Application of transitional care in older adults: A bibliometric analysis.

Critical assessment of geriatric oncology guidelines based on the AGREE II tool.

Quality cancer care for older adults from culturally and linguistically diverse backgrounds: Perspectives from the Cancer and Aging Research Group Junior Board.

Current practice, training and skill assessment of central venous access device insertion: Perspectives of intensive care trainees in adult intensive care units across Australia and New Zealand and their recommendations for improvement: Central Venous Lines Insertion: Practice, Education, Recommendation 2.0 (CLIPER 2.0).

Strategies for Family-Centered End-of-Life Care in the Adult Intensive Care Unit.

Evidence-based practice (EBP) is central to high-quality acute care, yet evidence on how specialist nurses engage with EBP remains limited. This study aimed to examine EBP beliefs, organisational culture, and self-reported implementation among specialist nurses working in acute care, and to assess associations with professional characteristics, including specialist certification and academic qualifications. A descriptive cross-sectional study. Data were collected between June and November 2023. Participants were specialist nurses employed in acute care roles, including critical care, emergency and urgent care, specialist medical and surgical units, and advanced practice positions. Validated instruments were used to measure EBP beliefs, organisational culture, and implementation. Analyses included descriptive statistics, group comparisons, and multivariable regression models. A total of 510 specialist nurses were included. Overall, nurses reported strong beliefs in EBP, moderately positive perceptions of organisational culture, and variable levels of implementation. Specialist certification was consistently associated with higher EBP implementation (standardised β = 0.24, 95% CI 0.15-0.33) and more positive organisational culture perceptions (β = 0.19, 95% CI 0.07-0.31), independent of experience and academic qualification. A clear pattern across clinical areas was observed, with higher EBP engagement reported in adult critical care and advanced practice roles, and lower organisational culture scores in emergency care settings. Among specialist nurses working in acute care, positive beliefs about EBP are widespread, but implementation varies and is associated with specialist certification and organisational context rather than years of experience or academic attainment. These findings highlight the importance of certification pathways and supportive organisational environments in strengthening EBP in high-acuity settings.

Care work and status subjugation: An exploration of the relationship between care work organisation and training, and the recruitment crisis in adult long-term care

Risk factors and clinical outcomes of pediatric versus adult intentional self-inflicted firearm injuries.

Objectives: This study aimed to provide foundational data to establish a cooperative management system for dental hygienists. This was achieved by exploring the meaning of oral health care as experienced by nursing care workers when caring for older adulys and by gaining an understanding of its essential structure. Methods: A qualitative phenomenological research design was employed. Data were collected through individual in-depth interviews conducted with 12 nursing care workers between September 1 and October 10, 2025. The participants were selected based on their experience in providing daily care for older adults. All interviews were audio-recorded, transcribed verbatim, and analyzed using Colaizzi’s phenomenological method, which involves identifying significant statements, formulating meanings, organizing subcategories, and deriving essential themes. Results: A total of 140 meaningful statements related to oral health care experiences were extracted from the interview data. These statements were organized into 12 subcategories, which were further integrated into five thematic clusters and refined into five central meanings. The identified central meanings included path chosen at a turning point in life, daily care involving rewards and responsibilities, beginning of oral health, continuing oral care practice, and sharing dreams with experts. These f indings illustrate how nursing care workers perceive oral health-care to be closely connected to both physical health and the quality of everyday care for older adults. Conclusions: Nursing care workers viewed oral health care not merely as a daily task, but as an integral aspect of life changes, daily care, limitations of their abilities and their aspiration to collaborate with experts. This information can inform future discussions on cooperative oral health-care systems involving nursing care workers and dental hygienists.

