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Kinesiophobia in heart disease: 'it is part of the process or is it? Perspectives from cardiac rehabilitation professionals - a qualitative study in healthcare settings

Por: Jacob · A. J. · Babu · A. S. · Padickaparambil · S.
Objectives

To explore cardiac rehabilitation (CR) professionals’ perspectives on kinesiophobia in patients with cardiovascular diseases. This study aims to understand the perspectives of healthcare professionals (HCPs) regarding their perceptions, assessments and management of kinesiophobia.

Design

A qualitative descriptive study using in-depth interviews and thematic analysis.

Setting

The study was carried out through online interviews at a university teaching hospital in South India.

Participants

HCPs involved in CR, from around the world, were invited to participate through advertisements on social media and through professional forums. 12 HCPs, including CR nurses (n=1), CR physicians (n=1), cardiac surgeons (n=1), cardiac electrophysiologists (n=1), rehabilitation physicians (n=1), cardiologists (n=2), exercise physiologists (n=2) and physiotherapists (n=3), agreed to participate.

Interventions

Not applicable (qualitative study without interventions).

Primary and secondary outcome measures

Qualitative data collected through in-depth interviews focused on HCP perceptions regarding kinesiophobia and its assessment, management and awareness within CR.

Results

Thematic analysis generated 337 codes, which formed seven subthemes: the perceived burden of kinesiophobia, reasons for kinesiophobia, HCP experiences with kinesiophobia, methods of assessing kinesiophobia, management strategies, reasons why kinesiophobia is overlooked and the importance of promoting awareness of kinesiophobia.

Conclusions

CR professionals recognise kinesiophobia as a significant issue among patients with heart disease but do not recognise the term or perceive it as a separate condition; instead, they view it as part of the overall clinical presentation. There is a strong need to advocate for early recognition and assessment of kinesiophobia and for the development of structured management strategies and its inclusion into CR programmes to improve patient outcomes during recovery.

Trial registration number

The study was prospectively registered in the Clinical Trial Registry of India (CTRI/2022/05/042502). This study received approval from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee-2 (Student Research) with reference number IEC2:13/2022.

Structural Vulnerability in Health Research: A Systematic Mixed Studies Review

ABSTRACT

Aims

To systematically examine how structural vulnerability has been defined and operationalised in United States-based health research, identify conceptual consistencies and methodological gaps, and propose core dimensions of structural vulnerability along with implications for future application in health research.

Design

A systematic mixed-studies review using a parallel-results convergent synthesis design.

Data Sources

PubMed, Embase, Scopus and CINAHL were searched from first publication through 2024 using the terms ‘structural* vulnerab*’ AND health.

Review Methods

Peer-reviewed English-language empirical studies conducted in the United States that applied the concept of structural vulnerability were identified. The Mixed Methods Appraisal Tool was used to assess study quality. Study content was analysed to identify how structural vulnerability was defined and operationalised.

Results

Thirty-seven predominantly high-quality studies published between 2011 and 2024 met inclusion criteria. Structural vulnerability was consistently defined through two interrelated dimensions: as a social positionality (characterised by constrained resilience, limited agency and imposed risks rooted in systemic discrimination and social hierarchies) and as a critical analytic framework for examining structural determinants of health. Quantitative studies predominantly used individual-level indicators (e.g., income, housing) and cross-sectional designs. Qualitative studies focused on experiences of structural vulnerability in relation to health outcomes and infrequently translated findings into structural interventions. The most frequently studied outcomes were infectious disease, substance use and mental health.

Conclusion

Structural vulnerability, as a conceptual and empirical lens, reveals how systems produce—and can potentially reduce—health risks. Findings underscore the need for geographically diverse and longitudinal studies, as well as multidimensional measures. Advancing health equity demands critiquing systemic causes of inequities and pursuing justice-oriented interventions.

Implications for the Profession

Nursing, positioned at the intersection of public health, social sciences and policy, is uniquely equipped to engage structural vulnerability as a critical analytic tool to address health inequities, design interventions and advocate for policy reform.

Impact

What problem did the study address? This study addressed a lack of clarity in the definition and operationalization of structural vulnerability in health research.

What were the main findings? The definition of structural vulnerability is consistent across quantitative and qualitative studies, but there are marked variations in its operationalization. Quantitative studies predominantly rely on individual-level indicators, while qualitative studies use it as a theoretical framework to guide analysis, interpret findings and examine structural determinants of health.

