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Phytochemical characterization, anticancer potential, and nanoemulsion-based delivery of <i>Chiliadenus montanus</i>

by Nour Aboalhaija, Hala Abulawi, Rania Hamed, Mohammad Alwahsh, Fatma Afifi, Heba Syaj, Elham Abusharieh, Ismail Abaza

Chiliadenus montanus (Vahl) Boiss. (Asteraceae) is a pharmacologically significant plant with different potent pharmacological properties. This study aimed to evaluate the phytochemical and anticancer activity of C. montanus, and to develop nanoemulsions (NEs) to enhance pulmonary delivery for lung carcinoma treatment. For that ethanol and water extracts, along with petroleum ether, chloroform, ethyl acetate, and methanol fractions, were assessed for total phenol and flavonoid contents, antioxidant activity, and cytotoxicity against H1299 and A549 lung cancer cell lines. The results showed that ethyl acetate fraction exhibited the highest phenol (47.94 ± 0.32 mg GAE/g of DW) and flavonoid (20.34 ± 1.48 mg rutin/g of DW) contents, while the ethanol extract showed the most potent antioxidant activity (IC₅₀ = 322.1 µg/mL) and selective cytotoxicity (IC₅₀ = 641.2 µg/mL) against H1299 cells. Nevadensin, chlorogenic acid, and sorbifolin were identified as the major constituents of the ethanol extract using liquid chromatography-mass spectrometry (LC-MS) analysis. Gas chromatography-mass spectrometry (GC-MS) analysis revealed α-phellandrene, 1,8-cineole, and α-cadinol as the lead volatile constituents. The major volatile compound of the aroma profile of the aerial parts, determined by solid phase micro extraction (SPME) was 1,8-cineole. Spontaneous emulsification was used to formulate ethanolic NE (S1-S4 NEs) with varying concentrations of ethanol extract, surfactant, cosurfactant, and oil phase. The optimal S4 NE demonstrated thermodynamic stability, appropriate pulmonary pH, and droplet sizes below 100 nm. These findings highlight the promising potential of C. montanus NE as a stable pulmonary drug delivery system for lung carcinoma therapy.

Management and outcomes of fractures over cranial venous sinuses: a scoping review protocol

Por: Takoutsing · B. · Wunde Njineck · U. · Wah · P. S. · Sebopelo · L. · Ngouanfo Tchoffo · J. · Bah · E. S. · Esene · I. N.
Introduction

Fractures over venous sinuses (FOVSs) are associated with difficulties in diagnosis and treatment resulting in a high level of morbidity and mortality. Despite its importance, there are limited aggregate data to guide the management of these fractures ultimately inflicting a major callenge to neurosurgeons. This protocol describes the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of FOVSs.

Methods and analysis

The proposed study will be conducted in accordance with the Arksey and O’Malley’s framework for scoping reviews. The research question, eligibility criteria and search strategy were developed based on the population, intervention, comparator and outcome strategy. The following electronic bibliographic databases will be searched without restrictions on language and date of publication: PubMed, WHO Global Index Medicus, African Journals Online, SCOPUS, Embase, Cochrane and ProQuest Central. All peer-reviewed studies of primary data reporting on the management and outcomes of FOVSs will be included. The data extracted from included articles will be presented through descriptive statistics, pooled statistics and a narrative description.

Ethics and dissemination

Because this study did not directly involve human individuals, ethical approval was not necessary. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at local, regional, national and international conferences and promotion over social media.

Personality traits, panel tenure, survey topic, and context as predictors of survey nonresponse patterns in high-frequency online longitudinal surveys

by Htay-Wah Saw, Arie Kapteyn

An extensive literature studies the relation between demographic and socio-economic characteristics and attrition in longitudinal studies. In this study, we analyze the independent effects of non-demographic variables—respondent personality traits, panel tenure, and survey topics, using unique datasets from two recently completed high-frequency online longitudinal studies conducted in the U.S. We used latent class analysis to group respondents into various classes based on similarities in their nonresponse patterns across all survey waves, which revealed substantial variations in patterns of nonresponse. Our results indicate that respondent personality traits were strong predictors of nonresponse patterns. Specifically, conscientiousness is positively associated with a lower likelihood of wave nonresponses. In contrast, more open, extroverted, neurotic, and agreeable respondents are more likely to exhibit higher wave nonresponses, but with effect sizes smaller than that of conscientiousness. We found no significant demographic effects on wave nonresponse in one of the studies focused on aging and well-being. However, in the study primarily focused on COVID-19-related topics conducted during the pandemic, we found a few significant demographic effects. Collectively, our findings suggest that personality traits may play a more significant role than conventional demographic and household variables in predicting nonresponse patterns in high frequency (at least one survey per month) online surveys.

