Conectar
Multidrug-resistant tuberculosis (MDR-TB) is an urgent public health challenge in Namibia, with profound socioeconomic consequences. The high burden of both tuberculosis and HIV complicates treatment and underscores the need for optimised drug therapies. Precision medicine, which leverages patient-specific genetic and molecular information, offers promise for improving MDR-TB outcomes. However, its effective application relies on population-specific data, particularly understanding how individuals metabolise tuberculosis drugs and how genetic diversity drives variability in treatment response. Currently, no pharmacokinetic (PK) or pharmacogenetic (PG) data on TB treatment exist for Namibian populations. This gap is particularly concerning, given the country’s genetic diversity, environmental factors and comorbidities that may uniquely influence drug metabolism. This study aims to generate PK and PG data to inform dose optimisation and support personalised treatment strategies for MDR-TB in Namibia. The findings will contribute to improved patient care and inform health system strengthening based on locally relevant evidence.
This cross-sectional study will consist of 100 Namibian participants with matched human DNA and PK data of MDR-TB cases receiving isoniazid, clofazimine, bedaquiline and the fluoroquinolones (levofloxacin or moxifloxacin). PK sampling will be divided as follows: 30 individuals will undergo intensive PK sampling, while the remaining (n=70) will undergo sparse PK sampling. DNA will be extracted at Stellenbosch University (SU), and samples will be genotyped using the H3Africa microarray. Sequences will be aligned to the human reference genome, hg38 (GRCh38p13), using the freely available Burrows-Wheeler Aligner. A subset of the samples (n=20–30) will undergo whole genome sequencing (WGS) to verify imputation results and identify novel genetic variants potentially affecting PK in this population.
Quality control and variant call format file generation will be performed using the Genome Analysis Toolkit best practices (V.3.5). Intensive and sparse PK data will be pooled for the development of a population PK (popPK) model using a non-linear mixed-effects modelling approach. The popPK model will characterise the relationship between TB drug dose and exposure, including quantifying covariates, including genetic variation, explaining PK variability, providing a foundation for dose optimisation and personalised treatment strategies.
Ethics approval was obtained from the University of Namibia Human Research Ethics Committee for Health (Ref. SOM18/2024), the Ministry of Health and Social Services (Ref. 22/4/2/3), the SU Health Research Ethics Committee (Ref. N21/11/136) and the University of Cape Town Human Research Ethics Committee (Ref. 500/2022).
Common mental health outcomes among children in conflict with the law in correctional facilities in Africa are an under-researched area with significant public health implications. This review will synthesise available and accessible evidence on the prevalence and associated factors of common mental health outcomes among children in conflict with the law in Africa.
Comprehensive electronic searches will date from 01 January 2015 to 31 December 2025 and will be conducted in PubMed, Sabinet, Scopus, EBSCOhost, Web of Science and PsycINFO. Articles will be screened using defined inclusion and exclusion criteria and assessed for eligibility by three independent reviewers. Discrepancies will be reviewed by a ninth reviewer. The selection process of included articles will be reported by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used. The Mixed Methods Appraisal Tool will assess study quality, and data will be synthesised using meta-analysis or a narrative synthesis approach, depending on heterogeneity levels.
This study will not require ethical approval from an institutional review board, as it does not entail the direct collection of data from children in conflict with the law, nor does it pose any risk to their privacy. Once finalised, the full review report will be submitted for publication in a peer-reviewed journal. The key findings will also be shared at both local and international conferences, highlighting common mental health outcomes among children in conflict with the law.
CRD420251011484.
Losses of functional reserve across multiple physiological systems have been identified in frail patients, yet the exact aetiology of frailty remains unclear. Although strongly associated with chronological age, frailty often develops at a younger age in patients with organ failure. Frailty is prevalent in patients with kidney failure; however, individuals experience improvements in physical frailty measures following kidney transplantation. This makes younger patients with kidney failure a unique population for studying both the accelerated onset of frailty and its reversal. This research project aims to test the hypothesis that frailty secondary to organ failure and age-related frailty are associated with similar molecular and physiological measures.
