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Cognitive impairment is associated with people with diabetes-related foot ulcers (DFU). However, it is unclear if cognitive impairment is associated with the ulcer itself or other co-existing diabetes-related complications such as peripheral neuropathy. We aimed to investigate cognition in people with diabetes-related peripheral neuropathy and compare those with DFUs to those without DFUs. In this age- and sex-matched, multicentre, case-control, observational study of 89 participants with Type 2 diabetes and peripheral neuropathy, we compared 49 participants with DFUs (cases) to 40 without DFUs (controls). Global cognition scores were assessed using the Montreal Cognitive Assessment tool. Participants with DFUs had similar characteristics to those without DFUs (all, p > 0.05), except for lower body mass index (p = 0.028). Participants with active DFUs had significantly lower global cognition scores compared to those without DFUs (median [IQR] 24.0 [21.0–25.0], 26.0 [24.0–28.0]; p < 0.001). After adjusting for other diabetes-related complications, lower global cognition was independently associated with a DFU, peripheral artery disease, lower physical activity and no family history of diabetes (all, p ≤ 0.019). People with DFUs had lower cognitive scores than those without DFUs, suggesting that the DFU itself is independently associated with cognitive impairment. Future studies should explore causal pathways and targeted management strategies.
There is an urgent need to improve surgical antimicrobial stewardship (AMS), to enhance individual care and reduce population-level antimicrobial resistance, but it is a complex issue.
We aimed to conduct an ethnographic study asking what would work in practice to improve surgical antibiotic prescribing behaviour?
Adopting a socio-cultural-historical perspective, we undertook ethnographic observations of clinical practice (43.5 hours) and semistructured interviews (n=31) with surgical staff, AMS staff and patients at two English National Health Service hospitals. Interview transcripts and observational fieldnotes were analysed using the Framework Approach. Additionally, we integrated stakeholder engagement throughout to ensure the findings were meaningful.
Our analysis of all fieldnotes (based on 43.5 hours of observation) and interview transcripts (n=31 from interviews with 31 different participants) identified that, while surgical staff were aware of antimicrobial resistance, they seldom considered AMS urgent or important in the acute setting where lack of time and the desire to mitigate perceived risk often prevailed. Other surgical issues were perceived to dominate senior decision-makers’ focus, thus perpetuating the status quo. Furthermore, attention to AMS was not always prioritised at the organisational level or by resource-limited AMS teams. Consequently, there was an absence of relationships and tools that foreground AMS. Electronic prescribing systems frequently hindered antimicrobial review and exacerbated patterns of siloed inter-disciplinary working, and feedback on antimicrobial prescribing and patient outcomes was largely absent. To improve AMS, surgical teams wanted sustainable improvements which effectively account for the hierarchical relationships, division of labour, rapid workflow and high staff turnover. Infection experts should better integrate into surgical teams to build relationships and trust, and to proactively contribute to patient care.
We offer data-driven, theoretically informed strategies to support change. Contextually appropriate improvements that address the status and visibility of AMS in surgery will be key. Further research is needed to assess the impact and sustainability of the suggested approaches.
Venous leg ulcers occur due to chronic venous insufficiency in the lower extremities and are often difficult to heal. Platelet-rich plasma and platelet-rich fibrin are products that contain high concentrations of platelets. This systematic review evaluated the effectiveness, safety and cost-effectiveness of these products for the treatment of venous leg ulcers. Guided by the 2020 Joanna Briggs Institute systematic review of effectiveness guideline, this review included original studies that investigated platelet-rich plasma and platelet-rich fibrin in the treatment of venous leg ulcers from databases including the Cochrane Library, Embase, Medline, CINAHL, PubMed, World Health Organisation International Clinical Trials Registry, Clinical Trials.gov and Australian New Zealand Clinical Trials Registry. Methodological quality was assessed using relevant appraisal checklists. Information related to general characteristics of included articles and relevant outcomes of interest were extracted and synthesised narratively. Of thirty-six eligible studies, 24 studies used platelet-rich plasma, eleven investigated fibrin-rich plasma and one study used both platelet-rich plasma and fibrin-rich. Most studies reported these products were effective in promoting wound healing, reducing other symptoms, and were safe to use. The use of platelet-rich plasma and platelet-rich fibrin resulted in significantly higher healed venous leg ulcers compared to control using conventional treatment (RR: 2.93, 95% CI, 1.90–4.53, p = 0.01). These products were safe to used topically and promoted to wound healing, reduced pain, either along or combined with other treatments. Platelet-rich plasma and fibrin-rich plasma improves wound healing and appears to be safe to use in the treatment of venous leg ulcers.
