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To assess the quality of the Spanish Triage System performed by nurses according to the triage code assigned to each patient and to examine factors associated with the need for re-evaluation after completion of triage.
Retrospective longitudinal observational study.
A retrospective analysis was conducted of patients triaged in the emergency department between 2018 and 2023. Patients triaged by other healthcare professionals and those who did not receive a triage priority level were excluded.
493,211 episodes were analysed. Most were low/intermediate acuity (Level IV 65.4%, Level III 23.9%; Level I 0.1%). Mean time-to-first physician record entry increased as acuity decreased (38 min Level I vs. 81 min Level V), yet recorded time-target compliance was lowest in Levels I–II (23.8% and 14.7%). Re-evaluation occurred more often in high-acuity levels and was independently associated with older age, male sex, lower oxygen saturation and longer emergency department length of stay; compared with Level I, Levels II–III and lower adjusted odds of re-evaluation.
Nurse-led triage demonstrated coherent clinical and operational stratification; however, the lowest recorded time-target compliance in the sickest patients suggests a gap between immediate care and electronic documentation.
Streamline documentation workflows for high-acuity cases and use re-evaluation risk profiles to prioritize monitoring and escalation.
Evidence on nurse-led Spanish Triage System performance and time-documentation quality is limited. Acuity and flow metrics showed expected gradients, but target-time compliance was lowest in Levels I–II; predictors of re-evaluation were also identified. Findings support emergency department nursing, quality improvement and potential benefits for patients attending emergency departments.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Poststroke motor dysfunction places a heavy burden on individuals and society. Virtual reality (VR) offers enhanced motor skill transfer and active rehabilitation by overcoming the scenario-specific constraints of conventional therapies. Validating the efficacy of VR rehabilitation could lead to scalable and cost-effective solutions, potentially enabling home-based rehabilitation. However, the widespread clinical application remains constrained by the lack of rehabilitation-specific VR and multidimensional quantitative assessments. The aim of this study was to investigate the multidimensional effects and neural mechanisms of VR rehabilitation in poststroke motor recovery.
This study is a prospective, randomised, controlled clinical trial protocol designed to evaluate the effects of multisensory VR training on motor dysfunction in patients who had a stroke using multidimensional assessments. The trial consists of a baseline assessment, a 4-week intervention period and an endpoint assessment. A total of 40 patients who had a stroke will be randomly allocated in a 1:1 ratio to either a VR combined with treadmill group or a treadmill-only group. The primary outcome measure is the Fugl-Meyer Assessment of Lower Extremity score, while secondary outcomes include three-dimensional gait analysis, the Berg Balance Scale score, the activities of daily living score and functional near-infrared spectroscopy results. Safety will be evaluated by monitoring the incidence of adverse events. This study aims to determine whether VR rehabilitation offers superior efficacy in improving motor function in patients who had a stroke by using a multidimensional assessment approach, including neural coupling function, muscle movement mechanics and clinical performance. The findings will provide robust, high-quality evidence to support the broader application of VR in clinical practice.
The trial was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (2022–155). This study protocol was registered with the clinicaltrials.gov (NCT06275516). The results will be published in a peer-reviewed journal or presented at a conference.
To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context.
Observational, cross-sectional study.
An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024.
Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations.
Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs.
The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs.
No patient or public contribution.
To estimate the proportion of Italian nurse managers (NMs) intending to leave (ITL) their positions and to identify associated socio-demographic, job-related, and psychosocial factors.
Cross-sectional study.
Between September and November 2023, 464 NMs from 19 public hospitals completed a case-report form and the short version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II). Latent Class Analysis (LCA) identified ITL profiles, and multiple logistic regression assessed factors associated with ITL.
284 NMs (61.2%; 95% CI 57–66) reported an intention to leave within 12 months. LCA identified two classes: (1) Low-ITL (54%)—mainly outpatient NMs from Central regions with strong relationships with management, good support, work–life balance, and autonomy (55.9% probability of being unlikely to leave). (2) High-ITL (46%)—mainly surgical or critical-care NMs, often from Northern regions, marked by poor management relations, low support and high work–family conflict (80.9% probability of being likely to leave). Multiple regression confirmed that stronger management relations reduced ITL (OR 0.60, 95% CI 0.46–0.79) whereas high job demands and work–health conflict increased it (OR 1.56, 95% CI 1.19–2.04). Northern location also predicted higher ITL (OR 1.58, 95% CI 1.03–2.44). Demographics, education, and clinical setting were not significantly associated.
