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Lateral hip pain due to hip abductor tendon pathology (ie, gluteal tendinopathy or tendon rupture) is a relatively new diagnosis. This patient group has previously been described as a clinical dilemma due to the often-short-lived effects of treatment. In the process of identifying the underlying pathology, however, more targeted treatment strategies have been explored. Recent research recommends exercise as a first-line treatment for this patient group along with patient education. However, patients seen in a hospital setting (secondary healthcare) often present recalcitrant lateral hip pain, tendon ruptures and multiple comorbidities. Whether patient education and exercise therapy are beneficial for patients in secondary healthcare has only been sparsely investigated. Therefore, this study aims to investigate changes in lateral hip pain following a 3 month physiotherapist-led patient education and exercise intervention in patients with MRI-proven hip abductor tendon pathology seen in a hospital setting.
In this prospective cohort trial, 60 patients, presenting lateral hip pain and MRI-verified hip abductor tendon pathology at the orthopaedic outpatient clinic at Horsens Regional Hospital, Denmark, a public teaching hospital, are included. Hip abductor tendon pathology will be diagnosed by clinical tests and MRI. The intervention consists of seven physiotherapist-led patient education and exercise sessions at the hospital during 3 months. The instructions will guide the patients in their daily home-based exercise sessions.
The primary outcome is change in lateral hip pain measured by the ‘pain’ subscale from the patient-reported outcome measure: the revised Copenhagen Hip And Groin Outcome Score (HAGOS). Secondary outcomes are changes in the remaining subscales of the revised HAGOS, Oxford Hip Score, Victorian Institute of Sports Assessment-Gluteal Questionnaire, European Questionnaire-Five Dimensions Five-Level, lateral hip pain (numeric rating scale score, 0–10), hip muscle strength and the 30 s chair stand test. Also, patient-reported Global Rating of Change in hip condition, as well as adherence and harms, will be reported.
This trial has been accepted by the Central Denmark Regions Ethics Committee (1-10-72-136-22). The study is registered at the Central Denmark Region List of Research Projects (Journal No 1-16-02-180-24) and clinicaltrials.gov (NCT06418217).
All results from this study, regardless of the direction, will be published in a peer-reviewed journal and presented at national and international congresses.
Increasing physical activity and effectively managing stress can positively impact immunity and may reduce the duration of respiratory tract infections (RTIs). As part of a larger trial, participants accessed a digital behavioural change intervention that encouraged physical activity and stress management to reduce RTIs. We aimed to understand the barriers and facilitators to engaging in physical activity and stress reduction.
A qualitative process analysis from semistructured interviews of the behavioural intervention in a randomised control trial.
Primary care in the UK.
34 participants (aged 18–82 years) in the behavioural intervention arm.
The larger trial involved four interventions: a gel-based antiviral nasal spray; a saline water-based nasal spray; a behavioural intervention; usual care. In this study, we focused on participants allocated to the behavioural intervention. The behavioural intervention included two components: one to increase physical activity (getting active) and another for stress management techniques (healthy paths) to reduce RTIs.
We analysed the interviews using thematic analysis with a critical realist perspective (focusing on). We developed five themes: digital intervention engagement, views on intervention allocation, the role of getting active, the role of healthy paths and benefits reinforcing behaviour. Participants’ views on the relevance and benefit of the behavioural intervention shaped their engagement with the intervention website and behaviour. Facilitators of intervention engagement included awareness of inactivity, goal setting, increasing immunity, positive outcome expectations and benefits from changing behaviour. Barriers to engagement included negative outcome expectations, such as around efficacy of the behaviours.
Overall, the results highlighted the importance of positive expectations for a digital intervention promoting physical activity and stress management for RTI reduction. Future interventions should consider how to clearly communicate a broad range of perceived benefits to users.
The trial was prospectively registered with International Standard Randomized Controlled Trial Number (ISRCTN) registry (17936080).
