Effect of pelvic floor-centered patient education programme in young women with primary dysmenorrhea: A randomized controlled trial.

Reflective practice is generally embraced in the teacher education systems but there are limited studies on how student teachers in special education programmes in Pakistan construct reflective practice. This qualitative study examined the ways in which student teachers in Initial Teacher Education (Special Education) programmes in the Punjab province construct reflective practice in the light of competing pressures of criticism and development. Based on semi-structured interviews with twenty participants and analysing the data using the framework of Reflexive Thematic Analysis, the research developed three themes: The Weight of Looking Inward, Navigating Institutional and Cultural Constraints, and Glimpsing Professional Growth Through Relational Reflection. The results suggest that student teachers oscillate between productive self-reflection and debilitating self-criticism shaped by the structural and cultural conditions of special education training in Punjab. The study contributes a contextualised account of how reflective practice is understood and enacted in a setting that remains under-researched and has implications for curriculum design and practice by teacher educators.

Doctor of nursing practice (DNP) programs face challenges related to variability and rigor of practice-focused scholarly work, particularly DNP projects. Inconsistent expectations and limited integration of evidence synthesis undermine competency development in evidence-based practice and knowledge translation. This article proposes embedding systematic review methodology as scaffolded signature assignments within a competency-based DNP curriculum. Guided by backward design and constructive alignment, assignments are intentionally aligned with doctoral competencies in evidence synthesis, critical appraisal, and research translation. Examples demonstrate how systematic review components can be operationalized as signature assignments across DNP project courses to support progressive competency attainment. Integrating systematic review methodology into signature assignments strengthens scholarly rigor, clarifies expectations for DNP scholarship, and enhances practice readiness by preparing graduates to address practice gaps and translate evidence into quality improvement and systems-level change.

The number of older people in Germany has risen steadily in recent decades. One in four people is now aged 65 or over. As people age, their health problems tend to increase, as do their fundamental care needs. Nurses play a key role in addressing these needs through a holistic approach. To fulfil this responsibility effectively, it is necessary to examine existing nursing research on the fundamentals of care for older people and to identify gaps in the current evidence base. Therefore, we plan to conduct a mapping review with the aim of mapping the extent, range and nature of nursing research activities on the fundamentals of care, as defined in the physical, psychosocial and relational components of the Integration of Care dimension of the Fundamentals of Care Framework for older people in Germany. We will search the electronic databases PubMed/MEDLINE, CINAHL, CareLit and GeroLit, the catalogue of the German Federal Ministry of Research, Technology and Space and the German National Library for publications on nursing research based on the Integration of Care dimension of the Fundamentals of Care Framework among older people (≥ 65years). There will be no time limit. We will include studies published in English and German. Initial screening of the first ten per cent of titles and abstracts and other stages will be carried out by two independent researchers. This process will be repeated until full agreement between the researchers. Any discrepancies will be resolved with consultation of a third reviewer. Results will be reported in a narrative synthesis and complemented by tabular and numerical presentations. To the best of our knowledge, this mapping review will be the first to provide an overview of current nursing research on the fundamentals of care for older people in Germany. The inclusion of German-language texts and the absence of time limits in this review are intended to complement previous reviews. The planned mapping review will also identify the evidence gap in research in this area and contribute to the determination of future scientific research in Germany. Consequently, the findings of the mapping review could be of great interest to nurses and other health professionals for evidence-based practice, research and educational programmes. In addition, the data can be used to develop a programme for the provision of age-friendly and caring living conditions for older people in the future. The protocol was registered with Open Science Framework (osf.io/9e3uv).

ABSTRACT Higher education institutions increasingly turn to work-integrated learning (WIL) programs to drive practice-based learning and employability outcomes. Explorations of good practice in WIL offer strong understanding of WIL pedagogy, curriculum and operations that support success. Recent comprehensive WIL quality frameworks propose features of WIL programs that drive quality, but it is unclear whether they outline sufficient guidance for new WIL program design and implementation. This dual case study explores highly successful WIL programs in Canada and Australia at the time they launched a second WIL program to examine the lived experience of developing quality WIL programs relative to comprehensive WIL quality frameworks. This insider research is based on interview and reflective data. Findings affirm the importance of WIL pedagogy, curriculum, infrastructure, and systems to support high-quality WIL, key components of existing quality frameworks. However, some aspects – internal collaboration, senior leadership support, and the role of government – are not sufficiently elaborated in extant WIL quality frameworks. Findings suggest that raising awareness about the benefits of WIL, fostering collaboration with non-WIL staff, and nurturing relationships with senior leaders in universities are critical to sustaining high-quality WIL programs over time. Further, governments play a critical role in supporting high-quality WIL by signaling WIL as a priority for higher education practice and funding WIL programs. Thus, nurturing internal relationships and navigating priorities and funding in external environments are critical for maintaining high-quality WIL programs.

