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PubMed2026

Measuring economic efficiency in adult intensive care units: A systematic review of methods, metrics, and evidence.

OBJECTIVES: Intensive care units (ICUs) consume substantial hospital resources, yet "efficiency" is inconsistently defined and measured. This study systematically reviewed how economic efficiency has been conceptualised and quantified in adult ICUs and appraised the quality of evidence. METHODS: Following PRISMA 2020 and a PROSPERO-registered protocol (CRD420251107866), we searched MEDLINE, Embase, CINAHL, Cochrane Library and Web of Science (2000-August 2025), plus global grey sources. Eligible studies explicitly defined efficiency and reported an efficiency metric/model linking ICU inputs (e.g., staff, beds/capacity, time, consumables, or costs) to outputs/outcomes (e.g., throughput/discharges, length of stay/resource use, risk-adjusted mortality). Dual independent screening and extraction were performed. Study quality was appraised using MMAT, and findings were synthesised narratively (SWiM), given heterogeneity. RESULTS: 39 studies (2001-2025) from 17 countries were included, all from high-income or upper-middle-income settings. Four methodological families were identified: (1) frontier modelling (predominantly DEA; occasional SFA/RFDH), (2) benchmarking indicators (risk-adjusted mortality and LOS/resource-use ratios; "efficiency matrix" quadrant classification), (3) cost-outcome evaluations, and (4) operational/process metrics. Across families, variation in decision-making units, input/output selection, and risk adjustment limited comparability; long-term and patient-reported outcomes were absent, and equity considerations were uncommon. CONCLUSIONS: ICU efficiency research is feasible but fragmented and often methodologically limited. Standardised definitions, validated risk adjustment, uncertainty quantification, and inclusion of patient-centred and equity-relevant outcomes are needed before efficiency metrics can reliably inform value-based decision making.

Intensive Care Units↗

PubMed2026

Nurse-Led Home-Based Mobile Health Cardiac Rehabilitation Program for Patients With Chronic Heart Failure: A Randomized Controlled Trial.

This 12-week randomized controlled trial evaluated a nurse-led mHealth intervention for patients with chronic heart failure, conceptually informed by Riegel's middle-range theory of self-care of chronic illness. The program integrated wearable activity tracking with weekly nurse-led behavioral coaching, reflecting the core self-care processes of monitoring, maintenance, and management. Compared with usual care, the intervention significantly improved daily step count, 6-minute walk distance, metabolic equivalents, and left ventricular ejection fraction. Findings highlight the effectiveness of theory-informed, nurse-delivered mHealth strategies in enhancing physical activity and cardiopulmonary function, while underscoring the critical role of advanced practice nurses in home-based chronic disease management.

Aged↗

PubMed2026

Ictal electroencephalography and heart rate as treatment criteria in electroconvulsive therapy: a systematic review of the literature.

BACKGROUND: Decades before the emergence of precision medicine, psychiatrists raised the question of whether specific seizure characteristics could help optimize electroconvulsive therapy (ECT), as relationships between some of these characteristics and better outcomes were found. From 1990 onward, researchers focused on electroencephalography (EEG) and cardiovascular markers, which were broadly adopted by guidelines worldwide. However, the prognostic value of these markers is still controversial. Here, we provide a systematic summary of the studies on this topic. METHODS: We conducted a literature review on the use of ictal EEG and heart rate as outcome predictors in ECT using the PubMed, EMBASE, Cochrane and PsycINFO databases. RESULTS: Thirty-seven studies addressing more than 100 quality markers fulfilled our inclusion criteria. Single EEG markers were assigned to five categories (postictal inhibition, amplitude, coherence, regularity, and seizure duration). Heart rate and composite markers were considered separately. In contrast to single EEG markers, heart rate and composite markers could be consistently linked to better outcomes in patients with depression. Only a few studies on schizophrenia could be retrieved. CONCLUSION: Multiparametric markers outperformed single markers. Furthermore, changes in heart rate during seizures were related to better outcomes. Although clinical assessment remains the cornerstone of treatment guidance decisions, EEG and cardiac monitoring could help prevent insufficient seizures during the period preceding clinical improvement. Evidence on schizophrenia remains limited. More randomized trials are needed to analyze the role of composite markers as prognostic tools.

