Conectar
by Thomas C. Scheier, Richard Whitlock, Mark Loeb, Philip James Devereaux, Andre Lamy, Michael McGillion, MacKenzie Quantz, Ingrid Copland, Shun-Fu Lee, Dominik Mertz
Sternal surgical site infections after cardiac surgery can lead to significant morbidity, mortality, and cost. The effects of negative pressure wound management and adding vancomycin as perioperative antimicrobial prophylaxis are unknown. The PICS-PREVENA pilot/vanguard trial, a 2x2 factorial, open label, cluster-randomized crossover trial with 4 periods, was conducted at two major cardiac surgery hospitals in Ontario, Canada. Sites were randomized to one of eight sequences of the four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and standard wound dressing or a negative pressure 3M Prevena incision management system (Prevena). Only diabetic or obese patients were eligible for the latter comparison. This trial investigated feasability including adherence to protocol of each intervention (goal: > 90% each) and loss to follow-up (goal:Many patients receive oral anticoagulation for reduced stroke risk in atrial fibrillation or as treatment or prevention of venous thromboembolism. Oral factor Xa inhibitors (oral FXaI, eg, apixaban, edoxaban or rivaroxaban) are commonly prescribed for this indication. Dabigatran, an oral direct thrombin inhibitor, is similarly approved. In vitro and animal model evidence suggests that dabigatran also has direct effects on Staphylococcus aureus virulence and infection. Observational data have shown that dabigatran users are less likely to develop S. aureus bacteremia (SAB), and a small randomised controlled trial showed that dabigatran has anti-S. aureus effects when compared with low molecular weight heparins during bloodstream infection. We seek to answer whether dabigatran is superior to the oral FXaIs in achieving better SAB outcomes among patients who independently require oral anticoagulation. We report the intervention-specific protocol, embedded in an adaptive platform trial.
The S. aureus Network Adaptive Platform (SNAP) trial [NCT05137119] is a pragmatic, randomised, multicentre adaptive platform trial that compares different SAB therapies for 90-day mortality rates. For this intervention (‘Dabi-SNAP’), patients receiving therapy with an oral FXaI will be randomised to continue as usual or to change to dabigatran as of the next scheduled dose. All subjects will receive standard of care antibiotics and/or antibiotics allocated through other active domains in the platform. As the choice of anticoagulant may not demonstrate large differences in mortality, a ranked composite of death and adverse outcomes (Desirability of Outcome Ranking, or DOOR) was chosen as the primary outcome.
The study is conditionally approved by the research ethics board of the McGill University Health Centre: identifier 2025-10900. Trial results will be published open access in a peer-reviewed journal and presented at a global infectious disease conference. The trial is registered at clinicaltrials.gov with the identifier NCT06650501.
Women who develop gestational diabetes mellitus (GDM) have a 60% lifetime risk of developing type 2 diabetes mellitus (T2D), which is already elevated within the first decade following childbirth. Despite the impact of lifestyle interventions to reduce long-term T2D risk in women with previous GDM, successful implementation of lifestyle interventions remains a barrier. Metformin is recommended for adults at increased risk of developing T2D; however, there is limited evidence of tolerability in the early postpartum period. Glucagon-like peptide 1 receptor agonists (GLP-1 RA) are effective at improving glycaemic status and body weight. However, GLP-1 RA have not been evaluated in the postpartum population. Finally, physical activity monitors may support behaviour changes related to physical activity to reduce long-term risk of T2D but are yet to be studied following GDM.
This will be a multicentre, randomised, open-label interventional pilot study. Using a 2x2 factorial design, we will examine the feasibility and acceptability of a pharmacotherapy intervention and a physical activity intervention in women with previous GDM at increased risk of developing T2D. Participants will be recruited from tertiary referral hospitals in Australia and will be randomised to receive either metformin alone or in combination with a GLP-1 RA and subsequently randomised to either a physical activity intervention involving activity monitor use, or usual care for 6 months, followed by a 6-month follow-up period. Primary feasibility outcomes include the acceptability and safety of the metformin and GLP-1 RA as measured through pill and injection counts, acceptability questionnaire and adverse events.
