Conectar
by Yun-Jin Hwang, So-Young Park, Jung-Hyun Park, Du-Hyong Cho
Vascular smooth muscle cells (VSMCs) plays an important role in maintaining vascular function by responding to various vasoactive stimuli within blood vessels. Far-infrared (FIR) rays has been shown to possess a variety of physiological effects including vasodilation, while the underlying molecular mechanism remains elusive. Here, we explored the molecular mechanism by which FIR irradiation suppresses vascular contraction using rat VSMCs and aortas. FIR irradiation enhanced the transport of intracellular Ca2+ from the cytosol to the sarcoendoplasmic reticulum (SER) via activation of sarcoendoplasmic reticulum Ca2+-ATPase (SERCA), which accompanied a decrease in intracellular ATP levels. Pretreatment with thapsigargin (TG), a specific SERCA inhibitor, or knockdown of SERCA2 gene expression reversed FIR irradiation-induced translocation of Ca2+ into the SER. Notably, FIR irradiation promoted the dissociation of SERCA2 and phospholamban (PLN), an endogenous SERCA inhibitor, without altering their total protein expression levels. The array of effects elicited by FIR irradiation was not observed under hyperthermic conditions (39°C). Moreover, FIR irradiation, but not hyperthermal condition, decreased the phosphorylation of myosin light chain (MLC) at Ser19, which was restored by pretreatment with TG or the knockdown of SERCA2 gene expression. FIR irradiation attenuated phenylephrine-induced vessel contraction in endothelium-deprived rat aortas. Consistent with the in vitro results, the reduction in MLC phosphorylation caused by FIR irradiation was reversed following pretreatment with TG in isolated aortas. Additionally, FIR irradiation increased blood flow in the carotid arteries of mice. Collectively, these results suggest that FIR irradiation activates SERCA2 by promoting its dissociation from PLN, independent of hyperthermic effects. This activation lowers cytosolic Ca²⁺ and ATP levels, reducing MLC phosphorylation and vascular smooth muscle contraction. These findings provide scientific evidence for the therapeutic potential of FIR therapy in the treatment and prevention of arterial narrowing conditions such as pathological vasospasm, and peripheral artery disease.To develop and evaluate the psychometric properties of the Forensic Nursing Competency Scale-Short Form (FNCS-SF) for hospital nurses.
Nurses who care for victims of sexual abuse, domestic violence and elder or child abuse require forensic nursing competencies. However, few valid and reliable tools exist to assess these competencies in hospital settings.
A cross-sectional study.
The study was conducted in two phases. Phase 1 involved the development and refinement of the FNCS-SF with input from 10 nurses. Phase 2 tested the tool's psychometric properties. A total of 420 nurses from two tertiary hospitals in South Korea participated. Participants were divided into two groups: Study 1 (n = 200) for exploratory factor analysis and Study 2 (n = 220) for confirmatory factor analysis.
The FNCS-SF consists of 27 items across six factors: awareness of the medicolegal problem, evidence-based practice in forensic nursing, collaborative forensic nursing with community partners, safety and security, professional career development and multidisciplinary integrated knowledge. An item analysis revealed significant correlations between each item and the total scale score. Criterion validity was supported by significant correlations between the FNCS-SF and attitudes and beliefs towards forensic nursing and the performance of the forensic nursing role. Confirmatory factor analysis supported a six-factor model with good fit indices. Cronbach's alpha indicated strong internal consistency.
The FNCS-SF is a valid and reliable tool for assessing hospital nurses' forensic nursing competencies, which can improve patient safety and treatment outcomes. Further validation in diverse clinical settings is recommended.
The FNCS-SF can be used to improve forensic nursing competency through professional development.
None.
The FNCS-SF provides a standardised framework to evaluate nurses' forensic competency, guiding education and practice to enhance clinical preparedness and deliver victim-centred care.
STROBE guidelines.
by Sang Ah Lee, Jin-Myung Kim, Hye Eun Kwon, Youngmin Ko, Joo Hee Jung, Sung Shin, Young Hoon Kim, Sung-Han Kim, Hyunwook Kwon
PurposeOptimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
Materials and methodsWe retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
ResultsThe cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
ConclusionIn this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
To explore the experiences of nurse leaders and managers in planning the hospital nursing workforce in accordance with the government-led response to the COVID-19 pandemic in South Korea.
