘Wound Hygiene Italia’ project was designed to provide expert-driven recommendations for the assessment, management and monitoring of venous leg ulcers, tailored to diverse settings of care (hospital, ambulatory and home care). The recommendations, developed by a multidisciplinary panel, emphasise the implementation of the Wound Hygiene strategy, a systematic approach targeting biofilm as a primary barrier to wound healing. Wound management is structured around four steps: cleansing, debridement, edge refashioning and dressing selection adapted to the wound bed characteristics, care setting and clinical capabilities, embedded in a holistic approach through comprehensive patient assessment and monitoring of overall well-being. The findings highlight the necessity of interdisciplinary collaboration, standardised tools and continuous patient monitoring, as assessed by objective metrics, such as wound size measurements and photographic documentation. Effective communication with patients and caregivers is also essential to ensure treatment adherence and foster trust in the care process. This framework integrates evidence-based practices to optimise outcomes and patient quality of life. By addressing both clinical and psychosocial factors, the recommendations promote a holistic, patient-centred approach that underscores the importance of education, structured follow-ups and tailored interventions.
Migration is a complex global phenomenon, with millions of people relocating each year driven by various social or personal reasons. Among them, refugees and asylum seekers form a particularly vulnerable subgroup, often forced to escape conflicts, persecution or life-threatening conditions. Most mental health assessment tools, originally developed in high-income countries and validated primarily in Western populations, may lack the cultural validity needed for this demographic. The primary objective is to systematically review and synthesise the psychometric properties and cultural validity of mental health assessment tools validated for refugees and asylum seekers. Secondary objectives are to (a) identify the range of mental health symptoms these tools assess and (b) describe the geographical coverage in terms of the regions of origin and host countries where tools have been validated.
Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review will conduct searches across different databases (ie, MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, Global Index Medicus, CINAHL and Scopus), from inception to January 2025, with no restrictions on language. We will include validation, adaptation or diagnostic accuracy studies, as well as any other study design that reports at least one psychometric property of a mental health assessment tool. Two pairs of reviewers will screen, extract and appraise each study independently. Methodological quality will be assessed with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk-of-Bias checklist for measurement studies and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) for diagnostic accuracy studies; the certainty of the evidence per property will be graded using the COSMIN-GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Narrative synthesis will be performed for all properties; where appropriate, meta-analyses will pool Cronbach’s α (Fisher-Z), intraclass correlations and sensitivity/specificity estimates using random-effects models. Inconsistency will be explored with subgroup analyses and meta-regressions; publication bias will be investigated with funnel plots and Egger’s test when ≥10 studies are available.
Ethical approval is not required for this systematic review, as no empirical data will be collected. Results will be disseminated through a peer-reviewed publication in a scientific journal and presented at relevant conferences.
CRD42024510901.
Fibrosing interstitial lung disease (F-ILD) are a heterogeneous group of diseases with multiple subtypes. Both idiopathic pulmonary fibrosis and other ILDs associated with a risk of developing progressive pulmonary fibrosis (PPF) are subtypes of this category. A multidisciplinary team discussion, including a chest high-resolution CT (HRCT), is usually considered the gold standard for diagnosis of F-ILD. Repeated HRCT is one of several established methods to assess progression and thus development of PPF, but it is associated with substantial costs and radiation exposure. Thoracic ultrasound (TUS) and other ultrasound (US) methods have emerged as radiation-free methods for both diagnosing and monitoring disease severity in F-ILD. Yet, consistent knowledge on the use of different TUS- and US methods in patients with F-ILD is limited.
The LORD study is a prospective cohort study conducted in participants with F-ILD at a tertiary ILD centre in Denmark. Physiological testing and patient-related outcome measures, together with TUS- and US examinations, will be performed at inclusion, after 6 and 12 months. The correlations between these assessments will be evaluated. HRCT will be conducted between 3 months prior to and 1 month after baseline, and after 1 year. At least 34 participants will be included.
The protocol was approved by the Danish Data Protection Agency (journal number: 22/45135) and the Science Ethics Committee for the Region of Southern Denmark (journal number: S-20220036). Results will be published in peer-reviewed international journals and will be presented at an international congress.
To synthesise the literature around the roles of general practice nurses (GPNs) and the barriers and facilitators of their role.
Integrative literature review using Whittemore and Knafls framework.
Papers were exported into Covidence for screening. Quality was appraised using the Mixed Method Appraisal Tool. Data were extracted into a summary table and analysed using thematic analysis.
