Conectar
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
The aim of this study was to innovatively utilise the BERTopic model for topic modelling in order to comprehensively identify and understand the factors contributing to bed falls.
Retrospective study.
The study collected 241 reports of bed fall accidents recorded by nurses from Peking University Third Hospital Nursing Department from 2014 to 2024. Among them, 102 reports met the inclusion and exclusion criteria.
This study follows the Minimum Information for Medical AI Reporting (MINIMAR). It collected patient bed fall reports from Peking University Third Hospital between 2014 and June 2024, preprocessed the texts, utilised the BERTopic library in Python for topic modelling, and manually aggregated secondary topics by combining visualisation results and professional knowledge.
We utilised cluster bar charts to visually display the distribution of the 22 secondary topics and further consolidated them into five core topics through the use of a topic distribution diagram and a topic similarity matrix diagram. These topics were related to patient factors, ward equipment and surroundings factors, medication risk factors, caregiver factors, and nursing practice factors. The study highlights the environment's specificity in bed falls, especially bedside safety and patient-bed rail interaction.
The innovation of this study lies in the successful utilisation of BERTopic technology to identify topics of risk factors for bed falls through alternative data sources, providing a scientific basis for formulating preventive measures. The findings aim to optimise nursing processes, improve ward environments and enhance educational training, ultimately reducing patient bed falls and enhancing medical safety, nursing quality and patient experience.
This study not only helps nurses identify risk factors for patient bed falls, but also provides important guidance for developing effective prevention strategies.
No patient or public contribution applied.
by Ploy Khongrungjarat, Chonnikan Tothong, Chanyanut Pankaew, Suchada Phimsen, Nopawit Khamto, Nutthamon Kijchalao, Warissara Wongkham, Piyathida Wongkham, Wipaporn Chuaymaung, Adsadayu Thonnondang, Apinun Limmongkon
Prenylated stilbenoids, particularly trans-arachidin-1 (Ara-1) and trans-arachidin-3 (Ara-3), have gained attention for their notable bioactivities and potential health-promoting properties. This study presents the first comprehensive investigation into the stability and biological efficacy of these compounds in both peanut hairy root culture crude extracts (PCE) and partially purified fractions derived from elicited peanut hairy root cultures. PCE stored at –20 °C and 4 °C maintained higher antioxidant capacity, total phenolic content compared to samples stored at room temperature. In cytotoxicity assays using SW480 colon cancer cells, the extract stored at –20 °C retained bioactivity with only minor changes in IC₅₀ values over three months, demonstrating superior stability under frozen conditions. Over a six-month period, partially purified fractions of Ara-1 and Ara-3 showed a time-dependent decline in compound content. However, Ara-3 maintained strong cytotoxicity against KKU-100 cholangiocarcinoma cells, while Ara-1 exhibited a significant loss in activity. These findings demonstrate that low-temperature storage, particularly at –20 °C, is crucial for preserving the chemical integrity and bioactivity of stilbenoid-rich extracts. The study underscores the importance of optimizing storage conditions to ensure consistent bioactivity, supporting the potential application of these compounds in the development of stable and effective pharmaceutical or nutraceutical products.
To develop a grounded theory that explains how formal care service providers experience caring for and supporting persons with early-onset dementia (EOD).
A grounded theory approach.
Thirty formal care service providers of persons with EOD were recruited from community-based dementia care facilities in northern and central Taiwan from August 2021 and February 2022 using purposive and theoretical sampling. Transcribed face-to-face, semi-structured interview data were analysed with constant comparative analysis. A theoretical framework was constructed from the data to describe the experience of being a formal care service provider for persons with EOD.
The core category of ‘client-as-partner care’ was the theoretical framework that explained the experience of formal care service providers and described how participants met the needs of persons with EOD. Five categories described the components of the process: (1) identifying clients' characteristics; (2) establishing a personal relationship; (3) enhancing self-esteem; (4) maintaining dignity; and (5) the influence of family members and community members. The first four categories were interactive and key to delivering client-as-partner care; the fifth category could alter any key component and reduce or improve the quality of care. Reflections shared by participants offered a window into the outcomes of successful client-as-partner care: quality of life improved for clients and job satisfaction increased for providers.
The client-as-partner care model for persons with EOD required knowledge of the client's unique characteristics, a strong provider-client relationship, offering strategies tailored to the client's abilities and interests, and fostering independence.
