Conectar
by Sishir Poudel, Laxman Wagle, Tara Prasad Aryal, Binay Adhikari, Sushan Pokharel, Dipendra Adhikari, Kshitiz Bhandari, Kshitiz Rijal, Jyoti Bastola Paudel
BackgroundMultidrug-resistant tuberculosis (MDR-TB) continues to be a major public health concern, especially in high-burden countries like Nepal. While individual risk factors are known, the cumulative impact of cardiometabolic factors on MDR-TB is not well understood.
MethodsA health-facility-based, age- and sex-matched 1:2 case-control study was conducted at MDR-TB treatment centers in Gandaki Province, Nepal. MDR-TB patients (cases) and drug-sensitive tuberculosis (DS-TB) patients (controls) were enrolled. Cases were defined as adults (≥18 years) with confirmed MDR-TB; controls were adults with sputum-positive DS-TB. Data on sociodemographics, cardiometabolic risk factors (alcohol, tobacco, abnormal body mass index, hypertension, diabetes), TB literacy, and treatment history were collected using a structured, pretested questionnaire by trained medical officers. Data were analyzed using Stata v13.0. Binary logistic regression was used to assess associations between risk factors and MDR-TB. Ethical approval was obtained from the Nepal Health Research Council and written informed consent was obtained from all participants.
ResultsA total of 183 participants (61 cases, 122 controls) were included. Mean age of participants was 42.5 years (SD = 18.5); 73.8% were male. Most participants were from urban areas (74.9%), and 66.7% were unemployed. Cardiometabolic risk factors were present in 79.2% of participants. Alcohol and tobacco use were reported by 59.6% and 45.9%, respectively; 9.8% had diabetes and 7.1% had hypertension. Known TB contact and prior TB history were reported by 26.8% and 31.1% respectively. In multivariate analysis, unemployment (AOR: 5.24, 95% CI: 1.33–20.64), and known TB contact (AOR: 8.89, 95% CI: 2.46–32.15) were significantly associated with MDR-TB. Cardiometabolic risk factors were not significantly associated.
ConclusionKnown TB contact and unemployment were significantly associated with MDR-TB, while the cumulative effect of cardiometabolic risk factors showed no significant impact, indicating that interventions should prioritize established TB-related risk factors.
To examine whether manpower and expertise understaffing are distinct, and whether they relate similarly to nursing stressors, burnout, job satisfaction and intentions to turnover.
A cross-sectional survey of hospital nurses nested within units was used.
The sample included 402 nurses. Nurses provided ratings of the study's variables using validated self-report measures. The data were analysed both as multilevel and single-level data.
Manpower and expertise understaffing contributed unique explained variance to all of the examined outcomes. Nurses within the same units experience different understaffing levels. Expertise understaffing emerged as a significantly stronger predictor than manpower understaffing for three of the six of the outcome variables (illegitimate tasks, job satisfaction and turnover intentions).
Manpower and expertise understaffing are distinct, and both are associated with nurse outcomes.
We have adhered to the STROBE guideline for cross-sectional studies.
Considering both manpower and expertise understaffing to maintain proper staffing levels in nursing units is crucial.
A Director of Patient Care Services from the hospital where the study was conducted is a member of the research team. This member contributed to designing and conducting the study as well as interpreting the results.
Medical oxygen supplementation is essential for treating severe illnesses and plays a critical role in managing life-threatening conditions, especially during the period of increased demand, such as the delta wave of COVID-19. The study aims to evaluate oxygen requirements and production to support effective capacity planning for future health crises.
Cross-sectional quantitative study. Data collection was carried out between 15 March and 19 December 2021.
The study used secondary data from Nepal’s Health Emergency Operation Centre. Regarding medical oxygen production, calculations included oxygen generated from both hospital-based oxygen plants and private companies, using their highest capacities for comparison. These production capacities were then assessed using three levels of efficiency (100%, 80% and 50%), revealing significant gaps when compared against the oxygen requirements of hospitalised COVID-19 patients, as guided by WHO recommendations. The results were communicated in terms of J-size cylinders, alongside average daily COVID-19 hospitalizations. Data was inputted and analysed using Microsoft Excel and presented in numbers and percentage.
