Conectar
To evaluate the research capability of clinical nurses in China and identify the determinants associated with their capability.
As nursing evolves into an increasingly independent discipline, the research capability of clinical nurses has become critical for the development of the profession, advancing evidence-based practice and improving patient care quality.
A multicentre cross-sectional survey was conducted using convenience sampling from September 2023 to February 2024, among clinical nurses in tertiary hospitals across three provinces in China. The Nursing Research Capability Self-Assessment Scale was used to assess the research capability of the nurses. Chi-square tests, one-way analysis of variance and multiple linear regression were used to examine factors associated with research capability. The Strengthening the Reporting of Observational Studies in Epidemiology was followed.
A total of 1074 clinical nurses participated. The mean research capability score was 89.11 ± 27.69, reflecting a moderate level of research capability. However, two dimensions of research questions and literature review received lower scores. Multiple linear regression analysis identified that education level, professional title, administrative position and nursing job title (all p < 0.05) were independent predictors of research capability.
Clinical nurses exhibit moderate research capability, with notable deficiencies in formulating research questions and conducting literature reviews. Key factors influencing research capability include education, professional title, administrative position, and job title. Targeted training and development programmes should address these factors to enhance nurses' research competence and advance nursing science.
Understanding maternal perceptions of the quality and safety of care serves as a crucial management tool for the planning and enhancement of health interventions. In Iran, where cultural norms emphasise mothers’ central role in caregiving and healthcare resources are often limited, incorporating their perspectives into nursing care strategies is essential. This study aimed to assess the perception of key nursing safety practices among Iranian mothers of children with leukaemia undergoing their first chemotherapy course.
A longitudinal study.
Oncology wards of hospitals affiliated with Tabriz University of Medical Sciences.
Mothers of children with leukaemia.
The mean perception score increased from 2.75 (out of 4) at baseline to 2.99 by week 4. The largest increases in perception were observed in patient identification and hand hygiene, with mean differences of 0.41 and 0.38, respectively. A significant increase in overall perception and subscales was observed (p
Actively involving mothers in the care process enhances their perceptions of safety and quality during hospitalisation. Supportive and educational interventions are needed to further improve the safety and quality of nursing care.
Current guideline-recommended antibiotic treatment durations for ventilator-associated pneumonia (VAP) are largely standardised, with limited consideration of individual patient characteristics, pathogens or clinical context. This one-size-fits-all approach risks both overtreatment—promoting antimicrobial resistance and adverse drug events—as well as undertreatment, increasing the likelihood of pneumonia recurrence and sepsis-related complications. There is a critical need for VAP-specific biomarkers to enable individualised treatment strategies. The Ventilator-associated pneumonia Biomarker Evaluation (VIBE) study aims to identify a dynamic alveolar biomarker signature associated with treatment response, with the goal of informing personalised antibiotic duration in future clinical trials.
VIBE is a prospective, observational, case-cohort study of 125 adult patients with VAP in Michigan Medicine University Hospital intensive care units. Study subjects will undergo non-bronchoscopic bronchoalveolar lavage on the day of VAP diagnosis (Day 1) and then on Days 3 and 5. Alveolar biomarkers (quantitative respiratory culture bioburden, alveolar neutrophil percentage and pathogen genomic load assessed via BioFire FilmArray polymerase chain reaction) will be assessed. An expert panel of intensivists, blinded to biomarker data, will adjudicate each patient’s Day 10 outcome as VAP clinical cure (control) or treatment failure (case). Absolute biomarker levels and mean-fold changes in biomarker levels will be compared between groups. Data will be used to derive a composite temporal alveolar biomarker signature predictive of VAP treatment failure.
Ethical approval was obtained from the University of Michigan Institutional Review Board (IRB #HUM00251780). Informed consent will be obtained from all study participants or their legally authorised representatives. Findings will be disseminated through peer-reviewed publications, conferences and feedback into clinical guidelines committees.
