Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 49 appraisals
Scandinavian journal of pain
Multimodal deep learning fusion for automatic pain detection in cancer patients
INTRODUCTION: Since pain is a multidimensional and subjective experience, pain assessment remains challenging. With advances in artificial intelligence (AI), automatic pain assessment (APA) systems offer a valuable opportunity for objective pain evaluation. However, most approaches focus on a single modality. In this proof-of-concept study, exploring multimodal fusion strategies in a controlled experimental setting, we present a deep learning framework for multimodal fusion that combines facial, acoustic, and textual information to improve APA in cancer patients. METHODS: A multimodal dataset was created from video-recorded interviews with oncologic patients. In Phase I, audio, video, and transcripts were segmented at the sentence level and temporally aligned using the Eudico Linguistic Annotator (ELAN) to ensure frame-level correspondence across modalities. In Phase II, modality-specific features were extracted: Facial Action Units from OpenFace, acoustic descriptors (MFCCs, chroma, spectral contrast, and Mel-spectrogram) from a dedicated speech-processing pipeline, and sentence-level textual embeddings from ITA-BERT. During training, the most effective analytical strategy was chosen through knowledge transfer approaches. The ELAN-assisted annotation pipeline streamlined expert labeling. Two architectures were implemented and compared: bimodal autoencoder fusion models and a transformer-based model with pairwise cross-modal attention. These models were trained and evaluated using subject-independent and stratified 5-fold cross-validation. To address the lack of independence between segments, a strictly subject-independent cross-validation strategy was adopted. RESULTS: Knowledge transfer using pretrained large-scale models outperformed traditional feature-based approaches and was applied to multimodal pain detection. Multimodal models achieved performance comparable to the strongest unimodal modality (text), while showing improved balance across modalities, suggesting potential complementary effects. Both multimodal architectures demonstrated high accuracy in distinguishing between pain and non-pain classes. The bimodal autoencoder achieved stable results across folds, with a mean accuracy of about 80 % and balanced error distribution. The pairwise transformer with cross-modal attention achieved similar performance, with smooth training and validation loss curves. No evident divergence between training and validation loss curves was observed across folds, suggesting stable behavior within the cross-validation setting. However, subject-level overfitting cannot be excluded given the limited sample size. CONCLUSION: Multimodal fusion enhances system robustness by integrating complementary signals. Despite limitations and the need for improvement, multimodal deep learning strategies can support the detection of observable pain-related expressions.
26 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A machine learning approach to profiling anxiety risk among cancer patients on treatment
PURPOSE: Previous literature has identified multiple risk factors for anxiety among individuals with cancer. However, the relative importance across many interrelated variables is not clear. Further, it is unknown how combined psychosocial factors and demographic/clinical characteristics increase an individual's vulnerability to anxiety. The aims of this study are to systematically test the following: (1) the best predictors of anxiety, (2) the best-performing classifiers for distinguishing high versus low anxiety, and (3) the most informative combinations of psychosocial features and demographic/clinical characteristics that heighten an individual's vulnerability to anxiety. METHODS: Machine learning (ML) models were used. For Aim 1, we tested the predictors of anxiety using the models of regularized regressions, GAMS, and best subset selection. For Aim 2, models tested included support vector machines (SVM), random forest, nearest neighbors, and XGBoost as the classifiers to predict high versus low anxiety. For Aim 3, gradient-boosted decision tree models were trained to examine the most important combinations of candidate predictors. We used SHapley Additive exPlanations (SHAP) to improve the interpretability of our ML models. RESULTS: Across five imputed datasets, using linear regression as the primary benchmark (MSE = 69.945 ± 8.131; MAE = 6.636 ± 0.361), elastic net showed the lowest average prediction error (MSE = 65.486 ± 8.323; MAE = 6.504 ± 0.357), although differences among predictor-based models were modest. For classifiers, random forest achieved the highest mean accuracy (0.751 ± 0.015), kNN achieved the highest PR-AUC (0.797 ± 0.016), and logistic regression achieved the highest ROC-AUC (0.835 ± 0.005). Participation self-efficacy was the most consistent key predictor of anxiety across models. The most important risk combinations of demographic and psychosocial/symptom variables included age-symptom communication barriers, age-cancer coping self-efficacy, ECOG performance status-depressive symptoms, the type of helper-psychological well-being, and education-psychological well-being. CONCLUSION: Our findings may inform risk stratification in clinical settings and facilitate personalized intervention designs aiming at relieving anxiety among cancer patients.
19 July 2026
Read appraisal →Vaccine
Instruments for measuring parents' vaccine hesitancy towards their children based on the COSMIN guidelines: A systematic review
BACKGROUND: Parental vaccine hesitancy undermines immunization gains, leading to resurgent outbreaks and increased child mortality. Reliable assessment instruments are urgently needed to guide effective interventions and improve coverage. Despite multiple vaccine hesitancy assessment instruments, no systematic reviews have evaluated the measurement properties of these instruments against established methodological standards, limiting evidence-based selection. OBJECTIVE: To systematically evaluate the methodological quality and measurement properties of vaccine hesitancy assessment instruments for parents of 0-18 children, providing an evidence-based basis for selecting appropriate instruments. DESIGN: Measurement properties are systematically reviewed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. METHODS: Six electronic databases were systematically searched from inception until July 15, 2025. Methodological quality was assessed using the COSMIN Risk of Bias Checklist and measurement properties were synthesized according to the COSMIN criteria. A modified Grading, Recommendations, Assessment, Development, and Evaluation system was used to assess the certainty of evidence. RESULTS: Forty studies evaluating 31 vaccine hesitancy assessment instruments were included. Based on COSMIN evidence grading, the Malay version of the modified vaccine hesitancy scale (MVHS-M), the Vietnamese version of the parent attitudes about childhood vaccines survey (PACV-Viet), and the parental attitude scale towards vaccination (PASV) received Category A recommendation. The general vaccine hesitancy scale (GVHS), vaccination attitudes examination (VAX), vaccine acceptance instrument (VAI), and vaccine barriers assessment tool (VBAT) received Category C recommendation, while others were Category B recommendation. CONCLUSIONS: This systematic review identified MVHS-M, PACV-Viet, and PASV as effective tools for assessing vaccine hesitancy in parents, suitable for both research and clinical use. Future research should comprehensively assess their measurement properties, especially exploring measurement error and responsiveness. REGISTRATION: A protocol was registered on the PROSPERO (CRD420251070194).
12 July 2026
Read appraisal →Current treatment options in oncology
Telemedicine and Virtual Reality Technologies in Pain Management for Cancer Patients: A Structured Narrative Review
Cancer-related pain remains a complex and persistent clinical challenge due to its multidimensional nature and the limitations of pharmacological treatments alone. In our view, telemedicine and virtual reality (VR) technologies represent complementary and increasingly relevant approaches that address different yet interconnected dimensions of pain management in oncology care. Telemedicine should be considered a key component of contemporary cancer care, particularly for continuous symptom monitoring, early detection of pain exacerbation, and timely clinical intervention. Its ability to enhance communication between patients and healthcare providers and to support continuity of care makes it especially valuable in the long-term management of cancer-related symptoms. In contrast, VR interventions offer a targeted, non-pharmacological strategy for modulating pain perception through attentional distraction, emotional regulation, and immersive engagement. Based on current evidence, VR appears particularly useful in the management of procedure-related pain and in patients experiencing persistent pain that is insufficiently controlled with standard approaches. We propose that the integration of telemedicine and VR should be considered within a coordinated, patient-centered care model, where telemedicine facilitates ongoing assessment and identification of patient needs, and VR is applied as an adjunctive intervention tailored to individual symptom profiles. Such an approach has the potential to enhance both symptom control and psychological well-being while supporting treatment adherence. However, despite their promise, the implementation of these technologies requires careful consideration of clinical context, patient characteristics, and system-level factors, including digital literacy and technological infrastructure. Future research should prioritize the development of standardized protocols and the evaluation of long-term outcomes to support the sustainable integration of these digital health strategies into routine oncology practice.
11 July 2026
Read appraisal →Journal of medical Internet research
Attitudes and Needs of Health Care Providers Toward Artificial Intelligence-Assisted Pediatric Palliative Care: Mixed Methods Study
BACKGROUND: While artificial intelligence's (AI's) transformative potential in health care is widely acknowledged, its application in highly sensitive, humanistic domains like pediatric palliative care (PPC) remains largely unexplored. OBJECTIVE: This study aims to explore the attitudes and needs of health care providers on the PPC assisted by AI, with the goal of informing future development and implementation of AI systems in this field. METHODS: This was an explanatory sequential mixed methods study consisting of a nationwide cross-sectional questionnaire survey (March-April 2025) followed by qualitative semistructured interviews (August-October 2025). The quantitative study aimed to investigate PPC health care providers' experiences, attitudes, and needs for the application of AI. Participants included team members of all recognized PPC teams in mainland China. The qualitative study aimed to explore in greater depth the potential future roles of AI in this field, as well as the features of an ideal AI-assisted tool for PPC. Potential interviewees were recruited from the pool of quantitative survey respondents. RESULTS: Among 352 survey respondents, most (n=205, 58.24%) reported moderate familiarity with AI, with large language models being the most commonly used (n=280, 79.55%). Among large language model users, over half (161/280, 57.50%) reported using them for clinical purposes. Attitudes were generally positive: 67.05% (236/352) believed AI's benefits would outweigh drawbacks, and 75% (264/352) considered its implementation feasible. The most desired applications were patient and family education (276/352, 78.41%) and symptom management (257/352, 73.01%). Interviews with 17 providers revealed three themes: (1) clinical roles and boundaries, (2) elements for clinical integration, and (3) challenges in development and deployment. CONCLUSIONS: This study reveals that PPC providers express positive attitudes and strong demand for AI-assisted clinical work. Furthermore, the research clarifies appropriate roles for AI, outlines elements for clinical integration, and highlights potential challenges in development and integration. This study provides evidence for the feasibility of AI application in PPC and offers guidance for the future development and deployment of AI tools.
5 July 2026
Read appraisal →BMJ supportive & palliative care
Ethical dilemmas for palliative care nurses: systematic review
BACKGROUND: Nurses play a unique and critical role in palliative care, and it is noteworthy that nurses often encounter ethical dilemmas in this field. OBJECTIVE: This review aims to conduct a summarised synthesis of the latest research on the ethical considerations nurses faced in palliative care. METHODS: We conducted a rigorous systematic review of relevant existing studies published in high-quality English peer-reviewed journals from January 2017 to July 2023. We identified a total of 4492 articles (1029 in Web of Science, 1570 in PubMed and 1893 in Science Direct). Out of these, only 13 studies met the inclusion criteria. RESULTS: Following the thematic analysis, the ethical considerations reported in these 13 studies were grouped into three main themes and four subthemes: ethical issues in communication (ethical issues in communication with patients, ethical issues in communication with families), ethical issues in decision-making (autonomy, dignity) and moral distress in palliative care. CONCLUSION: This study elaborated on the ethical challenges faced by nurses in their communication with patients and families as well as decision-making and analysed the causes and effects of ethical distress, hoping to give a hand to ethical issues for nurses' work in palliative care.
