Conectar
To describe antibacterial consumption (ABC) in four paediatric inpatient facilities in Sri Lanka in 2023.
Descriptive cross-sectional study, adapted from the WHO Global Antimicrobial Resistance and Use Surveillance System methodology.
Paediatric inpatient facilities in two tertiary and two secondary care government hospitals located across three provinces.
Data on antibacterials for systemic use, J01 in the Anatomical Therapeutic Chemical (ATC) classification issued to these paediatric inpatient facilities in 2023 by their respective hospital pharmacies.
(1) ABC at ATC third and fifth levels expressed as defined daily doses (DDDs)/100 admissions, (2) ABC as per WHO ‘Access, Watch and Reserve’ category, (3) choice of antibacterials within a class, (4) DU 75% for oral and parenteral dosage forms, (5) quality indicators such as amoxicillin index and broad:narrow spectrum ratio.
In 2023, total antibacterial (J01) consumption across the four paediatric inpatient facilities was 94.49 DDDs/100 admissions. Together, non-penicillin beta-lactams, penicillins and macrolides/lincosamides/streptogramins accounted for 90–98%. Co-amoxiclav was the most consumed antibacterial, and six agents (co-amoxiclav, cefotaxime, clarithromycin, azithromycin, cefuroxime and meropenem) collectively accounted for 70–90%. Aminoglycosides, tetracyclines, sulfonamides and trimethoprim, and quinolones contributed minimally. Access and Watch group antibacterials accounted for 34 and 65%. Quality indicators demonstrated disproportionately higher use of broad-spectrum and Watch group antibacterials.
High use of broad-spectrum and Watch-group antibacterials was observed across the four paediatric inpatient facilities. The findings highlight targets for antibacterial stewardship programmes and demonstrate the feasibility of ABC surveillance in Sri Lanka.
by Ali Shakhshir, Mahdi Aljamal, Abdallah Alem, Ibrahim Aljamal, Zainah Amjad Issa
BackgroundClinical, laboratory, and imaging correlates of complicated appendicitis are well studied, but routinely recorded gross-pathology morphometrics and pathology-confirmed evidence from Palestine are less well characterized. We evaluated correlates of histopathological severity and adjusted associations with complicated appendicitis.
MethodsThis retrospective cohort included appendectomy encounters at Al-Makassed Islamic Charitable Society Hospital from December 2015 to July 2025. Source reconciliation identified 1,287 unique encounters; 245 histologically normal appendices and 32 records without a classifiable severity category were excluded, leaving 1,010 patients. Complicated appendicitis was defined as gangrenous or perforated disease. Group comparisons used chi-square or Monte Carlo exact tests and Kruskal-Wallis tests. A prespecified logistic model included age, sex, appendicolith, white blood cell count (WBC), and C-reactive protein (CRP).
ResultsThe cohort included 227 catarrhal/simple, 458 suppurative, 262 gangrenous, and 63 perforated cases. Operative approach, nausea and/or vomiting, other intraoperative findings, appendicolith, WBC, neutrophil percentage, operative duration, and hospital stay differed across severity categories. In the adjusted model (n = 991), appendicolith was associated with higher odds of complicated appendicitis (adjusted odds ratio 2.20, 95% confidence interval 1.37–3.52; P = 0.001), whereas WBC showed an unexpected inverse association (adjusted odds ratio 0.938 per 1 × 10⁹/L, 95% confidence interval 0.906–0.971; P < 0.001). Age, sex, and CRP were not independently associated. Discrimination was weak (area under the receiver operating characteristic curve 0.594, 95% confidence interval 0.557–0.632). Maximum diameter, wall thickness, and appendix length showed no significant adjusted linear associations.
ConclusionsAppendicolith was associated with complicated appendicitis, but weak discrimination and limited explained variation preclude use of the model as a clinical prediction tool. The inverse WBC association and negative linear morphometric findings require cautious interpretation.
by Anirudh Bhatia, Justin Elser, Steven J. Carrell, Brent Kronmiller, Melissa Sutton, Christine Kelly, Tyler S. Radniecki
BackgroundWastewater surveillance is a valuable tool for monitoring SARS-CoV-2 at the community level. As the virus diversified into many variants and subvariants that share overlapping mutations, resolving them accurately from wastewater becomes a key bioinformatic challenge.
