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New generation of paediatricians in the health care system: are paediatric residents ready to manage children without supervision? A survey using respiratory infections as a model

Por: Del Bene · M. · Diana · A. · Corsello · A. · Cecere · F. · Indolfi · C. · Mozzillo · E. · Nunziata · F. · Pascarella · F. · Rossi · F. · Sibilio · M. · Ummarino · M. · Guarino · A.
Objectives

To measure the perceived autonomy level in managing lower respiratory tract infections (LRTIs) among paediatric residents and to compare perceived autonomy with the assessments by tutors who directly supervise and evaluate residents

Design/setting

A survey on managing LRTIs was distributed among all Italian paediatric residents and tutors via Google Forms between January 1 and 31, 2024.

Participants, residents and tutors were classified according to their training year and clinical setting: primary care paediatrics (PCP), emergency department (ED) and hospital ward (HW).

Outcome

Perceived autonomy of paediatric residents in managing LRTI in different settings; overall perceived autonomy and interest in employment.

Results

A total of 391 questionnaires were returned, with 273 completed by residents and 118 by tutors. Among residents, 3% in their first year felt fully capable of managing LRTIs without supervision in both ED and HW settings. This percentage remained below 25% until the third year and increased to 72% in ED and 83% in HW by the fifth year. In PCP settings, autonomy ranged from 15% in the first year to 96% in the final year. No differences were found between residents’ self-evaluations and tutors’ assessments. Confidence in skills showed no regional differences across Italy.

Conclusion

Most residents did not feel ready to manage winter respiratory infections in children without supervision, especially in the ED compared with the HW; however, self-confidence was higher in the PCP setting. Tutors shared similar perceptions. The location did not affect the response pattern. These findings caution against employing residents to work autonomously, particularly in emergency settings.

Electrical Burns: A Retrospective Study at the Lebanese Burn Center in Geitaoui Hospital, Lebanon (2011–2024)

ABSTRACT

Electrical burns are among the most severe burn injuries, often leading to deep tissue damage, systemic complications, and prolonged hospitalisation. In Lebanon, limited national data on electrical burn injuries limits the understanding of their epidemiology and management. This study aims to assess the prevalence and characteristics of electrical burns in patients admitted to the specialised burn care unit in Geitaoui Hospital in Lebanon. A retrospective observational study was conducted by reviewing the medical records of patients admitted from 1st January 2011 to 31st December 2024. Data on demographics, burn characteristics, hospitalisation outcomes, infections, surgical interventions, and laboratory findings were extracted and analysed using SPSS version 26. Thirty patients were included, with a male predominance (96.7%) and the mean age was 29.6 years. Third-degree burns were observed in 70.0% of cases, and 66.7% of patients had burns affecting 10%–30% of their total body surface area. High-voltage injuries accounted for 50.0% of cases. Upper extremities were the most commonly affected site (93.3%). The mean hospital stay was 25.69 days, and the mortality rate was 10.0%. Infection was documented in 43.3% of cases. The most frequently isolated pathogens were Acinetobacter (20.0%) and Pseudomonas aeruginosa (16.7%). Surgical intervention was required in 63.3% of patients, most frequently skin grafting (36.7%). This study contributes national data on electrical burns and emphasises the importance of preventive and multidisciplinary care strategies.

Cutaneous non-volar melanoma dermoscopy and histopathology correlation: a systematic review protocol

Por: Bouceiro Mendes · R. · Henrique · M. · Augusto-Simoes · P. · Argenziano · G.
Introduction

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.

Methods and analysis

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.

Ethics and dissemination

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.

PROSPERO registration number

CRD42024564919.

