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Multimodal analgesic strategies designed to minimise perioperative opioid exposure are fundamental components of enhanced recovery after surgery (ERAS) pathways. Despite widespread implementation of ERAS protocols, the optimal analgesic regimen remains undefined, as the individual contributions of specific agents to overall analgesic efficacy and opioid-sparing effects are not fully elucidated. Intravenous lidocaine, a widely utilised local anaesthetic, possesses both analgesic and anti-inflammatory properties and has been associated with improved gastrointestinal recovery. This study seeks to pragmatically evaluate the impact of incorporating perioperative intravenous lidocaine infusion into established ERAS pathways on postoperative functional recovery.
The Impact of PerioperAtive LidocAine Infusions (IMPALA) on ERAS trial is a single-centre, pragmatic, cluster-randomised, double-blinded, placebo-controlled study. A total of 2290 patients undergoing elective colorectal surgery, emergency general surgery, urology, ventral hernia repair, surgical oncology or spine surgery will be randomly assigned to receive either intraoperative and postoperative intravenous lidocaine infusions (administered for up to 48 hours) or placebo as part of a standardised multimodal analgesic regimen integrated into established ERAS pathways. The primary outcome is case mix index–adjusted resource length of stay, defined as the time interval from surgical initiation to hospital discharge adjusted for case mix index. The primary outcome is total inpatient opioid consumption within the first 72 hours, reported in oral morphine milligram equivalents. Secondary outcomes include various in-hospital clinical endpoints derived from the electronic health record.
This protocol and accompanying statistical analysis plan outline the study design, primary and secondary endpoints and analytic methodology. The IMPALA-ERAS trial has received ethical approval from the Vanderbilt University Institutional Review Board (IRB: 250617). The findings will be disseminated via peer-reviewed publications and presentations at national conferences. Results from this trial are expected to inform evidence-based practices regarding perioperative lidocaine infusion and its potential contributions to enhanced postoperative recovery in surgical patients.
The foundation of nursing care is the nurse–client relationship. The Fundamentals of Care (FoC) Framework provides guidance on the core elements of this relationship: trust, focus, anticipate, know, and evaluate. A gap remains in understanding how older adults and nurses themselves engage with these relational elements in the context of long-term community care. This may hinder nurses and their clients from collaborating in care practices.
To explore how older adults and nurses, through and within their ongoing relationship in community care, concretely enact and co-construct the five elements of the nurse–client relationship and explore factors influencing this relationship.
A qualitative descriptive research design was employed in 2022–2023, utilizing both individual and group interviews. Thirteen unique clients and relatives as informal care givers and 22 nurses participated.
‘Trust’ related to clients trusting the nurses' expertise and nurses enabling clients to feel confident and safe. ‘Focus’ was understood as a shared aim and actions towards maintaining independency and autonomy of clients. ‘Anticipate’ was characterized by nurses responding to clients' preferences and needs and clients and nurses making shared decisions regarding care. ‘Know’ was aimed at gaining a good understanding of clients' needs, which required clients to be open and committed to telling their needs, and nurses actively listening to their clients. Finally, ‘evaluate’, both formal and informal, revealed to be necessary to align and adjust care when necessary. Poor care coordination and continuity of care were contextual factors influencing the caring relationship.
We showed that nurses and clients in community care settings were engaged in a constructive relationship to collaborate for optimal nursing care. An empirical understanding was obtained about how the core elements of this relationship were put into practice. These elements develop over time, influenced by the nurse–client interaction and the specific context.
This study highlights that both the client and the nurse have an active role in establishing the nurse–client relationship.
What problem did the study address? This study addressed how older adults and nurses themselves engage with the relational elements of trust, focus, anticipate, know, and evaluate in the context of long-term community care. What were the main findings? An empirical understanding was obtained of how nurses and clients put these relational elements into practice. These elements evolve over time, influenced by nurse–client interactions and specific contexts. Where and on whom will the research have an impact? This research will impact community-care nurses by offering them practical insights into establishing effective relationships with clients and engaging in dialogue about clients' responsibilities in shaping these relationships.
We adhered to the Consolidated criteria for reporting qualitative research (Coreq) guidelines (International Journal for Quality in Health Care, 2007, 19, 349).
In the research team, two co-researchers (J.A. and J.Z.) participated in the design of the study, data collection and analyses. These co-researchers are older women with experiences in participating in qualitative research (collecting and analysing data) and community-based nursing care (as informal care giver).
To examine the link between urinary incontinence (UI) and physical activity participation in women. Little research has explored this relationship, despite the long-term effects of reduced physical activity on women’s health and well-being.
A cross-sectional survey was conducted using self-reported data collected through social media and university channels.
Adults aged 18 years or older identifying as women, including transgender women who had undergone gender-affirming vaginoplasty and people assigned female at birth. In total, 413 individuals completed the survey, of whom 3 were excluded for not meeting inclusion criteria. Most respondents (n=403; 98%) identified as female, with the largest age group being 25–44 years (n=176; 46%).
Severity of urinary incontinence (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)), physical activity quantity and intensity (International Physical Activity Questionnaire-Short Form (IPAQ-SF)) and self-reported impact of UI on participation in physical activity. Analysis of IPAQ-SF and ICIQ-UI SF scores evaluated associations between UI and activity quantity and intensity. Free-text responses were categorised and their frequencies were recorded.