These findings suggest that healthcare organizations should prioritize managerial and organizational strategies targeting modifiable work-related factors to reduce nurse managers' intention to leave. Interventions aimed at improving organizational support, work environment, and job satisfaction may contribute to workforce retention at the managerial level. Future research should evaluate the effectiveness of targeted organizational interventions in sustaining nurse manager retention.
Evidence-Based Practice (EBP) is essential to healthcare quality and safety, integrating scientific evidence with clinical expertise and patient preferences. Despite its importance, EBP implementation still faces major challenges. Educational interventions have proven effective in strengthening EBP competencies among healthcare.
To evaluate the impact of a personalized educational intervention on EBP competencies among healthcare professionals. Working at a private tertiary general hospital, comparing performance before and after the intervention.
A randomized controlled trial involving healthcare professionals was conducted. Eligible and consented participants were randomly assigned to either an Intervention Group (IG) receiving an Evidence-Based Practice (EBP) course or a Control Group (CG) not receiving the course, stratified by job level, role, and work shift. From the completers, 18 participants were randomly selected for the IG, and all 7 available CG participants were included in the final sample for analysis. All study participants completed two validated instruments: the Assessing Competencies in Evidence-Based Medicine (ACE) and the Fresno Test. The educational intervention consisted of a seven-week course with weekly three-hour sessions, for a total of 21 h. Comparative analyses were conducted using a Linear Mixed Model, adjusted for educational level, job level, time working at the hospital, and weekly workload.
A statistically significant increase in general EBP knowledge was observed in the IG following the intervention, with a mean gain of 19.1%. Separate analysis showed improvements of 10.8% in ACE and 24.2% in Fresno Test scores. No statistically significant changes were observed in the CG. Furthermore, after the intervention, the IG outperformed the CG for both general EBP knowledge and Fresno Test scores on both pre- and post-intervention comparisons.
The educational intervention had a positive statistically significant impact on EBP knowledge and skills among healthcare professionals in the IG compared to the CG. These findings underscore the potential of structured educational initiatives to enhance the quality of clinical practice through improved EBP competencies.
UTN U1111-1322-8443
To assess the factors influencing dentists’ choice of restorative materials for posterior restorations, with a particular emphasis on the perceived influence of social media on patient preferences among general dental practitioners in Palestine.
Cross-sectional web-based survey.
A total of 550 general dentists practising in Palestine were invited between May and December 2023 through convenience and snowball sampling via social media platforms; 390 responded, and 350 complete responses were included in the final analysis.
No specific intervention was applied; this was an observational, questionnaire-based study.
Dentists’ selection of restorative materials (composite, amalgam or high-viscosity glass-ionomer cement (HVGIC)) for posterior restorations in relation to tooth type, patient age, oral hygiene, moisture control, financial status and social media influence.
Descriptive statistics, ² tests and multinomial logistic regression were used to examine associations and control for potential confounders.
Material selection varied significantly by tooth type (p
Patient-related factors were the main determinants of material selection, whereas practitioner demographics played a minimal role. HVGICs are preferred for paediatric and elderly patients because of their suitability for age-specific clinical needs. The influence of social media, assessed in this study as dentists’ perceptions rather than direct measures of patient behaviour, underscores its growing role in shaping dentists’ impressions of patient expectations and highlights the importance of evidence-based guidance and public education to support patient-centred, clinically appropriate restorative decisions.
by Mariana Moraes de Lima Perini, Alyssa F. Fayemi, Julie N. Pugh, Elizabeth M. Scott, Karan Bhula, Austin Chirgwin, Olivia N. White, Nicolas F. Berbari, Jiliang Li
Primary cilia play a crucial role in the development and mechanosensation of various tissue types, including bone. In this study, we investigated their role in bone growth and adaptation by targeting two cilia specific genes, IFT88 and MKS5. Conditional knockout (cKO) of IFT88 in osteoblasts significantly reduced body weight and femur length in mice compared to the littermate controls. Additionally, female IFT88 cKO mice exhibited a significant suppression of bone formation rate compared to the littermate controls. To further explore the role of primary cilia in osteocytes, osteocytes specific MKS5 cKO mice underwent axial ulnar loading at a peak force of 2.9N for females and 3.2N for males with 120 cycles per day for three consecutive days. Load induced bone formation rate was significantly decreased by 48% in males and 42% in females compared to the littermate control mice. These findings underscore the critical role of primary cilia in bone development and mechano-adaptation. They suggest that functional primary cilia in osteoblasts are essential for skeletal development, while those in osteocytes mediates mechanically induced bone formation, highlighting its potential as therapeutic targets for bone loss prevention.Well-being of healthcare professionals (HCPs) is vital for care quality, staff retention and overall healthcare system effectiveness. This study aims to identify the organisational and workplace variables associated with sick leave and measures of engagement of HCPs on department level within a single Dutch academic hospital.
