Conectar
The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.
An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.
Two tertiary stroke care centres in South India participated in the study.
Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.
High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.
The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).
The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.
The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.
Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).
Non-communicable diseases (NCDs) are rapidly escalating in developing countries and social factors such as the dynamics of the family play an important part in the lifestyle choices that lead to the onset and maintenance of chronic illness. There remains a gap in Malaysia as the majority of the studies were focused on the normal population rather than directly towards persons having NCDs. This study aimed to examine emerging risk factors such as family functionality and its association with NCD.
A cross-sectional survey was conducted using a multistage random sampling method.
Urban residential areas in Selangor, Malaysia.
A total of 2542 adults residing in urban areas of Selangor were recruited.
Family functionality was measured using the APGAR (Adaptation, Participation, Gain or Growth, Affection and Resources) scale and multiple logistic regression was performed to measure the association between emerging risk factors and NCD.
The prevalence of diabetes mellitus and hypertension was 10.8% and 6.1%, respectively. Widowed/separated status (adjusted OR (AOR) 41.53, 95% CI 19.06 to 90.48, p value=0.001) was reported to be a predictor of diabetes. As for hypertension, familial functionality (AOR 4.2, 95% CI 1.11 to 14.50, p value
There is a growing concern that family functionality is an emerging risk factor for NCDs. Future family-centred health promotion programmes should be incorporated to improve self-management behaviours and health outcomes.
by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan
BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.
MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.
ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.
ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.
by Eslam T. Mashaqbeh, Tamam El-Elimat, Osama Y. Alshogran, Iyad Hamzeh, Zahraa M. Obeidat, Ahmed H. Al Sharie, Feras El Hajji
The concurrent use of herbal dietary supplements with prescription medications raises safety concerns due to the potential for clinically significant interactions. Matcha, a shade-grown green tea consumed as an ultra-fine powder, is rich in catechins that may inhibit the transport of P-glycoprotein (P-gp) substrates such as nadolol. This study investigated the effects of administering single and multiple doses of matcha on the pharmacokinetics of nadolol in an in vivo animal model. Male Sprague-Dawley rats (n = 32) were randomly assigned to four groups. Group 1 (negative control) was administered normal saline followed by a single oral dose of nadolol (10 mg/kg). Group 2 (matcha single-dose) was administered a single dose of matcha (250 mg/kg) whisked in normal saline, followed by nadolol (10 mg/kg) after 30 min. Group 3 (positive control) received itraconazole (50 mg/kg), followed by nadolol (10 mg/kg) after 30 min. Group 4 (matcha multiple-dose) received matcha (250 mg/kg daily for 21 days) before administering nadolol (10 mg/kg) on day 21. Blood samples were collected at 0, 0.33, 0.66, 1, 1.5, 2, 3, 4, 5, 8 and 24 h. Nadolol concentrations in plasma were measured by a validated high-performance liquid chromatography with fluorescence detection (HPLC-FL) method. Pharmacokinetic parameters were estimated using the PK solver add-in for Microsoft Excel. To ensure quality control, caffeine, a key marker compound of matcha green tea, was quantified using HPLC with ultraviolet detection (HPLC-UV). A single oral dosage of matcha (250 mg/kg) had no statistically significant effects on the pharmacokinetics of nadolol compared to the control group (p > .05). Although the multiple-dose matcha group showed an increase in Cmax (~45%), AUC0-t (~18%), and AUC0-∞ (~22%) for nadolol compared to the control group, these differences were not statistically significant (p > .05). In contrast, the t½ (h) of nadolol increased significantly from 4.0 ± 1.6 in the control group to 7.7 ± 4.2 (p = .039) in the matcha multiple-dose group. Itraconazole co-administration significantly increased systemic exposure (AUC) of nadolol (p = .009), confirming the validity of the animal model. Caffeine, a key marker compound in matcha tea, was quantified at 4.18 ± 0.44% w/w of dry matcha tea powder, equivalent to 41.8 ± 4.4 mg/g. This is the first study to explore the potential pharmacokinetic interaction between matcha tea and nadolol. Single and multiple oral doses of matcha green tea had negligible effects on most pharmacokinetic parameters of nadolol, except for an increased half-life in the multiple-dose group. Further research is needed to establish the clinical relevance of this interaction before definitive recommendations on the safety of matcha tea and nadolol coadministration can be made.by Nirul Isamuddin Nasir, Mohd Hasni Ja’afar, Norfazilah Ahmad
IntroductionThis review focuses on the need to identify the lung function assessment tools used for young EC users. The objectives are to examine the current and emerging methods used in assessing lung function among young EC users, besides identifying the alterations in lung function following EC exposure measured by those tools.
