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Ayer — Abril 21st 2026Tus fuentes RSS

Social enrichment mitigates facial expressions and physiological indicators of short-term stress in horses

by Ana Caroline Bini de Lima, Vanessa Cristini Sebastião da Fé, Maria Simara Palermo Hernandes, Emily Caroline Pfeifer de Cristo, Ana Gabrieli dos Santos Fagundes Euzébio, Maria Vitória e Silva Sousa, Fabiana Ribeiro Caldara, Viviane Maria Oliveira dos Santos

This study aimed to evaluate the ability of social noncontact environmental enrichment to facilitate social buffering and to characterize the emotional experience of horses subjected to restraint in stock by assessing physiological parameters and facial expressions. Pantaneiro horses (n = 11) were evaluated in a crossover design with two treatments: social noncontact enrichment during stock restraint and social isolation during stock restraint. Physiological parameters (heart rate, heart rate variability, respiratory rate, ocular temperature by infrared thermography, and auricular temperature by infrared thermometer) and facial expressions (EquiFACS) were assessed throughout the 24-minute restraint period. When horses were accompanied by a conspecific, heart rate, respiratory rate, and eye temperature were lower (p nostril dilator (AD38), inner brow raiser (AU101), upper eyelid raiser (AU5), eye white increase (AD1), ears forward (EAD101), and ears back (EAD104), was also lower (p 
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Development and Psychometric Validation of the Palliative Care Experience Scale (PCES): An Experience‐Oriented Assessment Instrument

ABSTRACT

Aims

Accelerated population aging has driven substantial growth in demand for palliative care services. Such services can effectively enhance the living quality for end-of-life patients through multidimensional interventions. Currently, China lacks a localised experience-oriented quality assessment scale for palliative care, resulting in gaps in service quality supervision. To develop a self-reported measurement for palliative care services, with the foundation in the Senses Framework.

Design

This study developed a scale by extracting core contributors of palliative care experiences through 14 patients and 16 families' narratives. To refine and improve the scale, a total of 19 experts were invited to participate in a two-round Delphi expert consultation. Additionally, an empirical research was conducted, with 380 valid samples from two independent cohorts collected to complete the full psychometric testing of the scale.

Results

The final Palliative Care Experience Scale (PCES) comprises two dimensions: sense of security and belonging, and sense of purpose and significance, with a total of 13 items. The total variance includes 79.26% that is explained by these two factors. Confirmatory factor analysis confirmed a stable factor structure for the PCES. The scale exhibited good reliability, with a total Cronbach' α of 0.937, McDonald' ω of 0.952, and Spearman-Brown corrected split-half reliability of 0.897. Cronbach's α for both dimensions exceeded 0.88. The scale's SEM was 1.50 and MDC95 was 4.16, offering a validated threshold to identify real changes in patients' palliative care experience.

Conclusion

This study developed an assessment scale of palliative care quality based on the Senses Framework, uniquely centred on patient experiences. Validated through robust methodologies, this scale fills a gap in the evaluation of experiential dimensions of palliative care in China, providing a scientific and feasible measurement tool for the continuous improvement of services.

Impact

This study addresses the critical gap of a culturally adapted, patient experience-centred tool for evaluating palliative care service quality in China. Its core finding is the successful development and full psychometric validation of the 13-item Palliative Care Experience Scale (PCES). This research provides a reliable tool for palliative care clinical practice and academic research to capture patients' care experience, offers clinicians and administrators a practical instrument to identify service gaps and guide quality improvement, and delivers foundational reference data for policymakers to advance patient-centred palliative care development in China.

Reporting Method

We adhered to the relevant EQUATOR reporting guidelines. The development and validation process followed the COSMIN framework for patient-reported outcome measures.

Patient or Public Contribution

Patients receiving palliative care and familes played an integral role in designing and conducting this study. In Phase I, qualitative data from semi-structured interviews with 14 patients and 16 families helped define core thematic constructs and develop the initial item pool, which ensured the scale's content validity were based on their real-life experiences. In Phase III, we recruited a new, independent cohort of participants to complete the psychometric testing of the scale, providing key data for its validation.

Exploring the Perceived Effectiveness, Impact and Benefits of a Work‐Based Cancer Survivorship Peer Support Programme: A Qualitative Descriptive Study

ABSTRACT

Aim

To explore the perceived effectiveness, impact and benefits of a work-based cancer survivorship peer support programme for healthcare employees who have experienced or are experiencing cancer.

Design

A qualitative descriptive study.

