Infection prevention and control (IPC) interventions are multifactorial and are used to prevent healthcare-associated infections in healthcare facilities. However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.
This systematic review aims to identify peer-reviewed publications reporting patient satisfaction outcomes in the context of IPC interventions, to document the methods used to assess patient satisfaction and to conduct a meta-analysis on reported satisfaction outcomes.
Systematic review and meta-analysis following the Joanna Briggs Institute (JBI) methodology and the PRISMA statement, with oversight from a steering group including PPI partners. Studies in peer-reviewed journals were included based on eligibility criteria.
MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, CINAHL and PsycINFO were searched in June 2024.
Included studies investigated satisfaction among hospitalised patients in acute care settings following IPC measures, including isolation, cohorting, screening, hand hygiene, antimicrobial stewardship, patient flagging, education, personal protective equipment use, visiting restrictions and treatment delays
Titles and abstracts were screened independently by two reviewers; disagreements were resolved by a third. Study quality was assessed using the JBI manual for evidence synthesis. A meta-analysis was conducted where four or more studies used comparable designs and methods within the same areas of IPC, with heterogeneity evaluated using Cochran’s Q statistic and I2 and pooled estimates calculated with 95% CIs using the Wilson (score) method.
Twenty-nine studies were identified. Among IPC measures, isolation precautions were the most commonly reported intervention (11 studies, 38%). The Likert scale was the predominant assessment method (13 studies, 45%). Patient satisfaction with IPC interventions ranged from 58.3% to 97.2%. Meta-analysis of four studies using the Hospital Consumer Assessment of Healthcare Providers and Systems survey showed substantial heterogeneity (I2, 55%, p=0.08) and a pooled patient satisfaction level of 69% (95% CI 63.6% to 74.4%) for isolation precautions.
Sixty-nine percent of isolated patients reported satisfaction with their care. Patient satisfaction with IPC interventions varies widely, highlighting limitations in current measurement approaches. Strengthening PPI in the design and evaluation of satisfaction measures is essential to capture meaningful data and improvements in IPC programmes.
IS 2024 CRD42024558385.
Frontotemporal dementia (FTD) remains challenging to diagnose owing to the marked clinical heterogeneity associated with the disease. This heterogeneity stems from the complex interplay of various clinical phenotypes, genetic mutations and underlying neuropathologies, such as TDP-43 and tau proteinopathies. Currently, there is no single confirmed biomarker that can reliably diagnose disease, specifically disease stage, disease subtype and underlying neuropathology. Recent research has indicated that neuroimaging techniques hold the most promise for the discovery of FTD biomarkers. We propose a protocol for a systematic review and meta-analysis to identify MRI and fluorodeoxyglucose positron emission tomography (FDG-PET) biomarkers associated with clinical, genetic and pathological subtypes of FTD. We aim to address the following research questions: can regional MRI volumetry and FDG-PET hypometabolism differentiate (1) FTD patients from healthy controls; (2) sporadic cases of FTD from healthy controls; (3) genetic cases of FTD (MAPT, GRN, and C9orf72 mutations); and (4) underlying neuropathology, specifically discriminating between tau- and TDP-43-based FTD?
Literature searches will be performed across three databases: Ovid Medline, Ovid Embase and Web of Science. Publications that have fewer than five participants, are non-human-based, not written in the English language or contain unpublished data will be excluded. Two independent investigators will screen and subsequently evaluate which publications to include. Should any disagreements arise, a third investigator will settle the discrepancy. After the random-effects meta-analysis has been used to extract and pool the data, I2 analysis will be used to quantify heterogeneity.
Ethics approval will not be required for this research. On completion, the systematic review and meta-analysis will be published in a peer-reviewed journal.
CRD42024545302.
We aim to use an agent-based model to accurately predict the spread of COVID-19 within multiple US state prisons.
We developed a semistochastic transmission model of COVID-19.
Five regional state-owned prisons within North Carolina.
Several thousand incarcerated individuals.
We measured (1) the observed and simulated average daily infection rate of COVID-19 for each prison studied in 30-day intervals, (2) the observed and simulated average daily recovery rate from COVID-19 for each prison studied in 30-day intervals, (3) the mean absolute percentage error (MAPE) of each prison’s summary statistics and the simulated results and (4) the parameter estimates of key predictors used in the model.
