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Severe pectus excavatum (PE) may impair cardiopulmonary and physical function. The effectiveness of surgical treatment to correct PE and restore physical function is widely debated due to a lack of high-quality comparative evidence. The RESTORE trial aims to determine the clinical and cost-effectiveness of corrective surgery for severe PE compared with conservative management for the first time in a randomised controlled trial (RCT).
RESTORE is a pragmatic, multicentre, RCT with an embedded observational cohort. 200 participants aged ≥12 years with severe PE will be recruited at around 12 National Health Service cardiothoracic surgical centres in England. Participants will be randomised 1:1 to receive either surgery within 3 months of randomisation (intervention arm) or no surgery until after the primary outcome measurement at 1 year (comparator arm). The primary outcome is change in physical functioning from baseline to 1 year as measured by the Short Form Health Survey (SF-36v2) physical function score. The primary economic outcome is cost-effectiveness. The key secondary outcome is change in % predicted VO2peak at 1 year measured by cardiopulmonary exercise test (CPET). Outcomes will be assessed at 1 year post-randomisation in the comparator arm and 1 year post-surgery in the intervention arm. The primary analyses will be undertaken on an intention-to-treat population using a linear mixed-effects model, adjusted for stratification variables via a binary covariate. Other secondary outcomes will include change from baseline of cardiopulmonary function (CPET and spirometry), health-related quality of life using the EuroQol 5 Dimension 5 Level (EQ-5D-5L) and SF-36v2 questionnaires, Hospital Anxiety and Depression Scale and disease specific symptoms (Phoenix Comprehensive Assessment for Pectus Excavatum Symptoms and Pectus Excavatum Evaluation Questionnaire). Adverse events, complications from surgery and operative technical success (Haller and Compression Indices from preoperative and postoperative CT scans) will also be assessed. Health economic analysis will estimate the incremental cost per quality adjusted life year at 1 year.
The trial was approved by East of Scotland Research and Ethics Service (24/ES/0034). Participants who are ≥16 years of age will be required to provide written informed consent. For participants
Investing in advanced nursing roles (AN) in social care is a strategic priority to address workforce challenges, create new career pathways, improve outcomes and future-proof the sector. However, there is limited understanding of these roles globally. This systematic scoping review maps the international presence and impact of post-qualification advanced practice roles for registered nurses (RNs) working in care homes and charitable organisations.
This review was conducted following the methodology established by the JBI and adhered to the PRISMA extension for scoping reviews checklist.
Studies were included if (1) they included RNs working in care homes, charities or not-for-profit health centres, (2) the RN was in a specialist, enhanced or advanced practice role and (3) if role details were provided. Studies were limited to those published in the English language between 2014 and 2024. Evidence was gathered from a comprehensive search of electronic databases (CINAHL, MEDLINE, Scopus, PubMed and Web of Science), grey literature, relevant webpages, and reference lists. Expert consultations were also conducted. Eligible full texts were reviewed in Covidence software by two independent researchers.
The search yielded 575 records, and 89 were taken forward for full-text screening. A total of 20 met the inclusion criteria: 19 were concerned with AN roles in care homes, and one focused on a charitable organisation. The majority of these studies (n = 12) were conducted in North America.
The literature on AN roles in care homes and charitable organisations is notably sparse. Despite this, the available evidence highlights substantial benefits, including improved care quality, enhanced resident outcomes and positive impacts on team dynamics. This review identifies four key themes: scope of practice, positive impacts, influencing factors and barriers, which provide a framework for policymakers, healthcare leaders and educators to optimise the contributions of this group within the evolving global social care sector.
Not undertaken because of the nature of scoping reviews.
This review highlights the crucial role of advanced nurses in enhancing care quality, resident outcomes, and workforce sustainability in care homes and charitable organisations. The findings provide direction for policymakers and health and social care leaders to further develop the role of nursing in social care settings globally.
FreshRSS 