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After resuscitation from out of hospital cardiac arrest (OHCA), mechanical ventilation (MV) and respiratory management are fundamental to support patients in the intensive care unit (ICU) and to minimise secondary brain injury. Best practices for MV and association with clinical outcomes in patients with OHCA remain unclear.
This protocol describes a pre-planned respiratory-focused series of sub-analyses within the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) trial, an ongoing interventional study evaluating 6-month mortality after randomisation in patients admitted to ICUs following OHCA. The primary aim is to describe real-world ventilator settings and gas-exchange targets during the first 72 hours after ICU admission in patients receiving invasive mechanical ventilation after OHCA. Secondary aims include to estimate the incidence of respiratory complications during ICU stay (eg, ventilator-associated pneumonia, acute respiratory distress syndrome, barotrauma); and to explore the association between early ventilator settings/gas-exchange parameters and 6-month outcomes (mortality and neurological status). Exploratory aim is to characterise weaning and extubation practices, including timing and failure rates.
Eligible patients will include adult STEPCARE participants receiving invasive MV after return of spontaneous circulation with available respiratory data recorded within the STEPCARE database.
Data collected in the STEPCARE trial that will be analysed include patients’ prehospital characteristics; clinical examination at hospital admission and at ICU admission; ventilator settings and arterial blood gases recorded at predefined time points during ICU stay. In particular: MV setting (mode, tidal volume, positive end-expiratory pressure, fraction of inspired oxygen, tidal volume, mechanical power, plateau/driving pressures), gas-exchange values (arterial partial pressure of oxygen and carbon dioxide, pH, arterial saturation of oxygen), timing of measurements and the occurrence/timing of respiratory complications and weaning outcomes.
The STEPCARE study has been approved by the regional ethics committee at Lund University (Dnr 2022-02425-01, Approved IRB on 2022-06-18) and by all ethics boards in the participating countries. No additional ethical approval is required for this predefined secondary analysis, as no further data collection or interventions will be performed. Findings will be disseminated through publication in peer-reviewed journals and, where appropriate, conference abstracts and presentations. Patients and the public were not involved.
This study aimed to explore the dual perspectives and challenges of clinical nursing educators and novice nurses regarding the implementation of nursing-specific mini-clinical evaluation exercise (mini-CEX) and direct observation of procedural skills (DOPS) in novice nurses’ training within a single tertiary hospital in China.
A descriptive qualitative research design was used. Participants were selected using a purposive sampling method, and semistructured interviews were conducted to collect data, which were then analysed following the six-step thematic analysis process.
The study was conducted at a tertiary hospital in Beijing, China.
A total of 24 participants were recruited from November to December 2023, comprising 13 clinical nursing educators and 11 novice nurses.
Four themes emerged: (1) novice nurse growth: true reflection of novice nurses’ clinical nursing abilities through direct observation; tailored learning pathways for individual growth; immediate feedback and self-reflection-driven engagement for individualised learning advancement; visual analytics for identifying targeted improvement areas and tracking progress across clinical domains; (2) educator teaching quality: practical contents and flexible methods of evaluation; real-time teaching adaptation and refined teaching plans; educator-led multidimensional nursing competencies cultivation; (3) obstacles in implementing evaluation tools: time-consuming processes in assessment and manual documentation; insufficient and delayed feedback due to heavy clinical workload; interruption of implementation by significantly changed clinical situation and (4) factors affecting implementation efficacy: subjective differences in scoring and inconsistent evaluation standards; lack of specialty in assessment tools; teaching-related factors; novice nurses’ personal factors; patient-related factors; feedback-related factors.
Educators and novice nurses perceived that the nursing-specific mini-CEX and DOPS have many advantages but raise concerns about time-consuming assessments, inadequate or delayed feedback, disruptions to implementation due to significant clinical changes, inconsistent standards and a lack of specialised assessment tools as well as multiple factors affecting its efficacy. Future research should focus on efficient strategies for optimal use.
by Qian Li, Yilun Huang, Samuel Yeung-Shan Wong, Winnie W. S. Mak, Xue Yang
Background and objectiveA well-established link exists between depression and Internet gaming disorder (IGD) at the individual level, while it remains unexplored within the family system. This study aims to investigate the interdependent relationship between parent and adolescent depression and IGD, and to identify the potential mechanisms.