Objectives and aimsThis study evaluated two distinct bioinformatic approaches, multilocus sequence typing (MLST) and Freyja, for identifying SARS-CoV-2 variants and subvariants in Oregon wastewater samples collected from February 2021 to February 2022.
MethodsThe MLST approach identified SARS-CoV-2 variants using unique mutations curated from clinical samples. In contrast, the Freyja approach resolved variant and subvariant abundances using genome wide mutation profiles weighted by sequencing depth. In this study, the variant and subvariants relative abundances produced by both approaches were compared against those observed in clinical surveillance data.
ResultsBoth approaches identified SARS-CoV-2 variants at relative abundances that agreed closely with those observed in clinical surveillance data. However, only the Freyja approach identified over 200 Delta subvariants, divided into three clades (21A, 21I and 21J) and two levels (Level 1 and 2) based on Pango subvariants. Delta subvariants showed strong agreement at Level 1 subvariants (rs = 0.892–0.944), while agreement at Level 2 subvariants was inconsistent (rs = 0.324–0.903).
ConclusionsThe Freyja approach provided enhanced resolution of SARS-CoV-2 variants and subvariants in wastewater, at abundances that agreed with clinical surveillance. This added resolution is a critical advantage for public health surveillance as SARS-CoV-2 continues to evolve and share mutations across variants and subvariants.
by Melissa Lagger, Hugo Najberg, Almir Miftaroski, Lucien Widmer, Sara Di Renzo, Pouya Iranmanesh, Maxime Matter, Boran Tekdogan, Stéphanie Perrodin, Beat Gloor, Christian Toso, Jean-Louis Frossard, Michel Adamina, Leo Buhler
Aim of the studyIntraductal papillary mucinous neoplasms (IPMNs) are among the most common cystic pancreatic neoplasms, with a potential to progress to malignancy. The increasing prevalence of IPMNs, coupled with the widespread use of GLP-1 receptor agonists (GLP-1 RAs) for diabetes and obesity management, raises concerns about the safety of these medications in patients with preexisting pancreatic conditions. Despite their proven metabolic benefits, questions remain about their impact on pancreatic pathology. This study investigates the association between GLP-1 RA use and IPMN progression to address this critical gap in the current literature.
MethodsThis retrospective multicentric cohort study will analyse data from January 2010 to July 2026 across three Swiss tertiary institutions. Patients with a radiological diagnosis of IPMN and/or treated with GLP-1 RAs will be included. Patients will be stratified into four groups according to a 2 × 2 design based on GLP-1 RAs exposure and IPMN status. The primary objective is to evaluate the impact of GLP-1 RAs on IPMN progression using radiological criteria from the Kyoto 2023 Consensus. Secondary objectives include assessing changes in tumour markers (CA19−9, CEA), the incidence of acute pancreatitis, the progression of IPMNs to high-grade dysplasia or invasive carcinoma, and the need for surgical intervention or altered surveillance protocols associated with GLP1 RAs use.
DiscussionThis study aims to explore potential associations between GLP-1 RA use and changes in IPMN characteristics, tumour markers, and disease progression. Given the retrospective design and expected small sample size (estimated at 30–60 patients in total), the study may not be powered to establish definitive correlations. Nonetheless, it will generate preliminary data to help inform hypotheses and guide future research. Any observed trends could provide valuable insights into the safety of GLP-1 RAs in patients with IPMNs and contribute to more informed clinical decision-making regarding the use of these agents in a population at risk for pancreatic disease progression.
