Conectar
To explore existing qualitative research on patients’ experiences from the onset of symptoms to the diagnosis of sarcoma, with the purpose of identifying patient-perceived barriers at both patient and healthcare system levels and to highlight opportunities for improvement.
Systematic review of qualitative studies using thematic synthesis.
We systematically searched Medline [Ovid], Embase [Ovid], PsycINFO [EBSCOhost] and CINAHL [EBSCOhost] from database inception to 11 April 2025 for qualitative studies reporting sarcoma patients’ experiences during their diagnostic trajectory. The final search was conducted on 11 April 2025. All articles were screened against predefined inclusion and exclusion criteria and methodological quality was appraised using the Critical Appraisal Skills Programme qualitative checklist. Six studies conducted in Australia, the Netherlands and the UK were included. Data were analysed using a thematic synthesis approach guided by Thomas and Harden (2008). Confidence in the synthesised findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERqual) approach.
Four overarching themes emerged: patients’ experience and interpretation of symptoms, diagnostic pathways, healthcare system factors, and reflections and recommendations. Key contributors to delayed diagnosis were symptom normalisation, misattribution by both patients and healthcare professionals, limited continuity of care and communication challenges. These findings were consistent across multiple countries, indicating relevance and validity in many settings. Patients emphasised the importance of disease awareness, persistence of patients and coordinated care.
Diagnostic delays in sarcoma are influenced by both patient and healthcare systemic factors. Addressing these factors requires increased disease awareness among healthcare professionals and the public, improved coordination within the healthcare system, and targeted research to guide future interventions. This review provides cross-country insights into barriers to early sarcoma diagnosis, informing future priorities in clinical practice and research.
CRD420251030726.
To justify the use of focus group interviews with patients and healthcare professionals within a phenomenological-hermeneutic approach inspired by the theory of the French philosopher Paul Gustave Ricoeur.
Methodological guidance and discussion grounded in Ricoeur's theory on narrative, dialogue, threefold mimesis and interpretation.
This phenomenological-hermeneutical approach to focus group interviews yields significant, in-depth understandings of lived experiences from both patients and healthcare professionals.
Ricoeur-inspired phenomenological-hermeneutical focus group interviews with patients and healthcare professionals offer a promising approach for exploring and generating new, valuable insights into the complexities of clinical nursing practice. Thus, this paper argues for an integration of focus group interviews and a phenomenological-hermeneutical approach within nursing science.
The approach has significant implications for nursing practice. By incorporating Ricoeur-inspired dialogue-based collective voices of patients and healthcare professionals in focus group interviews, nursing practices can be refined, leading to improved patient care and more effective clinical interventions. Thus, this approach advocates for a broader adoption of Ricoeur-inspired focus group interviews in nursing research and in health research in general to enhance the understanding and development of clinical models.
No available EQUATOR guidelines were applicable to this methodological paper, as no new data were created or analysed.
As this is a methodological paper, no new patient or public contributions are included.
To explore the experiences of nurses transitioning from a clinical ward to a newly established respiratory intermediate care unit (IMCU).
A qualitative descriptive approach was adopted to capture the lived experiences of redeployed nurses. This design was selected to address the research question: What are the initial experiences of nurses transitioning from general ward settings to a newly established IMCU for respiratory patients?
Two focus groups were conducted in June 2024, involving 14 purposefully selected registered nurses. Data were analysed using Braun and Clarke's thematic analysis framework, with the study reported in line with the Standards for Reporting Qualitative Research.
The analysis revealed two interconnected themes reflecting the complexity of the redeployment experience. The first theme, ‘The introspection of waiting amidst change and readiness’, captures the emotional ambivalence nurses felt, characterised by anticipation, uncertainty and a perceived lack of preparedness. This phase was marked by concerns over clinical competence, fear of errors and the weight of new legal and ethical responsibilities. The second theme, ‘The road to organizational change with both driving forces and obstacles’, highlights nurses' concerns about physician readiness, feeling undervalued and limited involvement in planning. At the same time, nurses emphasised the importance of teamwork, structured preparation, experiential training and having the right equipment.