Cross-sectional study using routinely collected organisational data.
A tertiary-care academic hospital in the Netherlands.
25 clinical departments were included. Department level variables were derived from routinely collected hospital databases. Availability of data varied across variables. Analysis included information on patient population, human resources, care processes, quality of care and employee and patient experiences to assess differences, correlations and predictors for sick leave and engagement.
Primary outcome measures were (1) sick leave (%) and (2) engagement, assessed through two staff-survey items (vitality and connectedness; 0–10 Numeric Rating Scale). Both outcomes were analysed at department level.
Employee population data showed the most consistent patterns across analyses. Departments with higher staffing capacity had higher sick leave and lower engagement in group comparisons (p=0.009, p=0.030, respectively). In multivariable models, higher staffing capacity remained associated with increased sick leave (B=1.38, 95% CI 0.53 to 2.23, p=0.003). Engagement was positively associated with higher inflow (B=0.92, 95% CI 0.06 to 1.77, p=0.037) and negatively associated with outflow (B = –1.36, 95% CI –2.08 to –0.63, p=0.001). No consistent associations were found with patient population and patient experience measures.
Workforce-related factors, particularly staffing capacity and inflow and outflow, are strongly linked to sick leave and engagement. Routinely collected hospital data can be used to identify at-risk departments and inform targeted strategies for improving workforce sustainability. Future studies should explore more granular, team-level data to better support staff well-being and care quality.
Settings with insufficient human resources struggle to provide timely eye care services and information to the population. mHealth (mobile healthcare) is a promising solution; however, evidence on the effectiveness of interactive voice response (IVR) and real-time phone-based education remains scarce, despite their potential to be scalable and cost-effective. This study aims to implement the Virtual Baithak, an interactive mHealth platform, to improve eye-health literacy among older adults residing in rural India. The objectives are to (1) Develop and validate the Virtual Baithak for improving vision health and (2) Determine its effectiveness, feasibility and acceptability among the older adults.
This 3-armed, parallel, randomised controlled trial of 14 months duration will enrol 381 older adults (aged 60 years and above). Participants will be blinded and randomly (computer-generated) assigned to either of the three groups based on the intervention for eye-health education they receive: both IVR and group calls moderated by a healthcare professional, only IVR and usual care. The two intervention arms will receive the information weekly over a 3-month period through the Virtual Baithak platform, which will be designed for this study using a participatory research approach to develop the content. The primary study outcomes are digital health literacy and vision health knowledge scores, measured at baseline and 14 months. The secondary outcomes include m-health technology acceptance and usage practices. A mixed-method process evaluation will be conducted to assess the intervention feasibility and implementation, including in-depth interviews with participants. The qualitative data will be thematically analysed to explore factors that promote or restrain the implementation. The inferential statistical quantitative analysis will be performed using linear mixed models.
The study has been approved by the ‘Institute Ethics Committee,’ PGIMER, Chandigarh, India (PGI/IEC/2022/EIC000282 dated 18 February 2022). The results will be disseminated via presentations and/or publications at the national and international levels.
CTRI/2023/02/049383, dated 1 February 2023.
