Conectar
by Aline Veras Morais Brilhante, Christina César Praça Brasil, Raimunda Magalhães da Silva, Marjan Askari, Luciana Andrade da Mota Sampaio, Jonas Loiola Gonçalves, Layane Sabóia, Lucas Alessandro Macedo Cruz, Helena Rodrigues Dias, Luciel Almeida Cavalcanti, Maria Julya Albuquerque Parente, Mariana Tavares Rocha, Melania Maria Ramos de Amorim
Autistic women experience increased obstetric and perinatal risks, partly driven by communication barriers within maternity care. Evidence on how these barriers are experienced in low- and middle-income countries remains scarce. This study aimed to analyze communication barriers in perinatal care based on narratives of autistic women who experienced pregnancy, childbirth, and postpartum care in Brazil. A qualitative study was conducted using the Hermeneutic-Dialectic Circle (HDC) approach. Thirty-four autistic women (22 with support level 1 and 12 with support level 2, including three non-speaking participants with complex communication needs) were recruited through convenience sampling, supplemented by active recruitment through participant referral, and participated in semi-structured interviews conducted in multiple accessible formats (video call, real-time messaging, in-person, and augmentative and alternative communication). Data were analyzed using constant comparative methods within the hermeneutic-dialectic framework, guided by the social model of disability and the neurodiversity paradigm. Three central categories were constructed: (1) communicational demands of autistic women and their non-recognition, including alexithymia, sensory hypersensitivity, and need for predictability; (2) institutional and interpersonal communication failures, encompassing symptom invalidation, disrespectful care, and exclusion of non-speaking women; and (3) experiences of respectful and effective communication, demonstrating that adapted strategies promote safety and autonomy. Participants’ narratives indicate that communication barriers in perinatal care for autistic women operate systemically rather than individually. Training healthcare professionals and implementing accessible communication strategies are essential to promote respectful, safe, and inclusive maternity care.
Risk screening for pre-eclampsia relies on accurate gestational age assessment, but routine access to ultrasound-based gestational dating remains challenging in many low- and middle-income countries. As part of the formative work for the ‘Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening’ (PEARLS) platform, we aim to validate and implement an artificial intelligence (AI)-based algorithm for estimation of gestational age, using blind sweeps done with a handheld ultrasound device. This study protocol outlines the accuracy cohort for AI-based gestational age estimation in participating facilities in Ghana, Kenya and South Africa.
This multicountry prospective cohort study will recruit 969 pregnant women at 13 health facilities across Kenya, Ghana and South Africa. The eligible population is pregnant women presenting for antenatal visits from 11+0 to 13+6 weeks’ gestation. Eligible women will have a gestational age assessment by a trained sonographer using fetal biometry (reference standard), followed by gestational age estimation conducted by a trained midwife using the AI-based Intelligent Ultrasound ScanNav FetalCheck system (experimental). Both conventional and AI-based gestational age scans will be conducted with the General Electric VScan Air platform. Women will return for a second visit between 14+0 and 27+6 weeks’ gestation (week of visit is randomly selected) for an assessment with both conventional and AI-based ultrasound. The primary objective is to determine the accuracy and precision of gestational age estimation using an AI ultrasound system in first and second trimesters, as compared with gestational age estimation using crown-rump length measurement by conventional ultrasound in first trimester (11+0 to 13+6 weeks’).
This study has received or sought ethics approval from the following entities: Australia: University of Melbourne, Office of Research Ethics and Integrity (Reference Number: 2024–28489-49438-3) and the Alfred Hospital Ethics Committee (Reference: Project 727/23); Ghana: Ghana Health Service Ethics Review Committee (GHS-ERC Number 002/01/24); Kenya: Kenyatta National Hospital, University of Nairobi ERC (Ref: KNH-ERC/01/MISC/20); South Africa: University of Cape Town, Faculty of Health Science, Human Research Ethics Committee (HREC Ref: 138/2024). Key findings will be disseminated to research teams to inform future scale-up of AI-based pregnancy dating and pre-eclampsia risk screening. Findings from this pilot work will be published in peer-reviewed open-access journals, conferences and meetings to maximise reach of our findings.
To evaluate the accuracy of the Emergency Severity Index (ESI) assignments by GPT-4, a large language model (LLM), compared to senior emergency department (ED) nurses and physicians.
