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by Elisabeth G. van der Hulst, Kenneth Meijer, Pieter Meyns, Christopher McCrum
Training fall-resisting skills can prevent falls in older adults. These fall-resisting skills include proactive gait adaptability, gait robustness, and reactive gait recovery, which allow people to effectively avoid, resist, and recover from balance threats, respectively. This pilot study guided the design of an RCT of fall-resisting skills training by investigating key design factors, such as the design of a placebo-control group, obstacle difficulty settings, exploring evaluation methods for gait robustness, testing the effect of task unpredictability on anxiety, and the general feasibility. Eleven healthy older adults performed non-task-specific “placebo” balance tasks and assessment and training tasks for each fall-resisting skill. Placebo tasks included static weight-shifting exercises and dual-task walking. For the fall-resisting skill tasks, participants walked on a treadmill under different conditions. For proactive gait adaptability, participants avoided projected obstacles varying in size, approach speed, and available response time. Gait robustness was assessed using perturbations of increasing magnitude, where the margin of stability following each perturbation was compared with participants’ perceived balance loss and researchers’ observations. For reactive gait recovery, perturbations with increasing unpredictability were applied, after which participants reported their anxiety scores. Weight-shifting tasks were perceived as balance training by most participants, indicating their potential as placebo tasks. Obstacle avoidance difficulty increased most with fast approach speed and large obstacle sizes. A margin of stability-based threshold did not consistently align with perceived balance loss or observer judgement. Anxiety did not increase with more unpredictable perturbation tasks when introduced gradually. Fall-resisting skill tasks generally were feasible for older adults.This study aims to describe current nurse prescribing practices in the absence of a legal framework, evaluate healthcare providers' preferred prescribing models, and their perceptions of the impact of nurse prescribing in Belgian hospitals.
Multicentre quantitative, cross-sectional survey.
Between December 2022 and April 2023, healthcare providers from seven Flemish hospitals completed an online survey after being presented with a short explanatory video on independent and supplementary nurse prescribing. The survey assessed demographics, current practices, expected impact and preferred prescribing models.
Of the 303 respondents, 86% were nurses, 10% were medical doctors and 4% were pharmacists.
Independent nurse prescribing or deprescribing of medications was reported by 75% in their current work context. Nurse prescribing was observed weekly or daily by 48%, primarily for initiating new medications. Overall, 44% preferred independent nurse prescribing over no prescribing.
Despite the absence of a legal framework, nurses in Belgian hospitals regularly prescribe medications. Most healthcare providers positively perceive the expected impact of nurse prescribing.
There is an urgent need for legal and institutional frameworks that acknowledge existing practices, define responsibilities and support safe and effective care. Structured policies could improve interprofessional collaboration, clarify clinical accountability and ensure consistent training for nurse prescribers.
This study addressed the widespread but informal practice of nurse prescribing in the absence of legal regulation in Belgium. It found that a majority of healthcare providers observed nurse prescribing in clinical practice and preferred formalised prescribing models. These insights can support health authorities, healthcare decision-makers and educators in designing regulations, implementation strategies and curricula aligned with clinical practice.
The authors adhered to the STROBE reporting checklist for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct, analysis or reporting.
Women constitute the majority of the global healthcare workforce—especially in nursing—yet remain under-represented in formal leadership roles. Understanding how gender disparities intersect with profession, age, and governance models is critical to advancing equity and strengthening nursing leadership within health systems.
Cross-sectional ecological study across publicly funded healthcare entities in Catalonia, Spain.
Data from 124 entities were collected as of 31 December 2023 and analyzed by gender, profession (physician, nurse, or other), age group (≤ 55, > 55), and governance model (direct vs. indirect management) across five hierarchical leadership levels. Descriptive and inferential analyses were conducted to examine gender disparities in leadership distribution.
A total of 8015 leadership positions were identified, of which 62.2% were held by women, despite women representing 75% of the workforce. A clear gender gradient emerged across leadership levels, with women's representation decreasing systematically at each step upward in the hierarchy. Women's representation declined significantly with increasing seniority, whereas men's representation increased at higher organizational levels. Among professions, male physicians were markedly represented at senior levels, while nurses—both women and men—were concentrated in lower and mid-level positions. Gender disparities were also shaped by age and governance model: younger women were clustered in frontline roles, and female leaders in indirectly managed entities were more evenly distributed across leadership levels than those in directly managed organizations.
