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Mapping the current landscape of Klinefelter Syndrome registries: a scoping review

Por: Stephenson · F. · Morris · A. · Arulkkumaran · N. · Lorenzo · A. · Mehta · S. · Cotton · A. · Yap · T.
Objectives

This scoping review identifies existing registries collecting data on Klinefelter’s syndrome (KS) patients and what data are collected, with the purpose of identifying any KS-specific registries. Findings to be used to inform future registry development.

Design

A comprehensive scoping review was conducted. Multiple sources were reviewed and articles screened based on inclusion criteria and exclusion criteria.

Data sources

Searches performed across multiple sources including PubMed, Embase, the Cochrane Library, WHO International Clinical Trials Registry Platform, Orphanet, EU Clinical Trials Register, King’s College London Library and charity organisation webpages.

Eligibility criteria

The included studies were required to focus on KS patients with reported data from an active registry that routinely collects data on KS patients.

Data extraction and synthesis

Basic information about registries identified in included articles was extracted. Registries identified were contacted with a standardised set of questions to collect additional contextual information. Findings are presented in tables.

Results

The scoping review included 18 articles. From those, 10 registries storing KS patient data were identified. Only one of those registries was KS-specific. Only three out of 10 registries collected data that encompassed genetic, clinical and social variables. Most data included in registries were collected exclusively from medical records, although some registries included data from patient surveys. Registries that received government funding had more KS participants than those that did not.

Conclusions

With only one KS-specific registry existing worldwide and none within the UK, this review has identified a need for the development of further KS-specific registries. Data collected could be used to develop an accurate KS phenotype and therefore lead to increased diagnosis of the disorder, improving the lives of people with KS.

Microbiota-gut-brain axis and treatment resistance in epilepsy: a multicentre prospective study protocol (CARE)

Por: Borghi · E. · Tassi · L. · dOrsi · G. · Uzzau · S. · Pivari · F. · Ricci · E. · Longoni · G. · Mingarelli · A. · Previtali · R. · Berardi · R. · De Diego · L. · Vigano · I. · Olivotto · S. · Compierchio · E. · Veggiotti · P. · Canevini · M. P. · Vignoli · A.
Introduction

Approximately one-third of people with epilepsy (PWE) experience resistance to treatment, including pharmacological therapies, epilepsy surgery, vagus nerve stimulation (VNS) and dietary interventions such as the ketogenic diet (KD). Emerging evidence suggests that the gut microbiota may influence seizure susceptibility and treatment response through the microbiota-gut-brain axis, potentially contributing to treatment resistance. The MiCrobiota-gut-brain Axis in Resistant Epilepsy project investigates how gut microbial features and associated host epigenetic signatures affect clinical outcomes in PWE undergoing diverse treatment strategies.

Methods and analysis

This is a multicentre, prospective, longitudinal study involving four clinical centres in Italy and one self-financing partner. Participants aged 3–50 years will be enrolled and stratified into four intervention cohorts: newly diagnosed drug-naïve epilepsy scheduled to start anti-seizure medications, focal drug-resistant epilepsy (DRE) undergoing epilepsy surgery, DRE receiving VNS, and DRE initiating KD. Clinical assessments (including body mass index calculation, self-reported monthly seizure count, dietary evaluation, quality of life scale and gastrointestinal symptoms scale), electroencephalography, MRI and biological sample collection (stool and blood) will be obtained at baseline and longitudinally at two or three timepoints over a 12-month observation period. Gut microbiota changes over time will be assessed via metagenomics (using 16S ribosomal RNA sequencing) and metaproteomics; the associated host DNA methylation profiles will be obtained from blood using Illumina EPIC arrays. Primary endpoints include identification of microbial or host methylation changes predictive of therapeutic response (ie, reduction from baseline in monthly seizure count) to the intervention. Data will be analysed using multivariate models and mixed-effect regression. Further, omics data and corresponding metadata will be integrated using multi-omics approaches to identify molecular signatures biomarkers predictive of treatment response and prognosis in PWE.

Ethics and dissemination

The study received ethical approval from the Research Ethic Board (Comitato Etico Territoriale Lombardia 3, ID 4896 – parere numero 4896_17.07.2024_N_bis). All participants or their legal guardians will provide written informed consent. Results will be disseminated through peer-reviewed publications, conference presentations or lay summaries targeting patient organisations.

Trial registration number

ClinicalTrials.gov Identifier NCT07010445, registered on 2 May 2025.

Patient Safety Competencies, Clinical Learning Environment and Unfinished Care From the Perspective of Nursing Students: A Multinational Study

ABSTRACT

Aim

To assess perceived patient safety competencies among nursing students and to examine their associations with their perceptions regarding clinical learning environment and unfinished nursing care.

