Conectar
Keratinocyte cancers (KCs) are increasing in incidence in the UK, with over 234 000 cases annually, largely due to demographic changes and sun exposure. Skin cancers, including malignant melanoma and KCs, are projected to cost the NHS over £180 million annually and impose healthcare demands. Although KCs have high cure rates following surgical excision and primary closure, wounds healing by secondary intention (HBSI) particularly on the lower leg present clinical challenges. Compression therapy (CT) known to improve venous insufficiency and venous ulcer healing may also benefit HBSI following lower limb KC excision but current evidence is sparse.
Healing of ExcisionAl wounds on Lower legs by Secondary intention (HEALS2) is a multicentre, prospective, Phase III, parallel group, open-label, randomised controlled trial with embedded internal pilot and blinded endpoint assessment. A total of 396 participants (≥18 years) from UK skin cancer surgery centres will be randomised 1:1 to assess the clinical and cost-effectiveness of standard care (SC) alone or with CT (SC+CT) for surgical wounds HBSI following excision of lower limb KCs.
The primary outcome is time to healing from randomisation (maximum 52-week follow-up). Secondary outcomes include incidence of infection, antibiotic usage, scar quality, safety (including complications and hospitalisations), quality of life, cost-effectiveness and relationship between post-partial closure wound area, type of partial closure method and time to healing. Exploratory objectives include association between short-term wound area reduction and time to HBSI, patient acceptability, adherence and associations between wound breakdown post-healing and CT use. A qualitative sub-study will explore patients’ experiences and decision-making during CT use.
Primary endpoint analysis will be conducted on the intention-to-treat population using a multivariable Cox Proportional Hazards modelling. Secondary outcomes and safety will be evaluated using other regression models and descriptive statistics, respectively. Cost-effectiveness will be evaluated using within-trial analysis and decision-analytic modelling. Patient and public involvement representatives are contributing to trial design and oversight. The study protocol complies with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) Statement.
Ethics approval has been granted by the Yorkshire & The Humber – Leeds East Research Ethics Committee (ref 23/YH/0247). Findings will be published in high-impact peer-reviewed journals.
This review explores the conceptual frameworks, methods, barriers and facilitators associated with the human-centred design (HCD) process employed when developing digital health dashboards (DHDs) for the care of older adults.
This scoping review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review (PRISMA-ScR) guidelines, ensuring a systematic approach to identifying and synthesising relevant literature.
Five databases were searched including EMBASE, MEDLINE, PsychInfo, CINAHL and Cochrane Library from January 2012 to 30 March 2026.
Studies were eligible if they involved the HCD of DHDs for health management in older adults aged 60 years and over. The design process could involve a range of stakeholders, including older adults, healthcare professionals, carers, technology experts and other relevant parties involved in dashboard design.
Search terms included older persons, ageing, decision support systems, dashboards, human-centred design etc. Study screening was done in Rayyan, and data extraction was conducted in MS Excel using the Joanna Briggs Institute data extraction tool. HCD approaches were mapped to the Double Diamond framework using thematic analysis.
A total of 15 studies were included which employed iterative HCD approaches, involving stakeholders at various stages of dashboard development. Several conceptual frameworks were identified including user-centred design and behaviour change frameworks as well as HCD methods identified including user interviews, focus groups, co-design workshops, usability testing and surveys. Key facilitators included ongoing user engagement, multidisciplinary collaboration and iterative prototyping. Barriers included limited digital literacy among older adults, challenges in recruiting diverse user groups and resource constraints impacting the breadth of HCD activities.
Dashboards developed using HCD approaches suggest improved usability, acceptability and relevance for older adults, supporting better self-management of health conditions. However, inconsistent frameworks, lack of research outside Europe, America and Australia and underuse of dashboard analytics were identified as challenges. Future research should adopt validated HCD frameworks, address acceptability factors and evaluate real-world use to develop more inclusive and sustainable digital health tools for older adults.
Post-stroke cognitive impairment (PSCI) negatively impacts peoples’ quality of life and functional independence. Its complexity poses challenges for both clinical management and intervention research. Despite global guidelines recommending cognitive assessment for all stroke survivors, there is no consensus on what, when or how to measure PSCI. Intervention studies use varied outcome measures, limiting comparability and clinical translation. Developing a core outcome set (COS) for PSCI could address these challenges by standardising outcome measurement, enhancing comparability across studies and facilitating the translation of research into clinical practice. This study aims to develop a COS for intervention research in PSCI.
