Conectar
by Subhanwita Manna, Bijaya Kumar Mishra, Krishna Kant Yadav, Pratibha Dhiman, Smiteerekha Sahoo, Chiranjeet Mishra, Tanveer Rehman, Ranjan Kumar Prusty, Ragini Kulkarni, Mahadev Bhise, Ashok Kumar Pandey, Ravikumar B. S., Ipsita Pal Bhowmick, Subrata Kumar Palo, Narayana Swamy D. M., Neha Srivastava, Umaer Alam, Reeta Singh, Manish Barvaliya, Vani Kandpal, Barsha Gadapani Pathak, Reema Mukherjee, Sanghamitra Pati
BackgroundUnsafe abortion continues to be a significant cause of avoidable maternal morbidity and mortality especially in low- and middle-income countries. Despite India’s permissive Medical Termination of Pregnancy (MTP) Act, operational gaps continue to prevent women from accessing safe abortion services. There is still a dearth of multi-centric mixed-methods research from rural areas on women’s experiences, provider perspectives, and facility readiness. This study aims to assess the status of comprehensive abortion care (CAC) in rural India by evaluating public-sector facility preparedness, provider experiences, care-seeking pathways, and identifying key barriers and facilitators as per CAC guidelines (2023). The findings will guide the development of a preliminary implementation approach (Model 0+) as well as future phases focused on testing, adaptation, and scale up to strengthen CAC availability, quality, and uptake.
MethodsThis study employs a convergent mixed-methods design across six geographically varied rural blocks in India (North, South, East, West, Central, and Northeast). There will be two participant groups: married women aged 18–49 years who are current, previous, or potential abortion service users, and public health system stakeholders involved in Comprehensive Abortion Care (CAC). A multistage cluster survey will enroll approximately 854 married women per site across 20 clusters. The qualitative component will comprise interviews with women who have had abortions in the last two years and healthcare practitioners, for a total of around 240 interviews. Additionally, 18 focus group discussions with Accredited Social Health Activists and Anganwadi Workers (three per site), will capture frontline worker’s perspectives. Quantitative data will be collected using KoboCollect and analysed using STATA (or an equivalent statistical software). Qualitative data will undergo combined phenomenological and thematic analysis using NVivo or equivalent software.
DiscussionThis study constitutes the first phase of a multi-stage implementation research programme. The study builds upon national CAC guidelines as a foundation of implementation of “Model 0” for abortion care and assesses their functioning in routine public-sector settings. Insights from women, frontline workers, and providers will inform development of a refined implementation strategy (“Model 0+”) grounded in real-world contexts. This evidence-driven approach is expected to yield a practical, acceptable, and scalable model for subsequent piloting, adaptation, and wider health system uptake.
To examine the association between compassion fatigue and spiritual care competence amongst palliative care nurses, investigate the mediating role of palliative care quality and determine the moderating effect of job satisfaction.
Palliative care nurses face intense emotional demands and end-of-life stressors, increasing their risk of compassion fatigue and potentially affecting care delivery. Spiritual care competence is central to holistic palliative nursing; however, its association with compassion fatigue and the organisational factors shaping this relationship remain unclear.
A cross-sectional, correlational study.
Using a convenience sampling approach, 141 nurses working in palliative care units across hospitals in different regions of Türkiye were recruited. Data were collected between April and August 2024 via an online questionnaire including demographic variables and validated instruments measuring compassion fatigue, palliative care quality, spiritual care competence and job satisfaction. Data were analysed using SPSS and PROCESS macro.
The mean spiritual care competence score was 107.9 ± 14.7. Compassion fatigue was negatively associated with palliative care quality and spiritual care competence, whereas palliative care quality was positively associated with spiritual care competence. Mediation analysis indicated a significant indirect association between compassion fatigue and spiritual care competence through palliative care quality. Moderated mediation analysis indicated that this indirect effect was significant only amongst nurses reporting higher job satisfaction.
Compassion fatigue was negatively associated with palliative care nurses' spiritual care competence. Mediation analysis suggested that this association was statistically explained by palliative care quality, whilst job satisfaction moderated the relationship between compassion fatigue and care quality.