Occupational health outcomes of work in the gig economy: a systematic review protocol

Por: Agyemang · C. B. · Darkwah · E. · Acquah-Coleman · R. · Hansen-Garshong · R. · Nkansah · E. A. · Hagan · S. · Parimah · F.
Introduction

The gig economy is a promising arena to reduce unemployment and provide other benefits such as the opportunity to earn supplemental income. Like all other forms of work, the gig space also presents occupational health issues for those working in it. This proposed review is aimed at identifying and describing the common occupational health outcomes reported within this workforce; second, to examine the risk factors that contribute to the development of these health issues; and third, to assess the interventions and support systems currently in place to promote the occupational health of gig workers.

Methods

A systematic review will be undertaken according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (2009). A search from 2015 to 2025 will be conducted on four global databases (Web of Science, SCOPUS, Academic Source Complete and Business Source Complete). Only records in English, full text and peer-reviewed journal articles will be included. Book chapters, thesis, reports and systematic reviews will be excluded. The Joanna Briggs Institute Critical Appraisal Tools will be used to assess the methodological rigour of various studies prior to inclusion for the final analysis. The extracted data will be synthesised using a narrative synthesis approach, integrating findings from both quantitative and qualitative studies.

Ethics and dissemination

This research is exempt from ethics approval because the work will be carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.

PROSPERO registration number

CRD420250654059.

Siblings of Children With Cancer and Their Challenges Across Everyday Life Contexts: A Two‐Phase Qualitative Study in Denmark

ABSTRACT

Aim

To explore the familial, emotional, social and school-related challenges experienced by school-aged siblings of children with cancer, focusing on how these challenges intersect across hospital, home and school in their everyday lives.

Design

Qualitative, two-phase, multi-site study.

Methods

Fieldwork was conducted at two distinct paediatric oncology wards, followed by semi-structured interviews with 11 siblings (aged 7–19 years) and 20 parents, recruited through criterion-based sampling. The data were analysed using reflexive thematic analysis.

Results

Analysis showed that siblings were often marginalised in hospital life due to (1) family logistics; (2) hospital-induced restrictions, rules and physical spaces and (3) perceptions of their presence as ‘problematic’, ultimately limiting their access. In family life, siblings experienced peripheral roles because (1) they were cared for by others, (2) had their needs subordinated and (3) faced shifting expectations. At school, siblings encountered (1) limited understanding from classmates and teachers and (2) insufficient support resources.

Conclusions

Siblings of children with cancer face significant, interconnected challenges, often amplified by the structural frameworks of healthcare, family and school contexts.

Impact

Siblings of children with cancer are often marginalised in their own lives. In healthcare, a family-centred approach to care should formally and actively include siblings. Nurses are well-positioned to promote this, ensuring whole-family support. Siblings would benefit from coordinated support bridging hospital, home and school.

Reporting Method

This study adheres to the SRQR Checklist.

Patient or Public Contribution

Parents helped shape the study focus by discussing preliminary observations and potential support needs.

A Nurse‐Led, School‐Based Social and Educational Intervention for Siblings of Children With Cancer (SUPREME): Process Evaluation of Perceived Impacts

ABSTRACT

Purpose

To explore siblings' and parents' experiences of, and perceived impacts of, a nurse-led school-based intervention (SUPREME) for siblings of children with cancer in Denmark.

Design

A qualitative process evaluation.

Methods

Fifteen siblings (aged 6–14 years) and 16 parents were recruited through criterion-based sampling following siblings' participation in the SUPREME intervention. Data consisted of semi-structured interviews and open-ended responses from an evaluation form, and were analysed thematically. Data were collected between May 2024 and February 2025.

Results

The intervention created a sense of normality for siblings by providing age-appropriate and credible information in the familiar school context, thereby strengthening the understanding of the family's cancer journey. The SUPREME nurse played a key role in easing the communication burden on siblings and parents, while also promoting recognition of siblings within the hospital setting as active participants in the family's cancer journey. Additionally, the intervention was perceived to accommodate varying levels of support needs across families.

Conclusion

The SUPREME intervention benefited siblings—and, by extension, their families—by equipping siblings with essential information, guiding their class communities on how to offer appropriate support and fostering siblings' inclusion in the family's cancer journey. The SUPREME intervention constitutes a new strategy for accessible, universal sibling support.

Implications for Profession and/or Patient Care

The healthcare system should formally ensure that professionals working with families affected by severe paediatric conditions provide family-centred care that actively includes siblings.