This study will follow the Core Outcome Set-STAndards for Development (COS-STAD) framework and will be conducted in six stages. First, a scoping review of intervention studies will identify commonly measured outcomes. Second, a rapid qualitative evidence synthesis will explore outcomes valued by stakeholders in the published literature. Third, qualitative focus groups with stroke survivors, support persons, and healthcare professionals will further identify outcomes of importance. Fourth, findings from the preceding stages will be synthesised to generate a comprehensive list of candidate outcomes. Fifth, a real-time modified eDelphi survey with key stakeholders will prioritise outcomes and identify those meeting predefined consensus criteria for inclusion in a Core Outcome Set for Post-Stroke Cognitive Impairment (COS-PSCI). Finally, international consensus meetings will be held to 1) finalise the COS-PSCI and 2) select appropriate outcome measurement instruments, guided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Patient and public involvement (PPI) will be embedded throughout all stages of the study.
Ethical approval has been obtained from the University of Limerick Education and Health Sciences Research Ethics Committee (2025_03_18_EHS) and the Health Service Executive Mid-West Research Ethics Committee (REC ref: 0296). Findings will be disseminated via peer-reviewed publications, international stroke conferences, social media platforms and public engagement events.
This study is registered in the Core Outcome Measures for Effectiveness database and is available at https://www.comet-initiative.org/Studies/Details/3508.
To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions.
A cross-sectional design.
An online survey was disseminated to members of 16 professional nursing organisations and associations between April and August 2024.
Responses from 396 participants were analysed. Most were registered nurses (n = 335, 84.6%), aged between 45 and 64 years (n = 217, 54.8%). Over half of the participants (n = 219, 55.3%) had some knowledge of voluntary assisted dying, and more than two-thirds (n = 274, 69.2%) strongly supported it. Respect for a person's rights (n = 345, 89.8%) and relieving suffering (n = 342, 89.1%) were the main reasons nurses participated. Most nurse practitioner participants would be prepared to assess a person's eligibility for voluntary assisted dying (n = 32, 82.1%) or prescribe a substance (n = 31, 79.5%), if permitted by law. Religion, age and years of experience were characteristics associated with reasons for participation.
In Australia, some RNs and NPs are willing to participate in a range of VAD-related activities. However, in some jurisdictions, nurses' engagement is limited by legislative and policy settings. Reconsideration of nurses' roles may enhance access.
With appropriate support, nurses can make a valuable contribution to the sustainability of the voluntary assisted dying workforce.
Diabetes self-management education and support (DSME/S) programmes must demonstrate effective engagement of family members to achieve diabetes self-management outcomes and well-being of the whole family. These are complex interventions and their effectiveness is context dependent. We present initial programme theories of DSME/S and aim to answer: In what contexts and through which mechanisms do DSME/S interventions involving family caregivers impact diabetes self-management outcomes?
The review will follow the Realist and Meta-narrative Evidence Syntheses: Evolving Standards and Pawson’s five steps: define the scope, develop initial programme theories, search for evidence, appraise studies and extract and synthesise data. Literature searching will be combined with feedback from patient and public involvement stakeholders. PubMed, EMBASE, CINAHL, Scopus and PsycINFO will be searched to February 2026, with citation tracking and grey literature included. Data will be synthesised inductively to develop programme theories and context–mechanism–outcome configurations.
This study is a realist synthesis protocol and does not require ethics approval. The study will use published evidence and grey literature with contributions from patient and public involvement stakeholders. The study will produce transferrable programme theories that explain the contexts and mechanisms that influence DSME/S intervention impact and the considerations required to maximise family involvement in diabetes care. These programme theories will provide conceptual frameworks for consideration when designing DSME/S interventions for various contexts in order to maximise self-management capabilities of the persons with diabetes while promoting the health of the family as a whole. Findings will be published in peer-reviewed journals and presented at scientific conferences.