Design

An international comparative cross-sectional study.

Methods

A total of 1442 nursing students from the Czech Republic, Italy, Slovakia, and Türkiye participated between February and December 2025. Data were collected using the Health Professional Education in Patient Safety Survey, the Clinical Learning Environment, Supervision and Nurse Teacher scale, and the Unfinished Nursing Care Survey for Students. Descriptive statistics, non-parametric tests, Spearman correlations, and multivariate general linear modelling were applied.

Results

Students reported significantly higher patient safety competencies in clinical compared with academic settings (p ≤ 0.001). Significant cross-country differences were observed across all competency domains (p ≤ 0.001). Perceived patient safety competencies were positively correlated with the overall quality of the clinical learning environment (r = 0.356–0.420; p < 0.001) and negatively correlated with unfinished nursing care (r = −0.107 to −0.171; p < 0.001). Multivariate analysis demonstrated that pedagogical atmosphere, premises of nursing care, supervisory relationship, and particularly the role of the nurse teacher were significant predictors of patient safety competencies.

Conclusion

The development of nursing students' patient safety competencies is closely linked to the quality of clinical learning environments. Strengthening educational and organisational conditions within clinical placements may play an important role in preparing future nurses for safe clinical practice.

Implications for the Profession and/or Patient Care

Improving the quality of clinical learning environments, strengthening supervision, and addressing unfinished nursing care may support the development of nursing students' patient safety competencies and contribute to safer patient care.

Reporting Method

The study was carried out according to the STROBE checklist.

Patient or Public Contribution

No Patient or Public Contribution.

Exploring Continuous Pressure Monitoring to Inform Decisions for Pressure Injuries in the Community: Secondary Analysis Using a Mobility and Pressure Exposure Algorithm

ABSTRACT

Frailty in community-dwelling individuals often leads to prolonged periods in bed or sitting, increasing their risk of pressure injury development. The Quality Improvement project ‘Pressure Reduction through cOntinuous Monitoring In the community SEtting’ (PROMISE) implemented the use of continuous pressure monitoring (CPM) to inform interventions. A secondary analysis of PROMISE data involving 17 patients was examined before and after the intervention. A novel algorithm using duration and magnitude of pressure signatures at the buttock area was estimated from the CPM data and an algorithm based on the sigmoid relationship between pressure and time was used to categorise risk pre- to post-intervention. The CPM intervention helped inform changes in support surface, posture and mobility advice. Duration and magnitude of pressure signatures revealed a high degree of inter-subject variability. At baseline 35% of (6/17) patients spent prolonged periods with potentially harmful interface pressures (high to very high exposure). Trends of improvements post-PROMISE intervention were observed, with 24% (4/17) in these higher exposure categories. This study demonstrated how CPM could be used to inform interventions for individuals living with pressure injuries in the community. An algorithm was used to understand trends in posture, mobility, and pressure exposure, showing some improvement pre- to post-intervention.

Association between exposure to non-steroidal anti-inflammatory drugs in pregnancy and miscarriage risk: a French nationwide retrospective cohort study

Por: Duong · C.-H. · Quentin · E. · Demailly · R. · Quantin · C. · Escolano · S. · Botton · J. · Tubert-Bitter · P. · Ahmed · I.
Objective

To evaluate the association between non-steroidal anti-inflammatory drugs (NSAIDs) and miscarriage, which remains elusive in the actual literature, using modelling approaches to mitigate time-related bias.

Design

Nationwide, population-based retrospective cohort study.

Setting

The study used data from the French National Mother-Child Register (EPI-MERES), developed from the French National Health Data System containing the health information (hospital admissions, drug dispensing, comorbidities, etc.) of about 99% French population.

Participants

4 857 907 pregnancies ended in a live birth, a stillbirth or a miscarriage from 2013 to 2019.

Interventions

Exposure to NSAIDs from 2 weeks before conception to the 20th week of pregnancy.

Main outcome measures

Miscarriage (ie, spontaneous abortion before the 20th week of pregnancy) from the sixth week of pregnancy. The Cox regression with a time-dependent exposure that incorporated a 3-day lag was used to estimate HRs and their 95% CIs adjusted for maternal characteristics. The 3-day lag period allows for addressing protopathic bias.

