Conectar
Biofilms are a key driver of chronicity and treatment failure in diabetic foot ulcers (DFUs), yet clinical evidence quantifying their impact and management remains fragmented. This systematic narrative review synthesised recent evidence (2015–2025) on the prevalence, diagnostics, and management of biofilm in DFUs. A Systematic Review of the Literature (SRL) was conducted following PRISMA 2020 guidelines across PubMed/MEDLINE, Scopus, Cochrane Library and ScienceDirect. Eligible studies included adults with DFUs reporting biofilm/bioburden metrics or interventions aimed at biofilm disruption. Risk of bias was assessed using RoB 2 for randomised trials and ROBINS-I for non-randomised studies. Data were narratively synthesised by evidence tier (Tier 1 = clinical; Tier 2 = preclinical/mechanistic). Of 600 records screened, 25 studies met inclusion criteria (Tier 1 n = 9; Tier 2 n = 5; reviews n = 11). Over half of bacterial isolates in DFUs were biofilm producers, with multidrug resistance exceeding 90% in several cohorts. Fungi were detected in 31% of ulcers by qPCR but only 9% by culture. Tier 1 clinical evidence supports standard care components—debridement, antiseptics, and negative-pressure wound therapy—for improved healing, though direct antibiofilm outcomes remain limited. Emerging strategies (enzymatic agents, peptides, cold plasma, smart dressings) show promise in vitro but lack clinical translation. Evidence for direct antibiofilm efficacy in DFUs remains scarce. Current data justify maintaining guideline-based care while prioritising trials that integrate validated biofilm endpoints, standardised microbiological methods, and antifungal components. Distinguishing established from experimental approaches is essential to advancing safe, evidence-based biofilm management in DFUs.
Artificial intelligence (AI)-based clinical decision support systems (CDSSs) are currently being developed to aid prescribing in primary care. There is a lack of research on how these systems will be perceived and used by healthcare professionals and subsequently on how to optimise the implementation process of AI-based CDSSs (AICDSSs).
To explore healthcare professionals’ perspectives on the use of an AICDSS for prescribing in co-existing multiple long-term conditions (MLTC), and the relevance to shared decision making (SDM).
Qualitative study using template analysis of semistructured interviews, based on a case vignette and a mock-up of an AICDSS.
Healthcare professionals prescribing for patients working in the English National Health Service (NHS) primary care in the West Midlands region.
A purposive sample of general practitioners/resident doctors (10), nurse prescribers (3) and prescribing pharmacists (2) working in the English NHS primary care.
The proposed tool generated interest among the participants. Findings included the perception of the tool as user friendly and as a valuable complement to existing clinical guidelines, particularly in a patient population with multiple long-term conditions and polypharmacy, where existing guidelines may be inadequate. Concerns were raised about integration into existing clinical documentation systems, medicolegal aspects, how to interpret findings that were inconsistent with clinical guidelines, and the impact on patient-prescriber relationships. Views differed on whether the tool would aid SDM.
AICDSSs such as the OPTIMAL tool hold potential for optimising pharmaceutical treatment in patients with MLTC. However, specific issues related to the tool need to be addressed and careful implementation into the existing clinical practice is necessary to realise the potential benefits.
