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Ayer — Octubre 2nd 2025Tus fuentes RSS

Retrospective analysis of value-driven outcomes of diabetic foot ulcer in a tertiary hospital in Singapore

Por: Chia · A. C. K. · Tan · I. E.-H. · Tan · Z. N. · Yeo · W. J. · Zhao · Y. · Yap · C. J. Q. · Ang · K. A. · Au · M. K. H. · Chong · T. T.
Objective

This study analysed the clinical outcomes and healthcare costs associated with diabetic foot ulcer (DFU) within a tertiary healthcare centre in Singapore.

Design

This is a retrospective, single-centre study. Patient data were extracted from the hospital’s electronic health system, including demographic, clinical and hospitalisation information. Hospitalisation costs were categorised into DFU-related and other hospitalisation costs. A one-way sensitivity analysis was performed to estimate the total healthcare costs associated with DFU.

Setting

Tertiary centre within a population suffering from a diabetic epidemic.

Participants

All patients aged 18 years or older who received DFU treatment between January 2019 and December 2023 at the Singapore General Hospital were included.

Results

A total of 2857 DFU patients were included in the study. In-hospital mortality remained stable at 5%–6% annually. Among the cohort, 39.1% underwent minor amputations, 19.6% had major amputations and 9.0% experienced both minor and major amputations. The median length of stay for surgical patients ranged from 10 (IQR 4–24) to 13 days (IQR 6–31), compared with 4 (IQR 2–8) to 5 (IQR 3–9.5) days for non-surgical patients. Total costs per admission for patients with DFU-related surgery ranged from US$28 588.96 to US$34 204.77, while for those without surgery, costs ranged from US$6637.59 to US$7955.23. Total hospitalisation costs for DFU during the study period ranged from US$65.87 million to US$72.16 million. All figures were inflation adjusted to 2023 US dollars.

Conclusions

DFU poses a significant clinical and economic burden in Singapore. Understanding the costs associated with DFU is essential for resource allocation and planning in DFU management.

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Relationship between anti-diabetic medication use and glycaemic control: a retrospective diabetes registry-based cohort study in Singapore

Por: Chan · S. L. · Yap · C. J. Q. · Xu · Y. · Chia · S. Y. · Mohamed Salim · N. N. B. · Lim · D. M. · Choke · E. · Carmody · D. · Tan · G. C. S. · Goh · S.-Y. · Bee · Y. M. · Chong · T. T.
Objective

This study aimed to determine the association between diabetes mellitus (DM) medication use and glycaemic control.

Design

This was a retrospective diabetes registry-based cohort study.

Setting

Singapore.

Participants

Patients aged 18 and above with incident DM in the SingHealth Diabetes Registry from 2013 to 2020 were included. The entire study period included a 1 year baseline period, a 1 year observation period and a 3 month outcome period.

Outcome measures

Drug use was measured using the proportion of days covered (PDC), and the changes in glycated haemoglobin (HbA1c) between the outcome and baseline periods were assessed. The associations between baseline HbA1c and PDC ≥0.80 and between PDC and change in HbA1c were analysed using logistic regression and the Kruskal–Wallis test, respectively.

Results

Of 184 646 unique patients in the registry from 2013 to 2020, 36 314 met the inclusion and exclusion criteria and were included in the analysis. The median PDC for any DM drug, oral DM drugs and insulin during the observation period was 20.3%, 16.8% and 0%, respectively. Those who had good glycaemic control at baseline were less likely to receive DM drugs and those with poor baseline glycaemic control or missing baseline HbA1c were more likely to be consistent users (PDC >80%) (px 10-16).

Conclusion

The relationship between DM drug use and glycaemic control is complex and non-monotonic. Higher PDC for any DM drug and oral DM drugs during the observation period was significantly associated with clinically relevant HbA1c improvements.

The Experience of Self‐Care in People With Osteoporosis: A Qualitative Descriptive Study

ABSTRACT

Introduction

Osteoporosis requires long-term self-care engagement, yet little is known about how individuals experience and manage self-care in everyday life. Understanding these experiences is essential to inform tailored nursing interventions. The objective of the study was to explore and describe the experience of self-care maintenance, monitoring, and management in people with osteoporosis.

Design

A qualitative descriptive study.

Methods

We conducted semi-structured interviews. Data were analyzed using Mayring's qualitative content analysis with a deductive approach based on Riegel's theory of self-care. We reported data in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist.

