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Acceptability and adoption of a multiparameter point-of-care testing (POCT) device in primary healthcare for non-communicable diseases in resourced-limited communities in Peru

Por: Huayanay-Espinoza · C. A. · Moran · D. · Albitres-Flores · L. · Bernabe-Ortiz · A. · Cahuana-Hurtado · L. · Vetter · B. · Safary · E. · Lazo-Porras · M.
Objectives

To assess the acceptability and adoption of multiparameter point-of-care testing (POCT) devices for the diagnosis and management of non-communicable diseases (NCDs) at the primary healthcare level in a resource-limited region of Peru.

Design

Qualitative case-control process evaluation.

Setting

Eight primary healthcare facilities in northern Peru, including both urban and rural centres, where routine chronic care and laboratory services are provided.

Participants

Sixty-three participants: 36 patients, 12 laboratory technicians, 10 healthcare professionals and five facility heads. Eligible patients were ≥18 years, residing in the catchment area, with or without prior NCD diagnoses. Healthcare workers, including physicians, nurses, laboratory staff and facility managers.

Interventions

Multiparameter POCT devices were installed in four intervention facilities, accompanied by staff training and community awareness activities, while four control facilities continued with conventional laboratory diagnostics.

Primary and secondary outcome measures

Primary outcome: perceptions of patients and healthcare workers regarding the acceptability and adoption of POCT devices. Secondary outcomes: identification of facilitators and barriers to implementation, including infrastructure, supply chains and training gaps.

Results

(1) Individuals: POCT was valued for speed and comfort, but concerns over accuracy were mentioned. (2) Intervention characteristics: laboratory staff valued POCT’s practicality in emergencies, but noted limitations in handling multiple samples. (3) Outer setting: urban centres outperformed rural facilities, with more staff and longer operating hours. (4) Inner setting: calibration gaps impacted POCT and conventional test reliability, requiring quality control and training. (5) Process: clear staff communication boosted patient confidence in POCT, but inconsistent training could lead to reliability doubts.

Conclusions

Multiparameter POCT devices show promise for enhancing NCD care in resource-limited primary healthcare settings, particularly in rural areas. However, their sustainability depends on broader health system reforms, including reliable supply chains, expanded training and stronger quality assurance mechanisms. Further research should examine strategies for embedding POCT within national regulatory and policy frameworks.

A Survey of Nurses' Views of the Current and Future Role of Community Registered General Nurses (CRGN)

ABSTRACT

Aim

To explore the views of community registered general nurses and directors of public health nursing on the current and future role of the community registered general nurse in the Republic of Ireland.

Design

Anonymous cross-sectional descriptive survey.

Methods

Two questionnaires were developed; one targeted at community registered general nurses and one targeted at assistant directors of public health nursing or directors of public health nursing who were working with community registered general nurses. Social media was used to recruit participants. Descriptive statistics were used while data from open-ended questions were analysed using NVivo software.

Results

A total of 97 community registered general nurses and 28 assistant directors of public health nursing or directors of public health nursing completed the surveys in 2023. There was consensus that community registered general nurses provide holistic care, including case management of adults with complex health needs living in the community. However, lack of promotional opportunities coupled with poor remuneration has resulted in job dissatisfaction. Respondents felt that community registered general nurses should focus on older adults, whereas public health nurses should focus on child health.

Conclusion

The role of the community registered general nurse needs to be clarified, and a promotional pathway developed to attract new graduates to this post.

Impact

This paper outlined the current role and vision for the future role of community registered general nurses.

Reporting Method

CROSS guidelines.

Client or Public Contribution

No patient or public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

This paper contributes to the challenges community nurses face regarding increased demand for community nursing, lack of career structure for some community nurses, and difficulties with staff retention within the community.