The country’s oxygen demand relies largely on the production from private enterprises, with meeting approximately 85.2% of the total requirement. Optimal production ensures that national oxygen needs will be met. The analysis highlighted that at 80% operational efficiency, 90.8% of the hospital’s requirements could be fulfilled. However, if operational efficiency drops to 50%, the fulfilment rate diminishes to 56.7%. The differences in requirement and production of oxygen are consistent across the provinces; however, a huge disparity was notable in Karnali and Sudurpaschim.
Continuous assessment of production capacities in both hospital and private enterprises producing oxygen is necessary to plan and address the gaps.
With ambient listening systems increasingly adopted in healthcare, analyzing clinician-patient conversations has become essential. The Omaha System is a standardized terminology for documenting patient care, classifying health problems into four domains across 42 problems and 377 signs/symptoms. Manually identifying and mapping these problems is time-consuming and labor-intensive. This study aims to automate health problem identification from clinician-patient conversations using large language models (LLMs) with retrieval-augmented generation (RAG).
Using the Omaha System framework, we analyzed 5118 utterances from 22 clinician-patient encounters in home healthcare. RAG-enhanced LLMs detected health problems and mapped them to Omaha System terminology. We evaluated different model configurations, including embedding models, context window sizes, parameter settings (top k, top p), and prompting strategies (zero-shot, few-shot, and chain-of-thought). Three LLMs—Llama 3.1-8B-Instruct, GPT-4o-mini, and GPT-o3-mini—were compared using precision, recall, and F1-score against expert annotations.
The optimal configuration used a 1-utterance context window, top k = 15, top p = 0.6, and few-shot learning with chain-of-thought prompting. GPT-4o-mini achieved the highest F1-score (0.90) for both problem and sign/symptom identification, followed by GPT-o3-mini (0.83/0.82), while Llama 3.1-8B-Instruct performed worst (0.73/0.72).
Using the Omaha System, LLMs with RAG effectively automate health problem identification in clinical conversations. This approach can enhance documentation completeness, reduce documentation burden, and potentially improve patient outcomes through more comprehensive problem identification, translating into tangible improvements in clinical efficiency and care delivery.
Automating health problem identification from clinical conversations can improve documentation accuracy, reduce burden, and ensure alignment with standardized frameworks like the Omaha System, enhancing care quality and continuity in home healthcare.
by Tremaine B. Williams, Pearman Parker, Milan Bimali, Maryam Y. Garza, Alisha Crump, Taiquitha Robins, Emel Seker, Ava Storey, Allison Purvis, Mya Tolbert, Anthony Drake, Taren Massey Swindle, Kevin Wayne Sexton
African Americans experience approximately 2.5 times more heart failure hospitalizations than Caucasians and the complexity of heart failure requires registered nurses to work in collaboration with other types of healthcare professionals. The purpose of this study was to identify care team configurations associated with long lengths of hospital stay in African Americans with heart failure hospitalizations and the related effect of the presence of registered nurses on their length of hospital stay. This study analyzed electronic health record data on the heart failure hospitalizations of 2,274 African American patients. Binomial logistic regression identified the association between specific care team configurations and length of stay among subgroups of African American patients. Of the significant team configurations, a Kruskal-Wallis H test and linear regression further assessed the team composition and the specific change in days associated with a one-unit change in the number of registered nurses on a patient’s care team. Six team configurations were associated with a long length of stay among all African Americans regardless of age, sex, rurality, heart failure severity, and overall health severity. The configurations only differed significantly in the proportion of registered nurses with respect to other care team roles. An increase in one additional registered nurse on a care delivery team was associated with an increase in length of stay of 8.4 hours (i.e., 504 minutes). Identifying the full range of social and technical care delivery tasks performed by RNs, and controlling for their effect on length of stay, may be a key strategy for reducing length of stay and explaining why these six configurations and RNs are associated with long LOS. The identification of these models can be used to support decision-making that optimizes the availability of patient access to high-quality care (e.g., clinical staffing and supplies).by Volodymyr Mavrych, Maryam Alamil, Olena Bolgova, Volodymyr Dvornyk
Background and purposeFrontotemporal dementia (FTD) is a devastating neurodegenerative disorder affecting behavior, language, and cognition. It has a complex and still poorly understood genetic basis. The prevalence of FTD and other neurodegenerative disorders varies in populations of different ethnicities. This study aimed to analyze the genetic structure of different ethnic populations at FTD risk loci and provide insights into possible genetic factors underlying the above variation.
