Conectar
Chronic diabetic foot ulcers (DFUs) complicated by osteomyelitis remain a major clinical challenge, often requiring aggressive treatments or surgical intervention. Novel non-invasive approaches such as laser and plasma therapy have shown promise in enhancing wound healing and reducing infection. As part of a broader study involving 20 patients with chronic DFUs (14 females and 6 males), a dual-modality treatment combining low-level laser therapy and PRP therapy was applied. Among the participants, two representative cases are presented in detail to highlight the clinical outcomes and treatment potential of this method. The first case involves a 65-year-old male with a chronic heel ulcer unresponsive to conventional therapies. The second case is a 58-year-old female with a necrotic toe and persistent ulceration. Treatment consisted of multiple sessions of laser and plasma therapy, integrated with standard wound care protocols. Progress was monitored through wound size, tissue regeneration, infection control, and overall healing response. Both patients demonstrated substantial clinical improvement, including resolution of necrotic tissue, reduction in wound size, and formation of healthy granulation tissue. No adverse effects were observed, and neither patient required surgical amputation. Further controlled studies are recommended to validate and generalise these findings.
by Saleh Abualhaj, Anas Alyazouri, Mosleh M. Abualhaj, Lina Alshadfan, Shadi Hamouri, Obada Alaraishy, Eman Alkhawaja, Amro Mureb, Ali Aloun, Abdallah Arabyat
BackgroundBariclip is an emerging non- resective bariatric device designed to restrict gastric capacity while preserving anatomical integrity. Unlike traditional sleeve gastrectomy, Bariclip implantation does not involve gastric resection, potentially minimizing surgical risk and allowing reversibility. However, data on its early efficacy and safety remain limited.
ObjectiveTo evaluate short-term surgical outcomes, weight loss metrics, and comorbidity resolution among patients undergoing Bariclip implantation.
MethodsThis retrospective observational study included 82 patients who underwent Bariclip placement at a single tertiary care center. Data were extracted from electronic medical records, operative logs, and follow-up notes. Outcomes assessed included total weight loss (TWL%) and excess weight loss (EWL%) at 2 weeks, 1, 2, 3, and 6 months postoperatively. Additional variables included operative time, hospital stay, early postoperative complications (within 30 days), reintervention rates, and changes in obesity-related comorbidities.
ResultsThe cohort had a mean age of 37.6 ± 9.9 years, with the majority being female (76.8%) and obese (mean BMI = 36.6 ± 4.7 kg/m²). Most patients (91.5%) underwent surgery for obesity management. Postoperatively, patients reported low pain scores (mean = 5.2), with no need for opioid analgesia and early mobilization in 62.2%. Complication rates were low (3.6%). Repeated measures ANOVA revealed a significant reduction in BMI over time (p Conclusion
Bariclip surgery demonstrated favorable short-term safety and efficacy, with substantial weight loss and low complications rate observed within six months. These findings support Bariclip as a promising minimally invasive option for weight management in select patient populations.
by Mahsa Pourshaban, Atefeh Allahbakhshian, Hadi Hasankhani
PurposeProviding holistic and high-quality nursing care to oncology patients necessitates integrating care across physical, psychological, spiritual, and emotional domains. This study explored the meaning of oncology nurses’ experiences of missed nursing care during the COVID-19 pandemic.
MethodsThis study employed a qualitative design based on Heidegger’s hermeneutic phenomenological approach as the foundational philosophical approach because of its focus on real-life experiences. The sample comprised fourteen nurses employed at various oncology departments in Iran. Data was collected from February 2023 to March 2025 with institutional permission and ethics committee approval (IR.TBZMED.REC.1401.1032). Data were collected through in-depth, semi-structured interviews. Data analysis was conducted concurrently with data collection following the approach outlined by Diekelmann et al. (1989). Standards for Reporting Qualitative Research (SRQR) were used.
ResultsFading connections between oncology nurses and patients, nursing managers, physicians, and the care environment have affected the quality of care and communication during the pandemic. Three subthemes include (1) care behaviors, (2) isolation in duty, and (3) disruption of care canvas and twelve meaning units were obtained. The most care deficits were primarily related to emotional and psychological support.
