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Clinical documentation is a significant driver of burnout among physicians. Ambient artificial intelligence (AI) scribes, which leverage generative large language models to automate the creation of clinical notes from patient–physician conversations, are rapidly emerging as a potential solution. While these tools promise to enhance efficiency and reduce administrative tasks, concerns about the quality, accuracy and potential biases persist. There is now a need for a systematic synthesis of evidence to evaluate the impact of these technologies in clinical practice. To assess the effects of ambient AI scribes on physicians’ clinical documentation, the specific objectives are to: (1) evaluate the effectiveness of these tools on documentation, including accuracy and completeness; (2) synthesise evidence on the impact on physician efficiency after adoption, including time spent on documentation and (3) examine physicians’ satisfaction with these tools, including physicians’ perceived burden.
A systematic review of quantitative or mixed-method studies as well as preprints will be conducted. We will perform a comprehensive search of four electronic databases (PubMed, IEEE Xplore, APA PsycInfo and Web of Science, along with medRix and ClinicalTrials.gov for preprints) for empirical studies published between January 2023 and March 2026. The review will synthesise studies comparing physicians’ use of ambient AI scribes with traditional documentation approaches. Given the anticipated heterogeneity of the studies, a narrative synthesis will be employed to summarise the findings. Where common quantitative outcomes exist, effect sizes will be calculated using Hedges’ g, mean differences or risk ratios/odds ratios as appropriate. The overall quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
As no patient data are involved in the data collection, no ethical approval is acquired. Results will be disseminated in a peer-reviewed, open-access journal, and presented at relevant academic conferences.
CRD420251149086.
Increasing demand for haematological specialist care makes the optimisation of referrals and outpatient workflow a priority. Automated placing of standardised test orders prior to the first appointment may provide haematologists with necessary information to reach diagnoses and initiate treatment at the first patient encounter, reducing low-value follow-up appointments. We aimed to evaluate rates of patient participation in an initiative using artificial intelligence to place standardised test orders as well as reasons for non-participation, differences in the number of participants and non-participants discharged back to primary care with a diagnosis or appropriate treatment plan, and potentially avoidable referrals.
A retrospective, multicentric cohort study.
Four academic hospitals in Madrid, Spain.
18 190 patients referred for a first haematologist appointment for 11 included presenting complaints.
Referral notes from primary care were classified using natural language processing and automated placement of standardised test order sets was carried out prior to first appointment for participating patients.
We compared demographic differences between participants and non-participants, the main motives for not participating, and the number of patients discharged back to primary care at first appointment with a diagnosis and treatment plan. Most frequent International Classification of Diseases, tenth revision codes for each of the included presenting complaints were described.
During the study period, 18 190 (41%) patients were referred for a first haematologist appointment for presenting complaints included in the intervention (‘eligible patients’), of which 612 (3.3%) patients agreed to participate in the intervention. Participants were significantly younger than non-participants. Most common motives for not participating were administrative reasons (6268, 76.9%). Only 122 (1.5%) patients expressed explicit unwillingness to participate. A significant increase in the number of patients discharged upon first appointment was observed for participants (146 (23.9%) vs 3375 (19.36%); p=0.041), signifying a 22% relative reduction in avoidable follow-up. The diagnosis ‘haematological disorders ruled out’ was constantly observed as one of the ten most common diagnoses made by the haematology specialist for all but one of the included presenting complaints.
Natural language processing of referrals from primary to specialist haematology care with automated placing of standardised test orders can decrease low-value follow-up appointments. Explicit refusal to participate was low. Participants tended to be younger than non-participants, underlining the importance of designing strategies to target the older population in order to improve participation.
Neck pain is a common issue among the working-age population, with a high recurrence rate and one of the highest healthcare costs globally. Exercise is proposed as one of the key components in managing this condition, and electrotherapy is established as a safe and proven analgesic measure. Telemedicine improves access to healthcare by removing geographical barriers and reducing costs, allowing consultations from any location and supporting the work-life balance of the patient.
