Conectar
Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.
To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.
The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.
MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs—including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps—will be assessed using area under receiver operating characteristic curves and 95% CIs.
MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.
MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.
This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.
Minimally invasive endoscopic procedures constitute the cornerstone of first-line treatment for bulbar urethral strictures, although their long-term effectiveness is limited by high recurrence rates. The Optilume drug-coated balloon (DCB) is a novel intervention combining mechanical dilation with localised delivery of paclitaxel to reduce recurrence by inhibiting scar tissue formation. While its efficacy has been demonstrated in patients with recurrent strictures, its potential as a first-line option in treatment-naïve patients remains unexplored. The FIRST-CARE trial aims to assess the efficacy and safety of Optilume DCB compared with standard endoscopic treatment in treatment-naïve patients with bulbar urethral strictures.
Design: Two-arm, randomised, single-blind (participant), investigator-initiated, parallel-group, multicentre clinical trial. Patients: The study will enrol 140 adult male patients with treatment-naïve, single bulbar urethral strictures ≤3 cm in length. Interventions: All patients will undergo the assigned procedure under general anaesthesia with 1.5 g intravenous cefuroxime. Optilume group patients will receive ≥5 min balloon dilation with localised paclitaxel delivery. The control group will receive standard endoscopic treatment (eg, direct visual internal urethrotomy, laser or dilatation). In both groups, a 12–14 French Foley catheter will be left in place for 3–5 days. Primary outcome: Freedom from repeat intervention within 12 months of follow-up. Primary analysis: Time-to-event will be defined from the date of intervention to the date a repeat intervention is decided (indicated and planned) due to confirmed recurrence, with censoring at 12 months. Groups will be compared using Kaplan-Meier survival analysis and the log-rank test. Cox regression and modified Poisson regression will be used to estimate HRs and relative risks.
The trial is approved by the Danish National Committee on Health Research Ethics (2401370) and will be conducted in accordance with the Declaration of Helsinki and principles of Good Clinical Practice. In line with national guidelines, all eligible patients are counselled regarding available treatment options prior to enrolment. Results will be disseminated via peer-reviewed publications and scientific presentations.
To determine the prevalence of undiagnosed diabetes and identify associated factors using a two-step diagnostic method combining fasting blood sugar with confirmatory glycated haemoglobin A1c (HbA1c) testing among adults 45 years and above in rural Sidama, Ethiopia.
A community-based cross-sectional design was conducted from 1 April to 31 July 2024. Data were collected through a census of adults aged 45 years and above using a pretested WHO-STEPwise questionnaire. Physical and biochemical tests were performed following standard protocols. Data were analysed using Stata V.17.
Selected rural kebeles of Shebedino district, Sidama, Ethiopia.
2875 adults aged 45 years and above.
Undiagnosed diabetes confirmed by HbA1c levels (≥48 mmol/mol or ≥6.5%).
The prevalence of undiagnosed diabetes confirmed by HbA1c was 1.2% (35 of 2871; 95% CI: 0.9% to 1.7%). Previously diagnosed diabetes was found in 0.5% (14 of 2875; 95% CI: 0.3% to 0.8%). The total diabetes prevalence, confirmed by HbA1c or prior diagnosis, was 1.7% (49 of 2871; 95% CI: 1.3% to 2.3%). A total of 1327 out of 2875 (46%) participants were undernourished. Advanced age (β=0.21; 95% CI: 0.08 to 0.32, p=0.001), and estimated annual income (β=0.15; 95% CI: 0.02 to 0.28; p=0.029) were significantly associated with elevated fasting blood sugar levels.
The prevalence of undiagnosed diabetes among rural adult population was low. Older age and higher income were significantly associated with elevated fasting blood sugar. Routine community-based diabetes screening among older population, health education and nutrition-focused interventions are recommended to sustain the low burden and address undernutrition.
