Conectar
To explore how neonatal nurse leaders sustain human-centred care while implementing digital technologies in neonatal intensive care units (NICUs).
Qualitative descriptive multi-site study across four NICUs in the Eastern Region of Saudi Arabia (November 2024–May 2025), reported in accordance with COREQ.
Purposive maximum-variation sampling recruited 24 neonatal nurse leaders across leadership levels, hospital types and digital maturity stages. Semi-structured interviews were conducted in Arabic or English, transcribed, translated as needed and thematically analysed in NVivo 14 using a hybrid inductive–deductive approach. Directed content analysis of key organisational documents enabled triangulation. Trustworthiness was supported through member checking, peer debriefing, audit trail, external review and double coding of a subset of transcripts.
Four interrelated strategies were identified: (1) embedding a values-based human-centred vision; (2) selecting and customising digital tools to strengthen, not replace, nurse–family connection; (3) redesigning workflows (e.g., device-free openings, protected presence time, family-inclusive portals) to preserve presence and partnership; and (4) fostering team capability and psychological safety for digital–human integration.
Human-centred care in digital NICUs is intentionally led and structurally engineered. The study offers a practice-ready framework that translates values into reproducible routines within complex sociotechnical systems.
The framework supports nurse leaders in aligning digital transformation with family-centred care, protecting nurse–family presence, and enhancing safety, trust and partnership for high-risk neonates.
Addresses risks of relational erosion in digital and AI-enabled NICUs and provides transferable nurse-led strategies to sustain ethical, family-centred practice.
COREQ-compliant qualitative study.
No Patient or Public Contribution.
by Ikgyu Shin, Nilay Bhatt, Alaa Alashi, Keervani Kandala, Karthik Murugiah
ObjectivesTo develop and compare prediction models for 30-day and 1-year mortality in Heart failure with preserved ejection fraction (HFpEF) using EHR data, utilizing both traditional and machine learning (ML) techniques.
BackgroundHFpEF represents 1 in 2 heart failure patients. Predictive models in HFpEF, specifically those derived from electronic health record (EHR) data, are less established.
MethodsUsing MIMIC-IV EHR data from 2008−2019, patients aged ≥ 18 years admitted with a primary diagnosis of HFpEF were identified using ICD-9 and 10 codes. Demographics, vital signs, prior diagnoses, and lab data were extracted. Data was partitioned into 80% training, 20% test sets. Prediction models from seven model classes (Support Vector Classifier (SVC), Logistic Regression, Lasso Regression, Elastic Net, Random Forest, Histogram-based Gradient Boosting Classifier (HGBC), and eXtreme Gradient Boosting (XGBoost)) were developed using various imputation and oversampling techniques with 5-fold cross-validation. Model performance was compared using several metrics, and individual feature importance assessed using SHapley Additive exPlanations (SHAP) analysis.
ResultsAmong 3,235 hospitalizations for HFpEF, 30-day mortality was 6.3%, and 1- year mortality was 29.2%. Logistic regression performed well for 30-day mortality (Area Under the Receiver operating characteristic curve (AUC) 0.83), whereas Random Forest (AUC 0.79) and HGBC (AUC 0.78) for 1-year mortality. Age and NT-proBNP were the strongest predictors in SHAP analyses for both outcomes.
ConclusionModels derived from EHR data can predict mortality after HFpEF hospitalization with comparable performance to models derived from registry or trial data, highlighting the potential for clinical implementation.
Neurogranin (Ng) has a role in synaptic plasticity and is considered a biomarker of synaptic dysfunction, a process hypothesised to be important in delirium. Few studies examining Ng in delirium exist, with mixed findings. This study aimed to investigate associations between cerebrospinal fluid (CSF) Ng concentrations and delirium in acutely admitted hip fracture patients.
Cross-sectional study.
Acutely admitted orthopaedic patients with hip fracture recruited from four participating hospitals in eastern Norway, representing secondary and tertiary care settings.
This study included 392 hip fracture patients. All admitted hip fracture patients operated in spinal anaesthesia were, regardless of age, considered for inclusion.
An in-house ELISA was used to measure CSF Ng concentration in patients acutely admitted with a hip fracture (n=392). Delirium status was evaluated daily according to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Editions criteria independently by two experienced geriatricians. A value
180 patients (46 %) developed delirium and 70% of these had dementia. CSF Ng concentration did not differ significantly between those with and without delirium (176 pg/mL vs 164 pg/mL), with an estimated difference in medians of 12 (95% CI –5.8 to 29.8), p=0.185. Analyses adjusted for age, gender and dementia status did not show a statistically significant difference in Ng concentrations between the patients.
