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La mayoría de los niños con dolor en los cartílagos de crecimiento (apofisitis) mejoran con el transcurso del tiempo. No está claro si el tratamiento de la apofisitis afecta a corto plazo al dolor, la capacidad funcional física ni a la participación en el deporte.
No está claro si algún tratamiento es mejor o peor que otro. Los estudios fueron en su mayoría pequeños y tuvieron problemas de diseño. Los estudios no siempre midieron los efectos no deseados del tratamiento, y ninguno midió si algún niño se retiró de los estudios debido a efectos no deseados.
La evidencia es limitada. La mayoría de los estudios incluyeron más niños que niñas e incluyeron niños más activos de media. Los niños a menudo sabían qué tratamiento recibían, lo que podría haber influido en los resultados.
Durante la pubertad, los niños a veces presentan dolor en los cartílagos de crecimiento de las caderas, las rodillas y los pies. Este dolor generalmente es causado por la irritación de los cartílagos de crecimiento debido a un estrés repetido a lo largo del tiempo, más que por un único episodio. El dolor suele ser a corto plazo y tiene un impacto limitado en la vida del niño. Sin embargo, a veces el dolor puede hacer que los niños cojeen, practiquen menos deporte o sean menos activos físicamente. Las afecciones reciben diferentes nombres según la localización del crecimiento, pero se conocen comúnmente como "apofisitis" o "lesiones apofisarias de las extremidades inferiores".
Muchos profesionales de distintas disciplinas sanitarias tratan la apofisitis, incluida la medicina general, la fisioterapia y la podología. Se utilizan muchos tratamientos, incluidos ejercicios, medicamentos, vendajes adhesivos, correctores posturales o dispositivos que se colocan en los zapatos, como ortesis plantar o elevadores de talón. Independientemente del tratamiento, la apofisitis generalmente mejora sola, pero en algunos casos, el dolor puede durar mucho tiempo.
Queríamos averiguar qué tratamientos alivian el dolor de forma efectiva y conocer si son seguros. Queríamos saber qué tratamientos mejoran la actividad física de los niños y su participación en el deporte. También queríamos saber si un tratamiento funcionaba mejor que otro.
Buscamos estudios que evaluaran los diferentes tipos de tratamientos para la apofisitis de las caderas, las rodillas y los pies. No buscamos tratamientos que implicaran cirugía.
Combinamos los resultados de los estudios que evaluaron los mismos tratamientos y utilizaron métodos similares para medir la efectividad. Calificamos el grado de certeza de esta evidencia.
Encontramos 10 estudios con 654 niños cuya edad promedio varió entre 10,3 y 13,3 años. Siete estudios se centraron en el dolor del talón (apofisitis calcánea) y 3 en el dolor frontal de la rodilla (apofisitis por tracción del tubérculo tibial).
Un estudio (23 niños) comparó un medicamento llamado dexametasona con placebo (tratamiento falso). No sabemos con certeza si la dexametasona alivia el dolor, mejora la capacidad funcional física o ayuda a los niños a retornar al deporte a corto plazo. Dos estudios (74 niños) informaron efectos no deseados de los medicamentos, pero la evidencia también fue muy incierta.
Un estudio (21 niños) comparó la dexametasona con la atención habitual. No sabemos con certeza si la dexametasona alivia el dolor, mejora la capacidad funcional física o ayuda a los niños a retornar al deporte a corto plazo. Un estudio (30 niños) informó sobre efectos no deseados, pero la evidencia también fue muy incierta.
Un estudio (22 niños) comparó la cinta kinesiológica con placebo. No sabemos con certeza si la cinta kinesiológica mejora el dolor o la capacidad funcional física a corto plazo. El estudio no informó sobre la participación en el deporte ni los efectos no deseados.
Un estudio (124 niños) comparó ortesis plantares con elevadores de talón. Encontró que probablemente hay poca o ninguna diferencia entre ellos en cuanto al dolor o la capacidad funcional física a corto plazo. El estudio no informó sobre la participación en el deporte. Un estudio (101 niños) informó que no hubo efectos no deseados.