Impact of Polyhexanide Care Bundle on Surgical Site Infections in Paediatric and Neonatal Cardiac Surgery: A Propensity Score‐Matched Retrospective Cohort Study

ABSTRACT

The primary aim of this study was to evaluate the impact of the polyhexamethylene biguanide (PHMB) care bundle on the occurrence rates of surgical site infections (SSIs) in paediatric and neonatal cardiac surgery, addressing a critical gap in paediatric-specific infection prevention protocols. A retrospective cohort study included patients under 18 years old who underwent cardiac surgery at IRCCS Policlinico San Donato. Cohort A (n = 117) received the PHMB care bundle from April to December 2023, while Cohort B (n = 801) received conventional care from September 2020 to March 2023. The 1:1 propensity score matching was used to balance covariates between cohorts, resulting in two comparable cohorts (Cohort A = 114 patients and Cohort B = 112). The study found a significant reduction in SSIs among patients receiving the PHMB care bundle compared with those receiving conventional care (1.8% vs. 7.1%, p = 0.048). The comprehensive nature of the PHMB care bundle, including educational programs, preoperative and postoperative antimicrobial treatments, and consistent application of best practices, was instrumental in achieving these outcomes. Implementing antimicrobial care bundles could significantly reduce SSIs in paediatric cardiac surgery. Future research is needed to refine the tested bundle with prospective approaches.

Knowledge, Attitude and Practices Towards Thermal Burns: A Cross‐Sectional Study in the Lebanese Population

ABSTRACT

This study investigates the knowledge, attitudes, and practices of the Lebanese population regarding thermal burns to inform targeted interventions. Using a cross-sectional design, data was collected from 1090 participants though a structured questionnaire. Key findings revealed a mean knowledge score of 14.89/20, indicating moderate understanding, with gaps in identifying third-degree burns and optimal cooling durations. Attitudes scores averaged 36.97/50, reflecting a strong support for burn prevention but low confidence in first aid. Practices scored 12.37/20, with many participants adhering to safety measures but relying on unverified remedies and lacking emergency preparedness. Significant correlations were found between the three domains, particularly between knowledge and practices (r = 0.328, p < 0.001), emphasising the role of education and attitudes in shaping behaviours. Multivariate analysis identified formal first aid training, education, and urban residency as strong predictors across all three domains, while older age negatively influenced knowledge. These results underscore the need for culturally tailored education and enhanced training to address gaps in burn prevention and management among the Lebanese population.

<i>In vivo</i> study of the radioadaptive response and low-dose hyper-radiosensitivity for chromosome breaks induced by gamma rays in wild-type <i>Drosophila melanogaster</i> larval neuroblasts: Dose and dose rate dependence

by Claudia Di Dio, Antonella Porrazzo, Alex De Gregorio, Patrizia Morciano, Maria Antonella Tabocchini, Giovanni Cenci, Francesca Cipressa, Giuseppe Esposito

Although the biological effects of low doses/dose rates of ionising radiation have been extensively studied both in vitro and in vivo, there are still knowledge gaps to be filled. For example, the mechanisms underlying the phenomena of radioadaptive responses and hypersensitivity to low doses of radiation are still not fully understood. This study aims to investigate the phenomenon of radioadaptive response in Drosophila melanogaster larval neuroblasts, focusing on the influence of different gamma priming doses and priming dose rates. We examined the modulation of cytogenetic damage, specifically the frequency of chromosome breaks, induced by a challenging dose of 10 Gy following different priming doses (0–2.7 Gy) delivered at dose rates ranging from 1.4 to 17 mGy/h. Our findings reveal the presence of a distinct window in which radioadaptive responses occurs, notably above a certain threshold dose when delivered at a rate of 1.4 mGy/h. Consistently with our previous results, we confirmed that the maximal protection was observed at a priming dose of 0.4 Gy delivered at 2.5 mGy/h. Additionally, we studied the occurrence of chromosome breaks after irradiating larval neuroblasts at doses ranging from 0.7 to 10 Gy. Notably, in this case we observed a low-dose hyper-radiosensitivity phenomenon up to 2.7 Gy, followed by increased resistance above 2.7 Gy. Our results provide insight into the complex cellular responses to low-dose/dose rate radiation and have implications in various fields, including radiation protection, diagnostics, theragnostics and biodosimetry.