Results

Participants (1 Male, 19 Females; Aged 55–80) Identified Four Themes of self-care: maintenance (e.g., Medication Adherence, Physical Activity), monitoring (e.g., Symptom Recognition, Test Interpretation), management (e.g., Lifestyle Reflections, Prevention), and general self-care. Key factors included motivation, trust in healthcare professionals, and integration of health behaviors into daily life. Barriers were low self-efficacy, poor symptom recognition, and inconsistent adherence.

Conclusion

Self-care in osteoporosis is a multidimensional and dynamic process influenced by individual beliefs, contextual factors, and support from healthcare professionals. Recognizing the variability in patients' self-care behaviors is essential to develop personalized education and support. Strengthening general health behaviors may enhance disease-specific self-care. This understanding can guide healthcare professionals in designing more effective, tailored care strategies.

Identifying bio-behavioural signatures of persistent opioid use risk in trauma injury patients: a protocol for a prospective cohort study

Por: Schmitz · J. M. · Yoon · J. H. · Kluwe-Schiavon · B. · Harvin · J. A. · Gunaratne · P. H. · Mouton · D. · Motley · K. · Fox · E. E. · Vincent · J. · Tarbet · M. · Walss-Bass · C.
Introduction

Exposure to prescription opioids following traumatic injury can increase the risk of developing tolerance, persistent opioid use and opioid use disorder. The mechanisms underlying opioid tolerance or dependence are not well understood, and no biomarkers predict risk. Opioid exposure causes epigenetic modifications, including alterations in microRNA (miRNA) expression. Several miRNAs, which regulate synaptic plasticity, are hypothesised to underlie substance use disorders and influence µ-opioid receptor levels, modulating opioid tolerance. This project aims to develop a bio-behavioural signature to predict persistent opioid use and chronic pain up to 6 months post-discharge.

Methods and analysis

The study will use a prospective cohort design, enrolling 180 adult patients at a Level I Trauma Center who are prescribed opioids at discharge. Prospective data will be collected in the hospital and at 7 days and 1, 3 and 6 months post-discharge. Biological data (genotyping and miRNA levels) and clinical measures of opioid use, pain, pain sensitivity (EEG) and psychosocial functioning will be collected at each time point. Bayesian regression methods will be used to identify baseline clinical, genetic, epigenetic and psychosocial predictors of opioid use and pain outcomes at 6 months post-discharge. Growth mixture modelling will identify distinct subgroups with varying trajectories, followed by Bayesian hierarchical modelling to predict trajectory classification based on predictor variables.

Ethics and dissemination plan

Ethics approval for this study was obtained from the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects (HSC-MS-24–0314). Findings will be disseminated in peer-reviewed scientific journals and at national and international conferences.

Mental Health Services Provided by Nurses in Schools and Higher Education Institutions in the Post COVID‐19 Era: Impeding Factors From a National Online Survey

ABSTRACT

Aim (s)

To examine competencies, attitudes, barriers and factors that influence the provision of mental health services by nurses in schools and higher education institutions in the post COVID-19 era in Taiwan.

Design

This cross-sectional study used nationwide proportionate stratified random sampling to recruit nurses from K–12 schools and higher education institutions.

Methods

Data were collected through an online survey administered between July and December 2024, with 305 responses received (response rate = 46.4%).

Results

Among the respondents, 55.1% provided advanced mental health services, while 38.3% delivered basic mental health services. The main barriers to the delivery of mental health services were lack of mental health-screening training (63.3%), insufficient brief screening tools (46.2%) and time constraints (42.6%). Nurses in junior and senior high schools were 5.78 and 3.07 times more likely, respectively, to provide advanced mental health services compared to those in universities. Furthermore, significant predictors of the provision of advanced mental health services included working in junior or senior high school, higher competence, and more positive attitudes; perceiving time constraints was a significant barrier.

Conclusion

Working in junior and senior high school settings was the most significant predictor of delivering advanced mental health services. These results underscore the need for targeted professional training, enhanced resources, and inter-professional collaboration to improve the quality of school-based mental health services.

Implications for Nursing Practice

Enhancing the attitudes and competencies of nurses in schools and higher education institutions towards mental health care is essential. Training should target nurses working in junior and senior high schools. Administrators must improve workflows, provide better tools and address barriers such as time constraints and limited referrals to support students' mental well-being.

