Conectar
The Research Domain Criteria (RDoC) approach initiated by the National Institute of Mental Health provides a comprehensive framework for guiding research on mental illness and health. Since retrospective studies have indicated associations between RDoC characteristics and clinically relevant as well as care-relevant outcomes, there is a need for prospective, theory-driven investigations that systematically link a priori defined assessments of RDoC constructs to clinically and care-relevant outcomes in a transdiagnostic psychiatric sample.
This prospective observational study assesses six domains—Positive Valence Systems, Negative Valence Systems, Cognitive Systems, Social Processes, Arousal and Regulatory Systems and Sensorimotor Systems—employing a comprehensive set of self-report and additional paradigms to assess cognitive functioning developed a priori in alignment with the RDoC framework while also assessing clinically and care-relevant variables (eg, length of hospital stay). A total of 300 adult participants will be recruited among in- and outpatients of two psychiatric hospitals in Germany (patient group) as well as from the general population (healthy control group). Including healthy individuals will allow for the investigation of continuous variations in psychological functioning rather than categorical distinctions between health and disease. Data collection includes self-reports, clinician ratings, file review and behavioural assessments. Electroencephalography is recorded in a subgroup of participants. A confirmatory factor analysis will be conducted to reproduce the factor structure and regression models will be used to investigate associations between RDoC domains and clinically relevant as well as care-related variables.
Ethics approval was obtained from the local ethics committee of the Brandenburg Medical School—Theodor Fontane (E-01-20220822). Results will be disseminated through peer-reviewed journals and academic conferences.
To identify enablers and barriers for scaling up non-communicable disease (NCD) interventions across diverse global contexts and to map these factors to the WHO’s health system building blocks.
A multi-method qualitative study applying the Consolidated Framework for Implementation Research to analyse data from multiple projects nearing or completing scale-up.
Global Alliance for Chronic Diseases-funded implementation research projects conducted across 18 low- and middle-income countries and high-income settings.
Data was derived from documents (n=77) including peer-reviewed publications, policy briefs, and reports and interviews with stakeholders (n=18) (eg, principal investigators, medical professionals, public health workers).
Various context-specific interventions targeting sustainable scale-up of NCD (eg, diabetes, hypertension, cardiovascular disease) interventions at the community, primary care or policy levels.
The primary outcome was identifying contextual enablers and barriers to intervention scale-up. Secondary outcomes included exploring how these factors aligned with health system building blocks (eg, leadership/governance, healthcare workforce).
Twenty enablers (eg, intervention adaptability, strong stakeholder engagement, local empowerment) and 25 barriers (eg, resource limitations, intervention complexity, stakeholder burnout) were identified. Contextual alignment, supportive governance and capacity building were critical for sustainability, while cultural misalignment and socio-political instability frequently hampered scaling efforts.
Tailoring interventions to local health systems, ensuring stakeholder co-ownership and incorporating strategies to mitigate stakeholder burn-out are essential to achieving sustainable, scalable NCD solutions. Future research should focus on integrating systematic cultural adaptation, sustainable financing and workforce capacity building into scale-up planning.
To provide an overview of doctoral programs in nursing offered in Ibero-American countries to inform regional collaboration and academic development.
This study was a descriptive, document analysis.
A systematic mapping was conducted using data obtained from official university and program websites, national postgraduate databases, and academic documents. The variables analysed included country, institution, year of implementation, number of faculty and students, course duration, delivery modality, costs, scholarship availability, internationalisation activities, and research lines.
A total of 94 active nursing doctoral programs were identified. Brazil emerged as the pioneer, launching the first doctoral program in 1982, and remains the regional leader, accounting for 43 programs. Most programs are offered by public institutions (76.6%), delivered primarily in face-to-face format (64.1%), and emphasise research (90.4%). There has been a consistent upward trend in the establishment of programs since 2000, with notable expansion between 2011 and 2025. Despite this progress, regional disparities persist, along with a lack of data standardisation and a limited presence of professional doctorates. While 69.1% of programs reported international activities, few offer joint or dual degrees. The most common thematic axis, “Health Care and Nursing,” proved to be broad and non-specific.
The study reveals the expanding landscape of nursing doctoral education in Ibero-America, while also exposing persistent challenges regarding access, curricular clarity and regional articulation.
Doctoral programs are essential for developing research capacity, academic leadership and evidence-based care. Strengthening these programs could enhance nursing responses to local health needs and promote scientific progress in care delivery.