Results

In total, there were 163 666 (3,37%) miscarriage cases, and 349 294 (7.19%) pregnancies were exposed to NSAIDs. Unexposed pregnancies were used as the reference category in all analyses. In the main analysis, exposure to NSAIDs increased the risk of miscarriage (HR, 1.83; 95% CI 1.81 to 1.86). The effect of individual drugs was heterogeneous, with 7 of the 19 drugs evaluated shown to increase the risk (flurbiprofen had the highest risk (HR, 3.28; 95% CI 3.15 to 3.41) and naproxen the lowest (HR, 1.09; 95% CI 1.01 to 1.18)). In the sensitivity analyses, increasing the lag time decreased the estimated HR (from HR, 2.25; 95% CI 2.21 to 2.28 with no lag to HR, 1.56; 95% CI 1.54 to 1.59 with a 7-day lag). Overall, the risk of miscarriage remained statistically significant in all the analyses.

Conclusions

Our study found that early exposure to NSAIDs could increase the risk of miscarriage. This finding contributes to the body of evidence on their safety profile and may help inform future recommendations for their use in pregnant women.

Peer network approaches for improving HIV testing, prevention and care utilisation among men in sub-Saharan Africa: a scoping review

Por: Otambo · W. O. · Harling · G. · Inghels · M. · Otto · M. · Blose · N. · Tram · K. H. · Tanser · F. · Mee · P.
Introduction

Limited male engagement in HIV prevention and care is a global challenge more pronounced in sub-Saharan Africa (SSA) contributing to ongoing transmission. However, peer network interventions show promise in improving engagement.

Objective

To map and synthesise evidence on peer network interventions for HIV prevention and care among men in SSA, with a focus on the types of strategies used, populations reached and how these interventions address cultural, social and structural barriers across the HIV care cascade.

Design

Scoping review of peer-reviewed literature, conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Setting

Community and facility-based HIV prevention and care settings across multiple countries in SSA.

Participants

Populations included men having sex with men, men in key occupational groups (fishermen, truck drivers), adolescents and young people, and men living with HIV. Studies not conducted in SSA, not peer-reviewed or not focused on male peer networks were excluded.

Interventions

Peer network interventions included peer education, peer navigation, HIV self-testing (HIVST) distribution, adherence support groups, disclosure and stigma-reduction counselling, technology-enabled peer support (SMS and social media) and community-based antiretroviral therapy (ART) delivery. Intervention duration and intensity varied across studies.

Outcome measures

Primary outcomes included HIV testing uptake, linkage to care, ART initiation, adherence, retention in care and viral suppression. Secondary outcomes included stigma reduction, disclosure and engagement among hard-to-reach male populations.

Methods

We conducted a review of literature published between November 2013 and November 2024, searching PubMed, Web of Science, Scopus and Cochrane databases. Studies were included if they examined peer network approaches in HIV prevention and care among men in SSA.

Results

A total of 905 records were identified, of which 75 studies met the inclusion criteria. Peer network interventions were implemented across diverse SSA contexts and male populations. Strategies such as peer-led education, social diffusion models, HIVST distribution and technology-enabled peer support consistently improved HIV testing uptake, linkage to care, ART initiation and adherence. Contextually tailored interventions such as community-based outreach addressing occupational risk environments and economic vulnerabilities were particularly effective in engaging men traditionally underserved by facility-based services. However, challenges persisted, including variable linkage to care following HIVST and sensitivity to user costs.

Conclusions

Peer-led interventions in HIV care for men in SSA effectively address cultural, social and structural barriers, improving testing, ART adherence and viral suppression. Tailored, technology-enhanced and community-based approaches ensure equitable HIV prevention and treatment outcomes, despite challenges like linkage to care.

Publication Dynamics Where Evidence Is Missing: Mapping Empty Reviews in Nursing

ABSTRACT

Introduction

The production of science is characterized by socio-political and technological forces that influence what knowledge is produced. In this context, empty reviews have received little attention, with debate ranging over the pros and cons of their publication. However, their dissemination may improve the ability to recognize and prioritize research gaps. The main aim of the study was to map empty reviews published in nursing science.

Materials and Methods

A scoping review in accordance with Arksey and O'Malley, Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The review protocol was registered in the Open Science Framework database in April 2025. Four databases and grey literature were searched; there were eligible scoping or systematic reviews defined as “empty” in the field of nursing. A modified framework of Patterns, Advances, Gaps, Evidence for practice, and Research recommendations was used to summarize the extracted data.

Results

Fifteen empty reviews were identified. In terms of Patterns, the empty reviews were mainly published in high-income countries over the last 10 years and related to clinical practise and outcomes, education and training, organizational and human resources, and approaches to maternity care, mental health, and nursing education. In general, reporting guidelines were used, while funding was not documented. In terms of Recommendations, more primary studies, the development of tools and the strategic use of empty reviews to inform the funding and research agenda were suggested.

