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The aim of this study is to assess nurse practitioner students' perceptions and engagement with Isabel's artificial intelligence (AI) based differential diagnosis tool to support their decision-making skills during their theoretical and clinical placement training.
This pilot study used a cross-sectional design.
Twenty-six nurse practitioner students provided feedback on their use of an AI differential diagnosis tool in both academic and clinical contexts. This survey used the Post-Study System Usability Questionnaire to assess the engagement levels and usability of the AI tool. Additional questions were included to evaluate the usage patterns, adequacy in training and confidence in diagnosis.
There were mixed engagement levels: 44.4% (n = 8/18) used Isabel in two subjects—typically one or both clinical placement units—and 27.8% (n = 5/18) in one subject; students most often used the tool to confirm differential diagnoses. Usability was rated positively with the disease ranking, red flag diagnosis and link to national guideline features demonstrating the highest student usage. While most students found the tool beneficial to use during clinical placement and completing university assignments, some reported challenges due to insufficient training, impacting confidence in clinical application.
Isabel has potential as a valuable educational tool in Nurse Practitioner programs, but successful implementation depends on adequate training and support. The findings highlight the importance of comprehensive training and support to maximise AI tool utilisation, with direct implications for programme curricula, clinical education strategies and potential improvements in diagnostic reasoning skills for future nurse practitioners.
This study provides an example of integrating artificial intelligence (AI) guided clinical decision-making training in nurse practitioner (NP) education. The findings can be used by educational institutions to trial similar AI-integrated learning approaches, enhancing diagnostic competence and potentially improving patient care outcomes.
The Study adhered to the STROBE checklist for reporting.
No patient or public contribution was made to this study.
Despite the availability of a safe and effective vaccine, 2000–3000 neonates die of tetanus yearly, predominantly in low- to middle-income countries (LMICs). Inaccurate coverage estimates and vaccination records, together with variability in vaccine response, make identifying individuals who lack protective immunity and may benefit from vaccination difficult. A more direct measure of protective immunity is widely accepted as anti-tetanus IgG concentration at or above 0.1 IU/mL. This study aims to evaluate the performance of a novel saliva-based point-of-care lateral flow test (CIS-IMMUNE Tet) for the binary classification of tetanus protective immune status (protected/unprotected) against WHO threshold-based classification of IgG concentration.
This is a diagnostic test accuracy study with a cross-sectional design conducted in Rwanda. A total of 390 participants will be prospectively enrolled through direct invitation by health centres and community health workers using a convenience sampling approach. Participants will be enrolled into four groups: children aged 5–10 years, healthy adults aged 18–25 years, pregnant women and adults aged 18–45 years with known immunosuppression. This sample size was estimated assuming a specificity of 85% based on proof-of-concept data, with a lower bound of the 95% CI no less than 65%, a significance level of 0.05 and 80% power using the exact binomial method (SAS POWER procedure). Protective immunity will be determined by analysis of anti-tetanus toxoid IgG concentrations in serum by ELISA and analysis of saliva samples using the CIS IMMUNE® Tet test. Test performance will be evaluated by estimating sensitivity, specificity, positive and negative likelihood ratios, each with CIs, for detecting protective immunity using the serum reference standard.
This study protocol was approved by the Rwanda National Ethics Committee (reference RNEC587/2024) and the University of Birmingham (reference ERN_5194-Oct2025). Results will be published in peer-reviewed medical journals and presented at national and international conferences.
This study aims to investigate the association between hourly nitrogen dioxide (NO2) concentrations and emergency hospital admissions for adult patients with asthma in the Birmingham–Solihull metropolitan area, West Midlands, UK.
A time-series study.
The study was conducted in the Birmingham–Solihull metropolitan area, West Midlands, UK.
Adult patients with asthma (aged ≥16 years at the time of admission) from 1 June 2016 to 31 May 2022 residing in Birmingham and Solihull, West Midlands.
We analysed the hourly rate of emergency hospital admissions for acute asthma. A Poisson generalised additive model combined with the distributed lag non-linear model was applied to assess the association between hourly NO2 concentrations and hourly counts of hospital admissions for acute asthma. Furthermore, the effect modification of the NO2-asthma association in specific participant groups, such as sex, deprivation index and ethnicity, was explored in stratified analyses.
