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Cancer inequities among vulnerable populations in rural areas remain a public health challenge in Canada. Rural populations are defined as vulnerable due to geographic isolation, limited access to specialized oncology care, and socioeconomic barriers such as transportation and financial toxicity. Professional navigation offers a potential solution to bridge these gaps, yet there is a lack of evidence on the barriers to and facilitators of its adoption in breast cancer survivorship. The objective of this study is to evaluate the effectiveness of a cancer navigation intervention using professional navigators compared to the standard of care (medical care) in improving the quality of life and functional outcomes of newly diagnosed survivors of breast cancer in interior British Columbia. A single-center, parallel-group, open-cohort randomized controlled trial is being conducted over 3 years. Ethics approval was obtained for the study. Participants who provide informed consent are randomized into 2 groups: the intervention group receives the cancer navigation intervention and the control group receives the standard of care (the usual medical care offered by health care practitioners). The baseline study time point spanned January to March 2025, the first follow-up spanned April to June 2025 at 3 months after enrollment, and the second follow-up spanned July to September 2025 at the end of 6 months after enrollment. The cancer navigation intervention comprises direct psychosocial and educational webinars, coordinated telephone support services, and community-based cancer care resources. Professional navigators are qualified registered nurses who facilitate information and connect participants with available supportive resources, services, and programs. The main outcomes are financial distress, quality of life, and satisfaction with navigation and interpersonal relationships. The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy, Functional Assessment of Cancer Therapy-Breast, Breast Cancer Navigation Survey, Participant Satisfaction With Navigation Scale, Satisfaction With Interpersonal Relationships Survey, and Breast Cancer Navigation Interview are used in the study. Steps are being taken to ensure the trustworthiness of the qualitative data. With a 5% level of significance (2 tailed) and 90% power, the sample size was calculated as 108. Data collection took place from January 2 to September 30, 2025. A total of 164 participants were recruited. This study aims to demonstrate effectiveness and satisfaction with professional navigation and knowledge translation for future implementation of a cancer navigation intervention in British Columbia.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Social care nurses practise at the intersection of health and social care, supporting people with complex, long-term and often fluctuating needs. Despite their central role in care coordination, clinical oversight and safeguarding, social care nursing remains under-recognised in policy, education and workforce planning in England. This article examines the case for recognising social care nursing as a form of specialist community nursing practice. The authors situate social care nursing alongside district nursing and general practice nursing, highlighting shared capabilities in risk management, coordination and autonomous decision making outside hospital environments. International comparisons illustrate how clearer credentials and development pathways can strengthen specialist identity. The article concludes that reframing social care nursing as part of the community nursing workforce is essential to improving professional recognition, education pathways, workforce sustainability and the quality and safety of care.
British Columbia's Mental Health Act permits the involuntarily detention and treatment of individuals who meet specific criteria. Over the past 15 years, British Columbia has seen an increasing trend in the number of involuntary psychiatric admissions. This qualitative study explores the experiences of people receiving and providing involuntary psychiatric treatment within two health organizations in British Columbia, Canada. Five focus groups were conducted with 23 individuals who had previously received involuntary psychiatric treatment at a facility operated by one of the two health organizations. All sessions were facilitated by individuals with lived experience of involuntary psychiatric treatment. Additionally, semi-structured interviews were conducted with 11 clinical staff and 10 non-clinical support personnel involved in delivering involuntary psychiatric treatment or associated services. Data were analyzed using reflexive thematic analysis, guided by an equity-oriented care framework. Seven themes were generated, including the limited availability of voluntary care options, the compounding role of social determinants of health in mental health crises, the lack of conclusive evidence supporting involuntary psychiatric treatment, the negative impacts on both patients and providers, and the importance of peer support. Across themes, participants described involuntary psychiatric care as shaped by systemic constraints with limited access to upstream, voluntary and community-based alternatives. These findings highlight the need for system-level reform to reduce reliance on coercive practices and to expand access to voluntary, community-based mental health supports that address underlying social and structural factors contributing to mental health crises.
