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Pilonidal sinus disease (PNS) in children and adolescents lacks standardised management pathways. Minimally invasive and outpatient-based strategies are increasingly adopted, but paediatric-specific data remain limited. This study evaluated outcomes following implementation of a structured, tiered outpatient pathway. A retrospective single-centre cohort study was conducted including patients aged ≤ 18 years treated for PNS between February 2023 and August 2024. Management followed a stepwise protocol: structured conservative care, in-clinic debridement and operative intervention (trephination or limited excision) for refractory or severe disease. Primary outcome was recurrence after documented healing. Secondary outcomes included time to healing, clinic utilisation and associations with clinical variables. 69 patients were included (median age 15 years [IQR 14–16]; 64% male). Twenty-three patients (33.3%) required operative management. Recurrence occurred in 6/23 (26.1%) in the operative group and 1/46 (2.2%) in the non-operative group (Fisher's exact p = 0.0045). Median follow-up duration did not differ significantly between groups. Prior infection at presentation showed a numerical but not statistically significant association with recurrence. Time to healing was prolonged in both groups and did not differ significantly. Within a structured outpatient pathway, paediatric patients demonstrated low overall recurrence rates. Conservative management was associated with lower recurrence; however, patients undergoing operative intervention likely represented a more severe subgroup. Prospective severity-adjusted studies are required to define optimal paediatric wound management strategies for PNS.
Environmental enteropathy (EE) is a syndrome affecting the gut characterised by villus blunting, reduced nutrient absorption and microbial translocation in children and adults experiencing a high burden of enteric infection due to inadequate access to clean water and sanitation.
We will conduct coordinated randomised controlled trials in six countries to determine if supplementation with indispensable amino acids (IAAs) can improve intestinal barrier dysfunction in six geographically diverse populations of 18–36 months old children with stunting or severe stunting. All trials will measure the same primary outcomes while secondary outcomes will be measured on a per-trial basis using standardised protocols across the project. The primary endpoint will be change in gut permeability as assessed by the lactulose/rhamnose ratio. Secondary endpoints include changes in amino acid and carbohydrate absorption using novel, isotope tracer tests. Other prespecified outcome measures include changes in EE biomarkers and child weight. IAA supplementation will be given daily for 28 days and evaluation of the major endpoints will be at baseline and after 28 days of supplementation.
Ethical approval will be obtained from the Research Ethics Committee at each participating site. Caregivers will provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and face-to-face meetings with participant caregivers.
CTRI: CTRI/2024/06/069187 (India); ClinicalTrials.gov (NCT06617130, Malawi;
Treatment for high-risk locally advanced prostate cancer typically includes radiation or radical prostatectomy plus androgen deprivation therapy (ADT), but the optimal use of neoadjuvant and adjuvant ADT in practice remains unclear. Relugolix and enzalutamide have demonstrated strong efficacy independently in the setting of advanced disease, but their combined use in neoadjuvant/adjuvant therapy has not been studied. This trial investigates their safety and efficacy as neoadjuvant/adjuvant therapy in patients undergoing definitive local treatment.
Relugolix and Enzalutamide as Neoadjuvant/Adjuvant to Local-regional treatment in Patients with High-risk, Locally Advanced Prostate Cancer (RENAPCA) is a prospective, single-arm, open-label phase Ib trial with blinded outcome assessment. The study is conducted across four tertiary oncology centres within the United States. Eligible participants are adult men with pathologically confirmed locally advanced high-risk prostate cancer who are candidates for definitive local therapy. Patients with significant comorbidities or a life expectancy of less than 6 months are excluded. The trial includes a 3+3 dose-escalation safety lead-in cohort (up to 12 patients) to determine dose-limiting toxicities and recommended phase 2 dose, followed by a dose expansion cohort (up to 46 patients). Interventions consist of 6 months of neoadjuvant therapy with relugolix plus enzalutamide, definitive local therapy (radical prostatectomy or radiation therapy), and 18 months of adjuvant therapy with relugolix plus enzalutamide. Primary outcomes include pathologic CR rate and minimal residual disease rate. Secondary outcomes include prostate-specific antigen response, progression-free survival, objective response rate, frequency and severity of adverse events, and positive margin/pathologic downgrade rate. Exploratory objectives include patient-reported outcomes and quality of life measures. RENAPCA will assess the safety and efficacy of neoadjuvant/adjuvant relugolix+enzalutamide in high-risk, locally advanced prostate cancer to support future larger-scale studies and potentially improve treatment outcomes.
