Conectar
by Tyler Marshall, Karin Olson, Adam Abba-Aji, Xin-Min Li, Richard Lewanczuk, Sunita Vohra
BackgroundShared decision-making (SDM) is a process in which healthcare providers (HCPs) and patients make health-related decisions collaboratively, guided by the best available evidence. Previous research suggests that emerging adults (aged 18–29) with mental health concerns might prefer SDM over traditional approaches; however, it remains unclear whether prevalent symptoms of anxiety, depression, or health-related quality of life (HRQL) are associated with the level of SDM that occurs during a clinical encounter.
ObjectiveThis study explored whether prevalent symptoms of anxiety, depression or HRQL among emerging adults were associated with the perceived level of SDM involvement during a single clinic visit at a primary care or community addiction and mental health (AMH) setting.
MethodsA cross-sectional survey was conducted using a subset of data (emerging adults and their HCPs) obtained from an overarching study on SDM in adults (18–64 years) in Alberta, Canada. Sociodemographic data were collected and reported descriptively. SDM was the primary outcome variable and was measured dyadically (i.e., the mean score between HCPs and patients) using the Alberta Shared Decision-Making Instrument (ASK-MI). Symptoms of patient anxiety/depression and HRQL were measured using the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D-5L. Pearson R correlation matrices were conducted to explore relationships between SDM, anxiety/depression, HRQL, and demographic variables.
ResultsForty-two emerging adult patients and 31 HCP dyads were recruited from six community AMH settings and eight primary care settings. The mean SDM dyad rating was 8.69 (SD, ± 2.01), indicating an “excellent” level of SDM. Symptoms of anxiety, depression, and HRQL were not significantly correlated with SDM dyad ratings during the clinic visit. Post hoc analyses showed that patient age was inversely related to SDM dyad ratings; R = −0.34, p = 0.03.
DiscussionIn this study, emerging adults reported high levels of perceived engagement in SDM, regardless of their HRQL or symptoms of anxiety and depression. However, several limitations, such as the risk of performance bias, should be considered when interpreting these findings. To strengthen the evidence base, future research should aim to address these limitations.
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 purpose of this manuscript is to offer an overview of knowledge regarding Evidence-Based Practice and implementation science. It addresses the question: What are the EBP implementation models used in nursing settings?
Discursive paper.
The databases were searched with the following keywords: ‘Nursing Faculty’, ‘Nurse educator’, ‘Academic’, ‘clinic’, ‘Evidence-based implementation’, ‘evidence-based practice’, ‘implementation’, ‘implementation science’, ‘undergraduate’, ‘nurse’. The search strategy aims to identify published studies. Eight databases were searched.
There are specific implementation models for implementing EBP: the IOWA Model, the Stetler Model, the Johns Hopkins Nursing Evidence-Based Practice Model, the Stevens Star Model, the Promoting Action on Research Implementation in Health Services (PARIHS), the Advancing Research and Clinical practice through close collaboration (ARCC) model. They were analysed according to the Nilsen classification. An evidence-based implementation project must be structured. First, it is necessary to choose an implementation model, then identify one or more implementation strategies, and finally, plan evaluation for implementation outcome. The use of implementation science ensures successful implementation or at least highlights barriers that need adjustment. Effective utilisation of implementation science facilitates the transfer of obtained results to similar contexts.
Implementation science complements the EBP process perfectly and ensures the proper implementation of evidence.
EBP mentors now have the entire structure of implementation science to succeed in implementing evidence-based data in both academic and clinical settings.
The discursive paper addresses the difficulties of implementing evidence in academic or clinical settings. Implementation science is the bridge between evidence and practice. Nurses now have everything they need to implement evidence-based practice successfully.
There was no patient or public involvement in the design or writing of this discursive article.
To explore healthcare professionals', patients', and family members' experiences of managing regular medications across the perioperative pathway in a specialist cancer hospital in Melbourne.
An exploratory qualitative study using a descriptive-interpretive approach.
Interviews were conducted with 11 patients and seven family members, and focus groups with 10 anaesthetists, seven surgeons, four nurses, and 10 pharmacists (N = 49) between October 2024 and April 2025. Transcripts were analysed using Braun and Clarke's reflexive thematic approach and mapped into the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 human factors framework.
