Conectar
by Bita Eshraghi, Jonas Hermansson, Lena Marions
IntroductionThe impact of female genital mutilation (FGM) on obstetric outcomes in high-income countries remains unclear and is an area of ongoing research. This nationwide study aimed to examine the risk of emergency cesarean section among primiparous women from countries where FGM is practiced, in comparison to Swedish-born women. Additionally, the study explored whether a confirmed diagnosis of FGM contributes to this potential risk.
Materials and methodsA Swedish nationwide cohort study including primiparous singleton term deliveries (≥37 + 0– Results
Women born in FGM-practicing countries (n = 13 246) had a significantly increased risk of emergency cesarean section (aOR 1.28, 95% CI: 1.21–1.35) compared to Swedish-born women (n = 199 914). Including FGM diagnosis as a covariate did not alter the result. When excluding women born in FGM-practicing countries outside Sub-Saharan Africa the aOR was amplified (aOR 1.58, 95% CI: 1.47–1.69). To further isolate the effect of FGM itself, we restricted the analysis to women born in FGM-practicing countries and compared those with a recorded FGM diagnosis to those without. This analysis showed no significant association between FGM diagnosis and emergency cesarean section (aOR 1.05, 95% CI: 0.90–1.23).
ConclusionsPrimiparous women from FGM-practicing countries have an increased risk of emergency CS compared to Swedish-born women, when giving birth in Sweden. The presence of FGM diagnosis did not contribute to this risk. Further research is needed to understand the underlying mechanisms for this to be able to improve obstetric care for migrant populations.
by Thomas C. Scheier, Richard Whitlock, Mark Loeb, Philip James Devereaux, Andre Lamy, Michael McGillion, MacKenzie Quantz, Ingrid Copland, Shun-Fu Lee, Dominik Mertz
Sternal surgical site infections after cardiac surgery can lead to significant morbidity, mortality, and cost. The effects of negative pressure wound management and adding vancomycin as perioperative antimicrobial prophylaxis are unknown. The PICS-PREVENA pilot/vanguard trial, a 2x2 factorial, open label, cluster-randomized crossover trial with 4 periods, was conducted at two major cardiac surgery hospitals in Ontario, Canada. Sites were randomized to one of eight sequences of the four study arms (Cefazolin or Cefazolin + Vancomycin (not analyzed) and standard wound dressing or a negative pressure 3M Prevena incision management system (Prevena). Only diabetic or obese patients were eligible for the latter comparison. This trial investigated feasability including adherence to protocol of each intervention (goal: > 90% each) and loss to follow-up (goal:by Lei Xiong, Ke Li, Wendy Siuyi Wong
BackgroundDigital media usage has become an integral part of daily life, but prolonged or emotionally driven engagement—especially during late-night hours—may lead to concerns about behavioral and mental health. Existing predictive systems fail to account for the nuanced interplay between users’ internal psychological states and their surrounding ecological contexts.
ObjectiveThis study aims to develop a psychologically and ecologically informed behavior prediction model to identify high-risk patterns of digital media usage and support early-stage intervention strategies.
MethodsWe propose a Dual-Channel Cross-Attention Network (DCCAN) architecture composed of three layers: signal identification (for psychological and ecological encoding), interaction modeling (via cross-modal attention), and behavior prediction. The model was trained and tested on a dataset of 9,782 users and 51,264 behavior sequences, annotated with labels for immersive usage, late-night activity, and susceptibility to health misinformation.
ResultsThe DCCAN model achieved superior performance across all three tasks, especially in immersive usage prediction (F1-score: 0.891, AUC: 0.913), outperforming LSTM, GRU, and XGBoost baselines. Ablation studies confirmed the critical role of both psychological and ecological signals, as well as the effectiveness of the cross-attention mechanism.
ConclusionsIncorporating psychological and ecological modalities through attention-based fusion yields interpretable and accurate predictions for digital risk behaviors. This framework shows promise for scalable, real-time behavioral health monitoring and adaptive content moderation on media platforms.
To investigate the current status of workplace spirituality and moral resilience among clinical nurses and to explore the relationship between these two factors, thereby providing a reference for developing strategies to enhance nurses' moral resilience.
