Monday, February 16, 2026

VTE Champions: February 2026



Welcome to the latest key papers and publications focussing mainly on venous thromboembolism and VTE champions in the nursing profession and the role they play as part of a clinical team.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Importance and performance of evidence-based clinical practice guidelines for prevention of venous thromboembolism among orthopedic hospital nurses
Abstract: Summary: Purpose: This study aimed to evaluate the perceived importance and performance of evidence-based clinical practice guidelines (EBCPG) for venous thromboembolism (VTE) prevention among nurses in orthopedic hospitals. Methods: A cross-sectional descriptive study was conducted among 188 nurses in three orthopedic hospitals in South Korea. Participants rated the importance and performance of 110 EBCPG for VTE prevention items across 10 domains using a 5-point Likert scale. Importance-performance analysis was utilized to identify gaps and prioritize areas for improvement. Results: The mean importance and performance scores for EBCPG for VTE prevention were 4.02 and 3.67, respectively, revealing a statistically significant gap (t = 10.67, p < .001). Differences were observed across domains, with “General interventions for VTE prevention” showing the highest scores for both importance and performance, while “VTE prevention for cancer patients” and “VTE prevention for surgical patients” exhibited the largest gaps. Conclusion: The findings highlight the need for targeted strategies to bridge the gap between the perceived importance and performance of EBCPG for VTE prevention, particularly in domains with significant performance deficiencies. Tailored education and institutional support are recommended to enhance guideline utilization and improve patient outcomes in orthopedic hospitals.
Source: Jeong D. Asian Nursing Research, Aug 2025; 19(3): 227-234

Risk factors and preventive measures of Venous Thromboembolism in trauma patients using trauma embolic scoring system: A retrospective chart review
Abstract: Background: Venous thromboembolism (VTE) is a major preventable complication in trauma patients, with varying incidence and risk factors across populations.

Aim/objective: To categorize VTE risk in Korean trauma patients using the Trauma Embolic Scoring System (TESS) and assess the application of prophylaxis by risk level.

Methods: This retrospective study at Korea University Guro Hospital involved 1913 trauma patients over two years. Data on demographics, injury specifics, and preventive treatments were analyzed using TESS. The study examined general, mechanical, and chemical interventions for VTE prevention.

Results: Of the patients, 1.4% were diagnosed with VTE. The average TESS score was 3.20, indicating lower injury severity but higher percentages of surgeries over 2 h and serious injuries. The findings showed VTE occurrences even in patients with TESS scores below the high-risk threshold, particularly in limb injuries. Nurse-led interventions like early physical activity were most common in the low-risk group, while mechanical prophylaxis like anti-embolism stockings was also predominantly used in this group. Chemical prophylaxis showed consistent administration across groups, with 37.5% of the high-risk group receiving Low Molecular Weight Heparin (LMWH), although only a minority received it within the recommended 48-hour.

Conclusions: The study reveals a need for vigilant monitoring and intervention across all risk categories, underscoring the importance of tailored VTE prevention guidelines in South Korea. It highlights the role of comprehensive management, including patient education and adherence to updated guidelines.
Source: Choi E J. International Emergency Nursing, Mar 2025; 79: 101585

Perioperative Hyperglycemia is an Independent Risk Factor for Venous Thromboembolism Events After Operative Treatment of Geriatric Femur Fractures
Abstract: Introduction: Geriatric femur fractures occur in complex hosts that pose significant challenges in perioperative management, with venous thromboembolism (VTE) as a well described complication. Hyperglycemia, prevalent in the perioperative period, has been implicated in increasing thrombotic risk. However, data on its impact on outcomes following femur fracture fixation in the elderly population remains limited.

Methods: A retrospective cohort analysis was conducted on adults >60 years old undergoing operative fixation for femur fractures between January 2017 and December 2019. Demographic information, comorbidities, and outcomes were collected from electronic medical records.

Results: Six hundred and fourteen patients met inclusion criteria. The average age was 78.7 years (30.3% male; 25.0% with diabetes mellitus (DM) diagnosis). Patients with postoperative glucose ≥180 mg/dL had significantly higher rates of pulmonary embolism (PE) and VTE within 90 days, and glucose ≥180 mg/dL was an independent predictor for these events. Those with a DM diagnosis had higher rates of sepsis but not PE, VTE, or other complications compared to those without DM.

Conclusion: Acute perioperative hyperglycemia, regardless of DM diagnosis, is an independent risk factor for VTE and PE following geriatric femur fracture fixation. Strict glucose control in the postoperative period may improve outcomes in this patient population.
Source: Herman Z J. Jun 2025; 16: 21514593251342423

Executive summary of the consensus document on home care treatment of pulmonary embolism
Abstract: Introduction: Hospital at Home (HaH) is a safe care modality that reduces costs and risks compared to conventional hospitalisation. Evidence supports the safety of outpatient management in patients with pulmonary embolism (PE).

Objectives and methods: To establish a protocol for the identification and clinical management of patients with PE who are candidates for HaH management. This document has been prepared jointly by the Venous Thromboembolism Group (VTE) and the Hospital at Home Group (HaH) of the Spanish Society of Internal Medicine (SEMI).

Results: A total of 44 statements were considered. Voting was carried out using a Likert scale. A total of 39 recommendations reached consensus.

Conclusions: The SEMI VTE and HaH working groups recommend evaluating home treatment of PE in patients with a low risk of complications.
Source: Ortega L O. Revista Clinica, May 2025; 225(5): 502280

Trust nurse wins international recognition for campaign to raise awareness of blood clot prevention
Abstract: A Trust Venous Thromboembolism (VTE) prevention campaign has received international recognition from the International Society on Thrombosis and Haemostasis (ISTH). Ahead of World Thrombosis Day on 13 October, the ISTH has announced its annual global advocacy award winners and awarded the Trust its Activity of the Year (high-income country) award.
Source: Buckinghamshire Healthcare NHS Trust. News 2025, Oct 2025

Venous Thromboembolism (VTE) Risk Assessment Collection
Abstract: The data collection was first made mandatory from June 2010, and data has been published quarterly from the first full quarter's data (July to September 2010).
Following feedback, the VTE Risk Assessment Data Collection was reinstated from April 2024, with the first submission due in July 2024.
The collection and publication of this data was paused to release NHS capacity to support the response to coronavirus (COVID-19). Following requests to restart, the collection underwent an assurance process which included consultation with providers.
The data collection remains unchanged from the previous collection.
Source: NHS England Data Collections, Sep 2025

Retrospective evaluation of the results of ultrasound-accelerated catheter-directed tombolysis in acute-subacute pulmonary embolism patients
Abstract: Objectives: Acute pulmonary embolism (PE) is one of the most serious forms of venous thromboembolism (VTE) with high mortality and morbidity. PE may present with right ventricular dysfunction and hemodynamic disturbances. Early diagnosis and appropriate treatment approaches play a critical role in improving survival. In this study, we evaluated the efficacy and safety of catheter-mediated thrombolytic therapy in intermediate-high-risk PE patients.

Methods: Our retrospective study was conducted at Ankara University between 2015 and 2020 and 66 intermediate-high-risk PE patients were analyzed. Clinical, biochemical and echocardiographic data of the patients were analyzed and their response to treatment was evaluated. The primary endpoint was 30-day mortality and secondary endpoints were hemodynamic improvement, length of hospitalization and complication rates.

Results: The mean age of the patients was 65 years and all of them presented with a diagnosis of symptomatic PE. After treatment, significant improvement was observed in right ventricular function, RV/LV ratio, ProBNP and Troponin I levels decreased significantly. Pulmonary artery pressures decreased and hemodynamic parameters improved. The early mortality rate after the procedure was 3% and the rate of major bleeding was low.

Conclusions: Catheter-mediated thrombolytic therapy provides hemodynamic improvement in intermediate-high-risk PE patients, while offering a low bleeding risk. Our results suggest that this therapy may be a safe and effective alternative. However, long-term results should be evaluated in large-scale, randomized studies.
Source: Karaçuha A F. Phlebology, Feb 2026; 41(1): 23-29
Contact the library for a copy of this article

Enhancing Patient Care: Venous Thromboembolism Prophylaxis in the Emergency Department
Abstract: Venous thromboembolism is a serious risk for hospitalized patients, especially those with long emergency department stays, yet preventive measures are often delayed. This review examines effective medication therapies and nursing interventions for venous thromboembolism prophylaxis in the emergency department. Accurate risk assessment, timely medication administration, and patient education are crucial. Medication prophylaxis, primarily with low-molecular-weight heparin, is preferred over mechanical methods. Barriers such as limited knowledge, unclear guidelines, patient refusal, and staffing shortages hinder optimal implementation. Strategies to improve prophylaxis include standardized protocols and nurse-driven initiatives. Emergency nurses are the first to care for patients in the healthcare setting and are in a key position to initiate risk assessments and additional prophylaxis but often lack the knowledge and resources. Healthcare institutions should prioritize education and address systemic barriers. Future research should focus on tailored guidelines for specific patient populations and evaluate prevention strategies. A multidisciplinary approach, incorporating evidence-based practices and patient input, is crucial for optimizing venous thromboembolism prevention and improving patient outcomes.
Source: Scannell M. Journal of Emergency Nursing, Jan 2026; 52(1): 59-65
Contact the library for a copy of this article

Nurses' knowledge and practice in Venous Thromboembolism prevention: Development and validation of a scale
Abstract: Aim: This study aimed to develop and evaluate a scale measuring nurses' knowledge and practice regarding VTE prevention.

Background: Venous thromboembolism (VTE) is serious but preventable. Nurses are crucial in risk assessment and prevention, yet gaps in knowledge and practice persist globally.

Design: A methodological design was used.

Methods: The item pool was generated through a literature review and expert consultation, followed by pilot testing. Nurses were recruited using convenience sampling from two large tertiary hospitals selected for their high patient volume and diverse clinical settings, ensuring adequate variability in VTE-related nursing practices. Eligible participants were registered nurses working in emergency, internal medicine, surgical, or intensive care units with at least six months of clinical experience. The final scale was administered to 200 nurses between March and May 2024. Construct validity was examined using exploratory and confirmatory factor analyses and reliability was assessed through internal consistency statistics.

Results: The Kaiser-Meyer-Olkin (KMO) measure was 0.953 and Bartlett's test was significant. Confirmatory factor analysis supported a two-factor model (knowledge and practice) with good fit indices (χ²/df = 1.09; GFI = 0.99; AGFI = 0.99; CFI = 1.00; RMSEA = 0.020; SRMR = 0.057). The final scale includes 20 items. Cronbach's alpha for the total scale was 0.965 and for the subscales it was above 0.90.

Conclusion: The developed scale is a valid and reliable tool for assessing nurses' knowledge and practice. It can be used in research and clinical audit to identify educational needs and guide interventions.
Source: Yuksel B. Nurse Education in Practice, Jan 2026; 90: 104660

Knowledge, Attitudes and Practices Regarding Venous Thromboembolism Prevention Among Orthopaedic Nurses in Comprehensive Hospitals: A Cross‐Sectional Survey
Abstract: Aims: This study aimed to investigate the current status of knowledge, attitudes and practices regarding venous thromboembolism (VTE) prevention among orthopaedic nurses in comprehensive hospitals in Yichang, Hubei Province, China, and to analyse influencing factors to provide a reference for implementing VTE prevention strategies.