Did the DNP kill the PhD? The relationship between PhD and DNP program enrollment and potential consequences for nursing.

Postgraduate education for advanced practice team members has emerged as a viable way of gaining critical experience needed for specialty practice. Residency and fellowship training programs have been part of the landscape for medical education for decades but have only recently become available to advanced practice team members. Most programs provide a year of structured learning, but there are few published reports of their value. We provide a description and outcome data of our specialty practice fellowship at an academic medical center over a 5-year period. A fellowship advisory board with representation from numerous specialties defined entry criteria, curriculum, and clinical site placement. Participant and preceptor experience was measured monthly to optimize rapid acquisition of skills. The curriculum was modified through rapid cycle quality improvement in response to scores lower than 70%. In total, 30 fellows have participated in the advanced practice nurse practitioner and physician assistant fellowship program between 2019 and 2023, among 8 specialty tracks. Of the participants from 2019 to 2023, 28 fellows graduated with successful program completion. Ninety-six percent were employed in specialty care settings at the time of graduation or within six months post program completion. The overall postfellowship retention rate at the training site was 79%. This outcome data supported the return on investment. This article provides data and insight into postgraduate fellowship programs with 5 years of cohort data, long-term outcomes, retention rates, and return on investment. In addition, it informs educators and employers with insight into programmatic design, evaluation, and outcomes in transition to practice programs.

Nursing on the Edge: Educating Independent and Resilient Post-Master of Science in Nursing Doctor of Nursing Practice Nurses for Extreme Environments.

The Mountain Model is an umbrella framework that can be used to guide evidence-based practice quality improvement (EBPQI), program evaluation (EBPPE), and policy analysis (EBPPA) initiatives. While steps of the Mountain Model for each type of initiative are similar, they diverge at the fifth step (methods) wherein clinicians and students must choose an appropriate framework and corresponding evaluation method that differs from research evaluation methods. The purpose of this article is to describe appropriate evaluation methods for EBPQI, EBPPE, and EBPPA initiatives. For EBPQI initiatives, graphical displays (eg, run charts, statistical process control charts) should be used to evaluate data over time. For EBPPE and EBPPA initiatives, data are often descriptively summarized and described. Examples of evaluation methods for each type are provided. This article provides practical guidance for clinicians and students completing EBPQI, EBPPE, or EBPPA initiatives and how to appropriately evaluate data.

Despite strong evidence supporting exercise in oncology, real-world data on its feasibility and effectiveness across cancer types remain limited. The CHOiCE (Choose Health: Oncological patients Centered Exercise) study aimed to evaluate a flexible, patient-centered exercise program in routine clinical practice. This prospective cohort study enrolled 180 adult patients undergoing treatments. Participants completed a 12-week program combining aerobic and resistance training, delivered in person, at home, or hybrid. Primary outcomes were recruitment rate, adherence, dropout, and safety. Secondary outcomes included physical fitness, quality of life, and physical activity. Subgroup analyses explored responses by cancer type, stage, treatment, and delivery mode. Recruitment rate was 82%, with a median attendance of 88%. The dropout rate was 32%, mainly due to personal reasons or disease progression. No serious adverse events were reported. Significant improvements were observed in the six-minute walk test (+39 m, P < .001), leg press strength (+7.1 kg, P < .001), handgrip strength (+1.0 kg, P = .003), and flexibility tests (P < .05). Quality of life improved in physical, role, emotional, and social functioning. Fatigue, nausea, dyspnea, insomnia, and appetite loss were significantly reduced. Patients with gastrointestinal cancer, stage III-IV disease, or undergoing chemotherapy showed the largest gains. A patient-centered exercise program for patients with cancer is feasible and effective in a real-world setting. These findings support integrating tailored exercise into routine oncology care. NCT04226508.