This trial is registered with the Australian and New Zealand Clinical Trials Registry (Registration Number: ACTRN12624001253594). This trial has received ethics approval from the South Eastern Sydney Local Health District Human Research Ethics Committee (Approval Number: 2024/ETH00042, protocol version v1.1, 28/02/2025).
Australian and New Zealand Clinical Trials Registry, Registration Number: ACTRN12624001253594.
Middle-aged adults face multifaceted physical and psychosocial challenges that impact their overall wellness. Exercise has become a key component of wellness interventions due to its positive impacts on physical and psychosocial health. However, the understanding of exercise-focused wellness interventions for this age group remains limited. Therefore, this scoping review aimed to identify and map the existing literature on exercise-focused wellness interventions for middle-aged adults and to summarise their characteristics and reported outcomes.
Scoping review.
Six databases, including PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science and PsycInfo, were initially searched on 29 July 2024, and the search was updated on 12 October 2025, with no restrictions on publication date. The reference lists of articles selected in the database search were also screened for further relevant studies.
We included interventional studies, specifically randomised controlled trials (RCTs) and quasi-experimental designs, that examined exercise-focused wellness interventions for middle-aged adults.
Two independent reviewers extracted data on study characteristics and intervention details and outcomes, and assessed the risk of bias. Any discrepancies were resolved by a third reviewer.
A total of 15 studies were included in the review, of which 9 were RCTs and 6 were quasi-experimental studies. Most interventions targeted middle-aged women and were implemented in community settings. Exercise was often combined with diet and stress management. The majority of the interventions lasted for 3 months with weekly sessions. Additionally, various delivery modes were employed, including face-to-face, online, individual and group-based approaches. Outcome variables were categorised into exercise and physical activity, dietary intake, anthropometry and body composition, cardiovascular health, biochemical markers, menopausal symptoms, psychosocial health and wellness. Only one study assessed wellness as an outcome of the intervention. Across the included studies, improvements were commonly reported for physical and psychosocial health, whereas changes in biochemical markers were limited.
Exercise-focused wellness interventions for middle-aged adults encompass varied content and outcome variables, contributing to improvements in physical, psychological and social dimensions of health. Delivery modes are diverse, demonstrating flexibility and adaptability for tailored interventions. There is a need to develop a validated, midlife-specific measurement tool that reflects the multidimensional nature of wellness. Moreover, exercise-focused interventions tailored for middle-aged men, particularly in workplace settings, should be developed.
The role of the interprofessional evidence-based practice (EBP) mentor is critical to integrate best practices into healthcare and academic environments to improve outcomes and reduce costs for patients, families, providers, students, and faculty. This study aimed to validate the knowledge, skills, and attitudes/beliefs (KSAs) needed for the EBP mentor. This role delineation study (RDS) assessed knowledge about the EBP mentor role and tasks as related to the steps and competencies of EBP.
Interprofessional EBP experts participated in an advisory panel. Focus groups were conducted with the advisory panel members to identify the KSAs needed for expert EBP mentors. The steps of EBP were broken into 11 domains to align with the processes and strategies needed for EBP methodology. The focus group data were analyzed to identify the KSAs for each domain. A role delineation survey was developed. Interprofessional experts were invited to complete the survey to validate the KSAs needed for the EBP mentor role. The online survey included demographic information and 11 sections that aligned with the steps of EBP and the 107 KSA items needing to be validated.
A total of 251 interprofessional EBP experts completed the survey (232 nurses, 19 interprofessionals). Healthcare providers comprised 82.5% of the sample, academic/researchers 15.5%, and “worked in both settings” 2%. The results reported strong inter-rater reliability (ranging from 0.836 to 0.955) and strong validity for each of the 11 domains and KSAs.