Clinical placement shortages continue to challenge pre-registration nursing education in the UK, particularly in primary care. This study evaluated the feasibility and acceptability of a 2-week virtual general practice simulation placement delivered to 313 pre-registration nursing students from year 1 and 2. The placement integrated simulated consultations, branching digital cases and documentation within a bespoke electronic health record. Using a mixed-methods design, evaluation data were collected through questionnaires, narrative feedback and system analytics. Quantitative findings demonstrated full completion of required hours, high engagement and strong documentation accuracy, while qualitative feedback highlighted perceived authenticity, enhanced digital literacy and the value of structured debriefing. Challenges included workload intensity, scheduling and technical access. The findings suggest that virtual general practice placements can extend placement capacity and support professional skill development in primary care education, when positioned as a complement to rather than a replacement for traditional clinical placements. Virtual general practice placements can expand placement capacity while supporting nursing students to develop documentation, communication and patient-safety skills within a safe and structured learning environment. Implementation of virtual general practice placements requires careful design of workload, reliable digital infrastructure and consistent supervisory support to maximise learning alongside traditional clinical placements.
The advanced nurse practitioner district nurse is a relatively new role in district nursing services in Northern Ireland. A solid evidence base is a prerequisite for district nurses, who need to be able to demonstrate their specific contributions to primary care and support the development of future advanced nursing roles within the specialty. This scoping review aimed to gain a greater comprehension of the advanced nurse practitioner role, and its contribution to the district nursing service needs, by identifying and evaluating the existing evidence. The search strategy was based on the population, concept and context framework. The primary search focused on CINAHL, Medline and Scopus. International, national and regional primary and secondary research was included. The keywords used for the literature search included: advanced nurse practitioner; advanced practice; community health nursing and district nursing. From 1790 identified records, 24 duplicates were removed and 1766 titles were screened, resulting in 13 studies included in the final scoping review following application of inclusion and exclusion criteria, date limits (2019-2023), and full-text eligibility screening. Three major themes emerged: role clarity; role preparation, development and implementation; and role value and support. The themes were inextricably related and linked to answering the research question and study objectives. The review identified a distinct lack of research on the role of the advanced nurse practitioner in district nursing practice, despite the comprehensive and broad search strategy. However, the evidence can be mapped in the context of local impact and within the district nursing service.
The wide-ranging and demanding role of community nurses is widely recognised. They need to be able to assess and manage a multitude of medical symptoms, general health issues and social factors. As a result, it is essential to have an expansive knowledge base as a starting point. However, the challenge of working in the community, often alone, also means needing a high level of expertise to tackle some challenging and demanding situations. It is essential to recognise this when exploring the training needs of community-based clinicians, as training needs assessment, and any subsequent plans to support the findings must ensure that the training provided meets these needs. When considering the training needs of community nurses in relation to bladder issues, it is useful to begin by reflecting on the range of bladder conditions. Urinary incontinence is a very common symptom and is, therefore, likely to be seen by community nurses on a regular basis. This article discussess some key points and commonly held beliefs that may be worth questioning.
Spirituality plays a significant role in end-of-life and palliative care, influenced by patients' religious and cultural backgrounds. Facing the reality that one's own life or that of a loved one is nearing its end can evoke feelings of hopelessness, anxiety and depression. Spiritual practices, such as invoking the intercession of saints or patrons, can provide comfort and hope, and a sense of meaning during this challenging and difficult time. Integrating these spiritual interventions into palliative care can support emotional wellbeing and enhance the holistic care of patients and their families.
