Background:Anemia is a common complication of chronic kidney disease (CKD) and is predominantly managed with erythropoiesis-stimulating agents (ESAs). Hemoglobin response to ESA therapy varies substantially among patients and remains difficult to predict owing to multiple interacting clinical and treatment-related factors. Machine learning approaches may help model hemoglobin dynamics using routinely collected clinical data. Purpose:To develop and evaluate machine learning models for predicting weekly hemoglobin changes in patients with CKD receiving ESA therapy. Patients and Methods:A retrospective cohort study was conducted using electronic medical records from a tertiary care center in Thailand (January 2012 to December 2022). Adult patients with CKD stages 3B-5 and an estimated glomerular filtration rate (eGFR) below 45 mL/min/1.73 m2 receiving ESA therapy were included. Four machine learning algorithms (Decision Tree, Random Forest, XGBoost, and Support Vector Machine) were trained using data from 80% of patients and evaluated on an independent test set comprising the remaining 20% of patients, with all longitudinal observations from each patient kept within the same partition. Performance was assessed using root mean square error (RMSE) and Pearson correlation coefficient. Results:A total of 834 patients contributing 10,335 clinical visits and 9,935 time-series observations were included. The median age was 71 years and 58.6% were female. RMSE values were 0.121, 0.115, 0.117, and 0.115 for Decision Tree, Random Forest, XGBoost, and Support Vector Machine, respectively. Pearson correlation coefficients ranged from 0.457 to 0.553 (all p < 0.001). Conclusion:Machine learning models trained on routinely collected clinical data showed feasibility for predicting short-term hemoglobin variability in patients with CKD receiving ESA therapy. Larger multicenter and external validation studies are needed to refine predictive accuracy and evaluate clinical utility.
INTRODUCTION:Integrated, people-centred care requires continuity and coordination across services, and nurses increasingly contribute to case management; however, evidence on its effectiveness for older adults living at home remains limited. This systematic review aimed to evaluate the effectiveness of nurse-led case management for community-dwelling older adults compared with usual care. METHODS:PubMed, CINAHL, Embase and the Cochrane Central Register of Controlled Trials were searched from inception to 13 August 2025, for randomised controlled trials comparing nurse-led case management with usual care among community-dwelling older adults with frailty or risk of functional impairment. Primary outcomes were institutionalisation, hospital admissions and mortality. Secondary outcomes included quality of life, emergency department visits, physical function, costs, client satisfaction and days living at home. This review was reported in accordance with PRISMA 2020. RESULTS:Fifteen trials involving 7995 participants were included. The evidence was of very low certainty for institutionalisation, mortality and hospital admissions, with pooled estimates indicating little to no difference. Nurse-led case management probably results in a slight improvement in the physical aspect of quality of life (SMD 0.08, 95% CI 0.00-0.15; moderate certainty). It probably also results in a slight improvement in the mental aspect of quality of life, although the confidence interval included no effect and probably results in little to no difference in physical function. Evidence regarding emergency department visits was of very low certainty. CONCLUSION:The evidence for the effects of nurse-led case management on institutionalisation, hospital admissions and mortality was of very low certainty. Nurse-led case management probably results in a slight improvement in the physical aspect of quality of life, although the clinical importance of this effect remains uncertain. Implementation and evaluation should align with the current uncertainty regarding healthcare utilisation outcomes and include patient-reported outcomes alongside utilisation outcomes. Future research and policy evaluation should use frameworks that assess long-term continuity and coordination of care and system-level impacts, in addition to individual health outcomes. IMPLICATIONS FOR PRACTICE:Nurse-led case management may yield a small improvement in physical quality of life for community-dwelling older adults, while effects on institutionalization, hospital admissions and mortality should be interpreted cautiously because the certainty of evidence is very low. Routine evaluation of nurse-led case management should include patient-reported outcomes, such as quality of life, alongside healthcare utilization outcomes. TRIAL REGISTRATION:PROSPERO: CRD420251114141.
