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To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery.
Mixed-methods study describing the development of a patient decision aid.
A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids.
Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group’s research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis.
We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid’s acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional).
Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.
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.To investigate the association between quantitative retinal vascular parameters and coronary artery disease (CAD) and to evaluate the efficacy of a retinal phenotype-based diagnostic model as a non-invasive tool for early CAD screening.
A retrospective cross-sectional study.
A single-centre study conducted at the Cardiovascular Center of Beijing Tongren Hospital, Capital Medical University, China, between January and October 2024.
417 patients with suspected angina undergoing their first coronary angiography (CAG) were enrolled. Inclusion criteria were age >18 years and high-quality fundus photography within 24 hours pre-CAG. Major exclusions were prior coronary interventions, severe systemic/valvular heart diseases and ocular conditions impairing retinal vascular visualisation.
The primary outcome was the association between quantitative retinal vascular parameters and the presence of CAD (defined as ≥50% stenosis). Secondary outcomes included the diagnostic performance area under the receiver operating characteristic curve (AUROC) of three predictive models: one based on quantitative retinal vascular parameters alone, one based on traditional risk factors and a combined model integrating both retinal and clinical variables.
This study enrolled 417 patients undergoing initial CAG. Compared with non-CAD controls (n=190), patients with CAD (n=227) had higher prevalence of hypertension, dyslipidaemia and diabetes, along with elevated levels of fasting blood glucose, lipoprotein(a) (Lp(a)), triglyceride (TG) and glycated haemoglobin (HbA1c) (all p
Our findings, derived from an artificial intelligence-based fully automated quantitative retinal vascular parameters measurement method, revealed that multiple quantitative fundus parameters—including FD, VD and other morphological parameters were significantly associated with CAD risk. The CAD diagnostic model we developed demonstrates strong performance and high interpretability, making it suitable for early CAD screening and diagnosis.
Video-assisted thoracoscopic surgery (VATS) lobectomy is a commonly employed surgical technique for the management of operable early stage non-small cell lung cancer (NSCLC). This procedure, however, is dependent on the patient’s ability to tolerate surgery. In light of this, stereotactic ablative radiotherapy (SABR) has emerged as a viable alternative treatment strategy for patients who are inoperable or who refuse surgery. Considering the lack of randomised controlled trials and the increased risk of bias in observational cohort studies, this study protocol proposes an emulated target trial design to investigate the causal effect of SABR, in comparison to VATS, on overall survival in operable early stage NSCLC patients.
Data on NSCLC patients will be collected from routinely collected university hospital records linked with German cancer registry data. This study protocol was developed using the target trial methodology outlined by Hernan et al. The protocol establishes specific parameters for key trial components in order to mitigate bias in the analysis of observational data and to facilitate the calculation of causal estimands. The target trial design that would be emulated is a multicentre open-label two-parallel arm superiority randomised trial. Mediators and confounding variables were determined through the use of a directed acyclic graph. The statistical analysis aims to measure the per-protocol and intention to treat effect of SABR versus VATS within 3 months of diagnosis, on survival, through the difference in restricted mean survival times, using weighted non-parametric Kaplan-Meier curves.
The Ethics Committee of the Medical Faculty of Martin Luther University Halle-Wittenberg with an approved addendum with Dnr 2023–112 has approved this study. The study uses anonymised routinely collected hospital and cancer registry data in accordance with applicable data protection regulations. Results will be disseminated through peer-reviewed publications and presentations at scientific conferences.
To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion.
An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022).
Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression.
Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables.
There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision.
Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety.
This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain.
This study adheres to the STROBE guidelines for reporting observational studies.
In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.
To explore public health nurses' experiences of child maltreatment preventive work in primary healthcare.
The metasynthesis approach was based on the guidelines by Sandelowski and Barroso for synthesising qualitative research.
The quality of the included studies was appraised using Joanna Briggs Institute Checklist for Qualitative Research. The analysis followed Braun and Clarke's reflexive thematic analysis.
Searches were conducted in five electronic databases: Cinahl, Medline, PsychINFO, Web of Science and SocINDEX in May and July 2024, and updated in April and December 2025.
Thirteen qualitative studies were included, and five themes were developed: Insufficient knowledge about when and how to act, building a therapeutic relationship with parents, keeping the child's best interest in focus, in need of better interdisciplinary support and ambivalence in addressing child maltreatment.
