As health technology has advanced, roles such as nurse informaticist, nurse informatician, and nurse informatics specialist have emerged to support its integration into clinical care. Despite growing demand for these nurses, there is limited understanding of how nurses are engaging in informatics across the Canadian health care system. Using a qualitative descriptive design and thematic analysis, this study aimed to explore the various nursing informatics roles that Canadian nurses assume in clinical practice settings, their experiences, and their contributions. Twenty-two nurses employed in nursing informatics roles within clinical settings in a Western Canadian province participated in semistructured interviews between September 2024 and February 2025. Findings revealed 3 themes: (1) qualifying for and advancing in nursing informatics roles, (2) rewarding aspects of nursing informatics roles, and (3) challenges associated with nursing informatics roles. Despite limited formal informatics education, this study shows that nurses are keen to assume nurse informatics roles given their clinical knowledge, but would benefit from more role clarity and support to advance their practice. Supporting nurses in developing their informatics practice roles not only advances the profession but also ensures the delivery of safe patient care in technologically enabled environments.

Loneliness is highly prevalent among Chinese older adults. Mindfulness-based interventions for older adults (MBOA) have demonstrated potential in alleviating loneliness. However, few studies have employed active controls with long-term follow-up.

This study aimed to assess the efficacy of MBOA in reducing loneliness compared with social contact control (SCC).

This parallel, randomised controlled trial (RCT) assigned community-dwelling lonely Chinese older adults (≥60 years) in Hong Kong to MBOA or SCC. Both interventions comprised 8 weekly 1.5-hour group-based face-to-face sessions. Assessments were conducted at baseline, postintervention and at 6-month and 12-month postrandomisation. The primary outcome was loneliness score at 12 months, analysed using analysis of covariance under the intention-to-treat approach. Secondary outcomes included depression, anxiety, health-related quality of life and healthcare utilisation. Changes in psychological measures were analysed using linear mixed models.

A total of 245 eligible participants were randomised to MBOA (n=123) or SCC (n=122). No significant between-group difference in primary outcome was found (mean difference=-0.14, p=0.52, effect size=-0.21), although both groups showed improvement in loneliness (within-group effect size: MBOA=-0.58, SCC=-0.31). MBOA participants reported reduced depressive symptoms and a decreasing trend in anxiety at 6 months compared with SCC.

This is the first RCT examining efficacy of MBOA in alleviating loneliness among Chinese older adults using an active control with long-term assessments. MBOA is not superior to SCC in reducing loneliness, although it may reduce psychological symptoms.

Clinicians could consider prioritising mindfulness-based interventions for lonely older adults when depressive or anxiety symptoms are prominent.

Cochrane Rehabilitation and the World Health Organization (WHO) Rehabilitation Programme have collaborated to produce four Cochrane overviews of systematic reviews that synthesize current available evidence from health policy and systems research (HPSR) in rehabilitation. Each overview focuses on one of the four pillars of HPSR as identified by the Cochrane Effective Practice and Organisation of Care (EPOC) taxonomy: delivery arrangements, financial arrangements, governance arrangements, and implementation strategies. This overview examined implementation strategies, defined by EPOC as interventions designed to bring about changes in healthcare organizations, the behavior of healthcare professionals, or the use of health services by healthcare recipients.

This overview aimed to synthesize current evidence on implementation strategies in rehabilitation from a health policy and systems research (HPSR) perspective. Our series of four overviews have the following overarching objectives. • To offer a broad synthesis of the existing evidence on health policy and systems interventions' effects. • To direct end-users, including policymakers, towards systematic reviews that may address their health policy questions. • To identify current research gaps and set priorities for future primary HPSR. • To pinpoint the needs and priorities for new evidence syntheses where no reliable, up-to-date systematic reviews currently exist.

We searched the Epistemonikos database, the Health Systems Evidence database, and EPOC Group systematic reviews to identify reviews published between 1 January 2015 and 17 November 2024. We applied no language limitations. We included Cochrane and non-Cochrane systematic reviews of randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) that evaluated the effectiveness of health policy and systems interventions for rehabilitation in health systems, specifically related to implementation strategies as defined in the EPOC taxonomy. All four overview teams collaborated to screen reviews and extract data. We used AMSTAR 2 to critically appraise the quality of the reviews. Results were analyzed descriptively and are based on reviews with ratings of high-to-moderate confidence, with low-confidence reviews reported separately.

