Conectar
The primary objective of this study is to investigate the perceived need and attitudinal perspectives regarding menstrual leave policies among young women in rural South India. The secondary objective was to determine the socio-demographic, menstrual and workplace-related factors associated with attitudes towards menstrual leave among young women.
An analytical cross-sectional study was performed from May 2023 to August 2023.
In a rural district of Tamil Nadu, South India.
The study encompassed 955 young female students above 18 years of age enrolled in educational institutions in a rural district of Tamil Nadu, India. Participants were pursuing diverse professional programmes including medical, dental, allied health sciences, pharmacy and engineering courses.
The primary outcomes included assessment of basic menstrual characteristics (age of menarche, regularity, product usage and pain experiences), pain evaluation using the WaLIDD scale (which measured working ability, anatomical pain location, pain intensity via Wong Baker scale and pain duration) and attitude assessment through a 10-dimension Likert scale. The attitude assessment explored both supportive factors (pain management, environmental considerations, medical leave allocation, menstruation normalisation and performance impact) and potential concerns (medicalisation, perceptions of fragility, stigma, disclosure issues and abnormal leave usage). Secondary outcome measures encompassed the analysis of factors influencing these attitudes, followed by a multivariable linear regression model to identify significant predictors.
Among 955 female students (mean age 19.56±1.33 years), the majority supported menstrual leave for maintaining hygiene (82.3%) and managing dysmenorrhoea (75.8%). A substantial proportion (64.4%) viewed it as a means of normalising menstruation discourse, while 61.6% believed it could enhance workplace performance. However, concerns existed about medicalising menstruation (47.9%) and reinforcing gender stereotypes (43.4%). Multivariate analysis revealed that medical students (B=0.67, 95% CI: 1.34 to 2.00), those with graduate-educated fathers (B=1.64, 95% CI: 0.31 to 2.97), earlier age at menarche (B=–0.23, 95% CI: –0.45 to –0.01) and participants reporting menstrual interference with daily activities (B=0.96, 95% CI: 0.02 to 0.89) held significantly more positive attitudes.
While young women generally support menstrual leave policies, particularly for hygiene and pain management, there are significant concerns about workplace stigmatisation and gender stereotyping. Educational background, parental education and personal menstrual experiences significantly influence attitudes toward menstrual leave. These findings suggest the need for carefully structured menstrual leave policies that balance biological needs with workplace/student place equality concerns.
The aim of this study was to analyse associations between crowded housing and children’s indoor living environment, respiratory and allergic disorders and general health.
A cross-sectional study.
Sweden, using data from the Swedish National Environmental Health Survey 2019.
The study sample included 48 512 children (aged 6–10 months, 4 years and 12 years). We also investigated associations in vulnerable subgroups, such as children with asthma and those living under unfavourable socioeconomic conditions.
Primary outcomes in the living environment were at least one sign of mould, poor indoor air quality, unpleasant odours, too warm indoors in summer and too cold indoors in winter. Primary outcomes for children’s health were asthma, airway problems, breathing difficulties, rhinitis symptoms, mould and mites allergy, pollen allergy, furred pet allergy and good general health.
About one in five children lived in an overcrowded home. Factors from the indoor living environment such as perceived poor indoor air quality and mould were significantly associated with crowded housing. Moreover, children who lived in overcrowded conditions were less likely to report good general health than children in non-crowded households (OR 0.64, 95% CI 0.54 to 0.76). This association was even stronger in children with asthma (OR 0.51, 95% CI 0.34 to 0.77). Few significant associations were, however, observed with the respiratory and allergic health outcomes.
Crowded housing is associated both with a poor indoor environment and with poorer general health in children. Children with asthma may experience even poorer general health.
Investigate the perception of male accessibility to the fields of nursing practice by those studying or teaching nursing in England.
Cross-sectional survey.
