New nanofiber glaucoma drainage implant: Effectiveness, safety, first <i>in vivo</i> results, and optimization of surgical technique

by Adela Klezlova, Petr Bulir, Alexandr Stepanov, Andrea Sidova, Magdalena Netukova, Jana Vranova, Katarina Urbaniova, Martina Grajciarova, Lenka Vankova, Zbynek Tonar, Pavel Studeny

Purpose

The purpose of the study is to evaluate the effectiveness, surgical preoperative and postoperative complications, histopathological findings, and optimize surgical technique after implantation of the new nanofiber glaucoma drainage implant (GDI).

Method

Implantation of the GDI, a unique nanofiber drainage device fabricated from polyvinylidene fluoride (PVDF) using the well-established electrospinning technology on the Nanospider™ platform, was first optimized in vitro on cadaver porcine bulbs before the initial in vivo implantations. PVDF was selected due to its favorable properties, including biocompatibility, anti-adhesive behavior, and mechanical stability, which are particularly advantageous in minimizing fibroblast colonization and fibrotic encapsulation. The Nanospider™ technology allows for reproducible, large-scale fabrication of nanofiber materials with controlled fiber morphology, which ensures uniformity and precision of implant dimensions.An in vivo study on 28 normotensive eyes from 14 laboratory New Zealand White rabbits was conducted. There were two groups of animals: the study group (14 eyes) and the control group (14 contralateral eyes). The study group underwent implantation of the new nanofiber GDI; the control group did not undergo any surgical procedure. Intraocular pressure (IOP) was measured preoperatively and at regular times postoperatively (Tono-Pen AVIA®). Preoperative and immediate postoperative complications were monitored. Histological quantification was performed using unbiased sampling and stereological methods to assess leukocyte infiltration, type I and type III collagen fractions, and both absolute and relative levels of inflammation.

Results

Based on the previous results and in vitro surgical experiences, the implant was narrowed to 2.0 mm, a thickness of 100 µm was chosen, and the implant was fixed with two scleral stitches to maintain its position. No serious preoperative complications occurred during in vivo experiments. There was one extrusion of the glaucoma implant noted after surgery, likely due to insufficient conjunctival fixation. This animal was excluded from both the study and the control groups. No serious instances of intraocular hypotension were observed after surgery. All animals tolerated the surgical procedure well, and the postoperative period was without any serious issues. In the study group, the average preoperative IOP was 13.6 mmHg (±4.1, n = 13). The average postoperative IOP on the first day, one, two, and three weeks, and one month after surgery decreased to 8.8 mmHg (±3.3, n = 13), 9.8 mmHg (±2.0, n = 13), 10.3 mmHg (±3.6, n = 13), 10.2 mmHg (±2.6, n = 13), and 9.7 mmHg (±2.0, n = 13), respectively. In the control group of contralateral eyes, the average preoperative IOP was 11.42 mmHg (±4.2, n = 13). The average postoperative IOP was 11.8 mmHg (±5.4, n = 13), 14.2 mmHg (±4.6, n = 13), 14.5 mmHg (±3.4, n = 13), 14.0 mmHg (±3.8, n = 13), and 14.2 mmHg (±2.4, n = 13), respectively, at the same follow-ups. In the study group, the IOP was statistically significantly lower by 29% at the end of the follow-up compared to the preoperative measurements (p = 0.009). Eyes with the implant showed greater leukocyte infiltration and less type I collagen compared to the group without implants. The ratio of type I to type III collagen was lower in the implant group, indicating delayed maturation and weaker connective tissue during early healing.

Conclusion

For easier implantation, minor technical adjustments such as implant narrowing and scleral fixation of the GDI were developed and tested using in vitro experiments. In vivo implantation of unique nanofiber GDI appeared safe and technically well-suited for our study. No serious perioperative or postoperative complications were observed. There was one scleral extrusion of the device, which was, in our opinion, caused by insufficient conjunctival fixation. A statistically significant IOP reduction was achieved at the end of the follow-up in the study group with implanted GDIs. Further studies on the effectiveness of the implant with longer monitoring periods, together with other surgical options such as combined cataract surgery and nanofibers GDI, are needed.

