Understanding the quality of published research is essential for nurses, educators and healthcare researchers striving to implement evidence-based practice. However, ‘quality assessment’ can seem abstract or overly technical, primarily for those new to research appraisal. In an era where clinical decisions and policy recommendations are increasingly data-driven, evaluating the methodological rigour of quantitative studies is more critical than ever.
High-quality research provides trustworthy, valid and ethically sound conclusions. In contrast, poorly conducted studies can lead to misguided clinical decisions, suboptimal patient care and inefficient resource use.
Quality assessment involves evaluating a study’s design, methodology and reporting to determine its risk of bias and trustworthiness.
Commentary on: Hassan, E. A., & El-Ashry, A. M. (2024). Leading with AI in critical care nursing: challenges, opportunities, and the human factor. BMC Nursing, 23(1), 752. doi: https://doi.org/10.1186/s12912-024-02363-4
Implications for practice and research Ensure transparent artificial intelligence (AI) systems to build trust and develop robust nurse training programmes to integrate AI effectively. Further studies on ethical AI use, reducing algorithmic bias, and AI’s long-term effects on nurse–patient relationships.
The integration of artificial intelligence (AI) in intensive care units (ICUs) marks a significant advancement in critical care, offering automated task management and enhanced data analysis. Historically, critical care has relied on high-acuity clinical decision-making, where nurses’ judgement and expertise are paramount. The rapid evolution of AI promises efficiency but raises concerns about ethical implications, role changes and trust. While AI tools improve clinical outcomes, their black-box nature and potential for...
Commentary on: Down L, Barlow M, Bailey SER, et al. Association between patient ethnicity and prostate cancer diagnosis following a prostate-specific antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Med 2024 Mar 1;22(1):82.
Implications for practice and research Clinicians should consider ethnic differences when interpreting prostate-specific antigen test results, particularly for black men, to ensure timely prostate cancer diagnosis and avoid overtreatment or undertreatment. Further studies are needed to explore genetic, environmental and healthcare access factors that contribute to ethnic differences in prostate cancer incidence and progression.
Prostate cancer is a common cancer worldwide, with incidence and mortality varying significantly across ethnic groups.
The 2024 revision of the Declaration of Helsinki (DoH) marks a pivotal shift in biomedical research ethics, with significant implications for nursing research. This paper critically evaluates the Declaration's relevance to nursing practice, with particular attention to challenges in low-resource settings. Key updates emphasising global health equity, environmental sustainability, participant-centred consent and artificial intelligence (AI) governance are examined through nursing's ethical lenses of justice, beneficence and patient advocacy.
Using a multidimensional ethical framework grounded in Virtue Ethics, utilitarianism and phenomenology, the manuscript explores how nurses can ethically engage vulnerable populations, safeguard data privacy and advance inclusive, community-based research.
It highlights gaps in the Declaration, particularly regarding algorithmic bias and digital consent and proposes practical strategies for nurse researchers, such as AI governance tools, dynamic consent models and context-sensitive sustainability practices.
Rather than treating ethics as an abstract principle, the paper grounds theory in real-world practice, offering case examples that reflect the lived constraints of nursing researchers in underfunded and culturally diverse environments. By aligning ethical ideals with operational realities, this work reinforces nursing's critical role in shaping equitable and ethically resilient research practices under the revised Declaration.
The COVID-19 pandemic threatened global HIV Test and Treat Efforts. We assessed whether it affected (1) the number of antiretroviral therapy (ART) initiations and (2) the proportion of timely ART initiations in people living with HIV (PLWH) globally.
Quasi-experimental, regression discontinuity design using routinely collected data from HIV clinics.
360 HIV care clinics across primary and secondary levels of care, participating in the International epidemiology Databases to Evaluate AIDS consortium, in 31 countries in Asia, Africa and the Americas.
177 391 PLWH (≥18 years old) who initiated ART 2 years before and 1 year after the onset of the COVID-19 pandemic in their country.
The primary outcome was the number of ART initiations per week; the secondary outcome was the proportion of timely ART initiations (ie, ART initiated within 7 days of enrolment). We assessed changes in these outcomes in the 52 weeks after compared to the 104 weeks before the pandemic onset, defined using each country’s peak Oxford Stringency Index score between January and June 2020.