The 2013–2016 Western African outbreak of the Ebola virus disease (EVD), the largest recorded outbreak since the discovery of Ebola virus (EBOV) in 1976, destabilised local health systems and left thousands of survivors at risk for postacute sequelae, including vision-threatening uveitis. In an EVD survivor with severe panuveitis, the detection of persistent EBOV in the aqueous humour, long after clearance of acute viremia, focused clinical and research attention on the host-EBOV interaction in the unique terrain of ocular immune privilege. Despite the recognition that uveitis is common and consequential in EVD survivors, our understanding of pathogenesis is extremely limited, including the contributions of viral persistence and ocular-specific and systemic immune responses to disease expression. In this study protocol, we outline a multifaceted approach to characterise EVD-associated intraocular inflammation, including the clinical phenotype and complications; the presence of EBOV (or EBOV RNA/antigen) in ocular fluids and tissues; and associated local ocular-specific and peripheral immune responses.
We use an observational cohort design, which includes EVD survivors and close contacts of EVD survivors (ie, no documented history of EVD), and we propose disease (clinical examination and imaging), as well as molecular, virologic and immunologic characterisation, to meet research objectives.
This study has received Institutional Review Board approval from University of Nebraska Medical Centre, Emory University and Sierra Leone Ministry of Health. Findings will be disseminated through peer-reviewed publications.
To estimate the association between maternal COVID-19 vaccination during pregnancy and adverse neonatal and maternal outcomes.
Population-based retrospective cohort study using a hospitalisation database linked with other health administrative databases.
Province of Quebec, Canada, from 1 May 2021 to 30 June 2023.
All singleton pregnancies resulting in a live birth or stillbirth at ≥20 weeks of gestation, excluding those with a conception date
We used robust Poisson regression models to estimate adjusted risk ratios (aRRs) for chorioamnionitis, postpartum haemorrhage, caesarean delivery, preterm birth, very preterm birth, small for gestational age (SGA), maternal and neonatal admission to intensive care unit (ICU, NICU) and severe neonatal morbidity. We used a Cox regression model with a time-varying exposure variable to estimate adjusted HRs (aHRs) for stillbirth. Propensity score weighting was used to adjust for potential confounding.
Among 140 073 singleton pregnancies resulting in live birth or stillbirth, 61 282 individuals (43.8%) received at least one dose of messenger RNA COVID-19 vaccine during pregnancy. Vaccination during pregnancy was not associated with an increased risk of chorioamnionitis (aRR 0.99, 95% CI 0.95 to 1.04), postpartum haemorrhage (aRR 1.03, 95% CI 0.99 to 1.06), very preterm birth (aRR 1.04, 95% CI 0.89 to 1.21) and stillbirth (aHR 1.14, 95% CI 0.94 to 1.39). Vaccination during pregnancy was significantly associated with a reduced risk of caesarean delivery (aRR 0.94, 95% CI 0.92 to 0.96), maternal ICU admission (aRR 0.80, 95% CI 0.65 to 0.98), SGA (aRR 0.94, 95% CI 0.91 to 0.98), NICU admission (aRR 0.91, 95% CI 0.85 to 0.96), preterm birth (aRR 0.94, 95% CI 0.90 to 0.99) and severe neonatal morbidity (aRR 0.91, 95% CI 0.85 to 0.98).
Our findings suggest that COVID-19 vaccination during pregnancy was not associated with an increased risk of adverse outcomes. Ongoing surveillance of the safety of maternal COVID-19 vaccination is essential as doses continue to be recommended for this group.
