The overuse of antibiotics for respiratory tract infections in primary healthcare in rural China is a particular challenge and is highly related to antibiotic resistance. Our research team designed a multi-component intervention focusing predominantly on health practitioners to reduce antibiotic prescriptions in rural communities of China. The effects of the intervention were evaluated through a randomised controlled trial. This study was conducted alongside the trial to develop a contextualised understanding of the implementation of the intervention and related influencing factors.

Qualitative process study nested in a randomised controlled trial, including observation and semi-structured interviews.

Primary healthcare in rural China.

27 health practitioners from township health centres assigned to the intervention arm.

A complex intervention to reduce antibiotic prescriptions in rural communities of China, which includes the following components: training for health practitioners, a public letter of commitment, patient leaflets, a decision support system and a peer support group.

Not applicable.

Data were analysed using thematic analysis.

The overall multi-component intervention was described as useful in reducing antibiotic prescribing, with a particularly high acceptance and use of patient leaflets and the public letter of commitment among health practitioners. There were mixed views on the decision support system and peer support group. Practitioners reported usability-related barriers to using the decision support system during consultations. Practitioners did not understand the role or benefits of the peer support group and found it difficult to initiate group discussions, due to the lack of any existing clinical team at the primary care level.

The multi-component intervention appears to be acceptable and useful in primary healthcare in rural China. Successful implementation requires a comprehensive understanding of the contextual characteristics of the setting. Interventions to reduce antibiotic prescribing in China in the future could consider wider stakeholders including patients, retail pharmacies and health authorities.

ISRCTN30652037 (01/12/2020).

Acute kidney injury (AKI) is a significant challenge in hospital settings, and accurately differentiating between intrinsic and prerenal AKI is crucial for effective management. The fractional excretion of urea (FEUN) has been proposed as a potential biomarker for this purpose, offering an alternative to traditional markers such as fractional excretion of sodium. This study aimed to assess the diagnostic accuracy of FEUN for differentiating intrinsic from prerenal AKI in hospitalised patients.

We conducted a systematic review and bivariate random effects meta-analysis of diagnostic accuracy studies. The study followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

PubMed, Embase and Cochrane databases were searched from inception to 1 November 2023.

We included observational studies that focused on patient with AKI and reported FEUN data sufficient to reconstruct a complete 2x2 contingency table (true positives, true negatives, false positives and false negatives) for evaluating its diagnostic accuracy.

Two reviewers extracted data, assessed risk of bias with Quality Assessment of Diagnostic Accuracy Studies-2 and graded certainty of evidence using the GRADE approach. Pooled sensitivity, specificity, positive and negative likelihood ratios, and the area under the summary receiver operating characteristic curve (SROC) were calculated; heterogeneity was measured with I². A prespecified subgroup restricted to patients receiving diuretics served as a sensitivity analysis.

12 studies involving 1240 patients were included, with an overall occurrence rate of intrinsic AKI of 38.8%. FEUN had a pooled sensitivity of 0.74 (95% CI 0.60 to 0.84) and specificity of 0.78 (95% CI 0.66 to 0.87), with positive predictive value and negative predictive value of 0.76 (95% CI 0.68 to 0.83) and 0.74 (95% CI 0.66 to 0.81), respectively. The SROC curve showed a pooled diagnostic accuracy of 0.83. Heterogeneity was substantial (I²>90%) for sensitivity and specificity. In a diuretic-only subgroup (six studies) specificity rose to0.87 and heterogeneity declined (I²=56%). Overall certainty of evidence was low owing to inconsistency.

FEUN is a biomarker with moderate diagnostic accuracy for differentiating between intrinsic and prerenal AKI in hospitalised patients. Its application could enhance AKI management; however, the high heterogeneity observed in our study highlights the need for further research to evaluate its utility across diverse patient populations and clinical settings.

CRD42024496083.

Breast and cervical cancers are among the most commonly diagnosed cancers in Ghana and impose substantial financial burden on households. Although diagnosis and treatment for these cancers are included in the National Health Insurance Scheme (NHIS) benefits package, stakeholders report limitations in the scope and implementation of coverage, leading to out-of-pocket payments and potential delays in care.

