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Ayer — Junio 14th 2026Tus fuentes RSS

Musculoskeletal surgeons use mixed reasoning rather than pure Bayesian strategies in clinical practice

by Robert Parisien, Alexander Drost, Amin Razi, Sina Ramtin, David Ring, Stein J. Janssen

Objectives

To inform efforts to promote regular and normalized Bayesian reasoning, we studied factors associated with the degree to which surgeons use Bayesian reasoning to navigate uncertainty across different clinical scenarios.

Methods

Science of Variation Group members (153; 58% North America, 30% Europe, 69% over 15 years of experience) completed an online survey reading 8 scenarios of test and treatment decisions and chose one of 4 answer options with higher scores indicating more Bayesian reasoning. Internal consistency of the survey was assessed using Cronbach alpha.

Results

The average Bayesian reasoning score across all scenarios was 3.0 (IQR 2.7–3.2) on a 4-point scale, indicating a relative context-dependent variability. Completely non-Bayesian reasoning was selected least often (8.6%, 90 of 1,044) and fully Bayesian reasoning represented 29% (301 of 1,044) of responses. Most surgeons showed mixed patterns (defined as reasoning in which prior probability is acknowledged but underweighted, without explicit probabilistic updating): 85% (121 of 142) used fully Bayesian reasoning at least once (121 of 142) while 42% (60 of 142) used completely non-Bayesian reasoning at least once. The Cronbach alpha was 0.43 suggesting the scenarios measured different aspects of clinical reasoning rather a unified construct.

Conclusions

The finding that surgeons use relatively context-dependent reasoning suggests an opportunity for surgeons to develop and practice Bayesian reasoning strategies both in training programs and in practice.

Delays in diagnosis and treatment of depressive disorder among young adults: A national online survey-based cross-sectional study

by Rena Xu, David Pletta, Caitlynn Feng, Cassandra Morrow, Maya C. Clark, Badar Omar, Alex S. Keuroghlian, Sari L. Reisner

Background

Depression is highly prevalent among U.S. young adults and associated with long-term functional impairment and increased suicide risk. While delays in diagnosis and treatment of depression are well documented among older adults, the magnitude and predictors of such delays in the younger population are poorly understood.

Objective

To characterize the time to diagnosis and treatment of depressive disorder and predictors of diagnostic and treatment delay among young adults.

Methods

This cross-sectional study used a self-reported survey conducted via the online research platform Prolific in May 2025. Eligible participants were U.S. adults aged 18–35 years with a history of at least one depressive episode. Sociodemographic, clinical, and psychosocial characteristics, including age of depressive symptom onset, degree of social support, and frequency of social group engagement, were assessed. Primary outcomes were probability of not receiving a depressive disorder diagnosis despite symptoms, time from symptom onset to diagnosis, probability of not seeking treatment, and time from symptom onset to treatment. Secondary outcomes were perceived treatment effectiveness and current symptom control.

Results

In total, 871 respondents met inclusion criteria. Of those with one or more lifetime depressive episodes, 46.2% reported never receiving a depressive disorder diagnosis. Median time from symptom onset to diagnosis was 3 years (IQR: 0–7). Over a quarter (27.4%) never sought treatment; among those who did, 93.5% received care, but 31.4% experienced a delay of 1–4 years, and 28.8% experienced a delay of 5 + years. Symptom onset in childhood (ages 0–12) or adolescence (ages 13–17) was associated with longer time to diagnosis and treatment and lower perceived treatment effectiveness. Greater social support was associated with shorter time to diagnosis; lower probability of never receiving a diagnosis, never seeking treatment, or experiencing prolonged treatment delay; and higher perceived treatment effectiveness and current symptom control. Frequent engagement in social groups was also associated with greater perceived treatment effectiveness.

Conclusions

Among U.S. young adults, prolonged delays in depression diagnosis and treatment are common. Early symptom onset is associated with longer delays and worse outcomes, whereas greater social support is associated with shorter delays and more favorable outcomes. These findings highlight the need for further research to clarify causal mechanisms and for interventions to promote timely diagnosis and treatment among young adults at risk for depression.