by Helena Tinnerholm Ljungberg, Martina Wallberg, Emmanuel Aboagye, Gunnar Bergström, Christina Björklund, Lydia Kwak, Susanna Toivanen, Irene Jensen
The prevalence of telework increased dramatically during the COVID-19 pandemic, and today it is not uncommon to refer to hybrid work as “the new normal” in work life. Leadership plays a pivotal role in hybrid work transitions, underscoring the need for research on post-pandemic managerial practices. This qualitative interview study with 15 professional service managers at a Swedish medical university, working in either central administration or a research department, provides a nuanced understanding of the experiences of implementing hybrid work in a higher education setting. The qualitative content analysis resulted in three main themes and six sub-themes: New ways of organising work (sub-themes: Hybrid work brings new opportunities and needs, and Hybrid work as an ongoing process of change); Changes for employees (sub-themes: Social interaction and sense of community, and Increased work-life balance); and Changes in leadership (sub-themes: Communication with employees and New expectations on managers). The findings of this study provide a more fine-grained understanding of how managers experienced both challenges and opportunities in implementing and managing hybrid working arrangements. Challenges included managing employee expectations and relations, while opportunities included potential improvements in work-life balance. A key conclusion of this study is that managers in hybrid work environments adjust their leadership, especially when communicating and managing relationships within teams and across the organization. Despite the identified challenges and despite managers’ wish to see their employees in person and on site, the interviewed managers are generally optimistic about hybrid work and see it as the future. To address the identified challenges, managers may benefit from networking and exchanging information with other managers in similar situations, as well as support from their organisation.
Asthma is a chronic respiratory disorder requiring ongoing medical management. This ecological study investigated the spatial and temporal patterns of notification rates for asthma from clinic visits and hospital discharges and identified demographic, meteorological and environmental factors that drive asthma in Bhutan.
Monthly numbers of asthma notifications from 2016 to 2022 were obtained from the Bhutan Ministry of Health. Climatic variables (rainfall, relative humidity, minimum and maximum temperature) were obtained from the National Centre for Hydrology and Meteorology, Bhutan. The Normalised Difference Vegetation Index (NDVI) and surface particulate matter (PM2.5) were extracted from open sources. A multivariable zero-inflated Poisson regression (ZIP) model was developed in a Bayesian framework to quantify the relationship between risk of asthma and sociodemographic and environmental correlates, while also identifying the underlying spatial structure of the data.
There were 12 696 asthma notifications, with an annual average prevalence of 244/100 000 population between 2016 and 2022. In ZIP analysis, asthma notifications were 3.4 times (relative risk (RR)=3.39; 95% credible interval (CrI) 3.047 to 3.773) more likely in individuals aged >14 years than those aged ≤14 years, and 43% (RR=1.43; 95% CrI 36.5% to 49.2%) more likely for females than males. Asthma notification increased by 0.8% (RR=1.008, 95% CrI 0.2% to 1.5%) for every 10 cm increase in rainfall, and 1.7% (RR=1.017; 95% CrI 1.2% to 2.3%) for a 1°C increase in maximum temperature. An increase in one unit of NDVI and 10 µg/m3 PM2.5 was associated with 27.3% (RR=1.273; 95% CrI 8.7% to 49.2%), and 2.0% (RR=1.02; 95% CrI 1.0% to 4.0%) increase in asthma notification, respectively. The high-risk spatial clusters were identified in the south and southeastern regions of Bhutan, after accounting for covariates.
Environmental risk factors and spatial clusters of asthma notifications were identified. Identification of spatial clusters and environmental risk factors can help develop targeted interventions that maximise impact of limited public health resources for controlling asthma in Bhutan.
Substance use among adolescent expectant mothers is a significant public health concern due to its adverse effects on both maternal and fetal health. Despite this, there is limited evidence regarding the patterns and factors influencing substance use among pregnant adolescents in Ghana.
This study aimed to explore the psycho-social and cultural factors that influence substance use among adolescent expectant mothers attending the antenatal clinic at the Upper East Regional Hospital in the Bolgatanga municipality.
A qualitative, descriptive exploratory design was employed. 17 adolescent expectant mothers were purposively recruited and interviewed using a researcher-developed semistructured guide. Interviews were audio-recorded, transcribed verbatim and analysed using a six-step thematic analysis guided by a deductive approach. The study was underpinned by the socioecological model, which allowed for the exploration of knowledge, social and cultural factors influencing substance use during pregnancy.
