Conectar
by Min Jung Kim, Eun-Gee Park, Changyoung Kim, Dong Yoon Kang, Borim Ryu, Kichul Shin
BackgroundA treat-to-target strategy involving treatment modification improves outcomes in gout, but evidence remains limited regarding the optimal approach when initial urate-lowering therapy (ULT) fails. This study aimed to investigate real-world ULT sequence patterns and evaluate treatment retention based on the initial agent, modification type, and comorbidities.
MethodWe analyzed electronic health record data collected from 2010 to 2022 from the common data model databases of two hospitals. Adults aged 18 years or older diagnosed with gout who initiated ULT and were followed for at least 2 years were included. Outcomes included the frequency and sequence of ULT prescriptions. Treatment modification, defined as switching to another ULT or adding an additional agent, was considered the end of retention for the previous regimen. Subgroup analyses were performed based on comorbidity.
ResultsAmong 2220 patients, febuxostat was the most common first-line agent (51.4%), with 90.9% maintaining therapy. Among those who modified febuxostat therapy, switchers and add-on users continued treatment similarly (91.5% vs. 86.8%, P = 0.33). Of allopurinol initiators, 55.8% changed therapy, mainly switching to febuxostat or benzbromarone rather than adding another agent (51.4% vs. 4.1%, P vs. 86.8%, P = 0.33). Among benzbromarone initiators, 57.2% changed therapy (switchers, 56.7%; add-on users, 0.5%; P P = 1.00). Chronic kidney disease was associated with low variability in ULT sequence.
ConclusionsULT demonstrated durable retention when used as first- or second-line treatment, with switching being more common than add-on therapy and maintaining similar retention rates.
To investigate the impact of parenting stress in both fathers and mothers on the quality of life (QoL) of children with down syndrome (DS) and the mediating effect of family adaptation.
This cross-sectional study was conducted between April 2023 and August 2023.
A total of 106 father–mother dyads of children with DS aged 2–12 years in South Korea were included. The parents independently completed questionnaires assessing parenting stress, family adaptation, and their children's QoL. The Actor–Partner Interdependence Mediation Model was used for the dyadic analysis.
The direct effect of parenting stress on children's QoL was not significant; however, the indirect effect of family adaptation was significant. Fathers' parenting stress indirectly influenced their children's QoL through their own and their mothers' family adaptations. Conversely, mothers' parenting stress indirectly influenced their children's QoL through their own family adaptation, although the mediating effect of fathers was not statistically significant.
Higher family adaptation in both fathers and mothers was associated with an improved QoL in children with DS. The pathways through which parents influenced their children's QoL differed but were interdependent. Therefore, dyadic interventions aimed at improving family adaptation in both fathers and mothers may help improve the QoL of children with DS.
This is the first study to examine parental influence on children's QoL based on dyadic interactions among fathers, mothers, and children with DS. This study highlights the importance of assessing and promoting fathers' and mothers' levels of family adaptation to improve the QoL of children with DS. Nurses should consider effective dyadic interventions for families that include both parents to maximise improvements in the QoL of children with DS.
No patient or public contributions.
This study adhered to the STROBE guidelines for cross-sectional studies.
To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.
A qualitative descriptive study.
The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.
The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.
Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.
The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.
This study was reported in accordance with the COREQ checklist.
No patient or public contribution.
This study aimed to develop a prediction model for the occurrence of medical adhesive-related skin injuries (MARSIs) based on electronic medical records (EMRs) of adult patients who underwent degenerative spine surgery. This study used the EMR data of adult patients who underwent degenerative spine surgery at a university hospital in Seoul between January 2020 and December 2024. Seven machine learning algorithms and the SuperLearner algorithm were used to evaluate the performance of the SuperLearner model. Performance was focused on the area under the curve (AUC), accuracy, sensitivity, specificity, precision and F1 score. Among the machine learning algorithms, the RuleFit algorithm showed the best performance, with an AUC of 0.723, accuracy of 0.689, sensitivity of 0.959, specificity of 0.276, precision of 0.762 and F1 score of 0.789. In contrast, predicting MARSI using the SuperLearner algorithm had an AUC of 0.951, accuracy of 0.834, sensitivity of 0.635, specificity of 0.964, precision of 0.921 and F1 score of 0.752. This study provides practical evidence for the early identification of high-risk patients and establishment of customized nursing plans by presenting a MARSI prediction model using the SuperLearner ensemble. Future research is recommended to verify the external validity of the model through prospective studies and integration of clinical decision support systems.