Methods

Purposive sampling was used to recruit 33 participants (10 peers, 12 peer supporters, 4 line managers and 7 members of the governance group). Data were collected between October 2024 and February 2025 through individual interviews and focus groups. Data were analysed using reflexive thematic analysis.

Results

Four themes were generated: Programme Reach and Adoption, Implementing the Programme, Programme Effectiveness and Impact and Programme Maintenance and Growth. Challenges included the pilot status of the programme impacting awareness and uptake, potential reluctance to share diagnoses and the impact of cancer on colleagues. The approach of peer supporters was considered central to the programmes' success. Peer supporters valued training and continuous practice development opportunities.

Conclusion

Demonstrated benefits, including satisfaction and the value of peer support, were evident. To ensure programme maintenance, increased recruitment and training of peer supporters and clear communication regarding the programme and referral pathways are essential. Financial support is required to maintain training and address dissemination challenges.

Implications for the Profession

Work-based peer support programmes can help cancer survivors reintegrate into the workforce more effectively, rebuilding confidence, fostering resilience and navigating workplace expectations. Enhanced staff well-being may also positively influence retention, performance and health-related disruptions.

Impact

Findings from this underexplored area of work-based peer support within a healthcare setting have the potential to influence healthcare leaders, policy makers and future research. Improving staff's' quality of life on return to work benefits the individual, the organisation and care delivery by ensuring a healthy, supported workforce.

Reporting Method

The Standards for Reporting Qualitative Research (SRQR) checklist and the Template for Intervention Description and Replication (TiDieR) checklist were utilised.

Patient or Public Contributions

No patient or public contribution.

Beyond Autonomy? Understanding Patient Participation in Contemporary Nursing Care: A Focused Ethnography of Chronic Illness Contexts

ABSTRACT

Aim

To explore how chronically ill patients, family members and nurses perceive and experience patient participation in nursing care within a Chinese hospital context.

Design

Focused ethnography.

Methods

The study was conducted in a Chinese public hospital over 8 months between February and September 2021. Data were generated through 90 h of participant observation and 30 semi-structured interviews, including individual and dyadic interviews with 10 nurses, 17 patients and 7 family members. Data were analysed using reflexive thematic analysis through an inductive and iterative process.

Results

An overarching theme ‘participation as relational, holistic and dynamic’ was developed, comprising three themes: (1) participation as fulfilling individual responsibility, (2) family members as co-participants and (3) participation as an evolving multidimensional practice. These themes suggest that participation was understood as a relational responsibility enacted through everyday interactions. Family members were actively involved in care processes, and participation extended across physical, intellectual and emotional dimensions. Digital information and technologies further reshaped participation, creating new opportunities and tensions in everyday care.

Conclusion

Patient participation in nursing care extends beyond autonomy-based models and is shaped by relational responsibilities, family involvement and evolving digital healthcare contexts.

Implications for the Profession and/or Patient Care

To promote patient participation, policies and practices should recognise relational and family-based dimensions of care. Healthcare organisations should foster environments that support collaborative participation among patients, families and nurses. Training and education should be developed to promote nurses' digital literacy, cultural competence, ethical sensitivity and relational communication to support participation in contemporary care contexts.

Impact

This study broadens prevailing autonomy-centred understandings of patient participation by demonstrating how participation is co-constructed through relational responsibilities and family involvement. The findings offer insights for nursing practice and policy in culturally diverse and increasingly digital healthcare environments.

Reporting Methods

COREQ.

Patient or Public Contribution

No Patient or Public Contribution.

Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial

Por: Huerta · M. · Lopez-Ben · S. · Llado · L. · Sanchez-Cabus · S. · Mils · K. · Molina · V. · Dopazo · C. · Vidal · L. · Dalmau · M. · Caralt · M. · Roson · N. · Merino · X. · Armario · D. · Salcedo · M. T. · Pellino · G. · Sapisochin · G. · Gomez-Gavara · C. · LIVERGREEN Collaborative Grou
Introduction

Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence.

Methods and analysis

This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years.

Ethics and dissemination

The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences.

EudraCT number

2023–5 08 316-27-00.

Trial registration number

NCT06398028.

Protocol version

V.12, 18 March 2025

Burnout, associated factors and coping strategies among nursing professionals in Kerala, India: a cross-sectional study

Por: Ambujam · J. K. · Francis · P. T. · Olickal · J. J. · Sarma · P. S. · Thankappan · K. R.
Objectives

To determine burnout prevalence, associated factors and coping strategies used by nursing professionals.

Design

Cross-sectional analytical study.

Setting

Public and private healthcare institutions in Kerala, India.