Findings from this study support the EBP mentor role and will guide interprofessional EBP education and EBP mentor positions in healthcare systems. The study showed that the tasks of the EBP mentor were consistent across settings, educational degrees, and professional roles. Validity for the tasks/role for an interprofessional Evidence-based Practice Certification was clear and outlined expectations for the EBP mentor role.
Palliative care reduces caregiver burden, alleviates patient symptoms, and supports treatment decision-making. However, despite these benefits, there is limited evidence on the effectiveness of palliative care interventions for caregivers of individuals with advanced dementia.
To integrate and analyze data on the effectiveness of palliative care interventions in improving caregiver outcomes in order to ensure that both patients and caregivers receive the support necessary for optimal care experiences, quality of life management, and advanced care planning.
A systematic search was conducted of six databases to identify relevant studies published from database inception to 12 December 2024. Randomized controlled trials (RCTs) investigating palliative care interventions for caregivers of people with advanced dementia were included. Version 2 of the Cochrane Risk of Bias tool was used to assess the risk of bias in the methodology of each study. Standardized mean differences (SMDs) between each intervention and control group were calculated. A random-effects DerSimonian and Laird model was applied to generate pooled SMD estimates for each outcome and assess its heterogeneity. A leave-one-out sensitivity analysis was performed to ensure the stability of the pooled effect sizes.
Eight RCTs were included in the final analysis. Palliative care interventions appeared to reduce conflict in decision-making among caregivers of people with advanced dementia.
Palliative care interventions were successful in reducing conflict in decision-making of caregivers of people with advanced dementia. However, the modality's effects on caregiver satisfaction and caregiver distress need further investigation.
Future palliative care interventions for caregivers of advanced dementia patients should focus on developing the contents of palliative care materials based on evidence-based evaluations and explore strategies to improve engagement between patients, caregivers, and healthcare professionals.
Polysubstance use (PSU), particularly opioid-involved and stimulant-involved PSU, is a growing issue in the USA. PSU increases the risk of negative health consequences, including infectious diseases, worsening physical and mental health conditions, and overdose-related deaths. These consequences occur in the context of varying health risk behaviours, substance-related preferences, and treatment engagements among people with PSU. To inform improvements in prevention, harm reduction, and substance use disorder (SUD) treatment, additional research is needed to comprehensively understand the current context and drivers of PSU preferences, motivations, and behaviours.
Herein, we describe the protocol for a prospective cohort study designed to capture detailed patterns, profiles, and trajectories of PSU, with the aim of comprehensively examining the drivers of PSU behaviours and SUD treatment utilisation. Adults (ages 18–75; n=400) who engage in PSU will be recruited from healthcare institutions, an established participant database maintained by an adjacent SUD research team, and online advertisements. Study assessments will capture dynamic patterns, choice preferences, and motivators of PSU via behavioural economic (BE) measures, detailed Timeline Follow-Back (TLFB) interviews, and self-administered surveys. The assessment timeline will include a baseline survey and TLFB interview, weekly TLFB interviews for 4 weeks post-baseline, and follow-up surveys and TLFB interviews at 4-, 8-, and 12-months post-baseline.
The study is funded through the National Institutes of Health Helping to End Addiction Long-term (HEAL) initiative and was approved by the University of Michigan Medical Institutional Review Board. Findings will be disseminated to academic, clinical, and community partners through the Michigan Innovations in Addiction Care through Research and Education programme. Results from this study will inform actionable and practical insights relevant to the delivery of personalised care in the context of PSU.
Gram negative bloodstream infections (GN BSI) are a leading cause of mortality worldwide, and antibiotic treatment approaches remain understudied. BALANCE+ is a perpetual Bayesian adaptive platform trial to test multiple treatment questions for hospitalised patients with GN BSI. The vanguard phase objective was to test the feasibility of the main trial.
Adaptive platform trial with five initial domains of investigation, each with open label 1:1 randomisation.