Client-as-partner care provides a person-centred approach that enhances support quality for persons with EOD and increases job satisfaction for formal care providers. Successful strategies can inform case management, strengthen support for this population and indirectly improve family caregivers' competencies.
No patient or public contribution.
COREQ (COnsolidated criteria for REporting Qualitative research).
Nursing students are the primary reserve force for hospital nurses. With the shrinking of nurse human resources and the increase in turnover rates, understanding the job preferences of nursing students is crucial for attracting nursing students.
To systematically review published studies on discrete choice experiments involving nursing students.
Ten databases were systematically searched from their inception to January 15, 2025. Two researchers independently used the International Society for Pharmacoeconomics and Outcomes Research checklist to evaluate the quality of the included studies. Thematic analysis was used to classify the attributes into broad categories and corresponding subcategories. The frequency, significance, relative importance, and willingness-to-pay of each attribute in the included studies were analyzed.
Fifteen studies spanning 12 countries were included, with a total of 102 individual attributes extracted and divided into two broad categories and six subcategories. Non-financial attributes were the most frequently reported broad category. The subgroup analyses indicated that nursing students from high-income countries valued income and were highly concerned about the working atmosphere.
Linking Evidence to Action:
The results of this systematic review provide important evidence for developing incentive policies to attract nursing students to the nursing profession.
Nurse-led self-care interventions represent a promising approach for chronic pain management. However, a comprehensive synthesis of their efficacy is lacking.
This systematic review and meta-analysis assessed the impact of the interventions on four key outcomes in chronic pain patients: pain intensity, quality of life, anxiety levels, and depression severity.
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search for relevant articles spanning from inception to November 2024 was carried out across multiple databases, including EMBASE, PubMed, CENTRAL, Web of Science (Core Collection), CINAHL, Scopus, and PsycINFO. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies. The meta-analysis was conducted using Stata 18 and Review Manager 5.4, and a GRADE evidence profile was subsequently generated.
The systematic review and meta-analysis involved 30 studies in total. The results of the data analysis indicated that the interventions alleviated pain intensity (SMD = −0.30, 95% CI: −0.41 to −0.20, Z = 5.57, p < 0.001). They also enhanced quality of life (SMD = 0.28, 95% CI: 0.14 to 0.42, Z = 3.83, p < 0.001), while reducing anxiety (SMD = −0.15, 95% CI: −0.29 to −0.01, Z = 2.11, p = 0.03) and depression symptoms (SMD = −0.27, 95% CI: −0.45 to −0.09, Z = 2.88, p = 0.004).
This systematic review demonstrated that nurse-led self-care interventions benefit chronic pain patients. Future research should conduct more rigorous randomized controlled trials to strengthen the evidence base for using such interventions in chronic pain management.
A lack of murine models that mimic impaired wound healing in people with type 2 diabetes has hindered research. The commonly used leptin-receptor knockout model (db/db) fails to accurately reflect the pathophysiology of human disease. This study aimed: (i) to investigate whether our novel murine model of diabetes, whilst less hyperglycaemic and obese than db/dbs, effectively demonstrated impaired wound healing, and (ii) to identify the most robust methods for quantifying wound closure. C57BL/6J mice were high-fat diet fed for a total of 11 weeks and injected with three doses of streptozotocin (65 mg/kg body weight) at week 5 with chow-fed mice as controls. All mice received four excisional wounds and were euthanised at day-4 or day-10 post-wounding (n = 8/group/timepoint). Wound healing was evaluated by digital planimetry, histology, Micro-CT, and tensiometry. Histological analysis was the most sensitive method for identifying impaired wound healing. Our high-fat diet/low-dose streptozotocin model had significantly higher non-fasting blood glucose (25.7 ± 5.4 mmol/L vs. 8.7 ± 0.8 mmol/L) and lower wound quality scores (day-4 post-wounding: 2.6 ± 1.9 vs. 4.4 ± 0.8) than healthy controls (both p < 0.05). At day-10 post-wounding, a linear trend in wound healing was observed between healthy controls, our novel model and the db/db model, indicating that our diabetic murine model may be clinically relevant for studying diabetes-related wound healing.
