Conectar
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
by Riham M. Hamadouk, Esra D. Albashair, Einass M. Alshareif, Ali Awadallah Saeed, Bashir A. Yousef
BackgroundToday, community pharmacists’ responsibilities have expanded beyond the traditional role to include the management of minor ailments. Acute uncomplicated cystitis is one of the most prevalent medical conditions seen in primary healthcare and can be managed by community pharmacists (CPs).
ObjectivesTo evaluate community pharmacists’ history-taking practice when responding to patients with acute uncomplicated cystitis.
MethodsA cross-sectional simulated patient study was conducted from November 2022 to January 2023 in Khartoum locality targeting only pharmacists. Six trained female students played the simulation in which they pretended to have the clinical symptoms of acute uncomplicated cystitis and requested treatment for their condition. The Interactions during the simulation were documented immediately in a data collection form after each visit. Descriptive statistics were used to report the study outcomes.
ResultsA total of 238 community pharmacies were visited. The majority of the pharmacists were female. The mean of the number of questions that were asked by the pharmacists was 1 (SD = 1.6) questions. Among the studied pharmacists, 45.4% asked at least one question during patient assessment. The most asked question was if the patient has a fever, representing 61 (25.6%) CPs, followed by if there is vaginal discharge, representing 38 (16%) CPs. In response to scenario 47 (19.7%) CPs decided to refer the patient to a physician, and 45 (18.9%) of the CPs advised the patient to increase water intake.
ConclusionsThe study has revealed a poor history-taking practice towards acute uncomplicated cystitis during patient assessment. Further studies exploring pharmacists’ involvement in patient assessment are required. Strategies to improve community pharmacists’ practice, like continuing pharmacy education and providing a national guideline regarding patient assessment should be considered seriously.
by Eslam T. Mashaqbeh, Tamam El-Elimat, Osama Y. Alshogran, Iyad Hamzeh, Zahraa M. Obeidat, Ahmed H. Al Sharie, Feras El Hajji
The concurrent use of herbal dietary supplements with prescription medications raises safety concerns due to the potential for clinically significant interactions. Matcha, a shade-grown green tea consumed as an ultra-fine powder, is rich in catechins that may inhibit the transport of P-glycoprotein (P-gp) substrates such as nadolol. This study investigated the effects of administering single and multiple doses of matcha on the pharmacokinetics of nadolol in an in vivo animal model. Male Sprague-Dawley rats (n = 32) were randomly assigned to four groups. Group 1 (negative control) was administered normal saline followed by a single oral dose of nadolol (10 mg/kg). Group 2 (matcha single-dose) was administered a single dose of matcha (250 mg/kg) whisked in normal saline, followed by nadolol (10 mg/kg) after 30 min. Group 3 (positive control) received itraconazole (50 mg/kg), followed by nadolol (10 mg/kg) after 30 min. Group 4 (matcha multiple-dose) received matcha (250 mg/kg daily for 21 days) before administering nadolol (10 mg/kg) on day 21. Blood samples were collected at 0, 0.33, 0.66, 1, 1.5, 2, 3, 4, 5, 8 and 24 h. Nadolol concentrations in plasma were measured by a validated high-performance liquid chromatography with fluorescence detection (HPLC-FL) method. Pharmacokinetic parameters were estimated using the PK solver add-in for Microsoft Excel. To ensure quality control, caffeine, a key marker compound of matcha green tea, was quantified using HPLC with ultraviolet detection (HPLC-UV). A single oral dosage of matcha (250 mg/kg) had no statistically significant effects on the pharmacokinetics of nadolol compared to the control group (p > .05). Although the multiple-dose matcha group showed an increase in Cmax (~45%), AUC0-t (~18%), and AUC0-∞ (~22%) for nadolol compared to the control group, these differences were not statistically significant (p > .05). In contrast, the t½ (h) of nadolol increased significantly from 4.0 ± 1.6 in the control group to 7.7 ± 4.2 (p = .039) in the matcha multiple-dose group. Itraconazole co-administration significantly increased systemic exposure (AUC) of nadolol (p = .009), confirming the validity of the animal model. Caffeine, a key marker compound in matcha tea, was quantified at 4.18 ± 0.44% w/w of dry matcha tea powder, equivalent to 41.8 ± 4.4 mg/g. This is the first study to explore the potential pharmacokinetic interaction between matcha tea and nadolol. Single and multiple oral doses of matcha green tea had negligible effects on most pharmacokinetic parameters of nadolol, except for an increased half-life in the multiple-dose group. Further research is needed to establish the clinical relevance of this interaction before definitive recommendations on the safety of matcha tea and nadolol coadministration can be made.