The study underscores the complexity of role transitions for nurses moving into semi-critical care settings like IMCUs. It reveals the need for targeted support strategies to reduce uncertainty and enhance role readiness.
To improve the redeployment experience and patient outcomes, healthcare organisations should prioritise structured training, tailored preceptorship programmes and inclusive decision-making processes. These measures can strengthen nurses' resilience, support workforce sustainability and ensure the delivery of high-quality, patient-centred care in intermediate care environments.
This study highlights the significant impact of inadequate preparation and communication on redeployed nurses' experiences in respiratory IMCUs, emphasising the need for structured training and supportive team dynamics. These findings can guide healthcare leaders, nurse managers and policymakers in developing evidence-based redeployment strategies that reduce anxiety, strengthen team cohesion and ultimately improve nurse adaptation and patient care in semi-critical settings.
We used the SRQR guidelines for reporting qualitative studies.
No patient or public contribution.
Autism spectrum disorder (ASD) is one of the most prevalent neurodevelopmental disorders (NDDs) and is frequently associated with psychiatric and somatic comorbidities. As a result, individuals with ASD use emergency departments more frequently than the general population. However, the core features of ASD pose specific challenges in emergency department care, particularly for adult patients and emergency staff frequently report limited training in this area. While paediatric presentations of ASD in the emergency department are well documented, the international literature on adults remains limited.
we conducted a single-centre retrospective study including all patients aged 15 years and older with a diagnosis of ASD who attended the Centre Psychiatrique d'Orientation et d'Accueil (CPOA), GHU Paris (Groupe Hospitalo-Universitaire) between 12 January 2016 and 31 December 2023. The objectives were to estimate the prevalence of ASD in this psychiatric emergency setting and to describe the patients’ socio-demographic and clinical characteristics, mode of arrival, reasons for consultation and referral following the emergency visit.
Among 69 447 patients who attended the CPOA during this period, 484 (0.7%) had a diagnosis of ASD. This population was predominantly male (71.9%), with a mean age of 25.1 years. The most frequent reasons for consultation were hetero-aggressive behaviour (37.0%) and anxiety (31.0%). Overall, 39.2% of patients were hospitalised, including 17.3% involuntarily, and 6.2% required physical restraint. The number of consultations involving patients with ASD increased significantly between 2016–2023.
This study provides a clearer understanding of the clinical and organisational challenges associated with the management of adult patients with ASD in psychiatric emergency departments. Although this study was descriptive and did not assess specific interventions, the observed patterns, in line with previous literature, suggest that adopted care strategies may help better address the needs of this population.
The involvement of older adults as active partners in research is increasingly being promoted to improve the relevance and impact of scientific knowledge. However, the evidence base on how older adults have been involved as active partners in healthcare research remains fragmented. To our knowledge, no review of reviews has yet provided a comprehensive overview of this body of evidence. Therefore, this umbrella review aims to synthesise review-level evidence on the involvement of older adults as active research partners. We address three questions: (1) How have older adults been involved as active partners in research? (2) What terminology, models and frameworks have been used? (3) What benefits and challenges have been reported related to involving older adults as active partners in research?
This study will follow the Joanna Briggs Institute (JBI) methodology for umbrella reviews. A comprehensive search will be conducted in Medline, CINAHL, Scopus, PsycINFO, Sociological Abstracts and Web of Science. Eligible reviews will be those reporting on the involvement of older adults (aged 60 years or older) as active partners in research. Two reviewers will independently screen titles, abstracts and full texts and perform data extraction using a standardised form. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Systematic Reviews. Findings will be synthesised narratively and thematically, with attention to reported roles, terminology, conceptual frameworks and the benefits and challenges of involvement.
As this umbrella review draws exclusively on secondary data from published sources, ethical approval is not required. Older adults, engaged as independent public contributors, have been involved in shaping the review protocol and will take part in interpreting the findings. Results will be disseminated through a peer-reviewed journal and presentations at academic and stakeholder conferences, and used to inform the design of a subsequent mixed-methods study focused on strengthening the involvement of older adults as active partners in research.
CRD420251064947.
