Conectar
To identify research gaps by mapping what is known about the barriers and enablers to pre-registration nursing students identifying signs of suicidal distress in healthcare consumers and providing clear pathways of support.
Scoping review.
This scoping review was conducted using Arksey and O'Malley's (2005) five stage framework and the Levec et al. (2010) extensions of this framework.
The Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete and Ovid MEDLINE databases were searched to identify relevant articles, keywords and search terms to inform the full search strategy for CINAHL. This search strategy was then adapted for Scopus, PsychInfo, Emcare, Medline and ERIC, searched in November 2024.
Studies eligible for inclusion (N = 28) represented research from 14 countries; most (53.5%, n = 15) used a quantitative design, 11 (39.3%) were qualitative and two (7.1%) used a mixed-methods design. Barriers found from the scoping review included a low level of knowledge of suicidality, stigma preventing students from assessing and acting on suicidal ideation, and a lack of confidence in providing care to healthcare consumers expressing suicidality. Enablers included lived experience, exposure to individuals expressing suicidal ideation and education, simulation and role play. This review also contributes to the existing literature about the relationship of nursing to existing suicide prevention frameworks and suggests revision of these frameworks to address staff attitudes and beliefs, as well as lived and living experience.
Nurses are ideally placed to assess and respond to suicidality among healthcare consumers, and preparation should begin during pre-registration studies. Our scoping review indicates that further research work is needed to address the barriers to working with healthcare consumers expressing suicidality and to enhance the enablers to provide safe care.
Addressing the barriers and enablers to pre-registration nursing students providing safe care for healthcare consumers expressing suicidality is essential. Further research is required to address the barriers and enhance the enablers identified in this scoping review.
What problem did the study address? This scoping review summarised the literature on pre-registration student ability to work with healthcare consumers expressing suicidality, identifying barriers and enablers. What were the main findings? Barriers include poor knowledge of suicidality, stigma, fear and a lack of confidence in working with healthcare consumers expressing suicidality. Enablers include lived experience, exposure to clinical settings where healthcare consumers express suicidality and simulation and education. Where and on whom will the research have an impact? The research will have an impact on providers of pre-registration nursing degrees, where the inclusion of content addressing suicidality and exposure to settings where individuals express suicidal ideation is shown to improve attitudes and knowledge of suicidality assessment.
PRISMA checklist for scoping reviews.
This study did not include patient or public involvement in its design, conduct or reporting.
This study explored how Structured Medication Reviews (SMRs) are being undertaken and the challenges to their successful implementation and sustainability.
A cross-sectional mixed methods online survey.
Primary care in England.
120 clinical pharmacists with experience in conducting SMRs in primary care.
Survey responses were received from clinical pharmacists working in 15 different regions. The majority were independent prescribers (62%, n=74), and most were employed by Primary Care Networks (65%, n=78), delivering SMRs for one or more general practices. 61% (n=73) had completed, or were currently enrolled in, the approved training pathway. Patient selection was largely driven by the primary care contract specification: care home residents, patients with polypharmacy, patients on medicines commonly associated with medication errors, patients with severe frailty and/or patients using potentially addictive pain management medication. Only 26% (n=36) of respondents reported providing patients with information in advance. The majority of SMRs were undertaken remotely by telephone and were 21–30 min in length. Much variation was reported in approaches to conducting SMRs, with SMRs in care homes being deemed the most challenging due to additional complexities involved. Challenges included not having sufficient time to prepare adequately, address complex polypharmacy and complete follow-up work generated by SMRs, issues relating to organisational support, competing national priorities and lack of ‘buy-in’ from some patients and General Practitioners.
These results offer insights into the role being played by the clinical pharmacy workforce in a new country-wide initiative to improve the quality and safety of care for patients taking multiple medicines. Better patient preparation and trust, alongside continuing professional development, more support and oversight for clinical pharmacists conducting SMRs, could lead to more efficient medication reviews. However, a formal evaluation of the potential of SMRs to optimise safe medicines use for patients in England is now warranted.
