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Exercise-based interventions are well-established in reducing falls and fall-related injuries, but adherence and accessibility remain key challenges, particularly in rural areas. While conventional in-person training is widely used, digital interventions may offer scalable solutions to enhance engagement and reach. However, pragmatic trials evaluating the real-world effectiveness of conventional and digitally supported fall prevention interventions are lacking, limiting the evidence base for their implementation in routine healthcare settings. The SURE-Footed into the Future Fall Intervention Trial (SURE-FIT) aims to compare the effectiveness of two structured fall prevention interventions—a conventional centre-based exercise programme and a hybrid telemedical programme combining in-person and tablet-supported training—against a wait-list control group in reducing falls and fall-related injuries among community-dwelling older adults.
This study is a pragmatic three-arm, parallel-group, randomised controlled superiority trial with a 1:1:1 allocation ratio. Participants (≥65 years, community-dwelling, planned n=2778) will be randomly assigned to (1) conventional centre-based training supplemented with printed materials for home-based continuation (conventional group), (2) a hybrid model integrating centre-based and tablet-supported training for continuation (tablet group) or (3) a wait-list control group. The intervention includes a 9-week supervised phase followed by 43 weeks of independent home-based training. The primary outcomes are the incidence rate of falls and fall-related injuries over 12 months. Secondary outcomes include physical functioning, physical activity, concerns about falling, loneliness and the risk of low protein intake. A process evaluation will assess intervention feasibility and implementation. Additionally, qualitative interviews will be conducted with participants, course instructors and municipal stakeholders to explore experiences, facilitators and challenges related to programme participation and implementation. A health-economic evaluation will be conducted to assess the cost-effectiveness of the structured fall prevention interventions. Data collection will take place at baseline and every 3 months via standardised questionnaires, with a subgroup undergoing physical performance testing and sensor-based activity monitoring. Analyses will follow an intention-to-treat approach.
Ethical approval has been granted by the Ethics Committee of Ulm University (271/23). Written informed consent will be obtained from all participants before enrolment. Study findings will be disseminated through peer-reviewed publications, scientific conferences and national fall prevention initiatives. Additionally, results will be shared with key municipal representatives, and the German National Association of Senior Citizens’ Organisations (BAGSO). A publicly accessible website will provide ongoing access to study information and findings in plain language.
DRKS00032878, German Clinical Trials Register
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 examine the characteristics of the health care needs corresponding to the medical care process and HR-QOL of women with cancer.
A descriptive design was adopted.
The study's participants were 122 women with cancer who completed a survey before and 6 months after treatment initiation. A principal component analysis (PCA) was conducted on a set of 12 health care satisfaction scores at each point. Correlations were examined between the resulting components and HR-QOL indicators, including subjective well-being, symptoms, symptom-related interference, anxiety and depression.
Most participants reported high health care satisfaction in both phases. PCA indicated the presence of 3 distinct domains: satisfaction with health care, health care management and supportive care. In both phases, these domains accounted for about 60% of the variance, while the remaining 40% was unexplained. Only satisfaction with health care was correlated with HR-QOL at both phases, with particularly strong associations observed for subjective well-being and depression at 6 months. Before treatment initiation, the item of ‘nursing care and practice’ received the highest average score, but demonstrated a negative loading on the component of ‘satisfaction with health care management’. The component of ‘satisfaction with supportive care needs’ was retained at both phases.
Health care plays a pivotal role in maintaining patients' quality of life, while supportive care and the integration of nursing practice within health care management remain essential.
High satisfaction scores do not necessarily mean that all health care needs are met. Addressing unmet needs from the perspective of HR-QOL and ensuring continuous supportive care throughout the treatment process is imperative.
Data provided by women with cancer was used.
To develop precision health (PH) competencies and evaluate their comprehensiveness and fit into nursing practice.
A modified e-Delphi technique was used to gather perceptions and achieve consensus on the inaugural set of PH domains, competency statements and sub-competencies developed by a workgroup formed under the aegis of the American Nurses Association (ANA).
A set of PH competencies and sub-competencies was developed by the ANA workgroup, beginning with a literature review, followed by a multi-step work process of the group over 3 years (2022–2025). Then, a modified e-Delphi technique was conducted via a four-point Likert scale Qualtrics survey, using a purposive sample of PH experts. The respondents were asked to agree or disagree with each competency or sub-competency statement and suggest modifications. The threshold of concordance was set at 80%.