Bipolar disorder (BD) affects approximately 40 million people worldwide and is a chronic, potentially disabling mood disorder. Although effective treatments exist, access to evidence-informed psychosocial care remains limited, particularly for culturally and linguistically diverse populations, contributing to persistent global treatment gaps. Digital mental health interventions (DMHIs), such as smartphone apps, offer a promising means to improve access to self-management support and quality of life (QoL), an outcome prioritized by people with BD and in clinical guidelines. However, most apps for BD lack quality and are not culturally adapted or co-designed with people with BD, limiting relevance and engagement. PolarUs (mobile app) is an evidence-informed DMHI developed using co-design with people with BD. The app is structured on the core 14 domains from the Quality of Life in BD scale, the only BD-tailored scale, combined with psychoeducation on self-management strategies and QoL. A recent pilot study demonstrated promising QoL, clinical, and feasibility outcomes. This study aims to culturally and linguistically adapt the PolarUs app into French, Chinese, and Spanish for the North American context using qualitative and co-design methods. Guided by community-based participatory research principles, whereby end users are engaged throughout the research process, and the Ecological Validity Framework of Bernal et al, we will engage advisory groups of people with lived experience from each linguistic community throughout the cultural adaptation process. Semimonthly virtual meetings will support systematic cultural adaptation of the self-management strategies, affirmations, and resources while maintaining fidelity to core evidence-based components. This will include cultural tailoring of app content and the identification of culturally appropriate resources. Advisory groups will also contribute to the cointerpretation of findings and the co-design of culturally appropriate recruitment and implementation strategies of PolarUs for a future clinical trial. Meetings will be recorded and coanalyzed as research data with advisory groups using qualitative reflexive thematic analysis to capture advisory group perspectives and experiences. This study was funded in October 2024. As of January 31, 2026, we enrolled 7 participants, and the results are expected to be published in the fall of 2026. The findings will support the development of a culturally appropriate DMHI for BD for additional linguistic communities, advance cultural adaptation methodologies, and inform preparation for a future clinical trial. This study will produce the first culturally adapted, BD-specific DMHI developed through co-design using a community-based participatory research approach with multilingual end users from traditionally underserved communities, advancing equitable access, engagement, and scalability of DMHIs for BD and digital health care more broadly.
In recent years, healthcare policy and reform in England has advocated for community care services that enable people to live well and die well at home. This article is a systematic review that sought to determine the characteristics of a positive experience of home-based, end-of-life care, as perceived by family members. A combined strategy of electronic and hand searching yielded 11 qualitative studies of European, Australasian and North American origin. The findings were analysed using directed content analysis. Four of the six national Ambitions for Palliative and End-of-Life Care in England were used as the coding framework. Nine categories were developed from the data to provide a concise, synthesised summary of existing research. Continuity of care, needs-based care and caring and capable staff were dominant category findings. In contrast, accounts of care and support after death were sparse. Investment in the community nursing workforce and services is essential for the delivery of high quality end-of-life care. It is important to recognise, involve and resource family carers, ensuring continuity and coordination of care and needs-based support before and after death. Further contemporary and contextual research is required to understand and inform the current and future provision of pre- and post-death patient and family care in the home.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.
This article aims to explore the ethical and legal considerations involved in the assessment of mental capacity by community nurses in the UK. Grounded in the principles of the Mental Capacity Act 2005, the article explores the practical challenges community nurses face when applying legal frameworks in varied clinical contexts, including home visits, remote consultations and multidisciplinary care. Key themes addressed include the role of consent, safeguarding responsibilities, fluctuating capacity in chronic illness, family and professional disputes and supported decision making for individuals with learning disabilities. The article also highlights how legal instruments such as the Human Rights Act 1998, Equality Act 2010, Care Act 2014 and Health and Social Care Act 2012 underpin safe and lawful practice. It also explores the implications of emerging legislation, such as the Data Protection and Digital Information Bill and regulatory guidance, on remote assessments and digital ethics. The author looks at cultural and religious considerations with attention to preventing bias and promoting equity. The article draws on recent literature and case law, including Re C (Adult: Refusal of Treatment), to illustrate the complex association between professional judgement and patient autonomy, while upholding healthcare professionals' legal duties. By providing a structured and comprehensive review, this article aims to equip community nurses with the legal literacy and ethical insight necessary to navigate capacity assessments confidently.