Participants

Nursing professionals in Kerala (n=349).

Primary and secondary outcome measures

Burnout levels (assessed with the Burnout Assessment Tool (BAT)) and coping strategies. Log-binomial regression was performed to identify factors associated with burnout.

Results

High burnout was reported by 36.1% of participants (126/349; 95% CI 31.1 to 41.4). Burnout prevalence was higher among nurses with an MSc (Master of Science) or higher educational qualification (adjusted prevalence ratio (APR)=1.46; 95% CI 1.04 to 2.03); those working in urban settings (APR=1.41; 95% CI 1.04 to 1.90); those who were single, divorced or separated (APR=1.58; 95% CI 1.18 to 2.12); those with travel time ≥30 min (APR=1.36; 95% CI 1.03 to 1.79); and those engaged in clinical/direct patient care duties (APR=1.75; 95% CI 1.18 to 2.59). Commonly reported coping strategies included active coping (59.6%), seeking instrumental social support (58.7%) and venting (54.4%), whereas negative strategies, such as substance use, were less frequent (22.9%).

Conclusions

Over one-third of the nurses in our study reported high burnout. Efforts to reduce burnout should focus on nurses with higher qualifications, those working in urban settings, those with higher travel time, those who are single/divorced/separated and those involved in clinical duties to enhance healthcare quality.

Expanding and Accumulating Transformative Potential: The Leadership Trajectories of Graduates of a Doctor of Philosophy in Nursing Education Programme

ABSTRACT

Aims

To describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme in a single university in the Philippines and examine how the doctoral programme influenced these trajectories.

Design

Qualitative design, specifically thematic narrative analysis.

Methods

A total of 10 purposively selected graduates of the programme were interviewed with the aid of videoconferencing and life-calendaring methods.

Results

The emerging central narrative theme is transformative potential. Leadership trajectories are characterised by expanding fields of transformative potential from within to beyond their organisations. Doctoral education shapes these trajectories through curriculum-driven capacity building, beyond-curriculum capacity building and character building.

Conclusion

The evolving leadership trajectories of graduates of the Doctor of Philosophy in Nursing Education programme are characterised by expanding and accumulating transformative potential.

Implications for the Profession

The findings can help nursing academic institutions design and improve postgraduate degrees, which will develop transformational leaders in the profession.

Impact

What problem did the study address?

This study aims to map and describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme.

What were the main findings?

The leadership trajectories of graduates are characterised by expanding and accumulating transformative potential.

Where and on whom will the research have an impact?

The findings can inform the planning, design and evaluation of doctoral nursing degree programmes in higher education institutions, as well as continuing educational programmes for nursing leaders in academic and clinical settings.

Patient or Public Contribution

Initial findings were sent to the graduates of Doctor of Philosophy in Nursing Education programme to validate the qualitative insights as part of member checking.

The Implementation of Advanced Practice Nursing in Primary Health Care: A Comparative Qualitative Study of Enablers and Barriers

ABSTRACT

Aim

To explore the enablers of and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil.

Design

A qualitative cross-country comparative study.

Methods

Nine focus groups were conducted: 4 in Brazil and 5 in Germany with 48 participants (23 primary health care policy stakeholders and 25 nurses practicing in primary health care and general practitioners) between May 2022 and June 2023. The data were analysed by content analysis using a deductive–inductive approach.

Results

Our findings reveal a need for clarity around the concept, specific roles and responsibilities of advanced practice nurses in primary health care. Although there is still no regulation in place for practising advanced practice nursing in either country, clear drivers can be observed, with Germany strengthening community health nursing and Brazil following clinical protocols in nursing practice. Dialogue among stakeholders—at both the policy and practitioner levels—is essential to bridge communication gaps. Additionally, involving patients in the implementation process is crucial for the holistic integration of advanced nursing roles.

Conclusions

Political, organisational and financial barriers persist, such as the need to establish both legal foundations and regulatory frameworks, enhance political participation within the nursing profession, and involve stakeholders in dialogue and consensus-building efforts. Giving advanced practice nursing a higher priority on political and research agendas—with policy adjustments and input from practitioners—can help integrate advanced practice nursing into primary health care.

Implications for the Profession and/or Patient Care

Our findings highlight that actively involving nursing as an equal partner in political discourse is seen by stakeholders as crucial to drive the implementation process forward sustainably.

Impact

This study addresses the lack of data on the enablers and barriers to implementing advanced practice nursing in primary health care in Germany and Brazil. It underscores the need for clearer definitions of advanced practice nursing in primary health care, as well as sufficient regulation and funding. Dialogue is essential to bridge gaps and foster mutual understanding. The findings support future practice development and research, especially in countries that have introduced advanced nursing practice roles in primary health care.