The ANA workgroup reached consensus on six domains, six competency statements and 43 sub-competency statements to represent PH in nursing practice in its entirety. Forty experts in the field evaluated and offered revisions to the final 44 sub-competencies that represent the knowledge and skills necessary for PH in general nursing practice. A majority of the competency statements obtained favourable agreement from the expert panel, and a typical pattern of convergence was observed over two rounds of evaluation.
The development of PH competencies is the essential first step in the attempt to integrate PH into nursing practice.
The competency statements will inform nursing curricula, clinical practice guidelines, funding opportunities and role expectations in all healthcare settings.
This work sets the stage for subsequent interprofessional practice initiatives and research exploring how these competencies influence patient outcomes, workforce readiness and the practical integration of advanced technologies into precise care.
Mother-infant skin-to-skin contact (SSC) improves developmental and cognitive outcomes in preterm infants. However, the effects of SSC on healthy term infants remain unclear. We aim to investigate the short-term and long-term impacts of SSC in full-term infants to provide supporting data emphasising the importance of mother-infant SSC in South Korea.
This study is a prospective, double-blind, randomised controlled trial. A total of 130 mothers and their healthy term infants will be recruited after birth. Participants will be randomised to the intervention (SSC) or control groups. Participants in both groups will be instructed on general newborn care guidance and requested to record the same in a mobile diary app daily for 2 weeks after hospital discharge. The intervention group will be educated on the importance and clinical advantages of mother-infant SSC and provided with practical guidance, along with an informational pamphlet. They will also be informed to engage in a minimum of 6 hours of SSC per day with the infant’s and mother’s chests exposed and in contact for at least 15 min per session and to keep a record of the contact time. Breastfeeding rate, time spent on SSC and holding clothed infant, maternal depression, anxiety and bonding scores will be measured. Infants’ growth, temperament and neurodevelopmental outcomes will be assessed. In addition, artificial intelligence algorithms will be developed to analyse infant movements captured in videos.
This study was approved by the institutional review board of the Korea University Anam Hospital (2024AN0613), and the results will be disseminated through scientific conferences and publications.
NCT06777524, registered on 14 January 2025.
Leishmaniasis poses a significant public health problem in Kenya, where effective case management and treatment rely on accurate diagnosis. This review aims to summarise the research landscape on leishmaniasis diagnostics in Kenya and identify gaps.
This scoping review expands a previously published scoping review on leishmaniasis in Kenya to further analyse studies focusing on diagnostics. The field of diagnostics was chosen because of recent pushes for novel tools and because of the role timely diagnosis plays in disease elimination. A comprehensive search of PubMed, Embase via Embase.com, Web of Science Core Collection, the Cochrane Library, ClinicalTrials.gov, WHO ICTRP and the Pan African Clinical Trials Registry was conducted, covering studies up to 5 January 2024.
After dual, blind screening with conflict resolution by a third reviewer, 41 studies were included in the review. These studies examined a range of diagnostic tools; however most were assessed in one or few studies, and none evaluated real-time PCR. Additional gaps in the research landscape include a lack of diagnostics for cutaneous leishmaniasis and post-kala-azar dermal leishmaniasis in Kenya, outdated literature surrounding the Direct Agglutination Test and randomised trials for any diagnostic tool.
Future research should focus on solidifying the validity and reliability of diagnostic tools in the Kenyan context and updating previous work.
Vector control is imperative for eliminating leishmaniasis as a public health problem in Kenya. As elimination efforts expand in East Africa, it is crucial to understand the current research landscape. To address that need and identify gaps, a scoping review was conducted to characterise the landscape of leishmaniasis vector research in Kenya.
Building on a previously published scoping review by this team, we updated database searches in PubMed, Embase via Embase.com, Web of Science Core Collection, the Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP) and the Pan African Clinical Trials Registry to incorporate literature up to 4 January 2024 and focused on vector-related papers. Studies classified as ‘prevention’ in the original scoping review were included due to overlapping definitions.
A total of 95 studies were included in the analysis. Although a wide range of sandfly species have been documented, most of the research is outdated, having taken place 20–40 years ago. Existing studies are mostly epidemiological with little focus on basic and clinical research. There are also no studies on post-kala-azar dermal leishmaniasis despite its potential contribution to the disease transmission cycle. The geographical scope of the research is largely limited to traditional transmission foci with little attention to new disease hotspots such as North Eastern Kenya.
These research gaps need to be addressed to better inform the country’s leishmaniasis prevention and vector control strategy.
