Implementing evidence-based interventions to improve nurse-patient communication is essential for enhancing patient satisfaction and clinical outcomes in oncology. However, robust evidence guiding the selection of effective and feasible communication training models for oncology nurses remains limited. This study aimed to compare the effectiveness of two structured communication training approaches, including case-based training and simulation-based training, in oncology nursing education. A quasi-experimental non-randomized controlled trial with a pretest-posttest design was conducted among 258 oncology nurses and 650 cancer patients. Oncology nurses were assigned to one of three groups based on pre-existing clinical shift rotations rather than random allocation: no training (NTG, n = 84), case-based training (CTG, n = 88), or simulation-based training (STG, n = 86). Both intervention groups received structured communication training covering therapeutic communication, needs assessment, instruction delivery, referral practices, and outcome evaluation. The STG used video-based scenarios with standardized patients (20 h), whereas the CTG used written clinical cases (16 h). Outcomes were measured using the Nursing Care Satisfaction Questionnaire, the Health Professionals Communication Skills Scale, and the Occupational Coping Self-Efficacy Scale for Nurses. Data were analyzed using repeated-measures ANOVA with sensitivity analyses. For patient satisfaction with nursing care, a significant time × group interaction was observed (F(2, 255) = 17.2, p < 0.001, partial η² = 0.12). Both CTG and STG showed significant improvements from pre- to post-intervention (p < 0.001), whereas the NTG showed no significant change (p = 0.81). Similarly, nurses' communication skills demonstrated a significant interaction effect (F(2, 255) = 19.6, p < 0.001, partial η² = 0.21), with significant improvements in both intervention groups compared with the control group (p < 0.001). For occupational coping self-efficacy, the interaction effect was also significant (F(2, 255) = 15.8, p < 0.001, partial η² = 0.19), indicating increased self-efficacy in both intervention groups (p < 0.001). No statistically significant differences were observed between CTG and STG at post-test for any outcomes. These findings indicate that case-based and simulation-based communication training may be effective in improving communication-related outcomes in oncology nursing, although conclusions regarding their relative effectiveness should be drawn with caution. Not applicable.
Malignant Brenner tumor (MBT) is a rare ovarian neoplasm with unpredictable behavior, posing significant diagnostic and therapeutic challenges. Current management advocates for risk-adapted strategies, though long-term outcome data supporting this approach are scarce. A 54‑year‑old postmenopausal Black African woman presented for cervical cancer screening, during which a right ovarian mass was incidentally found. Subsequent surgical staging and histopathology confirmed a FIGO stage IC2 malignant Brenner tumor with an elevated Ki-67 index. A multidisciplinary team implemented a risk-adapted strategy comprising radical surgery followed by platinum-based chemotherapy. Treatment was well-tolerated, with only grade 1 peripheral neuropathy reported. At the eight-year follow-up, the patient remains in complete remission, with normal imaging and tumor markers. This case illustrates the potential efficacy of risk-adapted management in early-stage malignant Brenner tumor, supporting contemporary paradigms that prioritize individualized risk assessment. The exceptional long-term outcome adds to the evidence for selective treatment modulation in appropriately stratified patients.
Falls and physical inactivity are both linked to increased dementia risk, but their joint impact has not been well studied. It remains unclear whether physical activity can mitigate the elevated dementia risk after a fall and whether it also lowers the likelihood of future falls. We used data from 44,488 adults aged ≥ 60 years in three cohorts. Falls and physical activity were self-reported. Incident dementia was tracked during follow-up. Cox proportional hazards models estimated the associations of falls with dementia and physical activity with dementia and falls, stratified by fall history. Over a median follow-up of 5.9-7.9 years, 3,492 dementia cases were identified. Falls were associated with a 70% higher risk of dementia (pooled HR = 1.70, 95% CI: 1.57-1.84). In the no-fall group, compared with inactivity, low, moderate, and high physical activity were progressively associated with lower risks of dementia (HRs = 0.63, 0.53, 0.43) and falls (HRs = 0.77, 0.68, 0.58). These protective effects were consistent among fallers, with similar dose-response gradients. Falls substantially increased dementia risk. Higher levels of physical activity were linked to lower risks of both dementia and falls, regardless of fall history.