Public health nurses face challenges in child maltreatment preventive work, including insufficient knowledge and limited interdisciplinary support. Even so, public health nurses demonstrate a strong commitment to children's safety and well-being and to building relations with families.
The findings suggest an increased focus on strengthening public health nurses' knowledge of child maltreatment and improved interdisciplinary collaboration.
The findings are of interest to healthcare professionals and health authorities to improve child maltreatment preventive work in primary healthcare.
This review adhered to relevant EQUATOR guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO registration number: CRD42025637855.
Commentary on: Taylor J, Hall R, Heathcote C, et al (2024). Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)Archives of Disease in Childhood Published Online First: 09 April 2024. doi: 10.1136/archdischild-2023–3 26 499
Implications for practice and research Clinicians should exercise caution when following clinical guidelines for managing gender dysphoria in youth due to concerns about methodological issues and evidence quality. Research on long-term outcomes of interventions is urgently needed to inform robust and transparent guidelines, incorporating input from gender diverse youth and families.
The visibility and acceptance of transgender identities have increased, leading to more young individuals questioning their gender or identifying as transgender.
This study aimed to explore the process of moral resilience among frontline healthcare professionals. By delving into experiences of handling moral challenges during a pandemic crisis, we aimed to understand dimensions of moral resilience, affecting factors and consequences. This understanding can inform the implementation of interventions to support healthcare professionals’ well-being and ability to deliver high-quality care, under both routine and extreme conditions.
A qualitative exploratory study was conducted using grounded theory methodology. Data were collected retrospectively through written narratives and individual interviews (September to November 2020).
General hospital wards allocated for patients with COVID-19 in two Swedish healthcare regions.
46 informants, comprising registered nurses, nursing assistants, physicians, managers and allied health professionals.
A conceptual model is presented that describes and explains the process of moral resilience among frontline healthcare professionals working in general hospital wards during a pandemic crisis. The model reveals a complex and dynamic iterative process, with components at both the individual and system levels being inevitably inter-related.
The findings emphasise that moral resilience within healthcare organisations is not solely dependent on individual qualities but also influenced by the working groups or teams, leadership and prevailing organisational structures. Supportive interventions should target workgroup dynamics and organisational culture while providing tailored support for individuals.
To explore the meaning of lived experiences of women with a hereditary risk of breast cancer who participate in surveillance of their breasts with magnetic resonance imaging.
Hermeneutic phenomenology.
Interviews on two occasions were made with 14 women in the surveillance programme. The verbatim transcripts were analysed according to van Manen. The analysis was an insightful iterative process and provided a sensitive understanding of the meaning of lived experiences.
Women's lived experiences were that surveillance was constantly present in their lives. Their experiences implied ‘needing to put on a mantle’, ‘not wanting to go through this alone’ and ‘wanting to keep their breasts’. The women created an invisible mantle that they put on when necessary to protect themselves. They wished to be open about their experiences and longed to be truly listened to. The women needed confirmation that they had the ethical right to their values and the choice they had made to participate in the programme. They were aware of the consequences of their decision, but they valued their breasts as a part of their identity and wanted to keep their breasts to remain who they were.
The understanding of the meaning of lived experiences of women in surveillance is vital for the development of person-centred care practice. Person-centredness should be integrated in the surveillance programme guidelines.
The study provides an understanding of the meaning of surveillance from the perspective of women. The evidence that women want to keep their breasts to preserve themselves as a person questions the norm of prioritising the bio-medical perspective in women's care.
COREQ.
No patient or public contribution.
Ovarian cancer patients often experience persistent symptoms such as fatigue and pain, impacting their quality of life. Current follow-up care, focused primarily on recurrence detection, may not adequately address these symptoms and can be burdensome. This study evaluates the feasibility of remote monitoring using patient-reported outcome measures (PROMs) and measurements of weight and abdominal circumference as an alternative to standard hospital visits. We aim to assess feasibility (ie, usability and satisfaction) of this approach and identify implementation barriers and facilitators.
This study is a single-centre longitudinal observational pilot that uses both qualitative and quantitative data to evaluate the feasibility of an innovative remote monitoring system for ovarian cancer follow-up care (Controle op Afstand, CopA). It is accessible to both healthcare professionals in the electronic health record and patients through the patient portal. Instead of 3-monthly in-hospital visits, patients are invited to complete regular surveys assessing PROMS about symptoms and quality of life and home measurements of weight and abdominal circumference. Feasibility will be assessed by (1) analysing patient and healthcare professional (HCP) experiences with CopA with the Measurement Instrument for Determinants of Innovations questionnaire for HCPs, and the ‘Experienced Usability and Satisfaction with Self-monitoring in the Home Setting’ questionnaire for patients, (2) investigating implementation barriers and facilitators using qualitative method and (3) performing a process evaluation of the intervention, assessing components such as reach, fidelity and compliance, time to response and number of (tele)consultations during the study period. Quantitative data will be analysed using descriptive statistics. Qualitative data will be analysed using thematic analysis.
