Conectar
Although healthcare infrastructure has improved in recent years, the preoperative journey of patients is often accompanied by anxiety. Allowing patients to walk to the operating theatre is a simple, yet underexplored strategy that may enhance their sense of autonomy and reduce anxiety. As patient-centred care gains importance, evaluating the effects of this approach on patient-reported outcomes may be more relevant than widely assumed.
In this scoping review, we aim to analyse the published literature on preoperative walking into the operating theatre and patient-reported outcomes, such as anxiety and satisfaction.
This study was a scoping review that followed the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses, Scoping Review extension guidelines.
Inclusion criteria were adult patients undergoing elective surgery and walking to the operating theatre. Data were extracted using a standardised form, and critical appraisal was performed by using ROBINS-I V2.0, RoB2 and ROB-E tools.
Embase, MEDLINE, Cochrane databases (OVID) and CINAHL (EBSCOhost) were searched up to 31st January 2025.
Our search identified 958 articles, with seven trials included in the final analysis. The studies, published between 1994 and 2022, involved 3001 patients from North America, Asia and Europe. The interventions varied, but most patients reported improved satisfaction and reduced anxiety when walking to the operating theatre. No adverse events were reported, although patient preferences varied, with younger patients more likely to prefer walking.
Walking to the theatre positively impacts patient satisfaction and autonomy. However, patient selection is key, as not all individuals are physically or mentally prepared for walking. Future research could explore unaccompanied walking and its effects on hospital resource utilisation. Preoperative walking is a beneficial intervention that enhances patient satisfaction and reduces anxiety, providing a feasible alternative to bed transport for many elective surgical patients.
No patient or public involvement.
To assess the correlation between complete blood count (CBC)-derived inflammatory markers and sepsis-associated delirium (SAD) risk in older intensive care unit (ICU) patients.
Retrospective cohort study.
ICUs at Beth Israel Deaconess Medical Center (2008–2019), using the Medical Information Mart for Intensive Care IV V.3.0 database.
3412 critically ill patients aged ≥65 years with sepsis. Exclusion: repeated ICU admission, death/discharge within 24 hours, missing delirium assessment or pre-sepsis delirium from non-septic aetiologies. SAD was diagnosed by Confusion Assessment Method for the ICU.
Incidence of sepsis-associated delirium.
Among 3412 older sepsis patients, 2092 (61.3%) developed SAD. Significant differences in platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index, systemic inflammation response index, pan-immune-inflammation value and neutrophil-monocyte-to-lymphocyte ratio were observed between SAD and non-SAD groups (all p0.05). Receiver operating characteristic and random forest analyses demonstrated predictive utility; incorporating markers into a baseline model significantly improved discrimination, with MLR providing the largest gain (area under the curve (AUC)=0.716 vs 0.703; AUC=0.013, DeLong test, p
CBC-derived inflammatory markers, particularly MLR, are associated with increased SAD risk in older adults and enhance the performance of a clinical prediction model in this population. Further research is needed to better understand the pathophysiological mechanisms underlying these associations.
Radiological imaging is a central facet of the multidisciplinary evaluation of suspected child physical abuse. Current guidelines for the imaging of suspected child physical abuse are often unclear, incomplete and highly variable regarding recommendations on critical questions, thereby risking clinical heterogeneity, unstructured decision-making and missed diagnoses. We, therefore, aim to develop and report an evidence-based and consensus-derived international guideline for the radiological investigation of index and contact children in the context of suspected physical abuse and to ascertain areas of scientific uncertainty to inform future research priorities.
The international guidelines for the imaging investigation of suspected child physical abuse (IGISPA) consensus group includes formal representation from 127 recognised experts across 14 subspecialties, six continents and 32 national and/or international organisations. Participants will be divided into five longitudinal subgroups (indications for imaging, skeletal imaging, visceral imaging, neuroimaging and postmortem imaging) with three cross-cutting themes (radiography, genetics and adaptations for low- and lower-middle-income countries). Each subgroup will develop preliminary consensus statements via integration of current evidence-based guidelines, systematic literature review and the clinical expertise of a multinational group of experts. Statements will then undergo anonymised voting in a modified e-Delphi process and iterative revision until consensus (≥80% agreement) is achieved. Final statements will undergo both internal and external peer review prior to endorsement.