1 July 2026
Read appraisal →JMIR research protocols
Exploring Non-Embodied AI-Based Digital Companions for Older Adults in Aging and Care Contexts: Protocol for a Scoping Review
BACKGROUND: Conversational artificial intelligence (AI) technologies are increasingly positioned as a response to social isolation, loneliness, and unmet psychosocial needs across health and care contexts. Non-embodied AI-based digital companions have attracted growing attention for their potential to support companionship, social interaction, communication, and psychosocial well-being among older adults, including people living with dementia. However, the evidence base remains underexplored. Terminology is inconsistently applied, systems are variably defined, and studies are distributed across disciplinary silos, limiting critical investigation of how these technologies are conceptualized, designed, and evaluated. OBJECTIVE: This study aims to map and critically synthesize the existing literature on non-embodied AI-based digital companions for older adults in aging, health, and care contexts. The review seeks to describe digital companions, examine methodological approaches, and identify research gaps. METHODS: This protocol follows the Joanna Briggs Institute methodology for scoping reviews and will be reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines). A comprehensive search will be conducted across multiple electronic databases, including MEDLINE, APA PsycINFO, CINAHL, Scopus, Web of Science, IEEE Xplore, and ACM Digital Library, as well as selected gray literature sources. The search strategy combined terms related to digital companions, conversational AI, aging, and care contexts, including concepts related to companionship, social interaction, communication, loneliness, and psychosocial support., Eligible studies will include empirical studies involving older adults that examine non-embodied AI-based digital companions designed primarily to support companionship, social interaction, communication, or related psychosocial support in aging, health, and care contexts. Two reviewers (YC and MG) will independently conduct study selection and data charting. Data will be synthesized using descriptive statistics and narrative analysis. RESULTS: This protocol outlines a systematic approach to identifying, selecting, and synthesizing the existing evidence on non-embodied AI-based digital companions. A preliminary PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-style search flow for the revised database searches identified 2289 records from MEDLINE, CINAHL, and APA PsycINFO. After duplicate removal and eligibility-based removals before screening, 1978 records remained available for title and abstract screening. The full scoping review will summarize study characteristics, populations, contexts, digital companion features, and methodological trends using descriptive tables and narrative synthesis. As of June 2026, the revised database searches had been completed for MEDLINE, CINAHL, and APA PsycINFO, and title and abstract screening was underway. The full scoping review results are expected to be submitted for publication after screening, data charting, and synthesis are completed. CONCLUSIONS: This scoping review is expected to clarify conceptual boundaries, map the scope of current research, and identify knowledge gaps related to non-embodied AI-based digital companions in health, aging, and care contexts. The findings will inform future research, design, and implementation of non-embodied AI-based digital companions.
26 June 2026
Read appraisal →JMIR nursing
Digital Leadership Scale for Clinical Nurses: Development and Validation of an Instrument
BACKGROUND: The rapid advancement of digital technologies, combined with the evolving complexity of health care environments, has introduced a new paradigm in nursing practice. Clinical nurses are now required not only to deliver safe and effective patient care but also to demonstrate competencies in digital literacy and innovation. Among these emerging competencies, digital leadership has become a critical attribute-enabling nurses to lead digital transformation, ensure patient safety, enhance care quality, and support system-level change within health care organizations. Despite its increasing relevance, there is a notable absence of validated measurement tools tailored to assess digital leadership in clinical practice. OBJECTIVE: This study aimed to develop and psychometrically validate a Digital Leadership Scale for Clinical Nurses (DLS-CN) to systematically evaluate the digital leadership capabilities of nurses working in clinical settings. METHODS: The scale development process followed a rigorous multistep procedure. Initial items were derived from previous qualitative research involving a literature review and in-depth interviews, complemented by an additional literature review conducted in this study. The content validity of 38 preliminary items was evaluated by 9 experts over 2 rounds. A pilot test was conducted with 30 nurses, followed by cognitive interviews with 5 nurses to refine item clarity and relevance. The final set of items was administered to 446 clinical nurses across various health care institutions. Data were randomly split for exploratory factor analysis and confirmatory factor analysis. Additional analyses were conducted to evaluate item discrimination, convergent validity, and internal consistency using IBM SPSS 25.0 and AMOS 23.0. RESULTS: The finalized DLS-CN consists of 29 items grouped under four domains: (1) ability to use digital technology, (2) digital safety management, (3) digital collaboration mindset, and (4) organizational influence. These 4 factors explained 56.9% of the total variance. The scale showed strong internal consistency (Cronbach α=0.95). Convergent validity was demonstrated through strong positive correlations with the Nursing Informatics Competency Scale (Pearson correlation coefficient r=0.82; P<.001) and the Self-Leadership Scale (Pearson correlation coefficient r=0.83; P<.001). CONCLUSIONS: The DLS-CN is a valid and reliable instrument for measuring digital leadership among clinical nurses. It offers a practical tool for educators, administrators, and researchers to assess and enhance digital leadership capabilities-ultimately supporting the digital transformation of health care systems.
24 June 2026
Read appraisal →BMJ open
Difficult intravenous access (DIVA) in the adult population: an umbrella review.
OBJECTIVES: To synthesise evidence from systematic reviews on difficult intravenous access (DIVA) in adults, focusing on definitions, diagnostic criteria, risk factors and clinical interventions to guide clinical practice and health policy. DESIGN: Umbrella review of systematic reviews and meta-analyses. SETTING: Any clinical setting involving adult patients requiring peripheral venous access (including hospital, emergency and outpatient care). DATA SOURCES: A systematic search was performed in PubMed, CINAHL, Cochrane, Scopus and Web of Science in July 2025. ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses published from 2014 to 2025 that addressed DIVA in the adult population were included. Primary studies and protocols were excluded. DATA EXTRACTION AND SYNTHESIS: Methodological quality was assessed using the Risk Of Bias In Systematic Reviews tool. Data extraction followed the Joanna Briggs Institute methodology for overviews and the Preferred Reporting Items for Overviews of Reviews reporting guideline. RESULTS: Seven reviews (six systematic reviews and one meta-analysis) were included. Three analytical dimensions emerged: (1) the conceptual and operational definition of DIVA, identifying common elements such as ≥2 failed attempts, lack of visible or palpable veins and a documented history of difficult access; (2) risk factors and clinical assessment, highlighting obesity, chronic diseases, prior chemotherapy, venous invisibility or non-palpability and the limited validation of diagnostic tools and (3) interventions, including organisational strategies (escalation protocols, specialised teams), technological resources (ultrasound guidance) and clinical measures (pain management and technique optimisation). CONCLUSIONS: DIVA is a multifactorial challenge that requires a standardised definition to improve clinical identification. Effective management relies on a combination of specialised training, the use of ultrasound technology and the implementation of escalation protocols to ensure patient safety and efficiency. PROSPERO REGISTRATION NUMBER: CRD420251084947.
14 June 2026
Read appraisal →PloS one
Motherhood choice in multiple sclerosis (MoMS) - Pilot trial of web-based decision support
BACKGROUD: Uncertainty concerning motherhood is common among women with multiple sclerosis (wwMS). Therefore, we developed and pre-tested a patient decision aid (PtDA) and a nurse-led decision coaching intervention (DC) to support motherhood choice. The DC includes the PtDA, a decision guide on motherhood choice, and decision coaching. METHODS: We conducted a randomised pilot trial across Germany to test feasibility, with decisional conflict (Decisional Conflict Scale, DCS) as an exploratory endpoint. Initially, we planned a 3:1 randomisation ratio (planned; PtDA = 48, DC = 16). Due to recruitment difficulties, we switched to a 1:1 randomisation ratio to ensure an appropriate sample size (PtDA > 20, DC > 10). Women between 18 and 45 years old with relapsing-remitting MS or clinically isolated syndrome, and who had not yet decided about motherhood, were eligible. We recruited two nurses for our decision coaching training course. We used questionnaires to measure decisional conflict, programme feasibility, knowledge, and worries regarding pregnancy in MS. Interviews were conducted to gain in-depth information on the potential feasibility of the programmes. Interviews were analysed thematically and questionnaires descriptively. We conducted explorative group comparisons and merged findings using joint display analysis. RESULTS: We trained two decision coaches in the DC group and recruited 35 wwMS (PtDA = 22; DC = 13) over five months. Median DCS scores in the DC group were 49 at baseline and 15 at follow-up (range 0-100; higher scores indicate greater decisional conflict). In the PtDA group, scores were 54 (baseline) and 31 (follow-up). Explorative group comparison indicated lower decisional conflict at follow-up in the DC group than in the PtDA group (p = 0.035). Interviewees (PtDA = 5; DC = 6; nurses = 2) described both interventions as helpful for decision-making. Qualitative findings indicate greater satisfaction levels in the DC group. CONCLUSION: Both interventions appear useful for wwMS in making motherhood choices. The DC programme seems more promising in supporting decision-making. TRIAL REGISTRATION: German Clinical Trials Register (DRKS); DRKS00038534.
14 June 2026
Read appraisal →Journal of medical Internet research
Experiences of Home-Dwelling Older Adults and Their Family Caregivers With Digital Health Services: Qualitative Study
BACKGROUND: As the population ages, demand for health services among older adults and caregivers increases. Digital health services help meet this demand. However, acceptance and experiences differ between older adults and caregivers. OBJECTIVE: This study aims to explore the specific experiences of home-dwelling older adults and their caregivers with digital health services, identify their willingness to use these services and the factors influencing their adoption, and identify their service needs to inform the subsequent design and optimization of digital health products and services. METHODS: From December 2023 to February 2024, a descriptive qualitative study was conducted. Researchers used purposive and maximum variation sampling to recruit 18 home-dwelling older adults and 17 family caregivers, including 10 matched dyads. Participants came from 7 community health service centers and a tertiary hospital in Hefei, China. Open-ended, semistructured, face-to-face interviews were conducted separately. Data were analyzed using conventional content analysis. RESULTS: Four main themes emerged. The first were the application characteristics, including usage situations and preferred functions. The second theme described specific service experiences, both positive and negative. The third was the influencing factors. Promoting factors included health needs, user experience, and subjective norms. Obstructive factors differed between groups and included low digital literacy, weak economic foundation, service security concerns, and lack of time. The fourth theme covered suggestions and expectations for improvement. Older adults appreciated the advantages but often had suboptimal experiences due to complex designs and threats to personal dignity. Conversely, caregivers valued efficiency but reported low use, hindered by time constraints and concerns about privacy and safety. CONCLUSIONS: This study reveals a critical gap between the potential and actual use of digital health services. Older adults face barriers with usability and digital literacy. Caregivers struggle to integrate these services and have trust issues. Future optimization requires action at several levels. Government support is needed through policies, authoritative platforms, and subsidies. Service providers should offer age-friendly, personalized design, and continuous support. Social support systems are also essential, such as digital reciprocity from family and peer help. These strategies are critical for enhancing user experience, bridging the digital divide, and enabling both older adults and their caregivers to fully benefit from digital health technologies.
14 June 2026
Read appraisal →JMIR formative research
Digital Health Monitoring and Intervention Suite for Stress in Frontline Nurses: Prospective Cohort Trial
BACKGROUND: Stress among health care workers (HCWs) contributes to burnout, workforce attrition, and adverse patient outcomes. Although virtual reality (VR), psychoeducation, ecological momentary assessments (EMAs), and wearables have independently shown promise in stress research, no integrated digital suite has combined controlled stress induction, intervention delivery, and longitudinal real-world monitoring in HCWs. OBJECTIVE: This study aimed to evaluate the feasibility, engagement, and preliminary effectiveness of a multimodal Digital Health Monitoring and Intervention suite for Stress framework integrating VR simulation, psychoeducation, EMAs, and wearable biometrics. We examined (1) the impact of VR simulation and psychoeducation on stress outcomes and (2) associations between physiological and self-reported mental health outcomes. METHODS: Ninety-nine nurses (mean age 33.7, SD 8.9 yr, 87% female) were enrolled in 2023. We conducted a single-arm prospective cohort study (NCT05923398). Using convenience sampling, participants were recruited from social media advertisements, flyers, and email notices distributed through professional listservs. Participants completed ≥2-week baseline monitoring, a single VR session (2 runs separated by a brief psychoeducation intervention), and 12-week follow-up. In-VR stress was assessed using the Subjective Units of Distress Scale (SUDS) and 4-item Moral Injury Outcome Scale (MIOS-4), with synchronous heart rate variability. Longitudinal outcomes included weekly and biweekly EMAs alongside 70 wearable-derived features. Paired t tests, aligned rank transform ANOVA, and Pearson correlations informed study objectives, with P values adjusted for multiple comparisons. Qualitative content analysis classified emotional responses during and after VR. RESULTS: VR significantly increased subjective stress across checkpoints in both runs, with attenuation in Run B relative to Run A (all P<.001). No significant heart rate variability differences were observed between runs (P=.15). During VR, 92% (91/99) of participants felt stressed, 36% (36/99) reported anxiety or nervousness, and 51% (50/99)-78% (77/99) endorsed anger, guilt, shame, and/or betrayal. Most (59/99, 60%) HCWs returned to an emotional baseline post-VR, although 12% (12/99) reported lingering distress. Immediate reliable improvements in anger, guilt, shame, and/or betrayal occurred for 50% (50/99)-75% (74/99) of participants post intervention. Anxiety (mean -0.53, SD 2.34; P=.03) and stress (mean -3.05, SD 11.35; P=.01) decreased 2 weeks post intervention, but were not sustained at 12 weeks. Increased sleep restlessness was the only wearable feature showing significant changes (mean 2.46%, SD 5.43; Padj<.001). In-VR stress correlated with 12-week real-world stress (SUDS: r=0.57-0.58; MIOS-4: r=0.58-0.61; all P<.01). Data completion exceeded 90%, with 71% achieving full compliance. CONCLUSIONS: This study moves beyond single-tool interventions to demonstrate the feasibility and preliminary effectiveness of an integrated, multimodal stress platform within a single coordinated framework. This trial demonstrates high engagement, short-term symptom responsiveness, ecological validity, and emotional safety. The framework provides a scalable model for proactive stress identification, skills training, and implementation in high-risk occupational settings. Randomized controlled trials are needed to establish sustained efficacy and optimize deployment for real-world implementation.