Humans↗

PubMed2026

Use of Wearable Sensors in Angelman Syndrome: A Systematic Review.

BACKGROUND: Wearable sensors are a promising method for collecting clinical trial outcome data for people with Angelman syndrome (AS). However, there has yet to be a systematic probe into the ways in which wearable sensors have been successfully used in AS. The current study aims to provide a quantitative summary of wearable sensors used in AS, including contexts of use and psychometric properties, and to present key narrative highlights. METHOD: Literature searches were performed in three electronic databases: APA PsycInfo, PubMed and Web of Science Core Collection. Data items were categorized into four categories: sample characteristics, study methodological details, wearable sensor characteristics and psychometric properties assessed. Sample characteristics included sample size, age, biological sex, race/ethnicity and cognitive/developmental functioning. Study methodological details were subdivided into study design and setting. Wearable sensor characteristics included sensor type, placement site, means of attachment, assessed construct and sensor-related data loss. Psychometric properties assessed included reliability and validity of sensor-derived data. RESULTS: We identified 16 articles through our systematic review. Wearable sensors were used to study sleep (n = 10, 62.5%), language (n = 2, 12.5%), gait (n = 2, 12.5%), caregiver proximity (n = 1, 6.3%), EEG power (n = 1, 6.3%), and arousal (n = 1, 6.3%) in AS through actigraphs, vocalization recorders, inertial sensors, radio-frequency identification watches, wireless EEG caps, and functional near-infrared spectroscopy caps, respectively. Findings from these studies broadly indicate that wearable sensors are feasible, reliable and valid for assessing a range of behaviours relevant to AS. CONCLUSIONS: Wearable sensors are a promising solution to enhance assessments in AS. However, with the small extant literature characterized by small sample sizes and restricted focus on a few relevant features in AS, there remains ample opportunities to explore the use of wearable sensors in people with AS. Additional studies will better inform clinical decision-making and ultimately improve the lives of people with AS and their families.

Humans↗

PubMed2026

Acceptability of alcohol-based hand rub during neonatal care in rural Ugandan households: a qualitative study nested within the BabyGel trial.

BACKGROUND: Poor access to water, sanitation and hygiene exacerbates the spread of infections among newborns. The BabyGel cluster randomised trial assessed the effectiveness of a community-level alcohol-based hand rub with a training component in reducing infection or death rates among newborns in Uganda. OBJECTIVE: Nested in the BabyGel trial, this study investigated the acceptability of the BabyGel intervention among mothers and household members in Eastern Uganda, using the Theoretical Framework of Acceptability. METHODS: In 2022, we conducted individual semistructured interviews with mothers, and group interviews with mothers and other household members, all recruited from intervention-arm clusters. Thematic analysis combined inductive and deductive coding, structured by the framework's seven constructs: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness and self-efficacy. RESULTS: Twenty mothers and 14 household members participated in 10 individual and 10 small group interviews. Participants found the intervention generally acceptable, appreciating its convenience and perceived protection against infection. Many described hand hygiene changes that persisted beyond the intervention period. However, concerns related to its harmful effects, spiritual beliefs and social tensions with visitors occasionally influenced its use. CONCLUSION: Alcohol-based hand rub combined with a training component was generally well accepted, driven by perceived health and practical benefits, although concerns related to safety, belief systems and social dynamics remained. Because data collection coincided with the COVID-19 pandemic, a period of heightened hygiene awareness, the acceptability observed could differ in nonpandemic periods. Culturally adapted education, community engagement and reinforcement of correct use may enhance acceptability and sustainability in similar settings.

Humans↗

PubMed2026

The musculoskeletal pain literacy questionnaire (MSK-PLq) - Part 1: Development of a preliminary version through a systematic review and Delphi consensus.