Since 2000, the world has achieved notable progress in reducing maternal mortality, though regional disparities remain pronounced. These uneven outcomes raise critical questions about whether countries are collectively converging toward the Sustainable Development Goal (SDG) 3.1 target of fewer than 70 deaths per 100,000 live births by 2030, or diverging into distinct clusters marked by persistent inequality. This study employs Gini coefficient decomposition and kernel density estimation (KDE) to quantify regional differences and trace the evolving distribution of maternal mortality ratios (MMRs) across 163 countries from 1990 to 2023. A convergence model is then applied to analyze long-run dynamics. Specifically, recognizing that the Phillips-Sul framework overlooks spatial dependence and mobility between clubs, the Local Directional Moran Scatterplot (LDMS) methodology is adopted, situating each country in Moran space and modeling trajectories as random vector fields (RVF). The findings show that: (1) Global maternal mortality fell consistently from 1990 to 2023, with distributions shifting lower. COVID-19 briefly widened disparities, but recovery by 2023 confirmed continued progress. (2) The global MMR Gini coefficient remained persistently high, averaging about 0.66, with inter-regional disparities as the primary source of inequality. (3) Countries are not converging along a single universal path but instead into three distinct clubs. By 2030, forecasts indicate that out of 163 countries, 65 (40%) will achieve the SDG 3.1 target, while 98 (60%) will remain above the threshold. This divergence highlights the urgent need for stronger health systems, socio-economic empowerment, and global partnerships to help lagging countries overcome entrenched high MMR trajectories.
The electronegative electroretinogram (ERG)-in which the dark-adapted bright-flash b-wave amplitude falls below the a-wave (b: a ratio < 1.0)-localizes dysfunction to the inner retina or photoreceptor-bipolar synapse. In inherited retinal disease (IRD), this waveform has been associated with a restricted set of genetic etiologies, but the evidence has not been systematically synthesized. To systematically identify and appraise the evidence on genetically confirmed IRD associated with electronegative ERG, characterizing reported gene-specific electrophysiologic patterns, structural correlates, and clinical features. A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library was conducted from inception through March 2026, following PRISMA 2020 guidelines. Studies reporting patients with genetically confirmed IRD and electronegative full-field ERG were included. For this review, electronegative ERG was defined quantitatively as a dark-adapted bright-flash b: a amplitude ratio below 1.0 where numerical data were provided; studies using only qualitative descriptors without numerical ratios were included but flagged in sensitivity analysis, as qualitative labelling introduces subjectivity and reduces cross-study comparability. Quality was assessed using Joanna Briggs Institute checklists. Evidence was synthesized narratively, stratified by gene group, because clinical and methodological heterogeneity precluded meta-analysis. Eighty-seven studies (approximately 1,250 patients; 23 countries; 1986-2025) met inclusion criteria. The literature was dominated by case reports and small case series (83%), with substantial heterogeneity in ERG protocols and inconsistent ISCEV compliance (documented in 61%). The most frequently reported associations were with genes causing congenital stationary night blindness (NYX, CACNA1F, TRPM1, GRM6, GPR179, CABP4, LRIT3), X-linked retinoschisis (RS1), and cone dystrophy with supernormal rod responses (KCNV2). Electronegative ERG patterns were commonly described across the CSNB and XLRS literature, with the greatest consistency for complete CSNB and KCNV2. Structural imaging correlates showed gene-group specificity, particularly foveal schisis in RS1-associated disease. Evidence for rarer gene associations was limited to isolated case reports. Risk of bias was high across most included studies. These limitations directly inform the confidence ratings assigned to each gene-phenotype association throughout the review. Electronegative ERG appears to be a potentially useful phenotypic marker that may help narrow the genetic differential in IRD, particularly for CSNB, XLRS, and KCNV2-associated disease. This utility is most applicable in clinical settings where comprehensive genetic sequencing is not immediately accessible; ERG findings should be interpreted in conjunction with structural imaging and clinical context rather than in isolation. However, the evidence base is constrained by small sample sizes, heterogeneous methodology, likely publication bias, and limited longitudinal data. Importantly, conclusions regarding rarer gene associations should be treated as preliminary, given that they rest on isolated case reports with high risk of bias. Prospective studies with standardized ERG protocols and reporting are needed to validate the diagnostic patterns identified in this review.
