Conectar
Medication administration errors are high-risk patient safety issues that could potentially cause harm to patients, thereby delaying recovery and increasing length of hospital stay with additional healthcare costs. Nurses are pivotal to the medication administration process and are considered to be in the position to recognize and prevent these errors. However, the effectiveness of interventions implemented by nurses to reduce medication administration errors in acute hospital settings is less reported.
To identify and quantify the effectiveness of interventions by nurses in reducing medication administration errors in adults' inpatient acute hospital.
A systematic review and meta-analysis was conducted up to 03/24. Six databases were searched. Study methodology quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools, and data extraction was conducted. Meta-analysis was performed to combine effect sizes from the studies, and synthesis without meta-analysis was adopted for studies that were not included in the meta-analysis to aggregate and re-examine results from studies.
Searches identified 878 articles with 26 studies meeting the inclusion criteria. Five types of interventions were identified: (1) educational program, (2) workflow smart technologies, (3) protocolised improvement strategy, (4) low resource ward-based interventions, and (5) electronic medication management. The overall results from 14 studies included in meta-analysis showed interventions implemented by nurses are effective in reducing medication administration errors (Z = 2.15 (p = 0.03); odds ratio = 95% CI 0.70 [0.51, 0.97], I 2 = 94%). Sub-group analysis showed workflow smart technologies to be the most effective intervention compared to usual care. Findings demonstrate that nurse-led interventions can significantly reduce medication administration errors compared to usual care. The effectiveness of individual interventions varied, suggesting a bundle approach may be more beneficial. This provides valuable insights for clinical practice, emphasizing the importance of tailored, evidence-based approaches to improving medication safety.
PRISMA guided the review and JBI critical appraisal tools were used for quality appraisal of included studies.
To explore aspects of interpersonal relationships in palliative care nursing, focusing on confidential conversations between patients and registered nurses (RN).
A qualitative study employing focused ethnography.
Data were collected through unstructured participant observations, field notes and interviews with patients and RN in specialist palliative care. Data were analysed using reflective thematic analysis.
Confidential conversations in palliative care are founded on trust that is fragile and develops dynamically through consistent interactions. Small talk, presence and silence are essential for initiating and maintaining trust and the interpersonal relationship. The environment, patient condition and RN emotional presence and competence shape these conversations. As the relationship evolves, conversations adapt to the patient's changing needs. Missed signals or interruptions can disrupt flow, but the potential for repair remains, allowing for restoration and strengthening of trust and connection.
Confidential conversations in palliative care are grounded in fragile, dynamic trust, necessitating ongoing presence, sensitivity and adaptability from RN. To support these interactions, healthcare environments must prioritise privacy, relational continuity and communication training. Future research should investigate how organisational structures and clinical settings influence confidential conversations.
Healthcare environments should facilitate confidential conversations by ensuring relational continuity and minimising distractions. Communication training that emphasises presence and management of silence can strengthen nurse–patient relationships, enhancing patient care and emotional support.
This study explores key aspects of confidential conversations in palliative care, emphasising trust and emotional sensitivity. It addresses a research gap in palliative care using rare observational methods to deepen understanding of nursing relational aspects. The findings offer practical guidance for enhancing communication and relational skills, informing training and policy development and ultimately, improving emotional support and care.
Findings are reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.
This study did not involve patient or public participation in its design, conduct or reporting.
This study aimed to describe the types of psychological and physical symptoms experienced by healthcare professionals who became second victims after a patient safety incident and the impact of the incident on their social and professional lives.
Scoping review.
JBI methodology for scoping reviews and PRISMA-ScR for reporting were followed.
The search was conducted on June 13, 2024, using the CINAHL (EBSCO), Scopus, PubMed (Medline), Medic and PsycInfo (EBSCO) databases. A grey literature search was also conducted.
A total of 96 papers were included. Healthcare professionals experienced psychological symptoms such as anger, sadness and guilt after a safety incident. Physical symptoms were reported, including symptoms related to sleep and gastrointestinal symptoms. At the professional and social levels, the incident affected their work, relationships and well-being. Positive impacts were also noted.
This study provides a comprehensive overview of healthcare professionals' experiences after safety incidents. In addition, this study also captured the positive impacts of safety incidents, such as learning from mistakes.