This study was reviewed by the Ethics Committee of the Amsterdam University Medical Centre (METC 2022.0256) and exempted it from further review as this study was not subject to the Dutch Medical Research Involving Human Subject Act. Results will be disseminated via peer-reviewed open-access publications, scientific conferences and targeted communication to patient organisations, healthcare providers and the wider public.
To analyse the current status of psychological resilience in Parkinson's disease (PD) patients and its correlation with social support and coping style.
A cross-sectional study.
PD patients hospitalized in a tertiary-level hospital in Shijiazhuang, Hebei Province, from March 2022 to March 2023 were selected for the study using the convenience sampling method. A general information questionnaire, psychological resilience scale, Medical Coping Modes Questionnaire and Perceived Social Support Scale were used to investigate 111 cases of PD. SPSS 25.0 software was used for statistical analysis. The data were analysed using independent samples t-test, one-way ANOVA, multiple linear regression analysis and the Pearson correlation coefficient.
Parkinson's disease patients have a moderate level of psychological resilience. The results of the Pearson correlation analyses showed that the level of psychological resilience was positively correlated with social support and confrontation and was negatively correlated with avoidance and acceptance-resignation. The results of multiple linear regression analysis showed that social support and acceptance-resignation were the influencing factors of psychological resilience in PD patients.
The psychological resilience of PD patients is at a moderate level. Social support and acceptance-resignation are the factors influencing the psychological resilience of PD patients.
This study analysed the level of psychological resilience in PD patients and its correlation with social support and coping style from the perspective of positive psychology to provide some reference for targeted clinical interventions. Our study found that social support and acceptance-resignation are influential factors in psychological resilience in PD patients. Medical staff should encourage patients to face the disease positively and their social support should be increased in order to improve their level of psychological resilience.
No patient or public contribution.
To evaluate the impact of game-based teaching on undergraduate nursing students' learning satisfaction, clinical thinking, clinical skills, and anxiety.
Systematic review and meta-analysis.
China National Knowledge Infrastructure, Wanfang, Weipu, SinoMed, CINAHL, PubMed, Web of Science, Cochrane Library, and Embase. Our systematic literature search was conducted up to 31 October 2024 and included all studies published before this date, with no restrictions on publication year.
The study quality was appraised using version 1 of the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tools for Quasi-Experimental Studies. A meta-analysis was performed using STATA version 12.
1712 undergraduate nursing students from 19 studies were included. Meta-analysis showed that game-based teaching improved undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. Game-based teaching did not significantly enhance undergraduate nursing students' problem-solving skills.
Our research findings indicated that game-based teaching had more significant potential to enhance undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. However, game-based teaching did not show a substantial advantage in improving problem-solving skills compared to other teaching methods. Limited studies of the effects of game-based teaching on clinical reasoning and anxiety in nursing students cannot be meta-analysed. Future studies could improve how game-based learning is designed to support undergraduate nursing students' development of these competencies.
This study explores the effects of game-based teaching in nursing education and finds that it promotes learning satisfaction, critical thinking, clinical decision-making, and clinical skills in undergraduate nursing students, while having no significant effect on problem-solving skills. Game-based teaching can be a functional pedagogical approach to guide nursing educators to improve learning outcomes for undergraduate nursing students.
Inapplicable.
This study investigates the impact of the hospital environment on nurse job productivity in the post-pandemic era, with a focus on the moderating role of occupational calling, based on the person-environment-occupation-productivity (PEOP) theory.
A mixed-methods approach was employed, combining two-stage quantitative surveys and qualitative interviews.
In April 2022, 230 nurses from 11 Chinese public hospitals participated in a two-stage quantitative survey. Additionally, qualitative interviews were conducted with 10 nurses and 2 physicians. Quantitative data were analysed using partial least squares structural equation modelling (PLS-SEM), while qualitative data were analysed through Colaizzi's method to identify themes. To ensure the validity and reliability of the mixed-methods design, the study adhered to the Mixed Methods Appraisal Tool (MMAT) guidelines. Both sets of data were used to evaluate the relationships between hospital environments, job productivity, and occupational calling.
