INTRODUCTION:Communication difficulties are a common but under-recognized feature of multiple sclerosis (MS) and can affect quality of life, social participation, and engagement with health care. The extent to which communication functioning is associated with health literacy, medication beliefs, and adherence in MS remains poorly understood. METHODS:This cross-sectional study included 307 adults with MS recruited from Al-Bashir Hospital in Amman, Jordan. Participants completed validated Arabic versions of the Communication and Language Assessment Questionnaire for Multiple Sclerosis (CLAMS), the Health Literacy Survey-12 (HLS-Q12), the Beliefs about Medicines Questionnaire (BMQ), and the Medication Adherence Report Scale (MARS-5). Sociodemographic data were collected. Quantile regression analysis was used to examine associations between communication functioning and health literacy, medication beliefs, adherence, and sociodemographic factors. RESULTS:Communication difficulties were commonly reported, particularly problems with word finding, maintaining a train of thought, remembering information, and following conversations. Lower health literacy scores were significantly associated with higher CLAMS scores, indicating greater communication difficulties. Higher medication concern scores were also independently associated with poorer communication functioning. Lower educational attainment was linked to higher CLAMS scores. Medication adherence, necessity beliefs, age, sex, employment status, and income were not significantly associated with communication functioning in the adjusted model. CONCLUSION:Communication difficulties are prevalent among adults with MS and are closely linked to health literacy and medication-related concerns. Addressing these factors may support more effective communication, improved self-management, and better engagement with care.
BACKGROUND:Cognitive impairment (CI) is a prevalent non-motor complication of Parkinson's disease (PD), yet accessible and reliable screening aids remain limited. This cross-sectional study aimed to quantify the strength of association and the cross-sectional classification value of routine blood indicators combined with standardized sleep questionnaires for prevalent CI in PD, using a strictly leakage-free model-development pipeline. METHODS:A total of 347 PD patients were enrolled and classified into PD-CI (n = 143) and PD-NCI (n = 204) groups based on the Montreal Cognitive Assessment (MoCA < 26). The cohort was first divided into training (70%, n = 242) and test (30%, n = 105) sets by stratified sampling; all subsequent feature selection and tuning were confined to the training data. Within the training set, 20 candidate predictors were screened using L1-penalized logistic regression with the lambda.1se criterion, yielding 10 variables. Four nested logistic regression models (baseline clinical, baseline plus blood, baseline plus sleep, and full model) were constructed alongside random forest (RF) and gradient boosting machine (GBM) classifiers. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC) with DeLong confidence intervals and between-model DeLong tests, calibration (slope, intercept, and Brier score with bootstrap intervals) and decision curve analysis; the untouched test set was scored once, and generalization was estimated by repeated 5 × 2 cross-validation. Robustness of the outcome definition was examined with education-adjusted and alternative MoCA cut-offs. RESULTS:The training-set LASSO retained 10 predictors: education, disease duration, Hoehn-Yahr stage, platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), homocysteine, C-reactive protein (CRP), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ). In the untouched test set, the full logistic regression model achieved an AUC of 0.943 (95% CI: 0.896-0.990) in the test set, higher than baseline (0.844), and comparable to the baseline-plus-blood (0.937) and baseline-plus-sleep (0.889) models; the incremental gain over baseline was statistically significant (DeLong p = 0.009). Repeated cross-validation gave a more conservative AUC of 0.921 (SD = 0.029). RF (0.956) and gradient boosting (0.944) did not outperform logistic regression. Calibration was acceptable (slope 1.18, intercept 0.03; test Brier 0.086, 95% CI 0.057-0.120) and findings were stable across alternative MoCA cut-offs (AUC 0.909-0.931). CONCLUSION:Combining routine blood indicators and sleep questionnaires is cross-sectionally associated with prevalent CI in PD and adds information beyond clinical variables alone. Because the design is cross-sectional, single-center, and only internally validated, the model should be regarded as a candidate screening aid that requires external, preferably multicenter and prospective, validation before any clinical use.
