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This study examines the mediating roles of distress, burden and social support, as well as the moderating effect of social support, in the relationship between the risk of prolonged grief and psychopathology in bereaved family caregivers of palliative care patients.
A cross-sectional study was conducted with 125 bereaved family caregivers. Validated assessment tools and the PROCESS macro in SPSS were used for mediation and moderation analyses.
Emotional burden mediated the relationship between prolonged grief risk and psychopathology, while distress and physical burden did not. Instrumental social support was a key mediator, highlighting the protective role of practical assistance, whereas emotional social support did not show significant mediation. Both types of social support moderated the relationship, buffering the negative impact on mental health.
Findings underscore the complex interactions between bereavement risk factors and psychopathology. Addressing emotional burden and enhancing social support may help reduce mental health risks in bereaved caregivers.
Healthcare professionals in palliative care should implement targeted interventions to reduce burden and strengthen support systems for bereaved caregivers. Nursing-led initiatives focused on emotional burden reduction may mitigate psychopathology risks.
Findings are relevant for healthcare professionals in palliative care and those designing interventions for bereaved caregivers. Emotional burden mediated the relationship between prolonged grief and psychopathology, while instrumental and emotional social support moderated its effects.
This study adhered to STROBE guidelines for cross-sectional research.
Beyond caregiver participation in data collection, patients and healthcare professionals contributed to study design, protocol development and dissemination.
To develop and validate decision trees using conditional probabilities to identify the predictors of mortality and morbidity deterioration in trauma patients.
A quasi-experimental longitudinal study conducted at a Level 1 Trauma Center in São Paulo, Brazil.
The study analysed 201 patient records using standardised nursing documentation (NANDA International and Nursing Outcomes Classification). Decision trees were constructed using the chi-squared automatic interaction detection (CHAID) algorithm and validated through K-fold cross-validation to ensure model reliability.
Decision trees identified key predictors of survival and mobility deterioration. Patients who did not require (NOC 0414) Cardiopulmonary Status but required (NOC 0210) Transfer Performance had a 97.4% survival rate. Conversely, those requiring (NOC 0414) Cardiopulmonary Status had a 25% risk of worsening mobility, compared to 9% for those who did not. K-fold cross-validation confirmed the model's predictive accuracy, reinforcing the robustness of the decision tree approach (Value).
Decision trees demonstrated strong predictive capabilities for mobility outcomes and mortality risk, offering a structured, data-driven framework for clinical decision-making. These findings underscore the importance of early mobilisation, tailored rehabilitation interventions and assistive devices in improving patient recovery. This study is among the first to apply decision trees in this context, highlighting its novelty and potential to enhance trauma critical care practices.
This study highlights the potential of decision trees, a supervised machine learning method, in nursing practice by providing clear, evidence-based guidance for clinical decision-making. By enabling early identification of high-risk patients, decision trees facilitate timely interventions, reduce complications and support personalised rehabilitation strategies that enhance patient safety and recovery.
This research addresses the challenge of improving outcomes for critically ill and trauma patients with impaired mobility by identifying effective strategies for early mobilisation and rehabilitation. The integration of artificial intelligence-driven decision trees strengthens evidence-based nursing practice, enhances patient education and informs scalable interventions that reduce trauma-related complications. These findings have implications for healthcare providers, rehabilitation specialists and policymakers seeking to optimise trauma care and improve long-term patient outcomes.
Patients provided authorisation for the collection of their clinical data from medical records during hospitalisation.
The study aimed to translate the PUKAT 2.0 tool from English to Italian. This was an adaptation and validation study; the validity of the Italian version was determined through content validity, item validity and construct validity. The reliability of the instrument was assessed by conducting a test–retest analysis on a sample of 62 nurses. The I-CVI indices were above the threshold of 0.78 for 91% of the questions, and according to the S-CVI index, 96% of the evaluators agreed that the questionnaire was highly relevant. The overall values for item difficulty were good, with two items being too difficult and none being too easy. The item discriminant index was overall good and reasonable, low for four items. The overall ICC was poor to moderate with a value of 0.48 (95% CI 0.26–0.65). The instrument has proven to be a good starting point although not yet completely reliable, as it clearly requires more basic preparation on the part of the staff, further modifications regarding the reliability and clarity of the questions and more training of the nursing staff if it is to be used in the Italian context.