MethodologyThis systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 flow checklist. Six databases (Web of Science, PubMed, Scopus, Taylor & Francis, SAGE, and ScienceDirect) were searched in April 2025 for original articles published between 2016 and 2025. Quality appraisal of the eligible articles was conducted using the Joanna Briggs Institute (JBI) Critical Appraisal Tools. Findings were synthesized using Narrative analysis.
ResultsA total of 7 studies were included. Spirometry was used in all included studies; however, it is unable to detect subclinical lung alterations, as observed through ventilation-perfusion (V/Q) MRI and fractional exhaled nitric oxide (FeNO). Acute exposure to EC results in a decrease of FEV₁, FVC, PEF, and MEF₇₅ spirometric parameters, as well as reducing FeNO levels, while concurrently increasing exhaled breath temperature (EBT). Besides, an increase in V/Q mismatch and heterogeneity in ventilation is observed, with a reduction in perfusion heterogeneity. Chronic EC exposure causes a reduction in FEV1, PEF, FEV1/FVC, and FEF25–75%, besides an increment of Carboxyhaemoglobin (HbCO) level. The assessment of the lung function post-EVALI in association with EC cessation revealed lung function improvement and increased diffusing capacity of the lung for carbon monoxide (DLCO).
ConclusionsSpirometry remains the first-line tool for assessing the lung function of young EC users; however, it often misses early lung dysfunction. Emerging methods (FeNO, DLCO, EBT, MRI, HbCO) increasingly complement this limitation. Tailoring multimodal assessment to exposure context, alongside screening and monitoring programs, may assist in early disease detection and prevent long-term respiratory effects.
Recent advances in treatment and care have improved survival rates for children and young adults with severe blood disorders such as sickle cell disease (SCD), transfusion-dependent beta-thalassaemia (TDT) and acute leukaemia. However, their quality of life and reproductive and psychosocial outcomes are not yet well studied. For SCD and TDT, robust survival data are mainly limited to North America. Thus, there is a need to fill these knowledge gaps to guide improvements in care, address unmet clinical needs and rigorously assess the efficacy of emerging novel therapies.
This is an observational population-based mixed-methods study of individuals diagnosed with SCD, TDT or acute leukaemia when under the age of 18 in England, involving a data linkage component and a patient-reported outcomes measures survey. Data linkage-eligible participants will be identified from national and regional databases, including the Hospital Episode Statistics, Yorkshire Specialist Register of Cancer in Children & Young People and the National Congenital Anomaly and Rare Diseases Registration Service. Data linkage will be processed within the NHS England and the University of Leeds’ secure, trusted research environments. Data will be accessed without consent under section 251 and approval by the confidentiality advisory group. It will assess survival rates for SCD and TDT as well as clinical, educational and mental health outcomes for SCD, TDT and acute leukaemia diagnosed in childhood.
Survey-eligible participants for SCD, TDT and acute leukaemia cohorts will be checked for their suitability to participate by the North of England clinical care teams. An NHS-approved survey provider will facilitate data checks with the NHS National Data Opt-Out Service. Consent is required for participation in the survey and for subsequent data linkage to existing databases. Surveys are conducted in various formats (online, paper and phone), with reminders sent after 21 days. The survey will assess quality of life and psychosocial and reproductive outcomes. Participants can withdraw at any time, and support is available via telephone helplines.
The study has received ethical and information governance approval from the Health Research Authority (Reference 24/YH/0186) and the Confidentiality Advisory Group (CAG 24/CAG/0138) to process identifiable data without consent. Study results will be available to patients, physicians, researchers, stakeholders and others through open-access publishing, results sharing via media platforms and presentations at conferences and meetings.
To explore the factors affecting the sustainable improvement of nurses' evidence-based practice (EBP) competency after receiving an EBP training program.
A sequential mixed-methods study.
