Conectar
Cardiovascular diseases, overweight, type 2 diabetes and chronic kidney disease increase the risk of cardiovascular events.
Glucagon-like peptide-1 analogues are recommended by the European Society of Cardiology and the American College of Cardiology to lower the risk of death and progression of cardiovascular disease in patients with cardiovascular disease and type 2 diabetes. Semaglutide, tirzepatide and liraglutide are approved by the US Food and Drug Administration and the European Medicines Agency for the treatment of type 2 diabetes mellitus and overweight. CagriSema is currently not approved, but several phase III trials are ongoing.
No previous systematic review has investigated the effects of semaglutide, tirzepatide, CagriSema and liraglutide, which may not be disease-specific, on hard binary outcomes for all trial populations at increased risk of cardiovascular events.
We will conduct a systematic review and search major medical databases (Cochrane Central Register of Controlled Trials, Medical Literature Analysis and Retrieval System Online, Excerpta Medica database, Latin American and Caribbean Health Sciences Literature, Science Citation Index Expanded, Conference Proceedings Citation Index—Science) and clinical trial registries from their inception and onwards to identify relevant randomised trials. We expect to perform the literature search in December 2025. Two review authors will independently extract data and assess the risk of bias. We will include randomised trials assessing the effects of semaglutide, tirzepatide, CagriSema and/or liraglutide in participants with an increased risk of cardiovascular events. The primary outcome will be all-cause mortality. Secondary outcomes will be myocardial infarction, stroke and all-cause hospitalisation. Data will be synthesised by aggregate data meta-analyses, Trial Sequential Analyses and network meta-analysis, risk of bias will be assessed with Cochrane Risk of Bias tool V. 2, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations and the Confidence in Network Meta-Analysis approach.
This protocol does not present any results. Findings of this systematic review will be published in international peer-reviewed scientific journals.
CRD42024623312.
To characterise and analyse doctoral programmes in nursing in Latin America through an exhaustive review of the official websites of the universities.
Descriptive and multiple correspondence analysis. Existing programmes were mapped out, identifying their geographic distribution and curricular characteristics.
A review of 59 doctoral programmes in nursing was conducted through the official web portals of universities in Latin America that were currently available (as of 2025) and that provided the required information. Thereafter, a matrix was built in Excel to consolidate the data.
The study identified an increase in the number of doctoral programmes in nursing offered in Latin America. Furthermore, these programmes were found to be more strongly concentrated in countries such as Brazil, Peru and Mexico, while other countries, including Guatemala and Uruguay, have recently incorporated such training.
Doctoral education in nursing in Latin America has experienced significant growth in recent years, consolidating itself as a fundamental pillar for the development of the discipline and the generation of knowledge in health. However, structural challenges persist, including limited funding for research, a lack of cooperation between universities, and the absence of programmes focused on Advanced Nursing Practice.
This contribution helps identify trends in the offering of doctoral programmes and inequalities in their geographic distribution, allowing for an understanding of how training varies across countries in the region while also consolidating Nursing as an academic and professional discipline.
Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.
To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.
A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.
Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.
Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.
To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.
by Andy Domínguez-Monterroza, Alfonso Mateos Caballero, Antonio Jiménez-Martín
Heart rate variability (HRV) is a well-established marker of autonomic regulation and undergoes profound maturation during early human development. In this study, topological data analysis (TDA) is applied to investigate the evolving geometric complexity of HRV across pediatric developmental stages. Using persistent homology in homological dimension 1, we extracted topological descriptors from time-delay embedded RR interval series of 127 individuals aged 1 month to 17 years. We identified statistically significant, age-dependent transformations in the topological structure of HRV signals. Neonates and infants exhibited a greater number and strength of persistent features, reflecting highly heterogeneous cardiac control dynamics during early autonomic maturation. In contrast, adolescents displayed reduced topological complexity and increased entropy, suggesting a shift toward more uniform and structured physiological control. Topological measures correlated with conventional HRV indices, confirming their physiological relevance. Furthermore, pairwise distances between persistence landscapes revealed an inverse relationship between intra-group topological variability and classical HRV measures. Collectively, our findings demonstrate that persistent homology provides a powerful, multiscale-aware framework to capture developmental trajectories in cardiac autonomic regulation, with potential applications in pediatric monitoring, developmental physiology, and early detection of dysautonomia.by Yizhuo Gong, Xinmeng Wang, Mingkun Yu, Peipei Zu
PurposeTo precisely evaluate the independent influence of two different optical zone (OZ) sizes (6.3 mm vs. 6.5 mm) on corneal biomechanical properties within 6 months after Small Incision Lenticule Extraction (SMILE) using multivariable-adjusted statistical models.
