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Protocol for a systematic review and meta-analysis of pharmacological and non-pharmacological interventions for chronic pain management in chronic kidney disease

by Chi Peng Chan, Babaniji Omosule, Courtney Lightfoot, Ellesha A. Smith, Ffion Curtis, James O. Burton, Paul Gardner, Sarah Jasat, Sherna F. Adenwalla, Jyoti Baharani, Daniel S. March

Background

Chronic pain affects up to 60% of people with chronic kidney disease (CKD), yet remains under-recognised and under-treated. Pain management in this population is complicated by altered drug pharmacokinetics, polypharmacy, and the potential nephrotoxicity of conventional analgesics. Despite the high prevalence and significant impact on quality of life, evidence-based guidance specific to pain management in CKD remains limited.

Objectives

This systematic review aims to evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions in reducing chronic pain intensity among people with CKD on dialysis, not on dialysis, and kidney transplant recipients, across all stages of CKD.

Methods

The primary outcome is the effectiveness of interventions in reducing chronic pain intensity as assessed by pain assessment tools. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov from their inception to the present date to identify studies for chronic pain management in people living with CKD. Study screening will be conducted independently by two reviewers. One reviewer will extract data from each study, with a second reviewer cross-checking for accuracy and completeness. Data will be extracted on study characteristics, participant demographics, intervention components, pain outcomes, and adverse events. The certainty of evidence will be evaluated independently by two reviewers using the GRADE approach. Where applicable, data will be combined in meta-analyses using random-effects models. Additionally, a network meta-analysis will be performed if enough studies are available.

Expected results

This review will synthesise the current evidence for pain management strategies in CKD, by evaluating effectiveness of interventions among people receiving different renal replacement therapy modalities with varying pain and disease phenotypes. Findings will highlight the comparative effectiveness of various interventions while considering their safety profiles specific to the CKD context. The review will identify gaps in the literature and provide recommendations for clinical practice and future research.

Significance

This review seeks to deliver a thorough evaluation of pain management strategies for people living with CKD. This systematic review is supported by the UK Kidney Association (UKKA), and findings will inform the upcoming UKKA guideline on symptoms management in people with CKD, alongside the other symptoms including itch, fatigue, and gastrointestinal symptoms. This review will aid clinicians in making well-informed decisions regarding pain management strategies, ensuring a balance between effectiveness and the specific risks associated with CKD.

STRATUM-OS: first step in the development and validation of the STRATUM tool based on multimodal data processing to assist surgery in patients affected by intra-axial brain tumours - observational study protocol

Por: Fabelo · H. · Ramallo-Farina · Y. · Morera · J. · Pineiro · J. F. · Lagares · A. · Jimenez-Roldan · L. · Burström · G. · Garcia-Bello · M. A. · Garcia-Perez · L. · Falero · R. · Gonzalez · M. · Duque · S. · Rodriguez-Jimenez · C. · Hernandez · M. · Delgado-Sanchez · J. J. · Paredes
Introduction

Integrated digital diagnostics can support complex surgeries in many anatomic sites, and brain tumour surgery represents one of the most complex cases. Neurosurgeons face several challenges during brain tumour surgeries, such as differentiating critical tissue from brain tumour margins. To overcome these challenges, the STRATUM project will develop a 3D decision support tool for brain surgery guidance and diagnostics based on multimodal data processing, including hyperspectral imaging, integrated as a point-of-care computing tool in neurosurgical workflows. This paper reports the protocol for the development and technical validation of the STRATUM tool.

Methods and analysis

This international multicentre, prospective, open, observational cohort study, STRATUM-OS (study: 28 months, pre-recruitment: 2 months, recruitment: 20 months, follow-up: 6 months), with no control group, will collect data from 320 patients undergoing standard neurosurgical procedures to: (1) develop and technically validate the STRATUM tool and (2) collect the outcome measures for comparing the standard procedure versus the standard procedure plus the use of the STRATUM tool during surgery in a subsequent historically controlled non-randomised clinical trial.

