Conectar
To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences.
With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation.
Cross-sectional study.
Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist.
Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences.
Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke.
Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies.
No patient or public contribution.
by Yaa Abrafi Ankomah, Bright Anneh Awaitey, Moses Monday Omoniyi, Benjamin Asamoah, Obed Kwame Numadzi, Kwofie Robert Amoah, Joel Innocent Goli
BackgroundPregnancy and childbirth increase the risk of pelvic floor muscle damage, leading to conditions such as urinary incontinence, fecal incontinence, and pelvic organ prolapse. This makes it imperative to adopt strategies such as pelvic floor muscle exercises (PFMEs) to ensure positive antenatal and postnatal experiences for women. Hence, the study aimed to assess the awareness, knowledge, practices, and beliefs of PFMEs among pregnant women in a Ghanaian setting.
ObjectiveWe assessed the awareness, knowledge, practices and beliefs of PFMEs among pregnant women in a Ghanaian setting.
DesignA cross-sectional descriptive research was conducted, recruiting 134 pregnant women through convenient sampling in selected antenatal clinics in Kumasi metropolis, Ashanti Region.
MethodsThe study adopted the questionnaire regarding pelvic floor muscle training among pregnant women used by Teerayut Temtanakitpaisan, Suvit Bunyavejchevin, Pranom Buppasiri and Chompilas Chongsomcha. Data on the socio-demographic characteristics of the women, their awareness, knowledge, beliefs and practices about PFMEs were recorded.
ResultsMore than half (64.9%) of the respondents were not aware of PFMEs. Subsequent analysis for this work was therefore done for participants who reported being aware (35.1%). Also, the principal sources of information from which the subjects acquired the knowledge of PFME were health-care providers (42.6%) and media outside the hospital (36.2%). With reference to beliefs 80.3% believed that PFME could reduce vaginal trauma and 83.0% believe PFME aids vaginal birth. In terms of PFME practice, 36.2% of the aware women performed PFME regularly.
ConclusionTo ensure pregnant women are well-informed about PFMEs, physiotherapists should work with antenatal care providers to develop comprehensive courses that include detailed information on PFME’s.
Organizational culture and readiness are critical determinants of evidence-based practice (EBP) implementation. The Organizational Culture and Readiness Scale for System-Wide Integration of EBP (OCRSIEP), developed within the ARCC framework, is a validated tool to assess these dimensions, but no Italian version currently exists.
To translate, culturally adapt, and psychometrically validate the OCRSIEP and its short form in Italian.
A validation study was conducted, using exploratory and confirmatory factor analyses to derive and test the underlying model, followed by reliability testing with multiple indices and measurement invariance analyses.
Data were collected from 405 Italian nurses. Factor analyses supported a 19-item, six-factor structure explaining 59.5% of the variance, with a second-order factor indicating an overarching construct. The three-item short form showed strong model fit and explained 67% of the variance. Subscales demonstrated acceptable-to-excellent reliability, and partial scalar invariance was established across public and private facilities.
The Italian OCRSIEP scales are valid and reliable tools to assess organizational readiness for EBP implementation. They can guide leaders, educators, and researchers in monitoring, benchmarking, and advancing EBP–oriented system transformation within the Italian healthcare context.
Kidney transplant recipients are at increased risk of surgical site infections (SSIs) due to procedural complexity and immunosuppression. This retrospective single-centre study examines the influence of BMI on SSI risk and identifies common pathogens. A total of 230 renal transplant patients were included in this analysis 2017 and 2019. All patients received a cephalosporin for prophylaxis, and wound swabs were taken from those who developed SSIs. SSIs occurred in 45 patients (19.6%) and were not significantly associated with age, sex or donor type. The most common organisms were coagulase-negative staphylococci (26.7%), Staphylococcus epidermidis (24.4%), Enterococcus faecalis (22.2%) and Candida albicans (22.2%). SSIs were significantly linked to surgical revision (p < 0.001) and higher BMI (p = 0.027). A BMI ≥ 28.1 was associated with threefold higher odds of SSIs (OR = 3.0; p = 0.001). Each one-unit increase in BMI was associated with a 7.2% increase in the odds of SSI occurrence (OR = 1.072; p = 0.020). Staphylococcus (p = 0.019) and Enterococcus (p = 0.048) infections were more common in patients with BMI > 28.1. Therefore, SSIs are a frequent complication posttransplant and are strongly associated with high BMI. Standard antibiotic regimens may not cover all relevant pathogens in obese patients, underscoring the need for tailored prophylactic strategies.
Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.
Scar outcomes are known to vary by skin tone and race, yet few studies have systematically evaluated these differences using validated tools. To evaluate differences in scar maturation across Fitzpatrick skin types and racial groups from 3 to 12 months postoperatively using the modified Patient and Observer Scar Assessment Scale (POSAS) scale. We conducted a prospective observational study of 40 patients undergoing breast surgery at a single academic centre. All scars were assessed at 3 and 12 months postoperatively using the modified POSAS. Fitzpatrick skin types were categorized into I–II, III–IV, and V–VI, and racial groups included Caucasian, Black, and Hispanic patients. Fitzpatrick Types I–II had the greatest vascularity reduction (–2.06 ± 2.10), while Types V–VI showed the least improvement (–0.80 ± 1.61). Pigmentation increased in Types V–VI (+0.35 ± 1.89) and improved in lighter skin tones. Black and Hispanic patients had significantly lower odds of favourable pigmentation outcomes (p < 0.07). Fitzpatrick Types V–VI also had lower odds of improved scar relief (OR = 0.125, p = 0.034). This study highlights differences in scar maturation across skin tone and racial categories using a standardized scale. These trends underscore the importance of tailoring postoperative scar counselling and interventions to individual patients’ skin types and racial backgrounds.
Strong primary healthcare enhances resource efficiency and resilience. Type 2 diabetes poses a growing global health challenge, with Argentina’s healthcare system struggling to detect and manage the disease effectively. Many patients bypass primary healthcare for secondary facilities, undermining continuity of care and increasing costs. Following a diagnostic process in collaboration with policymakers, we propose evaluating a redesigned primary care model consisting of codesigned evidence-based implementation strategies to improve type 2 diabetes management in Mendoza, Argentina.
This is an efficient, parallel-arm cluster randomised controlled Hybrid Type II trial with 12 clusters (administrative areas with 2–3 health facilities) allocated 1:1 to control (usual care) or intervention. In phase I, we will codesign, pilot and refine an implementation strategy package. In phase II, we will conduct the trial: 9-month baseline data collection, 15-month intervention and 6-month sustainability period. We will enrol a cohort of 396 patients with type 2 diabetes at primary healthcare centres and follow them for 12 months during the intervention and 6 months sustainment using routine clinical records and patient surveys. In phase III, we will conduct analysis, report and disseminate findings. The primary outcome will be a composite outcome including glycaemic control (glycated haemoglobin (HbA1c)
All study activities will comply with national and international ethics guidelines, presenting minimal risk to participants. The protocol was submitted and approved by the local independent ethics committee at the Mendoza Ministry of Health (Consejo Provincial de Evaluación ética en investigación en Salud-Provincial Health Research Ethics Review Board, Reference number: 149/2024). Facility-level permission will be obtained for participation and sharing of deidentified data. Written informed consent will be required from study participants, who will receive information on the study’s purpose, procedures, risks and benefits. Dissemination activities and outputs will include writing and submitting manuscripts for publication; writing policy briefs to support strategy implementation in other regions or countries; and tailoring outputs for patients, clinicians and researchers. We anticipate that improvements in disease management and patient experience will have clinical and economic benefits related to reduced usage of secondary-level and tertiary-level facilities, lower cost per visit and a reduced number of clinical events related to diabetes.
To investigate what works when using Patient-Reported Outcome Measures (PROMs), for whom, in what contexts, and why in four Value-Based Healthcare (VBHC) programmes.