Three interrelated themes were constructed: (1) Work system elements shaping perioperative medication management, encompassing medication and surgical contexts, documentation gaps, reliable medication information, communication infrastructures, roles and responsibilities, and perioperative area resources; (2) Processes influencing medication management practice, characterised by continuity of care at transition points and flagging processes, interdisciplinary collaboration and role interpretation in medication management, patient involvement, family member involvement, and healthcare professional perspectives; and (3) Outcomes of medication management, including patient and organisational outcomes, such as workflow inefficiencies, procedure cancellations, and unplanned readmissions.
Findings indicated that addressing the complexity of perioperative medication safety demands coordinated contributions across multiple professional disciplines. Strengthening interdisciplinary collaboration, clarifying shared responsibilities, embedding structured reconciliation processes at transitions of care, standardizing communication protocols, and involving patients and families are all critical strategies.
This study highlights the need for interdisciplinary coordination and clear role definitions, with nurses as the key contributor, to support collaborative medication decisions in perioperative cancer care.
This study explored challenges in managing regular medications during cancer surgery, offering insights to guide safer practices for perioperative teams, patients, and families in cancer care settings.
COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines.
None.
To assess the feasibility of conducting a definitive randomised controlled trial (RCT) to test the clinical and cost-effectiveness of a tailored exercise intervention compared with usual care for people aged 80 years and older with hip and/or knee osteoarthritis (OA) and comorbidities.
Two-arm, parallel-design, multicentre, pragmatic, feasibility RCT.
Four National Health Service outpatient physiotherapy services across England.
Adults aged 80 years and over with clinical hip and/or knee OA and ≥1 comorbidity.
Participants were randomised 1:1 via a central web-based system to be offered: (1) a 12-week tailored exercise programme or (2) usual care. Participants and outcome assessors were not blinded to treatment allocation.
(1) Ability to screen and recruit participants; (2) retention of participants at 14-week follow-up; (3) intervention fidelity (proportion of participants who received ≥4 intervention sessions as per protocol) and (4) participant engagement (assessed by home exercise adherence).
Between 12 May 2022 and 26 January 2023, 133 potential participants were screened, of whom 94 were eligible. The main reasons for ineligibility were symptoms not consistent with hip or knee OA (10/39, 25.6%) or already having had a physiotherapy appointment (8/39, 20.5%). 51 of 94 (54%) eligible participants were recruited. Participants had a mean age of 84 years (SD 3.5), 31 (60.8%) were female and 96.1% reported their ethnicity as White British (n=49/51). 45 of 51 participants (88%) provided outcome data at the 14-week follow-up time point. Four or more intervention sessions were attended by 13/25 (52%) participants. Home exercise log completion declined over time: 6/23 participants (26.1%) returned completed exercise logs for all 12 weeks. The median number of days home exercises were recorded each week was 5 (range 0–7).
This study demonstrated that a definitive trial would be feasible. Before proceeding, modifications to ensure recruitment of a diverse population and intervention fidelity should be addressed.
Despite low sensitivity and implementation challenges, the tuberculin skin test (TST) remains the standard-of-care tuberculosis (TB) infection test in Mexico. Interferon gamma release assays (IGRA) may overcome TST-related challenges. Within the confines of the local programmatic setting, this cross-sectional study evaluated the prevalence of TB infection (TBI) and concordance of TST and IGRA in three high-risk populations in Mexicali, Baja California, Mexico.
Household contacts (HHC) of individuals with TB, people who use drugs (PWUD), people deprived of liberty (PDL) and prison employees underwent evaluation for TBI using TST and QIAreach, a novel IGRA. Prevalence of infection, concordance of test results and reactivity trends of time-to-results (TTR) by TST-induration size were assessed.
In total, 214 of 411 (52.07%) people who had TST and 269 of 460 (58.48%) people who had IGRA tested positive for TBI. Frequency of infection varied across risk groups (HHC 29 (29.6%); PWUD 67 (70.53%); PDL 111 (56.06%) and prison employees 7 (35.0%), p20 mm, p=0.05).
All risk groups had a high frequency of TBI, necessitating locally tailored guidelines for screening, treatment and management of TBI to optimise care for vulnerable populations.
Primary care electronic health records provide a rich source of information for inequalities research. However, the reliability and validity of the research derived from these records depend on the completeness and resolution of the codelists (ie, collections of medical terms/codes) used to identify populations of interest. The aim of this project was to develop comprehensive codelists for identifying people from ethnic minority groups, people with learning disabilities (LDs), people with severe mental illness (SMI) and people who are transgender.
