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To assess the quality of the Spanish Triage System performed by nurses according to the triage code assigned to each patient and to examine factors associated with the need for re-evaluation after completion of triage.
Retrospective longitudinal observational study.
A retrospective analysis was conducted of patients triaged in the emergency department between 2018 and 2023. Patients triaged by other healthcare professionals and those who did not receive a triage priority level were excluded.
493,211 episodes were analysed. Most were low/intermediate acuity (Level IV 65.4%, Level III 23.9%; Level I 0.1%). Mean time-to-first physician record entry increased as acuity decreased (38 min Level I vs. 81 min Level V), yet recorded time-target compliance was lowest in Levels I–II (23.8% and 14.7%). Re-evaluation occurred more often in high-acuity levels and was independently associated with older age, male sex, lower oxygen saturation and longer emergency department length of stay; compared with Level I, Levels II–III and lower adjusted odds of re-evaluation.
Nurse-led triage demonstrated coherent clinical and operational stratification; however, the lowest recorded time-target compliance in the sickest patients suggests a gap between immediate care and electronic documentation.
Streamline documentation workflows for high-acuity cases and use re-evaluation risk profiles to prioritize monitoring and escalation.
Evidence on nurse-led Spanish Triage System performance and time-documentation quality is limited. Acuity and flow metrics showed expected gradients, but target-time compliance was lowest in Levels I–II; predictors of re-evaluation were also identified. Findings support emergency department nursing, quality improvement and potential benefits for patients attending emergency departments.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Spirituality is a crucial yet complex element of holistic nursing care, particularly when providing care for older adults with depression. In Thailand, depression poses a significant mental health challenge. Thai cultural values are deeply interwoven with individuals' beliefs, making spirituality a critical factor in addressing the care of older adults with depression. This study aimed to explore how older adults with depression experience spirituality and construct meaning from it in their daily lives.
An interpretative phenomenological study.
In-depth interviews of 30 older Thai adults living with depression (aged 60–85 years) from an outpatient psychiatric clinic in southern Thailand were conducted using semi-structured interview questionnaires. Interpretive phenomenological analysis was employed. Data were collected from June to August 2024.
Five themes emerged from the phenomenological data analysis: (1) elusiveness of spiritual meaning, (2) holding oneself together through inner power, (3) finding acceptance through faith in a higher power, (4) family ties shaping peace and despair, and (5) being guided and cared for.
This study highlights that older adults with depression perceive spirituality as essential for their well-being. Personal practices, such as meditation and chanting, played a key role in strengthening spirituality and reducing the risk of relapse in depressive symptoms, which are distinct for each older adult. Understanding spirituality's role in mental health guides nurses to develop strategies for providing more empathetic spiritual care.
Nurses must address depression in older adults through individualized practices to effectively empower their inner strength and coping mechanisms. Understanding each individual's spiritual practices is essential to help them harness their inner strength when coping with depression.
by Julia Drespling, Steffen Heelemann, Selina Strathmeyer, Heike Kühn, Bianca Schwarz, Lars Mundhenk
Equine asthma is a chronic, non-infectious inflammatory disease of the lower airways in horses, classified as mild to moderate (MEA) or severe (SEA). Its pathogenesis is not fully understood and is influenced by environmental and seasonal factors. In this cross-sectional study, seasonal effects on the bronchoalveolar lavage fluid (BALF) metabolome were investigated in asthmatic and non-asthmatic horses. The metabolome of 230 BALF samples from horses across different seasons, classified as cytologically unremarkable (CUA), MEA, or SEA, was analyzed using proton nuclear magnetic resonance spectroscopy (1H-NMR). Principal component analysis was performed for each season, and metabolite profiles were statistically compared between seasons within each group. Altered metabolites were subjected to pathway enrichment analysis using the FELLA R package. Asthmatic horses showed significant seasonal changes in metabolite concentrations between warm and cold seasons, whereas only trends were observed in CUA horses. Pathway analysis indicated enrichment of cholesterol metabolism across all groups. The mTOR signaling pathway was only enriched in SEA horses. Several metabolites—including valine, taurine and carnitine —were altered during the transition from winter to spring in asthmatic horses. These findings indicate that the winter to spring transition significantly modulates the airway metabolome in asthmatic horses, particularly in SEA-affected animals.To evaluate the impact of a 5-min delay in needle removal after haemodialysis on complications and patient satisfaction in newly created arteriovenous fistulas.