Trial Registration: ClinicalTrials.gov Identifier KCT0010601.
To investigate whether patient safety culture is associated with nurses' turnover intention and to examine correlational sequential pathways involving burnout and job satisfaction, drawing on Conservation of Resources theory.
A descriptive, correlational design.
This study used data collected during 2023 from a hospital-wide patient safety culture survey conducted in four hospitals in South Korea. The sample comprised 3082 nurses from diverse units. Relationships among patient safety culture, burnout, job satisfaction, and turnover intention were examined using a mediation model within a structural equation modelling framework (WLSMV estimator with probit link), controlling for age and hospital tenure.
Patient safety culture was associated with lower burnout and higher job satisfaction. Burnout was associated with lower job satisfaction and with a higher likelihood of turnover intention, whereas job satisfaction was associated with a lower likelihood of turnover intention. When burnout and job satisfaction were considered together, the association between patient safety culture and turnover intention was explained through these two factors rather than by a direct pathway.
Patient safety culture functions as an organizational resource that relates to reduced burnout and enhanced job satisfaction, which together relate to lower intention to leave.
Strengthening patient safety culture—alongside efforts to reduce strain and foster positive job attitudes—may support nurse well-being and improve retention, thereby supporting continuity and safety of patient care.
This study addresses persistent nurse turnover intention in hospitals and identifies patient safety culture as an organizational lever that operates through reduced burnout and improved job satisfaction. The findings can guide nurse leaders and policymakers in hospitals to implement culture-focused strategies that support staff well-being, enhance retention, and sustain safe patient care.
STROBE guidelines were followed.
No patient or public contribution.
by Hongjun Park, Beechui Koo, Jungwook Shin, Byoung Hyuck Kim, James J. Sohn
Approximately one-third of US adults have tattoos, yet the dosimetric impact of intradermal tattoo pigments during radiation therapy remains uncharacterized. Commercial tattoo inks contain unregulated metallic impurities including chromium, lead, and nickel, raising concerns about dose perturbations in tattooed skin. This work quantifies radiation dose perturbations induced by high-atomic-number (Z) tattoo pigments under clinically relevant radiotherapy conditions. Monte Carlo simulations (TOPAS) modeled layered skin phantoms with a 0.3-mm intradermal tattoo layer embedded at 1.25–1.55 mm depth. Three commercial inks were evaluated: carbon-based (black) and metal-containing (Fe-rich brown, Al-containing orange) at pigment loadings of 5–100 vol% within the tattoo layer, to establish upper-bound effects. Electron (6, 18 MeV) and photon (6, 18 MV) beams were simulated with standard clinical geometry (1 × 1 cm² field, SSD = 100 cm). Photon irradiation produced pronounced, depth-localized dose enhancement, with peak dose enhancement factor (DEF) reaching 2.5 for brown ink at 18 MV, a 62% mean increase relative to non-tattooed skin driven by high-Z–mediated secondary electron production. Electron beams exhibited energy-dependent behavior: 6 MeV produced modest enhancement (peak DEF ~ 1.07), while 18 MeV unexpectedly generated dose deficits (DEFTo examine the use of triage systems in primary care in the UK.
Integrative literature review and narrative synthesis.
PubMed, EMBASE, CINAHL and Cochrane Library were searched in October 2024.
An integrative literature review was conducted following Whittemore and Knafl's (2005) five-step process. Of 1440 articles retrieved, 305 duplicates were removed, and 1086 excluded after title and abstract screening. Two additional articles were identified through citation and hand searches. Twenty studies were quality-assessed using the Mixed Methods Appraisal Tool, and data were extracted for narrative synthesis.
