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Commentary on: Yıldız E, Yıldırım Ö. The mediating role of psychological flexibility in the relationship between psychotic symptom severity and depression in individuals diagnosed with schizophrenia. J Psychiatr Ment Health Nurs. 2024. (in press) doi: 10.1111/jpm.13040.
Implications for practice and research Mental health nurses’ training could be more focused on clinical skills and knowledge in enhancing psychological flexibility to minimize the impact of psychotic symptoms on comorbid depression in people with schizophrenia. Further development of the intervention of building psychological flexibility is of research interest for the clinical management of people with schizophrenia.
Schizophrenia is a mental disorder affecting approximately 23.9 million people worldwide, significantly contributing to the global disease burden, revealing 14.8 (10.9–19.1) million years lived with disability in 2021.
Evaluation of the impact of atherosclerotic cardiovascular disease (ASCVD), particularly polyvascular disease, on 30-day and 365-day mortality among intensive care unit (ICU) patients diagnosed with sepsis.
Retrospective cohort study.
This study was conducted using data from the Medical Information Mart for Intensive Care IV, a publicly available critical care database from a tertiary care hospital in the US.
A total of 7895 adult ICU patients with sepsis were included between 2008 and 2022. Among them, 3314 (41.97%) had ASCVD, defined by International Classification of Diseases (ICD) codes for coronary artery disease, peripheral artery disease or stroke.
The primary outcomes were all-cause mortality at 30 and 365 days following ICU admission.
ASCVD patients with a greater number of disease beds tend to be male, older, have lower body mass index, heart rates, mean blood pressure, respiratory rate and temperature, compared with non-ASCVD patients. Before propensity-score matching, patients with ASCVD (3314) had significantly higher 30-day (29.21% vs 24.14%, p
Integrated management of sepsis and ASCVD—using targeted interventions such as tailored pharmacotherapy and risk factor modification—may reduce mortality and morbidity in this high-risk population.
To determine whether hormonal contraceptives are associated with subsequent risks of suicidal behaviour and depression among women of reproductive age.
Nationwide register-based study.
Swedish national population using health and death registers. Nationwide registries provided individual-level information about the use of hormonal contraception, suicidal behaviour, depression and potential confounders.
All women in Sweden from 1 January 2006 to 31 December 2013.
Suicidal behaviour events or registered deaths due to suicide were identified through the National Patient Register and Cause of Death Register, respectively. Clinical diagnoses of depression were obtained from the patient register. Cox regression models were used to estimate HRs with 95% CIs of suicidal behaviour and depression in women using hormonal contraceptives.
We followed more than two million women for a median of 6.8 years (12.4 million person-years in total). No increased risk was observed among women using oral contraceptives or non-oral combined oestrogen/progestin formulations. Non-oral progestin-only contraceptives were associated with an increased risk of suicidal behaviour using both population-based (HR=1.17, 95% CI 1.13 to 1.21) and within-individual (HR=1.16, 95% CI 1.11 to 1.21) analyses. Age-stratified analyses revealed that during late adolescence (age 15–18), use of oral contraceptives or non-oral combined formulations was associated with an increased risk of suicidal behaviour (range of HRs: 1.09–1.35), an effect that was not observed in adulthood. In contrast, non-oral progestin-only contraceptives were associated with an increased risk of suicidal behaviour during both late adolescence and adulthood.
We found no overall increased risk of suicidal behaviour among women using oral contraceptives or non-oral combined formulations. However, the observed increased risk associated with hormonal contraceptive use during adolescence, as well as with non-oral progestin-only contraception—particularly gonane-containing formulations—across the entire reproductive window warrants attention and further investigation.
The development of myopia is subject to individual genetic predisposition and environmental risk exposures. This study aims to investigate the trajectories and predictors of spherical equivalent (SE) among multiethnic school-aged children in Southwest China.
