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Cuando a la embarazada se le ha administrado oxitocina por vía intravenosa para iniciar o acelerar el trabajo de parto, interrumpir la oxitocina una vez que se encuentra en la fase activa del trabajo de parto, en lugar de continuar administrándola hasta el parto, podría suponer poca o ninguna diferencia en la necesidad de realizar una cesárea (parto mediante un corte en el abdomen) y parece ser seguro tanto para la madre como para el bebé.
Interrumpir la oxitocina cuando comienza el trabajo de parto activo podría ayudar a evitar contracciones excesivas y reducir la exposición innecesaria a la medicación, pero podría hacer que el trabajo de parto dure más, aunque el resultado para la duración del trabajo de parto no estuvo muy claro.
Las decisiones acerca de si continuar o interrumpir la oxitocina se deben discutir con los profesionales sanitarios y tener en cuenta la situación clínica (incluido el progreso del trabajo de parto, las contracciones, el estado actual de la mujer y el bebé), la monitorización disponible y las preferencias de la mujer.
Cuando se acerca el momento del parto ("a término", es decir, después de las 37 semanas de embarazo) a las embarazadas a veces se les administra oxitocina artificial, un medicamento que se utiliza para iniciar las contracciones (uterinas) necesarias en el parto o para hacerlas más intensas. A menudo se administra por goteo en una vena. Una vez que se ha establecido el trabajo de parto activo (que es cuando el cuello uterino se ha dilatado al menos 4 cm y las contracciones se producen de forma regular), se considera que el cuerpo produce suficiente oxitocina natural para mantener la progresión del trabajo de parto. Continuar administrando oxitocina artificial una vez que la mujer está en trabajo de parto activo podría hacer que las contracciones sean demasiado frecuentes o demasiado fuertes, lo que podría causar sufrimiento al bebé y aumentar la probabilidad de que la mujer necesite que se le realice una cesárea (un corte en la tripa para sacar al bebé).
Queríamos saber si la interrupción de la oxitocina una vez que el trabajo de parto está activo reduce el riesgo de cesárea y si tiene algún efecto beneficioso o perjudicial para las madres o los bebés.
Buscamos estudios que compararan los 2 enfoques en mujeres con un embarazo único (es decir, un bebé, sin mellizos ni trillizos) a término, que recibían oxitocina para la inducción o para acelerar el trabajo de parto, de manera que se pudiera averiguar si es mejor:
interrumpir la oxitocina una vez que comienza la fase activa del trabajo de parto, o
continuar con la oxitocina hasta que se produzca el parto.
Buscamos evidencia hasta el 17 de noviembre de 2025. Cuando fue posible, combinamos los resultados de los estudios para obtener la máxima cantidad de información. Evaluamos la fiabilidad de cada estudio y la confianza en los resultados, en función de factores como el tamaño de los estudios, si estaban bien diseñados y ejecutados y cuán precisos fueron sus resultados.
Incluimos 9 estudios con 4814 mujeres. Los estudios se realizaron en hospitales de Dinamarca, Estados Unidos, Francia, India, Irán, Israel, Tailandia y Turquía. Los estudios utilizaron varias definiciones diferentes de trabajo de parto activo.
La interrupción de la oxitocina durante la fase activa del trabajo de parto:
podría suponer poca o ninguna diferencia en el número de partos por cesárea (8 estudios, 4710 mujeres);
supone poca o ninguna diferencia en el número de partos instrumentales (5 estudios, 3776 mujeres); y
podría reducir el riesgo de contracciones demasiado frecuentes o demasiado fuertes (llamadas taquisistolia o hiperestimulación uterina) (3 estudios, 1371 mujeres); pero
el trabajo de parto fue aproximadamente 35 minutos más largo, de media, cuando se interrumpió la oxitocina, aunque este resultado no estuvo muy claro (8 estudios, 4141 mujeres).
Además, durante la fase activa del trabajo de parto, se observó lo siguiente:
no hubo diferencias claras entre continuar e interrumpir la oxitocina en las puntuaciones de Apgar (una evaluación rápida de lo bien que se encuentra el recién nacido después del parto) (5 estudios, 2096 mujeres);
no hubo diferencias claras entre continuar e interrumpir la oxitocina en los signos de reducción del suministro de oxígeno al bebé antes del parto, medido con la prueba de la sangre del cordón umbilical después del parto (6 estudios, 4086 mujeres); y
probablemente hay poca o ninguna diferencia entre continuar e interrumpir la oxitocina en cuanto al ingreso del recién nacido en la unidad neonatal (7 estudios, 4606 mujeres).