The study found significant correlations between the hospital's indoor, spatial and sanitary environments and nurses' job productivity. Additionally, the research revealed that occupational calling moderates the relationship between indoor and spatial environments and job productivity to varying extents. However, occupational calling does not significantly moderate the impact of the sanitary environment on job productivity.
This study provides insights into the transformative effects on hospital environments in the post-pandemic era, emphasising the importance of combining personal intrinsic and environmental extrinsic factors to boost nursing productivity. It proposes strategies for optimising hospital indoor, spatial, sanitary environments and enhancing nurses' occupational calling, providing practical, theoretical and educational insights to healthcare policymakers and practitioners.
There was no patient or public contribution in this study, as the focus was on nurses.
To explore why parents consent to or decline organ donation after their child's death and identify the factors that influence their decision-making.
Mixed-methods analysis of routinely collected quantitative and qualitative data from 594 cases in the United Kingdom between 2018 and 2024.
Quantitative analysis of clinical and demographic variables of potential donors, including regression analyses examining associations with parental consent. Qualitative content analysis and frequency counts of anonymised clinical notes of parental discussions and decision-making. Integration of quantitative and qualitative findings on similar phenomena of interest.
For each additional life-year of the child, the odds of parental consent increased by 6%; the odds of consent among white families were five times higher than those of non-white families; and the odds of consent for donation after brainstem death were 1.78 times higher than those for donation after circulatory death. Parental non-support was influenced by the perception that organ donation prolonged or altered end-of-life care, cultural and religious beliefs and the need for surgery. Factors facilitating consent included altruism, creating a positive legacy, and prior knowledge of organ donation. Parents fell into four decision groups: those who immediately consented, hesitated but consented, hesitated but declined and immediately declined.
This study provides new insights and theories about which parents are more likely to consent to paediatric organ donation. Findings highlight a range of factors that shape parental decisions and the need for approaches tailored to the varied concerns and complexities that parents face in navigating end-of-life care for their child. Developing specific support strategies that acknowledge contextual, religious and procedural concerns may enhance consent rates and facilitate a more bespoke family-centred approach to paediatric organ donation and palliative care. Other countries achieve better paediatric consent rates, suggesting there is potential to further improve policy and practice, underpinned by a programme of research.
What is already known: Internationally, there is a shortage of organs for paediatric transplants, and parental consent is the limiting factor in most high-income countries. Paediatric organ donation is unique from adults, and there is limited research into why parents consent to or decline organ donation for their child. What this paper adds: This analysis identified a range of interconnected factors that could positively or negatively influence parental consent decisions, with emotional, logistical, procedural and religious factors acting as critical barriers to consent. Additionally, parents were categorised into four decision-making groups that have distinct decision-making patterns and characteristics. Implications for practice and policy: These findings provide a foundation for better understanding why parents choose not to consent to organ donation for their child, which can begin to inform the development of policies and practices that better create the conditions for consent and a more family-centred approach in paediatric end-of-life care.
This study highlights critical factors predicting and shaping parental decisions and indicates a need for approaches tailored to the emotional and logistical complexities that parents face. Specific support strategies that acknowledge contextual, religious and procedural concerns may facilitate a more bespoke family-centred approach to paediatric end-of-life care and enhance organ donation consent rates.
What problem did the study address? Internationally, there is a shortage of organs available for children in need of transplants. Parental consent for paediatric organ donation is a limiting factor in most high-income countries. The emotive nature of a child's death makes paediatric organ donation complex and unique, and there is limited research on the factors influencing parental decision-making and the reasons parents choose to consent to or decline organ donation after their child's death. What were the main findings? We identified a range of interconnected factors that could positively or negatively influence parental consent decisions, with emotional, logistical, procedural and religious factors acting as critical barriers to consent. For the first time, parents have been categorised into four decision-making groups that have distinct decision-making patterns and characteristics. A novel and prevalent factor that negatively impacted consent was that organ donation prolonged or altered end-of-life care, often due to organ donation being raised after plans had been made for end-of-life care. This highlights the need for health systems to adopt proactive and timely approaches to integrating paediatric organ donation with care pathways. This study also identified that parents were 1.78 times more likely to consent to organ donation via a donation by brain death pathway compared to a donation by circulatory death pathway. Where and on whom will the research have an impact? This is the largest study of paediatric organ donation outside of the United States (where the healthcare system is predominantly for-profit and therefore a different model and context compared to the United Kingdom) and provides new insights and understandings that can assist Specialist Nurses in Organ Donation, clinical teams and palliative care specialists in tailoring their approach to end-of-life care to achieve the best consent outcome for each child, their parents and wider family. Findings provide a valuable foundation for the development of future research and developments in policy and practice in the United Kingdom and countries with similar health systems. Findings also include generalisable insights that can be utilised internationally, irrespective of the health system.