Linking Evidence to Action

Empty reviews in nursing may indicate neglected or emerging areas that can help orient research agendas to ensure equity-oriented priorities and reduce the marginalization of under-investigated topics. Recognizing empty reviews as legitimate scholarly outputs supports transparent mapping of knowledge gaps, helping funders, institutions, and research programs direct resources to under-investigated areas. Dedicated registries that publicly report empty reviews, establish minimum reporting standards, and require explicit keywords in titles and abstracts would improve transparency and accessibility, and stimulate targeted primary research that can turn “empty” areas into active inquiry. From this perspective, empty reviews may attract research investment rather than be seen as methodological failures.

Predictors of unplanned 30-day hospital readmission: a retrospective cohort study in north-east Italy

Por: Sartor · G. · Fusco · M. · Milana · M. · Marcon · E. · Battagello · J. · Zardetto · A. · Ruggieri · M. G. · Grotto · G. · Rigon · L. · Arcara · G. · Conte · P. · Buja · A.
Objective

Unplanned hospital readmissions within 30 days of discharge measure the quality of healthcare. This study aims to identify the characteristics of patients at higher risk of readmission.

Design

Retrospective cohort study.

Setting

North-east Italy (Marca Trevigiana Local Health Authority).

Data source

The study examined a total of 39 467 index admissions from hospital discharges (SDO) in the 890 000-inhabitant area during 2022.

Outcome measure

Readmission rates and 95% CIs were computed by risk factor, age and type of admission (surgical or medical). A logistic mixed-effects model was used to estimate readmission OR, adjusting for potential confounders.

Results

A total of 2197 readmissions occurred within 30 days of the index admission, resulting in an overall rate of 30-day readmissions of 6.7% (CI 6.4% to 7.0%). The median time to readmission was 11 days (IQR 5 to 20). In the multivariate analysis, after adjusting for age and sex, the following clinical conditions were associated with a higher risk of readmission: alcohol-related disease (OR=2.06, CI 1.36 to 3.13), metastatic cancer (OR=1.98, CI 1.57 to 2.50), epilepsy (OR=1.93, CI 1.36 to 2.75), dialysis or end-stage kidney disease (OR=1.92, CI 1.39 to 2.66), chronic obstructive pulmonary disease (OR=1.88, CI 1.49 to 2.36), stoma (OR=1.72, CI 1.22 to 2.44), transplant (OR=1.62, CI 1.03 to 2.55), being bedridden (OR=1.57, CI 1.28 to 1.93), anaemia (OR=1.57, CI 1.35 to 1.83), urinary tract infection (OR=1.54, CI 1.30 to 1.83), pneumonia (OR=1.52, CI 1.31 to 1.75), dementia (OR=1.49, CI 1.24 to 1.79), diabetes (OR=1.37, CI 1.17 to 1.61) and transfusion (OR=1.34, CI 1.03 to 1.73).

Conclusion

Several chronic and acute conditions at index admission significantly increased the risk of readmission. Strengthening transitional care, outpatient services and palliative care could mitigate readmissions.

Trans-sectoral patient pathways in urgent and emergency care (TRANSPARENT study): protocol for a prospective, mixed-methods study in Germany

Por: Bienzeisler · J. · Hertwig · M. K. · Heidemeyer · H. · Alhaskir · M. · Majeed · R. W. · Kombeiz · A. · Hoy · W. · Huening · S. · Goettgens · F. · Unterkofler · J. · Rademacher · S. · Panagiotidis · D. · Marewski · V. · Sommer · A. · Schirrmeister · W. · Walcher · F. · Otto · R. · Ehrentr
Introduction

Urgent and emergency care in Germany is delivered across multiple, loosely connected sectors. In the absence of coherent, time-resolved data on patient movements between emergency medical services (EMS), out-of-hours ambulatory care, emergency departments (EDs) and inpatient care, inefficiencies and coordination gaps remain difficult to quantify. A process-centric, trans-sectoral analysis is required to characterise real-world patient pathways and identify actionable levers for improvement. The study aims to reconstruct, model and analyse patient pathways for urgent health complaints across all relevant sectors of the healthcare system in a German model region.

Methods and analysis

We will employ a mixed-methods observational study design. Routine data from EMS, out-of-hours ambulatory care, EDs and subsequent inpatient care will be pseudonymised at source, linked via a trusted third party and analysed within a trusted research environment. Time-stamped event logs will support process mining for discovery, conformance and performance analysis alongside descriptive statistics with stratification by context, such as setting, time of day, urgency and patient cohorts. Anonymous cross-sectional surveys of patients and front-line professionals, complemented by quarterly snapshot surveys in out-of-hours ambulatory care and interviews, will provide convergent evidence on the motives, barriers and coordination of utilisation behaviour. Enrolment for surveys is anticipated from the fourth quarter of 2025; routine data capture covers 1 January–31 December 2026; analyses and dissemination run until 31 December 2027.

