Conectar
by Sean Hartmann, Andrew Sharp, Heather Johnston, Michael S. Gee, Susie Y. Huang, Mukesh G. Harisinghani, Jens Gühring, Wei-Ching Lo, Vibhas Deshpande, Oleg S. Pianykh
PurposeHigh complexity of modern processes renders manual process optimization impossible. The main goal of our work was to formalize and to demonstrate the practical efficiency of explainable rule-learning AI in complex process optimization.
Materials and methodsProcess optimization methodology was based on globally-optimal Boolean rule-learning AI models, capable of identifying multiple inefficiency patterns, and supporting process-oriented optimization metrics. To illustrate this approach in real-word environment, the study used 3994 liver and prostate Magnetic Resonance Imaging (MRI) exams performed on five 3T scanners at three outpatient facilities from January 2019 to January 2024. Imaging exams longer than 25 minutes were labeled as requiring optimization, which applied to 35.4% of liver and 52.6% of prostate cases. Rule-learning AI was applied to the MRI scanner log data to discover short and interpretable process optimization rules. The selected Boolean rules were used to implement improved exam protocols, and a permutation test was used to measure the statistical significance of the resulting change in average exam duration.
ResultsN=1000 top rules, identifying the most significant processing delay patterns, were discovered by rule-learning AI from the scanner log data based on F1 score. A smaller set of 20 top rules was selected using the secondary operational impact metric, an estimate of each rule’s impact on average scan duration. A change in liver MRI protocols based on findings from the top rule resulted in a 10.9% reduction of median scan time. The proportion of long liver exams was reduced from 35.4% to 23.9% (p < 0.001). Similar optimizations in prostate protocols were used to add a new scanning sequence, improving exam quality.
ConclusionsGlobally optimal, multi-model rule-learning AI can transform feature-rich device logs into concise, interpretable, and operationally meaningful rules. When combined with domain expertise, this approach can support measurable and sustainable improvements in complex clinical workflows.
Hyperbaric oxygen therapy (HBOT) is an established adjunctive treatment for selected diabetic foot ulcers, although evidence regarding its effectiveness remains heterogeneous. We conducted a retrospective, single-center, observational study of adult diabetic patients receiving HBOT (2.5 ATA, 100% oxygen) for a lower-limb wound at the only hyperbaric center in Guadeloupe, a French Caribbean territory, between January 2020 and June 2023. Among 257 patients treated with HBOT, 71 diabetic patients met inclusion criteria (mean age 63.1 ± 12.7 years; 69% male). Peripheral arterial disease and osteitis were highly prevalent, while the proportion of current smokers (7.9%) was notably lower than in previously published HBOT cohorts, a distinctive feature of this population. HBOT was considered a last resort, after failure of prolonged conventional therapy, in 63% of patients, likely contributing to the modest six-month healing rate of 34% (18/53 evaluable patients) and 19% rate of major amputation occurring during or after HBOT. Patients referred through the multidisciplinary Diabetic Foot Care Unit had fewer major amputations despite older age and greater vascular burden, though this comparison may reflect referral-related selection bias. No candidate factor, including glycemic control, referral pathway, or delay to HBOT, reached statistical significance in univariable analysis. This descriptive, single-arm finding cannot establish HBOT efficacy but is consistent with a role for HBOT within coordinated multidisciplinary diabetic foot care, highlighting the importance of earlier referral and optimised patient selection.
Colorectal cancer patients with peritoneal metastases have a very poor prognosis. A minority of these patients is eligible for curative cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The peritoneal cancer index (PCI) is an important criterion to select patients for CRS-HIPEC. Due to challenges in peritoneal metastasis detection by imaging, the PCI is currently routinely assessed by invasive diagnostic laparoscopy in addition to CT and/or MRI. Yet, open-close procedures and early disease recurrence following CRS-HIPEC are common, indicating the need for better patient selection tools. Fibroblast activation protein (FAP)-targeted imaging has recently emerged as a promising strategy for visualising peritoneal disease. The aim of this study is to assess the potential value of FAP inhibitor positron emission tomography/CT (FAPI-PET/CT) as an alternative non-invasive tool for quantitative PCI assessment.
