Conectar
The evidence for the optimal duration of psychotherapy for borderline personality disorder (BPD) is scarce. Two previous trials have compared different durations of psychotherapy. The first compared 6 months versus 12 months of dialectical behaviour therapy for BPD (the FASTER trial). The second compared 5 months versus 14 months of mentalisation-based therapy for BPD (the MBT-RCT trial). The primary objective of the present study will be to provide an individual patient data pooled analysis of two randomised clinical trials by combining the two short-term groups and the two long-term groups from the FASTER and MBT-RCT trials, thereby providing greater statistical power than the individual trials. Accordingly, we will evaluate the overall evidence on the effects of short-term versus long-term psychotherapy for BPD and investigate whether certain subgroups might benefit from short-term versus long-term psychotherapy.
An individual patient data pooled analysis of the FASTER trial and the MBT-RCT trial will be conducted. The primary outcome will be a composite of the proportion of participants with a suicide, a suicide attempt or a psychiatric hospitalisation. The secondary outcome will be the proportion of participants with self-harm. Exploratory outcomes will be BPD symptoms, symptom distress, level of functioning and quality of life. We will primarily assess outcomes at 15 months after randomisation for the FASTER trial and at 16 months after randomisation for the MBT-RCT trial. Predefined subgroups based on the design variables in the original trials will be tested for interaction with the intervention as follows: trial, sex (male compared with female), age (below or at 30 years compared with above 30 years) and baseline level of functioning (Global Assessment of Functioning baseline score at 0–49 compared with 50–100).
The statistical analyses will be performed on anonymised trial data that have already been approved by the respective ethical committees that originally assessed the included trials. The final analysis will be published in a peer-reviewed scientific journal and the results will be presented at national seminars and international conferences.
CRD42024612840.
The mental health of people living with HIV (PLWH) is a growing concern globally, particularly in sub-Saharan Africa (SSA), where there is limited access to mental healthcare, with evidence showing high levels of depression, anxiety and neurocognitive disorders among this population. While Mental Health Disorders (MHDs) can impede HIV care and promote adverse health outcomes, there is limited literature on MHDs among PLWH. This scoping review will explore the existing literature on the burden and factors associated with MHDs among adults living with HIV in SSA.
Arksey and O’Malley’s methodological framework will guide the search of this scoping review. Relevant original research articles published in English from 1 January 2000 to 31 May 2025 on MHDs among PLWH in SSA will be identified through searches in the African Index Medicus, African Journal Online, PubMed and Embase databases. Four independent reviewers, working in pairs (one reviewer and one verifier), will screen the titles, abstracts and later the full texts, adopting the population, concept and context framework. Other coauthors will serve as tiebreakers whenever there is disagreement on the eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews flowchart will be presented. We will perform a narrative synthesis to report our findings.
This scoping review protocol does not require ethical approval, as it relies solely on publicly available existing data and does not involve human participants. We will disseminate the findings from this review through peer-reviewed publications and presentations at local and international conferences.
The protocol was registered in the Open Science Framework (https://osf.io/8ymqu).
Traumatic brain injury (TBI) often causes permanent neurological dysfunction. Although no medication has been validated yet to prevent secondary injury of brain tissue, recent animal studies have reported that perampanel, a glutamine receptor antagonist, could improve the neurological functions of animals with TBI by mitigating the abnormal calcium influx and cell death around the site of primary injury. The present study aims to elucidate the efficacy of perampanel administration in improving the neurological function of patients with TBI.
The perampanel for alleviation of secondary injury in TBI trial is a multicentre, phase-II, open-label randomised controlled trial targeting patients with mild-to-moderate TBI. This trial will include adult TBI patients with a Glasgow Coma Scale score of 9–14 from five tertiary centres. Patients with epilepsy as a comorbidity, delayed presentation of symptoms (>24 hours after injury) or Injury Severity Score of ≥25 will be excluded. The study participants will be randomly assigned to either the perampanel group (2 mg/day) or the control group (fosphenytoin administered at a dose of 15–18 mg/kg/day, followed by 5–7.5 mg/kg/day of fosphenytoin). In both groups, the medication will be initiated within 12 hours of the TBI diagnosis and continued for 7 days. The antiepileptic drugs can be increased, changed or added as necessary if early post-traumatic seizures are observed. The primary outcome is favourable neurological outcome, defined as a Glasgow Outcome Scale Extended score of ≥5 at 90 days after the TBI diagnosis, which will then be compared between the groups through an intention-to-treat analysis.
