Conectar
Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training.
This single-blinded, parallel-group RCT will recruit 100 adults aged 55–80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.
The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution.
Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.
The trial is registered at ISRCTN12097135, registration date: 7 June 2024.
by Stephen J. Flusberg, Asher Donnelly, J. D. Jarolimek, Esmé Nix, Lili B. Davis, Boshang Yin, Lindsey Anderson, Dylan Ciolfi, Kevin J. Holmes
A person accused of victimizing others may be described as the “real” victim by their defenders to garner empathy and mitigate blame. Recent research shows that this rhetorical strategy, known as “victim framing,” can increase support for a man accused of sexually assaulting a woman. Little is known, however, about its effects in other contexts. Across five experiments (N = 2,941), we investigated whether victim framing generalizes beyond prototypical sexual assault cases. Participants read fictionalized news reports where one party was labeled the victim (or neither was) and expressed support for the individuals involved. We found significant framing effects across diverse scenarios: (a) a man accused of sexual assault who self-described as the victim; (b) a woman accused of sexually assaulting a man; (c) same-sex assault allegations involving men or women; (d) a celebrity or stranger accused of physically assaulting his girlfriend; and (e) a police officer who shot an unarmed civilian. As in prior work, only participants who explicitly cited the victim-related language as influencing their evaluations showed robust and reliable framing effects. Multiple observer characteristics (e.g., gender, political ideology) predicted attitudes in expected ways, yet victim framing effects persisted when controlling for these individual differences. Taken together, these findings are consistent with a social-pragmatic account of victim framing: many people treat a victim label as communicating relevant information and adjust their evaluations accordingly, while others either do not draw this inference or weigh other information more strongly. Our findings highlight the power and limits of explicit forms of linguistic framing.People living with concurrent cancer and mental health disorders face heightened vulnerability within healthcare systems that are predominantly organised around biomedical treatment pathways. Although cancer care has advanced substantially, less is known about how these patients experience recognition of their psychological vulnerability, continuity of care, communication and opportunities to participate meaningfully in decisions about treatment.
To explore patients' experiences of living with concurrent cancer and mental health disorders, with particular focus on how they experience being met in their individual needs within oncology care.
This qualitative study used individual semi-structured interviews with 11 adult patients receiving current or recent cancer treatment and living with an existing mental health or neurodevelopmental condition. Participants were recruited purposively from oncology and haematology departments at two Danish hospitals between September 2024 and December 2025. Data were analysed using interpretive qualitative content analysis.
Six interrelated themes were identified: (1) being treated for cancer while mental illness was left outside the room; (2) the hidden work of self-coordination in a fragmented system; (3) communication as care: the need for predictability and adaptation; (4) cancer treatment as a trigger for mental health deterioration; (5) stigma, legitimacy and self-silencing; and (6) relational continuity and being remembered as protective factors. Across themes, participants described a persistent tension between technically competent somatic treatment and insufficient recognition of psychological vulnerability, support needs and relational needs.
Patient-centred oncology care for people living with co-morbidity depends not only on clinical expertise, but on recognition, adapted communication, shared responsibility and relational continuity. The findings suggest that vulnerability is shaped not only by illness itself, but also by how care systems and professional practices are organised.
Small but meaningful changes in everyday oncology practice including psychologically informed communication, continuity of contact persons, explicit recognition of mental health needs and shared coordination of care—may substantially improve safety, participation and patient experience for this population.
Patients living with concurrent cancer and mental health disorders contributed to this study through individual qualitative interviews. Their lived experiences formed the empirical foundation of the study and informed the analysis and interpretation of findings. Patients were not involved in the design of the study or the preparation of the manuscript.
Vision reduction is linked to reduced quality of life, self-care capacity, increased fall risk, cognitive decline and depression. Prevalence increases with age. In response, WHO recommends regular vision assessment at primary care level, such as general practice (GP), for adults +50 years. However, research on detection of age-related vision reduction in GP is limited. The objective is to assess the feasibility and clinical utility of implementing vision screening in Danish general practice following an annual control consultation for patients aged ≥70 years with minimum one chronic condition.