The school-based cohort study was conducted from October 2020 to March 2023 in Yunnan province, Southwest China. Ocular examinations and questionnaire surveys were administered at each visit. A total of 679 students with complete records from all three visits were included in the final analyses. Group-based trajectory modelling was used to identify SE trajectories. Associations between the trajectory groups and baseline predictors were assessed using multinomial logistic regression.
We identified two distinct trajectory groups of SE in grades 2–3: slow progressive (84.4% of students) and rapid progressive (15.6%). Multivariate analysis indicated that children with myopic parents and those who often stayed in the classrooms during recess were more likely to belong to the rapid progressive group. By contrast, three trajectory groups of SE were identified in grade 7: slow progressive (52.3% of students), moderate initial and rapid progressive (33%) and low initial and rapid progressive (14.7%). In multivariate models, being a girl, having myopic parents, using mobile screens for more than 0.5 hours per day and often staying in the classrooms during recess were predictors of the progressive groups. Moreover, there were no significant differences in SE trajectories between Han and ethnic groups.
There is heterogeneity in the developmental trajectories of SE, for both primary and secondary school students. Tailored intervention strategies based on the predictors of the SE trajectories should be under special consideration.
Lack of familiarity and limited digital literacy frequently limit the ability and willingness of older adults to use digital health tools. This study aimed to investigate the factors influencing the intention to use digital health information and services (DHIAS) and their actual use among indigenous Taiwanese older adults, based on the theory of planned behaviour (TPB) and digital health literacy.
Cross-sectional quantitative study using a structured questionnaire.
Community-based settings at the primary care level; 11 cultural health stations located in Eastern Taiwan.
A total of 170 Indigenous elders aged ≥55 years were recruited. Inclusion criteria included: Indigenous descent, aged ≥55 years, cognitively intact and able to communicate in Mandarin. All participants completed the interview-based survey.
The primary outcomes were the intention to use DHIAS and its actual use. Predictors included digital health literacy and TPB constructs. All variables were measured using validated or adapted items within the questionnaire.
The mean score for intention to use DHIAS was 1.50 (SD=0.90) and the mean score for actual behaviour was 1.68 (SD=1.14). Hierarchical regression analyses indicated that subjective norms (β=0.270, p
Digital health literacy and TPB constructs critically influence digital health engagement among older populations. Interventions aimed at improving digital health engagement among older populations should focus on enhancing digital skills and creating socially supportive environments. Future studies should explore culturally tailored strategies to reduce digital disparities in communities with limited healthcare access.
by Frederick Nchang Cho, Marie Clarie Fien Ndim, Diane Zinkeng Tongwa, Christabel Afor Tatah, Franklin Ngwesse Ngome, Eugine Mbuh Nyanjoh, Andrew N Tassang
BackgroundHuman Immunodeficiency Virus (HIV) remains a major public health concern in sub-Saharan Africa. In Cameroon, young people are disproportionately affected but underrepresented in HIV testing statistics.
ObjectiveTo explore knowledge, attitudes, and behaviours related to HIV testing among youth in Kumba, Cameroon, and to identify barriers to inform community-based interventions.
MethodsA cross-sectional qualitative study was conducted using nine focus group discussions (FGDs) with 75 youth (52 females and 23 males) aged 18 - 35 years across four quarters in the Kumba II municipality. Participants were purposively sampled to reflect diverse educational and occupational backgrounds. Data were thematically analysed using Braun and Clarke’s framework with NVivo Version 14.
ResultsParticipants demonstrated high awareness of HIV testing services (90.7%) and transmission via sexual contact (96.0%), though knowledge gaps remained regarding non-sexual transmission and testing procedures. While 93.3% had previously undergone HIV testing, 57.3% reported stigma and 46.7% raised confidentiality concerns as ongoing barriers. Female participants feared being labelled as promiscuous, while males cited social norms that discourage help-seeking. Most participants supported school-based or youth-centred community testing, emphasising the need for privacy and youth-friendly environments. Key motivators for testing included the desire to know one’s status (82.7%), symptom appearance (28.0%), and unprotected sex (17.3%).
