Conectar
Recognising and acting on the connection to Country as a determinant of Indigenous peoples’ well-being is necessary to improve health inequities. Indigenous Australians experience a greater burden of chronic liver disease and poorer outcomes due to ongoing impacts of colonisation across determinants of health. This is exacerbated by a gradient in health outcomes based on remoteness, lack of specialist healthcare services and barriers to access. Our research aims to explore better ways to provide chronic liver disease screening and surveillance for very remote Indigenous Australian communities using non-invasive technologies On-Country.
Using an innovative combination of Indigenous and Quantitative research methodologies, this project involves 11 communities across four very remote sites in South Australia and Western Australia. The study comprises three parts: (1) site engagement with Aboriginal health services and remote communities; (2) a 12-month liver check (screening) phase and (3) a 24-month liver monitoring (surveillance) phase. The liver monitoring phase will use a stepped-wedge randomised controlled trial design where sites will have usual hepatocellular carcinoma (HCC) monitoring for a period of between 6 and 18 months and then On-Country monitoring for a period of between 6 and 18 months depending on treatment-sequence allocation. Recommended HCC monitoring involves 6 monthly liver ultrasounds and serum alpha-fetoprotein as per the site’s usual care processes, where participants travel to regional centres for liver ultrasound. On-Country monitoring will involve liver ultrasound and serum tumour markers provided On-Country every 6 months. The primary outcome is the difference in adherence to surveillance On-Country compared with usual care. In addition to statistical and health economic methods, yarning circles have been incorporated to explore participant experiences, their knowledge of liver disease and views about the On-Country monitoring.
This study was granted ethics approval from the relevant national and state Aboriginal Health Research Ethics Committees. Findings will be reported to all participants and will be disseminated to the broader community and local health services. Translation of outcomes will be supported by key Indigenous Australian and healthcare stakeholders, including peak health bodies and consumer groups. Dissemination with the academic community will be through peer-reviewed publications and presentations at relevant conferences.
ACTRN12625000256471.
To synthesise qualitative evidence on factors influencing the mental wellbeing of aged care workers across professional roles and system levels.
Systematic qualitative review.
Systematic literature search for qualitative and mixed-methods studies. Data was synthesised using thematic and visual network analyses.
Five academic databases (Medline, Embase, Scopus, PsycINFO, and CINAHL) were searched from 1st January 2014 to 13th March 2025.
Thirty-eight studies were included, with most focused exclusively on nursing staff (n = 23, 61%). Staff experiences indicated that mental wellbeing challenges in aged care are both widespread and complex. Thematic synthesis identified 13 themes influencing mental wellbeing, including: three micro-level themes (personal factors; work engagement; workers' skills and abilities); seven meso-level themes (job demands; professional relations; job control; leadership; professional development; workplace resources; organisation-level governance); and three macro-level themes (policy and regulation; structure and governance; societal perceptions).
This review highlights the complex, multi-level factors influencing aged care worker mental wellbeing and underscores the need for coordinated interventions spanning individual, organisation, and broader system-level domains. The review extends existing conceptual models by demonstrating that workforce wellbeing is shaped not only by individual and organisational factors but also by broader societal narratives and governance structures.
Improving aged care worker wellbeing is essential for workforce sustainability and quality of care. Findings support the development of targeted, multi-level interventions.
Understanding the drivers of mental wellbeing provides aged care providers with a framework for action that goes beyond individual coping, focusing on strengthening workplace environments, including organisational culture, leadership, staffing, and resources. For policymakers, the findings demonstrate how policy and governance decisions shape frontline experiences, offering evidence to guide workforce reform.
The PRISMA guidelines were used.
PROSPERO CRD420251053123.
No patient or public contribution.
Growing numbers of clinicians are dealing with mental and behavioral health issues, including burnout, depression, and suicidal ideation. Prevalence of these conditions in pediatric critical-care (PCC) nurses is reported to be as high as 42%–77%.
The purpose of this evidence-based quality improvement project was to implement a cognitive behavioral skills-building (CBSB) program to improve well-being and resiliency in PCC nurses.
The 7-week MINDBODYSTRONG (MBS) program was implemented with two cohorts of neonatal/PCC nurses in a 222-bed academic, tertiary care pediatric hospital, using a virtual platform and offering 1 sequential session per week. Each participant was asked to complete an anonymous baseline and post-program survey that included the following measures: Generalized Anxiety Disorder (GAD-2), Perceived Stress Scale (PSS4), Patient Health Questionnaire (PHQ-2), and a Single Item Measure of Burnout. Post-program surveys also included a MBS program evaluation.