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Targeted Muscle Reinnervation (TMR) or Regenerative Peripheral Nerve Interface (RPNI) for pain prevention in patients with limb amputation: A protocol for a systematic review and meta-analysis

by Jesús del Moral Preciado, David Gurpegui, Montserrat Royo, Bernardo Hontanilla

Introduction

Regenerative Peripheral Nerve Interface (RPNI) and Targeted Muscle Reinnervation (TMR) have demonstrated superior outcomes compared to classical amputation in prophylactic prevention of pain, primarily by reducing the incidence of symptomatic neuromas, residual limb pain, and phantom limb pain. However, direct comparisons between these two techniques remain limited. Furthermore, their comparative effectiveness across diverse patient demographics (including age, sex, and comorbidities) and surgical variables (amputation level, etiology, and nerve handling) has not been systematically evaluated. Therefore, the objective of this systematic review and meta-analysis is to synthesize the available evidence to determine the comparative safety and efficacy of primary TMR or RPNI.

Methods and design

This review will be conducted following the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive electronic search will be performed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, PubMed, and MedRxiv, without language restrictions. We will include randomized controlled trials, quasi-randomized trials, and observational studies. Study selection and data extraction will be managed using Covidence. Two reviewers will independently screen titles and abstracts, assess full-text eligibility, evaluate risk of bias, and extract data.

Ethics and dissemination

As this systematic review relies on the analysis of secondary data from published studies, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number

CRD42024617299

Self‐Efficacy as a Mediator Between Medication Adherence and Self‐Care in Inflammatory Bowel Disease: A Multicenter Cross‐Sectional Study

ABSTRACT

Aims

To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables.

Design

Multicenter, cross-sectional.

Methods

A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours.

Results

Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours.

Conclusions

Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship.

Implications for Clinical Practice

Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance.

Impact

The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours.

Patient or Public Contribution

Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.

Wearable Technologies for Detecting Near‐Falls: A Systematic Review With Implications for Geriatric Nursing Practice

ABSTRACT

Background

Near-falls, defined as events in which individuals momentarily lose their balance but avoid falling, are strong predictors of subsequent falls. Wearable technologies have the potential to accurately detect near-falls in both laboratory and real-world settings, providing opportunities for early intervention in geriatric nursing practice.

Aims

This study has a two-fold aim: (1) to appraise and synthesize current evidence on wearable sensor technologies for near-fall detection, and (2) to discuss their potential applications for monitoring near-fall risk and implementing prevention strategies in older adults.

Methods

This is a systematic review. Articles were searched in five electronic databases (PubMed/MEDLINE, Embase, CINAHL, Web of Science, and IEEE Xplore) that explored wearable sensors for near-fall detection. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

A total of 18 studies, mostly experimental or observational, were included. Inertial Measurement Units (IMUs) were the most commonly used wearable technology, and the most frequently captured biomarker was linear acceleration. Lower-body placements (feet, ankles, and lower back) demonstrated superior performance in detecting near-falls. Single-sensor systems achieved sensitivities of 80%–98%, whereas multi-sensor configurations achieved 100% sensitivity, 99% specificity, and 100% accuracy.

Linking Evidence to Action

Integrating wearable technologies for near-fall detection into geriatric nursing practice may enhance early identification of older adults at high risk for falls and enable timely, personalized interventions. Future research should validate these technologies in real-world settings and assess their acceptability among nurses, caregivers, and older adults.

Shared Decision‐Making and Trajectories of Self‐Management Confidence in Nurse‐Led Chronic Condition Care: A Longitudinal Evaluation

ABSTRACT

Aim

To examine whether shared decision-making at baseline is associated with trajectories of self-management confidence over 12 months among individuals living with chronic conditions attending nurse-led clinics.

Design

A longitudinal design.

Methods

Individuals with at least one clinician confirmed chronic condition were recruited from six nurse-led primary care clinics between March and September 2022. Data collection took place between March 2022 and September 2023, with baseline, 6 and 12-month assessments completed within routine follow-up contacts. Self-management confidence was measured using the Self-Efficacy for Managing Chronic Disease Scale, and perceived shared decision-making was assessed using the nine-item Shared Decision-Making Questionnaire (SDM-Q-9). Linear mixed-effects modelling examined changes in confidence over time and associations with baseline shared decision-making, adjusting for age, gender, education and number of chronic conditions.

Results

Of 157 eligible individuals approached, 151 consented to participate (96.2%), and 146 were retained at 12 months (96.7%). Mean self-management confidence increased from 40.2 at baseline to 44.5 at 12 months. In adjusted models, confidence was significantly higher at 6 months (β = 2.63, 95% CI: 1.54–3.72, p < 0.001) and 12 months (β = 4.21, 95% CI: 2.93–5.49, p < 0.001) compared with baseline. Higher baseline shared decision-making was positively associated with repeated confidence scores across follow-up (β = 0.10, 95% CI: 0.04–0.16, p = 0.002). The association was stronger among participants aged under 60 years.