Chronic intestinal immune activation reveals separable impacts of inflammation and barrier loss on hallmarks of ageing

by Jeanette Alcaraz, Charlotte Keyse, Charles Hall, David W. Walker, David P. Doupé, Rebecca I. Clark

Inflammaging is considered a driver of age-associated pathology across tissues. Similarly, intestinal permeability is a feature of ageing and underlies a range of inflammatory and age-related diseases. Increased intestinal permeability has been described as both a cause and a consequence of inflammation. Both intestinal permeability and inflammation are closely associated with microbial dysbiosis, epithelial dysplasia and mortality but dissecting the complex interplay between these phenotypes remains challenging. Here we genetically induce intestinal immune activation in Drosophila and stratify animals by their intestinal barrier status using the Smurf assay. We demonstrate that intestinal barrier failure has a distinct impact on the microbiota. Further, immune activation, both within the intestine and systemically, drives intestinal barrier failure and mortality even in the absence of the microbiota. Importantly, immune-induced intestinal barrier failure takes time to develop and is closely associated with the onset of mortality. Our work adds to building evidence that the impact of intestinal permeability on the microbiota and on animal health needs to be considered independently of its relationship with inflammation.

Assessing the Clinical and Cost Effectiveness of Dialkylcarbamoylchloride (DACC) Coated Post‐Operative Dressings Versus Standard Care in the Prevention of Surgical Site Infection in Clean or Clean‐Contaminated, Vascular Surgery (DRESSINg Trial): Study

ABSTRACT

Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.

Siblings of Children With Cancer and Their Challenges Across Everyday Life Contexts: A Two‐Phase Qualitative Study in Denmark

ABSTRACT

Aim

To explore the familial, emotional, social and school-related challenges experienced by school-aged siblings of children with cancer, focusing on how these challenges intersect across hospital, home and school in their everyday lives.

Design

Qualitative, two-phase, multi-site study.

Methods

Fieldwork was conducted at two distinct paediatric oncology wards, followed by semi-structured interviews with 11 siblings (aged 7–19 years) and 20 parents, recruited through criterion-based sampling. The data were analysed using reflexive thematic analysis.

Results

Analysis showed that siblings were often marginalised in hospital life due to (1) family logistics; (2) hospital-induced restrictions, rules and physical spaces and (3) perceptions of their presence as ‘problematic’, ultimately limiting their access. In family life, siblings experienced peripheral roles because (1) they were cared for by others, (2) had their needs subordinated and (3) faced shifting expectations. At school, siblings encountered (1) limited understanding from classmates and teachers and (2) insufficient support resources.

Conclusions

Siblings of children with cancer face significant, interconnected challenges, often amplified by the structural frameworks of healthcare, family and school contexts.

Impact

Siblings of children with cancer are often marginalised in their own lives. In healthcare, a family-centred approach to care should formally and actively include siblings. Nurses are well-positioned to promote this, ensuring whole-family support. Siblings would benefit from coordinated support bridging hospital, home and school.

Reporting Method

This study adheres to the SRQR Checklist.

Patient or Public Contribution

Parents helped shape the study focus by discussing preliminary observations and potential support needs.

Lower versus standard dose-intensity continuous renal replacement therapy: a protocol for a systematic review and meta-analysis

Por: Lumlertgul · N. · Kusirisin · P. · Kung · J. Y. · Duquette · D. · Fujii · T. · Zarbock · A. · Wald · R. · Bagshaw · S. M.
Introduction

The 2012 Kidney Diseases Improving Global Outcomes clinical practice guideline recommends prescribing continuous renal replacement therapy (CRRT) doses in patients with acute kidney injury (AKI) between 20 and 25 mL/kg/hour, with a need to consider further augmentation to 25–30 mL/kg/hour. Observational data have shown that lower-dose CRRT (

Methods and analysis

Ovid MEDLINE, Ovid Embase, CINAHL and Cochrane Library will be searched for studies from inception to present. We will evaluate the risk of bias using the modified Cochrane tool for randomised controlled trials and the Cochrane Risk of Bias In Non-randomised Studies—of Interventions tool for cohort studies. Two reviewers will independently complete study selection, data extraction and bias assessment. Inclusion criteria will be randomised controlled trials and observational studies (cohort) including patients with AKI receiving CRRT. The exposure will be lower dose-intensity CRRT (

Ethics and dissemination

Ethics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication.

