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To explore the experiences of nurses transitioning from a clinical ward to a newly established respiratory intermediate care unit (IMCU).
A qualitative descriptive approach was adopted to capture the lived experiences of redeployed nurses. This design was selected to address the research question: What are the initial experiences of nurses transitioning from general ward settings to a newly established IMCU for respiratory patients?
Two focus groups were conducted in June 2024, involving 14 purposefully selected registered nurses. Data were analysed using Braun and Clarke's thematic analysis framework, with the study reported in line with the Standards for Reporting Qualitative Research.
The analysis revealed two interconnected themes reflecting the complexity of the redeployment experience. The first theme, ‘The introspection of waiting amidst change and readiness’, captures the emotional ambivalence nurses felt, characterised by anticipation, uncertainty and a perceived lack of preparedness. This phase was marked by concerns over clinical competence, fear of errors and the weight of new legal and ethical responsibilities. The second theme, ‘The road to organizational change with both driving forces and obstacles’, highlights nurses' concerns about physician readiness, feeling undervalued and limited involvement in planning. At the same time, nurses emphasised the importance of teamwork, structured preparation, experiential training and having the right equipment.
The study underscores the complexity of role transitions for nurses moving into semi-critical care settings like IMCUs. It reveals the need for targeted support strategies to reduce uncertainty and enhance role readiness.
To improve the redeployment experience and patient outcomes, healthcare organisations should prioritise structured training, tailored preceptorship programmes and inclusive decision-making processes. These measures can strengthen nurses' resilience, support workforce sustainability and ensure the delivery of high-quality, patient-centred care in intermediate care environments.
This study highlights the significant impact of inadequate preparation and communication on redeployed nurses' experiences in respiratory IMCUs, emphasising the need for structured training and supportive team dynamics. These findings can guide healthcare leaders, nurse managers and policymakers in developing evidence-based redeployment strategies that reduce anxiety, strengthen team cohesion and ultimately improve nurse adaptation and patient care in semi-critical settings.
We used the SRQR guidelines for reporting qualitative studies.
No patient or public contribution.
To explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community-dwelling older adults.
A cross-sectional study was conducted with 262 community-dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.
Validated self-reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.
Anxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.
Increased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community-dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community-dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.
Understanding factors associated with advance care planning engagement among community-dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community-dwelling older adults in advance care planning.
The STROBE statement checklist was used as a guide to writing the manuscript.
The study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.
To determine the effectiveness of nurse-led/involved home-based interventions for older people with COPD and to explore the experiences of older people and nurses with the interventions.
A mixed-methods systematic review following the JBI methodology for mixed-methods systematic reviews.
The search included relevant and peer-reviewed studies published from January 2010 to December 2023 in CINAHL, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, EMBASE, JBI, EMCARE and ProQuest.
English-language reports of nurse-led/involved home-based interventions for people with COPD were included based on authors’ consensus. Three reviewers performed independent quality appraisal using JBI tools. A convergent segregated approach was used for data synthesis and integration.
Seven interventions were identified in two mixed-methods, two qualitative, two quasi-experimental studies, and one secondary analysis from a randomised control trial. The effectiveness of the interventions was measured with various outcomes and was effective to some extent, with reduced hospitalisation, hospitalisation days, hospitalisation cost and all-paid claims. However, the outcomes were not statistically significant, and the effectiveness was inconclusive. While patients appreciated support and resources, some perceived them as a double-edged sword.
Patients preferred more holistic interventions over extended periods. The inconclusive findings and limitations warrant further research with larger sample sizes and comparable measurement tools and outcomes.
This is the first mixed-methods systematic review on the effectiveness of home interventions for people with COPD with a clear definition of ‘nurse-led’. Nurses felt highly valued by patients and other health professionals; however, they reported a lack of support from management. The lack of interventions led by nurses challenges them to lead, deliver and evaluate what matters to people with COPD.