Addressing compassion fatigue as a critical occupational risk in palliative care nursing is essential. Organisational strategies that enhance job satisfaction and support high-quality care delivery may help sustain nurses' spiritual care competence and promote high-quality palliative nursing practise.
No patients or members of the public were involved in this study. Palliative care nurses participated by completing online questionnaires.
This cross-sectional study was reported in accordance with the STROBE Statement.
by Nemanja Đorđević, Jovan Ranin, Ivana Gmizić, Biljana Ljujić, Marko Marković, Ivan Rajković, Jovana Ranin, Ivana Raković, Sofija Sekulić Marković, Biljana Popovska Jovičić
Metabolic syndrome (MS) is highly prevalent among people living with HIV (PLWH) receiving antiretroviral therapy (ART) and is driven by persistent low-grade inflammation. Hypoxia-inducible factor 1 alpha (HIF-1α) polymorphisms may influence inflammatory pathways underlying MS. This study investigated the association of the rs11549465 HIF-1α polymorphism with inflammatory markers and MS in PLWH receiving ART. We conducted a multicenter case-control study including 116 PLWH treated at two University Clinical Centers in Serbia. Participants were classified according to NCEP ATP III criteria. Genotyping was performed by Real-Time PCR using TaqMan assays. C-reactive protein (CRP) and fibrinogen levels were significantly higher in participants with MS (p < 0.05). ROC analysis demonstrated their potential as biomarkers of MS with cut-off values of 1.85 mg/L for CRP and 2.49 g/L for fibrinogen. Age significantly correlated with CRP and Neutrophil/Lymphocyte ratio (p < 0.05). Elevated CRP and fibrinogen levels were associated with hypertension, hypertriglyceridemia, and other MS-abnormalities (p < 0.05). The HIF-1α rs11549465 CT + TT genotype was associated with higher IL-6 levels among participants with MS (p = 0.026). CRP and fibrinogen may complement existing MS criteria in identifying PLWH at increased risk of cardiovascular disease and diabetes. These findings highlight the role of chronic inflammation and genetic variability in metabolic complications of HIV.The hepatitis C virus (HCV) is a significant healthcare burden across the globe and is a major cause of liver malignancies. However, patients with serious mental illness (SMI) living with HCV are disproportionately affected and underserved within the current care framework. A previous meta-analysis on this topic yielded a prevalence of 8%, which is considerably higher than that observed in the broader population. Since the original review was published in early 2022, an update is required to incorporate data published during and after the COVID-19 pandemic and to evaluate its effect on overall prevalence and care.
This systematic review and meta-analysis will replicate the methodology of the original review. To ensure a thorough investigation, a systematic search strategy will be implemented across PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and Web of Science to include studies published from 2 July 2020 to 22 June 2026. The review will include prospective observational and retrospective cross-sectional studies conducted among adults aged over 18 years with a verified SMI diagnosis and laboratory-confirmed HCV status. A dual-reviewer protocol will be employed to evaluate all retrieved titles, abstracts and full-text manuscripts to ensure unbiased selection. Any disagreements will be adjudicated by a third senior investigator. Methodological rigour will be assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Prevalence Studies Quality Assessment Tool for Systematic Reviews of Observational Studies. This validated instrument will ensure transparency and standardised quality assessment and will be supplemented by a customised 3-point global assessment. A Generalised Linear Mixed Model (GLMM) with a logit transformation will be used for the meta-analytical synthesis to effectively account for expected heterogeneity and extreme proportions, while the degree of inconsistency across studies will be quantified using the I2 statistic.
Formal ethical clearance is not required for this study, as it relies entirely on the synthesis of secondary data from published articles.
CRD420261331799.
Female genital mutilation (FGM)/cutting remains highly prevalent in Somalia and is associated with a range of long-term gynaecological and urological complications. However, data on lower urinary tract symptoms (LUTS) and their severity across different FGM types are limited. The aim of this study was to examine the association between FGM type and LUTS among symptomatic care-seeking women with FGM and to evaluate whether symptom severity differed according to FGM type.
This cross-sectional study included 122 symptomatic women with a history of FGM who presented with LUTS between January and April 2024.