This study provides the first comprehensive mapping of nursing doctoral programs in Ibero-America, highlighting regional disparities and areas for academic collaboration, with potential impact on policy-making, curriculum development, and the strengthening of research capacity in nursing education.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology).
No patient or public contribution.
by Thomas Buyinza, Edward Buzigi, Joshua Kitimbo, Gabriel Ssabika, Mary Mbuliro, Julius Kiwanuka, Justine Bukenya, David Guwatudde, Rawlance Ndejjo
IntroductionAdolescents and young adults (AYAs) worldwide display poor dietary behaviors, including high consumption of sugar-sweetened beverages and insufficient intake of fruits and vegetables. These issues are more pronounced in Sub-Saharan Africa, such as rural Eastern Uganda, where 45.3% of adolescents eat low-diversity diets high in refined grains and fats. Such diets raise the risk of malnutrition and diet-related non-communicable diseases (NCDs). However, there is limited contextual evidence on the multi-level factors influencing AYAs’ dietary behaviors in rural Uganda. This study examined socio-ecological factors shaping dietary behaviors among AYAs in this setting.
MethodsA qualitative study guided by the socio-ecological model (SEM) was conducted in Mayuge District, Eastern Uganda. Focus group discussions (FGDs) were held with AYAs, including male and female, aged 10–14, 15–19, and 20–24 years. To have a nuanced understanding of how AYAs’ dietary behaviours are shaped, additional FGDs were conducted with parents or guardians and teachers, and key informant interviews with the district education officer, nutrition focal person, civil society staff, and food vendors. Data were analyzed in ATLAS.ti using both inductive and deductive thematic approaches: data-driven sub-themes were first identified inductively, then deductively mapped onto pre-determined themes of the SEM.
ResultsDietary behaviors were shaped by satiety, energy needs, sensory appeal, and nutrition knowledge at the individual level. Peer influence, parental control, and food’s perceived link to attractiveness acted interpersonally, while community factors included gendered cultural taboos, norms, and health worker advice. At the societal level, cultural identity, ancestral restrictions, and media exposure strongly influenced choices.
ConclusionsThis study contributes novel rural-specific evidence from rural Uganda, where AYAs’ diets are uniquely constrained by satiety demands, parental dominance, cultural taboos, and seasonal scarcity; contrasting with urban contexts where convenience, autonomy, and wider food environments prevail. Multi-level interventions integrating nutrition education, family and peer engagement, cultural dialogue, and household food security support are essential for promoting healthier diets in resource-limited rural settings.
by Ryan D. Parsons, Sarah Bauermeister, Julian Turner, Natalie Coles, Simon Thompson, Emma Squires, Tracey Riseborough, Joshua Bauermeister, Abbie Simpkin, Naomi French, Shankly Cragg, Hazel Lockhart-Jones, Olly Robertson, Abhaya Adlakha, Ian Thompson, John Gallacher
Adolescent mental health and wellbeing are of growing concern globally with increased incidence of mental health disorders in young people. BrainWaves provides a framework for relevant and diverse research programmes into adolescent mental health and wellbeing that can translate into practice and policy. The research programme is a partnership with schools centred on establishing a large (n > 50,000) cohort and trials platform. Reported here is the BrainWaves cohort pilot study. This was designed as proof-of-concept for our recruitment and data capture pipelines, and for cost-modelling. A network of research schools was recruited and a computer-driven questionnaire administered. The eligible population was 16 + year olds who were attending the research schools. Of 41 research schools, 36 (88%) participated over one three-week and one four-week data collection period. From an eligible population of 33,531 young people, 16,010 (48%) attended the study lesson and created an account. Of the 16,010 (100%) who created an account, 15,444 (96%) consented to participate, 9,321 (60%) consented to linkage of research data with educational records, and 6,069 (39%) consented to linkage of research with school/college attendance data. Participants were aged 16–19 years, 59% female, and 76% White. Higher levels of anxiety and depression were found in females than males. Higher levels of media-based social networking were found in females, whereas higher levels of media-based gaming were found in males. Females were more likely to report insufficient sleep whilst males were more likely to report high levels of exercise. This study confirmed an ability to recruit at pace and scale. Whilst the response-rate does not indicate a representative sample, the demographics describe an inclusive and diverse sample. Data collected confirmed findings from previous studies indicating that the electronic data collection methods did not materially bias the findings. Initial cost-modelling suggests these data were collected for around £20 per participant.by Mohajit Arneja, Swetharajan Gunasekar, Dharaneswari Hari Narayanan, Joshma Joseph, Harilalith Kovvuri, Sharath Shanmugam, Pavitraa Saravana Kumar, Asuwin Anandaram, Vinod Kumar Balakrishnan, Jayanty Venkata Balasubramaniyan, Sadhanandham Shanmugasundaram, Sankaran Ramesh, Nagendra Boopathy Senguttuvan
BackgroundFaster time to reperfusion can be achieved by minimizing various patient and system-level delays that contribute to total ischemic time. Procedural delays within the catheterization laboratory represent a non-negligible and modifiable component in the chain of reperfusion, but remain unquantified by conventional metrics such as door-to-ballon (D2B) time. Universal catheter approaches have rapidly gained traction as an alternative to the traditional two catheter approach for transradial coronary interventions. However, their utility for both diagnostic angiography and subsequent angioplasty is limited, and the impact of this strategy on reperfusion outcomes has remained unexplored. We utilized a procedural metric termed fluoroscopy-to-device (FluTD) time to quantify the efficiency of a single catheter strategy, and assessed its impact on epicardial and myocardial perfusion.