This longitudinal study will recruit 150 patients in three groups. Group A (kidney transplant recipients aged ≥40 years; n=50) and Group B (patients aged ≥40 years active on the kidney transplant waitlist; n=50) will comprise younger adults with frailty from organ failure. Group C (adults aged ≥65 years (or ≥55 years for Aboriginal and Torres Strait Islander patients); n=50) will comprise older community dwellers. The primary outcome is the Frailty Index (FI). Secondary outcomes include the change in FI over time, and at baseline when considering various clinical metadata, immune parameters, kidney function and nutrition intake which will be measured at baseline and 12-month time points. Longitudinal changes in frailty will be analysed using linear mixed models with multiple testing corrections for false discovery rates.
Endocrine profiles and metabolomics, measures of immune function and microcirculatory dysfunction, will be measured by liquid chromatography-mass spectrometry and/or gas chromatography-mass spectrometry. The gut microbiome will be sequenced via shotgun metagenomics (Illumina NextSeq500, 150 bp paired-end, 3Gbp/sample). Circulating cell-free DNA/mitochondrial DNA will be quantified through droplet digital PCR. Microcirculation will be assessed via sublingual dark field videomicroscopy with glycocalyx markers measured by ELISA.
This study will be conducted with all stipulations of this protocol, and the conditions of the ethics committee approval. Ethical principles have their origin in the Declaration of Helsinki, all Australian and local regulations and in the spirit of the standard of Good Clinical Practice (as defined by the International Conference on Harmonisation). Organs/tissues will be sourced ethically and will not be sourced from executed prisoners or prisoners of conscience or other vulnerable groups.
Ethics approval was received by the Metro South Health Research Ethics Committee (HREC/2023/QMS/95392) and ratified by the University of Queensland.
Results will be disseminated through peer-reviewed publications, academic conferences, participant newsletters and health organisation collaboration.
Despite several intensive interventions, HIV remains a major public health challenge affecting many individuals worldwide and highlighting ongoing gaps in HIV testing.
To assess the proportion of ‘never been tested for HIV’ and the risk factors associated therewith among women aged 15–49 years.
The 2022 Tanzania Demographic and Health Survey data were used for this study. The variable of interest was whether women of reproductive age (WRA) reported never being tested for HIV. A total weighted sample of 15 254 WRA participated in the study. A survey logistic regression model was employed to determine factors associated with never being tested for HIV, as it accounts for the complexity of the sampling design. Analysis was performed at a 5% level of significance using R statistical software V. 4.5.2.
Of the 15 254 WRA that participated, 3082 (20.2%) reported never being tested for HIV. The median (IQR) age of participants was 28 (21–37) years. The odds of never being tested for HIV decreased with increasing age (OR=0.96; 95% CI 0.95 to 0.97). Furthermore, factors such as having primary or secondary education, being pregnant or breastfeeding, marital status (married, living with a partner, widowed, divorced or separated), living in a female-headed household, using the internet, abstaining from sex, being aware of HIV test kits but never using them, media exposure, belonging to the middle wealth index category, using contraceptives and having other sexual partners besides a spouse within the past 12 months was found to be associated with never being tested for HIV among WRA in Tanzania.
This current study identified several factors associated with never being tested for HIV among WRA. To enhance HIV testing uptake in this population, government and public health stakeholders should design targeted interventions that address these determinants, particularly by improving access to education, promoting health awareness and integrating HIV testing into routine reproductive health services.
To explore how parents perceive health care encounters related to their child's higher weight and to interpret these experiences within the broader societal context shaped by cultural norms and representations.
A qualitative design was employed using semi-structured interviews to capture parents' experiences. The study was informed by a conceptual framework that views weight as both a personal and socially constructed phenomenon.
Eighteen parents from Finland were interviewed between May 2022 and June 2023. The data were analysed using reflexive thematic analysis to identify key themes in parents' experiences and perceptions.
Three main themes were identified. The relational dimension highlighted the importance of individualised care, where health care professionals take time to get to know the family and recognise each member as an individual. The emotional dimension emphasised the need to protect the child, strengthen parental self-efficacy and provide sensitive, skilled support that fosters a sense of safety. The practical dimension focused on the need for active and targeted care, including structured weight-related routines, multidisciplinary collaboration and services that respond to the everyday realities of families.
The study highlights the need for health care encounters that are individualised, emotionally safe and sensitive to the diverse realities of families. Moving beyond weight-centric approaches, care should offer a range of supportive options that reflect parents' varied expectations, concerns and needs.