Methods: From February to March 2024, a total of 257 orthopaedic nurses from nine comprehensive hospitals in Yichang were surveyed using a convenience sampling method and investigated with a knowledge, attitudes and practices questionnaire for VTE prevention. Multiple linear regression analysis was conducted to identify factors influencing knowledge, attitudes and practices regarding VTE prevention among orthopaedic nurses.

Results: The overall score for knowledge, attitudes and practices regarding VTE prevention among orthopaedic nurses was 88.54 ± 5.73, with knowledge scoring 73.56 ± 7.69, attitudes scoring 95.66 ± 7.79 and practices scoring 95.96 ± 7.04. Position, training frequency, quality inspection and discharge follow‐up were significant factors influencing knowledge, attitudes and practices scores (p < 0.05).

Conclusions: In the orthopaedic departments of comprehensive hospitals in Yichang, Hubei Province, China, the overall level of knowledge, attitudes and practices regarding VTE prevention among nurses is generally good, with positive attitudes and practices observed. However, there is potential for improvement in knowledge levels. Recommendations include enhancing standardized VTE training, improving knowledge levels, strengthening health education and ensuring discharge follow‐up to optimize VTE prevention efforts.
Source: Cui W. International Journal of Nursing Practice, Oct 2025; 31(5): e70048

Risk Factors and Preventive Measures of Venous Thromboembolism in Trauma Patients using Trauma Embolic Scoring System: A retrospective chart review
Abstract: Background: Venous thromboembolism (VTE) is a major preventable complication in trauma patients, with varying incidence and risk factors across populations.

Aim/objective: To categorize VTE risk in Korean trauma patients using the Trauma Embolic Scoring System (TESS) and assess the application of prophylaxis by risk level.

Methods: This retrospective study at Korea University Guro Hospital involved 1913 trauma patients over two years. Data on demographics, injury specifics, and preventive treatments were analyzed using TESS. The study examined general, mechanical, and chemical interventions for VTE prevention.

Results: Of the patients, 1.4% were diagnosed with VTE. The average TESS score was 3.20, indicating lower injury severity but higher percentages of surgeries over 2 h and serious injuries. The findings showed VTE occurrences even in patients with TESS scores below the high-risk threshold, particularly in limb injuries. Nurse-led interventions like early physical activity were most common in the low-risk group, while mechanical prophylaxis like anti-embolism stockings was also predominantly used in this group. Chemical prophylaxis showed consistent administration across groups, with 37.5% of the high-risk group receiving Low Molecular Weight Heparin (LMWH), although only a minority received it within the recommended 48-hour.

Conclusions: The study reveals a need for vigilant monitoring and intervention across all risk categories, underscoring the importance of tailored VTE prevention guidelines in South Korea. It highlights the role of comprehensive management, including patient education and adherence to updated guidelines.
Source: Choi, E. International Emergency Nursing, Mar 2025; 79: 101585
Contact the library for a copy of this article

The Status of Nurses Working in Surgical Units in Delivering Patient Education on Venous Thromboembolism
Abstract: Objective: This study was planned to examine the status of education delivered by nurses working in surgical units regarding venous thromboembolism (VTE).

Methods: This descriptive cross-sectional study was conducted between May 2024 and June 2024. The study participants consisted of 126 nurses working in the surgical units of a city hospital in Türkiye. Data were collected using the "Patient Education Practice Form" developed by the researcher. Descriptive statistics (number, percentage, mean, standard deviation, median values) were used for data analysis.

Results: When examining the nurses' education practices, 19.8% stated that they always delivered patient education on mobilization, ankle exercises, and correct leg positioning while sitting; 19.1% on signs and symptoms of VTE; 19.0% on lifestyle changes; 18.3% on anticoagulants; 18.2% on laboratory tests in pharmacological prophylaxis; 17.5% on situations requiring emergency admission and patient safety; 16.7% on hydration; and 15.9% on elevating the legs and using compression stockings. The issues nurses faced in delivering patient education included difficult working conditions and insufficient nursing staff (86.5%), lack of knowledge about VTE (54.8%), absence of guidelines on VTE and patient education in the clinic (53.2%), considering patient education as the physician's responsibility (48.4%), insufficient presentation and teaching skills (47.6%), lack of prioritization of patient education activities in the institution, lack of teaching materials (45.2%), and low health literacy of patients (32.5%).

Conclusion: Increasing nurses' knowledge and awareness through education on delivering patient education regarding VTE and addressing the perceived barriers to patient education by surgical nurses are essential for ensuring effective patient instruction.
Source: Özbaş N. Journal of Nursology, Mar 2025; 28(1): 56-63

VTE Prevention Ability Among Community Nurses in the Medical Consortium Based on the Kirkpatrick Model Evaluation of the Effects of Training
Abstract: Purpose: To explore the application of the Kirkpatrick model in VTE prevention training among community nurses in the medical consortium.

Method: A team of experts was established to formulate a VTE prevention ability training program for community nurses in the medical consortium. According to a literature review, the results of a questionnaire survey and the results of on-site supervision surveys of nurses in five community health service centers in the medical consortium. The Kirkpatrick model was applied to train 117 nurses in five community service centers, and the effects on the four dimensions (i.e., the reaction layer, learning layer, behavior layer, and results layer) were observed.

Results: A total of 100% of nurses’ reported satisfaction with the training, and the attendance rate was ≥98%. After the training, the theoretical knowledge of VTE prevention and the results of the skills assessment of community nurses in the medical consortium were significantly greater than the pretraining levels (p < 0.001). Three months after training, the nurses’ VTE prevention execution score significantly improved compared with the pretraining scores (p < 0.001). The compliance rate and standard rate of ankle pump movement significantly improved compared with those before training (p < 0.001).

Conclusion: Training based on the offset model can effectively improve VTE prevention knowledge among community nurses in the medical consortium, thereby enhancing VTE prevention among patients and at improving the compliance and standardization of patients' self-prevention. These findings provide a reference for future in-service training programs targeting VTE prevention among nurses in community hospitals.
Source: Fan W. Public Health Nursing, Mar 2025; 42(2): 949-956

Nursing Assessment to Prevent Venous Thromboembolism
Abstract: Medical-surgical nurses care for patients who are at risk for venous thromboembolism (VTE). Through increased knowledge, assessment skills, team communication, and patient education, nurses play a key role in preventing VTE and improving patient outcomes.
Source: Bartzak P. MEDSURG Nursing, Jan/Feb 2025; 34(1): 49-51
Contact the library for a copy of this article

Nursing Interventions for People at Risk of Venous Thromboembolism Associated with Chemotherapy: Scoping Review
Abstract: Introduction: Venous thromboembolism is the second leading cause of death in people
with cancer. This risk increases in people undergoing chemotherapy. This complication causes physical and emotional suffering, and targeted nursing interventions are essential. 

Objective: To map the scientific evidence on nursing interventions to prevent and manage venous thromboembolism in people with cancer undergoing chemotherapy. 

Methods: Scoping Review according to the methodology of the Joanna Briggs Institute. The research was conducted in the MEDLINE® and CINAHL® databases in April 2023. The review followed the PRISMA-ScR EQUATOR checklist. 

Results: Twenty-six articles published between 2004 and 2023 were included. After analysis,
three main dimensions emerged: assessment of the risk of venous thromboembolism,
independent interventions, and interdependent interventions. 

Conclusion: Nurses play a crucial role in preventing and managing venous thromboembolism, using a
systematised approach to risk assessment, education, monitoring for signs and/or symptoms of these complications and implementing targeted interventions.
Source: Robalo Lopes Marcelino A I. Onco.news, Jan-Jun2025; 18(50): 33-45

The Effect of a Mobile-Supported Venous Thromboembolism Training Program on Surgical Nurses' Knowledge and Practices
Abstract: Providing effective training for surgical nurses is important to prevent venous thromboembolism (VTE). This study was conducted to evaluate the effect of a mobile-supported venous thromboembolism training program on the knowledge and practices of surgical nurses. A total of 147 surgical nurses were given mobile-supported venous thromboembolism training. The data were collected using an Information and Practices Form. It was determined that the nurses' knowledge and practice scores increased significantly over time, from baseline (T0) to immediately after training (T1) and 1 month after training (T2) (P < .0005). All nurses were satisfied with the mobile-based VTE training. A moderate and positive correlation was found between the satisfaction scores of the nurses and their knowledge and practice scores immediately after training (P < .05). A weak and positive correlation was found between knowledge and practice scores immediately after training and 1 month later (P < .05). One month before VTE training, two patients were readmitted to the hospital with postoperative VTE. No patients who were given care by the same nurses were readmitted with postoperative VTE 1 month after training. In conclusion, mobile-supported training provided improvement and ensured the sustainability of nurses' knowledge and practices regarding VTE, was a satisfactory and acceptable training strategy, positively affected patient outcomes, and prevented repeated hospitalizations.
Source: Özbaş N. CIN: Computers, Informatics, Nursing, Jan 2026; 44(1): e01271
Contact the library for a copy of this article

Venous thromboembolism prophylaxis in adults hospitalised for psychiatric illness: an evidence-based clinical practice guideline developed using GRADE
Abstract: Introduction: Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths. Adults hospitalised with psychiatric illness vary in their risk of VTE, and therefore in their likelihood of benefiting from thromboprophylaxis. There is a paucity of evidence-based practice guidelines addressing VTE prophylaxis for this population despite recognition of additional VTE risk factors in this population.

Aim: To develop an evidence-based guideline on VTE prophylaxis for patients hospitalised with psychiatric illness using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).

Method: An international, multidisciplinary, guideline panel including clinical experts, methodologists, and a patient partner was recruited by invitation. Panelists were selected based on methodological and clinical expertise on this subject. Panel members were diverse in geography (from Ireland, the United Kingdom, France, and Canada), expertise and gender. The panel was composed of four advanced specialist psychiatric pharmacists, four consultant haematologists, four consultant psychiatrists, one advanced nurse practitioner in psychiatry, one advanced nurse practitioner in anticoagulation, a methodologist with expertise using GRADE, and a patient partner with lived experience of VTE. The panel prioritised two clinical questions and related population, interventions, outcomes, and secondary analyses according to their importance for patients. GRADE was used to assess certainty of evidence and to move from evidence to risk-stratified recommendations.

Results: The panel made three recommendations: a strong recommendation against parenteral pharmacological prophylaxis for patients at low risk of VTE (moderate-certainty evidence); a conditional recommendation in favour of parenteral pharmacological prophylaxis in high-risk patients (low-certainty evidence); and a strong recommendation against graduated compression stockings in patients at high risk of VTE with a contraindication to parenteral pharmacological prophylaxis (low-certainty evidence).