In the UK, approximately 5.4 million adults live with asthma, of whom one in five have an uncontrolled form. Uncontrolled asthma reduces quality of life and increases healthcare use. Engaging with peers through online health communities (OHCs) can empower patients to self-manage their long-term condition. While OHCs have been in existence for several years and growing numbers of patients access them, the role of primary care in signposting patients to them has been minimal and ad hoc. We have co-developed with patients and healthcare professionals (HCPs) an intervention for adult patients with asthma, consisting of an appointment with a primary care HCP to introduce online peer support and sign patients up to an established asthma OHC, followed by OHC engagement. Feasibility work found the intervention acceptable to patients and HCPs. This protocol outlines our plan to test the intervention’s effectiveness and cost-effectiveness.
An individual randomised controlled trial will be carried out. Eligible participants will be recruited via an online survey sent to adult patients on the asthma register in 50–70 general practices in several UK locations. Participants will be invited to attend a one-off, face-to-face appointment with a primary care HCP, during which they will be individually randomised to the intervention or usual care. An asthma control test (primary outcome) and other measures of clinical effectiveness will be collected at baseline and every 3 months over a 12-month follow-up period. Descriptive and inferential statistics will be used to compare outcome measures between study arms. Cost-effectiveness assessment of the intervention compared with current standard of asthma management in primary care will be reported. A sample of patients and HCPs will be interviewed at study exit and the data analysed thematically.
The study was approved by a National Health Service Research Ethics Committee (reference: 25/NE/0006). Written consent will be obtained from all participants. Findings will be disseminated through various means, including sharing with general practices, conference presentations and peer-reviewed publications.
The aim of this integrative review was to explore registered nurses' understandings of organisational culture and cultures of care in aged care.
Integrative literature review.
A literature search was conducted of Medline (OVID), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health, and Informit databases in June 2024. In October 2024, a search for grey literature was conducted focusing on Google Scholar, the Analysis and Policy Observatory (Australia), Australian Government websites, European Union Institutions and Bodies, and usa.gov. The inclusion criteria were Australian and international literature published in English between 2004 and 2024. The inclusion criteria were amended to focus on literature published from 2014 to 2024.
Seventeen research studies met the inclusion criteria for the review. Four primary themes were identified: competing hierarchies of power; the multifaceted role of nurses in long-term care settings; standing still is not an option; and implications for culture change strategies in practice.
Registered nurses in aged care are pivotal to evolving clinical and administrative practice and creating organisational cultures that affirm the rights of older people, including providing a supportive workplace for those who care for them, in an environment focussed on developing and sustaining quality care. Viewing the complex relationships at different organisational levels through the prism of Foucault's ideas on disciplinary power generates new insights into the role of registered nurses in aged care settings. This review also underscores that research on organisational culture in aged care is at a formative stage. There is potential for future research that fosters a robust evidence base to support the development of organisational cultures that nurture a person-centred environment ultimately leading to improved care and staff experience.
Registered nurses in aged care settings are advocating for a transformative shift in organisational cultures that prioritises inclusivity, compassion and person-centred care. Empowering nurses through clinical and administrative leadership roles is crucial for cultivating person-centred organisational cultures in aged care settings. It is essential that policymakers invest in the development of registered nurses who can excel in clinical and operational roles at management and executive levels. Policy changes that promote frameworks that facilitate nursing leadership are essential for establishing and maintaining person-centred workplace cultures.
Prisma extension for scoping reviews (PRISMA—ScR).
This study did not include patient or public involvement in its design, conduct, or reporting.
