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This study aimed to evaluate the validity and reliability of the Postpartum Sleep Quality Scale (PSQS) for assessing sleep quality among postpartum women in Vietnam during the COVID-19 pandemic. The major hypothesis is that the PSQS will provide a reliable and valid measure of postpartum sleep disturbances and their correlation with mental health outcomes, particularly postpartum depression (PPD).
A cross-sectional, observational study was conducted from May to December 2023.
The study was carried out at a leading maternal healthcare centre in Vietnam, located in Hanoi, Vietnam.
A total of 223 postpartum women participated in the study, with inclusion criteria specifying women aged 18–45 years, who had delivered within the past 3 months, and were capable of completing the survey. Participants with severe psychiatric or neurological disorders or those experiencing postpartum complications affecting sleep were excluded.
The primary outcome was the psychometric evaluation of the PSQS, including internal consistency (Cronbach’s α), construct validity (through exploratory factor analysis) and concurrent validity (via correlation with the Edinburgh Postnatal Depression Scale and the Perinatal Infant Care Social Support Scale). Secondary outcomes included the relationship between sleep quality and PPD as well as the role of social support in moderating sleep disturbances.
Exploratory factor analysis identified a three-factor structure for the PSQS: (1) sleep efficiency and satisfaction, (2) sleep disruptions and infant-related disturbances and (3) postpartum sleep impairment and daytime fatigue. The PSQS demonstrated strong internal consistency (Cronbach’s α=0.839–0.875). Poor sleep quality was significantly correlated with higher PPD scores (r=0.6890, p
The PSQS is a reliable and valid tool for assessing postpartum sleep quality in Vietnamese women. Its multidimensional structure provides valuable insights into postpartum sleep disturbances. Enhancing social support may improve maternal sleep and mental health. Further research is needed to explore the long-term impact of sleep quality on postpartum recovery and mental well-being.
The International Classification of Functioning, Disability and Health (ICF) represents a major milestone in understanding functioning and disability and is widely used in clinical practice, management and health research. Despite its relevance, implementation of the ICF remains inconsistent across health services and care settings. Evidence on barriers and facilitators to implementation remains fragmented, limiting the development of effective, context-sensitive implementation strategies. This scoping review aims to map barriers and facilitators influencing ICF implementation in health services and to identify implementation strategies reported in the literature.
This scoping review protocol will follow the methodological recommendations of the Joanna Briggs Institute, Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Qualitative, quantitative and mixed-methods primary studies describing the implementation of the ICF in health services will be included with no language restrictions, published since 2001. Searches will be conducted in PubMed/MEDLINE, Scopus, Embase, Web of Science, LILACS, SciELO and PEDro databases. Studies will be selected in two stages by two independent reviewers using the Rayyan platform. Disagreements will be resolved by consensus or by a third reviewer. Data will be extracted using a standardised form. Barriers and facilitators will be mapped and categorised according to the Consolidated Framework for Implementation Research (CFIR), enabling a theory-informed synthesis of implementation determinants across settings. Findings will be summarised using descriptive statistics and narrative synthesis, including implementation contexts, strategies, barriers and facilitators.
Ethical approval is not required because this review will use data from publicly available published studies and will not involve human participants. Findings will be disseminated through peer-reviewed publication, conference presentation and knowledge translation activities targeting researchers, healthcare professionals, service managers and policymakers.
10.17605/OSF.IO/VRQPD.
To map and analyse how artificial intelligence technologies interact with and support clinical judgement processes in nursing across practice and educational contexts.
Scoping review.
JBI methodology for scoping reviews.
An electronic search was conducted on 1 July 2025 across MEDLINE, CINAHL, Scopus, Web of Science, and IEEE Xplore to identify studies published since January 2015. Additional sources of grey literature included ProQuest Dissertations & Theses Global, preprint servers (medRxiv and arXiv), and websites of relevant organisations.