Investigate the epidemiological characteristics of outpatients initially diagnosed with skin ulcers who were ultimately confirmed to have cutaneous malignant tumours, and provide a diagnostic and therapeutic basis for the occurrence of secondary diseases in chronic wounds. We conducted a retrospective study analysing clinical data from patients initially diagnosed with skin ulcers at our hospital between July 2021 and February 2025, and analysed the epidemiological characteristics of malignant transformation in these ulcer cases. Among 128 patients initially diagnosed with skin ulcers, 16 cases (12.5%) were confirmed with cutaneous malignancies. The malignant group had a significantly higher mean age (69.44 ± 11.30 years) compared to the non-malignant group (58.39 ± 17.88 years; t = 5.752, p = 0.01). The distribution of lesion sites differed significantly between the malignant and non-malignant groups (χ2 = 30.498, p < 0.01). In the malignant group, the head and neck (41.2%) and trunk & extremities (41.2%) were the predominant sites. The most common malignancy was squamous cell carcinoma (SCC). The trunk & extremities was the most frequent site (62.5%). The second was basal cell carcinoma, which mainly occurs in the head and neck (80.0%). The mean duration of ulceration was 4.5 years. The primary treatment modality was surgical excision (11 cases, 68.8%). Approximately one-seventh of skin ulcer cases were confirmed as cutaneous malignancies. This finding underscores the significance of skin ulcers as potential malignant lesions, highlighting the need for clinicians to maintain a high index of suspicion and promptly perform histopathological examinations to improve early detection rates of skin cancers.
To explore the relationship between nurses' decision-making styles and missed care across different stages of the nursing process (assessment and evaluation, planning, implementation) in oncology care settings.
A cross-sectional study was conducted among oncology nurses from three hospitals using convenience sampling. Data were collected through a sociodemographic questionnaire, the Oncology Missed Nursing Care Self-Rating Scale (OMNCS) and the General Decision-Making Style Scale (GDMS). Mann–Whitney U tests and binary logistic regression were employed to analyse the associations between different decision-making styles and missed care.
Missed care was commonly reported across all dimensions, with the highest prevalence observed in the planning stage. The rational decision-making style was dominant, with significantly higher scores in the non-omission group. It was negatively associated with missed care during the implementation stage (OR = 0.460, 95% CI 0.251–0.844; p = 0.012). The intuitive-impulsive decision-making style showed a protective effect in all dimensions (OR = 0.254–0.337, 95% CI 0.128–0.501, 0.172–0.661; p < 0.01). In contrast, the dependent and avoidant styles both significantly increased the risk of missed care during the assessment and evaluation stage.
Nurses' decision-making styles play a crucial role in the occurrence of missed care, with different styles exerting varying influences across stages of the nursing process. Therefore, nursing managers should recognise the role of these styles in nursing quality and tailor interventions to support nurses with dependent or avoidant decision-making styles. Moreover, using simulated training or decision support systems to transition between rational and intuitive approaches offers a promising strategy to reduce stage-specific missed care, enhance oncology nursing quality and improve patient safety.
Identifying high-risk stages for missed care, incorporating assessments of nurses' decision-making styles and implementing personalised interventions provide a new management pathway to reduce missed care and enhance patient safety.
What problem did the study address?: This study provides new evidence that nurses' decision-making styles are significantly associated with missed care, with this relationship varying across different stages of the nursing process. What were the main findings?: The rational style was the most common decision-making style among oncology nurses, with the non-omission group scoring significantly higher than the omission group. The intuitive-impulsive style consistently showed a protective effect across all stages. In contrast, both dependent and avoidant styles increased the risk of missed care during the assessment and evaluation stage. Where and on whom will the research have an impact?: This study informs the development of targeted interventions for nursing management. Immediate priorities include implementing structured tools and training during high-risk care stages, while long-term strategies should focus on simulation-based training and fostering a supportive culture to enhance decision-making skills and reduce missed care.
The STROBE checklist.