Online questionnaire with three closed-scale questions and two open-text questions designed to elicit perceptions on the accessibility of men to the fields of nursing practice. The questionnaire was distributed to the staff and students at 61 nursing schools in England. Inferential and descriptive statistics were used to analyse the closed questions data and inductive content analysis was used to analyse open-text questions data.
Students (n = 52) and staff (n = 51) responded to the survey. Adult (Mdn = 6, IQR = 2) and mental health (Mdn = 6, IQR = 2) were perceived as the most accessible fields of nursing practice to men, and child (Mdn = 4, IQR = 2) the least. Specialised practice areas in acute and emergency (Mdn = 6, IQR = 2), education (Mdn = 6, IQR = 2), leadership (Mdn = 7, IQR = 1), prison services (Mdn = 7, IQR = 1), and research (Mdn = 7, IQR = 2) were rated the most accessible to men and neonatal care (Mdn = 3, IQR = 3) the least. Societal stereotyping and stigma were seen as barriers to men entering the nursing profession. The perception that nursing is a feminised profession persists and a distrust of men is associated with child nursing. Men were viewed as progressing to leadership roles with greater ease than women.
Societal level stereotyping and stigma are perceived as prevalent in nursing practice areas considered less accessible to men entering the nursing profession.
This study adds insight into the gendered nature of nursing and highlights the barriers to men entering a profession with a workforce crisis.
STROBE cross-sectional studies guidelines. COREQ guidelines for content analysis.
No patient or public contribution.
Spironolactone is a useful and effective acne treatment option for adult female patients. We aim to establish whether spironolactone could be a safe treatment for the management of acne in the female adolescent population as well. The objective of this scoping review is to provide an evidence map of the safety profile of spironolactone in the paediatric population aged 0–17 across all clinical indications.
This scoping review will be conducted according to the Joanna Briggs Institute scoping review protocol. Relevant publications will be searched on the MEDLINE, Embase and Web of Science databases from inception until July 2025. The authors of included studies will be contacted using contact details provided in the manuscript to check for any further published or unpublished data on the review question. An initial search will be conducted using keywords to identify relevant articles. After identifying the research strategy, articles will be extracted into a reference management tool, and a two-part study selection process will be systematically applied by two reviewers. The first part consists of screening titles and abstracts to define the eligibility of each article. In the second part, the full texts will be screened and only relevant articles will be kept. All articles related to the safety of spironolactone in children and adolescents across all clinical indications will be included. Data will be extracted using a scoping review management software such as Covidence, collated and charted to summarise all the relevant methods, outcomes and key findings in the articles.
This scoping review will provide an extensive overview of the available safety evidence for the use of spironolactone in children and teenagers. Since the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. The results will be disseminated in a peer-reviewed publication.
Electrical burns are among the most severe burn injuries, often leading to deep tissue damage, systemic complications, and prolonged hospitalisation. In Lebanon, limited national data on electrical burn injuries limits the understanding of their epidemiology and management. This study aims to assess the prevalence and characteristics of electrical burns in patients admitted to the specialised burn care unit in Geitaoui Hospital in Lebanon. A retrospective observational study was conducted by reviewing the medical records of patients admitted from 1st January 2011 to 31st December 2024. Data on demographics, burn characteristics, hospitalisation outcomes, infections, surgical interventions, and laboratory findings were extracted and analysed using SPSS version 26. Thirty patients were included, with a male predominance (96.7%) and the mean age was 29.6 years. Third-degree burns were observed in 70.0% of cases, and 66.7% of patients had burns affecting 10%–30% of their total body surface area. High-voltage injuries accounted for 50.0% of cases. Upper extremities were the most commonly affected site (93.3%). The mean hospital stay was 25.69 days, and the mortality rate was 10.0%. Infection was documented in 43.3% of cases. The most frequently isolated pathogens were Acinetobacter (20.0%) and Pseudomonas aeruginosa (16.7%). Surgical intervention was required in 63.3% of patients, most frequently skin grafting (36.7%). This study contributes national data on electrical burns and emphasises the importance of preventive and multidisciplinary care strategies.