Where and on whom will the research have an impact? This review offers a clear framing for integrating structural vulnerability in health research in efforts to advance health equity.

Reporting Method

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guideline.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct or reporting.

Educational outcomes for children and young people with cancer: study protocol for a population-based cohort study using linked education and hospital data from England

Por: Nath · S. · Stone · T. · Lam · J. · Feltbower · R. G. · Hargrave · D. · McCabe · M. G. · Brown · H. · Hickinbottom · L. C. L. · Jackson · K. · Paget · L. · Stanley · T. · Watts · P. S. · Harron · K.
Introduction

Childhood cancer survivors (CCSs) experience educational disruptions during and following treatment, yet robust, longitudinal evidence on educational performance remains limited. We will investigate differences in educational outcomes between CCSs and non-cancer peers during primary and secondary school. We will also explore how sociodemographic factors and age at diagnosis contribute to potential differences in General Certificate of Secondary Education (GCSE) examinations, a critical indicator of future academic and employment prospects.

Methods and analysis

We will use the Education and Child Health Insights from Linked Data (ECHILD) to capture linked health and education data for children born in National Health Service (NHS)-funded hospitals in England. We will generate birth cohorts spanning September 1997 to August 2015 (estimated sample size: ~10 million), formed of pupils expected to have undertaken national curriculum assessments between academic years 2004/2005 and 2021/2022 including Key Stage (KS) 1, 2 and 4, corresponding to ages 7, 11 and 16 respectively. Cancer diagnosis will be identified from inpatient hospital records, using International Classification of Diseases, 10th Revision codes (ICD-10). We will investigate differences between CCS and their non-cancer peers in terms of their sociodemographic characteristics and describe trends in educational performances at all KSs, recorded Special Educational Needs and Disabilities (SEND) and school absences. Differences in KS4 (GCSE) performances between CCS and non-cancer peers will be quantified, according to and accounting for geographic region, sex, deprivation, ethnicity and birth characteristics. To assess whether cancer diagnosis disrupts academic trajectories, we will restrict analysis to those with KS2 attainment data and investigate KS4 performance. We will finally explore the influence of age at diagnosis on educational performance at KS4.

Ethics and dissemination

Ethics approval was granted by NHS Health Research Authority Research Ethics Committee (20/EE/0180). Findings will be shared with academics, policymakers, children and families affected by childhood cancer, and published in journals. Code/metadata will be shared on ECHILD GitHub repository.

Generative AI at the Bedside: An Integrative Review of Applications and Implications in Clinical Nursing Practice

ABSTRACT

Aim

The aim of this integrative review is to critically appraise and synthesise empirical evidence on the clinical applications, outcomes, and implications of generative artificial intelligence in nursing practice.

Design

Integrative review following Whittemore and Knafl's five-stage framework.

Methods

Systematic searches were performed for peer-reviewed articles and book chapters published between 1 January 2018 and 30 June 2025. Two reviewers independently screened titles/abstracts and full texts against predefined inclusion/exclusion criteria focused on generative artificial intelligence tools embedded in nursing clinical workflow (excluding nursing education-only applications). Data were extracted into a standardised matrix and appraised for quality using design-appropriate checklists. Guided by Whittemore and Knafl's integrative review framework, a constant comparative analysis was applied to derive the main themes and subthemes.

Data Sources

CINAHL, MEDLINE, and Embase.

Results

Included literature was a representative mix of single-group quality improvement pilots, mixed-method usability and feasibility studies, randomised controlled trials, qualitative descriptive and phenomenological studies, as well as preliminary and proof-of-concept observational research. Four overarching themes emerged: (1) Workflow Integration and Efficiency, (2) AI-Augmented Clinical Reasoning, (3) Patient-Facing Communication and Education, and (4) Role Boundaries, Ethics and Trust.

Conclusion

Generative artificial intelligence holds promise for enhancing nursing efficiency, supporting clinical decision making, and extending patient communication. However, consistent human validation, ethical boundary setting, and more rigorous, longitudinal outcome and equity evaluations are essential before widespread clinical adoption.

