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Mindfulness-Based Interventions (MBIs) have gained traction in various healthcare settings, particularly for stress reduction among healthcare professionals. This meta-analysis aimed to evaluate the effectiveness of MBIs on reducing stress and depression in obstetrical nurses.
A comprehensive literature search was done across multiple databases, including Cochrane Library, PsycINFO/PsycNet, PubMed/MEDLINE, Web of Science, and Google Scholar. The risk of bias for each included study was assessed using the Cochrane Risk of Bias Tool. Subgroup analyses were done according to intervention time (less than 8 weeks, 8 weeks, more than 8 weeks) and population. Meta-analysis was done using random-effects models. Effect sizes were calculated using standardized mean differences (SMD). Heterogeneity was assessed using the I 2 statistic.
The sample size in 55 studies was 4612 nurses and midwives (2904 in the intervention group and 1708 in the control group). The meta-analysis showed a significant overall effect of MBIs on reducing stress levels (SMD = −0.71; 95% CI [−0.97, −0.44]; p < 0.001), and depression (SMD = −0.74; 95% CI [−1.35, −0.13]; p < 0.001) among midwives and nurses. Subgroup analysis showed that the effects of intervention duration on reducing stress (X 2 = 3.01, p = 0.220) was not significant, but its effect on depression (X 2 = 61.46, p = 0.000) was significant.
Healthcare organizations should integrate structured MBIs into staff wellness initiatives to promote mental well-being. Nursing education programs can include mindfulness components to strengthen coping skills. Future work should also examine combined mindfulness–CBT programs (e.g., MINDBODYSTRONG) and address organizational factors contributing to burnout for a more comprehensive approach.
Atrial fibrillation (AF), with a prevalence of 1–2%, is the most common cardiac arrhythmia. AF is associated with a fivefold increased risk of cardioembolic events; approximately 20% of all strokes are caused by AF. Pulmonary vein isolation (PVI) has become the first-line treatment for AF. However, PVI cannot eliminate the residual stroke risk. Current guidelines recommend that anticoagulation be continued in this specific group of patients, regardless of the presence or absence of AF. In this large AF population post-PVI, who are considered to be in an earlier stage of AF, it is unknown whether left atrial appendage closure (LAAC) offers an alternative to direct oral anticoagulant (DOAC) therapy.
The trial will be a prospective, randomised, multicentre non-inferiority study comparing two treatment strategies in AF patients after atrial ablation. Patients will be randomly assigned to either percutaneous LAAC (group A) or DOAC treatment (group B) in a 1:1 ratio; both sequential and concomitant planned ablation with or without LAAC are accepted. Randomisation will be conducted using web-based randomisation software. A total of 1012 participants (506 patients per group) will be enrolled. The primary effectiveness measure will be the occurrence of any of the specified events within 24 months after randomisation: stroke/transient ischaemic attack/systemic thromboembolism, cerebral haemorrhage, other major haemorrhages (Bleeding Academic Research Consortium ≥2), cardiovascular mortality and all-cause mortality.
The study was approved by the Ethical Review Board of Shanghai Chest Hospital, China (KS(Y)20287). Written informed consent will be obtained from all participants. The trial will follow the Declaration of Helsinki and Good Clinical Practice. Confidentiality will be maintained with anonymised, securely stored data. Findings will be disseminated through peer-reviewed publications and conferences.
ChiCTR2000036538.
To explore the conceptualisation of social frailty and discuss its role in shaping the disease trajectory of heart failure. Based on the discussion, recommendations on how to prevent and manage social frailty in this clinical cohort are delineated.
A discursive paper.
This paper searched two databases, PubMed and Google Scholar, for a narrative review of the literature related to social frailty and heart failure from 2008 to 2024.
By integrating the conceptualisation of social frailty from different theoretical paradigms, social frailty is a multi-domain construct that relies on a balance between the availability of environmental resources, social interactions and an individual's ability to maintain and acquire these resources to enhance their well-being. Substantial evidence showed the prognostic impact of social frailty on patient-reported, functional and clinical outcomes of patients with heart failure. The underlying mechanism is still under-investigated, but heart failure-related self-care may mediate its impact. Based on this evidence, improving social frailty may rely on a diagnostic protocol to enhance the person-centred care planning on ways to optimise the social resources to support complex self-care.
