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This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.
As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.
Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.
Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.
The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.
This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.
For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.
The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.
To examine workplace experiences, perspectives on coming out at work, organisational climate and mental health status of lesbian, gay, bisexual, transgender, queer/questioning and other sexual, and gender minority healthcare providers (LGBTQ+ HCPs) within an East Asian cultural context.
Observational, cross-sectional study.
An online cross-sectional survey was conducted among 173 Taiwanese LGBTQ+ HCPs between May and August 2024.
Most of the 173 respondents did not disclose their LGBTQ+ identities to any colleagues, and approximately two-fifths met the clinically significant threshold for depressive symptoms. Furthermore, compared to LGBTQ+ HCPs who disclosed to all, most, about half or a few colleagues, those who had not disclosed to any colleagues reported higher levels of depressive symptoms, lower self-esteem, less comfort with disclosure, greater perceived necessity to conceal their LGBTQ+ identities, lower scores for job stability or security, poorer interpersonal relations and lower agreement that an LGBTQ+-inclusive workplace climate would influence their willingness to remain in their current jobs. Although approximately 80% of the LGBTQ+ HCPs reported that they were familiar with national workplace antidiscrimination laws and that their organisations had grievance mechanisms, nearly two-fifths did not trust the grievance systems or procedures within their organisations.
Results emphasise the urgent need to create an LGBTQ+-inclusive workplace environment with clear and enforceable antidiscrimination policies and inclusive organisational practices to improve both disclosure safety and mental health outcomes for LGBTQ+ HCPs.
The study results extend existing knowledge by identifying the relationship between different levels of disclosure and mental health status among LGBTQ+ HCPs. They also highlight the importance of establishing support groups, a comprehensive mental health referral system and enforcement mechanisms that safeguard legal rights without compromising the privacy or safety of LGBTQ+ HCPs.
No patient or public contribution.
This study aimed to explore culturally and linguistically diverse (CALD) fathers' early parenting support needs in the perinatal period in Australia.
A qualitative descriptive research study. Participant fathers were recruited using purposive and snowball sampling who self-identified as CALD.
Data were collected through semi-structured telephone interviews with 15 Australian fathers aged between 29 and 56 years in July–November 2022. Data were analysed using Braun and Clarke's six stages of thematic analysis to code, categorise and identify themes from the data.
Four major themes and six sub-themes emerged from the data, ‘Under pressure’, ‘Slipping through the cracks’, ‘Gaining knowledge and support by health professionals’, and ‘Path ahead: changed roles and being supported by peers’ that encompassed fathers' early parenting experiences and support needs in the perinatal period.
Culturally and linguistically diverse fathers experience challenges in navigating maternal health care settings and at times interactions with health professionals. However, findings from this study showed that fathers were determined to navigate resources, services and networks that supported their transition to fatherhood in the early postpartum weeks. There is a need for maternity settings to be a ‘father-inclusive’ environment where informational and practical support is readily available to them. Legislation reform is needed that recognises fathers as parents who require adequate ‘paid’ parental leave entitlements that foster family relationships and recognises the role fathers play in the development of their child.
This study provides insights into the support needs of CALD fathers in the perinatal period. Findings from this study have the potential to shape and design culturally appropriate health services and interventions tailored to CALD fathers that meet their nuanced needs through the lens of cultural competence and trauma informed maternity care.
What problem did the study address?: The study explored the support needs of CALD fathers in the perinatal period. What were the main findings?: The findings revealed CALD fathers feel a sense of responsibility and pressure to live up to socio-cultural expectations and support the family unit while engaging in paid employment to earn a living. At times fathers were not encouraged to be parenting partners by health professionals, and there was an expectation that they would be familiar and have knowledge about pregnancy, labour, birth and the transition to fatherhood. Some fathers struggled with their transition to parenthood either due to lack of paid parental support or limited to no family support. However, some fathers found alternatives to manage and adjust in the early weeks postpartum, which included peer support groups and online information. Where and on whom will the research have an impact?: The research has the potential to impact all fathers, as the findings may be transferrable across a number of communities. The research also has the potential to influence cultural competence training for health care professionals and inform policy development that employs a family centred model of maternity care inclusive of culturally diverse families.