ConclusionsDespite strong awareness and high testing uptake, stigma and confidentiality concerns persist among youth in Kumba. To enhance HIV testing rates, community-based strategies should prioritise mobile clinics, peer outreach, and confidential youth-centred services. Strengthening education about HIV transmission and demystifying the testing process may further reduce barriers.
by Shirley Ge, Hope Lappen, Luz Mercado, Kaylee Lamarche, Theodore J. Iwashyna, Catherine L. Hough, Virginia W. Chang, Adolfo Cuevas, Thomas S. Valley, Mari Armstrong-Hough
BackgroundRacial and ethnic disparities in the delivery and outcomes of critical care are well documented. However, interventions to mitigate these disparities are less well understood. We sought to review the current state of evidence for interventions to promote equity in critical care processes and patient outcomes.
MethodsFour bibliographic databases (MEDLINE/PubMed, Web of Science Core Collection, CINAHL, and Embase) and a list of core journals, conference abstracts, and clinical trial registries were queried with a pre-specified search strategy. We analyzed the content of interventions by categorizing each as single- or multi-component, extracting each intervention component during review, and grouping intervention components according to strategy to identify common approaches.
ResultsThe search strategy yielded 11,509 studies. Seven-thousand seventeen duplicate studies were removed, leaving 4,491 studies for title and abstract screening. After screening, 93 studies were included for full-text review. After full-text review by two independent reviewers, eleven studies met eligibility criteria. We identified ten distinct intervention components under five broad categories: education, communication, standardization, restructuring, and outreach. Most examined effectiveness using pre-post or other non-randomized designs.
ConclusionsDespite widespread recognition of disparities in critical care outcomes, few interventions have been evaluated to address disparities in the ICU. Many studies did not describe the rationale or targeted disparity mechanism for their intervention design. There is a need for randomized, controlled evaluations of interventions that target demonstrated mechanisms for disparities to promote equity in critical care.
by Pornpen Sangthawan, Thammasin Ingviya, Songyos Rajborirug, Jirayut Janma, Siribha Changsirikulchai
BackgroundThailand implemented a peritoneal dialysis (PD)-first policy under its universal health coverage (UHC) from 2008 to 2022. This study aims to describe patient survival during dialysis and after kidney transplantation (KT), and to identify factors associated with survival in these periods among UHC-covered patients undergoing PD, hemodialysis (HD), or transitioning between dialysis modalities.
MethodsThis retrospective study analyzed data from patients receiving PD, HD, or KT, recorded by the National Health Security Office (NHSO) between January 2013 and December 2021. Patients were categorized into four groups: PD, HD, PD-to-HD transition, and HD-to- PD transition. Survival factors were analyzed using Cox proportional hazards models.
ResultsAmong 81,572 patients receiving kidney replacement therapy, 38.9% were on PD, 35.3% were on HD, 10.2% transitioned from PD to HD, and 15.6% transitioned from HD to PD. Patients transitioning from PD to HD had superior 3- and 5-year survival rates compared to the other three groups. Survival outcomes were significantly influenced by age at dialysis initiation, diabetes, and comorbidities. Overall, 1,517 patients (1.9%) received KT: 70.4% had PD, 19.8% HD, and 9.8% had transitioned. Median follow-up time before KT was 94.5 months. Post-KT survival rates were comparable across dialysis groups. Factors associated with post-KT survival were age, cardiac disease, antibody-mediated rejection, and delayed graft function.
ConclusionsUnder Thailand’s PD-first policy, starting with PD and later switching to HD was linked to better survival than staying on a single modality or switching from HD to PD. A higher proportion of PD patients underwent KT compared to HD patients. Post-KT survival rates remained similar across all dialysis modalities. These findings underscore the importance of individualized dialysis modality selection and proactive transition planning to optimize patient outcomes.