This study responds to the need for a deeper understanding of how parents experience health care encounters related to their children's higher weight. The findings highlight the importance of designing care interactions that provide professionals with adequate time, expertise and training to deliver individualised, stigma-sensitive care.
COREQ.
No patient or public contribution.
There is a high level of older people neglect in Nigeria, especially in the rural setting, and they did not receive much attention in terms of their overall health and well-being. Government social interventions are usually geared towards the children, adolescents, pregnant women and lactating mothers. Evaluating the level of functional decline and social support among these groups and how it affects their overall well-being will enable policy formulations geared towards holistic care for them. This study aimed to determine the level of functional dependence in some basic activities of daily living (ADLs: mobility, dressing, grasp and bathing) and social support in older people to enhance evidence-based advocacy to all stakeholders in older people care.
This was a hospital-based cross-sectional study of 160 (75 males and 85 females) older people aged 65–98 years selected through systematic random sampling. The 2 test, t-test and logistic regression were used for analysis.
The response rate was 100%. The mean age of male respondents was 76.31±8.34 years and that of the female respondents was 76.87±7.47 years. A statistically significant association was found between age >75 years, absence of a spouse, low education level and functional dependence in all ADLs studied. Although age independently predicted dependence in all studied ADLs, except dressing and grasp, marital status predicted dependence in dressing and bathing, and availability of care also predicted dependence in mobility.
Age is an independent risk factor for functional dependence in mobility and bathing, and marital status independently predicted dependence in dressing and bathing. Not receiving care also independently predicted dependence in mobility. Thus, improvements in the biopsychosocial, biomedical and economic well-being of older people will ameliorate the impact of poor care on functional status and ADLs.
by Nguyen Thien Duc, Nguyen An Ninh, Nguyen Phi Trinh, Le Quang Tuyen, Nguyen Van Hung, Dinh Hoang Khanh, Nguyen Van Luat, Nguyen Huu Phuc Dai, Tran Duc Huy, Chu Duc Hoa, Tran Vuong The Vinh
PurposesAnatomy is fundamental in medical education, yet cadaveric dissection faces challenges including limited specimens, high costs, and chemical hazards. Interactive anatomy tables such as the Pirogov system offer innovative alternatives, but evidence from Southeast Asia is limited.
MethodsIn a prospective cohort, 188 medical students (139 in Y1 and 49 in Y2) were randomly assigned to the Pirogov table group (Group A, n = 99) or the cadaveric dissection group (Group B, n = 89). Knowledge acquisition was measured using a validated 20-item multiple-choice test before and after the intervention. Student perceptions were evaluated with a 10-item Likert-scale questionnaire covering four domains: knowledge and understanding, spatial visualization and relationships, learning experience and engagement, and effectiveness and practical value. Data were analyzed using paired and independent t-tests and Welch’s t-test.
ResultsBoth groups showed significant knowledge gains (Group A: 4.3 ± 1.65 to 5.2 ± 1.75, p Conclusion
The Pirogov table and cadaveric dissection were associated with similar short-term improvements in anatomy knowledge. Students valued the Pirogov table for visualization and engagement. These findings support integrating digital tools with cadaveric dissection to enhance anatomy education, particularly in resource-limited contexts.
by Viet Anh Nguyen, Viet Hoang, Thi Quynh Trang Vuong, Thi Nga Phung, Nghi Phan Bich Hoang
ObjectivesChairside bonding of auxiliaries directly to aligners can avoid remanufacturing trays, but optimal protocols may be substrate-specific across modern thermoformed and 3D-printed materials. This study aimed to compare bond strength and failure mode across six representative aligner materials using a universal primer-orthodontic adhesive combination and a one-step aligner adhesive, with and without sandblasting.
Materials and methodsPolyethylene terephthalate glycol-modified (PETG), thermoplastic polyurethane (TPU), and glycol-modified polycyclohexylenedimethylene terephthalate (PCTG), together with three 3D-printed resins (TA-28, TC-85DAC, DCA), were prepared as 0.76-mm plates (n = 64). Specimens received alumina sandblasting or no treatment, then were bonded with either of two bonding strategies (n = 16). After thermocycling, bond strength was tested, and failures were scored by ARI. Two- and three-way ANOVA and proportional-odds modeling assessed effects (α = 0.05).
