Conectar
Type 2 diabetes (T2DM) and cognitive impairment are common long-term chronic conditions affecting older people in hospital. Cognitive impairment can complicate glucose monitoring and lead to diabetes-related emergencies in T2DM. Traditionally, point of care test measurements of capillary blood glucose are conducted in-hospital for T2DM while continuous glucose monitoring (CGM) is not widely used.
To understand the feasibility, acceptability and tolerability of using CGM in older inpatients with T2DM and cognitive impairment.
32 older people (mean age=78.7±6.7 years) with comorbid T2DM and cognitive impairment (Abbreviated Mini-Mental Test ≤8/10 and Mini-Addenbrooke’s Cognitive Examination ≤22/30) were recruited within a tertiary care hospital in the UK. All participants were naive to CGM and were asked to wear blinded Dexcom G7 sensors for up to 10 days. Participants were asked about feasibility, acceptability and tolerability questions at the point of sensor removal.
29 participants (96%) reported no pain during CGM fitting. All participants (100%) agreed that they did not notice wearing the sensor, and it did not affect their day-to-day hospital activities. All participants (100%) found it ‘very easy’ or ‘easy’ to have the sensor fitted and wearing it for 10 days, with 27 participants (90%) finding CGM convenient. 17 participants (57%) reported favourable perceptions of the subcutaneous sensor sensation.
CGM use in older inpatients with T2DM and cognitive impairment is highly feasible and acceptable for patients. Future studies and trials are now needed to evaluate the clinical use of CGM for glucose monitoring in hospitalised or community-dwelling older individuals with T2DM and cognitive impairment.
Cognitive impairment after critical illness is a common occurrence that has a profound impact on millions of people worldwide each year. Currently, no interventions after critical illness have been found to promote cognitive recovery. Cognitive training has shown promise in other populations (eg, community-dwelling adults), predominantly in improving the trained cognitive domain (eg, memory, reasoning or executive function). In pilot work, in-person cognitive training with intensive care unit (ICU) survivors was found to not only improve the trained domain but also may reduce disabilities in daily function. Computerised cognitive rehabilitation (CCR) is a more scalable option, which we have demonstrated the feasibility of use among ICU survivors. Whether CCR is efficacious in ICU survivors remains unknown.
The Returning to Everyday Tasks Utilising Rehabilitation Networks-III (RETURN-III) study is a multicentre, randomised, double-blinded, parallel group controlled trial testing the hypothesis that CCR versus active control will result in less cognitive impairment after critical illness. Adult patients who recently experienced acute respiratory failure or shock in medical and surgical ICUs at two hospitals in Nashville (TN, USA) will be enrolled. Participants will be randomised within 12 weeks of hospital discharge to a 12-week home-based programme of CCR (or control), with the goal of five 30 min sessions per week. In-person assessments will be performed at baseline, 3 months and 12 months after randomisation. The primary outcome is global cognitive function 3 months after randomisation using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score. Secondary outcomes will include 12-month RBANS global cognitive function, 3-month and 12-month subjective cognition by the Cognitive Self-Report Questionnaire, daily function related to cognition by the Functional Activities Questionnaire and processing speed/executive function by Trail Making Test part B. With an anticipated enrolment of 160 patients, the study will have at least 80% power to detect a 7-point or higher difference in RBANS cognition scores between the two groups (
The RETURN-III study was approved by the institutional review boards at each participating site. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences following completion of data collection.
Traumatic catheter removal (TCR) occurs when a urinary catheter is removed with the balloon inflated, causing urethral injury. We aim to identify cases of TCR, determine at-risk populations and describe outcomes and interventions.
Retrospective medical record review.
EMERSE, a natural language processing tool, was used to identify cases of TCR in a large academic hospital (2014–2024). Charts were reviewed for demographics, causes and outcomes of TCR. Descriptive statistics and chi-square analyses were run for comparison of categorical variables.
Among 198 patients, average age was 68, and 86% (170) were male. Patients removed their own catheter in 75% of TCRs; staff removed the catheter incorrectly in 22% of cases. 65 patients experienced an escalation of care after TCR. 156 patients had gross haematuria, requiring manual irrigation (n = 31, 20%), continuous bladder irrigation (n = 12, 8%), or surgical clot evacuation (n = 3, 2%). 21 patients had a catheter-associated UTI after TCR. 31 patients had repeated TCRs. Patients with altered mental status were more likely to have repeat TCR. Prevention mechanisms included sedating medications (n = 50), patient sitters (n = 29), restraints (n = 28), hand mitts (n = 15) and decoy catheters (n = 12). Sedating medications were associated with less repeat TCR events, while restraints and patient sitters were not.
