Serious Gaming for Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer: Protocol for a Randomized Clinical Trial.

BACKGROUND: Older adults are at high risk for toxicity due to cancer treatment and increased risk for adverse events related to chemotherapy-induced nausea and vomiting (CINV). Unfortunately, older adults report multiple treatment-related symptoms but use few strategies to self-manage these symptoms due to erroneous beliefs related to the effectiveness of commonly taught self-management strategies. We developed a novel serious game, Managing at Home (MAH), to help older adults learn how to effectively self-manage CINV at home. OBJECTIVE: This study has 2 aims. Aim 1 is to examine changes in CINV severity, self-management behaviors, functioning, quality of life, cognitive representation, and health care use within the intervention group from baseline (T1) to completion of the study (T6). Aim 2 is to determine the efficacy of the MAH intervention by comparing differences in primary outcomes (CINV severity and health care use) and secondary outcomes (self-management behaviors, functioning, and quality of life) between the intervention and control groups at each follow-up visit (T2-T6) and completion of the study (T6). METHODS: This is a longitudinal randomized clinical trial. We will collect data from 500 older adults receiving cancer-related chemotherapy at baseline (T1) and at each treatment cycle until cycle 6 (T6). Participants will be enrolled if they are 60 years or older of age, are newly diagnosed with cancer, being treated with any chemotherapy agent with moderate or high emetic potential, are on a 2-, 3-, or 4-week treatment cycle, are proficient in English, and have a telephone. Previous diagnosis or treatment for cancer, end-stage disease with less than 6 months to live, and uncorrected visual or hearing impairment are exclusion criteria. RESULTS: This study was funded in September 2022 and received institutional review board approval in October 2022. As of July 2023, the enrollment of participants is ongoing and currently has 130 enrolled participants. Data collection and analysis will be complete in 2027. CONCLUSIONS: This study addresses self-management of CINV in older adults using an innovative serious game. The MAH intervention uses simulation and gaming technology to engage older adults in active learning in order to reframe erroneous perceptions about symptom self-management. If shown to be effective, it can easily be adapted to include other cancer-related symptoms or other chronic illnesses. TRIAL REGISTRATION: ClinicalTrials.gov NCT05838638; https://clinicaltrials.gov/study/NCT05838638. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64673.

The pediatric self-management model in asthma: A theory analysis and evaluation.

THEORETICAL PRINCIPLES: The Pediatric Self-management Model (PSMM) is a middle-range theory geared at understanding the relationship between factors influencing chronic illness management in children. PSMM is a family-centered model that focuses on the unique factors present in the pediatric population. PHENOMENA ADDRESSED: Pediatric asthma is a leading chronic respiratory illness in the United States, affecting over 4.6 million children in 2020. Over 40% of children with asthma will have at least one exacerbation per year. On average, a child with asthma will miss nine additional school days annually. Using the Walker and Avant framework for theory analysis, the PSMM is examined through the lens of pediatric asthma to evaluate its applicability to pediatric asthma shared management and adherence. RESEARCH LINKAGES: The PSMM has been used as a framework for understanding the roles of managing chronic illness in children, but it has yet to be applied to pediatric asthma. Asthma outcomes inherently depend on preventative medicine and home care strategies for symptom management and response outside the healthcare facility. The PSMM is a new framework for understanding barriers and facilitators within pediatric asthma management and highlights the importance of the dyadic relationship between child and parent to successfully share healthcare responsibility.

Medications Adherence and Associated Factors Among Patients with Stroke in Iraq.