Implications for the Profession and Patient Care

Although generative artificial intelligence could reduce nurses' documentation workload and routine decision-making burden, these gains cannot be assumed. Safe and effective integration will require rigorous nurse training, robust governance, transparent labelling of AI-generated content, and ongoing evaluation of both clinical outcomes and equity impacts. Without these safeguards, generative artificial intelligence risks introducing new errors and undermining patient safety and trust.

Reporting Method

PRISMA 2020.

A Mixed‐Methods Exploration of Staff Needs for Coping With Grief and Loss in Residential Aged Care

ABSTRACT

Aims

To examine residential aged care staff's experience of death and grief, and their support needs.

Methods

A mixed-methods sequential explanatory design, using an online cross-sectional survey that included the Texas Revised Inventory of Grief and the Grief Support in Health Care Scale. Followed by semi-structured interviews with direct care workers and managers working in residential aged care homes were conducted.

Results

Over 60% of participants experienced five or more resident deaths in the previous 12 months. Although, different levels of grief were experienced among different roles, the importance of open communication and opportunities for farewells after resident death was highlighted. Participants suggested support and education to normalise grief and promote self-care.

Conclusion

Recognising staff grief following the resident death is important. Providing support and education may help improve staff wellbeing and contribute to the delivery of high-quality care for both residents and their families.

Implication for the Profession and/or Patient Care

Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.

Reporting Method

The STROBE and SRQR checklists were applied.

Patient or Public Contribution

No Patient or Public contribution.

Evaluation of a text-mining application for the rapid analysis of free-text wildlife necropsy reports

by Stefan Saverimuttu, Kate McInnes, Kristin Warren, Lian Yeap, Stuart Hunter, Brett Gartrell, An Pas, James Chatterton, Bethany Jackson

The ability to efficiently derive insights from wildlife necropsy data is essential for advancing conservation and One Health objectives, yet close reading remains the mainstay of knowledge retrieval from ubiquitous free-text clinical data. This time-consuming process poses a barrier to the efficient utilisation of such valuable resources. This study evaluates part of a bespoke text-mining application, DEE (Describe, Explore, Examine), designed for extracting insights from free-text necropsy reports housed in Aotearoa New Zealand’s Wildbase Pathology Register. A pilot test involving nine veterinary professionals assessed DEE’s ability to quantify the occurrence of four clinicopathologic findings (external oiling, trauma, diphtheritic stomatitis, and starvation) across two species datasets by comparison to manual review. Performance metrics—recall, precision, and F1-score—were calculated and analysed alongside tester-driven misclassification patterns. Findings reveal that while DEE (and the principals underlying its function) offers time-efficient data retrieval, its performance is influenced by search term selection and the breadth of vocabulary which may describe a clinicopathologic finding. Those findings characterized by limited terminological variance, such as external oiling, yielded the highest performance scores and the most consistency across application testers. Mean F1-scores across all tested findings and application testers was 0.63–0.93. Results highlight the utility and limitations of term-based text-mining approaches and suggests that enhancements to automatically capture this terminological variance may be necessary for broader implementation. This pilot study highlights the potential of relatively simple, rule-based text-mining approaches to derive insights natural language wildlife data in the support of One Health goals.

Perceptions of an AI-based clinical decision support tool for prescribing in multiple long-term conditions: a qualitative study of general practice clinicians in England

Por: dElia · A. · Morris · S. G. · Cooper · J. · Nirantharakumar · K. · Jackson · T. · Marshall · T. · Fitzsimmons · L. · Jackson · L. J. · Crowe · F. · Haroon · S. · Greenfield · S. · Hathaway · E.
Background

Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are currently being developed to aid prescribing in primary care. There is a lack of research on how these systems will be perceived and used by healthcare professionals and subsequently on how to optimise the implementation process of AI-based CDSSs (AICDSSs).

Objectives

To explore healthcare professionals’ perspectives on the use of an AICDSS for prescribing in co-existing multiple long-term conditions (MLTC), and the relevance to shared decision making (SDM).

Design

Qualitative study using template analysis of semistructured interviews, based on a case vignette and a mock-up of an AICDSS.

Setting

Healthcare professionals prescribing for patients working in the English National Health Service (NHS) primary care in the West Midlands region.

Participants

A purposive sample of general practitioners/resident doctors (10), nurse prescribers (3) and prescribing pharmacists (2) working in the English NHS primary care.

