Conectar
Scalp follicular unit (FU) transplantation is a highly effective yet underutilised minimally invasive technique for promoting healing in chronic and recalcitrant cutaneous wounds. In this case series, five patients with long-standing nonhealing leg ulcers of mixed etiologies were treated exclusively with single FU grafts harvested from the scalp with a 0.9–1-mm punch. Complete re-epithelialization occurred in three cases by 6, 3 and 1 month, respectively, while the remaining two cases showed marked partial improvement at 6 months, with reduction in ulcer area and pain. Overall, all five patients experienced a favourable clinical outcome. Case reports suggest that the transplantation of a minimum of 4 FU grafts/cm2 is required to promote effective wound closure, with higher graft densities being associated with faster healing. However, the optimal graft density and placement, whether uniform distribution or targeting the wound edge to exploit an ‘edge effect’, require further investigation. Considered alongside prior reports, these results suggest that 1-mm single-FU grafting achieves wound healing comparable to, and often faster than, 2–3-mm punch grafts. Additionally, the technique is less invasive and causes less bleeding, overall supporting wider use as an adjunct in multidisciplinary wound care.
Level of Evidence: IV
To make informed health choices, and avoid waste and unnecessary suffering, people need critical thinking skills. However, like health interventions, educational interventions can have adverse effects. In this systematic review, the objective was to assess the extent to which researchers have included potential adverse effects in studies of interventions intended to improve the critical thinking of laypeople about health choices.
This study was a systematic review, in which we updated the search for an earlier systematic review of intended effects of relevant interventions. The earlier review did not address potential adverse effects. We did not update the analysis of intended effects.
We searched Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Epistemonikos, Medical Literature Analysis and Retrieval System Online (MEDLINE), Education Resources Information Center (ERIC) and Web of Science up to March 2025. In addition to studies from the original review and updated search, we included any additional studies included in a similar, even earlier review. Our unit of analysis was study report (eg, journal article).
We included all studies from the original review. We applied the same inclusion criteria to the results of the updated search: the study included a comparison, the population was laypeople and the intervention was intended to improve understanding of ≥1 key concept for informed health choices.
We extracted data about study design (randomised trial or other), participants (children, adolescents or adults), study setting (countries), main intervention (resources delivered to participants) and comparator (usual/no intervention or other). For the analysis, we extracted verbatim text describing any assessment of a potential adverse effect of the intervention. We conducted a narrative synthesis of the extracted data.
We included 35 reports of quantitative studies (including multi-method and mixed-methods studies). Most often, the study was a randomised trial, the setting was a high-income country, the population included adults (including university students) and the intervention was school-based (including university). In one of the 35 reports, authors described assessing a potential adverse effect.
To our knowledge, this is the first systematic review assessing the extent to which researchers have assessed adverse effects of any category of educational interventions. Our review shows that researchers generally have not assessed potential adverse effects of interventions to improve critical thinking about health choices. Researchers should pay more attention to such effects, while policymakers and educators making decisions about implementing relevant interventions should consider the lack of evidence. The findings of this study suggest a need for research that facilitates assessing potential adverse effects of interventions to improve critical thinking about health choices.
To examine whether self-reported thriving at work is associated with biomarkers of stress, inflammation, neuroplasticity and neurodegeneration in nurses.
A cross-sectional study.
An online questionnaire measuring thriving at work was administered to nurses in a teaching hospital in Michigan, U.S. over 5 weeks in 2024. A subsample of 100 questionnaire respondents provided blood samples for biomarker analysis. Multiple regression was used to identify self-reported and biomarker predictors of nurse thriving. Cluster analysis was used to distinguish between nurses with high and low levels of thriving based on a combination of self-report and biomarker data.
Higher self-reports of individual and work-related resources predicted higher thriving. Cortisol, a stress hormone, was significantly and inversely associated with thriving. No blood-based biomarkers of inflammation or neuroplasticity predicted thriving. Neurofilament light chain, a marker of neurodegeneration, was not a direct predictor but modified the effects of interpersonal and work resources on thriving.