Realist evaluation.
Evaluation of Heart Failure, Parkinson's Disease, Epilepsy and Cataract surgery programmes using data from a scoping review, documentary analysis, questionnaires, quantitative routinely collected data and semi-structured interviews with staff, patients and carers (July 2022–August 2023). Programme theories and logic models were developed, tested and refined.
We conducted 105 interviews (67 patients, 21 carers and 17 staff) and collected data from 230 patients (66 Epilepsy, 140 Heart Failure and 24 Parkinson's Disease) and 14 staff via questionnaires. Clinicians used PROMs data to regularly monitor patients with Heart Failure and Epilepsy, which resulted in better triage and tailoring treatment, prioritisation of access based on the urgency of need, and facilitation of referral to relevant professionals. In Heart Failure, this further resulted in a more efficient provision of care and better use of resources, care closer to home, improved health outcomes (e.g., better symptom management) and service redesign. The same was not observed in Epilepsy, as patients who required mental health treatment had to be referred, but they were not always able to access specialist services. PROMs were discontinued in Cataract surgery services mainly due to the lack of integrated IT systems, which caused an increased workload and staff resistance. In Parkinson's Disease, patients were asked to complete PROMs even though the information was not consistently being used.
Findings challenge the orthodoxy that implementing PROMs is universally good and brings about real improvements in patient outcomes in a VBHC context. PROMs are generally ill-suited for long-term use with patients in routine care without further adaptation. Greater staff and patient involvement are imperative to enhance the acceptability and relevance of the programmes.
Patient-Reported Outcome Measures can improve care when embedded in well-supported systems. Implementation must be realistic, involve staff and patients, and be underpinned by clear leadership and robust digital infrastructure. Co-designed patient-facing tools can improve accessibility and engagement.
What problem did the study address? There is limited evidence on how Patient-Reported Outcome Measures function across different routine healthcare contexts. What were the main findings? Patient-Reported Outcome Measures improved care in Heart Failure but not in other services, largely due to contextual barriers. Where and on whom will the research have an impact? Findings are relevant for clinicians, service designers, and policymakers seeking to implement meaningful person-centred outcome measurement in long-term conditions.
We adhered to Realist and Meta-narrative Evidence Syntheses: Evolving Standards II guidance and to the Guidance for Reporting Involvement of Patients and the Public.
The study was developed alongside a wide range of patient and public stakeholders involved in the Aneurin Bevan University Health Board Value-Based Healthcare programme, third sector and specific individuals and groups representing the four included services (i.e., St. David's Hospice Care, British Heart Foundation, Digital Communities Wales, Epilepsy Action, Digital Communities Wales, Parkinson's UK Cymru, Race Equality First, Aneurin Bevan Community Health Council, Value- Based Healthcare Patient Reference Group and Wales Council of the Blind). A total of 10 virtual meetings were strategically planned to address gaps, assist in the interpretation of findings, and ensure that outcomes were pertinent and accessible to the specific needs and circumstances of under-represented or vulnerable groups.
by Sian E. Wanstall, Brandon W. J. Brown, Meagan E. Crowther, Claire Dunbar, Robert J. Adams, Anjum Naweed, Amy C. Reynolds
BackgroundParamedics face unique occupational hazards, including high operational demands, trauma exposure, and shift work, all of which impact mental well-being. Suboptimal sleep is also common in this workforce and closely linked to adverse mental health outcomes. This scoping review synthesizes evidence to date on interventions to support paramedic mental well-being including sleep-based interventions.
Materials and methodsThis review was pre-registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/7VSD9). Systematic database searches were conducted in October 2024 for original research published after 2004. Data were narratively synthesised, and findings reported following established guidelines.
