Conectar
Increased risks and concerns regarding patient safety in early-phase studies exist because knowledge about the new intervention is still accumulating. This means that narrow eligibility criteria are needed. However, if early-phase studies are narrow in their inclusion, for example, by not including diverse populations, there is a potential risk that new therapies have insufficient relevant efficacy and safety data. Existing research has explored equity, diversity and inclusion (EDI) factors in early-phase pharmaceutical studies, but it has not been possible to find studies that have systematically examined whether EDI factors have been considered in surgical studies reporting innovative procedures. We aim to examine how EDI factors are considered in early-phase surgical studies and surgical innovation reports to explore how this may impact on later-phase evaluation and inclusive intervention implementation.
A scoping review following the JBI (Joanna Briggs Institute) and Arksey and O’Malley’s five-step process is being conducted. We will search Scopus, PubMed and Web of Science for surgical early-phase studies. A two-step screening process for eligibility is being used. Independent double screening will take place for 20% of the papers. Eligible articles will report early evaluation of an innovative surgical/invasive procedure. Excluded will be comparative and later-phase studies and early evaluations of pharmaceutical products even in a surgical setting. Data on article details, patient eligibility and whether protected characteristics are reported and considered will be extracted. Information about EDI considerations reported in the introduction or discussion of the papers will also be extracted. Findings will be discussed with a patient advisory group. A content synthesis approach will be undertaken and descriptive summaries presented.
This study does not require ethical approval being a secondary analysis. The findings will be disseminated through academic journal publications and oral presentations.
Significant advances in systemic therapy have improved survival for patients with advanced-stage non-small cell lung cancer (NSCLC). However, the present treatment strategies and dose-fractionation for high-dose palliative radiotherapy (RT) are based on trials from the 1990s, when RT planning was simple with less precise delivery. Contemporary lung RT uses 4D-CT, volumetric modulated arc radiotherapy, aided by online verification using cone beam CT, which enables greater accuracy and better target volume coverage, while reducing doses to normal organs at risk. The Shortened High-dose Palliative Radiotherapy for Lung Cancer study aims to evaluate the safety and feasibility of reducing the number of RT fractions and RT duration, using contemporary planning, verification and delivery techniques.
This single-arm, multicentre, phase-II study will test the shortened hypofractionated accelerated palliative RT regimen of 30 Gy in 6 alternate-day fractions, with strict normal tissue dose constraints. We aim to recruit 37 patients across 4 sites within the West Midlands. Quality assurance for the RT is supported by the Radiotherapy Trials Quality Assurance Group (RTTQA). Patients with locally advanced or metastatic NSCLC, who are candidates for high-dose palliative RT, before or after first-line systemic therapy, are eligible for recruitment. The primary objective of this study is to assess the safety of the proposed dose-fractionation. Secondary objectives include evaluating toxicity profiles, patient-reported outcome measures, time to progression, feasibility and the National Health Service cost-saving.
This study is conducted in accordance with the International Council for Harmonisation Good Clinical Practice (ICH GCP) guidelines and all applicable regulatory frameworks, including, but not limited to, the UK policy framework for health and social care research, as well as the Health Research Authority and Health and Care Research Wales regulations. Approval for the study was granted on 18 April 2024 (IRAS project ID: 332998; REC reference: 24/WM/0032). The chief investigator is responsible for obtaining informed consent from participants. Any individual delegated this responsibility is thoroughly authorised, trained and competent to conduct the informed consent process. On completion of the trial, the results will be shared with participants in a plain language summary and will be submitted for publication in a peer-reviewed journal. If successful, this study will inform a phase III randomised controlled trial to assess efficacy. For updates on the study, visit the study web page (https://research.mededcoventry.org/About-Us/Meet-The-Team/TMU/Ship-Rt).
