Conectar
by Metha Yaikwawong, Khanittha Kamdee, Kasarnchon Mek-yong, Somlak Chuengsamarn
This work aimed to clarify how polymorphisms in the TNF gene relate to metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and a broad spectrum of cardiometabolic characteristics, while also determining their impact on circulating TNF‑α concentrations. A total of 765 participants were genotyped for rs1800629 and rs361525, and serum TNF-α was also measured. To assess these relationships, multivariable logistic regression models—incorporating age, sex, and body mass index (BMI)—were applied to estimate adjusted odds ratios (aORs) and their corresponding 95% confidence intervals (CIs). Both variants were significantly associated with MetS: rs1800629 (crude OR = 2.22, 95% CI: 1.45–3.44, P P P = 0.035; adjusted OR = 2.84, 95% CI: 1.17–7.31, P = 0.025). The rs1800629 variant was also linked to T2DM risk (adjusted OR = 2.61, 95% CI: 1.35–5.24, P = 0.006), whereas rs361525 showed no such association. Carriers of rs1800629 had higher mean TNF-α levels (PCommentary on: Dumitru C. Exploring the transformative power of dance: a scoping review of dance interventions for adults with intellectual disabilities. J Intellect Disabil 2023;2023:17446295231218781.
Implications for practice and research Dance is a simple, safe and cost-effective intervention that improves the physical and mental health of individuals with intellectual disability (ID). Further research should be conducted into specific dance programmes/activities and enhancements such as music and incorporated into the treatment plan for individuals with ID.
Intellectual disability (ID) is a relatively common neurodevelopmental disorder affecting 2–3% of the general adult population.
Commentary on: Examining sedentary behaviours of adults with intellectual disabilities: A qualitative analysis - Safi et al.
Implications for practice and research The high prevalence of sedentary behaviour (SB) in individuals with intellectual disability (ID) contributes to poorer mental health outcomes Individuals with ID can and should be direct participants in research, which can then identify modifiable policy and environmental factors that can reduce SB.
Sedentary behaviour (SB) is different from physical inactivity
by Carmen Villagrasa, Giorgio Baiocco, Zine-El-Abidine Chaoui, Michael Dingfelder, Sébastien Incerti, Pavel Kundrát, Ioanna Kyriakou, Yusuke Matsuya, Takeshi Kai, Alessio Parisi, Yann Perrot, Marcin Pietrzak, Jan Schuemann, Hans Rabus
Biological effects induced by diverse types of ionizing radiation are known to show important variations. Nanodosimetry is suitable for studying the link between these variations and the patterns of radiation interactions within nanometer-scale volumes, using experimental techniques complemented by Monte Carlo track structure (MCTS) simulations. However, predicted nanodosimetric quantities differ among MCTS codes, primarily because each code employs distinct molecular-scale particle interaction models. This multi-code study examines these variations for low-energy electrons (20–10,000 eV), which play a critical role in energy deposition and biological effects by virtually all types of ionizing radiation. Specifically, the hypothesis tested in this work is that inter-code variability in nanodosimetry results is mainly caused by differences in assumptions regarding total interaction cross sections. Ionization cluster size distributions and derived nanodosimetric parameters were simulated with seven MCTS codes (PARTRAC, PHITS-TS, MCwater, PTra, and three Geant4-DNA options) in liquid water as a surrogate for biological tissue. Significant inter-code differences were observed, especially at the lowest energies. They were substantially reduced upon replacing the original cross sections in each code with a common, averaged dataset, created ad-hoc for this study and not based on theoretical assumptions. For example, for 50 eV electrons in 8 nm spheres, the variability in the predicted mean ionization numbers decreased from 23% to 5%, and in the probability of inducing two or more ionizations from 34% to 7% (relative standard deviations). This quantification demonstrates that total interaction cross sections are the primary source of uncertainty at low electron energies. A sensitivity test using DNA damage simulations with the PARTRAC code revealed that cross section variations notably affect biological outcome predictions. Replacing the code’s original cross sections with the averaged ones increased the predicted double-strand break yield by up to 15%. These findings underscore the urgent need for improved characterization of low-energy electron interaction cross sections to reduce uncertainties in MCTS simulations and enhance mechanistic understanding of radiation-induced biological effects.To evaluate nurses' perspectives on factors influencing the acceptability and practicality of comfort rounding, focussing on personalised nutritional and mobility care.
Mixed-methods feasibility study.
Focus group interviews with nurses were conducted before, during and at the end of the implementation period (2022–2023). A questionnaire assessed acceptability and practicality among nurses at the end of the implementation. Data were analysed using directed content analyses and descriptive statistics.
