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Cocaine use disorder (CUD) is a significant public health concern in the USA, with considerable prevalence and mortality and no Food and Drug Administration (FDA)-approved pharmacotherapies. Recent advances in addiction science emphasise the need for novel, mechanism-based treatments. Glucagon-like peptide-1 receptor agonists, such as semaglutide, have shown promise in modulating reward-related behaviours and may offer therapeutic benefits for CUD. We present a study protocol evaluating semaglutide, as an adjunct to cognitive behavioural therapy (CBT), as a novel approach for treating CUD.
This is a randomised, double-blind, placebo-controlled trial enrolling 75 treatment-seeking adults with CUD. Participants will be randomised 1:1 to receive either once-weekly semaglutide (0.25–1.0 mg) or placebo injections over 14 weeks, alongside weekly individual CBT. Primary outcomes include changes in neurophysiological reactivity to drug-related and non-drug-related motivationally relevant cues (late positive potential), behavioural economics (cocaine demand), craving (Cocaine Craving Questionnaire) and cocaine use (self-report, urine drug screens). Exploratory aims assess associations between mechanistic changes and cocaine use, consumption of other substances (ie, tobacco, alcohol and cannabis) and dose–response relationships. Data will be analysed using Bayesian statistical methods using an intention-to-treat approach.
The study has been approved by the UTHealth Committee for the Protection of Human Subjects (HSC-MS-25-0412) and is registered on ClinicalTrials.gov. All participants will provide written informed consent. Findings will be disseminated through peer-reviewed publications and scientific conferences.
To examine and map the available literature on outcomes associated with interventions carried out by advanced practice nurses in chronic wound care.
The role of the advanced practice nurses in wound care is identified as a key element in the management of patients with chronic wounds. However, the literature offers fragmented knowledge of the outcomes associated with their practice.
Scoping review.
This scoping review was conducted following the methodological framework proposed by Arskey and O'Malley, following the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review. PRISMA-ScR Checklist is included in the manuscript. Observational or experimental studies related to patients affected by chronic wounds and cared for by advanced practice nurses in wound care were included.
The following databases were queried: PubMed, CINAHL, Cochrane Library, and Scopus from 01 May 2025 to 31 October 2025.
The search strategy in the consulted databases identified 1956 studies; 31 met the inclusion criteria. Different types of chronic wounds were investigated: diabetic foot ulcers, venous leg ulcers, and pressure injuries. The most frequently measured outcomes were clinical responses (healing, recurrence, complications), organizational efficiency (referrals, resource utilization), and patient-reported outcomes.
Evidence from the included studies suggests that Advanced practice nurses led wound care models may be associated with faster healing, lower recurrence and complication rates, and more efficient care pathways, across different settings. This review highlights the global applicability of APN-led models, showing consistent improvements in clinical, organizational, and patient-reported outcomes through core interventions.
This scoping review follows Arskey and O'Malley's methodological framework and the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review.
No Patient or Public Contribution.
The revision protocol was registered on the OSF (https://doi.org/10.17605/OSF.IO/P9TA4).
by Gilbert Mua Akwa, Tankeng Leonard Tanko, Njowe Serge Ludwig, Ange Veronique Ngo Bilong, Nana Chunteng Theophile
BackgroundFootball injuries are a major source of morbidity among athletes, imposing health and economic burdens on teams and systems. While extensive surveillance exists in Europe, data from sub-Saharan Africa remain scarce. This study described the incidence, patterns, severity, and contextual factors of match-related injuries among professional male footballers in Cameroon.
MethodsA prospective cohort design was conducted during the 2023/2024 Cameroon Elite 1 and Elite 2 league playoff tournaments. Match-day medical officers recorded all medical-attention injuries using standardized consensus-based forms [1]. Injury incidence was calculated per 1,000 player-hours, and descriptive analyses summarized injury characteristics. Ethical approval was obtained from the University of Douala and authorization from the Cameroon Football Federation.