The present study has been approved by the Certified Review Board of Keio at the principal institution (approval number: N20240004). Written informed consent will be obtained from all participants or their legal representatives. The results will be disseminated via publications and presentations.
Japan Registry of Clinical Trials (jRCTs031250067).
To investigate the relationship between demographic characteristics and extracurricular achievements among UK medical students.
National, cross-sectional survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
Binary indicators of extracurricular engagement, including PubMed-indexed authorship, academic presentations, quality improvement projects, leadership roles and academic prizes. Logistic regression models were used to explore associations with demographic and extracurricular achievement predictors.
Logistic regression analysis showed that students from private schools (OR 1.35, CI 1.20 to 1.53, p
Significant disparities in extracurricular achievement exist among UK medical students, principally associated with gender, private schooling and familial links to medicine. Apparent ethnic differences were largely attenuated after adjustment for other variables, indicating socioeconomic factors as stronger predictors of engagement. Given the role of these achievements in postgraduate selection, targeted interventions by medical schools and professional bodies to widen access to funding, mentorship and structured guidance for all students, regardless of perceived advantage, may support equitable opportunity without undermining merit-based standards.
To explore factors influencing UK medical students’ specialty choices and examine variations in these influences across demographic groups and stages of training.
National, cross-sectional online survey.
All 44 UK medical schools recognised by the General Medical Council.
8,395 medical students.
The primary outcome was the specialty preferences of UK medical students. The secondary outcomes were factors behind these preferences and how these factors vary across demographic groups and different stages of training.
General Practice (15.3%), Paediatrics (10.6%) and Anaesthetics (9.9%) were the most preferred specialties among final-year students. Work-life balance (84.1%), compatibility with family life (78.2%), positive training experiences (85.2%) and future specialty outlook (74.9%) were key factors influencing specialty choice. Only 23.1% of students felt confident about securing a specialty training post, with confidence higher among males (OR 1.36, 95% CI 1.21 to 1.52, p
This study highlights disparities in specialty preferences and influencing factors among UK medical students. A focus on improving career guidance, exposure to various specialties and supporting equitable access to training opportunities is essential for fostering a motivated and sustainable medical workforce.
This study aimed to estimate the prevalence of depression and anxiety and associated risk factors among non-communicable diseases (NCD) clinic attendees in rural Rwanda.
Cross-sectional.
44 health centres in three rural districts in Rwanda.
Adults aged 18 years and older with a clinical diagnosis of diabetes, hypertension and/or asthma, who were attending a follow-up appointment during the study period (n=595).
Primary outcome measures were depression (measured by Patient Health Questionnaire-9) and anxiety (measured by Generalised Anxiety Disorder-7). Explanatory measures included sociodemographic and behavioural risk factors associated with depression and anxiety.
Of 595 participants, 265 (44.5%) had depression (95% CI: 40.5% to 48.6%) and 202 (33.9%) had anxiety (95% CI: 30.1% to 37.9%). Comorbidity of depression and anxiety was found in 137 participants (23%). Participants with no formal education had significantly higher odds of reporting depression and anxiety compared with those with primary and secondary/higher education (adjusted OR (aOR)=2.08; 95% CI=1.27 to 3.33, p=0.004, aOR=5.00; 95% CI=1.12 to 25.00, p=0.035, respectively). In addition, participants who were unemployed were more likely to report depression and anxiety (aOR=3.03; 95% CI=1.62 to 5.67, p
The overall prevalence of depression and anxiety was found to be significantly high among the study participants. The risk factors that were associated with depression and anxiety included level of education, district of residence, employment status and past trauma exposure. The findings emphasise the need for integrating mental health screening into NCD care, district-specific interventions, employment support services and trauma-focused care.
Background
The wear and tear from chronic stress exposure has been linked to premature aging through allostatic load; however, it is unclear how chronic stress exposure affects physical functioning and physical activity in older adults.
Objectives
The study aims were to examine the behavioral and functional adaptation to chronic stress in older adults and its mediational pathways.