An observational study of 100 consecutive adult ED patients was conducted. ESI scores assigned by GPT-4, triage nurses, and by a senior clinician. Both model and human experts were provided the same patient data.
GPT-4 assigned a lower median ESI score (2.0) compared to human evaluators (median 3.0; p < 0.001), suggesting a potential overestimation of patient severity by the LLM. The results showed differences in the triage assessment approaches between GPT-4 and the human evaluators, including variations in how patient age and vital signs were considered in the ESI assignments.
While GPT-4 offers a novel methodology for patient triage, its propensity to overestimate patient severity highlights the necessity for further development and calibration of LLM tools in clinical environments. The findings underscore the potential and limitations of LLM in clinical decision-making, advocating for cautious integration of LLMs in healthcare settings.
This study adhered to relevant EQUATOR guidelines for reporting observational studies.
by Jargalmaa Amarsanaa, Trinh Xuan Thi Nguyen, Mostafa Saidur Rahim Khan, Yoshihiko Kadoya
BackgroundConcerns about increased loneliness during the COVID-19 pandemic have been widely reported. However, long-term trajectories of loneliness remain insufficiently described.
ObjectiveTo examine annual trends and five-year transition patterns of loneliness in Japan from 2020 to 2024 using data from a nationwide online panel.
MethodsWe analyzed data from 1,673 adults who participated in all five annual survey waves from 2020 to 2024 and had complete information on the variables used in the analysis. Loneliness was measured using the three-item UCLA Loneliness Scale. Descriptive statistics were used to estimate annual prevalence and five-year transition patterns. Sensitivity analyses were conducted using a stricter loneliness threshold.
ResultsThe prevalence of loneliness peaked in 2021, declined in 2022, and remained relatively stable from 2022 to 2024. Most respondents demonstrated stable trajectories over five years, either consistently reporting loneliness or consistently not reporting loneliness. A smaller proportion exhibited transient loneliness during the pandemic period. Under the stricter loneliness threshold, the 2021 peak and the predominance of stable over transitional sequences were preserved, although the ranking of specific sequences changed.
ConclusionsAmong respondents retained in this five-wave online panel, loneliness prevalence peaked in 2021, declined in 2022, and remained relatively stable from 2022 to 2024. Stable trajectories were more common than transitional trajectories. These findings provide descriptive evidence on long-term loneliness patterns but should not be interpreted as nationally representative prevalence estimates.
Critical congenital heart disease (CHD) is associated with neurodevelopmental disorders, recognised as the most common long-term morbidity in affected children. In critical CHD, that is, CHD requiring cardiac surgery within the first 3 months of life, 30%–50% of children have lower developmental scores. Therefore, early identification of at-risk infants is crucial, yet there is no scientifically evaluated care programme in France. This study aims to evaluate early neurodevelopmental status in infants with prenatally diagnosed critical CHD and to determine how intrinsic susceptibility, prenatal and postnatal factors are functionally associated with developmental delay in this population.
Caractérisation et Accompagnement des Troubles du neurodéveloppement Associés aux MAlfoRmations cArdiaques coNgénitales (CATAMARAN) is a prospective, multicentre cohort study including 150 fetuses with critical CHD and their parents across eight French tertiary CHD centres. The primary objective will be to estimate the proportion of developmental delay at 6 months using the Bayley Scales of Infant and Toddler Development. Secondary objectives will include exploring potential prenatal, perinatal, perioperative determinants of developmental delay. Data collection will span pregnancy to 6 months of age including clinical assessments, maternal questionnaires (stress and nutrition), multimodal imaging and extensive biobanking (placenta, cord and peripheral blood, stool samples). To explore potential genetic and other multi-omic factors involved in the occurrence of a developmental delay, a case-control analysis will be conducted within the cohort.