Tobacco use causes approximately 8 million deaths worldwide each year. Against the backdrop of a rapidly expanding game market, there is growing potential to develop tailored gaming interventions for smoking cessation. This study protocol describes the development of a personalised Serious Game Applet based on an integrated TTM–PMT–HAPA framework (Transtheoretical Model, Protection Motivation Theory, Health Action Process Approach) and evaluates its effectiveness compared with conventionalShort Messaging Service (SMS) -based smoking cessation interventions.
Design: The study comprises two phases. The first involves developing the Serious Game Applet using the TTM–PMT–HAPA theoretical framework. The second phase consists of a multicentre, two-arm, single-blind cluster randomised controlled trial, which will enrol 1320 eligible smokers from various enterprises. Enterprises will be randomised to either the Serious Game Applet group or the SMS push control group. Eligible participants include daily smokers aged 18–45 years, working in non-tobacco-related enterprises, with exhaled carbon monoxide levels ≥6 ppm.
Outcomes: Primary outcomes are smoking abstinence rates at 3 and 6 months. Secondary outcomes include abstinence rates at 1, 2 and 9 months; point-prevalence cessation rates at 1, 2, 3, 6 and 9 months; changes in cigarette consumption; stage transitions in smoking cessation; nicotine dependence scores and withdrawal symptoms. The trial will be conducted as a field study targeting smartphone users across three cities in Fujian Province, China.
This study has been approved by the Biomedical Research Ethics Committee of Fujian Medical University (Approval No. 127, 2024). Results will be disseminated through peer-reviewed journals and academic conferences.
ChiCTR2400088105.
To synthesise literature about horizontal violence or workplace bullying among Intensive Care Unit nurses, exploring its awareness, factors, impacts, and strategies.
Following PRISMA standards, a mixed systematic review using a narrative synthesis approach and thematic analysis design of the Joanna Briggs Institute.
Four electronic databases from 2013 to 2023 studies published were searched.
Eight studies were included: three qualitative and five quantitative. Four key themes emerged: (i) awareness and understanding of horizontal violence or workplace bullying, (ii) factors affecting horizontal violence or workplace bullying, (iii) impacts of horizontal violence or workplace bullying, and (iv) strategies to address horizontal violence or workplace bullying.
Addressing horizontal violence or workplace bullying requires hospitals should adopt conflict resolution policies, stress management programs, and supportive supervision to improve nurse retention. Nurse management should establish confidential reporting mechanisms, provide training on interpersonal respect, and implement supportive structures to promote psychological safety. Intensive care unit nurses are encouraged to take proactive steps to address workplace bullying, ensuring improved staff well-being and care quality.
This paper addresses a significant gap in the literature regarding horizontal violence or workplace bullying among Intensive Care Unit nurses.
The findings will impact on healthcare administrators, policymakers, and educators. By understanding horizontal violence or workplace bullying, strategies can be implemented to improve workplace environment, support nurses' well-being, increase nurse retention, and improve the quality of patient care.
This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review methodology, including data selection, extraction, and synthesis, follows PRISMA standards to ensure clarity, transparency, and reproducibility.
This study did not include patient or public involvement in its design, conduct, or reporting.
There is a protocol that does not require registration, it made accessible at: https://doi.org/10.17605/OSF.IO/CFNEJ.