Twenty studies were selected, including four randomised controlled trials, three quasi-experimental studies, eleven descriptive studies and two qualitative studies. The most common type of triage was telephone triage, most frequently performed by nurses. The most common health outcomes included subsequent patient re-contacts after triage, patient symptoms or complaints, current health status and patient safety. The benefits of triage included high patient satisfaction, workload redistribution, reduced GP workload and emergency department crowding, improved resource utilisation, access to care and communication. The challenges of triage included increased overall contact time, mis-triage issues, recruitment and retention challenges, the unsuitability of the decision support tool for the primary care setting and lower usage among older and less affluent groups.
This review examined the current use of triage in primary care in the UK, identifying common patterns in triage processes and classifications. Several benefits were identified, though some ongoing concerns about triage remain.
This paper provides essential evidence about the current use, effectiveness and challenges of triage in UK primary care. The findings can support healthcare policymakers, practitioners and researchers in planning and improving triage systems.
Integrative review.
Individuals experiencing moderate to severe mental illness have low rates of workforce inclusion, with a consequence of high welfare dependency, affecting both societal costs and health. Individual Placement and Support (IPS) is an approach to supported employment where the goal is to help people obtain jobs on the open rather than sheltered labour markets. Despite multiple randomised controlled trials (RCTs) indicating that the IPS model enables employment better than treatment as usual, with widespread adoption in some jurisdictions, the broader impacts of this large-scale implementation on mental health, quality of life and social functioning remain unknown.
Between 2012 and 2019, Norway introduced IPS through both local and national government projects. This study assesses the social and economic benefits of the implementation of IPS using Norwegian registry data, focusing on 18–45-year-old people receiving specialist mental healthcare, and who did not have steady employment at treatment start. Instead of assessing IPS efficacy in an RCT design, we use a naturalistic study design, evaluating IPS effectiveness by comparing aggregate population-level outcomes over time between areas where IPS was not available.
In work package (WP) 1, we mapped the availability and implementation of IPS across Norway. This involved analysing information on funding, resource and capacity levels to understand how IPS had been rolled out across the country. While completed, we include a description of WP1 here, as it informs WP2 and WP3. WP2 is an effectiveness evaluation investigating the population-level outcomes of implementing IPS, focusing on health, mortality, quality of life and social functioning. Finally, in WP3, we assess the financial implications of implementing IPS from a public purse perspective, synthesising data on resource use and costs of implementation with data from WP2.
Overall, we will examine the societal effects of IPS implementation on employment, welfare dependency, mental healthcare use, emergency care visits, self-harm and suicide, general mortality, crime and victimisation. Emphasis will be on long-term outcomes, and we will model the economic consequences of IPS. This study aims to inform policy making and strategies for implementing IPS at scale.
This is an effectiveness study using registry data. The Regional Committee for Medical Research Ethics Northern Norway, REK North has approved the use of registry data without informed consent for this project (approval number 134553).
The findings will be disseminated both in academic peer-reviewed journals, directly to informants in WP1, to the public through media and the project website, and at relevant conferences and seminars for specific relevant target groups.
Not applicable
Cognitive impairment is associated with people with diabetes-related foot ulcers (DFU). However, it is unclear if cognitive impairment is associated with the ulcer itself or other co-existing diabetes-related complications such as peripheral neuropathy. We aimed to investigate cognition in people with diabetes-related peripheral neuropathy and compare those with DFUs to those without DFUs. In this age- and sex-matched, multicentre, case-control, observational study of 89 participants with Type 2 diabetes and peripheral neuropathy, we compared 49 participants with DFUs (cases) to 40 without DFUs (controls). Global cognition scores were assessed using the Montreal Cognitive Assessment tool. Participants with DFUs had similar characteristics to those without DFUs (all, p > 0.05), except for lower body mass index (p = 0.028). Participants with active DFUs had significantly lower global cognition scores compared to those without DFUs (median [IQR] 24.0 [21.0–25.0], 26.0 [24.0–28.0]; p < 0.001). After adjusting for other diabetes-related complications, lower global cognition was independently associated with a DFU, peripheral artery disease, lower physical activity and no family history of diabetes (all, p ≤ 0.019). People with DFUs had lower cognitive scores than those without DFUs, suggesting that the DFU itself is independently associated with cognitive impairment. Future studies should explore causal pathways and targeted management strategies.
