Conectar
First post-contrAst SubtracTed (FAST) MRI, an abbreviated breast MRI scan, has high sensitivity for sub-centimetre aggressive breast cancer and short acquisition and interpretation times. These attributes promise effective supplemental screening. Until now, FAST MRI research has focused on women above population-risk of breast cancer (high mammographic density or personal history). DYAMOND aims to define the population within the population-risk NHS Breast Screening Programme (NHSBSP) likely to benefit from FAST MRI. The study population is the 40% of screening clients aged 50–52 who have average mammographic density (BI-RADS (Breast Imaging Reporting and Data System) B) on their first screening mammogram. DYAMOND will answer whether sufficient numbers of breast cancers, missed by mammography, can be detected by FAST MRI to justify the inclusion of this group in a future randomised controlled trial.
Prospective, multicentre, diagnostic yield, single-arm study with an embedded qualitative sub-study: all recruited participants undergo a FAST MRI. An internal pilot will assess the willingness of sites and screening clients to participate in the study. Screening clients aged 50–52, with a clear first NHSBSP mammogram and BI-RADS B mammographic density (by automated measurement) will be invited to participate (recruitment target: 1000). The primary outcome is the number of additional cancers detected by FAST MRI (missed by screening mammography). A Fleming’s two-stage design will be used as this allows for early stopping after stage 1, to save participants, funding costs and time continuing to the end of the study if the question can be answered earlier.
The NHSBSP Research and Innovation Development Advisory Committee and the Yorkshire and Humber–Sheffield Research Ethics Committee (23/YH/0268, study ID (IRAS): 330059) approved this research protocol. Participation involves a two-stage informed consent process, enabling screening for eligibility through automated mammographic density measurement. Patients with breast cancer helped shape the study design and co-produced participant-facing documents. They will disseminate the results to the public in a clear and meaningful way. Results will be published with open access in international peer-reviewed scientific journals.
by Simon Knobloch, Philipp Haul, Saskia Rusche, Heiko Paland, Darius Zokai, Moritz Haaf, Jonas Rauh, Christoph Mulert, Gregor Leicht
When confronted with dichotically presented syllables, right-handed healthy individuals tend to consciously perceive syllables presented to the right ear more often. This phenomenon, known as the right-ear advantage, is driven by delayed processing of information from the left ear in left temporal auditory cortex due to its indirect relay through the corpus callosum. In contrast, less is known about about the corresponding mechanisms for stimuli processed in the right temporal hemisphere. In this study, we developed a melody-based dichotic listening paradigm designed to induce a left-ear advantage. This novel paradigm, alongside a classical syllable-based paradigm was tested in 40 healthy right-handed participants. We also examined the influence of musical education on lateralization of auditory processing. Our results revealed a significant left-ear advantage for the perception of dichotically presented melodies and replicated established findings of a right-ear advantage for syllables. No group differences emerged between participants with or without current or past musical practice. However, among those with musical training, a greater number of years of practice was associated with a reduced right-ear advantage for syllables and an increased report of melodies presented to the left-ear. These findings suggest that the left-ear advantage in dichotic perception of melodies reflects right hemispheric processing of musical stimuli. Moreover, monitoring of the left ear seems to be altered by musical practice. Future research using neuroimaging techniques will be necessary to confirm this finding.
This paper outlines key developments, innovations, and milestones in the field of spirituality and spiritual care in nursing.
A discursive paper.
Nursing scholars have significantly influenced the profession and contributed to the development of nursing knowledge, particularly in the field of spirituality and spiritual care. Key research has focused on nurses' perceptions and attitudes toward spirituality, clarifying foundational spiritual concepts, and establishing a framework of core spiritual care competencies for the profession.
Despite these advancements, significant gaps remain in nurses' knowledge, understanding, and experience in providing spiritual care. The development of agreed-upon spiritual care competencies at the European level offers important guidance for the profession, and educational initiatives are underway to support their integration. However, the field remains in an early stage of development, and further research is needed to embed spiritual care competencies into national and international nursing policy and practice. Moreover, continued research is also essential to inform and evaluate current educational programmes and nursing interventions, and to support the translation of evidence-based knowledge into effective spiritual care delivery.
