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Referrals to speech and language pathology are infrequent for people with Parkinson’s disease (PD), despite speech and communication being often affected and greatly impacting their quality of life. This study investigated the knowledge, self-competence and challenges faced by speech and language pathologists (SLPs) in Malaysia when managing PD cases.
Participants self-administered an online-survey in a cross-sectional study design. The survey consisted of 14 questions on current practices of SLPs with their patients with PD, self-perceived competence when assessing and managing PD and perceived barriers for catering to patients with PD. Inferential statistics were run on self-perceived competence across domains and their relationship with demographic/current practice factors. Descriptive statistics were used to analyse perceived barriers.
The survey was administered in English through Google Forms.
54 Malaysian SLPs with at least one active case of PD in their caseload were invited via email and WhatsApp Messenger. These contacts were obtained from the Speech-Language Therapists Association of Malaysia (SPEAK), and snowball sampling was encouraged to recruit additional SLPs through other social networks.
To quantify Malaysian SLPs’ self-perceived competence levels (assessed on 5-point Likert scales) in assessing and managing five key domains in patients with PD: speech, language, oro-motor skills, cognition and swallowing; and to identify the frequency and types of barriers encountered in clinical practice with patients with PD through structured multiple-choice questions. Secondary outcomes included quantifying current service delivery patterns (frequency of PD referrals, stage at referral, caseload size), multidisciplinary consultation patterns and confidence levels in managing rehabilitation risks associated with PD, all measured through structured survey items with categorical or ordinal response options.
Most participants had 1–5 patients with PD in their active caseload, referred at a middle or advanced stage of the disease. The majority of participants felt competent in assessing and managing motor speech and language in patients with PD. Conversely, most of them did not feel competent in assessing and managing cognition in these patients, regardless of demographic factors or current practices. This difference was significant. Most participants also reported facing barriers such as health conditions or comorbidities, family expectations on the therapy outcome and the unavailability of a multidisciplinary approach.
The study reveals that SLPs working in Malaysia feel competent in working with motor speech and language in individuals with PD. However, it highlights a need for additional training to address cognitive assessment and management as a crucial tool to boost functional communication in people with PD. The study also reveals a need for promoting a multidisciplinary approach.
Turnover intention among nurses is a well-established predictor of actual turnover. Despite the critical nursing shortages during COVID-19, the relative contributions of individual and organisational factors to increased turnover intention remain insufficiently understood.
This study aimed to identify the determinants of turnover intention among clinical nurses at both individual and organisational levels and to evaluate the independent effects of these factors in infectious situations.
This study conducted a secondary analysis of cross-sectional data collected in Hong Kong between April 2020 and September 2021.
A convenience sample of 188 Chinese registered nurses in Hong Kong was recruited. The survey assessed questions on demographic, organisational and workplace violence-related characteristics, the Post-Traumatic Stress Disorder Checklist-Civilian Version, the Brief Coping Orientation to Problems Experienced Inventory and the Anticipated Turnover Scale. Univariable and structured multi-phase linear regression analyses were performed to identify associated factors and to evaluate the influence of individual- and organisational-level factors. The study followed the STROBE checklist for reporting cross-sectional studies.
The regression model, incorporating individual- and organisational-level factors, explained 22.68% of the variance in turnover intention. Individual-level factors associated with increased turnover intention included younger age, high levels of post-traumatic stress symptoms and low use of accommodation coping strategies. Organisational-level factors included exposure to workplace violence and insufficient support for reporting such incidents.
This study underscores the significance of minimising workplace violence and enhancing workplace safety, in addition to addressing individual-level factors, to reduce nurses' turnover intention—particularly in the context of future pandemics and epidemics.
These findings provide insights into the factors influencing clinical nurses' turnover intention, supporting the development and implementation of targeted clinical protocols and regulations to address modifiable factors and promote a sustainable nursing workforce.
No patient or public contribution.
To examine the association between socioeconomic status (SES), financial subsidies and awareness-related factors such as age, cancer stage and family history, and the uptake of cancer genetic testing, with a focus on equitable access to care.
Retrospective cohort study.
Tertiary care cancer genetics service in Singapore.
The study population included 2687 individuals of all ages, genders and ethnicities who attended pretest counselling between 2014 and 2020 and were eligible for genetic testing for hereditary cancer syndromes.