ResultsNineteen sources were included, involving 1,067 participants across seven countries. Seventeen interventions were examined, predominantly via randomized controlled trials (58%), utilizing a total of 43 different measurement scales to evaluate mental health and sleep outcomes. Interventions included psychological (37%), sleep, fatigue and/or shift work (32%), and complementary and alternative medicine (32%) approaches which primarily focussed on the individual-level (94%). Studies were limited by sample sizes, design and quality, limited long term follow-up, and low baseline symptoms.
ConclusionsThis review highlights a critical gap in robust, evidence-based, system-level interventions to address poor sleep and mental well-being in paramedics. Future research should prioritise co-designed, context-sensitive approaches, ideally integrated within organisational structures to ensure relevance and accessibility.
To investigate the relationship between nursing ethical leadership style, work environment (workload, interpersonal conflicts) and patients' objective nursing-sensitive outcomes (accidental falls, pressure ulcers, nosocomial infections, restraints and deaths).
Nationwide multicentre cross-sectional multilevel survey.
Validated self-report scales were used to assess nurses' perceptions of ethical leadership, workload and interpersonal conflict. Nursing staffing and objective patient' nursing-sensitive outcomes were measured at the ward level. Descriptive and inferential analyses were conducted. Structural equation modelling examined the relationships among these variables based on Donabedian's conceptual framework.
Data from 2349 nurses across 158 wards in 25 Italian acute care hospitals were analysed. The multilevel model showed an excellent fit. Ethical leadership was negatively associated with both workload and interpersonal conflict. Workload was significantly linked to higher rates of pressure ulcers, falls and deaths in patients. Ethical leadership was indirectly associated with improved patient outcomes through reduced workload.
Head nurses' ethical leadership has a pivotal role in shaping the work environment and enhancing nursing-sensitive outcomes by reducing workload and fostering positive interpersonal dynamics. These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting better patient outcomes.
These findings emphasise the need for healthcare organisations to invest in ethical leadership development as a critical strategy for improving care quality and promoting safer, more effective patient outcomes.
The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.
This study did not include patient or public involvement.
Cultivating moral values and principles in leadership enables leaders to effectively communicate these values to their staff. Addressing unethical behaviours, fostering open dialogue about organisational ethics, and supporting leaders in the ethical decision-making process contribute to a healthier nurses' work environment. Healthcare organisations investing in the development and promotion of ethical leaders improve care quality.
The study was registered in the research registry (www.researchregistry.com) under the record number (researchregistry7418), following a published protocol.
Patients in intensive care units (ICUs) and their families face existential physical, psychosocial and spiritual distress. Integrating palliative care (PC) into ICU care may benefit patients, relatives and ICU clinicians. Prior PC studies have shown a reduction in ICU length of stay (LOS) and distressing symptoms without altering overall mortality. A shorter ICU LOS may alleviate the burden for patients and relatives and help optimise the use of limited intensive care resources. PC in the ICU, however, remains underused, partly due to limited access and knowledge of ICU clinicians. Also, robust data regarding the effectiveness and cost-effectiveness of PC treatment in the ICU are scarce. We established the ‘enhancing palliative care in ICUs’ (EPIC) study to implement a system-based harmonised practice model across European ICUs. The aim is to investigate if early integration of PC via telemedicine, clinician education and bedside tools is effective and cost-effective, ultimately benefiting patients, relatives and ICU clinicians.
This multicentre, controlled, cluster-randomised, non-blinded stepped-wedge design trial with crossover phase aims to recruit around 2,000 patients from five European countries. All adult patients admitted to participating ICUs—with an ICU LOS exceeding 72 hours, where cancer is not the primary cause of critical illness, and who are not expected to die within the next 24 hours—are screened for the need for specialised PC based on the attending physician’s judgement. This judgement is triggered by the presence of one or more of the following: (1) significant disagreement among ICU team members and/or relatives about the appropriateness of current ICU treatment, (2) considerations of limiting life-sustaining therapy or (3) the anticipation that a specialised PC consultation may benefit the patient, their relatives or the ICU team. Patients identified as needing specialised PC and their relatives are then enrolled after obtaining written informed consent.
The complex intervention consists of (a) a blended-learning programme to foster knowledge and attitude about PC among ICU clinicians, (b) bedside tools, including a checklist to identify patients in need of PC and a factsheet and (c) standardised telemedical consultations from trained EPIC interventionists. Patient and relative follow-up is conducted 3 months post-ICU discharge. Outcomes include clinical measures (including ICU LOS (primary outcome), severity of critical illness, invasive treatments and health-related quality of life), economic endpoints (resource use, costs, cost–consequence situation, cost-effectiveness), ICU clinician burnout and distress, and patient and family perception about the quality of symptom management, care and communication. Endpoint analyses will employ generalised linear mixed models, accounting for the clustered data structure and stepped wedge design.
EPIC complies with the Declaration of Helsinki and has been approved by all local ethics committees. A decision-making structure is established to ensure trial procedures are carried out according to Good Clinical Practice. Study findings will be published in peer-reviewed journals and communicated to participants, healthcare professionals and the public. Sets of anonymised study data will be made available following Findable, Accessible, Interoperable, and Reusable principles.
Colon cancer (RC) patients holding an intestinal stoma recorded lower health-related quality of life (HRQOL) levels. Intestinal stoma leads to several difficulties, like travel, work, and sporting activities. Patients with an intestinal stoma frequently experienced changes in their HRQOL. The COH-QOL-Ostomy questionnaire comprehensively measured these changes across physical, psychological, social, and spiritual domains. We reviewed literature in order to assess any differences in HRQOL between females and males and between intestinal stoma permanence among these patients. We conducted a literature review from: British Nursing Collection, Embase, MEDLINE, Nursing & Allied Health Database, PubMed, Scopus and Web of Science databases, without any time limits. The protocol was registered with PROSPERO no. CRD420251040414. A total of 492 records were identified. Of these, 362 records were removed, obtaining 130 potential records. However, 126 of these were excluded as they did not meet the inclusion criteria including only 4 records for further analysis. The COH-QOL-Ostomy questionnaire has been considered to assess HRQOL total score and its related sub dimensions, specifically physical, psychological, social and spiritual well-being. For each item, a Likert scale has been associated raging from zero (worse outcome) to 10 (good outcome). A total of 915 observations were collected, specifically 401 related to females and 514 to males. Additionally, a total of 670 observations were recorded: 338 belonging to the temporary group and 332 to the permanent one. Data reported a significant difference in the Psychological Well Being dimensions between the two groups, in favour of the female group (t = −3.66; p = 0.035). Considering the ostomy permanence, the temporary group reported a significant and better total quality of life score (t = −7.53; p = 0.017), Psychological Well Being dimension (t = −5.24; p = 0.035), and in social dimension (t = −8.09; p = 0.015), too. Sex-related differences in HRQOL assessments could help patients to achieve the most appropriate interventions to ameliorate QOL perceptions. Permanence criteria for ostomy could better address healthcare professionals for a specific clinical pathway to improve, especially in social support, which could positively contribute to better self-care for these patients.
This study investigated the efficacy and safety of a novel thermo-reversible antimicrobial wound gel (TRG, revyve Antimicrobial Wound Gel) designed to combat biofilm-related infections in wounds. The TRG was evaluated for its ability to disrupt biofilms, sustain antimicrobial activity and promote wound healing. The gel exhibited thermo-reversible properties, transitioning from a less viscous liquid ≤ 18°C to a highly viscous solid gel at wound temperature which would facilitate easy application and removal. Antimicrobial testing demonstrated that TRG effectively inactivated a broad range of wound-related pathogens, including Staphylococcus aureus and Pseudomonas aeruginosa, with a 99.99%–99.9999% reduction in bacterial counts within 30 min. The TRG also maintained its antimicrobial efficacy after multiple inoculations with high microbial load (107 CFU/mL) over 7 days. In vitro biofilm assays showed effectiveness against biofilm bacteria with a reduction of ≥ 99.99% bacterial counts with one application over the course of 7 days. Biocompatibility testing confirmed that TRG was safe, with no signs of tissue necrosis or signs of tissue damage and no impact on wound healing in a porcine wound model. TRG's ability to reduce both planktonic and biofilm-based bacteria without compromising wound healing makes it a promising candidate for treating both chronic and acute wounds.
To combine qualitative and quantitative data to evaluate the feasibility, participant satisfaction and effectiveness of a hybrid pulmonary rehabilitation programme following hospital discharge for an exacerbation of chronic obstructive pulmonary disease (COPD).
Convergent parallel mixed method study nested in a larger ongoing prospective study; this report includes a subset of 21 participants who complete the qualitative and quantitative assessments between May 2023 and January 2024.
Semi structured interviews using open-ended questions were conducted and analysed using a thematic analysis approach. Participants were interviewed after completing an 8-week hybrid home-based rehabilitation programme, including four face-to-face and four remote sessions. Quantitative assessments—covering disease impact, anxiety and depressive symptoms, and exercise tolerance—were conducted at the beginning and end of the intervention in the same participants who took part in the interviews, and a 10-item satisfaction questionnaire was also completed after the programme.
May 2023 to January 2024.
GRAMMS checklist was followed.
21 people with chronic obstructive pulmonary disease (11 females; mean age 62 ± 7 years; mean FEV1 30% ± 10% of predicted) were interviewed. Five major themes were identified: (i) accessibility and adaptation to individual needs; (ii) confidence in the transdisciplinary care manager model, confirmed by high satisfaction score (95/100); (iii) integration of informal carers; (iv) perceived benefits supporting maintenance of health behaviour, consistent with the statistically and clinically significant improvements observed across all quantitative outcomes; and (v) hybrid programme challenges (technical issues and preference for face-to-face visits).
The hybrid programme resulted in significant improvements in physical and psychological outcomes, and participants reported high levels of satisfaction. Qualitative findings highlighted the value of home-based delivery, supervision by a single care manager, informal carer involvement and emotional support in shaping feasibility and satisfaction. However, challenges related to remote sessions indicate that telerehabilitation may not be suitable for all patients and should not be used as a standalone PR option.
Given the strong preference of participants for face-to-face visits over remote visits, telerehabilitation should always include a minimum of individual or group face-to-face supervised sessions. The balance between supervision modalities should be personalised according to participants' needs and progress.
To evaluate the effect of mutuality on self-care in people with CHD and the contribution of their caregivers, and whether such relationships can be mediated by self-efficacy.
Secondary analysis of baseline data from a multi-centre longitudinal study.
Patients at the onset of coronary artery disease who underwent angioplasty, along with their caregivers, were included in the sample. Data from 136 patients and 136 caregivers were used for the analysis. Mutuality between patients and caregivers was measured using the Mutuality Scale. Self-care was measured using the Self-Care of Coronary Heart Disease Index and the Caregiver Contribution to Self-Care of Coronary Heart Disease Index. The actor–partner interdependence mediation models were used to assess the mediating role of self-efficacy for self-care between perceived mutuality and self-care behaviours.
An actor indirect effect was found between patient mutuality and their self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on their contribution to self-care maintenance, self-care monitoring, and self-care management, through the mediation of their self-efficacy. Caregiver mutuality had a positive indirect effect on patient self-care maintenance and on patient self-care monitoring, through the mediation of patient self-efficacy. All models demonstrated satisfactory fit to the data.
Mutuality between patients and caregivers enhances self-care behaviours in patients with coronary heart disease, and self-efficacy is a crucial mediator in this relationship. Interventions targeting both mutuality and self-efficacy within patient–caregiver dyads may improve self-care outcomes.
We adhered to STROBE guidelines.
Patients and members of the public were not involved in the design, conduct, reporting, or dissemination plans of this research.
by Hao Ma, Fred M. Tatum, Robert E. Briggs, Rohana P. Dassanayake, Tasia M. Kendrick, Eduardo Casas
Pasteurella multocida is a pathogen that causes bovine respiratory disease, and the development of an effective vaccine is important for improving animal health. Live-attenuated vaccines induce a long-lasting immune response with minimal side effects. The objective of this study was to evaluate potential live vaccine candidates from three P. multocida mutants produced by separately disrupting the genes of filamentous hemagglutinin 2 (fhaB2), hydrogenase-1 operon (hyaE), and n-acylneuraminate-9-phosphatase (nanP) of a serogroup 3 strain (P1062, WT) by clinical testing and transcriptome analysis. Challenge with WT and the three mutants conferred protection against P. multocida, with less lung lesions (4.7–6.2%) compared to 22.4% in the sham group. Transcriptome analysis identified 807 differentially expressed protein-coding transcripts (DETs) in the blood and 6473 DETs in the liver compared to the sham, WT, and each of the mutants. In total, 15 and 64 differentially expressed microRNAs (DEmiRNAs) and 12 and 74 differentially expressed long non-coding RNAs (DElncRNAs) were identified in blood and liver, respectively. The DEmiRNAs were not significantly associated with the DETs within each comparison. DElncRNAs were associated with 12 and 170 DETs in blood and liver respectively. The greatest number of unique DETs were found between hyaE and sham groups in the liver, which agreed with the low colonization rate in the nares and palatine tonsils. For the DETs between sham and WT the under-enriched gene ontology terms in blood were all included in the liver for the DETs identified by WT vs. sham, nanP vs. sham, and hyaE vs. sham, and were related to the signaling pathway, stimulus, and sensory perceptions in biological processes with the molecular function of olfactory receptor activity. The number of identified DETs, decreased percentage of lung lesions, and colonization rates indicate that fhaB2 could be a promising vaccine candidate.Admission to a mental health ward can be distressing for people living with dementia and their carers. While carer involvement is associated with improved outcomes, carers often report feeling excluded from decision-making and support during admissions. There is limited understanding of how wards engage with carers and what strategies might enhance involvement. This study seeks to address this gap by exploring carer and patient experiences during and after admission and co-producing evidence-based strategies for improved support and involvement.
The FIND ME study uses a convergent parallel mixed-methods design. A national online survey will map provision of mental healthcare for people with dementia across the UK. Narrative interviews will be undertaken with carers of current inpatients (n=24) and recently discharged individuals (n=24), with opportunities for dyadic interviews with people with dementia. Ethnographic fieldwork across three wards (30 days per site) will provide insight into organisational cultures, staff practices and carer involvement. Evidence-based co-design workshops with carers, people with dementia and staff will use these findings to identify priorities and develop practical strategies for service improvement. Finally, a feasibility study will test the acceptability, relevance and potential for implementation of these co-designed strategies. Quantitative data will be analysed descriptively, while qualitative data will undergo narrative and thematic analysis. Triangulation across datasets will ensure rigour.
Ethical approval has been granted by London Camberwell St Giles Research Ethics Committee and the Health Research Authority (REC Ref: 25/LO/0040). Informed consent will be obtained from all participants, with capacity assessed in line with the Mental Capacity Act (2005). Dissemination will include peer-reviewed publications, conference presentations and freely available multilingual resources for carers, people with dementia and ward staff, supported by NHS and third-sector partners.
NIHR161439
Breast screening uptake remains low in parts of the UK, partly due to barriers including limited transport access. Offering free transport to screening appointments may help address this and improve uptake. This general practitioner (GP) cluster-randomised feasibility trial will assess whether offering free door-to-door transport alongside routine screening invitations increases attendance.
Eight general practices in Yorkshire will be randomised to either the intervention (routine invitation plus information about booking free door-to-door transport) or control (routine invitation only) group. Around 8000 women due for routine breast screening will be included. Primary feasibility outcomes include GP recruitment and randomisation, intervention fidelity, proportion of women from the 10% most deprived areas, acceptability and data transfer processes. Secondary outcomes include understanding travel behaviour, cost-effectiveness and screening uptake. Data will be collected from routine National Health Service (NHS) screening records, data linkage with NHS England, travel surveys and qualitative interviews exploring experiences and acceptability. Patient and public involvement is embedded throughout with members contributing to advisory and oversight roles.
The trial has received ethical approval from the London–Harrow Research Ethics Committee, Section 251 approval from the Confidentiality Advisory Group and other relevant regulatory bodies. The University of Hull is the study sponsor. Results will be disseminated through peer-reviewed journal publications, conference presentations and plain English summaries for participants and the public. Findings will inform the feasibility and design of a potential larger trial to improve breast screening uptake via transport support.
Evidence-based practice (EBP) is widely endorsed as a cornerstone for high-quality, patient-centered care. However, its integration into daily clinical routines remains inconsistent, particularly in settings where cultural, educational, and organizational challenges persist. Reliable, contextually adapted tools are essential to measure EBP implementation and guide improvement efforts.
This study aimed to validate the Italian versions of the EBP Implementation Scale and its short-form (3-item) version.
A cross-sectional survey design was adopted. Both versions of the EBP Implementation Scale were translated and culturally adapted in accordance with internationally recognized guidelines. Data were gathered from a national sample of 405 nurses through a combination of convenience and snowball sampling. Psychometric assessment encompassed confirmatory and Bayesian factor analyses, evaluation of internal consistency and test–retest reliability, and measurement invariance testing. All analyses were performed in R Studio.
Confirmatory factor analyses confirmed that both versions (long and short) of the scale measure a single underlying construct. The instruments demonstrated high reliability (ω = 0.96 and 0.87 respectively). Measurement invariance across educational groups was partially established, as the partial scalar invariance model demonstrated acceptable fit (CFI = 0.991, RMSEA = 0.045), suggesting consistent interpretation of the scale across different levels of EBP training. Latent profile analysis revealed distinct subgroups of EBP implementers, with notable differences in latent means (p < 0.001) associated with previous education in evidence-based practice.
The Italian EBP Implementation Scales are valid and reliable tools for assessing EBP implementation behaviors. They can support education planning, monitor practice changes over time, and inform interventions aimed at enhancing evidence-based care.
To describe the prevalence and characteristics of traditional, complementary and integrative medicine (TCIM) practice and product use by the population of the UK providing up-to-date data on the landscape of TCIM use in the UK.
A cross-sectional online survey, administered using the Qualtrics platform, among adults (aged 18 years and over) residing in the UK (England, Wales, Scotland or Northern Ireland). Data were collected between May and October 2024. The 40-item instrument covered four domains: demographics, health status, use of health products and practices, and use of health services. Descriptive statistics were used to summarise survey responses, and ² tests were applied to assess associations between participant characteristics and TCIM use. Backwards stepwise logistic regression was conducted to identify predictors of TCIM use across four outcome categories (p≤0.05).
The sample (n=1559) was broadly representative of the UK population. Prevalence of any TCIM use over a 12-month period was 65.9% with 19.1% consulting a TCIM practitioner and 63.3% using any TCIM product or practice. Bodywork therapists (massage therapists 9.4%, chiropractors 7.9%, yoga teachers 5.0%) and homeopaths (4.1%) were the most commonly consulted TCIM practitioners and Anthroposophic doctors were the least commonly consulted (2.1%). Among TCIM products, vitamin and mineral supplements were the most commonly used (37.3%) and relaxation or meditation practices were reported by 19.4% of respondents. TCIM users were more likely to be female, identify as Asian or Black, have a chronic disease diagnosis, report good health, possess private health insurance, have a higher education level, be employed (or seeking employment) and sometimes experience financial management difficulties.
There is substantial use of TCIM across the UK adult population and there is a need for more research on integrating TCIM into mainstream healthcare and the National Health Service. Clear strategies are necessary to enhance communication between TCIM and conventional healthcare providers, ensure patient safety and promote person-centred, coordinated models of care.
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