Purpose: Stroke poses significant challenges to affected individuals, their families, and healthcare systems, with adherence to medications being a pivotal determinant of health outcomes. In this study, we aim to evaluate the medication adherence of stroke patients living in Iraq, and explore how patients' demographic and clinical details relate to their adherence levels. Furthermore, we seek to assess the self-care practices used by stroke patients and their adherence to them. Patients and Methods: We carried out a cross-sectional correlational study conducted from November 2022 to April 2023, stroke patients diagnosed in seven hospitals across Baghdad and Al-Mothanna governorate were recruited, with diagnoses confirmed by physicians and senior neurologists using MRI and/or CT scans. Patients' adherence to medications, demographic data, clinical characteristics, and self-care activities were analyzed using descriptive statistics and regression analyses. Results: Of the 200 participants, mean age was 58.27 years, with males constituting 53.5%. About 40.5% had a hemorrhagic stroke, and 59.5% an ischemic stroke. The mean adherence score was 13.36 (SD= 4.658) out of a possible 28. Factors significantly correlated with medication adherence included age, monthly income, time since having a stroke, and education level. Adherence was also significantly linked to having diabetes mellitus or high blood pressure. The assessment of participants' self-care activities and medication adherence revealed that responses to questions about healthcare habits varied, with "None" being the most common response for most items. Notably, we found no significant association between adherence and factors such as gender, marital status, living place, and smoking status. Conclusion: Medication adherence remains suboptimal among stroke patients in Iraq. Various demographic and clinical factors play a role in influencing adherence. The conformity to medication regimens and factors associated with it among individuals who have suffered a stroke in Iraq is vital.

Self-care practices among professional nurses employed in primary health care clinics.

BACKGROUND:  Professional nurses typically promote and advocate self-care practices to their patients to achieve better health outcomes, but rarely engage in these practices themselves. METHODS:  A qualitative, descriptive phenomenological approach was used in this study. Ten professional nurses employed in different primary health care facilities were purposively sampled. Semi-structured interviews were conducted to collect data, which were analysed using Colaizzi's data analysis strategy, and data saturation was reached. RESULTS:  Two themes were identified. Theme 1: the participants expressed that internal and external factors compromised self-care practices, such as subconscious self-neglect, insufficient resources, and a depressed economy, which encouraged them to work extended hours. Theme 2: participants' holistic well-being was compromised, as they neglected their mental well-being. CONCLUSION:  Self-care practices among professional nurses seem unachievable. The extent of this population's self-care neglect was evident during the coronavirus disease 2019 (COVID-19) pandemic when professional nurses globally gave of themselves relentlessly.Contribution: This is the first study conducted on the topic in the City of Ekurhuleni, and the findings will provide relevant stakeholders with a directive on what strategies, policies, and guidelines to develop and implement to make self-care practices attainable for professional nurses.

[Improving the Accuracy of Patient Self-Care After Joint Replacement Surgery].

BACKGROUND & PROBLEMS: Joint replacement wound stitches are typically not removed until two weeks after the operation. Therefore, patients with joint replacement must be able to execute proper wound care after discharge from the hospital to reduce the risk of wound infection. Prior data from Chang Gung Memorial Hospital's orthopedics ward indicate only 69% of joint-replacement patients are able to perform wound care properly at home. Potential causes for this noted by patients include age-related forgetfulness, being unable to discern redness or swelling in the wound, and language comprehension difficulties (i.e., Taiwanese vs. Mandarin). Poor rates of wound care may also be attributable to incomplete wound care education by nursing staff and wound care education being provided without adequate practice on the day of patient discharge. PURPOSE: This project was implemented to improve the accuracy of wound self-care performed by patients after joint replacement surgery and to enhance their related knowledge and wound-care technical correctness. RESOLUTION: A wound care education checklist, wound care cue cards, wound care video clips, wound condition red flag cue cards, and customized wound care pack were proposed and implemented. RESULTS: The rate of accuracy of wound self-care performance increased from 69% pretest to 98% posttest, showing the intervention to have effectively improved post-discharge wound care quality. CONCLUSIONS: To effectively improve the post-discharge accuracy of wound self-care in patients with joint replacement, the consistency of post-surgery wound care education given by nursing staff to patients should be improved, patients should be reminded of wound assessment and care steps, and patients should be aware that wound abnormalities require an immediate return to the hospital for follow-up treatment.

Requirements and Key Features of a Mobile Application for Adolescent Self-Care From a Stakeholders Perspective: A Qualitative Study.