Diabetic foot ulcers (DFUs) are a major cause of infection, hospitalisation, and amputation. Collagen-based dressings—especially collagen combined with oxidised regenerated cellulose (ORC)—are proposed to improve healing by modulating matrix metalloproteinases (MMPs), stabilising the extracellular matrix (ECM), and tempering inflammation; some formulations also include antimicrobial or bioactive adjuncts. We conducted a systematic review of randomised controlled trials (RCTs) following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. Adults with DFUs were eligible. Interventions included collagen-alone or collagen-combination dressings (e.g., collagen–oxidised regenerated cellulose [collagen–ORC]/silver, collagen–chitosan) versus standard of care (SOC) or alternative dressings. To ensure comparable outcomes, the quantitative synthesis was pre-specified and restricted to complete wound closure (yes/no, intention-to-treat [ITT]) from collagen-combination RCTs with aligned constructs; other outcomes were synthesised narratively. Meta-analyses were performed in Microsoft Excel using Mantel–Haenszel methods for risk ratios (RR) with a fixed-effect primary model and DerSimonian–Laird random-effects sensitivity analysis; heterogeneity was summarised with Cochran's Q, between-study variance (τ 2), and Higgins' I 2 statistic (I 2), and a 95% prediction interval was reported for random-effects. (Protocol not registered). Six studies (five randomized controlled trials and one single-blinded non-randomized comparative study; total n = 314) met inclusion. In a focused meta-analysis of the two collagen-combination RCTs, treatment was associated with a higher probability of complete wound closure versus control (RR 1.69, 95% confidence interval [CI] 1.05–2.72; I 2 = 0%). One assessor-blinded RCT of collagen alone reported higher 12-week closure versus a placebo dressing and was not pooled due to heterogeneity. Across studies, signals also favored collagen-based care for earlier area reduction and, in one trial, fewer infection-related withdrawals; mechanistic work showed reductions in MMP-9/TIMP-2. However, most trials were small and single-centre, comparators and adjuncts varied, follow-up was short (~8 days–24 weeks, clinical endpoints typically 4–20 weeks), outcome definitions were non-standardised, and key confounders (off-loading, infection management, vascular status, glycaemic control) were inconsistently addressed. Collagen-based dressings—particularly collagen-combination formulations—appear to improve complete closure when added to the standard of care (SOC) for diabetic foot ulcers (DFUs), but the evidence is limited by study size, heterogeneity, and risk of bias. Larger, prospectively registered, multicentre RCTs with standardised outcomes and longer follow-up are needed to define clinical and cost-effectiveness and to identify which patients benefit most. Collagen–ORC dressings show promise as an adjunctive treatment for DFUs by influencing the inflammatory microenvironment and supporting tissue repair. However, the certainty of the current evidence remains limited, highlighting the need for further high-quality randomised studies.
To explore the perceived impact of a nurse-led domestic and family violence service on access to care.
Delivered from a metropolitan community based not for profit organisation, this nurse-led service provided a multidisciplinary response to meeting the needs of women, and or women and children experiencing the consequences of domestic and family violence and homelessness. This involved integration of specialist community services to support women's safety planning, housing, and mental health.
A mixed methods single-site study was conducted.
Routine patient attendance data were analysed to identify service use. Semi-structured interviews with service providers and key stakeholders explored perceived service impact on access to care.
Data were collected over 2.5 years from n = 233 women experiencing domestic and family violence, of whom 28% (n = 64) identified as First Nations, and 26% (n = 61) had at least one dependent child. The nurse facilitated access through referrals, and care navigation, often driving and accompanying women to their appointments. Person-centered and trauma sensitive approaches were highly effective in gaining trust. Qualitative data themes were, care environment, macro context, care outcomes and person centeredness.
Stakeholders' perspectives highlight the need to improve health professionals' capability to respond effectively when women disclose domestic and family violence. The success of this nurse-led service was its capacity for flexibility, which meant it could address women's unmet health needs in most environments and directly facilitate their access to mainstream healthcare and social supports.
Accessing healthcare is extremely challenging for women experiencing domestic violence in Australia. The nurse-led specialist service provided much needed support to women experiencing domestic and family violence and to health professionals within the broader organisation, to improve access to care. Optimising the nurse's scope of practice in terms of authority to refer for investigations and prescribe medications, would further increase access to care.
This study has been reported using the Consensus Reporting Items for Studies in Primary Care (CRISP) checklist.
No Patient or Public Contribution.
To provide a comprehensive understanding of the cultural adaptation and professional integration experiences of migrant nurses in the receiving country.
A convergent parallel mixed methods design with concurrent sampling was employed.
Professional nurses who migrated from various Middle Eastern and North African countries, including Egypt, Syria, Palestine, Yemen, Jordan, Iraq and Saudi Arabia, were enrolled. The Quantitative data was collected through an online questionnaire involving open-ended questions for the qualitative data. Data was collected from November 2023 to March 2024.