by Fahad Saleem, Fazal ur Rehman Khilji, Sajjad Haider, Qaiser Iqbal, Baharudin Ibrahim, Fatiha Hana Shabaruddin, Mohammad Bashaar
Terrorism-related disasters (TRDs) continue to exert profound and recurring pressures on healthcare systems, particularly in vulnerable regions like Pakistan. Although pharmacists are increasingly recognized as an essential component of disaster management, there is a clear gap in the literature regarding their preparedness, experience, and specific roles in responding to TRDs particularly in low and middle-income countries. This study aimed to explore the preparedness, experiences, and response strategies of pharmacists managing TRDs at the Trauma Centre of Sandeman Provincial Hospital, Quetta, Pakistan. A qualitative design was adopted, guided by the Consolidated Criteria for Reporting Qualitative Research. Semi-structured, face-to-face interviews were conducted with pharmacists (n = 10) providing services at the Trauma Centre. Data were audio-recorded, transcribed verbatim, validated by participants, and analyzed using thematic content analysis. Analysis revealed five overarching themes: (1) pharmacists’ experiences with terrorism-related incidents and existing response mechanisms; (2) professional and personal responses to emergencies, reflecting both commitment and psychological burden; (3) preparedness challenges, including lack of disaster management training, limited awareness of policies and protocols, and inadequate understanding of triage and coordination; (4) barriers such as security risks, pharmacy curriculum deficiencies, insufficient experiential learning, and minimal involvement in planning and management activities; and (5) recommendations for strengthening capacity, including revising curricula, implementing structured training programs, conducting regular disaster drills, and expanding pharmacists’ roles in preparedness and response. Findings revealed a pronounced lack of formal training in disaster management, limited awareness of protocols and triage systems, and minimal involvement of pharmacists in planning and coordination activities. Despite strong professional commitment and frontline engagement, pharmacists’ contribution remain constrained by educational, structural, and policy-level shortcomings. The study highlights the urgent need for integrating disaster management into pharmacy curricula, implementing structured training programs and regular disaster drills, and expanding pharmacists’ roles within institutional and national disaster preparedness frameworks.
by Alyssa Howren, Quan L. Tran, Sadaf Sediqi, Saadiya Hawa, Douglas K. Owens, Eleni Linos, Titilola O. Falasinnu, Yashaar Chaichian, Julia F. Simard
BackgroundSystemic lupus erythematosus (SLE) is a heterogeneous autoimmune rheumatic disease whose epidemiology and clinical prognosis vary by race and sex. Observed disparities in SLE may be partly attributable to cognitive processes in clinical decision-making, which can influence diagnostic accuracy and clinical management. We aimed to examine variation in primary care physicians’ (PCP) diagnosis and management of SLE when all content of a clinical case is identical, apart from race and sex.
MethodsWe distributed an online randomized factorial survey from 04/11/2024–06/10/2024 to PCPs across the US. Participants were presented with one of four possible SLE vignettes – Black female, White female, Black male, White male – for which all other clinical content was identical. Block randomization was used to randomly modify the race (Black/White) and sex (female/male) of the SLE “case”. Primary outcomes were correct text-based responses for SLE diagnosis at initial case presentation and after reviewing additional lab results. Secondary outcomes were participants’ review time and planned next steps (treatment, referral, tests) as a proxy for cognitive bias and certainty, respectively. We calculated descriptive statistics for all outcomes stratified by assigned randomized factor and used chi-square tests to evaluate between-group differences.
Results1031 PCPs (42.7% women, mean age 52.1 ± 12.1 years) completed the case. At initial presentation, 63.9% of participants correctly identified SLE as a differential diagnosis. An initial diagnosis of SLE significantly differed by the race and sex of the case (p Conclusion
A patient’s race and sex may influence diagnostic accuracy and clinical decision-making for SLE in primary care. The observed variation in diagnostic accuracy, which aligns with the descriptive epidemiology of SLE, highlights the need for targeted interventions to ensure equitable diagnostic processes.