Social frailty poses a greater risk to health outcomes in patients with heart failure. Further research is needed to explore determinants and interventions for social frailty in this population.
This paper increases the awareness of social frailty in heart failure patients and provides important insights on how to combat this social determinant of poor health outcomes among this clinical cohort. A dual-purpose approach of improving social resources and self-care behaviours may have great promise in reducing their social frailty, and this postulation will need to be investigated in future research.
There is no involvement of patients or the public in the design or writing of this discursive paper.
Urinary incontinence, often perceived as embarrassing, perpetuates the stigma that delays treatment and encourages concealment. This stigma significantly diminishes quality of life and imposes both financial and medical burdens. Although prior research has examined stigma reduction in urinary incontinence, it persists as a widespread issue. Most studies have focused on interviews, primarily addressing urine leakage, with a limited understanding of the factors influencing urinary incontinence stigma and their interrelations. More in-depth quantitative studies are crucial to inform targeted interventions.
(1) To develop targeted interventions aimed at alleviating urinary incontinence-related stigma in older adults. (2) To identify factors that mitigate stigma in older adults with urinary incontinence. (3) To examine the associations between these factors and stigma.
Cross-sectional survey.
A cross-sectional survey was conducted with 510 older adults across three hospitals in Guangdong from July 2022 to January 2024, utilising the SSCI-24 and Incontinence Severity Index. Three multivariate linear regression models, adjusted for covariates based on directed acyclic graphs, were employed to explore the relationships between variables and stigma. Additionally, subgroup analyses were performed.
Participants reported higher levels of self-stigma compared to perceived stigma. Multivariate analysis revealed significant associations between urinary incontinence type, severity, frequency of micturitions and stigma. Key factors contributing to stigma reduction include managing incontinence severity, reducing frequency of micturitions and preventing the progression to mixed incontinence.
The study identified associations between urinary incontinence characteristics—type, severity and frequency of micturitions—and stigma. Strategies for stigma reduction are proposed, underscoring the vital role of nurses in this process.
The findings of this study contribute to a deeper understanding of stigma surrounding urinary incontinence in older adults and provide insights for developing more effective interventions by healthcare professionals and community caregivers.
This study adhered to the STROBE checklist for observational studies.
No patient or public contribution.
This study aims to develop an indicator system for assessing the humanistic care competencies of nurses in infectious disease hospitals and provide a scientific measurement tool to understand the current humanistic care competencies level of infectious disease nurses.
A mixed-methods design integrating qualitative interviews and a modified Delphi study.
Initially, we derived a list of potential indicators of humanistic care for nurses in infectious disease hospitals from literature reviews and interviews with a nominal group technique (n=41). Following this, 26 experts from across China participated in two Delphi rounds from May to July 2023. Then the indicators were screened, revised and supplemented using the boundary value method and expert opinions. Next, the hierarchical analysis method was utilised to determine the weights of the indicators.
The average effective response rate across the two Delphi rounds was 94%. The authority coefficients for the first and second rounds were 0.85 and 0.90, respectively, suggesting the experts were highly authoritative. There was a consistent rating among experts with a coordination coefficient for each indicator (p < 0.001). Ultimately, this study identified 4 primary indicators, 8 secondary indicators, and 35 tertiary indicators. The four primary indicators and their weights are basic care competency (0.158), therapeutic care competency (0.544), spiritual care competency (0.158) and safety care competency (0.140).
This research provides a scientifically rigorous and comprehensive framework to evaluate the humanistic care competencies of nurses in infectious disease hospitals in China. This system will serve as an effective tool for evaluating the humanistic care competencies of nurses in specialized infectious disease hospitals in China and other overseas regions.
This study provides a new tool to assess the humanistic care competencies of nurses in infectious disease hospitals. Form an effective humanistic care competencies index system that can be used to build and develop the need for nurses to possess different aspects of humanistic care competencies tailored to infectious disease patients in hospitals.
No patients or public contribution.
To analyse trends and characteristics of multidrug-resistant (MDR) bacteria over the past 7 years, in relation to patterns of antimicrobial use, to inform rational antimicrobial use and strengthen hospital infection control measures.
Retrospective cohort study.
A large teaching hospital in Tianjin, a major metropolitan city in northern China.