La fiabilidad de la evidencia varió mucho. Tenemos seguridad en los resultados relacionados con los partos instrumentales, las puntuaciones de Agpar y la reducción del suministro de oxígeno al bebé antes del parto, y bastante seguridad con respecto a los resultados relacionados con el ingreso del recién nacido en la unidad neonatal. Tuvimos algunas dudas sobre los resultados relacionados con la cesárea y la hiperestimulación uterina, y muchas dudas sobre los resultados relacionados con la duración de la fase activa del trabajo de parto. Algunos motivos de esta incertidumbre fueron los siguientes:
las participantes de los estudios sabían en qué grupo se encontraban, es decir, si la oxitocina continuaba o se interrumpía, lo que podría haber afectado los resultados;
los estudios utilizaron diferentes definiciones para las medidas que informaron, como la fase activa del trabajo de parto, la taquisistolia uterina y la hiperestimulación uterina; y
el tiempo que las embarazadas estuvieron en trabajo de parto varió entre los estudios.
La evidencia está actualizada hasta el 17 de noviembre de 2025.
Life expectancy for people with type 1 diabetes has increased due to improved treatment of diabetes and its comorbidities, allowing many to reach old age. Still, we lack knowledge of how individuals with type 1 diabetes age. On one hand, those who reach older age can be considered survivors, but on the other hand their long-standing diabetes might still exhibit negative impacts on their health and functional ability. Healthy ageing is the WHO’s priority for this decade. The focus has shifted from chronological age to functional ability, which reflects the ability of individuals to perform meaningful activities. Functional ability is shaped by intrinsic capacity, the environment and their interaction. Intrinsic capacity encompasses five main domains: cognition, vitality, sensory function, locomotion and psychological domain. This observational study aims to assess how this vulnerable group of individuals with type 1 diabetes age and to identify factors that contribute to their healthy ageing, intrinsic capacity and its domains.
The FinnDiane LifeOne Study is a prospective observational cohort study. We aim to recruit a minimum of 300 individuals with type 1 diabetes from the FinnDiane Study, aged >65 and a minimum of 100 matched controls without insulin-dependent diabetes. The cohort will be comprehensively characterised, including clinical assessment, laboratory tests, questionnaires and a geriatric assessment of different aspects of functioning ability, with 5 years intervals. We will compare the individuals with type 1 diabetes to their matched controls. For those with type 1 diabetes, we will further assess which factors from the FinnDiane baseline and trajectories during follow-up predict healthy ageing in above 65-year-olds.
The LifeOne Study protocol is approved by the Ethics Committee of HUS Helsinki University Hospital (HUS/4387/2023) and the study adheres to the Declaration of Helsinki. Written informed consent is obtained from each participant. Findings will be published in international peer-reviewed journals with an open access choice.
Chronic pain affects around 28 million adults in the UK and is associated with impaired work ability, reduced productivity and increased sickness absence. Access to work-focused support within healthcare services is limited, and most employers do not routinely provide structured assistance for employees living with chronic pain. The Pain-at-Work Toolkit is a co-created, web-based intervention designed to improve work ability, self-management, and workplace experiences for employees living with chronic pain. A feasibility trial demonstrated strong acceptability, exceptional recruitment and potential improvements in work ability, providing clear justification for progression to a fully powered evaluation. This paper describes the protocol for a definitive cluster randomised controlled trial to evaluate the effectiveness, cost-effectiveness and implementation of the Pain-at-Work Toolkit.
This two-arm, open-label cluster-randomised controlled trial will recruit at least 70 organisations (minimum 35 clusters per arm) and at least 685 participants. Organisations will be randomised 1:1 to (a) support-as-usual (SAU) or (b) SAU plus the Pain-at-Work Toolkit, and Pain-at-Work Manager’s Toolkit as an implementation-support component. The primary outcome is work ability at 3 months, measured using the Work Ability Index (three-item version). Secondary outcomes include work self-efficacy, sickness absence, presenteeism, productivity loss, job satisfaction, job stressfulness, turnover intentions, anxiety, depression and health-related quality of life. A mixed-methods process and implementation evaluation will assess fidelity, contextual influences and mechanisms of impact. A health economic evaluation will estimate cost-effectiveness from employer and societal perspectives. Analyses will follow intention-to-treat principles using multilevel modelling.