Objective:To systematically compare the clinicopathological features and prognostic outcomes of renal-limited thrombotic microangiopathy (RL-TMA) and systemic thrombotic microangiopathy (Sys-TMA) using a semiquantitative pathological scoring system. Methods:We retrospectively analyzed 47 patients with biopsy-proven TMA between 2018 and 2025, categorized as RL-TMA (n = 42) or Sys-TMA (n = 5) based on systemic manifestations. Clinical, pathological, and follow-up data were collected. A composite renal endpoint served as the primary outcome. Kaplan-Meier and Cox regression analyses were used for survival analysis and prognostic factor identification. Results:RL-TMA patients were older, with higher hemoglobin and platelet levels, lower lactate dehydrogenase, less complement C3 consumption, and significantly fewer multiorgan dysfunctions than Sys-TMA patients. Pathologically, Sys-TMA was dominated by acute microvascular lesions, whereas RL-TMA showed more chronic changes (glomerulosclerosis, arteriolar hyalinosis) and more frequent immune complex deposition. Total immunofluorescence intensity and IgG, IgG2, IgG4, and C1q deposition were significantly higher in RL-TMA (all P < 0.05). Over a median follow-up of 16-20 months, end-stage kidney disease incidence did not differ significantly between groups (9.5% vs 0%, P > 0.05). In RL-TMA, univariate analysis showed that lower hemoglobin was associated with worse renal outcomes (HR = 0.946, P = 0.004). Serum albumin showed no clear association (HR = 0.992, P = 0.862), while pathological scores lacked independent predictive value. Kaplan-Meier analysis showed no statistically significant difference in renal progression-free survival between the two groups (P = 0.97). Conclusion:This study delineates significant differences between RL-TMA and Sys-TMA across clinical, pathological, and prognostic dimensions, suggesting that RL-TMA may represent a distinct clinicopathological entity, warranting further validation in larger prospective studies. Given the small sample size of the Sys-TMA group, these results should be interpreted as exploratory and hypothesis-generating. Hemoglobin levels showed an association with renal outcomes in univariate analysis, but this finding requires further investigation in larger cohorts before any clinical utility can be established.
Human orf is a zoonotic parapoxvirus infection that is typically self-limiting with resolution in 3-6 weeks but may cause severe disease in immunocompromised patients. We report a kidney transplant recipient who developed a rapidly progressive fingertip lesion following contact with raw meat during Eid al-Adha. Initial misdiagnosis and surgical excision were followed by marked lesion progression, mimicking a vascular tumor. Histopathology confirmed orf virus infection. However, PCR testing was not done as the test was not available. Topical imiquimod was not initiated due to an active wound. Weekly liquid nitrogen cryotherapy as monotherapy resulted in complete resolution after nine sessions without recurrence. Further modifications/reduction in immunosuppressive medication was not needed. This case highlights cryotherapy as a potential treatment option for orf infection in transplant recipients.
INTRODUCTION:Life issues relating to identity, meaning and dignity are inherent to human existence and remain significant throughout the entire lifespan. To meet the needs of older persons residing in nursing homes, it is essential to understand their views on everyday life, particularly regarding the proximity of death, reflections on future death and dying, and the potential for meaning in everyday life. However, these views have received limited attention in research. The aim of this study was therefore to explore older persons' views regarding everyday life and reflections on their future death and dying while residing in nursing homes. METHODS:A meta-ethnographic synthesis was conducted by searching CINAHL, PubMed and PsycINFO supplemented with manual searches, guided by the SPIDER tool. The synthesis focused on peer-reviewed empirical research papers published in English, between 1 January 2000 and 7 April 2025. RESULTS:Eighteen studies were identified and analysed based on older persons' expressed experiences and views on everyday life in nursing homes. Studies with proxy perspectives or mixed-method designs were included; however, only qualitative data representing older persons' own views were extracted and analysed, primarily from participants able to engage in interviews. Three analytic themes were formulated: Loss of the Familiar World, Trying to Maintain Personal Identity, Death as Close and Tangible. An overarching metaphor was synthesised: Maintaining and Shaping a Living Space for a Visible Future. CONCLUSIONS:Living in a nursing home involves an everyday life marked by losses and an ongoing awareness of future death and dying. At the same time, older persons actively strive to uphold identity, personal dignity and meaningful relationships. Understanding these processes is essential for supporting older persons in everyday nursing care. IMPLICATIONS FOR PRACTICE:Nursing staff should make time for regular conversations about resident' lives and concerns, including thoughts about death and dying, and support activities that help them maintain their sense of self.