Ethics and dissemination

The protocol was approved by the participant ethics committees. Results will be disseminated in scientific conferences and peer-reviewed journals.

Trial registration number

NCT07036783.

A Qualitative Study Exploring Nursing Scope of Practice for the Care of People Experiencing Homelessness

ABSTRACT

Aim

To explore the key knowledge, skills, attributes and organisational support that nurses require to optimise their scope of practice when providing care to people experiencing homelessness.

Design

A qualitative descriptive study exploring nurses' scope of practice for addressing health needs of people experiencing homelessness.

Methods

Interviews and focus groups were conducted from 2022 to 2024 with 42 people with lived experience of homelessness across two Australian cities. Thematic analysis identified essential skills, attributes and approaches to improve access to care and eliminate stigma. Findings were then presented in focus groups with 11 registered nurses in specialist homeless health services to elicit views on optimising scope of practice. The study follows COREQ reporting guidelines for qualitative research.

Results

Lived-experience participants—ranging from 18 to 84 years, a third living in cars or tents—identified key nursing attributes and practices, including approachability, compassion, non-judgement, flexibility, community embeddedness, trauma-informed and culturally safe practice, plus skills in physical and mental health assessment, medication management and service navigation. Nurse participants agreed with lived-experience participants, and highlighted organisational support needs, including information sharing, clinical supervision, assertive outreach, nurse prescribing and long-term funding for nurse-led programs.

Conclusion

With rising housing instability, preparing nurses to optimise access to care for people experiencing homelessness is critical. Optimal scope of practice includes personal attributes to build rapport and reduce stigma alongside clinical skills. Co-developing educational programs in partnership with people with lived experience of homelessness and homeless health nurses offers a promising approach.

Impact

This research informs the scope of practice definitions and the future development of a co-developed nursing education pathway and organisational framework to improve access to care for people experiencing homelessness in Australia.

Patient or Public Contribution

Limited patient and public involvement was incorporated and focused on providing feedback on interview guides.

Determining the burden of falls amongst community-dwelling older people in Ireland to inform falls care delivery: secondary data analysis from the Irish longitudinal study on ageing - the defined study

Por: Briggs · R. · Ward · M. · Scarlett · S. · van der Velde · N. · Hernandez · B. · Romero-Ortuno · R. · Tysinger · B. · May · P. · Ahern · E. · Kenny · R. A.
Objective

Falls represent the most frequent reason older people are admitted to hospital and significantly increase the likelihood of functional decline, healthcare utilisation and early mortality. The aim of this study is to comprehensively delineate the burden of falls amongst community-dwelling older people in Ireland.

Design

Population-representative analysis of Wave 6 of the Irish Longitudinal Study on Ageing (TILDA) estimating incidence of falls requiring medical attention and emergency department (ED) attendance, fractures and fear of falling over 12 months. Additional data detailing falls-risk increasing drugs (FRIDs) and prior falls were also analysed.

Using Central Statistics Office Census 2022, the population of older people in Ireland was multiplied by the proportion of TILDA participants with each outcome of interest to yield population-level estimates.

Participants/Setting

Population-representative sample of 2299 (55% female) community-dwelling people in Ireland aged ≥70 years.

Results

Almost 12% (proportion 0.12 (95% CI 0.10 to 0.13)) of participants, corresponding to almost 62 000 older people in Ireland, reported a fall requiring medical attention in 12 months, with 6% (proportion 0.06 (95% CI 0.05 to 0.07)), or over 32 000 people, attending ED due to a fall. Over 3% (proportion 0.03 (95% CI 0.03 to 0.04)) reported sustaining a fracture. Almost half of participants reporting a fall requiring medical attention were prescribed FRIDs, and over half had also reported a fall when assessed at the prior wave of the study (ie, 2 years ago).

Conclusions

The burden of falls amongst community-dwelling older people is considerable; 1 in 8 required medical attention for a fall and 1 in 16 attended the ED with falls over 12 months.

Currently, there is no national falls strategy in Ireland. These findings, alongside our ageing population, underscore the need for strengthened falls-prevention strategies to reduce avoidable morbidity and healthcare utilisation.

