Attrition Rates Research Articles

It takes a village: Feedback from personnel in addiction treatment programs indicates support for changing the intake process

IntroductionThe initial intake encounter represents a critical point for treatment engagement in outpatient addiction treatment programs. Despite the intake assessment being more comprehensive, personalized, and capable of matching clients to level of treatment, addiction treatment programs continue to have among the highest attrition rates. Thus, it may not be what, but how services are delivered that contributes to attrition. The Consolidated Framework for Implementation Research (CFIR) offers a comprehensive framework to attend to sources of needed innovation for the intake process. The current study used a mixed method design, guided by CFIR, to obtain feedback from personnel in addiction treatment programs on the current intake process, as well as the facilitators and barriers to changing the intake process. MethodsPersonnel within New Mexico-based addiction treatment programs completed measures of individual and organizational readiness to make changes within their programs (N = 79; 76 % women, 79 % White, 55 % Latino/a). From this sample, 38 participants completed a CFIR-based semi-structured interview to identify potential barriers and facilitators to changing the intake process. ResultsParticipants reported moderate-to-high scores on readiness and capability to make organizational changes. For qualitative data, we identified nine broad themes, grouped based on (1) perspectives of current intake process (Intake Process, Organization Culture, Change Perspectives, Internal Communication, Client Needs) and (2) perspectives of changing the intake to an MI session (MI knowledge/attitudes, MI at intake, MI in organization, MI fit with Client Needs). ConclusionsFindings highlight that there are specific components of the intake content and process that appear to disengage clients, specific policies and procedures that appear to overburden staff, and key stakeholders and resources needed to improve the intake process. Recommendations are provided for intake-specific and procedural-level changes both in the organization and with outside agencies to improve the intake process.

Black, Low-Income Undergraduates’ Perceptions of Course-Related Factors Associated With Reduced Academic Stress at a Predominantly White Institution

Academic stress is a common struggle for learners of all ages. High levels of academic stress can sometimes relate to lower academic outcomes and higher attrition rates. Black college students at predominantly White institutions (PWIs) face unique stressors such as discrimination and imposter syndrome. Being low-income can carry added stressors associated with a lack of access to resources. Prior literature indicates that support and stronger relationships with faculty are associated with lower stress levels and higher academic success. The purpose of this study was to develop a better understanding of course-related factors that reduce academic stress among Black, low-income undergraduates at a PWI. Interviews with 19 Black undergraduates recruited from a department that servees low-income, first-generation students revealed a set of interrelated factors that produce greater feelings of support, relatedness, and competence, which aligns with a reduction in stressful experiences. A thematic analysis was used to create descriptive categories and produce a visual representation of these factors. Implications for university staff and faculty are discussed.

Enhancement of Stress Granule Formation by a Chiral Compound Targeting G3BP1 via eIF2α Phosphorylation.

The chirality of a chemical differentiates it from its mirror-image counterpart. This unique property has significant implications in chemistry, biology, and drug discovery, where chiral chemicals display high selectivity and activity in achieving target specificity and reducing attrition rates in drug development. Stress granules (SGs) are dynamic assemblies of proteins and RNA that form in the cytoplasm of cells under stress conditions. Modulating their formation or disassembly could offer a novel approach to treating a wide range of diseases. This has led to significant interest in SGs as potential therapeutic targets. This study examined the NTF2-like domain of G3BP1 as a possible target for SG modulation. Molecular docking was used to simulate the interactions of compounds with the domain, and a potential candidate with a chiral structure was identified. The experiments showed that the compound induced the formation of SG-like granules. Importantly, the ability of this compound to modulate SG offers valuable insights into a new mechanism underlying the dynamics and promoting the assembly of SGs, and this new mechanism, in turn, holds potential for the development of drugs with diverse mechanisms of action and potentially synergistic effects.