The paper has adhered to the EQUATOR COREQ reporting guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
Whereas diabetes-related stigma is increasingly recognized as a barrier to diabetes management, little is known about this social phenomenon in collectivist African settings. The purpose of this study was to examine diabetes-related stigma among adults with type 2 diabetes (T2D) in Ghana, highlighting behavioral and psychological mechanisms underpinning the impact of stigma on hemoglobin A1C.
Cross-sectional analytical design.
Adults with T2D (n = 190), seeking care at a tertiary hospital in Ghana, were recruited. A battery of questionnaires assessing psychological (diabetes-related stigma, depression, anxiety, diabetes distress) and behavioral constructs (diabetes concealment and diabetes self-management) were administered. Venous blood samples were obtained for A1C assessment. A latent variable, “adverse psychological outcomes” comprising anxiety, depression, and diabetes distress, was derived and validated using confirmatory factor analysis. Structural equation modeling was used to test multiple psychological and behavioral pathways through which stigma was associated with A1C.
Participants had an average age of 59.44 (SD = 10.7) years, were mostly female (70.5%, n = 134), and had T2D diagnosis for a median of 14.5 years. We found significant indirect effects of T2D stigma on HbA1c through adverse psychological outcomes alone (β = 0.16; 95% CI: 0.01, 0.32, p = 0.038), as well as the combination of adverse psychological outcomes and self-management behaviors (β = 0.16; 95% CI: 0.001 to 0.32, p = 0.048). We also found that the association between T2D stigma and diabetes self-management was fully mediated by adverse psychological outcomes, and participants who conceal their diabetes tend to report greater adverse psychological outcomes.
We note that adverse psychological outcomes play a central role in how T2D stigma is associated with HbA1c. Our findings provide preliminary insight into potential aspects of diabetes that may be targeted in future stigma-reduction interventions.
Our results do provide some indication that addressing mental health issues in individuals with T2D may be an effective intervention strategy in curtailing the adverse clinical effects of T2D stigma. Additionally, our results highlight the importance of incorporating mental health care as part of routine diabetes management in Ghana and other similar African countries where mental health issues are often not prioritized by the healthcare system.
This study aimed to assess the psychological outcomes of family members of patients who were resuscitated in the Emergency Department (ED) and analyse factors associated with these outcomes.
This study utilised a cross-sectional design
Data were collected using a self-reported questionnaire sent to family members of patients who had undergone resuscitation in the ED from February 2024 to January 2025. Instruments for data collection included The Impact of Event Scale-Revised (IES-R), the short version of The Depression, Anxiety and Stress Scale–21 items (DASS-21), the Multicultural Quality of Life Index (MQLI) and questions related to demographic variables and the resuscitation event.
A total of 106 family members completed the questionnaire. Of this, 64.2% (n = 68) reported witnessing the resuscitation attempt, and 35.8% (n = 38) did not witness the event. Family members who witnessed the resuscitation displayed more symptoms of post-traumatic stress disorder (PTSD), measured by the IES-R, compared to those who did not witness the event. A statistically significant negative correlation was found between the IES-R and the MQLI scores, indicating that higher PTSD symptoms correlate with lower quality of life (QoL) ratings.
The findings of this study indicated that witnessing the resuscitation of a loved one in the ED is associated with increased PTSD symptoms.
Patients' and family members' cultural and religious needs should be acknowledged by the health care providers. Study findings indicate that family members prefer to be with the patient during the patient's resuscitation. However, without adequate support from hospital staff, this experience may cause adverse psychological effects. Strategies to support family members during and after resuscitation should be developed and integrated into the management of in-hospital resuscitation.
This study followed the STROBE guidelines.
No patient or public contribution.