by Gianluigi Serio, Consiglia Pacelli, Claudia Piccoli, Nazzareno Capitanio, Giuseppe Cibelli, Anna Antonia Valenzano, Francesca Landini, Leonardo Carlucci, Paola Palladino
The ketogenic diet (KD) is a low-carbohydrate diet that induces and sustains a ketosis state and minimizes somatic glucose levels. Several psychological studies have described the positive effects of ketosis on cognitive functions for a wide range of neuropsychiatric conditions (e.g., Alzheimer’s disease; epilepsy), leading to greater interest in the KD today. However, the psychological and cognitive effects of inducing ketosis via diet remain unclear, especially in healthy people. From an initial pool of thirty participants, eight undergraduate students performed a cognitive assessment before (baseline) and after three weeks (follow-up) of an isocaloric ketogenic diet. Several neuropsychological measures and psychometric tests have been administered to investigate psychological chronotype, sleep quality, eating habits, anxiety and cognitive components of attention, inhibition, and memory. Non-parametric Bayesian analysis showed that the ketogenic diet affected cognitive functions. Participants performed cognitive tests faster at follow-up than at baseline, showing improvements in visual-motor cognitive and processing speed components. However, they were less accurate on working memory tasks, suggesting a decreasing performance of higher cognitive functions. Finally, no differences in anxiety levels were found between baseline and follow-up. The results could have significant implications for identifying specific cognitive models of students based on specific lifestyle habits and nutritional patterns, allowing the implementation of targeted interventions to improve university learning conditions.by Giacinto Angelo Sgarro, Paride Vasco, Domenico Santoro, Luca Grilli, Marco Giglio, Natale Daniele Brunetti, Luigi Traetta, Giuseppe Cibelli, Anna Antonia Valenzano
Sudden Cardiac Death (SCD) is a critical and unexpected condition that occurs due to cardiac causes within one hour of the onset of acute cardiovascular symptoms or twenty-four hours in unwitnessed cases. Despite advancements in cardiovascular medicine, practical methods for predicting SCD are still lacking, and there are no standardized systems to identify individuals at risk, especially in seemingly healthy populations such as athletes. In this study, we employed hierarchical clustering and principal component analysis (PCA) on data from 711 competitive athletes, revealing distinct patterns and cluster distributions in PCA space. Specifically, Clustering revealed characteristic feature combinations associated with increased SCD risk in athletes. Notably, certain clusters shared traits, including participation in Class C sports, sinus tachycardia, ventricular pre-excitation, personal or family history of heart disease, T-wave inversions, and prolonged QTc intervals. PCA helped visualize these patterns in distinct spatial regions, highlighting underlying structures and aiding intuitive risk interpretation. These results enable scientists to derive cluster metrics that serve as reference points for classifying new individuals and visually representing risk patterns in a clear graphical format. These findings establish a foundation for predictive tools that, with additional clinical validation, could aid in the prevention of SCD. The dataset used in this study, along with the clustering and PCA results, is available to the scientific community in an open format, together with the necessary tools and scripts to enable independent experimentation and further analysis.by Andrea Valdivia-Gago, Patricia J. García, Sherilee L. Harper, Angela Soria, Carol Zavaleta-Cortijo
Peru issued multiple COVID-19 policies for the Amazon, yet how they worked in practice for Indigenous Peoples remains under-documented. We conducted a sequential multi-method qualitative study, reviewing 20 national and regional policy documents (Mar–Dec 2020) and interviewing 12 implementers, regional and local officials from the health sector (n = 8) and the Ministry of Culture (n = 4), plus one central-level culture representative, in Loreto and Junin. Triangulating top-down policy review with bottom-up practitioner accounts across two contrasting regions strengthened validity. Policies frequently lacked explicit intercultural guidance, clear monitoring indicators, and dedicated budgets. Implementers described budget misalignment, omission of specific health networks, delayed supplies, and connectivity barriers that fostered dissatisfaction and a perception that services prioritized data collection over care. Effects were most acute in remote and low-connectivity settings; Indigenous federations’ participation in Loreto sometimes mitigated challenges, while in Junin travel-fund constraints limited participation. Pandemic preparedness must institutionalize intercultural approaches and secure sustainable funding with clear accountability. Co-design with Indigenous organizations, ring-fenced implementation budgets, practical communication strategies, and routine monitoring are essential to protect Indigenous Peoples in future health emergencies.Analyse the concept of expertise among practicing clinical nurses in hospital settings.
