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Objective To conduct an integrative review of the scientific literature to explore adult patient-reported reasons for using the emergency department (ED) non-urgently. Method A literature search of CINAHL, Cochrane, Embase, PsycINFO, and MEDLINE was conducted with filters for humans, published January 1, 1990-September 1, 2021, and English language. Methodological quality was assessed using Critical Appraisal Skills Programme Qualitative Checklist for qualitative and National Institutes Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies for quantitative studies. Data was abstracted on study and sample characteristics, and themes/reasons for ED use. Cited reasons were coded using thematic analysis. Results Ninety-three studies met inclusion criteria. Seven themes were found: need to be risk averse with respect to the health issue; knowledge and awareness of alternative sources of care; dissatisfaction with primary care provider; satisfaction with ED; ED accessibility and convenience resulting in low access burden; referred to the ED by others; and relationships between patients and health care providers. Discussion This integrative review examined patient-reported reasons for attending the ED on a non-urgent basis. The results suggest that ED patients are heterogenous and many factors influence their decision-making. Considering the complexity with which patients live, treating them as a single entity may be problematic. Limiting excessive non-urgent visits likely requires a multi-pronged approach. Conclusion For many ED patients, they have a very clear problem which needed to be addressed. Future studies should explore psychosocial factors driving decision-making (e.g., health literacy, health-related personal beliefs, stress and coping ability).

Background: In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with stroke. There are various NIBS methods depending on the stimulation site and stimulation parameters. However, there is no systematic NIBS review of post-stroke cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study is to conduct a systematic review and meta-analysis on effectiveness and safety of NIBS for cognitive impairment after a stroke to obtain new insights. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). Methods: All English articles from MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL were searched from inception up to 31 December 2020. Randomized and prospective controlled trials were included for the analysis. Studies with at least five individuals post-stroke, whereby at least five sessions of NIBS were provided and using standardized neuropsychological measurement of cognition, were included. We assessed the methodological quality of selected studies as described in the Physiotherapy Evidence Database (PEDro) scoring system. Results: A total of 10 studies met eligibility criteria. Six studies used repetitive transcranial magnetic stimulation (rTMS) and four studies used transcranial direct current stimulation (tDCS). The pooled sample size was 221 and 196 individuals who received rTMS and tDCS respectively. Eight studies combined general rehabilitation, cognitive training, or additional therapy with NIBS. In rTMS studies, target symptoms included global cognition (n = 4), attention (n = 3), memory (n = 4), working memory (WM) (n = 3), and executive function (n = 2). Five studies selected the left dorsolateral prefrontal cortex (DPLFC) as the stimulation target. One rTMS study selected the right DLPFC as the inhibitory stimulation target. Four of six studies showed significant improvement. In tDCS studies, target symptoms included global cognition (n = 2), attention (n = 4), memory (n = 2) and WM (n = 2). Three studies selected the frontal area as the stimulation target. All studies showed significant improvement. In the meta-analysis, rTMS showed a significant effect on attention, memory, WM and global cognition classified by neuropsychological tests. On the other hand, tDCS had no significant effect. Conclusions: In post-stroke patients with deficits in cognitive function, including attention, memory, and WM, NIBS shows promising positive effects. However, this effect is limited, suggesting that further studies are needed with more precision in stimulation sites and stimulation parameters. Future studies using advanced neurophysiological and neuroimaging tools to allow for a network-based approach to treat cognitive symptoms post-stroke with NIBS are warranted.

Background While several studies have tracked the care paths of patients in the early phases of stroke recovery, studies examining the transition from inpatient to outpatient rehabilitation are lacking. Examining this transition allows for improved understanding and refinement of the process whereby patients are referred and admitted to programs. The objective of this study was to examine the referral patterns of stroke rehabilitation inpatients to outpatient stroke therapy services, their demographics, and clinical profile. Methods This study examined patients who: (1) were admitted to an inpatient stroke rehabilitation unit between January 1, 2009 and March 1, 2016, (2) had a stroke diagnosis, (3) had an inpatient length of stay of > 1 day, and (4) lived within the geographical boundaries of the South West Local Health Integration Network which allowed them access to both hospital-based and home-based stroke rehabilitation outpatient programs. Patient data was collected from the National Rehabilitation Reporting System, as well as three hospital outpatient administrative databases. These databases were cross-referenced to determine each patient’s pathway. Those referred to an outpatient therapy program, and those who attended the outpatient programs, were compared to those who were not, and did not, respectively. Results 1497 inpatients were included in the analysis. Upon discharge, 1037 (69.3%) of patients had an outpatient clinic, follow-up appointment scheduled; of those, 902 (87.0%) patients attended at least one outpatient clinic visit. 891 (59.5%) were referred to one of the interdisciplinary outpatient stroke rehabilitation programs; of those, an outpatient therapy program was attended by 80.9% of patients ( n  = 721). Of those receiving outpatient therapy services, the number of patients attending the in-hospital versus home-based program were equal, 360 and 361 individuals, respectively. Conclusion This study allows for a better understanding of the transition between inpatient and outpatient stroke care. There is a paucity of this type of information in stroke rehabilitation literature to date. This study acts as a starting point in improving rehabilitation planning across the continuum of care.

As artificial intelligence (AI) technology permeates health care settings, nurse leaders must position themselves to shape its development, implementation, and impact, guiding meaningful change that benefits nurses and care delivery. Nurse leaders possess the capacity to influence decisions, shape practice, and ensure the delivery of ethical, safe, and high-quality care. While AI technology is reshaping many aspects of health care delivery, there is limited knowledge on how nurse leaders perceive and experience this shift. This scoping review aimed to explore the intersection of nursing leadership and AI technology in health care by mapping current evidence, identifying key concepts, and highlighting knowledge gaps within the literature. This scoping review was guided by the Joanna Briggs Institute methodology and reported on using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. A systematic search of 4 electronic databases (CINAHL [EBSCO Information Services], Ovid MEDLINE [Wolters Kluwer], PsycINFO [American Psychological Association], and Scopus [Elsevier]) was conducted for English-language, peer-reviewed literature published between 2014 and 2025. Gray literature was also reviewed. Articles were included if they met the inclusion criteria by exploring the population of nurse leaders and the concept of AI technology within the context of health care settings and were published in English from May 2014 forward. A total of 26 articles were included in the analysis. Qualitative content analysis and numerical summary supported the inductive identification and synthesis of data categories. Of the 26 articles included, 8 were empirical (qualitative, quantitative, or mixed methods), and 18 were conceptual or theoretical articles. Although 1 article was Canadian, there were no empirical studies conducted by Canadian researchers. The qualitative content analysis of the primary search findings revealed 6 overarching data categories: (1) leading digital transformation and technology integration, (2) AI technology and the nursing role: reshaping practice, (3) ethical considerations of AI technology for nurse leaders, (4) AI technology as a facilitator of innovative leadership, (5) education and training on AI technology in nursing practice, and (6) influence of AI technology on the work environment. This review confirms that nurse leaders play an essential role in shaping the future of health care in the context of AI technology. Although this review highlights a growing recognition of nursing leadership as a crucial driver of AI technology integration in health care, there is a lack of research to guide practice, policy, and leadership development through education, despite emerging interest and a recent increase in empirical work. The findings accentuate the need for increased investment in nurse-led research and leadership development to ensure that AI systems are designed, implemented, and evaluated in a manner that upholds ethical care, equity, and professional nursing values. As health care systems increasingly adopt AI technology, nurse leaders must be equipped with the knowledge, tools, and support required to lead transformative change and act as AI technology directors.

In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with traumatic brain injury (TBI). However, there is no systematic NIBS review of TBI cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study was to conduct a systematic review examining the effectiveness and safety of NIBS for cognitive impairment after a TBI. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). All English articles from the following databases were searched from inception up to 31 December 2020: Pubmed/MEDLINE, Scopus, CINAHL, Embase, PsycINFO and CENTRAL. Randomized and prospective controlled trials, including cross-over studies, were included for analysis. Studies with at least five individuals with TBI, whereby at least five sessions of NIBS were provided and used standardized neuropsychological measurement of cognition, were included. A total of five studies met eligibility criteria. Two studies used repetitive transcranial magnetic stimulation (rTMS) and three studies used transcranial direct current stimulation (tDCS). The pooled sample size was 44 individuals for rTMS and 91 for tDCS. Three of five studies combined cognitive training or additional therapy (computer assisted) with NIBS. Regarding rTMS, target symptoms included attention (n = 2), memory (n = 1), and executive function (n = 2); only one study showing significant improvement compared than control group with respect to attention. In tDCS studies, target symptoms included cognition (n = 2), attention (n = 3), memory (n = 3), working memory (WM) (n = 3), and executive function (n = 1); two of three studies showed significant improvement compared to the control group with respect to attention and memory. The evidence for NIBS effectiveness in rehabilitation of cognitive function in TBI is still in its infancy, more studies are needed. In all studies, dorsolateral prefrontal cortex (DLPFC) was selected as the stimulation site, along with the stimulation pattern promoting the activation of the left DLPFC. In some studies, there was a significant improvement compared to the control group, but neither rTMS nor tDCS had sufficient evidence of effectiveness. To the establishment of evidence we need the evaluation of brain activity at the stimulation site and related areas using neuroimaging on how NIBS acts on the neural network.