Reporting Method

The COnsolidated criteria for REporting Qualitative research (COREQ).

Patient or Public Contribution

No involvement of patient and public contribution.

What Does This Paper Contribute to the Wider Global Clinical Community?

Our study highlights the growing adoption of expanded nursing responsibilities even in countries that have not yet formally implemented advanced practice nursing roles.

Safe Mobility in Hospitalised Older Adults: A Concept Analysis

ABSTRACT

Aim

To conduct a concept analysis of ‘safe mobility’, with specific application in hospitalised older adults, identifying its defining attributes, antecedents and consequences.

Background

The promotion of safe mobility is essential for maintaining the functionality of hospitalised older adults. However, this idea is not yet clearly defined in the scientific literature, requiring a conceptual analysis for better understanding and applicability in nursing practice.

Design

Concept analysis.

Methods

The concept analysis methodology of Walker and Avant was employed, consisting of eight steps. Sources from the scientific literature (BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Thesis and Dissertation Catalogue, as outlined in a scoping review previously published by the authors) and terminologies from dictionaries and nursing practice, such as SNOMED CT, ICNP, NANDA, NIC and NOC, were analysed.

Results

The concept of ‘safe mobility’ does not have a consolidated definition but was identified through three defining attributes: active movement, prevention of fall-related harm and prevention of immobility-related harm. The antecedents include the older adults' conditions, adaptation of the hospital environment, training of the multidisciplinary team, patient behaviour and family involvement. The consequences involve the maintenance of functionality, improvement of quality of life, reduction of hospital length of stay and costs, as well as a decrease in rates of readmission, referrals to long-term care institutions and mortality.

Conclusion

The concept analysis revealed that safe mobility involves promoting active movement and preventing harm related to both immobility and falls.

Implications for the Profession and Patient Care

Strategies based on this concept can improve the quality of life of older adults, reduce complications and optimise hospital costs.

No Patient or Public Contribution

This concept analysis examines existing literature and does not require patient-related data collection. The methodological approach does not necessitate collaboration with the public.

Prevalence and Determinants of Workplace Violence Against Nurses in the Italian Home Care Settings: A Cross‐Sectional Multicentre Study

ABSTRACT

Aims

To describe the prevalence and determinants of workplace violence against nurses in the Italian home care setting.

Design

Secondary cross-sectional analysis of data from the multicentre study AIDOMUS-IT.

Methods

Nurses employed in home care services provided by Italian Local Health Authorities were interviewed using a variety of instruments. A multivariable binary logistic regression model was performed to model the risk of workplace violence against nurses in the last 12 months. Variables related to violence were selected among sociodemographic characteristics (such as age and gender), work-related factors (including years of experience, team composition, overtime working, previous experience in mental health care, burnout) and organisational elements (including leadership and support, workload, staffing and resources adequacy, and time to reach the patients' homes). Adjusted odds ratios (aOR) were used to present the results.

Results

A total of 3949 nurses participated in the study and 20.49% of them reported to have experienced an episode of violence in the last 12 months. Determinants of higher risk of violence episodes were younger age (aOR = 1.02, p = 0.002), higher workload (aOR = 1.01, p = 0.002), working in a multiprofessional team (aOR = 1.24, p = 0.018), perception of inadequate managerial leadership and support (aOR = 1.38, p = 0.003), and higher burnout levels (aOR = 1.01, p < 0.001).

Conclusion

The prevalence of workplace violence against Italian home care nurses is high. Several modifiable determinants were found to be associated with a higher risk of violence, which can potentially be mitigated with tailored interventions.

Implications for the Profession and/or Patient Care

Effective preventive strategies must be developed to lessen workplace violence against nurses in the home care setting. These strategies should focus on strengthening nursing managers' leadership and support skills, enhancing team-building strategies, avoiding inadequate workload, monitoring nurses' burnout, estimating optimum staffing levels, and assigning advanced-career nurses to home care services. These measures are imperative to guarantee the quality and safety of home care organisations and to attain favourable outcomes in the provision of care.

Impact

This study aimed to explore the prevalence and determinants of workplace violence against nurses in the Italian home care settings. We found that out of the 3949 nurses surveyed, 20% of the sample reported one episode of violence during the last 12 months. Determinants of this violence included younger age, higher workload and burnout, being in a multiprofessional team, and perception of lack of leadership and support by the nurse manager. The results of this study can be used to tailor interventions aimed at mitigating the risk factors of violence, particularly those that can be modified (e.g., workload, burnout, and leadership).