ResultsBond strength showed significant main effects of material and sandblasting, with significant material–sandblasting and material–primer interactions. The primer main effect was not significant. Post hoc tests confirmed substrate-specific rankings. PETG with Bond Aligner (non-sandblasted) reached 26.71 MPa, while DCA with universal primer (sandblasted) reached 22.36 MPa. Sandblasting generally increased bond strength, with some exceptions. Failure mode was material-dependent and not completely parallel with bond strength.
ConclusionsBonding efficacy depends on the aligner substrate. For thermoformed trays, a one-step aligner adhesive is preferable, with sandblasting contraindicated for PETG but advantageous for more elastic TPU and PCTG. For 3D-printed trays, a universal primer-orthodontic adhesive combination performs more consistently, with sandblasting benefiting DCA and TA-28, whereas TC-85DAC performs slightly better without it.
Musculoskeletal pain is a global issue affecting millions of individuals. Healthcare provider gender bias (HCP-GB) in pain management or treatment may have implications. This study aimed to systematically (1) identify and map the scientific and grey literature as it relates to HCP-GB in the assessment, diagnosis and management of musculoskeletal pain, and (2) identify current gaps that necessitate further research.
This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
The following databases were searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (EBSCOhost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022 and updated in May 2025. Relevant grey literature was identified.
All screening was performed by two reviewers during title/abstract screening and full-text screening stages. Articles published in English, Spanish and German were included if they involved participants with musculoskeletal pain and examined HCP-GB as the dependent variable.
Two reviewers independently extracted data from the bibliometric, study characteristics and pain science variables. Results were descriptively mapped, and the frequency of concepts, population and characteristics was narratively reported.
21 full-text articles were included. All articles were published in North America and Europe. A total of 3694 healthcare providers from various specialty areas were examined. A majority of studies (57.1%; n=12) measured HCP-GB using written case vignettes, 33.3% (n=7) used case vignettes plus virtual human pictures/videos, and 9.5% (n=2) used real patients. The influence of patients’ sex in HCP pain assessment was reported in 28.5% (n=6) of the articles, while 42.9% (n=9) reported gender bias regarding HCP non-pharmacological treatment recommendations. Male patients were more likely to receive exercise recommendations for back pain and laboratory testing, whereas female patients received more psychological treatment recommendations and counselling from their HCP.
While there appears to be inconsistent use of the terms sex and gender, the literature informing this review suggests an existence of gender bias in the management of patients with musculoskeletal pain. Future research should be more purposeful in the use of sex/gender-related terms and consider exploring the impact of implicit bias training to rectify potential gender biases present in HCP.
Parents of adolescents with a mental disorder describe having overwhelming feelings regarding the psychiatric diagnosis, which they respond to with grief. Existing research indicates that these parents face unique challenges, such as self-blame and stigma. Parents are crucial in adolescent care, and healthcare professionals should find interventions that educate parents about the disorder, treatment and symptom management. The aim of this study was to explore and describe parents' experiences in having an adolescent with a mental disorder admitted to the psychiatric unit of a public hospital in Gauteng, South Africa.
The study used Heidegger's interpretive phenomenological design.
A qualitative, exploratory, descriptive and contextual method was used. Data were collected through semi-structured telephonic interviews with 10 parents who had an adolescent with a mental disorder admitted to a public hospital in Gauteng, South Africa. Tesch's thematic coding steps were used for data analysis.
The themes arising from the findings reflected (1) parents experienced that their lives were stuck amid grief for the loss of what their adolescent child used to be, and anxiety about what the future holds, (2) parents experienced that when they reached out for professional help, the healthcare system failed them due to a lack of guidance, information and support, (3) parents experienced that they prayed for divine intervention as a coping strategy, and (4) parents experienced stigma from the community.
The findings illustrate the need for psychiatric nurses to facilitate the mental health of parents of adolescents with a mental disorder. Furthermore, positive attitudes among parents are improved once they are empowered and receive the necessary support, and stigmatization will also be reduced. It is recommended that further research be conducted to explore the effectiveness of emotional and professional support in addressing the challenges parents experience with an adolescent who has a mental disorder.
This paper contributes knowledge to nursing practice by exploring the experiences of parents who have an adolescent with a mental disorder in the South African context.