Conclusions

Within established nurse-led chronic condition care, perceived shared decision-making was statistically associated with subsequent trajectories of self-management confidence over 12 months. Confidence demonstrated gradual change rather than stability within routine practice.

Implications

Strengthening the visibility and consistency of collaborative dialogue within nurse-led consultations may support self-management confidence. Structured conversational approaches that help nurses enact shared decision-making more explicitly warrant further evaluation in primary care.

Patient or Public Contribution

No patients were involved in study design.

Transfer of faeces in ulcerative colitis 2: improving efficacy - study protocol for a multicentre randomised controlled trial (TURN2 study)

Por: Benard · M. V. · Van Der Spek · M. J. · Davids · M. · Visser · C. E. · Zoetendal · E. G. · Rethans · B. · Zwezerijnen-Jiwa · F. H. · Visschedijk · M. C. · Oldenburg · B. · Weersma · R. K. · Ponsioen · C. Y.
Introduction

The interaction between the gut microbiota and the host immune system is implicated in the pathogenesis of inflammatory bowel disease, including ulcerative colitis (UC). Targeting the gut microbiota with faecal microbiota transplantation (FMT) from a healthy donor has shown promise in inducing remission in patients with active UC. However, mixed results and protocol heterogeneity have limited its practical application. Our previous Transfer of Faeces in Ulcerative Colitis; Restoring Homeostasis (TURN) trial found a correlation of clinical response with specific strains and butyrate production. Since most gut microbes, including many butyrate producers, are anaerobes, anoxic processing of donor stool may be essential to increase efficacy of FMT in UC. This trial aims to enhance FMT efficacy by applying strict anoxic processing, selecting donors based on microbial composition and using repetitive dual-route administration.

Methods and analysis

This randomised, double-blind, placebo-controlled, multicentre study evaluates the efficacy of strictly anoxic prepared donor FMT compared with anoxic prepared autologous FMT in patients with mild to moderate active UC. An open-label extension option is available for non-responders in the autologous arm. Included patients will receive 4 weekly FMTs, comprising two double-route administrations (nasoduodenal administration combined with enema) and two single enemas. Donors are selected based on their microbiota profile, informed by our previous TURN trial and literature. A total of 76 patients evaluable for the primary endpoint will be included. The primary endpoint is steroid-free clinical and endoscopic remission at week 8, assessed by the adapted Mayo score. An interim analysis will be conducted midway through the study by a Data Safety Monitoring Board to monitor efficacy and safety. Other outcomes of this study include the evaluation of clinical, endoscopic and histological response. In addition to clinical results, this study aims to provide valuable insights into specific microbial strains, metabolites and mechanisms correlated with response, aiding in the development of future microbial therapies.

Ethics and dissemination

Ethics approval was obtained from the medical ethics committee of the Amsterdam University Medical Centre in the Netherlands (reference number 2018_057). All participants will provide written informed consent. The results of the trial will be disseminated through publication in a peer-reviewed journal and presentations at (inter)national conferences.

Trial registration number

Prospectively registered in May 2018 in the Dutch Trial Register (NTR/LTR) as NL7770. Assigned NL-OMON52507 following the transition of the Dutch Trial Register to the Overview of Medical Research in the Netherlands. Also registered at ClinicalTrials.gov (NCT05998213).

Experiences of families participating in a 10-week family-focused e-Health healthy lifestyle programme for school-aged children with overweight or obesity: a qualitative study

Por: Zhu · D. · Dordevic · A. L. · Davidson · Z. E. · Gibson · S.
Objective

To explore families’ experiences participating in a 10-week web-based lifestyle programme for school-aged children with overweight or obesity.

Design

A qualitative study using inductive analysis of semi-structured interview data.

Setting

Victoria, Australia.

Participants

Families (children aged 7–13 years with overweight or obesity—body mass index ≥85th percentile—and accompanying parent) recruited for a randomised controlled trial that evaluated the effectiveness of the web-based programme and who received the programme (n=102 children/85 families) were invited to participate in a semi-structured interview at 3 months post-programme.