Fetal alcohol spectrum disorder (FASD) is a diagnostic term that describes the neurodevelopmental and physical effects resulting from prenatal exposure to alcohol. Individuals living with FASD can experience lifelong challenges, yet with a diagnosis and sufficient support for the individual and their whānau (families), people can live fulfilling lives. Currently, little is known of the prevalence and impact in Aotearoa, New Zealand (NZ). Our aim is to identify the prevalence and understand the needs of young people living with FASD and other neurodevelopmental disorders in Youth Justice (YJ) residences in Aotearoa, NZ. One study will investigate the prevalence of FASD in this setting. The outcomes of both studies may demonstrate barriers and enablers, as well as strengths and gaps in YJ services of Aotearoa, NZ. The outcomes of both studies may guide reinforcing of current best practices as well as highlight necessary and novel initiatives together providing best support for the children and adolescents and their whānau as well as staff across YJ residences.
Extensive consultation with Māori and Pacific Advisory groups, researchers and experts in FASD and justice settings, individuals living with FASD and YJ staff together informed the development of this study.
Children and adolescents (hereafter young people) aged 10 to 18 years and currently residing in YJ residences are eligible for participation and assessment for FASD through assenting and consenting to provide personal and social histories and completed physical and neuropsychological assessments. The comprehensive FASD histories, screening and assessment will be conducted by a neuropsychologist and paediatrician employing standardised assessment practices and instruments. The team will also collect information from health, education and care and protection records; from the young people themselves; and from their family and staff. The study will reference Whakakotahitanga, the newly released (2024) guidelines for screening and diagnosing FASD in Aotearoa, NZ while also acknowledging the differences imposed under constraints of funding research including, for example, time and money. An individualised report will be prepared for each young person and their whānau. Study data will be analysed with descriptive statistics as appropriate. Our findings will be considered by the Māori and Pasifika advisory groups for framing and culturally secure translation, disseminated with all participating young people, translated to YJ services and staff, government and community neurodiversity sectors. Outcomes will be made available through community hubs, conferences, reports and peer-reviewed journal publications.
The study has received ethical approval from the Southern Health and Disability Ethics Committee (2024 Full 20065). Locality ethical approval has been granted from Oranga Tamariki (Ministry of Children), and a privacy impact evaluation has been undertaken. The findings will be shared through peer-reviewed publication, local and national conferences and with key agencies including Oranga Tamariki.
by Faten Al-hussein, Laleh Tafakori, Mali Abdollahian, Khalid Al-Shali
Type 2 diabetes (T2D) is a chronic condition affecting millions globally. A robust predictive model to estimate the number of new cases of T2D can facilitate precise monitoring and effective intervention strategies. This study aims to predict the number of new T2D cases per month in Saudi Arabia and identify the Key Performance Indicators (KPIs) associated with T2D, using count regression models, Poisson Regression (PR), Negative Binomial Regression (NBR), Poisson Inverse Gaussian Regression (PIGR), and Bell Regression (BR). De-identified data from 1,000 patients with T2D in Saudi Arabia were used to develop the models. The performance of the full models, which include recommended Key Performance Indicators (KPIs), is compared using metrics such as the coefficient of determination (R2), root mean squared error (RMSE), mean absolute error (MAE), 10-fold cross-validation (CV-10), Akaike information criterion (AIC), and Bayesian information criterion (BIC). The most significant KPIs identified by the full models were utilized to develop the reduced models. The full NBR model outperformed other models, achieving R² of 0.88, RMSE of 0.93, MAE of 0.69, CV-10 of 1.21, AIC = 873.23, and BIC = 880. The reduced NBR model, focusing solely on the five most influential variables (marital status, age, body mass index (BMI), total cholesterol (TC), and high-density lipoprotein (HDL)), with R² = 0.84, RMSE = 1.10, MAE = 0.86, CV-10 = 1.37, AIC = 899, and BIC = 910, also outperformed other reduced models. The Likelihood Ratio Test (LRT) did not show a significant difference between the full and reduced NBR models (p = 0.694), supporting the adequacy of the reduced model. The proposed reduced model, utilizing only five significant KPIs, can help healthcare providers develop effective, targeted strategies by monitoring a smaller number of KPIs to reduce the rising number of T2D cases in Saudi Arabia.