The aim of this study is to compare the efficacy of e-Health versus a face-to-face programme in the therapeutic management of non-specific neck pain through exercise and analgesic electrotherapy.
A randomised clinical trial with 100 participants suffering from non-specific neck pain will be conducted. Participants will be evenly divided into two groups to receive analgesic electrotherapy combined with a cervical exercise programme delivered either via an e-Health programme or face-to-face programme. A total of 24 sessions will be administered over 8 weeks. Data collected will include demographic and clinical information, disability, pain intensity, fear of movement, sleep quality, catastrophising, quality of life and range of motion. Assessments will be conducted at the start of the study (baseline), at 8 weeks (post-treatment), and 2 months after completing the intervention (follow-up).
This protocol has been approved by the Andalusian Biomedical Research Ethics Coordinating Committee (SICEIA) with number register (SICEIA-2024-000820) on 25 September 2024. Findings will be disseminated through publications in peer-reviewed journals and presentations at international and national conferences.
ClinicalTrials.gov (NCT06842381).
The hormone replacement drug levothyroxine is the most common therapy for people with reduced function of the thyroid gland. The optimal dosage varies considerably between individuals, and reaching the correct dosage is often a time-consuming task. To reduce the time needed for dose adjustments, we have developed a model for calculating each patient’s optimal dosage and an associated decision support tool (DST). We present the study protocol for a randomised controlled trial using the DST in initiation and adjustment of levothyroxine therapy for thyroidectomised patients. The aim of the study is to assess the tool’s efficacy on therapeutic target achievement and to investigate whether faster dose adjustments lead to better patient-reported outcomes on symptoms and health-related quality of life (HRQoL).
We will conduct a randomised, controlled, multicentre, non-blinded, parallel arm trial with three intervention groups and one control group. We will include 240 patients undergoing total or completion thyroidectomy in three Norwegian hospitals. Patients allocated to the three intervention groups will have the option to use the DST in dose adjustments after the operation. Each intervention group will test a different version of the DST. The control group will follow standard care practice. The randomisation ratio will be 1:1:1:1. Our primary outcome is proportion of patients within biochemical target at 8 weeks postoperatively. Secondary outcomes are distance from biochemical target at 8 weeks, mean time to achieve biochemical target, change in HRQoL, adverse events and number of days absence from work.
The study has been approved by the Norwegian Medical Products Agency (CIV-23-02-042436), The Norwegian Ethics Committee for Clinical Trials on Medicinal Products and Medical Devices (547311), and the patient protection officer at the University Hospital of North Norway. All participants will give written informed consent prior to inclusion. Results will be published open access in international peer-reviewed journals and communicated to the public through appropriate channels.
Strong primary healthcare enhances resource efficiency and resilience. Type 2 diabetes poses a growing global health challenge, with Argentina’s healthcare system struggling to detect and manage the disease effectively. Many patients bypass primary healthcare for secondary facilities, undermining continuity of care and increasing costs. Following a diagnostic process in collaboration with policymakers, we propose evaluating a redesigned primary care model consisting of codesigned evidence-based implementation strategies to improve type 2 diabetes management in Mendoza, Argentina.
This is an efficient, parallel-arm cluster randomised controlled Hybrid Type II trial with 12 clusters (administrative areas with 2–3 health facilities) allocated 1:1 to control (usual care) or intervention. In phase I, we will codesign, pilot and refine an implementation strategy package. In phase II, we will conduct the trial: 9-month baseline data collection, 15-month intervention and 6-month sustainability period. We will enrol a cohort of 396 patients with type 2 diabetes at primary healthcare centres and follow them for 12 months during the intervention and 6 months sustainment using routine clinical records and patient surveys. In phase III, we will conduct analysis, report and disseminate findings. The primary outcome will be a composite outcome including glycaemic control (glycated haemoglobin (HbA1c)
All study activities will comply with national and international ethics guidelines, presenting minimal risk to participants. The protocol was submitted and approved by the local independent ethics committee at the Mendoza Ministry of Health (Consejo Provincial de Evaluación ética en investigación en Salud-Provincial Health Research Ethics Review Board, Reference number: 149/2024). Facility-level permission will be obtained for participation and sharing of deidentified data. Written informed consent will be required from study participants, who will receive information on the study’s purpose, procedures, risks and benefits. Dissemination activities and outputs will include writing and submitting manuscripts for publication; writing policy briefs to support strategy implementation in other regions or countries; and tailoring outputs for patients, clinicians and researchers. We anticipate that improvements in disease management and patient experience will have clinical and economic benefits related to reduced usage of secondary-level and tertiary-level facilities, lower cost per visit and a reduced number of clinical events related to diabetes.
