Cataract surgery in patients with advanced cognitive impairment who cannot consent for surgery: an evaluation of surgical outcomes, review of the literature and recommendations for the cataract pathway

BACKGROUND

Patients with advanced cognitive impairment and cataract are an under-represented group with limited data on surgery outcomes and best practice. The burden of cataract in these groups is significant, and its functional impact can be severe and poorly recognised. We aimed to evaluate cataract surgery outcomes and optimise the surgical pathway for this group at our unit.

METHODS

We conducted a retrospective observational study of adult patients with advanced dementia or learning disability and no capacity to consent to having cataract surgery between January 2021 and May 2023 at Moorfields Eye Hospital in London, UK. Data were collected on clinic assessment, consent, choice of anaesthetic, choice of immediate versus delayed sequential bilateral cataract surgery and intraoperative and postoperative findings.

RESULTS

51 patients (67 eyes), 40 (78%) with dementia and 17 (22%) with a learning disability, were included. 24 (36%) eyes had advanced cataract, and 15 (22%) of eyes had corrected distance visual acuity (CDVA) of counting fingers or worse. Surgery was performed under local anaesthetic (± sedation) in 37 (55%) cases. There were no intraoperative complications. Subjective visual improvement was recorded in 49 (73%) cases. There was a median improvement in CDVA of 0.55 LogMAR. The refractive outcome was within 1D of the target outcome in 31 (72%) eyes. 35 (81%) eyes had a hyperopic outcome.

CONCLUSIONS

These patients present late with advanced cataract. Multidisciplinary and family/carer input for assessment, consent and anaesthesia selection is necessary. Surgery was most often performed under local anaesthesia, and the complication rate and visual outcomes were acceptable.

Quaternized chitosan-based injectable self-healing hydrogel for improving wound management in aging populations

The clinical management and treatment of skin wounds in the elderly present significant challenges due to changes in skin structure and function. This study introduces a novel injectable self-healing hydrogel composed of quaternized chitosan and carboxymethyl chitosan (HACC/CMCS, HC), designed through electrostatic interactions. Its excellent injectability and self-healing properties enhance the application of hydrogel dressings and prolong their functional lifespan. Moreover, the adhesion and flexibility of HC hydrogel contribute to their stability in highly dynamic regions, thereby preventing detachment and enhancing their hemostatic function. The material exhibits excellent biocompatibility and possesses antibacterial properties that protect wounds from external microbial damage, thereby reducing the risk of infection while maintaining a moist environment that facilitates healing. Importantly, the in vivo test have demonstrated that the HC hydrogel significantly enhances collagen deposition, reduces senescent cell accumulation, and accelerates wound closure. Therefore, this study offers a safe, effective, and cost-efficient solution for managing wounds in the aging population.

Improving concordance with long-term compression therapy amongst people with venous ulceration: A Delphi study- clinician cohort

Research by Nelson and Adderley (2016)reveals that 60-80 % of individuals affected by chronic venous insufficiency (CVI) develop venous leg ulcers (VLU). The gold standard treatment for VLU is the application of compression therapy (CT), which promotes venous return, reduces venous pressure, and minimizes stasis (Bullock & Manias, 2022). Patient concordance to CT is suboptimal, with only 40 % concordance, leading to a higher risk of VLU recurrence (Eri ckson et al., 1995; Fi nlayson et al., 2014; K app et al., 2013). This poses a significant and costly healthcare challenge (Smith & McGuiness, 2010). A Delphi study was conducted to ascertain the factors that influence concordance with CT using a clinician cohort. The study asked participants to rank factors that facilitated concordance and those that acted as barrier. Results revealed that clinicians identified 44 factors that facilitated concordance and 46 factors that acted as a barrier in the initial phase. The consensus level, measured by a Kendall W Coefficient, ranged from moderate to strong amongst the participants (Zanotti & Chiffi, 2015).

Comparison of emergency physician opinions with MSOFA and PREMEWS scores in determining the necessity of non-traumatic internal medicine patient transfers to the emergency department: a longitudinal study

BACKGROUND

Accurate prehospital decision-making is critical in emergency care to ensure the appropriate use of resources and optimal patient outcomes. However, the alignment between emergency physicians' clinical judgments and scoring systems such as Prehospital Modified Early Warning Score (Pre-MEWS) and the modified Sequential Organ Failure Assessment (mSOFA) remains underexplored.

OBJECTIVE

This study investigates the consistency of prehospital Pre-MEWS and in-hospital mSOFA scores with emergency physicians' judgments in determining the necessity of non-traumatic Internal Medicine Patient transfers to emergency departments (EDs). Additionally, it evaluates the clinical outcomes of these transfers.

METHODS

In this longitudinal study conducted between 2019 and 2020 in Semnan, Iran, 675 non-traumatic Internal patients transferred to a single ED were analyzed. Pre-MEWS scores were recorded prehospital, while mSOFA scores and physicians' evaluations were documented post-transfer. Outcomes included discharge, hospital admission, ICU transfer, or death.

RESULTS

This study analyzed 675 non-traumatic Internal patients transferred to the emergency department, with a mean age of 55.93 ± 21.89 years. 31% of transfers were deemed unnecessary by emergency physicians. The mean length of stay was 5.63 ± 5.69 h, showing a significant correlation with higher Pre-MEWS and mSOFA scores (p < 0.0001). Based on Pre-MEWS, patients were stratified into three risk levels: Green (≤ 3, no ICU/mortality), Yellow (4-12, 3.8% ICU admissions, no deaths), and Red (≥ 13, all deceased patients). mSOFA scoring identified two risk levels: Yellow (1-5, 0% mortality, ICU risk rising to 20%) and Red (≥ 6, ICU admissions up to 100%, mortality risk reaching 676.8%). Specifically, all deceased patients had Pre-MEWS scores ≥ 13, and ICU admission was observed in 3.8% of patients with Pre-MEWS scores between 4 and 12. The mSOFA score demonstrated superior predictive accuracy for mortality and ICU admission compared to Pre-MEWS. However, Pre-MEWS provided practical utility for prehospital triage.

CONCLUSION

Combining scoring systems with clinical judgment can improve decision-making in prehospital settings. Enhanced integration of tools and expertise is recommended to reduce unnecessary transfers and optimize emergency care.

Exploring the design and impact of integrated health and social care services for children and young people living in underserved populations: a systematic review

OBJECTIVE

To explore the evidence for interventions that integrate child health and social care and support programmes and the impact they have on child health and wellbeing.

DATA SOURCES

The Cochrane Library, Ovid Medline, Ovid Embase, Ovid Emcare, Ovid Health Management Information Consortium (HMIC) database, and Ovid Social Policy and Practice, Proquest Psychinfo and Ebscohost Cinahl.

ELIGIBILITY

Peer-reviewed original research that described an intervention integrating health care and social support or care interventions for children and young people (CYP) up to the age of 18 years in high-income countries. All databases were searched from inception to August 2023.

DATA EXTRACTION AND SYNTHESIS

16 studies were identified: 9 quantitative studies including 4 RCTs, 5 qualitative studies and 2 mixed methods studies. Studies were assessed for quality and a narrative review performed. Study heterogeneity meant a meta-analysis could not be completed.

RESULTS

For the purposes of clarity and understanding we collated the identified studies bv mode of delivery. In doing so we determined three main models of delivering integrated health and social care services: Targeted support for vulnerable groups, where the provision of packages of interventions focussed on target populations, this showed potential for decreasing the need for social support in the long-term but with limited evidence for reducing referrals into other services. These types of service were more successful in meeting specific objectives such as lower rates of smoking, and reducing repeat pregnancies; Collaborative health and social support, which typically collocated health and social care practitioners, demonstrated improved collaborative working but with little impact on workload, job satisfaction, or service delivery; and School centred health and social care, which were based in educational facilities and improved some aspects of CYP wellbeing and physical health but with concerns they added to teacher workload.

CONCLUSIONS

Integrated health and social support programmes offer promising solutions to addressing health inequity in children and young people in underserved populations. However, more robust and consistent study designs are needed to guide researchers and policy makers in their implementation and evaluation.

PROSPERO REGISTRATION

CRD42023399907.

The effect of muscles in the treatment of lower limb lymphedema: respiratory muscles or leg muscles?

PURPOSE

This study aimed to compare the effects of manual lymphatic drainage and bandaging (MLDB) combined with calf muscle exercise training (CMT) and/or inspiratory muscle training (IMT) on edema, muscle strength, functional capacity, functionality, and quality of life (QoL) in patients with secondary lower limb lymphedema (LLL).

METHOD

A total of 76 patients (mean age: 47.06 ± 16.16 years; 84.2% female) with LLL were included in the study and randomized into four groups: MLDB alone (Group 1), MLDB + CMT (Group 2), MLDB + IMT (Group 3), and MLDB + CMT + IMT (Group 4). The training programs were administered for 30 min per day, five days per week, over three weeks. Edema was assessed using circumference measurements (CM) and tissue dielectric constant (TDC). Muscle strength was evaluated using maximum inspiratory/expiratory pressure (MIP/MEP) and a dynamometer. Functional capacity was assessed with the 6-Minute Walk Test (6MWT), functionality with the Lower Extremity Functional Scale (LEFS), and QoL with the Lymphedema Quality of Life Scale (LYMQOL).

RESULTS

In the intra-group analyses, all assessments improved in all groups, except for MIP, MEP, and gastrocnemius muscle strength in Group 1 and MIP in Group 2 (p < 0.05). In the inter-group analyses, Group 3 showed the largest effect sizes (ES) for reductions in TDC (ES: 2.34) and improvements in LYMQOL (ES: 1.74), MEP (ES: 1.46), and LEFS (ES: 1.44) (p < 0.001 for all). Group 4 had the largest ES for increases in MIP (ES: 1.42, p < 0.001). Group 2 showed the largest ES for improvements in gastrocnemius muscle strength (ES: 1.41, p < 0.001). However, there were no significant differences among the groups in CM or 6MWT results (p > 0.05).