ConclusionWhen human and professional relationships are compromised, the essence of nursing care is lost, and it risks being reduced to a mechanical, task-focused practice. The experiences of oncology nurses during the COVID-19 pandemic reveal significant gaps in nursing care that stem from professional, relational, and systemic challenges. Addressing these issues is crucial for improving nurse well-being and patient outcomes in future healthcare crises.
Nicotine vaping is common among children and youth, and even more so among those with mental health concerns. Identifying and managing nicotine vaping in child and youth mental health treatment settings is key to addressing this modifiable risk factor for poorer physical and mental health in young people. Recommendations exist for screening, assessment and treatment of youth vaping; however, it remains unclear whether current practices in child and youth mental health programmes align with recommended standards.
An explanatory sequential mixed methods design with three stages will be employed. In the first stage, a cross-sectional survey will be distributed to all eligible Canadian hospitals to identify practices in assessment and treatment of nicotine vaping within their child and youth mental health and addictions programmes. This survey will also assess barriers and facilitators for the uptake of the 2021 Canadian Paediatric Society recommendations on management of youth vaping. Semi-structured focus groups and interviews will be conducted in stage two, with clinicians, managers, youth and caregivers. Qualitative data will be analysed using a reflexive thematic approach. In stage three, findings and proposed behaviour change interventions will be reviewed at a knowledge mobilisation meeting with the goal of developing a national knowledge mobilisation plan to improve assessment and treatment of youth vaping in hospital-based mental health and addictions programmes.
This study has received ethics approval from the Research Ethics Board at the Children’s Hospital of Eastern Ontario (Protocol #25/19X). Participants will provide informed consent prior to participating. Results will be published in peer-reviewed journals and presented at scientific conferences. Summaries will be provided to the funders of the study and to participating hospitals.
Heart failure clinics (HFCs) are associated with increased survival rates, lower hospitalisation and improved quality of life. This study investigated factors influencing patient access to multidisciplinary outpatient HFCs from the perspective of patients and cardiologists.
This was a qualitative study. A trained researcher conducted semistructured face-to-face interviews with patients and online interviews with cardiologists. Interviews, conducted between March and October 2023, were audio-recorded. Transcripts were cleaned (deidentification, translation verification) and analysed by two trained researchers independently using systematic text condensation in NVivo v12. Codes were derived from the transcripts and grouped and organised into themes. Two authors independently coded data, reconciling disagreements with the senior author, followed by respondent validation. Member checking ensued.
Outpatient multidisciplinary HFCs in Qatar.
A purposive sample of patients diagnosed with heart failure who had attended at least one HFC appointment at Qatar’s Heart Hospital were approached in person or via phone, and cardiologists with the authority to make referrals to these clinics via the electronic medical record system were emailed; interviews ensued until theme saturation was achieved.
26 individuals (14 patients and 12 cardiologists) participated in the interviews. Four major themes were identified: health system organisation (subthemes: benefits, HFC triage criteria, need/capacity), HFC referral processes (subthemes: electronic record system, patient communication and education), care continuity and communication (subthemes: patient navigators, clinician preferences) and access challenges (subthemes: transportation, costs).
Resources are needed to expand HFC capacity and coverage, leverage electronic medical record tools as well as telehealth, educate physicians and patients on referral guidelines and processes and engage primary care to ultimately improve patient outcomes.
by Mohammed Hadi Bestaoui, Ali Lounici, Amar Tebaibia, Latifa Henaoui, Nawal Brikci-Nigassa, Houssem Baghous, Amel Bensefia
BackgroundVisceral adipose tissue (VAT) is associated with several cardiometabolic risk factors, particularly metabolic syndrome and insulin resistance. Reference values for VAT vary across populations, genders, and ages. Data on visceral fat in the Algerian population are lacking. This study aimed to establish reference values for VAT in a general adult population. The secondary objectives were to determine cardiometabolic consequences and to propose suggested threshold values for VAT to predict metabolic syndrome.
Materials and methodsThis cross-sectional, analytical study randomly selected participants from the electoral list of Tlemcen, Algeria. VAT was measured using dual-energy X-ray absorptiometry (DXA) General Electric Healthcare© Lunar iDXA.
