Conectar
by José Manuel García-Moreno, Tyler Adams, Amber Beynon, Janine Vlaar Olthuis, Stephan U. Dombrowski, Richelle Witherspoon, Niels Wedderkopp, Jeffrey J. Hébert
BackgroundRehabilitation and behavior change interventions are commonly used after lumbar surgery to improve recovery, but their effects on physical capacity and physical activity remain unclear. This study aimed to investigate the effectiveness of rehabilitation and behavior change interventions on physical capacity and physical activity behavior in patients following lumbar surgery for degenerative disease.
MethodsEMBASE, MEDLINE, PsycINFO, and CENTRAL were searched from inception to September 2025 and reference lists were hand-searched. Randomized controlled trials assessing rehabilitation or behavior change interventions on physical capacity or physical activity behavior in adults with lumbar degenerative disc disease who underwent lumbar surgery were included. Review author pairs independently extracted data and assessed included studies. Risk of bias was assessed with the Cochrane tool, and study quality with the Grading of Recommendations Assessment, Development and Evaluation classification. Results were pooled using random-effects models and reported as standardized mean differences (SMD) with 95% confidence intervals (CI).
ResultsExercise was more effective than minimal or usual care in improving trunk extension endurance in the immediate term (SMD, 1.54; 95% CI, 0.93–2.16). Supervised exercise outperformed self-directed exercise in improving trunk extension endurance in the immediate term (SMD, 1.28; 95% CI, 0.75–1.81). Psychologically informed rehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.26; 95% CI, 0.02–0.49), but not in the immediate term (SMD, 0.17; 95% CI, −0.14 to 0.49). Physical activity advice did not increase physical activity levels compared to minimal or usual care in the immediate term (SMD, 0.21; 95% CI, −0.13 to 0.55). Prehabilitation was more effective than minimal or usual care in increasing physical activity levels in the intermediate term (SMD, 0.28; 95% CI, 0.03–0.53). Certainty of evidence ranged from low to moderate.
ConclusionsFor adults with lumbar degenerative disease who underwent lumbar surgery, exercise, especially supervised programs, improved trunk extension endurance in the immediate term. Psychologically informed rehabilitation and prehabilitation increased physical activity levels in the intermediate term, while physical activity advice showed no benefit. Findings are limited by low certainty of evidence and high risk of bias.
by Emily Tufano, Kondaiah Palsa, Rebecka O. Serpa, Timothy B. Helmuth, Gabriela Remit-Berthet, Sara Mills-Huffnagle, Mathias Kant, Aurosman Sahu, James R. Connor
Iron is essential for normal physiological function, yet dysregulation of iron metabolism is increasingly recognized as a hallmark of cancers such as glioblastoma (GBM). Recent clinical evidence suggests that systemic iron deficiency anemia (IDA) negatively impacts GBM outcomes in a sex-dependent manner, but the mechanisms linking systemic iron availability to tumor iron metabolism remain poorly understood. Here, we interrogate the impact of systemic iron through dietary modulation (control, iron deficiency (ID), and high iron diets), stratified by sex, on tumor iron handling and GBM outcomes utilizing an immune competent (C57BL/6) GBM (GL261) mouse model. Subsequently, we analyzed clinical samples to evaluate translational value. In the preclinical study, we show that iron deficiency decreased survival in males but conferred a slight survival advantage in females, consistent with prior clinical trends. Among circulating iron markers, only ferritin light chain (FTL), but not ferritin heavy chain (FTH) or serum iron, positively correlated with survival in males but not females. In the brain, contralateral iron levels reflected dietary iron status in males but not females, further supporting sex-dependent regulation of local and circulating iron. Notably, tumor iron content remained unchanged in males but was significantly elevated in ID female tumors, complemented by increased transferrin receptor (TfR1) and FTH expression. In clinical GBM samples, we observed non-statistically significant but similar survival trends across varying iron and ferritin levels, suggesting potential translational relevance of our exploratory model. These findings demonstrate that systemic iron availability exerts a sex-specific effect on tumor iron handling, highlighting a critical relationship between systemic and tumor iron regulation in GBM.by Sandra S. Chaves, Valérie Bosch Castells, Ainara Mira-Iglesias, Joan Puig-Barberà, F. Xavier López-Labrador, Miguel Tortajada-Girbés, Mario Carballido-Fernández, Joan Mollar-Maseres, Germán Schwarz-Chávarri, Javier Díez-Domingo, Alejandro Orrico-Sánchez, Valencia Hospital Network for the Study of Influenza and other Respiratory Viruses (VAHNSI)
BackgroundUnderstanding the burden of acute viral respiratory infection-related hospitalizations is crucial for guiding research and development. Unlike influenza, respiratory syncytial virus (RSV), or severe acute respiratory syndrome coronavirus 2, no pharmaceutical interventions exist for other respiratory viruses; therefore, their impact remains poorly characterized. This study aimed to investigate the association of current non-vaccine-preventable respiratory viruses, especially rhinovirus/enterovirus (RV/EV), on hospitalizations during the respiratory seasons.