Comfort rounding's acceptability and practicality were influenced by nurses' attitudes, knowledge and skills, patient characteristics and the nurse–patient relationship. Barriers included workload, time pressure, team culture and the extensive, rigid design of comfort rounding. Questionnaire responses demonstrated nurses perceived added value of comfort rounding and frequently engaged patients in activities related to nutrition and mobility. However, it was not performed as originally intended.
Nurses considered personalised nutritional and mobility care important and frequently provided it during ‘usual care’. However, nurses were critical of comfort rounding's acceptability and practicality and did not perform it as intended.
Comfort rounding's concept does not align well with current nursing practice. Greater tailoring to nurses' preferences or alternative approaches to structuring personalised nutritional and mobility care are recommended.
What problem did the study address: Hospitalised patients often receive suboptimal nutritional care and are largely inactive. The challenge is to integrate personalised nutritional and mobility care effectively into standard nursing practice to enhance patient safety and well-being. Comfort rounding could improve patient safety and satisfaction; however, there is no research evaluating the feasibility of comfort rounding in relation to personalised nutritional and mobility care. What were the main findings: Comfort rounding was generally perceived as valuable and aligned with existing care routines, but its rigid structure was often considered impractical. Comfort rounding was not performed as originally intended due to the influence of individual, social and organisational factors. Flexibility in execution emerged as a critical factor for successful integration. Where and on whom will the research have an impact?: Comfort rounding can enhance attention to nutrition, mobility and patient participation when adapted to local contexts and delivered with flexibility. Policymakers and nurse leaders should avoid rigid protocols and instead support tailored implementation strategies alongside the practical delivery of locally tailored interventions.
Consolidated criteria for reporting qualitative research and Checklist for Reporting of Survey studies.
Nurses were involved in all stages of the study, contributing through focus group interviews and completing a questionnaire to help develop and evaluate comfort rounding.
PaNaMa Research Management System, number 112832
by Pawasoot Supasai, Kanwasee Kanjana, Kannawee Boonchuenchom, Yosanan Yospaiboon
PurposeTo assess surgically induced astigmatism (SIA) after XEN gel stent implantation over 5 visits during a 3-month follow-up. Changes in intraocular pressure (IOP), IOP-lowering medications, and best-corrected visual acuity (BCVA) were also assessed.
MethodsThis prospective cohort study recruited 24 eyes from 24 glaucoma patients at KKU Eye Center, Khon Kaen University, Thailand. All eyes underwent XEN implantation, using our specific surgical technique. We evaluated both the magnitude and the axis of SIA at 1, 2 weeks, 1, 2 and 3 months after the procedure. Preoperative and postoperative intraocular pressure (IOP), IOP-lowering medications, and best-corrected visual acuity (BCVA) were also analyzed.
ResultsWe observed a statistically significant centroid SIA of 0.14 D. at an axis of 105° and median SIA of 0.36 D. at 1 week following XEN (p Conclusions
Ab Interno XEN gel stent implantation induces a small SIA immediately after the surgery, but no further significant change during 3-month follow-up period. Although SIA has no significant effect on visual acuity, this should be addressed with patients preoperatively. Further studies are needed to investigate how different surgical techniques may affect refractive changes after XEN.
Commentary on: Effectiveness of educational interventions in reducing stigma of healthcare professionals and healthcare students towards mental illness: A systematic review and meta- analysis—Wong et al.
Implications for practice and research Training programmes for all healthcare professionals should incorporate appropriate and early education on mental illness and its common societal implications to ensure that care is inclusive and non-judgmental. Education must be tailored, multimodal (in-person/online; contact-no-contact) and repeated. Further research looking at why, when and how stigma develops is necessary.
Stigma exists in society towards mental health and is also demonstrated by healthcare professionals. It develops early on in careers and impacts the delivery of care which further stigmatises this already disadvantaged population. Up to 75% of individuals with mental illness refuse treatment because of stigma leading to negative outcomes.
Postdischarge surveys are critical in collecting patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs), but response rates vary and are often low.
To assess determinants that are associated with survey completion by phone in a complex medical care setting.
Secondary analysis of a prospective controlled interrupted time series analysis.
As part of the non-randomised controlled In-HospiTOOL trial, a survey was conducted to gather data on PREMs and PROMs in multimorbid patients from seven hospitals in Switzerland.
31 103 medical acute care hospitalisations among seven intervention hospitals who were eligible for the survey.
Over a 6-month pre-intervention phase (August 2017 through January 2018) and a subsequent 12-month intervention phase (February 2018 through January 2019), patients were contacted by phone 30 days after hospital admission.
The primary outcome was responsiveness to the survey. We assessed group differences between responders and non-responders, and associations of patient characteristics with survey completion were estimated using generalised estimating equations.