Clinical and biological data will be collected through a secure system, with anonymised samples analysed in specialised facilities under collaborative agreements. Data confidentiality, traceability and long-term storage are ensured through controlled access and audit trails. Study results will be published and shared with families and the public through the patient association Petit Coeur de Beurre. This study received approval from a French ethics committee in November 2024 (no. 2024-A00425-42).
by Justin Clements, Jenna E. Stanek, Kylie Gallegos, Jessica Celmer, Jesse Berryhill, Andrew Thiros, Mark A. Peyton, Shannon M. Gaukler
Polychlorinated biphenyls (PCBs) are a group of industrial chemicals that were widely used in the United States before being banned by the Toxic Substances Control Act in 1976. Concerns regarding PCBs arose in the 1960s due to their toxicity, classification as a carcinogenic compound, and longevity in the environment. Although the production of PCBs in the United States is currently banned, PCBs can still be found in legacy equipment, and the environment and PCBs are still unintentionally produced in common building materials. To document the concentration of PCBs in biota predominantly found in northern New Mexico, biota (mammalian, avian, and reptilian) were opportunistically collected from 2009 to 2025. We grouped biota species into feeding guilds (carnivore, herbivore, and omnivore) to examine whether different feeding guilds had higher or lower proportions of total PCBs, PCB homologs, dioxin-like PCB congeners, and toxic equivalents. When we examined the concentrations of PCB homologs and total PCBs, we found the highest abundance of PCBs in the carnivore feeding guild compared with both herbivores and omnivores. We also observed differences of dioxin-like PCB congeners among feeding guilds, examined in this study. Toxic equivalents were also observed at higher values in carnivores. Furthermore, we demonstrate the biomagnification of PCBs across trophic levels, with higher concentrations observed in mountain lions relative to their primary ungulate prey (mule deer and elk). A comparison of biota revealed a significant difference in concentrations of PCBs found in samples (mule deer and elk) collected in developed areas when compared with rural locations, with the developed areas having higher concentrations. Our investigation provides significant insight into the distribution, composition, and biomagnification of PCB in terrestrial animals in New Mexico, including the biomagnification of PCBs within the carnivore feeding guild, which could be at a higher risk of adverse effects from PCB exposure.
Chronic back pain (CBP), defined as back pain persisting for more than 3 months, is highly prevalent and associated with substantial socioeconomic burden and impaired quality of life. Pain catastrophising is an important cognitive-affective factor in the maintenance of CBP and may fluctuate in daily life. Conventional treatment approaches often do not address these momentary dynamics. Just-in-time adaptive interventions (JITAIs) deliver tailored support at opportune moments based on time-varying information and may therefore complement existing treatments for CBP. In this study, ecological momentary assessment (EMA) is used to capture momentary pain-related states and guide the delivery of adaptive microinterventions. To our knowledge, no JITAI specifically targeting pain catastrophising in CBP has yet been evaluated in a randomised controlled trial.
This pragmatic, two-arm randomised controlled trial will compare a JITAI with enhanced treatment as usual (TAU+). A total of 100 participants will be recruited to obtain an evaluable sample of 86 participants. Eligible participants are adults with CBP persisting for more than 3 months and an average pain intensity over the previous week of at least 3 on a 0–10 Numerical Rating Scale. Participants in the intervention group will receive app-based, adaptive microinterventions, such as relaxation exercises and physical activities triggered by EMA responses on pain catastrophising and pain intensity. Participants in the TAU+ group complete the same EMA assessments but will not receive adaptive micro-interventions. The primary outcome is reduction in pain catastrophising, assessed with the Pain Catastrophizing Scale. Secondary outcomes include pain intensity, pain interference, pain behaviour, pain quality, physical functioning, anxiety, depression, fatigue, sleep disturbance, social participation, fear-avoidance beliefs, pain-related self-efficacy and treatment satisfaction. Primary and secondary outcomes will be analysed using between-group comparisons according to the intention-to-treat principle. Exploratory analyses will examine proximal, short-term effects of microinterventions using dynamic structural equation modelling. Assessments will be conducted at baseline before randomisation (T0), mid-treatment 2 weeks after intervention start (T1), end of treatment 4 weeks after intervention start (T2) and at 3 months (T3) and 6 months (T4) after end of treatment.
This study has been approved by the Ethics Committee of the Charité Universitätsmedizin Berlin (approval number: EA4/207/21, 18 October 2021). Results will be submitted for publication in peer-reviewed journals and presented at conferences.
DRKS00028494.
To scope and synthesise qualitative literature relating to nurses' experiences of providing care to consumers with alcohol and other drug issues and explore how meaning is constructed in practice.
Scoping review.
A scoping review was conducted following Arksey and O'Malley's framework. Findings were analysed using thematic analysis.