Reporting Method

This study adhered to the relevant cross-sectional EQUATOR STROBE guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

Impact

This study examined the barriers to mental health service delivery among nurses in schools and higher education institutions and identified key determinants influencing their provision of such services. Nurses in schools and higher education institutions face challenges in providing mental health services due to a lack of mental health training, insufficient brief screening tools and time constraints. Advanced services were more common in junior and senior high schools, with competence and attitude being key predictors of their delivery.

Linguistic mechanisms of knowledge-exchange in a dark-web money laundering forum

by Emily Chiang

Money laundering facilitates serious crime, enables the expansion of criminal operations, and destabilises economies. Extant scholarship is largely concerned with anti-money laundering approaches, with far less attention being paid to the language and behaviours of the individuals who engage in money laundering. ‘Dark-web’ discussion fora are prime loci for illicit knowledge exchange and key enablers of money laundering, yet, are underexplored as sites for understanding the online activities and behaviours of users. This paper reports on a corpus-assisted discourse analysis of one such forum, guided by research questions around the key topics and common linguistic strategies by which knowledge is exchanged within a large community of individuals interested in money laundering, and the ways in which this community serves its members. The analysis identifies the forum as an extremely efficient and productive site for knowledge-exchange and thus ‘criminal upskilling’, which is attributed to three core characteristics: a strict adherence to community rules, a highly knowledgeable user base, and a culture of friendliness and reciprocity.

Italian Version of the Fundamentals of Care Framework and the Fundamentals of Care Practice Process: A Comprehensive Validation Study

ABSTRACT

Aims

To translate, culturally adapt and validate the Italian version of Fundamentals of Care Framework and the Fundamentals of Care Practice Process.

Design

Qualitative tool validation study.

Methods

The study followed internationally recommended procedures, including forward–backward translation, expert committee review, content validation through cognitive interviews and face validity testing with nurses and nursing students. Data were collected between January and October 2023.

Results

Key terms were culturally and linguistically adapted to enhance clarity and contextual relevance, with changes informed by expert feedback. Content validation confirmed conceptual equivalence, and face validity testing demonstrated that Italian versions were perceived as clear, appropriate and applicable across clinical and educational settings.

Conclusion

Cultural adaptation of theoretical frameworks is essential for ensuring their relevance and usability in local contexts. The Italian versions of the Fundamentals of Care Framework and the Fundamentals of Care Practice Process will provide a robust, evidence-based foundation for person-centred care across education, research and clinical practice.

Impact

By making these tools accessible in Italian, this study supports the integration of fundamentals of care into national nursing education and practice, promoting international consistency in person-centred care. It lays the groundwork for curriculum reform, clinical implementation and global collaboration in nursing.

Reporting Method

Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Patient or Public Contribution

This study did not involve any patient or public contribution.

Trial Registration

ClinicalTrials.gov identifier: NCT05177627

The Effectiveness of Instant Messaging‐Based Interventions on Health Behavior Change: A Systematic Review and Meta‐Analysis

ABSTRACT

Background

Instant messaging-based applications are increasingly used to deliver interventions designed to promote health behavior change. However, the effectiveness of these interventions has not been evaluated.

Aims

This systematic review and meta-analysis aimed to evaluate the effectiveness of instant messaging-based interventions on health behavior change, addressing a gap in the literature regarding the impact of instant messaging on various health behaviors.

Methods

We conducted comprehensive searches of six electronic databases (PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science) from their inception until July 2024, utilizing terms related to health behavior and instant messaging. Two authors independently screened studies and extracted data. Randomized controlled trials published in English that investigated the effects of instant messaging-based interventions on health behavior change, including physical activity, sedentary behavior, sleep, diet/nutrition, cancer screening, smoking cessation, and alcohol consumption were included. We used the revised Cochrane Risk-of-Bias Tool to assess the quality of the studies.

Results

Fifty-seven randomized controlled trials published between 2014 and 2024 were included. The results showed that compared with the control groups, instant messaging-based interventions had statistically significant differences in physical activity (SMD = 0.52, 95% CI [0.21, 0.83], p < 0.001) and sleep (SMD = −0.93, 95% CI [−1.44, −0.42], p < 0.001). It also significantly impacted smoking cessation (OR = 1.88, 95% CI [1.28, 2.7], p < 0.001). However, it did not influence sedentary behavior (SMD = 0.25, 95% CI [−0.24, 0.74], p = 0.01) or diet/nutrition (SMD = 0.01, 95% CI [−0.31, 0.34], p < 0.001).

