Conectar
Medical device–related pressure injuries are a significant and largely preventable patient safety problem, yet existing pressure injury risk scales do not adequately capture device-specific risk factors in adults. This methodological study developed and psychometrically evaluated a standardized risk assessment scale to identify medical device–related pressure injury risk in hospitalized adult patients. An initial item pool was generated from an extensive literature review and clinical expertise, and content validity was assessed by seven experts using the Davis technique (content validity index = 0.96). The scale was administered to 160 adults receiving at least one medical device in medical, surgical and oncology wards and intensive care units of a university hospital. Construct validity was evaluated using binary logistic regression, exploratory factor analysis, and receiver operating characteristic curve analysis, demonstrating strong discrimination (area under the curve = 0.844, 95% confidence interval 0.728–0.961) with an optimal cut-off score of 14.5 (sensitivity 70.6%, specificity 88.8%). Exploratory factor analysis of the final version of the MedRAS (Kaiser-Meyer-Olkin = 0.792) revealed a two-factor structure (Device and Mechanical Factors; Patient and Tissue Factors) explaining 50.92% of the total variance, with all factor loadings above 0.30. The scale showed good internal consistency (Cronbach's alpha = 0.80) and very good inter-rater reliability (Cohen's kappa = 0.806, p < 0.001). This device-focused scale may support early risk identification and targeted preventive nursing interventions, with potential to improve patient safety and quality of care in inpatient/critical care settings.
by Nadieh Abdallah, Ahed Almahdi, Diana Shella, Rasha Al-Masri, Iyad Maqboul, Mohammad Jaber, Ramzi Shawahna
This study was conducted to assess the incidence and types of complications and mortality following liver biopsy, and to identify independently associated factors that can inform clinical practice in a resource‑limited healthcare system. A retrospective multicenter study was conducted across six major hospitals between January 2020 and December 2025. Medical records of 218 patients undergoing percutaneous and laparoscopic liver biopsies were reviewed. Demographic, clinical, laboratory, procedural, and outcome variables were extracted using a validated data collection form. Inferential analyses were conducted using chi‑square, Fisher’s exact, and Mann‑Whitney U tests, while multivariate logistic regression models were employed to identify factors independently associated with complications and mortality. The most common types of complications were infection (n = 7, 3.2%) and hemorrhage (n = 6, 2.8%), followed by pulmonary complications (n = 4, 1.8%), metabolic disturbances (n = 3, 1.4%), and acute kidney injury (n = 2, 0.9%). Mortality was recorded in 6 patients (2.8%). Higher pre-operative white blood cell count was independently associated with infections (OR: 1.28, 95% CI: 1.02–1.62, p = 0.036). Older age was independently associated with mortality (OR: 1.07 per year increase, 95% CI: 1.01–1.15, p = 0.035). Hemorrhage and pulmonary complications were more frequent after laparoscopic biopsy and under general anesthesia, although these associations did not remain significant in adjusted models. This study provides the first systematic evidence on liver biopsy safety in Palestine, a resource‑limited healthcare system, thereby filling a critical gap in the regional literature. The study identified pre-operative increases in white blood cell count as a predictor of infection and older age as a predictor of mortality. These simple, pragmatic markers can guide monitoring and risk stratification in constrained environments, offering actionable insights for clinicians and policymakers. Future studies should be conducted to evaluate whether these markers can help reduce complications and mortality.by Riham M. Hamadouk, Esra D. Albashair, Einass M. Alshareif, Ali Awadallah Saeed, Bashir A. Yousef
BackgroundToday, community pharmacists’ responsibilities have expanded beyond the traditional role to include the management of minor ailments. Acute uncomplicated cystitis is one of the most prevalent medical conditions seen in primary healthcare and can be managed by community pharmacists (CPs).
ObjectivesTo evaluate community pharmacists’ history-taking practice when responding to patients with acute uncomplicated cystitis.
MethodsA cross-sectional simulated patient study was conducted from November 2022 to January 2023 in Khartoum locality targeting only pharmacists. Six trained female students played the simulation in which they pretended to have the clinical symptoms of acute uncomplicated cystitis and requested treatment for their condition. The Interactions during the simulation were documented immediately in a data collection form after each visit. Descriptive statistics were used to report the study outcomes.
