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To explore the impact of simulation-based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real-world clinical practice.
A qualitative study.
Semi-structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation-based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.
The study involved 17 participants aged 22–50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation-based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.
Simulation-based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real-world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.
Healthcare practitioners and policymakers should prioritise simulation-based training in nursing education and professional development to improve the quality of care for elderly patients.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
The engagement and interview data from nursing participants provided valuable insights into the impact of simulation-based training on communication and empathy in elderly care.
To assess HIV knowledge, stigma and perceived adequacy of HIV curricular coverage among medical students in Egypt and to identify factors associated with HIV stigma.
An online-based cross-sectional study.
Medical schools across Egypt. Data were collected in August 2025 using a bilingual (Arabic/English) online questionnaire using convenience sampling.
First- through fifth-year students enrolled in Egyptian medical schools.
HIV knowledge was assessed using the Brief HIV Knowledge Questionnaire (HIV-KQ-18); HIV-related stigma was assessed using the Healthcare Providers HIV/AIDS Stigma Scale (HPASS) and perceived adequacy of HIV curricular coverage.
A total of 1503 students participated (mean age 20.6 years; 57.4% female), half of whom (48.9%) rated curricular coverage of stigma and psychosocial aspects of HIV as inadequate. The mean HIV-KQ-18 score was 8.96/18 (SD 4.26). Only 39.9% recognised that HIV cannot be transmitted through kissing, 47% believed washing after sex is protective and just 41.3% knew that not all infants born to mothers with HIV will have AIDS. The mean HPASS score was 60.1/108 (SD 17.6). Most students (76.8%) worried about contracting HIV from patients, 52% believed patients acquired HIV through risky behaviours and 43.6% endorsed a right to refuse providing care. Knowledge and stigma were inversely but weakly correlated (r = –0.17, p<0.001), and higher knowledge was independently associated with lower stigma on multivariable regression (B=–0.16, p<0.001). Despite higher knowledge, males reported significantly higher stigma (B=0.25, p<0.001) compared with their female counterparts. Similarly, participants who completed the Arabic form had significantly lower knowledge and higher stigma (B=0.24, p<0.001).
HIV stigma is prevalent among medical students in Egypt, with significant variations observed across gender, survey language and levels of HIV knowledge. These findings call for multifaceted interventions and curriculum reform to reduce stigma among future clinicians.
by Belal Elmarhoumy, Mahmoud Salloum, Thamir Bahattab, Hussein Alhelaly, Mohammed Sghaireen, Matheel AL-Rawas, Johari Yap Abdullah, A. S. M. Rafiul Haque, Mohammed Mousa
The present study evaluated the influence of 3% and 10% (by weight) silicon dioxide (SiO2) and titanium dioxide (TiO2) nanoparticles (NPs) on the tear strength, tensile strength, and elongation at break of a room-temperature vulcanizing (RTV) maxillofacial silicone elastomer (MFSE; A-2000) after two years of natural tropical weathering. A total of 160 specimens (80 dumbbell-shaped and 80 trouser-shaped) were allocated to non-weathered and weathered groups, each divided into five subgroups (n = 8): unfilled control, 3% SiO2, 10% SiO2, 3% TiO2, and 10% TiO2. Weathered specimens were exposed outdoors in a hot, humid tropical climate for two years. Mechanical properties were measured using a universal testing machine. Data were analyzed using two-way ANOVA followed by Tukey HSD post-hoc tests (α = 0.05). In non-weathered specimens, 3% SiO2 increased tear strength by 34% (17.89 ± 0.31 vs. 13.38 ± 1.07 N/mm; P < 0.001) and tensile strength by 35% (4.28 ± 0.27 vs. 3.16 ± 0.13 MPa; P < 0.001) compared with the unfilled control. After natural tropical weathering, only the 3% SiO2 group maintained a significantly higher tear strength (14.03 ± 2.10 N/mm) than the unfilled group (11.09 ± 1.53 N/mm; P = 0.007). Weathering significantly reduced tear strength in all NP-filled groups (P < 0.001) but increased tensile strength across all groups (P < 0.01), with the smallest increase observed in the 10% TiO2 group (+10.1%; P = 0.004). Elongation at break decreased significantly in all groups following weathering (P < 0.001); however, NP-filled groups retained substantially higher elongation values (losses of 13.1–17.6%) than the unfilled control (loss of 51.1%). In conclusion, the incorporation of 3% SiO2 NPs significantly enhanced the mechanical properties of A-2000 MFSE both before and after two years of natural tropical weathering, whereas higher loading (10%) offered no additional benefit. These findings support the use of low-content SiO2 NPs to improve the long-term durability of maxillofacial prostheses.by Lee Jia Hui, Nicole Lam Koh Yie, Justine Yap, Muhamad Nasrul, Ali Haider Mohammed, Bassam Abdul Rasool Hassan, Lee Jia Jia, Dinesh Sangarran Ramachandram, Ruth Sim, Angelina Lim, Juman Dujaili, Ali Blebil
BackgroundDespite advancements in cancer therapy, opportunistic infections remain a significant obstacle to successful patient outcomes. This highlights the necessity for research into the role of antimicrobial prophylaxis in preventing opportunistic infections within oncology care. Therefore, this study aims to develop and validate a questionnaire that assesses pharmacists’ knowledge and practices regarding antimicrobial prophylaxis in cancer patients.