Complex health intervention in a Danish general practice setting. Testing a patient baseline questionnaire with 18 items on self-reported vision and quality of life in combination with three vision tests: Colenbrander Mixed Contrast Card Test for near vision, Amsler Grid test and Confrontational Visual Field Test. 18–20 GP clinics and 450 patients are planned to be included. After GP consultation, all patients visit a collaborating optometrist for a comprehensive vision assessment including refraction, intraocular pressure measurement, fundus photography and optical coherence tomography (OCT). Data and pictures from the optometrist are evaluated by an ophthalmologist, who refers to further follow-up and/or treatment if deemed necessary.
Feasibility outcomes: patient recruitment rate, patient adherence, as well as patients’ and health providers’ experiences with the intervention. Clinical outcomes: GP staff assessment of patient vision and patient-reported assessment compared with ophthalmologic assessment. This includes identifying the need for new glasses and detecting eye diseases that require further evaluation, monitoring or treatment. This study will provide evidence on the feasibility of integrating vision screening into routine general practice, potentially helping expedient referrals and improving detection and access to primary eye-health care for older adults.
The study is registered and approved by Danish Research Ethics and Data Protection, VEK F-23070033 and in ClinicalTrials.gov: NCT07015034. Findings will be disseminated in peer-review journals, academic conferences and with the public through patient organisations and public health events.
ClinicalTrials.gov; identifier: NCT07015034.
Effective treatment for clinical obesity is available but is rarely offered by healthcare systems, which often treat complications without treating the underlying cause. The LightWAY trial will investigate the clinical benefits and harms as well as cost-effectiveness of an intensive weight loss intervention compared with existing weight management programmes for people with clinical obesity.
LightWAY is an investigator-initiated, international, randomised, parallel-group clinical superiority trial with blinded outcome assessment. Six hundred people seeking treatment for clinical obesity (body mass index ≥35 kg/m2 with comorbidities) will be recruited in centres in the UK and Denmark and randomised 1:1 to one of two groups. The experimental group will be offered a 2-year intensive weight loss programme providing support and advice to follow a total diet replacement programme, followed by gradual transition to an energy-reduced diet in combination with increased physical activity and if needed, prescription of weight loss medication. The control group will receive usual care, typically comprising brief behavioural support for weight loss and treatment of the complications of obesity or occasionally referral to specialist weight management services. The two co-primary outcomes are cardiometabolic risk, assessed with metabolic syndrome severity Z-score, and body weight assessed at 2 years. The secondary outcomes include the Short Form-36 mental component scale, 4-metre gait speed and proportion of participants achieving ≥20% weight loss. The key adverse effects will be the proportion of participants with at least one serious adverse event, incidence of eating disorders and disproportional loss of bone mass. Incremental cost-effectiveness will be assessed over the trial period and over the lifetime through modelling.
Ethical approval was granted in the UK (August 2024, 24/SC/0211) and Denmark (December 2023, H-23065222). Findings will be disseminated through peer-reviewed journals and scientific conferences and to participants in the trial and clinicians.
Long covid affects a significant proportion of people following SARS-CoV-2 infection and is associated with persistent symptoms such as fatigue, cognitive dysfunction and breathlessness which can negatively impact a person’s ability to return to and remain in work. Although tiered vocational rehabilitation (VR) models have been proposed, these are often generic, lack empirical validation and may not address the complex, fluctuating needs of this population.
To co-design a VR intervention (the COVID-19-VR intervention) to support return to work (RTW) for people with long covid (pwLC).
Primary and secondary care.
Mixed-methods target population-centred, person-based approach in three stages: Stage 1: interviews (n=21) with pwLC to identify issues and challenges faced in working with long covid. Stage 2: three co-design workshops with pwLC and service providers to (a) generate guiding principles, (b) identify key intervention features to address work needs, (c) create a logic model to illustrate how the intervention could work and (d) develop a treatment plan and resources. Stage 3: feasibility and acceptability testing in six cases (three critical care admissions, three primary care referrals).