CONCLUSION

Compared to enhancing leg muscle strength, improving respiratory muscle function in addition to MLDB had a greater impact on reducing edema and enhancing functionality and QoL.

TRIAL REGISTRATION NUMBER

NCT05609526. Registration Date: 14.11.2022.

Dealing with lipoedema: women's experiences of healthcare, self-care, and treatments-a mixed-methods study

BACKGROUND

Lipoedema is a loose connective tissue disease primarily affecting women characterized by an abnormal build-up of painful fat in the legs and arms. In healthcare, lipoedema is often confused with obesity, and today, diagnostic tools and standardized guidelines for adequate treatments are lacking. Still, research on how affected women manage their health problems and whether they are satisfied with their care remains sparse. Therefore, this study aimed to contribute knowledge on healthcare experiences, and their use and self-reported effects of self-care and treatments among women with lipoedema.

METHODS

This national study, with a mixed-methods design, involved 245 women with lipoedema, recruited from all Lipoedema Association groups across Sweden. Data were collected between June and September 2021 through an online survey that included closed- and open-ended questions on self-care, lipoedema treatment, patient satisfaction, and healthcare experiences. Data were analysed using descriptive and inferential statistics, and qualitative reflexive thematic analysis.

RESULTS

The results showed a delay in diagnosis spanning decades, often preceded by numerous healthcare visits. Many women attempted to cope with their health problems using various self-care approaches. However, lipoedema treatments performed by healthcare providers were deemed the most effective. Overall, the women reported significantly low satisfaction with healthcare. The lowest score, 48 points out of 100, was found in the overall impression of offered care, reflecting perceived inefficiency and unmet expectations. Compared to a general Swedish female population, the most significant gaps were found in the dimensions of information and knowledge, and emotional support, 22 and 25 points lower, respectively. The women described their experiences in healthcare as a challenging and isolated journey. Four themes were generated: A lonely and demanding journey in the healthcare system; An uncertainty of and inconsistency in available healthcare; A burden of being unheard and disrespected in healthcare; and The impact of lack of knowledge in healthcare.

CONCLUSIONS

Seeking care for lipoedema is a long and burdensome journey with limited access to tailored care. Many women make significant efforts to manage their health problems independently. This emphasizes a need for timely lipoedema diagnosis, improved support, and better access to effective treatments.

What do we know about nursing practice in relation to functional ability limitations, frailty and models of care among older people in home- and facility-based care: a scoping review

BACKGROUND

Nursing practice in long-term care, must support the delivery of safe and evidence-based care, especially for older people with functional ability limitations and frailty, with the competency, knowledge and structured working modes such practice requires. Understanding, detecting and preventing these conditions is important in a context where care is given to a significant number of older people with complex care needs. Our aim was to map published literature on how functional ability limitations and frailty among older people (65 and above) in home-and facility-based care (i.e. long-term care) were described by key stakeholders, and to identify models of care (MoCs) targeting these conditions.

METHODS

We followed Arksey and O'Malley's methodological steps and the PRISMA-ScR reporting guidelines. The PubMed, CINAHL and PsycInfo databases were used to identify papers published between June 2002 and June 2022. The search was updated in May 2024. A descriptive analysis was conducted where the identified patterns were organised and categorised with the support of the Pattern, Advances, Gaps, Evidence for practice and research Recommendations framework (PAGER).

RESULTS

A total of 18,875 unique records were identified. Of these, 26 papers were included. The findings implied a discrepancy between the older people's subjective- and the nurses' more objective, 'matter-of-fact' perspective. The older people described both conditions in terms of identity loss and an emotional struggle to remain independent. They also highlighted the importance of positive connotations in relation to their efforts to adapt and accommodate the situation to the conditions. Nursing practice targeting the conditions were predominantly described as being reactive, based on their experiences and guided by 'intuition'. The identified MoCs mainly targeted functional ability limitations while focusing on educating nurses.

CONCLUSION

A point of saturation seems to have been reached regarding research focusing on older people's descriptions of frailty in home-based care. The same cannot be said about older people's or nurses' descriptions concerning functional ability limitations or MoCs. Intervention studies focusing on nursing practice and the development of MoCs that target these conditions preferably in a home-based care context could substantially benefit the development of knowledge within nursing and nursing practice.

TRIAL REGISTRATION

OPEN SCIENCE FRAMEWORK: https://doi.org/10.17605/OSF.IO/FNHSA .

Desire to Die Communication Training for Professionals: Developing Online Formats

Background

Severely ill patients often express a desire to die, which can turn into suicidality. To support health professionals in managing this issue, we initially created a two-day face-to-face training to enhance self-confidence, knowledge, attitudes, and skills. Due to the increasing need for more accessible formats, we aimed to transition this training online and develop a complementary website.

Methods

Multimethod approach to develop and evaluate an online training and a website on dealing with the desire to die in palliative care in Germany. This involved: (1) reviewing literature on effective didactic elements, (2) digitalizing the face-to-face training and creating the website with ongoing expert feedback, and (3) piloting and evaluating these resources through online surveys.

Results

We retrieved suggestions for the development of online trainings and websites from n = 39 publications. Through these results and expert discussion, an online version of our training and a website were developed. For evaluation, we conducted two trainings (face-to-face (n = 8) and online (n = 19)) with multiprofessional participants. All improved significantly in self-confidence after the training without differences between online and face-to-face training. Website evaluation of usability, comprehension, information quality, presentation, and sustainability by n = 71 users yielded favorable feedback with improvement suggestions for structure and plain language.

Conclusions

Dealing with the desire to die can be taught not only face to face but also through online training and an educational website. This can ensure low-threshold access to scientifically sound information and training units for those health professionals confronted with the desire to die.

Clinical leadership during the Covid-19 pandemic: a scoping review

PURPOSE

Leadership was a critical component in managing the Covid-19 pandemic. A scoping review of clinical leadership investigates the leadership styles employed by clinicians during times of unprecedented crisis, with the Covid-19 pandemic as a focus.

DESIGN/METHODOLOGY/APPROACH

The scoping review was designed based on a five-stage approach proposed by Arksey and O'Malley (2005). Three key databases were searched: Scopus, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and ProQuest Healthcare Administration between 2020 and 2022.

FINDINGS

Of the 23 papers included in the review, the majority were based on developed countries. Seven leadership approaches were found to be useful in times of crises, with compassionate leadership being particularly effective. Seven key themes relating to the pandemic were also identified.

RESEARCH LIMITATIONS/IMPLICATIONS

This review is limited by the search strategy employed and the possibility some publications could have been missed. However, it is clear from the results that there is limited research on healthcare leadership outside of the acute setting and in developing countries. These are important areas of further research that need to be pursued to inform our learning for other times of unprecedented crisis.

ORIGINALITY/VALUE

Various leadership styles were employed during the pandemic, but compassionate leadership, which fosters a collaborative, caring and kind environment, becomes a necessity when faced with uncertainty and adversity. This review identifies key factors that leaders need to manage during the pandemic. Practically, it sheds light on leadership strategies that may be employed in future unprecedented crises.

The relationships between self-neglect and depression, social networks, and health literacy in Turkish older adults: a cross-sectional study

BACKGROUND

Self-neglect is common among older adults and may have devastating health consequences.

OBJECTIVE

This study aims to examine the relationships between self-neglect and depression, social networks, and health literacy (HL) in older adults.

METHODS

The cross-sectional study was conducted between March and May 2024 at four family health centres located in a district of Istanbul, Turkey. A total of 370 older adults, aged 65 years and above, were selected by simple random sampling from among those who visited the family health centres during the study period. A Sociodemographic Information Form, the Revised Turkish version of Mini Mental State Examination, the Istanbul Medical School Elder Self-Neglect Questionnaire, the Lubben Social Network Scale, the Geriatric Depression Scale-Short Form, and the Turkish Health Literacy Scale-32 were used for data collection. Data were analysed using descriptive statistics, Pearson's correlation analysis, hierarchical linear regression analysis, and serial multiple mediation analysis.

RESULTS

The mean age of the participants was 71.42 ± 5.54 (65-90) years, and 55.7% were women. The prevalence of self-neglect among the participants was 34.9%, and the prevalence of depressive symptoms was 46.2%. The HL levels of 62.7% of the participants were inadequate, and those of 31.6% were problematic-limited. HL, depression, social networks, gender, education status, and income status were statistically significant predictors of self-neglect (R2 = 0.508, p < 0.001). Depression had a significant direct effect on self-neglect (effect = -0.148, p < 0.001), as did social networks (effect = 0.107, p < 0.001) and HL (effect = 0.107, p < 0.001). The mediating effect of social networks in the relationship between depression and self-neglect was significant (LLCI = -0.043, ULCI = -0.015), with an effect size of -0.028. The mediating effect of HL in the relationship between depression and self-neglect was also significant (LLCI = -0.121, ULCI = -0.063), with an effect size of -0.089.

CONCLUSION

Our findings showed that HL, depression, and social networks play a critical role in predicting self-neglect in older adults, and social networks and HL partially mediate the relationship between depression and self-neglect. Based on these results, efforts to improve HL and strengthen social support systems would be beneficial in mitigating the effects of depression and reducing self-neglect in older adults.