To synthesise the literature around the roles of general practice nurses (GPNs) and the barriers and facilitators of their role.
Integrative literature review using Whittemore and Knafls framework.
Papers were exported into Covidence for screening. Quality was appraised using the Mixed Method Appraisal Tool. Data were extracted into a summary table and analysed using thematic analysis.
CINAHL, Medline, and Google Scholar were used to identify papers published between January 2000 and February 2025 in English that reported primary research about GPN roles.
Twelve papers were included in the review. The four overarching themes were role characteristics, the clinical role, the non-clinical role, and barriers and enablers. Findings suggest ambiguity surrounding the GPN role, with inconsistent perspectives and overlapping responsibilities contributing to underutilisation. GPNs played an important role in continuity of care and reported a desire to spend more time on health promotion, health education and assessment. GPNs were leaders in collaboration as they functioned as agents of connectivity for patients and staff. The GPN role faces both barriers and enablers, with the organisational structure, interprofessional relationships, and professional development.
The GPN role offers an opportunity to enhance access to general practice care. However, there is limited and mixed literature describing the roles of GPNs. Future research should more closely explore the current practice of GPNs to inform policy and optimal utilisation of the workforce to the full extent of their practice scope.
Understanding the complex roles of GPNs requires more robust data on clinical activity. These data would have the potential to inform ways to optimise the GPN role within the multidisciplinary team.
This study adhered to the PRISMA reporting guideline.
This review did not include patient or public involvement.
To explore how classmate ‘ambassadors’ experienced and engaged in social interaction while visiting a hospitalised peer undergoing cancer treatment.
A phenomenological-hermeneutic inspired exploratory study.
Using on-the-go semi-structured interviews and participant observations from January to December 2023 in Denmark, we included 27 school-aged ambassadors aged 6–18 years old; 18 participated in pre- and post-visit interviews, while all 27 took part in observations during 19 visits. Van Manen's phenomenological-hermeneutic approach guided thematic analysis.
Six themes emerged: (1) visiting the hospital, (2) being supportive, (3) aligning expectations, (4) being unsure, (5) safeguarding the relationship and (6) leaving the hospital. Ambassadors were eager to visit, seeking to be good friends by offering social, emotional and physical support. They were mindful of the information shared to prevent the hospitalised children from feeling excluded. Social interactions often involved allowing the hospitalised children to take on decision-making roles, recognising their well-being as a priority.
Ambassadors found hospital visits meaningful as they wanted to make a difference and sought to support their hospitalised peers. Their role was shaped by their understanding of friendship and the disease trajectory. Social interactions were largely conflict-free due to the pre-visit alignment of expectations.
Classmates found visits meaningful and wished to make a difference. Healthcare professionals should facilitate visits to strengthen social connections between the hospitalised child and their surroundings as a part of family-centred care within paediatric oncology.
Problem: Cancer treatment often causes social disruption for children with cancer, making the transition to everyday life more difficult post-treatment.
Classmates were eager to visit hospitalised peers, demonstrating awareness of cancer and a desire to support them.
Facilitating classmate visits may enhance classmates' understanding of cancer and aid hospitalised children's reintegration into everyday life.
The COREQ checklist was used.
Ambassadors contributed to designing the interview guides.
Enhances knowledge of supporting social relationships between hospitalised children and their classmates during cancer treatment. However, the RESPECT study is rooted in the Danish cultural context, where it is common to attend local volunteer activities after school. Although getting diagnosed with a life-threatening illness such as cancer may be difficult to talk about with peers and even a taboo in some countries, we do expect that interventions with structured possibilities for social interactions are an important step towards normalisation of communicating about childhood cancer.
by Qiaoling Li, Jing Zhang, Shasha Meng, Fengxiang Tian, Qinqin Mei, Hui Wang, Hong Qi
BackgroundSelf-regulated fatigue is often assessed in studies of chronic diseases. Research is needed on the self-regulation of fatigue and physical activity in lung cancer patients undergoing treatment, and the impact of these factors on this population.
ObjectiveThe goal of this study is to investigate the current status, influencing factors, and correlation between self-regulatory fatigue and physical activity in lung cancer patients undergoing comprehensive treatment.