The only supportive therapy for patients with severe acute kidney injury (AKI), a common complication among the critically ill, is dialysis. Based on the literature and current guidelines, continuous renal replacement therapy (CRRT) with a total effluent dose of 20–25 mL/kg/hour and adjustments to ensure such dose is delivered despite down time (eg, due to surgical procedures) is recommended. However, experimental and clinical studies suggest that azotaemia, which can be induced by lowering the effluent dose, may accelerate renal recovery. This clinical study investigates whether a lower effluent dose (10–15 mL/kg/hour) for a maximum of 7 days or until successful (>24 hours) liberation of CRRT in critically ill patients with a dialysis-dependent AKI accelerates renal recovery and reduces time on CRRT compared with guideline-directed standard dose (25–30 mL/kg/hour).
The Ketzerei trial is an international, multicentre randomised, controlled trial, designed to investigate if a lower effluent dose (10–15 mL/kg/hour) accelerates renal recovery and reduces the time on CRRT compared with the guideline directed standard effluent dose (25–30 mL/kg/hour). The study aims to enrol 150 critically ill patients with a dialysis-dependent AKI. Eligible patients will be randomised to receive either a standard effluent dose (control group, 25–30 mL/kg/hour) or lower effluent dose (interventional group, 10–15 mL/kg/hour). The primary endpoint is the number of days free from CRRT and alive (from randomisation through day 28). Key secondary endpoints include the number of (serious) adverse events due to potential uremia, the duration of RRT and intensive care unit survival.
The Ketzerei trial has been approved by the Ethics Committee of the Chamber of Physicians Westfalen-Lippe (2023–343 f-s), the University of Muenster and subsequently by the corresponding Ethics Committee of the participating sites. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research.
clinicaltrials.gov (NCT06021288).
In current clinical practice, breast cancer is treated according to hormone receptor and human epidermal growth receptor 2 expression (HER2) status, which play an important role in disease management and overall prognosis. Trastuzumab deruxtecan (T-DXd) has been studied in multiple global prospective DESTINY-breast trials. Recent marketing authorisation for T-DXd has been granted from Health Canada for HER2-positive breast cancer who have received prior treatment with trastuzumab emtansine, or at least one prior anti-HER2-based regimen in the metastatic setting, or who have received a prior anti-HER2-based regimen in the neoadjuvant or adjuvant setting and developed disease recurrence during or within 6 months of completing neoadjuvant or adjuvant therapy. T-DXd is also indicated for HER2-low unresectable and/or metastatic breast cancer (mBC) patients who have received at least one prior line of chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy. However, there is a paucity of evidence assessing T-DXd in the real-world setting. As such, the overarching aim of this study is to generate Canadian real-world evidence on discontinuations and treatment modifications for patients with HER2+ and HER2-low mBC undergoing treatment with T-DXd.
This is a hybrid, longitudinal cohort study design leveraging patient support programme (PSP) secondary data with additional primary data collection to assess study treatment-related outcomes among patients with HER2+ and HER2-low mBC receiving treatment with T-DXd. Mainly, this study will leverage secondary data from the PSP, which will include clinical and demographic characteristics as well as duration, modification and intensity of treatment information for patients while enrolled in the PSP. These data will be supplemented with primary data, which will be collected via a patient questionnaire and include additional self-reported clinical and demographic characteristics not captured within the PSP, including follow-up data on therapies received, treatment discontinuation information after the PSP closure and frequency of CT scans and cardiac monitoring scans.
The study protocol was approved by the Advarra Institutional Review Board on 13 December 2023 (ID: D133HR00037). Findings will be disseminated by publication in peer-reviewed journals, through oral and poster presentations for various audiences, websites and scientific meetings. Written informed consent will be obtained from all patients prior to agreeing to participate in this study.
Participant recruitment for primary data collection began on 22 April 2024 and was completed on 8 October 2024. Primary data collection for follow-up will continue through up to 12 months after the date of the last enrolment.
Digitalisation in healthcare has resulted in fragmented solutions and limited interoperability. The Fast Healthcare Interoperability Resources (FHIR) standard is increasingly adopted to enable standardised data exchange, yet its complexity creates usability challenges for clinicians and developers. To address these challenges, this study evaluates the usability of an enhanced FHIR Questionnaire Resource Editor designed to improve workflow efficiency, accessibility and user satisfaction in creating and managing healthcare questionnaires.