The aim of this paper is twofold: (1) to introduce a phenomenological-hermeneutic approach and discuss its application within the context of WSs in the field of health science, (2) To present a method and a practical guide when conducting WSs in the field of health science.
Epistemological and methodological discussions based on workshops as a self-standing research method.
The epistemological and methodological discussions show that workshops conducted in health science are a self-standing research methods and align with a phenomenological-hermeneutical approach. Examples of research studies within this framework are provided to illustrate how workshops can be conducted in health science within this epistemological approach.
The phenomenological-hermeneutical approach embraces workshops as a research method as it includes individual experiences through self-reflection and shared contributions through interpretation. Furthermore, a systematic approach with regard to planning, conduction, data collection, and data analysis leads to reliable findings, enhancing the transparency of the research method and thus creating scientific knowledge. This paper argues that the systematic approach of “the how” to conduct workshops with “the why” enhances the transparency and trustworthiness of the research.
Workshops are a way to involve and engage users in co-design processes that aim to develop solutions in clinical practice. User involvement has become an important part in academia and is essential in all aspects of the research process. However, we need solid systematic methods to create valid knowledge. Workshops are a self-standing research method, and a phenomenological-hermeneutical approach allows for an understanding of the phenomena as they unfold, emphasising subjective perceptions and meanings, which will finally lead to the development of a suitable solution for clinical practice.
This paper contributes theoretical knowledge about the use of workshops as a research method. It combines “the how” to conduct a workshop with “the why” and highlights the relevance of a phenomenological-hermeneutical approach. The main argument is that workshops are a self-standing research method; hence, this paper adds value in the academic field as it provides a scientific framework. The paper presents a method and a practical guide for researchers who plan to conduct workshops in the field of health science.
No available EQUATOR guidelines were applicable to this methodological paper because no new data was created or analysed.
This is a methodological paper, and thus, there was no direct patient or public involvement.
To co-design a nurse-led family support intervention for patients with cancer and their family members.
An intervention co-design process.
The Experience-Based Co-Design method was conducted in a hospital in northern Spain from January 2024 to February 2025 with nurses, patients and family members, following The Point of Care Foundation's eight steps: observations, individual interviews, editing the trigger film, feedback events, co-design and validation events and celebration event.
Four themes emerged from the integrated dataset. (1) Cancer: a family affair, (2) Needs of patients with cancer and their families, (3) The importance of establishing a trust-based nurse-family relationship and (4) Barriers and facilitators for a family-oriented approach in care. These findings informed feedback events where stakeholders identified critical intervention areas, including family support, illness communication, emotional expression and the importance of trust. Based on these results, the Family CARE-ON intervention was structured around three core components: Engaging, Supporting and Empowering.
This study highlights the value of the Experience-Based Co-Design methodology, with active engagement from stakeholders, to develop a family support intervention in oncology care. Further research is needed to evaluate the feasibility and effectiveness, as well as to explore the implementation and scalability of the intervention in oncological settings.
Co-designing a family support intervention together with stakeholders ensures alignment with their needs and expectations, while also fostering the feasibility of the intervention in clinical practice.
The results show how stakeholders co-designed a family support intervention, drawing from their own experiences and perspectives on the impact of cancer on the family.
Guidance for reporting intervention development studies in health research (GUIDED) and Template for Intervention Description and Replication (TIDieR).
Nurses, patients and family members were involved in designing the family support intervention.
To map the scope of nursing work and models of service delivery in Australian primary and secondary schools for children aged 3–18 years.
Scoping Review.
A search of CINAHL, Medline, PsycINFO, ERIC, Informit and Google was conducted in August 2024 for peer reviewed, non-peer reviewed and grey literature giving insight into nursing work in primary and secondary Australian schools in urban, regional and remote areas of all Australian states and territories.
The review employed Johanna Briggs Institute methodology for scoping reviews and reported the findings in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
One hundred and forty-two sources were included. Findings indicate that nurses working in Australian schools conduct a wide range of activities which vary by jurisdiction, education sector, employer and school type. Models of nursing service delivery are similarly varied and range from full-time school-based nurses to nurses who visit schools on an occasional basis.