The study was conducted at the antenatal clinic of the Upper East Regional Hospital in Bolgatanga and involved adolescent expectant mothers attending the clinic.
Analysis revealed three major themes: knowledge of substance use, social factors and cultural factors influencing substance use. Participants demonstrated understanding of substance use, including its definition, causes and potential consequences. Social influences, particularly peer pressure and family dynamics, were reported as motivating factors for substance use. Cultural factors, including local beliefs, practices and community attitudes, also played a significant role in shaping substance use behaviours among these adolescents.
The findings indicate that while adolescent expectant mothers possess knowledge about the risks and consequences of substance use during pregnancy, many continue to engage in such behaviours. Peer and family influences, alongside cultural beliefs and community attitudes, were identified as key drivers of substance use. These results highlight the need for targeted, culturally sensitive substance use education and intervention programmes within antenatal clinics and the broader community to support adolescent mothers in reducing substance use during pregnancy.
To evaluate the clinical effectiveness of a Nurse Practitioner led procedural support service for children with procedural anxiety, and identify facilitators and barriers to its sustained implementation and optimisation.
An effectiveness–implementation hybrid type 3 study used a prospective mixed methods evaluation approach.
From December 2022 to May 2023, data were collected from children, parents and clinicians using a nurse practitioner-led service at a quaternary paediatric hospital in Brisbane, Australia. A prospective audit assessed clinical outcomes, while qualitative interviews explored implementation barriers and facilitators.
The clinical audit (n = 40) confirmed the service was effective and safe, ensuring procedural completion with minimal distress. Descriptive statistics indicated low pain and anxiety scores. There was a moderate negative relationship between pain scores and the use of distraction techniques. Interviews with thirty-three participants showed the service improved access to procedural care, reduced the need for physical restraint and general anaesthesia, and enhanced clinical workflow through preadmission assessments.
Utilising a Nurse Practitioner support service represents a safe and effective strategy to enhance access for paediatric patients with procedural anxiety.
This study underscores the significance of specialised nursing roles in managing paediatric procedural anxiety, offering a replicable model to enhance procedural outcomes and mitigate medical trauma across healthcare settings.
Minimising pain and distress is important in all clinical encounters with children to reduce the risk of medical-related trauma and the future avoidance of healthcare.
The report of study outcomes was guided by the Standards for Reporting Implementation Studies (StaRI) initiative.
Patients or the public were not included in the design, conduct or reporting of the study.
To partner with healthcare professionals and other stakeholders to identify top 10 research priorities within universal child and adolescent health promotion and disease preventive services.
The study used an adapted James Lind Alliance (JLA) approach. This included a priority setting partnership within the field of municipal health promotion and preventive services for children and adolescents, the gathering of research needs as reported by a national sample of healthcare professionals and other stakeholders and the sorting, evidence checking and final prioritisation of two top 10 lists corresponding with the two municipal service areas: (1) pregnancy care and child health centres 0–5 years and (2) school health service and youth health centres. The research needs were collected using an online survey asking: ‘In your opinion, what should scientific communities in Norway conduct research on to enhance child and adolescent health promotion and preventive services?’. Suggested needs framed as topics were sorted and categorised in Microsoft Excel. The digital survey Nettskjema was applied for final prioritisation by voting.
Municipal child and adolescent health promotion and disease prevention services in Norway.
Altogether, 1141 healthcare professionals and other stakeholders (government administrators and university staff).
The participants submitted a total of 1780 research needs. Following the steps of the JLA priority setting process, the two final top 10 lists were generated. The lists include research priorities relating to, for example, health literacy, mental health promotion, counselling and teaching, follow-up of children and families in vulnerable positions and interdisciplinary collaboration.
