Nurses play a key role in medication review. This study explores nursing students' awareness and understanding of concepts (pharmacology, medication review, polypharmacy, and deprescribing) and gives insight into their preparedness to engage with these in clinical settings. This cross-sectional survey was conducted at a London higher education institution. The sample comprised 127 third-year undergraduate adult and paediatric nursing students. Data were collected using a structured questionnaire, which included free-text items to capture qualitative insights. Quantitative data were analyzed using descriptive statistics, while thematic analysis explored qualitative responses. Respondents were familiar with the terms medication review (94%, 118/125) and polypharmacy (76%, 96/126), but not deprescribing (37%, 46/125). Although respondents could identify triggers for initiating a medication review, their understanding of the collaborative nature of the process for healthcare professionals and patients was inconsistent. Respondents were able to identify medications that may warrant review and potential deprescribing. Core concepts related to medication review were generally understood by respondents. However, understanding of deprescribing, as well as the nurse's role in advocating for patients during medication review, was less consistent.

Nursing research has developed unevenly across history, shaped by shifting institutional structures, professional aspirations and societal demands. Yet existing historical reviews have largely adopted descriptive approaches, while few have applied an explicit theoretical lens to explain why this unevenness persists. This paper addresses that gap by examining the historical development of nursing research through Greenwood's trait-based professionalisation framework. Drawing on a narrative historical review spanning seven chronological periods, the analysis reveals a recurring pattern of partial professionalisation; nursing has consistently generated specialised knowledge yet has struggled to secure organisational infrastructure to embed and control that knowledge within clinical practice. The historical analysis suggests that knowledge production alone within a profession does not guarantee epistemic control.

BACKGROUND:With widespread adoption of high-sensitivity troponin assays, more individuals with myocardial injury are now identified, with type 1 myocardial infarction (T1MI) being less common despite having the most well-established evidence base to inform care. This study assesses the temporal time course of cardiovascular events among various forms of myocardial injury. METHOD:Consecutive hospital encounters were identified. Using the first episode of care during the sampling period, myocardial injury classifications (i.e., T1MI, acute injury/type 2 myocardial infarction [T2MI], chronic injury, and no injury) were established via two machine learning algorithms. The temporal time course of increased hazard for mortality, recurrent myocardial infarction, heart failure, and arrhythmia over 3 years were explored. RESULTS:There were 176,787 index episodes; 6.9% were classified as T1MI, 6.0% as acute injury/T2MI, and 26.7% as chronic injury. Although each classification was associated with an early increased risk of all-cause mortality compared with no injury (incidence rate ratio [IRR]<30 days: T1MI: 19.97 [95% confidence interval 12.50-32.69]; acute injury/T2MI: 26.51 [16.80-42.97]; chronic injury: 15.37 [10.22-23.95]), the instantaneous relative hazard for recurrent myocardial infarction was highest in those with initial T1MI (IRR<30 days: T1MI: 28.81 [22.75-36.76]; acute injury/T2MI: 10.23 [7.60-13.77]; chronic injury:5.54 [4.34-7.41]). In contrast, the instantaneous hazard for heart failure in those with initial acute injury/T2MI and chronic injury remained increased over long-term follow up unlike in T1MI (IRR1 3 yrs: T1MI: 5.52 [4.99-6.09]; acute injury/T2MI: 10.36 [9.51-11.30]; chronic injury:7.40 [6.90-7.94]). CONCLUSIONS:The substantial and persistent rate of late cardiac events highlights the need to establish an evidence base for the therapeutic management of "non-T1MI" diagnostic classifications and suggests opportunity to improve late outcomes using existing and emerging therapies.

In heart failure, cardiac cachexia often presents in people as weight loss accompanied by muscle wastage, loss of appetite and reduced quality of life. Such people often have a poor prognosis. However, the impact of these symptoms on Thai patients’ quality of life is unknown. Therefore, this study aimed to explore cardiac cachexia, its symptoms, and its effect on quality of life using a mixed-method sequential explanatory design. Data for this study were collected from a specific cardiac failure clinic in a large hospital in Bangkok, Thailand, from August 2022 to January 2023. Forty-two patients with heart failure were screened for cardiac cachexia using cachexia consensus criteria and bioelectrical impedance vector analysis. They also completed the Simplified Nutritional Appetite Questionnaire, the Thirst Distress Scale for Heart Failure and the Kansas City Cardiomyopathy Questionnaire to assess appetite, thirst, and quality of life, respectively. Thirty-eight participants were included for statistical analysis and divided into two groups: those with confirmed or suspected cardiac cachexia (n = 7) and those without (n = 31). The former group reported low appetite scores; however, no significant differences were observed between the two groups’ appetite, thirst, or quality of life. After identifying patients with cardiac cachexia, six semi-structured interviews were conducted using an interview guide and analyzed through thematic analysis. The interviews revealed two common themes: Changes in diet and thirst and a Reduction in physical activity levels. Both themes complement the quantitative results. This study initiates a significant step in the understanding of cardiac cachexia in the Thai population with heart failure. Nurses can play a crucial role in identifying and managing patients with or at risk of cardiac cachexia.