We followed a three-stage process to define and extract relevant codelists. First, groups of interest were defined a priori. Next, relevant clinical codes, relating to the groups, were identified by searching Clinical Practice Research Datalink (CPRD) publications, codelist repositories and the CPRD Code Browser. Relevant codelists were extracted and merged according to group, and duplicates were removed. Finally, the remaining codes were reviewed by two general practitioners (GPs).
The curated codelists were compared using a representative sample in the UK. The frequencies of individuals identified using the curated codelists were assessed and compared with widely used alternative codelists.
Comprehensiveness was assessed in a representative CPRD population of 10 966 759 people.
After removal of duplicates and GP review, codelists were finalised with 325 unique codes for ethnicity, 558 for LD, 499 for SMI and 38 for transgender. Compared with comparator codelists, an additional 48 017 (76.6%), 52 953 (68.9%) and 508 (36.9%) people with LD, SMI or transgender code were identified. The proportions identified for ethnicity, meanwhile, were consistent with expectations for the UK (eg, 6.50% Asian, 2.66% black and 1.44% mixed).
The curated codelists are more sensitive than those widely used in practice and research. Discrepancies between national estimates and primary care records suggest potential record/retention issues. Resolving these requires further investigation and could lead to improved data quality for research.
We calculate positive predictive values (PPVs) of patients presenting with unexpected weight loss (UWL) being diagnosed with cancer within 6 months, using data from a population of Australian primary care patients to replicate results from a previous UK study.
A diagnostic accuracy study involving calculation of the PPV for any cancer using retrospective data from routinely collected electronic healthcare records. The index date is defined as the first recorded UWL presentation and the reference standard is cancer diagnosis within 6 months of the index date.
This study uses primary care data from the Patron primary care database, linked to hospital admissions data and the Victorian Cancer Registry. We include only patients who presented to their General Practitioners (GPs) at least once between 1 July 2007 and 1 February 2022.
Patients were included if they were at least 18 years of age at the index date, had no previous diagnosis of cancer or previous weight loss intervention, including being prescribed medications for weight loss. 13 306 patients out of a primary care population of 1 791 051 patients were identified that met the eligibility criteria.
When stratified by age, sex and smoking status, we found PPVs lower than those derived in a previous UK primary care study, though still above 3% for male non-smokers over 60, female smokers over 70 and all males over 70. Patients from ages 60–79 with at least one abnormal blood test result had PPVs consistently above 3%, while overall, patients with abnormal blood test results have PPVs of up to 35%.
We confirmed that many PPVs, while consistently below those derived in the UK study, are above clinically significant thresholds and increasing with age and the number of different abnormal blood test results.
Acknowledging equality, diversity and inclusion (EDI) in research is not only a moral imperative but also an important step in avoiding bias and ensuring generalisability of results. This protocol describes the development of STAndards for ReporTing EDI (START-EDI) in research, which will provide a set of minimum standards to help researchers improve their consistency, completeness and transparency in EDI reporting. We anticipate that these guidelines will benefit authors, reviewers, editors, funding organisations, healthcare providers, patients and the public.
To create START-EDI reporting guidelines, the following five stages are proposed: (i) establish a diverse, multidisciplinary Steering Committee that will lead and coordinate guideline development; (ii) a systematic review to identify the essential principles and methodological approaches for EDI to generate preliminary checklist items; (iii) conduct an international Delphi process to reach a consensus on the checklist items; (iv) finalise the reporting guidelines and create a separate explanation and elaboration document; and (v) broad dissemination and implementation of START-EDI guidelines. We will work with patient and public involvement representatives and under-served groups in research throughout the project stages.
The study has received ethical approval from the Imperial College London Research Ethics Committee (study ID: 7592283). The reporting guidelines will be published in open access peer-reviewed publications and presented in international conferences, and disseminated through community networks and forums.
The project is pre-registered within the Open Science Framework (https://osf.io/8udbq/) and the Enhancing the Quality and Transparency of Health Research Network.
Endocrine disorders, such as hypo/hyperthyroidism and diabetes, affect over 5% of the world’s population, with an additional 5% of cases remaining undiagnosed. Despite the increasing prevalence of endocrine disorders, especially in low- to middle-income countries (LMICs), limited research offers comprehensive guidance on treating this complex medical field. This scoping review aims to provide evidence-based recommendations for efficient, effective and accessible treatment of paediatric thyroid conditions and diabetes in LMICs.
Scoping review guidelines outlined by the Preferred Reporting Items for Systematic and Meta-Analysis Extension for Scoping Reviews, using the Joanna Briggs Institute (JBI) methodology to analyse healthcare administration approaches in LMICs.