Impact

What problem did the study address? The position of siblings of children with cancer is often complex, as they may simultaneously serve as visible front figures of the family while remaining overlooked. This study explored how parents and siblings of children with cancer experienced participating in a new sibling support intervention.

What were the main findings? Nurses play a central role in supporting siblings of children with cancer by bridging family, hospital and school contexts.

Where and on whom will the research have an impact? Nurse-led, cross-sectoral interventions such as SUPREME may help normalise siblings' everyday lives and promote their inclusion in the family's cancer journey.

Reporting Method

This study followed the Standards for Reporting Qualitative Research checklist.

Patient and Public Involvement

No patients, participants, or members of the public were involved in the design of this specific study.

Postnatal care utilisation and health beliefs among mothers in the Jazan region of Saudi Arabia: a cross-sectional study

Por: Altraifi · A. A. · Albasheer · O. · Abdelwahab · S. I. · Chourasia · U. · Abdelmageed · M. M. · Hakami · A. M. · Khormi · A. H. · Medani · I. E. · Ali · S. A. · Habeeb · S. A. · Shebaly · G. A. · Somaily · M. M. · Harshan · S. M. · Ali · S. M. · Hukma · S. H.
Background

The postnatal period is critical for preventing maternal and neonatal morbidity and mortality. Globally, a significant proportion of maternal and neonatal deaths occur within the first 6 weeks after delivery. Timely and adequate postnatal care (PNC) can detect and manage life-threatening complications; however, service utilisation remains alarmingly low in many low- and middle-income countries, including Saudi Arabia. Addressing the behavioural and perceptual factors that influence service use is essential for improving health outcomes.

Objectives

This study aimed to assess mothers’ utilisation of PNC services and examine how their health beliefs and sociodemographic characteristics influence this behaviour.

Design

A cross-sectional study guided by the Health Belief Model (HBM) was conducted to explore predictors of PNC utilisation.

Setting

Eight primary healthcare (PHC) centres were randomly selected from 179 PHC centres distributed in the different governorates of the Jazan region of Saudi Arabia.

Participants

A total of 464 mothers were surveyed between October and December 2023 using an interviewer-administered questionnaire.

Primary and secondary outcome measures

The primary outcome was PNC utilisation, defined by the number of postnatal visits. The independent variables included sociodemographic characteristics and HBM constructs (perceived susceptibility, benefits, barriers and cues to action).

Results

In terms of PNC utilisation, 80.0% of participants had two or fewer postnatal visits, whereas 20.0% had three or more postnatal visits. Perceived barriers had the strongest influence (mean score 2.51±0.87), followed by cues to action (2.43±0.89), susceptibility (1.92±0.72) and benefits (1.86±0.64). In the multivariate analysis, perceived barriers, cues to action and perceived susceptibility were significantly associated with PNC utilisation, with adjusted ORs of 1.679 (95% CI: 1.007 to 2.799), 0.470 (95% CI: 0.256 to 0.863) and 0.405 (95% CI: 0.197 to 0.832), respectively.

Conclusions

PNC utilisation in the Jazan region remains suboptimal. Perceptual factors, particularly barriers and cues to action, play a central role in service use. Health interventions targeting these beliefs and improving follow-up mechanisms may help increase PNC engagement and improve maternal and infant health outcomes in Saudi Arabia.

Common mental health outcomes and access to support services among adolescents living with HIV in sub-Saharan Africa: a protocol for a systematic review

Por: Klutsey · D. A. · Amankwah-Poku · M. · Quarshie · E. N.-B. · Oppong Asante · K.
Introduction

The prevalence of HIV in adolescents is a major global health concern, and research into the influence of HIV on mental health outcomes in this demographic is ongoing. We will conduct a comprehensive systematic review of common mental health outcomes in adolescents with HIV infection (aged 10–24 years). Recognising the specific psychosocial issues that adolescents living with HIV infection are confronted with, this review aims to integrate existing research on the prevalence, risk factors and protective factors related to both positive and negative mental health outcomes in this population.