Background: Heart failure (HF) patients can experience poor appetite and intense thirst. The Thirst Distress Scale for HF (TDS-HF) and the Simplified Nutritional Appetite Questionnaire (SNAQ) are tools used to assess these symptoms. However, these questionnaires are not currently available in Thai.Aims: To translate the TDS-HF and SNAQ into the Thai language and to evaluate the reliability and validity of these translated instruments.Methods: The TDS-HF and the SNAQ were translated from English to Thai using a forward-backward method. Their face and content validity, their internal consistency and test-retest reliability, were assessed with a sample of 20 HF patients recruited from a single supra-tertiary hospital in Thailand.Results: Participants reported that the TDS-HF and the SNAQ had face validity. The content validity was assessed as adequate by the expert panel. The Cronbach's alphas of the TDS-HF and the SNAQ were 0.91 and 0.71, respectively. The intraclass correlation coefficients of the TDS-HF and the SNAQ were 0.91 and 0.91, respectively.Conclusions: The Thai versions of the TDS-HF and the SNAQ demonstrate adequate validity and reliability. These tools hold significant potential for supporting clinical practice, particularly for nurses involved in HF management by helping to assess thirst and appetite effectively.

Background:Clinical work-up for suspected acute coronary syndrome (ACS) is resource intensive. Objectives:This study aimed to develop a machine learning model for digitally phenotyping myocardial injury and infarction and predict 30-day events in suspected ACS patients. Methods:Training and testing data sets, predominantly derived from electronic health records, included suspected ACS patients presenting to 6 and 26 South Australian hospitals, respectively. All index presentations and 30-day death and myocardial infarction (MI) were adjudicated using the Fourth Universal Definition of MI. We developed 2 diagnostic prediction models which phenotype myocardial injury and infarction according to the Fourth UDMI (chronic myocardial injury vs acute myocardial injury patterns, the latter further differentiated into acute non-ischaemic myocardial injury, Types 1 and 2 MI) using eXtreme Gradient Boosting (XGB) and deep-learning (DL). We also developed an event prediction model for risk prediction of 30-day death or MI using XGB. Analyses were performed in Python 3.6. Results:The training and testing data sets had 6,722 and 8,869 participants, respectively. The diagnostic prediction XGB and deep learning models achieved an area under the curve of 99.2% ± 0.1% and 98.8% ± 0.2%, respectively, for differentiating an acute myocardial injury pattern from no injury or chronic myocardial injury pattern and achieved 95.5% ± 0.2% and 94.6% ± 0.9%, respectively, for differentiating type 1 MI from type 2 MI or acute nonischemic myocardial injury. The 30-day death/MI event prediction model achieved an area under the curve of 88.5% ± 0.5%. Conclusions:Machine learning models can digitally phenotype suspected ACS patients at index presentation and predict subsequent events within 30 days. These models require external validation in a randomized clinical trial to evaluate their impact in clinical practice.

BackgroundIn cases of evolving myocardial injury not definitively attributed to coronary ischaemia precipitated by plaque rupture, referral for invasive coronary angiography (ICA) may be influenced by observed troponin profiles. We sought to explore association between early ICA and elevated high-sensitivity troponin T (hs-cTnT) concentrations with and without dynamic changes, to examine if there may be a hs-cTnT threshold associated with benefit from an initial ICA strategy. MethodsUsing published studies (hs-cTnT study n = 1937, RAPID-TnT study n = 3270) and the Fourth Universal Definition of Myocardial Infarction (MI), index presentations of patients with hs-cTnT concentrations 5-14ng/L were classified as 'non-elevated' (NE). Hs-cTnT greater than upper reference limit (14ng/L) were classified as 'elevated hs-cTnT with dynamic change' (encompassing acute myocardial injury, Type 1 MI, and Type 2 MI), or 'non-dynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT <5ng/L and/or eGFR<15mmol/L/1.73m(2) were excluded. ICA was performed within 30 days of admission. Primary outcome was defined as composite endpoint of death, MI, or unstable angina at 12 months. ResultsAltogether, 3620 patients comprising 837 (23.1%) with non-dynamic hs-cTnT elevations and 332 (9.2%) with dynamic hs-cTnT elevations were included. Primary outcome was significantly higher with dynamic and non-dynamic hs-cTnT elevations (Dynamic: HR: 4.13 95%CI:2.92-5.82; p<0.001 Non-dynamic: HR: 2.39 95% confidence interval [CI]:1.74-3.28, p<0.001). Hs-cTnT thresholds where benefit from initial ICA strategy appeared to emerge was observed at 110ng/L and 50ng/L in dynamic and non-dynamic elevations, respectively. ConclusionEarly ICA appears to portend benefit in hs-cTnT elevations with and without dynamic changes, and at lower hs-cTnT threshold in non-dynamic hs-cTnT elevation. Differences compel further investigation.

