Conectar
Adverse pregnancy and perinatal outcomes (APPOs), including pre-term birth, pre-eclampsia and gestational diabetes, can result in maternal and neonatal morbidity and mortality, parental anxiety and increased healthcare costs. A better understanding of the causes of APPOs is essential to inform lifestyle and pharmaceutical interventions for their prevention and management. Given the difficulty of undertaking randomised controlled trials in pregnant women, triangulating evidence from across methods with different sources of bias may improve causal inference for APPOs. The purpose of the Mendelian randomisation in pregnancy (MR-PREG) collaboration is to support such triangulation using genetic (eg, Mendelian randomisation (MR)) and non-genetic (eg, partner negative controls) approaches to investigate the causal effects of maternal exposures on a comprehensive set of APPOs.
The MR-PREG collaboration includes individual participant data from three birth cohorts (two from the UK and one from Norway) and UK Biobank, as well as summary data from FinnGen and publicly available genome-wide association studies (GWAS). Data have been harmonised across studies and currently include information on up to 35 APPOs in up to 707 797 women.
The main aims of MR-PREG are to strengthen the evidence base for (1) prevention, by advancing understanding of maternal lifestyle factors on APPOs, (2) the role of pre-conceptional health, by improving understanding of the effect of maternal pre-existing conditions on APPOs, and (3) treatments, by evaluating the efficacy and safety of existing medications used for pre-existing conditions, and by identifying and testing novel or repurposed therapies for APPOs. To date, our published work has mainly addressed aims 1 and 3. Examples include triangulation of evidence from MR, conventional multivariable regression and paternal negative control, showing that higher maternal body mass index increases the risk of multiple APPOs, as well as the identification of maternal circulating metabolites and proteins that may influence birth weight.
Future priorities include increasing diversity within the MR-PREG collaboration by expanding representation of participants from non-European ancestries. We are also integrating molecular data, including circulating protein levels and placental transcriptomics, to better characterise the molecular mechanisms underlying APPOs. Additionally, we are using whole-exome and whole-genome sequencing to identify novel causal genes and to inform the prioritisation of candidate therapeutic targets for APPOs.
To investigate the effects of organisational interventions on the incidence, healing and management of pressure injuries in adult patients in acute hospital settings.
Systematic review.
The review included adult patients at risk of or with pre-existing pressure injuries in acute hospital settings, excluding mental health units, emergency departments or operating theatres. Interventions employed in the included studies were categorised using the Cochrane Effective Practice and Organisation of Care taxonomy.
Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Complete and Web of Science Core Collection were searched from 01 January 2012 to 31 December 2023.
Of 8861 records identified, 7 prevention studies met the inclusion criteria. Six studies reported reductions in pressure injury incidence. Included studies employed various combinations of 14 organisational strategies to enhance practices. Educational interventions were utilised in six studies, including educational meetings, materials and outreach visits. Other common strategies included audit and feedback, communities of practice and continuous quality improvement. The interventions targeted patients and clinicians, primarily nurses, with some involving multidisciplinary teams. The focus was on enhancing healthcare practices through systematic approaches and stakeholder engagement.
Organisational strategies targeting both patients and clinicians as part of an intervention bundle may enhance the prevention of pressure injuries in acute hospital settings. Further, high-quality effectiveness–implementation hybrid trials are required to evaluate these strategies.
Organisational factors influence clinicians' ability to implement evidence-based practices. The effectiveness of specific organisational strategies in acute settings is uncertain. Multiple organisational strategies targeting patients and clinicians may improve the implementability of a pressure injury prevention intervention.
This study adhered to PRISMA guidelines.
Neither patients nor the public were directly involved in this study.
To synthesise the application, construction methods, challenges, and optimisation strategies of Patient Journey Maps (PJMs) in care transitions.
A scoping review guided by Arksey and O'Malley's framework and PRISMA-ScR.
Nine databases, including PubMed, Embase, CINAHL, Cochrane Library, Web of Science, CNKI, etc., searched from January 2015 to March 2025.
Two reviewers independently screened studies, extracting data from 23 studies across 12 countries, synthesised via descriptive and thematic analyses informed by nursing theories.
PJMs targeted elderly, children/adolescents, and special-needs populations across in-hospital referrals, inter-hospital transitions, and community adaptation. PJMs development integrated qualitative (interviews, co-design) and quantitative (process mining, EHR analysis) methods to map stages, touchpoints, and emotional curves. Challenges included collaboration breakdowns (78.3%), information fragmentation (74.0%), and psychosocial barriers (47.8%). Optimization strategies emphasised interdisciplinary collaboration, standardised processes, technology enablement, and patient-centred interventions.
PJMs enhance care transitions by visualising patient experiences and systemic gaps, improving continuity and safety. Scalability requires addressing technological adaptation, policy alignment and resource equity. Future research should prioritise dynamic, digitally driven PJM tools and cross-regional collaboration for health equity.
This review informs clinical practice and policy by bridging theoretical and practical gaps in transitional care via interdisciplinary strategies and technology integration.
Advances global nursing practice with patient-centered strategies, promotes health equity through collaboration, and informs policy and digital innovation for dynamic care transitions.
None.
Not registered.
To provide a structured analysis of the acceptability of transcatheter aortic valve implantation to support clinical conversations, decision making and recovery for older adults with aortic stenosis and their carers.
While transcatheter aortic valve implantation is an effective treatment for heart valve disease, its acceptability to patients and caregivers remains unclear. Understanding the acceptability of clinical procedures is key for influencing patient engagement in self-care and guiding the information and support patients and carers need.
A descriptive, qualitative study used deductive content analysis, guided by Sekhon's Theoretical Framework of Acceptability.
Participants included 18 aortic stenosis patients (mean age 84.2 ± 4.1 years) and 8 carers from three Australian metropolitan hospitals (2018–2020). Semi-structured interviews were conducted 4–6 months post–TAVI and transcribed verbatim. Analysis used Sekhon's Theoretical Framework of Acceptability across three temporal zones, with deductive coding examining affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy.
Participants described high prospective, concurrent and retrospective acceptability of transcatheter aortic valve implantation. Perceived prospective acceptability framed the procedure as lifesaving. Peri-operatively, participants found the procedure simple, low-risk and minimally disruptive, ensuring high concurrent acceptability. Post-procedure, patient participants described a slow but gradual return to normal, growing confidence and a reengagement with their valued pastimes. The absence of structured rehabilitation advice led to self-designed recoveries and uncertainty about safe limits.
Transcatheter aortic valve implantation was perceived as a highly acceptable intervention that helped this group of mostly older adults achieve their personal goals.
Despite the minimally invasive nature of transcatheter aortic valve replacement, optimising recovery and rehabilitation requires a holistic approach that addresses both clinical needs and patient goals.
None in the conceptualisation or design.
FreshRSS 