PRELUCA is a randomised, intervention, non-inferiority study designed to use real-time, longitudinal circulating tumour DNA (ctDNA) measurements to evaluate the efficacy of immunotherapy in patients with advanced non-small cell lung cancer (NSCLC). The primary outcome is overall survival between the two groups: the standard of care group (computer tomography scan evaluation) and intervention group (ctDNA evaluation).
The inclusion and exclusion criteria align with European Society for Medical Oncology treatment guidelines and permit broad inclusion of NSCLC patients, ensuring ‘real-world’ representativeness. The study uses a tumour-informed method, using baseline next generation sequencing analyses to design patient-specific droplet digital PCR assays, which are run with collected blood samples 1 week prior to the intended treatment, enabling real-time evaluation via ctDNA Response Evaluation Criteria in Solid Tumours.
Inclusion began in July 2023 and patients are now being actively included in five locations across Denmark. Approval by The Committee on Health Research Ethics of Region Zealand was gained on 4 May 2023.
To explore baseline activities of daily living (ADL) profiles and their association with memory decline over time in cognitively healthy, community-dwelling older adults.
Observational panel study.
This study analysed data from Waves 7–10 of the English Longitudinal Study of Ageing (the search was performed on May 28, 2024), including 2925 older adults aged above 65 with no dementia or cognitive impairments at baseline (Wave 7, 2014–2015). To categorise participants by their daily functional abilities at baseline, latent class analysis was conducted to derive participants' activities of daily living profiles. A linear mixed model was used to explore whether these baseline activity profiles might predict different memory decline rates (trajectories) over time, accounting for baseline demographic factors (gender, age, ethnicity, education, marital status and chronic diseases).
Social demographics (younger age, female gender, white ethnicity, higher education and being partnered) and ADL profiles outweigh health conditions in predicting participants' memory function. Different baseline profiles were linked to different memory decline trajectories. An impairment profile with grocery shopping capability was linked to slower memory decline.
This study showed that ADL profiles had a substantial correlation with memory decline, accounting for the significant impact of sociodemographic factors. An impairment profile that preserved grocery shopping abilities appeared to offer protective benefits and potentially slow memory decline.
Strengthening nursing strategies that support older adults in maintaining the ability to grocery shop, such as guiding caregivers to promote involvement rather than shopping for the older adults entirely, or accompanying older adults grocery shopping as part of community nursing care, might help delay age-related memory decline in this population.
Patients or members of the public were not directly involved in the study's design, conduct, reporting, or dissemination plans.
The MD Anderson Oropharynx Cancer (MDA-OPC) cohort is a unique single-institution, prospective longitudinal cancer cohort. The cohort aims to enhance the therapeutic index of OPC management by supporting data needs for independent investigators to conduct rigorous observational studies examining exposures and factors associated with acute and late toxicities, cancer progression, recurrence, new malignancies and quality of life in OPC survivors.
A total of 1811 patients with OPC with a minimum follow-up of 6 months have been consented to our prospective registry between 18 March 2015 and 29 December 2023. Clinical and treatment (Tx) data are available on all patients, including previously untreated patients (1443, 80%). Most previously untreated patients (97%) consented to longitudinal patient-reported outcomes and functional assessments for critical time points including pre-Tx, during-Tx and post-Tx at 3–6 months, 12 months, 18–24 months and annually up to 5 years.
The median age for the MDA-OPC cohort is 66 years (range, 25–96) with the majority being male (89%), white (92%) and with human papillomavirus (HPV)/p16-associated OPC (88%) primarily located in the tongue base or tonsil (90%). For previously untreated patients, 79% were diagnosed with stage I/II disease, and nearly half underwent curative intent chemoradiation. Overall survival was significantly higher for HPV/p16-associated OPC at 1 year (98% vs 93%) and 5 years (83% vs 54%; p
Future work includes expansion of the MDA-OPC cohort and survivorship surveillance to 10 years under the recently funded OPC-SURVIVOR research programme (P01CA285249), which aims to identify non-invasive, clinic-ready biomarkers and examine novel phenotypes and mechanistically matched mitigation strategies for latent OPC sequelae. Additionally, we aim to expand our advanced data infrastructure by integrating large data streams from parallel clinical trials and imaging registries.
by Frederick Nchang Cho, Marie Clarie Fien Ndim, Diane Zinkeng Tongwa, Christabel Afor Tatah, Franklin Ngwesse Ngome, Eugine Mbuh Nyanjoh, Andrew N Tassang
BackgroundHuman Immunodeficiency Virus (HIV) remains a major public health concern in sub-Saharan Africa. In Cameroon, young people are disproportionately affected but underrepresented in HIV testing statistics.
