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To explore the narrated experiences of adult children during the initial phase of their transition process when their elderly parent transfers from home to a nursing home.
The article describes part of a qualitative study with a narrative, longitudinal, prospective design.
Narrative interviews were conducted with a sample comprising eight adult children at three time points between February and July 2022. Narratives from the first interviews obtained during the initial transition phase are presented. This article explores the narratives of one woman and one man. The data were analysed using a thematic narrative approach. A constructed timeline gave a narrative chronology and facilitated the generation of three storylines and a unifying plot.
The narratives provide insight into a complex, emotionally demanding, and morally challenging initial transition phase. This generated the following three storylines: doubting the decisions, a shift in the filial responsibilities and an emotional roller coaster. These storylines were closely intertwined, and they shaped the unifying plot of experiencing persistent ambivalence.
Adult children encounter significant burdens due to shifting roles and experiences of intergenerational ambivalence during the initial transition phase when their elderly parent transfers from home to a nursing home. Informal caregivers are crucial for maintaining and developing a sustainable health-care service, which makes it necessary to allocate resources and provide systematic support to enable adult children to continue their care responsibilities.
Nurses and other health-care personnel need to acknowledge the challenges and heavy burdens experienced by adult children when their elderly parent transfers from home to a nursing home. This should be addressed through systematic follow-up and dialogue with adult children.
This study provides knowledge that will enable health-care personnel to recognise adult children in this situation and support them during this phase.
Reporting was performed in accordance with the consolidated criteria for reporting qualitative research (COREQ). There were no patient or public contributions.
To address whether eating disorders (ED) or insulin omission (IOM) in adult persons living with type 1 diabetes (pwT1D) are associated with impaired glycaemic control.
Cross-sectional analysis.
The French-Speaking Diabetes Society—Type 1 Diabetes Cohort (SFDT1) is an ongoing epidemiological cohort study that includes pwT1D in France who attend hospitals or private ambulatory diabetes centres.
Adult participants from the SFDT1 study, with data on ED and IOM. The current analysis was performed on data collected during the baseline visit in participants enrolled between December 2020 and March 2024.
Using the SCOFF, a self-reported questionnaire to screen for ED, and a single question on IOM to screen for IOM, we described four categories of pwT1D: no ED & no IOM, ED & no IOM, no ED & IOM and ED & IOM. We performed unadjusted and adjusted (for age, sex, diabetes duration, social vulnerability, smoking, alcohol status and insulin treatment) multinomial logistic regression models with the four categories as the outcome and glycaemic variables as explanatory variables, including continuous glucose monitoring (CGM) variables and HbA1c. No ED & no IOM was the reference outcome for all comparisons. We stratified each model by sex and fear of hypoglycaemia.
We included 1113 participants, 51% males, median (IQR) age 38 (29–50) years, diabetes duration 21 (12–32) years. Prevalences were as follows: no ED & no IOM: 68% (n=758), ED & no IOM: 11% (n=124), no ED & IOM: 16% (n=177) and ED & IOM: 5% (n=54). With the fully adjusted model, and compared with the group no ED & no IOM, time in range (OR (95% CI) 0.5 (0.4 to 0.7)) and time below range (0.5 (0.3 to 0.8)) were inversely associated with ED & IOM. Moreover, time in range (0.4 (0.4 to 0.5)) was associated with IOM & no ED. Time above range (2.2 (1.6 to 2.9)), Glycaemic Risk Index (1.8 (1.3 to 2.5)), glucose monitoring indicator (2.2 (1.7 to 2.9)) and HbA1c (2.0 (1.5 to 2.5)) were directly associated with ED & IOM. We did not observe associations between CGM variables and ED & no IOM. Most associations were valid in both men and women. The associations were stronger in participants with a fear of hypoglycaemia. However, the associations remained even in people with a fear of hypoglycaemia.
Both ED and IOM are frequent in pwT1D, and IOM seems to be associated with impaired glycaemic control. As our analysis was cross-sectional, we cannot infer causality and cannot know whether IOM was a result of glycaemic control or the inverse (reverse causality). Our results suggest that IOM should be systematically screened in clinical practice. Further research is needed to better identify and care for EDs, with or without IOM, in T1D.
To estimate the prevalence and comorbidity patterns of mental health disorders (MHDs) in persons with vitiligo and compare relative risks (RRs) with dermatological diseases (atopic dermatitis and psoriasis) and non-vitiligo comparator cohorts using claims data.
Retrospective matched cohort study using nationwide statutory health insurance claims data.
German statutory health insurance claims (DAK-Gesundheit), 2016–2020.
A 40% anonymised sample of insured persons (N=2 885 984). In 2020, persons with vitiligo (International Statistical Classification of Diseases, Tenth Revision, German Modification L80) were compared with cohorts with atopic dermatitis (L20), psoriasis (L40) and persons without vitiligo. Cohorts were propensity score matched (1:3) by age and sex.
Prevalence of MHDs and RRs across comparator cohorts.
Internal plausibility of expert-informed claims-based MHD case definitions using diagnosis-only versus diagnosis-plus-care criteria.
In 2020, 4 631 persons were diagnosed with vitiligo. Affective disorders and neurotic, stress-related and somatoform disorders showed the highest prevalence, with depressive episodes ranging from 8.9% to 19.2% and somatoform disorders from 5.3% to 17.9% across definitions. In matched comparisons with atopic dermatitis, only a few and inconsistent differences were observed. In contrast, more pronounced and consistent differences were identified in comparisons with psoriasis. Emotional disorders in childhood showed higher risks under the most sensitive case definition (RR=2.29, 95% CI 1.14 to 4.61), whereas hyperkinetic disorders showed consistent effects across all definitions (RR range=1.58–1.93). Compared with persons without vitiligo, risks were higher for social phobia (RR range=2.10–2.81) and anxiety disorders (RR range=1.64–1.93).
Persons with vitiligo show a substantial burden of affective and stress-related MHDs. The mental health comorbidity profile was largely comparable to that of atopic dermatitis, whereas more pronounced differences were observed in comparisons with psoriasis. Claims-based prevalence estimates were sensitive to case definition, highlighting the importance of transparent operationalisation.
The prognostic value of left atrial (LA) strain in patients with heart failure with reduced ejection fraction (HFrEF) has not been fully elucidated. Therefore, this study investigated the prognostic value of LA strain in HFrEF patients in relation to all-cause mortality.
A total of 822 echocardiograms from HFrEF patients admitted to a heart failure clinic were analysed offline. To calculate left atrial reservoir strain (LA RS) and left atrial contractile strain (LA CS), LA two-dimensional speckle tracking was performed in the 4-chamber, 2-chamber and 3-chamber view. The end-point was all-cause mortality. The association between LA strain parameters and outcome was examined using Cox regression.
The median follow-up time was 40 months and follow-up was 100% complete. During follow-up, a total of 137 patients (16.7%) died of all causes. In a final multivariable model adjusted for clinical and echocardiographic parameters including global longitudinal strain, LA RS and LA CS were significantly associated with all-cause death during follow-up (LA RS, HR 0.96, 95% CI 0.92 to 0.99, p=0.014, pr. 1% increase) (LA CS, HR 0.95, 95% CI 0.92 to 0.98, p=0.002, pr. 1% increase).
When added to the final multivariable model, both LA RS and LA CS contributed with incremental prognostic value as determined by C-statistic (LA RS: C-stat difference 0.007, 95% CI 0.000 to 0.020, p=0.050) (LA CS: C-stat difference 0.009, 95% CI 0.000 to 0.023, p=0.030).
In HFrEF patients, LA RS and LA CS were associated with all-cause mortality and contributed incremental prognostic value in addition to established prognostic measures.
Although research and evidence-based practice are widely regarded as foundational to high quality patient care, little is known about the evidence-based practice and research competencies of ambulatory care nurses.
The aim of this study was to measure the self-perceived evidence-based practice and research competencies and learning needs of ambulatory care nurses.
In 2024, a national sample of 2790 ambulatory care nurses participated in an online cross-sectional structured survey measuring evidence-based practice and research competencies. Respondents rated their competency using the EBP Capability Beliefs Scale and the Application of Knowledge and Skills subscale from the Research Competencies Assessment Instrument for Nurses (RCAIN). Results were compared across practice settings, job roles, and subspecialties.
Higher education levels correlated with higher scores in both evidence-based practice and research competencies. After controlling for education level, nurses from specialty or procedural areas scored higher in evidence-based practice competencies than nurses from all other work environments. Direct care nurses scored lower than nurses in all other roles in research competencies. Statistically significant correlations were also found between evidence-based practice competencies and the type of organization where a nurse worked.
Findings indicate EBP and research competencies must be increased among ambulatory care nurses. Leadership support and resource allocation are critical for EBP development. Among ambulatory care nurses, those in direct care roles may have the greatest opportunities to develop EBP and research competencies. Nurses with limited exposure to EBP and research should be encouraged to engage in professional development activities on these topics. Education and EBP mentorship for ambulatory care nurses should be tailored to the ambulatory care environment where possible, to make it relatable to learners.
Cardiopulmonary bypass has been used to perform complex cardiac surgery for over 70 years. Advances in bypass techniques and perioperative medicine have increased the safety of cardiac procedures, leading to reduced morbidity and mortality. Nevertheless, cardiopulmonary bypass still carries risks, including systemic inflammation and dysfunction of various organs. To date, optimal blood pressure management during cardiopulmonary bypass remains a subject of ongoing debate. Conflicting evidence exists regarding negative outcomes associated with both low and high mean arterial pressures. Current clinical guidelines recommend a broad target range for mean arterial pressure during cardiopulmonary bypass, which underscores the existing gap in knowledge. In non-cardiac surgery, the time-weighted average of mean arterial pressure has been used to determine minimum safe thresholds, with greater deviation from 65 mm Hg associated with an increased risk of adverse outcomes. However, the definition and reporting of low blood pressure during cardiopulmonary bypass varies between studies, and the use of time-weighted averages below the threshold is still uncommon. Details on pump flow during extracorporeal circulation are seldom reported.
We plan to conduct a retrospective, single-centre data analysis to investigate the effects of both arterial blood pressure and extracorporeal pump flow, including their time-weighted averages and areas under defined thresholds, during cardiopulmonary bypass on neurological outcomes in adult patients undergoing cardiac surgery between 2014 and 2023. The study will include both elective and emergency procedures, with separate analyses conducted based on the urgency and complexity of the operations. Digitally recorded anaesthesia and perfusion records will be imported and validated to extract information on haemodynamic parameters, neurological monitoring and extracorporeal circulation. Ischaemic and haemorrhagic strokes will be identified by screening postoperative brain imaging records for keywords indicating neurological events. Diagnostic data and additional patient and procedural information will be extracted from the local cardiac surgery database and hospital information system. Information about incidence and course of postoperative delirium will be extracted from the patient data management system used in intensive care. We expect to include approximately 500–700 cases per year in the final analysis.
The local ethics committee approved our study (Ethics Committee of the Medical University of Graz, IRB00002556, 36-296 ex 23/24). We aim to publish the results of our study preferably in an open access format.
The study protocol was registered at the Center for Open Science (https://doi.org/10.17605/OSF.IO/FAMV3).
This study engaged key stakeholders—older adults, family caregivers, home care support workers, nurses, and home healthcare leaders—to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.
A qualitative methodology with a quantitative component, early-phase exploratory design.
Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.
Among 18 participants—older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)—findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).
While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.
Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.
Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.
Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.
Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.
An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.
Immune checkpoint inhibitors (ICIs) have become an important treatment option for selected cancer patients in recent years. In this overview of systematic reviews, we aim to present a comprehensive summary of the evidence on neurological immune-related adverse events (irAEs) in patients treated with ICIs.
The overview will follow the preferred reporting items for overview of reviews statement. All systematic reviews reporting on neurological irAEs in adult patients treated with ICIs will be included. We will search PubMed, EMBASE and Cochrane’s Database of Systematic Reviews. Two authors will independently screen studies and extract data, with disagreements resolved by discussion or a third reviewer. Methodological quality will be assessed using AMSTAR-2. We will assess overlap by identifying shared primary studies and summarising their frequency in a table. Data will be presented narratively and in tables; when possible, frequencies of neurological irAEs and weighted means, along with associated distributions, will be reported.
As this study involves secondary analysis of published literature and does not include primary data collection, ethical approval is not required. Findings will be disseminated through peer-reviewed publications.
CRD420251020892.
Suicidal thoughts and behaviours are linked to a wide range of mental health conditions. New interest in the psychiatric benefits of nitrous oxide (N2O) has only recently emerged. The broad pharmacological effects of N2O are thought to be due in large part to N-methyl-d-aspartate antagonism and opioid effects. The purpose of this study protocol is to test whether inhalational N2O exerts rapid antisuicidal effects as a transdiagnostic treatment for suicidal ideation.
This is the protocol of a single-centre pilot study of N2O inhalation in 85 psychiatric inpatients. The initial 45-min double-blind, randomised, placebo-controlled inhalation session either consists of 50% N2O and 50% oxygen (‘active treatment’) or 50% oxygen plus air. The primary outcome is the change in Beck Scale for Suicidal Ideation scores between the day before and the day after inhalation. A second inhalation containing N2O will be administered 1 week after the first inhalation to ensure that all study participants receive the active treatment at least once. For the mechanism of action and prediction, a nested biomarker substudy will employ multimodal techniques, including analysis of hair and blood samples and electroencephalography.
This study was approved by the local ethics committee (‘Kantonale Ethikkommission—Kanton Zürich’) and by the Swiss Agency for Therapeutic Products (Swissmedic). Study results will be disseminated primarily by peer-reviewed scientific journals and also by conference presentations, patient and public events and social media.
ClinicalTrials.gov ID NCT06636357.
Ecuador es un país pluricultural y multiétnico, caracterizado por la búsqueda de promover la propiedad comunal, la toma de decisiones colectiva y prácticas de vida sostenibles en sus comunidades autónomas. A través de este enfoque principal que enfatiza la solidaridad y la cooperación, estas comunas han podido crear soluciones alternativas a los problemas que enfrentan sus comunidades. A pesar de estos éxitos, las comunidades de los diversos grupos indígenas, aún enfrentan desafíos, como acceso limitado a recursos básicos, apoyo gubernamental, estigmatización y conflictos con comunidades vecinas. Sin embargo, continúan abogando por su derecho a la autodeterminación y trabajan para crear una sociedad más equitativa. Explorando los temas y experiencias de estas comunas, podemos comprender mejor el potencial de los movimientos de base para abordar las injusticias sociales y allanar el camino hacia comunidades más sostenibles e inclusivas. Cabe destacar que esta es solo una pequeña comuna indígena, y que hay muchos más grupos en todo el país, como los Shuar, Tsáchilas, Huaorani, Chachi, entre otros.
Ecuador es un país pluricultural y multiétnico, caracterizado por la búsqueda de promover la propiedad comunal, la toma de decisiones colectiva y prácticas de vida sostenibles en sus comunidades autónomas. A través de este enfoque principal que enfatiza la solidaridad y la cooperación, estas comunas han podido crear soluciones alternativas a los problemas que enfrentan sus comunidades. A pesar de estos éxitos, las comunidades de los diversos grupos indígenas, aún enfrentan desafíos, como acceso limitado a recursos básicos, apoyo gubernamental, estigmatización y conflictos con comunidades vecinas. Sin embargo, continúan abogando por su derecho a la autodeterminación y trabajan para crear una sociedad más equitativa. Explorando los temas y experiencias de estas comunas, podemos comprender mejor el potencial de los movimientos de base para abordar las injusticias sociales y allanar el camino hacia comunidades más sostenibles e inclusivas. Cabe destacar que esta es solo una pequeña comuna indígena, y que hay muchos más grupos en todo el país, como los Shuar, Tsáchilas, Huaorani, Chachi, entre otros.
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