TROMPET is a prospective observational proof-of-concept study. A total of 25 colorectal cancer patients with suspected or verified peritoneal metastases who are eligible for CRS-HIPEC based on MRI will be included in this study. Patients younger than 18, pregnant and/or breastfeeding, with any contraindication(s) for MRI, PET, CT and/or CRS-HIPEC, and/or with a known additional malignancy within the past five years are excluded. Participants will receive [18F]AlF-FAPI-74 PET/CT prior to surgery. The primary objective is to determine the correlation between PCI scores determined by FAPI-PET/CT and ‘true’ PCI scores determined by histopathological analysis of all resected lesions. The secondary objectives include the correlations between PCI scores determined by FAPI-PET/CT, by MRI and during surgery, the potential of FAPI-PET/CT to detect extraperitoneal metastases, and molecular and immunohistochemical analysis of resected tissue to provide insight into the nature of FAPI-PET-positive lesions. The primary endpoint is all PCI scores determined by FAPI-PET and histopathology and their correlation on patient level. If this study shows that the PCI score can be accurately determined preoperatively by FAPI-PET/CT, it will form the basis for further developing FAPI-PET/CT as a quantitative, standardised, non-invasive diagnostic tool for selecting patients for CRS-HIPEC. Moreover, the ‘radiology-pathology’ setup of the study will allow us to characterise FAPI-PET-positive and PET-negative lesions in detail, providing further insight into the strengths and potential pitfalls of FAPI-PET/CT in the detection of peritoneal metastases from colorectal cancer.
This study is approved by the assigned Medical-Research-Ethics-Committee (METC NedMec) on 19-08-2024. All participants will provide written informed consent. Study results will be disseminated through (inter)national meetings and peer-reviewed publications.
2024-512301-16-01
Skeletal fractures are a leading cause of death and disability and a growing global public health concern. Internal fixation is a common surgical treatment indicated for several fractures, yet there are few comprehensive epidemiological studies describing mortality following the procedure.
Data were extracted from an England-wide administrative database (Hospital Episode Statistics, HES) and linked to mortality records from the Office for National Statistics (ONS). All records from patients aged 18 years or older who were admitted due to a non-polytrauma single fracture and underwent internal fixation between 2013 and 2023 were included. Crude and adjusted mortality rates were calculated as well as the restricted mean time lost.
A total of 630 758 admissions were included in the primary analysis. Of these, 55% were female, and the mean±SD age was 59±23 years. Primary open reduction internal fixation was the most common procedure (54% of cases), followed by closed reduction internal fixation (35%). Overall, mortality rates following internal fixation were 2% within 30 days, 5% within 90 days and 10% within 365 days. Mortality rates were described by fracture region and reduction procedure. Variation in mortality rates across fracture regions and procedures was attenuated in the case-mix-adjusted estimates.
This study described national crude and adjusted mortality rates following internal fixation for the treatment of skeletal fractures. These findings provide population-level descriptive benchmarks for clinical and epidemiological interpretation and may inform decision-making by clinicians and patients as well as the design of randomised controlled trials and other research studies.
The North West London Diabetes Cohort is established to provide systematic characterisation of a large diabetes population as a foundation for complications research and prognostic modelling. Many predictive modelling studies neglect the essential descriptive characterisation of underlying cohorts, focusing narrowly on model accuracy. This cohort profile addresses this gap by comprehensively describing the demographic composition, clinical characteristics and complication incidence patterns. The notably diverse, multiethnic population enables examination of ethnic disparities and supports future development of reliable prognostic models and evidence-based prevention strategies for diabetes complications.
At baseline, 337 271 patients with diabetes were identified. It includes 279 067 patients with type 2 diabetes, 17 638 with type 1 diabetes, 33 590 with gestational diabetes and 6916 with unspecified diabetes. The earliest diabetes diagnosis dates to January 1932, with data updated to 27 May 2025.