Experiences and perceptions of meals on wheels volunteers in providing nutritional care to older adults: A qualitative evidence synthesis

In the community, Meals on Wheels (MoW) programmes are instrumental in the delivery of meals to nutritionally vulnerable older adults. This qualitative evidence synthesis aimed to explore the perceptions and experiences among volunteers of MoW services of their role in supporting nutrition care. Scopus, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and PsycINFO were searched employing qualitative data collection and analysis methods. Results were synthesized using Thomas and Harden's three step approach for thematic synthesis. Three articles were included and two themes were identified: (1) complexity in coordinating MoW to ensure service delivery, and (2) the MoW volunteers' perception of their role in providing nutrition care was eclipsed by the social element of their role. While MoW is pivotal to support older adults' independence, challenges like staffing, funding constraints, and limited community awareness of the service persist. Volunteers' express positivity but face concerns about time commitment and replacement recruitment. Exploring MoW volunteers' broader roles in food insecurity is imperative to understand and address the complex dynamics of providing nutrition care and support to older adults.

Identifying comorbidity patterns of mental health disorders in community-dwelling older adults: a cluster analysis

As global life expectancy increases, understanding mental health patterns and their associated risk factors in older adults becomes increasingly critical. Using data from the cross-sectional Trinity Ulster Department of Agriculture study (TUDA, 2008-2012; n = 5186 ; mean age 74.0 years) and a subset of participants followed-up longitudinally (TUDA 5+, 2014-2018; n = 953 ), we perform a multi-view co-clustering analysis to identify distinct mental health profiles and their relationships with potential risk factors. The TUDA multi-view dataset consists of five views: (1) mental health, measured with Center for Epidemiologic Studies Depression Scale [CES-D] and Hospital Anxiety and Depression Scale [HADS], (2) cognitive and neuropsychological function, (3) illness diagnoses and medical prescription history, (4) lifestyle and nutritional attainment, and (5) physical well-being. That is, each participant is described by five distinct sets of features. The mental health view serves as the target feature set, while the other four views are analyzed as potential contributors to mental health risks. Under the multi-view co-clustering framework, for each view data, the participants (rows) are partitioned into different row-clusters, and the features (columns) are partitioned into different column-clusters. Each row-cluster is most effectively explained by the features in one or two column-clusters. Notably, the row-clusterings across views are dependent. By analyzing the associations between row clusters in the mental health view and those in each of the other four views, we can identify which risk factors co-occur and contribute to an increased risk of poor mental health. We identify five distinct row-clusters in the mental-health view data, characterized by varying levels of depression and anxiety: Group 1, mild depressive symptoms and no symptoms of anxiety; Group 2, acute depression and anxiety; Group 3, less severe but persistent depression and anxiety symptoms; Group 4, symptoms of anxiety with no depressive symptoms; and Group 5, no symptoms of either depression or anxiety. Cross-view association analysis revealed the following key insights: Participants in Group 3 exhibit lower neuropsychological function, are older, more likely to live alone, come from more deprived regions, and have reduced physical independence. Contrasting Group 3, participants in Group 2 show better neuropsychological function, greater physical independence, and higher socioeconomic status. Participants in Group 5 report fewer medical diagnoses and prescriptions, more affluent backgrounds, less solitary living, and stronger physical independence. A significant portion of this group aligns with cognitive health row-clusters 1 and 3, suggesting a strong link between cognitive and mental health in older age. Participants with only depressive (Group 1) or anxiety symptoms (Group 4) exhibit notable differences. Those with anxiety symptoms are associated with healthier clusters across other views. The co-clustering methodology also categorizes the questions in the CES-D and HADS scales into meaningful clusters, providing valuable insights into the underlying dimensions of mental health assessment. In the CES-D scale, the questions are divided into four clusters: those related to loneliness and energy, those addressing feelings of insecurity, worthlessness, and fear, those concerning concentration and effort, and those focused on sleep disturbances. Similarly, the HADS questions are grouped into clusters that reflect themes such as a strong sense of impending doom, nervousness or unease, and feelings of tension or restlessness. By organizing the questions from both scales into these smaller groups, the methodology highlights distinct symptom patterns and their varying severity among participants. This approach could be leveraged to develop abridged versions of the assessment scales, enabling faster and more efficient triage in clinical practice.

Informal caregiving following stroke: a qualitative exploration of carer self-identification, care-related language and support experiences

OBJECTIVES

Following a stroke, people often receive informal care from friends and family. Some carers adopt the role quickly, whereas others find it more difficult to see themselves as a 'carer' and do not access relevant support. To understand the process of how and when informal carers start to see themselves as such, and their preferred terminology and experiences of support in this role.

DESIGN

The study adopted an exploratory qualitative design, collecting data through semistructured interviews with participants and a brief survey of participant demographics. Data were analysed thematically using a template analysis approach. Patient, carer and public involvement collaboration, through a formed carer advisory group, enhanced the study methodology.

SETTING

The project was a nationwide study, with participants residing across the UK. The study took place from September 2021 to April 2024.

PARTICIPANTS

18 adults (aged 18 years and above) who had provided care or support to a friend or family member after a stroke that occurred at least 1 year prior to participation completed the study.

RESULTS

Five main themes were developed: (1) adopting and adjusting to the care role, (2) accessibility of support, (3) perceptions of support, (4) acceptability of care-related language and terminology and (5) function of care-related language and terminology. Facilitators and barriers to participants self-identifying with the care role were identified. Self-identification was found to commonly occur at four key points along the stroke trajectory: instant recognition at the time of the stroke event; at the point of planning discharge from hospital; on initial return home from hospital; and at a later stage in the caregiving experience. Two main contrasting opinions around the acceptability of care-related terminology were shared: a favourable view of care-related language and a depreciative view. Accessibility of support services and suggestions for future support provision were discussed.

CONCLUSIONS

Individuals identify as 'carers' at different points and to different extents throughout the stroke trajectory. Findings outline the factors that facilitate this self-identification process and those which constitute challenges to adjusting to the role. Recommendations are made relating to the accessibility of support for informal carers of stroke survivors, including: use of more accessible and inclusive care-related language, educational needs relating to what a 'carer' is and involvement of carers and wider family in the rehabilitation process.

Pregnant Women's Knowledge of Pelvic Floor and Related Dysfunctions: A Scoping Review

Pregnancy and childbirth can have far-reaching effects on women's pelvic floor health. It is important to educate pregnant women about pelvic floor health and potential birth-related pelvic floor (PF) changes as part of continuous midwifery care. This scoping review aims to identify the current state of research on knowledge and knowledge gaps in pregnant women regarding the PF and PF dysfunction (PFD) in order to derive conclusions and recommendations for midwifery care and midwifery science. This review follows the Arksey and O'Malley framework and the PRISMA Statement. The literature search was conducted on databases PubMed, CINAHL, and Web of Science using various search terms and defined inclusion criteria. Eleven articles were included. The results show a considerable context-related knowledge deficit among pregnant women, with a high prevalence of PFDs such as urinary incontinence (UI), fecal incontinence (FI), or prolapse symptoms (POP). All contributions emphasize the importance of improved specific education and health advice regarding the PF and PFD for pregnant women to close knowledge gaps and promote sustainable PF health. Demands are made on the professional group 'midwife', which emphasize the importance of specific and target group-appropriate educational concepts on the subject of the PF and PFD.

Green and Sustainable Electrospun Poly(vinyl alcohol)/Eggshell Nanofiber Membrane with Lemon-Honey for Facial Mask Development

Facial masks contain additives such as thickeners and preservatives that have adverse effects on the skin, and there is growing demand for organic products. Inspired by this, we developed a poly(vinyl alcohol) (PVA) nanofibrous facial mask that contains all-natural ingredients such as honey and an eggshell membrane (ESM) by a green solvent-based electrospinning technique. Various analyses, including SEM, XRD, FT-IR, and TGA measurements, and tests for water solubility, wettability, water absorption and retention, antioxidant activity, and antibacterial properties were performed. SEM analysis showed average diameters from 257 to 325 nm. XRD results indicated decreased crystallinity after cross-linking. FT-IR measurements confirmed ester and acetal cross-link formation. TGA demonstrated enhanced thermal stability in cross-linked samples, especially PVA10%_lemon/esm10/honey20-H. Water solubility tests showed that heated samples were more stable. Water absorption rates exceeded 400%, with PVA10%_lemon/esm10/honey20-H having the highest retention rate. Wettability analysis showed significant changes in contact angles after heating. Antioxidant assays revealed that PVA10%_lemon had the highest DPPH activity (71.2%) among unheated samples, decreasing after cross-linking. Antibacterial tests showed significant activity only in PVA10%_lemon/esm10/honey20, against both Escherichia coli and Bacillus subtilis bacteria. Active ingredients can be added directly to this facial mask. This facial mask is gentler on the skin, and its ingredients have antiaging and anti-inflammatory properties. This mask can avoid the use of preservatives. This prepared facial mask has potential to be used in the organic skincare product industry and can also help the chemical industry toward sustainable and healthy practices.

Adherence to Compression Garments in Lymphedema Patients: A Cross-Sectional Study

Background/Objectives: This study evaluated adherence to compression garments, their role in edema stabilization, and factors influencing patient compliance. Materials and Methods: This observational, descriptive, cross-sectional study evaluated adherence to compression garments in 92 patients with lymphedema treated at the University Hospital of Gran Canaria Dr. Negrín. In addition, sociodemographic, clinical, and design-related factors influencing adherence were analyzed. The evaluation was conducted via telephone questionnaires and a review of medical records. Results: The study revealed low adherence to compression garments in patients with lymphedema. Adherence was related to the garments' etiology, severity, and perceived comfort. Conclusions: The findings highlight the need to improve education strategies and personalize treatment recommendations to enhance adherence.