ResultsA total of 238 community pharmacies were visited. The majority of the pharmacists were female. The mean of the number of questions that were asked by the pharmacists was 1 (SD = 1.6) questions. Among the studied pharmacists, 45.4% asked at least one question during patient assessment. The most asked question was if the patient has a fever, representing 61 (25.6%) CPs, followed by if there is vaginal discharge, representing 38 (16%) CPs. In response to scenario 47 (19.7%) CPs decided to refer the patient to a physician, and 45 (18.9%) of the CPs advised the patient to increase water intake.
ConclusionsThe study has revealed a poor history-taking practice towards acute uncomplicated cystitis during patient assessment. Further studies exploring pharmacists’ involvement in patient assessment are required. Strategies to improve community pharmacists’ practice, like continuing pharmacy education and providing a national guideline regarding patient assessment should be considered seriously.
All children in England should receive a health review at 2–21/2 years, with the Ages and Stages Questionnaire third edition (ASQ-3) used to collect public health surveillance data on child development. However, practitioners also value tools that assess individual children’s development—consistent with ASQ-3’s original purpose. Concerns about licensing costs and barriers to digitalisation have prompted interest in alternative tools to the ASQ-3 in England.
To inform policy, we conducted a rapid scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to identify tools that can measure or assess early child development.
Searched PubMed, PsycINFO and Web of Science from January 2012 to November 2022, with targeted search update November 2024.
We included English-language studies published after January 2012 that described or evaluated tools in English which could measure or assess early child development in children
We extracted key features and reliability, validity, sensitivity and specificity of tools which could feasibly be implemented at the 2–21/2-year review (eg, including multiple age versions and
We identified 112 unique publications describing 34 tools; six met our feasibility criteria for the 2–21/2-year review (reported in 53 studies). Only ASQ-3 and CREDI offer domain-specific scoring—a government priority. ASQ-3 moderately detects mild delays and performs better for severe delays in at-risk groups. Caregiver Reported Early Development Instruments (CREDI) was designed for public health surveillance, and we do not yet know how it performs for individual assessment.
ASQ-3 and CREDI are most promising for use at the 2–21/2-year review. However, we lack UK-based validation and norming studies, even for ASQ-3. Ultimately, careful implementation and integration into existing systems will determine a tool’s value for identifying developmental needs, supporting families and producing high quality data for public health surveillance.
To synthesise the literature around the roles of general practice nurses (GPNs) and the barriers and facilitators of their role.
Integrative literature review using Whittemore and Knafls framework.
Papers were exported into Covidence for screening. Quality was appraised using the Mixed Method Appraisal Tool. Data were extracted into a summary table and analysed using thematic analysis.
CINAHL, Medline, and Google Scholar were used to identify papers published between January 2000 and February 2025 in English that reported primary research about GPN roles.
Twelve papers were included in the review. The four overarching themes were role characteristics, the clinical role, the non-clinical role, and barriers and enablers. Findings suggest ambiguity surrounding the GPN role, with inconsistent perspectives and overlapping responsibilities contributing to underutilisation. GPNs played an important role in continuity of care and reported a desire to spend more time on health promotion, health education and assessment. GPNs were leaders in collaboration as they functioned as agents of connectivity for patients and staff. The GPN role faces both barriers and enablers, with the organisational structure, interprofessional relationships, and professional development.
The GPN role offers an opportunity to enhance access to general practice care. However, there is limited and mixed literature describing the roles of GPNs. Future research should more closely explore the current practice of GPNs to inform policy and optimal utilisation of the workforce to the full extent of their practice scope.
Understanding the complex roles of GPNs requires more robust data on clinical activity. These data would have the potential to inform ways to optimise the GPN role within the multidisciplinary team.
This study adhered to the PRISMA reporting guideline.
This review did not include patient or public involvement.
Explore the care escalation process initiated by parents concerned about their hospitalised child's deterioration and healthcare providers' response to parental concerns.