MethodsThe data of single-nucleotide polymorphisms (in total 32) with genome-wide significance were extracted from the GWAS Database. The individual genotype data were retrieved from the 1000 Genomes Phase 3 Project. We analyzed several standard parameters of population genetic structure and computed a composite polygenic risk score. In total, five major ethnic superpopulations and 26 subpopulations were analyzed.
ResultsAll populations were significantly differentiated (P −5) at the FTD risk loci. Ethnic populations manifested clear differences in the enrichment/depletion patterns of the risk alleles as evidenced by heatmaps. The population-specific unweighted genetic risk scores were relatively low and averaged at 0.091 ± 0.078. The scores differed significantly at the super- and subpopulation levels.
ConclusionsThe results suggest that the major ethnic groups and their subpopulations differ by the allelic and genotypic structure at the FTD risk loci. This may be one of the key factors explaining the different prevalence of FTD across populations. However, currently available data on the epidemiology and genetics of FTD warrant further research.
Cognitive Behavioural Therapy (CBT) has demonstrated positive effects on emotional well-being and quality of life in individuals with dementia. Limited evidence constrains the generalisability of these findings.
This review was conducted in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) that implemented CBT and assessed cognitive function, depressive symptoms, anxiety and quality of life in individuals with dementia were included. Seven databases—APA PsycINFO, CINAHL, Cochrane Library, Embase, MEDLINE, PubMed and Web of Science—were searched up to 10 October 2024. The Risk of Bias 2 (RoB-2) tool was used to evaluate the methodological quality of included studies. Pooled standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models for each outcome.
A total of 10 RCTs, involving 1412 individuals with dementia and published between 2011 and 2024, were included in the analysis. CBT was associated with a reduction in anxiety (pooled SMD = −0.94; 95% CI = −1.33 to −0.55; I 2 = 0.00%; p < 0.04). No significant differences were found in cognitive function, depression or quality of life between those receiving CBT and those in the control groups.
This study suggests that CBT alleviates anxiety in people with dementia. However, further investigation is required to clarify its effects on cognitive function, depressive symptoms and quality of life. Future research should focus on the development of CBT protocols, alongside the exploration of relevant outcome measures.
CBT has shown potential in improving emotional well-being and quality of life in individuals with dementia. The findings inform healthcare professionals about its clinical utility and effectiveness in dementia care.
The findings suggest that traditional CBT may not fully address the needs of people with dementia, emphasising the importance of incorporating multisensory stimulation and caregiver involvement to enhance therapeutic outcomes.
This study aimed to assess the coronavirus disease 2019 (COVID-19) hospitalisation costs and its associated factors on Nepalese households during the second wave of the pandemic, within the context of Nepal’s COVID-19 response.
A cost-descriptive cross-sectional study.
Kathmandu Metropolitan City, Nepal.
We enrolled 306 hospitalised patients.
Telephonic interviews were conducted with COVID-19 patients between May and July 2022. Cost was assessed from a patient’s perspective. We assessed factors associated with the medical cost of COVID-19 treatment services using a generalised linear model with gamma distribution and log link in both bivariable and multivariable models for estimating coefficients and confidence intervals. Data were analysed using STATA version 13, adjusting for the potential confounders: socio-demographic characteristics, type of hospital, intensive care unit (ICU) requirement, lead time to hospital admission and number of days at hospital stay.