We did not find an association between delirium and CSF concentrations of Ng. This could imply that synaptic dysfunction and degeneration, involving Ng, are not key processes in the development of delirium. Further studies on other synaptic proteins are warranted to better explore synaptic dysfunction’s potential role in the pathophysiology of delirium.
by Owis Eilayyan, Thamer A. Altaim, Alaa Salameh, Fadi M. Al Zoubi
BackgroundThe Keele STarT Back Tool (STarTBack) was developed to categorize people with low back pain based on disability risk. The tool was cross-culturally adapted and validated in different languages and countries, including Arabic in Saudi Arabia. However, the tool has not been cross-culturally adapted and validated among Arabic-Jordanian speakers.
ObjectiveTo cross-culturally adapt and validate the Keele STarT Back Tool (STarTBack) for Arabic-speaking adults with low back pain (LBP) in Jordan.
MethodsThis prospective cross-sectional study was conducted in hospitals and physical therapy departments. The STarTBack was translated following international guidelines. Cross-cultural adaptation was assessed through interviews with experts and individuals with LBP. Internal consistency, construct validity (via correlation with related measures), and discriminative validity (using Receiver Operating Characteristic curves) were examined.
ResultsTwenty participants participated in the content validity assessment (mean age: 41.3 years; 50% female), while 107 participants took part in the pre-final version testing (mean age: 39.2 years; 54.2% female). One item required minor modification for clarity. Our preliminary results showed that the adapted STarTBack-AR demonstrated good internal consistency (Cronbach’s α = 0.73). Moderate-to-high correlations supported construct validity. Discriminative validity was acceptable-to-excellent for disability, catastrophizing, anxiety and depression.
ConclusionThe culturally adapted STarTBack-AR is a reliable and valid tool for stratifying Arabic-speaking Jordanian patients with LBP according to their risk of disability. Its implementation has potential to improve care through targeted treatment approaches, thereby reducing the risk of disability.
Non-specific symptoms of testosterone deficiency (TD) and lack of awareness impact diagnosis and appropriate treatment. This study aimed to characterise the awareness of key symptoms of TD in community-dwelling men and contextualise this against the reported prevalence of these symptoms.
Cross-sectional survey comprising 54 questions (including assessment of symptoms as per the qADAM questionnaire and where relevant, men’s experiences while on TD treatment). The survey was distributed through online media channels, Prolific and academic networks.
Community-dwelling men in the UK.
Associations between age, participant demographics and a ‘positive’ qADAM score were assessed using logistic regression. A positive qADAM score was defined as self-rated ‘poor’ or ‘terrible’ libido or erection strength or rating 3 of the other questionnaire domains as ‘poor’ or ‘terrible’.
Of 973 men, 49% indicated high likelihood of TD using qADAM scores—5% were formally diagnosed. Men over 50 years of age had 1.54–2.0 times higher odds of TD compared with men aged
Almost half of the responders exhibited a burden of TD-associated symptoms, but under 5% had a formal diagnosis. These findings suggest significant gaps between symptom awareness and access to treatment options.
To explore the impact of intergenerational relationships on the social resilience of elderly populations in Arab societies. Additionally, the study aimed to identify the factors that influence the quality of these relationships and their role in enhancing or diminishing the resilience of older adults.
A qualitative study.
Semi-structured interviews were conducted between June and July 2024 with 12 elderly participants from urban and semi-urban communities in Al-Ahsa, Saudi Arabia. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to intergenerational relationships and social resilience.
The study involved 12 participants aged 61–85 years (average age of 72 years), with a mix of educational backgrounds and living arrangements. Strong intergenerational ties were found to significantly enhance social resilience by providing emotional support and a sense of security. Participants in multi-generational households reported more positive outcomes compared to those with less frequent family contact. However, generational differences and modern-life pressures posed challenges to maintaining these relationships.
The findings underscore the importance of fostering strong intergenerational relationships to support the social resilience of elderly populations in Arab societies. Future research should explore interventions that bridge generational gaps and strengthen family ties, particularly in the context of evolving social structures.
Healthcare practitioners and policymakers should consider the role of intergenerational relationships when designing interventions aimed at improving the well-being and resilience of older adults in a culturally sensitive approaches.
The Consolidated Criteria for Reporting Qualitative Research (COREQ).
The engagement and interview data from elderly participants provided valuable insights into the dynamics of intergenerational relationships and their impact on social resilience.
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