BackgroundExistential distress, marked by hopelessness, loss of meaning, and spiritual suffering, is prevalent among patients with advanced illness, and is associated with psychological burden and a wish to hasten death (WTHD).PurposeThis systematic review aimed to synthesize current evidence on meaning in life (MIL) in adult palliative care (PC) populations, focusing on its associations with quality of life (QOL), mental health, existential and spiritual well-being (SWB), and WTHD.MethodsMEDLINE, Web of Science, Scopus, and the Cochrane Library were searched for eligible studies (English, 2016-2024) involving adult cancer patients receiving PC. MIL was examined as a central intervention component or outcome. Risk of bias was assessed: findings were synthesized narratively. The review was registered in PROSPERO.ResultsEight studies (n = 1733 participants) were included: four cross-sectional, two randomized controlled trials, one longitudinal observational study, and one qualitative study. Several studies had small samples and substantial attrition. Risk of bias was high (n = 7), and moderate in one cross-sectional study. MIL was inversely associated with depression, anxiety, demoralization, and WTHD; and positively associated with QOL and SWB. MIL may also mediate psychological outcomes (eg, purpose, coherence, and personal values). However, heterogeneity in MIL conceptualization and measurement, combined with low methodological quality, limited comparability and certainty of findings.ConclusionMIL may be relevant to psychosocial/existential outcomes in PC. Conclusions are constrained by a small and methodologically weak evidence base. Further high-quality, longitudinal research is needed before MIL-centered interventions can be recommended for routine clinical practice.

As patients with intestinal failure reach adulthood, transitioning to adult care remains challenging because of a lack of specialized programs. This study evaluated outcomes of patients who transitioned care from a pediatric intestinal rehabilitation program. A retrospective cohort study was conducted of intestinal failure patients who turned 20 years old between 2013 and 2022 with follow-up through February 2025. Patient characteristics, including demographics, anatomy, nutrition, and comorbidities, were collected for all patients at the age of 18 years. Patients were classified into exposure groups based on whether they transitioned to adult care or continued follow-up at our institution. Univariate analysis comparing groups was performed with Mann-Whitney U test or chi-square/Fisher's exact test, with P < 0.05 being significant. Forty-six patients were included, with 68% having short bowel syndrome. Nine patients (20%) had an ostomy and 14 of 46 (30%) continued to receive parenteral nutrition. Twenty-seven patients (59%) transitioned to adult care at a median age of 20.8 (interquartile range [IQR], 3.8) years. No demographic, nutrition, or comorbidity differences were observed between groups. Higher mortality rates occurred among patients who transitioned care compared with patients continuing care at our institution (33% vs 5%; P = 0.02). The median time duration to death was 12 months (IQR, 43.5). Patients transitioned to adult care have a higher mortality rate, despite no obvious difference in medical complexity based on medical devices or comorbidities. Additional studies are needed to understand this difference. Increased awareness and structured transition programs are essential to ensuring optimal long-term outcomes.

Access to quality healthcare for individuals with chronic diseases like inflammatory bowel disease (IBD) remains a global challenge. Tweens (aged 9-12 years) and teens (typically aged 13-19 years) with IBD face unique challenges compared to adults, including limited access to medications, difficulties transitioning to adult care, and barriers to clinical trial enrollment. Additional concerns include mental health, social media influence, and growth through puberty. This review article brings together current evidence reported by pediatric IBD clinicians worldwide to highlight these issues. While many challenges are universal, some are region specific and reflect geographic disparities in care.

Inflammatory bowel diseases (IBD) are chronic gastrointestinal disorders with systemic manifestations for which highly effective therapies and better understanding of treatment targets have transformed patient care. Due to the low mortality and frequent early onset, as well as increasing prevalence of IBD, most patients are living with their disease for decades. Presently, proactive use of treat-to-target approaches aimed at endoscopic outcomes and integration of steroid-sparing advanced therapies have become a cornerstone of IBD management, with the intent to optimize patient outcomes and achieve remission. However, the substantial costs tied to research, development, and intricate manufacturing have resulted in advanced therapies being costly, leading to widespread implementation of a complex and non-standardized prior authorization (PA) process. The heterogeneity in policies, coverage exclusions, and standard procedures across insurers makes the PA navigation process labor-intensive, costly, and time-consuming, and does not always result in consistent favorable outcomes or coverage for patients. Additionally, insurer-related treatment delays have been associated with adverse clinical outcomes and increased absenteeism. Furthermore, PA denials often lead to the use of non-preferred agents lacking evidence of clinical benefit. This review will attempt to summarize the costs related to IBD, assess how delays related to the PA process and administrative processes contribute to both direct and indirect cost burdens, and identify strategies that can potentially reduce overall costs in both pediatric and adult IBD care.