As an anonymous survey of consenting healthcare professionals, this study did not require ethical approval. Experts provided written informed consent to participate prior to commencement of the modified Delphi process. The IGISPA consensus statement and any subsequent guidance will be published open access in peer-reviewed medical journals.
Interest in workplace bullying (WPB) has been steadily growing with a focus on understanding its consequences as well as prevalence rates in different occupations and across different countries with varying cultural contexts. Research in the Middle East remains limited, especially in Lebanon. The scarcity of data from the Lebanese healthcare sector underscores the need to better understand WPB in this unique sociocultural and organisational environment.
The primary aim of this study is to investigate the prevalence of WPB among healthcare providers and hospital staff in Greater Beirut. The secondary aim is to investigate the relationship between WPB, psychological well-being, burnout and sick leaves in the Lebanese cultural context.
A cross-sectional study design was conducted.
Seven hospitals in Greater Beirut took part in the study, including six private hospitals and one public hospital.
A total of 958 participants aged 18–64 were recruited using stratified proportionate non-random sampling. Stratification by hospital size and department aimed to ensure broad representation of nursing and support staff across institutions. The participants included nursing and supporting staff, of which 26.3% were males and 73.7% were females. Those employed for less than 6 months were excluded.
The Arabic versions of each of the Negative Acts Questionnaire-Revised (NAQ-R), the General Health Questionnaire (GHQ-12) and the Copenhagen Burnout Inventory (CBI) were administered. These instruments were selected for their established reliability and widespread use in cross-cultural occupational health research. Surveys were administered via paper-and-pencil (six hospitals) and online (one hospital). Prevalence of bullying using the NAQ-R cut-off scores was first calculated and then their respective thresholds identified using receiver operating characteristic analysis. Pearson’s correlation coefficient was used to evaluate the relationship between the NAQ-R and the GHQ-12, CBI and number of sick leaves.
Using the lower threshold as a cut-off on the NAQ-R, 35.1% of participants were classified as bullied. When applying the higher threshold as a cut-off, the percentage was slightly lower but remained comparable at 32.4%. Results showed that across the two outcomes, those who were bullied both when using a lower threshold and upper threshold were significantly more distressed and burnt out (pt(df) = –8.43, p±1.96; Upper threshold: ² (4, N=902)=9.963, p=0.019, Standardised residual for 6–10 days=2.2>±1.96).
Findings yielded lower prevalence rates of WPB among nurses and the entire sample as compared with research carried out in the Arab region. Our study further supports the impact of culture on the perpetuation of WPB and the uniqueness of Lebanon’s culture on influencing this prevalence. Results indicated that participants who were bullied were significantly more distressed, more burnt out and reported taking up more sick leaves. These findings highlight the need to consider local workplace culture when addressing bullying and reinforce the significant psychological and occupational toll bullying takes on affected individuals. Healthcare institutions are encouraged to implement and reinforce clear antibullying policies, WPB prevention strategies and confidential reporting mechanisms. Future research should explore longitudinal patterns of bullying, obtain a more nationally representative sample and examine the effectiveness of targeted interventions to create safer, more supportive work environments.
The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.
A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.
An ED in a tertiary hospital in western China.
2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.
The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.
Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p
Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.
Children with limited access to dental care can be negatively impacted by reduced frequency of oral health monitoring, delays in diagnosis of dental disease and increased waits for dental care, resulting in them experiencing more disease (extent and amount). Smartphone-based intraoral photography has been cited as having the potential to improve oral health monitoring for children through screening; however, it has not been well evaluated, and its limitations are unclear. The picture-perfect study aims to assess diagnostic accuracy, feasibility and acceptability to determine whether remote photographic monitoring can be effectively integrated into pathways of dental care for children aged 6-16 years.
Observational, cross-sectional, mixed-methods study with three workflows: Workflow 1: development of user-friendly, comprehensive guidance to help parent/carers (parents) take high-quality intraoral photographs of their children’s mouths. The guidance will be codesigned with parents and healthcare professionals. Workflow 2: diagnostic accuracy using intraoral photographs taken by a parent of their children will be evaluated by comparing clinicians' diagnoses from the photographs to gold-standard clinical visual-tactile examinations. Parent–child dyads (n=110) will be recruited to capture intraoral photographs using positioning aids, guidance and smartphones provided by the research team. The diagnoses will focus on plaque accumulation, gingival health, restoration status and dental caries. Diagnostic accuracy will be assessed using sensitivity, specificity, positive predictive value, negative predictive value and area under the curve. Workflow 3: assessment of feasibility and acceptability will be through task completion rates, photograph quality and participant feedback. Qualitative interviews and an online survey will capture parents’ and children’s experiences. Observational data will provide insights into practical challenges.