Fifteen RNs registered for and completed the MBS program. 93.3% completed both the baseline and post-program survey. Results demonstrated positive clinical effects across all four mental health measures with large effects noted in the GAD-2 and PSS-4, and small effects noted in the PHQ-2 and the Single Item Measure of Burnout. 100% of participants found MBS helpful and recommended that it be offered to a wider audience.
Implementation of the MBS CBSB program demonstrated clinical effectiveness on measures of anxiety, perceived stress, depression, and burnout in PCC nurses. The program was well received by participants. Strategies for broader implementation should be explored.
by José Manuel García-Moreno, Tyler Adams, Amber Beynon, Janine Vlaar Olthuis, Stephan U. Dombrowski, Richelle Witherspoon, Niels Wedderkopp, Jeffrey J. Hébert
BackgroundRehabilitation and behavior change interventions are commonly used after lumbar surgery to improve recovery, but their effects on physical capacity and physical activity remain unclear. This study aimed to investigate the effectiveness of rehabilitation and behavior change interventions on physical capacity and physical activity behavior in patients following lumbar surgery for degenerative disease.
MethodsEMBASE, MEDLINE, PsycINFO, and CENTRAL were searched from inception to September 2025 and reference lists were hand-searched. Randomized controlled trials assessing rehabilitation or behavior change interventions on physical capacity or physical activity behavior in adults with lumbar degenerative disc disease who underwent lumbar surgery were included. Review author pairs independently extracted data and assessed included studies. Risk of bias was assessed with the Cochrane tool, and study quality with the Grading of Recommendations Assessment, Development and Evaluation classification. Results were pooled using random-effects models and reported as standardized mean differences (SMD) with 95% confidence intervals (CI).
ResultsExercise was more effective than minimal or usual care in improving trunk extension endurance in the immediate term (SMD, 1.54; 95% CI, 0.93–2.16). Supervised exercise outperformed self-directed exercise in improving trunk extension endurance in the immediate term (SMD, 1.28; 95% CI, 0.75–1.81). Psychologically informed rehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.26; 95% CI, 0.02–0.49), but not in the immediate term (SMD, 0.17; 95% CI, −0.14 to 0.49). Physical activity advice did not increase physical activity levels compared to minimal or usual care in the immediate term (SMD, 0.21; 95% CI, −0.13 to 0.55). Prehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.28; 95% CI, 0.03–0.53). Certainty of evidence ranged from low to moderate.
ConclusionsFor adults with lumbar degenerative disease who underwent lumbar surgery, exercise, especially supervised programs, improved trunk extension endurance in the immediate term. Psychologically informed rehabilitation and prehabilitation increased physical activity levels in the intermediate term, while physical activity advice showed no benefit. Findings are limited by low certainty of evidence and high risk of bias.
Skin failure is increasingly recognised across healthcare settings, yet its definition, diagnostic criteria and relationship to pressure injuries remain inconsistent with little interdisciplinary consensus. This lack of clarity complicates bedside assessment, documentation and quality reporting. Historically, pressure injuries were viewed as preventable events associated with inadequate care, but growing evidence shows that some wounds develop despite optimal preventive measures, particularly in patients with multimorbidity or limited physiological reserve. This article will review the historical development of skin failure and how it is intertwined with contrasting theories of pressure injury formation that began in the 19th century. We will track the proliferation of definitions and overlapping terms that muddle contemporary documentation and classification, and demonstrate why a unified definition is urgently needed. Skin failure represents the intersection of tissue deformation with systemic vulnerability including hypoperfusion, inflammation, vascular dysfunction, oedema, medication effects, immune compromise, nutritional depletion and age-related changes. A meaningful and practical definition must span all healthcare environments and patient populations, supporting accurate diagnosis and equitable evaluation of care quality. We outline a call to action that includes interdisciplinary consensus, standardised terminology and the development of predictive tools that integrate physiologic data, advanced analytics, and patient-centered outcomes across the healthcare continuum.
by Jordan Bellis, Lydia Monk, Ritika Jhawar, Galia Pollock, Angela Liu, Charleen Jacobs-McFarlane, Brittany McCrary, Jeffrey Glassberg, Susanna Curtis
Sickle Cell Disease (SCD) is a hemoglobinopathy affecting millions of people globally. Pain, both acute and chronic, affects over half of those living with SCD, but treatment of chronic pain is an ongoing challenge. While opioid treatments are widely used for chronic pain, it’s efficacy is limited, so alternatives must be explored. This protocol outlines a procedure for investigation of dronabinol, an FDA-approved synthetic tetrahydrocannabinol (THC), for the treatment of pain in patients living with SCD and chronic pain. The study is an 8-week, randomized, double-blind placebo-controlled study which aims to assess both the efficacy and safety of this opioid alternative to pain treatment. The study will also track biomarkers of inflammation as THC has demonstrated anti-inflammatory properties, and inflammation is a driver of SCD pain and disease severity. Results from this study have the potential to further clinical understanding of cannabinoids for pain management in Sickle Cell Disease treatment and spark new questions for research.by Helen W. Li, Jesse Kiprono Too, Sarah Nyanchama Nyariki, Charles Nathan Nessle, Sara Malone, Rachel Matsumoto, Teddy Ashibende Aurah, Jeffrey A. Blatnik, JoAnna Hunter-Squires, Ivan Seno Saruni
BackgroundCapacity for elective general surgical care is an important reflection of a health system’s ability to meet a population’s surgical needs and is currently known to be inadequate in many low- and middle-income countries. Patient agency is a key, understudied factor which shapes how and when patients ultimately decide to engage with formal care. Understanding factors which influence patient care seeking activity can have important implications for how current and future health systems may be utilized. This study aims to explore how patients approach the navigation and triage of their elective hernia condition within the Kenyan surgical care system.
MethodsWe conducted a qualitative study of 38 convenience-sampled patients diagnosed with an elective hernia condition at a tertiary referral hospital in Kenya between November 2023 and March 2024. We utilized Braun and Clarke’s six-step model of thematic analysis to generate key themes across the phases of care seeking, reaching and receiving as modeled in the Three Delays Framework.
ResultsWe identified three main cross-cutting themes including (1) the flow of power from patients to providers, and vice versa, take the form of consent or knowledge, respectively; (2) trust is a limited currency required for patients to engage with formal care; and (3) internal and external contextual factors remain the foundation for patient-provider care activities. We incorporated these themes together in a framework which illustrates the cyclical nature by which each factor feeds back on the others, ultimately affecting patient care.
ConclusionsFluctuating flows of patient power and trust interacts with existing infrastructural context to influence the ability of a health system to generate care. Recognizing the interaction of these key factors may have important bearing on the successful implementation of any larger systemic efforts or policies to improve access to elective surgical care.
by Wenshu Li, Jeffrey A. Leibowitz, Shuoguo Wang, Louisa Walker, Chang Xu, Kuei-Ting Chen, Alexa B. Schrock, Jason Hughes, Nimesh Patel, Julia A. Elvin, Lauren L. Ritterhouse, Ethan Sokol, Garrett Frampton, Lucas Dennis, Bahar Yilmazel, Brennan Decker
Homologous recombination repair (HRR) is a cellular pathway for high-fidelity double strand DNA break repair that uses the sister chromatid as a guide to ensure chromosomal integrity and cell viability. Deficiency in the HRR pathway (HRD) can sensitize tumors to poly (ADP-ribose) polymerase inhibitors (PARPi) and platinum-based chemotherapy, offering an avenue to identify patients who may benefit from targeted therapies. HRD signature (HRDsig) is a pan-solid-tumor biomarker on the FoundationOne®CDx (F1CDx®) assay that employs a DNA scar-based approach to calculate a score based on copy number features (e.g., segment size, oscillation patterns, and breakpoints per chromosome arm) and does not rely on HRR gene alterations, enabling detection of genomic and epigenetic mechanisms of HRD. After finalizing the HRDsig algorithm, analytical validation was conducted in a CAP-accredited, CLIA-certified laboratory on 278 solid tumor and normal tissue specimens. HRDsig results were compared with an independent HRD biomarker, defined by the presence of a reversion mutation restoring HRR gene function. In this evaluation, 100 HRD-positive and 126 HRD-negative samples showed a positive percent agreement of 90.00% and a negative percent agreement of 94.44%. The limit of detection (LoD) was estimated at 23.04% tumor purity, with the limit of blank (LoB) confirmed as zero in 60 normal tissue replicates. Reproducibility testing on 11 positive and 11 negative samples across multiple labs, reagent lots, and sequencers yielded agreement in 99.49% of positive and 99.73% of negative replicates. HRDsig status remained consistent in the presence of interfering substances, demonstrating 100% concordance in spiked samples. These validation results underscore the high analytical concordance, low false-positive rate, and overall robustness of HRDsig for reliable assessment of homologous recombination deficiency.To examine and synthesise the current literature to gain insights into nursing students' experiences, their perceived learning effectiveness of patient safety and its influencing factors.
Integrative review.
CINAHL, Medline, Scopus, and Embase databases from January 2011 to October 2023.
Of the 5940 papers initially retrieved, 33 were included after title, abstract, and full-text screening. No papers were omitted through quality appraisal.