Ethics and dissemination

The study received ethical approval from the Ethics Committee of the Medical Faculty at RWTH Aachen University (EK 25-351). Survey modules are conducted anonymously with voluntary participation and without collection of direct identifiers; routine care data are processed in pseudonymised form and analysed within a trusted research environment. Stakeholder interviews will be conducted with informed consent. Results will be disseminated through peer-reviewed publications, conference presentations and summary reports for participating institutions and stakeholders, complemented by plain-language materials to support patient-centred navigation.

Trial registration number

DRKS00035916.

Multicentre international observational study on airway management for anaesthesia: the STARGATE study protocol

Por: Russotto · V. · Sansovini · C. · Muraccini · M. · Collino · F. · Myatra · S. N. · Higgs · A. · Brewster · D. · Curic Radivojevic · R. · Parotto · M. · Karamchandani · K. · Landoni · G. · Sorbello · M. · Monfroglio · M. · Rovescala · G. · Martinelli · P. · Tinelli · O. · Meessen · J. · Be
Introduction

More than 300 million major surgical procedures are carried out under general anaesthesia each year worldwide, and advanced airway management remains one of the leading daily challenges for clinicians. Data from large international prospective cohort studies on adverse events such as cardiovascular collapse, cardiac arrest and severe hypoxaemia during advanced airway management to facilitate anaesthesia are lacking.

Methods and analysis

The International obServational sTudy on AiRway manaGement in operAting room and non-operaTing room anaEsthesia (STARGATE) study will be an international prospective observational cohort study describing the incidence of major adverse events associated with advanced airway management (tracheal intubation or supraglottic airway device placement) for general anaesthesia in the operating and non-operating room for surgery and medical procedures. The secondary aim will be to describe the practice of airway management in a large international cohort. Critically ill patients will be excluded from this study. Data on patients’ characteristics, type of procedure and the adopted airway management strategy, post-procedure adverse events, operator characteristics and in-hospital mortality will be prospectively collected. The study aims to enrol 10 500 patients.

Ethics and dissemination

The study has been approved by the Ethics Committee of the coordinating centre (Comitato Etico Interaziendale AOU San Luigi Gonzaga, N° 25/2023). Each of the participating centres will then seek approval of their local Ethics Committee before enrolment. Data will be disseminated to the scientific community by original articles submitted to international peer-reviewed journals.

Trial registration number

NCT05759299.

Evidence-based team intervention to reduce diagnostic errors in anaemia and CKD diagnoses in primary care: protocol for a stepped-wedge cluster RCT

Por: Novikov · Z. · Mehra · N. · Li · X. · Wells · R. · Ottosen · M. · Hwang · K. · Avritscher · E. B. C. · Green · C. · Lee · K. H. · Oguin · X. · Janecka · M. · Espinoza · M. · Adebowale · B. · Araya · A. · Wahed · A. · Thomas · E.
Introduction

Diagnostic errors in primary care are common, particularly in the interpretation and follow-up of abnormal haemoglobin (Hgb) and estimated glomerular filtration rate (eGFR) results. These errors frequently result in missed or delayed diagnoses of serious conditions such as anaemia and chronic kidney disease. This protocol describes a stepped-wedge cluster randomised controlled trial designed to evaluate a novel, evidence-based, team-based intervention aimed at improving diagnostic safety and efficiency.

Methods and analysis

The study will be conducted across 12 University of Texas Physicians (UTPs) primary care clinics in Houston, Texas, USA. Adult patients (≥18 years) with newly identified abnormal Hgb or eGFR results will be eligible for inclusion. The intervention integrates automated tracking of abnormal laboratory results, nurse navigators to support patient follow-up and engagement, and clinical pathologists to provide diagnostic guidance to primary care providers. The primary outcome is diagnostic safety, defined as the proportion of patients who receive a correct diagnosis within 6 months. Secondary outcomes include diagnostic efficiency, appropriate test utilisation, cost-effectiveness, patient activation and implementation metrics such as acceptability, fidelity and sustainability. The study will also explore barriers and facilitators to successful implementation using mixed-methods evaluation.

Ethics and dissemination

This trial has been approved by the Institutional Review Board at The University of Texas Health Science Center at Houston. Study results will be disseminated through peer-reviewed publications and conference presentations, and findings will be reported to UTP leadership to inform potential system-wide implementation.

Trial registration number

NCT05735314.

Patient Engagement Interventions to Improve Medication Management of Older Patients Across Transitions of Care: A Mixed Methods Systematic Review

ABSTRACT

Aims

Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.

Design

A mixed-methods systematic review.

Methods

A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.

Data Sources

Six databases were searched from inception to April 2024.

Results

The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.

Conclusions

While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.