Linking Evidence to Action

Instant messaging-based interventions are promising in enhancing health behavior change, including physical activity, sleep, and smoking cessation. Leveraging real-time communication and multimedia content can improve patient engagement and intervention effectiveness.

The relationship between family environments growing up and behavioral health among LGBTQ+ adults: The mediating role of internalized homonegativity

by Pin-Chen Chiang, Yinuo Xu, Denise Yookong Williams, Ankur Srivastava, Jake A. Leite, Adam R. Englert, William J. Hall

Purpose

Disparities in the behavioral health outcomes for lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) adults—such as depression, anxiety, and alcohol use—are often attributed to experiences of discrimination, victimization, and lack of supportive environments, including hetero- and cis-normative family settings. Yet, how family environments in childhood influence LGBTQ+ adults’ behavioral health and internalized homonegativity has not been extensively examined.

Methods

This study utilized a U.S. national dataset of LGBTQ+ adults (N = 499). Data were collected in November 2020 using an online survey. A series of multivariate ordinary least squares regression models and Sobel tests were performed.

Results

Results showed that as homophobic messages from family increased, levels of depression (β = .19, p β = .17, p β = .13, p β = .11, p β = .15, p z = 3.35, p z = 3.09, p z = 2.80, p z = 2.66, p z = 3.76, p z = 3.45, p  Conclusion

Study findings underscore the importance of inclusive climates within a family and internalized homonegativity as a mediator for LGBTQ+ individuals’ behavioral health. Implications for intervention and future research are discussed.

Need for evidence-based indications for CS delivery

Por: Chiavarini · M. · Giacchetta · I.

Commentary on: Wyss C, Inauen J, Cignacco E, Raio L, Aubry EM. Mediating processes underlying the associations between maternal obesity and the likelihood of cesarean birth. Birth. 2024 Mar;51(1):52-62. doi: 10.1111/birt.12751. Epub 2023 Aug 24.

Implications for practice and research

  • It is important for future clinical practice to understand the risks of Caesarean Section (CS) to properly counsel pregnant patients, even if the patient is obese.

  • It would be crucial to have CS delivery indications that are accepted at national and international levels, even in in obese women.

  • Context

    According to the literature, it appears that obese pregnant women are more likely to undergo a caesarean section than non-obese women. However, the mechanisms underlying these data have not yet been clarified.

    Methods

    The aim of the study of Wyss et al1 was to assess the factors contributing to the association...

    Enhancing early detection and treatment of psychosis in Germany: a protocol for the health economic evaluation of an artificial intelligence-guided complex intervention

    Introduction

    Psychosis, characterised by chronic symptoms often emerging in youth, imposes a substantial burden on individuals and healthcare systems. While early detection and intervention can mitigate this burden, there is limited evidence on the cost-effectiveness of such approaches. To address this lack of evidence, this study protocol outlines the health economic implications of an artificial intelligence (AI)-based intervention, the Computer-Assisted Risk-Evaluation (CARE), designed to prevent psychosis. The intervention uses AI technologies to enhance the diagnosis and treatment quality for individuals at high risk of psychosis.

    Methods and analysis

    The health economic evaluation has been designed alongside a 12-month multicentre randomised controlled trial comparing CARE with treatment as usual from both payer and societal perspectives. An implementation cost analysis will complement the evaluation, and long-term consequences beyond the trial will be explored descriptively. Based on a literature review, an initial economic logic model will guide subsequent analyses by depicting CARE’s programme theory.

    The cost-effectiveness assessment will include averted cases of manifest psychosis and quality-adjusted life-years using the EuroQol 5-Dimensions 3-Level instrument. Other effectiveness outcomes will also be incorporated into a cost–consequence analysis. Cost-effectiveness acceptability curves reflecting statistical uncertainty will be constructed, incorporating various payer and societal willingness-to-pay values. The implementation cost analysis will follow a mixed-methods approach to capture facility-specific costs.

    A dark logic model, emphasising negative outcomes, will be developed to investigate long-term consequences. Further, the initial economic logic model will be refined using trial data and expert interviews. This comprehensive approach aims to provide decision-makers not only with evidence on the cost-effectiveness of CARE, but also with a broader understanding of the implications of the intervention.

    Ethics and dissemination

    The study has received ethical approval and plans to disseminate its findings through publication in a peer-reviewed journal and conference presentations.