Methods and analysis

The following electronic databases will be searched for publications from 1959 up to December 2025: PubMed, PsycINFO, Global Health, Embase, African Journals OnLine and African Index Medicus. The review will focus on both positive and negative mental health outcomes: positive outcomes include resilience, subjective happiness and post-traumatic growth, whereas the negative outcomes include depression, anxiety, post-traumatic stress disorder, substance use disorder and suicidality. Peer-reviewed primary observational studies that report prevalence rates for common mental health outcomes outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, and the International Classification of Diseases, 11th Edition, their associated factors, as well as barriers to and facilitators of use of mental health support services among this population, will be included in the review. Google Scholar and ProQuest Dissertations & Theses Global as well as Electronic Theses and Dissertations from Ghana, South Africa, Uganda and Kenya, will also be searched for grey literature. The review will be limited to publications in English or French. To assess the methodological rigour of the selected studies, the Joanna Briggs Critical Appraisal Tools will be used. The synthesis will include a narrative summary and, if applicable, a meta-analysis of quantitative data depending on the extent of heterogeneity observed in the included studies. Subgroup analyses will be conducted to investigate differences in mental health outcomes by age, sex and socioeconomic position, where applicable. This systematic review will be reported in accordance with the PRISMA statement.

Ethics and dissemination

This review will use secondary data and does not require ethical approval. The findings will be shared through peer-reviewed publications and conference presentations. The emphasis will be on translating research findings into practical mental health interventions and HIV-specific support services for adolescents.

PROSPERO registration number

CRD42024568512.

Role of Adjunctive corticoSTEROIDs on clinical outcomes in severe Scrub typhus pneumonitis: ASTEROIDS study protocol - a randomised controlled trial

Por: Peter · J. V. · Venkatesh · B. · Premkumar · P. S. · Chacko · B. · Gunasekaran · K. · Krishna · B. · Chaudhry · D. · Saravu · K. · Wyawahare · M. · Ray · S. · Chandiraseharan · V. K. · Carey · R. · Rathinam · J. · Varghese · G. M.
Introduction

Recent studies have demonstrated a beneficial role of steroids in severe community-acquired pneumonia, severe COVID-19 infection and acute respiratory distress syndrome (ARDS) of diverse aetiology. This multicentre randomised controlled trial in severe scrub typhus pneumonitis and ARDS will compare the effects of 6 mg of dexamethasone once per day with placebo, in addition to standard treatment, on ventilator-free days (VFD), mortality and ventilatory requirement.

Methods and analysis

The study, involving six sites, will recruit 440 patients with severe scrub typhus pneumonitis or ARDS to concealed, block-randomised, site-specific assignment of dexamethasone or placebo for 4–7 days. The primary outcome will be VFD, defined as days alive and free of ventilation at 28 days. Secondary outcomes will include 28-day mortality, need and duration of ventilation, and treatment failure, defined as death, or escalation of respiratory support from simple devices (nasal cannula, mask) to non-invasive or invasive ventilation, or the use of open-labelled steroids for worsening shock. The study will also ascertain if antinuclear antibody (ANA) expression during the acute phase of illness will predict steroid responsiveness. Subgroup analyses will be conducted a priori on ANA expression and the need for ventilation. All analyses will be conducted on an intention-to-treat basis. The trial, which commenced in April 2025, would clarify the role of corticosteroids in scrub typhus pneumonitis.

Ethics and dissemination

The Institutional Review Board and Ethics Committee of the lead site, Christian Medical College, Vellore, India, has approved the study (IRB Min No 15920 (INTERVE) dated 22 November 2023). The remaining five sites have obtained approval from their respective ethics committees. Study results will be published in an international peer-reviewed journal.

Trial registration number

CTRI/2024/12/077709. Registered 5 December 2024.

Lay health worker-delivered and technology-based interventions for sexual and reproductive health among adolescents and young adults in low- and middle-income countries: protocol for a scoping review

Por: Kern · M. · Neumann · C. · Bosompim · B. · Ann · D. · Kurniawan · A. L. · Dlamini · N. · Nabukeera · S. · Machanyangwa · S. · Tewahido · D. · Shinde · S. · DASH Collaborators · Bukenya · J. · Laxy · Burns · Fawzi · Sando · Moshabela · Oduola · Guwatudde · Sie · Berhane · Manu · Bärnig
Background

Adolescents and young adults (AYAs) in low- and middle-income countries (LMICs) are at high risk of harmful sexual and reproductive health (SRH) practices due to limited knowledge, low availability or acceptability of modern contraceptives, gender inequality and cultural practices like child marriage. Preventive and educational interventions by lay health workers or through technological means are a cost-effective and scalable solution. Unfortunately, too little is currently known about the scope, content and conditions of the effectiveness and sustainability of these approaches and synthetic evidence on this topic is scarce. To help fill this knowledge gap and to identify where further research is needed, we will conduct a scoping review of technology-based or lay health-worker delivered preventive and educational SRH interventions targeting AYAs in LMICs. This information is valuable to both policymakers and researchers as it provides a synthesis of existing interventions, highlights best practices for their implementation and identifies potential avenues for future research.