MethodThe research was conducted in 2 phases. Phase I focused on questionnaire development, which included assessing content validity using face validity, Delphi technique, and pilot testing. An initial questionnaire comprising 53 items was generated. The questionnaire was then distributed, and the data were collected from Survey Monkey. Phase II involved the psychometric evaluation of the questionnaire’s validity and reliability. Data analysis was performed using Item Response Theory (IRT), Exploratory Factor Analysis (EFA), and Cronbach’s alpha to establish construct validity and reliability.
ResultThe finalized questionnaire consists of 43 items, comprising 29 knowledge and 14 practice items. IRT analysis was applied to knowledge items, with acceptable discrimination (≥0.25), difficulty (−3–3), and guessing (≤0.4) parameters. Eight items were removed from the knowledge domain based on IRT analysis. Furthermore, EFA has shown high correlation between items and their respective factor, with each receiving an acceptable factor loading of >0.4. However, one domain has a reliability value of Conclusion
The results of this study have validated that the developed questionnaire possesses exceptional psychometric qualities, confirming its accuracy and reliability to evaluate pharmacists’ knowledge and practice towards antimicrobial prophylaxis in oncology care. The validated tool enables future research and targeted educational interventions to improve pharmacists’ skills in managing infection risks for cancer patients.
To quantify the effect of nurse-led or nurse-coordinated multicomponent non-pharmacological interventions on delirium incidence in hospitalised older adults and to examine secondary outcomes, intervention components and moderators of effect.
Systematic review and meta-analysis.
Nine electronic databases (PubMed/MEDLINE, EMBASE, CINAHL, CENTRAL, Web of Science, Scopus, PsycINFO, LILACS and ICTRP) were searched from January 1999 to March 2026.
Randomised controlled trials and quasi-experimental studies evaluating nurse-led multicomponent interventions targeting ≥ 2 delirium risk factors in adults aged ≥ 60 years were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Random-effects meta-analysis generated pooled risk ratios (RR) and mean differences (MD). Subgroup analyses, meta-regression and GRADE assessment were conducted. The review followed PRISMA 2020 and was registered in PROSPERO.
Twenty-one studies (n = 6354) were included. Nurse-led multicomponent interventions significantly reduced delirium incidence (RR 0.64, 95% CI 0.58–0.70; I 2 = 0%). HELP-based protocols demonstrated the largest subgroup effect (RR 0.58). Interventions also reduced delirium duration (MD−0.91 days), falls (RR 0.63) and length of stay (MD −1.23 days). Subgroup and meta-regression analyses did not identify statistically significant effect moderators. Evidence certainty was moderate.
Nurse-led multicomponent interventions significantly reduce delirium incidence and related adverse outcomes in hospitalised older adults (moderate certainty of evidence). Structured programmes such as HELP represent evidence-informed best practice and should be strongly considered for implementation within acute care systems.
These findings provide moderate-certainty evidence supporting nurse-led delirium prevention as a high-value, scalable strategy to improve patient outcomes and reduce healthcare burden. The results inform clinical practice, workforce planning and policy by emphasising the central role of nursing in delivering effective multicomponent care.
Not applicable.
This review was prospectively registered in PROSPERO (CRD420261338135).
Modern healthcare systems are experiencing a rapid state of change, and it is evidence-based practice (EBP) that is playing a key role in ensuring safe and quality patient care. While EBP has been correlated with favorable patient outcomes, its predictive association with the quality of nursing work life (QNWL) has not been explored, especially in the Middle East region like Jordan.
This study evaluated EBP knowledge, attitudes, practices, and barriers among Jordanian nurses and factors that predict QNWL.
Descriptive, correlational, and cross-sectional research designs have been used. A convenience sample of 198 nurses in five Jordanian hospitals was completed in EBPQ, EBP Barriers Scale, and Brooks' QNWL Scale.
Participants (mean age 29.99; 58.1% female) reported a moderate level of EBP (M = 111.30) or QNWL (M = 153.45). Organizational issues were the greatest challenge to EBP implementation. Higher levels of QNWL had significant relationships with being female, having a bachelor's degree, and working in private hospitals. Of interest, EBP knowledge was one of the predictors of QNWL, followed by educational level.
Findings indicate that strengthening the knowledge of nurses on EBP can improve QNWL. Structured skill-based EBP training and skills development through mentorship should be given priority. Managers should encourage conducive environments with time and resource protection. Policymakers should make EBP competencies part of continuing professional development as well as licensure standards. Future studies should use longitudinal and intervention designs to investigate mechanisms of causal influence and test EBP-oriented workforce strategies.
by Heba Mohammed Arafat, Akbar Ali, Tengku Ahmad Damitri Al Astani Tengku Din, Ohood Mohammed Shamallakh, Rashid Jusoh, Maya Mazuwin Yahya, Wan Zainira Wan Zain, Wan Faiziah Wan Abdul Rahman
BackgroundBreast cancer outcomes improve substantially with earlier detection, yet mammography performance can be limited in dense breasts and may lead to false-positive investigations. Circulating microRNAs (miRNAs) and lipidomic/metabolomic signatures have emerged as promising minimally invasive biomarkers that could complement imaging for early-stage detection. The aim of this systematic review and meta-analysis is to evaluate the diagnostic accuracy of circulating microRNAs and lipidomic/metabolomic biomarkers for early breast cancer detection and to explore between-study heterogeneity.
Materials and methodsA PRISMA 2020–compliant systematic review and meta-analysis were conducted. MEDLINE (PubMed), Web of Science, Scopus, Springer, ScienceDirect, and the Cochrane Library were searched for eligible diagnostic studies assessing circulating microRNAs and lipidomic/metabolomic biomarkers measured in serum or plasma. No language restrictions were applied. Non-English reports were screened and, when potentially eligible, translated for full-text assessment and data extraction. Studies using whole blood were excluded. Study quality was assessed using QUADAS-2. Random-effects models (DerSimonian–Laird) pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and summary ROC (SROC) area under the curve (AUC). Heterogeneity was evaluated using Q and I2 statistics, and small-study effects were assessed using Deeks’ test.
ResultsThirty-two studies (2015–2025) comprising 6,935 participants (3,697 breast cancer cases; 3,238 controls) were included. Pooled sensitivity was 0.87 (95% CI [0.83, 0.90]) and pooled specificity was 0.84 (95% CI [0.79, 0.88]), with pooled DOR 46.10 (95% CI [27.80, 76.70]), PLR 5.17 (95% CI [3.99, 6.68]), NLR 0.16 (95% CI [0.13, 0.21]), and SROC AUC 0.92 (95% CI [0.87, 0.94]). Heterogeneity was substantial (I2 = 88.29% for sensitivity; I2 = 90.20% for specificity). In subgroup analyses, serum-based studies showed higher pooled specificity than plasma-based studies. A formal threshold effect assessment did not reveal a statistically significant correlation between sensitivity and false-positive rate (Spearman ρ = −0.334, p = 0.062). Deeks’ test suggested potential small-study effects (p = 0.043).
ConclusionsCirculating microRNA and lipidomic/metabolomic biomarkers demonstrate strong overall diagnostic performance for breast cancer detection; however, substantial heterogeneity and potential small-study effects limit their immediate clinical translation. Given that most included studies used retrospective case-control designs rather than prospective screening cohorts, these biomarkers are best regarded as investigational, complementary tools rather than replacements for mammography at this stage. Future large, prospective, standardized studies with harmonized pre-analytics and prespecified thresholds are needed to support the implementation of screening or triage pathways.
To understand pregnant women’s perception of the quality of antenatal care (ANC) services in terms of service provision and experience in Sudan, a country with one of the highest rates of maternal deaths worldwide.
A cross-sectional facility-based study.
Public primary healthcare centres in Khartoum state, Sudan.
473 pregnant women attending ANC visits. Data were collected through face-to-face interviews using a standardised questionnaire.
The perceived quality of ANC services assessed across two continuous domains: service provision score and care experience score.
The mean score for service provision was 19.96±3.03 out of 56. The great majority of the participants did not have their height or weight measured at any ANC visits 85% and 64.5%, respectively. About 87.1% and 82.5% of the participants, respectively, had blood and urine tests during each ANC visit. However, only 52.6% of the women reported receiving tetanus injections. The percentage of women receiving ultrasound examination at each visit was 88.4%. The mean score of care experience was 58.68±8.22 out of 84. Three-quarters of the women (74%) understood the purpose of the tests performed. The majority felt free to ask questions (87.3%). But only half and a third of the women were told about the signs of pregnancy complications and where to go in case any complications occurred, respectively. In linear regression, being married and older age had significant positive effects on women’s perception of care provision (p=0.004 and p=0.003, respectively). Regarding the experience of care, older age affected care experience positively (p=0.038), while rural residency (p=0.044), being illiterate (p
Women’s perception of the quality of ANC in terms of service provision and care experience was below average. Several factors were associated with their negative perceptions. These factors need to be further investigated and addressed to improve the quality of ANC provided.
To assess the prevalence of discontinuation of short-term oral antibiotic therapy and to identify its predictors among patients attending outpatient department pharmacy units of public hospitals in Harar, Eastern Ethiopia.
Facility-based prospective follow-up study.
All public hospitals in Harar, Eastern Ethiopia.
A total of 422 patients who received short-term oral antibiotics from Hiwot Fana Comprehensive Specialized Hospital (HFCSH) and Jugal General Hospital (JGH) from 20 January to 20 April 2024 were recruited using a systematic random sampling technique. Of the participants enrolled during the initial recruitment, only 400 completed the follow-up interview and were therefore included in the final analysis. The mean age of the respondents was 35.89±13.21 years and 280 (70.0%) were female.
The primary outcome was discontinuation of short-term oral antibiotic therapy, measured based on self-reported leftover antibiotics. Multivariable logistic regression was used to identify factors associated with discontinuation. Adjusted ORs (AORs) with 95% Confidence Intervals (CIs) were reported, and statistical significance was set at p
The prevalence of short-term oral antibiotic discontinuation was 35.3% (95% CI 31% to 40%). Factors independently associated with antibiotic discontinuation included larger family size (AOR=1.18; 95% CI 1.01 to 1.36), a negative attitude towards antibiotics (AOR=2.09; 95% CI 1.19 to 3.66), dissatisfaction with medication-related information (AOR=7.20; 95% CI 2.84 to 18.24), prescriptions for dental indications (AOR=7.50; 95% CI 2.21 to 25.50), treatment duration of ≥7 days (AOR=2.88; 95% CI 1.08 to 7.68) and interruption of therapy during the treatment course (AOR=4.06; 95% CI 2.14 to 7.33).
Short-term oral antibiotic discontinuation remains a substantial challenge among outpatients, highlighting important gaps in adherence and continuity of care. Patient perceptions, the adequacy of medication counselling and treatment-related characteristics appear to play a critical role in shaping adherence behaviour. Targeted interventions to improve patient education, communication and follow-up support are essential to promote appropriate antibiotic use and help reduce the risk of antimicrobial resistance.
by Abdeta Muktar Ahmed, Mohamed Abdilahi Ahmed, Abdulkadir Mohammed Nuh, Hamse Khalif Hassan
BackgroundMaternal mortality remains a major global health challenge, disproportionately affecting low- and middle-income countries. Despite international efforts, nearly 95% of maternal deaths occur in these regions, with Sub-Saharan Africa bearing the highest burden. Limited knowledge of obstetric danger signs is a key factor contributing to delays in seeking care, which in turn increases the risk of preventable maternal complications. Evidence on maternal awareness in Somaliland is scarce.
ObjectiveThis study aimed to assess the level of knowledge of obstetric danger signs and associated factors among pregnant women attending antenatal care in Hargeisa, Somaliland.
MethodsA facility-based cross-sectional study was conducted from July 2 to August 4, 2022, among pregnant women attending antenatal care services. A total of 222 participants were selected using a systematic random sampling technique from eight maternal and child health centers. Data were collected through face-to-face interviews using a pretested and structured questionnaire and analyzed with SPSS version 25. Bivariate and multivariate logistic regression was carried out.