by Charlotte J. Whiffin, Kathleen Joy O. Khu, Brandon G. Smith, Isla Kuhn, Santhani M. Selveindran, Laura Hobbs, Samin Davoody, Yusuf Docrat, Orla Mantle, Upamanyu Nath, Lara Onbaşı, Stasa Tumpa, Ignatius N. Esene, Harry Mee, Fergus Gracey, Shobhana Nagraj, Tom Bashford, Angelos G. Kolias, Peter J. Hutchinson
Following calls for more qualitative research in neurosurgery, this scoping review aimed to describe the range and reach of qualitative studies relevant to the field of neurosurgery and the patients and families affected by neurosurgical conditions. A systematic search was conducted in September 2024 across six databases: Medline via Ebsco; Embase via OVID; PsycINFO via Ebsco; Scopus; Web of Science Core Collection; and Global Health via Ebsco. Eligibility criteria were based on Population, Concept, and Context. The search identified 18,809 hits for screening with 812 included in the final analysis. Seven themes were identified from a content analysis of study aims: 1 Perspectives of living with a neurosurgical condition; 2 Family perspectives; 3 Perceptions of neurosurgery; 4 Perceptions of general healthcare care; 5 Decision making; 6 Advancing neurosurgery; and, 7 Understanding neurosurgical conditions. Traumatology was identified as the most researched sub-specialty (43.2%) yet few studies were led explicitly by a neurosurgeon (1.6%) or those with a neurosurgical affiliation (10.5%). Lead authors were predominantly from high income countries (93.7%), as were most multi-author teams (86.6%). There was a trend towards increasing publication over time; however, only 8.4% of papers were published in neurosurgical specific journals. The data set had an average Field Weighted Citation Impact of 0.96 and Field Weighted Views Impact of 1.11, 18.9% were cited in policy documents in 15 countries. This scoping review provides a comprehensive picture of the current qualitative research base in neurosurgery and suggests ways to improve the conduct and reporting of such studies in the future. Addressing these challenges is crucial if qualitative research is to advance the neurosurgical evidence base in a rigorous way.Postoperative pulmonary complications (PPCs) represent a significant cause of postoperative morbidity and even mortality. However, there is a lack of consensus regarding this composite endpoint, the definition of the individual components, classification and optimal outcome measures. This study aims to refine the PPCs composite framework by evaluating its construct validity, assessing the necessity and risks of a composite measure and exploring the feasibility of differentiating severity categories.
A Delphi consensus process will be conducted, engaging an international multidisciplinary group of 30–40 panellists, including clinicians, researchers, patients, public representatives and health economists. Through iterative rounds, the study will seek agreement on the individual components of the PPCs composite. Additionally, consensus will establish a framework for a composite outcome measure based on a standardised severity classification, appropriate timeframes and weighted grading of PPCs.
Consensus, defined by ≥75% concurrence in multiple choice questions or on Likert–scale statements, will be evaluated from round 2 onwards. Delphi rounds will be continued until all statements have reached stability of responses evaluated by 2 tests or the Kruskal-Wallis test.
The study will be conducted in strict compliance with the principles of the Declaration of Helsinki and will adhere to ACCORD guidance for reporting. Ethics approval has been obtained for this study from the University of Wolverhampton, UK (SOABE/202425/staff/3). Informed consent will be obtained from all panellists before the commencement of the Delphi process. The results of the study will be published in a peer–reviewed journal with the authorship assigned in accordance with ICMJE requirements.
NCT06916598 (clinicaltrials.gov).
by Lucie Ancel, Jules Gueguen, Guillaume Thoër, Jules Marçais, Aïda Chemloul, Bernard Le Guen, Marc Benderitter, Radia Tamarat, Maâmar Souidi, Mohamed Amine Benadjaoud, Stéphane Flamant
The threat of nuclear or radiological events requires early diagnostic tools for radiation induced health effects. Localized radiation injuries (LRI) are severe outcomes of such events, characterized by a latent presymptomatic phase followed by symptom onset ranging from erythema and edema to ulceration and tissue necrosis. Early diagnosis is crucial for effective triage and adapted treatment, potentially through minimally invasive biomarkers including circulating microRNAs (miRNAs), which have been correlated with tissue injuries and radiation exposure, suggesting their potential in diagnosing LRI. In this study, we sought to identify early miRNA signatures for LRI severity prognosis before clinical symptoms appear. Using a mouse model of hindlimb irradiation at 0, 20, 40, or 80 Gy previously shown to lead to localized injuries of different severities, we performed broad-spectrum plasma miRNA profiling at two latency stages (day 1 and 7 post-irradiation). The identified candidate miRNAs were then challenged using two independent mouse cohorts to refine miRNA signatures. Through sparse partial least square discriminant analysis (sPLS-DA), signatures of 14 and 16 plasma miRNAs segregated animals according to dose groups at day 1 and day 7, respectively. Interestingly, these signatures shared 9 miRNAs, including miR-19a-3p, miR-93-5p, miR-140-3p, previously associated with inflammation, radiation response and tissue damage. In addition, the Bayesian latent variable modeling confirmed significant correlations between these prognostic miRNA signatures and day 14 clinical and functional outcomes from unrelated mice. This study identified plasma miRNA signatures that might be used throughout the latency phase for the prognosis of LRI severity. These results suggest miRNA profiling could be a powerful tool for early LRI diagnosis, thereby improving patient management and treatment outcomes in radiological emergency situations.It is unclear how mis- and disinformation regarding healthcare policy changes propagate throughout Latino communities via social media. This may lead to chilling effects that dissuade eligible individuals from enrolling in critical safety net programmes such as Medicaid. This study will examine pathways and mechanisms by which sentiment in response to mis- and disinformation regarding healthcare policies on social media differentially impact health disparity populations, thus supporting the design of tailored social media interventions to mitigate this.