The generational loss of expert clinical nurses was exacerbated globally by the novel coronavirus. This ongoing loss combined with the increased complexity of hospitalised patients has prompted an urgent need to understand expertise among clinical nurses who practice in hospital settings.
Walker and Avant's concept analysis method was used. PubMed, Medline, CINAHL and Access Medicine were searched (1982–2025) for research studies and literature reviews published in English that addressed clinical nursing expertise in hospitals.
Expertise is the knowledge and skills that are enculturated from immersion in a domain. Common attributes include obtaining salient information from different sources, interpreting patient situations rapidly and holistically, and performing actions that are individualised, immediate and appear instinctive. Common antecedents include deliberate accumulation of relevant experience and contextual connections within the hospital. Facilitating improved outcomes and facilitating improved outcomes are common consequences.
The attributes, antecedents and consequences of clinical nursing expertise are complementary and cross specialties. Experts' apparently instinctive actions are not intuitive but rather related to relevant past experiences, pattern recognition and skilled know-how. The requirements to develop expertise have evolved with the increased volume of available knowledge.
Expertise requires cultivating relevant experiences through active engagement with patients and creating contextual connections with others regarding hospital systems and processes. Experts should be formally included when developing processes and guidelines. Low-fidelity proxy measures like years of experience should be replaced with psychometrically validated instruments to measure expertise.
This concept analysis addresses the ambiguity of clinical nursing expertise by synthesising over 40 years of literature and provides insights for clinical nurses and researchers regarding the importance of context and the growing complexity of care delivery.
No patient or public involvement.
Existing psychological and pharmacological interventions for young people at ultra-high risk (UHR) for psychosis have shown benefit in at least delaying the transition to psychosis, but they have limited benefit for comorbid disorders or social dysfunction, which are prominent for those at UHR. We developed a moderated online social therapy platform (named Momentum) including: (1) transdiagnostic therapeutic interventions targeting social functioning, depression, generalised anxiety and social anxiety; (2) a moderated, peer-led online community and (3) specialised human support from clinicians, career consultants and peer workers. The aim of this trial is to determine whether, in addition to treatment as usual (TAU), Momentum, a 12-month digital intervention, informed by the complex intervention framework, is superior to 12 months of TAU in improving social functioning in UHR young people.
The study design is a prospective, parallel group, rater-masked randomised controlled trial. We will recruit young people aged 14–27 years, meeting one or more UHR for psychosis criteria. Participants are randomly assigned to the condition using randomly permutated blocks with a 1:1 allocation ratio. Participants are stratified by age (
Melbourne Health Human Research Ethics Committee (HREC/42964/MH-2018) provided ethics approval for this study. Findings will be made available through scientific journals and forums and to the public via social media and the Orygen website. De-identified individual participant data will be available after publication for 3 years via the Health Data Australia catalogue (https://www.researchdata.edu.au/health). Requests must include a methodologically sound proposal. Specific conditions of use may apply and will be specified in a data sharing agreement (or similar) that the requester must agree to before access is granted. Supplementary material including study protocol, informed consent material and statistical analysis plan will also be available.
Australian New Zealand Clinical Trial Registry (ANZCTR), ACTRN12619001411134.
Severe pectus excavatum (PE) may impair cardiopulmonary and physical function. The effectiveness of surgical treatment to correct PE and restore physical function is widely debated due to a lack of high-quality comparative evidence. The RESTORE trial aims to determine the clinical and cost-effectiveness of corrective surgery for severe PE compared with conservative management for the first time in a randomised controlled trial (RCT).