Methods and resultsIn this retrospective study, consecutive STEMI patients undergoing transradial primary PCI (pPCI) at a tertiary care center in India between May 2022 to October 2024 were analyzed. Patients were divided into two groups: 51 underwent PCI using a single universal guiding catheter (UGC), and 51 underwent the conventional two-catheter (CTC) approach. The primary outcome of the study was a comparison of the FluTD time between the two procedural strategies. Secondary outcomes included myocardial blush grade (MBG), Thrombolysis in Myocardial Infarction (TIMI) flow grade, total fluoroscopy time, radiation dose, device safety and efficacy, and procedural success.The median FluTD time was significantly shorter in the UGC compared to the CTC group (3 minutes [IQR 3–4] vs. 10 minutes [IQR 8–17], p Conclusion
A single catheter strategy for both angiography and pPCI in STEMI patients was associated with a significant reduction in FluTD time and improved microvascular perfusion, without compromising device safety or efficacy. In low- and middle-income countries (LMICs), where intra- and extra-procedural delays are often more pronounced, inclusion of the single catheter strategy can optimize catheterization workflows and yield substantial cost-savings.
To estimate the treatment outcomes among individuals treated for hypertension in the public sector in 89 districts across 15 states in India and to identify the risk factors for uncontrolled blood pressure (BP).
An analysis of a cohort of people with hypertension from 2018 to 2022 from public sector health facilities.
All India Hypertension Control Initiative (IHCI) implementing districts using digital information systems across 15 states of India, namely Andhra Pradesh, Bihar, Goa, Gujarat, Jharkhand, Karnataka, Maharashtra, Nagaland, Puducherry, Punjab, Rajasthan, Sikkim, Tamil Nadu, Uttar Pradesh and West Bengal.
Individuals aged 30 years or older, who were diagnosed with hypertension or on medication at the time of registration between 1 January 2018 and 31 December 2021 were included in the study.
Treatment outcomes were controlled BP, uncontrolled BP and missed visits in the reporting quarter (1 January 2022–31 March 2022). We analysed the risk factors for uncontrolled BP.
Out of 1, 235, 453 hypertensive individuals enrolled in the IHCI project across 15 states, 1, 046, 512 remained under care, with 44% BP control. The control varied from 26% to 57% in various types of facilities. The states of Maharashtra, Punjab and Rajasthan had above 50% control, while Nagaland, Jharkhand and Bihar had below 25%. BP control declined from 68% when defined using a single recent reading to 52% when defined using the two-visit readings. Younger individuals (
We documented the implementation of IHCI strategies at scale and measured treatment outcomes in a large cohort. Overall, BP control improved with variations across states. We need focused strategies to improve control in higher-level facilities, among males and people with diabetes. Using two BP readings may support consistent treatment adherence.
Nurses' burnout, work instability (WI), and job satisfaction (JS) in their practice environment (PE) are well established in the literature. However, perinatal missed care (PMC), a subset of missed nursing care, remains underreported among maternity nurses.
To examine the mediating role of PE and burnout in the associations of WI, JS, and PMC among maternity nurses.
