Conectar
by Catarina Simões, Diana S. Vasconcelos, Raquel Xavier, Xavier Santos, Catarina Rato, D. James Harris
Fire has long been recognized as an important ecological and evolutionary force in plant communities, but its influence on vertebrate community ecology, particularly regarding predator-prey interactions, remains understudied. This study reveals the impact of wildfires on the diet of Podarcis lusitanicus, a lizard species inhabiting a fire-prone region in the Iberian Peninsula. In order to explore diet variability associated with different local burn histories, we evaluated P. lusitanicus diet across three types of sites in Northern Portugal: those had not burned since 2016, those burned in 2016, and those more recently burned in 2022. Podarcis lusitanicus is a generalist arthropod predator with dietary flexibility. Given the turnover of arthropod species after fire, it is expected to find variations in diet caused by different fire histories, especially between unburned and recently burned sites. From DNA metabarcoding of faecal samples, our study revealed that while prey richness remained unaffected by wildfire regime, significant shifts occurred in diet composition between more recently burned and unburned areas. Specifically, we found that differences in diet composition between these two fire regimes were due to the presence of Tapinoma ants and jumping spiders (Salticus scenicus). These prey were present in the diets of lizards occupying unburned areas, while these were absent in areas burned in 2022. Interestingly, diets in unburned areas and areas burned in 2016 showed no significant differences, highlighting the lizards’ ecological flexibility and the habitat’s resilience over time. The ant species T. topitotum was found in dominance in both burned areas, suggesting that this species may be fire tolerant. In addition, families such as Cicadellidae and Noctuidae were found to be more associated with more recently burned areas. The use of DNA metabarcoding in this study was essential to provide a more detailed and accurate view of predator-prey interactions in ecosystems susceptible to fire, and therefore a better understanding of changes in prey consumption in this fire-adapted ecosystem.To systematically review the evidence on the association between non-standard working time arrangements (such as night work or shift work) and the occurrence of safety incidents.
Systematic review conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a structured narrative approach and the Synthesis Without Meta-analysis framework to evaluate and summarise findings.
MEDLINE, Embase, PsycINFO, Web of Science and ProQuest Health and Safety Science Abstracts were searched through February 2024.
We included peer-reviewed English-language studies of paid workers (18–70 years) that examined the association between non-standard working time arrangements and safety incidents (accidents, near-accidents, safety incidents or injuries), excluding cross-sectional designs and studies on unpaid workers, athletes or military personnel.
Two reviewers independently extracted data and assessed risk of bias using standardised forms, extracting study characteristics (author, year, country, sector and population), working time arrangements and exposure assessment, outcomes and their assessment, and reported risk estimates. We conducted a narrative synthesis, classifying studies into three exposure contrasts (shift worker versus non-shift worker, time-of-day and shift intensity), and summarised risk estimates using forest plots without calculating pooled effects.
A total of 13 569 records were screened, and 24 studies met the inclusion criteria. The results indicated that shift workers generally had an elevated safety incident risk compared with non-shift workers (risk estimates ranged from 1.11 to 5.33). Most of the included studies found an increased risk of safety incidents during or after night shifts. Accumulated exposure to evening or night shifts increased the risk of safety incidents during the following 7 days. However, bias and heterogeneity across studies in design, populations and outcome measures resulted in an overall low to very low certainty of the evidence.
Non-standard working time arrangements, including night and evening shifts, appear to increase the risk of occupational safety incidents. Despite the low certainty of evidence, the findings highlight a potential area for preventive measures in work scheduling. Future longitudinal studies using individual data on daily working hours are needed.
To examine the relationship between weight loss and problems with oral intake in institutionalised older adults.
A 1-year longitudinal observational study.
Data were obtained from a prospective study conducted in three nursing homes and two long-term care facilities in Japan. Participants' problems with oral intake were assessed using items published in 2021 by the Japanese Ministry of Health, Labour and Welfare. Baseline and follow-up factors were compared between individuals who experienced a weight loss of 5% or more and those who did not. Separate multivariable logistic regression models were constructed for each oral intake assessment item to examine its independent association with weight loss of 5% or more, accounting for transitions in each item between baseline and the 1-year follow-up.
In total, 172 institutionalised older adults were included in the analysis. Among them, 57 (33.1%) participants experienced a weight decrease of 5% or more. The emergence of somnolence or clouding of consciousness during meals at the 1-year follow-up in participants without these signs at baseline was independently associated with a weight loss of 5% or more, after adjustment for baseline characteristics.