Research priorities for child and adolescent health promotion and preventive services were identified through structured user involvement of healthcare professionals and other stakeholders using the JLA framework. The two lists address key knowledge gaps and reflect current societal and professional challenges. The findings can enhance research relevance, foster collaboration and guide research and research funding.
Introducción: La Inseguridad Alimentaria (IA), vinculada a la pobreza, favorece el consumo de alimentos poco nutritivos y aumenta el riesgo de enfermedades crónicas. Su comprensión es clave en enfermería comunitaria y escolar para fomentar hábitos saludables desde edades tempranas. Objetivo: Analizar la relación entre el Nivel Socioeconómico (NSE) e IA en Estudiantes de Una Universidad Pública del Norte de Sinaloa, México. Metodología: Estudio cuantitativo, descriptivo, correlacional y transversal en estudiantes de 18 a 25 años inscritos en un programa de Licenciatura. Los participantes fueron seleccionados a partir de un muestreo aleatorio simple. La muestra fue de 311 estudiantes. Se aplicó una cédula de datos sociodemográficos, el cuestionario AMAI y la Escala Latinoamericana y Caribeña de Inseguridad Alimentaria. Resultados: En los hogares sin presencia de menores, la IA severa presenta mayor prevalencia en NSE medio (29,6%) y alto (32,5%). Se observó una correlación positiva y significativa entre el NSE y la IA, tanto en hogares sin integrantes menores de edad (rs = 0,263, p < 0,01), como en aquellos con menores (rs = 0,231, p < 0,01). Conclusiones: En esta población de estudiantes universitarios, se observó que a medida que aumenta el NSE, también lo hace la IA, lo que sugiere que esta no es exclusiva de los sectores socioeconómicos bajos, sino que también afecta de forma considerable a los niveles medio y alto. La persistencia de esta problemática en todos los niveles sugiere que factores estructurales, más allá del ingreso, como el acceso a alimentos nutritivos, educación alimentaria y estabilidad laboral, podrían influir significativamente.
ABSTRACT
Introduction: Food insecurity (FI), linked to poverty, promotes the consumption of unhealthy foods and increases the risk of chronic diseases. Understanding it is key in community and school nursing to foster healthy habits from an early age. Objective: To analyze the relationship between socioeconomic status (SES) and FI in students at a public university in Northern Sinaloa, Mexico. Methodology: A quantitative, descriptive, correlational, and cross-sectional study was conducted with students aged 18 to 25 years enrolled in an undergraduate program. Participants were selected using simple random sampling. The sample consisted of 311 students. A sociodemographic data form, the AMAI questionnaire, and the Latin American and Caribbean Food Insecurity Scale were administered. Results: In households without children, severe FI was more prevalent in middle (29.6%) and high (32.5%) SES groups. A positive and significant correlation was observed between socioeconomic status (SES) and food insecurity (FI), both in households without minor members (rs = 0.263, p < 0.01) and in those with minors (rs = 0.231, p < 0.01). Conclusions: In this population of university students, it was observed that as SES increases, so does FI, suggesting that it is not exclusive to low socioeconomic sectors, but also significantly affects middle and high levels. The persistence of this problem at all levels suggests that structural factors, beyond income, such as access to nutritious food, nutrition education, and job stability, could have a significant influence.
Since 2018, WHO has endorsed the use of whole-genome sequencing (WGS) of Mycobacterium tuberculosis complex isolates to detect drug-resistant tuberculosis (DR-TB). This endorsement was based on the assumption that a faster and more detailed description of the resistance profile would improve treatment prescription for DR-TB by healthcare providers, and hence the treatment outcomes of patients. Nonetheless, this assumption has not been tested in routine clinical practice and different scenarios. In Brazil, WGS is not routinely used for the diagnosis of DR-TB, having been carried out in only a few centres for research purposes. With this trial, we will evaluate whether a WGS-based drug-resistance report improves treatment adequacy in patients with pulmonary DR-TB, compared with the current standard-of-care diagnostic methods used in the state of São Paulo, Brazil.