PROSPERO registration number

CRD420251135606.

Protective factors for maternal mental health and life satisfaction during the COVID-19 pandemic: a longitudinal analysis

Por: Johannessen · P. M. · Madsen · C. · Hart · R. K. · Lund · I. O. · Pettersen · J. H. · Gustavson · K. · Roysamb · E. · Nesvag · R. · Brandlistuen · R. E. · Ask · H.
Objective

Mothers’ mental health and life satisfaction may have been negatively affected due to challenges during the COVID-19 pandemic. Given the risk of future crises, knowledge of possible mitigating factors in this population is essential. This study aims to examine whether the pandemic affected the level of protective factors such as social support, physical activity and employment situation, and how these factors are associated with mental distress and life satisfaction.

Design

Longitudinal cohort study.

Outcome measures

Primary outcomes were mental distress (measured by the eight-item version of the Hopkins Symptom Checklist) and life satisfaction (measured by the Satisfaction With Life Scale). As the first step, we investigated changes in the levels of social support (defined by the number and frequency of social contact), physical activity (average hours of physical activity during a week), employment situation (actively working vs sick leave or unemployed), alcohol consumption (measured by the Alcohol Use Disorders Identification Test-Consumption) and relationship satisfaction (measured by the five-item version of the Relationship Satisfaction Scale).

Methods

We analysed data from two waves of the Norwegian Mother, Father and Child Cohort Study (n=~18 000 mothers); one pre-pandemic wave and one wave where half of the sample responded after the onset of the pandemic, with pandemic exposure being defined by questionnaire response timing rather than cohort recruitment. To assess changes in protective factors over time and pandemic exposure, we used difference-in-differences analyses and regression discontinuity design. Associations between protective factors with mental distress and life satisfaction, and possible moderation by pandemic exposure, were investigated using multiple regression models with interaction terms adjusted for potential confounders.

Results

Apart from physical activity, which declined less across time in the pandemic group (B=0.09, 99% CI 0.05 to 0.12), protective factors did not change during the pandemic. Social support, employment situation and relationship satisfaction were associated with mental distress and life satisfaction, whereas physical activity showed a unique relationship with mental distress. Most associations were similar across pandemic exposure groups, except employment situation which appeared to have a stronger protective effect in the pandemic group (β=–0.12, 99% CI –0.24 to –0.00).

Conclusions

Changes over time in self-reported levels of protective factors were generally consistent among mothers independent of the pandemic. These factors appear to play an equally important role for mental distress and life satisfaction both under ordinary circumstances and during public health crises. Our findings enhance the understanding of how potential protective factors among mothers are associated with mental distress and life satisfaction in the context of a global stressor. Future studies should investigate additional mitigating factors that may be particularly relevant during global crises and explore the causal relationship between protective factors, mental health and life satisfaction.

Acceptance, and Impact Mechanisms: Patient and Healthcare Professional Insights From a Self‐Management Intervention for Newly Diagnosed With Inflammatory Arthritis

ABSTRACT

Aim

To evaluate the acceptability, mechanisms of impact, and contextual factors affecting a 9-month, nurse-led self-management intervention specifically designed for newly diagnosed patients with inflammatory arthritis, from both the patient and healthcare professional (HPs) perspectives.

Design

A qualitative longitudinal study.

Methods

Individual baseline and follow-up interviews were conducted with 12 patients (baseline n = 12; follow-up n = 10) and four focus group interviews were conducted with 4 HPs at key intervention stages. Interview guides were drafted with open-ended questions and iteratively refined across interviews to match the evolving stages of the intervention. Data analysis was conducted using template analysis. This study adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ): 32-item checklist.