Introducción: La Toma de Decisiones Compartida (TDC) es una competencia de enfermería que busca respetar y promover la autonomía del paciente, favorecer la relación de confianza con el profesional, mejorar el cuidado y tener a la persona como centro de su cuidado. El cáncer se está convirtiendo en una enfermedad crónica que genera incertidumbre y una continua decisión en el cuidado. Existen estudios que revelan los beneficios en la salud de una TDC a partir de una relación de confianza entre el paciente y la enfermera. Objetivos: Conocer las intervenciones de enfermería para una TDC en el ámbito de la oncología y diseñar un plan de implementación de intervención de enfermería para una TDC en una unidad de oncología. Metodología: revisión narrativa de la literatura. Se revisaron las bases de datos Pubmed y CINAHL. Resultados: se incluyeron cinco artículos para el análisis de los resultados: una revisión sistemática (RS) y cuatro ensayos clínicos aleatorizados (ECAs). La calidad de estos fue evaluada con el instrumento Critical Appraisal Skills Programme español (CASPe). Se encontraron varias intervenciones de ayuda para la TDC dirigidas a los profesionales y a los pacientes, teniendo todas ellas en común la capacitación a los profesionales, y considerando los valores y preferencias del paciente. Conclusiones: Las intervenciones de ayuda para la TDC mejoran la actitud en los profesionales de enfermería, y aumenta la satisfacción del paciente en los cuidados al preservar su autonomía, aumentar su participación y mejorar la relación con el profesional, por lo que mejora un cuidado centrado en la persona.
ABSTRACT
Introduction: Shared Decision Making (DBT) is a nursing competence that seeks to respect and promote patient autonomy, favor the relationship of trust with the professional, improve care and, ultimately, have the person as the center of their care. Cancer is becoming a chronic disease that generates uncertainty and a continuous decision in care. There are studies that reveal the health benefits of a DBT from a relationship of trust between the patient and the nurse. Objectives: To know the nursing interventions for a DBT in the field of oncology and to design a plan for the implementation of a nursing intervention for a DBT in an oncology unit. Methodology: narrative review of the literature. We reviewed the Pubmed and CINAHL databases. Results: We included five articles for outcome analysis: one systematic review and four RCTs. The quality of these was assessed with the Spanish Critical Appraisal Skills Programme (CASPe) instrument. We found several interventions to help BDD aimed at professionals and patients, all of which had in common the training of professionals, taking into account the values and preferences of the patient. Conclusions: Interventions to help with DBT improve the attitude of nursing professionals and increase patient satisfaction in care by preserving their autonomy, increasing their participation and improving the relationship with the professional, thus improving person-centered care.
Las Unidades de Cuidados Prolongados en Psiquiatría, los ofertan a pacientes con Trastorno Mental Grave (TMG). Supone un desafío ético, queriendo mantener su autonomía y más, en situación de crisis terminal.
Las Instrucciones Previas, en este sentido, son una herramienta valiosa que busca la autodeterminación también en este tipo de usuario. El marco jurídico la salvaguarda, incluso cuando la capacidad de decisión esté comprometida.
Para hacerlo realidad, nuestra idoneidad nos privilegia para establecer una relación terapéutica, evitando el paternalismo y fomentar la cooperación valorando las particularidades cognitivas y emocionales de cada persona.
Preguntas como: qué conocimiento de la enfermedad, aceptación de tratamiento y preferencias ante medidas de reanimación, hechas desde la sensibilidad clínica y la información comprensible, persiguen esa adaptación para un formato de conversación estructurada y respetuosa.
Por ello, para la búsqueda de estrategias que den voz a los pacientes con TMG, invitamos a reflexionar a nuestro colectivo. Para un cuidado centrado en la persona.
To explain the relationship between occupational well-being dimensions and overall occupational well-being among nurse and social care educators, with particular focus on hybrid work status.
A cross-sectional survey study.
The quantitative data were collected from Finnish nurse and social care educators (n = 367) in autumn 2023 and analysed using multiple regression with interaction analysis.
Overall personal occupational well-being was rated higher than work community occupational well-being, especially among hybrid-working educators. In models including all occupational well-being dimensions (working conditions, work community, worker's resources and work, and professional competence), only work community and worker's resources and work remained statistically significant positive relationships with occupational well-being. Hybrid work status moderated these relationships: the relationship between work community and occupational well-being was stronger among on-site educators, and professional competence was associated with work community occupational well-being only among them.
Voluntary hybrid work may support personal occupational well-being among nurse and social care educators, yet the enduring importance of work community—particularly for on-site educators—highlights the need to sustain work community resources across all work modalities.
Occupational well-being strategies in educational institutions could benefit from reflecting diverse work arrangements. For hybrid models, emphasis might be placed on combining flexible work options with support for self-leadership and virtual community-building to ensure equitable well-being across modalities. Strengthening team-based collaboration can help maintain connection, competence, and resilience regardless of work setting.
This study provides evidence on the factors supporting occupational well-being among nurse and social care educators depending on the hybrid work status. Work community and individual resources are key predictors, with implications for tailoring support strategies in institutions adapting to hybrid work models.