Intervention

Families received a 10-week family-focused electronic health (e-Health; web-based) lifestyle programme with health coaching sessions—an evidence-based programme adapted from its in-person, group-based counterpart.

Results

A total of 28 families, including 34 children (eight siblings) and mostly mothers, shared their experiences. 10 themes were identified on family members’ experiences and aligned with the socioecological model: intrapersonal—knowledge development on healthy living; experiences and stigma related to overweight, obesity or weight; engaging with structural features of the web-based programme, interpersonal—family dynamic; connections with others (non-healthcare professionals) outside of home; relationship with healthcare professionals, environmental/institutional—impact of COVID-19 lockdowns; health-promoting environments; promotion of and access to overweight or obesity management programmes; web-based programme as part of a larger or established system. Each theme highlighted factors that influenced programme uptake and engagement.

Conclusions

Valuable insights were gained on ways to better adapt e-Health (web-based) lifestyle programmes for children with overweight or obesity. Families perceived advantages in a web-based lifestyle programme and highly regarded humanised features and elements comparable to conventional in-person programmes. Further research is needed to explore the perspectives of families from diverse populations, fathers and families who decline participation in the follow-up period. Web-based lifestyle programmes that incorporate contemporary e-Health technologies, including responsive AI, also warrant further investigation to maximise programme benefits.

Trial registration number

ACTRN12621001762842.

Healthcare experiences of transgender and gender-diverse people in the UK: a scoping review

Por: Davidson · L. · Moore · A. · Grove · A. · Gauly · J.
Objectives

To map the existing literature on transgender and gender-diverse (TGD) people’s experiences of healthcare in the UK, summarising key findings and characteristics of current research.

Design

This scoping review was guided by the Arksey and O’Malley framework and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Data sources

MEDLINE, Embase, PsycINFO and Web of Science were searched on 29 October 2024. Reference lists of included studies were searched to identify further relevant literature.

Eligibility criteria for selecting studies

Primary research of any design reporting the healthcare experiences of TGD people in the UK from 2019 onwards was included.

Data extraction and synthesis

Relevant data were extracted using a data charting form guided by the research questions and the Arksey and O’Malley framework. Results were narratively synthesised to provide a comprehensive overview of the literature.

Results

52 studies were included, comprising qualitative (n=38), mixed-methods (n=12) and quantitative (n=2) designs. TGD people reported varying experiences across general and transition-related healthcare settings. Positive experiences were often attributed to individual clinicians. Negative experiences were common, including transphobic discrimination, insufficient clinician knowledge and barriers to effective transition-related care. Strategies for navigating healthcare, such as information sharing within the TGD community and educating clinicians about trans health needs, reflected adaptive responses to systemic barriers.

Conclusion

The findings highlight a need for greater recognition of diverse gender identities, more inclusive approaches in healthcare education and practice and further targeted research. This is especially urgent in light of the recent UK Supreme Court judgement regarding definitions of ‘sex’ under the Equality Act 2010, the emerging implications of which risk compounding existing barriers by reinforcing exclusionary practices within healthcare settings and further limiting recognition and protections for TGD people in the UK.

Risk Profiles in Hospitalized Adults Based on Functional Capacity, Pressure Injury Risk, and Fall Risk: A Cluster and Multiple Correspondence Analysis

ABSTRACT

Background

Patient safety is a global priority, as adverse events represent the 14th leading cause of morbidity and mortality worldwide. Among the most common complications in hospitalized adults are functional decline, pressure injuries, and falls, all of which increase hospital stays, healthcare costs, and mortality. Although these risks are typically assessed independently, their interaction has been scarcely explored, and the identification of integrated patient risk profiles could better guide nursing care.

Objective

To establish profiles of adult inpatients based simultaneously on their level of functional capacity, risk of pressure injuries, and risk of falls.

Design

Cross-sectional observational study.

Participants

A total of 2.666 patients were admitted to adult inpatient units in a Spanish hospital.

Methods

Data from the Barthel, Braden, and Downton scales collected within 24 h of admission were analyzed. A hierarchical cluster analysis followed by the k-means method was used to classify patients. Relationship between profiles and clinical variables were explored through multiple correspondence analysis, and predictors for each profile were identified using multinomial logistic regression.

Results

Three patient profiles were identified: profile 1 (low risk), minor dependency, low risk of pressure injuries and falls (68.5%); profile 2 (moderate risk), moderate dependency and intermediate risk (15.4%); and profile 3 (high risk), severe dependency with high risk of pressure injuries and falls (16.1%). Older age, female sex, and higher comorbidity were significantly associated with higher-risk profiles (p < 0.001).