A qualitative study using Charmaz's constructivist grounded theory.
Participants included healthcare providers, cultural mediators and parents of children hospitalized for ≥ 3 days, who had experienced previous urgent intensive care admission or parental concern during hospitalization, in a tertiary pediatric hospital. Data were collected through focus groups, and analyzed using a grounded theory methodology with NVivo Software.
A total of 13 parents, 7 cultural mediators and 68 healthcare providers participated in 16 focus groups. Two main categories were identified: (1) Parents navigating the uncertainty of the escalation system to get a response; (2) Healthcare providers balancing parents' concerns, their own situation awareness, escalation processes and team relations. We developed a Grounded theory called ‘Parents Supporting Timely Escalation Processes’ (P-STEP). By monitoring their children, parents identify early signs of deterioration and advocate for escalation. Reasons for concern are their child's behaviour, communication failure and admission on an off-service ward. Parents escalate by contacting ward providers, their child's specialist or the most trusted staff and, only selected parents, the Rapid Response Team. Staff escalate parents' concern according to their own situation awareness, parent evaluation and ward escalation practices. Parent's emotions and trust are influenced by the timeliness and type of staff response.
While some parents effectively advocate for their child, others face obstacles due to unclear and lack of formal care escalation systems. Understanding how parents escalate care and healthcare providers respond is essential to identify facilitators, barriers, key stakeholders, and implement a formal system for parent-initiated escalation of care.
Integrating parents into processes of escalation and rapid response systems could optimise early recognition and improve responsiveness in paediatric deterioration.
The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines.
Parents and HCPs participated as interview respondents.
To examine individual variations in mental health trajectories and identify associated risk factors among patients with lung cancer.
A longitudinal study.
Participants recruited from outpatient clinics at five time points: 1, 3, 6, 9 and 12 months after a diagnosis. Data collected included demographic and disease-related characteristics, symptom distress, and mental health. Hierarchical Linear Modelling (HLM) was used to analyse changes in mental health trajectories and identify significant predictors. The study is reported using the STROBE checklist.
In total, 130 patients with lung cancer were included in the study. Mental health demonstrated a significant improvement over time, with notable individual variations in patterns of improvement. Male patients and those experiencing high levels of symptom distress exhibited slower improvements in mental health over time.
Patients with lung cancer showed overall improvement in mental health within 1 year following a diagnosis; however, the pattern of improvement varied among individuals. Male patients and those with high levels of symptom distress constituted a vulnerable group, exhibiting poorer mental health outcomes over time.
Early assessments of and individualised interventions for symptoms distress to improve mental health should be considered essential components of care to enhance the overall well-being of patients with lung cancer.
These findings highlight the need for healthcare professionals implementing person-centred interventions aimed at improving mental health that might be beneficial for patients with lung cancer.
Study methods and results reported in adherence to the STROBE checklist.
Patients contributed their consent, time, and data to the study.
by Ibrahim Abdalla Alfaki, Michal Grivna, Mohamed El Sadig
Despite significant progress in road safety in developed countries, it remains a persistent and critical challenge in the developing world. This study investigates the long- and short-term relationships between socio-economic conditions and road safety performance in affluent developing countries, using the United Arab Emirates (UAE) as a case study. Employing an autoregressive distributed lag (ARDL) cointegration error-corrected model with data from 1980 to 2024 (sourced from the UAE Federal Government, the World Bank, and UN World Population Prospects), the analysis examines the link between the road crash severity index (fatalities to total injuries) and core socio-economic variables—GDP per capita, unemployment rate, and population density—while controlling for traffic law enforcement via fines. The findings confirm a long-term equilibrium, with an error correction term indicating road safety adjusts to socio-economic shocks at a rapid annual rate of 60%. Granger-causality tests further establish that these socio-economic factors significantly influence road safety outcomes, a concern underscored by an identified upward trend in crash severity. We conclude that socio-economic conditions are a fundamental determinant of road safety, highlighting the necessity for policy interventions that move beyond traditional engineering solutions. Consequently, road safety must be reframed not solely as a transportation concern but as an integral objective of public health and socioeconomic policy, which requires a collaborative, multi-sectoral approach to forge a resilient, safe system.To map self-care activities related to indwelling urinary catheters in community-residing adults.