We will search social media from X/Twitter, Facebook/Instagram and Reddit for keywords relating to health benefit programmes. Demographic, geographical location and other characteristics of users will be used to stratify social media data. Posts will be classified as fake-news-related or fact-related based on curated lists of fake-news-related websites. The number, temporal dissemination and positive or negative sentiment in reacting to posts and threads will be examined using the Python-based Valence Aware Dictionary and sEntiment Reasoner (VADER). Using a crowd-sourcing methodology, a novel Spanish-language VADER (S-VADER) will be created to rate sentiment to social media among Spanish-speaking Latinos. With the proposed approach, we will explore reactions to the dissemination of fake-news- or fact-related social media tweets and posts and their sources. Analyses of social media posts in response to healthcare-related policies will provide insights into fears faced by Latinos and Spanish speakers, as well as positive or negative perceptions relating to the policy over time among social media users.
Our study protocol was approved by the University of California, Los Angeles IRB (IRB#23–0 01 123). Results from this study will be disseminated in peer-reviewed journals and conference presentations, and S-VADER will be disseminated to public repositories such as GitHub.
In Zimbabwe, pregnancy termination is generally prohibited unless and only if the circumstances are in sync with the conditions stipulated in the Termination of Pregnancy (ToP) Act of 1977. This raises questions about the modern-day rights of bodily autonomy and integrity (BAI). Funded by the AIDS and Rights Alliance for Southern Africa, this study, therefore, seeks to review and analyse sexual and reproductive health and rights policies and how they relate to the ToP Act (1977) and BAI.
This study will use a concurrent multimethod approach. First, policies related to the ToP and bodily autonomy and integration will be reviewed and analysed using the policy analysis triangle. Concurrently, a qualitative and quantitative survey will be conducted on purposively selected key informants and focus group discussions with purposively selected women and men, as well as 200 stratified selected women. Qualitative findings will be recorded, transcribed and thematically analysed using MAXQDA V.20 Pro. Simultaneously, the quantitative output will be collected using KoboCollect, exported into Excel and analysed using both Excel and STATA. The strengths, weaknesses, opportunities and threats (SWOT) framework and the Basic Logic Model will guide the triangulation of the findings and development of a policy brief.
Ethical approval for this study was obtained from the National University of Science and Technology Institutional Review Board at Bulawayo, Zimbabwe (Ethics Number: NUST/IRB/2023/23). Written consent would also be sought from the participants. A policy brief would be developed and shared with key stakeholders. At least three manuscripts would emanate from this study and will be submitted for publication in reputable peer-reviewed journals.
The surgical safety checklist (SSC) is designed to improve the safety of surgical procedures, reduce avoidable complications and deaths and foster better communication and collaboration among healthcare providers. Despite the global acceptance of the initiative, there is limited comprehensive research on the challenges, success factors, impact and the role of professional organisations in SSC implementation in Indonesia. This study aimed to explore the implementation of SSC in Indonesia by investigating the challenges, success factors, impact and role of professional organisations in SSC implementation in Indonesia based on the perspective of the surgical team.
This descriptive qualitative study, part of a larger research project, employed purposive sampling to select 13 interview participants from surgical teams across hospitals with varying ownership structures, as well as members of surgical-related professional organisations. Data were collected through in-depth interviews and analysed using thematic analysis.