Thirty-seven ICU nurses participated from an adult ICU in Egypt. The qualitative phase used a category-generating approach with focus group interviews and content analysis. The quantitative phase followed a cross-sectional descriptive design using self-report questionnaires. The study adhered to the Good Reporting of a Mixed Methods Study (GRAMMS) guidelines and was registered with ClinicalTrials.gov (NCT05941364).
Qualitative analysis generated six subcategories, organised into three overarching themes: working environment challenges, job dissatisfaction and organisational obstacles. Quantitative findings revealed low levels of motivation (M = 19.1, SD = 2.2, out of 60), self-efficacy (M = 18.4, SD = 8.66) and self-regulation (M = 124.9, SD = 52.6). The highest mean score was observed for the Sustained Implementation Support Scale (M = 94.7, SD = 5.0, out of 140). These variables showed negative correlations with the sustainability gap. Integration of findings through a joint display demonstrated a convergence of results regarding training program burden and low motivation.
Sustaining nurses' EBP literacy requires addressing long-term obstacles such as inadequate job satisfaction, limited workplace support and lack of team cohesion. Sustained organisational support and leadership development are essential for EBP clinical integration.
The study highlights key strategies for nurses' development to enhance care quality, including improving self-efficacy through mentorship and fostering a supportive work environment. Health policies should establish EBP as a core competency, offer flexible schedules, ongoing training, adequate resources, and empower nurse leaders for successful implementation.
This study addresses the critical challenge of sustaining nurses' competency improvements after EBP training. The findings are crucial for healthcare administrators, policymakers and educators aiming to design effective EBP training programs. By addressing these factors, the study has the potential to improve patient outcomes.
No patient or public contribution.
by Ahmed Usama Fahim, Atika Aboni, Shirajoom Munira, Nishat Tasnim Toosty
IntroductionChild discipline, while intended to instill appropriate behavior, often manifests as violent practices in low- and middle-income countries, including Bangladesh. Maternal exposure to violence, attitude towards intimate partner violence (IPV), and disciplinary beliefs serve as key determinants of physical disciplinary practices. These dynamics illustrate how exposure to violence in adulthood can shape parenting behaviors, highlighting the urgency of addressing cultural attitudes that sustain harsh physical discipline.
Materials and methodsThis study analyzed nationally representative cross-sectional data from the 2019 Bangladesh Multiple Indicator Cluster Survey (MICS) which included 30044 mother-child (children aged between 2 and 14 years) pairs. Physical disciplinary practice is analyzed as an ordered outcome, considering maternal experience of physical violence as the primary exposure along with their attitudes toward IPV and disciplinary beliefs as mediators. This study used ordinal logistic regression within a structural equation modeling framework and bootstrapping technique to analyze indirect associations, providing robust inference that accounts for sampling variability and accommodates binary mediators.
ResultsMothers exposed to violence had significantly higher odds of physically disciplining their children (odds ratio, OR=1.77 and 95% confidence interval, CI=[1.60, 1.95]). Three mediators significantly increased the odds of adopting harsh physical disciplinary practice by 2% through maternal positive attitudes toward IPV, by 51% through their disciplinary beliefs, and by 6% through their overall life satisfaction. The total association indicated that maternal exposure to violence nearly tripled the odds (OR = 2.89 and 95% CI= [2.52, 3.31]) of physical disciplinary practices.
ConclusionThis study suggested that supportive environment for children can be fostered by reducing violence against women, promoting mothers’ life satisfaction, and reshaping women’s perceptions of spousal abuse and disciplinary beliefs.