Recognising signs of somnolence or clouding of consciousness during meals may be useful for the early detection and prevention of weight loss in institutionalised older adults.
Early detection of individuals at risk is essential to prevent significant weight loss and its associated adverse outcomes. Recognising somnolence or clouding of consciousness during meals may enable earlier detection and intervention to prevent weight loss and improve the quality of care for older adults.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
Asthma is a leading cause of morbidity and healthcare use among children. Risk factors of childhood asthma include atopic predisposition and severe wheezing episodes caused by rhinovirus infection in early life. In children with first-time rhinovirus-induced wheezing, we aim to study the response of a short corticosteroid treatment to prevent recurrent wheezing and asthma.
This is a double-blind, randomised, placebo-controlled, phase IV, international multicentre trial involving eight sites in Norway, Sweden and Finland. Two hundred and eighty 3–23 months old steroid-naïve children are randomised 1:1 to receive oral dexamethasone (0.3 mg/kg/day) versus placebo in 3 days for their first wheezing episode and rhinovirus infection. Rhinovirus is diagnosed with multiplex PCR. The two co-primary outcomes are time to next physician-confirmed wheezing episode, and time to asthma, within 24 months from inclusion. Asthma is defined as fulfilment of the 2007 National Asthma Education and Prevention Program—criteria for initiating asthma controller medication in children aged 0–4 years. Primary interaction analyses are age, gender, atopic predisposition, risk genotypes and viral co-detection. The optimal cut-off on the rhinovirus genome load used to define a true rhinovirus infection will be assessed by exploring interactions between rhinovirus genomic loads and study drug on the co-primary outcomes. Secondary outcomes are number of wheezing episodes, duration and severity of each wheezing episode, bronchial hyperreactivity, quality of life and safety (height/weight development) at 24 months from inclusion.
Rhinovirus positive children with acute wheezing fulfilling inclusion and exclusion criteria are enrolled after informed consent from both caregivers. This trial has received ethical approval from all sites. Results will be submitted to Competent Authorities and disseminated via peer-reviewed publications and conferences within paediatrics and other relevant fields. If proven effective, findings may be implemented directly into paediatric clinical guidelines.
Dermoscopy has a proved validity in the diagnosis of cutaneous melanoma, which is one of the most aggressive forms of skin cancer. Although some studies have demonstrated a relationship between specific dermoscopic and pathologic melanoma features, there is no solid evidence allowing reliable conclusions. This study will evaluate the evidence regarding this association.
Observational studies eligible for our systematic review will enrol adults with histological cutaneous non-volar melanoma diagnosis and with dermoscopy image analysis. We will search the following databases: PubMed, Embase, Web of Science, MEDLINE and Cochrane Library. We will not impose any language or date restrictions. Outcomes of interest include the association of at least one of the melanoma dermoscopy features (irregular pigmentation, blue-white veil, atypical network, multicomponent pattern, atypical dots and/or globules, regression, peripheral tan structureless area, negative network, shiny white structures, atypical vessels and streaks/pseudopods), with melanoma Breslow index or other histopathology characteristics (melanoma subtype, mitotic index and presence of ulceration). Two reviewers will independently screen and search results, extract data from eligible studies and assess risk of bias. The evidence derived by this study will elucidate the possible link between melanoma dermoscopy and histopathology. If we could predict melanoma thickness based on dermoscopy, we would be able to anticipate melanoma treatment with impact on survival.
Ethical approval is not required because this is a literature-based study. It will be published in scientific Pubmed indexed open access journals to ensure its accessibility.
CRD42024564919.
Asthma is a major personal and public health problem worldwide, with a significant impact on patients’ quality of life and health systems. The prevalence of asthma in children is 9.1% and in adolescents is 11%. Greater literacy among children is related to better asthma control. There are many validated Patient-Reported Outcome Measures (PROMs) related to asthma, but there are only a few, and no gold standard, to measure children and adolescents’ knowledge of asthma. Therefore, the purpose of this systematic review is to evaluate the most suitable asthma self-knowledge PROMs for the paediatric population with asthma.