Patient and healthcare professionals' perception of weekly prophylactic catheter washout in adults living with long-term catheters: qualitative study of the CATHETER II trial

OBJECTIVES

To explore trial participants' experience of long-term catheters (LTC), the acceptability of washout policies, their experience of the CATHETER II trial (a randomised controlled trial comparing the clinical effectiveness of various washout policies versus no washout policy in preventing catheter associated complications in adults living with long-term catheters) and their satisfaction with the outcomes. The objectives of the healthcare professionals (HCPs) focus group and interview were to explore their attitudes towards weekly prophylactic catheter washout, views on the provision of training and participants' ability to enact washout behaviours.

METHODOLOGY

A longitudinal qualitative study embedded within the CATHETER II randomised controlled trial, which included semi-structured interviews and focus groups with participants from multiple trial sites. Data were analysed using the Theoretical Framework of Acceptability and Theoretical Domains Framework. This UK community-based study included 50 (24 female, 26 male) CATHETER II trial participants, aged between 23 and 100 years, with LTC and able to self-manage the washout and study documentation either independently or with the help of a carer. Seven HCPs (five female, two male) also participated.

RESULTS

The participants had positive attitudes towards weekly prophylactic saline or acidic catheter washouts and other trial elements, such as washout training, catheter calendar and monthly phone calls. Participants and HCPs found the 'ask' of the CATHETER II trial and the weekly self-administered prophylactic washout policies to be feasible. The participants reported that the catheter washout training provided during the trial enhanced their self-efficacy, skills and self-reported capability to carry out the washouts. Participants reported having positive outcomes from the weekly washout. These included reduced blockage, pain or infection, reduced need for HCP support and greater psychological reassurance. HCPs attested to the participants' understanding of and adherence to the weekly washouts and other elements of the trial.

CONCLUSIONS

This study shows acceptability, feasibility and self-reported fidelity of the CATHETER II trial on a behavioural level. Self-management for prophylactic catheter washouts is both feasible and, following training, achievable without any need for additional support.

TRIAL REGISTRATION NUMBER

ISRCTN17116445.

Can ChatGPT Help General Practitioners Become Acquainted with Conversations About Dying? A Simulated Single-Case Study

Background/Objectives: General practitioners (GPs) should be able to initiate open conversations about death with their patients. It is hypothesized that a change in attitude regarding discussions of death with patients may be accomplished through doctors' training, particularly with the use of artificial intelligence (AI). This study aimed to evaluate whether OpenAI's ChatGPT can simulate a medical communication scenario involving a GP consulting a patient who is dying at home. Methods: ChatGPT-4o was prompted to generate a medical communication scenario in which a GP consults with a patient dying at home. ChatGPT-4o was instructed to follow seven predefined steps from an evidence-based model for discussing dying with patients and their family caregivers. The output was assessed by comparing each step of the conversation to the model's recommendations. Results: ChatGPT-4o created a seven-step scenario based on the initial prompt and addressed almost all intended recommendations. However, two points were not addressed: ChatGPT-4o did not use terms like "dying", "passing away", or "death", although the concept was present from the beginning of the conversation with the patient. Additionally, cultural and religious backgrounds related to dying and death were not discussed. Conclusions: ChatGPT-4o can be used as a supportive tool for introducing GPs to the language and sequencing of speech acts that form a successful foundation for meaningful, sensitive conversations about dying, without requiring advanced technical resources and without placing any burden on real patients.

Neck dose-limiting rings reduce head and neck lymphedema in early nasopharyngeal carcinoma patients undergoing IMRT: a dosimetric-clinical validation

This study aimed to determine the optimal limiting dose to reduce head and neck lymphedema in patients with early nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT) by setting dose limiting rings at the anterior and posterior regions of the neck. A total of 15 patients with early NPC were included, and 5 sets of IMRT plans were designed for each patient. Plan A was a conventional plan without dose limiting rings, while Plans B-E were set dose limiting rings with gradients of 20 Gy, 18 Gy, 16 Gy, and 14 Gy, respectively, whose remaining parameters were consistent with Plan A. Through Analysis of Variance (ANOVA) for randomized block design data and Bonferroni pairwise multiple comparisons, the impact of dose limiting rings on target coverage and doses to organs at risk was evaluated and the optimal limiting dose was determined. After that, 50 patients with early NPC (25 with rings according to the optimal limiting dose, 25 without rings) were treated with IMRT to determine if there was a difference in the incidence of head and neck lymphedema. Ultimately, 16 Gy was determined as the optimal limiting dose threshold for achieving the balance of target coverage and protection of organs at risk. Compared with the conventional plan, setting cervical anterior and posterior dose limiting rings of 16 Gy did not affect the target dose coverage (all P > 0.05), only slightly affected homogeneity index and increased monitor units (MUs) (both P < 0.05). The doses of the inner ears, mandible, and brainstem were not affected (all P > 0.05), meanwhile, the doses of the oral cavity, larynx, and thyroid were reduced significantly (all P < 0.05). The doses of the parotid glands and spinal cord slightly increased (both P < 0.05), but still within the tolerance range. Clinical cohort verification showed that setting the dose limiting rings of 16 Gy at the anterior and posterior regions of the neck significantly reduced the occurrence of head and neck lymphedema (P < 0.05). Through dosimetric and clinical cohort verification studies, the optimal limiting dose for the cervical anterior and posterior dose limiting rings has been determined, hoping to provide a new design method of IMRT plans to reduce head and neck lymphedema after radiotherapy for early NPC.

Collagen-Based Wound Dressings: Innovations, Mechanisms, and Clinical Applications

Collagen-based wound dressings have developed as an essential component of contemporary wound care, utilizing collagen's inherent properties to promote healing. This review thoroughly analyzes collagen dressing advances, examining different formulations such as hydrogels, films, and foams that enhance wound care. The important processes by which collagen promotes healing (e.g., promoting angiogenesis, encouraging cell proliferation, and offering structural support) are discussed to clarify its function in tissue regeneration. The effectiveness and adaptability of collagen dressings are demonstrated via clinical applications investigated in acute and chronic wounds. Additionally, commercially accessible collagen-based skin healing treatments are discussed, demonstrating their practical use in healthcare settings. Despite the progress, the study discusses the obstacles and restrictions encountered in producing and adopting collagen-based dressings, such as the difficulties of manufacturing and financial concerns. Finally, the current landscape's insights indicate future research possibilities for collagen dressing optimization, bioactive agent integration, and overcoming existing constraints. This analysis highlights the potential of collagen-based innovations to improve wound treatment methods and patient care.

Do not attempt cardiopulmonary resuscitation practice and policy in Ireland: a mixed-methods study of service user and advocacy group perspectives

BACKGROUND

Cardiopulmonary resuscitation offers the potential to save a person's life. However, this highly invasive medical treatment is not always appropriate, and the likelihood of success is relatively low. In Ireland, the Health Service Executive (HSE) National Consent Policy establishes the national guidance in respect of DNACPR decisions, and this was supplemented by HSE Guidance Regarding Cardiopulmonary Resuscitation and DNAR Decision-Making during the COVID-19 Pandemic. Previous research on DNACPR practice in Ireland concentrated on the perspective of the medical and nursing professions and was completed prior to publication of the supplementary guidance. In contrast, this article reports on research which investigates service user and advocacy group perspectives on DNACPR practice and policy in Ireland.

METHODS

The research utilized mixed methods design to collect quantitative and qualitative data. A questionnaire with close-ended and open-ended questions was distributed via Qualtrics, targeting the public while explicitly excluding healthcare workers to focus on patient and caregiver experiences. Recruitment involved identifying relevant advocacy and state organizations and leveraging professional networks and social media to maximize participation and minimize selection bias. Recruitment was conducted through collaboration with organizations that advocate for individuals affected by DNACPR decisions. Survey data were analysed in SPSS for closed questions and thematic analysis for open responses. Four semi-structured interviews with representatives of advocacy groups were completed, transcribed and analysed using thematic analysis. The qualitative and quantitative data's reporting rigour was guided by the CROSS and SRQR guidelines.

RESULTS

A total of 148 participants completed the survey, and 4 interviews were completed with representatives of advocacy groups; 70.5% (n = 98) selected the correct definition of a DNACPR decision. Many survey participants overestimated the rate of survival for both in-hospital and out-of-hospital cardiac arrest. There was a strong desire for involvement and support in the decision-making process. Interviewees drew attention to poor awareness of national policy, uncertainty as to the decision-making authority of family members and difficulties in communication. Interviewees also highlighted the need for additional information concerning the nature of DNACPR and CPR.

CONCLUSIONS

The research study highlights points of weakness in the DNACPR decision-making framework for service users. While there is a desire to be involved in the DNACPR decision-making process, this is challenged by deficiencies in the understanding of CPR and uncertainty surrounding decisional authority. The decision-making framework may be strengthened by the development of accessible information and educational resources.

Deep Dissecting Hematoma, an Often Misdiagnosed Lesion: Case-Control Analysis of Risk Factors and Wound-Healing Prognosis

OBJECTIVES

Deep dissecting hematomas (DDHs) represent severe acute wounds, predominantly affecting older patients. This study aimed to identify DDH risk factors and analyze factors associated with good wound-healing prognosis.

DESIGN

Retrospective, multicenter, case-control study from January 2016 to March 2022.

SETTING AND PARTICIPANTS

A total of 240 patients, 60 patients with DDH and 180 controls with venous or arterial ulcers.

METHODS

Primary endpoint was analysis of demographic and clinical parameter differences between patients and controls to identify DDH risk factors. Secondary endpoint was analysis of DDH-wound healing to identify factors associated with good prognosis defined as ≥40% healing of the initial wound 1 month after debridement.