This research protocol has been approved by the Institutional Review Board of the University of Oklahoma Health Sciences Center (7 March 2024). The study is based on voluntary participation with informed written consent.
Research on psychosocial interventions for dementia demonstrates increased rigour and robustness. However, if we are to influence practice, beyond results from randomised controlled trials, a variety of types and sources of evidence is needed. The Medical Research Council (MRC) framework offers a valuable guide for developing, evaluating and implementing complex interventions, to facilitate integration of research into practice. There is limited knowledge of how researchers design, evaluate and implement psychosocial intervention studies in dementia, using the MRC framework. This scoping review aims to: (1) identify the methodological and methods trends, use and gaps in the development, evaluation and implementation of psychosocial interventions for dementia, and (2) determine if and how the MRC six core elements were considered and applied in studies.
Six databases (Ovid MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library) will be searched for studies published from 2015 (when MRC process guidance was published) to 2025. Identified deduplicated citations will be imported into Covidence software, where up to 40% of title/abstracts will be double screened by independent reviewers. ASReview will be used to rank articles by relevance, with a stopping criterion of 250 consecutive irrelevant articles. Full texts will be reviewed by a single reviewer and those excluded will be checked by a second reviewer. Data extraction will include study aim/objective (ie, to develop/adapt; test feasibility/pilot; evaluate; implement); methodology and methods applied; information on which MRC six core elements were considered (yes/no), and if so, how they were addressed (ie, qualitative details). A narrative synthesis, alongside graphical representations (eg, table/bar charts/histograms), will be used to synthesise findings on methodologies and methods mapped onto the MRC framework.
This secondary analysis scoping review does not require ethics approval. Results will be disseminated through peer-reviewed publication(s), seminars, webinars, conferences, postgraduate dementia programmes, blogs, commissioner briefings and social media. The findings will provide a state-of-the-art overview of current practices; advance methods/methodology such as informing a Delphi consensus study on appropriate research approaches; and guide researchers in application of the MRC framework to widen the scope of dementia care evidence for practice improvements.
Submitted to Open Science Framework https://doi.org/10.17605/OSF.IO/S56NQ.
This real-world study investigated the changes of lipid lowering therapy (LLT) usage in patients with high or very high cardiovascular (CV) risk in the UK and the group of all other European countries in the SANTORINI study up to 1 year from baseline and the impact this treatment had on the attainment of low-density lipoprotein cholesterol (LDL-C) risk-adjusted goals set by the National Institute for Health and Care Excellence (NICE) and those in the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidaemia guidelines.
Secondary analysis of the SANTORINI dataset (an international, prospective, observational, non-interventional study (NCT04271280)).
Primary and secondary care centres in the UK and the group of other European countries (Austria, Belgium, Denmark, Finland, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, Sweden and Switzerland).
663 UK patients with high and very high CV risk were included in this analysis and 8502 from the group of other European countries. Of these, 380 UK patients and 6830 from the group of other European countries had LDL-C information available at baseline and 1-year follow-up.
The primary objectives were to describe patients’ lipid management, LDL-C levels at 1-year follow-up and their attainment of 2023 NICE (≤2.0 mmol/L) and 2019 ESC/EAS LDL-C 2019 guideline-recommended LDL-C goals (
Over the course of 1-year follow-up, the overall proportion of UK patients on no LLT reduced from 20.4% at baseline to 7.1%, similar to that observed in the group of other European countries (baseline–20.9%, 1 year–3.0%). The proportion of UK patients receiving LLT monotherapy increased from 74.8% at baseline to 84.9%, higher at both time points than that observed for the group of other European countries (baseline: 52.0%, 1 year: 55.0%). The use of any combination therapy increased slightly from baseline to 1 year in the UK overall cohort (4.9% vs 7.1%) and overall in the group of all other European countries, the cohort increased from baseline (27.1%) to 1 year (40.2%). Overall, mean (SD) LDL-C levels in the UK were 2.5 (1.2) mmol/L at baseline and 2.1 (1.0) mmol/L at 1 year and for the group of other European countries were 2.4 (1.2) mmol/L at baseline and 2.0 (0.9) mmol/L at 1 year. The overall proportions of UK patients achieving the UK NICE treatment goal and ESC/EAS 2019 guidelines at baseline versus 1-year follow-up were 40.3% vs 52.6% and 22.9% vs 32.9%, respectively; 21.1% and 30.9% of patients in the group of other European countries achieved the ESC/EAS 2019 guidelines at baseline and 1-year follow-up, respectively.