The 2024 revision of the Declaration of Helsinki (DoH) marks a pivotal shift in biomedical research ethics, with significant implications for nursing research. This paper critically evaluates the Declaration's relevance to nursing practice, with particular attention to challenges in low-resource settings. Key updates emphasising global health equity, environmental sustainability, participant-centred consent and artificial intelligence (AI) governance are examined through nursing's ethical lenses of justice, beneficence and patient advocacy.
Using a multidimensional ethical framework grounded in Virtue Ethics, utilitarianism and phenomenology, the manuscript explores how nurses can ethically engage vulnerable populations, safeguard data privacy and advance inclusive, community-based research.
It highlights gaps in the Declaration, particularly regarding algorithmic bias and digital consent and proposes practical strategies for nurse researchers, such as AI governance tools, dynamic consent models and context-sensitive sustainability practices.
Rather than treating ethics as an abstract principle, the paper grounds theory in real-world practice, offering case examples that reflect the lived constraints of nursing researchers in underfunded and culturally diverse environments. By aligning ethical ideals with operational realities, this work reinforces nursing's critical role in shaping equitable and ethically resilient research practices under the revised Declaration.
Opioid use disorder (OUD) is a debilitating condition characterised by the overuse of opioid medications and the development of physical and/or psychological dependence. Consequences of this condition include chronic impairment, distress and later life-altering health conditions such as overdose, all of which have been highlighted by the prominence of OUD in the USA in recent years. Buprenorphine is a standard OUD treatment and commonly used for pain management. Understanding changes in distribution patterns across the USA is vital for continuing to improve outcomes for OUD patients.
This study used the Drug Enforcement Administration’s Automated Reports and Consolidated Ordering System (ARCOS) and the US Census Bureau Population Estimates databases to analyse changes in buprenorphine distribution among pharmacies and hospitals from 2019 to 2023, to determine temporal patterns and to identify state-level disparities using the data. The data were corrected for population to identify patterns of buprenorphine distribution in the USA from 2021 to 2022 and 2022 to 2023 through examining percent changes in milligrams per 100 population at the national and state levels.
The year-to-year percent change of national buprenorphine distribution from pharmacies has remained positive but changed from a 12.2% increase from 2019 to 2020 (figure 4) to a four per cent increase every year from 2020 to 2023. From 2021 to 2022, there was a +4.9% increase in total grams of buprenorphine distributed to pharmacies and a 95% CI [–5.1, 14.9], with the District of Columbia, South Dakota and Nebraska outside of the 95% CI. Distribution to hospitals increased by 10.2% [-32.3, 52.7] during 2021–2022, with Hawaii, New Hampshire and Delaware being outside of 95% CI. From 2022 to 2023, there was an increase of +5.7% and 95% CI [–3.5, 14.9] in pharmacy distribution, with states including Washington, Rhode Island and Kansas remain outside of the 95% CI. Hospital distribution has decreased from twenty per cent between 2019 and 2020 (figure 4) to eighteen per cent between 2022 and 2023.
Following increases in buprenorphine distribution during the COVID pandemic, a consistent increase has continued year-over-year in most states and the country overall by both pharmacies and hospitals. Some states (eg, Rhode Island, Georgia, District of Columbia) have not followed this pattern. Notably, Hawaii went from the most negative percent change in hospital distribution to the most positive change in the timeframe analysed. This may offer opportunities to analyse more specific impacts of the increased buprenorphine distribution on populations and their outcomes associated with OUD.
To identify clustered trajectories of self-reported disability following the initiation of care by a physical therapist in outpatient orthopaedic settings and to determine baseline factors that distinguish between different trajectories.
Retrospective cohort study using electronic health record and patient-reported outcome data.
Data were extracted from the ATI Patient Outcomes Registry, encompassing patient encounters from over 900 ATI outpatient physical therapy clinics in 26 states across the USA.