This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Not applicable.
by Maria Grazia De Iorio, Michele Polli, Sara Ghilardi, Stefano Frattini, Mara Bagardi, Alessandra Paganelli, Maria Cristina Cozzi, Kenza Seghrouchni, Paola Giuseppina Brambilla, Giulietta Minozzi
Non-epidermolytic ichthyosis (NEI) is a hereditary skin disorder affecting several dog breeds, most notably the Golden Retriever. It is primarily caused by a loss-of-function variant in the PNPLA1 gene, while a second, less common form is associated with a deletion in the ABHD5 gene. This retrospective study aimed to assess the prevalence and temporal trends of both mutations in Golden Retrievers tested in Italy between 2017 and September 2025. A total of 508 genetic tests were analyzed, including 463 dogs tested for the PNPLA1 mutation, 42 for the ABHD5 deletion, and 3 for both variants. DNA was extracted from blood or buccal samples and analyzed by real-time PCR followed by confirmatory Sanger sequencing. Among the PNPLA1 tested dogs, 42% were clears (wt/wt), 37% carriers (wt/mut), and 21% affected (mut/mut), with calculated allele frequencies of 60% wild-type and 40% mutant. A significant temporal decline in mutant allele frequency was observed, accompanied by an increasing number of animals tested over time, suggesting growing interest in genetic screening and its impact on selective breeding. Conversely, all dogs tested for the ABHD5 deletion were wild-type, supporting its rarity in the breed. Overall, these findings confirm that PNPLA1-related ichthyosis remains one of the most prevalent hereditary disorders in Golden Retrievers, although its frequency is decreasing. The results emphasize the effectiveness of genetic testing in disease prevention and highlight the importance of continued monitoring to maintain genetic health within the breed.To identify and compare the digital competence profiles of nurse educators, the background variables associated with profiles, and the self-assessed level of digital competence in four European countries.
A descriptive comparative cross-sectional study.
Data were collected from nurse educators (n = 263) in 36 nursing education organisations in Finland, Malta, Slovakia and Spain. Partitioning around medoids (PAM) clustering was used to identify competence groups, and descriptive and inferential statistics were used to examine the association of nurse educators' background variables.
The clustering analysis resulted in two nurse educator digital competence profile groups: high and moderate. The profiles differed based on completed pedagogical studies and teaching experience, with an emphasis on the high competence profile. Educators in the high competence profile group showed greater interest in using educational technology and self assessed their digital competence at a higher level compared to educators in the moderate competence profile group. Nurse educators' lowest digital competence was in the safe and responsible use of technology, such as knowing copyright laws.
Despite the heterogeneous background of nurse educators, international continuing professional development needs in digital competence are identified. Nurse educators' continuing education should support the utilisation of technology through pedagogical approaches, and educators' competence in the safe and responsible use of technology (e.g., how to protect digital materials) must be enhanced in nursing education organisations.
This study highlights the need to further develop nurse educators' digital competence. Continuing professional development should target preparation in safe and responsible technology use and include pedagogical studies and mentoring from experienced peers.
The STROBE checklist was adhered to in reporting the results.
Each participating educational organisation assigned a contact person to distribute the survey to the nurse educators.
Neoplastic foot ulcers are particularly challenging for dermatologists and specialists in hard-to-heal wounds because their location and comorbidities can delay accurate diagnosis. We performed a multicentre, retrospective study analysing clinical and histological data, focusing on neoplastic foot ulcers collected over the past 5 years. We evaluated patients' demographic characteristics, clinical features, histological diagnosis, tumour onset and ulcer site. Statistical analyses were conducted using SPSS software, v.30. In total, 106 patients affected by foot skin ulcers were enrolled in the present protocol (52 women, 54 men). The mean age was 70.15 years. In most cases, the neoplastic ulcer was due to primary tumour ulceration. The dorsum of the foot was the most common site of neoplastic ulcers (66%). From a clinical perspective, most lesions were classified as ulcerated nodules (n = 58), ulcerated plaques (n = 8) or hypergranulating ulcers (n = 25), all with thickened, atypical edges. Histological diagnoses included melanoma (n = 45), non-melanoma skin cancers (n = 34), benign tumours (n = 18) and rarer malignancies (n = 9). A statistically significant correlation was found between histotype and clinical lesion type, and between age and histotype. The study provided preliminary data on the clinical and histological characteristics of neoplastic foot ulcers, warranting further exploration in a prospective, multicentre study.