We identified 7882 systematic reviews, of which 15 met our inclusion criteria. Three reviews overlapped substantially with other reviews, and eight received low- or critically low-confidence ratings. Ultimately, four moderate- to high-confidence reviews contributed to the synthesis; two were Cochrane systematic reviews. Most primary studies were from high-income countries; none were from low-income countries. Most strategies targeting healthcare professionals (e.g. guideline dissemination, interactive workshops, opinion leaders, audit and feedback) or healthcare recipients (e.g. structured monitoring, telehealth support, counseling, motivational interviewing) included more than one component. Strategies targeting healthcare recipients' use of health services in cardiac rehabilitation may show small benefits in terms of participation (enrollment, adherence, completion), but effects on other outcomes are uncertain. The effects of strategies targeting older healthcare recipients via telehealth are uncertain. Strategies targeting healthcare professionals may have little to no effect on professional or patient and carer outcomes in stroke rehabilitation. For musculoskeletal conditions, there were no evidence-certainty ratings, so intervention effects are unclear. We found no reviews of strategies targeting health service organizations or specific types of rehabilitation practice. The evidence certainty was generally low; evidence of adverse events was missing or uncertain; and reporting on organizational, implementation, economic, and equity outcomes was scarce.

Current evidence on implementation strategies in rehabilitation is limited, mostly of low certainty, and derived from high-income countries. Multicomponent, patient-targeted strategies may modestly improve cardiac rehabilitation participation, but effects in other areas remain uncertain. Further high-quality research using well-defined frameworks is needed, especially in low- and middle-income countries, to identify effective strategies and evaluate organizational, implementation, and equity outcomes. Future Cochrane overviews of reviews in HPSR should consider including a broader range of study designs, such as observational, qualitative, and mixed-methods evidence, to better capture evidence on implementation strategies in rehabilitation.

This Cochrane review was funded by the Italian Ministry of Health (Ricerca Corrente). The funder played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

The protocol was first published in the European Journal of Physical and Rehabilitation Medicine online on 27 January 2025. The manuscript was received on 11 November 2024 and was accepted on 26 November 2024.

DOI 10.23736/S1973-9087.24.08833-6.

Melatonin is a neurohormone that primarily regulates sleep patterns and circadian rhythms by interacting with melatonin receptors MT1 and MT2. Disruptions in circadian rhythms may contribute to mood disorders; for example, individuals with major depressive disorder often have significantly lower melatonin levels compared to healthy individuals. In this report, we present a patient who experienced a depressed mood and nighttime sleep disturbances and was treated with melatonin. In patients with depression, factors such as insomnia or poor psychosocial conditions can increase the risk of suicidal thoughts.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a modern class of medications initially approved for type 2 diabetes mellitus (T2DM) but now also widely used for obesity. Although these drugs offer significant benefits for glycemic control, weight loss, and cardiorenal health, studies consistently show a pronounced sex difference in their use. However, there is a scarcity of studies addressing the factors responsible for these sex differences in GLP-1RA utilization in the United States.

To examine time- and sex-specific factors associated with GLP-1RA utilization among US adults before and after the landmark approval of semaglutide for chronic weight management.

We analyzed data from the 2019-2022 Medical Expenditure Panel Survey, a nationally representative survey of US adults (aged ≥18 years). GLP-1RA use was identified via prescription drug files. Descriptive statistics and chi-square tests compared characteristics of GLP-1RA users by time and sex. Multivariable logistic regression models estimated associations between individual characteristics and GLP-1RA use, both overall and among time- and sex-stratified cohorts. Subgroup analysis was conducted in adults with T2DM.

