Conectar
Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders (NDDs) and is frequently associated with psychiatric and somatic comorbidities. As a result, individuals with ASD use emergency departments more frequently than the general population. However, the core features of ASD pose specific challenges in emergency department care, particularly for adult patients and emergency staff frequently report limited training in this area. While paediatric presentations of ASD in the emergency department are well documented, the international literature on adults remains limited.
we conducted a single-centre retrospective study including all patients aged 15 years and older with a diagnosis of ASD who attended the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), GHU Paris (Groupe Hospitalo-Universitaire) between 12 January 2016 and 31 December 2023. The objectives were to estimate the prevalence of ASD in this psychiatric emergency setting and to describe the patients’ socio-demographic and clinical characteristics, mode of arrival, reasons for consultation and referral following the emergency visit.
Among 69 447 patients who attended the CPOA during this period, 484 (0.7%) had a diagnosis of ASD. This population was predominantly male (71.9%), with a mean age of 25.1 years. The most frequent reasons for consultation were hetero-aggressive behaviour (37.0%) and anxiety (31.0%). Overall, 39.2% of patients were hospitalised, including 17.3% involuntarily, and 6.2% required physical restraint. The number of consultations involving patients with ASD increased significantly between 2016–2023.
This study provides a clearer understanding of the clinical and organisational challenges associated with the management of adult patients with ASD in psychiatric emergency departments. Although this study was descriptive and did not assess specific interventions, the observed patterns, in line with previous literature, suggest that adopted care strategies may help better address the needs of this population.
The aim of this study is to assess nurse practitioner students' perceptions and engagement with Isabel's artificial intelligence (AI) based differential diagnosis tool to support their decision-making skills during their theoretical and clinical placement training.
This pilot study used a cross-sectional design.
Twenty-six nurse practitioner students provided feedback on their use of an AI differential diagnosis tool in both academic and clinical contexts. This survey used the Post-Study System Usability Questionnaire to assess the engagement levels and usability of the AI tool. Additional questions were included to evaluate the usage patterns, adequacy in training and confidence in diagnosis.
There were mixed engagement levels: 44.4% (n = 8/18) used Isabel in two subjects—typically one or both clinical placement units—and 27.8% (n = 5/18) in one subject; students most often used the tool to confirm differential diagnoses. Usability was rated positively with the disease ranking, red flag diagnosis and link to national guideline features demonstrating the highest student usage. While most students found the tool beneficial to use during clinical placement and completing university assignments, some reported challenges due to insufficient training, impacting confidence in clinical application.
Isabel has potential as a valuable educational tool in Nurse Practitioner programs, but successful implementation depends on adequate training and support. The findings highlight the importance of comprehensive training and support to maximise AI tool utilisation, with direct implications for programme curricula, clinical education strategies and potential improvements in diagnostic reasoning skills for future nurse practitioners.
This study provides an example of integrating artificial intelligence (AI) guided clinical decision-making training in nurse practitioner (NP) education. The findings can be used by educational institutions to trial similar AI-integrated learning approaches, enhancing diagnostic competence and potentially improving patient care outcomes.
The Study adhered to the STROBE checklist for reporting.
No patient or public contribution was made to this study.
Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum-based 1H nuclear magnetic resonance (NMR) measurement combined with short-time Fourier transform (STFT) for time-frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time-frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision-guided treatment strategies.
This study examined the effects of food accessibility on eating habits, home eating environment and anthropometrics among rural parent-child dyads.
This secondary data analysis utilised baseline and post-intervention data from a mindful eating intervention trial. Parents completed an online survey assessing their sociodemographics, height, weight, eating habits, food resource management behaviours, child feeding attitudes and practices, home eating environment and household food insecurity. Trained data collectors measured children’s height, weight, percent body fat and skin carotenoids at childcare centres. Using Geographic Information System tools, food accessibility was estimated by linking participants’ zip codes to Zip Code Tabulation Areas.
