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Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.
Multicentre, retrospective, observational, new-user, active-comparator cohort study.
Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.
Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.
Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.
The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.
SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.
by Jieyu Zhao, Kota Kurisu, Kazuki Ohashi, Toshiya Osanai, Katsuhiko Ogasawara, Miki Fujimura
In this work, we aimed to assess the impact of clazosentan on clinical labour time costs within Japan’s value-based healthcare system using time-driven activity-based costing. Time-driven activity-based costing was employed to analyse the labour time costs associated with preventing cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Time-driven activity-based costing simplifies cost analysis by utilising time as the primary cost driver. We compared two treatment approaches: conventional therapy with fasudil hydrochloride and postoperative therapy with clazosentan. Scenario and sensitivity analyses were performed to assess the impact of physicians’ costs on the results. The use of clazosentan for the prevention of cerebral vasospasm significantly reduced human resource costs, particularly in cases where symptomatic vasospasm did not occur, yielding savings of approximately 51,343 yen. The greatest cost reductions were observed among nursing staff, with a 30% decrease in the absence of symptomatic vasospasm and a 15% reduction when symptomatic vasospasm was present. The cost reductions for physicians were comparatively smaller, particularly in cases where symptomatic vasospasm occurred. Sensitivity analyses indicated that clazosentan reduced overall costs by approximately 35,000–50,000 yen; however, costs increased in the presence of symptomatic vasospasm. Clazosentan for subarachnoid haemorrhage treatment significantly reduces human resource costs, especially in nursing staff. These findings support the potential of clazosentan for broader clinical use, given its cost-savings and clinical benefits in reducing cerebral vasospasm following aneurysmal subarachnoid haemorrhage.
Technology-assisted interventions offer a promising alternative to conventional cardiac rehabilitation. However, there is limited evidence on their effectiveness, particularly in non-Western settings with emphasis on exercise self-efficacy.
To evaluate the effects of a 12-week, technology-assisted hybrid cardiac rehabilitation (TecHCR) program on physical, physiological, and psychological outcomes of patients with coronary heart disease.
A two-arm parallel randomized controlled trial including 160 participants was randomly assigned to either TecHCR or usual care. TecHCR was underpinned by the Health Belief Model, consisting of three supervised exercise training and occupational therapy sessions, a fitness watch for exercise self-monitoring, six audio-visual educational videos, and a weekly video call follow-up. Data were collected at baseline, immediately post-intervention, and at 24 weeks post-intervention.
Participants in TecHCR demonstrated significantly greater improvement in exercise self-efficacy (β = 5.909, 95% CI [3.146, 8.672]; p < 0.001), health-promoting behaviors (β = 9.058, 95% CI [5.524, 12.591]; p < 0.001), and perceived anxiety levels (β = −1.255, 95% CI [−1.893, −0.616]; p < 0.001) at immediate post-intervention and (β = 8.506, 95% CI [4.951, 12.061]; p < 0.001, β = 14.563, 95% CI [8.809, 20.317]; p < 0.001, β = −1.145, 95% CI [−1.975, −0.315]; p = 0.007, respectively) 24 weeks post-intervention when compared with the control group. No statistically significant improvements were observed in perceived depression and cardiovascular risk factors.
The TecHCR program, combining supervised sessions with technology-assisted components, is an effective approach for significantly improving exercise self-efficacy, health-promoting behaviors, and anxiety in patients with coronary heart disease. Healthcare institutions should consider implementing hybrid programs to overcome barriers to traditional cardiac rehabilitation, leveraging technology to extend support and maintain patient engagement beyond supervised sessions.
clinicaltrials.gov identifier: NCT04862351
by Wafaa T. ALQadrie, Ali M. Saleh, Sami AL-Rawashdeh, Ola N. Alfuqaha, Suheir I. Abdallah
BackgroundIn recent years, the concept of followership has gained significant attention, challenging the traditional leadership-centric view of organizational management positions. While effective followership is vital to the success of any organization, it has often been overlooked, especially in healthcare, where teamwork is crucial.
AimThe current study aimed to identify the followership styles of nurses in Jordan and examine how these styles relate to nurses’ demographic and work-related characteristics.
MethodA descriptive cross-sectional design was employed. Using a multistage sampling approach, 351 registered nurses were recruited from governmental, private, and teaching hospitals across northern, central, and southern Jordan. Data were collected through an online survey using the validated Kelley Followership Questionnaire–Revised (KFQ-R). Both descriptive and inferential statistical analyses were conducted.
ResultsFindings revealed that the predominant followership style was exemplary (68.7%), followed by the pragmatist (31.3%). Chi square test revealed statistically significant difference between followership style and marital status (χ² (1) = 6.193, p = .013), working area (χ² (2) = 7.405, p = .025), nursing care delivery system (χ² (3) = 13.926, p = .003), and Decision-making style (χ² (3) = 17.173, p = .001). The binary logistic regression was significant, χ² (26) = 67.77, p
by Yong Jae Lee, Nam Kyeong Kim, Kidong Kim, Chel Hun Choi, Keun Ho Lee, Jong-Min Lee, Kwang Beom Lee, Dong Hoon Suh, Sunghoon Kim, Min Kyu Kim, Seok Ju Seong, Myong Cheol Lim
ObjectiveTo identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.
MethodsIn this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI 2 and aged >18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.
ResultsOut of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p > 0.999) and 2-years (0.0% vs. 3.4%, p = 0.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.
ConclusionsFascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.
Trial registrationClinicalTrials.gov NCT04643197
In recent decades, transcranial electrical stimulation (tES) has become a widely used non-invasive method for modulating brain function in clinical and non-clinical populations. However, existing tES trials exhibit substantial methodological heterogeneity, often limiting the reproducibility and interpretability of findings. There currently exists a paucity of consensus-driven, standardised recommendations outlining the key factors that should be reported and/or controlled in tES studies. Accordingly, this project aims to develop Consolidated Guidelines for Reporting and Evaluation of studies using tES (CoRE-tES), a tool designed to assess the methodological quality and reporting of laboratory-based and home-based tES studies. These guidelines will support improved quality, consistency, replication and transparency in research involving tES modalities, including transcranial direct current stimulation, transcranial alternating current stimulation and transcranial random noise stimulation.
CoRE-tES will be developed and disseminated over five stages. Stage 1 will comprise a review of recent tES literature to assess methodological and reporting quality. Stage 2 will employ a Delphi process to seek agreement among international tES experts on a list of items for inclusion in CoRE-tES. In stage 3, a consensus meeting will be held to synthesise and prioritise the agreed items to form CoRE-tES. Stage 4 will involve production of the final CoRE-tES checklist and an accompanying evaluation and elaboration document. In stage 5, CoRE-tES will be disseminated via journal publication, conferences, professional meetings and social media campaigns.
Ethics approval has been obtained from the Western Sydney University Human Research Ethics Committee (approval number H16803). Findings will be disseminated through scientific conferences and peer-reviewed journal publications, and CoRE-tES will be indexed on the Enhancing the QUAlity and Transparency Of health Research Network website.
This study aimed to understand the dissemination of information relating to coronavirus disease 2019 (COVID-19) and its impact on nursing care in the early phase of transmission.
COVID-19 has spread globally, causing an unprecedentedly large number of casualties. Nurses face challenges in dealing with patients with COVID-19 with limited information about the pathogen.
This qualitative study followed the COREQ guidelines.
Fifteen nurses were recruited from two university hospitals in South Korea using a snowballing technique for in-depth interviews in May 2020. All interviews were recorded and transcribed verbatim. Content analysis was performed on the interview data.
Two themes emerged: access to COVID-19 information and the impact of information on nursing care. The categories of access to COVID-19 information were lack of nursing-specific information, limited information cascading from top management and confusion due to varying points of view. The categories of the impact of information on nursing care were unprepared management that aggravates exhaustion, lack of personal protective equipment that creates anxiety and being a nurse leader to overcome the pandemic.
