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High-flow nasal oxygen versus nasopharyngeal oxygen insufflation during upper aerodigestive tract endoscopy: protocol for a multicentre randomised controlled non-inferiority trial (OPTIGO)

Por: Alleyrat · C. · Drilleau · R. · Brasseur · J.-M. · Karayan · J. · Saenz-Molina · C. · Frasca · D. · Boisson · M. · Beaumatin · G.
Introduction

Upper aerodigestive tract endoscopy is routinely performed for the diagnosis and staging of head and neck cancers. These procedures are commonly conducted under general anaesthesia with spontaneous ventilation to optimise surgical exposure and avoid tracheal intubation. However, maintaining adequate oxygenation remains challenging, particularly in patients with altered airway anatomy due to prior surgery or radiotherapy.

Standard practice often involves a preliminary laryngoscopy to insert a nasopharyngeal oxygen catheter, which may increase procedural complexity and interfere with surgical conditions. High-flow nasal oxygen (HFNO) has emerged as a promising alternative for maintaining oxygenation in various perioperative settings.

The OPTIGO trial aims to determine whether HFNO is non-inferior to nasopharyngeal oxygen insufflation in preventing intraoperative oxygen desaturation during upper aerodigestive tract endoscopy.

Methods and analysis

The OPTIGO study is a multicentre, prospective, randomised, open-label, non-inferiority trial conducted in three French centres. A total of 610 adult patients scheduled for endoscopic procedures of the pharynx, larynx and oesophagus will be randomised in a 1:1 ratio to receive either HFNO or standard oxygenation via a nasopharyngeal oxygen catheter.

The primary outcome is the occurrence of intraoperative oxygen desaturation, defined as a peripheral oxygen saturation ≤85% at any time from induction to the end of the procedure.

Secondary outcomes include intraoperative complications, postoperative laryngeal pain, surgeon comfort, duration of the procedure, anaesthetic drug consumption, and perioperative gas exchange.

Ethics and dissemination

This study has been approved by the independent ethics committee CPP Est 1 (10 April 2025; EudraCT 2025-A00278-41). The trial will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice Guidelines.

Results will be disseminated through presentations at scientific conferences and publication in peer-reviewed journals.

Trial registration number

CPP Est 1 EudraCT 2025-A00278-41 (Clinical trial NCT07004699).

Self-management experiences and needs in patients with chronic obstructive pulmonary disease: a meta-synthesis of qualitative studies

Por: Chen · Y. · Zeng · H. · Hongmin · R. · Yang · N. N. · Cheng · C. L. · Liu · R. · Luo · L. W. · Jimei · L. · Lina · M.
Objectives

To systematically review qualitative studies on the self-management experiences and needs of patients with chronic obstructive pulmonary disease (COPD) and to provide evidence for developing needs-based self-management intervention strategies.

Design

A systematic review and meta-aggregation of qualitative studies conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement.

Data sources

PubMed, Cochrane Library, Web of Science, Scopus, CINAHL, Embase, CNKI, Wanfang Database, VIP Database and CBM were searched from database inception to March 2025 for qualitative studies on COPD self-management experiences and needs.

Eligibility criteria

Qualitative studies involving adults (≥18 years) with a confirmed diagnosis of COPD that reported patients’ real feelings, experiences and needs during the self-management process in any setting (hospital, community or home). Studies were excluded if the full text could not be obtained or data were incomplete, if they were duplicate publications or if they were not published in Chinese or English.

Data extraction and synthesis

Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardised form and assessed methodological quality using the 2016 Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Findings (participants’ quotations and authors’ interpretive statements) were synthesised using a JBI meta-aggregation approach to develop categories and overarching synthesised findings.

