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Migraine is a primary headache showing a multifactorial component that includes altered pain processing, psychological/emotional problems, neurocognitive and executive function deficits, all with a possible genetic association. The aim of the current study will be to evaluate the association between sensitisation, psychological/emotional, neurocognitive and genetic profile on conditioned pain modulation (CPM) in women with migraine from a multidisciplinary perspective.
A cross-sectional observational case–control study including 90 women with chronic migraine, 90 women with episodic migraine and 90 women without migraine (as controls) will be conducted. Clinical variables (disability, pain), processing (sensitisation-associated, neuropathic-like symptoms), psychological/emotional (anxiety, depression, sleep quality, catastrophising), neurocognitive (attention), executive functions (memory, mental inhibition, speed processing) and genetics (Val158Met polymorphism rs4680 gene) will be assessed in all subjects by healthcare professionals. Subsequently, CPM will be evaluated with the cold-pressor test paradigm by assessing changes obtained in mechanical and thermal stimuli. The association of each group of variables on CPM will be analysed with multivariate analyses (OMNIBUS analysis of variance). A network model will also be created to identify those variables showing the greatest key measure of centrality with the rest of the severity indicators (strength, intermediation and closeness) to establish the potentially therapeutic targets in patients with migraine from a multidisciplinary point of view.
The protocol of the current study has been approved by the Ethics Committee of all involved institutions (Hospital Universitario Fundación Alcorcón 24–117, Universidad Rey Juan Carlos 010220240912024). All procedures will be conducted following the Declaration of Helsinki. Participants will be informed of the aims and procedures of the study and will receive the informed written consent which should be signed before their inclusion. Study results will be disseminated through peer-reviewed publications and presentations at scientific meetings.
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.
The COVID-19 pandemic induced significant changes in access policies to general practice (GP) in most countries. This study aimed to compare and discuss changes in the diagnostic patterns and GP procedures before and during the pandemic.
A register study including data from 11 Danish GP clinics.
Enlisted patients from GP followed 1 year before (February 2019 to January 2020; n=48 650) and 1 year during (April 2020 to March 2021; n=47 207) the COVID-19 pandemic.
Diagnostic patterns, consultation type (face-to-face, email and phone), contact persons (GP or GP staff) and patient characteristics.
The average number of contacts with GP increased from 6.3 contacts per year per patient before the pandemic to 8.3 annual contacts during the pandemic (p
Although these findings cannot prove causality, they demonstrate significant changes in diagnostic patterns, balance between different contact types, and responsible contact persons during the pandemic. Changes mean that it has become a significantly different product that GPs offer their patients. The coming years will show whether these changes remain, whether the quality of treatment and care is the same and whether the changed balance in patient handling (GP or GP staff) is experienced as beneficial by the patients.
Patients with limited proficiency in the primary language who do not receive a healthcare interpreter have poorer health outcomes. Clinician preference is an important factor in determining whether a healthcare interpreter will be used; yet little is known about their experiences and preferences for working with healthcare interpreters.
To review and synthesise the evidence examining nurses' experiences of working with healthcare interpreters when caring for patients with limited proficiency in the primary language.
This review follows the reporting items contained within the ENTREQ statement. A systematic search of the literature was undertaken from inception to August 2024 in the databases CINAHL, Embase, Medline, PsychInfo, PubMed, Scopus, and ProQuest Dissertations and Theses Global. Included studies were assessed using the Critical Appraisal Skills Programme tool for qualitative studies. Thematic synthesis was undertaken on studies meeting the inclusion criteria, including studies undertaken in acute settings. Articles were limited to English-language papers and peer-reviewed.
Eighteen studies representing the experiences of 416 nurses from eight countries were included in the review. Four themes were identified: (1) working with Interpreters, (2) tensions and challenges, (3) making connections, and (4) workarounds.
Nurses' experiences of working with healthcare interpreters were overwhelmingly positive; however, concerns about interpretation accuracy, unreliable technology, additional time required when working with a healthcare interpreter, and being sidelined were evident. Nurses commonly resorted to using bilingual nurse colleagues and family members when healthcare interpreters were unavailable.
This review highlights the need for nurses to be allocated additional time in their patient loads when caring for patients with limited proficiency in the primary language. Healthcare policy that accommodates the use of bilingual healthcare professionals as well as the need for nurses to receive formal training on working collaboratively with healthcare interpreters is needed.