RESTORE is a pragmatic, multicentre, RCT with an embedded observational cohort. 200 participants aged ≥12 years with severe PE will be recruited at around 12 National Health Service cardiothoracic surgical centres in England. Participants will be randomised 1:1 to receive either surgery within 3 months of randomisation (intervention arm) or no surgery until after the primary outcome measurement at 1 year (comparator arm). The primary outcome is change in physical functioning from baseline to 1 year as measured by the Short Form Health Survey (SF-36v2) physical function score. The primary economic outcome is cost-effectiveness. The key secondary outcome is change in % predicted VO2peak at 1 year measured by cardiopulmonary exercise test (CPET). Outcomes will be assessed at 1 year post-randomisation in the comparator arm and 1 year post-surgery in the intervention arm. The primary analyses will be undertaken on an intention-to-treat population using a linear mixed-effects model, adjusted for stratification variables via a binary covariate. Other secondary outcomes will include change from baseline of cardiopulmonary function (CPET and spirometry), health-related quality of life using the EuroQol 5 Dimension 5 Level (EQ-5D-5L) and SF-36v2 questionnaires, Hospital Anxiety and Depression Scale and disease specific symptoms (Phoenix Comprehensive Assessment for Pectus Excavatum Symptoms and Pectus Excavatum Evaluation Questionnaire). Adverse events, complications from surgery and operative technical success (Haller and Compression Indices from preoperative and postoperative CT scans) will also be assessed. Health economic analysis will estimate the incremental cost per quality adjusted life year at 1 year.
The trial was approved by East of Scotland Research and Ethics Service (24/ES/0034). Participants who are ≥16 years of age will be required to provide written informed consent. For participants
This review seeks to explore the illness narratives of children and young people focusing on their healthcare trajectories; the right to health; and the kind of stories told about them.
This scoping review adopts a narrative approach to analyse how the illness experience of Spinal Muscular Atrophy is represented in the literature, moving beyond biomedical descriptions to consider sociocultural and historical dimensions. We explore how global and local forces shape everyday life and therapeutic possibilities for people with this condition.
Four online databases were used to identify papers published between 2014 and 2024 in English and Spanish. The analysis process was guided by the PAGER Framework.
Twenty-one articles met the criteria for the review, mainly published in the Global North. Following organisation of Patterns, findings were categorised into three themes: (1) Parents as storytellers of young people's life trajectories; (2) Tropes about everyday life with Spinal Muscular Atrophy; and (3) The right to health as a narrative terrain. Findings show that access to medical treatment, information, and healthcare coverage poses difficulties when navigating the healthcare system with little institutional support.
The voices of individuals with Spinal Muscular Atrophy are rarely reported, often represented by their parents. There are opportunities to develop strategies that enhance the experiences of children and young people when seeking care, which should have a rights-based, intersectional, and family-centred approach.
This review highlights the need to listen to children and young people's voices, offer support to caregivers, and further explore the right to health in the Global South.
The interpretation of the findings was enriched by the involvement of patients, who participated as advisors for the research team. Their contributions ensured the research remained aligned with concerns and priorities informed by lived experience of the disease.
Intermittent theta-burst stimulation (iTBS) is a non-invasive brain stimulation technique that has been shown to improve cognition and mood when applied to certain brain structures and regions. Despite research demonstrating that iTBS may have clinical utility in treating cognitive and mood changes, no study has yet been conducted to explore the potential to modulate the neurophysiological changes that can underpin cognitive and mood changes during the menopause transition. Cognitive and psychological symptoms are commonly reported by females experiencing the menopause transition, and it is thought that these symptoms arise due to various neurophysiological, metabolic and endocrinological changes. Despite being common, there is a lack of treatments available for managing these symptoms and a scarcity of data regarding the mechanisms by which they occur.
The aim of this 5-week randomised, sham-controlled, double-blinded pilot clinical trial (n=72) is to assess the underlying mechanisms of action of iTBS in females in the late menopause transition and the relationship with cognition and mood. Data will be analysed using StataTM. Normality checks will guide the choice between parametric and non-parametric tests. Generalised linear models will assess within-subject and between-subject effects across timepoints, with additional regression analyses exploring associations between biomarkers, cognition and mood. Effect sizes, CIs and relevant test statistics will be reported, with significance set at p
The study protocol has been reviewed and ethically approved by the Western Sydney University Human Research Ethics Committee (H16200; 8 November 2024). All participants will provide written informed consent prior to enrolment. Results from this trial will be disseminated via peer-reviewed publications and conference presentations, with findings shared in accordance with open science and data transparency principles.
ACTRN12625000030471, Australian New Zealand Clinical Trials Registry
Creating a healthy work environment requires balancing organizational goals with ethical responsibilities, where head nurses' ethical leadership can shape staff outcomes by mitigating work–family conflicts and promoting nurses' well-being, retention, and patient safety. This study aims to analyze the mediating role of work–family between head nurses' ethical leadership and nurses' reported errors, turnover intention, and physical and mental health.