Spiritual support is proven to be an important consideration for many patients and families globally. Imbedding spiritual care education into both undergraduate and postgraduate nursing curricula is essential to prepare nurses to address the spiritual needs of patients in healthcare settings. Structured curricula that provide clear instructions on how to recognise, assess, and respond to spiritual concerns in clinical practice can enhance nurses' competence and confidence. Embedding spiritual care into education and training helps normalise spiritual care as a component of holistic nursing, supporting its inclusion in everyday care rather than treating it as an optional or marginal practice. Such educational integration has the potential to improve the consistency and quality of spiritual care across healthcare settings.
Internationally there are evident gaps in the consistent provision of spiritual care to patients and their families. These are being addressed through conceptual clarity, the agreed-upon competencies, and enhanced educational initiatives. It is essential to continue to increase awareness among the nursing profession on the necessity of addressing spiritual care needs, within the context of cultural perspectives to ensure that value is placed on the significance of these issues on a global scale.
There was no patient or publication contribution in this specific commentary.
To explore the identity and body experiences of emerging adults with congenital heart disease.
Qualitative descriptive study.
Narratives from 152 emerging adults about living with congenital heart disease and its impact on their identity and body experiences were analysed using template analysis. An inductive and deductive approach was combined, and the frameworks of illness identity and experience of embodiment were used as a starting point.
The template analysis generated two primary themes: (1) identity and (2) body, each containing several subthemes. For identity, the subthemes were (1.1) illness identity and (1.2) acknowledgement. For body, the subthemes were (2.1) the dimensions of embodiment and (2.2) the process of embodiment. In addition, the related themes (3) self in light of the other and (4) lack of impact were included.
This study highlights the unique challenges emerging adults with congenital heart disease can encounter regarding their identity and body experiences.
Patient care would benefit from adopting a more holistic and person-centred approach that fosters positive identity and body experiences in emerging adults with congenital heart disease.
This study deepens our understanding of how congenital heart disease affects identity and body experiences in emerging adults. Recognising these aspects as crucial to psychological care can facilitate patients in sharing identity and body-related challenges and receiving tailored support.
This study adheres to the EQUATOR guidelines and used SRQR as the reporting method.
Emergency Departments face increasing pressure due to rising patient demand, complex presentations, and resource constraints, resulting in long waits and extended stays. Nurse-initiated protocols enable nurses to commence investigations and treatments based on clinical guidelines, improving care and efficiency. Despite evidence supporting their effectiveness, few nurse-initiated protocol implementation strategies are grounded in behaviour change theory. This gap may contribute to limited uptake, as many initiatives fail to address the complex factors influencing clinician behaviour.
To develop a behaviour change theory-informed implementation strategy to enhance the uptake of nurse-initiated protocols in the emergency department.
A framework-based intervention design was used.
The Behaviour Change Wheel and Theoretical Domains Framework guided the development of the implementation strategy. Barriers and enablers identified through prior research in 2023 using surveys and focus groups were mapped to relevant intervention functions. Behaviour change techniques were selected based on their potential to address barriers or strengthen enablers. The APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects, and Equity) were applied to optimise feasibility.
Nine barriers and ten enablers to nurse-initiated protocols use were identified and categorised using the COM-B (Capability, Opportunity and Motivation) framework and mapped to the Theoretical Domains Framework. Eight intervention functions were selected and mapped to 24 behaviour change techniques and 23 delivery modes. The key implementation strategies are education, clinical champions, documentation changes, audit and feedback, and leadership engagement. Stakeholders confirmed the feasibility of the selected strategies.
Theory-informed, context-specific strategies are essential for implementing nurse-initiated protocols in emergency departments. This approach enables the design of targeted, feasible interventions that directly respond to identified barriers and enablers. Future research should test context-specific implementation strategies, assess their long-term impact on healthcare outcomes, and evaluate their scalability across diverse healthcare settings.
By targeting the behavioural determinants of clinician practice, this study fills a critical gap in implementation science within emergency nursing. This study identified 24 behaviour change techniques across eight intervention functions to support nurse-initiated protocol uptake. Strategies such as education, clinical champions, and audit provide a practical, replicable framework to overcome barriers, enhance autonomy, and reduce care delays. Findings support sustainable implementation in emergency settings, with future research needed on long-term impact and scalability.
There is no EQUATOR guideline available for this study.
This study did not include patient or public involvement in its design, conduct, or reporting.