MethodsThis retrospective study included myopic patients who underwent SMILE between 2022 and 2024. Patients were grouped into two groups based on the planned OZ: Group A (6.3 mm, 44 eyes) and Group B (6.5 mm, 54 eyes). Corneal biomechanical parameters were measured using the Corvis ST preoperatively and at 1, 3, and 6 months postoperatively. Linear Mixed Models (LMM) were used to assess the independent effect of OZ size, adjusting for key baseline covariates and accounting for inter-eye correlation by including a random intercept for patient identifier (ID).
ResultsA total of 98 eyes were analyzed. Baseline analysis revealed a significant imbalance between the groups, with Group A (6.3 mm OZ) having higher myopia and a greater corneal stromal ablation depth (both P 0.05), with the sole exception of Ambrosio Relational Thickness Horizontal (ARTH) (P = 0.012). In contrast, several preoperative covariates, particularly corneal stromal ablation depth and preoperative central corneal thickness, were identified as significant predictors of multiple postoperative biomechanical parameters.
ConclusionThe independent effect of a 0.2 mm difference in optical zone size on corneal biomechanical properties after SMILE appears to be limited. After comprehensive statistical adjustment, the results suggest that preoperative anatomical and surgical parameters, especially corneal stromal ablation depth, are the primary drivers of the postoperative biomechanical response, rather than the minor difference in OZ size itself. This study underscores the importance of confounder adjustment in refractive surgery research and suggests that maximizing the residual stromal bed may be more critical for maintaining corneal biomechanical integrity than fine-tuning the optical zone diameter.
Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, inflammatory bowel diseases (IBDs) of unknown origin, affecting the gastrointestinal tract and often causing extraintestinal symptoms. Conventional treatments (eg, glucocorticosteroids, immunomodulators) and targeted advanced treatments, including anti-TNFα, antibodies to p40 subunit of IL-12/23, antibodies to p19 subunit of IL-23, anti-α4β7 integrin, Janus kinase inhibitors (JAKis) and sphingosine-1-phosphate receptor (S1PR) modulators, do not achieve sustained responses for all patients, leaving significant unmet therapeutic needs.
This prospective, multi-centre observational study will follow a cohort of 240 patients across multiple study centres within NHS trusts in the UK who are initiating or switching biologics, specifically anti-TNFα and anti-α4β7 integrin for UC, and anti-TNFα, antibodies to p40 subunit of IL-12/2 and JAKi for CD. Through comprehensive profiling of immunological, transcriptional, microbiome, genetic and proteomic markers at baseline, week 12, and week 52, this study aims to uncover non-invasive biomarkers that predict response to these drug classes, ultimately advancing personalised medicine in IBD.
Ethical approval for the Nottingham/AstraZeneca study was granted by the West of Scotland Research Ethics Committee. Recruitment began in December 2022 and is currently ongoing at 10 NHS Trust sites across the UK. Study findings will be disseminated by publication in peer-reviewed journals and presentations at relevant national and international conferences.
The study aims to calculate the curative care expenditure (CCE) from different comorbidity states of chronic hepatitis B (CHB), to provide a reference for the relevant government departments to optimise health insurance protection measures for this disease.
A prevalence-based retrospective study.
This study included 1600 medical institutions, covering general hospitals, traditional Chinese medicine hospitals, specialised hospitals and maternal and child health hospitals.
The cohort included 238,617 CHB outpatients and 4312 inpatients.
CCE for CHB was estimated based on System of Health Accounts 2011.
The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. The majority of CCE was spent by outpatient services (USD 67.16 million), the main source of financing schemes was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions. The CCE varied significantly across different comorbidity groups. The CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent by patients aged 30–39 years and those aged 40–49 years, respectively. The CCE in the high comorbidity group was mainly spent by patients aged 50–54 years.
The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment. This situation poses a heavy medical burden not only on individuals, but also on society. Therefore, the financing structure needs to be optimised urgently. Potential policy directions may improve the outpatient mutual aid protection mechanism.
The utilisation of artificial intelligence in the context of nursing education has become increasingly extensive. However, various studies show differing perspectives and attitudes among nursing students, and the findings have not been systematically synthesised.