By recognising the symptoms and impacts associated with the second victim syndrome, appropriate support can be provided for healthcare professionals.
The findings of this study can be used to identify the relevant harm to professionals after a safety incident, which could help to improve the well-being of these workers.
No patient or public contribution.
Open Science Framework, https://archive.org/details/osf-registrations-5cdmu-v1
Soft silicone multi-layer dressings are commonly used for pressure ulcer (pressure injury) prevention, yet their effectiveness varies based on design, construct, and material properties. This study evaluated the protective efficacy of a new multi-layer dressing, ALLEVYN COMPLETE CARE (ACC, Smith & Nephew Limited), which incorporates an advanced structure facilitating the dissipation of shear forces through internal layer-on-layer frictional sliding within the dressing. Using a combination of experimental frictional energy absorber effectiveness (FEAE) testing and computational finite element modelling, we quantified the capacity of this dressing to mitigate strain and stress concentrations in the soft tissues of the supported posterior heel. The dressing demonstrated considerable frictional sliding between its adjacent layers, resulting in FEAE = 93% under simulated, clinically relevant usage conditions. This was associated with the dissipation of shear forces and alleviation of strain/stress concentrations in the skin and underlying soft tissues below the dressing. The dressing completely eliminated the stress and strain peaks at the top quartiles of the strain/stress domain (with reference to a no-dressing case). This work provided valuable insights into advanced testing methods and beneficial design principles for pressure ulcer prevention dressings. Earlier investigations concluded that a previous-generation ALLEVYN LIFE dressing achieved high levels of FEAE and thus provided protection. Our findings here establish that the next-generation dressing, ACC, demonstrates even greater protective capacity.
This review explores the roles, competencies, and scope of practice of APNs in critical care based on international literature. It also derives implications for the development of advanced nursing roles in Austria.
Integrative review.
The research team conducted a systematic search of PubMed, CINAHL, and Web of Science to identify relevant peer-reviewed publications from 2007 to 2023.
A systematic search of electronic databases was undertaken, following Whittemore and Knafl's five-step methodology. The included publications met the defined inclusion criteria and were appraised for quality using the Joanna Briggs Institute critical appraisal checklists. Relevant data were extracted and thematically analysed.
The analysis of 14 international studies revealed recurring themes related to APN core competencies and scope of practice in critical care. These were structured according to Hamric's model. However, Austria faces several challenges, including limited legal frameworks, missing educational structures, and a lack of role clarity. These factors hinder the implementation of APN roles.
Internationally, APNs demonstrate advanced clinical skills, provide leadership in team-based care, and integrate evidence-based practice. These attributes enhance patient outcomes and system efficiency. In Austria, restrictive regulations, limited education, and unclear roles hinder these competencies. Reform is needed to align with international standards, and further research should explore their implementation in Austria.
A gap exists between internationally demonstrated APN competencies and the current state of advanced nursing practice in Austria. This highlights the need for clearer role definitions, regulatory frameworks, and educational strategies. Addressing this gap would strengthen APN roles and improve healthcare quality. This study highlights the need to bridge this disparity.
This review follows the PRISMA 2020 guidelines for systematic reviews Page et al. (2021).
No patient or public contribution.
This study was an investigation of the key factors influencing nurse retention and attrition focusing on the perspectives of current and former nurses within the context of the ongoing nursing shortage exacerbated by the COVID-19 pandemic.
This descriptive, cross-sectional study was designed to explore the complex dynamics of nurse retention and attrition in a rural and northern academic hospital in northwestern Ontario.
An online survey was administered to current and former nurses to compare the perspectives of those with no intention of leaving the organisation, those contemplating departure within the next year, and those who had reduced their work hours in the past 5 years.
Of the 288 respondents, 47% indicated no intention to leave and 17% reported having already left the organisation. The primary reasons for attrition included excessive workload demands, challenges maintaining a healthy work-life balance and dissatisfaction with management practices and organisational support. Respondents recommended improving leadership effectiveness, increasing staffing levels and implementing retention-focused initiatives to enhance job satisfaction and reduce turnover.
This study underscored the urgent need for strategic interventions tailored to retain nursing staff, particularly in rural and northern communities already facing significant recruitment and retention challenges. By addressing workload pressures, enhancing work-life balance, strengthening leadership and offering retention initiatives, health care organisations can improve job satisfaction and reduce attrition. System-level changes are essential to creating a sustainable and supportive environment for nursing professionals.