    Trial registration number

    NCT05813080.

    Risk assessment of arteriovenous fistulas focusing on the relationships between the properties of shunted blood flow sounds and a medical/surgical history of hemodialysis patients

    by Keiko Tanaka, Keisuke Nishijima, Ken’ichi Furuya, Satoko Shin, Michiaki Kai

    The global prevalence of end-stage kidney failure is increasing, with hemodialysis as the primary treatment. An arteriovenous fistula serves as a critical lifeline for patients undergoing hemodialysis, yet its function often deteriorates due to complications such as narrowing or blockage of the blood vessels. This study aimed to clarify the relationships between the sound properties of blood flow through arteriovenous fistulas and a medical/surgical history of patients undergoing hemodialysis by analyzing the distribution of sound frequencies from 100 to 4,000 Hz. Data were collected from 53 patients to identify two key parameters: the time point within one cycle of arteriovenous fistula sounds where the power distribution reached its peak, expressed as a percentage, and the specific frequency where the power was highest within the analyzed range. The results showed that well-functioning arteriovenous fistulas exhibited peak power within the first 25 percent of the sound cycle and the highest power at 200 Hz. In contrast, higher peak percentages and lower power at 200 Hz were associated with surgical interventions due to complications such as narrowing or blockage of the arteriovenous fistula. These findings suggest that the sound properties of arteriovenous fistulas, combined with patient-specific characteristics, may serve as non-invasive indicators of arteriovenous fistula function and help predict the risk of complications. This approach provides valuable insights for improving the management of arteriovenous fistulas and patient outcomes in hemodialysis therapy.

    Repetitive transcranial magnetic stimulation as an adjunct to quadriceps strengthening exercise in knee osteoarthritis: a pilot randomised controlled trial

    Por: Chang · W.-J. · Chiang · A. · Chowdhury · N. · Adie · S. · Naylor · J. M. · Finn · H. · Rizzo · R. R. N. · Gorgon · E. · OHagan · E. · Schabrun · S. M.
    Objective

    To examine the feasibility, safety and perceived patient response of a combined repetitive transcranial magnetic stimulation (rTMS) and quadriceps strengthening exercise intervention for knee osteoarthritis.

    Methods

    A two-arm, participant-blinded, therapist-blinded and assessor-blinded, randomised controlled trial with additional follow-up of pain and function at 3 months. Participants were randomised to receive active rTMS+exercise (AR+EX) or sham rTMS+exercise (SR+EX) twice weekly for 6 weeks while completing home exercises twice a week. Primary outcomes included recruitment rate, treatment attendance, dropouts, willingness to undergo therapy (11-point Numeric Rating Scale, ‘not at all willing’=0 and ‘very willing’=10), success of participant, therapist and outcome assessor blinding, adverse events and Global Perceived Effect Scale. Secondary outcomes were pain, function and measures of physiological mechanisms.

    Results

    86 people were screened, 31 (36%) were randomised, 28 (90%) completed the treatments and 3 (10%) dropouts at 3-month follow-up. Both groups had high treatment attendance (98.4% and 100%). All participants scored at least 7 on the willingness to undergo therapy scale. Blinding was successful. No adverse events were reported. At the postintervention assessment, 80% in the AR+EX group and 75% in the SR+EX group reported an improvement on the Global Perceived Effect Scale. Both groups demonstrated within-group improvements in pain at the postintervention assessment but not at the 3-month follow-up. Function improved only in the AR+EX group at the postintervention assessment.

    Conclusions

    Combined rTMS and quadriceps strengthening exercise intervention for knee osteoarthritis is feasible, safe and well-received. A full-scale trial is justified to assess the clinical benefits of this novel treatment.

    Trial registration number

    ACTRN12621001712897.

    Primary care providers experience and satisfaction with personalised breast cancer screening risk communication: a descriptive cross-sectional study

    Por: Omeranovic · A. · Lapointe · J. · Fortier · P. · Bergeron · A.-S. · Dorval · M. · Chiquette · J. · Boubaker · A. · Eloy · L. · Turgeon · A. · Lambert-Cote · L. · Joly · Y. · Brooks · J. D. · Walker · M. J. · Stockley · T. · Pashayan · N. · Antoniou · A. · Easton · D. · Chiarelli · A. M.
    Objective

    To describe primary care providers’ (PCPs) experience and satisfaction with receiving risk communication documents on their patient’s breast cancer (BC) risk assessment and proposed screening action plan.