Ten hospitals across four Canadian provinces.
Individuals admitted to hospital with blood cultures yielding Gram negative bacteria.
The five initial domains of investigation included: antibiotic de-escalation versus no de-escalation; oral transition to beta-lactam versus non-beta-lactam treatment; routine versus no routine follow-up blood cultures (FUBCs); central vascular catheter replacement versus retention; and, ceftriaxone versus carbapenem treatment for low risk AmpC organisms.
Domain-specific recruitment rates and protocol adherence.
During the vanguard phase, 719 patients were screened, of whom 563 (78.3%) were eligible, with 179 (31.8%) enrolled into the platform. The platform recruitment rate was 1.37 patients/site-week. Recruitment varied by domain: routine versus no FUBC domain 1.23 patients/site-week; oral beta-lactam versus non-beta-lactam domain 0.48; de-escalation versus no de-escalation domain 0.28; low risk AmpC domain 0.02; catheter replacement versus retention domain 0.01. Domain specific protocol adherence rates were 145/158 (91.8%) for routine versus no routine FUBC, 53/60 (88.3%) for oral beta-lactam versus non-beta-lactam, 26/33 (78.8%) for de-escalation versus no de-escalation, 3/3 (100%) for low risk AmpC, and 0/1 (0%) for line replacement versus retention. There was complete ascertainment of all study outcomes in hospital 170/170 (100%) and near complete ascertainment at 90 days 162/170 (95.3%).
The vanguard phase demonstrated overall trial feasibility by recruitment rate and protocol adherence, with differences across interventions, leading to a transition to the main BALANCE+ platform trial with minimal protocol modifications.
by Saleh A. Alqahtani, Shadan AlMuhaidib, Dimitri A. Raptis, Waleed K. Al-Hamoudi, K. Rajender Reddy, Dieter C. Broering, Saad A. Alghamdi, The OTCE Collaborative
BackgroundLiver transplantation (LT) represents the life-saving treatment for advanced liver disease. We aim to investigate LT indication trends and outcomes in Saudi Arabia, following the evolution of effective therapies for hepatitis C virus (HCV) and the rising fatty liver disease prevalence.
MethodsWe retrospectively analyzed data from adult patients who underwent LT from 2011 to 2023 at a tertiary referral center in Saudi Arabia. We assessed demographics, LT indication trends, Model for End-stage Liver Disease (MELD) scores, donor type, and survival outcomes.
ResultsA total of 1,419 patients were included. The median age was 56.9 years, with 37.4% female. Living donor LT (LDLT) represented 79.8% of all transplants, and 22.0% of recipients had hepatocellular carcinoma (HCC). Metabolic dysfunction-associated steatohepatitis (MASH) was the predominant indication for LT (33.2%), followed by HCV (18.0%) and hepatitis B virus (HBV) (17.1%). Overall survival rates at 1-, 2-, 3-, 5-, and 10-years post-transplantation were 87.9%, 85.0%, 82.4%, 77.7%, and 71.3%, respectively. Hazard ratios (HR) for mortality were lower in patients with HBV compared to MASH (HR: 0.44, 95% CI: 0.28–0.69, p Conclusions
MASH represents the leading indication for LT in this large cohort, necessitating preventive strategies and early detection efforts.
To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.
An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.
From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.
The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.
Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.
This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.
Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.
The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.
Patients or the public were not included in the design, conduct or reporting of the study.
To develop and evaluate the psychometric properties of the Forensic Nursing Competency Scale-Short Form (FNCS-SF) for hospital nurses.
Nurses who care for victims of sexual abuse, domestic violence and elder or child abuse require forensic nursing competencies. However, few valid and reliable tools exist to assess these competencies in hospital settings.
A cross-sectional study.
The study was conducted in two phases. Phase 1 involved the development and refinement of the FNCS-SF with input from 10 nurses. Phase 2 tested the tool's psychometric properties. A total of 420 nurses from two tertiary hospitals in South Korea participated. Participants were divided into two groups: Study 1 (n = 200) for exploratory factor analysis and Study 2 (n = 220) for confirmatory factor analysis.