We will conduct a non-randomised controlled clinical trial with two arms to compare the intervention group (ie, individuals receiving a WGS-based report) with a historical control group (i.e., individuals who received resistance diagnostics based on the standard of care of conventional genotyping and phenotyping techniques). The primary outcome will be the proportion of patients whose treatment scheme was adequate based on complete resistance profile determined by WGS and/or phenotypic drug-susceptibility testing (pDST). Other secondary outcomes will also be considered. The target sample size is 88 eligible patients per group. The intervention group will be prospectively recruited over 18 months and the control group will be composed of patients diagnosed with pulmonary DR-TB up to 2 years before the start of the trial. To ensure comparability, isolates from the control group will undergo WGS retrospectively, and pDST will be performed retrospectively in both groups. This clinical trial will take place in six medical centres for the treatment of DR-TB in the state of São Paulo. This study is intended to support the implementation of the WGS in the routine diagnosis of DR-TB in the state of São Paulo.
Ethical approval was obtained from the Human Research Committee of the Institute of Biomedical Sciences, University of São Paulo, Brazil (CAAE: 79497924.1.1001.5467). Study results will be published in peer-reviewed journals and disseminated to policymakers and stakeholders.
U1111-1308-4669.
Phasix mesh is a fully resorbable synthetic mesh for use in clean and contaminated ventral incisional hernia repairs. Long-term absorbable Phasix mesh appears to be a safe and promising device in incisional hernia repair, with low recurrence rates; however, data on long-term complications after surgery, particularly after the resorption period of the mesh, are scarce.
This protocol describes a study of several European registries on the use of a Phasix mesh in incisional hernia repair. The primary endpoint of the study is long-term complications at 2–5 year follow-up after mesh implantation, with secondary endpoints including hernia recurrence and complications during short-term follow-up.
Ethical approval was not required for this protocol as the study is based on anonymised registry data collected with prior patient consent in each registry. Each participating registry has its own ethical approval process, and this study will adhere to those regulations. The results will be disseminated through peer-reviewed publications and conference presentations.
To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.
A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.
Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.
Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).
Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.
Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.
This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.
No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.
To investigate whether treatment with oral corticosteroids and intravenous immunoglobulin (IVIg) improves pregnancy outcomes in women with unexplained recurrent pregnancy loss (RPL) following assisted reproduction technology (ART) treatment.
A randomised, double-blinded, parallel-group, placebo-controlled trial conducted from January 2021 to February 2024.
A single-centre trial at a Danish tertiary clinic for RPL management.
80 women with at least two consecutive early pregnancy losses following ART, age 18–41 years, body mass index below 35, and no identified cause of RPL. Forty participants were allocated to each group, with 37 fulfilling the protocol criteria in each group.
Participants were randomised to receive either a combination of low-dose oral prednisolone starting on the first day of menstruation and IVIg given the first time around the time of embryo transfer; or matching placebo tablets and albumin infusions. Treatment continued until gestational week 8+4 in those who conceived with a total of four infusions.
The primary outcomes were the ongoing pregnancy rate (OPR) defined as a living fetus in gestational week 13 among all randomised participants and in those who conceived after embryo transfer, respectively, based on intention-to-treat (ITT) and per-protocol (PP) analyses. Secondary outcomes included safety outcomes related to pregnancy complications and neonatal health.
OPR was equal to live birth rate. Among all randomised participants (ITT), the OPR was 25.0% in the treatment group and 15.0% in the placebo group (relative risk 1.67; 95% CI 0.67 to 4.15; p=0.26). Among participants without major protocol deviations (PP), OPRs were 21.6% and 16.2%, respectively (relative risk 1.33; 95% CI 0.51 to 3.47; p=0.55). Among participants who became pregnant following embryo transfer, ongoing pregnancy occurred in 83.3% of the treatment group and 42.9% of the placebo group (relative risk 1.94; 95% CI 1.01 to 3.75; p=0.05). No differences in adverse events or neonatal outcomes were observed between the two groups.