Results

Patients valued the tailored individual sessions, which provided emotional support and improved their understanding of IA. Group sessions received mixed feedback, with some patients suggesting a need for more organisation. The intervention fostered a sense of community, reducing isolation and empowering patients to navigate the healthcare system better. HPs praised the patient-centred approach and emphasised the importance of training and organisational support.

Conclusion

Both patients and HPs highly accepted our nurse-led self-management intervention, though group sessions received mixed feedback. Key impact mechanisms were the proactive management of symptoms and lifestyle, and the intervention's tailored support and emotional guidance. The HPs experienced professional growth but scheduling occasionally conflicted with regular work.

Impact

This study has provided valuable information in understanding intervention mechanisms. Findings from the evaluation will be used to refine the intervention.

Patient or Public Contribution

Two patients contributed to the development of the intervention, and a patient research partner was actively engaged in all phases of this study.

Patient Agitation in the Intensive Care Unit: A Concept Analysis

ABSTRACT

Aim

Exploring the concept of patient agitation in the intensive care unit.

Background

Patient agitation in the intensive care unit is of widespread concern and linked to negative outcomes for patients, staff, and family members. There is currently no consensus on what constitutes agitation in the intensive care context, hindering effective and tailored prevention and management.

Design

Concept Analysis.

Method

Walker and Avant's eight-step concept analysis approach.

Data Sources

A comprehensive search was carried out in the databases MEDLINE, PsychINFO and CINAHL. A total of 32 papers published between 1992 and 2023 were included, reviewed, and analysed to explore definitions, attributes, antecedents and consequences of patient agitation.

Results

Patient agitation in the intensive care unit is characterised by excessive motor activity, emotional tension, cognitive impairment, and disruption of care, often accompanied by aggression and changes in vital signs. Antecedents encompass critical illness, pharmacological agents and other drugs, physical and emotional discomfort, patient-specific characteristics and uncaring staff behaviours. Consequences of agitation range from treatment interruptions and poor patient outcomes to the psychological impact on patients, families, and staff.

Conclusion

Agitation in the intensive care unit is a complex issue which significantly impacts patient treatment and clinical outcomes. For healthcare professionals, patient agitation can contribute to high workloads and job dissatisfaction. Due to the complex nature of agitation, clinicians must consider multifaceted strategies and not rely on medication alone. Further research is needed to fully understand patient agitation in the ICU. Such understanding will support the development of improved strategies for preventing and managing the behaviours.

Implications

A clearer understanding of patient agitation supports the development of tailored interventions that improve patient care, guide ICU training, and inform future research.

Patient or Public Contribution

This concept analysis was developed with input from a patient representative.

Evaluating the impact of a national brain health education course for older adults with intellectual and developmental disabilities and caregivers: Brain Health-IDD Program protocol

Por: Lunsky · Y. · Bobbette · N. · Chiu · M. · Thakur · A. · Patel · P. · Volpe · T. · Balogh · R. · Baskin · A. · Beaudoin · M.-J. · Dever · M. J. · Durbin · A. · Fogle · A. · Kelly · C. · Lake · J. · Lefkowitz · G. · Mallett · H. · McCabe · J. · Noonan · J. · Selick · A. · Shooshtari · S. · Socka
Introduction

Adults with intellectual and/or developmental disabilities (IDD) experience higher rates of age-related health concerns, including dementia, than adults without disabilities. Despite this, current efforts to support brain health in ageing have often excluded this population. To address this gap, we will codesign, codeliver and evaluate a national virtual brain health education programme, Brain Health-IDD, for ageing individuals with IDD, family caregivers and health and social care providers.

Methods and analysis

This study will evaluate the Brain Health-IDD Program, an interactive virtual psychoeducation course codesigned and coled by an interdisciplinary team of clinicians and people with lived experience. Three participant groups will be recruited from across Canada: adults with IDD, aged 40 years and older; family caregivers who have a family member with IDD aged 40 years and older or who are themselves aged 60 years and older; and health or social service providers who support adults with IDD aged 40 years and older. Outcomes will be measured at baseline, postcourse and 3-month follow-up. Data will be collected through structured surveys, including both closed and open-ended questions, and focus group interviews.

