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To assess the quality of the Spanish Triage System performed by nurses according to the triage code assigned to each patient and to examine factors associated with the need for re-evaluation after completion of triage.
Retrospective longitudinal observational study.
A retrospective analysis was conducted of patients triaged in the emergency department between 2018 and 2023. Patients triaged by other healthcare professionals and those who did not receive a triage priority level were excluded.
493,211 episodes were analysed. Most were low/intermediate acuity (Level IV 65.4%, Level III 23.9%; Level I 0.1%). Mean time-to-first physician record entry increased as acuity decreased (38 min Level I vs. 81 min Level V), yet recorded time-target compliance was lowest in Levels I–II (23.8% and 14.7%). Re-evaluation occurred more often in high-acuity levels and was independently associated with older age, male sex, lower oxygen saturation and longer emergency department length of stay; compared with Level I, Levels II–III and lower adjusted odds of re-evaluation.
Nurse-led triage demonstrated coherent clinical and operational stratification; however, the lowest recorded time-target compliance in the sickest patients suggests a gap between immediate care and electronic documentation.
Streamline documentation workflows for high-acuity cases and use re-evaluation risk profiles to prioritize monitoring and escalation.
Evidence on nurse-led Spanish Triage System performance and time-documentation quality is limited. Acuity and flow metrics showed expected gradients, but target-time compliance was lowest in Levels I–II; predictors of re-evaluation were also identified. Findings support emergency department nursing, quality improvement and potential benefits for patients attending emergency departments.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Language-concordant care, or healthcare in one’s preferred language, is important both for health equity and for improving health outcomes. Linguistic minorities, like Francophones in Ontario, Canada, are at risk of poorer clinical outcomes if they receive non-language-concordant primary care. However, common ratio-based access measures can provide misleading views of minorities’ actual access levels. This cross-sectional geospatial study demonstrates a new way to measure primary care access using average travel time to the nearest five English- and French-speaking family physicians. We also introduce the concept of primary care access fragility, where a region’s primary care access may depend on one or a few local family physicians. Our research question is: are there differences in travel burden and access fragility for census subdivisions (CSDs) across language (English/French), rurality (urban/rural) and region (north/south) in the province of Ontario, Canada?
We conducted a cross-sectional geospatial analysis to estimate English-language and French-language primary care travel burdens and access fragility in Ontario, Canada. We used population and boundary data from Statistics Canada’s 2021 census, road-network data from OpenStreetMaps, and family physician practice locations and language abilities from the College of Physicians and Surgeons of Ontario. We measured travel burden using Valhalla, an open-source road-network analysis platform.
We conducted our analysis for Ontario, Canada’s 577 CSDs, which correspond roughly to municipalities and with populations ranging from 5 inhabitants in Rainy Lake 17B to a high of 2 794 356 in Toronto.
Using public data from January 2026, we identified 15 762 family physicians practising in Ontario, of whom 11.0% reported speaking French. Patient data were obtained from the most recent 2021 census.
Our first primary outcome measures were CSD-level mean travel time to the nearest five English-speaking family physicians, and CSD-level mean travel time to the nearest five French-speaking family physicians, which we compared to explore regional inequities in travel burden. Our secondary outcome measures were based on a novel notion of the travel burden component of ‘primary care access fragility’. This metric indicates how dependent a region’s access is on a small number of local physicians and is defined as the difference between the CSD-level mean travel time to the nearest one physician and to the nearest five physicians. As the difference in travel times grows, so too does access fragility.
Median differences in French-language and English-language travel burdens were strongly significant across rurality, regions and overall (median difference 13.4 min, p
Compared with the general public, Ontario’s French-speakers face higher travel burdens to language-concordant family physicians and higher access fragility, especially in rural and northern regions. Our results are of interest to policymakers and health-system planners, and our methods are applicable to other populations and regions.
Evidence-Based Practice (EBP) is essential to healthcare quality and safety, integrating scientific evidence with clinical expertise and patient preferences. Despite its importance, EBP implementation still faces major challenges. Educational interventions have proven effective in strengthening EBP competencies among healthcare.