13 June 2026
Read appraisal →BMC geriatrics
Components and effects of psychosocial support interventions for relatives of patients with delirium in hospitals, systematic review
BACKGROUND: Relatives of patients with delirium are often confronted with patients' challenging behaviours such as hyperactivity, aggression, or hallucinations. As a result, feelings of anxiety and depression episodes have been described. The aim is to identify psychosocial support intervention for relatives of patients with delirium in hospitals, describe components and effects, and identify research gaps. METHODS: Systematic review based on PRISMA, including psychosocial support intervention studies addressing burden and support needs of adult relatives of hospital patients with delirium. We searched the databases Medline, Web of Sience, CINAHL, Livivo, PsycINFO, and Cochrane Library in 07/2024 and reference lists. We assessed reporting using TIDieR and CReDECI2 and methodological quality using ROB-1 and the JBI tool for quasi-experimental studies. We performed narrative syntheses. RESULTS: We identified eight intervention studies addressing relatives of patients with delirium in different settings. Intervention components included provision of information using flyers, videos, web-sites, or telephone calls, and mentoring in the intensive care unit. Reporting of interventions was mostly poor. No study reported a process evaluation. Four of six studies showed a significant difference in relatives' delirium knowledge. For relatives' psychological outcomes, no clear effects were shown. Overall, study quality was limited. CONCLUSIONS: More effectiveness studies are needed with better reporting of intervention components, ideally addressing psychological aspects. Feasibility and acceptance of new interventions should be described within accompanying process evaluations. TRIAL REGISTRATION: https://osf.io/7jbsk .
13 June 2026
Read appraisal →Journal of tropical pediatrics
A randomized controlled trial to evaluate the efficacy and safety of a double-walled incubator compared to a radiant warmer in the care of extremely low-birth-weight infants
This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.
12 June 2026
Read appraisal →JMIR research protocols
The Effectiveness of Art Activities and Peer Group Participation on Psychological Well-Being Among Older Adult Center Residents: Protocol for a Randomized Controlled Trial
BACKGROUND: Transitioning to residential centers often induces significant psychological stress in older adults, adversely affecting their psychological well-being (PWB) and ability to age healthily. Chinese art activities and their combination with peer group participation have demonstrated efficacy in improving emotional well-being and fostering social connectivity among younger populations but have not been examined in older adult populations to date. OBJECTIVE: This study aims to assess the efficacy of Chinese art activities or their combination with peer group participation in enhancing PWB among Chinese older adults living in a residential center. METHODS: This multicenter randomized, assessor- and analyst-blinded trial uses a "max-min-con" design with 3 groups: control, Chinese art activities, and Chinese art activities plus peer group participation (1:1:1 allocation). A total of 90 participants aged 60 to 85 years and with a stay of 1 year or less will be recruited from 3 older adult centers (30 from each center) and assigned via minimized randomization to the groups. Interventions will consist of 3 sessions within a single week (Monday, Wednesday, and Friday). Baseline evaluations will be conducted before randomization to assess PWB, loneliness, happiness, relaxation, and salivary cortisol levels. Outcome evaluations will be conducted 30 minutes prior to and following each intervention session to assess immediate effects. A follow-up evaluation is planned 1 week after the final intervention to measure sustained outcomes. RESULTS: The study was funded in September 2024. Participant recruitment commenced on May 9, 2025, and ended on August 20, 2025, with the recruitment of 90 participants. Data collection ended on October 31, 2025, and data analysis is expected to conclude in April 2026, with the anticipated publication of results in 2026. CONCLUSIONS: This study is the first randomized controlled trial to evaluate the effects of Chinese art activities, either alone or combined with peer group participation, on enhancing PWB in older people and the efficacy of salivary cortisol as a biomarker for the assessment of PWB. The findings will provide empirical evidence to assist policymakers and older adult centers in selecting appropriate interventions, with the long-term potential to improve psychological health in older adults.
31 May 2026
Read appraisal →BMJ open
Self-management experiences and needs in patients with chronic obstructive pulmonary disease: a meta-synthesis of qualitative studies
OBJECTIVES: To systematically review qualitative studies on the self-management experiences and needs of patients with chronic obstructive pulmonary disease (COPD) and to provide evidence for developing needs-based self-management intervention strategies. DESIGN: A systematic review and meta-aggregation of qualitative studies conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. DATA SOURCES: PubMed, Cochrane Library, Web of Science, Scopus, CINAHL, Embase, CNKI, Wanfang Database, VIP Database and CBM were searched from database inception to March 2025 for qualitative studies on COPD self-management experiences and needs. ELIGIBILITY CRITERIA: Qualitative studies involving adults (≥18 years) with a confirmed diagnosis of COPD that reported patients' real feelings, experiences and needs during the self-management process in any setting (hospital, community or home). Studies were excluded if the full text could not be obtained or data were incomplete, if they were duplicate publications or if they were not published in Chinese or English. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened titles, abstracts and full texts, extracted data using a standardised form and assessed methodological quality using the 2016 Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Findings (participants' quotations and authors' interpretive statements) were synthesised using a JBI meta-aggregation approach to develop categories and overarching synthesised findings. RESULTS: 15 qualitative studies were included, comprising 251 patients with COPD. A total of 52 findings were identified, grouped into 13 categories and synthesised into 4 overarching findings: (1) physical symptom burden strongly shapes psychological well-being during COPD self-management; (2) patients face multiple and interrelated barriers to effective self-management; (3) some patients develop active coping strategies and self-management resources; and (4) patients express multidimensional and continuing support needs. CONCLUSIONS: Patients with COPD experience substantial physical and psychological distress and face multiple challenges in the self-management process. Healthcare professionals should prioritise patients' lived experiences, establish comprehensive and coordinated support systems and develop diversified, needs-based intervention strategies to address patients' multidimensional needs, thereby enhancing self-management capacity and improving quality of life. PROSPERO REGISTRATION NUMBER: CRD42024607051.
29 May 2026
Read appraisal →JMIR aging
Developing Customized Personas to Capture Intrinsic Capacity Profiles and Digital Monitoring Intentions in Older Adults: Mixed Methods Study
BACKGROUND: Integrated Care for Older People (ICOPE), focused on monitoring and optimizing the intrinsic capacity (IC) of older adults, is a new model of geriatric care that is currently being accelerated globally. Digital health technologies are recommended for longitudinal IC monitoring to provide precise and timely interventions. However, little is known about the psychological intentions of engaging in digital monitoring of IC according to the profile heterogeneity of IC among older adults. OBJECTIVE: This study aims to map a set of customized personas to capture the profiles of IC and match psychological intentions that support personalized digital IC monitoring. METHODS: An explanatory sequential mixed methods study was conducted at 16 sites in Beijing, China. Older adults aged ≥60 years (n=481) were selected to complete the quantitative survey. Latent profile analysis, descriptive statistics, and logistic regression analyses were performed to cluster subgroups using Mplus (Muthén & Muthén) and SPSS (IBM Corp). A subsample of participants from each profile (n=25) was purposively sampled for semistructured interviews. An inductive-deductive content analysis was used to identify similar attributes and to affirm the personas gradually. A joint statistical and thematic visualization method was used to integrate the customized personas. RESULTS: Three profiles of IC patterns emerged: "multisubdomain decline-IC imbalance group," "multisubdomain moderate-sensory deficit group," and "multisubdomain robust-whole balance group." The distribution of latent profiles was influenced by age, education, monthly per capita household income, self-rated health, and number of chronic diseases, while positively impacting older adults' functional ability. The following customized personas were captured regarding established themes: "affects my mood-anxious evader," characterized by avoidance and anxiety, low digital interest, and perceived social isolation; "capitalize on what comes-accommodative adopter," pragmatically oriented toward disease detection, with moderate digital openness but limited self-efficacy; and "more autonomy-active improver," who exhibited proactive engagement, high digital literacy, and motivation rooted in self-management and social participation. CONCLUSIONS: This study is the first to integrate latent profile analysis with customized qualitative personas to link the heterogeneity of IC with the psychological intentions underlying digital monitoring. The resulting personas model provides an actionable framework for tailoring digital IC monitoring strategies in community-based integrated care. The findings emphasize the need to align monitoring approaches with older adults' IC characteristics, psychological readiness, digital literacy, and social support to enhance engagement in digital IC monitoring.
29 May 2026
Read appraisal →JMIR research protocols
An AI-Enabled Predictive Harm Response Management Algorithmic Tool to Reduce Adverse Events in Health Care Settings (PreHaRM): Protocol for a Three-Phase Model Development and Pilot-Testing Study
BACKGROUND: Current data analysis and coordination methods do not effectively support nurses and midwives in risk reduction, as retrospective reporting does not allow real-time insights and precludes proactive, preventive care. Analysis of administrative data within Australia's health care sector to predict risk may help address this shortcoming. Predictive analytics can transform these data into meaningful insights, identifying harm risk profiles that benefit the performance of Australian and international clinical programs. Importantly, these tools may support nurses and midwives in preventing adverse events and predicting high-risk situations. Researchers, in collaboration with local health network staff, will develop a proof-of-concept predictive risk algorithm. The "predictive harm response management algorithmic tool to reduce adverse events in healthcare settings" program (project DHCRC-0156) will provide real-time insights via an interactive dashboard, enabling nurses, midwives, and health administration to assess risks and optimize resources in health care settings. This protocol details the algorithm development activities for subproject 1a, predictive risk model development, which aims to develop and pilot-test a predictive harm algorithm across 2 South Australian local health networks. OBJECTIVE: This study aims to identify the clinical harm outcome of interest and relevant data sources per site and build a suitable data solution to model predictors of harm risk and identify actionable clinical, workforce, and environmental factors that affect the harm outcome of interest. METHODS: This study design includes three phases: (1) model generation, (2) model evaluation, and (3) prototype development. Data linkage by SA-NT DataLink can only proceed following approval from each of the following: the South Australia Department for Health and Wellbeing Human Research Ethics Committee, the University of South Australia Human Research Ethics Committee, and hospital governance committees. The clinical dataset will be split into a training set, a validation set, and a test set. Exploratory data analysis will be undertaken to ascertain features and classify outcomes from the raw dataset. Derived features will be computed, feature correlations will be estimated, and initial feature selection will be performed. Iterative model development will occur over 3 stages, and a dashboard to display these results will be developed. RESULTS: The study commenced on July 19, 2021, and will conclude on December 31, 2025. Finalized results are expected in December 2025. CONCLUSIONS: This research will conclude with the development of the algorithm for transferability to health care environments. Research activities will be detailed in publicly available reports and manuscripts prepared for peer-reviewed journals that will be drafted in accordance with existing and appropriate checklists. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/75474.