The combination of oral corticosteroids and IVIg did not improve overall pregnancy rates in women with RPL after ART. However, among those who achieved pregnancy after embryo transfer, the risk of pregnancy loss appeared reduced. Larger randomised trials are needed to confirm these findings.
ClinicalTrials.Gov: NCT04701034. Registration date: 5 January 2021
EudraCT number: 2020-000256-35; Registration date: 11 November 2020
The North Denmark Region Committee on Health Research Ethics: N-20200066, Registration date: 16 December 2020
The Data Protection Agency: 2020-156; Registration date: 4 November 2020
WHO universal trial number: U1111-1273-8585
Date of first patient’s enrolment: 28 January 2021.
To explore Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease in primary care.
An inductive, descriptive qualitative study.
Data were collected through semi-structured interviews with 11 purposively sampled Registered Nurses of varying levels of experience from eight regions in Sweden. The audiotaped interviews were conducted over a 5-month period (December 2023–April 2024), transcribed verbatim and analysed using interpretive description.
Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease are described by three themes (seven subthemes): Patient continuity (Building personal relationships: Being accessible and enabling trust and confirmation), Collaborator continuity (Having a colleague to lean on: Colleagues can lean on me: Feeling alone with my expertise) and Continuity with myself (Trusting my own competence: Carrying a burden alone).
Consolidated Criteria for Reporting Qualitative Research Guidelines.
This study provides an understanding of Registered Nurses' experiences of continuity of care in primary care. The results may help improve future care since nurses play an essential role in the care of chronic obstructive pulmonary disease within primary care.
To enhance continuity of care for patients with chronic obstructive pulmonary disease, the relationship between the nurse and the patient is important, as is collaboration with colleagues. This collaborative approach allows these nurses to maintain continuity with both the patients and themselves, fostering a more stable and effective care environment.
This study offers valuable insights into the experiences of Registered Nurses in maintaining continuity of care within primary care, particularly for patients with chronic obstructive pulmonary disease. By highlighting the critical role of Registered Nurses in managing these patients, the study underscores the importance of strong nurse–patient relationships and effective collaboration among healthcare professionals.
No Patient or Public Contribution.
by Jack Jefferson, Claire Reigate, Alessandra Giacomini, M. Jordana Rivero, Matthew Hitchings, Tamsyn Uren Webster, Konstans Wells
Livestock grazing in confined pastures often means grazing on a less diverse diet than under more natural conditions and increased exposure to gastrointestinal parasites prevailing in these pastures. However, how sward composition influences gut microbiome (GM) diversity and its relationship with parasite burden remains poorly understood. In this study, we analysed the faecal GM of weaned lambs grazing on two distinct sward types (perennial ryegrass and a mixed-species sward) over three consecutive months using 16S rRNA sequencing, in order to assess how microbial diversity and composition are related to environmental conditions and the gastrointestinal nematode (GIN) burden in naturally infected lambs. Sward type and sampling time explained some of the variation in GM alpha diversity and community composition (beta diversity), whereas individual lamb identity accounted for considerably more variation in microbial assemblages. Shifts in the relative abundance of bacterial genera such as Saccharofermentans, Anaerosporobacter, Butyrivibrio in relation to sward type and sampling time suggest mostly adaptive fluctuations in response to diet and pasture condition. Abundance shifts of Negativibacillus, and Candidatus Saccharimonas were also associated with GIN burden, which, in turn, was higher in lambs grazing on mixed swards compared to ryegrass. Our findings add to the growing understanding of how sheep microbiomes vary with pasture management and changes in parasite burden. We highlight that individual identity may shape gut microbiota, and that potential triadic interactions among gastrointestinal parasites, sward exposure, and the gut microbiome underscore the importance of considering host, parasite, and environmental factors collectively when evaluating microbiome dynamics in grazing livestock.