CINAHL, Medline, and Google Scholar were used to identify papers published between January 2000 and February 2025 in English that reported primary research about GPN roles.
Twelve papers were included in the review. The four overarching themes were role characteristics, the clinical role, the non-clinical role, and barriers and enablers. Findings suggest ambiguity surrounding the GPN role, with inconsistent perspectives and overlapping responsibilities contributing to underutilisation. GPNs played an important role in continuity of care and reported a desire to spend more time on health promotion, health education and assessment. GPNs were leaders in collaboration as they functioned as agents of connectivity for patients and staff. The GPN role faces both barriers and enablers, with the organisational structure, interprofessional relationships, and professional development.
The GPN role offers an opportunity to enhance access to general practice care. However, there is limited and mixed literature describing the roles of GPNs. Future research should more closely explore the current practice of GPNs to inform policy and optimal utilisation of the workforce to the full extent of their practice scope.
Understanding the complex roles of GPNs requires more robust data on clinical activity. These data would have the potential to inform ways to optimise the GPN role within the multidisciplinary team.
This study adhered to the PRISMA reporting guideline.
This review did not include patient or public involvement.
There is an urgent need to improve surgical antimicrobial stewardship (AMS), to enhance individual care and reduce population-level antimicrobial resistance, but it is a complex issue.
We aimed to conduct an ethnographic study asking what would work in practice to improve surgical antibiotic prescribing behaviour?
Adopting a socio-cultural-historical perspective, we undertook ethnographic observations of clinical practice (43.5 hours) and semistructured interviews (n=31) with surgical staff, AMS staff and patients at two English National Health Service hospitals. Interview transcripts and observational fieldnotes were analysed using the Framework Approach. Additionally, we integrated stakeholder engagement throughout to ensure the findings were meaningful.
Our analysis of all fieldnotes (based on 43.5 hours of observation) and interview transcripts (n=31 from interviews with 31 different participants) identified that, while surgical staff were aware of antimicrobial resistance, they seldom considered AMS urgent or important in the acute setting where lack of time and the desire to mitigate perceived risk often prevailed. Other surgical issues were perceived to dominate senior decision-makers’ focus, thus perpetuating the status quo. Furthermore, attention to AMS was not always prioritised at the organisational level or by resource-limited AMS teams. Consequently, there was an absence of relationships and tools that foreground AMS. Electronic prescribing systems frequently hindered antimicrobial review and exacerbated patterns of siloed inter-disciplinary working, and feedback on antimicrobial prescribing and patient outcomes was largely absent. To improve AMS, surgical teams wanted sustainable improvements which effectively account for the hierarchical relationships, division of labour, rapid workflow and high staff turnover. Infection experts should better integrate into surgical teams to build relationships and trust, and to proactively contribute to patient care.
We offer data-driven, theoretically informed strategies to support change. Contextually appropriate improvements that address the status and visibility of AMS in surgery will be key. Further research is needed to assess the impact and sustainability of the suggested approaches.
Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts.
This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version.
A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test–retest reliability, and measurement invariance testing. All analyses were performed in R Studio.
Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice.
The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.
by Akram J. Alahmar, Noha M. Elhosseiny, Rehab R. Mahmoud, Ahmed S. Attia
Acinetobacter baumannii is a growing threat characterized by worrisome antibiotic resistance. A deeper understanding of its resistance and virulence mechanisms is essential for developing new and effective treatments. Herein, we explore the role of the two-component (NtrB-NtrC) signal transduction system and two distinct glutamine synthetases (GlnA-1 and GlnA-2) in the nitrogen assimilation, stress response, and virulence in A. baumannii. Under nitrogen-limited conditions, the ntrC mutant showed significantly defective growth kinetics when ammonium was the sole source of nitrogen, whereas the glnA2 mutant exhibited an obvious growth defect when putrescine was the sole source of nitrogen. Moreover, under nitrogen limitation, the glnA1 and glnA2 expression increased by approximately twofold and ninefold, respectively. An enzymatic activity assay demonstrated that the A. baumannii extracellular glutamine synthetase activity is dependent on the type II secretion system (T2SS), confirming our previous results from a T2SS secretome study. Interestingly, this activity is also regulated by NtrC. An infection model using Galleria mellonella revealed that the ntrC mutant was significantly less virulent than both the wild-type and glnA2 mutant strains. These results provide new insights into the nitrogen regulatory network and its contribution to the A. baumannii virulence, underscoring NtrC as a promising target for future antimicrobial strategies.To develop and validate decision trees using conditional probabilities to identify the predictors of mortality and morbidity deterioration in trauma patients.
