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Histological characterization of major internal organs in infant common marmosets (<i>Callithrix jacchus</i>)

by Hyeon Ah Kim, Na-Young Lee, Jina Kwak, Hee Jin Choi, Gyeong Min Yoon, Sang Hyeok Seok, Yu Jin Lee, Na Yun Lee, Dae-Yong Kim, Jun Won Park, Byeong-Cheol Kang

The common marmoset (Callithrix jacchus) is a widely used nonhuman primate model in biomedical research. However, access to infant tissues is limited, and descriptive histological information for early postnatal organ development is needed. We examined a qualitative, descriptive histological overview of five major organs (liver, kidney, spleen, lung and heart) in infant (0–3 weeks) and adult (>12 months) marmosets using hematoxylin and eosin, Ki67 immunohistochemistry, Alcian blue–periodic acid–Schiff, and Sirius red staining. The examined infant livers showed multilayered hepatocyte cords, higher nuclear-to-cytoplasmic ratios, and extramedullary hematopoiesis, and the adult livers exhibited organized hepatic plates and mature stromal structures. The infant kidneys demonstrated active nephrogenesis with immature nephrons, showing progressively more mature glomerular morphology in adults. The spleen displayed small and poorly developed white pulp in infants but fewer, larger, and distinct white pulp structures in adults. The lungs showed thick interalveolarsepta and irregular airspaces during the early postnatal stages, with progressive septal thinning and expanded airspaces in maturity. The infant hearts exhibited loosely packed cardiomyocytes and developing valves, with the adult hearts showing hypertrophied, striated myocardium and compact collagenous valve structures. This study provides descriptive histological information for interpreting developmental features in infant marmosets and supports the use of these data in developmental primate pathology.

Nurses' Perceptions of Safety Management for Patients With Dementia in Acute Care Hospitals: A Q‐Methodological Study

ABSTRACT

Aim

To identify the types of nurses' perceptions regarding safety management for patients with dementia in acute care hospitals.

Design

A Q-methodological study.

Methods

Data were collected between 31 July and 30 September 2025. A total of 161 statements were generated through individual in-depth interviews with eight registered nurses from general wards at a tertiary acute care hospital in South Korea and through a literature review. Subsequently, 34 statements were selected for Q-sorting and 22 nurses completed the procedure. Data were analysed using PQMethod with principal component analysis and varimax rotation, followed by interpretive analysis.

Results

Four types of nurses' perceptions of safety management for patients with dementia were identified: physical control, relational collaboration, sceptical conformity and adaptive flexibility.

Conclusion

Safety management for patients with dementia in acute care requires a context-dependent, multidimensional approach encompassing physical, emotional, environmental and organisational aspects.

Implications for the Profession and/or Patient Care

Understanding nurses' distinct perceptual orientations can inform type-specific practice interventions and support efforts towards safer, more person-centred care for patients with dementia in acute care settings.

Impact

This study offers insights for moving beyond uniform approaches and designing tailored, type-specific safety strategies in acute care by showing that similar safety behaviours may carry different meanings across nurses' perceptual orientations.

Reporting Method

This study followed the Standards for Reporting Qualitative Research and Q-methodology conventions.

Patient or Public Contribution

No patient or public contribution.

Protocol for a randomised, double-blind, placebo-controlled clinical trial on the effects of high-dose vitamin B multivitamin supplementation with and without Passiflora incarnata on neural connectivity and oxidative metabolism in healthy adults

Por: Yeong · C. H. · Wong · Y. H. · Lim · S. Y. · Tan · B. K. · Seerangam · S. · Chinna · K. · Ramli · N. · Rahmat · K. · Nawawi · O. · Tan · L. K. · Che Ahmad · A. · Stajic · V. · Tay · J. P.
Introduction

B-vitamins and herbal supplements such as Passiflora incarnata have demonstrated potential benefits for cognitive and neurological functions. This study aims to evaluate the neural and biochemical effects of high-dose vitamin B multivitamin supplementation, with and without P. incarnata, in healthy adults using multimodal neuroimaging and biomarker assessments.