Persistent gender disparities—particularly affecting nurses and younger professionals—highlight the need for inclusive leadership development, transparent promotion pathways, and robust gender-disaggregated data for workforce planning. Strengthening nursing leadership is not only a matter of equity but a strategic priority for building inclusive and responsive health systems.
Complex chronic wounds are an increasing health concern, affecting individuals both physically and psychologically. To measure the quality of life of this population properly translated and validated questionnaires in their native language are needed. The aim of this work is to provide a validated instrument for measuring the quality of life in the Catalan speaking population with complex wounds. A cultural adaptation of the Wound-QoL-17 questionnaire into Catalan was carried out by independent official translators and the back translation was approved by the original author. Validity, reliability, responsiveness, and feasibility were assessed. Face and content validity were determined by a group of experts: the 17 items of the Wound-QoL-17 Catalan version were appropriate for their purpose. Reliability was demonstrated by an interclass correlation coefficient of 0.884 for the scores obtained by two different observers and of 0.928 for the same observer on two time points. Chronbach's alpha coefficient was 0.926. Responsiveness was proved by a Pearson's correlation coefficient of 0.661. Feasibility was shown by the time, 3.46 min, taken to complete the questionnaire.
by Elisabetta Ferraro, Graziana Da Rold, Roberto Celva, Elisa Dalla Libera, Stefania Leopardi, Giulia Simonato, Paola De Benedictis, Nadia Cappai, Arianna Dissegna, Carlo Vittorio Citterio, Rudi Cassini, Federica Obber
The grey wolf (Canis lupus) population is expanding in parts of Europe due to legal protection and favorable ecological conditions. As wolves increasingly move into urban and suburban areas, interactions with domestic dogs become more frequent, raising the risk of pathogen transmission and posing potential threats to both wolf conservation and public health. This study investigated the health status of wolves in the Foreste Casentinesi National Park (Italy) using non-invasive fecal sampling conducted between May 2019 and March 2020. Samples were genetically analyzed to identify individuals and then screened for viral pathogens, Canine Coronavirus and Parvovirus, using PCR, Sanger sequencing, and phylogenetic analysis. Parasitological examinations were performed using flotation techniques on whole samples, and real-time PCR targeting Echinococcus granulosus and E. multilocularis was conducted on selected samples. Of the 260 samples collected, genetic analysis identified 80 individual wolves belonging to 8 packs. Only one sample tested positive for Coronavirus (1.2%), and none for Parvovirus. The detected sequence clustered with strains previously reported in wolves and foxes in Italy. Copromicroscopy revealed a high prevalence of veterinary-relevant endoparasites, including Eucoleus spp. (90.0%), Sarcocystis spp. (42.5%), Taeniids (28.7%), and Ancylostomatids (26.2%). Trichuris vulpis, Toxocara canis, and coccidia showed prevalence rates below 2%. All 104 samples tested for E. granulosus or E. multilocularis were negative. These findings suggest that while wolves in the FCNP commonly harbor several canine parasites, their role in the transmission of zoonotic pathogens appears limited. Although phylogenetic data suggest that coronavirus strains tend to cluster within wildlife species, molecular data on domestic dogs remain scarce. Nonetheless, the high prevalence of shared parasites highlights the need for ongoing surveillance in both wild canids and domestic carnivores. As wolves increasingly inhabit human-dominated landscapes, understanding disease dynamics at the wildlife–domestic interface is essential for effective conservation and public health strategies.The handover process is a critical component of patient safety, enabling effective communication and the transfer of responsibility among nurses. However, despite their critical role, it is often compromised by interruptions, lack of standardization, and variability in practice, which may reduce quality and nurse satisfaction. Existing tools primarily measure information transfer and efficiency but rarely incorporate nurses' perspectives on safety and satisfaction. This gap underscores the need for a validated instrument that comprehensively assesses handover quality from both a professional and safety perspective.