This cohort profile describes baseline characteristics of patients with comprehensive data collected on demographics (age, sex, Deprivation Index, ethnicity), clinical measures (glycated haemoglobin, body mass index, blood pressure, lipids and estimated glomerular filtration rate) and 14 major diabetes complications tracked longitudinally. Key findings for patients with type 2 diabetes reveal diabetic retinopathy as the most common complication (74.6 per 1000 person-years), followed by hypertension (51.0) and kidney disease (31.4). Cumulative incidence analyses using the Aalen-Johansen estimator, which accounts for mortality as a competing risk, demonstrated significant ethnic disparities, with black, Asian, mixed and other ethnic groups showing elevated risk compared with white patients. Time-varying Cox models identified strong clustering between cardiovascular and renal complications, confirming a cardiometabolic-renal syndrome. Mental health conditions (depression and anxiety) were prevalent throughout the disease timeline, occurring both before and after diabetes diagnosis.
This cohort will be used as a platform for developing and validating prognostic models for diabetes complications, enabling risk stratification and targeted interventions. Future work will incorporate medication data to refine diabetes type classification, examine the effectiveness of antidiabetic medications in preventing different complications and address demographic differences in prognostic model performance and prediction accuracy. To better characterise lifestyle, further interrogation of electronic health record data will examine recording of advice given, including dietary advice, referral to weight management schemes and presence of alcohol consumption codes.
To gain consensus and prioritise barriers to effective pressure injury prevention for at-risk patients and to collaboratively generate, discuss and recommend intervention strategies that could address these prioritised barriers in the acute medical-surgical hospital context.
Nominal Group Technique.
Participants involved in pressure injury prevention across acute medical-surgical services in a tertiary hospital in Australia were purposively sampled. Pre-reading materials informed the discussion on barriers to prevention. Participants ranked 11 barriers that were collaboratively developed and identified practical context-specific solutions. Data were analysed using inductive content analysis.
Nine multidisciplinary participants prioritised three final barriers to effective pressure injury prevention: inadequate skin assessment and monitoring, competing priorities and workflow pressures and insufficient education and inconsistent knowledge. Proposed solutions focused on developing concise, accessible decision support tools such as quick reference flowcharts to enhance confidence, consistency and timeliness of appropriate pressure injury prevention practices.
The Nominal Group Technique enabled consensus-building, guided the development of actionable priorities and informed targeted intervention strategies to address key barriers in acute care nursing practice.
Findings from this study offer nurse leaders and researchers practical insights to co-create an intervention that drives evidence-based pressure injury prevention practice change in acute medical-surgical settings. Adoption of these targeted approaches may enhance hospital patient safety through pressure injury prevention implementation.
Reporting guideline for PRIority Setting on health research (REPRISE).
No patient or public contribution.
To compare the effectiveness of different intervention strategies for improving self-care maintenance, self-care management and self-care confidence in adults with heart failure.
Systematic review and network meta-analysis.
Following PRISMA-NMA guidelines, randomised controlled trials evaluating heart failure self-care interventions were included. Self-care was assessed using the Self-Care of Heart Failure Index across the eligible studies. Interventions were classified as knowledge/cognition-oriented, skill/behaviour-oriented, monitoring/feedback-reinforcement, motivation/empowerment-oriented or multicomponent. Risk of bias was assessed with RoB 2. Pairwise meta-analyses and exploratory network meta-analyses were performed.
PubMed, Embase, Scopus, Web of Science, CENTRAL, CINAHL and PsycINFO were searched from inception to March 2025.
Fifty-four trials involving 6508 participants were included, of which 32 contributed to the meta-analysis. In pairwise meta-analysis, motivation/empowerment-oriented and skill/behaviour-oriented interventions improved self-care maintenance, whereas knowledge/cognition-oriented, monitoring/feedback-reinforcement and motivation/empowerment-oriented interventions improved self-care management. Multicomponent interventions improved maintenance, management and confidence, but were not clearly superior to more focused strategies. Subgroup analyses suggested greater benefits from personalised provider feedback than from predominantly automated feedback. Exploratory network meta-analysis showed similar patterns, although rankings should be interpreted cautiously because the network was star-shaped and lacked direct comparisons between active interventions.