Associations between growth deviations and coeliac disease (CD) in children have been documented, but longitudinal evidence-particularly concerning when such deviations first emerge-is limited. The aim of this study was to investigate the occurrence and timing of growth deviations in relation to CD diagnosis, and to assess whether these patterns differed between boys and girls in a Swedish preschool population. This retrospective longitudinal study was conducted as part of the project Evidence based knowledge about deviant growth in children 0-6 years. A total of 185 children with CD were identified through the Regional Healthcare Information Platform. Background characteristics and growth deviations relative to the time of CD diagnosis were analysed using descriptive statistics and tests, including chi square, Mann-Whitney U, one way ANOVA, Kruskal-Wallis, paired t tests, and Wilcoxon signed rank tests. Of the 185 participating children, 64 (34.6%) were boys and 121 (65.4%) were girls. Growth deviations were most pronounced at the time of diagnosis, with mean weight SDS of - 0.54 (± 1.2) and mean height SDS of - 0.48 (± 1.1). No significant sex differences were observed. Children diagnosed between 36 and 48 months exhibited significantly greater negative height SDS deviations at one year and six months prior to diagnosis compared with younger age groups. Significant improvements in both weight SDS and height SDS were observed during the two years following diagnosis and initiation of treatment. Growth deviations varied according to age at CD diagnosis, with the most pronounced deviations occurring in proximity to the diagnostic timepoint. Growth improved significantly during the two years following diagnosis. These findings suggest that subtle growth deviations may be detectable years before diagnosis, supporting the clinical value of careful growth monitoring in paediatric care. Further research on the implementation of growth based screening parameters in routine practice is warranted.
Blood pressure (BP) management after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) remains challenging, and evidence on how BP levels relate to prognosis is inconsistent. We performed a systematic review and meta-analysis to evaluate associations between pre-/post-treatment BP levels and clinical outcomes after IVT. We conducted this systematic review and meta-analysis in accordance with PRISMA. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 8, 2026, restricted to English-language published clinical studies. Adults with AIS treated with intravenous alteplase were eligible. Pre-treatment BP was defined as the measurement closest to IVT initiation; post-treatment BP preferentially referred to the mean BP within 2-4 h after completion of alteplase infusion (or 24-72 h when unavailable). Outcomes included 3-month functional outcome (favorable modified Rankin Scale (mRS) 0-2 vs. unfavorable mRS 3-6), symptomatic intracranial hemorrhage (sICH; study-specific definitions), and 3-month mortality. Mean differences (MDs) and odds ratios (ORs) were pooled using fixed- or random-effects models based on heterogeneity. Thirty-four studies were included. For functional outcome, 5,582 patients had favorable outcome and 5,179 had unfavorable outcome; the weighted mean pre-treatment SBP was 150.0 vs. 151.5 mmHg, respectively, and the pooled MD indicated lower pre-treatment SBP in the favorable group (MD = - 5.58 mmHg, 95% CI - 9.04 to - 2.12; I²=79%). For post-treatment SBP, 4,963 vs. 4,467 patients were included; the weighted mean SBP was 144.9 vs. 149.0 mmHg, and the pooled MD was - 4.09 mmHg (95% CI - 4.98 to - 3.20; I²=0%). For sICH, 279/12,362 (2.26%) patients developed sICH; the weighted mean pre-treatment SBP was 151.6 vs. 157.9 mmHg (no sICH vs. sICH), and the pooled MD was - 5.89 mmHg (95% CI - 8.26 to - 3.51; I²=0%). For post-treatment SBP, 182/10,541 (1.73%) patients developed sICH; the weighted mean SBP was 147.2 vs. 159.7 mmHg, and the pooled MD was - 11.71 mmHg (95% CI - 15.05 to - 8.37; I²=45%). Evidence for mortality and BP variability was limited. Higher SBP before and after IVT was associated with poorer 3-month functional outcome and with sICH. Further prospective studies with standardized BP ascertainment and outcome definitions are needed.