The findings highlight the critical need for immediate action to address the nursing crisis in rural and northern health care settings. They emphasise the importance of systemic interventions aimed at improving staffing levels, leadership practices and overall work conditions to safeguard the future of nursing in these underserved regions.
No patient or public contribution.
This research will contribute to the extant literature on the retention and attrition levels of nursing by offering a unique perspective from a rural and northern academ. The findings may help to guide hospital administrators to develop targeted strategies to enhance nurse retention rates within their organisations. By prioritising nurse satisfaction, these efforts will foster positive nurse–patient interactions and improve overall care outcomes.
This study is reported according to STROBE guidelines.
To examine the decision-making processes underlying missed nursing care.
A qualitative study using Critical Incident Debriefing interviews.
Fifteen nurses from inpatient wards in a general hospital participated in semi-structured interviews following their morning shifts. Interviews focused on care prioritisation incidents leading to missed nursing care. Data were analysed using thematic analysis.
Analysis revealed a central theme of emotions as crucial determinants in care prioritisation decisions. Two subthemes emerged: emotions as drivers of care prioritisation decisions and emotions as responses to these decisions. Positive emotions motivated nurses to prioritise care for specific patients, while negative emotions sometimes led to care delays. Successful care completion generated professional satisfaction, while care omissions produced complex emotional responses, including guilt, frustration and helplessness.
The dual emotional processes identified in this study—emotions functioning as both drivers and responses in care decisions—challenge purely structural explanations of missed nursing care. This perspective reframes nurses as emotionally engaged decision-makers who actively navigate care priorities rather than passively react to contextual constraints, offering a more comprehensive framework for understanding the complexity of clinical judgement in real-world settings.
This study positions emotions as legitimate components of clinical decision-making rather than cognitive biases. For nursing practice, this necessitates integrating emotional awareness into professional development. For patient care, recognising emotional underpinnings may promote equitable care distribution through interventions that engage with the emotional realities of nursing work.
This study addressed limited understanding of decision-making in missed nursing care, particularly emotions' role. Findings reveal how emotions influence nurses' prioritisation decisions and wellbeing, with implications for nurses, educators and administrators seeking interventions addressing structural and emotional dimensions.
This study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines (Appendix S1).
No patient or public contribution.
by Megan Wiggins, Marie Varughese, Ellen Rafferty, Sasha van Katwyk, Christopher McCabe, Jeff Round, Erin Kirwin
BackgroundDuring public health crises such as the COVID-19 pandemic, decision-makers relied on infectious disease models to evaluate policy options. Often, there is a high degree of uncertainty in the evidence base underpinning these models. When there is increased uncertainty, the risk of selecting a policy option that does not align with the intended policy objective also increases; we term this decision risk. Even when models adequately capture uncertainty, the tools used to communicate their outcomes, underlying uncertainty, and associated decision risk have often been insufficient. Our aim is to support infectious disease modellers and decision-makers in interpreting and communicating decision risk when evaluating multiple policy options.
MethodsWe developed the Decision Uncertainty Toolkit by adapting methods from health economics and infectious disease modelling to improve the interpretation and communication of uncertainty. Specifically, we developed a quantitative measure of decision risk as well as a suite of risk visualizations. We refined the toolkit contents based on feedback from early dissemination through conferences and workshops.
ResultsThe Decision Uncertainty Toolkit: (i) adapts and extends existing health economics methods for characterization, estimation, and communication of uncertainty to infectious disease modelling, (ii) introduces a novel risk measure that quantitatively captures the downside risk of policy alternatives, (iii) provides visual outputs for dissemination and communication of uncertainty and decision risk, and (iv) includes instructions on how to use the toolkit, standard text descriptions and examples for each component. The use of the toolkit is demonstrated through a hypothetical example.