The study included 18 943 adults with asthma exacerbations who attended the four acute hospitals in the study area during the study period. The study observed a significant positive association between hospital admissions for acute asthma and hourly NO2 concentrations. The mean NO2 exposure (18 µg/m3) over a lag of 0–24 hours was associated with a 13% (RR=1.13, 95% CI 1.01 to 1.26) increase in the risk of daytime emergency hospital admissions for acute asthma in comparison with no exposure. The results show a significant association between NO2 exposure and hospital admissions for a lag of 3–6 hours. Furthermore, subgroup-specific analysis indicated a higher positive risk associated with hourly NO2 among patients living in the most deprived areas.
This study strengthens the evidence for the importance of using high-temporal resolution air pollution data to examine impacts on health, particularly where there are marked temporal patterns in exposure. Understanding these exposure–response relationships will improve healthcare preparedness and resource allocation in relation to air pollution levels.
To discuss the dyadic and triadic interviewing techniques as distinct approaches to data collection in qualitative research.
Methodological/methodical discussion.
Underpinned by a layered theoretical basis involving interpretivism, social constructivism and symbolic interactionism, dyadic and triadic interviewing approaches represent a tapestry that seeks to illuminate not only what participants think at the individual level, but also how they think together to generate shared, nuanced meanings. Key methodical considerations include participant recruitment and selection to form the dyads or triads, ethical issues, navigating power dynamics, determining saturation at the dyad or triad level and shifting the unit of analysis from the individual level to the dyad or triad level. Notable challenges to using these approaches include logistical complexity, ethical risks and the great need for skilled moderation.
Dyadic and triadic interviewing techniques occupy a vital methodological niche in qualitative studies, particularly within the contexts of health and social care research where relational dynamics and collaborative decision-making are central. By foregrounding co-constructed narratives and real-time interactions, dyadic and triadic interviewing techniques illuminate the interplay of individual agency, power asymmetries and cultural norms, offering insights that transcend the limitations of individual interviews or focus groups.
The increasing complexity of care, treatment pathways, recovery and family-centered decision making warrants engagement beyond individual interviews. Dyadic and triadic interview techniques facilitate this by combining the in-depth benefit of individual interviews and shared interpretations of focus group discussions to capture meanings and experiences.
This methodological/methodical discussion offers clarity to employing dyadic or triadic interviewing approaches to improve their uptake in health and social care research.
Not applicable.
No patient or public contribution.
Loneliness significantly affects the physical and mental health of older adults, particularly those in long-term care settings. Despite the high prevalence of loneliness, comprehensive reviews on psychosocial interventions targeting loneliness in these populations are scarce.
To evaluate the effects of psychosocial interventions in reducing loneliness among long-term care residents.
A systematic review and meta-analysis.
We conducted a comprehensive search across five databases—CINAHL, EMBASE, PubMed/Medline, PsychINFO and The Cochrane Library—from inception to 14 February 2025. The inclusion criteria encompassed randomised controlled trials, quasi-experimental studies and pilot studies published in English that assessed psychosocial interventions for loneliness amongst long-term care residents. The Effective Public Health Practice Project framework was utilised for the quality assessment.
A total of 19 studies with 1646 participants were included. Results indicated that psychosocial interventions significantly reduced loneliness in long-term care residents. The interventions were categorised into lifestyle and leisure activities, psychological interventions, social support interventions and animal/robot-assisted interventions. Subgroup analyses revealed significant effects for lifestyle and leisure activities, group-based interventions, face-to-face delivery and interventions that less than 8 weeks.
Psychosocial interventions demonstrated a large effect size in reducing loneliness amongst long-term care residents. Interventions that incorporated lifestyle and leisure activities with a physical activity component, delivered face-to-face in group settings and lasted for less than 8 weeks may be particularly effective.
This review provides updated evidence that psychosocial interventions could improve loneliness amongst residents in long-term care settings. Consequently, it offers solid information to inform policy changes and intervention strategies.
The researching results were reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis checklist.
This study is a systematic review with meta-analysis, and such details do not apply to our work.
Trial Registration: This protocol was registered in the PROSPERO database (ID: CRD42024534009)
by Emily Dunlap, Yanbing Zhou, Manny M.Y. Kwok, Billy C.L. So, Hirofumi Tanaka
ObjectiveTo evaluate the effects of aquatic exercise compared with non-exercise controls and land-based exercise on arterial stiffness and endothelial function.
DesignSystematic review and meta-analyses of randomized controlled trials assessed using the Cochrane risk-of-bias tool and Grading of Recommendations Assessment, Development and Evaluation.
Data sourcesPubMed/MEDLINE, CINAHL Plus, SPORTDiscus, and reference lists, searched from database inception to April 16, 2025.
Eligibility criteriaStudies evaluating chronic aquatic exercise (multi-session interventions) compared with land-based exercise or non-exercise comparison groups in adults, measuring arterial stiffness via pulse wave velocity (PWV) or endothelial function via flow-mediated dilation (FMD).
ResultsThis review includes 18 randomized controlled trials with 845 participants (mean age 65 ± 7 years). Studies compared aquatic exercise with non-exercise controls (8 studies), land-based exercise (6 studies), or both (4 studies). Exercise sessions averaged 50 minutes, 3 times weekly for 11 weeks. Most studies (17 out of 18) implemented moderate-to-vigorous intensity protocols. Aquatic exercise resulted in improvements in arterial stiffness compared with non-exercise controls (7 studies; SMD = –2.37, 95% CI: –4.46 to –0.29; I2 = 98%: low certainty), with most evidence reflecting systemic and peripheral PWV. Changes in arterial stiffness did not differ from those observed after land-based exercise (6 studies; SMD = –0.07, 95% CI: –0.34 to 0.20; I2 = 0%, moderate certainty). For endothelial function, aquatic exercise may improve outcomes versus non-exercise controls (6 studies; SMD = 0.91, 95% CI: 0.39 to 1.43; I2 = 68%; low certainty) and may lead to greater improvements than land-based exercise (7 studies; SMD = 0.55, 95% CI: 0.05 to 1.06; I2 = 75%; low certainty).
ConclusionAquatic exercise improves systemic and peripheral arterial stiffness as well as endothelial function compared with non-exercising controls. Changes in arterial stiffness do not differ from those observed after land-based exercise. Aquatic exercise may provide greater improvement in endothelial function than land-based exercise, though this is supported by low-certainty evidence, and substantial heterogeneity limits confidence in the generalizability of this finding.
PROSPERO registrationCRD42025642087.
To examine the potential mediating role of social support and depression between loneliness and quality of life among long-term care facility residents.
A cross-sectional study.
A convenience sample of 121 long-term care facility residents was recruited between June 2024 and March 2025. Validated instruments assessed loneliness, social support, depression, and quality of life. Multivariable regression and mediation analyses explored relationships and mediation effects among these variables.
Participants had a mean age of 80.6 years. Loneliness was reported by 80.2% of residents, poor social support by 82.6%, depressive symptoms by 33.1%, and reduced quality of life by 52.1%. Multivariable analysis identified loneliness and depression as significant predictors of diminished quality of life. Mediation analysis revealed that depression partially mediated the relationship between loneliness and quality of life, while social support did not.
Loneliness and depression significantly influence quality of life in long-term care facility residents, with depression as a partial mediator. Targeted interventions addressing both loneliness and depression are essential to enhance residents' well-being.
Nursing practice must prioritise interventions for loneliness and depression to improve quality of life in long-term care facilities, with a particular focus on managing depressive symptoms.
This work informs nursing practice and policy to enhance well-being in long-term care facilities by highlighting the critical role of loneliness and depression. Nursing interventions should prioritise targeted mental health support and personalised care plans to address these issues effectively. Further research is needed to clarify the contextual role of social support in this population to improve intervention effectiveness.
The authors have followed the STROBE checklist for reporting methods.
No patient or public contribution outside of the participation in the actual study for purposes of data collection.
FreshRSS 