To explore how practical nurses perceive telehomecare in relation to sustainability.
This study had a qualitative exploratory design.
Ten practical nurses working with telehomecare were interviewed in February–April 2024. The interviews were individual, semi-structured and were analysed through Braun and Clarke's reflexive thematic analysis.
The overarching theme of this study was ‘Telehomecare: A catalyst for a multifaceted transformation towards sustainable practices in homecare nursing’, with three main themes and seven subthemes. The three main themes were ‘Reshaped delivery of care’, ‘Reformed work environment’ and ‘Reallocated resources'. The findings reveal that nurses have multifaceted perspectives on telehomecare in relation to sustainability, recognising both its positive and negative impacts on healthcare organisations, nurses and clients while also acknowledging that more sustainable practices demand significant changes in the healthcare environment.
Telehomecare has significant impacts on multiple dimensions of sustainability within healthcare and notable drawbacks. These findings emphasise the critical need for comprehensive education and training in sustainable digital work practices to enhance healthcare professionals' awareness of environmental impacts. This underscores the importance of transformative leadership that drives organisational change towards sustainable healthcare practices and implements effective sustainability policies.
The findings present some aspects of telehomecare that contribute to a lesser environmental impact from a nursing care perspective, encouraging healthcare leaders to make conscious and effective strategic decisions towards more sustainable healthcare. The findings strengthen nurses, leaders and policymakers' knowledge and awareness of sustainable nursing activities in the digital milieu, highlighting the urgent need for transformation of healthcare practices to decrease the environmental impact.
The study followed the consolidated criteria for reporting qualitative studies (COREQ).
This study did not include patient or public involvement in its design, conduct or reporting.
Primary sclerosing cholangitis (PSC) is the classical hepatobiliary manifestation of inflammatory bowel disease (IBD). No therapy currently halts disease progression. The strong gut–liver axis implicated in PSC pathogenesis supports the investigation of microbiome-targeted treatments. Oral vancomycin (OV), an antibiotic with potential immunomodulatory properties, has shown encouraging results in improving clinical symptoms and liver biochemistry in PSC. However, prospective data on its safety and efficacy remain limited.
Oral Vancomycin for primary sclerosing Cholangitis in ITaly (VanC-IT) is a phase II, dose-finding, randomised, placebo-controlled, trial designed to evaluate the efficacy and safety of OV in patients with PSC, with or without underlying IBD. Adults and adolescents aged 15–75 years will be enrolled following a 10-week screening and run-in period and randomised in a 1:1:1 ratio to receive either placebo, OV 750 mg/day or OV 1500 mg/day for 24 weeks. Randomisation will be stratified by baseline liver stiffness (
The protocol has been approved by the Ethics Committee CE Brianza on 10 February 2023, number 4017. Trial registration number NCT05876182. Participants will be required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.
by Devon Hori Harvey, Micah Ngatuvai, Siale Vaitohi, Paige E. Faasuamalie, Maegan Tupinio, Lisa H. Smith
BackgroundPacific Islanders experience significant health disparities. One contributing aspect to these disparities is the lack of racial concordance as Pacific Islanders are underrepresented in the U.S. physician work force. Several factors contribute to this underrepresentation including lack of support systems for Pacific Islander premed and medical students. Pasifikas in Medicine (PiM) is a recently established national student organization founded to provide support for Pacific Islander premed students, medical students, residents, fellows and attending physicians. This study seeks to understand the impact of PiM on medical student experiences.
MethodsAn anonymous survey was distributed to the PiM listserv and to Diversity, Equity and Inclusion offices of allopathic and osteopathic medical schools across the U.S. The survey included seven questions for demographic data, ten 5-point ordinal questions to evaluate the impact of PiM on medical student experiences, and three free text questions.
