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Is intensive behavioural change enhanced with dialectical behavioural therapy feasible for weight management in adolescents living with higher body weight? A protocol for a pilot randomised controlled trial in three centres in Canada

Por: Cameron · E. E. · Morrison · K. M. · Ho · J. · Roos · L. · Katz · L. · Mushquash · A. · Dart · A. · Wicklow · B. A. · Senechal · M. · Jung · M. E. · Strachan · S. M. · Afifi · T. O. · Archibald · M. · Andrade · B. · Hadjiyannakis · S. · Hamilton · J. · Slaght · J. · Penner · K. · Balshaw
Introduction

For adolescents living with higher body weight, changing lifestyle behaviours can be met with challenges due to psychosocial factors, such as mental health and emotional challenges. Few behavioural interventions have included skill development to manage these mental health and emotional challenges.

Methods and analysis

The feasibility of a dialectical behavioural therapy (DBT)–enhanced lifestyle intervention will be evaluated through a pilot randomised controlled trial. We will recruit 90 adolescents aged 14–17 years with a body mass index Z-score >1.4 and mild-to-moderate depressive symptoms to participate with a caregiver in the trial. Adolescents will be randomised 2:2:1 to one of the three study arms: (A) behavioural lifestyle intervention with DBT skills training, (B) behavioural lifestyle intervention alone (ie, without DBT skills training) or (C) control. The interventions will include two sessions weekly for 16 weeks that include (1) one modified DBT skills training with two facilitators, supervised by a clinical psychologist, combined with one behavioural lifestyle session delivered by a dietitian and/or a kinesiologist and (2) two behavioural lifestyle sessions alone. DBT skills training will consist of teaching mindfulness, emotion regulation, distress tolerance, interpersonal effectiveness and walking the middle path modules. Behavioural sessions will be guided by evidence-based practices for goal setting, dietary counselling, improving sleep, reducing screen time and structured physical activity. The main outcomes are enrolment rates, adherence to the intervention and retention rates for follow-up measurements. The secondary outcome will be changes in the quality of life (Pediatric Quality of Life Inventory) and daily physical activity levels between baseline and immediately post-intervention. Adolescents will participate in a focus group incorporating photo elicitation to explore satisfaction, acceptability and perceived benefits of the study arms.

Ethics and dissemination

This study has received ethical approval from the University of Manitoba’s Biomedical Research Ethics Committee (HS24295-H2020:427), Hamilton Health Sciences & McMaster University (HiREB 18159) and The Conjoint Health Research Ethics Board (CHREB), University of Calgary (REB24-1084). Results will be disseminated through publication in peer-reviewed journals and be relevant to researchers and clinicians involved in paediatrics and paediatric weight management.

Trial registration number

NCT05338944.

Internal Regulation Core as a hub of disruptive innovation in hospital management: a scoping review protocol

Por: Gomes · L. M. · Moreira · F. d. M. B. · Junior · G. F. X. · Duani · H. · Andrade · M. V. M. d. · Ferrari · T. C. A.
Introduction

This scoping review protocol aims to examine the role of the Internal Regulation Core (IRC) as an intra-hospital governance structure that coordinates capacity and patient flow and may function as a strategic hub for disruptive innovation in hospital management. By integrating organisational routines, rules and, when available, enabling technologies, IRCs may strengthen operational efficiency and contribute to higher-quality care delivery. As hospitals face increasing operational complexity and constrained resources, clarifying what IRCs are, how they are implemented across settings, and what innovations and impacts are reported has become a priority.

Methods and analysis

This scoping review will follow the Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted across five databases (MEDLINE/PubMed, Embase, Scopus, Web of Science and LILACS) and grey literature sources, without language or date restrictions. The searches were conducted up to 6 July 2025. Two reviewers will independently screen studies and extract data using a standardised form; disagreements will be resolved by consensus or a third reviewer. Findings will be synthesised descriptively and thematically, with results presented in tables and narrative summaries, including innovation streams.

Trial registration number

Open Science Framework (10.17605/OSF.IO/HWZJS).

UNIversity students LIFEstyle behaviours and Mental health cohort (UNILIFE-M): study protocol of a multicentre, prospective cohort study

Por: Schuch · F. B. · Waclawoscky · A. · Tornquist · D. · Oyeyemi · A. L. · Sadarangani · K. P. · Takano · K. · Teychenne · M. · Balanza-Martinez · V. · ONeil · A. · Romain · A. J. · McGrath · A. · Alselmi · A. · Andrade-Lima · A. · Zanetti · A. C. G. · Trompetero-Gonzalez · A.-C. · Heiss
Introduction

Students enrolling in higher education often adopt lifestyles linked to worse mental health, potentially contributing to the peak age onset of mental health problems in early adulthood. However, extensive research is limited by focusing on single lifestyle behaviours, including single time points, within limited cultural contexts, and focusing on a limited set of mental health symptoms.