Patients receiving physical therapy after surgery were excluded. The final analytical sample included 597 245 unique patients initiating care between 1 January 2016 and 31 December 2021 for management of a spine, upper extremity or lower extremity musculoskeletal condition.
Patients received treatments which could include strengthening and range of motion exercises, manual therapy, education, functional training and pain-relieving modalities.
The primary outcome was trajectory of self-reported, joint-specific disability measure scores up to 6 months following initial evaluation.
Three distinct disability trajectory clusters were identified (proportion of sample; beta coefficient (95% CI)): significant immediate worsening (3.4%; –1.31 (–1.33, –1.28)), significant gradual improvement (61.4%; (0.36 (0.35, 0.36)) and minimal change (35.2%; –0.20 (–0.21, –0.19)). Results were similar when stratified by primary diagnosis of upper extremity, lower extremity or spine conditions, with small differences in the relative proportion of trajectory class membership by body region. Predictive factors for less favourable disability trajectories included older age, lower physical and mental health scores, body region, higher social deprivation index, insurance type and certain comorbidities.
Most patients showed improvement in disability after exposure to treatment by a physical therapist, but a notable proportion experienced minimal change or worsening. Multiple demographic, physical, mental and social health factors differentiated trajectory class membership, highlighting opportunities to improve how and to whom this type of guideline-supported non-pharmacological care is delivered.
This study investigates the knowledge, attitudes, and practices of the Lebanese population regarding thermal burns to inform targeted interventions. Using a cross-sectional design, data was collected from 1090 participants though a structured questionnaire. Key findings revealed a mean knowledge score of 14.89/20, indicating moderate understanding, with gaps in identifying third-degree burns and optimal cooling durations. Attitudes scores averaged 36.97/50, reflecting a strong support for burn prevention but low confidence in first aid. Practices scored 12.37/20, with many participants adhering to safety measures but relying on unverified remedies and lacking emergency preparedness. Significant correlations were found between the three domains, particularly between knowledge and practices (r = 0.328, p < 0.001), emphasising the role of education and attitudes in shaping behaviours. Multivariate analysis identified formal first aid training, education, and urban residency as strong predictors across all three domains, while older age negatively influenced knowledge. These results underscore the need for culturally tailored education and enhanced training to address gaps in burn prevention and management among the Lebanese population.
To determine whether an invasive approach is associated with favourable long-term outcomes among elderly medical patients in the intensive care unit (ICU), compared with a conservative approach.
Nationwide observational study (OCTO-REVERSE study) using data prospectively collected in the National French Healthcare Database (covering 99% of the population, 66 million people).
Comprehensive multicentre study through the linkage of large-scale national registries (including all public or private facilities) from 2013 to 2018 to avoid ambiguities related to the COVID-19 pandemic.
All non-surgical patients aged 80 years or older admitted to an ICU in France during the period (n=107 014 patients at 822 hospitals).
The main outcome was the 1-year survival rate. The association of the two approaches with 1-year survival was estimated using a time-dependent Cox model and a propensity score (PS) adapted to time-to-event analysis, yielding the average treatment effect in the treated and extended weighted Kaplan–Meier curves.
107 014 patients were categorised into two groups based on the type of care received: invasive (n=51 680 (48%) received invasive ventilation and/or vasopressor support) or conservative (n=55 334 (52%) received neither). 1-year survival rate was significantly lower in the invasive group than in the conservative group (27% vs 59% estimated with extended time-dependent Kaplan–Meier method). The risk of death in the invasive group remained significantly higher after time-dependent PS weighting (HR 1.64; 95% CI 1.60 to 1.69; p
Among the whole population of critically ill elderly medical patients in France, the invasive approach was unknowingly associated with end-of-life care in nearly three quarters of cases. Further research is needed to align intensive care with compassionate goals.
To explore the characteristics of oral healthcare education interventions for stroke clinicians and the effectiveness of these interventions in improving the oral health knowledge, attitudes, confidence, and practice among acute stroke clinicians.
