More than meets the eye: phenomenological insights into the functioning of people with lipoedema

PURPOSE

The aim of this study was to explore the functioning of people with lipoedema from their perspective.

METHODS

This was a qualitative study following a phenomenological perspective using individual in-depth interviews with a convenience sample of 13 Dutch people with lipoedema. The data were analysed by using an interpretative phenomenological approach.

RESULTS

Two overarching group experiential themes (GETs) were identified: (1) "physical complaints are only a part of their problems", and (2) "longing for improved appearance and functioning". The GETs were composed of the following subordinate GETs: "disproportionate functioning of the lower body", "navigating daily life with lipoedema", "coping with uncertainty", "the toll of shame and stigmatization", "consequences of a very negative self-image", "desire for change and improved appearance and functioning", and "an ongoing journey of acceptance".

CONCLUSIONS

Participants experience that physical complaints affect daily activities, but with adequate adaptability, participation issues are relatively limited. Instead, shame about their appearance and (fear of) stigmatization mainly leads to social avoidance. Additionally, participants long for freedom to do what they want, wear what they want, and desire a different appearance. Therefore, the experienced level of acceptance of the condition is context- and situation-dependent and not straightforward, which is complicated by the burden of knowing that the condition is chronic.

Vancomycin wound penetration in open-heart surgery patients receiving negative pressure wound therapy for deep sternal wound infection

INTRODUCTION

It is hypothesized that systemically administered antibiotics penetrate wound sites more effectively during negative pressure wound therapy (NPWT). However, there is a lack of clinical data from patients who receive NPWT for deep sternal wound infection (DSWI) after open-heart surgery. Here, we evaluated vancomycin penetration into exudate in this patient group.

PATIENTS AND METHODS

For this prospective observational study, we enrolled 10 consecutive patients treated with NPWT for post-sternotomy DSWI. On the first sampling day, serum and exudate samples were synchronously collected at 0 (pre-dose), 0.5, 1, 2, 3 and 6 h after vancomycin administration. On the following three consecutive days, additional samples were collected, only before vancomycin administration.

RESULTS

The ratio of average vancomycin concentration in wound exudate to in serum was higher for free (unbound) (1.51 ± 0.53) than for total (bound + unbound) (0.91 ± 0.29) concentration (p = 0.049). The percentage of free vancomycin was higher in wound exudate than serum (0.79 ± 0.19 vs. 0.46 ± 0.16; p = 0.04). Good vancomycin wound penetration was maintained on the following three days (vancomycin trough exudate-to-serum concentration ratio > 1). The total hospital stay was significantly longer in patients with DSWI (46 ± 11.6 days) versus without DSWI (14 ± 11.7 days) (p < 0.001). There was no in-hospital or 90-day mortality. Two patients experienced late DSWI recurrence. All-cause mortality was 4.8% during a median follow-up of 2.5 years.

CONCLUSION

Vancomycin effectively penetrates wound exudate in patients receiving NPWT for DSWI after open-heart surgery.The protocol for this study was registered at ClinicalTrials.gov on July 16, 2024 (NCT06506032).

Using maternal sepsis patient journeys to map and prioritise barriers to quality maternal healthcare in Malawi: a multidisciplinary stakeholder consultation workshop

BACKGROUND

Malawi has made progress in improving access to maternity care services, shifting the focus to quality of care as an essential determinant of maternal health outcomes. However, no effective mechanisms exist to use patients' experiences of care at health facilities to inform and improve the quality of maternal healthcare.

OBJECTIVE

To use maternal sepsis patient journeys in a workshop with maternal health stakeholders to identify and prioritise barriers in care and recommend interventions to improve maternal healthcare quality in Malawi.

METHODS

In February 2024, in Blantyre, Malawi, using a modified nominal group technique, 28 stakeholders reviewed the patient journeys of three women hospitalised at Queen Elizabeth Central Hospital, who had sepsis after childbirth. Patient journeys narrate events experienced within a healthcare system in the patient's words. In a multiframework approach (Four Delays, Respectful Maternity Care, and WHO Quality of Care), stakeholders identified and prioritised barriers to care and recommended interventions to improve the quality of maternal healthcare. Content analysis of the workshop data linked barriers with stakeholders' suggested interventions.

RESULTS

Nineteen barriers identified included various delays in receiving care, mistreatment by healthcare providers, and suboptimal quality of care. Stakeholders found patient journeys valuable and insightful for identifying gaps in the quality of care and promoting sepsis awareness among healthcare workers and the public.

CONCLUSIONS

Patient journeys are a novel tool for capturing the experience of care in Malawi. They have the potential to guide strategic improvements in maternal healthcare quality and ultimately reduce maternal morbidity and mortality.

Detection and management of clinical deterioration in a virtual hospital: A work system analysis

Timely detection and management of patient deterioration is critical to minimise adverse events and death. The study aimed to understand the processes of detecting and managing deterioration in a virtual care environment, assess work system barriers and facilitators, and identify changes needed to the technology. Data were collected using interviews and document reviews and presented as process map and a work system analysis. We found that nurses and patients were key stakeholders in detecting deterioration, while management of deterioration was primarily performed by doctors and patients. We uncovered more barriers in the detection process than the management process, with the majority of barriers relating to technologies. Most facilitators related to people and included clinician expertise and carer support. Duplication of work and difficulty assessing some signs virtually were also revealed as barriers to the deterioration detection process. This study led to work system changes to mitigate some of these barriers.

Examination and testing of structural validity of the Confidence in Dementia Scale with nursing students. An international perspective

BACKGROUND

As the prevalence of dementia continues to rise globally, nurses are increasingly at the forefront of providing care. Effective dementia care relies on not just knowledge, but also the confidence to translate this knowledge into meaningful action. Enhancing nursing education programmes to build both knowledge and confidence is critical. As no studies have explored measuring confidence in dementia care over an extended period (beyond six months), there is a need for a rigorous and robust analysis of the Confidence in Dementia (CODE) Scale, to determine whether it is a psychometrically sound tool for assessing confidence over time.

METHODS

A cross-sectional series design was used to collect longitudinal data from a census of nursing students over a 3-year period. A standardized instrument, the Confidence in Dementia Scale was administered repeatedly to a sample (time 1 n = 247; time 2 n = 239; time 3 = n = 216). Analyses were performed using SPSS for descriptive statistics and JASP for structural equation modelling. An initial exploratory factor analysis was conducted using the first data set to explore the factor structure. A confirmatory factor analysis was performed (on the second and third data sets) to confirm the factor structure and assess the model's overall validity. COSMIN guidelines inform the analysis process, and the findings are reported using STROBE guidelines.

RESULTS

The factor structure replicated and confirmed the one factor structure identified by international findings. The findings confirm its usefulness of the Confidence in Dementia scale to gauge health professionals' confidence in dementia care before going into practice.

CONCLUSIONS

This study highlights the need for psychometrically valid tools that can measure confidence over an extended period, encompassing the three-year degree programme and beyond.

Mapping the lung-brain axis: Causal relationships between brain network connectivity and respiratory disorders

BACKGROUND

The mechanistic relationship between respiratory disorders and brain function remains poorly understood, despite growing evidence of cognitive and neurological manifestations in respiratory diseases. We aim to identify whether specific brain network connectivity patterns causally influence respiratory disease susceptibility, while respiratory conditions might reciprocally affect brain network architecture.

METHODS

We performed bidirectional Mendelian randomization (MR) analyses using genome-wide association studies (GWAS) of brain network connectivity from UK Biobank resting-state functional MRI (rs-fMRI) data (N = 31,453) and GWAS data from ten major respiratory conditions: chronic obstructive pulmonary disease (COPD), asthma, idiopathic pulmonary fibrosis (IPF), sleep apnea syndrome (SAS), lung squamous carcinoma (LUSC), lung adenocarcinoma (LUAD), small cell lung carcinoma (SCLC), hospitalized COVID-19, very severe COVID-19, and bronchiectasis. Five MR methods, inverse variance weighted (IVW) with multiplicative random-effect model, weighted median, weighted mode, MR Egger, and MR-robust adjusted profile score (MR-RAPS) were employed to ensure causal inference.

RESULTS

In forward analysis, five respiratory disorders - asthma, IPF, SAS, LUSC, and very severe COVID-19 - showed significant causal associations (p < 1.31 ×10-4) with 11 rs-fMRI phenotypes, spanning multiple brain networks including the central executive, subcortical-cerebellum, motor, limbic, attention, salience, visual, and default mode networks. In reverse analysis, twelve brain functional networks demonstrated genetic associations with eight respiratory conditions (COPD, asthma, IPF, SAS, LUSC, SCLC, hospitalized COVID-19, and very severe COVID-19), predominantly involving attention, salience, default mode, visual, and central executive networks.

CONCLUSIONS

Our study provides preliminary genetic evidence suggesting potential causal relationships between brain network connectivity and respiratory disorders, contributing to our understanding of the lung-brain axis. While the identification of disease-specific network alterations offers promising insights, further clinical validation is needed before these findings can be translated into therapeutic interventions.