Heart failure self-care interventions are not equally effective across domains. Motivation/empowerment-oriented approaches showed the clearest signal for self-care maintenance, whereas knowledge-based and personalised monitoring/feedback strategies appeared more relevant for self-care management. These findings support a more targeted approach to intervention design.
Healthcare professionals should tailor strategies to specific self-care goals, prioritising motivational techniques for maintenance, structured education and monitoring with personalised feedback for management.
No patient or public involvement.
CRD420250652676
by Karikalan Nagarajan, Stephen Arangba, Basilea Watson, Muniyandi Malaisamy, Linette Muanching, Suchita Singh, Sanjay Kumar Mattoo, Vijaya Elangbam, W. Shashi Singh, Senthil Sellappan, Dahiiru Ngade, Amow Ngaopuo, Lungnalii K. T, Thangpa Serto, Pfokreho Pfoze, Dina Nair, Vignes Anand Srinivasalu, Elizabeth R K, Pung Mark, Hanna R N, Peter Yonuo, Sumpi Percy, Harpreet Kaur
BackgroundInvolving community volunteers in the tuberculosis (TB) program is widely acknowledged and considered a key element of the community engagement strategy in the TB program of India, especially in predominantly tribal North Eastern districts. Inadequate TB knowledge, attitudes and Practices (KAPs) about health and related risk factors could be a key barrier to using community volunteers or lay persons in health program.
MethodsWe trained 708 volunteers from student and women organisation (SAWOs) in 189 villages, Senapati District, Manipur between February 2023 and August 2025. A training on identifying TB symptomatics, sputum collections, transportations, patient support and follow-up during their treatment, counselling were provided. A TB-KAP pre and post data were collected in REDCap software and analysed using Stata. To assess the impact of the training on participants’ KAP regarding TB, both descriptive and inferential statistical methods were used. Statistical significance was determined at p-value Results
Of 708 trained volunteers, 339 were retained during the full training and assessment. With respect to the knowledge score, the probability of being in the highest knowledge category increased from 10% to 65% after training, while the likelihood of being in the lowest two categories dropped from 61% to 8%. The mean attitude score about TB increased from 24.53 (SD = 4.79) to 25.40 (SD = 4.83) after training. This difference of 0.87 points was statistically significant (t(353)=−3.58, p = 0.0004), with a 95% confidence interval of [−1.35, −0.39]. Significant positive changes were seen in the anticipated health-seeking intentions of the volunteers in terms of seeking care for symptoms within 1–2 weeks (p = 0.0009).
ConclusionOur study demonstrated that focused and culturally appropriate short term training can produce significant immediate gains in TB knowledge, with modest improvements in attitudes and reported health-seeking intentions, even in the remotest tribal areas among community volunteers.
Virtual reality (VR)-based cognitive–motor training has emerged as a promising nonpharmacological intervention for older adults with mild cognitive impairment (MCI). However, evidence regarding its effectiveness in community-dwelling populations remains inconclusive.
The aim of this study is to evaluate the effectiveness of VR-based cognitive–motor training on cognitive and functional outcomes in community-dwelling older adults with MCI.
A comprehensive literature search was conducted in PubMed, Embase, MEDLINE, CINAHL Complete, PsycINFO, Scopus, and the Cochrane Library from inception to October 15, 2025. The quality of included studies was assessed using the Joanna Briggs Institute critical appraisal tools. Risk of bias was assessed using the revised Cochrane Risk of Bias tool. Meta-analysis was conducted using random-effects models.