Of 31 103 eligible patients, 25 557 (82.2%) completed the survey 30 days after hospital admission. Responders were marginally older than non-responders (median (IQR) age, 73 (60–82) years vs 72 (57–82); standardised mean difference (SMD), –0.08), were more likely to be Swiss (81.9% vs 74.4%; SMD, –0.18), to have private healthcare insurance (22.9% vs 17.9%; SMD, 0.12), to be living at home before admission (85.7% vs 78.6%; SMD, 0.18) and to be less frail (67.4% vs 59.1%; SMD, 0.18). A longer length of stay (OR 0.98; 95% CI 0.97 to 0.99), discharge to a non-home institution (OR 0.50; 95% CI 0.46 to 0.54) and rehospitalisation within 30 days (OR 0.78; 95% CI 0.68 to 0.89) is associated with a decreased responsiveness.
The study shows that achieving a high survey response rate among vulnerable acute care patients is feasible, which in turn allows for the effective identification of key determinants and enhances the collection of information on patients’ experiences and outcomes.
The impact of anaesthesia modality on oncological outcomes in patients with high-risk non-muscle invasive bladder cancer (NMIBC) remains uncertain. Emerging evidence suggests that anaesthetic agents and techniques may influence tumour biology and recurrence through immunomodulatory and neuroendocrine pathways. However, prospective randomised trials comparing spinal and general anaesthesia in this population are lacking.
This single-centre, prospective, parallel-arm randomised controlled trial will enrol 370 patients with clinically suspected high-risk NMIBC undergoing transurethral resection of bladder tumour. Participants will be randomised 1:1 to receive either spinal or general anaesthesia. The primary endpoint is time to recurrence over a 104-week follow-up period. Secondary endpoints include time to progression, Bacillus Calmette–Guérin (BCG) unresponsiveness and a composite oncological event. Additional secondary outcomes include postoperative opioid consumption (morphine equivalents), obturator jerk occurrence, acute urinary retention and tolerance to immediate intravesical chemotherapy. Safety outcomes will include treatment-emergent adverse events, Clavien-Dindo graded surgical complications, haemorrhagic events and anaesthesia-related risks. Exploratory endpoints involve perioperative biomarker analyses. Data will be analysed on an intention-to-treat basis.
Recruitment has not yet started. It is expected to begin in December 2025 and to be completed by June 2029. The planned follow-up period for each participant is 104 weeks. This manuscript is based on protocol V.1.0, dated March 2025. Results will be disseminated through peer-reviewed journals and conference presentations
Peripheral arterial disease (PAD) commonly coexists with chronic kidney disease (CKD). Patients with symptomatic PAD often require endovascular revascularisation to relieve pain or salvage limbs. However, the iodinated intra-arterial contrast routinely used in these procedures is nephrotoxic, placing patients with CKD at increased risk of acute kidney injury (AKI) and long-term renal decline. Carbon dioxide (CO2) delivered via automated injection is a potential alternative imaging contrast medium. This trial will evaluate whether using CO2 instead of iodinated contrast reduces the risk of AKI and short-term renal function decline in this high-risk group.
This is a multicentre, open-label, prospective randomised controlled trial across six secondary-care National Health Service (NHS) vascular surgery centres. A total of 174 patients with PAD and CKD undergoing endovascular intervention will be randomised 1:1 to receive iodinated contrast (standard of care) or CO2 via automated injector (Angiodroid). All perioperative care will follow local NHS protocols.
The primary outcome is log serum creatinine at 2, 30 and 90 days postprocedure. Key secondary outcomes include: incidence and severity of AKI within 48 hours postprocedure, major adverse kidney events (death, dialysis or >25% estimated glomerular filtration rate decline) by 90 days, inpatient length of stay, procedural pain, quality of life, procedural success, reinterventions, acceptability and feasibility (patient/practitioner questionnaires) of using CO2, and cost-effectiveness (healthcare resource use analysis). A mixed-methods process evaluation will be undertaken with patients and clinicians.
The trial has been approved by an NHS ethical review committee (24/WA/0332) and patients have been involved in trial design. Findings will be disseminated to participants, clinicians and the wider public through patient groups, lay summaries, social media, conferences, peer-reviewed journals and NHS policy channels.
Commentary on: Impact of Crisis Care on Psychiatric Admission in Adults with Intellectual Disability and Mental Illness and/or Challenging Behavior: A Systematic Review—Tai et al.
Implications for practice and research Crisis care should be integrated into community care for this vulnerable and difficult-to-treat population to improve community tenure and reduce healthcare costs. Crisis care versus intensive community care needs to be defined, and standardised models compared, to optimise outcomes in different healthcare jurisdictions.
There is a high prevalence of psychiatric disorders among individuals with intellectual disability. In keeping with deinstitutionalisation, this population has also been moved from hospital to community but not necessarily accompanied by the specialised resources required. Consequently, there are high admission rates, however, this has been associated with traumatic experience (for patients and caregivers), potential neglect and abuse. Community crisis care has been studied for other patient groups but...
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