This mixed-methods usability evaluation will recruit 10 healthcare professionals and/or informatics experts via convenience sampling. The study will consist of four general phases: (1) an initial session to familiarise users with the tool; (2) a task analysis phase supported by eye-tracking to identify strengths and weaknesses; (3) retrospective think-aloud interviews to explore strategies used during tasks and (4) completion of a validated usability questionnaire, such as the System Usability Scale, to quantify user satisfaction. We will analyse quantitative data using descriptive and inferential statistics. Qualitative feedback will be examined through thematic analysis and affinity mapping. The primary outcome is to assess the editor’s usability and accessibility and to identify areas for improvement.
This study protocol has been reviewed and approved by the Ethics Committee of the Medical Faculty at the University of Würzburg (ethikkommission@uni-wuerzburg.de) under approval number (24/24-sc). All participants will provide informed consent. Results will be disseminated through peer-reviewed journals, conferences and open-access platforms to inform future iterations of FHIR-based tools.
Poststroke depression affects approximately 30% of stroke survivors and is linked to worse functional outcomes, cognitive decline, reduced quality of life and increased mortality. While early treatment of poststroke mental health conditions is critical, current pharmacological options offer limited efficacy. Music listening interventions are a promising, low-risk, accessible and affordable alternative that may enhance recovery through engagement of reward-related brain circuits. However, most music listening studies have focused on the acute stage of stroke, lack objective measures of music engagement and rarely assess underlying neural mechanisms. To address these gaps, we propose a feasibility study of a remotely delivered music-listening intervention for individuals with chronic stroke, incorporating objective tracking of music exposure and multimodal assessments of mental health, cognitive, neural and physiological changes.
We will conduct a parallel group randomised controlled feasibility trial enrolling 60 patients with chronic stroke from a well-characterised stroke registry in New York City. Participants will be randomised to either an intentional music listening (IML) group or an active control group that listens to audiobooks. The study includes a 4-week preintervention period during which no treatment is administered; this phase is designed to assess the stability of outcome measures. Following this, participants will engage in 1-hour daily listening sessions over a 4-week intervention period. All listening activity (ie, track identity, duration and engagement) will be continuously tracked using custom open-source software, providing a measure of treatment dose. Behavioural outcomes related to mental health will be assessed at baseline, preintervention, postintervention and 3-month follow-up. Multimodal biomarkers (functional and structural MRI, electrodermal activity and heart rate) will be collected preintervention and postintervention. The primary objective is to establish feasibility, defined by rates of retention and adherence, treatment fidelity, feasibility, acceptability and participant burden. Secondary outcomes include recruitment and randomisation rates. This trial will provide essential data to inform the design of future large-scale clinical studies of IML for poststroke mental health recovery.
The study was approved by New York University’s Institutional Review Board (FY2024-8826). All human participants will provide written informed consent prior to participation and will be adequately compensated for their time. Results will be reported in peer-reviewed journals.
by Johanna Charlotte Neubauer, Anna Kaiser, Leon Lettermann, Tobias Volkert, Alexander Häge
ObjectiveThis study evaluates the performance of four large language models—ChatGPT 4o, ChatGPT o1-mini, Gemini 2.0 Flash, and Gemini 1.5 Flash—in answering multiple-choice questions in child and adolescent psychiatry to assess their level of factual knowledge in the field.
MethodsA total of 150 standardized multiple-choice questions from a specialty board review study guide were selected, ensuring a representative distribution across different topics. Each question had five possible answers, with only one correct option. To account for the stochastic nature of large language models, each question was asked 10 times with randomized answer orders to minimize known biases. Accuracy for each question was assessed as the percentage of correct answers across 10 requests. We calculated the mean accuracy for each model and performed statistical comparisons using paired t-tests to evaluate differences between Gemini 2.0 Flash and Gemini 1.5 Flash, as well as between Gemini 2.0 Flash and both ChatGPT 4o and ChatGPT o1-mini. As a post-hoc exploration, we identified questions with an accuracy below 10% across all models to highlight areas of particularly low performance.