We aimed to investigate the learning needs of general practitioners and their preferences as regards the most appropriate teaching session for continuing medical education in wound management. A survey targeting general practitioners at the public health centres in the City of Helsinki. Twenty-seven general practitioners participated in the study. The majority (74.1%) had received education in medical school, 40.7% from wound care nurses, and 40.7% from colleagues. Participants felt the most competent in wound diagnosis (59.3%) and etiological tests (55.6%) and requested training in these topics (74.1% and 74.1%). A peer-led lecture (88.9%) was the most preferred technique, followed by lectures by wound care nurses (55.6%), an educational video (44.4%), a specialist-led lecture (37.0%), an interactive wound product session (29.6%), and digital self-study (29.6%). Wound diagnostics and etiological tests are recognised as crucial topics for continuing medical education. Peer-led lectures were preferred over other techniques; however, we observed varying preferences regarding the most optimal technique. Based on our results, we propose a half-day training including lectures, interactive and hands-on activities, and reflection, led by a peer and a wound care nurse with supporting video materials. Future studies could assess its impact on learning outcomes and wound care quality.
To describe the latest information on types of psychosocial interventions and their effectiveness on loneliness reduction among older adults in community and residential care settings, and the experience with these interventions.
Umbrella review.
The Joanna Briggs Institute methodology for umbrella reviews.
Cochrane Database of Systematic Reviews; Cumulative Index of Nursing and Allied Health Literature; Medline; Embase; Emcare; PsycINFO; ProQuest Dissertation & Thesis Global; Ovid Nursing Database; MedRxvi.
Twenty-two reviews were included. Seven major types of psychosocial intervention were identified: (1) social facilitation interventions, (2) psychological therapies, (3) health and social care provision, (4) animal-assisted interventions, (5) befriending interventions, (6) leisure and skill development, and (7) other interventions. Social facilitation interventions that provide synchronised interaction, psychological therapies, health and social care provision, and animal (−assisted) interventions demonstrated positive effects while leisure/skill development and befriending interventions warrant more rigorous evidence. Group settings, synchronised interaction and purpose-driven are identified as facilitators, whereas technological issues and safety issues are barriers to participation.
Seven types of psychosocial interventions are currently available for loneliness among community-dwelling older adults, and a positive effect in reducing loneliness was demonstrated in some types. Facilitators and barriers to their participation were synthesised. Two future research directions are suggested: (1) reviews on meaning-centred interventions to provide a comprehensive understanding and (2) implementation studies employing community-based paraprofessionals to promote programme scalability and accessibility.
Health and social care practitioners (e.g., nurses), researchers and policymakers are recommended to employ social facilitation interventions with synchronised interaction, psychological therapies, health and social care provision and animal-assisted interventions to address loneliness among community-dwelling older adults.
This review provided empirical information on available effective interventions to address loneliness among community-dwelling older adults. It also provided information for nurses to implement psychosocial interventions in the community.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO CRD 42023482852, registered 25/11/2023
by Viet Anh Nguyen, Van Hung Nguyen, Thi Quynh Trang Vuong, Quoc Thanh Truong, Thi Trang Nguyen
Large language models (LLMs) are increasingly explored as diagnostic copilots in digital pathology, but whether the newest reasoning-augmented architectures provide measurable benefits over earlier versions is unknown. We compared OpenAI’s o3 model, which uses an iterative planning loop, with the baseline GPT-4o on 459 oral and maxillofacial (OMF) cases drawn from standard textbooks. Each case consisted of two to five high-resolution haematoxylin-and-eosin micrographs, and both models were queried in zero-shot mode with an identical prompt requesting a single diagnosis and supporting microscopic features. Overall, o3 correctly classified 31.6% of cases, significantly surpassing GPT-4o at 18.7% (Δ = 12.9%, PThis study aimed to investigate the relationship between stress, self-compassion, and fertility adjustment in women undergoing infertility treatment in Turkey and to determine whether stress influences fertility adjustment through the mediating effect of self-compassion.
A cross-sectional and descriptive design was used in the study.
The study was conducted with 290 women who applied to the in vitro fertilisation unit in a university hospital in Ankara, Turkey. Descriptive statistics, Pearson correlation, and structural equation analysis were used for statistical analysis.