Purpose:Chronic kidney disease (CKD) is a major public health concern in the United States, with persistently rising incidence and mortality. This study aimed to quantify geographic and demographic disparities in CKD mortality across the United States and to examine the association between CKD mortality and ambient temperature variation. Patients and Methods:CKD deaths and age-adjusted mortality rates (AAMRs) for 1999-2023 were obtained from CDC WONDER and stratified by census region, state, sex, race, age group, and urbanization level. Mortality trends were quantified using joinpoint regression. Primary temperature-mortality analyses used CDC WONDER-linked NLDAS temperature data for 1999-2011, while supplementary descriptive analyses used independently retrieved NLDAS temperature estimates for 2012-2023. Temperature-mortality associations were evaluated using Spearman rank correlations, quasi-Poisson regression models, and distributed lag nonlinear models (DLNMs). Results:From 1999 to 2023, 628,937 CKD deaths occurred, with national AAMR increasing steadily. Mortality rates were consistently higher in men and nonmetropolitan areas. AAPC rose fastest in the West and Midwest, though recent AAMR declines were noted in the Northeast and South. Winter mortality exceeded summer across regions. In the primary DLNM analysis, cold exposure at the region-specific 5th percentile was associated with higher cumulative CKD mortality risk, with risk ration (RR) ranging from 1.065 in the Northeast to 1.505 in the Midwest; the association reached statistical significance only in the Midwest (RR 1.505, 95% CI: 1.091-2.075), while hot-exposure estimates at the 95th percentile were generally imprecise and not statistically significant. Conclusion:CKD mortality in the United States increased from 1999 to 2023 with marked geographic and demographic disparities. Cold air temperature was associated with higher short-term mortality risk.
AIM:The purpose of this study was to compare the efficacy of different non-pharmacological multicomponent interventions in community-dwelling older adults with frailty or prefrailty and to determine the most effective non-pharmacological multicomponent interventions. BACKGROUND:Frailty or prefrailty is highly prevalent among community-dwelling older adults and contributes to significant distress among older adults and increases the caregiver burden. Non-pharmacological multicomponent interventions are recommended for first-line management; however, the comparative efficacy among interventions remains unclear. METHODS:A systematic electronic literature search was performed in the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Wanfang, VIP and Sinomed databases up to July 1, 2025. Randomized controlled trials (RCTs) evaluating the efficacy of non-pharmacological multicomponent interventions compared with routine care or other interventions in community-dwelling older adults with frailty or prefrailty were included. A random effects model based on restricted maximum likelihood (REML) estimation was used for the network meta-analysis. Efficacy was assessed via standardized mean differences with 95% credible intervals, and interventions were ranked via surface under the cumulative ranking curve (SUCRA) probabilities. RESULTS:Twenty-two RCTs were included in the analysis. For overall frailty level, exercise + cognitive intervention achieved the highest rank (SUCRA = 84.7%), followed by exercise + cognitive + social support intervention (SUCRA = 83%) and exercise + nutritional intervention (SUCRA = 72%). With respect to motor ability, exercise + nutrition + psychological intervention was the most effective intervention (SUCRA = 77.1%). DISCUSSION:Non-pharmacological multicomponent interventions have a positive effect on improving the physical condition of community-dwelling older adults with frailty or prefrailty. Nurses and care managers should actively prioritize the integration of the above two interventions into personalized frailty or prefrailty care plans, maximizing the efficacy of non-pharmacological management. CONCLUSIONS:Exercise + cognitive intervention is likely the most effective non-pharmacological multicomponent intervention for reducing the frailty level, and exercise + nutrition + psychological intervention is likely the most effective non-pharmacological multicomponent intervention for improving motor ability in community-dwelling older adults with frailty or prefrailty. IMPLICATIONS FOR PRACTICE:The study identified the best non-pharmacological multicomponent interventions to improve frailty or prefrailty in community-dwelling older adults, providing a basis for the development of practical interventions in later gerontological nursing practice. REGISTRATION NUMBER:PROSPERO: CRD420251115805.
