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Global prevalence and determinants of hospital-acquired COVID-19: protocol for a systematic review and meta-analysis

Por: Ribaric · N. L. · ONeill-Byrne · Z. · Hellinger · A. · Pan · D. · Wilson · N. M. · Viola · I. M. · Walsh · T. S. · Lawton · T. · Afanasjevs · S. · Calabria · C. · De Angelis · F. · Brehm · T. T. · Zapf · A.
Introduction

A proportion of patients hospitalised for COVID-19 acquire the disease during their hospital stay, underscoring the risk of hospital-acquired COVID-19 (HA-COVID-19). This risk is presumed to be high, given how commonly and intensely air and surfaces within hospitals are reportedly contaminated with SARS-CoV-2. However, the true extent of HA-COVID-19 worldwide remains unknown, with limited understanding of factors that influence its occurrence and how these have evolved over time. This review will therefore aim to estimate the pooled prevalence of HA-COVID-19 among hospitalised COVID-19 patients globally and investigate differences by country, type of hospitals, medical specialty, length and timing of studied periods.

Methods and analysis

A systematic review and meta-analysis will be conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE and PubMed Central (via PubMed), Scopus, Embase (via Ovid), the Web of Science Core Collection as well as websites of public health agencies (PHA) will be searched until 1 July 2026. All journal articles and sources from PHAs reporting any primary data on the prevalence of HA-COVID-19 will be included. Methodological quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The primary outcome will be the global prevalence of HA-COVID-19. Data synthesis will include random-effects proportional meta-analysis. Estimates will be presented with two-sided 95% CIs and heterogeneity assessed using the I² statistic.

Ethics and dissemination

Ethical approval is not needed as no original data will be generated. This review will be published in an international, peer-reviewed journal.

PROSPERO registration number

CRD420251136884.

Health Outcomes Led by Advanced Practice Nurses in Patients With Chronic Wounds: A Scoping Review

ABSTRACT

Aim

To examine and map the available literature on outcomes associated with interventions carried out by advanced practice nurses in chronic wound care.

Background

The role of the advanced practice nurses in wound care is identified as a key element in the management of patients with chronic wounds. However, the literature offers fragmented knowledge of the outcomes associated with their practice.

Design

Scoping review.

Methods

This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. Observational or experimental studies related to patients affected by chronic wounds and cared for by advanced practice nurses in wound care were included.

Data Sources

The following databases were queried: PubMed, CINAHL, Cochrane Library, and Scopus from 01 May 2025 to 31 October 2025.

Results

The search strategy in the consulted databases identified 1956 studies; 31 met the inclusion criteria. Different types of chronic wounds were investigated: diabetic foot ulcers, venous leg ulcers, and pressure injuries. The most frequently measured outcomes were clinical responses (healing, recurrence, complications), organizational efficiency (referrals, resource utilization), and patient-reported outcomes.

Conclusion

Evidence from the included studies suggests that Advanced practice nurses led wound care models may be associated with faster healing, lower recurrence and complication rates, and more efficient care pathways, across different settings. This review highlights the global applicability of APN-led models, showing consistent improvements in clinical, organizational, and patient-reported outcomes through core interventions.

Reporting Method

This scoping review follows Arskey and O'Malley's methodological framework and the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review.

Patient or Public Contribution

No Patient or Public Contribution.

Protocol Registration

The revision protocol was registered on the OSF (https://doi.org/10.17605/OSF.IO/P9TA4).

Implementing Wound Hygiene in the Italian Healthcare Context: Expert Recommendations for the Management of Venous Leg Ulcers

ABSTRACT

The ‘Wound Hygiene Italia’ project was designed to provide expert-driven recommendations for the assessment, management and monitoring of venous leg ulcers, tailored to diverse settings of care (hospital, ambulatory and home care). The recommendations, developed by a multidisciplinary panel, emphasise the implementation of the Wound Hygiene strategy, a systematic approach targeting biofilm as a primary barrier to wound healing. Wound management is structured around four steps: cleansing, debridement, edge refashioning and dressing selection adapted to the wound bed characteristics, care setting and clinical capabilities, embedded in a holistic approach through comprehensive patient assessment and monitoring of overall well-being. The findings highlight the necessity of interdisciplinary collaboration, standardised tools and continuous patient monitoring, as assessed by objective metrics, such as wound size measurements and photographic documentation. Effective communication with patients and caregivers is also essential to ensure treatment adherence and foster trust in the care process. This framework integrates evidence-based practices to optimise outcomes and patient quality of life. By addressing both clinical and psychosocial factors, the recommendations promote a holistic, patient-centred approach that underscores the importance of education, structured follow-ups and tailored interventions.

Assessment of vestibulo-ocular reflex function in people with Parkinsons disease: a cross-sectional study in a rehabilitation setting using the video head impulse test

Por: Ferri · N. · Casagrande Conti · L. · Manzari · L. · Piatti · D. · De Angelis · D. · Nocentini · U. · Tramontano · M.
Background

Parkinson’s disease (PD) is a neurodegenerative, progressive disorder known for motor and non-motor symptoms. The vestibular system, via the vestibulo-ocular reflex (VOR), is crucial for maintaining dynamic gaze stability, and its role in PD is raising interest among researchers. Indeed, vestibular dysfunction in PD may exacerbate postural instability and gait disturbances; however, the prevalence of vestibular dysfunctions remains unclear. This study aims to objectively investigate the VOR function in people with PD using the video head impulse test.

Methods

This is a cross-sectional study conducted in a neurorehabilitation hospital. People with PD were included if they had no cognitive impairment and the ability to walk without physical assistance. The video head impulse test was used to assess the VOR function across all six semicircular canals, using both the Head Impulse Paradigm (HIMP) and the Suppression Head Impulse Paradigm (SHIMP) paradigms.

Results

35 people with PD (mean age: 69.9±8.4; 11 females) with moderate motor symptoms (MDS-UPDRS-part III: 27.7±6.8) were included. Using normative cut-offs, 69% of the participants had at least one dysfunctional canal (60% hypo-gain, 9% hyper-gain). The prevalence reached 83% when both the HIMP and SHIMP paradigms were considered.

Conclusion

There is a high prevalence of vestibular dysfunction in people with PD. The instrumental assessment of VOR gains could reveal undiagnosed vestibular dysfunctions and, in the future, lead to more specific rehabilitation management of people with PD.

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