MethodsData from a prospective study that used multiplex polymerase chain reaction to conduct long-term surveillance on respiratory viruses in Valencia, Spain were analyzed. Patients aged ≥50 years hospitalized due to respiratory illness from 2014–15–2019–20 were included.
ResultsRespiratory viruses were detected in 35.2% (3,755/10,675) of hospitalized patients with acute respiratory illness. Influenza and RSV accounted for 22.1% of hospitalizations, RV/EV for 7.6%, and other non-vaccine-preventable viruses for 5.4%. Adults ≥75 years had average seasonal hospitalization incidence rates more than twice those aged 65–74 years and eight times those aged 50–64-year-olds. No significant differences in severity markers were observed among patients with or without virus identified, those aged ≥75 years had a 2–3 times higher mortality rate compared to younger age groups.
ConclusionsThe potential impact of respiratory viruses on hospitalization rates among older adults, particularly those aged ≥75 years, highlights the need for targeted interventions to reduce healthcare system burden. Enhanced diagnostic capabilities and the development of next-generation preventive strategies, including vaccines and therapeutics, could improve patient outcomes and strengthen the resilience of the healthcare system during respiratory virus seasons.
by Esther Ortega-Martin, Javier Alvarez-Galvez
ObjectiveTo characterize the heterogeneity of Long COVID (LC) by identifying distinct patient profiles based on symptoms and quality of life (QoL), and to examine the sociodemographic and clinical predictors associated with these profiles.
Study designA cross-sectional observational study was conducted.
MethodsWe recruited 363 patients with LC in Spain via an online survey. Symptom patterns were identified through latent class analysis of 15 binary symptoms. QoL was assessed with the patient-derived LC-6D-QoL across six dimensions, and cluster analysis defined QoL subgroups. Logistic regression was applied to examine clinical and sociodemographic predictors of QoL profiles.
ResultsTwo symptom profiles emerged: a low-burden profile, dominated by fatigue and cognitive problems, and a high-burden profile with multisystem involvement. QoL clustered into three profiles—high, middle, and low QoL—with more than half of participants in the low QoL group. Symptom burden and employment status were the strongest predictors of poor QoL, whereas age, sex, education, and income showed limited associations. Social support was more frequently reported among participants with low QoL.
ConclusionsLC is characterized by distinct clinical and QoL profiles, with strong interactions between multisystem symptom burden and social determinants. Identifying patients at greatest risk of poor QoL can inform stratified interventions and integrated policies that combine medical care, psychosocial support, and workplace reintegration.
Staphylococcus aureus (S. aureus) bacteraemia is a common and severe infection. With mortality rates ranging from 20–30% and long-term impairments in over a third of survivors, better treatments are urgently needed. Linezolid, a well-established treatment for pneumonia and complicated skin infections, has been shown in preclinical studies to strongly suppress S. aureus virulence factors critical to bacterial persistence and tissue damage. Hence, we aim to investigate whether the addition of linezolid to standard therapy in patients with S. aureus bacteraemia leads to an overall improvement in patient-relevant outcomes.