Scoping review guided by Joanna Briggs Institute methodology.
Systematic searches of electronic databases (CINAHL, MEDLINE, Embase) and targeted grey literature search were conducted for documents published between 2000 and October 2023.
Documents describing self-care activities and the management of catheter-related complications in community-residing adults (aged ≥ 18 years) were included. Three independent reviewers used Covidence to screen titles and abstracts and full-text articles, appraise the quality of the literature, and extract data. Directed content analysis of the extracted data was conducted, informed by the mid-range theory of self-care of chronic illness, and summarised narratively.
A total of 32 documents were included; nine qualitative studies, eight expert opinions, six quantitative studies, five guidelines, two quality improvement projects, and two reviews. The majority (81.3%) of the documents were concerned with the prevention and management of catheter-associated urinary tract infection (CAUTI; n = 26). Many self-care activities were reported across the self-care processes of maintenance, monitoring, and management. Maintaining the catheter and drainage system, and self-care education topics related to maintaining the catheter were the most cited (n = 17 [53.1%] and n = 20 [62.5%], respectively). Less emphasis was given to management self-care activities, such as seeking support from clinicians (n = 13, 40.6%).
The scoping review findings provide a greater understanding of how persons with indwelling catheters maintain and monitor their catheters and highlight that much less is known about how they manage situations when complications arise.
The findings can guide the design of community care programmes and serve as a basis for developing patient self-care education resources. These findings should be consolidated and examined by nursing researchers, clinicians, and persons with lived experience to provide holistic guidance on self-care of indwelling catheters and associated complications.
by Elisabetta Ferraro, Graziana Da Rold, Roberto Celva, Elisa Dalla Libera, Stefania Leopardi, Giulia Simonato, Paola De Benedictis, Nadia Cappai, Arianna Dissegna, Carlo Vittorio Citterio, Rudi Cassini, Federica Obber
The grey wolf (Canis lupus) population is expanding in parts of Europe due to legal protection and favorable ecological conditions. As wolves increasingly move into urban and suburban areas, interactions with domestic dogs become more frequent, raising the risk of pathogen transmission and posing potential threats to both wolf conservation and public health. This study investigated the health status of wolves in the Foreste Casentinesi National Park (Italy) using non-invasive fecal sampling conducted between May 2019 and March 2020. Samples were genetically analyzed to identify individuals and then screened for viral pathogens, Canine Coronavirus and Parvovirus, using PCR, Sanger sequencing, and phylogenetic analysis. Parasitological examinations were performed using flotation techniques on whole samples, and real-time PCR targeting Echinococcus granulosus and E. multilocularis was conducted on selected samples. Of the 260 samples collected, genetic analysis identified 80 individual wolves belonging to 8 packs. Only one sample tested positive for Coronavirus (1.2%), and none for Parvovirus. The detected sequence clustered with strains previously reported in wolves and foxes in Italy. Copromicroscopy revealed a high prevalence of veterinary-relevant endoparasites, including Eucoleus spp. (90.0%), Sarcocystis spp. (42.5%), Taeniids (28.7%), and Ancylostomatids (26.2%). Trichuris vulpis, Toxocara canis, and coccidia showed prevalence rates below 2%. All 104 samples tested for E. granulosus or E. multilocularis were negative. These findings suggest that while wolves in the FCNP commonly harbor several canine parasites, their role in the transmission of zoonotic pathogens appears limited. Although phylogenetic data suggest that coronavirus strains tend to cluster within wildlife species, molecular data on domestic dogs remain scarce. Nonetheless, the high prevalence of shared parasites highlights the need for ongoing surveillance in both wild canids and domestic carnivores. As wolves increasingly inhabit human-dominated landscapes, understanding disease dynamics at the wildlife–domestic interface is essential for effective conservation and public health strategies.by Eneida Yuri Suda, Cristina Dallemole Sartor, Anice de Campos Passaro, Ricky Watari, Eunice Young Docko, Isabel C. N. Sacco
BackgroundThis study aimed to identify the predictive effects of different aspects of diabetic peripheral neuropathy (DPN) and other already known risk factors for falls through a comprehensive logistic model within community-dwelling older adults with diabetes and DPN. This paper also provides a model that estimates the probability of a fall occurring in a real-world clinical scenario.