The inclusion criteria will be children and adolescents diagnosed with asthma (population), validated PROMs about asthma self-knowledge (intervention), between each PROM (comparison) and measurement properties (outcome) (validity, reliability, interpretability and responsiveness). The search process will be conducted in PubMed, Web of Science, EMBASE and SCOPUS. The risk of bias evaluation will be done independently by two authors with the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist, and the quality of evidence will be evaluated based on the Grading of Recommendations Assessment, Development and Evaluation approach.
Ethics approval is not applicable for this study since the data that will be collected are secondary data and are already in the public domain. The results will be disseminated through peer-reviewed publication and conference presentations.
CRD42024577500.
Global organizations have pronounced about the importance of involving people in health care, however, this process is challenging. Given the availability of evidence that addresses people's experiences of involvement in nursing care, it is important to produce recommendations at this point by synthesizing the evidence. So, this review aims to synthesize the available qualitative evidence about people's experiences of their involvement in nursing care in a hospital setting.
Systematic review of qualitative evidence.
This systematic review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A comprehensive search strategy was conducted in nine databases/resources. The selection process, methodological quality assessment, and data extraction were conducted independently by two reviewers. The data were synthesized using the meta-aggregation approach, and the results were graded according to ConQual.
A total of 75 findings and 141 illustrations were extracted from the 15 included studies. These findings were aggregated into 12 categories and generated into three synthesized findings: (1) People who are hospitalized conceptualize and attribute importance to involvement in nursing care as an active process of participation and monitoring of care, decision-making, opinion, and partnership; (2) The establishment of a relationship between hospitalized people and nurses, trust, communication, and information are essential for participation in care; (3) People's participation in care is affected by the person's own constraints and preference for assuming a passive role, by barriers associated with a lack of information, the organization of care, the relationship established between nurses, and paternalistic attitudes.
People who were admitted to hospital conceptualized and attached importance to this phenomenon, perceived the conditions necessary to promote it, and the barriers they experienced.
This systematic review provides recommendations for nurses' clinical practice (with grade B). It recommends that nurses should establish a partnership relationship with hospitalized people, through trust, communication and information; give people the opportunity to monitor care, participate in decision-making and give their opinion; assess the person's preferences for involvement and other factors; and that the barriers to this process identified here should be assessed and addressed in each context. As such, this review provides very valuable information for nurses' clinical practice and should also be incorporated into health policy.
Protocol Registration: PROSPERO CRD42024506501.
by Jaimee Cooper, Jeenu Mittal, Max Zalta, Nicholas DiStefano, Delany L. Klassen, Keelin McKenna, Dimitri A. Godur, Andrea Monterrubio, Moeed Moosa, Rahul Mittal, Adrien A. Eshraghi
Cochlear implantation is a surgical intervention to provide auditory rehabilitation to individuals with severe to profound hearing loss. Intraoperative electrocochleography (ECochG) has emerged as a promising tool for monitoring cochlear health during cochlear implant (CI) surgery. This systematic review aims to synthesize current evidence regarding the effectiveness of intraoperative ECochG in predicting postoperative residual hearing levels in CI recipients. A comprehensive literature search was conducted across major databases including PubMed, Embase, Web of Science, and SCOPUS. The protocol for this systematic review was registered in the PROSPERO database (registration number: CRD42023476617). The key outcomes assessed were the correlation between intraoperative ECochG patterns and postoperative residual hearing levels, as well as the influence of surgical techniques and electrode design on ECochG responses and hearing preservation. The Risk of Bias analysis was conducted using the Joanna Briggs Institute Critical Appraisal Tool. The review included a total of eighteen studies that met the inclusion and exclusion criteria. A significant correlation was reported between specific intraoperative ECochG response patterns and the preservation of residual hearing post-surgery. Studies highlighted that robust ECochG responses typically indicated a higher likelihood of postoperative hearing preservation. The review also identified factors influencing ECochG responses, including electrode design and insertion techniques. Several studies reported improved preservation of residual hearing with modifications in surgical approaches guided by ECochG feedback. Intraoperative ECochG monitoring emerges as a crucial tool in predicting and potentially enhancing postoperative residual hearing outcomes in implanted individuals. The review underscores the value of ECochG in guiding surgical technique adjustments, thereby maximizing hearing preservation. However, the heterogeneity in study designs and ECochG protocols suggests a need for standardization in this field. Future research should focus on large-scale, multicenter trials to establish definitive guidelines for integrating ECochG in CI surgeries, with an emphasis on long-term hearing outcomes.The objective was to explore treatment experience of hip denervation via PEricapsular Nerve Group block with phenol in non-operative management and end-of-life (EOL) care after hip fractures.
