Conectar
Medication administration errors are high-risk patient safety issues that could potentially cause harm to patients, thereby delaying recovery and increasing length of hospital stay with additional healthcare costs. Nurses are pivotal to the medication administration process and are considered to be in the position to recognize and prevent these errors. However, the effectiveness of interventions implemented by nurses to reduce medication administration errors in acute hospital settings is less reported.
To identify and quantify the effectiveness of interventions by nurses in reducing medication administration errors in adults' inpatient acute hospital.
A systematic review and meta-analysis was conducted up to 03/24. Six databases were searched. Study methodology quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools, and data extraction was conducted. Meta-analysis was performed to combine effect sizes from the studies, and synthesis without meta-analysis was adopted for studies that were not included in the meta-analysis to aggregate and re-examine results from studies.
Searches identified 878 articles with 26 studies meeting the inclusion criteria. Five types of interventions were identified: (1) educational program, (2) workflow smart technologies, (3) protocolised improvement strategy, (4) low resource ward-based interventions, and (5) electronic medication management. The overall results from 14 studies included in meta-analysis showed interventions implemented by nurses are effective in reducing medication administration errors (Z = 2.15 (p = 0.03); odds ratio = 95% CI 0.70 [0.51, 0.97], I 2 = 94%). Sub-group analysis showed workflow smart technologies to be the most effective intervention compared to usual care. Findings demonstrate that nurse-led interventions can significantly reduce medication administration errors compared to usual care. The effectiveness of individual interventions varied, suggesting a bundle approach may be more beneficial. This provides valuable insights for clinical practice, emphasizing the importance of tailored, evidence-based approaches to improving medication safety.
PRISMA guided the review and JBI critical appraisal tools were used for quality appraisal of included studies.
To quantify and describe the use of real-world data (RWD) in National Institute for Health and Care Excellence (NICE) oncology technology appraisal (TA) final appraisal determination documents.
A systematic literature review was conducted on pharmaceutical NICE oncology TAs published between April 2000 and March 2024 (covering financial years 2000/2001 to 2023/2024 inclusive) extracted on 22 August 2023 (2000/2001 - 2022/2023) and 8 August 2024 (2023/2024).
NICE TA final appraisal determination documents.
All pharmaceutical oncology TAs published between April 2000 and March 2024 (financial years 2000/2001 to 2023/2024) that did not go on to be terminated.
The data required for eligibility screening was extracted from an Excel file directly from the NICE website, where data related to each TA was extracted using an automated script derived from published sources. TAs were assessed based on prespecified review criteria covering whether an RWD submission was reported by the committee, and if so, which RWD sources were used, alongside the methods reported and any feedback from the committee regarding the use of RWD. Bias was not assessed as part of the study.
Of 310 TAs identified, 135 (48.0%) used RWD. A variety of RWD types were used, mostly from UK or US data sources. 47 TAs (34.8%) leveraged RWD from multiple sources. RWD was mostly used in comparisons of survival (41.5%), to inform utility values (26.7%) and to compare baseline characteristics (19.3%), with matched adjusted indirect comparisons (MAICs) and external control arms (ECAs), seen from 2015 and 2018, respectively. The committee expressed concerns around the RWD presented by the company in 53 TAs (39.2%), the most common being a lack of generalisability to the UK population and/or National Health Service practice and comprehensiveness of the RWD.
This study quantifies the increasing use of diverse RWD sources in NICE oncology TAs, as well as the shift towards more complex methods like MAICs and ECAs. The feedback of the NICE committee highlights key areas of improvement as the generalisability and maturity of the RWD presented.
Multiple sclerosis (MS) is a chronic neurological condition that affects approximately 150 000 people in the UK and presents a significant healthcare burden, including the high costs of disease-modifying treatments (DMTs). DMTs have substantially reduced the risk of relapse and moderately reduced disability progression. Patients exhibit a wide range of responses to available DMTs. The Predicting Optimal INdividualised Treatment response in MS (POINT-MS) cohort was established to predict the individual treatment response by integrating comprehensive clinical phenotyping with imaging, serum and genetic biomarkers of disease activity and progression. Here, we present the baseline characteristics of the cohort and provide an overview of the study design, laying the groundwork for future analyses.
POINT-MS is a prospective, observational research cohort and biobank of 781 adult participants with a diagnosis of MS who consented to study enrolment on initiation of a DMT at the Queen Square MS Centre (National Hospital of Neurology and Neurosurgery, University College London Hospital NHS Trust, London) between 01/07/2019 and 31/07/2024. All patients were invited for clinical assessments, including the expanded disability status scale (EDSS) score, brief international cognitive assessment for MS and various patient-reported outcome measures (PROMs). They additionally underwent MRI at 3T, optical coherence tomography and blood tests (for genotyping and serum biomarkers quantification), at baseline (i.e., within 3 months from commencing a DMT), and between 6–12 (re-baseline), 18–24, 30–36, 42–48 and 54–60 months after DMT initiation.