To explore how public health nurses at child and family health clinics work to prevent maltreatment and the experiences of public health nurses in the maltreatment prevention efforts.
Child maltreatment is a serious societal issue with major consequences. Preventive efforts are increasing and have broad political support. A key objective of the child and family health clinic services is to prevent, identify, and stop maltreatment, abuse, and neglect. National clinical guidelines outline, in general terms, how such work should be conducted. However, limited research exists on how public health nurses prevent maltreatment and the effectiveness of their methods.
A qualitative and explorative design was used, based on semi-structured interviews with 14 public health nurses conducted as part of the project ‘Public Health Nurses in Child and Family Clinics' Role in Preventing and Detecting Child Maltreatment’ at Oslo Metropolitan University. The interviews were carried out between August and November 2021. We used qualitative content analysis with an inductive approach to analyse the data.
Three main categories were developed: 1. Structure and system: weaving prevention into daily practice; 2. To dare and endure: a negotiation of courage and understanding, and 3. To empower and uphold: the goal of strengthening and supporting parents. The results show the importance of early intervention, barriers to discussing maltreatment with parents, and the importance of building trust and empowering parents.
Preventing maltreatment is a key part of public health nurses' clinical work, focusing on early risk identification and parental guidance. While building trust with families is prioritised, structural, resource, and guideline-related challenges persist.
This study provides knowledge about Norwegian public health nurses clinical work with child maltreatment at the child and family health clinics, which can serve as a valuable foundation for further research as well as for collaborating services.
EQUATOR guidelines were followed, using the COREQ checklist.
No patient or public contribution.
We investigated the epidemiology and impact on mortality of antimicrobial resistance (AMR) in cancer patients with bacteraemia at Oxford University Hospitals (OxUH), UK, and Oslo University Hospital (OsUH), Norway, during 2008–2018.
Historical cohort study.
Regional hospital trusts with multiple sites in OxUH and OsUH.
Patients with cancer and blood cultures positive for one of six pathogen groups during a hospital stay within 3 years following their first cancer diagnosis were followed for 30 days after their first bacteraemia episode. We determined the number of cases and the proportion of infections with an AMR phenotype. Excess mortality and the population-attributable fraction (PAF) due to AMR were estimated by contrasting observed mortality at the end of follow-up with an estimated counterfactual scenario where AMR was absent from all bacteraemias, using inverse probability weighting.
30-day all-cause mortality following the first bacteraemia episode.
A resistant phenotype of the causative pathogen.
The study included 1929 patients at OxUH and 1640 patients at OsUH. The highest resistance proportions were found for vancomycin resistance in enterococci (85/314, 27.1%) and carbapenem-resistance in Pseudomonas aeruginosa (63/260, 24.2%) at OxUH, and third-generation cephalosporin resistance in Escherichia coli (62/743, 8.3%) and Klebsiella pneumoniae (14/223, 6.3%) at OsUH. Observed mortality for all infections was 26.4% at OxUH, with an estimated counterfactual mortality without AMR of 24.7%, yielding an excess mortality of 1.7% (95% CI: 0.8 to 2.5%). The PAF was 6.3% (95% CI: 2.9 to 9.6%), meaning an estimated 32 of 509 deaths could be attributed to AMR. Limited events at OsUH precluded a similar estimate.
Despite estimating modest excess mortality, the mortality attributable to resistance in these two high-income, low-prevalence settings highlights the potential for escalation if global resistance trends continue to worsen.
Despite being a leading cause of female morbidity and mortality, female-specific cardiovascular disease (CVD) is understudied, underdiagnosed and undertreated. Pregnancy complications involving the placenta, including pre-eclampsia, pregnancy-induced hypertension and foetal growth restriction, are thought to reflect global maternal vascular derangements that indicate a twofold to eightfold increased risk of future CVD. This calls for a better understanding of female cardiovascular pathophysiology to allow development of targeted screening and prevention strategies.