MethodsA cross-sectional dyadic study was conducted with adolescents and their parents (primary caregiver) in Hong Kong. Adolescents completed anonymous surveys in classrooms, and parents completed online surveys via WhatsApp or phone interviews. The Actor-Partner Interdependence Model (APIM) and Actor-Partner Interdependence Mediation Model (APIMeM) were utilized to test the interdependence and mediators between depression and IGD in parent-child dyads, respectively.
ResultsA total of 1,277 parent-child dyads were included. Depressive symptoms in parents (β = 0.072) and adolescents (β = 0.273, both p Conclusions
Adolescent depressive symptoms were positively associated with their own and parental IGD symptoms, which were mediated by adolescent-reported family relationships and adolescent gaming time. The influence of adolescents’ mental health problems on parents’ problematic behaviors within the family system should not be overlooked.
by Daniel H. Nguyen, Debottama Das, Ali Bilgin, Dianne Patterson, Matthew Hook, Chris Butson, Alberto Cacciola, Vinod Kumar Jangir, Manojkumar Saranathan
Leveraging diffusion tractography, connectivity-based parcellation (CBP) is one of the oldest methods for thalamic nuclei segmentation. The goal of this work was to reassess CBP using higher spatial resolution diffusion MRI data and reconstruction algorithms, and to compare it with recent state-of-the-art methods for thalamic nuclei segmentation. Furthermore, these methods were systematically evaluated against three histological atlases and one functional MRI–based atlas to examine their relative anatomical similarities and differences. High resolution diffusion and T1-weighted MRI data from 67 healthy individuals in the Human Connectome Project Young Adult database were analyzed. CBP was performed using probabilistic tractography with cortical targets derived from combining labels of the Human Connectome Project Multi-Modal Parcellation 1.0 atlas into 8, 11, and 23 regions. Results were compared against three recent methods: orientation distribution function clustering (ODF), track density imaging (TDI), and structural MRI-based segmentation. Group level analyses were conducted in the Montreal Neurological Institute space, and Dice overlap coefficients were calculated using four atlases (three histological, one functional). CBP results using newer data and methods were still remarkably similar to the original CBP parcellation results. Across atlases, a consistent hierarchy was observed: HIPS-THOMAS performed best, followed by TDI, ODF, and CBP (Kendall’s W = 1.00, p = 0.007). Histological atlases showed strong mutual agreement (Pearson r = 0.71–0.85), whereas the Zhang atlas demonstrated lower concordance (Pearson r = 0.51–0.63). Despite methodological advances, CBP remains constrained in its ability to delineate thalamic nuclei with histological accuracy. By contrast, structural and diffusion microstructural approaches provided better nuclear localization. These findings highlight the need for hybrid workflows that integrate structural and diffusion-based information to enable more reliable thalamic segmentation for neuroscience research.by Hui-Ying Luk, Casey R. Appell, Fangyuan Zhang, Jarrod Blinch, K. Sreekumaran Nair, Chwan-Li Shen, Danielle E. Levitt
IntroductionGlycemic dysregulation is a hallmark of type 2 diabetes (T2D) and contributes to skeletal muscle (SKM) loss and frailty risk, especially in older adults. Glycemic control and physical function are supported by SKM capillarization and mitochondrial function, and their impairment contributes to T2D development. While high-intensity interval training (HIIT) is a promising intervention, adherence and effectiveness remain concerns for prescribing HIIT among older adults at risk for T2D. Local heat therapy (LHT) may be a more practical initial strategy to improve SKM architectural factors and precondition SKM, enhancing physiological adaptations to exercise in this population.