Among 177 391 newly enrolled PLWH, 129 743 initiated during the pre-pandemic and 47 648 post-pandemic onset. 72.5% of ART initiations were timely pre-pandemic whereas 82.3% were during the pandemic. Absolute number of ART initiations remained stable during the pandemic period in 25 of 31 countries but decreased significantly in six countries: India (–5.0 p, 95% CI –9.2 to –0.7), Rwanda (–10.0 p, –18.6 to –1.4), Malawi (–33.4 p, –54.1 to –12.3), South Africa (–130.8 p, –188.6 to –73.1), Zimbabwe (–12.9 p, –20.0 to –5.8) and Togo (–19.6 p, –39.1 to –0.1). The proportion of timely initiations was stable in all countries except in Kenya (+4.2 pp, 95% CI +0.3 to +8.1) and in Mozambique (+2.7 pp, +0.5 to +4.9), where it increased significantly.
A deeper understanding of the factors that contributed to sustaining ART initiations, particularly in settings with stringent public health and social measures, is needed. These insights should inform preparedness strategies, resource allocation and policy development to ensure continuity of HIV services during future health emergencies, in line with World Health Organisation recommendations.
Large-scale stroke registries can provide critical insights into disease mechanisms, progression and healthcare needs, informing prevention and care. However, few collect detailed demographic, brain imaging, and comprehensive long-term follow-up data. To address this, we established the prospective Stroke Investigation Group in North And central London (SIGNAL) registry in 2017.
The SIGNAL registry included 3931 adults aged ≥18 years with confirmed acute stroke (cerebral ischaemia or intracerebral haemorrhage (ICH)) admitted to the University College London Hospital hyperacute stroke unit between January 2017 and 2020, drawn from an ethnically diverse North and Central London population (~1.6 million). Baseline data included demographic, clinical, brain imaging and next-of-kin information. Six month follow-up included measures of functional status and non-motor outcomes (anxiety, depression, fatigue, sleep, pain, language, continence, social participation, cognition) via face-to-face, telephone or postal follow-up methods.
The mean age of individuals included in the SIGNAL registry was 72.1 years, and 1806 (45.9%) were female. The ethnic distribution comprised 2365 (60%) white, 649 (16.5%) black and 511 (13%) Asian. Stroke diagnoses included 3371 (85.8%) with cerebral ischaemia and 560 (14.2%) with ICH. On admission, 2240 individuals (57.0%) had a National Institutes of Health Stroke Scale score >4, indicating moderate stroke severity. At hospital discharge, the median functional outcome, measured by the modified Rankin Scale, was 3 (IQR 1–4), indicating moderate disability. At 6 months, functional outcomes measured with mRS were available for 3755 individuals (95.6%) with a median score of 1 (IQR=0–3) and non-motor outcomes were available for 3080 individuals (92.3%). The most prevalent adverse non-motor outcomes were fatigue 1756 (57%), reduced social participation 1694 (55%) and sleep disturbance 1663 (54%).
Further analyses of SIGNAL registry data will investigating associations between stroke mechanisms, subtypes and neuroimaging features and 6-month functional status, non-motor outcomes and cognitive impairment. Longer term follow-up of survivors for ~10 years is also planned.
To examine demographic and occupational attributes associated with work-life balance (WLB) satisfaction among physician assistants/associates (PAs) using a national dataset.
This is a cross-sectional study using 2023 national data.
USA.
The study included 149 909 board certified PAs who updated, confirmed or verified their profile questions.
Descriptive and bivariate statistics, followed by multivariate logistic regression, were conducted to identify factors associated with WLB satisfaction among PAs. The primary outcome was a binary variable derived from a 7-point scale assessing PAs’ satisfaction with WLB. Responses of ‘Somewhat’, ‘Mostly’ and ‘Completely’ satisfied were coded as ‘Satisfied’, while ‘Neither/Nor’, ‘Somewhat’, ‘Mostly’ and ‘Completely’ dissatisfied were coded as ‘Not satisfied’. Our analytical sample comprised 86,000 PAs who responded to a question inquiring about their satisfaction with WLB.