Nationwide Multicenter cross-sectional study.
Validated self-report scales were used to assess nurses' perceptions of head nurses' ethical leadership, work–family conflict, error, turnover intention, physical and mental health. Descriptive and inferential analyses were conducted. Structural equation modeling examined the relationships among these variables based on Della Bella's and Fiorini's framework.
Data from 409 nurses across seven Italian hospitals was analyzed. The structural equation model showed an excellent fit. Head nurses' Ethical leadership was negatively associated with work–family conflicts, turnover intention, and errors, and positively associated with nurses' health. Work–family conflicts were significantly linked to turnover intention, errors, and nurses' health. Work–family conflicts mediate the relation between ethical leadership and turnover intention, errors, and nurses' health.
Promoting healthy work environments is crucial for nurses', patients', and organizations' well-being. Ethical leadership helps achieve this condition by reducing work–family conflicts, fostering nurses' well-being, decreasing turnover intention, and improving care quality. Disseminating ethical leadership programs and integrating with work–life balance policies can therefore strengthen both staff retention and organizational outcomes.
Ethical leadership can foster patient care, reduce turnover intention and errors, and improve nurses' well-being. Therefore, maintaining employee performance and organizational results requires integrating work–life balance policies with ethical leadership development programs.
The study adhered to The Strengthening the Reporting of Observational Studies in Epidemiology checklist.
This study did not include patient or public involvement.
The study was preregistered on the Open Science Framework https://osf.io/8jk37/overview.
This study did not include patient or public involvement in its design, conduct, or reporting.
Countries face challenges in maternal and newborn care (MNC) regarding costs, workforce and sustainability. Organising integrated care is increasingly seen as a way to address these challenges. The evidence on the optimal organisation of integrated MNC in order to improve outcomes is limited.
(1) To study associations between organisational elements of integrated care and maternal and neonatal health outcomes, experiences of women and professionals, healthcare costs and care processes and (2) to examine how the different dimensions of integrated care, as defined by the Rainbow Model of Integrated Care, are reflected in the literature addressing these organisational elements.
We included 288 papers and identified 23 organisational elements, grouped into 6 categories: personal continuity of care; interventions to improve interdisciplinary collaboration and coordination; care by a midwife; alternative payment models (non-fee-for-service); place of birth outside the obstetric unit and woman-centred care. Personal continuity, care by a midwife and births outside obstetric units were most consistently associated with improved maternal and newborn outcomes, positive experiences for women and professionals and potential cost savings, particularly where well-coordinated multidisciplinary care was established. Positive professional experiences of collaboration depended on clear roles, mutual trust and respectful interdisciplinary behaviour. Evidence on collaboration interventions and alternative payment models was inconclusive. Most studies emphasised clinical and professional aspects rather than organisational integration, with implementation barriers linked to prevailing biomedical system orientations.
Although the literature provides substantial evidence of organisational elements that contribute to improved outcomes, a significant gap remains in understanding how to overcome the barriers in sustainable implementation of these elements within healthcare systems. Interpreted through a systems and transition science lens, these findings suggest that strengthening integrated maternity care requires system-level changes aligning with WHO policy directions towards midwifery models of person-centred care.
To assess healthcare professionals' digital health competence and its associated factors.
Cross-sectional study.
The study was conducted from October 2023 to April 2024 among healthcare professionals in Italy, using convenience and snowball sampling. The questionnaire included four sections assessing: (i) socio-demographic and work-related characteristics; (ii) use of digital solutions as part of work and in free time, and communication channels to counsel clients in work; and DigiHealthCom and DigiComInf instruments including measurements of (iii) digital health competence and (iv) managerial, organisational and collegiality factors. K-means cluster analysis was employed to identify clusters of digital health competence; descriptive statistics to summarise characteristics and ANOVA and Chi-square tests to assess cluster differences.
Among 301 healthcare professionals, the majority were nurses (n = 287, 95.3%). Three clusters were identified: cluster 1 showing the lowest, cluster 2 moderate and cluster 3 the highest digital health competence. Most participants (n = 193, 64.1%) belonged to cluster 3. Despite their proficiency, clusters 2 and 3 scored significantly lower on ethical competence. Least digitally competent professionals had significantly higher work experience, while the most competent reported stronger support from management, organisation, and colleagues. Communication channels for counselling clients and digital device use, both at work and during free time, were predominantly traditional technologies.