Preventive care - asking, advising or referring patients for help with smoking, nutrition, alcohol, physical activity, and weight (SNAP-W) - is not consistently provided in routine outpatient care due to barriers such as time, other priorities, and forgetfulness. Digital health interventions (DHIs) integrated into routine care offer a promising solution and are acceptable to clinicians and patients. A systematic review is needed to synthesise existing evidence on the effectiveness of DHIs that engage patients, alongside routine care, to provide preventive care targeting SNAP-W in outpatient settings. We will include randomised and non-randomised studies that compare a DHI supporting the provision of preventive care for SNAP-W health behaviours with usual care. The DHI must integrate with routine clinician-provided care. Participants will be adult patients/clients of any outpatient healthcare service. The primary outcomes will be provision/receipt of preventive care elements addressing the SNAP-W health behaviours. Secondary outcomes will include SNAP-W behaviour change outcomes. Eligible studies will be identified via MEDLINE, EMBASE, PsycINFO, Scopus, and CINAHL. Two reviewers will independently conduct study selection, data extraction, and risk of bias assessment, with a third resolving disagreements.Risk of bias will be assessed using Cochrane RoB-2 for randomised and ROBINS-I for non-randomised trials. If feasible, a meta-analysis will be conducted to estimate the pooled effect of DHIs by health behaviour. Exploratory sub-group (e.g., type of clinical setting, preventive care element) analyses will be conducted to determine possible causes of statistical heterogeneity. If a meta-analysis is not feasible, results will be summarised using direction of effect per the Synthesis Without Meta-analysis guidelines. This review will identify whether DHIs that engage patients as part of outpatient health care are effective at improving delivery of SNAP-W preventive care for adults attending these services. These findings will be of interest to service providers, policy makers and implementation researchers seeking to improve health outcomes through routine preventive care provision. PROSPERO CRD420251067831.

Pediatric respirology presents distinctive challenges relative to adult care: patients have difficulties performing pulmonary function tests, more frequently have trouble complying, have distinct pathophysiology relative to adults, and have diseases that occur alongside normal or abnormal lung development. Understanding and disentangling the effects of disease and growth are important to identifying the pathophysiology that drives pediatric disease and affects the quality-of-life of this vulnerable group. Magnetic resonance imaging (MRI) can provide detailed images of lung structure and function using either standard 1H MRI or hyperpolarised 129Xe (xenon) gas MRI. Radiation exposure in this vulnerable group is problematic, but MRI is ionising radiation free and safe to perform in children and neonates. Exam acquisition speed has improved with some scans taking as little as four seconds. Structural imaging using proton MRI can assess the airways and locate consolidation, mucus plugging, and bronchiectasis. Dynamic structural imaging can extract information about lung motion, airway collapse, and even be used to extract ventilation and perfusion information. In the last decade, pulmonary MRI has been examined a wide variety of diseases including asthma, bronchopulmonary dysplasia, bronchiolitis obliterans, childhood interstitial lung diseases, cystic fibrosis, and multiple rare lung diseases. This multi-technique approach using MRI provides a holistic view that elucidates underlying disease mechanisms and connects them to patient outcomes and treatment response. This review will examine developments in pulmonary MRI over the past decade, with the aim of illustrating recent advances in research and how these discoveries are beginning to be applied to clinical settings.

Duchenne muscular dystrophy (DMD) management is guided by established clinical standards, yet real-world implementation data in Spain remain limited. The DMD-NEEDS study aimed to characterize the pediatric management landscape as reported by a select cohort of specialists within the national pediatric neurology community. This non-interventional, cross-sectional, web-based survey involved 41 pediatric neurologists from the Spanish Society of Pediatric Neurology (SENEP) who actively manage patients with DMD. The study focuses specifically on the pediatric stage and the transition to adult care. Clinicians reported that a slight majority of patients (53.7%) were diagnosed between 2 and 3years of age, frequently within 6 months of symptom onset. Multiplex ligation-dependent probe amplification (MLPA) was the primary diagnostic tool for 92.7% of participating clinicians, frequently supplemented by gene sequencing (80.5%) or genetic panels (75.6%) to confirm single point mutations and duplications. Estimated loss of ambulation typically occurred between ages 11 and 13 years, with major clinical complications emerging between ages 12 and 17 years. Adherence to pharmacological standards was high: 95.1% of respondents prescribed corticosteroids as first-line therapy, and 89.7% specifically utilized a high-dose deflazacort regimen (0.9mg/kg/day). Despite these trends, 31.7% of respondents lacked access to multidisciplinary care teams, and 58.5% reported that health-related quality-of-life questionnaires are not utilized in routine practice. These findings reveal a proactive clinical landscape characterized by early diagnosis and high adherence to international pharmacological standards. However, persistent gaps in multidisciplinary access and patient-centered monitoring highlight critical unmet needs. The implementation of a dedicated multidisciplinary framework and standardized management protocols is essential for optimizing the care of patients with DMD.