ResultsThe accuracy of the tested models ranged from 68.3% to 78.9%. Both ChatGPT and Gemini demonstrated generally solid performance in the assessment of in child and adolescent psychiatry knowledge, with variations between models and topics. The superior performance of Gemini 2.0 Flash compared with its predecessor, Gemini 1.5 Flash, may reflect advancements in artificial intelligence capabilities. Certain topics, such as psychopharmacology, posed greater challenges compared to disorders with well-defined diagnostic criteria, such as schizophrenia or eating disorders.
ConclusionWhile the results indicate that language models can support knowledge acquisition in child and adolescent psychiatry, limitations remain. Variability in accuracy across different topics, potential biases, and risks of misinterpretation must be carefully considered before implementing these models in clinical decision-making.
To explore and describe how healthcare professionals within the oncological outpatient setting perceive quality of care.
A qualitative, descriptive design with a phenomenographic approach was used, with focus group discussions as the means of data collection.
Primary care in oncological outpatient units in four hospitals in Sweden.
Through purposive sampling, 20 healthcare professionals entered and completed the study by participating in four focus groups, five participants in each group. Inclusion criteria were assistant nurses, nurses or physicians delivering treatment and care with radiation and/or anticancer drugs in oncological outpatient units. Excluded were healthcare professionals who had worked less than 3 months at the oncological outpatient unit.
Two descriptive categories emerged from the data: ‘The professional’s personal ability for good care’ and ‘The structural conditions for good care’. These categories consist of descriptions of quality of care being perceived as a good meeting with patients, patient participation, continuity, accessibility and care grounded in science.
According to the healthcare professionals, quality of care relies on organisational structures in combination with a professional and personal interaction between the patients and the healthcare professionals. Knowledge about what healthcare professionals believe constitutes quality of care should therefore be highly valuable to policymakers and hospital management.
To evaluate the effects of diabetes mellitus (DM) and body mass index (BMI) on long-term all-cause mortality in chronic total occlusion (CTO) patients.
Retrospective, nationwide cohort study.
Swedish Coronary Angiography and Angioplasty Registry, between June 2015 and December 2021.
24 284 patients with angiographically confirmed CTO. Prior coronary artery bypass graft surgery excluded. Subgroups were defined by DM status and BMI categories (underweight, healthy weight, overweight, obesity).
Long-term all-cause mortality, assessed by Kaplan-Meier analysis and multivariable Cox proportional hazards regression.
DM was present in 30.3% of patients and conferred a 31% higher risk of mortality (HR: 1.31, 95% CI: 1.20 to 1.42; p2, lowest risk (nadir) at 32 kg/m2 and modest rise above 35 kg/m2.
In this nationwide CTO cohort, DM independently predicted higher long-term mortality, accompanied by more severe comorbidities and greater CTO complexity, and insulin therapy further elevated hazard. Overweight and obese patients had better survival, while underweight individuals had the poorest prognosis. These findings underscore the importance of individualised risk assessment and management strategies in CTO patients, particularly those with DM or low BMI.
Patient engagement (PE), or a patient’s participation in their healthcare, is an important component of comprehensive healthcare delivery, yet there is not an existing, publicly available, measurement tool to assess PE capacity and behaviours. We sought to develop a survey to measure PE capacity and behaviours for use in ambulatory healthcare clinics.
Measure development and psychometric evaluation.
A total of 1180 adults in the USA from 2022 to 2024, including 1050 individuals who had indicated they had seen a healthcare provider in the prior 12 months who were recruited nationally via social media across three separate samples; 8 patient advisors and healthcare providers recruited from a large, midwestern US Academic Medical Center; and 122 patients recruited from five participating ambulatory clinics in the Midwestern USA.