A total of 190 352 inpatients aged >18 years, admitted between 1 January 2017 and 31 December 2023, were included. Patients were eligible if they had complete clinical data and met the five quality control indicators for multidrug-resistant bacteria (QC-MRB), defined in the ‘Hospital Infection Surveillance Specifications’ (WS/T 312–2023). Patients with MDR infections before admission or those with duplicate results from multiple specimens were excluded.
Statistical analysis revealed a detection rate of 12.11% for the five QC-MRB and an incidence rate of 0.20%. The findings also indicated an upward trend in the detection and incidence rates of carbapenem-resistant Enterobacteriaceae, despite a relatively stable rate of antimicrobial use over 7 years. A positive correlation was observed between the incidence of MDR bacteria and the intensity of antimicrobial use within the hospital setting.
The hospital’s bacterial data align with national trends. It established an interdisciplinary management framework for clinical data analysis and prediction of antimicrobial resistance. This approach enhances infection control measures and supports the rational use of antimicrobials.
Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.
To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.
A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.
Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.
Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.
To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.
To explore the associations between arterial stiffness (AS) onset age and type 2 diabetes mellitus (T2DM) risk.
Large-scale cohort study.
The largest medical centre in central China.
This study enrolled 22 588 participants free of T2DM at baseline. All participants took an annual physical examination from 2012 to 2016, with fasting blood glucose and brachial–ankle pulse wave velocity measurements.
Cox proportional model was used to investigate the association between AS onset age and T2DM risk. Sex-specific analysis was also performed, and the association between early vascular ageing (EVA), normal vascular ageing (NVA), supernormal vascular ageing (SUPERNOVA) onset age and diabetes risk was also examined.
A total of 757 (3.4%) participants were diagnosed with T2DM. Compared with participants free of AS in each specific age group, the earlier AS onset age was more strongly associated with T2DM risk, especially for middle age, with the fully adjusted hazard risk (HR) and 95% CI of 4.63 (2.79–7.67) for AS onset age at 50. Similar results were observed both in males and females, with the fully adjusted HR and 95% CI of 4.54 (2.60 to 7.93) for males and 4.86 (1.48 to 16.01) for females, with AS onset age at 50. Such an association was also observed in the exploration of EVA, NVA and SUPERNOVA onset age and incident T2DM risk.
This study revealed that the middle-aged onset of AS was more significantly associated with a higher T2DM risk. Early screening of AS, especially in middle age, may assist in T2DM detection and postpone diabetic vascular complications.
Oesophageal cancer (EC) presents a substantial global health challenge, ranking eighth in incidence and sixth in cancer-related mortality. Oesophageal squamous cell carcinoma (ESCC) is the primary subtype and accounts for approximately 90% of cases in Asia. Despite treatment advances, the 5-year survival rate remains modest at 10%–30%. Immune checkpoint inhibitors, exemplified by KEYNOTE-590 and CheckMate 577 trials, have reshaped EC therapeutic landscapes. Our study addresses the critical gap in understanding the real-world impact of PD-1 (Programmed Death-1) inhibitors, conducting a multicentre, real-world, observational cohort analysis focused on ESCC. This research endeavours to provide practical insights into PD-1 treatment for EC, facilitating informed clinical decision-making and optimising patient outcomes in diverse healthcare settings.
This multicentre study includes patients diagnosed with histopathologically confirmed ESCC who have consented to treatment with PD-1 inhibitors. It is structured into two distinct segments: Part A, characterised by its retrospective nature, and Part B, representing the prospective arm. Within both parts, four stratified cohorts are delineated, comprising Cohort 1 (preoperative neoadjuvant/conversion therapy), Cohort 2 (postoperative adjuvant therapy), Cohort 3 (first-line therapy for advanced ESCC) and Cohort 4 (≥2 lines of therapy for advanced ESCC). The primary endpoint is the objective response rate in diverse treatment cohorts. Secondary endpoints include pathologic complete response rate, disease-free survival, progression-free survival, overall survival, adverse events, immune-related adverse events, quality of life and the intricacies of immunotherapy patterns and hyperprogression. Furthermore, exploratory endpoints scrutinise potentially predictive biomarkers, as well as the clinical and genomic characteristics inherent to ESCC patients if possible. The study endeavours to enrol 417 participants, subject to a comprehensive 5-year follow-up period.
We will collect and analyse real-world data from Chinese ESCC patients treated with PD-1 inhibitors to observe and describe the efficacy and safety of PD-1 inhibitors in Chinese patients with ESCC at various treatment stages.