Building RECOVERY: development of the registry of eating disorders and their co-morbidities OVER time in youth

BackgroundEating disorder (ED) research is limited by the lack of longitudinal cohort studies, particularly those in adolescents, and the lack of inclusion of multiple perspectives and diagnoses. The objective of this study was to describe the development of a longitudinal cohort of adolescents/young adults representing varied ED diagnoses and including perspectives of parents and multi-disciplinary clinicians in addition to those of patients.MethodsPatients of an outpatient ED program who were age 10–27 years, along with their parents and clinicians, were recruited to participate in a longitudinal web-based study. Using univariate, bivariate, and multivariate analyses, we assessed rates of participation among different groups (i.e., parents, patients, different clinical disciplines) as well as factors related to attrition.Results71% of patients, 75% of parents, 56% of adolescent medicine providers, 20% of primary care physicians, 83% of dietitians, and 80% of mental health clinicians invited agreed to participate. At 12 months, 32% of patient participants had not completed their on-line surveys. Attrition rates were higher for parents (55%) and clinicians (45% of nutritionists, 55% of primary care physicians, 51% of Adolescent/Young Adult providers, and 64% of mental health providers) at 12 months.ConclusionsA longitudinal registry of patients with EDs is feasible and efficient when using web-based surveys. However, clinician participation is particularly hard to secure and maintain.

Feasibility and effectiveness of a foam rolling intervention in pregnant women requiring bed rest for foetal protection: a randomised controlled trial

BackgroundBed rest during pregnancy can lead to reduced physical activity, impairing lower limb venous blood flow and increasing the risk of deep vein thrombosis (DVT) and muscle atrophy. We investigated the clinical efficacy of foam rolling intervention (FRI) in enhancing lower limb venous blood flow, mitigating the risk of DVT and muscle atrophy in pregnant women on bed rest.MethodsThis single-blind, randomised controlled trial enrolled 86 pregnant women with long-term bed rest for foetal protection (≥ 7 days), gestational age ≥ 20 weeks, and maternal age < 40 years. Participants were randomly assigned to a control or experimental group using a random number table. The control group received standard care, whereas the experimental group underwent FRI. Researchers and statisticians were aware of the treatment groups, however, the participants were blinded. Lower limb blood flow velocity, D-dimer levels, incidence of DVT, and the extent of lower limb muscle atrophy were assessed in both groups at baseline and post-intervention (day 7). To account for a 5% attrition rate and potential sampling error, the estimated sample size for each experimental and control group was 40.ResultsBefore the intervention, no significant differences were observed between the experimental and control groups in peak blood flow, mean flow velocity, D-dimer values, or leg circumference (P > 0.05), however, the peak blood velocities of the popliteal veins were significantly higher in the control group (P = 0.031). On the seventh day post-intervention, the experimental group had significantly higher mean and peak blood velocities in femoral and popliteal veins, significantly (P < 0.05), lower mean D-dimer levels (P = 0.035), and a significantly smaller reduction in thigh and calf circumference (P < 0.001). Consequently, the rate of thigh muscle atrophy was significantly slower in the experimental group (P = 0.011).ConclusionsFRI is an effective intervention for improving lower limb venous blood flow, mitigating the risk of DVT and muscle atrophy in pregnant women on bed rest.Trial registrationThis trial was retrospectively registered with the Chinese Clinical Trial Registry on June 18, 2024 (registration number: ChiCTR2400085770).

Key considerations for digital decentralised clinical trials from a feasibility study assessing pacing interventions for long COVID

Post COVID-19 condition or long COVID is highly prevalent and often debilitating, with key symptoms including fatigue, breathlessness, and brain fog. There is currently a lack of evidence-based treatments for this highly complex syndrome. There is a need for clinical trial platforms to rapidly evaluate nonpharmacological treatments to support affected individuals with symptom management. We co-produced a mixed methods feasibility study to evaluate a multi-arm digital decentralised clinical trial (DCT) platform to assess non-pharmacological interventions for Long COVID, using pacing interventions as an exemplar. The study demonstrated that the platform was able to successfully e-consent participants, randomise them into one of four intervention arms, capture baseline data, and capture outcomes relevant to a health economic evaluation. The study also highlighted several challenges, including difficulties with recruitment, imposter participants, and high attrition rates. We highlight how these challenges can potentially be mitigated to make a fully powered DCT more feasible.