Eleven studies were included. Mapped against Tanner's Clinical Judgement Model, AI applications predominantly supported early cognitive phases (noticing and interpreting) through predictive models and decision support systems, while responding and reflecting phases received minimal attention.
Current AI research in nursing concentrates on computational pattern recognition, with the reflective processes central to expertise development remaining largely unexamined. Future research should examine how AI influences nurses' cognitive and interpretative processes across all phases of clinical judgement, with primary studies in nursing education representing a particularly underdeveloped priority.
The integration of artificial intelligence into nursing practice should be guided by a clear understanding of how these technologies support clinical judgement. Artificial intelligence-enabled tools must be rigorously developed, implemented, and evaluated to enhance nurses' reasoning processes while safeguarding patient safety, professional autonomy, and quality of care.
Research on artificial intelligence in nursing rarely employs theoretical frameworks of clinical judgement, limiting understanding of how these technologies interact with cognitive processes central to professional expertise. This review provides a theoretically grounded synthesis, identifying research gaps and implementation priorities for AI development aligned with nursing clinical judgement.
PRISMA-ScR.
This study did not include patient or public involvement in its design, conduct or reporting.
Trial Registration: Protocol registered in Open Science Framework (https://osf.io; DOI: https://doi.org/10.17605/OSF.IO/UH7RA), and subsequently published in a peer-reviewed journal, DOI: https://doi.org/10.62741/ahrj.v2i4.73.
Chagas disease (CD) remains a major cause of cardiac and digestive morbidity and premature death in the Americas. Although benznidazole (BZN) and nifurtimox (NFX) are the only two available trypanocidal agents worldwide, direct comparisons between these two drugs in Brazilian adults are lacking. Therapeutic efficacy in chronically infected adults remains unclear as parasitological response is variable and serological negativisation is not frequent within short-term follow-up. Furthermore, the genetic diversity of Trypanosoma cruzi may influence treatment response and has been largely overlooked in clinical studies. The BENBRASIL trial aims to compare the efficacy and safety of BZN versus NFX in adults with chronic CD and to explore geographical variation in response to standard BZN treatment.
The BENBRASIL trial is a multicentre, randomised, double-blind, double-dummy phase II superiority trial conducted in Brazil alongside a prospective observational cohort.
A total of 150 adults with chronic indeterminate or mild cardiac forms of CD will be randomly allocated in a 1:1 ratio to receive standard BZN dose or NFX for 8 weeks in a double-blind, double-dummy placebo-controlled design and will be followed for 12 months. The primary endpoint is therapeutic efficacy defined as sustained parasitological response in PCR for parasitic DNA results for 12 months follow-up. Treatment failure will be defined as one confirmed PCR positivity, treatment discontinuation due to toxicity or death related to CD. Secondary outcomes include drug tolerability (including graded adverse events), treatment adherence and serological titres. The sample size (75 participants per arm) was calculated to provide approximately 80–85% power to detect a 25% absolute difference in sustained PCR negativity between groups at a two-sided α of 0.05. Additionally, a prospective observational cohort will enrol 300 additional participants receiving standard treatment of BZN to evaluate the effectiveness and safety of BZN across five epidemiological and geographical regions of Brazil representing distinct parasite genetic backgrounds. It aims to explore geographical variation in parasitological response within different discrete typing units using mixed-effects regression models adjusted for baseline covariates. The primary analysis will follow the intention-to-treat principle. For the primary endpoint, missing outcome data will be conservatively classified as treatment failure, with sensitivity analyses using multiple imputations. Recruitment began in March 2024.
The protocol has been approved by Brazil’s National Research Ethics Committee and the institutional review boards of all participating centres. Written informed consent will be obtained from all participants. An independent Data Safety Monitoring Board will oversee safety outcomes. Study findings will be disseminated through peer-reviewed publications, scientific conferences and communication with national health authorities. Results may guide clinical practice and regulatory policies, strengthening therapeutic options for CD.