Background:Hyperkalemia after a Long Interdialytic Interval (LIDI) is a potentially life-threatening complication in patients undergoing intermittent hemodialysis. The risk is exacerbated especially in populations known for Potassium-rich dietary habits and cultural tradition of weekend gatherings. Patiromer is a potassium binder that helps treat Hyperkalemia. This study aimed to evaluate the efficacy of Patiromer in the management of LIDI Hyperkalemia in patients with ESKD on Intermittent Hemodialysis, with Potassium rich dietary habits as in Saudi Arabia. Methods:Adult patients who had completed 3 months on Intermittent Hemodialysis, were screened for LIDI hyperkalemia pre dialysis (serum K >5.3 mmol/L).Patients with hyperkalemia were prescribed Patiromer on days off Hemodialysis during the LIDI (Thursday and Friday for Saturday group; Friday and Saturday for Sunday group). Pre HD serum potassium levels were monitored after the LIDI at weeks 1, 2, 4, 8, 12, 24, and 52. Patient Compliance was ensured through telephonic communication with the patient or the care giver. Results:Among the 127 patients on Intermittent Hemodialysis, 58 were identified with LIDI hyperkalemia out of whom 52 patients completed one year follow-up. 36 had serum K 5.3-5.9 mmol/l, 11 had serum K 6-6.5 mmol/l, 5 had serum K 6.5 mmol/l and above. Patiromer therapy resulted in a mean serum potassium reduction of 0.8-2.5 mmol/L, with a sustained average reduction of 1.57 mmol/L observed over 52 weeks. The treatment was well tolerated, with no drop outs reported due to side effects. Conclusion:Patiromer demonstrated sustained efficacy and excellent tolerance in preventing hyperkalemia after the LIDI in our potassium rich diet population undergoing Intermittent Hemodialysis.
Aims and Objectives To clarify how Ikigai and closely related meaning constructs are described in literature relevant to older people in Korea and to propose a provisional, context-informed conceptual framework for gerontological nursing.Background Ikigai, often glossed as "a life worth living," has been associated with well-being in later life, yet its meaning and operationalisation vary across settings. Greater conceptual clarity is needed to support culturally responsive nursing assessment and care planning.Methods Rodgers' evolutionary method of concept analysis (Rodgers, 2000) was used to examine contemporary scholarly use of Ikigai and related concepts in 13 peer-reviewed studies (published 2002-2024; searched January 2000-June 2025), of which 10 were conducted outside Korea and three in Korea. Data were analysed to identify defining attributes, antecedent contexts, consequences and related concepts.Results Six defining attributes were identified: psychological equanimity, purposefulness in life, self-worth and personal value, social connectedness, cultural belonging, and reflective wisdom and self-integration. Four antecedent contexts were identified: family and intergenerational change, cultural and value transformation, health and functional challenges, and existential and social disconnection. Four consequence domains were identified: emotional stability and psychological balance, active health orientation and functional preservation, life fulfilment and satisfaction, and community integration and social engagement. In literature relevant to older people in Korea, Ikigai was not presented simply as a list of valued sources, but was provisionally interpreted as a process through which relational sources such as family roles, intergenerational continuity and everyday responsibilities may be internalised as an enduring sense of life's worth.Conclusions Ikigai may be understood as a dynamic and context-dependent meaning process in later life that includes both valued sources of worth and a sense of life's worth. This review offers a provisional conceptual framework for gerontological nursing and supports further qualitative and measurement research in Korea.Implications for Practice This framework can support gerontological nurses in assessing meaning, dignity, purpose and relational continuity alongside physical and functional indicators. Nurses may use open-ended questions and observable indicators to identify valued roles, relationships and routines that sustain older people's sense that life is worth living. Meaning-centred and culturally responsive care planning may help support participation, autonomy and continuity during later-life transitions.
BACKGROUND:Discriminatory nursing care endangers patient rights, ethical standards and fair access to treatment-yet the lived experiences of nurses who engage in such practices remain understudied. This study seeks to explore Iranian nurses' personal experiences with their own discriminatory behaviours towards vulnerable patients in everyday clinical settings. METHODS:A qualitative conventional content analysis was conducted in 2024, using in-depth, unstructured interviews with 13 nurses from both public and private hospitals in Iran. Participants were purposefully sampled to ensure maximum variation, and data collection continued until saturation was reached. The interviews were analysed using the five-step framework developed by Graneheim and Lundman. RESULTS:A central theme, 'discrimination in service provision for vulnerable patients', emerged, highlighting two main categories: (1) Professional Shortfalls in the Care of Older Adults and (2) Shortfalls in Care for Persons at the End of Life. Nurses reported prioritizing younger patients, delaying or withholding essential care, reducing therapeutic communication and demonstrating inconsistent adherence to professional standards. CONCLUSION:Findings reveal subtle yet widespread discriminatory practices against older adults and end-of-life patients. Combating these disparities requires targeted education, supportive organizational policies and strategies to increase nurses' awareness of unconscious bias. IMPLICATIONS FOR PRACTICE:Reducing discriminatory behaviours promotes equitable, person-centred care. Enhancing empathy, prioritizing the needs of vulnerable patients and strengthening adherence to professional standards foster trust, dignity and a more inclusive clinical environment.