ResultsAcross 139 matches, 171 injuries were recorded giving an incidence of 37.3 per 1,000 player-hours. Elite 2 players had more than double the rate of Elite 1 players (53.6 vs. 26.3). Lower-limb injuries (71.9%) predominated, mainly affecting the thigh (33.9%) and lower leg (17.5%). The most common diagnoses were cramps (20.5%), contusions (19.9%), and sprains (17.5%). Severe injuries (>28 days) represented 20.5%, with tears, fractures, and concussions most frequent. Nearly half injuries occurred in the final 30 minutes of play, and midfielders and attackers sustained 68% of all injuries.
ConclusionThis first surveillance study in Cameroon reveals a high match injury burden, particularly in lower-tier leagues. The late-match clustering supports fatigue-related mechanisms, emphasizing the need for targeted prevention focusing on conditioning, workload regulation, and medical readiness in African football.
by Navdeep Kaur, Marcus V. Merfa, Alexandra K. Kahn, Rodrigo P. P. Almeida, Leonardo De La Fuente
Xylella fastidiosa (Xf) is an insect-transmitted, xylem-limited bacterial plant pathogen that infects hundreds of plant species. This pathogen causes bacterial leaf scorch in southern highbush blueberry (Vaccinium corymbosum interspecific hybrids) in the southeastern United States, a disease that has not yet been reported elsewhere. Previously, a comparative genomic analysis of Xf and ancestral host species identified evolutionary events of gene gain and loss related to host range specificity. Here, by using a similar workflow, we identified two loci that are significantly found in blueberry-infecting strains. Locus_1088 included a hypothetical protein and a small part of the N-terminus of an orphan RelE toxin, while Locus_2741 was annotated as a hypothetical protein. Using a protocol based on natural competence, mutants were generated in three Xf subsp. multiplex strains from blueberry. Less biofilm, more planktonic growth, and increased twitching motility as compared to its wild-type (WT) were observed for the strain LA-Y3C_1088 mutant. In blueberry virulence assays, the LA-Y3C_1088 mutant caused significantly more severe symptoms than LA-Y3C_WT, whereas no significant differences were observed for other mutated strains. Interestingly the mutation of Locus_1088 additionally disrupted a toxin (part of a toxin-antitoxin system) that is likely responsible for the phenotypic changes observed. However, because the two independent mutants were not generated, we could not determine whether the phenotype resulted from disruption of hypothetical protein or the toxin. Additionally, since the coffee-isolated but never tested in blueberry Xf subsp. fastidiosa strain CFBP8073 was found to encode the two blueberry-associated loci studied here, its virulence was assessed in blueberry. This strain caused severe symptoms comparable to the control strain AlmaEm3 from blueberry. Due to the complexity of understanding host specificity in Xf, any advance in identifying genetic markers for host specificity in this devastating pathogen could greatly improve management of Xf worldwide.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.
Commentary on: Kata A, Dillon EC, Christina Keny RN, et al.‘There’s So Much That They're Enduring’: Experiences of Older Adults Undergoing Major Elective Surgery. Ann Surg. Published online April 9, 2024. doi:10.1097/SLA.0000000000006293
Implications for practice and research Routine psychosocial assessments for older adults may be implemented throughout the perioperative continuum to proactively identify emotional challenges and offer tailored support. The effectiveness of integrated mental health and social support in improving surgical outcomes should be investigated in this vulnerable population, including longitudinal studies on mental health interventions.