MethodsWe used a convenience sampling method to enroll 188 lung cancer patients admitted to two tertiary hospitals in Chengdu from October 2024 to April 2025. Data were collected using a general information questionnaire and two scales: the Self-Regulatory Fatigue Scale (SRF-S) and The International Physical Activity Questionnaire-long form (IPAQ-L).
ResultsThe mean self-regulatory fatigue score was 42.19 ± 9.06. The total metabolic equivalent (MET) of physical activity was 544.00 (0.00, 1386.00) MET-min/week, with leisure-time activity accounting for 429.00 (0.00, 1188.00) MET-min/week (data presented as median and interquartile range). Significant negative correlations were observed between Self-Regulatory Fatigue total scores and energy expenditure from housework, leisure activities, as well as total physical activity expenditure. Furthermore, self-regulatory fatigue was negatively correlated with both moderate-intensity and low-intensity physical activity, but positively correlated with high-intensity physical activity (P P R² = 0.306).
ConclusionEngaging in appropriate leisure and household activities at moderate-to-low intensity may help alleviate the severity of self-regulatory fatigue in lung cancer patients undergoing comprehensive treatment. Healthcare providers should encourage appropriate activity to reduce the psychological burden and conserve self-regulatory resources.
To characterise long-term trajectory of recovery in individuals with long covid.
Prospective cohort.
Single-centre, specialist post-COVID service (London, UK).
Individuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024.
Routine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of ‘best health’ (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure.
We included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0–346) days since first assessment and 502 (251–825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94–468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00–4.28) and post: HR 1.34 (1.05–1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33–0.42)), myalgia (HR 0.59 (0.45–0.76)) and dysautonomic symptoms (HR 0.46 (0.34–0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased.
In the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery.
This study aims to identify factors associated with early antenatal care (ANC) initiation using a survival analysis approach applied to nationally representative data.
This study used a cross-sectional design based on data from the nationally representative 2022 Bangladesh Demographic and Health Survey. The survey was conducted at the community level across all administrative divisions of Bangladesh. A total of 5128 ever-married women aged 15–49 years who had a live birth within 5 years prior to the survey were included in the analysis. Women with missing or incomplete information regarding the timing of their first ANC visit were excluded from the study.
The primary outcome was early initiation of ANC, defined as the first ANC contact within the first trimester.
The study applied survival analysis methods, including Kaplan-Meier survival curves, log-rank tests and an Accelerated Failure Time model, to assess the determinants of early ANC initiation.
Only 37.9% (95% CI 36.0% to 39.9%) of women in Bangladesh initiated ANC within the first trimester. Early ANC initiation was associated with higher maternal age, education, skilled employment, wealthier households, media exposure, higher decision-making autonomy, higher husband’s education and urban residence. Women who reported that distance to a health facility was not a big problem had initiated ANC earlier than those who considered distance a major barrier. Regional disparities were also evident, with women from Barishal, Chattogram, Rajshahi, Khulna and Rangpur accessing ANC later than those in Dhaka.
Persistent inequalities in early ANC initiation highlight the need for targeted policies to reduce financial barriers, improve healthcare accessibility and strengthen awareness campaigns to ensure equitable maternal healthcare in Bangladesh.
Nasogastric tubes (NGTs) are standard practice in the management of adhesive small bowel obstruction (ASBO). Their insertion can be associated with significant patient discomfort and complications. Current research suggests that patients with ASBO managed with NGTs may experience poorer outcomes and higher rates of operative intervention compared with those managed without. However, to date, there are no prospective clinical trials evaluating this.
This study will be designed as a single centre, prospective, non-inferiority randomised controlled trial to determine if the avoidance of an NGT is non-inferior to its use in ASBO. Patients meeting inclusion criteria will be randomised to either receive an NGT or no NGT for ASBO management. The primary outcome will be the rate of operative intervention as determined by review of medical records at day 30 post discharge. Secondary outcomes will include rate of bowel resection or bowel ischaemia, length of hospital and intensive care unit (ICU) stay, time to operative intervention, rate of ICU admission, incidence of postoperative complications (Clavien-Dindo classification), quality of life scores (European Quality of Life 5 Dimension 5 Level: EQ-5D-5L) at admission, day 30 and day 90, 90-day mortality, incidence of pulmonary complications (Melbourne Group Scale), rate of NGT specific complications and rate of Gastrografin use. The study will be powered at 80% to detect a clinically relevant difference of 10% between groups receiving an NGT compared with no NGT, requiring a total of 490 study participants. Statistical analysis will follow intention to treat principles. Differences between treatment arms will be summarised using mean differences, 95% CIs and p values.