One hundred five nurses responded to the quantitative questionnaire, and 32 answered the open-ended questions. The findings revealed that mean scores for cultural competence and professional self-concept were 83.41 ± 12.90 and 76.28 ± 11.16, respectively. Migrant nurses experienced challenges such as language barriers (91.4%), social interaction (82.9%) and difficulties adapting to daily living activities (100%). The majority of them reported positive outcomes as better working conditions (91.4%), higher standard of living (89.5%) and professional development opportunities (94.3%). Nurses emphasised accepting cultural diversity, participating in cultural competency training, building relationships with local colleagues and utilising support mechanisms and mentorship for cultural adaptation.
This study highlighted the importance of support systems, cultural competency training and integration initiatives to facilitate successful adaptation and professional integration.
Orientation programs and cultural competency training should be developed to support migrant nurses. Initiatives should include language acquisition support, financial assistance for certification programs and promotion of diversity and inclusion in healthcare settings.
This study addressed the challenges migrant nurses face when transitioning to a new cultural and professional environment. It found that migrant nurses experience difficulties with language, social interaction and daily living activities. The research impacted healthcare institutions by guiding the development of orientation programs and cultural competency training, supporting policymakers in addressing systemic barriers and empowering migrant nurses with practical strategies for adaptation.
This study adhered to the Good Reporting of A Mixed Methods Study (GRAMMS).
No patient or public involvement.
by Oumarou I. Wone Adama, Iman Frédéric Youa, Alexandra Bitty-Anderson, Arnold Junior Sadio, Rogatien Comlan Atoun, Yao Rodion Konu, Hezouwe Tchade, Martin Kouame Tchankoni, Kokou Herbert Gounon, Kparakate Bouboune Kota-Mamah, Abissouwessim Egbare Tchade, Godonou Amivi Mawussi, Fiali Ayawa Lack, Fifonsi Adjidossi Gbeasor-Komlavi, Anoumou Claver Dagnra, Didier Koumavi Ekouevi
IntroductionIn Togo, the syndromic approach is used for the diagnosis and management of sexually transmitted infections (STIs). The aim of this study was to evaluate the syndromic approach for diagnosis of STIs among female sex workers (FSW) in Lomé, Togo.
MethodsA cross-sectional study was carried out from September to October 2023 among FSW in Lomé (Togo). FSW aged 18 years and above were included. A gynecological examination was performed for syndromic diagnosis, and the Xpert® CT/NG were used to screen vaginal swabs for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The performance (predictive values) of the syndromic approach to STI diagnosis was evaluated using the Xpert® CT/NG test as the gold standard.
ResultsA total of 357 FSW were recruited. The median age of FSW was 32 years (IQR: [26–40 years]) and 8.2% had attained a higher level of education. The prevalence of syndromic STI among FSW was 33.3%. Vaginal swabs were positive for CT (8.4%) and NG (8.7%), with a prevalence of bacterial STIs (CT and/or NG) of 14.3%. The syndromic approach to STI diagnosis demonstrated a positive predictive value of 24.3%.
ConclusionThe prevalence of STIs is relatively high among FSW in Lomé. According to this study, the diagnosis of STIs using the syndromic approach has limited relevance. National STI screening and management policies urgently need to be rethought, incorporating recent technological advances.
Multimorbidity or the presence of two or more long-term conditions is now common in people undergoing surgery. However, current care pathways often miss these healthcare encounters to support long-term health promotion. Therefore, there is a need for practical, scalable approaches that can be integrated into routine surgical care, for which limited solutions exist at present. We have co-designed a structured preoperative checklist to help identify and manage long-term conditions in patients listed for elective surgery. This study aims to evaluate the feasibility and acceptability of this preoperative checklist in patients undergoing elective surgery.
This is a mixed-methods feasibility study in one National Health Service trust in the UK. We will recruit up to 50 adults scheduled for elective surgery and use the checklist during initial surgical clinic appointments. Quantitative data will include recruitment and retention rates, completion of the checklist and baseline clinical characteristics, analysed using descriptive statistics. Qualitative data will be collected through semistructured interviews with up to 16 patients and clinicians. These interviews will be analysed thematically, guided by the Consolidated Framework for Implementation Research. Triangulation of quantitative and qualitative data will allow us to explore fidelity, acceptability, barriers and facilitators to implementation and refine the intervention ahead of a future pilot cluster randomised trial.