To systematically review the perceptions and attitudes of nursing students on the application of artificial intelligence in nursing education.
Mixed-methods systematic review.
A comprehensive literature search was conducted across 10 databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, Scopus, China Science and Technology Journal Database, SinoMed, China National Knowledge Internet, and WanFang database, the inclusive years of articles searched were from 1969 to 2025. Two researchers independently screened the literature and extracted the data. The mixed methods assessment tool was used to evaluate the risk of bias in the included literature. The relevant data were extracted and synthesised according to the Joanna Briggs Institute's convergence synthesis method, ensuring the comprehensive integration of qualitative and quantitative results. These results were then integrated into the Technology Acceptance Model.
A total of 28 articles were included, including 13 qualitative studies, 13 quantitative studies, and 2 mixed-method studies. According to the Technology Acceptance Model, the perceptions and attitudes of nursing students on the nursing education's adoption of artificial intelligence were integrated into 10 categories of three comprehensive themes: (i) Nursing students' perceptions and attitudes of the ease of use of artificial intelligence in nursing education, including 3 categories; (ii) nursing students' perceptions and attitudes on the usefulness of artificial intelligence in nursing education, including 4 categories; (iii) nursing students' behavioural intention, including 3 categories.
Overall, our study demonstrated that nursing students had an active willingness to utilise artificial intelligence. However, they acknowledged that certain issues persist regarding the ease and practicality of artificial intelligence in nursing education.
No patients or members of the public were directly involved in this systematic review, as the study synthesised existing literature.
Mental skills training (MST), which systematically uses techniques to build mental skills, is a popular intervention approach that may benefit dancers. However, information presented in existing MST interventions in dance is dispersed, making it difficult to offer evidence-based recommendations. To address this, the Template for Intervention Description and Replication (TIDieR) can improve transparency and replicability in intervention reporting, thus supporting researchers in assessing existing evidence and enhancing future intervention design. Guided by this framework, the aim of this mixed-methods systematic review was to provide an overview of existing MST interventions in dance and examine (1) the characteristics of effective MST interventions in dance and (2) how the reporting of these interventions aligned with the 12 TIDieR items.
Mixed-methods systematic review.
PsycInfo, Medline, Embase, SportDiscus, Web of Science and the first 30 pages of Google Scholar were searched from database inception until August 2024.
Quantitative, qualitative or mixed-methods approaches investigating MST interventions in which dancers used mental techniques, developed mental skills or enhanced mental qualities to improve physical and mental well-being.
Two reviewers independently screened identified studies in Covidence. Using the TIDieR framework, one reviewer extracted data while a second checked 30% of studies for accuracy. A convergent integrated synthesis was conducted.
Findings from the 21 included studies indicated that intervention effectiveness was determined by characteristics relating to both recipients and deliverers. While TIDieR items describing intervention content were most reported, few studies described fidelity.
Future MST interventions in dance should consider multiple aspects of effectiveness and involve dancers and deliverers in mapping needs, values and outcomes. Structured reporting tools like TIDieR may enhance reporting clarity and intervention replicability.
CRD42024537249.
by Wenlong Qian, Kou Xu, Shuo Li, Zhuo Zhang, Xiaoxiao Hou, Bingjie Min, Jia Ling, Xinyu Zhu, Hui Zhou, Wenjuan Xu, Wenming Yang, Shijian Cao, Yonghua Chen
BackgroundPenicillamine(D-Penicillamine) and trientine are first-line therapies for Wilson’s Disease (WD), yet real-world data on their adverse events (AEs) remain scarce. We analyzed the FDA Adverse Event Reporting System (FAERS) to comprehensively assess the safety of penicillamine and trientine in WD treatment.
MethodsAEs for penicillamine and trientine (2004Q1–2024Q4) were analyzed using Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Bayesian Confidence Propagation Neural Network (BCPNN).
ResultsWe found 1,452 and 760 AEs related to penicillamine and trientine, respectively. In all adverse event (AE) reports, the ratio of females to males was approximately 1.3, with the highest proportion of AE reports in the 21–30 age group, and the largest number of AE reports coming from the United States. Signal detection showed that the most commonly reported AEs for penicillamine and trientine were drug hypersensitivity and tremor, respectively, with the highest proportions in the SOC categories of immune system disorders and gastrointestinal disorders. The main AEs for both drugs involved condition aggravated, and identified potential safety signals requiring further validation for the two drugs, such as decreased bone density and brain atrophy for penicillamine, and memory impairment, oesophageal ulcer and starvation for trientine. In addition, we found that women were more likely to experience drug hypersensitivity in penicillamine adverse event reports, while men were more likely to experience cutis laxa.