Investigating the effects of reminiscence using smells on loneliness and depressive symptoms in community-dwelling older adults: a randomised controlled trial

BACKGROUND

The use of a variety of sensory elements is recommended when implementing reminiscence therapy. However, there is a lack of evidence supporting this recommendation. This study aimed to examine the benefits of using smell as a memory trigger during reminiscence therapy for community-dwelling older adults, focusing on its effects on loneliness and depressive symptoms.

METHODS

Seventy-nine community-dwelling older adults were randomly allocated to either an intervention or a control group. Participants in the intervention group underwent a total of eight 40-min. reminiscence therapy sessions once a week that used smell as a trigger. The control group underwent similar reminiscence therapy but only used themed conversations. Their responses were assessed pre- and post-intervention using the UCLA Loneliness Scale version 3 (UCLA LS3), which evaluates loneliness, and the Geriatric Depression Scale-15-Japanese, which measures the state of depressive symptoms.

RESULTS

The pre-intervention comparison of the participants' characteristics and each evaluation item showed significant differences (P = 0.030) between the two groups' olfactory visual analogue scale (VAS) scores. Subsequently, we performed analysis of covariance via repeated measurements, using olfactory VAS as the covariate, and found significant interactions in UCLA LS3 (P = 0.006) alone. To identify items for consideration during interventions, we examined factors related to post-intervention UCLA LS3 scores. Our results showed that the notion of usefulness, by which participants perceived the smell triggers to be useful for inducing reminiscence (P = 0.045), was significantly related to pre-intervention UCLA LS3 scores (P < 0.001) in the intervention group.

CONCLUSION

These findings show that using smell as a trigger during reminiscence therapy can effectively alleviate loneliness and suggest the need to prepare appropriate odorants for facilitating reminiscence.

Comparative Analysis of Quality of Life of Family Caregivers of Patients With Heart Failure and Cancer Who Receive Palliative Care

BACKGROUND

Quality of life (QoL) is the criterion-standard outcome in palliative care for patients with various illnesses and their family caregivers. There is a need to determine the factors affecting caregivers' QoL in each population and the differences between groups to design differentiated intervention strategies.

PURPOSE

The aims of this study were to compare the role adoption, social support, and QoL of family caregivers of patients with heart failure and cancer in palliative care and to examine the determinants of QoL.

METHODS

A comparative study was conducted with the family caregivers of patients with cancer (n = 81) and heart failure (n = 80) in palliative care. Quality of life in life-limiting situations, role adoption, and social support questionnaires were also administered. A χ 2 test, Student t test, and Mann-Whitney U test were used for between-group comparisons. Multiple linear regression was used to examine the effects of the correlated variables on caregivers' QoL.

RESULTS

Caregivers of patients with heart failure had better QoL ( P = .006) and lower tangible social support ( P = .007) than caregivers of patients with heart failure. No differences were found in caregiver role adoption between the groups. Linear regression indicated that for caregivers of patients with cancer, social support, role adoption, caregiver age, and patient functional status affect caregiver QoL. For caregivers of patients with heart failure, role adoption and patient functional status are predictors of QoL.

CONCLUSIONS

Overall, healthcare professionals should focus on improving social support and caregiver role adoption and provide greater attention to the QoL of caregivers of patients with cancer.

Moderate drinking benefits cognitive health in middle-aged and older Chinese: A latent class growth model analysis based on CHARLS

While alcohol use among older population is linked to various health risks, recent studies indicate potential benefits from moderate consumption, highlighting a contentious debate regarding its impact on health in this demographic. This study aims to identify distinct trajectories of alcohol use among middle-aged and older adults in China and examine their associations with multidimensional health outcomes, including cardiovascular, cognitive, and psychological health. This study utilized data from the China Health and Retirement Longitudinal Study (CHARLS), tracking a sample of 10,927 participants (54.33 % female; mean age = 57.61, SD = 8.95) through five waves of data collection. Latent Class Growth Modeling (LCGM) was employed to analyze alcohol use trajectories. Health outcomes were assessed through self-reported health measures and clinical data including lipoprotein levels. Four distinct alcohol use trajectories were identified: Moderate (6.3 %), Decreasing (11.0 %), Increasing (6.9 %), and Constantly Low (75.8 %). The Moderate trajectory was associated with significant higher cognitive scores compared to Increasing (p = .027) and Constantly Low group (p = .012). Moreover, higher levels of high density lipoprotein were linked with the Increasing and Decreasing trajectories, suggesting a protective cardiovascular effect. The findings highlight the complexity of alcohol use behaviors among older adults in China and underscore the need for targeted health interventions. Understanding the nuanced impacts of different drinking patterns on multidimensional health outcomes can aid in developing more effective public health strategies and clinical practices tailored to the needs of aging populations. Further research is recommended to explore the causal relationships and long-term health impacts of these trajectories.

Bioactives for Estrogen-Deficient Skin: Topical and Oral Supplement Clinical Studies. A Narrative Review

Bioactive compound applications by topical or oral administration have gained increased utilization/awareness in providing health benefits particularly due to changes in hormone levels and aging, especially in women with the decline and loss of estrogens. This narrative review focuses on the bioactive compounds such as the phytoestrogens that have estrogenic properties for improving skin health. Notably, phytoestrogens bind and/or activate estrogen beta receptors, which are abundant in skin layers to improve dermal health. This review presents: (a) skin characteristics with aging in women, (b) changes in hormone levels with aging in women (especially with estrogen deficiency), (c) the characteristics of phytoestrogens and other bioactive compounds, (d) topical and oral clinical studies of bioactive compounds (phytoestrogens) as antiaging treatment(s) for estrogen-deficient skin (during peri- and postmenopause), and (e) the advantages of treating the skin from the outside to inside by traditional topical therapies and treating the skin from the inside to the outside by nutraceutical supplementation, which represents a relatively new innovation of increasing popularity. While this is a growing area of research with promising results, more investigations are needed to understand the mechanism(s) of how combination ingredient formulations work to improve skin health and slow down the advancement of the aging process.

Prevalence and correlates of generalized anxiety disorder and subthreshold anxiety symptoms in south China: A network perspective

AIMS

To investigate the prevalence of generalized anxiety disorder (GAD) and subthreshold anxiety symptoms (SAS) in Guangdong province of China, and to identify the central anxiety symptoms, while further exploring their associations with sociodemographic characteristics, lifestyle factors, and somatic diseases.

METHODS

This survey was conducted in 21 administrative regions of Guangdong province with multistage-stratified cluster random sampling method. Multivariate logistic regression analyses were performed to estimate the adjusted odds ratios (ORs) and their 95 % confidence intervals (CIs). Network analyses were conducted to explore the centrality of anxiety symptoms.

RESULTS

A total of 16,377 individuals were included in this study. The weight 12-month prevalence rates for GAD and SAS were 3.5 % and 10.0 %, respectively. Multivariable logistic regression analysis identified several factors significantly associated with increased risks of GAD and SAS, including younger age, female, no spouse, current alcohol consumption, never exercising, comorbidities, sleep duration of less than 7 h. Notably, the factors related to GAD and SAS largely overlapped, with urban residency and napping correlating specifically with SAS, and mental health literacy correlating specifically with GAD. Network analysis identified "Trouble relaxing" (GAD4) as the most central symptom of anxiety.

CONCLUSIONS

GAD and SAS were prevalent among residents in south China. More attention and assistance should be prioritized to individuals with younger age, female, no spouse, current alcohol consumption, sleep less than 7 h, and comorbid with somatic diseases. Taking regular exercise and improving mental health literacy may be beneficial in preventing and controlling anxiety.

Beyond the physical: The interplay of experienced weight stigma, internalised weight bias and depression in lipoedema

This study explored experienced weight stigma, internalised weight bias and depressive symptom severity in lipoedema, a chronic health condition that primarily affects women and involves painful and disproportionate adipose tissue. This study utilised an international cross-sectional online survey involving N = 1070 women over 18 years old (Mage = 48.9 years old) with self-reported diagnosed or suspected lipoedema. Participants completed measures of demographic and health characteristics, experienced weight stigma, internalised weight bias and depressive symptoms (PHQ-9). Chi-square analysis showed experienced weight stigma differed between those with stage 1 (n = 57), stage 2 (n = 311), Stage 3 (n = 664) and stage unknown (n = 38) lipoedema. Hierarchical linear regression determined the effects of weight stigma on depression and the mediating role of internalised weight bias. Experienced weight stigma (p < .001) and internalised weight bias (p < .001) were related to depressive symptoms beyond age and symptoms of lipoedema (BMI, lipoedema symptom severity and mobility). Internalised weight bias partially mediated the effect of experienced weight stigma on depression. Psychological attributes of experienced weight stigma and internalised weight bias uniquely contribute to depressive symptoms in lipoedema. Increased awareness of the psychological effects of weight stigma and the role of internalised weight bias in women's experience of lipoedema on depression is needed.

Use of artificial intelligence to support quality of life of people with dementia: A scoping review

BACKGROUND

Dementia has an impact on the quality of life (QoL) of people with dementia. Tailored services are crucial for improving their QoL. Advances in artificial intelligence (AI) offer opportunities for personalised care, potentially delaying institutionalisation and enhancing QoL. However, AI's specific role in approaches to support QoL for people with dementia remains unclear. This scoping review aims to synthesise the scientific evidence and grey literature on how AI can support the QoL of people with dementia.