The total median cost for hospitalisation was US$ 754.9. The median direct medical, direct non-medical and indirect costs were US$ 624.4, US$ 49.3 and US$ 493.02, respectively. After adjusting for potential confounders, the cost of COVID-19 treatment was 6.9 times higher among those admitted to private hospital (95% CI 5.72 to 8.32, p
The cost of the COVID-19 treatment was beyond the average monthly income of Nepalese, indicating adverse consequences from the financial burden of a household. The direct medical cost was associated with the type of hospital, requirement of ICU, lead time to hospital admission, and length of hospital stay. Therefore, it is urgent to address the issue of high medical expenses, particularly to strengthen the health system’s resilience against unforeseen crises and pandemics.
by Shanhe Liu, Shuailin Li, Shao-Lun Hsu, Fabian N. Fries, Zhen Li, Swarnali Kundu, Berthold Seitz, Maryam Amini, Shweta Suiwal, Julia Zimmermann, Simon Trusen, Tanja Stachon, Nóra Szentmáry
PurposeThe aim of this study was to investigate apoptosis in primary aniridia limbal stromal cells (LSCs) and to assess changes in the expression of genes and proteins associated with the apoptotic pathway in response to cobalt chloride (CoCl2)-induced hypoxic stress, in vitro.
MethodsPrimary human limbal stromal cells were isolated from the limbal region of both aniridia (AN-LSCs; n = 8) and healthy (LSCs; n = 8) donors. The cells were treated with 0 µM, 50 µM, and 75 µM CoCl2 for 48 hours. Apoptosis in each group was assessed by Flow cytometry (FC). The expression levels of apoptosis-related genes, including CASP 3/7/8/9/10, BCL2, BID, BAX, CDKN1A (p21), CDKN1B (p27), TNFα, XIAP, and BIRC5 (Survivin), were measured by qPCR. Protein level of these markers was analyzed by FC. TNFα protein expression in the supernatant was quantified using ELISA.
ResultsFlow cytometry analysis revealed a significantly higher apoptosis rate in AN-LSCs compared to LSCs (p BCL2 mRNA levels (p = 0.0291), Caspase-8 (p = 0.0341), Caspase-10 (p = 0.0085), Bcl-2 (p = 0.0014), XIAP (p = 0.0003) and Survivin (p = 0.0074) protein levels were significantly higher in LSCs than in AN-LSCs. Conversely, Caspase-3 (p = 0.0366), Caspase-9 (p = 0.0354), p21 (p = 0.0003), and p27 (p = 0.0164) protein levels were significantly higher in AN-LSCs than in LSCs. In LSCs, exposure to 75 µM CoCl₂ led to a reduction in BCL2 mRNA (p = 0.0102) and protein levels (p = 0.0484), accompanied by an increase in CDKN1B mRNA level (p = 0.0265). In AN-LSCs, 75 µM CoCl₂ treatment resulted in a decrease in CASP3 (p = 0.049), CASP7 (p = 0.041) and BCL2 (p = 0.0218) mRNA and Bcl-2 protein levels (p = 0.0405) and an increase of TNF-α protein levels in the cell culture supernatant (p = 0.0251).
ConclusionsThe apoptosis rate of LSCs from patients with congenital aniridia is higher than that of the control group, accompanied by alterations in multiple apoptosis-related markers. Additionally, CoCl₂-induced hypoxic stress further increases apoptosis in AN-LSCs and leads to changes in the expression of Caspase 3, Caspase 7, Bcl-2, and CDKN1B (p27). Further research is needed to elucidate the potential therapeutic targets in AAK, with the aim of preventing or slowing the progression of aniridia-associated keratopathy.
Falls among older adults are a major public health concern, often leading to serious outcomes such as fractures, head trauma, and increased mortality. Virtual reality (VR) interventions have emerged as a promising strategy for fall prevention by improving balance, reducing fear of falling, and enhancing confidence. However, the impact of VR interventions on specific outcomes such as fear of falling, balance, and postural control in older adults remains insufficiently synthesized.
Systematic review and meta-analysis.
A comprehensive systematic search of six databases was conducted from inception to January 20, 2025. Randomized controlled trials (RCTs) evaluating VR interventions targeting fear of falling, balance, and postural control in older adults were included. Methodological quality was assessed using the Cochrane risk-of-bias tool (RoB-2). Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random-effects models for each outcome.
Seventeen RCTs involving 988 older adults, published between 2016 and 2025, met the inclusion criteria. VR interventions demonstrated significant effects in reducing fear of falling (SMD = −0.40; 95% CI: −0.72 to −0.08; I 2 = 45.10%; p = 0.02), improving balance (SMD = 0.45; 95% CI: 0.07–0.83; I 2 = 73.54%; p = 0.02), and enhancing postural control (SMD = 0.50; 95% CI: 0.13–0.86; I2 = 46.89%; p = 0.01).