Previous work in South Africans living with HIV and chronic pain has raised questions regarding maintained levels of physical activity while in pain, patterns of pain disclosure and recruitment of social support. Recent data suggest that pain in people living with HIV may be more due to issues of poverty rather than HIV. We explored how South Africans with chronic pain living in a rural area: (1) understand and experience chronic pain, (2) how chronic pain affects activity levels and (3) the relationship between pain disclosure and social support.
We conducted a qualitative study using in-depth interviews. Transcripts were analysed using thematic data analysis.
The Ndlovu Care Group Research Centre in the rural Elandsdoorn, Dennilton area in Limpopo province, South Africa, between April and July 2019.
34 individuals (19 women, 15 men) with a mean age of 37 years (SD 8) living with chronic pain, half of whom were living with HIV, and half without.
Perceived causes of pain included illness or injury, ‘thinking too much’ and non-Western perspectives. Three patterns of activity in response to chronic pain emerged: perseverance, reduced activity and complete inactivity. Reasons for perseverance included fear of losing income, perceived social stigma or no social support. Patterns of pain disclosure included full, selective (telling some people but not others depending on their perceived trustworthiness), partial (sharing pain presence but not how severe it was) and non-disclosure. Disclosing pain was common in women and was used to recruit practical support. Men rarely disclosed to recruit support, and if they did, would recruit for financial support. Disclosing pain was also a strategy to avoid the social stigma of being labelled ‘lazy’. Patterns of activity, disclosure and type of support recruited did not differ between those with and without HIV.
Our findings suggest that activity levels, disclosure and recruitment of support in South Africans living with chronic pain are influenced by low income, social stigma and gender, rather than HIV.
The study aims to understand the changing context of RACFs and the role of RACF managers in preparing to confront the COVID-19 pandemic and to provide insights into how the use of visual telehealth consultation might be incorporated to assist with managing whatever might arise.
An interpretive descriptive study design was employed, and data were collected using semi-structured interviews conducted via telephone or videoconference. Purposive recruitment targeted clinical managers responsible for the COVID-19 response in RACFs.
RACF clinical managers were invited to discuss their responses to COVID-19 including the management of RACF and staff. Semi-structured interviews explored the COVID-19-related challenges, the response to these challenges and how telehealth might assist in overcoming some of these challenges. This study followed Thorne's (2008) three-stage process of interpretive description. The COREQ checklist was used in preparing this manuscript.
Two main themes were identified. The first theme ‘keeping people safe’ was comprised of three subthemes; fear and uncertainty, managing the risks and retaining and recruiting staff. The second theme was ‘keeping people connected’, had two subthemes; being disconnected and isolated and embracing technology.
Findings from this study provide valuable insight into understanding the context and the challenges for RACFs and the staff as they attempt to keep residents safe and connected with healthcare providers and the outside world.
Understanding the experiences of RACF managers in preparing to respond to the pandemic will better inform practice development in aged care in particular the use of telehealth and safe practices during COVID-19. Increased awareness of the challenges faced by RACFs during a pandemic provides policymakers with valuable insights for future planning of pandemic responses.
To investigate clinicians' perspectives on the transition from hospital to home and identify gaps in care for older adults living with frailty during the transfer of care.
Qualitative reflexive thematic analysis of focus groups
Focus groups were conducted with clinicians using purposive sampling. Participants were eligible if they had provided or overseen the clinical care of a patient transferring from hospital to home. Verbatim transcripts were analysed, and themes were identified using NVivo through the development of codes and exploration of core commonalities.
A total of 28 clinicians participated in five focus groups. Participants included nurses (n = 14), allied health (n = 8), medical officers (n = 2), managers and hospital executives (n = 4). Themes were categorised into four domains: (1) system fragmentation and finite resources challenge healthcare navigation for everyone; (2) the interplay of cultural and societal considerations in the context of ageing; (3) fragile cycle of care for older patients who frequent hospitalisation; and (4) effective communication and expertise being critical for quality care.
Despite decades of research, the transition from hospital to home for older adults living with frailty remains a persistent challenge. This study identified significant and continued unmet needs in navigating a complex health system, underscoring the evidence-practice gap in transitional care services. Results have informed the development and implementation of a feasibility study (TRANSFER-II), currently underway, that tests the feasibility of a nurse-coordinated model of transitional care support for older adults.