This study, approved by the National Health Service (NHS) Research Ethics Committee (Integrated Research Application System [IRAS]: 24/EE0137), will be conducted in adherence to the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. Written informed consent will be obtained from all participating parents, with age-appropriate assent from children prior to enrolment. Participants have the right to withdraw at any time without explanation, and their data will be anonymised to ensure privacy and confidentiality. Study findings will be disseminated through peer-reviewed journals, conference presentations and reports to relevant stakeholders.
The study protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/WX29D.
Skin tone can affect clinical signs and device accuracy in paediatric anaemia and deterioration detection, creating risks of inequity.
Studies show disparities in diagnostic accuracy across different skin tones, supported by community-based evidence.
(1) Build multicenter networks with standardised skin-tone data. (2) Validate devices across varied skin tones. (3) Train clinicians in dark-skin sign recognition. (4) Include equity metrics in paediatric quality indicators.
Reducing skin-tone bias is essential for equitable paediatric care. Collaborative research across diverse regions is needed.
To co-produce a prototype intervention to help nurses improve the assessment and care of the sexual health needs of men with inflammatory bowel disease.
Inflammatory bowel disease can have a significant impact on the sexual health and well-being of men, but has largely been neglected in research and clinical guidelines. Men with the disease report that sexual health is not discussed during consultations, while healthcare practitioners describe a lack of confidence to initiate sexual health assessments. At present, no evidence-based tool exists to support nurses in detecting, assessing, and providing care for the sexual health of men with the disease.
A mixed-methods study shaped by phase 1 of the Medical Research Council's framework for the development of complex interventions.
(1) Cross-sectional surveys of (i) men with inflammatory bowel disease, (ii) nurses, and (iii) inflammatory bowel disease services to determine the current state of sexual health provision across the UK National Health Service. (2) Semi-structured interviews with men and the partners of men with IBD and asynchronous focus groups with health professionals to explore appropriate and acceptable ways to provide sexual healthcare. (3) Three consecutive co-production workshops inclusive of men with the disease, healthcare professionals, and stakeholders to formulate a prototype intervention.
This study will create an evidence-based prototype intervention that will provide nurses with the knowledge and skills required to effectively assess the sexual health needs of men with inflammatory bowel disease and provide appropriate, patient-centred care.
The study design was supported by a patient group. The study delivery will be supported by a patient co-investigator and stakeholder group inclusive of men with lived experience of the disease.
This report adheres to the SPIRIT 2013 checklist for standard protocol items for clinical trials.
clinicaltrials.gov ID: NCT06562751
by Juliana Rodrigues Tovar Garbin, Franciéle Marabotti Costa Leite, Ana Paula Brioschi dos Santos, Larissa Soares Dell’Antonio, Cristiano Soares da Silva Dell’Antonio, Luís Carlos Lopes-Júnior
A comprehensive understanding of the factors influencing the epidemiological dynamics of COVID-19 across the pandemic waves—particularly in terms of disease severity and mortality—is critical for optimizing healthcare services and prioritizing high-risk populations. Here we aim to analyze the factors associated with short-term and prolonged hospitalization for COVID-19 during the first three pandemic waves. We conducted a retrospective observational study using data from individuals reported in the e-SUS-VS system who were hospitalized for COVID-19 in a state in a southeast state of Brazil. Hospitalization duration was classified as short or prolonged based on a 7-day cutoff, corresponding to the median length of hospital stay during the second pandemic wave. Bivariate analyses were performed using the chi-square test for heterogeneity. Logistic regression models were used to estimate odds ratios (ORs) and their respective 95% confidence intervals (CIs), with statistical significance set at 5%. When analyzing hospitalization duration across the three waves, we found that 51.1% (95%CI: 49.3–53) of hospitalizations in the first wave were prolonged. In contrast, short-duration hospitalizations predominated in the second (54.7%; 95% CI: 52.4–57.0) and third (51.7%; 95% CI: 50.2–53.2) waves. Factors associated with prolonged hospitalization varied by wave. During the first wave, older adults (≥60 years) (OR=1.67; 95%CI: 1.35–2.06), individuals with ≥10 symptoms (OR=2.03; 95%CI: 1.04–3.94), obese individuals (OR=2.0; 95%CI: 1.53–2.74), and those with ≥2 comorbidities (OR=2.22; 95%CI: 1.71–2.89) were more likely to experience prolonged hospitalization. In the second wave, he likelihood of extended hospital stays was higher among individuals aged ≥60 