Force platforms are widely used to assess postural stability and vertical jump performance, yet their cost and limited portability restrict routine clinical and field-based use. The Meloq EasyBase force platform offers a practical alternative, but its validity and reliability require investigation. The aim of this study was to investigate the reliability and to provide evidence of concurrent validity of the Meloq EasyBase force platform for the evaluation of balance-related parameters and jumping in healthy young adults. Seventy-eight healthy young adults (mean age: 21.85 ± 1.68 years) participated in this cross-sectional study. Static balance was assessed during single-leg stance on dominant and non-dominant limbs, with center of pressure (CoP) displacement, velocity, directional sway, and ellipse area recorded. CMJ height was also measured. Assessments were repeated after 7-10 days. Reliability was evaluated using intrarater intraclass correlation coefficients (ICC), standard error of measurement (SEM), and minimum detectable change (MDC). Concurrent validity against a clinical balance test was examined using correlations with the Flamingo Balance Test (FBT). Balance parameters demonstrated moderate to high reliability (ICC = 0.58-0.76), with velocity-based and directional CoP measures showing higher consistency. CMJ height showed excellent reliability (ICC = 0.96; SEM = 1.53 cm; MDC95% = 4.24 cm). Significant low-to-moderate correlations were observed between FBT scores and most force platform balance parameters (r = 0.23-0.32, p < 0.05). The Meloq EasyBase force platform demonstrates high reliability for vertical jump performance and moderate reliability for balance parameters. The observed low-to-moderate correlations with the Flamingo Balance Test provide preliminary evidence of concurrent validity.
To synthesize evidence on the association of active or passive smoking with asthma in adolescents. A comprehensive search of Embase, PubMed, Scopus, and Web of Science were conducted from inception to January 2026. Only human studies published in English were included. Observational studies evaluating active or passive smoking in adolescents aged 10-19 years were eligible. Studies reporting odds ratio (OR), hazard ratio (HR), relative risk (RR), prevalence ratio (PR), incidence rate ratio (IRR), or prevalence odds ratio (POR) with 95% confidence interval (95% CI) were included. Two reviewers independently screened studies. Key study characteristics, including authors, year, setting, age range, design, sample size, exposure type, asthma outcome, adjusted covariates, and effect estimates, were independently extracted and cross-verified by two reviewers, with discrepancies resolved by consensus. Seventy-seven studies met inclusion criteria, with 72 contributing to meta-analysis. Active smoking (adjusted odds ratio [aOR] = 1.16; 95% CI: 1.13-1.20), cigarette use (aOR = 1.19; 95% CI: 1.13-1.26), e-cigarette use (aOR = 1.13; 95% CI: 1.10-1.16), and passive smoking (aOR = 1.23; 95% CI: 1.17-1.29) were all significantly associated with asthma. Parental smoking conferred elevated risk (aOR = 1.85; 95% CI: 1.33-2.36), and exposure from friends showed the strongest association (aOR = 3.70; 95% CI: 1.63-5.78). Both active and passive smoking significantly increase asthma risk in adolescents, with both cigarette use and e‑cigarette use showing adverse associations. Friend smoking represents the most potent passive exposure. According to the GRADE assessment, the certainty of evidence for these associations was rated as very low, reflecting limitations in study design, confounder adjustment, and exposure measurement. Future studies should incorporate longitudinal designs, validated biomarkers, and standardized outcome measures to better characterize dose-response patterns and underlying mechanisms.
This retrospective study presents a 10-year-old male with multi-systemic venous thromboembolism (VTE) secondary to COVID-19, including right ventricular thrombus(40 mm × 18 mm), bilateral iliac vein thrombosis, pulmonary embolism, and renal vein thrombosis. The child presented with fever, abdominal pain, and elevated inflammatory markers (CRP 222.72 mg/L, WBC 22.41 × 10⁹/L). Imaging confirmed extensive thrombi in the right ventricle, pulmonary arteries, and lower extremities. Anticoagulation with rivaroxaban (10 mg QD) was initiated alongside anti-infective and anti-inflammatory therapies. Over a 3-year follow-up, thrombus burden significantly regressed, with D-dimer decreasing from 73 430 µg/L to 290 µg/L, and no recurrence or bleeding complications were observed. Coagulation parameters (PT, APTT) stabilized within therapeutic ranges. This case suggests the efficacy and safety of rivaroxaban in long-term management of multi-system VTE in pediatric patient, especially in cases of COVID-19-associated hypercoagulability. The primary clinical outcomes were the resolution of thrombus burden as evidenced by imaging and the absence of bleeding complications or recurrence during the follow-up period. The findings align with emerging evidence supporting direct oral anticoagulants (DOACs) in children, emphasizing individualized dosing and long-term management. Further studies are warranted to validate DOACs' role in pediatric thrombosis, especially in the context of viral infections.
