Conectar
Anastomotic leak is a major complication after anterior resection for rectal cancer, with reported rates of 10–15%. Recent evidence implicates the gut microbiome, where specific bacteria colonise the anastomotic site and secrete collagenase that weakens healing tissue. Preclinical studies demonstrate that tranexamic acid can inhibit this process when delivered rectally into the bowel lumen. This protocol outlines a feasibility trial of rectally administered tranexamic acid delivered via rectal catheter to the anastomotic site after anterior resection, accompanied by embedded microbiome and qualitative substudies.
This is an open-label, single-centre, randomised controlled feasibility trial. 45 patients undergoing anterior resection for rectal or sigmoid cancer will be randomised 2:1 to receive tranexamic acid or sterile water, administered intraoperatively and on postoperative days 1–3 via a rectal catheter. Feasibility outcomes include assessment of recruitment, intervention adherence, protocol compliance and safety. Exploratory clinical outcomes include anastomotic leak and other postoperative complications. A mandatory microbiome substudy will characterise changes in microbial composition and bacterial collagenase activity, providing mechanistic insight into treatment response. An optional qualitative substudy will explore acceptability of the intervention from the perspectives of patients and healthcare professionals.
The protocol was approved by the North West Liverpool Central Research Ethics Committee and the Medicines and Healthcare products Regulatory Agency on 30 October 2024 (24/NW/0254). Recruitment commenced on 7 January 2025 following receipt of site-specific approvals. Feasibility, mechanistic and qualitative findings will be disseminated through peer-reviewed publications, academic conferences and stakeholder engagement activities. The results will inform progression to a definitive phase III trial and shape key elements of study design.
Reports of evidence-based practice (EBP) and quality improvement (QI) in nursing journals often vary in reporting quality, hindering translation into practice. A critical appraisal tool for evidence-based practice quality improvement (EBPQI) has recently been made available on the EQUATOR Network.
A descriptive cross-sectional study of full-length articles (Jan–Jun 2025) from 28 nursing journals that accept reports of EBP and/or QI (per submission guidelines); each article was scored by two authors using the open-access critical appraisal tool for EBPQI.
Collectively, these journals published 86 issues and 949 full-length articles; 30 (3.2%) articles were identified as EBP or QI reports and were published among 10 (33%) journals. Of these 30 articles, only 6 (20%) used appropriate EBP and/or QI methods and were therefore appraised using the EBPQI critical appraisal tool. Based on the EBPQI critical appraisal tool, the EBP and QI reports varied in how and to what extent they met EBPQI criteria.
Variation exists in journal guidance and reporting of EBP/QI initiatives. Consistent use of EBPQI criteria highlights the need for standardized reporting to improve transparency, transferability, and translation into practice.
Transparent, standardized reporting of EBP and/or QI initiatives enables clinicians to appraise relevance and transferability to practice. Reporting aligned with recognized guidelines (or clear justification for deviations) is warranted.
To identify nurse practitioners' and registered nurses' willingness to participate in voluntary assisted dying, and the factors that influence these decisions.
A cross-sectional design.
An online survey was disseminated to members of 16 professional nursing organisations and associations between April and August 2024.
Responses from 396 participants were analysed. Most were registered nurses (n = 335, 84.6%), aged between 45 and 64 years (n = 217, 54.8%). Over half of the participants (n = 219, 55.3%) had some knowledge of voluntary assisted dying, and more than two-thirds (n = 274, 69.2%) strongly supported it. Respect for a person's rights (n = 345, 89.8%) and relieving suffering (n = 342, 89.1%) were the main reasons nurses participated. Most nurse practitioner participants would be prepared to assess a person's eligibility for voluntary assisted dying (n = 32, 82.1%) or prescribe a substance (n = 31, 79.5%), if permitted by law. Religion, age and years of experience were characteristics associated with reasons for participation.
In Australia, some RNs and NPs are willing to participate in a range of VAD-related activities. However, in some jurisdictions, nurses' engagement is limited by legislative and policy settings. Reconsideration of nurses' roles may enhance access.
With appropriate support, nurses can make a valuable contribution to the sustainability of the voluntary assisted dying workforce.
by Honor Morris, Maria Duaso, Marilyn Ijeomah-Orji, Lisa Akester, Jenny Roddy, Jayne Samples, Kate Heighway, Nigel Simpson, Tomasina Stacey
BackgroundOnline peer support groups offer virtual spaces where members can share experiences, seek advice, and offer mutual support. While in-person peer support in pregnancy has shown benefits such as improved well-being and reduced isolation, limited research has explored online peer support groups. This scoping review aims to examine the types, contexts, and perceived benefits of online peer support for pregnant people.
MethodsA systematic search was conducted in five databases (Embase, Medline PsychInfo, MIDIRS and CINAHL) from inception to December 2024. Eligible studies examined online peer support accessed by pregnant participants with direct interaction. Thematic analysis was applied to identify structural factors influencing the functioning of online peer support groups. The Langford Conceptual Analysis of Social Support was used to categorise type of support.
FindingsA total of 27 studies were included. The findings highlighted several structural factors that influence the functioning of online peer support groups for pregnant people. Group size was identified as a key factor, with smaller groups promoting more meaningful interactions. Active moderators supported participant interaction and ensured information quality, while privacy settings, such as closed groups and anonymised participation, fostered safe discussions. Emotional support, such as expressions of empathy, reassurance, and encouragement, was the most reported benefit, followed by informational and appraisal support. Instrumental support was observed less frequently.
ConclusionThis scoping review identified key structural factors shaping the design and functioning of online peer support groups for pregnant people. Group size, active moderation, and privacy settings influenced participation and engagement. Further research is recommended to explore how these structural elements impact long-term engagement and overall effectiveness for pregnant people.This project is funded by the National Institute for Health and Care Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number NIHR205347). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
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