To characterise NHIS coverage for breast and cervical cancer care and to explore challenges affecting implementation from the perspectives of key stakeholders.

Qualitative exploratory study using semi-structured key informant interviews and a focused desk review of national guidelines and NHIS policy documents.

12 key informants were purposively sampled based on roles in cancer policy, financing or service delivery.

Although the NHIS officially lists coverage for consultation, diagnosis, radiotherapy and selected chemotherapy medications, participants reported that these benefits are not fully realised in practice. Respondents described persistent out-of-pocket payments for breast and cervical cancer services due to incomplete or delayed reimbursement of screening and diagnostic costs, limited inclusion of costly imaging procedures and the exclusion of some essential and innovative therapies, including immunotherapy. Delayed NHIS reimbursement was cited as a recurrent problem that constrains facility cash flow and contributes to co-payments at the point of care. Stakeholders also highlighted misalignment between NHIS reimbursement tariffs and actual service costs, which discourages some facilities from providing certain listed services and thereby limits patient access.

NHIS coverage for breast and cervical cancer care still contains significant gaps, particularly in preventive services and access to advanced therapies. Policy actions should focus on strengthening preventive coverage (including screening and human papillomavirus vaccination), aligning tariffs with service costs, ensuring timely reimbursements and updating the medicines list through transparent, evidence-informed review processes.

Age-standardised incidence rates of myocarditis have been widely reported; this metric primarily provides a cross-sectional view of risk based on a fixed standard population and does not capture the effects of population ageing. Lifetime risk represents the probability of developing myocarditis over an individual’s lifespan and incorporates both demographic ageing and competing mortality, thereby offering a complementary perspective that reflects the burden experienced in real-world populations. This study aimed to estimate the global lifetime risk of myocarditis.

This was a systematic analysis using publicly available aggregated data from Global Burden of Disease Study 2021.

The study included 204 countries and territories from 1990 to 2021.

We used deidentified data from the general population to measure the lifetime risk of developing myocarditis.

The primary outcome was the estimated lifetime risk of developing myocarditis at the global, regional and national levels. Secondary outcomes included long-term trends in lifetime risk using the average annual percentage change (AAPC), variation in lifetime risk by age and sex, differences across Sociodemographic Index (SDI) levels assessed with concentration indices, and future risk estimated using an Autoregressive Integrated Moving Average (ARIMA) model.

The global lifetime risk of developing myocarditis increased from 1.33% (95% CI 1.32% to 1.33%) in 1990 to 1.50% (95% CI 1.49% to 1.50%) in 2021 (AAPC: 0.388%, 95% CI 0.314% to 0.462%). High and high-middle SDI countries had the greatest risks. In 2021, risk was higher in males (1.59%, 95% CI 1.59% to 1.60%) than in females (1.40%, 95% CI 1.39% to 1.40%). People over 40 years, especially older women, had higher lifetime risks. Forecasts based on the ARIMA model suggest that the risk will continue to rise through 2050.

From 1990 to 2021, the global lifetime risk of developing myocarditis has shown an upward trend. It is crucial to enhance early detection and diagnostic capabilities in primary care settings.

This study assessed the global burden of glaucoma using data from the Global Burden of Disease (GBD) 2021 study. The analysis of epidemiological trends aimed to inform future public health prevention strategies.

Retrospective cross-sectional study.

None.

Analysis of 1990–2021 GBD data on glaucoma prevalence, disability-adjusted life years (DALYs), age-standardised prevalence rates (ASPR), and age-standardised DALY rates (ASDR). Estimated annual percentage changes (EAPC) were calculated, Joinpoint regression identified trend changes, and Autoregressive Integrated Moving Average (ARIMA) modelling projected the burden for the year 2050.