OBJECTIVE: Chronic musculoskeletal (MSK) pain is a leading cause of disability worldwide, and self-management is a first-line approach recommended by international clinical guidelines. Access to evidence-based information that enhances health literacy may support patients' engagement in their self-management and treatment decision-making, potentially reducing disease burden and pain. However, no tool currently exists to assess health literacy specifically in MSK pain. This study aimed to develop and describe the preliminary version of a knowledge-based questionnaire to evaluate MSK pain literacy, the Musculoskeletal Pain-Literacy questionnaire (MSK-PLq). METHODS: A systematic literature review identified existing health literacy instruments and generated a preliminary list of domains. A two-round Delphi study with 22 panellists (19 experts and three people living with chronic MSK pain), followed by consensus meetings, was used to refine domains and items (≥70% agreement). Readability was assessed using the Flesch Reading Ease (FRE) score and three stakeholders were consulted to review the questionnaire for comprehensibility, clarity, and face validity. RESULTS: Six domains were retained (Understand, Access, Appraise, Apply, Digital, Beliefs), comprising 20 items in the preliminary version of MSK-PLq. Readability was acceptable (mean FRE 74, indicating fairly easy reading), and subject feedback supported the questionnaire's clarity and face validity. CONCLUSIONS: The preliminary version of the MSK-PLq is proposed as the first knowledge-based tool to assess functional, interactive, and critical aspects of MSK pain literacy. It may have applications in clinical practice, research, education, and digital health, by informing tailored patient education and supporting self-management strategies, although further psychometric validation is required.

Humans↗

PubMed2025

Mediators of Change in Cognitive Behavioral and Mindfulness-Based Online-Interventions for Hypoactive Sexual Desire Dysfunction in Women.

Low sexual desire is a common sexual problem among women. When it is accompanied by significant personal distress, it may be diagnosed as hypoactive sexual desire dysfunction (HSDD). Both cognitive behavioral therapy (CBT) and mindfulness-based therapy (MBT) are effective treatments for HSDD when delivered in person or online. In this randomized controlled treatment study, CBT and MBT consisted of eight guided self-help modules delivered online, and participants completed measures at pretreatment and after 3, 6, and 12 months. Nine variables were examined as potential mediators of treatment outcomes (i.e., sexual desire and sexual distress), namely mindfulness, self-compassion, rumination, body connection, self-consciousness, relationship satisfaction, sexual communication, depression, and anxiety. In total, 212 women diagnosed with HSDD were randomized to either CBT or MBT (Mage = 36.3, SD = 10.2). Improvements in self-compassion, rumination, body connection, and self-consciousness partially mediated treatment outcomes in at least one of the treatment groups. Mediation effects were mostly small, explaining up to 15% of the total effects. No systematic differences in mediation pathways between CBT and MBT were found. These findings emphasize the importance of emotion regulation, metacognitive processes, and embodiment for the effective treatment of HSDD. Future research should refine treatment components to enhance efficacy and ensure that psychological interventions adequately address common concerns among women with HSDD.

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PubMed2026

Associations Between Short Video Exposure, Empathy and Attitudes Toward End-Of-Life Care Among Nursing Students: A Cross-Sectional Study.