A cross-sectional and correlational study employed consecutive sampling to recruit maternity nurses (n = 312) from five hospitals in Saudi Arabia (three government and two private hospitals in Hail and Makkah regions, respectively). Maternity staff nurses, regardless of their sex, years of professional nursing experience, or nationality, who met inclusion criteria were included in this study. Data was collected from July to September 2024 using four standardized self-report scales. Structural equation modeling was utilized for statistical analyses.
Maternity nurses' WI negatively influenced PE (β = −0.23, p = 0.014), while positively affected PMC (β = 0.15, p = 0.031). The PE positively affected JS (β = 0.24, p = 0.034) but had a negative effect on burnout (β = −0.24, p = 0.007) and PMC (β = −0.21, p = 0.038). Burnout negatively affected JS (β = −0.25, p = 0.028), while positively associated with PMC (β = 0.20, p = 0.022). PE mediated the associations between WI and burnout (β = 0.05, p = 0.019), JS (β = −0.07, p = 0.020), and PMC (β = −0.06, p = 0.008). Meanwhile, burnout mediated between PE and JS (β = 0.05, p = 0.030) and PMC (β = −0.04, p = 0.023).
Understanding the relationships among maternity nurses' burnout, JS, PE, and PMC is key to improving the quality of perinatal care and ensuring the patients' well-being. By focusing on strategies to enhance the PE (e.g., adequate staffing and resources, improved nurse–patient ratio), reduce burnout (e.g., meditation and mindfulness programs, coping intervention programs), and improve JS (e.g., work schedule flexibility, facilitate work-life balance, staff professional development), healthcare organizations can mitigate the occurrence of PMC.
by Emmanuel Timmy Donkoh, Iddrisu Wahab Abdul, Abraham Kwadzo Ahiakpa, Isaac Williams, Rita Nyaaba Akologo, Stephen Danyo, Chrysantus Kubio, Kofi Effah, Joseph Emmanuel Amuah
BackgroundCervical cancer, though preventable, remains the second most diagnosed cancer and the primary cause of cancer-related deaths among females in Sub-Saharan Africa. The significance of coordinated screening programmes for reducing the burden of cervical cancer in Africa is not well documented. This systematic review will summarize published reports from key databases, grey literature and programme reports to assess the performance of cervical cancer prevention programmes in Ghana.
MethodsTo be eligible for inclusion, interventions must target Ghanaian women with cervical cancer screening and prevention strategies using methods such as visual inspection with acetic acid (VIA), mobile colposcopy, HPV DNA testing, cytology (Pap smear), and treatment approaches such as cryotherapy, thermal ablation, loop electrosurgical excision procedure (LEEP). A comprehensive electronic search strategy will be used to identify studies published since database inception, and indexed in MEDLINE, EMBASE, CINAHL and Web of Science. The search strategy will include MeSH terms (and synonyms) relevant to cervical cancer, screening/treatment methods, geographic focus and implementing institution. We will include searches for grey literature, recognizing the value of programmatic and governmental reports that might not appear in traditional databases. Search results will be summarized in line with PRISMA guidelines. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach will be used to evaluate and document evidence certainty for all outcomes, internal validity of included reports, inconsistency, indirectness, imprecision, and publication bias. Where sufficient homogeneity exists among included studies in terms of interventions, study designs, populations, and outcome measures, we will perform a meta-analysis to calculate pooled effect estimates and their corresponding 95% confidence intervals.
SignificanceThis systematic review will assess the performance and impact of cervical cancer screening and prevention programmes conducted in Ghana to date and identify what contextual strategies have delivered the most impact as well as highlight what gaps remain in our understanding of how a nationwide screening programme can be properly construed for maximum impact.
by Resham B. Khatri, Rolina Dhital, Sabita Tuladhar, Nisha Joshi Bhatta, Yibeltal Assefa
BackgroundImproving maternal health is a global priority for overall socioeconomic development countries, especially in the low- and middle-income countries including Nepal. Recently, Nepal has made significant progress in enhancing access to maternal health services and in reducing maternal mortality ratio (MMR). Nonetheless, the MMR remains high (151 maternal deaths per 100,000 live births), with a slower rate of decline in recent years, particularly among disadvantaged groups. This study investigates trends and determinants of key maternal health services in Nepal.