Globally, the number of prevalent glaucoma cases increased from 4 072 106.59 (95% uncertainty interval (UI) 3 489 888.7 to 4 752 867.3) in 1990 to 7 587 672.9 (95% UI 6 522 906 to 8 917 725.4) in 2021. Concurrently, DALYs increased from 467 600.4 (95% UI 323 490.5 to 648 641.6) in 1990 to 759 900.2 (95% UI 530 942.9 to 1 049 127.2) in 2021. In contrast, the ASPR and ASDR declined to 90.1 per 100 000 population (95% UI 77.8 to 105.5) and 9.1 per 100 000 population (95% UI 6.3 to 12.5) in 2021, respectively. During the COVID-19 pandemic period (2019–2021), the slowest growth rates in crude case numbers and overall disease burden were observed, accompanied by the most pronounced decline in annual percentage change of ASPR. The highest estimates for both case counts and DALYs were identified in the 70–74 age group, with males demonstrating higher prevalence rates than females. Furthermore, regions with lower Sociodemographic Index (SDI) values bore a disproportionately higher burden of glaucoma.

These findings underscore the need to strengthen early screening and treatment of glaucoma, particularly in ageing populations, male groups and low SDI regions. We urge cautious interpretation of COVID-19 related data and vigilance against potential post-pandemic surges in burden. Critical strategies include enhanced screening and intervention for high-risk groups, targeted prevention measures and integration of ophthalmic care into public health emergency frameworks to alleviate the disease burden.

To explore the chain-mediating role of academic buoyancy and academic burnout between self-directed learning ability (SDLA) and learning engagement in undergraduate nursing students.

A cross-sectional survey.

This study was conducted in December 2024, involving 239 nursing undergraduates from a university in Daqing city, Heilongjiang province.

Independent samples t-tests and analysis of variance were employed to examine the relationships between undergraduate nursing students’ characteristics and learning engagement. Pearson correlation analysis was used to analyse the correlations among the variables. Based on self-determination theory, the chain-mediating effects of academic buoyancy and academic burnout between self-directed learning ability and learning engagement were tested using Model 6 of the SPSS PROCESS macro (V.3.5), with bootstrap samples set to 5000.

A total of 239 undergraduate nursing students were included in the analysis, of whom 84.94% were female. The sample comprised students from all academic years, including first-year (27.62%), second-year (33.47%), third-year (17.57%) and final-year students (21.34%). Most participants selected nursing as a voluntary major choice (62.34%), and 43.51% were from urban areas. The 239 undergraduate nursing students scored 72.26±10.26 on SDLA, 14.90±2.64 on academic buoyancy, 53.75±9.33 on academic burnout and 50.81±7.64 on learning engagement. SDLA and academic buoyancy were positively correlated with learning engagement (all p

SDLA is associated with higher learning engagement among nursing students through academic buoyancy and reduced academic burnout. These findings highlight the importance of developing SDLA and clarify the mediating roles of academic buoyancy and burnout in this relationship, providing valuable insights for enhancing learning engagement in nursing education.

A combination of chemotherapy and immune checkpoint inhibitor therapy has been demonstrated to be effective as a first-line treatment of gastric or gastro-oesophageal junction (G/GEJ) cancer. The conventional treatment strategy for patients with advanced/metastatic human epidermal growth factor receptor 2-negative G/GEJ cancer is recommended. However, the response rate and enhancements in survival are still significantly insufficient. The present study will investigate the efficacy and safety of incorporating a bevacizumab biosimilar IBI305 into chemotherapy and immunotherapy as a first-line treatment for advanced or metastatic G/GEJ cancer.

This single-arm, open-label, prospective phase Ib/II clinical study will involve 57 participants. In phase Ib of the trial, patients with advanced or metastatic G/GEJ cancer will receive capecitabine and oxaliplatin (CapeOX) together with sintilimab (200 mg intravenously every 3 weeks) and IBI305 (7.5, 10 or 15 mg/kg intravenously every 3 weeks) in a 3+3 dose-escalation design to evaluate dose-limiting toxicities (DLTs) within 6 weeks of treatment initiation. In phase II, the patients will receive CapeOX combined with sintilimab and IBI305 at the recommended phase II dose. The primary objectives will be to assess DLTs (phase Ib) and the objective response rate (phase II). The secondary objectives will include progression-free survival, overall survival, disease control rate, duration of response, adverse effects, quality of life and safety.