Despite nursing students' generally positive attitude towards patient safety, their idealistic view did not translate into actual actions of upholding patient safety due to various factors. Moreover, their experiences and perceived effectiveness of learning patient safety were influenced by factors such as organisational safety culture and pedagogical contexts. Thematic analysis revealed four themes: ‘perception, attitudes, and evaluation towards patient safety’; ‘supportive organizational culture as impetus to promote patient safety’; ‘perceived confidence, knowledge, and competence toward patient safety’; and ‘educational contexts and pedagogies to promote learning of patient safety’.
There is an inadequate focus on patient safety in clinical education compared to classroom education. Given that the clinical setting serves as an authentic learning environment of patient safety, nursing faculties play a crucial role in reforming existing nursing curricula to integrate patient safety education in both settings to ensure continuity of learning. Clinical nursing leaders should also proactively review and reform organisational culture and practices to enable nursing students' acquisition and internalisation of patient safety learning.
This review highlighted the need for further collaboration between nursing faculties and healthcare institutions to advocate an environment conducive to nursing students' effective learning of patient safety.
Reporting adheres to the Reporting items for systematic review and meta-analyses (PRISMA) 2020 guidelines.
No patient or public contribution.
To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.
Systematic review.
Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.
Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.
The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.
Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.
Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.
These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.
This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
No patient or public contribution.
Trial Registration: CRD42023413817
Background
Chronic pain is a major cause of distress and disability, and biomarkers may aid in the assessment and treatment of it. Urine metabolites may be valuable bioindicators that can provide biological insight regarding chronic pain.
Objectives
To investigate the relationship between a multimarker composite measure of metabolites and patient-reported outcomes scores in adults with chronic pain, using data from a pragmatic clinical trial with a sequential, multiple-assignment randomized trial design.
Methods
Self-reported measures and urine samples from 169 active-duty service members with chronic pain were collected. Urine was analyzed using a preestablished panel of metabolites, including four previously identified biomarkers of pain: kynurenic acid, pyroglutamic acid, ethylmalonic acid, and methylmalonate. Multivariable linear regression models—adjusted for participant characteristics such as age and sex—were used to cross-sectionally examine the relationship between 11 patient-reported outcomes (fatigue, sleep-related impairment, anxiety, depression, anger, pain catastrophizing, physical function, pain interference, satisfaction with participation with social roles, pain intensity, and pain impact score) and the four urine metabolites both individually and as a composite (urine metabolite pain indicator, or UMPI). Given the study’s small sample size and exploratory nature, a significance threshold of p ≤ .10 was used for all analyses.
Results
The UMPI showed statistically significant associations with five self-reported measures (fatigue, anxiety, depression, physical functioning, and pain impact score); adjusted Pearson correlations ranged from .18 to .25. Individual metabolite analyses supported these findings, with all relationships between individual metabolites and self-reported measures showing positive associations. Kynurenic acid and ethylmalonic acid showed the strongest associations, each having statistically significant relationships with four individual self-reported measures, while pyroglutamic acid had statistically significant relationships with three self-reported measures and methylmalonate with none. The UMPI demonstrated feasible reliability.
Discussion
Our finding of associations between the UMPI and components of the self-reported measures supports the development of the UMPI and these four urine metabolites as biomarkers for chronic pain outcomes. Further research is planned and will be essential for establishing mechanistic insight and guiding biomarker development within the context of pain management. No abstract available Background
Engagement with self-monitoring of blood pressure (BP) declines, on average, over time but may vary substantially by individual.
Objectives
We aimed to describe different 1-year patterns (groups) of self-monitoring of BP behaviors, identify predictors of those groups, and examine the association of self-monitoring of BP groups with BP levels over time.
Methods
We analyzed device-recorded BP measurements collected by the Health eHeart Study—an ongoing prospective eCohort study—from participants with a wireless consumer-purchased device that transmitted date- and time-stamped BP data to the study through a full 12 months of observation starting from the first day they used the device. Participants received no instruction on device use. We applied clustering analysis to identify 1-year self-monitoring, of BP patterns.
Results
Participants had a mean age of 52 years and were male and White. Using clustering algorithms, we found that a model with three groups fit the data well: persistent daily use (9.1% of participants), persistent weekly use (21.2%), and sporadic use only (69.7%). Persistent daily use was more common among older participants who had higher Week 1 self-monitoring of BP frequency and was associated with lower BP levels than the persistent weekly use or sporadic use groups throughout the year.
Conclusion
We identified three distinct self-monitoring of BP groups, with nearly 10% sustaining a daily use pattern associated with lower BP levels. 
FreshRSS 