A cross-sectional survey design.
From February to April 2025, a convenience sampling method was used to select 1680 nurses from ten hospitals in the Pingliang area of China. Data were collected using the general data questionnaire, Workplace Spirituality Scale(WSS). Furthermore, the relationship between workplace spirituality and moral resilience was analyzed.
A total of 1657 valid questionnaires were ultimately recovered, yielding an effective response rate of 98.63%. The mean score for workplace spirituality was 102.36 ± 21.65, and the mean score for moral resilience was 41.76 ± 6.31, both indicating a moderate level. A significant positive correlation was found between the two variables (r = 0.231, p < 0.05). Multivariate linear stepwise regression analysis revealed that monthly income, department, monthly night shifts, and workplace spirituality scores were significant predictors of moral resilience (p < 0.05).
The moral resilience of clinical nurses is at a moderate level. Enhancing workplace spirituality can contribute to improving their moral resilience.
Perioperative psychological symptoms are prevalent among patients undergoing lung surgery and can contribute to adverse clinical outcomes. Pharmacological interventions for these symptoms have inherent limitations. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising non-invasive therapeutic approach. This study aims to evaluate the efficacy of taVNS in managing perioperative psychological symptoms in patients undergoing elective thoracoscopic pneumonectomy under general anaesthesia.
This single-centre, prospective, randomised, double-blind, controlled trial will enrol 176 patients scheduled for elective thoracoscopic lung resection. Participants will be randomly allocated to either the active taVNS or the sham taVNS groups in a 1:1 ratio. Both groups will receive 30 min active or sham stimulation sessions at four time points: (1) the afternoon prior to surgery, (2) the morning of the surgery, (3) following extubation and (4) the first afternoon postsurgery. The primary outcome is the incidence of perioperative anxiety, assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale. Secondary outcomes include depression scores, stress index, sleep quality, pain scores, incidence of postoperative delirium, fatigue, cough symptoms and postoperative recovery quality, all evaluated through validated assessment tools. Analyses will be conducted using intention-to-treat and per-protocol populations.
The Ethics Committee of Affiliated Hospital of Xuzhou Medical University granted approval for the study with approval number: XYFY2024-KL444-01. Dissemination will be via national anaesthesia conferences and publication in the peer-reviewed literature.
ChiCTR2400090542.
In Canada, many families want to breastfeed, but there are several common challenges they may encounter. Currently, 91% of Canadian families initiate breastfeeding after giving birth, yet only 38% of babies are breastfed exclusively to 6 months. In 1991, the Breastfeeding Committee for Canada (BCC) was established to implement the World Health Organization’s Ten-Step Baby-Friendly Hospital Initiative, a series of evidence-based in-hospital practices to support families to breastfeed. Then, in recognition of the need to support breastfeeding beyond the hospital setting, the BCC expanded the Baby-Friendly Initiative (BFI) to apply the Ten Steps to both hospitals and community health settings. However, uptake of the BFI Ten Steps in community settings has been low and methodology on how to optimise implementation of the Ten Steps in community is not well developed. Therefore, the objective of this project is to develop and evaluate a quality improvement collaborative with 25 community health services from across Canada to learn how to best support the implementation of the BFI Ten Steps in community, with the ultimate goal of improving breastfeeding outcomes.
This protocol describes the activities of the Community Baby-Friendly Initiative Collaborative (CBFI-C) and the methods used to evaluate its effectiveness. We will use the Institute for Healthcare Information Breakthrough Series (IHI-BTS) model, a proven quality improvement model that has been widely used in clinical settings, but is not yet widely used in community settings. The IHI-BTS combines three virtual learning sessions with action cycles that allow the participating sites time to test and track small practice changes. Sites will be asked to track care indicator and breastfeeding outcome data, engage in monthly webinars, receive coaching from trained mentors, participate in focus groups and participate in a final summative workshop. We will use a multi-site case study approach, combining aggregate care indicator data and qualitative data from webinars, focus groups and workshops to evaluate how the CBFI-C model supports community sites in the process of implementing the BFI Ten Steps.