The FNCS-SF consists of 27 items across six factors: awareness of the medicolegal problem, evidence-based practice in forensic nursing, collaborative forensic nursing with community partners, safety and security, professional career development and multidisciplinary integrated knowledge. An item analysis revealed significant correlations between each item and the total scale score. Criterion validity was supported by significant correlations between the FNCS-SF and attitudes and beliefs towards forensic nursing and the performance of the forensic nursing role. Confirmatory factor analysis supported a six-factor model with good fit indices. Cronbach's alpha indicated strong internal consistency.
The FNCS-SF is a valid and reliable tool for assessing hospital nurses' forensic nursing competencies, which can improve patient safety and treatment outcomes. Further validation in diverse clinical settings is recommended.
The FNCS-SF can be used to improve forensic nursing competency through professional development.
None.
The FNCS-SF provides a standardised framework to evaluate nurses' forensic competency, guiding education and practice to enhance clinical preparedness and deliver victim-centred care.
STROBE guidelines.
To determine the clinical characteristics and identify not only the Korean Triage and Acuity Scale levels of older patients with pneumonia in the emergency department but also the factors associated with their survival.
This study employed a retrospective observational design.
This study was conducted at the emergency department of a university hospital in Seoul, South Korea. It utilised medical data from January 1 to December 31, 2023. The study sample comprised 327 patients aged 65 years or older who received a pneumonia diagnosis (International Classification of Diseases: J10–J18). Binary logistic regression analysis was performed to identify independent factors associated with their survival.
Survival was significantly associated with and influenced by sex (specifically, male sex), initial Korean Triage and Acuity Scale level, oxygen supplementation in the emergency department, consciousness level (specifically, painful response), body temperature (> 37.5°C) and a diagnosis of solid or hematologic malignancies.
The findings highlight the need for improved triage protocols, emphasising consciousness level, body temperature and malignancies. Incorporating geriatric-specific age thresholds and oncologic status into Korean Triage and Acuity Scale classifications may enhance risk stratification, timely intervention and resource allocation in emergency department settings.
This study provides insight into triage accuracy for older pneumonia patients, emphasising early recognition of high-risk individuals and strengthening nursing assessment protocols. Improved Korean Triage and Acuity Scale classifications can optimise resource allocation and emergency care strategies, ultimately reducing mortality rates.
The study provides actionable insights for emergency nurses, triage clinicians and policymakers. The findings support the refinement of KTAS protocols to enhance risk stratification and guide resource allocation for older pneumonia patients, ultimately aiming to reduce mortality rates.
Adhered to STROBE guidelines for observational studies.
Although patients did not directly participate, the findings advocate for patient-centred triage improvements, enhancing early identification of high-risk older patients with pneumonia.
The home-based primary care cohort was set up to identify the characteristics of Home-Based Primary Care (HBPC) users across three domains: health-related information, utility of healthcare service and care-related information.
A total of 407 patients enrolled in five HBPC centres were recruited between January 2023 and March 2024. The baseline survey was conducted among 332 participants who provided informed consent for both study participation and home visits. The second wave of data collection is scheduled to take place 6 months after enrolment, while the third wave will be conducted 12 months post-enrolment. During each home visit, trained interviewers administered structured survey questionnaires. On completion of the 12-month follow-up period, the dataset will include survey data, intervention records from the five participating HBPC centres, home mortality status and institutionalisation risk linked to each participant.
This study examines HBPC in Korea, integrating the Widely Integrated Services in Home model with the long-term care insurance system. Among participants, 30.1% lived alone, and 74.1% were homebound, showing similarities to findings from a US HBPC study. Analysing cohort data, this study evaluates the impact of HBPC on healthcare utilisation, aligning with international findings on reduced hospitalisations and costs. As the first HBPC effectiveness study in Korea, it highlights its role in enhancing care for homebound older adults and shaping national health policies.