The weighted prevalence of GLP-1RA use increased significantly from 6,158,326 (0.47%) in 2019-2020 to 10,410,021 (0.79%) in 2021-2022 (P < 0.0001). The rate of use was 0.48% and 0.46% in women and men, respectively, in 2019-2020 (P = 0.837) and increased to 0.82% in women and 0.76% in men in 2020-2022 (P = 0.964). T2DM was the strongest predictor of GLP-1RA use (odds ratio [OR] = 56.1 [2019-2020] and OR = 32.7 [2021-2022]), but the proportion of users with T2DM slightly decreased over time (92.8% in 2019-2020 to 90.2% in 2021-2022 [P = 0.239]). This decrease was especially pronounced in women during the 2021-2022 period, with men exhibiting a notably higher proportion of T2DM patients (94.4%) compared with women (86.2%) (P = 0.002). The proportion of users with obesity increased significantly (5.3% to 9.2%, P = 0.024), nearly doubling among female users (4.9% to 10.6%). The association with obesity strengthened over time (OR = 1.85 to 5.59), especially among women (OR: 6.43 vs 2.04 in men). Among women, depression was linked to greater use. In patients with T2DM, the use of insulin and oral antidiabetic medications was associated with higher GLP-1RA utilization.

This study confirms the increasing utilization of GLP-1RAs in the United States, particularly among women. Although type 2 diabetes remains the primary predictor of GLP-1RA use, obesity has emerged as a key associated factor, especially among women. The stronger associations observed in women with obesity and depression highlight the role of clinical and psychosocial factors, which underscores the need for sex-sensitive approaches in obesity and diabetes management.

Several factors, as genetics, diet, and gut microbiota, are associated with the development of type 1 diabetes (T1D). Akkermansia muciniphila, an abundant bacterium in human microbiota, has anti-inflammatory properties and can correct metabolic disorders. The effects of the administration of inulin, a prebiotic which increases Akkermansia muciniphila gut levels, are unknown in subjects with T1D.

49 subjects with T1D, age 46 [37-53] years, 30 females (61%), duration of disease 20 [11-27] years, HbA1c 64 [59-72] mmol/mol, were randomized in group A (inulin 3 g twice daily for 3 months + insulin, n=24) and in group B (insulin alone, n=25). Body weight, glycated hemoglobin (HbA1c), daily insulin units, continuous glucose monitoring (CGM) metrics, and Bristol stool scale (BSS) score were collected at enrollment and after 3 months.

After 3 months, subjects in group A showed a significant decrease in body weight [group A -2 (-3; 0) kg and group B 0 (-1; 1) kg, p=0.03] and daily insulin units [group A -1.5 UI (-3.1; 0) vs. group B 0.6 (0; 1.7), p=0.01]. After 3 months, changes in HbA1c and CGM were similar between groups. In both groups, there was no change in BSS score (p=0.39) nor in Akkermansia muciniphila gut levels.

Inulin was associated with a slight body weight decrease and insulin need reduction, but not with an increase in Akkermansia muciniphila levels. More studies are required to explore this issue.

The aim of this study was to examine the effect of the lipid parameter non-high-density lipoprotein cholesterol (non-HDL-C) on the occurrence of major cardiovascular event (MACE) in patients after first-time ST-elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (pPCI) and implantation of drug-eluting stent (DES). Seventy-eight patients (54 male and 24 female, median age 58.62±11.14 years) with the diagnosis of first-time STEMI who were treated with pPCI with DES implantation in the period from January 2018 until January 2020 were included in the study. Patients were followed for two years of the intervention for the occurrence of MACE and its association with baseline non-HDL-C, as well as total cholesterol, LDL-C, HDL-C and triglycerides. During 2-year follow-up, 20 (25.6%) patients had MACE. There was no significant difference in baseline parameters such as age, hypertension, presence of diabetes mellitus, and post-interventional use of statin therapy between patients with and without MACE. The levels of baseline lipid parameters were significantly higher in patients who experienced MACE, as follows: total cholesterol (p=0.009), LDL-C (p=0.028) and non-HDL-C (p=0.007). Pearson χ²-test showed that both non-HDL-C and LDL-C were significant predictors of MACE occurrence during 2-year follow-up, but non-HDL-C had a more significant correlation than LDL-C (p=0.007 vs. p=0.028). Our initial report shows that baseline non-HDL-C was a more significant predictor of the occurrence of MACE after first-time STEMI than LDL-C, which reflects the importance of the residual risk of MACE occurrence while enabling identification and close monitoring of high-risk patients.