This is a cross-sectional study to investigate the relationship between nurses' decision-making styles and missed care at specific stages of the nursing process. In the design phase, the research team collected data on oncology nurses' general information, missed care status and decision-making styles by reviewing relevant literature. During the research process, the nurses participated in data collection, providing key primary data for the study. This cooperation ensured the smooth execution of the research and contributed to obtaining effective results.
by Nguyen Hong Tan, Tran Manh Tuan, Pham Minh Chuan, Nguyen Duc Hoang, Le Quang Thanh, Le Hoang Son
Artificial Intelligence (AI) has been dramatically applied to healthcare in various tasks to support clinicians in disease diagnosis and prognosis. It has been known that accurate diagnosis must be drawn from multiple evidence, namely clinical records, X-Ray images, IoT data, etc called the multi-modal data. Despite the existence of various approaches for multi-modal medical data fusion, the development of comprehensive systems capable of integrating data from multiple sources and modalities remains a considerable challenge. Besides, many machine learning models face difficulties in representation and computation due to the uncertainty and diversity of medical data. This study proposes a novel multi-modal fuzzy knowledge graph framework, called FKG-MM, which integrates multi-modal medical data from multiple sources, offering enhanced computational performance compared to unimodal data. In addition, the FKG-MM framework is based on the fuzzy knowledge graph model, one of the models that represent and compute effectively with medical data in tabular form. Through some experiment scenarios utilizing the well-known BRSET dataset on multi-modal diabetic retinopathy, it has been experimentally validated that the feature selection method, when combining image features with tabular medical data features, gives the highest reliability results among 5 methods including Feature Selection Method, Tensor Product, Hadamard Product, Filter Selection, and Wrapper Selection. In addition, the experiment also confirms that the accuracy of FKG-MM increases by 12–14% when combining image data with tabular medical data than the related methods diagnosing only on tabular data.
Chronic dyspnoea is a prevalent symptom, and primary care is ideally placed to identify and manage it. However, chronic dyspnoea is under-reported by patients and can be a diagnostic dilemma for practitioners. A fully automated system of patient screening, coupled with a clinical decision support system (CDSS) that uses a validated and evidence-based dyspnoea algorithm, may improve detection, diagnosis and management of the condition. There is currently no CDSS validated for chronic dyspnoea diagnosis and management in primary care in Australia. The objectives of this study are to assess the clinical impact of a CDSS for chronic dyspnoea in primary care. We hypothesise that the use of the CDSS will lead to a clinically significant improvement in patient-reported dyspnoea scores, reduced time to diagnosis and healthcare costs at 12 months compared with standard care.
The BREATHE study is an open-label, cluster-randomised controlled trial of standard of care compared with a CDSS. General practices (n=40) in metropolitan, regional/rural and rural/remote settings will be recruited and randomised equally to pre-screening for chronic dyspnoea and usual standard-of-care management or pre-screening and CDSS-guided management. The CDSS includes an algorithm derived from a robust data and clinical knowledge model and incorporates evidence-based recommendations for the assessment and management of chronic dyspnoea. It is integrated into general practice medical software systems, fitting in the workflow of general practitioners (GPs). Eligible patients will be ≥18 years old and will have previously consented to receive SMS communication from their practice. In-scope patients will receive an automated text message prior to their GP appointment and will be screened for chronic dyspnoea (≥4 weeks). Patients identified with chronic dyspnoea will be invited to participate in the BREATHE study and followed up for 12 months. The primary outcome is improvement in the Dyspnoea-12 (D-12) score from baseline to 12 months, measured by the Dyspnoea-12 (D-12) questionnaire. Secondary outcomes include disease-specific questionnaires to assess changes in clinical outcomes, time to final diagnosis, quality of life, healthcare utilisation and costs incurred to patients.
The trial is registered at ANZCTR (ACTRN12624001451594). ANZCTR is a primary registry that meets the requirements of the ICMJE and is listed on the ICTRP Registry Network.
The study protocol has been approved by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and complies with the National Health and Medical Research Council ethical guidelines. Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practice reception area.
The COmmunity HEalth System InnovatiON (COHESION) project (2016–2019) was a 4-year collaboration between research teams from Mozambique, Nepal, Peru and Switzerland. It conducted formative health system research using tracer chronic conditions, non-communicable diseases (diabetes and hypertension) and one neglected tropical disease per country (schistosomiasis in Mozambique, leprosy in Nepal and neurocysticercosis in Peru).
Findings guided the co-creation of interventions to improve diagnosis and management through a participatory approach with communities, primary healthcare workers and regional health authorities.