AIM: This cross-sectional study examined the associations between short video exposure, nursing students' empathy, and attitudes toward end-of-life (EOL) care, and tested whether perceived impact is statistically consistent with an indirect pathway in these relationships. DESIGN: A descriptive cross-sectional study. METHODS: In total, 534 undergraduate nursing students were included. Data were collected using a self-designed questionnaire, including the Attitudes Toward Care of the Dying Scale and the Jefferson Scale of Empathy-Health Professions Student version for empathy assessment. Statistical analysis for correlation and mediation analysis (PROCESS macro) was performed. RESULTS: 85.96% of students watch short videos for more than 30 min daily, with more than 60% of them viewing EOL-related content. Students with prior caregiving experience or formal palliative care education showed significantly higher empathy and more positive attitudes (p < 0.05). Exposure to medical and EOL-related short videos was positively correlated with perceived impact, empathy, and positive EOL attitudes, with effect sizes ranging from very weak to modest (r = 0.10 to 0.27). The data were consistent with an indirect pathway between short video exposure and empathy via perceived impact (indirect effect = 0.04; 95% bootstrap CI [0.01, 0.08]). However, for EOL attitudes, short video exposure showed a direct association rather than an indirect pathway via perceived impact (direct effect = 0.09, p < 0.01). CONCLUSION: In this cross-sectional study, short video exposure was modestly associated with nursing students' empathy, with data consistent with an indirect pathway via perceived impact; the observed associations explained only approximately 1% to 7% of the variance in the outcome variables. However, reshaping EOL attitudes may require more systematic education beyond brief video exposure. These findings are hypothesis-generating and await validation through longitudinal and experimental research using standardized video content. IMPLICATIONS FOR NURSING PRACTICE: Nursing educators should consider integrating curated short video content into palliative care curricula to enhance students' empathy and perceived impact of end-of-life education. However, brief video exposure alone may be insufficient to reshape deeper end-of-life attitudes, suggesting the need for comprehensive, multi-modal educational strategies.

Humans↗

PubMed2026

Current Concepts and Emerging Technologies in Aesthetic Outcome Assessment of Breast Reconstruction.

Aesthetic outcomes are a crucial determinant of the overall success of breast reconstruction. Recently, aesthetic assessment has evolved from relying mainly on subjective impressions to incorporating more quantitative methods. This systematic review summarizes current concepts and emerging technologies in aesthetic outcome assessment after breast reconstruction. A comprehensive search of studies evaluating aesthetic outcomes following implant-based, autologous or hybrid breast reconstruction was performed between 2000 and 2025. Assessments were classified as subjective or objective. Extracted variables included assessment characteristics, aesthetic outcome domains, and patient-centered outcomes. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine. A total of 51 studies involving 7711 participants from 16 countries were included. Subjective tools were most frequently employed, led by the BREAST-Q (35/51, 69%), followed by expert- or panel-based evaluations (17/51, 33%) and the visual analog scale (2/51, 4%). Objective methods were applied in 19 studies and included 3-dimensional surface imaging (8/51, 16%), BCCT.core (7/51, 14%), eye tracking (3/51, 6%), and artificial intelligence-based analyses (3/51, 6%). Although subjective tools captured satisfaction with breast appearance, objective tools quantified morphological parameters and positional landmarks. BREAST-Q remains the cornerstone of outcome evaluation after breast reconstruction, providing patient-centered perspectives, including, but not limited to, aesthetic perception. A progressive shift toward multimodal evaluation was noticed, as no single modality comprehensively addressed all aesthetic domains. Future research should focus on integrating subjective and objective assessment methods within a unified framework. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.

Humans↗

PubMed2026

Self-reported physical activity in a randomized study from Norwegian Healthy Life Centres.

AIM: This study examines firstly if participation in a three-month intervention at Norwegian Healthy Life Centres (HLCs) improved self-reported physical activity (SR-PA), and secondly to what extent physical activity (PA) status at six months and changes from baseline were associated with demographic and motivational predictors. BACKGROUND: Regular PA is promoted as a central component of public health initiatives aimed at preventing noncommunicable diseases. METHODS: This randomized controlled trial included 118 participants (57 in the intervention group) recruited from HLCs in South-western Norway. The intervention effect was assessed by comparing the intervention group with the waiting-list control group after six months. We examined sociodemographic and motivational predictors of change combining both groups into a single cohort. This trial was registered at ClinicalTrials.gov (ID: NCT02247219). FINDINGS: At six-month follow-up, participants in the intervention group reported higher levels of SR-PA compared with the control group. The estimated effect was modest (B = 0.26, 95% CI -0.01 to 0.53), equivalent to ≈0.37 SD. Although the confidence interval included zero, the estimate remained compatible with a modest positive effect. Autonomous motivation and social support were positively associated with SR-PA after 6 months, while psychological defiance showed a negative association. Autonomous motivation and psychological defiance impacted PA change during the 6-month period in opposite directions.