MethodsWe conducted further analysis of secondary data from the most recent three Nepal Demographic and Health Surveys (NDHS) conducted in 2011 (n = 1,057), 2016 (n = 964), and 2022 (n = 981) among women aged 15–49 who had at least one live birth prior to each survey. The outcome variables for the trend analysis included the uptake of at least four antenatal care (4ANC) visits, institutional deliveries, first postnatal care (PNC) within 48 hours of childbirth, and completion of all these three routine visits. Determinants of institutional delivery, delivery in private health facilities (HFs), cesarian section (CS) deliveries, and uptake of maternity incentive were investigated. Independent variables included socioeconomic characteristics of women and their marginalization status, geographic factors (e.g., province), health system factors (health service use). A multivariable logistic regression analysis was conducted using data from the NDHS 2022 to investigate the associated determinants of outcome variables considering p value Results
Results showed low completion rates (59%) of all three maternity care visits and significant discontinuity of care throughout the maternity continuum (82% 4ANC, and 73% PNC visits). From 2011 to 2022, there were increased institutional deliveries overall (47% to 81%) and CS within private HFs (30% to 51%), alongside a decreasing trend in the utilization of maternity incentives (87% to 78%). Women from Karnali province and those facing multiple forms of marginalization (women form lower wealth status and who belong to marginalized ethnicities (e.g., Dalits or Janajatis), and lack of education had lower odds of institutional delivery. Conversely, women who attended at least 4ANC visits had higher odds of institutional delivery. Higher odds of childbirth in private HFs were identified in the Koshi, Bagmati, Madhesh, and Lumbini provinces, particularly among women with fewer forms of marginalization. In contrast, women who worked as manual labor or those with higher birth orders had lower odds of childbirth in private HFs. Notably, higher odds of delivery by CS were observed among older women, women who were Maithili native speakers, and in provinces where higher delivery in HFs. Furthermore, the odds of uptake of maternity incentives were lower among women who had gave births in private HFs.
ConclusionsMarginalized women experience lower uptake of routine maternity care visits and higher discontinuation along the antenatal through to ponstantal period, creating significant equity gaps in Nepal. The increasing trend of deliveries in private HFs, particularly deliveries by elective CS without maternity incentives could lead to financial hardship while seeking routine maternal health care. Health systems should adopt targeted strategies addressing specific needs, considering intersecting marginalization factors. Key interventions include improving infrastructure, hiring and training local health workers, revising maternity incentives, regulating private HFs, and conducting quality audits, including increasing trends of CS deliveries.
by Ashvene Sureshkumar, Robert Simpson, Mark Bayley, Monika Kastner, Jillian Scandiffio, Emilia Main, Claire Zhang, Harzaan Gnanakaran, Joshua Wijeratne, Alesha Saxena, Sarah Munce
ObjectiveThis paper aims to standardize a scoping review protocol for completion of a scoping review. The proposed scoping review aims to: 1) determine the extent of the literature on which implementation strategies have been used to develop, deliver, and sustain psychological interventions for people with multiple sclerosis (PwMS) and 2) investigate how equity, diversity, inclusion and accessibility considerations are embedded within these implementation strategies and psychological interventions more broadly.
IntroductionPeople with multiple sclerosis experience high levels of stress, anxiety and depression. Psychological interventions, such as mindfulness-based interventions have been shown to be effective in managing these symptoms, yet their implementation in clinical practice is underexplored. Investigating the implementation of psychological interventions can help contextualize the efficacy and impact of these programs for PwMS. This proposed review aims to fill this knowledge gap by determining which implementation strategies have been used to develop and deliver psychological interventions for PwMS.
MethodsThis scoping review will follow the Joanna Briggs Institute (JBI) methodology and reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR). The search will be conducted across MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsychInfo (Scopus). Two reviewers will independently conduct screening and data extraction in duplicate, with any disagreements resolved through discussion and involvement of a third reviewer. Data extraction will be guided by the JBI template. Quantitative data will be reported descriptively, and a conventional content analysis will be undertaken for qualitative data.
Inclusion criteriaThis scoping review will include studies globally published in peer-reviewed academic journals in English involving PwMS that report on implementation strategies for live, professional-led psychological interventions. Pharmacological studies or studies focusing only on effectiveness of psychological interventions will be excluded.
To explore the perspectives of Kazakhstani healthcare professionals on environmental sustainability in healthcare.
An exploratory qualitative design.