748 participants provided baseline data. They were mostly female (68%) and White (75%) participants, with relapsing–remitting MS (94.3%), and with an average age of 40.8 (±10.9) years and a mean disease duration of 7.9 (±7.4) years since symptom onset. Despite low disability (median EDSS 2.0), cognitive impairment was observed in 40% of participants. Most patients (98.4%) had at least one comorbidity. At study entry, 59.2% were treatment naïve, and 83.2% initiated a high-efficacy DMT. Most patients (76.4%) were in either full- or part-time employment. PROMs indicated heterogeneous impairments in physical and mental health, with a greater psychological than physical impact and with low levels of fatigue. When baseline MRI scans were compared with previous scans (available in 668 (89%) patients; mean time since last scan 9±8 months), 26% and 8.5% of patients had at least one new brain or spinal cord lesion at study entry, respectively. Patients showed a median volume of brain lesions of 6.14 cm3, with significant variability among patients (CI 1.1 to 34.1). When brain tissue volumes z-scores were obtained using healthy subjects (N=113, (mean age 42.3 (± 11.8) years, 61.9% female)) from a local MRI database, patients showed a slight reduction in the volumes of the whole grey matter (–0.16 (–0.22 to –0.09)), driven by the deep grey matter (–0.47 (–0.55 to –0.40)), and of the whole white matter (–0.18 (–0.28 to –0.09)), but normal cortical grey matter volumes (0.10 (0.05 to 0.15)). The mean upper cervical spinal cord cross-sectional area (CSA), as measured from volumetric brain scans, was 62.3 (SD 7.5) mm2. When CSA z-scores were obtained from the same healthy subjects used for brain measures, patients showed a slight reduction in CSA (–0.15 (–0.24 to –0.10)).
Modelling with both standard statistics and machine learning approaches is currently planned to predict individualised treatment response by integrating all the demographic, socioeconomic, clinical data with imaging, genetic and serum biomarkers. The long-term output of this research is a stratification tool that will guide the selection of DMTs in clinical practice on the basis of the individual prognostic profile. We will complete long-term follow-up data in 4 years (January 2029). The biobank and MRI repository will be used for collaborative research on the mechanisms of disability in MS.
This study was designed to explore the potential categories and their characteristics of self-compassion in Chinese enterostomy patients and then to investigate related factors.
A cross-sectional study.
The research focused on enterostomy patients who were hospitalised in two tertiary hospitals in Yangzhou City, China, between Nov 2022 and Aug 2023.
222 adult enterostomy patients in China completed the questionnaires.
This study investigated scores from the Self-Compassion Scale, Perceived Stress Scale and the Social Support Rating Scale. Information on the patients included: age, gender, marital status, monthly household income, types of medical insurance, education level, place of residence, enterostomy complications, postoperative time and whether adjuvant chemotherapy was given.
Three profiles of self-compassion in enterostomy patients were identified: ‘low self-compassion group’ (class 1), ‘moderate self-compassion group’ (class 2) and ‘high self-compassion group’ (class 3), accounting for 40.5%, 28.0% and 31.5%, respectively. The multivariate logistic analysis showed adjuvant chemotherapy, social support (PP
There is significant heterogeneity in self-compassion among enterostomy patients, and nearly half of them belong to the ‘low self-compassion group’. Focused interventions are required for females, patients with permanent enterostomy, low educational level and undergoing adjuvant radiotherapy. The self-compassion ability of patients can be effectively improved by reducing perceived stress and enhancing social support. These findings provide a basis for constructing targeted intervention strategies.