METHOD

Following Joanna Briggs Institute guidelines, we searched PubMed, Scopus, ACM Digital Library, and Google Scholar in January 2024. Studies on AI, QoL (using Lawton's four-domain QoL definition), and people with dementia across various care settings were included. Two reviewers conducted a two-stage screening, and a narrative synthesis identified common themes arising from the individual studies to address the research question.

RESULTS

The search yielded 5.467 studies, after screening, thirty studies were included. Three AI categories were identified: monitoring systems, social robots, and AI approaches for performing activities of daily living. Most studies were feasibility studies, with little active involvement of people with dementia during the research process. Most AI-based approaches were monitoring systems targeting Lawton's behavioural competence (capacity for independent functioning) domain.

CONCLUSION

This review highlights that AI applications for enhancing QoL in people with dementia are still in early development, with research largely limited to small-scale feasibility studies rather than demonstrating clinical effectiveness. While AI holds promise, further exploration and rigorous real-world validation are needed before AI can meaningfully impact the daily lives of people with dementia.

Clinical Effects of Thread-Dragging Therapy on Gangrene of Non-ischemic Diabetic Foot Ulcers

OBJECTIVE

To investigate the clinical effects of thread-dragging therapy on gangrene of non-ischemic diabetic foot ulcers (NIDFU).

METHODS

A total of 136 patients with NIDFU were recruited from the Department of Peripheral Vascular Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between June 21, 2021 and February 1, 2023, and randomized into an intervention group and a control group, with 68 cases in each group. Both groups received basic treatment. The intervention group was treated with thread-dragging therapy, while the control group was treated with debridement combined with routine dressing changes after surgery. Both groups were treated continuously for 2 months. The amputation rates and changes in the ulcer area were compared between the groups. The inflammatory response index including peripheral white blood cells (WBCs), neutrophil percentage (NEUT%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), and interleukin 6 (IL-6) were compared between the two groups.

RESULTS

After treatment, the ulcer areas in the intervention group were significantly smaller than that of the control group (8.50±3.88 cm2 vs. 10.11±4.61 cm2, P<0.05). The amputation rates of the two groups were not statistically significant (4.4% vs. 5.9%, P>0.05). Differences of WBCs count, CRP, and ESR before and after therapy in the intervention group were better than the control group (P<0.05). However, there were no significant differences in changes of NEUT%, PCT, and IL-6 between the two groups (P>0.05).

CONCLUSION

Thread-dragging therapy may be effective in the treatment of NIDFU, with the additional advantages of less tissue damage after healing. (Registration No. ChiCTR2100047496).

Dynamic Covalent Hydrogels for Wound Healing

Given their hydrophilic nature, hydrogels have shown great potential as wound dressing materials. However, traditional hydrogel dressing materials are static and do not adapt to dynamic wound environments, which in turn limits their wound healing efficacy. Introducing dynamic covalent chemistries can be an effective strategy to improve hydrogel properties for effective wound healing, such as shape adaptability, stimuli responsiveness, self-healing capability, and antibacterial properties. We discuss the properties and chemistries of dynamic covalent bonds for wound healing. We critically analyze the advances of dynamic covalent hydrogels for wound healing and further propose new dynamic covalent chemistries for wound healing.

Development and validation of competencies for home-based nursing care: an e-Delphi study

Background

The expected competencies of nurses in home-based care remain unclear. A list of professional competencies that are agreed upon by a panel of content expert are needed to offer some form of standardized expectations among nurses and home-based care stakeholders.

Objectives

To evaluate the content validity of the professional competencies identified for home-based nursing care.

Design

An e-Delphi method was used.

Settings

A purposive sampling of local and international experts in home-based nursing care or community nursing.

Methods

Preliminary competency items were developed inductively from earlier studies and deductively by a steering committee. Sixteen experts performed two rounds of content validation. The Item-Content Validity Index, Scale-Content Validity Index/Average (S-CVI/Ave) and Fleiss' kappa coefficient were evaluated.

Results

In Round One, the list was revised to 49 items. In Round Two, the list was revised to 45 items, categorized into eight domains of practice: (1) client assessment and care planning; (2) nursing care in a home-based setting; (3) management of clients with health conditions, (4) interpersonal relationships and communications; (5) collaboration and teamwork; (6) critical thinking and problem-solving skills; (7) professional development and leadership; and (8) innovation and research. The S-CVI/Ave was 0.95. The overall acceptable clarity was 94.1 %.

Conclusions

This study generated a list of competencies that have reached consensus among a panel of experts. The list offers insights into the expected competencies of home-based care nurses. Further validity and reliability testing is needed to determine the underlying structure of the competencies.

Awareness of scar management post lower segment caesarean section - A survey

OBJECTIVE

Unhealed caesarean section scars accompany risks of complications which can lead to morbidity, mortality, and complications in future pregnancies. Thorough knowledge of scar healing and management strategies in females undergoing caesarean section is of utmost importance. Our study aims to study the level of awareness of scar healing, management, and scar precaution in females undergoing C-sections.

METHODOLOGY

330 females who underwent C-sections from 2019to to 2021 were included. A self-administered validated questionnaire translated into regional languages was used. The questionnaire assessed level of awareness in 3 domains-scar healing, scar management, and scar precautions.

RESULTS

59% of females were aware of scar management strategies. 52% of females gained knowledge concerning scar healing, management, and precaution through relatives and friends; followed by 35% by gynaecologists/medical camps. Multigravida females were more aware of domains of scar healing and management strategies, whereas primigravida were more aware of precautions concerning caesarean scar.

CONCLUSION

Awareness regarding overall scar management will aid in coping with physical stressors postpartum and its complications. Awareness programs should be initiated by health-care professionals to increase awareness among females undergoing C-sections. Primigravida's should be enlightened regarding scar healing and treatment strategies while multigravida should be explained thoroughly regarding scar precautions.

Unveiling the therapeutic journey of snail mucus in diabetic wound care

A diabetic wound (DW) is an alteration in the highly orchestrated physiological sequence of wound healing especially, the inflammatory phase. These alterations result in the generation of oxidative stress and inflammation at the injury site. This further leads to the impairment in the angiogenesis, extracellular matrix, collagen deposition, and re-epithelialization. Additionally, in DW there is the presence of microbial load which makes the wound worse and impedes the wound healing cycle. There are several treatment strategies which have been employed by the researchers to mitigate the aforementioned challenges. However, they failed to address the multifactorial pathogenic nature of the disease. Looking at the severity of the disease researchers have explored snail mucus and its components such as achacin, allantoin, elastin, collagen, and glycosaminoglycan due to its multiple therapeutic potentials; however, glycosaminoglycan (GAGs) is very important among all because they accelerate the wound-healing process by promoting reepithelialization, vascularization, granulation, and angiogenesis at the site of injury. Despite its varied applications, the field of snail mucus in wound healing is still underexplored. The present review aims to highlight the role of snail mucus in diabetic wound healing, the advantages of snail mucus over conventional treatments, the therapeutic potential of snail mucus, and the application of snail mucus in DW. Additionally, clinical trials, patents, structural variations, and advancements in snail mucus characterization have been covered in the article.

Polypharmacy is Associated with Diabetic Foot Ulcers in Type 2 Diabetes mellitus

Objectives: This observational study aimed to investigate the relationship between polypharmacy and the existence of diabetic foot ulcers in patients with type 2 diabetes. Methods: Patients with T2DM with and without diabetic foot ulcers who presented to the endocrinology outpatient clinic between August 2020 and November 2021 were involved in the study. Overall, five hundred and twelve patients with T2DM (293 patients with diabetic foot ulcer and 219 patients without diabetic foot ulcer) were included. The exclusion criteria were pregnancy, lactation, type 1 diabetes, patients under 18 years and over 65 years of age, and history of malignancy. The information of drugs administered, demographic and clinical data were obtained from the patient files. The Wagner score was used to evaluate the severity of ulcers. Results: The comparison of the two groups revealed that patients with diabetic foot ulcers had significantly higher rates of diabetic retinopathy (p = 0.017). The patients with diabetic foot ulcers who had polypharmacy had significantly higher rates of hypertension, ischaemic heart disease, diabetic retinopathy, and complaints of diabetic neuropathy (P < 0.001, P < 0,001, p = 0.021 and P = 0.004, respectively). In the binary logistic regression analyses, polypharmacy was independently associated with diabetic foot ulcers in all models. Conclusion: Polypharmacy should be seriously concerned in type 2 diabetes mellitus in patients with diabetic foot ulcers and polypharmacy was related to diabetic foot ulcers.