Effectiveness of Mindfulness‐Based Couple Interventions on Psychological Distress in Patients With Cancer and Their Partners: A Critical Review

ABSTRACT

Aims

To summarise and critically appraise the evidence of mindfulness-based interventions for psychological distress in patients with cancer and their partners.

Design

A critical review.

Methods

The critical appraisal checklists of the Centre for Evidence-Based Management were utilised for the quality appraisal while reporting the results using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement.

Data Sources

Six electronic databases were searched, including MEDLINE, CINHAL, Embase, PsycINFO, the Cochrane Library, and Web of Science, from inception to August 2023.

Results

A total of six studies were included. Mindfulness-based interventions in general improved psychological distress among patients with cancer and their partners. However, the components of the interventions varied.

Conclusion

Treating patients with cancer and their partners as a unit may improve psychological distress for both parties. It is recommended that cancer couples be involved in mindfulness-based interventions simultaneously to achieve positive effects. Future research into the effectiveness and best practices of mindfulness-based interventions remains necessary.

Implications for the Profession and/or Patient Care

The findings provide information and evidence for improving psychological distress among patients with cancer and their partners to guide the development of a mindfulness-based intervention.

Impact

Mindfulness-based interventions were effective in improving psychological distress in patients with cancer and their partners. The effectiveness of mindfulness-based interventions varied based on intervention formats. Engaging cancer couples in mindfulness-based intervention together may have a positive impact on both partners.

Reporting Method

Preferred Reporting Item for Systematic Reviews and Meta-Analyses Statement 2020.

Patient or Public Contribution

No Patient or Public Contribution.

Neuromodulation through brain stimulation-assisted cognitive training in patients with post-chemotherapy subjective cognitive impairment (Neuromod-PCSCI) after breast cancer: study protocol for a double-blinded randomised controlled trial

Por: Rocke · M. · Knochenhauer · E. · Thams · F. · Antonenko · D. · Fromm · A. E. · Jansen · N. · Aziziaram · S. · Grittner · U. · Schmidt · S. · Vogelgesang · A. · Brakemeier · E.-L. · Flöel · A.
Introduction

Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as ‘chemobrain’). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

Methods and analysis

The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

Ethics and dissemination

Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

Trial registration number

ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.

Exploring Nursing Students' Perspectives on Patient Safety Culture in Clinical Settings: A Mixed‐Method Study

ABSTRACT

Background

Patient safety in undergraduate nursing studies is an indispensable component of the curriculum. The process of experiential learning from practice is of high value not only in terms of personal development but also enables students to identify and address critical areas of patient safety that require improvement.

Aim

To explore Czech undergraduate nursing students' perceptions of patient safety culture during clinical practice through a mixed-method sequential study.

Methods

Data were collected between 2021 and 2024 using a mixed-method approach. The quantitative phase utilised the hospital survey on patient safety culture for nursing students. Four hundred and eighty-two undergraduate nursing students from 16 faculties across the Czech Republic participated. The subsequent qualitative phase employed semi-structured interviews with 12 undergraduate nursing students from one faculty in the Czech Republic. Descriptive and inferential statistical methods were used to analyse quantitative results, complemented by a reflective thematic analysis of qualitative data.

Results

The most negatively rated survey dimensions were ‘Frequency of events reported’ (37.0%) and ‘Nonpunitive responses to errors’ (42.4%). Predictors for reporting adverse events in clinical practice were ‘Indicators of good practice’ (p ≤ 0.05). Based on the quantitative phase, the interpretive journey of nursing students' experiences from Exposure to adverse events, through Feeling disconnected and Cognitive dissonance, to the necessity of Speaking up for patient safety culture was captured in the qualitative phase.

Conclusions

Nursing students struggle to engage in a patient safety culture, particularly in reporting adverse events during clinical practice. Strengthening education on reporting and standards is essential for students, along with professional development for clinical staff to align practices and cultures.