Systematic searches were conducted between September and November 2025 across Medline, Emcare, CINAHL and Google Scholar, using controlled vocabulary and keywords relevant to nurses' experiences of providing care to consumers with alcohol and other drug issues.
Twenty-four studies from 12 countries were included. Seven themes were identified: emotional aspects of care, education, training and skills in practice, the spectrum of stigma, ethical issues in professional practice, navigating pain management, limited support, and how meaning is constructed in practice.
Nurses' experiences of providing care to consumers with alcohol and other drug issues are shaped by multiple intersecting factors influencing care delivery and professional practice. Further research is needed to examine how workplace culture, language and interpersonal interactions influence healthcare experiences, and inform education, service development and support needs.
Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.
No patient or public contribution.
The incidence of cancer is increasing across all age groups including children. This disease and its costly treatment affect not only the patient but their entire family—especially parents as primary caregivers—leading to psychological distress, physical exhaustion and financial strain. Social support serves as a vital protective factor for parents facing their child’s cancer diagnosis. As a complex, context-dependent phenomenon emerging from social interactions, its process requires exploration within diverse cultural settings. Thus, this study aims to explain the process of social support for parents of children with cancer in the sociocultural context of Iran.
This protocol outlines a qualitative study using grounded theory design. Data will be collected via semi-structured interviews. Parents of children with cancer will initially be selected through purposive sampling. Subsequent participants will be recruited via theoretical sampling to fully develop emerging concepts and theory dimensions. Sampling will continue until conceptual and theoretical saturation is achieved. Data analysis will follow Corbin and Strauss’s (2015) constant comparative method, using MAXQDA V.2022 software.
Ethical approval was obtained under the code IR.UMSU.REC.1403.129. Written informed consent will be obtained from all participants before data collection. Study findings will be shared through presentations at national conferences, publication in peer-reviewed journals and dissemination of results to participating centres and interested participants.
Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated diarrhoea in adults, with recurrence rates of 15%–25% after a first episode and up to 65% after multiple recurrences. Recurrent CDI leads to significant morbidity, diminished quality of life, prolonged antimicrobial exposure and increased healthcare utilisation. Faecal microbiota transplantation (FMT) demonstrates high efficacy for multiple recurrent CDI, but its benefit when used earlier—after the first episode in high-risk patients or first recurrence—remains insufficiently studied. Emerging evidence suggests early FMT may improve sustained clinical cure rates and reduce recurrence. This trial evaluates whether early introduction of oral FMT following standard therapy improves outcomes compared with standard therapy alone.
This is a multicentre, randomised, open-label, pragmatic phase III superiority clinical trial conducted across eight Swiss clinical centres. A total of 100 adults will be enrolled. Patients with either (1) a first CDI episode and risk factors for recurrence or (2) a first CDI recurrence and who first receive the real-world standard of care anti-CDI antibiotics (10 days of vancomycin or fidaxomicin) are randomised 1:1 to oral FMT following standard antibiotic therapy or standard therapy alone. The intervention group receives within 12 hours to 4 days of the last antibiotics administration, 15 to 20 oral FMT capsules twice on two consecutive days if the CDI is non-severe; those with severe CDI receive an additional 2-day FMT course. The control group does not receive any additional treatment after completing the 10 days of standard therapy. The primary endpoint is the proportion of patients having experienced a CDI recurrence at 8 weeks post completion of treatment (assessed per-protocol and intention-to-treat). Secondary outcomes include early and late recurrence rates, sustained cure at 6 and 12 months, quality-adjusted life years, recurrence-free and overall survival at 12 months. Exploratory analyses include microbiota diversity, biomarker identification and assessment of immunologic and microbial predictors of recurrence. Safety/tolerability is also assessed.
The study will be conducted in accordance with International Council for Harmonisation Good Clinical Practice, the Declaration of Helsinki and Swiss regulatory standards. Results will be disseminated through peer-reviewed publications and conference presentations.
Cardiovascular disease is a leading cause of death worldwide, of which coronary artery disease is the most common form. Sudden cardiac death (SCD) is a serious complication following acute myocardial infarction (MI), accounting for the highest percentage of all deaths in this population. Currently implantable cardioverter-defibrillators (ICDs) provide an acceptable method of primary prevention of SCD. However, the current literature is heterogeneous with regard to studies evaluating the benefits of ICDs for the primary prevention of SCD after MI, particularly relating to the timing of ICD implantation, risk stratification of patients for ICD implant selection and reporting non-rhythmic deaths after ICD implantation.