Ethical approval was provided by the Ethics Committee for Medical Research and New Medical Technology of Sichuan Cancer Hospital, China (Approval No. SCCHEC-02-2023-096). Each participating hospital has applied for research permission from the Institutional Review Board of its unit. We will disseminate the results through peer-reviewed journals and academic conferences.
ChiCTR2300078657.
Workplace violence is a pervasive issue in healthcare systems, with nurses being among the most vulnerable healthcare professionals. Despite the recognition of high prevalence, the consequences and mechanisms of workplace violence on professional competency, particularly patient safety competency, warrant further investigation.
This study aimed to examine the relationships among workplace violence, organisational silence behavior, psychological resilience, and patient safety competency among Chinese nurses.
A descriptive cross-sectional correlational design was employed among a convenience sample of clinical registered nurses from public hospitals in Hunan Province, China. An online anonymous questionnaire was utilised to collect research data. SPSS statistical software was used to perform descriptive statistical analyses, Pearson correlation analyses, and mediation effects analyses.
A total of 1440 clinical registered nurses participated in this study, with physical assault being the most prevalent form. Pearson correlation analysis revealed a positive relationship between workplace violence and organisational silence behavior (r = 0.93, p < 0.001), and a negative relationship with psychological resilience (r = −0.84, p < 0.001) and patient safety competency (r = −0.89, p < 0.001). Mediation analysis indicated that organisational silence behavior mediated the negative relationship between workplace violence and patient safety competency, while psychological resilience moderated this association among nurses (All p < 0.05).
This study provides empirical evidence that workplace violence significantly impairs patient safety competency among nurses. The findings underscore the critical role of organisational silence behavior in mediating this relationship, while psychological resilience serves as a protective factor. Targeted interventions aimed at reducing workplace violence, fostering open communication, and enhancing psychological resilience are essential to safeguarding patient safety and improving healthcare quality.
This study offers valuable insights for the development and implementation of targeted support programs and intervention strategies to mitigate workplace violence and enhance patient safety in healthcare settings. Government agencies and healthcare institutions must prioritize preventing all forms of workplace violence against nurses, enhancing psychological resilience, and ensuring patient safety competency to improve healthcare quality and patient outcomes.
This study aimed to validate the mediating role of nurses' AI trust in the relationship between AI uncertainties and AI competence.
A cross-sectional study.
A purposive sample of 550 registered nurses with at least 1 year of clinical experience from three tertiary and two secondary hospitals in Jinan and Hangzhou, China, was used. Data were collected using structured questionnaires assessing AI uncertainty, trust and competence. Demographic data included gender, age, education level, years of clinical experience, professional title and hospital level. Mediation analysis.
Most nurses were from tertiary hospitals (88.9%), held a bachelor's degree (87.6%), and had over 6 years of experience. The mediating role of AI trust between AI uncertainties and AI competence is validated. AI uncertainties affected AI trust (B = 0.39, p < 0.0001), explaining 10% of the variance. AI uncertainties and AI trust affected AI competence (B = 0.25 and 0.67, p < 0.0001), explaining 63% of the variation. AI trust's total effect was 0.51, comprising direct and indirect effects of 0.25 and 0.26, respectively.
Hospitals can reduce uncertainty through an AI-transparent decision-making process, providing clinical examples of AI and training nurses to use AI, thereby increasing trust. Second, AI systems should be designed to consider nurses' psychological safety needs. Hospital administrators utilise optimised AI technology training and promotional techniques to mitigate nurses' resistance to AI and enhance their positive perceptions of AI competence through trust-building mechanisms.
Impact: Enhancing nurses' AI trust can reduce uncertainty and improve their competence in clinical use. Strategies such as transparency, explainability and training programmes are crucial for improving AI implementation in healthcare.
This study focused solely on clinical nurses and did not include patients or the public.
The study adhered to STROBE guidelines.
The optimal method for conducting spontaneous breathing trials (SBTs) remains a subject of ongoing debate. High-flow oxygen via endotracheal tube (HFOT) has emerged as a novel alternative for SBTs. However, studies investigating the associated physiological changes are lacking. Compared to high-flow nasal cannula (HFNC), HFOT has demonstrated diminished physiological effects, likely due to the bypassing of the upper airway, which may limit its widespread adoption as an SBT strategy. Two HFOT interfaces with different expiratory port diameters will be evaluated. It is hypothesised that the narrower interface would generate higher airway pressure and mitigate weakening physiological effects compared to the HFNC. This study aims to compare the physiological effects of two HFOTs compared to T-piece during SBTs.