Adolescence is characterized by many changes and these changes differentiate adolescents' self-care needs. The use of smartphones and tablets to provide healthcare services has expanded, and the user-centered design could help to create mobile applications based on users' needs. Therefore, the present study aimed to identify the data requirements and key features of mobile application for adolescent self-care from a stakeholder perspective. This study was conducted with a qualitative approach to identify the key features of mobile application for adolescent's self-care as well as educational content axes for five component of self-care using conventional and directed content analysis respectively. From 3 sub-groups 30 participants were selected based on purposive sampling with maximum variety and sampling was performed until data saturation. Data were collected through in-depth semi-structured interviews. Participants' informed consent was obtained before the interview. The interview lasted 20-40 min and MAXQDA software version 10 was used for data analysis. In this study, four criteria of acceptability, reliability, transferability, and validity proposed by Guba and Lincoln were used to evaluate and validate the data. After conducting the interviews, 789 initial codes, 12 sub-categories, and 3 categories (app view, app content architecture, app self-care content) were emerged, which reflects the key features of a mobile application and the necessary educational content. The research findings could provide a guide for future mobile application development considering the viewpoints of health professionals, content, and software experts. Addressing the features and requirements in practice could lead to designing efficient and effective mobile applications.

Measuring the quality of self-care of elderly patients with dementia in a developing country.

In developing countries like Uganda, people with dementia are cared for by non-medically trained family members with minimal support from the formal healthcare system. The quality of care in this setting is largely unknown but significantly affects the well-being of those with dementia. A tool designed to measure the quality of informal care for old frail adults with or without dementia was translated into Luganda. A committee of experts reviewed and finalized the translation, which was pilot-tested and then used to measure the quality of dementia self-care. We consecutively enrolled 105 caregivers of elderly people with dementia; the median age was 35 years (Interquartile Range 26-47 years), and 67% were females, taking care of a grandparent (44%) or a parent (34%). We used confirmatory factor analysis to assess for structural validity and computed correlation coefficients and Cronbach's alpha to assess for discriminant validity and internal reliability, respectively. The three-factor model applied to the 20 items, adequately fit the data (Comparative Fit Index = 0.88, Tucker-Lewis Index = 0.87, Root Mean Square Error of Approximation = 0.08; 90% Confidence Interval (0.06-0.09), Standardized Root Mean Square Residual = 0.089). There was good discriminant validity, and correlation coefficients between dimensions/scales and the Dementia Knowledge Assessment Scale scores were low. There was good internal reliability with all items Cronbach's alpha ranging from 0.69 to 0.89. Our findings demonstrated that this culturally adapted, shorter measurement tool is valid and reliable. The tool can be used by researchers, health workers, and agencies to assess the quality of self-care for elderly people with dementia in Uganda.

Addressing the 2021 Essentials with new approaches for developing leadership, resilience, and self-care/well-being in undergraduate baccalaureate nursing students.

INTRODUCTION: New graduate nurses are not always prepared for the challenges of the chaotic clinical environment or to exercise leadership skills in a clinical capacity. Resilience and self-care are essential facets of successful leadership, as well as necessary components to prevent burnout in nurses. PURPOSE: The purpose of this article is to demonstrate how this School of Nursing implemented approaches to prepare the next generation of nurses with strong skills in the areas of leadership, resilience, and self-care/well-being while addressing the Essentials. METHODS: Faculty explored new ideas, as well as showcased teaching strategies they had already successfully implemented, that aligned with the Essentials with the undergraduate baccalaureate pilot student cohort. RESULTS: Two "Essential" Competencies, Domain 9 Professionalism and Domain 10 Personal, Professional and Leadership Development, as well as related sub-competencies, were addressed by the thirteen teaching strategies. Anecdotal student reflection comments supported high levels of satisfaction with these strategies. CONCLUSIONS: Preparing student nurses to meet the Essentials is critical to helping nurses thrive in contemporary practice settings. Equipping a generation of nurses with self-care practices to protect their own well-being, while at the same time meeting the Essentials expectations, is crucial to cultivating a sustainable nursing workforce.

