Tag: pubmed

Nurs Open. 2026 Apr;13(4):e70541. doi: 10.1002/nop2.70541.

ABSTRACT

BACKGROUND: Internationally qualified nurses (IQNs) form a critical part of the global health workforce, yet persistent structural inequities continue to limit their recognition and career mobility. Health systems in developed countries rely on IQNs to address shortages, but structural bias, credential hierarchies, and historically embedded knowledge valuation systems impede the full utilisation of their specialty skills. While regulatory standards are designed to protect patient safety, misalignment between global education systems and local recognition frameworks can inadvertently produce inequitable outcomes.

AIM: To explore how IQNs transfer and apply their specialty skills within the Australian health system and to identify the equity-oriented facilitators and barriers that shape this process.

DESIGN: A meta-synthesis of a sequential explanatory mixed-methods research program, underpinned by a pragmatic and explicit equity framework informed by principles of fairness, transparency, and recognition of global competence.

METHODS: Four interconnected studies (online surveys, interviews, and focus groups) were conducted with IQNs and recruiting managers across Australia. Phase 3 involved a meta-synthesis of findings from Phases 1 and 2, which were previously published, using joint display analysis and meta-inference generation to examine structural, organisational, and individual determinants of specialty skill utilisation.

RESULTS: Findings across four primary empirical studies reported in six peer-reviewed publications reveal that IQNs bring advanced specialty expertise that can enhance care quality and equity. However, system-level constraints, including recruitment bias, fragmented transition pathways, and inconsistent recognition of international qualifications, restrict their impact. Equity-focused transition programs and inclusive leadership development for both IQNs and recruiting managers emerged as critical mechanisms for change.

CONCLUSION: Harnessing IQNs’ specialised skills is not only a workforce imperative but a matter of justice. Balancing regulatory standards for patient safety with equitable recognition practices will enable nurses to act as agents of transformative change.

PATIENT OR PUBLIC CONTRIBUTION: The study involved 115 participants (n = 71 IQNs; n = 44 recruiting managers) whose lived experiences illuminate the urgent need for inclusive policy reform and equity-driven workforce transformation.

PMID:41964306 | DOI:10.1002/nop2.70541

Orthod Craniofac Res. 2026 Apr 10. doi: 10.1111/ocr.70122. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the dentoalveolar effects on the upper first premolars after two maxillary expansion protocols-rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC)-before and 6 months after treatment.

MATERIALS AND METHODS: Cone-Beam Computed Tomography (CBCT) images of 20 patients who underwent maxillary expansion with the Hyrax appliance under two activation protocols were evaluated. Dental and alveolar measurements at the premolar region (tooth length, alveolar bone level and thickness) were measured before (T1) and after expansion (T2). Intra- and inter-examiner reliability was determined using Intraclass Correlation Coefficients. Statistical analyses included the Shapiro-Wilk test and Student’s t-tests for paired and independent samples. Statistical significance was set at 5%.

RESULTS: A significant increase in interpremolar distances was observed, both in the radicular and coronal levels (4.29 mm and 4.97 mm), with greater coronal than root distance. This was more evident in the Alt-RAMEC group. Alveolar thickness showed an average reduction of 0.54 mm after expansion.

CONCLUSIONS: The expansion effects of the two protocols were similar in the premolar region, resulting in a reduction in alveolar thickness. A tendency for greater tooth inclination and root reduction was observed after the Alt-RAMEC protocol.

TRIAL REGISTRATION: IRB: 42856915.1.0000.5336.

PMID:41964302 | DOI:10.1111/ocr.70122

Transfusion. 2026 Apr 10. doi: 10.1111/trf.70172. Online ahead of print.

ABSTRACT

BACKGROUND: Low Titer Group O Whole Blood (LTOWB) use has expanded to include patients with non-traumatic bleeding etiologies. While a large body of evidence supports a potential survival benefit of LTOWB in trauma patients, data demonstrating the safety and efficacy of LTOWB in non-trauma patients are lacking.

STUDY DESIGN AND METHODS: Non-trauma adult patients at two hospitals who received at least one unit of LTOWB were included in the study. Patient demographics, transfusion and laboratory data, diagnoses, mortality, and hospital length of stay were collected between January 1, 2018, and June 30, 2024. LTOWB recipients were further stratified by O versus non-group O blood group, and laboratory markers of renal failure and hemolysis were compared between these two groups.

RESULTS: A total of 319 unique patients with 320 LTOWB transfusion episodes were included. The most common indications for transfusion were gastrointestinal and cardiovascular bleeding (266/320, 83%). In-hospital survival at 24 h and 30 days posttransfusion was 75% and 53%, respectively. There was no statistically significant difference in markers of hemolysis between group O and non-group O LTOWB recipients. There were no reported transfusion reactions.

DISCUSSION: In non-trauma settings, LTOWB was most commonly utilized in patients with gastrointestinal and cardiovascular bleeding. LTOWB is a safe alternative to component therapy in non-trauma adult populations. However, additional studies are needed to focus on efficacy and clinical outcomes in non-trauma patients that receive LTOWB for severe hemorrhage.

PMID:41964300 | DOI:10.1111/trf.70172

Pain Res Manag. 2026;2026(1):e8822463. doi: 10.1155/prm/8822463.

ABSTRACT

BACKGROUND: Toradol, a potent nonsteroidal anti-inflammatory drug, is widely used for perioperative analgesia, especially in orthopedic surgeries. Postmarketing surveillance is crucial due to its extensive clinical application. This study aimed to investigate adverse events (AEs) associated with Toradol using the FDA Adverse Event Reporting System (FAERS), analyze the association strengths of key AEs, and provide clinical references.

METHOD: FAERS data from 2004 Q1 to 2017 Q4 were analyzed, including reports where Toradol was the primary suspect drug. Disproportionality analyses were conducted using ROR, PRR, BCPNN, and EBGM algorithms to detect safety signals.

RESULT: Among 377 eligible reports, key AEs included immune system disorders (anaphylactic reaction, ROR = 16.28), renal and urinary disorders (oliguria, ROR = 25.57), and gastrointestinal disorders (erosive duodenitis, ROR = 231.08). Notably, 29.86% of reports were from consumers, with a lower proportion from healthcare professionals. Most AEs (73.10%) occurred within 7 days of administration; rare but severe events, including deafness and cardiorespiratory arrest, were also identified.

CONCLUSION: Our findings, derived from hypothesis-generating signal detection analyses, provide real-world safety data on Toradol, highlighting high-risk AEs and reporting biases. Enhanced vigilance and monitoring, especially in high-risk populations, are imperative. However, these signals require confirmation through prospective, controlled studies to establish causality.

PMID:41964289 | DOI:10.1155/prm/8822463

Nurs Open. 2026 Apr;13(4):e70543. doi: 10.1002/nop2.70543.

ABSTRACT

AIM: This study aims to examine the relationships among cultural intelligence, teamwork cognition and teamwork attitude, which are deep-seated factors influencing teamwork among nursing students.

DESIGN: This was a cross-sectional survey study.

METHODS: Convenient sampling was used to select 301 nursing students from a nursing college in Shanghai for this investigation. The data collection utilized a self-made general information questionnaire, cultural intelligence scale, teamwork attitude scale and teamwork cognition scale. Statistical methods such as t-tests, Pearson correlation analysis and structural equation modeling were employed for the analysis of the mediating effects.

RESULTS: The scores for nursing students were (4.45 ± 0.79) for cultural intelligence, (3.84 ± 0.78) for teamwork attitude and (3.85 ± 0.63) for teamwork cognition. Cultural intelligence showed a positive correlation with both teamwork cognition and attitude (r = 0.639, 0.507, both p < 0.01). Teamwork attitude partially mediated the association between cultural intelligence and teamwork cognition (β = 0.42, p < 0.01), with direct and indirect effects of 0.32 and 0.42, respectively.

CONCLUSIONS: Cultural intelligence was positively associated with teamwork cognition among nursing students, and teamwork attitude may partially mediate this association. These findings suggest that strengthening cultural intelligence and teamwork attitude may support teamwork cognition in nursing education. However, because of the cross-sectional design, these findings should be interpreted as correlational rather than causal. No Patient or Public Contribution.

PMID:41964286 | DOI:10.1002/nop2.70543

J Investig Med. 2026 Apr 10:10815589261444738. doi: 10.1177/10815589261444738. Online ahead of print.

ABSTRACT

BACKGROUND: In clinical practice, effectively managing agitation and hemodynamic stability during general anesthesia awakening remains challenging, despite their importance for patient safety and recovery.

PURPOSE: This study aimed to expound the effect of dexmedetomidine combined with anesthesia awakening nursing on agitation and hemodynamics in patients under general anesthesia during awakening period.

STUDY TYPE: A prospective studyPopulation: Ninety patients who underwent general anesthesia surgery were selected and divided into a control group (dexmedetomidine+routine nursing care) and an intervention group (dexmedetomidine+anesthesia awakening nursing), with 45 cases in each group.Assessment technique(s) or outcome(s):The post-anesthesia recovery room stay and awakening time, VAS score, the occurrence of agitation during the awakening period, and incidence of adverse reactions were compared.

STATISTICAL TESTS: Categorical data were expressed as rates or percentages; measurement data were expressed as mean ± standard deviation. Differences were significant at P < 0.05 (two-sided).

RESULTS: Intervention group patients had shorter recovery room stay (29.98±6.88 vs. 37.78±6.58 min) and recovery time (8.52±0.99 vs. 10.62±0.99 min) versus controls (P<0.05). VAS scores were lower at 2 hours (4.53±0.63 vs. 5.58±0.54) and 6 hours post-surgery (2.47±0.69 vs. 4.49±0.51). Anesthesia recovery agitation (13.33% vs. 37.78%) and postoperative adverse reactions (11.11% vs. 44.44%) were reduced (all P<0.05).

DATA CONCLUSION: Dexmedetomidine combined with anesthesia awakening care can enhance sedation scores, reduce pain levels, and have a minimal impact on patients’ hemodynamics, ultimately improving the quality of awakening. This approach also leads to higher patient satisfaction with care, making it a promising option for clinical promotion and application.

PMID:41964271 | DOI:10.1177/10815589261444738

Microbiome. 2026 Apr 10. doi: 10.1186/s40168-026-02337-5. Online ahead of print.

ABSTRACT

BACKGROUND: Salivary agglutinin, also known as deleted in malignant brain tumors 1 (DMBT1), is an anti-microbial protein. DMBT1 is low in saliva from patients with oral squamous cell carcinoma (OSCC) and dramatically increases after treatment, with accompanying microbial changes. While this suggests an association between DMBT1 suppression and changes in the oral microbiota, causation has not been established. DMBT1 is also a tumor suppressor protein; its loss promotes OSCC progression, but its role in OSCC development is unknown. In this study, OSCC development was investigated in a murine carcinogen model that simulates human OSCC. Microbiota were standardized between Dmbt1 knockout (Dmbt1^-/-) and wild-type (Dmbt1^+/+) mice via interbreeding and co-housing. Saliva was collected at baseline and at 4, 8, 12, 16, and 22 weeks post-carcinogen initiation (stopped at 16 weeks). Tongues were harvested at week 22 for histopathology, and the salivary microbiome was profiled by 16S rRNA sequencing. Microbial diversity metrics and conditional dependence networks assessed community structure, while longitudinal patterns were analyzed using a locally sparse varying coefficient mixed model and functional principal component analysis (fPCA).

RESULTS: Despite microbiota standardization, Dmbt1^-/- and Dmbt1^+/+ displayed differences in microbiome composition based on β-diversity metrics. At endpoint, carcinogen-treated Dmbt1^-/- showed higher OSCC prevalence and more aggressive invasion than Dmbt1^+/+. Several OTUs, including those from Lachnospiraceae, Sphingomonas, Carnobacteriaceae, and Candidatus Saccharibacteria families, demonstrated differential abundance patterns over time, either genotype-specific, diagnosis-specific, or both. Notably, Sphingomonas and Lachnospiraceae exhibited time-dependent abundance differences in mice that developed OSCC. fPCA identified taxa with abundance trajectories that were different between OSCC and precancer and genotype specific.

CONCLUSIONS: Thus, DMBT1 shapes salivary microbiota composition and protects against OSCC development. Dynamic, genotype-specific microbial shifts during carcinogenesis underscore the complex interplay between the oral microbiota and cancer progression. Video Abstract.

PMID:41964098 | DOI:10.1186/s40168-026-02337-5

Ital J Pediatr. 2026 Apr 10;52(1):56. doi: 10.1186/s13052-026-02236-3.

ABSTRACT

BACKGROUND: Antimicrobial resistance (AMR) represents a threat to global public health. The antibiotics’ effectiveness against a variety of infections consequently has been declined with increasing morbidity, mortality, and treatment failure. To combat this, the implementation of Antimicrobial Stewardship Programs (ASPs) is essential for slowing the spread of resistant pathogens.

AIM OF THE WORK: The current study aimed to assess the outcomes following implementation of Antimicrobial Stewardship Program (ASP) at Alexandria University Children’s Hospital.

METHOD: The study was conducted over nine months in a general pediatric ward. First, the medical records and microbiological reports were reviewed to establish tailored antibiotic guidelines. During the intervention phase, the ASP focused on prospective audits and physicians’ education. The program’s impact was evaluated through several key metrics: adherence to the guidelines, patient outcome (mortality rate and length of stay) and antibiotic consumption (expenditure, days of therapy, and treatment duration). All statistical analyses were conducted using IBM SPSS version 20.0.

RESULTS: 219 patients in the preintervention phase were compared to 214 patients (post-intervention). Following ASP, the use of single antibiotics increased in post-intervention (69.6% versus 26%). During the study period, 70 interventions were required with a high acceptance rate (59%). The mean length of hospital stays decreased [10.80 (3-26) versus 12.89 (4-33) days], and both DOT/1000 patients and the average cost of antibiotics decreased (27.82% and 44.94%, respectively). Following ASP, the use of Tigecycline (-100%), Meropenem (-57.79%), and Vancomycin (-46.35%) reduced with an increase in the use of Cefotaxime (80.43%), Ceftriaxone (20.27%), and Ceftazidime (62.87%).

CONCLUSION: The implementation of institutional guidelines along with Prospective Audit and Feedback (PAF) was associated with improvements in antibiotic utilization, particularly in the resource-limited settings.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:41964087 | DOI:10.1186/s13052-026-02236-3

Nurs Open. 2026 Apr;13(4):e70525. doi: 10.1002/nop2.70525.

ABSTRACT

AIM: To identify the factors influencing nurses’ Evidence-based practices (EBP) competencies and clinical decision-making (CDM) levels.

DESIGN: A convergent parallel mixed-methods study.

METHODS: The quantitative data were collected from 387 nurses via the EBP Competence Questionnaire and the Clinical Decision-Making in Nursing Scale, while qualitative data were gathered from semi-structured interviews with 20 nurses. Quantitative data were analysed using descriptive statistics, ANOVA, and multiple linear regression, and qualitative data were subjected to thematic content analysis.

RESULTS: Regression analysis revealed that higher education, research involvement, and following scientific publications positively influenced EBP competencies. Working in inpatient units and clinical nursing roles negatively affected EBP and CDM abilities. A significant positive correlation was found between EBP competence and CDM skills. Qualitative findings identified four themes: Implementation Areas of EBP, Competence in EBP, Impacts of EBP, and Facilitators and Barriers to EBP.

CONCLUSION: Strengthening nurses’ EBP competencies and CDM requires targeted strategies such as education, access to organizational resources and supportive policies.

IMPLICATIONS FOR THE PROFESSION: Addressing barriers and fostering a culture of continuous learning can enhance patient care and nursing outcomes.

IMPACT: By addressing gaps in EBP implementation and decision-making skills, the findings serve as a benchmark for policymakers, educators and healthcare administrators to create supportive infrastructures, promote continuous professional development, and foster a culture of evidence-based practice worldwide.

REPORTING METHOD: The study was reported in accordance with the GRAMMS guidelines.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

PMID:41964064 | DOI:10.1002/nop2.70525

Arthroplasty. 2026 Apr 10;8(1):26. doi: 10.1186/s42836-026-00383-w.

ABSTRACT

BACKGROUND: Dislocation is a serious complication that should be avoided in total hip arthroplasty (THA). Combined anteversion (CA) of the cup and stem is a concept for appropriate implant positioning; however, the effect of functional changes in femoral rotation has not been well investigated. In this study, we investigated whether functional CA, considering femoral rotation, is associated with dislocation in patients who underwent revision THA.

METHODS: Overall, 82 patients who underwent revision THA and had at least one year of follow-up with pre-operative and post-operative supine computed tomography imaging were included. The cup and stem were placed with a target combined angle of 37.3° using Widmer’s formula. Anatomical and functional CAs were calculated post-operatively. Functional CA was defined as the sum of cup anteversion and stem anteversion, with femoral external rotation. Patient demographics, component alignment parameters, CA, and their association with post-operative dislocation were statistically evaluated.

RESULTS: Dislocation was observed in 12 patients. In these dislocated cases, there were no significant differences in cup angle, stem angle, and anatomical CA compared to non-dislocated cases. However, dislocated cases showed significantly higher values of functional CA (50.0 ± 17.4° [range, 5.5-67.6] vs. 35.6 ± 13.0° [range, 4.0-68.8], p = 0.022) and significant deviation from identical CA [15.0 ± 8.9° [range, 3.1-31.8] vs. 7.5 ± 8.1° [range, 0.1-33.3], p = 0.014).

CONCLUSIONS: Functional CA, considering femoral rotation, was associated with post-operative dislocation after revision THA. Therefore, consideration of femoral rotation may be important for implant positioning in revision THA.

PMID:41964056 | DOI:10.1186/s42836-026-00383-w