Daily Challenges and Resources of Adults with Chronic Dysphagia: A Qualitative Investigation

Identifying and addressing daily challenges and resources associated with chronic oropharyngeal dysphagia (OD) is a pivotal, though still neglected component of person-centred care, yet overlooked in research studies. To investigate these dimensions, 25 Italian adults with chronic OD due to cancer or neurodegenerative diseases participated in semi-structured interviews, designed following a modified framework analysis approach. Two researchers independently transcribed and coded interviews, elaborated a working analytical framework, indexed and charted the data, solving discrepancies through negotiated agreement and discussion with a third researcher. Proportion agreement on extracted quotations was calculated. Overall, 457 quotations were extracted from the interviews (88% agreement). Daily challenges pertained to physical, practical, and social domains; most participants reported OD-related problems; almost half mentioned care needs and obstacles in using healthcare services. Concerning resources in OD management, most participants referred to problem-focused and meaning-focused coping strategies, personal capabilities, and support from family and healthcare services. Finally, almost half of the participants reported OD-related changes in life view and meaning. Findings suggest that adjusting to OD implies challenges and resource mobilization in different life domains. Future studies should longitudinally elucidate the dynamics of positive adjustment, to promote patient-centred OD care based on individually perceived needs and challenges, and to inform healthcare policies.

Sleep quality and lymphedema in breast cancer survivors: a mixed method analysis

PURPOSE

The purpose of this convergent mixed methods study was to assess the perceptions and characteristics of sleep in breast cancer survivors (BCSs) and elucidate perceptions of sleep among BCS with lymphedema.

METHODS

Participants were BCS with and without lymphedema. Both groups completed the Pittsburgh Sleep Quality Index (PSQI), PROMIS® Sleep Disturbance (8a short form), and wore an actigraph on their wrist to capture sleep/wake cycles for 7 days/nights while logging their sleep using a sleep diary. The coefficient of variation of sleep efficiency was calculated from the sleep diary to assess intraindividual variability. In addition, a subsample of BCS with lymphedema participated in a semi-structured qualitative interview. The qualitative data was analyzed separately, and the themes were applied to provide a more nuanced explanation of the quantitative outcomes.

RESULTS

The BCS with lymphedema (n=23) had a significant difference in PSQI (p=0.002), PROMIS® Sleep Disturbance (p=0.084), and sleep efficiency coefficient of variation (p=0.014) compared to BCS without lymphedema (n=23). There were no statistically significant differences between groups in the actigraphy results. BCS with lymphedema perceived that lymphedema management contributed to their sleep disturbance, further exacerbating their mind/body fatigue.

CONCLUSION

This study provides the foundation for future research to investigate the integration of sleep interventions with lymphedema management for holistic survivorship care for BCS with lymphedema.

IMPLICATIONS FOR CANCER SURVIVORS

An innovative sleep health intervention designed to consider the unique factors contributing to sleep disturbance in BCS with lymphedema will fill a gap in their post-cancer treatment quality of life.

'I'm Not a Bad Mom, I'm a Sick Mom': Using Photovoice to Examine Parental Recovery Narratives Given Institutional Constraints

Substance use disorder is highly stigmatised despite its contemporary medicalisation. Because of the criminalisation of substance use, parents with substance use disorder must often navigate recovery while interacting with the criminal legal and child welfare systems. Restitution narratives of illness do not sufficiently capture the recovery experiences of parents with substance use disorder whose recoveries may better align with a quest narrative. This study uses qualitative photovoice discussion data to examine the recovery narratives constructed by parents with substance use disorder as they navigate institutional and interpersonal obligations. Using template analysis of 23 transcripts from photovoice group sessions with 29 individuals who have substance use disorder, we find that criminal legal system and child welfare system obligations limit participants' ability to fully engage in the recovery process. Carceral institutions act as a barrier to substance use recovery and parenting capacity by conferring punitive consequences that prioritise restitution. Parents in recovery must navigate these restitutive institutions while seeking self-improvement and using their lived experiences to rebuild community with their families. Understanding parental recovery experiences may inform the improved design and implementation of parenting and behavioural health supports available to help break intergenerational cycles of trauma and addiction.

Trust in nurses and its association with medication adherence of cardiovascular patients: A descriptive correlational study

Background

Medication adherence plays an important role in managing cardiovascular diseases. Trust in nurses may be effective in enhancing medication adherence in patients with cardiovascular diseases.

Aim

This study aimed to investigate the correlation between trust in nurses among cardiac patients and their medication adherence and explore the predictors of medication adherence.

Methods

This descriptive correlational design was conducted among "302″ cardiac patients hospitalized at Amir Al-momenin Teaching Hospital affiliated with Maragheh University of Medical Sciences. Data was gathered using a demographic characteristics questionnaire, Medication Adherence Scale, and Trust in Nurses' Scale. Data was analyzed using descriptive (frequency, percentage, mean, standard deviation, median, and descriptive tables) and inferential (Kruskal-Wallis, Mann-Whitney, Spearman correlation coefficient, and quartile regression) statistics. Data was gathered from October 2023 to January 2024. The data was analyzed using SPSS software ver.21.

Findings

The mean and standard deviation of medication adherence and trust in nurses were 91.6 ± 6.9 and 10.5 ± 3.9, respectively. A significant positive correlation was found between trust in nurses and medication adherence(r = 0.61). There was a significant difference in medication adherence based on the type of disease. So that, the median medication adherence was the highest for coronary artery patients and the lowest for hypertensive patients. The results of quartile regression analysis showed that trust in nurses and type of disease are the main predictors of medication adherence (R2 =20 %.).

Discussion and conclusions

The results indicated that medication adherence among cardiovascular patients was moderate and patients' trust in nurses was less than average. Considering the type of disease as an unmodifiable variable, trust in nurses was the main modifiable factor that plays an important role in increasing medication adherence of cardiovascular patients. Therefore, appropriate strategies such as teaching communication skills to nurses, and training and attracting interested individuals with high communication skills should be taken to enhance patients' trust in nurses.

Effectiveness of technological interventions on psychosocial well-being and perception of technological interventions among people with Parkinson's disease: A systematic review

OBJECTIVES

The increasing number of technological interventions related to Parkinson's disease (PD) signifies growing research interest in the PD technological domain. It remains unknown how these interventions could affect the psychosocial health of people with PD. This systematic review aims to explore how technological interventions affect people with PD psychosocial well-being and their perception towards these interventions.

METHOD

A systematic review was conducted using Cochrane Library®, Embase®, IEEE Xplore Digital Library®, PsycInfo®, PubMed® and Web of Science® databases following PRISMA guidelines. Two individual assessors conducted quality appraisals using the Mixed Method Appraisal Tool. Both quantitative narrative and qualitative thematic synthesis were adopted to analyse the extracted data.

RESULTS

This review included 27 articles with 752 people with PD, with seven categories of technologies implemented in physical rehabilitation. Qualitative findings indicated the overarching theme of coping with technological intervention. Three themes were identified: user perception of intervention design and functional appropriateness, attitude shift and coping, and perceived benefits from technological interventions. Unsuccessful coping attempts and overcomplicated intervention designs induced negative emotions and affected the psychosocial well-being of people with PD.

CONCLUSIONS

Although most PD technological interventions focused on physical rehabilitation, people with PD reported a psychosocial gain in improved autonomy and reinforced social relationships during the intervention period. A better rewardability intervention design was considered more satisfying and could promote self-acceptance rather than stress-inducing. Interventions' technological complexity should match participants' expectations and technological literacy to facilitate the coping process with the intervention for people with PD. More research would be required to quantify the reported psychosocial gain and examine the technological literacy of people with PD when designing a more appropriate intervention regime.

Vaginocutaneous fistula caused by recurrent labial abscess: A case report

Urogenital fistulas are characterized by communication tracts that connect two surfaces or distinct organ systems. A vaginocutaneous fistula is a rare type of urogenital fistula that is characterized by persistent perineal discharge. This case report describes a female patient who suffered from recurrent labial abscesses and a fistula that connected the lower vagina to the inner thigh. There were symptoms of persistent perineal discharge, and the patient had an offensive odor. The patient had a history of six recurrent right labial abscesses over a period of two years prior to the formation of two fistulous openings. The right medial aspect of the inner thigh, adjacent to the labia majora, was found to have a 0.7 cm opening, which was confirmed by magnetic resonance imaging. Intraoperatively, the fistulous tract was readily delineated using dye. Complete fistulectomy was performed. This report highlights an unusual presentation of a urogenital fistula, the diagnostic challenges, and the management strategies. It emphasizes the need for timely identification and intervention in such cases.

Percutaneous Endoscopic Gastrostomy with T-Fasteners versus "Pull Technique": Analysis of Complications

INTRODUCTION

 The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the "pull-technique" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications.

MATERIALS AND METHODS

 A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded.

RESULTS

 In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [p < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]).

CONCLUSIONS

 P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.

Understanding the Impact of Ostomy Dejecta Constituents on Peristomal Skin Health and Models for Its Characterisation

An ostomy, or stoma, is a surgically created percutaneous aperture from a hollow organ (e.g., small intestine) to the body's surface. Physicians may recommend an ostomy as a temporary or permanent solution to a range of disorders of the gastrointestinal tract, with up to 130 000 ostomies performed annually in the United States. An ostomy facilitates the expulsion of waste products, termed dejecta and circumvents the compromised organs. While an ostomy can be a lifesaving treatment, it is a disruption of regular digestive flow and has a number of associated complications including hernia, prolapse and necrosis. The most commonly observed complications are peristomal skin complications (PSCs), attributed to the leakage of dejecta onto the peristomal skin or the skin directly surrounding the stoma. Despite the prevalence of PSCs, little is known about the precise etiological factors that play a role in PSC formation. This review discusses the constituents of dejecta and their possible roles in PSC formation. Additionally, we identify a number of in vitro and in vivo skin models that could be used to study PSCs. Identification of the components of dejecta and understanding their interaction with skin models can facilitate the development of interventions to treat and prevent PSCs.