The SYNTAX Score II (SS II) is a clinical tool that allows individualized prediction of mortality in patients with multivessel coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The aim was to examine whether lipid profile, uric acid and diabetes had a positive correlation with higher values of SS II. The study included 72 CAD patients. An online calculator was used to calculate SS II. Statistical tests (Mann Whitney U test and Shapiro-Wilk test) were used to assess correlations and differences in lipid profile, uric acid and diabetes status according to SS II values. There was a significant positive correlation between the proportion of patients with HDL levels above the reference values and SS II PCI. Patients with lower LDL values had significantly increased values of SS II CABG, but not SS II PCI. There was no significant correlation of total cholesterol and triglycerides with SS II PCI or SS II CABG. Patients with hyperuricemia had significantly higher SS II PCI but not SS II CABG. People with diabetes had significantly increased SS II PCI but not SS II CABG compared to non-diabetic patients. In conclusion, SS II is associated with some of the classic risk factors for atherosclerosis (uric acid, diabetes), whereas in our patient cohort there was a surprising correlation of SS II with high HDL levels and low LDL levels.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and a major contributor to morbidity and mortality. Although diabetes is a well-established risk factor for AF, the role of prediabetes-a modifiable metabolic condition-remains uncertain. Clarifying this relationship may help identify individuals at risk and guide early preventive strategies.

We performed a systematic review and meta-analysis of cohort studies identified through PubMed, Embase, and Web of Science databases up to November 21, 2025. Studies reporting adjusted hazard ratios for incident AF in adults with prediabetes compared with normoglycemic controls were included. Pooled estimates were calculated using random-effects models, and heterogeneity was assessed using the I² statistic. Prespecified subgroup analyses explored variations by definition of prediabetes, geographic region, follow-up duration, age, and sex. Publication bias was evaluated using Egger's and Begg's tests.

Twelve independent datasets from 11 cohort studies, including over 15 million participants and 277,164 incident AF cases, were analyzed. Prediabetes was associated with a modest but statistically significant increased risk of AF (pooled hazard ratio: 1.20; 95% confidence interval: 1.08-1.35), with substantial heterogeneity. Sensitivity analyses showed consistent results. Subgroup analyses indicated a numerically stronger association in Asian populations than in Europe and North America; this finding should be interpreted cautiously given heterogeneity and limited studies per subgroup. Other subgroup analyses were broadly consistent, and overall evidence of publication bias was limited.

Prediabetes is associated with increased AF risk across diverse populations. Given the observational design, these findings indicate association rather than causation. Early identification and management of prediabetes may provide an opportunity for AF prevention.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251233423.

Metabolic syndrome (MetS) represents the concurrent manifestation of multiple cardiometabolic risk factors, including visceral obesity, hyperglycemia, hypertension, hypertriglyceridemia, and low HDL-cholesterol, cumulatively predisposing to accelerated atherosclerosis and type 2 diabetes mellitus (T2DM). Hypothyroidism frequently coexists with T2DM and further exacerbates insulin resistance (IR), lipid abnormalities, and systemic inflammation, increasing the prevalence and severity of MetS in this population. Oral semaglutide is a glucagon-like peptide-1 receptor agonist approved for T2DM management; however, its impact on MetS parameters in patients with coexisting hypothyroidism remains insufficiently explored. This study aimed to evaluate the effects of oral semaglutide on key MetS components in this high-risk subgroup. We conducted a single-center retrospective cohort study involving 51 adult patients with confirmed hypothyroidism and T2DM, on oral semaglutide (final dose = 14 mg daily) and monitored for 6 months. Clinical and biochemical parameters were analyzed, including glycated hemoglobin (HbA1c), body mass index (BMI), blood pressure, and lipid profile. At 6 months, mean HbA1c decreased by 6.7% (P < 0.001), BMI was reduced by 4.04% (P < 0.001), triglycerides decreased by 6.7% (P < 0.001), and HDL-C increased by 9% (P = 0.002). In this observational study, treatment with oral semaglutide was associated with improvements in several components of MetS among patients with coexisting hypothyroidism and T2DM. While these findings suggest a potential therapeutic role for semaglutide in complex metabolic profiles, they should be interpreted with caution due to the study's design limitations. Further prospective studies are warranted to confirm these observations and to explore the interaction between semaglutide and levothyroxine.