An increasing number of older adults living with frailty are undergoing surgery, yet scarce data on postoperative functional recovery, care needs after surgery, and extent of caregiver supports exist. To characterize older adults' and caregivers' recovery experiences in the first 6 months after surgery. This mixed-methods, multicenter, prospective nested cohort study included 17 hospitals in Canada. Participants included adults aged 65 years or older with a Clinical Frailty Scale score of 4 or more, who were recovering after major elective noncardiac surgery between March 16, 2021, and June 13, 2023, and their caregivers. Surveys included functional status via basic and instrumental activities of daily living, care needs, and care received or provided. A subset of patients and caregivers were invited to participate in semistructured interviews about their experiences and were analyzed using interpretive descriptive qualitative analysis. There were 289 individuals, including 204 older adults (mean [SD] age, 72.8 [5.6] years; 108 males [52.9%]) and 85 caregivers (mean [SD] age, 68.2 [12.2] years; 50 females [59.5%]), who participated in surveys, and 63 individuals (43 older adults and 20 caregivers) who participated in interviews. Older adults had a median (range) Clinical Frailty Score of 4 (3-6), indicating mild frailty, and 190 (93.1%) had 1 or more chronic diseases. Caregivers had a median (range) of 2 (0-8) chronic diseases, and 69 (82%) were spouses. Two months postoperatively, 129 of 203 older adults (64%) had more than 1 instrumental activities of daily living impairment, decreasing to 84 of 198 (42%) at 6 months after surgery; 68 of 203 (33%) had more than 1 activities of daily living impairment 2 months postoperatively, and this decreased to 38 of 198 (19%) at 6 months after surgery. Themes related to the recovery experiences were: (1) inadequate patient and caregiver education, preparation for surgery, and discharge; (2) the association of reduced independence with patient and caregivers; (3) the association of surgery with mental health; and (4) postoperative support from the health care team. All participants indicated that they wanted to be better prepared for surgery and discharge. In this mixed-methods cohort study, functional recovery in the first 6 months after noncardiac major elective surgery was associated with daily living impairment for older adults and their caregivers. Targeted interventions including preoperative education, caregiver-inclusive discharge planning (eg, wound-care teaching, how to recognize complications and what to do for support, and more rehabilitation), and early follow-up after discharge may optimize recovery experiences.
England and Wales have an increasingly large number of people for whom English is not their first language. This impacts healthcare delivery, as the communication barrier has an impact on taking medical history and, consequently, the care that is delivered. NHS policy states that professional interpretation and translation services should be used, but this is not always practical. In practice, many healthcare professionals use translation apps on their phones. This approach has both strengths and weaknesses, and although they can help communication, they also have the potential to allow harm to occur.
BACKGROUND: Quality of life (QoL) is a central priority in dementia care, yet most nursing homes (NHs) in Canada rely on clinical indicators that do not capture the emotional and social dimensions of residents’ well-being. Little is known about how clinical, social, and NH factors jointly shape QoL for residents living with dementia. This study examined the associations of resident social characteristics, clinical conditions, and NH factors with resident QoL. METHODS: This cross-sectional study included publicly funded NHs in the Canadian provinces of Alberta, British Columbia, Manitoba, Nova Scotia, and Ontario. QoL was measured using staff-proxy interviews to complete the DEMQOL-CH. Staff also provided information about resident social characteristics. Clinical data were obtained from routinely collected, standardized resident assessments. NH characteristics were reported by administrators. We used linear regression with robust standard errors to assess associations of social, clinical, and NH variables with resident QoL. Multiple imputation addressed missing data, and model fit was compared using the Akaike Information Criterion. RESULTS: The final sample included 2,950 residents in 67 NHs. Older age was also associated with lower QoL (-0.009 per standard-deviation increase in age, 95%CI: −0.016; −0.002). Clinical factors that were significantly associated with lower QoL were: depressive symptoms (coefficient=-0.066, 95%CI: -0.082; -0.050), responsive behaviours (-0.034, 95%CI: -0.054; -0.015), and health instability (-0.027, 95%CI: -0.045; -0.010). More severe cognitive impairment was associated with higher staff-rated QoL (0.039, 95%CI: 0.023; 0.055). Compared with Ontario, residents in British Columbia (− 0.059, 95%CI: −0.079; −0.040) and Manitoba (− 0.039, 95%CI: −0.061; −0.017) had lower QoL. Living in a large NH was associated with lower quality-of-life scores relative to small homes (− 0.034, 95%CI: −0.051 to − 0.016). The combined model, which incorporated social, clinical, and facility factors, had the best fit. CONCLUSIONS: QoL in Canadian NHs appears to be shaped primarily by resident clinical conditions and facility environments rather than individual social characteristics. Interventions that address mental health, behavioural symptoms, and environmental stressors may yield the greatest improvements in resident well-being.