A phase I, open-label, multicentre, first-in-human study to evaluate safety, pharmacokinetics and efficacy of AMG 404, a PD-1 inhibitor, in patients with advanced solid tumours

Por: Price · T. · Lugowska · I. · Chawla · S. P. · Falchook · G. · Subbiah · V. · Monzon · J. G. · Arkenau · H.-T. · Hui · M. · Kuboki · Y. · Dziadziuszko · R. · Shibaki · R. · Hong · M. H. · Tan · D. · Rocha Lima · C. M. · Wang · K. · Hindoyan · A. · Shi · W. · Wong · H. · Kistler · M. · Prenen
Objective

To evaluate the safety, tolerability, pharmacokinetics (PK) and preliminary antitumour activity of AMG 404, a fully human IgG1 monoclonal antibody targeting programmed cell death-1, in patients with advanced solid tumours.

Design

First-in-human phase I study comprising eight dose expansion cohorts, including cohorts with microsatellite instability-high (MSI-H) tumours and non-small cell lung cancer with high programmed death-ligand 1 expression (NSCLC/PDL1-H, tumour proportion score ≥50%).

Setting

Conducted across 28 global sites.

Participants

This study enrolled adult patients with histologically or cytologically confirmed metastatic or locally advanced solid tumours not amenable to curative treatment with surgery or radiation. The inclusion criteria included a life expectancy of >3 months, ≥1 measurable or evaluable lesion per modified Response Evaluation Criteria in Solid Tumours (RECIST) V.1.1, an Eastern Cooperative Oncology Group performance status of ≤2 and adequate haematological, renal and hepatic function. Patients with prior treatment with checkpoint inhibitors, primary brain tumour or untreated or symptomatic brain metastases and leptomeningeal disease and history of other malignancy within the past 2 years were excluded.

Interventions

The planned doses were 240 mg, 480 mg and 1050 mg of AMG 404 administered every 4 weeks (Q4W).

Primary and secondary outcome measures

Primary endpoints were dose-limiting toxicities (DLTs), treatment-emergent adverse events, treatment-related adverse events, changes in vital signs and clinical laboratory tests. Secondary endpoints included PK parameters, incidence of antidrug (AMG 404) antibodies and antitumour activity assessed per modified RECIST V.1.1 (objective response, duration of response, progression-free survival (PFS), disease control and duration of stable disease).

Results

A total of 171 patients were enrolled; 168 were treated. Median (range) follow-up was 36.3 weeks (1.6–137.1). No DLTs were observed. Grade 3 and serious treatment-related adverse events occurred in 16 (9.5%) and 12 (7.1%) patients, respectively. The 480 mg Q4W dose was selected as the recommended phase II dose. AMG 404 serum exposure increased approximately dose proportionally. The objective response rate (80% CI) was 19.6% (15.7–24.1) for the overall population and 36.6% (26.4–47.8) and 30.8% (14.2–‍52.3) for cohorts with MSI-H tumours (n=41) and NSCLC/PDL1-H (n=13), respectively. The overall disease control rate (80% CI) was 54.8% (49.5–59.9). The median (80% CI) PFS was 3.7 (3.5–4.5) months for the overall population and 14.8 (9.0–not estimable) and 4.4 (2.2–9.7) months for cohorts with MSI-H tumours and NSCLC/PDL1-H, respectively.

Conclusions

AMG 404 monotherapy was tolerable at the tested doses, with encouraging antitumour activity observed across tumour types.

Trial registration number

NCT03853109.

Cross‐Cultural Adaptation and Cross‐Validation of the Italian Version of the EPICC Spiritual Care Competency Self‐Assessment Tool for Clinical Nurses

ABSTRACT

Aim

To cross-culturally adapt and psychometrically test the Italian version of the EPICC Spiritual Care Competency Self-Assessment Tool for clinical nurses (EPICC Tool-It).

Design

Multicentre, cross-sectional validation study.

Methods

The 28-item EPICC Tool was translated into Italian and culturally adapted following a rigorous methodology. A nationwide survey was conducted. Psychometric evaluation included content validity, structural validity (exploratory and confirmatory factor analyses), construct validity (known group analysis) and reliability using Cronbach's alpha, McDonald's omega and factor score determinacy.