ABSTRACT Background There is a lack of comparative studies between posterior circulation saccular aneurysms (SA) and dissecting aneurysms (DA). This study aims to comprehensively compare the clinical characteristics, treatment strategies, and outcomes of SA and DA. Methods We included all consecutive patients with posterior circulation aneurysmal subarachnoid hemorrhage (aSAH) who underwent surgical treatment between January 2017 and December 2020 from the Chinese Multicenter Cerebral Aneurysm Database (CMAD). Baseline data were retrospectively collected, and survival status and 2‐year mRS scores were prospectively assessed. Functional outcomes were categorized as favorable (mRS 0–2) and unfavorable (mRS 3–6). Logistic regression models were used to explore the association between aneurysm morphology and outcomes. Results Note that 406 patients with posterior circulation aSAH who underwent surgical treatment were included, comprising 314 (77.3%) with SA and 92 (22.7%) with DA. In unadjusted analyses, DA was associated with a lower rate of unfavorable outcomes at 2 years (17.1% vs. 34.8%, p = 0.003) but a higher rate of parent vessel sacrifice (22.8% vs. 8.0%, p < 0.001), while ischemic complications were comparable between groups. After further adjustment for covariates, DA showed a trend toward a lower risk of unfavorable outcomes in Model 3 (OR = 0.490, 95% CI 0.237–1.013, p = 0.054). In addition, the association between DA and a higher risk of parent vessel sacrifice remained consistent across all models (Model 1: OR = 3.419, 95% CI 1.811–6.456, p < 0.001; Model 2: OR = 2.737, 95% CI 1.415–5.293, p = 0.003; Model 3: OR = 2.899, 95% CI 1.463–5.747, p = 0.002). Conclusion DA may be associated with a trend toward better long‐term functional outcomes compared with SA. Although parent vessel sacrifice was more frequently required, it was not associated with an increased risk of ischemic complications.
ABSTRACT Objective To explore the cognitive impairment in patients with schizophrenia of different clinical manifestations and its relationship with symptom severity and functional status. Methods The clinical data of 160 patients with schizophrenia who were treated in our hospital from April 2019 to December 2025 were selected for the study. The Positive and Negative Syndrome Scale (PANSS) scores were used to classify patients into the positive group (n = 93) and the negative group (n = 67). The recorded cognitive scores, PANSS scores, and Personal and Social Performance (PSP) scores were compared. Distributional assumptions were examined before analysis; Welch's t‐test and Spearman rank correlation were used, and Hedges' g with 95% confidence intervals was reported for significant between‐group comparisons. Results The positive group had higher PANSS positive symptom and PSP scores but lower PANSS negative symptom scores than the negative group (all p < 0.001). The positive group also showed higher recorded cognitive total and domain scores (all p < 0.001). Spearman analysis showed that PANSS negative symptom scores were inversely correlated with the recorded cognitive total score and PSP score (rho = −0.350 and −0.464, respectively), whereas PANSS positive symptom scores were positively correlated with these outcomes (rho = 0.652 and 0.781, respectively; all p < 0.001). The recorded cognitive total score was positively correlated with PSP score (rho = 0.655, p < 0.001). Conclusion Cognitive performance differs across clinical symptom profiles in schizophrenia. Patients with predominant negative symptoms showed poorer cognitive performance and social functioning than patients with predominant positive symptoms. These findings support assessment of symptom profile, cognition, and functioning together, without implying causality.
BACKGROUND:This study aims to evaluate and compare the effects of two neurorehabilitation methods-action observation therapy (AOT) and XBOX 360 Kinect™ (XBOX) on upper extremity body structure functions, activity, and functional participation levels in children with Unilateral Cerebral Palsy (UCP). METHODS:Forty-five children with UCP (aged 5-15 years) were randomly divided into three groups: AOT, XBOX, and Conventional (CNV). All groups received conventional physiotherapy (45 minutes, twice weekly for 3 weeks). The AOT group had additional 30-minute daily telerehabilitation sessions, while the XBOX group used XBOX 360 Kinect for the same duration. Evaluations included the Modified Ashworth Scale (MAS), Jamar Hand Dynamometer, Baseline Mechanical Grip Meter, Selective Control of the Upper Extremity Scale (SCUES), Jebsen Taylor Hand Function Test (JTHFT), Abilhand-Kids, and Pediatric Quality of Life Inventory (PedsQL). Statistical significance was set at p<0.017. RESULTS:Both AOT and XBOX groups showed greater improvements than CNV(p<0.017). AOT achieved clinically meaningful gains in all grasp types and selectivity, while XBOX mainly improved pinch, lateral grip, and forearm selectivity. Both groups improved in ABILHAND-Kids and PedsQL, with broader gains in AOT. CONCLUSION:AOT and XBOX are effective supplementary therapies for upper extremity rehabilitation in children with UCP, complementing conventional physiotherapy. CLINICAL TRIAL NUMBER:NCT05327179.
