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To explore how parents perceive health care encounters related to their child's higher weight and to interpret these experiences within the broader societal context shaped by cultural norms and representations.
A qualitative design was employed using semi-structured interviews to capture parents' experiences. The study was informed by a conceptual framework that views weight as both a personal and socially constructed phenomenon.
Eighteen parents from Finland were interviewed between May 2022 and June 2023. The data were analysed using reflexive thematic analysis to identify key themes in parents' experiences and perceptions.
Three main themes were identified. The relational dimension highlighted the importance of individualised care, where health care professionals take time to get to know the family and recognise each member as an individual. The emotional dimension emphasised the need to protect the child, strengthen parental self-efficacy and provide sensitive, skilled support that fosters a sense of safety. The practical dimension focused on the need for active and targeted care, including structured weight-related routines, multidisciplinary collaboration and services that respond to the everyday realities of families.
The study highlights the need for health care encounters that are individualised, emotionally safe and sensitive to the diverse realities of families. Moving beyond weight-centric approaches, care should offer a range of supportive options that reflect parents' varied expectations, concerns and needs.
This study responds to the need for a deeper understanding of how parents experience health care encounters related to their children's higher weight. The findings highlight the importance of designing care interactions that provide professionals with adequate time, expertise and training to deliver individualised, stigma-sensitive care.
COREQ.
No patient or public contribution.
by Alyssa Howren, Quan L. Tran, Sadaf Sediqi, Saadiya Hawa, Douglas K. Owens, Eleni Linos, Titilola O. Falasinnu, Yashaar Chaichian, Julia F. Simard
BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune rheumatic disease whose epidemiology and clinical prognosis vary by race and sex. Observed disparities in SLE may be partly attributable to cognitive processes in clinical decision-making, which can influence diagnostic accuracy and clinical management. We aimed to examine variation in primary care physicians’ (PCP) diagnosis and management of SLE when all content of a clinical case is identical, apart from race and sex.
MethodsWe distributed an online randomized factorial survey from 04/11/2024–06/10/2024 to PCPs across the US. Participants were presented with one of four possible SLE vignettes – Black female, White female, Black male, White male – for which all other clinical content was identical. Block randomization was used to randomly modify the race (Black/White) and sex (female/male) of the SLE “case”. Primary outcomes were correct text-based responses for SLE diagnosis at initial case presentation and after reviewing additional lab results. Secondary outcomes were participants’ review time and planned next steps (treatment, referral, tests) as a proxy for cognitive bias and certainty, respectively. We calculated descriptive statistics for all outcomes stratified by assigned randomized factor and used chi-square tests to evaluate between-group differences.
Results1031 PCPs (42.7% women, mean age 52.1 ± 12.1 years) completed the case. At initial presentation, 63.9% of participants correctly identified SLE as a differential diagnosis. An initial diagnosis of SLE significantly differed by the race and sex of the case (p Conclusion
A patient’s race and sex may influence diagnostic accuracy and clinical decision-making for SLE in primary care. The observed variation in diagnostic accuracy, which aligns with the descriptive epidemiology of SLE, highlights the need for targeted interventions to ensure equitable diagnostic processes.
More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking.
The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients.
The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals.
To analyse predictors of burnout in nursing professionals during and after the COVID-19 pandemic.
Cohort study.
A two-phase study conducted during the COVID-19 pandemic's peak (2020) and post-vaccination period (2022). Data from nursing professionals of four hospitals in southern Brazil included sociodemographic, occupational, lifestyle, and health variables, and Maslach Burnout Inventory responses. Multivariate logistic and linear regression analyses were used to identify independent predictors of burnout syndrome. The study was approved by the Research Ethics Committee (approval no. 4.152.027).
A sample of 163 participants were assessed at two distinct time points. In 2020, 9.2% of nursing professionals experienced burnout syndrome, decreasing slightly to 7.4% in 2022. As for the burnout dimensions, emotional exhaustion was reported by 27% of professionals in 2020 and 26.4% in 2022. Depersonalisation affected 28.2% during the pandemic and 25.2% afterward. Low professional accomplishment was identified in 29.4% of professionals in 2020, increasing to 30.1% in 2022. Distinct predictors were identified for overall burnout and its specific dimensions. The main predictors included: perceiving a mental health impact from the pandemic, previous mental health issues, recent medical leave, and working directly with COVID-19 patients.
Burnout syndrome remained stable post-pandemic. Key predictors were identified, highlighting the need for preventive mental health interventions.
Identifying predictors of burnout in nursing professionals supports the development of targeted interventions to protect mental health, improve job satisfaction, and enhance the quality of patient care during and after health crises.
