Conectar
To assess anaesthesia capacity and practice in Sierra Leone by enumerating the anaesthesia workforce by volume, training level and distribution across urban and rural areas and facility ownership; estimating the prevalence of anaesthesia methods used for common surgical procedures by provider category; and evaluating hospital infrastructure and the availability of essential anaesthesia-related medications and equipment.
A nationwide, cross-sectional, facility-based study combining structured questionnaires administered through face-to-face interviews with facility leads and retrospective review of surgical and anaesthesia logbooks.
Public and private hospitals and clinics in Sierra Leone providing surgical care with general, regional or local anaesthesia within an operating theatre.
69 of 78 eligible surgical facilities nationwide were included. Facilities providing surgical services between September 2022 and August 2023 were eligible; facilities without registries or declining participation were excluded.
Across participating facilities, the anaesthesia workforce comprised 198 full-time positions, predominantly non-physician providers, with only 40.4% (80/198) trained to administer anaesthesia independently. Ketamine-based and spinal anaesthesia were most common, while general anaesthesia with a protected airway accounted for just 5.0% (415/8339) of procedures. Anaesthesia practices varied by provider training level. Essential infrastructure, equipment and medications fell below international minimum standards, with shortages most pronounced in rural facilities.
Severe shortages of certified anaesthesia providers, limited anaesthesia techniques and inadequate material resources remain major barriers to safe anaesthesia and surgical care in Sierra Leone. Targeted investments in workforce development, infrastructure and resource allocation—particularly in rural areas—are required to improve the safety, quality and equity of anaesthesia care nationwide.
To identify and synthesise qualitative and quantitative evidence of nurse managers' qualities, practices and styles related to leading nurses' interprofessional collaboration.
Mixed-methods systematic review.
Two authors independently selected studies based on predefined inclusion criteria, assessed quality and extracted data. A thematic synthesis with a convergent qualitative design was used.
CINAHL, PubMed and Scopus were searched from January 1, 2010, to September 7, 2025. Citations of relevant articles were screened.
A total of 32 articles were included. The analysis revealed two leadership core qualities, five core practices, and three core styles of nurse managers that promote nurses' interprofessional collaboration. Core qualities were proficiency and mindset. Core practices comprised empowering, communicating and informing, commitment to interprofessional collaboration, creating possibilities, and establishing an enhancing atmosphere. Core styles included authentic, transformational, and transactional leadership styles.
The results reflect the situational nature of nursing leadership related to interprofessional collaboration. Successful leadership requires managers to adopt primarily a transformational leadership style, yet more traditional leadership is required occasionally. Results indicate that nursing leadership is foremost a process that evolves within its context.
Greater clarity on how leadership influences nurses' interprofessional collaboration supports leaders, organisations, and educational institutions in developing and sustaining effective leadership.
This review demonstrates that the quality of nursing leadership is a central factor for successful interprofessional collaboration.
The PRISMA guidelines for Systematic Reviews and Meta-Analysis were used.
This study did not include patient or public involvement in its design, conduct or reporting.
Multimorbidity or the presence of two or more long-term conditions is now common in people undergoing surgery. However, current care pathways often miss these healthcare encounters to support long-term health promotion. Therefore, there is a need for practical, scalable approaches that can be integrated into routine surgical care, for which limited solutions exist at present. We have co-designed a structured preoperative checklist to help identify and manage long-term conditions in patients listed for elective surgery. This study aims to evaluate the feasibility and acceptability of this preoperative checklist in patients undergoing elective surgery.
This is a mixed-methods feasibility study in one National Health Service trust in the UK. We will recruit up to 50 adults scheduled for elective surgery and use the checklist during initial surgical clinic appointments. Quantitative data will include recruitment and retention rates, completion of the checklist and baseline clinical characteristics, analysed using descriptive statistics. Qualitative data will be collected through semistructured interviews with up to 16 patients and clinicians. These interviews will be analysed thematically, guided by the Consolidated Framework for Implementation Research. Triangulation of quantitative and qualitative data will allow us to explore fidelity, acceptability, barriers and facilitators to implementation and refine the intervention ahead of a future pilot cluster randomised trial.
This study has received approval from the Yorkshire & The Humber - Sheffield Research Ethics Committee (approval number: 25/YH/0045). All participants will give written informed consent. Results will be published in peer-reviewed journals and shared with participants, the public and policy stakeholders.
To describe nurse leaders' perceptions of factors related to the development of their own interpersonal communication competence.
Qualitative descriptive study.
Individual semi–structured interviews were conducted with 21 nurse leaders in three wellbeing service counties in Finland. Data were collected between February and April 2024 and analysed using an inductive content analysis.
The analysis identified two main categories, each comprising several subcategories: (1) individual factors related to development, which encompassed participants' perceptions on how inherent qualities, personal experiences, reflexivity, motivation and communication training were related to the development of interpersonal communication competence, and (2) interpersonal factors related to development, which demonstrated the role of situational contexts, feedback and social support in competence development.
This study frames the development of nurse leaders' interpersonal communication competence as a lifelong and continuous process. The findings emphasise the interplay of individual and interpersonal factors, encompassing various competence categories and dimensions. This dynamic underscores the importance of developing interpersonal communication competence in workplaces through various practices, in addition to formal communication training.
The findings enhance our understanding of nurse leaders' interpersonal communication competence and the factors related to it. The study also identifies various practices for fostering nurse leaders' communication competence.
The study provides valuable insights for healthcare organisations and educational institutions by highlighting the importance of providing nurse leaders with opportunities to promote their interpersonal communication competence through both formal communication training and their daily work activities.
Reporting adhered to the SRQR checklist.
No patient or public Involvement.
To examine the association between behavioural risk factors and their physiological sequelae among adults aged 40 and above in Bo District, Sierra Leone.
Cross-sectional study.
Household survey in Bo District, Sierra Leone.
The study included 1978 randomly sampled adults aged 40 and above (44.4% male and 55.6% female). The majority of participants were aged 40–49 years (34.5%). Data were collected using a household survey based on the validated WHO STEPs questionnaire.
Multivariable logistic regression analysis was performed to determine associations between behavioural risk factors (diet, physical activity and salt intake) and the presence of hypertension, diabetes and/or obesity, adjusting for sociodemographic variables.
The primary outcomes were the presence of hypertension, diabetes or overweight/obesity. Hypertension was defined as systolic blood pressure of ≥140 mm Hg and/or diastolic blood pressure of ≥90 (measured); diabetes as fasting glucose of ≥7.0 mmol/L, random plasma glucose level of ≥11.1 mmol/L or the use of antidiabetic medications (self-reported) and overweight/obesity as having a body mass index of ≥25 kg/m² (measured).
At least one physiological risk factor for cardiovascular diseases, that is, hypertension, obesity or diabetes, was present in 43.5% of participants. Hypertension was associated with urban living (OR=1.46, 95% CI (1.41 to 1.51)), older age (OR for 80+=3.98, 95% CI (3.70 to 4.28)), insufficient fruit and vegetable intake (OR=1.52, 95% CI (1.46 to 1.60)) and low physical activity (OR=1.35, 95% CI (1.27 to 1.43)). Diabetes was associated with urban residence (OR=1.84, 95% CI (1.66 to 2.05)), older age (OR for 70–79=3.82, 95% CI (3.28 to 4.45)), low fruit and vegetable consumption (OR=1.61, 95% CI (1.36 to 1.90)), high salt intake (OR=1.34, 95% CI (1.21 to 1.49)) and low physical activity (OR=1.47, 95% CI (1.26 to 1.71)). Obesity was associated with urban living (OR=1.66, 95% CI (1.59 to 1.72)), high salt intake from two or more sources (OR=1.21, 95% CI (1.17 to 1.25)) and low physical activity (OR=1.30, 95% CI (1.22 to 1.39)). Male sex (OR=0.37, 95% CI (0.36 to 0.38)) and older age (OR for 80+=0.39, 95% CI (0.35 to 0.43)) were protective factors.
In Bo District, nearly half of adults over 40 face hypertension, diabetes or obesity, especially urban dwellers, older age groups and those eating too few fruits and vegetables, consuming excess salt and getting little exercise. Public health efforts should focus on urban-targeted nutrition education, salt-reduction strategies, community exercise programmes and routine blood pressure and glucose screening, working with local leaders to ensure sustainable lifestyle changes and early disease detection.
Background
Comorbidities such as Type 2 diabetes mellitus significantly and adversely influence heart failure outcomes, especially in Black adult populations. Likewise, heart failure has a negative effect on diabetes and cardiometabolic outcomes. Dyspnea, a common symptom of heart failure, often correlates with disease severity and prognosis. However, the relationship between comorbid diabetes, dyspnea severity, and cardiometabolic biomarkers in Black adults with heart failure remains understudied.
Objectives
The purpose of this pilot study was to examine differences in the distressing heart failure symptom of dyspnea and in cardiometabolic and inflammatory biomarkers in Black adults living with heart failure with and without diabetes.
Methods
Black adults with heart failure were enrolled in this cross-sectional pilot study. Cardiometabolic and inflammatory biomarkers were measured via multiplex immunoassay. Univariate general liner models were used to identify group differences between persons with heart failure with comorbid diabetes and those without, controlling for age, sex, and comorbid burden.
Results
Participants were mostly female with a mean age of 55 years and mean left ventricular ejection fraction of 33%. Participants with diabetes exhibited higher dyspnea scores compared to those without diabetes, indicating greater symptom burden. Moreover, individuals with comorbid diabetes demonstrated higher levels of cardiometabolic and inflammatory markers.
Discussion
Comorbid diabetes was associated with higher dyspnea severity and adverse cardiometabolic profiles in Black adults with heart failure. These findings underscore the importance of targeted interventions addressing diabetes management and cardiometabolic risk factors to improve symptom control and outcomes in this high-risk population. Further research is warranted to elucidate the underlying mechanisms and develop tailored therapeutic strategies for managing comorbidities in persons with heart failure, particularly in minoritized communities. 
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