Conclusion: Clinicians should not use parenteral pharmacological prophylaxis in adults hospitalised with psychiatric illness at low risk of VTE; and should consider using parenteral pharmacological prophylaxis for high-risk adults with no contraindications. Graduated compression stockings are not recommended in high-risk patients when parenteral pharmacological prophylaxis is contraindicated. These GRADE- based recommendations offer one of the first evidence-based practice guidelines for thromboprophylaxis decisions in psychiatric in-patient settings.
Source: Purcell A. International Journal of Clinical Pharmacology, Jan 2026

Venous Thromboembolism (VTE) Risk Assessments in Psychiatric Inpatients Audit
Abstract: Aims: The aim of this audit was to assess the compliance of Coventry and Warwickshire Partnership NHS Trust (CWPT) with the National Institute for Health and Care Excellence (NICE) venous thromboembolism (VTE) in over-16s guidelines. NICE guidelines recommend that all acute psychiatric patients should be assessed to identify their risk of VTE and bleeding as soon as possible after admission to hospital or by the time of the first consultant review. In addition, NICE guidelines also recommend that all patients admitted to an acute psychiatric ward should be reassessed for risk of VTE and bleeding at the point of consultant review.

Methods: All patients admitted to inpatient wards in CWPT are required to have a digital physical health document, which contains a section on VTE risk assessment, completed by the duty doctor. The digital physical health document for all inpatients (n=244) across 16 wards in CWPT were retrospectively reviewed in October 2024. A standardised tool was created to collect data using an adaptation of the NICE VTE guidelines. This tool ensured parallel data was collected for each patient, including whether patients had a VTE risk assessment completed on admission to hospital, whether VTE risk assessments were dated and signed, at what point in time VTE risk assessments were completed following admission, and whether patients had a VTE risk assessment completed at the point of consultant review.

Results: 63% (n=153) of patients had a VTE risk assessment completed and documented on admission to hospital, including being signed and dated. 63% (n=154) of patients had a VTE risk assessment completed within 24 hours of admission. 99% (n=242) of patients did not have a VTE risk assessment completed at the point of consultant review. 5% (n=13) of patients had a VTE risk assessment completed without being signed and/or dated. 7% (n=16) of patients had documentation of communication of assessment with a registered mental health nurse.

Conclusion: CWPT’s compliance with NICE recommendations for VTE risk assessment was deemed below standard. Recommendations have been made to introduce a VTE risk assessment section into every new doctor’s induction, to ensure they are aware of the importance of completing them and how to complete them appropriately. In addition, if possible, making the VTE risk assessment a required field to submit the physical health aspect of the clerking proforma would aid in increasing compliance rates. A re-audit in 6–12 months is also recommended.
Source: Kanabar R. BJPsych Open, Jun 2025; 11(S1): S249-S250

Venous Thromboembolism Risk Assessment Audit
Abstract: Aims: This audit is most relevant to acute inpatients at a general psychiatric hospital (St Ann’s Hospital and Chase Farm Hospital) in which there is high turnover of acutely unwell psychiatric patients being admitted. This set of patients are at significant risk of venous thromboembolism due to immobility and the nature of their illnesses.
People with psychiatric disorders may be at risk of developing venous thromboembolism, particularly when acutely unwell and admitted to an acute psychiatric ward. This may be due to the presence of risk factors such as reduced mobility due to psychiatric illness or sedation, dehydration due to poor oral intake or comorbid physical illnesses. The use of antipsychotic medications also increases thrombotic risk. Parity of esteem for mental health is a priority for health care and should include equity of provision for the management of physical health problems in those people presenting primarily with mental illness.
Also, there are issues which may cause concerns with regard to VTE prophylaxis in this population such as capacity to consent to interventions, interactions of psychotropic medications with pharmacological thromboprophylaxis and risk issues around the use of pharmacological and mechanical strategies for people who self harm.
The aim of this audit is to find out if admitting doctors are complying with North London NHS Foundation Trust policy and Department of Health guidelines. This will be carried out looking at 40 admissions across 4 wards in St Ann’s Hospital and Chase Farm Hospital between 1/1/2023 to 30/6/2023.

Methods: Data collection using designed questionnaire.

Standards: Trust policy and Department of Health guideline to be used as standard.

Results: Out of the 40 admission cases viewed, none of them had VTE risk assessment done. Hence no data available to analyse.

Conclusion: It is unfortunate that doctors are no longer doing VTE risk assessment on an acute psychiatric ward. This is still being emphasized by Department of Health.
Source: Neru S. BJPsych Open, Jun 2025; 11(S1): S261-S262

Acceptance of artificial intelligence clinical assistant decision support system to prevent and control venous thromboembolism among healthcare workers: an extend Unified Theory of Acceptance and Use of Technology Model
Abstract: Background: Venous thromboembolism (VTE) is an important global health problem and the third most prevalent cardiovascular disorder. It has been proven that computerized tools were helpful in the prevention and control of VTE. However, studies that focused on the acceptance of computerized tools for VTE prevention among healthcare workers were limited.

Objective: This study aims to explore what factors are influencing healthcare workers’ acceptance of the Artificial Intelligence Clinical Assistant Decision Support System (AI-CDSS) for VTE prevention based on the extended Unified Theory of Acceptance and Use of Technology (UTAUT).

Methods: We conducted a cross-sectional survey among healthcare workers in three grade-A tertiary hospitals in Shanxi, China. Statistically, the hypothesized model was evaluated by AMOS structural equation modeling.

Results: 510 (72.86%) valid surveys were collected in total. The results showed that performance expectancy (β = 0.45, P < 0.001), effort expectancy (β = 0.21, P < 0.001), and top management support (β = 0.30, P < 0.001) positively influenced healthcare workers’ intention. Top management support was an antecedent of performance expectancy (β = 0.41, P < 0.001), social influence (β = 0.57, P < 0.001), effort expectancy (β = 0.61, P < 0.001), and information quality (β = 0.59, P < 0.001). In addition, Social influence positively influenced performance expectancy (β = 0.52, P < 0.001), and information quality positively influenced system quality (β = 0.65, P < 0.001). Social influence did not influence nurses’ behavioral intention (β = 0.06, p = 0.376), but negatively influenced clinicians’ behavioral intention in the model (β = −0.19, P < 0.001). System quality positively influenced nurses’ behavioral intention; (β = 0.16, P < 0.001), and information quality positively influenced clinicians’ behavioral intention (β = 0.15, p = 0.025).

Conclusion: With this model explaining 76.3% variance of the behavioral intention variable, this study could be useful as a reference for hospital administrators to evaluate future developments and facilitate the implementation of AI-CDSS for VTE prevention.
Source: Wang J. Frontiers in Medicine, Feb 2025; 12

Friday, October 24, 2025

Health Librarianship: October 2025

Introducing a collection of key papers focussing mainly on the role of the health/medical/clinical librarian.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Comparing the performance of librarians and medical specialists in retrieving clinical evidence: an observational study
Abstract: Access to precise and reliable scientific evidence is one of the fundamental principles of Evidence-Based Medicine (EBM) in clinical decision-making processes. Medical librarians, by employing advanced search and information retrieval techniques, play a pivotal role in accessing such evidence. This observational study compared the search and evidence retrieval behaviors of two groups: Medical librarians and medical specialists familiar with EBM and systematic reviews. The study population consisted of 40 participants (20 medical librarians and 20 medical specialists), whose performance in retrieving the best available evidence from credible sources was evaluated using two distinct clinical scenarios. A researcher-developed checklist was created in accordance with the Guidelines for Evaluating Evidence-Based Search Strategies and was utilized to assess the search performance of participants. The findings revealed that medical librarians employed structured search strategies and were more successful in retrieving accurate evidence. They consistently utilized structured search strategies, field-specific search tools, and narrowing techniques in all cases. In contrast, medical specialists spent less time on searches and exhibited a greater tendency to use natural language terms in their search queries. medical specialists did not systematically employ controlled vocabulary or place keywords in specific fields, such as titles, keywords, or abstracts. In conclusion, librarians’ expertise in accessing the best available evidence underscores their crucial role in supporting medical specialists in obtaining and implementing evidence, thereby improving the quality and reliability of evidence-based practices in healthcare settings.
Source: Medical Reference Services, May 2025; 44(2): 169-186
Contact the library for a copy of this article

Don’t Close Medical Libraries: That’s Where You Find Librarian Partners to Advance Medicine and Science
Abstract: In the fields of medicine and science, the battle between books and digital communication is over. Just as their predecessors for many centuries used Latin as their lingua franca, physicians and scientists have chosen digital communication and “reading without books” for sending and receiving stored information. Yet the battered and tattered book lives on, as Jeff Bezos demonstrated, making books the core product of his Amazon empire. I believe the 2 to 3 million surviving institutional libraries1 should not close their doors because libraries are where the librarians are, and librarians are the facilitators and guardians of medical and scientific knowledge. They are an integral part of the health care team.
Source: Ophthalmology; October 2025, 132(10): 1073-75

Not just a book lady: Shifting perceptions of librarians’ role in the 21st Century
Abstract: The role of librarians has undergone a profound transformation in the 21st century. Once perceived primarily as custodians of books and quiet spaces, librarians are now essential players in digital literacy, research support, community engagement, and technological innovation. However, outdated stereotypes continue to shape public perception, often failing to reflect the evolving realities of the profession. This disconnect challenges the recognition and full utilisation of librarians’ expertise in modern information environments. This research explores how perceptions of librarianship have shifted over time and emphasises the dynamic, multifaceted responsibilities librarians now undertake. As a secondary research study, the paper draws from a wide range of existing literature, including academic journals, case studies, and professional reports, to examine the transformation of the librarian's role in various contexts, particularly in academic and public libraries. Findings indicate contemporary librarians are information managers, digital navigators, instructional partners, and community advocates. They contribute significantly to online learning, data management, information ethics, and user empowerment. However, despite these expanded roles, many librarians still face limitations in public understanding due to persistent traditional stereotypes. This research concludes that to bridge the gap between perception and reality, there must be increased advocacy, visibility, and professional development. Recognising and promoting the modern librarian's role will enhance the profession’s image and ensure its continued relevance and impact in today’s knowledge-driven society.
Source: Journal of Library Services and Technologies, June 2025; 7(2): 232-43

Medical Librarians in The Role of Research Facilitators: A Case Report (Immune Deficiency Clinic of Mashhad Akbar Children's Hospital)
Abstract: Introduction: Clinical librarians or information specialists working in hospitals and medical schools are typically graduates of medical or general librarianship programs. Through the knowledge and expertise they acquire during their academic training and internships, they serve as valuable resources in meeting the information and research needs of physicians and clinical staff across healthcare systems. In this report, we examined the impact of the clinical librarian's presence in the hospital's immunodeficiency clinic registry project and addressed the challenges involved in registering immunocompromised patients and establishing the registry system.

Objective: The impact of the clinical librarian’s presence as a research facilitator in the
immunodeficiency patient registry project.