Long-term hospitalized patients with schizophrenia (SZ) often experience significant oral health problems, and oral frailty (OF) can further exacerbate the decline in their quality of life. However, the status and key influencing factors contributing to OF in this population remain insufficiently explored. Most existing studies rely on traditional regression models, which are prone to overfitting when processing high-dimensional data, making accurate risk identification difficult. This study aims to clarify the current status of OF in this population in Southwest China, identify the influencing factors, and optimize the predictive model using machine learning (ML), thereby providing a basis for clinical practice. A total of 404 long-term hospitalized patients with SZ from three psychiatric hospitals in Southwest China were enrolled in this study. The Oral Frailty Index-8 was employed to assess OF. Nine feature selection methods and five ML models were employed to optimize the model through two-stage feature selection, while Shapley Additive Explanations (SHAP) were used to analyze the model's predictive logic. The prevalence of OF in this population was determined to be 69.3%. The optimal model identified was the random forest, with the Area Under the Curve increasing to 0.779 following two-stage optimization. Compared to non-feature selection, performance improved by approximately 6.57%. SHAP analysis revealed that the Number of Teeth, Number of Psychiatric Hospitalizations, Self-discontinuation of Medication, Marital Status, and Age were core risk factors for OF. The prevalence of OF in long-term hospitalized patients with SZ is notably high. Two-stage feature selection enhances the accuracy of the predictive model, and the identified core factors can serve as a reference for developing individualized oral intervention programs in clinical practice.

Introduction. Following the full-scale Russian invasion of Ukraine, there has been a substantial increase in the need for accessible, rapid-acting, and non-pharmacological approaches to alleviate symptoms of post-traumatic stress disorder and depression among Ukrainian refugees. One potentially useful intervention is the Transcendental Meditation program. Aim. To assess the effectiveness of the Transcendental Meditation program in reducing symptoms of post-traumatic stress disorder and depression in Ukrainian refugees residing in Germany. Materials and methods. The study included 80 Ukrainian refugees: 40 participants in the intervention group who practiced Transcendental Meditation for 60 days and 40 participants in the the non-practicing control group. Symptoms of post-traumatic stress disorder were assessed using the PCL-5 and IES-R scales, while depressive symptoms were measured using the BDI-II at baseline and after 30 and 60 days. Parametric and non-parametric statistical methods were applied for data analysis. Results. As early as 30 days after the start of the intervention, the meditation group demonstrated a statistically significant reduction in symptoms of post-traumatic stress disorder and depression compared with baseline values. The proportion of participants with probable post-traumatic stress disorder decreased from 60.0% to 2.5%, and after 60 days no participant in this group remained above the diagnostic cutoff. At both 30 and 60 days, the intervention group showed statistically significantly better PCL-5, IES-R, and BDI-II scores than the control group. In the control group, no significant reduction in post-traumatic stress disorder symptoms was observed, whereas depressive symptoms tended to worsen by the end of follow-up. Conclusions. Regular practice of the Transcendental Meditation program is associated with a rapid and statistically significant reduction in symptoms of post-traumatic stress disorder and depression among Ukrainian refugees. The program may be considered a promising adjunctive or alternative non-pharmacological approach within psychosocial support systems; however, further research in larger samples is required.

Student attendance constitutes a fundamental indicator of instructional continuity and character development in madrasah education. Irregular and low attendance rates remain evident at Madrasah Aliyah Al-Muhdi, thus requiring systematic educational interventions involving both teachers and parents. This study aims to analyze the initial condition of student attendance, the implementation of the home visit program, the forms of teachers’ personal approaches, and the effectiveness of these strategies in improving student attendance during the Teaching Practice (PPK) program. This research employed a descriptive qualitative approach. Data were collected through observation, in-depth interviews, and documentation, and analyzed using data reduction, data display, and conclusion drawing with triangulation techniques. The findings reveal that the home visit program strengthened school–family partnerships and increased parental involvement in monitoring students’ learning. Teachers’ personal approaches, implemented through individualized guidance and interpersonal communication, improved students’ motivation and discipline awareness. Overall, these strategies significantly enhanced student attendance and consistency.