by Jorman H. Tejada-Perdomo, Valentina Gutierrez-Perdomo, Juana V. Agudelo-Castro, Jorge A. Pérez-Gamboa, Alejandro Weinstein, Sebastián San Martín, Rodrigo Salas, Jorge A. Ramos-Castaneda
The use of devices that facilitate rapid airway isolation is essential when managing critical patients in emergencies. In recent years, additive manufacturing has emerged as an innovative, versatile, and accessible technology for developing medical devices. This study presents the design, development, and validation of an extraglottic medical device created using computer-aided design tools and stereolithographic 3D printing to facilitate blind intubation by first responders. The device was iteratively modeled and fabricated with biocompatible materials; validation in airway simulators and human cadaveric specimens assessed dimensions, friction, intubation technique, and learning curve, and ease of use was rated with a Likert scale. Ten iterations led to a final design with low friction and minimal cervical manipulation; ramp angle, cup geometry, and distal tip were optimized for tube passage, and BioMed Flex 80A showed high strength and anatomical compatibility. The final version is a safe, reusable, and functional alternative for airway management and blind orotracheal intubation, particularly in emergencies and resource-limited settings; clinical validation in live patients is still needed.
To explore existing research regarding how nurses' unclear responsibilities influence their professional role development in hospital settings.
A scoping review was conducted according to Arksey and O'Malley.
The Population Exposure Outcome framework was used to identify eligible inclusion and exclusion criteria and search terms. The included articles have been thematically analysed in guidance by Braun and Clarke.
Twenty-six studies conducted between 2016 and 2024 were identified in CINAHL, PubMed and Scopus.
The roles of nurses were highly adaptable within hospital settings and healthcare teams, requiring nurses to assess both organisational shortcomings and colleagues' needs. These assessments depended on the nurses' competence and motivation for professional growth.
There was a clear need to strengthen organisational structures and frameworks to support the evolving role of nurses. Basic nursing education must be better at preparing nurses for their upcoming leadership role.
Increasing complexity and unclear responsibilities contribute to role ambiguity among nurses. The review highlights the importance of recognising nurses as visible and accountable leaders. There is also a need to support nurses' adaptability through improved basic education, which may have implications for both clinical practice and education.
The PRISMA Scoping Review checklist was used during the review process. The PRISMA flowchart was used to report the database searches.
This study did not include patient or public involvement in its design, conduct, or reporting.
The aetiology of eating disorders (EDs) is complex, involving an interplay of genetic and environmental factors. Children at familial high risk (FHR) for EDs demonstrate increased risk of developing EDs themselves compared with children born to parents without EDs, though the majority remain unaffected. The BLOOM study is an FHR study that aims to identify biological, neurocognitive and psychosocial risk and protective pathways to EDs. Results of this study will help identify trait markers of EDs, inform targeted preventive intervention strategies and clarify how to mitigate genetic risk of EDs.
This prospective cohort study will enrol 510 children aged 8–10 years, including 360 at FHR for developing EDs (comprising 120 children each from mothers with anorexia nervosa, bulimia nervosa and binge ED) and 150 children not at FHR. Participants will be recruited over 2 years and followed up every 2 years. Data collection will include dual X-ray absorptiometry scans to evaluate body composition, saliva samples for genotyping, neurocognitive testing, self and parent-reported questionnaires and semistructured diagnostic interviews of psychopathology and well-being. Optional data collection will include fasting blood samples, stool samples and brain MRI scans. Mothers and secondary caregivers will complete questionnaires regarding family functioning and their mental health.
The study has been approved by the Danish Data Protection Agency (p-2023-14826) and the Regional Ethics Committee of Health Research of the Capital Region of Denmark (H-23043100). Written consent will be obtained from all participants. Results will be disseminated at scientific conferences, in peer-reviewed publications, PhD dissertations and to relevant stakeholders.
FreshRSS