Not applicable due to systematic review.
The combination of a reduction in the Danish hospital bed count, the shortage of hospital staff and demographic changes challenges the Danish hospital capacity. This was further highlighted during the COVID-19 pandemic when hospitals worldwide were overwhelmed by infected patients requiring acute hospital care. To address these challenges, a hospital-at-home (HaH) programme offers an alternative to conventional in-hospital admission. Furthermore, HaH has the potential to improve patient outcomes, reduce costs and increase patient satisfaction. However, few studies have evaluated HaH in a Scandinavian setting, and this article describes the protocol for a randomised controlled trial (RCT) comparing an HaH model with continued conventional in-hospital admission. The main aim of the trial is to evaluate physical activity level and mental wellbeing in patients admitted at home compared with conventionally admitted patients.
110 clinically stable patients from two internal medical wards at Nordsjaellands Hospital in Denmark will be included and randomised in a ratio of 1:1 to either continued conventional in-hospital admission (control group) or virtual HaH model (intervention group). The control group will receive standard hospital treatment, and the intervention group will be transferred home for continued treatment (eg, intravenous antibiotics or oxygen treatment). The primary outcome measures are physical activity assessed using daily step count (during the first 24 hours after inclusion, as an intermediary indicator of the risk of adverse events) and treatment satisfaction (assessed using a patient satisfaction survey). Secondary outcome measures are adverse events of special interest, escalation of care, readmission rate postdischarge (30 days and 90 days), mortality (associated and 7 days, 30 days and 90 days postdischarge), process data (eg, the number of teleconsultations) and a health economic evaluation.
The study was approved by the Danish Research Ethics Committees (no. 2303051) and the Danish Medicines Agency (CIV-23-03-042542) and will be monitored by the Copenhagen University Hospital Good Clinical Practice unit. Results will be published in peer-reviewed journals and presented at relevant national and international conferences. We also plan to communicate the results to relevant stakeholders in the Danish healthcare system.
Care transitions, particularly hospital discharge, present significant risks to patient safety. Deficient medication-related discharge communication is a major contributor, posing substantial risk of harm to older patients. This protocol outlines the Improved Medication communication and Patient involvement At Care Transitions (IMPACT-care) intervention study, designed to evaluate the effects of a multifaceted intervention for older hospitalised patients on medication-related discharge communication compared with usual hospital care.
A pre–post intervention study will be conducted in two surgical and one geriatric ward of a university hospital in Sweden. The study will begin with a control period delivering usual care, followed by a training period and then an intervention period. The intervention comprises four components performed by clinical pharmacists: (1) information package provided to patients and/or informal caregivers, (2) preparation of medication-related discharge documentation, (3) facilitation of discharge communication and (4) follow-up call to patients or their informal caregiver. Eligible participants are aged ≥65 years, manage their own medications independently or with informal caregiver support, and are admitted to the study wards. Each study period (control and intervention) will last until 115 patients have been included. The primary outcome is the quality of medication-related discharge documentation, assessed using the Complete Medication Documentation at Discharge Measure (CMDD-M). Secondary outcomes include patients’ perceptions of knowledge and involvement in discharge medication communication, and their sense of security in managing medication post-discharge; adherence to medication changes from hospitalisation that persist after discharge; and unplanned healthcare visits following discharge. A process evaluation is planned to explore how the intervention was implemented. Patient inclusion began in September 2024.
The study protocol has been approved by the Swedish Ethical Review Authority (registration no.: 2023-03518-01 and 2024-04079-02). Results will be published in open-access international peer-reviewed journals, and presented at national and international conferences.
Effective glucose control in surgical patients at risk of hyperglycaemia and hypoglycaemia is crucial, as these conditions can lead to surgical site infections, prolonged hospital stays and death. Fingerstick glucose monitoring (FSGM), the standard measurement of glucose, can be painful for patients and time-consuming for nursing staff, especially with hourly monitoring around surgery. Continuous glucose monitoring systems (CGMS) offer a less invasive alternative with better glucose regulation in outpatients.
The GLUCOSENS study compares the effects of CGMS and FSGM on point-of-care measurements and time-in-range (3.9–10.0 mmol/l) glucose levels (primary outcome), patient satisfaction and experience and nursing staff workload and experience in surgical wards. Furthermore, it evaluates CGMS accuracy during perioperative periods and medical imaging.