Results

15 qualitative studies were included, comprising 251 patients with COPD. A total of 52 findings were identified, grouped into 13 categories and synthesised into 4 overarching findings: (1) physical symptom burden strongly shapes psychological well-being during COPD self-management; (2) patients face multiple and interrelated barriers to effective self-management; (3) some patients develop active coping strategies and self-management resources; and (4) patients express multidimensional and continuing support needs.

Conclusions

Patients with COPD experience substantial physical and psychological distress and face multiple challenges in the self-management process. Healthcare professionals should prioritise patients’ lived experiences, establish comprehensive and coordinated support systems and develop diversified, needs-based intervention strategies to address patients’ multidimensional needs, thereby enhancing self-management capacity and improving quality of life.

PROSPERO registration number

CRD42024607051.

Association between physical fitness and anthropometric indicators according to area of residence in Chilean adolescents: a cross-sectional study

Background

Research has yielded contradictory results regarding differences in physical fitness and cardiometabolic risk between children and adolescents living in rural and urban areas.

Objectives

The present study aimed to analyse the moderating role of area of residence on the association of physical fitness and anthropometric parameters in Chilean adolescents.

Design and setting

Cross-sectional analysis of a nationally representative school-based sample from Chile.

Participants and measures

A total of 7,833 adolescents with an average age of 15.8±0.7 years participated in both rural (n=759) and urban (n=7,074) settings. Physical fitness tests were evaluated using the Assessing Levels of Physical Activity and Fitness (ALPHA-Fitness) battery and anthropometric variables such as body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). Generalised linear models with Gaussian distributions were constructed to estimate moderation models, with anthropometric-related variables as dependent variables, physical fitness variables as independent variables and area of residence as a moderator. Moderation analyses were conducted to examine whether the area of residence influences the association between physical fitness and anthropometric indicators (WC, WHtR and BMI).

Results

In all models, place of residence did not moderate the potential associations between physical fitness and anthropometric indicators; for example, cardiorespiratory fitness with WC (B=0.13, 95% CI 0.05 to 0.31; 0=0.160), WHtR (B=0.08, 95% CI –0.03 to 0.20; p=0.143) or BMI (B=0.08, 95% CI –0.03 to 0.20; p=0.207).

Conclusions

These findings suggest the associations between physical fitness and anthropometric outcomes do not differ significantly between rural and urban adolescents.

Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial

Por: Huerta · M. · Lopez-Ben · S. · Llado · L. · Sanchez-Cabus · S. · Mils · K. · Molina · V. · Dopazo · C. · Vidal · L. · Dalmau · M. · Caralt · M. · Roson · N. · Merino · X. · Armario · D. · Salcedo · M. T. · Pellino · G. · Sapisochin · G. · Gomez-Gavara · C. · LIVERGREEN Collaborative Grou
Introduction

Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence.

Methods and analysis

This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years.

Ethics and dissemination

The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences.

EudraCT number

2023–5 08 316-27-00.

Trial registration number

NCT06398028.

Protocol version

V.12, 18 March 2025

Translation, Validation and Cross‐Cultural Adaptation of the Patient and Observer Scar Assessment Scale Version 3.0 (POSAS 3.0) Into Malay Language for Injury‐Related Scar