This meta-analysis highlights the effectiveness of VR interventions in reducing fear of falling and improving balance and postural control among older adults.
VR represents a valuable tool in fall prevention strategies, addressing key outcomes essential for maintaining independence and mobility in this population.
Poor quality handover instructions prepared by hospital staff have been identified as a key threat to safe discharges. To optimise patient safety, it is important to identify and understand the influences on how discharge documentation is prepared by hospital staff. The aim of this study was to systematically identify and explore important barriers and enablers to the preparation of high-quality discharge documentation by healthcare professionals (HCPs) for primary care teams at patient discharge.
HCPs from different staff groups (doctors, nurses, pharmacists, occupational and physiotherapists) participated in online interviews.
Semistructured interviews informed by the theoretical domains framework (TDF), to identify key influences on the preparation of discharge documentation. Anonymised transcripts were analysed thematically using a combined inductive-deductive approach. Themes were framed as influences on the preparation of discharge documentation. The likely importance of influences was decided through iterative team discussions structured on predetermined criteria. Criteria included whether the influence was an existing enabler, whether beliefs about the influences were expressed voluntarily and how often they were mentioned.
12 HCPs were interviewed (5 junior doctors, 1 advanced nurse practitioner, 2 nurses, 1 occupational therapist, 1 physiotherapist and 2 pharmacists). Of 44 influences identified, 10 were deemed most important in the preparation of discharge documentation, spread across five TDF domains: knowledge (eg, lack of awareness of guidelines), skills (experience of hospital staff), social and professional role and identity (effective team communication), environmental context and resources (eg, software limitations) and social influences (eg, lack of feedback).
This study identified 10 important influences on how discharge documentation is prepared by hospital staff. These influences are potential targets for subsequent interventions to improve the quality of discharge documentation and patient safety during discharge.
Injury to triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain, of which peripheral TFCC tears are amenable to repair. The surgical approaches to treat TFCC tears are well-established, with arthroscopic or arthroscopic-assisted repair as the preferred method. However, the postoperative rehabilitation protocols significantly vary across different studies, ranging from 2 to 9 weeks, often without sufficient justification.
This research is designed to conduct a randomised controlled trial at a single centre with double-blinding to compare the clinical and functional results of two immobilisation protocols of 3 weeks and 6 weeks, following arthroscopic repair of peripheral TFCC tears (ie, Palmar 1B, 1C and 1D) in adults, considering the phase of ligament healing. The hypothesis that there will be no significant difference in outcomes between the two groups is considered. Adults aged 18–60 years of both genders who present with ulnar-sided wrist pain and satisfy the inclusion criteria are included in the study. Following the arthroscopic TFCC repair using the Polydioxanone Suture (PDS) inside-out suture technique, the patients will be immobilised in an above-elbow cast according to their assigned immobilisation groups, which will be determined by a computer-generated 1:1 block randomisation. In this study, each group will have at least 16 participants. The primary outcomes will be evaluated by the weight-bearing press test and the ballottement test. Secondary outcomes, including the Visual Analogue Scale (VAS) score, grip strength, pinch strength, foveal sign, Modified Mayo Wrist Score (MMWS), patient-rated wrist/hand evaluation (PRWHE) score and the range of movements in the wrist and forearm, will be assessed and compared across the groups at each point of assessment, with the results subsequently reported in a detailed manner. The study will be reported in accordance with Consolidated Standards of Reporting Trials (CONSORT) guidelines.
The Ethics Committee of Kasturba Medical College, Manipal, approved the trial (approval No. IEC1 - 386). The data from this trial will be presented at academic conferences and published in peer-reviewed international journals.
This trial has been registered at the Clinical Trial Registry of India (registration number: CTRI/2023/03/050692).
Suicide rates in India are among the highest in the world, with the most recent suicide death rate estimates ranging between 18 and 21 deaths per 100 000 population (compared with the global average of 11/100 000). Responsible media reporting of suicide is one of the few evidence-based population-level suicide prevention interventions. Reports of recent suicides are a routine daily feature in major newspapers in India, and the reporting style carries many concerning features. In 2019, the Press Council of India adopted the WHO media guidelines, yet there has been no investigation as to whether this guidance is being followed. The aim of this paper was to systematically investigate whether the quality of print media reports of suicides has changed since the adoption of media guidelines for suicide reporting in India.