Elderly patients, defined as adults aged 65 years and above, represent a growing segment of the surgical population.
by Elham Ahmadi, Sophia Baierl, Stephan Voss, Ida Asenkerschbaumer, Ursula Berndt, Leonie Bernhard, Anita Hennig, Anna-Lena Würfele, Michaela Coenen
Urban soundscapes, particularly those experienced in green spaces, have been increasingly recognized as factors that influence human mental health. This scoping review explores the existing literature on soundscapes within urban green spaces and their associated mental health outcomes. It aims to classify the methodologies used in this domain, identify mental health outcomes related to urban green space soundscapes, and examine specific soundscape elements and their correlations with mental health. A systematic search of peer-reviewed studies was conducted. After screening titles, abstracts, and full texts, 22 studies met the inclusion criteria. Diverse methodological approaches were identified, with an emphasis on quantitative multi-method designs. Commonly studied mental health outcomes include stress reduction, mood enhancement, perceived restorativeness, and cognitive restoration. Standardized psychometric tools, such as the Perceived Stress Scale (PSS-14), Positive and Negative Affect Schedule (PANAS) and Perceived Restorativeness Soundscape Scale (PRSS) are frequently used as outcome measures. Natural soundscape elements such as birdsong, water sounds, and rustling leaves had a positive association with relaxation and perceived mental restoration throughout all studies, while mechanical sounds, such as traffic noise were linked to adverse mental health outcomes. These findings highlight that natural soundscapes in urban green spaces have a potential positive relationship with mental health by reducing stress and enhancing mood. However, the cross-sectional design and methodological heterogeneity of the included studies limit causal interpretation. Future research should explore multi-sensory experiences and examine soundscapes in diverse urban contexts to provide more robust insights into their relationship with mental health. The practical implications suggest that urban planners should prioritize integrating natural sound elements into urban areas to improve mental health. The study protocol of this scoping review had been registered at OSF (osf.io/4r7gd).A growing number of national diagnostic reference levels based on clinical indications (NDRLci) in CT have been implemented worldwide since the International Commission on Radiological Protection’s 2017 recommendation. This study aims to compare NDRLci practices, identify influencing factors and propose evidence-based recommendations for NDRLci development, based on the literature published between 1996 and 2025.
Systematic review.
A systematic literature search was conducted in PubMed, Web of Science and Scopus from 1996 to 24 august 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was followed to report the study selection process in this review. Joanna Briggs Institute’s critical appraisal tools were used to evaluate the articles critically.
Adult patients undergoing CT scans for various clinical indications.
Clinical indication-based CT protocols with reported NDRLci values as CT dose index volume and dose length product (DLP).
The primary outcomes were NDRLci values reported for various clinical indications. The secondary outcomes were CT technology, protocol parameters and patient characteristics influencing NDRLci.
A total of 4146 articles were identified. 410 full texts were examined and 11 studies were included in the systematic review. 25 clinical indications across seven anatomical regions were identified across 11 included studies. The NDRLci for urinary stones and cerebrovascular accident had the highest number of references, while flank pain and occlusion had the lowest number. The highest NDRLci in DLP was found for total body CT in severe trauma (3830 mGy cm) and the lowest for sinusitis (70 mGy cm).
Several factors contribute to dose discrepancies for the same clinical indications in CT imaging, including kilovolt peak and milliampere-second, scan length, number of phases, patient size, reconstruction algorithm, CT scanner age and specifications, underscoring the need for standardised and optimised CT protocols. This review highlighted several challenges, which emphasise the importance of international organisations to standardise the development of NDRLci to improve comparability across countries.
CRD42024603574.