Four focus group discussions (FGDs) on environmental sustainability in healthcare were conducted among healthcare professionals (nurses, physicians, midwives and physical therapists) from June to August 2023 in three cities of Kazakhstan. Each FGD consisted of at least 6 to 11 participants and lasted between 60 and 90 minutes. The collected data were analysed using the thematic analysis.
A total of 137 initial codes were identified and further organized into 22 sub-themes based on similarities in codes and meanings, and then 5 significant themes were identified. The five main themes are ‘Environmental Sustainability Practices in Healthcare’, ‘Purposes of Environmental Sustainability in Healthcare’, ‘Impact of Environmental Sustainability in Healthcare in Patients’, ‘Challenges in Implementing Environmental Sustainability in Healthcare’ and ‘The Role of Healthcare Leadership in Improving Environmental Sustainability in Healthcare’.
The findings highlighted the perceptions and practices of healthcare professionals on environmental sustainability's purposes in healthcare, its impacts on patients and its implementation challenges. The study also underscored the critical role of strong and active leadership in ensuring a sustainable implementation of green policies in healthcare facilities and achieving successful results of environmentally conscious healthcare practices.
The findings provide invaluable information that can be used by policymakers and healthcare organization leaders to create a sustainable healthcare system. Implementing environmental sustainability practices in healthcare should be widespread, intentional, and sustainable, entailing strong leadership and unwavering personal and organizational commitment.
No patient or public contribution.
We adhered to relevant EQUATOR guidelines, specifically the Consolidated Criteria for Reporting Qualitative Research.
To explore Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease in primary care.
An inductive, descriptive qualitative study.
Data were collected through semi-structured interviews with 11 purposively sampled Registered Nurses of varying levels of experience from eight regions in Sweden. The audiotaped interviews were conducted over a 5-month period (December 2023–April 2024), transcribed verbatim and analysed using interpretive description.
Registered Nurses' experiences of continuity of care for patients with chronic obstructive pulmonary disease are described by three themes (seven subthemes): Patient continuity (Building personal relationships: Being accessible and enabling trust and confirmation), Collaborator continuity (Having a colleague to lean on: Colleagues can lean on me: Feeling alone with my expertise) and Continuity with myself (Trusting my own competence: Carrying a burden alone).
Consolidated Criteria for Reporting Qualitative Research Guidelines.
This study provides an understanding of Registered Nurses' experiences of continuity of care in primary care. The results may help improve future care since nurses play an essential role in the care of chronic obstructive pulmonary disease within primary care.
To enhance continuity of care for patients with chronic obstructive pulmonary disease, the relationship between the nurse and the patient is important, as is collaboration with colleagues. This collaborative approach allows these nurses to maintain continuity with both the patients and themselves, fostering a more stable and effective care environment.
This study offers valuable insights into the experiences of Registered Nurses in maintaining continuity of care within primary care, particularly for patients with chronic obstructive pulmonary disease. By highlighting the critical role of Registered Nurses in managing these patients, the study underscores the importance of strong nurse–patient relationships and effective collaboration among healthcare professionals.
No Patient or Public Contribution.
by Joseph E. Rubin, Florence Huby, Roshan P. Madalagama, Shyamali de Alwis, Melinda Wyshynski, Rasika Jinadasa
The ability to prepare sterilized media is a critical capability of any microbiology lab. Diagnostic labs in low-resource settings, which lack autoclave facilities, are therefore severely limited in their ability to perform basic assays such as bacterial culture or biochemical tests. This investigation aimed to validate the use of a commercially available pressure cooker as an autoclave substitute to produce agar plates. First, a Geobacillus stearothermophilus biological indicator was used to confirm adequate sterilization. Next, the colony morphology of several important bacterial species were compared on MacConkey and 5% sheep’s blood agar plates prepared using the pressure cooker with those made in an autoclave. Finally, disc diffusion susceptibility testing was performed to determine whether the sterilization method impacts the inhibitory zone diameters. Overall, the morphology of colonies was similar on media prepared in both ways; key phenotypic characteristics (lactose fermentation, colour, shape, hemolysis and smell) were the same. Kirby-Bauer disc diffusion test results were nearly identical. These findings indicate that a commercially available pressure cooker may be suitable to prepare media in low-resource laboratories.by Daniel Bekele Ketema, Min Jun, Sradha Kotwal, Workagegnehu Hailu, Martin Gallagher, Rohina Joshi
BackgroundChronic kidney disease (CKD) is a growing public health problem in Ethiopia. However, evidence on the health system and contextual factors influencing CKD care remains limited. This study explored the barriers and facilitators to CKD care from the perspectives of healthcare providers and other stakeholders.