Low-value care provides little or no benefit to patients, or its risk of harm outweighs the potential benefits. Non-nursing tasks refer to tasks performed by nurses below their scope of practice. With increasing pressure on the global nursing workforce, it is necessary to identify these concepts to deliver fundamental care.
To assess the prevalence, influencing factors and associations of low-value nursing care, and to identify non-nursing tasks and potential solutions in surgical hospital care settings.
The study followed a cross-sectional study design using a self-developed questionnaire.
A questionnaire on low-value care and non-nursing tasks was distributed to surgical wards in four hospitals in The Netherlands.
A total of 302 nurses responded to the survey. Five most prevalent low-value care practices were identified, including routine preoperative fasting (84.8%), taking over blood glucose monitoring (59.3%) and leaving in place any type of venous catheter (42.1%). These practices were mainly performed due to habitual practice, in accordance with an established protocol, or upon physicians' request. Most reported non-nursing tasks were administrative duties and cleaning patient rooms and equipment. Provided solutions included clearly defining responsibilities and taking personal responsibility.
Low-value care, provided by surgical nurses, is common in daily practice. This requires targeted de-implementation of each low-value care practice, based on influencing factors. Additionally, 85.8% of nurses perform non-nursing tasks daily or several times a day, underlining the need to re-organise nursing tasks.
De-implementing low-value care and reducing non-nursing tasks is necessary to ease pressure on the global nursing workforce and to improve fundamental care.
Low-value nursing care and non-nursing tasks persist when nurses lack leadership responsibility.
STROBE checklist.
No patient contribution.
Globally, the circulation of influenza and other seasonal respiratory viruses changed dramatically during the COVID-19 pandemic. This study aims to determine the trends of acute respiratory infections (ARIs) caused by SARS-CoV-2, influenza A, influenza B and respiratory syncytial viruses (RSVs) in patients presenting to hospitals in the Lao People’s Democratic Republic (PDR) (Laos).
Prospective surveillance study.
Four provincial hospitals across Laos between March 2021 and July 2023.
Participants of all ages who met our case definition for an ARI (axillary temperature ≥37.5°C or history of fever AND cough or other respiratory symptoms/signs OR loss of smell and/or taste) presenting to the hospital less than 10 days after symptom onset were eligible to be enrolled in the study. Combined nasopharyngeal and throat swabs were tested for SARS-CoV-2, influenza A, influenza B and human RSV (hRSV) using probe-based real-time RT (Reverse transcription)-PCR assays.
The proportion of patients in whom SARS-CoV-2, influenza A, influenza B and hRSV was detected.
There were 4203 patients recruited, of whom 898 (21%) were children aged under 5 years. SARS-CoV-2 was detected in 16.9% of patients, followed by influenza A, influenza B and hRSV (8.4%, 7.2% and 4.7%, respectively). 98 patients (2.3%) were diagnosed with probable co-infection, with at least two viruses detected. After May 2022, the number of cases of influenza A, influenza B and hRSV increased rapidly. Six per cent of patients (263) had a quick Sequential Organ Failure Assessment score of ≥2, and 34 (0.8%) patients died, of whom 11 tested positive for a respiratory virus.
During the COVID-19 pandemic in Laos, few respiratory viruses were detected by passive surveillance until the relaxation of non-pharmaceutical interventions implemented for infection control. After restrictions were lifted, influenza A, influenza B and hRSV emerged rapidly, showing the importance of continuous surveillance.
Dynamic and complex health systems require innovative and adaptive solutions to support patient safety and achieve equitable health outcomes for Indigenous populations. Understanding the ways by which Indigenous (and specifically Māori) nurse practitioners (NPs) practice patient safety is key to enhancing Indigenous health outcomes in predominantly westernized healthcare systems.
To describe Māori NPs perspectives on patient safety when caring for Māori and understand how Māori NPs deliver safe health care.
A group of five Māori NPs worked alongside a Māori nurse researcher to explore their perceptions of patient safety. Together, they held an online hui (focus group) in early 2024. Data were analysed collectively, informed by kaupapa Māori principles, using reflexive thematic analysis.
Māori NP experiences, expressions and understandings of patient safety envelop cultural safety and have many facets that are specific to the needs of Māori populations. The three themes showed: (1) Te hanga a te mahi: the intersection of cultural and clinical expertise; (2) Mātauranga tuku iho: the knowledge from within, where safe practice was strongly informed by traditional knowledge and cultural practice; (3) Te Ao hurihuri: walking in two worlds, where Māori NPs navigated the westernized health system's policies and practices while acting autonomously to advocate for and deliver culturally safe care.