MethodsThis cross-sectional retrospective study analyzed data from subjects that had never fallen (non-fallers, n = 534) and that had fallen at least twice in the previous year (fallers, n = 101). The logistic regression analysis was performed on a training sample randomly extracted from the original sample (non-fallers: n = 85; fallers: n = 81). The model was validated by checking the performance parameters using a test sample comprised of 10% of fallers (n = 16) and a proportionate subsample of non-fallers (n = 85) from the original dataset.
ResultsThree predictive models were developed. The best model (0.762 receiver operating characteristic[ROC] curve area, 60.4% accuracy, 68.8% sensitivity, 58.8% specificity) identified age (odds ratio[OR]=1.06[95%CI: 1.02, 1.10], P = 0.002), Michigan Neuropathy Screening Instrument score (OR=1.23[95%CI: 1.08, 1.40], P = 0.001), and self-reported balance problems (OR=2.65[95%CI: 1.29, 5.45], P = 0.008) as predictors of falls. A second model with good performance parameters (0.750 ROC curve area, 62.4% accuracy, 62.5% sensitivity, 62.4% specificity) showed that age (OR=1.04[95%CI: 1.01, 1.07], P = 0.015), balance problems (OR=3.29[95%CI: 1.64, 6.59], P = 0.001), and DPN severity (OR=1.18[95%CI: 1.03, 1.34], P = 0.018) were predictors of falls.
ConclusionsWe showed the potential of a predictive model for recurrent falls based on commonly evaluated variables in community-dwelling individuals with diabetes for use in clinical practice. Even for individuals who are not at a high risk for falls, it is crucial to assess the combination of DPN signs, symptoms, and severity and the perception of balance problems, as these are more relevant in people with diabetes than the traditional physical impairments associated to aging.
Existing psychological and pharmacological interventions for young people at ultra-high risk (UHR) for psychosis have shown benefit in at least delaying the transition to psychosis, but they have limited benefit for comorbid disorders or social dysfunction, which are prominent for those at UHR. We developed a moderated online social therapy platform (named Momentum) including: (1) transdiagnostic therapeutic interventions targeting social functioning, depression, generalised anxiety and social anxiety; (2) a moderated, peer-led online community and (3) specialised human support from clinicians, career consultants and peer workers. The aim of this trial is to determine whether, in addition to treatment as usual (TAU), Momentum, a 12-month digital intervention, informed by the complex intervention framework, is superior to 12 months of TAU in improving social functioning in UHR young people.
The study design is a prospective, parallel group, rater-masked randomised controlled trial. We will recruit young people aged 14–27 years, meeting one or more UHR for psychosis criteria. Participants are randomly assigned to the condition using randomly permutated blocks with a 1:1 allocation ratio. Participants are stratified by age (
Melbourne Health Human Research Ethics Committee (HREC/42964/MH-2018) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. De-identified individual participant data will be available after publication for 3 years via the Health Data Australia catalogue (https://www.researchdata.edu.au/health). Requests must include a methodologically sound proposal. Specific conditions of use may apply and will be specified in a data sharing agreement (or similar) that the requester must agree to before access is granted. Supplementary material including study protocol, informed consent material and statistical analysis plan will also be available.
Australian New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619001411134.
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 Khalid Al Kubaisi, Derar H. Abdel-Qader, Nadia Al Mazrouei, Abduelmula R. Abduelkarem, Yahya H. Dallal Bashi Dallal Bashi, Moh’d Ahmad Shara
Background and aimNausea and vomiting of pregnancy (NVP) is the most common medical condition of gestation, affecting up to 90% of women and significantly impacting their quality of life. Community pharmacists (CPs) are often the first point of contact for these women, yet there is a lack of objective data on their practice quality in Jordan. This study aimed to conduct the first national, simulated patient study to assess objectively the assessment, management, counseling, satisfaction and predictors of appropriate practice among Jordanian community CPs when managing NVP.
