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Mindfulness-based interventions are widely used, yet concerns about potential negative effects—particularly those related to mindfulness meditation practice—have gained increasing attention. Individuals with difficult-to-treat depression (DTD) represent a population of particular relevance due to heightened vulnerability, but comparative evidence on clinically relevant negative outcomes of mindfulness-based cognitive therapy (MBCT) versus established alternative psychotherapies in this group is lacking. This protocol describes a systematic review and individual participant data (IPD) network meta-analysis to assess and compare the incidence of clinically relevant negative outcomes associated with MBCT and the cognitive behavioural analysis system of psychotherapy (CBASP), an established individual psychotherapy for DTD.
Randomised controlled trials of MBCT and CBASP for adults with DTD were identified through systematic searches of major databases. Eligible studies must compare MBCT or CBASP (alone or with treatment as usual) to each other or to control groups. The primary outcome is clinically significant deterioration, defined as a ≥6-point increase on the Patient Health Questionnaire-9 or equivalent. Secondary outcomes are suicidality and treatment dropout. IPD will be requested from trial investigators; aggregate data will be used when IPD is unavailable. One-stage random-effects IPD network meta-analyses will be conducted to integrate direct and indirect evidence and to examine participant-level moderators of deterioration. Adverse events reported in the included trials will be summarised descriptively at the study level.
No local ethical review was required following consultation with the Swedish Ethical Review Authority. Primary trial investigators obtained local ethical approval and will share pseudonymised IPD. Findings will inform clinical decision-making and guideline development by strengthening the evidence base on potential negative effects of MBCT and CBASP in adults with DTD, including identification of subgroups at increased risk. Results will be disseminated through peer-reviewed publication and accessible summaries for relevant stakeholders.
CRD42022332039
To investigate factors influencing the implementation of advanced practice nursing roles within healthcare organisations in seven European countries from the perspective of advanced practice nurses.
A cross-sectional survey was conducted between September 2021 and December 2022, involving advanced practice nurses from Belgium, Finland, Germany, Iceland, Ireland, Spain and the Netherlands. The countries were selected to represent different stages of implementing advanced practice nursing roles, from emerging to well-established.
A self-administered questionnaire was used to address five domains: patient care, practice patterns, policy and legal, educational and workforce-related factors. Descriptive statistics, chi-squared tests and correspondence analysis were employed to identify patterns and country-specific differences across these domains of implementation factors.
A total of 491 advanced practice nurses participated in the study. While almost three-quarters of the participants indicated satisfaction with their job, the study highlighted multifaceted factors influencing the implementation of advanced practice nursing roles across countries. The Netherlands, Ireland and Belgium reported mainly facilitators, whereas Finland, Iceland and Germany noted barriers or a lack of knowledge. Spain mostly reported neutral or moderate positions. Key challenges included role ambiguity, interprofessional collaboration gaps, limited managerial support, workload imbalances, limited mentorship and underutilised competencies. Results also indicated that advanced practice nurses are partially hindered by operating in isolation from other professions.
The findings emphasise the need for robust organisational support, interprofessional collaboration and clear role definitions to facilitate the integration of advanced practice nursing roles. Addressing professional isolation through networking and mentorship is crucial to sustaining the advanced practice nursing workforce.
Policy should prioritise support for advanced practice nursing, including structured mentoring and networking opportunities. Further research on advanced practice nurses' well-being and long-term role sustainability in Europe is recommended.
What problem did the study address? What were the main findings? Where and on whom will the research have an impact?
This study reported factors influencing advanced practice nurse role implementation across seven European countries with different levels of role development. Key challenges included role ambiguity, interprofessional collaboration gaps and limited support. The findings can guide healthcare managers and policymakers on the key factors to consider when integrating advanced practice nursing roles into their teams.
The rise in mental disorders in Organisation for Economic Co-operation and Development (OECD) countries warrants close consideration, as mental disorders cause long-term sickness absences (LTSA) and increase the risk of disability pensioning (DP). This study compared how different mental disorders as a basis for LTSA pose risks for a subsequent DP.
Population-based prospective cohort study.