ABSTRACT

Patient and Observer Scar Assessment Scale Version 3.0 (POSAS 3.0) is a robust instrument for scar evaluation. Currently, no validated POSAS 3.0 in the Malay language is available. This study aimed to translate, culturally adapt, and psychometrically evaluate POSAS 3.0 for Malay-speaking populations in Malaysia. Malaysian patients were recruited between 31 October 2023, to 31 December 2024. Translation was conducted using a forward and backward translation approach. Reliability was assessed using internal consistency (Cronbach's alpha) and test–retest. Face validity was addressed with 10 patients, and content validity was evaluated by four clinical specialists. Content validity was evaluated using the item-content validity index (I-CVI) and content validity ratio (CVR). Construct validity was assessed using exploratory factor analysis (EFA). Seventy-eight participants with facial (n = 39, 50.0%) and non-facial (n = 39, 50.0%) soft tissue scars were recruited for the EFA. The Malay POSAS-O demonstrated acceptable internal consistency (α = 0.75) and excellent inter-rater reliability, with item-level intraclass correlation coefficient (ICCs) ranging from 0.91 to 1.00 and total score ICC of 0.99. Agreement for categorical scar severity ratings was almost perfect (κ = 0.89). The Malay POSAS-P showed excellent internal consistency (α = 0.89), and test–retest reliability for the total score was good to excellent (ICC = 0.89). Intermittent symptom items (painful, shooting, burning and fragile) exhibited lower stability, reflecting natural symptom variability. Content validity was excellent, with all items achieving I-CVI and CVR values of 1.00. EFA supported construct validity, with adequate Kaiser-Meyer-Olkin (KMO) values (POSAS-O: 0.88; POSAS-P: 0.85), significant Bartlett's tests, strong communalities and factor loadings. The cumulative variance explained was 79.05% for POSAS-O and 68.19% for POSAS-P. The Malay version of the POSAS 3.0 is a reliable, valid, and culturally appropriate instrument for scar assessment. Its strong psychometric properties support its application in clinical practice and research involving Malay-speaking populations.

The transition from winter to spring has an impact on the airway metabolome profile of asthmatic horses

by Julia Drespling, Steffen Heelemann, Selina Strathmeyer, Heike Kühn, Bianca Schwarz, Lars Mundhenk

Equine asthma is a chronic, non-infectious inflammatory disease of the lower airways in horses, classified as mild to moderate (MEA) or severe (SEA). Its pathogenesis is not fully understood and is influenced by environmental and seasonal factors. In this cross-sectional study, seasonal effects on the bronchoalveolar lavage fluid (BALF) metabolome were investigated in asthmatic and non-asthmatic horses. The metabolome of 230 BALF samples from horses across different seasons, classified as cytologically unremarkable (CUA), MEA, or SEA, was analyzed using proton nuclear magnetic resonance spectroscopy (1H-NMR). Principal component analysis was performed for each season, and metabolite profiles were statistically compared between seasons within each group. Altered metabolites were subjected to pathway enrichment analysis using the FELLA R package. Asthmatic horses showed significant seasonal changes in metabolite concentrations between warm and cold seasons, whereas only trends were observed in CUA horses. Pathway analysis indicated enrichment of cholesterol metabolism across all groups. The mTOR signaling pathway was only enriched in SEA horses. Several metabolites—including valine, taurine and carnitine —were altered during the transition from winter to spring in asthmatic horses. These findings indicate that the winter to spring transition significantly modulates the airway metabolome in asthmatic horses, particularly in SEA-affected animals.

Severidad de síntomas prostáticos y factores adheridos en adultos mayores del Hogar de Ancianos “San José de las Canoas” del cantón Catamayo

Introducción. Los síntomas prostáticos abarcan alteraciones en el vaciado, llenado, posmicción y volumen urinario, su aparición está influida por factores de riesgo como la edad, la raza, la predisposición genética y los hábitos dietéticos. Objetivo. Analizar la severidad de los síntomas prostáticos con los factores epidemiológicos y clínicos de los residentes del del Hogar de Ancianos “San José de las Canoas”, del cantón Catamayo. Metodología. Se realizó un estudio descriptivo, cuantitativo, no experimental, y corte transversal, con una muestra de 30 participantes. Para la recolección de datos se utilizó el cuestionario “International Prostate Symptom Score” (IPSS) destacándose por su alta confiabilidad y validez. El estudio contó con la aprobación de un Comité de Ética en Investigación en Seres Humanos y se llevó a cabo respetando los principios bioéticos establecidos. Resultados. 18 de los pacientes estudiados presentaban síntomas moderados. Se obtuvo una asociación estadística entre la severidad de los síntomas síntomas prostáticos y la edad (p= 0,007) y el grado de instrucción (p= 0,046). En cuanto a la presencia de comorbilidad (diabetes, hipertensión arterial/cardiopatía), se observó una relación significativa en la muestra (p= 0,043) en términos generales. Discusión. Los datos revelan que los síntomas prostáticos moderados se asocian con factores sociales y clínicos críticos, como el aislamiento, la falta de educación y enfermedades relacionadas con el estilo de vida, este panorama exige acciones integrales para mejorar la salud y calidad de vida de esta población vulnerable.