An initial survey was developed based on a concept mapping approach with a Project Advisory Board composed of patients, researchers and clinicians. Social media was then used to recruit 540 participants nationally (Sample 1) to complete the initial, 101-item version of the survey to generate data for factor analysis. We conducted exploratory and confirmatory factor analyses to assess model and item fit to inform item reduction, and subsequently conducted cognitive interviews with eight additional participants (patient advisors and providers; Sample 2), who read survey items aloud, shared their thoughts and selected a response. The survey was revised and shortened based on these results. Next, a test–retest survey, also administered nationally via another round of social media recruitment, was administered two times to a separate sample (n=155; Sample 3), 2 weeks apart. We further revised the survey to remove items with low temporal stability based on these results. For clinic administration, research staff approached patients (n=122; Sample 4) in waiting rooms in one of five ambulatory clinics to complete the survey electronically or on paper to determine feasibility of in-clinic survey completion. We engaged in further item reduction based on provider feedback about survey length and fielded a final revised and shortened survey nationally via a final round of social media recruitment (n=355; Sample 5) to obtain psychometric data on this final version.
Cronbach’s alphas, intraclass correlations (ICCs), Comparative Fit Index (CFI), root mean square error of approximation (RMSEA), standardised root mean squared residual (SRMR).
The final PE Capacity Survey (PECS) includes six domains across two scales: ‘engagement behaviours’ (ie, preparing for appointments, ensuring understanding, adhering to care) and ‘engagement capacity’ (ie, healthcare navigation resources, resilience, relationship with provider). The PECS is 18 questions, can be completed during a clinic visit in less than 10 minutes, and produces scores which demonstrate acceptable internal consistency reliability (α=0.72 engagement behaviours, 0.76 engagement capacity), indicating items are measuring the same overarching construct. The scales also had high test–retest reliability (ICC=0.82 behaviours, 0.86 capacity), indicating stability of response over time, and expected dimensionality with high fit indices for the final scales (behaviours: CFI=0.97; RMSEA=0.07; SRMR=0.05; capacity: CFI=0.99; RMSEA=0.06; SRMR=0.06), indicating initial evidence of construct validity.
The PECS is the first known measure to assess patients’ capacity for engagement and represents a step toward informing interventions and care plans that acknowledge a patient’s engagement capacity and supporting engagement behaviours. Future work should be done to validate the measure in other languages and patient populations, and to assess criterion-related validity of the measure against patient outcomes.
The healthcare system is complex, involving multiple interactions among individuals, organisations and systems. Many patients, particularly those with limited health system literacy, struggle to navigate it. A reliable instrument is crucial for accurately measuring individuals’ navigational abilities. However, a systematic review of psychometric properties of existing instruments for measuring health system literacy has not been conducted. This review aims to provide a comprehensive assessment of methodological quality and measurement properties of these instruments.
A search was conducted in MEDLINE, EMBASE, CINAHL, APA Psyfor, SCOPUS, Web of Science and Google Scholar from the date the database was created to 14 December 2024. Eligible studies include those published in English and focusing on developing and validating an instrument for measuring the construct of health system literacy in adults aged 18 or older. Two researchers will independently review, select and extract eligible studies, while all members of the research team will be involved in assessing methodological quality and the quality of measurement properties. This systematic review will adhere to the Consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines for conducting systematic reviews of psychometric properties. We will provide summary tables of study characteristics and instrument characteristics used to measure health system literacy. Measurement properties and their quality will be assessed using the COSMIN standard criteria and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). We will also evaluate methodological quality of measurement properties using the COSMIN Risk of Bias checklist.
This review does not collect original data, so obtaining ethical approval is not applicable. The findings will be disseminated through peer-reviewed journals, which can assist researchers and providers in choosing the appropriate instrument measuring health system literacy.
CRD420251004362.
There is a wealth of reviews investigating the relations between healthcare worker (HCW) variables and quality of care (QoC) outcomes. Individually, these reviews predominantly focus on one aspect relevant to HCWs’ functioning at work, unintentionally contributing to a scattered body of evidence. This umbrella review uses the concept of sustainable employability (SE)—a multidimensional construct that captures an individual’s long-term ability to function adequately at work and in the labour market—to integrate existing reviews on the topic, and to examine if and how HCWs’ SE is related to QoC.
An umbrella review of systematic reviews was conducted.
Systematically conducted reviews or meta-analyses of empirical primary studies (quantitative, qualitative or mixed methods) were included.