Background:Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among patients with advanced chronic kidney disease (CKD). However, data on its prevalence and patterns in Sub-Saharan Africa remain scarce. Purpose:To determine the prevalence and spectrum of CVD among patients with advanced CKD in Johannesburg, South Africa. Patients and Methods:This retrospective study enrolled adults aged ≥18 years with advanced CKD attending the renal clinic at Chris Hani Baragwanath Academic Hospital between 2009 and 2018. Demographic, clinical, laboratory, electrocardiographic, and echocardiographic variables were extracted from medical records. CVD was defined as heart failure, ischemic heart disease, arrhythmias, non-rheumatic valvular heart disease, pericardial disease, stroke, or peripheral vascular disease, supplemented by clinical, electrocardiographic, or echocardiographic findings. Patients were grouped by their CVD status. Multivariable logistic regression identified independent factors associated with CVD. Results:Among 300 participants (mean age of 55.3 ± 15.0 years, 54.3% males), CVD prevalence was 58.7%. The mean age at CVD diagnosis was 46.6 ± 13.7 years, with a median interval of 8.3 months (IQR, 2.5-27.6) between the onset of CKD and CVD diagnosis. Patients with CVD were younger than those without (52.8 ± 13.8 vs 58.8 ± 16.0 years; p<0.001), had higher diastolic blood pressure (88.5 ± 20.6 vs 81.3 ± 17.6 mmHg; p = 0.002), and a higher prevalence of obesity (54.6% vs 38.7%; p<0.001). Predominant CVD manifestations were ischemic ECG changes (95.1%) and diastolic dysfunction with heart failure (45.5%). Higher diastolic blood pressure (aOR 1.04; 95% CI 1.00-1.08; p = 0.029) and reduced estimated GFR (aOR 0.96; 95% CI 0.94-0.99; p = 0.022) were independent predictors of CVD. Conclusion:CVD is highly prevalent in advanced CKD and occurs at a young age. Early cardiovascular risk assessment and integrated cardio-renal management strategies are essential in this high-risk population.
BACKGROUND:Social frailty is increasingly recognised among people living with heart failure and is linked to a range of clinical and psychosocial risk factors, with significant implications for health outcomes. However, inconsistencies in the conceptualisation and measurement of social frailty, coupled with a lack of systematic reviews, hinder evidence synthesis and the development of targeted interventions. OBJECTIVE:This scoping review aimed to map current evidence on the definition, measurement tools, prevalence, associated factors and health-related outcomes of social frailty in individuals with heart failure. METHODS:Following the PRISMA-ScR guidelines, a comprehensive electronic search was conducted in June 2025 across eight databases: Web of Science, PubMed, CINAHL Complete, Scopus, Embase, Cochrane, CNKI and Wanfang. Search terms were guided by the Population-Concept-Context mnemonic, focusing on heart failure, social frailty, and healthcare or community settings and in accordance with the aim of the review. RESULTS:A total of 27 articles were included. No unified definition of social frailty was identified, and existing assessment tools exhibited heterogeneity. Prevalence rates varied widely across settings and measurement tools. Factors associated with social frailty included sociodemographic characteristics, socioeconomic status, clinical severity, psychological status and contextual factors. Social frailty was consistently linked to adverse outcomes such as diminished quality of life, increased rehospitalisation risk and higher mortality. CONCLUSIONS:The current literature highlights significant conceptual and methodological gaps in understanding social frailty in heart failure. Standardised definitions, validated assessment tools and deeper exploration of underlying mechanisms are needed to guide effective interventions and improve holistic care for people living with heart failure. IMPLICATIONS FOR PRACTICE:Routine assessment of social frailty, including living arrangements, perceived social support and social participation, may facilitate the early identification of older people with heart failure who are at increased clinical and social risk. Identification of social frailty may help uncover unmet social needs and facilitate timely referral to social and community resources. As coordinators of holistic care, nurses can promote multidisciplinary collaboration and support tailored interventions that address both symptom burden and social functioning, thereby helping to reduce functional limitations and social isolation. Technology-enabled approaches, such as digital health platforms, care robots and interactive tools, may provide additional opportunities to enhance social engagement, improve access to care and promote more holistic and person-centred heart failure management.
AIM:This study examines how the domains of the Fundamentals of Care (FoC) framework are integrated within age-friendly hospital strategies and to what extent patients and families have been engaged in developing, implementing or evaluating these strategies. DESIGN:Scoping review guided by the Joanna Briggs Institute's updated methodological guidance for the conduct of scoping reviews. METHODS:We reviewed empirical literature using Covidence describing the operationalization of age-friendly strategies within hospital-based care systems. We conducted a descriptive analysis to summarize the literature and used directed content analysis to deductively map the data to the FoC framework. DATA SOURCES:We conducted systematic searches of electronic databases (Ovid Medline, Ovid Embase, Cochrane Central, PsycINFO and CINAHL) of empirical literature published between 1 January 2014 and 27 August 2024, with no restriction on study design and limited to English-only publications. RESULTS:We included 18 peer-reviewed papers. Most practice change initiatives map to the physical care domain of the FoC framework, followed by psychosocial care of recipients. Fewer initiatives address relational and contextual elements. Only two of 18 studies reported engaging patients or families in the development, implementation and evaluation of age-friendly initiatives. CONCLUSION:The scoping review findings provide greater insight into which of the FoC framework domains are operationalized when age-friendly strategies are implemented within hospital systems, with less attention paid to patient and caregiver engagement. IMPLICATIONS FOR PRACTICE:The findings can support the intentional involvement of patients and caregivers to ensure such initiatives are patient- and family-centred. These findings should also clarify elements of the FoC framework that may receive less attention when implementing age-friendly strategies, which could help support the quality care of older adults and impact patient- and provider-reported outcomes. REPORTING METHODS:We followed the PRISMA-Scoping Reviews reporting guideline. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.
Objective:Angiogenesis and oxidative stress contribute to the pathogenesis of diabetic nephropathy (DN). The isoflavone biochanin A (BCA) has reported anti-inflammatory and antioxidant properties; we evaluated whether BCA modulates inflammatory and angiogenic markers in renal tissue of streptozotocin-induced diabetic rats. Materials and Methods:Thirty-six male Wistar rats (180-200 g) were randomized into six groups (n = 6): non-diabetic control (vehicle), diabetic control (STZ 55 mg/kg, i.p.), and two diabetic groups treated with BCA (10 or 15 mg/kg; Oral). Treatments were administered for 42 days. On day 42 animals were sacrificed and blood and renal tissues collected. Renal VEGF, TNF-α, IL-1β, IL-6, IL-18, NF-κB, TGF-β, RAGE, CTGF, and MDA were measured by ELISA. Renal tissues evaluate histopathologically for mesangial expansion, cellularity, and angiogenesis. Results:BCA treatment reduced fasting blood glucose in diabetic rats and significantly decreased renal VEGF, TNF-α, and IL-1β concentrations versus diabetic controls (p < 0.05). No clear dose-response was observed between 10 and 15 mg/kg; other markers showed non-significant trends toward improvement. Conclusion/Discussion:BCA reduced key angiogenic and proinflammatory markers in diabetic rat kidney, suggesting potential nephroprotective effects; further studies are needed to define mechanisms, optimal dosing, and long-term safety.
INTRODUCTION:Near falls, defined as recoverable postural instability, are increasingly recognised as important experiences that can provide insight into balance and mobility in older people, yet they are often underreported and inconsistently documented. Unlike falls, which have been clearly defined and extensively investigated, the conceptual definition of near falls remains inconsistent. This concept analysis aimed to clarify the phenomenon traditionally described as 'near falls' and to establish a more precise conceptual definition in older people. METHODS:This is a concept analysis using the framework by Walker and Avant. A comprehensive literature search of four databases was conducted in Medline, PubMed, Scopus and CINAHL. Data extraction and synthesis were guided by the eight-step framework of Walker and Avant. RESULTS:A total of 23 articles were included in the analysis. Antecedents included intrinsic and extrinsic factors. Defining attributes of near falls comprised transient loss of balance, activation of compensatory mechanisms (e.g., rapid stepping, trunk or limb adjustments) and successful prevention of a fall. Consequences involved increased fall risk, changes in physical functions and psychological impacts. CONCLUSIONS:Based on findings, the concept was refined and reconceptualised as 'Compensated Loss of Balance' (CLB), a more precise term emphasising recoverable postural instability through successful corrective responses. IMPLICATIONS FOR PRACTICE:Integrating CLB into clinical screening, research frameworks and fall prevention guidelines may enhance early detection of postural instability and promote more standardised approaches to fall risk assessment and prevention.