Sociodemographic characteristics, FGM type, clinical symptoms, and vaginal and urine culture results were recorded. LUTS severity and associated bother were assessed using the International Consultation on Incontinence Questionnaire–Female Lower Urinary Tract Symptoms Long Form (ICIQ-FLUTS-LF). Comparisons were made between women with FGM types I–II and those with type III.
The mean age of participants was 31.7±7.6 years. Women with FGM type III had a significantly higher prevalence of positive urine culture growth, history of urinary tract infection (UTI) and prior antibiotic use, and abdominal pain compared with those with types I–II (p<0.05). Median scores for all LUTS domains and corresponding bother scores were significantly higher in women with FGM type III compared with types I–II (all p<0.001), and similar findings were confirmed in regression analyses.
Among symptomatic care-seeking women with FGM, type III was associated with greater LUTS burden, higher reported history of UTI and greater symptom-related distress compared with types I and II.
Acute wounds with high exudate output, such as split-thickness skin-graft donor sites, require dressings that effectively manage fluid, reduce pain, and support timely epithelialization. Foam dressings are widely used, but superabsorbent materials may provide advantages in exudate handling. This study compared the absorption performance, wound healing, and pain outcomes of foam versus superabsorbent dressings in donor-site wounds. Thirty patients undergoing split-thickness skin grafting were enrolled, with no exclusions or loss to follow-up. Each donor site was divided into two equal zones, with one receiving a foam dressing and the other a superabsorbent dressing according to randomized allocation. Data were collected using coded identifiers. Clinical outcomes, including absorption capacity, wound epithelialization, pain scores, and complications, were evaluated at 3-day intervals through postoperative day 15. Experimental testing showed that a 10 × 10 cm foam dressing weighed 7.5 g and absorbed 75 mL of saline, whereas the superabsorbent dressing weighed 5.5 g and absorbed 93 mL. Clinically, absorption power was significantly higher with the superabsorbent dressing on day 3 (104.09 vs. 71.87 mg/cm2/day; p = 0.034), day 6 (84.45 vs. 40.91 mg/cm2/day; p < 0.001), and day 9 (76.59 vs. 19.74 mg/cm2/day; p = 0.022). Pain scores tended to be lower with the superabsorbent dressing on days 6 and 9, although the differences were not statistically significant. Wound epithelialization was comparable between groups, with no allergic reactions, infections, or other complications observed. Superabsorbent dressing demonstrated superior absorption capacity compared with foam dressing, while achieving comparable epithelialization and healing outcomes. Pain scores tended to be lower with the superabsorbent dressing during the early postoperative period, although the differences were not statistically significant.
1.
The Tesamorelin as an Adjunct to Exercise for Improving Physical Function in HIV (TRIUMPH) study is a randomised controlled trial with the overall goal of examining the combined effect of exercise and the growth hormone-releasing hormone analogue tesamorelin on physical function.
TRIUMPH is a two-site, double-blind, randomised trial of 100 sedentary older adults (aged 50–80 years) living with HIV who are frail or at risk for frailty and have excess abdominal adiposity. Enrolled participants will be randomised to receive tesamorelin or placebo as an adjunct to a home-based semisupervised exercise programme for 24 weeks, followed by a 24-week extension phase of independent exercise. We will determine short-term and sustained effects of tesamorelin plus exercise on clinical endpoints, including physical function, muscle content and quality, quality of life, and exercise adherence at Weeks 24 and 48. We also will elucidate effects of tesamorelin plus exercise on biological endpoints, including muscle fat and mitochondrial function at Week 24.
Ethical approval for the TRIUMPH study was obtained from the Institutional Review Boards at participating sites. All participants provide written informed consent prior to enrolment. Study findings will be disseminated through peer-reviewed publications and scientific conferences and may inform future interventions to improve physical function among older adults living with HIV.
Despite optimised antiseizure medication, pharmacoresistant epilepsy still affects a substantial proportion of adult patients, especially when epilepsy surgery is not possible or is rejected. Transcutaneous vagus nerve stimulation (t-VNS) is a non-invasive neuromodulatory approach for which the evidence from randomised studies to date does not allow for a reliable assessment of its benefits due to small case numbers and methodological limitations. Transcutaneous vagus nerve stimulation as add-on therapy versus pharmacotherapy alone (TRAVAST) is a prospective, multicentre, randomised, triple-blind, controlled trial to investigate whether t-VNS as an add-on to established pharmacotherapy improves seizure-related and patient-relevant outcomes in adults with pharmacoresistant epilepsy.
A total of 164 adults (aged 18–65) with pharmacoresistant epilepsy and clinically manifest seizures who are not eligible for or refuse (further) resective epilepsy surgery will be enrolled at 15 sites. Patients are assigned 1:1 to active t-VNS or sham stimulation in addition to stable antiseizure medication for 12 months. t-VNS is performed using a non-implanted stimulator with an ear electrode as a daily self-administered therapy in the home environment. The primary outcome is the proportion of patients with at least 50% reduction in mean seizure frequency after 52±2 weeks compared with a 4-week baseline period, documented in a standardised epilepsy diary. Secondary outcomes include additional response rates, seizure freedom, seizure severity, health-related quality of life, psychological and cognitive parameters, treatment retention and safety, including device-related events and sudden unexpected death in epilepsy.
The trial protocol has been approved by an ethics committee (Ethics Committee of LMU of Munich). All patients will provide written consent prior to inclusion and can withdraw from the trial at any time without this affecting their further care. The results will be published in specialist journals, reported in trial registries, made available anonymously for scientific use and communicated back to the participating physicians, patients and the public.
DRKS00039592.
by Muhammad Kamruzzaman Mozumder, Ummay Kulsum Keya, Fayaza Ahmed, Imtiazuddin Gazi, Konica Gop, Pooja Bhattacharjee, Md. Akramul Islam, Shayla Islam
BackgroundShortage of qualified mental health professionals and limited access to specialized care, coupled with a high burden of mental health problems, particularly anxiety and depression, is a growing public health concern in Bangladesh. A possible solution being tested is the utilization of existing community resources. Availability of a psychometrically valid and reliable screening tool for early detection of mental health problems is of paramount importance. The present study aimed at testing the psychometric properties of the Bangla version of the ultra-brief PHQ-4.
MethodsEmploying practicing mental health professionals as data collectors, this cross-sectional study used data from 357 adults from an urban and two rural communities of Bangladesh.
ResultsConfirmatory factor analysis indicated excellent model fit for the two-factor structure of the Bangla PHQ-4 (χ2 = 0.103 at p > .01, RMSEA = 0.000, CFI = 1.000, TLI = 1.007, and SRMR = .006) for the total sample. The model demonstrated factorial invariance for sex, age, and mental health state. The scale demonstrated high internal consistency (McDonald’s ω = .869) and strong construct validity, evidenced by high correlation with the SRQ-20 (r = .747), K-6 (r = .820), self-rated mental health state (r = −.677), and interviewer-rated mental health state (r = −.680). The scale also demonstrates excellent diagnostic accuracy (AUC = .906), and acceptable sensitivity (82%) and specificity (83%) using a cutoff score ≥ 6.
ConclusionThis study provided evidence of satisfactory psychometric properties of the Bangla PHQ-4 in terms of factor structure, group level invariance, internal consistency, and construct validity in Bangladeshi rural and urban community samples.
by Preechaya Wongkrajang, Titiwan Pientong, Ratchaneekorn Hanyongyuth, Panutsaya Tientadakul
Lupus anticoagulants (LA) are heterogeneous antiphospholipid antibodies that interfere with phospholipid-dependent coagulation assays, resulting in considerable variability among detection methods. Although international guidelines recommend a stepwise approach incorporating screening, mixing, and confirmatory testing, integrated strategies omitting routine mixing studies are widely used. Different percentile-based cutoffs have been proposed for defining LA positivity.We retrospectively analyzed 135 citrated plasma samples requested for LA testing. Five LA detection approaches were evaluated: 4 integrated assays and 1 activated partial thromboplastin time (APTT)–based approach following the ISTH-recommended stepwise algorithm with a mixing study. The integrated assays comprised silica clotting time, dilute Russell viper venom time (dRVVT) using 2 different reagent systems, and an APTT-based assay. Precision studies and reference intervals were established, and LA positivity rates were compared using 97.5th and 99th percentile cutoffs. Inter-assay agreement and associations with anticardiolipin (aCL) and anti–β2-glycoprotein I (aβ2GPI) antiphospholipid antibodies were assessed. LA positivity rates varied across procedures (19.3%–35.6%) at the 97.5th percentile. Application of the 99th percentile decreased positivity for dRVVT-HemosIL and APTT-based assays. Positivity increased at the 97.5th percentile in patients tested according to ISTH indications, with minimal impact in noncompliant cases. Inter-assay agreement ranged from fair to substantial and was influenced by assay type and cutoff definition. APTT-based assays showed the strongest associations with aCL and aβ2GPI antibodies. LA detection is strongly influenced by assay selection and cutoff strategy. Positivity rate–based evaluation provides a practical framework for comparing LA assays in laboratory practice, particularly in the absence of a reference standard.Advance care planning is a complex process and requires a culturally sensitive communication approach. Competence in initiating advance care planning requires specific education and training for healthcare providers. This qualitative descriptive study aims to explore the experiences and perspectives of healthcare providers across 12 Regional Health Sectors in Thailand regarding impacts of communication training on advance care planning implementation.
