Conectar
Spiritual well-being (SpWB) is a critical yet often underexplored component of holistic care for patients with advanced cancer. This study aimed to assess the SpWB and quality of life (QOL) levels and examine their correlation among patients receiving palliative care at a tertiary cancer centre in Kerala, India.
Institution-based cross-sectional observational study among patients with advanced cancer conducted between August 2023 and December 2024.
The outpatient department of a major tertiary-level, autonomous cancer centre under the Government of Kerala, India.
398 patients with advanced cancer aged 18 and above.
SpWB and QOL were measured using validated Malayalam versions of the Functional Assessment of Chronic Illness Therapy–Spiritual well-being Expanded Version and European Organisation for Research and Treatment of Cancer, Quality of Life Core 30 questionnaires, respectively. Data collection included patient self-reports or assistance by a medical social worker.
The median (IQR) age of participants was 59 (51–65) years; most were married (94.5%) and from an upper-lower socioeconomic background (55%). Hinduism was the predominant religion (67.1%). Almost all patients (99%) were aware of their diagnosis, but only 62.3% knew their prognosis. The median (IQR) SpWB score was 67.5 (57–76), significantly higher in females (p=0.02). The median (IQR) QOL score was 50 (41.7–66.7). SpWB was positively correlated with QOL (r=0.766, p
SpWB showed a strong positive correlation with QOL among patients with advanced cancer. Enhancing SpWB may play a pivotal role in improving overall QOL in palliative care settings.
Neutropenic fever (NF) has a crude mortality rate of 3–18%. International guidelines recommend that all patients with NF receive ultrabroad-spectrum antibiotics (UBSAs) within 1 hour of emergency department (ED) registration. However, over 70% patients presenting to hospital with suspected NF (sNF) cannot access absolute neutrophil count (ANC) result within 1 hour, do not have NF and do not require UBSAs. In ED and hospitalised patients with sNF, we hypothesise that the ASTERIC protocol effectively and safely reduces the use of UBSAs compared with standard care alone.
This pragmatic, parallel, multicentre, type 1, hybrid effectiveness-implementation, stepped-wedge, before-and-after, cluster randomised controlled trial aims to evaluate whether antibiotic prescribing can be safely reduced through implementing a multifaceted antibiotic stewardship intervention (ASTERIC) in adult patients with sNF presenting to EDs. The sNF was defined as a fever with a single oral temperature of ≥38.3°C (101°F) within 24 hours before ED registration or a temperature of ≥38.0°C (100.4°F) sustained over a 1-hour period, following last chemotherapy or targeted therapy within 6 weeks for any solid tumour, or in any period following therapies against leucaemia, lymphoma, myelodysplastic syndrome, aplastic anaemia, multiple myeloma or recipient of HSCT. The study will involve eight hospitals in Hong Kong with variable baseline practice. We will include 704 adult patients (352 patients in pre-implementation and post-implementation periods, respectively) with sNF (tympanic temperature ≥38.3°C) and 48 staff participants (6 staff participants in each hospital). Healthcare professionals will receive a multifaceted stewardship intervention consisting of risk assessment tools, fast-track ANCs, a decision tool for patient management and antibiotic use, supported by an educational package and staff interaction programmes (ASTERIC protocol). Patients’ blood ANC, and cancer therapy and chronic illness therapy scores will be measured. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and Proctor conceptual frameworks will be followed for evaluation of implementation. The main outcome measures are the mean total dose of UBSAs prescribed in 7 days and serious adverse events at 30 days. Data analysis will incorporate intention-to-treat, per-protocol and as-treated analyses for service outcomes (effectiveness, safety, quality of life assessments and cost-effectiveness) and mixed methods for implementation outcomes, informed by the Theoretical Domains Framework. We expect that the study results will inform health policy with improvement in hospital services in treating stable sNF, evidenced by improved safe antibiotic stewardship, early antibiotic de-escalation and reduced costs and length of stay.
The institutional review boards of all study sites approved this study. This study will establish the ASTERIC protocol safely improves antibiotic stewardship and clinical management in adult patients with sNF. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. All patients with sNF will be influenced by the new protocol which is agreed at hospital level. Randomisation is at hospital level, not patient level. Patient consent is sought for follow-up and data access, not for treatment. Staff consent is sought for interviewing.
Our objective was to examine the barriers and facilitators encountered by primary and secondary healthcare professionals when collaborating at the care continuum between primary and secondary care. We aimed to identify specific challenges, observed benefits and proposed changes. By analysing these experiences and identifying opportunities for redesign, we aimed to define specific domains that could improve collaboration, thereby supporting sustainable access to and quality of care in the face of rising demand and constrained resources.
A qualitative exploratory study using semi-structured interview data guided by two domains of the Consolidated Framework for Implementation Research (CFIR), including Inner Setting—Tension for Change and Individual Characteristics, as well as selected implementation outcomes defined by Proctor et al, all viewed through a service (re)design lens.
Consultation and communication between primary and secondary healthcare professionals in a Dutch urbanised area.
37 users of collaboration services (eg, telephone, correspondence) were interviewed between August 2021 and October 2022, including 14 general practitioners (GPs) (10 females, 4 males) and 23 specialists (10 females, 13 males).
Four key domains with subthemes, subdivided per operation and CFIR domain, were identified as central to optimising the collaboration of professionals within the primary-secondary care continuum: (1) software and record integration; (2) seamless personal interaction; (3) eliminating a sense of ‘us vs them’ and (4) gaps in continuity of care.
This study reveals that healthcare professionals in both primary and secondary care face similar collaboration challenges due to system-level issues and inadequate collaboration tools, leading to increased workload, miscommunication and reduced quality of care. Improving collaboration between GPs and specialists requires not only adjustments to individual services, but a comprehensive overhaul of the referral and back-referral process. A more integrated approach, addressing key domains, is crucial for enhancing care quality, streamlining workflows and improving health outcomes.
by Berrak Çakmak, Ebubekir Yıldız, Tuba Tortop
BackgroundThere are a few studies evaluating dental students’ knowledge and awareness of intraoral scanners. This study aims to evaluate and compare the knowledge and awareness of levels 3rd, 4th, and 5th-grade dental students regarding intraoral scanners and their use in orthodontics.
MethodsA survey adapted from similar studies was administered to a total of 278 volunteer undergraduate students [comprising 3rd (n = 94), 4th (n = 88), and 5th-grade (n = 96)] to assess their awareness of intraoral scanners. Descriptive statistics, including frequencies and percentages, were used to analyze the variables within the scope of the study. The Fisher–Freeman–Halton exact test was employed to compare responses across different academic years. A p-value of Results
Of the participants, 33.81% were 3rd-grade, 31.65% were 4th-grade, and 34.53% were 5th-grade dental students. There was no significant difference in the distribution of participants across academic grades (p > 0.05). Among the students, 96.81% of the 3rd-grade, 89.77% of the 4th-grade, and 83.33% of the 5th-grade students reported that they had never used an intraoral scanner (p rd-grade students (71.28%) believed that IOSs were used in the treatment of skeletal Class II malocclusions and the fabrication of maxillary expansion appliances, compared to the other grade groups. In contrast, 5th-grade students more frequently associated IOS usage with indirect bonding procedures (63.54%) (p Conclusion
Students in the 4th and 5th grades demonstrated a greater level of knowledge compared to 3rd-grade students. It is recommended that practical training opportunities be expanded and the dental curriculum be revised accordingly to support hands-on experience with intraoral scanners.
To identify a frame of reference for resident safety management in nursing homes.
Q-methodology.
This study was conducted using Q-methodology to identify shared perspectives about resident safety management among nursing home professionals. Data were collected from 13 May 2023, through 29 August 2023. Thirty-four professionals, including nurses, care workers, social workers and physical therapists, classified Q-samples into a normal distribution grid through Q-sorting. Data analysis was performed using the PQmethod programme. Q-factors were interpreted by integrating interview transcripts, demographic data and factor arrays that organised the analysis results.
The analysis included the Q-sort of 33 professionals, with an average age of 46.03 years and 6.53 years of nursing home experience, after excluding one individual who did not fit any Q-factor. Four Q factors explaining 63% of the total variance were identified: constructing individualised possible risk trajectories, utilising ingrained safety principles, creating supportive safety environments and coordinating safety principles with individual needs.