This study adhered to the Good Reporting of a Mixed-Methods Study (GRAMMS) reporting standards.
Patients or the public were not involved in this study.
This study investigates how observed workplace ostracism affects nurses' helping behaviour from a bystander's perspective, examining the mediating roles of moral courage and employee resilience to inform strategies for fostering workplace harmony in nursing settings.
A cross-sectional study design was adopted.
A survey of 346 nurses from two Grade III, Level A hospitals in Henan, China, utilised scales measuring workplace ostracism, moral courage, helping behaviour and employee resilience. SPSS Statistics 26.0, Mplus 8.3 and the SPSS macro program Process 4.1 plugin were used to test the associations among variables.
Observed workplace ostracism positively correlated with nurses' helping behaviour, with moral courage partially mediating this relationship. Employee resilience moderated both the link between observed workplace ostracism and moral courage, and the indirect effect of observed workplace ostracism on helping behaviour through moral courage.
Nurses with high levels of resilience demonstrate moral courage when observing workplace ostracism and engage in helping behaviours towards those ostracised.
This study examines how workplace ostracism undermines nursing team cohesion and individual well-being. It highlights that bolstering nurses' resilience and moral courage can alleviate these adverse effects, thereby improving patient care quality. Nursing managers are advised to adopt targeted strategies, such as resilience training, to mitigate workplace ostracism.
This study employs a questionnaire to explore nurses' views of workplace ostracism and helping behaviours, aiming to inform strategies for fostering nursing team harmony and improving care quality.
This study strictly follows the STROBE reporting guidelines to ensure the clarity and credibility of the research findings.
Data were collected from hospital nurses through electronic questionnaires.
To review the evidence on the experiences and perceptions of culturally and linguistically diverse informal carers supporting older adults during transitions from hospital to home, including their interactions with transitional care interventions.
Scoping review guided by Arksey and O'Malley's framework.
We searched CINAHL, MEDLINE, Embase, Emcare, AMED, PsycINFO, Global Health, Social Work Abstracts, JBI EBP, Scopus, Web of Science Core Collection, ProQuest and Informit for studies published between January 2010 and November 2024.
Two reviewers independently screened studies and extracted data. Analysis followed the Patterns, Advances, Gaps, Evidence for Practice and Research recommendations framework.
Seventeen studies involving 1275 carers were included. Carer experiences were summarised into four themes: (1) cultural and communication barriers; (2) role ambiguity and practical challenges; (3) limited involvement in discharge planning and (4) barriers to accessing support and services. Perceptions of transitional care interventions were mixed. While some interventions improved carer preparedness and reduced stress, most lacked cultural tailoring and did not address carers' psychosocial and communication needs.
Culturally and linguistically diverse informal carers face challenges navigating transitional care. While involving them in care planning improves outcomes, implementation remains inconsistent. Emotional support and culturally tailored services are insufficient.
There is a need for culturally and linguistically tailored transitional care programmes that prioritise carer education and communication support. Key areas for improvement include: (1) health literacy and system navigation; (2) involvement in care planning; (3) communication with providers; (4) psychosocial and emotional support and (5) culturally appropriate services. Future research should explore the unique emotional and psychosocial needs of these carers to inform targeted support strategies.
This review follows the PRISMA guideline for reporting.
No patient or public contribution.
Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.
To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer.
This was a methodological study.
Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test–retest reliability were also evaluated.
A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.
The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.
The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.
This manuscript followed the STROBE guidelines.
Patients with gynecologic cancer participated in this study and provided the data through the survey.
To consolidate the best evidence on digital therapeutic interventions for self-management in patients with hip fragility fractures, providing a foundational guide for clinicians in developing digital therapy-based self-management plans.
Integrative review.
A comprehensive electronic search was conducted across multiple databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Chinese databases like China National Knowledge Infrastructure and SinoMed. This study retrieved papers published from the establishment of the database to September 2023.