Community Health Centres (CHCs) are community-governed organizations often located in communities facing significant challenges with social determinants of health. To date, no review has summarized the evidence on the effects of team-based models of care on patient outcomes. The objective of this systematic review was to synthesize the evidence on the characteristics of interprofessional teams practicing in CHCs and their associations with patient outcomes. A systematic review was conducted following the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. In October 2024, an electronic search was performed in five databases and the grey literature using a combination of descriptors and keywords. No restrictions were applied regarding language or year of publication. Screening and data extraction were independently conducted by two reviewers. The included papers focused on interprofessional teams composed of at least three different types of providers (e.g., physician, nurse, and nutritionist) practicing in CHCs and addressing at least one patient outcome (e.g., satisfaction, diabetes management). The risk of bias was assessed by two independent reviewers using the Joanna Briggs Institute checklist. From 6,309 identified papers, 36 papers were included. Most papers focused on team composition (n = 18) and staffing patterns (n = 8). Adjustments to staffing patterns-such as increasing full-time equivalents, expanding team size, and diversifying skill mixes-were associated with improved patient satisfaction and increased number of visits. Adding a chiropractor reduced opioid prescriptions and patient pain, while including a pharmacist improved hepatitis management and patient satisfaction. Inconsistent findings were observed regarding the inclusion of nurse practitioners and physician assistants in interprofessional teams and their impact on the number of patients seen in CHCs. Specialized interprofessional teams addressing diabetes, pain management, and childhood obesity had better health outcomes and care management compared to standard care, highlighting the value of tailored interprofessional collaboration in achieving improved health outcomes for specific populations. Specific team compositions are associated with improved health outcomes for the populations served by CHCs. Future research is needed to deepen the understanding of the associations between team composition, the type of care provided, and patients' clinical and psychosocial needs.
The amniotic membrane (AM), which is derived from the placenta and is composed of columnar epithelium, a basement membrane, and an avascular stroma, is commonly preserved through cryopreservation. Its biological properties-combining safety, versatility, and efficacy-have positioned it as an innovative therapeutic option in pediatric ophthalmology for multiple ocular pathologies. To explore the available evidence on the clinical applications of the AM in pediatric ocular pathologies. A scoping review was conducted in accordance with the PRISMA guidelines, using databases such as PubMed, LILACS, Scopus, SciELO, and EBSCO, without date restrictions. Sixteen studies published between 2002 and 2025 were included, encompassing retrospective studies, cohort studies, case reports, and narrative reviews. The evidence was categorized into general benefits, benign neoplasms, surface defects, severe hypersensitivity, cryptophthalmos, ocular trauma, and glaucoma. The reviewed studies demonstrated that AM, owing to its anti-inflammatory, antimicrobial, and antiangiogenic properties, is effective as a biological bandage in various pediatric ocular conditions. Its application promotes re-epithelialization, modulates inflammation, and improves healing. Nevertheless, further studies are needed to establish standardized protocols and validate their long-term effectiveness in this age group. The use of the AM has shown promising results as a safe and effective intervention in pediatric ophthalmology, highlighting its therapeutic value in challenging, multifactorial clinical scenarios.
Personalized nutrition (PN) shows promise for improving cardiometabolic health; however, evidence on its summarized methodologies and effectiveness remains limited and inconsistent. This review evaluates the effects of PN interventions on cardiometabolic outcomes in adults with overweight or obesity. We searched five databases for randomized controlled trials (RCTs) published up to March 2026. Eligible RCTs included at least one biological component to guide personalized dietary advice. Data were pooled using a random-effects meta-analysis, with heterogeneity assessed by Cochran's Q statistic and quantified using I2. Risk of bias and certainty of evidence were assessed. Fifteen RCTs met the inclusion criteria, each comparing PN with standard, non-personalized dietary interventions. PN implementation varied substantially in the quantity and type of individual-level features, algorithms applied, and personalization strategies used. No significant differences were observed between PN and controls in energy intake or macronutrient composition. 46.7% employed specific dietary patterns as controls or withheld nutritional counseling. Pooled analyses showed slightly greater reductions in body weight and body fat in the PN group compared with controls, but no effects on body mass index, waist circumference, lipid profile, or glycemic markers. GRADE certainty ranged from moderate to very low across the assessed outcomes. PN interventions modestly reduce body weight and body fat. Importantly, the absence of a standardized PN framework hampers evaluation and comparison of the effectiveness of nutritional personalization strategies. Future research should aim to establish standardized PN definitions, harmonized individual-level features, and transparent reporting. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: CRD420251134855.