Reporting Method

The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or Public Contribution

No patient or public contribution.

Daytime circadian patterns of exhaled volatile organic compounds in adults without and with type 1 and type 2 diabetes: protocol for an exploratory observational study

Por: Nicolier · C. · Rothenbühler · M. · Balmer · M. L. · Witthauer · L.
Introduction

Circadian regulation modulates metabolic and hormonal processes throughout the day, yet it remains unclear whether these diurnal fluctuations are reflected in exhaled volatile organic compound (VOC) profiles and whether such temporal patterns differ between individuals with and without diabetes. Previous breath analysis studies in diabetes have shown heterogeneous results, which may reflect differences in analytical approaches and the lack of standardised sampling times.

Methods and analysis

This prospective, single-centre observational study examines daytime VOC dynamics from 08:00 to 16:00 among adults without diabetes, and individuals with type 1 diabetes or type 2 diabetes. 60 participants will complete one in-person visit with repeated breath measurements using a BreathSpec® gas chromatography–ion mobility spectrometry system (GC-IMS) device, capillary glucose testing, body composition assessment, questionnaires, and oral and stool microbiota sampling. A standardised breakfast is provided; subsequent meals follow structured timing but are not standardised. The primary outcome is temporal variation in VOC intensities. Secondary outcomes include between-group differences and associations with glucose levels, body composition and microbiota composition. Analyses will use established GC–IMS tools and exploratory multivariate approaches.

Ethics and dissemination

Ethics approval was granted by the Ethics Committee of the Canton of Bern (BASEC 2023-01143). Results will be shared via peer-reviewed publications, conferences and lay summaries.

Trial registration number

NCT05984979.

Pelvic floor exercise: Awareness, knowledge, beliefs and practices among pregnant women in a Ghanaian setting

by Yaa Abrafi Ankomah, Bright Anneh Awaitey, Moses Monday Omoniyi, Benjamin Asamoah, Obed Kwame Numadzi, Kwofie Robert Amoah, Joel Innocent Goli

Background

Pregnancy and childbirth increase the risk of pelvic floor muscle damage, leading to conditions such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This makes it imperative to adopt strategies such as pelvic floor muscle exercises (PFMEs) to ensure positive antenatal and postnatal experiences for women. Hence, the study aimed to assess the awareness, knowledge, practices, and beliefs of PFMEs among pregnant women in a Ghanaian setting.

Objective

We assessed the awareness, knowledge, practices and beliefs of PFMEs among pregnant women in a Ghanaian setting.

Design

A cross-sectional descriptive research was conducted, recruiting 134 pregnant women through convenient sampling in selected antenatal clinics in Kumasi metropolis, Ashanti Region.

Methods

The study adopted the questionnaire regarding pelvic floor muscle training among pregnant women used by Teerayut Temtanakitpaisan, Suvit Bunyavejchevin, Pranom Buppasiri and Chompilas Chongsomcha. Data on the socio-demographic characteristics of the women, their awareness, knowledge, beliefs and practices about PFMEs were recorded.

Results

More than half (64.9%) of the respondents were not aware of PFMEs. Subsequent analysis for this work was therefore done for participants who reported being aware (35.1%). Also, the principal sources of information from which the subjects acquired the knowledge of PFME were health-care providers (42.6%) and media outside the hospital (36.2%). With reference to beliefs 80.3% believed that PFME could reduce vaginal trauma and 83.0% believe PFME aids vaginal birth. In terms of PFME practice, 36.2% of the aware women performed PFME regularly.

Conclusion

To ensure pregnant women are well-informed about PFMEs, physiotherapists should work with antenatal care providers to develop comprehensive courses that include detailed information on PFME’s.

The Italian Organizational Culture and Readiness Scale for System‐Wide Integration of EBP (OCRSIEP) Scale: Psychometric Adaptation of an Existing Scale

ABSTRACT

Background

Organizational culture and readiness are critical determinants of evidence-based practice (EBP) implementation. The Organizational Culture and Readiness Scale for System-Wide Integration of EBP (OCRSIEP), developed within the ARCC framework, is a validated tool to assess these dimensions, but no Italian version currently exists.

Aim

To translate, culturally adapt, and psychometrically validate the OCRSIEP and its short form in Italian.

Methods

A validation study was conducted, using exploratory and confirmatory factor analyses to derive and test the underlying model, followed by reliability testing with multiple indices and measurement invariance analyses.

Results

Data were collected from 405 Italian nurses. Factor analyses supported a 19-item, six-factor structure explaining 59.5% of the variance, with a second-order factor indicating an overarching construct. The three-item short form showed strong model fit and explained 67% of the variance. Subscales demonstrated acceptable-to-excellent reliability, and partial scalar invariance was established across public and private facilities.

Linking Evidence to Action

The Italian OCRSIEP scales are valid and reliable tools to assess organizational readiness for EBP implementation. They can guide leaders, educators, and researchers in monitoring, benchmarking, and advancing EBP–oriented system transformation within the Italian healthcare context.

Development and acceptability of a patient decision aid for people with degenerative cervical myelopathy: an international mixed-methods study

Por: Gamble · A. R. · Anderson · D. B. · McKay · M. J. · Davies · B. · Macpherson · S. · Van Gelder · J. · Hoffmann · T. · McCaffery · K. · Stevens · S. X. · Ammendolia · C. · Chauhan · R. V. · Zipser · C. M. · Boerger · T. F. · Tetreault · L. A. · Fehlings · M. G. · Dustan · E. · Nugent · C
Objectives

To develop and user-test a patient decision aid for people diagnosed with degenerative cervical myelopathy and who are considering surgery.

Design

Mixed-methods study describing the development of a patient decision aid.

Setting

A draft decision aid was developed by a multidisciplinary steering group (including study authors with degenerative cervical myelopathy, health professionals and researchers) informed by the best available evidence, authorship consensus and existing patient decision aids.

Participants

Patient-participants and health professional-participants who manage people with degenerative cervical myelopathy were recruited through social media and the steering group’s research and practice network. Quantitative questionnaires were used to gather baseline data, descriptive feedback, refine the decision aid and assess its acceptability. Qualitative semi-structured interviews were conducted online to gather feedback on the decision aid and were analysed using reflexive thematic analysis.

Results

We conducted 32 interviews: 19 patient-participants and 13 health professional-participants who manage people with degenerative cervical myelopathy (neurosurgeons, neurologists, physiotherapists, orthopaedic surgeons, general practitioners, rehabilitation and pain specialists and consultant occupational physicians and chiropractors). Participants were from 10 countries (Australia, Canada, Cyprus, Germany, Ireland, New Zealand, Sweden, Switzerland, United Kingdom and USA). Most participants rated the decision aid’s acceptability as good-to-excellent and agreed with most aspects of the decision aid (eg, defining degenerative cervical myelopathy, management recommendations, potential benefits and harms, questions to consider asking a health professional).

Conclusion

Our patient decision aid was rated as an acceptable tool by both health professional-participants who treat degenerative cervical myelopathy and patient-participants with lived experience of degenerative cervical myelopathy. This decision aid can be used by clinicians and people with degenerative cervical myelopathy to help with shared decision making following a diagnosis of degenerative cervical myelopathy. A study testing the potential benefits of this decision aid in a clinical setting is recommended.

Factors Influencing Intention to Leave Among Nurse Managers: A Cross‐Sectional Study

ABSTRACT

Aims

To estimate the proportion of Italian nurse managers (NMs) intending to leave (ITL) their positions and to identify associated socio-demographic, job-related, and psychosocial factors.

Design

Cross-sectional study.

Methods

Between September and November 2023, 464 NMs from 19 public hospitals completed a case-report form and the short version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II). Latent Class Analysis (LCA) identified ITL profiles, and multiple logistic regression assessed factors associated with ITL.

Results

284 NMs (61.2%; 95% CI 57–66) reported an intention to leave within 12 months. LCA identified two classes: (1) Low-ITL (54%)—mainly outpatient NMs from Central regions with strong relationships with management, good support, work–life balance, and autonomy (55.9% probability of being unlikely to leave). (2) High-ITL (46%)—mainly surgical or critical-care NMs, often from Northern regions, marked by poor management relations, low support and high work–family conflict (80.9% probability of being likely to leave). Multiple regression confirmed that stronger management relations reduced ITL (OR 0.60, 95% CI 0.46–0.79) whereas high job demands and work–health conflict increased it (OR 1.56, 95% CI 1.19–2.04). Northern location also predicted higher ITL (OR 1.58, 95% CI 1.03–2.44). Demographics, education, and clinical setting were not significantly associated.

Linking Evidence to Action

These findings suggest that healthcare organizations should prioritize managerial and organizational strategies targeting modifiable work-related factors to reduce nurse managers' intention to leave. Interventions aimed at improving organizational support, work environment, and job satisfaction may contribute to workforce retention at the managerial level. Future research should evaluate the effectiveness of targeted organizational interventions in sustaining nurse manager retention.