A qualitative study was conducted with semistructured interviews. The interviews were analysed using thematic discourse analysis.
The study was conducted in a large regional hospital in the Netherlands. Proxies (first-contact person, often a first-degree or second-degree relative) of frail older adults treated between January 2022 and June 2023 were included, as patients had either cognitive impairment or were deceased.
The process surrounding hip denervation was emotionally charged due to the EOL setting and preceding discussion on whether or not to operate. The EOL setting impaired information uptake in participants and complicated communication. Hip denervation was experienced as a partial source of comfort. Logistics and aftercare were described as suboptimal. Participants emphasised the importance of a dignified and autonomous EOL phase.
This study describes treatment experience from the patient–proxy perspective. It highlights the importance of a provider setting attuned to EOL care needs. Adequate pain management, effective communication and realistic autonomy for patients and proxies are warranted.
Chronic wounds can impact the quality of life of working-age individuals. However, the specific challenges and burdens these patients face in the workplace remain understudied. This study aimed to 1) investigate how chronic wounds affect work life and 2) develop a screening tool for identifying highly affected patients. In total, 51 patients with chronic wounds answered a questionnaire on demographics, employment status, wound-related limitations, workplace conditions, social welfare use and subjective burden of disease. To assess the subjective burden, we developed a specific research tool on employment and chronic wounds (REACH Score) to measure and quantify the impact of the chronic wound on working patients. The patients, who answered the questionnaire, were employed (78%), on sick leave (18%) or retired (4%). They spent an average of 5.3 h per week on wound-related activities. Regarding workplace stressors, we found that taking breaks when needed was correlated with less time off sick and better work-related quality of life. Patients reported career concerns and reduced productivity. The REACH score was significantly correlated with sick leave, work difficulties, time consumed by the wound and overall quality of life. According to our pilot-study, the impact of chronic wounds on patients of working age is most evident in the form of sick leave and reduced work performance and in a reduced quality of life. It is crucial to identify the key factors contributing to stress in the work environment in a larger sample in order to improve the working conditions of patients and detrimental socioeconomic effects on the workforce. The REACH score is a novel tool to screen employed patients with chronic wounds for reduced work capacity and quality of life.
Arterial stiffness as assessed by pulse wave velocity (PWV) improves the prediction of first-ever and recurring stroke and of stroke outcomes when measured in the days after stroke. Here, we investigated the longitudinal dynamics of PWV in the days after acute ischaemic stroke.
Monocentric, prospective cohort study nested within a clinical trial registry with repeated measurement assessment of PWV.
Comprehensive middle European stroke centre.
20 men and women that suffered stroke from November 2022 through August 2023.
Change in carotid-femoral PWV was investigated by recording PWV four times between 1.2 and 9.9 days after stroke using a Vicorder device. Haemodynamic and patient-, stroke- and care-related variables were investigated as potential modifiers of PWV trajectories.
Twenty patients aged 61.3±16.9 years (14 males) were included. There was a daily decline in PWV of –0.19 m/s (95% CI: –0.29 to –0.09; p0.05). Rank-order correlation between the earliest and latest PWV measurements was 0.87 (95% CI: 0.69 to 0.95; p
A marked decline in PWV during the first week after acute ischaemic stroke should be accounted for when interpreting PWV after recent stroke.
The STROKE-CARD Registry was registered at ClinicalTrials.gov (NCT04582825).
The evidence on products for the prevention of radiodermatitis is limited. The primary objective was to analyse the effectiveness of the spray skin protectant ‘non-burning barrier film’ in the prevention of radiodermatitis with moist desquamation in patients with the anal canal and rectal cancer followed in nursing consultations compared to a standardised moisturiser based on Calendula officinalis and Aloe barbadensis. Single-blind randomised clinical trial. The study was performed in a hospital in Rio de Janeiro, Brazil, with 63 patients undergoing anal canal and rectal cancer treatment, randomised into one of the following two groups: an experimental group, which used a spray skin protectant and a control group, which used a moisturiser. Data were collected using an initial and subsequent evaluation form and were assessed using descriptive and inferential analyses. Participants who used the spray skin protectant had a lower chance of presenting radiodermatitis with moist desquamation and a longer time without this outcome when compared to the control group. The overall incidence of radiodermatitis was 100%, with 36.5% being severe. Furthermore, 17.5% of participants discontinued radiotherapy due to radiodermatitis. There were no differences between the groups regarding the severity of radiodermatitis and the number of patients who discontinued radiotherapy. The skin protectant was effective in preventing radiodermatitis with moist desquamation amongst patients with anal canal and rectal cancer.
Diabetic foot ulcers (DFUs) pose a significant clinical challenge, often leading to amputations and hospitalisation. This study aimed to investigate the characteristics and outcomes of DFUs treated with surgical debridement and standardised wound care. This descriptive cross-sectional study focused on diabetic patients with appropriate vascular conditions, as determined by an Ankle Brachial Index >0.9. Based on their infection status, participants were admitted to Poursina Hospital in Rasht, Iran, and subjected to initial supportive measures, antibiotic therapy and surgical debridement. The study incorporated primary treatment with wet bandages, silver spray and fibrinolysin ointment. Statistical analysis employed SPSS 22 software. Most patients were male (54.7%) and under 60 years old (50.7%). Overweight status was prevalent in 69.3% of diabetic ulcer patients, amongst whom 48% underwent wrist debridement. The 64% and 36% of the cases had grade III and grade II Texas index. Moreover, 96% of patients exhibited signs of infection and were classified as Stage Texas B. Reoperation was necessary for 34.7% of patients. The mean hospital stay was 8.5 ± 7.55 days, and the average recovery time was 15.2 ± 15.19 days. Out of 75 patients, 10 were unable to return to limb function due to disability. In this study, around one-third of patients required secondary repair with grafts and flaps. A small number of them were unable to recover because of underlying disability, and the mean recovery time in other cases was 24 days. Future studies should follow up with patients for longer periods to assess long-term therapeutic outcomes and quality of life.
Background and aims: Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation. Patients and methods: Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed. Results: A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time. Conclusions: It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate.
To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care.
The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews.
Data were collected during 2020–2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research.
Three key themes emerged: ‘Diabetes when life is noisy’, ‘Sacrifices and compromises in life’ and ‘The double silence’. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment.
Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways.
The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.
Delirium is a common disorder for patients after cardiac surgery. Its manifestation and care can be examined through EHRs. The aim of this retrospective, comparative, and descriptive patient record study was to describe the documentation of delirium symptoms in the EHRs of patients who have undergone cardiac surgery and to explore how the documentation evolved between two periods (2005-2009 and 2015-2020). Randomly selected care episodes were annotated with a template, including delirium symptoms, treatment methods, and adverse events. The patients were then manually classified into two groups: nondelirious (n = 257) and possibly delirious (n = 172). The data were analyzed quantitatively and descriptively. According to the data, the documentation of symptoms such as disorientation, memory problems, motoric behavior, and disorganized thinking improved between periods. Yet, the key symptoms of delirium, inattention, and awareness were seldom documented. The professionals did not systematically document the possibility of delirium. Particularly, the way nurses recorded structural information did not facilitate an overall understanding of a patient's condition with respect to delirium. Information about delirium or proposed care was seldom documented in the discharge summaries. Advanced machine learning techniques can augment instruments that facilitate early detection, care planning, and transferring information to follow-up care. Pyoderma gangrenosum (PG) is a non-infectious, neutrophilic dermatosis that was difficult to diagnose in clinical practice. Today, the PARACELSUS score is a validated tool for diagnostics. Based on this score, patients with clearly diagnosed PG were examined with regard to predilection sites. In this retrospective study, the data of patients from the University Hospitals of Essen and Erlangen were analysed in whom the diagnosis of PG could be clearly confirmed using the PARACELSUS score. A total of 170 patients, 49 men (29%) and 121 women (71%) with an average age at first manifestation of 55.5 years, could be included in the analysis. The predilection sites were identified as the lower legs in 80.6% of the patients and the extensor sides in 75.2%. Other localisations of PG were the thighs in 14.1%, mammae and abdomen in 10.0% each, back and gluteal in 7.1% each, feet in 5.9%, arms in 4.7%, genital in 3.5% and head in 2.9%. This retrospective study is the first to identify a collective of PG patients with the highest data quality using the PARACELSUS score. It could be shown that PG can basically occur on the entire integument. However, the predilection sites of PG, which have now been reliably identified for the first time, are the lower legs and in particular the extensor sides.
FreshRSS 