Nursing excellence depends not only on individual clinical competence but also on the organizational conditions in which nurses work, learn, lead, and participate in patient care. This systematic literature review synthesized 17 substantive nursing sources supplied for the revised manuscript to examine nurse empowerment, nursing leadership, professional development, work engagement, workforce well-being, professional identity, cultural values, and community engagement. The literature includes studies and reviews from the Philippines and international settings published from 2021 to 2026. The synthesis identified five interconnected areas: nurse empowerment and participation; nursing leadership and professional support; professional development, education, and incentives; work engagement, well-being, and workforce sustainability; and professional identity, cultural values, collaboration, and community engagement. The reviewed literature indicates that empowerment is associated with professional and organizational outcomes, while supportive leadership and continuing development strengthen nurses’ capacity to respond to changing healthcare needs. Evidence also emphasizes the importance of healthy work environments, rewards, professional identity, cultural responsiveness, and collaboration. The review concludes that nursing excellence is best understood as an organizational and professional system in which nurses are empowered, supported, continuously developed, and enabled to contribute to quality nursing practice.
BACKGROUND:Myocardial infarction (MI) incidence is increasing in adults aged < 40 years, however, as many as 25% may occur with no traditional risk factors. AIM:To look at non-traditional risk factors for early onset MI. METHODS:Based on the guidance of PRISMA-2020, search of PubMed, EMBASE, Web of Science, Scopus and Cochrane Central Register of Controlled Trials between April 2015 and April 2020 for observational studies focusing on the association between non-traditional risk factors and MI in adults aged 18-40 years. Two reviewers independently screened studies, extracted data and checked quality using Newcastle-Ottawa Scale or Agency for Healthcare Research and Quality checklist. The protocol was registered in PROSPERO, No. CRD420251061098. RESULTS:Thirteen studies (7 cohort, 4 case-control, 2 cross-sectional) from 11 countries met inclusion criteria with a sample size ranging from 154 participants in a pilot case-control study to 5.7 million people in a United States National Inpatient Sample analysis. Psychosocial factors showed consistent associations: Depression showed an MI risk 1.6-3.1-fold higher and being unpartnered was associated with a post-MI readmission risk that was 28%-31% higher. Autoimmune conditions had the greatest associations, with human immunodeficiency virus infection quadrupling odds of MI (4.06), and the risk of systemic lupus erythematosus doubling (2.12). Obstructive sleep apnea increased major adverse cardiovascular events by almost four times (hazard ratio = 3.87). Adhering to the Mediterranean diet was protective (odds ratio = 0.55). Accelerated biological aging (shortening of telomeres) separated young patients with MI from controls. Traditional risk factors did not account for up to 30% of MI cases in each of the cohorts. Most studies were of moderate to high quality, although causes of heterogeneity in design and age stratification of participants mixtures limited causality inference. CONCLUSION:Non-traditional psychosocial, autoimmune, inflammatory, and lifestyle factors play an important role in the risk of MI in young adults. Integrating these factors into risk prediction models could improve the early identification of high-risk individuals and target prevention strategies for this vulnerable population.
Extracorporeal membrane oxygenation (ECMO) provides short-term cardiopulmonary support for patients with end-stage heart and lung failure and is increasingly used as a bridge to transplantation. Its expanding clinical role has prompted the need to clarify how patient selection, timing of initiation, and complication risks influence transplant eligibility and outcomes. This review aims to evaluate contemporary evidence on ECMO as a bridge to heart and lung transplantation by outlining selection criteria, analysing the timing of intervention, summarising survival and complication data, and identifying the limitations that prevent consistent clinical standardisation. For the selection of articles, a narrative review approach was used. Articles were screened from PubMed and Rayyan, restricted to English-language studies published within the past 15 years, using the search terms "ECMO", "heart failure", and "lung failure". Paediatric studies and non-English literature were excluded. Across the literature, patient selection is guided by absolute contraindications (e.g., chronic multiorgan dysfunction, unrecoverable primary cardiac disease) and relative contraindications such as advanced age. Early initiation of ECMO is consistently associated with improved survival. The venoarterial (VA)-ECMO and venovenous (VV)-ECMO provide critical cardiac and respiratory support with varying survival outcomes; however, the therapy is associated with substantial clinical risks, including renal failure, significant bleeding, systemic infection, and vascular complications such as stroke or limb ischaemia. Prolonged bridging due to donor shortages further complicates outcomes and limits comparability across centres. Thus, it reinforces that ECMO is a crucial bridge to heart and lung transplantation. However, its effectiveness depends on precise patient selection, early and standardised initiation strategies, and unified clinical guidelines. Improved standardisation and consistent reporting are essential to optimise outcomes and strengthen long-term post-transplant evidence.
BACKGROUND:There is a profound gap in the access and affordability of quality mental healthcare for distressed Filipino migrant workers taking refuge in government welfare shelters worldwide. Known as Overseas Filipino Workers (OFWs), these hardworking individuals brave the unknown in hopes of a better future. However, for a country that prides itself on its labour export, inadequate measures exist to address mental health disorders that arise from difficult overseas experiences. This study aimed to develop evidence-informed policy recommendations for integrating telepsychiatry services delivered by Filipino mental health professionals into existing OFW programs. METHODS:A multi-stakeholder engagement approach was employed through four focus group discussions with 32 key representatives from relevant government agencies, professional organizations, academics, and policy implementers in November 2024. RESULTS:Five critical themes emerged: (1) Perceived benefits and opportunities to safeguard mental wellbeing; (2) Implementation barriers encompassing technical infrastructure limitations, workforce capacity constraints, and operational challenges; (3) Policy framework requirements including institutionalisation mechanisms, regulatory harmonisation, and bilateral health agreements; (4) Health financing considerations addressing sustainable funding models, insurance coverage expansion, and cost-sharing arrangements; and (5) Health service delivery infrastructure highlighting digital platform development and data security protocols. Findings informed the development of agency-specific policy briefs and a comprehensive stakeholder implementation framework. CONCLUSIONS:Telepsychiatry integration requires coordinated health system strengthening across multiple sectors, tackling policy, financing, and service delivery components simultaneously. These findings have the potential to transform mental health support for OFWs through technology-enabled care delivery, marking a significant step towards inclusive and equitable service for this vulnerable population.
