Conectar
In current practice, fluid volumes administered to children following kidney transplant vary widely. Up to 52% of children experience fluid overload-related complications. Current fluid guidelines are not evidence-based and the optimal amount of fluid for children after transplant is not known. The aim of Randomised multiple centre trial of conservative versus LIberal fluid adMInisTration for children receiving a kidney tranSplant (LIMITS) is to determine whether relative limitation of fluid volume administered to children receiving kidney transplants is superior to liberal fluid volume administration.
LIMITS is a pragmatic, open-label, UK-based, multicentre randomised controlled trial, with an internal pilot phase and integrated economic evaluation. A total of 140 children receiving kidney transplants will be randomised to receive either conservative postoperative fluid administration (maximum of 150 mL/m2/hour for no longer than 18 hours, followed by a fixed daily target of maximum 1.5 L/m2/day thereafter) versus the comparator of liberal postoperative fluid administration (fluid volume administered to replace urine output and insensible losses for at least 48 hours with target urine output >2 mL/kg/hour). The primary outcome is mean days at home in the first 30 days after kidney transplant. The primary outcome will be analysed using a mixed linear regression model adjusted for donor type (living vs deceased donor) and participant weight (
The trial received Health Research Authority approval on 20 August 2025 (REC reference: 25/EE/0161, IRAS project ID: 354370). Findings will be presented to academic groups via national and international conferences and peer-reviewed journals. The patient and public involvement group will play an important part in disseminating the study findings to the public domain.
To estimate the prevalence and frequency of workplace incivility and bullying across multiple healthcare roles; compare experiences among occupational groups; examine associations with psychological symptoms (stress, anxiety and depression); assess interrelations among mistreatment dimensions (experienced workplace incivility (EWI), witnessed workplace incivility (WWI), instigated workplace incivility (IWI and experienced workplace bullying (EWB)); and evaluate associations with demographic and contextual variables.
Cross-sectional study.
Three teaching hospitals in Arak, Iran, between March and December 2023.
A stratified random sample of 550 healthcare workers was invited; 392 responded (response rate 71.3%) and 359 with complete data were included, comprising nurses, interns, residents, general practitioners and administrative staff.
Workplace incivility (Workplace Incivility Scale), workplace bullying (Negative Acts Questionnaire-Revised) and psychological symptoms (Depression, Anxiety and Stress Scale-21 Items).
The sample (N=359) was 64% female with a mean age of 32 years. Significant differences were observed across occupational groups for WWI, IWI and EWB (all p
Workplace incivility and bullying are widespread across healthcare roles, with broadly comparable exposure across clinical staff. Direct experiences of mistreatment showed the most consistent associations with psychological distress, and mistreatment dimensions appeared to operate within interconnected patterns. Addressing these issues requires system-level interventions targeting structural and cultural drivers to promote psychologically safe clinical environments.
In 2023, cholera caused over 95 000 deaths globally, predominantly in low-income and conflict settings, and contributed to the wasting, stunting and malnutrition of millions in countries where the disease is endemic. Moreover, the frequency and magnitude of cholera outbreaks are rising. As a result, the demand for outbreak control interventions is quickly outpacing existing resources. Oral cholera vaccination (OCV) is one intervention among many used to limit further transmission. Since 2022, one-dose OCV (OCV1) has replaced the standard two-dose OCV due to limited global supply. However, only a handful of on-the-ground surveys of OCV1 effectiveness presently exist.
This study aims to assess the transmission of cholera in outbreak settings using digital public health approaches and quantify OCV1 effectiveness in complement to on-the-ground surveys.
Using Haiti and Cameroon as natural case studies representing two disparate geographical and sociodemographic contexts, we employed computational digitisation techniques to extract weekly case counts from non–machine-readable images of outbreak epidemic curves. We then leveraged the R package EpiEstim to derive estimates of the effective reproduction number (Rt). To assess OCV1 effectiveness in the two considered countries, we applied VaxEstim, an extension of EpiEstim requiring three inputs: the basic reproduction number (R0), Rt, and vaccine coverage. Notably, our work provides the first known real-world application of VaxEstim in low-resource settings.
Early in either outbreak, weekly estimates of Rt were elevated (Haiti, 2.60 (95% credible interval (CrI) 2.42 to 2.79); Cameroon, 1.90 (95% CrI 1.14 to 2.95)). Thereafter, Rt estimates oscillated around the critical threshold of 1 in both settings. Haiti exhibited marginally higher OCV1 effectiveness than Cameroon (75.3% (95% CrI 54.0 to 86.4%) versus 54.9% (95% CrI 18.9 to 84.9%)).