Data on the number of interventions by profession, institutionalisation and hospitalisation status and duration, and death at home occurrence are being separately collected from five HBPC centres and will be included in the analysis. The analysis will examine associations between these variables to identify risk factors influencing institutionalisation. Additionally, this study plans to link the dataset with the National Health Insurance Service-Senior (NHIS-Senior) customised cohort for further analysis.
This study aimed to understand the knowledge possessed by informal medicine vendors regarding antibiotics and antibiotic resistance, identify the perceptions held by informal medicine vendors about antibiotics and their uses and examine the practices employed by informal medicine vendors in the sale and distribution of antibiotics.
Exploratory qualitative study using semi-structured interviews and direct observations.
Markets and shops across 11 villages in the Nanoro health district, Burkina Faso.
23 informal medicine vendors, aged between 25 and 55 years and with 8–30 years of experience, were recruited through snowball sampling in the Nanoro health district of Burkina Faso.
Informal medicine vendors exhibited a limited understanding of antibiotics, often confusing them with other treatments and referring to them using local terminologies based on perceived use and effectiveness. Antibiotics were perceived as universal remedies, supported by therapeutic belief, empirical reasoning and community solidarity, with empirical diagnosis, approximate dosing and informal preparation techniques passed on through imitation. These findings emerged across themes including perceptions, symbolic attributes and sales practices.
Informal medicine vendors in rural Burkina Faso demonstrated limited understanding of antibiotics and antimicrobial resistance, with practices shaped by local beliefs and empirical experience. These findings underscore the need for context-sensitive interventions that include tailored education and regulatory engagement to improve antibiotic stewardship and mitigate the spread of resistance.
Preoperative administration of tranexamic acid (TXA) reduces perioperative blood loss and transfusion requirements in total hip arthroplasty (THA), but optimal dosing remains uncertain due to the narrow range of doses explored in prior studies. This study aims to define the dose–response of intravenous TXA in THA, focusing on perioperative haemoglobin drop to improve blood-sparing effect.
This monocentric, double-blind, placebo-controlled, parallel-group, dose-finding study will enrol 170 adults undergoing THA, aiming to randomise 150 patients. Participants will be allocated using a minimisation technique with a random component in equal proportions to receive either placebo or one of four intravenous TXA doses: 300 mg, 500 mg, 1000 mg or 3000 mg. Dose selection and sample size are based on a model-based meta-analysis that employed a maximum effect (Emax) model with a maximum effect of 40% and an ED50 (dose providing 50% of Emax) of 400 mg. The primary outcome will be the relative perioperative haemoglobin drop at postoperative day 3. Secondary outcomes include TXA exposure and perioperative fibrinolytic activity as measured by D-dimer levels. Only patients receiving the allocated study treatment will be analysed (modified intention-to-treat population). The dose–response relationship for the primary outcome will be analysed using non-linear mixed-effect models.
The study protocol was approved by the French ethics committee (Institutional Review Board Sud Méditerranée V) and the French National Agency for the Safety of Medicines and Health Products (ANSM). Results will be disseminated at conferences and published in peer-reviewed journals.
CTIS 2022-502532-38-01; NCT03822793.
Cerebral palsy (CP) is the most common motor disability in children, with higher prevalence in low-income and middle-income countries (LMICs) compared with high-income countries (HICs). Children with CP (CwCP) often face significant challenges in achieving toileting independence due to motor, sensory and cognitive impairments. Parents play a pivotal role in managing these challenges, often encountering significant emotional, physical and social burdens. Despite the importance of toileting for autonomy and dignity, limited evidence exists on tailored toilet training programmes for CwCP, especially in LMICs. Understanding parental perspectives is essential to addressing these gaps and informing family-centred interventions.