Retrospective cohort study.
This study analysed 109 patients with new arteriovenous fistulas undergoing initial cannulation 8–12 weeks post-surgery. Participants were divided into two cohorts: a conventional group (n = 42) receiving immediate needle removal after pump cessation, and a delayed group (n = 67) retaining needles for 5 min post-pump cessation before removal. Outcomes included haemostasis time, hematoma incidence, 3-month reintervention rates, and patient satisfaction measured by a 5-point scale.
Delaying needle removal by 5 min reduced mean haemostasis time by 32% compared to immediate removal (16.4 min vs. 24.1 min). Hematoma incidence decreased substantially by 76% in the delayed group (3.3% vs. 13.1%). At 3-month follow-up, reintervention rates were 66% lower with delayed removal (9.0% vs. 26.2%). Patients also reported 50% less procedure-related pain and significantly higher satisfaction scores (median 4.5 vs. 2).
A brief 5-min delay in needle removal significantly reduces complications and enhances patient-centered outcomes during early arteriovenous fistula use.
This protocol establishes an evidence-based standard for post-dialysis needle management, directly reducing compression-induced pain and reintervention needs while requiring no additional nursing resources. Implementation can immediately improve vascular access safety in haemodialysis units.
The study addresses high complication rates (26.2%) from immediate needle removal in immature fistulas. Key findings demonstrate 76% fewer hematomas and 66% lower reinterventions with 5-min delayed removal. This evidence may transform global haemodialysis nursing protocols, benefiting a substantial population of patients receiving new fistulas annually.
This study follows the STROBE checklist.
Patients and the public were not involved in the design, conduct, or reporting of this retrospective medical record analysis.
by Gift Treighcy Banda-Mtaula, Ibrahim Simiyu, Sangwani Nkhana Salimu, Stephen A. Spencer, Nateiya M. Yongolo, Marlen Chawani, Hendry Sawe, Jamie Rylance, Ben Morton, Adamson S. Muula, Eve Worall, Felix Limbani, Miriam Taegtmeyer, Rhona Mijumbi, on behalf of the Multilink consortium
Multimorbidity, the presence of multiple chronic health conditions, is a leading cause of death globally. In Malawi, chronic noncommunicable and communicable diseases such as HIV frequently co-exist, putting pressure on an under-resourced system. However, the health system is primarily structured around disease-specific [vertical] programs, which hinders person-centred care approaches to multimorbidity. Our study focuses on multimorbidity care and explores the perceptions of healthcare workers on the patient pathways and service organisation throughout the patient’s interaction with the health facilities. This cross-sectional qualitative study took an interpretivist approach. We conducted 13 days of clinical observations at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. We also conducted 13 days of clinical observations and semi-structured in-depth interviews with different cadres of purposively sampled healthcare workers (n = 22) at Queen Elizabeth Central Hospital and Chiradzulu District Hospital. Through thematic analysis, we identified an understanding of the organisation of care and healthcare workers’ perspectives on the delivery of services. Findings showed both hospitals provided services for inpatients and outpatients with multimorbidity, including screening, management, prevention of secondary conditions and rehabilitation. Patient diagnosis and management for multimorbidity were often delayed due to frequent stockouts of medication and consumables necessary for diagnostic testing for NCDs at the hospital level. Some healthcare workers were not equipped with the knowledge, skills, or guidelines to manage multimorbidity. As HIV care is currently better resourced than other chronic conditions, healthcare facilities may strengthen the supply chain, healthcare workers’ training sessions and monitoring and evaluation tools to ensure NCDs are well managed, learning from HIV programmes.by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEFby Mariana Moraes de Lima Perini, Alyssa F. Fayemi, Julie N. Pugh, Elizabeth M. Scott, Karan Bhula, Austin Chirgwin, Olivia N. White, Nicolas F. Berbari, Jiliang Li