PwLC described work-related problems relating to: fluctuating symptoms (cognition, fatigue and breathlessness), employer, coworker and family’s understanding of long covid and workplace adjustments. We developed a 6-session, 12-week individually tailored, remotely delivered intervention that included vocational goal setting, RTW planning, fatigue/symptom management, financial advice, and where permitted, education for family/employers, employer engagement and negotiation of a phased RTW. Following feasibility testing, changes included accommodating the long-term nature of long covid, addressing unmet psychological needs, and adding content on adjustment, processing traumatic experience and performance/symptom anxiety, with extended delivery including monitoring, review and case coordination.
PwLC may need specialist help to RTW. Our COVID-19-VR appears feasible and acceptable and warrants further evaluation using a staged approach, prior to any definitive effectiveness trial.
Frailty is a clinical syndrome characterised by impaired homeostatic mechanisms and reduced physiological reserve. Hospital admissions for ambulatory care sensitive conditions (ACSCs) are commonly used as indicators of quality in primary healthcare. We aimed to examine the association between frailty and the use of healthcare resources, including unplanned hospital visits due to ACSCs and non-ACSCs and visits to general practitioners (GPs) and medical specialists (MSs) in primary care. We hypothesised that frail individuals would have similar odds of hospital visits due to ACSCs and non-ACSCs.
Registry-based epidemiological study.
Data from the Danish Lolland-Falster Health Study and national health registers. Data were collected in a rural region of Denmark between February 2016 and February 2020.
10 154 randomly selected individuals aged ≥50 years participating in the Lolland-Falster Health Study with valid frailty measurements.
Hospital visits due to any diagnosis, hospital visits due to ACSCs and non-ACSCs, and visits to GPs and MSs in the primary care sector.
After adjustment for age, sex, comorbidity and socioeconomic factors, frail participants had higher odds of hospital visits due to any diagnosis (OR 1.27, 95% CI 1.02 to 1.57; p=0.03). The odds of hospital visits due to ACSCs (OR 1.42, 95% CI 0.97 to 2.08; p=0.07) and non-ACSCs (OR 1.16, 95% CI 0.91 to 1.47; p=0.22) were not significantly different. Frail individuals had higher odds of visiting their GP (OR 1.21, 95% CI 1.00 to 1.46; p=0.047) but not a medical specialist (OR 0.82, 95% CI 0.62 to 1.07; p=0.15).
Among frail individuals, the distinction between unplanned hospital visits due to ACSCs and non-ACSCs is not meaningful. This finding is consistent with the understanding of frailty as a state of reduced physiological reserve, in which minor stressors may lead to hospital care regardless of diagnostic category.
Robot-assisted laparoscopic surgical procedures are commonly perceived to result in fast recovery; however, the postoperative course can be challenging for many patients. We have previously found severe pain and a significant decrease in the patient-reported outcome measure Quality-of-Recovery 15 (QoR-15) in a cohort of patients undergoing robot-assisted upper urinary tract surgery. In similar settings, intrathecal analgesia is sometimes used to improve recovery; however, its benefits have not been established. Therefore, this study aims to examine the effects of intrathecal analgesia in this setting compared with an active comparator intravenous lidocaine.
In this randomised, assessor-blinded multicentre trial, 220 patients scheduled for robot-assisted upper urinary tract surgery under general anaesthesia are recruited after obtaining informed consent. They are randomised to receive either intrathecal analgesia or an intraoperative infusion with lidocaine. The primary study outcome is the decrease in QoR-15 from baseline to postoperative day 1. Other outcomes of interest include postoperative pain, length of stay and postoperative complications. Differences in intraoperative haemodynamics and postoperative inflammatory parameters will also be analysed.
This study has been approved by the Swedish Medical Products Agency (5.1.1-2023-69740 and 5.1.2-2025-030145). The results of this study will be presented at national and international meetings and submitted for publication in peer-reviewed international medical journals.
The main treatment of chronic subdural haematoma (CSDH) is neurosurgical evacuation with subsequent drainage. However, consensus on optimal drain modality and placement is lacking.
To examine whether 24-hour active subperiosteal drainage is non-inferior to 24-hour passive subdural drainage after a single burr hole evacuation of a symptomatic CSDH.
SUPERDURA is a multicentre randomised non-inferiority trial encompassing all neurosurgical units in Denmark. Adult patients with symptomatic CSDH admitted to a Danish neurosurgical unit for single burr hole evacuation will be screened for inclusion. Patients who are not able to give informed consent, and patients with recurrent CSDH, known cerebrospinal fluid abnormalities and other known brain pathologies will be excluded. Patients with bilateral CSDH will be registered as one case and treated similarly on both sides. Before surgical haematoma evacuation, patients will be randomised to 24-hour passive subdural drainage or 24-hour active subperiosteal drainage. The patients included and the two study statisticians will be blinded. The primary outcome is a composite outcome of 90-day mortality and symptomatic CSDH recurrence. Secondary outcomes are 90-day simplified modified Rankin score, 90-day serious adverse events and complications related to surgery or occurring during admission, including intracerebral haemorrhage due to misplaced drains, acute subdural haematoma, tension pneumocephalus, wound infection, drain seepage, subperiosteal haematoma, thromboembolic events, infections and seizures.
A detailed statistical analysis plan is published separately. Sample size simulations of non-inferiority with a threshold of 7% increased relative risk show that a total of 354 participants will be required to demonstrate a relative risk reduction of recurrent CSDH and mortality of 30% for the cohort receiving active subperiosteal drainage given a stable power above 80% with an alpha of 5%. The study inclusion period is estimated to last 2 years.
Ethics approval for the inclusion of competent patients has been obtained from the North Denmark Region Committee on Health Research Ethics. Results of the primary and secondary outcomes will be submitted for publication in an international peer-reviewed journal and presented at relevant neurosurgical meetings.
N-20240009, accepted 13 May 2024 and 13 December 2024.
by Josefine Lampinen, Håkan Littbrand, Ingeborg Nilsson, Annika Toots, Yngve Gustafson, Jerry Öhlin, Henrik Holmberg, Birgitta Olofsson, Anita Ericsson, Mia Conradsson
BackgroundTo meet the complex needs of adults with dementia, a team-based, individualized rehabilitation approach may be required. This randomized controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation program for older adults with dementia, in terms of follow-up and response rates, and potential short- and long-term effects in adults with dementia on social participation, loneliness, and mental health.
MethodsParticipants (mean age (SD) 78.7 (±6.6) years), were randomized to an intervention group (n = 31) or usual care (n = 30). The rehabilitation program consisted of a 20-week rehabilitation period and two follow-ups after 5 and 14 months. An interdisciplinary team performed assessments and interventions based on the individual’s goals. Assessors blinded to group allocation performed structured assessments at baseline and after 5, 12, 24, and 36 months.
ResultsInitially, response rates in participants with dementia were high for all assessments in the areas of social participation, loneliness, and mental health. Response rates after 12 months decreased, particularly for cognitively demanding questions with multiple-choice options in the area of social participation. Overall, there were few statistically significant differences between the groups in the outcomes over 36 months, but some of the findings seemed potentially clinically meaningful in favor of the intervention group: increased frequency of active recreation and organized social activities outside the home, as reported by both participants with dementia and caregivers or staff; as well as experienced more frequent visits to family and friends; and short-term reduction in depressive symptoms.
ConclusionsAssessments made of loneliness and mental health in this study over three years seemed feasible. It seemed cognitively demanding for participants with dementia to answer questions regarding social participation over time; therefore it seemed worthwhile to also ask informal caregivers or staff to avoid data loss. The positive findings noted during assessments and potential effects indicate that it is relevant to proceed further to an adequately powered RCT and conducted in additional geographical regions.
Trial registrationISRCTN – The UK’s Clinical Study Registry: http://www.isrctn.com/ISRCTN59155421
Adults with type 1 diabetes (T1D) are at markedly elevated risk of atherosclerotic cardiovascular disease (ASCVD). Guidelines recommend statin use for ASCVD prevention in diabetes between the ages of 40 and 75 years. This study aimed to evaluate statin prescribing rates for primary and secondary prevention of ASCVD in this age range with T1D and to identify disparities and barriers to optimal statin use.
A retrospective cross-sectional study of 266 adults with T1D aged 40–75 years was conducted at an integrated health system between 2020 and 2024. Demographic features, statin prescribing patterns, low-density lipoprotein (LDL) cholesterol levels and use of additional lipid-lowering agents were extracted from medical records. Barriers to prescribing were identified via endocrine physician documentation.
Among 266 adults with T1D aged 40–75 years, only 43.2% (95% CI 0.37 to 0.49) were prescribed guideline-recommended statin and 39.3% of those with a history of ASCVD received a high-intensity statin. Overall, 47.7% (95% CI 0.42 to 0.54) of patients achieved the latest LDL cholesterol targets, and 53.0% (95% CI 0.47 to 0.59) if using pre-2023 targets. Deferral to another healthcare professional (23.3%), statin intolerance (15.8%), and clinical inertia (9.0%) were the most common barriers to therapy. In multivariable analyses, female sex was independently associated with lower odds of receiving guideline-recommended statin therapy (aOR 0.45, 95% CI 0.24 to 0.85, p=0.015) and lower odds of achieving LDL targets (OR 0.43, 95% CI 0.28 to 0.64, p=0.046), while ASCVD history was associated with higher odds of statin use (aOR 2.75, 95% CI 1.34 to 5.57, p=0.005). Very few patients received adjunctive lipid-lowering agents (ezetimibe 4.1%, PCSK9 inhibitor 0.4%, none on bempedoic acid).
Notable gaps exist in statin prescribing and LDL goal attainment among adults with T1D, particularly women. Efforts to enhance care coordination, promote healthcare professional education and expand the use of adjunctive lipid-lowering therapies may help improve cardiovascular prevention in this high-risk population.
The involvement of older adults as active partners in research is increasingly being promoted to improve the relevance and impact of scientific knowledge. However, the evidence base on how older adults have been involved as active partners in healthcare research remains fragmented. To our knowledge, no review of reviews has yet provided a comprehensive overview of this body of evidence. Therefore, this umbrella review aims to synthesise review-level evidence on the involvement of older adults as active research partners. We address three questions: (1) How have older adults been involved as active partners in research? (2) What terminology, models and frameworks have been used? (3) What benefits and challenges have been reported related to involving older adults as active partners in research?
This study will follow the Joanna Briggs Institute (JBI) methodology for umbrella reviews. A comprehensive search will be conducted in Medline, CINAHL, Scopus, PsycINFO, Sociological Abstracts and Web of Science. Eligible reviews will be those reporting on the involvement of older adults (aged 60 years or older) as active partners in research. Two reviewers will independently screen titles, abstracts and full texts and perform data extraction using a standardised form. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. Findings will be synthesised narratively and thematically, with attention to reported roles, terminology, conceptual frameworks and the benefits and challenges of involvement.
As this umbrella review draws exclusively on secondary data from published sources, ethical approval is not required. Older adults, engaged as independent public contributors, have been involved in shaping the review protocol and will take part in interpreting the findings. Results will be disseminated through a peer-reviewed journal and presentations at academic and stakeholder conferences, and used to inform the design of a subsequent mixed-methods study focused on strengthening the involvement of older adults as active partners in research.
CRD420251064947.
To explore the views of health care professionals involved in initiatives that have led to successful research-related roles for nurses and midwives working in community settings.
A sequential mixed-methods study.