This study has received approval from the Yorkshire & The Humber - Sheffield Research Ethics Committee (approval number: 25/YH/0045). All participants will give written informed consent. Results will be published in peer-reviewed journals and shared with participants, the public and policy stakeholders.
by Ayça Toprak-Semiz, Efsane Yavuz-Bedir, Hakan Yüzüak, Murat Usta, Demet Şengül
Hazelnut, antioxidant, anti-inflammatory effects, has an important role in a healthy diet. High fructose corn syrup (HFCS), used as a sweetener in ready-made food, beverages; causes hyperlipidemia, fatty liver, cardiovascular system damages; oxidative stress, inflammation play role in these damages. Based on these data, we aimed to examine liver and heart damage caused by HFCS in rats and to investigate possible role of hazelnut enriched food in preventing/improving these damages. During this process, weight change, food, liquid consumption were recorded. Biochemical parameters were measured with standard enzymatic techniques. Inflammatory cytokines were determined by ELISA. Liver and heart tissues were evaluated histopathologically, changes were scored, graded. HFCS decreased food, increased liquid consumption. Feeding with hazelnut reduced fluid consumption. HFCS increased weight gain, hazelnut did not reverse it. LDH, CK values increased in HFCS group due to heart damage. While damage occurred in livers of HFCS group due to increased levels of TNF-α and IL-1ß, feeding with hazelnut did not change it. In heart, inflammatory cytokines were similar between groups. In histopathological analysis, inflammation was observed both in livers, hearts of HFCS group. In hazelnut group, a significant decrease in damage was observed compared to HFCS, HFCS+H groups. According to our results, hazelnut supplementation reduced liquid intake and showed limited cardiac protection, but did not reverse HFCS-induced hepatic or cardiac injury.Sensory balance is the individual's ability to regulate internal and external sensory stimuli to remain in a functional and balanced state.
This study aims to explore in depth the experiences of psychiatric nurses caring for trauma victims in building sensory balance and well-being.
Psychiatric nurses caring for trauma victims may be constantly exposed to intense sensory stimuli such as yelling and agitation. It is known that post-traumatic stress disorder and burnout are seen in nurses caring for these individuals; however, it is noteworthy that studies on how this process is reflected sensoryly in individuals are limited.
Snowball sampling method was used in this qualitative phenomenological study. In-depth interviews were conducted with 14 volunteer psychiatric nurses caring for trauma victims. Data were collected using a semi-structured interview form and analyzed using Colaizzi's method. COREQ guidelines were adhered to throughout the research process.
Four categories and a total of eight themes were obtained from the in-depth interviews. “Traces of Traumatic Contact, Emotional Armor and Inner Distance, Transformation through Exhaustion, Institutional Silence and Seeking Solidarity”.
This study shows that psychiatric nurses caring for trauma victims are both professionally and individually traumatized and face the risk of losing their identity. It has also been found that nurses withdraw both sensorially and emotionally and experience burnout. But in some cases this process transforms into the development of awareness and maturity. It was also found that despite adverse working conditions, contact with nature, silence and collegial solidarity played a protective role in rebuilding well-being.
This study addresses in depth the sensory, emotional and identity impacts experienced by psychiatric nurses caring for trauma victims and draws attention to the effects of these conditions on the process of well-being construction. The results of the study provide important points for the development of education, self-care and institutional support mechanisms to support nurses' well-being.
Excessive opioid prescribing after surgery can lead to adverse events and exacerbate the opioid crisis. Patients undergoing outpatient breast surgery are often prescribed opioids to manage pain at home; however, the value of this approach is uncertain. The Postoperative Analgesia Intervention with Non-opioid Alternatives (PAIN Alt) trial will address the following research question: among patients undergoing outpatient breast surgery, does opioid-free analgesia (OFA) result in non-inferior 7-day pain intensity and pain interference in comparison to opioid analgesia (OA)?