The varied scope of nursing work and models of service delivery provide evidence that the nursing workforce in schools is adaptable and flexible, but unequal access to nursing services raises important questions about equity. There is an urgent need for a national approach to nursing work in Australian schools.
This is the first review to map the scope of nursing work and models of service delivery in Australian primary and secondary schools.
An alarmingly low number of children meet public health guidelines for physical activity and dietary behaviours and, therefore, are at increased risk of developing lifestyle-related diseases. This paper describes the protocol of the B-Challenged project, which aims to co-create systemic actions to promote active outdoor play and healthy dietary behaviours before, during or after their outdoor play together with children themselves.
In five European countries, child-centred Participatory Action Research (PAR)—combined with systems dynamics methods—was conducted with 15–20 child co-researchers (aged 9–12 years) and 15–20 adult actors (eg, youth workers, local policy makers). In the first phase, the main drivers of children’s active outdoor play and related dietary behaviours were mapped by (1) analysing existing cohort data, and (2) conducting child-centred PAR. In the second phase, systemic actions targeting the local physical and social environments will be co-created and implemented by child co-researchers and adult actors to promote children’s active outdoor play and related healthy dietary behaviours. A mixed-methods design will be used to evaluate (1) if actions positively contributed to systems change and 6- to 12-year-olds’ outdoor play and related dietary behaviours (140 children per country); (2) the process of conducting multi-actor, child-centred PAR and implementing the co-created actions and (3) if the child-centred PAR positively contributed to child co-researchers’ feelings of empowerment.
Ethics approval for the mapping phase was obtained and approval for implementation and evaluation will be obtained from the five local research institutions. Participating children, one of their parents/caregivers and adult actors had given informed consent before participating in the project. Throughout the project, child-friendly methods, materials and language will be applied, and ethical challenges and potential solutions will be discussed. Project results will be disseminated locally and internationally through various channels and activities among the scientific community, professionals—for example, in health and policy making, children and other citizens.
by Malik Hamrouni, Ayushman Gupta, Sophie Middleton, Sabrina Prosper, Theresa Harvey-Dunstan, Joanne Porte, Tricia M. McKeever, Ian P. Hall, Charlotte E. Bolton
AimsTo characterise symptoms, function and patient-reported outcome measures (PROMs), and identify associated factors in adults with persisting respiratory symptoms post-COVID.
MethodsCross-sectional analysis of 210 non-hospitalised adults referred to a post-COVID respiratory clinic (December 2020-July 2024) who consented to research. Assessments included demographics, symptoms, lung function, chest CT, and several PROMs: MRC dyspnoea score, Nijmegen Questionnaire score (NQ), Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, Short Physical Performance Battery (SPPB) and Fried Frailty Index. Multivariate logistic regression examined key exposure-outcome associations.
ResultsAmong participants (mean age 49.4 years; 68% female; median 13.3 months since COVID-19 diagnosis), 95% reported shortness of breath, 54% had clinically significant breathlessness (MRC ≥ 3), 68% had an NQ score (>23) consistent with dysregulated breathing, 32% had a low SPPB score ( Conclusion
In non-hospitalised patients with persistent respiratory symptoms post-COVID, dysregulated breathing, deconditioning and psychological distress were key factors linked with symptom burden. These findings suggest a multidisciplinary approach should be considered to optimise recovery.
Adnexal torsion is a gynaecological emergency in which prompt diagnosis and management are critical to preserving ovarian function. However, the clinical presentation is often non-specific, and diagnosis primarily relies on pelvic ultrasound, a modality with limited sensitivity that can lead to misdiagnosis and unnecessary surgery. Contrast-enhanced ultrasound (CEUS) has emerged as a promising imaging technique that may enhance diagnostic accuracy by better characterising adnexal vascularisation.
The aim of this study is to assess whether the addition of CEUS to standard diagnostic procedures can reduce the rate of unnecessary emergency surgeries. Specifically, we compare two diagnostic strategies in cases of high clinical suspicion of adnexal torsion: the current standard approach versus an experimental strategy incorporating CEUS. The primary outcome is the rate of inappropriate surgical interventions, defined as emergency surgery performed within 6 hours without intraoperative confirmation of torsion.