As a continuation of this effort, the research team initiated the COHESION Implementation project (COHESION-I) with two objectives: (1) implement and evaluate the context-specific co-created interventions in Mozambique, Nepal and Peru (Component 1) and (2) adapt the COHESION approach to India, a country that did not benefit from a formative phase previously (Component 2). This protocol manuscript focuses on Component 1.
A mixed-methods, pre–post quasi-experimental design will be used, including quantitative, qualitative, economic and process evaluations. Each country will have three arms: (1) co-created and co-designed interventions; (2) only co-designed intervention and (3) the usual care arm. Data will be collected longitudinally over 18 months to assess the effect of the interventions. The main outcomes include patient satisfaction (Patient Satisfaction Questionnaire Short Form), health system responsiveness (WHO responsiveness domains) and quality of life (EuroQol 5 dimensions 5 levels). The qualitative evaluation will explore how satisfaction is perceived among service users with chronic conditions and healthcare workers. Other outcomes per type of evaluation will be considered such as perceived value of health services, cost estimation and acceptability of the intervention components, among others.
Approvals were obtained from Ethics Committees of Universidad Peruana Cayetano Heredia (Peru), Universidade Eduardo Mondale (Mozambique) and Nepal Health Research Council (Nepal). Results will be disseminated through peer-reviewed publications and scientific conferences.
Tongxinluo capsule (TXL) is widely used in China as an adjunctive therapy for patients with acute coronary syndromes (ACS) who underwent percutaneous coronary intervention (PCI), collectively referred to as ACS-PCI. However, current evidence on its therapeutic effects and safety remains limited and insufficiently synthesised. This review aims to evaluate the therapeutic effects and safety of adding TXL to Western medical therapy (WM) in this population.
A systematic literature search was performed in PubMed, the Cochrane Library, CNKI, VIP and Wanfang from inception to August 2024; a rapid supplemental search was conducted up to November 2025, without language restrictions, to identify randomised controlled trials (RCTs) evaluating the therapeutic effects and safety of adding TXL to WM in patients with ACS-PCI. Dichotomous outcomes were summarised using risk ratios (RRs) with 95% CIs; absolute risk reductions (ARRs) were estimated as risk differences, and corresponding numbers needed to treat (NNTs) were calculated. Continuous outcomes were summarised using mean differences (MDs) with 95% CIs. All meta-analyses were performed using a random-effects model. The included studies generally had limitations in methodological quality, heterogeneity across analyses was low to moderate and the potential for publication bias could not be excluded. The evidence certainty for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
Eighteen RCTs involving 1800 participants were included. Low-certainty evidence indicated that adding TXL to WM may reduce the risks of restenosis (RR=0.30, 95% CI 0.10 to 0.91; ARR=0.056, NNT=18), revascularisation (RR=0.28, 95% CI 0.10 to 0.80; ARR=0.069, NNT=15), myocardial infarction (RR=0.44, 95% CI 0.20 to 0.98; ARR=0.033, NNT=31), angina (RR=0.32, 95% CI 0.17 to 0.61; ARR=0.076, NNT=14) and other cardiovascular events (RR=0.41, 95% CI 0.24 to 0.71; ARR=0.075, NNT=14). It also improved Seattle Angina Questionnaire scores (MD=8.82, 95% CI 6.58 to 11.05) and quality of life (qualitative synthesis). However, no statistically significant reductions were observed for sudden cardiac death (RR=0.39, 95% CI 0.12 to 1.27; ARR=0.022, NNT=45), or non-cardiovascular adverse events (RR=0.67, 95% CI 0.32 to 1.40; ARR=0.043, NNT=24) when TXL was added to WM.
Current evidence suggests that adjunctive TXL may reduce key cardiovascular events and improve symptoms and quality of life in patients with ACS-PCI, without increasing the risk of non-cardiovascular adverse events. However, all findings are based on low-certainty evidence. These results provide preliminary support for the use of TXL as an adjunctive therapy, but high-quality, multicentre RCTs are needed to confirm these effects and inform clinical guidelines.
CRD42024509453.
Both varicose veins (VV) and iliac vein compression syndrome (IVCS) can cause skin damage and functional impairment in the lower extremities, and these issues often coexist. However, the question of whether IVCS exacerbates VV progression and leads to differences in the surgical outcomes of therapy for VV remains unanswered. Therefore, no high-level evidence-based medical data is available to support the concomitant use of iliac vein stenting in patients with VV and severe IVCS, and treatment protocols vary significantly among different centres. This study will investigate the effects of concomitant iliac vein stenting on post-procedure varices recurrence and quality of life (QoL) on the basis of a prospective, multicentre, randomised controlled trial with the goal of providing a foundation for the standardised treatment of patients with VV and IVCS.