29 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Nonpharmacological dyspnoea-relief strategies in lung cancer: a systematic review and network meta-analysis
BACKGROUND: Dyspnoea is a common and distressing symptom in lung cancer patients. While various dyspnoea-relief strategies show promise, their comparative effectiveness remains unclear. METHODS: We conducted a systematic review and network meta-analysis of randomised controlled trials on nonpharmacological dyspnoea-relief strategies in lung cancer patients, using studies published until 12 June 2025 from the databases PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. The primary outcome was dyspnoea score post-intervention. RESULTS: 4138 participants from 46 randomised controlled trials were included in the analysis. Among 10 nonpharmacological dyspnoea-relief strategies in lung cancer patients, acupressure (surface under the cumulative ranking curve (SUCRA) 98.7%, Hedges' g -1.96, 95% CI -2.92 to -0.99) demonstrated the highest efficacy, followed by fan (SUCRA 83.7%, Hedges' g -1.11, 95% CI -1.72 to -0.50), and multicomponent interventions (SUCRA 80.7%, Hedges' g -1.01, 95% CI -1.49 to -0.52). In post-operative lung cancer patients, multicomponent interventions (SUCRA 97.4%, Hedges' g -1.55, 95% CI -2.16 to -0.94) were the most effective, followed by cognitive behavioural therapy (SUCRA 74.8%, Hedges' g -0.90, 95% CI -1.75 to -0.05). For patients with pre-existing dyspnoea, acupressure (SUCRA 90.9%, Hedges' g -1.72, 95% CI -3.01 to -0.42) and fan therapy (SUCRA 77.3%, Hedges' g -1.18, 95% CI -2.10 to -0.27) were the top interventions. CONCLUSIONS: Acupressure is the primary strategy for alleviating dyspnoea in lung cancer patients, including those with pre-existing dyspnoea, followed by fan therapy, while multicomponent interventions are recommended for post-operative patients.
29 May 2026
Read appraisal →JMIR research protocols
Reducing Mis-triage in Emergency Departments (RemEDy): Protocol for Improving Triage Accuracy Through Real-time Evaluation and Artificial Intelligence
BACKGROUND: Mis-triage represents a global concern, with reported rates ranging from 15% to 33%. Understanding its causes and contributing factors is essential for ensuring patient safety. Currently, available studies have mainly focused on evaluating triage systems rather than investigating the human factors affecting triage performance. A major limitation in triage evaluation studies is the lack of standardized criteria to assess patient acuity and the absence of a clear consensus on how to measure triage accuracy. Most studies rely on retrospective data, which often fail to capture real-life clinical complexity. Therefore, the underlying causes and consequences of mis-triage remain partially understood. OBJECTIVE: This study aims to improve triage by defining the optimal triage evaluation process and identifying clinician-, patient-, and system-level factors that compromise its accuracy and safety. METHODS: Reducing Mis-Triage in Emergency Departments (RemEDy) will be a 4-phase, mixed methods project conducted across 7 Swiss emergency departments. The first phase will focus on developing a standardized triage evaluation instrument, combining evidence from a scoping review of triage evaluation processes, workshops with triage clinicians using design thinking methodology, and a modified Research and Development-University of California Delphi involving international experts and patient representatives. The second phase will prospectively implement this instrument in real time within a multicenter observational cohort study to evaluate triage performance; quantify mis-triage; and identify predictors at the patient level (eg, demographics), clinician level (eg, training), and system level (eg, crowding and length of stay). The third phase will focus on designing and validating an artificial intelligence-based decision support tool, applying multimodal models that integrate real-time triage data to enhance acuity prediction and minimize human error. The fourth phase will develop and evaluate a targeted training program, guided by the Capability, Opportunity, Motivation, and Behavior model, to strengthen triage accuracy and mitigate cognitive biases. RESULTS: The project was funded by the Swiss National Science Foundation in March 2025 (grant 10004535). At submission, the scoping review is ongoing and expected to be completed in early 2026. Development and piloting of the triage evaluation instrument will take place in 2026. A multicenter cohort study is planned between October 2026 and June 2027. The intervention study is scheduled between October 2027 and December 2028. Final results are expected in 2029. CONCLUSIONS: The RemEDy project addresses key limitations of current triage research, including the lack of standardized evaluation methods. By combining expert and clinician consensus; real-time assessment; and multilevel analysis of patient-, clinician-, and emergency department-level factors, RemEDy is expected to provide a more comprehensive understanding of mis-triage and its causes. RemEDy will establish a novel framework for real-time triage evaluation and inform the development of targeted training programs with the potential to improve triage accuracy, safety, and equity. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/92264.
28 May 2026
Read appraisal →Journal of perinatal medicine
Early kangaroo care in preterm ≤32 weeks and very low birth weight infants: a systematic review and meta-analysis
OBJECTIVES: Kangaroo care (KC), involving skin-to-skin contact, early breastfeeding and early discharge, demonstrated benefits in improving outcomes for preterm and low birth weight infants. This systematic review and meta-analysis aimed to evaluate the effectiveness of early KC (initiated within the first 24 h) vs. conventional neonatal care in very preterm infants (≤32 weeks) and/or very low birth weight (VLBW) infants (<1,500 g). METHODS: A comprehensive search of MEDLINE, SCOPUS, Web of Science, and CENTRAL databases was conducted. Randomized controlled trials (RCTs) comparing early KC to conventional care in very preterm and/or VLBW infants were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted using R, with relative risks (RR) and 95 % confidence intervals (CI) calculated. RESULTS: Four RCTs, encompassing 1,679 newborns, were included. Meta-analysis revealed a significant reduction in mortality risk (RR=0.81, 95 % CI: 0.67-0.98) with early KC. The pooled RR for infection risk was 0.89 (95 % CI: 0.77-1.02). The impact on hypothermia was mixed, with moderate heterogeneity observed. CONCLUSIONS: Early KC may reduce mortality and morbidity in very preterm and VLBW infants although its effects on hypothermia vary by severity. Further studies are required to assess its effects on infants weighing <1,000 g or born before 28 weeks of gestation.
26 May 2026
Read appraisal →JMIR nursing
Health Care Professionals' Perspectives on the Use of a Wearable Device for Early Detection and Continuous Vital Signs Monitoring of Acute Respiratory Infections in Nursing Homes: Qualitative Study
BACKGROUND: The growing aging population and staff shortages are placing pressure on Dutch nursing homes (NHs). These challenges have led to an increased interest in digital health technologies. Among these are wearable devices that allow for remote continuous monitoring of vital signs. An example is the Healthdot (smartQare), a wearable electronic device that continuously monitors heart rate, respiratory rate, and physical activity. In the context of acute respiratory infections (ARIs) in NHs, where initial symptoms can go unnoticed, continuous monitoring may aid in early recognition, timely intervention, and reduce staff workloads. However, little is known about how health care professionals perceive the use of continuous vital signs monitoring devices, such as the Healthdot, for this cause in NHs. OBJECTIVE: This study aims to explore the perspectives of healthcare professionals on the use of the Healthdot for early detection and monitoring of ARIs in NHs, to inform potential future implementation. METHODS: Semistructured interviews were conducted with 20 physicians, nurses, and certified nursing assistants from 4 NHs and 1 acute geriatric community hospital located in a NH. Interview transcripts were thematically analyzed to identify themes regarding their perspectives on the use of the Healthdot for monitoring ARIs in this setting. RESULTS: Five main themes were identified that related to the appropriate use of the Healthdot for NH clients and health care professionals: alignment of Healthdot use and NH clients' treatment policies, balancing safety and freedom, impact of the Healthdot on work processes, supporting rather than replacing care, and possible use during pandemics and in the future. Additionally, several preconditions for the use of the Healthdot were identified, including its usability, a support base among care staff, adequate training and guidance, communication with NH clients and their relatives, and a clear policy regarding its use. CONCLUSIONS: Given the complexity of care in NHs, where clinical care is typically balanced against quality of life and a homelike environment, physicians generally expressed reserved attitudes toward the Healthdot, highlighting the need to consider multiple factors in its implementation. Care staff were generally positive about the device. Nevertheless, tailored assessment for each individual NH client remains essential, balancing treatment goals, safety, autonomy, and person-centered care. Additionally, clear communication and alignment between health care professionals in this setting are crucial, specifically regarding their expectations of the Healthdot's role in care processes. This study offers practical guidance that may inform future implementation efforts of continuous vital sign monitoring devices in NHs.
26 May 2026
Read appraisal →Medicine
Effects of a psychological capital intervention on emergency nurses' work engagement and turnover intention: A randomized controlled trial
BACKGROUND: Emergency nurses are exposed to high occupational stress, which leads to decreased psychological capital, reduced work engagement, and high turnover intention. Evidence on targeted psychological capital intervention (PCI) for this population remains limited. METHODS: A parallel randomized controlled trial was conducted. A total of 122 emergency nurses from a tertiary hospital in Zhejiang Province were randomly assigned to the intervention group (6-week PCI, n = 61) or the control group (routine training, n = 61). Outcomes were measured at baseline (T0), post-intervention (T1), 1 month (T2), and 3 months (T3) using the Psychological Capital Questionnaire, Utrecht Work Engagement Scale, and Turnover Intention Scale. RESULTS: Baseline characteristics and outcome scores were comparable between groups (all P > .05). At T1 to T3, the intervention group had significantly higher Psychological Capital Questionnaire and Utrecht Work Engagement Scale scores and lower Turnover Intention Scale scores than the control group (all P < .001). Psychological capital was positively correlated with work engagement (R = 0.604, P < .001) and negatively correlated with turnover intention (r = -0.624, P < .001). CONCLUSION: This 6-week PCI program significantly improves psychological capital and work engagement, and reduces turnover intention among emergency nurses, with effects sustained for at least 3 months. These findings support the utility of PCI as a psychological management strategy for emergency nursing staff.
25 May 2026
Read appraisal →Scientific reports
Impact of nurse-led postoperative education on health outcomes following endovascular aortic repair: a randomized trial
The purpose of this randomized controlled clinical trial was to investigate the health effects of an education-based intervention performed at a nurse-led clinic, for patients who underwent endovascular treatment for abdominal aortic aneurysm. Fifty-four adult patients were randomized to the intervention group (n = 26) or the control group (n = 28). The control group received standard care, and the intervention group received standard care alongside two consultations at a specialist surgical nurse-led clinic. The consultations focused on individual motivational support and education about abdominal aortic aneurysm disease. Data was collected prior to surgery (baseline) and at one, six, and 12 months postoperatively for each group. Outcomes of interest included participants' responses to the Health Education Impact Questionnaire, responses to the EuroQol Five Dimensions Questionnaire, and responses to four complementary items specific to the scope of this study. Both groups reported overall high ratings of perceived health throughout the study period. While there were no statistically significant differences between the two groups, the control group showed a substantial improvement in perceived understanding of their diagnosis over time. This randomized controlled trial did not find any significant health benefits as compared to standard treatment.Trial registration ClinicalTrials.gov (19/05/2025 NCT06986252). Retrospectively registered.
24 May 2026
Read appraisal →European journal of pediatrics
The effect of virtual reality glasses used during inhaler treatment on anxiety, fear and vital signs in children: a randomized controlled trial
UNLABELLED: This study aimed to determine the effect of virtual reality (VR) glasses used during inhaler treatment on anxiety, fear and vital signs in children. The study had an experimental, randomized controlled design. Participants were assigned to groups using a lottery method based on simple randomization. The random sequence was generated by physically mixing up 30 red (experimental) and 30 white (control) cards. All the data were collected and finalized by two trained researchers (Yasemin Özyer Güvener, a nurse researcher, and Şeyma Şimşirgil Kara, a pediatrician). Participants were recruited using a convenience sampling method from among individuals who met the inclusion criteria. In terms of baseline measurements, the experimental group had significantly higher mean pulse rate, fear scores, and anxiety scores (130.23 ± 14.64, 2.77 ± 1.25, and 4.60 ± 2.04, respectively) compared to the control group (118.83 ± 17.10, 2.07 ± 1.26, and 2.80 ± 2.07, respectively) (p = 0.007, p = 0.035, and p = 0.001, respectively). For post-intervention measurements, the experimental group had significantly lower mean fear and anxiety scores (0.443 ± 0.16 and 0.703 ± 0.22, respectively) compared to the control group (2.39 ± 0.16 and 3.197 ± 0.22, respectively) (p < 0.001 and p = 0.001, respectively). CONCLUSION: It was determined that VR glasses reduced anxiety and fear, increased oxygen saturation, and reduced respiratory and pulse rates. They can thus be used as an alternative method to reduce fear and anxiety levels and balance vital signs during inhalation therapy in children. WHAT IS KNOWN: • Virtual reality (VR) is an effective non-pharmacological method for reducing pain, anxiety, and fear in pediatric patients during various medical procedures. • VR applications create a sense of presence in a virtual world, limiting the impact of anxiety and fear in clinical settings. WHAT IS NEW: • Using VR glasses during the administration of inhaled medication significantly reduces anxiety and fear levels in children compared to traditional methods. • While evidence for VR use during inhalation therapy was previously limited, this study demonstrates its effectiveness as a promising alternative to improve treatment compliance and physiological responses in pediatric patients.