ObjectiveTo explore knowledge, attitudes, and behaviours related to HIV testing among youth in Kumba, Cameroon, and to identify barriers to inform community-based interventions.
MethodsA cross-sectional qualitative study was conducted using nine focus group discussions (FGDs) with 75 youth (52 females and 23 males) aged 18 - 35 years across four quarters in the Kumba II municipality. Participants were purposively sampled to reflect diverse educational and occupational backgrounds. Data were thematically analysed using Braun and Clarke’s framework with NVivo Version 14.
ResultsParticipants demonstrated high awareness of HIV testing services (90.7%) and transmission via sexual contact (96.0%), though knowledge gaps remained regarding non-sexual transmission and testing procedures. While 93.3% had previously undergone HIV testing, 57.3% reported stigma and 46.7% raised confidentiality concerns as ongoing barriers. Female participants feared being labelled as promiscuous, while males cited social norms that discourage help-seeking. Most participants supported school-based or youth-centred community testing, emphasising the need for privacy and youth-friendly environments. Key motivators for testing included the desire to know one’s status (82.7%), symptom appearance (28.0%), and unprotected sex (17.3%).
ConclusionsDespite strong awareness and high testing uptake, stigma and confidentiality concerns persist among youth in Kumba. To enhance HIV testing rates, community-based strategies should prioritise mobile clinics, peer outreach, and confidential youth-centred services. Strengthening education about HIV transmission and demystifying the testing process may further reduce barriers.
To examine the representation of nurses in Croatian graduate nursing programs and to explore its implications for academic equity, professional development, and nursing leadership.
Cross-sectional descriptive study using document analysis.
Data on lecturers and course leaders for the 2022/2023 academic year were retrieved from all graduate and specialist nursing programs in Croatia. A total of 694 lecturers and 545 course leaders were analysed by professional background.
Nurses accounted for 19% of lecturers in university graduate programs and 14% in specialist studies. As course leaders, they represented 11% in specialist studies and only 4% in university graduate programs. Thirty courses lacked assigned lecturers. The findings demonstrate a strong dominance of medicine and other professions in teaching roles.
Nurses remain markedly underrepresented in academic positions, which may limit their ability to shape curricula, influence educational standards and strengthen professional identity.
Improving the academic presence of nurses could be important for advancing leadership capacity, curriculum relevance and professional equity. Stronger representation may help enhance the profession's authority and indirectly benefit patient care.
What problem did the study address?: The study explored limited nurse representation in graduate nursing education and its implications for equity and autonomy. What were the main findings?: Nurses are a small minority in lecturer and course leader roles, with most positions occupied by non-nursing professionals. Where and on whom will the research have an impact?: The findings are relevant to educators, regulators and policymakers in Croatia and internationally, particularly in countries where nurses face barriers to academic participation. The study supports ongoing policy efforts to strenghten nurses' academic representation and leadership in higher education.
No patient or public contribution. This study relied exclusively on publicly available academic data and did not involve patients, service users or members of the public.
Barcode medication administration (BCMA) systems are increasingly being implemented in hospital settings, with the aim of decreasing medication administration errors. However, the majority of the literature demonstrating the value of BCMA in supporting patient safety is from the USA. Furthermore, little is known about the underlying mechanisms that support its use. This study aims to explore the impact of BCMA on patient safety including medication admisntration errors and nursing time spent providing direct patient care, in terms of what works, for whom, under what circumstances, and how.