This study fills a gap in post-pandemic research by identifying predictors of burnout in nursing professionals. It supports the development of policies and interventions to protect mental health and improve working conditions in Brazilian hospitals.
STROBE guidelines for cohort studies.
Participants contributed only through data collection.
The term ‘culture of care’ began to be used following the Francis Report in the UK in 2013. This concept involves three dimensions: personal care, leadership care and co-worker care. Personal care focuses on employees’ attitudes and behaviours. Co-worker care relates to a sense of community, and leadership care relates to how employees perceive leaders and managers as caring individuals dedicated to ensuring the well-being of others. Previous studies investigating culture assessment tools used in the healthcare system reported that although organisations are increasingly using culture assessment instruments, there is a focus on assessing safety and quality cultures rather than on caring perspectives. This scoping review aims to map existing studies related to the assessment of culture of care.
This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The search strategy will include four indexed databases (PubMed, EMBASE, Cochrane Library and Latin American and Caribbean Literature in Health Sciences) and additional sources not retrieved with the adopted search strategy. The search strategy will be constructed using the controlled vocabulary in Health Sciences Descriptors, Medical Subject Headings and Emtree. Relevant articles in all languages, without restrictions related to date of publication, will be considered eligible for inclusion. Two independent researchers will select articles based on the inclusion criteria, and a third author will be consulted to establish consensus, if necessary. Data extraction will involve a form with information on the study characteristics, methodological issues and main results from the evidence sources. The extracted data will be analysed using descriptive and content analysis.
Ethics approval is not required, as this review will use data from publicly available bibliographic sources. The results will be disseminated through publications in scientific journals and presentation of the evidence to interested parties.
The protocol was registered in the Open Science Framework (DOI: 10.17605/OSF.IO/U9Q53).
For large primary spontaneous pneumothorax (PSP), drainage or simple aspiration are the two first-line treatment options. Outpatient ambulatory strategies have a success rate of almost 80% with few complications. New French recommendations suggest that an outpatient strategy should be preferred if an appropriate care network is in place. However, establishing this care network remains the main obstacle to the use of this strategy. Thus, outpatient management of PSP remains rare, which is neither optimal for the patient, with a likely impact on quality of life (QOL) and satisfaction with care, nor for the healthcare system, with increased costs. We hypothesise that outpatient treatment of PSP compared with usual inpatient management could improve quality of care and represent a more efficient, generalisable and sustainable strategy.
In this multicentre, cluster-controlled, randomised interventional study with stepped wedge implementation, patients aged 18–50 presenting to the emergency department (ED) with a first episode of large PSP will be enrolled in seven university hospitals in France. The main objective of this study is to evaluate the impact on changes in QOL of an ambulatory strategy for the management of large PSP in the ED compared with usual inpatient management. The primary outcome is the difference in QOL as measured by SF-36 score, between drain placement and 6 months. Clinical criteria (pulmonary expansion at 6 days, pain, dyspnoea, complications, recurrence), perceived quality of care (satisfaction, patient preference, anxiety) and ease of implementation of the care pathway will also be assessed. A cost-utility analysis will be carried out to evaluate the incremental cost-utility ratio at 1 year, defined as the difference in costs divided by the difference in utility estimated by the EQ-5D scores.
Ethics approval has been obtained by the Comité de Protection des Personnes Nord Ouest III N° 2024-36. Study findings will be disseminated by publication in a high-impact international journal. Results will be presented at national and international emergency healthcare meetings, and participating patients notified of the main conclusions.
This trial is registered with Clinical Trials Registry NCT06471608. The trial protocol and statistical design are fully described in this study protocol. Additional data can be provided on reasonable request to the sponsor. Protocol version: V2.1 - 21/11/2024.
To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic.
An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software.
Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile.
Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures.
Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development).
There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations.
This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies.
We have adhered to the SRQR reporting guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
A key part of the patient safety system is how it responds to and learns from safety incidents. To date, there is limited research on understanding system-based approaches to investigating incidents that occur within this complex interacting system.
The aims of this study were to qualitatively explore mental health professionals’ perceptions of patient safety incident investigations; to understand the impact of the transition to systems-based approaches and to explore the influence of different elements of the system on the goals of patient safety.
The qualitative study involved 19 semi-structured interviews with professionals working within the patient safety system across two mental health National Health Service trusts. The data were analysed using thematic analysis.