In this UK-focused analysis of the SANTORINI study, use of LLT increased modestly over 1 year, accompanied by a reduction in average LDL-C levels. However, mean LDL-C remained above the NICE goal, and attainment of both NICE and ESC/EAS LDL-C thresholds remained suboptimal. The findings highlight continued opportunities to optimise lipid management in UK clinical practice, including the potential for broader use of combination therapies.
Persistent fatigue is a frequent symptom in chronic medical conditions. Systematic reviews of non-pharmacological interventions for fatigue have identified interventions that are effective at reducing fatigue, but there is limited published evidence on the cost-effectiveness of these interventions.
To identify non-pharmacological fatigue interventions that have the potential to be cost-effective in patients with long-term medical conditions.
Decision analytic modelling with intervention costs estimated from staff time and quality-of-life outcomes mapped from a systematic review and network meta-analysis of fatigue outcomes.
UK National Health Service (NHS).
People with persistent fatigue associated with a chronic medical condition.
Non-pharmacological fatigue interventions versus usual care.
Net monetary benefit from a UK NHS and Personal Social Services perspective; quality-adjusted life years (QALYs) gained; intervention costs valued at 2022/23 prices; costs and benefits discounted at 3.5% per annum.
In the base-case analysis, expected costs from the probabilistic analysis for individual and group interventions were: £267 and £157 for physical activity promotion, £810 and £485 for cognitive behavioural therapy (CBT)-Fatigue and £462 and £214 for mindfulness. The expected QALYs gained were similar for mindfulness and physical activity promotion (0.061 and 0.060, respectively), but lower for CBT-Fatigue (0.045). All interventions provided positive incremental net monetary benefit (INMB) versus usual care when valuing a QALY at £20 000. However, since group interventions are less costly than individual ones, and we assumed equivalent clinical benefit, they are expected to provide greater INMB. These findings remained robust across different scenarios, except for CBT-Fatigue (individual), which had negative INMB in some scenarios.
There remains uncertainty regarding which intervention is most cost-effective due to limitations in the underlying evidence base. Future research is recommended to compare the cost-effectiveness of these interventions across a broad population with different chronic conditions.
Research and innovation are essential for advancing clinical practice and safeguarding patient safety in healthcare. This review aims to assess the research capacity of Advanced Practice Nurses in Australian healthcare settings. By identifying the barriers and enablers to, the findings aim to inspire research engagement of paediatric nurses.
A rapid review methodology was used to systematically identify, appraise and synthesise data relevant to Advanced Practice Nurses' research capacity.
A comprehensive search of Ovid Medline and Cumulative Index to Nursing and Allied Health Literature databases was conducted, covering publications from 1 July 2010 to May 2024. Additional reference checks and grey literature searches were undertaken to identify relevant studies.
Data extraction and quality appraisal were conducted independently and checked by the research team. The Mixed Methods Appraisal Tool was used for quality assessment and a descriptive narrative synthesis approach integrated findings across qualitative, quantitative, and mixed methods studies.
Eight studies met the inclusion criteria. Findings revealed that while Advanced Practice Nurses value research and evidence-based practice, barriers—such as time constraints, limited resources, and lack of organisational support—restricted their engagement. Leadership support and structured mentorship were identified as critical enablers of research capacity.
This review highlights the need for targeted strategies to enhance Advanced Practice Nurses' research capacity within Australian healthcare. Addressing identified barriers and fostering a supportive environment can empower Advanced Practice Nurses to better utilise their roles, contributing to improved patient care and healthcare innovation.
This research addresses the limited understanding of research capacity among Advanced Practice Nurses identifying challenges and opportunities for engagement. It is particularly relevant for healthcare organisations, policymakers, and educational institutions seeking to strengthen research capacity among APN roles. Findings will inform evidence-based practice, patient outcomes, and research culture in Australian healthcare services.