Case Presentation: The immunodeficiency clinic at Akbar Children's Hospital, serving 250 patients,
is among the most active of its kind in the country. While some patients attend regularly and receive
their medications, others—previously hospitalized and diagnosed with immunodeficiency—
discontinue follow-up due to factors such as long travel distances, high costs of medication and
treatment, and other barriers. This report outlines, step by step, the process of activating the patient
registry within Rabbit (the health research information management infrastructure), highlighting the
clinical librarian’s facilitating role in implementing this system.

Conclusion: The presence of clinical librarians or general librarians (on the condition of passing
familiarization units with medical terms, etc.) in research projects as research facilitators, research
assistants, or research experts, due to familiarity with the specializations and skills required for
research, can have a significant contribution to the progress of the project.
Source: Journal of Pediatric Perspective, 2025; 13(8): 19641-45
Contact the library for a copy of this article

Medical librarians and little free libraries: Connecting rural communities to health information
Abstract: Background: Consumer health libraries connect communities to reliable and accurate health information while Little Free Libraries (LFL) provide communities globally with access to free books with a 'take one leave one' type policy.
Objectives: To discuss how medical librarians used already established LFLs as outreach opportunities to provide consumer health books to rural locations in East Tennessee's Appalachia region in the United States.
Methods: Researchers reviewed the population's literacy levels, the Index of Medical Underservice scores, and the availability of established LFLs. Twenty-two established LFL locations were selected and one new LFL was built for an eye clinic. Eleven health books were purchased for each established LFL, and 33 books were purchased for the new LFL.
Results: Researchers went back to each location 5 months after delivery. 90% of the books were taken from the already established LFLs. Ten books were taken from the new LFL.
Discussion: Using already established LFLs is a great opportunity to provide relevant health information to rural communities. The new LFL allowed for a partnership between the library and a rural eye clinic.
Conclusion: By distributing health books to already established LFLs, researchers brought relevant health information books to rural and medically underserved communities.
Source: Health Information and Libraries Journal, Dec 2024; 41(4): 394-403

Physical therapy students' perceptions of embedded medical librarians within evidence-based practice courses: a mixed-methods pilot study
Abstract: Objective: Previous work within academic medical centers has indicated the potential value of embedded medical librarian programs within health sciences professional degree programs. This study sought to determine the perceived benefit that an embedded medical librarian (EML) provided to an evidence-based practice (EBP) course within an entry-level physical therapy degree program.
Methods: Learners completed an anonymous survey at the end of an EBP course about the impact of the EML on the course and their own EML utilization. Frequency and percentages were calculated for quantitative data; qualitative data were analyzed using an iterative process for code development.
Results: Forty (98%) learners completed the survey. Seventy-five point six percent of learners utilized the EML 1-2 times per class session and 31.7% outside of class sessions. Learners overwhelmingly "agreed" (53.7%) or "strongly agreed" (39.0%) that they would consult the EML for literature searches required in future courses. Seventy point seven percent "strongly agreed" that the EML improved their ability to conduct a literature search. All learners either "agreed" (43.9%) or "strongly agreed" (56.1%) that the EML added value to the course. Ninety point two percent considered the EML as an integral part of the course. Themes from the qualitative analysis agreed that the EML added value to the course and facilitated skills that would be useful throughout the curriculum.
Conclusion: Learners believe that having an EML improves their ability to conduct a literature search. Providing learners with EML access during their education experience facilitates development of this skill. Early and continued instruction throughout the entry-level DPT curriculum in informatics ensures program compliance with accreditation standards.
Source: Journal of the Medical Library Association; Apr 2025; 113(2): 143-7

UK survey demonstrates a wide range of impacts attributable to clinical librarian services
Abstract: Objective To understand the impact of the UK Clinical Librarian (CL) workforce and benchmark the results against a study undertaken in the North West region of the English National Health Service (NHS). Methods An online survey was distributed by CLs to their service users regarding literature searches that had been carried out on their behalf in the 6 months from April to October 2017. Interviews were later carried out in person with selected respondents to the questionnaires. Results CLs across the UK contribute to a wide range of outcomes, with 41% of search requests contributing to the choice of intervention, and 41% also to the advice offered by the clinician requester to a patient or their carer. These results are in line with the previous work undertaken in the North West. Discussion CLs provide diverse services to clinical teams. They support the continuing professional development and personal research needs of team members, service development needs of organisations, and the information provided contributes to improved quality and safety of patient care. Conclusion The survey confirms the findings of the earlier NW study. It demonstrates the impact of services based around literature searching on patient care.
Source: Health information and libraries journal, 2021; 39(2): 116–131

Supporting staff information: the role of the renal clinical librarian
Abstract: The study investigates the role of the renal clinical librarian in an acute renal setting in supporting information needs of clinical staff by providing a literature searching service for the benefit of the multidisciplinary team.
Source: Journal of Renal Nursing, July 2025; 7(4): 198–200

A scoping review of librarian involvement in competency-based medical education
Abstract: Objective: A scoping review was undertaken to understand the extent of literature on librarian involvement in competency-based medical education (CBME).
Methods: We followed Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. A search of peer-reviewed literature was conducted on December 31, 2022, in Medline, Embase, ERIC, CINAHL Complete, SCOPUS, LISS, LLIS, and LISTA. Studies were included if they described librarian involvement in the planning, delivery, or assessment of CBME in an LCME-accredited medical school and were published in English. Outcomes included characteristics of the inventions (duration, librarian role, content covered) and of the outcomes and measures (level on Kirkpatrick Model of Training Evaluation, direction of findings, measure used).
Results: Fifty studies were included of 11,051 screened: 46 empirical studies or program evaluations and four literature reviews. Studies were published in eight journals with two-thirds published after 2010. Duration of the intervention ranged from 30 minutes to a semester long. Librarians served as collaborators, leaders, curriculum designers, and evaluators. Studies primarily covered asking clinical questions and finding information and most often assessed reaction or learning outcomes.
Conclusions: A solid base of literature on librarian involvement in CBME exists; however, few studies measure user behavior or use validated outcomes measures. When librarians are communicating their value to stakeholders, having evidence for the contributions of librarians is essential. Existing publications may not capture the extent of work done in this area. Additional research is needed to quantify the impact of librarian involvement in competency-based medical education.
Source: Journal of the Medical Library Association: JMLA, Jan 2025; 113(1): 9-23
Contact the library for a copy of this article

Consulting with an embedded librarian: student perceptions on the value of required research meetings
Abstract: Objective: This qualitative research project was undertaken to discover how students perceive the embedded librarian in their nursing class. The researchers determined how a required group research meeting was valued by students and whether that value warranted the necessary time and energy by an embedded librarian.
Methods: Researchers conducted focus groups with twenty-three students from two different sections of the same nursing research methods undergraduate course. Students' responses to a series of five questions were recorded within Zoom and supplemented by handwritten notes. Data was coded by hand and patterns that emerged from the five focus groups were analyzed.
Results: Participants reported overall satisfaction with the embedded librarian and students felt they benefitted from the required research meeting with the librarian, which was part of the searching assignment rubric and closely tied to the assignment itself.
Conclusion: Based on the data, a required research meeting with an embedded librarian, who is familiar with the course assignments, reinforces classroom instruction, point-of-need assistance with search strategies, and the opportunity to strengthen the relationship with the librarian for future research needs.
Source: Journal of the Medical Library Association: JMLA, Oct 2024; 112(4): 324-331

Applying user experience strategies to enhance an NHS library space
Abstract: This study explores the application of user experience (UX) strategies to enhance the learning environment within the Leeds General Infirmary Library, part of the Leeds Teaching Hospitals NHS Trust. Despite the growing importance of UX in digital services and academic libraries, its adoption in health libraries has been limited. This paper details the implementation of three UX techniques—Graffiti walls, observations and behavioural mapping, and love and breakup letters—adapted from Andy Priestner's toolkit. The findings highlight user preferences and behaviours, leading to practical, low-cost improvements in the library space. The study underscores the value of UX methodologies in optimising library services to better meet user needs, even in resource-limited settings.
Source: Health Information & Libraries Journal, Jun 2025; Early View

Training and facilitating the use of reminiscence resources in a health promotion library context
Abstract: Health promotion libraries provide borrowable resources to support a wide range of health topics; resources are designed to be accessible and improve the impact of key health messages. Reminiscence resources aim to facilitate engagement and socialisation for people who find accessing long-term memory challenging. This article provides an overview of the reminiscence service provided by the Library Service at Bradford District Care NHS Foundation Trust. It will consider the rationale for providing this service, how resources are selected in collaboration with customers and how they are promoted through various approaches to library training. The library offers training to healthcare professionals and other customers caring for people with dementia; training demonstrates different ways in which reminiscence resources can be used. An impact case study completed by a customer following the use of a bespoke reminiscence memory box indicates that caregivers find the resources helpful in supporting people with dementia. This is particularly beneficial when carers have received training from librarians in using the resources. Tailored resources can be especially effective, as compared to generic or off-the-shelf items. Customer collaboration with librarians to inform and support collection development should be encouraged to ensure that resources reflect the needs of users.
Source: Health Information & Libraries Journal, Sep 2025; Early View

Understanding clinical library services as knowledge mobilisation activities: Mixed method evaluation of an Evidence Access service in a mental health trust
Abstract: Background
Access to tailored evidence syntheses can support frontline clinical staff to make evidence-informed care decisions, but evaluation of such services requires understanding of user needs within context.
Objectives
We evaluated an Evidence Access service by clinical librarians in a mental health trust in northern England to assess impacts on staff decision making and identify areas for improvement.
Methods
The evaluation was guided by the integrated Promoting Action on Research in Health Services framework. We evaluated the service through a survey, semi-structured interviews, and service mapping with the library team.
Results
Staff who used the service valued it highly and particularly appreciated the rapid response and trusting relationships with library staff. Mental health nurses required proactive support to encourage them to access the service.
Discussion
The service could be used to generate clinically relevant research questions in collaboration with researchers, but would require support for the negotiation of the value of different questions and understanding of each other's needs and priorities.
Conclusions
An Evidence Access service provided by a clinical librarian is highly valued by mental health staff. Collaboration between researchers and clinicians to identify and respond to evidence gaps would require commitment to building relationships and capacity.
Source: Health Information & Libraries Journal, Nov 2024; Early View

Impact of librarian-led case learning sessions on third-year medical students' clinical skills
Abstract: This article examines how direct engagement with credible resources significantly enhances students' practical skills in clinical scenarios. The program prepares students to utilize authoritative resources, fostering confidence in real-world clinical settings, especially in resource-limited environments. Data from student evaluations indicate a marked improvement in perceived difficulty of EBM cases and overall performance scores following the implementation of librarian-led learning sessions. This approach not only meets accreditation standards but also equips future healthcare professionals with essential skills for effective patient care. This underscores the crucial role of librarians in enhancing students' abilities to appraise and apply evidence-based knowledge.
Source: Health Information & Libraries Journal, Jun 2025; Early View