The primary outcome was the uptake of genetic testing. The main explanatory variables were SES (proxied by Housing Index), subsidy status, age, cancer stage and family history. Analyses examined whether associations varied across SES and age subgroups.
Receipt of financial subsidies was strongly associated with testing uptake (adjusted OR 9.15, 95% CI 2.68 to 31.20). Uptake exceeded 90% among subsidised individuals across all socioeconomic strata, compared with 56–68% among non-subsidised individuals, with the largest gains in the lowest SES group (43 vs 28 percentage points (pp) in the highest). The level of subsidy was not associated with uptake. Younger patients (18–39 years) had higher uptake than those aged 60+ (66% vs 57%); patients with advanced cancer (stage IV) had the highest uptake (82% vs 57–66% in earlier stages); and family history was associated with increased uptake, strongest for having a child with cancer (+28 pp). Interaction analysis suggested that the additive effects of subsidies were greatest in lower SES groups and in older adults.
Financial subsidies were strongly associated with higher genetic testing uptake. Awareness indicators like age, cancer stage and family history were associated with higher uptake. The association between subsidies and uptake varied by SES and age, suggesting that subsidies may help reduce disparities and improve equitable access to genetic testing services.
Flexible ureteroscopy has advanced modern stone management; however, lower pole renal stones remain a challenge due to suboptimal ureteroscope deflection and navigation using conventional flexible and navigable suction ureteral access sheaths (FANS). The SCULPT trial is designed to assess whether the novel steerable FANS—which enables active controlled deflection—can improve the success rate of lower pole access during flexible ureteroscopy.
This multicentre, prospective, single-blinded, randomised controlled superiority trial will recruit 400 adult patients (aged 18–75 years) with solitary lower pole renal stones ≤2 cm diagnosed by CT from 20 high-volume urological centres in China. Participants will be randomised 1:1 to undergo flexible ureteroscopy with either steerable or conventional FANS. The primary outcome is the success rate of navigating into the lower pole calyx (defined as successful direct stone visualisation, laser lithotripsy and aspiration without adjunct use). Secondary outcomes include immediate and 1 month stone-free rates, operative time, complication profiles (graded by Clavien–Dindo), instrument damage rates, quality-of-life assessments and cost analysis. Statistical analysis will be performed using appropriate tests for continuous and categorical data, with their significance set by prespecified superiority margins.
The study protocol has been designed in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Ethical approval was centrally granted by the Institutional Review Board of The First Affiliated Hospital of Guangzhou Medical University and adopted by all participating centres following local feasibility review. The trial results will be disseminated via peer-reviewed publication and presentation at international conferences.
To systematically review the existing literature and address the following research question: What are the most effective techniques used to minimise adverse effects resulting from subcutaneous injections of low-molecular-weight heparin among patients with cardiovascular diseases?
A scoping review.
A comprehensive search was conducted across multiple databases, including CINAHL, PubMed, EMBASE and the Cochrane Library, from 1 February 2014 to 31 January 2024. Participants were aged 18 years or older, diagnosed with venous thromboembolism or arterial thromboembolism and had prescribed subcutaneous injections of low-molecular-weight heparin. The collected data were analysed following the Joanna Briggs Institute approach, and it was organised and categorised based on the main objectives of the review.
Twenty studies were eligible, including 1 best practice project, 7 randomised controlled trials and 9 quasi-experimental studies. The techniques under investigation encompassed various aspects, including the injection site, injection duration (e.g., 30 s vs. 10 s), injection method (e.g., needle insertion angle), duration of needle withdrawal after injection, pressure application time and cold pressure. Preliminary evidence suggests that techniques such as using the abdominal site and slower injection rates may help reduce adverse effects. However, the optimal parameters for injection duration, waiting time, pressure and cold application, including the duration of these applications, remain uncertain due to limitations in sample size and heterogeneity in interventions and outcome measures across the studies.
Ensuring the accurate administration of low-molecular-weight heparin is of utmost importance as it plays a critical role in decreasing mortality rates and minimising substantial healthcare costs linked to complications arising from incorrect administration. The findings from the current review have significantly contributed to strengthening the evidence base in this field, providing more robust and reliable information.
This review emphasises the significance of implementing standardised subcutaneous injection techniques for low-molecular-weight heparin in patients with cardiovascular disease in order to reduce complications and enhance patient outcomes.
