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Antimicrobial resistance (AMR) and biofilm formation significantly hinder chronic wound management, necessitating safer and more effective therapeutic options. This study evaluates the antimicrobial, antibiofilm, cytocompatibility and anti-inflammatory properties of a novel antimicrobial hydrogel Formulation (#1) compared with commercially available wound hydrogel and cream Formulations (#2–5). Antimicrobial activity was assessed using minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) assays against Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, and mixed-species cultures. Biofilm-related efficacy was evaluated via crystal violet (CV) staining and minimum biofilm inhibitory concentration (MBIC) assays. Cytotoxicity was examined using ISO-compliant MTT and confluency assays on L929 fibroblasts. In vivo anti-inflammatory effects were assessed using intra-cutaneous injection in New Zealand White rabbits with histological evaluation per ISO 10993-23. Formulation 1 showed the lowest MIC and MBC values across all pathogens, including polymicrobial cultures, indicating strong broad-spectrum efficacy. In biofilm assays, it reduced biofilm biomass by 50%–60% within 10 min and prevented new formation at lower MBIC values than Formulation 2, especially in mixed-species models. Cytotoxicity testing confirmed Formulation 1 maintained ≥ 81% cell viability across all concentrations, outperforming other products and meeting ISO and USP safety thresholds. In vivo, both Formulation 1 and 2 induced minimal inflammation, with Formulation 1 showing slightly milder tissue responses. Formulation 1 demonstrated strong antimicrobial efficacy, reliable biofilm control, and favourable cytocompatibility compared with the comparator formulations tested in this study. These findings support further evaluation of this formulation for chronic wounds complicated by biofilms and antimicrobial resistance.
Immunosuppression is associated with an increased risk of delayed SARS-CoV-2 viral clearance, severe COVID-19 and related death. This heterogeneous group of affected patients includes but is not limited to those with a haematological malignancy, people on immunosuppressive therapy for the treatment of autoimmune/inflammatory diseases and those following bone marrow transplantation (BMT). Immunosuppression is associated with decreased rates of anti-spike IgG seroconversion following COVID-19 vaccination. While clinical guidelines have been established to guide vaccination pre-splenectomy and post-BMT, there are limited data to guide timing of COVID-19 or other booster vaccines in adults commencing new or intensified moderate to severe immunosuppression. The comparison of immunity-boosting regimens for COVID-19 upon initiation of immunosuppressive therapy (CIRCUIT) study was designed to address this knowledge gap. CIRCUIT investigates whether administration of a third (or subsequent) COVID-19 booster vaccine ≤2 weeks prior to immunosuppression provides greater anti-spike IgG-mediated immunity than a booster given 24 weeks after new or intensified immunosuppression, that is, week 24 timepoint (Group 1; n=280). Additionally, the research will investigate whether giving a fourth post-BMT COVID-19 booster vaccine at 9 months post-transplant provides greater anti-spike IgG-mediated immunity than a booster given 15 months post-transplant (Group 2; n=40).
The CIRCUIT study is an open-label, multicentre randomised clinical trial. Participants will be randomised 1:1 to receive either an additional COVID-19 booster ≤2 weeks pre-immunosuppression and a diphtheria/tetanus toxoids (DT) booster at 24 weeks following new or intensified immunosuppression (week 24 timepoint) or receive a DT booster ≤2 weeks pre-immunosuppression and an additional COVID-19 booster at week 24 (Group 1). Group 2 participants who underwent autologous or allogenic BMT in the last 9 months will be randomised 1:1 to either receive a fourth post-BMT COVID-19 booster at 9 or 15 months post-transplant. The primary outcome will be the integrated time-weighted area under the curve anti-SARS-CoV-2 neutralising antibody (NAb) response over 12 months from a SARS-CoV-2 booster as assessed by a high-throughput SARS-CoV-2 NAb platform assay. Key secondary outcomes of the CIRCUIT randomised control trial will include safety and generation of SARS-CoV-2 antigen specific T and B cell responses.
The research protocol was approved by the Western Sydney Local Health District Human Research Ethics Committee on 25 August 2022 (Ref no. 2022/PID00782 – 20022/ETH0069). Study results will be published in peer-reviewed medical journals and presented at local and international conferences. All findings regardless of the outcome will be reported.