This study underscores the value of combining digitised case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.
The Zoī cohort is a prospective longitudinal cohort study, designed to advance personalised prevention by systematically screening for undiagnosed or asymptomatic conditions, identifying early risk markers and predicting future disease risks.
Recruitment takes place in a dedicated prevention-focused health centre. Adults aged 18 years and older are enrolled either as paying customers or through company-sponsored programmes. This manuscript presents the design of the cohort and the characteristics of the first 1000 participants (67.5% male, mean age 51.1 years, high education levels). The cohort exhibits a healthy volunteer bias, with lower smoking and obesity rates and higher educational attainment than the general French population, which limits generalisability.
Data collection is conducted in a standardised environment and combines over 500 self-reported items, clinical examinations, extensive biomarker profiling (196 biomarkers) and multimodal imaging (vascular, breast, abdominal and pelvic ultrasound, full-body composition, retinal scan). For several major diseases, risk is further estimated through established clinical prediction models. Despite lower obesity and smoking rates than the general population, almost half (45.6%) of those who reported no ongoing diseases had at least one undiagnosed chronic condition, most frequently hypertension and hypercholesterolaemia. Male sex and older age were significantly associated with disease unawareness (p
Longitudinal follow-up is collected via yearly re-evaluations and through a dedicated application. The cohort is designed as a deeply phenotyped, longitudinal resource to support interdisciplinary research collaborations, the development and validation of early risk stratification models and the evaluation of preventive interventions.
Secondary lower extremity lymphoedema is a chronic progressive condition that frequently develops after cancer treatment and results in persistent swelling, recurrent cellulitis and impaired quality of life. Lymphaticovenous anastomosis (LVA) is an established physiological microsurgical treatment; however, postoperative outcomes vary and evidence-based adjunctive postoperative management remains limited. A novel pneumatic lymphatic drainage (PLD) system has been developed to deliver anatomically directed, pathway-aligned mechanical stimulation that mimics manual lymphatic drainage. Its clinical efficacy following LVA has not yet been evaluated in a randomised controlled trial.
This multicentre, open-label, parallel-group randomised controlled trial will enrol adults (≥18 years) with unilateral secondary lower extremity lymphoedema (International Society of Lymphology stage I–II) undergoing LVA. Participants will be randomised 1:1 to receive PLD plus standard postoperative care or standard postoperative care alone. PLD will be initiated on the day of surgery and continue for 6 months (Day 183). The primary outcome is the rate of improvement in excess limb volume (EV) at Day 183 relative to baseline, calculated from circumferential measurements taken at 4 cm intervals using the truncated cone method, with the contralateral limb serving as an internal control. Secondary outcomes include longitudinal trajectories of EV, improvement in excess limb fluid volume assessed by bioimpedance, the Lymphedema Quality of Life Questionnaire, cellulitis incidence and safety outcomes. A total of 64 participants (32 per group) will provide 80% power (two-sided α=0.05) to detect a 15-percentage-point between-group difference in the rate of improvement in EV at 6 months, assuming a common SD of 20 percentage points and allowing for attrition. Primary analyses will follow the ITT principle using mixed-effects models for repeated measures.
The study was approved by the Chiba University Certified Review Board (approval number: CRB0119-25; approval date: 15 December 2025) and was conducted in accordance with the Declaration of Helsinki and the Japanese Clinical Trials Act. Results will be disseminated through peer-reviewed publications and presentations at national and international scientific conferences, irrespective of study outcomes.
jRCTs032250600.
Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with a broad range of physical, emotional and social burdens. Existing tools such as Systematic Coronary Risk Evaluation and WHO CVD risk charts identify clinical risk factors but fail to capture patient-perceived burden and the risk of burden awareness. The Assessment of Burden of Chronic Conditions (ABCC)-tool, a validated, person-centred instrument, offers a more holistic approach. The aim of the current study is to develop and validate a new module within the ABCC-tool for patients with an elevated cardiovascular (CV) risk or CVD (cardiovascular risk management (CVRM) module).
A mixed-methods design was used across four phases and expert meetings to identify the items for the module. All phases took place in the Netherlands. Phase 1 (literature search) was performed in 2021, phase 2 (semistructured interviews) was completed between January and October 2021, phase 3 (survey) was completed in November 2023 and December 2024, and phase 4 (semistructured interviews) was completed in January 2025.