To develop and validate the Handover Quality Questionnaire (HAND-Q), a tool assessing nurses' satisfaction with handovers and their perceived impact on patient safety.
HAND-Q development included a conceptualization phase (literature review, expert discussions) and a validation phase (pilot and large-scale testing). Exploratory and Confirmatory Factor Analyses (EFA, CFA) assessed psychometric properties.
EFA revealed four factors: Satisfaction, Patient Safety, Care Pathway Safety, and Handover Content. CFA confirmed good model fit. Inter-factor correlations showed strong links between handover quality and safety, alongside discrepancies between satisfaction and objective standards.
The HAND-Q offers a practical tool to assess handover quality, support standardization, enhance patient safety, and inform training and digital solutions.
This study aims to (1) describe the content of consultations within school health services, (2) outline school nurses' assessments, and (3) identify factors that influence the duration of consultations.
A cross-sectional observational study was conducted.
The data were collected in Norway during November 2023 using a self-report form by school nurses (n = 96). Consultations (n = 382) were registered and analysed using descriptive statistical methods and multiple linear regression analyses to identify factors influencing the duration of consultations.
Nearly 30% of the pupils had to wait for a consultation and 29% of the registered consultations were drop-in. School nurses had to prioritise due to limited time in 41% of the consultations. Mental health was the predominant theme. Several adverse factors, such as interruptions during consultations, affected the time spent.
This study provides knowledge about the content of consultations within school health services in Norway, contributing to the enhancement of this activity within these services.
The insights from this study may serve as a foundation for developing guidelines for consultations, helping to ensure equitable support for all children and adolescents.
To our knowledge, this is the first study that gives a broad insight into consultations within the Norwegian school health services. Having enough resources is essential for providing good services. Politicians and central authorities need to consider this when deciding on budgets.
This study adhered to STROBE guidelines for reporting cross-sectional studies.
No patient or public involvement.
Cognitive impairments, such as dementia and Alzheimer’s disease, are considered a significant public health challenge as they affect mental functions like memory, attention, language and decision-making. With the growing number of older individuals, the prevalence of these diseases is also increasing and is projected to reach 152 million worldwide by 2050. These disorders result in difficulties with judgement, communication and daily activities, leading to more hospitalisations and risks such as disorientation in the environment and a higher likelihood of falls. Current hospital safety assessment tools mainly focus on physical aspects and overlook other crucial factors. Therefore, this study aims to clarify the concept of safety challenges for patients with cognitive impairment and to develop and psychometrically validate a multidimensional instrument for use in hospital settings.
A sequential exploratory study with mixed methods will be conducted. In the first qualitative phase, based on a content analysis approach, the aim is to explain and clarify safety issues in patients with cognitive impairment. Participants will be purposively selected until saturation is reached in educational-therapeutic centres affiliated with the University of Medical Sciences, and unstructured in-depth interviews will be conducted. The data will be analysed simultaneously using MAXQDA V.20 software. Additionally, a literature review on safety issues in patients with cognitive impairment will be conducted to supplement aspects that may not have emerged in the interviews.
In the second phase, an instrument based on the inductive–deductive method will be developed. The items will be created based on the participants’ experiences and the literature review. Face, content and construct validity, as well as reliability, will be assessed. Data synthesis will involve a linkage strategy, where the qualitative data will be linked to the quantitative data immediately after the completion of the qualitative phase, once the protocols are developed.
This study is part of a postdoctoral project approved by the Tehran University of Medical Sciences Research Ethics Board (IR.TUMS.FNM.REC.1403.006). Findings will be disseminated at the local, national and international levels.
To describe the variation in nurse educators' conceptions of how they facilitate critical thinking in bachelor nursing students.
Qualitative study with a phenomenographic approach.
Data was collected through twenty-six semi-structured interviews with nurse educators conducted in Sweden between March and June 2024.
The result of this study can be understood as five descriptive categories: Creating a safe and trustful relationship with the students, Encouraging a dialogue with the students, Using space as a tool, Using artefacts as a tool, and Using oneself as a tool.