by Min Wang, Yushun Yan, Wanqiu Yang, Ruini He, Lingdan Zhao, Yikai Dou, Yuanmei Tao, Xiao Yang, Qingqing Xiang, Xiaohong Ma
Psychiatric nurses represent a high-stress occupational group that experiences elevated levels of suicidal ideation (SI), emphasizing the need for focused mental health interventions. The main purpose of this study was to examine the prevalence of SI among psychiatric nurses and to identify the psychological and occupational factors associated with SI. A total of 1,835 psychiatric nurses completed questionnaires on depressive symptoms (PHQ-9), SI, quality of work-related life (QWL), and burnout. Multivariate logistic regression and phenotypic network analyses were conducted to identify factors associated with SI and the potential pathways linking depressive symptoms, burnout, and QWL to SI. The results indicated that 11.33% of the participants had SI in the past two weeks. Multivariate logistic regression revealed that emotional exhaustion, depersonalization, personal accomplishment, stress at work, general well-being, and the home-work interface were significant predictors of SI. Network analysis further revealed that psychomotor changes, guilt, sad mood, low energy, and appetite changes were the symptoms most directly associated with SI. In addition, sad mood, general well-being, and work-home interface were linked to job and career satisfaction, whereas sad mood and low energy were associated with emotional exhaustion and SI. These findings contribute valuable large-scale evidence on the mental health challenges faced by psychiatric nurses and highlight the importance of addressing mood disturbances, energy loss, and work-related stress in SI prevention efforts for this vulnerable group.by Adedapo Olufemi Bashorun, Larry Kotei, Abdoulie F. Jallow, Ousubie Jawla, Emmanuel U. Richard-Ugwuadu, Muhammed Jagana, Lamin Bah, Amadou Tijan Bah, Karamo Conteh, Mamadou S.K. Jallow, Mehrab Karim, Bai Lamin Dondeh, Anne Segonds-Pichon, Gary M. Clifford, Iacopo Baussano, Bruno Pichon, David Jeffries, Ed Clarke
Human papillomavirus (HPV) infection is a primary cause of preventable deaths from cervical cancer, a condition of profound inequality with approximately 90% of deaths occurring in low- and middle-income countries, particularly in sub-Saharan Africa. In May 2018, the WHO Director-General declared a Joint Global Commitment to Cervical Cancer Elimination, highlighting the critical role of HPV vaccines in achieving this goal. However, there is a lack of systemically collected data on HPV prevalence in The Gambia, and impact data from high-income countries may not be reliably extrapolated to West African settings due to geographical variation in HPV types and distinct behavioural, biological, and sociodemographic exposures. The Gambia introduced a two-dose HPV vaccination schedule in 2019, but coverage has been very low, interrupted mainly by the COVID-19 pandemic. This presents a key opportunity to generate vital baseline data on HPV prevalence in the population before potential scale-up of vaccination efforts. The PHASE survey, a multi-stage cluster survey, aims to establish the baseline, population prevalence estimates of high-risk and low-risk, vaccine-type and non-vaccine-type HPV infection in 15- to 49-year-old females in The Gambia by measuring urinary HPV-DNA. The survey will also quantify the effects of various exposures on HPV prevalence, including sexual behaviour, the presence of other sexually-transmitted infections (STIs) - Neisseria gonorrhoea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV), Mycoplasma genitalium (MG), syphilis, as well as blood borne viruses, human immunodeficiency virus (HIV), hepatitis B and hepatitis C; obstetric history, socio-demographic characteristics, and cervical cancer screening and/or treatment. Additionally, the study will provide important antimicrobial resistance (AMR) data for NG and MG in sub-Saharan Africa, a region poorly represented in global surveillance programs. This data is needed to guide regional treatment guidelines and advocate for new solutions, including gonococcal vaccines. The AMR data are expected to immediately influence recommendations regarding the appropriate choice of antibiotics for syndromic STI management in West Africa and hence to address an important driver of AMR in the sub-region. Leveraging on the Medical Research Council Unit The Gambia funded Health Demographic Surveillance system (HDSS) as its sampling frame, the survey will utilize validated diagnostic assays and culturally sensitive data collection methods, to ensure both scientific rigor and local relevance. Tools such as Audio Computer-Assisted Self-Interviewing (ACASI) technology, developed in consultation with local community advisory boards, are included to reduce social desirability bias in reporting sexual behaviour. This approach aims to maximize both the reliability and cultural appropriateness of the findings. This study directly addresses the critical need for baseline epidemiological data on HPV in a West African setting to accelerate vaccine impact and drive new interventions towards cervical cancer elimination. By understanding other factors that influence HPV (like other STIs, sexual behaviour, etc.), the study aims to ensure that, when the vaccine’s impact is measured later, changes in other confounding factors that may impact on HPV prevalence can be accounted for. The study will also establish the population prevalence of the measured STIs and their relationship to common symptoms and other adverse health outcomes related to STIs.Recent legislation in the UK regarding requirements for new developments to increase biodiversity may have significant implications for the environment and population health. Despite this, relatively little is known regarding the health and social benefits of increasing biodiversity in densely populated urban areas.
This protocol outlines plans for a mixed-method, longitudinal, natural experiment study which will evaluate the planned, biodiversity-focused redevelopment of six small urban parks in Edinburgh, Scotland (UK). Using systematic observation (at baseline, 1 month post-intervention and 1 year post-baseline) and a longitudinal household survey (at baseline and 1 year post-baseline), the primary outcomes of personal well-being, and secondary outcomes of nature connectedness and park usage behaviours, will be assessed, respectively. Consent for data linkage of respondent’s health records will also be sought. Process evaluation will employ semi-structured, qualitative interviews with stakeholders and walk-along interviews with local residents in order to understand implementation processes. Space-related well-being will also be assessed using citizen science approaches.
This study was approved by the University of Edinburgh’s School of Health in Social Sciences ethics committee. This study will provide further evidence for policymakers, the public and researchers of the health and social well-being effects of urban biodiversity interventions. Study findings will be disseminated via public forums such as community workshops and through publication in peer-reviewed journals and presentation at scientific conferences.
Postpartum depression (PPD) is a debilitating condition affecting over 20% of postpartum women, with disproportionately higher rates among black and Latina women compared with their white counterparts. Current recommendations for PPD prevention demand significant healthcare system resources, highlighting the need for alternative, evidence-based interventions that minimise strain on these systems. Mindfulness has been shown to effectively reduce depressive symptoms and prevent relapse across various populations. However, no studies to date have evaluated the efficacy of a digitally delivered mindfulness intervention specifically for black and Latina women at increased risk of PPD.
This article presents the protocol for the Healthy Mama and Baby study, a randomised controlled trial (RCT). This trial evaluates whether a mobile-based (mHealth) mindfulness intervention tailored for pregnant women reduces depressive symptoms among pregnant black and Latina women at high risk for PPD.
We are conducting a fully remote RCT, recruiting 600 pregnant black and/or Latina women at risk of PPD from Kaiser Permanente Northern California (KPNC), an integrated healthcare delivery system. Participants are enrolled before 30 weeks’ gestation. They are randomised into either an mHealth mindfulness intervention arm, which receives access to a mindfulness app tailored specifically for pregnant and postpartum women, or a time-matched and attention-matched active control arm, which receives access to an online program of calming nature sounds. Both arms are instructed to engage in their assigned program for 5–20 min per day for 6 weeks. Outcome assessments are conducted online at baseline, post intervention and post partum (~7 weeks post partum) using validated questionnaires. Outcomes include depressive symptoms (primary) and anxiety, sleep and perceived stress (secondary).
All study procedures have been approved by the KPNC Institutional Review Board. The findings will be disseminated widely through peer-reviewed publications and conference presentations.
Coronary artery bypass grafting (CABG) remains one of the most commonly performed cardiac surgeries worldwide. Despite surgical advancements, a significant proportion of patients experience psychological distress following surgery, with depression being particularly common. Current evidence regarding the effectiveness of preoperative psychological interventions in improving postoperative mental health outcomes remains inconclusive. There is a critical need for predictive models that can identify patients at risk of developing clinically significant depressive symptoms (CSDSs) and related psychological conditions after CABG. This multicentre observational study aims to develop and validate prognostic models for predicting CSDSs and other psychological outcomes, including anxiety, post-traumatic stress symptoms and quality of life, 6 weeks after elective CABG surgery.
The study will recruit 300 adult patients undergoing elective CABG (with or without valve intervention) across two Swiss hospitals. Data collected will include demographic, clinical, psychometric, inflammation-related and interoceptive variables. A training set (n=200) will be used to develop predictive models using machine learning, while a held-out test set (n=100) will be used for model validation. The primary outcome prediction will focus on CSDSs, assessed using the Patient Health Questionnaire-9 (PHQ-9), with analyses conducted both categorically (PHQ-9 total score ≥10) and continuously as complementary approaches. Secondary models will address anxiety, using the General Anxiety Disorder Scale-7, post-traumatic stress, using the post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders-5 and health-related quality of life, using the 12-item Short Form Survey. A simplified ‘light solution’ model with fewer predictors will also be developed for broader applicability. This study will address an important gap in perioperative mental healthcare by identifying key predictors of psychological morbidity following CABG, particularly CSDSs. The resulting models may inform future screening and preventive strategies and improve postsurgical outcomes through early identification and intervention in high-risk individuals.
The responsible ethics committee has reviewed and approved this project (Kantonale Ethikkommission Zürich, BASEC number: 2023-02040). The study minimises participant burden by integrating brief validated instruments and limiting psychiatric interviews to relevant outcomes, while ensuring ethical safeguards and respect for participant rights (including written consent). Results will be shared through peer-reviewed publications, conference presentations and stakeholder meetings involving clinicians and mental health professionals. Findings will also be communicated to participating centres and patient communities in accessible formats.
The presence of acne can significantly impact patients’ health-related quality of life (HRQoL); however, the correlation between patient-reported HRQoL impairment and clinician-evaluated severity has been unclear. The objective of the study was to evaluate HRQoL in patients with different acne severity using generic, dermatology-specific and acne-specific instruments and investigate the correlation between clinical severity and HRQoL.
Data for the cross-sectional survey were extracted from March 2017 to December 2018. The convenient sampling strategy was used to select participants.
The study was conducted at the Department of Dermatology, Qilu Hospital, Shandong University.
A total of 1056 outpatients participated in the survey, and 962 patients were analysed in the study.
The generic instrument (EuroQol 5-Dimensions 5-Levels, EQ-5D-5L), dermatology-specific instrument (Dermatology Life Quality Index, DLQI) and acne-specific instrument (Cardiff Acne Disability Index, CADI) were administered to assess HRQoL and the Global Acne Grading System was used to measure clinical severity.
The mean health state utility (HSU) EQ-5D-5L score of 0.96 (SD: 0.06), a total DLQI score of 6.84 (SD: 4.88) and a total CADI score of 5.72 (SD: 2.81). Patients with moderate and severe acne showed greater impairment compared with patients with mild acne, as evidenced by significantly lower HSU scores (–0.017 and –0.066) and higher DLQI (1.457 and 2.043) and CADI scores (0.726 and 1.685). Clinical severity was weakly correlated with HRQoL scores for all acne severities (rs=–0.131 to 0.167).
Acne is associated with significant HRQoL impairments, especially in terms of psychosocial functioning. It is very important to incorporate HRQoL assessment into clinical practice in future research, and dermatology-specific and acne-specific HRQoL instruments should be used in combination to assess the health status of acne patients.
Health coaching is the process of working with a trained coach, peer, or healthcare professional towards self-determined health and wellness goals. Health coaching is being increasingly adopted in multiple healthcare settings and has been shown to improve overall health outcomes and long-term maintenance of chronic conditions in multiple countries and healthcare settings. Research surrounding the costs of implementing health coaching and its effects on healthcare costs, particularly long-term costs, has been limited. Although analysis of healthcare costs has become an important priority in recent years, the available literature looking at the cost impacts of health coaching is small and inconclusive, finding mixed results with a variety of methodologies. This scoping review aims to identify gaps in the literature and help set a research agenda regarding the costs of health coaching implementation and its impacts.
The scoping review will be structured according to Levac et al’s enhancement to Arksey and O’Malley’s framework for conducting scoping reviews. PubMed, Embase, and the Health and Medicine Collection will be searched for peer-reviewed research that includes health and wellness coaching and some measurement of cost. Details about the type of study, cost analysis, methodology and results from the included articles will be extracted and summarised. Full-text publications, excluding editorials and opinion pieces, included in this scoping review will be published in 2017 or later, will be written in English, will align with the definition of health coaching as described by the National Board for Health and Wellness Coaching
Findings will be disseminated through a peer-reviewed publication and through presentations to both health system and community-based entities currently using or considering adopting health coaching. Ethics approval is not a requirement for this review as no human research participants will be involved. All data will be obtained from publicly available literature, with no primary data generated.
The quality of paid disability support services has significant implications for the autonomy, well-being and community participation of adults with disability. However, variability in service provision and evaluation persists. Despite the growing public investment and focus on improving support quality, there appears to remain a lack of comprehensive tools and measures to evaluate the quality of paid disability support. This scoping review aims to systematically identify and map the existing tools and measures used to evaluate the quality of paid disability support for adults with disability.
This scoping review will be conducted following the methodology outlined by Arksey and O’Malley, enhancements proposed by Levac et al and the Joanna Briggs Institute along with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews guidelines. The research question guiding the review is: ‘What existing tools and measures are available to evaluate the quality of paid disability support services?’ Comprehensive searches will be conducted in MEDLINE, PsycINFO, Embase, CINAHL and Scopus to identify peer-reviewed articles published in English since 2014. Supplementary grey literature searches will also be conducted, alongside an online survey to obtain stakeholder input. Articles or grey literature sources that report on tools or measures for evaluating paid disability support for adults (aged 18–65 years) with disability will be included. Data extraction will focus on study characteristics, participant demographics and the characteristics of the quality of support measurement tools. A narrative synthesis will be used to present the findings.
Ethical approval will be obtained for the online stakeholder survey component of the review. No ethical approval is required for the scoping review of the literature. The results will be disseminated through peer-reviewed publications, conference presentations and accessible formats to ensure a wide audience is reached, including researchers, policymakers and disability service providers.
by Nipaporn Butsing, Nalinrat Thongniran, Jesada Keandoungchun
BackgroundStrokes are the major cause of disability. Functional recovery following an acute stroke is time-dependent and varies depending on several factors. This study aimed to investigate changes in functional outcomes after stroke from discharge to six months post-discharge and to identify factors associated with changes in functional outcomes during this six-month period.