International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42024539163
Androgen deprivation therapy (ADT) improves survival in advanced prostate cancer but may lead to debilitating side effects, including sarcopenic obesity and a 10–45% increased risk of other comorbidities. Guidelines recommend exercise and nutrition interventions during ADT, but access to these services is often limited, and referral pathways are unclear. This study aims to evaluate the feasibility and preliminary efficacy of an online, home-based, multi-faceted, exercise, nutrition and education programme (ProHealth) for men with prostate cancer treated with ADT. ProHealth was co-designed with consumers and healthcare professionals to include (i) education on prostate cancer and treatment-related side effects and (ii) multimedia behaviour change resources to support individualised nutrition and exercise behaviour change.
This 12-week randomised controlled trial (target n=50) will include men treated with ADT for >3 months or who have completed ADT in the last 24 months, are overweight or obese and are not under the care of a dietitian or exercise professional. Participants will be randomised (1:1) to the ProHealth intervention or usual care. The intervention group will receive four consultations with an Accredited Practising Dietitian to promote a high protein and energy reduced diet, and five consultations with an Accredited Exercise Physiologist to follow a home-based progressive resistance training and aerobic exercise programme. The primary outcomes are feasibility (recruitment rate, retention, data completeness, reach, safety, consultation attendance and adherence, and usage of the ProHealth web platform), acceptability and satisfaction of the ProHealth intervention. Exploratory secondary outcomes will be assessed at baseline and 12 weeks and include changes in body weight and composition (total and appendicular fat-free mass, fat mass), quality of life (Functional Assessment of Cancer Therapy (FACT)—General, FACT-Prostate, FACT-Fatigue), physical function (30-second sit-to-stand), dietary intake (3-day food diary) and physical activity (7-day accelerometer). Linear regression models will estimate differences between the intervention and usual care group. Qualitative interviews on participant satisfaction will be transcribed verbatim for thematic analysis.
This study is approved by Deakin University Human Research Ethics Committee (DUHREC2024-038) and registered on Australian and New Zealand Clinical Trials Registry (ACTRN12624000874516). Findings will be disseminated through peer-reviewed journals, scientific meetings and other public forums.
ACTRN12624000874516.
To examine HIV care attrition patterns and risk factors among adolescent girls and young women (AGYW) enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Tanzania.
Prospective cohort study.
The study was conducted in three regions of Tanzania: Kagera, Tabora and Dar es Salaam across 543 public and private health facilities.
A total of 10 147 pregnant and postpartum AGYW living with HIV attending PMTCT services between 1 January 2018 and 31 December 2020 were included in this study and followed prospectively until they were censored at the last appointment date or 31 December 2023, whichever was earlier.
The primary outcome was time to HIV care attrition, defined as death, discontinuation of antiretroviral treatment (ART) or loss to follow-up (LTFU). LTFU was defined as failure to attend a scheduled clinic appointment and being absent from care for ≥90 consecutive days following a missed appointment among non-transfers. Kaplan-Meier analyses were used to estimate time to first attrition. The Anderson-Gill proportional hazard model estimated the risk factors for repeated care interruptions, adjusted for baseline characteristics and stratified by ART status at PMTCT enrolment.
A total of 3259 attrition events were observed, of which 79% occurred within the first year, with the median time to first attrition of 4 months (IQR: 1–8), 96.3% were due to LTFU. Over two-thirds of first-year attrition occurred among AGYW newly started on ART at PMTCT enrolment, who had more than twice the attrition rate of those already on ART (28.6 vs 11.2 per 100-person-years). Of AGYW lost to follow-up, 44.8% returned to care and 20.9% experienced subsequent attrition. Among AGYW new on ART, attrition was higher in those enrolled late in their third trimester (adjusted HR (aHR) 1.20; 95% CI 1.01 to 1.42) versus those in the first trimester and lower during the postpartum period (aHR 0.58; 95% CI 0.43 to 0.79). In AGYW already on ART, attrition rate was higher among adolescents 18–19 years (aHR 1.37; 95% CI 1.13 to 1.66) and those enrolled late; during the second (aHR 1.41; 95% CI 1.16 to 1.72) and third trimesters (aHR 1.57; 95% CI 1.23 to 2.00) or post partum (aHR 1.36; 95% CI 1.09 to 1.70) compared with the first trimester. AGYW with early-stage HIV, on second-line regimens and attending facilities with fewer AGYW, had a lower attrition rate in contrast to comparison groups.