A meta-analysis will be performed to estimate the pooled effect size of randomised controlled trials (RCTs) examining the relationship between prophylactic transvenous ICD (TV-ICD) implantation and other medical therapies for primary prevention of SCD after MI. A comprehensive literature search and review will be performed using electronic medical databases including Scopus, Ovid MEDLINE, EMBASE (Ovid Platform), Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ProQuest (Health and Medicine) and CINAHL (EBSCO) from January 1980 to June 2025. The literature search will be limited to peer-reviewed original studies carried out in human subjects and published in English. Type of study design will be limited to RCTs. The systematic review and meta-analysis will be developed according to the Joanna Briggs Institute Manual for Evidence Synthesis (2024 edition) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 guidelines. Data analysis will be performed according to a structured and predetermined analysis plan. The primary outcome of the study will be all-cause-mortality, for which Hazard Ratios (HRs) will be reported as a measure of effect with 95% CI. Based on data availability, subgroup analysis will be carried out. The effect sizes will be reported based on a random effects model.
This systematic review and meta-analysis will evaluate and provide primary evidence for the effectiveness of prophylactic implantation of TV-ICDs on all-cause mortality in patients who experienced MI, aiming for primary prevention of SCD after MI. The primary prevention of SCD after MI is an important goal to reduce community incidence of out-of-hospital cardiac arrests, improving patient survival rates and their quality of life after MI. Out-of-hospital cardiac arrests currently have a survival rate of less than 10% and could result in long-lasting neurological damage in those who survive.
CRD42023456995.
To compare the diagnostic accuracy of four available automated electronic medical record (EMR) retrieval methods, including a large language model (LLM)-assisted workflow, against manual chart adjudication for identifying cardiovascular events.
Retrospective diagnostic accuracy study.
Three sites within a single US tertiary health system.
Two adult cohorts with previously adjudicated cardiovascular outcomes were included. Cohort 1 included 2258 patients treated with immune checkpoint inhibitors, and Cohort 2 included 1426 patients who underwent transcatheter aortic valve replacement.
The reference standard was clinician manual chart adjudication. Outcomes included ischaemic stroke or transient ischaemic attack, myocardial infarction (MI), heart failure (HF) exacerbation or hospitalisation and a composite major adverse cardiovascular events (MACE) outcome. Automated retrieval methods included International Classification of Diseases (ICD) codes, primary diagnosis, problem list and a zero-shot LLM workflow. Area under the (receiver operating characteristic) curve (AUC), sensitivity, specificity and net reclassification improvement were assessed.
In Cohort 1, the LLM achieved the highest AUC for stroke (0.920; 95% CI 0.881 to 0.958), MI (0.938; 95% CI 0.905 to 0.971) and composite MACE (0.880; 95% CI 0.854 to 0.907), whereas ICD-based retrieval had a higher AUC for HF (0.882; 95% CI 0.845 to 0.918 vs 0.873; 95% CI 0.831 to 0.914). In Cohort 2, the LLM achieved the highest AUC for all evaluated outcomes: stroke (0.915; 95% CI 0.862 to 0.968), MI (0.928; 95% CI 0.839 to 1.000), HF (0.844; 95% CI 0.803 to 0.884) and composite MACE (0.862; 95% CI 0.829 to 0.895). In Cohort 1, differences in AUC between the LLM and ICD methods were not statistically significant across outcomes, whereas in Cohort 2 the LLM showed significantly higher AUC for stroke and composite MACE.
In this multisite retrospective validation study, the LLM-assisted workflow showed strong but context-dependent performance for identifying cardiovascular events from the EMR. Performance varied by outcome and cohort, and ICD-based retrieval remained competitive for some use cases. These findings support a complementary role for LLM-assisted extraction in retrospective cardiovascular outcomes research.
This study aims to investigate the association between hourly nitrogen dioxide (NO2) concentrations and emergency hospital admissions for adult patients with asthma in the Birmingham–Solihull metropolitan area, West Midlands, UK.