Ethics approval for this evaluation was obtained from the CHIPER Health Research Ethics Board (Number HS26947-H2025:157)). The results of the CBFI-C evaluation will be shared in a report, peer-reviewed publications and presentations to government and academic audiences. The findings will inform effective quality improvement strategies to enhance uptake of the BFI in community health settings.
by Lijun Guo, Qiong Li, Jingyi Li, Feng Yang
Parkinson’s disease (PD) is a neurodegenerative disorder characterized by dopaminergic neuron loss and neuroinflammation, with emerging roles of peripheral immune dysregulation in disease progression. This study aimed to investigate the regulatory network of CD4 + T cells in PD through multi-omics integrative analysis. Transcriptomic and miRNA datasets from peripheral blood mononuclear cells (PBMCs) of 20 PD patients and 17 healthy controls were analyzed (GSE22491, GSE100054, GSE16658). Differential expression analysis identified 287 mRNAs and 73 miRNAs (|log₂(fold change)| ≥ 0.5, false discovery rate CD4 and SEMA6A. A competing endogenous RNA (ceRNA) network was constructed, comprising 38 lncRNAs, three miRNAs (miR-155-5p, miR-27a-3p, miR-27b-3p), and their target mRNAs CD4 and SEMA6A. Four lncRNAs (including XIST, NORAD, and INE1) were identified to functionally regulate CD4. Immune cell infiltration analysis revealed increased proportions of naïve CD4 + T cells and activated dendritic cells in PD patients. CD4 expression positively correlated with γδ T cells (r = 0.48, p = 0.032) and activated NK cells (r = 0.45, p = 0.048). Gene set enrichment analysis associated CD4 with neurodegenerative pathways (e.g., Parkinson’s disease: normalized enrichment score = 1.57, p = 0.002) and oxidative phosphorylation (normalized enrichment score = 1.89, p = 7.4 × 10 ⁻ ⁶). These findings highlight a peripheral CD4 + T cell-centric ceRNA network that modulates immune-metabolic crosstalk and neuroinflammation in PD. This study provides novel insights into immune-driven neurodegeneration and suggests potential therapeutic targets for PD through metabolic-immune reprogramming.by Cyndirela Chadambuka, Prossy Kiddu Namyalo, Rhea Raghunauth, Navya Arora, Fiona Kouyoumdjian, Beverley M. Essue
The risk of gender-based violence (GBV) against migrant women is largely exacerbated by precarious employment opportunities available to them as they go through the resettlement process. Despite the risk that the connection of precarious employment and GBV pose to migrant women’s health and wellbeing, critical gaps exist in literature. Our scoping review sought to identify and synthesize evidence on the interconnectedness of GBV and precarious employment among migrant women. Six electronic databases were searched for empirical literature and two reviewers independently conducted title/abstract and full text screening of studies that met the inclusion criteria. Data synthesis was guided by the intersectionality theory and the Feminist Political Economy framework. 50 articles met the criteria for inclusion in this review. Our findings reveal that precarious employment plays both a catalytic and consequential role in GBV. Findings highlighted how post-migration shifts in gender roles, schedule unpredictability leading to work-life imbalance, and debt bondage trap migrant women in cycles of exploitation and abuse. Few studies highlighted how human trafficking is intertwined with precarious labor markets, where the exploitation and abuse of migrant women mirror the characteristics of human trafficking. This review underscores the urgent need for integrated policy responses that are not only focused on individual supports but also address the structural drivers or labor precarity and protect migrant women from GBV and human trafficking. By applying an intersectional lens, policies and intervention programs can tackle systemic oppression across economic, and social systems essential in reducing exploitation and abuse to advance migrant women’s wellbeing.To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).
An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.
All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.
Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.
Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022–31 March 2022). We analysed the risk factors for uncontrolled BP.
Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (
We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.
Phasix mesh is a fully resorbable synthetic mesh for use in clean and contaminated ventral incisional hernia repairs. Long-term absorbable Phasix mesh appears to be a safe and promising device in incisional hernia repair, with low recurrence rates; however, data on long-term complications after surgery, particularly after the resorption period of the mesh, are scarce.
This protocol describes a study of several European registries on the use of a Phasix mesh in incisional hernia repair. The primary endpoint of the study is long-term complications at 2–5 year follow-up after mesh implantation, with secondary endpoints including hernia recurrence and complications during short-term follow-up.
Ethical approval was not required for this protocol as the study is based on anonymised registry data collected with prior patient consent in each registry. Each participating registry has its own ethical approval process, and this study will adhere to those regulations. The results will be disseminated through peer-reviewed publications and conference presentations.
Value-based healthcare (VBHC) strives to improve the healthcare system by focusing on value of care, that is, patient relevant outcomes relative to the costs for achieving these outcomes. Within VBHC, patient participation is crucial to identify patient relevant outcomes and value improvement potential. However, patient participation in VBHC initiatives remains limited. Therefore, we aimed to improve patient participation within VBHC teams with the ultimate aim to develop a practical guide for patient participation in VBHC.
An action research study.
This study was conducted in seven collaborating Dutch hospitals from March 2023 to November 2024.
Seven VBHC teams were selected to participate in the cyclical action research steps, that is, orientation, planning, implementation, and evaluation, in which patient participation was implemented or improved. These included the following patient groups: prostate cancer, vulnerable elderly, breast cancer, diabetes, maternity care, colorectal cancer and chronic kidney disease.
Both qualitative and quantitative data were collected. Qualitative data included observations and minutes of meetings with the intervention teams. Quantitative data included responses to the Public and Patient Engagement Evaluation Tool (PPEET) by multiple members of the intervention (n=7) and control teams (n=94) at three time points (T1=6 months, T2=12 months, T3=end of study). Qualitative data were thematically analysed and quantitative data were analysed descriptively. Finally, the data were triangulated to create an overview of lessons learnt in improving patient participation.
Patient participation goals varied across teams, leading to diverse actions, such as establishing a diabetes patient panel and distributing questionnaires to patients with colorectal cancer. PPEET results show that 71% of intervention team members reported that patient participation had an impact on the team’s outcomes compared with 44% in control teams (T3). Furthermore, 80% of the intervention team members initially wanted training in patient participation (T1), which dropped to 29% at T3. Overall, 22 lessons in improving patient participation in multidisciplinary project teams were identified and compiled into a practical guide.
The action research process improved the process and impact of patient participation in the intervention teams. Furthermore, the results indicate that the action research process enhanced the team members’ knowledge and skills on patient participation. The practical guide developed in this study can be used to support implementation of patient participation in VBHC.
by Jaime Carballedo-Pulido, Mariona Farrés-Tarafa, Juan Roldán-Merino, Marta Berenguer-Poblet, Montserrat Girabent-Farrés, Carla Otero-Arús, Susana Santos-Ruiz
BackgroundAlthough the SBAR framework is widely used in clinical and educational settings, there is a lack of validated Spanish-language tools that objectively assess its use by students in simulation. The adaptation and validation of the SBAR-LA rubric address this gap and provide a resource for training and evaluating structured communication.
ObjectiveTo conduct the cross-cultural adaptation and psychometric validation of the SBAR-LA rubric in Spanish for assessing structured communication skills in undergraduate nursing students during clinical simulation.
MethodsA two-phase cross-sectional psychometric validation study was conducted. Phase one involved cross-cultural adaptation, including forward and backward translation, expert panel review, and cognitive debriefing with nursing students. Phase two assessed inter-rater reliability using Krippendorff’s alpha based on 97 performance evaluations obtained in different simulation scenarios. The SBAR-LA-Sp rubric contains 10 dichotomous items across the four SBAR dimensions.
ResultsThe Spanish version of the SBAR-LA rubric demonstrated excellent inter-rater reliability, with a Krippendorff’s alpha of 0.933 (95% CI: 0.905–0.956). Internal consistency and agreement between raters were also high, confirming the instrument’s robustness.
ConclusionsThe Spanish version of the SBAR-LA rubric provides an objective measure of structured communication in nursing simulation. The findings support its use in academic training. Further research is needed to examine its effect on learning outcomes.
Limited literature has focused on people with cancers' preference for care providers in scenarios where trade-offs may have to be made.
To report the results of a comprehensive search and synthesis of discrete choice experiments or best-worst scaling studies (± willingness to pay estimates) in scenarios involving cancer nurses, with a focus on: (1) preferred care provider; and (2) relative importance of attributes of care provision for people with cancer.
A search was conducted across: CINAHL, Cochrane Central Register of Controlled Trials, EconLit, Medline, PsycINFO, Scopus, Web of Science Core Collection, and Google Scholar for discrete choice experiments published between January and July 2025. Data were extracted and appraised by two authors. Results were narratively synthesised.
Of 461 studies screened, 11 were included, published in Australia (n = 3), UK (n = 3), and China (n = 5) including people with breast (n = 4), gastric (n = 4), prostate (n = 1), or mixed cancers (n = 2). In six studies exploring scenarios of follow-up care (i.e., survivorship/surveillance), cancer medical specialists were the preferred care provider, followed by cancer nurses, and then general practitioners. In four of the five studies of supportive care scenarios (i.e., diet and exercise advice, anxiety and depression screening), cancer nurses were the preferred care provider, followed by allied health professionals, then cancer medical specialists. The highest WTP estimate was $US226.15 for a medical specialist to provide follow-up care. For supportive care, the highest WTP was $US137.52 for a cancer nurse to provide diet-based lifestyle advice post-treatment for breast cancer.
Cancer nurses are highly valued by people with cancer, particularly for supportive care provision. Opportunities exist for an increase in cancer nurse specialists with expanded scope of practice, to support the preference of people with cancer to have cancer medical specialists, or cancer nurse specialists provide expert cancer follow-up care.
Employees of a cancer patient advocacy group were involved in the design of the study, interpretation of the data, and the preparation of the manuscript. No patients were involved in this work. However, this systematic review prioritized patient voices by including studies that reported on the preferences of people with cancer.
To examine state-level variation in mental health screening practices for high school athletes in the USA and evaluate associations between screening protocols and adolescent depression-related and suicide-related outcomes.
Cross-sectional study of preparticipation examination (PPE) forms and Youth Risk Behaviour Surveillance System (YRBSS) data.
High school athletics across all 50 US states and the District of Columbia.
732 676 high school students who completed the 2021 YRBSS survey (grades 9–12).
Prevalence of depressive symptoms and suicide-related behaviours, measured using YRBSS items on sadness/hopelessness, suicide ideation, planning, attempts and suicide attempts resulting in injury. State-level PPE forms were reviewed for presence and depth of mental health screening, including Patient Health Questionnaire-4 (PHQ-4) and eating disorder (ED) risk questions.
Screening practices varied widely, ranging from no mention of mental health in some states to required evaluations with formal referral protocols in others. Of 732 676 students, 503 861 (68.7%) reported feeling sad or hopeless, 608 416 (83.0%) seriously considered suicide and 64 072 (8.8%) attempted suicide in the past year. States with required screening protocols had higher reported rates of depressive symptoms (71.0% vs 68.7%, p
High school athletes represent a vulnerable group in need of structured and standardised mental health screening. State-level screening policies were associated with lower suicide attempt rates, though causal inference is limited by the cross-sectional design. Standardised use of validated mental health tools may support early identification and intervention for at-risk adolescents.
In Arizona, chronic diseases, mental health conditions, haemorrhage and infections remain significant causes of severe maternal morbidity (SMM). Community health worker (CHW) interventions address social determinants of health and enhance healthcare access, which is particularly important for improving maternal health among high-risk Medicaid beneficiaries.
The Arizona Health Start Programme (HSP), a home-visiting intervention, uses CHWs to improve maternal and child health outcomes through health education, referral support and advocacy services for at-risk pregnant and postpartum women with children up to age 2 years. Over 80% of HSP participants are insured by Medicaid. The goal of this evaluation is to determine if, among Arizona Medicaid beneficiaries, participation in HSP improves (1) the risk of experiencing SMM, (2) the care management of pregnant women diagnosed with chronic conditions (eg, diabetes, hypertension) and (3) the care management of pregnant women diagnosed with depression, compared with pregnant women who did not participate in HSP. To test our hypothesis, we employ a quasi-experimental design using retrospective data and propensity score matching to establish comparison groups using Arizona Medicaid claims and enrolment records spanning the study period (2008–2019).
No primary data will be collected. This work is supported through an inter-agency contract from Arizona Department of Health Services (ADHS); approved by the ADHS Human Subjects Review Board, Project #17–00010, determined as non-human subjects research. Evaluation of the proposed outcomes will be completed by June 2027, and findings will be disseminated to HSP directors, managers and CHWs, as well as through academic journals and conferences.
To explore parents' experiences of holding children for healthcare procedures in an Australian paediatric hospital setting.
A qualitative exploratory study was undertaken at a paediatric tertiary hospital in Melbourne, Australia.
Semi-structured interviews were conducted with parents of children who had undergone a procedure during their hospital admission. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis.
Eight parents were interviewed, with four themes becoming apparent from their experiences, representing the multiple roles parents undertook when holding their child for a procedure. Parent as a protector was identified as the overarching role, with all roles involving aspects of parents protecting their child. The remaining roles included comforter—where parents supported their child by providing reassurance and being present; helper—where parents actively sought a role or stepped up to assist during a procedure and enforcer—where at times parents had a belief that to facilitate some procedures holding was necessary. A sliding-scale schema illustrates that these roles are not static, but rather positioned along a continuum, with some parents moving between roles throughout a procedure.
This study provided valuable insight into the complexity of parents' involvement when supporting their child during a procedure. The varying roles suggest parents balance the desire for their child to feel safe (holding as a comforter) with wanting to get the procedure done (holding as an enforcer).
This research impacts clinicians, parents and children involved in healthcare procedures. Clinicians can use the sliding-scale schema that illustrates the distinct roles parents can take on, as a visual tool to promote parental involvement and help parents define their role during a procedure.
Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was utilised when reporting findings.
No patient or public contribution.
Determine the positive psychological experience of patients with chronic heart failure through a systematic literature review and to provide a reliable basis for their psychological care.
Qualitative meta-synthesis.
A qualitative meta-synthesis was conducted to extract and analyse qualitative research from PubMed, Web of Science, Embase, Cochrane, CINAHL, PsycINFO and Chinese Database, including China National Knowledge Internet, Wanfang Database, China Biology Medicine Disc and VIP database from the inception of the database to 24 March 2024.
Two researchers screened, extracted and cross-checked data. Disputes resolved via discussion or 3rd researcher. Irrelevant titles/abstracts were excluded; full-texts were reviewed for final inclusion.
A total of 17 qualitative studies yielded 58 results, categorised into 10 groups and synthesised into three themes: positive attitudes and emotional responses, positive changes after the disease diagnosis and supportive factors for positive psychology.
Heart failure patients can experience positive psychology post-illness. Care providers should prioritise psychological assessment and support factors to meet needs, foster rehabilitation and improved quality of life.
CHF patients crucially contributed to this qualitative meta-synthesis by sharing insights into their positive psychological experiences, resilience and coping strategies.
To explore determinants impacting an Electronic Health Record-based information system implementation and their association with implementation fidelity based on the Theoretical Domains Framework (TDF) from nurses' perspectives.
Exploratory sequential mixed-method design.
In stage one, semi-structured interviews with 53 purposively selected nurses informed the exploration of TDF domains influencing the implementation of the information system with directed content analysis. In stage two, a cross-sectional survey, informed by the qualitative findings, was conducted among 482 nurses to identify the most relevant and relatively important TDF domains by running generalised linear regression models.
The qualitative interviews generated 13 TDF domains that were identified as major influencing factors, including technology characteristics, knowledge, attitudes, role agreement, self-efficacy, goal-setting, information circulation, and communication among nurses. Quantitative findings showed that 70% of nurses used and printed the written form through the information system, and only 34% offered verbal education consistently. Regression analysis identified nine domains that were relevant and important factors for implementation fidelity, including knowledge, skills, role identity, beliefs in consequences, beliefs in capabilities, intentions, goals, memory and decision processes, and environmental context.
Our findings confirmed previous evidence on determinants of implementing digital health technologies, including knowledge, competencies, perceived effectiveness, role agreement, intentions, decision processes, and environmental context. Additionally, we highlighted the importance of goal-setting for successful implementation.
This study investigated the relatively important associated factors that can impact the successful implementation of the nurse-led information system for post-acute care based on nurses' perspectives. These results can guide nurse practitioners in implementing similar initiatives and support evidence-based decision-making. Researchers can also further investigate the relationships between the identified determinants.
Journal Article Reporting Standards for Mixed Methods Research.
No patient or public contribution.
by Oumarou I. Wone Adama, Iman Frédéric Youa, Alexandra Bitty-Anderson, Arnold Junior Sadio, Rogatien Comlan Atoun, Yao Rodion Konu, Hezouwe Tchade, Martin Kouame Tchankoni, Kokou Herbert Gounon, Kparakate Bouboune Kota-Mamah, Abissouwessim Egbare Tchade, Godonou Amivi Mawussi, Fiali Ayawa Lack, Fifonsi Adjidossi Gbeasor-Komlavi, Anoumou Claver Dagnra, Didier Koumavi Ekouevi
IntroductionIn Togo, the syndromic approach is used for the diagnosis and management of sexually transmitted infections (STIs). The aim of this study was to evaluate the syndromic approach for diagnosis of STIs among female sex workers (FSW) in Lomé, Togo.
MethodsA cross-sectional study was carried out from September to October 2023 among FSW in Lomé (Togo). FSW aged 18 years and above were included. A gynecological examination was performed for syndromic diagnosis, and the Xpert® CT/NG were used to screen vaginal swabs for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). The performance (predictive values) of the syndromic approach to STI diagnosis was evaluated using the Xpert® CT/NG test as the gold standard.
ResultsA total of 357 FSW were recruited. The median age of FSW was 32 years (IQR: [26–40 years]) and 8.2% had attained a higher level of education. The prevalence of syndromic STI among FSW was 33.3%. Vaginal swabs were positive for CT (8.4%) and NG (8.7%), with a prevalence of bacterial STIs (CT and/or NG) of 14.3%. The syndromic approach to STI diagnosis demonstrated a positive predictive value of 24.3%.
ConclusionThe prevalence of STIs is relatively high among FSW in Lomé. According to this study, the diagnosis of STIs using the syndromic approach has limited relevance. National STI screening and management policies urgently need to be rethought, incorporating recent technological advances.
Our objective was to examine the barriers and facilitators encountered by primary and secondary healthcare professionals when collaborating at the care continuum between primary and secondary care. We aimed to identify specific challenges, observed benefits and proposed changes. By analysing these experiences and identifying opportunities for redesign, we aimed to define specific domains that could improve collaboration, thereby supporting sustainable access to and quality of care in the face of rising demand and constrained resources.
A qualitative exploratory study using semi-structured interview data guided by two domains of the Consolidated Framework for Implementation Research (CFIR), including Inner Setting—Tension for Change and Individual Characteristics, as well as selected implementation outcomes defined by Proctor et al, all viewed through a service (re)design lens.
Consultation and communication between primary and secondary healthcare professionals in a Dutch urbanised area.
37 users of collaboration services (eg, telephone, correspondence) were interviewed between August 2021 and October 2022, including 14 general practitioners (GPs) (10 females, 4 males) and 23 specialists (10 females, 13 males).
Four key domains with subthemes, subdivided per operation and CFIR domain, were identified as central to optimising the collaboration of professionals within the primary-secondary care continuum: (1) software and record integration; (2) seamless personal interaction; (3) eliminating a sense of ‘us vs them’ and (4) gaps in continuity of care.
This study reveals that healthcare professionals in both primary and secondary care face similar collaboration challenges due to system-level issues and inadequate collaboration tools, leading to increased workload, miscommunication and reduced quality of care. Improving collaboration between GPs and specialists requires not only adjustments to individual services, but a comprehensive overhaul of the referral and back-referral process. A more integrated approach, addressing key domains, is crucial for enhancing care quality, streamlining workflows and improving health outcomes.
FreshRSS 