Understanding the diverse subjectivities of professionals can help develop strategies that promote collaboration among nursing home professionals and support preventive safety management practices.
The frame of reference derived from nursing home professionals' perspectives suggests a resident-tailored framework.
This study supports the development of interprofessional education tailored to the specific needs of nursing home settings by identifying shared perspectives among nursing home professionals. The findings highlight the need for clear guidelines to help professionals balance resident autonomy with safety and assess the impact of family involvement.
Reporting involved qualitative and quantitative approaches, in compliance with the MMAT criteria for mixed-method research.
No Patient or Public Contribution.
To develop a method for computationally detecting fall events using clinical language models to complement existing self-reporting mechanisms.
Retrospective observational study.
Text data were collected from the unstructured nursing notes of three hospitals' electronic health records and the Korean national patient safety reports, totalling 34,480 records covering the period from January 2015 to December 2019. Note-level labelling was conducted by two researchers with 95% agreement. Preprocessing data anonymisation and English translation were followed by semantic validation. Five language models based on pretrained Bidirectional Encoder Representations from Transformers (BERT) and Generative Pretrained Transformer (GPT)-4 with prompt programming were explored. Model performance was assessed using F measurements. Error analysis was conducted for the GPT-4 results.
Fine-tuned BERT models with the English data set outperformed GPT-4, with Bio+Clinical BERT achieving the highest F1 score of 0.98. Fine-tuned Korean BERT with the Korean data set also reached an F1 score of 0.98, while GPT-4 achieved a competitive F1 score of 0.94. GPT-4 with prompt programming showed much higher F1 scores than GPT-4 with a standardised prompt for the English data set (0.85 vs. 0.39) and the Korean data set (0.94 vs. 0.03). The error analysis identified that the common misclassification patterns included fall history and homonyms, causing false positives and implicit expressions and missing contextual information, causing false negatives.
The clinical language model approach, if used alongside the existing self-reporting, promises to increase the chance of identifying the majority of factual falls without the need for additional chart reviews.
Inpatient falls are often underreported, with up to 91% of incidents missed in self-reports. Using language models, we identified a significant portion of these unreported falls, improving the accuracy of adverse event tracking while reducing the self-reporting burden on nurses.
Not applicable.
Chronic wounds pose a public health challenge, with community pharmacists increasingly recognised for their potential role in wound care. Since all chronic wounds originate from acute wounds, pharmacists can play a proactive role in preventing chronicity. Assessing pharmacy staff's wound care knowledge is essential as initiatives to enhance their involvement are underway in Australia. This study aimed to assess wound care knowledge among pharmacists and non-pharmacist staff in Australian community pharmacies. A national cross-sectional electronic survey was conducted between January and August 2022. Developed with multidisciplinary experts, it assessed understanding of wound healing, referral protocols, wound identification, management, and dressing selection. Descriptive and content analyses were performed, and multivariate linear regression identified predictors of knowledge scores. Of 120 responses, 70% were pharmacists, 14% non-pharmacist staff, and 16% unspecified. The median knowledge score was 27 out of 37 (IQR = 21, 30; range = 5–37). Profession, experience, and prior training were significant predictors of higher scores (p < 0.001, R 2 = 0.347). Dressing knowledge was weakest, with only 10 out of 103 respondents (9.7%) correctly identifying all types and applications. Critical knowledge gaps underscore the need for targeted educational interventions for pharmacy staff.
To systematically synthesise nurses' perspectives on dignified death, providing a culturally informed and comprehensive understanding.
Meta-ethnography.
This study was conducted using Noblit and Hare's approach, which included reciprocal translation, refutational synthesis, and line-of-argument synthesis. Methodological rigour and credibility were evaluated using the Critical Appraisal Skills Program (CASP) checklist. The review included peer-reviewed qualitative studies published in English or Korean that focused on nurses' or nursing students' views on dignified death in end-of-life care.
A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and the Web of Science in August 2023, with an updated search in August 2024. Seventeen qualitative studies published between 2010 and 2024 met the inclusion criteria.
Four interconnected themes emerged: A death that embraces humanity, a death that preserves personal identity, a death that facilitates connection and reconciliation, and a death that affirms acceptance and spiritual serenity. These themes, including eight sub-themes, highlight cultural influences shaping nurses' approaches to dignified death.