This is a prospective, open-label, multicentre, randomised (1:1), controlled, superiority trial. A total of 256 women presenting with a high clinical suspicion of adnexal torsion will be enrolled over a period of 36 months. Participants will be randomly assigned to either the standard diagnostic strategy or an experimental strategy that includes CEUS. The primary endpoint is the proportion of emergency surgical procedures (performed within 6 hours of hospital admission) in which adnexal torsion is not confirmed.
The study was approved by the French Ethics Committee, the CPP (Comité de Protection des Personnes) on 28 October 2024. The results of this study will be published in peer-reviewed journals and presented at relevant national and international conferences. The ethical approval number from the CPP is 6115.
NCT06677554; 2024-511720-13-00.
by Jeanette Alcaraz, Charlotte Keyse, Charles Hall, David W. Walker, David P. Doupé, Rebecca I. Clark
Inflammaging is considered a driver of age-associated pathology across tissues. Similarly, intestinal permeability is a feature of ageing and underlies a range of inflammatory and age-related diseases. Increased intestinal permeability has been described as both a cause and a consequence of inflammation. Both intestinal permeability and inflammation are closely associated with microbial dysbiosis, epithelial dysplasia and mortality but dissecting the complex interplay between these phenotypes remains challenging. Here we genetically induce intestinal immune activation in Drosophila and stratify animals by their intestinal barrier status using the Smurf assay. We demonstrate that intestinal barrier failure has a distinct impact on the microbiota. Further, immune activation, both within the intestine and systemically, drives intestinal barrier failure and mortality even in the absence of the microbiota. Importantly, immune-induced intestinal barrier failure takes time to develop and is closely associated with the onset of mortality. Our work adds to building evidence that the impact of intestinal permeability on the microbiota and on animal health needs to be considered independently of its relationship with inflammation.Cutaneous T cell lymphoma (CTCL) is a group of non-Hodgkin lymphomas that primarily affects the skin and can mimic inflammatory dermatoses. Unlike many skin diseases, CTCL can lead to disabling symptoms, and advanced CTCL can even be fatal. Early studies investigating health-related quality of life (HRQOL) in patients with mycosis fungoides (MF) and Sézary syndrome (SS), common subtypes of CTCL, demonstrated significant impairment across numerous domains. The aim of this current study is to develop a core domain set (CDS) to identify the essential aspects of MF/SS that influence HRQOL that should be measured in therapeutic clinical trials. In the future, this set of core concepts will be used to identify the best patient- reported outcome measure(s) (PROM) for HRQOL for MF/SS clinical research.
Multiple strategies will be used to generate candidate concepts: systematic review of the literature, qualitative study and a survey study of healthcare providers. A Delphi consensus process including a comprehensive group of stakeholders (patients, caregivers/care partners, a multidisciplinary group of healthcare professionals, patient advocacy groups, pharmaceutical industry representatives, methodologists and government agencies) will be used to achieve consensus. Statistical corrections for multiple significance testing and false positive findings will be undertaken.
The study was submitted for and received institutional review board approval at the University of Washington (IRB# STUDY00018890 and STUDY00019407). Informed consent will be obtained from all participants where necessary. We will disseminate our findings through peer-reviewed, open access publications and presentations at national/international conferences. We will provide a plain language summary in lay terms for patients and families to patient advocacy groups for distribution to their network.
The protocol is registered in the Core Outcome Measures in Effectiveness Trials (COMET) database.
At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother–infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings.
To identify factors associated with antenatal depression, anxiety, and maternal–fetal bonding among at-risk mothers.
This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal–fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding.
Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = −0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = −0.09, p = 0.06). Younger mothers (β = −2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = −1.44, p = 0.02). Model fit ranged from 0.14 to 0.65.
Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes.
(1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care.
(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal–infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers.
STROBE reporting checklist.