Major depressive disorder (MDD) is among the most common psychiatric disorders in children and adolescents. While previous meta-analyses have synthesised evidence on the efficacy and acceptability of newer-generation antidepressants in this population, specific adverse events (AEs) remain poorly characterised. This is of high clinical importance, as AEs are burdensome for patients, can reduce treatment adherence and lead to discontinuation. Here, we present a protocol for a network meta-analysis designed to evaluate the specific AE profile and comparative tolerability of newer-generation antidepressants in children and adolescents with MDD.
The planned study will include double-blind randomised controlled trials that compared one active drug with another and/or placebo for the acute treatment of MDD in children and adolescents. The following antidepressants will be considered: agomelatine, alaproclate, bupropion, citalopram, desvenlafaxine, duloxetine, edivoxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, paroxetine, reboxetine, sertraline, venlafaxine, vilazodone and vortioxetine. The primary outcomes will include the number of patients experiencing at least one AE, specific non-serious AEs, serious AEs (eg, suicidal ideation) and AEs leading to treatment discontinuation. Published and unpublished studies will be retrieved through a systematic search in the following databases: PubMed, Embase, Cochrane Library (including the Cochrane Central Register of Controlled Trials), Web of Science Core Collection, PsycInfo and regulatory agencies’ registries. Study selection and data extraction will be performed independently by two reviewers. For each outcome, a network meta-analysis will be performed to synthesise all evidence. Consistency will be assessed through local and global methods, and the confidence in the evidence will be evaluated using the Confidence in Network Meta-Analysis web application. All analyses will be conducted in the R software.
The planned review does not require ethical approval. The findings will be published in a peer-reviewed journal and may be presented at international conferences.
CRD420251011399.
This scoping review aimed to explore and identify literature about the scope of practice for nurse practitioners working as immunisers in primary healthcare.
The review was conducted according to the JBI scoping review framework.
A comprehensive literature search was conducted on 11 December 2023 to identify primary studies examining the role of nurse practitioners in immunisation delivery within global primary healthcare settings. The inclusion criteria were limited to peer-reviewed primary research that specifically examined nurse practitioners’ roles in primary healthcare settings in immunisation clinics and/or administering immunisations. Data were systematically extracted using a data extraction table, and article screening was independently performed by two reviewers. Reporting of findings was guided by the PRISMA-ScR checklist.
Medline, Scopus and CINAHL including peer-reviewed literature from January 2000 to December 2023.
A total of 1025 articles were identified; following screening and removal of duplicates, 52 articles underwent full-text screening and 8 articles that met the inclusion criteria were included in this review. Themes were identified using a qualitative descriptive approach: nurse practitioner scope of practice in primary healthcare; nurse practitioners addressing service gaps in primary healthcare; and the nurse practitioner's role in immunisation provision in primary healthcare.
Findings suggest that the roles and responsibilities of nurse practitioners working in primary healthcare are highly variable. Little research has been conducted to explore the nurse practitioner's immuniser role in primary healthcare.
No patient or public involvement was included in this scoping review.
This review provides insight into the current knowledge about the Nurse Practitioner Immuniser role in Primary Healthcare. While Nurse Practitioners have contributed to public immunisation efforts globally, the role and scope of nurse practitioner immunisers in primary healthcare are still evolving.
Identifying patients with chest pain potentially due to acute coronary syndrome (ACS) early is crucial for triage nurses. They need a reliable, validated screening tool.
This study aims to develop an initial screening scale to detect ACS in patients presenting with chest pain in the emergency department.
We analyzed electronic medical records of 3131 chest pain patients from 103,041 emergency department visits between January 2018 and December 2019. ACS diagnosis was confirmed by cardiologists through clinical symptoms, electrocardiograms, and cardiac enzyme levels. The study proceeded in four stages: (1) identifying potential ACS predictors through a literature review, (2) validating these predictors with experts, (3) comparing data between ACS and non-ACS patients and (4) developing a screening scale based on identified predictors. Statistical methods included univariate analysis and binary logistic regression. The scale's accuracy was assessed using ROC curve analysis and compared to existing tools.
Eight significant ACS predictors were identified: male sex, age over 49 for males and over 65 for females, typical symptoms, initial pain scale score of 6 or higher, pain duration of at least 10 min, history of ACS, hypertension, and dyslipidemia. Each predictor was scored, with typical symptoms and severe pain receiving higher scores, totaling up to 10 points. A score of 6 or more indicated high ACS risk, demonstrating accuracy comparable to the HEART and TIMI score systems.
This study developed a new ACS screening scale for use by triage nurses in emergency departments. This scale can facilitate early detection and intervention for patients at high risk of ACS.
FreshRSS 