This Danish two-centre study will be conducted at the general surgical wards of Odense and Zealand University Hospital and will involve 305 patients over 18 months. The study is divided into three periods: first, a standard care period with point-of-care FSGM (110 patients); second, an intervention period with point-of-care CGMS (110 patients); third, another standard care period with point-of-care FSGM combined with a blinded sensor for comparing continuous glucose data from this period with continuous glucose data from the intervention period (85 patients). Furthermore, the study will include 24 nursing staff.
Data will be collected through medical file reviews on glucose levels, patient satisfaction questionnaires, a patient field study, an observation study of the nursing staff’s workload and qualitative interviews of nursing staff.
The study is registered with the Records of Processing Activities in the Region of Southern Denmark for research and quality projects (ID number: 23/36734) and has been approved by the Regional Scientific Ethical Committee in Southern Denmark (ID number: S-20240041). The results will be published in international peer-reviewed journals.
ClinicalTrials.gov Registry (NCT06473480)
To explore how youth understand and manage risk associated with food allergy in everyday life, aiming to inform future advanced nursing and care initiatives.
Qualitative study based on critical psychological practice research.
Data was generated through participant observation and informal interviews during a 2-day camp with youth aged 18–23years (n = 10), diagnosed with food allergy in childhood. Data analysis used thematic analysis informed by a critical psychology theoretical framework.
Risk associated with food allergy is an integrated aspect of the youth life trajectories. The allergy clinic plays a crucial role in how they come to understand and manage risk. Paradoxically, knowledge of risk fosters safety as well as uncertainty. Bodily awareness plays a crucial role in managing food allergy, but minor bodily sensations can trigger anxiety and fear of anaphylaxis. Establishing routines emerges as a key strategy for managing risk, as routines reduce anxiety and facilitate participation in everyday social activities.
The study highlights the complexity of managing food allergy in the everyday life of youth. How risk knowledge is translated from the clinic into everyday life varies and impacts risk management strategies in different ways.
HCP must address both physical and psychosocial aspects of living with the risk associated with food allergy. Individually tailored risk communication that considers personal circumstances and experiences can help reduce anxiety and support strategies for managing food allergy in everyday life.
Integrating patients' everyday perspectives and risk management into healthcare fosters personalised care. Nurses and doctors should help patients bridge the gap between medical advice and its practical application, addressing both physical and emotional aspects of managing health risks.
The SRQR guideline for reporting qualitative research.
Patient representatives were involved in developing the protocol, research questions and study aims.
To explore residents' experiences of the mealtime environment in nursing home.
An exploratory qualitative design was employed to gain in-depth insights.
Twenty semi-structured interviews were conducted with residents at a nursing home. Data were analysed using thematic analysis as outlined by Braun and Clarke. The consolidated criteria for Reporting Qualitative research checklist were used to support the research process.
Four main themes emerged from the analysis: (1) The significance of food, emphasising the centrality of food quality and variety in residents' mealtime experiences. (2) Security through routines, illustrating how established mealtime routines provide comfort and predictability. (3) Variability in staff influence, reflecting residents' perceptions of staff competence and their impact on the dining experience. (4) Limited social interactions, highlighting the varied social dynamics and their effects on residents' sense of community and isolation.
The study underscores the critical importance of food quality, staff compliance and consistent routines in enhancing mealtime experiences in nursing homes. Additionally, it reveals that the ability to choose social interactions plays a significant role in residents' satisfaction and social well-being.
This study provides valuable insights for improving mealtime experiences in nursing homes, suggesting that person-centred care and resident involvement in meal planning can enhance satisfaction and nutritional intake.
The findings offer practical guidance for healthcare management, emphasising the need to prioritise and personalise mealtime environments to better meet residents' needs and preferences.
To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges.
Daily oral care is important to patients' health and well-being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate.
A qualitative study exploring participants' experiences to gain new in-depth knowledge of oral care among hospitalised patients.
A phenomenological-hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi-structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation.
Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self-reliant patients need help with oral care; and the mouth reflects the life lived.
The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self-care capacity.
Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice.
The COREQ criteria for reporting qualitative research were adhered to.
A patient representative was involved in the discussion of the proposal, conduct and results of the study.
FreshRSS 