To evaluate the impact of a personalized educational intervention on EBP competencies among healthcare professionals. Working at a private tertiary general hospital, comparing performance before and after the intervention.
A randomized controlled trial involving healthcare professionals was conducted. Eligible and consented participants were randomly assigned to either an Intervention Group (IG) receiving an Evidence-Based Practice (EBP) course or a Control Group (CG) not receiving the course, stratified by job level, role, and work shift. From the completers, 18 participants were randomly selected for the IG, and all 7 available CG participants were included in the final sample for analysis. All study participants completed two validated instruments: the Assessing Competencies in Evidence-Based Medicine (ACE) and the Fresno Test. The educational intervention consisted of a seven-week course with weekly three-hour sessions, for a total of 21 h. Comparative analyses were conducted using a Linear Mixed Model, adjusted for educational level, job level, time working at the hospital, and weekly workload.
A statistically significant increase in general EBP knowledge was observed in the IG following the intervention, with a mean gain of 19.1%. Separate analysis showed improvements of 10.8% in ACE and 24.2% in Fresno Test scores. No statistically significant changes were observed in the CG. Furthermore, after the intervention, the IG outperformed the CG for both general EBP knowledge and Fresno Test scores on both pre- and post-intervention comparisons.
The educational intervention had a positive statistically significant impact on EBP knowledge and skills among healthcare professionals in the IG compared to the CG. These findings underscore the potential of structured educational initiatives to enhance the quality of clinical practice through improved EBP competencies.
UTN U1111-1322-8443
To map and synthesise the main recommendations for arterial blood gas (ABG) collection in intensive care units (ICUs).
A scoping review was conducted according to the PRISMA-ScR Checklist, supported with The PAGER framework and guided by the Joanna Briggs Institute methodology to ensure methodological rigour and analytical comprehensiveness.
Data collection was conducted from February to April 2024. The data sources included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PubMed Central, Scientific Electronic Library Online (SciELO), Web of Science (WoS), SCOPUS, Science Direct, Virtual Health Library (VHL), Excerpta Medica database (Embase), CAPES Thesis and Dissertation Catalogue, Brazilian Digital Library of Theses and Dissertations (BDTD), Scientific Open Access Repository of Portugal (RCAAP), Theses Canada and the Oswaldo Cruz Foundation (Fiocruz) repository.
Key findings recommend the radial artery as the preferred puncture site, an insertion angle of 30° to 45°, the use of 1 or 3 mL syringes and 20G or 23G gauge needles. Transport and storage at room temperature are advised. Cryoanalgesia and subcutaneous analgesia methods were found to be effective for pain management.
The review highlights the best practices for arterial blood gas collection in critical care. The synthesized evidence strengthens clinical practice, informs guidelines for intensive care nursing and promotes safer, higher-quality care for critically ill patients.
The evidence-based recommendations identified can enhance nursing care related to arterial blood gas collection. Adherence to these practices promotes safer, more humanised and evidence-based care during the procedure.
The report of this study followed the PRISMA-ScR Checklist.
There was no patient or public involvement in this scoping review.
Spirituality has gained increasing attention in healthcare, particularly in palliative care, as it supports meaning, purpose and connection during illness. While literature extensively explores patients’ spiritual needs, growing evidence highlights the importance of addressing the spiritual needs of caregivers and healthcare professionals. Caregivers and relatives often face emotional, ethical and practical challenges during prolonged care pathways, impacting their well-being. Limited training and tools can hinder spiritual care, contributing to distress and burnout among professionals and unmet needs for families. Addressing spirituality in neurodegenerative disease palliative care is essential for holistic, person-centred approaches that foster coping, hope and ethical decision-making. This scoping review aims to map evidence on spiritual needs and challenges of caregivers, relatives and healthcare staff in end-stage neurodegenerative disease care.
This review will follow the Joanna Briggs Institute framework (JBI) for scoping reviews. The search and reporting process will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Inclusion criteria followed JBI’s population, concept and context framework with no date or geographical limits; only English and Italian sources ensured accurate interpretation. Searches will use university-access databases and grey literature to capture policy and non-peer-reviewed sources. Databases selected: PubMed, CINAHL, APA PsycINFO and Scopus for comprehensive, multidisciplinary coverage. This inclusive approach is aligned with the purpose of scoping reviews, which aim to map the breadth and depth of available literature. Researchers independently screened titles/abstracts in Rayyan software with blinding, resolved discrepancies collaboratively, piloted and refined extraction tables, and jointly synthesised themes through iterative meetings to ensure rigour and consensus. Findings will highlight existing knowledge, identify gaps and inform future research and practice.