by Andrés Castellanos-Chacón, Daniela Arias-Otero, Valeria Uribe-Jaramillo, Juan David Leongómez, Milena Vásquez-Amézquita
The attentional system tends to prioritize negative stimuli in the early stages of processing, favoring threat detection. However, it is unclear whether this bias is maintained or reversed toward positive stimuli at later stages. In this study, we used a free-viewing paradigm with eye tracking to examine early and late attentional biases toward negative, positive, and neutral stimuli (humans in emotionally unloaded activities) versus control stimuli (inanimate objects) in 122 participants without affective disorders (64 men, 58 women). We fitted generalized linear mixed models with random intercepts for stimuli and random intercepts and slopes for participants, and used non-parametric bootstrap resampling to obtain robust estimates and confidence intervals. Additionally, the number of first fixations was analyzed with a COM-Poisson. Results showed that participants fixated faster (χ2(3) = 97.55, p 2(3) = 337.45, p χ2(3) = 200.24, p χ2(3) = 207.02, pThe digital transformation of healthcare has created an urgent need for primary care physicians (PCPs) to acquire competencies in digital health. However, the structure and scope of postgraduate training programmes remain poorly defined and unevenly implemented worldwide, and no scoping review has yet synthesised the evidence. This review aims to map existing postgraduate digital health training programmes for PCPs, including their content, structure and delivery approaches.
This scoping review will follow the Joanna Briggs Institute methodology and adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A systematic search will be conducted across five databases (PubMed, Scopus, Cochrane Library, ScienceDirect and Web of Science) and relevant grey literature, covering publications from January 2019 to June 2025. Studies describing postgraduate digital health training programmes for PCPs will be eligible for inclusion. Data will be extracted and synthesised descriptively and thematically using an inductive approach.
As this study is based on a review of publicly available literature, ethical approval is not required. The findings will be disseminated through a peer-reviewed publication and conference presentations and will inform future curriculum development and policy in digital health education for PCPs. The results may also inform national curriculum reforms and accreditation standards, supporting more consistent and competency-based digital health education globally.
This scoping review protocol has been registered with the Open Science Framework.
Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.
To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.
The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.
MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.
MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.
MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.
This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.
by Gianluigi Serio, Consiglia Pacelli, Claudia Piccoli, Nazzareno Capitanio, Giuseppe Cibelli, Anna Antonia Valenzano, Francesca Landini, Leonardo Carlucci, Paola Palladino
The ketogenic diet (KD) is a low-carbohydrate diet that induces and sustains a ketosis state and minimizes somatic glucose levels. Several psychological studies have described the positive effects of ketosis on cognitive functions for a wide range of neuropsychiatric conditions (e.g., Alzheimer’s disease; epilepsy), leading to greater interest in the KD today. However, the psychological and cognitive effects of inducing ketosis via diet remain unclear, especially in healthy people. From an initial pool of thirty participants, eight undergraduate students performed a cognitive assessment before (baseline) and after three weeks (follow-up) of an isocaloric ketogenic diet. Several neuropsychological measures and psychometric tests have been administered to investigate psychological chronotype, sleep quality, eating habits, anxiety and cognitive components of attention, inhibition, and memory. Non-parametric Bayesian analysis showed that the ketogenic diet affected cognitive functions. Participants performed cognitive tests faster at follow-up than at baseline, showing improvements in visual-motor cognitive and processing speed components. However, they were less accurate on working memory tasks, suggesting a decreasing performance of higher cognitive functions. Finally, no differences in anxiety levels were found between baseline and follow-up. The results could have significant implications for identifying specific cognitive models of students based on specific lifestyle habits and nutritional patterns, allowing the implementation of targeted interventions to improve university learning conditions.To explore existing strategies for managing sleep disorders in individuals with vision impairment (VI), identifying interventions, geographical trends and research gaps.
Scoping review.
Medline ALL (Ovid), Embase and Web of Science Core Collection, with supplementary searches in Google Scholar. The final search was completed on 28 November 2025.
Original research studies examining strategies to manage sleep disorders in adults (≥18 years) with VI, published in English. Studies focusing on animal models or unrelated to sleep management were excluded.
Two reviewers independently screened titles, abstracts and full texts using Covidence, extracted data using a predefined form and resolved discrepancies by consensus. A narrative synthesis approach was used to summarise findings by intervention type, study design and outcomes.