This is a parallel, assessor-blind, open-label randomised trial conducted at seven university-affiliated hospitals in Canada. A sample of 540 adult patients (>18 years) undergoing outpatient mastectomy or lumpectomy will be included. Participants are allocated 1:1 to receive OA (around-the-clock non-opioids and opioids for breakthrough pain) or OFA (around-the-clock non-opioids, with adjustment of non-opioid drugs and/or non-pharmacological interventions for breakthrough pain). The co-primary outcomes are 7-day pain intensity and pain interference (measured using the Brief Pain Inventory). Secondary outcomes include adverse drug events, physical and mental health status, satisfaction with pain management, postoperative complications, chronic pain, opioid misuse, persistent opioid use, healthcare utilisation and costs. The primary statistical analyses will follow the intention-to-treat principle and be conducted using mixed-effects modelling.
This trial is coordinated by the McGill University Health Centre (ethics approval MP-37-2024-102530), with ethics approval being sought at all participating sites. Our results will be published in an open-access, peer-reviewed journal, presented at relevant conferences and disseminated to the public through press releases.
In the Netherlands, approximately 2200 major amputations of the lower extremities are performed each year, the majority in vascular patients. Around 61% of these patients will develop postamputation pain (PAP). PAP is a severe, lifelong, disabling condition profoundly affecting quality of life. During amputations, the common practice is to cut the nerves without employing nerve-surgical techniques to prevent chronic pain due to neuroma formation. In recent years, targeted muscle reinnervation (TMR) has been the most frequently studied technique for treating PAP, inhibiting neuroma formation by rerouting the cut mixed nerve to a functional motor nerve. We hypothesise that a primary TMR procedure during major lower limb amputations will result in a lower prevalence of PAP.
We propose a national, multicentre, randomised, sham-controlled trial comparing TMR with traction neurectomy in major amputations of the lower extremities in patients with vascular disease. 203 patients will be recruited with an indication for a transfemoral to transtibial amputation as a primary or secondary sequela of vascular disease. The subjects are randomly assigned to the TMR group or the traction neurectomy group. PAP will be evaluated 1 year postoperatively as the primary endpoint. Secondary outcomes include quality of life, mobility, neuropathic pain, hospital anxiety and depression, cost-effectiveness and complications.
This study has been reviewed and approved by the local ethical review body, ‘The Medical Ethics Committee Leiden The Hague Delft’, under the reference: P24.073 on 28 November 2024. Results will be published in peer-reviewed journals.
NCT06719245. Dutch trial registry: NL87196.058.24
To compare birth weight-to-placental weight (BW:PW) ratios between pregnancies complicated by gestational diabetes mellitus (GDM) and normoglycaemic pregnancies, and to evaluate the associations between BW:PW ratio, perinatal outcomes, and placental histopathologic features within the GDM group.
A prospective cohort study.
A university hospital in Bangkok, Thailand.
A total of 200 women with GDM and 100 normoglycaemic controls.
BW:PW ratios were calculated and compared between the two groups. Participants with GDM were stratified into three categories based on the BW:PW ratio percentiles: 90th. Perinatal outcomes and placental histological abnormalities were analysed across these categories.
Median BW:PW ratios were not significantly different between the GDM and normoglycaemic groups: 6.3 (IQR 5.6 to 6.9) versus 6.2 (IQR 5.6 to 6.8); p=0.399. Within the GDM cohort, the BW:PW ratio cut-offs corresponding to the 10th and 90th percentiles were 5.2 and 7.6, respectively. The prevalence of small-for-gestational-age (SGA) neonates differed significantly among the three BW:PW ratio groups: 14.3% (90th); p=0.004. Similarly, the prevalence of chorangiosis varied significantly across these groups (66.7%, 52.9% and 22.7%, respectively; p=0.009). A BW:PW ratio 90th percentile was associated with reduced odds of chorangiosis (aOR 0.35; 95% CI 0.11 to 0.85).
BW:PW ratios did not differ significantly between the GDM and normoglycaemic groups. However, in GDM pregnancies, extremes in the BW:PW ratio were associated with distinct perinatal and placental outcomes, indicating altered placental efficiency and potential clinical relevance.
TCTR20211122001.
Diabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.
The review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.
This scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.
by Berrak Çakmak, Ebubekir Yıldız, Tuba Tortop
BackgroundThere are a few studies evaluating dental students’ knowledge and awareness of intraoral scanners. This study aims to evaluate and compare the knowledge and awareness of levels 3rd, 4th, and 5th-grade dental students regarding intraoral scanners and their use in orthodontics.