Primary outcomes are participation, satisfaction and changes in knowledge and self-efficacy related to brain health among the three participant groups. Secondary outcomes for both adults with IDD and family caregivers include changes in health-related behaviours (social connections, sleep hygiene and physical activity), physical health, mental wellbeing, resilience and whether cognitive screening is initiated for adults with IDD and for caregivers. For health and social service providers, secondary outcomes include changes in brain health promotion practices and whether cognitive screening for older adults with IDD is initiated.

Analysis of open-text survey responses and qualitative data from focus group interviews will explore the experiences of participants with the Brain Health-IDD Program.

Ethics and dissemination

Institutional ethics approval was obtained from the Centre for Addiction and Mental Health Research Ethics Board. Programme findings and resources will be shared with advocacy groups, disability agencies, family caregiver organisations, clinicians and policymakers in the fields of disability, health and ageing at the provincial, national and international levels.

Retrospective validation of an artificial intelligence system for diagnostic assessment of prostate biopsies on the ProMort cohort: study protocol

Por: Ji · X. · Zelic · R. · Aspegren · O. · Mulliqi · N. · Fiorentino · M. · Giunchi · F. · Molinaro · L. · Boman · S. E. · Szolnoky · K. · Liu · L. X. · Pettersson · A. · Vincent · P. H. · Eklund · M. · Akre · O. · Kartasalo · K.
Introduction

Prostate cancer diagnosis and treatment planning depend on accurate histopathological assessment of needle biopsies, particularly through the Gleason scoring system. The inherently subjective nature of the grading creates variability between pathologists, potentially resulting in suboptimal patient management decisions. These reproducibility challenges extend beyond Gleason scoring to encompass other critical diagnostic and prognostic markers, including cancer volume quantification and detection of cribriform morphology patterns and perineural invasion. Artificial intelligence (AI) applications in digital pathology have emerged as promising solutions for enhancing diagnostic consistency and accuracy, with recent research demonstrating that automated systems can match expert-level performance in prostate biopsy evaluation. Nevertheless, comprehensive validation studies have revealed concerning limitations in model generalisability when deployed across different clinical environments and patient populations. Recent systematic reviews revealed widespread risk-of-bias limitations and insufficient external validation in AI diagnostic studies, highlighting critical needs for accumulated evidence supporting generalisability before clinical implementation. Rigorous external validation with preregistered protocols using independent datasets from diverse clinical settings remains essential to establish the reliability and safety of AI-assisted prostate pathology systems.

Methods and analysis

This study protocol establishes a framework for the retrospective external validation of an AI system developed for prostate biopsy assessment, to be conducted on the case-control samples of the National Prostate Cancer Register of Sweden, ProMort study (1998-2015). The primary aim is to evaluate the AI model’s diagnostic accuracy and Gleason grading performance using completely independent datasets separate from any model development or previously used validation cohorts. The diversity of the validation samples, spanning multiple geographic regions, temporal collection periods and reference standards, allows evaluation of model robustness across varied clinical contexts. Secondary aims encompass evaluating AI performance in cancer length estimation and detection of cribriform patterns and perineural invasion. This protocol delineates procedures for data collection, reference standard clarification and prespecified statistical analyses, ensuring comprehensive validation and reliable performance assessment. The study design conforms to established reporting guidelines Checklist for Artificial Intelligence in Medical Imaging (CLAIM) and Standards for Reporting Diagnostic Accuracy Studies using Artificial Intelligence (STARD-AI), and recognised best practices for AI validation in medical imaging.

Ethics and dissemination

Data collection and usage were approved by the Swedish Regional Ethics Review Board and the Swedish Ethical Review Authority (permits 2012/1586-31/1, 2016/613-31/2, 2019-01395, 2019-05220). The study adheres to the Declaration of Helsinki principles, and findings will be made available in open access peer-reviewed publications.