Results

The sample included 725 clinical nurses (76% female, 80% hospital-based), on average 38.7 years old (SD 11.33), with 14.6 years (SD 11.03) of experience. Confirmatory factor analysis supported a four-factor model (Knowledge of spirituality, Attitudes towards spirituality and spiritual care, Knowledge of spiritual care and Skills in spiritual care), with a second-order factor for the EPICC Tool-It. Construct validity was supported through known group analysis, showing score variation based on nurses' experience, education and religiosity. Internal consistency was excellent across all factors and the overall scale.

Conclusion

A valid, multidimensional instrument is provided to assess spiritual care competencies in Italian-speaking nurses. The EPICC Tool-It is suitable for research and practice, facilitating evaluation of self-perceived competencies and educational effectiveness.

Implications for the Profession and/or Patient Care

The use of the EPICC Tool-It by nursing managers, educators and clinicians is recommended in both clinical and research settings to support education on spiritual care competencies.

Impact

The EPICC Tool-It sets reliable measurement standards for spiritual care competencies, enhancing holistic care and comprehensive understanding of competencies globally.

Reporting

This study adheres to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) guidelines.

Patient or Public Contribution

Patients, service users, caregivers, or the public were not involved in the study. However, nurses as target users of the tool participated in the cultural adaptation and validation process.

Sexual and Gender Minority Migrants' Experiences of Health Service Access and Utilisation: A Qualitative Meta‐Synthesis

ABSTRACT

Aims

To describe and synthesise qualitative studies exploring sexual and gender minority migrants' experiences of health service access and utilisation.

Design

Systematic meta-synthesis of qualitative studies.

Data Sources

Systematic searches in four databases and citation screening were conducted in 2023 and 2024. English-language empirical qualitative studies published in scientific journals within 10 years were included. Of 1109 screened, 21 reports were included.

Methods

Included reports were appraised using CASP and JBI checklists. Extracted results were analysed with inductive content analysis in a collaborative process.

Results

All reports had acceptable quality, including 365 participants from 72 countries. A range of external and internal barriers to accessing health services were reported, including financial constraints and fears. Although migrants expressed an appreciation of health services, they also experienced non-affirming behaviours and discrimination related to their intersecting identities. Several essential components in health services necessary to cater to the needs of migrants were addressed, including the personality and manner of health professionals as well as adherence to confidentiality.

Conclusion

Barriers to health services, intersectional discrimination and non-affirming behaviours when interacting with health services are pressing issues that need further attention.

Implication for the Profession and/or Patient Care

Ensuring safety through affirming support is key to achieving high-quality and accessible health services for sexual and gender minority migrants. Nurses and other health professionals need to carefully consider intersectional layers related to sensitivity and safety when supporting sexual and gender minority migrants. Open, friendly, validating, respectful and encouraging communication is essential in clinical settings.

Impact

This review addressed experiences of health services amongst a marginalised population. The findings highlight the importance of affirming care and are relevant for health professionals, stakeholders and decision-makers.

Reporting Method

ENTREQ.

Patient or Public Contribution

Two persons with lived experience were involved in the meta-synthesis.

Comparing Safety and Accuracy of Standardised Versus Subjective Triage Code Assignment by Nurses: A Multicenter Observational Simulated Study

ABSTRACT

Background

Standardised triage systems have been in place for decades with minor modifications, while nurses' skills and knowledge have significantly advanced.

Aim

To determine whether nurses' clinical expertise outperforms triage systems in simulated clinical cases.

Design

A multicenter simulated observational study.

Methods

The study was conducted from January 1, 2024 to March 31, 2024, in four Italian emergency departments, enrolling triage-performing nurses. Thirty clinical cases, based on real patients representing daily emergency department influx, were reconstructed. The primary outcome was the agreement between the triage code assigned by the Manchester Triage System and the code assigned based on clinical expertise. The secondary outcome compared the predictive ability of the codes assigned by nurses regarding clinical outcomes, such as death within 72 h, the need for hospitalisation, and the need for life-saving intervention. The study was reported in accordance with the STROBE statement.