Participants acknowledged the positive impact of SSC on patient safety; however, challenges such as compliance issues, teamwork dynamics and unsafe behaviour persisted. Key success factors included strong organisational and policy support at the institutional level, including hospital accreditation, educational programmes, safety and quality committees, regular audits and workload management. However, professional organisations in Indonesia have not played a significant role in promoting SSC.
Effective SSC implementation strategies must target the micro, meso and macro levels for comprehensive success. Future research should prioritise overcoming barriers and harnessing the influence of professional organisations to standardise SSC practices, ultimately enhancing patient safety across healthcare settings.
This initiative utilised knowledge translation (KT) strategies, including digital storytelling (DST) as both a narrative and educational tool, to amplify voices and support trauma-informed healing for individuals living with chronic wounds. A multi-method KT approach was employed, involving: (1) patient DST; (2) a national Patient Journey conference; (3) webinars and conference sessions; (4) a social media campaign; (5) infographics and supplements and (6) an open-access digital library. Since its launch in November 2021, the initiative has garnered significant engagement. Twenty-five patients and care partners across Canada shared their wound care journeys. In June 2022, 191 patients, advocates, policymakers and healthcare providers attended the inaugural virtual Patient Journey. Additionally, 102 participants joined three Patient Journey events between June and October 2024. Patient stories received 23 012 views, and the social media campaign and infographics reached over 900 healthcare professionals, policymakers and advocates across Canada. The initiative raised awareness of the challenges faced by individuals living with wounds. Storytellers described grief, frustration and confusion, underscoring the need for person-centred wound care, timely specialised services and better healthcare navigation. Their experiences revealed care gaps, highlighting the urgent need for systemic change to promote equity and inclusivity in wound care.
Surgical site infection is a post-operative complication, which has a significant clinical impact on the affected individual as well as the healthcare system. They are associated with poor outcomes such as increased length of hospital stay, morbidity, mortality and readmissions. As a result, surgical site infections are used as an indicator of the quality of surgical care and for benchmarking. The aim of the review is to gain insight on the current prevalence/incidence and surveillance of surgical site infection in South Africa. The objective was to determine the surgical site infection rate associated with Maxillo-facial and Oral Surgery procedures. A literature review was conducted with the search strategy limited to articles published in English with no limitation to the period. Fifteen articles were deemed eligible for the review according to the inclusion criteria. Eleven articles focused on the epidemiology of surgical site infection in South Africa. The surgical site infection rate varies from 0.65-48% with heterogeneity in the characteristics of the surveillance programmes. The review showed variability in the SSI rates with similar variability in the incidence of surgical site infection as reported on sub-Saharan and African countries (7.93, 9.3, 19.1, 14.5% respectively). The above information was gleaned from institutional point/period prevalence or incidences due to a lack of an integrated national surveillance programme. Thus, there is an urgent necessity to establish an integrated national surveillance programme to facilitate monitoring as well as prevention of surgical site infection in South Africa.
Despite evidence supporting nurse-led digitalized diabetes interventions, gaps persist in understanding their specific impact on community-dwelling patients with type 2 diabetes mellitus (T2DM). Prior reviews lacked a quantitative synthesis of these interventions' effects on outcomes like self-care, HbA1c, and quality of life (QoL), limiting their applicability to clinical practice. This study aimed to systematically evaluate and quantify the effectiveness of nurse-led digitalized diabetes management programmes for community-dwelling adults with T2DM.
We searched six databases to identify relevant articles from their inception to June 2024. Randomized controlled trials that evaluate the effects of nurse-led digitalized diabetes management programs for community-dwelling patients with T2DM were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise the included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0.
Eleven RCTs were included, encompassing 2943 participants from various regions. Nurse-led digitalized programs significantly improved self-care behaviors (SMD = 1.15; 95% CI: 0.49 to 1.81), and QoL (SMD = 0.65; 95% CI: 0.37 to 0.94). The interventions also demonstrated a clinically meaningful reduction in HbA1c levels (MD = -0.25%; 95% CI: −0.43 to −0.06), highlighting their potential in improving glycaemic control. Heterogeneity across studies was substantial for self-care but moderate for HbA1c and QoL.