Between December 2022 and January 2023 a survey was completed by health care professionals with relevant experience of successful research-related initiatives for nurses and midwives in community settings. Survey responses were categorised into low, medium or high-priority examples of productive practice. Nineteen of the twenty responders who provided high-priority examples were interviewed between May and July 2023. The research capacity development for impact framework underpinned data collection and analysis. Data were thematically analysed using the framework method.
The seven themes of the research capacity development for impact framework: leadership and sustainability, skills and confidence building, infrastructures, linkages and collaborations, ownership and responsibilities, actionable dissemination and co-production were identified as important features of successful research-related roles in community settings. A new cross-cutting theme of trust and relationships was generated. The initiation, continued growth and ambition continuum guided the development of the planning change and features of success template.
This study highlighted the key features that matter when planning change and developing research-related roles for nurses and midwives in community settings.
Study findings have the potential to inform policy and practice for organisations focused on developing research capacity and capability in community settings.
This study adhered to the COREQ reporting guidelines.
No patient or public involvement.
To identify illegitimate tasks performed by registered nurses (RNs) in surgical care and explore why they perform them through the lens of gender theory and nursing history.
A qualitative study guided by gender theory, nursing history and the Fundamentals of Care framework.
RNs (n = 48) at three surgical wards attended a lecture on gender theory and a lecture on nursing history, each followed by focus group interviews (n = 12) with 6–8 participants. The analysis included two steps: (A) a content analysis of the interviews to identify illegitimate tasks and (B) a gender analysis using Connell's framework and nursing history.
The RNs describe their work situation in clinical practice as fragmented by illegitimate tasks. The results show how this can be explained as induced by gender theory and nursing history, with the main theme RNs support overall patient care and work climate at the cost of nursing care—a behaviour explained by gender theory and nursing history, presented in four categories: (1) performing administrative tasks and information processing outside the nursing profession, (2) maintaining a pleasant workplace, (3) being constantly available, facilitating and compensating for physicians and (4) backing up nursing assistants.
Contemporary RNs frequently utilise their resources to carry out a wide range of illegitimate tasks. The findings illustrate that RNs remain influenced by their history and still integrate traditionally female-associated tasks and behaviours into the workplace, often without conscious awareness. This knowledge can be used to understand why RNs perform illegitimate tasks without being asked to do so. Primarily, managers and also RNs must consider their complex situation from this perspective to implement systematic organisational changes that ensure patients receive the nursing care they need.
There is a global shortage of registered nurses (RNs). Patients suffer from missed nursing care. RNs describe their work as fragmented, with frequent interruptions and illegitimate tasks they feel expected to prioritise, even if not prompted by routines or requests. RNs are influenced by nursing history, integrating traditionally female-associated tasks and behaviours into the workplace, often subconsciously. When nurse managers and RNs become aware of these problems, it can pave the way for change, which can free up nursing resources and improve patient care. By becoming aware of what constitutes illegitimate tasks and understanding why nurses perform them, organisational changes can be made to fully utilise RNs' competencies. The findings point to a systemic issue that calls for strategic leadership from managers to drive substantive change.
by Simon Söderholm, Martin Ulander, Vanessa William Toma, Sara Kaufmann, Xiangyu Qiao, Daniel Berglind, Susanna Calling, Bledar Daka, Ludger Grote, Mats Martinell, Frida Bergman, Pontus Henriksson, Carl-Johan Östgren, Wen Zhong, Claudio Cantù, Fredrik Iredahl
Coffee is the most common drink in the world, second only to water. This makes caffeine, the ingredient of coffee known for its wakefulness-promoting effects, one of the most used psychoactive substances. The psychoactive property of caffeine is well-characterized, and entails its interaction with the adenosine receptors, involved in sleep regulation. While studies have shown a deleterious immediate effect of caffeine on sleep, less is known about the effects of chronic caffeine exposure. In the present cross-sectional study, we investigated this relationship across a large cohort of 30,154 individuals participating in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), which allowed us to compare habitual coffee intake with sleep habits, subjective estimate of daytime sleepiness, and underlying genetic variants. According to our analyses, different degrees of coffee consumption, confirmed by statistical association with previously reported genetic variants, showed very low association with estimated patterns of sleep habits or perceived daytime sleepiness. These results indicate that coffee may be less impactful on sleep habits than previously thought, or that other mechanisms, such as the adaptive capabilities of the adenosine system in adult coffee users, may dampen its psychoactive potency.To explore aspects of interpersonal relationships in palliative care nursing, focusing on confidential conversations between patients and registered nurses (RN).