Results

Seventy-seven triage nurses completed the 30 vignettes. The agreement between the MTS-assigned code and the clinical expertise triage reported a Cohen's kappa of 0.576 (95% CI: 0.564–0.598). For death within 72 h, the clinical expertise code reported better results than the Manchester Triage System. For life-saving interventions, the Manchester Triage System reported a lower performance than clinical expertise. The variability in triage code assignment was higher for clinical expertise compared to the Manchester Triage System.

Conclusions

Triage codes assigned by nurses based on clinical expertise perform better in terms of clinical outcomes, suggesting a need to update triage systems to incorporate nurses' knowledge and skills. However, standardised triage systems should be maintained to reduce variability and ensure consistent patient classification.

Reporting Method

The study was conducted and reported according to the STROBE statement.

Patient or Public Contribution

No patient or public contribution.

Isolated and Combined Effects of Sedentary Behaviour and Physical Activity on Muscle Strength in Older Adults: A Prospective Cohort Study

ABSTRACT

Aim

We aim the isolated and combined effects of sedentary behaviour exposure time and physical activity levels on muscle strength in older adults.

Design

This prospective observational cohort study, analytical in nature, using exploratory survey methods and physical performance testing. With 5-year longitudinal follow-up (2015–2020).

Methods

A total of 459 older adults participated in the baseline, with a total of 224 being included/located again in the follow-up. We evaluate muscle strength using handgrip tests and sit-to-stand tests. The international physical activity questionnaire was used to measure physical activity and sedentary behaviour. Generalised Estimation Equations tested both independent and combined effects, reporting results as β coefficients and confidence intervals.

Results

Older adults exhibiting low sedentary behaviour displayed enhanced handgrip strength compared to those with high sedentary behaviour. Notably, older adults who were sufficiently active with low sedentary behaviour, sufficiently active with high sedentary behaviour, and insufficiently active with low sedentary behaviour showed increased handgrip strength compared to their counterparts who were insufficiently active with high sedentary behaviour. This trend was consistent for lower limb strength.

Conclusion

Interventions that encourage a reduction in sedentary behaviour and an increase in physical activity are essential to maintain muscle strength among older adults.

Implications for Practice

The findings of this study underscore the importance of addressing both sedentary behaviour and physical activity levels in clinical interventions aimed at preserving muscle strength in older adults. Routine assessments of physical activity and sedentary behaviour could help tailor personalised exercise programs, potentially enhancing functional independence and reducing the risk of frailty and disability in older patients.

Patient or Public Contribution

Patients were involved in the sample of the study.

Reporting Method

This study was conducted in accordance with the Strengthening Research in Observational Studies in Epidemiology (STROBE) guidelines.

Using ‘Situation‐Background‐Assessment‐Recommendation’ Method in Palliative Care to Enhance Handover Quality and Nursing Practice: A Mix Method Study

ABSTRACT

Aim

To evaluate the impact of using ‘Situation-Background-Assessment-Recommendation’ method (‘SBAR’) in a palliative care setting.

Background

Effective handover communication is crucial for patient safety. Standardised communication tools, such as the SBAR method, are recommended to reduce errors and improve care coordination, but their use in palliative care is not investigated.

Design

Mixed method study design, adhering to the GRAMMS guideline.

Methods

From January to October 2021, a SBAR guide tailored for palliative care was developed using the Delphi method and implemented in a Hospice setting. Data on 150 nurse handovers were collected before and after implementation to assess changes in nursing outcomes, including medication errors, adverse events and the identification of psychological and spiritual needs. Nurses' perceptions on the handover process were gathered through a qualitative survey.

Results

The SBAR guide significantly improved the handovers quality, reducing medication errors and eliminating adverse events postimplementation. The identification of psychological and spiritual needs increased during postimplementation period. Nurses also reported improved clarity, accuracy and completeness of information during handover.