Primary cilia play a crucial role in the development and mechanosensation of various tissue types, including bone. In this study, we investigated their role in bone growth and adaptation by targeting two cilia specific genes, IFT88 and MKS5. Conditional knockout (cKO) of IFT88 in osteoblasts significantly reduced body weight and femur length in mice compared to the littermate controls. Additionally, female IFT88 cKO mice exhibited a significant suppression of bone formation rate compared to the littermate controls. To further explore the role of primary cilia in osteocytes, osteocytes specific MKS5 cKO mice underwent axial ulnar loading at a peak force of 2.9N for females and 3.2N for males with 120 cycles per day for three consecutive days. Load induced bone formation rate was significantly decreased by 48% in males and 42% in females compared to the littermate control mice. These findings underscore the critical role of primary cilia in bone development and mechano-adaptation. They suggest that functional primary cilia in osteoblasts are essential for skeletal development, while those in osteocytes mediates mechanically induced bone formation, highlighting its potential as therapeutic targets for bone loss prevention.Objetivo. Evaluar si existe asociación entre depresión y ansiedad con el rendimiento académico en estudiantes de enfermería de la Universidad Villasunción, Aguascalientes, México. Metodología. Estudio cuantitativo, observacional, descriptivo-correlacional y de corte transversal. La población estuvo conformada por 273 estudiantes de la Licenciatura en Enfermería. Se seleccionó una muestra de 161 participantes mediante muestreo estratificado. Para evaluar la depresión se utilizó el Inventario de Depresión de Beck II (BDI-II) y para ansiedad el Inventario de Ansiedad de Beck (BAI). El rendimiento académico se obtuvo a partir del promedio general acumulado. Los datos se analizaron mediante estadística descriptiva y prueba de chi-cuadrado de Pearson utilizando SPSS versión 27, con un nivel de significancia de p ≤ 0.05. Resultados. El 54.7% de los estudiantes presentó niveles mínimos de depresión, mientras que el 16.1% reportó niveles graves. En cuanto a la ansiedad, el 30.4% mostró niveles mínimos y el 20.5% niveles graves. El rendimiento académico predominante fue “Bueno” (59%). Mediante la prueba de chi-cuadrado de Pearson se identificó una asociación estadísticamente significativa entre depresión y rendimiento académico (p= 0.030). En contraste, la ansiedad no mostró una asociación significativa con el rendimiento académico (p= 0.506). Discusión. La depresión se asocia significativamente con el rendimiento académico en estudiantes de enfermería, lo que evidencia la importancia de considerar la salud mental como un factor relevante en el desempeño académico universitario.
ABSTRACT
Objective. To evaluate whether there is an association between depression and anxiety and academic performance among nursing students at Universidad Villasunción in Aguascalientes, Mexico. Methodology. A quantitative, observational, descriptive-correlational, cross-sectional study was conducted. The population consisted of 273 undergraduate nursing students. A sample of 161 participants was selected using stratified sampling. Depression was assessed using the Beck Depression Inventory II (BDI-II), and anxiety was measured using the Beck Anxiety Inventory (BAI). Academic performance was obtained from the students’ cumulative grade point average. Data were analyzed using descriptive statistics and Pearson’s chi-square test with SPSS version 27, considering a significance level of p ≤ 0.05. Results. A total of 54.7% of students presented minimal levels of depression, while 16.1% reported severe levels. Regarding anxiety, 30.4% showed minimal levels and 20.5% severe levels. The predominant academic performance category was “Good” (59%). Pearson’s chi-square test identified a statistically significant association between depression and academic performance (p = 0.030). In contrast, anxiety did not show a significant association with academic performance (p = 0.506). Discussion. Depression is significantly associated with academic performance among nursing students, highlighting the importance of considering mental health as a relevant factor in university academic outcomes.
