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Digital App for Speech and Health Monitoring Study (DASH): protocol for a prospective longitudinal case-control observational study for developing speech datasets in neurodegenerative disorders and dementia

Por: Tam · J. · Weaver · C. · Ihenacho · A. · Newton · J. · Virgo · B. · Barrett · S. · Neale · J. · Perry · D. · Smith · A. · Chandran · S. · Watts · O. · Pal · S. · DASH Consortium · Ali · Baxter · Bozkhurt · Burr · Chandran · Chau · Clancy · Coupland · Devon · Entwistle-Thompson · Gardiner
Introduction

Neurodegenerative disorders (NDDs) represent an unprecedented public health burden. These disorders are clinically heterogeneous and therapeutically challenging, but advances in discovery science and trial methodology offer hope for translation to new treatments. Against this background, there is an urgent unmet need for biomarkers to aid with early and accurate diagnosis, prognosis and monitoring throughout the care pathway and in clinical trials.

Investigations routinely used in clinical care and trials are often invasive, expensive, time-consuming, subjective and ordinal. Speech data represent a potentially scalable, non-invasive, objective and quantifiable digital biomarker that can be acquired remotely and cost-efficiently using mobile devices, and analysed using state-of-the-art speech signal processing and machine learning approaches. This prospective case–control observational study of multiple NDDs aims to deliver a deeply clinically phenotyped longitudinal speech dataset to facilitate development and evaluation of speech biomarkers.

Methods and analysis

People living with dementia, motor neuron disease, multiple sclerosis and Parkinson’s disease are eligible to participate. Healthy individuals (including relatives or carers of participants with neurological disease) are also eligible to participate as controls. Participants complete a study app with standardised speech recording tasks (including reading, free speech, picture description and verbal fluency tasks) and patient-reported outcome measures of quality of life and mood (EuroQol-5 Dimension-5 Level, Patient Health Questionnaire 2) every 2 months at home or in clinic. Participants also complete disease severity scales, cognitive screening tests and provide optional samples for blood-based biomarkers at baseline and then 6-monthly. Follow-up is scheduled for up to 24 months. Initially, 30 participants will be recruited to each group. Speech recordings and contemporaneous clinical data will be used to create a dataset for development and evaluation of novel speech-based diagnosis and monitoring algorithms.

Ethics and dissemination

Digital App for Speech and Health Monitoring Study was approved by the South Central—Hampshire B Ethics Committee (REC ref. 24/SC/0067), NHS Lothian (R&D ref. 2024/0034) and NHS Forth Valley (R&D ref. FV1494). Results of the study will be submitted for publication in peer-reviewed journals and conferences. Data from the study will be shared with other researchers and used to facilitate speech processing challenges for neurological disorders. Regular updates will be provided on the Anne Rowling Regenerative Neurology Clinic web page and social media platforms.

Trial registration

ClinicalTrials.gov NCT06450418 (pre-results).

Cognitive dysfunction and its association with inflammation in acute exacerbations of COPD: protocol for a prospective hospital-based cohort

Por: De Luca · S. N. · Burrell · L. M. · Collins · A. · Jackson · M. · Vlahos · R. · McDonald · C. F.
Introduction

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation that is not fully reversible and is associated with an abnormal inflammatory response of lungs to noxious particles and gases. The inflammatory and reparative processes occurring in the lungs induce a ‘spill-over’ of inflammatory mediators into the circulation, resulting in an increase in systemic inflammation, which is further increased during acute exacerbations of COPD (AECOPD), leading to the development of extra-pulmonary comorbidities, such as cognitive impairment. Cognitive impairment affects up to 61% of people living with COPD. Heightened levels of inflammation have been linked to increased risk of cognitive impairments; however, the exact mechanisms remain unclear, thus hampering the development of therapeutics. This study aims to determine whether patients hospitalised with an acute COPD exacerbation show impaired cognitive function compared with recovery (~day 45), and whether such dysfunction is associated with systemic inflammation and oxidative stress.

Methods and analysis

A prospective, observational study will be conducted at Austin Health in Victoria, Australia. Eligible participants will be assessed during admission for AECOPD and following stabilisation (approximately day 45). The primary outcome is the difference in cognitive function between admission for AECOPD to recovery using non-verbal cognitive tests. Secondary outcomes are changes in systemic markers of inflammation, oxidative stress and ACE2 catalytic activity. Tertiary outcomes are anxiety and depression scores.

Ethics and dissemination

Ethical approval has been granted in Australia by Austin Health Human Research Ethics Committee (HREC 56099) with governance approval at Austin Hospital. The results will be published in peer-reviewed scientific journals and presented at national and international scientific conferences. Findings will be disseminated to consumers in publications for lay audiences.

The Relevance of Sustainability and the Climate Crisis to the Nursing Profession and Nursing Education: A Literature Review

ABSTRACT

Introduction

The climate crisis impacts global health and is exacerbated by the healthcare sector's emissions. Nurses, as the largest professional group, are key to promoting climate-resilient, low-carbon health systems. Integrating climate change and sustainable development into nursing education is crucial, yet gaps remain in understanding their representation in curricula and practice. This review examines the role of nursing in addressing climate change and sustainable development, focusing on their integration into education and related recommendations.