Conclusion

This is the first study to evaluate the impact of SBAR for handover in palliative nursing care. Findings show the added value of using communication tools.

Integrated virtual screening and MD simulation study to discover potential inhibitors of mycobacterial electron transfer flavoprotein oxidoreductase

by Kaleem Arshad, Jahanzab Salim, Muhammad Ali Talat, Asifa Ashraf, Nazia Kanwal

Tuberculosis (TB) continues to be a major global health burden, with high incidence and mortality rates, compounded by the emergence and spread of drug-resistant strains. The limitations of current TB medications and the urgent need for new drugs targeting drug-resistant strains, particularly multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, underscore the pressing demand for innovative anti-TB drugs that can shorten treatment duration. This has led to a focus on targeting energy metabolism of Mycobacterium tuberculosis (Mtb) as a promising approach for drug discovery. This study focused on repurposing drugs against the crucial mycobacterial protein, electron transfer flavoprotein oxidoreductase (EtfD), integral to utilizing fatty acids and cholesterol as a carbon source during infection. The research adopted an integrative approach, starting with virtual screening of approved drugs from the ZINC20 database against EtfD, followed by molecular docking, and concluding with molecular dynamics (MD) simulations. Diacerein, levonadifloxacin, and gatifloxacin were identified as promising candidates for repurposing against TB based on their strong binding affinity, stability, and interactions with EtfD. ADMET analysis and anti-TB sensitivity predictions assessed their pharmacokinetic and therapeutic potential. Diacerein and levonadifloxacin, previously unexplored in anti-tuberculous therapy, along with gatifloxacin, known for its efficacy in drug-resistant TB, have broad-spectrum antimicrobial properties and favorable pharmacokinetic profiles, suggesting potential as alternatives to current TB treatments, especially against resistant strains. This study underscores the efficacy of computational drug repurposing, highlighting bacterial energy metabolism and lipid catabolism as fruitful targets. Further research is necessary to validate the clinical suitability and efficacy of diacerein, levonadifloxacin, and gatifloxacin, potentially enhancing the arsenal against global TB.

The Impact of Emotional Intelligence on Nurses' Professional Quality of Life in Pre‐Hospital Emergency Settings: A Multicentre Mixed‐Method Study

ABSTRACT

Background

Pre-hospital emergency nurses, frequently exposed to high-stress situations, are at risk for burnout and stress-related issues, affecting their overall well-being. The Professional Quality of Life (ProQoL) scale, widely used among hospital nurses, remains untested in pre-hospital emergency settings.

Aim

To adapt and validate the ProQoL scale for pre-hospital emergency contexts and explore the protective role of emotional intelligence in professional well-being.

Methods

A mixed-method study was conducted. The qualitative approach involved semi-structured interviews to inform the modification of items for adapting the ProQoL to the pre-hospital emergency setting. A quantitative method was applied to assess the relationship between emotional intelligence and professional well-being through content and face validity measures.

Results

Qualitative interviews suggested refining the ProQoL for pre-hospital emergency settings, emphasising factors such as job satisfaction and professional conduct. The revised 21-item Pre-Hospital Emergency-Professional Quality of Life (PHE-ProQoL) scale demonstrated strong content validity (I-CVI: 0.86-1, S-CVI: 0.9) and face validity. Significant correlations were observed between emotional intelligence and professional well-being, with negative correlations between emotional intelligence and both burnout (Pearson's r = −0.859) and post-traumatic stress (Pearson's r = −0.792), and a positive correlation with compassion satisfaction (Pearson's r = +0.917). Pre-hospital nurses displayed moderate levels of compassion satisfaction (27.3 ± 9.81), high emotional intelligence (28.0 ± 9.58), especially in empathy, and substantial levels of burnout (22.5 ± 6.09) and stress (21.2 ± 4.3).

Discussion

The study found that pre-hospital emergency nurses exhibit moderate compassion satisfaction and above-average emotional intelligence, particularly in perceiving and managing others' emotions. However, they also experience significant levels of burnout and post-traumatic stress.