A time-series study.
The study was conducted in the Birmingham–Solihull metropolitan area, West Midlands, UK.
Adult patients with asthma (aged ≥16 years at the time of admission) from 1 June 2016 to 31 May 2022 residing in Birmingham and Solihull, West Midlands.
We analysed the hourly rate of emergency hospital admissions for acute asthma. A Poisson generalised additive model combined with the distributed lag non-linear model was applied to assess the association between hourly NO2 concentrations and hourly counts of hospital admissions for acute asthma. Furthermore, the effect modification of the NO2-asthma association in specific participant groups, such as sex, deprivation index and ethnicity, was explored in stratified analyses.
The study included 18 943 adults with asthma exacerbations who attended the four acute hospitals in the study area during the study period. The study observed a significant positive association between hospital admissions for acute asthma and hourly NO2 concentrations. The mean NO2 exposure (18 µg/m3) over a lag of 0–24 hours was associated with a 13% (RR=1.13, 95% CI 1.01 to 1.26) increase in the risk of daytime emergency hospital admissions for acute asthma in comparison with no exposure. The results show a significant association between NO2 exposure and hospital admissions for a lag of 3–6 hours. Furthermore, subgroup-specific analysis indicated a higher positive risk associated with hourly NO2 among patients living in the most deprived areas.
This study strengthens the evidence for the importance of using high-temporal resolution air pollution data to examine impacts on health, particularly where there are marked temporal patterns in exposure. Understanding these exposure–response relationships will improve healthcare preparedness and resource allocation in relation to air pollution levels.
Atrial fibrillation (AF), a common arrhythmia, is associated with impaired quality of life and increased stroke risk and mortality. Clinical guidelines recommend leveraging digital technologies to support patient education and AF self-management. Conversational artificial intelligence (AI) technologies may support patient engagement with self-management by enabling human-like conversations. This study aims to evaluate the effectiveness of a conversational AI intervention (Conversational artificial intelligence HeAlth supporT in Atrial Fibrillation Self-Management (CHAT-AF-S)) in improving quality of life in patients with AF.
CHAT-AF-S is a 3-month randomised controlled trial with 1:1 allocation and embedded process evaluation. We will randomise 480 adults (aged 18 years and older) with documented AF to the CHAT-AF-S intervention or usual care. Primary outcome is the Atrial Fibrillation Effect on QualiTy-of-life overall score. We will follow the intention-to-treat principles and data analysts will be blinded. Intervention participants will be invited to complete a user experience survey and take part in an interview to explore the feasibility, acceptability, perceived use and barriers and enablers to implementing the intervention. Qualitative data will be analysed thematically.
Ethics approval was obtained from the Western Sydney Local Health District Human Ethics Research Committee (2023/ETH00765). Written and informed consent will be obtained from all study participants before commencing any study procedures. Results will be disseminated via peer-reviewed publications and presentations at international conferences.
Australian New Zealand Clinical Trials Registry (registration number: ACTRN12623000850673).
To investigate the associations between the use of epidural analgesia (EA) and intrapartum care, labour, birth and neonatal outcomes in uncomplicated pregnancy low-risk women, to inform evidence-based intrapartum practices and support informed maternal choice.
Retrospective cohort study.
Single maternity hospital in Northern Italy.
A total of 3406 uncomplicated pregnancy low-risk women who gave birth between 2019 and 2023 were included. Participants were grouped according to whether they received EA (n=417) or not (n=2989).
Labour progression, intrapartum care practices, maternal and neonatal outcomes were evaluated according to exposure to EA. Associations between EA and the study outcomes were assessed using descriptive and inferential statistics and multivariable logistic and linear regression analyses, adjusted for maternal age, parity and other outcome-specific confounders.
Women receiving EA experienced higher rates of prolonged first and second stage of labour (adjusted OR (aOR) 24.3 and 5.0, 95% CI 17.8 to 33.6 and 3.8 to 6.6, respectively), amniotomy and oxytocin use (aOR 7.7 and 17.8, 95% CI 5.7 to 10.6 and 12.9 to 24.6, respectively), caesarean section (aOR 7.2, 95% CI 3.1 to 17.1), lithotomy position at birth (aOR 2.3, 95% CI 1.7 to 3.0) and urinary retention (aOR 6.0, 95% CI 3.1 to 11.5). No differences were observed in neonatal outcomes.