Healthcare services are mainly organised around single health conditions and need reconfiguration to meet the needs of people with multiple long-term conditions (multimorbidity). Typically, people are offered annual reviews for each of their long-term conditions separately. In a randomised controlled trial, a comprehensive computerised template based on a personalised care model increased the person-centredness of multimorbidity reviews in primary care, but there were implementation challenges. We sought to understand and address the challenges of implementing a template to support personalised primary care for people with multimorbidity (PP4M).
To explore the extent of implementation and factors influencing uptake of the PP4M intervention. To understand factors influencing implementation and normalisation of the template.
Convergent parallel mixed methods within a non-randomised hybrid implementation-effectiveness study. Normalisation Process Theory (NPT) informed design, data collection and analysis.
Primary care (general practices) in three English regions.
Quantitative: Patients aged 18 years or over and had at least three types of long-term conditions (routine data collection); staff involved in using the template in implementation practices (Normalisation MeAsure Development (NoMAD) questionnaire).
Qualitative: Staff at implementation practices.
A multimorbidity computerised template to support personalised annual reviews. NPT-informed implementation package delivered to implementation practices included: process mapping, software support and training.
Routine medical record data; NoMAD questionnaires and qualitative interviews in implementation practices.
Measures of reach, fidelity, acceptability and sustainability.
Quantitative data: descriptive statistics, logistic regression and difference-in-difference models. Qualitative data analysis conducted using NPT coding manual.
In practices that received an NPT-informed implementation package, use of the template increased more, across patients with a range of demographics and health conditions, than in those that did not receive the implementation package (OR 2.86 (95% CI 2.34 to 3.49)). The implementation package successfully triggered NPT processes of coherence and cognitive participation, and, to a lesser extent, collective action and reflexive monitoring. Contextual factors, including a lack of staff generalist skills and disease-specific incentives, impeded engagement and sustained implementation.
Focusing on the processes of normalisation as mechanisms of implementation facilitated development of an implementation strategy with potential to trigger those mechanisms, but did not sufficiently address contextual factors. Implementation strategies to support personalised care must consider wider system and practice level contextual factors, such as incentives and staff training.
https://doi.org/10.1186/ISRCTN40295449 (2022–08-03, retrospectively registered.)
To describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme in a single university in the Philippines and examine how the doctoral programme influenced these trajectories.
Qualitative design, specifically thematic narrative analysis.
A total of 10 purposively selected graduates of the programme were interviewed with the aid of videoconferencing and life-calendaring methods.
The emerging central narrative theme is transformative potential. Leadership trajectories are characterised by expanding fields of transformative potential from within to beyond their organisations. Doctoral education shapes these trajectories through curriculum-driven capacity building, beyond-curriculum capacity building and character building.
The evolving leadership trajectories of graduates of the Doctor of Philosophy in Nursing Education programme are characterised by expanding and accumulating transformative potential.
The findings can help nursing academic institutions design and improve postgraduate degrees, which will develop transformational leaders in the profession.
What problem did the study address?
This study aims to map and describe the leadership trajectories of graduates of a Doctor of Philosophy in Nursing Education programme.
What were the main findings?
The leadership trajectories of graduates are characterised by expanding and accumulating transformative potential.
Where and on whom will the research have an impact?
The findings can inform the planning, design and evaluation of doctoral nursing degree programmes in higher education institutions, as well as continuing educational programmes for nursing leaders in academic and clinical settings.