Since secondary data will be analysed, no ethical approval is required. The results will be disseminated through publications subject to peer review. The protocol has been registered with the Open Science Framework https://doi.org/10.17605/OSF.IO/X9275
Video-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small cell lung cancer (NSCLC). This procedure, however, is dependent on the patient’s ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomised controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.
Data on NSCLC patients will be collected from routinely collected university hospital records linked with German cancer registry data. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicentre open-label two-parallel arm superiority randomised trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within 3 months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted non-parametric Kaplan-Meier curves.
The Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg with an approved addendum with Dnr 2023–112 has approved this study. The study uses anonymised routinely collected hospital and cancer registry data in accordance with applicable data protection regulations. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.by Mary Yeboah, Richard Abeiku Bonney, Loretta Adu-Boahemaa Antwi, Pius Amponsah Anane, Obed Kwabena Offe Amponsah, Peter Agyei-Baffour
BackgroundNon-communicable diseases (NCDs) cause 74% of global deaths, disproportionately affecting LMICs like Ghana. Chronic treatment remains hindered by medicine shortages and high costs, consuming over 50% of the minimum wage incomes. Despite Ghana’s NCD policies, supply chain gaps and price inflation persist. This study assesses access to medicine, operationally defined as availability and affordability, in three municipalities to inform reforms for Universal Health Coverage and achieve SDG 3.4 targets.
MethodsThis cross-sectional mixed study assessed the availability and affordability of NCD medicines in three municipalities in Ghana using WHO/HAI methods. Data on 62 medicines were collected from nine health facilities, supplemented by interviews with pharmacy managers.
ResultsThis study assessed access to NCD medicines across three municipalities in Ghana, revealing stark disparities. Availability varied significantly by location (Oforikrom 70% vs. Juaben 48.6%, p Conclusion
This study highlights inequities in access to NCD medicines in Ghana, with stark gaps in availability and affordability, especially in underserved areas. Findings reveal high costs, stock-outs, and geographic disparities as key factors, underscoring the need for supply chain reforms, price regulation, and municipal oversight to advance equitable, sustainable, universal health coverage.
by Melissa Beck Wells
Students classified under Other Health Impairment (OHI), a category that includes Attention-Deficit/Hyperactivity Disorder (ADHD), are frequently disciplined in school settings despite ADHD being classified as a neurodevelopmental rather than a behavioral disorder. This study examined patterns of disciplinary removal among students served under the Individuals with Disabilities Education Act (IDEA), Part B, focusing on comparisons between OHI and Emotional Disturbance (ED). Using publicly available IDEA Part B discipline data, a descriptive longitudinal analysis was conducted across three academic years (2019–2020, 2020–2021, and 2021–2022). Percentage-based indicators were analyzed to examine the proportion of students ages 3–21 subject to disciplinary removal by disability category and state. Across all three years, students classified under OHI experienced disciplinary removal at rates comparable to, and in many states exceeding, those of students classified under ED. These patterns persisted despite year-to-year variation associated with the COVID-19 pandemic. Findings are interpreted through IDEA procedural safeguards and DSM-5 diagnostic frameworks, highlighting a potential misalignment between neurodevelopmental disability classification and behavioral support provision. The study discusses how Universal Design for Learning (UDL) may reduce disciplinary risk through proactive design, while emphasizing that individualized behavioral interventions, including Functional Behavioral Assessments and Behavior Intervention Plans, remain legally required when behavior is a manifestation of disability.by Cecilia Aguilar-Vega, Jaime Bosch, Satoshi Ito, Benjamin Ivorra, Hyunkyu Jeong, José Manuel Sánchez-Vizcaíno