years (OR=2.04; 95%CI: 1.58–2.62) and those with ≥2 comorbidities (OR=1.77; 95%CI: 1.29–2.41). In the third wave, prolonged hospitalization was more frequent among older adults (OR=1.89; 95%CI: 1.65–2.17,), individuals with 5–9 symptoms (OR=1.52; 95%CI: 1.20–1.92), obese individuals (OR=2.2; 95%CI: 1.78–2.73), and those with comorbidities (OR=1.45; 95%CI: 1.22–1.72 and OR=2.0; 95%CI: 1.69–2.45). In conclusion, we identified variations in hospitalization patterns across the pandemic waves, although the differences were relatively subtle. These variations likely reflect gradual shifts in the risk factors associated with prolonged hospital stays. Our findings highlight t the importance of implementing targeted public health interventions, particularly those designed to reduce disease severity and improve clinical outcomes among vulnerable populations at greater risk of extended hospitalization.The climate crisis impacts global health and is exacerbated by the healthcare sector's emissions. Nurses, as the largest professional group, are key to promoting climate-resilient, low-carbon health systems. Integrating climate change and sustainable development into nursing education is crucial, yet gaps remain in understanding their representation in curricula and practice. This review examines the role of nursing in addressing climate change and sustainable development, focusing on their integration into education and related recommendations.
A narrative literature review was conducted to synthesize existing recent research on nursing, climate change, and sustainable development. No restrictions were applied to study design; however, studies published before 2017 were excluded.
A search was conducted in PubMed, CINAHL, and Google Scholar (January 2023, and updated in August 2024). Relevant studies were screened and duplicates removed. Data extraction followed inductive content analysis, with coding and categorization being undertaken collaboratively. MAXQDA PLUS 2022 was used for analysis, and new findings from the follow-up search were incorporated into existing categories or new ones were developed.
The review analyzed 33 articles on nursing's role in addressing climate change. Findings highlight gaps in knowledge, delayed responses, and the need for nurses to take on leadership roles. Education is crucial, yet curricula integration remains limited. Nurses must engage in advocacy, interdisciplinary collaboration, and policy development. Barriers include a lack of faculty awareness and overloaded curricula. A collective call for action urges nurses to embrace sustainability, strengthen research, and lead in achieving climate resilience.
This review highlights the need to integrate climate change and sustainable development into nursing education and practice. Nurses are vital to public health and to addressing climate change, but education gaps hinder their potential. Future research should focus on improving curricula, exploring Advanced Practice Nursing leadership roles, and addressing healthcare system challenges.
Integrating Sustainable Development and the Climate Crisis into nursing education and practice is crucial to preparing nurses for the health challenges posed by environmental changes, as well as for ensuring effective patient care, disaster response, and policy advocacy. Their integration is a process and should be viewed as being a consequence of the delayed responses, as identified in this review. This process should specifically address the identified gaps, such as the lack of basic knowledge concerning climate change and sustainable development, as well as learning to take on leadership roles in practice. More specifically, taking a leadership role includes both acting as a knowledge multiplier and increasing the health literacy of the general population.
At present, the available evidence regarding the relationship between prone position ventilation (PPV) and tracheal injury score remains inadequate. This study seeks to gain deeper insights into the relationship between PPV and tracheal injury score in intensive care unit (ICU) patients with invasive ventilation.
A secondary analysis of a prospective cohort study.
Our study was conducted in a Class III hospital in Hebei Province, China.
Patients aged over 18 years admitted to the ICU between 31 May 2020 and 10 November 2023 with a tracheal tube and expected to be on the tube for more than 24 hours.
The primary outcome was tracheal injury score, assessed via fibreoptic bronchoscopy for hyperaemia, ischaemia, ulcers and perforation. Lesions were classified as moderate, severe or confluent based on extent.
Among the 149 selected participants, the average age was 58.4±16.2 years, with 65.8% being male. The results of adjusted linear regression showed that PPV was associated with tracheal injury scores (β: 5.33; 95% CI 3.84 to 6.82). Subgroup analysis indicated that PPV is significantly associated with an increased tracheal injury score, and this association remains consistent across different ages, sex, septic shock and non-septic shock groups, and duration of intubation
Our findings suggest PPV may be associated with tracheal injury score, highlighting a potential link between PPV and tracheal injury score.