To examine how family caregivers of deceased nursing home residents scored and justified their ratings for each item on the Quality of Dying in Long-Term Care scale and to identify the consistencies and discrepancies between their perceptions and the scores assigned when assessing the residents' end-of-life experience.
A convergent mixed-methods design, comprising a cross-sectional study and a thematic analysis for quantitative and qualitative phases, respectively.
Quantitative and qualitative data were collected simultaneously between May 2018 and February 2019. The two sets of data were analysed separately. For the quantitative component, family caregivers completed the quality of dying in long-term care scale and a single-item question assessing the final month of the residents' life. Descriptive statistics, Mann–Whitney U-tests for comparative analyses and Spearman's correlations were applied to the quantitative data, while deductive thematic analysis was conducted for the qualitative data obtained through semi-structured interviews.
Sixty-nine family caregivers completed the QoD-LTC, and 11 participated in qualitative interviews. The mean overall QoD-LTC score was 39.29 (SD = 7.58). The highest-rated domain was ‘Personhood’ (M = 4.32; SD = 0.68), while the lowest was ‘Preparatory Tasks’ (M = 2.66; SD = 1.26). Interviewed family caregivers reported effective management of pain and other symptoms, satisfaction with the care provided and respectful and appropriate treatment. However, they identified significant shortcomings in communication concerning end-of-life issues, coping with death and advance care planning. Residents with cognitive impairment had significantly lower scores on the ‘closure’ (p < 0.01) and ‘preparatory tasks’ (p = 0.03) domains as well as on the overall QoD-LTC score (p = 0.01).
The findings demonstrate consistency between the quantitative and qualitative data, with high scores reported across most domains of the QoD-LTC scale, with the exception of the ‘Preparatory Tasks’ domain. Cognitive impairment among residents was associated with lower perceived quality of the dying process from the perspective of family members.
Aspects related to closure and preparatory tasks were often overlooked. Strategies to enhance end-of-life communication and advance care planning are needed.
The study adhered to the EQUATOR guidelines. The Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS) checklist for mixed-methods studies, the STROBE checklist for cross-sectional studies, and the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for qualitative studies were used for reporting.
No funding was received for the completion of this study.
To determine the application rate of the preventive measures, alternate air anti-decubitus mattress and postural changes in patients who develop hospital-acquired pressure injury (HAPI) on the basis of their preventive or reactive temporality.
This is an ambispective observational study that included adult patients without pressure injuries admitted to Mancha Centro Hospital (Spain) who developed at least one HAPI during hospitalisation (August 2022 to March 2023).
The main variables were the implementation of preventive measures and the time of their application. Other variables were comorbidities, sociodemographic and clinical variables, Braden and Barthel scale, variables related to the application of preventive measures and information to characterise HAPI.
180 patients who developed 276 HAPI during their admission were included; 73.9% of the patients received a risk assessment upon admission, and 53.9% were re-evaluated. At some point during admission, an anti-decubitus mattress was placed in 73.3% of the patients, and 76.1% received postural changes.
Among the patients at risk at the time of HAPI onset, 49.4% had received anti-decubitus mattress preventively, 23.9% had received it reactively, and 26.7% did not receive it. Among the patients without contraindication for postural changes, 51.4% received them before the lesions appeared, 33.6% received them after the lesions appeared, and 13.6% did not receive them.