ResultsA total of 34 individuals participated in the study with 21 individuals completing the evaluative portion of the survey. Of 28 who responded, 27 (96.4%) were the first in their family to attend medical school, and 25 (89.2%), planned to serve Pacific Islander patient populations in their medical career. For the 10 evaluative questions, 7 scored ≥ 4.0 of of 5.0. Identifying Mentors, Faculty Networking, and Research Opportunities scored less well. Qualitative data was favorable of PiM and demonstrated significant camaraderie, community, and connection to other Pacific Islander physicians and medical students.
ConclusionPasifikas in Medicine fills an unmet need by creating a space dedicated to addressing the challenges unique to Pacific Islander students, separate from other minority groups. Improvements to PiM should begin with creating more mentorship opportunities, faculty networking and research opportunities. Additionally, increasing PiM presence nationally and locally within medical schools could further strengthen Pacific Islander medical student experience.
by Maha Rabayaa, Mustafa Ghanim, Malik Alqub, Mohammad Abuawad, Majdi Dwikat, Samar Alkhaldi, Haneen Badawi, Johnny Amer
IntroductionAllergy is a form of chronic illness with an increasing prevalence globally. Adequate knowledge among the community about the causes, symptoms, and treatment of allergy is crucial in preventing the associated life-threatening complications. Limited research has been conducted in Palestine regarding this health priority. The current study aimed to assess the Palestinian community’s level of knowledge regarding allergy.
MethodsAn observational cross-sectional study was conducted using an online questionnaire targeting Palestinians aged 18 years and older between 1 June 2024 and 26 January 2025. The questionnaire gathered demographic information about the participants and assessed their knowledge level concerning allergy.
ResultsA total of 1002 participants were included in the study. The mean age of the participants was 30.33 years. 66.1% of the participants were females, 60.2% were unmarried, 60.1% had possessed a bachelor’s degree, 63.1% had a personal history of allergy, and 82% reported knowing of someone with allergies. The mean knowledge score about allergies was 5.4 out of 10, with over half of the participants having an average level of knowledge (4–6). The knowledge score about allergies was significantly different based on the participants’ sex, marital status, place of residence, educational level, and occupation (p-value Conclusion
The Palestinians’ knowledge of allergy is considered good regarding its common causes and symptoms. However, there is still inadequate knowledge about the treatment of allergy and its less common causes. The community awareness of allergy should be improved through targeted campaigns and brochures aimed at achieving earlier diagnosis and proper management to prevent the development of life-threatening complications.
by Claire A. MacGeorge, Matthew Henry, Hannah A. Ford, Lacy Malloch, Emily Fratesi, Shannon Cabaniss, Jaime Baldner, Melody Greer, Kristin Gaffney, Milan Bimali, Preetha Abraham, Linda Y. Fu, P. Songthip Ounpraseuth, Christine B. Turley
BackgroundAttention-deficit/hyperactivity Disorder (ADHD) is the most common neurobehavioral condition of childhood and can be controlled with stimulant medication. Evidence-based guidelines endorse use of standardized ADHD symptom reports to facilitate medication titration to therapeutic dosage. Children living in under-resourced areas experience barriers to receiving this recommended evidence-based care. The Remote ADHD Monitoring Program (RAMP) uses a text-based platform to relay symptom reports from caregivers and teachers to healthcare providers. This pilot study is a feasibility study examining intervention uptake. It compares the submission of structured symptom reports in those children enrolled in RAMP compared to usual care as well as utilization of the RAMP platform by providers.
MethodsThis paper describes the protocol to evaluate the feasibility of deploying RAMP in practices serving rural or underserved children. We will recruit 36 dyads from 4 practices in 2 separate states. Each dyad will include a caregiver and their child aged 5–11 years with a diagnosis of ADHD who is starting or reinitiating stimulants. Dyads will be randomized 1:1 to receive the RAMP intervention or usual care with attention controls. Our primary outcome is number of symptom reports (paper assessments in control arm and RAMP reports in intervention arm) per participant that are completed by caregivers and teachers and returned to providers. Our secondary outcome is proportion of submitted RAMP reports that are reviewed by providers.