African swine fever (ASF) is a lethal disease of swine that has spread across Asia since its introduction in 2018. South Korea first reported the disease in September 2019 in domestic pigs, and since then, more than 4,000 cases have been reported in wild boars during its expansion up to August 2024. Due to the high number of ASF notifications in wild boars in South Korea, contrasted with their scarcity in most Asian countries, analyzing the spatiotemporal spread of the disease in a setting with active surveillance provides valuable insights. In this study, we performed a trend-surface analysis on temporally gridded case data to characterize the overall geographic spread and direction of ASF in wild boars across South Korea, from its emergence to August 2022. Additionally, we propose a novel approach distinct from previous studies, to estimate spread velocity by incorporating an upper threshold to avoid unrealistic values. The model described the spread of ASF in the study area. The disease showed greater expansion in the east of the country. Initially, a south and eastward direction was estimated. The estimated median velocity was 19.53 km/month, with cell-level velocities ranging from 2.45 to 69.99 km/month. Velocity increased notably from autumn 2021 onward and varied substantially across years. Our results show the dynamics of ASF in wild boars of South Korea, providing new evidence of their role in the epidemiology of the disease.by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEFby Mariana Moraes de Lima Perini, Alyssa F. Fayemi, Julie N. Pugh, Elizabeth M. Scott, Karan Bhula, Austin Chirgwin, Olivia N. White, Nicolas F. Berbari, Jiliang Li
Primary cilia play a crucial role in the development and mechanosensation of various tissue types, including bone. In this study, we investigated their role in bone growth and adaptation by targeting two cilia specific genes, IFT88 and MKS5. Conditional knockout (cKO) of IFT88 in osteoblasts significantly reduced body weight and femur length in mice compared to the littermate controls. Additionally, female IFT88 cKO mice exhibited a significant suppression of bone formation rate compared to the littermate controls. To further explore the role of primary cilia in osteocytes, osteocytes specific MKS5 cKO mice underwent axial ulnar loading at a peak force of 2.9N for females and 3.2N for males with 120 cycles per day for three consecutive days. Load induced bone formation rate was significantly decreased by 48% in males and 42% in females compared to the littermate control mice. These findings underscore the critical role of primary cilia in bone development and mechano-adaptation. They suggest that functional primary cilia in osteoblasts are essential for skeletal development, while those in osteocytes mediates mechanically induced bone formation, highlighting its potential as therapeutic targets for bone loss prevention.by Ana Laura Januário Lelis, Leandro Aparecido Ferreira da Silva, Daniel Moretto Casali, Tiago Leiva, Murilo Chuba Rodrigues, José Paulo Roman Barroso, Pedro Veloso Facury Lasmar, Camila Lisboa Tomaz, Anabelle Jorge Barbosa, Camila Cesario Fernandes Sartini, Johnny Maciel de Souza, Danilo Domingues Millen
This study evaluated the effects of increasing narasin doses on ruminal fermentation, nutrient digestibility, ruminal pH stability, papillae histology, and microbial composition in Angus cattle fed feedlot diets. Three rumen-cannulated Angus steers (average body weight: 680 kg) were assigned to a 3 × 3 Latin square design and received diets containing 13, 20, or 27-ppm of narasin. Each experimental period consisted of 14 days of adaptation followed by seven days of sampling. Ruminal degradability was assessed on days 15–17, apparent digestibility on days 15–19, continuous ruminal pH on days 19–20, and samples for short-chain fatty acids (SCFA), microbiota, and ruminal histology were collected on days 20 and 21. Ruminal degradability was not affected by narasin dose. Digestibility of acid detergent fiber (ADF) was significantly influenced, with the greatest values observed at 27-ppm (P = 0.01). Increasing narasin doses improved ruminal pH stability, as indicated by a linear increase in minimum pH (P = 0.01) and a reduction in the duration of pH below 5.6 (P = 0.10). At 13 ppm, SCFA production, particularly acetate and propionate, increased (P P P = 0.02), and butyrate (P P P = 0.03). Narasin supplementation altered ruminal microbial composition, increasing the relative abundance of Lachnospiraceae and Isotricha while reducing lactic acid–producing bacteria. In terms of ruminal morphology, supplementation with 20-ppm of narasin increased the keratin layer thickness of ruminal papillae (P = 0.02), suggesting enhanced epithelial development. Overall, narasin supplementation modulated ruminal function and microbial ecology, with doses between 13 and 20-ppm providing the most favorable balance between fermentative efficiency and ruminal health in feedlot cattle.Socioeconomic inequalities in neonatal mortality are observed globally but gaps remain in the evidence from current reviews, specifically: a wider range of socioeconomic indicators at the individual, household and area level than previous reviews, and alternative time frames to define neonatal mortality. Thus, a comprehensive updated review of the literature is required, focusing on multiple measures of socioeconomic status and alternative time frames, to assess the relationship between maternal socioeconomic status and neonatal mortality in high-income countries.
Three different search approaches will be used: electronic searching of three databases, grey literature searching and reference list checking. First, the three databases Medline, Scopus and Web of Science will be searched using relevant synonyms and adapted terms from medical subject heading terms (MeSH) in Medline for maternal socioeconomic status and neonatal mortality identified from previous systematic reviews on inequalities in adverse pregnancy outcomes. Second, grey literature will be searched by entering the relevant terms into Google. Title, abstract and full text screening will be conducted by the review team against the inclusion and exclusion criteria, with at least 10% checked by a second reviewer to assess for any bias and errors. We will also conduct the kappa statistic for inter-rater reliability. Third, the reference lists of included studies will be reviewed for any additional studies that meet the criteria. Data will be extracted using a data extraction form and extracted studies will be assessed using the Liverpool Quality Assessment Tool. A narrative synthesis will be conducted and, where appropriate, meta-analysis will be performed. If the data allow, subgroup analysis by neonatal care population and specific gestational ages will be performed.
Ethical approval is not required as all studies in this systematic review will be publicly available. The findings of this review will be presented at conferences and disseminated in peer-reviewed publications.
CRD42022315407.
Well-being of healthcare professionals (HCPs) is vital for care quality, staff retention and overall healthcare system effectiveness. This study aims to identify the organisational and workplace variables associated with sick leave and measures of engagement of HCPs on department level within a single Dutch academic hospital.
Cross-sectional study using routinely collected organisational data.
A tertiary-care academic hospital in the Netherlands.
25 clinical departments were included. Department level variables were derived from routinely collected hospital databases. Availability of data varied across variables. Analysis included information on patient population, human resources, care processes, quality of care and employee and patient experiences to assess differences, correlations and predictors for sick leave and engagement.
Primary outcome measures were (1) sick leave (%) and (2) engagement, assessed through two staff-survey items (vitality and connectedness; 0–10 Numeric Rating Scale). Both outcomes were analysed at department level.
Employee population data showed the most consistent patterns across analyses. Departments with higher staffing capacity had higher sick leave and lower engagement in group comparisons (p=0.009, p=0.030, respectively). In multivariable models, higher staffing capacity remained associated with increased sick leave (B=1.38, 95% CI 0.53 to 2.23, p=0.003). Engagement was positively associated with higher inflow (B=0.92, 95% CI 0.06 to 1.77, p=0.037) and negatively associated with outflow (B = –1.36, 95% CI –2.08 to –0.63, p=0.001). No consistent associations were found with patient population and patient experience measures.
Workforce-related factors, particularly staffing capacity and inflow and outflow, are strongly linked to sick leave and engagement. Routinely collected hospital data can be used to identify at-risk departments and inform targeted strategies for improving workforce sustainability. Future studies should explore more granular, team-level data to better support staff well-being and care quality.
Patient decision aids (PtDAs) are effective interventions to support patient involvement in health decisions and have the potential to impact favourably on health inequities by reducing gender bias in clinical practice. The aim was to explore sex and gender reporting and differences in randomised controlled trials (RCTs) evaluating PtDAs for adults making treatment or screening decisions.
Secondary analysis of the Cochrane review of PtDAs of RCTs that reported sex and/or gender. The original review searched MEDLINE, Embase, PsychINFO and EBSCO from journal inception to March 2022. Two team members independently screened citations, extracted data and assessed risk of bias. For this secondary analysis, we only included primary outcomes from the original review. We assessed appropriate use of terminology for sex (biological attribute) and gender (social construct). When terms were used interchangeably, it was considered inaccurate. Findings were synthesised descriptively, and we used meta-analysis when two or more RCTs were conducted with females/women or males/men using similar outcome measures.
Informed values-choice congruence and the quality of the decision-making process (eg, knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision making, undecided) and adverse events (eg, decision regret, emotional distress) by sex and gender.
Of 209 RCTs in the original review, 206 reported sex and/or gender, with 35 (17%) using accurate terminology. Of 206 RCTs, 70 were with females/women only, 27 males/men only, 12 analysed by sex/gender and 97 RCTs did not disaggregate findings by sex or gender. Meta-analysis comparing RCTs for females/women to usual care and RCTs for males/men only compared with usual care showed similar mean differences in knowledge scores (10.84 vs 9.38 out of 100; p=0.44). Males/men had significantly higher self-reported participation in decision making compared with females/women (RR 3.16 vs 0.95; p
In PtDA RCTs, sex and gender terms are used interchangeably and 6% analysed outcomes by sex or gender. Meta-analysis of males/men only given PtDAs showed higher self-reported decision making participation in clinical practice compared to usual care versus females/women only compared with usual care. Researchers must improve reporting sex and gender in PtDA RCTs to assess how it influences health inequities.
The research explored how individuals experience chronic pain within their everyday social contexts over a 12-month period. The study focused on the interplay between pain and social worlds, through analysis of experiences of social relationships included in engagement in meaningful activities such as hobbies and work.
Drawing on ethnographic approaches from social science, the study involved 295 research visits with 19 participants living with chronic pain (totalling approximately 418 hours of fieldwork) and 48 semistructured interviews (around 30 hours).
The study was carried out in South West England, UK.
19 participants were identified through the Avon Longitudinal Study of Parents, 12 women and 7 men, all identifying as white British, aged between 32 and 33 years.
The analysis identified three key themes: (1) Social connections and everyday fluctuations in chronic pain; and (2) the interplay between work, family roles and fluctuations in chronic pain; and (3) Social spiralling and fluctuations in chronic pain. The third theme builds on and combines the patterns identified in the first two themes, drawing together how changes in social connections and balancing of roles coalesce in the experience of fluctuation in chronic pain. Relationships, roles and how these were experienced varied across participants, but all of their descriptions indicated that the constant flux was understood, even if financial or other circumstances meant that people were unable to exert agency that would have proved beneficial. Across themes, interconnected social processes appear to shift and move together, amplifying their collective impact on the experience of chronic pain.
Fluctuations in chronic pain were complex, shaped by and entangled with social contexts that vary in meaningful ways. The findings suggest that to address chronic pain effectively, health and social care may need to move beyond individual-level solutions to consider the multiple, interacting layers of influence that shape and sustain the experience of chronic pain.
This study defines adverse religious experiences (AREs), describes how these gendered harms affect women and develops a Classical Grounded Theory (CGT) model of women's recovery and inform trauma- and gender-responsive nursing practice.
Using the CGT design, the study explores women's lived experiences with AREs, focusing on their primary concern and the strategies they used to address it.
Fifteen North American women participated in open-ended, semi-structured interviews conducted between May and June 2023. Data collection and analysis occurred concurrently by using constant comparison. Theoretical saturation was reached by approximately 12 interviews and was confirmed through three additional interviews. Theoretical coding was guided by Glaser's Six Cs.
The central issue was Loss of Self, with limited agency, embodiment and autonomy due to internalised religious control. This study conceptualises AREs as a gendered determinant of health and introduces a nursing-generated explanatory model of women's recovery from religious harm. The Basic Social Process, Discovering Self, includes six cyclical phases: Living with Toxicity, Loss of Self, Recognizing Woundedness, Leaving Negativity, Seeking Restoration and Awakening to Wholeness. Analytic integration with the Six Cs showed that doctrinal rigidity, gendered hierarchies, conditional belonging, turning points and psychological, spiritual and relational consequences shaped individual recovery paths. Recovery proved a nonlinear, whole-person process spanning spiritual, physical, sexual and relational domains.
Discovering Self offers the first explanatory model of women's recovery from religious harm, identifying mechanisms of oppression and pathways for reclaiming agency, embodiment and voice.
This study provides a roadmap for trauma- and gender-responsive nursing care, education and policy. The findings align with global priorities in health and gender equality.
This study followed the SRQR guidelines and used CGT methodology.
Patients or the public were not involved in the study.
Actualmente el cuidado de la salud (entendida también como bienestar) es uno de los principales valores, no es de extrañar que los ciudadanos quieran informarse sobre cómo mantenerse sanos e incluso, sobre cómo ser felices (aunque esto último pueda ocasionar más malestar y frustración en quienes suponen que la felicidad es algo que se alcanza y no que algo que se construye). En esta búsqueda de información, las redes sociales, apps e internet juegan un papel fundamental. Sin embargo, estas fuentes no siempre aportan información válida o fiables y por ello, es necesario suplir esa necesidad de información garantizando un acceso a un conocimiento válido, sustentado en evidencia científica. Las enfermeras, por nuestra mayor accesibilidad, cercanía a la población y porque seguimos siendo los profesionales de la salud que inspiran más confianza, debemos tomar un rol protagonista en la alfabetización en salud de la población, para que los ciudadanos sean más competentes tanto para cuidar de su salud como para manejar la enfermedad y controlar los síntomas, pues todo ello redunda en un mayor bienestar y autonomía de nuestros pacientes.
ABSTRACT
Introducción. Los síntomas prostáticos abarcan alteraciones en el vaciado, llenado, posmicción y volumen urinario, su aparición está influida por factores de riesgo como la edad, la raza, la predisposición genética y los hábitos dietéticos. Objetivo. Analizar la severidad de los síntomas prostáticos con los factores epidemiológicos y clínicos de los residentes del del Hogar de Ancianos “San José de las Canoas”, del cantón Catamayo. Metodología. Se realizó un estudio descriptivo, cuantitativo, no experimental, y corte transversal, con una muestra de 30 participantes. Para la recolección de datos se utilizó el cuestionario “International Prostate Symptom Score” (IPSS) destacándose por su alta confiabilidad y validez. El estudio contó con la aprobación de un Comité de Ética en Investigación en Seres Humanos y se llevó a cabo respetando los principios bioéticos establecidos. Resultados. 18 de los pacientes estudiados presentaban síntomas moderados. Se obtuvo una asociación estadística entre la severidad de los síntomas síntomas prostáticos y la edad (p= 0,007) y el grado de instrucción (p= 0,046). En cuanto a la presencia de comorbilidad (diabetes, hipertensión arterial/cardiopatía), se observó una relación significativa en la muestra (p= 0,043) en términos generales. Discusión. Los datos revelan que los síntomas prostáticos moderados se asocian con factores sociales y clínicos críticos, como el aislamiento, la falta de educación y enfermedades relacionadas con el estilo de vida, este panorama exige acciones integrales para mejorar la salud y calidad de vida de esta población vulnerable.
ABSTRACT
Introduction. Prostatic symptoms include alterations in voiding, filling, postvoiding and urinary volume, their appearance is influenced by risk factors such as age, race, genetic predisposition and dietary habits. Objective. To analyze the severity of prostatic symptoms with epidemiological and clinical factors in the residents of the “San José de las Canoas” Elderly Home in Catamayo. Methodology. A descriptive, quantitative, non-experimental, cross-sectional study was carried out with a sample of 30 participants. The “International Prostate Symptom Score” (IPSS) questionnaire was used for data collection, standing out for its high reliability and validity. The study had the approval of a Human Research Ethics Committee and was carried out respecting the established bioethical principles. Results. 18 of the patients studied had moderate symptoms. Statistical association was obtained between severity of prostatic symptoms and age (p= 0,007) and education degree (p= 0,046). Regarding the presence of comorbidity (diabetes, arterial hypertension/cardiopathy), a significative association was observed in the sample (p= 0,043). Discussion. Data reveal that moderate prostatic symptoms are associated with critical social and clinical factors, such as isolation, lack of education and lifestyle-related diseases, this scenario calls for comprehensive actions to improve the health and quality of life of this vulnerable population.
FreshRSS 