MethodsA survey adapted from similar studies was administered to a total of 278 volunteer undergraduate students [comprising 3rd (n = 94), 4th (n = 88), and 5th-grade (n = 96)] to assess their awareness of intraoral scanners. Descriptive statistics, including frequencies and percentages, were used to analyze the variables within the scope of the study. The Fisher–Freeman–Halton exact test was employed to compare responses across different academic years. A p-value of Results
Of the participants, 33.81% were 3rd-grade, 31.65% were 4th-grade, and 34.53% were 5th-grade dental students. There was no significant difference in the distribution of participants across academic grades (p > 0.05). Among the students, 96.81% of the 3rd-grade, 89.77% of the 4th-grade, and 83.33% of the 5th-grade students reported that they had never used an intraoral scanner (p rd-grade students (71.28%) believed that IOSs were used in the treatment of skeletal Class II malocclusions and the fabrication of maxillary expansion appliances, compared to the other grade groups. In contrast, 5th-grade students more frequently associated IOS usage with indirect bonding procedures (63.54%) (p Conclusion
Students in the 4th and 5th grades demonstrated a greater level of knowledge compared to 3rd-grade students. It is recommended that practical training opportunities be expanded and the dental curriculum be revised accordingly to support hands-on experience with intraoral scanners.
by Alicia A. Grima, Linda T. Hiraki, Shelly Bolotin, Andrew D. Paterson, Jennifer D. Brooks
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected millions of people worldwide. While most infected individuals who survive do so with no long-term consequences, approximately 10 to 70% develop long-term sequelae. Of particular concern has been the development of autoimmune diseases. Viral triggers for autoimmune disease have been thoroughly studied for previous viral infections and several recent studies have sought to investigate the link between SARS-CoV-2 and new onset autoimmune disease. Several reviews have also been conducted on the topic, however, many of these reviews are limited in focus, emphasizing biological mechanisms and case reports, as opposed to estimates of risk. Further, these reviews do not capture more recent cohort studies that have been published investigating the association between SARS-CoV-2 and new onset autoimmune disease. Therefore, there is a need for a more comprehensive and temporally updated systematically conducted review of the literature to address the question What is the risk of incident (i.e., new onset) autoimmune disease following a SARS-CoV-2 infection among adults (≥18 years)?. A systematic search of MEDLINE, EMBASE, CINAHL, and grey literature will be conducted, with results screened in duplicate in two stages: 1) Title and abstract screening and 2) Full text screening. A standardized data extraction sheet will be used on any studies passing through both stages of screening to extract details on publication, study population, exposure, and outcomes. Narrative and tabular synthesis of overall findings will be conducted, with diversity and heterogeneity of included studies discussed. If possible, a meta-analysis will also be conducted to combine findings of risk across the included studies. This protocol has been registered to PROSPERO (registration number: CRD42024594446).Many patients who are extubated after receiving mechanical ventilation for acute respiratory failure experience extubation failure (ie, require reintubation hours to days after extubation). High-quality evidence shows that extubating patients directly to non-invasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC), rather than conventional low-flow oxygen, can prevent extubation failure. These guideline-recommended interventions, however, require care coordination involving multiple intensive care unit (ICU) team members and are infrequently used. Interprofessional education (IPE), which teaches members of multiple professions together, could effectively address this implementation gap in complex, team-based, critical care settings, particularly when paired with a customisable protocol.
This batched, stepped-wedge, cluster-randomised, type 2 hybrid effectiveness–implementation trial will test three hypotheses: (1) when compared with traditional online education (OE), IPE increases implementation of preventive postextubation respiratory support, (2) the benefits of IPE are increased when paired with a clinical protocol and (3) preventive postextubation NIV for high-risk patients and preventive postextubation HFNC for low-risk patients reduce in-hospital mortality when compared with conventional postextubation oxygen therapy. The trial will recruit 24 clusters made up of one or more ICUs that care for at least 100 mechanically ventilated patients per year in a large multihospital health system in the USA. All clusters will receive OE, IPE and a clinical protocol, with timing determined by randomisation. We will also randomise half of the clusters to education promoting postextubation NIV for patients at high risk of extubation failure and preventive, postextubation HFNC for patients at lower risk, whereas the other half will be randomised to education promoting postextubation HFNC for all eligible patients. We will include all patients who are invasively mechanically ventilated for at least 24 hours. The primary implementation endpoint is the rate of use of postextubation NIV or HFNC among eligible participants. The primary clinical endpoint is in-hospital mortality truncated at 60 days from intubation.