During a pandemic of emerging infectious diseases, nurses should have access to up-to-date information tailored to their working environment. Human resources, material resources and systematic support are needed for nurses who provide care for patients with an infectious disease.
A collaborative interprofessional education system for emerging infectious diseases is needed for effective communication and consistent care during a pandemic. Nurse leaders should be prepared to deliver profession-specific information for standardised care and respond to nursing management needs by using resources and tailoring the workforce.
Non-communicable diseases (NCDs) and their associated risk factors are becoming increasingly prevalent worldwide. NCDs are both a health burden and an economic burden, but many can be prevented by public health interventions that include screening and treatment. The primary objective was to determine the prevalence of NCDs pre-diabetes, suspected diabetes, hypertension and high total cholesterol (TC)/high-density lipoprotein (HDL) ratio, as well as the prevalence of high cardiovascular risk (CVR) in the United Arab Emirates (UAE). The secondary objective was to assess modifiable risk factors for NCDs and investigate correlations between these risk factors and age, sex and emirate of residence.
A health screening programme (HSP) for the early detection and treatment of NCDs was launched in 2021 to screen, diagnose and treat NCDs. This retrospective cross-sectional study analysed HSP data collected from April 2021 to December 2023.
Primary healthcare centres in the UAE.
34 290 participants in the HSP who were screened for the first time.
Of the participants, 60.4% were female, and 51.8% were 18–39 years old. Pre-diabetes was found in 17.3% (95% CI, 16.9% to 17.7%), suspected diabetes type 2 in 6.1% (95% CI, 5.8 to 6.3), hypertension in 13.9% (95% CI, 13.5% to 14.3%), and high TC/HDL ratio in 8.1% (95% CI, 7.8% to 8.4%). A high CVR was found in 11.5% (95% CI, 11.1% to 11.8%) of overall participants and 52.5% (95% CI, 50.5% to 54.5%) of people with diabetes. The OR of high CVR was 11.95 for suspected diabetics. Modifiable risk factors, such as smoking, physical inactivity, overweight and obesity, were all associated with age and sex; in addition, age and sex interacted in their effect on these factors.
The prevalence of the four NCDs and high CVR was high in the northern emirates. High CVR was especially common among people with diabetes. A large majority of participants had one or more modifiable risk factors. Age, sex and their interaction correlated strongly with the modifiable risk factors. These results can guide the introduction of specialised preventive and curative services to enhance public health and well-being.
There is an increasing need for highly accessible health management platforms for comprehensive symptoms of Parkinson disease. Mobile apps encompassing nonmotor symptoms have been rarely developed since these symptoms are often subjective and difficult to reflect what individuals actually experience. The study developed an app for comprehensive symptom management and evaluated its usability and feasibility. A single-group repeated measurement experimental design was used. Twenty-two participants used the app for 6 weeks. Monitoring of nonmotor symptoms, games to address motor symptoms, and medication management were incorporated in the app. Quantitative outcomes were self-assessed through an online questionnaire, and one-on-one telephone interviews were conducted to understand the user's point of view. The successful experience of self-monitoring had improved participants' self-efficacy (Z = −3.634, P
The poor usability of electronic health records contributes to increased nurses' workload, workarounds, and potential threats to patient safety. Understanding nurses' perceptions of electronic health record usability and incorporating human factors engineering principles are essential for improving electronic health records and aligning them with nursing workflows. This review aimed to synthesize studies focused on nurses' perceived electronic health record usability and categorize the findings in alignment with three human factor goals: satisfaction, performance, and safety. This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five hundred forty-nine studies were identified from January 2009 to June 2023. Twenty-one studies were included in this review. The majority of the studies utilized reliable and validated questionnaires (n = 15) to capture the viewpoints of hospital-based nurses (n = 20). When categorizing usability-related findings according to the goals of good human factor design, namely, improving satisfaction, performance, and safety, studies used performance-related measures most. Only four studies measured safety-related aspects of electronic health record usability. Electronic health record redesign is necessary to improve nurses' perceptions of electronic health record usability, but future efforts should systematically address all three goals of good human factor design. 
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