Student attendance constitutes a fundamental indicator of instructional continuity and character development in madrasah education. Irregular and low attendance rates remain evident at Madrasah Aliyah Al-Muhdi, thus requiring systematic educational interventions through the involvement of teachers and parents. This study aims to analyze the initial condition of student attendance, the implementation of the home visit program, the forms of teachers’ personal approaches, and the effectiveness of these strategies in improving student attendance during the Teaching Practice (PPK) program. This research employed a descriptive qualitative approach. Data were collected through observation, in-depth interviews, and documentation, and analyzed using data reduction, data display, and conclusion drawing with source and technique triangulation. The findings indicate that the home visit program strengthened school–family partnerships and increased parental involvement in supervising students’ learning. Teachers’ personal approaches, implemented through guidance, individualized mentoring, and interpersonal communication, improved students’ motivation and disciplinary awareness. The implementation of both strategies proved effective in significantly increasing and regularizing student attendance. Therefore, the home visit program and teachers’ personal approaches represent effective pedagogical strategies for improving student attendance in madrasah education.

Background: Graduate nursing students face unique challenges balancing the demands of school, work, and personal life, putting both their academic success and individual well-being at risk. Objectives: This study examined the impact of embedding Community Resiliency Model© training in a Doctor of Nursing Practice (DNP) program at a U.S. public university to determine the utility of and perceived need for resilience training in this population and measure student resilience, burnout, and posttraumatic growth. Methods: A quantitative, pre/post design was used to evaluate outcomes via surveys utilizing open-ended questions and three validated instruments before and following resilience training. Results: Among 98 students who participated, the training was described as good to excellent quality (95%) and most (85%) continued to use the skills learned. All students recommended that resilience training should be included in a DNP program. There were no statistically significant differences in measures of resilience, burnout, or posttraumatic growth. Conclusions: A holistic approach including building resilience is needed to appropriately support graduate nursing students. Implications for Nursing: Resilience training is essential to equip DNP students with the skills needed to navigate demands of personal and professional life while ensuring their own well-being and that of those they serve.

Background: Oncology and palliative care staff frequently encounter death yet often lack structured opportunities for reflection following these experiences.Objectives: This study asked: How can we develop and implement a reflective practice program for oncology and palliative care staff to support them with patient death? Reflective practice is recognized as a valuable tool to support staff well-being; however, there is limited literature describing how such interventions are implemented in the hospital setting.Methods: A participatory insider-action research approach was undertaken to codevelop a reflective practice program. A multidisciplinary Action Research Group collaborated through a series of meetings to codesign the program. The data consisted of contemporaneous notes capturing group discussions on what was needed to develop the program. Thematic analysis was used to identify key ideas and patterns that emerged from these discussions, enabling the group to identify factors required to develop a format to support guided reflection.Results: Key themes included the importance of language, timing and location, facilitation and structure, and case selection. The final outcome was a practical, semistructured format for reflective practice sessions for staff to follow as a framework to support reflection and emotional processing in response to patient death.Conclusions: Using an insider action research approach, this staff-led project offers an adaptable framework for structured reflection in acute hospital settings and represents an important initial step towards embedding reflective practice into the culture of health care.

ABSTRACT Revisions to the Sexual Experiences Survey (SES-V) allow for assessment of sexual exploitation without heterosexual norms or gendered language. SES-V estimates show alarmingly high prevalence in queer and trans (QT) individuals. However, little evidence compares sexual exploitation characteristics across intersecting sexual orientation and gender identity (SOGI). Using SES-V data from two adult samples (N = 850), we compared sexual exploitation prevalence and characteristics of across SOGI. Sexual exploitation prevalence was higher in QT individuals. Further disaggregation illuminated nuance, including significantly higher prevalence in bisexual and heterosexual cis women compared to lesbians. Sexual orientation played a role in sexual exploitation risk across genders and perpetrators were mostly cis men. Findings indicate the need for attention to nuance within the LGBTQ+ umbrella. Similarities in characteristics across SOGI suggest the role of socioecological factors. Future research should focally sample to produce diverse samples. Services should expand to support diverse sexual exploitation scenarios and provide community-level prevention. PRACTICE IMPACT STATEMENT Prevention and programming materials should be expanded to include diverse sexual exploitation scenarios and survivor-victims. Incorporating community-based practices and network-oriented approaches in sexual exploitation services can additionally help reach survivor-victims and perpetrators who would otherwise not seek out those services and influence the larger socioecological norms and beliefs that lead individuals to perpetrate sexual exploitation.