Descriptive, qualitative study.
Semistructured interviews were conducted with 10 participants at three general hospitals in Seoul and Gyeonggi Province from August to October 2022. Eligible participants were nurse leaders and managers who were involved in decision making and management of the nursing workforce for the COVID-19 response or who served on a COVID-19 response team at each study hospital. Data were analysed using inductive content analysis.
Four main themes emerged from the interview data, each with subthemes: exacerbated inherent vulnerabilities, highlighting existing nursing shortages and financial constraints; delay to systematic response, with frequent government ad-hoc orders increasing disruptions to on-site operations and inefficiencies of the external workforce; creation of new conflicts, including those related to nursing staff deployment and compensation gaps and demands on new leadership, with the need for effective crisis management and visionary leadership.
The results indicate that nurse leaders and managers face unexpected challenges in effectively planning their nursing workforce during the pandemic. These challenges are further compounded by centralised ad-hoc government orders that prioritise the urgent demands of COVID-19 patient care, often overlooking the unique needs and circumstances of individual hospitals.
There is a need for more flexible and localised workforce planning strategies to better support nurse leaders and managers. Furthermore, ongoing collaboration between healthcare leaders and policymakers is crucial to address the disconnect between centralised government-led responses and hospital-specific needs, which could enhance the resilience of the nursing workforce and improve disaster and emergency preparedness in the future.
COREQ checklist was used.
No patient or public contribution. Data were obtained from healthcare professionals.
The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels.
A cross-sectional study was used.
This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool.
Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change–health-related information, and experience in setting climate change–health goals and strategies significantly influenced PBCH.
We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels.
By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients.
Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses.
This study adhered to the STROBE guidelines.
No Patient or Public Contribution.
by Hanui Lee, Gyeong Han Jeong, Geun-Joong Kim, Seung Sik Lee, Byung Yeoup Chung, Hyoung-Woo Bai
Exosomes are cell-derived vesicles that play a crucial role in intracellular communication and are promising biomarkers for therapeutic applications. Despite their significant potential, the application of exosomes as biological therapeutics is limited by their low yield and inconsistent production quality. Ionizing radiation is known to enhance exosome release; however, this effect has been primarily studied in cancer cells. Given the critical role of macrophages in immune regulation and their potential for exosome-based therapies, we investigated the impact of gamma radiation on the secretion of macrophage-derived exosomes. This study demonstrated that gamma radiation significantly enhanced exosome release by both naïve and polarized macrophages. This effect was associated with the overexpression of Myh10 and Myo5b, the motor proteins that play crucial roles in exosome biogenesis and secretion. Furthermore, RNA sequencing and western blot analyses identified the EGFR/IGFR-MYC signaling axis as a key upstream pathway regulating the expression of Myh10 and Myo5b, thereby accelerating exosome secretion. These findings provide a deeper understanding of the molecular mechanisms underlying radiation-induced exosome secretion from macrophages and offer a novel strategy for optimizing exosome production to advance exosome-based therapeutic applications.by Sitaporn Youngkong, Panida Yoopetch, Montarat Thavorncharoensap, Montira Assanatham, Usa Chaikledkaew, Suchai Sritippayawan
Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.This study aimed to understand the dissemination of information relating to coronavirus disease 2019 (COVID-19) and its impact on nursing care in the early phase of transmission.
COVID-19 has spread globally, causing an unprecedentedly large number of casualties. Nurses face challenges in dealing with patients with COVID-19 with limited information about the pathogen.
This qualitative study followed the COREQ guidelines.
Fifteen nurses were recruited from two university hospitals in South Korea using a snowballing technique for in-depth interviews in May 2020. All interviews were recorded and transcribed verbatim. Content analysis was performed on the interview data.
Two themes emerged: access to COVID-19 information and the impact of information on nursing care. The categories of access to COVID-19 information were lack of nursing-specific information, limited information cascading from top management and confusion due to varying points of view. The categories of the impact of information on nursing care were unprepared management that aggravates exhaustion, lack of personal protective equipment that creates anxiety and being a nurse leader to overcome the pandemic.