Background: Secreted phosphoprotein 1 (SPP1), a glycoprotein encoded by the SPP1 gene, can be detected in body fluids and tumor tissues of various diseases, representing a promising candidate biomarker. However, its application in focal segmental glomerulosclerosis (FSGS) remains at the exploratory stage. Patients and Methods: In a small-scale cohort, Bulk-RNA sequencing was employed to screen for core differentially expressed genes in urinary cells of FSGS patients, with SPP1 identified as a key candidate. RT-qPCR and ELISA were subsequently used to detect SPP1 expression in clinical urine samples. An adriamycin (ADR)-induced FSGS mouse model was established, and renal histopathological changes were evaluated using hematoxylin-eosin (HE), periodic acid-Schiff (PAS), and Masson staining. Immunohistochemistry and immunofluorescence were performed to examine the expression of SPP1, fibronectin, and F4/80 in renal tissues, with assessment of the effects of prednisone intervention. Results: Urinary SPP1 expression was significantly elevated in FSGS patients, particularly in those with CKD stage III. In the ADR mouse model, as glomerulosclerosis progressed, albuminuria levels increased, accompanied by enhanced expression of SPP1 and F4/ 80-positive macrophages. Prednisone treatment attenuated these parameters. Conclusion: SPP1 is involved in the progression of FSGS and is closely associated with renal immune inflammation and fibrosis. Prednisone exerts renoprotective effects by downregulating SPP1 expression and inhibiting macrophage infiltration, suggesting that SPP1 represents a promising molecular marker for disease monitoring and targeted intervention in FSGS.
BACKGROUND:This investigation scrutinises the psychometric qualities of the Arabic version of the Older People's Quality of Life-Brief (OPQOL-brief) scale in a sample of Arabic-speaking older adults to support culturally appropriate assessment of lived experience and person-centred care in later life and to strengthen gerontological nursing assessment and evaluation across settings. METHOD:A cross sectional study included 539 Arabic-speaking older Egyptians (50.3% women; 60.7% aged 65-75). Forward-backward translation and cultural adaptation procedures support linguistic and cultural equivalence. Data collection uses a mixed-mode approach (face-to-face and online) to support inclusive participation; procedures were standardised across modes to minimise measurement differences. RESULTS:The scale yielded a three-factor structure reflecting the multidimensional nature of quality of life in older adults. Internal consistency was high for the total score (Cronbach's alpha and McDonald's omega = 0.92). Measurement properties did not differ significantly by gender, supporting cross-gender interpretability. Concurrent validity showed a strong positive correlation between Arabic OPQOL-brief and resilience scores (r = 0.60, p < 0.001), supporting its relevance to nursing care planning and outcome monitoring. Psychometric testing in this study includes factor structure, internal consistency reliability, concurrent validity and measurement invariance. CONCLUSION:This research closes a gap in the literature and supports the Arabic OPQOL-brief as a robust tool for assessing quality of life in Arabic-speaking older adults. IMPLICATIONS FOR PRACTICE:The new scale can help support nurse-led person-centred assessment, care coordination and evaluation of interventions.
Introduction:Chronic kidney disease (CKD) is accompanied by systemic metabolic dysregulation, and metabolomics provides a robust approach for identifying disease-specific metabolic signatures and potential biomarkers. Hypertension may be closely associated with metabolic disturbances in CKD. This study aimed to characterize serum metabolic alterations and dysregulated pathways in CKD, and screen candidate metabolite biomarkers for distinguishing CKD patients from healthy individuals. Methods:A total of 65 participants (35 CKD patients and 30 healthy controls) were enrolled in this study. Serum metabolic profiling was performed using high-resolution mass spectrometry-based untargeted metabolomics, while targeted analysis of small molecule metabolites was conducted via liquid chromatography-mass spectrometry (LC-MS). Multivariate statistical analyses including principal component analysis (PCA) and orthogonal partial least squared-discriminant analysis (OPLS-DA) were applied to identify metabolic alterations between groups. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was used to annotate the functional roles of differentially expressed metabolites. Independent t-tests and Pearson correlation analyses were performed to validate the expression and correlation of key metabolites. Results:A total of 1,426 metabolites were detected in all serum samples, with 1,246 successfully identified by secondary mass spectrometry. Differential analysis revealed 397 significantly altered metabolites (216 up-regulated and 181 down-regulated) between the CKD and control groups. KEGG enrichment analysis indicated that these differential metabolites were mainly involved in phenylalanine metabolism, arginine and proline metabolism, and glutathione metabolism, suggesting systemic metabolic dysfunction in CKD. Targeted analysis of catecholamines showed that serum concentrations of adrenaline and nicotinamide mononucleotide (NMN) were significantly altered in CKD patients compared with healthy controls (P < 0.05), though no significant linear correlation was observed between these two metabolites and CKD progression via Pearson correlation analysis. Discussion:The identified metabolic pathway dysregulations (amino acid metabolism and redox-related pathways) are core metabolic characteristics of CKD, which are closely associated with renal function impairment, oxidative stress and hypertension in CKD. Adrenaline and NMN may serve as potential candidate biomarkers for CKD, and their abnormal expression may be linked to the activation of the renin-angiotensin system and dysregulation of renal energy metabolism. However, the specific mechanistic roles of these two metabolites in CKD pathophysiology remain to be elucidated. Conclusion:This study comprehensively characterized serum metabolic alterations in CKD and identified key dysregulated metabolic pathways, as well as adrenaline and NMN as potential candidate biomarkers. These findings enhance the understanding of biochemical dysregulation underlying CKD and provide novel insights for future diagnostic biomarker development and targeted therapeutic exploration for CKD.