RESULTS

Patients were mainly female (n = 47, 78%), 63% misdiagnosed, median age: 87 years, and median Cumulative Illness Rating Scale (CIRS) score: 20/56. The low limb was the main DDH localization. Thirty-three (55%) patients had dermatoporosis, 53 (88%) were malnourished, and 51 (85%) had peripheral vascular disease. DDH developed post-trauma in 42 (70%) patients, with 29 (48%) of them resulting from falls. Half of the patients experienced DDH complications: acute anemia (n = 31, 52%) and local infection requiring oral antibiotics (n = 22, 37%). Time to starting appropriate care was significantly longer when the first DDH consultation was outside our expert center. DDH was significantly associated [adjusted OR (95% CI)] with low-molecular-weight heparin [1.95 (5.12-92.1); P < .001], dermatoporosis [3.75 (1.63-9.04); P = .002], age [1.09 (1.02-1.17); P = .02], and CIRS score [1.08 (1.01-1.17); P = .05]. Chemotherapy was significantly associated with delayed wound healing (P = .03) and age (P = .04) and skin grafting within 1 month (P = .003) were significantly associated with good wound healing.

CONCLUSIONS AND IMPLICATIONS

This analysis of DDH risk factors based on a case-control study of a large geriatric cohort identified novel results on prognostic factors for DDH healing. Larger prospective studies are needed to extend our findings.

Debridement - how efficient can a wound dressing be? The answer from a large prospective observational study

OBJECTIVE

To evaluate the performance and tolerance of two polyabsorbent fibre dressings (a pad impregnated with a technology lipido-colloid healing matrix and a rope) in an unselected cohort of patients with wounds of various aetiologies in daily practice.

METHOD

A prospective, observational, multicentre study was conducted in 152 centres across Germany. Wounds were treated with the evaluated dressings (UrgoClean pad and UrgoClean rope, Laboratoires Urgo, France) for six weeks. Main outcomes included changes in: overall wound healing progression; wound bed tissues; exudate; infection status; malodour; and pain, as well as acceptability and tolerance of the dressings.

RESULTS

A total of 1558 patients (aged 3-100 years) were included: 944 patients with chronic (mostly venous leg ulcers, diabetic foot ulcers and pressure ulcers) wounds; and 614 with other wounds (mostly surgical wounds, skin abrasions and burns). By the final visit, 42.0% of wounds had healed within 33±15 days, and a wound healing improvement was reported in 52.5%. Continuous reduction in sloughy tissue was observed (from 60% initially to 10% at final visit), regardless of dressing or wound type. This improvement was associated with a reduction in: infection rates, by 87.3%; malodour, by 86.7%; maceration by 65.6%; and spontaneous pain by 60.4%. Both dressings were rated as 'very well' tolerated and 'accepted' by most patients (85.3 and 76.1%, respectively), and judged as 'extremely useful' by the majority of physicians (72.0%), notably in cases of infected wounds without antibiotic therapy.

CONCLUSION

The two dressings assessed in this study were shown to be efficient in removing sloughy tissue and promoting wound healing, regardless of wound type or infection status. These results are consistent with previous clinical evidence and support their intended use.

Connecting Care Closer to Home: Evaluation of a Regional Motor Neurone Disease Multidisciplinary Clinic

The optimal approach to managing motor neurone disease (MND) is through integrated, person-centred care (PCC), complemented by access to specialised MND multidisciplinary clinics (MDCs). However, in Australia, MND care is fragmented and uncoordinated.

OBJECTIVES

To evaluate participant experiences of the implementation of a new regional MND MDC in New South Wales, Australia, and explore factors influencing its implementation.

METHODS

A qualitative evaluation was conducted. We used semi-structured interviews with people living with MND (plwMND) (n = 4), family carers (n = 2), healthcare providers (n = 6), and social care providers (n = 2). First, deductive analysis using the Theoretical Domains Framework and COM-B model was applied to identify factors influencing the adoption and sustainability of the MDC. Then, an inductive thematic analysis identified the impact of the MND MDC from participant perspectives.

RESULTS

The MND MDC was found to be appropriate and acceptable for providing equitable access to PCC MND care that was 'closer to home'. The three main themes from the inductive analysis indicated that: 1. Implementing it was a 'good idea' [the MND-MDC]; 2. It 'flushes out' local service gaps and/or challenges; and 3. It results in positive outcomes. Key facilitators to implementation identified from the deductive analysis were staff expertise, strong trusting relationships with all clinic participants, and the belief that the MND MDC optimised care. Barriers to implementation included a lack of staff remuneration, organisational boundaries, limited representation of specialities, and anticipated difficulties in coordinating care with existing services.

CONCLUSIONS

The commitment to providing equitable access to an MND MDC in a regional area is crucial to optimise care for plwMND and their families. However, overcoming complex organisational boundaries, creating local solutions, and building strong partnerships are key challenges to securing ongoing financial support and local health district 'buy-in' to support sustainability.

Exploring loneliness: conceptualisation and impact in older adults

Loneliness is a pervasive and distressing emotional experience that profoundly impacts the lives of older adults. This article explores the conceptualisation of loneliness, emphasising its subjective nature and the perceived discrepancy between desired and actual social relationships. Drawing from psychological theories, loneliness is understood as an emotional response to perceived social isolation, encompassing feelings of emptiness, sadness and longing for companionship. In older adults, loneliness is exacerbated by life transitions, such as retirement and bereavement, as well as physical health limitations. The impact of loneliness on older adults' health and wellbeing is significant, with associations documented between chronic loneliness and poor mental health outcomes, including depression, anxiety and cognitive decline. Moreover, loneliness is linked to adverse physical health outcomes, such as cardiovascular disease and mortality, as well as functional decline and decreased quality of life. Recognising the multifaceted impacts of loneliness in older adults underscores the importance of developing interventions and support systems that address both the quantity and quality of social connections, promoting healthy ageing and meaningful engagement in later life.

Is lipedema a progressive disease?

BACKGROUND

It is not yet known whether lipedema is a progressive chronic disease or not. The aim of this paper is to describe the long-term changes in the volume of the lower limbs.

METHODS

The primary endpoint of this prospective cohort study of patients with lipedema was the percentage of volume change (PVC) during follow up. Progression was defined as when the PVC was > 10% from the baseline, whereas improvement was defined as when the PVC was < -10%, and stability as PVC -10% to 10%.

RESULTS

A cohort of 100 patients with lipedema were included in the study. The average follow-up period from the start of this study was 4.6 years. The average PVC was 2.8%. Stability was observed in 62% of the patients, progression in 28%, and improvement in 10%. In the univariate analysis, a significant positive association was observed between PVC and both BMI-change and waist-to-height ratio (WHtR)-change. The more the BMI increased, the more the lipedema progressed (p < 0.0001), as did the WHtR (p < 0.0001). In the adjusted regression analysis, age was not seen to be an influencing factor for PVC. Regarding maintenance therapies, no associations were observed.

CONCLUSION

Lipedema was seen to be stable in two-thirds of the patients. Age was not related to progression. Progression was related to WHtR increase, which is an indicator of abdominal fat gain. This demonstrates the relationship between fat gain and lipedema progression.

Exploring physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity: A qualitative study

AIM

To explore the physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity.

DESIGN

Descriptive qualitative study.

METHOD

Data collection was conducted through semi-structured interviews with 19 community-dwelling oldest-old adults with chronic multimorbidity. The study was conducted between December 2022 and May 2023. ATLAS.ti software was used for data analysis.

RESULTS

Three main themes with their respective sub-themes and units of meaning were developed from the data analysis: (1) motivational factors for engaging in physical activity; (2) fear of getting hurt during physical activity and (3) confidence in being physically active.

CONCLUSION

Motivation, kinesiophobia and confidence are three core elements that influence the experience of physical activity in oldest-old adults with chronic multimorbidity. Interventions tailored to meet the needs of the oldest-old adults are important for promotion and development of active ageing.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and other healthcare professionals should design, implement and evaluate interventions that aim to increase oldest-old adults' motivation and confidence, while decreasing their fear to engage in physical activity.

IMPACT

This study provides insights into the way community-dwelling oldest-old adults with chronic multimorbidity experience physical activity in their daily lives. Our findings suggest that motivation, kinesiophobia and confidence are key factors for oldest-old adults to engage in physical activity. These findings could contribute to the design and implementation of interventions that specifically aim at raising the physical activity levels of community-dwelling oldest-old adults with chronic multimorbidity.

REPORTING METHOD

The study findings are reported according to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Use of Intraoperative Manual Drainage for the Detection of Lymphatic Ducts for Lymphaticovenous Anastomosis

BACKGROUND

Manual lymphatic drainage (MLD) is a widely accepted conservative treatment for lymphedema. Lymphaticovenous anastomosis (LVA) is a minimally invasive bypass surgery that improves lymphedema. However, identifying the lymphatic duct can be challenging during LVA. Transient dilation of the lymphatic ducts can be accomplished with intraoperative MLD, which can definitively identify and isolate the lymphatic ducts. This study describes the use of this intraoperative MLD procedure.

METHODS

LVA procedures that used intraoperative MLD were compared with those that did not. The lymphatic diameter, LVA site, rate of cellulitis episodes, and indocyanine green (ICG) lymphography pattern characteristics between the 2 groups were compared. The surgeon performed MLD distal to the incision.

RESULTS

The intraoperative MLD drainage (+) and drainage (-) groups consisted of 269 and 189 anastomoses, respectively. The median lymphatic duct diameter in the drainage (+) group was significantly larger (0.6 vs 0.5 mm; P < 0.001). The drainage (+) group had significantly higher linear pattern rates preoperatively (76.2% vs 37.6%; P < 0.001), lower extremity (68.4% vs 51.9%; P < 0.001), distal site (81.8% vs 63.5%; P < 0.001), and postoperative improvement by local ICG lymphography pattern (22.7% vs 14.3%; P = 0.03). The rate of cellulitis episodes was significantly lower in the drainage (+) group.