Methods and analysis

The UNIversity students’ LIFEstyle behaviours and Mental health cohort (UNILIFE-M) is a prospective worldwide cohort study aiming to investigate the associations between students’ lifestyle behaviours and mental health symptoms during their college years. The UNILIFE-M will gather self-reported data through an online survey on mental health symptoms (ie, depression, anxiety, mania, sleep problems, substance abuse, inattention/hyperactivity and obsessive/compulsive thoughts/behaviours) and lifestyle behaviours (ie, diet, physical activity, substance use, stress management, social support, restorative sleep, environment and sedentary behaviour) over 3.5 years. Participants of 69 universities from 28 countries (300 per site) will be assessed at university admission in the 2023 and/or the 2024 academic year and followed up for 1, 2 and 3.5 years.

Ethics and dissemination

The study was first approved at a national level in Brazil (CAE:63025822.8.1001.5346). Study sites outside Brazil obtained additional ethics approval from their institutions using the main approval. Results from the UNILIFE-M cohort will be disseminated through scientific publications, presentations at scientific meetings, press releases, the general media and social media.

Barriers and strategies for pain management in non-verbal people with dementia in residential care facilities: protocol for an e-Delphi study

Por: Felix · I. B. · Ramos · C. · Guerreiro · R. · Hughes · J. D. · Hoti · K. · Andrade · T. · Guerreiro · M.
Introduction

Pain is a prevalent symptom in people living with dementia. Evidence shows that pain frequently remains unrecognised and untreated in this vulnerable population, leading to avoidable suffering. Effective pain management is hindered by multifactorial barriers at the individual, organisational and policy level. This study aims to achieve expert consensus on the key barriers to pain management in non-verbal people living with dementia and strategies to address these barriers within Portuguese residential care facilities.

Methods and analysis

An e-Delphi study will be conducted using two rounds of online questionnaires. The Behaviour Change Wheel (BCW) framework guided the development of e-Delphi statements by linking identified determinants (i.e., barriers and facilitators) to intervention functions. Barriers were extracted from the literature reviews and mapped into the capability, opportunity and motivation–behaviour model. Intervention functions were then selected using the BCW linkage matrices and operationalised into practical strategies. A purposive and snowball sampling approach will be used to recruit a heterogeneous panel of experts across national residential care facilities, including nurses, physicians, managers and policymakers with relevant experience in dementia. During the e-Delphi rounds, participants will be invited to rate the relevance of each barrier and associated strategy(ies) on a five-point Likert scale and provide comments or suggestions. Consensus will be defined as ≥75% agreement on each statement.

Ethics and dissemination

Ethical approval for this study was obtained from the Egas Moniz Ethics Committee (Ref. 1586), and all procedures will comply with the Declaration of Helsinki. Informed consent will be obtained from all participants. The findings will be disseminated through a peer-reviewed publication, scientific events and stakeholder networks, including residential care facilities, to inform future practice and policy in dementia care.

A Comprehensive Assessment of the Environmental Impact of Different Infant Feeding Types: The Observational Study GREEN MOTHER

ABSTRACT

Aim(s)

To observe and compare the environmental impacts of different types of infant feeding, considering the use of formula, infant feeding accessories, potentially increased maternal dietary intake during breastfeeding (BF) and food consumption habits.

Design

An observational cross-sectional multicentre study conducted in the Barcelona Metropolitan Area of the Catalan Institute of Health.

Methods

Data were collected from 419 postpartum women on infant feeding type (formula milk and accessories), maternal dietary intake (24-h register) and food consumption habits from November 2022 to April 2023. The environmental impacts (climate change (CC), water consumption and water scarcity) of the infant feeding types and maternal diet were calculated using the IPCC, ReCiPE and AWARE indicators, respectively. The differences in impacts were calculated by Kruskal–Wallis test.

Results

Significant differences for the three environmental impacts were observed. The CC impact of formula milk and feeding accessories was 0.01 kg CO2eq for exclusive BF, 1.55 kg CO2eq for mixed feeding and 4.98 kg CO2eq for formula feeding. While BF mothers consumed an extra 238 kcal, no significant differences were found related to maternal diet across feeding types.

Conclusion

Exclusive BF was the most sustainable type of infant feeding, considering formula and infant feeding accessories. In our study, the difference between the impacts of BF and non-BF mothers' diet was insignificant.

Implications for the Profession and/or Patient Care

Offer informative and educational support for midwives and other healthcare professionals on BF and a healthy, sustainable diet to transfer this knowledge to the general public.