The Strengthening the Reporting of Observational Studies in Epidemiology STROBE guidelines.
No Patient or Public Involvement.
To explore the meaning older Asian immigrants attribute to social isolation and loneliness, their management strategies, utilisation of resources and impact on health.
Systematic review of qualitative studies.
AgeLine, CINAHL, MEDLINE, ProQuest, PsycINFO, Scopus, and Web of Science databases were searched in September 2024.
Inclusion criteria: participants were Asian immigrants to Western countries aged 65 and over, community-living and experiencing social isolation and loneliness. Antonovsky's Sense of Coherence was used to frame the thematic analysis.
Ten papers were included and analysed deductively using elements of the sense of coherence framework: • Comprehensibility: Social isolation and loneliness are viewed as multifaceted, influenced by cultural and environmental dislocation, language barriers, intergenerational conflicts, deteriorating health and mobility, and socioeconomic challenges. • Manageability: included engaging in culture-specific community programs, family and ethnic community support and living within ethnic enclaves mitigated isolation and loneliness. • Meaningfulness: Strong family ties, active community involvement, spirituality, volunteerism, and cultural practices fostered resilience. However, accepting the changing values of their new world, living independently, and carving their own niche provided meaning to their transformed reality.
Older Asian immigrants experience social isolation and loneliness through a cultural lens, shaped by migration experiences, language barriers, and shifting family dynamics. Cultural roots, family ties, spirituality, community, acceptance, and independence enhance sense of coherence. Recognising the dynamic interplay between cultural identity, resilience, and adaptation is key to understanding their lived experience.
This review informs culturally sensitive interventions, guiding healthcare, community services, and policy to support social participation, mitigate loneliness through ethno-specific activities, and improve the quality of life for aging immigrant populations in Western countries.
The review was undertaken and reported using the PRISMA guidelines.
None.
PROSPERO (CRD42023425752)
Pressure injury represents a significant but preventable health problem, especially in clinical settings characterised by a high degree of risk. Despite the critical role played by nurses in pressure injury prevention, evidence suggests that inconsistencies remain concerning their knowledge and skill levels. This study aimed to determine the level of knowledge amongst nurses regarding pressure injury prevention and the factors associated with this level. The sample of this cross-sectional study consisted of 346 nurses reached through convenience sampling. The research data were collected online using the nurse descriptive form and the Pieper–Zulkowski Pressure Injury Knowledge Test, accessed through a Google Forms link shared on various social media platforms between December 2023 and February 2025. Most of the 346 nurses who participated in the study were female (89.0%), and the mean age was 36.19 years (±8.52 years). Most participants had a bachelor's degree (76.8%), and 35.6% had more than 20 years of professional experience. The pressure injury knowledge test score of the nurses was 43.00 (10.50). There was a significant difference in knowledge scores between clinical units (p = 0.009); the highest scores were found in nurses working in high-risk units (e.g., operating theatre) (p = 0.029). The study demonstrated that the implementation of unit-specific, practise-based training programmes is imperative to enhance nurses' knowledge. It is suggested that future studies utilise a combination of methods in order to address the individual, environmental and organisational factors that have a bearing on knowledge levels.
Commentary on - Lindekilde CR, Pedersen ML, Birkeland SF, Hvidhjelm J, Baker J, Gildberg FA. Mental health patients' preferences regarding restrictive interventions: an integrative review. J Psychiatr Ment Health Nurs. 2024 May 2. doi: 10.1111/jpm.13057.
Implications for practice and research Mental health patients perceive observation as the least restrictive intervention. Mental health professionals should consider environment, communication and duration that could influence patient preferences for restrictive interventions. More research is needed on developing a global definition for restrictive interventions and also to understand patient preferences and views regarding various restrictive interventions.
Philippe Pinel has been honoured in history for his ‘humane treatment’ and ‘unchaining the mentally ill’.
Qualitative research methods allow investigators to gain a detailed understanding of phenomena, based on the collection and analysis of rich data. An important element of some qualitative studies is key informants (KIs)—those are a specific set of participants who are able to provide particularly valuable viewpoints and insights on the issues or questions being examined.