To introduce a new service delivery intervention to improve equity of access to home dialysis therapy and describe the process of intervention development. Despite strong evidence in favour of home dialysis, its uptake remains stubbornly low in England and elsewhere. Furthermore, uptake levels vary between kidney services and between population groups. The Inter-CEPt study identified several enablers of access to home dialysis, including: receptive organisational cultures; adoption of reflective practice; engagement in quality improvement, and shared belief in the benefit of home dialysis. Drawing on the Inter-CEPt study, and using established intervention development frameworks, we developed 'Location of Dialysis Care in Kidney Life' as a targeted intervention for improving the uptake of home dialysis. In this paper, the intervention and the processes involved in its design are described. This involved co-design workshops with professional stakeholders and people with lived experience. The Location of Dialysis Care in Kidney Life intervention consists of two principal components: (1) quality improvement activities focussed on supporting dialysis care in the home, and (2) dedicated home therapies leadership roles and activities in kidney services. The rationale of the intervention is to develop and sustain a culture that improves equitable access to home dialysis. We report a staged process of intervention development that combines the principles of evidence-based intervention development and user co-design. The resulting intervention proposal can be adapted by kidney services to meet their specific needs and challenges. The study identifies organisational culture as one of the biggest determinants of uptake in home dialysis. No other study to our knowledge has fully investigated this as a barrier to home dialysis, nor indeed how to begin to change it. The Location of Dialysis Care in Kidney Life intervention requires future piloting and evaluation.
Loneliness has become a global public health problem associated with serious diseases and early mortality. A promising non-medical group-based strategy to address loneliness is nature-based social prescribing (NBSP). The aim of this paper is to describe the design of a health economic evaluation of NBSP interventions alongside trials conducted in the EU H2020 project RECETAS. The health economic evaluation will be conducted alongside the RECETAS randomized controlled trials in Barcelona, Prague, and Helsinki, and comprises cost-utility, cost-effectiveness, and cost-capability analyses. Depending on each study site's specific setting and target population, the economic evaluation will be performed from a societal and/or a healthcare perspective. NBSP interventions, which include referring lonely people to participate in activities organized in a natural environment and providing a selection of nearby nature-based community resources, will be evaluated against usual care. Effectiveness measures include health-related quality of life assessed with the EQ-5D-5 L questionnaire, changes in loneliness obtained from the De Jong Gierveld Loneliness Scale, and capability derived from the ICECAP-A questionnaire. Direct healthcare costs, indirect and informal costs as well as the actual costs of the intervention will be included. The data on health outcome and health care resource utilization will be collected at baseline and at three-, six- and twelve-months follow-up of the trial. The incremental cost-utility ratio, incremental cost-effectiveness ratio, and incremental cost-capability ratio will be calculated. National willingness-to-pay thresholds will be applied where available. Our study protocol provides a systematic framework designed prospectively for conducting the health economic evaluation of the NBSP intervention for people suffering from loneliness. Through the publication of the study protocol, the research process becomes transparent and reproducible. This reduces bias when interpreting the results and conclusions and ensures good evidence-based practice, so that decision makers can provide evidence-based recommendations without arbitrariness to support NBSP implementation. Barcelona (Spain) trial ClinicalTrials.gov, ID NCT05488496. Registered 29 July 2022 Prague (Czech Republic) trial ClinicalTrials.gov, ID NCT05522140. Registered August 25, 2022 Helsinki (Finland) trial ClinicalTrials.gov, ID NCT05507684. Registered August 12, 2022.