Results

The proposed tool generated interest among the participants. Findings included the perception of the tool as user friendly and as a valuable complement to existing clinical guidelines, particularly in a patient population with multiple long-term conditions and polypharmacy, where existing guidelines may be inadequate. Concerns were raised about integration into existing clinical documentation systems, medicolegal aspects, how to interpret findings that were inconsistent with clinical guidelines, and the impact on patient-prescriber relationships. Views differed on whether the tool would aid SDM.

Conclusion

AICDSSs such as the OPTIMAL tool hold potential for optimising pharmaceutical treatment in patients with MLTC. However, specific issues related to the tool need to be addressed and careful implementation into the existing clinical practice is necessary to realise the potential benefits.

Integrated analysis of genome, metabolome, and transcriptome reveals a bHLH transcription factor potentially regulating the accumulation of flavonoids involved in carrot resistance to Alternaria leaf blight

by Claude Emmanuel Koutouan, Marie Louisa Ramaroson, Angelina El Ghaziri, Laurent Ogé, Abdelhamid Kebieche, Raymonde Baltenweck, Patricia Claudel, Philippe Hugueney, Anita Suel, Sébastien Huet, Linda Voisine, Mathilde Briard, Jean Jacques Helesbeux, Latifa Hamama, Valérie Le Clerc, Emmanuel Geoffriau

Resistance of carrot to Alternaria leaf blight (ALB) caused by Alternaria dauci is a complex and quantitative trait. Numerous QTL for resistance (rQTLs) to ALB have been identified but the underlying mechanisms remain largely unknown. Some rQTLs have been recently proposed to be linked to the flavonoid content of carrot leaves. In this study, we performed a metabolic QTL analysis and shed light on the potential mechanisms underlying the most significant rQTL, located on carrot chromosome 6 and accounting for a large proportion of the resistance variation. The flavonoids apigenin 7-O-rutinoside, chrysoeriol 7-O-rutinoside and luteolin 7-O-rutinoside were identified as strongly correlated with resistance. The combination of genetic, metabolomic and transcriptomic approaches led to the identification of a gene encoding a bHLH162-like transcription factor, which may be responsible for the accumulation of these rutinosylated flavonoids. Transgenic expression of this bHLH transcription factor led to an over-accumulation of flavonoids in carrot calli, together with significant increase in the antifungal properties of the corresponding calli extracts. Altogether, the bHLH162-like transcription factor identified in this work is a strong candidate for explaining the flavonoid-based resistance to ALB in carrot.

Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices: A descriptive survey study

Abstract

Aim

To explore Australian and New Zealand nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

Design

A cross-sectional survey design.

Methods

An online survey was sent to Australian and New Zealand nursing and midwifery educators across the 45 Schools of Nursing and Midwifery between July and September 2023. The online survey consisted of 29 open- and closed-ended questions about nursing and midwifery educators' planetary health knowledge, views, confidence and teaching practices.

Results

There was a total of 127 responses to the first open-ended question. A total of 97 nursing and midwifery educators then completed the remaining questions. While educators had mostly positive views about integrating planetary health into their teaching, they lacked the knowledge and/or confidence to do so effectively.

Conclusion

Australian and New Zealand nursing and midwifery educators acknowledge that planetary health should be included in nursing and midwifery curricula, but most reported a deficit in knowledge and/or confidence to integrate these complex concepts into their teaching. When considering planetary health, most educators focussed on climate change, which demonstrates their limited understanding of the concept of planetary health.

Implications for the Profession

All nurses and midwives need to understand how the health of the planet and human civilization are interconnected and be prepared to address complex global health challenges now and in the future. Across the world, key healthcare organizations have called upon nursing and midwifery educators to prepare the healthcare workforce to practice in a more sustainable way, including supporting decarbonization of healthcare. However, our study has demonstrated that nursing and midwifery educators do not feel ready to respond due to a lack of required knowledge and/or confidence.

Reporting Method

We used the Consensus-Based Checklist for Reporting of Survey Studies (CROSS).

Patient or Public Contribution

No patient or public contribution.

Retaining Human Connectedness in Increasingly AI Driven Environments

Journal of Advanced Nursing, Volume 81, Issue 12, Page 8391-8393, December 2025.

Planetary Health in Nursing: A Scoping Review

ABSTRACT

Aim

To map the extent of the use of the term ‘planetary health’ in peer-reviewed nursing literature.