The purpose of this study is to explore the mediating effect of entrepreneurial self-efficacy (ESE) on the relationship between entrepreneurship education (EE) and the entrepreneurial intention (EI) of students belonging to the University of India and Taiwan also access the entrepreneurial self-efficacy level of India and Taiwan university students. The participants of this study included 299 university students (undergraduate and graduate) from India and Taiwan, the data was collected by online questionnaire survey circulated by mail. In the study, the researchers performed One-Way ANOVA, Correlation analysis, and Linear Regression analysis to check the hypothesis and at the end mediation analysis through “The process Macro” in SPSS software. The findings showed that: (1) there is no discernible difference between Indian and Taiwanese students' entrepreneurial intention (EI) features, and (2) Taiwanese students had greater levels of entrepreneurial self-efficacy than Indian university students. (3) Entrepreneurship education significantly impact the entrepreneurial intention and self-efficacy of the Indian and Taiwanese university. (4) The association between entrepreneurship education and entrepreneurial self-efficacy is significantly favorable, however, the relationship between entrepreneurship education and entrepreneurial intention is partially impacted by the mediating effect of entrepreneurial self-efficacy.

Background: The impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex.Methods: Two similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months.Results: The HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT <30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT <30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87-2.77,P < 0.001). Less cardiac stress testing with unmasking amongst those <30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females <30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01).Conclusion: Compared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.

BACKGROUND:Diagnosis of acute myocardial infarction (AMI) requires a combination of elevated cardiac troponins, and clinical or echocardiographic evidence of coronary ischaemia. Identification of patients with a high likelihood of coronary plaque rupture (Type 1 myocardial infarction [MI]) is crucial as it is these patients for whom coronary intervention has been well-established to provide benefit and reduce subsequent coronary ischemic events. However, high-sensitivity cardiac troponin (hs-cTn) assays have increasingly identified patients with hs-cTn elevations not due to Type 1 MI where recommendations for ongoing care are currently limited. Understanding the profile and clinical outcomes for these patients may inform the development of an emerging evidence-base.METHODS:Using two previously published studies (hs-cTnT study n=1,937, RAPID-TnT study n=3,270) and the Fourth Universal Definition of MI, index presentations of patients to South Australian emergency departments with suspected AMI, defined by high sensitivity cardiac troponin T (hs-cTnT) greater than the upper reference limit (14 ng/L) and without obvious corresponding ischaemia on electrocardiogram (ECG), were classified as either Type 1 MI (T1MI), Type 2 MI (T2MI), acute myocardial injury (AI), or chronic myocardial injury (CI). Patients with non-elevated hs-cTnT (defined as <14 ng/L) were excluded. Outcomes assessed included death, MI, unstable angina, and non-coronary cardiovascular events within 12 months.RESULTS:In total, 1,192 patients comprising 164 (13.8%) T1MI, 173 (14.5%) T2MI/AI, and 855 (71.7%) CI were included. The rate of death or recurrent acute coronary syndrome was greatest in patients with T1MI, but also occurred with moderate frequency in Type 2 MI/AI and CI (T1MI: 32/164 [19.5%]; T2MI/AI: 24/173 [13.1%]; CI:116/885 [13.6%]; p=0.008). Of all the deaths observed, 74% occurred among those with an initial index diagnostic classification of CI. After adjusting for age, gender and baseline comorbidities, the relative hazard ratios for non-coronary cardiovascular readmissions were similar across all groups: Type 2 MI/AI: 1.30 (95% confidence interval 0.99-1.72, p=0.062); CI: 1.10 (95% confidence interval 0.61-2.00, p=0.75).CONCLUSIONS:Non-T1MI accounted for the majority of patients presenting with elevated hs-cTnT without ischaemia on ECG. Patients with T1MI had the highest rates of death or recurrent AMI; however patients with T2MI/AI and CI experienced a substantial rate of non-coronary cardiovascular re-hospitalisations.