Conclusions

Hospitalized adults can be reliably classified into risk profiles based on functional capacity and the risk of pressure injuries and falls.

Implications

The identification of combined risk profiles may potentially guide nursing strategies to enhance patient safety, support individualized care planning, and contribute to optimizing resource distribution in hospital settings.

Impact

Loss of functional capacity, pressure injuries, and falls are key nursing-sensitive indicators of care quality. Profile-based stratification offers a new framework for personalized, data-driven, and safety-oriented nursing care.

Clinical Relevance

The identification of integrated risk profiles based on functional capacity, pressure injury risk, and fall risk may support more comprehensive nursing assessment in hospitalized adults. These profiles may help inform care prioritization, facilitate early identification of vulnerable patients, and contribute to more efficient allocation of nursing resources. Incorporating multidimensional risk stratification into clinical practice may enhance coordinated and patient-centered care planning.

Assessing Quality of Action Research Using the Quality Assessment Action Research Checklist (QuARC): A Hybrid Systematic Narrative Review

ABSTRACT

Aim

To evaluate the quality of action research studies using the Quality Assessment Action Research Checklist (QuARC) and to assess its utility as a tool for quality appraisal.

Design

A hybrid systematic narrative review following Turnbull et al.'s six-stage methodology and reported in accordance with PRISMA 2020 guidance.

Data Sources

Scopus was searched for author self-identified action research studies published between January 2020 and March 2024.

Review Methods

Two reviewers independently selected studies meeting inclusion criteria: health science action research papers addressing any or all of QuARC's four quality factors. A scoring system was used to capture each of QuARC's 17 quality items, which was scored as 0 (absent), 0.5 (partial) or 1 (comprehensive). Narrative synthesis was undertaken across the four QuARC domains.

Results

Thirty-two studies met the inclusion criteria. Reporting frequencies across QuARC were: Context (92.5%, mean = 3.7/4), Quality of Relationships (55% mean = 2.2/4), Quality of Action Research Process (62.5% mean = 2.5/4), and Quality of Outcomes (62.5% mean = 3.1/5). Reporting gaps were most evident in reflexive co-analysis, relational evaluation and explicit theoretical contribution.

Conclusion

Global reporting of rigour and quality in action research remains inconsistent. QuARC functioned both as an appraisal instrument and as an analytic lens, revealing systematic patterns in how action research privileges practical change over theoretical articulation and reflexive relational work. Further refinement and validation are recommended to strengthen its reliability as an appraisal tool.

Implications

Findings highlighted a critical need to establish a standardised, validated approach to assess quality in action research. Adoption of QuARC can enhance consistency, clarity and comparability across studies, strengthening the evidence base for action research methodologies.

Impact

This first systematic synthesis of QuARC's application provides an evidence base for its further development. This lays foundations for international standards in quality appraisal, strengthening the credibility, reproducibility and influence of action research.

Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey

ABSTRACT

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

Evolution of Patient and Public Involvement and Engagement in Health‐Related Research: A Concept Analysis

ABSTRACT

Aims

To clarify the definition and evolution of Patient and Public Involvement and Engagement (PPIE) and identify its attributes, antecedents, and consequences in health-related research.

Design

This study follows Rodgers' evolutionary concept analysis with a seven-step framework.

Methods

Datasets were searched using terms related to PPIE and key categories (i.e., attributes, antecedents, and consequences). Data were sourced from CINAHL, PsycInfo, Scopus, PubMed, and Web of Science covering publications from inception to October 31, 2024. Document titles, abstracts, and keywords were manually screened to identify relevant studies for full-text review.

Results

A total of 1751 documents were screened, resulting in 38 eligible studies included in the final analysis. PPIE has evolved from a narrow focus on patient inclusion and participation, where patients had minimal influence on research and researchers resisted sharing control of research, to a collaborative model emphasising sustained partnerships, shared contributions, equitable power distribution, and active involvement across research stages. This shift has been driven by research innovation, a growing emphasis on healthcare equity and patient-centred care, technological advances, and stakeholder advocacy (e.g., patients, funders, ethics committees). While PPIE enhances research relevance and impact, barriers, such as resource constraints, power imbalances, patient limited research capabilities and increased researcher workload persist. Facilitators, such as training programmes, standardised guidelines, flexible arrangements and transparent communication can enable meaningful partnerships.