This study has been approved by the Hunter New England Human Research Ethics Committee (2023/ETH00296). Results will be disseminated through peer-reviewed publication and conference presentations.
This study has been registered prospectively in the Australia and New Zealand Clinical Trials Registry (ACTRN12623000341628).
by Priscilla Kapombe, Choolwe Jacobs, Mark W. Tenforde, Kashala Kamalonga, Diane Morof, Terrence Lo, Mweene Cheelo, Lloyd Mulenga, Sombo Fwoloshi, Cordilia M. Himwaze, Patrick Musonda, Mpundu Makasa, Jonas Z. Hines
Zambia has achieved improvements in life expectancy among persons living with HIV (PLHIV) because of high antiretroviral therapy (ART) coverage, which should improve survival due to reductions in AIDS-defining conditions. However, recent estimates of the most common causes of death are not widely available. We utilized mortality surveillance data to report on common causes of death among persons with HIV who died in community settings in Zambia. The Zambian Ministry of Health conducted sentinel mortality surveillance of community deaths in 45 hospitals in 33 of 116 districts from January 2020 through December 2023. Verbal autopsies (VA) were conducted through interviews with relatives or close associates of deceased persons using the 2016 World Health Organization tool. HIV status was reported. A probable cause of death was assigned by a validated computer algorithm (InterVA5). We describe the top assigned causes of death stratified by HIV status. Verbal autopsies were conducted for 67,079 community deaths, of which 11,475 (17.1%) were persons with HIV. The mean age at death was 45 years among persons with HIV and 48 years for persons without HIV (T-test p
This scoping review will evaluate and synthesise what is known about the impact of structural and social determinants of health on neurodegeneration among adults of African American or Black (AAB) racial identity with a history of traumatic brain injury (TBI). The primary objective is to examine how structural factors, such as healthcare access, influence disparities in neurodegeneration following TBI. Given higher rates of TBI and worse outcomes among Black individuals compared with White individuals, this review seeks to fill the gap in research concerning underrepresentation of AAB populations.
Guided by the Joanna Briggs Institute Evidence framework, this review will systematically search PubMed (MEDLINE), Embase and Cochrane CENTRAL Library (Wiley) for relevant studies. Eligible studies will involve adult human participants diagnosed with neurodegenerative conditions, including dementia and cognitive impairment, and with a history of TBI. Studies must include participants of AAB and non-Hispanic White (NHW) racial identity to facilitate comparisons. The review will focus on identifying potential factors contributing to disparities in neurodegeneration. Data synthesis will include narrative summaries, comparative tables and visualisations to highlight racial disparities in neurodegeneration risk and AAB representation in TBI research. This approach is its structured framework will evaluate the depth of racial inclusion across studies, allowing for a more nuanced understanding of how structural and social determinants shape outcomes.
As this review involves only previously published literature, institutional review board approval will not be required. The findings will be disseminated through peer-reviewed publications, conference presentations and lay summaries.
To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).
An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.
All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.
Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.
Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022–31 March 2022). We analysed the risk factors for uncontrolled BP.
Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (
We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.
by Abebe Fenta, Tebelay Dilnessa, Destaw Kebede, Mekuriaw Belayneh, Zigale Hibstu Teffera, Bewket Mesganaw, Adane Adugna, Wubetu Yihunie Belay, Habtamu Belew, Desalegn Abebaw, Bantayehu Addis Tegegne, Zelalem Dejazmach, Fassikaw Kebede, Gashaw Azanaw Amare
BackgroundCo-infection with the human immunodeficiency virus (HIV) and tuberculosis (TB) is a primary cause of death and morbidity. The rate of morbidity and death from TB-HIV is still Ethiopia’s top health issue.
ObjectiveThis study aimed to assess the incidence and predictors of mortality among TB-HIV co-infected individuals on anti-TB and anti-retroviral dual Therapy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
MethodsA retrospective cohort study was conducted at the Debre Markos Comprehensive Specialized Hospital among 436 TB-HIV co-infected individuals. A computer-generated random sampling technique was used to select patient charts registered from September 1st, 2011, and August 31st, 2020. Epi-Data version 3.1 was used for data entry, and STATA version 13 was used for the analysis. The Kaplan-Meier survival curve was applied to estimate the cumulative survival time of the TB-HIV patients. Log-rank tests were utilized to compare the survival time across various categories of explanatory variables. Bi-variable and multivariable Cox proportional hazard models were fitted to find predictors of TB-HIV mortality.