The Māori NP lens on patient safety is vital for promoting culturally responsive and effective health care. By recognizing the unique needs of Māori patients and families and incorporating cultural perspectives into practice, Māori NPs contribute to a more comprehensive and inclusive approach to patient safety that goes beyond westernized principles and practices.
No patient or public contribution.
Many cancer treatments can result in reduced fertility, impacting survivors’ opportunities for biological parenthood. Fertility preservation (FP) methods for boys and young men, such as cryopreservation of testicular tissue or sperm, offer hope but are currently underused among young male patients with cancer. Despite guidelines recommending early discussion of fertility implications, many newly diagnosed males do not receive FP counselling or referral to fertility services. Male cancer survivors face a higher likelihood of infertility than their peers, yet focused FP decision-making support is lacking. This study aims to address this gap by developing and evaluating the first dedicated patient decision aid (PtDA) for boys and young male patients with cancer aged 11–25 years old, to help them make informed FP decisions before receiving cancer treatment.
The current study follows a multistage process: developing the PtDA, alpha testing for acceptability with former patients, parents and healthcare professionals, and beta testing in clinical settings to ensure effective integration into routine care. Using a combination of interviews and questionnaire data, this research will assess the PtDA’s acceptability and impact on decision-making.
This study has been prospectively registered on the Research Registry (10273). Ethics approval has been obtained from Leeds Beckett University and the National Health Service/Health Research Authority before undertaking data collection. The final resource will be disseminated widely and made freely available online via our dedicated Cancer, Fertility and Me website, for use in clinical and research practice.
Paediatric major trauma patients with more severe injuries and physiological or biochemical abnormalities as a result of the injury are more likely to require invasive management in the form of an operation/interventional radiology (IR). Adverse psychological outcomes, such as post-traumatic stress disorder, anxiety, depression and adjustment disorder, are frequently observed in paediatric patients with major trauma. Similarly, it is recognised that children and adolescents who have invasive management are also at an increased risk of adverse psychological outcomes. However, it is not known to what extent major trauma patients requiring invasive management are at risk of adverse psychological outcomes compared with those managed conservatively. This study aims to determine whether paediatric major trauma patients who require an operation/IR have increased odds of having an adverse psychological outcome compared with those who are managed conservatively.
The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. The databases Medline (via Ovid), Embase (via Ovid), PsycInfo (via Ebscohost) and Cinahl (via Ebscohost) will be searched from inception to February 2025. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. For randomised controlled trials, the Cochrane Risk of Bias Tool will be employed, while for non-randomised studies, the Newcastle-Ottawa Quality Assessment Scale will be used. We will assess bias using contoured funnel plots (with p set at 0.01, 0.05 and 0.10), non-parametric trim-fill analysis, leave-one-out analysis and Galbraith plotting. We will execute formal (Egger) testing for funnel plot asymmetry and also calculate prediction intervals if sufficient study N of 10 is accrued. Certainty and confidence in cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
Ethical review is not required as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences.
CRD42025643459.
In response to global outcries of poor healthcare, organisational interventions have been implemented with the aim of promoting compassionate care. An overall synthesis of qualitative data, including the perspectives of healthcare staff who have attended interventions, can establish ‘what works’ and inform future interventions.
To synthesise existing research exploring how healthcare staff experience organisational interventions for compassionate care.
Qualitative evidence synthesis.
A qualitative evidence synthesis was conducted in August 2023. Five databases were searched: MEDLINE, Academic Search Premier, CINAHL, APA PsycInfo and APA PsycArticles. Articles met the following criteria: (a) reported on the experiences of healthcare staff who had participated in organisational interventions for compassionate care, (b) taken place in a healthcare setting, (c) use of a qualitative or mixed-methods methodology, (d) published in English and (e) published since 2010. A thematic synthesis was conducted using NVivo software to synthesise findings. Data from the complete ‘findings/results’ sections were included in the synthesis. The final search protocol and search strategy were registered on PROSPERO (ID: CRD42023472404) and are reported using the PRISMA guidelines.
Eighteen qualitative or mixed-methods studies were included in the review, encapsulating the experiences of healthcare staff across eight countries. Four themes were identified: (1) holding back, (2) humanising healthcare, (3) values are instilled and (4) sustainability is important.