Adults living with chronic conditions may need to access health programmes to mitigate health-related challenges that persist long after discharge from the hospital. Community physical activity programmes represent critical opportunities for health promotion and chronic disease self-management that can extend beyond hospital-based services. However, navigating the healthcare system and connecting to much-needed physical activity programmes can be challenging due to fragmentation of the health and social care system, especially for those who are transitioning between different healthcare providers, settings, stages of recovery and funding sources (eg, public, private). Patient navigation services can assist with this fragmentation by providing tailored support to individuals with chronic conditions. However, our understanding of patient navigation services in Canada is limited. This rapid review seeks to explore the landscape of patient navigation services supporting Canadians with chronic conditions in connecting to physical activity programmes in the community.
The rapid review will follow the recommendations published by Garritty et al in 2024. Integrated Knowledge Translation will be employed to facilitate meaningful engagement of people with lived experience of chronic conditions throughout the entire research process. Studies published in English that examine patient navigation services in physical activity for community-dwelling Canadians with chronic conditions will be included. Ovid MEDLINE, Embase, Emcare, CINAHL and Google Canada will be searched for articles published from 1990 to May 2025 to identify the characteristics, strengths and limitations, and prioritised features of patient navigation services for community physical activity programmes. The Mixed Methods Appraisal Tool will be used to assess the quality of included studies.
This protocol is a rapid review of published literature and does not require ethical approval. Review findings will be disseminated to various key interest groups through publications, presentations, infographics, social media posts and/or videos.
Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.
Multicentre, retrospective, observational, new-user, active-comparator cohort study.
Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.
Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.
Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.
The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.
SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.
(1) To determine the mediating effects of children's transition readiness, which reflects self-management skill acquisition, and family resilience on the relationship between parenting stress and the quality of life (QOL) of parents and children with spina bifida (SB). (2) To conduct an exploratory analysis of the differences in the mediating pathways based on the presence of SB-related clinical characteristics.
A cross-sectional study.
Data were collected from a single centre in South Korea between October 2022 and July 2024. Participants included children aged 7–13 years diagnosed with myelomeningocele, lipomyelomeningocele or tethered cord syndrome, along with their parents. Statistical analysis was conducted using SPSS and the MEDYAD macro for actor–partner interdependence mediation model analysis.
Family resilience significantly mediated the relationship between parenting stress and both child and parent QOL. However, transition readiness was not a significant mediator in the overall sample. Among children with SB-related clinical characteristics, transition readiness significantly mediated the association between parenting stress and child QOL. In contrast, family resilience mediated the relationship between parenting stress and parent QOL. No significant mediators were found in children without SB-related clinical characteristics.
This study highlights the mediating role of family resilience and transition readiness in improving the QOL of children with SB, particularly those with clinical characteristics. The findings suggest that interventions should be tailored to address both family resilience and transition readiness, especially for children with SB-related clinical challenges.
These findings are valuable for nurses supporting children with SB, as the results highlight the importance of transition education tailored to SB-related clinical characteristics. In particular, nurse-led transition education may play a key role in enhancing transition readiness and improving the QOL of children with SB who have clinical characteristics.
None.
STROBE Checklist for cross-sectional studies.
High blood pressure (BP) in obese populations poses significant cardiovascular risks, yet the comparative effectiveness of various weight loss interventions on BP remains unclear. This systematic review and network meta-analysis (NMA) aims to assess the comparative effectiveness of weight loss interventions in overweight/obese adults with prehypertension/hypertension on BP change and adverse events (AEs).
A systematic review and Bayesian NMA of randomised controlled trials of weight loss interventions in overweight/obese patients with prehypertension/hypertension will be conducted. PubMed, EMBASE and the Cochrane library (CENTRAL) and relevant references will be searched up to June 2025. Primary outcomes are changes in systolic and diastolic BP; secondary outcomes include AEs, body weight reduction (kg) and quality of life. Study selection, data extraction and methodological quality assessment using Cochrane risk of bias (RoB) 2.0 will be performed by independent two authors. A Bayesian NMA will be conducted using BUGSnet, with surface under the cumulative ranking curve to rank interventions. Subgroup analyses will explore heterogeneity by baseline BP severity, intervention duration and comorbidities, and sensitivity analyses will be performed for robustness of the results by RoB and sample size.