Impact

Raise the general public's awareness about BF and a healthy, sustainable diet. To reduce environmental impacts through behavioural changes.

Reporting Method

STROBE.

Patient or Public Contribution

Patients of the Catalan Health Service reviewed the content of the data collection tools.

Trial Registration: (for the whole GREEN MOTHER project): NCT05729581 (https://clinicaltrials.gov)

Use of digital self-care solutions for diabetes long-term management: a scoping review protocol

Por: Correia · J. C. · Fakih El Khoury · C. · El Chaar · D. · Arakelyan · S. · Rasooly · A. · Loffreda · G. · Joshi · S. · Cohen · J.-D. · De Andrade · V. · Petre · B. · Lapao · L. V. · Perrin · C. · Pataky · Z.
Introduction

Diabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.

Methods and analysis

The review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.

Ethics and dissemination

This scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.

Enhancing Breast Cancer Survivorship Care: The Role of Nurses in Post‐Treatment Follow‐Up—A Scoping Review

ABSTRACT

Aim

To examine the role of nurses in providing post-treatment follow-up care to breast cancer survivors, and to assess the impact of this care on survivors' satisfaction.

Methods

Scoping review.

Data Sources

An electronic literature search from PubMed and CINAHL databases was conducted, covering the period from 2013 to November 2023.

Results

Twenty-seven articles were included in this review, highlighting key areas in which nurses play essential roles in the provision of post-treatment care for breast cancer survivors. The identified nursing roles include the surveillance and early detection of relapses, the assessment and support of self-management for late physical and psychosocial effects of cancer, health promotion and care coordination. Regarding satisfaction, survivors reported high overall satisfaction with nursing care. However, satisfaction levels varied with regard to specific needs, particularly in managing the fear of recurrence.

Conclusions

Nurses play a fundamental role in delivering post-treatment care to breast cancer survivors. However, evidence regarding their specific contributions and survivors' satisfaction with long-term care remains limited, underscoring the need for further research to enhance care during the long-term survivorship phase.

Implications for the Profession

Consolidating the diverse roles of nurses in post-treatment care into a unified framework could support comprehensive and personalised care, addressing unmet needs. Evaluating patient satisfaction with nursing follow-up helps identify effective interventions and areas for improvement in future research.

Impact

This review analyses the diverse roles of nurses in the follow-up care of breast cancer survivors and highlights the impact of nursing care on patient satisfaction.

Reporting Method

This study adhered to the PRISMA-ScR reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

Aspectos prácticos para la acogida humanizada en el centro quirúrgico y la sala de recuperación postanestésica: cuidando más allá de la técnica

La experiencia de un procedimiento quirúrgico puede ser angustiante tanto para los pacientes como
para sus familiares, lo que requiere la atención integral del equipo quirúrgico para minimizar las
inseguridades. Así, el objetivo de esta comunicación breve es reflexionar sobre la importancia de la
acogida humanizada en el Centro Quirúrgico y la Sala de Recuperación Postanestésica, presentando
aspectos prácticos para mejorar este enfoque. La humanización del cuidado implica una comunicación
efectiva, una atención personalizada y la creación de un ambiente acogedor. Este manuscrito destaca
estrategias para optimizar la acogida en el bloque quirúrgico. La humanización en la asistencia quirúrgica refuerza la esencia del cuidado en salud, yendo más allá de la mera aplicación de protocolos
técnicos

Hope‐Promoting Communication With Pediatric Patients With Chronic Diseases and Their Families: A Scoping Review

ABSTRACT

Introduction

The way communication is conducted directly influences the professional–patient relationship, how patients cope with their diagnosis, and their sense of hope throughout treatment. This study aims to map the literature on strategies that healthcare professionals can use to promote hope in communication with pediatric patients and their families in the context of chronic illness. Based on this objective, the study highlights an algorithm to assist healthcare professionals in instilling hope in this population through communication.

Design

Scoping review.

Methods

This systematized review was conducted using the databases PubMed, LILACS, PsycInfo, Embase, CINAHL, and Scopus, employing the PCC framework and the Boolean operators AND and OR. The time frame was limited to the last 20 years (2004–2024). A total of 734 studies were identified across the databases, with an additional four retrieved through manual citation searches, resulting in 19 articles included in the final sample.

Results

The findings highlight three key pillars for promoting hope in communication: (1) careful preparation for information delivery, which involves identifying the diverse needs of families and creating a physically comfortable and emotionally supportive environment; (2) providing information and emphasizing how it is presented—considering content, clarity, honesty, empathy, and adaptation to the recipient's specific needs; and (3) follow-up after information delivery, ensuring emotional support and active, skilled listening.