A total of 15 studies involving 706 participants were included, with 362 participants receiving VR-based cognitive–motor training and 344 receiving control intervention. Compared with control interventions, VR-based cognitive–motor training was associated with significant improvement in global cognition measured using the Montreal Cognitive Assessment. However, no significant improvement was observed for the Mini-Mental State Examination. Borderline improvement was found for executive function measured by Trail Making Test Part B. No significant effects were observed for instrumental activities of daily living, depressive symptoms, or walking performance. Substantial heterogeneity was observed across studies.
VR-based cognitive–motor training may improve global cognition in community-dwelling older adults with MCI. However, evidence for functional outcomes remains limited, and findings should be interpreted cautiously because of substantial heterogeneity across studies.
VR-based cognitive–motor interventions may provide feasible nonpharmacological approaches for gerontological, community, and rehabilitation nursing practice. Nurses may support implementation through patient and caregiver education, adherence monitoring, and continuity of cognitive care in community settings.
To assess how social robots impact anxiety, pain, fear and stress in children and adolescents during perioperative nursing.
A systematic review and meta-analysis of randomised controlled trials and quasi-experimental studies.
Following Joanna Briggs Institute guidelines, eligible studies included participants under 21 undergoing surgery or perioperative care, used social robot interventions with comparators, assessed anxiety, pain, fear and stress, and employed randomised or quasi-experimental designs. Two independent reviewers screened and extracted data.
A systematic search was conducted in April 2024 and updated twice (December 2024, October 2025) across CINAHL, Web of Science, Scopus, PubMed, Cochrane CENTRAL, Medic, PsycArticles, Institute of Electrical and Electronics Engineers and grey literature sources (Google Scholar, Mednar).
Seven studies (663 participants) showed heterogeneity in social robotic interventions. A meta-analysis of two studies (302 participants) found a significant reduction in children's and adolescents' post-operative anxiety, whereas a narrative synthesis identified three studies reporting reduced perioperative anxiety. However, the interventions had little or no effect on perioperative pain, fear or stress.
This review suggests that social robotic interventions may reduce perioperative anxiety in children and adolescents, potentially serving as non-pharmacological distraction tools in paediatric care. Evidence for their effects on pain, fear and stress is limited, highlighting the need for further research to identify effective interventions and clarify their role in perioperative nursing.
This review highlights social robotic interventions as promising non-pharmacological tools for reducing perioperative anxiety in children and adolescents.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-Analysis reporting guidelines.
No patient or public contribution.
This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024549796)
This study aimed to explore stroke survivors' interoceptive and emotional experiences. Interoception, defined as the perception and interpretation of internal bodily states, may influence emotional regulation after stroke.
This study employed a descriptive phenomenological study.
This study was conducted in the Neurology and Rehabilitation Departments of a tertiary hospital in Zhengzhou, China. Semi-structured interviews were undertaken with stroke survivors receiving rehabilitation services. Sixteen stroke survivors were recruited through purposive sampling and conducted face-to-face semi-structured in-depth interviews. Data collection and analysis were conducted simultaneously, and the Colaizzi seven-step analysis method was used to code and extract themes from the transcripts.
A total of five themes and 13 sub-themes were summarised, including: (1) Physical ‘disconnection’—interoceptive experience disorders; (2) Interconnected bodily sensations and emotional experiences; (3) Gradually learning to understand and regulate bodily sensations; (4) Perceptual regulation empowerment and limitations in social relationships; (5) The Social-Cultural context of expressing internal feelings.
Stroke survivors may frequently experience significant interoceptive dysfunction, which is closely related to emotional state, cultural cognition, and social support.
This study followed the Consolidated Criteria for Reporting Qualitative Research checklist.
Stroke survivors participated through semi-structured interviews, and four survivors reviewed the interview guide before data collection to improve question clarity and relevance.
The findings of this study have important implications for clinical practice and nursing education. Healthcare providers should pay greater attention to stroke survivors' bodily perceptions and emotional experiences during rehabilitation. Interoceptive awareness strategies, such as mindfulness, breathing exercises, and body awareness training, could be incorporated into rehabilitation programmes to help patients better regulate emotions. In addition, nursing education could strengthen training related to emotional assessment and interoceptive awareness to promote more holistic and patient-centred care.
by Yu-Tsung Lin, Wen-Chien Wang, Yu-Hsien Lin, Yun-Che Wu, Kun-Hui Chen, Chien-Chou Pan, Ching-Heng Lin, Jun-Sing Wang, Cheng-Hung Lee
PurposeAlbumin levels have demonstrated superior predictive value for surgical outcomes across a variety of surgeries. However, their effect on long-term survival after vertebroplasty for vertebral compression fracture has not yet been well studied. This study aims to investigate the relationship between preoperative albumin levels and long-term survival in patients who underwent percutaneous vertebroplasty for vertebral compression fractures.
Materials and methodsWe enrolled patients who underwent vertebroplasty for vertebral compression fracture between the period of May 1, 2013 to June 30, 2020 in a single medical center. Patients who were diagnosed with a pathologic compression fracture, underwent additional spinal instrumentation during the same surgery, and those without data regarding their bone mineral density (BMD) were excluded. Cox proportional hazard models were conducted to examine the effects of hypoalbuminemia ( Results
A total of 145 patients were analyzed, and the median follow-up period was 2.12 (interquartile range 1.51–3.28) years (mean follow-up 2.65 [SD 1.78] years). Compared with normal albumin levels, patients with hypoalbuminemia were found to be independently associated with a higher risk of all-cause mortality (hazard ratio 3.154, p = 0.014). These findings remained significant when albumin was examined as a continuous variable (hazard ratio 0.242, p = 0.001) and even after multivariate adjustment as well (hazard ratio 0.192, p = 0.004).
ConclusionHypoalbuminemia was associated with all-cause mortality among patients who underwent vertebroplasty for vertebral compression fractures. Our findings highlighted the impact of nutritional status on long-term mortality in an elderly surgical population.
Neoadjuvant chemotherapy (NAC) followed by definitive treatment consisting of either radical radiotherapy or radical cystectomy is the recommended treatment for patients with organ-confined muscle-invasive bladder cancer (OC-MIBC). A randomised controlled trial (RCT) aimed to compare the effectiveness of radical radiotherapy and radical cystectomy but failed to recruit. Radical radiotherapy is non-invasive and organ-preserving, and observational studies have suggested this treatment may be associated with similar outcomes compared with radical cystectomy. However, in these observational studies, the risk of confounding was high, and they did not consider the receipt of NAC. The surgery or radiotherapy (SORT) for the early-stage cancer study will assess the comparative effectiveness and cost-effectiveness of either radical cystectomy or radical radiotherapy, both after NAC for OC-MIBC. We will use a target trial emulation approach to reduce the risk of bias when assessing comparative effectiveness from observational data.
The SORT study will use UK’s National Cancer Registry to identify individuals diagnosed with urothelial OC-MIBC (T2-4aN0M0) between 1 January 2015 and 31 December 2021 who received either radical radiotherapy or radical cystectomy after NAC. The data will be linked to Hospital Episode Statistics (HES), National Radiotherapy Data Set (RTDS) and Systemic Anti-Cancer Therapy (SACT) data sets to gather information on clinical, tumour and socio-demographic characteristics and receipt of treatment. Using the target trial emulation framework, we will define the eligibility criteria and radical radiotherapy and radical cystectomy receipt. To reduce the risk of confounding, we will use advanced statistical approaches to allow for differences in measured baseline characteristics between the comparison groups.
The primary outcome is 3-year all-cause mortality after radical treatment receipt. Secondary outcomes will include all-cause and bladder-cancer-associated mortality at 3 and 5 years, time to death, incremental costs and incremental cost-effectiveness reported according to net health benefits.
The study was approved by the London School of Hygiene and Tropical Medicine Ethics Committee (Reference number 29717 - 1). Results will be communicated in open-access journals and conferences to clinicians, researchers, patients and policymakers.
by Huixiang Ouyang, Ching Wan, Ronald Fischer
The past decades have generated a substantial volume of psychological literature on threat. However, the absence of systematic cross-field synthesis has resulted in limited understanding of major research domains and relationships between different lines of threat research. We analyzed 51,903 psychological publications on threat retrieved from APA PsycInfo, Scopus, and Web of Science Core Collection that were published between 1961 and 2023. We conducted structural topic modeling on publication titles and abstracts to identify key research topics, and network analysis on the resulting topics to map the thematic structure of the literature. 25 topics emerged, organized into four thematic areas through exploratory graph analysis: 1) threat processing mechanisms, 2) health and clinical threats, 3) social psychological threats, and 4) collective threats. Network analysis revealed differential connectivity patterns within and between thematic areas. Areas showed limited connectivity with each other and no area emerged as a central hub, suggesting gaps in cross-domain integration. Topic prevalence trends revealed diversification in research interest over time, together with responsiveness to broader developments within psychology and evolving societal concerns. Notably, mechanism-focused research declined over the past decade while event-driven research on specific threats increased, indicating reactive rather than theory-driven investigation. These findings provide insights into the landscape of psychological literature on threat and reveal critical gaps in current examinations alongside strategic opportunities to advance cross-field integration.Disparities in cancer care among lesbian, gay, bisexual and transgender (LGBT) individuals persist across healthcare systems worldwide. Nurses play an important role in delivering culturally competent cancer care; however, limited research has examined nurses' practices in caring for LGBT individuals with cancer and identified factors influencing such care, particularly in non-Western cultural contexts.
To examine nurses' experiences in providing cancer care for LGBT individuals, their cancer care behaviours, influencing factors and perceived needs regarding knowledge, skills and care settings for delivering culturally competent cancer care.
Cross-sectional survey.
Between September and December 2024, a cross-sectional survey was conducted in Taiwan across two hospitals, ten nursing associations, five cancer-related foundations and three online nursing communities. A total of 608 nurses with experience caring for patients with cancer were recruited through purposive and snowball sampling. Nurses completed either an online or paper-based survey.
Nearly half of the nurses had no prior experience providing cancer care for LGBT individuals. Experience providing such care was associated with older age, non-heterosexual identity, longer length of service, higher LGBT-related care competencies and higher levels of job-related compassion satisfaction and stress. Affirmative cancer care behaviours were associated with a broader and more integrated set of competencies, including knowledge, attitudes, skills, affirmative beliefs and job-related compassion satisfaction. Nurses also reported unmet needs regarding knowledge, skills and care settings for delivering culturally competent cancer care to LGBT individuals.
These findings highlight the importance of education, resources and resilience support to strengthen nurses' delivery of culturally competent cancer care for LGBT individuals.
Related training courses, curricula and supporting resources are essential to enhance nurses' culturally competent cancer care practices for LGBT individuals.
STROBE checklist.
No patient or public contribution.
Despite the evidence for the efficacy of lifestyle interventions for type 2 diabetes prevention, there remains a gap in translating this evidence-based practice into real-world settings.
To summarize current evidence regarding the relationship between participant characteristics, intervention components, and the effect of lifestyle interventions for individuals with prediabetes.
The initial search of PubMed, Embase, the Cochrane Library, and Web of Science was performed on 6th December 2023 and was subsequently updated on 5th October 2025. Randomized controlled trials on lifestyle interventions (diet and/or physical activity), compared to usual care, no intervention, or wait-list control, in adults with prediabetes were eligible. Outcomes included the incidence of type 2 diabetes and normoglycemia, fasting plasma glucose (FPG), 2-h plasma glucose, hemoglobin A1c (HbA1c), fasting insulin (FI), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Random-effects meta-analyses were performed to estimate relative risks (RRs) and mean differences. Subgroup analyses and meta-regressions were conducted by participant characteristics and intervention components.