ConclusionThis study reveals the characteristics of AEs and potential associated risks in the clinical application of penicillamine and trientine, emphasizing individualized medication and vigilant monitoring strategies to provide guidance for safe medication use.
Being exposed to adverse psychosocial working conditions contributes to poor mental health in young workers. This study explores whether psychosocial work adversities are a necessary condition for work-related emotional exhaustion in young workers.
Data from the ‘Netherlands Working Condition Survey 2021’ was used. By applying a novel method called Necessary Condition Analysis, we tested two psychosocial work adversities as necessary conditions for high work-related emotional exhaustion in young workers: (1) a composite score of high job demands and low job resources and (2) a composite score of high job demands. Additionally, we tested whether the threshold for job demands as a necessary condition for high work-related emotional exhaustion differed for young workers with low versus high resources.
Secondary data analysis on a national working population-based survey.
The sample included 5791 young workers in the Netherlands (aged
Work-related emotional exhaustion.
A high level of the composite on job demands and job resources is necessary for a high level of work-related emotional exhaustion in young workers (effect size=0.11, p
Both psychosocial work adversities were necessary conditions for high work-related emotional exhaustion in young workers. The necessity threshold for job demands was higher for young workers with high job resources, compared with the group with low resources. This indicates that removing psychosocial work adversities and ensuring the presence of job resources might contribute to the prevention of high work-related emotional exhaustion in young workers.
To describe the level of family decision-making self-efficacy and its associated factors among Chinese family members of ICU patients.
Cross-sectional descriptive quantitative study.
Using convenience sampling, 154 ICU patients and their family members from two tertiary hospitals completed a paper-based questionnaire assessing sociodemographic characteristics of patients and their family members, patients' disclosure of preferences to their family members, and family members' decision-making self-efficacy, anxiety and depression, uncertainty of illness, coping and social support. The data were analysed using independent-samples t-tests, one-way analysis of variance, Pearson correlation and multiple linear regression.
The average scores of self-efficacy in treatment, comfort promotion and facing death decision-making were 4.3 (SD = 0.6; range = 1–5), 4.2 (SD = 0.6; range = 1–5) and 3.5 (SD = 0.6; range = 1–5), respectively. Active coping was a predictor of self-efficacy in treatment, comfort-promoting and facing death decision-making. Patients' disclosure of preferences regarding mechanical ventilation, family members' anxiety and illness uncertainty were predictors of self-efficacy in treatment decision-making. Patients' disclosure of preferences regarding expensive medications was a predictor of self-efficacy in comfort-promoting decision-making, and patients' age was a predictor of self-efficacy in facing death decision-making.
Chinese family members of ICU patients reported relatively high self-efficacy in treatment and comfort promotion decision-making but lower self-efficacy in facing death decision-making. Active coping plays a critical role in enhancing decision-making self-efficacy across these three types of decisions. The predictors of decision-making self-efficacy varied according to the specific type of decision.
For Chinese family members of ICU patients, targeted strategies to strengthen their active coping skills are key to enhancing their confidence in making decisions with or for patients. Patients' disclosure of preferences to their family members is helpful for improving family members' confidence in making treatment and comfort promotion decisions. Extra support is especially needed for end-of-life decision-making, particularly when the patient is younger.
This research informs future interventions by highlighting active coping and patients' disclosure of preferences to family members as key factors to strengthen decision-making self-efficacy among Chinese family members of ICU patients. However, family members' decision-making self-efficacy appears to be culturally specific, underscoring the need to design family-centered critical care approaches that are tailored to cultural contexts in other settings. Besides, while our research found a positive association between anxiety and self-efficacy in treatment decision-making, the relationship between them requires further investigation.
STROBE guidelines.
No Patient or Public Contribution.
Over 777 million COVID-19 infections have occurred globally, with data suggesting that 10%–20% of those infected develop Long COVID. Fatigue is one of the most common and disabling symptoms of Long COVID. We aim to assess the feasibility and safety of a new, remotely delivered, multimodal rehabilitation intervention, paced to prevent post-exertional malaise (PEM), to support the conduct of a future, definitive randomised trial.