The financial burden of diabetes-related foot disease (DFD) in Australia remains inadequately understood. This study aimed to explore the direct costs and resource utilisation associated with DFD management, incorporating insights from healthcare professionals actively involved in the treatment of individuals with DFD. A three-step approach informed the economic evaluation. First, a systematic review identified existing Australian cost data. Second, semi-structured interviews with healthcare professionals generated estimates of resource utilisation and addressed data source gaps. Third, a Markov model evaluated the costs of DFD management at both the individual and health system levels. The model included direct costs related to hospital admissions, outpatient/community visits, medications, diagnostics, wound care, offloading devices and amputation-related expenses. The average annual cost per patient for DFD management was AUD $44 691. The primary cost drivers were hospital admissions ($21 566), outpatient/community visits ($14 212) and wound debridement ($5918). The total cost to the Australian healthcare system in 2026 is estimated at AUD $3.08 billion, with projections reaching AUD $3.81 billion by 2030. This study provides essential cost estimates for DFD management at both the individual and health system levels, offering critical insights for policymakers seeking to optimise service delivery and improve patient outcomes in Australia.
To examine whether self-reported thriving at work is associated with biomarkers of stress, inflammation, neuroplasticity and neurodegeneration in nurses.
A cross-sectional study.
An online questionnaire measuring thriving at work was administered to nurses in a teaching hospital in Michigan, U.S. over 5 weeks in 2024. A subsample of 100 questionnaire respondents provided blood samples for biomarker analysis. Multiple regression was used to identify self-reported and biomarker predictors of nurse thriving. Cluster analysis was used to distinguish between nurses with high and low levels of thriving based on a combination of self-report and biomarker data.
Higher self-reports of individual and work-related resources predicted higher thriving. Cortisol, a stress hormone, was significantly and inversely associated with thriving. No blood-based biomarkers of inflammation or neuroplasticity predicted thriving. Neurofilament light chain, a marker of neurodegeneration, was not a direct predictor but modified the effects of interpersonal and work resources on thriving.
Biological markers do play a role in nurses' thriving at work and may contribute important complementary information to that provided by nurse self-reports.
Nurses thrive in a work situation characterised by positive reports of individual, interpersonal and work resources and lower levels of stress. Efforts to enhance thriving could positively impact nurses' well-being and conditions for providing high-quality patient care.
This study addressed the question of whether self-reported thriving at work among nurses is reflected in biomarkers of stress, inflammation, and neurocognitive health. A profile of high self-reported work-related resources and low cortisol distinguished higher levels of nurses' thriving from lower levels. Organisational efforts to enhance nurses' thriving can positively impact nurses' health, their work environment, and patient care.
We followed the STROBE checklist in reporting this study.
No Patient or public contribution.
Glaucoma is one of the leading causes of irreversible blindness and is characterised by progressive loss of retinal ganglion cells. While therapies to lower intraocular pressure slow the progression of the disease in most patients, a significant subset still shows progression despite treatment. Transcorneal electrical stimulation (TES) may potentially activate neuroprotective pathways and slow the progression of visual field defects. The OkuStim 2 System is a medical device for TES which was originally developed for the treatment of retinitis pigmentosa and similar retinal dystrophies and shall now be tested for the treatment of glaucoma. Stimulation of the diseased retina with weak currents can activate signalling pathways and the release of substances that have a protective effect on the retinal cells. This neuroprotective effect might preserve physiological functions of the retina for longer and slow down its gradual degeneration. Long-term use is required to maintain this effect. The TES-GPS study is investigating the safety and efficacy of TES in open-angle glaucoma.
TES-GPS (short title for glaucoma pilot study) is a prospective, randomised, double-blind, sham-controlled, single-centre pilot study at the University Medical Center Mainz. 50 patients with progressive visual field loss due to open-angle glaucoma will be randomised 1:1 to receive either TES with the OkuStim 2 System or sham stimulation. The primary endpoint is the change in visual field sensitivity (Humphrey mean deviation) after 18 months. Secondary endpoints include changes in visual acuity, intraocular pressure, optical coherence tomography (OCT) parameters and quality of life (National Eye Institute Visual Function Questionnaire 25, NEI-VFQ 25). The intervention consists of weekly 30 min TES sessions, which are conducted in the patient’s home after initial training in the clinic. The study comprises up to 13 scheduled visits over 18 months.