Hand-foot syndrome (HFS) is a common side effect of chemotherapy drugs such as 5-fluorouracil and capecitabine, impairing daily function and quality of life. This study aimed to compare international clinical guidelines regarding assessment and management of HFS to identify areas of consensus and divergence and evidence gaps. Guidelines were identified through PubMed (from inception to February 2025), with a supplementary search on Google. Only the most recent versions of English guidelines were included. Data extraction focused on the guideline methodology and recommendations on the prevention, assessment, and management of HFS. Each guideline was critically appraised using the AGREE II checklist. Six guidelines were identified authored by the following cancer agencies: British Columbia Cancer (BCC), European Society of Medical Oncology (ESMO), Cancer Institute NSW (eviQ), Oncology Nursing Society (ONS), United Kingdom Oncology Nursing Society and Acute Oncology (UKONS AO), and United Kingdom North Cancer Alliance (UKNCA). Regarding prevention, five of six guidelines (83%) advised avoiding chemical and physical stressors to the hands and feet and using alcohol-free moisturizer. Only ESMO, BCC, and eviQ recommended oral celecoxib to prevent capecitabine-induced HFS. ESMO and ONS recommended cooling procedures to prevent taxane-induced HFS. Likewise, BCC and eviQ recommend cooling procedures for all agents. All guidelines except ONS recommended dose suspension with grade 2 or 3 HFS and continuation when resolved or improved. ESMO and BCC recommended topical corticosteroids for grade 1 HFS, ESMO for grade 2 or 3, and eviQ for prophylactic use. Finally, BCC and ESMO suggested to consider oral dexamethasone for PEGylated doxorubicin-induced HFS. While general skin care and dose modification guideline recommendations were consistent, pharmacological recommendations varied. Guidelines are key for healthcare professionals in supporting patients with HFS. Therefore, regular updates with emerging evidence for interventions such as topical diclofenac are needed to ensure the quality of care.
Wound assessment in the UK community setting remains heavily reliant on visual cues, such as erythema, which are unreliable in darker skin tones. This continued reliance on a light-skin norm represents a form of hidden systemic bias that risks delayed diagnosis and avoidable harm for a growing segment of the population. This article draws on empirical and conceptual literature to develop a critical narrative analysis of how skin tone diversity affects wound assessment, diagnosis and management in UK community nursing practice. It synthesises evidence on diagnostic delays, critiques the inadequacy of the blanching test and outlines a multisensory, equity-focused assessment framework. By proposing strategies across clinical practice, education and policy, this article challenges the status quo, arguing that true safety requires not just new tools but the dismantling of embedded racial biases within healthcare structures.
Community staff are central to preventing the spread of infection among older adults in community settings, such as care homes, domiciliary care, supported living and primary care. Early detection of infection in older adults is challenging because of atypical presentations and high vulnerability. Community nurses and adult social care workers are often the first to notice subtle changes in health status that can signal infection. Swift reporting through established escalation pathways enables rapid action to contain risk and prevent outbreaks. Despite national guidance emphasising infection prevention and control competence, workforce pressures, limited specialist capacity and barriers such as infectious presenteeism impede early detection and reporting. This article integrates local system learning from Northumberland and North Tyneside and discusses infectious presenteeism in private care homes. The article also illustrates clearly how community and adult social care staff from a variety of settings contribute to infection prevention and control and outlines structures that support timely action. Essential components include continuous training tailored to community settings, clearly defined reporting pathways with supportive leadership, and collaborative partnerships that integrate community staff observations into public health action. Building capability, opportunity and motivation among the community workforce is central to sustainable infection prevention and control practice. The article concludes with recommendations for nursing practice and service leaders to strengthen early detection, reporting mechanisms and organisational cultures that support proactive infection control.
Dementia is a syndrome caused by progressive neurological conditions. The majority of people will be diagnosed with late-onset dementia and will be over the age of 65 years, though a significant number may also be diagnosed before this age, termed young-onset dementia. People with dementia, especially late-onset, are more likely to have other comorbid conditions, and often multiple health conditions, more so in number than age-equivalent populations without dementia. One of the common comorbid conditions experienced by people with dementia is diabetes, which may have been present before any diagnosis of dementia is made, or onset may also be after the person's diagnosis of dementia. The ongoing management of diabetes as a person's dementia progresses can often raise significant anxiety in both health and care professionals and family carers alike. This article discusses some of the issues to consider in the management of diabetes in a person with dementia.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.