Initial findings were sent to the graduates of Doctor of Philosophy in Nursing Education programme to validate the qualitative insights as part of member checking.
by Peesit Leelasawatsuk, Pasawat Supanimitjaroenporn, Nattida Rodsom, Theepat Wongkittithaworn, Manupol Tangthongkum
Nasopharyngeal carcinoma is prevalent in Thailand, with a substantial proportion of cases diagnosed at advanced stages. The standard treatment, concurrent chemoradiotherapy, is associated with considerable adverse effects, which may compromise therapeutic efficacy and diminish patients’ quality of life. While vitamin C has shown potential in reducing chemotherapy-induced toxicities in some cancers, its effects in nasopharyngeal carcinoma remain unclear. In this randomized, double-blind, placebo-controlled trial, patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy were assigned to receive either 2 g of intravenous vitamin C or placebo prior to chemotherapy. The incidence of gastrointestinal adverse effects—including nausea, anorexia, mucositis, diarrhea, and dysphagia—did not differ significantly between groups. However, longitudinal analysis demonstrated a significantly attenuated decline in platelet counts in the vitamin C group compared with placebo. Although intravenous vitamin C did not reduce gastrointestinal toxicities, the observed platelet preservation suggests a potential supportive effect that warrants further investigation. Trial registration The study was registered with the Thai Clinical Trial Registry (TCTR20190316003) on March 16, 2019.Chronic diseases require sustained medication adherence, yet nonadherence remains common, leading to poor outcomes and increased healthcare costs. Digital self-management technologies such as mobile health (mHealth) apps, SMS reminders, and web-based platforms offer scalable ways to support adherence, but evidence on their overall effectiveness across diverse contexts is fragmented.
To systematically review and meta-analyze the effectiveness of self-management technologies in improving medication adherence among adults with chronic diseases and to examine potential moderators of intervention impact.
Following PRISMA guidelines, we searched PubMed, Scopus, Web of Science, CINAHL, and JMIR for peer-reviewed studies (January 2010–June 2025) evaluating digital self-management interventions with adherence outcomes and comparator groups. Eligible designs included RCTs, quasi-experimental, and controlled before-after studies in adults with chronic disease. Random-effects meta-analysis estimated pooled effect sizes (Cohen's d). Heterogeneity (I 2), subgroup analyses, and publication bias (Egger's, Begg's, trim-and-fill) were assessed.
Fifty-two studies were included, spanning 2015–2025. Early interventions (2015–2019) focused on feasibility, using SMS and basic web tools; later years (2021–2025) showed technological maturity, dominated by mHealth apps integrating monitoring, reminders, and education. The pooled random-effects effect size was d = 0.268 (95% CI 0.123–0.414, p = 0.0003), indicating a small-to-moderate benefit. Heterogeneity was high (I 2 = 89%). Medium-duration (10.8–24 weeks) interventions had the largest effect (d = 0.50), and effects varied markedly by country (e.g., Iran d = 2.29; Taiwan d = −0.94). Begg's test suggested possible publication bias; trim-and-fill adjustment increased the pooled effect to d = 0.366.
Digital self-management technologies yield a statistically significant, small-to-moderate improvement in medication adherence across chronic diseases, with potential underestimation due to selective reporting. Effectiveness is moderated by temporal trends, geography, intervention duration, and study design, underscoring the need for context-specific adaptation and methodological rigor. Future research should prioritize large, well-controlled trials, pre-registration, and exploration of cultural and systemic determinants to optimize intervention impact.
Evidence-Based Practice (EBP) is essential to healthcare quality and safety, integrating scientific evidence with clinical expertise and patient preferences. Despite its importance, EBP implementation still faces major challenges. Educational interventions have proven effective in strengthening EBP competencies among healthcare.
To evaluate the impact of a personalized educational intervention on EBP competencies among healthcare professionals. Working at a private tertiary general hospital, comparing performance before and after the intervention.
A randomized controlled trial involving healthcare professionals was conducted. Eligible and consented participants were randomly assigned to either an Intervention Group (IG) receiving an Evidence-Based Practice (EBP) course or a Control Group (CG) not receiving the course, stratified by job level, role, and work shift. From the completers, 18 participants were randomly selected for the IG, and all 7 available CG participants were included in the final sample for analysis. All study participants completed two validated instruments: the Assessing Competencies in Evidence-Based Medicine (ACE) and the Fresno Test. The educational intervention consisted of a seven-week course with weekly three-hour sessions, for a total of 21 h. Comparative analyses were conducted using a Linear Mixed Model, adjusted for educational level, job level, time working at the hospital, and weekly workload.