Phase 2 involved 14 experts by experience (patients with CVD or people at elevated risk) and 10 healthcare professionals in the field of CVD. Phase 3 included 86 healthcare professionals. Phase 4 included 12 experts by experience. In total, four expert meetings took place, attended by three experts by experience, nine healthcare professionals and seven researchers.
The module was refined iteratively, using qualitative and quantitative insights at each phase of development. The model was only finalised after thorough content validation.
No suitable patient-reported outcome measures (PROMs) focusing specifically on CVRM were identified in the literature. Interviews revealed significant burdens in terms of physical, emotional and social burdens. Feedback from expert meetings and validation rounds led to substantive refinement. The final module contains 10 items and was deemed valid by both experts by experience and healthcare professionals.
The CVRM module of the ABCC-tool has been systematically developed and validated in terms of content. The final module focuses on the multidimensional burden of CVD and dealing with its risk factors and aims to support self-management. The module complements existing risk assessment tools by focusing on the burden experienced by the patient and the burden resulting from risk awareness.
To investigate how patients with sarcoma present prior to diagnosis—through a general practitioner (GP) or another healthcare professional (HCP)—and describe presenting symptoms.
International observational cohort study.
Data were obtained from the longitudinal ‘QUality of life and Experiences of Sarcoma Trajectories’ (QUEST) cohort study, conducted across the Netherlands, the United Kingdom (UK), Australia and New Zealand.
Among 572 patients, 487 (85.1%) started their diagnostic trajectory at the GP (subcohort 1) and 85 (14.9%) with another HCP (subcohort 2)—mainly medical specialists treating unrelated conditions (36/85; 42.4%). Soft tissue sarcoma patients most often reported swelling, whereas bone sarcoma patients reported unexplained pain. Notably, 31/85 (36.5%) of subcohort 2 were asymptomatic. Reasons for delaying GP visits included assuming symptoms were minor and expecting them to resolve. Patients sought care when, among others, symptoms persisted and worsened.
Most patients first consulted a GP, underlining the role of primary care in sarcoma diagnosis internationally. Due to rarity and nonspecific symptoms, faster diagnosis remains challenging, requiring improvements in both primary and specialist care.
NCT03441906; Results.
To examine the factors affecting employed mothers' exclusive breastfeeding by testing Bronfenbrenner's Ecological Systems Theory.
A cross-sectional study was conducted.
A random sample of 201 employed mothers who had given birth 6 months ago was recruited from two hospitals and two primary healthcare centres in Saudi Arabia. Data were collected using self-reported questionnaires that included background characteristics and valid and reliable Arabic measures. Hierarchical logistic regression was used to analyse the data across ecological levels.
More than a third (36.8%) of employed mothers did not practice exclusive breastfeeding. The logistic regression with four ecological levels (individual characteristics, microsystem, exosystem, and macrosystem) explained 42.9% of the variance in employed mothers' exclusive breastfeeding. In the final model, the significant gendered predictors of exclusive breastfeeding were perception of milk supply (OR = 1.029), mental health status (OR = 0.931), workplace support (OR = 1.024), and social norms (OR = 2.009).
Breastfeeding among employed mothers is predicted by gender-based factors, including perceived milk insufficiency, maternal mental health burden, workplace conditions, and social norms. This underscores the importance of developing multi-level programmes that empower women to follow the recommended breastfeeding practices.
During routine care, healthcare providers should assess the perception of milk supply and maternal mental health. They should advocate for flexible workplace policies that enable women to breastfeed and develop community campaigns targeting social norms.
The findings show the effect of key gendered factors on exclusive breastfeeding among employed mothers. These findings can inform maternal healthcare practices, gender-sensitive workplace policies, and social norm transformation.
The study follows STROBE reporting guidelines.
No patient or public contribution.
Pressure injuries are largely preventable yet remain common in hospital care. This multi-hospital study assessed nurses' knowledge, attitudes and practices for prevention in governmental, private and charitable hospitals in Nablus, Palestine, and examined links with professional characteristics. A descriptive cross-sectional study was conducted in six hospitals in Nablus city, Palestine. A total of 231 registered nurses were recruited using convenience sampling and completed a content-validated, self-administered questionnaire assessing demographics, knowledge (20 items), attitudes (11 items), and practices (17 items). Data were analysed using descriptive statistics, one-way analysis of variance with Tukey post hoc tests, and binary logistic regression for adequate knowledge and practice (≥ 80%). Overall, 64.5% demonstrated adequate knowledge, and 58.0% expressed a favourable attitude. Practice adherence averaged 70.9 ± 16.3 out of 100. Only 31.6% achieved ≥ 80%, indicating suboptimal practice in most participants. Key gaps involved massage avoidance and the use of lifting devices. Knowledge was higher with recent PI training (1–2 years vs never: OR = 4.110, 95% CI 1.622–10.414, p = 0.003; 2–3 years vs never: OR = 3.047, 95% CI 1.208–7.687, p = 0.018). Practice adequacy was higher with training < 1 year ago vs never (OR = 4.146, 95% CI 1.636–10.512, p = 0.003). Other adjusted associations were imprecise and treated as exploratory. Nurses showed generally adequate knowledge, whereas routine preventive practice remained less consistent. Recent training was associated with better knowledge and practice, suggesting that targeted education, supervised skills training, unit-level protocols and audit with feedback may support improvement.