MethodsA descriptive qualitative study was conducted using purposive and maximum variation sampling to recruit healthcare providers (including general practitioners, nephrologists/internists, nurse) and non-communicable disease (NCD) officers and program coordinators. Interviews were audio recorded, transcribed, and thematically analysed, underpinned by the Theoretical Domains Framework version 2.
ResultsFifteen participants (six general practitioners, five nephrologists/internists, one nurse, and three NCD program officers and coordinators) were included. About 40% of participants had over six years’ experience. Key barriers to CKD care included patient misconceptions, low patient and healthcare provider awareness, shortage of health workforce, knowledge gaps among junior healthcare providers, limited resources, high out-of-pocket costs, absence of registries for CKD, weak referral systems, inconsistent access to medicines and diagnostics, lack of structured training, and conflict-related disruptions. Facilitators included adherence to guidelines by senior staff, inclusion of CKD into national non-communicable disease strategies, and increased use of media for public health education.
ConclusionsAddressing key barriers and enhancing prioritisation of CKD by clinicians and policymakers is critical. Strengthening workforce capacity, awareness, referral systems, and integration into national strategies offers opportunities to improve CKD care.
To co-develop storyboards and scripts for multimedia resources to support the information needs of informal carers (carers) of older adults from Greek, Italian and Chinese (Cantonese- and Mandarin-speaking) Australian backgrounds during hospital-to-home transitions.
A modified experience-based co-design methodology was used to co-develop four storyboards and scripts with Greek, Italian and Chinese Australian carers and advocates from multicultural community-aged care organisations. To promote relevance, a Carer Advisory Group guided the research. The Carer Advisory Group, comprising 10 people, included carers and advocates from participating multicultural community-aged care organisations, a social worker from a large public health service, and policy representatives. Twenty-nine participants took part from June 2023 to April 2024. Data collection involved two rounds of co-development including 2 workshops, 9 small group interviews and 11 individual interviews. Round 1 focused on understanding participants' experiences of older adult care transitions, information needs and advice for other carers. This information was used to develop categories and example quotes to draft four storyboards reflecting participants' descriptions of the carer and patient journey during care transitions. Round 2 involved draft storyboards being presented to the same participants who advised on their acceptability. Certified interpreters and translators were used throughout data collection.
The co-developed categories, four storyboards and scripts are presented. Participants and the Carer Advisory Group agreed that the findings would be used to develop multimedia resources to support the information needs of carers and older adults from Greek, Italian and Chinese Australian backgrounds in care transitions.
The storyboards and scripts for multimedia resources are expected to improve access to information and services for carers and older adults from culturally and linguistically diverse backgrounds. The storyboards and scripts are examples to guide policymakers and leaders in improving transitional care in Australia and internationally.
The reporting of the study has adhered to the COREQ guidelines.
Informal carers were involved in the Carer Advisory Group which provided guidance and consultation to each phase of the project. Their contributions included reviewing the ethics application prior to submission for ethical review, and reviewing storyboards and scripts to optimise the relevance for informal carers and older adults.
This integrative review aimed to describe the postoperative wound care practices and knowledge of nurses in acute care settings. Whittemore and Knafl's framework was used to identify and synthesise relevant studies. Full-text, primary articles published after 2000, focusing on postoperative wound care by nurses in hospital settings, were included. Quality appraisal was undertaken using the Mixed Methods Appraisal Tool (MMAT) for qualitative and quantitative studies and the Standards for QUality Improvement Reporting Excellence (SQUIRE) 2.0 for quality improvement (QI) studies. Five databases were searched (MEDLINE, Scopus, CINAHL, Embase and Web of Science) in August 2024. Of the 5329 studies, 36 articles were included. Inductive content analysis was used for data synthesis. Three categories were identified: Variation in using a holistic approach impacts optimal wound care practice, nurses' surgical wound care practices are shaped by individual factors, organisational support, and resource availability, and nurses' participation in surgical wound care is influenced by role clarity and multidisciplinary collaboration. In conclusion, this integrative review highlights that acute care nurses predominantly focused on technical dressing procedures with limited emphasis on comprehensive assessment, documentation, nutrition and patient education. Therefore, adopting a more holistic approach in surgical wound care could minimize practice variations among nurses.