ABSTRACT

Introduction. Prostatic symptoms include alterations in voiding, filling, postvoiding and urinary volume, their appearance is influenced by risk factors such as age, race, genetic predisposition and dietary habits. Objective. To analyze the severity of prostatic symptoms with epidemiological and clinical factors in the residents of the “San José de las Canoas” Elderly Home in Catamayo. Methodology. A descriptive, quantitative, non-experimental, cross-sectional study was carried out with a sample of 30 participants. The “International Prostate Symptom Score” (IPSS) questionnaire was used for data collection, standing out for its high reliability and validity. The study had the approval of a Human Research Ethics Committee and was carried out respecting the established bioethical principles. Results. 18 of the patients studied had moderate symptoms. Statistical association was obtained between severity of prostatic symptoms and age (p= 0,007) and education degree (p= 0,046). Regarding the presence of comorbidity (diabetes, arterial hypertension/cardiopathy), a significative association was observed in the sample (p= 0,043). Discussion. Data reveal that moderate prostatic symptoms are associated with critical social and clinical factors, such as isolation, lack of education and lifestyle-related diseases, this scenario calls for comprehensive actions to improve the health and quality of life of this vulnerable population.

The Family Caregiver Role From the Perspective of Older Women Experiencing Poverty in a High‐Income Country: A Qualitative Study

ABSTRACT

Aim

To explore how older women experiencing poverty in a high-income country perceive their family caregiver role from a gender perspective.

Design

Descriptive qualitative study.

Method

A convenience sample of seventeen older female caregivers experiencing poverty was interviewed in-depth between October 2023 and March 2024. Reflexive thematic analysis was conducted following the phases described by Braun & Clarke. ATLAS.ti software was used for data analysis.

Results

Three main themes were developed from the data analysis: (1) The duality of family caregiving: between informal female support and structural neglect, (2) family care in later life as a continuation of a life devoted to others, (3) older female family caregiving as a gender issue.

Conclusions

Older female caregivers experiencing poverty have limited formal support and unequal access to resources. Older women experiencing poverty experience both gratitude and despair in their caregiving role, which inevitably deteriorates their health.

Implications for the Profession and/or Patient Care

Nursing interventions for older female caregivers experiencing poverty should include an assessment of social determinants of health, focusing on gender and socio-economic barriers. Implementing system navigation interventions, such as community-based case management, resource referral programmes, and personalised care coordination, could connect older female family caregivers to essential resources and support networks, thus addressing their mental health needs and promoting equity, which would enhance their overall well-being and dignity.

Impact

Experiencing poverty increases the vulnerability of older female caregivers, exacerbating gender inequality. These women often face mental health issues as they face the pressure of meeting their own needs and those of their care recipients with a lack of formal support. This neglect can lead to serious health problems, which emphasises the need for equitable nursing interventions.

Reporting Method

The study is reported following the COREQ guidelines.

Patient or Public Contribution

No patients or public were involved in the study development and implementation.

Experiences and Responses to Cancer‐Related Anorexia Across Patients, Caregivers and Healthcare Professionals: A Qualitative Meta‐Synthesis

ABSTRACT

Aim

To synthesise qualitative evidence on how patients, caregivers and healthcare professionals perceive and respond to cancer-related anorexia (CRA), and to develop a multi-level framework for improving CRA care.