Implications for the Profession and/or Patient Care

Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.

Impact

Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.

Reporting Method

PRISMA guidelines.

Patient or Public Contribution

No patient or public contribution.

Protocol Registration

PROSPERO (registration number CRD42024557385).

Reliability and Validity of the Italian Translation of the Updated Version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT 2.0)

ABSTRACT

The study aimed to translate the PUKAT 2.0 tool from English to Italian. This was an adaptation and validation study; the validity of the Italian version was determined through content validity, item validity and construct validity. The reliability of the instrument was assessed by conducting a test–retest analysis on a sample of 62 nurses. The I-CVI indices were above the threshold of 0.78 for 91% of the questions, and according to the S-CVI index, 96% of the evaluators agreed that the questionnaire was highly relevant. The overall values for item difficulty were good, with two items being too difficult and none being too easy. The item discriminant index was overall good and reasonable, low for four items. The overall ICC was poor to moderate with a value of 0.48 (95% CI 0.26–0.65). The instrument has proven to be a good starting point although not yet completely reliable, as it clearly requires more basic preparation on the part of the staff, further modifications regarding the reliability and clarity of the questions and more training of the nursing staff if it is to be used in the Italian context.

Intelligent monitoring to predict atrial fibrillation (NOTE-AF): clinical study 1 for the 'Health virtual twins for the personalised management of stroke related to atrial fibrillation (TARGET) project - a protocol for a prospective cohort analysis

Por: Essa · H. · Johnston · B. · Lip · G. Y. H. · Ortega-Martorell · S. · Williams · K. · Welters · I. D. · TARGET Consortium · Ortega-Martorell · Olier · Mistry · Knowles · Bellfield · Aikodon · Lotto · Jones · Dawson · Thijssen · Maganaris · Baltzopoulos · McDowell · Smith · Ohlsson
Introduction

Atrial Fibrillation (AF) is the most common arrhythmia worldwide affecting an estimated 5% of people over the age of 65 and is a leading cause of stroke and heart failure. Identification of patients at risk allows preventative measures and treatment before these complications occur. Conventional risk prediction models are static, do not have flexibility to incorporate dynamic risk factors and possess only modest predictive value. Artificial intelligence and machine learning-powered health virtual twin technology offer transformative methods for risk prediction and guiding clinical decisions.

Methods and analysis

In this prospective observational study, 1200 patients will be recruited in two tertiary centres. Patients hospitalised with acute illnesses (sepsis, heart failure, respiratory failure, stroke or critical illness) and patients having undergone high-risk surgery (major vascular surgery, upper gastrointestinal surgery and emergency surgery) will be monitored with a patch-based remote wireless monitoring system for up to 14 days. Clinical and electrocardiographic data will be used for modelling the risk of new-onset AF. The primary outcome is episodes of AF >30 s and will be described as ratio of episodes/patient and as percentage of patients having episodes of AF. Secondary outcomes include 30-day and 90-day readmission rates and complications of AF.

The aim of this study is to generate data for the development and validation of health virtual twins predicting onset of AF in an at-risk population. The intelligent monitoring to predict atrial fibrillation (NOTE-AF) study is part of the TARGET project, a Horizon Europe funded programme which includes risk prediction, diagnosis and management of AF-related stroke (https://target-horizon.eu/).

Ethics and dissemination

The study has received approval by the Health Research Authority and the National Research Ethics Service (REC reference 24/NW/0170, IRAS project ID: 342528) in the UK and has been registered on clinicaltrials.gov (NCT06600620). Results will be disseminated as outlined in the TARGET protocol to communicate project ideas, activities and results to diverse audiences.

Trial registration number

NCT06600620.

Educational outcomes for children and young people with cancer: study protocol for a population-based cohort study using linked education and hospital data from England

Por: Nath · S. · Stone · T. · Lam · J. · Feltbower · R. G. · Hargrave · D. · McCabe · M. G. · Brown · H. · Hickinbottom · L. C. L. · Jackson · K. · Paget · L. · Stanley · T. · Watts · P. S. · Harron · K.
Introduction

Childhood cancer survivors (CCSs) experience educational disruptions during and following treatment, yet robust, longitudinal evidence on educational performance remains limited. We will investigate differences in educational outcomes between CCSs and non-cancer peers during primary and secondary school. We will also explore how sociodemographic factors and age at diagnosis contribute to potential differences in General Certificate of Secondary Education (GCSE) examinations, a critical indicator of future academic and employment prospects.