Cardiac cachexia is a muscle wasting process that often develops in those with chronic heart failure resulting in weight loss, low levels of physical activity, reduced quality of life, and is associated with a poor prognosis. The pathology of cardiac cachexia is complex with new evidence emerging that implicates several body systems. This review describes the pathophysiology associated with cardiac cachexia and addresses: 1) hormonal changes- neurohormonal abnormalities and metabolic hormone imbalance; 2) mechanisms of muscle wasting in cardiac cachexia, and the integral mechanisms between changed hormones due to cardiac cachexia and muscle wasting processes, and 3) associated abnormalities of gastrointestinal system that contribute to cardiac cachexia. These pleiotropic mechanisms demonstrate the intricate interplay between the affected systems and account for why cardiac cachexia is difficult to manage clinically. This review summarises current pathophysiology of cardiac cachexia and highlights symptoms of cardiac cachexia, implications for clinical practice and research gaps.

Background There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients. Method A systematic search was conducted. Result Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated. Conclusion The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.

Aim: This systematic review was undertaken to investigate the impact of social media use in relation to student engagement in nursing education.Background: The availability of social media has transformed global connectivity within education systems. Social media has been used in various educational contexts. The widespread use of social media has prompted a demand for a better understanding of how it might be used in nursing education. While research has previously explored the positive effects of using social media on a range of learning outcomes in nursing education, studies have not specifically focused on how these positive features have an impact on students' engagement as a vital component of successful learning.Design: This review uses the Joanna Briggs Institute approach to conducting systematic reviews and follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting a sys-tematic review.Methods: Following predefined inclusion criteria, a search of electronic databases was performed using a three -step strategy to identify relevant studies. The following databases were searched: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Centre (ERIC), MEDLINE and PubMed. A further manual search was performed to identify potentially relevant articles. The included studies were assessed for methodological quality by all reviewers using the Mixed Methods Appraisal Tool. NVivo software was used for organising data and developing themes. Results: Data from sixteen studies with different designs were extracted and thematically synthesised. The syn-thesised findings yielded five themes: 1) interaction and communication; 2) managing stress; 3) positive online community; 4) time spent; and 5) digital literacy and e-professionalism.Conclusions: This review reveals that using social media to support nursing students' learning has positive benefits in terms of promoting several aspects of their engagement, such as rapid interaction and communication. Further empirical studies, however, should aim to measure social media's effects on nursing students' engage-ment with their courses and their academic attainment.

Aims: Explore the impact of deploying high-sensitivity (hs) cardiac troponin T (cTnT) assay across a state-wide health service. Methods and results: Presentations to emergency departments of six tertiary hospitals between January 2008 and August 2019 were included; standard cTnT assay was superseded by hs-cTnT in June 2011 without changing the reference range (>= 30 ng/L reported as elevated), despite cTnT level of 30 ng/L being equivalent to similar to 44 ng/L with hs-cTnT. Clinical outcomes were captured using state-wide linked health records. Interrupted time series analyses were used adjusted for seasonality and multiple co-morbidities using propensity score matching allowing for correlation within hospitals. In total, 614,847 presentations had >= 1 troponin measurement. Clinical ordering of troponin decreased throughout the study with no increase in elevated measurements amongst those tested with hs-cTnT. Small but statistically significant changes in index myocardial infarction (MI) diagnosis (-0.36%/year, 95%CI [confidence interval]:-0.48, -0.24,p < 0.001) and invasive coronary angiography (0.12%/year, 95%CI:0, 0.24,p = 0.02) were seen, with no impact on death/MI at 30 days or 3-year survival in episodes of care (EOCs) with elevated cTnT after hs-cTnT implementation. Length of stay (LOS) was shorter among those with an elevated hs-cTnT (-4.44 h/year, 95%CI:-5.27, -3.60, p < 0.001). Non-elevated cTnT EOCs demonstrated shorter total LOS and improved 3-year survival (adjusted hazard ratio:0.90, 95%CI:0.83, 0.97,p = 0.008) although death/MI at 30 days was unchanged using hs-cTnT. Conclusion: Widespread implementation of hs-cTnT without altering clinical thresholds reported to clinicians provided significantly shorter LOS without a clinically significant impact on clinical outcomes. A safer cohort with non-elevated cTnT was identified by hs-cTnT compared to the standard cTnT assay.

Heart failure as a comorbidity in the older population with COVID-19 poses an additional threat to those affected. Patients with both COVID-19 and heart failure share similar risk factors, which result in magnification of pathological outcomes. These include a common inflammatory pathology and related coagulopathy. Both illnesses pose a risk of arrhythmia. Polypharmacy further complicates safe drug administration and worsens the risk of medication-induced arrhythmia. Additionally, both conditions present challenges regarding attaining and maintaining an appropriate nutritional state. Exploration of the interplay between these factors demonstrates the gravity of the co-existence of these conditions and helps understand the difficulties faced when caring for this patient group. Although care provided to COVID-19 patients is primarily related to symptom presentation, based on the analysis conducted, there are some recommendations for practice in relation to evidence and guidelines when managing heart failure patients in primary care within the context of the COVID-19 pandemic.