Conclusions

Burnout and post-traumatic stress significantly affect pre-hospital emergency nurses. Enhancing emotional intelligence is crucial for their well-being. Nursing managers now have access to a validated and reliable tool to assess this.

The Relationship Between Nurses' Digital Health Literacy and Their Educational Levels, Professional Roles, and Digital Attitudes: A Cluster Analysis Based on a Cross‐Sectional Study

ABSTRACT

Aim

The current study aimed to identify digital health literacy levels among nurses with respect to their education, role and attitude towards digital technologies.

Design

Cross-sectional study.

Methods

Through convenience sampling, all Registered Nurses, managers/leaders and nurse researchers employed in Hospitals, University Hospitals and Districts were recruited and surveyed using an online questionnaire. The data collection tool assessed: (I) demographics, (II) Digital Health Literacy (DHL) with the Health Literacy Survey19 Digital (HLS19-DIGI) instrument including DHL dealing with digital health information (HL-DIGI), interaction with digital resources for health (HL-DIGI-INT) and use of digital devices for health (HL-DIGI-DD); (III) attitudes on the use of digital technologies in clinical practice. The multiple correspondence analysis was applied to identify three clusters for the education/professional role (A, B, C) and three for digital technologies' use (1, 2, 3). The one-way nonparametric analysis of variance (Kruskal–Wallis test) was applied to compare HL-DIGI, HL-DIGI-INT and the HL-DIGI-DD scores among clusters.

Results

Among 551 participants, the median scores of the HL-DIGI, the HL-DIGI-INT and the HL-DIGI-DD questionnaires were 70.2, 72 and 2.00, respectively. The distribution in the clusters ‘educational/professional role’ was A, (58.8%); B, (16.5%); and C, (24.7%). Nurses in a managerial or coordinator role and with a postgraduate degree used digital resources with greater frequency. The distribution in the clusters ‘use of digital technologies’ was: 1, (54.6%); 2, (12.2%); and 3, (33.2%). The HL-DIGI-DD and HL-DIGI scores of clusters 1, 2 and 3 differed significantly.

Conclusion

DHL among nurses is strongly influenced by the education level, professional role, habits and attitude towards digital technologies. Nurses with coordinator roles used digital technologies with greater frequency and had a higher level of DHL.

Reporting Method

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were used for reporting.

Patient or Public Contribution

No Patient or Public Contribution.

Trial Registration: Local Ethical Committee of the Polyclinic of Bari (code: DHL7454, date: 21/09/22)

The impact of gender on the nursing figure and nurses' interprofessional relationships: A multimethod study

Abstract

Aims

To identify the current presence of stereotypes about the nursing profession in Italy and to understand how gendered processes and modalities are regulated and expressed in the physician-nurse dyad, and the implications for professional identity and autonomy.

Design

Qualitative multimethod design.

Methods

Forty-five interviews were conducted with nurses and physicians. The collected qualitative data underwent automatic textual data analysis using a multidimensional exploratory approach and a gender framework analysis.

Results

In Italy, nurses' roles are still associated with gender stereotypes stemming from the predominant male culture, which affects sexual and gender identity, the division of labor, and access to career paths. This leads to disadvantages in the nursing profession, which is heavily dominated by women.

Conclusion

Biological differences between sexes generate an unconscious yet shared symbolic gender order composed of negative stereotypes that influence nurses' professional roles and activities. They follow behaviors that enter the work routine and institutionalize organizational processes. These effects are also seen in the asymmetric, limited, and reciprocal interprofessional relationships between male physicians and female nurses, where the former hinders the latter's professional autonomy and access to top positions.

Implications for the Profession

This survey raises awareness of gender issues and stimulates reflection. It also enables health and nursing organizations to take action to raise gender awareness and education by countering the image of a non-autonomous profession. The analysis of gender processes allows us to identify interventions that can counteract forms of oppression in the work environment that lead to the emergence of nursing as a non-autonomous profession.

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