We detected a significant association between the preventive application of anti-decubitus mattress and postural changes with the Braden reassessment; admission to the intensive care unit; mechanical ventilation, vasopressors, nasogastric tube; mental state confused; hospital isolation; low Barthel and Braden scores; impaired mobility; inability to perform postural changes; diaper; urinary/faecal incontinence; and sedatives.
Only approximately half of the patients received preventive measures. Although patients with a more unfavourable clinical profile were more likely to receive these measures, increased awareness and training among healthcare professionals are necessary to ensure broader and more consistent implementation of preventive strategies.
This study explores the real-world use of preventive measures in hospitalized patients who develop HAPI. In half of the patients, these measures were applied reactively, highlighting the need to introduce strategies that facilitate the implementation of evidence-based practices.
This study was reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
In the present study, data from patients have been obtained, but the patients or caregivers have not contributed to the development of the manuscript.
To assess the potential for microbial contamination of open-but-unused portions of wound dressings stored under real-life conditions in healthcare facilities, to inform safer and evidence-based wound care practices. Observational, descriptive, longitudinal, prospective study. Eleven types of non-adhesive wound dressings were sampled after opening and storage under usual clinical conditions in a hospital inpatient unit and a primary care centre in Andalusia, Spain. Samples were collected on six predefined sampling days (Days 0, 2, 3, 4, 5 and 6 after opening), cultured under standardised laboratory conditions and microorganisms were identified using mass spectrometry. Differences in contamination were examined by dressing type, healthcare setting, storage time and handling conditions. Microbial growth was frequently detected in open-but-unused dressings from the first day after opening, particularly after enrichment culture and increased with handling and time. The most frequent microorganisms were coagulase-negative staphylococci and Staphylococcus aureus. Contamination patterns were similar across settings, although microbial diversity was higher in the hospital. Silver-containing dressings showed slightly lower contamination, but not enough to indicate protection. Scissors used for cutting dressings had high microbial loads, suggesting a potential source of cross-contamination. Open-but-unused dressings may become contaminated shortly after opening under routine clinical practice conditions, across different healthcare settings and dressing types.
To measure and compare the temporal variations in sub-bandage pressure compression systems in the Andalusian Health System (SAS). Additional objectives included assessing the relationship between pressure and healing, analysing the influence of the healthcare professional applying the bandage, and determining bandage stiffness. This prospective observational and multicentre study included 140 patients with active VLUs in Andalusia. Sub-bandage pressures were measured at three anatomical points in the leg for 96 h, under different positions and activities. The bandage application technique was standardised through specific training provided to advanced practice nurses. The initial pressures were higher than those recommended by guidelines, but showed a notable reduction within the first 24 h, stabilising within therapeutic ranges for the remainder of the 96-h study period. Most systems showed low dynamic and static stiffness. No significant pressure differences were found attributable to the nurses or the location of the injury. The observed pressure dynamics, initially high, with a subsequent drop and final stabilisation, suggest a high material settlement or application to compensate for the expected loss. The sustained pressure stability confirms the effectiveness of the systems over 96 h.
Negative pressure wound therapy (NPWT) is widely used to facilitate healing by improving local perfusion, reducing edema and controlling exudate. The porous foam dressing is central to NPWT effectiveness, however, its performance in viscous, particle-rich exudates remains challenging. Standard industry tests often rely on protein-free aqueous solutions, which overlook the complex rheology and particulate load of real wounds. This study reports a bench evaluation of a multilayer foam prototype compared with three commercial dressings under NPWT, using a simulated viscous exudate with suspended particles. We recorded 60-min drainage curves and quantified effluent turbidity as a simple, interpretable proxy for particulate transport, summarised as percentage of input turbidity recovered. The mass-based endpoint (percent solid matter recovered) showed the same ranking as turbidity. At −75 mmHg, the prototype recovered 31.6% of input turbidity, exceeding commercial foams (≤ 9.7%). At −125 mmHg, particulate recovery decreased across all dressings (≤ 9.1%). A matrix-only control indicated that commercial effluents, particularly at −75 mmHg, clustered near background level, whereas the prototype evacuated substantially more particulate while maintaining robust fluid drainage. These findings suggest that moderate negative pressure and multilayer architecture can help preserve channel patency and reduce clogging in complex exudates. We highlight the need for test methodologies that incorporate viscosity and particulate content, and for practical guidance that links dressing architecture and pressure settings to exudate characteristics. Prospective validation, including larger-sample confirmation, particle-size distributions and ultimately clinical endpoints, is warranted.