Methods and analysis

This is a phase I/II, randomised, double-blind, placebo-controlled clinical trial involving 108 healthy adults aged 30–55 years, allocated to three groups: (A) high-dose vitamin B multivitamin supplementation with P. incarnata; (B) high-dose vitamin B multivitamin supplementation alone; and (C) placebo. Participants will take two tablets daily for 24 weeks. The primary outcomes are changes in default mode network connectivity assessed using resting-state functional magnetic resonance imaging and diffusion magnetic resonance imaging, together with safety outcomes including vital signs, clinical laboratory parameters and adverse event monitoring. Secondary outcomes include regional brain metabolite concentrations measured by proton magnetic resonance spectroscopy and plasma biomarkers of one-carbon metabolism, including vitamin B6, vitamin B12, folate and homocysteine.

Ethics and dissemination

Ethics approval was granted by the Medical Research Ethics Committee, Ministry of Health Malaysia (NMRR-19-379-46101 (ISR); Protocol Number: Exec B). Results will be disseminated through peer-reviewed publications and scientific conferences.

Trial registration number

ACTRN12622001150730.

Hospital‐Based Robotic Applications in Nursing Practice: A Scoping Review

ABSTRACT

Introduction

The integration of robots into clinical practice requires careful consideration of their alignment with nursing workflows, patient needs, and clinical contexts. This scoping review aimed to support effective technology adoption by systematically identifying and classifying how robots are used in hospital-based nursing practice using standardized nursing terminology.

Design

A scoping review following Arksey and O'Malley's five-stage framework.

Methods

A structured search was conducted in five peer-reviewed databases (PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE) for studies published between January 2019 and July 24, 2025. The data were analyzed to classify the types of nursing tasks supported by the robots. Robotic functions were classified into direct care, indirect care, and associated work using standardized nursing terminology, Hurst's framework, and the Clinical Care Classification system to provide a codified and structured analysis of nursing tasks.

Results

A total of 40 studies were included in the final review. Thirty-three focused on direct care with robots, primarily supporting psychological, physiological, and functional care. The key interventions included coping support, emotional support, infection control, and vital sign monitoring. Only one study involved indirect care, and nine focused on associated work, such as errands and cleaning.

Conclusions

Robots are primarily used for direct care, such as emotional support and monitoring, while their role in indirect care—requiring professional judgment including documentation—remains limited. This suggests that future development should prioritize user-centered designs and ethical guidelines aligned with actual clinical needs. Properly implemented robotic technology will serve as a strategic tool to enhance nursing efficiency and improve practice environments amidst chronic workforce shortages.

Clinical Relevance

By categorizing robotic functions using standardized nursing terminology, this review offers a structured understanding of how robots can support nursing. These insights help identify tasks that can be delegated to robots during crises, such as pandemics or staffing shortages, allowing nurses to focus on essential patient care.

Effects of a Computational Fluid Dynamics‐Based Mobile Education Program on Syringe‐Based Wound Irrigation

ABSTRACT

The study aimed to develop a computational fluid dynamics-based mobile wound irrigation education program and explore changes in irrigation pressure control, wound irrigation-related knowledge and performance confidence in syringe-based wound irrigation. This study used a single-group pre–post design. A computational fluid dynamics-based mobile wound irrigation program was developed following the Analysis, Design, Development, Implementation, and Evaluation model. The program enabled learners to manipulate irrigation variables and visualize pressure distribution in real time. Thirty-four participants were recruited. Irrigation pressure was measured using a load cell-based device, and knowledge and performance confidence were assessed pre- and post-intervention. Data were analysed using paired t-tests and content analysis. The mean irrigation pressure increased significantly, although the post-intervention mean remained below the recommended pressure range and the proportion of participants achieving the recommended range rose from 0% to 44%. Knowledge and performance confidence also improved significantly. Qualitative findings indicated enhanced understanding of performance standards, improved technical awareness and reduced uncertainty during skill execution. Participation in the computational fluid dynamics-based mobile education program was associated with improvements in irrigation pressure control, related knowledge and performance confidence in syringe-based wound irrigation. These findings should be interpreted as preliminary because of the single-group pre–post design. Numerical visualization and real-time feedback may be useful educational strategies for facilitating the transition from experience-based skill performance to data-driven practice.

Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea: KCT0011256.

The Use of Triage in Primary Care in the UK: An Integrative Review and Narrative Synthesis

ABSTRACT

Aims

To examine the use of triage systems in primary care in the UK.

Design

Integrative literature review and narrative synthesis.

Data Sources

PubMed, EMBASE, CINAHL and Cochrane Library were searched in October 2024.

Methods

An integrative literature review was conducted following Whittemore and Knafl's (2005) five-step process. Of 1440 articles retrieved, 305 duplicates were removed, and 1086 excluded after title and abstract screening. Two additional articles were identified through citation and hand searches. Twenty studies were quality-assessed using the Mixed Methods Appraisal Tool, and data were extracted for narrative synthesis.

Results

Twenty studies were selected, including four randomised controlled trials, three quasi-experimental studies, eleven descriptive studies and two qualitative studies. The most common type of triage was telephone triage, most frequently performed by nurses. The most common health outcomes included subsequent patient re-contacts after triage, patient symptoms or complaints, current health status and patient safety. The benefits of triage included high patient satisfaction, workload redistribution, reduced GP workload and emergency department crowding, improved resource utilisation, access to care and communication. The challenges of triage included increased overall contact time, mis-triage issues, recruitment and retention challenges, the unsuitability of the decision support tool for the primary care setting and lower usage among older and less affluent groups.

Conclusions

This review examined the current use of triage in primary care in the UK, identifying common patterns in triage processes and classifications. Several benefits were identified, though some ongoing concerns about triage remain.

Impact

This paper provides essential evidence about the current use, effectiveness and challenges of triage in UK primary care. The findings can support healthcare policymakers, practitioners and researchers in planning and improving triage systems.

No Patient or Public Contribution

Integrative review.

Prescribing Practices and Behaviours of Advanced Practice Nurses and Pharmacists: A Nationwide Cross‐Sectional Survey

ABSTRACT

Aim

To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.

Design

Cross-sectional national survey.

Methods

A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.

Results

Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.

Conclusion

APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.

Implications for the Profession

Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.

Impact

This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.

Reporting Method

STROBE checklist.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct, or reporting.

Effect of fascial closure using barbed sutures on incisional hernias in midline laparotomy for gynecological diseases: A multicenter randomized controlled trial (KGOG 4001)

by Yong Jae Lee, Nam Kyeong Kim, Kidong Kim, Chel Hun Choi, Keun Ho Lee, Jong-Min Lee, Kwang Beom Lee, Dong Hoon Suh, Sunghoon Kim, Min Kyu Kim, Seok Ju Seong, Myong Cheol Lim

Objective

To identify the effect of fascial closure using barbed sutures on the incidence of incisional hernia in patients undergoing elective midline laparotomy for gynecological diseases.

Methods

In this multicenter, non-blind randomized controlled trial conducted from February to December 2021, patients with a BMI 2 and aged >18 years, scheduled for midline laparotomy, were randomly assigned to receive either barbed (experimental) or non-barbed sutures (control) for fascial closure. The primary outcome was the cumulative incidence rate of incisional hernia up to 1-year post-surgery. Secondary outcomes included incisional hernia up to 2-years post-surgery, wound complications, and postoperative pain assessed by Brief Pain Inventory-Korean scores, and Numeric Rating Scale.