Scoping review, guided by Arksey and O'Malley's (2005) framework.
Original full-text studies reporting educational oral healthcare interventions for stroke clinicians, including but not limited to nurses, were eligible for inclusion. Included studies were extracted and appraised using the Joanna Briggs Institute (JBI) Checklist aligned to the study methodology. Narrative synthesis was used to describe heterogeneous findings.
Key electronic bibliographic databases including CINAHL, Cochrane, MEDLINE (Ovid), ProQuest, Pubmed, and Scopus, in addition to grey literature, were searched for studies published between 1st January 2000 and 20th January 2024.
Five studies conducted in acute inpatient settings were included: two randomised controlled trials, two mixed-methods studies, and one quality improvement project. Most (n = 4) studies developed complex interventions that included education and other components (products, referral pathways, assessment tools), and were delivered either face-to-face or as an online program. Most studies reported positive changes in oral health knowledge, attitudes, and confidence. There was limited measurement of the acceptability and feasibility of the interventions, with only one study reporting positive feedback from clinicians. There was no evidence to support changes in clinical practice following any of the included interventions.
Existing evidence indicates interventions for stroke clinicians have some potential for building stroke clinicians' capacity to provide adequate oral healthcare. There is however no evidence linking these interventions to optimised patient outcomes. There is a need for research focused on the implementation and dissemination of tailored oral health educational interventions incorporating clinically meaningful outcomes.
Existing oral healthcare educational interventions appear to have a positive effect on stroke clinicians' oral health knowledge, confidence, and attitudes. Educational interventions in oral healthcare are perceived to be acceptable and feasible; however, further research is needed to design and test the effect of new interventions.
Integrated oral healthcare is particularly important for stroke survivors who are at greater risk of preventable aspiration pneumonia. This scoping review highlights the characteristics of existing educational programs for stroke clinicians, their effectiveness, and gaps in existing evidence. Review findings substantiate the need for future research to enhance existing oral healthcare interventions, to translate knowledge acquired from training into clinical practice, and to capture appropriate measures of effect.
The PRISMA-ScR Checklist.
This review was registered with the Open Science Framework registry (https://doi.org/10.17605/OSF.IO/4BWVF).
Paediatric cervical spine injury (CSI) is uncommon but can have devastating consequences. Many children, however, present to emergency departments (EDs) for the assessment of possible CSI. While imaging can be used to determine the presence of injuries, these tests are not without risks and costs, including exposure to radiation and associated life-time cancer risks. Clinical decision rules (CDRs) to guide imaging decisions exist, although two of the existing rules, the National Emergency X-Radiography Low Risk Criteria and the Canadian C-Spine Rule (CCR), focus on adults and a newly developed paediatric rule from the Pediatric Emergency Care Applied Research Network (PECARN) is yet to be externally validated. This study aims to externally validate these three CDRs in children.
This is a multicentre prospective observational study of children younger than 16 years presenting with possible CSI following blunt trauma to 1 of 14 EDs across Australia, New Zealand and Singapore. Data will be collected on presenting features (history, injury mechanism, physical examination findings) and management (diagnostic imaging, admission, interventions, outcomes). The performance accuracy (sensitivity, specificity, negative and positive predictive values) of three existing CDRs in identifying children with study-defined CSIs and the specific CDR defined outcomes will be determined, along with multiple secondary outcomes including CSI epidemiology, investigations and management of possible CSI.
Ethics approval for the study was received from the Royal Children’s Hospital Melbourne Human Research Ethics Committee in Australia (HREC/69436/RCHM-2020) with additional approvals from the New Zealand Human and Disability Ethics Committee and the SingHealth Centralised Institutional Review Board. Findings will be disseminated through peer-reviewed publications and future management guidelines.
Registration with the Australian New Zealand Clinical Trials Registry prior to the commencement of participant recruitment (ACTRN12621001050842). 50% of expected patients have been enrolled to date.