No patient or public contribution.
by Taylor E. Gin, Charlotte O. Moore, Trey Tomlinson, Grace Wilson, Amiah Gray, Cameron Sutherland, Kamilyah Miller, Krista Li, Michael Canfield, Brian Herrin, Erin Lashnits, Benjamin Callahan
BackgroundCtenocephalides felis is a common ectoparasite of dogs and cats and can transmit a variety of pathogens including Bartonella and Rickettsia species. These bacteria, along with the known endosymbiont Wolbachia, are well-documented members of the C. felis microbiome, but species-level information is limited. Additionally, little is known about the variation in the C. felis microbiome in fleas from different sources and when different sequencing methods are applied to the same samples.
ObjectiveThis study aimed to characterize the flea microbiome using both short-read (V3/V4) and long-read (full-length) 16S rRNA gene sequencing, determine whether long-read sequencing improves species-level identification especially in known pathogenic genera, and evaluate differences in microbial composition between fleas collected from cats, dogs, and environmental traps.
MethodsFleas were collected from cats, dogs, and traps in flea-infested homes in Florida, pooled by source, and sequenced using short- (V3/V4) and long-read (full-length) 16S rRNA gene sequencing. Microbial prevalence and abundance were compared across sequencing approaches. Community composition was evaluated for differences between sources and houses. Candidate members of the flea microbiome were identified based on a combination of prevalence, abundance, and statistical signatures of potential contaminant origin. For Rickettsia and Bartonella, species-level taxonomic assignments were refined using a phylogenetic approach.
ResultsWolbachia, Rickettsia, and Bartonella were the most prevalent and abundant taxa. Spiroplasma was identified as a fourth core member of the flea microbiome. Long-read sequencing enabled better, but not perfect, species-level classification of Bartonella and Rickettsia compared to short-read sequencing. Important relationships between specific ASVs and flea sources were identified, for example fleas from cats harbored higher abundances of B. clarridgeiae and B. henselae than fleas from traps.
Exploring the concept of patient agitation in the intensive care unit.
Patient agitation in the intensive care unit is of widespread concern and linked to negative outcomes for patients, staff, and family members. There is currently no consensus on what constitutes agitation in the intensive care context, hindering effective and tailored prevention and management.
Concept Analysis.
Walker and Avant's eight-step concept analysis approach.
A comprehensive search was carried out in the databases MEDLINE, PsychINFO and CINAHL. A total of 32 papers published between 1992 and 2023 were included, reviewed, and analysed to explore definitions, attributes, antecedents and consequences of patient agitation.
Patient agitation in the intensive care unit is characterised by excessive motor activity, emotional tension, cognitive impairment, and disruption of care, often accompanied by aggression and changes in vital signs. Antecedents encompass critical illness, pharmacological agents and other drugs, physical and emotional discomfort, patient-specific characteristics and uncaring staff behaviours. Consequences of agitation range from treatment interruptions and poor patient outcomes to the psychological impact on patients, families, and staff.
Agitation in the intensive care unit is a complex issue which significantly impacts patient treatment and clinical outcomes. For healthcare professionals, patient agitation can contribute to high workloads and job dissatisfaction. Due to the complex nature of agitation, clinicians must consider multifaceted strategies and not rely on medication alone. Further research is needed to fully understand patient agitation in the ICU. Such understanding will support the development of improved strategies for preventing and managing the behaviours.
A clearer understanding of patient agitation supports the development of tailored interventions that improve patient care, guide ICU training, and inform future research.
This concept analysis was developed with input from a patient representative.