CRD420251179485.
by Emily Tufano, Kondaiah Palsa, Rebecka O. Serpa, Timothy B. Helmuth, Gabriela Remit-Berthet, Sara Mills-Huffnagle, Mathias Kant, Aurosman Sahu, James R. Connor
Iron is essential for normal physiological function, yet dysregulation of iron metabolism is increasingly recognized as a hallmark of cancers such as glioblastoma (GBM). Recent clinical evidence suggests that systemic iron deficiency anemia (IDA) negatively impacts GBM outcomes in a sex-dependent manner, but the mechanisms linking systemic iron availability to tumor iron metabolism remain poorly understood. Here, we interrogate the impact of systemic iron through dietary modulation (control, iron deficiency (ID), and high iron diets), stratified by sex, on tumor iron handling and GBM outcomes utilizing an immune competent (C57BL/6) GBM (GL261) mouse model. Subsequently, we analyzed clinical samples to evaluate translational value. In the preclinical study, we show that iron deficiency decreased survival in males but conferred a slight survival advantage in females, consistent with prior clinical trends. Among circulating iron markers, only ferritin light chain (FTL), but not ferritin heavy chain (FTH) or serum iron, positively correlated with survival in males but not females. In the brain, contralateral iron levels reflected dietary iron status in males but not females, further supporting sex-dependent regulation of local and circulating iron. Notably, tumor iron content remained unchanged in males but was significantly elevated in ID female tumors, complemented by increased transferrin receptor (TfR1) and FTH expression. In clinical GBM samples, we observed non-statistically significant but similar survival trends across varying iron and ferritin levels, suggesting potential translational relevance of our exploratory model. These findings demonstrate that systemic iron availability exerts a sex-specific effect on tumor iron handling, highlighting a critical relationship between systemic and tumor iron regulation in GBM.To identify facilitators and barriers to quality, equitable discharge teaching by paediatric emergency department nurses during the COVID-19 pandemic, describe impacts of inequitable discharge teaching, and identify potential solutions to the barriers.
Twenty-two nurses in a single urban paediatric hospital participated in individual interviews from January to April 2022 via phone or videoconference. Interviews were transcribed and analysed using an inductive codebook.
Six barriers to equitable discharge teaching were identified: ED overcrowding, travel nurse training/knowledge, burnout and stress, increased role complexity, COVID precautions, and resource bottlenecks. Two facilitators were also identified: engagement and effective communication. Nurses described the impacts of these barriers along with proposed solutions to improve discharge teaching.
The COVID-19 pandemic created additional barriers to discharge teaching in the paediatric emergency department. Nurses identified barriers and facilitators, the impacts on patients and families, and potential solutions to improve equitable discharge teaching.
This study identifies how periods of high patient volumes or frequent process changes during a pandemic exacerbate inequities in discharge teaching.
This study identifies barriers and facilitators that shaped nurses' ability to provide quality, equitable discharge teaching during the COVID-19 pandemic and offers actionable guidance for hospital leaders and health systems to improve discharge teaching and enhance emergency preparedness for future public health crises.
This study conforms to the Standards for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
ClinicalTrials.gov identifier: NCT04676490
Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.
To explore the application of Classic Grounded Theory (GT) methodology in nursing research and critically appraise studies employing Classic GT against the validated framework Guideline for Reporting and Evaluating Grounded Theory (GUREGT) research studies.
Systematic review without meta-analysis
The review followed the PRISMA statement and used the Synthesis Without Meta-analysis (SWiM) guideline for data analysis. The quality of included articles was assessed using the CASP qualitative research appraisal tool, and the GUREGT framework was applied to evaluate adherence to Classic GT guiding principles.
Databases were PUBMED, CINAHL, Nursing and Allied Health Database (ProQuest).
Twenty-nine studies from 2010 to 2024 met the inclusion criteria. Findings revealed inconsistencies in the reporting of Classic GT methodology in nursing research, with frequent omissions of key methodological elements. The GUREGT tool, while user-friendly and practical, highlights gaps in areas such as identifying the main concern, philosophical positioning, and engagement with the literature. These omissions can compromise methodological rigour, suggesting that further refinement of the GUREGT tool is necessary.
The GUREGT tool provides a promising framework for improving the reporting and evaluation of Classic GT studies. However, its current version requires enhancement to fully address the unique demands of Classic GT and ensure rigorous application and reporting of the methodology. Development of a dedicated reporting guideline tailored to Classic GT is critical for advancing the quality of nursing research and supporting researchers in generating robust, theory-driven insights.
Few studies critically appraise Classic GT methodology in health research. This review highlights the need for dedicated reporting guidelines to support methodological rigour and transparency in Classic GT studies.
This review adhered to EQUATOR reporting guidelines.
No patient or public contribution.
No abstract available 
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