Organisational interventions for compassionate health care are valued and appreciated by healthcare staff and foster reflection and connection. Interventions facilitate clinical creativity, improve staff well-being and strengthen communication between staff.
The implementation of organisational interventions for compassionate care should be encouraged in healthcare settings. Interventions that consider organisational cultures are driven by organisational values and are embedded with sustainability in mind can improve staff well-being and positively impact the provision of patient care.
PRISMA guidelines were followed in the reporting of this review.
To evaluate the feasibility and acceptability of integrating point-of-care ultrasound scan (POCUS) by midwives into routine antenatal care (ANC) services.
Prospective, observational, multiphase, implementation science study.
Primary outcomes included the proportion of midwives who completed training and competency checks for basic obstetric scanning using a POCUS device; the feasibility and acceptability of midwife-delivered POCUS from the perspectives of midwives and pregnant women captured on structured questionnaires; and the proportion of scans meeting predefined quality standards. Secondary outcomes included responses to acceptability-related questionnaires administered to midwives and pregnant women.
Rural, periurban and urban health centres in Blantyre District, Malawi.
Pregnant women attending ANC and midwives providing care at participating health facilities.
Obstetric registrars trained and mentored 45 midwives, and 42 (93%) completed the training. Most midwives (95%, n=40) found providing POCUS during ANC was feasible and acceptable. Overall, device durability was rated positively. Of the 1499 pregnant women who received a scan, 99% (n=1484) reported that receiving an ultrasound from a midwife during ANC was acceptable. Independent assessors determined that over 70% of the subsample of reviewed scans met minimum quality standards.
Midwife-delivered POCUS is feasible and highly acceptable in diverse antenatal settings in Malawi. These findings support task-sharing models as a means of expanding access to this essential ANC service, particularly in low-resource settings.
Chronic and non-healing wounds are a global health issue with limited effective treatments. Wound care costs continue to rise, highlighting the need for new therapies. Medicinal plants, particularly African species, show promise for enhancing wound healing. This review analysed 93 studies and identified 37 relevant to wound healing, covering 39 plant species. Ten species were identified for their rich phytochemical content, specifically flavonoids, terpenoids, and alkaloids (plant-derived compounds). These compounds act synergistically, enhancing the wound healing process at each stage. Flavonoids reduce inflammation and support tissue turnover, while terpenoids enhance collagen production and wound closure. Alkaloids offer antimicrobial benefits and support wound contraction. Notable plants include Ageratum conyzoides and Aspilia africana (Asteraceae family); promoting haemostasis by lowering plasma fibrinogen and enhancing platelet-derived growth factors; Withania somnifera (Solanaceae); and Entada africana (Fabaceae), effectively regulating inflammation. In the proliferative phase, Ocimum gratissimum (Lamiaceae), Calendula officinalis (Asteraceae), and Centella asiatica (Apiaceae) although C. officinalis is native to Southern Europe, and C. asiatica an Asian-native; they are widely used in African traditional medicine and included here for their relevance in African wound healing practices; Justicia flava (Acanthaceae), Alternanthera sessilis (Amaranthaceae), and Acalypha indica (Euphorbiaceae); play key roles in enhancing collagen production, angiogenesis, and re-epithelialisation. This comprehensive analysis highlights the role of African medicinal plants in wound healing and their potential to improve wound care therapy.
To analyse research publication performance of Australian and New Zealand professors and associate professors of nursing and midwifery, and compare with 2016 data.
A search of university websites was conducted to identify all nursing and midwifery professoriate in Australia and New Zealand. Each individual was then searched in the Scopus database to identify individual total citations, h-index, number of publications, first author Field Weighted Citation Impact (FWCI) and overall FWCI. Comparisons with 2016 data were also undertaken.
A total of 304 academics were included, comprising 270 from Australia and 34 from New Zealand, and 169 full professors and 135 associate professors. Overall, total publications and citations had increased. Maximum h-index had increased; however, median only changed slightly.
The study provides contemporary data that can support cases for academic promotion along with other benchmarking activities.
Findings reflect the current research publication performance of the Australian and New Zealand professoriate and provide invaluable data for academic benchmarking in those countries and also in many others.