Thursday, May 22, 2025

Sepsis Champions: May 2025

Welcome to the latest key papers and publications focussing mainly on all things sepsis in the nursing profession.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Factors and outcomes associated with under- and overdiagnosis of sepsis in the first hour of emergency department care
Abstract: Background: Sepsis remains the leading cause of in-hospital death and one of the costliest inpatient conditions in the United States, while treatment delays worsen outcomes. We sought to determine factors and outcomes associated with a missed emergency physician (EP) diagnosis of sepsis.
Methods: We conducted a secondary analysis of a prospective single-center observational cohort of undifferentiated, critically ill medical patients (September 2020–May 2022). EP gestalt of suspicion for sepsis was measured using a visual analog scale (VAS; 0%–100%) at 15 and 60 min post–patient arrival. The primary outcome was an explicit hospital discharge diagnosis of sepsis that was present on arrival. We calculated test characteristics for clinically relevant subgroups and examined factors associated with initial and persistent missed diagnoses. Associations with process (antibiotics) and clinical (mortality) outcomes were assessed after adjusting for severity.
Results: Among 2484 eligible patients, 275 (11%) met the primary outcome. A VAS score of ≥50 (more likely than not of being septic) at 15 min demonstrated sensitivity 0.83 (95% confidence interval [CI] 0.78–0.87) and specificity 0.85 (95% CI 0.83–0.86). Older age, hypoxia, hypotension, renal insufficiency, leukocytosis, and both high and low temperature were significantly associated with lower accuracy due to reduced specificity, but maintained sensitivity. Of 48 (17%) and 23 (8%) missed cases at 15 and 60 min, elevated lactate, leukocytosis, bandemia, and positive urinalysis were more common in the missed sepsis compared to nonsepsis cases. Missed diagnoses were associated with median (interquartile range) delay of 48 (27–64) min in antibiotic administration but were not independently associated with inpatient mortality as risk ratios remained close to 1 across VAS scores.
Conclusions: This prospective single–academic center study identified patient subgroups at risk of impaired diagnostic accuracy of sepsis, with clinicians often overdiagnosing rather than underdiagnosing these groups. Prompt abnormal laboratory test results can “rescue” initial missed diagnoses, serving as potential clinician- and systems-level intervention points to reduce missed diagnoses. Missed diagnoses delayed antibiotics, but not mortality after controlling for severity of illness.
Source: Pandy Shivansh R. Academic Emergency Medicine, 2024 Dec; 32(3):

Development and validation of a prediction model for in-hospital mortality in patients with sepsis
Abstract: Background: Sepsis, a life-threatening condition marked by organ dysfunction due to a dysregulated host response to infection, involves complex physiological and biochemical abnormalities.
Aim: To develop a multivariate model to predict 4-, 6-, and 8-week mortality risks in intensive care units (ICUs).
Study Design: A retrospective cohort of 2389 sepsis patients was analysed using data captured by a clinical decision support system. Patients were randomly allocated into training (n = 1673) and validation (n = 716) sets at a 7:3 ratio. Least Absolute Shrinkage and Selection Operator (LASSO) regression identified variables incorporated into a multivariate Cox proportional hazards regression model to construct a prognostic nomogram. The area under the receiver operating characteristic curve (AUROC) assessed model accuracy, while performance was evaluated for discrimination, calibration and clinical utility.
Results: A risk score was developed based on 11 independent predictors from 35 initial factors. Key predictors included minimum Acute Physiology and Chronic Health Evaluation II (APACHE II) score as having the greatest impact on prognosis, followed by days of mechanical ventilation, number of vasopressors, maximum and minimum Sequential Organ Failure Assessment (SOFA) scores, infection sources, Gram-positive or Gram-negative bacteria and malignancy. The nomogram demonstrated superior discriminative ability, with AUROC values of 0.882 (95% confidence interval [CI], 0.855–0.909) and 0.851 (95% CI, 0.804–0.899) at 4 weeks; 0.836 (95% CI, 0.798–0.874) and 0.820 (95% CI, 0.761–0.878) at 6 weeks; and 0.843 (95% CI, 0.800–0.887) and 0.794 (95% CI, 0.720–0.867) at 8 weeks for training and validation sets, respectively.
Conclusion: A validated nomogram and web-based calculator were developed to predict in-hospital mortality in ICU sepsis patients. Targeting identified risk factors may improve outcomes for critically ill patients.
Relevance to Clinical Practice: The developed prediction model and nomogram offer a tool for assessing in-hospital mortality risk in ICU patients with sepsis, potentially aiding in nursing decisions and resource allocation.
Source: Shi W. Nursing in Critical Care, 2025 Apr; 30(3):

Investigating key factors of feeding intolerance in sepsis: A scoping review
Abstract: Background: At present, domestic and international research on the current status of feeding intolerance in septicemia patients only stops at the study of influencing factors; however, due to the specificity of the disease, the influencing factors are numerous and controversial.
Aims: To systematically analyse the studies related to the occurrence of feeding intolerance in patients with sepsis, to find out the influencing factors of feeding intolerance in these patients and to provide a reference for nursing staff to develop relevant interventions.
Study Design: The study employed Arksey and O'Malley's methodology to carry out a scoping review. We conducted a systematic search, using the scoping review as a framework, for relevant Chinese and English literature on factors influencing feeding intolerance in patients with sepsis in China Knowledge Network, Wanfang, CINAHL, Pubmed, Web of Science and Google Scholar, covering a time frame from construction to 1 September 2024. We identified research questions, completed literature screening and quality assessment, extracted data and summarized and analysed the data.
Results: The review included a total of 13 papers. Factors influencing feeding intolerance in septicemia patients included patient factors, disease factors, biochemical indicators, feeding determinants, clinical treatment and drug effects.
Conclusions: Factors affecting feeding intolerance in patients with sepsis are multifaceted. We should develop individualized care plans based on relevant risk factors to improve feeding tolerance and shorten hospital stays in patients with sepsis.
Relevance to Clinical Practice: In order to improve the ability of ICU nurses to identify the risk factors of feeding intolerance in patients with sepsis, it is recommended to conduct systematic training on the pathophysiology of sepsis, influencing factors of feeding intolerance and intervention measures and assist nurses to implement appropriate intervention measures.
Source: Ling Y. Nursing in Critical Care, 2025 Apr; 30(3):

The triglyceride glucose index and delirium risk in sepsis patients: A causal inference study
Abstract: Background: Sepsis, a grave systemic infection, presents substantial health challenges. While insulin resistance frequently occurs in sepsis conditions, its relationship with sepsis-associated delirium remains insufficiently explored.
Aim: This study aimed to explore the causal effect between the triglyceride glucose (TyG) index and its risk of delirium in patients with sepsis through the use of causal inference.
Study Design: A cohort of 5461 sepsis patients admitted to the intensive care unit (ICU) was selected from the Medical Information Mart for Intensive Care IV database. Patients were grouped into high TyG (≥9.48) and low TyG (<9.48) categories. Propensity score matching was applied to control for confounders, and the average treatment effect on the treated was calculated.
Results: Of the 5461 patients, 59.6% experienced delirium. The incidence of delirium was higher in the high TyG group (1751 patients; 66.6%) than in the low TyG group (56.3%) (p < .001). The results of the logistic regression analysis indicated that the risk of delirium was significantly higher in the high TyG group (adjusted odds ratio 1.34, 95% confidence interval: 1.16–1.53). Following matching, the delirium risk increased by 6.9% in the high TyG group (T = 3.29), a finding that was confirmed by a Rosenbaum sensitivity analysis.
Conclusions: The TyG index represents a straightforward and efficacious instrument for nursing staff to ascertain the likelihood of delirium in patients with sepsis during the routine monitoring of their condition. The ability to make causal inferences in observational studies provides a novel approach to research.
Relevance to Clinical Practice: The TyG index represents a readily applicable instrument for ICU nurses to identify the risk of delirium in sepsis patients. This enables the possibility of early intervention in high-risk individuals and the optimization of care outcomes.
Source: Li X. Nursing in Critical Care, 2025 Feb; 30(2):

Decreased racial disparities in sepsis mortality after an order set–driven initiative: An analysis of 8151 patients
Abstract: Background: Sepsis is a leading cause of hospital mortality and there is evidence that outcomes vary by patient demographics including race and gender. Our objectives were to determine whether the introduction of a standardized sepsis order set was associated with (1) changes in overall mortality or early antibiotic administration or (2) changes in outcome disparities based on race or gender.
Methods: Patients seen in the emergency department and admitted to the hospital with a diagnosis code of sepsis were identified and divided into a preintervention cohort seen during the 18 months prior to the initiation of a new sepsis order set and an intervention cohort seen during the 18 months after a quality initiative driven by introducing the order set. Associations between time period, race, gender, and mortality were assessed using univariate and multivariate logistic regression models. Other outcomes included early antibiotic administration (<3 h from arrival).
Results: Overall mortality was unchanged during the intervention period (7.8% vs. 7.2%) in both univariate (relative risk [RR] 1.08, 95% confidence interval [CI] 0.93–1.26) and multivariate logistic regression (RR 1.11, 95% CI 0.93–1.28) models. Although male gender tended to have higher mortality, there was no statistically significant association between gender and mortality in either cohort. In the multivariable model, Black race was associated with increased risk of death in the preintervention period (RR 1.41, 95% CI 1.02–1.94), but this association was not present in the intervention period. Patients of color also saw significantly more improvement in early antibiotic administration during the intervention period than White patients.
Conclusions: An order set–driven sepsis initiative was not associated with overall improved mortality but was associated with decreased racial disparities in sepsis mortality and early antibiotics.
Source: Fernandez Olivera Maria L. Academic Emergency Medicine, 2025 Jan; Early View

Diagnostic safety and quality optimization in sepsis study protocol
Abstract: Background: Sepsis ranks among the “Big Three" conditions most prone to harmful diagnostic errors. Despite its high prevalence and severity, health systems lack effective and contextually tailored strategies to optimize diagnostic accuracy for sepsis.
Objectives: The purpose of this study is to understand factors related to high sepsis diagnostic accuracy using principles and tools of safety and implementation science.
Methods: This is a multi-site study involving 20 hospitals across four states in the United States. The primary objectives are to (1) describe hospital-level variability and understand barriers and facilitators to sepsis diagnostic accuracy and (2) apply cross-case and coincidence analysis to determine minimally sufficient and necessary conditions for optimal sepsis diagnosis that minimizes under- and overtreatment. To identify barriers and facilitators of acute sepsis diagnosis, we will conduct electronic surveys and in-depth interviews with key informants from each hospital. We will use data from electronic health records (EHR) and data warehouses to operationalize sepsis diagnostic accuracy.
Results: We have enrolled 20 hospitals and begum data collection. The findings of this study will be used to develop a context-specific toolkit that guides the selection of feasible and important strategies to promote optimal sepsis diagnosis in diverse hospitals settings.
Conclusions: The study uses tools and principles from safety and implementation science to generate first-of-its-kind evidence to improve diagnostic excellence in sepsis.
Source: Shrestha Sachita. Journal of Hospital Medicine, 2025 Apr; Early View