18–59-year-old Finns starting a new psychiatric LTSA in 2020. LTSA was measured through sickness allowance accumulated over 12 months. A 48-month follow-up started from the onset of LTSA. Six mental disorder types were identified.
The outcome variable was the time in months to a first paid DP spell. Using Cox proportional hazards regression stratified by sex, the DP risks of different mental disorders were examined, adjusting for comorbidity, length of LTSA and sociodemographic variables. The risks are presented as absolute risk differences and both unadjusted and covariate-adjusted HRs.
Compared with depression-related LTSA, psychoses (HRs 2.93 (95% CI 2.55 to 3.36) for women/2.99 (95% CI 2.67 to 3.36) for men) and other mood disorders (HRs 1.64 (95% CI 1.40 to 1.92)/1.49 (95% CI 1.25 to 1.78)) were associated with higher covariate-adjusted HRs, while anxiety disorders (HRs 0.65 (95% CI 0.59 to 0.72)/0.76 (95% CI 0.67 to 0.87)) and psychiatric sleep disorders (HRs 0.47 (95% CI 0.38 to 0.59)/0.58 (95% CI 0.44 to 0.78)) showed lower HRs. Higher age, lower education and socioeconomic status, comorbid mental disorders, chronic diseases and longer LTSA increased the risk.
Different mental disorders as basis for LTSA pose differing risks for permanent work disability. Among mental disorders, depression poses a relatively average risk for DP. Although anxiety and sleep disorders commonly cause LTSA, they are not associated with high DP risks. Psychotic and bipolar disorders are especially detrimental to work ability in today’s work life.
Understanding the patient perspective is crucial for enhancing healthcare delivery and outcomes for chronic conditions like diabetic foot ulcers. This qualitative study examined the perspectives of patients with diabetic foot ulcers to inform clinical strategies for both physicians and current patients to enhance care and prevent lower extremity amputations. Fifteen patients with a history of diabetes and diabetic foot ulcers and/or amputations participated in semi-structured interviews which explored their lived experiences and advice for both physicians and fellow patients to improve diabetic foot ulcer related care. Interview transcriptions were analysed to identify recurring themes. Advice for physicians emphasised increasing patient education, initiating preventive foot care at the time of diabetes diagnosis, providing instructions for managing diabetic ulcers early and demonstrating empathetic bedside manner. Advice for fellow patients focused on adopting healthy lifestyle practices, regular foot self-examinations, consistent blood glucose monitoring, medication adherence and seeking prompt medical attention for new or worsening foot lesions. Participants also stressed the importance of routine check-ups with providers to support prevention and management efforts. This qualitative study highlights the value of incorporating patient perspectives to improve our understanding of diabetic foot ulcer onset, care and outcomes and thereby reduce the risk of lower extremity complications.
About 30% of depressed patients suffer from a protracted course in which the disorder continues to cause significant burden despite treatment efforts. While originally developed for relapse prevention, mindfulness-based cognitive therapy (MBCT) has increasingly been investigated in depressed patients with such ‘difficult-to-treat’ courses. This is a protocol for an individual participant data (IPD) meta-analysis aiming to determine efficacy and potential moderators of MBCT treatment effects in this group based on evidence from randomised controlled trials.
Systematic searches in PubMed, Web of Science, Scopus, PsycINFO, EMBASE and the Cochrane Controlled Trials Register for randomised controlled trials were completed on 17 June 2024. Authors of identified studies have contributed IPD, and data extractions have been completed. An update search will be conducted immediately before the start of data analyses. We will investigate the following outcomes: (a) self-reported and observer-reported severity of depression symptomatology, (b) remission and (c) clinically meaningful improvement and deterioration. One-stage and two-stage IPD-MA will be conducted with one-stage models using the observed IPD from all studies simultaneously as the primary approach. One-stage IPD models will include stratified study intercepts and error terms as well as random effects to capture between-study heterogeneity. Moderator analyses will test treatment-covariate interactions for both individual patient-level and study-level characteristics.
