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Lung ultrasound (LUS) is accurate for diagnosing pneumonia in the emergency department (ED), but standard training is time-intensive, limiting its widespread implementation. We evaluated LUS proficiency for pneumonia diagnosis and perceived adoption barriers after a short training programme.
This study was conducted in the frame of the PLUS-IS-LESS trial (Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments) (NCT05463406), a pragmatic stepped-wedge cluster-randomised clinical trial evaluating a clinical management algorithm combining LUS and procalcitonin to guide antibiotic use for lower respiratory tract infections (LRTIs) in 10 Swiss EDs.
All medical supervisors (senior registrars and senior physicians) from the participating EDs were invited to go through the PLUS-IS-LESS LUS training programme and all those who completed the training programme were included in this study.
The training programme included an e-learning course, followed by a half-day on-site training session with theory and hands-on practice. For proficiency evaluation, a validated structured assessment of LUS skills (LUS-OSAUS) was adapted into a 32-question online quiz and five bedside LUS examinations. Success was defined as achieving a score ≥80% on both the online quiz and supervised practical assessment. Success rates were compared between physicians according to their characteristics (age, sex, medical experience, previous use of ultrasound or LUS, linguistic region of work and type of hospital) using a ² test. A 6-month follow-up survey identified factors associated with non-certification and barriers to the clinical use of LUS for managing LRTIs.
Of 122 trained physicians, 83 (68 %) completed both quiz and supervised LUS and 61 (50%) achieved certification. The most challenging items were pleural line assessment (83% success), recognition of consolidations (83%) and decision-making based on LUS findings (72%). Physicians <40 years had a higher success rate (p=0.009). Among those without complete certification, limited access to an ultrasound machine and low perceived added value of LUS were the main identified reasons. Lack of time was the most frequently reported barrier overall to LUS integration into ED workflows (77%).
After receiving short training and focused proficiency testing, only half of physicians achieved certification, underscoring the challenges of broad LUS implementation. Limited time, equipment access and low perceived clinical value were key barriers, and integrating LUS findings into decision-making remained difficult. Ongoing support, supervision and protected time may be needed to enhance LUS adoption in EDs.
The Dutch guideline ‘Gallstone disease’ (2016) recommends performing a cholecystectomy within 72 hours following endoscopic retrograde cholangiopancreatography (ERCP) for common bile duct stones to prevent recurrent gallstone-related complications. Nevertheless, guideline adherence in the Netherlands remains low, and the time between ERCP and cholecystectomy often exceeds 72 hours. Our project aims to improve national guideline adherence to 85% or higher and thereby reduce the incidence of gallstone-related complications after ERCP.
The Dutch-TIMELINESS is a multicentre implementation project using a Multiphase Optimisation Strategy. The project includes 61 Dutch hospitals. In phase 1, all patients undergoing ERCP for choledocholithiasis from 1 January to 31 March 2023 will be analysed to serve as a benchmark. In phase 2, each hospital develops and implements its own tailored protocol in line with the guideline, guided by the benchmark data. In phase 3, from 1 December 2025 to 31 March 2026, the new protocols will be prospectively evaluated with real-time monitoring and refined as necessary. Statistical methods are predefined in the protocol.
The Medical Research Ethics Committees United reviewed the protocol and concluded it does not fall under the scope of the Medical Research Involving Human Subjects Act (WMO). Local institutional research departments and the board of directors reviewed and approved the protocol in all participating hospitals. Results will be published in international peer-reviewed scientific journals and presented at national conferences.
Asthma, chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are prevalent chronic respiratory diseases associated with increased comorbidity, mortality and healthcare costs. Physical activity and exercise are widely recommended as part of treatment for these conditions, yet the specific effects of Nordic walking (NW) remain underexplored. The aims of this randomised controlled trial (RCT) are to improve physical fitness, functional capacity and respiratory health and increase regular physical activity and quality of life of older adults with asthma and/or COPD and/or OSA through a supervised 3-month group-based NW intervention combined with resistance, balance and mobility training.
This single-blinded, parallel-group RCT will recruit 100 adults aged 55–80 years diagnosed with asthma and/or COPD and/or OSA in the Northern Savo region of Finland. Participants will be randomly allocated to either an intervention group or a control group.
The intervention group will participate in a 12-week supervised exercise programme consisting of progressive NW sessions twice per week and resistance, balance and mobility training once per week. The primary outcome is a change in cardiorespiratory endurance. Secondary outcomes include functional capacity, physical activity level, spirometry parameters and quality of life. The control group will continue their usual physical activity and receive physical activity guidance after 12 weeks. Measurements were conducted at baseline, three and 9 months. Data will be analysed according to the intention-to-treat principle. Group differences over time will be examined using appropriate parametric or non-parametric methods depending on data distribution.
Ethical approval was obtained from the Regional Medical Research Ethics Committee of Eastern Finland Collaborative Area (892/13.00/2023). Findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.
The trial is registered at ISRCTN12097135, registration date: 7 June 2024.
Treatment for women with endometriosis is only partially or temporarily effective. Moreover, medical hormonal treatment is associated with debilitating side effects and interferes with fertility, while surgery has a relatively high risk of complications. Meanwhile, women with endometriosis show increasing interest in implementing lifestyle interventions to alleviate symptoms and improve health-related quality of life (HRQoL). Integrating these lifestyle interventions can provide a holistic approach to the treatment of this debilitating disease. However, scientific evidence supporting the effectiveness of these interventions is limited. This study is designed to investigate the effectiveness of two lifestyle interventions and the combination of both: an anti-inflammatory diet intervention (AIDI) could improve immune cell function and reduce inflammation, resulting in improved HRQoL and alleviating pain. In addition, the integration of cognitive behavioural therapy (CBT) aims to provide insight into pain mechanisms and coping with pain, and to assist in sustaining dietary adjustments.
The Pain in Endometriosis And the Relation to Lifestyle (PEARL) study is a five-arm randomised controlled trial with a pre-post factorial design with two factors: an AIDI and CBT. The study population will consist of 250 premenopausal women, of whom 200 are diagnosed with endometriosis and experience pain symptoms and 50 are healthy controls (HC). Women with endometriosis will be recruited from one academic tertiary and five secondary hospitals in the Netherlands. They will be randomised (1:1:1:1) among four intervention groups: standard care (SC) (SC group), SC and an AIDI (SC + AIDI group), SC and CBT (SC + CBT group), and SC, AIDI and CBT (SC + AIDI + CBT group). Women with endometriosis will visit the hospital twice during the intervention period, at the start (T0) and end (T2) of the 13-week intervention period. HC will not undergo any of the interventions and will have one hospital visit (T0). Participants will complete questionnaires regarding pain symptoms, HRQoL, physical activity level, sleep, diet quality, pain cognitions, and stress at T0 and T2. Furthermore, they are instructed to collect menstrual effluent, a vaginal swab and a faecal sample. During the study visits, peripheral blood will be drawn and scalp hair samples will be taken. The primary outcome is average pain, measured using a numerical rating scale. Secondary outcomes focus on HRQoL, inflammation, immune system characteristics, vaginal- and gut microbiome, and hair cortisol levels. These are considered to reflect potentially underlying mechanisms of the effect of both interventions on the primary outcome. Biological samples and questionnaires of women with endometriosis and HC will be compared to establish the differences in secondary outcomes.
This study protocol has been approved (approval number: NL86247.091.24) by the METC Oost-Nederland from Radboud University Medical Centre on July 11, 2024. Prior to participation, participants are required to provide informed consent. The results will be widely disseminated through scientific peer-reviewed journals, and presentation to a broad audience in scientific meetings, congresses, patient meetings, as well as in policy-relevant forums.
Problems with healthcare provision in general practice are already present and expected to worsen in the future. Therefore, retaining medical professionals in the long-term. An important factor in deciding on a profession is its compatibility with one’s own life. This study aimed to examine general practitioners’ working environment, social environment, their current work-life integration and potential changes enabled by interprofessional working concepts.
A qualitative approach was used, with guided focus group interviews with 37 general practitioners followed by individual interviews with 10 general practitioners. The interviews were verbatim transcribed and analysed using the framework method. The primary analyses were conducted, overall and separately for each gender. A professional group also carried out analyses. The subgroup analyses are based purely on qualitative trends.
Both genders and all professional groups perceived work-life integration as necessary. Men tended to report a better work-life integration than women. Women were more likely to work part-time and emphasised difficulties with childcare. When establishing interprofessional concepts, participants hope for more opportunities for delegation and co-determination, which can go hand in hand with reduced workload.
In this current study, women tended to perceive a greater degree of double burden both in their job and leisure time than men did. Beyond these gender and professional group differences, there were also tendencies towards differences between women with and without children. The findings indicate that work-life integration is an important factor in the professional setting of general practice. Particularly given the increasing number of female general practitioners, the establishment of part-time and childcare options is necessary.
To critically and constructively explore the future of mental health nursing in Flanders (Belgium) by examining the historical evolution, current challenges, and potential strategies for clinical excellence and advancement.
This study used a historically informed and contextualised grounded analyses to envision future perspectives that support strategically targeted perspectives in compact regions such as Flanders (Belgium).
A synthesis of published literature, policy documents, academic sources, and Flemish nursing research was conducted to identify key directions.
By addressing local challenges, particularly related to education and labor market scarcity, this paper proposes three key directions for progress: ‘Back to good basics’, ‘Reclaiming the driver's seat of clinical advancement’ and ‘Revitalizing clinical excellence from within clinical nursing practice’.
These interlinked perspectives provide a framework for revitalising mental health nursing in Flanders, supporting clinical excellence and development while responding to the most pressing contemporary challenges. Although rooted in a compact regional context, the insights and proposed directions may inspire similar reflections and initiatives in international mental health nursing contexts.
To systematically review advanced nursing roles in caring for people with cognitive impairment and their relatives in acute care hospitals, focusing on describing roles and intervention components.
Systematic review.
We included qualitative and quantitative studies on nurses in advanced roles caring for people with diagnosed or suspected cognitive impairment and their relatives, assessing outcomes at patient, staff and organisational levels. Nurses' advanced role profiles ranged from nurse-led interventions up to Advanced Practice Nurses. We employed the Mixed Methods Appraisal Tool for critical appraisal and conducted a synthesis without meta-analysis using a content analysis approach.
MEDLINE, CINAHL, Cochrane Library, ALOIS, Web of Science and LIVIVO up to May 2024, along with forward and backward citation tracking.
We included 48 studies that described 39 distinct interventions. The majority of these studies employed a quasi-experimental design. Most interventions involved Advanced Practice Nurses (n = 23) and focused on people at risk of or experiencing delirium (n = 22). Nurses in advanced roles predominantly engaged in tasks related to direct clinical practice, as well as coaching and guidance for patients, relatives and colleagues. Their responsibilities also included leadership, collaboration and consultation on a regular basis. Activities related to research and ethical decision-making were infrequently reported.
Many areas of responsibility of nurses in advanced roles align with the needs of hospitalised people with cognitive impairment. Nurses in advanced roles increasingly take on diverse activities across all competence domains of Advanced Practice Nursing, with a focus on coaching and guidance, as well as clinical practice, while leadership, collaboration, research and ethical decision-making become more prominent as their formal training advances.
Our comprehensive description of advanced nursing roles in the care of people with cognitive impairment provides a foundation for developing and refining such roles in hospitals.
We followed the PRISMA guideline and SWiM guideline for reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
Prospero number: CRD42021265157
Huntington's disease has a disruptive effect on entire families. While previous reviews have examined lived experiences of individuals with Huntington's Disease, their informal caregivers, or their offspring, none have provided a comprehensive overview that integrates these three perspectives.
A scoping review.
Providing an integrated view and a holistic understanding of the multifaceted challenges faced by families affected by Huntington's disease.
We operationalised the lived experiences using the keywords: “barriers”, “facilitators” and “needs”. We extracted and thematically analysed data from 35 articles searched from 1993 to 2023.
Twelve themes were identified, organised into three dimensions: (1) Having the Disease: encompassing the symptoms and progression of the disease; (2) Family Dynamics: reflecting the challenges of living in a household affected by Huntington's disease; and (3) Outside World: describing relationships and interactions with relatives, friends, health services and wider social structures.
The dimensions and related experiences of all three perspectives are intertwined. These experiences are mutually reinforcing, with fluid shifts in perspective occurring between family members. While the needs of family members overlap, they also diverge, highlighting the need for a systemic, family-centred approach to address the evolving challenges faced by all family members.
No Patient or Public Contribution.
To evaluate nurses' perspectives on factors influencing the acceptability and practicality of comfort rounding, focussing on personalised nutritional and mobility care.
Mixed-methods feasibility study.
Focus group interviews with nurses were conducted before, during and at the end of the implementation period (2022–2023). A questionnaire assessed acceptability and practicality among nurses at the end of the implementation. Data were analysed using directed content analyses and descriptive statistics.
Comfort rounding's acceptability and practicality were influenced by nurses' attitudes, knowledge and skills, patient characteristics and the nurse–patient relationship. Barriers included workload, time pressure, team culture and the extensive, rigid design of comfort rounding. Questionnaire responses demonstrated nurses perceived added value of comfort rounding and frequently engaged patients in activities related to nutrition and mobility. However, it was not performed as originally intended.
Nurses considered personalised nutritional and mobility care important and frequently provided it during ‘usual care’. However, nurses were critical of comfort rounding's acceptability and practicality and did not perform it as intended.
Comfort rounding's concept does not align well with current nursing practice. Greater tailoring to nurses' preferences or alternative approaches to structuring personalised nutritional and mobility care are recommended.
What problem did the study address: Hospitalised patients often receive suboptimal nutritional care and are largely inactive. The challenge is to integrate personalised nutritional and mobility care effectively into standard nursing practice to enhance patient safety and well-being. Comfort rounding could improve patient safety and satisfaction; however, there is no research evaluating the feasibility of comfort rounding in relation to personalised nutritional and mobility care. What were the main findings: Comfort rounding was generally perceived as valuable and aligned with existing care routines, but its rigid structure was often considered impractical. Comfort rounding was not performed as originally intended due to the influence of individual, social and organisational factors. Flexibility in execution emerged as a critical factor for successful integration. Where and on whom will the research have an impact?: Comfort rounding can enhance attention to nutrition, mobility and patient participation when adapted to local contexts and delivered with flexibility. Policymakers and nurse leaders should avoid rigid protocols and instead support tailored implementation strategies alongside the practical delivery of locally tailored interventions.
Consolidated criteria for reporting qualitative research and Checklist for Reporting of Survey studies.
Nurses were involved in all stages of the study, contributing through focus group interviews and completing a questionnaire to help develop and evaluate comfort rounding.
PaNaMa Research Management System, number 112832
Preventing maternal stress is important for the healthy development of a child. Prenatal home visits were introduced as an integral part of the Dutch preventive youth healthcare for this purpose. This study aims to gain insight into the current state of prenatal home visits.
Mixed methods explanatory sequential design.
Two questionnaires, one for managers and one for nurses, were distributed to all 38 Dutch youth healthcare organisations. These could be filled in from 29 February to 15 April 2024. Respondents were subsequently invited to participate in an explanatory focus group on 12 June 2024, to help interpret the findings. Questionnaire data were analysed descriptively. Focus group data were analysed qualitatively using open inductive coding. Informed consent was obtained through a privacy statement included with the questionnaire.
The manager questionnaire had 17 respondents (from 17 organisations), of which 10 participated in the focus group, while the nurse questionnaire had 124 respondents (from 34 organisations), with 8 in the focus group. This study found large differences between youth healthcare organisations regarding collaboration agreements with municipalities, collaboration with referrers, the organisational process and the execution of prenatal home visits in practice. Managers and nurses encounter difficulties with assessing vulnerability in practice and how the intended target group should be reached effectively. While effective collaboration with potential referrers is believed to be essential for achieving accurate and appropriate referrals, the process was experienced as overly complex. No standardised system for documenting data from prenatal home visits was found.
Significant variations exist in organisation and implementation of prenatal home visits across youth healthcare organisations in the Netherlands. The unclear definition of ‘potential vulnerability’ results in an insufficiently defined target group. The lack of standardised data registration hinders the monitoring of the quality, continuity and effectiveness of these visits.
Variations in organisation and implementation of prenatal home visits may lead to unequal access to care and support for pregnant women and their unborn children across Dutch regions.The lack of a clear definition for ‘potential vulnerability’ results in challenges in identifying and reaching the intended target group, potentially excluding individuals who would benefit most from these services. The absence of a standardised system for data documentation prevents systematic monitoring and evaluation, making it difficult to assess the effectiveness of prenatal home visits and identify areas for improvement. This threatens the long-term embedding of prenatal home visits in the Netherlands. Further research should also aim to gain insight into the perspective of parents and midwives.
The paper adheres to the Standards for Reporting Qualitative Research (SRQR) and the Good Reporting of a Mixed Methods Study (GRAMMS) checklists.
There was no patient or public contribution to our study.
To explore Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease in primary care.
An inductive, descriptive qualitative study.
Data were collected through semi-structured interviews with 11 purposively sampled Registered Nurses of varying levels of experience from eight regions in Sweden. The audiotaped interviews were conducted over a 5-month period (December 2023–April 2024), transcribed verbatim and analysed using interpretive description.
Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease are described by three themes (seven subthemes): Patient continuity (Building personal relationships: Being accessible and enabling trust and confirmation), Collaborator continuity (Having a colleague to lean on: Colleagues can lean on me: Feeling alone with my expertise) and Continuity with myself (Trusting my own competence: Carrying a burden alone).
Consolidated Criteria for Reporting Qualitative Research Guidelines.
This study provides an understanding of Registered Nurses' experiences of continuity of care in primary care. The results may help improve future care since nurses play an essential role in the care of chronic obstructive pulmonary disease within primary care.
To enhance continuity of care for patients with chronic obstructive pulmonary disease, the relationship between the nurse and the patient is important, as is collaboration with colleagues. This collaborative approach allows these nurses to maintain continuity with both the patients and themselves, fostering a more stable and effective care environment.
This study offers valuable insights into the experiences of Registered Nurses in maintaining continuity of care within primary care, particularly for patients with chronic obstructive pulmonary disease. By highlighting the critical role of Registered Nurses in managing these patients, the study underscores the importance of strong nurse–patient relationships and effective collaboration among healthcare professionals.
No Patient or Public Contribution.
FreshRSS 