AGYW newly started on ART at PMTCT enrolment are more likely to have early and recurring dropout. Given the cyclical nature of HIV care engagement, tailored and repeated interventions are needed to support continuous retention and re-engagement for pregnant and postpartum AGYW with HIV.
To explore emergency nurses' experiences and perceptions of violence from patients and visitors in China, focusing on its nature, contributing factors, and consequences.
A qualitative descriptive design was employed.
Thirteen emergency nurses from eight tertiary public hospitals in a provincial capital city in northern China were recruited using purposive and snowball sampling; most were female and had several years of emergency nursing experience. Data were collected through semi-structured, face-to-face interviews conducted in Mandarin and analysed using latent content analysis.
Two overarching themes were identified. The first theme, Nurses as Healers or Targets: Confronting Misplaced Anger, described how violence from patients and visitors emerged in high-pressure emergency environments, often involving verbal abuse, threats, or physical aggression, and was shaped by situational stressors and perceived power imbalances. The second theme, Healing in Shackles: Maintaining Professional Composure and Emotional Desensitization, captured nurses' efforts to remain professional while experiencing fear, exhaustion, and emotional distancing following repeated exposure to violence.
Violence from patients and visitors represents a persistent occupational challenge for emergency nurses, with cumulative effects on their emotional wellbeing and professional functioning. The findings highlight the need to shift responsibility for managing violence from individual nurses to organizational and systemic levels.
Strengthening organizational responses, such as emotional support mechanisms, clear visitor management policies, and accountability for violence prevention, may help create safer and more sustainable emergency care environments.
This study adhered to the COREQ reporting guidelines.
1. What problem did the study address? This study addressed the persistent problem of violence against emergency nurses in urban tertiary hospital emergency departments in northern China, particularly incidents perpetrated by patients and visitors. It explored how nurses perceive the nature of such violence, the factors contributing to its occurrence, and its consequences for their professional and personal well-being.
2. What were the main findings? Violence against nurses by patients and visitors in the ED was often driven by enabling factors, such as high-pressure environments, nurses' visibility, and perceived power imbalances, as well as by reward-based motivations. Nurses responded with professional composure but reported limited peer and managerial support. Over time, cumulative exposure led to physical harm, lingering emotional distress, heightened vigilance, and emotional detachment.
3. Where and on whom will the research have an impact? The findings will inform nurse leaders, policymakers, and hospital administrators by reframing resilience as an organizational responsibility. Embedding structured emotional support, transparent visitor management, and violence-prevention accountability within hospital governance can foster safer and more sustainable work environments.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore staff and patient perception of the newly co-developed wearable monitoring system (WMS), including acceptability of use in clinical practice.
Pragmatic qualitative descriptive study.
Semi-structured interviews were conducted with 12 patient participants and eight staff members between June 2023 and August 2024, and were analysed thematically.
Three themes were identified, building on previous qualitative work around the use of WMS on hospital wards. The first theme—centralised continuous monitoring enhances care—explores how WMS provides staff with a means to provide safe, efficient care with the ability to see the vital signs away from the patient. Patients reported feeling safer, knowing they were being monitored when staff were not at the bedside. The second theme—human connection at the bedside—considers how both patients and staff emphasised that the system should not replace nurse/patient interactions and face-to-face care, even though it provided patients with a stronger sense of independence. The final theme—system usability and integration into care—focuses on use of the system in clinical practice and implications for the future.
Wearable monitoring systems have the potential to support nurses to provide safer, more efficient care, whilst providing reassurance to patients. However, centralised monitoring should not replace face-to-face clinical contact, and careful consideration should be given to who would benefit most from the technology.
This study extends existing knowledge of the impact of WMS from being a tool to enhance patient safety to an intervention to improve nurse efficiency and patient experience, within the context of a high-demand surgical ward.