Methods and analysis

We will use the Education and Child Health Insights from Linked Data (ECHILD) to capture linked health and education data for children born in National Health Service (NHS)-funded hospitals in England. We will generate birth cohorts spanning September 1997 to August 2015 (estimated sample size: ~10 million), formed of pupils expected to have undertaken national curriculum assessments between academic years 2004/2005 and 2021/2022 including Key Stage (KS) 1, 2 and 4, corresponding to ages 7, 11 and 16 respectively. Cancer diagnosis will be identified from inpatient hospital records, using International Classification of Diseases, 10th Revision codes (ICD-10). We will investigate differences between CCS and their non-cancer peers in terms of their sociodemographic characteristics and describe trends in educational performances at all KSs, recorded Special Educational Needs and Disabilities (SEND) and school absences. Differences in KS4 (GCSE) performances between CCS and non-cancer peers will be quantified, according to and accounting for geographic region, sex, deprivation, ethnicity and birth characteristics. To assess whether cancer diagnosis disrupts academic trajectories, we will restrict analysis to those with KS2 attainment data and investigate KS4 performance. We will finally explore the influence of age at diagnosis on educational performance at KS4.

Ethics and dissemination

Ethics approval was granted by NHS Health Research Authority Research Ethics Committee (20/EE/0180). Findings will be shared with academics, policymakers, children and families affected by childhood cancer, and published in journals. Code/metadata will be shared on ECHILD GitHub repository.

Cross-sectional survey investigating knowledge, attitudes and reasons for use of food supplements in rheumatological diseases: the IntegraRE study protocol

Por: Iacoponi · F. · Cardamone · E. · Pastorelli · A. · Rosetti · M. · Agrimi · U. · Silano · M. · Stacchini · P. · Laurenti · R. · Marotto · D. · Gargiulo · R. · Boniglia · C. · Di Giacomo · S.
Introduction

Rheumatological diseases represent a widespread heterogeneous group of disorders, united by chronic musculoskeletal inflammatory processes. Despite the increasing effectiveness of new therapies, the lack of adequate treatments for certain conditions and the occurrence of adverse drug reactions have led to the need for alternative strategies, including food supplements. These products are perceived by the patient as a valuable aid without adverse effects. However, adverse reactions to food supplements have been reported, although their incidence cannot be established due to the lack of consumption data. In this context, the IntegraRE project aims at collecting information on the use of food supplements in rheumatology, considering both physicians and patients.

Methods and analysis

A survey-based cross-sectional study has been designed into two consecutive phases: Phase 1 aims to investigate rheumatologists’ knowledge, attitudes and recommendations to patients regarding food supplements, while Phase 2 focuses on estimating patients’ intake of food supplements, including the specific products used, unit consumed and reasons for their consumption. Questionnaires will be collected from at least 287 rheumatologists and 2000 patients, geographically distributed in proportion to the Italian population. These will gather information on sociodemographic variables, lifestyle factors, knowledge, clinical practices and supplement consumption.

Ethics and dissemination

The study protocol has been approved by the Ethics Committee of the Italian National Institute of Health (approval no. AOO 0032395 on 24 July 2024). The results, which will be widely disseminated through conference presentations, peer-reviewed publications and dedicated project webpage, will provide an understanding of the use of food supplements in rheumatology and allow guidelines to be drawn up on their correct use in the clinical practice of rheumatological diseases. Overall, this survey will increase people’s awareness of the effects of food supplements and encourage their safe and conscious use.

Nursing Doctorate Issues, Challenges and Expected Changes Across Europe: A Rapid Review and Experts' Opinion

ABSTRACT

Aims

Updating recent reviews and enriching the available evidence with expert opinions on the challenges and expected reforms needed in doctoral education across Europe.

Design

A dual design based on a rapid review and an online survey.

Data Source/Review Method

The PubMed, CINAHL and Scopus databases were searched for studies published between January 2020 and June 2025 using the terms “PhD” AND “nursing”. In parallel, an online survey with open-ended questions was distributed to a purposive sample of academic experts in each European country. Findings from the literature were juxtaposed and integrated with the data from the expert survey and integrated.

Results

A total of 23 studies and 26 expert opinions. Doctoral nursing education in Europe is facing seven key challenges regarding: (1) institutions and their structure, (2) supervision, (3) candidates, (4) research process and outcomes, (5) professional development and career progression, (6) international collaboration and (7) paradigm-related concerns. Six anticipated changes/recommendations were identified in (1) structural and policy reforms, (2) supervision and mentoring, (3) candidate recruitment, retention and support, (4) financial and institutional support, (5) professional development and career recognition, (6) collaboration and internationalisation. While some challenges and changes were confirmed by the literature, others emerged from the experts' insights.

Conclusions

Complex challenges are faced by European doctoral nursing education, some under-researched as issues of supervision and candidate experience. Strengthening structures, mentorship and international collaboration is essential to align education with academic standards and healthcare needs.