Ethical approval is not required for this systematic review as it will involve analysis of data only from previously published studies. The results will be disseminated through presentations at international conferences and publication in peer-reviewed journals.
CRD42022376688.
by Paola Ximena Gonzalez-Lerma, Crystal Lloyd, Scarlet J. Park, Ken Dawson-Scully
Chemotherapeutic agents used for most common cancers are frequently associated with neurotoxicity, which often include debilitating side effects such as seizures. Docetaxel, one of the most widely and effectively used chemotherapeutic drugs, is associated with an array of symptoms referred to as Docetaxel-Induced Peripheral Neuropathies (DIPNs), including motor neuropathy, tingling, muscle weakness, and numbness. In this study, we use the electroconvulsive assay to model DIPN-related muscle weakness in C. elegans, via shock induction. We show that acutely or chronically exposing nematodes to docetaxel increases time to recovery from shock-induced seizure-like behaviors. Additionally, we find that sildenafil citrate, a PDE-5 inhibitor, and a novel bicyclic bridge compound, Resveramorph-3 (RVM-3), are both effective at rescuing the animals from prolonged seizure-like movement duration following acute and chronic exposure to docetaxel. The results demonstrate that sildenafil citrate and RVM-3 are potential candidates for mitigating the neurological deficits resulting from DIPNs.Poverty can have profound negative impacts on parent, child and family health. Primary care providers are in a unique position to address child poverty. Some team-based models have integrated community support workers (CSWs) for social service system navigation assistance. The overall aim of this study is to rigorously test a poverty reduction intervention (navigation of financial supports) embedded in primary care. The primary objective is to compare parenting stress between CSW-supported, structured review of financial supports and social system navigation (intervention) and receipt of written summary of local resources (usual care).
This is a multisite pragmatic superiority randomised controlled trial with a 1:1 allocation to the CSW-supported social system navigation versus no navigation. Parent–child dyads (80 parents of children aged Do you ever have difficulty making ends meet at the end of the month?’) will be recruited during a scheduled health supervision visit from primary care practices in Kingston, Ontario. Intervention group participants will have a structured review of financial supports with a trained CSW and will meet up to 6 times over 6 months. Outcomes are measured at baseline, 6 months and 12 months after randomisation. The primary outcome is the Parenting Stress Index Fourth Edition Short Form (PSI-4-SF) total score at 6 months. Secondary outcomes include household income, food insecurity, parent mental health (depression and anxiety) and child health. An internal pilot study was used to obtain more reliable estimates of the SD of PSI-4-SF at 6 months to recalculate the sample size (if needed) and assess randomisation and completion rates. Qualitative interviews conducted 9 months after enrolment explore parent experiences with the CSW intervention.
Research ethics approval by Queen’s University Health Sciences REB. Results will be shared with the College of Family Physicians of Canada, the Ontario SPOR SUPPORT Unit and academic forums.
Connecting Families (Registered 12 October 2021 at www.clinicaltrials.gov;
Mental health and substance use problems among people released from prison contribute substantially to premature mortality and emergency services demand. Understanding of mental health and substance use-related health service contacts prior to these severe and costly outcomes is limited. We assessed mental health and substance use-related contact with multiple services, comparing rates of contact among people released from prison to a matched general population sample who had not recently been in prison.
To compare rates of health service contacts for mental health and substance use between people released from prison and a matched general population sample.
We conducted a retrospective cohort study using linked administrative data with nationwide coverage. The cohort contained all people released from any Scottish prison in 2015 (exposed group), and a random general population sample matched (ratio 1:5) on sex, age, postcode and deprivation indices, who had no imprisonment in the 5 years prior (unexposed group). We linked individual-level administrative healthcare (prescriptions, outpatient, inpatient, emergency/unscheduled care: 2010–2020), prison (admissions, releases: 2010–2020) and deaths records (2015–2020). We estimated adjusted incidence rate ratios (aIRRs) with 95% CIs using fixed-effects Poisson regression with cluster-robust standard errors, controlling for time-in-community, pre-index mental health and substance use-related health service contacts, and comorbidities. We stratified models by mental health (MH), substance use (SU) and dual diagnosis (attributable to both MH and SU).
Scotland.
We linked records for 8313 people released from prison, and 41 213 matched individuals. Mental health and substance use-related contact rates were significantly higher for people released from prison across all services, and particularly for emergency and unscheduled care. aIRRs for ambulance contacts were MH=7.75 (95% CI 5.76 to 10.42), SU=7.58 (95% CI 5.71 to 10.08), dual diagnosis=8.28 (95% CI 6.50 to 10.55); and accident and emergency department contacts were MH=4.88 (95% CI 3.78 to 6.29) and SU=7.98 (95% CI 5.71 to 11.17). aIRRs for community prescriptions were MH=1.80 (95% CI 1.67 to 1.94), SU=5.95 (95% CI 4.83 to 7.32), dual diagnosis=5.33 (95% CI 3.70 to 7.68); drug and alcohol services were 7.13 (95% CI 6.00 to 8.48); and outpatient attendances were 2.61 (95% CI 2.17 to 3.16). aIRRs for 24-hour unscheduled telephone support were MH=7.63 (95% CI 4.93 to 11.83) and SU=8.29 (95% CI 3.99 to 17.22); and out-of-hours general practice were MH=5.14 (95% CI 3.66 to 7.22), SU=5.89 (95% CI 3.11 to 11.14) and dual diagnosis=8.85 (95% CI 2.94 to 26.63). aIRRs for general/acute hospital admissions and day cases were MH=2.97 (95% CI 1.43 to 6.16), SU=7.85 (95% CI 4.42 to 13.91), dual diagnosis=13.11 (95% CI 7.95 to 21.61); and for psychiatric admissions were MH=3.62 (95% CI 2.39 to 5.49), SU=10.74 (95% CI 6.12 to 18.84) and dual diagnosis=7.74 (95% CI 4.30 to 13.94).
Improved post-release mental health and substance use care is vital for individual and public health. Despite elevated rates of contact with community mental health and substance use services, people released from prison have disproportionately high rates of contact with emergency and unscheduled care services. This suggests that early support is either inadequate or not accessed by those in greatest need.
Policymakers and service providers should consider investment in tailored transitional and post-release intervention at individual and population level, to improve health and thus prevent later high-cost service use and avoidable mortality. Our results also suggest high-quality care must be available and accessible beyond the immediate post-release period to permit sustained engagement or engagement at a later date.
There is an urgent need to improve surgical antimicrobial stewardship (AMS), to enhance individual care and reduce population-level antimicrobial resistance, but it is a complex issue.
We aimed to conduct an ethnographic study asking what would work in practice to improve surgical antibiotic prescribing behaviour?
Adopting a socio-cultural-historical perspective, we undertook ethnographic observations of clinical practice (43.5 hours) and semistructured interviews (n=31) with surgical staff, AMS staff and patients at two English National Health Service hospitals. Interview transcripts and observational fieldnotes were analysed using the Framework Approach. Additionally, we integrated stakeholder engagement throughout to ensure the findings were meaningful.
Our analysis of all fieldnotes (based on 43.5 hours of observation) and interview transcripts (n=31 from interviews with 31 different participants) identified that, while surgical staff were aware of antimicrobial resistance, they seldom considered AMS urgent or important in the acute setting where lack of time and the desire to mitigate perceived risk often prevailed. Other surgical issues were perceived to dominate senior decision-makers’ focus, thus perpetuating the status quo. Furthermore, attention to AMS was not always prioritised at the organisational level or by resource-limited AMS teams. Consequently, there was an absence of relationships and tools that foreground AMS. Electronic prescribing systems frequently hindered antimicrobial review and exacerbated patterns of siloed inter-disciplinary working, and feedback on antimicrobial prescribing and patient outcomes was largely absent. To improve AMS, surgical teams wanted sustainable improvements which effectively account for the hierarchical relationships, division of labour, rapid workflow and high staff turnover. Infection experts should better integrate into surgical teams to build relationships and trust, and to proactively contribute to patient care.
We offer data-driven, theoretically informed strategies to support change. Contextually appropriate improvements that address the status and visibility of AMS in surgery will be key. Further research is needed to assess the impact and sustainability of the suggested approaches.
To explore whether a delay from referral to first contact with nurse-led community health services is associated with the likelihood of subsequent emergency department attendance.