A qualitative study employing focused ethnography.
Data were collected through unstructured participant observations, field notes and interviews with patients and RN in specialist palliative care. Data were analysed using reflective thematic analysis.
Confidential conversations in palliative care are founded on trust that is fragile and develops dynamically through consistent interactions. Small talk, presence and silence are essential for initiating and maintaining trust and the interpersonal relationship. The environment, patient condition and RN emotional presence and competence shape these conversations. As the relationship evolves, conversations adapt to the patient's changing needs. Missed signals or interruptions can disrupt flow, but the potential for repair remains, allowing for restoration and strengthening of trust and connection.
Confidential conversations in palliative care are grounded in fragile, dynamic trust, necessitating ongoing presence, sensitivity and adaptability from RN. To support these interactions, healthcare environments must prioritise privacy, relational continuity and communication training. Future research should investigate how organisational structures and clinical settings influence confidential conversations.
Healthcare environments should facilitate confidential conversations by ensuring relational continuity and minimising distractions. Communication training that emphasises presence and management of silence can strengthen nurse–patient relationships, enhancing patient care and emotional support.
This study explores key aspects of confidential conversations in palliative care, emphasising trust and emotional sensitivity. It addresses a research gap in palliative care using rare observational methods to deepen understanding of nursing relational aspects. The findings offer practical guidance for enhancing communication and relational skills, informing training and policy development and ultimately, improving emotional support and care.
Findings are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.
This study did not involve patient or public participation in its design, conduct or reporting.
Palliative care supports the physical, emotional, social and spiritual needs of people with serious life-limiting illness. Future research must align with the priorities of people approaching the end of their lives, and those close to them.
To undertake a refresh of the James Lind Alliance Palliative and End of Life Care Priority Setting Partnership, to identify and prioritise areas for future research.
The James Lind Alliance process was applied, between May 2023 and February 2025. An initial online survey collected areas for future research from participants. These were synthesised into a long list of questions and shortlisted through a second online survey. Final ranking of priorities was achieved using an adapted Nominal Group Technique within a prioritisation workshop.
People living with serious life-limiting illnesses, carers, friends and family members supporting them, bereaved people, health and social care professionals, volunteers working in palliative and end-of-life care and members of the public.
1032 and 626 responses were received to survey 1 and 2, respectively. 20 people with lived and professional experience attended the prioritisation workshop. An updated list of 24 priorities for palliative and end-of-life care research was produced.
The priorities reflect the range of issues shaping end-of-life experiences and serve as a call to action for researchers and funders.
To investigate associations between shift work patterns and sleep disturbance, and to assess if the association is modified by demographic factors, socioeconomic factors, anthropometric and lifestyle factors, health conditions or sleep traits.
Analysis of cross-sectional data obtained from the UK Biobank baseline assessment.
UK Biobank, a large-scale prospective cohort study which recruited half a million participants aged 40–69 years between 2006 and 2010 from across the UK.
A total of 285 175 employed or self-employed participants at baseline (2006–2010), including 148 296 (52.0%) females and 136 879 (48.0%) males. The sample comprised 94.0% White, 0.7% Mixed race, 0.36% East Asian, 2.0% South Asian, 1.8% Black and 0.89% from other ethnic backgrounds.
Sleep disturbance was defined as the presence of both insomnia and excessive sleepiness symptoms.