ConclusionThe Decision Uncertainty Toolkit improves existing methods for communicating infectious disease model results by providing additional information regarding uncertainty and decision risk associated with policy alternatives. This empowers decision-makers to consider and evaluate decision risk more effectively when making policy decisions. Improved understanding of decision risk can improve outcomes in future public health crises.
by David Robert Grimes
BackgroundThe advent of mass-market Light Emitting Diodes (LEDs) has seen considerable interest in potential dermatological applications of LED light photobiomodulation (PBM) for a range of conditions, with a thriving market for direct-to-consumer LED treatments, including red light, blue light, and yellow light wavelengths. Evidence of efficacy is however mixed, and studies report a wide range of irradiances and wavelengths as well as outcome measures, rendering interpretation, comparison, and even efficacy evaluation prohibitive and impeding evidence synthesis.
MethodsThis work establishes a model for comparing patient received doses, applying this to existent studies to ascertain potential inhomogeneity in reported doses and wavelengths employed. Patient doses were contrasted to equivalent solar exposure time needed to achieve fluences reported at specified wavelengths in the red light (RL), blue light (BL), and yellow light (YL) portion of the spectrum, yielding a comparison of reported doses to typical solar irradiance at the Earth’s surface. Methodological aspects including dose validation, blinding, and bias were also analysed.
Results27 relevant studies for dermatological conditions including acne vulgaris (n=9, 33.3%), wrinkle-reduction (n=5, 18.5%), wound-healing (n=3, 11.1%), psoriasis severity (n=3, 11.1%), and erythemal index (n=7, 25.9%) were assessed. Outcome measures were highly heterogeneous between studies, with total patients ranging from 14 – 105 (median: 26). Fluences and wavelengths used in treatment differed over three orders of magnitude across studies even for the same conditions (0.1 J cm−2−126 J cm−2, median: 40.5 J cm−2). Derived equivalent solar time ranged from 0.01-19.35 hours (median: 3.3 hours), with central wavelengths between 405nm (BL) - 660nm (RL). No studies reported any dose validation, 10 (37.0%) were sponsored by the device manufacturer with a further 3 (11.1%) conducted by commercial dermatology practices offering the therapy under investigation. Assessors were unblinded to the treatment/ control groups in 33.3% (n=9), while a further 9 (33.3%) did not have any non-light control group, leaving only 33.3% (n=9) with both control group and blinded outcome assessment.
ConclusionsResults of this analysis suggest that fluences, wavelengths, and effective dose vary inconsistently between studies with often scant biological justification. This analysis suggests that better dose quantification and understanding of the underlying biophysics as well as plausible biological justifications for various wavelengths and fluences are imperative if LED therapy studies for dermatology are to be informative and research replicability improved.
by Andrea C. Aplasca, Peter B. Johantgen, Christopher Madden, Kilmer Soares, Randall E. Junge, Vanessa L. Hale, Mark Flint
Amphibian skin is integral to promoting normal physiological processes in the body and promotes both innate and adaptive immunity against pathogens. The amphibian skin microbiota is comprised of a complex assemblage of microbes and is shaped by internal host characteristics and external influences. Skin disease is a significant source of morbidity and mortality in amphibians, and increasing research has shown that the amphibian skin microbiota is an important component in host health. The Eastern hellbender (Cryptobranchus alleganiensis alleganiensis) is a giant salamander declining in many parts of its range, and captive-rearing programs are important to hellbender recovery efforts. Survival rates of juvenile hellbenders in captive-rearing programs are highly variable, and mortality rates are overall poorly understood. Deceased juvenile hellbenders often present with low body condition and skin abnormalities. To investigate potential links between the skin microbiota and body condition, we collected skin swab samples from 116 juvenile hellbenders and water samples from two holding tanks in a captive-rearing program. We used 16s rRNA gene sequencing to characterize the skin and water microbiota and observed significant differences in the skin microbiota by weight class and tank. The skin microbiota of hellbenders that were housed in tanks in close proximity were generally more similar than those housed physically distant. A single taxa, Parcubacteria, was differentially abundant by weight class only and observed in higher abundance in low weight hellbenders. These results suggest a specific association between this taxa and Low weight hellbenders. Additional research is needed to investigate how husbandry factors and potential pathogenic organisms, such as Parcubacteria, impact the skin microbiota of hellbenders and ultimately morbidity and mortality in the species.by Tanya N. Leary, Lyn Kaye, Olivia Chin, Kar Yee Phoon, David Phalen