Implications for Profession and/or Patient Care

Efforts are needed at the European level to strengthen doctoral education in nursing to ensure well-prepared academic and clinical nurses.

Impact

Findings may support in the development of more cohesive and high-quality doctoral nursing programs across Europe and inform targeted reforms.

Reporting Method

The rapid review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Patient/Public Involvement

This study did not include patient or public involvement in its design, conduct or reporting.

Magnetism in Nursing Education: A Qualitative Embedded Case Study of High‐Applicant Nursing Programs Amid a National Decline

ABSTRACT

Aims

To describe the factors that characterise nursing programs that continue to attract a high number of applicants even though the total number of applicants is declining.

Design

A qualitative embedded case study in Italy on 2025.

Methods

A purposive sample of four undergraduate nursing programs for which there were more applicants than places in the last three academic years, compared to the rest of the macro-region, where an average ratio of 0.8 applicants/place was documented. Key informants (dean, clinical practice coordinator, nurse educators, students) from each program were involved. A semi-structured, open-ended interview was conducted focusing on the factors that make the identified nursing programs attractive. The recorded interviews (n = 19) were analysed thematically by triangulating the data. A member check was also conducted.

Results

Five factors make a nursing program attractive: (1) the strategic location of the university, (2) the reputation and influence of the nursing program, (3) the structured, innovative, and open-oriented nursing curriculum, (4) the quality of the tutorial system and (5) the program's commitment to student support and development.

Conclusion

Even in times of declining enrollment and fewer applicants, certain factors can make a nursing program magnetic.

Implications for the Profession and/or Patient Care

The map of emerging factors can serve as a strategy to help nursing programs attract students and improve their overall appeal.

Impact

What problem did the study address? ○

In some countries, there is a downward trend in applicants to the nursing profession, raising serious concerns about the growing global nursing workforce gap.

With the decline in applicants, the long-term sustainability of nursing programs is also at risk.

No study has investigated the factors that characterise nursing degree programs, which attract even more applicants in a context of declining attractiveness.

What were the main findings? ○

Five magnetic factors have emerged, one of which is external and the others internal to the nursing program.

The external factors relate to the program itself—and are embedded in the social, civic and academic environment of the host university and the city.

The internal factors relate to the strong leadership and commitment of the nursing programme to promote its quality.

Where and on whom will the research have an impact on? ○

Findings may inform actions at the policy, university and individual nursing program levels.

Reporting Method

COnsolidated criteria for REporting Qualitative Research Checklist.

Patient or Public Contribution

Data collection and validation involved citizens (students) attending the identified nursing programs.

Randomised controlled trial to assess the efficiency and effectiveness of remote care compared with in-clinic care for adult cochlear implant recipients in the first 12 months after activation: a protocol of the INSPIRE study

Por: Quaranta · N. · Murri · A. · Denys · S. · Verhaert · N. · Huinck · W. · Townsend · J. · Swinnen · F. · Dhooge · I. · de Klerk · A. · Mehta · D. · Brotto · D. · Craddock · L. · Hoskam · G. · Schou · I. M. · McBride · M. E. · Campbell-Bell · C.
Introduction

Post-surgical care following cochlear implantation is a pivotal part of the rehabilitation journey for cochlear implant (CI) recipients. However, frequent in-clinic visits, particularly in the first year following CI activation, can place a significant burden on CI recipients. Moreover, the growing number of CI recipients may pose a challenge for CI clinics to provide consistent and lifelong care. Cochlear Remote Care is a platform that enables the delivery of post-surgical care through remote hearing assessments and remote video appointments, offering an opportunity to enhance clinic efficiency, eliminate geographical barriers, reduce financial burdens and provide flexible post-surgical options. The primary objective of this study is to compare self-reported hearing ability in daily life among CI recipients who receive post-surgical care through Remote Care with those receiving routine in-clinic care during the first year following CI activation. Additionally, the study will assess the time and costs associated with these care models for both the clinic and patients.

Methods and analysis

This multi-centre randomised controlled trial is set to be conducted across 11 clinics in the United Kingdom, Italy, the Netherlands, Belgium and Australia, with an anticipated sample size of 148 participants. All participants will be adults with post-lingual deafness and unilateral CIs. Following baseline measurements at 3 months post-activation, participants will be randomly assigned to either in-clinic visits or Remote Care appointments. At six and 12 months after activation, participants will complete a comprehensive battery of audiometric tests and questionnaires on patient-reported outcomes, usability and resource utilisation.

Ethics and dissemination

Ethics approval has been obtained for each clinical site. Study findings will be disseminated widely through peer-reviewed publications, lay language summaries and conference presentations.

Trial registration number

NCT05552118.

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