by Wenshu Li, Jeffrey A. Leibowitz, Shuoguo Wang, Louisa Walker, Chang Xu, Kuei-Ting Chen, Alexa B. Schrock, Jason Hughes, Nimesh Patel, Julia A. Elvin, Lauren L. Ritterhouse, Ethan Sokol, Garrett Frampton, Lucas Dennis, Bahar Yilmazel, Brennan Decker
Homologous recombination repair (HRR) is a cellular pathway for high-fidelity double strand DNA break repair that uses the sister chromatid as a guide to ensure chromosomal integrity and cell viability. Deficiency in the HRR pathway (HRD) can sensitize tumors to poly (ADP-ribose) polymerase inhibitors (PARPi) and platinum-based chemotherapy, offering an avenue to identify patients who may benefit from targeted therapies. HRD signature (HRDsig) is a pan-solid-tumor biomarker on the FoundationOne®CDx (F1CDx®) assay that employs a DNA scar-based approach to calculate a score based on copy number features (e.g., segment size, oscillation patterns, and breakpoints per chromosome arm) and does not rely on HRR gene alterations, enabling detection of genomic and epigenetic mechanisms of HRD. After finalizing the HRDsig algorithm, analytical validation was conducted in a CAP-accredited, CLIA-certified laboratory on 278 solid tumor and normal tissue specimens. HRDsig results were compared with an independent HRD biomarker, defined by the presence of a reversion mutation restoring HRR gene function. In this evaluation, 100 HRD-positive and 126 HRD-negative samples showed a positive percent agreement of 90.00% and a negative percent agreement of 94.44%. The limit of detection (LoD) was estimated at 23.04% tumor purity, with the limit of blank (LoB) confirmed as zero in 60 normal tissue replicates. Reproducibility testing on 11 positive and 11 negative samples across multiple labs, reagent lots, and sequencers yielded agreement in 99.49% of positive and 99.73% of negative replicates. HRDsig status remained consistent in the presence of interfering substances, demonstrating 100% concordance in spiked samples. These validation results underscore the high analytical concordance, low false-positive rate, and overall robustness of HRDsig for reliable assessment of homologous recombination deficiency.by Ariffin Kawaja, Aminath Shiwaza Moosa, Eric Kam Pui Lee, Ian Kwong Yun Phoon, Andrew Teck Wee Ang, Zi Ying Chang, Aileen Chelsea Ai’En Lim, Jonathan Yap, Weiting Huang, Ding Xuan Ng, Melvin Yuansheng Sng, Hao Yuan Loh, Chirk Jenn Ng
IntroductionRecent hypertension guidelines recommend ambulatory blood pressure monitoring (ABPM) for accurate diagnosis and monitoring. However, patients’ experiences with cuff and wearable ABPM devices in primary care remain unclear. This study compared the acceptance of three devices (oscillometry cuff, tonometry wrist, and photoplethysmography chest devices) among patients with hypertension in primary care.
MethodsA multi-method study was conducted. Thirty-five participants with hypertension were recruited from two public primary care clinics in Singapore. All participants used cuff-based and either wrist or chest wearable devices for 24 hours. Structured surveys and in-depth audio-recorded interviews were used to gather feedback on their views, experiences, and challenges using the devices. The interviews were thematically analysed, and the surveys were analysed using descriptive statistics.
ResultsAll participants used the cuff (n = 35) device, while the wrist and chest devices were used by two-thirds (n = 22) and a third (n = 11) of the participants, respectively.The device usability questionnaire found that most participants were satisfied with the chest device, which did not disrupt their daily activities. Conversely, cuff arm devices interfered with daily activities (48%) and sleep (26%), were cumbersome (32%), and caused embarrassment (26%). The wrist device was uncomfortable (33%) and painful (22%) for some participants.The qualitative data were categorised into five themes: comfort, convenience, perceived accuracy, and impact on routine and sleep. Participants found the chest device more comfortable and convenient than the cuff and wrist devices. The cuff device was perceived as the most accurate due to its inflation-based BP measurement. All devices minimally affected routines and sleep, though participants expressed safety concerns about the cuff device, particularly while driving.
ConclusionWhile wearable ABPM devices offer increased comfort, convenience and reduced impact on patient’s daily activities, concerns regarding their accuracy must be addressed before the widespread adoption of these devices in routine clinical practice.
by Lei Wang, Chang Han Ma, Si Yuan Yang, Zheng Gang Zhang
BackgroundHigh-dose intravenous iron supplementation offers substantial hematologic protective benefits in clinical practice; however, its efficacy in enhancing blood protection during cardiac surgery remains uncertain. The present study aimed to investigate the effects and safety of high-dose intravenous iron as an optimal blood management strategy for patients undergoing cardiac procedures.