Primary insomnia is a highly prevalent sleep disorder that significantly affects quality of life. Acupoint injection (AJ), a traditional therapy that combines pharmacological and acupuncture effects, has been increasingly applied in clinical practice. However, evidence of its efficacy and economic value is lacking. This study determined the clinical effectiveness of AJ and established the relative ranks of AJ-related therapies for the treatment of primary insomnia. The clinical effectiveness and cost-effectiveness of AJ-related therapies for primary insomnia were evaluated through a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). We searched 11 electronic databases for relevant studies published up to June 10, 2025. The Pittsburgh Sleep Quality Index (PSQI) and effective rate were used as outcome measures. The quality of included studies was assessed using the Risk of Bias 2.0 tool. Pairwise meta-analysis and NMA were performed using RevMan 5.4 and R, respectively. The cost-effectiveness of the interventions was subsequently determined based on regional intervention costs. Twenty-four randomized controlled trials involving 1,851 participants were included in the meta-analysis. AJ combined with manual acupuncture (MA) significantly reduced PSQI scores based on the results of the pairwise meta-analysis and was among the most effective interventions based on the results of the network meta-analysis. The cost-effectiveness analysis revealed that AJ combined with MA was associated with better outcomes at modest additional costs, as indicated by the favorable incremental cost-effectiveness ratio (ICER) values for PSQI improvement and additional responders. This study is the first to comprehensively synthesize evidence on the clinical effectiveness and cost-effectiveness of acupoint injection for primary insomnia. AJ combined with MA significantly improves sleep quality and may be a cost-effective and safe adjunctive therapy within the context of traditional medicine practice. It may be a feasible treatment option for primary insomnia. However, this conclusion should be validated through future studies due to the limitations of the quality of the literature. Further high-quality RCTs with standardized economic evaluations are warranted to confirm these findings.
Dementia is a neurocognitive disorder that involves deterioration in cognitive and daily functioning, leading to loss of independence and reduced quality of life. While pharmacological treatments offer limited symptomatic relief, non-pharmacological approaches such as exercise have shown promise in improving cognitive and functional outcomes. However, evidence from community-based structured exercise interventions remains limited, particularly in low-resource settings. This trial aims to evaluate the effects of a community-based structured group exercise program on cognitive and physical function among older adults with dementia. This assessor-blinded, community-based randomized controlled trial will be conducted from February to September 2026 in Bangladesh. A total of 120 older adults diagnosed with dementia will be randomly allocated (1:1) to either the experimental group (structured group exercise program with healthy lifestyle advice) or the control group (healthy lifestyle advice alone). The intervention will consist of supervised sessions three times a week for 12 weeks, followed by a 12-week follow-up period. The outcome will be measured on both cognitive and physical function bases. Cognitive function will be evaluated using the Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), Trail Making Test (TMT) A-B, and Digit Span Test (DST). Physical function will be measured using the Senior Fitness Test (SFT), Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Instrumental Activities of Daily Living scale (IADLs). All outcomes will be measured at baseline, posttest (12 weeks), and follow-up period (12 weeks). Data will be analyzed using SPSS following the intention-to-treat principle. The findings are expected to support the integration of physiotherapist-led, community-based exercise into dementia care, offering a feasible, safe, and cost-effective approach for improving cognitive and physical function in older adults with dementia. Despite potential limitations in generalizability, the study's community implementation and follow-up design will contribute valuable insights into sustainable rehabilitation practices in resource-limited settings. This trial is registered prospectively in the Clinical Trial Registry India; ID: CTRI/2025/10/096618; Registered on: 29/10/2025. Link: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTQ0NDg3&Enc=&userName=.
To assess Egyptian nursing students' level of AI knowledge, perceptions of AI benefits, and fears regarding AI in nursing education and practice, and to examine associated sociodemographic factors. The rapid integration of artificial intelligence (AI) into healthcare has generated both enthusiasm and apprehension among nursing professionals and students. While AI offers substantial potential benefits in clinical efficiency, decision support, and educational innovation, important concerns remain regarding individualised care, professional displacement, and data privacy. This combination of promise and concern suggests a cautiously receptive context in which nursing students may recognise AI's value while remaining uncertain about its implications for practice and education. Therefore, evidence-based assessment of nursing students' knowledge and perceptions is needed. A cross-sectional descriptive design was utilised in this study. A convenience sample of 2412 nursing students was drawn from two nursing faculties between May 2024 and January 2025. Data were collected using a structured three-part questionnaire covering individual sociodemographic characteristics, a dichotomous AI knowledge test, and an attitude scale measuring perceived benefits and fears regarding AI. Approximately 46.4% of students demonstrated good AI knowledge (mean score 3.2 ± 1.3 out of 5). The mean perceived benefits score was 10.9 ± 3.5 (maximum 14), indicating generally favourable views of AI's educational and clinical support applications. The mean fear score was 5.0 ± 1.6. Notably, 72.2% of students expressed concern that AI may replace nurses in the future, and 57.8% reported discomfort with using AI in educational settings. Statistically significant differences were observed across academic years for knowledge, perceived benefits, and fears, and across age groups for perceived benefits and fears; age-related differences in knowledge were smaller but remained statistically significant. No significant differences were found by gender or university. Egyptian nursing students demonstrated a foundational understanding of AI and broadly recognised its benefits for education and clinical support. Nevertheless, substantial gaps in formal AI training and pronounced fears about professional displacement were identified. Structured, ethically grounded AI educational programs are urgently needed to enhance students' digital competencies and ensure the safe and effective use of AI in nursing practice. Not applicable.