This study followed the applicable guidelines established by the PRISMA 2020 statement. The PRISMA checklist for systematic reviews was utilised for reporting purposes.
There is no patient or public contribution to declare.
OSF registries: osf.io/phk72
The aim of the study was to investigate the impact of the use of baby-friendly community initiative (BFCI) model on various stakeholders in the community.
Quasi-experimental research design.
The study was conducted in public premises and online workshops from April 2019 to September 2022. Participants were followed up for a period of 1 month, except for those employed at public premises. The program involved training based on an accredited BFCI framework to cultivate a breastfeeding-friendly attitude and knowledge. A paired sample t-test was used to examine breastfeeding attitude and knowledge scores before and after BFCI training among staff employed from public premises. An analysis of variance was conducted to examine the breastfeeding self-efficacy and attitude scores, measured repeatedly at different timepoints over 1-month timepoint (T0, T1 and T2) among pregnant and postpartum women.
A total of 2340 perinatal women and 1339 staff from public premises were recruited. For staff, there was an increase in the mean score of breastfeeding knowledge and attitude by 5.8 and 6.1, respectively, at T1. Similarly, for perinatal women, there was an increase in the mean score of breastfeeding self-efficacy and attitude by 6.6 and 3.3, respectively, at T1.
In summary, a BFCI model, with active community participation, accreditation and an award system, has been effective in promoting breastfeeding. Adapting the baby-friendly hospital initiative to local contexts and employing a social theory model can enhance breastfeeding promotion and improve infant health outcomes. Prioritizing culturally sensitive breastfeeding education is crucial for successful BFCI implementation.
Healthcare professionals should consider clients' culture and socio-economic backgrounds when providing breastfeeding education to maximize effectiveness. The target audience for breastfeeding education should be expanded to include various community stakeholders beyond families.
What problem did the study address? This study addressed the problem of knowledge gaps among stakeholders in building a breastfeeding-friendly community, particularly in implementing a baby-friendly community initiative (BFCI) as part of a baby-friendly hospital initiative (BFHI). The research filled a service gap by providing effective interventions targeting community stakeholders and assessing the impact of a BFCI program on their knowledge and attitudes towards breastfeeding.
What were the main findings? The findings highlighted the effectiveness of a BFCI program in enhancing breastfeeding knowledge and attitudes among frontline staff and increasing breastfeeding confidence among mothers. These findings contribute to the understanding of the program's impact on different stakeholders in the community.
Where and on whom will the research have an impact? It impacts on global policymakers by providing insights for developing comprehensive guidelines for future BFCI implementations. It also contributes to the creation of a more baby-friendly community, benefiting breastfeeding families and their infants by promoting and supporting breastfeeding families.
This study has adhered to relevant EQUATOR guidelines using the TREND reporting guideline.
No patient or public contribution.
This study provides an overview of the establishment of a localized BFCI program. It also opens up a new direction for the community to investigate BFCI strategies for community stakeholders. It also provides evidence to support other countries in following a similar process, as each country approaches becoming breastfeeding-friendly in its own unique way.
No protocol.
Chronic pain is a common health condition that significantly impacts the quality of life of those affected, affecting one in five people in Canada. The prevalence of this condition tends to increase with age, making it a major health issue given the ageing population. However, its management remains inadequate and requires significant mobilisation of healthcare professionals as well as the development of multiple therapeutic solutions. Among these, non-pharmacological interventions such as hypnosis and virtual reality have proven effective. Nevertheless, while the existing literature seems promising, it presents methodological limitations. Therefore, this study aims to assess the effectiveness of an intervention combining virtual reality and hypnosis in an ageing population suffering from a widespread chronic pain condition, that is, hand arthritis.
This study will be a single-centre randomised clinical trial. Participants will be randomly assigned to one of two conditions: one receiving an intervention combining virtual reality and hypnosis, and the other receiving only virtual reality. The effectiveness of the intervention on current perceived pain before and after the intervention (primary outcome) will be evaluated. Secondary outcomes will include anxiety and depressive symptoms, quality of life, relaxation and fatigue. Exploratory analyses will also be conducted to contribute to the emerging literature by examining physiological variables such as heart rate variability, respiratory rate and electrodermal activity during the intervention, and their relationship with primary and secondary outcomes.