Of 4368 records screened, 16 studies met inclusion criteria. Participants ranged from 18 years to 85 years (median 40.5). Most studies included individuals with no light perception, though VI definitions were often inconsistent. Pharmacological interventions dominated (13/16, 81.3%), mainly melatonin or melatonin receptor agonists, with some use of zopiclone, low-dose benzodiazepines and tricyclic antidepressants. Non-pharmacological approaches were under-represented, including bright light exposure (n=1), virtual Hatha yoga (n=1) and caffeine modulation (n=1). Substantial variation existed in sleep assessment methods.
This scoping review highlights the predominant focus on pharmacological treatments, especially melatonin, while non-pharmacological strategies remain underexplored. Future research should explore accessible, non-pharmacological interventions and address sleep health inequities faced by individuals with VI.
10.17605/OSF.IO/7E83R.
Creating a healthy work environment requires balancing organizational goals with ethical responsibilities, where head nurses' ethical leadership can shape staff outcomes by mitigating work–family conflicts and promoting nurses' well-being, retention, and patient safety. This study aims to analyze the mediating role of work–family between head nurses' ethical leadership and nurses' reported errors, turnover intention, and physical and mental health.
Nationwide Multicenter cross-sectional study.
Validated self-report scales were used to assess nurses' perceptions of head nurses' ethical leadership, work–family conflict, error, turnover intention, physical and mental health. Descriptive and inferential analyses were conducted. Structural equation modeling examined the relationships among these variables based on Della Bella's and Fiorini's framework.
Data from 409 nurses across seven Italian hospitals was analyzed. The structural equation model showed an excellent fit. Head nurses' Ethical leadership was negatively associated with work–family conflicts, turnover intention, and errors, and positively associated with nurses' health. Work–family conflicts were significantly linked to turnover intention, errors, and nurses' health. Work–family conflicts mediate the relation between ethical leadership and turnover intention, errors, and nurses' health.
Promoting healthy work environments is crucial for nurses', patients', and organizations' well-being. Ethical leadership helps achieve this condition by reducing work–family conflicts, fostering nurses' well-being, decreasing turnover intention, and improving care quality. Disseminating ethical leadership programs and integrating with work–life balance policies can therefore strengthen both staff retention and organizational outcomes.
Ethical leadership can foster patient care, reduce turnover intention and errors, and improve nurses' well-being. Therefore, maintaining employee performance and organizational results requires integrating work–life balance policies with ethical leadership development programs.
The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.
This study did not include patient or public involvement.
The study was preregistered on the Open Science Framework https://osf.io/8jk37/overview.
This study did not include patient or public involvement in its design, conduct, or reporting.
In recent decades, transcranial electrical stimulation (tES) has become a widely used non-invasive method for modulating brain function in clinical and non-clinical populations. However, existing tES trials exhibit substantial methodological heterogeneity, often limiting the reproducibility and interpretability of findings. There currently exists a paucity of consensus-driven, standardised recommendations outlining the key factors that should be reported and/or controlled in tES studies. Accordingly, this project aims to develop Consolidated Guidelines for Reporting and Evaluation of studies using tES (CoRE-tES), a tool designed to assess the methodological quality and reporting of laboratory-based and home-based tES studies. These guidelines will support improved quality, consistency, replication and transparency in research involving tES modalities, including transcranial direct current stimulation, transcranial alternating current stimulation and transcranial random noise stimulation.
CoRE-tES will be developed and disseminated over five stages. Stage 1 will comprise a review of recent tES literature to assess methodological and reporting quality. Stage 2 will employ a Delphi process to seek agreement among international tES experts on a list of items for inclusion in CoRE-tES. In stage 3, a consensus meeting will be held to synthesise and prioritise the agreed items to form CoRE-tES. Stage 4 will involve production of the final CoRE-tES checklist and an accompanying evaluation and elaboration document. In stage 5, CoRE-tES will be disseminated via journal publication, conferences, professional meetings and social media campaigns.