TCR has been historically difficult to characterize due to lack of diagnosis code and inconsistent reporting. In this study, a surprising number of TCR events occurred when hospital staff removed patients' catheters. These instances could be decreased with targeted education on the safe removal of catheters. Sedating medications were associated with fewer repeat TCR events. Restraints and patient supervision were not, indicating that they may not be effective prevention mechanisms. Further research is needed to identify optimal education and patient-centred interventions to prevent TCR.
STROBE guidelines.
None.
Chronic kidney disease (CKD) is a significant global health concern, contributing substantially to mortality; in advanced stages, adults often require kidney supportive care (KSC), a model of care/intervention that addresses complex palliative and supportive needs. These needs often remain insufficiently addressed, particularly among adults receiving haemodialysis, due to the interplay of multiple contextual factors and inconsistent reported outcomes. Consequently, it remains unclear how, for whom and under what circumstances KSC works (or does not work). Therefore, this rapid realist review aims to identify the key contexts in which KSC interventions have been implemented and the mechanisms that influenced palliative care outcomes for adults receiving haemodialysis.
Rapid realist review is a structured, theory-driven approach to evidence synthesis conducted within a condensed timeframe, aiming to explain how and why interventions work, for whom and in what contexts, to identify effective models of service delivery. This rapid realist review will be conducted following a multiple-step process, including defining the project scope and research questions development (including how the findings will be utilised); development of search terms and identification of relevant literature; quality appraisal; data extraction and preliminary programme theory development; validation and refinement of programme theory with content experts; and dissemination of findings.
A systematic literature search will be conducted from 2020 to 2025 using the following databases: MEDLINE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Scopus and Academic Search Complete, with supplementary forward and backward citation tracking. Two reviewers will screen titles and abstracts for relevant research, and the full papers selected will be used to extract data and assess the quality of evidence based on relevance, richness and rigour. Data extraction and synthesis will be conducted iteratively to identify context-mechanism–outcome configurations (CMOCs), which will inform the development and refinement of the programme theory, rather than simply informing palliative care outcomes.
A 10-member expert panel will review, evaluate and reflect on the initial CMOCs in light of their clinical expertise and personal experience. The reporting of findings from this review will be guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES). This rapid realist review will support service redesign to better address the unmet palliative care needs of adults receiving haemodialysis and inform policy initiatives and education to deliver context-specific KSC across the UK and globally.
This study received ethics approval from Coventry University Ethics Committee (Ref-P182536). Results will be disseminated to stakeholder groups and by means of publication in a peer-reviewed journal and presentation at international scientific conferences.
CRD420251000111.
To measure differences in hospital use between homeless adults using the homeless health peer advocacy (HHPA) service (clients) and non-clients in London.
We conducted a cohort study with linkage to Hospital Episode Statistics (HES) 1 year prior and postenrolment.
London, UK.
People who are homeless in London aged over 18 years residing in a hostel, attending a day centre or being referred by a homelessness service; experiencing difficulties accessing healthcare; and speaking either English or Polish. Participants were required to provide consent for linkage to HES. To be classified as a client, individuals must have used the HHPA service at least once between January and July 2021; non-clients were those who had never used the service.
Peer advocacy is the provision of support by volunteer-trained advocates with lived experience of homelessness to individuals to overcome barriers to accessing health services.
The primary outcome was not attending a scheduled outpatient appointment (‘did-not-attend’) over 12 months postrecruitment, commencing from their baseline interview date. Secondary outcomes included the number of accident and emergency (A&E) and inpatient admissions (all and planned admissions) during that same period.
We estimated the probability of non-attendance using Poisson regression and the number of inpatient admissions and A&E visits using negative binomial regression models. Models included: (1) propensity score weights and (2) propensity score weights and imbalanced confounders. Sensitivity analyses assumed that participants who did not link to HES had no hospital attendance. Exploratory analyses examined differential effects of peer advocacy by clients’ type of peer advocacy engagement (new vs ongoing clients; supported vs unsupported) and by clients’ anxiety or depression symptom scores measured with the Patient Health Questionnaire-4 (PHQ4).
153 clients and 158 non-clients were recruited between July and December 2021. Most were male (77.5%) with a median age of 48 years. Weighted regression models suggested no evidence of effect of peer advocacy on non-attendance (rate ratio (RR) 0.97 (95% CI 0.67 to 1.42)), no difference in the mean number of A&E visits (2.59 95% CI 1.93, 3.24 vs 1.76 95% CI 1.13, 2.40) but more inpatient admissions (1.65 95% CI 1.10, 2.20 vs. 0.53 95% CI 0.27, 0.82) for HHPA clients vs non-clients respectively. This was supported in sensitivity analyses. In exploratory analyses, clients with PHQ4 scores of 9–12 had greater probability of non-attendance at outpatient appointments (RR 1.98 (95% CI 1.0 to 3.89)) compared to non-clients. Those with scores of 6–8 had 5.86 (95% CI 2.73 to 9.0) completed appointments versus 1.87 (95% CI 0.41 to 3.34) among non-clients and 1.13 (95% CI 0.01 to 0.27) inpatient admissions compared with 0.13 (95% CI –0.01 to –0.27) among non-clients.