Methods and analysisHeat and Exercise in Aging as Therapy (HEAT) is a two-phase, randomized, sham-controlled clinical trial investigating the efficacy of LHT to improve glycemic control and decrease frailty risk via improved SKM architecture among older adults with prediabetes. LHT is tested as a standalone intervention and as a means to precondition SKM for subsequent HIIT, improving exercise adaptations. In Phase 1, LHT and sham (CON) groups apply heat pads for 90 minutes/day, 6 days/week, for 12 weeks. A separate HIIT group completes 4x4-minute cycling intervals at 90–95% VO₂peak, 3 days/week. In Phase 2, LHT and CON groups begin HIIT. Participants (≥50 years) have impaired fasting glucose (100–125 mg/dL) and/or HbA1c (5.7–6.4%). Biospecimen collection and clinical assessments occur at baseline (T1), after Phase 1 (T2), and Phase 2 (T3). To our knowledge, this is the first study to determine the use of local heat pad on pre-diabetic older population. If successful, LHT may be a practical, scalable, non-invasive intervention to improve glycemic control and reduce frailty risk in older adults with prediabetes, preventing progression to T2D.
Emerging evidence supports a role for interleukin 6 (IL-6), a pro-inflammatory cytokine, in the pathogenesis of treatment-resistant major depressive disorder (TRD). However, interventional studies targeting IL-6 in this population remain scarce. Tocilizumab is a humanised monoclonal antibody that inhibits IL-6 signalling and is approved for the treatment of autoimmune conditions such as rheumatoid arthritis. The primary objective of this study is to examine whether IL-6 inhibition via tocilizumab can impact depressive symptoms, inflammation-related biomarkers and cognition in patients with TRD. A secondary objective is to compare the biological profiles of patients with TRD with elevated inflammation to those of healthy controls.
This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.
The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.
Developmental regression is when children lose one or more skills they have established. Families caring for these children need timely recognition to assist diagnosis and tailored interventions. Families also need support to develop practical skills for caregiving and strategies to promote family well-being and community participation. Given the high caring demands, flexibly delivered approaches are needed to accommodate family routines. Online delivery of health-related interventions that provide coaching, information, or both has been found to be a feasible and effective option for families. Family Focus is a new family-centred online programme, co-designed with parents and family advocates, clinicians, and researchers to support and empower primary carers.
This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation.
Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies.
by Patricia Fiorino, Luigi Fernandes Rosa Cauduro, Danielle Silberspitz Konig, Leonardo Fernandes Rosa Cauduro, Caio de Araujo Santos, Juliana Alves Kavai, Isadora Durigan Duarte, Anna Laura Viacava Américo
Zebrafish (Danio rerio) are widely used as models in cardiovascular research due to their rapid development, optical transparency, and genetic similarity to humans. However, the lack of standardized experimental conditions, particularly regarding developmental stage and microenvironmental parameters, limits reproducibility across studies. This study aimed to characterize cardiovascular function in Zebrafish larvae and evaluate the impact of developmental stage and environmental factors. Wild-type AB embryos were maintained under standard conditions, and heart rate (HR), cardiac output (CO), and ejection fraction (EF) were measured at 24, 30, 48, 52, 56, 72, 78, and 80 hours post-fertilization (hpf). The effects of variations in temperature (27.0, 27.5, and 28.0 °C) and pH (7.0, 7.4, and 8.0) were also assessed. Results showed a progressive increase in HR from 24 to 72 hpf, stabilizing thereafter. CO exhibited two phases of elevation: an early rise between 24–48 hpf and a stronger increase between 48–56 hpf. EF remained generally stable, with a transient reduction at 48 hpf. Cardiovascular performance reached a physiologically stable state after 72 hpf, defining a reliable window for functional studies. Environmental conditions modulated these parameters: temperature variation induced approximately 20% difference in HR and reduced EF, while CO was minimally affected. In contrast, pH variations within the physiological range had no significant impact on HR, CO, or EF. These findings highlight developmental and environmental variables that may influence cardiovascular measurements in Zebrafish larvae and support the development of more consistent experimental approaches in cardiovascular and toxicological research.by Wasim Labban, Juan Forero, Lindsey Westover, Mark Sommerfeldt, Stephanie Nathanail, Lauren Beaupre
ObjectivesTo compare dynamic postural stability, measured by time to stabilization (TTS) and postural stability indices (PSI), after double-leg counter-movement jump (CMJ) landing in individuals 9–24 months following anterior cruciate ligament reconstruction (ACLR) and healthy controls. Additionally, to explore the effect of sex and ACLR status on postural stability.