PubMed, Google Scholar, MEDLINE, EconLit, Science Direct and Scopus were searched using a set of search terms from 19 December 2023 to 16 January 2024. An additional high-level search was performed in May 2025.
Selection of a variety of peer-reviewed publications with a setting in LMICs. Articles were included if they described an intervention strategy related to select paediatric chronic diseases, endocrine conditions or non-communicable diseases. The treatment strategies in question were government initiatives, mobile health, specialised programmes and primary care.
One reviewer manually reviewed articles and documented findings on Microsoft Excel. In accordance with JBI methodological guidelines, no risk of bias assessment or quality appraisal of included studies was conducted.
After reviewing primary care, specialised care, government intervention programmes and mobile care initiatives within developing countries, primary care with an emphasis on task shifting emerged as the best approach for treating paediatric endocrine disorders.
Despite recommendations favouring specialised care or government interventions, primary care proves to be the optimal method for treating endocrine conditions. Given limited healthcare funding in LMICs, implementing primary care initiatives can achieve significant health outcomes while maximising resources.
Evidence-based practice (EBP) should be implemented in clinical settings and practiced by registered nurses as it improves healthcare quality, safety, costs, and patient outcomes. For this to occur, nurses need to be skilled and acculturated. An EBP culture needs to be developed and sustained, both in initial academic programs and in clinical settings. Implementation models already exist and are being used, but outcomes are not consistently measured.
The aim of this scoping review was to gather and map the use of EBP implementation models as well as their implementation strategies and outcomes.
The methodology for the JBI Scoping Reviews was applied. The databases queried were PubMed, CINAHL, EMBASE, EMCARE, AMED, BNI, HMIC, PsycInfo. Inclusion criteria were as follows: Any primary study that describes the implementation of EBP in nursing, clinical, or academic settings. Studies using the following EBP implementation models were included: the ARCC Model, ARCC-E Model, IOWA Model, Stetler Model, Johns Hopkins Nursing EBP Model, ACE Star Model as well as PARIHS and i-PARIHS. They must have used Proctor's taxonomy for implementation outcomes as well as described implementation strategies according to the ERIC classification. Data extraction was performed by four independent reviewers in February 2024. There was no language or date limitation. Three independent reviewers performed an initial selection on titles and abstracts. Reading of the full texts was carried out by two independent reviewers using the JBI SUMARI.
A total of 2244 articles were retrieved. After removing duplicates and applying the inclusion criteria, 26 articles were reviewed, and data extracted. The most used implementation model was the PARiHS or i-PARiHS model followed by the IOWA model, the ARCC model combined with the JHNEBP model and the Stetler model. Nearly all studies used the implementation strategy domain “Use evaluative and iterative strategies” of ERIC classification. Overall, the selected studies used between 1 and 2 outcomes from Proctor's eight available.
The underuse of existing taxonomies (Proctor, ERIC) prevents an exhaustive mapping of the use of implementation models. The vocabulary used is too vague, and the implementation strategies are sometimes poorly described. An effort needs to be made to report on all work done to transfer the results to other settings and thus improve health care practices.
Semi-urgent surgery where surgical intervention is required within 48 h of admission and the patient is medically stable is vulnerable to scheduling delays. Given the challenges in accessing health care, there is a need for a detailed understanding of the factors that impact decisions on scheduling semi-urgent surgeries.
To identify and describe the organisational, departmental and contextual factors that determine healthcare professionals' prioritising patients for semi-urgent surgeries.
We used the Joanna Briggs Institute guidance for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist. Four online databases were used: EBSCO Academic Search Complete, EBSCO Cumulative Index to Nursing and Allied Health Literature, OVID Embase and EBSCO Medline. Articles were eligible for inclusion if they published in English and focussed on the scheduling of patients for surgery were included. Data were extracted by one author and checked by another and analysed descriptively. Findings were synthesises using the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework.
Twelve articles published between 1999 and 2022 were included. The Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework highlighted themes of emergency surgery scheduling and its impact on operating room utilisation. Gaps in the management of operating room utilisation and the incorporation of semi-urgent surgeries into operating schedules were also identified. Finally, the lack of consensus on the definition of semi-urgent surgery and the parameters used to assign surgical acuity to patients was evident.
This scoping review identified patterns in the scheduling methods, and involvement of key decision makers. Yet there is limited evidence about how key decision makers reach consensus on prioritising patients for semi-urgent surgery and its impact on patient experience.
No Patient or Public Contribution.
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