Population ageing poses significant challenges for health systems, particularly in ensuring effective health care for older adults within daily life contexts. This study aimed to analyze factors related to elderly health care in daily life among community-dwelling older adults by integrating individual, social, and environmental dimensions. A quantitative cross-sectional design was employed involving 240 elderly participants aged 60 years and above. Data were collected using structured questionnaires measuring socio-demographic characteristics, health status, daily health care practices, social support, and environmental conditions. Descriptive statistics and multivariate regression analyses were used to examine associations between variables. The results indicated that overall engagement in daily health care practices was moderate, with higher adherence observed in medication use and personal hygiene, and lower engagement in physical activity and routine health monitoring. Multivariate analysis revealed that family social support, self-rated health, accessibility of health services, educational level, and age were significantly associated with daily health care practices. Family social support emerged as the strongest predictor. These findings highlight that elderly health care in daily life is influenced by the interaction of personal capacity, social relationships, and environmental accessibility. Strengthening family-based support, improving health literacy, and enhancing access to community and health services are essential to promote healthy ageing and sustain daily health care practices among older adults.

The effect of implementing of multi-modal strategies on ventilator associated event (VAE) rate in adult critical care department: Retrospective cohort study in Saudi Arabia.

Malnutrition is common among patients with decompensated liver cirrhosis and linked to poor prognosis. Guidelines recommend intensified nutrition support e.g. parenteral nutrition, but evidence regarding safety and effectiveness is scarce. We aimed to investigate the impact of nutrition support, specifically parenteral nutrition, on mortality (primary end point) and on cirrhosis-specific complications (secondary end points) in patients with advanced liver cirrhosis. Consecutive malnourished patients with decompensated cirrhosis treated at our center between 2013 and 2018 were investigated. Fifty-three patients received specialized nutrition support; 33 received parenteral nutrition. The specialized nutrition support group (cohort 1) and the home parenteral nutrition group (cohort 2) were compared with patients without specific dietary support (standard-of-care group) after 1:1 and 1:2 propensity score matching, respectively. Mortality, hepatic encephalopathy, infections, and rehospitalization were investigated within 90 days. Median baseline Model for End-Stage Liver Disease score (possible range 6-40 points) was 18 in cohort 1 and 16 in cohort 2. No impact of specialized nutrition support on the clinical outcome was detected. Between cohort 2 and standard of care, no differences in mortality and rehospitalization were observed. Whereas parenteral nutrition was associated with increased risk for bloodstream infections (hazard ratio [HR] = 21.3; P = 0.004), overall incidence of bacterial infections was comparable between groups (HR = 0.82; P = 0.45). Of note, the likelihood for hepatic encephalopathy was significantly reduced in cohort 2 in the multivariable competing risk model (HR = 0.28; P = 0.03). Home parenteral nutrition seems safe overall and may ameliorate the risk for hepatic encephalopathy in candidates for liver transplant.

Local public health departments (LHD) geographic distribution and scope of practice result in them as a primary source of care for rural older adults. The 4M's framework (What Matters, Medications, Mentation, Mobility) was developed to assess their needs. Public health is a good fit for implementing the 4M's framework. Phase 1) develop and implement a quality improvement project; Phase 2) adapt the project as needed and measure implementation outcomes (percentage of older adults assessed using the 4Ms; continued agency funding after project end) METHODS: The project utilized the Institute for Healthcare Improvement Plan-Do-Study-Act (PDSA) process to design and measure change. Seven PDSA cycles were conducted over a seven-month period at LHD clinics. 285 participants accessed a clinic with 80 participants completing the 4M's assessment tool for a 28% completion rate. Leadership identified four existing funding sources to reallocate and five potential new grants to sustain the project. Utilizing LHDs is an innovative approach for 4M's implementation. Obtaining data provides valuable information on what is important to older adults. Expansion of the 4M's to other programs, connecting older adults to resources, and tying results to patient-centered outcomes will be important next steps.