Ethical approval was granted by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref: FMHS 1200226) and the UK Health Research Authority and Health and Care Wales (IRAS 367449). Findings will be disseminated through peer-reviewed publications, conference presentations, stakeholder reports and public summaries.
To examine how household members, community health research workers (CHRWs) and broader social networks influenced pregnant women’s capabilities, opportunities and motivations to consume a daily balanced-energy protein (BEP) supplement or a multiple micronutrient supplement (MMS) in the context of an effectiveness trial in rural Bangladesh.
In-depth interviews, group interviews, focus group discussions, thematic analysis using the Capability, Opportunity, Motivation-Behaviour (COM-B) framework.
Gaibandha, Bangladesh.
Women (n=32) who had completed participation in the TARGET-BEP randomised trial, their husbands (n=13) and mothers-in-law (n=13), who participated in 13 group interviews, and CHRWs (n=39) who participated in six focus group discussions.
Capability to adhere to BEP and MMS was strengthened when family members understood the value of supplements and actively supported supplementation. Children emerged as unexpected facilitators, reminding mothers to consume supplements and tracking intake. Opportunity to use supplements consistently was enhanced by women’s educational attainment and the availability of household resources. Finally, motivation to take the supplements was influenced by many actors including neighbours, who could offer support but also often transmitted rumours and taboos, and CHRWs, who adeptly adapted adherence messages to the local context and to women’s specific concerns.
To improve antenatal supplement adherence and maternal–infant health in Bangladesh and similar contexts, pregnancy nutrition programmes should move beyond the woman-as-sole-agent paradigm by: (1) co-designing messages for husbands, mothers-in-law, children and neighbours in conversation with effective community health workers, such as those working in the TARGET-BEP trial; (2) equipping community health workers with flexible, family-engaging counselling strategies; and (3) complementing women’s education gains with gender-transformative and family-inclusive interventions.
ClinicalTrials.gov NCT05576207
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
In this commentary, I consider the disparity between the care we see as a necessity for cancer patients and the lack of care we afford to many persons with chronic disease.
I ground my arguments in my own clinical practice and research experiences over a 50-year period augmented by reference to available literature sources.
In tracing developments within the fields of cancer and chronic illness care, I draw on my own research and that of others.
Although chronic illness has long been recognised as causing the majority of the burden on our health care systems and as a significant source of suffering in our society, it has not attracted the level of enthusiasm from researchers, policy makers, and health care systems that we have seen in the context of other diseases such as cancer. Nurses have an intimate knowledge of the suffering occasioned by chronic illness; however, it has been difficult for nursing to mobilise coordinated action in prioritising a re-balance of health systems to better serve those with chronic conditions.
The advent of medical assistance in dying in Canada has shed a spotlight on the implications of the discrepancy between our prioritising patient need in the care and support of patients with conditions such as cancer, in contrast with the supports and services we make available to those with chronic conditions.
Although nursing intimately engages with the burden of chronic illness, it has not mobilized coherent advocacy toward strengthening our societal commitment to this aspect of our care systems.
There is an opportunity for nursing to make a meaningful difference in a fundamental health care system inequity if we can come to understand that chronic illness is as deserving of our collective research, practice change, and policy attention as is cancer.
No patient or public contribution.
The Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen Therapy Trial (ICU-ROX) compared conservative oxygen therapy with usual care in mechanically ventilated adults in Australian and New Zealand intensive care units. Dissemination focused on publication and presentation, with no targeted approach.
The current study aimed to investigate whether health practitioners from intensive care units that participated in ICU-ROX were more likely to report they knew the trial results and had read the publication than those from intensive care units that did not participate; explore whether there was a difference between doctors' and nurses' knowledge of the ICU-ROX results and whether they read the publication.
Survey using a self-administered, quantitative design, developed for this study.
Convenience sample of 197 Australian and New Zealand intensive care specialist doctors and nurses.
There was no difference in the knowledge of the study results between respondents from intensive care units that participated in ICU-ROX compared to those that did not. Nurses were significantly less likely to have knowledge of the trial results or have read the publication than doctors. The commonest way for doctors and nurses to get the results was by word of mouth at work.