A statistically significant increase in general EBP knowledge was observed in the IG following the intervention, with a mean gain of 19.1%. Separate analysis showed improvements of 10.8% in ACE and 24.2% in Fresno Test scores. No statistically significant changes were observed in the CG. Furthermore, after the intervention, the IG outperformed the CG for both general EBP knowledge and Fresno Test scores on both pre- and post-intervention comparisons.
The educational intervention had a positive statistically significant impact on EBP knowledge and skills among healthcare professionals in the IG compared to the CG. These findings underscore the potential of structured educational initiatives to enhance the quality of clinical practice through improved EBP competencies.
UTN U1111-1322-8443
To determine whether a novel urine collection device (the ‘Pee-in-Pot (PiP)’) produces the same rates of reportable urine culture results as standard of care (SOC) urine collection. To determine whether the PiP produces comparable microscopy results to SOC urine collection. To estimate the carbon footprint of the PiP compared to SOC urine collection.
A prospectively designed, single-centre, paired comparison study.
A district general hospital in Southwest England, including antenatal clinical, accident and emergency, medical and surgical ward environments.
Adults aged 18 or over.
Urine passed through the PiP device before being decanted into a 10 mL boric acid tube for microscopy and culture, compared with the same urine contained only in a sterile plastic vessel before being decanted into a boric acid tube for microscopy and culture.
The proportion of positive urine culture results.
The proportion of heavy mixed growth culture results. Comparison of particle counts: all small particles, bacteria, red blood cells and white blood cells.
Microscopy was performed for 1353 paired samples, of which 808 paired samples both underwent culture. Overall, urine cultures were positive in 9.3% (75/808) and 10.0% (81/808) of PiP and control cases, respectively. Overall matching between PiP and control arms for reportable positive culture results was 98.5% (796/808), with a Cohen’s Kappa test coefficient () of 0.9149 (almost perfect agreement). There was no significant difference in the rate of positive urine culture results between testing arms for any organisms (margin of non-inferiority prospectively defined as ±2.5% for Escherichia coli positive cultures). For microscopy, there was agreement in meeting culture thresholds for 1308 of 1353 paired samples with a difference in culturing rates of 0.00517 (95% CI –0.0045 to 0.015, ie, high level of agreement). The estimated base case carbon footprint of PiP testing was 95g CO2e compared to 270g CO2e for SOC testing.
This study found the PiP to be non-inferior for routine urine microscopy and culture testing and to have a lower carbon footprint compared with SOC urine testing.
Commentary on: Tong, F., Wang, Y., Gao, Q., Zhao, Y., Zhang, X., Li, B., & Wang, X. (2024). The epidemiology of pregnancy loss: global burden, variable risk factors, and predictions. Human Reproduction, 39(4), 834-848.
Implications for practice and research Development of preventive measures for pregnancy loss from policy makers in countriesof concern. Investigation of minority women across underrepresented countries to determine causesand trends of pregnancy loss.
Pregnancy loss carries significant healthcare challenges to individuals, certain regions and the world at large. Pregnancy loss is defined as the spontaneous end of a pregnancy before the fetus has reached viability and encompasses all losses from conception until 20–24 weeks Dimitriadis E,
This study aimed to investigate factors influencing the acceptance of smartphone applications among high-risk pregnant women in the Lao People's Democratic Republic to support continuous care.
An explanatory sequential mixed-methods design.
The quantitative phase included 167 high-risk pregnant women recruited from four tertiary hospitals in Vientiane, Lao PDR. Validated questionnaires were used to measure demographics, digital technology usage, eHealth literacy and anxiety. Data were analysed using descriptive statistics and multiple regression analysis. In the qualitative phase, in-depth interviews with 20 women were conducted to further explore experiences, perceptions and barriers related to smartphone application usage. Interviews were analysed via direct content analysis.
Quantitative findings indicated that smartphone application acceptance was significantly predicted by eHealth literacy (B = 1.53, 95% CI 1.22–1.84, p < 0.001) and pre-existing non-communicable diseases (B = 4.39, 95% CI 1.05–7.73, p = 0.010). Anxiety negatively impacted acceptance (B = −0.28, 95% CI −0.51 to −0.05, p = 0.019). The model explained 53.9% of the variance in smartphone application acceptance (R 2 = 0.539). Qualitative findings highlighted four key themes: awareness of pregnancy risks, unclear health information, perceived benefits of smartphone applications including accessibility and emotional reassurance and practical barriers such as internet costs and limited digital literacy.
Positive perceptions of smartphone applications regarding accessibility and reassurance were observed, alongside significant barriers, such as limited digital literacy and internet costs. Addressing these factors may enhance the adoption and effective utilisation of digital health technologies among high-risk pregnant populations.
No patient or public contribution.
Migration is a complex global phenomenon, with millions of people relocating each year driven by various social or personal reasons. Among them, refugees and asylum seekers form a particularly vulnerable subgroup, often forced to escape conflicts, persecution or life-threatening conditions. Most mental health assessment tools, originally developed in high-income countries and validated primarily in Western populations, may lack the cultural validity needed for this demographic. The primary objective is to systematically review and synthesise the psychometric properties and cultural validity of mental health assessment tools validated for refugees and asylum seekers. Secondary objectives are to (a) identify the range of mental health symptoms these tools assess and (b) describe the geographical coverage in terms of the regions of origin and host countries where tools have been validated.
Reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, the review will conduct searches across different databases (ie, MEDLINE, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO, Global Index Medicus, CINAHL and Scopus), from inception to January 2025, with no restrictions on language. We will include validation, adaptation or diagnostic accuracy studies, as well as any other study design that reports at least one psychometric property of a mental health assessment tool. Two pairs of reviewers will screen, extract and appraise each study independently. Methodological quality will be assessed with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk-of-Bias checklist for measurement studies and QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) for diagnostic accuracy studies; the certainty of the evidence per property will be graded using the COSMIN-GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Narrative synthesis will be performed for all properties; where appropriate, meta-analyses will pool Cronbach’s α (Fisher-Z), intraclass correlations and sensitivity/specificity estimates using random-effects models. Inconsistency will be explored with subgroup analyses and meta-regressions; publication bias will be investigated with funnel plots and Egger’s test when ≥10 studies are available.
Ethical approval is not required for this systematic review, as no empirical data will be collected. Results will be disseminated through a peer-reviewed publication in a scientific journal and presented at relevant conferences.
CRD42024510901.
Whereas diabetes-related stigma is increasingly recognized as a barrier to diabetes management, little is known about this social phenomenon in collectivist African settings. The purpose of this study was to examine diabetes-related stigma among adults with type 2 diabetes (T2D) in Ghana, highlighting behavioral and psychological mechanisms underpinning the impact of stigma on hemoglobin A1C.
Cross-sectional analytical design.
Adults with T2D (n = 190), seeking care at a tertiary hospital in Ghana, were recruited. A battery of questionnaires assessing psychological (diabetes-related stigma, depression, anxiety, diabetes distress) and behavioral constructs (diabetes concealment and diabetes self-management) were administered. Venous blood samples were obtained for A1C assessment. A latent variable, “adverse psychological outcomes” comprising anxiety, depression, and diabetes distress, was derived and validated using confirmatory factor analysis. Structural equation modeling was used to test multiple psychological and behavioral pathways through which stigma was associated with A1C.
Participants had an average age of 59.44 (SD = 10.7) years, were mostly female (70.5%, n = 134), and had T2D diagnosis for a median of 14.5 years. We found significant indirect effects of T2D stigma on HbA1c through adverse psychological outcomes alone (β = 0.16; 95% CI: 0.01, 0.32, p = 0.038), as well as the combination of adverse psychological outcomes and self-management behaviors (β = 0.16; 95% CI: 0.001 to 0.32, p = 0.048). We also found that the association between T2D stigma and diabetes self-management was fully mediated by adverse psychological outcomes, and participants who conceal their diabetes tend to report greater adverse psychological outcomes.
We note that adverse psychological outcomes play a central role in how T2D stigma is associated with HbA1c. Our findings provide preliminary insight into potential aspects of diabetes that may be targeted in future stigma-reduction interventions.
Our results do provide some indication that addressing mental health issues in individuals with T2D may be an effective intervention strategy in curtailing the adverse clinical effects of T2D stigma. Additionally, our results highlight the importance of incorporating mental health care as part of routine diabetes management in Ghana and other similar African countries where mental health issues are often not prioritized by the healthcare system.
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.
by Patcharaporn Charoenrit, Pimjai Niparuck, Porpon Rotjanapan
There are no definitive clinical practice guidelines regarding the necessity and dosage of trimethoprim–sulfamethoxazole (TMP/SMX) prophylaxis for Pneumocystis jirovecii pneumonia (PJP) in individuals undergoing rituximab therapy. This retrospective study evaluated the effectiveness and safety of various TMP–SMX prophylactic dosing regimens over a 1-year period in 690 patients with non-Hodgkin lymphoma treated with rituximab at a university hospital in Thailand from 2013 to 2022. Out of these patients, 622 (90.1%) received TMP/SMX, with a mean duration of prophylaxis of 265.7 days (SD 85.66). The overall incidence of PJP was 1% (7 patients), which was significantly higher in the non-prophylaxis group (5.8%, 4 patients) compared to the prophylaxis group (0.6%, 3 patients). No cases of PJP occurred among those receiving standard prophylaxis or a single-strength tablet every other day, three times a week. However, instances in the prophylaxis cohort were reported in patients who took two single-strength tablets twice daily, twice a week. Prophylaxis resulted in a significant reduction in the one-year incidence of PJP, with a hazard ratio of 0.105 (95% CI: 0.023–0.469). Mild adverse reactions were noted in 3.05% of patients, all of whom recovered. These findings suggest that TMP/SMX prophylaxis was associated with a lower incidence of PJP and was well tolerated. Future studies should explore optimal dosing strategies while considering patient selection bias and concurrent immunosuppressive therapy.To assess the acceptability and adoption of multiparameter point-of-care testing (POCT) devices for the diagnosis and management of non-communicable diseases (NCDs) at the primary healthcare level in a resource-limited region of Peru.
Qualitative case-control process evaluation.
Eight primary healthcare facilities in northern Peru, including both urban and rural centres, where routine chronic care and laboratory services are provided.
Sixty-three participants: 36 patients, 12 laboratory technicians, 10 healthcare professionals and five facility heads. Eligible patients were ≥18 years, residing in the catchment area, with or without prior NCD diagnoses. Healthcare workers, including physicians, nurses, laboratory staff and facility managers.
Multiparameter POCT devices were installed in four intervention facilities, accompanied by staff training and community awareness activities, while four control facilities continued with conventional laboratory diagnostics.
Primary outcome: perceptions of patients and healthcare workers regarding the acceptability and adoption of POCT devices. Secondary outcomes: identification of facilitators and barriers to implementation, including infrastructure, supply chains and training gaps.
(1) Individuals: POCT was valued for speed and comfort, but concerns over accuracy were mentioned. (2) Intervention characteristics: laboratory staff valued POCT’s practicality in emergencies, but noted limitations in handling multiple samples. (3) Outer setting: urban centres outperformed rural facilities, with more staff and longer operating hours. (4) Inner setting: calibration gaps impacted POCT and conventional test reliability, requiring quality control and training. (5) Process: clear staff communication boosted patient confidence in POCT, but inconsistent training could lead to reliability doubts.
Multiparameter POCT devices show promise for enhancing NCD care in resource-limited primary healthcare settings, particularly in rural areas. However, their sustainability depends on broader health system reforms, including reliable supply chains, expanded training and stronger quality assurance mechanisms. Further research should examine strategies for embedding POCT within national regulatory and policy frameworks.
by Hanna Klimza, Bartosz Zakrzewski, Andrzej Porębski, Małgorzata Wierzbicka
ObjectivesAdjuvant intralesional administration of bevacizumab has shown promising effects in the management of recurrent respiratory papillomatosis (RRP). However, the optimal therapeutic parameters remain undefined. This prospective study aimed to compare the efficacy of two distinct intralesional bevacizumab administration protocols following surgical resection of RRP.
MethodsBetween 15/09/2023 and 31/12/2024, adult patients with RRP were enrolled in a prospective research study. Participants were allocated to one of two bevacizumab administration protocols, delivered intralesional during direct microlaryngoscopy and CO₂ laser excision. Disease severity was assessed using the Derkay, Dikkers and Numerical scoring systems, as well as the Voice Handicap Index (VHI), at baseline and at 8-week intervals.
ResultsBoth treatment regimens were associated with reduction in disease burden and improved voice outcomes. No statistically significant differences in disease control were observed between the two administration protocols.
ConclusionThis study indicates that both dosing regimens of bevacizumab were effective as an adjunctive therapy of recurrent respiratory papillomatosis. The higher intralesional doses of bevacizumab are relatively safe and well tolerated in adult patients with laryngeal RRP. Further studies with extended follow-up are warranted to define long-term efficacy and optimal dosing strategies.
by Tanaporn Anosri, Soraya Kaewngam, Ram Prajit, Kornrawee Suwannakot, Nataya Sritawan, Anusara Aranarochana, Wanassanan Pannangrong, Jariya Umka Welbat, Peter Wigmore, Apiwat Sirichoat
Methotrexate (MTX) is used in treating several malignancies. However, MTX neurotoxicity remains a significant clinical side effect, leading to cell division malformation, and neurogenesis impairment. Chrysin, a flavonoid compound found in natural products, demonstrates various biological characteristics, including neuroprotective and antioxidant properties. The purpose of this study was to investigate the ameliorative effect of chrysin on oxidative damage and neurogenesis impairment caused by MTX. Male Sprague-Dawley rats were randomly divided into four groups, including the vehicle, MTX (75 mg/kg), chrysin (10 mg/kg), and chrysin+MTX groups. Chrysin was orally administered for 15 days. MTX was administered intravenously on days 8 and 15. The hippocampal neural stem cells were evaluated using sex determining region Y-box 2 (sox2) and nestin immunofluorescence staining. Antioxidant enzyme expression and the levels of oxidative stress marker were assessed. Additionally, the expressions of nuclear factor erythroid 2-related factor 2 (Nrf2), brain-derived neurotrophic factor (BDNF), cAMP-response element binding (CREB), and phosphorylated CREB (pCREB) were evaluated using Western blotting. Results showed that MTX significantly decreased the activity of antioxidant enzymes and produced oxidative stress. MTX also impaired neurogenesis, evidenced by decreased sox2 and nestin-positive cells and decreased expression of Nrf2, BDNF, CREB, and pCREB in the hippocampus and prefrontal cortex. However, chrysin significantly reversed the effects of MTX on these parameters. In conclusion, chrysin exhibits neuroprotective effects against MTX-induced neurogenesis impairment by upregulating antioxidant enzyme activity, reducing oxidative stress, and improving protein expression related to neurogenesis.To critically appraise and synthesise the evidence about the effects and experiences of care models and interventions to improve person-centred care for older people in long-term care facilities.
A mixed methods systematic review, following the Joanna Briggs Institute guidance and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
MEDLINE, PubMed, CINAHL, PsycINFO, Embase, Web of Science, Cochrane Library, and Thaijo were searched to identify relevant primary research published in English and Thai from January 2000 to February 2024.
All relevant primary research with quantitative, qualitative, and mixed methods design was included. A convergent synthesis approach was used to synthesise and integrate findings.
4070 records were identified, of which 30 studies were retained: 12 quantitative, nine qualitative, and nine mixed methods studies. The evidence revealed five themes: (1) personalised preference, social engagement, and well-being; (2) autonomy and dignity; (3) a home-like environment; (4) family involvement and satisfaction; and (5) organisational and staff support.
This review indicated that person-centred care models and interventions could improve residents' quality of life, autonomy, and promote individual care provision, create an environment based on individual needs, and involve families in care, although challenges such as staff shortages and lack of managerial support may hinder successful implementation. Future work is required to evaluate and identify effective strategies to strengthen organisational support, including leadership development, staff retention, and resource allocation, and evaluate how organisational culture influences the adoption and success of person-centred care practices.
The review provides valuable insights and a comprehensive understanding of the care models and interventions specifically designed to improve person-centred care and enhance the quality of life for older people in long-term care facilities.
Not applicable.
The protocol was registered with the PROSPERO (CRD42024509504)
FreshRSS 