Those interviewed identified that a change in approach to incident investigation, from root cause analysis to systems-based, would lead to rigorous investigations that are effectively linked to learning. Over time, this was described as a contributory factor to reducing feelings of blame and positively influencing safety culture. There were considerations of potential negative effects from a systems-based approach, such as the shifting rather than elimination of blame, and the possibility of missing individual poor practice. The findings identify the presence of several interdependencies across the system that could have a positive or negative influence on the outcomes of incident responses.
This study demonstrates that the interdependencies within the system and our limited understanding of safety in mental healthcare introduces complexity and uncertainty to incident investigation outcomes. This is likely to impact on safety incident responses and learning, where acknowledging and evaluating this complexity is likely to reduce any potential negative outcomes that exist.
Photobiomodulation therapy (PBMT), particularly when combined with a static magnetic field (PBMT-sMF), is a promising non-pharmacological approach for managing musculoskeletal disorders. However, high-quality evidence for its efficacy in lateral epicondylitis remains limited.
The study aims to investigate the effectiveness of PBMT-sMF vs placebo in reducing pain, improving function and modulating inflammatory markers in individuals with lateral epicondylitis.
Multicentre, randomised, triple-blinded, placebo-controlled trial.
Three outpatient physiotherapy clinics in Brazil.
50 adults (18–50 years) with unilateral lateral epicondylitis and baseline pain ≥50 on the visual analogue scale (VAS).
Participants received either active PBMT-sMF (n=25) or placebo (n=25), 2 times per week for 3 weeks. PBMT-sMF involved multi-wavelength irradiation at 4 epicondyle sites (60 s; 27.1 J/site). The placebo group underwent the same procedure without active irradiation.
The primary outcome was degree of pain rating (VAS). Secondary outcomes included forearm disability (Patient-Rated Tennis Elbow Evaluation, PRTEE), grip strength, serum tumour necrosis factor-alpha (TNF-α) levels and treatment satisfaction. Assessments were conducted at baseline, post-treatment (3 weeks) and at 4-week follow-up.
PBMT-sMF yielded a higher responder rate (defined as the proportion of participants achieving at least a 30% reduction in pain intensity relative to baseline) than placebo (72% vs 40%, p=0.045), with a clinically and statistically significant between-group difference. Compared with placebo, the PBMT-sMF group showed significantly greater reductions in pain intensity both at the end of treatment (51.4±19.8 vs 36.9±22.6; p=0.0223) and at follow-up (37.4±24.1 vs 20.3±21.2; p=0.0049). TNF-α levels also decreased significantly in the PBMT-sMF group compared with placebo at both time points (p
PBMT-sMF significantly reduced pain intensity and TNF-α levels, suggesting an anti-inflammatory mechanism. Although functional outcomes were not improved, PBMT-sMF may be a valuable short-term, non-invasive option for lateral epicondylitis pain management.
NCT04829734 on ClinicalTrials.gov
Sickle cell disease (SCD) is due to the mutation of haemoglobin (Hb), from HbA to HbS and characterised by recurrent vaso-occlusive crises (VOC), which can progress to acute chest syndrome (ACS), a leading cause of death in adults with SCD. Hypoxia is a key modifiable factor in the polymerisation of HbS and the pathogenesis of VOC. High-flow nasal oxygen (HFNO) delivers humidified gas at high oxygen concentrations and flow rates: the former may reverse sickling (metabolic effect) to accelerate VOC resolution and prevent ACS, while the latter may reduce the risk of ACS by mitigating hypercapnia and generating positive airway pressure that limits hypoventilation and atelectasis (pulmonary effect). The study hypothesises that HFNO is a safe and effective strategy for treating VOC and preventing secondary ACS, and will assess this using a multi-arm multi-stage (MAMS) trial design.
This is a prospective, multicentre, randomised, open-label controlled trial following an MAMS design with three phases and four arms: one control (low-flow oxygen) and three HFNO intervention arms with varying fraction of inspired oxygen levels (low, intermediate, high). The pilot stage will assess safety and feasibility, using the rate of cardiac and neurological events as the primary endpoint. In the activity stage, arms demonstrating acceptable safety will be compared for efficacy based on the rate of VOC resolution without complications by day 5, allowing selection of the most promising arm. The final efficacy stage will compare the selected HFNO strategy to control, with prevention of secondary ACS by day 14 as the primary endpoint. The study aims to enrol up to 350 VOC episodes in total.
The study has been granted ethical approval (CPP SUD MEDITERRANEE IV). Following the provision of informed consent, patients will be included in the study. The results will be submitted for publication in peer-reviewed journals.