Over two-thirds (71.7%) of PAs indicated satisfaction with WLB. The multivariate logistic regression revealed that the types of specialties that PAs practised were among the strongest factors associated with WLB satisfaction. Compared with PAs in primary care, those practising in dermatology (adjusted OR (aOR)=1.83; 95% CI 1.66 to 2.02), general surgery (aOR=1.64; 95% CI 1.48 to 1.83), pain medicine (aOR=1.63; 95% CI 1.41 to 1.89) and hospital medicine (aOR=1.52; 95% CI 1.37 to 1.68) had higher odds of being satisfied with WLB (all p
Our findings revealed that PAs practising in non-primary care specialties had the highest odds of reporting satisfaction with WLB. Identifying factors strongly associated with PA work-life balance can aid in developing targeted interventions. However, further research is needed to understand the intrinsic and extrinsic factors influencing PAs’ WLB.
Commentary on: Chauhan A, Newman B, Manias E, et al. Creating safer cancer care with ethnic minority patients: A qualitative analysis of the experiences of cancer service staff. Health Expect. 2024 Jan 30;27(1):e13979.
Implementing culturally competent communication strategies, including interpreters and culturally adapted materials, can enhance patient safety and engagement. Further studies are needed to evaluate the effectiveness of communication tools and strategies in improving safety outcomes for ethnic minority patients with cancer.
This qualitative study explores the experiences of healthcare staff in creating safer cancer care environments for ethnic minority patients. People from ethnic minority groups, who face an increased risk of safety events, often encounter barriers such as language and cultural differences.
Multiple well-considered but siloed initiatives and programmes exist in Australia to support ear and hearing screening and assessment for Indigenous children. However, the lack of coordination of these programmes leads to inefficiencies in resource allocation and disrupts opportunities to implement a cost-effective, efficient, and easily navigable system of care. Indigenous children experience high prevalence rates of middle ear disease, as well as earlier onset, increased severity and longer infections compared with non-Indigenous children. The aims of this study are to: (1) Understand current ear and hearing screening programmes in three New South Wales communities and evaluate their strengths and limitations, (2) Strengthen, implement and evaluate ear and hearing screening programmes and (3) Identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.
A series of desktop searches and co-design workshops will be completed to achieve aim (1) and (2) and the results will be mapped into work-as-done and work-as-imagined using the Functional Resonance Analysis Method. Strengthened screening programmes will be implemented in communities using the criteria from national and international guidance documents and the Practical, Robust, Implementation and Sustainability Model and evaluated. Finally, workshops will be conducted with key stakeholders to identify the barriers and facilitators for scaling strengthened ear and hearing screening programmes nationally and the importance and feasibility of each factor.
This project has received ethics approval from the Aboriginal Health and Medical Research Council Human Research Ethics Committee (Ref: 2350/24). Results will be disseminated to the community through the CEOs of the Aboriginal Community Controlled Health Organisations as well as published in peer-reviewed journals and presented at conferences. The findings from data collected will be used to inform the co-production of an enhanced system for ear and hearing care.
To assess the extent to which cancer centres in Arab countries adhere to the 2016 American Society of Clinical Oncology/Oncology Nursing Society (ASCO/ONS) chemotherapy administration safety standards.
Multicentre cross-sectional survey.
Sample of the largest cancer treatment facilities across 10 Arab countries, including governmental, private, university-affiliated and daycare centres where chemotherapy is administered.
A multidisciplinary team of healthcare professionals (including head nurses, oncologists, oncology pharmacists and quality staff) at each centre completed a structured survey on adherence to the ASCO/ONS chemotherapy administration safety standards.
The primary outcome was the proportion of cancer centres fully implementing each of the 46 ASCO/ONS safety standards, grouped into four domains: (1) creating a safe environment—staffing and general policy; (2) treatment planning, patient consent and education; (3) ordering, preparing, dispensing and administering chemotherapy; and (4) monitoring after chemotherapy administration.
Of the 25 centres invited, 19 (76%) participated. The domain most frequently fully implemented was treatment planning, patient consent and education (12/19 centres, 63.2%). The remaining domains were fully implemented by four centres or fewer. The lowest implementation was observed for standards requiring policies for documentation and follow-up of patients who miss or cancel scheduled visits or chemotherapy treatments. Centres accredited by the Joint Commission International and those that specifically reported adherence to internationally recognised oncology guidelines were more likely to fully implement specific domains of the ASCO/ONS chemotherapy administration safety standards.
Significant gaps exist in the implementation of ASCO/ONS chemotherapy administration safety standards at cancer centres across Arab countries. These findings highlight opportunities for targeted interventions and policy development to improve chemotherapy safety in the region.