Reviews were eligible for inclusion if they included studies that focused on HCWs providing direct patient care; explored a relation between SE indicators and QoC outcomes; were peer-reviewed and published in an academic journal in either English or Dutch and were appraised as high-quality reviews.
We followed the Joanna Briggs Institute manual for Evidence synthesis when conducting this review. Nine verified indicators of SE, pertaining to health, well-being and competence domains of SE, were used to identify published reviews in Embase, Medline, PsycINFO and CINAHL up until 10 May 2024. Quality of reviews was critically appraised with the Joanna Briggs Institute Critical Appraisal Instrument. Data were extracted by one reviewer in a standardised form with a second reviewer verifying outcome data that directly informed our evidence statements.
55 high-quality reviews were included, and 6 SE indicators linked to 19 QoC outcome categories were identified, distinguishing a total of 50 unique relations—whether positive, negative, partial, absent or mixed. Although extensive, evidence is disproportionally represented, with reviews on ‘burn-out’ and ‘lack of knowledge/skills’ being over-represented and well-established. Only four reviews covered multiple SE domains simultaneously.
When theoretically integrated, there is an impressive array of evidence showing the crucial role of HCWs’ SE for QoC. Researchers are advised to adopt more multidimensional perspectives and concepts to empirically validate the interrelatedness of individual HCW variables for QoC. Practitioners may use this overview to consider interventions that target multiple indicators of HCWs’ SE.
The rising burden of non-communicable diseases (NCDs), including mental health disorders (MHDs) such as anxiety and depression, poses a significant public health challenge globally. Evidence suggests that both diabetes and hypertension, the two most prevalent NCDs, are linked to a higher prevalence of MHDs. However, there is a lack of evidence on prevalence of generalised anxiety disorder (GAD) and depression among adults living with both diabetes and hypertension in Bangladesh. We aimed to assess the prevalence of GAD and depression and explore the associated factors among adults living with diabetes and hypertension comorbidity in rural Bangladesh.
We implemented a cross-sectional study.
The study was conducted in Chirirbandar, a sub-district of Dinajpur, Bangladesh.
We interviewed a total of 387 adults living with diabetes and hypertension comorbidity.
We had two primary outcome measures: GAD and depression. Individuals scoring ≥10 on the General Anxiety Disorder-7 scale were considered as having GAD and individuals scoring ≥10 on the Patient Health Questionnaire-9 scale were considered as having depression. The outcome variables were dichotomised based on these scores.
The prevalence of GAD was 7.24% (95% CI 5.04 to 10.29). Education level (grades 5–9) (adjusted OR (AOR): 3.40, 95% CI 1.26 to 9.19) and household wealth status (highest wealth tertile) (AOR: 0.12, 95% CI 0.02 to 0.62) were associated with GAD. The prevalence of depression was 17.83% (95% CI 14.32 to 21.98). Socioeconomic factors associated with depression included unemployment (AOR: 3.26, 95% CI 1.05 to 10.10) and household wealth status (highest wealth tertile) (AOR: 0.45, 95% CI 0.21 to 0.98). Higher odds of depression were also observed among participants with controlled hypertension (AOR: 3.88, 95% CI 1.81 to 8.35). Other factors, such as tobacco use, dietary diversity and physical activity, were not associated with GAD or depression.
A high prevalence of GAD and depression was observed among adults living with diabetes and hypertension comorbidity. The findings from the study emphasise the need for integration of mental health services into the existing non-communicable disease care. The identified factors associated with GAD or depression should be considered to develop targeted interventions for people with hypertension and diabetes comorbidity in Bangladesh.
Blue light (peak wavelength 442 nm) has been shown to modulate the immune response in preclinical models of intra-abdominal sepsis and pneumonia. In vivo pathways involve optic nerve stimulation with transmission to the central nervous system, activation of parasympathetic pathways terminating at the spleen, and downstream immune effects including decreased inflammatory tissue damage and improved pathogen clearance. Related effects on pain mediators including proinflammatory cytokines (interleukin 6, TNF- α) and autonomic tone (increased parasympathetic outflow) suggest possible analgesic properties that would be highly relevant to a trauma population.