Acute atherosis is a placental vascular lesion, which histologically resembles systemic atherosclerosis. The PlacEntal Acute atherosis RefLecting Subclinical atherosclerosis study investigates the association between placental acute atherosis lesions and subclinical systemic atherosclerosis up to 20 years postpartum.
This study will improve our understanding of the relationship between pregnancy complications and CVD to identify potential prevention targets and treatments. In addition, it could determine whether the placenta can improve identification of young women at high risk of CVD. These women could benefit from risk-reducing interventions.
This longitudinal prospective cohort study will include women who are either currently pregnant or from a historical cohort. Both groups will have placental histopathology and a single postpartum CVD assessment. The CVD assessment will include medical history taking, blood tests, electrocardiography and echocardiography. Additionally, coronary CT angiography focusing on the presence of atherosclerotic plaques and calcium score will be carried out.
The currently pregnant women will either have a pre-eclamptic pregnancy (pre-eclamptic group) or an uncomplicated normotensive pregnancy (uncomplicated group), and their placenta will be collected prospectively. The single CVD assessment will be carried out 6–36 months postpartum.
Women from the historical cohort had a pre-eclamptic pregnancy 10–20 years ago. Placental tissue is available for reanalysis. The single CVD assessment will take place immediately and corresponds with 10–20 years postpartum.
Exclusion criteria are contraindications to diagnostic assessment necessities: iodinated contrast, beta-blockers or glyceryl trinitrate. Women with uncomplicated pregnancies will be excluded if they have a pre-existing auto-immune condition, chronic hypertension or diabetes mellitus. In the pre-eclamptic group, there are no additional exclusion criteria.
Ethical approval was granted by the Medical Ethics Committee in Maastricht University Medical Centre+ (NL52556.068.15/METC152019). Participants will give written informed consent. Results will be shared in peer-reviewed journals and conference presentations.
NCT05500989; ClinicalTrials.gov Identifier.
by Shaleesa Ledlie, Alice Holton, Pamela Leece, Bisola Hamzat, Joanna Yang, Gillian Kolla, Nikki Bozinoff, Rob Boyd, Mike Franklyn, Ashley Smoke, Paul Newcombe, Tara Gomes
ObjectiveTo investigate trends and the circumstances surrounding fatal substance-related toxicities directly attributed to alcohol, stimulants, benzodiazepines or opioids and combinations of substances in Ontario, Canada.
MethodsWe conducted a population-based cross-sectional study of all accidental substance-related toxicity deaths in Ontario, Canada from January 1, 2018 to June 30, 2022. We reported monthly rates of substance-related toxicity deaths and investigated the combination of substances most commonly involved in deaths. Demographic characteristics, location of incident, and prior healthcare encounters for non-fatal toxicities and substance use disorders were examined.
ResultsOverall, 10,022 accidental substance-related toxicity deaths occurred, with the annual number of deaths nearly doubling between the first and last 12 months of the study period (N = 1,570–2,702). Opioids were directly involved in the majority of deaths (84.1%; N = 8,431), followed by stimulants (60.9%; N = 6,108), alcohol (13.4%; N = 1,346) and benzodiazepines (7.8%; N = 782). In total, 56.9% (N = 5,698) of deaths involved combinations of substances. Approximately one-fifth of individuals were treated in a hospital setting for a substance-related toxicity in the past year, with the majority being opioid-related (17.4%; N = 1,748). Finally, 60.9% (N = 6,098) of people had a substance use disorder diagnosis at time of death.
ConclusionsOur study shows not only the enormous loss of life from substance-related toxicities but also the growing importance of combinations of substances in these deaths. A large proportion of people had previously interacted within an hospital setting for prior substance-related toxicity events or related to a substance use disorder, representing important missed intervention points in providing appropriate care.
The aim of the present study was to examine the reliability and validity (structural and convergent) of the Resilience and Strain Questionnaire in Caregivers of People with Dementia (ResQ-Care-Dem).
Cross-sectional survey study.