Methods

This review will include studies on SRH preventive and educational interventions targeting AYAs aged 10–24 years in LMICs. It encompasses interventions delivered by lay health workers or via technological means, assessing various outcomes including but not limited to SRH literacy, sexual risk behaviours, pregnancies, sexually transmitted infections and gender-based violence. Key databases, including PubMed via MEDLINE and Embase, will be searched from 1 January 2000 up to 23 January 2024, using a comprehensive search strategy. Screening will be conducted using Covidence software. Data extraction will cover study details, methods, intervention strategies, outcomes and findings. A narrative synthesis will be conducted following synthesis without meta-analysis guidelines.

Ethics and dissemination

The scope of this scoping review is limited to publicly accessible databases that do not require prior ethical approval for access. The findings will be disseminated through peer-reviewed journal publications, as well as presentations at national and international conferences and stakeholder meetings in LMICs.

Scoping review registration

The final protocol is prospectively registered with the Open Science Framework on 7 May 2024 (osf.io/vna2z).

Protocol for the OPTIMSE-1 randomised clinical trial to test specialist-led identification and management of cardio-renal-metabolic-pulmonary disease in machine learning algorithm-detected high-risk community-dwelling individuals

Por: Nadarajah · R. · Wahab · A. · Joseph · T. · Reynolds · C. · Bennett · S. · Haris · M. · Smith · A. B. · Hayward · C. · Wu · J. · Gale · C. P.
Introduction

People identified as higher risk by a machine learning algorithm (Future Innovations in Novel Detection of Atrial Fibrillation [FIND-AF]) are at increased risk of cardio-renal-metabolic-pulmonary disease and cardiovascular death. The OPTIMISE-1 randomised controlled trial aims to test the effect of community-based specialist-led identification and management of cardio-renal-metabolic-pulmonary (CRMP) disease and risk factors compared with usual care on the use of therapeutic interventions over a follow-up of 6 months among high FIND-AF risk community-dwelling individuals.

Methods and analysis

OPTIMISE-1 is a multicentre, pragmatic, prospective, randomised, open-label, blinded-endpoint strategy trial that will recruit 138 participants aged 30 years or older, with a high FIND-AF risk score and previously enrolled in the FIND-AF pilot study (NCT05898165), to be randomised 1:1 to a specialist-led care intervention or usual care. The primary endpoint is a composite of initiation or increase of guideline-directed CRMP therapies. The secondary endpoints are the components of the primary endpoint, time to primary endpoint, diagnosis of new CRMP diseases or risk factors, time to diagnosis of new CRMP diseases or risk factors, initiation or increase of guideline-directed CRMP therapies for participants with recorded CRMP disease, initiation or increase of guideline-directed CRMP therapies for participants with newly diagnosed CRMP disease and change in participant-reported quality of life.

Ethics and dissemination

The study has ethical approval (the North East & North Tyneside 2 Research Ethics Committee reference 24/NE/0188). Findings will be announced at relevant conferences and published in peer-reviewed journals in line with the Funder’s open access policy.

Trial registration number

Clinicaltrials.gov NCT06444711.

School health professionals understanding of culture: a scoping review

Por: Wahlström · E. · Landerdahl Stridsberg · S. · Larsson · C. · Stier · J.
Introduction

Culture underpins social interaction between school health professionals and children. Both practice and research suggest that cultural variations, migration and intercultural interactions pose potential challenges in encounters between school health professionals and children and may relate to the health professionals’ understanding of their own culture as a factor in such encounters. Still, for the school health services (SHS), reviews collating existing research on school health professionals’ understanding of culture are lacking.

Objectives

This review aims to identify, describe and analyse existing research on school health professionals’ (ie, school nurses, school social workers, school doctors and school psychologists) understanding of culture.

Design

A scoping review of peer-reviewed and published scientific articles on school health professionals’ understanding of culture.

Inclusion criteria

Articles published between 2013 and 2024 on culture, SHS and school nurses, school doctors, school social workers or school psychologists.

Methods and analysis

Searches were conducted in October 2023 and September 2024 in 10 databases. Two reviewers independently screened the article titles, abstracts and full texts for inclusion. Extracted data were analysed using descriptive statistics and qualitative content analysis. The qualitative content analysis focused on content related to theoretical considerations, key findings and conceptualisations of culture.

Results

From 1784 screened articles, 100 articles were screened in full text and 21 articles fulfilled the eligibility criteria. After identifying two additional articles through manual searches, a total of 23 articles were included in the review. The findings show that the articles primarily applied a quantitative study design, focused on school psychologists and school nurses and were conducted in the USA and Nordic-Baltic area. Self-understanding was mainly studied using validated instruments, leaving the conceptualisation of culture to the researchers. Still, only about half of all the articles described the theoretical conceptualisation of culture. Studies of intercultural interaction focused on the challenges of encountering ‘diverse’ children and raised concerns about barriers and hindrances to the encounters.