Biological markers do play a role in nurses' thriving at work and may contribute important complementary information to that provided by nurse self-reports.
Nurses thrive in a work situation characterised by positive reports of individual, interpersonal and work resources and lower levels of stress. Efforts to enhance thriving could positively impact nurses' well-being and conditions for providing high-quality patient care.
This study addressed the question of whether self-reported thriving at work among nurses is reflected in biomarkers of stress, inflammation, and neurocognitive health. A profile of high self-reported work-related resources and low cortisol distinguished higher levels of nurses' thriving from lower levels. Organisational efforts to enhance nurses' thriving can positively impact nurses' health, their work environment, and patient care.
We followed the STROBE checklist in reporting this study.
No Patient or public contribution.
Joaquín Juan Penalva desentraña en esta reseña los entresijos literarios de la trilogía narrativa "Tiempos baldíos" de José Siles
Cardiogenic shock (CS) is a complex syndrome characterised by primary cardiac dysfunction. Despite advances in therapeutic options such as mechanical cardiac support, it remains associated with high mortality. Although previous registries have described heterogeneous populations and outcomes across different centres, contemporary real-world data on management practices remain limited. This gap is particularly evident in low- and middle-income countries, where there is no robust registry that clearly defines the current state of CS management. Therefore, a multicentre registry is needed to better characterise current practices and outcomes. Our study aims to gain insight into current therapeutic trends in Mexico, a low- to middle-income country with a significant cardiovascular disease burden.
The Mexican Registry of Cardiogenic Shock is a quality initiative that aims to identify therapeutic trends, demographic characteristics and clinical presentations. It also aims to evaluate outcomes, including mortality and cognitive function at in-hospital and 1-year follow-ups, and to identify areas for improvement in the care process across the broad spectrum of CS.
Ethical approval for this multicentre study was obtained from the local research ethics committees of all participating institutions. The study results will be disseminated to all participating institutions in the form of summary reports and presentations on completion of the analysis.
To develop and evaluate a questionnaire for measuring factors that contribute to thriving at work among nurses.
A cross-sectional study.
An online questionnaire was administered in March 2024 to nurses in a community teaching hospital in Michigan, US. Questionnaire content was based on a literature search and was pilot tested among nursing professionals within the hospital system. Questionnaire factor structure was examined with exploratory and confirmatory factor analyses with split-half sample validation.
Based on exploratory and confirmatory factor analysis, a three-factor solution presented the best model, with factors comprised of 15 items measuring individual resources (3 items), work resources (6 items) and interpersonal aspects of the nursing work environment (6 items). Reliability estimates for all three factors exceeded 0.80, indicating good internal homogeneity. The questionnaire also demonstrated acceptable split-half validity and reliability.
The questionnaire presented here provides a potentially useful tool for measuring and evaluating thriving at work among nurses.
A better understanding of factors that enhance nurse thriving would lay the foundation for targeted interventions aimed at improving the nursing work environment and nurse well-being. Enhancing nurse thriving could have a potentially positive impact on patient care.
This study addressed the need to understand factors that contribute to thriving in nursing work. The questionnaire that was developed revealed a three-factor solution measuring individual nurse resources, work environment resources and work interpersonal resources. By measuring thriving among nurses, hospitals and other healthcare organisations are taking an important first step in identifying interventions to enhance the nursing work environment, nurse well-being and potentially the quality of patient care.
We followed the STROBE checklist in reporting this study.