Results

Out of 174 patients (experimental, 86; control, 88), 36 were excluded due to dropout or loss to follow-up, leaving 138 patients (experimental, 67; control, 71) included in the analysis. The groups were balanced in terms of cancer surgeries, mean wound length, and mean surgery time. The cumulative incidence rates of incisional hernia up to 1-year (0.0% vs. 1.4%; p > 0.999) and 2-years (0.0% vs. 3.4%, p = 0.496) post-surgery did not differ significantly between the experimental and control groups. Additionally, no significant differences were observed in the incidence of wound dehiscence 4 weeks post-surgery, cumulative incidences of wound dehiscence and wound infection up to 4 weeks post-surgery, or postoperative pain scores between the groups.

Conclusions

Fascial closure using barbed sutures resulted in no cases of incisional hernia up to 2-years post-surgery, but did not demonstrate a significant reduction in incisional hernia rates compared with the non-barbed suture.

Trial registration

ClinicalTrials.gov NCT04643197

Frequency and Associated Factors of Interruptions During the Medication Administration Process Among Nurses in South Korea: A Cross‐Sectional Study

ABSTRACT

Aim (s)

To investigate the frequency and associated factors of interruptions initiated by human and environmental sources during the medication administration process among nurses in South Korea.

Design

A cross-sectional descriptive study.

Methods

Data were collected from January to March 2022 through an online survey administered to nurses working in tertiary hospitals in South Korea. The survey assessed interruptions during the medication administration process, nursing work environments and organisational culture. Descriptive statistics and regression analysis were used to identify factors associated with interruptions.

Results

Human-initiated interruptions were more frequent than those initiated by environmental sources. Human-initiated interruptions increased with a higher patient load and a relation-oriented organisational culture but decreased with adequate staffing and resources, as well as an innovation-oriented culture. Environment-initiated interruptions were more frequent in settings with a task-oriented culture and less frequent among female nurses.

Conclusion

The findings highlight the importance of understanding the distinct characteristics of interruptions and developing targeted strategies based on their sources and contributing factors. Creating supportive environments and fostering an organisational culture that actively prevents unnecessary interruptions are essential for enhancing medication safety and workflow efficiency.

Implications for the Profession and/or Patient Care

To apply these findings in clinical practice, it is necessary to allocate staffing resources appropriately to reduce interruptions. Providing education on the importance of maintaining uninterrupted medication administration processes is essential to reduce human-initiated interruptions.

Impact

This study provides practical evidence that organisational culture and staffing are associated with interruptions in clinical nursing practice. Nurse managers should apply these findings by promoting staffing adequacy and fostering a collaborative, innovative environment that encourages continuous improvement and openness to change. Tailored strategies that reflect the specific characteristics of different types of interruptions can help reduce their occurrence and improve medication safety.

Reporting Method

STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Enhancing Adverse Event Reporting With Clinical Language Models: Inpatient Falls

ABSTRACT

Aims

To develop a method for computationally detecting fall events using clinical language models to complement existing self-reporting mechanisms.

Design

Retrospective observational study.

Methods

Text data were collected from the unstructured nursing notes of three hospitals' electronic health records and the Korean national patient safety reports, totalling 34,480 records covering the period from January 2015 to December 2019. Note-level labelling was conducted by two researchers with 95% agreement. Preprocessing data anonymisation and English translation were followed by semantic validation. Five language models based on pretrained Bidirectional Encoder Representations from Transformers (BERT) and Generative Pretrained Transformer (GPT)-4 with prompt programming were explored. Model performance was assessed using F measurements. Error analysis was conducted for the GPT-4 results.

Results

Fine-tuned BERT models with the English data set outperformed GPT-4, with Bio+Clinical BERT achieving the highest F1 score of 0.98. Fine-tuned Korean BERT with the Korean data set also reached an F1 score of 0.98, while GPT-4 achieved a competitive F1 score of 0.94. GPT-4 with prompt programming showed much higher F1 scores than GPT-4 with a standardised prompt for the English data set (0.85 vs. 0.39) and the Korean data set (0.94 vs. 0.03). The error analysis identified that the common misclassification patterns included fall history and homonyms, causing false positives and implicit expressions and missing contextual information, causing false negatives.