DiscussionAs telehealth use increases, it is critical that we improve access to high quality care for children with chronic conditions. Leveraging technology may be a meaningful approach to improve efficiency in optimizing medication management. This pilot study tests a text-based platform designed to improve communication between the caregivers and teachers of children with ADHD and health care providers. If successful, a future trial will examine the effectiveness of the RAMP intervention on improvement in symptoms.
Trial registrationClinicalTrials.gov NCT06743425.
by Carly E. Hawkins, Thomas P. Hahn, Jessica L. Malisch, Gail L. Patricelli
Males in socially monogamous species can achieve reproductive success through multiple tactics– by defending paternity within the social nest and siring extra-pair offspring, or both. Previous studies have found that sperm morphology may differentially affect fertilization success in extra-pair compared to within-pair matings; therefore, we explored whether sperm morphological traits can predict the probability of success within components of reproductive success. Here, we measured sperm component traits (head length and flagellum length) and derived traits (total length and flagellum:head ratio) in free-living Mountain White-crowned Sparrows (Zonotrichia leucophrys oriantha) and examined how these morphological traits relate to extra-pair and within-pair reproductive components of reproductive success. We found no evidence for correlations between sperm morphology and total seasonal reproductive success. However, we did find that sperm morphology appeared to be associated with whether a male was successful at acquiring extra-pair offspring or defending his own paternity within his nest: males that achieved extra-pair success had longer flagella and longer total length of sperm cells compared to males that did not sire outside of their social nest. In contrast, males that successfully defended all paternity within their social nest tended to have shorter heads and larger flagellum:head ratios compared to males that lost paternity in their social nest. While these patterns suggest that different sperm traits may be linked to success in different components of reproductive success, they should be interpreted with caution given the exploratory nature of this study and limited sample size, and further investigation is warranted.
This study aimed to explore the psychosocial adaptation processes and coping methods among patients with diabetic retinopathy (DR), emphasising the importance of understanding their lived experiences.
A qualitative study using semi-structured interviews.
A tertiary eye hospital in northeastern Iran.
The participants comprised patients with DR, their families and healthcare professionals.
Qualitative data were analysed based on transactional stress theory using deductive thematic analysis to identify psychosocial adaptation concepts.
65% of participating patients had DR for more than 5 years. Analysis of 49 patient and 14 healthcare professional interviews revealed 6 key themes encompassing 15 categories and 33 subcategories: primary appraisal (threat perception, motivational assessment, self-blame), secondary appraisal (perceived control over disease outcomes, perceived control over emotions, self-efficacy), coping efforts (problem management, emotional regulation), meaning-based coping (positive reassessment, reinforcement of religious beliefs, constructive approach), moderators (seeking information, all-encompassing assistance) and adaptation (emotional health, individual-social functioning).
The analysis revealed that deficits in disease awareness, financial and systemic barriers and emotional distress significantly impeded adaptive coping. Conversely, self-efficacy, social and organisational support, and meaning-based coping strategies were key facilitators. Our findings suggest that facilitating positive psychosocial adjustment in patients with DR may require interventions that address these specific barriers and leverage these facilitators, such as providing comprehensive disease knowledge and constructing robust support systems. This study highlights the potential value of a holistic care approach that integrates medical treatment, targeted patient education and psychological support to improve the overall quality of life for these patients.
To explore the challenges and opportunities in clinical skills teaching and learning among faculty, final-year medical students and patients at a private medical university in Pakistan, within the context of a low- and middle-income country (LMIC) medical education system.
An exploratory descriptive qualitative design using inductive thematic analysis utilising in-depth interviews and focus group discussions, framed within a metaphorical lens.
A single private-sector tertiary care teaching hospital and affiliated undergraduate medical college in an urban setting in Pakistan.