Patients and members of the public were involved in study design and data collection. Their contributions included participating in advisory groups, ensuring the research addressed patient-relevant priorities.
by Ana Caroline Bini de Lima, Vanessa Cristini Sebastião da Fé, Maria Simara Palermo Hernandes, Emily Caroline Pfeifer de Cristo, Ana Gabrieli dos Santos Fagundes Euzébio, Maria Vitória e Silva Sousa, Fabiana Ribeiro Caldara, Viviane Maria Oliveira dos Santos
This study aimed to evaluate the ability of social noncontact environmental enrichment to facilitate social buffering and to characterize the emotional experience of horses subjected to restraint in stock by assessing physiological parameters and facial expressions. Pantaneiro horses (n = 11) were evaluated in a crossover design with two treatments: social noncontact enrichment during stock restraint and social isolation during stock restraint. Physiological parameters (heart rate, heart rate variability, respiratory rate, ocular temperature by infrared thermography, and auricular temperature by infrared thermometer) and facial expressions (EquiFACS) were assessed throughout the 24-minute restraint period. When horses were accompanied by a conspecific, heart rate, respiratory rate, and eye temperature were lower (p nostril dilator (AD38), inner brow raiser (AU101), upper eyelid raiser (AU5), eye white increase (AD1), ears forward (EAD101), and ears back (EAD104), was also lower (pby Emily Tufano, Kondaiah Palsa, Rebecka O. Serpa, Timothy B. Helmuth, Gabriela Remit-Berthet, Sara Mills-Huffnagle, Mathias Kant, Aurosman Sahu, James R. Connor
Iron is essential for normal physiological function, yet dysregulation of iron metabolism is increasingly recognized as a hallmark of cancers such as glioblastoma (GBM). Recent clinical evidence suggests that systemic iron deficiency anemia (IDA) negatively impacts GBM outcomes in a sex-dependent manner, but the mechanisms linking systemic iron availability to tumor iron metabolism remain poorly understood. Here, we interrogate the impact of systemic iron through dietary modulation (control, iron deficiency (ID), and high iron diets), stratified by sex, on tumor iron handling and GBM outcomes utilizing an immune competent (C57BL/6) GBM (GL261) mouse model. Subsequently, we analyzed clinical samples to evaluate translational value. In the preclinical study, we show that iron deficiency decreased survival in males but conferred a slight survival advantage in females, consistent with prior clinical trends. Among circulating iron markers, only ferritin light chain (FTL), but not ferritin heavy chain (FTH) or serum iron, positively correlated with survival in males but not females. In the brain, contralateral iron levels reflected dietary iron status in males but not females, further supporting sex-dependent regulation of local and circulating iron. Notably, tumor iron content remained unchanged in males but was significantly elevated in ID female tumors, complemented by increased transferrin receptor (TfR1) and FTH expression. In clinical GBM samples, we observed non-statistically significant but similar survival trends across varying iron and ferritin levels, suggesting potential translational relevance of our exploratory model. These findings demonstrate that systemic iron availability exerts a sex-specific effect on tumor iron handling, highlighting a critical relationship between systemic and tumor iron regulation in GBM.To identify facilitators and barriers to quality, equitable discharge teaching by paediatric emergency department nurses during the COVID-19 pandemic, describe impacts of inequitable discharge teaching, and identify potential solutions to the barriers.
Twenty-two nurses in a single urban paediatric hospital participated in individual interviews from January to April 2022 via phone or videoconference. Interviews were transcribed and analysed using an inductive codebook.
Six barriers to equitable discharge teaching were identified: ED overcrowding, travel nurse training/knowledge, burnout and stress, increased role complexity, COVID precautions, and resource bottlenecks. Two facilitators were also identified: engagement and effective communication. Nurses described the impacts of these barriers along with proposed solutions to improve discharge teaching.
The COVID-19 pandemic created additional barriers to discharge teaching in the paediatric emergency department. Nurses identified barriers and facilitators, the impacts on patients and families, and potential solutions to improve equitable discharge teaching.
This study identifies how periods of high patient volumes or frequent process changes during a pandemic exacerbate inequities in discharge teaching.
This study identifies barriers and facilitators that shaped nurses' ability to provide quality, equitable discharge teaching during the COVID-19 pandemic and offers actionable guidance for hospital leaders and health systems to improve discharge teaching and enhance emergency preparedness for future public health crises.