Prevention of secondary infections by interferon-gamma in ICU-acquired sustained immune suppression in France: study protocol of the PLATINIUM randomised trial

Por: Hernandez Padilla · A. C. · Daix · T. · Hotchkiss · R. S. · Monneret · G. · Tadie · J. M. · Jeannet · R. · Plateker · O. · Vaidie · J. · Durand-Zaleski · I. · Magne · J. · Giraudeau · B. · Francois · B.
Introduction

Some intensive care unit (ICU) patients develop an extremely deep and sustained immunosuppression that increases the risk of secondary infections and can ultimately compromise survival. Thanks to an easily accessible and simplified immune monitoring to identify immunological failure, a personalised immune restoration approach is now feasible. Among the different therapeutic strategies in this field, interferon gamma (IFN-) is probably the most interesting drug to reduce the burden of secondary infections in the ICU.

Methods and analysis

This is a two parallel group multicentre blinded add-on randomised trial comparing immunorestoration by subcutaneous injection of IFN- to standard of care in targeted ICU patients. The study will be performed in 23 ICUs in France. Patients hospitalised in the ICU for a week, with multiple organ failure defined by a sequential organ failure assessment score ≥6 during this first week, will be enrolled. If within 96 hours after inclusion, these patients express immunosuppressed features defined by a low absolute lymphocyte count (x109/L) and low expression of human leucocyte antigen-DR (HLA-DR) on monocytes (13 500 antibodies bound per cell and an absolute lymphocyte count >1200 x109/L) at day 10, healthcare costs at day 90 and rate of serious adverse reactions and suspected unexpected serious adverse reaction at day 90. We plan to randomise 326 patients.

Ethics and dissemination

The study will be implemented in accordance with European regulations and was independently reviewed and approved by the French Ethics Committee Comité de Protection des Personnes Ile de France III (EUCT number: 2024-516780-93-00). The results will be reported in international peer-reviewed journals and presented at international and national conferences.

Trial registration number

NCT06774235.

Modelo de cuidado holístico de la gestación de las mujeres indígenas del pueblo de Los Pastos

El presente estudio fundamenta la construcción de un modelo de cuidado holístico e intercultural de las mujeres indígenas del Pueblo de los Pasto en el ciclo del embarazo, parto y puerperio; consta de cuatro elementos claves, la relación-tensión entre el conocimiento en salud y saber indígena, los actores que diversifican las formas de cuidado institucional y cultural, los escenarios de cuidado más allá de las instituciones de salud con implicación del saber étnico, la reivindicación de las percepciones, vivencias y experiencias de las mujeres y de las parteras reclamando un cuidado integral bajo la sinergia entre el saber científico y el étnico. La fundamentación fue resultado de un proceso hermenéutico en cuádruple vía- encuentro con ideas fuerza resultado de la revisión bibliográfica, priorización de marcos normativos exigentes de una atención humanizada y diferencial, el diálogo con mujeres gestantes y el reconocimiento invaluable de las parteras del pueblo de los Pastos. En ese sentido, la investigación se guio por el análisis e interpretación en doble vía, primero, interpretación bibliográfica de textos científicos, académicos y marcos normativos afines al estudio, y segundo, relatos y argumentos culturales obtenidos a través de entrevista, grupos focales y diálogos de saberes con mujeres y parteras.

Reseña del Capítulo 2: “Análisis del Modelo de Promoción de la Salud de Nola Pender”

Resumen

 Gerardo Pérez Hernández escribe una reseña sobre el capítulo 2 del libro de Beltrán Báez y Colaboradores “Análisis de modelos conceptuales de enfermería.”, de la editorial UTP Editorial Indizada con la fecha de publicación del 2025.

Palabras clave: Promoción de la salud; Metaparadigmas; Enfermería

Care Needs of Community‐Dwelling Older Adults Living in Poverty and Their Relationship With Other Biopsychosocial Variables: A Cross‐Sectional Study

ABSTRACT

Aim

To assess the care needs of older adults living in poverty in a high-income country and to analyse their relationship with other outcome variables.