The COVID-19 pandemic disparately affected incarcerated populations in the USA, with severe morbidity and infection rates across the country. In response, many predictive models were developed to help mitigate risk. However, these models did not feature the systemic factors of prisons, such as vaccination rates, populations and capacities (to determine overcrowding) and design and were not generalisable to other prisons.
An agent-based model that used geospatial contact networks and compartmental transmission dynamics was built to create predictive microsimulations that simulated COVID-19 outbreaks within five North Carolinian regional prisons between July 2020 and June 2021. The model used the characteristics of an outbreak’s initial case size, a given facility’s capacity and its incarcerated vaccination rate as additional parameters alongside traditional susceptible-exposed-infected-recovered transmission dynamics. By fitting the model to each prison’s data using approximate Bayesian computation methods, we derived parameter estimates that reasonably modelled real-world results. These individualised estimates were then averaged to produce generalised parameter estimates for North Carolina state prisons overall.
Our model had a mean average MAPE score of 23.0 across all facilities, meaning that it reasonably forecasted facilities’ average daily positive and recovery rates of COVID-19. Our model estimated an average incarcerated vaccination rate of 54% across all prisons (with a 95% CI of ±0.12). In addition, the prisons of this study were estimated to be operating at 90% of their capacity on average (95% CI ±0.16). Given the high levels of COVID-19 observed in these prisons, which averaged over one-third positive tests on respective 1-day maxima, we conclude that vaccination levels were not sufficient in curbing COVID-19 outbreaks, and high occupancy levels likely exacerbated the spread of COVID-19 within prisons.
In addition, data gaps in facilities without recorded daily testing resulted in poor spread predictions, demonstrating how important consistent data release practices are in incarcerated settings for accurate tracking and prediction of outbreaks.
The findings of this study better quantify how spatial contact networks and facility-level characteristics unique to congregate living facilities can be used to predict infectious disease spread. Our approach also highlights the need for increased vaccination efforts and potential capacity reductions to mitigate COVID-19 transmission in prisons.
Cognitive behavioural therapy (CBT) and interpersonal psychotherapy (IPT) are both efficacious treatments for depression, but it is less clear how both compare on outcome domains other than depression and in the longer term. Moreover, it is unclear which of these two psychotherapies works better for whom. This article describes the protocol for a systematic review and individual participant data (IPD) meta-analysis that aims to compare the efficacy of CBT and IPT for adults with depression on a range of outcomes in both the short and long term, and to explore moderators of the treatment effect. This study can enhance our understanding of treatments for depression and inform treatment personalisation.
Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library from inception to 1 January 2026, to identify randomised clinical trials (RCTs) comparing CBT and IPT for adult depression. Researchers of eligible studies will be invited to contribute their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to examine (a) treatment efficacy on all outcome measures that are assessed at post-treatment or follow-up in at least two studies, and (b) various baseline participant characteristics as potential moderators of depressive symptom level at treatment completion.
Ethical approval is not required for this study since it will be based on anonymised data from RCTs that have already been completed. The findings of the present study will be disseminated through a peer-reviewed journal or conference presentation.
Selective dorsal rhizotomy (SDR) is one of the treatment options available for spasticity management in ambulatory children and young people with cerebral palsy (CYPwCP). Although improvements in gross motor function one to two years after surgery have been established, evidence of longer-term benefit requires further investigation. Given the irreversible nature of SDR and the increased rehabilitation commitments required from families and clinicians, providing evidence of longer-term benefits is essential to support their decision-making. This study aims to investigate medium (3–5 years) and long-term (6–10 years) SDR outcomes in ambulatory children with CP and how SDR affects families’ lives over time.
This is a convergent parallel mixed-methods study using the International Classification of Functioning, Disability and Health as a theoretical framework. The study aims to recruit 90 CYPwCP participants, who had SDR at a tertiary hospital in the UK when aged between 3 and 14 years. Participants (parents and CYPwCP) will be invited to complete an online survey and attend the hospital for one follow-up visit 3 or more years after SDR. Comparisons will be made with existing data on objective measures and parent-reported outcomes collected in clinical practice at baseline, 6, 12 and 24 months to understand the trajectory of changes. Semistructured interviews will be conducted with 18–20 parents/carers and 25–30 CYPwCP to understand their perspectives on the outcomes of SDR compared with their prior expectations. The Framework Method will be used to analyse qualitative data both inductively and deductively. Qualitative and quantitative study data will be integrated using joint displays.