Conclusions

This review shows that SHS professionals’ understanding of culture has mainly been studied within two SHS professions, within a narrow geographical sphere and without a theoretical stance on culture. Thus, more qualitative research, a clearer theoretical conceptualisation of culture and more research on SHS professionals’ practice and self-understanding are needed.

Effectiveness of a Nurse‐Led HeartMath Training Program on Resilience, Emotional Adjustment, and Treatment Motivation Among Patients With Substance Use Disorder: A Randomized Control Trial

ABSTRACT

Background

Although multimodal rehabilitation programs are effective for substance use disorders and widely used, addiction is still a global socioeconomic problem. Providing practical strategies, such as the HeartMath intervention for managing stress at the moment, helps mitigate the physical, emotional, and psychological impacts associated with substance use disorder, promotes resilience, and enhances treatment motivation.

Aim

To investigate the effects of the nurse-led HeartMath Training Program on resilience, emotional adjustment, and treatment motivation among patients with substance use disorder.

Method

A randomized controlled trial (RCT) was used to carry out this study. This study was conducted at the inpatient unit for patients with addiction at Elmaa'mora Hospital for Psychiatric Medicine in Alexandria, Egypt. The subjects were 130 patients with substance use disorders (65 in each group). Researchers used three tools to collect the necessary data: Tool I Resilience Scale, Tool II Brief Adjustment Scale–6, and Tool III Treatment Motivation Questionnaire.

Result

The difference in resilience, emotional adjustment, and treatment motivation between the study and control groups after the Nurse-Led HeartMath training intervention was statistically significant.

Linkage Evidence to Action

The HeartMath Training Program is efficacious in improving resilience and emotional adjustment among patients with substance use disorder and increasing their treatment motivation.

Trial Registration

ClinicalTrials.gov identifier: NCT06437366

Randomised trial of home sleep apnoea testing compared to in-lab polysomnography for the evaluation of obstructive sleep apnoea in children: rationale and study protocol

Por: Roman Rosado · Y. D. · Somayaji · M. · Stefanovski · D. · Uwah · E. A. · Ward · M. · Tapia · I. E. · Galion · A. · DelRosso · L. M. · Davidson Ward · S. L. · Cielo · C. M.
Introduction

Obstructive sleep apnoea (OSA) affects 1–5% of the paediatric population, including 55–90% of children with Down syndrome (DS), and has been associated with negative effects on neurocognitive development, cardiovascular health, immune development and quality of life. In-lab attended polysomnography (PSG) is currently the gold standard for the diagnosis of OSA in children, but it poses challenges due to the burden on families and limited testing facilities. Home sleep apnoea testing (HSAT), an unattended sleep test done at home, is an accepted alternative for adults but lacks sufficient evidence to be used clinically for the evaluation of OSA in children. HSAT may be especially beneficial for children with DS or others with sensory issues or those who struggle with sleeping in a laboratory setting overnight.

Methods and analysis

This single-centre trial compares HSAT to PSG for the diagnosis of OSA in children, including those with DS. The trial will enrol 317 children 5–12 years old, including approximately 100 with DS. The primary outcome is the diagnostic accuracy of HSAT compared with PSG for OSA evaluated through ROC. Secondary outcomes include the agreement between HSAT and PSG for therapeutic decision-making and comparison of preference and acceptability of HSAT versus PSG. This trial seeks to evaluate HSAT as an alternative diagnostic tool for paediatric OSA, potentially expanding testing options for clinicians and families.

Ethics and dissemination

This study has been approved by the Institutional Review Board at Children’s Hospital of Philadelphia (#21–0 19 533). Informed consent will be obtained from all participants, and no identifiable data will be reported.

Trial registration number

NCT05382754.

Association between medical comorbidities at diagnosis and paediatric acute lymphoblastic leukaemia and lymphoblastic lymphoma outcomes: protocol for a systematic review

Por: Amankwah · E. K. · Mosha · M. · Dean · J. · Mayer · J.
Introduction

Medical comorbidity at diagnosis is associated with treatment outcome in cancer. The aim of this project is to synthesise the evidence on the association between medical comorbidities and paediatric acute lymphoblastic leukaemia and lymphoblastic lymphoma outcomes.