ResultsThe mortality rate of TB-HIV co-infected individuals was 15.6%, with a median survival time of 42 months. Being male (Adjusted hazard Ratio (AHR)1.914;95%CI: 1.022–3.584), having CD4 count Conclusion and recommendation
The mortality rate among TB-HIV co-infected patients at Debre Markos Comprehensive Specialized Hospital was high. Being male gender, having a CD4 count below 50 cells/mm³, being ambulatory and bedridden, having low baseline weight, and having low hemoglobin were the important predictors of mortality. To reduce mortality, it is crucial to focus on the early identification and management of high-risk patients, particularly those with low CD4 counts, poor functional status, and low hemoglobin. Strengthening integrated TB and HIV care services is recommended to improve patient survival outcomes.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
The Munich Security Conference 2024 highlighted the complex connections between climate change and global security risks. Engaging students in fighting climate change is a stepping stone to achieving the Sustainable Development Goals.
To investigate the effect of a video-based climate change program on revitalising eco-cognizance, emotional response, and self-efficacy among nursing students in rural communities.
A randomised controlled trial research design was adopted.
A total of 140 nursing students completed a survey related to the Climate Change Perceptions, the Climate Change Anxiety Scale, and the Environmental Self-Efficacy Scale. The study group engaged in the video-based climate change program, while the comparison group received flyers related to climate change across the globe.
The intervention group significantly improved climate change perception and environmental self-efficacy compared to the control group, with large effect sizes. On the other hand, significantly lower levels of cognitive impairment due to climate change anxiety were recorded among the intervention group compared to the control group.
Our intervention improved nursing students' climate change literacy, pro-environmental attitudes, environmental self-efficacy, and anxiety. Future research may target a variety of university majors and use RCTs nested in a mixed-method design to capture the student experience with climate change before and after the RCT.
This study demonstrated that a comprehensive educational program significantly improved climate literacy, pro-environmental attitudes, and environmental self-efficacy among undergraduate nursing students while reducing climate anxiety. The findings of this study offer valuable insights for enhancing student nurses' ability to translate their scientific understanding into informed decision-making regarding issues like climate change.
Drastic natural disasters, including extreme temperatures, flooding, wildfires and snow and sandstorms, significantly affect populations, including nursing students. Early screening and management of climate change anxiety among university students is recommended as a buffer against upcoming mental health issues. Student counselling services are urged to consider the effect of climate change as a mental health parameter that significantly affects students' psychological and, consequently, academic life and progress. A video-based climate change program (VBCCP) is beneficial for equipping students with climate change literacy. The revitalization of the participant's overall eco-emotional response, pro-environmental behaviour and cognizance signalled the potential of VBCCP as a simulation teaching tool that might be integrated into nursing curriculums. Additionally, VBCCP is a cost-effective strategy that complies with International Nursing Association for Clinical Simulation and Learning (INACSL) requirements. The VBCCP can be delivered in the conventional classroom environment or through the digital platform without incurring additional costs and in alignment with the definition of simulation provided by the Agency for Healthcare Research and Quality.
No public or patient contributions.
RCT registration: NCT06223412, on 23rd January 2024
by Chalachew Genet, Wendemagegn Enbiale, Anna Rommerskirchen, Rajiha Abubeker, Wudu Tafere, Tsehaynesh Gebre-Eyesus, Michael Getie, Alem Tsega, Muluken Acham, Addisu Melese, Tewachew Awoke, Wondemagegn Mulu, Degu Ashagrie, Tadele Amsalu, Achenef Motbainor, Endalew Gebeyehu, Mulugeta Kibret, Bayeh Abera, Endalkachew Nibret, Abaineh Munshea
IntroductionExtended spectrum β-lactamase (ESBL) and carbapenemase-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) emanating from raw cow milk are among the leading contributors to the spread of antimicrobial resistance (AMR). Due to the misuse and overuse of antibiotics in dairy farms, cow’s milk has become a reservoir of ESBL- and carbapenemase-producing E. coli and K. pneumoniae posing a growing public health threat, especially in areas where the consumption of raw milk is common. However, compared to the clinical sector, the prevalence of ESBL- and carbapenemase-producing E. coli and K. pneumoniae in the food sector is under-studied.