MethodsThis cross-sectional laboratory-based study included 41 participants: 21 individuals (10 females) 9–24 months post-ACLR and 20 healthy controls (10 females). Participants performed double-leg countermovement jumps (CMJs) on force plates, landed, and maintained the landing position for 10 seconds. Time to stabilization (TTS), defined as the time (s) required for the ground reaction force to reach and maintain a stable state following landing, and postural stability index (PSI), a composite measure of the ability to maintain equilibrium during the transition from dynamic to static conditions, were calculated and compared between groups.
ResultsThe ACLR group exhibited significantly higher TTS values than healthy controls, indicating a longer duration to achieve stability. Specifically, the resultant vector TTS when combined from both force plates (RVTTS-C), and the vertical TTS in the operated leg (VTTS-op) was higher in the ACLR than the healthy controls (p = 0.03, p = 0.02, respectively). Furthermore, males with ACLR demonstrated higher VTTS combined (VTTS-C) and VTTS-op than females post-ACLR (p = 0.03, p Conclusion
Our study revealed significant deficits in dynamic postural stability in individuals post ACLR, with notable sex differences. The findings suggest a need for targeted neuromuscular rehabilitation to improve landing stability post ACLR and reduce the risk of secondary injury. Further research is needed to understand sex-specific postural stability mechanisms for tailored rehabilitation.
Crohn's disease (CD) is primarily characterised by chronic gastrointestinal inflammation; however, its systemic nature frequently leads to musculoskeletal complications. Among these, clinically significant foot pathologies can impair mobility and negatively impact patients' overall quality of life. Despite their relevance, the specific influence of podiatric manifestations on health-related quality of life in individuals with CD remains insufficiently explored, underscoring a critical gap in current disease management. The aim of this study was to assess the extent to which foot-related health issues affect the quality of life in people living with CD compared with a healthy population. This multicenter observational case–control study was conducted across five provinces in southern Spain—Málaga, Granada, Jaén, Sevilla, and Cádiz—between January 2024 and February 2025. The study included 110 participants, evenly divided between individuals diagnosed with CD (n = 55) and healthy controls (n = 55), matched for age, sex, and body mass index. All participants completed the validated Spanish version of the Foot Health Status Questionnaire (SFHSQ), which assesses four foot-specific domains and four general health domains. Due to the non-normal distribution of the data, non-parametric statistical methods were applied, with the Mann–Whitney U test used to evaluate differences between groups. Participants with CD exhibited significantly lower scores across all domains of the SFHSQ, with the exception of the Footwear domain, which showed no statistically significant difference (p = 0.406). Compared with healthy controls, individuals in the CD group reported greater impairments in foot pain, foot function, general foot health, and in broader health-related domains including general health, physical activity, and social capacity (p < 0.01 for all). CD significantly compromises foot-related QoL. These results highlight the need to include podiatric evaluations as part of comprehensive, multidisciplinary care approaches aimed at enhancing mobility, functional capacity, and general well-being in affected individuals.
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.
Diabetes mellitus is a highly prevalent metabolic disorder associated with chronic, low-grade inflammation. Of recent interest is the association between diabetes and circadian rhythm disruption. The aim of this review is to evaluate and synthesise clinical evidence for whether diabetes affects homeostatic diurnal patterns to proinflammatory markers in the human body. This could inform the optimal timing of immune-targeted therapies over the course of the day.
This systematic review will include primary clinical research studies reporting on diurnal variations, defined as an afternoon/evening (PM) minus a morning (AM) value, within a timeframe of 12±4 hours, for predefined proinflammatory markers, in individuals with diabetes (type 1 or type 2) compared with healthy controls. A search of online databases (Cochrane CENTRAL, Ovid MEDLINE and Ovid Embase) will be performed. Grey literature searches will be performed in clinical trial registries. Two review authors will independently screen retrieved citation records at the title/abstract and full-text levels. Study quality will be assessed using an appropriate National Institute of Health quality assessment tool. A meta-analysis will be performed if more than one study reports equivalent data for any outcome. Statistical heterogeneity will be assessed using the 2 test. Where a meta-analysis is not possible or unlikely to be meaningful, a narrative synthesis of the findings will be provided.