Educational programmes and organisational policies prioritising digital health competence development are needed to advance digital transition and equity in the healthcare workforce.
Greater emphasis should be placed on the ethical aspects, with interventions tailored to healthcare professionals' digital health competence. Training and policies involving managers and colleagues, such as mentoring and distributed leadership, could help bridge the digital divide. Alongside traditional devices, the adoption of advanced technologies should be promoted.
This study adheres to the STROBE checklist.
None.
by Desirée Valera-Gran, Miriam Hurtado-Pomares, Iris Juárez-Leal, Rocío Muñoz-Sánchez, Irene Campos-Sánchez, Paula Noce, Jessica Piñero, Eva-María Navarrete-Muñoz
BackgroundParents of children with developmental delays (DD) often face significant challenges that affect their mental health and occupational balance. While early intervention services traditionally focus on child development, the occupational needs and well-being of parents remain underexplored. The EQo-Mental project aims to examine the association between parental mental health, occupational balance, and meaningful activity engagement, and to co-develop family-centred strategies that promote well-being in early intervention contexts.
MethodsThis sequential mixed-methods study includes two phases. The quantitative phase will involve approximately 700 parents of children aged 0–6 years attending early intervention centres in Alicante, Spain. This phase comprises two components: (1) the psychometric validation of the Spanish versions of two occupational measures—the Occupational Balance Questionnaire (OBQ-E) and the Engagement in Meaningful Activities Survey (EMAS)—and (2) a cross-sectional analysis examining associations between occupational and mental health outcomes. Participants will complete a sociodemographic questionnaire along with validated self-administered instruments assessing occupational balance, meaningful activity engagement, stress, anxiety, depression, and psychological well-being. In the qualitative phase, participatory sessions and focus groups will be conducted with a subsample of parents and key stakeholders to explore perceived occupational and mental health needs and to co-design actionable strategies for improving occupational balance and family well-being. Participant recruitment began in November 2023 and is ongoing; data collection is expected to be completed by October 2025.
AnalysesPsychometric analyses will first be conducted to evaluate the validity and reliability of the OBQ-E and EMAS. Next, descriptive analyses and multiple regression models adjusted for potential confounders will be used to explore associations between occupational and mental health variables. Phase 2 consists of a participatory-action research process, including discussion groups and a multi-stakeholder focus group. Qualitative data will be analysed using reflexive thematic analysis.
OutcomesFindings from EQo-Mental will inform the design of evidence-based, family-centred strategies that support occupational balance, parental well-being, and engagement in meaningful activities. By addressing the occupational needs of parents, the project seeks to foster more resilient families and strengthen early intervention services through an inclusive, occupation-focused approach.
The article describes the outcomes of a single-centre investigation on the use of OZOILE to improve the healing process in patients with chronic diabetic ulcers. This is a non-randomised interventional study which aims to assess the differences between two groups (total 200 patients) by evaluating healing time at 15, 30, 45, 60, 75 and 90 days. Pain assessment with VAS scale at 15, 30 and 45 days, biofilm test and tissue regeneration by histological evaluation were also taken into consideration. The outcomes show faster healing, reduced pain, control of local infection, aesthetically pleasing and qualitatively better healing. Our treatment strategy involves applying OZOILE detergent without rinsing, Ozoile spray oil and Ozoile cream followed by a non-adherent dressing (paraffin gauze). This integrated protocol shows a safe and effective treatment for diabetic chronic wound healing in a cost-effective manner. The group treated with the Rigenoma/Ozoile protocol demonstrated significantly superior outcomes compared to the control group, including accelerated healing, reduced pain levels, effective management of unpleasant odour, and high levels of compliance from both patients and surgeons. Overall, Ozoile markedly reduced healing time compared with standard care, with results robust across multiple analytical approaches.
by Denise Skiadopoulos, Alaina Bandstra, Valerie Kattouf, Corina van de Pol, Vivek Labhishetty, Sumeer Singh
ObjectiveHeterophoria is routinely measured during a comprehensive ocular examination. The aim of the current study is to compare the inter-examiner repeatability of the Neurolens measurement device (nMD), a commercially available instrument that objectively assesses phoria, to the inter-examiner repeatability of prism alternating cover test and the von Graefe method.