MethodsThe study included 155 consecutive patients with a first stroke and were hospitalized in an acute stroke unit at an advanced tertiary hospital in Bangkok between April 2020 and August 2021. The patients’ functional outcomes were evaluated using the modified Rankin Scale (mRS) and the Barthel Index (BI) before hospital discharge and at one-, three-, and six-month post-discharge. Friedman tests were used to assess changes in mRS scores over six months. Linear mixed effect regression was applied to identify the change in BI scores during the six months post-discharge.
ResultsOf the participants, 62.6% were men, and the mean age was 64.0 (SD = 12.5). The median mRS scores ranged from 3.0 at discharge to 0.0 at six months post-discharge. Significant changes in mRS scores were identified within three months post-discharge, and differences by stroke subtype and severity (P Conclusion
The time after discharge, gender, stroke subtype, and stroke severity are significant factors affecting functional outcomes after a stroke. The most significant improvement in functional outcomes occurred within one month post-discharge.
To evaluate the effectiveness of nutrition care delivered by general practitioners (GPs) compared with usual or no care on dietary and health outcomes in adults with diet-related chronic conditions or risk states and to examine which intervention components are associated with effectiveness.
A systematic review of randomised controlled trials (RCTs).
CINAHL, Embase, MEDLINE and ProQuest Nursing and Allied Health databases were searched in October 2021 and updated in February 2024 for articles related to GPs, nutrition care and diet-related health outcomes.
Published RCTs were included according to the following criteria: adults with or at risk of diet-related chronic conditions; nutrition care delivered by GPs in the primary care setting; usual or no care as comparators; and dietary and/or health outcomes with a minimum 3-month follow-up. No restriction was placed on the date of publication.
Duplicates were reconciled in EndNote. Two reviewers independently screened the titles, abstracts and full texts in Covidence. Two independent reviewers completed the critical appraisal and data extraction. Disagreements were resolved through discussion or with a third reviewer. The Motivation Actions and Prompts (MAP) framework was used to analyse the behaviour change components of study interventions. Results were reported using narrative synthesis and certainty in findings was summarised using GRADEpro GDT software.
Seven RCTs met the inclusion criteria (5744 patients). The trials were conducted in Australia, Italy and the USA from 1991 to 2013, with follow-up periods from 3 to 12 months. A consistent effect in favour of the intervention was found for diet scores (2 RCTs, 3038 participants). Other outcomes had mixed effects: (1) fat intake (2 RCTs, 2299 participants) – one study with an effect in favour of the intervention and one with mixed effects; (2) blood pressure (3 RCTs, 3063 participants) – one study with mixed effects and two with no effect; (3) body mass index (6 RCTs, 5538 participants) – two studies with an effect in favour of the intervention, two with no effect and two reporting no between group differences; (4) body weight (2 RCTs, 511 participants) – one study with an effect in favour of the intervention and one with no effect and (5) cholesterol (4 RCTs, 2505 participants) – one study with an effect in favour of the intervention and three with mixed effects and/or limited reporting. All studies had a motivation and action route to behaviour change and two had a prompted component, according to the MAP framework. The interventions spanned nine behaviour change groupings and 16 behaviour change techniques. There was a very low certainty of findings in all cases and the studies were of low to moderate methodological quality.
There is mixed evidence of the effectiveness of GP-delivered nutrition care among adults with diet-related chronic conditions or risk states. Additionally, most interventions did not include prompting and had a limited range of behaviour change techniques. The effectiveness of nutrition care delivered by GPs is an understudied area that warrants greater experimental investigation and requires more robust methods and reporting.
CRD42021289011.
by Myriam El Khoury-Malhame, Souheil Hallit, Maria-Jose Sanchez-Ruiz, Sleiman El Hajj, Rita Doumit
IntroductionAnxiety is one of the major global mental health concerns, particularly amidst accumulating adversities. It is the leading cause of distress in adolescents worldwide and has a profound deleterious impact on their mental and physical health and wellbeing. This paper seeks to identify and validate the psychometric properties of the Arabic version of the GAD-7 in Lebanon, aiming to improve the much-needed overall mental health screening in Middle Eastern countries.
MethodsThis study includes a cross-sectional design including 638 adolescents in Lebanese public schools. Participants aged 15−18 years were assessed using GAD-7 (anxiety), PCL-5 (post-traumatic stress disorder), and PTGi (post-traumatic growth) in their Arabic versions at two-time points, spaced three months apart.
ResultsOur analyses revealed that the 7 items of the GAD-7 converged into a single factor. Composite reliability of scores was adequate in the total sample (ω = .88/ α = .87). The convergent validity for this model was satisfactory. Results showed invariance across gender at the configural, metric, and scalar levels, with males showing a higher level of wellbeing compared to females. The pre-posttest assessment for the GAD-7 scale was conducted on 359 participants; the intraclass correlation coefficient was adequate 0.83 [95% CI.79;.86]. Our analyses also show that anxiety symptoms were significantly correlated with higher PTSD (r = 0.68; p r = −.12; p = .004).