Nurse-led digitalised diabetes management programmes effectively enhance self-care behavior, reduce HbA1c levels, and improve QoL among community-dwelling patients with T2DM. These findings underscore the potential of digitalised interventions as scalable and accessible alternatives to traditional diabetes management, particularly in non-institutionalized settings.
Nurse-led digitalised diabetes management programmes can empower community-dwelling patients with T2DM to achieve better health outcomes by enhancing self-care and glycaemic control while improving QoL. Their integration into routine clinical practice could address barriers to care, optimize diabetes management, and reduce the long-term burden of the disease.
The International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42024594874
This study investigated the relationship between clinician assessments and the AI-generated scores, highlighting how correlations vary based on clinician expertise. It also explored the proportion of tissue types identified by clinicians relative to AI assessments and assess the inter-clinician agreement in quantifying tissue types, identifying variations based on clinician experience. A cross-sectional survey used purposive, non-random sampling to recruit 50 wound care clinicians. Participants reported their specialisation and experience level before identifying and quantifying granulation, slough, eschar, and epithelialisation in nine wound images. An AI model analysed the same images for comparison. Experienced clinicians and wound care specialists reported higher confidence in assessments. Inter-clinician agreement was moderate–good for granulation and slough (ICC: 0.763–0.762) and moderate–excellent for eschar (ICC: 0.910), but moderate–poor for epithelialisation (ICC: 0.435). Clinicians strongly correlated with AI for granulation, slough, and eschar (r = 0.879, 0.955 and 0.984, respectively). Epithelialisation was more challenging, with a 60% identification rate and moderate correlation with AI (r = 0.579). AI-generated scores aligned with clinician assessments for granulation, slough, and eschar. However, epithelialisation, which is crucial for objectively measuring healing progress, showed greater variability, suggesting that AI could improve the reliability of its assessment, potentially leading to more consistent wound evaluation to guide treatment decisions.
by Corinne E. Metzger, Landon Y. Tak, Samantha Scholz, Matthew R. Allen
High circulating parathyroid hormone (PTH) leading to secondary hyperparathyroidism is proposed to be a key driver of the skeletal phenotype of chronic kidney disease-mineral bone disorder (CKD-MBD) leading to high bone turnover and cortical bone deterioration. The association between high PTH and the skeletal phenotype is typically clearly demonstrated in preclinical models of CKD; however, clinical studies show the relationship between PTH and skeletal outcomes is not as clear. The clinical data have led to a proposed hyporesponsiveness to PTH in the CKD setting with unclear causes. In the current study, we assessed skeletally mature male C57BL/6J mice at 12-weeks and 21-weeks of adenine-induced CKD (Ad) with the second timepoint seven weeks longer than we have previously assessed. We found that serum BUN was high in Ad mice in both groups indicating the presence of kidney disease while PTH was higher in 21-wk Ad vs. 12-wk Ad. Despite the higher PTH, bone formation rate in 21-wk Ad mice was lower than 21-wk Ad mice. Additionally, immunohistochemical assessment of the PTH receptor, PTHR1, and RANKL, a key factor upregulated by PTH, showed a lower percentage of osteocytes positive for the proteins in 21-wk Ad vs. 12-wk Ad. Furthermore, regression analyses demonstrated a positive relationship between serum PTH and PTHR1 and RANKL at 12-weeks, but this relationship was lost by 21-weeks. Overall, these data indicate that prolonged exposure to continuously elevated PTH in adenine-induced CKD mice eventually led to an altered skeletal response indicating lower responsiveness of bone, particularly osteocytes, to the chronic PTH signal. This has implications for using PTH as a surrogate marker of bone outcomes in CKD as well as pointing to the need to better understand the time-based relationship between PTH and skeletal outcomes in CKD.Complex magnetic fields (CMFs) represent an emerging frontier in regenerative medicine, offering significant potential for innovative therapeutic strategies. This review examined both the theoretical foundations and practical applications of CMFs, focusing on their roles in tissue regeneration and antifungal activity. A comprehensive review of electronic databases (PubMed, Scopus, and Embase) identified seven pivotal studies on in vitro models concerning the CMF topic. Although the number of studies is limited, they collectively highlighted the promising therapeutic potential of CMFs in enhancing wound healing, reducing oxidative stress, and neuroinflammation in diabetic neuropathy, positively influencing mitochondrial function, modulating immune responses, promoting cellular communication, inhibiting the growth and adhesion of Candida albicans to medical surfaces, and enhancing dental pulp stem cell proliferation under inflammatory conditions. These findings suggested that CMFs may offer an eco-sustainable approach, effectively targeting pathogens while preserving human cell integrity. While the current body of research is insightful, it remains in its early stages. To fully leverage the therapeutic potential of CMFs, more comprehensive studies are needed to refine their application and confirm their effectiveness across diverse clinical scenarios. This is essential for integrating CMFs into clinical practice, where they promise to revolutionise treatment approaches.