This study aimed to gain clinician consensus on which signs/symptoms reported to be indicative of biofilm in chronic wounds are likely to be so. An international, two-round eDelphi process including wound care clinicians ran from December 2023 to February 2024. Participants rated 26 items on a 9-point Likert scale. Consensus to include: ≥ 70% of respondents rate an item 7–9, ≤ 15% rate it 1–3. Consensus to exclude: ≥ 70% of respondents rate an item 1–3, ≤ 15% rate it 7–9. Eleven items (visual indicators [a shiny, slimy, persistent layer, easily removed, returns quickly without frequent intervention]; failure to respond to antimicrobials; infection > 30 days duration; poor quality granulation tissue; stalled wound despite optimal management; persistent/prolonged inflammation; wound > 6 weeks duration; soft tissue deterioration despite antimicrobials/debridement; signs of local infection; tunnelling/undermining; presence of slough) achieved consensus to include status. To our knowledge, consensus work on this topic has not previously been performed on such a wide scale. When examined alongside similar work, clinical opinion on the matter lacks coherence. We hope that these findings will help direct us toward greater cohesiveness. The work supports a need for research to quantify the predictive abilities of signs and symptoms reported to be indicative of biofilm in chronic wounds.
by Jonathan Karisa, Cassidy Rist, Mercy Tuwei, Kelly Ominde, Brian Bartilol, Zedekiah Ondieki, Haron Musani, Caroline Wanjiku, Joseph Mwangangi, Charles Mbogo, Martin Rono, Philip Bejon, Marta Maia
BackgroundThe use of MALDI-TOF MS for mosquito identification and surveillance is routinely used in developed countries as an affordable alternative to molecular methods. However, in low- and middle-income countries (LMIC) where mosquito-borne diseases carry the greatest burden, the method is not commonly employed. Using the Kenyan national malaria program (NMCP) as a case study, we compared the costs of current methods used for malaria vector surveillance to those that would be incurred if MALDI-TOF MS were used instead.
MethodsA deterministic decision tree analytic model was developed to systematically calculate the costs associated with materials and labour, and time-to-results for two workflows, i.e., current molecular methods versus MALDI-TOF MS. The analysis assumed an annual sample size of 15,000 mosquitoes (representing the average number of mosquitoes analysed annually by the Kenyan NMCP) processed at a local laboratory in Kenya.
FindingsWe estimate that if the Kenyan national entomological surveillance program shifted sample processing completely to MALDI-TOF MS, it would result in 74.48% net time saving, up to 84% on material costs and 77% on labour costs, resulting in an overall direct cost savings of 83%.
InterpretationAdoption of MALDI-TOF MS for malaria vector surveillance can result in substantial time and cost savings. The ease of performance, the rapid turn-around time, and the modest cost per sample may bring a paradigm shift in routine entomological surveillance in Africa.
Diabetes mellitus is a significant global health challenge, requiring innovative strategies to improve management and mitigate complications. Digital health technologies offer promising solutions to enhance diabetes self-care by providing real-time feedback, improving communication and supporting data-driven decision-making. Despite the increasing adoption of digital self-care interventions, there is a lack of comprehensive synthesis of evidence on their impact, accessibility and integration into healthcare systems. This scoping review aims to map existing research on digital self-care solutions for diabetes management, identify knowledge gaps and highlight best practices and key factors influencing adoption.
The review will follow Arksey and O’Malley’s framework and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A systematic search will be conducted in Medline, Scopus, Embase, CINAHL and Google Scholar, focusing on studies published from January 2004 to December 2024 in English, French, Arabic, Portuguese, Spanish, Italian, Czech, Slovak and Chinese. Studies reporting on digital self-care solutions for diabetes management will be included, covering experimental and quasi-experimental study designs. Data extraction will cover study and participant characteristics, digital solution features, and barriers and facilitators to adoption. Ethical and equity considerations will also be analysed using established frameworks. Two reviewers will independently screen studies, with discrepancies resolved by a third reviewer.
This scoping review will provide a comprehensive understanding of digital self-care solutions for diabetes management, offering insights to inform future research and enhance self-care practices globally. Findings will be disseminated through peer-reviewed publications, conferences and interest holder engagements to inform clinical practice and policy development. As this study involves the review of existing literature, ethical approval is not required.
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