IgA-dominant infection-related glomerulonephritis (IgA-IRGN) is a histopathological variant of staphylococcus-associated glomerulonephritis (SAGN) that occurs as a result of an immune response to S. aureus antigens, with subsequent deposition of IgA in the nephron. This can lead to acute kidney injury, hematuria, and proteinuria. It is important to differentiate IgAIRGN from primary IgA nephropathy (IgAN) because the treatment strategies differ. IgA-dominant IRGN requires treatment of the infection with antibiotics, whereas treatment of primary IgAN involves immunosuppression. Here, we present a case that highlights the clinical dilemma of distinguishing IgA nephropathy from IRGN. Our patient presented with chronic osteomyelitis secondary to Staph. The hospital course was complicated by acute renal failure that required dialysis. Renal biopsy showed IgA deposits, and the patient was initially treated with steroids for IgA Nephropathy. The patient did not respond to immunosuppressive treatments and had a second biopsy, clinical history, and course that closely resembled IgA-IRGN. The patient was eventually removed from dialysis after five months. In patients with documented S. aureus infection who present with acute kidney injury, hematuria, and proteinuria, IgA-IRGN should be considered as the etiology. Source control measures should be attempted when necessary and patients should be treated with an appropriate course of antibiotics. Proper diagnosis is important to avoid exposure to immunosuppressive medications and potentially worse outcomes in these patients.
BACKGROUND:Nursing homes care for a significant proportion of individuals with advanced dementia, yet timely hospice referrals remain a challenge. The Advanced Dementia Prognostic Tool (ADEPT) is a mortality risk score instrument that holds promise for improving care planning by providing a standardised, accessible method for identifying residents at risk of death within 6 months. AIMS:To describe current nursing home processes for identifying residents with dementia for hospice referral and gather stakeholder input on integrating ADEPT into routine assessment practices. METHODOLOGY:A qualitative descriptive design guided by the Consolidated Framework for Implementation Research (CFIR) was employed. Data were gathered through online surveys and individual interviews (n = 5) as well as a focus group (n = 4) with interdisciplinary staff from six Florida nursing homes. Analysis involved deductive coding using a CFIR-based codebook and thematic synthesis. REPORTING METHOD:The Standards for Reporting Qualitative Research (SRQR) checklist was followed. RESULTS:Current processes for identifying hospice-eligible residents rely on regular assessments and interdisciplinary collaboration but reveal significant gaps, including delays in referrals and inconsistent practices. Participants viewed ADEPT as a promising tool to complement goals-of-care conversations and enhance care planning, rather than exclusively triggering hospice initiation. Implementation barriers included the need for electronic system integration, regulatory compliance and staff education, while facilitators encompassed strong leadership support, interdisciplinary coordination and alignment with existing workflows. CONCLUSION:ADEPT has the potential to improve hospice referral processes in nursing homes by providing a structured, accessible framework to support care planning and interdisciplinary discussions. Addressing barriers through targeted training, leadership engagement and pilot testing is essential to optimise its implementation and impact. IMPLICATIONS FOR PRACTICE:ADEPT could support end-of-life care in nursing homes by fostering timely, goal-directed care planning for residents with dementia, ultimately enhancing both care quality and staff decision-making processes.