ObjectiveThis study aimed to determine the prevalence of ESBL and carbapenemase-producing E. coli and K. pneumoniae in raw bulk cow milk from Dairy Cooperatives in Northwest Amhara, Ethiopia.
MethodsA cross-sectional study was conducted from January to April, 2025 among 257 dairy cooperative member farms. Sociodemographic and related data were collected using a structured questionnaire. Five milliliters of raw bulk cow milk were collected aseptically from each farm in four Dairy Cooperatives (DCs) (DC-A to D). 10 microliters of milk sample were directly inoculated into MacConkey agar. Escherichia coli and K. pneumoniae were identified using standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. ESBL and carbapenemase production were confirmed phenotypically via combination disk tests and modified carbapenem inactivation methods, respectively.
ResultsThe prevalence of E. coli and/or K. pneumoniae in raw cow milk was 21% (95% CI, 16.5–26.4%), with respective individual prevalence of 8.2% and 14.8%. ESBL-producing E. coli and K. pneumoniae accounted for 23.8% and 15.8% of isolates, respectively, while 2.6% of isolates (only K. pneumoniae) were carbapenemase producers. Resistance to ampicillin and amoxicillin-clavulanic acid exceeded 70%. All E. coli and 94.7% of K. pneumoniae isolates remained susceptible to carbapenems. Nearly half of all isolates (45.8%) were multidrug resistant (MDR), and 51.9% of MDR isolates were co-resistant to at least six antibiotics. Having additional non-farming occupations (AOR: 4.17, 95% CI: 1.49–11.67), large herd size (AOR: 3.21, 95% CI: 1.26–8.18), having pet animals (AOR: 6.53, 95% CI: 1.39–30.7), and use of calabash milk pail (AOR: 7.37, 95% CI: 1.45–37.49) were significantly associated with milk culture positive result for E. coli and/or K. pneumoniae.
ConclusionRaw milk in Northwest Amhara harbors ESBL and carbapenemase-producing E. coli and K. pneumoniae posing a substantial public health risk coupled with MDR and resistance to critically important antimicrobials. Strengthened AMR surveillance, improved farm hygiene, restricted antibiotic use, and public education on milk safety are urgently needed.
Improving global access to pain management medications for cancer patients remains a critical priority. Nurses are now understood to play an essential role in cancer pain medication management, yet the barriers and facilitators they encounter require urgent identification.
This systematic review aimed to identify the barriers and facilitators for nurses in managing cancer pain medication.
This systematic review followed the Joanna Briggs Institute (JBI)'s guidelines for qualitative systematic reviews.
Eleven databases (PubMed, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, OPENGREY.EU, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed) were searched from their inception to 9th July 2025. Articles were evaluated for quality using JBI critical appraisal tools. Data extraction was performed according to JBI standardised protocols, and evidence synthesis was conducted using JBI meta-aggregation, which involved extracting findings, categorising them into thematic groups and synthesising them into comprehensive statements.
Twenty-four qualitative studies were reviewed in the present study. Two synthesised findings regarding the barriers and facilitators for nurses in managing cancer pain medication were integrated: (1) Barriers for nurses to manage cancer pain medication were summarised into five categories: systemic barriers, resource barriers, knowledge and skills barriers, financial and cultural barriers and communication and psychological barriers; (2) Facilitators for nurses to manage cancer pain medication were summarised into three categories: nursing capacity building, supportive care environments and collaborative support systems.
Multilevel barriers impede nurse-led cancer pain management, necessitating policy reforms (e.g., tiered prescribing), investments in telehealth/training and culturally responsive interprofessional collaboration. Prioritising facilitators, capacity building, supportive environments and collaboration is vital to empower nurses in delivering equitable, evidence-based pain relief.
This review equips clinical managers and policymakers with evidence to implement policy and practice reforms, such as tiered prescribing and interprofessional collaboration, which are critical to empower nurses in delivering effective cancer pain management.
This systematic review was prospectively registered in PROSPERO prior to the initiation of the search (Registration ID: CRD42024570807).
There was no patient or public contribution.
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