The Developmental Origins of Health and Disease (DOHaD) hypothesis highlights the pivotal role of early-life nutrition in shaping lifelong health and disease risk. Low birth weight (LBW) remains a major public health issue associated with increased susceptibility to metabolic and cardiovascular disease, underscoring the need for early nutritional interventions. We investigated whether dietary supplementation with soy protein isolate (SPI) during lactation could mitigate adverse developmental programming in a rat model of LBW induced by maternal calorie restriction. Dams received an SPI-supplemented diet during lactation, and offspring were evaluated for postnatal growth, circulating IGF-1 and corticosterone concentrations, and pituitary expression of Gas5 lncRNA, miR-23b, and Pomc. Stress responsiveness and glucocorticoid receptor sensitivity were also assessed. SPI supplementation restored postnatal growth and IGF-1 concentrations in female offspring, and in males, it normalized pituitary Gas5 lncRNA and Pomc mRNA expressions, reduced stress-induced corticosterone hypersecretion, and improved pituitary glucocorticoid sensitivity. These findings indicate that SPI intervention during lactation can partially reverse epigenetic dysregulation of the stress and somatotropic axes caused by fetal undernutrition. Nutritional modulation during lactation thus represents a critical window for early intervention in LBW offspring. SPI supplementation may enhance endocrine and metabolic resilience, providing a practical nutritional programming approach to reduce future disease risk, consistent with the DOHaD paradigm.

With a lack of medical workforce delaying patient access to general practitioners (GPs) in rural and remote regions, models of care are urgently needed to improve access and continuity of care. This evaluation aims to understand implementation outcomes, determinants and strategies to support broader implementation of the Virtual Integrated Practice (VIP) Program. VIP provides an urban-based GP to a rural general practice in Queensland, offering ongoing care to patients remotely via telehealth. The VIP GP joins the practice part-time for a minimum of 12-18 months and works onsite for a short period (3-5 days) every 6 months. This mixed methods evaluation reviewed the service, billing, cost and patient survey data collected, and qualitative interviews were conducted with VIP GP delivery staff. The interview transcripts were coded, and thematic analysis was guided by the Consolidated Framework for Implementation Research and used to derive implementation determinants. The service was delivered in eight rural/remote Queensland practices (2021-2024) involving 8309 episodes of care. Recurrent costs included staff wages, GP onsite visits and digital infrastructure. Qualitative interviews conducted with 15 VIP GP delivery staff highlighted determinants related to VIP GP model design and relative advantage, partnership codesign and funding, cost, infrastructure, and program staff. This evaluation highlighted the ongoing feasibility of the VIP model in supplementing rural workforce and improving patient access and continuity of care. Strategies key to implementation include partner and recruitment support and ensuring suitable practice staff and digital infrastructure at the practice.

Professional advancement programs (PAPs) serve as structured pathways for promotion and recognition of clinical contributions among advanced practice registered nurses (APRNs) and physician associates (PAs). Despite the growth of PAPs, there is a lack of identification and standardization of these programs in the literature. This article describes the development and iterative evaluation of a PAP called Advanced Practice Provider Recognition and Incentive Structure (APPRAISE). APPRAISE was created within a large urban academic health system with a multidisciplinary committee of APRN and PA representatives. This paper presents the cycles of evolution from a tiered clinical ladder to a simplified retrospective point-based incentive structure. In addition, this paper outlines key features of APPRAISE and the benefits and challenges between clinical ladders and incentive structures. Benefits of PAPs include increased visibility of APRN and PA contributions, enhanced mentorship, and alignment with organizational goals. Identified challenges include stakeholder turnover and budget constraints. APPRAISE provides a blueprint for sustainable PAP development, emphasizing flexibility, stakeholder collaboration, and fiscal considerations. Future research should assess the impact of PAPs on retention, job satisfaction, and clinical outcomes.