This study was approved by the institutional review board of the University of Pittsburgh and an independent data safety monitoring board. We describe the methods herein using the Standard Protocol Items for Randomised Trials framework and discuss key design decisions. We will disseminate results to participating healthcare providers, through publication in a peer-reviewed medical journal and via presentations at international conferences.
The aim of this study was to prioritise a set of indicators to measure World Health Organization (WHO) quality-of-care standards for small and/or sick newborns (SSNB) in health facilities. The hypothesis is that monitoring prioritised indicators can support accountability mechanisms, assess and drive progress, and compare performance in quality-of-care (QoC) at subnational levels.
Prospective, iterative, deductive, stepwise process to prioritise a list of QoC indicators organised around the WHO Standards for improving the QoC for small and sick newborns in health facilities. A technical working group (TWG) used an iterative four-step deductive process: (1) articulation of conceptual framework and method for indicator development; (2) comprehensive review of existing global SSNB-relevant indicators; (3) development of indicator selection criteria; and (4) selection of indicators through consultations with a wide range of stakeholders at country, regional and global levels.
The indicators are prioritised for inpatient newborn care (typically called level 2 and 3 care) in high mortality/morbidity settings, where most preventable poor neonatal outcomes occur.
The TWG included 24 technical experts and leaders in SSNB QoC programming selected by WHO. Global perspectives were synthesised from an online survey of 172 respondents who represented different countries and levels of the health system, and a wide range of perspectives, including ministries of health, research institutions, technical and implementing partners, health workers and independent experts.
The 30 prioritised SSNB QoC indicators include 27 with metadata and 3 requiring further development; together, they cover all eight standard domains of the WHO quality framework. Among the established indicators, 10 were adopted from existing indicators and 17 adapted. The list contains a balance of indicators measuring inputs (n=6), processes (n=12) and outcome/impact (n=9).
The prioritised SSNB QoC indicators can be used at health facility, subnational and national levels, depending on the maturity of a country’s health information system. Their use in implementation, research and evaluation across diverse contexts has the potential to help drive action to improve quality of SSNB care. WHO and others could use this list for further prioritisation of a core set.
by Wananit Wimuttisuk, Pisut Yotbuntueng, Pacharawan Deenarn, Punsa Tobwor, Kamonluk Kittiwongpukdee, Surasak Jiemsup, Rapeepun Vanichviriyakit, Chanadda Kasamechotchung, Suganya Yongkiettrakul, Natthinee Munkongwongsiri, Siriwan Khidprasert, Vanicha Vichai
The microsporidian Enterocytozoon hepatopenaei (EHP) is a highly contagious pathogen that causes severe growth retardation in penaeid shrimp. EHP infection damages the hepatopancreatic tubules, causes hematopoietic infiltration, and recruits granulocytes and inflammatory cells to the shrimp stomach and intestine. In this study, we investigated whether EHP infection induced the eicosanoid biosynthesis pathway in the gastrointestinal tract of the Pacific white shrimp Litopenaeus vannamei. Shrimp hepatopancreases, stomachs, and intestines were collected on days 0, 7, and 21 of the EHP cohabitation experiment for analysis. On day 7, the levels of cyclooxygenase (COX) and prostaglandin F synthase (PGFS) enzymes, which catalyze the production of prostaglandins, were elevated in the hepatopancreas of EHP-infected shrimp. The stomach of EHP-infected shrimp also contained higher levels of 12-hydroxyeicosatetraenoic acid (12-HETE) and 12-hydroxyeicosapentaenoic acid (12-HEPE) than the control shrimp. Nevertheless, the most significant impact of EHP infection on day 7 was observed in shrimp intestines, in which the levels of prostaglandin F2α (PGF2α), 8-HETE, and four isomers of HEPEs were higher in the EHP-infected shrimp than in the control shrimp. As the EHP infection progressed to day 21, the upregulation of COX and PGFS persisted in the EHP-infected hepatopancreas, leading to increasing levels of PGF2α and 15-deoxy-Δ12,14-prostaglandin