This is a single-centre, prospective, physiological randomised crossover study in adult patients receiving mechanical ventilation for more than 24 hours who are deemed ready for SBT. After enrolment, each patient will be disconnected from the ventilator and undergo five SBT phases in random order: T-piece at 6 L/min, HFOT via interface with an expiratory port diameter of 9.8 mm at 40 L/min and 60 L/min and HFOT via interface with an expiratory port diameter of 6.9 mm at 40 L/min and 60 L/min. To reduce carryover effects, each phase will be separated by a 10-min washout period during which baseline mechanical ventilation is resumed. Key physiological parameters will be assessed in each study phase, including airway pressure, changes in end-expiratory lung volume, vital signs, oxygenation levels and inspiratory effort. Postextubation inspiratory effort will also be measured. Finally, 20 patients with the complete five SBT phases and postextubation datasets will be analysed
The study protocol has been approved by the Institutional Ethics Committee and Review Board of Beijing Shijitan Hospital, Capital Medical University (IIT2024-157-002). The data generated in the present study will be available from the corresponding author on reasonable request. The results of the trial will be submitted to international peer-reviewed journals.
The optimal blood pressure (BP) target for patients with heart failure (HF) remains a topic of debate. The relationship between out-of-office BP measurements and the prognosis of HF patients is still unclear. However, there is a lack of large-scale studies investigating out-of-office BP levels in Chinese populations with HF. This study aims to outline the rationale and design of the Out-of-Office Blood Pressure Measurements in Patients with Heart Failure registry (OOBPM-HF) study in China.
The OOBPM-HF study is a prospective, multicentre, observational cohort study involving participants recruited from 26 hospitals in China. Patents with relatively stable HF symptoms will undergo a screening process to determine their eligibility for study participation. Data from baseline clinical, laboratory and imaging examinations will be collected. BP parameters, including office BP, ambulatory BP and home BP, will be measured and documented. The primary endpoint of the study is the composite endpoint of death from cardiovascular causes and HF hospitalisation. Participants will be followed up for a duration of 18 months.
The study will establish a comprehensive understanding of the associations between out-of-office BP measurements and HF prognosis within the Chinese population. The findings of this study will provide valuable insights into the optimal BP range for patients with HF and will contribute to the management of BP in this patient group.
ChiCTR2400090786; Result.
Postoperative pulmonary complications (PPCs) induced by mechanical ventilation in general anaesthesia are related to poor clinical outcomes. Positive end-expiratory pressure (PEEP) is a key component of the lung protective ventilation strategy. Individualised PEEP guided by end-expiratory oesophageal pressure (Pes) to maintain a positive end-expiratory transpulmonary pressure can avoid alveolar collapse and improve the respiratory mechanics. However, there is no research studying the relationship between the Pes-guided PEEP titration and PPCs. The aim of our study is to investigate the potential role of Pes-guided PEEP titration on the incidence of PPCs and respiratory mechanics.
A total of 232 elderly patients undergoing major laparoscopic surgery under general anaesthesia will be recruited in four tertiary teaching hospitals in China. Patients will be randomly allocated to the control group (PEEP set at 3 cm H2O) without lung recruitment manoeuvres (RMs) or Pes-guided PEEP group with RMs in a 1:1 ratio. Preoperative preparation, anaesthesia management and postoperative care will be performed similarly in both groups. The primary outcome will be the development of PPCs within 7 days after surgery. The intraoperative respiratory parameters, the oxygenation index, vital signs and non-respiratory complications within 7 days after surgery, the 15-item Quality of Recovery-15 questionnaire, unplanned reintubation and unplanned transfer to the intensive care unit, hospital stay, perioperative plasma levels of lung injury biomarkers, complications within 30 days after surgery and 90-day mortality after surgery will be recorded and evaluated as the secondary outcomes.
The study has received ethics approval from the ethics committee of the Zhongshan Hospital, Fudan University (China) with the approval number B2023-334R. The results of the study will be submitted for publication in peer-reviewed journals.
Version 1, on 9 October 2023.
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