Trial registrationClinicalTrials.gov NCT07014709
by Isabella DeStefano, Adanna Ibeku, Krystal Hunter, Melissa Micallef, Alla Kushnir
“Late preterm” or “LPT” neonates are generally defined as infants born between 34 0/7 and 36 6/7 weeks gestation and constitute approximately 74% of all preterm births. While much effort has been put into evaluating the nutritional needs of early preterm or low birthweight infants, there is a shortage of research on the nutritional needs of LPT infants. This work examined how adherence to current nutrition guidelines and how the use of fortification of feeds affected the growth of LPT neonates in the first year of life. A retrospective chart review was conducted of 898 neonates born between 34 0/7 and 36 6/7 weeks gestation, as identified from electronic medical records. The study site where the data was obtained was an urban hospital in New Jersey. Head circumference, weight, and length at birth, documented as measurements, percent, and z-scores, at discharge, at two months, at six months, and at twelve months post birth, were collected and evaluated. Data regarding the neonate’s feeding regimen, caloric fortification, and type of nutrition at the point of discharge were assessed. Data were analyzed using independent t-tests and Mann-Whittney U tests to assess the relationship between adherence and growth parameters. Of these participants, 50.1% were male, the mean gestational age was 34.91 (±1.19), and the mean birth weight was 2317 (±489) grams. Infants with lower birth weight (BW) were more likely to receive fortification (BW p < 0.001, BW percentile p < 0.001). Participants who followed fortification guidelines had lower birth weight, discharge weight, and weight percentile (p < 0.001), as well as lower z-scores for BW, length, and head circumference (HC) at birth and at discharge. At six and twelve months, weight, weight percentile, length, length percentile, head circumference, and head circumference percentiles were not statistically significant. The results show that adherence to nutritional guidelines recommending fortified feeding is associated with growth within the first year of life of LPT infants. By two, six, and twelve months, there were no differences in z scores in participants with fortification.To evaluate resilience, burnout, intent to leave and use of resiliency skills among new graduate nurses following the introduction of resiliency skills during a nurse residency programme.
This programme evaluation used a quasi-experimental, repeated-measures design, with assessments conducted at baseline, 2 weeks and 3 months following the intervention.
Nurse residents participated in a 1-h, in-person introduction to the evidence-based Community Resiliency Model (CRM) as part of a didactic day away from bedside care. The CRM is a sensory-focused self-care approach to regulating the nervous system and is associated with improved healthcare worker well-being and work team engagement. Changes in resilience and burnout were evaluated over time, and relationships among resiliency skill use, resilience, burnout and intent to leave were examined.
The training was well received based on post-intervention surveys. A total of 135 nurse residents were trained, and 68 provided evaluation data at baseline and 3 months. No significant changes in resilience, burnout or intent to leave scores were observed. However, 73% of new graduate nurse participants reported using the resiliency skills at least once during the 3 months following training.
This evaluation suggests that the CRM training is feasible and acceptable as an addition to new graduate nurse professional development strategies. Although no significant changes in resilience, burnout or intent to leave were observed, the majority of participants reported using resiliency skills following training. Introducing sensory-based resiliency skills during the residency period may provide nurses with practical strategies for managing role transition and work-related stress that can be reinforced and further developed throughout their careers.
by Hissah F. AlMuhaysh
Digital transformation has fundamentally reshaped higher education, creating dynamic and technology-mediated learning environments that demand more than technical proficiency. Students must develop strong psychological, cognitive, and behavioural competencies to navigate these changes effectively. This study examines the structural relationships between Emotional Intelligence (EI), Cognitive Flexibility (CF), Soft Skills (SS), and Self-Directed Learning (SDL), while also assessing the direct influence of Digital Transformation (DT) on students’ learning behaviours in King Faisal University, Saudi Arabia. A quantitative cross-sectional design was adopted, with data collected from 525 female university students using a structured self-report questionnaire. Participant recruitment commenced on 13/05/2025 and ended on 19/08/2025. The proposed conceptual model was analysed using Partial Least Squares Structural Equation Modelling (PLS-SEM), allowing for the examination of complex predictive relationships among the constructs.:Emotional Intelligence was significantly associated with both cognitive flexibility and soft skills.. Cognitive flexibility showed a significant positive association with soft skills and directly contributing to self-directed learning. Soft skills further demonstrate a substantial positive effect on SDL, highlighting their role as applied behavioural competencies. Additionally, Digital transformation was significantly associated with self-directed learning, reflecting the growing importance of digital environments in shaping autonomous learning behaviours. The model explains a substantial proportion of variance in Self-Directed Learning (R² = 0.58), indicating strong predictive power. The study supports a hierarchical competence framework in which emotional intelligence fosters cognitive adaptability, which in turn enhances behavioural skills that drive self-directed learning. Digital transformation acts as a critical contextual catalyst in this process. These findings emphasise the need for higher education institutions to adopt holistic strategies that integrate the development of emotional, cognitive, and behavioural skills to promote effective learning in digitally transformed environments.To explore the cultural challenges and complexities faced by researchers conducting studies with cancer patients in the Chinese cultural context.