J2 (15d-PGJ2). The upregulation of prostaglandins was in contrast with the decreasing levels of HETEs and HEPEs in the hepatopancreas of EHP-infected shrimp. Meanwhile, the stomach of EHP-infected shrimp contained higher levels of prostaglandin D2, PGF2α, 15d-PGJ2, and most of the hydroxy fatty acids than the control shrimp. The levels of eicosanoid precursors, namely arachidonic acid and eicosapentaenoic acid, were upregulated in the shrimp gastrointestinal tract collected on days 7 and 21, suggesting that substrate availability contributes to the increasing levels of eicosanoids after EHP infection. Our study provides the first comprehensive analysis of the eicosanoid biosynthesis pathway in response to EHP infection. Moreover, the results indicate that eicosanoids are part of the host-pathogen interactions in crustaceans.by Prakasit Tonchoy, Nestor Asiamah, Rufus Akintimehin, Pannawadee Singkaew
Occupational exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with adverse health effects, yet evidence on the cognitive consequences of such exposure remains fragmented and has not been systematically synthesized across occupational groups. This protocol outlines a systematic review that will examine the relationship between occupational PAH exposure and cognitive impairment across eight predefined occupational categories. Relevant studies will be identified through electronic searches of major databases, including PubMed, Web of Science, Scopus, Embase, ProQuest, PsycINFO, CINAHL, the Cochrane Library, and Google Scholar. Eligible studies must assess PAH exposure in occupational settings and evaluate cognitive outcomes using validated instruments, with domain-specific neuropsychological tests prioritized as primary outcomes and global screening tools (e.g., MoCA, MMSE) included as supportive outcomes. Both observational and comparative study designs will be considered. Titles and abstracts will be screened by two independent reviewers, and full texts of potentially eligible articles will be assessed using predefined criteria. Data will be synthesized narratively, with contingency meta-analysis conducted where sufficient comparable data are available and heterogeneity is acceptable. Prespecified subgroup analyses will be undertaken by occupational category, biomarker, cognitive domain, and exposure context, with meta-regression considered if an adequate number of studies are identified. Risk of bias will be assessed using JBI tools at the study level and ROBIS at the review level, with planned sensitivity analyses. The review will consolidate current evidence on PAH-related cognitive outcomes across occupational groups, including under-studied populations such as wildland firefighters, and will inform occupational health policy, workplace screening initiatives, and future research aimed at safeguarding cognitive health in exposed populations.by Pimwarat Srikummoon, Patrinee Traisathit, Wimrak Onchan, Chagkrit Ditsatham, Natthapat Thongsak, Nawapon Nakharutai, Salinee Thumronglaohapun, Titaporn Supasri, Phonpat Hemwan, Imjai Chitapanarux
Luminal A is the most common subtype of breast cancer and has the best prognosis comparing to the others. The association between air pollution and survival of breast cancer have been reported but not specific to this subtype. We examined pollutant distributions over a decade in upper Northern Thailand, the area of high average annual particulate matter levels, and their impact on the mortality and recurrence risks of patients with luminal A breast cancer. Retrospective data of 1,305 luminal A breast cancer patients diagnosed from 2003 to 2018 were enrolled to this study. Cox proportional hazard models were used to identify factors associated with mortality and recurrence risks including all known risk factors and the annually averaged concentrations of pollutants. On multivariable analysis; metastatic stage (adjusted hazard ratio (aHR) =10.50; 95% confidence interval (95%CI): 7.23–15.25), smoking history (aHR = 1.72; 95% CI: 1.14–2.60), and age ≥ 50 years old (aHR = 1.46; 95% CI: 1.13–1.90) were significant factors influencing mortality risk. Factors contributing to recurrence risk included metastatic stage (aHR) 4.96 (95% CI: 2.78–8.83) and exposure to the time-updated local concentration of PM10 > 55 µg/m3 (aHR = 1.68; 95% CI: 1.16–2.45). Exposure to air pollutants is one of the detrimental factors affected to recurrence and mortality in luminal A subtype breast cancer.
FreshRSS 