This study conforms to the Standards for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
ClinicalTrials.gov identifier: NCT04676490
by Dominika Buni, Áron Botond Kovács, Enikő Wehmann, Dénes Grózner, Krisztián Bányai, Eszter Zsófia Nagy, Janet Bradbury, Marco Bottinelli, Elisabetta Stefani, Salvatore Catania, Inna Lysnyansky, László Kovács, Miklós Gyuranecz, Zsuzsa Kreizinger
Mycoplasma iowae is an economically significant pathogen that causes reduced hatchability, late embryo mortality and leg deformities, chondrodystrophy and skeletal lesions in poults. While prevention is essential in the control of infection, the appropriate administration of antibiotics may reduce economic losses during outbreaks. As a first step in the exploration of antimicrobial resistance mechanisms in M. iowae, target modification and efflux pump activity were examined in the present study. Point mutations were analyzed in previously described antibiotic binding sites in the whole genome sequences of 99 M. iowae strains. Mismatch amplification mutation assays (MAMAs) were designed and validated for the differentiation of mutations corresponding to elevated minimum inhibitory concentration (MIC) values for fluoroquinolones. Broth microdilution assays were performed to evaluate the effect of efflux pump inhibitors. In the presence of orthovanadate (OV), MIC values were significantly lower than in the absence of OV for spiramycin, tilmicosin, tylosin and oxytetracycline, which may indicate the presence of an active efflux system in M. iowae. Putative promoter regions of efflux-related genes were predicted and characterized. Genetic mutations, previously described in other bacteria, were described to be associated with elevated fluoroquinolone, macrolide and lincomycin MICs in M. iowae, although certain resistant phenotypes remained unexplained, promoting future examinations for deeper insights. The developed MAMAs may support rapid identification of M. iowae strains with elevated MIC values for fluoroquinolones. The better understanding of the efflux pump mechanisms enables the development of alternative methods for the support of therapy against this pathogen.Patients discharged from intensive care units (ICUs) are at high risk of adverse long-term outcomes including cardiovascular and/or renal events and a 1-year mortality of approximately 22%. Plasma biomarkers measured at ICU discharge have demonstrated strong prognostic value, with elevated cardiac or renal biomarkers identifying patients at particularly high risk of poor outcomes. Sodium-glucose cotransporter 2 inhibitors are now widely recognised for their cardioprotective and nephroprotective effects in chronic conditions such as type 2 diabetes, heart failure or chronic kidney disease. These agents improve both morbidity and mortality across a range of high-risk populations. We hypothesise that a therapeutic strategy aimed at preventing the progression of cardiovascular and/or renal injury following ICU discharge may improve long-term outcomes in ICU survivors.
This is a multicentre, double-blind, randomised, placebo-controlled clinical trial conducted across 16 teaching and non-teaching ICUs in France. We will enrol 600 adult patients (18 years of age or older) who have received mechanical ventilation and/or vasopressors for at least 24 hours during their ICU stay, and who meet at least one of the following criteria at ICU discharge: N-terminal pro-B-type natriuretic peptide (NT-proBNP) >800 pg/mL or BNP >90 ng/L, an estimated glomerular filtration rate between 25 and 90 mL/min/m². Eligible patients will be randomised in a 1:1 ratio to receive either dapagliflozin (10 mg once daily) or a matching placebo for a duration of 1 year. The primary outcome is a composite endpoint assessed at 1 year after randomisation, comprising: all-cause mortality, unscheduled hospitalisation for acute heart failure and decrease in renal function. Feasibility will be assessed based on patient and clinical acceptability and recruitment performance, including enrolment rates across participating centres.
This study has been approved by the Institutional Review Board (CPP Ile-de-France 5). Written informed consent will be obtained from all participants prior to enrolment and the initiation of any study-related procedures. Dapagliflozin is a widely available medication with an established safety profile. If proven effective, it would represent a readily deployable strategy to improve long-term outcomes in ICU survivors. The study is described in accordance with the Standard Protocol Items: Recommendations for Interventional Trials framework, and key design features and methodological decisions are outlined accordingly. DAPA-ICU aims to evaluate the efficacy of dapagliflozin in cardiorenal protection among critically ill patients following ICU discharge. The main trial results will be submitted for publication in a peer-reviewed journal as soon as they become available after final analysis.
Over 50% of patients participating in cardiac rehabilitation (CR) experience poor sleep and/or, closely related, psychological stress. Although stress management interventions are generally available, they are typically underutilised in CR, and sleep remains an underaddressed component within CR. This is concerning, as poor sleep and stress not only reinforce each other but are also associated with poorer cardiovascular health and lower quality of life. Therefore, the primary aim of the OPtimising CArdiac REhabilitation by REfining Sleep and STress (RESST) study is to investigate the (cost-)effectiveness of adding a behavioural intervention targeted at improving sleep and managing stress during CR (RESST intervention) on sleep and psychological stress. Furthermore, the study aims to explore the (bidirectional) associations between sleep, stress and lifestyle behaviours.
This parallel-arm multicentre randomised controlled trial will include 200 CR patients across 3 major CR centres in the Netherlands who experience poor sleep and/or stress. Patients will be randomised in a 1:1 ratio to standard CR or standard CR with the RESST intervention. Standard CR is a structured programme combining exercise, lifestyle guidance and risk management. On top of standard CR, the RESST intervention consists of 5 in-person group sessions targeting sleep and stress and is based on Acceptance and Commitment Therapy and Cognitive Behavioural Therapy. Primary outcomes are accelerometer-assessed and self-reported sleep and perceived stress. Secondary outcomes include quality of life, psychosocial well-being, chronic stress biomarkers (hair cortisol and cortisone), momentary fatigue, momentary stress and physical activity. Linear mixed models will be used to assess changes in outcomes at 3-month (after intervention and/or CR completed) and 6-month follow-up. The momentary data collected with ecological momentary assessment and accelerometry will be analysed using multilevel linear mixed models to explore the (bidirectional) relationship between sleep, stress and other lifestyle components such as physical activity.
This study was approved by the ethics committee of Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands (MEC-2024-0238). The findings will be disseminated through publications in peer-reviewed journals, presentations at academic conferences and professional and patient publications.
To explore how children, caregivers and healthcare providers experience shared decision-making in real time within an interdisciplinary paediatric feeding clinic in multicultural Singapore.
A qualitative ethnographic approach was used.
Data collection involved one-time participant observations of interdisciplinary feeding clinic consultations, observations of healthcare providers-only debrief and follow-up interviews with caregivers. Data were collected from July 2024 to November 2024. Participants included caregivers, healthcare providers and otherwise well children presenting with feeding difficulties. Fieldnotes, including observational matrices, reflexive journals and interview transcripts, were analysed thematically using Braun and Clarke's six-step process for thematic analysis.
Twenty observations and 11 interviews were conducted. Four themes were identified: (1) Centring the child: building trust and respect; (2) Tensions and teamwork: negotiating expertise and expectations; (3) Feeding across cultures; and (4) Parenting under pressure: the social context of feeding choices.
In an interdisciplinary feeding clinic, shared decision-making extends beyond the clinical encounter, reflecting relational, cultural and structural realities. The feeding clinic modelled effective shared decision-making through child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. However, divergent perceptions of what problematic feeding entails, caregivers' hesitancy in taking on an active role in consultations, and the external pressures caregivers contended with constrained this process. These findings highlight the need for inclusive, culturally responsive care models and more caregiver support interventions that acknowledge the full complexity of feeding care.
Nurses, with their central role in relational and communicative care, are uniquely positioned to bridge tensions between medical paternalism and collaborative, family-centred approaches. By facilitating trust, clarifying goals and supporting caregiver participation in feeding decisions, they play a critical role in advancing child health outcomes while strengthening caregiver agency within multicultural healthcare systems.
This study revealed how cultural, familial and systemic pressures shape caregiving practices, often constraining caregiver participation and shared decision-making in clinical encounters. Shared decision making in an interdisciplinary feeding clinic comprised of child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. This study expounds on the potentially critical role nurses could play within the multidisciplinary team to negotiate expectations, foster caregiver agency and contribute to culturally responsive, family-centred feeding care.
The reporting of this study is guided by the Standards for Reporting Qualitative Research (SRQR).
This study did not include patient or public involvement in its design, conduct or reporting.
Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.
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