BACKGROUND:Neurogenic bowel dysfunction significantly affects those living with spinal cord injury (SCI). Guidelines position colostomy as a last resort, but this is not reflected in current practice. Pathways and professional attitudes are inconsistent. AIM:Explore the attitudes of health professionals towards colostomy as an option for people living with SCI. METHODS:Online questionnaire for health professionals; descriptive statistics and thematic analysis. RESULTS:122 responses. Indications for colostomy: increasing independence (87%), intractable bowel difficulties (82%), patient choice (80%). Concerns regarded complications (71% overall), decisional regret (35% overall) and access to specialist nursing/lack of patient education (each 32% overall). Free-text analysis revealed themes of 'Lives transformed', 'Patient-centred choice', 'Right services, right reasons', 'Colostomy concerns', 'Health professionals' knowledge gaps', 'Differing perspectives' and 'Patient education is key'. CONCLUSION:Attitudes to colostomy are shifting, however concerns and inconsistencies in pathways, knowledge and support persist. Guidance needs to evolve to reflect current practice and incorporate patient perspectives.
Sam Foster discusses what can be learnt from the Ockenden and Amos reviews and identifies challenges that all nursing leaders should consider, including the importance of listening to our staff.
BACKGROUND:Convex baseplates are essential in ostomy care for patients with challenging stomas. However, guidelines for optimal use remain limited. Clear recommendations are needed since appropriate convexity selection is central to prevent leakage and peristomal skin complications. AIM:To develop consensus-based best practice guidelines for clinical routine and use of convex baseplates from the early postoperative period in Nordic ostomy care. METHOD:A scoping literature review and input from a Nordic advisory board informed 14 statements related to standard stoma care and indications/follow-up when using convexity. Consensus was explored using a modified Delphi method and nominal group technique (NGT) with stoma care nurses from Sweden, Norway, Denmark and Finland. FINDINGS:With modifications of four and removal of one, consensus was finally achieved for 13 statements. CONCLUSION:This study provides a structured framework for optimal use of convexity in Nordic ostomy care, supporting more consistent clinical practice and enabling an individualised approach to improving patient outcomes.
People with intellectual disability have a higher prevalence of epilepsy, care complexity, comorbidity and polypharmacy than the general population. These patients are often found to be on multiple medications without a clear rationale for ongoing prescriptions. Recent evidence has highlighted the ongoing exposure to avoidable health inequalities and premature death in this population group, in which medicines management can play an influential role. This article aims to identify practical interventions to mitigate the risk of diagnostic overshadowing and health inequalities in individuals with intellectual disability and complex epilepsy. The discussion centres on a comprehensive retrospective analysis of the care outcomes experienced by an individual with a diagnosed epilepsy syndrome (Lennox-Gastaut syndrome). Rationalising medication is complex but can reduce the risk of drug interactions and adverse outcomes. Iatrogenic effects can be mistaken for physical health symptoms and confound care pathways. Systematic assessment and collaboration with appropriately experienced clinicians improves outcomes. Prospective therapeutic drug monitoring may have a role to play in mitigating adverse outcomes and diagnostic overshadowing in individuals with intellectual disability and complex epilepsy.
Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses limitations that restrict the right to liberty, potentially exposing the vulnerable to disproportionate restrictions and undignified care.