Do burn injury prevention interventions change what people know and how people think? A systematic review investigating the impact on psychological constructs

INTRODUCTION

Burns can result in life-long physical and psychological difficulties. Interventions aimed at preventing burns are therefore important. Behaviour change theories propose that psychological variables (e.g., knowledge, attitudes, beliefs, self-efficacy) are associated with injury prevention behaviour. However, whether or not burn prevention interventions impact psychological variables is uncertain. This systematic review aimed to address this gap in the literature.

METHODS

A systematic review was conducted according to PRISMA guidelines. Electronic databases (CINAHL, MEDLINE, PubMed and Scopus) were searched for randomized control trials (RCTs) of burn prevention interventions which measured at least one psychological construct. Studies were quality assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

Eight studies met inclusion criteria. A narrative synthesis was conducted. Seven RCTs detailed interventions aimed at reducing paediatric burns (five delivered to parents/caregivers and two delivered to children). One RCT was aimed at adults. All RCTs measured burns knowledge, but findings were mixed about whether knowledge changed following interventions. Four RCTs measured self-efficacy, with all finding an increased perceived ability to engage in burn prevention behaviour following interventions. Risk perceptions (e.g., around the perceived severity and susceptibility of burns) were rarely measured.

CONCLUSION

To date, burn prevention RCTs have mainly focused on paediatric burns and most often measured knowledge change. However, the impact of interventions on knowledge is variable. Future burn prevention interventions should measure a range of psychological constructs, as these are likely to be important in burn prevention behaviour.

Cervical proprioception and dysphagia severity in multiple sclerosis: A cross-sectional clinical analysis

This study aimed to investigate the relationship between dysphagia severity and neck proprioception, pain, and mood in individuals with multiple sclerosis (MS). The individuals were divided into two groups according to the severity of dysphagia: dysphagia group (n = 13) with a score of 3 and above on the Dysphagia Assessment Scale in Multiple Sclerosis (DYMUS) scale and mild dysphagia group (n = 13) with a score of 2 and below. Clinical swallowing function was evaluated with the Turkish version of the Eating Assessment Tool-10 (T-EAT-10) and DYMUS. Proprioception was assessed with a laser by noting the deviation from the center target in centimeters. Neck pain severity was assessed with the Visual Analogue Scale (VAS), and mood was assessed with the Beck Depression Inventory (BDI). Individuals with severe dysphagia demonstrated statistically significantly greater proprioceptive impairment in cervical extension and right rotation. A significant difference was also found between the two groups in terms of clinical swallowing evaluations, neck pain status, and mood measurements. The findings suggest that proprioceptive deficits, increased pain, and mood disturbances are closely associated with dysphagia severity in MS. A multidimensional approach addressing dysphagia, proprioception, and pain management may be beneficial in optimizing dysphagia rehabilitation in patients with MS.

Mitochondrial Fusion Protein 2-Modified Bone Marrow Mesenchymal Stem Cells Improved Hyperglycemia-Induced Schwann Cell Injury via Regulating Mitochondria-Associated Endoplasmic Reticulum Membranes

OBJECTIVE

High glucose damages rat Schwann cells (SCs), which is closely related to the dysfunction of mitochondria-associated endoplasmic reticulum membranes (MAMs). Therefore, the present study aimed to investigate the protective effects and mechanisms of modified bone marrow mesenchymal stem cells (BMSCs) and mitochondrial fusion protein 2 (Mfn2) modified BMSCs against SCs injury.

METHODS

The Mfn2-modified BMSCs were constructed after culturing with neural-induced differentiation solution. MAP-2 (microtubule-associated protein-2, neuron marker) and GFAP (glial fibrillary acidic protein, astrocytes marker) immunofluorescence staining was used to observe changes in the differentiation potential of neural-like BMSCs. SCs (RSC96) cells cultured under high glucose conditions were cocultured with Mfn2-modified BMSCs. Changes in functional protein expression of MAMs were detected by Western Blot. Transmission electron microscopy (TEM) was used to observe the microscopic morphology of MAMs, mitochondria and endoplasmic reticulum.

RESULTS

The expression level of Mfn2 was significantly increased in BMSCs transfected with Mfn2. The fluorescence densities of MAP-2 and GFAP were significantly upregulated in Mfn2-BMSCs after induction by neural inducible differentiation solution. When RSC96 was incubated with high glucose and Mfn2-modified/non-modified BMSCs, the expression level of Mfn2 in RSC96 was significantly increased, while PERK, IP3R and Drp1 expressions were significantly reduced. And the Mfn2-modified BMSCs showed more significant effects comparing to Mfn2-non-modified BMSCs. The TEM showed the structural integrity of MAMs, clear structure of mitochondrial cristae and obvious and structurally intact extension of endoplasmic reticulum in Mfn2-BMSC group.

CONCLUSIONS

Mfn2 transfection promoted neural-like cell differentiation in BMSCs. Mfn2-modified BMSCs modulated the structural and functional homeostasis of MAMs by regulating the expression levels of MAMs functional proteins.

Early-Career Registered Nurses' Experiences of Implementing Non-Pharmacological Interventions for Delirium Management: A Qualitative Descriptive Study

AIM

This study aims to describe early-career registered nurses' experiences of using non-pharmacological interventions for delirium management in general medicine.

BACKGROUND

Non-pharmacological interventions are recommended for delirium management, but implementation can be challenging because of the complex and time-consuming nature of delirium behaviours.

DESIGN

This study employs a qualitative exploratory descriptive design.

METHODS

Semi-structured interviews and focus groups were conducted between May and June 2022 with early-career registered nurses from general medical wards of two hospitals in Australia. Transcripts were analysed using thematic analysis in NVivo.

RESULTS

Twenty-two nurses participated. Two conceptual areas with seven themes were identified: factors that prepare and support nurses, which include (1) comprehensive education that supports readiness to manage delirium, (2) accessing the expertise of colleagues and (3) valuing family as essential in delirium care; and experiences of applying knowledge to manage delirium, which include (4) enacting delirium care within the context of the work environment, (5) nurses' use of non-pharmacological interventions, (6) communicating through the confusion and (7) managing escalating behavioural symptoms for safety.

CONCLUSIONS

This study highlights the elements needed to prepare and support early-career nurses in delirium care. Delirium care is complex, and nurses identified the need for more preparatory education. Support from experienced nurses and family was essential for delirium management, de-escalation of behavioural symptoms and safety.

Adaptive Capacity Within the Homecare Setting: The Importance and Value of a Shared Perception of Risk

OBJECTIVES

Patients receiving homecare are living their everyday lives in their own homes. Adapting care to individual needs, preferences, risks, and family situations is seen as essential. The overall aim of this study was to develop empirical knowledge of risk perception in homecare services. The research question that guided the study was: How is a shared perception of risk between health care professionals and leaders a part of providing high-quality care within a homecare setting?

METHODS

The research design was a multiple-embedded case study including 3 single cases. Participants were recruited from 3 Norwegian municipalities. Two focus group interviews were conducted in each municipality. In total, 19 informants participated, including 11 homecare department leaders and 8 health care professionals. The data were analyzed using thematic analysis according to Braun and Clarke's 6-phase thematic analysis.

FINDINGS

Two higher-order themes were developed from the data: "Risk perception is a collective understanding" and "A flawed system requires adapting just to make it work." The study showed that, in the homecare departments, leaders' and health care professionals' opinion, flexibility and professional discussions are key to enhancing the system's adaptive capacity. High-quality care is always perceived as person-centered and adaptive. Overgeneralizations and the use of guidelines were perceived as demanding. The findings also showed that making sense of and managing risks within a homecare setting is complex.

CONCLUSIONS

Bridging the gaps by conceptualizing and acting upon risks in the homecare setting constitutes a fundamental part of adaptive capacity at a system level. However, better alignment of system demands to local risks is needed for sustainable and safe services.

From pelvic radiation to social isolation: a qualitative study of survivors' experiences of chronic bowel symptoms after pelvic radiotherapy

PURPOSE

We explored survivors' experiences of chronic bowel symptoms following pelvic radiotherapy, strategies employed in living with these symptoms, effects on daily activities, and roles at home and in the workplace.

METHODS

Semi-structured interviews were conducted with 28 individuals (10 gynaecological, 14 prostate, four anal/rectal cancer survivors) who had completed pelvic radiotherapy at least six months prior to data collection and who had experience of bowel symptoms during this post-treatment period. Reflexive thematic analysis was undertaken.

RESULTS

We propose four themes describing a process leading from experience of symptoms to withdrawal from activities and roles. These are (1) losing control (the experience of unintended anal leakage or discharge); (2) experiencing embarrassment and fear (the experience of embarrassment or fear of embarrassment as a result of discharge becoming public); (3) managing and reacting (acting to reduce the likelihood of discharge or to prevent this becoming public); and (4) restriction and withdrawal (avoiding specific activities or situations so as to reduce or remove the risk of embarrassment). Returning to the workplace presented additional challenges across these themes.