This prospective, multicentre, randomised controlled trial will enrol 160 patients with VV and severe IVCS. All patients will be randomly divided into either the VV endovenous thermal ablation (ETA) alone group or the VV ETA combined with iliac vein stenting (ETAS) group. Baseline data will be collected and follow-up will be conducted at 1, 6, 12 and 36 months after the procedure. The primary outcome is post-procedure VV recurrence (as assessed by clinical and ultrasound examination). Secondary outcomes include QoL scores (according to the Aberdeen Varicose Vein Questionnaire, the Chronic Lower Limb Venous Insufficiency Questionnaire, the European Quality of Life Five-Dimensions, and the Venous Clinical Severity Score) and the incidence of post-procedure complications. Bleeding complications resulting from anticoagulation therapy and stent-related complications (such as restenosis and deep vein thrombosis) will also be recorded for patients in the ETAS group.
This study has been approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (approval number: XJTU1AF2024LSYY-075). Written informed consent has been obtained from all participants. The final results of this study will be published in a peer-reviewed journal and presented at national or international conferences.
This protocol was registered on chictr.org.cn prior to enrolment, which began on 19 June 2024 (Registration ID: ChiCTR2400085815).
Obesity is a key risk factor for kidney stones (KS). The body roundness index (BRI) is a newer measure for assessing body fat distribution. Studies in Western populations have linked BRI to KS risk, but no such research has been conducted in Asian populations. This study aimed to examine the association between BRI and KS in Chinese adults.
This cross-sectional study included 78 386 Chinese adults who underwent abdominal ultrasound examination. Data on demographic characteristics, clinical history and laboratory parameters were collected. The diagnosis of KS was based on the ultrasound findings. Multivariable logistic regression examined the association between the BRI and KS risk. The analysis incorporated subgroup analyses, dose-response relationship assessment and mediation analysis.
Multivariable-adjusted logistic regression analyses revealed that the BRI was significantly positively correlated with KS risks in both genders, with a more pronounced effect observed in males (OR 1.16, 95% CI 1.12 to 1.20) compared with females (OR 1.11, 95% CI 1.04 to 1.20). Participants in the highest BRI tertile had a 47% and 23% higher KS risk in males and a 23% higher KS risk in females, respectively, compared with the lowest tertile. Dose-response analysis showed a non-linear relationship between BRI and KS risk in both males and females. Mediation analysis indicated that low-density lipoprotein cholesterol accounted for 7.2% of the association in females, whereas hypertension (14.8%) and uric acid (12.5%) were the primary mediating factors in males. Subgroup analyses confirmed that the association was modified by age and diabetes in females and by diabetes in males.
The findings demonstrate a significant association between elevated BRI and increased KS risk, underscoring the necessity of implementing gender-specific strategies and considering mediating factors in KS prevention.
Diabetes mellitus significantly increases the risk of cardiovascular disease (CVD). While mobile health (mHealth) interventions show promise, there is limited evidence on the efficacy of multimodal approaches for managing comprehensive CVD risk factors. This systematic review and meta-analysis aimed to evaluate the effectiveness of multimodal mHealth interventions in managing CVD risk factors in patients with diabetes.
Systematic review and meta-analysis of randomised controlled trials (RCTs), reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.
MEDLINE, Web of Science, Embase, Cochrane Library and CINAHL were searched for RCTs published from January 2010 to December 2024.
RCTs involving adults (≥18 years) with diabetes who received multimodal mHealth interventions (incorporating at least three components such as mobile apps, remote monitoring and SMS reminders) for ≥3 months, compared with standard care, were included.
Two independent reviewers screened records, extracted data and assessed the risk of bias using the original Cochrane risk of bias (RoB) tool. Perform effect size pooling using R V.4.4.3 and report the corresponding results, taking into account the observed heterogeneity.