21 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of survivorship programmes to enhance health-related quality of life of colorectal cancer survivors: a systematic review and meta-analysis of randomised controlled trials
PURPOSE: This study aimed to assess the effectiveness of the survivorship programmes by synthesising and analysing the available evidence to enhance health-related quality of life (HRQoL) amongst colorectal cancer (CRC) survivors. METHODS: Ten English-language databases were searched from inception to June 2025 in this systematic review and meta-analysis. All randomised controlled trials (RCTs) were included. Available data were pooled in a meta-analysis using RevMan (version 5.4.0). Two independent reviewers performed the database searches, extracted the data, assessed the methodological quality by using the Cochrane Risk-of-Bias tool (version 2) and evaluated the overall quality of findings by using Cochrane GRADE. RESULTS: A total of 22 RCTs involving 2949 CRC survivors were identified. The meta-analysis results (thirteen studies) indicated a significant improvement in the physical (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI, 0.18, 0.86], P = 0.002, I2 = 88%) and mental domains of HRQoL (SMD = 0.4, 95% CI [0.06, 0.74], P = 0.02, I2 = 86%). Sensitivity analysis involved reducing the heterogeneity after removing one study. No publication bias was found. The overall quality of findings was from 'low' to 'moderate'. CONCLUSIONS: The detailed components of the survivorship programme can enhance HRQoL in physical and mental domains, indicating its potential as valuable evidence for health providers to support CRC survivors post-treatment. Future research should focus on expanding the delivery of such programme comprehensively by integrating mobile health into a nurse-led approach to optimise geographic diversity and improve social HRQoL.
19 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effects of activity pacing-related interventions on cancer-related fatigue and classification of behavior change techniques: A systematic review and meta-analysis
PURPOSE: Although physical activity is recommended for managing cancer-related fatigue (CRF), activity pacing (AP) and energy conservation are also implemented to balance activity and rest. This systematic review assessed the effectiveness of AP-related interventions and behavior change techniques (BCTs) employed in AP-related interventions for CRF management. METHODS: We searched PubMed, CINAHL, CENTRAL, and Ichu-shi databases for articles published up to February 28, 2026. After assessing the risk of bias, we performed meta-analyses for quantitative synthesis. We also identified and classified BCTs using data from the Behavior Change Technique Taxonomy version 1. RESULTS: Among the 1257 identified studies, 10 (7 randomized controlled trials [RCTs] and 3 non-RCTs) met the inclusion criteria. The effect size was small but not significant (standardized mean differences [SMD] = - 0.36; 95% confidence intervals [CI]: - 0.73 to 0.00; 5 studies; 617 participants), with substantial heterogeneity (I2 = 66%). Compared with controls, the intervention showed a moderate, statistically significant effect in the subgroup of patients undergoing chemotherapy (SMD = - 0.58; 95% CI: - 0.87 to - 0.29; three studies; 197 participants with breast cancer). The primary BCTs used in AP-related interventions were "goal setting," "social support," and "graded tasks." CONCLUSION: AP-related interventions may provide some benefit in improving CRF, particularly during chemotherapy. However, the certainty of the current evidence is extremely low. Although these interventions represent useful approaches, further RCTs are needed, and digitization of AP-related intervention programs incorporating effective BCTs may be beneficial.
17 May 2026
Read appraisal →BMJ open
Prediction of inpatient falls and key predictors using machine learning applied to electronic health records: a retrospective cohort study in a tertiary hospital in Türkiye
OBJECTIVE: Traditional fall risk tools are often inaccurate and burdensome. This study aims to develop a predictive model for inpatient falls and identify the most influential variables using machine learning applied to electronic health record data. DESIGN: A retrospective cohort study. SETTING: A large tertiary university hospital in Türkiye. PARTICIPANTS: Adult patients (≥18 years) hospitalised in a university hospital between January 2017 and June 2023. PRIMARY OUTCOME MEASURES: Occurrence of inpatient falls recorded in incident reporting systems. RESULTS: A total of 518 fallers were identified and compared with 3121 non-fallers. Fallers were significantly older (median 68.5 vs 64 years, p<0.001), had longer hospital stays (16 vs 12 days, p<0.001) and higher comorbidity burden (p<0.001). They were also more likely to receive high fall-risk medications (86% vs 76%, p<0.001) and had a higher prevalence of mental disorders (26.3% vs 17.2%, p<0.001). The random forest quantile classifier demonstrated the highest discrimination (area under the curve (AUC) 0.821, 95% CI 0.781 to 0.861), with balanced sensitivity (0.799, 95% CI 0.734 to 0.867) and specificity (0.722, 95% CI 0.691 to 0.755). Pairwise comparisons using DeLong's test showed significantly higher AUC compared with several models (adjusted p=0.001), while differences with eXtreme Gradient Boosting were not significant (p=0.240). Key predictors included comorbidity burden, age, number of fall-risk-increasing medications and laboratory variables such as eosinophil and basophil counts, blood urea nitrogen, sodium and red blood cell count. CONCLUSION: Machine learning models using electronic health data can predict inpatient falls and reveal key risk factors. The random forest quantile classifier offers a promising approach for improving fall risk prediction in imbalanced clinical datasets.
15 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A Noddings' caring theory-based intervention to enhance coping with death competence in advanced lung cancer patients: a randomized controlled trial
PURPOSE: This randomized controlled trial aimed to evaluate the effects of a Noddings' caring theory-based intervention on coping with death competence (CDC), death attitudes, and psychological distress in patients with advanced lung cancer. METHODS: Seventy inpatients were randomly allocated to the intervention group (n = 35) or the control group (n = 35). The 3-week intervention comprised modeling, dialogue, practice, and recognition phases. Outcomes, including CDC, attitude toward death, anxiety, and depression, were assessed at baseline (T0), post-intervention (T1), and 1-month follow-up (T2). RESULTS: No significant between-group differences were observed at baseline. Following the intervention, patients in the intervention group demonstrated significantly higher CDC total and subscale scores, more positive death attitudes, and lower anxiety and depression scores than those in the control group at both post-intervention and 1-month follow-up. CONCLUSION: The Noddings-based program effectively enhanced death-coping competence, improved death attitudes, and reduced psychological distress in patients with advanced lung cancer. TRIAL REGISTRATION: ChiCTR2600118530, 2/6/2026 retrospectively registered.
12 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
A systematic review of the assessment model for palliative care needs in cancer patients
BACKGROUND: Timely palliative care can reduce the disease burden and improve quality of life in patients with cancer. Although several studies have developed assessment models for palliative care needs in cancer patients, the quality and clinical applicability of these models remain unclear. OBJECTIVE: To systematically review existing assessment models for palliative care needs in patients with cancer, with a focus on their characteristics, predictors, risk of bias, and applicability. METHODS: A systematic search was conducted in PubMed, Cochrane Library, Embase, Web of Science, CINAHL, Scopus, China National Knowledge Infrastructure (CNKI) through September 12, 2025. Data extraction and evaluation were rigorously performed by two researchers based on the Prediction Model Risk of Bias Assessment Tool (PROBAST). RESULTS: A total of 5714 articles were identified, and eight studies were included, which covered 24 models for assessing palliative care needs. The sample size of the included studies ranged from 179 to 54,628, with areas under the curve ranging from 0.724 to 0.998. The models in all the included studies encompassed four categories of predictive factors: general demographic data, symptom/functional assessments, laboratory indicators, and treatment status. Five studies were rated as having a high risk of bias, primarily due to high risks associated with participants and conclusions, with generally low applicability. CONCLUSION: Existing models demonstrate potential for identifying patients with cancer who have increased palliative care needs using routinely collected clinical data. Commonly included predictors were symptom burden, functional status, laboratory parameters, treatment-related factors, and demographic characteristics. However, the overall body of evidence is constrained by a substantial risk of bias, particularly arising from inappropriate data sources, limited sample sizes, suboptimal handling of continuous variables, insufficient reporting of missing data, and the lack of robust internal or external validation. In addition, many models adopted mortality-based surrogate outcomes rather than clinically meaningful indicators of palliative care needs. Therefore, the currently available models should be interpreted with caution, and further high-quality model development and external validation are required before they can support broader routine clinical implementation. Future research should prioritize clinically actionable outcomes and incorporate patient-, caregiver-, and family-level factors to improve the relevance of these models for referral decisions and care planning.
12 May 2026
Read appraisal →European journal of pediatrics
Oral dextrose gel vs standard care for the treatment of hypoglycemia in high-risk neonates: an open-label randomized controlled trial
UNLABELLED: To determine whether 40% dextrose gel with oral feeds reduces NICU admission for asymptomatic hypoglycemia compared with standard care with oral feeds in at-risk neonates within 48 h of life. Secondary objectives were to assess rebound and recurrent hypoglycemia, hyperglycemia, and exclusive breastfeeding at discharge and at 6 weeks. Open-label randomized controlled trial conducted at a tertiary hospital in South India between April 2023 and May 2024. Neonates born at ≥ 35 weeks of gestation with asymptomatic hypoglycemia within the first 48 h of life were randomly assigned to receive either 200 mg/kg of oral 40% dextrose gel with oral feeds or standard care with oral feeds alone. The primary outcome was NICU admission for hypoglycemia. A total of 193 neonates were enrolled, with 98 in the standard care group and 95 in the gel group. Baseline characteristics were comparable. NICU admission for hypoglycemia occurred in 4.2% in gel group and 12.2% in standard care group (RR 0.34, 95% CI 0.11-1.03; p = 0.06), with a number needed to treat of 13. Exclusive breastfeeding was higher in gel group at discharge (97% vs 76%; p < 0.001) and at 6 weeks (90% vs 69%; p < 0.001). Rebound hypoglycemia, recurrent hypoglycemia, and hyperglycemia were similar between groups. CONCLUSION: Oral dextrose gel was associated with fewer NICU admissions, but the primary outcome did not reach statistical significance. Improved breastfeeding rates were observed as secondary outcomes. These findings should be interpreted cautiously and confirmed in adequately powered studies. TRIAL REGISTRATION: Clinical Trials Registry of India (CTRI/2023/02/050027). WHAT'S KNOWN: • Oral 40% dextrose gel is an eff ective fi rst-line treatment for neonatal hypoglycemia and has been shown to reduce treatment failure and intravenous glucose use in previous trials. • Existing evidence is predominantly from high-income settings, with limited randomized data from low- and middle-income countries assessing pragmatic outcomes such as NICU admission. WHAT IS NEW: • In this open-label randomized controlled trial, oral dextrose gel was associated with fewer NICU admissions for hypoglycemia (4.2% vs 12.2%) and higher exclusive breastfeeding rates at discharge and 6 weeks compared with standard care. • These fi ndings support the potential utility of dextrose gel as a simple, low-cost intervention for managing neonatal hypoglycemia in resource-limited settings.