We will conduct a randomised, two-arm feasibility trial (COVIDEx intervention vs usual care). Sixty participants with Long COVID will be recruited and randomised prior to giving informed consent under a modified Zelen design using 1:1 allocation with random permuted blocks via central randomisation to receive either the COVIDEx intervention or usual care. The 50-minute, remotely delivered, COVIDEx intervention will occur twice weekly for 8 weeks. All participants will wear a non-invasive device throughout their entire study participation, to track heart rate, blood oxygen saturation, steps, sleep and monitor PEM. The primary feasibility objectives will be recruitment rates, intervention fidelity, adherence, acceptability (intervention and design), retention, blinding success and outcome completeness. Secondary objectives will include refined estimates for the standard deviation and correlation between baseline and follow-up measurements of fatigue. Feasibility and clinical outcomes will be collected at baseline, 4, 8, 12 and 24 weeks. Qualitative interviews with participants and physiotherapists will explore intervention acceptability and barriers/facilitators.
Ethical approval for this study was obtained by the Western University Health Sciences Research Ethics Board (REB# 123902). Dissemination plans include sharing of trial findings at conferences and through open access publications and patient/community channels.
The aim of this study was to explore the follow-up needs of patients with diabetic foot ulcers.
A qualitative descriptive study was conducted, guided by Engel's biopsychosocial model.
Purposive sampling was used to recruit 17 patients with diabetic foot ulcers of Wagner grade ≥ 1. These patients had received care in the Endocrinology and Metabolism Department or the Wound Clinic of a tertiary hospital in Xi'an, China. Guided by the biopsychosocial model, individual face-to-face semi-structured interviews were conducted between April and July 2024. Data were analysed using thematic analysis.
Nine themes were identified. In the biological domain, patients reported needs for disease care and lifestyle modification. In the psychological domain, they highlighted the importance of emotional coping support and building trust with healthcare providers. In the social domain, patients expressed needs for personalised follow-up, equitable access to healthcare, financial support, community assistance, and management of family caregiving role conflicts.
This study identified biological, psychological, and social follow-up needs among patients with diabetic foot ulcers, highlighting the importance of holistic follow-up to promote recovery and improve quality of life after discharge.
Nurses should assess and address the biological, psychological, and social follow-up needs of patients with diabetic foot ulcers after discharge, providing tailored care to promote ulcer healing and prevent recurrence.
This study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist.
None.
by Weixin Chen, Jiaming Yan, Zhenxing Kong, Yuliang Sun, Wenfei Zhu, Jie Kang
ObjectivesAir quality in China has become an increasing concern, its association with physical fitness remains unclear. This study represents one of the largest nationwide investigations of this association, leveraging data from 174,246 students aged 7–22 years across 30 provinces.
MethodsAnnual concentrations of PM₂.₅, PM₁₀, SO₂, NO₂, CO, O₃, and the Air Quality Index (AQI) were obtained from the Tracking of Atmospheric Pollution in China dataset. Physical fitness was evaluated through a comprehensive set of field-based tests covering anthropometric, cardiopulmonary, flexibility, muscular strength, and endurance. Associations were examined using generalized linear models with progressive adjustments: Model 1 controlled for demographic factors (age, sex, residence, province), Model 2 additionally accounted for physical activity and parental factors, and Model 3 further incorporated temperature and humidity.
ResultsAfter adjusting for covariates, each 1 μg/m³ increase in PM₂.₅ and PM₁₀ was associated with decreases in physical fitness scores of 0.18 [95% CI: −0.22, −0.14] and 0.12 [−0.16, −0.08] points, respectively. SO₂, O₃, and CO showed similar negative associations, with reductions of 0.42 [−0.47, −0.38], 0.21 [−0.25, −0.16], and 0.16 [−0.20, −0.11] points, respectively. In contrast, NO₂ exhibited a positive association, with an increase of 0.29 [0.25, 0.33] points per 1 μg/m³. AQI was also inversely related to fitness, decreasing scores by 0.17 [−0.21, −0.13] points per 1-unit increase.
ConclusionsAmbient air pollution is adversely associated with physical fitness among Chinese children, adolescents, and young adults, highlighting the importance of air quality improvement strategies for youth health. Future longitudinal studies are warranted to strengthen causal inference.