During a pandemic of emerging infectious diseases, nurses should have access to up-to-date information tailored to their working environment. Human resources, material resources and systematic support are needed for nurses who provide care for patients with an infectious disease.
A collaborative interprofessional education system for emerging infectious diseases is needed for effective communication and consistent care during a pandemic. Nurse leaders should be prepared to deliver profession-specific information for standardised care and respond to nursing management needs by using resources and tailoring the workforce.
To investigate the frequency and associated factors of interruptions initiated by human and environmental sources during the medication administration process among nurses in South Korea.
A cross-sectional descriptive study.
Data were collected from January to March 2022 through an online survey administered to nurses working in tertiary hospitals in South Korea. The survey assessed interruptions during the medication administration process, nursing work environments and organisational culture. Descriptive statistics and regression analysis were used to identify factors associated with interruptions.
Human-initiated interruptions were more frequent than those initiated by environmental sources. Human-initiated interruptions increased with a higher patient load and a relation-oriented organisational culture but decreased with adequate staffing and resources, as well as an innovation-oriented culture. Environment-initiated interruptions were more frequent in settings with a task-oriented culture and less frequent among female nurses.
The findings highlight the importance of understanding the distinct characteristics of interruptions and developing targeted strategies based on their sources and contributing factors. Creating supportive environments and fostering an organisational culture that actively prevents unnecessary interruptions are essential for enhancing medication safety and workflow efficiency.
To apply these findings in clinical practice, it is necessary to allocate staffing resources appropriately to reduce interruptions. Providing education on the importance of maintaining uninterrupted medication administration processes is essential to reduce human-initiated interruptions.
This study provides practical evidence that organisational culture and staffing are associated with interruptions in clinical nursing practice. Nurse managers should apply these findings by promoting staffing adequacy and fostering a collaborative, innovative environment that encourages continuous improvement and openness to change. Tailored strategies that reflect the specific characteristics of different types of interruptions can help reduce their occurrence and improve medication safety.
STROBE checklist.
No patient or public contribution.
To explore the experiences of registered nurses in Korea on patient advocacy, focusing on their perceptions, activities and influencing factors.
A qualitative study grounded in a social constructionist paradigm.
Between September and October 2024, focus group interviews were conducted with 19 Korean registered nurses who possessed at least 3 years of clinical experience. Data were evaluated using the reflexive thematic analysis by Braun and Clarke.
Three main themes were identified, comprising 11 sub-themes and 39 codes: the perceptions of nurses: advocacy as an invisible yet pervasive safeguard for patient safety, rights and comfort; advocacy activities: advocacy as contextual strategies involving interventions, empowerment and coordination; influencing factors: advocacy shaped by organisational, interprofessional and individual factors.
These findings underscore the crucial role of registered nurses in safeguarding the safety, rights and comfort of patients, yet this advocacy remains frequently unrecognised and underappreciated in daily practice. Registered nurses engage in a wide range of adaptive and strategic advocacy approaches tailored to individual patient needs and clinical contexts. Multiple factors influence these practices, including those at the organisational, interprofessional and personal levels.
This study expands the understanding of how Korean registered nurses practice advocacy and highlights the need for greater recognition and institutional support for patient advocacy activities. Healthcare leaders can use these insights to develop supportive organisational policies and foster collaborative cultures, while also strengthening the competencies of registered nurses in clinical knowledge, ethical judgement and communication skills to enhance their capacity for patient advocacy. The identified advocacy strategies provide practical guidance for implementing patient advocacy and inform the design of nursing education and training programs that prioritise advocacy.
This study followed the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
The Intensive Care Unit Randomised Trial Comparing Two Approaches to Oxygen Therapy Trial (ICU-ROX) compared conservative oxygen therapy with usual care in mechanically ventilated adults in Australian and New Zealand intensive care units. Dissemination focused on publication and presentation, with no targeted approach.