Following COVID-related disruptions to the work of peer advocates and health services, we found mixed evidence on the effect of peer advocacy: with no evidence of impact on outpatient appointments or use of emergency services; but increased inpatient admissions.
by Ciaran M. Fairman, Alex M. Brooks, Darren G. Candow, Kylah E. Jackson, Genevieve Bottone, Brett Scott, Kenneth S. Anderson, Katie R. Hirsch, Thomas D. Cardaci, Brandon N. VanderVeen, Christine E. Blake, Tiejun Zhang, Jiajia Zhang, E. Angela Murphy
PurposeThe purpose of this trial was to assess the feasibility, acceptability and safety of a 10-week hybrid (in-clinic and virtual) resistance exercise training RET program with or without CrM in individuals treated for colorectal cancer.
MethodsTwenty-seven participants were randomized to RET plus 5 grams/day of CrM (EXSUPP; n = 13) or 5 grams/day corn-starch maltodextrin placebo (EXPLA; n = 14). RET was performed three times per week. Feasibility was assessed through recruitment, retention and fidelity (percentage of prescribed RET and supplementation completed). Acceptability was evaluated using a 5-point Likert scale, and safety was monitored through adverse event reporting. Secondary outcomes (body composition, muscular strength, physical function) were assessed pre- and post-intervention using baseline-adjusted ANCOVA models and focus group interviews.
ResultsRegistry-based recruitment identified 1378 potentially eligible individuals and 27 of 410 assessed (6.6%) enrolled, highlighting recruitment challenges. Retention was high (24/27; 88.9%). Adherence to RET and supplementation was strong (both > 85%) with no serious adverse events reported. Participants reported high acceptability for both in person and virtual components. No significant between group differences were observed for secondary outcomes; however, both groups demonstrated modest improvements in muscular strength and short physical performance battery (SPPB) scores.
ConclusionsA hybrid RET program with CrM was feasible, acceptable and well tolerated in individuals with colorectal cancer who were previously treated with chemotherapy.
Implications for Cancer SurvivorsHybrid supervised RET is safe, acceptable, and associated with modest improvements in strength and physical function among individuals treated for colorectal cancer. While creatine supplementation did not demonstrate clear additive effects in this pilot trial, further adequately powered studies are warranted.Trial Registration: NCT06420726.
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with reduced quality of life and increased healthcare utilisation. AF is increasingly recognised as a manifestation of an underlying cardiometabolic disease process, with obesity and related metabolic risk factors contributing to its development and progression. Consequently, upstream risk factor modification, including structured weight management, has emerged as a potential strategy to improve AF outcomes. While dietary and exercise interventions have been studied individually, the effectiveness of programmes combining both components has not been systematically reviewed in patients with AF who are overweight or obese. This review aims to assess the impact of combined nutritional and physical activity interventions on AF-related outcomes.
A systematic search will be conducted in MEDLINE, CINAHL, EMBASE and EMCARE from database inception to April 2026. Eligible studies will include randomised controlled trials, quasi-experimental studies and controlled cohort studies evaluating combined dietary and physical activity interventions in adults with AF who are overweight or obese. The primary outcome will be AF symptom burden measured using validated instruments. Secondary outcomes will include quality of life, anthropometric measures, metabolic parameters and AF arrhythmia burden. Risk of bias will be assessed using RoB 2 and Risk of Bias in Non-randomised Studies of Interventions. Where appropriate, meta-analysis will be performed using random-effects models.
Ethical approval is not required. Findings will be disseminated through peer-reviewed publications and scientific meetings.
Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/HCUZ3).
To assess uptake of nirsevimab, a long-acting monoclonal antibody for respiratory syncytial virus (RSV) prevention, during the first season of Ireland’s Pathfinder pilot universal newborn immunisation programme and to identify socio-demographic and perinatal predictors of uptake.
Cross-sectional analysis of routinely collected programme data.
Ireland’s Mid-West region, served by University Maternity Hospital Limerick, the sole maternity and neonatal hospital for the region.
Infants born 1 September 2024 to 28 February 2025.
Uptake of nirsevimab before hospital discharge.