Humans↗

PubMed2026

Integration of ear and hearing care services in low- and middle-income health systems: a systematic review and qualitative synthesis.

Hearing loss is a global public health burden and mostly affects those living in low- and middle-income countries (LMICs). One approach to address ongoing challenges is the World Health Organization's recommendation for the integration of ear and hearing care (EHC) services into healthcare packages. However, little is known about EHC integration approaches, particularly in LMICs additionally, these approaches have not been investigated through a health systems lens. This qualitative review aimed to describe the various approaches to the EHC service integration in LMICs and to identify enabling and constraining factors. We reviewed 17 studies, with a focus on LMICs, using adaptations of the Valentijn integration and World Health Organization EHC frameworks, following the PRISMA guidelines. Our investigation showed that most integration approaches were at micro or individual level. Enabling factors for integration of EHC services were training, mentorship, collaboration, technology, inclusion of EHC in healthcare packages and investment in EHC services. Barriers were challenges with training, facilities and equipment, policy implementation and resourcing of EHC services. We further described factors influencing healthcare seeking behaviour and the use of integrated EHC services, such as access and ability to pay, referral systems and communication and awareness. This study describes the complex nature of EHC integration and ways to support integration. Key considerations are the level of integration, training to address workforce issues and factors influencing service utilisation as we work towards health system strengthening.

Humans↗

PubMed2026

Access Block and Ambulance Ramping: The Canaries of the Healthcare System.

OBJECTIVE: To identify evidence-based factors leading to the global challenge of hospital access block and inform strategies to improve emergency access performance. METHODS: A mixed methods approach was followed comprising an umbrella review of published systematic reviews, qualitative analysis of the perspectives of patients and healthcare workers, and quantitative analysis of contextual factors and 6 years of ambulance, emergency inpatient and ward movement records for the 25 largest public hospitals in Queensland, Australia. RESULTS: A key set of findings and recommendations were identified to improve emergency access that are practical and actionable. These comprise the introduction of inpatient discharge metrics and monitoring to shift focus from the front door of hospitals to the 'back door'; increasing support for primary care, community care, aged care, NDIS and vulnerable groups; maintaining demand-side strategies such as increasing inpatient-equivalent care alternatives (e.g., hospital in the home, acute care within nursing home services); investment in prehospital flow; improving hospital processes such as extended-hour discharge lounges; improving workforce; and revising funding policies. CONCLUSIONS: The study findings fill a gap in the evidence regarding challenges and recommendations for improving patient flow within hospital emergency departments and across the broader health system. Focussing efforts at the 'back end' of the inpatient journey is a critical step to improve emergency care outcomes.

Humans↗

PubMed2026

External ventricular drain safety campaign and opportunities for global neuroanesthesiology quality and safety.

PURPOSE OF REVIEW: This review describes the conceptualization and implementation of the External Ventricular Drain (EVD) Safety Campaign, a global patient safety initiative by the Society for Neuroscience in Anesthesiology and Critical Care. It summarizes recent literature on EVD insertion and maintenance, highlights opportunities to advance quality and safety in neuroanesthesiology, and outlines priorities and a framework for future work. RECENT FINDINGS: The Society for Neuroscience in Anesthesiology and Critical Care launched a global initiative to improve EVD management. EVD insertion and maintenance remain key areas of ongoing research and quality improvement, particularly in reducing complications. SUMMARY: The EVD Safety Campaign provides a structured framework to improve care delivery and patient outcomes worldwide. Continued focus on standardization, education, and complication reduction, especially infection prevention, will be essential to advancing the field.

Humans↗

PubMed2026

Intentions to use different modalities of long-acting HIV PrEP among men who have sex with men and transgender and gender diverse persons in the Netherlands.

Insight into intentions to use long-acting HIV pre-exposure prophylaxis (PrEP) is essential for successful implementation. We assessed intention to use three hypothetical long-acting PrEP modalities (oral, intramuscular and subdermal) among HIV-negative men who have sex with men (MSM) and transgender and gender diverse persons in Amsterdam, recruited through the Amsterdam Cohort Studies (ACS-participants) and social media (survey-participants). Intention was measured per modality using a 7-point Likert scale. We modeled the probability of high intention to use long-acting PrEP using relative risk regression. Of 1258 participants [1231 (97.9%) MSM; 557 ACS and 701 survey; median age 40 years (IQR 32-50)], 76% had ever used oral short-acting PrEP. Intention to use was highest for monthly oral long-acting PrEP [ACS: median 4.5 (IQR 2-6), 38% high intention; survey: median 7 (IQR 6-7), 81% high intention], followed by 2-monthly intramuscular PrEP [ACS: median 3 (IQR 2-5), 19% high intention; survey: median 5 (IQR 3-7), 47% high intention], and implants [ACS: median 2 (IQR 1-4), 9% high intention; survey: median 4 (IQR 2-7), 37% high intention]. PrEP-experienced participants had higher intention to use oral long-acting PrEP and injectables than PrEP-naïve participants. Offering multiple PrEP modalities may improve the acceptability of HIV prevention strategies and increase PrEP uptake and retention in PrEP care.

Humans↗

PubMed2026

Teaching Engagement and Caregiving Help in the Intensive Care Unit (TEACH-ICU) Scale: Content Validity.

BACKGROUND: Having family members provide care to their loved ones in the intensive care unit (ICU) is a beneficial yet seldom implemented approach. For family members to perform caregiving, nurses must be willing to teach, and such willingness is a developing area of research. OBJECTIVES: To adapt an instrument validated in family members, the Family Willingness for Caregiving Scale, to address nurses' willingness to teach family members caregiving skills. METHODS: Purposive and snowball sampling were used to recruit 10 expert ICU nurses through the American Association of Critical-Care Nurses' research website and social media platforms. The researchers conducted cognitive interviews with the nurses to address the instrument's content validity. RESULTS: The scale was refined based on the participants' feedback. Items were deleted, added, and revised. Furthermore, scale instructions were adjusted to emphasize the willingness to teach families of patients receiving mechanical ventilation. Qualitative themes emerged related to barriers to family engagement, including time constraints, patient acuity, and nurse and family characteristics. CONCLUSIONS: Content validity of the scale was assessed, with future research aimed at pilot testing and evaluating construct validity before using the scale as a research instrument. Practical implications include using the scale as an evaluation tool to determine nurses' willingness to teach family members about caregiving. After evaluation, various strategies could be incorporated to enhance family engagement in adult ICUs.

Humans↗

PubMed2026

Effectiveness of symptom map-based education in the management of premenstrual syndrome: a randomized controlled trial.

PURPOSE: To evaluate the effectiveness of a symptom map-based educational intervention for the non-pharmacological management of premenstrual syndrome (PMS), with a focus on symptom reduction among women with differing baseline symptom severity. METHODS: This randomized controlled study was conducted between May and December 2024. A total of 110 women meeting diagnostic criteria for PMS were randomly assigned to an intervention group (n = 55) or a control group (n = 55) using block randomization, and 101 participants completed follow-up assessments. The intervention comprised structured education based on a PMS symptom map and evidence-based self-care strategies. Outcomes included PMS symptom severity (Premenstrual Syndrome Scale), pain intensity (Visual Analog Scale), psychological symptoms (Depression Anxiety Stress Scale-21), and PMS-specific life satisfaction. CLINICAL TRIAL REGISTRATION: NCT06585475. RESULTS: Compared with the control group, women in the intervention group reported significantly lower pain (adjusted mean 4.21 vs. 6.81, p < .001) and stress levels (8.54 vs. 12.03, p < .001) at follow-up. The intervention was particularly effective in reducing PMS symptom severity and depressive symptoms among participants with higher baseline symptom burden. Improvements in PMS-specific life satisfaction were observed, with reductions in depressive symptoms contributing to this effect. CONCLUSION: A symptom map-based educational intervention is a clinically applicable, non-pharmacological approach for PMS management. This structured education appears especially beneficial for women with more severe baseline symptoms and may be integrated into routine gynecological care to support individualized symptom management.