Design

A qualitative meta-synthesis using the Joanna Briggs Institute (JBI) methodology, informed by the Social Ecological Model (SEM).

Methods

Seven databases were searched for qualitative studies from inception to April 2025. Studies were assessed using the JBI Critical Appraisal Checklist. Meta-aggregation was used to synthesise findings, and the ConQual method assessed confidence levels.

Data Sources

PubMed, Embase, CINAHL, PsycINFO, Cochrane Library, CNKI and WanFang.

Results

Seventeen studies from 10 countries were included, reflecting the perspectives of patients, caregivers and healthcare professionals. Four synthesised findings were identified. At the individual level, CRA was linked to physical decline, emotional distress and changes in identity. The interpersonal level involved feeding-related tensions and caregiver burden. Organisational barriers included delayed care and poor cultural responsiveness. Policy-level factors such as limited insurance coverage and rural access further impeded care. Overall confidence in these synthesised findings was low to moderate.

Conclusion

CRA is not solely a biological condition but a multidimensional experience. Addressing CRA requires integrated and context-sensitive strategies across personal, relational, organisational and policy domains.

Implications

Nurses and clinicians should address not only physical symptoms but also the emotional and social dimensions of eating. Structured support for caregivers and improved service access, particularly in underserved settings, are needed.

Impact

This study provides a multi-level understanding of CRA. The findings support better patient care, caregiver support and more equitable healthcare policy design.

Reporting Method

JBI methodology and ENTREQ guideline.

Patient or Public Contribution

No Patient or Public Contribution.

Trial Registration

PROSPERO Database: CRD420251041265

Context-dependent dysregulation of store-operated calcium channels in head and neck squamous cell carcinoma

by Heba Ghozlan, Saja Al-Malahmeh, Othman Al-Shboul, Anas J. Mistareehi, Lina Elsalem

Store-operated calcium entry (SOCE), mediated by ORAI1–3 calcium channels and stromal interaction molecules STIM1 and STIM2, is increasingly recognized as a regulator of cancer progression. However, its role in head and neck squamous cell carcinoma (HNSCC) and its relationship with major oncogenic pathways remain poorly defined. Transcriptomic and clinical data from The Cancer Genome Atlas (TCGA) were analyzed to profile isoform-specific ORAI1–3 and STIM1–2 expression across HNSCC subtypes and oncogenic contexts. In parallel, the effects of pharmacologic SOCE inhibition with 2-aminoethoxydiphenyl borate (2-APB) were evaluated in FaDu (epidermal growth factor receptor [EGFR]-high, PIK3CA–wild-type) and Detroit-562 (metastatic, PIK3CA–mutant) cells by assessing viability, migration, and clonogenic survival. TCGA analysis revealed a context-dependent SOCE expression profile. ORAI1–3 and STIM2 were broadly upregulated in tumors, while STIM1 was significantly downregulated, particularly in advanced and basaloid subtypes. PIK3CA mutations, especially the H1047R hotspot, were associated with higher STIM1 expression, whereas EGFR expression correlated positively with STIM1/2 but negatively with ORAI1/3. In vitro, Detroit-562 cells expressed higher levels of SOCE components and showed greater sensitivity to SOCE inhibition, with marked reductions in viability, migration, and clonogenic capacity. FaDu cells, despite higher EGFR expression, exhibited lower SOCE gene expression and relative resistance to 2-APB, which suggests reduced dependence on SOCE-mediated signaling. These findings suggest that SOCE components are transcriptionally dysregulated in HNSCC and may represent a context-dependent therapeutic vulnerability, particularly in PIK3CA-mutant tumors. Validation in additional preclinical models, patient-derived xenografts, and clinical specimens is required to establish SOCE as a biomarker and therapeutic target in HNSCC.