Methods
Data from the Health and Retirement Study 2016 and 2020 (N = 3075, mean age 66 years) were analyzed. Chronic and perceived stress exposure was quantified using Troxel’s Chronic Stressors Scale and Cohen’s Perceived Stress Scale. Physical activity was quantified using self-reported questionnaires, including light, moderate, and vigorous physical activity. Physical functioning was operated as a latent construct with four perceived physical limitations (i.e., difficulty in movement, hand strength, shortness of breath, and balance). The cross-sectional data were analyzed using latent regression analysis. The longitudinal data were analyzed using serial mediation based on MacKinnon’s bias-corrected bootstrap confidence intervals.
Results
Cross-sectionally, psychological stress, as a latent construct indicated by stress exposure and stress perception, explained more variances in perceived physical limitation than physical activity. Longitudinally, perceived stress and physical activity mediated the relationship between chronic stress exposure and perceived physical limitation with significant indirect effects. Furthermore, perceived physical limitation suppressed the effect of chronic stress exposure on physical activity levels. The effects of mediation and suppression remained significant after the adjustment for age, gender, years of education, race, number of comorbidities, working status, and marital status.
Discussion
The promotion of physical activity and physical functioning in older adults might not achieve the optimal outcome if the program design overlooks the target population’s chronic stress process and functional limitations. Uterine serous carcinoma (USC) accounts for 40% of endometrial cancer-related deaths. The standard of care for stages III and IV USC yields a 20%–30% survival at 2 years and a 10%–20% survival at 3–5 years. Recent advances in the second-line treatment of advanced or recurrent USC are rapidly evolving. Targeted therapeutic approaches with the use of lenvatinib plus pembrolizumab, as well as the use of trastuzumab deruxtecan, offer new hope for successful second-line therapies for patients. However, further investigation into novel targeted therapeutic approaches is warranted, given the high burden of disease associated with this aggressive histological subtype. USC shares clinical and genomic similarities with epithelial ovarian cancer, suggesting a correlation with ‘BRCAness’. Niraparib, a potent PARP1 and PARP2 inhibitor, was shown to have a positive impact on platinum-sensitive recurrent ovarian cancer, regardless of the presence or absence of BRCA status. Our hypothesis is that patients with stage III, stage IV and platinum-sensitive recurrent USC receiving niraparib maintenance in addition to standard therapy for USC may have an improved progression-free survival.
Participating sites include the primary site, Northwell Health Zucker Cancer Centre, and secondary site, Rutgers Cancer Institute of NJ. Females over the age of 18 with stage III, stage IV or platinum-sensitive recurrent USC will be recruited and enrolled based on inclusion/exclusion criteria. 24 subjects will be enrolled during phase 1 and 21 subjects will be enrolled during phase 2, over a total of 3 years. Patients will receive an individualised dose of niraparib daily every 28 days per cycle for 1 year or until progression of disease. Follow-up of disease status will continue for 5 years poststudy treatment. This phase II clinical trial will employ a Simon two-stage minimax design to test the null hypothesis that the 1 year response rate is
Ethical approval was granted by Northwell Health Cancer Institute institutional review board (reference number: 19–0380) and PRMS. Alongside journal publications, results will be available publicly on completion of the study as approved by the sponsor investigator.
NCTN04080284
To investigate unmet need trajectories among young stroke survivors, identify predictive factors and evaluate the lagged effects of unmet needs on post-stroke health outcomes.
Prospective longitudinal study.
We recruited 122 patients with stroke, assessed at four time points over a 6-month follow-up period. The Unmet Needs Questionnaire assessed unmet needs. Predictive factors included participant characteristics and stroke-related factors. Outcome variables included physical functions, quality of life, depressive symptoms and return-to-work status. Generalised Estimating Equations were employed.
Unmet need trajectories decreased over time. Sex, marital status, stroke history, stroke severity, fatigue and cognitive function were key unmet need predictors. Lagged unmet needs were associated with poorer post-stroke health outcomes.
This study highlights the dynamic nature of unmet needs in young stroke survivors and underscores the importance of addressing these needs to improve post-stroke health outcomes. Targeted interventions are essential to mitigate the negative impact of unmet needs on recovery.