Causes of moral distress among midwives: A scoping review.

Numerous studies have evidenced moral distress among midwives; however, to date no research synthesis on causes of moral distress among midwives has been conducted. A scoping review was carried out to identify, comprehensively map, and categorize possible causes of moral distress among midwives, and to identify knowledge gaps. Six data bases were searched using Boolean logic. To be included, studies had to (a) present empirical findings on (b) causes of moral distress (c) among midwives (d) in English, German, French, or Italian. We included a final set of 43 studies. The vast majority of studies came from high-income countries (83.7%) and used a qualitative approach (69.8%); 48.8% of the studies were published in the past 5years. Identified single reasons of moral distress were grouped into eight broader clusters, forming a coherent framework of reasons of moral distress: societal disregard, contemporary birth culture, resources, institutional characteristics, interprofessional relationships, interpersonal mistreatment of service users, defensive practice, and challenging care situations. These clusters mostly capture moral distress resulting from a conflict between external constraints and personal moral standards, with a smaller proportion also from an intraindividual conflict between multiple personal moral standards. Despite projected increases in demand for midwives, the midwifery workforce globally faces a crisis and is experiencing substantial strain. Moral distress further exacerbates the shortage of midwives, which negatively affects birth experiences and birth outcomes, ultimately rendering it a public health issue. Our findings offer points of leverage to better monitor and alleviate moral distress among midwives, contributing to reducing attrition rates and improving birth experiences and birth outcomes. Further research is essential to explore the issue of ecological moral distress, develop evidence-based interventions aimed at alleviating moral distress among midwives, and evaluate the effects of both individual and system-level interventions on midwives, intrapartum care, and service users' outcomes.

Synergetic enhancement of wear resistance of polyimide coatings through the integration of MoS2 nanoflowers and MXene nanosheets

Composite nano-lubricating fillers have attracted much attention due to their excellent synergistic effect. In this study, MoS2 nanoflowers composed of two-dimensional nanosheets were synthesized by precise control of hydrothermal conditions. Using the "bridging" effect of dopamine, the flower-like MoS2 was assembled with MXene to form a unique compound filler. This distinctive structure perfectly retained the shape of the MoS2 flower. The impacts of compound fillers on the thermodynamic, mechanistic, and frictional properties of polyimide (PI) coatings were scrutinized. The formation of the compound fillers between MXene and MoS2 effectively improve the interface compatibility of individual materials in the PI matrix. The compound fillers can enhance the thermodynamic stability and mechanical properties of PI. It is noteworthy that the frictional coefficient of the PI/(MoS2:MXene = 4:6) compound coating decreased by 47.2 %, and the attrition rate reduced by 98.5 % compared to the pure PI coating. The compound lubricating filler prepared by the combination of two types of two-dimensional lubrication fillers has an important application prospect in the field of wear resistance of polymer materials.

Genicular Artery Embolization, Radiofrequency Ablation, and Corticosteroid Therapy for Knee Osteoarthritis: A Cost-Effectiveness Analysis Using Randomized Clinical Trial Data.

