Do ChatGPT and Gemini provide accurate answers to patient questions about glenohumeral arthritis?

Incorporating ecological realism into biological control risk assessment.

Neurocritical intensive care unit (ICU) patients are not routinely screened for palliative care (PC) consultations. Unmet PC needs can delay establishing goals of care, increase the length of stay, and decrease patient and family satisfaction. Nurses can best advocate for appropriate PC referrals when given adequate resources and tools. Nurse-driven screening results in more appropriate PC recommendations. The project was a descriptive pre/post evidence-based practice intervention design. An electronic survey on comfort and knowledge of PC was distributed to neurocritical ICU nurses before and after an educational intervention regarding the definition of PC and the use of the Center to Advance PC's ICU screening tool. Nurses' comfort when assessing for PC consults increased from 62.5% to 91.7%, and for requesting consults from a physician, from 58.4% to 75%. Nurses' knowledge of PC being compatible with aggressive treatment increased from 41.7% to 95.8%. Nurses recommended PC in 66.7% of patients based on 3 or more screening criteria selected. The screening tool highlighted that more than 62% of patients in the neurocritical ICU had a PC need on admission. Implementing a screening tool and educational intervention can increase nurses' comfort and knowledge in recommending PC consults. The screening tool effectively identified patients with PC needs, empowering nurses to advocate for appropriate PC referrals.

Effect size measurements in single-case experimental designs are essential for identifying evidence-based practices; however, each effect size index has notable limitations. To address constraints of nonoverlap-based indices, Aydin and Tanious (2022) introduced the performance-criteria-based effect size (PCES), which quantifies socially meaningful behavioral change. However, the original PCES for trend correction (PCEStrend) uses a basic split-middle method. This study sought to enhance PCEStrend measurements by incorporating five advanced linear trend-fitting techniques. A total of 87 published graphs with therapeutic baseline trends were analyzed, comparing techniques using performance indicators such as mean absolute scaled error, coefficient of variation, and R2, along with visual judgments and ancillary outcomes (e.g., out-of-bounds forecasts and missing data imputation). Results revealed that ordinary least squares (OLS) provided the most accurate and reliable adjustments. Based on these findings, PCES calculations with OLS were incorporated into a user-friendly Google Sheet tool to increase accessibility and facilitate applied use.

Use of evidence-based practice (EBP) is imperative to ensure safe patient care; however, literature reveals that nurses identify barriers to developing and implementing EBP, such as lack of knowledge, training, and mentorship. The purpose of this study was to explore the effects of an instructor-led EBP program on nurses' beliefs, implementation self-efficacy, and competency using EBP in a clinical setting. The eight-session program included instruction and interactive activities covering EBP implementation strategies following the Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care. Pre- and post-program survey data were used to evaluate program effectiveness. Statistical analysis of survey responses from 11 participants revealed significant improvements in EBP beliefs and self-perceived competency to engage in EBP. Non-significant improvements were seen in EBP implementation self-efficacy. The findings validate the effectiveness of an intentional, RN-tailored educational initiative in elevating nurses' EBP beliefs, competency, and implementation self-efficacy.

Mapping strategies and outcomes of evidence-based practice training for clinical nurses: A scoping review.

This literature review examines the importance of Evidence-Based Practice (EBP) in nursing, with a focus on its application in Intensive Care Units (ICUs). EBP, through the synthesis of qualitative and quantitative data, promotes evidence-based decision-making, improving care quality, reducing mortality, and limiting complications. The methodology involved a search of the MEDLINE, ELSEVIER, and SCOPUS databases for studies published from 2000 onwards. The findings highlighted key interventions, such as infection prevention, septic shock management, pressure ulcer prevention, and end-of-life care. Additionally, the use of telemedicine and artificial intelligence fosters the integration of EBP into nursing practice. Despite advancements, the review highlights challenges such as lack of time, insufficient training, and limited administrative support. Strategies are proposed, including continuous education, technological support, and strengthening clinical practice through information systems. The findings indicate that the full integration of EBP can lead to significant improvements in care quality and clinical outcomes in ICUs, establishing it as a vital tool for delivering high-level nursing care.

The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level. We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5. Twenty-nine communities in Massachusetts, New York, and Ohio, USA. Simulated community residents with non-prescribed opioid use or OUD. Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities. Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation. A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.