We used content analysis to assess the quality of suicide reporting against WHO guidelines in nine of the most highly read daily newspapers in the southern state of Tamil Nadu between June and December 2016 and June and December 2023. Our analyses of changes in reporting were based on a sample of 1681 print newspaper articles from 2016 and 512 print newspaper articles from 2023. Two-tailed t-tests and proportion tests on aggregate means and frequencies assessed whether the reporting characteristics had changed between 2016 and 2023.
There were small yet statistically discernible reductions in the proportion of articles containing various potentially harmful reporting characteristics, such as articles placed on the front page (4.9–1.8%, p=0.002) and articles mentioning the suicide method (92.7–86.5%, p
We observed substantial improvements in the reporting quality of some English-language newspapers, with minimal improvements in the quality of reporting in Tamil-language newspapers. The media guidelines in India are supporting the early phases of a culture shift on media reporting of suicide, yet they are just the start of the conversation. Strategies are required to engage and support vernacular language newspapers in India on their reporting of suicide, with media sector leadership as a core component.
Cancer patients, at both early and advanced stages, face complex bio-psycho-social-spiritual problems impacting their quality of life (QoL). Managing Cancer and Living Meaningfully (CALM) therapy is a psychotherapeutic approach that helps cancer patients find hope and meaning in life, thereby improving QoL.
This study aimed to critically assess the effects of CALM therapy on the QoL in cancer patients.
This was a systematic review and meta-analysis of randomised controlled trials (RCTs).
The main outcome was QoL, and the secondary outcomes were anxiety, depression, spiritual well-being, fatigue and sleep quality. Five English databases (PubMed, Embase, Scopus, Cochrane Library and ProQuest) and one trial registry site (Clinicaltrial.gov) were searched from their inception until March 2024. The pooled effect sizes were calculated using random-effects models and expressed as standard mean difference (SMD) or weighted mean difference (WMD). Review Manager 5.4 was used for data analysis. A sensitivity analysis was done by excluding one trial at a time to check the consistency of the results on QoL. The study protocol was prospectively registered on PROSPERO (CRD42023398655).
Fifteen trials met the inclusion criteria for the systematic review and twelve for the meta-analysis, with a total of 1635 cancer patients. CALM therapy showed significant benefits on QoL (SMD = 1.97), spiritual well-being (WMD = 1.93) and sleep quality (SMD = −1.56) compared with usual care. It also reduced anxiety (SMD = −1.94), depression (SMD = −1.28) and fatigue (SMD = −5.86) significantly. The sensitivity analysis confirmed the stability of these results when each trial was removed one by one.
CALM therapy may improve QoL, spiritual well-being, sleep quality and relieve anxiety, depression and fatigue in cancer patients.
This therapy should be promoted clinically as a comprehensive psychotherapeutic approach in cancer care.
CRD42023398655.
Nurses and healthcare support staff have a higher suicide risk than the public. This elevated risk calls for increased efforts to support mental health. Additionally, nursing leaders' education on employee-specific suicide prevention is lacking.
An evidence-based project was implemented using the PICO question: Among nurse leaders at an academic healthcare system in California, does the provision of an educational program using role-playing practice and the creation of a suicide prevention toolkit versus no standard education or training improve self-efficacy and knowledge on how to take action with a team member who is suspected of being suicidal or voicing suicidal ideation?
Education sessions were planned based on the literature, with surveys collected preintervention, immediately posteducation, and 1-month postintervention to assess suicide prevention self-efficacy and knowledge. Knowledge was measured using a researcher-constructed questionnaire validated by six suicide prevention experts. The General Self-Efficacy Scale (range: 10–40) was used.
Sixty participants attended one of 11 scheduled remote-learning sessions. Mean self-efficacy significantly improved (pre: 31.3 [n = 46, min: 18, max: 40]; immediate post: 33.49 [n = 37, min: 24, max: 40]; 1-month post: 33.77 [n = 31, min: 28, max: 40]) (X 2 = 8.0184, df = 2, p = 0.01815). The proportion of incorrect knowledge questions was significantly lower postintervention (mean pre: 24.5%, immediate post: 11.5%, 1-month post: 10.7%, X 2 = 23.195, df = 2, p = 0.000001). All participants (100%, n = 55) recommended the program. Leaders reported feeling better prepared to support suicidal employees.