This is a randomised controlled trial in which adult trauma inpatients (
Full ethical approval for this trial has been granted by the University of Pittsburgh Institutional Review Board. On study completion, results will be published in the peer-reviewed literature and at ClinicalTrials.gov.
Coronary artery bypass grafting (CABG) remains one of the most commonly performed cardiac surgeries worldwide. Despite surgical advancements, a significant proportion of patients experience psychological distress following surgery, with depression being particularly common. Current evidence regarding the effectiveness of preoperative psychological interventions in improving postoperative mental health outcomes remains inconclusive. There is a critical need for predictive models that can identify patients at risk of developing clinically significant depressive symptoms (CSDSs) and related psychological conditions after CABG. This multicentre observational study aims to develop and validate prognostic models for predicting CSDSs and other psychological outcomes, including anxiety, post-traumatic stress symptoms and quality of life, 6 weeks after elective CABG surgery.
The study will recruit 300 adult patients undergoing elective CABG (with or without valve intervention) across two Swiss hospitals. Data collected will include demographic, clinical, psychometric, inflammation-related and interoceptive variables. A training set (n=200) will be used to develop predictive models using machine learning, while a held-out test set (n=100) will be used for model validation. The primary outcome prediction will focus on CSDSs, assessed using the Patient Health Questionnaire-9 (PHQ-9), with analyses conducted both categorically (PHQ-9 total score ≥10) and continuously as complementary approaches. Secondary models will address anxiety, using the General Anxiety Disorder Scale-7, post-traumatic stress, using the post-traumatic stress disorder checklist for Diagnostic and Statistical Manual of Mental Disorders-5 and health-related quality of life, using the 12-item Short Form Survey. A simplified ‘light solution’ model with fewer predictors will also be developed for broader applicability. This study will address an important gap in perioperative mental healthcare by identifying key predictors of psychological morbidity following CABG, particularly CSDSs. The resulting models may inform future screening and preventive strategies and improve postsurgical outcomes through early identification and intervention in high-risk individuals.
The responsible ethics committee has reviewed and approved this project (Kantonale Ethikkommission Zürich, BASEC number: 2023-02040). The study minimises participant burden by integrating brief validated instruments and limiting psychiatric interviews to relevant outcomes, while ensuring ethical safeguards and respect for participant rights (including written consent). Results will be shared through peer-reviewed publications, conference presentations and stakeholder meetings involving clinicians and mental health professionals. Findings will also be communicated to participating centres and patient communities in accessible formats.
Exposure to prescription opioids following traumatic injury can increase the risk of developing tolerance, persistent opioid use and opioid use disorder. The mechanisms underlying opioid tolerance or dependence are not well understood, and no biomarkers predict risk. Opioid exposure causes epigenetic modifications, including alterations in microRNA (miRNA) expression. Several miRNAs, which regulate synaptic plasticity, are hypothesised to underlie substance use disorders and influence µ-opioid receptor levels, modulating opioid tolerance. This project aims to develop a bio-behavioural signature to predict persistent opioid use and chronic pain up to 6 months post-discharge.
The study will use a prospective cohort design, enrolling 180 adult patients at a Level I Trauma Center who are prescribed opioids at discharge. Prospective data will be collected in the hospital and at 7 days and 1, 3 and 6 months post-discharge. Biological data (genotyping and miRNA levels) and clinical measures of opioid use, pain, pain sensitivity (EEG) and psychosocial functioning will be collected at each time point. Bayesian regression methods will be used to identify baseline clinical, genetic, epigenetic and psychosocial predictors of opioid use and pain outcomes at 6 months post-discharge. Growth mixture modelling will identify distinct subgroups with varying trajectories, followed by Bayesian hierarchical modelling to predict trajectory classification based on predictor variables.
Ethics approval for this study was obtained from the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects (HSC-MS-24–0314). Findings will be disseminated in peer-reviewed scientific journals and at national and international conferences.
To explore the lived experiences of intensive care nurses caring for patients with limited English proficiency.
A hermeneutic, interpretive phenomenological design was used.