CONCLUSIONS

The successful detection rate of the lymphatic duct based on the intraoperative MLD was high on the distal side of the extremity and the lymphatic duct without sclerosis. This method was also effective for early-stage lymphedema.

Role of therapeutic treatment with antiseptic solutions in the care of diabetic foot ulcers

BACKGROUND

Diabetic foot ulcers (DFUs) are a prevalent and severe complication of diabetes, leading to significant morbidity, impaired health-related quality of life (HRQoL) and economic burden on healthcare systems. The complexity of DFUs often results in prolonged healing and high recurrence rates. Effective management strategies are crucial for improving outcomes and reducing complications.

AIM

This study aimed to review the efficacy of antiseptic solutions in the treatment and care of DFUs.

METHOD

A literature analysis was conducted to review clinical studies and guidelines on the use and efficacy of antiseptic solutions, particularly Octenisept® (0.1% octenidine dihydrochloride and 2% 2-phenoxyethanol). The review focused on the antimicrobial properties, biofilm-disruption capabilities and wound healing outcomes associated with the use of antiseptic solutions in DFU management.

RESULTS

Antiseptic solutions have potential to reduce bioburden, disrupt biofilm and modulate healing. There is a need to balance antimicrobial clinical efficacy with tolerability and cytotoxicity. The use and choice of adjunctive antiseptic solutions must be tailored to the patient, as antimicrobial efficacy can vary for antiseptic solutions, particularly for hypochlorous solutions. It is important to use products according to their instructions, with consideration of minimum contact time to maximise clinical efficacy. Low-pressure irrigation is adjunctive, and concurrent wound-bed preparation, including debridement, frequent inspection, infection and moisture control, remain important.

CONCLUSIONS

The therapeutic application of antiseptic solutions in DFU care presents a promising approach to enhancing wound healing and reducing infection risks. Integrating these solutions into standard wound care protocols could lower the incidence of complications, improve HRQoL and decrease the economic burden associated with diabetic foot disease. Further large-scale studies are recommended to validate these findings and refine guidelines for antiseptic use in DFU management.

Risk Prediction Model of Peristomal Skin Complications Among Patients with Colorectal Cancer and an Ostomy: A Cross-sectional Study in Shanghai, China

OBJECTIVE

To analyze the risk factors for peristomal skin complications (PSCs) in patients with colorectal cancer and an ostomy, construct a prediction model, and verify its effectiveness.

METHODS

In this cross-sectional study, researchers recruited 265 patients with an ostomy at the stoma clinic of a tertiary hospital, from May 2022 to August 2023. Patients were divided into two groups: complications group (n = 81) and no complications group (n = 184). Researchers constructed a logistic regression prediction model using univariate and multivariate analyses. From May 2023 to August 2023, a validation group of 135 patients with an ostomy was selected for external validation of the model.

RESULTS

The incidence of PSCs was 30.57% in the modeling group and 30.37% in the validation group. The predictor variables were preoperative and postoperative health education, tumor therapy within 3 months, preoperative stoma positioning, stoma height, stoma type, and excrement state. The Hosmer-Lemeshow test yielded a P value of .513, the area under the receiver operating characteristic curve was 0.872, the Youden index was 0.561, and the sensitivity and specificity were 0.827 and 0.734. For external validation, the Hosmer-Lemeshow test yielded a P value of .835, the area under the receiver operating characteristic curve was 0.887, and the sensitivity and specificity were 0.905 and 0.720, respectively.

CONCLUSIONS

The prediction model demonstrates good predictive efficacy and can serve as a reference for clinical caregivers in identifying patients at high risk of PSCs.

Adherence and Awareness of Patients with Age-Related Macular Degeneration to AREDS 2 Recommended Nutritional Supplements

BACKGROUND & AIMS

Age-related macular degeneration (AMD) stands as the leading cause of visual impairment and blindness in developed nations. The Age-Related Eye Disease Study 2 (AREDS 2) conclusively demonstrated the advantages of vitamin and mineral supplementation in either preventing or slowing down the progression of AMD. This survey was crafted to evaluate the utilization of nutritional supplements and to gauge the knowledge, attitudes, and practices of patients with AMD. The aim was to identify factors predicting adherence and explore the public health implications.

METHODS

A cross-sectorial study was conducted involving 148 patients through a survey carried out at a tertiary-level hospital. The survey focused on patients with AMD who were candidates for nutritional supplements.

RESULTS

The primary outcome was the rate of adherence to AREDS recommendations, which was found to be 83%. Female gender (P = 0.038), effective medication regimen management (P < 0.01), and higher levels of education (P < 0.01) emerged as independent factors significantly associated with adherence.

CONCLUSIONS

While ophthalmologists play a crucial role in addressing neovascular complications of AMD, they also bear the responsibility of promoting patient adherence to AREDS supplements. Achieving optimal compliance requires addressing the multifaceted factors identified in this study, with specific attention to patients' educational backgrounds and informational requirements.

Breast cancer wound imaging: evaluation of the cross-localisation method

OBJECTIVE

Wound image acquisition has been widely used in wound care; however, there are few reports on scientifically accurate technology in wound image acquisition for wound evaluation. This study compared the effectiveness of a cross-localisation method with a direct photographic method for image acquisition of breast cancer wounds.

METHOD

The wounds of eligible patients were assessed by direct measurement, direct photography, and by a cross-localisation method using the Bates-Jensen Wound Assessment Tool (BWAT) with 13 items. After four months, the wound images were re-evaluated and re-recorded for consistency assessment.

RESULTS

The experimental cohort comprised 150 patients. The consistency of the total BWAT score between the direct photograph acquisition and direct measurement methods was poor (Kappa=0.375). Only wound size, induration and exudate type presented general consistency. There was a good consistency between the cross-localisation image method and the direct measurement method (Kappa=0.786). The wound size, depth, oedema, induration and granulation tissue demonstrated complete consistency between the direct measurement and cross-localisation methods (Kappa=1.000).

CONCLUSION

Wound imaging using direct photography does not present the wound characteristics with complete clarity; however cross-localisation with an objective reference showed optimal performance in this study. The cross-localisation method can provide more specific and accurate wound evaluation.

Patient reported tools for assessing potential medicine-related symptoms: A systematic review

BACKGROUND

Medicine-related symptom assessment tools have been developed to assist healthcare professionals in detecting potential medicine-related symptoms. This systematic review aimed to identify and evaluate the measurement properties of medicine-related symptom assessment tools.

METHOD

A systematic search was conducted in Ovid Medline, Ovid Embase, Ovid PsychInfo, and SCOPUS databases up to March 16, 2024. The primary studies that described either the development or measurement properties of a tool for identifying medicine-related symptoms were included. Screening and data extraction was done independently by two reviewers using Covidence. The methodological risk of bias and assessment results of reported measurement properties were evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist.

RESULT

Eleven studies met the inclusion criteria, reporting on nine unique tools. All included tools had sufficient content validity assessment results. The PHArmacotherapeutical Symptom Evaluation-20 (PHASE-20) had adequate to very good methodological quality internal consistency, construct validity, and reliability. The Patient-Reported Adverse Drug Event Questionnaire also showed adequate methodological quality with sufficient reliability, criterion validity, and construct validity but required over 30 min to complete. The PHASE-proxy exhibited adequate to very good methodological quality, with sufficient results in criterion validity, structural validity, internal consistency, and reliability. The Patient-Reported Outcome Measure Inquiry into Side-Effects showed sufficient content validity but lacked data on other measurement properties.

CONCLUSION

The majority of the identified tools were tested for one or more measurement properties. Among these tools, PHASE-20 is suitable for assessing medicine-related symptoms in elderly individuals who can participate independently, while PHASE-Proxy is for older adults with dementia or communication disabilities in nursing homes.

Digital Health Interventions for Cancer Prevention Among Racial and Ethnic Minority Groups in the United States: A Scoping Review

OBJECTIVE

The COVID-19 pandemic abruptly accelerated the use of digital health for cancer care. Previously, researchers identified a variety of digital health interventions for cancer prevention. The purpose of the present scoping review was to identify digital health interventions for cancer prevention designed for racial/ethnic minority groups.

METHODS

The scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and was guided by the Arksey and O'Malley methodological framework. A search of PubMed, Ovid MEDLINE, and CINAHL for peer-reviewed research articles published from database inception to August 21, 2023, was conducted. Peer-reviewed studies published in English that employed digital health interventions for cancer prevention, that were conducted among racial/ethnic minority groups, and that were conducted in the United States were included. Also included were cancer prevention interventions for people who did not have cancer, people who did have cancer, and cancer survivors. Excluded were interventions that included non-Hispanic White individuals, interventions performed outside the United States, interventions that combined face-to-face methods with digital strategies, and interventions that did not clearly include digital health. Articles that focused on technologies for collecting and transmitting health data (e.g., remote patient monitoring) without an explicit tie-in to cancer prevention intervention outcomes were also excluded.

RESULTS

Following screening, eight articles met the eligibility criteria. Six of the articles were published prior to the COVID-19 pandemic, and two were published during it. The digital health interventions for cancer prevention in racial/ethnic minority groups included screening (n = 5), emotional support and education (n = 1), human papillomavirus vaccination (n = 1), and education and treatment (n = 1). A consistently measured outcome was intervention efficacy. Four authors explicitly stated that theories or theoretical constructs were employed to guide intervention development. Also, no interventions were created using novel devices such as emerging technologies.

CONCLUSIONS

We identified several notable gaps regarding digital health for cancer prevention among racial/ethnic minority groups. Addressing these gaps may help guide continued innovation in the use of digital health for cancer prevention among racial/ethnic minority groups.

