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☐ ☆ ✇ BMJ Open

Health behaviours in patients with lower limb deep vein thrombosis following hip or knee arthroplasty: latent profile analysis and influencing factors based on a cross-sectional study in Urumqi, China

Por: Hu · N. · Tang · X. · Yang · M. · Li · Y. · Yan · P. · Li · Y.-l. — Enero 7th 2026 at 04:50
Objective

This study aims to categorise health behaviours in patients with lower limb deep vein thrombosis and explore the factors that influence these behaviours.

Design

A cross-sectional study.

Setting

This study was conducted in four tertiary general hospitals in Urumqi, China.

Participants

This study included a total of 544 participants.

Primary and secondary outcome measures

Self-rated abilities for health practices, health behaviour motivation, social support and health behaviour were the primary outcome measures.

Results

Model 3 demonstrated superior fit across indices, supported by an Entropy value of 0.806 and a significant bootstrap likelihood ratio test (p

Conclusion

Three latent health behaviour subgroups, namely low, moderate and good, were identified among patients with lower limb deep vein thrombosis following hip or knee arthroplasty. Self-rated abilities for health practices, health behaviour motivation and social support were associated with these subgroups. These findings may provide preliminary insights for developing targeted interventions to support health behaviour improvement in this patient population.

☐ ☆ ✇ BMJ Open

Adjunctive Tongxinluo capsule for patients with acute coronary syndromes undergoing percutaneous coronary intervention: a GRADE-assessed systematic review and meta-analysis of randomised controlled trials

Por: Liang · S.-B. · Wang · Y.-F. · Li · Y.-F. · Chen · W.-J. · Zhu · Y.-S. · Hua · Z. · Zheng · H.-M. · Niu · Z.-C. · Robinson · N. · Liu · J.-P. · Li · Y.-L. — Diciembre 30th 2025 at 15:31
Background

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.

Methods

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.

Results

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.

Conclusion

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.

PROSPERO registration number

CRD42024509453.

☐ ☆ ✇ BMJ Open

Effect of qigong on sleep quality and hyperarousal in patients with chronic insomnia: a study protocol for a multi-centre randomised controlled trial

Por: Cui · J. · Han · H. · Yue · H. · Xie · C. · Ma · J. · Xie · F. · You · Y.-l. · Yao · F. — Diciembre 25th 2025 at 05:45
Introduction

Chronic insomnia is a pressing public health issue that significantly affects patients’ quality of life. In China, Prolong Life With Nine Turn-Method (PLWNT) Qigong exercise has long been used to improve sleep quality, yet evidence that supports its efficacy for chronic insomnia treatment remains lacking. The aim of this study is to evaluate the effectiveness and safety of the PLWNT qigong exercise for treating chronic insomnia and its relationship with hyperarousal.

Methods and analysis

This multi-centre randomised controlled trial will recruit 348 eligible patients from three hospitals in Shanghai. Participants will be randomly assigned to either the treatment group (PLWNT qigong exercise) or the control group (cognitive behavioural therapy). The treatment will occur once a week for 12 weeks, followed by an 8-week follow-up phase. The primary outcome is the change in the total Pittsburgh Sleep Quality Index (PSQI) score from baseline to week 12. The secondary outcomes are the scores on the Hyperarousal Scale (HAS), Insomnia Severity Index (ISI), Multidimensional Fatigue Inventory 20 (MFI-20), Hospital Anxiety and Depression (HADS), Medical Outcome Trust 36–Item Short Form Health Survey (SF–36) and Gastrointestinal Symptom Rating Scale (GSRS), gut microbiota, actigraphy, sleep diary, cortisol, adrenocorticotrophic hormone, corticotropin-releasing hormone, polysomnography and functional MRI. All adverse events during the trial will be promptly recorded and assessed. The PSQI, HAS, ISI, MFI-20, HADS, SF–36 and GSRS will be evaluated at baseline, 6 weeks post-treatment and 12 weeks post-treatment, as well as at the 4- week and 8- week follow-ups. Other outcomes will only be evaluated at baseline and 12 weeks post-treatment.

Ethics and dissemination

The trial has been approved by the Ethics Committee of the Shanghai Municipal Hospital of Traditional Chinese Medicine (2024SHL-KY-92–01). Written informed consent was obtained from all participants before their involvement in the trial. Results of this study will be published in peer-reviewed journals or at conferences.

Trial registration number

ITMCTR2024000534.

☐ ☆ ✇ BMJ Open

Longitudinal trends in burnout among healthcare professionals during the COVID-19 pandemic: a 4-year prospective cohort study in a tertiary medical centre in Taiwan

Por: Lee · S.-Y. · Hsu · W.-T. · Ho · W. C. · Lin · Y.-L. · Lin · C.-F. · Wang · C.-L. · Ho · H.-E. · Fu · P.-K. · Chu · W.-M. · Tsan · Y.-T. — Noviembre 28th 2025 at 03:17
Objectives

This study aimed to investigate the evolution of burnout levels and cardiovascular risk among healthcare professionals during the COVID-19 pandemic, identifying associated risk factors, with a particular focus on the impact of working hours, job roles and working units.

Design

A longitudinal, observational study was conducted.

Setting

The study was carried out in a medical centre in central Taiwan, encompassing various healthcare settings.

Participants

A total of 1502 healthcare workers participated, including nurses, medical technicians, resident doctors, attending physicians and administrative staff. Participants were selected based on consistent completion of a 4-year questionnaire, with exclusion criteria for those who did not complete.

Primary and secondary outcome measures

The primary outcome measured was burnout levels using the Chinese version of the Copenhagen Burnout Inventory. The secondary outcome was cardiovascular risk calculated from employees’ health check-up data using the Framingham Risk Score.

Results

Cardiovascular risk showed an upward trend over 4 years. Personal and work-related burnout significantly decreased from 2019 to 2020 but increased from 2020 to 2022, aligning with changes in weekly working hours. Nurses exhibited the most pronounced fluctuations, likely due to their younger average age, shorter professional tenure and frequent direct patient contact, which may heighten vulnerability to pandemic-related stressors. In contrast, attending physicians demonstrated age as a protective factor against burnout, as greater seniority, clinical experience and professional maturity may buffer stress and foster resilience. Participants who worked in COVID-related units generally had elevated burnout levels and working hours. During the initial outbreak in 2020, employees working in COVID-related units had reduced working hours but stable burnout levels, while employees in non-COVID-related units experienced decreased burnout.

Conclusions

This study highlights the critical impact of long working hours on burnout among healthcare professionals during the COVID-19 pandemic. Nurses emerged as a vulnerable group, sensitive to pandemic-induced changes, while attending physicians exhibited more resilience. COVID-related units face greater stress and are less likely to benefit from reductions in patient numbers and working hours during the pandemic. Our findings underscore the urgent need for tailored interventions, such as regulated work hours, flexible scheduling and enhanced organisational and peer support, to protect healthcare workers’ well-being. These strategies can strengthen workforce resilience and sustainability in future public health crises.

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