No patient or public contribution.
by Faith Morley, Lauren Mount, Anjile An, Erica Phillips, Rulla M. Tamimi, Kevin H. Kensler
The rising prevalence of individuals reporting extreme stress has major public health implications as it increases vulnerability to accelerated premature biological aging, thus increasing risk of chronic disease. To examine the impact of stress on premature biological aging, we assessed the association between exposure to increased stress, quantified by the Perceived Stress Scale, and odds of high allostatic load (AL). To illuminate previously unexplored socio-contextual factors, we controlled for self-reported individual and neighborhood social determinants of health that included discrimination, loneliness, food insecurity, neighborhood disorder, and neighborhood social cohesion. We utilized a cross-sectional design to examine the association between perceived stress and AL among 7,415 participants ages 18–65 in the All of Us Research Program, who enrolled from 2017–2022. We used logistic regression to evaluate the association between stress and high AL, controlling for sociodemographic factors and self-reported social determinants of health. Participants who were younger, receiving Medicaid, or Hispanic had increased prevalence of high stress. High stress was associated with elevated odds of high AL in age and sex-adjusted models (OR=2.18, 95%CI = 1.78, 2.66, high stress vs. low), an association which remained significant after adjusting for social determinants of health (OR=1.29, 95%CI = 1.01, 1.65). Using restricted cubic splines, high stress was significantly associated with increased odds of high AL, even after controlling for upstream individual and neighborhood-level determinants of health. While individuals living below the medium poverty-to-income ratio demonstrated little appreciable association between high stress and increased odds of high allostatic load, those living above the median poverty-to-income ratio reporting increased stress appeared to have increased odds of high allostatic load. Through addressing the upstream factors causing undue burdens of stress, which particularly affect marginalized communities and younger generations, we can begin to address premature biological aging and the comorbid conditions it accompanies.
by Melissa L. Woodward, Morgan W. Wolsey, Sophia Shalchy-Tabrizi, Jeffrey N. Bone, Tyler Black, Quynh Doan
BackgroundThe pediatric mental health crisis pre-dated the COVID 19 pandemic with rates of mental health visits to pediatric emergency departments steadily increasing for the last decade. The COVID-19 pandemic has profoundly impacted children and adolescents and understanding the trajectory of their psychosocial status is important for appropriate resource allocation and policy planning.
MethodsMyHEARTSMAP is a digital self-assessment mental health evaluation that examines four major psychosocial domains: psychiatry, social, function, and youth health. Children and adolescents throughout British Columbia, and their guardians, completed the baseline assessment between August 2020 and July 2021 (51.8% completed by guardian only, 40.2% youth and guardians, 7.9% youth only). Both children and their guardians repeated the MyHEARTSMAP evaluation three-months after their baseline. Patient demographics and psychosocial concerns were statistically described and compared between baseline and follow-up. A logistic regression model assessed the influence of baseline scores and demographic factors on follow-up severity.
Results241 of 424 participants (56.8%) completed both the baseline and three-month follow-up. The majority of participants reported no change overtime across the psychosocial domains. Both improvement and decline occurred in each domain, with a greater proportion of psychosocial states improving rather than worsening, for all domains. Higher severity of psychosocial concerns reported at baseline indicated a greater likelihood of psychosocial concerns at 3-month follow-up for psychiatric, social and function concerns. Demographic, pandemic, and support service variables were not associated with psychosocial trajectories.
ConclusionsThe severity of youth mental health concerns in British Columbia remained consistent through three-month follow up, despite the changing nature of the COVID-19 pandemic during this period. Greater persistence of psychosocial concerns with increased severity highlights the need for early intervention to prevent worsening mental health. Community support is needed for youth experiencing mental health concerns to address mild psychosocial concerns before presentation at the emergency department.
To identify and synthesise the ethical, feasibility and acceptability challenges associated with implementing eye-tracking research with clinicians in acute care settings and to explore strategies to address these concerns.
Scoping review using the Joanna Briggs Institute methodology.
Six databases (MEDLINE, CINAHL, EMBASE, Web of Science, APA PsycInfo and ProQuest Dissertations & Theses Global) were searched for peer-reviewed articles. Reference lists of included studies were also hand-searched.
Eligible studies involved clinicians using or interacting with eye-tracking devices in acute care environments and addressed at least one ethical, feasibility, or acceptability consideration. Data were extracted and thematically analysed. Knowledge users, including clinicians, ethicists and a patient partner, were engaged during protocol development and findings synthesis.