The findings emphasise the influence of cultural context in shaping end-of-life care and support the development of culturally sensitive nursing education and guidelines to enhance care quality.
This research provides culturally grounded strategies to improve end-of-life care and strengthen nurses' competencies in delivering holistic support.
This study highlights cultural variations in nurses' approaches to balancing autonomy, family expectations, and spiritual needs, offering practical insights for holistic, patient-centred, and culturally sensitive care.
This review complies with the Equator and improving reporting of meta-ethnography (eMERGe) guidelines.
No patient or public contribution.
Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.
To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.
A multicenter simulated observational study.
The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.
Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564–0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.
Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.
The study was conducted and reported according to the STROBE statement.
No patient or public contribution.
To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.
A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.
Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.
English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.
Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.
The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.
A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.
This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.
This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.
Trial Registration: The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885
To present the pooled estimated prevalence of adverse events in pronated intubated adult COVID-19 patients.
A systematic review and meta-analysis.
This study used the Cochrane Library, CINAHL, Embase, LILACS, Livivo, PubMed, Scopus, and Web of Science databases as data sources.
The studies were meta-analysed using JAMOVI 1.6.15 software. A random-effects model was used to identify the global prevalence of adverse events, confidence intervals and the heterogeneity data. Risk of bias was assessed using the Joanna Briggs Institute tool, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Of the 7904 studies identified, 169 were included for full reading, and 10 were included in the review. The most prevalent adverse events were pressure injuries (59%), haemodynamic instability (23%), death (17%) and device loss or traction (9%).
The most prevalent adverse events in mechanically ventilated pronated patients with COVID-19 are pressure injuries, presence of haemodynamic instability, death and device loss or traction.
The evidence identified in this review can help improve the quality and safety of patient care by helping to design care protocols to avoid the development of adverse events that can cause permanent sequelae in these patients.
This systematic review addressed the adverse events related to prone position in intubated adult COVID-19 patients. We identified that the most prevalent adverse events in these patients were pressure injuries, haemodynamic instability, device loss or traction and death. The results of this review may influence the clinical practice of nurses who work in intensive care units and, consequently, the nursing care provided not only to COVID-19 patients but for all intubated patients due to other reasons in intensive care units.
This systematic review adhered to the PRISMA reporting guideline.
As this is a systematic review, we analysed data from primary studies conducted by many researchers. Thus, there was no patient or public contribution in this review.
Single studies support the presence of several post-COVID-19 symptoms; however, there is no evidence for the synthesis of symptoms.
We attempt to provide an overview of the persistent symptoms that post-COVID-19 patients encounter, as well as the duration of these symptoms to help them plan their rehabilitation.
Systematic review and meta-analysis.
A total of 16 studies involving 8756 patients post-COVID-19 were included.
The CINAHL, PubMed, EMBASE, Scopus, and Web of Science databases were searched from 2019 to August 2021. Observational studies that reported data on post-COVID-19 symptoms were included. The methodological quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal for Observational Studies. We included medium- to high-quality studies. We used a random-effects model for the meta-analytical pooled prevalence of each post-COVID-19 symptom, and I 2 statistics for heterogeneity.
From the 2481 studies identified, 16 met the inclusion criteria. The sample included 7623 hospitalised and 1133 non-hospitalised patients. We found the most prevalent symptoms were fatigue and dyspnea with a pooled prevalence ranging from 42% (27%–58%). Other post-COVID-19 symptoms included sleep disturbance 28% (14%–45%), cough 25% (10%–44%), anosmia/ageusia 24% (7%–47%), fever 21% (4%–47%), myalgia 17% (2%–41%), chest pain 11% (5%–20%), and headache 9% (2%–20%). In addition to physical symptoms, anxiety/depression was also prevalent 27% (8%–53%).
Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms and experienced up to 12 months.
Multiple persistent symptoms are still experienced until 12 months of post-Covid 19. This meta-analysis should provide some awareness to nurses to highlights the unmet healthcare needs of post-COVID-19 patients. Long-term monitoring for the evaluation and treatment of symptoms and conditions and rehabilitation programs should be conducted.
FreshRSS 