The current study aimed to investigate whether health practitioners from intensive care units that participated in ICU-ROX were more likely to report they knew the trial results and had read the publication than those from intensive care units that did not participate; explore whether there was a difference between doctors' and nurses' knowledge of the ICU-ROX results and whether they read the publication.
Survey using a self-administered, quantitative design, developed for this study.
Convenience sample of 197 Australian and New Zealand intensive care specialist doctors and nurses.
There was no difference in the knowledge of the study results between respondents from intensive care units that participated in ICU-ROX compared to those that did not. Nurses were significantly less likely to have knowledge of the trial results or have read the publication than doctors. The commonest way for doctors and nurses to get the results was by word of mouth at work.
Participation in ICU-ROX did not make a difference to knowledge of the findings. While the dissemination of trial results was extensive, it failed to adequately reach nurses, who play an important role in administering oxygen in intensive care.
This study has provided further evidence that nurses working in intensive care were unlikely to read the research results of an important study about oxygen management.
Researchers, unit management and nurse leaders need to ensure dissemination methods that will reach nurses are used for research findings.
This study followed the STROBE reporting guidelines for observational studies.
No patient or public contribution.
This study is a substudy of a trial that was prospectively registered before the first participant was recruited: ACTRN12615000957594
To assess 10 common indicators of clinical trial risks across regions.
Retrospective pooled analysis of routine central-monitoring outputs.
Data came from a central-monitoring platform (2015–2025), which contains data from clinical trials conducted worldwide by 46 different sponsors and contract research organisations acting on behalf of sponsors. Trial sites were grouped into seven geographic regions—North America, Central/South America, Western Europe, Eastern Europe, Africa/Middle East, Asia, Pacific—to assess regional differences in monitored clinical-trial risks.
Primary outcome—Relative Key Risk Indicator (KRI) risk score, defined as the relative risk in the selected region in comparison to the expected risk computed using data across all regions globally for 10 common risks usually assessed in clinical trials.
A total of 585 studies involving 56 189 sites comprising data from all regions of the world were used in the analysis. No obvious concerns were identified regarding the conduct of reliable clinical research in any region. However, for some KRIs (eg, off-schedule visit rate, protocol deviation rate and screen failure rate), there was substantial variability observed of relative risks across regions. Conversely, some other KRIs (eg, visit-to-entry cycle time and adverse event reporting rate) had a very narrow distribution across all regions.
These results highlight regional differences across some common risks that may help clinical trials sponsors to plan future trials and take prospective measures to reduce KRI-related risks in some regions of the world.
A novel advanced synthetic bioactive glass matrix was studied in patients with non-healing diabetic foot ulcers (DFUs). Bioactive glasses can be constructed to be biocompatible, with water-soluble materials in multiple geometries including fibre scaffolds that mimic the 3D architecture of a fibrin clot. In this trial, chronic, Wagner Grade 1 DFUs were randomised to receive borate-based bioactive glass Fibre Matrix (BBGFM) plus standard of care (SOC) therapy for 12 weeks or SOC alone. The primary study endpoint was the proportion of subjects that obtained complete wound closure at 12 weeks. Secondary endpoints included time to achieve complete wound closure at 12 weeks. In the modified intent-to-treat (mITT) analysis, 48% (32/67) treated with BBGFM plus SOC healed at 12 weeks compared to 24% (16/66) with SOC alone (p = 0.007). In the per protocol (PP) population, 73% (32/44) of subjects treated with BBGFM plus SOC healed versus 42% (16/38) in the SOC group (p = 0.007). Based on the success of this trial, BBGFM demonstrates faster healing of DFUs compared to SOC and should be considered in the treatment armamentarium for Wagner Grade 1 DFUs. Future trials should investigate the use of BBGFM for healing deeper chronic DFUs, other wound aetiologies, or complex surgical wounds.
To explore the influences of workplace bullying experiences, witnessing workplace bullying and bystander types on Speaking up for patient safety (SUPS) among hospital nurses.
Cross-sectional study.
A survey was conducted in September 2021 using a structured questionnaire about workplace bullying experiences, witnessing workplace bullying, bystander types, and SUPS. The questionnaire was administered to 200 bedside nurses from two tertiary university hospitals in South Korea.
One hundred and ninety-nine responses were analysed. A hierarchical regression model, incorporating organisational factors, workplace bullying experiences, witnessing workplace bullying, and bystander types explained approximately 44.0% of the variance in nurses' SUPS. Witnessing workplace bullying and the perpetrator-facilitating bystander negatively influenced SUPS, whereas victim-defending bystander had a positive influence on SUPS.
Findings suggest that witnessing workplace bullying and the bystander types of nurses working on patient care units are more impactful on nurses' SUPS than individual experiences of bullying. Notably, the victim-defending and perpetrator-facilitating bystander types were identified as key factors influencing SUPS.
Nurse managers should understand the roles of witnesses and bystanders working on a patient care unit, and how these roles may extend beyond traditional views of perpetrators and victims. Developing strategies to support and effectively manage witnesses and bystanders working on patient care units may promote positive SUPS behaviours among clinical nurses.
What problem did the study address?
Speaking up for patient safety (SUPS) in clinical settings is critical in maintaining and enhancing patient safety. However, a negative work environment, such as one that promotes workplace bullying may hinder nurses' willingness to engage in SUPS. Because many nurses involved in workplace bullying may be witnesses or bystanders rather than direct perpetrators or victims of such situations, this study explored the potential influences of workplace bullying, including the roles of witnesses and bystanders, on SUPS. What were the main findings?
SUPS was influenced more by witnessing workplace bullying and specific bystander types, namely victim-defending and perpetrator-facilitating bystanders, than by workplace bullying experiences. Where and on whom will the research have an impact?
These findings highlight the importance of addressing the roles of witnesses and bystanders in workplace bullying. Nurse managers should broaden their focus beyond perpetrators and victims to include the roles and views of all nursing staff within a department. By effectively managing witnesses and bystander types, they can foster an environment that enhances SUPS behaviours among nurses.
This study adhered to STROBE guidelines.
No Patient or Public Contribution.
To synthesise evidence on nurses' roles in long-term care settings and map their interactions.
Systematic review with network analysis.
Thematic synthesis was used to identify nurses' roles, and network analysis mapped their interactions across domains.
Six databases—Cumulative Index to Nursing and Allied Health Literature, PubMed, Embase, Cochrane Library, Research Information Sharing Service and Database of Periodical Information Academic—were searched for peer-reviewed articles from 2014 to 2024. The Mixed Methods Appraisal Tool assessed study quality.
Fifteen studies were included. Nurses' roles spanned six domains: collaboration, education, leadership, resident-centred care, quality improvement and resource management. Network analysis revealed collaboration and leadership as the most central, each with a degree centrality of five, acting as bridges across domains. Three thematic clusters emerged: collaboration and resource management focused on operational teamwork; leadership and quality improvement centred on systemic care enhancements; and education and resident-centered care emphasised training and resident-focused care. A technological competence gap was identified, alongside barriers like staffing shortages and role ambiguity.
Nurses' interconnected roles are critical for resident-centered care; however, they require systemic support to address barriers and technological gaps.
Enhanced interprofessional training, leadership development and digital skill integration can improve care quality and nurse well-being in long-term care settings.
This study addressed the complexity of nurses' roles in long-term care and their structural interactions, finding collaboration and leadership as pivotal with three role clusters and a technological gap, impacting long-term care nurses, educators and policymakers to inform workforce strategies.
This study adhered to the PRISMA 2020 guidelines and was preregistered in PROSPERO (CRD42024588422).
This study did not include patient or public involvement in its design, conduct or reporting.
PROSPERO: CRD42024588422
by Cheyenne R. Wagi, Renee McDowell, Anyssa Wright, Kathleen L. Egan, Christina S. Meade, April M. Young, Madison N. Enderle, Angela T. Estadt, Kathryn E. Lancaster
BackgroundHepatitis C virus (HCV) and injection drug use among young women are dramatically rising in the rural United States. From 2004 to 2017, heroin use among non-pregnant women increased 22.4% biennially, mirroring increases in HCV cases, especially among younger populations. Young women who inject drugs (YWID, ages 18–35) face elevated HCV risk due to biological, behavioral, and socio-cultural factors. Barriers to HCV testing and treatment services further delay diagnoses, fuel transmission, and limit access to harm reduction services. This study applies the Theoretical Domains Framework (TDF) to identify factors influencing HCV testing and treatment among YWID in rural Appalachia Ohio.