Advance Care Planning During Healthcare Transitions for Community‐Dwelling Older Adults in Their End of Life: A Scoping Review

ABSTRACT

Background

Older adults often experience unplanned hospital admissions at the end of life, which may conflict with their wish to remain at home. Advance care planning (ACP) can help align care with patient preferences, but timely discussions and documentation are often lacking. Effective communication across healthcare settings is therefore essential.

Aim

To explore how ACP is delivered for community-dwelling older adults, focusing on intervention components, communication during care transitions and related barriers and facilitators.

Design

A scoping review conducted according to Joanna Briggs Institute methodology and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Methods

We systematically searched six databases (PubMed, Embase, CINAHL, PsycINFO, Scopus and Web of Science) on 7 April 2025 for peer-reviewed primary studies on ACP interventions for community-dwelling older adults during healthcare transitions. Data were extracted using a structured table.

Results

Sixteen studies from seven countries (2016–2024) were included, with most conducted in the United States. ACP interventions typically involved healthcare professional education, structured documentation and coordination across settings. Communication strategies included written records, discharge summaries, telephone calls, face-to-face meetings and electronic systems. Key facilitators were timely patient identification, GP involvement, clear role distribution and use of existing clinical structures. Barriers included time constraints, unclear responsibilities, fragmented communication, insufficient training and emotional reluctance. ACP was often deprioritised due to acute care episodes.

Conclusion

ACP for community-dwelling older adults is a complex intervention challenged by structural, organisational and relational barriers. Future research should explore sustainable, context-sensitive ACP models that emphasise long-term integration, patient experiences and diverse care settings.

Patient or Public Contribution

No patient or public contribution.

Virtual reality-based cognitive rehabilitation programme to support employment in patients with breast cancer: protocol for the Cog-RV pilot study

Por: Vieira Jales · I. · Hummel · E. · Clarisse · B. · Gouranton · V. · Cogne · M. · Lecuyer · A. · Leconte · A. · Lequesne · J. · Ahmed-Lecheheb · D. · Morel · A. · Fernette · M. · Joly · F. · Lange · M.
Introduction

Cancer-related cognitive impairment is frequently reported by patients with breast cancer after chemotherapy. These difficulties can hinder return to work. It is therefore particularly important to assess and manage these impairments, especially to facilitate employment. We propose the Cog-VR pilot study to assess patient adherence to a virtual reality (VR)-based cognitive rehabilitation programme to support employment.

Methods and analysis

This prospective interventional pilot study aims to assess adherence to a VR-based cognitive rehabilitation programme in patients with breast cancer (n=23) treated by chemotherapy reporting cognitive complaints following cancer and its treatments. The programme consists of six weekly individual sessions (1 hour/week), including cognitive training, psychoeducation and VR immersion (10–15 min). VR tasks train executive functions, attention, memory and processing speed. The primary endpoint is the programme adherence, defined as completing at least five out of six VR sessions, each lasting a minimum of 5 min. The main secondary endpoints are objective cognitive tests and patient-reported outcomes (subjective cognitive functioning (Functional Assessment of Cancer Therapy—Cognitive Scale), anxiety/depression (Hospital Anxiety and Depression Scale) and fatigue (Functional Assessment of Chronic Illness Therapy—Fatigue)) assessed before and after the programme. Furthermore, cyber sickness (Simulator Sickness Questionnaire) at each session, VR usability (System Usability Scale—third session) and patient satisfaction to the programme will also be assessed.

Ethics and dissemination

The study was approved by the local ethics committee (French Ouest II personal protection committee no. ID RCB: 2023-A02163-42) on January 2024. It was validated by the review board of the participating center. An individual participant data-sharing statement is not planned. Written informed consent will be obtained from all patients before any study procedure. The results of this pilot study will be disseminated through peer-reviewed journals and conference presentations.

Trial registration number

NCT06267014.

Unsupervised home-based exercise training can help improve symptoms of maternal physical discomfort during pregnancy

Por: Ette · L.