MethodsMajor databases, including PubMed, Embase, and Cochrane, were searched on June 20, 2025, for randomized controlled trials (RCTs) comparing red blood cell transfusion rates in adult patients undergoing high-dose intravenous iron supplementation versus those receiving control therapy (placebo) following cardiac surgery. The secondary outcome measures included postoperative hemoglobin levels, length of hospital stay, and incidence of adverse events.
ResultsSeven RCTs involving 975 subjects were identified in the database search. Compared with the control group (placebo), high-dose intravenous iron significantly decreased the rate of postoperative red blood cell transfusion among patients undergoing cardiac surgery (risk ratio 0.69, 95% confidence interval [CI] 0.52–0.91, P = 0.009, I2 = 61%, n = 975, certainty of evidence: moderate). Furthermore, one week or more following surgery, administration of high-dose intravenous iron resulted in a significant increase in postoperative hemoglobin levels (mean difference 0.71, 95% CI 0.41 to 1.01, P 2 = 63%, certainty of evidence: moderate). Significant differences between the groups were not observed for the other outcome measures, including mortality, infection rates, and cardiovascular events.
ConclusionsHigh-dose intravenous iron supplementation during the perioperative period of cardiac surgery significantly reduces the risk of red blood cell transfusion and enhances postoperative hemoglobin levels. Although the present study demonstrated a favorable safety profile for intravenous iron administration, the limitations of the present meta-analysis necessitate continued vigilance regarding potential drug-related risks associated with intravenous iron therapy. Systematic review protocol: CRD420251069827 (PROSPERO).
by Sunghoon Jeon, Keunho Kim, Cheolwon Choe, Juil Choi, Gun Lee, Chung-Do Lee, Hyeon-Jeong Moon, Jun-Gyu Park, Jin-kyung Kim, Namsoon Lee, Dongwoo Chang
Quick-soluble gelatin microparticles (QS-GMP) are emerging embolic agents under investigation for temporary vascular occlusion, offering reduced ischemic risk compared to permanent materials. The aim of this preclinical study was to evaluate the safety and efficacy of QS-GMP for transarterial embolization in a rabbit model of urinary bladder embolization. Twelve male New Zealand White rabbits underwent bilateral umbilical artery embolization using QS-GMP. Animals were assigned to four time-points (immediately, 3, 7, and 14 days post-embolization), with comprehensive assessments including clinical observations, hematologic and serum biochemical analysis, angiography, and histopathology. The procedure was technically feasible in all animals without intraoperative complications. Temporary hematuria and a transient decrease in body weight were observed post-procedure, both of which resolved spontaneously. Complete occlusion of the cranial vesical artery and absence of bladder wall perfusion were achieved immediately after embolization, followed by full recanalization at 3 days. Angiographic imaging at 7 and 14 days revealed transient hypervascularization of the bladder wall. Histopathological analysis showed marked edema, epithelial necrosis, and inflammatory infiltration at 3 and 7 days, with full urothelial regeneration observed at 14 days. No signs of ureteral or renal injury, or adverse systemic responses were detected. These findings suggest that QS-GMP may serve as a feasible option for temporary arterial occlusion in future veterinary lower urinary tract applications, although further long-term evaluation is warranted.To test a theoretical model examining the impact of the work environment on nurses' physical and mental health issues, job burnout, and healthcare productivity.
This cross-sectional study employed structural equation modelling to test a theoretical model linking work environment, physical and mental health issues, job burnout, and healthcare productivity. Data were collected from 600 staff nurses using validated self-report questionnaires administered at one medical teaching hospital and two regional hospitals in Taiwan.
The work environment was significantly associated with healthcare productivity, nurses' physical and mental health issues, and job burnout. Physical and mental health issues were positively related to job burnout, which, in turn, negatively impacted healthcare productivity.