The study is conducted in accordance with ISO14155, Medical Device Regulation (EU) 2017/745, International Council for Harmonisation Good Clinical Practice and the Declaration of Helsinki. Approval was obtained from the Ethics Committee of the Landesaerztekammer Rheinland-Pfalz in Mainz and from Bundesinstitut fuer Arzneimittel und Medizinprodukte. Results will be published in peer-reviewed journals and presented at scientific conferences.
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
by Takashi Kitagataya, Anuradha Krishnan, Kirsta E. Olson, Florencia Gutierrez, Michelle Baez-Faria, Maria Eugenia Guicciardi, Kevin D. Pavelko, Adiba I. Azad, Gregory J. Gores
AimThe underlying mechanisms contributing to cholestatic liver injury remain unclear. The pro-inflammatory leukocyte-restricted cytokine interleukin-17A (IL-17A) has been implicated in human cholestatic liver injury. However, mechanistic insights are lacking and require further exploration in preclinical models. Herein, we examined the effect of IL-17A genetic ablation in a mouse model of cholestatic liver injury.
MethodAge and gender-matched littermate wild type (WT) and Il-17a-/- C57BL/6 mice were fed an intermittent 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet for 21 days to induce cholestatic liver injury or a control diet.
ResultsAs compared to WT littermates, Il-17a-/- mice displayed more abundant desmin-positive myofibroblasts and increased fibrosis. NanoString analysis of intrahepatic leukocyte populations using a fibrosis-related gene panel identified upregulation of Tnfsf14 (encoding the protein LIGHT) in the DDC-fed Il-17a-/- mice. Although mass cytometry identified an increase in myeloid cells in both genotypes of the DDC-fed mice, we could not identify LIGHT expression in this cell lineage. Instead, the upregulation of LIGHT expression was largely restricted to a CD4+ T cell population as assessed by flow cytometry. Enhanced LIGHT expression was observed in a Th1+ CD4+ T cell population. LIGHT activated primary human hepatic stellate cells in vitro, suggesting that LIGHT stimulation of hepatic fibrogenesis may be direct.
ConclusionTaken together, these data suggest that IL-17A restrains expression of the profibrogenic cytokine, LIGHT, by Th1-polarized CD4+ T cells, and implicate a role for LIGHT in cholestatic fibrogenesis in DDC-fed mice; a finding which requires validation in additional models.
This study aims to determine the medico-social factors that predicted workers’ low work ability (LWA) leading to long-term absenteeism and permanent medical unfitness for work.
This was a cross-sectional analysis based on a cohort of workers followed up by an occupational health service in the south of France.
Employees visited by the service completed the Work Ability Index (WAI), a self-administered questionnaire. A score of 26 points or more defines high work ability while a score of 25 points or less defines LWA (scoring from 6 to 50 points). Occupational and medico-social data were obtained from computerised medical records. Logistic regression models were applied.
Of the 2104 WAIs completed the baseline questionnaire, the factors most associated with LWA were mental disorders (OR: 3.46), adaptation of the workstation (OR: 2.88) and long/iterative stoppages (OR: 2.87). Blue collar (OR: 2.50), white collar (OR: 2.34), permanent contracts (OR: 1.79), disability (OR: 2.63), recognition as a disabled worker (OR: 2.37), musculoskeletal disorders of the neck (OR: 2.52) and back (OR: 1.69) also appear to be associated with a risk of LWA.
White-collar and blue collar workers affected by mental disorders and musculoskeletal disorders of the neck and back appear to be significantly associated with a risk of LWA. To adjust LWA preventive measures, future studies are needed to discuss further these risk factors.