by Smail Acila, Nora Allioui, Samir Derouiche
Heavy metal contamination poses a significant threat to agricultural productivity. This study investigated the physiological and biochemical responses of Cucurbita pepo seeds to cadmium (Cd) and copper (Cu) stress (100–200 µM) during germination. Although germination rates remained high (86.67–93.33%), seed vigor indices declined significantly under metal stress. Cadmium exhibited stronger growth inhibition, reducing total seedling length by 63.02% at 200 µM, whereas copper primarily affected biomass accumulation, reducing the seedling weight-based vigor index (SVIW) by 40.4%. Biochemical analyses revealed metal-specific impacts on reserve mobilization. Cadmium exposure (200 µM) decreased soluble sugars in cotyledons by 16%, while maintaining protein content at 106% of control levels, indicating inhibition of protein degradation and impaired reserve utilization. In contrast, copper at 100 µM increased cotyledonary sugars by 63%, reflecting its dual role as both a micronutrient and stressor. Principal component analysis confirmed the greater toxicity of Cd, which explained 79.7% of the variance in metabolic disruption. These findings demonstrate that cadmium consistently impairs seedling establishment by disrupting nutrient mobilization pathways, while copper exhibits concentration-dependent effects, being stimulatory at low concentrations but inhibitory at higher levels. This study provides crucial insights into heavy metal phytotoxicity mechanisms and underscores the importance of monitoring metal pollution in agricultural systems to enhance crop resilience.Digital technology in primary healthcare service delivery can enhance accessibility, service delivery and health outcomes in rural populations. The objective of this systematic review is to review and synthesise the scope and impact of digital health technology innovations within rural primary healthcare settings.
Systematic review.
Articles published on PubMed, PsycINFO, Cochrane Central, SCOPUS, Web of Science, EMBASE and CINAHL between January 2013 and October 2025 were searched using key search terms.
Patient, intervention, context, outcome model criteria guided article eligibility. Included articles were undertaken in rural populations, used digital health technology for treatment or management, explored the impact of digital health technology on rural primary healthcare and reported on healthcare outcomes. Included articles were in the English language and presented peer-reviewed primary research.
Extraction was performed using a bespoke standardised template by multiple reviewers. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. Descriptive analysis and conventional inductive content analysis were applied to quantitative and qualitative data, respectively. The review is written in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement guidelines.
66 studies were included in the review. Most studies were conducted in the USA (n=26). Most studies focused on adult patient populations, with limited representation of Indigenous (In=3) and paediatric populations (n=2). Telemedicine/telehealth interventions using audio, video or both were the most common (n=36). Remote patient monitoring or point-of-care testing was integrated into 21 studies. Physical health conditions, particularly diabetes (n=17), cardiovascular diseases (n=11) and general primary healthcare concerns (n=13) were commonly reported. Others reported on areas including mental health, hypertension, obesity and pregnancy care.
Conventional inductive content analysis identified key themes: cost and time effectiveness, quality healthcare provision, consumer acceptance from both patients and practitioners, and healthcare service provider perspectives. Uptake barriers included staff workload and patient non-compliance, while facilitators encompassed process standardisation and practitioner acceptance and endorsement. Consumer acceptance was linked to satisfaction, willingness to engage and improved health outcomes and well-being.
Digital health interventions in rural primary healthcare offer significant potential to improve healthcare delivery, reduce costs and enhance patient access, satisfaction and health outcomes. However, careful consideration of factors such as feasibility, consumer and practitioner acceptance, and recognition of limitations is crucial for successful implementation. The review underscores the importance of flexible policies to support emerging digital healthcare solutions, including the integration of artificial intelligence. Overall, digital health interventions offer a promising avenue to improve healthcare outcomes in rural areas and should be prioritised for government funding and investment.
CRD42023477233.
by Ernest V. Boiko, Elena V. Samkovich, Irina E. Panova, Alexander A. Ivanov, Sergey B. Shevchenko, Sergey L. Vorobyev, Elizaveta S. Kalashnikova, Victoria G. Gvazava, Elizaveta A. Masian, Alexandra E. Kim
PurposeTo define optimal exposure parameters and the therapeutic window for transscleral photodynamic therapy (TSPDT) with chlorin e6 by evaluating clinical, histological, and thermal effects of subthreshold, therapeutic, and suprathreshold settings in rabbit eyes.
MethodsThe study was conducted on 21 healthy rabbits. TSPDT was performed using a 660 nm laser and chlorin e6 (2.5 mg/kg). Transscleral probes (5 mm: 0.1 W, 0.17 W, 0.3 W; 10 mm: 0.3 W, 0.6 W) with integrated thermosensors were used. Enucleation and histological analysis were performed 14 days post-irradiation.