Ethics approval has been obtained from the Western Sydney University Human Research Ethics Committee (approval number H16803). Findings will be disseminated through scientific conferences and peer-reviewed journal publications, and CoRE-tES will be indexed on the Enhancing the QUAlity and Transparency Of health Research Network website.
This study aimed to investigate the factors influencing health-related quality of life (HRQoL) in patients undergoing haemodialysis, focusing on the association between HRQoL dimensions and sociodemographic variables, clinical parameters, mental health status and biochemical indicators.
A multicentre cross-sectional study conducted over 30 months.
The study was carried out in secondary care centres across multiple locations in the Community of Extremadura, Spain.
A total of 150 patients undergoing haemodialysis were recruited between March 2022 and September 2023. Inclusion criteria required patients to be diagnosed with chronic kidney disease (CKD) and undergoing haemodialysis. Patients unable to provide informed consent or with severe cognitive impairment were excluded.
HRQoL was assessed using the Kidney Disease Quality of Life 36-item Short Form scale. Mental health parameters, specifically anxiety and depression, were evaluated using the Hospital Anxiety and Depression Scale. Biochemical markers such as haemoglobin and haematocrit levels, as well as sociodemographic and clinical data, were analysed for their influence on HRQoL.
Symptoms of anxiety and depression were prevalent among patients undergoing haemodialysis. Anxiety had the greatest negative effect on HRQoL, being significantly associated with lower scores in the mental component summary (MCS) (β = –2.06; 95% CI –2.78 to –1.33; R² = 0.106; p
Depression and anxiety, along with older age, were identified as key factors negatively affecting HRQoL of patients undergoing haemodialysis. Management of mental health, alongside optimisation of clinical care to minimise complications, could enhance the HRQoL in this patient population. Further research is recommended to develop targeted interventions addressing anxiety and other modifiable factors influencing HRQoL in haemodialysis patients.
Frailty is a key predictor of adverse surgical outcomes in older adults, contributing to increased postoperative complications, prolonged hospitalisation and delayed recovery. Prehabilitation—targeting improvements in physical function before surgery—can mitigate these risks. However, traditional programmes often face low adherence due to logistical barriers. Integrating smart wearable devices into tele-supervised, home-based prehabilitation may enhance adherence, engagement and clinical outcomes.
This trial protocol describes the PREhabilitation of frail elderly PAtients undergoing majoR surgEry at HOME study with the objective to evaluate the effectiveness of a wearable-enhanced, tele-supervised prehabilitation programme (swSEP) versus standard care (unsupervised prehabilitation, uSEP) on improving preoperative functional capacity and postoperative outcomes in frail older adults undergoing major elective surgery.
This single-centre, prospective, randomised controlled trial will enrol 190 patients aged ≥65 years scheduled for major elective, non-cardiac surgery at Singapore General Hospital. Participants with frailty (Edmonton Frail Scale ≥6) will be randomised 1:1 to either the swSEP group (tele-supervised exercise with Fitbit Inspire 3 monitoring) or the uSEP group (standard physiotherapy education, exercise booklet and inspiratory muscle training if maximal inspiratory pressure 2O). The primary outcome is change in 6 min walk test distance from baseline to 1–3 days presurgery. Secondary outcomes include 30 s sit-to-stand test, handgrip strength, postoperative complications (per American College of Surgeons National Surgical Quality Improvement Program), hospital length of stay, readmissions, five-level version of the EuroQol five-dimensional questionnaire (EQ-5D-5L) and adherence. Data will be analysed using t-tests, analysis of covariance, logistic regression and Cox models, with stratification by baseline nutritional status.
Approved by the SingHealth Institutional Review Board (CIRB Ref: 2024/2242). Trial registered on ClinicalTrials.gov (NCT06633614). Results will be disseminated via peer-reviewed publications and academic conferences. Contact: irb@singhealth.com.sg
ClinicalTrials.gov Identifier: NCT06633614
FreshRSS 