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To evaluate the impact of a 5-min delay in needle removal after haemodialysis on complications and patient satisfaction in newly created arteriovenous fistulas.
Retrospective cohort study.
This study analysed 109 patients with new arteriovenous fistulas undergoing initial cannulation 8–12 weeks post-surgery. Participants were divided into two cohorts: a conventional group (n = 42) receiving immediate needle removal after pump cessation, and a delayed group (n = 67) retaining needles for 5 min post-pump cessation before removal. Outcomes included haemostasis time, hematoma incidence, 3-month reintervention rates, and patient satisfaction measured by a 5-point scale.
Delaying needle removal by 5 min reduced mean haemostasis time by 32% compared to immediate removal (16.4 min vs. 24.1 min). Hematoma incidence decreased substantially by 76% in the delayed group (3.3% vs. 13.1%). At 3-month follow-up, reintervention rates were 66% lower with delayed removal (9.0% vs. 26.2%). Patients also reported 50% less procedure-related pain and significantly higher satisfaction scores (median 4.5 vs. 2).
A brief 5-min delay in needle removal significantly reduces complications and enhances patient-centered outcomes during early arteriovenous fistula use.
This protocol establishes an evidence-based standard for post-dialysis needle management, directly reducing compression-induced pain and reintervention needs while requiring no additional nursing resources. Implementation can immediately improve vascular access safety in haemodialysis units.
The study addresses high complication rates (26.2%) from immediate needle removal in immature fistulas. Key findings demonstrate 76% fewer hematomas and 66% lower reinterventions with 5-min delayed removal. This evidence may transform global haemodialysis nursing protocols, benefiting a substantial population of patients receiving new fistulas annually.
This study follows the STROBE checklist.
Patients and the public were not involved in the design, conduct, or reporting of this retrospective medical record analysis.
by Meshack Achore, Martine Hackett, Tatiana Ramirez
IntroductionCommunity health workers (CHWs) play a critical role in advancing health equity by bridging underserved communities with health and social services. However, expanding responsibilities, emotional labor, and fragmented service systems contribute to burnout. While prior research has examined CHW burnout in urban, rural, and crisis contexts, little is known about how burnout is experienced and mitigated in suburban settings characterized by geographic dispersion and administrative fragmentation. This study explored how CHWs in suburban Long Island, New York, experience emotional labor overload and the strategies they use, individually and organizationally, to prevent burnout.
MethodsWe conducted a qualitative descriptive study using purposive and snowball sampling and recruited 10 CHWs from Nassau and Suffolk counties in New York. Data were collected through ten semi-structured interviews and five participant observations. Participants were primarily women aged 35–44 years, most of whom (86%) worked in Nassau County and reported 2–5 years of experience. Transcripts were analyzed thematically using Braun and Clarke’s six-step framework in ATLAS.ti.
ResultsTwo overarching themes emerged: (1) Creating a healthy work-life balance, in which CHWs managed burnout by setting boundaries and practicing self-care; and (2) Building support structures in the workplace, where organizational supports such as supervision, peer collaboration, and ongoing training promoted resilience. Participants emphasized the importance of self-care rituals, spiritual grounding, and collegial networks as protective factors against emotional exhaustion.
ConclusionsBurnout among suburban CHWs is shaped by the interaction of individual coping practices and organizational conditions within fragmented service systems. Strengthening supervision, peer support infrastructure, and professional development opportunities may enhance workforce resilience and sustainability. Investments in organizational support structures are critical to sustaining CHWs’ capacity to promote health equity.
To assess public support and predictors of favourable or unfavourable views towards expanding Advanced Practice Nurse (APN) roles in Germany.
A quantitative, cross-sectional survey using Germany as a national case study.
Data came from the Politikpanel Deutschland, an online survey conducted 15–28 July 2024. After exclusions, 6733 respondents were included. Data were weighted by age, gender, federal state, and voting intention. Descriptive statistics, subgroup comparisons, and multinomial logistic regression were applied to analyse attitudes towards APNs, with results reported as average marginal effects and predicted probabilities.
Overall, 52.8% of respondents supported expanding APN roles, 25% opposed, and the remainder were undecided. Support was stronger among younger, male, and highly educated respondents, and those open to digital health technologies. Support was lower in East Germany and the city-states Berlin and Bremen, while it was higher in the south-west and north. Political ideology strongly predicted attitudes: supporters of right-wing parties were more likely to oppose, whereas left-leaning voters were more supportive.