Sarcoptes scabiei causes a fatal disease (mange) in bare-nosed wombats (BNWs) (Vombatus ursinus) across their range and can threaten isolated populations with extinction. Repeated dosing of moxidectin (Cydectin®) at a dosage rate of 0.5 mg/kg is effective at treating individual BNWs but is difficult to administer on a population basis where treatment success has varied. This paper documents the temporary (~20 month) eradication of mange from a semi-isolated population of BNWs using repeated dosing of Cydectin® administered by burrow flaps. Treated BNWs were marked with nontoxic paint and selected burrows were monitored with camera traps demonstrating that 64–96% of wombats in the population were treated with each dosage. Treatment success was attributed to the installation of burrow flaps on all burrows in the treated area. This treatment program shows that isolated high-density populations can be successfully treated for S. scabiei infection with repeated dosages of Cydectin® (0.5 mg/kg) and questions the need for higher dosages that have been advocated. Mange returned to the population of BNWs after 20 months possibly as the result of migration of an infected BNW from a nearby population, suggesting mange affected populations may require periodic retreatment. Monitoring of burrow entrances confirmed that burrows provide habitat used by many species of birds, reptiles, and mammals, and suggest burrows could be occasional sites of mange spillover among species. Camera trap monitoring also showed when BNWs in this population leave and return to their burrows; how many BNWs enter a burrow and explore the burrow entrances each night; and how these parameters are impacted by season and mange status; variables that are valuable to know when treating populations of BNW for mange.by Claudia Castro, Jacquelyn Badillo, Melissa Tumen-Velasquez, Adam M. Guss, Thomas S. Collins, Frank Harmon, Devin Coleman-Derr
Recent wildfires near vineyards in the Pacific United States have caused devastating financial losses due to smoke taint in wine. When wine grapes (Vitis vinifera) are exposed to wildfire smoke, their berries absorb volatile phenols derived from the lignin of burning plant material. Volatile phenols are released during the winemaking process giving the finished wine an unpleasant, smokey, and ashy taste known as smoke taint. Bacteria are capable of undergoing a wide variety of metabolic processes and therefore present great potential for bioremediation applications in many industries. In this study, we identify two strains of the same species that colonize the grape phyllosphere and are able to degrade guaiacol, a main volatile phenol responsible for smoke taint in wine. We identify the suite of genes that enable guaiacol degradation in Gordonia alkanivorans via RNAseq of cells growing on guaiacol as a sole carbon source. Additionally, we knockout guaA, a cytochrome P450 gene involved in the conversion of guaiacol to catechol; ΔguaA cells cannot catabolize guaiacol in vitro, providing evidence that GuaA is necessary for this process. Furthermore, we analyze the microbiome of berries and leaves exposed to smoke in the vineyard to investigate the impact of smoke on the grape microbial community. We found smoke has a significant but small effect on the microbial community, leading to an enrichment of several genera belonging to the Bacilli class. Collectively, this research shows that studying microbes and their enzymes has the potential to identify novel tools for alleviating smoke taint.by Anni Varjonen, Toni Saari, Sari Aaltonen, Teemu Palviainen, Mia Urjansson, Paula Iso-Markku, Jaakko Kaprio, Eero Vuoksimaa
We examined the associations of midlife and old-age cardiovascular risk factors, education, and midlife dementia risk scores with cognition at 90 + years, using data from a population-based study with 48 years of follow-up. Participants were 96 individuals aged 90–97 from the older Finnish Twin Cohort study. Individual cardiovascular risk factors assessed via questionnaires in 1975, 1981, 1990, and 2021–2023 included blood pressure, body mass index, physical activity, and cholesterol, and self-reported educational attainment. The Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score and an educational-occupational attainment score were used as midlife dementia risk scores. Cognitive assessments included semantic fluency, immediate and delayed recall from a 10-word list learning task, and a composite cognitive score. Regression analyses were conducted with dementia risk factors predicting cognition at 90 + years, adjusting for age, sex, education, follow-up time, and apolipoprotein E genotype (ε4-carrier vs non-carriers). Results showed that higher education and higher educational-occupational score were associated with better cognitive performance in all cognitive measures. Those with high midlife blood pressure scored significantly higher in all cognitive tests than those with normal blood pressure. Conversely, those with high old-age blood pressure scored lower in semantic fluency and composite cognitive score, but not in immediate or delayed recall. Other cardiovascular risk factors and the CAIDE score did not show consistent associations with cognition. Education appears to have a long-lasting protective effect in cognitive aging, whereas midlife and old-age cardiovascular risk factors were not significantly associated with cognition at 90 + years.by Catarina Simões, Diana S. Vasconcelos, Raquel Xavier, Xavier Santos, Catarina Rato, D. James Harris