    Design

    Descriptive cross-sectional study.

    Setting

    A survey was distributed to all 763 PCPs linked to 1642 women participating in the Personalized Risk Assessment for Prevention and Early Detection of Breast Cancer: Integration and Implementation (PERSPECTIVE I&I) research project in Quebec, approximately 1–4 months after the delivery of the risk communication documents. The recruitment phase took place from July 2021 to July 2022.

    Participants

    PCPs.

    Main outcome measures

    Descriptive analyses were conducted to report participants’ experiences and satisfaction with receiving risk communication. Responses to two open-ended questions were subjected to content analysis.

    Results

    A total of 168 PCPs answered the survey, from which 73% reported being women and 74% having more than 15 years of practice. Only 38% were familiar with the risk-based BC screening approach prior to receiving their patient risk category. A majority (86%) agreed with the screening approach and would recommend it to their patients if implemented at the population level. A majority of PCPs also reported understanding the information provided (92%) and expressed agreement with the proposed BC screening action plan (89%). Some PCPs recommended simplifying the materials, acknowledging the potential increase in workload and emphasising the need for careful planning of professional training efforts.

    Conclusion

    PCPs expressed positive attitudes towards a risk-based BC screening approach and were generally satisfied with the information provided. This study suggests that, if introduced in Canada in a manner similar to the PERSPECTIVE I&I project, risk-based BC screening would likely be supported by most PCPs. However, they emphasised the importance of addressing concerns such as professional training and the potential impact on workload if the approach were to be implemented at the population level. Future qualitative studies are needed to further explore the training needs of PCPs and to develop strategies for integrating this approach with the high workloads faced by PCPs.

    Effectiveness of a Rotating‐Leg Prepper for Reducing Pressure Injury and Preventing Surgical Site Infection in Patients Undergoing Heart Surgery: Paired Matching Randomised Controlled Trial

    ABSTRACT

    This study aims to evaluate the effectiveness of a rotating-leg prepper (intervention) compared with a rolled gauze bandage (control) in reducing pressure injury and preventing surgical site infection in the legs of patients undergoing heart surgery. The paired-matched, open, randomised controlled trial was conducted from September 2022 to July 2024. The participants were composed of the patient and the staff groups. Sixty patients were paired-matched to the intervention and control groups. Before painting the resting area with an antiseptic, the ankle presented non-blanchable erythema, which was recorded as a pressure injury. The intervention group showed significantly lower pressure injury (0% vs. 76.6%, p = 0.001) than the control group, with a relative risk of 5.29 (95% CI: 2.71–10.30). Both groups exhibited no significant difference in surgical site infection. However, the relative risk of surgical site infection in the control group was 2.03 (95% CI: 1.57–2.64). Thirty staff participants were purposively sampled to evaluate the effects of both leg lifting methods and assess their satisfaction with the leg prepper. The overall satisfaction with the rotating-leg prepper was 4.87 ± 0.22. Rotating-leg preppers can reduce pressure injury and prevent surgical site infections in patients' legs during heart surgery.

    Global Prevalence, Incidence, and Factors Influencing Falls in Older Adults With Dementia: Implications for Nursing and Healthy Aging

    ABSTRACT

    Introduction

    Dementia notably increases fall risk in older adults, leading to major injuries and considerable concerns from health-care professionals. However, comprehensive evidence regarding the prevalence, incidence rate, and moderating factors of falls in institutional settings is limited. This study aimed to evaluate the prevalence, incidence rates, and moderating factors of falls among older adults with dementia in nursing homes and dementia-specialized care units.

    Design

    A meta-analysis.

    Methods

    We searched CINAHL, PubMed, Embase, ProQuest, Scopus, Web of Science, and PsycINFO from database inception to April 30, 2024. Older adults with dementia in nursing homes or dementia-specialized care units were included. The pooled prevalence was analyzed using a generalized linear mixed model with random effects using R software. Incidence rates were reported per person-year using comprehensive meta-analysis software. Study quality was assessed using Hoy's criteria. Variations in the pooled prevalence of falls were explored through moderator analyses.