Commentary on: Weng, M.-H., Chou, H.-C., & Liaw, J.-J. (2024). The effects of unsupervised home-based exercise training during pregnancy: A systematic review. Worldviews on Evidence-Based Nursing, 00, 1–7.

Implications for practice and research

  • Nurses and midwives working with pregnant women can safely recommend a home exercise plan, preferably a theoretical-based programme of exercise, to improve physical discomfort symptoms during pregnancy;

  • This systematic review suggests that further research is needed to identify and more consistently evidence the benefits of these types of exercise to maternal mental health during pregnancy.

  • Context

    Symptoms of physical discomfort, such as sleep disturbance, prenatal back pain and postnatal urinary stress incontinence, are commonly associated with pregnancy. Strategies to support women be relieved of, minimise or better manage these symptoms are a welcome approach to improving women’s quality of life whilst pregnant. Exercise is one of many lifestyle factors that...

    <i>Mycobacterium tuberculosis</i> complex lineages and drug resistance patterns among tuberculosis patients with or without diabetes mellitus in southern Ghana

    by Emelia Konadu Danso, Prince Asare, Amanda Yaa Tetteh, Phillip Tetteh, Augustine Asare Boadu, Ivy Naa Koshie Lamptey, Augustina Angelina Sylverken, Kwasi Obiri-Danso, Jane Sandra Afriyie-Mensah, Abraham Adjei, Dorothy Yeboah-Manu

    Drug-resistant (DR) tuberculosis (TB) and diabetes mellitus (DM) are intersecting epidemics that complicate management of both diseases and worsen patient outcomes. We conducted a prospective cohort study of 758 GeneXpert-confirmed pulmonary TB patients, of whom 75 had DM. Demographic, clinical, radiographic, and anthropometric data were collected at baseline. Sputum samples were cultured for mycobacterial isolation, and the obtained isolates were characterized for Mycobacterium tuberculosis complex (MTBC) lineage and drug-susceptibility testing using spoligotyping and microplate alamar blue assay. The TB-diabetes (TB-DM) comorbid cohort was older [TB-DM: 53/75 (70.7%) vs. 241/683 (35.3%) aged 41–60 years) (p 

    Drug-related stigma among people who inject drugs – development and validation of the drug use stigma scale (DUSS)

    by Robin A. Pollini, Catherine E. Paquette, Brandon Irvin, Jennifer L. Syvertsen, Christa L. Lilly

    Drug use is a highly stigmatized behavior, and drug-related stigma is a key driver of behavioral risk, lower health care utilization, and associated adverse health outcomes among people who inject drugs (PWID). While instruments exist for measuring drug-related stigma, their applicability to community-based PWID across multiple stigma types (enacted, anticipated, internalized) and settings (health care, society, family) is limited, as most were developed using treatment-based samples and all were developed in urban populations. This study sought to develop a Drug Use Stigma Scale (DUSS) that addresses these limitations. We developed an initial list of 39 items based on literature review and qualitative interviews (N = 27) and three focus groups (N = 28) with PWID recruited from syringe services programs and via peer referral in two predominantly rural West Virginia counties. The scale items were administered in a survey to 336 PWID recruited from the same two counties divided into development and validation samples. Responses to the 39-item scale went through a multidimensional refinement process, including examination of internal consistency, Confirmatory Factor Analysis (CFA), and a three-factor CFA based on stigma setting. Next, a set of final measurement CFAs were conducted. Finally, the resulting scale was examined for criterion-related concurrent validation. The final DUSS consisted of 16 items with excellent fit statistics for the development sample: SRMR: 0.03, RMSEA: 0.09, GFI: 0.92, CFI: 0.96, NFI: 0.94. Fit attenuated but remained satisfactory for the validation sample. DUSS scores were significantly associated with increased odds of not seeking healthcare when needed (OR: 1.47, p = 0.001; OR: 1.61, p 

    How can midwives in Germany be supported in advising on early childhood allergy prevention in a health literacy-responsive way? Protocol for a mixed-methods study to co-design and evaluate an educational intervention following the Medical Research Council