In uncomplicated pregnancy low-risk women, EA during active labour was associated with increased rates of clinical interventions and altered labour patterns, with no differences in neonatal outcomes. These findings underscore the importance of the midwife’s role in promoting physiological labour while ensuring effective pain management.
To understand nurses' perceptions of non-technical skills in recognising and responding to clinical deterioration in hospital settings.
A mixed methods systematic review was undertaken, guided by the Joanna Briggs Institute Manual for Evidence Synthesis.
A systematic search of the primary research literature published between 2012 and October 2025 was undertaken. A convergent integrated approach to synthesis, without meta-analysis, was undertaken.
The MEDLINE, CINAHL, Scopus, PsychInfo and Embase electronic databases were searched. Reference lists of full-text articles retrieved were reviewed for additional data sources.
Twenty-four primary studies were included. Narrative synthesis resulted in six main themes: (1) situational awareness, (2) effective teamwork and communication, (3) leadership and culture, (4) intuition, (5) level of experience and (6) fear of retribution. Across studies, supportive team culture and strong communication facilitated recognition and escalation, whereas inexperience and fear of criticism delayed action.
Early recognition and response to a clinical deterioration is beyond simply detecting physiological parameters. The process of recognition and response to a deterioration is enabled due to non-technical skills. In situations where the team has effective and positive team culture, where there is psychological safety, where all levels of expertise are given a voice without fear of retribution, everyone is safe to raise the alarm. Strengthening these skills and supporting junior nurses may improve escalation practice.
The implementation of early warning scores or rapid response systems is a well-developed mechanism to improve outcomes for deteriorating patients. Unfortunately, there has been less emphasis and value placed on development of non-technical skills in the recognition and response to clinical deterioration. Organisations and professions need to mitigate barriers to the implementation of nurses' non-technical skills to improve patient outcomes.
What problem did the study address? ○
A lack of current synthesised evidence of nurses' non-technical skills in the recognition of, and response to, clinical deterioration.
What were the main findings? ○
Organisational cultures that devalue less experienced nurses and non-technical skills, risk delays in recognition and response to clinical deterioration.
Where and on whom will the research have an impact? ○
Patients, health care professionals and health care delivery may benefit from integration of non-technical skills into deterioration response frameworks, implemented within psychologically safe organisational cultures.
Reporting Method
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (2020).
Patient or Public Contribution
No patient or public contribution. This review received no financial support.
Trial Registration
The protocol for this review was registered with PROSPERO (CRD42022327788) (crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327788)
by Jenny Paola Alfaro-García, Julieta María Ramírez-Mejía, Paola Rojas-Estevez, Diego Alejandro Álvarez-Díaz, Geysson Javier Fernández, Carlos Alberto Orozco-Castaño, Boris Anghelo Rodríguez-Rey, Juan Carlos Gallego-Gómez, Miguel Vicente-Manzanares
Dengue virus (DENV) represents a growing global health challenge with billions of people at risk. Severe Dengue (SD), a complication of DENV infection that involves generalized hemorrhage, is driven, at least in part, by endothelial dysfunction. Endothelial dysfunction refers to increased permeability due to inflammation, mechanical injury and/or modification of the genetic program of endothelial cells. Previous work showed that exposure of endothelial cells to conditioned media from DENV-infected cells (CMDV) increased permeability and cellular stiffness, repressed endothelial markers and induced mesenchymal genes. However, the generality, extent, mechanism and ultimate impact of these events in the onset of SD remain elusive. Here, we integrate analysis from in vitro treatment of endothelial cells with media containing UV-inactivated DENV with computational modeling to investigate the key features of CMDV-induced endothelial alterations and their potential impact on endothelial dysfunction. We found that CMDV increased SNA1 and CDH2 expression, while suppressing endothelial genes OCLN and CDH5. Global transcriptomics analysis revealed that CMDV triggered a transient pro-inflammatory response, followed by induction of selected tissue repair genes and matrix remodeling. A non-directed asynchronous network model (NDAM-CMDV) identified IL6 and FN1 as central nodes of DENV-induced endothelial trans-differentiation, providing new molecular insights that predict the evolution of the disease and identify potential therapeutic targets.
FreshRSS