Predicting cervical cancer screening participation using self-care behaviors among women in Iran.

BACKGROUND: Cervical cancer screening is an effective and accessible method for preventing this cancer. However, low participation rates among women have been reported. Self-care is one of the solutions to improve access to health services. This study was conducted to determine the prediction of cervical cancer screening participation using self-care behaviors among women in Iran. MATERIALS AND METHODS: This cross-sectional study was conducted on 310 eligible women who were referred to comprehensive health centers and women's clinics in teaching hospitals in Isfahan, Iran, from November 2020 to April 2021. Participants were enrolled using convenience sampling. The data collection tool included researcher-made questionnaires on personal and fertility characteristics, participation in cervical cancer screening, and self-care behaviors related to cervical cancer and its screening. Descriptive and inferential statistical methods were used for data analysis using the Statistical Package for the Social Sciences (SPSS) version 22 software. RESULTS: The results showed that the intention to undergo screening was low among individuals who had not undergone screening. Lack of awareness and not having enough time were the most common barriers to screening. The results of logistic regression analysis indicated that self-efficacy was the significant predictor of cervical cancer screening. With an increase in the self-care score, the 12% chance of doing a Pap smear increases significantly (P = 0.002). Furthermore, the results of multiple regression showed that with an increase in the self-care score, the chance of women who refer to screening every year, every 2-3 years, and every 4-5 years is increased to 25% (P = 0.001), 34% (P < 0.001), and 11% (P = 0.032), respectively, compared with non-referral. DISCUSSION: According to the results, self-care was a predictor of performing a Pap smear, and it was related to its regular performance of Pap smear too. Therefore, designing and implementing necessary interventions to increase self-care behaviors can improve women's participation in cervical cancer screening and its regularity.

Examining the Impact of the Design-Thinking Intergenerational Service-Learning Model on Older Adults' Self-Care Behaviors and Well-Being.

The Design-Thinking Intergenerational Service-Learning Model (DTISLM), rooted in the biopsychosocial model, aims to empower older adults to improve their chronic-disease management behavior through tailored programs addressing their specific healthcare needs. This study, conducted in Taiwan, used a convenience sampling method (n = 172) to evaluate the impact of DTISLM on Taiwan's adult day center participants' perception of self-care behaviors, feelings of happiness, depression, and perceived social support using pretest-posttest surveys. The results indicated a significant enhancement in participants' perception of self-care behaviors, reduction in depression score, and improvements in perceived social support following the completion of the program. The findings underscore the efficacy of applying a design-thinking framework in an intergenerational context. Future studies should investigate how the DTISLM can be scaled to various demographics and healthcare settings to enhance its applicability and understand its long-term effects.

Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: a cross sectional study.

BACKGROUND: Pregnant women face great challenges during the coronavirus disease 2019(COVID-19) pandemic. The purpose of this study was to explain the main dimensions of adoption of self-care behaviors against COVID-19 based on the health belief model(HBM) in pregnant women. METHODS: This cross-sectional and analytical study was conducted in Iran, at the end of the third wave of the COVID-19 pandemic, between January and April 2021. Two hundred and thirty pregnant women who referred to Urmia health centers were selected using multi-stage random sampling. The data were collected using an online questionnaire including items that measured the participants' demographic characteristics, the knowledge questionnaire, the HBM items, and questions assessing the adoption of self-care behaviors against COVID-19. The data were analyzed using SPSS software version 20. Descriptive statistics, bivariate Pearson's correlation test, and multiple linear regression were used to analyze the data. RESULTS: The results of this study showed that the rate of self-care behaviors against COVID-19 in the pregnant women participating in the present study was not very favorable. It was also shown that among the constructs of the HBM, knowledge, self-efficacy, and perceived barriers were the most important predictors of adopting self-care behaviors with a variance of 24% change among the pregnant women. CONCLUSION: Knowledge, self-efficacy, and perceived barriers were found in this study as the strongest predictors of self-care behaviors among pregnant women. Thus, it is suggested to implement interventions commensurate with the results of this study.