Design

Scoping Review.

Data Sources

CINAHL, ProQuest Nursing & Allied Health Premium, MEDLINE, APA PsycINFO, ProQuest Dissertations & Theses and Web of Science were searched in January and February 2024 for English and French-language publications. A follow-up search was conducted on 10 June 2024 to determine if additional literature was published.

Review Methods

A scoping review was conducted using the Arksey and O'Malley methodology for scoping reviews. To be included the article had to explicitly use the term ‘planetary health’ and ‘nursing’ or ‘nurses’.

Results

Sixty-eight articles met the criteria for the scoping review and were included in this review, with the majority published between 2017 and 2024. Predominant literature included discussion papers, commentaries and editorials. A lack of original research is apparent. Most of the publications were calls to action for nurses to advance planetary health in nursing education, practice, research and advocacy work.

Conclusions

Literature confirms that planetary health is a recent and an important topic in nursing, and nurses have a well-documented role to play in planetary health, given the numerous calls to action in nursing leadership, education, practice and research. There is a need to publish the essential work nurses are doing in planetary health in various nursing domains.

Impact

This scoping review revealed a clear and urgent call to action for nurses to address planetary health. Given this finding, nurses have a responsibility to advocate for a planetary health approach in the profession and take action to contribute to planetary health through education, research, practice and advocacy.

No Patient or Public Contribution

Not applicable, as no patients or public were involved.

The Impact of Thriving at Work and Occupational Supports: Early Career Nurse Intentions to Leave an Organisation and Profession

ABSTRACT

Aim

To examine the direct and indirect predictors of thriving at work and its impact on intention to leave the organisation or profession among early career nurses.

Design

A repeated cross-sectional design.

Methods

A sub-study of early career nurses as part of an Australian longitudinal follow up study, commenced in 2018, was conducted. The sub-study asked early career nurses between their second and sixth year after graduating to complete a structured online questionnaire assessing thriving at work and several predictor variables. Data were analysed using Pearson's correlation, multiple linear regression, and path analysis.

Results

Among the 67 participants (response rate of 42.9%), thriving at work was positively correlated with occupational hardiness, social support from colleagues, and wellbeing, while negatively correlated with compassion fatigue. Thriving at work and perceived organisational support were the significant predictors of intention to leave the organisation, while perceived organisational support was the only significant predictor of intention to leave the profession.

Conclusion

The importance of strong collegial relationships, compassion fatigue, and improving wellbeing to enhance thriving at work are highlighted. Fostering an environment where employees can thrive is crucial to reduce the intentions to leave an organisation. Relationships with the managers and quality of care provision also play a crucial role in reducing turnover and leave intentions. Perceived organisational support enhances employee wellbeing, thereby reducing turnover intentions. Future strategies should focus on comprehensive support systems to retain nurses in their organisation and the profession.

Implications for the Profession

Enhancing thriving at work and perceived organisational support can reduce early career nurses' intention to leave their organisation. However, job stressors and interpersonal conflicts also influence professional leave decisions.

Reporting Method

This study has adhered to the STROBE guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

Achieving consensus on the essential knowledge and skills needed by nursing students to promote planetary health and sustainable healthcare: A Delphi study

Abstract

Aim

To achieve consensus on the knowledge and skills that undergraduate/pre-licensure nursing students require to steward healthcare towards a more sustainable future.

Design

A two-phase real-time Delphi study.

Methods

Phase 1 included the generation of Planetary Health, climate change and sustainability knowledge and skill statements based on a review of relevant literature. Phase 2 consisted of a real-time Delphi survey designed to seek consensus on the proposed statements from a panel of 42 international experts.

Results

Of the 49 survey statements, 44 (90%) achieved ≥75% consensus and 26 (53%) achieved ≥80% consensus. Three were removed and 32 were modified to improve clarity of language.

Conclusion

The knowledge and skills statements that emerged through this Delphi study can serve as a guide for incorporating Planetary Health, climate change and sustainability into nursing education programs.

Implications for the Profession

Incorporating Planetary Health and climate change education into nursing programs has the potential to produce more environmentally conscious and socially responsible nurses.