Public support for expanding APN roles in Germany is moderate but uneven across demographic, regional, and political cohorts. Younger individuals and those favouring digital health technologies may drive future acceptance, while political resistance and regional disparities remain barriers.
This first, large-scale survey of German public attitudes towards APNs suggests that policymakers should (i) link APN role expansion with digital health innovations, (ii) address regional differences through tailored communication, and (iii) ensure that patients, physicians, and healthcare professionals perceive APN integration as enhancing, not diminishing primary care quality. Strengthening legal and educational frameworks and fostering collaboration between physicians and nurses will not only be essential to integrate APNs into Germany's healthcare system and, thereby, mitigate physician shortages, but also to foster public acceptance of APNs.
None.
CROSS-checklist.
Walking, as a simple, low-cost and easily implemented form of exercise, offers multiple health advantages. The WalkLung trial aims to evaluate the efficacy of a home-based walking exercise and education intervention in promoting early functional recovery after lung cancer surgery.
WalkLung is a multicentre, parallel-group, randomised controlled trial conducted at three hospitals in China, with stratification by study centre. A total of 116 patients with postoperative lung cancer will be randomised in a 1:1 ratio to either the intervention group (home-based walking exercise and education for 4 weeks) or the control group (usual care). The primary outcome is the longitudinal walking difficulty score during the 4-week postdischarge, measured by the validated perioperative symptom assessment for lung surgery scale (0–10 scale), assessed at discharge and weekly for 4 weeks. Secondary outcomes are the 6-min walk test, pulmonary function, complications, physical activity level, quality of life, social functioning, exercise adherence and adverse events. Long-term outcomes (up to 6 months) will be analysed and reported separately. All analyses will use an intention-to-treat approach, with outcome measures analysed as appropriate using generalised estimating equations for repeated measures, and t-tests or 2 tests.
Ethical approval was obtained from the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital (No. SCCHEC-02-2025-091) and all participating subcentres. Written informed consent will be obtained from all participants. The manuscript is based on protocol V.1.0 (2 January 2025). The study findings will be disseminated through peer-reviewed journal publications and conference presentations.
ChiCTR2500103081.
To identify multifactorial contributors to treatment-seeking delays among Chinese young and middle-aged stroke patients using socioecological model.
Descriptive phenomenological interview study.
A tertiary hospital in China.
Twenty acute stroke patients with treatment-seeking delays and 16 family members were recruited for dyadic semistructured interviews.
Barriers influencing treatment-seeking delays across individual, interpersonal and systemic levels. And how do interlevel interactions shape decision-making trajectories?
Data analysis revealed 5 overarching themes encompassing 12 subthemes: (1) limited stroke-specific health literacy; (2) psychological barriers at symptom onset; (3) inadequate interpersonal support systems; (4) structural impediments to timely care; (5) decision-making dynamics across levels. Delay was characterised as a sequential cascade mediated by cognitive misattribution, emotional paralysis, relational dependency, institutional constraints and cross-level feedback loops. Two dominant pathways, silent progression and diverted seeking, were identified.
Treatment-seeking delay among young and middle-aged stroke patients arises through dynamic interactions across socioecological strata rather than isolated factors. Integrated interventions targeting public awareness, familial preparedness, workplace policies and healthcare accessibility are required to disrupt this cascade.
To consolidate the best evidence on digital therapeutic interventions for self-management in patients with hip fragility fractures, providing a foundational guide for clinicians in developing digital therapy-based self-management plans.
Integrative review.
A comprehensive electronic search was conducted across multiple databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Chinese databases like China National Knowledge Infrastructure and SinoMed. This study retrieved papers published from the establishment of the database to September 2023.
Studies were selected based on inclusion criteria, such as relevance to hip fragility fractures and self-management through digital therapies. Quality assessments were conducted independently by two reviewers using established tools for each type of study, ensuring the inclusion of high-quality evidence.
Fifteen studies were included: 4 guidelines, 5 expert consensus documents, 5 systematic reviews and 1 evidence summary. From these, 26 best practices were identified across 4 domains: digital design, self-management influencing factors, intervention plans and intervention content.
This integrative review provides a comprehensive, evidence-based summary of digital therapeutic interventions for self-management in patients with hip fragility fractures. The findings offer healthcare professionals a scientific basis for integrating digital therapy into clinical practice, highlighting its potential to enhance patient self-management.
