DESIGN: This study employed a hybrid systematic narrative review.
METHODS: Eligible studies were reviewed following the hybrid systematic narrative review guidelines. Peer-reviewed articles published in English between January 2015 and June 2024 were included. These articles were retrieved from CINAHL, PubMed, Web of Science and Scopus databases. Quantitative, qualitative and mixed-methods studies were also included. All the included studies underwent data synthesis, analysis and quality assessment.
RESULTS: Sixteen studies were included: twelve studies examined trauma-informed care (TIC) in nursing practice and four focused on nursing education. Four primary frameworks were identified, with the Substance Abuse and Mental Health Services Administration (SAMHSA) framework being the most referenced. Most nurses held positive attitudes toward TIC, although their knowledge levels were generally moderate. Educational interventions significantly improved the TIC skills of nursing students. Although TIC offers substantial benefits, its implementation remains challenging. These challenges include time constraints, limited resources and concerns regarding potential re-traumatization.
CONCLUSION: Nurses generally showed positive attitudes toward TIC; however, significant knowledge gaps and implementation barriers remained. Addressing these challenges by incorporating TIC into nursing education could enhance nursing competencies. Standardized TIC education is essential for improving clinical practice and optimizing patient outcomes. Future research should evaluate the effectiveness of TIC in diverse healthcare settings and develop strategies to support nurses in high-pressure environments. Expanding and deepening TIC curricula holds significant potential for enhancing care quality and fostering a trauma-informed healthcare system.
METHODS: In this phase Ib, randomized, double-blind, placebo-controlled study, patients received AMG 557 210 mg (n = 10) or placebo (n = 10) weekly for 3 weeks, then every other week for 10 additional doses. The corticosteroid dosage was tapered to ≤7.5 mg/day by day 85, and immunosuppressants were discontinued by day 29. Primary end points on day 169 were safety, immunogenicity, the Lupus Arthritis Response Index (LARI; defined by a reduction in the tender and swollen joint counts), ≥1-letter improvement in the musculoskeletal domain of the British Isles Lupus Assessment Group (BILAG) index, and medication discontinuation. The secondary/exploratory end points were changes in the tender and swollen joint counts, BILAG index scores (musculoskeletal, global), and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).
RESULTS: The incidence of adverse events, most of which were mild, was similar between groups. LARI responses occurred in 3 of 10 patients receiving AMG 557 and 1 of 10 patients receiving placebo (P = 0.58). More patients in the AMG 557 group achieved a ≥4-point improvement in the SLEDAI score on day 169 (7 of 10 patients) compared with the placebo group (2 of 10 patients) (P = 0.07). Patients treated with AMG 557 (versus placebo) had greater improvements from baseline in the global BILAG index scores (-36.3% versus -24.7%) and the SLEDAI score (-47.8% versus -10.7%) and in tender (-22.8% versus -13.5%) and swollen (-62.1% versus -7.8%) joint counts on day 169.
CONCLUSION: AMG 557 showed safety and potential efficacy, supporting further evaluation of the clinical efficacy of ICOSL blockade in patients with SLE.