ChiCTR2000037842, registered 3 September 2020 retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=57011.
Skin allografts are essential in managing complex wounds, yet their availability is limited by low post-mortem donation rates. Skin harvested during body contouring surgeries offers a novel and sustainable source to expand tissue supply. We conducted a retrospective descriptive study at the Tarapacá Skin and Tissue Bank from January 2022 to December 2024. All donations from body contouring surgeries were processed as cryopreserved total skin allografts following national tissue banking standards. Variables included donor demographics, harvested area, units produced, microbiological results, and discard rates. To describe clinical performance, we present our group's initial clinical series of treated patients. From 248 living donors (mean age 41.3 years), 81 293 cm2 of skin generated 2050 units. The discard rate was 27%, mainly due to a storage failure and isolated microbial contamination. Clinically, all patients achieved complete initial graft take, followed by gradual necrotic eschar formation at an average of 21 days. Eschar removal revealed vital tissue firmly adhered to the recipient bed, rich in fibroblasts and neovascular structures. Subsequent management included either escharectomy with split-thickness autografting over the neodermis, or spontaneous eschar lysis and skin regeneration, with the graft functioning as a dermal regenerator. This model increases tissue availability while providing allografts with both coverage and dermal regenerative properties.
by Yordi Sebastián Tamayo-Molina, Juan Felipe Valdés-López, Geysson J. Fernandez, Silvio Urcuqui-Inchima
Dengue virus (DENV), the etiological agent of dengue fever, remains a global health concern, leading to severe illness and death in the absence of any definitive cure. Research has shown that vitamin D may reduce DENV replication in vitro and that dengue patients with low or deficient vitamin D levels are at higher risk of severe dengue. Studies indicate that viral replication is inhibited in human monocyte-derived macrophages (MDM) differentiated in the presence of vitamin D (D3MDM), suggesting that vitamin D may prevent DENV entry into host cells. However, despite these findings, the role of vitamin D in regulating the temporal expression patterns of genes as early, mid, and late transcriptional profile of DENV-infected macrophages remains unclear. Therefore, utilizing a kinetic transcriptomic profile is crucial. This approach provides detailed insights into the dynamic changes in gene expression over time, helping to clarify how vitamin D can modulate the immune response at critical stages of DENV infection. To address the transcriptional dynamics, we conducted a comprehensive analysis of gene expression patterns in MDM and D3MDM infected with Dengue virus serotype 2 (DENV-2). Utilizing bulk RNA sequencing alongside a standard viral growth curve, we systematically analyzed transcriptional kinetics by selecting key time points: 1.5, 3, 5.5, and 10 hours post-infection (h.p.i.) to monitor early viral entry and replication events and 24 h.p.i. to assess gene expression during peak viral particle production. Our temporal analysis revealed a progressive increase in cellular transcripts within the first hour of infection, with a more pronounced gene expression pattern in DENV-2-infected MDM compared to DENV-2-infected D3MDM at this early stage. Enrichment analysis indicated a reduced inflammatory response in DENV-2-infected D3MDM. Additionally, transcription factor analysis suggested diminished NF-κB signaling, but enhanced IRF5 activity was elevated in the DENV-2-infected D3MDM. High-dimensional clustering analysis identified nine unique gene clusters across both macrophage types, with notable upregulation of genes associated with antiviral activity, including IDO1, ISG20, OASL, IFI44L, RSAD2, IFIT1, MX1, EPSTI1, CXCL10, and CXCL11 in DENV-2-infected D3MDM at 1.5 h.p.i., suggesting an enhanced early antiviral response. These findings indicate that vitamin D modulates the magnitude and diversity of the early transcriptional responses, highlighting its potential as a therapeutic option to mitigate DENV severity.by Alessandro Roman, Charlotte Linthout, Ben Raymond, Constantianus J. M. Koenraadt