Dental students face intense academic and clinical pressures, yet large-scale studies utilizing rigorous theoretical frameworks to evaluate their mental health remain limited in China. This study aimed to investigate the prevalence of depression, anxiety, and stress among Chinese undergraduate dental students, identify key sociodemographic and experiential correlates, and evaluate the associations of coping styles with mental health outcomes using a Directed Acyclic Graph (DAG) framework. Following STROBE guidelines, a national cross-sectional survey was conducted among 1,712 dental undergraduates from 34 universities across five geographic regions. Psychological distress was assessed via the DASS-21, and coping mechanisms via the SCSQ. Multivariable analyses were employed-specifically, multiple linear regression for continuous subscale scores and ordinal logistic regression for categorical severity levels-to identify factors independently associated with psychological morbidity. The prevalence of at-risk symptoms was 46.1% for anxiety, 36.0% for depression, and 24.4% for stress. Significant regional disparities were observed, with students in the Western region reporting the highest distress levels (Mean total score = 17.81 ± 10.59; p < 0.001). In multivariable models, suboptimal physical health emerged as the strongest factor independently associated with distress (β = 0.37; AOR = 3.71-4.44). While positive coping exhibited a significant inverse association with symptom severity (AOR = 0.87-0.92, p < 0.001), negative coping, poor college adaptation (β = -0.15), appearance dissatisfaction (β = -0.13), and excessive family interference were associated with significantly increased psychological burden. Chinese dental undergraduates experience a substantial burden of psychological distress, characterized primarily by anxiety and depression. This distress is disproportionately distributed, with students in Western China and those reporting suboptimal physical health emerging as particularly vulnerable. Positive coping strategies act as vital buffers associated with better mental health, whereas negative coping, body image dissatisfaction, and poor college adaptation are linked to increased psychological burden. Dental education institutions must implement targeted, evidence-based psychological support systems prioritizing these vulnerable cohorts.
Healthcare students' attitudes towards dementia are crucial to the quality of care. Experiential learning is a promising strategy; however, the comparative effectiveness of its various modalities remains unclear. This systematic review and meta-analysis aimed to evaluate the impact of experiential learning interventions on healthcare students' attitudes towards dementia. A comprehensive literature search was conducted across eight databases (e.g., PubMed, Embase, Cochrane Library) for studies published up to August 2024. A total of 2,350 articles were initially identified using the keywords "experiential learning," "students," "attitude," and "dementia." Only studies that evaluated the impact of experiential learning on attitudes towards dementia using the Dementia Attitude Scale (DAS) were included. Thirteen studies involving 1,861 healthcare students were included. Experiential learning significantly improved attitudes towards dementia (WMD = 9.46, 95% CI [6.33-12.58], p < 0.001). Both short-term (single-session) and long-term programs (multiple-session) demonstrated comparable levels of improvement (p = 0.49). Artistic interventions (e.g., storytelling, visual arts) produced significantly greater effects than non-artistic interventions (WMD = 13.44 vs. 7.58, p = 0.02). Interdisciplinary interventions were associated with greater improvement in attitudes, whereas virtual learning formats showed inconsistent outcomes and lacked sufficient representation for robust subgroup analysis. Experiential learning, particularly artistic and interdisciplinary approaches, significantly enhances healthcare students' attitudes towards dementia. Even brief interventions proved effective, underscoring their applicability in resource-limited settings. However, methodological limitations, such as quasi-experimental designs, short-term follow-ups, and limited disciplinary and geographic diversity, restrict generalizability. Future studies should employ rigorous designs, explore virtual innovations, and assess long-term outcomes to inform scalable, evidence-based dementia education.