Participation in ICU-ROX did not make a difference to knowledge of the findings. While the dissemination of trial results was extensive, it failed to adequately reach nurses, who play an important role in administering oxygen in intensive care.
This study has provided further evidence that nurses working in intensive care were unlikely to read the research results of an important study about oxygen management.
Researchers, unit management and nurse leaders need to ensure dissemination methods that will reach nurses are used for research findings.
This study followed the STROBE reporting guidelines for observational studies.
No patient or public contribution.
This study is a substudy of a trial that was prospectively registered before the first participant was recruited: ACTRN12615000957594
To explore oncology nursing advance care planning practices and understand how to better support nurses in conducting advance care planning with patients and their families.
Qualitative interpretive descriptive methodology.
Semi-structured, individual telephone or Zoom interviews with 19 oncology nurses in a Western province of Canada between May and August 2022. Interviews were audio-recorded, transcribed, de-identified, and analysed using inductive, thematic, and constant comparative techniques.
Oncology nurses highlighted several factors affecting their ability to engage in advance care planning, including (1) uncertainties related to the nursing role in advance care planning, such as how and when a nurse ought to engage; (2) the educational, experiential, and training environment; and (3) structural barriers, such as a lack of time, space, and privacy; models of care that inhibit nurses from developing longitudinal relationships with their patients; and team dynamics that affect advance care planning interdisciplinary collaboration.
To create environments that support oncology nurses to conduct advance care planning, the findings suggest uncertainties be addressed through a clear and cohesive organisational approach to advance care planning and ongoing, integrated educational opportunities. Further, service delivery models may need to be restructured such that nurses have dedicated time and space for nurse-led advance care planning and opportunities to develop trusting relationships with both patients and their interdisciplinary colleagues.
Oncology nurses recognised the value of advance care planning in supporting patient-centred care and shared decision making, yet they reported limited engagement in advance care planning in their practice. To support oncology nurses in conducting advance care planning, healthcare leaders may address (1) advance care planning-related uncertainties and (2) structural barriers that prevent nurses from engaging in advance care planning with patients and their families. Findings may guide modifications to care models, enhancing support for oncology nurses in conducting advance care planning.
We selected and adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) as the most applicable guideline.
No patient or public contribution.
Emergency Departments face increasing pressure due to rising patient demand, complex presentations, and resource constraints, resulting in long waits and extended stays. Nurse-initiated protocols enable nurses to commence investigations and treatments based on clinical guidelines, improving care and efficiency. Despite evidence supporting their effectiveness, few nurse-initiated protocol implementation strategies are grounded in behaviour change theory. This gap may contribute to limited uptake, as many initiatives fail to address the complex factors influencing clinician behaviour.
To develop a behaviour change theory-informed implementation strategy to enhance the uptake of nurse-initiated protocols in the emergency department.
A framework-based intervention design was used.
The Behaviour Change Wheel and Theoretical Domains Framework guided the development of the implementation strategy. Barriers and enablers identified through prior research in 2023 using surveys and focus groups were mapped to relevant intervention functions. Behaviour change techniques were selected based on their potential to address barriers or strengthen enablers. The APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity) were applied to optimise feasibility.
Nine barriers and ten enablers to nurse-initiated protocols use were identified and categorised using the COM-B (Capability, Opportunity and Motivation) framework and mapped to the Theoretical Domains Framework. Eight intervention functions were selected and mapped to 24 behaviour change techniques and 23 delivery modes. The key implementation strategies are education, clinical champions, documentation changes, audit and feedback, and leadership engagement. Stakeholders confirmed the feasibility of the selected strategies.
Theory-informed, context-specific strategies are essential for implementing nurse-initiated protocols in emergency departments. This approach enables the design of targeted, feasible interventions that directly respond to identified barriers and enablers. Future research should test context-specific implementation strategies, assess their long-term impact on healthcare outcomes, and evaluate their scalability across diverse healthcare settings.
By targeting the behavioural determinants of clinician practice, this study fills a critical gap in implementation science within emergency nursing. This study identified 24 behaviour change techniques across eight intervention functions to support nurse-initiated protocol uptake. Strategies such as education, clinical champions, and audit provide a practical, replicable framework to overcome barriers, enhance autonomy, and reduce care delays. Findings support sustainable implementation in emergency settings, with future research needed on long-term impact and scalability.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS 