AIM:To synthesise and critically appraise the evidence on educational interventions designed to improve electrocardiogram interpretation competence among registered nurses. BACKGROUND:Electrocardiogram interpretation is a core clinical competence for nurses and is essential for recognising and managing cardiac abnormalities. Despite its importance, evidence consistently demonstrates suboptimal electrocardiogram interpretation competence among nurses, alongside variability in education and training provision. DESIGN:Systematic review. METHODS:MEDLINE (Ovid), CINAHL, Embase and Scopus were searched from inception to 2 March 2025, with an updated search on 15 April 2026, supplemented by grey literature searching. Study selection, data extraction and quality appraisal using Joanna Briggs Institute critical appraisal tools were conducted independently by two reviewers. Due to heterogeneity in study design, interventions and outcome measures, a narrative synthesis was conducted. RESULTS:Twenty-three studies met the inclusion criteria, including randomised controlled trials and pre-post quasi-experimental studies conducted across diverse clinical settings and countries. Educational interventions were associated with improvements in nurses' electrocardiogram competence. Interventions were synthesised into five themes: traditional and structured education; technology-enhanced learning; micro-learning approaches; blended and learner-centred models; and sustainability and reinforcement of learning over time. Interventions incorporating active learner engagement, structured practice and reinforcement appeared more likely to support meaningful learning gains. Evidence of learning attenuation over time was reported. CONCLUSIONS:Educational interventions can improve electrocardiogram interpretation competence among nurses; however, electrocardiogram interpretation represents a complex clinical competency requiring ongoing development rather than one-off training. Spaced learning and reinforcement-based educational approaches may better support sustained competence.

Obesity is a significant risk factor for cardiovascular disease (CVD) and attributed to two-thirds of mortality linked to CVD worldwide. Expert position papers call for clinicians to screen for, identify, and treat this modifiable CVD risk factor. However, there is reluctance by many clinicians to initiate often-challenging clinical conversations. For researchers, identifying a robust methodology to collect sensitive data within this area can be difficult. One such methodology is factorial survey design, which incorporates variables of interest into clinical vignettes, which are then disseminated as a survey. Vignettes that replicate the realities of practice have been extensively authenticated through international studies and are particularly appropriate when exploring sensitive topics. This methods paper discusses implementing factorial design within an Internet-Mediated platform using the innovative approach of embedding photographs within clinical vignettes. The recruitment of a large, complete, multiprofessional dataset (n = 427) indicated that clinicians engaged easily with the Internet Mediated platform and viewed virtual vignettes with integrated patient photographs as authentic, reflecting the complexities of clinical practice.

ABSTRACT Aim To determine which pain management approaches have been implemented in an acute hospital setting and gauge the extent to which they effectively assess and manage pain among patients with dementia. Design The review followed the Joanna Briggs Institute framework, guided by the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis extension for scoping reviews (PRISMA‐ScR). Method The search strategy was designed to locate published and unpublished studies through online databases such as MEDLINE (Ovid) and CINAHL, as well as relevant grey literature sources, such as the WHO database. The review included primary and secondary research publications from 2005 to 2023 relating to patients with dementia in an acute hospital setting. The study focused on overall pain management approaches, including pain assessment, processes, and interventions to manage pain. Tables were used to extract and synthesise results using descriptive statistics. Results Fourteen studies met the inclusion criteria. They included a range of designs: five cross‐sectional and two cohort studies; five interventional studies; one action research project; and one quality improvement programme. The interventions identified in the review mainly involved validating pre‐existing pain assessment tools, such as the Pain Assessment in Advanced Dementia Scale (PAINAD). Overall, the authors' primary strategy for implementing their respective interventions was organising participant awareness‐raising and training sessions. Conclusions There is a lack of standardised, person‐centred protocols for managing pain in patients with dementia and a dearth of evidence relating to pain reduction among this client group. While valid pain assessment tools exist, their use alone does not guarantee timely or effective pain relief. Although studies reported the development of interventions to promote effective pain management, they did not consistently demonstrate a systematic reduction in pain among the patient groups. Whilst education on pain management is vital, it has been shown that education alone is insufficient to improve care. Implications for Practice The review identified several validated instruments for assessing pain in people living with dementia; however, the availability of tools alone is not enough to change practice. A broader shift in pain management is required. Nurses need organisational support not only to incorporate observational pain assessment tools into routine workflows but also to connect assessments to clear clinical actions and adopt a proactive, holistic approach. This includes preventing diagnostic overshadowing by recognising pain as a potential cause of behavioural change and ensuring that pain management strategies go beyond assessment to deliver timely, person‐centred interventions. Health care providers need to support nursing staff beyond providing training and updates to encourage evidence‐based practice and to engender a culture in which pain management is a priority. Patient or Public Contribution No patient or public contribution was made towards this review.

[This corrects the article DOI: 10.1371/journal.pone.0332744.].

AIMS:To identify, appraise and synthesise the current evidence relating to symptoms, experiences, management and impact of menopause on QoL among women with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) and to identify evidence gaps. METHODS:We conducted a scoping review guided by Arksey and O'Mally's framework by searching CINAHL, MEDLINE, EMBASE, PsychINFO and PubMed using an iterative approach to pre-specified eligibility criteria which were reviewed with increasing familiarity with the literature. Studies focusing on peri-menopausal and menopausal people assigned female at birth with a diagnosis of T1DM or T2DM were included. RESULTS:In total, 16,681 records were identified from which 77 papers were subjected to full review, with 22 eligible. Research focus and methodology varied: 16 observational studies, 2 expert consensus reviews, 2 interventional studies, 1 patient and public involvement paper and 1 qualitative grounded theory paper. PRISMA-ScR guidelines were followed for transparency of reporting. Findings indicate women with diabetes experience menopausal symptoms similar to those of women without diabetes; however, they may be at risk of increased severity of symptoms, HRT use was linked to lower HbA1c levels but is largely overlooked, limited research has been undertaken exploring women's experiences and awareness of support during the menopause; existing research evidence suggests they are ill-informed and lacking effective evidence based support. There is a particular dearth of evidence relating to women with T1DM. CONCLUSIONS:This review provides evidence that menopause has a negative influence upon quality of life for many women with diabetes. The impacts span managing diabetes and menopausal symptoms and seeking and receiving support. A hypothesised bidirectional relationship between diabetes and menopause may exist: whereby progression of one may be influenced by the other also resulting in a lower quality of life. While high-level evidence on this complex inter-relationship remains limited, particularly in T1DM populations, it suggests significant unmet need for those experiencing diabetes and menopause together.

AIM:To establish a comprehensive pre-implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach. BACKGROUND:Pain is common yet frequently under-recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM-B, may help identify determinants of practice and inform implementation strategies. DESIGN:Multiple-methods study, underpinned by the COM-B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions. METHODS:The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (n = 148) completed an adapted 6-item COM-B self-evaluation scale (0-10). Semi-structured interviews with ward managers and a pain management specialist nurse (n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation (n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines. RESULTS:Staff reported high perceived capability, opportunity and motivation, suggesting strong self-reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM-B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections. CONCLUSION:A discrepancy exists between self-reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care. IMPLICATIONS FOR CLINICAL PRACTICE:Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system-level processes to support timely person-centred pain management. REPORTING METHODS:STROBE guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION:A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.

Background International guidelines recommend structured diabetes education to empower individuals with type 2 diabetes (T2D). While DESMOND is an effective programme for T2D management, it is often inaccessible to people with intellectual disabilities (ID) due to their unique needs. There is limited evidence on the effectiveness of adapted T2D education for this group, despite the importance of tailored support in preventing complications and early mortality. We previously adapted the DESMOND programme for adults with ID, creating DESMOND-ID. A feasibility study showed it is possible to recruit and deliver the programme to adults with ID and their carers, who found it valuable. Initial findings suggest DESMOND-ID may improve blood glucose control, warranting further investigation through a large-scale randomised controlled trial (RCT). Methods The "My Diabetes & Me" study will be conducted in two stages: an internal pilot and a main RCT. The pilot will recruit 108 participants over 10 months to assess recruitment and retention, using glycated haemoglobin (HbA1c, mmol/mol) at six months as the primary outcome. This will inform the design of the main study. Across both stages, 450 participants will be randomly assigned to receive either the DESMOND-ID intervention or treatment as usual (TAU). The intervention group, with their carers, will attend weekly sessions for seven weeks, plus two booster sessions at one and three months post-programme. Primary outcome is HbA1c at six months. Secondary outcomes include HbA1c at 12 and 18 months (pilot only), anthropometric data, self-reported outcomes, and other risk factors. A process evaluation will explore barriers and facilitators to implementation using qualitative and quantitative methods. Conclusion DESMOND-ID is the first structured T2D education programme tailored for adults with ID, and this RCT is the first to evaluate its clinical and cost-effectiveness. Trial Registration 09/11/2022 ISRCTN83150600 (https://doi.org/10.1186/ISRCTN83150600)

BACKGROUND:The challenges of recruitment to randomised controlled trials have been well documented. The additional challenges of recruiting people with intellectual disabilities (ID) and significant health co-morbidities have been the focus of less attention. The aim of this work was to explore issues around the screening and recruitment of adults with ID and Type 2 Diabetes (T2D) into the internal pilot of the 'My Diabetes and Me' Randomised Controlled Trial. The findings were used to develop recommendations and implement interventions to address challenges for recruitment to the main study. METHODS:A multiple methods approach using the QuinteT Recruitment Intervention was employed across three National Health Service sites in the United Kingdom. Semi-structured interviews were undertaken with staff, and adults with ID/T2D recruited to the study; analysis of recruitment discussion recordings, and a review of documentation pertaining to screening logs and research meetings was also performed. Thematic analysis identified the complexity of challenges and potential enablers to recruitment in this population. RESULTS:Recruitment challenges began much earlier than anticipated with significant organisational process challenges to be overcome. The discomfort felt by some staff in putting potential participants forward was evident as they don't feel the study is appropriate for this population, or they feel out of their depth. Engagement and 'buy-in' from people with ID/ T2D were much more positive. The emotional labour involved in ensuring the internal pilot progressed to the main study was noteworthy. CONCLUSION:The use of QRI methodology within an ID RCT is a novel approach, unearthing emotional challenges and significant systemic organisational process challenges. The findings of this study clearly illustrate the informed implementation strategies that are needed to improve recruitment processes, minimise the emotional labour relating to NHS organisational 'buy-in' and address the preparation and readiness of NHS health and social care staff for research in under-represented populations.

ABSTRACT Aim This review aimed to assess the evidence of benefit from Nurses and Midwives' Clinical Academic (NMCA) appointments and establish the value of their contribution to the key stakeholders: patients, the individual joint appointees, academic institutions and health and social care organisations. Background Jointly appointed clinical academic posts for nurses and midwives are rare, making up less than 0.1% of the workforce in the UK. Design A scoping review. Methods Conducted following the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. Data Sources ProQuest, SCOPUS, MEDLINE Ovid, CINAHL Ultimate and British Library EThOS were searched for English‐language publications from January 2013 to December 2023. Results Thirteen papers met the inclusion criteria. Key themes were the introduction of effective care guidelines and interventions, shared decision‐making in care and research, individual professional growth and development, motivation and job satisfaction, improved clinical–academic partnerships and research advancement. Conclusion There is emerging evidence of significant benefits from clinical academic posts in nursing and midwifery; studies have generally been qualitative, focusing less on quantitative approaches. Implications for the Profession and/or Patient Care This study demonstrates potential benefits to both the nursing/midwifery profession and patients, particularly regarding the generation of new knowledge and provision of quality care.

Background Managing diabetes mellitus alongside the onset and development of dementia poses many challenges for those living with these conditions as well as their families, carers and service providers. Aim To describe nurses' positive experiences when managing adults with diabetes and dementia, as well as the issues and challenges. Method Qualitative, semi-structured focus group interviews were conducted with community and diabetes specialist nurses drawn from five health and social care trusts. Findings Four themes were identified: whose responsibility is it?; community and diabetes specialist nurses – the pivot point; education to manage comorbidities; and interprofessional communication. Conclusion Community and diabetes specialist nurses experience many challenges when supporting individuals living with diabetes and dementia. Sharing patient information among practitioners in different settings is critically important. IT could overcome the limitations of note-keeping 'silos', but further education is recommended to establish more effective communication and partnership working.

Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.

Introduction: Managing the impacts of the menopause can be a tedious experience for many women, and when coupled with diabetes, the challenges are multiplied. Literature searches confirm a dearth of information and support to help women with these dual conditions. Methods: A Patient Public Involvement exercise involving an online survey disseminated electronically via social media amongst the Type 1 diabetes online community. It comprised five closed questions and one open question to elicit priority needs. The survey was supplemented with a subsequent Twitter chat. The paper conforms to the guidance for reporting of patient and public involvement in health and social care research (GRIPP). Results: Of the 184 women who completed the survey across the United Kingdom, most were aged between 40 and 59 years (n = 167, 90.8%). Although 137 (72.8%) women reported that menopause had impacted on their diabetes, only a minority (n = 50, 27.2%) indicated that it had ever been discussed with them. The overarching theme from the open question was of an overall Lack of awareness about the impacts of menopause, with the following subthemes: 1) Need for information about menopause, 2) An additional burden, 3) Symptoms of diabetes or menopause? and 4) Communication – expectations of care. Conclusions: Women need information, support and guidance during this phase of life. This oft overlooked aspect of care is engendering frustration and suboptimal diabetes management and will be a topic raised with increasing frequency in general practice and diabetes specialities. The management of diabetes and menopause deserves more attention across the diabetes community.

This paper aims to describe experiences and challenges when managing diabetes along with dementia from the perspectives of those living with these conditions, their informal carers and health care professionals. The scoping review included studies published within the last 10 years (2012-2022) from EBSCO Research Databases: CINAHL, Health Business, Soc Index, ERIC, Medline, Information Science & Technology Abstracts and a review of reference lists. Three hundred and fifty-six papers were identified of which 11 studies met the inclusion criteria that focused on the experiences of managing the comorbidities of diabetes and dementia. Six papers focused on the implications of those individuals diagnosed with both conditions, four on implications for their informal carers (unpaid), two included both the individuals and their informal carers. There was one study that reported experiences of health care professionals. Individuals faced extraordinary challenges managing both conditions to perform activities of self-care such as taking medications, monitoring glucose levels, healthy eating, exercising and attending appointments. Informal carers reported that caring for both conditions was burdensome, sometimes overwhelming and they wanted more support from family and patients' health care providers. This scoping review revealed that many individuals and their informal carers were struggling with the impact of these comorbid conditions. Challenges such as lack of information and support were evident but there were few examples of solutions to improve diabetes management in those with dementia. To provide holistic care we need to integrate knowledge and skills from the areas of diabetes, mental health and social care. There is very little information relating to the experiences of health care professionals who work with those living with these conditions. Copyright (c) 2023 John Wiley & Sons.

Background:Evidence indicates that poor glycemic control is associated with increased morbidity and length of stay in hospital. There are a wide range of guidelines published, which seek to ensure safe and effective inpatient glycemic control in the hospital setting. However, the implementation of these protocols is limited in practice. In particular, the feasibility of "flash" and continuous glucose monitoring (CGM) remains untested on general wards. Method:Scoping Review. Results:If used in the general ward hospital settings, CGM and flash glucose monitoring (FGM) systems could lead to improved glycemic control, decreased length of stay, and reduced risk of severe hypoglycemia or hyperglycemia. Potential problems include lack of experience with this technology and costs of sensors. Rapid analysis of glucose measurements can facilitate clinical decision making and therapy adjustment in the hospital setting. In addition, people with diabetes may be empowered to better self-manage their condition in hospital as they have direct access to their glucose data. Conclusions:More studies are required in which the feasibility, benefits and limitations of FGM and CGM in non-intensive care unit hospital settings are elucidated. We need evidence on which types of hospital wards might benefit from the introduction of this technology and the contexts in which they are less useful. We also need to identify the types of people who are most likely to find FGM and CGM useful for self-management and for which populations they have the most benefit in terms of clinical outcomes and length of stay.

A chatbot usability questionnaire (CUQ) was designed to measure the usability of chatbots. Study objectives: 1) to test the construct validity of CUQ (i.e. does it differentiate between chatbots that we rank as having poor, average or good usability), 2) to assess the intra-rater reliability of CUQ (i.e. do participants provide the same answers/scores when assessing the usability of the same chatbots two weeks apart), and 3) to undertake exploratory factor analysis to study the underlying factors that CUQ measures. Three chatbots were selected by co-authors that were regarded as having good, average and poor usability. Participants used each of the chatbots and completed the CUQ scale for each. Participants repeated this process two weeks later to facilitate the measurement intra-rater variability. Paired t-tests were used to compare CUQ scores from each of the three chatbots. Exploratory factor analysis was used to identify the factors within the CUQ. Paired t-tests and correlation was used to measure intra-rater reliability. There was a total of 156 CUQ survey completions (26 participants completed the CUQ for 3 different chatbots and for 2 rounds: 26 * 3 * 2 = 156). Intra-rater reliability was supported as there was a good correlation between how participants completed the CUQ for the same chatbot at approximately two weeks apart (r > 0.7). As a form of construct validity, the CUQ scores for each of the three chatbots were statistically significant (p < 0.05). Factor analysis shows that the CUQ measures four factors 1) personality, 2) user experience, 3) error handling and 4) onboarding of the chatbot.

Aim To estimate and examine hospitalisation costs of Type 1 and Type 2 diabetes in an Irish public hospital. Methods A retrospective audit of hospital inpatient admissions over a 5-year period was undertaken, and a wide range of admission-related data were collected for a sample of 7,548 admissions. Hospitalisations were costed using the diagnosis-related group methodology. A series of descriptive, univariate and multivariate regression analyses were undertaken. Results The mean hospitalisation cost for Type 1 diabetes was euro4,027 and for Type 2 diabetes was euro5,026 per admission. Sex, admission type and length of stay were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 1 diabetes. Age, admission type, diagnosis status, complications status, discharge destination, length of stay and year were significantly associated with hospitalisation costs for admissions with a primary diagnosis of Type 2 diabetes. Length of stay was associated with higher mean costs, with each additional day increasing Type 1 diabetes costs by euro260 (p = 0.001) and Type 2 diabetes by euro216 (p < 0.001). Unscheduled admissions were associated with significantly lower costs than elective admissions; euro1,578 (p = 0.035) lower for Type 1 diabetes and euro2,108 (p < 0.001) lower for Type 2 diabetes. Conclusions This study presents estimates of the costs of diabetes care in the Irish public hospital system and identifies the factors which influence costs for Type 1 and Type 2 diabetes. These findings may be of interest to patients, the public, researchers and those with influence over diabetes policy and practice in Ireland and internationally.