To systematically map existing literature on antimicrobial stewardship (AMS) practices and identify critical gaps in the management of suspected urinary tract infections (UTIs) in long-term care facilities (LTCFs) worldwide. A scoping review of studies published between 2014 and 2024 was conducted using EBSCOhost Advance (Ageline, MEDLINE Ultimate, and CINAHL Ultimate), PubMed, Scopus, Google Scholar, and TRIP databases. The review followed the Joanna Briggs Institute (JBI) methodology and was reported in accordance with the PRISMA-ScR checklist. Of 4327 records screened, 74 studies (including 2 identified through hand searching) met inclusion criteria. Data were synthesised deductively into four overarching themes: (1) prevalence of UTIs in LTCFs over the past decade; (2) AMS practices and existing gaps; (3) underlying concepts and contextual factors shaping AMS implementation; and (4) risks associated with deviations from evidence-based practice. Theme 2 was further inductively analysed, revealing five subthemes: (i) suboptimal prescribing practices; (ii) diagnostic inaccuracies and misdiagnoses; (iii) limitations in documentation and review processes; (iv) deficits in knowledge, training, and guideline adherence; and (v) contextual and system-level influences. This review presents a global synthesis of evidence on the high prevalence of UTIs and persistent critical gaps in antimicrobial stewardship practices in LTCFs. We found there is widespread overdiagnosis of asymptomatic bacteriuria, driven by unreliable diagnostic practices, resulting in excessive exposure to antimicrobials and increased risk of antibiotic resistance and other adverse outcomes. The review also highlights the central role of frontline workers in UTI diagnosis and antimicrobial decisions. Furthermore, it advocates for a targeted, behaviourally informed AMS initiative that emphasises diagnostic clarity and implementation of evidence-based practices in LTCFs.

Gabapentinoids (gabapentin and pregabalin) are increasingly prescribed for spinal pain despite limited evidence of benefit and recognised risks. Understanding which characteristics influence prescribing and how prescription use has evolved may inform safer and more evidence-based practice. To compare determinants of gabapentinoid use and changes over time between two separate cohorts of patients referred to the Spine Centre of Southern Denmark. Our study comprised two cohorts: the first, from 2013 to 2014 (n = 16,732), and the second, from 2021 to 2022 (n = 13,939). Redeemed gabapentinoid prescriptions were assessed within a 12-month window (6 months before and after the spine centre index date) and linked with diagnostic, socioeconomic and patient-reported information. Patients were categorised as continued users, initiators, discontinuers or non-users using a ≥ 30 defined daily dose classification threshold to distinguish sporadic from more sustained dispensing. Multinomial logistic regression, incorporating demographic, socioeconomic and clinical covariates, identified characteristics associated with use. Gabapentinoid use more than doubled from Cohort 1 to Cohort 2, with continued users increasing from 2.4% to 6.6% and initiators increasing from 3.5% to 6.1%. Radiculopathy, higher disability and concurrent opioid or weak analgesic use showed the strongest positive associations with use across both cohorts. Gabapentinoid use for patients with spinal pain attending secondary care in Denmark increased substantially across the decade, despite only modest differences in patient characteristics. Gabapentinoid use remained concentrated among patients with radiculopathy and concurrent analgesic use, underscoring continued reliance on pharmacological management. This study identifies a marked rise in gabapentinoid prescribing for spinal pain in secondary care and shows that the increase was only partly explained by differences in patient characteristics. The findings highlight continued use in patient groups where clinical benefit remains unproven, reinforcing the need for safer, more evidence-based prescribing strategies.

Pediatric Facial Trauma: Growth Disturbance and Occlusion Management.

Community integration is a key outcome for individuals with a history of homelessness after they attain permanent housing. The goals of finding purpose, meaning, and belonging in one's community-despite their importance in predicting mental well-being and housing stability-are frequently elusive for recently housed individuals. This study aimed to evaluate a novel psychosocial intervention that combines two evidence-based practices, motivational interviewing (MI) and cognitive-behavioral therapy (CBT), to improve motivation and functional outcomes related to community integration. Sixty veterans with a recent history of homelessness who were admitted to a U.S. Department of Veterans Affairs supportive housing program in the past year were included in a randomized controlled trial comparing the 12-session MI-CBT treatment with treatment as usual. Participants were assessed at four time points during the study period, which included 24 weeks of active treatment and 12 weeks of follow-up. The primary outcome measures were motivational deficits (negative symptoms), level of behaviors consistent with motivational change, and social and work functioning. Compared with participants in the control group, participants who received MI-CBT showed significantly greater improvement (p<0.05) in motivational deficits over the 12-week acute treatment period. Their gains relative to baseline were maintained at follow-up. MI-CBT yields improvements in motivational deficits. Implications for future studies and for improving generalizability of the motivational negative symptom gains to daily functioning domains are discussed.