Early Recognition of Sepsis in Prehospital Settings: A Review of Screening Tools and Practices

Sepsis remains a global health challenge, with millions affected and high mortality rates. Early recognition is critical for improving outcomes, particularly in prehospital settings where timely interventions can significantly impact patient survival. This literature review examines screening tools used in prehospital environments, focusing on their predictive abilities, ease of use, and limitations in detecting sepsis. Tools such as the quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), Systemic Inflammatory Response Syndrome, and Monocyte Distribution Width offer varied strengths and applications in identifying sepsis. Research shows that NEWS and NEWS2 demonstrate higher sensitivity for predicting mortality, while qSOFA offers simplicity but may lack sensitivity outside of acute care settings. Differential diagnoses, such as pulmonary embolism and adrenal crisis, can mimic sepsis, making accurate assessment essential. The review highlights the role of Emergency Medical Services (EMS) and Family Nurse Practitioners in early detection and emphasizes the importance of evidence-based practices and clear protocols. This review aims to provide EMS and Nurse Practitioners with the knowledge and tools to recognize sepsis early, ensuring appropriate referrals and improving patient outcomes.

Cultural safety and First Nations health content within tertiary education for undergraduate health-care students: A scoping review

INTRODUCTION

Many health professional university programs have integrated content on First Nations health into their curricula in response to the serious health inequities between First Nations and non-First Nations peoples.

METHODS

A scoping review was conducted, aiming to provide a deeper understanding of the various ways that tertiary education institutions are incorporating content on First Nations health and cultural safety into health professional education curricula, and how learning outcomes related to cultural capability are assessed. Online databases were used to identify papers published globally between 1995 and 2021, from which 28 were selected.

CONSUMER AND COMMUNITY INVOLVEMENT

First Nations co-authors, working alongside occupational therapy academics, have ensured that the meaning and context of the relevant studies have been thoroughly understood and that appropriate terminology has been used throughout the review.

FINDINGS

There is considerable variability in the way that content on First Nations health is delivered and assessed within the tertiary sector for health-care students, internationally. There are limited assessment tools that provide a comprehensive understanding of the ability to work in a culturally safe manner with First Nations peoples.

CONCLUSION

The importance of having an understanding of First Nations peoples and health is recognised, with many institutions now, including this information into the university curricula as one method to positively impact the health outcomes of First Nations peoples, as well as in response to health professional accreditation and registration requirements. There remains variability with regard to how this content is delivered and assessed. Despite encouraging data on learning outcomes, it remains unclear whether this intervention has an impact on the health-care practices of graduates once they enter the workforce. Further research into the impact of this strategy is warranted in order to determine its effectiveness.

PLAIN LANGUAGE SUMMARY

Many university programs for health professionals are recognising the importance of, including information about First Nations people in their courses, in an attempt to improve understanding and delivery of services to this population and address health inequities. This scoping review investigated how universities teach health-care students about First Nations health and cultural safety. It also explored how students' knowledge in this area was assessed. A total of 28 papers were selected and analysed within this review. The review found that there is great of variation in how universities teach and evaluate knowledge of this subject area. Some use a mix of online and face-to-face classes; it may be taught as a one off class or integrated throughout the entire curriculum. Activities like cultural immersion are also used. While many studies showed that students' knowledge and attitudes improved after learning about First Nations health, it is unclear if this education affects how the students practice as health-care professionals once they graduate, and if this has any impact on the health care and outcomes for First Nations people. Further research in this area is needed, focussing on how various teaching methods affect student learning, and how to accurately measure cultural safety. It should also consider the impact of culturally safe care on First Nations people's health and wellbeing. This review has some limitations. It only reviewed studies published in English and did not fully explore Indigenous teaching methods, nor did it consider the impact this innovation has on future practice as a health-care professional.

Evaluating Treatment Outcomes of Vitamin B12 and Folic Acid Supplementation in Obsessive-Compulsive Disorder Patients With Deficiencies: A Comparative Analysis

Introduction Obsessive-compulsive disorder (OCD) imposes a considerable impact on day-to-day functioning. Many people experience insufficient symptom relief even after taking the optimum dose of OCD medications. Reduced levels of folic acid and vitamin B₁₂, along with elevated homocysteine (HCY), have been suggested as possible factors in the persistence of obsessive-compulsive (OC) symptoms. This study investigated how supplementation of vitamin B₁₂, folic acid, and selective serotonin reuptake inhibitors (SSRIs) affects OC symptoms and related biochemical markers. Methods A comparative study enrolled 72 OCD patients. For eight weeks, the conventional treatment group received SSRIs or other anti-obsessive medication. In contrast, the nutrient-supplemented group received supplements of vitamin B₁₂, folic acid, and SSRIs. Micronutrients HCY, folic acid, and vitamin B₁₂ were measured at baseline and after eight weeks. Besides, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was applied to assess the severity of OCD symptoms at the baseline, four-week, and eight-week visits. Results Group A (conventional treatment with nutrient supplement) showed significant improvements in vitamin B₁₂, blood folic acid, and reductions in HCY levels compared to Group B (conventional treatment). However, no substantial differences in insight levels were observed between the groups. Both groups exhibited decreased Y-BOCS scores, indicating a reduction in OCD symptoms; however, the improvements in Group A (conventional treatment + nutrient supplement) were statistically significant. Conclusions When taken with SSRIs, vitamin B₁₂and folic acid supplements seem to improve OCD patients' clinical results. These results imply that this supplementation could be a useful therapeutic adjunct.

Association of Clinical Indicators of Acute Deterioration and Morbidity and Mortality in the Residential Aged Care Population: A Retrospective Cohort Study of Routinely Collected Health Data

INTRODUCTION

The timely identification of acute deterioration in people living in residential aged care is critical to reducing rates of resident morbidity and mortality. However, residents often present with atypical or nonspecific presentations that make this difficult. This study aimed to quantify the strength of the relationship between the indicators acute deterioration reported in the literature and morbidity and mortality.

METHOD

A retrospective cohort study using routinely collected health data. A single dependant acute deterioration variable (emergency department presentation or hospital admission or death within 7 days of the last completed international resident assessment instrument long-term care facility (interRAI-LTCF) assessment) was correlated with indicators of acute deterioration reported in the literature and available in interRAI-LTCF. Univariate and multivariate logistic regression analysis evaluated this association.

RESULTS

Nine variables were independently associated with acute deterioration. These were being 'largely asleep or unresponsive' odds ratio (OR): 7.95, 95% CI: 4.72-13.39, p < 0.001, 'easily distracted' (OR: 1.78, 95% CI: 1.28-2.49, p < 0.001), eating 'one or fewer meals a day' (OR: 2.13, 95% CI: 1.67-2.73, p < 0.001), reduced activities of daily living (OR: 2.06, 95% CI: 1.11-3.82, p = 0.02) inability to complete toilet transfer (OR: 1.95, 95% CI: 1.24-3.03, p = 0.004), 'dyspnoea; at rest' (OR: 1.81, 95% CI: 1.32-2.49, p < 0.001), 'two or more falls in 30 days' (OR: 1.53, 95% CI: 1.15-2.03, p = 0.003), peripheral oedema (OR: 1.37, 95 CI: 1.07-1.77, p = 0.014) and daily pain (OR: 1.37, 95% CI: 1.05-1.77, p = 0.019).

CONCLUSION

Presenting with one of nine variables made residents between 1.4 and 8 times more likely to be experiencing acute deterioration than others living in the facility. The monitoring the resident for these variables by healthcare assistants could support the timely identification of acute deterioration.

TRIAL REGISTRATION

Not applicable.

Can Lymphatic Transport Impaired by Total Knee Arthroplasty be Managed with Manual Lymphatic Drainage?

Objective: It is known that particles released from the prosthesis due to wear after joint replacement surgery affect the lymphatic system. This study aimed to investigate the effect of the manual lymphatic drainage (MLD) technique on pain, edema, and blood lactate dehydrogenase (LDH) levels in the early period of lymphatic transport affected by total knee arthroplasty (TKA). Method: Twenty-four patients who underwent TKA were randomly allocated (control: 12; MLD: 12). Both groups received postoperative rehabilitation. The MLD group also received MLD in the first 3 days after surgery. Clinical assessment was undertaken on the third day and at the sixth week postoperatively. The Visual Analog Scale (VAS) was used for pain during activity, algometer measurements for pain threshold levels, and the Frustum method for leg volumes. The LDH was recorded using laboratory measurements. Results: A significant difference was found in the VAS activity-related pain scores of the groups according to the assessment time (MLD: χ2 = 47.175; p = 0.000; control; χ2 = 30.995; p < 0.000). The pain threshold significantly increased in the MLD group from postoperative day 2 (2nd day, 3rd day, 6th week, respectively; p = 0.015; p = 0.001; p < 0.000). Leg volume significantly decreased over time in both groups after surgery (p < 0.001); however, there was no significant difference between the groups (first-third postoperative days and sixth week; p = 0.192; p = 0.343; p = 0.453; p = 0.908, respectively). While the LDH significantly decreased after drainage in the MLD group (first-third postoperative days; p = 0.002; p = 0.005; p = 0.006, respectively), it increased with exercise in the control group, first day (p = 0.004) and second day (p = 0.019). Conclusions: MLD added to exercise therapy is more effective than exercise therapy alone in reducing the LDH level, a marker of pain and muscle damage, but is not effective for edema due to surgery.

Development of mobile educational applications designed for nurses: A narrative review

OBJECTIVE

To identify and synthesise existing literature about the use of mobile educational applications (apps) designed to enhance the learning experience of nurses and midwives.

DESIGN

A narrative review using a systematic, structured and comprehensive search of the literature.

DATA SOURCES

Medline Complete (EBSCO), CINAHL (EBSCO), ERIC (EBSCO) and Embase (OVID) electronic databases.