A total of 42 181 (14.8%) participants had sleep disturbance defined based on insomnia and excessive sleepiness. 236 200 (82.8%) were non-shift workers, while 48 975 (17.2%) were shift workers, which included 24 062 (49.1%) working day shifts only, 17 940 (36.6%) working night shifts sometimes or usually, and 6973 (14.2%) working night shifts always. Compared with non-shift workers, all shift workers had higher multivariable-adjusted odds of sleep disturbance: (non-night shifts: OR in model 3 (OR) 1.21 (95% CI 1.16 to 1.27); sometimes/usually night shifts: OR 1.37 (95% CI 1.30 to 1.44) and always night shifts: OR 1.50 (95% CI 1.38 to 1.63)). The association between shift work pattern and sleep disturbance was modified by age (pinteractioninteraction=0.0005) and smoking status (pinteraction=0.04).
Shift work is associated with a higher odds of sleep disturbance compared with non-shift work in all participants, with greatest odds observed among those always working night shifts. The association was stronger among individuals who were younger than 55 years old, from an ethnic minority background and never smokers. Future large-scale longitudinal studies are needed to further investigate these associations.
Cardiovascular disease (CVD) is the leading cause of mortality in patients undergoing chronic haemodialysis (HD). However, relatively few data exist regarding the influence of dialysis treatment on cardiac biomarkers such as high-sensitivity cardiac troponin I and T (hs-cTnI and hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), complicating their interpretation in the diagnosis of acute coronary syndrome and heart failure. This study aims to investigate the intradialytic kinetics of hs-cTnT, hs-cTnI and NT-proBNP, during HD and haemodiafiltration (HDF), in patients treated with chronic HD.
Single-centre, randomised, open-label, crossover study, comparing high-flux HD (FX 100 dialyser) and postdilution HDF (FX 1000 dialyser), regarding their potential clearance of hs-cTnI, hs-cTnT and NT-proBNP, in 24 stable patients treated with in-centre HD without acute CVD. The study will investigate changes in concentrations during and after high-flux HD and postdilution HDF and calculate reduction ratios, dialyser clearance and clearance by adsorption to the membrane of the selected cardiac biomarkers. Blood samples will be collected at baseline, after 10, 30, 60, 120, 180 and 240 min of dialysis and 30 min postdialysis. After 120 min of dialysis, dialysate will also be collected from the dialyser outlet line. The primary outcome is change from baseline in concentrations of hs-cTnI, hs-cTnT and NT-proBNP during high-flux HD and postdilution HDF.
The study has been approved by the North Denmark Region Committee on Health Research Ethics (N-20240016). Results will be published in an international peer-reviewed journal and disseminated at national and international research meetings.
To explore the lived experience of young people aged 16–24 years diagnosed with melanoma and that of their significant other in England.
Interpretive phenomenological analysis.
Data were collected between August 2023 and January 2024 from one specialist cancer centre in England. Thirteen young people were approached, and 10 took part. Each young person was asked to nominate a significant other. Five nominated a significant other, and five nominated no one. Although interviews were offered face-to-face, virtual was the preferred method. In-depth semi-structured interviews were audio-recorded with the participant's consent. Interview data were transcribed verbatim and analysed.
The core conceptual thread woven throughout the findings was ‘It's like being on a rollercoaster,’ which is representative of the ups and downs of the treatment trajectory, often without the support of age-appropriate specialist care. Four superordinate themes were identified: ‘Is something wrong?’, ‘Suddenly it's serious’, ‘Out on a limb’ and ‘Finding our place’.
Although most young people were treated in a primary treatment centre for adults with cancer, their experience was challenging from route to diagnosis through their treatment and beyond. Few received age-appropriate care to support their physical, emotional, and social wellbeing to help them navigate the experience.
There is limited evidence exploring the experiences of teenagers and young adults living with melanoma or that of their significant other. This enriched understanding supports improvement of the care pathway and service delivery for these young people and their families.
One young person with lived experience was paid as a consultant to be part of the research team. He helped develop the grant application and research questions, data analysis, and writing this paper.
FreshRSS 