CONCLUSIONS

Impacts of chronic bowel symptoms can be severe. Survivors employ a variety of methods and strategies in living with their symptoms. Some of these support continued role fulfilment but some constitute a withdrawal from pre-treatment roles. Current healthcare provision and statutory protections fail to fully meet needs following pelvic radiotherapy.

IMPLICATIONS FOR CANCER SURVIVORS

There is a need to develop and implement evidence-based services and supported self-management programmes for survivors experiencing chronic bowel problems post-radiotherapy.

Revealing the promising era of silk-based nanotherapeutics: a ray of hope for chronic wound healing treatment

Chronic wounds significantly contribute to disability and affect the mortality rate in diabetic patients. In addition, pressure ulcers, diabetic foot ulcers, arterial ulcers, and venous ulcers pose a significant health burden due to their associated morbidity and death. The complex healing process, environmental factors, and genetic factors have been identified as the rate-limiting stages of chronic wound healing. Changes in temperature, moisture content, mechanical strain, and genetics can result in slow wound healing, increased susceptibility to bacterial infections, and poor matrix remodelling. These obstacles can be addressed with natural biomaterials exhibiting antimicrobial, collagen synthesis, and granulation tissue formation properties. Recently, silk proteins have gained significant attention as a natural biomaterial owing to good biocompatibility, biodegradability, reduced immunogenicity, ease of sterilization, and promote the wound healing process. The silk components such as sericin and fibroin in combination with nano(platforms) effectively promote wound repair. This review emphasises the potential of sericin and fibroin when combined with nano(platforms) like nanoparticles, nanofibers, and nanoparticles-embedded films, membranes, gels, and nanofibers.

A Clinical Decision Support Tool for the Management of Diabetes-Related Foot Ulcers (DRFUs) Using a Topical Haemoglobin Spray

Diabetes related foot ulcers (DFUs) are complex and costly to manage, with the prevalence of non-healing wounds steadily increasing across the globe. Non-healing wounds can occur when clinicians fail to undertake an appropriate assessment, fail to recognise the importance of systemic or local complications, or provide the optimal treatment. The aetiological causes behind non-healing wounds are multifactorial; however, the purpose of this article is to focus on the role of oxygen in non-healing wounds and to introduce readers to advances in the delivery of topical oxygen therapy (TOT) via a haemoglobin spray. Importantly, this article incorporates a clinical decision support tool (CDST) to help clinicians identify the most appropriate individuals for whom topical haemoglobin may be most beneficial and the most appropriate time for introducing the intervention to improve wound healing outcomes.

The Potential Role for a Painless Enzymatic Debridement Gel in Wound Bed Preparation for Venous Leg Ulcers-A Dose Escalation Study

Venous leg ulcers (VLUs) are painful wounds that require thorough debridement to optimise their chances of healing. We sought to assess the impact on debridement pain from the use of tarumase gel in a prospective Phase IIA open-label, multi-centre, dose escalation study and comparing this to historical pain scores derived from a review of surgical and mechanical debridement within similar chronic wound populations. With tarumase gel, no increase in pain over baseline was observed, irrespective of whether pain was assessed 15-30 min after administration or whether the gel had been resident on the wound for 48-72 h. At the highest concentration of tarumase tested [11 U/mL], all reported NRS scores were below 2.90 (categorised as slight pain) with small trends towards a reduction in the pain score from as early as the first application. By contrast, from previous literature, surgical and mechanical debridement, when used without anaesthesia, commonly resulted in pain scores in excess of 50 mm on 100 mm visual analogue scales (VAS), categorised as moderate to severe pain. Pain from surgical/mechanical debridement can be reduced by topical anaesthetic creams; however, this requires at least 30-60 min of application and subsequent removal prior to debridement, making it impractical to use in busy clinic facilities.

Interventions in primary care to increase uptake of adult vaccines: a systematic review

BACKGROUND

There is a significant gap in understanding which strategies effectively enhance vaccination rates for recommended adult vaccines in primary care settings. This review aimed to identify interventions in outpatient clinics that increase vaccination rates for commonly recommended adult vaccines and describe the change in vaccination rate associated with each intervention aimed at increasing vaccination rates in adults.

METHODS

Systematic searches identified randomized, controlled trials aiming to increase the rate of vaccination in adults in outpatient clinics. Following PRISMA guidelines, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Two reviewers independently extracted relevant data and assessed risk of bias. Meta-analysis was not done due to heterogeneity of data.

RESULTS

Forty-four RCTs met inclusion criteria. Clinician reminders to order vaccine increased vaccination 4%-32%. Electronic health record (EHR) prompts to patients or physicians increased vaccination 1%-16%. Bundled interventions increased vaccination 4%-42%, with more intensive interventions associated with higher increases. RCT of interventions involving face-to-face contact with patients increased vaccinations 6%-17%. Group outpatient visits increased vaccination 13%-17%, home visits 6%-17%, and physician or nurse recommendation 15%.

CONCLUSIONS

Clinics may increase vaccination rates by reminding doctors to order vaccine, promoting face-to-face conversations about vaccination, and instituting bundled clinic process improvements. EHR prompts may be less effective.

Evaluation of dental students' attitude to elderly patients based on demographic data: a cross-sectional study

BACKGROUND

Comprehensive curricular modifications in dental education are essential to address the healthcare needs of the growing geriatric population. In this context, incorporating attitudes of dental students towards this complex patient group into the design of educational programs is crucial for developing effective curricula. The aim of this study was to evaluate the attitudes of dental students towards elderly patients during their educational progress, which is a crucial period in the formation of dentists' approaches to patients and treatment, and to consider the influence of demographic data in this process.

METHODS

In this cross-sectional study, a two-part questionnaire was administered to 3rd-, 4th-, and 5th-year students at Marmara University, Faculty of Dentistry. The first part collected demographic data on age, gender, place of residence, presence of grandparents, and history of living with grandparents. The second part used the validated Ageism Scale for Dental Students (ASDS) with 5 items on a 6-point Likert scale. Mann-Whitney U and Kruskal-Wallis tests were used for two- and multi-group comparisons, respectively, and the Spearman Correlation Test examined age-scale score relationships. A Type 1 error rate of 0.05 was applied.

RESULTS

A total of 305 students participated, 204 (66.9%) of whom were female. The distribution across the 3rd, 4th, and 5th years was 35.1%, 32.1%, and 32.8%, respectively. The median ASDS score was 3.2. No significant differences in ASDS scores were found concerning age (p = 0.925), gender (p = 0.631), year of study (p = 0.581), place of residence (p = 0.282), presence of grandparents (p = 0.199), or history of living with grandparents (p = 0.859).

CONCLUSION

Demographic factors did not significantly affect ASDS scores. Larger, translated, and validated studies in different regions of Türkiye are needed. However, the neutral attitudes observed among students suggest that the content of geriatrics in dentistry education should be strengthened in a way that promotes positive attitudes towards elderly patients.

Italian Oncology at the Crossroads: Between Hospital Bed Cuts and the Need for a Transition to Integrated Community-Based Simultaneous Care

BACKGROUND

In Italy, public health investments have not kept pace with the rising demand for cancer care. Hospitalization costs are increasing, and length of stay (LOS) remains a critical metric for hospital efficiency and care quality.

METHODS

An ecological study analyzed hospital discharge records of patients admitted to "Policlinico Tor Vergata" (Rome, Italy) in 2022. Associations between cancer types and key variables influencing inpatient care were analyzed using logistic regression models (AOR; 95% CI), along with discharge patterns.

RESULTS

Among 14,451 ordinary hospitalizations, cancer diagnoses accounted for 16.4%, with blood cancers as the largest subgroup (20.1%). LOS outliers (5%) contributed to 11,342 excess hospitalization days. Blood cancers were associated with prolonged LOS (2.031; 1.499-2.753), while blood (2.368; 1.911-2.933), gastric (2.216; 1.603-3.062), and bladder cancers (2.661; 2.133-3.319) had a higher infection risk. Patients with bladder cancers were more likely to be ≥65 years old (2.661; 2.133-3.319). Secondary diagnoses were more likely to occur in gastric cancer types (1.637; 1.486-1.802). A discharge analysis revealed that 46.8% of cancer patients were discharged home without activation of home care services, and only 0.2% received home care activation. Cancer patients were more likely to be discharged home (2.150; 1.911-2.418) while awaiting completion of diagnostic or therapeutic processes.

CONCLUSIONS

Our findings highlight the significant variability in hospitalization patterns across cancer types and the inadequacy of current discharge planning processes. The burden of prolonged LOS highlights the unsustainability of current care models. An urgent transition toward integrated, community-based simultaneous care models is needed to reduce healthcare costs, prevent prolonged hospitalizations, and improve outcomes, particularly for vulnerable elderly patients.