Materials and methodsA national, cross-sectional study using a simulated patient methodology was conducted in 380 community pharmacies, selected via proportionate stratified random sampling. Two validated scenarios (mild NVP and severe NVP with red flags) were used. A validated structured data collection form documented CPs ‘ assessment, management, counseling, and patient satisfaction. Multivariable logistic regression was used to identify independent predictors of “Appropriate Practice.” All data were analysed using SPSS (V28.0).
ResultsA significant gap between guideline-recommended care and actual practice was evident, particularly in high-risk situations. While most CPs (84.2%) initiated symptom inquiry, crucial assessment of red flags in the severe NVP scenario was dangerously low (e.g., inquiry about dehydration, 21.1%). This assessment failure translated directly to practice: only 56.8% of CPs correctly referred the high-risk patient, while 43.2% inappropriately sold an over-the-counter medication, delaying necessary medical care. Counseling on medication safety was consistently poor, with only 29.9% of CPs discussing potential side effects. Despite these clinical deficiencies, the overall patient satisfaction was high, appearing to be driven more by interpersonal skills than clinical accuracy. Multivariable analysis revealed that appropriate practice was independently predicted by prior maternal health training (aOR = 3.48, p p = 0.009). Conversely, a high pharmacy workload was a significant independent barrier, reducing the odds of providing appropriate care by 50% (aOR = 0.50, p = 0.018).
ConclusionJordanian community CPs are a critical but currently underperforming resource in maternal care. The prevalent gaps in clinical assessment and referral for severe NVP represent a significant patient safety risk. A one-size-fits-all approach to quality improvement is unlikely to succeed. Instead, a dual-pronged strategy is essential: (1) national professional pharmacy bodies must mandate targeted continuing professional development in maternal health, focusing on risk assessment and referral protocols; and (2) health policymakers and community pharmacy owners must address systemic barriers, particularly the detrimental impact of high workload on the delivery of safe and effective patient care.
Anxiety disorders, obsessive–compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are common in children and adolescents and can lead to significant impairment. Cognitive behavioural therapy (CBT) with exposure is the first-line treatment, yet approximately half of treated youth do not achieve full remission. Dysfunctional cognitions—negative automatic thoughts, maladaptive beliefs and distorted interpretations—are considered key targets of CBT, but evidence in youth is mixed and underpowered. This study will examine whether change in dysfunctional cognitions mediates treatment outcome in anxiety, OCD and PTSD symptoms and whether this association varies across individual characteristics.
An individual participant data meta-analysis (IPDMA) of randomised controlled trials of CBT for youth aged 5–18 years with anxiety disorders, OCD or PTSD will be conducted. The search strategy includes the databases APA PsycINFO, MEDLINE and Web of Science Core Collection from inception to 8 September 2025. It is supplemented by screening reference lists, trial registries, grey literature and outreach to relevant research groups. Eligible trials must include at least one validated measure of dysfunctional cognitions administered at minimum pre- and post-treatment, and clinical outcomes assessed at post-treatment and follow-up. The two primary outcomes are (1) child-reported symptom severity and (2) clinician-rated clinical severity. Data will be harmonised for dysfunctional cognition scores, moderators (age, gender, socioeconomic status, comorbidity), and primary outcomes. One-stage Bayesian mixed-effects models will examine whether changes in dysfunctional cognitions predict improvements in primary outcomes and whether these effects are moderated by individual characteristics. Missing data will be addressed using multiple imputation within the Bayesian framework, and study-level heterogeneity will be modelled using random intercepts and slopes.
All datasets will be de-identified and managed under General Data Protection Regulation standards. Each included trial will have ethical approval permitting data sharing and reuse, and the secondary analysis of the shared datasets has been approved by the University of Amsterdam. Findings will be disseminated via a peer-reviewed publication, scientific conferences and open sharing of analysis scripts and harmonisation procedures.