Commentary on: Shen K, McGarry BE, Gandhi AD. Health care staff turnover and quality of care at nursing homes. JAMA internal medicine. 2023 Nov 1;183(11):1247–54.
Implications for practice and research Reducing staff turnover in nursing homes can lead to significant improvements in the quality of care. Future research should focus on the factors influencing staff retention and the mechanisms through which turnover affects care quality.
This study investigates the association between healthcare staff turnover and quality of care in nursing homes.
Assisted dying is changing. Countries around the world, including the UK,
The opportunity to write this editorial could not be more timely, having recently been invited to join the Independent Expert Panel of the UK Government’s Health and Social Care Committee, evaluating the state of palliative care in England.
There is a wealth of research...
Patient falls in hospitals lead to patient harm, staff distress and economic burden on health systems. There are few strategies with robust evidence demonstrating benefit for the prevention of falls, especially in acute hospital settings. Education and multicomponent fall prevention approaches are promising. Rigorous systematic measurement of implementation has been lacking in most hospital fall prevention trials. This paper describes the protocol for a trial that will evaluate the impact of supported implementation of tailored multicomponent fall prevention interventions on patient falls in hospital.
A stepped-wedge hybrid type I effectiveness implementation cluster randomised trial will be conducted. Twelve inpatient wards across four metropolitan hospitals will be enrolled in the trial, clustered into groups of four and randomised to commence the intervention at one of three time periods. Patients and ward staff will be recruited to complete pre-implementation surveys, which, combined with analysis of routinely collected local falls data and staff brainstorming, will inform tailored multicomponent fall prevention interventions for each ward. Wards will receive quality improvement training, clinical facilitation and staff education for at least 4 months to support implementation of their fall prevention interventions. The primary outcome—rate of falls—will be measured using routinely collected hospital falls data from the incident management system and medical records. Pre-implementation and post-implementation patient and staff surveys, qualitative interviews and bedside audits will measure secondary effectiveness and implementation outcomes. Healthcare utilisation from hospital data will inform the cost-effectiveness analysis.
The Sydney Local Health District Human Research Ethics Committee (RPAH Zone) approved this trial (protocol number X24-0087 and 2024/ETH00583). The trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572). Data collection commenced in October 2024, due for completion in May 2026. Results will be published in reputable international journals and presented at relevant conferences.
Australian and New Zealand Clinical Trials Registry (ACTRN12624000896572).
The aim of this study is to explore in depth adolescents’ insights regarding experiences of spectacle lens wear and its correlation with self-perception, quality of life, social interactions, adherence and barriers.
Qualitative design through individual interviews and thematic analysis.
Middle school students in five regions of Jakarta Province.
31 middle school adolescents who participated and received free spectacle wear by the Indonesian Ophthalmologist Association.
A set of semistructured questionnaires exploring adolescents’ perception regarding spectacle lens wear, adapted from the PedEyeQ. Interviews were conducted on site or through Zoom and were then transcribed.
Thematic analysis identified three themes, as follows: (1) experience with eyeglasses, (2) motivation and encouragement and (3) barriers to usage. This study found that more than half of adolescents received their first spectacles during the outreach programme, with most reporting improved vision and academic performance after spectacle wear. However, adherence varied, as some participants—particularly those with moderate to high myopia and astigmatism—did not use their new glasses due to discomfort, poor fit or dissatisfaction with visual clarity. While initial adaptation often involved dizziness or soreness, most adjusted within a week. The majority recognised the importance of spectacle wear, describing clearer vision, reduced eye strain and improved confidence, though a minority viewed it as unnecessary. Parents played a central role in influencing health-seeking behaviour, and limited prior access to eye examinations and geographic challenges restricted care for several adolescents. Financial concerns were reported by a small proportion, while psychological barriers such as fear of teasing or negative self-perception were the major barrier. Overall, adolescents highlighted both the benefits and challenges of spectacle wear, with motivation shaped by personal experience, parental influence and accessibility of eye care services.