A quasi-experimental longitudinal study conducted at a Level 1 Trauma Center in São Paulo, Brazil.
The study analysed 201 patient records using standardised nursing documentation (NANDA International and Nursing Outcomes Classification). Decision trees were constructed using the chi-squared automatic interaction detection (CHAID) algorithm and validated through K-fold cross-validation to ensure model reliability.
Decision trees identified key predictors of survival and mobility deterioration. Patients who did not require (NOC 0414) Cardiopulmonary Status but required (NOC 0210) Transfer Performance had a 97.4% survival rate. Conversely, those requiring (NOC 0414) Cardiopulmonary Status had a 25% risk of worsening mobility, compared to 9% for those who did not. K-fold cross-validation confirmed the model's predictive accuracy, reinforcing the robustness of the decision tree approach (Value).
Decision trees demonstrated strong predictive capabilities for mobility outcomes and mortality risk, offering a structured, data-driven framework for clinical decision-making. These findings underscore the importance of early mobilisation, tailored rehabilitation interventions and assistive devices in improving patient recovery. This study is among the first to apply decision trees in this context, highlighting its novelty and potential to enhance trauma critical care practices.
This study highlights the potential of decision trees, a supervised machine learning method, in nursing practice by providing clear, evidence-based guidance for clinical decision-making. By enabling early identification of high-risk patients, decision trees facilitate timely interventions, reduce complications and support personalised rehabilitation strategies that enhance patient safety and recovery.
This research addresses the challenge of improving outcomes for critically ill and trauma patients with impaired mobility by identifying effective strategies for early mobilisation and rehabilitation. The integration of artificial intelligence-driven decision trees strengthens evidence-based nursing practice, enhances patient education and informs scalable interventions that reduce trauma-related complications. These findings have implications for healthcare providers, rehabilitation specialists and policymakers seeking to optimise trauma care and improve long-term patient outcomes.
Patients provided authorisation for the collection of their clinical data from medical records during hospitalisation.
Venous leg ulcers (VLU) account for the majority of chronic wounds, with an estimated rise in prevalence due to demographic change. Care often does not comply with evidence, and patients remain passive and uninformed. To support general practice VLU care, the ‘UlcusCrurisCare’ (UCC) project developed a multimodal intervention comprising provider training, software-supported case management and standardised patient education. Experts from the medical community (physicians, nurses, association of medical assistants), health insurance and patient representatives provided their assessment of barriers in VLU care, requirements for intervention components and their expected effects. Semi-structured interviews and questionnaires were used at two measuring points. Qualitative data analysis was based on the Theoretical Domains Framework. Quantitative data were analysed descriptively. Ten experts named a lack of knowledge and application regarding compression therapy, reluctance to assume role as primary care provider, and inadequate remuneration as barriers for evidence-based VLU care. To effectively address these barriers, interventions are required to foster the use of compression therapy and patient education. A multimodal approach such as pursued in UCC is expected to effectively address deficits in VLU care at general practitioner level by promoting provider knowledge about evidence-based treatment and supporting patient adherence.
To characterise neighbourhood food environments in British Columbia (BC) and determine whether food environment characteristics are associated with fruit and vegetable (FV) intake.
A cross-sectional study using geospatial linkage of food environment measures within 1 km residential buffers, analysed with mixed-effects models
Urban neighbourhoods in BC, Canada.
Approximately 25 000 adults aged 35–69 years from the BC Generations Project cohort.
FV intake as a continuous variable (servings/day) and as a binary measure (
Approximately 50% of participants lived in neighbourhoods without chain grocery stores, fast-food outlets or convenience stores within walking distance. Neighbourhoods in the highest density category for fast-food outlets were associated with lower odds of consuming ≥5 servings of FV per day (OR=0.89, 95% CI 0.80 to 0.98). Associations between chain grocery stores, convenience stores and FV intake were attenuated after adjusting for neighbourhood characteristics including walkability, and material and social deprivation.
The findings suggest limited neighbourhood access to retail food outlets across urban areas in BC. Participants living in neighbourhoods with greater density of fast-food restaurants were less likely to consume
FreshRSS 