Conectar
To explore relatives' experiences of the circulatory death of a family member following out-of-hospital cardiac arrest and to explore their hypothetical perspectives on being asked to decide about organ donation in this situation. This study forms part of a broader initiative undertaken to assess the prerequisites for implementing uncontrolled donation after circulatory death in Sweden with a focus on ethical issues.
A qualitative design, using semi-structured interviews with open-ended questions.
Data were collected in Sweden between March 2024 and September 2024 and analysed using reflexive thematic analysis with an inductive, descriptive approach. Included were 13 bereaved relatives, four men and nine women.
The analysis generated three themes: ‘Fluctuating between hope and despair’, which describes relatives' experiences of their family member's sudden cardiac arrest; ‘Exposed to vulnerability’, concerning their experiences of death and their perspectives on reasoning about the deceased person's wishes regarding donation; and ‘Balancing a major life change’, which involves experiences of facilitators and barriers to dealing with the loss.
Awareness of the deceased family member's wishes regarding organ donation facilitates relatives' ability to support the deceased's known or presumed wishes. Compassionate and communicatively competent healthcare professionals influence relatives' capacity to reason about the deceased's wishes and cope with their experience of loss. Ensuring sufficient time for goodbyes and providing follow-up may facilitate emotional processing and should be considered when implementing uncontrolled donation after circulatory death.
Policies and clinical practice should ensure that relatives are adequately informed and supported in reasoning on their family members' wishes regarding organ donation. To achieve this, nurses and other healthcare professionals require training in compassionate and empathetic communication strategies. Such training is essential both for guiding relatives through reasoning about their family preferences and for providing emotional support during the grieving process.
What is already known? ○
Organ donation after sudden death in out-of-hospital cardiac arrest is a complex process that raises ethical issues concerning both the timing and the content of conversation with the deceased's relatives, as well as the relatives' capacity to reason about the deceased's wishes in the context of sudden death.
○Knowing the wishes of the deceased person, personal beliefs, and receiving clear, direct, and honest information from nurses and other healthcare professionals prepares relatives to reason about the deceased's known or presumed wishes regarding organ donation.
What were the main findings? ○
The quality of nurses' and healthcare professionals' communicative competence and their behaviours influence relatives' ability to reason and reflect on organ donation.
○Factors that facilitate family members' experiences of donation following out-of-hospital cardiac arrest and death include awareness of the deceased's wishes regarding organ donation, being able to see with their own eyes that their family member is dead, and having sufficient time to say farewell.
○Follow-up from health care services could have an impact on relatives' experiences and their processing of loss.
Where and on whom will the research have an impact? ○
This research has an impact on organ donation services, pre-hospital emergency care, and emergency department operations. It can assist nurses and physicians in planning ethical and family-centred care in cases of out-of-hospital sudden death and uncontrolled donation after circulatory death.
COREQ-checklist.
No patient or public involvement in design, conduct or reporting.
Organizational culture and readiness are critical determinants of evidence-based practice (EBP) implementation. The Organizational Culture and Readiness Scale for System-Wide Integration of EBP (OCRSIEP), developed within the ARCC framework, is a validated tool to assess these dimensions, but no Italian version currently exists.
To translate, culturally adapt, and psychometrically validate the OCRSIEP and its short form in Italian.
A validation study was conducted, using exploratory and confirmatory factor analyses to derive and test the underlying model, followed by reliability testing with multiple indices and measurement invariance analyses.
Data were collected from 405 Italian nurses. Factor analyses supported a 19-item, six-factor structure explaining 59.5% of the variance, with a second-order factor indicating an overarching construct. The three-item short form showed strong model fit and explained 67% of the variance. Subscales demonstrated acceptable-to-excellent reliability, and partial scalar invariance was established across public and private facilities.
The Italian OCRSIEP scales are valid and reliable tools to assess organizational readiness for EBP implementation. They can guide leaders, educators, and researchers in monitoring, benchmarking, and advancing EBP–oriented system transformation within the Italian healthcare context.
Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts.
This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version.
A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test–retest reliability, and measurement invariance testing. All analyses were performed in R Studio.
Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice.
The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.
by Akram J. Alahmar, Noha M. Elhosseiny, Rehab R. Mahmoud, Ahmed S. Attia
Acinetobacter baumannii is a growing threat characterized by worrisome antibiotic resistance. A deeper understanding of its resistance and virulence mechanisms is essential for developing new and effective treatments. Herein, we explore the role of the two-component (NtrB-NtrC) signal transduction system and two distinct glutamine synthetases (GlnA-1 and GlnA-2) in the nitrogen assimilation, stress response, and virulence in A. baumannii. Under nitrogen-limited conditions, the ntrC mutant showed significantly defective growth kinetics when ammonium was the sole source of nitrogen, whereas the glnA2 mutant exhibited an obvious growth defect when putrescine was the sole source of nitrogen. Moreover, under nitrogen limitation, the glnA1 and glnA2 expression increased by approximately twofold and ninefold, respectively. An enzymatic activity assay demonstrated that the A. baumannii extracellular glutamine synthetase activity is dependent on the type II secretion system (T2SS), confirming our previous results from a T2SS secretome study. Interestingly, this activity is also regulated by NtrC. An infection model using Galleria mellonella revealed that the ntrC mutant was significantly less virulent than both the wild-type and glnA2 mutant strains. These results provide new insights into the nitrogen regulatory network and its contribution to the A. baumannii virulence, underscoring NtrC as a promising target for future antimicrobial strategies.Elevated left ventricular end-diastolic pressure (LVEDP) in ST-segment elevation myocardial infarction (STEMI) has been studied in patients who received thrombolysis or who were treated early in the primary percutaneous coronary intervention (PCI) era; LVEDP was found to be a predictor of adverse outcomes in these retrospective post hoc analyses. The aim of the current analysis is to assess the prognostic value of the elevated LVEDP in STEMI patients undergoing primary PCI in current contemporary practice.
Prospective, single-centre study.
Our study enrolled STEMI patients with elevated LVEDP undergoing primary PCI at John Hunter Hospital, Newcastle, Australia.
The primary endpoint was the combination of 12-month all-cause mortality and heart failure admissions, comparing different quartiles of LVEDP.
A total of 997 patients underwent primary PCI at our hospital during the 5-year study period (age: 64±13 years, males: 73%; n=728) from 1 January 2015 to 31 December 2019. The median LVEDP for the whole cohort was 27 mm Hg (IQR: 22–31 mm Hg). The median LVEDP was 17 mm Hg (IQR: 13–18 mm Hg) and 33 mm Hg (IQR: 30–36 mm Hg) for 1st and 4th quartiles respectively (p
LVEDP is an independent predictor of adverse outcomes in STEMI patients, despite a relatively normal LVEF. Further prospective studies are needed to assess the effects of early reduction in LVEDP on the prognosis.
FreshRSS 