Project results demonstrate the need to provide suicide prevention training for leaders. The authors recommend requiring training/return demonstration competency as a component of new leaders' onboarding. This program can easily be modified for nurses from prelicensure through senior leadership.
Suicide rates in healthcare members are higher than those of the general population. Suicide prevention programs can help nursing leaders feel better prepared to support and connect at-risk healthcare workers with resources.
by Vahid Sadeghi, Alireza Mehridehnavi, Maryam Behdad, Alireza Vard, Mina Omrani, Mohsen Sharifi, Yasaman Sanahmadi, Niloufar Teyfouri
A considerable amount of undesirable factors in the wireless capsule endoscopy (WCE) procedure hinder the proper visualization of the small bowel and take gastroenterologists more time to review. Objective quantitative assessment of different bowel preparation paradigms and saving the physician reviewing time motivated us to present an automatic low-cost statistical model for automatically segmenting of clean and contaminated regions in the WCE images. In the model construction phase, only 20 manually pixel-labeled images have been used from the normal and reduced mucosal view classes of the Kvasir capsule endoscopy dataset. In addition to calculating prior probability, two different probabilistic tri-variate Gaussian distribution models (GDMs) with unique mean vectors and covariance matrices have been fitted to the concatenated RGB color pixel intensity values of clean and contaminated regions separately. Applying the Bayes rule, the membership probability of every pixel of the input test image to each of the two classes is evaluated. The robustness has been evaluated using 5 trials; in each round, from the total number of 2000 randomly selected images, 20 and 1980 images have been used for model construction and evaluation modes, respectively. Our experimental results indicate that accuracy, precision, specificity, sensitivity, area under the receiver operating characteristic curve (AUROC), dice similarity coefficient (DSC), and intersection over union (IOU) are 0.89 ± 0.07, 0.91 ± 0.07, 0.73 ± 0.20, 0.90 ± 0.12, 0.92 ± 0.06, 0.92 ± 0.05 and 0.86 ± 0.09, respectively. The presented scheme is easy to deploy for objectively assessing small bowel cleansing score, comparing different bowel preparation paradigms, and decreasing the inspection time. The results from the SEE-AI project dataset and CECleanliness database proved that the proposed scheme has good adaptability.The aim of this study was to (i) identify barriers and enablers and (ii) inform mitigating or strengthening strategies for implementing nurse-initiated care protocols at scale in emergency departments (EDs).
Embedded mixed methods.
The study included four clusters with a total 29 EDs in NSW, Australia. Concurrent quantitative and qualitative data were collected via electronic nursing and medical staff surveys and analysed. Barriers and enablers to implementation were identified and mapped to the domains of the Theoretical Domains Framework (TDF). Selection of intervention functions and behaviour change techniques (BCTs) enabled development of implementation strategies.
In total, 847 responses from nursing and medical staff (43%) reported four enablers for use and implementation: (i) knowing or being able to learn to use simple nurse-initiated care; (ii) protocols help staff remember care; (iii) carefully considered education programme with protected time to attend training; and (iv) benefits of nurse-initiated care. Nine barriers were identified: (i) lack of knowledge; (ii) lack of skills to initiate complex care (paediatric patients, high-risk medications and imaging); (iii) risk for inappropriate care from influence of cognitive bias on decision-making; (iv) punitive re-enforcement; (v) protocols that are too limited, complex or lack clarity; (vi) perceived lack of support from medical or management; (vii) perception that tasks are outside nursing role; (viii) concern nurse-initiated care may increase the already high workload of medical and nursing staff; and (ix) context. The barriers and enablers were mapped to nine TDF domains, five intervention functions and 18 BCTs informing implementation using strategies, including an education programme, pre-existing videos, audit and feedback, clinical champions and an implementation plan.
A rigorous, systematic process generated a multifaceted implementation strategy for optimising nurse-initiated care in rural, regional and metropolitan EDs.