Mental health help-seeking intentions among health workers in the east coast of peninsular Malaysia: Perceived barriers and predictive factors

by Muhammad Syafiq Kunyahamu, Aziah Daud, Ijlal Syamim Mohd Basri, Tengku Alina Tengku Ismail, Mohd Faiz Md Tahir

Introduction

Mental health problems among health workers are a growing concern globally, including in Malaysia. Despite the availability of mental health services, some health workers do not seek professional help. This study aims to determine the level of health workers’ intention to seek professional help, examine the barriers they perceive, and identify predictors of mental health help-seeking intention.

Methods

This cross-sectional study involved 470 health workers in the East Coast region of Peninsular Malaysia. Data was collected using a self-administered questionnaire. Linear regression analysis was employed to identify the predictors of professional help-seeking intention.

Results

The mean score for mental health help-seeking intention was 4.90 (SD = 1.03). Perceived need for help positively predicted help-seeking intention (B = 0.532, p  Conclusions

This study highlights the roles of the perceived need for help and perceived stigma barriers in predicting health workers’ help-seeking intentions, offering a basis for targeted interventions and policies to enhance mental health support within Malaysian healthcare settings.

Intensive Care Unit Nurses' Perceptions of Work Environments: A Cross‐Sectional Study From Five European Counties

ABSTRACT

Aim

To explore intensive care nurses' perceptions of their work environments at the unit and organisational levels according to the American Association of Critical Care Nurses standards, their impact on care quality, national differences, and demographic associations.

Design

Cross-sectional study using a survey design.

Methods

Study conducted between January 2021 and April 2022, using a convenience sample of intensive care unit nurses across Cyprus, Spain, Croatia, and Poland, Romania. The Critical Elements of a Healthy Work Environment Scale (CEHWES) developed by the American Association of Critical Care Nurses and cross-culturally adapted by the authors was used, which included four sections, including sociodemographic data and a total of 50 questions. The core section of the tool comprised 16 questions using Likert-type response (1—strongly disagree—4 strongly agree). Perception of fulfilment of healthy work environment standards was calculated using the aforementioned Likert-type scale.

Results

A total of 1183 nurses participated reporting moderate perception of fulfilment of the standards, with mean scores ranging from 2.6 to 2.8. Skilled communication and effective decision making were the highest rated. 56% (n = 662) reported awareness of some standards and while 25.8% (n = 305) reported full or significant implementation in their unit. Significant differences related to the perception of all standards were observed across countries. Implementation of the standards was significantly associated with higher quality of care having better perception when standards were fully implemented.

Conclusions

This study shows moderate perception of healthy work environment standards among intensive care nurses. Country differences highlight the need for more awareness, training, and further implementation of the standards, which is linked to better care quality.

Implications for the Profession

Work environment still need to improve and needs to be prioritised by organisations, considering local and national particularities. Having a measuring tool available in multiple languages facilitates comparisons and getting a global picture.

Impact

The questionnaire used is validated in different languages, allowing results to be compared with other countries. Novel data from countries that were poorly investigated is now available. More evidence points out the need to prioritise work environment for maintaining quality in patient care.

Reporting Method

The study has been reported following the STROBE checklist.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Spanish Translation, Cultural Adaptation and Validation of the Person‐Centred Practice Inventory‐Care (PCPI‐C): Enhancing Collaborative Care and Patient Involvement

ABSTRACT

Aim(s)

To translate, culturally adapt and validate the first Spanish version of the Person-centred Practice Inventory-Care (PCPI-C) instrument.

Design

Cross-cultural adaptation and psychometric validation.

Methods

Two-phase research design: (1) the PCPI-C's translation and cultural adaptation from English to Spanish following the ‘Translation and Cultural Adaptation of Patient-Reported Outcomes Measures-Principles Guide of Good Practice’ tool; and (2) a cross-sectional quantitative survey to assess the Spanish version's psychometric properties.