Design

A cross-sectional study.

Method

Data were collected between September 2022 and February 2024 from 384 older adults in southeastern Spain. Descriptive statistics were calculated to assess older adults' care needs. A multiple linear regression analysis was carried out to determine the percentage by which the socio-demographic or outcome variables could explain the number of met care needs among older adults in poverty.

Results

Around 20% of the care needs amongst older adults living in poverty were unmet. The most frequently unmet care need was related to money (53.6%). Almost 30% of participants were at risk of malnutrition, 18% felt lonely, and 80% perceived a low level of social support. Age, history of falls, emergency room visits, functionality, perceived social support, quality of life and nutritional status significantly predicted the number of needs met.

Conclusion

The health conditions of older adults living in poverty are suboptimal and may negatively influence their care needs. Nurses should consider these factors when designing, implementing and evaluating interventions to promote the biopsychosocial health of this population.

Implications for the Profession and/or Patient Care

Nursing interventions to promote health amongst older adults living in poverty should focus on identifying unmet care needs, particularly those related to financial and social support. Interventions should prioritise improving nutritional status, enhancing social support networks and addressing loneliness.

Impact

Living in poverty increases older adults' vulnerability due to unmet financial, nutritional and social support needs. These unmet needs can negatively affect older adults' physical and mental health.

Reporting Method

The study has been reported following the STROBE guidelines.

Patient or Public Contribution

The study's participants only participated in the data collection process.

Household factors influencing cockroach infestations and helminth parasites: Insights from a rural community in Guatemala

by Wendy C. Hernández-Mazariegos, Felipe I. Torres, Manuel Rodríguez, Christian M. Ibáñez, Luis E. Escobar, Federico J. Villatoro

Cockroaches are vectors of pathogens and parasites that pose public health risks, especially in developing countries with poor hygiene and inadequate infrastructure. This study aimed to identify the household factors associated with the occurrence of cockroaches and the helminth parasites they carry in a rural community. Data on household infrastructure, presence of domestic animals, and insect control methods were collected from 70 households in rural Guatemala. Cockroaches were captured using traps and manually. A Generalized Linear Mixed Model revealed that households with concrete roofs had 94% lower abundance of cockroaches than those with metal sheet roofs, while the presence of cats increased cockroach abundance by 2.6 times (p Moniliformis moniliformis, were identified, marking the first report of such parasites in household cockroaches in Guatemala. These results highlight the need for improved housing infrastructure and integrated pest management strategies to mitigate the risks associated with cockroach-borne parasites in vulnerable communities.

Keratorefractive lenticule extraction (KLEx) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the treatment of myopia and compound myopic astigmatism: study protocol of a randomised clinical trial in Mexico

Introduction

Kerato-lenticule extraction (KLEx) is a refractive surgery technique that, in contrast with femtosecond laser-assisted in situ keratomileusis (FS-LASIK), does not require the creation of a flap to correct refractive defects. The potential advantages of this technique are related to the absence of a flap and its complications. On the other hand, FS-LASIK is the most widely practised refractive surgery worldwide, as it offers excellent visual outcomes and is currently the gold standard of refractive surgery. The objective of this study is to compare the effectiveness and safety of KLEx versus FS-LASIK as a treatment option in patients with myopia or myopic astigmatism.

Methods and analysis

This double-masked, parallel-group, single-centre randomised clinical trial will enrol 80 eyes from adults with myopia or compound myopic astigmatism within the ranges sphere –0.50 to –12.00 D and cylinder –0.50 to –6.00 D, recruited at the Instituto de Oftalmología Conde de Valenciana, Mexico City, Mexico. Participants will be allocated to KLEx or FS-LASIK and assessed at baseline and 1 day, 1 week, 1, 3, 6 and 12 months postoperatively. The primary outcome is uncorrected visual acuity at all postoperative visits. Secondary outcomes include postoperative spherical equivalent, best-corrected visual acuity (BCVA), loss of ≥2 BCVA lines, the proportion of eyes within ±0.50 D of the refractive target, corneal aberrations over a 5 mm pupil, epithelial changes and adverse events. Participants and outcome assessors will be masked to the assigned surgical technique.

Ethics and dissemination

Participant confidentiality will be maintained with the publication of results. This study was approved by the research and ethics committee of the Instituto de Oftalmología Fundación de Asistencia Privada Conde Valenciana (CI-017-2024). The study results will be disseminated in scientific articles published in peer-reviewed journals and presented through research posters at national and international conferences.

Trial registration number

ClinicalTrials.gov registry (NCT06477081).

Development and validation of a case identification algorithm for hand trauma patients using health administrative data and the epidemiology of hand trauma in a universal healthcare system

Por: Wong · C. R. · Tu · K. · Hernandez · A. · Urbach · D. R. · Witiw · C. · Hansen · B. · Ko · A. · Tsai · P. · Baltzer · H.
Objectives

Our primary objectives were (1) to develop and validate an administrative data algorithm for the identification of hand trauma cases using clinical diagnoses documented in medical records as the reference standard and (2) to estimate the incidence of hand trauma in a universal public healthcare system from 1993 to 2023 using a population-based research cohort constructed using a validated case identification algorithm.

Design

A population-based retrospective validation study.

Setting

Ontario, Canada, from 2022 to 2023 (validation) and from 1993 to 2023 (estimation).

Participants

Our reference standard was the known hand trauma status of 301 patients (N=147 with hand trauma) who presented to an urban tertiary-care hand trauma centre in Toronto, Ontario.

Primary and secondary outcome measures

(1) The sensitivity, specificity, positive and negative predictive values of the optimal algorithm to identify hand trauma using provincial health administrative data and (2) age-standardised and sex-standardised incidence rates of hand trauma among men and women, by age, and by area of patient residence.

Results

The optimal algorithm had a sensitivity of 73.8% (95% CI 66.6% to 81.0%), specificity of 80.1% (95% CI 73.8% to 86.5%), positive predictive value of 78.1% (95% CI 71.2% to 85.0%) and negative predictive value of 76.1% (95% CI 69.5% to 82.7%). Over the study period, the age-standardised and sex-standardised incidence of hand trauma increased from 384 to 530 per 100 000. The greatest increase was observed in males and individuals aged 0–19 and 80+, with higher incidence rates in Southern compared with Northern Ontario.

Conclusions

Our algorithm enabled identification of hand trauma cases using health administrative data suitable for population-level surveillance and health services research, revealing a rising burden of hand trauma from 1993 to 2023. These findings can support improved surveillance, resource allocation and care delivery for this public health problem.

Barriers and facilitators to performing benign paroxysmal positional vertigo manoeuvres among primary care physicians in Barcelona: a qualitative study

Objective

To explore the barriers and facilitators in adherence to the guidelines in the management of benign paroxysmal positional vertigo from the perspective of primary care physicians.

Design

Qualitative study using focus groups.

Setting

L’Hospitalet del Llobregat (Barcelona), Spain.

Study design

Qualitative study using focus groups. Structured 90 min focus groups were conducted until data saturation was reached. Each session included a moderator and an observer from the research team. Sessions were transcribed and thematically analysed by three independent researchers.

Participants

Purposeful sampling was used to form four groups of 4–10 participants, selected by sex, age, years of experience and primary care team (PCT). Participants were recruited between January and February 2023.

Results

A total of 34 family physicians belonging to four PCTs participated in the study. The main barriers identified were a lack of time, negative initial experiences, a fear of harming patients (especially older adults), difficulty in nystagmus visualisation and challenges in managing patient expectations, as many preferred medication over physical manoeuvres. Facilitators included potential time savings from effective early management, the value of initial practical training with periodic refreshers, access to expert consultants for case discussions and the availability of digital tools, such as tutorials, videos and aids for nystagmus interpretation.

Conclusion

Health systems should invest in protected time for history-taking and physical examination, and in regular, updated training for primary care professionals. This could improve vertigo management and reduce unnecessary investigations and medications, ultimately benefiting both patients and the healthcare system.

Understanding smartphone use patterns in higher education: A latent class approach to behavioral and health risk typologies

by Ramón Ventura Roque Hernández, Rolando Salazar Hernandez, Adán López Mendoza

Introduction

The widespread use of smartphones among university students has raised concern because of their potential effects and the need to detect profiles of problematic use. This study aimed to identify, characterize and differentiate different profiles of smartphone users in a sample of university students on the basis of variables such as use, nomophobia, risk and sociodemographic characteristics.

Methods

A total of 681 university students participated. A total of 681 university students participated in this study. The sample was recruited using a non-probabilistic, convenience sampling method. Latent class analysis -LCA- was performed to identify profiles from variables that included smartphone use patterns such as daily hours, messaging, social networks, browsing, history of technology adoption, situational use, NMPQ nomophobia questionnaire -a scale designed to assess the fear of being without a smartphone-, and reported consequences such as accidents, visual or musculoskeletal problems. The resulting classes were compared in subsequent analyses using chi-square tests for categorical variables and Mann‒Whitney U tests for ordinal variables.

Results

LCA revealed two clearly differentiated user profiles. Class 1 (n = 348) grouped users with moderate use and less exposure to risks and was characterized by shorter daily use of smartphones (mean = 5.46 hours), significantly lower scores on the total scale of nomophobia (mean NMPQ = 65.4 out of 140 possible points, moderate level), a lower frequency of accidents reported due to mobile use and lower reports of visual and musculoskeletal health problems. Class 2 (n = 333) grouped users with high digital involvement and multiple vulnerabilities and showed a significantly more intensive use pattern (mean = 11.01 hours per day), higher levels of nomophobia (mean NMPQ = 74.3 out of 140 possible points, moderate level), and a higher frequency of accidents and major visual and musculoskeletal health problems.

Conclusion

While both groups of undergraduate students could benefit from awareness and training programs, interventions could be differentiated and designed to mitigate the risks associated with problematic smartphone use. These findings provide evidence for higher education institutions and health professionals in the development of programs aimed at promoting digital well-being among university students.

Comparing emergency department reattendance and health and social-related vulnerability between people experiencing homelessness and people living in stable housing in Australia: a prospective cohort study

Por: Currie · J. · Vasquez-Hernandez · A. · Jones · L.
Objectives

Few studies have quantified the vulnerability of people experiencing homelessness and its association with emergency department (ED) reattendances. The study objectives were to identify the health and social-related vulnerability, comorbidities and reattendance to an ED within 28 days, of people experiencing homelessness and people living in stable housing.

Design

Prospective cohort study, 28 September 2023 to 12 October 2023.

Setting

Metropolitan ED in an inner-city public hospital.

Participants

Eligible participants were those who attended the ED between 8am and 5pm during the 2 week study period (2023), those aged 18 years and over and able to provide informed consent, and those deemed well enough to participate.

Intervention

The homeless health access to care tool (HHACT) assesses a person’s unmet needs and quantifies their level of health and social-related vulnerability (low, moderate, high). The HHACT was applied to each participant. Routinely collected administrative data was used to identify participant demographics and ED usage on the day of study enrolment and any ED reattendance within 28 days.

Main outcomes and measures

Outcome measures were the identification of participants’ level of health and social-related vulnerability and its relationship to ED reattendance.

Results

Of the 300 ED participants, 38 (12.6%) were experiencing homelessness. There was a greater than twofold increase in odds of 28-day ED reattendance for participants experiencing homelessness (OR=2.93, CI 1.29 to 6.36; p=0.008) or had moderate to high vulnerability scores (participants living in stable housing and participants homeless) (OR=2.67, CI 1.29 to 5.36; p=0.007). Compared with participants in stable housing, prevalence of comorbidities among participants experiencing homelessness was greater regarding mental health challenges (65.8% vs 21.8%); three or more physical health conditions (36.8% vs 13%) and greater alcohol and other drug use (36.8% vs 17.2%).