The trial protocol was approved by the Ethics Committee of West China Hospital and ClinicalTrials. The final results will be published in a peer-reviewed journal upon completion of the study.

NCT05640609.

To assess Chinese medical staff’s knowledge and attitudes towards insomnia and explore their association with mental health status.

A multicentre cross-sectional survey conducted across hospitals in China using convenience sampling.

Multiple hospitals across different regions of China; level of care primarily secondary.

A total of 654 medical staff enrolled from 23 hospitals between April and June 2023, with 420 (64.22%) nurses. Inclusion criteria encompassed hospital staff involved in patient care; exclusion criteria included those on leave or unwilling to participate. Data on sex and ethnicity were collected but not specified in the abstract.

Primary outcomes included insomnia knowledge and attitudes, assessed by a structured questionnaire. Secondary outcomes encompassed mental health status, measured via the Depression-Anxiety-Stress Scale (DASS)-21 (stress, anxiety and depression). The interactions between these variables were analysed using structural equation modelling (SEM).

Of the participants, 392 (59.94%) reported insomnia symptoms. The median scores for insomnia knowledge and attitudes were 16.0 (range 0–24) and 27.0 (range 7–35), respectively. The median DASS-21 score was 30.0; 189 (28.90%) experienced stress, 400 (61.16%) anxiety and 302 (46.18%) depression. SEM analysis indicated that night shift work (β=–0.101, p=0.024) and job satisfaction (β=–0.258, p

Medical staff showed limited understanding of insomnia and a high prevalence of stress, anxiety and depression. Targeted education, optimised shift scheduling and accessible mental health support are recommended to promote staff well-being and improve care quality. Nevertheless, the findings should be interpreted with caution because of the cross-sectional design and convenience sampling method.

To summarise the symptom clusters (SCs), assessment tools and their evolution at different stages of postsurgical chemotherapy in oesophageal cancer patients, providing reference for future research design and precise symptom management.

A systematic search and literature review were conducted according to the Joanna Briggs Institute Scoping Review Methodology framework and PRISMA extension for scoping reviews (PRISMA-ScR) guidelines.

Databases searched include PubMed, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science, Embase, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wanfang, VIP Chinese Journal and China Biomedical Literature Database. The search covered the period from database inception to 30 November 2024, and references were traced backward.

Patients aged ≥18 years with postsurgical oesophageal cancer undergoing adjuvant chemotherapy; studies focusing on SCs before, during or after chemotherapy; original quantitative research; published in Chinese or English. Exclusion criteria included neoadjuvant or palliative chemotherapy, reviews, conference abstracts and inaccessible full-text articles.

Two independent reviewers screened, extracted and cross-checked the data. Content analysis was employed to summarise the SCs, assessment tools and phase-related changes.

A total of 11 studies were included (8 in Chinese, 3 in English). Twelve SCs were identified, with gastrointestinal-related, eating-related and physical function-related clusters being the most common. Eleven assessment tools were used, with MD Anderson Symptom Inventory-Gastrointestinal Cancer Module and its Chinese version being the most frequently applied. Difficulty eating was the most prominent SC before chemotherapy, gastrointestinal symptoms were the most severe during chemotherapy and psychological-physical symptoms dominated in the postchemotherapy phase.

The composition of SCs in oesophageal cancer chemotherapy evolves dynamically across different stages. However, the existing evidence is mainly derived from small sample cross-sectional studies, with high heterogeneity in tools and methods. Standardised assessment criteria and longitudinal validation are needed to develop stage-specific, evidence-based interventions that can be widely applied.