Un estudio (43 niños) comparó la amortiguación del talón con una correa para el talón. No sabemos con certeza si la amortiguación del talón mejora la capacidad funcional física o causa algún efecto no deseado a corto plazo. El estudio no informó sobre la participación en el deporte.
Ninguno de los estudios informó si algún niño se retiró de los estudios debido a efectos no deseados.
En la mayoría de los estudios, los niños y los cuidadores sabían qué tratamientos recibían, lo que podría haber influido en la forma en que notificaron las mejorías. Lo anterior podría afectar la fiabilidad de los resultados.
La apofisitis suele mejorar por sí sola a medida que los niños crecen y se cierran los cartílagos de crecimiento, por lo que es difícil saber si cualquier mejoría se debe al tratamiento o a la recuperación natural por el paso del tiempo.
Hubo muchos más niños que niñas en los estudios, y la mayoría de los participantes eran muy activos físicamente. Es poco probable que la afección repercuta de manera diferente en los niños y las niñas, pero no sabemos con certeza si los hallazgos se pueden aplicar a los niños que son menos activos físicamente.
Finalmente, la mayoría de los estudios solo tuvieron un escaso número de participantes. Esto significa que no podemos confiar en los resultados ni podemos saber si los hallazgos se aplicarían a un grupo más amplio de niños con apofisitis.
La evidencia está actualizada hasta el 4 de enero de 2025.
To identify and examine evaluation methods and metrics used for specialist cancer nursing.
A scoping review of published and grey literature on evaluation approaches for specialist cancer nursing roles and models of care.
Comprehensive searches were conducted across CINAHL, Cochrane Library, Medline, PsycINFO and Google Scholar for English-language published and grey literature published between January 2014 and November 2025. Two reviewers independently screened and extracted data. Findings were synthesised narratively and mapped to the Strong Model of Advanced Practice Nursing and Quintuple Aim.
Of 3360 records screened, 23 sources met the inclusion criteria: 14 published articles, and 9 grey literature sources (conference abstracts, theses, textbooks). Most sources originated from the USA (n = 12, 52%) or high-income countries (n = 22, 96%), and focused on nurse navigator roles (n = 9, 39%). Five themes emerged in the sources: (1) purpose of evaluation; (2) development of methods and metrics; (3) selection and implementation; (4) data collection approaches; and (5) challenges and considerations. Evaluation was primarily used to demonstrate value and drive quality improvement through pragmatic methods. Metrics varied widely and were concentrated in the Strong Model domains of Direct Comprehensive Care and Support of Systems, with fewer addressing Education, Research and Professional Leadership. Key challenges to evaluation included role variability and lack of standardised tools.
Despite the lack of standardised evaluation practices for specialist cancer nursing, the five themes synthesised in this review can guide evaluation of specialist cancer nursing roles and models of care in real-world settings. Opportunity exists for international collaboration to develop a comprehensive, context-sensitive set of metrics, relevant in diverse healthcare settings, that capture both excellence in service delivery and nursing scholarship.
What problem did the review address? ○
Specialist cancer nurses perform a diverse range of interventions and roles that are complex in nature, leading to challenges in their accurate evaluation.
○Effective and efficient approaches to evaluation of specialist cancer nursing roles are crucial to demonstrate their value.
○A significant body of literature has demonstrated the efficacy of specialist cancer nursing roles and models of care in a research framework; however, evaluation is needed to better understand the impact of translating this evidence into real-world settings.
What were the main findings? ○
A scoping review exploring evaluation methods and metrics of specialist cancer nursing revealed five key themes: (1) purpose of evaluation; (2) development of evaluation methods and metrics; (3) selection and implementation of evaluation methods and metrics; (4) methods of data collection; and (5) challenges and considerations.
○Evaluation of specialist cancer nursing is important, however variation in nurses' roles and responsibilities and lack of standardised measurement tools were key challenges.
○Evaluation metrics varied widely and were specific to specialist cancer nursing roles; predominantly reported under the domains of Direct Comprehensive Care and Support of Systems, with fewer reported under Education, Research and Professional Leadership.
Where and on whom will the research have an impact? ○
Nursing and health service leaders can use the identified themes and subthemes as a framework to guide evaluation of specialist cancer nursing. The predominance of English-language and high-income country evidence limits the global applicability of these findings.
○Gaps in knowledge can drive the future work of cancer nursing organisations to collaboratively develop a comprehensive list of evaluation metrics that can be contextualised for specific roles across diverse health care settings.
○Specialist cancer nurses in all roles and models of care should have metrics for Research, Leadership and Professional Leadership to support the scholarship of nursing.
○Consistent national role definitions, shared competency frameworks and standardised outcome measures should be embedded in policy and commissioning to enable systematic evaluation, appropriate resourcing, and integration into workforce and service planning of specialist cancer nurses.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews PRISMA-ScR checklist.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data and the preparation of the manuscript. No patients were involved in the conduct of this scoping review.
Bloodstream infections (BSIs) are a major cause of morbidity and mortality worldwide. Although recent clinical trials have increasingly adopted patient-centred outcome measures, patient-informed selection of outcome measures remains limited in infectious disease research. Greater deliberate engagement and partnership with patients and families are required to ensure that outcomes reflect priorities that are meaningful to those with lived experience. Our study aims to incorporate patient-informed perspectives into outcome selection for BSI clinical trials.
We will undertake an exploratory sequential mixed methods study nested with the currently running international BALANCE+ trial of Gram-negative BSI (NCT06537609). All study materials will be co-developed and piloted with patient partners. Phase I will consist of virtual focus groups with past patient and family member participants of the BALANCE+ trial from intensive care and ward settings (total of 24–40 participants), using purposive sampling to maximise variation across demographic characteristics. Data will be audio-recorded and transcribed verbatim and analysed thematically using dual independent coding and consensus methods. Phase II will encompass development and administration of a survey (total ~100 respondents) to rank and prioritise outcomes identified in phase I, with responses descriptively summarised and integrated with qualitative findings. In phase III, virtual meetings with relevant parties including patients/families and investigators/study team members in the infectious disease field will be held to generate consensus-based recommendations and inform implementations with BALANCE+ and future trials.
Ethics approval has been obtained from the University of Calgary for all study activities and participating BALANCE+ sites to enable recruitment. Study findings will be disseminated through peer-reviewed publications, community engagement, conference presentations and integration into ongoing and future trials.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
To examine the extent of adherence to high-level principles in remote prescribing and investigate how medical and non-medical prescribers comply with these principles.
Scoping Review.
A systematic search of CINAHL, PubMed, Medline, the Cochrane Database of Systematic Reviews, the Web of Science, and the Ovid Emcare databases was performed. A grey literature search was conducted on relevant professional websites and Google Scholar. Literature was searched from January 2007 to March 2025.
Research results were uploaded to Raayan for management and selection of evidence. Two reviewers independently scored and appraised papers using a structured data extraction form. The ‘United Kingdom High-level Principles for Good Practice in Remote Consultations and Prescribing’ served as a coding framework for deductive manifest content analysis.
Searches identified 6870 studies. After screening the title and abstract, 54 full texts were reviewed, and 14 studies were identified for analysis. Adherence to high-level principles was limited and inconsistent. Data categories were developed into 5 themes: (1) Patient privacy and vulnerability, (2) Adequate assessment, (3) Guidelines and evidence-based prescribing, (4) Investigations and safety netting, and (5) Organisational safety and creating safe systems.
This review provided insight into the challenges that medical prescribers face when adhering to governance principles during remote prescribing practice. However, no research about how non-medical prescribers integrate remote prescribing governance into their practice was found.
Remote prescribing has become firmly embedded within the current healthcare system and robust governance is required to safeguard patient outcomes. Further research exploring how non-medical prescribers integrate the high-level principles into practice will inform prescribing governance for this group.
No patient or public contribution was sought as the scoping review focused solely on the existing literature.
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