A qualitative study was conducted in Catalonia (Spain), incorporating the views and opinions of relatives, healthcare professionals and patients on what they considered a ‘good death’. This study aimed to describe barriers, facilitators and unmet needs related to the achievement of a good death.
We recruited adult patients with advanced or chronic conditions, relatives and health and social care professionals involved in end-of-life processes of care, management or strategic planning. All participants took part in a qualitative study. The study was informed by phenomenological, hermeneutical and social constructivist perspectives and included 23 in-depth interviews and three focus group discussions with a total of 31 participants. Fieldwork was conducted between February and April 2022. Data were transcribed and analysed using qualitative thematic content and discourse analysis.
Six main themes were identified, comprising 17 subthemes. Facilitators and barriers related to achieving ‘a good death’ were categorised according to whether they occurred before death or during the dying process. Key facilitators include high-quality palliative care, open communication about death and the ability to choose the place of death. Key barriers included bureaucratic delays, inadequate resources, insufficient professional training and lack of respect for patients’ preferences and wishes.
Our study highlights the need to understand factors that facilitate or hinder the achievement of a good death and the quality of the dying process. Specifically, understanding individual preferences and unmet needs, enhancing communication, increasing awareness, reducing bureaucratic barriers and ensuring adequate resources are essential to support a more dignified end-of-life experience for patients, caregivers and healthcare professionals.
The aims of this study were (1) to develop and validate the interactive CLAIM Test (iCLAIM Test) to measure children’s ability to assess claims about treatment effects and make informed health choices and (2) to measure this ability in Spanish primary school children using the developed test.
We followed a multistep process including (1) definition of the test scope, (2) selection of the questions, (3) translation process, (4) design and development of the online test, (5) external review with experts, (6) user-test with children and (7) cross-sectional validation study with Rasch analysis.
Spanish primary schools.
Twelve experts (75% women) participated in the review, 11 children (45% girls) participated in the user-test and 480 Spanish primary school children (46.5% girls) from fourth to sixth grades (9–12 years old) participated in the cross-sectional validation study.
The iCLAIM Test is an online, interactive and user-friendly test in Spanish that measures children’s ability to understand and apply key concepts of the informed health choices (IHC) Project when assessing claims about treatment effects and making IHCs. The test includes 30 questions: six demographic questions and 24 questions from the Claim Evaluation Tools item bank. Less than 40% of the students who participated in the cross-sectional validation study showed basic knowledge of the IHC Key Concepts and how to apply them, and less than 4% showed a clear knowledge. The test showed a good fit to the Rasch model and was acceptable to the target audience.
The iCLAIM Test is the first instrument validated for measuring children’s ability to assess treatment claims in Spain. In the future, we can tailor IHC education interventions and improve critical thinking skills about the health of Spanish children.
Cancer is the leading cause of death and morbidity among children and adolescents worldwide. Functionality-based interventions are relevant among children and adolescents with an oncological diagnosis, whence studies summarising evidence on this topic are needed. This systematic review will summarise evidence on the effect of interventions to improve functionality indicators among paediatric patients diagnosed with cancer.