Overall uptake was 89.4% (1600/1790) and did not vary by month (p=0.119); it was similar by sex (male 89.5%, female 89.2%; p=0.838). Preterm infants had higher uptake than term (96.9% vs 88.7%; p=0.001), and those admitted to the neonatal unit also had higher uptake (93.0% vs 88.4%; p=0.009). In adjusted analyses, maternal age (adjusted OR (aOR) 1.06 per year, 95% CI 1.03 to 1.09, p
During the first season of Ireland’s Pathfinder RSV pilot programme in the Mid-West region, nearly 90% of newborns received nirsevimab before discharge. Uptake was consistently high across months, indicating effective implementation but lower among infants of Irish Traveller and other white background mothers, highlighting the need for targeted, culturally adaptable equity strategies within a high-uptake programme. These findings may inform national and international policies and offer practical lessons for universal RSV immunisation.
Hypertension is the leading global risk factor for mortality, causing over 10 million deaths annually. In sub-Saharan Africa, hypertension prevalence is high, particularly in rural areas, where it is less likely to be diagnosed, treated or controlled effectively. This results in a high burden of complications, including heart failure, stroke and kidney disease. Community-centred approaches using community health workers (CHWs), risk-based approaches and simplified treatment regimens have shown promise in improving hypertension management. However, there is limited evidence on the effectiveness of such approaches in rural sub-Saharan Africa.
The primary aim of this study is to assess the feasibility of a community-centred intervention for hypertension management in rural Kenya and The Gambia. The objectives are to evaluate the intervention’s adoption, fidelity, reach and dose; understand the mechanisms of action and contextual factors affecting its implementation; assess acceptability from the perspectives of patients, healthcare providers and policymakers; estimate the costs associated with the intervention; and evaluate study procedures to inform the design of a future full-scale trial.
We will conduct a mixed-methods, non-randomised, single-arm feasibility study, designed in accordance with the Consolidated Standards of Reporting Trials (CONSORT) framework and checklist for feasibility and pilot studies, including best practice guidance for non-randomised feasibility studies. The study will be conducted in two rural sites: Kilifi, Kenya and Kiang West, The Gambia. The intervention was codesigned with stakeholders and includes community-based hypertension screening by CHWs, risk stratification and hypertension-mediated organ damage assessment at primary healthcare facilities, followed by treatment initiation using single-pill combination (SPC) antihypertensive therapy for eligible individuals. Training will be provided to all healthcare providers involved in the study. We will screen 500 participants aged 30–80 years at their residence (250 from each country), and we expect that about 45% will be referred for additional assessments and of these 25% (or 10% of the total sample) will be prescribed treatment with SPC. Data collection to evaluate the intervention and its implementation will involve quantitative measures of feasibility and clinical outcomes; observations to assess fidelity and costing measures; and qualitative interviews and focus group discussions with patients, healthcare providers and policymakers to understand the acceptability and contextual influences on intervention implementation.
Ethics approval was obtained from the Kenyan National Committee for Science, Technology and Innovation (ref: 415561), the Gambia Government/Medical Research Council Joint Ethics Committee (ref: 31372) and the London School of Hygiene and Tropical Medicine Ethics Committee (ref: 31372). Study findings will be disseminated through peer-reviewed publications, conferences, policy briefs, community engagement forums and accessible summaries shared via the Improving Hypertension Control in Rural sub-Saharan Africa and partner newsletters.
This study is registered with the ISRCTN- The UK’s Clinical Study Registry (ISRCTN81228019), and Pan African Clinical Trials Registry (PACTR202504839027548).
People with severe mental illness (SMI) engage in less physical activity (PA) and more sedentary behaviour (SB) than the general population, contributing to poorer physical health outcomes in this population. Therefore, the aim of this study was to evaluate the feasibility of a multi-component behaviour change intervention called Walking fOR Health (WORtH), delivered by community mental health teams, aimed at increasing PA and reducing SB compared with a one-off education session in people with SMI.
Feasibility randomised controlled trial (RCT).
Study recruitment and intervention delivery took place within four community mental health teams in the UK and Ireland.
Eligible participants had a diagnosis of a SMI and no contraindications to participating in physical activity. Fifty-four participants (25 male, 29 female; mean age 51.6 years) were recruited.
Participants were randomised to the 13-week WORtH intervention, comprising education, activity tracking and health coaching or an education-only control.
Feasibility outcomes included recruitment, retention, adherence and acceptability. Clinical outcomes included device-measured (Axivity AX3) and self-reported PA and SB, body anthropometry, physical function and mental well-being.
This feasibility study met 90% target recruitment and 94% of participants provided follow-up data. Adherence to allocated intervention and engagement with all core intervention components was >80%. Qualitative feedback indicated high levels of satisfaction. Valid device-measured moderate-vigorous PA (MVPA), the intended primary outcome for a definitive trial, was obtained from 90% of participants at baseline and 75% of participants at post-intervention. Point estimates indicated a mean increase of 8.6 min/day of MVPA in the intervention group (baseline 54.7 min/day (95% CI 39.5 to 70.0); follow-up 63.3 min/day (95% CI 50.1 to 76.4)) and of 1.0 min/day in the control group (baseline 42.1 min/day (95% CI 24.6 to 59.6); follow-up 43.1 min/day (95% CI 29.6 to 56.5)).
The results of this study support the feasibility of the WORtH intervention in adults with SMI, and findings will be used to optimise the design of a definitive RCT.
Women residing in rural areas or belonging to lower socioeconomic status (SES) strata experience disproportionately low rates of breast cancer screening, contributing to delayed diagnoses and poorer prognoses. In addition, their participation in clinical trials remains markedly limited, reducing opportunities to access preventive and screening interventions. Promoting research preparedness among women before disease onset may empower them to make informed decisions regarding their health and willingness to participate in clinical research with fewer emotional and logistical barriers.
This project applies a community-based participatory research approach to develop and refine the WeCARE (Women’s Engagement for Cancer Awareness, Resources and Education) intervention for women aged 50–74 years who have either never undergone breast cancer screening or have not received screening in the past 5 years and who reside in rural areas or belong to low SES groups. The intervention consists of two components. Component 1 is a single-day, in-person community forum that includes (a) an educational seminar led by an oncologist to address breast cancer risk and screening guidelines, (b) survivor storytelling to enhance emotional engagement and cultural resonance and (c) facilitated navigation to breast cancer screening and future research participation. Component 2 involves structured post-forum follow-up through multiple touchpoints (phone calls and mailed boosters) to reinforce knowledge, address barriers and support screening completion and research enrolment. Quantitative data (eg, screening completion, satisfaction and follow-up engagement) will be summarised using descriptive statistics to assess feasibility and reach on 50 participants. Qualitative feedback from participants will undergo thematic analysis to identify barriers, facilitators and perceived cultural relevance. Integrated mixed-method interpretation will inform iterative refinement of the WeCARE intervention and guide design of subsequent larger trials.
Approved by the Mayo Clinic Institutional Review Board (IRB #25–008934). All participants will provide informed consent. Procedures ensure confidentiality, cultural sensitivity and participant safety. Data will be stored in REDCap and disseminated through publications, conferences, local town halls and community reports.
Namaste Care, a non-pharmaceutical daily multicomponent palliative care intervention, offers care for people with dementia, aiming to improve quality of life of those living with dementia as well as their family and caregivers. This systematic review explores the Namaste Care intervention and its clinical and economic effects in multiple care settings. The aim of this review is to consolidate existing evidence on Namaste Care’s clinical and economic outcomes and examine the tools used for data collection.
A systematic literature search was conducted (PubMed, Scopus and Web of Science) to identify peer-reviewed studies on Namaste Care’s impact on quality of life, costs, health, economic outcomes and benefits up to 22 February 2026. Methodological quality was assessed using the Mixed Methods Appraisal Tool, while the completeness of reporting of economic evaluation studies was evaluated according to the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS).
31 studies reported the clinical and/or economic outcomes of Namaste Care. The results for quality of life and quality of dying were mixed, while 5 of 11 studies evaluating quality of life reported significant improvements. The various quality-of-life instruments used include the Quality of Life in Late-Stage Dementia (QUALID), EQ-5D-3L and EQ-5D-5L instruments, ICEpop CAPability Measure for Older People (ICECAP-O), ICECAP Supportive Care Measure (ICECAP-SCM), Quality of Life for People with Dementia (QUALIDEM) and Carers-DEMentia Quality of Life (C-DEMQOL). The clinical outcomes considered included pain, behavioural symptoms and quality of end-of-life care. The Medication Quantification Scale and Minimum Data Set indicated reductions in antidepressant and antianxiety medication use. Seven studies reported significant improvements in well-being, and two studies reported reduced stress among family members following Namaste Care sessions. A subset of five studies reported a range of economic outcomes.
The findings suggest that Namaste Care improves well-being, reduces caregiver stress and lowers the use of antidepressant and antianxiety medications at a moderate cost. The current literature is characterised by small, non-random, heterogeneous studies. Randomised controlled trials, which include economic evaluations, help to improve evidence-based research to support funding and implementation decisions on Namaste Care.
CRD42024560056.
by Tadgh Connery, Sofija Kukulite, Conor Farrell, Rosa Horgan, Karen Barry, Megan Doyle, Annalisa Setti, Mike Murphy
BackgroundDeath anxiety is fast becoming recognised as a transdiagnostic construct across myriad mental health conditions. Though existing clinical treatments of death anxiety, such as Cognitive Behaviour Therapy type interventions, have been shown to be effective, Terror Management Theory (TMT) proposes self-esteem as a protective factor against death anxiety by endowing individuals with a feeling of significance in life and helping them to process the nature of death and its inevitability. Despite the centrality of self-esteem to TMT, however, extant research examining its relationship with death anxiety has yet to be synthesised. The current study aims to systematically review peer-reviewed, quantitative research examining the association between death anxiety and self-esteem and, where possible, to test the strength of these associations through meta-analysis.
MethodA systematic search of quantitative and mixed-methods studies will be conducted across six databases: MEDLINE; PsycINFO; PubMed; Web of Science; CINAHL and; EMBASE. Google Scholar will also be searched and the first 200 records by relevance will be screened for eligibility. Searches will be conducted by TC, and records will be screened by TC, SK, CF, RH and KB, so that each record is screened for eligibility by at least two authors. Data extraction and quality assessment, using the Joanna Briggs Inventory Risk of Bias tools, will be performed by TC, SK, CF, RH and KB, so that each record is assessed by at least two authors, with doubts and discrepancies being resolved through discussion with AS and MM. A narrative synthesis of relevant data will be presented and, where sufficient data are available, meta-analysis will be conducted using the MAJOR extension for Jamovi to establish an overall effect size for the association between death anxiety and self-esteem. Should sufficient data be available, demographic factors, such as gender and age, and clinical population status (clinical vs. non-clinical population) will be examined as moderators of the effect. This protocol was developed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and has been registered in PROSPERO (CRD42024591775).
DiscussionThe current review will systematically examine the relationship between death anxiety and self-esteem. Should sufficient data be available, an overall effect size of the relationship will be generated. By better understanding how death anxiety is related to self-esteem, and by establishing the size and significance of the relationship will aid firstly in systematically validating TMT and, secondly, identify whether self-esteem may be targeted in future death anxiety interventions to reduce death anxiety and improve individuals’ overall mental health.
To explore the views of community registered general nurses and directors of public health nursing on the current and future role of the community registered general nurse in the Republic of Ireland.
Anonymous cross-sectional descriptive survey.
Two questionnaires were developed; one targeted at community registered general nurses and one targeted at assistant directors of public health nursing or directors of public health nursing who were working with community registered general nurses. Social media was used to recruit participants. Descriptive statistics were used while data from open-ended questions were analysed using NVivo software.
A total of 97 community registered general nurses and 28 assistant directors of public health nursing or directors of public health nursing completed the surveys in 2023. There was consensus that community registered general nurses provide holistic care, including case management of adults with complex health needs living in the community. However, lack of promotional opportunities coupled with poor remuneration has resulted in job dissatisfaction. Respondents felt that community registered general nurses should focus on older adults, whereas public health nurses should focus on child health.
The role of the community registered general nurse needs to be clarified, and a promotional pathway developed to attract new graduates to this post.
This paper outlined the current role and vision for the future role of community registered general nurses.
CROSS guidelines.
No patient or public contribution.
This paper contributes to the challenges community nurses face regarding increased demand for community nursing, lack of career structure for some community nurses, and difficulties with staff retention within the community.
Nurse practitioner-sensitive outcomes (NPSOs) are critical indicators of the quality and effectiveness of nursing care provided to older adults. These outcomes, which include metrics such as falls, pressure ulcers, infection rates, frailty, delirium, length of stay, hospital readmissions, and quality of life (QoL), are essential for assessing the impact of nurse practitioners (NPs) and enhancing patient safety. Despite their importance, the current literature on NPSOs in services for older adults remains limited. This scoping review aims to address this gap by systematically mapping the existing research, identifying key themes, and uncovering areas needing further exploration. By doing so, the authors seek to provide a comprehensive overview that will inform future research directions and contribute to the enhancement of clinical practice in older person services (OPS). This review is important for healthcare providers, policymakers, and researchers who are committed to improving the quality of nursing care and outcomes for older people.
The aim of this scoping review is to map the existing research on NPSOs in services for older adults. This review seeks to identify key themes and gaps in the current literature to guide future research and enhance clinical practice in this area.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were utilised to structure this scoping review.
From initial screening of 3593 manuscripts drawn from seven databases, 66 were deemed eligible for full screen. Five studies met the inclusion criteria and were ultimately selected for data extraction and analysis. The most common outcome measures reported were complications and comorbidities, and QoL.
This review highlights that the reporting of NPSOs in older person care is lacking and requires further attention.