Studies were selected based on inclusion criteria, such as relevance to hip fragility fractures and self-management through digital therapies. Quality assessments were conducted independently by two reviewers using established tools for each type of study, ensuring the inclusion of high-quality evidence.
Fifteen studies were included: 4 guidelines, 5 expert consensus documents, 5 systematic reviews and 1 evidence summary. From these, 26 best practices were identified across 4 domains: digital design, self-management influencing factors, intervention plans and intervention content.
This integrative review provides a comprehensive, evidence-based summary of digital therapeutic interventions for self-management in patients with hip fragility fractures. The findings offer healthcare professionals a scientific basis for integrating digital therapy into clinical practice, highlighting its potential to enhance patient self-management.
This review underscores the value of digital therapies in empowering patients to take an active role in their rehabilitation, potentially improving adherence to self-management strategies and long-term outcomes.
No patient or public contribution was used for this study.
Limited male engagement in HIV prevention and care is a global challenge more pronounced in sub-Saharan Africa (SSA) contributing to ongoing transmission. However, peer network interventions show promise in improving engagement.
To map and synthesise evidence on peer network interventions for HIV prevention and care among men in SSA, with a focus on the types of strategies used, populations reached and how these interventions address cultural, social and structural barriers across the HIV care cascade.
Scoping review of peer-reviewed literature, conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
Community and facility-based HIV prevention and care settings across multiple countries in SSA.
Populations included men having sex with men, men in key occupational groups (fishermen, truck drivers), adolescents and young people, and men living with HIV. Studies not conducted in SSA, not peer-reviewed or not focused on male peer networks were excluded.
Peer network interventions included peer education, peer navigation, HIV self-testing (HIVST) distribution, adherence support groups, disclosure and stigma-reduction counselling, technology-enabled peer support (SMS and social media) and community-based antiretroviral therapy (ART) delivery. Intervention duration and intensity varied across studies.
Primary outcomes included HIV testing uptake, linkage to care, ART initiation, adherence, retention in care and viral suppression. Secondary outcomes included stigma reduction, disclosure and engagement among hard-to-reach male populations.
We conducted a review of literature published between November 2013 and November 2024, searching PubMed, Web of Science, Scopus and Cochrane databases. Studies were included if they examined peer network approaches in HIV prevention and care among men in SSA.
A total of 905 records were identified, of which 75 studies met the inclusion criteria. Peer network interventions were implemented across diverse SSA contexts and male populations. Strategies such as peer-led education, social diffusion models, HIVST distribution and technology-enabled peer support consistently improved HIV testing uptake, linkage to care, ART initiation and adherence. Contextually tailored interventions such as community-based outreach addressing occupational risk environments and economic vulnerabilities were particularly effective in engaging men traditionally underserved by facility-based services. However, challenges persisted, including variable linkage to care following HIVST and sensitivity to user costs.
Peer-led interventions in HIV care for men in SSA effectively address cultural, social and structural barriers, improving testing, ART adherence and viral suppression. Tailored, technology-enhanced and community-based approaches ensure equitable HIV prevention and treatment outcomes, despite challenges like linkage to care.
by Simon Söderholm, Martin Ulander, Vanessa William Toma, Sara Kaufmann, Xiangyu Qiao, Daniel Berglind, Susanna Calling, Bledar Daka, Ludger Grote, Mats Martinell, Frida Bergman, Pontus Henriksson, Carl-Johan Östgren, Wen Zhong, Claudio Cantù, Fredrik Iredahl
Coffee is the most common drink in the world, second only to water. This makes caffeine, the ingredient of coffee known for its wakefulness-promoting effects, one of the most used psychoactive substances. The psychoactive property of caffeine is well-characterized, and entails its interaction with the adenosine receptors, involved in sleep regulation. While studies have shown a deleterious immediate effect of caffeine on sleep, less is known about the effects of chronic caffeine exposure. In the present cross-sectional study, we investigated this relationship across a large cohort of 30,154 individuals participating in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), which allowed us to compare habitual coffee intake with sleep habits, subjective estimate of daytime sleepiness, and underlying genetic variants. According to our analyses, different degrees of coffee consumption, confirmed by statistical association with previously reported genetic variants, showed very low association with estimated patterns of sleep habits or perceived daytime sleepiness. These results indicate that coffee may be less impactful on sleep habits than previously thought, or that other mechanisms, such as the adaptive capabilities of the adenosine system in adult coffee users, may dampen its psychoactive potency.
FreshRSS 