The Chinese neuroimmunological disease database (NIDBase) cohort was established to explore genetic and environmental risk factors, clinical features, multi-omics data and prognostic biomarkers. The aim is to enhance our understanding of central nervous system (CNS) demyelinating diseases. Additionally, the establishment of this cohort will address the critical issue of the lack of comprehensive genetic data and biological samples for precision diagnosis and treatment research related to neuroimmunological diseases in China.

56 hospitals in various regions of China were selected to participate in this study. The patients diagnosed with CNS demyelinating diseases were recruited, including clinically isolated syndrome (CIS), multiple sclerosis (MS), neuromyelitis optica spectrum disease (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A).

At the time of patient enrolment, the clinical information is designated as baseline data. The collected baseline data include demographic information, disease history, clinical features of each demyelinating event, treatment records, standardised scales, questionnaire assessments and laboratory test results. Furthermore, biological samples, MRI and high-density electroencephalography (hd-EEG) data will be collected at baseline. All patients will be followed up at 3 months and 6 months and annually thereafter. As of December 2024, 3866 patients with CNS demyelinating diseases have been enrolled, including 84 CIS, 282 MOGAD, 1405 MS and 2095 NMOSD. Our findings indicate that CNS demyelinating diseases, particularly NMOSD, are more prevalent in women in China, with significant age differences observed among NMOSD patients compared with those with CIS, MS and MOGAD.

In future, all patients in our cohort will be followed up at 3 months and 6 months and then annually. By the end of December 2024, the database has been locked and is now being processed and analysed, while our data continue to be updated and expanded for further analysis. Both prospective and retrospective observations will be included in this study. Subsequent publications will emerge from this multicentre cohort, encompassing genomics, clinical cohort studies, hd-EEG biomarkers, imaging-based radiomics and electrical stimulation therapies.

NCT06443333.

Chemotherapy is the standard second-line treatment option for advanced biliary tract cancer (BTC), but its therapeutic efficacy is suboptimal. Disitamab vedotin (RC48) and lenvatinib have demonstrated promising efficacy in human epidermal growth factor receptor 2 (HER2)-positive BTC and other malignancies. In this study, we aim to evaluate the efficacy and safety of RC48 in combination with lenvatinib in second-line or above treatment for HER2-positive advanced BTC.

This is a single-centre, single-arm, open-label, exploratory phase II clinical study in patients with HER2-positive unresectable locally advanced or metastatic BTC who have failed prior therapy. 31 patients will be enrolled in this study to receive the combination of RC48 and lenvatinib. The primary study endpoint is objective response rate, and the secondary study endpoints are disease control rate, duration of response, progression-free survival and overall survival.

The study has received approval from the Medical Ethics Committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (approval No. (2023)0367-01). Results will be disseminated through publication in peer-reviewed journals and through other appropriate media channels.

ChiCTR2300076406.

Inflammatory bowel disease (IBD) patients in China exhibit critically low levels of physical activity, yet evidence for telemedicine-based aerobic exercise interventions remains scarce, particularly with objective physiological validation.

In this single-centre, open-labelled, semi-crossover randomised controlled trial, 28 inactive/mildly active adult IBD patients with low level of baseline physical activity will be randomly assigned to immediate or delayed 12-week telemedicine-based aerobic exercise training. The exercise prescription, stratified by baseline activity level, is designed to progressively elevate physical activity levels to moderate intensity. The telemedicine-based programme used fitness bands synchronised to a mobile app, WeChat-based real-time feedback and online group support and communication. The primary outcome is change in peak oxygen uptake measured by cardiopulmonary exercise testing (CPET). Secondary outcomes include other cardiorespiratory fitness parameters measured by CPET, physical activity level measured by International Physical Activity Questionnaire Short Form, Exercise Benefits/Barriers Scale, clinical disease activity, inflammatory markers, Inflammatory Bowel Disease Questionnaire, nutritional indices, Fatigue Severity Scale and Hospital Anxiety and Depression Score.

The trial has been approved by the Ethics Committee of the Affiliated Lihuili Hospital of Ningbo University (KY2024SL379-01). Results will be published in peer-reviewed journals and presented at scientific conferences.

NCT06804733.