To synthesise and critically analyse existing reviews of evidence on mentorship in nursing and midwifery, providing a comprehensive overview of current knowledge.
A scoping meta-review.
The review was conducted using the scoping meta-review framework outlined by Sarrami-Foroushani et al. (2015), alongside the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to ensure rigour and transparency. The following steps were included: (i) defining the problem, (ii) literature search and criteria, (iii) study selection and data extraction, (iv) data synthesis, (v) presentation of results and (vi) interpretation and recommendations.
A comprehensive search strategy was designed, utilising Boolean operators, truncation and predefined keywords across seven databases including MEDLINE, CINAHL, Embase, PsycINFO, Epistemonikos, ERIC and Google Scholar.
Following double-blind screening of 269 papers, 14 literature reviews were included. The findings provided a detailed overview of mentorship programme types (formal and informal), outcome measures used to evaluate mentorship effectiveness and recommendations for future programmes. Identified themes included skill development, job satisfaction, career progression and retention outcomes, together with challenges including time constraints and balancing clinical responsibilities with mentorship roles. Formal mentorship programmes that are adequately supported and integrated into the organisational culture can improve healthcare systems, workforce stability and patient outcomes. Informal mentorship continues to offer valuable, flexible support, particularly when used alongside formal structures. Implementation challenges exist, such as time constraints, limited organisational support, and mismatched mentor-mentee pairings.
This review highlights the critical role of mentorship in nursing and midwifery, offering insights into effective practices, challenges and potential areas for further research. The findings suggest that formal, structured mentorship programmes produce consistent benefits, including enhanced clinical skills, confidence and satisfaction among mentees, as well as leadership development and professional fulfilment for mentors, while positively impacting organisational efficiency and patient outcomes. Successful mentorship programmes require organisational commitment, with protected time, resources, and ongoing mentor training.
Mentorship programmes in nursing and midwifery enhance professional development, job satisfaction, and retention, enabling a stable healthcare workforce. Mentorship for mentors and mentees is linked to increased confidence, competency and readiness for advanced roles among nurses and midwives. Fostering mentorship in healthcare can lead to improved quality and continuity of care as mentees grow into more competent and confident practitioners.
Formal mentorship programmes that are adequately supported and integrated into the organisational culture can improve healthcare systems, workforce stability and patient outcomes. Policymakers responsible for healthcare workforce development can use these findings to advocate for mentorship as a strategic investment, potentially influencing policies related to nurse retention, professional development and funding allocations for mentorship initiatives. Structured mentorship improves job satisfaction, reduces turnover and fosters professional growth, thus reducing costs associated with recruitment and training.
The findings are reported in line with the PRISMA guidelines (Page et al., 2021) and through a narrative synthesis, summarising and analysing the results of various reviews to present a cohesive understanding of mentorship practices in nursing and midwifery. This method allowed for the integration of qualitative and quantitative findings and the identification of common themes and patterns across studies.
Patients or members of the public did not directly contribute to this review. However, by focusing on mentorship practices that support nurses and midwives, the study indirectly addresses public interests, as improved mentoring contributes to the quality of patient care. Future studies could benefit from patient or public feedback on desired qualities in care providers, further informing the development of mentorship programmes aligned with patient-centred care outcomes.
by Ian C. Murphy, Kelly Bryan, Muriel Burk, Rong Jiang, Francesca Cunningham, Sarah Providence, Elizabeth Rightnour, Sarah Zavala, Kathleen Morneau, Trisha Exline, Stacey Rice, Travis Schmitt, Kelly Drumright, Jennifer Lee, BreAnna Davids, Tram Guilbeault, Brooke Klenosky, Ann-Marie Sutherland, Abbie Rosen, Lauren Ratliff, Kenneth Bukowski, Margaret A. Pisani, Andrew Franck, Mark Wong, Preston Witcher, Kathleen M. Akgün
OBJECTIVESEarly data suggested higher sedative requirements for ventilated COVID+ patients, deviating from established guidelines. We assessed the relationship between sedative use and outcomes in mechanically ventilated Veterans during the COVID-19 pandemic.
DesignRetrospective Medication Use Evaluation
SettingNational Sample of 13 Distinct VA Medical Center Intensive Care Units
PatientsCritically ill Veteran patients requiring mechanically ventilation for ≥2 days
InterventionsNone.