The concept of using KIs dates back to early anthropological studies, where researchers relied on local experts to help better understand cultural practices and social structures. Over time, this approach has evolved, with increasing recognition of the value that KIs bring to a wide array of fields, including public health, education, social sciences, medicine and nursing.
by Josefine Lampinen, Håkan Littbrand, Ingeborg Nilsson, Annika Toots, Yngve Gustafson, Jerry Öhlin, Henrik Holmberg, Birgitta Olofsson, Anita Ericsson, Mia Conradsson
BackgroundTo meet the complex needs of adults with dementia, a team-based, individualized rehabilitation approach may be required. This randomized controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation program for older adults with dementia, in terms of follow-up and response rates, and potential short- and long-term effects in adults with dementia on social participation, loneliness, and mental health.
MethodsParticipants (mean age (SD) 78.7 (±6.6) years), were randomized to an intervention group (n = 31) or usual care (n = 30). The rehabilitation program consisted of a 20-week rehabilitation period and two follow-ups after 5 and 14 months. An interdisciplinary team performed assessments and interventions based on the individual’s goals. Assessors blinded to group allocation performed structured assessments at baseline and after 5, 12, 24, and 36 months.
ResultsInitially, response rates in participants with dementia were high for all assessments in the areas of social participation, loneliness, and mental health. Response rates after 12 months decreased, particularly for cognitively demanding questions with multiple-choice options in the area of social participation. Overall, there were few statistically significant differences between the groups in the outcomes over 36 months, but some of the findings seemed potentially clinically meaningful in favor of the intervention group: increased frequency of active recreation and organized social activities outside the home, as reported by both participants with dementia and caregivers or staff; as well as experienced more frequent visits to family and friends; and short-term reduction in depressive symptoms.
ConclusionsAssessments made of loneliness and mental health in this study over three years seemed feasible. It seemed cognitively demanding for participants with dementia to answer questions regarding social participation over time; therefore it seemed worthwhile to also ask informal caregivers or staff to avoid data loss. The positive findings noted during assessments and potential effects indicate that it is relevant to proceed further to an adequately powered RCT and conducted in additional geographical regions.
Trial registrationISRCTN – The UK’s Clinical Study Registry: http://www.isrctn.com/ISRCTN59155421
by Vu Nhi Ha, Le Chi Cao, Tran Hai Dang, Dao Thi Huyen, Nguyen Tien Dung, Le Huu Song, Nguyen Linh Toan, Truong Nhat My, Thirumalaisamy P. Velavan
BackgroundHepatitis E virus (HEV) causes sporadic outbreaks worldwide, with zoonotic and waterborne genotypes contributing to infections. In Vietnam, HEV genotypes 3 and 4 circulate among humans and swine, but data from remote, ethnic minority populations remain limited.
MethodsA cross-sectional study was conducted among 272 ethnic minority students at Thai Nguyen University of Medicine and Pharmacy (TUMP) to determine HEV infection markers and associated risk factors. Anti-HEV IgM and IgG were tested in serum samples using Wantai ELISA kits, and HEV RNA was detected by nested PCR targeting the ORF1 region. Demographic and exposure data were collected via structured questionnaires. Statistical analyses were performed using binary logistic regression.
ResultsOne participant (0.37%) tested positive for anti-HEV IgM, and 69 (25%) were positive for anti-HEV IgG, while HEV RNA was undetectable. HEV-IgG seroprevalence increased significantly with age (p = 0.004) but showed no sex-related differences. Consumption of tap or mixed water sources (p = 0.043) and raw or undercooked pork liver (p = 0.018) were significantly associated with HEV-IgG positivity. Multivariate analysis confirmed these factors as independent predictors of prior HEV exposure (adjusted OR = 1.6 and 4.8, respectively).
ConclusionsA moderate HEV seroprevalence among ethnic minorities indicates substantial prior exposure in northern Vietnam. Strengthening water sanitation, food safety awareness, and routine HEV surveillance is recommended to mitigate infection risk in vulnerable communities.
Clinical psychology interventions for reducing obesity have developed alongside pharmacological and surgical treatments, but usually as interventions for individual patients. Any healthcare intervention rests on a logic model: assumptions that through specific physical and social mechanisms, it will produce certain intended outcomes, provided that conducive background conditions (‘contexts’) exist. Using evidence from the feasibility trial preceding a full randomised controlled trial (RCT), this paper assesses the empirical validity of the initial logic model of a new group-based weight management intervention: PROGROUP, designed for patients with body mass index (BMI) ≥40 kg/m2 or ≥35 kg/m2 with comorbidities. We aimed to test whether:
PROGROUP’s programme components produce the intended outcomes at all, whatever their size and how. The intervention can practicably be implemented (‘delivered’) as designed. How the programme and delivery components affected each other.