A supportive work environment plays a critical role in promoting nurses' well-being, reducing burnout, and improving productivity. This study advances the understanding of work environment factors that nurse administrators can target for improvement.
Modifying key organisational and interpersonal aspects of the work environment and cultivating a more supportive culture may enhance nurses' well-being, reduce turnover, and improve workforce productivity.
This study adhered to STROBE guidelines for observational studies as per the Equator network.
No patient or public contribution.
High-intensity statin therapy is recommended as a first-line strategy for lowering low-density lipoprotein cholesterol (LDL-C) levels in patients with acute myocardial infarction (AMI). A combination of moderate-intensity statin and ezetimibe at an equivalent dose to high-intensity statin may achieve similar LDL-C reduction with fewer side effects. This study evaluates the long-term efficacy and safety of this approach, initiated following AMI, compared with high-intensity statin monotherapy.
The ROSUZET-AMI trial is a multicentre, prospective, open-label, randomised, non-inferiority trial. Patients with AMI who underwent percutaneous coronary intervention were randomised 1:1 to receive either moderate-intensity statin with ezetimibe (rosuvastatin 5 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The primary endpoint is the composite of cardiovascular death, major coronary events (non-fatal myocardial infarction, documented unstable angina requiring hospitalisation and all coronary revascularisation events occurring at least 30 days after randomisation), or non-fatal stroke.
Ethics approval for this study was obtained from the Institutional Review Board of Seoul St. Mary’s Hospital (No. 2020-0424-0003). Informed consent is obtained from every participant before randomisation. The results of this study will be submitted for publication in international peer-reviewed journals, and the key findings will be presented at international scientific conferences.
To assess the association of normal systolic blood pressure maintenance (SBPmaintain) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk.
Retrospective cohort study with a mean follow-up of 3.3 years.
Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed.
10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBPmaintain (maintain (≥120 mmHg) at the time of follow-up CAC scan.
CAC progression was defined as a difference of ≥2.5 between the square roots () of the baseline and follow-up coronary artery calcium score (CACS) (transformed CACS). Annualised transformed CACS was defined as transformed CACS divided by the interscan period.
Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, pmaintain was inversely associated with an annualised transformed CACS (β: –0.18, 95% CI: –0.25 to –0.12, pmaintain showed a lower risk of CAC progression than ≥elevated SBPmaintain in non-diabetics; however, this association was not observed in patients with diabetes.
Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.
Teleconsultation has gained significant traction due to advancements in information and communication technologies. While much attention has been given to physician-to-patient teleconsultation, the factors influencing physician-to-physician teleconsultation remain underexplored.
This scoping review aims to map and synthesise the existing evidence on the factors influencing physician-to-physician teleconsultation.
We included publications of all methodological designs that specifically addressed factors affecting physician-to-physician teleconsultation. Studies focusing primarily on physician-to-patient teleconsultation without sufficient detail on physician-to-physician components were excluded. The search was limited to articles published in English and Persian between 2014 and 2024.
Eight electronic databases (PubMed, Scopus, Web of Science, etc) were searched from January 2014 to June 2024.
Data extraction was performed by two independent reviewers using a standardised form. Extracted data included study characteristics, key factors influencing teleconsultation and main findings.
From 12 included studies, five key influencing components were identified: ‘patient-related factors’, ‘medical team competencies’, ‘infrastructure and technology’, ‘timing factors’ and ‘planning and programme evaluation’. Among these, infrastructure and technology were the most frequently reported factors across the studies, while patient-related factors were less commonly addressed.
This review identifies a comprehensive set of factors that influence physician-to-physician teleconsultation. The findings provide a foundation for developing effective teleconsultation programmes and highlight the need for more research in diverse healthcare settings.
by Anna M. Leone, Friday Saidi, Lauren A. Graybill, Qinghua Li, Twambilile Phanga, Feng-Chang Lin, Twaambo E. Hamoonga, K. Rivet Amico, Wilbroad Mutale, Benjamin H. Chi
ObjectiveWhen measured continuously, adherence to HIV pre-exposure prophylaxis (PrEP) is consistently low in studies of pregnant and postpartum women. We investigated how PrEP adherence aligned with HIV exposure risk.