No patient or public contribution.
by Martina Ferrari-Díaz, Ashuin Kammar-García, Juan Silva-Pereyra, Carmen García-Peña
Cognitive reserve (CR) refers to the adaptation of cognitive performance to endure brain pathology or the aging process. CR can be categorized into static (education and occupation) or dynamic (leisure and physical activities) proxies. Typically, longitudinal studies assess CR as a composite score at baseline and cognitive performance as a global score. This study aimed to compare the relationship between different CR proxies (static and dynamic) with 9-year domain-specific cognitive trajectories, and the risk of cognitive impairment in older adults. Data from the latest four waves of the Mexican Health and Aging Study (MHAS; n = 3102, baseline mean age = 66.62 years) were used. Mixed effects models were performed with CR as independent variables and cognitive trajectories (verbal memory encoding and retrieval, verbal fluency, constructional praxis, visual attention, and memory) as outcomes. Education and leisure activities were significant positive predictors of all cognitive domains. Physical activities were a positive predictor of verbal fluency and verbal memory encoding only. Occupation was a positive predictor of verbal fluency and visual attention. Logistic regression analysis was performed to assess the relationship between CR and the risk of cognitive impairment, where education (OR: 0.79, 95% CI: 0.76, 0.83), occupational complexity (OR: 0.85, 95% CI: 0.77, 0.95), and leisure activities (OR: 0.96, 95% CI: 0.95, 0.97) were significant protective factors. Increasing the years of education can serve as a preventive strategy to delay the clinical manifestation of cognitive impairment while implementing leisure activities can act as an intervention to promote cognition even in later years.by Emmanuel Kumah, Dorothy Serwaa Boakye, Eunice Agyei, Richard Boateng, Veronica Penaman Asamoah, Emmanuel Osei Tutu
IntroductionSince its emergence, HIV/AIDS has remained one of the most significant global health challenges, with key populations—such as sex workers, men who have sex with men (MSM), transgender people, people who inject drugs (PWID), and individuals in prisons or other closed settings—disproportionately bearing the burden of the epidemic. These groups, often at heightened risk due to social, legal, and structural vulnerabilities, face persistent barriers to accessing prevention, treatment, and care services. Despite progress in reducing new infections and improving treatment outcomes, these disparities, exacerbated by stigma, structural inequalities, and insufficient political commitment, continue to limit the effectiveness of global HIV responses.
AimThis scoping review protocol aims to systematically map the range of HIV prevention, treatment, and care interventions and strategies targeting key populations worldwide. Rather than formally evaluating effectiveness, the review will describe the nature, extent, and types of interventions implemented, identify barriers to implementation, and highlight gaps in research and practice.
MethodsFollowing the Joanna Briggs Institute (JBI) guidelines for scoping reviews, the study will systematically identify and analyze evidence from multiple databases, including PubMed, Embase, CINAHL, Scopus, and PsycINFO, alongside regional and grey literature sources. The review will include studies focusing on key populations and evidence-based interventions, such as prevention tools, treatment strategies, and policy or structural interventions. Data will be extracted and synthesized using quantitative and qualitative approaches, with results presented through descriptive statistics and thematic analysis. Findings will inform the development of a comprehensive, evidence-based framework tailored to the unique needs of key populations.
ConclusionBy mapping available interventions and strategies for HIV prevention, treatment, and care among key populations, this review will provide a comprehensive overview of existing approaches, barriers, and gaps. The findings will inform future research, policy, and practice, supporting more targeted, inclusive, and sustainable HIV responses that contribute to global efforts to end AIDS as a public health threat by 2030.
The ventilatory ratio (VR) is a simple and accessible index that reflects ventilatory efficiency in critically ill patients. Although several studies have examined its potential as a prognostic marker in acute respiratory distress syndrome (ARDS), the results remain inconsistent and inconclusive. This systematic review and Bayesian meta-analysis aimed to evaluate the association between VR and mortality in adult patients with ARDS.
Two investigators will independently conduct systematic literature searches in the PubMed, Embase, Scopus, Cochrane Library and Latin American and Caribbean Health Sciences Literature / Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS) databases, covering all publications from database inception to July 2025.
This systematic review and meta-analysis will include prospective and retrospective cohort studies evaluating the association between the VR and mortality in adult patients with ARDS. Specifically, we aim to answer the following Patient, Population or Problem, Intervention, Comparison, and Outcome (PICO) question: In adult patients with ARDS (Population), is an elevated VR (Exposure), compared to lower or normal VR values (Comparison), associated with an increased risk of mortality (Outcome)?