ResultsA total of 301 adults (147 men and 154 women) with a mean age of 49.3 ± 15.1 years participated. The median (25th-75th percentiles) VAT mass was 1364 g (690–2049) in men and 1060 g (585–1590) in women. Binary logistic regression analyses demonstrated that cardiometabolic risk factors, including hypertension, type 2 diabetes, dyslipidemia, metabolic syndrome, insulin resistance according to HOMA2-IR, hepatic steatosis, and sleep apnea syndrome, were significantly dependent on VAT mass. Threshold values for VAT to predict metabolic syndrome (according to International Diabetes Federation) were ≥ 1369 g in men (sensitivity: 86.2%, specificity: 74.2%, Youden’s index: 0.604) and ≥ 1082 g in women (sensitivity: 76.3%, specificity: 76.9%, Youden’s index: 0.532).
ConclusionThis study provides reference values for VAT in an urban Algerian adult population and highlights its importance in assessing cardiometabolic risk.
Despite an increasing use of screens among preschool children and evidence suggesting potential adverse effects, there is a paucity of longitudinal research that aims to disentangle the multifaceted components of screen use and their unique associations with development. We present a protocol for a large-scale national longitudinal study with repeated measurements in Danish preschool children, with the aim of investigating the cross-sectional and cross-lagged longitudinal associations between screen use and psychological outcomes.
The Digital Child Study is a national prospective observational cohort of Danish preschool children. Baseline parent-report data collection commenced in 2024 via online questionnaires, and in total will include three time points over 1 year: baseline (age 4 years), and follow-ups at 6 and 12 months (ages 4.5 and 5 years). Participants were divided into two waves based on birth dates, starting in March and September 2024. Recruitment targeted parents and primary caregivers of all Danish children born between specific dates in 2020. Of 30 235 children whose parents were sent invitations, baseline questionnaire data were available for 11 690 (39%).
Children’s screen use was measured by detailed information of amount, content and timing of children’s screen use, and the broader context, incorporating parental mediation strategies, attitudes, motivations and practices. Cognitive and socioemotional developmental outcomes were measured using validated tools such as the Strengths and Difficulties Questionnaire, the Nordic Five-to-Fifteen parent questionnaire and the Behaviour Rating Inventory of Executive Function—Preschool Version. Questionnaire data will be linked to national social and health registries to enable long-term follow-up. Statistical analyses will include longitudinal modelling to explore associations between screen use and developmental outcomes, with sensitivity analyses for robustness. The study’s large sample size provides high statistical power to detect meaningful effects.
The study adheres to ethical research guidelines, ensuring voluntary participation, confidentiality and compliance with data protection laws, with approvals from relevant authorities. Findings will be disseminated through peer-reviewed publications, conferences and plain-language summaries to engage stakeholders and the broader community.
Transitions from the emergency department (ED) to home are high-risk periods for medication-related harm. Pharmacist-led interventions during this period may improve medication safety and care continuity, yet co-design approaches to develop such interventions remain underused. The aim of this study is to co-design a pharmacist-led transition of care programme for patients discharged from the ED.
This study will be conducted at a 371-bed secondary-care teaching hospital in Qatar and will follow two sequential phases using qualitative and participatory methods. Phase I will involve focus groups and semistructured interviews with key stakeholders (clinical pharmacists, physicians, nurses and patients or patient representatives). Phase II will consist of an intervention co-design workshop with decision makers (leaders, policymakers and representatives from Phase I). Participants will be recruited using purposive and snowball sampling. Interviews will be audio recorded and transcribed verbatim. Data will be analysed using an inductive-deductive approach, guided by the Theoretical Domains Framework, the Care Transitions Framework and the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria for evaluation of intervention feasibility.
The anticipated outcome is a prototype intervention detailing target recipients, core components, workflow, implementation strategies and supporting tools. This prototype will be pilot-tested to assess feasibility and inform further refinement.
The study was approved by the Medical Research Centre of Hamad Medical Corporation-Qatar (MRC-01-24-699) and Qatar University Institutional Review Board (QU-IRB 009/2025-EM). Written informed consent will be obtained from all study participants prior to participation. Research findings will be disseminated through institutional stakeholder briefings, presentations at national and international scientific conferences and publication in peer-reviewed journals. Patient representatives will contribute throughout the intervention development process.
To examine the association between individual social capital and depression in older adults in Iran and to test the hypothesis that higher levels of social capital are inversely associated with depressive symptoms.
Cross-sectional study using baseline data from a longitudinal cohort.