This scoping review aims to explore parents’ perspectives on toileting management for CwCP, focusing on strategies, challenges and unmet needs, to inform future research and the development of supportive interventions. This scoping review will be conducted in accordance with the guidelines of the Joanna Briggs Institute and summarised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews framework. The English language full-text articles, published between January 2014 and December 2024, addressing the parental perspectives, challenges and strategies related to the task of toileting in CwCP below 18 years of age will be included. Systematic searches will be conducted through PubMed, EMBASE, CINAHL, Scopus, Web of Science and grey literature. The data will be extracted and analysed thematically using Microsoft Excel.
The present protocol has been registered in the Open Science Framework (DOI: https://doi.org/10.17605/OSF.IO/73YQZ). Ethical approval is not required, as this review uses secondary data from published studies and does not involve direct participant recruitment. The findings will synthesise themes related to parents’ strategies, challenges and expectations in toileting management for CwCP. They will help address existing literature gaps and inform the development of practical, evidence-informed toileting education programmes for parents.
by Yong Seok Jo, Seung Jae Lee, Hyun Jin Lee, Jeon Mi Lee
ObjectivesThis study aimed to determine the preferred timing and measurement sites for electroneuronography (ENoG) to predict early recovery from acute peripheral facial paralysis.
MethodsWe retrospectively evaluated 42 patients with acute peripheral facial paralysis who received standard treatment with oral corticosteroids. The severity of facial paralysis was assessed at the initial visit and after 1 month using the House–Brackmann grading system. Patients were classified into recovery and non-recovery groups according to changes in the grade. ENoG was performed at the initial visit and after 2 weeks. ENoG amplitudes of four facial muscles (frontalis, nasalis, orbicularis oculi, and orbicularis oris) at the initial visit and after 2 weeks, as well as age, sex, affected side, and diagnosis, were compared between the two groups.
ResultsNo differences were observed in degeneration ratios across all subsites in the initial ENoG, which can be explained by the fact that Wallerian degeneration is not yet complete at this early stage. However, the second ENoG, performed after degeneration had progressed, showed significant differences across all subsites. Binary logistic regression analysis revealed that the degeneration ratio of the orbicularis oris muscle was the best predictor of early recovery (odds ratio, 0.961; p = 0.014). Receiver operating characteristic curve analysis also revealed that the degeneration ratios of all subsites measured in the second ENoG were useful in predicting early recovery, with the highest possibility at the orbicularis oris muscle (area under the curve = 0.789). When the degeneration ratio exceeded 60% in all subsites in the second ENoG, a favorable prognosis was not expected.
ConclusionThis study provides the preferred testing time and measurement sites for ENoG to predict early recovery from facial paralysis. Given the personal and social impact of facial paralysis, predicting early recovery is crucial for reassuring patients, providing better treatment, and encouraging early reintegration into society.
by Jin-Hwa Kim, Ji-Soo Jeong, Jeong-Won Kim, Eun-Hye Chung, Su-Ha Lee, Je-Won Ko, Youn-Hwan Hwang, Tae-Won Kim
Moutan Cortex (MC), the dried root bark of Paeonia suffruticosa, is used in traditional Chinese and Korean medicine to treat enteritis for its anti-inflammatory properties. This study compared the pharmacokinetic (PK) profiles of paeonol and paeoniflorin in normal and dinitrobenzene sulfonic acid (DNBS)-induced colitis rats, and to determine how repeated low-dose MC [MC(L), 0.5 g/kg] or high-dose MC [MC(H), 2.5 g/kg] alters PK and disease severity. Using ultra-performance liquid chromatography–tandem mass spectrometry, we found that DNBS modestly increased paeonol AUClast (NC: 247.8 ± 63.7 vs DNBS: 337.0 ± 120.8 hr*ng/mL) and decreased paeoniflorin (NC: 474.1 ± 11.7 vs DNBS: 463.7 ± 106.8 hr*ng/mL) compared to controls (ns). After repeated dosing, the maximum plasma concentration (Cmax) of paeonol was higher in the MC(H) than that in the MC(L) group (MC(L): 63.81 ± 29.74 vs MC(H): 4221.5 ± 1579.2 ng/mL, p max in the MC(H) group was also higher than MC(L) group (MC(L): 60.5 ± 15.3 vs MC(H): 164.7 ± 74.7 ng/mL, pThe purpose of this concept analysis is to clarify the meaning of digital health equity beyond a simplistic definition, obtaining a richer meaning that can guide the digital healthcare landscape.
With the growing spread of digital health, digital health equity should be at the center of healthcare. Health outcomes for equity-deserving groups may be compromised without a clear understanding of digital health equity. Although the concept of ‘health equity’ has been analysed before; no concept analysis has been completed for the concept of ‘digital health equity’.
Concept analysis using Walker and Avant's method.
Articles from PubMed, Scopus and Google Scholar with no limitation on the period of data collection.
Walker and Avant's concept analysis method was used to outline attributes, antecedents, consequences, and empirical referents of the concept digital health equity.
The main attribute of digital health equity is digital health technology that benefits everyone fairly. The antecedents include: (1) appropriate infrastructure; (2) cognitive abilities including digital literacy; (3) intersectionality of multiple vulnerabilities; (4) presence of the core ethical principles in healthcare; (5) digital accessibility with careful consideration of the social determinants of health; and (6) co-creation of digital health technologies. The main consequences are improved patient health outcomes and elimination of the digital divide.
This analysis explored the concept of digital health equity as a means to promote positive health outcomes for equity-deserving groups, highlighting the critical role of nursing practice and research in addressing digital health disparities.
This paper can have an impact on nursing practice, education and wider social and economic issues. First, various barriers encountered by patients when utilising digital health technologies can be understood. Second, clinicians can be encouraged to assess digital health equity, improve interventions for equity-deserving groups, and evaluate the effectiveness of digital health interventions to ensure they are equitable. In the context of educational implications, the understanding of digital health equity can be used to facilitate the creation of appropriate education materials for clinicians. Finally, on a wider social and economic scale, understanding digital health equity can aid in the creation of policies to enable equitable digital health technologies.
No patient or public contribution because this paper is a concept analysis.
To develop a machine learning (ML)-based predictive model to determine the key predictors of dissatisfaction after occupational injury (OI).
A retrospective cohort study.
Nationwide 5-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance in South Korea.
A total of 2298 workers who completed compensation-related medical care in 2017.
Predictive modelling was conducted with extreme gradient (XG) Boost, light gradient boosting machine (GBM), CatBoost and random forest. SHapley Additive Explanations (SHAPs) analysis was conducted to interpret the feature importance. Further, logistic regression was conducted for comparison.
This study evaluated postinjury satisfaction among workers using survey items associated with satisfaction levels. We adopted a 5-year follow-up period.
Of the 2298 participants, 570 were dissatisfied. The logistic regression model indicated that dissatisfaction was significantly associated with unemployment (adjusted OR (aOR) 1.701; 95% CI: 1.296 to 2.233), lack of private health insurance (aOR 1.347; 95% CI 1.042 to 1.741) and lower perceived socioeconomic status (aOR 2.097; 95% CI 1.109 to 3.965). Among the ML models, light GBM exhibited the highest area under the receiver operating characteristics curve (0.770 (95% CI 0.718 to 0.819)), followed by CatBoost (0.768 (95% CI 0.718 to 0.815)), random forest (0.766 (95% CI 0.715 to 0.814)) and XGBoost (0.765 (95% CI 0.717 to 0.811)). The SHAP analysis demonstrated the total number of household members, extent of pain interference with daily life, perceived health status before injury and financial factors as the strongest predictors.
This study developed and demonstrated robust predictive performance of an ML-based model for determining dissatisfaction after OI. The key features included employment status, financial stability, chronic pain and cognitive function, highlighting the multifaceted nature of worker satisfaction.
FreshRSS 