We use individual linked administrative data on use of community health and hospital services. We identify a cohort of 343,721 individuals referred to community health services in England by their primary care provider in 2019. We then track their subsequent community healthcare contacts and emergency department attendances.
We exploit variation in the time to contact caused by weekend delays, which create longer times to first contact for people referred later in the working week. The main analysis compares patients referred on Thursday with those referred on Tuesday.
We show that 6.7% of patients referred on Thursday wait an extra two days for their first community contact relative to those referred on Tuesday. Despite this delay, we find no evidence that people referred on Thursday are more likely to have a subsequent emergency department attendance compared to those referred on Tuesday.
We do not find delayed community health services contact to be associated with an increased risk of emergency attendance amongst patients referred to community services by their primary care provider. This suggests that short delays in contact time are not detrimental for this group.
Shifting care from hospital to community settings is a key priority for health systems internationally. In England, community health services face significant staffing shortages, limiting the extent to which services can be responsive and support the desired strategic shift. Our findings suggest that these constrained community providers could use their limited capacity to prioritise responding quickly to other patients without harming those referred via primary care.
STROBE guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
Falls among older adults represent a major public health challenge, yet research examining the role of social determinants of health (SDOH) in fall risk remains limited. This study aimed to identify factors associated with fall occurrence and fall frequency among community-dwelling older adults in Korea, with particular emphasis on SDOH.
A cross-sectional study design.
We used a large nationwide sample (n = 9746) from the 2023 National Survey of Older Koreans. The number of falls in the past year served as the dependent variable. Independent variables included a range of socioeconomic and environmental variables as SDOH, alongside biological and behavioral variables. A zero-inflated negative binomial (ZINB) regression analysis was employed to address excess zeros and overdispersion in fall count data.
Among participants, 94.8% experienced no falls, 3.2% reported a single fall, and 1.9% reported recurrent falls. In the logit model for fall occurrence, higher household income level, absence of age-friendly housing, higher access to parks, and lower access to welfare centers were associated with higher risk of fall occurrence. In the count model for fall frequency, higher education level, presence of age-friendly housing, and outdoor mobility barriers were associated with higher fall frequency within the at-risk group.
The findings provide empirical evidence on the critical roles of SDOH in falls among community-dwelling older adults. Specifically, a ZINB regression analysis identified distinct sets of SDOH associated with fall occurrence versus fall frequency, highlighting the complex and multifaceted nature of fall patterns among older adults.
Healthcare providers and policymakers seeking to reduce falls should implement tailored, SDOH-integrated strategies by addressing the different mechanisms underlying fall occurrence and fall frequency.
Venous leg ulcers occur due to chronic venous insufficiency in the lower extremities and are often difficult to heal. Platelet-rich plasma and platelet-rich fibrin are products that contain high concentrations of platelets. This systematic review evaluated the effectiveness, safety and cost-effectiveness of these products for the treatment of venous leg ulcers. Guided by the 2020 Joanna Briggs Institute systematic review of effectiveness guideline, this review included original studies that investigated platelet-rich plasma and platelet-rich fibrin in the treatment of venous leg ulcers from databases including the Cochrane Library, Embase, Medline, CINAHL, PubMed, World Health Organisation International Clinical Trials Registry, Clinical Trials.gov and Australian New Zealand Clinical Trials Registry. Methodological quality was assessed using relevant appraisal checklists. Information related to general characteristics of included articles and relevant outcomes of interest were extracted and synthesised narratively. Of thirty-six eligible studies, 24 studies used platelet-rich plasma, eleven investigated fibrin-rich plasma and one study used both platelet-rich plasma and fibrin-rich. Most studies reported these products were effective in promoting wound healing, reducing other symptoms, and were safe to use. The use of platelet-rich plasma and platelet-rich fibrin resulted in significantly higher healed venous leg ulcers compared to control using conventional treatment (RR: 2.93, 95% CI, 1.90–4.53, p = 0.01). These products were safe to used topically and promoted to wound healing, reduced pain, either along or combined with other treatments. Platelet-rich plasma and fibrin-rich plasma improves wound healing and appears to be safe to use in the treatment of venous leg ulcers.
FreshRSS 