What Do Younger and Well-Educated Adults Think about Self-Medication? Results of a Survey during a Public Science Event at Leipzig University.

BACKGROUND: Consecutive visitors to a public science event at Leipzig University were asked about their opinions/attitudes regarding their personal use of self-medication. METHODS: A written questionnaire survey addressed (i) participants' characteristics, (ii) frequency of self-medication use in the last 12 months, (iii) symptoms/complaints most frequently considered applicable, (iv) preconditions, (v) limitations, (vi) risks, (vii) fears, (viii) medication information sources, (ix) influencing factors, and (x) reasons for decision making. RESULTS: (i) A total of 189 visitors (median age: 29.0 years; Q25/Q75: 22.0/44.0) participated, of whom 64.0% were female, 38.6% had a university degree, 20.1% were in training, and 14.8% were licensed in a healthcare profession. (ii) A total of 59.3% of participants stated that they had used self-medication regularly in the last 12 months. The most common answers in the respective questions were (iii) headache, 86.2%; (iv) mild complaints/symptoms, 94.7%; (v) duration, 91.6%; (vi) "self-medication may cause adverse drug reactions", 94.2%; (vii) "developing a habituation effect", 58.7%; (viii) pharmacists, 93.7%; (ix) "physician's recommendation", 89.3%; (x) "intensity of complaints", 92.6%; and (vi) 61.3% believed that they could choose an appropriate self-medication. CONCLUSION: Younger and well-educated adults report using self-medication frequently and rate their expertise as high. Healthcare professionals are the preferred source of information.

Internet-delivered emotional self-management program for the general population during the COVID-19 pandemic: Usability testing.

Introduction: Internet-based self-help interventions have the potential to help people address their emotional needs at relatively low costs. However, if the system does not offer optimal functions, it could reduce end-user adherence and satisfaction with treatment and compromise the effectiveness of the program. This study evaluated the usability of an Internet-based self-help intervention for emotional self-management among the general population of Italy during the COVID-19 pandemic. Methods: A balanced sex-age sample of 10 individuals who met the inclusion criteria were consecutively recruited online. The think-aloud testing method, the system usability scale and an ad hoc semi-structured interview were used to determine the overall system usability.Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. Results: The participants were mostly satisfied with the usability of the program. However, older users (<45 years) encountered some problems, which took longer, made more mistakes, and needed more help in performing the tasks than their younger counterparts. The analysis of the interviews revealed three central themes: general thoughts about the platform, weaknesses of the platform and difficulties encountered while navigating and completing tasks, and strengths of the platform. Discussion: Based on the results of this study, important improvements will be made before the RinasciMENTE program is tested under real-world conditions. Conducting usability testing is a crucial step at an early stage of the development process of an Internet-based self-help intervention to identify potential usability problems with the system.

Self-Management Systems for Patients and Clinicians in Parkinson Care: Protocol for an Integrated Scoping Review, Product Search, and Evaluation.

BACKGROUND: Parkinson disease (PD) poses emotional and financial challenges to patients, families, caregivers, and health care systems. Self-management systems show promise in empowering people with PD and enabling more control over their treatment. The collaborative nature of PD care requires communication between patients and health care professionals. While past reviews explored self-management systems in PD diagnosis and symptom management with a focus on patient portals, there is limited research addressing the interconnectivity of systems catering to the needs of both patients and clinicians. A system's acceptability and usability for clinicians are pivotal for enabling comprehensive data collection and supporting clinical decision-making, which can enhance patient care and treatment outcomes. OBJECTIVE: This review study aims to assess PD self-management systems that include a clinician portal and to determine which features enhance acceptability and usability for clinicians. The primary aim is to assess evidence of clinicians' acceptability and usability of self-management systems with a focus on the integration of systems into clinical workflows, data collection points, monitoring, clinical decision-making support, and extended education and training. METHODS: The review will entail 3 separate stages: a literature review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, a product search, and an evaluation of the level of evidence for the identified products. For the first stage, 5 databases will be searched: PubMed, CINAHL, Scopus, ACM digital library, and IEEE Xplore. Studies eligible for inclusion will be qualitative, quantitative, and mixed methods studies examining patients' and clinician's perceptions of the acceptability and usability of digital health interventions, synthesized by a narrative qualitative analysis. A web search in the iOS Apple App Store and Android Google Play Store will identify currently available tools; the level of evidence for these will then be assessed using the Oxford Centre for Evidence-Based Medicine guidelines. RESULTS: Literature search and screening began soon after submission of the protocol, and the review is expected to be completed by end of September 2024. CONCLUSIONS: This review will examine currently available self-management systems in PD care, focusing on their acceptability and usability. This is significant because there is limited research addressing the integration of clinicians into these systems. The findings from this study may provide critical knowledge and insight to help inform future research and will contribute to the design of self-management systems that promote collaborative efforts in PD care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/58845.

Hybrid model of care for older persons for improvement of frailty index-a community-based interventional study in an urban setting.

BACKGROUND: An older person undergoes a 'disablement' process with aging. A comprehensive geriatric assessment centered around the functional status informs the healthcare provider of their frailty status, based on which tailored interventions may be designed to help prevent/reverse frailty. This study was conducted to assess the improvement in frailty index by training older persons for self-care practices using a multi-domain behavioural intervention, assisted by their caregivers. METHODS: It is a community-based interventional trial among older persons aged ≥ 60 years and their primary caregivers conducted in an urban community for a period of 15 months. A hybrid model, which exploits the advantages of every indigenous geriatric model of care, in providing a holistic care to old persons, was developed and adopted. Intervention was designed to incorporate all domains of frailty assessed, based upon self-efficacy and social interdependence theory. Frail-VIG scale and SPPB scores were used to measure the outcomes. RESULTS: 128 older persons and their primary caregivers were recruited. Median age was 70 and 67 years in the intervention and control group respectively, with majority being males. The median frailty index at baseline was 0.36 in both the groups, with improvement in intervention group (0.20) and worsening in control group (0.44) at end-line. From the DID analysis, a reduction of 0.19 points of frailty index was observed (even after adjustment for co-variates) in the intervention group, as compared to the control group. Also, it was observed that age and gender of the old person, their per capita income and the family support played an interactive effect in improvement of the frailty index. There was a significant difference in SPPB scores as well, between the groups [5 (1) in CG vs. 7 (2) in IG, p < 0.001]. CONCLUSION: Frailty could be reversed with appropriate interventions designed on the pillars of self-efficacy, and social interdependence among family members. The hybrid model of care delineates the role of caregivers, who reinforce the old persons to follow prescribed interventions.

The Influence of Patient-Provider Communication on Self-Management Among Patients With Chronic Illness: A Systematic Mixed Studies Review.

AIM: To explore the influence of patient-provider communication on patient self-management of chronic illness. DESIGN: Systematic Mixed Studies Review. DATA SOURCES: CINAHL, Google Scholar, EMBASE and PubMed were searched until March 2024. METHODS: Employed a result-based convergent design and the Mixed Method Appraisal Tool to evaluate studies. Narrative analysis, quantitative studies and thematic analysis for qualitative studies and overall results. RESULTS: Thirteen articles published between 2003 and 2023 were included. Chronic illnesses studied: diabetes, heart failure, hypertension, chronic obstructive pulmonary disease and asthma. Data synthesis yielded the overarching theme: adaptive interpersonal communication. An approach that adapts communication content to each patient's unique needs, employs verbal and nonverbal communication, builds a connection and establishes patient rapport. CONCLUSION: Available evidence suggests that patient-provider communication influences chronic illness self-management. A provider's ability to adjust and tailor their communication style is an important factor in helping patients to achieve optimal self-management. Future research should explore this phenomenon in other common chronic illnesses not included in this review. Additionally, research on the patient's role in this process could help improve patient-provider communication. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings from this review have significant implications for shared and participatory decision making, where patients and providers collaborate to develop plans of care for patients to achieve optimal self-management. Additionally, this review can contribute to the development of educational content and communication strategies for nurses and all healthcare professionals caring for patients with chronic illnesses. IMPACT: This is the first mixed studies systematic review to describe the influence patient-provider communication on patient self-management of chronic illness. These findings consolidate existing evidence, providing a pathway for practical application to clinical practice and the potential to significantly impact the delivery of patient-centred care and healthcare quality. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

A calculator for musculoskeletal injuries prediction in surgeons: a machine learning approach.

BACKGROUND: Surgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice. METHODS: Cross-sectional study carried out using an online form (12/2021-03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP. RESULTS: A total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65-5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84-12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28-2.98 and 2.16, 1.37-3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons. CONCLUSIONS: The prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

Treatment effects of two pharmaceutical skin care creams for xerotic feet among persons with diabetes: Rationale and design of a two-armed double blind randomized controlled trial.

Introduction: To minimize the risk of developing foot-ulcers, persons with diabetes are given the advice to daily inspect their feet and to apply skincare formulations. However, commercially available skincare products have rarely been developed and evaluated for diabetes foot care specifically. The primary aim of this randomized controlled trial (RCT) is to evaluate the effects in reducing foot xerosis in persons with diabetes without foot-ulcers using two skincare creams containing different humectants (interventions) against a cream base non-humectant (comparator). Secondary outcomes are to evaluate differences on skin barrier integrity, low-molecular weight biomarkers and skin microbiota, microcirculation including transcutaneous oxygen pressure, degree of neuropathy, and HbA1c between intervention-comparator creams. Methods: Two-armed double-blind RCT, registered in ClinicalTrials.gov Identifier: NCT06427889. With 80 % power, two-tailed significance of 2.5 % in each arm, 39 study persons is needed in each arm, total 78 persons, 98 including dropouts, to be able to prove a reduction of at least one category in the Xerosis Severity Scale with the intervention creams compared to the comparator. In one arm, each participant will treat one foot with one of the intervention creams (Oviderm® or Canoderm®), while the opposite foot will be treated with the comparator cream (Decubal®lipid cream), twice a day. If needed, participants are enrolled after a wash-out period of two weeks. The participants will undergo examinations at baseline, day 14 and day 28. Discussion: This RCT evaluate the potential effects of humectants in skin creams against foot xerosis in persons with diabetes.

The mediating effect of self-efficacy on the relationship between self-care ability and disability level in older adult patients with chronic diseases.

Objective: This study investigates the mediating effect of self-efficacy on the relationship between self-care ability and disability level in older adult patients with chronic diseases. Methods: A convenience sampling method was used to select 372 older adult patients with chronic diseases from five tertiary hospitals in Chengdu, Sichuan Province. General demographic information was collected using a questionnaire, and self-efficacy, self-care ability, and disability were assessed using standardized scales. Data were analyzed using SPSS 26.0, and the PROCESS macro was employed to test the mediating effect of self-efficacy. Results: The mean score for self-efficacy was 26.09 ± 7.20, for self-care ability was 113.19 ± 23.31, and for disability was 154.19 ± 29.32. Self-efficacy was positively correlated with self-care ability (r = 0.73, p < 0.001. and negatively correlated with disability (r = -0.84, p < 0.001. and self-care ability and disability (r = -0.91, p < 0.001.. The indirect effect of self-efficacy on the relationship between self-care ability and level of disability was -0.03 (95% CI -0.08 to -0.04), accounting for 16.67% of the total effect. Conclusion: Self-efficacy partially mediates the relationship between self-care ability and disability in older adult patients with chronic conditions. Healthcare providers can improve self-care behaviours and self-efficacy in older adult patients through effective interventions to reduce the incidence of disability.