Findings showed insight that adolescent understanding regarding eye health is imperative to support adherence. However, psychological barriers act as a major factor that impedes lens wear. Involving parents and teachers in understanding urgency and severity of eye health in adolescents, specifically refractive error and its long-term negative impact, as well as the prominent psychological barriers, may improve adolescent perception and adherence.
To explore the experiences and support needs of Black Canadian parents with preterm infants and to engage them in co-creating a culturally informed framework to inform nurses, healthcare providers and community organisations to better serve this population.
Preterm birth (PTB) is a traumatic experience that places significant physical and emotional strain on families and other caregivers. Despite research showing that Black mothers are at risk of PTB, little is known about their experiences of giving birth to a preterm infant and the challenges they encounter caring for these children in Canada. This lack of research specifically on Black parents in Canada makes it difficult to identify their psychosocial needs and develop intervention programmes to address their unique challenges.
A two-phase qualitative exploratory design informed by a community engagement lens will be used.
In Phase 1, five focus groups (n = 48) and 6–8 in depth interviews will be conducted with Black parents of preterm infants. Questions will explore experiences in the NICU, transition home, access to support, coping strategies and mental well-being. One focus group will be conducted with the parent advisory council of the Canadian Premature Babies Foundation, our community partner to explore gaps in services. The data from Phase 1 will be analysed and findings will be used to informed Phase 2 concept mapping exercise. This research was approved by the Toronto Metropolitan University Research Ethics Board.
There is a paucity of research addressing the experiences and needs of Black parents with preterm infants. Thus, this study is well positioned to generate the much-needed Canadian empirical knowledge on the unique experiences and stressors face by Black parents with preterm infants and inform the design of programmes and services to better support them.
This study is in collaboration with the Canadian Premature Babies Foundation, our community partner.
Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.
To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.
A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.
Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.
Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.
No patient or public contribution.
To identify and compare the digital competence profiles of nurse educators, the background variables associated with profiles, and the self-assessed level of digital competence in four European countries.
A descriptive comparative cross-sectional study.
Data were collected from nurse educators (n = 263) in 36 nursing education organisations in Finland, Malta, Slovakia and Spain. Partitioning around medoids (PAM) clustering was used to identify competence groups, and descriptive and inferential statistics were used to examine the association of nurse educators' background variables.
The clustering analysis resulted in two nurse educator digital competence profile groups: high and moderate. The profiles differed based on completed pedagogical studies and teaching experience, with an emphasis on the high competence profile. Educators in the high competence profile group showed greater interest in using educational technology and self assessed their digital competence at a higher level compared to educators in the moderate competence profile group. Nurse educators' lowest digital competence was in the safe and responsible use of technology, such as knowing copyright laws.
Despite the heterogeneous background of nurse educators, international continuing professional development needs in digital competence are identified. Nurse educators' continuing education should support the utilisation of technology through pedagogical approaches, and educators' competence in the safe and responsible use of technology (e.g., how to protect digital materials) must be enhanced in nursing education organisations.
This study highlights the need to further develop nurse educators' digital competence. Continuing professional development should target preparation in safe and responsible technology use and include pedagogical studies and mentoring from experienced peers.
The STROBE checklist was adhered to in reporting the results.
Each participating educational organisation assigned a contact person to distribute the survey to the nurse educators.
To map the scope of nursing work and models of service delivery in Australian primary and secondary schools for children aged 3–18 years.
Scoping Review.
A search of CINAHL, Medline, PsycINFO, ERIC, Informit and Google was conducted in August 2024 for peer reviewed, non-peer reviewed and grey literature giving insight into nursing work in primary and secondary Australian schools in urban, regional and remote areas of all Australian states and territories.
The review employed Johanna Briggs Institute methodology for scoping reviews and reported the findings in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
One hundred and forty-two sources were included. Findings indicate that nurses working in Australian schools conduct a wide range of activities which vary by jurisdiction, education sector, employer and school type. Models of nursing service delivery are similarly varied and range from full-time school-based nurses to nurses who visit schools on an occasional basis.
The varied scope of nursing work and models of service delivery provide evidence that the nursing workforce in schools is adaptable and flexible, but unequal access to nursing services raises important questions about equity. There is an urgent need for a national approach to nursing work in Australian schools.
This is the first review to map the scope of nursing work and models of service delivery in Australian primary and secondary schools.
FreshRSS 