Humans↗

PubMed2026

Effectiveness and implementation of task-sharing cognitive-behavioral interventions for perinatal mental health: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of cognitive-behavioral interventions (CBIs) delivered by nonspecialist providers (NSPs) on perinatal depressive (PND) and anxiety symptoms, and to narratively synthesize their implementation processes and reported implementation outcomes, including acceptability, feasibility, fidelity, cost, and sustainability. METHODS: We systematically searched eight databases from inception to April 8, 2025. Eligible studies were randomised controlled trials (RCTs) assessing CBIs delivered by NSPs for PND and/or anxiety. Two reviewers independently screened, extracted, and assessed trials. Meta-analyses employed random-effects models, with subgroup, sensitivity, meta-regression, and publication bias analyses conducted in Stata 18.0. Implementation processes and outcomes were reported as frequencies or percentages across trials. RESULTS: A total of 47 trials (11, 357 participants) were included in the systematic review, of which 37 trials (8,709 participants) were included for meta-analyses. CBIs were conducted in 12 countries. Nurses and midwives delivered 45% of CBIs. CBIs were associated with reduced PND post-intervention compared with control conditions (standardized mean difference [SMD] -0.49, 95% CI -0.63 to -0.35; I² = 86.8%). Limited evidence from four trials suggested a small sustained effect at 12 months (SMD -0.14, 95% CI -0.27 to -0.02; I² = 26.4%). Reductions in anxiety symptoms were observed immediately post-intervention (SMD, -0.45, 95% CI -0.65 to -0.25; I²=81%), but evidence for longer-term effects was limited. Subgroup analyses confirmed consistent effects across diverse settings, populations, and intervention characteristics. Reporting of implementation processes (e.g., training, supervision, fidelity) was limited, with only 23.4% of trials assessing fidelity and 10.6% evaluating costs. CONCLUSIONS: NSP-delivered CBIs showed beneficial effects on PND and anxiety, with generally encouraging evidence for acceptability and feasibility. However, evidence for sustained effects beyond the immediate post-intervention period remains limited. Future studies should strengthen long-term follow-up and improve reporting of implementation processes and outcomes, particularly in rural and adolescent perinatal populations, to inform scalable and equitable task-sharing models.

Humans↗

PubMed2026

Discarding Bedside Cart Paper-Packaged Supplies Between Patients: What Evidence Is Required?

BACKGROUND: Discarding paper-packaged sterile supplies from bedside supply carts between patients in pediatric intensive care units (PICUs) is a potential practice to target for environmental stewardship. OBJECTIVES: To determine opinions about this practice, including what evidence should be required to implement and what evidence would be adequate to abandon it. METHODS: A survey was distributed to all pediatric intensivists engaged in multicenter research in Canada and to all PICU nurses at one institution in Canada. RESULTS: The response rate was 75 of 254 (30%). The practice occurred in 54 (72%) of the respondents' units. Ten respondents (13%) agreed the practice was effective in preventing nosocomial infections. Most respondents agreed the practice should be based on empirical evidence, including a combination of improved patient outcomes (n = 57, 76%), rate of contamination of supplies within the supply carts (n = 55, 73%), and survivability of pathogens inoculated onto paper (n = 56, 75%). Most respondents agreed they would be comfortable with a randomized controlled trial (n = 52, 69%) and would support action based on the results (n = 54, 72%). The potential trial outcome most highly ranked was next-patient nosocomial infection with pathogen from the previous patient (n = 23, 31%); this was ranked more often by intensivists (P = .005). Other outcomes highly ranked included next-patient colonization with pathogen from the previous patient (n = 44, 59%) and pathogen detection on supplies within the supply cart (n = 43, 57%). CONCLUSIONS: Most respondents agreed that the practice was not based on empirical evidence, agreed the practice should be based on empirical evidence, and would agree to a randomized trial with patient-important outcomes.

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