ResultsFundus examination on day 14 revealed distinct treatment zones correlating with laser settings. The therapeutic window was defined as 0.14–0.17 W (5 mm probe; power density: 0.693–0.866 W/cm²; energy density: 415.8–519.6 J/cm²) and 0.48–0.6 W (10 mm probe; 0.611–0.764 W/cm²; 366.6–458.4 J/cm²) with 600 s exposure time, achieving selective choroidal damage without scleral or retinal injury (ΔT ≤ 4.5°C). Suprathreshold settings (≥0.3 W for 5 mm; ≥ 0.6 W for 10 mm) induced retinal necrosis (up to 50%) and scleral coagulation (ΔT ≥ 8°C) with power densities exceeding 0.866 W/cm² (5 mm) and 0.764 W/cm² (10 mm).
ConclusionTSPDT with chlorin e6 enables selective targeting of intraocular pathological tissues while preserving scleral and retinal integrity. Defining the therapeutic window and using real-time thermal monitoring enhances treatment safety. These findings lay a foundation for clinical protocols for uveal melanoma and other intraocular tumors.
Mothers’ mental health and life satisfaction may have been negatively affected due to challenges during the COVID-19 pandemic. Given the risk of future crises, knowledge of possible mitigating factors in this population is essential. This study aims to examine whether the pandemic affected the level of protective factors such as social support, physical activity and employment situation, and how these factors are associated with mental distress and life satisfaction.
Longitudinal cohort study.
Primary outcomes were mental distress (measured by the eight-item version of the Hopkins Symptom Checklist) and life satisfaction (measured by the Satisfaction With Life Scale). As the first step, we investigated changes in the levels of social support (defined by the number and frequency of social contact), physical activity (average hours of physical activity during a week), employment situation (actively working vs sick leave or unemployed), alcohol consumption (measured by the Alcohol Use Disorders Identification Test-Consumption) and relationship satisfaction (measured by the five-item version of the Relationship Satisfaction Scale).
We analysed data from two waves of the Norwegian Mother, Father and Child Cohort Study (n=~18 000 mothers); one pre-pandemic wave and one wave where half of the sample responded after the onset of the pandemic, with pandemic exposure being defined by questionnaire response timing rather than cohort recruitment. To assess changes in protective factors over time and pandemic exposure, we used difference-in-differences analyses and regression discontinuity design. Associations between protective factors with mental distress and life satisfaction, and possible moderation by pandemic exposure, were investigated using multiple regression models with interaction terms adjusted for potential confounders.
Apart from physical activity, which declined less across time in the pandemic group (B=0.09, 99% CI 0.05 to 0.12), protective factors did not change during the pandemic. Social support, employment situation and relationship satisfaction were associated with mental distress and life satisfaction, whereas physical activity showed a unique relationship with mental distress. Most associations were similar across pandemic exposure groups, except employment situation which appeared to have a stronger protective effect in the pandemic group (β=–0.12, 99% CI –0.24 to –0.00).
Changes over time in self-reported levels of protective factors were generally consistent among mothers independent of the pandemic. These factors appear to play an equally important role for mental distress and life satisfaction both under ordinary circumstances and during public health crises. Our findings enhance the understanding of how potential protective factors among mothers are associated with mental distress and life satisfaction in the context of a global stressor. Future studies should investigate additional mitigating factors that may be particularly relevant during global crises and explore the causal relationship between protective factors, mental health and life satisfaction.
To explore and map the landscape of doctoral nursing research across eight countries.
A scoping review.
This review followed the Joanna Briggs Institute methodology for scoping reviews and included doctoral theses in nursing defended between 2020 and 2023 in Austria, Italy, Israel, the Netherlands, Poland, Portugal, Slovakia and the United Kingdom.
Searches were conducted across 15 national and university repositories (4 national, 11 university) in the eight participating countries.
This review included 431 doctoral nursing theses, the majority of which employed quantitative methodologies and focused on patient populations and healthcare professionals. Key topics included clinical nursing care, quality of care, quality of life, home care, perinatal care and the work environments.
Nursing doctoral research shows progress in healthcare delivery, patient care and education via digital tools, holistic approaches and professional development. Yet gaps persist in mental health, paediatrics and marginalised groups. Limited qualitative/mixed-methods research and weak interdisciplinary collaboration reveal further opportunities.
This review underscores that nursing doctoral research is addressing major healthcare and professional challenges. Nonetheless, the identified gaps emphasise the need for more comprehensive and inclusive research to enhance equity and guide future nursing practices and policies.