ReBEC U1111-1287-7587. Date of registration: 06/07/2023 (https://ensaiosclinicos.gov.br/rg/RBR-973pt5n).
Reflexionar sobre los riesgos psicosociales relacionados con el trabajador de enfermería insertado en contextos laborales degradantes, se justifica por la relevancia en la estructuración del conocimiento real que cumple con la prevención y promoción de los efectos positivos del trabajo, así como también garantiza la salud de los trabajadores. Al estimar la relación entre trabajo y trabajador, las medidas de los riesgos psicosociales se han convertido en un desafío para la seguridad y la salud del profesional de enfermería. Las situaciones negativas en las relaciones laborales culminan en daños a la salud de los trabajadores, que pueden ser tanto físicos como mentales, así como daños a la comunidad en general. El contenido antagónico de la violencia, de la salud mental y de la atención relacionada con la enfermería está representado en esta enigmática triangulación, cuya falta de reflexión exige investigaciones urgentes, para mitigar la enfermedad acelerada de esta categoría de trabajadores. La configuración de esta reflexión, por lo tanto, se basa en mirar la enfermería en el marco de esta triangulación. Por lo tanto, esta investigación tuvo como objetivo describir los contornos de la violencia como un riesgo psicosocial en la vida de los trabajadores de enfermería, así como el impacto en la sociedad como usuario del sistema de salud.
Genitourinary syndrome of menopause (GSM) is a chronic, oestrogen-deficient condition that is frequently underdiagnosed and undertreated. Although low-dose vaginal estriol improves epithelial trophism and microbial balance, a substantial proportion of women report persistent symptoms. High-quality randomised evidence evaluating combined therapeutic strategies remains scarce. Energy-based modalities, including the erbium:YAG (Er:YAG) laser (=2940 nm), have been proposed as adjunctive treatments. This trial aims to assess the efficacy of Er:YAG laser therapy combined with vaginal estriol compared with estriol alone in postmenopausal women with GSM.
This is a single-centre, randomised, double-blind, controlled clinical trial. Postmenopausal women aged 45–70 years with vaginal pH ≥5.0 and at least one moderate GSM symptom (Visual Analogue Scale ≥4) will be eligible. Exclusion criteria include current systemic or local hormone therapy, previous vaginal energy-based treatment, abnormal cervical cytology and body mass index ≥35 kg/m2. All participants will receive vaginal estriol cream (0.5 mg per dose) daily for 14 days, followed by twice-weekly administration for 16 weeks. Participants will be randomised (1:1) to receive either estriol plus sham Er:YAG laser or estriol plus active Er:YAG laser. Three laser sessions will be delivered at approximately 4-week intervals. Assessments will occur at baseline, monthly during treatment and 4 months after the final session. The primary outcome is the Vulvovaginal Health Index, with the primary endpoint defined as the change from baseline to 4 months post-treatment, reflecting sustained effect. Secondary outcomes include GSM symptom severity, vaginal microbiome composition (16S rRNA sequencing), quality of life (Menopause Rating Scale) and sexual function (Female Sexual Function Index). Data will be analysed using repeated-measures analysis of variance or appropriate non-parametric tests, with significance set at p
Ethical approval has been obtained from the Human Research Ethics Committee of UNINOVE. Written informed consent will be obtained. Findings will be disseminated via peer-reviewed journals and scientific meetings.