According to the results of structural equation modelling, self-compassion was found not to affect fertility adjustment, while infertility-related stress directly influenced both self-compassion and fertility adjustment. Additionally, self-compassion was not found to mediate the relationship between stress and fertility adjustment in women undergoing infertility treatment.
The findings suggest that different dynamics may contribute to women's infertility-related stress and fertility adjustment.
This study highlights the importance of developing strategies to enhance fertility adjustment in women receiving infertility treatment and underscores the need for nurses working in this field to evaluate women's attitudes toward themselves to provide individualised care aimed at alleviating infertility-related stress.
The findings indicate that self-compassion does not have the expected effect in coping with infertility. Specifically, the lack of a direct effect of self-compassion on fertility adjustment, along with the strong influence of stress on both self-compassion and fertility adjustment, suggests that stress management-focused interventions may take precedence. These results indicate that approaches aimed at stress management during infertility treatment can play a critical role in supporting women's adjustment processes.
STROBE guidelines were followed for this study.
There is no patient or public contribution.
To evaluate the accuracy of the arterial oxygen partial pressure/inspired oxygen fraction (PaO2/FiO2) ratio in predicting mortality among acute respiratory distress syndrome (ARDS) patients in Vietnam.
A retrospective observational study.
A central hospital in Vietnam.
Adult patients diagnosed with ARDS based on the Berlin definition and admitted to Bach Mai Hospital between August 2015 and August 2023. ARDS severity was converted from descriptive categories to the Berlin score, ranging from 1 (PaO2/FiO2>300 mm Hg) to 4 (PaO2/FiO2≤100 mm Hg).
All-cause hospital mortality.
Of 345 patients, 67.5% were male, and the median age was 55.0 years (IQR: 39.0–66.0). Hospital mortality was 61.2% (211/345). On the first day of admission, the PaO2/FiO2 ratio (areas under the receiver operating characteristic curves (AUROC): 0.585 (95% CI 0.522 to 0.649)) showed limited predictive ability for hospital mortality. Incorporating the PaO2/FiO2 ratio into the Berlin score did not substantially improve accuracy (AUROC: 0.578 (95% CI 0.516 to 0.641)). Both measures were less accurate than Sequential Organ Failure Assessment (SOFA) (AUROC: 0.650 (95% CI 0.590 to 0.711)), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUROC: 0.685 (95% CI 0.628 to 0.742)) and Confusion, Urea >7 mmol/L (20 mg/dL), Respiratory rate ≥30 breaths/min, Blood pressure (systolic 2/FiO2 values (adjusted OR, AOR: 0.988 (95% CI 0.979 to 0.996)) were independently associated with lower mortality risk, while higher Berlin (AOR: 2.477 (95% CI 1.190 to 5.156)), SOFA (AOR: 1.278 (95% CI 1.102 to 1.482)), APACHE II (AOR: 1.236 (95% CI 1.108 to 1.379)) and CURB-65 (AOR: 7.142 (95% CI 2.581 to 19.763)) scores were associated with increased mortality risk.
In this study of ARDS patients in Vietnam, the PaO2/FiO2 ratio demonstrated limited discriminatory ability for hospital mortality, and incorporating it into the Berlin score did not meaningfully improve performance. While less accurate than SOFA, APACHE II and CURB-65 scores, the PaO2/FiO2 ratio and Berlin score remained independently associated with mortality risk. These findings should be interpreted cautiously, given the retrospective design, single-centre setting and potential selection bias; further validation in larger, multicentre studies is warranted.
To explain how government policies affected decision-making on Nurse Practitioner and Physician Assistant employment and training within Dutch healthcare organisations, and how organisational and sectoral circumstances were influential.
An online, cross-sectional survey study.
A literature- and interview-based program theory was tested using surveys. Respondents from hospital care, (nursing) home care, primary care, and intellectual disability services were recruited using convenience sampling. Data analysis used descriptive statistics and inferential tests. Open-ended responses were analysed using thematic synthesis techniques. Survey results were clustered to assess verification, falsification, or refinement of program theory elements.
A total of 568 experts in hiring and training healthcare professionals participated. Respondents indicated that most government policies promoted employment and training. Organisational and sectoral circumstances caused significant variations in Nurse Practitioner and Physician Assistant deployment across healthcare sectors, shaping how decision-makers interpreted and acted on government policies. Specific circumstances within primary care hampered deployment.