Conclusions

Interpersonal communication between the healthcare professional, the patient, and the family was mainly focused on the transmission of information about the disease and treatment in a clear and empathetic manner, considering who is receiving the information and how the information is interpreted.

Clinical Relevance

This review provides guidance for healthcare professionals in implementing communication strategies that foster hope in the context of pediatric chronic illness. Additionally, this guide may serve as a model for training students and healthcare professionals. Further research is needed to implement and explore additional effective communication strategies for this population across diverse cultural settings.

Recuperación de la actividad física y deportiva cuando eres portadora de una ostomía

Objetivo principal: Identificar las intervenciones adecuadas, desde el preoperatorio, para recuperar progresivamente la actividad previa a la formación del estoma, de forma segura. Metodología: Búsqueda de evidencias, siguiendo el modelo PRAXIS. Recomendaciones de Buena Práctica: a) motivar el autocuidado en el preoperatorio, b) instruir, el personal de hospitalización, en la movilización  temprana adecuada c) promover la actividad física progresiva de forma individual d) instruir en habilidades y estrategias para una práctica deportiva segura Prácticas de autocuidado: saber manejarse y adaptarse a los cambios físicos, conocer tu cuerpo y desmitificar miedos,  disfrutar de la actividad deportiva en grupo,  compartir experiencias con otras personas ostomizadas.

Cuando la esperanza llama a la puerta: reflexiones sobre la enseñanza para la atención de la salud

Objetivo principal: Presentar, en forma de diario de campo, reflexiones sobre la experiencia docente en la docencia para la salud en Brasil, con enfoque en la pedagogía de Paulo Freire. Metodología: Presentar, en forma de diario de campo, reflexiones sobre la expe-riencia en la docencia para la salud en Brasil, con enfoque en la pedagogía de Paulo Freire. Resultados principales: La relación entre el docente y los alumnos proporcionó aprendizajes que implican descubrimientos para la necesidad de cambios y / o perfeccionamiento teórico, desde el punto de vista de la descolonialidad. Conclusión principal: A través del acto educativo, docentes y alumnos pueden desarrollar conocimientos para una práctica docente reflexiva.

Expediente Electrónico vs Expediente Físico para mejorar la calidad del proceso de atención en pacientes hospitalizados

Objetivo principal: Comparar la eficacia del uso del Expediente Clínico Electrónico (ECE) Vs Expediente Clínico Físico (ECF) en la mejora la calidad en atención de pacientes hospitalizados. Metodología: Se consideraron estudios relacionados con uso del ECE, utilizando los descriptores DeCS y MeSH, operadores booleanos AND, NOT y OR. Criterios inclusión: artículos de revisión con cinco años de publicación; criterios exclusión: pacientes ambulatorios o de consulta externa. Resultados principales: La evidencia establece ventajas del uso ECE como la facilidad de uso, accesibilidad, lectura, calidad en la documentación, control de información sobre los cuidados de los pacientes, cumplimiento normativo y toma de decisiones, lo cual reduce el riesgo de errores médicos; sin embargo, algunas desventajas es el empleo de hardware, software, redes; requiere soporte técnico las 24 horas al día. Conclusión principal: el empleo del ECE establece eficacia en la atención al paciente hospitalizado mediante la minimización de tiempos en registros y el aumento en la seguridad de la información.

Calidad de Vida Relacionada con la Salud, de pacientes dializados, Hospital Puerto Montt, Chile

Objetivo: Describir variables clínicas, sociodemográficas, Calidad de Vida Relacionada con la Salud (CVRS) en Hemodiálisis (HD) y Peritoneodiálisis (PD), en Hospital Puerto Montt, Chile. Metodología: cuantitativo descriptivo, transversal. n=75 (47 HD, 28 PD). Aprobado por Comité de Ética, revisión fichas clínicas, cuestionario sociodemográfico y KDQOL-36. Resultados: 51% mujeres, 49% hombres, 56% sector urbano, 20% 51-60 años. HD: 49% casados, 36% tratamiento sobre 84 meses. PD; 43% casados, 25% tratamiento 12-48 meses. KDQOL-36: 43% HD y 54% PD perciben “Buena” su salud. Esfera física; 25%, ambas terapias, refiere limitación en actividades de la vida diaria; 38% de PD refiere dolor “moderado”. Esfera psicológica; HD 28% refiere tranquilidad y sosiego “casi siempre”; PD 35% desánimo y tristeza “algunas veces”. Conclusiones: existe impacto negativo en dimensiones de CVRS; pero, globalmente considerada “Buena”; permitiendo formular mejoras para pacientes.

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