    Results

    This meta-analysis included 21 studies involving 35,449 participants. The pooled prevalence of falls was 45.6%, with subtypes showing 39.2%, 35.2%, and 29.0% among Alzheimer's dementia, vascular dementia, and mixed dementia subtypes, respectively. Falls were more prevalent in dementia-specialized care units (53.0%) than in nursing homes (42.6%). The overall incidence rate was 3.61 per person-year, higher in dementia-specialized care units (5.80) than in nursing homes (3.17). Subgroup analyses revealed higher fall prevalence in women (70.0%) than in men (30.6%). Meta-regression indicated that comorbidities, including delirium, visual impairment, and arthritis, increased fall risk.

    Conclusions

    This meta-analysis revealed a high incidence of falls in nearly half of older adults with dementia, particularly among those in dementia specialized care units.

    Clinical Relevance

    Healthcare professionals should prioritize regular fall risk assessments, tailored interventions, and environmental safety modifications, particularly in dementia-specialized care units, to reduce fall-related injuries and improve patient outcomes.

    Safety and Efficacy of Nurse‐Led Weaning Protocols on ICU Patients: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

    ABSTRACT

    Background

    Mechanical ventilation (MV) is a critical intervention for critically ill patients in intensive care units (ICUs). However, extended durations of MV are associated with adverse outcomes such as prolonged ICU stays, elevated mortality rates, and increased health-care costs. To address these challenges, nurse-led weaning protocols have been identified to be a promising strategy for enhancing the weaning process. This approach leverages the advantages of nurses' closer patient monitoring and more stringent adherence to protocols relative to physicians.

    Aim

    This systematic review and meta-analysis evaluated the safety and efficacy of nurse-led weaning protocols compared with physician-directed weaning, specifically in terms of reducing MV duration and improving patient outcomes in ICU settings.

    Methods

    A comprehensive search of databases was conducted to identify randomized controlled trials (RCTs) that compared nurse-led weaning protocols with physician-directed weaning. A total of 6 RCTs met the inclusion criteria, encompassing 1278 patients across various countries. Data on MV duration, failed weaning rates, in-hospital mortality, and ICU length of stay were extracted and analyzed using meta-analytic techniques.

    Results

    The meta-analysis revealed that nurse-led weaning protocols significantly reduced MV duration by 8% to 45% across the included studies. However, no significant differences were observed in the rates of failed weaning (risk ratio [RR]: 0.96; 95% confidence interval [CI] [0.63, 1.47]; p = 0.86) or in-hospital mortality (RR: 1.06; 95% CI [0.85, 1.33]; p = 0.58). Additionally, patients in the nurse-led group experienced a shorter ICU length of stay, with a standardized mean difference of 0.62 (p < 0.01).

    Linking Evidence to Action

    Nurse-led weaning protocols are a safe and effective strategy for reducing MV duration without compromising patient safety. The implementation of these protocols has the potential to enhance ICU operational efficiency and reduce health-care costs, thereby reinforcing the critical role of nurses in leading interventions in critical care environments.

    Clinically Significant Functional Impairments and Symptoms in COVID‐19 Survivors: Empirical Research Quantitative

    ABSTRACT

    Background

    COVID-19 survivors may experience complex, distressing and persistent symptoms, referred to as long COVID, lasting months or years after diagnosis. More evidence is needed for effective long COVID screening and management.

    Aim

    To explore the clinical profile of long COVID and factors associated with its development.

    Design

    A multicentre correlational study using a cross-sectional design.

    Methods

    Adults diagnosed with COVID-19 6–9 months earlier were recruited via social media and referrals from three facilities. Participants provided demographic data and assessed their symptoms and functional status using validated questionnaires. Data were analysed using descriptive statistics and binomial logistic regression.

    Results

    Among 102 participants, 13%–30% reported significant impairments in cognitive, emotional and physical functioning. Over 10% experienced symptoms such as diarrhoea, sleep problems, dyspnoea, nausea, fatigue and pain. These impairments and symptoms were associated with acute symptom severity, chronic disease, overweight status, regular exercise and living without partners.

    Conclusion

    This study adds to the literature by examining long-term functional status and symptoms in omicron survivors using comprehensive, validated tools. The findings highlight the prevalence and clinical significance of long COVID symptoms, aiding in the identification of functional impairments requiring medical and nursing interventions.

    Implications for the Profession and Patient Care

    Nurses should recognise these symptoms and educate survivors about potential challenges. Policies addressing long-term issues, including research, health services and education, are essential.

    Reporting Method

    This study follows the STROBE guideline (Table S1).

    Patient or Public Contribution

    Patients self-reported symptoms for this study.

    Trial Registration

    ClinicalTrials.gov (NCT05303103)

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