Design

A narrative literature review was conducted to synthesize existing recent research on nursing, climate change, and sustainable development. No restrictions were applied to study design; however, studies published before 2017 were excluded.

Methods

A search was conducted in PubMed, CINAHL, and Google Scholar (January 2023, and updated in August 2024). Relevant studies were screened and duplicates removed. Data extraction followed inductive content analysis, with coding and categorization being undertaken collaboratively. MAXQDA PLUS 2022 was used for analysis, and new findings from the follow-up search were incorporated into existing categories or new ones were developed.

Results

The review analyzed 33 articles on nursing's role in addressing climate change. Findings highlight gaps in knowledge, delayed responses, and the need for nurses to take on leadership roles. Education is crucial, yet curricula integration remains limited. Nurses must engage in advocacy, interdisciplinary collaboration, and policy development. Barriers include a lack of faculty awareness and overloaded curricula. A collective call for action urges nurses to embrace sustainability, strengthen research, and lead in achieving climate resilience.

Conclusion

This review highlights the need to integrate climate change and sustainable development into nursing education and practice. Nurses are vital to public health and to addressing climate change, but education gaps hinder their potential. Future research should focus on improving curricula, exploring Advanced Practice Nursing leadership roles, and addressing healthcare system challenges.

Clinical Relevance

Integrating Sustainable Development and the Climate Crisis into nursing education and practice is crucial to preparing nurses for the health challenges posed by environmental changes, as well as for ensuring effective patient care, disaster response, and policy advocacy. Their integration is a process and should be viewed as being a consequence of the delayed responses, as identified in this review. This process should specifically address the identified gaps, such as the lack of basic knowledge concerning climate change and sustainable development, as well as learning to take on leadership roles in practice. More specifically, taking a leadership role includes both acting as a knowledge multiplier and increasing the health literacy of the general population.

Azithromycin as adjunctive treatment for uncomplicated severe acute malnutrition (AMOUR): study protocol for a double-masked randomised controlled trial

Por: Bountogo · M. · Zakane · A. · Ouedraogo · T. A. · Ouermi · L. · Compaore · G. · Compaore · A. · Coulibaly · B. · Koueta · F. · Burroughs · H. R. · Fetterman · I. · La Mons · J. L. · Lebas · E. · Doan · T. · Hsiang · M. · OBrien · K. S. · Arnold · B. · Sie · A. · Oldenburg · C. E.
Introduction

Amoxicillin is recommended for children with uncomplicated severe acute malnutrition (SAM). However, some trials have shown no difference in amoxicillin for nutritional recovery in children with SAM compared with placebo. In addition, amoxicillin treatment requires two times per day dosing for 7 days, which may influence adherence. Azithromycin is a broad-spectrum antibiotic that can be provided as a single dose and has reduced mortality in children aged 1–59 months when provided by mass drug administration. The AMOUR trial is designed to assess amoxicillin, azithromycin and placebo as part of outpatient treatment of uncomplicated SAM.

Methods and analysis

This double-masked randomised controlled trial will enrol 3000 children over 3 years in an individually randomised 1:1:1 allocation to azithromycin, amoxicillin or placebo arms and follow them for 12 months. Children eligible to enrol in the study will be aged 6–59 months and have uncomplicated non-oedematous SAM as defined by weight-for-height Z-score

Ethics and dissemination

Ethical approval was obtained from the Institutional Review Board at the University of California, San Francisco (Protocol 23–39411) and the Comité d’Ethique pour la Recherche en Santé in Ouagadougou, Burkina Faso (Protocol 2024-01-08). The results of this study will be disseminated to the Ministry of Health, community stakeholders and via peer-reviewed publications and academic conferences.

Trial registration number

NCT06010719.

The impact of COVID‐19 on nurse alcohol consumption: A qualitative exploration

Abstract

Aims and objectives

To explore the long-term impact of the COVID-19 pandemic on nurse alcohol consumption.

Background

The COVID-19 pandemic has caused immense disruption to healthcare services worldwide, and nurses have not been immune, experiencing burnout, declining mental health and ultimately, attrition from the profession. Increases in alcohol consumption have been reported across subsections of society, including those with pre-existing mental ill health and experiencing high stress, and exploring this phenomenon in nurses is essential for workforce well-being and sustainability.

Design

Qualitative descriptive study design.

Methods

Secondary analysis of individual, semi-structured interviews with nurses (N = 42) from diverse settings across Australia, including community, primary and hospital settings, conducted in July and August 2021. Data were analysed using structural coding and reported in accordance with the CORE-Q guidelines.

Findings

Two key themes were found after analysis of the data: (1) factors influencing alcohol consumption (subthemes: workplace factors and external factors), and (2) the pandemic's influence on alcohol consumption (subthemes: increased consumption, moderation of consumption and alcohol as a reward).

Conclusions

Several participants described increased alcohol consumption because of the COVID-19 pandemic, particularly due to the stress of working in an environment where resources were scarce. Workplace factors such as overtime, missed breaks and heightened workload were all described as driving stress, and in turn increased alcohol consumption.

Relevance to clinical practice

Increased alcohol consumption has been associated with burnout, absenteeism and intention to leave. The nursing profession is currently undergoing significant continuing stress providing care and management to patients with the SARS-CoV-2 virus, and increased alcohol consumption is a significant threat to personal and workforce well-being, workforce sustainability and quality nursing care.

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