Twenty-five studies published from 2010 to 2024 were included. Seven challenges were identified: obtaining ethical approval, managing consent, privacy and confidentiality concerns, collecting data in unpredictable environments, interference with care, participant comfort and data loss or unreliability. Knowledge users highlighted the importance of early institutional engagement, clear protocols, continuous consent and context-sensitive ethical reflection.
Eye-tracking offers valuable insights into clinician behaviour and cognition, but its implementation in acute care raises complex ethical and methodological issues. Responsible use requires anticipatory planning, stakeholder engagement and flexible yet rigorous protocols.
By informing the development of ethically sound study protocols and consent practices, this work contributes to safer, more transparent and patient-centred research that respects participant autonomy and protects clinical workflows.
The protocol was registered with the Open Science Framework (https://osf.io/jn4yx).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Page et al., 2021) and its Extension for Scoping Reviews (Tricco et al., 2018).
A patient partner was involved in protocol development, interpretation of findings and development of study recommendations. Their contributions included participating in advisory groups and providing feedback alongside clinicians and ethicists during focus groups. This input helped ensure the research addressed patient-relevant priorities and informed the development of ethically responsible practices for conducting eye-tracking research in clinical care settings.
To conduct a concept analysis of ‘safe mobility’, with specific application in hospitalised older adults, identifying its defining attributes, antecedents and consequences.
The promotion of safe mobility is essential for maintaining the functionality of hospitalised older adults. However, this idea is not yet clearly defined in the scientific literature, requiring a conceptual analysis for better understanding and applicability in nursing practice.
Concept analysis.
The concept analysis methodology of Walker and Avant was employed, consisting of eight steps. Sources from the scientific literature (BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Thesis and Dissertation Catalogue, as outlined in a scoping review previously published by the authors) and terminologies from dictionaries and nursing practice, such as SNOMED CT, ICNP, NANDA, NIC and NOC, were analysed.
The concept of ‘safe mobility’ does not have a consolidated definition but was identified through three defining attributes: active movement, prevention of fall-related harm and prevention of immobility-related harm. The antecedents include the older adults' conditions, adaptation of the hospital environment, training of the multidisciplinary team, patient behaviour and family involvement. The consequences involve the maintenance of functionality, improvement of quality of life, reduction of hospital length of stay and costs, as well as a decrease in rates of readmission, referrals to long-term care institutions and mortality.
The concept analysis revealed that safe mobility involves promoting active movement and preventing harm related to both immobility and falls.
Strategies based on this concept can improve the quality of life of older adults, reduce complications and optimise hospital costs.
This concept analysis examines existing literature and does not require patient-related data collection. The methodological approach does not necessitate collaboration with the public.
To assess the impact of opening a large community-based asynchronous review ophthalmic clinic on attendance delays among patients with stable chronic eye disease attending a London teaching eye hospital network.
Interrupted time-series analysis of routine electronic health records of appointment attendances.
A large eye hospital network with facilities across London, UK, between June 2018 and April 2023.
We analysed 69 257 attendances from 39 357 patients, with glaucoma and medical retina accounting for 62% (n=42 982) and 38% (n=26 275) of visits, respectively. Patients over 65 made up 54% (n=37 824) of attendances, while 53% (n=37 014) were from the more deprived half of the population, and 51% (n=35 048) were males.
An asynchronous review clinic opened in a shopping centre in London, in autumn 2021, following the COVID-19 lockdown in spring 2020.
Average attendance delays (days), calculated as the difference between follow-up attendance date and the latest clinically appropriate date determined at the preceding attendance.
Pre-COVID-19, attendance delays for chronic eye disease monitoring were increasing by 0.9 days per week (95% CI, 0.8 to 0.9) on average, worsening to 2.0 days per week (95% CI, 2.0 to 2.0) after the first COVID-19 national lockdown, mid-March 2020. Opening the asynchronous review clinic increased appointment capacity, with delays decreasing on average by 8.1 days per week (95% CI, 8.1 to 8.2) shortly after opening. The rate of decrease slowed to 0.3 days per week (95% CI, 0.3 to 0.3) after 5 months. We found no significant differences in average attendance delays by age, gender or level of deprivation.
The asynchronous review clinic significantly reduced attendance delays across the hospital network, addressing pre-existing backlog for stable chronic eye diseases. The reduction appeared to be maintained after the initial backlog had been cleared.
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