UI was reported by 76.8% (n=315) of participants, with a median ICIQ-UI SF score of 6.0 (IQR 6.0, range 1.0–21.0) in those reporting UI. One-third (32.5%; n=133) agreed or strongly agreed that UI influenced their decision to start physical activity, and 37.3% (n=153) agreed that UI during activity affected whether they continued; free-text responses indicated this was a negative influence. Those with lower UI scores reported a higher quantity of physical activity, although this was not statistically significant (Kruskal-Wallis H=5.093, p=0.165). Significant reductions were observed in vigorous (H=10.733, p=0.013) activity time among those with more severe UI. Ordinal regression analysis showed a positive relationship between low intensity of physical activity and high levels of UI (OR 2.26, 95% CI 1.38 to 3.71, p=0.001). Age was not found to be a confounding variable. Analysis of free-text responses revealed themes of UI and its links to physical activity, strategies to prevent or cope with UI and the physical and emotional impacts of UI.
In this sample, a high prevalence of UI was associated with lower intensity of physical activity. Most strategies employed by participants addressed leaks when they occurred, with few mentioning preventive approaches, such as pelvic floor exercises. Public health campaigns should reframe UI, shifting the narrative towards prevention and treatment through early intervention.
Drowning remains a substantial global health challenge, and research in this area predominantly relies on observational study designs due to ethical, practical and administrative limitations. Although the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement is available, adherence within the drowning research community has been inconsistent and frequently incomplete. Consequently, essential methodological components and drowning-specific factors are often under-reported or inconsistently described, impeding quality, reproducibility, critical appraisal and evidence synthesis.
This protocol outlines the development of an extension to the STROBE statement, specifically for reporting observational studies in drowning epidemiology (STROBE-D). The proposed extension aims to provide structured guidance for authors, reviewers and editors, thereby enhancing the clarity, transparency and comparability of reporting practices.
The development of the STROBE-D statement will follow established recommendations and methodological frameworks for guideline creation. The process will include a scoping review and initial draft preparation, a two-round modified Delphi process using surveys with multidisciplinary and international expert participation, an expert consensus meeting to finalise the content and manuscript, public comment with interest-holder involvement and a final revision before submission for peer review.
The Committee on Health Research Ethics in the Region Zealand of Denmark waived the need for ethical approval as this is a consensus study (EMN-2025-09099). Findings will be disseminated through open access peer-reviewed publications, targeted communication through professional networks, conferences and social media platforms. The STROBE-D statement will serve as an extension to the STROBE statement, specifically tailored to observational studies in drowning epidemiology to improve consistency and transparency. Simultaneous publications of the original STROBE-D statement and the accompanying explanation and elaboration paper will be pursued in line with existing best practices.
by Paula Becerra Fuello, Javier Lescure, Aaron Lackinger, María Sedeño Ráez, Jesús Gámiz Caro, Gonzalo Aranda Jiménez
This pilot study evaluates the feasibility and limitations of a multi-proxy approach for identifying potential indicators of horizontal positioning in cremated heads from archaeological, and to a lesser extent, forensic contexts. Two outdoor experimental cremations using fleshed and dry pig crania were conducted to evaluate the influence of pre-burning condition, vertical placement within the pyre and pyre dynamics on the expression of lateralised burning patterns. Combining macroscopic observations, fragmentation, colorimetric and Fourier-Transform Infrared Spectroscopy in Attenuated Total Reflectance (FTIR-ATR) mode, our preliminary observations suggest that lateralised differences in thermal exposure may be detectable under certain conditions. Significant differences (p-valueEcuador es un país pluricultural y multiétnico, caracterizado por la búsqueda de promover la propiedad comunal, la toma de decisiones colectiva y prácticas de vida sostenibles en sus comunidades autónomas. A través de este enfoque principal que enfatiza la solidaridad y la cooperación, estas comunas han podido crear soluciones alternativas a los problemas que enfrentan sus comunidades. A pesar de estos éxitos, las comunidades de los diversos grupos indígenas, aún enfrentan desafíos, como acceso limitado a recursos básicos, apoyo gubernamental, estigmatización y conflictos con comunidades vecinas. Sin embargo, continúan abogando por su derecho a la autodeterminación y trabajan para crear una sociedad más equitativa. Explorando los temas y experiencias de estas comunas, podemos comprender mejor el potencial de los movimientos de base para abordar las injusticias sociales y allanar el camino hacia comunidades más sostenibles e inclusivas. Cabe destacar que esta es solo una pequeña comuna indígena, y que hay muchos más grupos en todo el país, como los Shuar, Tsáchilas, Huaorani, Chachi, entre otros.
Ecuador es un país pluricultural y multiétnico, caracterizado por la búsqueda de promover la propiedad comunal, la toma de decisiones colectiva y prácticas de vida sostenibles en sus comunidades autónomas. A través de este enfoque principal que enfatiza la solidaridad y la cooperación, estas comunas han podido crear soluciones alternativas a los problemas que enfrentan sus comunidades. A pesar de estos éxitos, las comunidades de los diversos grupos indígenas, aún enfrentan desafíos, como acceso limitado a recursos básicos, apoyo gubernamental, estigmatización y conflictos con comunidades vecinas. Sin embargo, continúan abogando por su derecho a la autodeterminación y trabajan para crear una sociedad más equitativa. Explorando los temas y experiencias de estas comunas, podemos comprender mejor el potencial de los movimientos de base para abordar las injusticias sociales y allanar el camino hacia comunidades más sostenibles e inclusivas. Cabe destacar que esta es solo una pequeña comuna indígena, y que hay muchos más grupos en todo el país, como los Shuar, Tsáchilas, Huaorani, Chachi, entre otros.
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