We will conduct a two-arm, parallel-group, multicentre, randomised controlled trial (Linezolid Plus Standard of Care) in 12 hospitals in Switzerland with blinded treating physicians, patients and outcome assessors. Hospitalised patients aged ≥18 years with S. aureus bacteraemia will be eligible. Patients will receive standard antibiotic treatment as prescribed by the treating physician. Within 72 hours of collection of the blood sample yielding the first positive blood culture, patients will be enrolled and randomised 1:1 to receive either adjunctive linezolid (600 mg orally two times per day for 5 days) or placebo. To determine patient-relevant outcomes, we implemented a comprehensive patient-representative consultation process. Consequently, we will use the desirability of outcome ranking (DOOR) established for S. aureus bacteraemia as the primary outcome at 90 days. The hierarchical composite DOOR outcome includes the following four components, ranked from most to least important: (1) survival, (2) return to level of function before S. aureus infection, (3) complications leading to treatment changes and serious adverse reactions; and (4) hospital length of stay. This approach will allow us to analyse the win ratio, that is, whether patients receiving linezolid have a better DOOR rank compared to patients in the placebo group. We calculated a target sample size of 606 patients providing 90% power at a two-sided significance level of 0.05.
Ethical approval was received from the Ethics committee for Northern and Central Switzerland (BASEC number 2025-00655). Eligible patients will be informed about the study by the local study team and asked for written consent if they wish to participate. For patients unable to provide informed consent, an appropriate substitute (ie, a close relative or a physician not involved in the research project) may make decisions based on the presumed wishes and the best interest of the patient. The patient’s own consent will be obtained as soon as their condition permits. Results will be published in peer-reviewed journals and in laymen's terms through various channels (social media, Swiss national portal HumRes).
Despite its serious impact, anorexia nervosa (AN) remains one of the least understood mental illnesses, with significant gaps in effective treatment options. No medications have been deemed effective and only 50% of individuals respond to conventional psychotherapies. Gastrointestinal (GI) bacteria have been found to be altered in individuals with AN. While, Fecal microbiota transplantation (FMT) has shown potential for alleviating anxiety and depression, its effects remain understudied for individuals with AN. This study aims to determine whether oral capsular FMT is acceptable to adolescents with AN and results in clinical improvement in weight and/or psychological symptoms.
This study will randomise 20 adolescents with AN, ages 12–17 years, to receive either FMT or placebo capsules. These 20 youth, as well as an additional 10 youth who decline trial enrolment, will participate in qualitative interviews. We will track recruitment rates and collect psychological and biological measures (blood, stool, urine and saliva) at multiple timepoints to assess how gut microbiota and their metabolites may influence the symptoms of AN. Interviews with participants and caregivers will explore their experiences and views on FMT as a treatment approach.
This study has received ethics approval by the Hamilton Integrated Research Ethics Board (#17493) and investigational drug approval by Health Canada (Dossier ID: c292423). Informed consent will be obtained by research staff from all participants. Findings will be disseminated through academic conferences, clinical forums and partnerships with advocacy organisations to reach clinicians, researchers and individuals with lived experience.
Self-injurious behaviour (SIB) consists of persistent, repetitive movements that can result in serious injury without suicidal intent. These behaviours are prevalent among children with neurodevelopmental disorders, including profound autism. Although many individuals benefit from currently available therapies, some exhibit treatment-refractory SIB that necessitates ongoing use of personal protective equipment and restraint, presumably due to stronger neurobiological drivers. We recently completed a phase I, open-label clinical trial demonstrating the safety, feasibility and preliminary efficacy of bilateral deep brain stimulation targeting the nucleus accumbens (NAc-DBS) in children with profound autism and severe, refractory SIB. The objective of the proposed study is to characterise the effectiveness of NAc-DBS in treating severe, refractory SIB in this unique and vulnerable population.
A single-centre, randomised double-blinded, crossover trial is proposed. Informed by the results of our pilot study, 25 subjects with autism spectrum disorder and severe, refractory SIB will undergo bilateral NAc-DBS. Following a 4-week recovery period, participants will be randomised to either group A (stimulation ON then OFF) or group B (stimulation OFF then ON). Each block will last 12 weeks, separated by a 2-week washout period. Following completion of the second block, all participants will enter a 6-month open-label phase with stimulation ON. The primary outcome is the difference in the Repetitive Behaviour Scale–Revised total score, between DBS-ON and DBS-OFF conditions. Secondary outcomes include measures of quality of life, caregiver burden, daily logs of SIB events and direct observation of SIB under structured analogues.
The proposed trial has been approved by the institutional Research Ethics Board (1000081171). Trial results will be disseminated through peer-reviewed publications and conference presentations.
Domestic sex trafficking is a major health and human rights concern associated with profound social, physical and psychological harms, including complex trauma. People who are being/have been sex trafficked often present to emergency departments (EDs) with unmet health needs and in contexts shaped by coercion, control and fear of authority. ED encounters represent an important setting for identifying sex trafficking, building trust, making referrals to specialised resources and facilitating an exit out of sex trafficking. This scoping review will explore the care experiences and processes for sex trafficked persons in EDs by synthesising existing evidence on the barriers and facilitators to providing high quality, equitable and effective emergency care. This review represents the first phase of a multi-stage study to develop quality indicators (QIs) for ED clinicians providing care for people experiencing domestic sex trafficking in Canada.
This scoping review will follow Arksey and O’Malley’s framework, as updated by Levac and colleagues, which consists of: (1) identifying a research question(s); (2) identifying relevant literature; (3) selecting studies; (4) charting/extracting data; (5) collating, summarising and reporting results; and (6) consulting with community partners. Five databases will be systematically searched to find scholarly, empirical studies describing emergency care experiences and processes for people being sex trafficked. Data will be extracted using a standardised charting tool developed by the lead author and research team.
Research Ethics Board (REB) approval is not required for this study as it involves an analysis of published literature only. Findings will be synthesised into a set of candidate QIs to be disseminated.
Chronic wounds represent a major global health and economic burden. Smart wound dressings integrate biosensing and stimuli-responsive materials to monitor and modulate biological parameters within the wound microenvironment. This scoping review maps the biological parameters monitored by smart wound dressings, an area not previously synthesized across preclinical and clinical contexts. Following Joanna Briggs Institute (JBI) and PRISMA-ScR frameworks, five databases were searched in March 2025. Studies published between 2008 and 2025 reporting biosensing or responding technologies in wound dressings were included. A total of 179 studies met the inclusion criteria, most being preclinical (in vitro or in vivo rodent models), with few human investigations. The most frequently monitored parameters were pH, temperature, oxygenation, moisture, bacterial burden, and protease activity (particularly MMP-9). Preclinical data showed enhanced collagen deposition, angiogenesis, and infection control compared with conventional dressings, whereas human studies mainly assessed feasibility and biocompatibility. Smart dressings demonstrate strong technical and biological performance, but clinical validation and standardized outcome reporting remain limited. Future interdisciplinary research should prioritize well-designed clinical trials to confirm therapeutic and economic benefits and enable translation into personalized wound care.
Calcium sulphate (CS) is a fully synthetic, sterile, bioabsorbable biomaterial extensively applied for the management of infected tissues and postoperative dead spaces resulting from surgical interventions. Residual DS may facilitate hematoma accumulation and bacterial colonisation, thereby heightening the risk of surgical-site infections. Within orthopaedic surgery, CS has been predominantly evaluated as a bone-void filler and an off-label antibiotic delivery vehicle—particularly in arthroplasty revisions, chronic osteomyelitis, and open fractures—yielding high rates of infection prophylaxis, bone regeneration, and low complication profiles. Commercially available as injectable ‘pearls’ or beads, CS permits local, sustained antibiotic elution while undergoing gradual biodegradation, thus obviating the need for secondary removal procedures. Over the last decade, Calcium Sulphate beads (CSBs) have transcended orthopaedics, gaining traction across general, vascular, and endocrine surgery disciplines for the prevention and treatment of complex wound infections. However, their application in plastic and reconstructive surgery remains underreported, despite the specialty's frequent engagement with complex soft-tissue defects, bone exposure, suture dehiscence, and trauma-related wounds vulnerable to infection. To our knowledge, this represents the first scoping review synthesising current evidence, clinical indications, and emerging roles of CSBs within plastic and reconstructive surgery.
To identify facilitators and barriers to quality, equitable discharge teaching by paediatric emergency department nurses during the COVID-19 pandemic, describe impacts of inequitable discharge teaching, and identify potential solutions to the barriers.
Twenty-two nurses in a single urban paediatric hospital participated in individual interviews from January to April 2022 via phone or videoconference. Interviews were transcribed and analysed using an inductive codebook.
Six barriers to equitable discharge teaching were identified: ED overcrowding, travel nurse training/knowledge, burnout and stress, increased role complexity, COVID precautions, and resource bottlenecks. Two facilitators were also identified: engagement and effective communication. Nurses described the impacts of these barriers along with proposed solutions to improve discharge teaching.
The COVID-19 pandemic created additional barriers to discharge teaching in the paediatric emergency department. Nurses identified barriers and facilitators, the impacts on patients and families, and potential solutions to improve equitable discharge teaching.
This study identifies how periods of high patient volumes or frequent process changes during a pandemic exacerbate inequities in discharge teaching.
This study identifies barriers and facilitators that shaped nurses' ability to provide quality, equitable discharge teaching during the COVID-19 pandemic and offers actionable guidance for hospital leaders and health systems to improve discharge teaching and enhance emergency preparedness for future public health crises.
This study conforms to the Standards for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
ClinicalTrials.gov identifier: NCT04676490
To explore the perceptions of older female caregivers living in poverty in a high-income country regarding their health and self-care needs.
Descriptive qualitative study.
Seventeen semi-structured interviews were conducted with older female caregivers between October 2023 and March 2024. The reflexive thematic analysis method described by Braun & Clarke was followed, and ATLAS.ti 25 software was used for data analysis.
The analysis identified one main overarching theme, ‘Caring as an expected role that shapes identity and daily life’ and two interrelated themes: (1) ‘The need for a holistic approach to self-care’ and (2) ‘Caring on empty in the context of economic hardship and limited support’.
Self-care among older female caregivers living in poverty is constrained by caregiving expectations and socioeconomic disadvantage. Addressing their health needs requires nursing interventions that recognise caregiving as a central element of their lives and adopt holistic, context-sensitive approaches.
Nursing interventions should comprehensively assess older female caregivers' multidimensional health needs and enhance access to integrated support and services, addressing structural gender and socioeconomic inequities to strengthen health, dignity, and resilience.
Living in poverty exacerbates the challenges older female caregivers face in attending to their own health and self-care, increasing the risk of exhaustion, distress, and chronic illness. Recognising and addressing these needs through equitable, targeted interventions is essential to reduce health inequalities.
The study has been reported following the COREQ guidelines.
Limited patient and public involvement was incorporated, focusing on verification of their transcripts, ensuring accuracy and credibility in the interpretation of their accounts.
by Boru Abera Ebsa, Maleda Tefera, Dawit Tamiru, Abraham Negash, Naol Oda, Merga Dheresa
BackgroundThe neonatal period is the most vulnerable time for an infant’s survival, particularly for preterm neonates. Preterm birth is among the leading causes of neonatal mortality. Many neonatal complications can be prevented, but preterm birth remains a leading cause of admission, death, and long-term complications, highlighting the need for further research on outcome and survival disparities across populations and settings. Therefore, this study aimed to assess survival status and predictors of mortality among preterm neonates admitted to neonatal intensive care units at public hospitals in the Harari region and Dire Dawa administration, Eastern Ethiopia, from November 1, 2021 to October 30, 2024.
MethodsThe hospital-based retrospective cohort study was conducted among preterm neonates admitted to the neonatal intensive care unit at public hospitals of the Harari region and Dire Dawa administration, Eastern Ethiopia. A simple random sampling technique was used, and data were extracted from neonates’ medical records and registration formats using a structured checklist prepared in English. Descriptive statistics, life table, Kaplan-Meier curves, and Log-rank test were used to estimate and compare survival time. Predictors of mortality were identified using the Cox Proportional Hazard model.
ResultsOut of 612 preterm neonates, 205 (33.5%; 95% CI: 29.76–37.39) died, corresponding to an incidence rate of 52.76 deaths per 1,000 preterm neonate-days (95% CI: 46.01–60.50), with a median survival time of 18 days. As multivariable cox-regression result, ≥ 4 antenatal care contact (AHR = 0.56; 95% CI: 0.36–0.89), receiving KMC (AHR = 0.16; 95% CI: 0.09–0.27), 5th minute APGAR score Conclusion
The incidence of preterm neonatal mortality was high in this study. Adequate Antenatal care (ANC) and kangaroo mother care (KMC) significantly improved preterm survival, while low APGAR score, resuscitation with bag and mask, neonatal sepsis, PNA, and RDS were major predictors of preterm neonatal death. Emphasis should be placed on strengthening antenatal and perinatal care, along with early detection and management of identified neonatal complications.
by Dominika Buni, Áron Botond Kovács, Enikő Wehmann, Dénes Grózner, Krisztián Bányai, Eszter Zsófia Nagy, Janet Bradbury, Marco Bottinelli, Elisabetta Stefani, Salvatore Catania, Inna Lysnyansky, László Kovács, Miklós Gyuranecz, Zsuzsa Kreizinger
Mycoplasma iowae is an economically significant pathogen that causes reduced hatchability, late embryo mortality and leg deformities, chondrodystrophy and skeletal lesions in poults. While prevention is essential in the control of infection, the appropriate administration of antibiotics may reduce economic losses during outbreaks. As a first step in the exploration of antimicrobial resistance mechanisms in M. iowae, target modification and efflux pump activity were examined in the present study. Point mutations were analyzed in previously described antibiotic binding sites in the whole genome sequences of 99 M. iowae strains. Mismatch amplification mutation assays (MAMAs) were designed and validated for the differentiation of mutations corresponding to elevated minimum inhibitory concentration (MIC) values for fluoroquinolones. Broth microdilution assays were performed to evaluate the effect of efflux pump inhibitors. In the presence of orthovanadate (OV), MIC values were significantly lower than in the absence of OV for spiramycin, tilmicosin, tylosin and oxytetracycline, which may indicate the presence of an active efflux system in M. iowae. Putative promoter regions of efflux-related genes were predicted and characterized. Genetic mutations, previously described in other bacteria, were described to be associated with elevated fluoroquinolone, macrolide and lincomycin MICs in M. iowae, although certain resistant phenotypes remained unexplained, promoting future examinations for deeper insights. The developed MAMAs may support rapid identification of M. iowae strains with elevated MIC values for fluoroquinolones. The better understanding of the efflux pump mechanisms enables the development of alternative methods for the support of therapy against this pathogen.Perioperative myocardial injury (PMI) is a common complication following non-cardiac, particularly thoracic, surgery and is associated with increased cardiovascular risk. Although guidelines recommend cardiac biomarker monitoring to detect PMI, its implementation in routine clinical practice remains limited.
To evaluate the combined use of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in predicting major adverse cardiovascular events (MACE) following elective thoracic surgery, and to determine whether NT-proBNP provides incremental prognostic value beyond hs-cTnI alone.
Multicentre observational cohort study.
Conducted between February 2021 and November 2023 in three Spanish tertiary hospitals.
Patients aged ≥45 years scheduled for elective thoracic surgery involving lung resection (pneumonectomy, lobectomy, bilobectomy or segmentectomy) under general anaesthesia. Exclusion criteria included urgent or non-thoracic surgery, active infection or sepsis and a history of severe heart failure (ejection fraction
Combined measurement of hs-cTnI and NT-proBNP at baseline (preoperatively) and at 24 and 48 hours postoperatively.
PMI was defined as hs-cTnI ≥45 ng/L at 24 and/or 48 hours or a ≥20% increase from baseline in patients with elevated preoperative concentrations.
Among 475 patients, PMI occurred in 11.8%. PMI had higher rates of prior stroke (12.5% vs 2.9%; p=0.004), smoking history (85.7% vs 64.0%; p=0.001) and severe renal dysfunction (7.1% vs 0.7%; p=0.001), with similar Revised Cardiac Risk Index distribution. Patients with PMI also had greater postoperative elevations of hs-cTnI and NT-proBNP (p
Combined hs-cTnI and NT-proBNP assessment improves perioperative cardiovascular risk stratification beyond ischaemia.
Older adults admitted to intensive care units (ICUs) following elective surgery face heterogeneous trajectories of recovery spanning the physical, cognitive and social domains. Biological ageing processes, including cellular senescence, may modulate these outcomes. Here, we present the protocol for an analytic prospective observational cohort study integrating biopsychosocial assessments and senescence-associated biomarkers to identify predictors of health-related quality of life (HRQoL) and post-ICU recovery.
Single-centre, prospective cohort study at the University Hospital Halle (Saale), Germany. Adults aged 60 years or older scheduled to undergo elective surgery and who have a planned postoperative stay in the ICU of at least 24 hours and who are able to provide consent will be enrolled. Baseline pre-ICU data will include the following: medical history, comorbidity, medications, routine laboratory values and a comprehensive geriatric assessment (eg, frailty, mobility, handgrip strength, Timed Up & Go, cognition, mood, loneliness, social status and EuroQol 5-Dimension 5-Level, EQ-5D-5L). A 5 mL serum sample will be collected for a senescence-associated secretory phenotype panel and additional ageing biomarkers. Skin autofluorescence will be used to estimate advanced glycation end-products. Telephone follow-ups at 3 and 6 months ascertain HRQoL, functional outcomes, psychosocial outcomes, rehospitalisations and institutionalisation. The primary endpoint is defined as a stable or improved HRQoL (EQ-5D-5L) at 3/6 months vs baseline. We intend to use multivariable predictive modelling with elastic-net regularisation and conduct internal validation using bootstrap resampling and cross-validation.
This study has been approved by the Ethics Committee of the Medical Faculty, Martin-Luther-University Halle-Wittenberg (No. 2025-112). Written informed consent is obtained from all participants. The results of this study will be reported in a peer-reviewed journal.
DRKS00037969.
Intensive care units (ICUs) can be a particularly challenging environment for patients who are mentally vulnerable. In addition to the physical stress associated with critical illness and its management, there are physiological and psychosocial factors that can negatively impact a patient’s mental health. Approximately half of ICU survivors will experience post-intensive care syndrome, a set of emotional, neuropsychological and physical sequelae that can significantly affect patients’ functionality and quality of life, both in the short and long term. The main objective of this study is to investigate whether the ICU Recovery Answers (ICURA) digital follow-up platform can effectively detect emotional and cognitive problems in critically ill patients and its impact on functionality and health-related quality of life during the first year after ICU discharge.
Multicentre longitudinal prospective study involving ICU adult patients, with randomised follow-up comparing a telemedicine monitoring programme versus usual medical care during 1 year after discharge. A total of 360 participants will be recruited during their ICU admission in two hospitals in Spain. Efficacy outcomes will focus on participants’ level of functioning, assessed with the WHO Short Disability Assessment Schedule, and quality of life, measured with the 12-Item Short Form Survey at 1, 6 and 12 months after ICU discharge. Emotional state and cognitive impairment will be evaluated using the Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 and Treatment-Outcome Post-Traumatic Stress Disorder Scale and the Montreal Cognitive Assessment by telephone at 1, 3, 6, 9 and 12 months after ICU discharge.
The implementation of this project is expected to have a direct impact on the satisfaction of ICU survivors, improving their well-being, personalised follow-up and quality of life. Results from this study will be disseminated at various scientific conferences, national and international meetings, and will be shared with the general public and other relevant parties. The dissemination of these results will occur through scientific publications, allowing the medical and scientific community to benefit from the study’s findings. Ethics approval from the Ethics Board of Parc Taulí Foundation and Balearic Islands with reference numbers 2022/3031 and IB 5072/22 PI: Protocol version 1 of 18 November 2022.
In the USA, an estimated 40–50 million operations are performed annually, with high rates of adverse events. Since the 1980s, report cards have been used for outcome measures and to improve safety of surgical care. As part of Making Healthcare Safer IV—an initiative aimed at publishing evidence-based reviews as they are completed to help healthcare leaders, researchers and policymakers act more quickly on evidence-supported practices—we performed an updated review on the certainty of evidence on patient safety practices related to the use of surgical report cards and outcome measurements.
Systematic review using the Grade of Recommendations Assessment, Development and Evaluation (GRADE) approach.
PubMed, Web of Science, Scopus and the Cochrane Library were searched from November 2011 to May 2023.
We included primary research studies (randomised control trials or observational studies with a comparison group, including pre–post studies) or observational studies that investigated a surgical report card in adult or paediatric surgical patients at the hospital or surgeon level in inpatient or outpatient settings. Excluded studies included: narrative reviews, scoping reviews, editorials, commentaries, abstracts, studies that measured only patient knowledge or levels of engagement or studies using local surgical dashboard data.
Screening and eligibility were done in duplicate, while data extraction was done by one reviewer and checked by a second reviewer. Specific items in the Risk Of Bias In Non-randomised Studies - of Interventions tool and a modification of the National Institutes of Health Tool were used to assess for bias in studies. Two reviewers assessed each study for risk of bias. A modified version of the GRADE framework was used to assess the certainty of evidence.
We identified 19 studies that met the inclusion criteria: 13 primary research studies and 6 descriptive studies of surgical collaboratives. Of the primary studies, nine used a pre–post or longitudinal study design and four used a regression discontinuity or concurrent controlled design. Seven of the studies were about the American College of Surgeons National Surgical Quality Improvement Project. Five studies were from single institutions and the remainder included nine to greater than 700 hospitals. Pre–post studies of report cards that prompted quality improvement (QI) programmes all reported improvements in outcomes, longitudinal studies reported benefits in some but not all outcomes and one in four controlled before-and-after studies reported a statistically significant mortality benefit. All studies, except for one, were at moderate or high risk of bias. Six collaboratives were identified with preliminary data.
Based on the above evidence, the theoretical rationale and parallel evidence in other settings, we judged that it was moderate certainty that report cards and outcomes measurements can improve surgical outcomes. However, given the evidence from studies where report cards were actively linked to institutional QI initiatives, we recommend that outcome data must be paired with actionable QI efforts to meaningfully improve patient outcomes.
To explore the perceived effectiveness, impact and benefits of a work-based cancer survivorship peer support programme for healthcare employees who have experienced or are experiencing cancer.
A qualitative descriptive study.
Purposive sampling was used to recruit 33 participants (10 peers, 12 peer supporters, 4 line managers and 7 members of the governance group). Data were collected between October 2024 and February 2025 through individual interviews and focus groups. Data were analysed using reflexive thematic analysis.
Four themes were generated: Programme Reach and Adoption, Implementing the Programme, Programme Effectiveness and Impact and Programme Maintenance and Growth. Challenges included the pilot status of the programme impacting awareness and uptake, potential reluctance to share diagnoses and the impact of cancer on colleagues. The approach of peer supporters was considered central to the programmes' success. Peer supporters valued training and continuous practice development opportunities.
Demonstrated benefits, including satisfaction and the value of peer support, were evident. To ensure programme maintenance, increased recruitment and training of peer supporters and clear communication regarding the programme and referral pathways are essential. Financial support is required to maintain training and address dissemination challenges.
Work-based peer support programmes can help cancer survivors reintegrate into the workforce more effectively, rebuilding confidence, fostering resilience and navigating workplace expectations. Enhanced staff well-being may also positively influence retention, performance and health-related disruptions.
Findings from this underexplored area of work-based peer support within a healthcare setting have the potential to influence healthcare leaders, policy makers and future research. Improving staff's' quality of life on return to work benefits the individual, the organisation and care delivery by ensuring a healthy, supported workforce.
The Standards for Reporting Qualitative Research (SRQR) checklist and the Template for Intervention Description and Replication (TiDieR) checklist were utilised.
No patient or public contribution.
FreshRSS 