CRD420251139130.
by Saleh Abualhaj, Anas Alyazouri, Mosleh M. Abualhaj, Lina Alshadfan, Shadi Hamouri, Obada Alaraishy, Eman Alkhawaja, Amro Mureb, Ali Aloun, Abdallah Arabyat
BackgroundBariclip is an emerging non- resective bariatric device designed to restrict gastric capacity while preserving anatomical integrity. Unlike traditional sleeve gastrectomy, Bariclip implantation does not involve gastric resection, potentially minimizing surgical risk and allowing reversibility. However, data on its early efficacy and safety remain limited.
ObjectiveTo evaluate short-term surgical outcomes, weight loss metrics, and comorbidity resolution among patients undergoing Bariclip implantation.
MethodsThis retrospective observational study included 82 patients who underwent Bariclip placement at a single tertiary care center. Data were extracted from electronic medical records, operative logs, and follow-up notes. Outcomes assessed included total weight loss (TWL%) and excess weight loss (EWL%) at 2 weeks, 1, 2, 3, and 6 months postoperatively. Additional variables included operative time, hospital stay, early postoperative complications (within 30 days), reintervention rates, and changes in obesity-related comorbidities.
ResultsThe cohort had a mean age of 37.6 ± 9.9 years, with the majority being female (76.8%) and obese (mean BMI = 36.6 ± 4.7 kg/m²). Most patients (91.5%) underwent surgery for obesity management. Postoperatively, patients reported low pain scores (mean = 5.2), with no need for opioid analgesia and early mobilization in 62.2%. Complication rates were low (3.6%). Repeated measures ANOVA revealed a significant reduction in BMI over time (p Conclusion
Bariclip surgery demonstrated favorable short-term safety and efficacy, with substantial weight loss and low complications rate observed within six months. These findings support Bariclip as a promising minimally invasive option for weight management in select patient populations.
To examine the geospatial distribution of gestational diabetes mellitus (GDM) over time in Australia.
An ecological study was conducted using data from the National Diabetes Services Scheme (GDM cases). Data at Statistical Area Level 2 (SA2) level, a medium-sized spatial unit, on population denominators (women who gave birth) were obtained from the Australian Bureau of Statistics. The spatiotemporal distribution of GDM was explored at the SA2 level over three periods: 2016–2017, 2018–2019 and 2020–2021. Hotspot and cluster analyses were undertaken using Getis-Ord Gi* and local Moran’s I statistics.
A nationwide study in Australia was conducted between 2016 and 2021.
Women diagnosed with GDM and those who gave birth were included.
Age-standardised and crude incidence of GDM per SA2.
During 2016–2021, 1 718 963 eligible women who gave birth in Australia were included. Hotspot areas of GDM were consistently observed in Victoria (Southwest and North Melbourne); Western Australia (South and Southwest Perth); Australian Capital Territory (ACT) (East and North Canberra); Queensland (North Brisbane) and New South Wales (West and Southwest Sydney and Southeast New South Wales). ACT (South Canberra), North Tasmania, Northern Territory (North Darwin) and Victoria (South East Melbourne) had new hotspot regions recorded in the last two consecutive study periods.
GDM incidence varies by geographical area over time, with hotspots in specific regions suggesting the need for geographically targeted policy interventions to curb the growing burden of GDM.
To systematically review and synthesise qualitative research on nurses' experiences of speaking up in various contexts and to identify factors facilitating or impeding such a behaviour.
This review was conducted as a qualitative metasynthesis, utilising the qualitative meta-ethnography approach.
A total of 6250 articles were screened. Two reviewers screened titles, abstracts and full texts. A total of 15 studies were included in this review. Researchers conducted a quality appraisal using the JBI critical appraisal checklist for qualitative research. An a priori protocol was created and registered on the Open Science Framework.
Literature searches were conducted in five international bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global) and five Korean databases (RISS, KISS, DBpia, KCI and NDSL).
Three main themes were identified from the 15 studies used in the metasynthesis: (1) decisional complexity of speaking up, (2) motivators for speaking up and (3) barriers to speaking up. Nurses experienced challenges in speaking up. They were, and continue to be, concerned about negative responses. Hierarchy structure and poor work environment were identified as barriers to speaking up; professional responsibility and a supportive atmosphere were identified as facilitators for speaking up.