Remote assessment of surgical site infection(SSI) lacks sensitivity for the diagnosis of SSI, but current evidence has not evaluated whether a combination of photographs and questionnaires improves diagnostic accuracy. This study aims to develop a remote diagnostic measure to identify SSI. A two-phase mixed methods study was conducted. In phase I, five clinicians reviewed the Bluebelle wound healing questionnaire(WHQ) on a five-point Likert scale of agreement for inclusion in a remote measure. Discussion generated a hypothesis as to which items should be included. In phase II, a cohort study, whereby clinicians evaluated patient's wound images and patients completed the WHQ, were reviewed for scale structure. Principal component analysis (PCA) with scree plot examination and maximum likelihood of estimation (MLE) for one, two and three factors were evaluated. Internal consistency was assessed with Cronbach's α. Phase I: hypothesis generation estimated a measure containing between 10 and 12 items would include all relevant items without ambiguity or redundancy. Phase II: a combined sample of 570 responses provided clinician reviewed images and patient responses. PCA suggested that a 12-item measure with a combined variance of 60.2% would have the best model fit. Cronbach's α was high at 0.841. One included item was highlighted as potentially ambiguous in phase I (wound pain), providing an additional model with this removed. MLE for one, two and three factors suggested measures with 8, 10 and 11 items, respectively. Total variances were low at 29.7%, 39.8% and 41.4% and Cronbach's α were high at 0.838, 0.827 and 0.823, respectively. Three potential models for a remote diagnostic measure were identified. Each is shorter than alternative available measures, which have not been designed for combined use, ensuring this is easy to use. Further evaluation for reliability and diagnostic accuracy is needed to validate a final measure that can be implemented in clinical practice.
Postoperative atrial fibrillation (POAF) affects approximately 20% of patients undergoing thoracic surgery and is associated with severe complications such as stroke, myocardial infarction, heart failure, and increased mortality. Early diagnosis is critical to mitigate these risks, but conventional monitoring is limited in detecting asymptomatic episodes. Smartwatches equipped with single-lead ECG and atrial fibrillation (AF) detection algorithms offer a novel approach for early POAF detection. This study aims to evaluate the effectiveness of smartwatch-based monitoring compared with standard care in identifying POAF following thoracic surgery.
The THOFAWATCH trial is a randomised, bicentric open-label study enrolling 302 adult patients undergoing major thoracic surgery (pneumonectomy or lobectomy) with one-lung ventilation. Eligible patients will be randomised into two groups: (1) the ‘Smartwatch Monitoring’ group, where participants will undergo rhythm monitoring using a smartwatch and (2) the ‘Conventional Monitoring’ group, receiving standard care without smartwatch monitoring. In the intervention group, any smartwatch-detected POAF episodes will be confirmed by 12-lead ECG. The primary outcome is the incidence of POAF within 7-day postsurgery. Secondary outcomes include the rate of asymptomatic POAF, cardiovascular prognosis evaluated at 2 and 6 months (composite major adverse cardiovascular events outcome), feasibility of smartwatch usage (device usage time and success rate of single-lead ECGs) and recurrence or management of AF at follow-up. Inclusion criteria include adults (>18 years) undergoing scheduled thoracic surgery and able to use the smartwatch device. Exclusion criteria encompass patients with prior AF, those requiring telemetry, or undergoing reoperations. Statistical analysis will assess the primary outcome using 2 or Fisher’s exact test (α=5%), while secondary outcomes will include descriptive and inferential statistics, with analysis conducted using SAS V.9.4.
Ethical approval for this bicentric study has been granted by the institutional review board (IRB) of the University Hospital of Amiens (Comité de Protection des Personnes sud-ouest et outre-mer 1, 21050 Toulouse, France, registration number ID RDB: 2022-A02028-27 in November 2024). The trial is registered under ClinicalTrials.gov (ID: (NCT06724718)). Results will be disseminated through peer-reviewed publications and scientific conferences to inform clinical practice regarding POAF detection and management following thoracic surgery.