The results will inform understanding of the use of MBCT in patients with current ‘difficult-to-treat’ depression and will contribute to arguments in favour of or against implementing MBCT as a treatment for this group. They will be published in a peer-reviewed journal and made available to stakeholders in accessible formats. No local ethical review was necessary following consultation with the Ethics and Governance Board of the University of Surrey. Guidance on patient data storage and management will be adhered to throughout.
CRD42022332039.
To describe nurses' self-perceived confidence in patient safety competencies and examine how work- and education-related factors influence this confidence.
A descriptive, explorative, cross-sectional survey design.
The Health Professional Education in Patient Safety Survey (H-PEPSS) was administered to a convenience sample of practising nurses and master's degree students in Estonia between May and September 2023. The following background variables were included: work experience, workplace, educational level and prior patient safety training. A total of 376 respondents completed the survey. Data were analysed using descriptive statistics and multivariable logistic regression, which returned the odds ratios for associations between background factors and confidence in patient safety.
Nurses perceived the highest confidence in understanding human and environmental factors, and the lowest confidence in teamwork. Having longer work experience was found to demonstrate a positive association with nurses' confidence in teamwork (OR = 1.03, 95% CI = 1.01–1.05) and safety culture (OR = 1.02, 95% CI = 1.00–1.04), compared to nurses with less experience. Nurses in smaller hospitals felt more confident managing safety risks (OR = 2.19, 95% CI = 1.14–4.21), compared to nurses from bigger hospitals. Master's degree students showed significantly higher confidence in responding to adverse events and safety culture than other respondents. Prior patient safety training was associated with greater confidence across several domains.
Confidence in patient safety competencies varies by domain and was found to be noticeably shaped by experience, education and workplace context. As such, targeted training and supportive environments are essential to ensuring high levels of competence among nursing professionals.
The findings underscore how improvements in training and organisational support can strengthen patient safety. Furthermore, retaining experienced and diversely educated nurses is key to building confidence and ensuring a competent workforce. The finding that respondents assess their confidence in teamwork as weak means that new educational interventions need to be designed and implemented to target this aspect of nursing care.
This study followed the STROBE guidelines for cross-sectional research.
No patient or public contribution.
Nurses are pivotal in EBHC implementation; however, its adoption remains limited, highlighting the need to investigate nurses' experiences and perceptions of their EBHC competence.
To critically appraise and synthesise qualitative evidence of nurses' experiences and perceptions of EBHC competence.
A qualitative systematic review.
The review followed the JBI methodology for qualitative systematic reviews. Inclusion criteria were qualitative studies published in Finnish, Swedish or English that explored nurses' experiences and perceptions of EBHC competence. Data were synthesised using JBI's meta-aggregation method and the findings were graded with the ConQual approach.
CINAHL, Medic, PubMed, Scopus and grey literature from EBSCO Open Dissertations and MedNar, searched in December 2023.
Seventeen qualitative studies were included. The study findings were generated from four synthesised findings with low confidence scores. The synthesised findings were: (1) Nurses' competence in Global Health, (2) Nurses' competence in enhancing Evidence generation, (3) Nurses' competence in optimising Evidence Transfer and (4) Nurses' competence in effective implementation of evidence. A new finding of this systematic review was that nurses did not express their experiences or perceptions on evidence synthesis.
Nurses' experiences of EBHC competence focus mainly on evidence implementation and global health. The lack of findings to evidence synthesis suggests that core principles of the EBHC model are not yet fully embedded in nursing practice. Nurses emphasised the need for greater support for developing EBHC competence.
Integration of EBHC into education, mentoring and adequate resources enhances nurses' competence, motivation and commitment to EBHC sub-dimensions, while also strengthening their professional confidence and development.
Strengthening nurses' EBHC competencies contributes to supporting the delivery of high-quality, effective and sustainable healthcare services.
PRISMA guidelines followed.
None.
PROSPERO-registered: CRD42021285179
Nintedanib is approved for the treatment of interstitial lung disease (ILD) with progressive pulmonary fibrosis (PPF). Real-life data on nintedanib treatment for this indication and on the combined use of antifibrotic and immunomodulatory drugs are limited. This study was aimed to collect detailed real-life data from all patients with non-idiopathic pulmonary fibrosis (IPF) PPF at the Hospital District of Helsinki and Uusimaa to identify the gap between patients included in randomised controlled trials and real-life patients.
This retrospective, real-life study characterised all patients with non-IPF PPF diagnosed and treated at the Hospital District of Helsinki and Uusimaa.
Thirty-one patients were identified as having non-IPF fibrotic ILD and meeting the PPF criteria in 2022 and 2023.
The most common diagnosis was connective tissue disease–ILDs, with 13 patients (42%), followed by fibrotic idiopathic non-specific interstitial pneumonia (iNSIP), with 10 (32%) patients. The most common radiological pattern was NSIP in 18 (58%) patients.
Among the 30 patients treated with nintedanib, six (20%) had to permanently discontinue treatment owing to side effects. Of the 19 patients who continued to receive nintedanib at the end of the follow-up period and for whom the dose was known, 9 (47%) continued to receive nintedanib at the full dose (150 mg two times per day) and 10 (53%) at the reduced dose (100 mg two times per day). Twenty-seven (87%) patients received immunomodulatory treatment at the time of PPF.
In our cohort, the underlying diagnoses and immunomodulatory treatments received significantly differed from those in the phase III licensing trial. More patients received nintedanib at a reduced dose than at a full dose, despite limited evidence of its efficacy and effectiveness. This highlights the large gap in evidence and the need for additional real-world data.
This study aimed to describe the types of psychological and physical symptoms experienced by healthcare professionals who became second victims after a patient safety incident and the impact of the incident on their social and professional lives.
Scoping review.
JBI methodology for scoping reviews and PRISMA-ScR for reporting were followed.
The search was conducted on June 13, 2024, using the CINAHL (EBSCO), Scopus, PubMed (Medline), Medic and PsycInfo (EBSCO) databases. A grey literature search was also conducted.
A total of 96 papers were included. Healthcare professionals experienced psychological symptoms such as anger, sadness and guilt after a safety incident. Physical symptoms were reported, including symptoms related to sleep and gastrointestinal symptoms. At the professional and social levels, the incident affected their work, relationships and well-being. Positive impacts were also noted.
This study provides a comprehensive overview of healthcare professionals' experiences after safety incidents. In addition, this study also captured the positive impacts of safety incidents, such as learning from mistakes.
By recognising the symptoms and impacts associated with the second victim syndrome, appropriate support can be provided for healthcare professionals.
The findings of this study can be used to identify the relevant harm to professionals after a safety incident, which could help to improve the well-being of these workers.
No patient or public contribution.
Open Science Framework, https://archive.org/details/osf-registrations-5cdmu-v1
To (1) analyse managers' experiences with handling patient safety incident reports in an incident reporting software, identifying key challenges; (2) analyse the incident report processes from the managers' perspective; (3) examine managers' perceptions of ways to support and improve health professionals' experiences of report-handling processes; and (4) investigate how, from their point of view, incident reporting software should be developed in the future.
A descriptive qualitative study.
Interviews and focus group discussions on Microsoft Teams from 11/2024 to 3/2025, including 16 participants, analysis with deductive and inductive content analysis.
Of 16 participants, 15 were managers and one was a patient safety expert. Most were nurse managers (n = 9). Four discussion themes were divided into 30 categories. Participants highlighted the need to improve the reporting software's terminology, classification and analysis tools. The use of artificial intelligence was desired but not currently integrated into the software. Participants were unsure of their skills to use all the software features. Clear and transparent handling processes, feedback, managers' behaviour and communication methods were seen as key to improving staff's experience with report processes. A real-time warning system was considered beneficial for various incident types. Specific questions must be answered before further developing such systems.
This study deepened the understanding of reporting software's challenges regarding its handling features. The handling processes of incident reports had multiple shortcomings, which may negatively affect health professionals' experiences in report handling. Real-time warning systems could assist healthcare managers in processing reports.
Organisational-level guidance for incident report processing is needed. Improvements to report processing and reporting software can improve shared learning and understanding of the status of patient safety.
No patient or public contribution.
COnsolidated criteria for REporting Qualitative research Checklist.
FreshRSS 