Methods and analysis

A systematic review of the literature will be conducted by developing a search strategy that will combine medical subject headings and natural language key words related to acute lymphoblastic leukaemia or lymphoma, medical comorbidities and treatment-related outcomes. We will search MEDLINE and EMBASE to identify studies in human subjects and written in English from the inception of each database to 30 September 2022. Two authors will independently screen the titles and abstracts of retrieved studies based on the inclusion and exclusion criteria to identify potentially eligible studies. Full-text articles of eligible studies and final included articles will be retrieved and reviewed in a similar manner by two independent reviewers. Data extraction from included articles will be conducted independently by two authors using a standardised data extraction form. Risk of bias in the included studies will be assessed using existing relevant tools. A narrative and tabular summary of the data, including outcomes, will be provided if the data do not warrant a meta-analysis. If a meta-analysis is feasible, we will pool all the effect estimates. Heterogeneity among study effect sizes will be tested with Cochran’s Q test and quantified by the I2 statistic.

Ethics and dissemination

This study will not include the collection of original data, but it will be a summary of aggregate existing data. Thus, ethics approval is not applicable. The findings of the study will be disseminated through peer-reviewed publications.

PROSPERO registration number

CRD42022366669.

Timing of mechanical ventilation and its association with in-hospital outcomes in patients with cardiogenic shock following ST-elevation myocardial infarction: a multicentre observational study

Por: Arabi · A. · Al Suwaidi · J. · Daoulah · A. · AlQahtani · A. A. · Shahid · Z. · Jamjoom · A. · Elmahrouk · A. · AlShehri · M. · Panduranga · P. · Al Rawahi · A. S. M. · Livingston · G. S. · Mousa · A. A.-d. T. · Aloui · H. · Aldossari · M. · Yousif · N. · Noor · H. · Rajan · R. · Al Mahm
Objective

To evaluate the association between the timing of invasive mechanical ventilation (MV) initiation and clinical outcomes in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI).

Design

Retrospective analysis of a multicentre registry.

Setting

Data were obtained from the Gulf-Cardiogenic Shock registry, which includes hospitals across six countries in the Middle East.

Participants

1117 patients diagnosed with STEMI and CS. Of these, 672 (60%) required MV and were included in this analysis.

Primary and secondary outcome measures

The primary outcome was in-hospital mortality. Secondary outcomes included comparisons of baseline characteristics, Society of Coronary Angiogram and Intervention (SCAI) shock stage, and clinical parameters among groups based on time to MV.

Results

Participants were categorised by time from shock diagnosis to MV: early (≤15 min), intermediate (30 min) and late (≥60 min). Median times were 15 min (IQR 10–20), 30 min (IQR 25–35) and 60 min (IQR 45–70), respectively. Baseline characteristics were comparable across groups. Increased delay in MV was associated with a higher mortality risk during the first 60 min post-diagnosis, beyond which the risk plateaued. Delayed MV was an independent predictor of in-hospital mortality (OR 2.14, 95% CI 1.36 to 3.38, p

Conclusions

Early initiation of MV in patients with STEMI complicated by CS was associated with lower in-hospital mortality. These findings highlight the importance of timely respiratory support, warranting further investigation in prospective or randomised controlled studies.

Focused ethnography of nurses interactions and behaviours in the therapeutic positioning of patients with traumatic brain injury in Pakistan: study protocol

Por: Iqbal · N. · Safadi · R. · Bardaie · N. · Waheed · A. · Froelicher · E. S.
Background

Proper positioning in trauma care is essential to prevent associated complications by stabilising haemodynamics, preserving the spine, securing the airway and protecting skin integrity. Motor vehicle crashes are the leading cause of traumatic brain injury (TBI) in Pakistan, necessitating rigorous safety measures and high-quality care due to their severe impact and high mortality rates. Resource-limited settings face significant challenges in providing adequate neurosurgical services. Moreover, there is a notable gap in the existing literature regarding effective care of patients with TBI. This study aims to address a gap in neurosurgical nursing research by exploring how nurses’ interactions and behaviors during positioning interventions contribute to the cultural understanding of nursing care strategies and how the specific cultural context of the neurosurgical ward shapes and informs these interactions.

Methods and analysis

The current study will use a focused ethnography design. Patients with TBI, along with nurses and doctors, will be purposively selected from the neurosurgical wards of two tertiary care hospitals in Islamabad, Pakistan, based on set eligibility criteria. Data will be collected through participant observation, semistructured interviews and analysis of documents and artefacts to ensure diversity and trustworthiness. Braun and Clarke’s Reflexive Thematic Analysis approach will be used for data analysis.