Multimethod proof-of-concept study by means of realist evaluation of the initial PROGROUP logic model. We:
Elicited the logic model underlying the intervention design. Compared these assumptions with data from a pre-RCT feasibility study in two English and one Welsh National Health Service (NHS) sites during 2021–2023. Revised the logic model in light of the data, noting how much variation in delivery the programme components (therapeutic mechanisms) could tolerate.
Specialised ambulatory mental health services in the English NHS.
Adults with severe obesity (BMI ≥40 kg/m2 or ≥35 kg/m2 with comorbidities).
Group-building techniques to enhance group members’ adoption of evidence-based methods of behaviour change affecting their dietary behaviour and physical activity.
Qualitative outcomes. What kinds of:
Mechanisms were established and triggered by the attempt to implement PROGROUP (secondary outcome, see objective 1 above). Patient behaviours resulted and whether patients sustained them after the intervention ended (primary outcome; see objective 1 above); and what kinds of context affected that (objectives 2 and 3).
Quantitative measures not used.
The initial logic model assumed that the following sequence of mechanisms would produce weight loss: referral from GP to specialist weight management services; further referral to PROGROUP; preparatory individual consultation; facilitated group sessions produce a group identity; group identity reinforces weight management capability and motivation; further individual consultations adjust for individual circumstances; behaviour change outside the treatment setting, producing weight loss. Contexts necessary for these mechanisms to work included: sufficient catchment population; group size, continuity and membership retention; suitable location; facilitator training; and practical support outside the treatment setting.
The findings suggested revisions to the logic model, but more in the delivery components and contextual assumptions than the core therapeutic mechanisms. There was scope to simplify the referral mechanisms. Different professions could implement the model. A realist evaluation of a pre-RCT feasibility study can be used to make the intervention’s logic model more securely evidence-based, serving as a proof-of-concept test for the intervention. It indicated the conditions under which such group psychological interventions might be more widely used.
Exercise therapy is the most recommended treatment for chronic low back pain (LBP), with evidence supporting modest effects, likely due to the heterogeneity of patient presentations. Evidence suggests that matching individuals to the most appropriate exercise type could improve outcomes. Systematic reviews also emphasise that effective exercise interventions should be patient centred, target paraspinal muscle health and be of sufficient duration. This study addresses these gaps using a targeted care approach to identify a homogenous sample that is more likely to respond to our interventions. The inclusion of a sample with predominant nociceptive pain profile will be performed with the integration of the Pain and Disability Drivers Management Model (PDDM) and the Lumbar Spine Instability Questionnaire (LSIQ). The primary aim of this two-arm randomised controlled trial is to compare the effectiveness of motor control plus isolated lumbar extension exercises (MC+ILEX, arm 1) to free-weight resistance training (arm 2) in reducing LBP-related disability. Secondary aims include examining whether changes in multifidus composition mediate disability improvements comparing intervention effects on muscle size and quality, strength, mobility, pain, quality of life, sleep, physical activity and satisfaction; exploring baseline LSIQ scores and sex/gender as moderators of treatment response; and investigating participants’ perceptions and experiences of exercise therapy.
A total of 106 participants will be recruited through primary and secondary care and randomised (1:1) to receive either MC+ILEX or free-weight resistance training. Both groups will complete 48 exercise sessions over 16 weeks. The primary outcome will be disability at 16 weeks, measured by the Oswestry Disability Index. Secondary outcomes include multifidus muscle composition and size, lumbar and gluteal muscle strength, hip range of motion, pain, physical and mental function, satisfaction and recovery, health-related quality of life, sleep quality and physical activity levels. Linear mixed-effects models will be used to assess primary and secondary outcomes. Regression analyses will explore whether baseline LSIQ scores moderate treatment effects on multifidus composition and other outcomes. A subsample of participants will undergo semistructured interviews before and after the intervention to explore their illness perceptions, illness mindsets, perceptions of exercise therapy, as well as their experiences and satisfaction with the two exercise interventions. Reflexive thematic analysis will be used to analyse qualitative data.
This study received ethics approval from the Central Ethics Research Committee of the Quebec Minister of Health and Social Services (CCER-25-26-14). Results will be submitted to peer-reviewed journals and scientific meetings.
FreshRSS 