by Michelle Lauge Quaade, Mikael Leijon, Mikhayil Hakhverdyan, Thomas Bruun Rasmussen, Charlotte Kristiane Hjulsager, Lars Andresen, Karin Mundbjerg, Anne Sofie Vedsted Hammer
Diarrhea outbreaks significantly affect the health and growth of farmed mink, posing economic and welfare challenges. While various pathogens have been linked to mink diarrhea, the causes during the weaning period remain unclear. Sporadic associations of mink coronavirus (MCoV), Campylobacter, and gastrointestinal disease in mink have been suggested. This study investigates the occurrence and levels of MCoV and Campylobacter in fecal samples from Danish farm mink (Neogale vison) and their potential association with post-weaning anorexia diarrhea syndrome (PADS), growth-period diarrhea (GPD), or pre-weaning diarrhea (PWD). The focus of the study is on PADS, studied through two case-control setups where case farms had known problems with PADS and control farms without such problems. Animals were also diagnosed based on necropsy pathological findings. Seventeen MCoV genomes were determined from five Danish farms. This data facilitated the development of an MCoV RT-qPCR and was applied across three study groups. Results showed high prevalence of both MCoV and Campylobacter spp. in all groups. No link was found between MCoV presence or levels and PADS diagnosis on the individual level; however, farm-level analysis revealed that MCoV was 2.35 times more likely (95% CI 1.027; 5.056) on PADS case farms than controls. Mink with PWD exhibited higher MCoV levels compared to GPD cases, suggesting a role at this developmental stage. Phylogenetic analysis revealed diverse and farm-specific MCoV strains, with sequences from healthy controls forming a distinct subclade, hinting at strain-specific pathogenicity. Campylobacter spp. presence was not significantly associated with PADS, but higher levels were observed in mink with PADS versus those without (not tested for PWD). These findings highlight the importance of surveillance and rigorous hygiene practices on mink farms to address risks from MCoV and Campylobacter spp., calling for further research to clarify their roles in PADS and overall mink health.Accurate identification of adverse events after colonoscopy is essential for quality assurance in colorectal cancer (CRC) screening. Review of medical records is labour intensive as adverse events are infrequent. The object of this study was to investigate the accuracy of claims data in identifying adverse events after colonoscopy in CRC screening.
Cross-sectional, retrospective.
Males and females aged 50–74 years were randomised to once-only sigmoidoscopy or biennial faecal immunochemical test in a CRC screening trial at two screening centres in Norway. Participants in the present study underwent follow-up colonoscopy from 2012 to April 2020 after initial positive screening test. We reviewed medical records for adverse events within 30 days following 11 205 colonoscopies.
The primary outcome of the study was to assess the sensitivity of claims data from the Norwegian Patient Registry to identify lower gastrointestinal bleeding using emergency contact International Statistical Classification of Diseases and Related Health Problems 10th Revision diagnostic code sets under two definitions: a stringent definition (codes explicitly identifying bleeding) and a broad definition (including suggestive codes). Secondary outcome measures included the sensitivity to identify perforation using a stringent and a broad definition. Additionally, we assessed whether incorporating procedure codes and non-emergency contacts improved accuracy.
87 cases of lower gastrointestinal bleeding and eight perforations were confirmed. Sensitivity for bleeding differed between the centres (p
Use of claims data underestimated adverse event rates following colonoscopy. Difference in coding practice across hospitals underscores the need for standardised reporting in screening programmes.
by Angelina Miller, Katja Lisa Schröder, Karsten Eike Braun, Caitlin Steindorf, Richard Ottermanns, Martina Roß-Nickoll, Henner Hollert, Thomas Backhaus
Zebrafish (Danio rerio) are widely used in biological research, but the impact of incubation temperatures on developmental endpoints is still insufficiently studied. This study quantifies developmental differences in zebrafish embryos incubated at 26°C and 28°C, focusing on key endpoints (heartbeat onset, hatching time, eye size, yolk sac consumption, and body length). For this purpose, we recorded a high-resolution time series comprising hourly observations of early developmental stages and key events and bi-hourly observations of body length until 120 hours post fertilization. Additionally, we recorded a low-resolution time series at 72, 96, and 119 hours post fertilization for detailed measurements of eye size, yolk sac area, and body length. Embryos incubated at 26°C showed consistent delays in developmental stages compared to those at 28°C, with delays becoming more pronounced at later stages. Yolk sac consumption was delayed by about 19.8 hours at 26°C by 119 hours post fertilization, suggesting a delayed onset of independent feeding. These findings suggest that time-based regulatory limits for rearing zebrafish, such as the 120-hour threshold in German regulations (TierSchVerV), do not fully account for temperature-dependent development. The results emphasize the need for guidelines linking incubation temperatures to developmental progress.
FreshRSS 