BACKGROUND & AIMS:Pressure ulcers (PUs) are prevalent chronic wounds associated with pain, infection, and prolonged hospitalisation. Adequate nutrition is important in both preventing and healing PUs; however, malnutrition frequently co-occurs and nutritional care in clinical practice remains suboptimal. This study aimed to explore healthcare professionals' knowledge, attitudes, practices, and perceived barriers to nutritional care for PU patients in hospitals, nursing homes, and home care settings. METHODS:A cross-sectional survey of 284 Flemish and Dutch healthcare professionals was conducted between April and June 2024. Knowledge, attitudes, practices, and barriers related to nutritional management of PUs were assessed. Descriptive statistics and ordinal logistic regression were used to analyse data and identify gaps in implementation of nutritional interventions. RESULTS:Most respondents (93.7%, n = 266) agreed or strongly agreed that inadequate nutritional guidance leads to more wound-healing complications, with dietitians reporting higher knowledge than nurses (p < 0.01), reflecting their specialised training amid limited dietitian availability in Flemish/Dutch settings, where nurses often take on primary responsibility for nutritional tasks (e.g., screening and adjustments). However, more than 60% of all respondents reported insufficient knowledge of glutamine/arginine supplementation. Reported barriers included unclear guidelines (63.3%, n = 180), insufficient knowledge of effective interventions (70.4%, n = 200), and high costs of supplementation (80.3%, n = 228), indicating a need for clearer guidelines and targeted education and policy support. CONCLUSION:Although healthcare professionals acknowledge the important role of nutrition in PU management, significant knowledge gaps, particularly between dietitians and nurses, and systemic barriers hinder effective care. Clearer guidelines, targeted education, and supportive policy measures (e.g., standardised nurse-led protocols) are needed to strengthen nutritional practices and improve patient outcomes.

Pressure ulcers pose a significant health challenge, requiring effective management strategies. Nutrition, particularly arginine and glutamine, supports collagen synthesis and tissue repair. This review evaluates the role of enteral glutamine and arginine supplementation on wound healing outcomes, addressing gaps in previous research. A PRISMA-guided systematic search of five databases identified studies published between 2004 and 2024 on adults with pressure ulcers receiving these supplements. Outcomes assessed included healing time, wound size reduction, local infection, recurrence, and pain. A narrative synthesis was performed due to heterogeneity, with bias assessed via Cochrane RoB2 and JBI checklists. Fifteen studies involving 1085 participants were included. Findings indicated a trend toward improved healing with arginine or combined arginine/glutamine supplements, with relative wound size reductions of 18.6% to 98.2% over 2 to 20 weeks. However, inconsistencies were noted, with seven studies showing non-significant or unreported differences in wound size, and six studies with similar issues for healing time. Glutamine was examined only in combination with arginine, limiting insights into its isolated effects. None of the studies reported on recurrence or pain outcomes. While arginine shows potential for enhancing healing, evidence remains inconclusive. Future research should emphasise follow-up until complete wound closure and explore the independent effects of glutamine on wound healing outcomes.

BACKGROUND:The concept of professional midwifery autonomy holds great significance in midwifery education. Notably, clinical placements play a crucial role in introducing students to its concept. However, the understanding and experiences of students regarding midwifery autonomy are relatively unknown.OBJECTIVES:This study aimed to examine the experiences and understanding of midwifery autonomy among final-year midwifery students.METHODS:A qualitative exploratory study using three focus group interviews with final-year midwifery students from each of the three Belgian regions; Flanders, Walloon and the Brussels Capital Region. Focus groups were recorded, transcribed verbatim and analysed using a thematic analysis.RESULTS:Upon data analysis, five key themes emerged; 1) working independently, 2) positive learning environment, 3) professional context, 4) actions and decisions of others and 5) beneficial for women. Students emphasized the importance of promoting professional midwifery autonomy through the ability to make their own professional decisions and take initiatives. They highlighted the need for a safe and supportive learning environment that encourages independent practice, nurtures self-governance and facilitates personal growth. Additionally, collaborative relationships with other maternity care professionals and increased awareness among women and the broader healthcare community were identified as essential factors in embracing and promoting professional midwifery autonomy.CONCLUSIONS:Our study provides valuable insights into the significance of midwifery autonomy among final-year midwifery students. To empower midwifery students to truly understand and experience professional midwifery autonomy, educators and preceptors should adopt strategies that enhance comprehension, foster independent yet collaborative practice, establish supportive learning environments, and equip students to navigate challenges effectively, ultimately improving maternal and new-born health.

Objective To identify challenges associated with midwives' professional autonomy in Belgium and develop recommendations to promote midwives’ recognition and professional autonomy. Design Through a document analysis study we identified challenges, categorized them into themes and linked them with Greenwood's sociological criteria for a profession. This involved an in-depth synthesis of findings from our published studies to comprehensively examine the challenges to optimizing midwifery autonomy and to develop corresponding recommendations. Findings We identified challenges related to midwife-led continuity care models, regulation of the midwifery profession, collaboration with stakeholders, professional esteem and professional culture. Based on them, our recommendations include prioritizing midwife-led continuity of care, fostering collaboration, tailoring continuous professional development, increasing public awareness and advocating for policy changes. The attribute of a profession which is lacking the most in midwifery in Belgium is recognized authority, which may result in midwives being undervalued, underutilized and underpaid. Key conclusions In this paper we identified challenges in Belgian midwives' recognition and professional autonomy and provided recommendations to address them, emphasizing the importance of recognized authority in midwifery. Implementing these recommendations can positively impact midwives' recognition and autonomy in Belgium and potentially in other countries. Implications for practice It is essential for policy makers to address the issue of the lack of recognized authority in midwifery, as it plays a critical role in facilitating decision-making, policy development, and the professionalization of the field. Implementing the outlined recommendations can drive positive changes in midwifery recognition and autonomy in Belgium and beyond.

IntroductionVarious nutrients play a physiological role in the healing process of pressure ulcers (PUs). Nutritional interventions include the administration of enteral nutritional supplements and formulas containing arginine, glutamine, and micronutrients. The aim of this systematic review is to evaluate the effectiveness of enteral nutritional supplements and formulas containing arginine and glutamine on wound-related outcomes. These include (1) time to healing, (2) changes in wound size, (3) local wound infection, (4) PU recurrence, and (5) PU-related pain.Materials and methodsThis protocol was developed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). A search will be conducted in the Cochrane Library, EMBASE, PubMed (MEDLINE), CINAHL (EBSCOhost interface) and Web of Science. In addition, a manual search will be conducted to identify relevant records. Except for systematic reviews, no restrictions will be placed on the study design, the population studied or the setting. Studies that do not address PUs, in vitro studies and studies that do not report wound-related outcomes will be excluded. Study selection, risk of bias assessment and data extraction will be performed independently by three researchers. Depending on the extent of heterogeneity of interventions, follow-up time and populations, results will be summarised either by meta-analysis or narrative synthesis.ConclusionsThis is the first systematic review to identify, evaluate and summarise the current evidence for enteral arginine and glutamine supplementation on wound-related outcomes in PUs. The review will provide a solid basis for deriving valid and clinically relevant conclusions in this area.

Introduction Despite the evidence that fatherhood has a long-term positive and protective effect on men's health, there is also evidence that fatherhood in the perinatal period can be complex and demanding. The challenging nature of fatherhood during the perinatal period can be further compounded by the experience of preterm birth. Preterm birth, defined as a birth occurring before 37 weeks of gestation, has been identified as a risk factor for maternal stress, anxiety, depression and post-traumatic stress. It can be hypothesised that preterm birth is also a risk factor for fathers mental health; however, as no attempt has been made to systematically review studies that have examined preterm births and father’s mental health during the perinatal period it is currently not known how common or signficant the impact of a preterm birth is on father’s mental health during this life stage. Aim The aim of the systematic review will be to critically appraise the empirical evidence that examined preterm birth and father’s mental health during the perinatal period. Design Systematic review Methods The review will be guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, the Cochrane Library, PsycARTICLES, PsycINFO, Psychology and Behavioural Sciences Collections will be searched to identify studies that meet the inclusion criteria. Studies that researched preterm birth during the perinatal period will be included if fathers mental health was the principal focus of the research, if fathers mental health was in the title and/or aim of the study or if fathers mental health was an outcome or dependent variable. Data will be extracted and presented in narrative form including tables and figures. Trial registration Trial registration: the protocol for this systematic review has been registered in PROSPERO [CRD42024536317]. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=536317 ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: N/A I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion

BackgroundScreening for gestational diabetes mellitus (GDM) is important to improve pregnancy outcomes and to prevent type 2 diabetes after pregnancy. Due to a lack of evidence, the 2019 Flemish consensus did not recommend screening for GDM in early pregnancy. Recently, a large randomized controlled trial (TOBOGM) demonstrated that screening for GDM before 20 weeks reduces the risk of neonatal complications in women with risk factors when using higher cut-offs to define GDM compared to the criteria used later in pregnancy.MethodsBased on this new evidence, members of the Diabetes Liga, the Flemish associations of general physicians (Domus Medica), obstetricians (VVOG), midwives (VBOV), diabetes nurse educators (BVVDV), dieticians (VBVD) and clinical chemists (RBSLM) have adapted the Flemish consensus on screening for GDM.BackgroundRecommendations: As in 2019, this new consensus recommends universal screening for overt diabetes in early pregnancy preferably by measuring fasting plasma glucose by using the same diagnostic criteria as in the non-pregnant state. Based on the new evidence, women with fasting plasma glucose 95-125 mg/dL (5.3-6.9 mmol/L) before 20 weeks gestation should be diagnosed as early GDM. In addition, in women with obesity and/or a history of GDM, it is advised to perform already a 75 g oral glucose tolerance test (OGTT) between 6 and 20 weeks gestation using higher cut-offs to diagnose early GDM [fasting >= 95 mg/dL (5.3 mmol/L), 1 hour >= 19 mg/dL (10.6 mmol/L) and/or 2 hour >= 162 mg/dL (9.0 mmol/L))]. The recommendation concerning screening for GDM between 24 and 28 weeks remains unchanged with a diagnosis of GDM based on the 75 g OGTT and IADPSG criteria [fasting >= 92 mg/dL (5.1 mmol/L), 1 hour >= 180 mg/dL (10.0 mmol/L) and/or 2 hour >= 153 mg/dL (8.5 mmol/L)].

reports of data from original research.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.• Short Reports -brief reports of data from original research.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.

reports of data from original research.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.• Short Reports -brief reports of data from original research.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.

reports of data from original research.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.• Short Reports -brief reports of data from original research.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.

reports of data from original research.• Review Papers -comprehensive, authoritative, reviews within the journal's scope.• Short Reports -brief reports of data from original research.• Methodology Papers -Papers that present different methodological approaches that can be used to investigate problems in a relevant scientific field and to encourage innovation.• Policy Case Studies -brief articles on policy development at a regional or national level.• Study Protocols -articles describing a research protocol of a study.

Background There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. Results In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women.

There is an exponential growth in the availability of mobile Health (mHealth) applications, resulting in increased use of pregnancy apps. However, the actual use, experience, and characteristics of women using pregnancy apps are relatively unknown. To map the current use of the Internet and mobile applications and the needs and expectations among pregnant women in Flanders. A cross-sectional study was conducted, using a semi-structured survey (April - June 2019) consisting of four different domains: (1) demographics; (2) use of multimedia; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using Independent Student’s t-tests and Chi-square tests. Correlations were investigated between maternal characteristics and the women’s responses. In total, 311 women fulfilled the questionnaire completely. The majority of multimedia were daily used by the women (computer/laptop 40,84%; GSM: 80,71%; and smartphone/iPhone: 97,43%). The obstetrician was their prior source of information (86.17%), followed by ‘websites/Internet’ (85.85%) and ‘apps’ (74.92%). Information was mostly searched about the development of the baby (88.45%), discomfort/complaints (80.71%) and health during pregnancy (79.74%), administrative/practical issues (74.92%) and breastfeeding (56.59%). About half of the women (55.31%) downloaded a pregnancy app (172/311), mostly searched app stores (43.02%; 74/172). Singleton pregnancies asked significantly more information to their mother (73.33%) or other family members (43.33%) than married women (mother (in law): 51.26% (p= 0.02); family members: 21.88% (p = 0.01)) or cohabiting women (mother (in law): 50.00% (p = 0.02)). Pregnant women with lower education had significantly more a pc or laptop than those with higher education (98.63% vs. 85.47%; p = 0.008), consulted more other family members for pregnancy information (41.10% vs. 23.08%; p <0.01) but less a gynaecologist (95.89% vs. 83.54%; p = 0.001), followed more prenatal sessions (80.77% vs. 32.48%; p = 0.04) and searched more for information on discomfort/complains during pregnancy (89.04% vs. 79.49%; p = 0.02). Compared to multigravida, primigravida asked more advice about their pregnancy to their environment (family members: primigravida: 40.37% vs. multigravida 20.10%; p < 0.001; or other pregnant women: primigravida: 53.21% vs. multigravida 40.20%; p < 0.03). Healthcare professionals need to be aware that mHealth apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited amount of apps are subjected to an external quality check. Therefore, it is important that caregivers refer to high quality digital resources and take the opportunity to discuss digital information with pregnant women. The study was approved by the Medical Ethics Committees of the hospital Oost-Limburg (no. 19/0026U, B-no. B371201939699) and Ghent University hospital (EC 2018/0120, B-no. B670201835156).