MethodsWe conducted in-depth interviews with YWID (n = 30) in 2023 to understand their HCV testing and treatment experiences in rural Appalachia Ohio. Interviews were transcribed, inductively coded, and analyzed using grounded theory. Identified themes were mapped onto the TDF domains.
ResultsKey TDF domains influencing HCV care included knowledge, beliefs about consequences, and intentions. While YWID knew where to get tested, they expressed uncertainty about treatment value and access while actively using drugs. Social influences, stigma, and mistreatment by healthcare providers created barriers to treatment. Environmental context and resources, such as transportation, also influenced access to care.
ConclusionsYWID in rural Appalachia face barriers to HCV care, such as gaps in knowledge about HCV treatment, which is compounded by gendered stigma, and logistical challenges. Rapidly changing treatment restrictions led to misinformation about treatment access. These gaps highlight the need for interventions specifically designed to address YWID lived experiences.
To describe: (1) the most visible information (from individuals or organisations) on UK social media regarding hormone replacement therapy (HRT)/menopause hormone treatment for menopause; (2) claims made by these sources for HRT and testosterone outwith the indications specified by the British National Formulary (BNF) and the National Institute of Health and Care Excellence (NICE) (ie, vasomotor instability, vaginal dryness, low mood associated with the menopause and, for testosterone, low libido after treatment with HRT) and for use for the prevention of future ill health and (3) conflicts of interest of commentators.
Cross-sectional study.
Online references to HRT, for use in menopause, in UK online media, comprising Facebook, Google, Instagram, TikTok and YouTube, 30 top ranked hits between 1 January 2022 and 1 June 2023 and Twitter (X) up to 1 May 2024.
Identification of the most visible information was performed via online searching with the term ‘HRT’ using incognito searches within each modality. Statements making claims were identified and analysed as to whether they were congruent with BNF and NICE advice on indications for use. Declarations of interest were extracted from the source or searched for if not apparent using a standardised search strategy. Data were entered into an Excel spreadsheet. Summary and descriptive statistics were used to summarise the results, including description of origin and types of claims, percentage of claims in agreement with NICE/BNF indications, relationship to financial interests and readership data, where available.
180 recommendations and/or claims for HRT were examined (30 from each of six platforms), made by professional individuals (53.4%), laypeople (41.7%) and patient, media and professional organisations (4.9%) completing the total. Overall, 67.2% of claims were outside of BNF/NICE recommendations. 139 (77.2%) were associated with a conflict of interest. In 117 cases, this was a conflict either directly or indirectly related to menopause, through provision of private practice, pharmaceutical industry funding or retail products marketed at the menopause.
Social media commonly contains claims for HRT outside BNF/NICE guidance. Conflicts of interest by commentators are also common, directly or indirectly related to menopause. Less than a quarter of media contained no commercial conflict. Policymakers should consider means to ensure that non-conflicted, evidence-based information is visible to professionals, patients and the public.
Open Science Framework (https://osf.io/r7e5c/).
Delirium is a frequent, yet often underdiagnosed, condition in intensive care units (ICUs), especially in postoperative patients. It has three subtypes: hyperactive, hypoactive and mixed, each with distinct clinical manifestations and outcomes. A deeper understanding of each subtype's prevalence and risk factors is essential for improving ICU patient care. This study aims to figure out the prevalence of each type of delirium and risk factors associated with each subtype of delirium.
This retrospective study included 4234 postoperative patients admitted to the surgical ICU between January 2017 and June 2019. Delirium was diagnosed using the Confusion Assessment Method for the ICU, and subtypes were determined using the RASS score. Multivariate logistic regression analysis was used to identify the risk factors associated with each delirium subtype. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
The prevalence of delirium was 8.7%, with mixed delirium being the most common subtype (47.7%), followed by hypoactive delirium (40.3%) and hyperactive delirium (12.0%). Each subtype was linked to different risk factors: hypoactive delirium was correlated with shorter ICU stays and pH and O2 imbalances, hyperactive delirium was associated with physical restraints and mixed delirium was linked to sedative medication and restraint use.