MethodsWe conducted a trial of a PrEP adherence support intervention in Lilongwe, Malawi. Pregnant women who met eligibility criteria for PrEP had visits at three and six months following enrollment. At each visit, HIV exposure risk was categorized as low or moderate/high (i.e., higher) risk based on an algorithm. PrEP adherence was measured via tenofovir concentrations, with functional adherence defined at levels consistent with ≥4 doses/week. HIV exposure risk and PrEP adherence were classified as either aligned (i.e., higher HIV risk/PrEP adherence, low HIV risk/PrEP non-adherence) or not aligned (i.e., higher HIV risk/PrEP non-adherence, low HIV risk/PrEP adherence). Probability differences (PD) were used to estimate the effect of the PrEP adherence intervention on aligned PrEP adherence.
Results164 women were included in the analysis. HIV exposure risk was higher for 81 participants (49%) at three months and 89 (54%) at six months. PrEP adherence was low at three months (34%) and at six months (29%). Aligned PrEP adherence was observed in 89 (54%) participants at three months and 83 (51%) at six months. 62% at higher HIV exposure risk were not aligned at month three, which increased to 68% at month six. The probability of aligned PrEP adherence was greater among those randomized to the intervention than those receiving standard of care at three months (PD:15.7%; 95%CI:0.8%, 30.6%). This was also evident in analyses that considered women with high HIV risk but low adherence.
ConclusionAlignment of PrEP adherence with HIV exposure risk was dynamic. PrEP adherence should be considered in the context of evolving HIV exposure risk during pregnancy and postpartum, with greater emphasis on periods of elevated HIV risk exposure.
Many patients who are extubated after receiving mechanical ventilation for acute respiratory failure experience extubation failure (ie, require reintubation hours to days after extubation). High-quality evidence shows that extubating patients directly to non-invasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC), rather than conventional low-flow oxygen, can prevent extubation failure. These guideline-recommended interventions, however, require care coordination involving multiple intensive care unit (ICU) team members and are infrequently used. Interprofessional education (IPE), which teaches members of multiple professions together, could effectively address this implementation gap in complex, team-based, critical care settings, particularly when paired with a customisable protocol.
This batched, stepped-wedge, cluster-randomised, type 2 hybrid effectiveness–implementation trial will test three hypotheses: (1) when compared with traditional online education (OE), IPE increases implementation of preventive postextubation respiratory support, (2) the benefits of IPE are increased when paired with a clinical protocol and (3) preventive postextubation NIV for high-risk patients and preventive postextubation HFNC for low-risk patients reduce in-hospital mortality when compared with conventional postextubation oxygen therapy. The trial will recruit 24 clusters made up of one or more ICUs that care for at least 100 mechanically ventilated patients per year in a large multihospital health system in the USA. All clusters will receive OE, IPE and a clinical protocol, with timing determined by randomisation. We will also randomise half of the clusters to education promoting postextubation NIV for patients at high risk of extubation failure and preventive, postextubation HFNC for patients at lower risk, whereas the other half will be randomised to education promoting postextubation HFNC for all eligible patients. We will include all patients who are invasively mechanically ventilated for at least 24 hours. The primary implementation endpoint is the rate of use of postextubation NIV or HFNC among eligible participants. The primary clinical endpoint is in-hospital mortality truncated at 60 days from intubation.
This study was approved by the institutional review board of the University of Pittsburgh and an independent data safety monitoring board. We describe the methods herein using the Standard Protocol Items for Randomised Trials framework and discuss key design decisions. We will disseminate results to participating healthcare providers, through publication in a peer-reviewed medical journal and via presentations at international conferences.
FreshRSS 