Conclusion

The clinical language model approach, if used alongside the existing self-reporting, promises to increase the chance of identifying the majority of factual falls without the need for additional chart reviews.

Impact

Inpatient falls are often underreported, with up to 91% of incidents missed in self-reports. Using language models, we identified a significant portion of these unreported falls, improving the accuracy of adverse event tracking while reducing the self-reporting burden on nurses.

Patient or Public Contribution

Not applicable.

Managing Postembolization Syndrome Through a Machine Learning–Based Clinical Decision Support System: A Randomized Controlled Trial

imageAlthough transarterial chemoembolization has improved as an interventional method for hepatocellular carcinoma, subsequent postembolization syndrome is a threat to the patients' quality of life. This study aimed to evaluate the effectiveness of a clinical decision support system in postembolization syndrome management across nurses and patient outcomes. This study is a randomized controlled trial. We included 40 RNs and 51 hospitalized patients in the study. For nurses in the experimental group, a clinical decision support system and a handbook were provided for 6 weeks, and for nurses in the control group, only a handbook was provided. Notably, the experimental group exhibited statistically significant improvements in patient-centered caring attitude, pain management barrier identification, and comfort care competence after clinical decision support system implementation. Moreover, patients' symptom interference during the experimental period significantly decreased compared with before the intervention. This study offers insights into the potential of clinical decision support system in refining nursing practices and nurturing patient well-being, presenting prospects for advancing patient-centered care and nursing competence. The clinical decision support system contents, encompassing postembolization syndrome risk prediction and care recommendations, should underscore its role in fostering a patient-centered care attitude and bolster nurses' comfort care competence.

A Microlearning-Based Self-directed Learning Chatbot on Medication Administration for New Nurses: A Feasibility Study

imageNew nurses must acquire accurate knowledge of medication administration, as it directly affects patient safety. This study aimed to develop a microlearning-based self-directed learning chatbot on medication administration for novice nurses. Furthermore, the study had the objective of evaluating the chatbot feasibility. The chatbot covered two main topics: medication administration processes and drug-specific management, along with 21 subtopics. Fifty-eight newly hired nurses on standby were asked to use the chatbot over a 2-week period. Moreover, we evaluated the chatbot's feasibility through a survey that gauged changes in their confidence in medication administration knowledge, intrinsic learning motivation, satisfaction with the chatbot's learning content, and usability. After using the chatbot, participants' confidence in medication administration knowledge significantly improved in all topics (P

Identifying Latent Topics and Trends in Premature Infant–Related Nursing Studies Using a Latent Dirichlet Allocation Method

imageThis study aimed to identify topics and within-topic core keywords in premature infant–related nursing studies published in Korean and international academic journals using topic modeling and to compare and analyze the trends in Korean and international studies. Journal databases were searched to extract nursing studies involving premature infants from 1998 to 2020. Journal databases included MEDLINE, Web of Science, CINAHL, and EMBASE for international studies and DBpia, the National Digital Science Library, the Korea Citation Index, and the Research Information Sharing Service for Korean studies. Abstracts from the selected 182 Korean and 2502 international studies were analyzed using NetMiner4.4.3e. In results, four similar topics (Korean vs international) were “pain intervention” versus “pain management”; “breast feeding practice” versus “breast feeding”; “kangaroo mother care”; and “parental stress” versus “stress & depression.” Two topics that appeared only in the international studies were “infection management” and “oral feeding & respiratory care.” Overall, the international studies dealt with diverse topics directly associated with premature. Korean studies mainly dealt with topics related to mothers of premature infants, whereas studies related to premature infants were insufficient. Nursing research in Korea needs to be expanded to research topics addressing premature infants.
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