by Patricia Fiorino, Luigi Fernandes Rosa Cauduro, Danielle Silberspitz Konig, Leonardo Fernandes Rosa Cauduro, Caio de Araujo Santos, Juliana Alves Kavai, Isadora Durigan Duarte, Anna Laura Viacava Américo
Zebrafish (Danio rerio) are widely used as models in cardiovascular research due to their rapid development, optical transparency, and genetic similarity to humans. However, the lack of standardized experimental conditions, particularly regarding developmental stage and microenvironmental parameters, limits reproducibility across studies. This study aimed to characterize cardiovascular function in Zebrafish larvae and evaluate the impact of developmental stage and environmental factors. Wild-type AB embryos were maintained under standard conditions, and heart rate (HR), cardiac output (CO), and ejection fraction (EF) were measured at 24, 30, 48, 52, 56, 72, 78, and 80 hours post-fertilization (hpf). The effects of variations in temperature (27.0, 27.5, and 28.0 °C) and pH (7.0, 7.4, and 8.0) were also assessed. Results showed a progressive increase in HR from 24 to 72 hpf, stabilizing thereafter. CO exhibited two phases of elevation: an early rise between 24–48 hpf and a stronger increase between 48–56 hpf. EF remained generally stable, with a transient reduction at 48 hpf. Cardiovascular performance reached a physiologically stable state after 72 hpf, defining a reliable window for functional studies. Environmental conditions modulated these parameters: temperature variation induced approximately 20% difference in HR and reduced EF, while CO was minimally affected. In contrast, pH variations within the physiological range had no significant impact on HR, CO, or EF. These findings highlight developmental and environmental variables that may influence cardiovascular measurements in Zebrafish larvae and support the development of more consistent experimental approaches in cardiovascular and toxicological research.by Ana Laura Januário Lelis, Leandro Aparecido Ferreira da Silva, Daniel Moretto Casali, Tiago Leiva, Murilo Chuba Rodrigues, José Paulo Roman Barroso, Pedro Veloso Facury Lasmar, Camila Lisboa Tomaz, Anabelle Jorge Barbosa, Camila Cesario Fernandes Sartini, Johnny Maciel de Souza, Danilo Domingues Millen
This study evaluated the effects of increasing narasin doses on ruminal fermentation, nutrient digestibility, ruminal pH stability, papillae histology, and microbial composition in Angus cattle fed feedlot diets. Three rumen-cannulated Angus steers (average body weight: 680 kg) were assigned to a 3 × 3 Latin square design and received diets containing 13, 20, or 27-ppm of narasin. Each experimental period consisted of 14 days of adaptation followed by seven days of sampling. Ruminal degradability was assessed on days 15–17, apparent digestibility on days 15–19, continuous ruminal pH on days 19–20, and samples for short-chain fatty acids (SCFA), microbiota, and ruminal histology were collected on days 20 and 21. Ruminal degradability was not affected by narasin dose. Digestibility of acid detergent fiber (ADF) was significantly influenced, with the greatest values observed at 27-ppm (P = 0.01). Increasing narasin doses improved ruminal pH stability, as indicated by a linear increase in minimum pH (P = 0.01) and a reduction in the duration of pH below 5.6 (P = 0.10). At 13 ppm, SCFA production, particularly acetate and propionate, increased (P P P = 0.02), and butyrate (P P P = 0.03). Narasin supplementation altered ruminal microbial composition, increasing the relative abundance of Lachnospiraceae and Isotricha while reducing lactic acid–producing bacteria. In terms of ruminal morphology, supplementation with 20-ppm of narasin increased the keratin layer thickness of ruminal papillae (P = 0.02), suggesting enhanced epithelial development. Overall, narasin supplementation modulated ruminal function and microbial ecology, with doses between 13 and 20-ppm providing the most favorable balance between fermentative efficiency and ruminal health in feedlot cattle.