Development and Characterization of a Collagen-Based Three-Dimensional In Vitro Model to Mimic Biofilm Formation in a Wound Bed

Current studies using in vitro biofilm culturing systems have been instrumental at elucidating wound biofilm formation but fail to account for the diverse environment that bacteria are exposed to within the host. In the current study, we recapitulated this wound biofilm microenvironment by creating a hydrogel composed of collagen, thrombin, fibrinogen, meat broth, and FBS and subsequently infected the scaffolds with UAMS-1. We characterized the material properties of the hydrogel (noninfected) and found no significant differences in the storage modulus when fibrin was added to the collagen hydrogel. When infected with UAMS-1, temporal growth and polysaccharide formation were observed through plating, SEM, and histological staining, indicative of biofilm formation. PCR analysis revealed heightened expression of adhesion-associated genes with no increase in expression of metabolic genes, indicating significant increase in the formation of a robust biofilm over time. Vancomycin was ineffective in eradicating the already-developed biofilm, whereas the total CFUs in rifampin-treated models decreased significantly compared to those in the untreated group. Although it was not significant, an increase in SCVs was observed in the rifampin-treated group, suggesting that rifampin may create a harsher environment against the Staphylococcus aureus, allowing the increase in more resistant bacteria. The persistence of an infection in our rifampin-treated 3D in vitro wound model indicates an increased similarity to the host environment compared to that of a static biofilm model.

Which acute deterioration tools are used in long-term care facilities and how have they been evaluated? A scoping review

BACKGROUND

Acute deterioration describes a rapid decline in health due to short-duration illnesses. This is an important topic for older adults living in long-term care facilities (LTCF). Signs of acute deterioration are often subtle, and there is no standardised system to manage it. The aim of this review is to scope the range of deterioration tools used in LTCFs, and to describe how they have been evaluated.

METHODS

A scoping review was conducted in accordance with the Joanna Briggs Institute methodology. Searches of five (MEDLINE, APA PsycInfo, Embase, CINAHL, HMIC) electronic databases (2013-2023, updated 2025) and relevant websites were followed by title/abstract (by two authors independently) and full-text screening. Eligible studies involved tools used to manage acute deterioration for adults > 65 years in LTCFs. Experimental and observational study designs were eligible, including quality improvement projects. No country or language restrictions were imposed. A narrative synthesis was conducted.

RESULTS

Twenty-six studies were included (23 peer-reviewed articles, two conference abstracts, one dissertation) after screening 5958 articles. A majority were from the UK (n = 10) and USA (n = 9), with small numbers from other high-income countries ((Australia (n = 2), Canada (n = 2), Sweden (n = 2), Switzerland (n = 1)). Studies employed a wide range of methodologies, with only one randomised study, and tools were frequently evaluated as part of multi-faceted interventions. The majority of studies described an intervention in which SBAR (situation-background-action-recommendation) (n = 15), National Early Warning Scores (n = 7) or STOP AND WATCH (n = 4) were a component. Studies used quantitative (n = 21) and qualitative (n = 9) methods to evaluate tools. Outcome measures were heterogeneous, with no data on resident experience. The majority of studies concluded potential benefit from using deterioration tools. There is some evidence that LTCF staff perceive tools, especially SBAR, as improving confidence in managing acute deterioration and aiding communication with external healthcare professionals.

CONCLUSION

Despite policy drivers to use deterioration tools in LTCFs, there is no robust evidence to support this. Direct benefits for resident care have not been demonstrated. Further research is required to compare tools to standard care, measure the impact on resident experience, and to determine if deterioration tools should become part of routine care in LTCFs.

Examining Education Models for Clinical Staff Working with People with Intellectual and Developmental Disabilities in Hospice and Palliative Care: A Narrative Literature Review

BackgroundEducation and training are essential for providing quality hospice and palliative care (HAPC). Despite individuals with intellectual and developmental disabilities (IDD) living longer with serious illness, healthcare professionals report inadequate training in this area. Additionally, IDD specialists consistently express discomfort and limited knowledge regarding HAPC.ObjectiveThis narrative review evaluates existing education and training models for hospice and palliative care (HAPC) professionals working with individuals with IDD, emphasizing the reciprocal educational needs between these two specialties.MethodsA comprehensive literature search was conducted in March 2024 across multiple databases, including Embase, PubMed, and CINAHL, using terms related to IDD, training, and palliative care. Inclusion and exclusion criteria were applied, resulting in seven relevant studies providing insight into educational interventions for IDD and palliative care professionals.ResultsFindings indicate that while several studies demonstrate positive outcomes regarding knowledge, self-efficacy, and satisfaction among participants, there is a lack of standardized training and patient-centered metrics. Existing interventions largely focused on improving the knowledge of IDD staff regarding HAPC, with limited attention given to educating HAPC professionals on the nuances and complexities needs of people with IDD.ConclusionThis review underscores the importance of developing and implementing evidence-based and standardized training programs that encompass the needs of both HAPC and IDD specialists. Future research should prioritize inclusive educational frameworks that involve individuals with IDD and their families in the development process. Attention to exploring metrics beyond self-reported outcomes to enhance the quality of HAPC provided to this vulnerable population should be prioritized.

Burnout combating strategies, triggers, implications, and self-coping mechanisms among nurses working in Saudi Arabia: a multicenter, mixed methods study

BACKGROUND

The World Health Organization (WHO) has defined burnout as an occupational phenomenon resulting from unsuccessfully managed chronic workplace stress. The well-being of healthcare professionals is the foundation for the health of patients and organizations. In Saudi Arabia, nursing plays a pivotal role in the healthcare sector, with both local and expatriate nurses taking part in various clinical and high-pressure services. However, rapid growth in healthcare facilities, staff shortages, and patient loads are adversely impacting stress levels among nurses.

METHODS

This study used a mix of research methods to survey 1,747 nurses (with a 90% response rate) from three major hospitals (King Fahad Medical City, King Saud Medical City, and King Faisal Specialist Hospital and Research Center), two smaller hospitals (Prince Mohammed Bin Abdulaziz Hospital and Al Habib Medical Group (HMG)-Al Suwaidi Hospital branch), and five primary healthcare centers, selecting participants randomly. Survey questionnaires collected data to evaluate the significance of the proposed burnout-combating strategies in relation to nursing administration, workload, and hospital administration responsibilities. Qualitative data were gathered through semi-structured interviews with 90 nurses to investigate and explore burnout triggers, implications, and coping mechanisms.

FINDINGS

A majority of the nurses (87.9%) indicated that assessing their needs and listening to their feedback could help them manage and prevent burnout. In comparison, 89.7% believed that their leaders should enhance the work environment and conditions, while 87% suggested adjusting the nurse-to-patient ratio to improve patient satisfaction. Conversely, 6.8% of the participants held a negative perception that each additional patient per nurse was associated with an increase in the mortality rate, whereas 3.4% felt that granting nurses more control over their schedules and conducting departmental meetings to discuss health could help alleviate work pressure. We identified three themes: factors that trigger burnout symptoms, the implications of burnout, and suggested coping mechanisms. Additionally, they highlighted the prevalence and likelihood of burnout triggers, implications, and coping strategies, providing critical insights for nurse leaders, workload management, and hospital administrators.

CONCLUSION

Nurse leaders, along with workload management strategies and hospital administrators, play a crucial role in mitigating and overcoming burnout. Establishing a healthy work environment is recognized as the most effective strategy for combating burnout, followed by implementing mental health education and training programs to enhance adaptive and cognitive resilience, promote health improvement, and strengthen resistance to burnout. Further research is needed to evaluate the effectiveness of these coping strategies for other healthcare professionals and to explore how cultural diversity, religious beliefs, and social factors may influence burnout triggers, consequences, and the development of self-coping mechanisms.

IMPLICATIONS FOR PRACTICE

Healthcare leaders should remain vigilant and prioritize strengthening resilience in hospital settings. Changes in institutional policies are essential to upholding suitable staffing ratios to reduce workload stress, implementing equitable scheduling practices to enhance work-life balance, and ensuring consistent, uninterrupted breaks to promote mental and physical rejuvenation. Organizations must implement policies that directly address the factors contributing to burnout.

CLINICAL TRIAL NUMBER

Not applicable.

Therapeutic Applications of Ketogenic Diets in Lipedema: A Narrative Review of Current Evidence

PURPOSE OF REVIEW

Lipedema is an abnormal accumulation of adipose tissue, predominantly observed in women, characterised by symmetrical fat deposition and tactile sensitivity in the extremities, affecting both sides of the body. This condition can lead to significant pain, impairing daily activities and causing substantial discomfort.

RECENT FINDINGS

While the etiology of the disease is not yet fully understood, genetic predisposition, hormonal fluctuations, a stressful lifestyle, as well as traumatic events are considered potential triggers. Lipedema remains a condition with low diagnostic awareness as well as is frequently misdiagnosed as obesity or lymphedema. While obesity is a risk factor for lipedema, the abnormal fat deposition characteristic of the disease can occur across a wide spectrum of body weights, from underweight to overweight individuals. Specific patterns of adipose tissue distribution may be associated with signs of inflammation as well as heightened pain perception, as well as individuals with eating disorders, such as anorexia, may additionally be affected. Ketogenic diets have emerged as a promising therapeutic option for lipedema. Characterized by low carbohydrate as well as high fat content, ketogenic diets facilitate metabolic improvements by reducing insulin resistance as well as supporting weight loss. Furthermore, they may mitigate tissue damage associated with lipedema by decreasing inflammation as well as oxidative stress levels.Nevertheless, current scientific data regarding the mechanisms of action as well as therapeutic efficacy of ketogenic diets are limited, necessitating further research to expand their clinical application.