Introducción. El dolor crónico en una condición multidimensional con elevada prevalencia que afecta en la calidad devida, entorno sociolaboral y predispone a enfermedades de Salud Mental. Metodología. Este estudio de metodologíamixta pretende hacer frente a la carencia de herramientas de valoración específicas en este contexto. La construcción delcuestionario se llevará a cabo mediante un proceso riguroso compuesto por un panel de expertos, grupo de discusión y prueba piloto, con el objetivo de analizar el manejo de las enfermeras. Los aspectos por evaluar serán suficiencia,claridad, coherencia y relevancia para obtener la versión definitiva del cuestionario. Con ello se busca conseguir una herramienta sólida que permite una mayor visibilización y desarrollo de las enfermeras en el manejo de esta comorbilidad.Relevancia. La importancia del estudio radica en desarrollar uno nuevo cuestionario que permita valorar los conocimientos de las enfermeras de Salud Mental respecto al dolor crónico, con el objetivo de detectar posibles áreas de mejora para proporcionar unos cuidados de mayor calidad basados en un enfoque enfermero biopsicosocial y la evidencia científica actual.
ABSTRACT
Introduction. Chronic pain is a multidimensional condition that impacts quality of life, socio- occupational environment, and predisposes individuals to mental health disorders. Methodology. This mixed-method study aims to address the lack of specific assessment tools in this context. The questionnaire was developed through a rigorous processinvolving an expert panel, a focus group, and a pilot test, with the objective of analyzing nurses' management of chronic pain. The evaluation will focus on assessing the adequacy, clarity, internal consistency, and relevance of the items in order to obtain the final version of the questionnaire. This process aims to produce a psychometrically sound instrument that contributes to enhancing the professional role and visibility of mental health nurses in the assessment and management of this comorbidity. Relevance. The relevance of this study lies in the development of a new questionnairespecifically designed to evaluate the level of knowledge that mental health nurses possess regarding chronic pain. The ultimate goal is to identify potential knowledge gaps and areas for improvement, thereby facilitating the delivery of higher-quality, evidence-based care grounded in a biopsychosocial nursing framework.
To explore public health nurses' experiences of child maltreatment preventive work in primary healthcare.
The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesising qualitative research.
The quality of the included studies was appraised using Joanna Briggs Institute Checklist for Qualitative Research. The analysis followed Braun and Clarke's reflexive thematic analysis.
Searches were conducted in five electronic databases: Cinahl, Medline, PsychINFO, Web of Science and SocINDEX in May and July 2024, and updated in April and December 2025.
Thirteen qualitative studies were included, and five themes were developed: Insufficient knowledge about when and how to act, building a therapeutic relationship with parents, keeping the child's best interest in focus, in need of better interdisciplinary support and ambivalence in addressing child maltreatment.
Public health nurses face challenges in child maltreatment preventive work, including insufficient knowledge and limited interdisciplinary support. Even so, public health nurses demonstrate a strong commitment to children's safety and well-being and to building relations with families.
The findings suggest an increased focus on strengthening public health nurses' knowledge of child maltreatment and improved interdisciplinary collaboration.
The findings are of interest to healthcare professionals and health authorities to improve child maltreatment preventive work in primary healthcare.
This review adhered to relevant EQUATOR guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO registration number: CRD42025637855.
Hand burns, although often limited in surface area, have a major impact on function and quality of life. Debridement—surgical or enzymatic—is a key component of treatment, with enzymatic debridement increasingly used for its selectivity and potential to preserve viable dermis. To evaluate and compare the functional outcomes of hand burns treated with surgical versus enzymatic debridement, using the DASH/Quick-DASH and Michigan Hand Questionnaire (MHQ) assessment tools. A systematic review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251034408). Searches were performed in PubMed, Scopus, and Web of Science without date restrictions. Inclusion criteria focused on studies evaluating hand burn function using DASH, Quick-DASH, or MHQ after enzymatic or surgical debridement in patients aged 16 or older. Methodological quality was assessed using the ROBINS-I tool. Of 547 studies identified, 7 met inclusion criteria: 4 surgical and 3 enzymatic. Functional recovery was generally better in cases where enzymatic debridement preserved viable dermis and avoided grafting. DASH and MHQ scores favoured enzymatic approaches, especially when conservative management followed debridement. However, methodological limitations and clinical heterogeneity limited direct comparison. Enzymatic debridement, through preservation of viable dermis and reduced grafting need, appears associated with improved functional outcomes in hand burns. Whilst surgical debridement remains essential for deeper burns, enzymatic methods may offer functional advantages and support early rehabilitation in appropriate cases.