A total of 48 participants were included in the study: 12 clinical faculty members representing various disciplines and levels of experience, 16 final-year medical students and 10 house officers and 10 patients from adult inpatient wards. Participants were purposively selected to ensure maximum variation in perspectives.
Six key metaphorical themes emerged, each reflecting both the challenges and opportunities within the clinical learning journey: (1) The Safety Harness—simulation as an opportunity for structured, risk-free skill development, yet limited by authenticity; (2) The Underwater Life—the irreplaceable but unpredictable nature of bedside learning in fostering empathy and communication; (3) The Stormy Seas—systemic and cultural barriers such as patient availability, gender constraints and limited faculty resources; (4) The Ship—students navigating self-development amid evolving expectations, digital distractions and shifting motivations; (5) The Engine Room Tools—balancing diverse teaching modalities while seeking optimal time distribution between simulation and bedside learning; and (6) The Guiding Compass—the pivotal role of clinical teachers as mentors and professional exemplars. Triangulated perspectives revealed that while structured simulation and bedside experiences complement one another, significant institutional, ethical and pedagogical challenges persist, many amplified by the realities of resource-limited LMIC settings.
This study underscores the complexities of clinical teaching and learning in an LMIC context, highlighting the need for a balanced, context-sensitive model that integrates simulation with authentic bedside exposure, supported by mentorship and reflective practice. Addressing structural and faculty-related barriers is essential to advancing equitable, patient-centred clinical education in resource-constrained environments.
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 Joseph E. Rubin, Florence Huby, Roshan P. Madalagama, Shyamali de Alwis, Melinda Wyshynski, Rasika Jinadasa
The ability to prepare sterilized media is a critical capability of any microbiology lab. Diagnostic labs in low-resource settings, which lack autoclave facilities, are therefore severely limited in their ability to perform basic assays such as bacterial culture or biochemical tests. This investigation aimed to validate the use of a commercially available pressure cooker as an autoclave substitute to produce agar plates. First, a Geobacillus stearothermophilus biological indicator was used to confirm adequate sterilization. Next, the colony morphology of several important bacterial species were compared on MacConkey and 5% sheep’s blood agar plates prepared using the pressure cooker with those made in an autoclave. Finally, disc diffusion susceptibility testing was performed to determine whether the sterilization method impacts the inhibitory zone diameters. Overall, the morphology of colonies was similar on media prepared in both ways; key phenotypic characteristics (lactose fermentation, colour, shape, hemolysis and smell) were the same. Kirby-Bauer disc diffusion test results were nearly identical. These findings indicate that a commercially available pressure cooker may be suitable to prepare media in low-resource laboratories.
To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic.
An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software.
Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile.
Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures.
Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development).
There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations.
This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies.
We have adhered to the SRQR reporting guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
With the rapid increase in the number of older adults living with chronic diseases and disabilities, there is a growing need to prepare nurses with positive attitudes and a willingness to work with older adults. This study aims to examine attitudes towards and willingness to work with older adults among nurses.
A cross-sectional survey was conducted among a purposive sample of 267 nurses at the University Hospital of Kotelawala Defence University, Sri Lanka. Participants completed a self-administered questionnaire consisting of socio-demographic variables, Kogan’s Attitudes Toward Old People Scale and questions related to willingness to work with older adults. Descriptive statistics and linear and logistic regression analyses were used in data analysis.
The majority were female nurses (71.9%, n=192) and held slightly negative (58%, n=155) or slightly positive (41.9%, n=122) attitudes towards working with older adults. Only 35.2% (n=94) were willing to work with older adults in this study. A male nurse (beta coefficient (β)=4.644, CI 2.392 to 6.896, p
Most nurses express slightly negative to positive attitudes and have little interest in working with older adults. Various socio-demographic factors have an impact on attitudes towards and willingness to work with older adults. Since nurses play a significant role in providing care for older adults, the development of positive attitudes is essential, and interventions and strategies are crucial to increasing their willingness to work with older adults.