Registered nurses and what may constitute their leadership in the home healthcare context

BACKGROUND

Registered nurses who are not employed in formal leadership positions are assumed to practice leadership, yet there is limited knowledge of what this entails. This study aimed to identify what may be recognised as critical aspects constituting leadership in registered nurses' daily interactions in the home healthcare context.

METHODS

A qualitative study design with a hermeneutical approach was employed. Data were collected through individual interviews with registered nurses working in three home healthcare contexts in three Norwegian municipalities. Data were analysed using thematic analysis.

RESULTS

The results are presented as three critical aspects that seem to be recognised as constituting leadership in the home healthcare context: (1) Negotiating accountability for nursing activities, (2) Gaining an overview of nursing activities, and (3) Managing nursing activities within a limited time.

CONCLUSIONS

In this study, leadership appears to emerge when the registered nurses act as meaning-makers in daily interactions with their colleagues. The nurses act as meaning-makers to achieve a specific goal: to accomplish nursing activities to care for patients needing help. Acting as meaning-makers involves the nurses being aware of and actively recognising negotiating accountability for nursing activities, gaining an overview of nursing activities, and managing nursing activities within a limited time. These are critical aspects that may constitute leadership in their daily interactions.

Protein intake and muscle mass of community-dwelling older adults: a cross-sectional study in Kigali, Rwanda

Older people are at high risk of protein deficiency, which accelerates the age-related loss of muscle mass. However, there is a paucity of data on the consumption of protein-rich animal-sourced foods and their relationship with dietary intake and muscle mass of older adults in low- and middle-income countries. Therefore, this study assessed ASF consumption and its associations with protein intake and muscle mass of older adults. A cross-sectional study was conducted among community-dwelling older adults in the Gasabo district, Rwanda. Dietary intake was estimated using two non-consecutive 24-h recalls. A structured questionnaire was used to collect data on socio-demographic characteristics. Inverse propensity score weighting was employed to assess the association between animal-source food (ASF) consumption and protein intake and muscle mass. Slightly more than half (56%, n = 189) of the older adults consumed ASFs. In adjusted models, ASF consumption was positively associated with protein intake (ATE: 9.6 g/d; CI, 6.8 to 12.4) and muscle mass (ATE: 1.7 kg; CI, 0.0 to 3.4). The results also showed that adding one and two or more ASFs to the diet was proportionally associated with an increase in protein intake (ATE: 4.7 g/d; 95% CI, 0.2 to 9.3 and ATE: 13.9 g/d; 95% CI, 5.9 to 22.0, respectively), but not with muscle mass (ATE: 1.2 kg; 95% CI - 1.4 to 3.9 and ATE: 1.4 kg; 95% CI - 0.6 to 9.6, respectively). The consumption of ASFs was generally low among community-dwelling older adults. However, older adults who consumed ASFs had improved protein intake and muscle mass compared with those who consumed plant-based diets. Large and prospective studies, extending beyond urban settings, are needed to identify factors that can be targeted to improve ASF consumption and overall dietary intake among older adults in Rwanda.

The accelerating effect of sugar on wound healing delayed by bevacizumab: A case report

RATIONALE

Bevacizumab, a recombinant humanized monoclonal antibody targeting vascular endothelial growth factor is associated with delayed wound healing. Sugar, a traditional remedy for wound healing, has shown significant efficacy in accelerating recovery. Here, we developed a new strategy for managing bevacizumab-associated delayed wound healing with the topical application of sugar.

PATIENT CONCERNS

A 42-year-old female with non-small cell lung cancer and brain metastases who underwent emergency surgical treatment for acute appendicitis while on bevacizumab developed delayed wound healing postoperatively.

DIAGNOSES

At 50 days postoperatively, the wound was still approximately 2 cm, indicating bevacizumab-associated delayed wound healing.

INTERVENTIONS

The patient had enlarged brain metastases and increased edema due to discontinuation of bevacizumab. Bevacizumab was reintroduced without complete wound healing. Concurrently, topical sugar was applied following routine wound disinfection.

OUTCOMES

The wound completely healed 21 days after initiating sugar therapy, coinciding with ongoing bevacizumab treatment.

LESSONS

The patient's wound healed completely with the application of topical sugar, even in the context of ongoing bevacizumab therapy, highlighting the efficacy of sugar in managing bevacizumab-induced delayed wound healing.

Advanced nurse practitioner experiences of referrals

In recent years primary care services in Scotland have increasingly employed advanced nurse practitioners (ANPs) to undertake roles that were traditionally fulfilled by GPs. The aim of this study was to explore the experiences of ANPs in primary care settings making independent referrals following a holistic advanced clinical assessment. A focus group interview was undertaken with five ANPs from one health board area in April 2023. The findings were themed into three principal areas: preparation for the role, communication and gate keeping. These three key areas were reported to result in a number of negative feelings and emotions for the ANPs. Recommendations from this study include the need to ensure ANPs are prepared to make independent referral, have independent access to make referrals, that colleagues understand the skill and autonomy of the ANP and that ANPs are offered regular restorative clinical supervision.

Associations between dementia symptoms and caregiver and relationship health: A prominent role for speech and language

BackgroundDementia is a significant public health issue globally. People with dementia (PWD) exhibit symptoms in multiple domains (e.g., cognition, emotion, motor, speech/language) that can vary in their impact on the caregiver and the PWD-caregiver relationship.ObjectiveWe assessed the relative impact of various dementia symptoms on caregiver health and well-being and on the PWD-caregiver relationship using a broad sampling of PWD symptoms and caregiver/relationship outcome measures.MethodsData were analyzed from 54 primary caregivers of PWDs who completed seven questionnaires assessing caregiver health and well-being and PWD-caregiver relationship quality. An exploratory factor analysis of these questionnaires revealed two primary factors: (a) General Distress (anxiety, burden, depression, general health, loneliness), and (b) Relationship Quality (interpersonal closeness, relationship satisfaction). Caregivers also rated nine categories of PWD symptoms (memory, executive functions, speech/language, visual/spatial, motor, changes in behavior, sleep, medical/sensory, activities of daily living).ResultsGreater caregiver General Distress was associated with greater PWD speech/language and sleep symptoms. Lower caregiver Relationship Quality was associated (at trend, p < 0.10, levels) with greater PWD speech/language and activities of daily living symptoms. Correlations with the seven individual caregiver outcome measures revealed that speech/language symptoms were the most robust predictors (correlated with five measures), followed by sleep and activities of daily living symptoms (correlated with two measures), and memory, visual/spatial, and motor symptoms (correlated with one measure).ConclusionsFindings highlight the profound adverse effects that PWD speech and language deficits may have on caregivers and underscore the importance of addressing these deficits in dementia care.

The National Early Warning Score (NEWS) Predicts the 28-Day Mortality in Patients With Severe Fever With Thrombocytopenia Syndrome: A Cross-Sectional Study

OBJECTIVE

To investigate the association between the New Early Warning Score (NEWS) and 28-day mortality in patients with severe fever with thrombocytopenia syndrome (SFTS).

DESIGN

A cross-sectional derivation and validation study.

METHODS

A total of 382 SFTS patients were included in retrospective and prospective studies. The primary outcome was short-term (28-day) mortality. Cox regression, receiver operating characteristic (ROC), and Kaplan-Meier analysis were utilised in the retrospective study to assess the association between NEWS and mortality. The prospective study assessed the applicability of the NEWS.

REPORTING METHOD

This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

RESULTS

Among 219 SFTS patients in the retrospective study, 27 (12.3%) died within 28 days. NEWS was significantly higher in non-survivors than in survivors (4.00 [1.00, 5.00] vs. 1.00 [1.00, 2.00]). The ROC curve for MEWS predicting 28-day mortality showed an area under the curve (AUC) of 0.757 (95% confidence interval: 0.65-0.87), with a cut-off of 3.5 (sensitivity: 90.6%; specificity: 55.6%). SFTS patients were stratified into low (NEWS < 4), medium (NEWS 4-6), and high (NEWS > 6) risk groups. Kaplan-Meier analysis showed significantly lower survival rates in medium and high risk groups compared to the low risk group. The prospective study included 63 SFTS patients, of whom 11 (17.5%) died. 28-day mortality significantly increased across NEWS categories: [low risk (4/50, 8.0%), medium risk (4/8, 50.0%), high risk (3/5, 60.0%)].

CONCLUSIONS

NEWS was a quicker, simpler, and valuable parameter to identify SFTS patients at risk of 28-day mortality.

RELEVANCE TO CLINICAL PRACTICE

An elevated NEWS at admission is associated with a higher risk of poor short-term prognosis in SFTS patients. Incorporating NEWS into emergency nursing practice may aid in the early identification of SFTS patients at risk of adverse prognosis.

PATIENT OR PUBLIC CONTRIBUTION

Emergency nurses performed the NEWS for the SFTS patients at admission.