To examine the contexts and mechanisms that enable compassionate mentorship in healthcare, in order to generate evidence-informed insights for fostering healthier, more sustainable work environments.
A rapid realist review.
Systematic searches were conducted in Ovid MEDLINE (1946–December 2024), Embase (1974–December 2024) and CINAHL (1981–December 2024). Additional sources included Google Scholar searches, reference list scanning and grey literature (e.g., practice guidelines, policy briefs, professional reports). The review was conducted between August 2024 and July 2025.
Realist review methods were applied to answer the question: What works, for whom, under what circumstances and why? The review proceeded in four stages: defining scope and research questions with an expert panel; iterative searching and screening; data extraction and synthesis into context–mechanism–outcome configurations (CMOCs); and development of a programme theory.
Twenty-two documents were included, spanning nursing, medicine, allied health and interdisciplinary contexts. Six CMOCs were identified, encompassing the following themes: (1) relationship compatibility; (2) vulnerability and self-exploration; (3) growth through untapped strengths; (4) anti-oppression and equity; (5) mentors' pride and confidence; and (6) culture of mentorship. The resulting programme theory conceptualises compassionate mentorship as a dynamic, multi-level process with cumulative impacts on individual well-being, professional development and organisational culture.
Compassionate mentorship represents not only a relational practice but also a structural intervention for healthier workplaces. Programmes should prioritise compatibility, cultivate psychological safety, invest in mentee growth, embed equity, recognise mentor contributions and institutionalise mentorship culture.
These strategies offer actionable pathways to strengthen workforce resilience, retention and sustainability.
One co-author is a retired nurse, ethicist and person with lived experience in the healthcare system. This co-author was integral to this project, serving on the scientific steering committee from project conceptualisation and funding application through study conduct and publication.
by Robin Devey-Burry, Julia Lukewich, Dana Ryan, Myuri Sivanthan, Maria Mathews, Marie-Eve Poitras, Cheryl Etchegary, Shabnam Asghari, Margot Antle
BackgroundFamily Care Teams were introduced in Newfoundland and Labrador (NL) as a strategy to strengthen primary care through team-based models that optimize interprofessional collaboration. Nurses, including nurse practitioners (NPs), registered nurses (RNs), and licensed practical nurses (LPNs), play critical roles in these models; however, little is known about nurses’ transition to these settings or the supports shaping their integration and effectiveness. To address this gap, we explored nurses’ experiences transitioning into Family Care Teams, including supports for integration and the barriers and facilitators influencing this process.
MethodsAs part of a qualitative descriptive study, we conducted semi-structured interviews with 25 nurses (6 NPs, 13 RNs, 6 LPNs) employed in Family Care Teams across five NL health zones. During the interviews, nurses described their experiences working in Family Care Teams, available practice supports, current roles, and barriers and facilitators to maximizing scope of practice. Interviews were transcribed and analyzed using qualitative content analysis and constant comparison.
ResultsParticipants described their transition to Family Care Teams in two stages: 1) orientation and 2) supportive learning relationships. Orientation was highly variable, ranging in length and structure. Learning in this area was often self-directed, technology-focused, and asynchronous, with limited emphasis on clinical preparation or role expectations. Mentorship and shadowing opportunities were inconsistently available, with many nurses lacking access to experienced role models within the newly established teams. These gaps contributed to role ambiguity, underutilization of nursing scope of practice, and prolonged adjustment periods.
ConclusionsOur findings reveal gaps in orientation and mentorship during nurses’ transition into Family Care Teams in NL. A common yet adaptable transition framework, expanded student placements, and structured mentorship are critical to optimizing nursing roles in team-based care. Strengthening practice supports and clarifying nursing contributions can improve access and care quality while informing broader initiatives to support nurses’ transition into primary care.
by Hang Sun, Haozhi Xu, Junying Li, Xiaoman Xie, Junmei Zhang, Hongjie Dong, Huanhuan Xie, Qi Wang, Guihua Zhao, Kun Yin, Jingyu Yang, Jianwei Zhou, Ruili Wu, Chao Xu
Gastric cancer (GC) is one of the most common and lethal cancers globally. methyltransferase-like 3 (METTL3)-mediated N6-methyladenosine (m6A) RNA methylation plays a crucial role in tumor initiation and progression by regulating RNA function. STM2457, a highly efficient METTL3 inhibitor, can inhibit METTL3 activity and may serve as a potential therapeutic strategy in cancers. However, the role of STM2457 for GC cells is still unknown. In this study, we analyzed the expression profile data of GC in TCGA and GEO databases, and further explored the expression involvement of METTL3 in GC cell line, investigated the therapeutic effect of STM2457 targeted inhibition of METTL3 in GC both in vitro and in vivo experiments. The results indicated that STM2457 could suppress GC cell proliferation and migration by inhibiting METTL3, and also promoted cell apoptosis and arrest the cell cycle in S phase. In addition, STM2457 could inhibit tumor growth in subcutaneous xenotransplantation mouse model. Our findings suggested that STM2457 had great potential for the treatment of GC and could serve as a foundation for future clinical applications.The interfaces between the fields of communication, education and health have been indicated by international institutions such as the WHO and the European Centre for Disease Prevention and Control. However, hegemonic scientific practices supersede dialogue between the three fields, isolating their practices. This fragmenting tendency is observed in scientific literature, which has created gaps in the dialogue and articulation between communication, education and health. Although health promotion requires both communicative and educational practices, the epistemological, historical, political, cultural and socioeconomic aspects have also engendered tensions between the fields. Communication is often seen as a mere instrument for other practices, rather than a phenomenon that (re)produces meanings and power dynamics. In opposing the reductionist and instrumentalising perspectives of knowledge fields, the primary objective of the scoping review is to map the scientific evidence on the interfaces between communication and education in health to indicate a conceptual framework that articulates communication and education practices within the context of health.
A transdisciplinary team developed this protocol based on the 2024 Joanna Briggs Institute Manual for Evidence Synthesis. The procedures required to conduct the review were guided by the frameworks proposed by Arksey and O'Malley, Levac et al and Peters et al. The study eligibility criteria were established based on the Problem, Concept and Context outlined in the research questions. Primary and secondary studies will be retrieved from nine sources, covering both conventional and grey literature. These sources include Embase, ERIC, LILACS, PubMed/MEDLINE, ScienceDirect, Scopus, Web of Science, the Brazilian Digital Library of Theses and Dissertations, and the Networked Digital Library of Theses and Dissertations. A categorised form will be used for data collection and subsequent analysis. The reporting of the review findings will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
The nature of the research and the use of secondary data sources do not require informed consent forms or approval from ethics committees in Brazil. The scientific findings from the review will be disseminated through peer-reviewed journals, academic conferences and other scientific communication channels.
The protocol was registered on the Open Science Framework (OSF) and is available at https://doi.org/10.17605/OSF.IO/Z3CX7.
This study aimed to explore the process of moral resilience among frontline healthcare professionals. By delving into experiences of handling moral challenges during a pandemic crisis, we aimed to understand dimensions of moral resilience, affecting factors and consequences. This understanding can inform the implementation of interventions to support healthcare professionals’ well-being and ability to deliver high-quality care, under both routine and extreme conditions.
A qualitative exploratory study was conducted using grounded theory methodology. Data were collected retrospectively through written narratives and individual interviews (September to November 2020).
General hospital wards allocated for patients with COVID-19 in two Swedish healthcare regions.
46 informants, comprising registered nurses, nursing assistants, physicians, managers and allied health professionals.