Out of 2730 screened records, 17 RCTs (n=2946 participants) met the inclusion criteria. Multimodal mHealth interventions significantly reduced haemoglobin A1c (HbA1c) (weighted mean difference (WMD) = –0.38%, 95% CI –0.52 to –0.24; p
Multimodal mHealth interventions are effective in improving several key cardiometabolic parameters, including glycaemic control, blood pressure, lipid profiles and physical activity levels in patients with diabetes. These interventions represent a promising strategy for comprehensive CVD risk factor management in this population.
CRD420251050970. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251050970.
To assess the current situation of nursing staff exposed to workplace violence in a teaching hospital in China, and analyze the relationship between workplace violence and their physical and mental health status, aiming to establish a foundation for enhancing the working conditions for nursing staff.
Cross-sectional study.
In 2024, a cross-sectional survey was conducted at a teaching hospital in Hubei Province, China, involving 3681 nursing staff. Assessments included workplace violence experiences and health outcomes using validated scales such as the Depression Screening Scale, Anxiety Disorder Screening Scale, Perceived Stress Scale, Psychological Resilience Scale, and Self-rating Symptom Scale. Statistical analyses incorporated propensity score matching and logistic regression.
Among the 3681 nursing staff surveyed, 33.4% (1228) reported experiencing workplace violence. Moreover, 53.6% (1974) reported symptoms of mild to severe depression, and 34.5% (1270) reported symptoms of mild to severe anxiety. Commonly reported physical health conditions included peptic ulcers (6.8%, 250), autoimmune diseases (6.6%, 241), hypertension (3.0%, 112), malignant tumors (2.0%, 73), and diabetes (1.5%, 54). Workplace violence exposure showed significant associations with gender, weekly working hours, professional roles, living situations, and alcohol consumption.
Workplace violence significantly increases the risk of both physical and psychological health problems among nursing staff. Relevant authorities should implement proactive prevention strategies to reduce the occurrence of workplace violence and thereby mitigate its associated adverse outcomes, including anxiety, depression, elevated stress levels, and chronic physical conditions.
This study found a high prevalence of workplace violence (33.4%) among nursing staff, linked to physical and mental health impairments. Screening for vulnerabilities and providing tailored psychological support can enhance resilience, reducing the frequency of violence and its detrimental impacts on staff well-being.
This study adhered to the STROBE checklist for observational studies.
This study did not include patient or public involvement in its design, conduct, or reporting. The contribution of patients/members of the public was limited solely to data collection.
To explore and describe registered nurses' perceptions of the patient and clinician characteristics, healthcare systems, and processes that contribute to deterioration resulting in a Medical Emergency Team (MET) review.
An exploratory descriptive qualitative study using semi-structured interviews.
A purposive sample of experienced registered nurses from acute medical and surgical wards in a large teaching hospital in Melbourne, Australia was recruited from July to August 2018. Semi-structured interviews were conducted, guided by a semi-structured interview schedule. Interviews were analysed using the 7 steps of Framework Method analysis: transcription, familiarisation, coding, developing a working analytical framework, applying the analytical framework, charting data into the framework, and interpreting the data.
Twenty-one interviews were conducted with participants who had a median of 5.5 years' total nursing experience and 2 years' experience in their current ward. The major finding was The Downward Spiral of Clinical Deterioration theme characterised by a worsening spiral of clinical deterioration risk culminating in MET review. The Downward Spiral comprised four sub-themes: Physiological Age, not Chronological Age Matters; Delirium Demands Attention; Unclear Therapeutic Goals; 24/7 Risk in a 9-to-5 Service.
This integrates existing knowledge to explain how patient characteristics and healthcare systems and processes interact to contribute to clinical deterioration risk in the time between admission and MET review.
Identifying patients at increased risk of deterioration may assist with earlier, proactive intervention and improve patient outcomes associated with clinical deterioration in acute healthcare.
Recognising and responding to clinical deterioration remains a challenge in acute healthcare, associated with poor patient outcomes and consuming substantial resources. To date, registered nurses' perceptions of the factors leading to Medical Emergency Team review have not been described. The Downward Spiral of Clinical Deterioration describes how patient and clinician characteristics and healthcare systems and processes interact to increase clinical deterioration risk, culminating in Medical Emergency Team review. These findings may help researchers integrate disparate clinical deterioration models and concepts. Insights into how the safety of healthcare systems can be improved may assist administrators and clinicians in reducing the incidence of clinical deterioration in the future.
The study is reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ).
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS