This study aims to explore the relationship between nurses' knowledge, attitudes, and practices regarding older adult abuse and their caring behaviours, focusing on Iranian nurses.
A cross-sectional exploratory study.
A cross-sectional correlational design included 250 nurses from medical education centres in Ardabil. A three-part questionnaire assessed demographic characteristics, knowledge, attitudes, and practices regarding elder abuse and caregiving. Data were collected from August to October 2024 and analysed using ANOVA, t-tests, Pearson correlations, and multiple regression analysis.
The study's findings are significant, revealing a moderate level of knowledge among nurses about older adult abuse. There are significant positive correlations between knowledge, attitudes, and caring behaviours, with higher education levels associated with better caring behaviours. However, practice scores did not align with knowledge and attitudes, indicating barriers such as workload and lack of training.
The findings reveal a significant link between nurses' knowledge and attitudes toward older adult abuse and their caring behaviours. Positive attitudes are associated with higher Caring Behaviours Assessment scores, suggesting that educational programs should enhance nurses' understanding and empathy toward older adult care. Addressing the identified gaps in knowledge and practice can lead to improved patient outcomes and a more compassionate healthcare environment for older adults. It is crucial to provide continuous training and support to empower nurses to apply their knowledge in practice effectively.
The study highlights the necessity for regularly occurring targeted educational interventions to enhance nurses' understanding of older adult abuse. Implementing continuous professional development programs for nurses can significantly improve patient outcomes and reduce instances of abuse. Healthcare organisations should foster supportive environments that encourage the regular reporting of suspected cases of abuse and ensure that nurses are consistently updated on best practices. Increasing community awareness about elder abuse is crucial for safeguarding vulnerable older adults.
EQUATOR guidelines were followed using the STROBE reporting method.
This study did not include patient or public involvement in its design, conduct, or reporting. Only nurses were involved in data collection.
Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.
Retrospective population-based observational study.
Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.
1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.
Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.
Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75–79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.
Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.
To critically assess the impact of theory-guided positive psychological interventions on the quality of life of breast cancer patients and survivors.
Systematic review and meta-analysis.
A comprehensive literature search was conducted across seven electronic databases from inception to August 2024. Randomised controlled trials that examined the effects of theory-guided positive psychological interventions on adult breast cancer patients or survivors and reported quality of life outcomes were included. Screening, data extraction and critical appraisal were independently performed by the reviewers using the revised Cochrane risk-of-bias tool (RoB2). A meta-analysis was conducted using RevMan Web. The study was reported following the PRISMA 2020 Statement.
Five randomised controlled trials were included. Only two of these studies showed a low risk of bias across all quality measures. The meta-analysis demonstrated a significant improvement in quality of life following theory-guided positive psychological interventions, with low heterogeneity. Subgroup analyses revealed that interventions lasting either less than or longer than 3 weeks, and both group-based and individual-based formats, had positive effects on quality of life. Additional psychological benefits were observed including reductions in depressive symptoms, anxiety, perceived stress and improvements in post-traumatic growth, resilience, hope and perceived benefits. One study also reported improvements in sleep quality.
The findings demonstrate that theory-guided positive psychological interventions can potentially significantly improve quality of life in breast cancer patients. However, the limited number of studies underscores the need for further high-quality research to validate these findings and identify the most effective intervention characteristics.
Our systematic review highlights that theory-guided positive psychological interventions show promise as an effective strategy for improving the quality of life in breast cancer patients. These interventions can enhance psychosocial support strategies, paving the way for better-informed approaches that lead to improved patient outcomes.
No patient or public contribution.
The systematic review and meta-analysis had been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration ID number: CRD42024581382
The aim of this study was to examine the epidemiology of disability in India and assess access to disability support and rehabilitation services by people with disability (PWD).
This study is a secondary analysis of data from the 76th round of the National Sample Survey (2018), focusing on disability in India.
The survey employed a stratified two-stage sampling design based on Census 2011, covering all states and union territories of India. Villages and urban blocks were selected in the first stage, while households were chosen in the second stage across rural and urban areas.
The survey included data from a population of 576 796 individuals residing in 118 152 households from 8992 village/urban blocks (5378 rural villages and 3614 urban blocks). The analysis focused on 107 125 individuals (61 707 male and 45 305 female) who reported at least one disability.
The primary outcome was ‘any disability’. Secondary outcomes included access to disability support and rehabilitation services, which assessed difficulties in accessing public buildings and transport, loss of employment after disability, availability of government support, enrolment in special schools, and possession of a disability certificate.
The overall weighted disability prevalence was 2.2%, with significant disparities across sociodemographic characteristics. Among PWD, 45.9% of those who acquired disability after birth were aged between 15 years and 59 years, and 20.8% received no government aid. About 40% of PWD struggled to use public transport, and 57.7% had difficulties accessing public buildings. Additionally, 60.7% reported job loss due to disability, and 69.6% lacked a disability certificate.
This study highlights disparities faced by PWD in accessing disability support and rehabilitation services. There is an urgent need for concerted efforts to minimise such experiences. This will help us enhance the well-being and participation of PWD and empower them to contribute to society with their true potential.
Patients with chronic limb-threatening ischaemia (CLTI) are often prescribed clopidogrel in order to reduce their risk of major adverse limb and cardiovascular events. Clopidogrel is metabolised by the CYP2C19 enzyme and genetic variations in CYP2C19 are common. These variants can influence an individual’s ability to metabolise clopidogrel to its active metabolite. Few studies have investigated the relationship between patient genotype and outcomes in vascular surgery. This work aims to establish the relationship between patient genotype and outcomes after revascularisation in patients with CLTI who are prescribed clopidogrel. It will consider whether pharmacogenetics can be used to ensure patients are prescribed effective medications to optimise their outcomes.
This is an observational cohort study of patients undergoing lower limb surgical, endovascular or hybrid revascularisation for CLTI at Manchester University NHS Foundation Trust. Patients taking clopidogrel post-procedure, as well as those prescribed a non-clopidogrel based medication regimen, will be recruited prior to or shortly after revascularisation. Patients will undergo CYP2C19 genotyping and will be followed up using online records. The study has 90% power to detect 114 amputations with a target sample size of 483 participants. The primary outcomes are risk of amputation at 1 year and a composite endpoint for the risk of major adverse limb events (MALE) or death from any cause at 1 year. Secondary outcomes are risk of MALE at 1 year, risk of major adverse cardiovascular events (MACE) or death from any cause at 1 year, death within 30 days of revascularisation, minor re-interventions at 1 year, total number of re-interventions at 1 year and rate of systemic or gastrointestinal bleed at 1 year.
Risk of amputation, MALE and MACE will be analysed using Cox models. All remaining outcomes will be analysed using negative binomial models. Potential competing events for the risk of amputation will be investigated as part of a sensitivity analysis. Patients given a non-clopidogrel-based medication will be compared as an additional analysis.
Manchester University Research Ethics Committee approval obtained as part of the Implementing Pharmacogenetics to Improve Prescribing (IPTIP) trial process (IRAS 305751). The results of the study will be published in a peer-reviewed journal and presented at international conferences.
This work is a sub-protocol for the IPTIP study which is registered as ISRCTN14050335.
This study investigated the association between perceived nursing workload and occupational fatigue in clinical nurses. We specifically focused on how nursing teamwork moderates this relationship.
Hospital nurses often face heavy workloads, leading to significant fatigue. Understanding the link between workload, fatigue and teamwork is crucial to addressing nurse burnout.
A cross-sectional study was conducted among 356 clinical nurses from five educational-therapeutic hospitals in Ardabil, Iran. Data were collected using validated instruments, including the Occupational Fatigue Exhaustion Recovery-15 (OFER) scale, the Quantitative Workload Inventory (QWI) and the Nursing Teamwork Survey (NTS). Hierarchical linear regression analysis assessed the relationships between perceived workload, occupational fatigue and nursing teamwork.
The study's findings show that increased nursing workloads were significantly linked to higher levels of both acute (B = 5.70 to 6.76, p < 0.001) and chronic fatigue (B = 6.71 to 7.16, p < 0.001). Additionally, effective nursing teamwork, comprising trust, team orientation, support, shared mental models and team leadership was associated with reduced fatigue levels.
Our study shows high workloads are linked to increased fatigue among nursing professionals. Teamwork can help lessen the adverse effects of workload on fatigue. Healthcare organisations should focus on optimising workload distribution and strengthening teamwork. Further research is needed to understand these dynamics and develop targeted interventions to support nursing staff in high-demand environments.
The study emphasises the need for healthcare organisations to prioritise workload management and enhance teamwork among nursing staff. Implementing structured workload assessments and fostering a collaborative work environment, along with policies promoting work–life balance, can improve patient care quality, benefit nursing professionals and contribute to a more resilient healthcare system.
The primary objective of this study was to develop a carboxymethyl cellulose (CMC) and carboxymethyl chitosan (CMCS) hydrogel containing ethylene diamine tetra acetic acid (EDTA) as the materials for wound healing. CMC and CMCS solutions were prepared with a concentration of 4% (w/v). These solutions were made using normal saline serum with a concentration of 0.5% (v/v). Additionally, EDTA with the concentrations of 0.01%, 0.05%, 0.1%, 0.5%, 1%, and 2% (w/v) was included in the prepared polymer solution. The analysis of the hydrogels revealed that they possess porous structures with interconnected pores, with average in size 88.71 ± 5.93 μm. The hydrogels exhibited a swelling capacity of up to 60% of their initial weight within 24 h, as indicated by the weight loss and swelling measurements. The antibacterial experiments showed that the formulated CMC/CMCS/EDTA 0.5% hydrogel inhibited the growth of Staphylococcus aureus and Pseudomonas aeruginosa. Moreover, the produced hydrogels were haemocompatible and biocompatible. At the last stage, the evaluation of wound healing in the animal model demonstrated that the use of the produced hydrogels significantly improved the process of wound healing. Finally, the findings substantiated the effectiveness of the formulated hydrogels as the materials for promoting wound healing and antibacterial agents.