Various vector control strategies are in place to reduce the spread of arthropod-borne viruses. Some of these, such as application of insecticides, are encountering operational challenges and a reduced overall effectiveness due to evolution of resistance. Alternative approaches for mosquito population control, such as the sterile insect technique, depend on efficient mass-rearing of healthy mosquitoes prior to mass-release in the field. Therefore, improving efficiency and quality of mass-rearing techniques is crucial to obtain fit mosquitoes. Previous studies have shown that Acetic Acid Bacteria of the genus Asaia can have a mutualistic effect on larval development in different mosquito species and can thus contribute to improved rearing output. However, whether improved performance in the larval stages may have knock-on effects in the adult stage, for example by increasing their capability to transmit arbovirus, remains unclear. Such effects may jeopardize future control efforts. We tested the effects of two Asaia species, Asaia krungthepensis and Asaia bogorensis, on development time and adult size under two rearing conditions: individual rearing and group rearing of Culex pipiens larvae. Besides investigating development and size, we also investigated whether Asaia spp. exposure during the larval stage can influence the vector competence of Culex pipiens pipiens for West Nile virus (WNV). Our work shows the potential of improving mass-rearing efficiency by employing Asaia krungthepensis as a mutualist for Culex pipiens pipiens. Importantly, this study reveals no significant increase in dissemination and transmission rate of WNV by Culex pipiens pipiens when inoculated with Asaia spp., although an increase in viral titer in the legs and the saliva was observed when the mosquitoes were inoculated with the two Asaia species. Interestingly, we confirmed that Asaia spp. bacteria did not establish as a permanent member of the microbiota of Culex pipiens pipiens. As Asaia spp. did not establish in adult mosquitoes, the observed change in WNV titers can be a result of indirect interactions of Asaia with the native Culex pipiens pipiens microbiome. Our results stress the importance of carefully evaluating host-symbiont interactions to avoid the potential of releasing mosquitoes with enhanced vector competence.Breast cancer (BC) is the most frequently diagnosed cancer worldwide. Both the disease itself and the side effects of its treatments significantly impair the quality of life (QoL) of women with BC. Non-pharmacological therapies (NPTs), including exercise therapies, mindfulness-based interventions, cognitive therapies, acupoint therapies, and other complementary therapies, are increasingly being employed to improve the QoL for women with BC. However, the effects and acceptability of NPTs may vary depending on the treatment phases (intra-treatment and post-treatment) of the women with BC. This systematic review and network meta-analysis aims to compare the effects and acceptability of NPTs among women with BC across different treatment phases.
Relevant randomised controlled trials will be systematically searched in 7 databases, including the Cochrane Library, Embase, PubMed, Web of Science, China National Knowledge Infrastructure, China Biomedical Literature Database, and Wanfang, covering the period from their inception to February 2025. Two researchers will independently assess the risk of bias using the Cochrane Risk of Bias Tool for Randomised Trials 2.0. The network meta-analysis will be conducted using STATA 16.0. The assessments of heterogeneity, inconsistency, publication bias, evidence quality and sensitivity analysis will also be conducted. The subgroup network meta-analysis will be conducted based on the treatment phases of women with BC.
This protocol does not need approval from an ethics committee, as it is conducted based on previous research data. The results will be disseminated via peer-reviewed publications.
PROSPERO CRD42023476312.
Acute unstable syndesmosis injuries require accurate reduction and stable fixation to improve short-term and long-term outcomes. Several different fixation methods have been established for acute syndesmosis injuries, each with pros and cons. Although some meta-analyses have reported better outcomes with suture-buttons than screws, the optimal fixation method remains uncertain because of heterogeneous study results and limited comparisons of emerging techniques. This network meta-analysis combining randomised and observational studies aims to determine the optimal fixation method for acute syndesmosis injuries.
Five electronic databases (PubMed, Cochrane Library, China National Knowledge Infrastructure, Wanfang Data and Embase) will be comprehensively searched from their inception through 1 June 2025 for randomised and observational studies, published in English or Chinese, that compared two or more fixation methods for acute syndesmosis injuries. Inclusion and exclusion criteria will be used for selection based on patient, intervention, comparison, outcome and study standards. Risk of bias will be evaluated by the Cochrane risk-of-bias tool 2 and the Newcastle–Ottawa scale, respectively. Conventional pairwise meta-analyses with the DerSimonian–Laird random effects model will be conducted first, followed by network meta-analyses with a three-level Bayesian hierarchical model. The outcome measures include functional outcomes, radiological indicators and postoperative complications. Data analysis will be conducted using Review Manager 5.3 and R 4.1.2. Heterogeneity, transitivity and inconsistency tests, subgroup and sensitivity analyses and publication bias will also be assessed.