NCT06724718; clinical trial.
by Vivian Y. Tat, Aleksandra K. Drelich, Pinghan Huang, Kamil Khanipov, Jason C. Hsu, Steven G. Widen, Chien-Te Kent Tseng, George Golovko
Severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and -2 (SARS-CoV-2) are beta-coronaviruses (β-CoVs) that have caused significant morbidity and mortality worldwide. Therefore, a better understanding of host responses to β-CoVs would provide insights into the pathogenesis of these viruses to identify potential targets for medical countermeasures. In this study, our objective is to use a systems biology approach to explore the magnitude and scope of innate immune responses triggered by SARS-CoV-1 and -2 infection over time in pathologically relevant human lung epithelial cells (Calu-3/2B4 cells). Total RNA extracted at 12, 24, and 48 hours after β-CoVs or mock infection of Calu-3/2B4 cells were subjected to RNA sequencing and functional enrichment analysis to select genes whose expressions were significantly modulated post-infection. The results demonstrate that SARS-CoV-1 and -2 stimulate similar yet distinct innate antiviral signaling pathways in pathologically relevant human lung epithelial cells. Furthermore, we found that many genes related to the viral life cycle, interferons, and interferon-stimulated genes (ISGs) were upregulated at multiple time points. Based on their profound modulation upon infection by SARS-CoV-1, SARS-CoV-2, and Omicron BA.1, four ISGs, i.e., bone marrow stromal cell antigen 2 (BST2), Z-DNA Binding Protein 1 (ZBP1), C-X-C Motif Chemokine Ligand 11 (CXCL11), and Interferon Induced Transmembrane Protein 1 (IFITM1), were identified as potential drug targets against β-CoVs. Our findings suggest that these genes affect both pathogens directly and indirectly through the innate immune response, making them potential targets for host-directed antivirals. Altogether, our results demonstrate that SARS-CoV-1 and SARS-CoV-2 infection induce differential effects on host innate immune responses.
Background
Older adults from specific racial and ethnic minoritized groups experience disproportionately higher asthma prevalence, morbidity, and mortality. They also often use emergency departments (EDs) to manage their asthma. High-quality primary care can improve asthma control and prevent ED use. Nurse practitioners (NPs) provide an increasing proportion of primary care to minoritized patients, yet often, they work in poor work environments that strain NP care.
Objectives
We examined whether racial and ethnic health disparities in ED visits among older adults with asthma are moderated by the NP work environment in primary care practices.
Methods
In 2018–2019, we used a cross-sectional design to collect survey data on NP work environments from 1,244 NPs in six geographically diverse states (i.e., Arizona, California, New Jersey, Pennsylvania, Texas, and Washington). We merged the survey data with 2018 Medicare claims data from 46,658 patients with asthma to assess the associations of all-cause and ambulatory care-sensitive conditions, ED visits with NPs’ work environment, and race and ethnicity using logistic regression.
Results
More than one third of patients with asthma visited the ED in 1 year, and a quarter of them had an ambulatory care-sensitive condition ED visit. Black and Hispanic patients were more likely than White patients to have all-cause and ambulatory care-sensitive condition ED visits. NP work environment moderated the association of race with all-cause and ambulatory care-sensitive condition ED visits among patients with asthma. Greater standardized NP work environment scores were associated with lower odds of all-cause and ambulatory care-sensitive condition ED visits between Black and White patients.
Discussion
Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with more favorable NP work environments. Preventing unnecessary ED visits among older adults with asthma is a likely benefit of favorable NP work environments. As the NP workforce grows, creating favorable work environments for NPs in primary care is vital for narrowing the health disparity gap. To develop and validate a screening tool to identify patients with cardiovascular disease at risk of poor oral health and requiring referrals.
This study was part of a larger pilot study involving a cross-sectional survey and an oral health assessment conducted with patients with cardiovascular disease.
A four-item screening tool was developed by an expert panel and validated through a cross-sectional survey of patients with cardiovascular disease. The survey contained the tool and the oral health impact profile (OHIP-14) (first gold standard). Additionally, all survey participants were provided a clinical oral health assessment (second gold standard). Sensitivity and specificity analysis was undertaken comparing the tool to the two gold standards to assess patients with cardiovascular disease at risk of poor oral health.
Three hundred and twenty-one participants completed the cross-sectional survey and eighty nine undertook the oral health assessment. Results from both approaches showed that the tool had high sensitivities (OHIP-14 = 89%, Oral assessment = 88%) and low specificities (OHIP-14 = 33% and Oral assessment = 24%).
The four-item screening tool is a simple and valid tool to identify patients with cardiovascular disease at risk of poor oral health and requiring a dental referral. The tool could be incorporated into routine practice of nurses across various cardiac settings.
To identify best practices to prevent violence against healthcare workers by patients at risk for aggression in the adult inpatient setting.
An integrative review.
Conducted using the Johns Hopkins Evidence-based Practice for Nurses and Healthcare Professionals Model. Title and abstract screening on 4186 articles resulted in 156 for full text review. Full text screening yielded 14 articles that met inclusion criteria.
A search of the databases PubMed, CINAHL, Embase, and JBI from January 2019 to February 2023.
The review revealed behavioural intervention teams, environmental changes, and coordinated communication plans were the most used strategies, however none demonstrated significant decreases in violence.
Health systems can implement strategies shown to decrease the incidence of violence in healthcare settings globally. Lack of consistency in the evidence suggests the need for further research to assess mitigating strategies for violence against healthcare workers in inpatient hospital settings.
Patient safety is a cornerstone of nursing practice; however, healthcare workers need to feel safe in their work environment. Violent events are chronically underreported, ill defined, and when reported, do not address change in the practice setting. Identifying strategies to address escalating behaviour before it results in violence is crucial for everyone's safety.
This integrative review exposes the scarcity of evidence available to address rising concerns about patients on healthcare provider violence (Type II) in the workplace. Although several assessment tools for identifying violent patients exist, evidence regarding prevention is woefully absent. The review highlights potential interventions for further study to equip healthcare workers to manage patients safely and effectively before an escalation occurs.
PRISMA checklist for integrative reviews.
No patient or public contribution was part of this review.
This study aimed to examine (a) changes in coping strategies and vicarious post-traumatic growth (VPTG) across three timepoints of the COVID-19 pandemic among nurses; (b) discrete groups of nurses with unique coping profiles and (c) the association of these coping profiles with VPTG across the timepoints.
Although literature abounds with the negative mental health consequences of the pandemic among healthcare professionals, much less is known about the positive consequences on nurses, the coping strategies that they use, and how these change over time.
This was a cross-sectional web-based survey at three timepoints during the pandemic.
A sample of 429 nurses completed online the Post-Traumatic Growth Inventory (PTGI) and the Brief Coping Orientation to Problems Experienced Inventory (COPE) to measure vicarious post-traumatic growth (VPTG) and coping strategies, respectively. The STROBE checklist was used to report the present study.
Significantly higher VPTG scores were observed during the third timepoint. Different coping strategies were employed across the three timepoints. Nurses responded to the pandemic either with an active, an avoidant or a passive coping profile. Significantly higher VPTG levels were reported by the nurses of the active profile compared to those of the passive profile, whereas the difference between active and avoidant profiles was not significant.
Notwithstanding the preponderance of the nurses with the active coping profile in achieving high VPTG, the avoidant copers had more gains (VPTG) than the passive copers, suggesting that doing something to cope with the stressor—let it be trying to avoid it—was better than doing nothing.
The identification of distinct coping profiles among nurses and their association with VPTG is of particular use to policymakers and practitioners in developing tailored prevention and intervention efforts to help the nurses effectively manage the demands of the pandemic.
No patient or public contribution since the study was exclusively conducted by the authors.
FreshRSS 