A descriptive qualitative study.
Semi-structured interviews were conducted with 22 nurse researchers from tertiary hospitals, medical universities, and secondary nursing colleges from all six regions in China between April 2023 and December 2024. Data were analysed using inductive thematic analysis as described by Braun and Clarke.
From the analysis, two themes were developed: (i) sociocultural factors, and (ii) strategies to navigate cultural complexities. Nearly all participants reported significant difficulties in conducting research with cancer patients, stemming not only from the vulnerability associated with a cancer diagnosis, but also from the cultural taboo surrounding cancer and death, and the influential role of family members in decision-making and patient protection. Researchers emphasised the need to carefully balance family members' roles as gatekeepers, manage power dynamics with healthcare professionals, uphold patient autonomy, and communicate sensitively while maintaining research integrity. To address these challenges, participants recommended consulting family members before approaching patients, involving both patients and families throughout the research process, improving ethical training for researchers, and developing culturally sensitive ethical guidelines specific to China.
Cultural traditions and norms play a significant role in shaping cancer research practices in China.
Developing culturally sensitive ethical guidelines specific to the Chinese context is essential to support research personnel and ensure the ethical integrity of cancer research.
China's taboos surrounding cancer and death, and deeply embedded cultural traditions and norms, family-centred decision-making, and filial piety profoundly shape the conduct of research involving patients with cancer, particularly when a tension exists with universal ethical principles.
The Consolidated Criteria for Reporting Qualitative Research.
No patient or public contribution.
To evaluate the availability of operating theatre structural resources for fracture fixation, identify key resource gaps and assess variation across facility tiers in hospitals delivering orthopaedic and trauma services in Tanzania.
National cross-sectional survey.
Hospitals providing orthopaedic and trauma services across all levels of care and ownership types in Tanzania.
Licensed orthopaedic and trauma surgeons in Tanzania (n=171) reported on 92 unique hospitals nationwide.
Operating theatre structural resources for fracture fixation across three domains: theatre infrastructure, core orthopaedic equipment and operative support resources. A composite score summarised overall structural resource availability.
Basic operating theatre infrastructure and utilities were widely reported; however, specialised infrastructure components and orthopaedic-specific resources were inconsistently available. Access to traction tables (23.9%), limb positioning systems (27.2%) and disposable sterile drapes and gowns (14.1%) was limited. Adequate orthopaedic instruments were reported in 45.7% of hospitals, while fluoroscopy and digital imaging systems were reported to be available in 47.8% and 29.3%, respectively. Implant supply and equipment maintenance systems were inconsistently reported.
Overall, only 17.4% of hospitals reported high structural resource availability, while 55.4% were moderate and 27.2% low. Marked disparities were observed across facility tiers, with 55.0% of zonal and national hospitals reporting high resource availability compared with 8.2% of regional and 4.3% of district hospitals. Higher tier hospitals demonstrated significantly greater availability of orthopaedic equipment, imaging and operative support resources (p
Operating theatre structural resources for fracture fixation are variably available across hospitals in Tanzania, with key deficiencies in orthopaedic-specific equipment, intraoperative imaging, instrument adequacy and operative support systems, including implant supply and equipment maintenance. These gaps are most pronounced at lower tier facilities, highlighting substantial disparities in resource distribution. Strengthening orthopaedic equipment, improving imaging access and reinforcing support systems, particularly at lower level hospitals, is essential to support more equitable delivery of fracture fixation services.
This study evaluated district-wide implementation of a digital wound model of care combining an artificial intelligence–enabled application with a virtual command centre across four hospitals and five community health centres in Australia. A post-implementation multimethods evaluation (January 2024–January 2026) of patients (n = 94), frontline clinicians (n = 75), and senior wound nurses (n = 9) and a product manager (n = 1) using surveys, semi-structured interviews and analysis of governance meeting minutes. Patient satisfaction was high: 91% rated care as ‘excellent’ or ‘good’, 93% 'agreed' or 'strongly agreed' it was effective and 96% 'agreed' or 'strongly agreed' that they felt confident in the care they received from their wound care provider. Just over half (59%) felt they were meaningfully involved in decisions about their own care, an area identified for targeted improvement in future iterations of the model. The most cited virtual care benefits included improved condition understanding (63%), and reduced travel (49%). Among the 28 patient app users, 89% reported improved communication between them and the wound care provider and 79% self-management confidence. Senior wound nurses rated the app highly for ease of use and continuity of care (both 86%), but poor connectivity was a limitation. Frontline clinicians valued enhanced documentation consistency but reported barriers including time pressures and training burden. This multisite implementation demonstrates that digital wound care models are highly acceptable and deliver perceived clinical benefit, while identifying patient involvement in decision-making and clinician workflow integration as priority areas for future investment.
To synthesize empirical evidence on decision-making factors and emotional outcomes among surrogate medical decision-makers for people with dementia.
Integrative review.
A comprehensive search was conducted following Whittemore and Knafl's integrative review methodology. Eligible studies were appraised using the Mixed Methods Appraisal Tool and synthesized through inductive content analysis, guided by the Transactional Model of Stress and Coping.
PubMed, CINAHL, Embase, Scopus and PsycINFO were searched in August 2025.
Eighteen studies representing 574 surrogate decision-makers for people with dementia were included. Surrogate decision-making unfolded as an iterative process of evaluating clinical and relational demands, mobilizing coping resources and reappraising earlier judgements as conditions changed, consistent with the Transactional Model of Stress and Coping. Decision-making was influenced by informational needs, communication quality, family dynamics, cultural values and organizational barriers. Emotional outcomes ranged from guilt, anxiety and regret to relief, acceptance and growth.
Surrogate medical decision-making in dementia reflects an iterative process of appraisal, coping and reappraisal, shaped by contextual, relational and organizational factors that influence emotional outcomes.
Nurses should assess decision-making contexts and provide tailored informational, relational and emotional support throughout the dementia care trajectory.
Dementia often requires family members and other surrogates to make complex medical decisions, yet limited synthesis has examined how they appraise and cope with these demands. This review found that surrogate decision-making is an iterative process shaped by evolving appraisals, coping resources and communication quality, leading to varied emotional outcomes. Findings highlight the need for research that examines how surrogate decision-makers with multiple competing roles appraise and cope with decisions across the dementia trajectory.
This review adheres to the PRISMA 2020 reporting guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
To identify existing and ideal practices for responding to patient-initiated workplace violence in the US Veterans Health Administration.
Cross-sectional, descriptive qualitative design.
Qualitative interviews with staff (n = 31) in eight veteran healthcare facilities located in the western United States (2023–2024). Guided by Spelten et al.'s model of strategies to reduce patient-initiated workplace violence, thematic analysis examined post-incident interventions with patients and identified recommendations for improvement.
Educating and setting limits with patients varied by facility. Most respondents were unaware of patient education/support that occurred post-incident. Respondents disagreed about the role that patients' clinical status should play; some wanted more leeway for certain patients (e.g., those diagnosed with dementia) and others wanted a consistent response (regardless of clinical status) to create a culture of respect.
Patient education and limit-setting are important elements in addressing patient-initiated workplace violence, but they are inconsistently used. Offering resources to patients is underutilised. Staff have differing perspectives on what constitutes ideal post-incident interventions for medically complex patients.
When responding to patient violence, healthcare systems may benefit from clear and consistently implemented protocols and tailored educational interventions and support for different patient populations (e.g., dementia). Staff may benefit from guidance on balancing patient care with limit-setting during encounters with medically complex patients.
We examined existing practices for responding to patient-initiated workplace violence and staff suggestions for improvement in a large healthcare system. Participants wanted additional and consistent patient interventions; opinions varied on how patient clinical status and intent should shape organisational responses. Staff can benefit from consistently implemented protocols for responding to patient violence. Healthcare systems may need to provide staff guidance on balancing patient care with limit-setting.
SRQR guidelines for qualitative studies.
No patient or public contribution.
To map and describe the digital health technologies and technology-supported interventions used by advanced practice nurses for cardiovascular risk management in primary health care, including the advanced nursing functions they support.
A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following PRISMA-ScR. A systematic search was performed in PubMed/MEDLINE, Web of Science, Embase, Scopus, CINAHL, Cochrane Library and SciELO, as well as grey literature sources, including the CAPES Portal and Epistemonikos. International studies published between January 2005 and May 2026 were eligible, without language restrictions. Two reviewers independently selected and charted the evidence; a third reviewer resolved unresolved disagreements.
A total of 3919 records were identified and 12 studies met the inclusion criteria. The evidence was grouped into four categories: technology-supported structured nurse-led care programmes; clinical decision support and algorithm-based software; telehealth, telenursing and telerehabilitation; and mobile or home-based self-management technologies. The structured programmes combined nursing care pathways with organizational, educational, communication, protocol-based, algorithmic or digital resources that supported programme delivery. The studies covered primary prevention, secondary prevention, chronic disease management and cardiac rehabilitation. The technologies and interventions supported clinical decision-making, risk stratification, monitoring and follow-up, health education, self-management support and lifestyle counselling and care coordination.
Digital health technologies and technology-supported interventions can strengthen advanced cardiovascular nursing practice when embedded in clearly defined care pathways. Their principal contribution is to connect clinical decision support, longitudinal follow-up and supported self-management; their broader value depends on workflow integration, role clarity, equitable access and appropriate governance.
The protocol was registered in the Open Science Framework on May 22, 2024.
To identify strategies for fostering sustainable second-order problem-solving behaviours among hospital nurses. The study evaluates the impact of an emotive audio narrative stimulus and examines barriers and enablers in a simulated clinical environment.
Mixed-methods observational study.
Eighty hospital nurses were randomly assigned to either an emotive patient-safety audio narrative or a control condition before completing two simulated tasks embedded with system-level operational failures. Real-time behaviours were coded; quantitative data were analysed using chi-square tests and logistic regression. Semi-structured interviews elicited actionable recommendations for practice implementation.
Despite widespread detection of operational failures (96.2%), second-order problem-solving behaviours remained infrequent across both tasks (overall 21.9%). While the narrative triggered strong emotional responses, it did not increase escalation or formal reporting behaviours. Nurses identified normalization of deviance, time pressure and absence of feedback loops as structural barriers to problem-solving agency. Conversely, team debriefings, audit-feedback mechanisms and simulation-based failure training were cited as enablers.
Emotional triggers raise awareness but do not bridge the awareness–action gap. Sustainable second-order problem-solving requires organizational strategies—such as team reflection, audit feedback and simulation training—that empower nurses and strengthen system learning.
To reduce patient harm from unresolved operational failures, healthcare organizations must promote failure awareness alongside redesigning work systems that facilitate escalation, interdisciplinary collaboration and empower nurses to improve flawed processes sustainably.
GRAMMS checklist.
Not applicable.
Sepsis management and antimicrobial resistance (AMR) are linked priorities. Early identification and treatment of sepsis with broad-spectrum antibiotics are key to reducing morbidity and mortality. We aimed to investigate clinicians’ decision-making about broad-spectrum antibiotics for suspected maternal sepsis in women admitted to hospital for childbirth, to identify if, how and why overtreatment may occur.
Qualitative study. Semistructured interviews were conducted online, transcribed verbatim, coded in MAXQDA and analysed using the thematic Framework Approach.
National Health Service (NHS) in England, Scotland and Wales, March–June 2024.
24 clinicians, purposively sampled for representation from relevant professions with roles in decision-making (n=15 obstetricians; n=4 anaesthetists; n=3 midwives; n=2 microbiologists).
Participants report increasing numbers of women in labour are being prescribed broad-spectrum antibiotics for suspected maternal sepsis per guidelines. Fear of missing sepsis, absence of evidence about sepsis during labour and beliefs about antibiotic use informed clinicians’ views, impacting workloads and women’s experiences. 9/24 participants said overtreatment is a problem; 21/24 believed overtreatment occurs. Clinicians’ beliefs, views and experiences are reported in three themes that provide a framework to explain how clinicians navigate guidelines including; why overtreatment can occur (Theme 1: The sepsis guideline is more than a guideline); how decisions to prescribe broad-spectrum antibiotics during labour are made (Theme 2: Trying to balance the whole picture) and where clinicians’ think the bigger picture problems lie (Theme 3: If we continue down this path where might we be). The framework encapsulates clinicians’ tacit knowledge governing decision-making and guideline use.
Clinicians link priorities for sepsis management and AMR, but antimicrobial stewardship comes second to concerns about missing sepsis in high-stakes maternity care. Overtreatment may be inevitable until better evidence to support decision-making for suspected maternal sepsis and point-of-care diagnostic tests for women in labour exist and are embedded in clinical guidelines and clinicians’ mindlines.
Intensive Care Units (ICUs) care for critically ill patients across all age groups, with many deaths occurring during or shortly after admission. For families, this can be associated with significant psychological distress, including prolonged grief, depression, and post-traumatic stress. Family experiences are influenced by the quality of end-of-life communication, involvement in decision-making, and the availability of bereavement support. Despite this, bereavement care across neonatal, paediatric, and adult ICUs remains inconsistent, highlighting the need for evidence-based strategies.
To identify, summarise, and report the effectiveness and impact of end-of-life and bereavement interventions delivered by ICU staff on family psychological, social, and physiological outcomes.
Overview of reviews.
Neonatal, paediatric, and adult ICUs internationally.
A comprehensive search (PROSPERO CRD42024581827) was conducted across Medline, Embase, Scopus, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, and PsycINFO, with an updated search in 2025. Screening was completed by two research team members. Risk of bias was assessed using ROBIS. Data were extracted as reported in each systematic review and analysed narratively.
Fifteen systematic reviews (145 primary studies) were included across neonatal (n = 4), paediatric (n = 1), adult (n = 9), and mixed settings. Interventions were diverse and often multi-component. Communication-focused strategies that were timely, honest, and individualised were associated with improved family satisfaction and perceptions of care. Opportunities for family presence, shared decision-making, and relational nursing support were reported as central to understanding, acceptance, and adjustment. Memory making and bereavement follow-up were valued, though impacts on psychological outcomes varied. Evidence was limited by inconsistent outcome measures and minimal paediatric-specific reviews.
ICU family-focused end-of-life and bereavement interventions can provide meaningful support, but effectiveness is difficult to determine due to inconsistent implementation and methodological variation. Findings highlight the importance of individualised and relational approaches, and suggest culturally responsive care may influence how interventions are experienced.
To explore transition experiences of newly graduated nurses transitioning into long-term care and home and community care.
Scoping Review.
Joanna Briggs Institute framework and Arksey & O'Malley's principles for scoping reviews were used. Covidence facilitated evidence selection. Two independent reviewers screened and extracted data, with a third resolving disputes. NVivo 14.0 supported data analysis, and thematic analysis highlighted transition experiences.
Data retrieved from Medline, EMBASE, CINAHL, PsycINFO, Scopus, Google Scholar and Google for published and grey literature; searched February 2026.
From 27 articles, analysis revealed four themes: (1) A Different World: Contextual Challenges in Long-Term Care and Home and Community Care Sectors, (2) Navigating as a New Graduate Nurse: Knowledge, Skills, and Behaviours, (3) Support and Guidance, (4) Emergence of Professional Self as a Nurse in Long-Term Care and Home and Community Care.