This protocol will follow Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA)-Protocols reporting guidelines. The systematic review will be conducted according to the Cochrane Handbook and PRISMA 2020. Studies will be searched in MEDLINE (PubMed), Embase, Web of Science, CENTRAL, LILACS and PEDro. Additional searches will include Google Scholar, reference lists of included studies, relevant reviews and trial registries. Studies will be included if they implement a functionality-based intervention. They must evaluate effects among paediatric patients with an oncological diagnosis. Secondary outcomes will include health-related quality of life. There will be no limits to language or year of publication, and articles published in peer-reviewed journals will be accepted. Only randomised controlled trials will be included. Risk of bias will be assessed using the Cochrane Risk of Bias Tool 2. Two independent reviewers will select studies, extract data and assess risk of bias. A narrative synthesis and meta-analysis will be conducted if studies are clinically and methodologically homogeneous. Statistical heterogeneity will be assessed using Higgins’ inconsistency test (I²). Meta-analysis may estimate combined effects using random-effects and the inverse variance method. The R statistical software will be used. The certainty of evidence will be evaluated for each outcome using the Grading of Recommendations Assessment, Development and Evaluation system.
This study used data from previously published studies, thus waiving submission to an Ethics Committee. Scientific dissemination strategies will include publication in peer-reviewed journals, conference presentations and workshops for the public.
CRD42024462833.
Integrated digital diagnostics can support complex surgeries in many anatomic sites, and brain tumour surgery represents one of the most complex cases. Neurosurgeons face several challenges during brain tumour surgeries, such as differentiating critical tissue from brain tumour margins. To overcome these challenges, the STRATUM project will develop a 3D decision support tool for brain surgery guidance and diagnostics based on multimodal data processing, including hyperspectral imaging, integrated as a point-of-care computing tool in neurosurgical workflows. This paper reports the protocol for the development and technical validation of the STRATUM tool.
This international multicentre, prospective, open, observational cohort study, STRATUM-OS (study: 28 months, pre-recruitment: 2 months, recruitment: 20 months, follow-up: 6 months), with no control group, will collect data from 320 patients undergoing standard neurosurgical procedures to: (1) develop and technically validate the STRATUM tool and (2) collect the outcome measures for comparing the standard procedure versus the standard procedure plus the use of the STRATUM tool during surgery in a subsequent historically controlled non-randomised clinical trial.
The protocol was approved by the participant ethics committees. Results will be disseminated in scientific conferences and peer-reviewed journals.
by Eva Artigues-Barberà, Ester García-Martínez, José María Palacín Peruga, Marta Ortega-Bravo
IntroductionChronic musculoskeletal pain is one of the leading causes of disability worldwide, affecting 11–50% of the population. In Spain, it accounts for up to 50% of the chronic pain consultations conducted in primary care settings. The most common disorders are carpal tunnel and subacromial impingement syndromes, with treatments, including surgical and nonsurgical approaches, notably the use of ultrasound-guided injections to improve symptoms.
MethodsA qualitative, phenomenological, and inductive study was conducted on patients diagnosed with carpal tunnel syndrome or subacromial impingement syndrome at primary care centers in Lleida to identify patient‑reported domains relevant to the routine follow-up of CTS and SAIS in primary healthcare, and to examine barriers and facilitators of treatments to inform patient‑centered follow-up protocols. Purposive sampling was used, and five focus groups were organised, selecting participants aged >18 years with or without prior surgical treatment. Data were collected between December 2022 and February 2023 using a semi-structured guide. The focus groups were recorded and thematically analysed using Atlas.ti.
ResultsTwenty-one patients aged between 44–75 years, predominantly women, participated in the study. The results were organised into six themes and 12 subthemes. The barriers identified were delays in diagnostic testing, overload of healthcare personnel, lack of coordination between care levels, and brevity of consultations. Effective communication, empathy of primary care professionals, and prompt management of treatments, such as injections, were highlighted as facilitators.
ConclusionThis study highlighted the complexity of managing chronic musculoskeletal pain and the need for a multidimensional approach. The identified barriers, along with facilitators, such as effective communication and empathy of professionals, emphasize the relevance of strengthening problem-solving capacity in primary care and fostering better coordination between care levels. These findings suggest that addressing these aspects may support more tailored follow-up and contribute to improving patients’ experiences of care.
To examine the associations among diabetes-related stress, treatment adherence, perceived social support, and health-related quality of life (HRQoL) in adults with type 1 diabetes mellitus (DM1), and to explore the mediating roles of support and adherence in this relationship.
A cross-sectional observational study using self-report standardised measures and mediation analysis.
A total of 772 Spanish adults with DM1 completed validated instruments measuring diabetes-related distress, perceived social support, treatment adherence, and HRQoL. Hierarchical multiple regression and serial mediation analysis (PROCESS Model 6, 10,000 bootstraps) were conducted, controlling for age, sex, and time since diagnosis.
Not applicable (primary data collection, not a review).
Diabetes-related stress was the strongest predictor of lower HRQoL. Perceived social support and treatment adherence also contributed significantly. Mediation analyses indicated that the impact of stress on HRQoL was partially mediated by perceived social support and, in sequence, by treatment adherence. The indirect path through social support alone and the sequential path involving both mediators were significant.
Stress and social support are critical in understanding and improving HRQoL in adults with DM1. Treatment adherence appears to be influenced by perceived support, highlighting an indirect mechanism linking stress to quality of life.
Healthcare professionals should integrate psychosocial assessments and interventions into routine diabetes care. Targeting stress reduction and enhancing social support may improve adherence and overall well-being in adults with DM1.
What problem did the study address? The study addressed the need to understand how psychosocial factors—specifically stress, perceived social support, and treatment adherence—contribute to HRQoL in adults with DM1. While prior research often focused on paediatric or clinical populations and rarely explored mediation models, this study sought to fill those gaps with data from a large community sample of adults.
What were the main findings? The main findings indicate that diabetes-related stress is the most significant predictor of reduced HRQoL. This relationship is partially mediated by perceived social support and, sequentially, by treatment adherence. While stress directly affects HRQoL, its negative impact is also channelled through diminished social support and decreased adherence. The indirect effect through treatment adherence alone was not significant.
Where and on whom will the research have an impact? The research has implications for adults living with DM1, particularly those in community settings outside of clinical supervision. It informs healthcare providers, diabetes educators, and policymakers on the importance of addressing emotional distress and strengthening support networks to improve both treatment adherence and overall quality of life.
This study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies. All methods and results are reported in alignment with EQUATOR Network recommendations for transparent and rigorous research reporting.
The study was conducted in collaboration with the Spanish Diabetes Federation (FEDE), which supported participant recruitment and dissemination through its affiliated associations. Patient input was incorporated throughout the study. A person with lived experience of type 1 diabetes contributed to the conceptual development of the research questions and the interpretation of findings. Their perspective helped ensure that the study design, choice of measures, and implications were relevant and meaningful to people living with the condition. This involvement supported a patient-centred approach to both the research and the manuscript preparation. Patients' participation as voluntary contributors was essential to the data collection process.
This study aims to evaluate a structured nurse-led follow-up programme coordinated by an advanced practice nurse (APN) as an alternative to conventional postdischarge care for patients with heart failure (HF). The main objective is to assess the clinical effectiveness and economic efficiency of the programme using quality-adjusted life years and healthcare costs related to resource use as outcome measures.
A quasiexperimental multicentre study will be conducted including an intervention group and a comparison group of patients discharged with HF from three public hospitals in the province of Málaga, Spain. The intervention group will be followed by an APN using a structured follow-up model, while the comparison group will receive standard care. Sociodemographic, clinical, quality of life, self-care, therapeutic adherence and healthcare resource utilisation data will be collected. The economic evaluation will be conducted from the perspective of the public healthcare system through a cost-utility analysis.
The study protocol has been approved by the corresponding Research Ethics Committee. All participants will provide written informed consent prior to inclusion. The results will be disseminated through peer-reviewed publications and presentations at national and international scientific conferences.