Semi-structured interviews were conducted with intensive care nurses recruited through purposive sampling. Data collection included Qualtrics screening surveys and semi-structured Zoom interviews. The research team, comprising linguistically diverse faculty and undergraduate research assistants, employed reflexivity techniques to minimise bias and enhance interpretive rigour. Data were analysed via inductive analysis using the hermeneutic circle.
Five main themes emerged organically from the data: Complications of Care Relating to Verbal Communication Challenges. Benefits and Barriers of Nursing Informatics in Linguistic Care. The Universal Language: Nursing Effort Builds Trust. The Ripple Effect: Chronological Considerations for Patient Care. Moving Forward: Where Do We Go From Here?
Based on these findings, a four-phase model was developed to guide individual and system-level interventions to reduce nurse moral distress and improve language equity in critical care.
Language barriers in the intensive care unit hinder communication, increase stress for patients and nurses, and impact care quality. While nurses' efforts to bridge these gaps are valued, systemic changes (such as expanded interpreter availability and improved cultural safety training) are necessary to support culturally, linguistically, and medically appropriate care.
Findings highlight the need for increased institutional support, additional resources for night-shift staff, and the integration of cultural humility education into intensive care training. The Limited English Proficiency Moral Distress Action Cycle for Critical Care Nursing, developed from this study, offers a flexible framework to guide the implementation of these improvements and reduce nurse moral distress. Future research should explore interventions to promote cultural and linguistic competence in multilingual patient populations.
Q: What problem did the study address?
A: The nurse-identified clinical, ethical, and workflow risks created when interpreters or translation tools are inadequate for critical care.
Q: What were the main findings?
A: Language barriers jeopardise teaching, informed consent, and symptom reporting. Video and phone interpreters or translation apps are vital but are often scarce, unreliable, or impersonal, particularly during night shifts. Nurses bridge these gaps by building trust through empathy, non-verbal communication, and learning key phrases. Yet, effective care for patients with limited English proficiency requires extra time, increasing workloads and fuelling moral distress related to language-discordant care. Nurses consistently called for 24/7 interpreter coverage; more reliable devices and cultural humility training must be implemented system-wide.
Q: Where and on whom will the research have an impact?
A: Findings can guide nurses, managers, leaders, and administrators to improve both language concordant and discordant nursing care and train nurses in cultural and linguistic competencies for a multilingual patient population. Ultimately, these efforts have been shown to improve the quality, outcomes, and cost-effectiveness of patient care. The study also identifies moral-distress triggers and introduces the Limited English Proficiency Moral Distress Action Cycle (LEP-MDAC). This model is proposed for use in other high-acuity settings worldwide that seek to provide language-concordant or language-discordant care effectively.
SRQR.
None.
To explore nursing students' experience of how the COVID-19 pandemic influenced the learning environment in clinical setting and how they responded to the change.
Qualitative descriptive interview study.
Eleven third-year baccalaureate nursing students from a University College in Northern Denmark participated in individual semi-structured interviews conducted in the spring 2021. Data analysis was guided by Braun and Clarke's thematic analysis.
Two themes were generated: ‘A compromised learning environment’ and ‘Adjusting to circumstances and making things work’.
Students perceived that their learning became secondary and was influenced negatively. Some students' focus shifted from an attention to learning opportunities to managing daily patient care and became hesitant to pose questions that were relevant to their learning. Students faced a dilemma between helping with daily tasks and prioritising their learning needs. Some students adjusted to the circumstances by taking the lead. Others reacted more passively and prioritised helping nurses in managing the daily workload.
The study highlights that changes in the work environment impact students. Institutions must ensure that students feel a sense of belonging and prioritise time with clinical supervisors for questions and reflection, avoiding situations where practical tasks take priority over learning. Since students manage changes differently, they require tailored support.
The study addressed changes in the clinical learning environment caused by the COVID-19 pandemic. The changes within the environment influenced the students learning negatively. The findings are of relevance to lecturers, supervisors, and academic decision-makers within nursing education and may guide the planning of clinical placements to better accommodate individual learning needs.
The study adheres to the COREQ guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS 