Conectar
Pain is an experience that is socially conditioned, like all human experiences. The scientific study of pain from a biopsychosocial perspective involves considering its complexity and multidimensionality. This means accounting for the anatomical and physiological elements of pain, as well as the psychological, social and cultural elements of pain. Despite the increasing acknowledgement of the biopsychosocial model, pain research still lacks standardised criteria for evaluating its social dimension. Moreover, the integration of social variables into empirical studies remains limited and fragmented. The aim of this review protocol is to analyse whether and how pain studies account for the social dimension, understood as the cultural, relational and contextual factors that shape the perception and experience of pain.
A systematic review will be conducted by consulting five international databases: PubMed, Web of Science Core Collection, Scielo Citation Index, Scopus and CINAHL Complete. The review will include empirical or theoretical studies on pain that consider its social dimension, are written in Spanish or English, are applied to human beings and align with the review’s objectives. The studies will then be exported to the Zotero bibliographic manager for further processing. The selection of studies will be carried out in two phases. The initial stage of the review process will involve a title and abstract analysis of the identified studies, followed by a full-text review. Data will be extracted using a bespoke tool created for this research. The quality of the studies will be assessed using a tool developed by our research group. Data synthesis will be carried out through descriptive and narrative analyses.
This systematic review protocol did not require ethical approval; however, the project in which it is framed has been approved by the CSIC Ethics Committee (271/2023). These findings will be disseminated by publication in high-impact, peer-reviewed journals and by presentation at relevant scientific conferences and academic congresses. The results will provide an overview of the integration of the social dimension of pain into the scientific literature, thereby contributing to the advancement of the field and informing future research, interventions and public policy.
CRD42024601863.
Digital therapeutics (DTx) show promise in bridging mental healthcare gaps. However, treatment selection often relies on availability and trial-and-error, prolonging suffering and increasing costs. Personalised prediction models could help identify individuals benefiting most from specific DTx.
The aim of this secondary analysis was to establish a machine learning-based prediction model for positive treatment outcomes in patients with depressive or anxiety symptoms after 8 weeks of internet-delivered cognitive behavioural therapy (iCBT).
We analysed a large real-world dataset of patients from the online therapy unit iCBT programme in Saskatchewan, Canada (2013–2021). Clinically significant changes in depressive symptoms or anxiety were measured using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7). We trained six prediction models using sociodemographic and mental health-related factors at baseline, compared model performances and calculated Shapley values for feature importance.
Data from 4175 patients using 34 features for prediction, identified by least absolute shrinkage and selection operator regression, showed the Gradient Boosted Model (gbm) and logistic regression (log) performed best, with balanced accuracies of 0.76, 95% CI (0.70 to 0.83) and 0.70, 95% CI (0.63 to 0.77). Shapley values indicated GAD-7 scores at baseline as the most important predictor of clinically significant improvement, along with mental health history and sociodemographic variables.
The gbm and log models achieved comparable accuracy in predicting clinically significant improvement after iCBT, supporting the use of simpler, interpretable methods in clinical practice.
These findings could help improve mental health treatment selection, iCBT assignment, enhance effectiveness and optimise treatment for patients.
Digital interventions may be a way of increasing access to rehabilitation after stroke, but there is limited knowledge on how they are perceived by stroke survivors. F@ce 2.0 is a home-based person-centred intervention for stroke rehabilitation that focuses on daily activities and participation in everyday life. The intervention spans over 8 weeks and uses Short-Message-Services (SMSs) to support goal achievement.
The aim of this study was to explore and describe experiences of rehabilitation with F@ce 2.0 from the perspective of people with stroke.
Qualitative inquiry was based on individual interviews at two time points, post-intervention and 6 months post-inclusion. Data were analysed using reflexive thematic analysis.
Home-based stroke rehabilitation in Sweden.
Twelve stroke survivors with mild to moderate stroke.
Three themes and seven sub-themes were constructed. The main themes were ‘Setting personally relevant goals requires a trusting relationship’,‘ SMSs as a tool for person-centred rehabilitation’ and ‘Collaboration with the team is essential for resuming daily activities after stroke’.
Supporting goal achievement through SMS messages may increase motivation and awareness in stroke rehabilitation. The results, however, illustrate the importance of personal meetings in rehabilitation, both for setting relevant goals and for identifying goal achievement strategies.
ClinicalTrials.gov NCT04351178;
This study aims to examine the self-efficacy levels of nurses in the management of pressure ulcers (PUs) and the demographic and professional factors affecting this. This cross-sectional and descriptive study was conducted with 436 nurses. Data were collected between January and April 2024, using the Nurse Identification Form and the Pressure Ulcer Management Self-Efficacy Scale (PUM-SES). In the study, the total mean score of the PUM-SES was found to be 58.77 ± 18.07 (min–max: 0–100). The mean scores of the sub-dimensions of the scale were assessment 57.54 ± 20.60, planning 59.14 ± 21.15, supervision 57.16 ± 21.86, decision making 60.02 ± 19.19 (min–max: 0–100). In addition, it was observed that the total scores of the PUM-SES were significantly higher for nurses who were 34 years old and older, had worked in the unit for 3 years or more and worked in intensive care clinics. Findings showed that nurses generally had a moderate PUM-SES score. Sociodemographic variables explained only 3.9% of the total variance. Age was significant in the sub-dimensions of surveillance (β = 0.241, p = 0.001) and decision-making (β = 0.162, p = 0.03); while the unit worked had a significant and negative effect on all sub-dimensions and the total score (β = −0.159, p = 0.001). The results obtained suggest that professional experience and the working environment may have an effect on the cognitive competence of nurses. Therefore, it is recommended that training programs be developed to support nurses' decision-making processes and professional competence.
Traditionally, surgical intervention has been the standard treatment for children with metopic synostosis, assuming that it reduces the risk of raised intracranial pressure, thereby preventing vision and cognitive impairment, and also restores the abnormal head shape. However, recent research suggests a sporadic occurrence of raised intracranial pressure in patients with metopic synostosis. In addition, following surgery, an overall tendency to have worse cognitive and behavioral outcomes and more refractive errors compared to healthy peers is observed. Research on conservative (non-surgical) treatment in metopic synostosis is limited and lacks a comparative design. The purpose of this study is to compare the (cost-)effectiveness of conservative and surgical treatment in patients with metopic synostosis.
This is the protocol for an observational cohort study with a duration of 8 years. A total of 450 patients with metopic synostosis will be included. The primary outcome is head growth as a predictor for increased intracranial pressure. Non-inferiority with regard to head growth from 0 to 8 years (yearly difference in SD) is determined using a linear mixed model adjusted for potential confounders. Secondary outcomes include papilledema, orthoptic outcomes; forehead shape; cognitive, behavioural and psychological outcomes; and societal costs. A cost-effectiveness analysis will be performed.
The study has been reviewed and approved by the Medical Research Ethics Committee of the Erasmus MC, University Medical Center Rotterdam (MEC-2022-0142). Written informed consent will be obtained from both parents of each participant. The results will be disseminated by publication in international peer-reviewed journals.
ClinicalTrials.gov NCT06069479.
To provide evidence of the cost savings of a quality improvement (QI) initiative preventing healthcare-associated infections (HAIs) in critical care settings.
A micro-costing study focused on financial data related to a nationwide multicentric project preventing central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).
Brazilian public healthcare system.
Adult, paediatric and neonatal intensive care units (ICUs) participating in the QI initiative.
This collaborative QI project implemented a multifaceted strategy to enhance infection-control measures. Participating ICUs reported the number of patients with and without HAIs and information on each HAI’s aggregate average cost (AC), which was analysed following the Brazilian Ministry of Health’s micro-costing guidelines. The 1-year preintervention period evidenced an aggregated AC in adult, paediatric and neonatal ICUs, respectively, of Intl$21 763.5 (95% CI 20 683.6 to 22 843.0), Intl$34 062.4 (95% CI 25 819.6 to 42 304.9) and Intl$32 903.2 (95% CI 29 203.6 to 36 602.4) for CLABSI; Intl$25 202.5 (95% CI 24 276.6 to 26 127.8), Intl$44 753.6 and Intl$17 238.4 for VAP and Intl$19 166.3 (95% CI 17 676.2 to 20 656.1) and Intl$55 873.3 (95% CI 43 563.1 to 68 183.1) for CAUTI (not included neonatal ICUs).
The cost savings were estimated using the HAIs prevented—expenses avoided—during the QI intervention period from September 2021 to December 2023. The HAIs prevented were estimated using the difference between observed and predicted infections based on the aggregated preintervention baseline.
Of the 188 participating ICUs, 31 voluntarily completed and provided the requested financial data with 100% accuracy. Considering the prevented 7342 HAIs for adult, paediatric and neonatal ICUs, respectively: 1647, 86 and 205 CLABSI; 3775, 114 and 118 VAP; and 1377 and 20 CAUTI, we estimated a saving of Intl$175.3 million (95% CI 153.2 to 180.9 million) to the Brazilian unified health system and a resultant estimated return on investment (ROI) of 890%.
This QI collaborative is a value-based initiative preventing HAIs in adult, paediatric and neonatal ICUs in South American settings. The substantial cost savings and a remarkable ROI underscore the economic viability of investing in comprehensive QI infection prevention strategies.
Using a 6-week porcine full-thickness excisional wound grafting model, we evaluated the Autologous Regeneration of Tissue (ART®) System, a novel skin harvesting device designed to collect autologous full-thickness autologous microcolumns (FTAM) at 0.5 mm in diameter. The donor skin sites were harvested using the ART® System and compared to split-thickness skin grafts (STSGs). Recipient sites were divided into three treatment groups: FTAM, STSG and Untreated control. Comparing the FTAM donor sites to the STSG donor sites, we observed significantly faster re-epithelization by Day 4 (p < 0.05), earlier adnexal structures and rete ridge formation by Week 3, and increased collagen and elastin content by Week 6. We also observed an increased rate of healing at the FTAM donor site whilst limiting donor site morbidity compared to traditional STSG donor sites. Time to recipient site closure was 2.4 weeks for STSG treated, 3.3 weeks for FTAM treated and 4.1 weeks for the Untreated control (p < 0.05). The STSG and FTAM recipient sites reached complete re-epithelialization by Weeks 4 and 5, respectively which was significantly faster compared to the Untreated control. However, the FTAM recipient site received only 10% of the donor site tissue relative to the recipient site area and the amount of donor site tissue grafted on the STSG recipient sites was 5× more than the FTAM recipient sites. Additionally, the FTAMs harvested by the ART® System augmented recipient wound site healing as a result of ‘epithelial island’ expansion in contrast to Untreated control sites that closed primarily by contracture.
FreshRSS