Patient flow and safety after implementing a community paramedicine service: a quasi-experimental study

Objective

Community paramedicine services (CPSs) may alleviate the increasing pressure on emergency medical services (EMSs) but lack the capacity for patient transport. The study aims to determine whether a municipality implementing the CPS between periods (CPS_REGION) compared with a control municipality (CTR_REGION) served by EMS only affected patient flow and safety in a rural Norwegian setting.

Design

A quasi-experimental study evaluating patient flow and safety before and after the introduction of CPS in one of two rural municipalities.

Setting

Two rural Norwegian municipalities that were served by EMS from nearby municipalities before the study started.

Participants

Before and after the introduction of CPS, a total of 604 and 650 patients, respectively, were included in CPS_REGION, and 367 and 408 patients, respectively, in CTR_REGION.

Interventions

CPS was introduced in CPS_REGION between the two data collection periods, whereas CTR_REGION continued to be served by EMS.

Outcome measures

The outcome of patient flow was assessed by the number of admissions to nearby hospitals, the number of patient contacts and the location for delivery and treatment. The outcome for safety was assessed as the need for medical recontact within 7 days and 30-day mortality.

Results

Hospital admission rates increased over the two study periods, being insignificant in CPS_REGION (+4.7%, p=0.373) and significant in CTR_REGION (+23.2%, p

Conclusions

Introducing CPS resulted in fewer hospital admissions, with more patients being treated locally. No safety concerns with respect to medical recontacts and 30-day mortality were observed. We conclude that CPS can alter patient flow towards more local treatment without compromising safety.

Older Adults' Self‐Care and Family Caregiver Contribution in Multiple Chronic Conditions: A Dyadic Qualitative Study

ABSTRACT

Aims

To explore how older adult-family caregiver dyads jointly manage multiple chronic conditions. Specifically, it investigates how dyads (i) prioritise chronic diseases, (ii) make and negotiate decisions related to self-care and (iii) define and distribute self-care tasks and caregiver contributions.

Design

A qualitative descriptive study using dyadic data collection and analysis.

Methods

Semi-structured interviews were conducted separately with chronically ill older adults and their family caregivers between July and December 2024. A hybrid inductive-deductive content analysis was applied. Dyadic analysis compared intra-dyad perspectives to identify patterns of agreement and disagreement.

Results

Thirty-four dyads (n = 68 participants) were interviewed. Older adults had a mean age of 80.09 years (SD = 6.95) and were affected by a median of four chronic conditions. Family caregivers had a mean age of 51.71 years (SD = 14.59), with most being the older adults' children (66.67%) and women (82.35%). Five categories, comprising 25 subcategories, were derived from the data. Disease prioritisation varied within dyads: older adults often focused on conditions with the most disabling symptoms, while caregivers emphasised those with higher risks of complication. Decision-making roles ranged from older adult-led to caregiver-led to shared. Care organisation followed three models: collaborative, older adult-directed, or caregiver-directed. Challenges in managing diseases included treatment adherence, care coordination, emotional burden and addressing multiple symptoms simultaneously. Role distribution in disease management and decision-making was complex and occasionally misaligned, sometimes resulting in conflict. Collaborative dyads reported greater adaptability and balance, while incongruent dyads experienced relational and organisational strain.

Conclusion

Managing multiple chronic conditions in older adults is a relational process shaped by interpersonal dynamics and shared responsibilities with family caregivers. Recognising dyadic relational patterns is essential for designing targeted educational interventions. Nurses should incorporate dyadic assessments into routine care to improve outcomes for older adults and reduce caregiver burden.

Implications for the Profession and/or Patient Care

This study highlights the importance of viewing chronic disease management as a dyadic process, rather than an individual task, involving both the older adult and the family caregiver. Tailored strategies that account for the relational dynamics within dyads, such as decision-making roles and care task distribution, are essential for effective chronic disease management.

Reporting Method

Consolidated criteria for reporting qualitative studies (COREQ).

Patient or Public Contribution

None.

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.

Autotrascendencia y su efecto en el bienestar físico, psicológico y social en adultos mayores

Objetivos: Conocer el efecto de la autotrascendencia sobre el bienestar, por lo cual se planteó la hipótesis que indica que a mayor autotrascendencia (intrapersonal, interpersonal y transpersonal [espiritualidad]) mayor bienestar (físico, psicológico y social) en los adultos mayores. Metodología: estudio descriptivo correlacional. La población fueron adultos mayores de ambos sexos. El muestreo fue probabilístico aleatorio estratificado, la muestra total fueron 251 adultos mayores. Resultados: El efecto de la autotrascendencia y la espiritualidad fue significativo (F_(1,249) = 4.24, p=.015) sobre el bienestar físico (consumo de alcohol sensato) explicando el 25% de la varianza total. Respecto al efecto de estas mismas variables sobre el bienestar psicológico se puede observar que el modelo fue significativo (F_(1,249) = 51.52,p=.001) explicando el 28.8% de la varianza total. Por último se identificó que el efecto de la autotrascendencia y la espiritualidad sobre el bienestar social fue significativo (F_(1,249) = 31.00, p=.001), este modelo explicó el 20.0% de la varianza total. Conclusiones: La autotrascendencia (intra e interpersonal y transpersonal [espiritualidad]) tiene efecto sobre el bienestar físico (consumo de alcohol sensato), bienestar psicológico y social. Debido a los resultados se considera que la enfermería debe de abordar estas problemáticas de estudio bajo marcos teóricos que promuevan el desarrollo integrar en el adulto mayor y facilitar el bienestar de la persona en todas las etapas de la vida.

ABSTRACT

Objectives: To know the effect of self-transcendence on well-being, for which the hypothesis was raised that indicates that the greater the self-transcendence (intrapersonal, interpersonal and transpersonal [spirituality]), the greater the well-being (physical, psychological and social) in elderly. Methodology: predictive descriptive study. The population was older adults of both sexes. The sampling was stratified random probabilistic, the total sample was 251 older adults. Results: The effect of self-transcendence and spirituality was significant (F_(1,249) = 4.24, p=.015) on physical well-being (sensible alcohol consumption) explaining 25% of the total variance. Regarding the effect of these same variables on psychological well-being, it can be seen that the model was significant (F_(1,249) = 51.52, p=.001) explaining 28.8% of the total variance. Finally, it was identified that the effect of self-transcendence and spirituality on social well-being was significant (F_(1,249) = 31.00, p=.001), this model explained 20.0% of the total variance. Conclusions: Self-transcendence (intra- and interpersonal and transpersonal [spirituality]) has an effect on physical well-being (sensible alcohol consumption), psychological and social well-being. Therefore, it is considered that nursing should address these study problems under theoretical frameworks that promote the comprehensive development of the elderly and facilitate the well-being of the person at all stages of life.

Patrones y representaciones sociales del consumo de alcohol en jóvenes universitarios

Introducción. El consumo de alcohol es un fenómeno complejo y multifactorial que puede surgir a partir de múltiples características del individuo y el entorno, así como de creencias e ideologías sobre esta conducta. Objetivo. Identificar los patrones del consumo de alcohol y explorar las representaciones sociales del consumo de alcohol que construyen los jóvenes universitarios. Metodología. Se realizó un estudio descriptivo con enfoque cualitativo. En la recolección cuantitativa se obtuvieron 59 participantes, a quienes se aplicó una cédula de datos personales y consumo de alcohol y el cuestionario AUDIT, en la recolección cualitativa se realizaron siete entrevistas semiestructuradas en línea. Resultados. En los 59 participantes, se identificó que el 93.2% consumió alcohol alguna vez en la vida, el 83.1% en el último año, el 55.9% en el último mes y el 28.8% en los últimos siete días. El 36.7% presentó consumo de bajo riesgo, el 34.7% dependiente o de riesgo y el 28.6% perjudicial. A partir de las siete entrevistas surgieron siete categorías: conducta previa relacionada, percepción de beneficios del consumo de alcohol, percepción de barreras para el consumo de alcohol, autoeficacia de resistencia al consumo de alcohol, afectos positivos relacionados al consumo de alcohol, influencias interpersonales e influencia situacional de las redes sociales. Discusión. Los resultados evidencian el papel que pueden tener las creencias, percepciones e ideologías sobre la conducta del consumo de alcohol en los jóvenes universitarios; hallazgos que se convierten en un importante aporte para el desarrollo de futuros estudios y de estrategias de prevención enfocada a jóvenes universitarios.

ABSTRACT

Introduction. Alcohol consumption is a complex phenomenon to study that can arise from multiple characteristics of the individual and the environment, as well as beliefs and ideologies about this behavior. Objective: Identify patterns of alcohol consumption and explore the social representations of alcohol consumption constructed by university students. Methodology. A descriptive study was carried out with a qualitative approach. In the quantitative collection, 59 participants were obtained, to whom a personal data and alcohol consumption card and the AUDIT questionnaire were applied; In the qualitative collection, seven semi-structured online interviews were conducted. Results. Of the 59 participants, it was identified that 93.2% consumed alcohol at some point in their lives, 83.1% in the last year, 55.9% in the last month and 28.8% in the last seven days. 36.7% presented low-risk consumption, 34.7% dependent or risky, and 28.6% harmful. Seven categories emerged from the seven interviews: previous related behavior, perception of benefits from alcohol consumption, perception of barriers to alcohol consumption, self-efficacy of resistance to alcohol consumption, positive affects related to alcohol consumption, interpersonal influences and situational influence of social relations. networks. Discussion. The results show the important role that beliefs, perceptions and ideologies can have on alcohol consumption behavior in university students; findings that become an important contribution to the development of future prevention strategies focused university students.

Desafíos en la formación en promoción de la salud en estudiantes universitarios

La promoción de la salud es “considerada un proceso que busca fortalecer las habilidades y capacidades de las personas para emprender una acción”. Asimismo, busca potenciar el trabajo con los grupos o las comunidades para actuar de manera mancomunada con el fin de ejercer control sobre los determinantes de la salud [Fragmento de texto].

Antenatal and postnatal depression – Are Polish midwives really ready for them?

Before January 2019, no established solutions regarding the screening, assessment, and treatment of patients suffering from perinatal depression existed in Poland. From 2019, a new standard of perinatal care has imposed the obligation to monitor the mental state of women during pregnancy and in the postpartum period on the healthcare providers (mainly on midwives). Thus, our study aimed to evaluate midwives’ knowledge about prenatal and postnatal mental health disorders in the first six months of implementing the new standard of perinatal care in Poland.

Vivir aquí y ahora con un síndrome autoinmune. Relato biográfico

El Síndrome de Sjögren es una enfermedad autoinmune sistémica que conduce al Síndrome Sicca, combinación de sequedad en ojos, cavidad oral, faringe, laringe y vagina. Se presenta frecuentemente asociado a otros trastornos autoinmunes, como artritis reumatoide y lupus eritematoso. Afecta generalmente a mujeres caucásicas entre 40-50 años. La patogénesis es desconocida, pudiendo ser desencadenada por factores genéticos, ambientales e infecciones víricas. La sintomatología, difusa, dificulta el diagnóstico. El objetivo del estudio es describir y comprender la experiencia vivida por una joven ante el diagnóstico y evolución de su enfermedad. En el texto se describen las manifestaciones clínicas, la calidad de vida, la actividad profesional, y las perspectivas de futuro. El relato biográfico aportó a nuestro trabajo una visión integradora del cuidado centrada en lo que la paciente considera importante.