11 May 2026
Read appraisal →Palliative & supportive care
Definitional confusion in nurses' and physicians' attitudes toward euthanasia in India: A systematic review and meta-analysis
INTRODUCTION: In India, the term euthanasia is frequently used to describe a wide range of end-of-life practices, including withdrawal of life-sustaining treatment and administration of lethal drugs. Such usage diverges from more narrow definitions that restrict euthanasia to the intentional administration of lethal drugs. OBJECTIVES AND SIGNIFICANCE OF THE RESULTS: This systematic review and meta-analysis examines how euthanasia has been defined and operationalized in quantitative studies of Indian physicians' and nurses' attitudes, and estimates the prevalence of approval when euthanasia is defined narrowly. METHODS: Following PRISMA 2020 guidelines, searches were conducted in PubMed, EMBASE, PsycINFO, and CINAHL for studies published from 2010 onward. Two investigators independently screened studies, extracted data, and assessed risk of bias using the Mixed Methods Appraisal Tool (MMAT). Studies were included in the meta-analysis only if they reported attitudes toward euthanasia as narrowly defined. RESULTS: Nine studies met inclusion criteria for the systematic review. Definitions of euthanasia varied considerably, and several studies combined attitudes toward treatment withdrawal with attitudes toward the administration of lethal drugs. Four studies reporting on 519 nurses and physicians provided data suitable for meta-analysis. Approval of euthanasia, defined as the intentional administration of lethal drugs, ranged from 12% to 20%, with a pooled prevalence of 16% (95% confidence interval: 0.13-0.19). This prevalence is notably lower than in earlier reports on Indian healthcare professionals' attitudes. CONCLUSION: Definitional inconsistency substantially affects reported attitudes toward euthanasia in Indian research. When euthanasia is defined narrowly, approval among healthcare professionals is low and consistent across studies. These findings highlight the need for conceptual clarity in future research to support accurate interpretation of empirical data and to strengthen the contribution of studies on ethical attitudes to ethical and palliative care scholarship.
10 May 2026
Read appraisal →The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
The effect of maternal scent-infused blanket on the stress level, crying duration and physiological parameters of premature newborns
BACKGROUND: Olfactory cues from the mother may soothe distress in premature infants in the Neonatal Intensive Care Unit (NICU). This study evaluated the effect of a maternal scent-infused blanket on stress, crying duration, and physiological parameters in premature newborns. METHODS: This double-blind randomized clinical trial included 69 premature infants who were randomly assigned to one of three groups: maternal scent-infused blanket, unscented blanket, or control (no blanket) group. Infants were covered with the assigned blanket for 60 min daily for 3 consecutive days. The maternal scent was obtained by placing a clean blanket in contact with the mother's bare chest overnight prior to each day's exposure, with fragrance-free cleansing products used and a new blanket for each session. Primary outcomes were stress level (Newborn Stress Scale, NSS), crying duration (chronometer), and Secondary outcomes were physiological parameters (heart rate, respiratory rate, oxygen saturation, and body temperature). Measurements were collected at 5 min before intervention, immediately after, and at 15, 30, 45, and 60 min during intervention, plus 5 min after intervention, each day for three consecutive days. Data were analyzed using one-way ANOVA and ANCOVA adjusting for baseline values; p < 0.05 denoted significance. RESULTS: Stress scores and crying duration differed significantly among groups during the intervention, with the maternal scent-infused blanket group showing lower NSS scores and shorter crying times than the unscented and no-blanket groups (p < 0.001). During exposure, heart rate, oxygen saturation, and body temperature differed among groups (significant at multiple time points, p < 0.001); by contrast, respiratory rate did not differ significantly (p > 0.05). Differences were not observed at baseline or immediately after the intervention for these physiological measures. CONCLUSION: The maternal scent-infused blanket may reduce stress and crying duration, with transient improvements in some physiological parameters during exposure. Maternal olfactory cues could serve as a feasible non-pharmacological adjunct to support comfort and well-being in vulnerable newborns, emphasizing parental involvement in neonatal care.
10 May 2026
Read appraisal →Journal of wound care
Incidence and risk factors of medical adhesive-related skin injury among ICU patients: a systematic review and meta-analysis
OBJECTIVE: To summarise the evidence regarding the incidence and risk factors of medical adhesive-related skin injury (MARSI) among patients in the intensive care unit (ICU). METHOD: A systematic review and meta-analysis was undertaken using articles available in nine databases: PubMed; the Cochrane Library; Web of Science; Embase; CINAHL; Chinese Biomedical Literature Database; China National Knowledge Infrastructure Database; Wanfang Database; and Weipu Database, from inception until 30 June 2024. Additional studies were identified by examining the references of relevant articles. The Stata 16.0 statistical platform (StataCorp LLC, US) was used for analysis. Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality standards. RESULTS: Of 14,743 titles screened, 19 studies involving 5218 patients were included in the systematic review. The pooled incidence of MARSI was 21% (95% confidence interval (CI): 14%, 28%), and the incidence of MARSI among neonatal ICU, paediatric ICU and adult ICU was 15% (95% CI: 6%, 26%), 48% (95% CI: 35%, 60%) and 16% (95% CI: 11%, 22%), respectively. Significant risk factors in adult ICUs included oedema (odds ratio (OR): 8.144; 95%CI: 3.267, 20.304), Braden scale score (OR: 0.733; 95%CI: 0.641, 0.837), length of ICU stay (OR: 1.072; 95%CI: 1.026, 1.120), mechanical ventilation (OR: 3.698; 95%CI: 1.900, 7.199), sedative use (OR: 6.022; 95%CI: 2.859, 12.687), Nutritional Risk Screening 2002 score (OR: 4.241; 95%CI: 1.984, 9.065) and hypoalbuminaemia (OR: 4.321; 95%CI: 1.967, 9.488). CONCLUSION: This study found that MARSI is prevalent among ICU patients and is associated with multiple risk factors. Improved strategies for identifying and clinically managing MARSI in ICU patients are needed. Nevertheless, large-sample and multicentre studies are still warranted to validate the present study's findings.
10 May 2026
Read appraisal →Journal of wound care
Exudate management with a next-generation multilayered foam dressing in traumatic and surgical wounds: a prospective, multicentre study
OBJECTIVE: The aim of this study was to evaluate the efficacy, performance and safety of ConvaFoam (Convatec Ltd., UK), a next-generation multilayered foam dressing, in indicated surgical and traumatic wounds. METHOD: This prospective, multicentre, open-label study (ClinicalTrials.gov: NCT05632276) evaluated ConvaFoam dressings in surgical and traumatic wounds. Eligible patients were managed with ConvaFoam dressings in accordance with their instructions for use (maximum seven-day wear time) for ≤4 weeks. The primary endpoint was the proportion of patients and total dressings with excellent exudate management (defined as absence of strikethrough or periwound maceration). Secondary endpoints included: exudate management in dressings worn for seven days; healing rate; wear time; pain on application; usability; and safety. RESULTS: The study enrolled 52 patients (mean age: 48.2 years) with surgical (54%) or traumatic (46%) wounds. Median dressing wear time was five days (interquartile range: 1-7 days). Among patients who completed the study, 81% (38/47) were observed to have achieved excellent exudate management throughout all wound care visits (90% confidence interval (CI): 71, 90%). Excellent exudate management was also observed in 93% (209/224) of total dressings applied (90% CI: 90, 97%), including in 96% (47/49) of dressings worn for seven days. Only one patient in the study experienced periwound skin maceration at any study timepoint. Wound healing was observed in 93% of surgical wounds and 25% of traumatic wounds during the study period. Low levels of pain and high user satisfaction as per numeric pain scale and utility questionnaire, respectively, were reported. CONCLUSION: ConvaFoam dressings demonstrated excellent exudate management in >90% of dressing changes, and may promote an optimal environment for healing in surgical and traumatic wounds.
10 May 2026
Read appraisal →Journal of medical Internet research
Online Community Support for Stroke Survivors and Caregivers: Scoping Review
BACKGROUND: Previous studies found that online communities are critical in supporting stroke survivors and caregivers for stroke recovery. However, it is unclear how such online communities are designed, or could be designed. OBJECTIVE: This review aims to identify the key design elements of an online community to support stroke survivors and caregivers, that is, the actors, types of community support, and supporting technologies. METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We included journal articles related to online community support for stroke. Editorials, registers, opinion pieces, letters, and conference papers were excluded. Online databases PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, and ProQuest were searched for articles published from January 2015 to June 2025. Articles were screened based on the title, abstract, and full text using Covidence software. After screening and full-text review, we read the selected articles in detail to analyze and synthesize information on key actors, types of support, and technologies used to support stroke survivors and caregivers. RESULTS: A total of 77 articles were included. These articles discussed digital support technologies (52 articles), community functions and roles (18 articles), online stroke community systems (6 articles), and the stroke ecosystem (1 article). Our review found that the online community of support for stroke survivors and caregivers includes the caregivers themselves (46 articles), health workers (24 articles), and the local community/society (14 articles). Online communities mainly provide informational support, including giving advice (28 articles) and tangible aids (29 articles), followed by social support to create a sense of belonging (26 articles). Technologies discussed included mobile health (25 articles), web-based systems (12 articles), virtual/augmented reality (8 articles), sensors/wearable technology (8 articles), video-guided exercise apps (4 articles), and telehealth/telerehabilitation/teleconsultation/telestroke (4 articles). Only one examined how cultural differences influence technology. CONCLUSIONS: Although technologies are essential in online communities of support for stroke survivors and caregivers, this review shows a lack of studies that analyze the use and role of technologies in such online communities. This could be because the key actors of the online communities are the caregivers, who mainly seek social support and therefore do not require sophisticated technology. Nevertheless, technologies such as telerehabilitation and video-guided exercise apps could be important for other actors, including the local community and health workers, to enable them to support stroke survivors and their caregivers.
3 May 2026
Read appraisal →JMIR research protocols
Geriatric Telemanagement of Health Conditions (GET HEALTH) in Nursing Home Residents Recently Discharged From the Hospital: Protocol for a Before-After Study
BACKGROUND: Nursing home (NH) residents have a high burden of multimorbidity and disability and are frequently hospitalized. Comprehensive geriatric assessment might reduce hospitalization. However, few geriatricians are working in NHs. Technology might be used to overcome this problem. OBJECTIVE: This study aims to verify if a geriatric telemanagement model improves patient outcomes in NH residents recently discharged from the hospital. METHODS: Clinical outcomes of NH residents recently discharged from the hospital are compared before and after the implementation of GTM, where a geriatrician evaluates each patient during televisits with NH staff and discusses the case with the general practitioner. NH residents aged ≥70 years readmitted to NHs after hospitalization in the 3 years prior to the COVID-19 pandemic (2017-2019) represent the control group enrolled in the retrospective preintervention phase. The primary outcome of the study is the hospital readmission rate during 6-month follow-up. Health technology assessment evaluates the cost-effectiveness of model implementation. RESULTS: A total of 333 NH residents were included in the preintervention retrospective study. Data collection started in February 2022 and was completed in February 2023. A total of 104 NH residents were recruited in the intervention study, from March 2024 to March 2025. Data analysis is currently in progress. CONCLUSIONS: Currently, NHs in Italy are striving to manage the complexity of older patients who are often hospitalized. A geriatric telemanagement model might reduce hospitalizations, and therefore negative outcomes, as well as health care costs in this vulnerable population.
3 May 2026
Read appraisal →BMJ health & care informatics
Does the accuracy of medication administration documentation improve with electronic medication systems? A stepped-wedge cluster randomised trial.
OBJECTIVES: Accurate documentation of medication administration is crucial for patient safety. This study compares the accuracy of documentation between paper-based and electronic medication management (eMM) systems. METHODS: A secondary analysis of data from a stepped-wedge cluster randomised trial of an eMM implementation was conducted. The eMM module allowed electronic prescribing, recording of drug dispensing, drug administration and medication reconciliation and monitoring. Medication administration processes were observed in a tertiary paediatric hospital in Sydney, Australia. Trained nurse observers recorded details of medication administrations which were then compared with the information documented by nurses about the administrations. RESULTS: 5095 administrations were analysed. With eMM compared with paper, significantly fewer administrations had no time documented (adjusted OR (aOR) 0.15; 95% CI 0.07 to 0.34; p<0.001), but documented details were more often inaccurate (aOR 4.6; 95% CI 3.3 to 6.6). Fewer doses were administered from incorrect prescriptions with eMM (aOR 0.25; 95% CI 0.18 to 0.36). CONCLUSION: eMM improves certain aspects of documentation but introduces new challenges, particularly in accurately recording administration details. Further investigation is needed to optimise these systems. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry 370325.
