To evaluate the feasibility and relevance of the LIFE-UP Day audit, a simple, 1-day benchmarking tool based on the multidisciplinary LIFE-UP bundle (Limit sedation, optimise nutritional Intakes, engage Families, promote Exercise and follow-UP the patients after discharge) and assessing the implementation of postintensive care syndrome (PICS) prevention strategies in daily practice.
Exploratory multicentre cross-sectional audit study.
Eight Belgian adult intensive care units (ICUs), between April and July 2024.
All patients present at 08:00 on the audit day and hospitalised for ≥24 hours.
An independent nurse collected data on sedation, analgesia, nutrition, family empowerment, physical exercise and post-ICU follow-up. A multidimensional LIFE-UP composite score (raw 0–10 points), normalised to a 5-point scale, was created to quantify adherence to PICS prevention practices based on current recommendations. Feasibility was evaluated through data accessibility, resource needs, cooperation of ICU teams and the ability to complete the audit within 1 day. Relevance was evaluated through adherence to the bundle, assessed by comparing LIFE-UP scores between ICUs. Quantitative results were expressed as median and IQR.
The audit was tested in 87 patients aged 68 (59–74) years, 9 (5–15.5) days after their admission. The audit was feasible across all ICUs: necessary data were available, resources required were minimal and cooperation was excellent. The LIFE-UP score highlighted significant variability between ICUs (2.5 (1.75–2.75), p
The LIFE-UP Day audit proved feasible and provides a first structured framework for benchmarking. Broader implementation will be essential to validate the LIFE-UP score, refine the model and ultimately determine whether it can translate into improved patient and family outcomes.
While there exist many individual and organisation-level initiatives aimed at reducing physician burnout and promoting wellness, there are no comprehensive frameworks or guidelines for evaluating initiatives targeted at physicians. To address this gap, we conducted a rapid review to understand the current state of initiative evaluation in this field and develop an evaluation framework for initiatives aimed at physician burnout and wellness.
A rapid review based on the Cochrane rapid review methods guidance.
MEDLINE, Embase and PsycInfo were searched from database inception to 2 May 2024 for concepts related to physicians, wellness initiatives and burnout, and organisational efforts.
We included studies with initiatives aimed at physician burnout, wellness or experience; targeted physicians, residents, fellows and/or physician faculty; were evaluated in some format; and took place within healthcare settings.
Two independent reviewers extracted data according to a standard template. For each study, we noted information related to the type of wellness initiative, evaluation approach, components measured in evaluations (‘evaluation indicators’) and gaps in evaluation. The same reviewers analysed the data quantitatively and thematically. Findings were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.
The database search yielded a total of 3786 references, of which 105 were included based on predefined inclusion and exclusion criteria. Various types of wellness initiatives (eg, mindfulness, peer support programmes, communities of practice) were delivered multimodally, or via curriculums and workshops, among other formats. Common evaluation approaches included surveys (95%, n=100/105) and interviews or focus groups (17%, n=18/105). Evaluation indicators spanned five categories: impacts (94.3%, n=99/105), participants’ reactions (65.7%, n=69/105), perspective and behaviour changes (46.7%, n=49/105), implementation (45.7%, n=48/105) and continuous improvement (6.7%, n=7/105). Evaluation gaps included limited responses from participants, failure to capture certain indicators (eg, physician turnover) and limited longitudinal measures.
Based on the findings and existing models, we developed a physician-focused evaluation framework, constituting two domains: implementation and impacts. This framework can enable organisations to better understand, assess and improve initiatives aimed at physician well-being, which can have positive impacts on patient care and the healthcare system.
The over 14 million African children who are HIV-exposed but uninfected (CHEU) are at risk for poor health outcomes, including neurodevelopmental conditions such as autism; however, no study to date has examined autism in CHEU in Africa, where the vast majority of these children live. Scalable diagnostic and neurobehavioural tools, including powerful, low-cost approaches such as eye-tracking, for detection and study of mechanistic neural processes are necessary to advance autism research in these settings. The objective of this study is to examine autism diagnostic outcomes and eye-tracking biomarkers in relation to CHEU while at the same time building capacity for neuro-health research in Kenya.
This study will leverage a longitudinally assessed cohort of CHEU and children who are HIV-unexposed and uninfected (CHUU) with well characterised HIV-related and contextual exposures. We will first determine and compare autism diagnostic outcomes between young CHEU and CHUU across a large cohort (n=850) of Kenyan children using research-grade autism assessment tools, and, second, determine whether neurobehavioural eye-tracking markers predict autism outcomes across this cohort.
Human subjects approvals have been obtained from Moi University Institutional Review and Ethics Committee (IREC; IREC/909/2024; Approval #0004835), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI; Reference #NACOSTI/P/25/415028), the Institutional Review Board of the Indiana University School of Medicine (Protocol #23171), with reliance agreements executed with Purdue University and Boston University. Dissemination of findings will occur through multiple channels within the research and clinical community, including peer-reviewed journal publications and conference abstracts and presentations. As part of capacity building efforts, the research team will also communicate study results to policy makers, the lay public and other health systems involved in the care of young children with disabilities via study-hosted workshops and conferences.
Personalised nutrition that incorporates genetic results into dietary interventions holds significant potential to optimise weight management and metabolic outcomes. While traditional calorie-restricted diets remain effective, emerging evidence suggests that variations in macronutrient distribution may offer additional benefits. Genetic variants help explain interindividual differences in dietary responses, with certain alleles showing enhanced weight loss and metabolic improvements with specific macronutrient distributions. However, comprehensive reviews of randomised controlled trials (RCTs) examining genotype-based dietary effects, particularly those focusing on macronutrient distribution metabolic pathway interactions, are lacking, limiting the development of robust evidence-based guidelines for nutrigenetic counselling. This systematic review aims to assess the influence of genetic variants on weight loss outcome in adults in response to varying macronutrient distribution diets (eg, low-fat, low-carbohydrate, high-protein diets) using evidence from RCTs.
We will systematically review RCTs examining weight loss outcomes of macronutrient-varied diets in adults with genotype stratifications to risk and protective allele. Multiple databases, PubMed, Cochrane Library, Scopus, Science Direct and Google Scholar, will be used. Reviewers will screen studies, extract data on study characteristics, weight loss, metabolic marker outcomes and genetic data, and assess the risk of bias using the Cochrane Risk of Bias Tool 2.0 tool.
All eligible RCTs will first be summarised in structured tables describing study characteristics, macronutrient distribution and genetic variants and will be analysed with narrative synthesis. For quantitative analysis, interventions will be grouped into three predefined diet types (high-protein, low to moderate carbohydrate and low-fat diet). Because heterogeneity across diet categories is expected, pooled effects will be estimated separately within each diet subgroup using random-effects meta-analysis, expressed as mean differences in weight change (kg). Within each subgroup, and when at least 10 studies or data are available, random-effects meta-regression will be used to examine potential moderators, including intervention duration, physical activity and ancestry. Heterogeneity will be evaluated using I2 and 2, and publication bias assessed when feasible. Evidence certainty will be graded using Grading of Recommendations Assessment, Development and Evaluation.
Ethical approval is not required for this protocol as it involves the analysis of data from primary studies. The findings will be disseminated through publication in peer-reviewed journals. Any enquiries regarding research integrity of this protocol may be directed to the Head of the Doctoral Program in Medical Health and Sciences, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada via the institutional email address s3fk@ugm.ac.id, as the responsible academic authority for research integrity.
CRD420251050587.
by Nurin Yasmin Mohd Khairudin, Awla Mohd Azraai, Rosfaiizah Siran, Nasibah Azme
Genistein is an isoflavone phytoestrogen that is considered a nutraceutical compound found in soybean. The mimicking of estrogen effects includes the ability to bind to the intracellular and cell membrane receptors of estrogen and exert biological functions like antitumor, anti-inflammatory, anti-oxidative, and antiproliferative properties. With more studies focusing on the therapeutic effect of genistein, both in vitro and in vivo, it is evident that genistein acts through multiple pathways including anti-apoptotic, anti-inflammatory, and anti-oxidative. As the effects of stroke are affecting more people and causing devastating repercussions, this warrants genistein to be utilized as a therapeutic drug. Therefore, further studies are due on the effects of genistein on humans so that clinical trials can be carried out for long-term benefits. This review encompasses various studies regarding the potential neuroprotective effects of genistein on cerebral stroke, examining both in vitro and in vivo experimental models. Four database searches: Web of Science (WoS), Scopus, PUBMED and Science Direct were searched from 1st January 1999 until 31st October 2025. The initial datasets identified through the database search yielded a total of 549 publications and 341 publications were finalized after removing duplicates. In the initial screening, a total of 293 studies were excluded due to their irrelevance to the main objective of this study. After assessing the suitability of the studies and following the PRISMA guidelines, a total of 31 articles were found to be suitable and systematically reviewed. Findings demonstrated the major mechanistic pathways involved in the therapeutic action of genistein are anti-apoptotic, anti-inflammatory, and anti-oxidative. Each of these mechanisms is governed by specific pathways, which will be thoroughly discussed, indicating that genistein can be effective as a therapeutic drug in ischemic stroke.by Sophie Lekkerkerker, Karin A. H. Kaasjager, Saskia Haitjema, Cornelia Hulsbergen-Veelken, Karin H. Herbschleb, Marianne C. Verhaar, Meriem Khairoun, Gurbey Ocak
BackgroundAlthough immune checkpoint inhibitors improve survival in patients with malignancies, a substantial number of patients treated with these agents experience immune-related adverse events. It is unknown whether inflammation-related hematological ratios are associated with immune-related adverse events or mortality.
ObjectiveWe aimed to investigate the association between pretreatment inflammation-related hematological ratios and the occurrence of immune-related adverse events and mortality in patients receiving checkpoint inhibitors.
MethodsPatients treated with checkpoint inhibitors within a tertiary hospital in the Netherlands were studied using routine care data between January 2013 and May 2020. Cox regression analysis was performed to assess the association between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocytes and platelets ratio (NLPR), and systemic immune-inflammation index (SII) and outcomes (immune-related adverse events or mortality).
ResultsAmong 664 patients treated with checkpoint inhibitors, 397 (59.8%) patients developed an immune-related adverse event and 363 (54.7%) patients died during a median follow-up period of 17 months (interquartile range 7–30 months). Hematological ratios were not associated with immune-related adverse events. However, highest tertiles as compared with lowest tertiles of all hematological ratios were independently associated with mortality (NLR: adjusted hazard ratio (HR) 2.23, 95% CI 1.69–2.95; PLR: adjusted HR 1.88, 95% CI 1.43–2.47; NLPR: adjusted 1.59, 95% CI 1.22–2.06; SII: adjusted HR 2.33, 95% CI 1.77–3.08).
ConclusionIn this study, pretreatment inflammation-based hematological ratios were not associated with future immune-related adverse events in patients treated with checkpoint inhibitors. However, elevated hematological ratios were associated with an increased mortality risk.
Nursing as a profession remains underrepresented in research leadership, funding success and scholarly authorship globally, which limits its influence on policy and practice. Within this broader context, racially minoritised nursing academics, including Black academics, face additional inequities that further hinder their visibility and progression. Evidence from the United States, Canada and Australia highlights persistent barriers to research careers and leadership opportunities for Black nurses. In the United Kingdom, these disparities are particularly evident: Black nursing academics face barriers to conducting research while in the wider National Health Service workforce, Black nurses are twice less likely than their White counterparts to be promoted. Together, these patterns constrain career progression and hinder the development of culturally competent healthcare education and practice.
To explore the barriers to conducting research among Black nursing academics working in UK universities that are not traditionally research intensive, and to co-create pragmatic, theory-informed recommendations for enabling supportive and equitable research environments.
A qualitative multi-study design underpinned by Intersectionality Theory and The Silences Framework.
Two work packages are proposed. Work Package 1 will use semi-structured interviews to explore the experiences and barriers of conducting research among up to 15 Black nursing academics based at UK universities that are not research-intensive. Work Package 2 will adopt a modified Delphi methodology, engaging key collaborators in two rounds of online codesign workshops. Findings from Work Package 1 will inform structured discussions in which collaborators will develop theory-informed, pragmatic recommendations to strengthen research capacity and engagement among Black nursing academics.
This study will address the persistent underrepresentation of Black nursing academics in research. While grounded in the UK, the anticipated outputs will have wider applicability, informing policy, shaping institutional strategies and guiding future research priorities across diverse academic and healthcare systems worldwide.
To offer a student-focused critical evaluation of the content and use of a digital competencies discipline-specific toolkit that was co-designed with students, offering ideas for training and development across several digital skills areas, such as digital creation, research, communication, innovation, and wellbeing.
A cross-sectional empirical study.
The toolkit was evaluated based on clarity, level of comprehension, accessibility, perceived relevance, and future implementation through a survey, which collected quantitative and qualitative data from 339 undergraduate nursing students in a single school and university in Scotland. Original research data were collected in June 2023.
Students evaluated the toolkit positively for its clarity, comprehensive nature, and practical resources, but suggested improvements for neurodivergent learners. Most students recommended implementing the toolkit early in their course and emphasised its benefits in continuous use. The toolkit was found to be relevant for practice placements and career development. Despite study workload concerns, students were positive about upskilling, highlighting the utility of the toolkit.
Digital literacy is essential as healthcare increasingly relies on digital tools, behaviours and processes. This study employed co-design strategies, supporting students to act as co-producers, change agents, and partners in learning.
The study highlights the need for continuous education in digital skills with suggestions for incorporating advanced skills for future practice, such as data analytics and artificial intelligence, and discusses the value of digital skills development in higher education to enhance student learning and future practice.
The research offers insights of international relevance into the development of a digital competencies toolkit that proposes nursing-specific educational digital skills interventions. The work fosters inclusivity, continuous digital skills improvement, and professional readiness.
The work followed the Equator Standards for Quality Improvement Reporting Excellence in Education.
No patient or public contribution.