The primary outcome will be mortality, as defined in each included study. Outcomes will be analysed according to the characteristics and reporting of the original publications.
The methodological quality of the included studies will be assessed using the Quality In Prognosis Studies tool, and the certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A hierarchical Bayesian random-effects model will be used to synthesise the data, with effect sizes expressed as ORs and 95% credible intervals. Weakly informative priors will be applied to model parameters.
Between-study heterogeneity will be assessed through the estimation of the between-study variance (²) and the I² statistic. Subgroup analyses will be conducted based on study design and ARDS aetiology, and a bivariate meta-regression will explore potential effect modifiers. A leave-one-out sensitivity analysis will also be performed to assess the robustness of the findings.
Publication bias will be evaluated using a Bayesian funnel plot and an adapted version of Egger’s test.
This systematic review does not require ethics approval. The results will be published in scientific journals, presented at national and international conferences and shared on social media in accessible language.
CRD420251008773
Migraine is a primary headache showing a multifactorial component that includes altered pain processing, psychological/emotional problems, neurocognitive and executive function deficits, all with a possible genetic association. The aim of the current study will be to evaluate the association between sensitisation, psychological/emotional, neurocognitive and genetic profile on conditioned pain modulation (CPM) in women with migraine from a multidisciplinary perspective.
A cross-sectional observational case–control study including 90 women with chronic migraine, 90 women with episodic migraine and 90 women without migraine (as controls) will be conducted. Clinical variables (disability, pain), processing (sensitisation-associated, neuropathic-like symptoms), psychological/emotional (anxiety, depression, sleep quality, catastrophising), neurocognitive (attention), executive functions (memory, mental inhibition, speed processing) and genetics (Val158Met polymorphism rs4680 gene) will be assessed in all subjects by healthcare professionals. Subsequently, CPM will be evaluated with the cold-pressor test paradigm by assessing changes obtained in mechanical and thermal stimuli. The association of each group of variables on CPM will be analysed with multivariate analyses (OMNIBUS analysis of variance). A network model will also be created to identify those variables showing the greatest key measure of centrality with the rest of the severity indicators (strength, intermediation and closeness) to establish the potentially therapeutic targets in patients with migraine from a multidisciplinary point of view.
The protocol of the current study has been approved by the Ethics Committee of all involved institutions (Hospital Universitario Fundación Alcorcón 24–117, Universidad Rey Juan Carlos 010220240912024). All procedures will be conducted following the Declaration of Helsinki. Participants will be informed of the aims and procedures of the study and will receive the informed written consent which should be signed before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.
Objetivo: diseño de una intervención psicoeducativa de enfermería para el control del peso gestacional en mujeres embarazadas mexicanas basado en Modelo de Promoción de la Salud. Método: Uso de teorías en el diseño de intervenciones. Resultados: Los determinantes que se utilizaron para el diseño de la intervención, fue la autoeficacia, barreras percibidas e intenciones de implementación. Se diseñaron dos manuales, uno para el facilitador y otro para el participante. Conclusiones: El modelo de promoción de la salud es útil para guiar intervenciones psicoeducativas.
Joaquín Juan Penalva hace un pormenorizado análisis en la reseña del último poemario de José Siles "Espejo de monos alumbrados".
Caso: ejemplo mujer de 52 años de edad, que vive en zona rural que, a raíz de la realización de una estoma digestivo definitivo, manifiesta rechazo afectivo-sexual. Objetivo: identificar intervenciones basadas en evidencias destinadas restablecer la vida sexual en la persona ostomizada, garantizando su seguridad, aceptación de su nueva realidad corporal y motivación hacia la práctica erótica. Metodología: búsqueda de evidencias siguiendo el modelo PRAXIS. Recomendaciones de buena práctica: (a) Orientar al paciente ostomizado en todos aquellos aspectos relacionados con su estoma para recuperar la autosuficiencia, (b) Ayudar a la persona ostomizada a mejorar su imagen corporal durante el contacto sexual, (c) Implementar aquellas estrategias que la ayuden a retomar la práctica erótica- sexual, (d) Trabajar con su entorno familiar las habilidades positivas de comunicación para favorecer la aceptación de su nueva realidad corporal, (e) Estimular el contacto y visitas con personas que ha pasado por idéntica experiencia. Prácticas de autocuidado: apoyo profesional, compartir temores y experiencia con entorno social y grupos de apoyo, superar la vergüenza, actitud positiva.