Improving global access to pain management medications for cancer patients remains a critical priority. Nurses are now understood to play an essential role in cancer pain medication management, yet the barriers and facilitators they encounter require urgent identification.
This systematic review aimed to identify the barriers and facilitators for nurses in managing cancer pain medication.
This systematic review followed the Joanna Briggs Institute (JBI)'s guidelines for qualitative systematic reviews.
Eleven databases (PubMed, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, OPENGREY.EU, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed) were searched from their inception to 9th July 2025. Articles were evaluated for quality using JBI critical appraisal tools. Data extraction was performed according to JBI standardised protocols, and evidence synthesis was conducted using JBI meta-aggregation, which involved extracting findings, categorising them into thematic groups and synthesising them into comprehensive statements.
Twenty-four qualitative studies were reviewed in the present study. Two synthesised findings regarding the barriers and facilitators for nurses in managing cancer pain medication were integrated: (1) Barriers for nurses to manage cancer pain medication were summarised into five categories: systemic barriers, resource barriers, knowledge and skills barriers, financial and cultural barriers and communication and psychological barriers; (2) Facilitators for nurses to manage cancer pain medication were summarised into three categories: nursing capacity building, supportive care environments and collaborative support systems.
Multilevel barriers impede nurse-led cancer pain management, necessitating policy reforms (e.g., tiered prescribing), investments in telehealth/training and culturally responsive interprofessional collaboration. Prioritising facilitators, capacity building, supportive environments and collaboration is vital to empower nurses in delivering equitable, evidence-based pain relief.
This review equips clinical managers and policymakers with evidence to implement policy and practice reforms, such as tiered prescribing and interprofessional collaboration, which are critical to empower nurses in delivering effective cancer pain management.
This systematic review was prospectively registered in PROSPERO prior to the initiation of the search (Registration ID: CRD42024570807).
There was no patient or public contribution.
Cluster randomised trials (CRTs) can be at risk of bias driven by differential identification and recruitment of participants across treatments, posing a threat to the validity of findings. We explored the awareness and importance, among CRT researchers, of the recommended bias mitigation measures.
Qualitative interview study using semistructured interviews.
Participants were researchers involved in conducting CRTs, including investigators, statisticians and trial coordinators. 24 participants, including statisticians (n=13, 54.2%), clinical investigators (n=9, 37.5%) and trial coordinators (n=2, 8.3%), were interviewed; with representation from the UK (n=10, 41.7%), Australia (n=5, 20.8%) and the USA (n=4, 16.7%).
Participants exhibited differing levels of knowledge related to biases. Some participants demonstrated high levels of knowledge, but we also identified prevalent misconceptions, with some evidence of superficial knowledge. While some participants worked in collaborative teams, other teams’ responsibilities were delineated, and this impacted on how knowledge of biases was shared and acted on. Logistical and practical issues could prevent known solutions to mitigate biases being implemented. Biases also manifested because of a perception from participant recruiters that the purpose of research is for participant benefit rather than producing generalisable knowledge; and a normalisation or expectation that CRTs produce a lower level of evidence.
There is an urgent need to ensure that CRTs are free from risks of bias. Mitigation measures are either not known, not practical or unconsciously subverted. More education and collaborative working might help. Preventing subconscious bias during participant recruitment and dispelling the myth that CRTs produce lower levels of evidence would require a change in culture.
To identify sex-specific patterns based on determinants related to sleep quality, using a representative sample of the Spanish adult population.
Cross-sectional, age-stratified and sex-stratified study.
Community-based assessments in two Spanish provinces (Salamanca and Ávila).
Adults aged 25–65 years (n=500), equally distributed by sex and five age strata, selected from the regional health-card database.
Objective sleep metrics from wrist actigraphy (time in bed, total sleep time (TST), sleep efficiency, wake after sleep onset, number/duration of awakenings, fragmentation/movement indices) and self-reported sleep quality (Pittsburgh Sleep Quality Index).
Standardised baseline assessments collected sociodemographic, clinical, mental-health and lifestyle variables using validated instruments. Actigraphy (ActiGraph GT3X+) recorded triaxial acceleration at 30 Hz over 5 days; data were aggregated in 60 s epochs (ActiLife). Sleep/wake was classified with Cole-Kripke and nocturnal episodes identified with Tudor-Locke before deriving sleep indices. Two-step cluster analysis was applied separately by sex.