ConclusionThe Arabic GAD-7 among Lebanese adolescents displayed highly satisfactory psychometric properties, underscoring its validity. This scale could be valuable for educators and clinicians as a screening tool to rapidly detect anxiety among this vulnerable age group as GAD-7 is easy-to-use, easy to understand, culturally sensitive for Arab population and age appropriate for 15–18-year-old students.
by Alix Boirot, Maria Claudia Addamiano, Clémence Casanova, Niamh M. Redmond, Géraldine Cazorla, Michel Rotily, Anne-Marie Schott-Petelaz, Christian Balamou, Zineb Doukhi, Myriam Kaou, Françoise Couranjou, Julien Mancini, Cyrille Delpierre, Marie-Anne Durand, Aurore Lamouroux
BackgroundColorectal cancer (CCR) is one of the leading causes of death worldwide. Early detection remains a highly effective strategy for curing this disease. In France, despite a free organised screening programme for people aged between 50 and 74, participation rates remain suboptimal. Socioeconomic position and health literacy levels exacerbate the situation, with the lowest screening rates observed in the most socially disadvantaged areas. This study assessed patients’ and General Practitioners’ (GP) views on the acceptability of an intervention to increase screening uptake using a simple brochure and video on the importance and process of CCR screening.
MethodWe conducted a cross-sectional qualitative study using semi-structured interviews with patients (n = 24) and GPs (n = 22) who used or participated in the DECODE project intervention. The interviews were conducted by telephone or videoconference and analysed thematically using Nvivo software and dual independent coding.
Results95% of GPs expressed a clear preference for the video over the brochure. Patients had varied results with 50% preferring the video, as it demonstrated how to do the test, versus the brochure. The humorous and de-dramatising aspects of the video were the two key factors highlighted by interviewees. However, support from healthcare staff (GPs, nurses, etc.) is still essential, in supporting patients in prevention. This presents a challenge for GPs, who are frequently constrained by time limitations during consultations.
ConclusionOur findings emphasize the need to tailor promotional materials for both patients and healthcare professionals to improve CCR screening uptake, balancing digital efficiency with maintaining core human relationships in healthcare. Such intervention can be integrated into different workflows. The addition of video into national CRC screening programs might also help. Targeting CRC screening interventions at provider-patient interactions, ensuring they are tailored, accessible, and engaging, is key to reducing disparities.
Housing First (HF) is an evidence-based approach to ending homelessness, particularly for individuals with mental illness. Yet, limited research explores which aspects of HF programmes facilitate change over time, within the context of a programme theory of change (ToC). A particular research gap includes how mechanisms of change within HF programmes differ between men and women. This study examines gender-specific pathways of change in the HF model based on secondary qualitative data from Toronto’s original At Home/Chez Soi (AH/CS) trial, focusing on outcomes of housing stability, socio-economic status, health and overall well-being.
This was a secondary qualitative analysis of the AH/CS trial data. This analysis was guided using a gender-sensitive ToC framework.
This multisector study was conducted in a large Canadian urban centre in Toronto, Canada.
A total of 32 participants (23 men and nine women) who identified themselves as male or female, 18 months after their enrolment in the treatment arm of the Toronto site of the AH/CS randomised controlled trial.
Semistructured interviews were conducted as part of the trial’s qualitative study. Thematic analysis was guided by the ToC framework and conducted using NVivo software. We assessed differences between men and women across the following outcome domains: housing stability, financial status, physical and mental health, substance use recovery and inpatient care.
The findings largely confirmed the ToC with participants, particularly women, experiencing greater improvements across all mechanisms of change, especially in housing stability, financial status and health outcomes. Men faced ongoing challenges, including difficulty maintaining stable income, limited engagement with education/training and continued struggles with mental health and substance use. Despite these improvements, both men and women participants reported ongoing challenges in achieving consistent income and accessing education or training opportunities.
This study provides insight into how mechanisms of change within HF programmes differ between men and women. It underscores the need for ongoing programme adaptation and gender-responsive evaluation to meet the diverse needs of individuals, particularly those with mental health illness and histories of chronic homelessness.
Acute intracerebral haemorrhage (ICH) is devastating with a 1 month mortality rate of ~40%. Cerebral oedema can complicate acute ICH and is associated with poor outcome. In patients with large ICH, the accompanying swelling increases mass effect and causes brain herniation. Mannitol, an osmotic diuretic, is used to treat cerebral oedema after traumatic brain injury, but its safety and efficacy in ICH is unclear. We aim to assess the feasibility of a phase II randomised, controlled trial of mannitol in patients with ICH with, or at risk of, cerebral oedema to inform a definitive trial.