Among postoperative ICU patients, mixed delirium was the most prevalent subtype, followed by the hypoactive and hyperactive forms. Identifying the unique risk factors for each subtype highlights the need for targeted prevention and management approaches in ICU. Further research is warranted to investigate the underlying mechanisms and to develop effective interventions tailored to each delirium subtype.
This study is distinct from previous research in that it comparatively analysed the risk factors for delirium according to subtype. By distinguishing between the subtypes of delirium and identifying their incidence and risk factors, it is possible to enhance the overall understanding of delirium, particularly given that some of the known risk factors are more strongly associated with certain types of delirium. Identifying risk factors according to the type of delirium can facilitate the planning of proactive interventions based on risk factors. Furthermore, it can serve as a valuable resource for the development of tools for predicting different types of delirium to provide more tailored and evidence-based care for patients with delirium.
No patient or public contribution.
International consensus guidelines support the initial administration of 30 mL/kg of intravenous fluids for haemodynamic resuscitation of newly diagnosed septic shock. Practice variation exists between the volume of fluids administered and timing of vasopressor commencement. The optimal approach in patients with septic shock is uncertain.
Australasian Resuscitation In Sepsis Evaluation: FLUid or vasopressors In emergency Department Sepsis is a 1000-participant multicentre, randomised, open-label, parallel group clinical trial conducted in patients with septic shock presenting to the emergency department in participating sites in Australia, New Zealand and Ireland. Participants are randomised (1:1) to either restricted fluids and early vasopressors or a larger initial intravenous fluid volume and later vasopressors. The primary outcome is days alive and out of hospital at day 90 postrandomisation. Secondary outcomes are all-cause mortality at day 90, time from randomisation until death (to day 90), days alive and at home at day 90 and ventilator-free, vasopressor-free and renal replacement-free days to day 28 postrandomisation and death or disability at 6-month and 12-month postrandomisation. Health-related quality of life will be assessed at day 180 and 12 months following randomisation.
The study was approved by Northern Sydney Local Health District Human Research Ethics Committee (HREC2020/ETH02874) on 21 January 2021. Patients will be enrolled under a waiver of prior consent. The patient or next-of-kin (or equivalent according to local jurisdiction) is approached at the first available opportunity and given a trial information sheet. According to local approvals, the patient or next-of-kin chooses to either continue in the trial or opt-out/decline continued participation. Results will be disseminated in peer-reviewed journals and presented at academic conferences.
Secondary and tertiary renal hyperparathyroidism (RHPT) are common sequelae of chronic kidney disease and are associated with worse patient mortality and quality of life. Clinical guidelines remain lacking with regard to recommendations for using intraoperative parathyroid hormone (IOPTH) during surgery for RHPT. A prospective randomised study will help evaluate the role of IOPTH in guiding surgery for secondary and tertiary RHPT.
Intraoperative parathyroid hormone monitoring to guide surgery in renal hyperparathyroidism is a pragmatic, multicentre, five-arm, parallel-group, patient-blinded and outcome assessor-blinded prospective pilot trial used to evaluate the feasibility of performing a definitive trial. Eligible participants include adult patients diagnosed with secondary or tertiary hyperparathyroidism who are candidates for subtotal or total parathyroidectomy. Consenting patients will be randomly assigned, through central allocation, in a 1:1:1:1:1 fashion to undergo surgery with IOPTH monitoring (four experimental arms: postexcision IOPTH samples taken at 10, 15, 20 or 25 min) or to undergo surgery without IOPTH monitoring (control arm). The primary feasibility objective is to estimate the percentage of eligible patients that are randomised: ≥70% proceed; 50–69% modify protocol before proceeding;
Ethics approval was obtained from the Hamilton Integrated Research Ethics Board. Pilot trial results will be shared widely through local, national and international academic and clinical networks and will be disseminated through conference presentations and publication in peer-reviewed journals.
NCT06542315, registered on 6 August 2024.
FreshRSS 