A qualitative descriptive study.
The participants were healthcare providers who had attended the communication training workshop and engaged in advance care planning from across 12 Regional Health Sectors in Thailand. Focus group discussions were conducted and transcriptions were analyzed following the qualitative framework approach. Several strategies were used to enhance trustworthiness.
Sixty healthcare providers participated in the study. Two main themes were identified: (1) a ripple effect of communication training; and (2) key components for successful advance care planning implementation. The communication training enhanced participants' knowledge and skills, and participants gained more confidence to initiate conversations with patients who had serious illnesses and families. The participants shared knowledge with and mentored junior nurses on conducting advance care planning. The participants also extended services to other advanced chronic diseases and advocated for early advance care planning. Finally, the participants took proactive action to raise public awareness of advance care planning in communities. The participants identified key components for successful advance care planning implementation. These included healthcare providers' knowledge, skills, and attitudes towards palliative care, knowing the patients, sufficient and dedicated time, continuity of care and institutional support.
The communication training had a ripple effect, enhancing health professionals' competence and efficacy. The effects are beyond individual benefits. The training transformed clinical practices and extended to raise public awareness on advance care planning. Essential components for successful advance care planning should be used as a framework to guide clinical practice.
To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants.
A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone.
Primary care.
Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30–60 min.
COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes.
Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally.
Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions.
These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial.
Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.
While compassion is widely recognised as an essential component of high-quality patient care, the compassion needs of clinicians often go unrecognised and unmet. Clinicians face multifaceted sources of workplace suffering, both sources inherent to working with the sick and avoidable sources due to healthcare systems and leadership challenges. Organisational compassion, defined as the continuous and systematic identification, prevention and alleviation of sources of suffering for healthcare workers, offers a paradigm shift in mitigating and preventing clinician suffering and burnout. Yet little is known about how clinicians experience suffering and compassion from their organisations, teams and leaders.
Our overarching goal is to develop a clinician-reported experience measure of organisational compassion. The purpose of this study was to explore how clinicians experience suffering and compassion in healthcare organisations.
This qualitative study used semistructured interviews of interdisciplinary paediatric hospice and palliative care clinicians from across the USA. A moderator’s guide was developed based on the literature of organisational compassion in management and healthcare and validated through practice interviews with clinicians. 22 participants were recruited via national paediatric hospice and palliative care email list serves. Video interviews were conducted via Zoom. Transcripts were analysed using a hybrid grounded theory-thematic analysis methodology to identify themes and to construct a theoretical framework of compassion experiences.
Five major themes of experiencing compassion emerged: (1) Feeling cared about, characterised by authentic, empathetic responses to clinician distress; (2) Dignity, encompassing being valued, respected and recognised as a whole person and professional; (3) Proximal (team) compassion, including camaraderie, shared workload and mutual support within teams; (4) Structural (organisational) compassion, reflecting policies, practices and benefits that alleviate or exacerbate suffering and (5) Compassionate leadership behaviours, such as presence, empathy and connection to frontline staff needs.
Healthcare work includes sources of both inherent and avoidable suffering for clinicians. In this study, we sought to understand how clinicians experience compassion from their organisations, leaders and team members during times of distress. We found five themes of experiencing compassion in healthcare organisations: feeling cared about; dignity; proximal (team) compassion; structural (organisational) compassion and compassionate leadership behaviours. These qualitative data and results will provide an empiric foundation for the development of a clinician-reported experience measure of compassion for use in healthcare settings. Such a measure will enable future research examining how compassion experiences in healthcare may predict workforce outcomes such as burnout, satisfaction, engagement and thriving. Ultimately, this work may support the design of interventions aimed at strengthening compassionate organisational cultures and improving conditions for the healthcare workforce and both experiences and outcomes of the patients they serve.
Public health students face academic and training pressures as well as challenges arising from patient and community expectations, which may adversely affect their quality of life (QoL) and contribute to burnout and student dropout. This study aimed to examine psychological self-care, burnout and QoL as well as the factors associated with these outcomes among university students.
A cross-sectional study conducted between January and March 2024.
Universities in northern, southern and northeastern Thailand.
A total of 1426 health-related students aged 18–25 years were recruited using non-probability sampling.
Data were collected using a self-administered questionnaire, which included the Thai version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF-THAI), the Maslach Burnout Inventory to assess emotional exhaustion (EE) and cynicism (CY) and a psychological self-care assessment.
Most participants (79.9%) reported a moderate level of QoL. The prevalence of burnout was 18.9%. Pearson’s correlation analysis indicated statistically significant relationships between psychological self-care, EE, CY and QoL (all p values
Good mental healthcare behaviours and lower levels of burnout are associated with higher QoL among public health students. Universities and programme administrators should implement mental health support strategies, including routine screening, counselling services and self-care promotion, to reduce burnout and improve students’ overall well-being.
Chronic kidney disease (CKD) is highly prevalent in Thailand and imposes a growing burden on the health system, driven by limited nephrology capacity and high rates of unplanned dialysis. The kidney failure risk equation (KFRE) estimates the risk of progression to kidney failure (KF) on age, sex, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio. This study aims to validate and, if required, recalibrate the four-variable KFRE for the Thai population and to assess the potential impact of KFRE-guided referral strategies on clinical care and health system performance.
We will conduct a retrospective cohort study using linked, de-identified national health databases covering approximately 70% of the Thai population. Adult patients with CKD stages 3–5 will be included. KFRE performance will be evaluated at 2 and 5 years for discrimination and calibration. If miscalibration is identified, the model will be recalibrated using Cox-based methods. Simulations (1000 iterations) indicated that approximately 920 KF events by 5 years would be required to achieve the target standard errors for the calibration slope. A subsequent impact analysis will compare KFRE-guided referral with current Thai CKD guideline criteria and real-world practice using a decision-tree and Markov modelling framework.
Ethical approval was obtained from the Ethics Committee of the Institute for the Development of Human Research Protections, Thailand (COA No. IHRP2025110), Imperial College London and the London School of Hygiene and Tropical Medicine. The requirement for informed consent was waived due to the use of anonymised secondary data. Findings will be disseminated through peer-reviewed publications, conferences and policy briefs to supplement evidence-based referral strategies and health system planning.
Cardiovascular disease (CVD) is the leading cause of death worldwide and is associated with a broad range of physical, emotional and social burdens. Existing tools such as Systematic Coronary Risk Evaluation and WHO CVD risk charts identify clinical risk factors but fail to capture patient-perceived burden and the risk of burden awareness. The Assessment of Burden of Chronic Conditions (ABCC)-tool, a validated, person-centred instrument, offers a more holistic approach. The aim of the current study is to develop and validate a new module within the ABCC-tool for patients with an elevated cardiovascular (CV) risk or CVD (cardiovascular risk management (CVRM) module).
A mixed-methods design was used across four phases and expert meetings to identify the items for the module. All phases took place in the Netherlands. Phase 1 (literature search) was performed in 2021, phase 2 (semistructured interviews) was completed between January and October 2021, phase 3 (survey) was completed in November 2023 and December 2024, and phase 4 (semistructured interviews) was completed in January 2025.
Phase 2 involved 14 experts by experience (patients with CVD or people at elevated risk) and 10 healthcare professionals in the field of CVD. Phase 3 included 86 healthcare professionals. Phase 4 included 12 experts by experience. In total, four expert meetings took place, attended by three experts by experience, nine healthcare professionals and seven researchers.
The module was refined iteratively, using qualitative and quantitative insights at each phase of development. The model was only finalised after thorough content validation.
No suitable patient-reported outcome measures (PROMs) focusing specifically on CVRM were identified in the literature. Interviews revealed significant burdens in terms of physical, emotional and social burdens. Feedback from expert meetings and validation rounds led to substantive refinement. The final module contains 10 items and was deemed valid by both experts by experience and healthcare professionals.
The CVRM module of the ABCC-tool has been systematically developed and validated in terms of content. The final module focuses on the multidimensional burden of CVD and dealing with its risk factors and aims to support self-management. The module complements existing risk assessment tools by focusing on the burden experienced by the patient and the burden resulting from risk awareness.
by Ratinan Dangwilailert, Somboon Lekmak, Duangtida Promlee, Tanyaporn Pongkunakorn, Parichart Permpikul
BackgroundHemoglobin (Hb) assessment is crucial to prevent blood donation from anemic donors. Most measurements are invasive and painful; however, an alternative, non-invasive hemoglobin measurement is available. This study aimed to compare non-invasive and point-of-care invasive hemoglobin test results with those from an automated blood analyzer in blood donors.
MethodsQualified blood donors were enrolled at a tertiary care hospital in Bangkok, Thailand. Hemoglobin was initially measured by the non-invasive device (Rad-67 Pulse CO-Oximeter) and a point-of-care invasive hemoglobin screening device (Mission HemoPro). Participants with point-of-care invasive hemoglobin ≥ 12.5 g/dL were eligible to donate, and during donation, standard hemoglobin measurements were obtained using an automated analyzer, XN-550. Those who were ineligible with point-of-care invasive hemoglobin Results
Of 300 participants, 295 had complete data. Of these, 169 were male (57.28%). Average non-invasive, point-of-care, and automated hemoglobin levels were 14.38 ± 1.12 g/dL, 13.65 ± 0.70 g/dL, and 13.90 ± 1.16 g/dL, respectively. The ICC between non-invasive, point-of-care, and automated hemoglobin measurement was 0.600 (95% CI: 0.522–0.668) and 0.897 (95% CI: 0.872–0.957). The sensitivity of the non-invasive Hb measurement was poor for detecting anemic donors when the Hb cut-off was set at 12.5 g/dL. This method received significantly higher satisfaction than the routinely used invasive device.
ConclusionThe non-invasive Hb measurement in blood donors showed moderate agreement with the standard test, but the sensitivity was poor when the cut-off hemoglobin was set at 12.5 g/dl. Since donor satisfaction was higher, this method may be used as an alternative screening tool, provided a higher Hb cut-off value is used.
To synthesise the best available evidence on mentors' experiences in mentoring nursing students during peer learning clinical practice.
A systematic review of qualitative studies.
Qualitative or mixed-methods (with a qualitative component) studies that met the inclusion criteria based on the phenomenon of interest were included. The selected studies were critically appraised using the standardised JBI Critical Appraisal Checklist. Findings from qualitative research were extracted and synthesised by using the JBI meta-aggregation approach.
A comprehensive search was conducted in September 2024 across six databases: Scopus, CINAHL, Ovid MEDLINE, Web of Science, ProQuest (Education collection) and MEDIC.
A total of 542 studies were screened, and 17 met the inclusion criteria. Three synthesised findings were identified: (1) Importance of pedagogical support for peer learning, (2) Mentors' support needs for mentoring in a peer learning model and (3) Characteristics of a favourable peer learning environment in clinical practice.
Mentors perceive peer learning as beneficial for nursing students' learning. The transition from the traditional mentoring model to the peer learning model requires distinct pedagogical approaches and competences from mentors, which can be enhanced by strengthening mentors' peer-learning competence.
It is essential to support mentors' competence in mentoring through peer learning by providing mentoring education. Learning models based on collaborative learning are beneficial for improving performance in clinical placements because they enable more nursing students to learn simultaneously in clinical practice.
This systematic review provides synthesised evidence of mentors' experiences in mentoring nursing students during peer learning in clinical practice. Mentors' role is to provide pedagogical support for nursing students in clinical practice conducted with peer learning. Before implementing peer learning in clinical practice, it is essential to consider the conditions for peer learning across various clinical settings and to provide support for mentors as they mentor nursing students through peer learning. These findings can support healthcare administrators, educators, mentoring education providers and mentors of peer learning in clinical practice.
This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement.
This study did not include patient or public involvement in its design, conduct or reporting.
The protocol is registered in The Open Science Framework (OSF): 10.17605/OSF.IO/5F9HP
This study aimed to comprehensively examine social and clinical factors contributing to postpartum depression among women in Nepal and identify their perspectives/experiences regarding postpartum mental health.
The explanatory sequential mixed-method study was conducted in two phases. In the quantitative phase, data were collected via survey of 200 postpartum women at immunisation clinics of two hospitals in Kathmandu Nepal. Measures included sociodemographic and perinatal factors and the Edinburgh Postpartum Depression Scale. Regression models were conducted to analyse data. In the qualitative phase, in-depth interviews were conducted with 15 participants having depression scores ≥ 10. Data were analysed using the thematic content analysis method. Qualitative and quantitative findings were integrated using the joint display and the narrative weaving approach to generate results.
Findings show that 28% of postpartum women screened positive for depressive symptoms, requiring referral for further evaluation. Integrated findings indicate that prenatal mental health problems, low birth weight or medical conditions among infants, intimate partner violence, partner substance abuse, and a lack of postpartum social support were major contributors to postpartum depression.
Depression is highly prevalent among women 6–12 months postpartum in Nepal and is associated with several clinical and social factors.
These findings have important implications, emphasising the need for routine screening using validated tools for early identification, timely treatment and referral of women at-risk for postpartum depression. Evidence-based clinical and community initiatives are needed to promote positive outcomes for women and their families.
External experts were consulted for survey questions and qualitative interview guide, then refined those instruments based on their feedback to improve construct validity. The immunisation clinic staff provided input during study design, for participant recruitment and data collection. Key findings were presented to stakeholders to validate the interpretation of findings.
by Tadgh Connery, Sofija Kukulite, Conor Farrell, Rosa Horgan, Karen Barry, Megan Doyle, Annalisa Setti, Mike Murphy
BackgroundDeath anxiety is fast becoming recognised as a transdiagnostic construct across myriad mental health conditions. Though existing clinical treatments of death anxiety, such as Cognitive Behaviour Therapy type interventions, have been shown to be effective, Terror Management Theory (TMT) proposes self-esteem as a protective factor against death anxiety by endowing individuals with a feeling of significance in life and helping them to process the nature of death and its inevitability. Despite the centrality of self-esteem to TMT, however, extant research examining its relationship with death anxiety has yet to be synthesised. The current study aims to systematically review peer-reviewed, quantitative research examining the association between death anxiety and self-esteem and, where possible, to test the strength of these associations through meta-analysis.
MethodA systematic search of quantitative and mixed-methods studies will be conducted across six databases: MEDLINE; PsycINFO; PubMed; Web of Science; CINAHL and; EMBASE. Google Scholar will also be searched and the first 200 records by relevance will be screened for eligibility. Searches will be conducted by TC, and records will be screened by TC, SK, CF, RH and KB, so that each record is screened for eligibility by at least two authors. Data extraction and quality assessment, using the Joanna Briggs Inventory Risk of Bias tools, will be performed by TC, SK, CF, RH and KB, so that each record is assessed by at least two authors, with doubts and discrepancies being resolved through discussion with AS and MM. A narrative synthesis of relevant data will be presented and, where sufficient data are available, meta-analysis will be conducted using the MAJOR extension for Jamovi to establish an overall effect size for the association between death anxiety and self-esteem. Should sufficient data be available, demographic factors, such as gender and age, and clinical population status (clinical vs. non-clinical population) will be examined as moderators of the effect. This protocol was developed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and has been registered in PROSPERO (CRD42024591775).
DiscussionThe current review will systematically examine the relationship between death anxiety and self-esteem. Should sufficient data be available, an overall effect size of the relationship will be generated. By better understanding how death anxiety is related to self-esteem, and by establishing the size and significance of the relationship will aid firstly in systematically validating TMT and, secondly, identify whether self-esteem may be targeted in future death anxiety interventions to reduce death anxiety and improve individuals’ overall mental health.
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