Staff wanted safe interventions that did not lead to increased workload. Staff also wanted support from management and medical teams. Common barriers included a lack of knowledge and skill in advanced practice. Clinicians and policymakers can consider these barriers and enablers globally when implementing in the ED and other high-acuity areas. Successful strategies targeting barriers to advanced practice by emergency nurses can be addressed at the local, state and national levels.
Implementation of new clinical practices in the ED is complex and presents challenges. Key barriers and enablers, including those related to initiating care and workloads in the ED were identified in this study. This research broadly impacts ED staff and policymakers globally.
Mixed Methods Reporting in Rehabilitation & Health Sciences (MMR-RHS).
Site senior nurse researchers for each cluster worked closely with site stakeholders, including local consumer groups. Consumer councils were engaged at all the sites. Site visits by the research nurses have been an important strategy for discussing the study with key stakeholders.
Australian and New Zealand Clinical Trial: ACTRN12622001480774p
Pain is a frequent post-stroke health concern, and several non-pharmacological interventions are commonly employed to manage it. However, few reviews have examined the effectiveness of such interventions, making it difficult to draw conclusions about their usefulness. Furthermore, subgroup analysis based on post-stroke pain level or intervention characteristics is rarely performed. This study aimed to investigate the effectiveness of non-pharmacological interventions and evaluate the significant factors associated with post-stroke pain through subgroup analysis.
Systematic review and meta-analysis.
Relevant studies were obtained from seven databases, from their commencement up to March 2024, as well as from the gray literature. The PICOS approach was used to evaluate the eligibility criteria of the studies. The RoB-2 tool was used to determine the risk of bias in each randomized trial. Pooled estimations of standardized mean difference and heterogeneity (quantified with I 2) were obtained using a random-effects model. The stability of the pooled result was then assessed using the leave-one-out approach. STATA 17.0 was used to run the meta-analysis.
Non-pharmacological interventions were effective in reducing pain immediately after intervention (pooled SMDs: −0.79; 95% confidence interval [CI]: −1.06 to −0.53; p < 0.001). The approach involving acupuncture, aquatic therapy, or laser therapy and rehabilitation training was effective for post-stroke hemiplegic shoulder pain. A pooled analysis of non-pharmacological interventions showed that both less than 4 weeks and more than 4 weeks of interventions were effective in alleviating pain in stroke patients.
Non-pharmacological approaches appear to be beneficial for reducing post-stroke pain. The outcomes based on the modalities merit further research.
Further studies are needed to determine the effects of different modalities on pain intensity following a stroke. Furthermore, to avoid overestimation of intervention efficacy, future randomized trials should consider blinding approaches to the interventions delivered.
Person-centered care emphasizes the importance of valuing and supporting the humanness of a person living with dementia as compared to focusing heavily on disease symptom management and treatment. The state of the evidence and outcomes from person-centered care is unclear and is an important knowledge gap to address informed evidence-based care for persons living with dementia.
To synthesize the evidence on the efficacy of person-centered care in improving health outcomes in people living with dementia.
Our search using the following databases: Academic Search Complete, CINAHL, COCHRANE library, EMBASE, MEDLINE, PubMed, and Google Scholar. The methodology quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Meta-analyses were performed using the DerSimonian and Laird random effects model to investigate the effectiveness of person-centered care on improving health outcomes in persons living with dementia.
Seventeen trials were included in this systematic review and meta-analysis. Person-centered care implementation was found to improve cognitive function (pooled SMD: 0.22; 9CRD420223808975% CI [0.04, 0.41], p = .02) in persons living with dementia, although outcomes including the impact of the care model on activities of daily living, agitation, depression, and quality of life remain inconclusive.
Person-centered care improves the cognitive function of persons living with dementia, which is clinically meaningful and should not be ignored or overlooked in delivering evidence-based care to this population. The findings of this study emphasize the importance of person-centered care implementation among people living with dementia as an approach in improving health outcomes particularly on cognitive function improvement. Person-centered care emphasizes the personhood of individuals living with dementia while respecting their needs, values, and beliefs and is identified as a preferred model of delivering dementia care in all settings as a non-pharmacological approach.
To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres.
Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care.
A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data.
From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training.
While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative.
Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care.
No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.
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