Seventy-seven studies (n = 22,629 participants) were included. Greater weight loss (%) was associated with larger reductions in diabetes incidence (β = 0.07 [0.02, 0.12], p = 0.010). Achieving ≥ 5% (vs. < 5%) weight loss was associated with higher reversion rates to normoglycemia (RR = 1.80 [1.55; 2.08] vs. 1.32 [1.03; 1.70]; p subgroup = 0.036). Interventions with supervised exercise training more effectively reduced diabetes incidence than those without this component (RR = 0.40 [0.24; 0.65] vs. 0.69 [0.63; 0.76]; p subgroup = 0.031). Younger participants showed greater improvements in FPG, HbA1c, FI, and HOMA-IR. Higher baseline HbA1c levels were associated with a greater reduction in HbA1c but a smaller FI improvement.
This meta-analysis provides valuable insights into the implementation of diabetes prevention programs. Weight loss is a critical determinant for diabetes prevention, and weight loss goal setting and progress monitoring are recommended. Adding supervised exercise sessions can enhance the program's effectiveness. Early interventions for younger individuals with lower HbA1c levels may prevent diabetes more effectively.
PROSPERO (CRD42024486361)
Neighbourhood migrant density is increasingly recognised as a social determinant of health. However, its association with hospitalised patients with cancer outcomes, such as mortality and readmission rates, remains understudied. This study examined whether neighbourhood migrant density influenced these outcomes and whether these associations varied before and during the COVID-19 pandemic.
Retrospective cohort study.
Swedish national registers.
Hospitalised patients with cancer (ICD code C00–C97) from 2014 to 2019 (before the pandemic) and 2020–2021 (during the pandemic).
90-day mortality and readmission rates. Independent variables were neighbourhood migrant density—categorised as total, Western and non-Western migrants (as a proportion of the total area population).
We identified 243 357 hospitalised patients with cancer before the pandemic and 112 935 during the pandemic. Swedish-born individuals and Western migrants residing in high migrant density neighbourhoods had higher rates of 90-day mortality (incidence rate ratio, IRR: 1.15, 95% CI 95% CI 1.12 to 1.19 and IRR: 1.09, 95% CI 1.00 to 1.18) and readmission (IRR: 1.16, 95% CI 1.13 to 1.19 and IRR: 1.14, 95% CI 1.07 to 1.22). During the pandemic, 90-day mortality rates significantly increased among Western migrants and 90-day readmission rates increased for all patients from high migrant density neighbourhoods.
High neighbourhoods migrant density was associated with increased 90-day mortality and readmission among Swedish-born individuals and Western migrants before the pandemic. These outcomes were exacerbated during the pandemic, particularly among migrants. Cancer care for residents in neighbourhoods with high migrant density needs to be improved, especially during public health crises.
by Ching-Chung Ko, Jheng-Yan Wu, Kuo-Chuan Hung, Shu-Wei Liao, Ya-Wen Tsai, Tsung Yu, Chien-Ming Lin, I-Wen Chen
PurposeCOVID-19 infection has been associated with cardiovascular complications, including new-onset atrial fibrillation/flutter (NOAF). However, the potential protective effect of COVID-19 vaccination against long-term NOAF risk following COVID-19 infection remains unclear.
MethodsThis retrospective cohort study used the TriNetX Research Network to identify adults diagnosed with COVID-19. Patients were divided into a vaccine group and control group (unvaccinated). After propensity score matching (238,750 patients per group), we assessed the primary outcome of 24-month NOAF incidence, with secondary outcomes at 1, 6 and 12 months. Subgroup analyses examined effects across patient characteristics and comorbidities. Sensitivity analysis was performed by excluding patients with severe COVID-19 illness.
ResultsThe 24-month NOAF incidence was significantly lower in the vaccine group compared to the control group (1.91% vs 2.18%; HR: 0.82, 95% CI: 0.78–0.85). This protective effect was also observed at 1 month (HR: 0.73, p Conclusion
COVID-19 vaccination was associated with a significantly reduced 24-month risk of NOAF after COVID-19 infection. These findings suggest vaccination may mitigate long-term cardiovascular sequelae of COVID-19. Future research should elucidate underlying protective mechanisms and optimize vaccination strategies for cardiovascular protection, particularly in high-risk populations.
FreshRSS 