Objective. To evaluate the relationship between opioid use and specific personality traits among individuals with chronic pain stratified by morphine equivalent doses (MEQ). Design. Observational cohort study. Setting. Chronic pain outpatient clinic in Canada (2017–2019). Patients. Participants were included if they (1) were at least 18 years old, (2) had been diagnosed with chronic pain (pain >3 months), and (3) were able to read and write in English. Interventions. None. Main Outcome Measures. Completion of the following outcome measures: Acceptance and Action Questionnaire, Anxiety Sensitivity Index, Brief-Coping with Problems Experience 28-item, Brief Pain Inventory Short Form, CAGE-AID substance misuse screening tool, EuroQol-5D, Generalized Anxiety Disorder 7-item, and Patient Health Questionnaire 9-item. One-way analysis of variance compared outcomes between MEQ groups. Results. 215 individuals (64.2% female) were included with a mean age of 52.7 ± 11.7 years and time since pain onset of 14.1 ± 10.2 years (range 1–45). There were no significant differences between MEQ groups with respect to sociodemographic and clinical health variables except for gender and employment status and time since pain onset. After controlling for gender, time since pain onset, and average pain severity, patients with MEQ 90+ mg had significantly higher scores for experiential avoidance and anxiety sensitivity in addition to increased pain interference, greater depressive and anxiety symptoms, more dysfunctional coping, and poorer QoL than those with MEQ 1–89 mg or MEQ 0 mg. Conclusions. Compared to individuals using no or lower-dose opioids to treat chronic pain, those using high-dose opioids had higher scores on two maladaptive personality traits (i.e., anxiety sensitivity and experiential avoidance) which was associated with poorer mood, greater pain interference, lower quality of life, and dysfunctional coping. These maladaptive personality traits may help to explain how individuals with chronic pain utilize higher doses of opioid analgesics.

According to Brathwaite, therefore, a history of the Caribbean can be found in oral literature that includes folklore. [...]something that is invariably present does not need preservation, but that which is soon forgotten deserves identification, intervention and preservation. Opening up the archive for folklore also includes, we believe, opening the literary text to oral forms, such as storytelling, conversations and interviews. Since the 1970s, Ramsawack began travelling through the country, interviewing villagers in rural communities, visiting wakes and attending nightly dances in order to collect folklore. Would you like to tell us where you were born and how you spent your childhood? AL RAMSAWACK (AR): Well, I was born in-you could consider it as a village at that time- during World War II, in 1932, in Sangre Grande, bordering on a cocoa estate in Sangre Chiquito.

(1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non-specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process. Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used. Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature. Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate. Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings.

Commentary on: Chang YS, Hu SH, Kuo SW, Chang KM, Kuo CL, Nguyen TV, Chuang YH. Effects of board game play on nursing students’ medication knowledge: a randomized controlled trial. Nurse Educ Pract. 2022 Aug;63:103412. doi: 10.1016/j.nepr.2022.103412.

Research on nonurgent emergency department use is predominately focused on patients’ perceptions. There are few published qualitative analyses of health care providers’ viewpoints on the subject. The aims of this study were to: (a) explore the perceptions of both nurses and physicians regarding the role that the emergency department plays within the larger health care system; (b) contextualize how nonurgent visits in the emergency department were described by nurse and physician participants; and finally, (c) describe perceived reasons for nonurgent use of the emergency department by patients. Using a qualitative descriptive approach, 16 emergency nurses and 12 emergency department physicians employed at a single institution (2 emergency departments) in Ontario, Canada, engaged in semi-structured interviews. Conventional content analysis was used to analyze qualitative data. Data were coded, iteratively reviewed, compared, and then placed into categories based on phrases, patterns, themes, and notable features. The overall role of the emergency department was perceived to be multifaceted in that it provided a place for quality care and acted as a safety net. Patients attending the emergency department non-urgently were characterized and differentiated by staff according to their underlying medical versus psychosocial/mental health condition. Health care providers reported that they believed nonurgent patients were influenced to attend the emergency department because of personal health beliefs, stress, and coping ability, health literacy, and/or satisfaction with emergency department functionality. Nonurgent use of the emergency department for minor medical conditions was generally discouraged by nurses and physicians; however, patients with psychosocial crises or mental health conditions that were nonurgent in nature were deemed appropriate and justified due to perceived gaps in health and social care in the community.