27 Apr 2026
Read appraisal →BMJ open
Effects of nurse-led shared decision-making on low-dose CT uptake and screening outcomes in high-risk populations: a systematic review and meta-analysis
OBJECTIVES: To evaluate the effects of nurse-led shared decision-making (SDM) on lung cancer screening outcomes, including low-dose CT (LDCT) uptake, benign findings, early cancer detection and willingness to participate among high-risk populations. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Medline via OvidSP, Cochrane Central Register of Controlled Trials, EMBASE via OvidSP, Web of Science, Scopus, grey literature databases and clinical trial registries were searched from inception to March 2025. ELIGIBILITY CRITERIA: Studies evaluating nurse-led SDM interventions in high-risk lung cancer populations, reporting outcomes including LDCT uptake rates, screening results (Lung-RADS (Lung Imaging Reporting and Data System) classifications), early-stage cancer detection or willingness to participate. Randomised controlled trials, quasi-experimental studies and observational studies were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data and assessed risk of bias using the Risk of Bias in Non-randomised Studies of Interventions (for non-randomised studies) and Cochrane Risk of Bias 2.0 (for randomised controlled trials). Meta-analyses were conducted using random-effects models. Meta-regression explored sources of heterogeneity. RESULTS: 13 studies (n=13 608 participants) were included, comprising 10 single-arm studies and three comparative studies. In single-arm studies without control groups, nurse-led SDM programmes achieved a pooled LDCT uptake rate of 98% (95% CI 28% to 100%; I²=99%), and willingness to participate was 68% (95% CI 24% to 93%; I²=98%). In comparative studies, nurse-led SDM showed no significant difference in LDCT uptake compared with usual care (RR 1.00, 95% CI 0.99 to 1.02; I²=0%), suggesting non-inferiority rather than superiority. Among individuals who completed screening, 81% (95% CI 77% to 85%) had benign or low-risk findings (Lung-RADS [Lung Imaging Reporting and Data System] I/II), and 2% (95% CI 1% to 3%) were diagnosed with early-stage lung cancer, rates consistent with benchmark screening trials. Meta-regression identified female sex as positively associated with uptake (β=0.54, p<0.001), while current tobacco use was negatively associated (β=-0.37, p=0.033). The risk of bias was moderate to serious across studies. CONCLUSIONS: Comparative evidence suggests that nurse-led SDM achieves equivalent LDCT uptake to standard care approaches, indicating feasibility as an alternative service delivery model. However, the predominance of single-arm studies, high heterogeneity and moderate-to-serious risk of bias limit causal inference. High uptake rates in single-arm studies likely reflect selection bias rather than intervention effectiveness. Current evidence supports the feasibility but not the superiority of nurse-led SDM. Well-designed randomised controlled trials are needed to establish comparative effectiveness and cost-effectiveness before recommending widespread integration of nurse-led SDM into lung cancer screening programmes. TRIAL REGISTRATION NUMBER: PROSPERO CRD420251033595. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1033595.
26 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Online self-compassion-based interventions on patient outcomes in patients with cancer: a systematic review
PURPOSE: This systematic review investigates the effectiveness of online self-compassion-based interventions and their impact on the outcomes of cancer patients. METHODS: A comprehensive search was carried out in the Web of Science Core Collection, Cochrane Library, CINAHL, PubMed, ScienceDirect, Scopus, Ovid, and SpringerLink databases without any year limitation until January 01, 2026. Cochrane and PRISMA guidelines were used for systematic review and reporting. RoB2 and Joanna Briggs Institute guidelines were utilized to assess the risk of bias. RESULTS: Eight studies included in the systematic review were conducted between 2017 and 2025 in Australia, the USA, the Netherlands, China, and Türkiye. The self-compassion interventions applied in the studies included mindful self-compassion, self-compassion-focused writing, compassion mind training, and kindness interventions. Online self-compassion-based interventions have been found to increase patients' levels of self-compassion, mindfulness, body image appreciation, well-being, self-acceptance, posttraumatic growth, and positive affect while reduce their levels of self-criticism, social isolation, anxiety, stress, and depression, body image distress. CONCLUSIONS: Studies have shown the positive effects of self-compassion-based interventions on patient outcomes. A sensitivity analysis that included only randomized controlled trials demonstrated robustness in all outcomes except anxiety; however, some research results were obtained from a single randomized controlled trial. Since some study results were derived solely from quasi-experimental studies, they were not included in the analysis. Therefore, more randomized controlled research is required to integrate these interventions into clinical patient care. Online self-compassion interventions can contribute to the planning of holistic nursing interventions for patient outcomes.
25 Apr 2026
Read appraisal →European journal of preventive cardiology
i-CARE: a smartphone-based intervention to enhance cardiac rehabilitation in coronary artery disease-a randomized controlled trial
AIMS: The global shortage of healthcare professionals creates challenges in managing chronic diseases. This study evaluated a remotely delivered, theory-based self-care support intervention, 'Internet-based CArdiac Rehabilitation Enhancement (i-CARE)', delivered through a smartphone application to enhance self-management in patients with coronary artery disease (CAD). METHODS AND RESULTS: In this assessor-blinded, two-arm randomized controlled trial conducted at two regional hospitals in Hong Kong, community-dwelling adults with angiographically confirmed CAD were randomly assigned (1:1) to standard care or the i-CARE intervention. i-CARE included personalized risk assessment, skill-building, and app-based support to improve self-care behaviours. The primary outcome was change in CAD self-care behaviours; secondary outcomes were self-reported health status, health-related quality of life (HRQoL), physiological, and biomarkers. Of 294 participants randomized (n = 147 per group), the i-CARE group showed significant greater improvements in self-care maintenance [β = 4.055, 95% confidence interval (CI) 1.420-6.691, P = 0.003] and self-care confidence (β = 5.609, 95% CI 1.089-10.129, P = 0.015) at 3 months, sustained at 6 months. For secondary outcomes, the intervention also resulted in significant reductions in systolic (β = -3.725, 95% CI -7.322 to -0.128, P = 0.042) and diastolic (β = -2.153, 95% CI -4.228 to -0.079, P = 0.042) blood pressure and improvements in HRQoL at 3 months (β = 0.208, 95% CI 0.073-0.343, P = 0.003), with persistent benefits for diastolic blood pressure and HRQoL sustained at 6 months. No significant differences were observed for cardiac-specific health status, blood glucose, lipid profile, or waist-to-height ratio. CONCLUSION: Remotely delivered i-CARE intervention effectively promote self-care among CAD patients and may help address critical healthcare workforce shortages, while also conferring secondary benefits in blood pressure and HRQoL. Cardiac rehabilitation is a comprehensive management approach with proven clinical benefits to delay disease progression. However, the participation rate in cardiac rehabilitation remains low due to common barriers such as time constraints and need for transportation to centres. Mobile health applications offer innovative solutions to overcome these barriers providing multidimensional support to meet the complex needs of coronary artery disease (CAD) patients and enhance their self-management capabilities. This study aimed to evaluate the effects of an internet-based Cardiac Rehabilitation Enhancement (i-CARE) intervention among community-dwelling adults with angiographically diagnosed CAD to enhance self-care behaviours. The findings showed promising potential of digital health interventions to improve self-care behaviours, blood pressure control, and health-related quality of life in CAD patients.
24 Apr 2026
Read appraisal →Annals of medicine
The effect of nutrition education interventions on dialysis patients' outcomes: a systematic review and meta-analysis
BACKGROUND: Non-adherence to dietary and fluid restrictions among dialysis patients is associated with adverse clinical outcomes. Quantifying the effectiveness of nutrition education interventions can inform practice and policy. METHODS: We searched MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO, Web of Science, and Scopus up to 15 July 2025, supplemented by trial registries and Google Scholar, with an updated search through 8 April 2026. Eligible studies included randomized and non-randomized trials evaluating nutritional education interventions in adult dialysis populations. Risk of bias was assessed using RoB-2 and ROBINS-I, certainty graded using GRADE, and random-effects meta-analyses conducted alongside subgroup, sensitivity, and meta-regression analyses. Publication bias was assessed with Egger and Begg tests and trim-and-fill where applicable. RESULTS: Forty-four studies comprising 4,106 participants were included. Nutrition education significantly improved knowledge (SMD = 1.09; 95% CI: 0.67-1.51) and health-related quality of life (SMD = 1.43; 95% CI: 0.86-2.00; I² = 0%), and reduced serum potassium (SMD = -0.52; 95% CI: -0.91 to -0.14; I² = 92%) and serum phosphate (SMD = -0.35; 95% CI: -0.56 to -0.15; I² = 81%). Results for albumin, creatinine, sodium, calcium, and BUN were inconsistent and non-significant. Most outcomes were rated low or very low certainty by GRADE, reflecting inconsistency, indirectness, and imprecision. Potential publication bias was identified for certain outcomes. CONCLUSIONS: Nutrition education consistently improves knowledge and quality of life and may modestly reduce serum phosphate and potassium in dialysis patients. High-quality registered trials with standardized outcomes and longer follow-up are needed to establish effectiveness and sustainability. PROSPERO REGISTRATION: CRD420251119567.
24 Apr 2026
Read appraisal →BMJ open
Early mobilisation after abdominal surgery: a concept analysis
OBJECTIVE: To clarify and define the clinical practice concept of early mobilisation after abdominal surgery. DESIGN: A concept analysis guided by Walker and Avant's method. DATA SOURCES: MEDLINE (Ovid), AMED-(Ovid), Embase (Elsevier) and CINAHL (EBSCO) were searched through 5 December 2024. ELIGIBILITY CRITERIA: Relevant studies that included combinations of the terms 'early mobilisation', 'early ambulation', 'early acceleration', 'abdominal surgery' and 'surgical procedures' were selected. We restricted the search to English full-text publications involving adult patients, limited to the year 2000 and onward. Inclusion criteria were original research articles describing the timing and/or type of mobilisation. DATA EXTRACTION AND SYNTHESIS: The study derives its defining attributes, antecedents and consequences through data analysis. To enhance understanding of the model, we constructed related and contrary cases of the concept and outlined relevant empirical referents. RESULTS: In total, 140 studies were included in the analysis. Early mobilisation is characterised by the key defining attributes of initiating active physical movement, including standing, sitting in a chair or walking, within the first 24 hours of surgery. Antecedents include haemodynamic and respiratory stability, adequate pain management, and the patient's cognitive and physical readiness. Contextual antecedents include competent and adequately staffed healthcare teams. Consequences include improved physiological recovery and enhanced postoperative outcomes. CONCLUSIONS: This analysis provides a clarified, practice-focused definition of early mobilisation after abdominal surgery. By delineating its key attributes and contextual prerequisites, the study offers a conceptual foundation that can support clinical guidelines, promote consistent implementation and inform future research aimed at optimising postoperative recovery.
20 Apr 2026
Read appraisal →Journal of medical Internet research
Effectiveness of mHealth Interventions for Improving eHealth Literacy Among Patients With Chronic Diseases: Meta-Analysis and Systematic Review
BACKGROUND: With the widespread use of the internet and mobile devices, eHealth literacy promotion is critical for medical equity. Mobile health (mHealth) serves as a pivotal tool for enhancing eHealth literacy by providing accessible, interactive platforms for health information engagement. However, the evidence regarding the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases remains inconclusive. OBJECTIVE: This study aimed to evaluate the effectiveness of mHealth interventions on eHealth literacy among patients with chronic diseases based on randomized controlled trials (RCTs) and summarize supportive evidence from quasi-experimental and qualitative studies. METHODS: A comprehensive search strategy was developed, and 8 electronic databases were systematically searched for studies published up to February 12, 2026. Patients with chronic diseases were included based on predefined inclusion criteria. The Cochrane risk of bias 2 tool for RCTs and the ROBINS-I tool for quasi-experimental studies were used to assess the risk of bias. Given the anticipated substantial heterogeneity among the studies included, we used a random-effects model based on the Hartung-Knapp-Sidik-Jonkman method to pool effect sizes. A narrative and quantitative synthesis of the findings was provided where appropriate. RESULTS: A total of 15 studies were included in this review, including 6 RCTs, 5 quasi-experimental studies, and 4 qualitative studies, involving a total of 2884 patients with chronic diseases. Meta-analyses of RCTs suggested that mHealth interventions could improve eHealth literacy, with a pooled mean effect size of standardized mean difference (SMD)=1. 19 (95% CI 0.14-2.23; P=.03; I²=97.75%; PI [prediction interval]=-2.68 to 5.05). Subgroup analyses by intervention targets showed that interventions on targets with specific disease produced larger mean effects (SMD=1.61; 95% CI 0.16-3.06; PI=-5.40 to 8.63), while interventions targeting the population with general chronic diseases produced smaller effects (SMD=0.36; 95% CI 0-0. 73; PI=-0. 21 to 0. 94). Analysis by intervention duration subgroup showed that the combined effect of studies with intervention duration <3 months was statistically significant (SMD=0.61; 95% CI 0.09-1.13; I²=88.04%; PI=-5.72 to 6.95); while the combined effect of studies with intervention duration ≥3 months was not statistically significant. Taking into account bias and the risk of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation), the certainty of RCT evidence was moderate, and the certainty of quasi-experimental evidence was low. CONCLUSIONS: mHealth interventions could improve eHealth literacy among patients with chronic diseases on average. By using prediction intervals, this study reveals that the effectiveness of mHealth interventions is highly context-dependent and closely linked to implementation factors. Advancing beyond prior work, this study centers on eHealth literacy as a core outcome and integrates multiple types of evidence. Meanwhile, this finding emphasizes the need for evidence-based intervention programs and more rigorous implementation of intervention designs in future research.