En este relato biográfico se abordó la experiencia de un paciente joven, que un accidente laboral sufre un traumatismo ocular que le provoca la perforación del globo ocular y que tiene como consecuencia la evisceración del mismo (la extracción del contenido intraocular y la sustitución por una prótesis). El objetivo de este trabajo fue realizar una entrevista profunda en la que se pudiera conocer a fondo la experiencia traumática por la que pasó un paciente joven, en edad laboral, para el que dicha situación provocó un cambio vital sustancial. De la misma forma, se trata de una situación también frustrante para el profesional que lo realiza puesto que se lleva a cabo cuando no hay ninguna posibilidad de restauración de la función visual.
Objetivo: Conocer la eficacia del tratamiento de personas con conducta hetero agresiva en los servicios de urgencias en comparación con los servicios de salud comunitarios. Método: Revisión sistemática de estudios en bases de datos: LILACS, Psychinfo, Scopus, Web de Ciencia, PUBMED y literatura gris en Google Scholar y en la lista de referencias. La búsqueda se realizó en junio de 2016. Dos mil ciento sesenta estudios fueron encontrados y seis de estos estudios fueron seleccionados para su análisis después de la aplicación de los criterios de exclusión. Resultados: El acercamiento a individuos con comportamiento agitado, agresivo o violento ocurre con mayor frecuencia en servicios de emergencia general y psiquiátrica con intervención médica. Los medicamentos utilizados para controlar la agitación y la sedación fueron benzodiazepina (midazolam, lorazepam), antihistamínico (prometazina), antipsicóticos típicos (haloperidol y droperidol) y antipsicóticos atípicos (olanzapina, ziprasidona, risperidona y quetiapina). Conclusión: Todos los fármacos evaluados promueven la sedación, pero esta revisión muestra ventajas en el uso de la combinación de haloperidol más prometazina.
Objetivo principal: identificar las producciones científicas sobre manejo de residuos procedentes de los servicios de salud (RSS) por el equipo de salud en unidades hospitalarias, y analizarlas a la luz de las buenas prácticas. Metodología: revisión integrativa con búsqueda en las bases LILACS, WEB OF SCIENCE, BDENF, MEDLINE / PUBMED. Criterios de inclusión: estudios realizados en unidades hospitalarias y que aborden la gestión en ese contexto. Resultados principales: se seleccionaron 24 publicaciones para representar la muestra de la encuesta. Gran parte de los profesionales no realizan la práctica de segregación y manejo correctamente. La falta de conocimiento de los profesionales es un factor agravante. Conclusión principal: es de extrema importancia la capacitación de los profesionales acerca del manejo adecuado y mayor inversión del gobierno para mejoras en la implantación de regulaciones y fiscalización para la gestión de RSS.
Objetivos: determinar los indicadores de morbilidad de la tuberculosis en una ciudad del nordeste brasileño prioritaria para el control de la enfermedad y describir características sociodemográficas y clínicas-epidemiológicas de los casos notificados. Método: se trata de un estudio epidemiológico descriptivo con enfoque cuantitativo, considerando todos los casos notificados mediante el Sistema Nacional de Información y Agravios de Notificación en 2015 y expresando los coeficientes de incidencia y prevalencia. Las variables relacionadas con la caracterización sociodemográfica tales como género, edad, raza/color, nivel de educación y zona de residencia, así como las de investigación clínica-epidemiológica, tipo de ingreso, forma clínica, realización de baciloscopía, cultivo, realización de tratamiento supervisado y desenlace de tratamiento fueron analizadas por medio de la estadística descriptiva. Resultados: las tasas de prevalencia e incidencia fueron respectivamente 26,0 y 24,5 casos/100.000 habitantes, donde la mayoría de los casos notificados pertenecían a la zona urbana (98,48%), haciendo hincapié en hombres (68,18%), con edades ≤ 40 años (60%), raza/color pardo (78,79%) y con el predominio de la enseñanza primaria completa (34,85%). En lo que atañe a las características clínicas y epidemiológicas, la mayoría presentaba la forma clínica pulmonar (89,39%), resaltando la baciloscopía de esputo positivo (40,91%), cultivo de esputo no realizada (92,42%), rayos-x torácicos sospechosos para tuberculosis (54,55%), enfermedades y agravios – SIDA (10,61%), y la situación de desenlace predominante fue la cura (86,36%). Conclusiones: a pesar del panorama epidemiológico evidenciado con indicadores de morbilidad por debajo del promedio nacional, la identificación del perfil clínico-epidemiológico de la población afectada señaló aspectos importantes que deben ser observados relacionados con la organización de los sistemas y servicios sanitarios para el control y vigilancia de esta enfermedad.
FreshRSS 