A conceptual model is presented that describes and explains the process of moral resilience among frontline healthcare professionals working in general hospital wards during a pandemic crisis. The model reveals a complex and dynamic iterative process, with components at both the individual and system levels being inevitably inter-related.
The findings emphasise that moral resilience within healthcare organisations is not solely dependent on individual qualities but also influenced by the working groups or teams, leadership and prevailing organisational structures. Supportive interventions should target workgroup dynamics and organisational culture while providing tailored support for individuals.
To evaluate the effect of lobeglitazone on renal disease progression in patients with type 2 diabetes mellitus using longitudinal real-world data.
Retrospective cohort study.
Hospital-based Common Data Model database.
A total of 14 712 adults with type 2 diabetes mellitus who visited the Diabetes Center of Ewha Womans University Mokdong Hospital between 2013 and 2019 were identified. A 1:2 propensity score matching was performed to compare patients treated with lobeglitazone plus metformin with those receiving metformin monotherapy, sulfonylurea plus metformin, or a dipeptidyl peptidase-4 (DPP4) inhibitor plus metformin.
Treatment with lobeglitazone plus metformin compared with metformin monotherapy, sulfonylurea plus metformin or DPP4 inhibitor plus metformin.
Renal progression, defined as initiation of renal replacement therapy, a sustained ≥30% decline in estimated glomerular filtration rate (eGFR) from baseline, or doubling of serum creatinine with a concurrent eGFR ≤45 mL/min/1.73 m².
The HR of renal progression was 0.84 (95% CI 0.58 to 1.21) in the lobeglitazone plus metformin compared with metformin monotherapy, 1.00 (95% CI 0.79 to 1.27) compared with sulfonylurea plus metformin group, 1.10 (95% CI 0.84 to 1.44) compared with DPP4 inhibitor plus metformin group after adjusting for multiple variables. Subgroup analyses demonstrated significant interactions by sex in the comparison with metformin monotherapy (P for interaction=0.0179) and by glycaemic control in the comparisons with sulfonylurea plus metformin (P for interaction=0.0161) and DPP4 inhibitor plus metformin (P for interaction=0.0006), suggesting potential heterogeneity in treatment effects.
Lobeglitazone showed renal outcomes comparable to those of other antidiabetic medications, with a possible heterogeneity in treatment effects according to sex and glycaemic control.
To address whether eating disorders (ED) or insulin omission (IOM) in adult persons living with type 1 diabetes (pwT1D) are associated with impaired glycaemic control.
Cross-sectional analysis.
The French-Speaking Diabetes Society—Type 1 Diabetes Cohort (SFDT1) is an ongoing epidemiological cohort study that includes pwT1D in France who attend hospitals or private ambulatory diabetes centres.
Adult participants from the SFDT1 study, with data on ED and IOM. The current analysis was performed on data collected during the baseline visit in participants enrolled between December 2020 and March 2024.
Using the SCOFF, a self-reported questionnaire to screen for ED, and a single question on IOM to screen for IOM, we described four categories of pwT1D: no ED & no IOM, ED & no IOM, no ED & IOM and ED & IOM. We performed unadjusted and adjusted (for age, sex, diabetes duration, social vulnerability, smoking, alcohol status and insulin treatment) multinomial logistic regression models with the four categories as the outcome and glycaemic variables as explanatory variables, including continuous glucose monitoring (CGM) variables and HbA1c. No ED & no IOM was the reference outcome for all comparisons. We stratified each model by sex and fear of hypoglycaemia.