    Por: von Sommoggy · J. · Steinmann · J. R. · Lander · J. · Bitzer · E. M. · Pawellek · M. · Brandstetter · S. · Apfelbacher · C. · Fillenberg · B. D.
    Introduction

    Health literacy (HL) is essential for making informed health-related decisions, for example enabling parents to reduce their child’s allergy risk. Health literacy does not, however, rely solely on an individual’s capacities, but is strongly influenced by external factors. Midwives provide important health advice to families, particularly since their relationship is close during a time of significant transition. This offers them a unique opportunity to positively influence the HL of parents, which in turn may support the health and well-being of the whole family. The aim of this study is to develop and evaluate an intervention that can support midwives in providing allergy prevention advice in a way that is in line with the concept of HL.

    Methods and analysis

    In accordance with the recommendations of the Medical Research Council framework in the first phase of this study, we will survey midwives (target sample size=379) in Germany regarding their practices, the potential barriers they face and enabling factors in providing advice on early childhood allergy prevention in an HL-responsive way. The data will be subjected to descriptive statistical analysis. Two co-design workshops will then be conducted with various stakeholders in two regions (Rhineland-Palatinate and Saxony) of Germany. Following the protocol proposed by the Stanford Design Thinking School, we will use design thinking to collect ideas for the intervention. Based on these ideas and our previous qualitative and quantitative study, we will develop an intervention in collaboration with didactic experts. The intervention will be piloted in three groups (midwives=10–15, midwives working as practice supervisors=5–10, students of midwifery=10–20). For the process evaluation, we will use observation protocols of the intervention conduct and qualitative interviews. For the outcome evaluation, we will use a questionnaire and observations in simulation laboratories with students of midwifery.

    Ethics and dissemination

    This study protocol was approved by the Ethics Committee of the University of Regensburg (ID 23-3441-101) and is in compliance with the Declaration of Helsinki. Participation in the study will only be possible after informed consent has been given. Our results will be presented at national and international conferences and published in scientific journals. Additionally, once it has been finalised, we will make the intervention available to educational institutions for (future) midwives.

    The Evidence‐Based Practice Mentor: Findings From a Role Delineation Study to Support the Role's Needed Knowledge and Skills

    ABSTRACT

    Background

    The role of the interprofessional evidence-based practice (EBP) mentor is critical to integrate best practices into healthcare and academic environments to improve outcomes and reduce costs for patients, families, providers, students, and faculty. This study aimed to validate the knowledge, skills, and attitudes/beliefs (KSAs) needed for the EBP mentor. This role delineation study (RDS) assessed knowledge about the EBP mentor role and tasks as related to the steps and competencies of EBP.

    Methods

    Interprofessional EBP experts participated in an advisory panel. Focus groups were conducted with the advisory panel members to identify the KSAs needed for expert EBP mentors. The steps of EBP were broken into 11 domains to align with the processes and strategies needed for EBP methodology. The focus group data were analyzed to identify the KSAs for each domain. A role delineation survey was developed. Interprofessional experts were invited to complete the survey to validate the KSAs needed for the EBP mentor role. The online survey included demographic information and 11 sections that aligned with the steps of EBP and the 107 KSA items needing to be validated.

    Results

    A total of 251 interprofessional EBP experts completed the survey (232 nurses, 19 interprofessionals). Healthcare providers comprised 82.5% of the sample, academic/researchers 15.5%, and “worked in both settings” 2%. The results reported strong inter-rater reliability (ranging from 0.836 to 0.955) and strong validity for each of the 11 domains and KSAs.

    Linking Evidence to Action

    Findings from this study support the EBP mentor role and will guide interprofessional EBP education and EBP mentor positions in healthcare systems. The study showed that the tasks of the EBP mentor were consistent across settings, educational degrees, and professional roles. Validity for the tasks/role for an interprofessional Evidence-based Practice Certification was clear and outlined expectations for the EBP mentor role.

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