Person-centred care (PCC) emphasises the overall identification of patients as individuals with emotional, social and psychological needs, especially in cases of profound changes in self-image, such as colostomy care. This article is a reflective case analysis of the care received by Mr Z. Mr Z is a retired professional who experienced emotional withdrawal after a permanent colostomy. This case analysis draws on the experience and insights gained during a clinical placement in the gastrointestinal surgery ward, highlighting the subtle but transformative role that emotional labour and relationship consistency can produce in person-centred care. Guided by three theoretical frameworks (the Fundamentals of Care Framework, the theory of Emotional Labour, and Bassot's Integrated Reflective Cycle), the authors critically examine how trust is established over time, how patients gradually re-engage in their care, and how nurses manage emotional boundaries while maintaining their presence. Even in an emotionally silent environment, person-centred care can be promoted through micro-adjustments to tone, timing and non-verbal communication. This reflective analysis emphasises the significance of emotional labour, which is usually not recognised in clinical care, and demonstrates how it can help reshape patients' autonomy and dignity.
Sexual harassment within health care, particularly in the NHS, has become an increasingly urgent concern following high-profile investigations and surveys exposing unacceptable workplace behaviours. Acute care settings such as theatres and critical care units appear to carry a higher risk for sexually inappropriate conduct, with many staff reporting unwanted sexual behaviours from colleagues, patients and the public. This article explores the prevalence of sexual harassment among acute care nursing teams in the NHS, analyses contributing factors, including organisational culture and under-reporting, and examines barriers to disclosure. Drawing upon national data and academic literature, it also evaluates potential solutions, including staff education, improved policy access, and the introduction of e-learning and active bystander training. Recommendations aim to support a cultural shift towards zero tolerance, encourage psychologically safe reporting mechanisms and protect nurses from harm. Ultimately, sexual harassment-free clinical environments demands urgent and sustained leadership at all levels of NHS care.
BACKGROUND:the professional nurse advocate (PNA) programme was introduced in 2021 to support nurse wellbeing and resilience after the pandemic through the Advocating for Education Quality Improvement (A-EQUIP) model. However, the impact of PNAs' quality improvement (QI) work remains underexplored. AIMS:This study aimed to explore the PNA leadership role in QI work and how these nurses develop QI initiatives. METHODS:A qualitative research design involved semi-structured interviews with eight PNAs. Themes were identified using thematic analysis. FINDINGS:The four themes related to: PNA preparedness for QI work and identifying projects; implementing projects and collaboration; monitoring and reporting on QI projects; and impact on patient outcomes, the reach of projects and sustainability. PNAs reported improvements in patient care and experience but challenges in preparedness and support were noted. CONCLUSION:This study emphasises the importance of organisational support, collaboration, time and ongoing transitional training if PNAs are to lead QI projects effectively.
John Tingle, Associate Professor, Birmingham Law School, University of Birmingham, discusses some recently published reports and considers the debate about relative priorities of patient safety and healthcare quality.
The 2018 Nursing and Midwifery Council's 'Future Nurse' standards introduced increased genericism to UK nursing education, prompting criticism from specialist fields concerned about diluted field-specific knowledge. This article reports on a curriculum innovation at one UK university that addressed local implementation challenges through targeted module development to include an increased number of field-specific modules alongside core content. Among others, two new modules were introduced, one on mental health for adult nursing students, and one on children and young people's mental health for both mental health and children's nursing students. Qualitative feedback revealed initial student hesitation about mental health content among adult nursing students, which improved by module completion. The children's mental health module demonstrated better alignment with student expectations. Despite implementation challenges, including appropriate content depth and delivery timing, both modules showed evidence of success. This curriculum innovation demonstrates a practical response to balancing generic competencies with field-specific expertise requirements.
Urinary tract infections (UTIs) are a common cause of morbidity in the paediatric population, with prevalence varying according to age, sex, and circumcision status. Differentiating between upper and lower tract infections is crucial, as upper UTIs carry a greater risk of renal scarring and long-term complications. Accurate diagnosis and timely management reduce acute symptoms and prevent sequelae such as chronic kidney disease and hypertension. Current guidance recommends urgent referral for infants under 3 months of age, short-course oral antibiotics for uncomplicated cystitis in older children, and longer treatment for pyelonephritis. Preventive strategies emphasise addressing risk factors such as constipation, hydration and bladder dysfunction, while limiting prophylactic antibiotic use to high-risk cases. Education of parents and carers is central to early recognition and long-term management.