REVIEW METHODS

Screening of 3512 articles according to inclusion and exclusion criteria using Covidence software resulted in sixteen studies for final analysis. Thematic analysis was conducted to develop key themes.

RESULTS

Four key themes were generated 1) design elements of mobile apps for nurses and midwives, 2) design factors impacting learner motivation, 3) influence of apps on nursing and midwifery practice, and 4) considerations for app development. The themes indicated a positive association between well-designed mobile educational apps and enhanced learner motivation. Additionally, recognising the importance of tailoring mobile educational apps for specific user groups and engaging in co-design processes with nurses and midwives during app development was identified as crucial for optimising their impact on nursing and midwifery education.

DISCUSSION

Mobile educational apps designed for nurses and midwives offer an innovative and engaging approach to delivering information and supporting learning. Creating apps tailored for nurses and midwives transforms their learning experience and serves as a useful adjunct to traditional clinical education.

Oral anticancer medicine interventions: A cross-sectional study in French community pharmacies

IntroductionThe increasing number of oral anticancer medicines (OAMs) dispensed in community pharmacies and the associated challenges (misuse, management of side effects) give the community pharmacist (CP) a major role in the pharmacotherapeutic management of cancer patients. In France, as a response to these challenges, cancer outpatients can schedule a meeting with their CP to ensure the safe and effective use of OAMs. The objectives of this study were to evaluate the perspectives of these interventions regarding their implementation and the opinion of French CPs.MethodsA declarative survey and semi-structured interviews were conducted with CPs that dispensed at least one OAM between January 2021 and March 2022. The study was conducted between April and August 2022.ResultsEighty-five CPs completed the survey. Of these pharmacists, 21% (n = 18) had already performed OAM interventions and 91% (n = 61) wanted to implement them. Lack of time, knowledge and training were the main barriers to implementation. No correlations were identified between the characteristics of community pharmacies and the likelihood of implementing OAM interventions.ConclusionsConsidering that CPs seem willing to implement them and the favourable context in France, this observational study highlights the potential of OAM interventions to improve the management of cancer patients. Though further studies are required to better evaluate the implementation and the potential effects of these interventions, OAM interventions could be relevant strategies in other healthcare systems to secure the management of cancer patients through the involvement of the CP.

Efficacy of complex decongestive therapy in managing limb swelling, pain, and enhancing functional recovery after arthroscopic reconstruction of anterior cruciate ligament

OBJECTIVE

To evaluate the efficacy of Complex Decongestive Therapy (CDT) in managing limb swelling, alleviating pain, and promoting functional recovery in patients following anterior cruciate ligament reconstruction (ACLR).

METHOD

This was a randomized controlled trial (RCT) involving 160 patients who underwent ACLR at a tertiary hospital in Shenzhen between August 2021 and April 2023. The study compared the outcomes of conventional nursing care with complex decongestive therapy (CDT). The differences in leg circumference, Visual Analog Scale (VAS) pain scores, and Active Range of Motion (AROM) were assessed at six time points during the perioperative period and up to 30 days post-surgery.

RESULTS

This study included 69 patients in the experimental group and 64 patients in the control group. After one month of treatment with CDT, significant differences in calf circumference were observed between the experimental and control groups on the 3rd (t = -2.083, P = 0.039) and 5th (t = -2.078, P = 0.040) postoperative days. Regarding changes in central patellar circumference, a significant difference was noted on the 5th postoperative day (t = -2.092, P = 0.038) in the experimental group. However, no significant differences in thigh circumference were observed at any of the six time points (P > 0.05). Visual analog scale (VAS) pain scores were significantly different on the 1st (t = -1.978, P = 0.048) and 3rd (t = -2.530, P = 0.011) postoperative days. Lysholm scores showed a significant difference between the groups on the 30th postoperative day (t = -3.438, P = 0.001), with no significant difference observed before surgery (P > 0.05). Significant differences in AROM were found on the 14th (t = -3.919, P = 0.000) and 30th (t = -2.615, P = 0.009) postoperative days.

CONCLUSION

CDT can effectively reduce limb swelling on the 3rd and 5th postoperative days, alleviate pain on the 1st and 3rd postoperative days, and enhance joint functional recovery on the 14th and 30th postoperative days.

Successful Care Conferences: Nursing Home Staff, Persons with Dementia, and Caregiver Perspectives

OBJECTIVES

The objective of this study was to identify best practices for nursing home (NH) virtual care conferences using Me & My Wishes-videos that document care preferences of residents, including those living with Alzheimer's disease and related dementias. Videos are shared during care conferences with care partners and staff to ensure that the care provided aligns with the resident's wishes, especially as they approach the end of life.

DESIGN

A qualitative descriptive design involving focus groups providing the perspective of 3 groups (people living with dementia, NH staff, and care partners) was used to determine what makes a successful care conference when the care conference is conducted virtually.

SETTING AND PARTICIPANTS

Convenience sampling was used to recruit focus group participants (ie, community advisors) from various geographic locations. Recruitment was facilitated through established relationships with community partner groups. Advisors included NH leaders, community-dwelling older adults, and care partners.

METHODS

Six virtual focus group sessions were conducted from February to June 2023. A semistructured guide was used to identify key factors of successful virtual care conferences when using the Me & My Wishes intervention. Sessions were recorded, transcribed, and analyzed using content analysis.

RESULTS

Three domains for successful virtual care conferences were identified. They are resident-driven, engaging, and structured. They include interdisciplinary care team members most familiar with the resident, prioritize the needs and preferences of residents to ensure they are central to the discussion, and encourage active participation of residents and care partners. Finally, care conferences are led by trained facilitators, with the entire interdisciplinary care team receiving training on conducting and participating in care conferences, including providing technology support to maximize resident and care partner engagement.

CONCLUSIONS AND IMPLICATIONS

Successful care conferences, whether in-person or virtual, require structured approaches that prioritize resident involvement and include people who know the resident best.

Modelling the effects of temperature, pH and osmotic shifts on the autofluorescence of Staphylococcus aureus in vitro

AIMS

This study aims to investigate how different wound microenvironmental factors (temperature, pH, and osmotic pressure) influence the autofluorescence of Staphylococcus aureus (S. aureus) and its underlying molecular mechanisms, specifically focusing on the porphobilinogen synthase gene (hemB) gene expression.

METHODS

We measured the average fluorescence intensity of S. aureus colonies under varying conditions of pH (3, 5, 7, 9, 11), temperature (25°C, 31°C, 37°C, 43°C), and osmotic pressure (0.9%, 1.8%, 2.7%, 3.6%) over time. Fluorescence intensity was quantified using ImageJ software. Additionally, RT-qPCR was used to analyze the expression levels of the hemB under these conditions.

RESULTS

Bacterial fluorescence intensity increased as the temperature ranged from 25°C to 43°C, with corresponding upregulation of hemB expression. At pH values between 3 and 11, fluorescence intensity decreased as pH increased, reflecting a similar trend in hemB expression. Fluorescence also diminished with higher osmotic pressures (0.9% to 3.6%), mirroring the downregulation of hemB.

CONCLUSIONS

Our findings indicate that temperature, pH, and osmotic pressure significantly affect the autofluorescence of S. aureus by modulating porphyrin accumulation through hemB gene expression. These environmental factors should be considered when using bacterial fluorescence for wound infection assessment.

A qualitative study of barriers and facilitators to compression stocking use in patients with chronic venous insufficiency

INTRODUCTION

Compression stocking therapy is the gold standard of treatment for conditions associated with lower limb venous dysfunction. The benefits in symptom relief and preventing disease progression are well documented. Despite this, adherence to compression stocking therapy is poor. This project aimed to identify factors affecting compression stocking adherence in Aotearoa New Zealand through qualitative evaluation of interviews of patients with chronic venous insufficiency.

METHODS

In this mixed-methods study, 25 participants were recruited, and semi-structured interviews were carried out until thematic saturation was reached. All participants also took part in surveys recording characteristics and Quality of Life questionnaires. Common interview themes were summarized and quality of life scores were compared between respondents.

FINDINGS

Interview respondents were a median of 64 years old, and were prescribed compression therapy a median of 8 years prior. The cohort spent a median of 8 h a day standing. Qualitative interviews identified three main themes influencing compression stocking use: physical factors, psychological factors and external factors. Subthemes included the influence of age and sex on participant perceptions of the stockings' appearance, and how comorbidities contribute to donning difficulty.

CONCLUSION

Understanding factors influencing patient adherence can enable clinicians to provide a multidimensional approach, mitigating barriers and emphasizing facilitators for the individual patient to improve adherence.

Assessing New Collagen Therapies for Wound Healing: A Murine Model Approach

Collagen proteins play important roles in wound healing and are of great interest in regenerative medicine. This study evaluated the efficacy of new collagen-based products and compared them to commercial products in a murine model of cutaneous healing. Circular excisional defects were generated on 72 Wistar rats. Six study groups were established according to the administered collagen treatment: Control (without treatment), SD-C (semidenatured), Catrix, Hy-C (hydrolyzed), N-C (native) and Helix3-CP. Seven and eighteen days post-surgery, animals were euthanized. Wound closure was macroscopically assessed by taking zenithal images of the defects. Morphological, histological and immunohistochemical studies were performed to evaluate the healing process. After 7 days, open areas and degree of epithelialization were similar among the groups. Significant differences were observed in contraction between control and the N-C and Helix3-CP groups. Untreated animals exhibited a more pronounced granulation tissue with a high number of inflammatory cells and a disorganised extracellular matrix with type III collagen deposition. After 18 days, animals treated with new collagen (Hy-C and N-C) exhibited accelerated wound closure, increased epithelialization and a more organised granulation tissue. Local administration of new collagen treatments promotes the progression of the reparative process and significantly accelerates wound closure compared with nontreated wounds.