Results

A sample of 200 patients participated to obtain the PCPI-C's Spanish version. No significant issues arose during the translation process or the consulting sessions. No item exhibited an inadequate value following adjustment via the weighted kappa index (−scale-level content validity average of 0.95 for clarity and 0.97 for relevance). Psychometric evaluation revealed acceptable internal consistency (Cronbach's alpha from 0.67 to 0.84) and strong construct validity. Exploratory and confirmatory factor analyses supported a five-dimensional structure consistent with the domain Person-Centred Processes. Fit indices improved after model refinements, achieving CFI = 0.92, SRMR = 0.05 and RMSEA = 0.07. This study's observed psychometric properties confirm that the PCPI-C's Spanish version retains the original instrument's theoretical integrity, while showing strong reliability and validity in the new context.

Conclusion

The PCPI-C's Spanish translation was psychometrically valid when tested with Spanish patients, thus providing a culturally appropriate, psychometrically sound tool to evaluate Spanish-speaking patients' perception of person-centred care.

Impact

This study provides a validated instrument that allows for the assessment of person-centred practice in Spanish-speaking clinical environments. It enables healthcare professionals to measure patients' perceptions, track the implementation of person-centred principles and supports international comparative studies, contributing to the development of more ethical and responsive models of care.

Patient or Public Contribution

Patients participated in cognitive consultations and completed the survey for psychometric testing, ensuring that the translated items were understandable, culturally appropriate and reflective of their experiences of person-centred care.

Advanced Nursing Roles for People With Cognitive Impairment and Their Relatives in Acute Care Hospitals: A Systematic Review

ABSTRACT

Aim

To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.

Design

Systematic review.

Methods

We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.

Data Sources

MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.

Results

We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.

Conclusion

Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.

Implications for the Profession and Patient Care

Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.

Reporting Method

We followed the PRISMA guideline and SWiM guideline for reporting.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Trial Registration

Prospero number: CRD42021265157

Thriving in Nursing Work: The Association Between Self‐Reports and Biomarkers of Stress, Inflammation and Neuroplasticity

ABSTRACT

Aim

To examine whether self-reported thriving at work is associated with biomarkers of stress, inflammation, neuroplasticity and neurodegeneration in nurses.

Design

A cross-sectional study.

Methods

An online questionnaire measuring thriving at work was administered to nurses in a teaching hospital in Michigan, U.S. over 5 weeks in 2024. A subsample of 100 questionnaire respondents provided blood samples for biomarker analysis. Multiple regression was used to identify self-reported and biomarker predictors of nurse thriving. Cluster analysis was used to distinguish between nurses with high and low levels of thriving based on a combination of self-report and biomarker data.

Results

Higher self-reports of individual and work-related resources predicted higher thriving. Cortisol, a stress hormone, was significantly and inversely associated with thriving. No blood-based biomarkers of inflammation or neuroplasticity predicted thriving. Neurofilament light chain, a marker of neurodegeneration, was not a direct predictor but modified the effects of interpersonal and work resources on thriving.

Conclusion

Biological markers do play a role in nurses' thriving at work and may contribute important complementary information to that provided by nurse self-reports.

Implications for the Profession and/or Patient Care

Nurses thrive in a work situation characterised by positive reports of individual, interpersonal and work resources and lower levels of stress. Efforts to enhance thriving could positively impact nurses' well-being and conditions for providing high-quality patient care.

Impact

This study addressed the question of whether self-reported thriving at work among nurses is reflected in biomarkers of stress, inflammation, and neurocognitive health. A profile of high self-reported work-related resources and low cortisol distinguished higher levels of nurses' thriving from lower levels. Organisational efforts to enhance nurses' thriving can positively impact nurses' health, their work environment, and patient care.

Reporting Method

We followed the STROBE checklist in reporting this study.

Patient or Public Contribution

No Patient or public contribution.

Strategies for Achieving Precision in Surgical Nursing Care—A Discursive Paper of a Project to Strengthen Person‐Centred Care, Teamwork and Professional Development

ABSTRACT

Aim

To provide an overview of a project aimed at enhancing person-centred surgical care through teamwork and professional development.