Population ageing is a global phenomenon that has resulted in an increase in the number of patients with chronic diseases and geriatric syndromes. Frailty, sarcopenia and neurocognitive disorders are among the most prevalent conditions affecting older adults and have a direct effect on their quality of life, and can impact the burden and budgets of health systems. Recently, the oral microbiome has gained attention as it may be a factor that potentially influences the onset and progression of these syndromes. However, this is still a new line of research that has not been deeply explored. This scoping review protocol aims to explore how the oral microbiome may be associated with the onset of prevalent geriatric syndromes, frailty, sarcopenia and neurocognitive disorders, providing a picture of the current evidence and potential gaps for future research.
The scoping review will follow the Johanna Briggs Institute (JBI) methodology and will be reported accordit to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines (PRISMA-ScR). Searches will be conducted in Medline, Embase, Cochrane Central, CINAHL, LILACS and Epistemonikos from inception to December 2025. Independent reviewers will perform the study selection and data extraction. A descriptive analysis of information will be conducted, highlighting oral microorganisms associated with these syndromes and emerging trends in the evidence. Original research studies in any language will be included. We will include randomised controlled trials, cohort studies, case–control studies and other relevant designs if they investigate the oral microbiome and its relation to geriatric syndromes in adults aged 65 or older, regardless of geographic location or setting.
Ethics approval is not required.
RESUMEN
Se pretende describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo y relacionar Enfermería, iconografía y musicoterapia atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo. Para realizar este trabajo se ha utilizado el método histórico descriptivo, la recogida de información se ha realizado a través de fuentes primarias y secundarias. Como resultados, resaltar la Enfermería en el Hospital de San Hermenegildo, pieza clave en la atención sanitaria, indicando sus funciones e intervenciones, así como la descripción del cuadro de “El Tránsito de San Hermenegildo”, situado en el extinguido Hospital de San Hermenegildo de Sevilla, así como aplicar una Mirada Enfermera a esta obra pictórica, resumiendo un Plan de Cuidados utilizando la nomenclatura NANDA-NIC-NOC. relacionando dicha iconografía con la Terapia Musical.
La Fundación del Hospital de San Hermenegildo en 1455, conocido popularmente como hospital del Cardenal, supuso un cambio, un avance en la Medicina, en la Enfermería, en los Cuidados, en las formas de curar, siguiendo una metodología diferente e innovadora.
Dar a conocer el extinguido hospital de San Hermenegildo, describir la Enfermería del Hospital de San Hermenegildo (1455-1837), aplicar una visión enfermera actual, a la obra iconográfica de El Tránsito de San Hermenegildo, así como relacionar Enfermería, iconografía y musicoterapia/terapia musical atendiendo a la obra pictórica del extinguido Hospital de San Hermenegildo de Sevilla.
Palabras clave: Enfermería; hospital de San Hermenegildo; Sevilla; iconografía; plan de cuidados de enfermería; musicoterapia; terapia musical; historia de la enfermería.
En el contexto contemporáneo, marcado por la aceleración, la fragmentación del tiempo y la lógica de la productividad, el cuidado se ve sometido a formas crecientes de cronometrización que amenazan su dimensión ética y relacional. Este artículo propone una reflexión filosófica en torno a la noción de kairós —el tiempo oportuno y significativo— como clave para comprender el cuidado más allá del tiempo técnico (cronos). A partir de un diálogo con autores como Aristóteles, Heidegger, Hartmut Rosa y Agustín de Hipona, se explora cómo el kairos es un tiempo oportuno, un tiempo virtuoso, o la phronésis, que permite habitar el presente como instante pleno en el que convergen pasado y porvenir, haciendo posible una acción situada, ética y abierta a la alteridad. La teoría de la resonancia de Hartmut Rosa se retoma como una apuesta por recuperar una temporalidad vivible, en la que el vínculo entre quien cuida y quien es cuidado no se reduce a una secuencia funcional, sino que se configura como relación transformadora, vibrante y cargada de sentido. Se concluye que el cuidado genuino exige resistir a la tiranía del tiempo cuantificado, para abrir paso a una ética del instante que devuelva profundidad, hospitalidad y humanidad al acto de cuidar.
FreshRSS 