A total of 154 rural parent-child dyads from low-income households were successfully recruited from 26 Head Start childcare centres in the USA. The children’s mean age was 47.16 months (SD=6.56) while parents averaged 32.68 years old (SD=8.00). About one-third of the parents were single and nearly a third had an annual family income below US$20 000. Additionally, 44.2% of parents were unemployed and over half only had an education level of high school or below. Mixed-effect models revealed that at baseline, limited access to full-service restaurants and greater access to limited-service restaurants were related to higher BMI z-scores (p=0.021, 0.040) and percent body fat (p=0.020, 0.032) in children. Longitudinal analyses using pre-post intervention data indicated that parents’ increases in fibre intake from baseline to post-intervention were correlated with less access to limited-service restaurants (p=0.034), while their improved food resource management behaviours over time were associated with greater access to grocery stores/supermarkets (p=0.043) after accounting for other types of food access. Additionally, more access to convenience stores was associated with increases in perceived parental weight (p=0.027) over time.
These findings suggest that food accessibility influences both dietary behaviours and health outcomes, with grocery stores and full-service restaurants having positive impacts, while limited-service restaurants and convenience stores have detrimental effects.
The clinical trial associated with the study’s data is registered at ClinicalTrials.gov under the identifier NCT05780008 on 27 February 2023.
Early-onset dementia, also referred to as young-onset dementia, affects people younger than 65 years of age. A diagnosis of dementia is often not considered when patients with symptoms of cognitive decline are < 65 years old, often resulting in a delayed diagnosis. Therefore, family caregiving for persons with early-onset dementia may differ from caregiving for persons with other dementias.
To explain the caregiving trajectory for new family caregivers of persons with early-onset dementia before and after diagnosis of the disease.
This qualitative study was conducted from a grounded theory perspective.
Family caregivers of persons recently diagnosed with early-onset dementia were recruited from two medical centres in northern Taiwan by a combination of purposive and theoretical sampling to inform the theory explaining the caregiving trajectory. Data were collected with face-to-face semi-structured interviews. Interview data were analysed with constant comparative analysis; data collection and analysis ceased when theoretical saturation was reached. A total of 15 family caregivers were interviewed.
The core theme describing the trajectory of the caregiving process for new family caregivers of persons recently diagnosed with early-onset dementia was maintaining a dynamic balance, which involved three interacting elements: (1) emotional reactions, (2) multitasking and facing conflicts, and (3) continual adjustments. A diagnosis helped caregivers find a temporary balance, but when disease progression increased, new adjustments were required.
Maintaining dynamic balance allowed caregivers to cope with their emotions, juggle the responsibilities associated with their new role, and adjust to the progression of dementia.
The findings describe the process of maintaining a dynamic balance for family caregivers of a spouse or parent with early-onset dementia. The elements used to achieve caregiving balance could help mental healthcare nurses educate family caregivers on how to adjust communication and provide them with information on when more practical support is needed.
No Patient or public contribution.
COREQ (COnsolidated criteria for REporting Qualitative research).
To examine residential aged care staff's experience of death and grief, and their support needs.
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.
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.
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.
Staff grief after a resident death needs to be recognised, and continuing education and support are required for their wellbeing.
The STROBE and SRQR checklists were applied.
No Patient or Public contribution.
In Australia, aligned to safety and quality standards, the health system implements standardised practices that include patient involvement in nursing bedside handover. Despite this mandate, it remains unclear whether patients are genuinely participating in nursing bedside handovers and whether their perspectives are being considered.
To explore patient perceptions of their involvement in nursing bedside handovers.
A cross-sectional survey study was conducted in two acute metropolitan hospitals in Western Australia from July 2021 to March 2022. The survey administered to patients, comprised three sections: demographic information; involvement in bedside handover; and perceptions of bedside handovers; utilising close-ended and Likert scale questions. Open-ended questions further explored participation in bedside handovers. Descriptive statistics and comparative analyses were performed and responses to open-ended questions underwent summative deductive content analysis.