Young stroke survivors continue to experience unmet needs in important areas even 6 months post-stroke. Nurses play a crucial role in addressing these challenges by regularly assessing patient care needs, monitoring their progress and implementing targeted interventions. Integrating routine nursing assessments into post-stroke care can help identify high-risk patients and ensure that individualised support is provided throughout the recovery process.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
Explore how previous patient safety research has described issues related to patient participation in psychiatric hospital care.
Integrated literature review.
The literature review was conducted according to Cooper's framework with the following five-step protocol: problem identification, a literature search, data evaluation, data analysis, and the presentation of results.
CINAHL, PubMed, PsycINFO, Scopus databases, years 2005–2023. After quality appraisal, a total of 62 articles were reviewed.
Three main categories related to patient participation in psychiatric hospital care were identified: communication (having information, being heard, therapeutic relationships and interaction quality), decision-making (treatment planning, treatment decisions, activities and working on behalf of patients) and restrictive measures (setting limits, exercising power, balancing patient autonomy and safety).
Psychiatric hospital care nursing staff continuously balance patients' autonomy, self-determination, and safety, taking into account their well-being and issues of responsibility. Wider use of positive risk-taking is needed to increase patient participation and safety in psychiatric hospital care.
Nursing staff should create favourable facilities for patient participation, foster an atmosphere of trust, respect, and encouragement, provide patients individual time to improve patient safety and recognise that they can exert power over patients due to constantly balancing patient autonomy and safety.
PRISMA guidelines.
No patient or public contribution.
To identify and synthesise recommendations and guidelines for mental health chatbot conversational design.
Integrative review.
Suitable publications presenting recommendations or guidelines for mental health conversational design were included. The quality of included publications was assessed using Joanna Briggs Institute Critical Appraisal Tools. Thematic analysis was conducted.
Primary searches limited to last 10 years were conducted in PubMed, Scopus, ACM Digital Library and EBSCO databases including APA PsycINFO, CINAHL, APA PsycArticles and MEDLINE in February 2023 and updated in October 2023. A secondary search was conducted in Google Scholar in May 2023.
Of 1684 articles screened, 16 publications were selected. Three overarching themes were developed: (1) explicit knowledge about chatbot design and domain, (2) knowing your audience and (3) creating a safe space to engage. Results highlight that creating pleasant and effective conversations with a mental health chatbot requires careful and professional planning in advance, defining the target group and working together with it to address its needs and preferences. It is essential to emphasise the pleasant user experience and safety from both technical and psychological perspectives.
Recommendations for mental health chatbot conversational design have evolved and become more specific in recent years. Recommendations set high standards for mental health chatbots. To meet that, co-design, explicit knowledge of the user needs, domain and conversational design is needed.
Mental health professionals participating in chatbot development can utilise this review. The results can also inform technical development teams not involving healthcare professionals directly.
Knowledge of developing mental health chatbot conversations appears scattered. In mental health chatbots, features that enhance the chatbot's ability to meet users' needs and increase safety should be considered. This review is useful for developers of mental health chatbots and other health applications used independently.
This integrative review was reported according to PRISMA guidelines, as applicable.
No patient or public contribution.
The effectiveness of health interventions delivered via a combination of in-person and electronic social networking services for caregivers of stroke survivors remains uncertain. This study evaluates the feasibility of implementing educational and peer support programs for these caregivers through such platforms.
Quasi-experimental design.
This study included 105 caregiver–survivor dyads, with 54 dyads allocated to the intervention group and the remaining 51 to the control group. The LINE intervention comprised a combination of in-person and electronic social networking services including stroke and rehabilitation education, problem-solving skills training, long-term care information support, and 24-h peer and professional support for caregivers. The outcomes were assessed at baseline, after 1 month, and after 3 months, and encompassed caregivers' care burden, depressive symptoms, perceived social support, and quality of life, as well as the rehabilitation adherence and depressive symptoms of stroke survivors. Generalized estimating equations were used to examine group differences. The data were collected between August 2021 and October 2022.
The average age of the caregivers was 48.3 years. Caregivers in the intervention group reported reduced care burdens and enhanced perceptions of social support and quality of life as compared to those in the control group. Additionally, stroke survivors in the intervention group were less likely to exhibit high-risk depressive symptoms.
Delivering a stroke caregiver support intervention via in-person and electronic social networking services, such as LINE, effectively reduced the care burden for caregivers of stroke survivors. Additionally, it enhanced caregivers' perceived social support and quality of life.