Cost-effectiveness of community-based interventions for reducing opioid overdose and non-overdose deaths: simulation modeling of HEALing Communities Study.

Shared decision-making and professional governance have long been defining features of American Nurses Credentialing Center (ANCC) Magnet-designated organizations, supporting high-quality outcomes, professional autonomy, and nurse engagement. Within our multi-Magnet-designated academic medical center, part of a larger academic health system, a shared governance structure had been in place for many years. However, to respond to the evolving demands of the academic medical center, the increasing complexity of health care delivery, and the need for stronger alignment between frontline practice and organizational strategy, the leadership and governance model was redesigned to fully integrate professional shared governance into the model with direct care nurses. The purpose of this article is to describe how an ANCC Magnet-designated academic medical center systematically developed, implemented, and evaluated a transition from traditional shared governance to a robust professional shared governance framework by intentionally engaging nurses at all levels of the organization. This work aimed to strengthen nurses' voice in decision-making; enhance professional accountability; and hardwire structures that align nursing practice, quality, and innovation with organizational priorities. A pre-post survey design was used to examine nurse engagement over a two-year period spanning the implementation of the professional shared governance model. Validated engagement measures were administered to nurses across the academic medical center before the redesign (2024 presurvey) and after its full implementation (2025 postsurvey). Comparative analyses were conducted to assess changes in overall engagement and in specific domains associated with professional practice, informatics, recruitment and retention, recognition, and evidence-based practice/research. A total of 248 and 286 nurses responded to the preimplementation and postimplementation surveys, respectively, and their responses were compared. Overall nurse engagement scores increased between the 2024 presurvey and the 2025 postsurvey, indicating stronger perceptions of involvement, influence, and professional support following implementation of the professional shared governance model. The largest gains were observed in domains related to maximizing the capabilities of clinical and information technology to support patients and families; recruitment, retention, and recognition activities; and engagement in evidence-based practice and research opportunities. Clinical nurses demonstrated increased engagement across all measured categories, mirroring the overall pattern of improvement and showing the most substantial gains in the same high-impact domains. Transitioning from shared governance to professional shared governance within an academic medical center is a complex, iterative, and developmental process that advances over time. Effective professional shared governance structures require intentional design, sustained leadership commitment, and active nurse participation at every level of the organization. To ensure these structures remain meaningful and high performing, they must be continuously evaluated, refined, and adapted to reflect contemporary practice, emerging priorities, and the evolving needs of nurses, patients, and the health system. By leveraging data-driven insights, incorporating innovative strategies, and maintaining a culture of shared accountability and collaboration, professional shared governance can remain agile, forward-thinking, and a powerful driver of nursing excellence and organizational outcomes.

Temporomandibular disorder (TMD) is a common source of nondental orofacial pain. Exercise therapy is a recommended conservative treatment, yet inconsistent reporting of protocols limits reproducibility and clinical application. The primary objective of this scoping review was to determine the reporting of exercise therapy interventions in randomised controlled trials for TMD using the Template for Intervention Description and Replication (TIDieR) checklist. This scoping review assessed the completeness of exercise intervention reporting in randomised controlled trials (RCTs) for TMD using the TIDieR checklist. A comprehensive search across five databases and grey literature identified eligible RCTs. Data were extracted and analyzed using descriptive statistics and a Mann-Whitney U test. Seventy-five RCTs published between 1993 and 2024 were included. The mean TIDieR score was 7.98/12, with only 6.7% of studies reporting all checklist items. Frequently reported elements included intervention name, rationale and procedures. Tailoring, modifications, fidelity and adherence were underreported. No significant improvement in reporting quality was observed post-TIDieR publication. Reporting gaps persist in TMD exercise research, limiting reproducibility and clinical translation. Greater adherence to standardised reporting tools like TIDieR is needed to enhance transparency and evidence-based practice.

In December 2024, the US Department of Veterans Affairs (VA) and the US Department of Defense (DoD) released a joint update of their 2017 clinical practice guideline (CPG) for the rehabilitation of individuals with lower limb amputation (LLA). This synopsis highlights the key aspects of the guideline development process and describes the CPG recommendations. The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development work group (WG) that included clinical stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline WG conducted a patient focus group, developed key questions, and systematically searched and evaluated the literature from a 8 year time frame (English-language publications from July 6, 2016 to March 15, 2024). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was utilized to evaluate the evidence and formulate recommendations. The WG developed 26 recommendations along with algorithms and supplemental materials to guide providers in providing evidence-based, interdisciplinary, patient-centered care through all phases of LLA rehabilitation. The CPG was reviewed by stakeholders outside the WG before approval by the VA/DoD Evidence-Based Practice WG. This article summarizes key features of the guideline to help clinicians utilize the CPG to support patient-centered care.

This review aimed to systematically synthesize qualitative evidence on the perceptions, experiences, and practices of athletes and stakeholders regarding sports injuries, with a primary focus on risk factors, consequences, injury reporting, rehabilitation, and prevention strategies. A systematic review of qualitative studies was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO. Six databases were searched from 2000 to July 2025. Eligible studies explored the lived experiences of sports injuries in athletes and stakeholders. Data were extracted, appraised using the CASP checklist, and synthesized thematically. Thirty-five studies were included, spanning a range of sports and competitive levels. Five overarching themes were identified: (i) risk factors including excessive training loads, poor recovery, early specialization, and psychosocial stressors; (ii) consequences of injury such as disrupted performance, long-term disability, financial costs, and significant psychological distress; (iii) rehabilitation highlighting both the challenges of self-management and the importance of interdisciplinary support; (iv) injury reporting and monitoring where normalization of pain, fear of deselection, and cultural pressures inhibited disclosure; and (v) injury prevention and performance sustainability emphasizing load management, evidence-based practices, collaborative monitoring, and contextual barriers such as limited resources and fixture congestion. Athletes and stakeholders perceive sports injuries as complex biopsychosocial phenomena shaped by cultural norms, resource availability, and interpersonal dynamics. Sustainable prevention requires both individualized and systemic approaches, combining tailored training plans, athlete-centered care, and structured surveillance systems. Qualitative insights highlight the necessity of embedding prevention and rehabilitation strategies within the lived realities of athletes, thereby enhancing health protection and long-term performance sustainability. REVIEW REGISTRATION: This review was prospectively registered on the Open Science Framework in March 2025 (registration DOI: https://doi.org/10.17605/OSF.IO/V79D2).

Research and innovation are essential for advancing clinical practice and safeguarding patient safety in healthcare. This review aims to assess the research capacity of Advanced Practice Nurses in Australian healthcare settings. By identifying the barriers and enablers to, the findings aim to inspire research engagement of paediatric nurses. A rapid review methodology was used to systematically identify, appraise and synthesise data relevant to Advanced Practice Nurses' research capacity. A comprehensive search of Ovid Medline and Cumulative Index to Nursing and Allied Health Literature databases was conducted, covering publications from 1 July 2010 to May 2024. Additional reference checks and grey literature searches were undertaken to identify relevant studies. Data extraction and quality appraisal were conducted independently and checked by the research team. The Mixed Methods Appraisal Tool was used for quality assessment and a descriptive narrative synthesis approach integrated findings across qualitative, quantitative, and mixed methods studies. Eight studies met the inclusion criteria. Findings revealed that while Advanced Practice Nurses value research and evidence-based practice, barriers-such as time constraints, limited resources, and lack of organisational support-restricted their engagement. Leadership support and structured mentorship were identified as critical enablers of research capacity. This review highlights the need for targeted strategies to enhance Advanced Practice Nurses' research capacity within Australian healthcare. Addressing identified barriers and fostering a supportive environment can empower Advanced Practice Nurses to better utilise their roles, contributing to improved patient care and healthcare innovation. This research addresses the limited understanding of research capacity among Advanced Practice Nurses identifying challenges and opportunities for engagement. It is particularly relevant for healthcare organisations, policymakers, and educational institutions seeking to strengthen research capacity among APN roles. Findings will inform evidence-based practice, patient outcomes, and research culture in Australian healthcare services. International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42024539163.

The peripartum period is a time of increased vulnerability to stress for women, yet no consensus definition of maternal peripartum stress exists. This paper reports work from European COST Action 22114 (TREASURE), which identified key concepts related to maternal peripartum stress in the literature and developed a consensus definition via a qualitative Delphi process involving 161 international researchers and clinicians. The resulting definition supports a shared understanding, enabling more targeted research and evidence-based clinical practice to improve perinatal care.

Drowning is a leading cause of unintentional injury death in children. Multiple layers of prevention are necessary, because no single method is effective in preventing drowning. This policy statement guides clinicians, families, community partners, injury-prevention professionals, and policy makers regarding evidence-based best practices for reducing pediatric drowning.