This review synthesised nurses' experiences of speaking up and influencing factors. Speaking up is crucial for nurses to improve patient safety, as frontline nurses are ideally positioned to observe early indicators of unsafe conditions in healthcare delivery.
Identified motivators and barriers of nurses' speaking-up behaviour offer considerations and opportunities for healthcare leaders and managers. This could lead to improvement in patient safety through the establishment of a safety culture that facilitates nurses' speaking-up behaviour.
The review adhered to the ENTREQ guideline.
No patient or public contribution has been made in this review.
Inhaled anaesthetics can be used in mechanically ventilated critically ill patients to provide sedation. This approach to sedation potentially improves patient and health system outcomes, but further supportive evidence is needed. The objective of the SAVE-ICU clinical trial is to compare the effectiveness of inhaled versus intravenous sedation in ventilated adults with acute hypoxaemic respiratory failure.
SAVE-ICU is a multicentre, open-label, pragmatic, randomised controlled trial conducted in 15 intensive care units (ICUs) in Canada and the USA. Eligible patients include mechanically ventilated and sedated adults with acute hypoxemic respiratory failure from COVID-19 or non-COVID causes with PaO2/FIO2 ratio 12 hour). A hierarchy of outcomes was identified at the time of trial design, as the trial was launched during the COVID-19 pandemic when study drug shortages, staffing challenges and healthcare system pressures were prevalent and there was a requirement for rapid evidence generation and implementation on this topic. The primary outcome and highest in the hierarchy is hospital mortality (requiring 758 participants). Secondary and lower hierarchical outcomes are ventilator-free days at day 30 (200 patients), quality of life at 3 months (144 participants) and ICU-free days at day 30 (128 participants). Additional secondary outcomes include median daily oxygenation at day 3 (PaO2/FIO2 ratio), need for adjunctive acute respiratory distress syndrome therapies (prone positioning, inhaled nitric oxide, paralysis with a neuromuscular blocking agent and extracorporeal membrane oxygenation) during ICU stay, days alive and free from delirium and coma at day 14, hospital-free days at day 60 and disability score at 3 months and 12 months after enrolment.
The protocol was approved by all hospital ethics committees and by Health Canada. Informed consent will be obtained from substitute decision makers or deferred consent (as permitted by site ethics board). Trial findings will be shared at the end of the study using peer-review publications, conference presentations and social media as part of the trial knowledge translation plan.
This study aims to analyse the barriers and facilitators towards an implementation of active breaks (ABs) intervention inside the workplace.
This study used a mixed-methods approach, incorporating virtual focus groups and an online questionnaire, conducted among the workers of Alma Mater Studiorum - University of Bologna (Italy). A total of 30 participants (N=30), including administrative and academic staff, PhD candidates, specialised trainees and research fellows, were involved in the study. Key themes and subthemes related to the barriers and facilitators of ABs interventions at the university were identified and categorised according to the three levels of the socio-ecological model.
The most commonly reported barriers are: lack of time, lack of motivation (intrapersonal level); lack of influence, lack of awareness (social level); physical space, organisational support (environmental level). The most commonly reported facilitators are: access to information, flexible work hours (intrapersonal level); group support, awareness programmes (social level); adequate spaces, organisational structure (environmental level). A significant majority (81.48%) recognised the problem of sedentary time at work, with strong interest (92.59%) in workplace interventions to reduce it. Flexibility in timing for ABs (44.44%) was preferred over fixed schedules, with preference for dedicated areas (37.04%) and outdoor spaces (29.63%). The majority (62.96%) preferred taking ABs in small groups open to all, with a qualified kinesiologist (40.74%) leading the management.
This study identified barriers and facilitators to an ABs intervention from the perspective of administrative staff, residents and researchers. These findings could help institutions foster an environment that promotes physical activity, reduces sedentary behaviour and promotes the well-being and safety of workers through an integrated and individual-centred approach.
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