Impact

The absence of consensus on the essential knowledge and skills expected of nursing students has hindered the advancement of curricula and impacted educators' confidence in teaching Planetary Health and climate change. This study has resulted in a meticulously crafted framework of knowledge and skill statements that will be beneficial to educators, the future nursing workforce, and, ultimately, the individuals and communities whom nurses serve.

Reporting Method

This paper adheres to the Conducting and REporting DElphi Studies (CREDES) reporting guideline.

Patient or Public Contribution

No patient or public contribution.

Triadic relationships between pasture exposure, gastrointestinal parasites, and hindgut microbiomes in grazing lambs

by Jack Jefferson, Claire Reigate, Alessandra Giacomini, M. Jordana Rivero, Matthew Hitchings, Tamsyn Uren Webster, Konstans Wells

Livestock grazing in confined pastures often means grazing on a less diverse diet than under more natural conditions and increased exposure to gastrointestinal parasites prevailing in these pastures. However, how sward composition influences gut microbiome (GM) diversity and its relationship with parasite burden remains poorly understood. In this study, we analysed the faecal GM of weaned lambs grazing on two distinct sward types (perennial ryegrass and a mixed-species sward) over three consecutive months using 16S rRNA sequencing, in order to assess how microbial diversity and composition are related to environmental conditions and the gastrointestinal nematode (GIN) burden in naturally infected lambs. Sward type and sampling time explained some of the variation in GM alpha diversity and community composition (beta diversity), whereas individual lamb identity accounted for considerably more variation in microbial assemblages. Shifts in the relative abundance of bacterial genera such as Saccharofermentans, Anaerosporobacter, Butyrivibrio in relation to sward type and sampling time suggest mostly adaptive fluctuations in response to diet and pasture condition. Abundance shifts of Negativibacillus, and Candidatus Saccharimonas were also associated with GIN burden, which, in turn, was higher in lambs grazing on mixed swards compared to ryegrass. Our findings add to the growing understanding of how sheep microbiomes vary with pasture management and changes in parasite burden. We highlight that individual identity may shape gut microbiota, and that potential triadic interactions among gastrointestinal parasites, sward exposure, and the gut microbiome underscore the importance of considering host, parasite, and environmental factors collectively when evaluating microbiome dynamics in grazing livestock.

Remote maternal-fetal telemedicine monitoring for high-risk pregnancy care: A feasibility study

by Jack Le Vance, Alexandra Emms, Victoria Hodgetts Morton, R. Katie Morris, Leo Gurney

High-risk pregnancies undergo regular antenatal monitoring, including cardiotocography (CTG) and ultrasound. Recently there has been an emergence of sophisticated remote telehealth interventions, potentially enabling care to be shifted into the home setting. Our aim was to evaluate the feasibility and acceptability of home CTG and home ultrasound monitoring for high-risk pregnancies. This was a single center study. Women aged ≥18 years, English speaking, singleton pregnancy, ≥ 32 weeks gestation and had at least one of four high-risk obstetric conditions were eligible. Participants were randomized to one of three groups: (1) home ultrasound; (2) home CTG; and (3) both, whilst continuing their routine antenatal care. The primary outcome was completion of 20 minutes of interpretable fetal heart recording and/or completion of an interpretable fetal ultrasound for each monitoring episode. Ultrasound interpretability was assessed for three validated criteria: fetal heartbeat, fetal movements and liquor volume assessment. Secondary outcomes included monitoring adherence, anxiety management, acceptability and safety. Fifteen participants, within three groups, completed 24 remote ultrasounds and 59 remote CTGs. Overall, the fetal heartbeat, movements and an assessment of the liquor volume were identified in 92%, 83% and 100% of all ultrasound scans respectively. 79% of all scans had all three criteria unanimously assessed. Three-quarters of all CTGs contained at least 20 minutes of continuous interpretable computerized fetal heartrate recording. Neither ethnicity, parity, BMI nor fetal presentation were significant factors for achievement of the primary outcome for both devices. There was non-significant reduction in anxiety scores before and after device usage (p = 0.19). Participants’ monitoring adherence and acceptability ratings were high in all groups. No adverse maternal-fetal outcomes relating to device usage occurred. Home ultrasound and cardiotocography are potentially feasible and acceptable to high-risk pregnant women. Larger studies are required to refine how best to implement such devices into clinical practice. ClinicalTrials ID: NCT06366711.