Online survey in Germany.
The ResQ-Care-Dem was completed by 243 informal caregivers of people with dementia (Mage=59.7 years, SD=10.9, 84.8% female).
The ResQ-Care-Dem consists of four scales: two resilience scales (psychological aspects and social aspects of resilience) and two burden scales (interpersonal burden and general burden). The reliability of the two resilience and two burden scales was assessed using Cronbach’s alpha as a measure of internal consistency. Structural validity was examined using a principal axis factor analysis. Convergent validity was assessed by Pearson’s correlations with the Zarit Burden Interview (ZBI-7), the Caregiver Self-Efficacy Scale (CES-8) and the Gain in Alzheimer Care Instrument (GAIN).
The ResQ-Care-Dem scales’ internal consistencies ranged between 0.65 and 0.81. The factorial structure could partly be confirmed, with the items of the four scales primarily loading on four factors. The burden scales demonstrated high and positive correlations with the score for caregiver burden (ZBI-7, r=0.51 – 0.55) and small to high, negative correlations with the scores for caregiver self-efficacy (CES-8, r=–0.52 –0.56) and gains from caregiving (GAIN, r=–0.21 –0.22), supporting construct validity of the scales. The resilience scales showed small to high positive correlations with the scores for caregiver self-efficacy (CES-8, r=0.50 – 0.57) and gains from caregiving (GAIN, r=0.27 – 0.50), as well as moderate negative correlations with the caregiver burden score (ZBI-7, r=–0.45 –0.50), providing evidence for the scales’ construct validity.
The reliability and structural validity of the ResQ-Care-Dem were partially confirmed. Evidence supporting its convergent validity suggests that the questionnaire has potential as a tool for assessing caregiver burden and resilience factors among informal caregivers of people with dementia. While these findings indicate potential practical applicability, future studies should investigate its performance in real-world settings and assess changes over time (eg, responsiveness) in longitudinal studies.
The ‘Developing and evaluating an adapted behavioural activation intervention for depression and diabetes in South Asia (DiaDeM)’ trial investigates a psychological intervention, behavioural activation (BA), on people with both diabetes and depression in Bangladesh and Pakistan. This study aimed to aid the intervention and trial design.
This was a modelling study using microsimulation to assess the intervention’s cost-effectiveness. Diabetes was modelled using the UK Prospective Diabetes Study model based on Pakistani patients and depression was modelled using Patient Health Questionnaire-9 (PHQ-9) trajectories allowing for multiple depressive episodes. It was assumed that diabetes-related adverse events increased depression recurrence, while depression impacted haemoglobin A1c, increasing diabetes-related events. The model estimated (1) maximum cost of BA which would be cost-effective (headroom analysis) to inform intervention design, and (2) value of reducing uncertainty around different measures (value of information analysis) to prioritise data collection in the DiaDeM study.
Analysis was conducted from a Pakistani healthcare perspective over a lifetime with costs and outcomes discounted at 3%.
BA plus usual care was compared against usual care. BA involved six sessions by a trained (non-mental health) facilitator. The usual care comparator was the prevailing mix of pharmacological and non-pharmacological treatments used in Pakistan.
The primary outcome was disability-adjusted life-years (DALYs). Secondary outcomes included life years, healthcare costs and the rate of depression and diabetes-related events.
Over their lifetime, individuals receiving BA plus usual care avoid 3.2 (95% credible interval: 2.7 to 3.8) years of mild depression and experience fewer diabetes-related events. BA plus usual care resulted in an additional 0.27 (0.03 to 0.52) life years, 0.98 (0.45 to 1.86) DALYs averted and had incremental healthcare costs of –US$97 (–US$517 to US$142), excluding BA costs. The maximum cost per BA course at which was cost-effective is US$83 (US$9 to US$214). Value of information analysis found the most important measures to include in the trial are the impact of depression on diabetes and PHQ-9 over time.