Community-based study conducted in primary care settings across urban and rural areas of Birjand County, Eastern Iran.
A total of 1348 community-dwelling individuals aged 60 years and older were recruited through multistage stratified cluster random sampling. Participants who were bedridden or had end-stage disease (life expectancy
The primary outcome was depression status, measured using the Patient Health Questionnaire 9 items, with a score≥10 indicating depression. The main explanatory variable was social capital, assessed using a validated 69-item questionnaire capturing domains such as collective activity, social trust and network structure. Univariable and multivariable logistic regression analyses were conducted to estimate adjusted ORs and 95% CIs for associations between depression and social capital dimensions. Statistical analyses were performed using Stata V.12.0
Of the total participants, 268 (19.94%) were identified as having depressive symptoms, with a significantly higher prevalence among women (27.44%) compared with men (11.88%). Depression was more prevalent among those in the lowest wealth quintile (32.09%) and individuals with low literacy levels (28.10%). Participation in collective activities was inversely associated with depression in the second (OR=0.62, 95% CI (0.42 to 0.93)), third (OR=0.45, 95% CI (0.29 to 0.71)), fourth (OR=0.59, 95% CI (0.37 to 0.93)) and fifth (OR=0.37, 95% CI (0.22 to 0.61)) quintiles. Social trust was also associated with lower odds of depression in the third (OR=0.62, 95% CI (0.39 to 0.99)) and fourth (OR=0.64, 95% CI (0.42 to 0.97)) quintiles. Furthermore, the second (OR=0.63, 95% CI (0.40 to 0.99)) and fifth (OR=0.38, 95% CI (0.23 to 0.63)) quintiles of social network structure were inversely related to depression. These findings suggest that higher levels of social capital, particularly in terms of collective participation, trust and social networks, are associated with a reduced likelihood of depressive symptoms in older adults.
Higher levels of social capital, particularly collective engagement, interpersonal trust and diverse social networks, are associated with lower odds of depression in older adults. These findings support the need for community-based interventions to strengthen social capital as a strategy for mental health promotion among the elderly in low-income and middle-income settings.
To examine the association between perceived quality of care and the level of coercion experienced by individuals hospitalised in acute mental health units.
National cross-sectional study.
Data were collected from 255 patients admitted to 12 acute mental health units across Spain. Standardised instruments assessed perceived quality of care and levels of coercion, humiliation and fear at discharge. Multiple linear regression analyses were used to explore associations between care quality dimensions and patients' experiences.
Perceived quality of care was significantly associated with lower levels of perceived coercion and humiliation. All dimensions of care quality showed inverse associations, with the “secluded” dimension showing the strongest association. The association between care quality and perceived fear was less consistent. These findings are particularly relevant for mental health nurses, who play a central role in delivering relational care and ensuring patients' emotional safety.
Higher perceived quality of care is associated with lower levels of coercion, humiliation, and fear during hospitalisation in acute mental health settings.
For mental health nursing, these results underscore the critical role of nurses in creating therapeutic environments that reduce coercive experiences. By fostering trust, promoting patient autonomy, and ensuring emotional and physical safety, nurses can significantly influence the quality of care and patient outcomes.
The study addresses the lack of evidence on how perceived quality of care influences experiences of coercion in acute mental health settings. Better perceived care quality is linked to reduced feelings of coercion, humiliation and fear. The research has direct implications for mental health nurses, clinical educators and healthcare managers aiming to improve patient experiences and reduce coercive practices in psychiatric care.
STROBE reporting guideline.
No patient or public contribution.
Diabetes mellitus is a growing global health concern, with a high prevalence in Egypt. Type 2 diabetes imposes substantial health and economic challenges. Diabetes Self-Management Education and Support (DSMES) programs, such as the Diabetes Conversation Map, have demonstrated promise in enhancing patient knowledge, self-management, and self-efficacy. However, evidence regarding their direct impact remains scarce, necessitating further investigation.
This study aimed to evaluate the effectiveness of the Diabetes Conversation Map program in improving knowledge retention, self-management, and self-efficacy among type 2 diabetes patients in Egypt.
A prospective, parallel, two-arm randomized controlled trial was conducted at the Damanhour Health Insurance Outpatient Diabetic Clinic in Egypt. A total of 120 adult patients with type 2 diabetes were randomized into a control group (n = 60), receiving standard diabetes education, and an intervention group (n = 60), attending 8 weekly interactive sessions using the Diabetes Conversation Map. Primary outcomes were assessed using validated questionnaires at baseline, post-intervention, and 3 months later.
The intervention group exhibited significant improvements in knowledge, self-management, and self-efficacy compared to the control group (p < 0.001). Additionally, positive correlations between these outcomes were observed post-intervention, replacing negative correlations observed at baseline.
The Diabetes Conversation Map program effectively enhances patient knowledge, self-management, and self-efficacy, supporting its integration into routine diabetes education. Healthcare providers should implement structured, interactive educational interventions to empower patients in managing their condition. Regular follow-ups and reinforcement strategies are necessary to sustain long-term self-efficacy improvements. Policymakers should consider incorporating evidence-based diabetes education into national healthcare programs. Future research should explore digital adaptations of the program to enhance accessibility and engagement.
Registration No: R000061691, Trial ID: UMIN000054044
This study aimed to identify the spiritual responses of nurses providing direct patient care during the COVID pandemic and explore how religious/spiritual struggles are associated with selected nurse outcomes.
A quantitative, cross-sectional observational study was conducted, based on the STROBE checklist, with 364 registered nurses recruited via convenience sampling between January 24 and March 12, 2022, in hospitals in Iran admitting COVID-19 patients. Data were collected through a self-report questionnaire, including the Moral Injury Symptom Scale–Health Professionals, Religious/Spiritual Struggles Scale-Short Form, Posttraumatic Growth Inventory, Job Satisfaction Scale, Copenhagen Burnout Inventory, Turnover Intention Scale, and Employee Engagement Scale.
Nurses reported high levels of moral injury during the pandemic, with an average score of 43.79 ± 15.20. Religious/spiritual struggles were generally low, with demonic struggles scoring the lowest (0.36 ± 0.68) and ultimate meaning struggles the highest (1.54 ± 0.99). Posttraumatic growth scores for spiritual change were moderately high (26.17 ± 4.73). Work-related burnout was moderate (64.31 ± 100.00), intention to leave was low (8.84 ± 3.92), and job satisfaction was moderate (3.67 ± 1.75).
The study found that nurses experienced both positive and negative spiritual responses during the pandemic. While most nurses reported a high level of moral injury and moderate job satisfaction, they experienced low religious/spiritual struggles and some spiritual growth. Incorporating spirituality into nursing practice may enhance professional fulfilment and nurse outcomes.
To evaluate the impact of spatial separation on patient flow in the emergency department.
This was a retrospective, time-and-motion analysis conducted from 15 to 22 August, 2022 at the emergency department of a tertiary hospital in Kuala Lumpur, Malaysia. During this duration, spatial separation was implemented in critical and semi-critical zones to separate patients with symptoms of respiratory infections into respiratory area, and patients without into non-respiratory area. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
Patients triaged to critical and semi-critical zones were included in this study. Timestamps of patient processes in emergency department until patient departure were documented.
The emergency department length-of-stay was longer in respiratory area compared to non-respiratory area; 527 min (381–698) versus 390 min (285–595) in critical zone and 477 min (312–739) versus 393 min (264–595) in semi-critical zone. In critical zone, time intervals of critical flow processes and compliance to hospital benchmarks were similar in both areas. More patients in respiratory area were managed within the arrival-to-contact ≤30 min benchmark and more patients in non-respiratory area had emergency department length-of-stay ≤8 h.
The implementation of spatial separation in infection control should address decision-to-departure delays to minimise emergency department length of stay.
The study evaluated the impact of spatial separation on patient flow in the emergency department. Emergency department length-of-stay was significantly prolonged in the respiratory area. Hospital administrators and policymakers can optimise infection control protocols measures in emergency departments, balancing infection control measures with efficient patient care delivery.
STROBE guidelines.
None.
The study obtained ethics approval from the institution's Medical Ethics Committee (MREC ID NO: 20221113–11727).
The author has checked and make sure our submission has conformed to the Journal's statistical guideline. There is a statistician on the author team (Noor Azhar).
To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care.
This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.
Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models.
One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.
Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective.
Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.
This review is reported against the PRISMA-ScR criteria.
No patient or public contribution.
The study protocol is published in BJGP Open (Moulton et al., 2022).
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