This review emphasized the need for addressing clinical and emotional aspects of transition, including proper orientation, tailored nurse residency programs, and workload management for facilitating integration and supporting development of nurses' professional identity.
This review may guide healthcare leaders in refining support systems for new nurses, ultimately elevating patient care standards in these sectors.
Addressing challenges new nurses face when assimilating into long-term care and home and community care environments may enhance nurse confidence, job satisfaction, recruitment, and retention.
The EQUATOR guidelines for PRISMA-ScR.
No patient or public contribution.
To determine the incidence of potentially stressful care interactions and their associated factors in hospitalized children observed over a 6-h period.
Observational, longitudinal, and prospective study.
The study was conducted in a paediatric inpatient unit at a teaching hospital in São Paulo, Brazil, with 75 hospitalized children aged between 28 days and under 10 years. The children were observed for 6 h during morning and afternoon periods to record the number of potentially stressful care interactions. Descriptive and inferential analyses were performed.
Eight hundred and fifty-nine potentially stressful care interactions were recorded, corresponding to a mean of 11 per child. Physical examinations were the most frequent procedure (n = 363; mean = 4.8), followed by vital signs measurements (n = 182; mean = 2.4) and nasal lavage (n = 119; mean = 1.6). The factors associated with a higher number of manipulations were younger children (p < 0.001), with emphasis on infants (mean = 16.7); those observed during the morning shift (mean = 12.3) (p = 0.04); and those with an underlying chronic condition (mean = 13.9) (p = 0.036).
Over a short observation period of hospitalized children, a high number of potentially stressful care interactions were observed, demonstrating the need to reflect on current care routines and identify opportunities for change.
This study has practical implications for healthcare professionals—particularly nursing staff—who routinely perform potentially stressful care interactions. These professionals must consider strategies to minimize frequent manipulations and/or reframe them through appropriate preparation of the child and family.
STrengthening the Reporting of OBservational studies in Epidemiology.
Acne vulgaris is a chronic inflammatory condition primarily caused by Cutibacterium acnes, which disrupts skin homeostasis, thereby triggering immune responses and sebum metabolism. Dysbiosis is an imbalance in the skin and gut microbiota identified as a significant factor contributing to acne progression. Standard therapy often relies on antibiotics, but the long-term use has increased antibiotic resistance, including in Indonesia. Consequently, alternative methods, such as probiotics and mesenchymal stromal cell secretomes, are gaining attention for immunomodulatory and regenerative properties. These novel therapies have shown promising results in modulating the skin and gut microbiota while reducing inflammation.
A phase 2 double-blind randomised controlled trial will be conducted using a parallel group design with four arms, namely: (1) standard therapy with oral probiotics and topical secretome (placebo), (2) standard therapy with oral probiotics (placebo) and topical secretome, (3) standard therapy with oral probiotics and topical secretome and (4) standard therapy with oral probiotics (placebo) and topical secretome (placebo). Sixty-four patients with mild to moderate acne vulgaris will be randomly allocated to these groups. Interventions will be administered over a period of 8 weeks, with outcomes to be measured at baseline and post-therapy. This study will be conducted at the Dermatology and Venereology Department of Bali Mandara General Hospital (RSBM). The primary outcome will be the reduction of comedones and inflammatory lesions, assessed using the Yolov8 method. Secondary outcomes will include gut and skin health parameters, such as tryptophan metabolites, collagen, pH, moisture, sebum levels and IL-6, to explore the relationship between microbiome balance, skin condition and inflammation in acne.
This study will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and the International Conference on Harmonisation–Good Clinical Practice guidelines. Ethical approval has been granted by the Health Research Ethics Committee of Bali Mandara Regional Hospital (Approval Reference Number: 060/EA/KEPK.RSBM.DINKES/2024). All participants will provide written informed consent prior to enrolment. Data confidentiality and participant safety will be upheld throughout the trial. The results of this study will be disseminated through journals, scientific conferences and relevant academic platforms to ensure wide accessibility and to support further research and clinical application in the field of dermatology, particularly in addressing antibiotic resistance and microbiome-based acne therapies.
FreshRSS 