Three clusters were identified for each sex, with age and educational level being the most influential factors. In men, the 65-year-old cluster with university education and lower anxious–depressive load showed the highest sleep efficiency (91.8±3.8%) and the lowest TST (351.7±74.8 min). In contrast, the 35-year-old cluster with middle or high school presented the lowest efficiency (88.3±10.0%) and higher TST (368.1±83.8 min). In women, the 55-year-old cluster with middle or high school and low emotional load showed the highest efficiency (93.6±2.8%), despite a reduced TST (352.0±79.7 min), while the 35-year-old cluster, with middle or high school and high levels of anxiety and depression, showed the worst efficiency metrics (89.5±3.9%) and a higher TST (394.8±67.3 min).
Sleep quality in Spanish adults is heterogeneous across sex-specific clusters shaped by age, education and mental-health burden. Cluster-based characterisation may support tailored public-health interventions.
Taking multiple medicines can be appropriate but has the potential to be problematic. The Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence THrough the Years (iSIMPATHY) project used the 7-Steps person-centred approach for medication reviews, supporting patients and clinicians to define and achieve realistic goals for drug treatment, and helping enable patients to lead healthy and active lives.
To assess the impact of pharmacist-led comprehensive person-centred medication reviews using the 7-Steps methodology.
iSIMPATHY sought to transform the approach to optimisation of medicinces through the delivery of person-centred medication reviews for people taking multiple medicines in primary care, hospital and outpatient clinics. The reviews were conducted by embedding a single approach for polypharmacy management, building on key recommendations from SIMPATHY.
Interventions made were graded, with 82% being classified as clinically significant and 4% potentially preventing major organ failure, adverse drug reactions or incidents of similar clinical importance. The average number of medications reduced from 12 to 11, with 92% of the reviews resulting in more appropriate medication use, thereby decreasing the likelihood of medication-related harm. Inappropriate medicines were stopped, reduced or altered to improve appropriateness. There were significant healthcare resource utilisation benefits as indicated by a positive return on investment for both medication and healthcare costs with a quality-adjusted life year gain of 7.4 per 100 patients.
Pharmacist-led, person-centred medication review using the 7-Steps approach was delivered across jurisdictions and healthcare settings, with positive impacts on the number and appropriateness of medicines, clinical interventions and cost savings outweighing expenditure on the service. The approach is scalable by means of the tools and resources developed over the duration of the project.
Quarantine during the COVID-19 pandemic resulted in longer-term sedentary behaviours and mental health problems. Our study aimed to evaluate the impact of the Otago exercise programme (OEP) on physical function and mental health among elderly with cognitive frailty during COVID-19.
Lockdowns and restrictions during the COVID-19 pandemic result in longer-term sedentary behaviours related disease and mental problem. Older people with cognitive frailty are more vulnerable to be influenced. Timely intervention may achieve better outcomes, OEP exercise was designed as a balance and muscle-strengthening programme for elderly people.
A parallel-group, assessor-blinded randomised controlled trial was performed according to CONSORT guidelines.
This study was conducted from July 2020 to October 2020 among 62 elderly people with cognitive frailty from a nursing home. Participants were randomly divided into an OEP group (n = 31) or a control group (n = 31). Both groups received sleep- and diet-related health education. The OEP group also received a 12-week group exercise programme. The Five Times Sit to Stand Test (FTSST), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT) were used to assess physical function. The Geriatric Depression Scale-15 (GDS-15) and the 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) were used to assess mental health. Outcomes were measured at 6 and 12 weeks.
Physical function and mental health were similar in the two groups at baseline. At 12 weeks, the OEP group (difference in change from baseline: FTSST, −2.78; TUGT, −3.73; BBS, 2.17; GDS-15, −0.72; SF-12 MCS, 2.58; all p < .001) exhibited significantly greater improvements than the control group (difference in change from baseline: FTSST, 1.55; TUGT, 1.66; BBS, −0.10; GDS-15, 1.07; SF-12 MCS, −5.95; all p < .001).
Our findings showed the OEP group had better physical function and mental health outcomes than the control group. OEP can be used to improve the physical and mental function among elderly people with cognitive frailty during the COVID-19 pandemic.
Relevance to clinical practice: Otago exercise program intervention programmes should be implemented to improve physical function for cognitive frailty elderly to reduce the harm of longer-term sedentary behaviours, and to ruduce depression symptom and improve mental health, particularly during COVID-19 pandemic period.
FreshRSS 