Fire has long been recognized as an important ecological and evolutionary force in plant communities, but its influence on vertebrate community ecology, particularly regarding predator-prey interactions, remains understudied. This study reveals the impact of wildfires on the diet of Podarcis lusitanicus, a lizard species inhabiting a fire-prone region in the Iberian Peninsula. In order to explore diet variability associated with different local burn histories, we evaluated P. lusitanicus diet across three types of sites in Northern Portugal: those had not burned since 2016, those burned in 2016, and those more recently burned in 2022. Podarcis lusitanicus is a generalist arthropod predator with dietary flexibility. Given the turnover of arthropod species after fire, it is expected to find variations in diet caused by different fire histories, especially between unburned and recently burned sites. From DNA metabarcoding of faecal samples, our study revealed that while prey richness remained unaffected by wildfire regime, significant shifts occurred in diet composition between more recently burned and unburned areas. Specifically, we found that differences in diet composition between these two fire regimes were due to the presence of Tapinoma ants and jumping spiders (Salticus scenicus). These prey were present in the diets of lizards occupying unburned areas, while these were absent in areas burned in 2022. Interestingly, diets in unburned areas and areas burned in 2016 showed no significant differences, highlighting the lizards’ ecological flexibility and the habitat’s resilience over time. The ant species T. topitotum was found in dominance in both burned areas, suggesting that this species may be fire tolerant. In addition, families such as Cicadellidae and Noctuidae were found to be more associated with more recently burned areas. The use of DNA metabarcoding in this study was essential to provide a more detailed and accurate view of predator-prey interactions in ecosystems susceptible to fire, and therefore a better understanding of changes in prey consumption in this fire-adapted ecosystem.There are substantial barriers to initiate advance care planning (ACP) for persons with chronic-progressive disease in primary care settings. Some challenges may be disease-specific, such as communicating in case of cognitive impairment. This study assessed and compared the initiation of ACP in primary care with persons with dementia, Parkinson’s disease, cancer, organ failure and stroke.
Longitudinal study linking data from a database of Dutch general practices’ electronic health records with national administrative databases managed by Statistics Netherlands.
Data from general practice records of 199 034 community-dwelling persons with chronic-progressive disease diagnosed between 2008 and 2016.
Incidence rate ratio (IRR) of recorded ACP planning conversations per 1000 person-years in persons with a diagnosis of dementia, Parkinson’s disease, organ failure, cancer or stroke, compared with persons without the particular diagnosis. Poisson regression and competing risk analysis were performed, adjusted for age, gender, migration background, living situation, frailty index and income, also for disease subsamples.
In adjusted analyses, the rate of first ACP conversation for persons with organ failure was the lowest (IRR 0.70 (95% CI 0.68 to 0.73)). Persons with cancer had the highest rate (IRR 1.75 (95% CI 1.68 to 1.83)). Within the subsample of persons with organ failure, the subsample of persons with dementia and the subsample of stroke, a comorbid diagnosis of cancer increased the probability of ACP. Further, for those with organ failure or cancer, comorbid dementia decreased the probability of ACP.
Considering the complexity of initiating ACP for persons with organ failure or dementia, general practitioners should prioritise offering it to them and their family caregivers. Policy initiatives should stimulate the implementation of ACP for people with chronic-progressive disease.
Endometriosis is a chronic condition affecting up to 11% of people presumed female at birth by the age of 44 years, characterised by the growth of tissue similar to the lining of the uterus on other organs. Endometriosis significantly impacts health-related quality of life (HRQoL) and imposes a substantial burden on both individuals and the healthcare system. International guidelines recommend the interdisciplinary management of endometriosis due to its significant biopsychosocial burden; however, research aimed at exploring psychological approaches for endometriosis is limited. This trial aims to evaluate the effectiveness of CodeEndo, an online co-designed interdisciplinary supportive care program, compared with a waitlist control (WLC), on HRQoL and biopsychosocial outcomes in people with a diagnosis of endometriosis.