No ethical approval is required because all the data will be collected from published research. The results of this study will be published in a peer-reviewed journal.
INPLASY202480027.
To evaluate the effect of mutuality on self-care in people with CHD and the contribution of their caregivers, and whether such relationships can be mediated by self-efficacy.
Secondary analysis of baseline data from a multi-centre longitudinal study.
Patients at the onset of coronary artery disease who underwent angioplasty, along with their caregivers, were included in the sample. Data from 136 patients and 136 caregivers were used for the analysis. Mutuality between patients and caregivers was measured using the Mutuality Scale. Self-care was measured using the Self-Care of Coronary Heart Disease Index and the Caregiver Contribution to Self-Care of Coronary Heart Disease Index. The actor–partner interdependence mediation models were used to assess the mediating role of self-efficacy for self-care between perceived mutuality and self-care behaviours.
An actor indirect effect was found between patient mutuality and their self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on their contribution to self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on patient self-care maintenance and on patient self-care monitoring, through the mediation of patient self-efficacy. All models demonstrated satisfactory fit to the data.
Mutuality between patients and caregivers enhances self-care behaviours in patients with coronary heart disease, and self-efficacy is a crucial mediator in this relationship. Interventions targeting both mutuality and self-efficacy within patient–caregiver dyads may improve self-care outcomes.
We adhered to STROBE guidelines.
Patients and members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
Kidney stones (KS) are a growing global health concern with significant morbidity. Although individual lifestyle factors have been linked to KS risk, the combined influence of healthy lifestyles and the mediating role of lipid metabolism remains unclear. This study aimed to investigate whether the atherogenic index of plasma (AIP) mediates the link between KS risk and a composite healthy lifestyle score.
Cross-sectional study.
National Health and Nutrition Examination Survey (NHANES) 2007–2016, USA.
7576 US adults (mean age, 47.39 years; 52.57% male).
The association between healthy lifestyle scores and KS risk was assessed by multivariable logistic regression. The mediating role of AIP was evaluated through mediation analysis. Dose–response relationships were examined by restricted cubic spline (RCS) analysis. Stratified analyses explored potential effect modifications by age, sex, race/ethnicity and metabolic conditions.
Participants in the highest healthy lifestyle score quartile had 0.49 times the odds of KS compared with individuals in the lowest quartile (OR, 0.49; 95% CI, 0.38 to 0.64). A 19% decreased risk of KS was linked to every unit rise in the healthy lifestyle score (OR, 0.81; 95% CI, 0.76 to 0.87). An inverse linear dose–response association was shown by RCS analysis between healthy lifestyle scores and KS risk (P-overallP-nonlinearity=0.321). AIP mediated 7.18% (95% CI, 1.07% to 14.40%) of the association between lifestyle and KS. The association remained across sensitivity analyses and subgroups.
A healthier lifestyle is linked to lower odds of KS, with AIP partially mediating this association. These results emphasise the potential importance of composite lifestyle modifications for the prevention of KS.
Many patients with tuberculosis (TB) suffer from a huge economic burden, even though TB services are often provided free of charge at the point of care. Costs can create significant barriers, hindering patients’ access to TB treatment. These costs include direct medical costs (such as consultation fees), direct non-medical costs (such as transportation costs) and indirect costs (such as wages foregone). This systematic review aims to synthesise the best available evidence on economic evaluations of patient-cost studies on self-administered treatment (SAT) for drug-sensitive TB compared with facility-based directly observed treatment, short-course (FB DOTS), globally.
We will conduct a systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and search PubMed, Academic Search Complete, Scopus, CINAHL Plus (EBSCO) and Google Scholar for articles published up to 2025, without date restrictions. Eligible studies must be full or partial (cost analyses without effectiveness data) economic evaluations conducted globally, comparing SAT to FB DOTS regarding TB patient costs. Grey literature will be included. Exclusion criteria include studies not reporting patient costs between SAT and FB DOTS, and non-economic evaluations (non-original research). Two independent reviewers will conduct the screening, data extraction and quality assessment. A quality assessment will be performed using the Consolidated Health Economic Evaluation Reporting Standards statement, the Consensus on Health Economic Criteria checklist and the ROBINS-I tool.
Ethics approval is not required for this systematic review because it does not use individual patient data. Instead, we will use publicly available economic evaluation research studies. Findings will be presented at international and national conferences and published in open-access, peer-reviewed journals.
CRD42024591221.
FreshRSS 