Design

A discursive paper with the purpose of describing and discussing the project activities to strengthen person-centred care, teamwork and professional development.

Methods

This project aimed to strengthen evidence-based surgical nursing care within a Surgery Department. The overarching goal was to foster an attractive and sustainable work environment for nursing professionals while simultaneously enhancing the quality of person-centred care, thereby improving patient outcomes and safety. Ultimately, the project aimed to position the department as a leading example of excellence in surgical nursing care, where evidence-based practice and person-centred values form the foundation of everyday work.

Results

The activities were guided by previous nursing evidence and aligned with Magnet Hospital standards. Continuous quality improvement efforts and team dialogue were central to achieving the goals. Leadership was provided by experienced nurses and researchers. The structured activities improved patient safety and care quality.

Conclusions

The project was successful as it enhanced precision in surgical nursing care by implementing structured activities focused on person-centred care, patient safety and professional development. These efforts led to improved quality of care and patient outcomes, demonstrating the effectiveness of evidence-based practices.

Impact and Implications for the Profession

A project with similar activities to those described in this paper can ensure that surgical patients receive high precision nursing care and serve as an example of promoting person-centred surgical nursing.

Reporting Method

None.

Patient or Public Contribution

None.

Phase II multicentre double-blind randomised controlled trial of a Bivalent VaccInation against Salmonella Typhi and Paratyphi A (BiVISTA) using a controlled human infection model of paratyphoid A infection: study protocol

Por: Paganotti Vicentine · M. · McCann · N. · Hennigan · O. · Maria · N. · Juarez Molina · C. I. · Koleva · S. · Islam · M. K. · Jones · E. · Flaxman · A. · Day · N. · MacDonald · A. · Adnan · M. · Singh · N. · Vernon · S. · Wilson · E. · Potey · A. V. · Dharmadhikari · A. · Gaidhane · S. · Kul
Introduction

Enteric fever, primarily caused by Salmonella enterica Typhi and Salmonella enterica Paratyphi A (SPA), is endemic mainly in South Asia, disproportionately affecting school-age children. Although typhoid conjugate vaccines (TCVs) are effective and implemented in many countries, no licensed vaccine exists against paratyphoid A. Bivalent vaccines targeting both S. Typhi and SPA may address this gap. Although field efficacy trials are not considered feasible, controlled human infection models (CHIMs) offer an alternative pathway for evaluating vaccine efficacy. This will be the first efficacy study of a bivalent vaccine against typhoid and paratyphoid A using a paratyphoid CHIM.

Methods and analysis

This is a phase II multicentre, double-blind, randomised controlled trial assessing the efficacy and immunogenicity of a bivalent conjugate vaccine candidate, Serum Institute of India Typhoid Conjugate Vaccine (Bivalent) (SII-TCV(B)), against SPA using a CHIM in healthy UK adults aged 18–55 years. A total of 192 participants will be randomised 1:1 to receive either SII-TCV(B) or a licensed Vi-polysaccharide typhoid vaccine (Vi-PS). All participants will be orally challenged with S. Paratyphi A (strain NVGH308) 28 days postvaccination. Participants will be monitored closely for 14 days and treated at 14 days postchallenge or promptly on diagnosis, according to prespecified criteria. The primary objective is to evaluate vaccine efficacy of SII-TCV(B) against paratyphoid infection using a CHIM. The coprimary immunogenicity objective is to assess non-inferiority of the typhoid IgG response compared with a licensed Vi-PS control.

Ethics and dissemination

The study has received ethical approval from the Berkshire Research Ethics Committee (24/SC/0309) and regulatory approval from the UK Medicines and Healthcare products Regulatory Agency. Results will be disseminated via peer-reviewed publications and scientific meetings.

Trial registration number

ISRCTN65855590.

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