Association between optimum blood glucose level and mortality in critically ill patients with septic shock: A real-world time-series data analysis
Abstract: Background: Sepsis remains a significant health challenge in ICU, with septic shock requiring meticulous glycaemic management due to metabolic dysregulation. Existing research highlights the detrimental effects of both hyperglycaemia and hypoglycaemia on septic patient outcomes, emphasizing the need for effective glycaemic control. Despite extensive studies, optimal glycaemic targets in septic shock patients remain contentious and unclear, necessitating further research.
Aim: Our study aims to identify optimal glycaemic targets for patients in septic shock by analysing time-series blood glucose data.
Study Design: This retrospective observational study utilized the MIMIC-IV database, encompassing ICU patients diagnosed with septic shock from 2008 to 2019. We extracted time-series blood glucose data and applied the Stineman interpolation to achieve a standardized resolution. The primary analysis involved calculating the time-weighted average blood glucose (TWA-BG) and examining its relationship with 28-day mortality using a restricted cubic spline model within a Cox regression framework. Sensitivity analyses with multiple models and subgroup analyses were used to reveal the robustness of the results.
Results: From 34 677 identified septic patients, 11 375 met the inclusion criteria. The optimal TWA-BG range, associated with the lowest 28-day mortality risk, was determined to be 105 to 131 mg/dL. Patients within this range exhibited significantly lower mortality rates compared to those with higher or lower TWA-BG levels. Sensitivity analyses confirmed these findings, indicating robustness across various subgroups and analytical models.
Conclusions: Our findings suggest that maintaining TWA-BG levels between 105 and 131 mg/dL minimizes the risk of 28-day, ICU, and in-hospital mortality in patients with septic shock.
Relevance to Clinical Practice: The results provide evidence-based guidance for ICU nursing interventions, advocating for a precise TWA-BG range to be maintained for septic shock patients, thus potentially setting new benchmarks for glycaemic control in critical care settings.
Source: Muhetaer Gulizeba. Nursing in Critical Care, 2025 Mar; 30(2):

Critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management: a systematic review
Abstract: Background: Sepsis is a critical condition with high global mortality, accounting for 11 million deaths annually. Nurses are central to sepsis management, and their knowledge, confidence, and clinical reasoning significantly impact patient outcomes.
Aim: This systematic review evaluates critical care nurses’ knowledge, confidence, and clinical reasoning in sepsis management and examines factors influencing these competencies.
Methods: A comprehensive search of PubMed, CINAHL, MEDLINE, Scopus, EMBASE, and the Cochrane Library was conducted, covering studies published from 2014 to 2023. Studies were included if they assessed knowledge, confidence, or clinical reasoning in sepsis management among critical care nurses using quantitative, qualitative, or mixed-methods approaches in clinical settings. Only peer-reviewed studies were considered to ensure academic rigor. The risk of bias was assessed using the JBI Checklist for quantitative studies and the CASP tool for qualitative studies, with discrepancies resolved through discussion or a third reviewer. A total of 70 records were screened, with 25 studies (sample sizes ranging from 28 to 835 nurses) meeting the inclusion criteria. Data extraction focused on study design, tools used, and key outcomes related to knowledge, confidence, and clinical reasoning in sepsis management.
Results: Across 25 studies involving over 5,000 nurses globally, knowledge scores were moderate, with significant gaps in early sepsis recognition (e.g., only 52% of nurses could define sepsis). In three studies, confidence improved with sepsis-specific training, showing a 10–25% increase post-intervention. Clinical reasoning was influenced by organizational factors, experience, and the use of technology, with decision-support tools enhancing timely sepsis recognition and reducing mortality by up to 23%.
Conclusion: This review provides a global perspective on sepsis management among critical care nurses, strengthened by diverse study designs. However, limitations include variability in measurement tools, self-reporting bias, small sample sizes, and language-based selection bias. Continuous education, targeted training, and the integration of AI-driven decision tools are essential to improving sepsis outcomes. Addressing gaps in sepsis knowledge and promoting better clinical reasoning will enhance the overall quality of care in critical settings.
Source: Abdalhafith O. BMC Nursing, 2025 ; 24:

Sepsis and Septic Shock Management and Care: A Case Presentation
Abstract: Approximately 1.7 million adults in America develop sepsis annually (Centers for Disease Control and Prevention [CDC], 2024). [...]350,000 Americans were reported to have died of sepsis in hospital settings. An increased chance of capillary leakage results in hypotension followed by an immunosuppression phase of the immune system. Because of the deregulation of the immune system, the host fails to control the infection; this can cause organ failure and death. Understanding the pathophysiology of sepsis helps nurses provide safe care, improve patients' quality of life, and plan therapeutic interventions to improve patients' survival in hospital settings. Discussion Nurses from the medical-surgical unit need to perform a thorough physical assessment when caring for a patient with sepsis to aid in effective management and treatment. Because sepsis may have widespread effects, the nurse must assess the neurological, respiratory, cardiovascular, gastrointestinal, and genitourinary systems.
Source: Cadet Myriam J. Medsurg Nursing, 2024 Sep/Oct; 33(5):
Contact the library for a copy of this article

Association between comorbidities at ICU admission and post-Sepsis physical impairment: A retrospective cohort study
Abstract: Purpose: Few studies have measured the association between pre-existing comorbidities and post-sepsis physical impairment. The study aimed to estimate the risk of physical impairment at hospital discharge among sepsis patients, adjusting for pre-existing physical impairment prior to ICU admission and in-hospital mortality.
Materials and methods: We analyzed all consecutive adult patients admitted to an ICU in a tertiary community hospital, Kameda Medical Center, with sepsis diagnosis from September 2014 to October 2020. Inverse probability attrition weighting using machine learning was employed to estimate the risk of physical impairment at hospital discharge for sepsis patients with and without pre-existing comorbidities at ICU admission. This estimation was adjusted for baseline covariates, pre-ICU physical impairment, and in-hospital mortality.
Results: Of 889 sepsis patients analyzed, 668 [75.1%] had at least one comorbidity and 221 [24.9%] had no comorbidities at ICU admission. Upon adjusting for baseline covariates, pre-ICU physical impairment, and in-hospital mortality, pre-existing comorbidities were not associated with an elevated risk of physical impairment at hospital discharge (RR: 1.02, 95% CI: 0.92, 1.14).
Conclusions: Pre-existing comorbidities prior to ICU admission were not associated with an increased risk of physical impairment at hospital discharge among sepsis patients after adjusting for baseline covariates and in-hospital mortality.
Source: Gildea A. BMJ, 2024 June; 385: q1173
Contact the library for a copy of this article

Improving Early Identification of Sepsis with a Modified Early Warning Score Review Tool
Abstract: Use of a sepsis screening tool led to a significant decrease in mortality and hospital length of stay, as well as earlier identification of sepsis and timelier treatment. Implementation of the Change in Practice During the unfreezing phase of the change (Lewin, 1951), hospital leaders identified sepsis as an underlying problem in recent morbidity and mortality cases on inpatient units. Hospital leaders, including quality management, and chief nursing and chief medical officers, were briefed on the extent of the problem by the project team (clinical nurse specialist [CNS], CNS student). [...]this project served as a temporary measure until information on the new EHR and its embedded screening tools were released.
Source: Lorenz Megan E. Medsurg Nursing, 2024 Nov/Dec; 33(6): 287-292
Contact the library for a copy of this article

Modified frailty index effectively predicts adverse outcomes in sepsis patients in the intensive care unit
Abstract: Background: Frailty and sepsis have a significant impact on patient prognosis. However, research into the relationship between frailty and sepsis in the general adult population remains inadequate. This paper aims to investigate the association between frailty and adverse outcomes in this population.
Method: This retrospective analysis investigated sepsis patients who were initially admitted to the intensive care unit (ICU). The Modified Frailty Index (MFI) was derived by tracking patients’ International Classification of Diseases (ICD) codes during their hospitalization. Patients were classified into two groups based on their MFI scores: a frail group (MFI ≥ 3) and a non-frail group (MFI = 0–2). The key outcomes were mortality rates at 90 and 180 days, with secondary outcomes including the incidence of delirium and pressure injury.
Result: Of the 21,338 patients who were recruited for this study (median age about 68 years, 41.8 % female), 5,507 were classified as frail and 15,831 were classified as non-frail. Frail patients were significantly more likely to have delirium (48.9 % vs. 36.1 %, p < 0.001) and pressure injury (60.5 % vs. 51.4 %, p < 0.001). After controlling for confounding variables, the multifactorial Cox proportional hazard regression analyses revealed a significantly elevated mortality rate at 90 days (adjusted HR: 1.58, 95 % CI: 1.24–2.02, p < 0.001) and 180 days (adjusted HR: 1.47, 95 % CI: 1.18, 1.83, p < 0.001) in the frail group compared to their non-frail counterparts.
Conclusions: Frailty independently predisposes adult sepsis patients in the ICU to adverse outcomes. Future investigations should concentrate on evaluating frailty and developing targeted interventions to improve patient prognosis.
Implication for clinical practice: The MFI provides a simple clinical assessment tool that can be integrated into electronic medical records for immediate calculation. This simplifies the assessment process and plays a key role in predicting patient outcomes.
Source: Li X. Intensive & Critical Care Nursing, 2024 Oct; 84:
Contact the library for a copy of this article

Early sepsis recognition: Is hypothermia the most neglected symptom?
Abstract: Sepsis is a heterogenous syndrome characterized by a life-threatening organ dysfunction due to a dysregulated host response to infection. Despite all efforts in infection prevention and control and advances in modern medicine, sepsis even nowadays remains an important cause of morbidity and mortality. As early aggressive treatment has been proven to improve survival, sepsis can be considered a time-sensitive emergency: early sepsis recognition results in timely intervention and therefore in better patient outcomes.
Source: Papathanakos G. Intensive & Critical Care Nursing, 2024 Oct; 84:
Contact the library for a copy of this article

Sepsis: the latest guidance on identification and management
Abstract: Sepsis is a life-threatening condition caused by the body's response to an infection. This article explores the role of assessment tools in sepsis identification, as well as the Sepsis Six strategy, which is used to treat the condition. One Sepsis Six intervention is the use of antibiotics; when used unnecessarily, these can contribute to antimicrobial resistance, so considering antimicrobial stewardship is an important aspect of sepsis management.
Source: Ahmed F. Nursing Times, 2024 Oct; 120(10): 36-39

Friday, April 25, 2025

Continence Champions: April 2025

Welcome to the latest key papers and publications focussing mainly on continence issues in the nursing profession.

Please click on the links below and enter your OpenAthens username and password to download the full text or contact the library at esth.hirsonlibrary@nhs.net to request the full text.

Experiences of Urinary Incontinence in Women Who Are Post-Menopausal: A Systematic Review
Abstract: To synthesise the qualitative knowledge of urinary incontinence in post-menopausal women to better understand the experiences and impact of urinary incontinence on quality of life. Urinary incontinence can be an unpleasant and stressful experience as many women assume it is a part of the natural ageing process. The experiences of urinary incontinence can impact many women in different ways as some are reluctant to discuss or report the incidences with health professionals. There were 85 studies identified in the review, and 61 were screened for eligibility. Only four were included in the review. Common themes were identified in the studies that included psychological, physical, informational/education, social, practical needs, intimacy and sexual aspects. The psychological and physical aspects were noted in all the included studies. Many of the studies identified the difficulties post-menopausal women endure in managing episodes of urinary incontinence, as many expressed shame and embarrassment when urinary incontinence occurred. The physical aspects included concerns about maintaining good hygiene and managing irritation on their skin from constant washing. The physical aspect also included exhaustion and tiredness from managing urinary incontinence episodes. Many women in the studies expressed a desire to have ongoing education about managing urinary incontinence and the need to discuss the topic more openly. The social impact of urinary incontinence was also captured in the review, as many women expressed the desire to be social with family and friends but felt reluctant due to the fear of urinary incontinence occurring in front of other people. The practical burden of managing urinary incontinence was illustrated in this review, as some women faced many challenges in managing soiled clothing, constant washing of clothing and the skin and the need to visit the bathroom regularly. The intimacy and sexual components of their lives have been disrupted by episodes of urinary incontinence and replaced with excuses for intimate activities. Post-menopausal women living with urinary incontinence experience a range of different burdens across many different areas in trying to manage their condition. Healthcare professionals need to acknowledge that post-menopausal women are reluctant to seek treatment due to shame and feelings that urinary incontinence is a normal part of aging. To ensure quality of life for post-menopausal women living with urinary incontinence, healthcare professionals need to tailor treatment strategies to provide better care.
Source: McKie, Amanda L. International Journal of Urological Nursing, Mar 2025; 19(1):

Adherence and uncertainty during rehabilitation for urinary incontinence: Validation of a scale
Abstract: We sought to create an Italian version of Mishel's Uncertainty in Illness Scale, dedicated to people undergoing conservative rehabilitation for urinary incontinence, for studying uncertainty as a determinant of therapeutic adherence. Urinary incontinence has a high prevalence worldwide, ranging from 25% to 45%. Incontinence is often treatable with conservative interventions but demands a long and intensive commitment from the patient. Results are not immediate, and relapses are possible. These patients can experience uncertainty and difficulty complying with rehabilitation programs, hence the importance of the therapeutic relationship with a healthcare professional. Mishel's theory of uncertainty can be used to measure uncertainty and the effects of such a relationship, but no instrument currently exists for this purpose. Prospective observational study enrolling all male and female adult patients admitted to a nurse-led outpatient pelvic clinic for non-neurogenic urinary incontinence, excluding puerpera. A scale named MUIS-PF (pelvic floor) was created, based on previous versions of Mishel's scale, and administered during the first consultation and at the end of the rehabilitation program. Internal consistency was assessed, and exploratory factor analysis was conducted. A total of 109 patients enrolled (54 M, 55 F) aged 64 ± 5 years, medial initial leakage 245 grams/day, IQR [90; 370]. Seventy-nine percent obtained continence; there were no dropouts during the study. Internal consistency of the MUIS-PF was high (93%), and structure analysis yielded a clear separation of the factors. Patient uncertainty decreased significantly at the end of the program compared to the first consultation (p < 0.001). The MUIS-PF is valid and reliable. Utilizing the correct approach, the nurse could significantly reduce the uncertainty of persons with incontinence by listening, giving clear information and searching for the best solution for their continence issues.
Source: Terzoni, S. International Journal of Urological Nursing, Oct 2024; 18(3):

Short-Term Urinary Incontinence After Radical Prostatectomy Is Still Based on Patients' Age, Nerve-Sparing Approach, and Surgical-Experience, Despite the Higher-Use of Robotic Surgery in 2022 Compared to 2016 Real-World Results of a Large Rehabilitation Center in Germany
Abstract: Background:
Despite constant improvements, incontinence is one of the most relevant and quality-of-life-reducing side effects of radical prostatectomy (RP) and, in addition to patient-specific factors such as age, the experience of the surgeon/center and the surgical technique used play an important role.
Aims:
To present current real-world data on short-term incontinence after RP from one of the largest German rehabilitation centers in 2022 and to compare it to the results from the same institution in 2016.
Methods and Results:
Retrospective, unicentric, univariate analysis of data from 1394 men after RP in 2022 on admission and discharge from the rehabilitation clinic. Incontinence defined as ≥ 1 pad/day was evaluated by quantitative measuring all day incontinence under a defined graduation and compared to the results of 2016. Totally, 1393 men were available for analysis in 2022 compared to 1390 in 2016. Median age for both cohorts was 66 years with minor differences in preoperative PSA levels. Despite different surgical approaches, no significant change in short-term incontinence rates in 2016 and 2022 were noted at discharge (76.9% vs. 77.9%, p = 0.56). A notable increase in patients with ISUP grade Group 2 and a shift towards robotic surgery were observed in 2022 (45.5%–71%). While nerve sparing led to a significant improvement in continence (p < 0.01), lymphadenectomy and T-stage were not related to any significant increase in short-term incontinence rates. Comparing age groups within the cohort, patients > 69 years exhibited the highest risk of short-term incontinence and least likelihood of regaining continence during rehabilitation (p < 0.01). Men treated at a certified prostate cancer center had significantly (p < 0.01) lower short-term incontinence rates.
Conclusion:
Our study shows little improvement in short-term postoperative incontinence rates after RP in Germany in the last 6 years and known risk factors for postoperative incontinence like age, nerve-sparing surgery, and level of experience were reproduced in our analyses. We conclude not only to carefully select but also to counsel patients before being treated for prostate cancer and to strongly advice treatment at certified centers.
Source: Püllen, L. Cancer Reports, Dec 2024; 7(12):

Adults with Intellectual Disabilities and Incontinence: Assessment and Toileting Issues
Abstract: Background:
Urinary and bowel incontinence are more common in adults with intellectual disability (ID), compared to the general population. Little is known about their incontinence experiences and toileting issues. The aim was to learn about their experiences and toileting issues.
Method:
Incontinence and toileting issues assessment was conducted with a community-based sample of 22 adults with ID and urinary incontinence, with or without bowel incontinence. Assessment included the IPSS, ICIQ-UI, and POTI checklists; bladder scans; and urine sample screening for presence of a urinary tract infection.
Results:
The majority (19 adults, 86%) developed urinary incontinence during adulthood. Seven adults (32%) also experienced bowel incontinence, and constipation was the most commonly reported health condition (13 adults, 59%), other than urinary incontinence. Fifty per cent (11 adults) had been treated for a urinary tract infection within the previous 12 months.
Conclusion:
There is an urgent need to develop accessible and reliable incontinence assessment materials with and for adults with ID and their supporters. These assessments should pay close attention to health conditions that can cause incontinence in this group and factors associated with incontinence which are more commonly experienced by adults with ID. These factors are potentially modifiable.
Source: Finlayson, J. Journal of Intellectual Disability Research, Nov 2024; 69(2):

Smart Personalized Continence Care for People with Profound Intellectual and Multiple Disabilities: A Theory and Practice- Based Implementation Guideline for a Digital Innovation
Abstract: Introducing smart technologies can personalize and improve continence care for people with profound intellectual and multiple disabilities within residential care facilities. Currently, continence care is provided according to fixed schedules. This can lead to oversaturated incontinence materials, leading to leakages and an increased chance of incontinence-associated dermatitis or unnecessary changes. Both result in an unneeded burden for individuals with profound intellectual and multiple disabilities and their caregivers. Smart technologies that notify caregivers when incontinence materials need to be changed can improve the quality of life for individuals experiencing incontinence and lead to a more efficient care process for their caregivers. Yet, implementation is challenging. We present a Guideline for Smart Continence Care (SCC) Implementation in Residential Disability Care. The guideline is systematically and iteratively developed by combining implementation literature and daily practice. Lessons learned from applying a draft version at six residential care facilities are integrated. Eight steps are identified and detailed to guide the SCC implementation process: (1) analyze and determine goals for each target group, (2) analyze the innovation, (3) analyze the context, (4) arrange preconditions, (5) formulate implementation strategy, (6) carry out and monitor the implementation, (7) evaluate and adapt implementation strategy, and (8) continued use and upscaling. The guideline is illustrated by examples from actual SCC implementation practice. This guideline is not only useful for those who lead the implementation of SCC in residential care, but may offer guidance for other care technology implementations in various care settings as well.
Source: Van Cooten, V. Journal of Policy and Practice in Intellectual Disabilities, Mar 2025; 22(1):

Urinary incontinence: implications for nursing practice
Abstract: Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes.
Source: Horta Reis da Silva, T. British Journal of Nursing, Dec 2024; 33(22):

Urinary incontinence in older adult women: fighting a rising tide
Abstract: The world's population is rapidly ageing, with conditions such as urinary incontinence, which are especially prevalent among older adults, expected to rise in prevalence as a result. Urinary incontinence is particularly common in older women; however, despite its profound impact on every aspect of women's health and wellbeing, it is often minimised by both individual patients and the wider healthcare system. Francesca Ramadan delves into the prevalence of and psychosocial effects and patient-related factors related to urinary incontinence in older women.
Source: Ramadan, F. British Journal of Community Nursing, Dec 2024; 30(1):

The invisible disability: how to manage urinary incontinence in a neurological patient
Abstract: Urinary incontinence is a significant challenge in patients with neurological conditions, requiring a multifaceted approach to management from a broad range of healthcare professionals. It not only affects quality of life, but also is a leading cause of emergency NHS admissions. The considerable increasing cost of emergency bladder and bowel admissions has highlighted the urgent need for education in uro-neurology across the multidisciplinary team. In response, the Uro-neurology Academy was established in 2023 and hosted an initial webinar in the summer of 2023, which explored a basic approach to managing urinary incontinence in a neurological patient from a medical, nursing and allied health perspective. The webinar also provided an update on the NHS England and NHS improvement neuroscience transformation programme which outlined future commissioning models for neurology, with implications for multiple sclerosis, bladder and urology services. This article will summarise the practical guidance and key points presented by the speakers and chair.
Source: Stross, R. British Journal of Neuroscience Nursing, April 2025; 21(2):

Revolutionising treatment for urinary incontinence and enhancing intimate wellness with EMSELLA
Abstract: Older people are at an increased risk of developing skin damage related to incontinence, including pressure ulceration and incontinence-associated dermatitis (IAD). Factors exacerbating risk in older people include: a higher rate of faecal and urinary incontinence, reduced mobility, long-term conditions and changes to skin barrier function, as a result of the ageing process. Nurses have a key role to play in the assessment of continence, IAD prevention and management. This article explores nursing knowledge in relation to continence care on six inpatient wards for older people, and describes the implementation of improvement strategies, in order to reduce voidable harm.
Source: Attewell, D. Journal of Aesthetic Nursing, Apr 2025; 14(2):

The impact of urinary and bowel incontinence: psychological and physical effects and interventions
Abstract: This clinical review explores the multifaceted impact of urinary and bowel incontinence on the physical and psychological wellbeing of individuals, particularly older adults. The psychological effects, which often include anxiety, depression and social isolation, are addressed through interventions such as cognitive behavioural therapy and peer support groups, which are crucial for alleviating the emotional burden. The review also examines conservative management strategies, such as pelvic floor muscle training, bladder retraining and dietary changes, as well as discussing pharmacological treatments and surgical options for more severe cases. A key emphasis is placed on the importance of a multidisciplinary approach and incorporating the expertise of continence nurses, physiotherapists, occupational therapists and psychologists to comprehensively address patient needs.
Source: Alsararatee, Hasan H. Gastrointestinal Nursing, Nov 2024; 22 (suppl 9):

The impact of incontinence on mental health
Abstract: Bladder and bowel issues, particularly those related to continence, can significantly impact an individual's mental health. These challenges often lead to isolation, anxiety, stress, depression and social anxiety, all of which can profoundly affect a person's quality of life. Healthcare professionals are uniquely positioned to recognise these concerns and incorporate them into assessments for bladder and bowel health. By actively listening, offering empathy and guiding patients toward further support—alongside providing practical treatment and management strategies—clinicians can play a vital role in delivering comprehensive care. This article explores common bladder and bowel issues, the psychological and social challenges they present, and the difficulties both patients and healthcare professionals face in addressing and managing them.
Source: Robson, M. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

To pad or not to pad? The use of containment products in healthcare
Abstract: Containment products, commonly known as incontinence pads, are medically used in healthcare for patients with bladder and bowel symptoms. However, using them without a clinical need or selecting the wrong style or absorbency can lead to avoidable patient harm. In some cases, product formularies are developed with a greater focus on cost than clinical need, restricting access to certain styles and limiting the number of products prescribed per day. While registered healthcare professionals are accountable for assessing and prescribing containment products for patients under their care, they may not always be aware of this responsibility. Providing pads prematurely can cause unintended physical harm, and foster psychological dependence and reluctance to pursue curative treatment.
Source: Evans, T. British Journal of Community Nursing, Apr 2025; 30(suppl 4a):

A review of the role for pelvic floor physiotherapy in postmenopausal women with urinary incontinence
Abstract: Urinary incontinence is a prevalent condition affecting women. Pelvic floor physiotherapy is a specialized field of physiotherapy dedicated to assessing and treating pelvic floor muscles. This therapy has demonstrated benefits in addressing stress urinary incontinence in premenopausal women, with numerous studies supporting its efficacy in this population. However, pelvic floor physiotherapy in the treatment of postmenopausal women is less well-established, and furthermore, the types of urinary incontinence in postmenopausal women are much broader. We provide a comprehensive review of recent literature investigating the effectiveness of pelvic floor physiotherapy therapy for various conditions in postmenopausal women, including urinary incontinence, urgency urinary incontinence, pelvic organ prolapse, genitourinary syndrome of menopause, sexual dysfunction, and urinary incontinence in the context of obesity, frailty, mobility, and dementia. After evaluating the current literature, it is evident that there is insufficient data to definitively endorse or dismiss the utilization of Pelvic floor physiotherapy for treating urinary incontinence in postmenopausal women. Nevertheless, considering the low associated risks of pelvic floor physiotherapy, we advocate for the initiation of comprehensive, large-scale randomized studies aimed at evaluating its effectiveness in addressing urinary incontinence in postmenopausal women with special attention to vulnerable subgroups, including individuals who are obese, frail or experiencing cognitive impairment.
Source: Walgren, Lauren A. Post Reproductive Health, Dec 2024; 30(4): 239-245
Contact the library for a copy of this article

Key in Lock Syndrome: A Case Report of Situational Urge Incontinence
Abstract: Urgency urinary incontinence, a subtype of overactive bladder, is a common complaint in primary care. One type of urgency urinary incontinence is key in lock or latchkey syndrome, which causes patients to release urine uncontrollably because of a situational environmental trigger or triggers. This incontinence often occurs when patients visualize the door of their house or hear running water. This article presents the case of an older adult woman experiencing recurrent genitourinary infections in the setting of worsening key in lock syndrome.
Source: White, Krista A. The Journal of Nurse Practitioners, Sep 2024; 20(8):
Contact the library for a copy of this article

Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow‐up study
Abstract:
Objective:
To investigate how reproductive history was associated with urinary incontinence in midlife.
Design:
A follow‐up study.
Setting:
Denmark.
Population:
A total of 39 977 mothers who participated in the Maternal Follow up (2013–2014) in the Danish National Birth Cohort. National registries provided their reproductive history.
Methods:
How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression.
Main outcome measures:
Self‐reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence.
Results:
At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10–1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35–0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86–0.98). Compared with no tear/first‐degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86–0.97) whereas third/fourth‐degree tears were associated with more (OR 1.14, 95% CI 1.04–1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence.
Conclusions:
Vaginal birth was associated with a higher risk of long‐term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.
Source: Kjeldsen, Anne C. BJOG: An International Journal of Obstetrics and Gynaecology, Oct 2024; 131(11): 1495-1505

A study to untangle the puzzle of urinary incontinence and frailty co‐occurrence among older adults: The roles of depression and activity engagement
Abstract: Aims:
To explore the co‐occurrence of urinary incontinence and frailty by testing the roles of depression and activity engagement guided by the mechanisms of common cause and interaction pathways.
Design:
A secondary analysis of a 1‐year three‐wave panel data collected from older nursing home residents in China.
Methods:
Changes in depression and activity engagement were regressed on urinary incontinence and frailty incidence underpinned by the common cause mechanism of chronic conditions co‐occurrence, and these changes were also taken as mediators linking from frailty to urinary incontinence incidence supported by the interaction pathways' mechanism.
Results:
A total of 348 older adults were included in this study, and 55.7% were women. The co‐occurrence of urinary incontinence and frailty was found in 16.7% of the participants at baseline. Older adults with sole frailty at baseline had almost twice the rate of incident urinary incontinence (32.7%) compared with those without (16.7%) over a 1‐year period. The subsample analyses showed that changes in depression and activity engagement failed to significantly predict the incidence of urinary incontinence and frailty. The mediating roles of these changes linking frailty to urinary incontinence incidence were also not statistically significant.
Conclusion:
The co‐occurrence of urinary incontinence and frailty is prevalent in older nursing home residents. Older adults with frailty at baseline are more likely to develop urinary incontinence a year later. The common cause and interaction pathways mechanisms for the co‐occurrence of urinary incontinence and frailty were not verified with changes in depression and activity engagement.
Source: Wang, C. Journal of Advanced Nursing, Nov 2024; 80(11): 4584-4592

Care Needs of Older Adults with Urinary Incontinence: A Cross-Sectional Study
Abstract: Purpose:
To explore care requirements of older adults with urinary incontinence (UI) and contributing factors.
Method:
This cross-sectional study used the Older Adults Urinary Incontinence Care Needs Inventory to survey participants with UI in three large-scale tertiary hospitals located in Guangzhou City, China, from January 2023 to November 2023. Statistical analyses, including analysis of variance, t tests, correlation analyses, and linear regression models, were conducted to assess factors influencing participants' care needs.
Results:
A total of 530 older adults with UI participated in the survey and mean standardized score for overall care needs was 78.65 (SD = 5.01), with mean scores for each dimension ranging from 70.88 (SD = 10.55) for social participation needs to 82.45 (SD = 7.11) for health education needs. Factors that were found to influence incontinence care needs in older adults included age, literacy level, number of leaks, and type of disease (F = 37.07, adjusted R2 = 0.290, p < 0.001).
Conclusion:
Comprehensive care for older adults with UI, encompassing physiological, psychological, and social aspects, is crucial. It is essential to tailor care to individual needs and characteristics, taking into account factors, such as age and education, to ensure effective care. [Journal of Gerontological Nursing, 50(5), 43–49.]
Source: Xiang, Su Y. Journal of Gerontological Nursing, May 2024; 50(5): 43-49

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer
Abstract: SUI is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (eg sporting activities), or on sneezing or coughing'.2 SUI affects many domains of a person's life, and a large proportion of SUI can be improved or cured, but SUI is often under-reported secondary to incontinence-related stigma.3 Primary care providers are therefore essential in the assessment and management of SUI. Pathophysiology and assessment of SUI is related to weakness of the pelvic floor and urethral sphincter, resulting in leakage of urine with increased intra-abdominal pressure, such as that experienced during exercise, coughing and laughing. Proactive management of constipation, as well and encouraging reduced intake of alcohol and caffeine, are suggested.9 Both body mass index and waist circumference are positively associated with SUI,10 and weight reduction has been shown to lessen SUI symptoms, as well as improve postoperative outcomes in patients undergoing surgical intervention for SUI.11 The literature demonstrates that women with chronic respiratory conditions were twice as likely to develop urinary incontinence compared to the general population, so management of respiratory comorbidities is essential.12 Smoking cessation should also be recommended to relevant patients.9 Pelvic floor muscle training (PFMT) is highly effective in managing SUI and has a strong body of evidence (particularly in mild-moderate severity SUI cohorts).13-15 PFMT aims to strengthen the pelvic floor and sphincter complex and should be recommended as a first-line therapy to all patients with SUI13'14 (Table 4). PVS were performed in increasing numbers following the concerns about the use of mesh for prolapse surgery27 and have comparable clinical outcomes to synthetic slings, without mesh-specific complications (Table 5).28 Systematic reviews quote success rates between 46.9 and 90%.22,29 Burch colposuspension Burch colposuspension is a mesh-free treatment for primary SUI and involves placing sutures between the anterior vaginal wall (either side of the urethra) and Cooper's ligaments, thereby elevating the urethra and providing a support mechanism against rises in intra-abdominal pressure.
Source: McDonald, J. Australian Journal of General Practice, May 2024: 53(5): 283-288

The impact of male urinary incontinence on quality of life and sexual health
Abstract: Men with urinary incontinence problems may have a fear of urinary incontinence during sexual intercourse, which may negatively affect their sexual lives. This study aimed to determine the effect of urinary incontinence on quality of life and erectile dysfunction in men. A total of 203 men with urinary incontinence who presented to a urology outpatient clinic were assessed using a patient information form, the International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐SF), and the International Index of Erectile Function (IIEF). The mean age was 63.48 ± 8.80 years, the mean ICIQ‐SF score was 13.45 ± 3.14 (moderate), and the IIEF erectile dysfunction score was 18.52 ± 6.48 (mild/moderate). Patient age correlated positively with the ICIQ‐SF total score (r = 0.309, p < 0.001) and negatively with the IIEF total score (r = −0.452, p < 0.001). The ICIQ‐SF score was negatively correlated with erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction scores (p < 0.001, p = 0.015, p = 0.037, p = 0.006 and p = 0.001, respectively). More severe urinary incontinence in men was associated with lower quality of life and greater erectile dysfunction. Further studies are needed to raise men's awareness of urinary incontinence.
Source: Gezginci, E. International Journal of Urological Nursing, Nov 2024; 18(3):



VTE Champions: February 2026

Welcome to the latest key papers and publications focussing mainly on venous thromboembolism and VTE champions in the nursing profession and...