Acute pneumonia (AP) remains a leading cause of death in the older population. Excess risk of death after AP is partly due to cardiovascular (CV) events. We aim to evaluate whether aspirin at a preventive dose (100 mg daily) introduced at the acute phase of AP reduces 90-day mortality.
The ASPirin for Acute Pneumonia in the elderlY study is a phase III multicentre randomised double-blind, placebo-controlled, superiority clinical trial, which will investigate the efficacy and safety of aspirin in older patients with AP hospitalised in a French university and non-university hospitals. Patients will be randomised in a 1:1 ratio between two groups receiving daily either 100 mg of aspirin or a placebo, within 84 hours following radiologically proven AP diagnosis for 90 days. This study aimed at assessing the efficacy of aspirin on all-cause mortality after AP at 90 days (D90) (primary objective), D30 and D120 after randomisation, CV mortality, major adverse CV events (MACE) (ie, myocardial infarction, stroke, heart failure, new atrial fibrillation and pulmonary embolism, CV death and sudden death) incidence, length of intensive care unit and hospital stay, unscheduled rehospitalisation, dependence, overall and MACE-free survival, as well as safety outcomes (bleeding incidence). The sample size, calculated considering a 90-day mortality of 25% and a reduction of 10% in the aspirin group, a two-sided alpha risk at 5% and power of 80%, is 500 patients to prove the superiority of aspirin over placebo. To account for screening failures and consent withdrawals, 600 patients (300 per arm) will be included.
This study has full approval from an independent Ethics Committee. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.
EU CTIS: 2024-510811-32-00.
To assess the upstream pharmaceutical supply chains of 10 high-use pharmaceuticals to detect vulnerabilities that may increase the risk of medicine shortages.
Cohort study.
Dutch outpatient setting in 2022.
A total of 407 authorised medicinal products for 10 pharmaceutical substances with the largest number of outpatients.
The diversity of active pharmaceutical ingredient (API) and finished pharmaceutical product (FPP) manufacturers, their geographic locations and the interdependencies between these manufacturers and marketing authorisation holders (MAHs).
For the 407 authorised medicinal products, 50 of the 90 API manufacturing sites were in Asia, and 38 were in Europe. For five pharmaceutical substances, most of the API sites were located outside Europe. Of the 128 FPP manufacturing sites, 94 were in Europe and 31 in Asia. For all 10 substances, at least 47% of FPP sites were located in Europe. API manufacturing for 122 of the 407 products (30%) was entirely performed outside Europe, and FPP manufacturing for 66 of the 407 products (16%). For four substances, more than half of the products depended on API manufacturing outside Europe. The number of distinct API and FPP manufacturing sites per substance was at least four. For amoxicillin, 16 of the 32 products (50%) entirely depended on one and the same API site. For omeprazole, 39 of the 85 products (46%) entirely depended on one and the same FPP site. MAHs applied dual sourcing for API and FPP manufacturing for 61 (15%) of the authorised medicinal products. For three pharmaceutical substances, none of the authorised medicinal products listed at least two API and FPP manufacturing sites.
Our study of the supply chains of high-use pharmaceutical substances indicates the need for a granular assessment of the interdependencies between MAHs, API and FPP manufacturers to identify upstream supply chain vulnerabilities.
To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients.
Systematic review.
Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database.
Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies.
Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders.
This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery.
Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery.
Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery.
The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020.
Due to the study design, no patient or public consultation took place.
FreshRSS 