Of the 390 participants, over half reported five or more bedside handovers (n = 197, 50.7%). Most perceived the importance of (n = 334, 79.0%), and expressed their satisfaction with (n = 327, 89.6%), involvement in bedside handover. Perceptions of handover were mostly positive. There were a few significant differences throughout based on type of hospital, gender and age-group. Open ended responses shared perceptions on the perceived benefits, challenges and barriers and ways to enhance involvement in bedside handover. Patients expressed several challenges, including lack of awareness of their right to participate, the approach of nurses and the timing of handovers as hindering their participation in bedside handovers.
Patients perceived the importance of, were mostly satisfied with, and had positive perceptions of bedside handover. However, several challenges hindered effective patient participation. Further research is needed into bedside handover as it is essential to enhance patient-centred quality care that aligns with national safety and quality healthcare standards.
Understanding the significance of patient involvement in bedside handovers motivates patients to actively share information about their care, leading to increased patient satisfaction and the promotion of patient-centred care. Addressing challenges through targeted strategies can enhance patient participation, communication, increased patient satisfaction and foster a more patient-centred approach to care.
The conduct of this study was supported by the consumer advisory group in the participating hospitals who also reviewed the survey questionnaires and conducted face validity of the survey.
Intraoperative anaesthesia handoffs represent a risk point in the care of surgical patients. Although often necessary to prevent fatigue, improve vigilance and optimise operational efficiency, critical information can be lost, potentially leading to postoperative complications. Structured handoffs can increase the transfer of knowledge during intraoperative anaesthesia handoffs, improving their quality. We therefore propose to test the primary hypothesis that a semi-structured intraoperative anaesthesia handoff cognitive aid reduces the number of serious 30-day complications in surgical patients.
We will enrol adults having non-cardiac surgery who are scheduled to have an intraoperative anaesthesia handoff for operational reasons. We plan a cluster randomised trial (enrolling over 18 months, anticipated sample size approximately 4500 patients) that will compare the Epic Electronic Health Record intraoperative anaesthesia handoff cognitive aid to routine handoffs. Our primary outcome will be the number of serious postoperative complications within 30 days. Our secondary outcomes will be: (1) the number of minor complications; and (2) the duration of postoperative hospitalisation. Bayesian analysis with generalised linear multilevel modelling will be used to estimate the effect of structured handoffs on the primary and secondary outcomes.
This study has been approved by the local institutional review board with a waiver of informed consent. Results will be disseminated in the medical literature with de-identified data available on request.
Temperature control is a fundamental intervention for neuroprotection following resuscitation from cardiac arrest. However, evidence regarding the efficacy of hypothermia in post-cardiac arrest syndrome (PCAS) remains unclear. Retrospective studies suggest that the clinical effectiveness of hypothermia may depend on the severity of PCAS. The R-CAST OHCA trial aims to compare the efficacy of hypothermia versus normothermia in improving 30-day neurological outcomes in patients with moderately severe PCAS following out-of-hospital cardiac arrest.
The multicentre, single-blind, parallel-group, superiority, randomised controlled trial (RCT) is conducted with the participation of 35 emergency and critical care centres and/or intensive care units at academic and non-academic hospitals. The study enrols moderately severe PCAS patients, defined as those with a revised post-Cardiac Arrest Syndrome for induced Therapeutic Hypothermia score of 5.5–15.5. A target number of 380 participants will be enrolled. Participants are randomised to undergo either hypothermia or normothermia within 3 hours after return of spontaneous circulation. Patients in the hypothermia group are cooled and maintained at 34°C until 28 hours post-randomisation, followed by rewarming to 37°C at a rate of 0.25°C/hour. Patients in the normothermia group are maintained at normothermia (36.5°C–37.7°C). Total periods of intervention, including the cooling, maintenance and rewarming phases, will occur 40 hours after randomisation. Other treatments for PCAS can be determined by the treating physicians. The primary outcome is a favourable neurological outcome, defined as Cerebral Performance Category 1 or 2 at 30 days after randomisation and compared using an intention-to-treat analysis.
This study has been approved by the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Ethics Committee (approval number: R2201-001). Written informed consent is obtained from all participants or their authorised surrogates. Results will be disseminated via publications and presentations.
jRCT1062220035.
FreshRSS 