Conclusion and relevance

The high ED reattendance suggests that people experiencing homelessness are not being adequately screened for unmet needs on their first presentation. Comprehensive screening using the HHACT may enhance the identification of the risk of reattendance and provide opportunities to intervene through targeted responses, such as integrated care pathways. While EDs are not designed to address the multifaceted needs of people experiencing homelessness, there is an urgent need to consider how to optimise this population’s access to appropriate care.

Genitourinary syndrome of menopause induced by breast cancer treatments: a randomised clinical trial protocol comparing multimodal pelvic floor physiotherapy and fractional CO2 laser therapy (PILME study)

Introduction

Genitourinary syndrome of menopause (GSM) is a prevalent condition among breast cancer survivors, often exacerbated by oncological treatments. Hormonal therapies are typically contraindicated in this population, necessitating effective non-hormonal interventions.

Methods and analysis

This randomised controlled trial aims to compare the effectiveness and cost-effectiveness of multimodal pelvic floor physiotherapy—comprising pelvic floor muscle training, non-ablative radiofrequency, therapeutic pelvic health education and the use of vaginal moisturisers—versus fractional CO2 laser therapy combined with vaginal moisturisers in alleviating GSM symptoms in breast cancer survivors. Participants will be randomly assigned to one of the two intervention groups. Primary outcomes include measures of sexual function (assessed by the Female Sexual Function Index), subjective pelvic perineal pain intensity (measured with a 100 mm Visual Analogue Scale) and health-related quality of life (assessed by the Functional Assessment of Cancer Therapy-Breast), assessed at baseline, post-intervention and at 3, 6 and 12 months of follow-up. Statistical analyses will be conducted to evaluate the clinical efficacy and cost-effectiveness of the interventions.

Ethics and dissemination

The study protocol has been approved by the Ethics and Health Research Committee of the University of Alcalá (Reference: CEIP/2024/1/012). All participants will provide informed consent prior to inclusion in the study. Findings will be disseminated through peer-reviewed journals and conference presentations, and by engaging with patient associations and survivor groups through tailored materials.

Trial registration number

NCT06721936.

A Comprehensive Assessment of the Environmental Impact of Different Infant Feeding Types: The Observational Study GREEN MOTHER

ABSTRACT

Aim(s)

To observe and compare the environmental impacts of different types of infant feeding, considering the use of formula, infant feeding accessories, potentially increased maternal dietary intake during breastfeeding (BF) and food consumption habits.

Design

An observational cross-sectional multicentre study conducted in the Barcelona Metropolitan Area of the Catalan Institute of Health.

Methods

Data were collected from 419 postpartum women on infant feeding type (formula milk and accessories), maternal dietary intake (24-h register) and food consumption habits from November 2022 to April 2023. The environmental impacts (climate change (CC), water consumption and water scarcity) of the infant feeding types and maternal diet were calculated using the IPCC, ReCiPE and AWARE indicators, respectively. The differences in impacts were calculated by Kruskal–Wallis test.

Results

Significant differences for the three environmental impacts were observed. The CC impact of formula milk and feeding accessories was 0.01 kg CO2eq for exclusive BF, 1.55 kg CO2eq for mixed feeding and 4.98 kg CO2eq for formula feeding. While BF mothers consumed an extra 238 kcal, no significant differences were found related to maternal diet across feeding types.

Conclusion

Exclusive BF was the most sustainable type of infant feeding, considering formula and infant feeding accessories. In our study, the difference between the impacts of BF and non-BF mothers' diet was insignificant.

Implications for the Profession and/or Patient Care

Offer informative and educational support for midwives and other healthcare professionals on BF and a healthy, sustainable diet to transfer this knowledge to the general public.

Impact

Raise the general public's awareness about BF and a healthy, sustainable diet. To reduce environmental impacts through behavioural changes.

Reporting Method

STROBE.

Patient or Public Contribution

Patients of the Catalan Health Service reviewed the content of the data collection tools.

Trial Registration: (for the whole GREEN MOTHER project): NCT05729581 (https://clinicaltrials.gov)

Understanding the Second Year of the COVID‐19 Pandemic From a Nursing Perspective: A Multi‐Country Descriptive Study

ABSTRACT

Aim(s)

To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic.

Design

An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software.

Methods

Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile.

Results

Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures.

Conclusion

Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development).

Implications for the Profession and/or Patient Care

There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations.

Impact

This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies.

Reporting Method

We have adhered to the SRQR reporting guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Nursing students’ experience and training in healthcare aid during the COVID‐19 pandemic in Spain

Background

During the COVID-19 pandemic health crisis, in some countries such as Spain, nursing students have offered to provide health assistance, but the role they have played, their degree of preparedness to face the situation, and what must be improved in their training to be ready for these situations is unknown.

Objective

Describe the experience and perceptions of students of the Nursing university degree during their participation as health support in the COVID-19 health crisis in Spain.

Design

We conducted a cross-sectional survey study.

Method

503 students enrolled in the 4th course of the Nursing degree in Spain during the months of March and April 2020. An online questionnaire was developed, based on a pilot study and distributed through the Nursing Association, students’ unions and students’ associations. Variables were used to describe their participation, degree of preparedness and training needs to determine how to improve training through descriptive statistics, as well as nonparametric tests to analyse the relationship between training and degree of preparedness nursing students. Results are reported according to the STROBE Statement.

Results

73.2% (368) of students offered to participate in healthcare aid, of which 225 were actively involved. 27.8% carried out nursing tasks without supervision, and 47.7% assisted COVID-19 patients as any other nurse. Only 3.4% felt very prepared to work in the field of intensive care, finding that those students who perceived a higher degree of preparedness had received previous training in personal protective equipment and mechanical ventilation (p < 0.005). The highest scores for training activities that may improve their preparedness were simulations to improve levels of anxiety and stress when managing critical patients, simulation in ventilatory support and mandatory practices in services where ventilators are used.

Conclusions

Although three out of four students were willing to provide health assistance, they recognise that they were not specially prepared in the field of intensive care and demand training with simulation to improve anxiety and stress levels in the management of critical patients and simulation in ventilatory support.

Relevance to clinical practice

Students have been vital resources for our health system and society when they have been needed. It is now up to us, both teachers and health authorities, to share their efforts by implementing the necessary improvements in training and safety measures not only because these affects the health and safety of the patient, but because they will be essential parts in future pandemics.

Enhancing Breast Cancer Survivorship Care: The Role of Nurses in Post‐Treatment Follow‐Up—A Scoping Review

ABSTRACT

Aim

To examine the role of nurses in providing post-treatment follow-up care to breast cancer survivors, and to assess the impact of this care on survivors' satisfaction.

Methods

Scoping review.

Data Sources

An electronic literature search from PubMed and CINAHL databases was conducted, covering the period from 2013 to November 2023.

Results

Twenty-seven articles were included in this review, highlighting key areas in which nurses play essential roles in the provision of post-treatment care for breast cancer survivors. The identified nursing roles include the surveillance and early detection of relapses, the assessment and support of self-management for late physical and psychosocial effects of cancer, health promotion and care coordination. Regarding satisfaction, survivors reported high overall satisfaction with nursing care. However, satisfaction levels varied with regard to specific needs, particularly in managing the fear of recurrence.

Conclusions

Nurses play a fundamental role in delivering post-treatment care to breast cancer survivors. However, evidence regarding their specific contributions and survivors' satisfaction with long-term care remains limited, underscoring the need for further research to enhance care during the long-term survivorship phase.

Implications for the Profession

Consolidating the diverse roles of nurses in post-treatment care into a unified framework could support comprehensive and personalised care, addressing unmet needs. Evaluating patient satisfaction with nursing follow-up helps identify effective interventions and areas for improvement in future research.

Impact

This review analyses the diverse roles of nurses in the follow-up care of breast cancer survivors and highlights the impact of nursing care on patient satisfaction.

Reporting Method

This study adhered to the PRISMA-ScR reporting guidelines.

Patient or Public Contribution

No patient or public contribution.

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