Measurements and main resultsThe proportion of patients receiving fentanyl, midazolam and propofol was higher during COVID years. Compared with pre-COVID, median fentanyl dose was higher during Years 1 and 2 (1575mcg [(IQR) 1000–1650] vs. 1900 [1250–3000] vs. 1910 [1150–3500]). Adjuvant antipsychotics use was relatively low but tended to increase over time (pre = 10.5% vs. Year 1 = 12.3% vs. Year 2 = 14.1%). Most patients started on antipsychotics in the ICU were continued on the drug after extubation. Mortality was higher during COVID years (pre = 26.9% vs. 1 = 36.8% and 2 = 35.9%). In stratified analyses by COVID status years 1–2 (n = 79, 27%), a higher proportion of COVID+ patients received fentanyl (96% vs. 84%) and propofol (90% vs. 77%) and at higher doses (fentanyl = 1650mcg vs. 2688mcg median cumulative dose; propofol maximum infusion rate = 30 mc/kg/min (20–50) vs. 40 (25–50)). Sedative doses were similar to pre-COVID among non-COVID patients. Anti-psychotics were more frequently continued post extubation among COVID+ (34.6% vs. non-COVID+=14.9%). COVID+ patients were also less likely to have awakening and breathing trials at 48 hours after intubation (18% vs. 46%).
ConclusionsSedative use and dosing increased during the first two years of COVID compared to pre-COVID, especially for COVID+ patients. The sustained elevated levels of fentanyl use in Year 2 suggests possible ‘therapeutic creep’ away from guideline-concordant practices for COVID+ patients. Antipsychotic prescription during intubation and following extubation was also more common among COVID + . These findings could inform development and implementation of safer sedation practices across VA ICUs during respiratory pandemics.
To examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels.
A pre-post observational design.
A systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing.
An adjustment to nurse staffing levels was made to all three emergency departments. Mean emotional exhaustion scores were significantly lower, and quality of work environment scores and levels of job satisfaction were significantly higher for nurses following staffing adjustments. There was an increase to the proportion of nurses who perceived an improvement in quality of care delivered. In general, the results indicated improvements in outcomes following adjustments to nurse staffing levels.
A more holistic organisational approach is required to address staffing in emergency departments. Initiatives that involve frontline nurses in resource planning facilitating a bottom-up approach to allow for improved work environments would be beneficial.
This study addressed a planned change to nurse staffing levels in emergency departments and staff outcomes pre and post changes to staffing levels.
This study highlighted that staffing an emergency department, based on nursing hours per patient presentation, was associated with improvements in staff outcomes.
The research will impact on nurses working in emergency departments as outcomes from this research were used to develop a Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings.
STROBE and SQUIRE checklist.
No Patient or Public Contribution.
by Vivian Hoffmann, Boaz Ndisio, Allan Barasa, Sheila Okoth, Mike Murphy
Foodborne illness is a major source of the global burden of disease, but public monitoring of hazards in food systems is overwhelmingly focused on the formal sector in high income countries. We contribute to the development of an evidence base on food safety risk in low-income and informal settings by monitoring aflatoxin prevalence in maize flour in Kenya. Aflatoxin is a contaminant which causes liver cancer and has been linked to childhood stunting. We carry out systematic monitoring of formally and informally processed maize flour from a range of retail vendors across ten urban sites in Kenya and analyze aflatoxin levels in commercial samples. Samples were obtained every two months from February-December 2021 and 1255 samples in total were analyzed. Almost all samples (97%) showed detectable levels of aflatoxin, with 16% of tested samples exceeding the national regulatory limit of 10 ppb. Mean contamination levels are significantly higher (pTo describe telephone-triage nurses' perceptions of their well-being and the system factors that influenced their well-being while conducting telephone-triage for COVID-19 during the pandemic.
This descriptive, qualitative study applied both inductive and deductive analysis to generate themes.
We interviewed a convenience sample of 27 nurses from two health systems about their perceptions of well-being when triaging patient calls about COVID-19 and reasons for those perceptions. Data collection occurred between November 2020 and June 2021. Themes were organised using the National Academies of Science, Engineering and Medicine framework.
Telephone-triage nurses' well-being was significantly impacted by COVID-19. Uncertainty regarding evolving COVID-19 guidance, increased call volumes and difficult patient responses were some of the key work system challenges that impacted nurses' well-being.
Our findings suggest the need to revisit work system factors that impact the well-being of telephone-triage nurses and develop organisational interventions to support nurses to provide optimal care during crisis situations.
Organisational information infrastructure should be bolstered for future pandemic responses to minimise impacts on nurses' well-being. Additionally, leaders need to realign tasks, workflows and workload of telephone triage during pandemic surges to prevent excessive demands on nurses.
This work contributes to understanding telephone-triage nurses' well-being during COVID-19. The increased demands they faced and impact on their well-being point to opportunities for organisational well-being interventions and development of crisis standards for tele-triaging to support nurses during high-stress, crisis situations.
The authors have adhered to COREQ guidelines for reporting.
No patient or public contribution.
FreshRSS 