Using retinal diagnostics as a biomarker for neurodegenerative diseases: protocol for a systematic review

Por: Sahin-Lodge · Z. · Pisani · S. · Nderitu · P. · Guu · T.-W. · Aarsland · D. · Jackson · T. L. · Ffytche · D. · Venkataraman · A. V.
Introduction

Retinal neurodegeneration has recently been shown to occur in tandem with neurodegenerative disease. In the expectation that disease-modifying treatments for Alzheimer’s disease (AD) and Parkinson’s disease (PD) will soon become available, it will be important to have clinically useful biomarkers for neurodegenerative disease subtyping to guide early diagnosis, inform on prognosis and stratify subgroups for treatment. Understanding differences in detectable retina changes in individuals with different neurodegenerative disease subtypes is therefore fundamental. The emerging field of oculomics posits that systemic and neurodegenerative disease can be characterised using detectable ocular biomarkers within retinal diagnostics. The aim of this review is to compare the performance of common retinal imaging modalities in neurodegenerative disease detection and subtyping.

Methods and analysis

This protocol has been reported in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. A comprehensive literature search will be conducted in PubMed, Web of Science and Scopus. Eligible studies will have reported using retinal diagnostic tools defined as optical coherence tomography (OCT), OCT angiography (OCTA), colour fundus photography (CFP) and electroretinography (ERG) in individuals with neurodegenerative diseases, including AD, PD, dementia with Lewy bodies, frontotemporal dementia, vascular dementia and mild cognitive impairment. There will be no time restrictions placed in these searches. Studies not written in English, not peer-reviewed and grey literature will be excluded. Screening for eligible studies and data extraction will be conducted by two independent reviewers, using predefined inclusion criteria. Any disagreements between the reviewers will be settled by discussion, and if required, third senior reviewer arbitration. The systematic review primary outcome is the performance of retinal diagnostics, namely OCT, OCTA, CFP and ERG in the detection and subtyping of aforementioned neurodegenerative diseases. The secondary outcome is to evaluate the association between changes in retinal diagnostic features (eg, retinal layer thicknesses) and neurodegenerative disease subtypes. The quality of the included studies will be assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluations) tool. A narrative synthesis approach will be used to analyse the results, with meta-analysis performed if there is sufficient data.

Ethics and dissemination

Ethical approval for this manuscript is not required, as this is a protocol for a systematic review and therefore no data are to be collected. Findings for this systematic review will be disseminated as a peer-reviewed publication and presentations at national and international symposiums including International Lewy Body Dementia Conference, International Congress of Parkinson’s Disease and Movement Disorders, The Association for Research in Vision and Ophthalmology.

PROSPERO registration number

CRD42023434024.

Organisational Factors and Nurses' Well‐Being in the Workplace: An Integrative Review

ABSTRACT

Aim

To report organisational factors known to positively contribute to nurses' well-being in the workplace.

Design

Integrative literature review.

Methods

Peer-reviewed journal articles using various methodological approaches, and theoretical works, published in English with a focus on organisational factors and nurses' well-being were included. Papers reporting on other healthcare professional groups and/or nursing students were excluded. Data were synthesised into an integrative review, with findings organised theoretically, according to the PERMA model (Positive emotions, Engagement, Relationships, Meaning, Accomplishment), otherwise known as The Well-being Model.

Data Sources

Relevant papers published between May 2020 and April 2025 were identified using CINAHL and PsycINFO electronic databases. Search date, April 24, 2025.

Results

The review included 18 articles, mostly from Europe and the United States, examining workplace factors that contribute to the health and well-being of nurses. Mapping findings to the PERMA domains showed that organisational support and individual strategies together foster flourishing among nurses.

Conclusion

This review highlights both individual factors (such as self-care, strength use and adaptive coping) and organisational structures (including supportive environments, professional development and recognition) that are essential for nurses' well-being and flourishing. However, effective interventions require systemic change, with leadership and education playing key roles in supporting nurses to flourish in the workplace.

Implications for the Profession and/or Patient Care

This review addressed the need to go beyond deficit models of nurses' well-being to pinpoint specific organisational factors that can help nurses to flourish. Prioritising nurse well-being is vital for high-quality, safe and sustainable healthcare systems. Investing in environments where nurses can flourish benefits both individuals and the broader healthcare system.

Reporting Method

This integrative review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

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