Objetivo: analizar los factores de riesgo cardiovascular del personal sanitario mediante la tabla REGICOR, en función edad, sexo, categoría profesional y turno de trabajo, así como el estrés laboral que experimenta nuestro equipo. Método: estudio descriptivo transversal cuya población fueron profesionales quirúrgicos Área V, Murcia, entre Enero y julio de 2020. Búsqueda bibliográfica y el instrumento un cuestionario con variables sociodemográficas y los factores de riesgo. Se explicó todo el proceso y firmaron Consentimiento Informado. Se calculó el RCV mediante REGICOR. El estrés con test de Hock y Escala General de Satisfacción. Resultados: muestra final n= 55, 18,2% (n =10) hombres y 81,8% (n= 45) mujeres, edades 35 y 64 y X= 49,4 años (DT = 8,7). Según la categoría profesional: 60% enferme-ros/as y 45,5% turno rodado. FRCV recogidos: IMC X=24,6 Kg/m2 presentando sobrepeso 32,1%, colesterol 30,9%, 22,6% hipertensos y 7,3% diabéticos. Edad y el riesgo coronario se relacionan de forma directa y significativa (r=0,550, p<0,001). Estrés< 42 puntos. Escala de satisfacción laboral 61,1 (DT=1,06). Conclusiones: los resultados obtenidos muestran elevadas prevalencias de factores de riesgo modificables especialmente obesidad, dislipemia y tabaquismo. Según la tabla Regicor elevada prevalencia de riesgo alto o muy alto. Sexo y edad fuertemente asociados al riesgo coronario. Mientras que el turno de trabajo y categoría profesional no existe asociación. El estrés no está relacionado en la población del Hospital Virgen del Castillo.
Objetivo principal: comparar los dispositivos supraglóticos frente a los dispositivos infraglóticos no quirúrgicos en el manejo de la vía aérea, para determinar cuál de ellos reúne las mejores condiciones para un uso eficiente en la atención en urgencias y emergencias. Metodología: la búsqueda fue realizada en las bases de datos de Pubmed, Cinahl y Scopus, incluyendo todos aquellos ensayos clínicos aleatorizados cuya antigüedad no sobrepasase los 10 años, redactados tanto en inglés como en español en población pediátrica o adulta. Se excluyeron ensayos realizados en cadáveres o maniquíes. Para evaluar su calidad metodológica hemos utilizado la escala PEDro. Resultados principales: encontramos un total de 8 ensayos clínicos que cumplieron con los criterios de inclusión. Conclusión principal: sería conveniente, pero no necesario, utilizar dispositivos supraglóticos en situaciones de emergencia.
La situación de la mujer embarazada, hoy en día en México, aún es muy complicada ya que a pesar de ser derechohabiente, de alguna institución de salud y tener servicio medico gratuito, estas no asisten a sus consultas de control prenatal, para la detección oportuna de factores de riesgo que pueden complicar su embarazo en algún trimestre. Argumentando que no asiste, por diversos factores, económicos y socio culturales los cuales permean en las mujeres mexicanas, sobre todo en las de bajo nivel educativo. Predomina en todos los niveles sociales aún el machismo y el genero, la influencia de los padres en el comportamiento de la mujer, hacia su esposo, motivo que influye culturalmente, en que solo asiste al medico cuando se sienten mal, o en el momento del parto únicamente, o con autorización del esposo. No toman en cuenta que los embarazos no son iguales y que pueden complicarse en el momento del parto
FreshRSS 