The project was approved by the Research Ethical Committee of the Hospital Maisonneuve-Rosemont (Project no 2024-3539). Participants will be asked to provide written consent for their participation. Results from this study will be shared through peer-reviewed publications, as well as oral and poster presentations at scientific events. The protocol for this study was preregistered on Open Science Framework and raw anonymised data will be available on this platform (https://osf.io/vbh72/?view_only=1d17c5708f894faab6669d85e1fde75d).
The prevalence of cardiovascular diseases (CVDs) is rapidly increasing across Asia, with the burden particularly high among individuals aged ≥50 years. Elevated low-density lipoprotein cholesterol (LDL-C) level is a well-established causal risk factor for CVDs. Mediterranean-Dietary Approaches to Stop Hypertension Intervention for Neurodegenerative Delay (MIND) diet is a cardioprotective diet, which is rich in plant-based foods. Combining it with stress-reducing practices, including forest bathing (FB), which involves immersive exposure to forest environments, has been shown to reduce LDL-C levels and other cardiovascular risk factors by modulating pro-inflammatory responses. However, existing evidence is limited due to small sample sizes and poor study design. Therefore, this study aims to investigate whether the MIND diet combined with FB can reduce CVD risks among Chinese adults in Hong Kong. It also compares the effects of the MIND diet combined with FB on cardiovascular and mental health.
A single-blind, randomised controlled trial involving three groups will be used to assess the impact of the MIND diet combined with FB on LDL-C levels in adults aged 50–75 years with elevated LDL-C levels. Participants (n=273) from local community centres will be randomly assigned to the MIND-plus-FB (who will receive nutrition education, follow the MIND diet for 12 weeks and participate in regular FB sessions), MIND-alone (who will receive nutrition education and follow the MIND diet for 12 weeks) or routine care (who will continue their usual activities and receive a general health talk along with pamphlets on cardiovascular risks) group. The change in LDL-C levels will be measured at weeks 4 and 12 (primary outcome). Additionally, changes in high-density lipoprotein cholesterol level, triglyceride level, glucose level, systolic blood pressure, waist circumference, body mass index, anxiety levels and emotional state will also be assessed at weeks 4 and 12. Statistical analyses will include intent-to-treat, 2 test, analysis of variance and generalised estimating equations.
This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023164). Research findings will be disseminated through publication in peer-reviewed journals and presentations at academic and primary healthcare conferences.
ClinicalTrials.gov ID: NCT06222632, registered on 25 January 2024. The ClinicalTrials.gov data are available at:
Artemisinin-based combination therapies (ACTs) remain the WHO-recommended treatment for uncomplicated Plasmodium falciparum malaria. However, the emergence and spread of artemisinin resistance (ART-R) threatens ACT efficacy. ART-R is phenotypically expressed as delayed parasite clearance, which can facilitate ACT partner drug resistance. ART-R has been causally linked to specific mutations in the Pfkelch13 gene.
The systematic review and associated meta-analysis aim to determine the correlation between Pfkelch13 (alleles present in the Kelch13 gene region of the P. falciparum parasite) genotypes and clinical and parasitological response to ACTs from a globally representative data set pooling individual patient data (IPD) from eligible published and unpublished studies. The eligibility criteria include Pfkelch13 genotyping results at baseline complemented by individually linked parasitological and clinical assessments following artemisinin-based treatment. The data will be curated, standardised and analysed using this proposed statistical analysis plan (SAP), adhering to PRISMA-IPD (PRISMA, Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Our SAP will apply hierarchical modelling to assess the effect of the P. falciparum parasite Pfkelch13 mutations on parasite clearance half-life and therapeutic efficacy across different regions. This will include study sites as random effects in the model and potential predictors such as age, sex, baseline parasite load and other potential effect modifiers as fixed effects. This analysis will enhance the understanding of the influence of Pfkelch13 mutations on malaria treatment outcomes.
Data were obtained with informed consent and ethical approvals from the relevant countries and were pseudonymised before curation in the Infectious Diseases Data Observatory (IDDO)/WorldWide Antimalarial Resistance Network (WWARN) repository. Data ownership remains with contributors. This IPD meta-analysis met the Oxford Tropical Research Ethics Committee criteria for waiving ethical review, as it is a secondary analysis of existing pseudonymised data. The resulting peer-reviewed publication and conference proceedings will help strengthen and enhance the efficiency of ART-R surveillance and response and support policy decisions.
CRD42019133366.
FreshRSS 