Ethical approval has been obtained through the Coventry and Warwick Research and Ethics Committee (24/WM/0078). Findings will be shared through international conferences, peer-reviewed journals, social media and dissemination events for families and CYP.
by Sabrina Lessard, Annie Bernatchez, Houda Garrach, Mélanie Couture, Claire Godard-Sebillotte, Sarita Israel, Rym Zakaria
ObjectiveThis project aims to gain a thoroughly understanding of the characteristics and experiences of psychological mistreatment among older adults, acknowledging the diversity within this population. It also seeks to identify clinical tools and practices for its detection and intervention. While there is extensive literature on mistreatment of older adults, specific studies focusing on psychological aspects and intersecting social and identity dimensions are scarce. The findings will provide valuable insights for policymakers and healthcare professionals, helping to shape interventions and policies aimed at countering mistreatment in the ageing population.
IntroductionPsychological mistreatment involves a range of behaviors, expressions, and gestures—or the lack of appropriate actions—that negatively impact an individual's health and dignity. Often subtle and difficult to detect, this type of mistreatment is prevalent and can coexist with other types of abuse. Examination of psychological mistreatment, shaped by various social and identity dimensions, is lacking in current research, particularly regarding how it is experienced by older adults. This scoping review seeks to map the current knowledge on psychological mistreatment of older adults, while highlighting gaps and future directions for research.
Inclusion criteriaThis scoping review will encompass studies that explore the characteristics and experiences of psychological mistreatment among older adults, including their experiences and those of perpetrators and witnesses. It will also identify clinical tools and practices for the detection and intervention of psychological mistreatment in this population.
MethodA scoping review will be undertaken by a multidisciplinary team, examining studies from post-2010, sourced from both bibliographic databases and grey literature, available in English or French. Employing an intersectional framework, the review will use Gender-Based Analysis Plus (GBA+) to examine how different forms of discrimination intersect and shape experiences of mistreatment. That is, this approach will help explore how social and identity dimensions—including gender, age, sexual orientation, ethnicity, socioeconomic status, and health conditions—shape the experiences and manifestations of psychological mistreatment.
To investigate specialist nurses' experience of psychological safety in ad hoc teams during emergency care.
Interpretive descriptive qualitative study.
Semi-structured interviews with nine specialist nurses were conducted in Sweden from May to June 2024 and analysed using reflexive thematic analysis (Braun & Clarke).
Four themes were identified: Interpersonal skills: implications for psychological safety; Individuality and team dynamics; Confidence, competence and collaboration; and Organisational responsibility for promoting psychological safety.
Psychological safety in ad hoc emergency care teams is a fragile and multifaceted phenomenon, shaped by interpersonal skills, leadership and organisational culture. Supportive environments characterised by open communication and proactive leadership enable specialist nurses to collaborate confidently and safely, even under acute stress. Targeted efforts to strengthen these factors are essential for optimising teamwork and patient outcomes.
The psychological safety implications for specialist nurses in ad hoc teams during emergency care are profound. Psychological safety fosters an environment that empowers nurses to leverage clinical expertise, collaborate in ad hoc teams and improve patient outcomes. Promoting psychological safety ensures specialist nurses feel respected, valued and secure, leading to better care and a more resilient workforce.
This qualitative study investigated specialist nurses' experience of psychological safety in ad hoc teams in acute care. The results will influence the awareness of nurses, specialist nurses, other professions, managers and organisations about the importance of feeling psychologically safe.
Presentation follows COREQ 32-item checklist.
No patient or public involvement.
Shows that psychological safety helps nurses perform in ad hoc emergency teams. Identifies key factors that affect teamwork and patient care.
The use of data science for health research produces complex ethical, legal and social challenges that traditional ethical oversight mechanisms struggle to address. In Nigeria, the current ethical guidelines were not designed for these challenges which include pervasive data environments, consent for secondary data use, algorithmic decision-making and bias, privacy risks, involvement of commercial entities, data colonisation, inequitable benefit-sharing and commercial data holdings. To address these gaps, we developed a draft guideline incorporating principles like trust, veracity, global justice and alternative ethical approval mechanisms. Here, we describe the protocol for a study aimed at validating the guideline through stakeholder consensus on the content, feasibility and acceptability of this subcode for national implementation.
We describe the use of a modified e-Delphi approach to iteratively synthesize expert opinions about ethical oversight for data science health research (DSHR) led by a multidisciplinary working group from the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI) team. We will invite 65 experts, including health researchers, ethics committee members, data scientists, health policymakers, funders and key opinion leaders in Nigeria to participate. Participants will rate 13 core principles, including global justice, algorithmic bias, data governance and related governance provisions on importance, desirability for inclusion in national guidelines, feasibility and confidence in implementation, using 5-point Likert scales, with optional free-text comments. We will summarise responses using descriptive statistics, assess consensus and polarity using pre-specified thresholds for the mean and IQR, and iteratively refine statements between rounds using qualitative content analysis of comments.
Ethical approval was obtained from the Nigerian National Health Research Ethics Committee and the University of Maryland IRB, and participants will provide informed consent. Results will be shared with the expert panel and national regulators and disseminated via publications and conferences.
The Core Outcome Measures for Improving Dementia Care (COM-IC) project aims to develop a core outcome set for measuring the quality of care provided to people living with dementia in routine care settings. In a previous stage of the project, 17 core outcomes were identified. This study is the next step, aiming to review the literature to identify existing or recommended, validated scales for measuring the identified core outcomes.
A rapid review
Six electronic databases (PubMed, Embase (Elsevier), CINAHL Complete (EBSCOhost), APA PsycINFO (EBSCOhost), Web of Science (Clarivate) and Scopus (Elsevier) were searched. Searches were completed on 12 July 2024.
Peer-reviewed systematic reviews or original validation studies of scales measuring dignity; engagement in advance care planning; pain; quality of life; feeling safe and secure; emotional well-being; diagnosis of dementia; behavioural and psychological symptoms of dementia; the importance of relationships; meaningful activities; hygiene and comfort; resource utilisation and safety incidents for people living with dementia were included. Peer-reviewed systematic reviews or original validation studies of the scales to measure informal carers’ quality of life, their educational opportunities, formal carers’ morale and dementia-specific qualifications were also included. All studies were required to have been conducted among people living with dementia or carers, as appropriate, and to have full texts available in English.
Data on the scale’s name, the number of subscales, subscales’ names, the number of items, response options, scoring, estimated time to complete the scale, recommended frequency of data collection and the setting where the scale was first validated were extracted. Findings are presented in figures, tables and narrative texts.
A total of 88 validated scales were identified. No scales measuring dignity, engagement in advance care planning, feeling safe and secure, hygiene or safety incidents were validated for people living with dementia. No scale was identified to measure the importance of relationships for people living with dementia, the formal carers’ dementia-specific qualifications or the educational opportunities for informal carers. The review also describes the 50 recommended or validated scales.
Several validated or recommended scales exist to measure core outcomes identified as important for assessing the quality of care provided to people living with dementia in routine care settings. This review offers COM-IC stakeholders and other potential users with information on the validated/recommended scales to measure these core outcomes.
To explore the existential lived experiences of emerging adult siblings of children with complex care needs.
A qualitative phenomenological design.
In-depth conversational interviews were conducted between February and June 2022 with nine emerging adult siblings (aged 16–27), who grew up with a brother or sister with complex care needs. Data were analysed using van Manen's phenomenology of practice approach.
Five core themes were identified: Loss of a familiar world: the profound changes and disruptions in siblings' lives. The sibling bond: endured and enduring love. Embracing the load: balancing responsibilities. Being behind the scenes: a lonely childhood. Jigsaw falling into place: siblings finding clarity and forging their own paths.
Early experiences of growing up with a sibling who has complex care needs, may resurface or shift in meaning, impacting long-term existential well-being, particularly when siblings feel overlooked by families, educators, and healthcare professionals. These silenced experiences often persist into emerging adulthood, shaping emotional health, relationships, and life choices.
The underrecognized existential needs of these siblings call for intentional, person-centred care. Our research advocates early, targeted interventions, emphasizing the pivotal role of nurses. A lifeworld-led phenomenological approach equips nurses to more effectively attend to the unmet needs of siblings within family care settings.
The research followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
Emerging adult siblings with lived experience of growing up alongside a brother or sister with complex care needs contributed important insights into the interpretation of findings, ensuring relevance to clinical nursing.
by Thomas Buyinza, Edward Buzigi, Joshua Kitimbo, Gabriel Ssabika, Mary Mbuliro, Julius Kiwanuka, Justine Bukenya, David Guwatudde, Rawlance Ndejjo
IntroductionAdolescents and young adults (AYAs) worldwide display poor dietary behaviors, including high consumption of sugar-sweetened beverages and insufficient intake of fruits and vegetables. These issues are more pronounced in Sub-Saharan Africa, such as rural Eastern Uganda, where 45.3% of adolescents eat low-diversity diets high in refined grains and fats. Such diets raise the risk of malnutrition and diet-related non-communicable diseases (NCDs). However, there is limited contextual evidence on the multi-level factors influencing AYAs’ dietary behaviors in rural Uganda. This study examined socio-ecological factors shaping dietary behaviors among AYAs in this setting.
MethodsA qualitative study guided by the socio-ecological model (SEM) was conducted in Mayuge District, Eastern Uganda. Focus group discussions (FGDs) were held with AYAs, including male and female, aged 10–14, 15–19, and 20–24 years. To have a nuanced understanding of how AYAs’ dietary behaviours are shaped, additional FGDs were conducted with parents or guardians and teachers, and key informant interviews with the district education officer, nutrition focal person, civil society staff, and food vendors. Data were analyzed in ATLAS.ti using both inductive and deductive thematic approaches: data-driven sub-themes were first identified inductively, then deductively mapped onto pre-determined themes of the SEM.
ResultsDietary behaviors were shaped by satiety, energy needs, sensory appeal, and nutrition knowledge at the individual level. Peer influence, parental control, and food’s perceived link to attractiveness acted interpersonally, while community factors included gendered cultural taboos, norms, and health worker advice. At the societal level, cultural identity, ancestral restrictions, and media exposure strongly influenced choices.
ConclusionsThis study contributes novel rural-specific evidence from rural Uganda, where AYAs’ diets are uniquely constrained by satiety demands, parental dominance, cultural taboos, and seasonal scarcity; contrasting with urban contexts where convenience, autonomy, and wider food environments prevail. Multi-level interventions integrating nutrition education, family and peer engagement, cultural dialogue, and household food security support are essential for promoting healthier diets in resource-limited rural settings.
by Xin Xu, Ghada Homsi, Sherry T. Liu, Jennifer M. Gaber, Naa A. Inyang, Brian L. Rostron, Caryn F. Nagler, James Nonnemaker
BackgroundIn 2022, 3.7% of U.S. adults currently smoked cigars. This study assesses cigar-smoking-attributable fractions in U.S. healthcare expenditures and associated annual healthcare expenditures overall and by payer, including publicly funded healthcare programs.
MethodsData were obtained from the 2000, 2005, 2010, and 2015–2017 National Health Interview Survey linked with corresponding panels from the Medical Expenditure Panel Survey data through 2018. The final sample (n = 53,733) was restricted to adults aged 25 + . Estimates from four-part models and data from the Personal Health Care component of the 2001–2018 National Health Expenditures Accounts were combined to estimate fractions of and annual healthcare expenditures attributable to cigar smoking. All models controlled for sociodemographic characteristics and health-related behaviors.
ResultsDuring 2001–2018, an estimated 1.8% (95% CI = 0.9%–3.4%) or $29.7 billion annually of U.S. healthcare expenditures could be attributed to cigar smoking. Most of this was funded by other third-party health insurance programs, a mix of private and public payers (e.g., Department of Veterans Affairs).
ConclusionsCigar smoking creates a preventable financial burden on the U.S. healthcare system. Health consequences associated with cigar smoking may remain after successful quitting. The findings underscore the importance of preventing initiation of cigar smoking and providing evidence-based cessation methods to reduce the health and economic burden of cigar smoking.
To assess the prevalence of depression or depressive symptoms among engineering students.
Systematic review and meta-analysis of prevalence surveys using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
PubMed, Index Medicus Global, EMBASE, Web of Science, Scopus and PsycINFO were searched from 1 January 2003 to 28 June 2024.
Studies were included if they: (1) reported the prevalence of depression or depressive symptoms among engineering students, (2) used a validated instrument with defined cut-off points to assess depression or depressive symptoms and (3) were published in a peer-reviewed journal.
Two researchers independently extracted data using a standardised spreadsheet, collecting information on country of data collection, survey years, year of training, sample size, mean age of participants, number and percentage of male participants, assessment instrument, cut-off points and prevalence estimates. Discrepancies were resolved by a third researcher. Risk of bias was assessed with the Risk of Bias for Studies of the Prevalence of Mental Health Disorders tool. Prevalence estimates were synthesised using random-effects meta-analysis. Between-study heterogeneity was assessed with ² tests and the I² statistic. Subgroup analyses were conducted according to severity cut-off points, and meta-regression was used to explore the influence of study-level characteristics on prevalence estimates.
23 studies involving 12 758 students across 11 countries were analysed. All studies used validated scales with cut-off points to assess depression or depressive symptoms. The overall pooled prevalence was 42.6% (95% CI 32.7 to 53.1) for studies using symptom severity cut-off points at mild or above, and 33.1% (95% CI 25.2 to 42.0) for studies using symptom severity cut-off points at moderate or above. Meta-regression indicated a progressive annual increase in prevalence (OR 1.14, 95% CI 1.01 to 1.28, p=0.034) across studies conducted from 2014 to 2024.
Prevalence of depression and depressive symptoms is high among engineering students, at levels comparable to medical students. Given the substantial impact, further research should investigate risk factors and evaluate preventive, early detection and treatment strategies tailored to engineering students.
CRD42024571131.
To identify the core attributes of quality care that supports well-being from the perspectives of those who access and provide stroke services.
Qualitative Interpretive Description study design involving in-depth semistructured individual and group interviews and analysis using journey mapping and conventional content analysis.
24 people with stroke, 13 family/whānau members and 34 healthcare professionals located throughout New Zealand.
Participants were recruited through health services, stroke support organisations and professional networks. Interviews were completed in person at people’s homes or workplaces or on an online videoconference.
Analysis generated a quality framework of domains. High-quality care that supports well-being after stroke in Aotearoa: supports people through uncertainty; fosters a sense of belonging; prioritises relationships and connecting ‘as people’; attends to the emotional aspects of stroke; centres people’s preferences and supports people to have choice and control; honours Māori knowledges and practices; responds to the strengths and needs of friends and whānau; and attends to people’s holistic long-term well-being.
This study offers a framework for considering holistic stroke care that supports areas of need not consistently addressed in stroke services. This framework can help structure practice and policy and can underpin future research in well-being.
This study aimed to evaluate the feasibility of delivering a vocational rehabilitation intervention (Return to Work After Trauma—ROWTATE), remotely to individuals recovering from traumatic injuries. The primary objectives were to assess therapists’ training and competence, adapt the intervention and training for remote delivery and assess the feasibility and fidelity of remote delivery to inform a definitive randomised controlled trial.
A mixed-methods feasibility study incorporating (1) telerehabilitation qualitative literature review, (2) qualitative interviews preintervention and postintervention with therapists and patients, (3) a team objective structured clinical examination to assess competency, (4) usefulness of training, attitudes towards (15-item Evidence-Based Practice Attitude Scale) and confidence in (4-item Evidence Based Practice Confidence Scale) evidence-based practice, intervention delivery confidence (8-bespoke questions) and intervention behaviour determinants (51-items Theoretical Domains Framework) and (5) single-arm intervention delivery feasibility study.
The study was conducted in two UK Major Trauma Centres. The intervention and training were adapted for remote delivery due to the COVID-19 pandemic.
Therapists: Seven occupational therapists (OTs) and clinical psychologists (CPs) were trained, and six participated in competency assessment. Seven OTs and CPs participated in preintervention interviews and surveys; six completed post-intervention interviews and four completed post-training surveys. Patients: 10 patients were enrolled in the single-arm feasibility study and 4 of these participated in postintervention qualitative interviews. Inclusion criteria included therapists involved in vocational rehabilitation delivery and patients admitted to major trauma centres. Exclusion criteria included participation in other vocational rehabilitation trials or those who had returned to work or education for at least 80% of preinjury hours. Intervention: The ROWTATE vocational rehabilitation intervention was delivered remotely by trained OTs and CPs. Training included competency assessments, mentoring and adaptation for telerehabilitation. The intervention was delivered over multiple sessions, with content tailored to individual patient needs.
Therapists found the training useful, reported positive attitudes (Evidence-Based Practice Attitude Scale mean=2.9 (SD 0.9)) and high levels of confidence in delivering evidence-based practice (range 75%–100%) and the ROWTATE intervention (range 80%–100%). Intervention barriers identified pretraining became facilitators post-training. Half the therapists needed additional support post-training through mentoring or additional training. The intervention and training were successfully adapted for remote delivery. High levels of fidelity (intervention components delivered: OTs=84.5%, CPs=92.9%) and session attendance rates were found (median: OT=97%, CP=100%). Virtually all sessions were delivered remotely (OT=98%, CP=100%). The intervention was acceptable to patients and therapists; both considered face-to-face delivery where necessary was important.
The ROWTATE intervention was delivered remotely with high fidelity and attendance and was acceptable to patients and therapists. Definitive trial key changes include modifying therapist training, competency assessment, face-to-face intervention delivery where necessary and addressing lower fidelity intervention components.
Research indicates that leadership in the health professions can facilitate improvement of quality and efficiency of healthcare services. In the Philippines, leadership in the health professions plays a critical role in driving improvements in healthcare delivery and health professions education. Thus, the landscape of leadership in the health professions merits continuous exploration and deeper understanding. This scoping review aims to explore the landscape of leadership in the health professions in the Philippines. The scoping review will include published and unpublished research papers of any kind, such as primary research studies, systematic reviews, meta-analyses, letters, guidelines, websites, blogs and grey literature that report about leadership in the health professions in the Philippines. Exclusions are leadership studies on the health professions that discuss the professions outside the scope and context of the practice.
The Joanna Briggs Institute (JBI) methodological framework for scoping review will be used in this review. A three-step search strategy will be used consisting of an initial search, full search and screening of reference lists. The databases that will be included are Cinahl Ultimate, Cochrane Library, Scopus, Embase, Emcare, Web of Science, JBI Evidence-based Practice Database, PubMed/Medline, ERIC, local journals and grey literature to determine pertinent sources about the topic. Sources searched will be screened by two independent reviewers and data will be extracted using a data extraction table. Disagreements will be resolved by a discussion through a third reviewer. The results of the search and the study inclusion process will be reported in full in the final scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review flow diagram. Search strategy using the included databases started in August to September 2025, data extraction will start by October 2025, data analysis will start by November 2025 and the review is expected to be completed by December 2025.
This study does not involve human participants and has been reviewed and classified for exempted review by the University of the Philippines Manila Research Ethics Board, which is a committee whose task is to make sure that research participants are protected from harm. The findings of the scoping review will be disseminated through conference presentations and publication in a scientific journal.
Streptococcus pneumoniae serotype 3 (SPN3) remains a significant contributor to invasive pneumococcal disease globally, despite its inclusion in widely administered vaccines. The next generation of pneumococcal vaccines may confer better protection against this serotype, reducing disease burden. We describe an ethically approved protocol for a double-blind randomised controlled trial assessing the impact of VAXNEUVANCE (15-valent pneumococcal conjugated vaccine (PCV15)) and 0.9% saline (placebo) on the acquisition, density and duration of SPN3 carriage using a controlled human infection model.
Healthy adults aged 18–50 years will be randomised 1:1 to receive PCV15 or placebo. Participants will be considered enrolled on the trial at vaccination. One month following vaccination, all participants will be intranasally inoculated with SPN3. Following inoculation, participants will be followed up on days 2, 7, 14 and 28 to monitor safety, SPN3 colonisation status, density and duration, as well as immune responses. The primary endpoint of the study is to assess the rate of SPN3 acquisition between vaccinated and unvaccinated participants defined by classical microbiological methods. Secondary endpoints will determine the density and duration of SPN3 colonisation and compare the immune responses between study groups. An exploratory cohort of 5 participants will be asked to consent to a nasal biopsy procedure during a screening visit and a second nasal biopsy 28 days after PCV15 vaccination. This cohort will only receive PCV15 and will not be challenged. Through this exploratory cohort, we will explore gene expression changes induced by PCV15 vaccination and their visualisation (spatial location) within the nasal tissue.
This protocol has been reviewed by the sponsor, funder and external peer reviewers. The study is approved by the NHS Research and Ethics Committee (Reference: 24/SC/0388) and by the Medicines and Healthcare Products Regulatory Agency (Reference: CTA 21584/0485/001-0001).
Surgical margins are crucial in determining postoperative local recurrence (LR) in patients with colorectal liver metastasis (CRLM) and hepatocellular carcinoma (HCC). Achieving a margin greater than 1 cm can be challenging due to constraints related to remnant liver reserve, proximity to major vascular structures and tumour depth. We previously published findings from a retrospective study suggesting that additional margin coagulation (AMC) using radiofrequency may reduce LR, and this multicentre randomised clinical trial aims to further assess this hypothesis.
The LIVERATION trial is an international, multicentre, single-blind, randomised, parallel-group, controlled clinical trial involving 698 patients undergoing liver resection for CRLM or HCC. Participants will be randomly assigned in a 1:1 ratio to either AMC (study group) or conventional liver resection (control group) to assess oncological outcomes for both CRLM and HCC. The primary outcome is the incidence of LR. Secondary endpoints include overall survival, disease-free survival, cancer-specific survival, surgical complications and quality of life. Follow-ups occur at 30 days, 90 days, and 1, 2 and 3 years postoperatively.
The LIVERATION trial has been approved by the Ethics Committee at the sponsor site Hospital del Mar de Barcelona, CEIM-PSMAR (Comité de Ética de la Investigación con Medicamentos – Parc de Salut Mar), as well as by the Institutional Ethics Committees in all participating countries. The results of the main trial, along with each of the secondary endpoints, will be submitted for publication in a peer-reviewed journal. The study adheres to national and international guidelines, including the Declaration of Helsinki, and complies with regulations for studies involving biological samples under Law 14/2007 on Biomedical Research. A dissemination strategy has been developed to engage stakeholders and facilitate knowledge transfer to support the use of the findings of the study. LIVERATION is funded by the European Union under the Horizon Europe Framework Programme (Project Number: 101104360).
by Giulia Simbula, Frederico M. Barroso, Enerit Saçdanaku, Gabriel Ene, Geanina Fănaru, Lekshmi B. Sreelatha, Miruna-Gabriela Vizireanu, Myrto Roumelioti, Nikoletta-Maria Boskovits, Sabina E. Vlad, Prem Aguilar, Miguel A. Carretero
Mesocosms, outdoor replicated ecological experiments within a controlled environment, have become a valuable tool for investigating a broad range of ecological questions across various sub-disciplines. This study presents a medium-sized mesocosm system (MS) designed for individual-level responses to abiotic factors and basic intraspecific interactions in small ground-dwelling reptiles, offering a practical alternative to large-scale facilities for resource-limited settings. Unlike large-scale facilities that are ideal for meta-community dynamics but impractical due to high costs and complexity, this system targets research contexts with limited resources requiring replicated experimental units. To validate the MS design, 16 units were constructed using cost-effective, widely available materials and equipped with a programmable irrigation system. A pilot test using Podarcis bocagei lizards provided a preliminary biological evaluation of the design and its suitability in housing wild-caught medium-small reptiles under semi-natural conditions over 7 months. Despite minor maintenance, the MS was resilient to environmental conditions, warranting an expansion to 32 units in subsequent years. Most individuals maintained or recovered body mass during the activity season, and displayed natural behaviours such as basking and foraging. The system’s modularity and adaptability offer a practical reference for ecological studies with similar constraints.The use of technology to support nurses' decision-making is increasing in response to growing healthcare demands. AI, a global trend, holds great potential to enhance nurses' daily work if implemented systematically, paving the way for a promising future in healthcare.
To identify and describe AI technologies for nurses' clinical decision-making in healthcare settings.
A systematic literature review.
CINAHL, PubMed, Scopus, ProQuest, and Medic were searched for studies with experimental design published between 2005 and 2024.
JBI guidelines guided the review. At least two researchers independently assessed the eligibility of the studies based on title, abstract, and full text, as well as the methodological quality of the studies. Narrative analysis of the study findings was performed.
Eight studies showed AI tools improved decision-making, patient care, and staff performance. A discharge support system reduced 30-day readmissions from 22.2% to 9.4% (p = 0.015); a deterioration algorithm cut time to contact senior staff (p = 0.040) and order tests (p = 0.049). Neonatal resuscitation accuracy rose to 94%–95% versus 55%–80% (p < 0.001); seizure assessment confidence improved (p = 0.01); pressure ulcer prevention (p = 0.002) and visual differentiation (p < 0.001) improved. Documentation quality increased (p < 0.001).
AI integration in nursing has the potential to optimise decision-making, improve patient care quality, and enhance workflow efficiency. Ethical considerations must address transparency, bias mitigation, data privacy, and accountability in AI-driven decisions, ensuring patient safety and trust while supporting equitable, evidence-based care delivery.
The findings underline the transformative role of AI in addressing pressing nursing challenges such as staffing shortages, workload management, and error reduction. By supporting clinical decision-making and workflow efficiency, AI can enhance patient safety, care quality, and nurses' capacity to focus on direct patient care. A stronger emphasis on research and implementation will help bridge usability and scalability gaps, ensuring sustainable integration of AI across diverse healthcare settings.