ResultsAbout 35.6% had a good knowledge specifically about pregnancy related obstetric danger signs. Only 57 women (25.7%) demonstrated overall good knowledge of obstetric danger signs across pregnancy, childbirth, and the postpartum periods. Knowledge was highest for vaginal bleeding (65% − 67%), while less visible complications such as convulsions and blurred vision were less frequently mentioned. Multivariate analysis revealed that secondary level education or higher (AOR = 3.6, 95% CI: 1.8–7.3), access to and usage of media (AOR = 2.6, 95% CI: 1.2–5.6), and institutional delivery (AOR = 3.4, 95% CI: 1.6–7.2), were significant predictors of knowledge.
ConclusionMaternal knowledge of obstetric danger signs in Hargeisa was low. Targeted health education, broader use of mass media, and promoting institutional delivery are critical strategies to improve and reduce preventable maternal mortality.
This study aimed to find the incidence and predictors of postoperative haemodynamic instability among adult surgical patients in the postanaesthesia care unit (PACU).
A multicentre prospective observational study was conducted from 1 June to 30 September 2024.
The study was conducted at three hospitals in the South Gondar Zone, north-west Ethiopia.
The study included 404 elective surgical patients undergoing surgery who were in the PACU. All adult patients who were fit, stable and underwent elective surgery under anaesthesia and were admitted to the PACU for monitoring and stabilisation were included in the study. Patients who were directly admitted to an intensive care unit or ward after an operation and those who refused to give consent were excluded from the study.
The study investigates the incidence and predictors of immediate postoperative haemodynamic instability in adult surgical patients.
The incidence of postoperative haemodynamic instability in the PACU was 47.8% (95% CI 43.1% to 52.5%). Multivariable logistic regression analysis shows that American Society of Anesthesiologists class III patients (adjusted OR (AOR): 3.04, 95% CI 1.48 to 6.25), patients with preoperative anxiety (AOR: 2.9, 95% CI 1.73 to 4.78), preoperative use of beta-blocker medication (AOR: 1.9, 95% CI 1.11 to 3.32), patients who experienced intraoperative haemodynamic instability (AOR: 1.8, 95% CI 1.2 to 3.14) and patients with a procedure lasting more than 4 hours (AOR: 3.7, 95% CI 3.26 to 9.67) were significantly associated with haemodynamic instability.
The incidence of postoperative haemodynamic instability in this study was high. Our findings highlight the urgent need for hospital quality improvement initiatives and healthcare professionals assigned to the PACU should monitor the patients continuously. We also recommend that future researchers monitor the patients for 24 hours.
Diabetic foot complications, including ulcers, infections, and amputations, remain a major cause of morbidity among individuals with diabetes, primarily driven by neuropathy and peripheral vascular disease. Despite being largely preventable, their burden remains substantial, particularly in high-risk populations. To assess the burden and associated factors of diabetic foot complications among patients attending a tertiary diabetes centre in the Qassim region, Saudi Arabia, between 2021 and 2024. A retrospective cross-sectional study was conducted using medical record data from 4119 patients attending a tertiary referral diabetes and endocrinology centre. Standardised clinical and demographic data were extracted and analysed to estimate the burden of diabetic foot complications and examine associated factors. The mean age of the participants was 58.8 ± 10.8 years; 60.5% were male, and 97.8% had type II diabetes. The mean BMI was 28.2 ± 2.9 kg/m2, and the mean HbA1c level was 8.9% ± 2.1%. Hypertension was present in 78.9% of participants. Foot ulcers were identified in 65.4% of patients, and 41.2% had a history of lower-extremity amputation. Multivariable logistic regression analysis demonstrated that age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes-related educational programs were independently associated with amputation. Male patients had higher adjusted odds of amputation than females (AOR = 1.48, 95% CI: 1.23–1.79), while type II diabetes was independently associated with higher odds of amputation (AOR = 1.41, 95% CI: 1.02–2.07). A high burden of diabetic foot complications was observed in this tertiary referral cohort, likely reflecting the concentration of advanced and complex cases. Older age, male sex, type II diabetes, smoking, hypertension, elevated BMI, higher HbA1c levels, and lack of participation in diabetes-related educational programs were independently associated with lower-extremity amputation. These findings highlight the importance of earlier referral of high-risk patients, strengthening diabetic foot screening within primary healthcare settings, and enhancing multidisciplinary foot care services to prevent progression to advanced disease and reduce avoidable amputations. However, given the retrospective cross-sectional design, the reported findings should be interpreted as associations rather than causal relationships.
Large language model tools are increasingly used in higher education, offering opportunities to support self-directed learning. In nursing education, course-specific AI virtual tutors may provide contextualised support while addressing concerns about content accuracy and alignment; yet empirical evidence remains limited.
This study evaluated the use and perceived impact of a co-designed AI-powered virtual tutor embedded in a graduate-level Master of Nursing (MN) course. We explored how students used the tutor, their perceptions of benefits and limitations, and its influence on learning and engagement.
A pilot study using a mixed-methods explanatory sequential design was employed. The tutor was trained on course-specific materials and integrated into the institutional learning management system. Data included anonymised usage logs and user interactions coded using Bloom's Taxonomy of Educational Objectives, post-course surveys assessing AI self-efficacy, usability, and learning impact, and semi-structured interviews with students and teaching assistants (TAs). Quantitative and qualitative strands were integrated through a joint display.
A total of 651 interactions by individuals within a group of ~120 MN students were logged. Interactions peaked in evenings and around assignment deadlines. Most interactions reflected lower-order education processes, with more application and analysis later in the course. Eleven participants completed surveys; students reported high AI self-efficacy and moderate tutor use. Perceived usefulness was mixed, but most reported the tutor enhanced both lower- and higher-level learning and recommended its future use. Interviews revealed that students valued the tutor's immediacy and course-specific accuracy, while TAs noted efficiency gains. Reported challenges included usability issues, scope limitations, privacy concerns, and risk of over-reliance on the tool.
A co-designed AI virtual tutor was feasible and valued for contextual relevance, though perceived usefulness was variable. Findings support responsible, pedagogically integrated use of AI tutors in graduate nursing education.
Medical device-related pressure injuries (MDRPIs) are a patient safety concern in acute and critical care settings. Registered nurses must implement preventive strategies, yet gaps remain in their knowledge, attitudes, and clinical practices related to MDRPI prevention. This study aimed to evaluate the effectiveness of a structured educational intervention in improving registered nurses' knowledge, attitudes, and practices related to MDRPI prevention. A quasi-experimental pre–post intervention study was conducted in a tertiary care hospital in Saudi Arabia, with 311 registered nurses participating. Data were collected using a questionnaire assessing knowledge, attitudes, and practices related to MDRPI prevention. Participants received a one-day structured educational program based on the knowledge, attitude, practice (KAP) framework and the evidence-based SKINCARE bundle. The educational intervention resulted in significant improvements. Mean scores increased from 14.17 (SD = 2.38) pre-intervention to 16.25 (SD = 1.97) post-intervention (t = −11.81, p < 0.001). The intervention demonstrated a moderate-to-large effect size (Cohen's d = 0.67), indicating meaningful improvement in nurses' preventive competencies. Structured educational programs can enhance registered nurses' knowledge and practices in MDRPI prevention. Integrating evidence-based training programs into routine hospital education may strengthen pressure injury prevention guidelines and improve patient safety outcomes.
Pressure injuries are largely preventable yet remain common in hospital care. This multi-hospital study assessed nurses' knowledge, attitudes and practices for prevention in governmental, private and charitable hospitals in Nablus, Palestine, and examined links with professional characteristics. A descriptive cross-sectional study was conducted in six hospitals in Nablus city, Palestine. A total of 231 registered nurses were recruited using convenience sampling and completed a content-validated, self-administered questionnaire assessing demographics, knowledge (20 items), attitudes (11 items), and practices (17 items). Data were analysed using descriptive statistics, one-way analysis of variance with Tukey post hoc tests, and binary logistic regression for adequate knowledge and practice (≥ 80%). Overall, 64.5% demonstrated adequate knowledge, and 58.0% expressed a favourable attitude. Practice adherence averaged 70.9 ± 16.3 out of 100. Only 31.6% achieved ≥ 80%, indicating suboptimal practice in most participants. Key gaps involved massage avoidance and the use of lifting devices. Knowledge was higher with recent PI training (1–2 years vs never: OR = 4.110, 95% CI 1.622–10.414, p = 0.003; 2–3 years vs never: OR = 3.047, 95% CI 1.208–7.687, p = 0.018). Practice adequacy was higher with training < 1 year ago vs never (OR = 4.146, 95% CI 1.636–10.512, p = 0.003). Other adjusted associations were imprecise and treated as exploratory. Nurses showed generally adequate knowledge, whereas routine preventive practice remained less consistent. Recent training was associated with better knowledge and practice, suggesting that targeted education, supervised skills training, unit-level protocols and audit with feedback may support improvement.
Burns are a major cause of morbidity in Yemen, and their prevention relies heavily on community knowledge and safe practices. Understanding gaps in awareness and behaviour is essential for designing effective interventions. This study assessed the knowledge, attitudes and practices (KAP) regarding burn prevention and first aid among a Yemeni community. A cross-sectional survey was conducted among 380 participants using a structured questionnaire distributed via social media and community networks. Data were collected on demographics, educational level, occupation, residential area and KAP related to household, electrical and chemical burns. Associations between participant characteristics and burn-related KAPs were analysed. Participants were predominantly female (63.7%), aged 15–45 years (79.8%), urban residents (92.9%) and university-educated (82.1%). Healthcare workers comprised 50.8% of respondents. Knowledge of burn prevention and first aid was highest among university-educated and healthcare participants, with 84.6% correctly identifying initial burn management. Unsafe practices, such as applying honey or toothpaste and improper handling of chemical or electrical injuries, were more common among less-educated, rural and nonhealthcare respondents. Urban participants demonstrated better preventive practices, while cultural reliance on traditional remedies persisted across all groups. Among predominantly urban and educated populations in Yemen, knowledge and attitudes toward burn prevention and first aid are generally favourable; however, gaps persist, particularly in rural and less-educated communities. Cultural practices and misconceptions continue to limit optimal care. These findings underscore the urgent need for culturally sensitive, literacy-appropriate, community-based interventions to improve burn prevention, first aid practices and equitable health outcomes.
by Seid Mohammed Abdu, Hussen Abdu, Endris Seid Muhaba, Ebrahim Msaye Assefa, Gosa Mankelkl
BackgroundThe sciatic nerve (SN), the longest and largest nerve in the body, arises from the L4-S3 nerve roots and exits as a single trunk below the piriformis muscle through the greater sciatic foramen. However, variations in its anatomy are common, believed to originate from embryological development. These variations show significant racial and geographical differences, which have often been overlooked in previous review studies. Therefore, this meta-analysis aims to address this gap by systematically reviewing global data to evaluate the impact of race on sciatic nerve variations.
MethodsA systematic review and meta-analysis were conducted to assess the pooled prevalence of SN variations among racial subgroups. A comprehensive literature search was performed using PubMed, Google Scholar, Hinari, and additional sources, including major anatomical journals and cross-referenced articles. Subgroup analyses by region and country were also conducted using a random-effects model. Heterogeneity was assessed with the Cochrane Q test and the I² statistic.
ResultsType A, considered the normal pattern, had the highest pooled prevalence at 86%. The remaining 14% represented variations of the sciatic nerve (SN). Among these, Type B was the most common at 7%, followed by Type C and G each observed in 2% of limbs, while less frequent variations included Type Type D (1%), Type E (0%), and Type F (0% (0–1)). Racial analysis showed that SN variations occurred in 15% of Asians, 12% of Whites, and 13% of Blacks. Regarding continents, the highest prevalence was in Asia with 15%, the second highest prevalence was observed in Europe with 14%, followed by Africa with 13%, and the lowest in America with 11%. No significant differences were found among the races and continents. However, East Asia showed the highest significant prevalence, with China at 35% and Japan at 32%.
ConclusionThis review revealed only modest and statistically non-significant differences in the prevalence of sciatic nerve variations across broad racial and continental groups. In contrast, substantial variation was observed at the regional level, with particularly high prevalence rates in East Asian countries, specifically China and Japan. These findings suggest that regional factors contribute more to the observed variations than racial factors.
Older adults face growing risks of depression and anxiety, yet stigma, comorbidities, cost, and limited access impede receipt of conventional care. Digital mental health interventions (DMHIs), including immersive virtual reality (VR), exergaming, and mobile apps, may reduce these barriers.
To evaluate the efficacy of DMHIs in reducing depressive and anxiety symptoms among adults aged ≥ 50 years.
We conducted a PRISMA adherent systematic review and meta-analysis of randomized controlled trials. Interventions included immersive VR, exergaming/physical digital platforms, mobile applications, and digital cognitive training. Standardized mean differences (SMDs) were pooled with random effects models; heterogeneity was assessed with I 2.
Nineteen RCTs (n = 718; mean ages 50.9–84.7 years) met inclusion criteria. Across studies, DMHIs significantly reduced depressive symptoms (SMD = −0.656, 95% CI = −0.932 to −0.380; p < 0.001) and anxiety symptoms (SMD = −0.559, 95% CI = −0.740 to −0.380; p < 0.0001). Immersive and physically engaging modalities (e.g., VR, exergaming) outperformed app-based approaches. Heterogeneity ranged from moderate to high (I 2 ≈ 69.6%–97%).
Offer DMHIs: especially VR or exergaming when access to in-person therapy is limited or as an adjunct to usual care. Provide brief onboarding and, when feasible, caregiver support to boost adherence and confidence with technology. Select or configure age-friendly interfaces (e.g., large fonts, simple navigation) to address common usability barriers. Integrate DMHIs into stepped-care or rehabilitation pathways and monitor outcomes with validated tools (e.g., GDS, STAI). Address equity by supplying devices/connectivity solutions and consider cost-effectiveness and long-term engagement in implementation plans.
Trial Registration: PROSPERO ID: CRD420250655153
by Nurdiana Mohammad Hussin, Nik Ruzyanei Nik Jaafar, Idayu Badilla Idris, Azmawati Mohammed Nawi
Individuals with breast cancer (BC) experience significant psychological distress, yet their utilization of mental health services remains low. This study identified key factors influencing help-seeking behavior through integrated Theory of Planned Behavior (TPB) and Health Belief Model (HBM) frameworks. We conducted in-depth interviews (IDIs) with eight BC patients and nominal group technique (NGT) with six health professionals, followed by Fuzzy Delphi Method (FDM) to assess expert consensus. The IDIs revealed that the individuals with BC recognized the value of professional psychological support but were reluctant to engage with these services personally. The participants identified emotional thresholds for help-seeking, expressed preference for informal support networks, and demonstrated varied understanding of mental health professional roles. The FDM evaluation demonstrated strong expert consensus across all assessed elements, particularly those related to emotional support mechanisms. Three barrier categories emerged: individual factors (mental health literacy, autonomy preferences), social factors (family support, cultural stigma), and systemic factors (healthcare integration gaps). Expert consensus exceeded 80% agreement across all domains.This study identified a complex interplay between individual psychological barriers and systemic factors affecting mental health help-seeking among individuals with BC. Effective interventions must address psychological barriers and healthcare delivery factors while respecting individual autonomy in coping choices. A multi-level approach targeting individual education, family support systems, and healthcare integration is recommended to improve mental health service utilization among individuals with BC.by Osman Yimer Mohammed, Kerstin Erlandsson, Tewodros Seyoum, Solomon Hailemeskel, Lemma Derseh, Helena Lindgren
BackgroundWork-related musculoskeletal disorder is a limiting, painful condition that affects the muscular, skeletal, articular, and nervous tissues of the body. The condition is mainly associated with poor working conditions and awkward body positions. Health professionals, including midwives, are among the most affected workforce globally. The condition affects the health of the professionals and the quality of care that professionals are expected to provide. However, there is a scarcity of information on the magnitude of the condition, its effect on midwifery practice, and associated factors. Objectives: This study aimed to assess the magnitude of work-related musculoskeletal disorder, its effect on midwifery practice, and associated factors among midwives in North Shoa Zone, Amhara Regional State, Ethiopia.
MethodAn institution-based cross-sectional study assessed the magnitude of work-related musculoskeletal disorder (WRMSD), the effect on midwifery practice, and associated factors. The Nordic Musculoskeletal Disorder Scale was used to assess the presence of WRMSDs in the nine regional body parts and its effect. A stepwise backward elimination logistic regression model was used, and significant association was declared at a p-value of less than 0.05.
ResultsA total of 473 (252 (53.3%) female and 221 (46.7%) male) midwives participated in this study. Overall, in the last 12 months, 355 (75.05%, 95% CI: 71.15% − 78.95%) midwives were affected by WRMSD, which was seen in any one of the nine regional body parts. About 45% (162) of them reported being unable to perform their daily tasks while they were affected, and 27% (96) of them sought treatment for their condition. The lower back was the most affected axial body part, reported by 300 (63.4%, 95% CI: 59% − 68%) midwives. Working in awkward or uncomfortable positions was significantly associated with the development of WRMSD (AOR: 1.81, 95% CI: 1.15–2.87). Similarly, awkward positions significantly affected the development of area-specific WRMSD in the lower back, upper back, neck, and limbs. Working in the same position for a longer time, seeing clients daily, and moving heavy objects were among the risk factors associated with developing area-specific WRMSD among midwives.
ConclusionThe magnitude of work-related musculoskeletal disorders is high among midwives, and a significant number of them were unable to perform their daily tasks. The lower and upper back are the most commonly affected areas. Working in uncomfortable positions and attending to large clients daily were common risk factors. Therefore, training midwives about safe working positions and reducing the workload is commendable.
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