Methods91young adults aged between 18–60 years were enrolled. Two experienced optometrists assessed phoria on each subject using three methods: the von Graefe method (VG), prism alternating cover test (PCT) and nMD. VG and PCT were performed at distance (6m) and near (40 cm). The nMD measurements were obtained using virtual distance (6m) and near (50 cm) targets. All the tests were performed in a single session by both the examiners in a randomized order.
ResultsAll study participants were students, staff, and faculty of the Illinois College of Optometry. Of the 91 participants recruited, 65 were female. All participants completed the study with no missing data. The repeatability analysis showed nMD (distance: 0.69 ± 0.77PD; near: 1.00 ± 0.98PD) to have the smallest mean absolute difference at both distance and near compared to VG (distance: 3.28 ± 3.18PD; near: 4.48 ± 3.99PD) and PCT (distance: 1.50 ± 2.36PD; near: 4.05 ± 3.69PD). Bland Altmann analysis showed that the phoria measurements from nMD exhibited significantly less variability when compared with VG and PCT.
ConclusionsThe Neurolens measurement device (nMD) has the highest inter-examiner repeatability when compared to traditional VG and PCT methods. Given that the measurements are objective and repeatable compared to the two traditional methods, this device has the potential to be a useful addition to current methods of clinical practice.
This study aimed to test the psychometric properties of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale in patients with cancer.
A multisite cross-sectional validation study was conducted.
Between November 2022 and July 2023, a convenience sample of 318 patients with cancer were enrolled in five Italian inpatient and outpatient facilities. Confirmatory factor analysis was performed on the three scales of the Self-Care of Chronic Illness Inventory and the Self-Care Self-Efficacy scale. Internal consistency was tested using Cronbach's alpha for unidimensional scales and McDonald's Omega for multidimensional scales. Construct validity was assessed with the global health status by Pearson's correlation. The COnsensus-based Standards for the selection of health Measurement INstruments reporting guidelines were followed for the reporting process.
Three hundred fourteen patients were included (median age: 55.5 years; male: 53.82%). Confirmatory factor analysis showed supportive fit indices for the three Self-Care of Chronic Illness Inventory scales (CFI: 0.977–1.000; SRMR: 0.004–0.78) and the Self-Care Self-Efficacy scale (CFI: 1.000; SRMR: 0.014). All scales demonstrated adequate internal consistency (0.89–0.99) and test–retest reliability (0.85–0.95). Construct validity was confirmed through correlations between Self-Care Self-Efficacy, each Self-Care of Chronic Illness Inventory scale, and global health status.
The Self-Care of Chronic Illness Inventory and Self-Care Self-Efficacy scales demonstrated excellent psychometric qualities and construct validity when administered to patients with cancer. Future research should explore self-care behaviours across different diseases and cultural contexts.
These tools can help develop targeted educational programs, improving patient outcomes.
Currently, there is a lack of knowledge regarding self-care behaviours in patients with cancer. These tools enable healthcare professionals to identify patient needs, design personalised interventions, and monitor their effectiveness over time.
No patient or public contribution.
by Jorman H. Tejada-Perdomo, Valentina Gutierrez-Perdomo, Juana V. Agudelo-Castro, Jorge A. Pérez-Gamboa, Alejandro Weinstein, Sebastián San Martín, Rodrigo Salas, Jorge A. Ramos-Castaneda
The use of devices that facilitate rapid airway isolation is essential when managing critical patients in emergencies. In recent years, additive manufacturing has emerged as an innovative, versatile, and accessible technology for developing medical devices. This study presents the design, development, and validation of an extraglottic medical device created using computer-aided design tools and stereolithographic 3D printing to facilitate blind intubation by first responders. The device was iteratively modeled and fabricated with biocompatible materials; validation in airway simulators and human cadaveric specimens assessed dimensions, friction, intubation technique, and learning curve, and ease of use was rated with a Likert scale. Ten iterations led to a final design with low friction and minimal cervical manipulation; ramp angle, cup geometry, and distal tip were optimized for tube passage, and BioMed Flex 80A showed high strength and anatomical compatibility. The final version is a safe, reusable, and functional alternative for airway management and blind orotracheal intubation, particularly in emergencies and resource-limited settings; clinical validation in live patients is still needed.
FreshRSS 