19 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Beyond breast cancer: mapping unmet needs and advancing an evidence-based framework of survivorship care
PURPOSE: The growing population of breast cancer survivors (BCS) underscores the need to address ongoing challenges that persist beyond active treatment. This scoping review aimed to systematically map the unmet needs of BCS and inform the development of an evidence-based survivorship care framework. METHODS: A systematic search of databases identified 13,401 studies, of which 170 met the inclusion criteria. Data were analyzed using qualitative content analysis and descriptive statistics to categorize unmet needs across studies. RESULTS: Six major categories of unmet needs were identified: physical symptom burden, psychosocial/emotional needs, informational needs, healthcare support needs, relational/sexual needs, and financial/occupational needs. Physical symptoms (33.5% of studies) and psychosocial/emotional concerns (32.4%) were most frequently reported. Based on these domains, a three-phase conceptual framework was developed: (1) universal needs screening, (2) targeted, multidisciplinary interventions tailored to individual survivors, and (3) ongoing evaluation through patient-reported outcomes to optimize care. CONCLUSIONS: Unmet needs among BCS are widespread and multifaceted, particularly regarding chronic physical symptoms and persistent psychosocial distress. Existing care frameworks are fragmented and insufficient. The proposed three-phase framework provides a structured approach to delivering proactive, patient-centred survivorship care. IMPLICATIONS FOR CANCER SURVIVORS: Implementing this framework can improve identification and management of unmet needs, enhance quality of life, support long-term physical and emotional recovery, and foster resilience throughout survivorship.
17 Apr 2026
Read appraisal →JMIR nursing
Nurses' Evaluation of a Service Robot for Inpatient Care: Technology Acceptance Study
BACKGROUND: The integration of robotic systems into nursing practice is increasingly discussed as a potential strategy to alleviate workload and support care processes in response to demographic changes and staffing shortages. However, the acceptance of nursing staff as primary end users remains a critical determinant for successful implementation. Despite technological advances, the practical requirements and perspectives of nursing staff have not been adequately considered in research and development efforts to date. OBJECTIVE: Building on the user-centered development approach applied, this study aimed to examine nursing staff's evaluation of a service robot designed to assist with routine tasks in inpatient care, as well as their intention to use it, while accounting for technology-specific and psychological determinants of acceptance. METHODS: A total of 30 nurses tested the robot across 3 application scenarios (information service, item delivery, and beverage delivery) in a simulated care setting, alternating between the roles of nurse and care recipient. Acceptance-related constructs, including intention to use, were measured using the Technology Usage Inventory. General attitudes toward robots were assessed via the General Attitudes Towards Robots Scale. Participants' prior experience with robotics was also documented. Spearman rank correlations and Mann-Whitney U tests were used for analysis. RESULTS: The robot was rated positively across all dimensions. Usability was high (median 20, IQR 18-21; scale range 3-21), as was perceived usefulness (median 21, IQR 16-24; range 4-28). Skepticism was low (median 10.5, IQR 7-12; scale range 4-28), and accessibility was moderate (median 10, IQR 8-13; scale range: 3-21). Intention to use was strong (median 224.5, IQR 157-248; scale range 0-300) and correlated positively with usability (rs(28)=0.505; P=.004), perceived usefulness (rs(28)=0.74; P<.001), and accessibility (rs(28)=0.628; P<.001), and negatively with skepticism (rs(28)=-0.516; P=.004). More positive personal attitudes toward robots were also associated with higher perceived usefulness (rs(28)=0.549; P=.002) and greater intention to use (rs(28)=0.483; P=.007). No significant differences in intention to use were found between participants with and without prior robotics experience (U=83.5; P=.62). CONCLUSIONS: The findings indicate a high level of acceptance among the participating nursing staff for the developed service robot within the tested scenarios. Considering the chosen user-centered development approach, they further underscore the need for strategies that combine participatory design, transparent communication of system capabilities and limitations, and structured opportunities for hands-on experience. Such measures, together with proactive knowledge transfer and skills development, are essential to sustainably leverage the practical potential of service robotics in nursing practice.
15 Apr 2026
Read appraisal →PloS one
Exploring barriers and enablers to diabetes self-care practice in Ethiopia, 2025: A qualitative systematic review
INTRODUCTION: Diabetes mellitus is a growing public health concern in Ethiopia, with increasing prevalence and a high proportion of undiagnosed cases. Effective self-care is crucial for managing diabetes; however, many patients face challenges ranging from personal beliefs to systemic and sociocultural constraints. Although multiple qualitative studies have explored these challenges, a synthesized, context-specific understanding that incorporates broader social and health system factors remains limited. This review aimed to synthesize qualitative evidence on barriers and facilitators of diabetes self-care practice in Ethiopia. METHODS: A qualitative systematic review was conducted in accordance with PRISMA 2020 and PRISMA-QS guidelines. A comprehensive search of PubMed/MEDLINE, Scopus, CINAHL, Web of Science, and Google Scholar was performed using relevant keywords and Medical Subject Headings. Eligible studies included primary qualitative and mixed-methods studies with extractable qualitative findings that explored diabetes self-care barriers and facilitators among patients, caregivers, or healthcare providers in Ethiopia. Purely quantitative studies, reviews, editorials, and studies conducted outside Ethiopia were excluded. Thematic synthesis was employed to integrate findings, and the GRADE-CERQual approach was used to assess confidence in the review findings. RESULTS: Eleven studies were included, comprising qualitative and mixed-methods designs conducted across diverse urban and semi-urban healthcare settings in Ethiopia. Study participants included adults with type 1 and type 2 diabetes, as well as healthcare professionals and caregivers. Six major barriers to diabetes self-care were identified: health system limitations, individual-level challenges, socioeconomic constraints, behavioral and lifestyle factors, cultural and social norms, and lack of social support. Key facilitators included strong family and social support, health education and counseling, patient motivation and skills, culturally aligned practices, and signs of health system readiness. CONCLUSION AND RECOMMENDATION: Diabetes self-care in Ethiopia is shaped by interconnected individual, cultural, and systemic factors. While substantial barriers persist, important enablers, particularly family involvement and supportive healthcare interactions, offer opportunities for improvement. Interventions should be culturally sensitive, community-centered, and supported by strengthened health systems. Policy efforts should prioritize integration of diabetes care into primary healthcare services, capacity building of healthcare providers, and incorporation of patients' lived experiences into care planning. Prospero registration number CRD420251033692.
11 Apr 2026
Read appraisal →JMIR mHealth and uHealth
Effectiveness of a Telecare-Based Intervention Program in Supporting Informal Caregivers of Community-Dwelling Older Adults in Reducing Stress Levels: Randomized Controlled Trial
BACKGROUND: Informal caregivers are essential in supporting community-dwelling older adults, especially as global populations age. However, caregiving responsibilities often result in high stress, depressive symptoms, and diminished quality of life. Traditional support services are fragmented, and many programs overlook caregivers' emotional and informational needs. Telecare-the remote delivery of health and social care via digital technologies-offers a promising approach to provide accessible, personalized, and timely support. OBJECTIVE: This study evaluated the effectiveness of a telecare-based intervention program, developed by a health-social partnership team, in improving psychological well-being and caregiving outcomes among informal caregivers of community-dwelling older adults. We hypothesized that caregivers in the intervention group would show greater improvements in stress, self-efficacy, depression, quality of life, and caregiving burden compared to those receiving usual care. METHODS: A single-blind randomized controlled trial was conducted from January to December 2023, with 75 informal caregivers providing care to older adults (aged ≥60 y) for at least 4 hours per week. Participants were randomized to an intervention group (n=38, 51%) or a control group (n=37, 49%). The 3-month intervention included (1) biweekly online nurse case management supported by a multidisciplinary health-social team, (2) personalized WhatsApp videos on caregiving skills, and (3) a password-protected caregiver website offering resources and peer discussion. The control group attended 6 in-person educational sessions at a community center. Outcomes such as stress, self-efficacy, depression, quality of life, and caregiving burden were measured at baseline and postintervention. RESULTS: Participants had a mean age of 65.5 (SD 9.617) years, and 81.3% (61/74) were female. Baseline characteristics were similar between groups. Compared to controls, the intervention group showed significantly higher self-efficacy (t=1.98; P=.04) and lower depression (t=-2.24; P=.03) at follow-up. Within-group improvements in the intervention group were also observed for stress, depression, self-efficacy, mental quality of life, and caregiving burden. No significant between-group differences were found for stress, quality of life, or caregiving burden. No significant within-group improvements were observed in the control group. CONCLUSIONS: This study provides novel evidence that a digitally delivered, nurse-led telecare program-integrating health and social services-can improve psychological outcomes among informal caregivers. These findings have practical implications for health systems seeking scalable, low-barrier solutions to support caregivers. Telecare models may be a valuable complement to traditional services, enhancing caregiver resilience and promoting aging in place while alleviating long-term strain on institutional care systems.
9 Apr 2026
Read appraisal →BMJ paediatrics open
Impact of parent education programmes on confidence and self-efficacy in parents of preterm infants: a systematic review
OBJECTIVE: Families of preterm infants can experience high stress during neonatal intensive care unit (NICU) hospitalisation, which interferes with the development of parenting confidence and self-efficacy through active engagement with their infants. Parent NICU support programmes provide guidance and education to build this connection. This systematic review examined the effects of parent education programmes on confidence and self-efficacy among parents of preterm infants. DESIGN: Systematic review in PubMed/Medline, PsycINFO, CINAHL, Google Scholar and Web of Science. SETTING: NICU. PARTICIPANTS: Parents of preterm infants. INTERVENTION: Education programmes offered to parents in the NICU. MAIN OUTCOME MEASURES: Quantitative surveys measuring parent confidence or self-efficacy. RESULTS: 14 studies met inclusion criteria from an initial 220 identified. Five were randomised controlled trials and nine were non-randomised studies. Programmes combining information delivery with opportunities for parent-infant engagement were most effective. Infant access and time to practise skills were key factors in transferring programme knowledge to increase parent confidence and self-efficacy. While 6 of the 14 studies did not show statistically significant differences between groups, all interventions demonstrated improvements in parental confidence or self-efficacy from baseline. Vast variability in duration of intervention, proper descriptions of facilitator trainings, methodological limitations and potential confounding factors reduced the overall quality of evidence to a low level. CONCLUSION: Both unit-specific programmes developed within individual NICUs and commercially available, copyrighted parent education programmes hold value. They are generally effective in building parent confidence and self-efficacy among parents of preterm infants. Integrating either type of programme into standard NICU care may hold promise for strengthening parental competence and promoting family-centred outcomes. Clarity on content/topics of programmes, duration and level of facilitator trainings can strengthen the process of supporting parents in the NICU, even in low resource settings. PROSPERO REGISTRATION NUMBER: CRD42024524063.
4 Apr 2026
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