The mannitol for cerebral oedema after acute intracerebral haemorrhage trial (MACE-ICH) aims to include 45 ICH participants from 10 UK sites with estimated largest diameter of haematoma volume >2 cm, presenting within 72 hours of onset with, or at risk of, cerebral oedema (limited Glasgow Coma Scale (GCS)8) with or without mass effect. Participants will be randomised (1:1:1) to 1 g/kg 10% single-dose intravenous mannitol, 1 g/kg 10% mannitol followed by a second dose at 24 hours, or standard care alone. Outcome assessors will be masked to treatment allocation. Feasibility outcomes include proportion of patients approached being randomised, participants receiving allocated treatment, recruitment rate, treatment adherence and follow-up. Secondary outcomes include serum electrolytes and osmolality at days 1–2; change in ICH and oedema volume at day 5; number of participants who developed urinary tract infection, GCS and National Institutes of Health Stroke Scale at day 5±2; length of hospital stay, discharge destination and death up to day 28; death and death or dependency by day 180 and disability (Barthel Index), quality of life (EuroQol, 5-D) and cognition (telephone mini-mental state examination) at day 180.
MACE-ICH received ethics approval from the East Midlands-Leicester Central research ethics committee (22/EM/0242). The trial is funded by a National Institute for Health and Care Research RfPB grant (203080). The results will be published in an academic journal and disseminated through academic conferences and patient support groups. Reporting will be in line with Consolidated Standards of Reporting Trials recommendations.
ISRCTN15383301; EUDRACT 2022-000283-22.
by Hui Ouyang, Xiaolin Dou, Xinying Li, Mingyu Cao, Zhijing Wu, Fada Xia
PurposeThis retrospective cohort study aimed to reevaluate the prognostic impact of sex and determine whether age modifies the effect of sex on cancer-specific survival (CSS) in PTC patients.
MethodsData for PTC patients diagnosed between 2004 and 2015 were retrieved from the SEER database. The primary outcome was CSS. The effect of Sex was evaluated using both relative (hazard ratios, HRs) and absolute measures (survival differences). Additionally, the effect of sex modified by age was assessed using restricted cubic spline curves from the Cox and Poisson models, with further analysis of the interaction between sex and age.
ResultsOf 77,349 patients, 16,152 (20.9%) were male. Men exhibited older age, more aggressive clinicopathological features, and received more radioactive iodine treatment. Multivariate Cox analysis determined male sex as an independent risk factor (adjusted HR: 1.46 (1.24–1.70). The 10-year and 15-year survival differences between men and women were 0.46% (95% CI, 0.25%−0.67%) and 0.77% (95% CI, 0.31%−1.22%), respectively. Moreover, a nonlinear effect for sex across age was observed, with HRs for men plateauing below age 50 and decreasing thereafter. Importantly and conversely, before age 50, the absolute survival difference increased slightly with age, but after 50, it significantly widened. Furthermore, A significant negative multiplicative interaction between sex and age was found.
ConclusionsOur analyses provide robust evidence that male sex is indeed an independent risk factor for CSS in PTC patients. Although younger female patients show a relative survival advantage, this does not translate into a substantial absolute benefit, which widens with advancing age.
We aimed to systematically review and quantify risk factors for first-ever diabetes-related foot ulcer (DFU). Four English and three Chinese electronic databases were searched for cohort and case–control studies reporting risk factors for first-ever DFU. Two researchers independently screened titles, abstracts and full text, extracted data and assessed the quality of included studies. Meta-analyses were performed for risk factors reported in at least two studies, using unadjusted odds ratios and standardised mean differences for dichotomous and continuous variables. Of 6736 potential studies screened, 23 were included in the meta-analysis and 24 in the systematic review. Twenty-eight significant risk factors for first-ever DFU were identified, including older age, obesity, male gender, unmarried status, alcohol consumption, current smoking, insufficient physical activity, longer diabetes duration, increased HbA1c, fasting plasma glucose, creatinine and triglyceride, decreased eGFR and high-density lipoprotein, high vibration perception threshold, albuminuria, low ankle-brachial pressure index ratio, cardiovascular, cerebrovascular and peripheral artery disease, retinopathy, nephropathy, neuropathy, myocardial infarction, foot deformity, skin dryness, insulin treatment and anti-hypertensive treatment. This study provides the first comprehensive synthesis of risk factors for first-ever DFU. Identifying high-risk individuals based on these factors can enhance early intervention strategies, reducing the burden of DFU in diabetes management.
FreshRSS 