Background: Many patients with symptomatic knee osteoarthritis (KOA) are refractory to traditional nonsurgical treatments such as intraarticular corticosteroid (CS) injection but are not yet eligible for or decline surgery. Genicular artery embolization (GAE) and radiofrequency ablation (RFA) are emerging adjunctive or alternative minimally invasive treatments. Objective: To perform a cost-effectiveness analysis (CEA) comparing CS, GAE, and RFA, for treatment of symptomatic KOA using a Markov model based on a de novo network meta-analysis (NMA) of randomized control trials. Methods: CEA was conducted to compare GAE and RFA to CS using a Markov cohort state-transition model from a U.S. Medicare payer's perspective over a 4-year time horizon. The model incorporated each treatment's success and attrition rates, costs, and utility benefit. Utility benefit values were derived at short-term (0.5-3 months) and long-term (6-12 months) posttreatment follow-up from NMA of published RCTs using an outcome of improved knee pain and/or function. Analyses were conducted at a willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY). Sensitivity analyses were performed, including when simulating various cost setting scenarios (i.e., office vs hospital outpatient treatment). Results: RFA demonstrated larger treatment effect than GAE, more pronounced at short-term [standardized mean difference (SMD), -1.6688, 95% CI [-2.7806; -0.5571], p=.003] than long-term (SMD -0.3822, 95% CI [-1.9743; 1.2100], p=.64) follow-up. Across cost setting scenarios, incremental cost-effectiveness ratios relative to CS were $561-1563/QALY for GAE versus $76-429/QALY for RFA (not counting scenarios in which RFA was dominated by CS). GAE demonstrated higher cost-effectiveness probability compared to RFA (41.6-54.8% vs. 18.4-29.2%, respectively). GAE was more cost-effective than RFA when the GAE clinical success rate and post-GAE utility value exceeded 32.1-51.0% and 0.562-0.617, respectively, and when the GAE quarterly attrition rate was less than 8.8-17.4%. RFA was more cost-effective when baseline pre-treatment utility values exceeded 0.695-0.713. Neither GAE costs nor RFA costs were sensitive parameters. Conclusion: Across scenarios, GAE was consistently the most likely cost-effective treatment option compared to RFA and CS, although clinical success rates, attrition rates, and utility values impact its cost-effectiveness. Clinical Impact: GAE is likely to be more cost-effective than RFA or CS for treatment of symptomatic KOA.

Meaningful Results with Limited Resources: Evidence from a Program to Support Graduate Students’ Scholarly Writing

Although writing is an essential skill for graduate students (in and beyond their degree programs), limited programmatic support exists to help students develop mindsets and habits needed to become effective, scholarly writers. Furthermore, attrition rates are on the rise in the U.S., with many students dropping out at the “all but dissertation” stage. The timing of departure indicates writing may be a widespread issue warranting direct intervention. We developed a campus-wide, six-week learning community and certificate program intended to increase students’ self-efficacy in academic writing, using readings, reflection, and discussion among graduate students. Pilot results from 32 participants indicate that a noncredit-bearing, short course can have positive impacts on graduate students’ emotions about writing, their literature management approaches, awareness of the social context of writing, and their understanding of writing resources and academic voice. Potential exists for this low-budget model to be applied more broadly and thereby improve efforts to retain and support graduate students.

Systematic Review and Meta-Analysis: Iron Deficiency and Iron Deficiency Anemia Among Military Recruits Undergoing Basic Combat Training

ABSTRACT Introduction The first period of military service consists of a physically and mentally challenging basic combat training (BCT) program. Factors like demanding physical exercise, limited recovery time, and restricted diet choice and food intake may challenge iron intake and homeostasis in recruits undergoing BCT. Iron-deficient individuals may experience reduced work capacity, fatigue, weakness, frequent infections, and increased injury risk. Limited knowledge is available on the extent of this potential health risk among military recruits. The aim of the present study was to systematically review published studies on the prevalence and change in prevalence of anemia, iron deficiency (ID), and ID anemia (IDA) among recruits undergoing BCT. Materials and Methods Electronic searches were conducted in the databases Medline (Ovid), Embase (Embase.com), and Web of Science (Clarivate Analytics) from database inception up until April 16, 2024. Inclusion criteria were observational studies with both cross-sectional and observational longitudinal designs that examined the effects of BCT (intervention) on iron status (outcome) in military recruits (population). Extracted data were the number of participants (n), age, sex, country/population, BCT duration, and relevant measures of prevalence and changes in prevalence of anemia, ID, and IDA (primary outcome) and physical performance, mood state, stress fractures, attrition rate, and nutritional supplements (secondary outcomes). The study quality and risk of bias were assessed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data and The National Institutes of Health Quality Assessment Tool for Before-After (Pre-Post) Studies With No Control Group. Meta-analyses were performed using restricted maximum-likelihood models, and the effect size was calculated as Cohen’s h with 95% CI. Results Twenty-two articles were systematically reviewed (n = 111,764 men and 12,650 women), and six of these papers (n = 388 men and 773 women) were included in the meta-analysis. There was a varying prevalence of anemia, ID, and IDA among military recruits at the start of BCT. Results from meta-analyses showed negligible and nonsignificant effects of BCT on the prevalence of anemia, ID, and IDA. The quality of the included cross-sectional studies ranging from fair to good, whereas a large proportion of the included longitudinal studies were classified as poor. No sign of publication bias was found. Conclusions The prevalence of anemia, ID, and IDA in military recruits seems not to be affected by the completion of BCT shorter than 16 weeks, whereas the effects of longer BCT durations remain unclear. Even though body iron homeostasis seems unaffected, adequate energy and nutritional intake should remain a priority. Future research could focus on dietary interventions to determine the optimal diet among female recruits in specifically exposed populations.

Spatial ability predicts short-term retention of declarative technical information in authentic engineering educational settings: an original study with two conceptual replications

ABSTRACT An association between spatial ability, particularly visualisation, and science, technology, engineering, and mathematics (STEM) education has been repeatedly demonstrated over the past four decades. Understanding this relationship is of critical importance as substantial evidence illustrates the malleability of spatial ability and that the effects of associated training interventions transfer to desirable STEM outcomes such as improved educational performance and reduced attrition rates. There currently exists a number of theories as to why spatial ability relates to STEM, such as that the nature of STEM activity is inherently spatial. However, there is a need to better understand this relationship from a cognitive perspective. This research examined the hypothesis that spatial ability is predictive of short-term retention for declarative technical information associated with engineering curricula. An original investigation in an authentic educational setting found that visualisation and interest in the lecture material were significant predictors of short-term knowledge retention. This effect was then replicated in two subsequent conceptual replication studies. Based on this predictive finding, it is theorised that increases in spatial ability may support the elongation of the knowledge forgetting curve which would have significant implications for instructional design.

Real-world treatment outcomes of transcranial pulsating electromagnetic fields as augmentation therapy for treatment-resistant depression

BackgroundTreatment outcomes of patients who had received T-PEMF as an augmenting therapy at Aalborg University Hospital, Aalborg, Denmark, was evaluated. MethodsPatients diagnosed with unipolar depression or bipolar disorder who had received a self-administered 8-week T-PEMF series between November 2019 and April 2023 were included. Data were retrieved from the patients' records. The primary outcome was the Hamilton Rating Scale for Depression 17-item version (HAMD17), both as a continuous measure and with proportions of response and remission reported. ResultsA total of 57 patients (65.1 % females, 86.0 % unipolar depression, mean age, 48 ± 14 years) were included. Duration of current depressive episode was almost equally divided for <2 years (38.6 %), 2–5 years (38.6 %) and > 5 years (22.8 %). HAM-D17 decreased significantly from baseline (20.8 (SD: 3.3)) to week 8 (14.5 (SD: 6.2), p < 0.001). An episode duration of 2–5 years was associated with lower odds of response on HAM-D6 (adjusted OR = 0.15, 95 % CI: 0.03; 0.96, p < 0.05) and self-rated HAM-D6 (adjusted OR = 0.09, 95 % CI: 0.01; 0.99, p = 0.05) when compared to an episode duration <2 years. LimitationsThis study is limited by a lack of a control group, limited controlling of confounders, small sample sizes, and an attrition rate of 29.8 % for the primary outcome. ConclusionT-PEMF reduced depressive symptoms in a real-world clinical setting including patients with both unipolar depression and bipolar disorder. Receiving T-PEMF within the first 2 years of the depressive episode was associated with an improved outcome.

A randomized trial testing digital medicine support models for mild-to-moderate alcohol use disorder

This paper reports the results of a hybrid effectiveness-implementation randomized trial that systematically varied levels of human oversight required to support the implementation of a digital medicine intervention for persons with mild-to-moderate alcohol use disorder (AUD). Participants were randomly assigned to three groups representing possible digital health support models within a health system: self-monitored use (SM; n = 185), peer-supported use (PS; n = 186), or a clinically integrated model CI; (n = 187). Across all three groups, the percentage of self-reported heavy drinking days dropped from 38.4% at baseline (95% CI [35.8%, 41%]) to 22.5% (19.5%, 25.5%) at 12 months. The clinically integrated group showed significant improvements in mental health and quality of life compared to the self-monitoring group (p = 0.011). However, higher attrition rates in the clinically integrated group warrant consideration in interpreting this result. Results suggest that making a self-guided digital intervention available to patients may be a viable option for health systems looking to promote alcohol risk reduction. This study was prospectively registered at clinicaltrials.gov on 7/03/2019 (NCT04011644).

Identifying what social emotional support first-year engineering students need to overcome setbacks in lab settings: a case study

ABSTRACT Engineering has high attrition rates in the United States, especially in underrepresented subpopulations in the first year of undergraduate study. An important component of combatting attrition is better understanding what social emotional supports are needed to retain students. In this case study, five first-year engineering students were interviewed across three semi-structured sessions. Transcripts were thematically analysed using the framework developed by the Collaborative for Academic, Social, and Emotional Learning (CASEL) to identify what social emotional learning (SEL) skills and forms of support are needed to overcome setbacks. Students shared that applying emotion regulation skills to manage frustration and relying on relationship skills to ask for help facilitated overcoming setbacks. Analysing the skills described and the desired supports students expressed within the context of the SEL framework provides a way to categorise and discuss how instructors can practically support their undergraduate engineering students in the classroom to better retain them.

Developing Clinical Judgment During Transition to Practice With Rapid-Cycle Deliberate Practice Simulation.

New-to-practice nurses (NPNs) make more errors than their experienced peers, affecting patient safety and contributing to sentinel events. Additionally, new nurses have a high attrition rate in their first year of practice. Simulation-based education may bridge the gap between education and practice by supporting the development of clinical judgment of NPNs. With quality improvement methods, an intradisciplinary team implemented a quality improvement project to improve NPNs' clinical judgment skills. A multipatient simulation that used rapid-cycle deliberate practice gave NPNs an opportunity to refine clinical decision-making and communication skills. In total, 24 NPNs participated in the pilot simulation. Pre- and postsurvey scores using the simulation effectiveness tool-modified showed self-reported improvement in clinical judgment and communication skills, among other competencies. Rapid-cycle deliberate practice simulation may support the development of essential nursing competencies, along with increased confidence and enhanced psychological safety among NPNs. [J Contin Educ Nurs. 202x;5x(x):xx-xx.].

“Anything that would help is a positive development”: feasibility, tolerability, and user experience of smartphone-based digital phenotyping for people with and without type 2 diabetes

BackgroundDigital phenotyping, the in-situ collection of passive (phone sensor) and active (daily surveys) data using a digital device, may provide new insights into the complex relationship between daily behaviour and mood for people with type 2 diabetes. However, there are critical knowledge gaps regarding its use in people with type 2 diabetes. This study assessed feasibility, tolerability, and user experience of digital phenotyping in people with and without type 2 diabetes after participation in a 2-month digital phenotyping study in Ireland. At study completion, participants rated methodology elements from “not a problem” to a “serious problem” on a 5-point scale and reported their comfort with the potential future use of digital phenotyping in healthcare, with space for qualitative expansion.ResultsEighty-two participants completed baseline. Attrition was 18.8%. Missing data ranged from 9–44% depending on data stream. Sixty-eight participants (82.9%) completed the user experience questionnaire (51.5% with type 2 diabetes; 61.8% female; median age-group 50–59). Tolerability of digital phenotyping was high, with “not a problem” being selected 76.5%—89.7% of the time across questions. People with type 2 diabetes (93.9%) were significantly more likely to be comfortable with their future healthcare provider having access to their digital phenotyping data than those without (53.1%), χ2 (1) = 14.01, p = < .001. Free text responses reflected a range of positive and negative experiences with the study methodology.ConclusionsAn uncompensated, 2-month digital phenotyping study was feasible among people with and without diabetes, with low attrition and reasonable missing data rates. Participants found digital phenotyping to be acceptable, and even enjoyable. The potential benefits of digital phenotyping for healthcare may be more apparent to people with type 2 diabetes than the general population.

Online yoga programme for resident physicians in Québec: an evaluation of feasibility and impact on mental health

ObjectivesTo evaluate the feasibility of the Bali Yoga Programme for Residents (PYB-R), an 8-week virtual yoga-based intervention and determine its impact on the mental health of resident physicians.DesignSingle-group repeated measures...

The effect of recreational therapy application on depression in hemodialysis patients: a randomized clinical trial.

Chronic kidney disease is a progressive disorder often leading to End-stage renal disease, necessitating hemodialysis treatment. Mild depression is prevalent among hemodialysis patients, adversely affecting their quality of life. This study aimed to evaluate the effect of a smartphone-based recreational therapy intervention on mild depression in hemodialysis patients. This randomized controlled trial was conducted at Montaserieh Hospital, Mashhad, Iran, involving 72 patients undergoing hemodialysis. Participants were randomly assigned to either the intervention group, receiving a custom-designed recreational therapy mobile app (including music, comedy, exercise, and educational content), or the control group, receiving standard care. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20220803055608N1). Outcome assessors and statisticians were blinded to minimize bias. Sample size was calculated for an expected effect size of 0.90 with 80% power, resulting in 36 participants per group, adjusted for a 6% attrition rate. Depression levels were assessed using the Beck Depression Inventory-II (BDI-II) at baseline and after a 30-day intervention. A total of 72 patients (36 per group) completed the analysis. The intervention group showed a significant decrease in depression scores compared to the control group (mean BDI-II score reduction: intervention group = 10.3 ± 4.1, control group = 4.6 ± 3.8; p < 0.001). Post-intervention, 86.1% of patients in the intervention group exhibited minimal depression (BDI-II score ≤ 13), compared to 61.1% in the control group (p = 0.005). The smartphone-based recreational therapy intervention significantly reduced mild depression in hemodialysis patients. This approach can serve as a valuable complementary strategy to manage mild depression in this population. Further research is warranted to explore the long-term sustainability of these benefits and the intervention's impact on other patient-reported outcomes. This study was registered in the Iranian Registry of Clinical Trials (no. IRCT20220803055608N1) on 28/08/2022.

Navigating Challenges and Opportunities in Nursing Education: Insights from Student Nurses at the National University of Lesotho

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Globally, student frustration and attrition rates are declining, underscoring the importance of investigating the academic and interpersonal challenges that students face after their first year. Objectives: exploring the experiences of National University of Lesotho student nurses on their course of education. &amp;lt;i&amp;gt;Method:&amp;lt;/i&amp;gt; A qualitative phenomenological research design was used to conduct research at the National University of Lesotho. Data was collected using an unstructured interview guide in two focus groups comprising all student nurses who are enrolled in the nursing and midwifery programme from their second year into the programme. This study employed a stratified random sampling procedure to select its respondents. This study made use of thematic analysis. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The results demonstrated clinical weariness caused by a severe workload. The tasks and responsibilities assigned to the students, which they consider to be the duties of registered nurses, frequently leave them feeling overburdened. Variations in clinical supervision experiences include negligence; some experience sexual abuse; and some students find the clinical setting quite unpleasant and inappropriate. On the other hand, students expressed that they are empowered by the current nursing curriculum to face the clinical challenges. &amp;lt;i&amp;gt;Conclusion:&amp;lt;/i&amp;gt; Despite appreciating the faculty&amp;apos;s supportive and inspiring environment, students had conflicting emotions about the instructional approaches and learning environments. There were variations in both instructional quality and clinical supervision.