Transfers from hospital to home, frequent readmissions and transitions in care are common for older adults living with frailty. Understanding the enablers and barriers in transitional care for this vulnerable population can enhance the quality of care, improve communication and inform the development of more effective transitional care models. The findings underline the critical role nurses play in addressing systemic gaps and improving continuity of care for older adults across diverse health systems.
Transitional care is complex, and older populations are more at risk of returning to hospital. Findings highlight the significant unmet needs in navigating a complex health system and revealed the fragile cycle of care for older adults who frequent hospital. Reiterating the importance of effective communication and clinical expertise in delivering safe patient-centred nursing care.
This qualitative study was reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.
Patients and carers contributed to the design of this qualitative study through consultation with a consumer advisory group, where potential transitional care interventions were discussed. These discussions highlighted a need to further explore transitional care unmet needs, informing the development of this focus group study.
Effective postoperative pain management is a critical component of surgical care, directly influencing patient recovery, satisfaction and long-term outcomes. Despite recent advances in pain management, postoperative pain remains poorly managed worldwide, suggesting that postoperative pain outcomes are influenced by factors beyond the inherent efficacy of available treatments. This scoping review aims to map the factors influencing postoperative pain management and recommendations that support optimal, evidence-based pain management after surgery.
A mixed methods scoping review will be conducted in accordance with the Joanna Briggs Institute manual for evidence synthesis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping review guidelines. PubMed (MEDLINE), Cumulative Index to Nursing & Allied Health Literature and PsycINFO will be searched for the relevant literature from the journals’ inception to September 2025. Two reviewers will independently conduct the screening of titles and abstracts, full-text articles and data extraction. Data will be mapped onto the Theoretical Domains Framework and Capability, Opportunity, Motivation—Behavior model. Where additional data requires coding, thematic analysis will be conducted using NVivo data management software.
The scoping review will analyse publicly available data. Therefore, ethical approval is not required. The findings will serve as a foundation for engaging relevant stakeholders in discussions aimed at implementing systemic changes to support healthcare providers in enhancing postoperative pain management. The results will be disseminated through a peer-reviewed journal publication, local fora and conference presentations to ensure broad visibility and impact.
While digital technologies can increase the availability and access to evidence-based interventions, little is known about how users engage with them and the mechanisms associated with effective outcomes. Process evaluations are an important component in understanding the aforementioned factors. The ‘SPARX-UK’ study is a randomised controlled pilot and feasibility trial evaluating personalised human-supported (from an ‘eCoach’) vs a self-directed computerised cognitive behavioural therapy intervention (cCBT), called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), aimed at adolescents with mild to moderate depression. We are comparing supported vs self-directed delivery of SPARX to establish which format should be used in a proposed definitive trial of SPARX. The control is a waitlist group. We will conduct a process evaluation alongside the trial to determine how the intervention is implemented and provide context for interpreting the feasibility trial outcomes. We will also look at the acceptability of SPARX and how users engage with the intervention. This protocol paper describes the rationale, aims and methodology of the SPARX-UK trial process evaluation.
The process evaluation will use a mixed-methods design following the UK Medical Research Council’s 2015 guidelines, comprising quantitative and qualitative data collection. This will include analysing data usage of participants in the intervention arms; purposively sampled, semi-structured interviews of adolescents, parents/guardians, eCoaches and clinicians/practitioners from the SPARX-UK trial; and analysis of qualitative comments from a survey from those who dropped out early from the trial. Quantitative data will be analysed descriptively. We will use thematic analysis in a framework approach to analyse qualitative data. Quantitative and qualitative data will be mixed and integrated to provide an understanding of how the intervention was implemented and how adolescents interacted with the intervention. This process evaluation will explore the experiences of adolescent participants, parents/guardians, eCoaches and clinicians/practitioners in relation to a complex digital intervention.
Ethical approval was granted by the National Health Service (NHS) Health Research Authority South West - Cornwall & Plymouth Research Ethics Committee (Ethics Ref: 22/SW/0149).
Contextualising how the intervention was implemented, and the variations in uptake and engagement, will help us to understand the trial findings in greater depth. The findings from this process evaluation will also inform the decision about whether and how to proceed with a full randomised controlled trial, as well as the development of more effective interventions which can be personalised more precisely via varying levels of human support. We plan to publish the findings of the process evaluation and the wider project in peer-reviewed journals, as well as disseminate via academic conferences.
ISRCTN: ISRCTN15124804. Registered on 16 January 2023,
FreshRSS 