Transforming Hospital Care: Impact of an Evidence‐Based Practice Course on Healthcare Professionals' Competencies in a Randomized Clinical Trial

ABSTRACT

Introduction

Evidence-Based Practice (EBP) is essential to healthcare quality and safety, integrating scientific evidence with clinical expertise and patient preferences. Despite its importance, EBP implementation still faces major challenges. Educational interventions have proven effective in strengthening EBP competencies among healthcare.

Main

To evaluate the impact of a personalized educational intervention on EBP competencies among healthcare professionals. Working at a private tertiary general hospital, comparing performance before and after the intervention.

Methods

A randomized controlled trial involving healthcare professionals was conducted. Eligible and consented participants were randomly assigned to either an Intervention Group (IG) receiving an Evidence-Based Practice (EBP) course or a Control Group (CG) not receiving the course, stratified by job level, role, and work shift. From the completers, 18 participants were randomly selected for the IG, and all 7 available CG participants were included in the final sample for analysis. All study participants completed two validated instruments: the Assessing Competencies in Evidence-Based Medicine (ACE) and the Fresno Test. The educational intervention consisted of a seven-week course with weekly three-hour sessions, for a total of 21 h. Comparative analyses were conducted using a Linear Mixed Model, adjusted for educational level, job level, time working at the hospital, and weekly workload.

Results

A statistically significant increase in general EBP knowledge was observed in the IG following the intervention, with a mean gain of 19.1%. Separate analysis showed improvements of 10.8% in ACE and 24.2% in Fresno Test scores. No statistically significant changes were observed in the CG. Furthermore, after the intervention, the IG outperformed the CG for both general EBP knowledge and Fresno Test scores on both pre- and post-intervention comparisons.

Conclusion

The educational intervention had a positive statistically significant impact on EBP knowledge and skills among healthcare professionals in the IG compared to the CG. These findings underscore the potential of structured educational initiatives to enhance the quality of clinical practice through improved EBP competencies.

Trial Registration

UTN U1111-1322-8443

Recommendations for Arterial Blood Gas Collection in Intensive Care: Scoping Review

ABSTRACT

Objectives

To map and synthesise the main recommendations for arterial blood gas (ABG) collection in intensive care units (ICUs).

Design

A scoping review was conducted according to the PRISMA-ScR Checklist, supported with The PAGER framework and guided by the Joanna Briggs Institute methodology to ensure methodological rigour and analytical comprehensiveness.

Methods

Data collection was conducted from February to April 2024. The data sources included: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PubMed Central, Scientific Electronic Library Online (SciELO), Web of Science (WoS), SCOPUS, Science Direct, Virtual Health Library (VHL), Excerpta Medica database (Embase), CAPES Thesis and Dissertation Catalogue, Brazilian Digital Library of Theses and Dissertations (BDTD), Scientific Open Access Repository of Portugal (RCAAP), Theses Canada and the Oswaldo Cruz Foundation (Fiocruz) repository.

Results

Key findings recommend the radial artery as the preferred puncture site, an insertion angle of 30° to 45°, the use of 1 or 3 mL syringes and 20G or 23G gauge needles. Transport and storage at room temperature are advised. Cryoanalgesia and subcutaneous analgesia methods were found to be effective for pain management.

Conclusion

The review highlights the best practices for arterial blood gas collection in critical care. The synthesized evidence strengthens clinical practice, informs guidelines for intensive care nursing and promotes safer, higher-quality care for critically ill patients.

Implications for the Profession and/or Patient Care

The evidence-based recommendations identified can enhance nursing care related to arterial blood gas collection. Adherence to these practices promotes safer, more humanised and evidence-based care during the procedure.

Reporting Method

The report of this study followed the PRISMA-ScR Checklist.

Patient or Public Contribution

There was no patient or public involvement in this scoping review.

Spiritual care challenges and needs of carers, health professionals and relatives of individuals living with neurodegenerative diseases in palliative and end-of-life care: a scoping review protocol

Por: De Luca · E. · Saba · A. · Bertarini · L. · Brusini · A. · Artioli · G. · Dellafiore · F.
Introduction

Spirituality has gained increasing attention in healthcare, particularly in palliative care, as it supports meaning, purpose and connection during illness. While literature extensively explores patients’ spiritual needs, growing evidence highlights the importance of addressing the spiritual needs of caregivers and healthcare professionals. Caregivers and relatives often face emotional, ethical and practical challenges during prolonged care pathways, impacting their well-being. Limited training and tools can hinder spiritual care, contributing to distress and burnout among professionals and unmet needs for families. Addressing spirituality in neurodegenerative disease palliative care is essential for holistic, person-centred approaches that foster coping, hope and ethical decision-making. This scoping review aims to map evidence on spiritual needs and challenges of caregivers, relatives and healthcare staff in end-stage neurodegenerative disease care.