INTRODUCTION Evidence-based practice (EBP) leads to improved health outcomes and reduces variability in the quality of care. However, literature on the knowledge, attitudes and use of EBP among midwives is scarce internationally and in Belgium. METHODS A cross-sectional study using an online semi-structured questionnaire explored practice, attitudes and barriers on EBP and clinical practice guidelines. Midwives (n=251) working in university and non-university hospitals, primary care, and midwifery education, in Flanders (Belgium) were included. RESULTS Midwives with a Master’s degree (57.7% vs 37.8%; p=0.004), ≤15 years since graduation (50.8% vs 35.5%; p=0.015) and aged <40 years (49.7% vs 34.6%; p=0.02), had better knowledge of the EBP-definition. The majority searched for literature (80.1%), mainly evidence-based (EB) clinical practice guidelines (50.6%), randomized controlled trials (45.0%) and systematic reviews (43.0%). Midwives found EBP necessary and realistic to apply in daily practice and support decision-making. They were willing to improve EBP-knowledge and skills but assumed to be competent in providing evidence-based care. Most respondents were convinced of the importance of EB clinical practice guidelines but did not believe guidelines facilitated their practices or enabled them to consider patient preferences adequately. Half of the midwives (55.8%) experienced barriers to EB clinical practice guideline use, mainly lack of time (35.9%), access (19.5%), and support (17.9%). CONCLUSIONS Although midwives showed a positive attitude towards EBP, education programs to promote EBP and improve EBP-related knowledge and skills are needed. Future efforts should focus on developing strategies for overcoming barriers and enhancing the consistency of EBP implementation.

OBJECTIVE:to examine the knowledge, attitude and practices (KAP) of Flemish midwives regarding miscarriage. DESIGN AND SETTING:a cross-sectional KAP study was conducted in 28 hospitals in Flanders (Northern region of Belgium) from September 2015 to January 2016. PARTICIPANTS:a total of 647 out of 1200 midwives (53.9%) working on maternity, labour and gynaecological wards, maternal and neonatal (intensive) care units, antenatal consultations, and reproductive medicine were recruited. MEASUREMENTS:data were collected using a semi-structured, self-administered questionnaire. FINDINGS:the mean knowledge score was 6.31 out of 10. Of all participants, 47% recently cared for couples with miscarriage, and the majority (97%) indicated a key role for midwives in the psychosocial support of those couples. Lack of time, incapability and fear of being overwhelmed by their own feelings were identified as main barriers for psychosocial support. Knowledge was more often evaluated as adequate when miscarriage was included in the midwifery education (31% vs. 17.3%, χ2 = 12.965, df = 1, p<0.001). Midwives trained for the topic 'miscarriage' more often valued their role in miscarriage care (98.8% vs. 94.1%, χ2 = 11.002, df = 1, p = 0.001). They considered themselves being more capable to provide adequate psychosocial support when feeling sufficiently trained in communicative skills (77.7% vs. 33.8%, χ2 = 96.574, df = 1, p<0.001). The majority (72.4%) indicated a lack of knowledge regarding miscarriage. Almost 89% expressed a need for extra training. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:midwives in Flanders assist in the care for couples with miscarriage and consider themselves as a key healthcare provider in the psychosocial support. This study highlighted several barriers regarding miscarriage care, e.g. a lack of knowledge and incapability. Adequate training in knowledge and communication skills is important and necessary in order to promote appropriate care to couples experiencing pregnancy loss and increase awareness among all health professionals involved in obstetric care. Further research should investigate to what extent miscarriage is included in the educational midwifery programmes, and how the current healthcare practice regarding miscarriage care is organised.

The objective of this study was to evaluate a new way for applying bed baths and reducing the risk for dry skin by comparing the effect of two washing methods on skin hydration. A cluster randomized trial was conducted. Skin hydration was measured before and after implementation of disposable wash gloves, using a MoistureMeter SC at three skin sites. Total skin hydration did not differ between residents at the start of the study in both groups. After implementation, the post minus pre hydration scores were higher for the intervention group than the control group at all skin sites. However, the difference was only significant at cheek site. The use of disposable wash gloves does not increase the risk for dry skin in comparison with traditional washing methods. These results may encourage the introduction of disposable wash gloves as an innovation in daily skin care practice.