We will use a mixed-methods realist evaluation. The study will be conducted in four phases, at two London NHS teaching trusts and one South West Region NHS Trust using different electronic health record systems. Phase 1 will involve documentary analysis and a narrative review to develop an initial programme theory for how BCMA is expected to work. Phase 2 will use interviews with key informants to refine this programme theory. The programme theory will then be tested in phase 3 using mixed methods: (1) observation of nurses’ medication administration; (2) analysis of alert data from the BCMA systems to understand the alerts’ clinical significance and utility and (3) interviews with nurses and hospital inpatients to explore their views. These data will be triangulated to refine and finalise the programme theory in phase 4, together with recommendations for practice.
The Study Coordination Centre has obtained approval (24/SC/0326) from the Oxford B NHS Research Ethics Committee and the Health Research Authority. The study’s findings will be presented at scientific meetings and published in peer-reviewed journals. Additionally, summaries of the findings will be produced, targeted at relevant groups such as healthcare professionals, policy-makers and study participants.
Lynch syndrome (LS) carriers have a 20–46% lifetime risk of colorectal cancer (CRC) due to mismatch repair gene variants. Mesalamine (5-ASA, 5-aminosalicylic acid), used safely in patients with ulcerative colitis, may reduce CRC risk in LS by decreasing microsatellite instability, a key driver of LS-related cancer. This study evaluates 5-ASA’s efficacy as a tolerable chemopreventive drug, aiming to improve long-term CRC prevention in LS.
This multicentre, multinational, randomised, double-blind, two-arm, phase II clinical study will compare the effects of a 2-year daily intake of 5-ASA (2000 mg) to placebo in LS carriers. The primary objective is to assess whether mesalamine reduces colorectal neoplasia, both benign and malignant, compared with placebo in LS carriers, as detected by colonoscopy at the end of the treatment period (24 months±1 month) and on study completion. Secondary objectives include evaluating whether 5-ASA reduces neoplasia/tumour multiplicity and progression compared with placebo at specified time points, examining variations in the effects of 5-ASA versus placebo based on cancer history, sex and age (
The trial is currently open for enrolment, having received ethical approval from the Regional Ethical Review Board in Stockholm and funding from the Swedish Research Council. The study protocol is the finalised V.10.0 (11 April 2024), transitioned to the European Clinical Trials Information System. LS remains underdiagnosed, which may limit recruitment. The results are of global interest and will be published in peer-reviewed journals and presented at scientific conferences.
ClinicalTrials.gov: NCT04920149. EudraCT: 2019-003011-55. EU CT: 2024-514765-19-01.
To systematically map evidence on the application of AI systems in nursing workforce management, with a targeted focus on the role of nurse leaders.
A scoping review.
A comprehensive literature search was conducted across six databases: CINAHL, IEEE Xplore, MEDLINE/PubMed, PsycINFO, Scopus, and Web of Science. Studies published in English between January 2015 and December 2024 were included.
Studies that focused on AI in the context of nursing leadership or workforce management were included, while those examining AI in healthcare but without a specific focus on nursing leadership/management were excluded.
A total of 1014 articles were retrieved, and 12 were included in this review. Eleven articles were published between 2022 and 2024. The findings show that AI systems in nursing management have been applied in several domains, including workforce planning, nursing safety, and staff prediction models. Although studies highlight the positive optimising potential of AI systems, others underscore the ethical implications of AI with respect to nursing leadership and management, particularly regarding discriminatory stereotypes in AI-generated nurse imagery and the critical role of nurse leaders in ethical AI integration in care. Only one study identified important barriers to AI integration, underlining the need for enhanced AI training for nurse managers.
Findings suggests that the application of AI systems in nursing leadership/management is in its early phases, with limited engagement of nurses in innovating and implementing AI-enabled systems. A substantial problem related to AI adoption remains—AI integration hinges on addressing the readiness and engagement levels of nurse leaders early on in the process of AI systems' innovation. To promote AI integration, AI competency, trust, and optimisation in healthcare, developing a basic working understanding of AI together with a culture of multidisciplinary AI development teams that include nurses are potentially proactive strategies.