Conclusion

The concept of PPIE is evolving toward greater clarity and consistency in research, positioning patients and the public as active, essential contributors rather than passive participants. Barriers and facilitators were identified to inform its utilisation in research.

Impact

This study clarifies the conceptual ambiguities of PPIE, informs theory development, and provides actionable insights. Healthcare and nursing researchers can draw on its findings to utilise PPIE to enhance collaborative and inclusive research practices that align with the needs of patients and the public.

Reporting Method

This study adheres to the PRISMA (2020) reporting guidelines for systematic reviews.

Patient or Public Contribution

One of our co-authors is a patient with lived experience of cancer, who contributed valuable comments and suggestions to enhance this paper.

An Innovative Doctor of Nursing Programme: Transforming Learning, Leadership and Health Systems

ABSTRACT

Aim

To provide an in-depth description of an innovative Doctor of Nursing programme which prepares nurses for senior roles in healthcare and related organisations. This programme provides nurse leaders with the knowledge and skills to advance systems through healthcare innovation design, implementation, and evaluation.

Methods

A comparison of doctoral nursing programmes, highlighting the unique aspects of the University of Calgary Doctor of Nursing programme.

Results

The University of Calgary Doctor of Nursing programme addresses key gaps that currently exist within nursing education. Few existing programmes directly support the development of nurses as healthcare leaders and innovators. This programme enables nurse leaders to leverage their front-line experience into senior system-level leadership roles. Each core course includes a building block assignment that develops key doctoral skills: framing research questions, appraising literature, selecting methods and data, planning ethically sound projects, and translating evidence into persuasive arguments for policy or system change.

Conclusion

Nurses play a vital role in healthcare around the world. The University of Calgary Doctor of Nursing programme recognises the value of investing in nursing leaders and emboldening them to leverage their frontline leadership experience to advance data-driven change, innovation, and policy development in the complex healthcare systems in which they work and lead.

Implications for the Profession

Currently, there is a dearth of programmes available to prepare nurses for senior leadership roles in healthcare or related organisations, despite significant demand from prospective students and employers alike. The University of Calgary Doctor of Nursing programme meets the workforce demand for a programme focused on nursing leadership, to advance health systems through skill development in systems innovation, appraisal of evidence and implementation science, as well as quality assurance/quality improvement and programme evaluation. This programme focus also better equips students to examine and evaluate systemic inequities and challenges currently facing healthcare systems, practitioners and users.

Co‐Designing a Model of Brilliant Care for Older People

ABSTRACT

Aim

This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.

Background

As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.

Design

Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.

Methods

Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.

Results

The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.

Conclusions

This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.

Relevance to Clinical Practice

For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.

Patient or Public Contribution

The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.

The Relationship Between Individual Social Responsibility and the Public's Intention to Act Violently Toward Nurses—A Cross‐Sectional Study

ABSTRACT

Aims

To explore (a) the associations between individual social responsibility and the public intention to use violence against nurses; and (b) the relationship between individual social responsibility, personal variables and the public's intention to employ violence against nurses.

Background

Workplace violence against nurses is a significant widespread occupational health issue. To date, no reference has been found to the association between personality traits such as individual social responsibility and the public's intention to use violence against nurses.

Design and Methods

A cross-sectional survey design with a convenience sample of 667 Israeli participants from among the public. A structured self-report questionnaire was distributed, including socioeconomic variables, individual social responsibility and responses to four vignettes describing incidents of violence directed at nurses. Multiple linear regressions were calculated for intention to employ violence, with demographic variables and individual social responsibility as independent variables. The STROBE checklist for cross-sectional studies was used for reporting.

Results

Negative correlations were found between individual social responsibility and the intention to employ violence against nurses. Gender, having witnessed physical violence and individual social responsibility explained 19% of the variance in the intention to employ violence against nurses. Demographic variables and having witnessed verbal or physical violence were found to moderate the association between individual social responsibility and the intention to employ violence against nurses.

Conclusions

Witnessing a violent incident in a healthcare setting is a risk factor for the intention to employ violence against nurses. Our findings point to the role of individual social responsibility as one of the strategies to help reduce violent events.

Implications for the Profession and/or Patient Care

Educating and promoting values of social responsibility among the public can reduce incidents of violence in healthcare settings, thus contributing to the safety and quality of care provided.

Patient or Public Contribution

The public contributed via study participation.

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