We included 1113 participants, 51% males, median (IQR) age 38 (29–50) years, diabetes duration 21 (12–32) years. Prevalences were as follows: no ED & no IOM: 68% (n=758), ED & no IOM: 11% (n=124), no ED & IOM: 16% (n=177) and ED & IOM: 5% (n=54). With the fully adjusted model, and compared with the group no ED & no IOM, time in range (OR (95% CI) 0.5 (0.4 to 0.7)) and time below range (0.5 (0.3 to 0.8)) were inversely associated with ED & IOM. Moreover, time in range (0.4 (0.4 to 0.5)) was associated with IOM & no ED. Time above range (2.2 (1.6 to 2.9)), Glycaemic Risk Index (1.8 (1.3 to 2.5)), glucose monitoring indicator (2.2 (1.7 to 2.9)) and HbA1c (2.0 (1.5 to 2.5)) were directly associated with ED & IOM. We did not observe associations between CGM variables and ED & no IOM. Most associations were valid in both men and women. The associations were stronger in participants with a fear of hypoglycaemia. However, the associations remained even in people with a fear of hypoglycaemia.
Both ED and IOM are frequent in pwT1D, and IOM seems to be associated with impaired glycaemic control. As our analysis was cross-sectional, we cannot infer causality and cannot know whether IOM was a result of glycaemic control or the inverse (reverse causality). Our results suggest that IOM should be systematically screened in clinical practice. Further research is needed to better identify and care for EDs, with or without IOM, in T1D.
Each year, an estimated 1700 children should be diagnosed with cancer in western Kenya, with leukaemia making up nearly one-third of cases. However, far fewer are actually diagnosed, highlighting significant delays or errors in diagnosis. Flow cytometry, which the WHO considers essential for leukaemia diagnosis, remains underused across sub-Saharan Africa due to high costs, outdated equipment and a lack of trained personnel. In Kenya, decades-old cytometers have been adapted for leukaemia detection, but these systems are now outdated. Newer platforms, such as simplified single-tube multiparametric assays, provide a scalable and sustainable alternative. This study presents a protocol to evaluate the accuracy of diagnosis and the potential for implementing a streamlined flow cytometry assay using peripheral blood, supported by a regional educational initiative.
This prospective, mixed-methods implementation study has three aims: (1) to assess the concordance between the Beckman Coulter ClearLLab 10C gold standard 4-tube assay and the streamlined ClearLLab LS 1-tube assay using paired bone marrow and peripheral blood samples; (2) to evaluate the feasibility of peripheral facility referrals and transport logistics with couriered peripheral blood samples from referring sites across western Kenya; and (3) to measure training effectiveness and knowledge gain through a multimodal educational programme using the Project ECHO (Extension for Community Healthcare Outcomes) model. Up to 300 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya, will be enrolled in Aim 1. A separate sample of 100 patients from peripheral facilities will be included in Aim 2. Surveys, knowledge assessments and structured interviews will be used to evaluate training impact under Aim 3. Diagnostic concordance, sensitivity, specificity and knowledge gain will be measured through appropriate quantitative and qualitative methods.
The protocol has received approval from institutional ethics committees at Moi University, MTRH and Indiana University. De-identified data will be analysed and shared through peer-reviewed publications, stakeholder presentations and educational platforms.
Alcohol use disorder and treatment-resistant depression (TRD) often co-occur, presenting a major clinical challenge with limited effective treatments. However, ketamine produces rapid antidepressant effects and has shown promise in reducing alcohol use, and acceptance and commitment therapy (ACT) can be effective for both substance use and mood disorders. This study explores the feasibility and acceptability of combining ACT with ketamine within the framework of the Montreal Model—a structured, integrative psychedelic ketamine therapy developed for severe TRD.
This study is a single-group, open-label feasibility trial at the Centre hospitalier de l'Université de Montréal (CHUM) Neuromodulation Ketamine Clinic in Montreal, Canada. 30 participants diagnosed with both alcohol use disorder and treatment-resistant depression will receive eight weekly in-person or virtual ACT sessions in addition to six intravenous ketamine infusions. The primary outcome is feasibility, assessed through study completion and protocol adherence. Secondary outcomes include recruitment rate, tolerability, safety, data completeness and healthcare resource use. Exploratory measures will examine changes in depressive symptoms, alcohol use and quality of life using validated tools. A subset of participants will participate in semistructured qualitative interviews to explore their experiences.
This study was approved by the ethics committee of the CHUM on 14 May 2025. The results of the trial, including primary and secondary outcomes, will be published in peer-reviewed scientific journals.
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