The purpose of this scoping review was to identify and summarize how technology can promote patient participation in the rehabilitation process in hip replacement. We conducted a scoping review following the steps outlined by the Joanna Briggs Institute. The PRISMA Checklist (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was utilized to systematically organize the gathered information. A thorough search of articles was performed on PubMed, Scopus, and CINAHL databases for all publications up to December 2022. Twenty articles were included in this study. Various technologies, such as mobile applications, Web sites, and platforms, offer interactive approaches to facilitate total hip replacement rehabilitation. The analyzed studies were based on the rehabilitation of total hip arthroplasty, which in most of them was developed in mobile applications and Web sites. The studies identified reflect trends in the application of digital health technologies to promote patient engagement in the rehabilitation process and provide risk monitoring and patient education. This study shows the development of a software for calculating the number of nursing team members required for providing care during the coronavirus disease 2019 pandemic. Study about the development of a technology based on the literature about data and indicators. The indicators were systematized in the following dimensions: institutional, professional, and occupational structure, all with a focus on coronavirus disease 2019. The software was created to be used on the Web, client-server, in browsers such as Internet Chrome, Explorer, and/or Mozilla Firefox, accessing via an Internet address and also allowing access by Windows, Android, and Linux operating systems, with MySQL database used for data storage. The data and indicators related to the institutional structure for coronavirus disease 2019 were systematized with 10 dimensions and indicators, and the professional and occupational structure, with 14 dimensions and indicators. The construction of computer requirements followed the precepts of software engineering, with theoretical support from the area. In the evaluation of the software, data simulation revealed points that had to be adjusted to ensure security, data confidentiality, and easy handling. The software provides to calculate the size and quality of the team, nursing sizing required due to the needs generated by the coronavirus disease 2019 pandemic. Objetivo: identificar los diagnósticos de enfermería y las intervenciones más frecuentes en la asistencia a los pacientes en hemodiálisis. Método: se realizó un estudio descriptivo, transversal, retrospectivo con un enfoque cuantitativo, realizado con 175 prontuarios de pacientes en hemodiálisis, asistidos en el servicio por un período de seis meses. Para la recolección de los datos, se utilizó la plataforma Google Forms®, generando una hoja de trabajo en Microsoft Excel®, un software que permite organizar, describir y analizar los mismos. Resultados principales: se identificaron tres diagnósticos de enfermería como más frecuentes: Riesgo de sangrado (67,2%); Riesgo de caída (56,5%) y Exceso de volumen de líquido (54,8%), en más de la mitad de los pacientes de acuerdo con los registros en los prontuarios. Las intervenciones de enfermería están dirigidas por el protocolo del procedimiento de hemodiálisis y no por los diagnósticos de enfermería. Conclusión: los diagnósticos más frecuentes se centran en las condiciones clínicas de la población estudiada, y no subvencionan las intervenciones de enfermería, que se definen con base en técnica de hemodiálisis.
Este artículo contempla una actualización con base a los diez puntos establecidos por el consenso Skin Changes at the Life's End [Cambios en la Piel en el Final de la Vida] (Scale, por su sigla en inglés) y tiene por objetivo discutir la evaluación de las condiciones y el cuidado de la piel en el final de la vida. Acerca de los pacientes y familiares, se propone la construcción de un plan de cuidados basándose en sus deseos que deben ser debidamente registrados. Para los profesionales de salud, las recomendaciones buscan la educación para la evaluación de los signos clínicos de falla e insuficiencia de la piel. Así pues, la prioridad es la comodidad del paciente. Se concluye que la utilización del consenso Scale va al encuentro de la filosofía de los cuidados paliativos y puede así mejorar los aspectos multidimensionales involucrados en la calidad del proceso de morir.
Este estudio tuvo como objetivos hacer que un panel de expertos diseñara y validara un algoritmo de soporte a la práctica clínica del enfermero promoviendo la transición segura entre el hospital y la comunidad. Se realizaron dos estudios: una revisión integrativa de literatura para diseñar el algoritmo, sometido a validación por un panel de 8 expertos, recurriendo a la técnica nominal. Fueron considerados los procedimientos éticos. El análisis y síntesis de los 30 estudios que conformaron la muestra bibliográfica permitió identificar las intervenciones eficaces para la prevención de caídas en la transición hospital-comunidad. El algoritmo final fue validado por el panel de expertos por unanimidad. La continuidad de los cuidados resulta vital para prevenir la caída o su recurrencia en los ancianos hospitalizados con alto riesgo de caída o que las sufrieron durante su internación. Las caídas después del alta hospitalaria requieren de investigación.
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