The conclusion is that the facilitation of critical thinking needs to be based on a safe and trustful relationship between educators and students. Without this relationship, it is not possible to establish the central dialogue, where the educator can facilitate critical thinking through asking counterquestions and provoking the students.
To become critical thinkers, the students need to put their knowledge and assumptions in a new light and question them. Here, the educator has a vital role in being the guide and facilitator.
The result indicated that it is vital for the educators to build a safe relationship with the students. The relationship is a precondition for the facilitative dialogue where the educators can ask reflective and provoking questions to stimulate critical thinking. Future nurses need to be prepared with critical thinking to enable evidence-based clinical decisions both during clinical practice as well as when being registered nurses.
SRQR guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To evaluate temporal trends in the epidemiology of hip osteoarthritis (OA) in the USA from 1990 to 2019, with stratification by sex and geographic region.
Cross-sectional time-series analysis using secondary data from the Global Burden of Disease (GBD) study.
US population-based analysis, stratified by the four US Census Bureau regions: Northeast, Midwest, South and West.
De-identified, aggregate population-level data representing all adults in the USA from 1990 to 2019, drawn from the GBD database.
Age-standardised rates per 100 000 population for years lived with disability (YLDs), prevalence and incidence of hip OA. Outcomes were stratified by sex and region. Statistical significance was defined as p
Between 1990 and 2019, hip OA in the USA increased by 23.91% in YLDs, 24.67% in prevalence and 25.22% in incidence. In 2019, the mean YLDs were 28.30 in women versus 25.48 in men; prevalence was 49.55 versus 41.08; and incidence was 919.29 versus 818.10 (all p
There has been a substantial rise in the burden of hip OA in the USA over the past three decades. Women and residents of the Northeastern USA are disproportionately affected. These findings underscore the need for targeted public health strategies that account for geographic and sex-based disparities in hip OA burden.
This study proposes an evaluation of the efficacy of machine learning algorithms in classifying chronic pain based on Italian nursing notes, contributing to the integration of artificial intelligence tools in healthcare within an Italian linguistic context. The research aimed to validate the nursing diagnosis of chronic pain and explore the potential of artificial intelligence (AI) in enhancing clinical decision-making in Italian healthcare settings. Three machine learning algorithms—XGBoost, gradient boosting, and BERT—were optimized through a grid search approach to identify the most suitable hyperparameters for each model. Therefore, the performance of the algorithms was evaluated and compared using Cohen's κ coefficient. This statistical measure assesses the level of agreement between the predicted classifications and the actual data labels. Results demonstrated XGBoost's superior performance, whereas BERT showed potential in handling complex Italian language structures despite data volume and domain specificity limitations. The study highlights the importance of algorithm selection in clinical applications and the potential of machine learning in healthcare, specifically addressing the challenges of Italian medical language processing. This work contributes to the growing field of artificial intelligence in nursing, offering insights into the challenges and opportunities of implementing machine learning in Italian clinical practice. Future research could explore integrating multimodal data, combining text analysis with physiological signals and imaging data, to create more comprehensive and accurate chronic pain classification models tailored to the Italian healthcare system. Objetivo principal: Conocer las características y consecuencias de las caídas en el Hospital Universitario Son Llàtzer. Metodología: Análisis descriptivo retrospectivo durante 7 años, de todos los pacientes que sufrieron una caída hospitalaria. Resultados principales: El 41% de pacientes eran mayores de 66 años. Variables como el riesgo, patologías previas y tratamiento farmacológico son factores relacionados con sufrir una caída. La mayoría de caídas ocurrieron en el área de hospitalización (91,3%), con el paciente solo (76,3%), en la habitación (59,5%), durante actividades de movilización (46,8%) o a causa de un resbalón (35,8%), en el turno de noche (45,2%) y sin lesiones (69,6%). Conclusión principal: En las caídas hospitalarias no influye un único factor, sino que son múltiples las variables que intervienen; tanto factores del propio paciente como factores estructurales.
Rev Enferm;41(2): 102-110, feb. 2018. tab, ilus. [Artículo]
Rev Enferm;41(2): 89-94, feb. 2018. graf, tab. [Artículo]
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