Government policies stimulated training and employment by: (1) removing practice restrictions (scope of practice expansion, legal acknowledgment), (2) facilitating cost-effective training and deployment (training grants, billing options), (3) providing sectoral knowledge on deployment, training, and healthcare outcomes (funding research and a sectoral knowledge center), and (4) establishing sectoral agreements (on apprenticeships). Organisational and sectoral circumstances significantly influenced outcomes. Key circumstances included flanking policies, stakeholder support, labor market capacity, healthcare demand, organisational resources and aims, and type of decision-makers (medical doctor or manager/director). Familiarity with the professions stimulated deployment.
The refined and verified program theory supports designing effective skill-mix policies and facilitating Nurse Practitioner and Physician Assistant employment and training. Tailoring skill-mix policies can optimise outcomes. This offers opportunities for governments, healthcare funders, organisations, and professionals to contribute to healthcare quality, cost efficiency, and patient satisfaction.
Healthcare professionals were part of the study population.
This study aims to identify key determinants and strategies for effectively implementing a reflection method to support adequate use of the ‘Informal Care’ guideline within community nursing. The SPARK (Self & Peer Assessment to Reflect on Quality Standards) reflection method, developed in an earlier participatory design-based study, is a structured group reflection approach designed to help nurses and nursing assistants reflect on and apply guideline recommendations in daily practice.
A mixed method study.
Six community care organisations in the Netherlands.
This mixed-method study collected qualitative data through observations and video recordings of group meetings with community nurses, nursing assistants and a patient representative, alongside quantitative questionnaires. This project included design and test group meetings to develop and evaluate prototypes of the reflection method. Observations were discussed, and video recordings were thematically analysed. The Measurement Instrument for Determinants of Innovations questionnaire was used to identify key determinants for effective implementation. The questionnaire results were analysed descriptively, using the Tailored Implementation in Chronic Diseases (TICD) framework to present preliminary determinants for validation. Implementation strategies were then selected in a group meeting. Based on this input, the research group operationalised the selected implementation strategies.
Twenty-nine determinants for implementing the reflection method were identified across seven TICD domains, including barriers such as limited support, knowledge and time, and facilitators such as team collaboration and prevention of caregiver overload. Based on these findings, three implementation strategies, namely knowledge enhancement, coaching development and leadership strengthening, were formulated to support integration into community nursing practice.
This study identified key determinants and strategies for implementing a reflection method in community nursing. While several determinants align with existing literature, context-specific determinants related to the heterogeneous group of registered nurses and certified nursing assistants also emerged. Strengthening guideline knowledge, coaching competencies and leadership is essential for sustainable, guideline-based reflection in practice.
To offer a comprehensive overview of the individual and organisational factors related to inclusive leadership among healthcare professionals.
Systematic review and meta-analysis.
The review was conducted following the Joanna Briggs Institute methodology for systematic reviews of effectiveness. Findings were synthesised using meta-analysis, a random effects model and narrative synthesis.
In January 2025, a systematic search was conducted with no time or geographical limits in the CINAHL, MEDLINE (PubMed), Mednar, ProQuest and Scopus databases. Studies in English, Swedish and Finnish were included.
A total of 34 studies were included. The meta-analysis revealed a statistically significant positive relationship between inclusive leadership and psychological safety among healthcare professionals (n = 10). The narrative synthesis further identified individual and organisational factors related to inclusive leadership. Individual factors consisted of well-being at work, performance and productivity, social behaviour, innovativeness and creativity and psychological capacity. Organisational factors revealed work community cohesion and citizenship, as well as organisational fairness and appreciation.
Inclusive leadership is a promising leadership behaviour, with positive outcomes for healthcare professionals and organisations. By enhancing psychological safety, inclusive leadership offers broader benefits for individuals and organisations. As such, it could improve the retention of professionals and the attractiveness of organisations in the healthcare sector.
To strengthen the functioning of healthcare organisations, leaders should be educated in inclusive leadership and its practical benefits. Training should focus on developing inclusive leadership behaviours that foster belonging, value individual uniqueness and encourage participation across all professional groups, creating an environment where both individuals and organisations can thrive.
The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used to report the results.
No patient or public contribution.
The protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (ID: CRD42024503861)
by Viet Anh Nguyen, Ngo The Minh Pham, Minh Ngoc Tran, Thi Bich Ngoc Ha, Thi Quynh Trang Vuong
IntroductionBonding fixed appliances to zirconia restorations is challenging, yet adult orthodontics increasingly involves ceramic crowns and patient-driven esthetic choices such as lingual appliances. Customized lingual brackets may improve fit and reduce adhesive thickness, but evidence on their bonding to zirconia is limited.
Materials and methodsThis in vitro study evaluated the shear bond strength of customized lingual brackets bonded to glazed zirconia after airborne-particle abrasion. Bracket manufacturing was either three-dimensionally (3D) printed cobalt-chromium or cast nickel-chromium. Primers were a universal adhesive (Single Bond Universal, 3M) or a primer containing 10-methacryloyloxydecyl dihydrogen phosphate Z-Prime Plus (Bisco), and adhesives were a light-cure orthodontic composite or a dual-cure resin cement. One hundred twenty-eight specimens (n = 16 per group) were tested. Shear bond strength was analyzed with three-way ANOVA, followed by post-hoc Tukey tests. Adhesive Remnant Index (ARI) scores were evaluated with ordinal regression. Significance was set at α = 0.05.
ResultsManufacturing modality significantly affected bond strength, with additively manufactured cobalt-chromium exceeding cast nickel-chromium (P = 0.049). The primer category and polymerization mode showed no significant main effects (P > 0.20) and no significant interactions. Group means clustered 9–10 MPa, and all combinations met the clinically accepted threshold. Additively manufactured brackets exhibited lower ARI scores than cast brackets (P Conclusions
On glazed, sandblasted zirconia, shear bond strength of customized lingual brackets showed a borderline main effect of fabrication method, whereas primer type and adhesive polymerization mode were not statistically significant. Failures were predominantly located at or near the zirconia–adhesive interface. Within this in vitro model, base manufacturing may warrant attention, whereas primer and curing mode may be selected for handling and workflow considerations, with clinical relevance yet to be established.
by Mohajit Arneja, Swetharajan Gunasekar, Dharaneswari Hari Narayanan, Joshma Joseph, Harilalith Kovvuri, Sharath Shanmugam, Pavitraa Saravana Kumar, Asuwin Anandaram, Vinod Kumar Balakrishnan, Jayanty Venkata Balasubramaniyan, Sadhanandham Shanmugasundaram, Sankaran Ramesh, Nagendra Boopathy Senguttuvan
BackgroundFaster time to reperfusion can be achieved by minimizing various patient and system-level delays that contribute to total ischemic time. Procedural delays within the catheterization laboratory represent a non-negligible and modifiable component in the chain of reperfusion, but remain unquantified by conventional metrics such as door-to-ballon (D2B) time. Universal catheter approaches have rapidly gained traction as an alternative to the traditional two catheter approach for transradial coronary interventions. However, their utility for both diagnostic angiography and subsequent angioplasty is limited, and the impact of this strategy on reperfusion outcomes has remained unexplored. We utilized a procedural metric termed fluoroscopy-to-device (FluTD) time to quantify the efficiency of a single catheter strategy, and assessed its impact on epicardial and myocardial perfusion.
Methods and resultsIn this retrospective study, consecutive STEMI patients undergoing transradial primary PCI (pPCI) at a tertiary care center in India between May 2022 to October 2024 were analyzed. Patients were divided into two groups: 51 underwent PCI using a single universal guiding catheter (UGC), and 51 underwent the conventional two-catheter (CTC) approach. The primary outcome of the study was a comparison of the FluTD time between the two procedural strategies. Secondary outcomes included myocardial blush grade (MBG), Thrombolysis in Myocardial Infarction (TIMI) flow grade, total fluoroscopy time, radiation dose, device safety and efficacy, and procedural success.The median FluTD time was significantly shorter in the UGC compared to the CTC group (3 minutes [IQR 3–4] vs. 10 minutes [IQR 8–17], p Conclusion
A single catheter strategy for both angiography and pPCI in STEMI patients was associated with a significant reduction in FluTD time and improved microvascular perfusion, without compromising device safety or efficacy. In low- and middle-income countries (LMICs), where intra- and extra-procedural delays are often more pronounced, inclusion of the single catheter strategy can optimize catheterization workflows and yield substantial cost-savings.
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