Ethics approval is not required for this systematic review as no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations.
CRD420251115780.
The COVID-19 pandemic highlighted the need for alternative healthcare delivery models, leading to the development of Continuous Remote Patient Monitoring (CRPM). CRPM allows for real-time monitoring of high-risk patients, reducing the burden on hospital resources. The integration of virtual nursing into CRPM has enhanced remote care capabilities, though it has also introduced new challenges related to patient safety and staffing, that is, nurse-to-patient ratios.
This scoping review aims to explore the current evidence on virtual nursing using CRPM and identify challenges or barriers that help further future research and healthcare practices.
This scoping review followed the PRISMA-ScR guidelines. Eligible studies focused on virtual nursing with physiological monitoring in either remote hospital or home-based care settings, with explicit examination of nursing care and its impact on patient and nursing outcomes. Peer-reviewed articles published in the past 10 years in English were included. Four databases (Ovid, PubMed, CINAHL, and Medline) were searched with support from a medical librarian. After screening 207 records using Covidence, 17 studies met the inclusion criteria. Two reviewers independently screened all records, with a third resolving discrepancies. Data was charted using a standardized extraction template.
Seventeen studies were included in this review. CRPM was associated with reported benefits in managing chronic conditions, extending acute care into home settings, and enhancing healthcare system adaptability, particularly during the COVID-19 pandemic. Clinical benefits included early detection of health deterioration, reduced hospital readmissions, and improved patient satisfaction. Nurses played a pivotal role in physiologic data interpretation and intervention, highlighting the importance of continuous oversight in achieving favorable outcomes. However, implementation challenges, such as alert fatigue, data overload, user interface complexity, and financial sustainability were consistently reported. These findings underscore the need for improved data management systems, targeted nurse training, and sustainable funding models to support broader CRPM adoption.
Virtual nursing within CRPM demonstrates strong potential to improve patient outcomes and reduce hospitalizations by extending inpatient-level physiologic surveillance into home-based and hospital-at-home settings through continuous, nurse-led monitoring. Successful integration of this model into routine practice will require addressing challenges related to data management, clinician workload associated with 24/7 surveillance, and sustainable funding mechanisms to support continuous virtual nursing coverage.
Intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes in Denmark and remains associated with high mortality and morbidity. It is challenging to distinguish neoplastic from non-neoplastic causes of ICH in the acute setting, and CT findings that may aid early differentiation have not been fully characterised. Existing ICH-classification systems (SMASH-U, H-ATOMIC and CLAS-ICH) have not been directly compared for diagnostic accuracy in this setting. Identifying radiological and clinical factors associated with underlying aetiology may support faster diagnosis, reduce time to workup related to potential underlying cancer and facilitate early targeted treatment of the underlying cause of ICH.
This study is a retrospective observational cohort including all patients admitted with acute ICH to the Department of Neurology, University Hospital of Southern Denmark, Aabenraa between January 2014 and December 2024 (estimated approximately n=610). Medical records and initial non-enhanced CT scans will be reviewed. Two neurologists and two radiologists, blinded to final diagnosis, will independently extract clinical presentation, topographical and volumetric haemorrhage characteristics, and classify each case using the abovementioned ICH-classification systems. Primary analyses will assess associations between clinical and radiological features and underlying neoplastic vs non-neoplastic aetiology. Secondary analyses will compare diagnostic performance of classification systems using sensitivity, specificity and receiver operating characteristic curves. Multivariate logistic regression models will be applied with Holm correction for multiple comparisons.
The study has been submitted to the National Danish Research Ethics Committee and the Danish Data Protection Agency. As data derive from completed disease courses, no patient contact is expected. Results will be disseminated through peer-reviewed journals, conferences and scientific presentations.
To examine which elements of thriving and PERMA may be associated with thriving and intentions to leave both the job and profession among early career nurses.
Retention of early career nurses is a global concern, with up to 60% leaving the profession within 2 years. While organisational factors have been widely examined, psychological constructs such as thriving and well-being are underexplored.
A cross-sectional design.
The study surveyed early career nurses (n = 90, response rate 34.1%) across Australia. Validated instruments assessed thriving, PERMA dimensions, organisational support and intention to leave. Multiple linear and logistic regressions identified key factors associated with thriving and intention to leave the job or profession. Reporting adhered to STROBE guidelines for observational studies.
Thriving was a significant factor associated with engagement (β 0.039, p = 0.031), relationships with colleagues (β 0.167, p = 032), and occupational hardiness (β 0.502, p = 0.001), while accomplishment was a negative factor associated with thriving (β −0.163, p = 0.001). Intention to leave the job was linked to lower levels of thriving (β −1.303, p = 0.048), reduced perceived organisational support (β −0.180, p = 0.048), and higher negative emotions (β 0.747, p = 0.009). Intention to leave the profession was associated with accomplishment (β 0.222, p = 0.048), perceived organisational support (β 0.193, p = 0.001), and years since graduation (β 0.299, p = 0.016).
Thriving was associated with engagement, peer support, and resilience, whereas attrition was associated with poor organisational support and negative affect. Accomplishment is negatively aligned with thriving and may reflect unmet expectations, increasing role strain, or other personal factors not directly related to organisational contexts. Results suggest psychologically supportive environments and PERMA-informed strategies may be important for enhancing early career nurse retention. Supporting nurses to thrive should be a key focus for managers seeking to sustain the nursing workforce.
This study provides actionable insights for creating psychologically supportive environments that may be associated with improved early career nurse retention. By applying the PERMA framework, healthcare leaders may consider implementing targeted strategies, such as fostering engagement, informing the importance of collegial relationships, and promoting resilience, in order to positively inform well-being and achieve lower levels of attrition in clinical settings.
No patient or public contribution.
To examine the role of self-efficacy in the relationship between medication adherence and self-care behaviours in patients with Inflammatory Bowel Disease by describing their levels and exploring the interconnections among these variables.
Multicenter, cross-sectional.
A total of 452 patients were recruited through consecutive non-probabilistic sampling across nine Italian outpatient Inflammatory Bowel Disease Units. Data were collected using validated tools: the Morisky Medication Adherence Scale-8, the Self-Care Self-Efficacy Scale, and the Self-Care of Chronic Illness Inventory. Descriptive statistics, Pearson correlations, and mediation analyses were performed to explore associations and the mediating role of self-efficacy between medication adherence and self-care behaviours.
Participants had a mean age of 43.49 years; 50.9% were male, 49.2% had Crohn's disease, and 50.8% had ulcerative colitis. Only 10.2% reported high medication adherence, while most showed medium or low adherence. The mean self-efficacy score was 74.82. Medication adherence was positively associated with self-care maintenance, and self-efficacy statistically accounted for part of this association. Lower levels were observed in self-care monitoring and management behaviours.
Medication adherence was positively associated with self-care maintenance, and self-efficacy partially explained this relationship.
Routine assessment of medication adherence and self-efficacy may help identify patients at risk of poor self-care. Interventions aimed at strengthening self-efficacy, such as motivational interviewing, nurse-led counselling, and digital monitoring tools, may improve adherence and self-care maintenance.
The study addressed low medication adherence and suboptimal self-care in patients with IBD. Findings support integrating self-efficacy-enhancing strategies into multidisciplinary care to improve adherence and self-care behaviours.
Patients completed validated self-report questionnaires; however, they were not involved in the study design, conduct, analysis, or manuscript preparation.
To assess perceived patient safety competencies among nursing students and to examine their associations with their perceptions regarding clinical learning environment and unfinished nursing care.
An international comparative cross-sectional study.
A total of 1442 nursing students from the Czech Republic, Italy, Slovakia, and Türkiye participated between February and December 2025. Data were collected using the Health Professional Education in Patient Safety Survey, the Clinical Learning Environment, Supervision and Nurse Teacher scale, and the Unfinished Nursing Care Survey for Students. Descriptive statistics, non-parametric tests, Spearman correlations, and multivariate general linear modelling were applied.