This study demonstrated that caregiver education and peer support programs administered through a combination of in-person and electronic social networking services can serve as an effective support system for the psychosocial health of stroke caregivers. These findings support the integration of such interventions into standard clinical practice by healthcare providers or governmental bodies.
This study was to translate the Pieper–Zulkowski pressure ulcer knowledge test (PZ-PUKT) into Traditional Chinese and evaluate its psychometric properties as well as identify the predictors of knowledge on pressure injury. The PZ-PUKT was translated into Traditional Chinese (TC-PZ-PUKT), and its content validity was evaluated. A total of 296 nurses participated in this study and completed the 72-item TC-PZ-PUKT online. The reliability of the TC-PZ-PUKT was analysed by evaluating its internal consistency and test–retest reliability. Hierarchical regression was used to determine factors associated with TC-PZ-PUKT scores. Content validity was achieved with a score of 0.986. Internal consistency was observed to be reliable, with a Cronbach's alpha of 0.858. The mean knowledge score on the TC-PZ-PUKT was 72.5%, with a 1-week test–retest reliability of r = 0.849. Education level, certification as a wound specialist and self-learning through reading articles, books or guidelines on pressure injury were significantly associated with TC-PZ-PUKT scores. The TC-PZ-PUKT is a valid and reliable tool. Education level, certification as a wound specialist and self-learning regarding pressure injury are related to knowledge of pressure injury.
To map the commonly used quantitative blood loss measurement methods in clinical practice and provide a solid foundation for future studies.
This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. We conducted a literature search using five databases to retrieve articles published between January 2012 and September 2022. The search was repeated on 29 February 2024. Data extraction and verification were carried out by two independent researchers using a self-designed data extraction form.
Ultimately, 26 studies published between 2012 and 2024 were considered eligible for inclusion. Six categories of methods were identified from the 26 articles. Among the included studies, only two involved randomized controlled trials, with the majority being observational studies. The World Health Organization (2012) version of the postpartum haemorrhage diagnostic criteria was predominantly used in most studies. Gravimetric and volumetric methods emerged as the most commonly used methods for quantifying postpartum haemorrhages. The timing of blood collection was inconsistent among the included studies. Only 12 studies mentioned measures for the management of amniotic fluid.
This scoping review supports the replacement of the visual estimation of blood loss with quantitative assessment methods. Supporting a specific assessment approach is not feasible due to the variability of the study. Future research should focus on establishing the best practices for specific quantitative methods to standardize the management of postpartum haemorrhage and reduce the incidence of postpartum haemorrhage-related adverse outcomes.
Healthcare professionals need to acknowledge the low accuracy of visual estimation methods and implement quantitative methods to assess postpartum blood loss. Given the limitations inherent in each assessment method, quantification of blood loss should be combined with assessment of maternal vital signs, physiologic indicators and other factors.
Operative therapy for superficial esophagus carcinoma is the main way to treat the disease. Endoscopic excision of lesions in the esophagus has become an alternative to surgical treatment for patients with esophageal carcinoma. To overcome the disadvantages of endoscope mucosa excision (EMR), an endoscopic submucosal dissection (ESD) technique has been developed. Although ESD is one of the most effective methods of endoscopy in patients with digestive tract tumors, there are potential complications after surgery, including hemorrhage in the surgical area and stenosis of the esophagus. The objective of this study was to evaluate EMR versus ESD based on post-operative hemorrhage and esophagus stenosis. All the related articles were retrieved from the e-databases. The main results were postoperative perforation, hemorrhage, and stenosis after surgery. There were no statistically significant differences in the incidence of post-operative wound hemorrhage (OR, 1.08; 95% CI, 0.36–3.29 p = 0.89). Similarly, there were no statistically significant differences in the rate of perforation after surgery (OR, 0.57; 95% CI, 0.17–1.95 p = 0.37). There were no statistically significant differences in the incidence of esophageal stricture after surgery (OR, 1.15; 95% CI, 0.26–5.15 p = 0.85). This analysis was different from the earlier meta-analysis because ESD and EMR did not show any notable differences with respect to the incidence of perforation after surgery, the hemorrhage of the wound or the stenosis of the esophagus. These findings must, however, be supported by more high-quality studies.
FreshRSS 