This is the first model to jointly model depression and diabetes for South Asia and uses novel methods to reflect the diseases and inform intervention and trial design. This evidence has helped to inform the design of the DiaDeM intervention and the trial to evaluate it.
DiaDeM trial: ISRCTN40885204, DOI: ; pre-results, DOI:
Among lower extremity artery disease (LEAD), symptomatic carotid stenosis (SCS) and abdominal aortic aneurysm (AAA), the disease burden is insufficiently illuminated from a patient and societal perspective. Such knowledge is central to identifying patients at risk of poorer outcomes. Therefore, the Danish Vascular (DanVasc) survey aims to describe self-reported health status, health literacy, medication adherence and loneliness, including changes over time, and investigate characteristics associated with worse self-reported health at baseline and their associations with poorer outcomes within 1 year (healthcare utilisation and mortality) in patients with LEAD, SCS and AAA.
The DanVasc survey, a national prospective cohort study combining survey data measured at several time points with register-based data, includes validated patient-reported outcome measures (PROMs) and ancillary questions developed with patient representatives. Our baseline survey (T0) follows the index contact in vascular outpatient clinics with follow-up surveys determined by the patient’s trajectory: (1) newly referred patients in conservative treatment trajectories; the date for the outpatient visit activates 1-month (T1), 3-month (T2) and 12-month (T3) follow-ups. (2) Patients referred for vascular surgery; the surgery date activates 1-month (T1), 3-month (T2) and 12-month (T3) follow-ups. The included PROMs assess health-related quality of life (HRQoL), anxiety and depression, sleep, frailty status, health literacy, medication adherence and loneliness. For LEAD, a disease-specific PROM evaluates HRQoL. For AAA, disease-specific ancillary questions are added. Additionally, the DanVasc survey includes questions on health behaviour, preventive measures and sexual life. The DanVasc survey will be linked to national registries to obtain socio-demographic information and data on redeemed prescriptions, clinical information, healthcare utilisation, comorbidities and mortality. From December 2023 to December 2024, we aim to recruit approximately 5500 patients from all seven DanVasc surgery departments. Patient characteristics will be reported using descriptive statistics. Changes over time and factors associated with poorer health outcomes will be analysed using linear, logistic and Cox proportional hazard models, presented as univariate and multivariate regressions.
Approval for the collection of medical record data was granted by the Central Denmark Region, acting on behalf of all Danish regions (record 1-45-70-94-22). Consent to participate is obtained prior to answering the survey. Results will be disseminated through peer-reviewed scientific publications and conference presentations, and findings will be shared with patients and relevant stakeholders via public and social media.
To analyse the qualitative evidence on the role of critical care nurses in rapid response teams.
Qualitative systematic review.
This qualitative systematic review employed Bettany-Saltikov and McSherry’s guidelines and is reported according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. Two pairs of blinded researchers screened the articles. The data were synthesised using a thematic analysis approach.
A systematic literature search was conducted using the CINAHL, Embase and MEDLINE databases.
Seven studies were included, and three main roles were identified: (1) balancing between confidence and fear in clinical encounters, (2) facilitating collaboration and (3) managing challenging power dynamics in decision-making.
Critical care nurses possess extensive knowledge and skills in providing critical care to patients experiencing deterioration on general wards. They play a vital role in facilitating collaboration between team members and ward staff. Furthermore, within the rapid response team, critical care nurses assume leadership responsibilities by overseeing the comprehensive coordination of patient care and actively engaging in the decision-making process concerning patient care.
Highlighting the central role of critical care nurses in rapid response teams as well such a team’s benefits in healthcare organisations can promote applications for funding to support further quality assurance of rapid response teams and thus enhance patient safety.
Health care organisations can assure the quality of rapid response team by providing economical resources and training. The education providers should facilitate and standardise curriculum for critical care nursing students to achieve necessary knowledge and skills as members in rapid response teams.
No patient or public contribution.
The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood.
This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects.
Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus.
Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0–5).
Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.
FreshRSS 