Ethics and dissemination

This study has been approved by the institutional review boards (IRBs) of Shifa Tameer-e-Millat University (IRB# 125–24) and the Pakistan Institute of Medical Sciences (No. f.1.1/215/ERB/SZABMU/1298). Potential ethical concerns will be addressed by protecting the rights of participants including avoiding harm, ensuring privacy and confidentiality and obtaining informed consent. In line with ethnography guidelines, this study adopted the process-informed consent to ensure informed and autonomous involvement. The study results will be shared with key stakeholders and published in scientific journals and presented at conferences.

Climate Anxiety and COPD: Unveiling Its Impact on Patients' Quality of Life Through a Multivariate Lens

ABSTRACT

Objective

To examine the impact of climate anxiety on the quality of life (QoL) of patients with COPD. It also explores how climate anxiety interacts with clinical factors, such as disease severity and comorbidities, to influence QoL.

Design

Cross-sectional.

Methods

A total of 270 COPD patients were recruited using a convenience sampling method. Data were collected through structured interviews and clinical assessments, incorporating the Climate Anxiety Scale, the St. George's Respiratory Questionnaire and the BODE Index. Hierarchical multiple regression analysis was performed to determine the predictors of QoL.

Results

The study found a statistically significant association between climate anxiety and both QoL (r = 0.81, p < 0.01) and COPD severity (r = 0.76, p < 0.01). COPD severity (B = 4.68, p < 0.01) and climate anxiety (B = 0.28, p < 0.01) were predictors of QoL. Among the covariates, former smokers, older patients and multiple comorbidities reported significantly worse QoL (B = 4.80, p = 0.03; B = 0.43, p < 0.01; B = 0.85, p = 0.02, respectively). Collectively all predictors explained 86% of the variance in QoL.

Conclusion

Climate anxiety significantly contributes to reduced QoL in COPD patients, beyond disease severity and demographic factors. Addressing psychological distress in COPD management is essential to improving patient outcomes.

Implications for Practice

Nurses should recognise climate anxiety as a key variable influencing COPD management. Incorporating climate anxiety screening into nursing assessments and providing targeted interventions can enhance patient support and improve overall COPD care.

Impact

Climate anxiety is an emerging concern in COPD. While previous research has focused on physical and clinical determinants of COPD-related QoL, climate anxiety remains underexplored. This study provides new evidence that climate anxiety is a predictor of poorer QoL, highlighting the need for holistic nursing interventions that address both physical and psychological health.

Reporting Method

This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Patient or Public Contribution

Patients with COPD were involved in this study.

Randomised controlled trial of a psychosocial digital health application to promote coping for caregivers of patients undergoing haematopoietic stem cell transplantation: a study protocol for the BMT-CARE app

Por: Willis · K. D. · Barata · A. · Freese · M. · Applebaum · A. J. · Nelson · A. · Traeger · L. N. · Horick · N. K. · Rabideau · D. J. · Temel · J. S. · Greer · J. A. · Jacobs · J. M. · El-Jawahri · A.
Introduction

Caregivers of patients undergoing haematopoietic stem cell transplantation (HSCT) experience tremendous psychological distress before, during and after HSCT. However, few interventions are tailored to the protracted needs of these caregivers while considering scalability and accessibility. We previously developed an evidence-based intervention for caregivers of patients undergoing HSCT that improved quality of life (QOL), caregiving burden and mood. We have since adapted this clinician-delivered intervention into a self-administered, digital health application (BMT-CARE app) and are currently evaluating the effect of this intervention on QOL in caregivers of patients receiving HSCT.

Methods and analysis

The study design is a non-blinded randomised controlled trial of a digital health intervention for caregivers of patients undergoing HSCT at the Massachusetts General Hospital Cancer Center. We are enrolling and randomising 125 caregivers to receive the BMT-CARE app or usual care in a 1:1 assignment, stratifying by transplant type (autologous vs allogeneic). Caregivers assigned to the BMT-CARE app complete five self-guided modules designed to improve coping and stress management prior to and up to 60 days post-HSCT. The modules include interactive, gamified features and video vignettes to optimise engagement. Participants complete questionnaires at baseline and days 10, 60 and 100 post-HSCT. The primary outcome is comparison of QOL at day 60 post-HSCT. Secondary outcomes include caregiver burden, anxiety and depression symptoms, as well as post-traumatic stress symptoms. We are also exploring the usability of the BMT-CARE app to inform refinements prior to future testing.

Ethics and dissemination

The study is funded by the Leukemia and Lymphoma Society and approved by the Dana-Farber/Harvard Cancer Center Institutional Review Board (Protocol #22–634 v.1.5). The results of this study will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials. Results will be disseminated at scientific meetings and in peer-reviewed journals.

Trial registration number

NCT05709912; Pre-results.

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