This review provides an overview of the scope of doctoral nursing research across eight countries, identifying key trends and research gaps. The findings are expected to inform nursing academia, policymakers, and healthcare professionals by guiding future research priorities, fostering interdisciplinary collaboration, and promoting equitable, patient-centred care practices.
No direct involvement in data collection; one lay reviewer gave feedback on readability and practice implications, informing minor refinements.
Non-specific thoracic spine pain (NTSP) is an under-recognised musculoskeletal condition associated with functional limitations, reduced quality of life and significant healthcare utilisation. Conservative management, including manual therapy, exercise and education, is widely used across physiotherapy, osteopathy and chiropractic practice. However, outcome measures used in NTSP research remain heterogeneous and inconsistently defined, limiting evidence synthesis and hindering progress toward developing a core outcome set (COS). This scoping review aims to systematically map the outcome measures reported in studies evaluating conservative care for adults with non-specific TSP, thereby identifying key outcome domains to inform future COS development.
This review will follow the Joanna Briggs Institute methodology for scoping reviews and is registered on the Open Science Framework. Five electronic databases (MEDLINE, CINAHL, Scopus, Web of Science, AMED) will be searched from July 2005 to July 2025, supplemented by searches of PROSPERO and Google Scholar. Eligible studies will include adults (≥18 years) receiving conservative care for TSP in non-hospital settings, reporting at least one outcome measure, and published in English. Study selection will involve two independent reviewers using Covidence, with data extracted using an iterative extraction tool. Findings will be synthesised narratively and presented in tables, with a preferred reporting items for systematic reviews and meta-analyses flow diagram used to report study selection. No quality appraisal will be undertaken, consistent with scoping review guidance.
Ethical approval is not required as this review uses published data. Findings will be disseminated through peer-reviewed publication, conference presentations and engagement with a patient and public involvement and engagement group to support relevance and translation into future COS development.
Clinical nurses face notable chronic stress due to work-related stressors, exacerbated by the COVID-19 pandemic, leading to somatic symptoms and low-grade inflammation. Mindfulness meditation has shown promise in reducing stress and improving health outcomes, but its effects on somatic symptoms and inflammatory biomarkers in nurses remain underexplored.
To assess the impact of mindfulness meditation on somatic symptoms and inflammatory biomarkers such as leptin, interleukin-6, and tumor necrosis factor-α among nurses. To explore the secondary effects on perceived stress and trait mindfulness because of the complex interlinked association with the primary outcomes of interest.
A randomized controlled trial was conducted with 102 nurses randomly assigned to a meditation group (8-week mindfulness meditation program) or a non-meditation group. Data were collected using self-report questionnaires (Mindfulness Attention Awareness Scale, Perceived Stress Scale, Patient Health Questionnaire-15) and blood samples for biomarker analysis at baseline and post-intervention.
The meditation group demonstrated notable reductions in perceived stress (p < 0.001), somatic symptoms (p < 0.001), IL-6 (p < 0.001), and leptin levels (p < 0.001) compared to the non-meditation group. Trait mindfulness increased markedly in the meditation group (p = 0.003), while TNF-α levels did not show notable changes.
Mindfulness meditation efficiently reduces perceived stress, somatic symptoms, and inflammatory biomarkers in nurses, highlighting its potential as a holistic intervention to improve both psychological and physical well-being in high-stress healthcare environments.
ClinicalTrail.gove, NCT06635278
Current research lacks a comprehensive understanding of evidence-based practice (EBP) adoption and its predictors across diverse healthcare professionals (HCPs) in the Eastern Mediterranean Region (EMR), particularly with a direct comparison between nurses and other professional groups.
This study aims to evaluate the EBP competencies, adoption levels, identified barriers, and associated predictors among nurses and other healthcare professionals (HCPs) within the EMR.
A cross-sectional, correlational, and comparative design was used. An electronic survey was distributed (April 27th–August 17th, 2023) via convenience/snowball sampling, inviting nurses, physicians, physiotherapists, dentists, and pharmacists across the EMR to complete the survey. Multivariate regression analysis and structural equation modeling (SEM) were used to identify predictors of EBP adoption.
A total of 4673 HCPs participated and reported several barriers to EBP adoption, including time constraints, difficulties in interpreting statistics, lack of authority to change practices, and insufficient equipment. Nurses had fewer postgraduate degrees but more work experience and full-time employment than other HCPs. Despite reporting more workplace EBP support, nurses read less research, had lower EBP scores and adoption propensity, and perceived greater barriers than other HCPs (p < 0.002). Multivariate regression showed the highest barrier scores in Syria/Tunisia and the lowest in the United Arab Emirates. Nurses reported significantly higher barriers compared to other HCPs (p < 0.001). Fear of Change was not a primary barrier overall, but was elevated in specific subgroups of nurses. SEM showed good fit: RMSEA = 0.077, SRMR = 0.053, CFI = 0.80, χ 2(df) = 917, p < 0.001. SEM showed that EBP adoption propensity and fear of change significantly mediate the relationship between HCPs' characteristics and EBP scores.
Despite having a positive attitude and propensity towards EBP, nurses lack the necessary knowledge and support to adopt it, and they face more barriers than other healthcare professionals. Nurses require greater support from healthcare leaders to enhance their EBP competencies and address the reported barriers. Policymakers and organizations should prioritize tailored, role-specific training and supportive structures and environments to ensure equitable and effective EBP implementation for improving patient outcomes across the EMR.
A lack of murine models that mimic impaired wound healing in people with type 2 diabetes has hindered research. The commonly used leptin-receptor knockout model (db/db) fails to accurately reflect the pathophysiology of human disease. This study aimed: (i) to investigate whether our novel murine model of diabetes, whilst less hyperglycaemic and obese than db/dbs, effectively demonstrated impaired wound healing, and (ii) to identify the most robust methods for quantifying wound closure. C57BL/6J mice were high-fat diet fed for a total of 11 weeks and injected with three doses of streptozotocin (65 mg/kg body weight) at week 5 with chow-fed mice as controls. All mice received four excisional wounds and were euthanised at day-4 or day-10 post-wounding (n = 8/group/timepoint). Wound healing was evaluated by digital planimetry, histology, Micro-CT, and tensiometry. Histological analysis was the most sensitive method for identifying impaired wound healing. Our high-fat diet/low-dose streptozotocin model had significantly higher non-fasting blood glucose (25.7 ± 5.4 mmol/L vs. 8.7 ± 0.8 mmol/L) and lower wound quality scores (day-4 post-wounding: 2.6 ± 1.9 vs. 4.4 ± 0.8) than healthy controls (both p < 0.05). At day-10 post-wounding, a linear trend in wound healing was observed between healthy controls, our novel model and the db/db model, indicating that our diabetic murine model may be clinically relevant for studying diabetes-related wound healing.
by Jessica Liu, Sameer Pandya, Andreas Coppi, H. Patrick Young, Harlan M. Krumholz, Wade L. Schulz, Guannan Gong
BackgroundNear real-time electronic health record (EHR) data offers significant potential for secondary use in research, operations, and clinical care, yet challenges remain in ensuring data quality and stability. While prior studies have assessed retrospective EHR datasets, few have systematically examined the integrity of real-time data for research readiness.
MethodsWe developed an automated benchmarking pipeline to evaluate the stability and completeness of real-time EHR data from the Yale New Haven Health clinical data warehouse, transformed into the OMOP common data model. Twenty-nine weekly snapshots of the EHR collected from July to November 2024 and twenty-two daily snapshots collected from April to May 2025 were analyzed. Benchmarks focused on (1) clinical actions such as patient additions, deletions, and merges; (2) changes in demographic variables (date of birth, gender, race, ethnicity); and (3) stability of discharge information (time and status). A synthetic dataset derived from MIMIC-III was used to validate the benchmarking code prior to large-scale analyses.
ResultsBenchmarking revealed frequent updates due to clinical actions and demographic corrections across consecutive snapshots. Demographic changes were most frequently related to race and ethnicity, highlighting potential workflow and data entry inconsistencies. Discharge time and status values demonstrated instability for several days post-encounter, typically reaching a stable state within 4–7 days. These findings indicate that while near real-time EHR data provide valuable insights, the timing of data stabilization is critical for accurate secondary use.
ConclusionsThis study demonstrates the feasibility of automated benchmarking to assess the integrity of real-time EHR data and identify when such data become analysis ready. Our findings highlight key challenges for secondary use of dynamic clinical data and provide an automated framework that can be applied across health systems to support high-quality research, surveillance, and clinical trial readiness.
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