This review underscores the value of digital therapies in empowering patients to take an active role in their rehabilitation, potentially improving adherence to self-management strategies and long-term outcomes.
No patient or public contribution was used for this study.
Split-thickness skin autografts are commonly used to treat extensive cutaneous defects. However, donor site morbidity, including pain, bleeding, and delayed epithelialization, remains a major clinical challenge. This study evaluates whether applying autologous platelet-rich plasma (PRP) to the donor site improves healing outcomes. A prospective cohort study was conducted at a tertiary-level academic hospital in Colombia. The study protocol was approved by the local Institutional Ethics Committee. Adult patients (> 18 years) undergoing split-thickness skin grafts for trauma, burns, oncologic resections, or chronic ulcers were included. Two groups were compared: the PRP group, in which autologous platelet-rich plasma was applied to the donor site, and the control group, which received standard wound care. The primary outcome was the quality of epithelialization at the donor site, while pain, assessed using the Numeric Rating Scale, was evaluated as a secondary outcome at multiple postoperative time points. Data were analysed using descriptive statistics and linear mixed-effects models adjusted for potential confounders, with statistical significance set at p < 0.05. A total of 46 patients were included (16 in the PRP group and 30 in the control group), with no significant demographic differences between groups. The PRP group demonstrated improved epithelialization quality, with lower Vancouver Scar Scale scores on postoperative days 7 and 14 (p < 0.05). Patients treated with PRP also reported a reduction of up to 50% in postoperative pain during early assessments (p < 0.001). These effects were maintained throughout the follow-up period, suggesting a sustained benefit of PRP on both healing quality and pain control. These findings suggest that autologous PRP application at split-thickness skin graft donor sites may enhance early epithelialization quality and reduce postoperative pain compared with standard wound care. PRP appears to be safe and may represent a useful adjunct to promote improved wound healing and patient recovery in reconstructive surgery. However, larger randomised controlled trials are required to confirm these findings and to establish the clinical effectiveness of autologous PRP in this setting.
by Xuying Zhang, Johanna Mainzer, Isabella Giambra, Tong Yin, Petra Engel, Hannah Hümmelchen, Henrik Wagner, Axel Wehrend, Christiane Egerer, Katharina Gerhards, Gerald Reiner, Sven König
Long tails trigger tail biting in pigs and increase the risk of flystrike infections in sheep. Tail docking has been a common management practice in both species for decades, but increasingly conflicts with legal animal welfare guidelines. Sustainable solutions require breeding strategies targeting shorter tails. In consequence, the aims were to conduct whole-genome sequencing (WGS)-based genome-wide association studies (GWAS) and comparative genomic analyses (CGA) to explore functional elements influencing tail traits. Phenotypically divergent experimental populations of pigs and sheep were established through unified selection and mating experiments. Tail traits included tail length (TL) measured at birth, and tail abnormalities (TA) assessed radiographically at 14 weeks of age. WGS-based GWAS identified a significant locus on SSC18 in pigs and suggestive loci for TL in both species, which, together with previously reported loci for TA, were further analyzed by CGA. The genomic windows of the significant locus on SSC18 in pigs and the TL GWAS locus on OAR4 in sheep were found to be conserved, harboring six common genes with predicted functional variants. These variants were jointly associated with TL (Plm ) in both species in linear regression models adjusted for sex, age of the dam, body length, and body weight. In other GWAS locus windows (±1 Mb), species-specific TL candidate genes were identified in sheep (HOXB13, MUC5B, EPB41L3, MTCL1, PIEZO2, MPPE1, and LOXHD1) and in pigs (KNL1, DISP2, SPRED1, TGFB2, and HAND1), each harboring associated putative functional variants. For TA, sheep-specific candidates (PGM2, LRRC66, CRACD, LOC105601916, and SH2D4B) and pig-specific candidates (MYOT, TMCO6, and PCDHAC2) were revealed using logistic regression models (Pglm ). GO analyses of candidate genes predicted shared biological processes between sheep and pigs, whereas pathway analyses indicated that common carbohydrate metabolism pathways, along with species-specific immune and inflammatory signaling, and pig-specific TGF-β signaling and endochondral ossification, may contribute to tail length variation and abnormalities. These findings provided deeper insights into the genetic basis of differential embryonic tail morphogenesis and perinatal tail development across species.Person-centred care (PCC) has been increasingly promoted in wound management, yet its theoretical foundations and practical application remain unclear. This scoping review aimed to map and synthesise how PCC frameworks, concepts and outcome measures have been used in wound care. Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a systematic search was conducted across major databases for studies published between 2020 and 2025. Eligible sources included empirical research, reviews and conceptual papers addressing PCC in adults with chronic wounds. Data were extracted and analysed descriptively across conceptual and evaluative domains. Fourteen publications met inclusion criteria. Only one explicit framework of person-centred wound care was identified. Most studies referred to patient-centred rather than person-centred approaches and applied principles such as empowerment, shared decision-making and communication without consistent theoretical grounding. Outcome assessment focuses mainly on clinical or functional indicators, with limited attention to relational or experience-based dimensions of care. Some studies used the term person-centred as an unreflected keyword. Person-centred wound management remains conceptually fragmented, methodologically heterogeneous and sometimes unreflected. Greater theoretical precision, consensus on terminology and development of validated frameworks and measurement tools are required to translate person-centred principles into consistent, evidence-based clinical practice.
by Devika A. Shenoy, William C. Cruz, Shamik Bhat, Katelyn Parsons, Aaron D. Therien, Kevin A. Wu, Christian A. Pean, William C. Eward
BackgroundRadical resection of bone tumors is a clinically effective but costly procedure. Despite the implementation of federal price transparency mandates, little is known about the nationwide variation in negotiated prices for these specialized oncologic surgeries. This study aimed to quantify the variation in negotiated rates for radical resection of the humerus and femur/knee and identify associated hospital, payor, and state-policy drivers.
MethodsThis cross-sectional study analyzed hospital-negotiated payor rates from the Turquoise Health database for current procedural terminology (CPT) codes 24150 (humerus resection) and 27365 (femur/knee resection). Multivariate linear regression was used to determine the associations between hospital size and type, payor class, and state-level policies (Medicaid expansion, Certificate of Need [CoN] laws, All-Payer Claims Database [APCD] mandates, and Nurse Practitioner [NP] scope of practice) on negotiated payor rates.
ResultsA total of 285,857 negotiated rates were analyzed. Significant price variation was observed across all factors. Large hospitals (>1000 beds) and Critical Access Hospitals (for femur/knee resection only) had significantly higher rates. CoN laws were associated with higher prices for both procedures (+$348.25 and +$667.98, respectively), as were APCD mandates for femur/knee resections (+$1231.24). Medicare Advantage plans paid inconsistently compared to commercial plans, paying more for humerus but substantially less for femur/knee resections.
DiscussionNegotiated prices for radical bone tumor resection are highly variable and influenced by a complex interplay of market dynamics, challenging the assumption that price transparency alone can standardize healthcare costs for specialized care.
To identify and describe instruments used to assess obstetric violence and evaluate their methodological quality and psychometric properties.
A scoping review.
Ten databases [Medline (via PubMed), Web of Science, the Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SinoMed, Wanfang Database, China National Knowledge Infrastructure (CNKI), VIP Database and China Medical Journal Full-text Database] were searched from inception to June 2025.
Studies focusing on the development or validation of obstetric violence measurement tools were eligible for this review. Methodological quality and psychometric properties were evaluated using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and criteria.
A total of 19 studies encompassing 25 obstetric violence measurement tools were included. These studies were conducted in 15 countries between 2018 and 2025. The tools targeted postnatal and pregnant women, healthcare providers, students and other populations. Most studies reported data on content validity, structural validity and internal consistency. Limited information was available on cross-cultural validity/measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity and responsiveness.
This review identified multiple obstetric violence instruments used across diverse populations and settings. Whilst the methodological quality and measurement properties of the included tools were sub-optimal, they nevertheless provide a foundation for the timely assessment of obstetric violence and subsequent research.
Future research should prioritise the establishment of a unified definition of obstetric violence, alongside the development, adaptation and rigorous validation of measurement instruments to enhance their reliability and validity.
This review underscores the need for maternity care professionals and educators to critically evaluate existing tools for measuring obstetric violence, given their current methodological limitations.
The PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist.
No patient or public contribution.
by Ratikorn Chaisiwamongkol, Rattapon Uppala, Phanthila Sitthikarnkha, Leelawadee Techasatian, Suchaorn Saengnipanthkul, Pope Kosalaraksa, Kaewjai Thepsuthammarat, Sirapoom Niamsanit
Background and aimsDiabetic ketoacidosis (DKA) remains a major cause of pediatric morbidity and death. This study examined national trends in DKA hospitalizations and factors associated with in-hospital mortality among Thai children.
Materials and methodsA nationwide, retrospective cohort study was conducted using data from the National Health Security Office (NHSO) during 2015–2023. Children aged 1 month to under 18 years hospitalized with DKA were identified using International Classification of Diseases, 10th Revision, Thai Modification (ICD-10-TM) codes. Prevalence and mortality were described by year and region. Factors associated with death were assessed with multivariable logistic regression; model discrimination used area under the curve (AUC).
ResultsAmong 10,669 admissions, national DKA prevalence increased from 4.5 to 11.8 per 10,000 pediatric hospitalizations, with Bangkok showing the highest rates. The overall intubation rate was 10.2%, peaking in infants and older adolescents. Although national mortality declined from 2.2% to 0.6%, regional and age-specific fluctuations persisted. Independent associations with mortality included malignancy (Adjusted odds ratio [AOR] 5.25, 95% CI: 1.63-16.92; p=0.005), septic shock (AOR 2.93, 95% CI: 1.71-5.03; p Conclusion
DKA hospitalizations are increasing in Thailand, with regional variation and persistent mortality risk, particularly among patients with critical complications and vulnerable groups. Although declining mortality trends and lower mortality in recurrent cases suggests improved protocol-based treatment, targeted prevention strategies remain essential for high-risk populations.
This article investigates school vaccination for adolescents with intellectual and developmental disability through the lens of person-centred care principles.
This is a theoretical framework analysis in which qualitative interview data were mapped to the principles of a Person-Centred Practice Framework.
Data were drawn from Vax4Health, an empirical study that aims to improve vaccination uptake and experiences for adolescents with disabilities.
Our four-step process included: identifying elements of the school vaccination programme that relate to the Framework domains; mapping programme capacities and challenges by each domain; identifying key factors influencing person-centredness; and synthesising these key influencing factors into three themes.
We extrapolated three themes: (1) Parents and students expressed strong support for the programme, but there is potential to enhance their participation in vaccination decision-making processes. (2) Nurses bring high levels of motivation, clinical experience, empathy and creativity to vaccinate students, but opportunities remain to enhance disability-specific training and knowledge of individual students' needs. (3) Special schools are committed to supporting families and facilitating the programme, but limited resourcing and unclear responsibilities present challenges that need addressing. We discuss how these themes relate to the five domains of the Framework. Key considerations for vaccination programme improvement towards a more person-centred approach are highlighted.
Applying the Framework to the findings of the Vax4Health study identified a range of opportunities to improve person-centred school-based vaccination for adolescents with IDD. Future research could involve engagement with all stakeholders to co-design interventions aimed at applying person-centred care principles to vaccinating students with IDD.
The findings from this analysis could be used to inform future implementation research into person-centred approaches to school vaccination aiming for positive outcomes for adolescents with IDD, their families and schools and health professionals.
To explore survivors' perspectives and experiences of psychological detachment while living with a stoma.
A qualitative descriptive study was conducted. This study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
A total of 15 semi-structured interviews were conducted between February 2024 and May 2024. The phenomenological method proposed by Colaizzi was used to analyze the data.
Four major themes emerged from the analysis: (1) Trapped in the Persistent Impact of Dual Traumas: Struggles with Adaptation; (2) Trapped by the Unrelenting Burden of Stoma Care: A Cycle of Powerlessness; (3) Trapped by the Shackles of a Stigmatised Identity: The Dilemma of Social Reintegration; and (4) Divergent Pathways of Detachment: Navigating Between Immersion and Transcendence. Within the main themes, eight subthemes were formulated.
This study thoroughly explored and elucidated the psychological detachment experiences of colorectal cancer survivors with a stoma, revealing its key role in mental health recovery and psychosocial rehabilitation and informing clinical interventions.
The study suggests that healthcare staff should guide survivors in drawing a clear boundary between stoma care and their personal life, encourage any correction of erroneous social cognition, and promote the positive development of psychological detachment among survivors.
This study explored the challenges of psychological detachment in stoma survivors, identifying key barriers like trauma, care burden, role misconceptions, and varying detachment levels. The findings can guide healthcare providers in supporting survivors' mental well-being and inform better survivorship care strategies.
There was no patient or public contribution.
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 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.
FreshRSS 