Students reported significantly higher patient safety competencies in clinical compared with academic settings (p ≤ 0.001). Significant cross-country differences were observed across all competency domains (p ≤ 0.001). Perceived patient safety competencies were positively correlated with the overall quality of the clinical learning environment (r = 0.356–0.420; p < 0.001) and negatively correlated with unfinished nursing care (r = −0.107 to −0.171; p < 0.001). Multivariate analysis demonstrated that pedagogical atmosphere, premises of nursing care, supervisory relationship, and particularly the role of the nurse teacher were significant predictors of patient safety competencies.
The development of nursing students' patient safety competencies is closely linked to the quality of clinical learning environments. Strengthening educational and organisational conditions within clinical placements may play an important role in preparing future nurses for safe clinical practice.
Improving the quality of clinical learning environments, strengthening supervision, and addressing unfinished nursing care may support the development of nursing students' patient safety competencies and contribute to safer patient care.
The study was carried out according to the STROBE checklist.
No Patient or Public Contribution.
Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disorder that typically begins in early childhood and affects up to 20% of children. Infants with a family history of allergic diseases or with elevated total IgE levels are at increased risk of developing AD. Emerging evidence shows that a subgroup of AD patients produce IgE autoantibodies against skin self-peptides, which are suggested to play a role in disease pathophysiology and predict the development of allergic diseases later in life. Notably, such autoantibodies have been detected in up to 15% of infants with AD under 1 year of age, indicating that IgE autoantibodies can arise early in life. The ‘Development of IgE Autoantibodies in Newborns with (high risk to develop) Atopic dermatitis’ (DIANA) study is a prospective birth cohort designed to address these knowledge gaps by following a target of 500 newborns during their first 24 months of life.
It aims to investigate the presence of IgE autoantibodies at birth (cord blood) and during early life (6, 12 and 24 months) using an immunoassay and their association with the development of AD in children from high-risk (n=400) and low-risk (n=100) families. Genetic and environmental influences are evaluated through questionnaires. Additional assessments will include skin and gut microbiome profiling using 16S rRNA sequencing (swabs), non-invasive evaluation of skin barrier function using electrical impedance spectrometry and analysis of the natural moisturising factor. We aim to decipher the underlying cause of IgE autoantibody development and allow preventive measures to counteract this.
This prospective, non-interventional observational study has been approved by the Ethics Committee of Universitair Ziekenhuis Brussel/VUB (07/06/2023; EC-2023-074) and will follow Good Clinical Practice, applicable regulations and the Declaration of Helsinki. Written informed consent will be obtained from parents or legal guardians. Participation is voluntary, and consent can be withdrawn at any time. All procedures comply with GDPR to ensure data confidentiality. Participant data will be pseudonymised, with the coding key accessible only to designated study members and securely stored on a restricted-access VUB server. Findings will be disseminated through peer-reviewed publications and conference presentations. Pseudonymised data will be made available upon reasonable request in accordance with institutional policies and data protection regulations
Data on medication concentrations in human milk and their potential effects on the breastfed infant remain limited, leaving clinicians with insufficient evidence to guide women who require medication while breastfeeding. The MedMilk study aims to systematically measure medication concentrations in human milk, calculate the relative infant dose (RID) and evaluate infant outcomes.
This observational clinical study will recruit breastfeeding women using prescription and over-the-counter medications. Women will provide milk and urine samples along with self-reported maternal and infant health data. The primary outcome is quantification of medication concentrations in human milk. Secondary outcomes include estimation of the RID based on measured milk concentrations, maternally reported infant symptoms and adverse events potentially related to medication exposure, and pharmacokinetically simulated infant plasma exposure. Analytical methods include solid-phase extraction liquid chromatography-tandem mass spectrometry for quantification combined with descriptive statistics and pharmacokinetic modelling. The study aims to recruit approximately 250 women across medication groups. For the most frequently used medications, we aim to include 20 participants per medication, with each participant contributing four milk samples and a urine sample. Biological samples will be stored in a biobank, and data in a secure database.
The study has been approved by the Regional Research Ethics Committee of the Capital Region of Denmark (Journal no. H-23062687) and the Danish Data Protection Agency (Ref. P-2023-14627). All participants will provide written informed consent before enrolment. Findings will be disseminated through peer-reviewed journal publications and presentations at relevant national and international scientific conferences.
FreshRSS 