To identify and address ethical challenges in doctoral supervision within nursing and health sciences and propose strategies to overcome them.
Following PRISMA guidelines, this mixed-method systematic review synthesises findings from quantitative, qualitative and mixed-methods studies published in English between 2014 and 2025. Studies were included if they examined ethical challenges in doctoral supervision and strategies to address them within nursing and health sciences. Exclusion criteria encompassed reviews, books, editorials, opinion papers, conference papers, studies unrelated to nursing or health sciences or published before 2014.
A systematic search was conducted in CINAHL, Education Source, ERIC, PubMed, Scopus and Web of Science Core Collection, yielding 1100 citations.
The methodological quality of included studies was assessed using the STROBE checklist for quantitative studies and the COREQ framework for qualitative studies. The findings were then synthesised and thematically organised.
Eleven studies met the inclusion criteria: four quantitative, four qualitative and three mixed methods. Ethical challenges in doctoral supervision emerged at three levels: individual (e.g., misaligned expectations, inadequate feedback, student adjustment difficulties), institutional (e.g., high student–supervisor ratios, limited support structures), and cultural (e.g., differing norms around autonomy and academic authority). Supervisors also reported role conflicts. Strategies to address these challenges included improved communication, supervision agreements, institutional support and targeted training.
Ethical challenges in supervision are shaped by individual, institutional and cultural factors. Addressing them requires multi-level strategies, including clear expectations, feedback mechanisms, structured training and culturally sensitive supervision practices. Applying ethical principles fosters a transparent and supportive academic environment that enhances doctoral outcomes.
Universities should adopt multi-level strategies, including supervisor training, mentorship structures and culturally informed policies, to strengthen the ethical integrity and effectiveness of doctoral supervision.
What problem did the study address?: This study synthesises ethical challenges in doctoral supervision within nursing and health sciences, focusing on communication barriers, institutional constraints and the transition from clinical practice to academia. What were the main Findings?: Misaligned expectations between supervisors and students, inadequate feedback and structural limitations, negatively impact the quality of supervision. Doctoral students struggle to adapt to academic expectations, while supervisors face challenges in balancing multiple roles. Effective communication, institutional support and targeted training programmes are essential for improving supervisory experience. Where and on whom will the research have an impact?: The research will inform universities and institutions offering doctoral education in nursing and health sciences. It will benefit doctoral students, supervisors and academic administrators by providing insights and strategies to enhance supervision quality and promote ethical practices.
This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No patient or public involvement.
This study aims to determine the incidence and impact of ocular injuries among the different combat sports disciplines of boxing, mixed martial arts (MMA), kickboxing and Muay Thai in Texas, USA.
A case–control study was conducted to analyse retrospective postmatch physical reports from combat sports matches that took place in the state of Texas from January 2019 to January 2022. Ocular injuries and other match characteristics such as sport type and match outcome were identified by postmatch physical reports. Postmatch physical reports were collected from the Texas Department of Licensing and Regulation database. Statistical analysis was used to stratify injuries and compare the impact of injuries on match outcome.
Combat sports fighters in Texas, USA.
3070 participants were included in the study. Participants were fighters who participated in combat sports matches in Texas, USA, between January 2019 and January 2022.
The original plan was to measure the incidence of ocular injuries across different combat sports including boxing, MMA, kickboxing and Muay Thai. However, due to a limited sample size of kickboxing and Muay Thai matches, the ocular injury incidence was only measured for boxing and MMA. The association between ocular injury and match outcome was assessed using 2 statistical analysis.
The respective incidence rates of ocular injuries in boxing and MMA were 9.7 and 12.2 injuries per 100 matches. The association between ocular injury and match outcome (win, lose or draw) was statistically significant in boxing but not statistically significant in MMA matches.
Our findings revealed that ocular injuries are significantly associated to losing a boxing match (p=0.011), but not associated to match outcome in MMA (p=0.232). Additionally, MMA matches report a larger variety of ocular injuries compared with boxing matches.
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