La formación del profesional de enfermería incluye tradicionalmente teoría y práctica estructurada en entornos hospitalarios y/o ambulatorios, con la finalidad de que desarrollen las habilidades necesarias para interpretar, intervenir y cuidar a los pacientes. Para el presente estudio se describen las Experiencias del Aprendizaje de la Práctica Clínica en Pasantes de la Licenciatura en Enfermería del periodo 2024-2025. Estudio de tipo cualitativo con enfoque fenomenológico, con nueve pasantes de servicio social seleccionados de 110 de forma aleatoria, a quienes se les realizó entrevista de 20 minutos promedio. El presente estudio se apegó a los lineamientos de la secretaria de Salud en materia de investigación en seres Humanos y a la declaración de Helsinki. Los resultados van desde las experiencias, vivencias, aprendizaje auténtico, escenarios clínicos, habilidades, profesores del área clínica. Se puede concluir que se divide las experiencias en dos momentos primer y segundo semestre, el primero, los estudiantes percibían la pasantía como una oportunidad esencial para aplicar conocimientos teóricos y desarrollar habilidades prácticas en un entorno real. Sin embargo, esta visión inicial estaba acompañada de emociones como miedo y ansiedad, reflejo de la inseguridad ante las exigencias del ámbito clínico y las expectativas de aprendizaje técnico y adaptación a nuevas responsabilidades; en la segunda mitad de la práctica clínica, los participantes valoran la pasantía como una experiencia transformadora, donde adquirieron competencias técnicas como el manejo de equipos médicos y habilidades socioemocionales como la empatía y la resolución de conflictos.
by Michelle Lauge Quaade, Mikael Leijon, Mikhayil Hakhverdyan, Thomas Bruun Rasmussen, Charlotte Kristiane Hjulsager, Lars Andresen, Karin Mundbjerg, Anne Sofie Vedsted Hammer
Diarrhea outbreaks significantly affect the health and growth of farmed mink, posing economic and welfare challenges. While various pathogens have been linked to mink diarrhea, the causes during the weaning period remain unclear. Sporadic associations of mink coronavirus (MCoV), Campylobacter, and gastrointestinal disease in mink have been suggested. This study investigates the occurrence and levels of MCoV and Campylobacter in fecal samples from Danish farm mink (Neogale vison) and their potential association with post-weaning anorexia diarrhea syndrome (PADS), growth-period diarrhea (GPD), or pre-weaning diarrhea (PWD). The focus of the study is on PADS, studied through two case-control setups where case farms had known problems with PADS and control farms without such problems. Animals were also diagnosed based on necropsy pathological findings. Seventeen MCoV genomes were determined from five Danish farms. This data facilitated the development of an MCoV RT-qPCR and was applied across three study groups. Results showed high prevalence of both MCoV and Campylobacter spp. in all groups. No link was found between MCoV presence or levels and PADS diagnosis on the individual level; however, farm-level analysis revealed that MCoV was 2.35 times more likely (95% CI 1.027; 5.056) on PADS case farms than controls. Mink with PWD exhibited higher MCoV levels compared to GPD cases, suggesting a role at this developmental stage. Phylogenetic analysis revealed diverse and farm-specific MCoV strains, with sequences from healthy controls forming a distinct subclade, hinting at strain-specific pathogenicity. Campylobacter spp. presence was not significantly associated with PADS, but higher levels were observed in mink with PADS versus those without (not tested for PWD). These findings highlight the importance of surveillance and rigorous hygiene practices on mink farms to address risks from MCoV and Campylobacter spp., calling for further research to clarify their roles in PADS and overall mink health.Type 2 diabetes is a growing global health challenge that requires effective prevention strategies. Public health and community-based approaches play an essential role in reaching vulnerable populations and addressing broader determinants of health. This protocol outlines a scoping review aimed at systematically mapping the existing evidence on lifestyle-based diabetes prevention interventions implemented in public health and community contexts.
A systematic literature search will be conducted to identify relevant studies published in English or German from 1 January 2014 onwards. The following databases will be searched: PubMed, Web of Science Core Collection, CINAHL (via EBSCO), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews (via OVID) and ClinicalTrials.gov. Relevant websites and grey literature sources will be searched to identify further eligible studies. (Cluster-)randomised controlled trials, non-randomised controlled trials and clinical trials will be included. These must examine nutrition-based, physical activity-based or lifestyle-based interventions aimed at preventing type 2 diabetes in healthy adults or individuals with pre-diabetes, implemented in public health or community settings. Case reports and studies involving medical therapies or pharmacological interventions will be excluded. The literature search started in May 2025 and is expected to be completed by the end of December 2025.
As this scoping review is based on the secondary analysis of publicly available data, no ethical approval is required. Our dissemination strategy includes publication in peer-reviewed journals, presentations at academic conferences and targeted dissemination to relevant interest holders.
This project has been registered at Open Science Framework (https://osf.io/zafg5/), as PROSPERO does not accept registrations for scoping reviews.
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