A hybrid type 1 effectiveness and implementation randomised controlled trial (RCT) will be conducted. Eligible participants will be randomly allocated to either the CodeEndo program (n=176) or WLC group (n=176) for 8 weeks. The primary outcome will be HRQoL, and secondary outcomes will include psychological symptoms (anxiety, depression, stress), self-efficacy, menstrual, bladder and gastrointestinal symptoms, pain, fatigue, sleep, exercise, diet, symptom bothersomeness and physical and psychological well-being, measured at 8 weeks post-randomisation (T2) and 6-month follow-up (T3). Cost-effectiveness will also be examined. Longitudinal qualitative individual interviews (up to n=40) will be conducted with participants who complete the CodeEndo program to explore benefits, barriers and facilitators of ongoing use. Additionally, the CodeEndo program will undergo evaluation by a group of endometriosis healthcare providers, who will assess potential barriers and facilitators to its real-world implementation. Various process evaluation strategies will also be measured to inform future implementation. Data analyses will incorporate mixed-effects regression models on an intention-to-treat basis, cost-consequences and cost-utility, dietary and qualitative thematic analysis.
This protocol received ethics approval from Deakin University Research Ethics Committee (DUREC Ref: 2024-157). Dissemination is expected to include peer-reviewed journal articles, reports, conference presentations as well as websites or social media platforms of relevant chronic pain organisations. Participants will be sent a summary of trial results.
ACTRN12623000598684p.
Documenting evidence on global health strategies and programmes that provide safeguards for vulnerable populations and strengthen overall pandemic preparedness is essential. This study aimed to identify factors associated with adherence to COVID-19 mitigation measures, COVID-19-related symptoms and testing, as well as pandemic-related income loss among internally displaced persons (IDPs) in urban and remote areas of Burkina Faso, Niger and Mali.
This cross-sectional study used fixed-site respondent-driven sampling (RDS).
Primary care settings across six urban and remote locations in Burkina Faso, Mali and Niger.
4144 internally displaced adults, who had been forced from their homes within 5 years of the survey, participated in the study. The survey was conducted between August and October 2021 in two selected locations in three countries: Kaya (n=700) and Ouahigouya (n=715) in Burkina Faso; Bamako (n=707) and Ménaka (n=700) in Mali; and Niamey (n=733), and Diffa (n=589) in Niger. Participants were included if they were born in the study countries, displaced due to conflict, violence or disaster, aged 18 years or older, and living or working in the study site for at least 1 month.
The primary outcomes measured were adherence to COVID-19 mitigation measures, presence of COVID-19 symptoms, COVID-19 testing and vaccination rates and pandemic-related income loss.
Among 4144 IDPs surveyed across 6 sites in Burkina Faso, Mali and Niger, over half (52%) reported experiencing at least one COVID-19 symptom in the preceding 2 weeks. However, 8% had ever been tested for COVID-19, and fewer than 5% had received a vaccine in all sites except Diffa, where 54% reported vaccination. While willingness to be vaccinated was high (ranging from 56.6% in Bamako to 89.5% in Niamey), access remained limited. Compliance with public health measures varied; for example, 41.7% of IDPs were able to maintain physical distance from non-household members, and just 60.2% reported wearing a mask. Chronic health conditions were consistently associated with higher odds of COVID-19 symptoms (Ménaka OR: 14.65; 95% CI: 7.36 to 29.17). Economic vulnerability was widespread, with more than half of IDPs in Bamako (58.1%) and Niamey (66.4%) reporting income loss due to the pandemic, and average monthly income declining by over 50% in most sites. IDPs in urban areas generally reported greater exposure to COVID-19 risk factors, while those in remote settings reported lower adherence and poorer access to basic preventive measures.
This is the first known RDS study to explore the impact of the COVID-19 pandemic on IDPs. Findings suggest that IDPs in urban areas may face heightened risks of exposure and infection, underscoring the need to prioritise them in public health efforts. Low testing and vaccination rates and significant income loss call for advocacy and economic relief to address these vulnerabilities. Future pandemic responses should integrate health interventions with targeted support, especially mitigating income loss to bolster IDPs’ resilience.
Cancer remains a major public health concern worldwide. Patient navigation, developed in the 1990s to address disparities in cancer outcomes, aims to guide patients through the complex healthcare system and improve access to timely, quality care. Despite its proven benefits, little is known about the implementation or impact of patient navigation programmes in African settings.
This scoping review aims to map the current evidence on components, procedures, outcomes and impact, as well as barriers and challenges to implementation of patient navigation programmes in cancer care across Africa.
This scoping review will follow Arksey and O’Malley’s scoping review framework, as further developed by Levac et al. A systematic search will be conducted across PubMed, African Journals Online and Google Scholar to identify relevant studies published from database inception to the date of the final search, using a combination of relevant keywords and MeSH terms. Eligible studies must be reported in English, have been carried out in Africa, involved patients diagnosed with cancer or navigating the cancer care continuum, and report on the description, implementation or evaluation of patient navigation programmes. Screening will be managed with Rayyan and carried out through a two-stage process: screening by titles and abstracts, then by full-text screening based on the prespecified inclusion and exclusion criteria. Data will be extracted into a structured Excel spreadsheet and synthesised using qualitative content analysis to identify programme characteristics, outcomes, barriers and implementation challenges.
This scoping review does not require ethical approval. Our findings will be published in a peer-reviewed, open-access journal on completion.
Medication returned by patients to healthcare facilities is a critical aspect of reverse logistics, intersecting healthcare delivery, patient safety and environmental sustainability, especially in low- and middle-income countries (LMICs) where systemic inefficiencies and socio-cultural factors may exacerbate the issue. While emerging medication return programmes are recognised for their potential to enhance resource efficiency and prevent misuse, they also signal inefficiencies in medical supply chains, prescribing practices and patient-provider interactions. This scoping review aims to systematically map the incidence and drivers of medication returned to health facilities by patients in LMICs.
This review follows Arksey and O'Malley’s scoping review framework and the PRISMA-ScR reporting guidelines. Searches will be conducted in Google Scholar, PubMed, CINAHL, Embase, Web of Science and Scopus, supplemented by grey literature sources and reference list screening. Searches will include studies from January 2005 to December 2025 and English-language publications, reflecting both the relevance of recent evidence and practical considerations for screening and analysis. Eligible studies must address the incidence or drivers of medication returned in LMICs and meet predefined inclusion criteria based on the Population, Concept, Context framework. Data will be extracted using a standardised charting form and analysed using narrative synthesis, supported by descriptive statistics and thematic analysis.
No ethical approval is required as this scoping review will analyse publicly available literature. Findings will be disseminated through peer-reviewed publications, academic conferences and healthcare organisations, with all data and search strategies made openly accessible through Springer Nature’s protocols.io preprint repository to support transparency and future research.
Springer Nature’s protocols.io dx.doi.org/10.17504/protocols.io.3byl4wd5ovo5/v1.
Peripheral arterial disease (PAD) affects approximately one in five people over 60 in the UK. In severe cases, revascularisation, such as surgical bypass or endovascular methods, is often required to restore limb perfusion. Between 2000 and 2019, 527 131 revascularisation procedures were carried out in the UK. Postprocedural surveillance is essential to detect restenosis and maintain vessel patency. However, standard surveillance using duplex ultrasound (DUS) is resource intensive. Ankle Doppler waveform assessment is quick, inexpensive and accurate for PAD diagnosis, yet its role in postrevascularisation surveillance remains unexplored. This study aims to evaluate the diagnostic accuracy of ankle handheld Doppler waveform assessment (ankle HHD) for detecting restenosis after lower limb revascularisation, as compared with formal DUS.
This is a prospective diagnostic accuracy study (ClinicalTrials.gov Identifier NCT06619223). We aim to recruit 121 people with PAD undergoing planned lower limb revascularisation at Imperial College Healthcare NHS Trust. Follow-up assessments will take place at 3 months, 6 months and 12 months post revascularisation. At each visit, a vascular scientist will perform the index test (Ankle HHD) followed by DUS as the reference standard. A subset of participants will undergo repeat testing to assess interobserver and intraobserver reliability. Restenosis will be defined as one or more arterial lesions of ≥50% stenosis or tandem lesions with a combined value of ≥50%. The primary outcome is the sensitivity of ankle Doppler waveform assessment for detecting restenosis, compared with DUS.
The study has received approval from Health Research Authority (HRA) and Health and Care Research Wales (REC reference 24/LO/0462). Results will be disseminated through research presentations and papers.
ClinicalTrials.gov, NCT06619223.
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