Methods and analysis

This review will follow the Joanna Briggs Institute framework (JBI) for scoping reviews. The search and reporting process will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. Inclusion criteria followed JBI’s population, concept and context framework with no date or geographical limits; only English and Italian sources ensured accurate interpretation. Searches will use university-access databases and grey literature to capture policy and non-peer-reviewed sources. Databases selected: PubMed, CINAHL, APA PsycINFO and Scopus for comprehensive, multidisciplinary coverage. This inclusive approach is aligned with the purpose of scoping reviews, which aim to map the breadth and depth of available literature. Researchers independently screened titles/abstracts in Rayyan software with blinding, resolved discrepancies collaboratively, piloted and refined extraction tables, and jointly synthesised themes through iterative meetings to ensure rigour and consensus. Findings will highlight existing knowledge, identify gaps and inform future research and practice.

Ethics and dissemination

Since secondary data will be analysed, no ethical approval is required. The results will be disseminated through publications subject to peer review. The protocol has been registered with the Open Science Framework https://doi.org/10.17605/OSF.IO/X9275

Primary cilia in osteoblasts and osteocytes are required for skeletal development and mechano-adaptation

by Mariana Moraes de Lima Perini, Alyssa F. Fayemi, Julie N. Pugh, Elizabeth M. Scott, Karan Bhula, Austin Chirgwin, Olivia N. White, Nicolas F. Berbari, Jiliang Li

Primary cilia play a crucial role in the development and mechanosensation of various tissue types, including bone. In this study, we investigated their role in bone growth and adaptation by targeting two cilia specific genes, IFT88 and MKS5. Conditional knockout (cKO) of IFT88 in osteoblasts significantly reduced body weight and femur length in mice compared to the littermate controls. Additionally, female IFT88 cKO mice exhibited a significant suppression of bone formation rate compared to the littermate controls. To further explore the role of primary cilia in osteocytes, osteocytes specific MKS5 cKO mice underwent axial ulnar loading at a peak force of 2.9N for females and 3.2N for males with 120 cycles per day for three consecutive days. Load induced bone formation rate was significantly decreased by 48% in males and 42% in females compared to the littermate control mice. These findings underscore the critical role of primary cilia in bone development and mechano-adaptation. They suggest that functional primary cilia in osteoblasts are essential for skeletal development, while those in osteocytes mediates mechanically induced bone formation, highlighting its potential as therapeutic targets for bone loss prevention.

Accelerating diagnosis of degenerative cervical myelopathy through improved education: a mixed-methods study protocol from Myelopathy.org RECODE-DCM to define stakeholders, knowledge requirements and an optimal intervention strategy

Por: Veremu · M. · Deakin · N. · Chauhan · R. V. · Lantz · J. M. · Toumbas · G. · Tabrah · J. · Kumar · V. · Zipser · C. M. · Plener · J. · Ammendolia · C. · Anderson · D. B. · dos Santos Rubio · E. J. · Tetreault · L. · Parnaik · R. · Rodrigues-Pinto · R. · Ongwen · O. M. · Sarewitz · E. · S
Introduction

Outcomes for degenerative cervical myelopathy (DCM) patients are limited by delayed and missed diagnoses, driven in part by poor professional awareness. Despite DCM being the most common cause of adult spinal cord injury, it remains under-recognised and undertaught in clinical education. Lessons from other common pathology like stroke and acute myocardial infarction highlight the potential of education to improve early diagnosis. This study will develop a professional education strategy to improve early DCM diagnosis. It will define key audiences and identify an effective delivery method, laying the groundwork for a sustained, targeted intervention.

Methods and analysis

The study aims to define who needs to know about DCM, what they need to know and how they can learn it. This will be carried out in three phases: phase 1—who and what: to establish the target population and to define core competencies for the educational intervention; phase 2—how: to create and review the educational intervention; phase 3—evaluation: to test whether the framework is an improvement to existing strategies.

Ethics and dissemination

Ethical approval is in place from the University of Cambridge (HBREC.2024.24). Results from the study will be disseminated through scientific publication, conference presentation, blog posts and podcasts.

PROSPERO registration number

CRD42023461838

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