This study adhered to the PRISMA-ScR guideline.
No patient or public contribution.
Hepatitis C virus (HCV) remains a leading cause of infectious disease-related morbidity in the USA, disproportionately affecting people who inject drugs and people who are incarcerated. Despite the availability of highly effective, highly tolerated direct-acting antivirals, treatment uptake in jails remains limited due to short stays, unpredictable release dates and system-level barriers. The original MINMON trial demonstrated that a low barrier ‘minimal monitoring"’ model can achieve high cure rates in community settings. This study, MINMON-J, aims to adapt and evaluate a modified version of the MINMON model for use in a jail setting, addressing the urgent need for scalable, low-barrier treatment approaches among justice-involved individuals.
MINMON-J is a single-arm, hybrid effectiveness-implementation pilot study protocol planned to recruit at the Rhode Island Department of Corrections. 40 people who are incarcerated with positive HCV RNA, who are treatment-naïve, without cirrhosis and awaiting trial, will receive 12 weeks of sofosbuvir/velpatasvir with no required lab monitoring during treatment. If released before treatment completion, participants will receive their remaining medication at discharge. Community health workers will provide post-release support. Mixed-methods evaluation will be guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance/Practical, Robust Implementation and Sustainability Model framework. Primary outcomes include feasibility, acceptability and adherence. Data will be collected through administrative records, surveys (Acceptability of Intervention Measure, Feasibility of Intervention Measure, Brief Adherence Rating Scale) and qualitative interviews with participants and other relevant parties. This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections Medical Research Advisory Group.
This study was reviewed and approved by the Brown University Health Institutional Review Board (2240400) and the Rhode Island Department of Corrections (RIDOC) Medical Research Advisory Group. All participants will provide written informed consent prior to enrolment. People who are incarcerated will be assured that participation is voluntary, will not impact their clinical care and that they may withdraw at any time without penalty. Study procedures follow ethical principles outlined in the Declaration of Helsinki and comply with federal regulations regarding research involving vulnerable populations.
Dissemination of findings will include peer-reviewed publications and presentations at national conferences focused on infectious diseases, implementation science and/or correctional health. Lay summaries will be shared with RIDOC leadership and community partners. De-identified data and associated metadata may be archived in a publicly accessible repository in accordance with National Institutes of Health data sharing policies, contingent on final institutional review board approval and participant protections.
The interaction between dementia and changes in health status accelerates the progression of dementia and health deterioration. Although health indicators exist for older adults, comprehensive ones for dementia are lacking.
To (1) establish core health indicators for older adults with dementia, (2) develop an integrated health assessment toolkit for older adults with dementia, and (3) test the feasibility and applicability of the integrated health assessment toolkit.
This study involved two phases. In the first phase, using the Delphi method, opinions from 10 experts were synthesized to establish core health indicators for older adults with dementia. In the second phase, with a descriptive research approach, an integrated health assessment toolkit was developed, evaluated by 10 daycare case managers for feasibility, and then pilot tested with 50 older adults with dementia across three daycare centers.
The core health indicators for older adults with dementia covered 18 indicators in five domains: (1) cognitive and behavioral impairment, (2) sensory and perceptual impairment, (3) disease and dysfunction, (4) functional fitness deterioration, and (5) social isolation. After two rounds of assessments, experts rated the criteria's importance and clarity at 0.94 and 0.89 on the scale-level content validity index/universal agreement (S-CVI/UA), respectively. In the second phase, the integrated health assessment toolkit was developed, which integrated five observational assessment scales and six physical function measures. The average applicability scores ranged from 7.80 to 9.90 out of 10. In the pilot test, the assessment process proceeded smoothly without any adverse events. However, 10 participants did not comply with wearing the actigraphy device.
The core health indicators and the corresponding health assessment toolkit are feasible to assess the health of older adults with dementia that could provide valuable insights and guide future interventions to enhance their well-being.
FreshRSS 