Conectar
by Weifeng Wang, Xianli Meng, Yan Zhao, Wei Gong, Xiaochen Jiang, Wenjuan Cao, Xueling Qiu, Chenxi Sun, Fan Sun, Yuchen Wang, Lu Tang
BackgroundTo alleviate pain in burn patients during dressing changes, it is necessary to identify an effective analgesic method. Conventional opioid analgesics have many limitations. Nitrous oxide is a fast-acting, safe and reversible inhaled analgesic gas. This systematic review will evaluate the effectiveness and safety of nitrous oxide in the treatment of pain during dressing changes in burn patients.
MethodThe protocol was developed according to the PRISMA-P checklist and registered on PROSPERO (CRD42024550197). A systematic search will be performed in the following databases: PubMed, EMBASE, Web of Science, Cochrane Library to identify clinical trials comparing nitrous oxide inhalation with standard care in pain management during dressing changes in burn wounds. The search of all databases will be conducted on October 15, 2025.Our search scope will include studies published between each database creation and search date.Two researchers will independently screen studies, extract data, and evaluate study quality using the Risk of Bias2 tool. Primary outcomes will include pain, anxiety, side effects, among others.R statistical software (version 4.3.1) and R studio will be used to perform meta-analyses.Effect size will be expressed by 95% confidence interval (Cl) of weighted mean difference (MD) and risk ratio (RR). Subgroup analyses and sensitivity analyses will be performed to explore sources of heterogeneity and assess the robustness of the results.Publication bias will be assessed using funnel plot and Egger test. We will use the Grading of Recommendation, Evaluation, Development and Evaluation (GRADE) to assess the quality of the evidence.
DiscussionOperative pain has always been a difficult problem for burn patients. This study will evaluate the analgesic effect of nitrous oxide on dressing change in burn patients through comprehensive search and rigorous methods, and provide evidence support for clinical decision-making.
Digital Creative Art Interventions (DCAIs) are innovative approaches to art interventions using digital technology, which can improve older adults' health. However, a comprehensive summary of the implementation of this intervention among older adults is lacking.
To summarise the deliveries and categories of DCAIs, review their feasibility and roles in older adults' healthcare, and explore the barriers and facilitators to implementing DCAIs in older adults.
Scoping review.
This scoping review followed Arksey and O'Malley's framework, and PRISMA-ScR was used to guide the report.
PubMed, Embase, EBSCOhost, Web of Science and Cochrane Library on 26 February 2024.
Thirty-one studies were selected in this review. We summarised the deliveries and categories of DCAIs in older adults. Besides, we cleared DCAIs to offer music, dance, museum, photo collage, drama, visual art interaction and mixed art intervention to older adults, primarily through videoconferencing or mobile applications. The five health promotion roles were physiological health enhancer, psychological caregiver, socialisation supporter, cognitive promoter and life optimiser. Most older adults believed DCAIs were not only feasible and acceptable, but they also met some barriers such as technological problems, problems brought about by older adults' decline in functioning, experience and privacy.
Despite the unique advantages of DCAIs, continuous improvements are needed. In the future, researchers and healthcare workers should focus on platform improvements, increasing interactivity, diversifying formats and ensuring security and privacy.
This review found that DCAIs offered new approaches to treatment options for older adults' physical and mental health. Therefore, it is recommended that they be continuously optimised and put into clinical practice.
No patient or public contribution.
This study summarised the DCAIs and provides the new approach for health promotion in older adults.
OSF (https://osf.io/m62x9/, registration DOI: https://doi.org/10.17605/OSF.IO/4ZGE6)
To analyse how refined living arrangements, in the context of digital access, affect elderly healthcare resource utilisation and satisfaction with healthcare needs.
A prospective cohort study. The study reporting is conformed to the STROBE checklist.
This longitudinal study utilised data from the 2018–2020 waves of the United States-based Health and Retirement Study and the 2013–2015 waves of the China Health and Retirement Longitudinal Study.
Baseline living arrangement was categorised into living alone, intergenerational living, living with spouse, nuclear living and proximate residence. Unmet healthcare needs at follow-up waves (i.e., 2020 wave of Health and Retirement Study and 2015 wave of China Health and Retirement Longitudinal Study) were classified into unmet clinical care needs and unmet preventive care needs, which were measured using three measurements on whether the participant had disorders, whether the participants use any clinical care, and whether the participants use any preventive care. Digital exclusion was assessed using a single question about internet access at baseline.
A total of 7116 participants from the China Health and Retirement Longitudinal Study cohort (female: 48.6%, mean age: 57.4 years) and 7266 from the Health and Retirement Study cohort (female: 64.9%, mean age: 65.1 years) were included. Compared with older adults living a nuclear arrangement, those living an inter-generational arrangement with digital exclusion had higher clinical care utilisation, but not necessarily lower risk of unmet clinical needs; they also had lower preventive care utilisation in the Health and Retirement Study cohort, while living with spouse led to higher preventive care utilisation in the China Health and Retirement Longitudinal Study cohort.
Living arrangements can affect older adults' healthcare utilisation and unmet healthcare needs, which can be moderated by digital exposure.
These findings suggest that healthcare providers should tailor care strategies by considering both living situations and digital literacy. Enhancing digital access, especially for those in inter-generational households, could help address unmet healthcare needs and improve overall care satisfaction.
This study using the STROBE CHECKLIST for reporting guideline.
No patient or public contribution.
By comparing data from both the United States and China, it highlights the importance of considering family structure and digital inclusion when addressing healthcare needs globally. The findings suggest that older adults in inter-generational living arrangements without digital access face higher clinical care demands but still struggle with unmet healthcare needs. This underscores the need for healthcare systems worldwide to address digital exclusion and adapt care strategies to individual living circumstances to enhance healthcare outcomes for the elderly population.
To explore the perspectives of community-dwelling older adults with sarcopenia on exercise engagement and adherence.
Sarcopenia is prevalent among community-dwelling older adults and is associated with a wide range of adverse health outcomes. Encouragingly, it is a treatable and potentially reversible condition through exercise interventions. However, studies on this population's views on exercise are scant, thus limiting the design and delivery of tailored, sustainable exercise interventions in primary care.
A descriptive qualitative study.
Data were collected through semistructured interviews with 27 community-dwelling older adults with sarcopenia from four community care centres in China between October 2023 and February 2024. The data were analysed using thematic analysis.
Four main themes with their respective subthemes were identified from the data analysis and described as: (1) limited capability to identify and engage in appropriate exercise; (2) various motivations influenced by personal values, resilience and habits; (3) exercise behaviour shaped by environmental and social factors; (4) expectations for community-based exercise programmes.
Older adults with sarcopenia often misbelieve muscle issues to be normal ageing, leaving their condition undiagnosed and unmanaged. Limited information about appropriate exercises leads them to engage in simple, unstructured activities. Motivation levels and contextual factors influence their exercise engagement and adherence. Nurse-led tailored, evidence-based and group-based programmes, complemented by home-based exercise resources, are needed to address challenges and support long-term adherence.
This study provides new insights into the perspectives, challenges and expectations of exercise in this specific population. Findings inform nurse-led exercise programmes in primary care that meet the needs and preferences of this population.
This study follows the Consolidated Criteria for Reporting Qualitative Studies.
Participant interviews offered valuable perspectives on exercise engagement and adherence.
To evaluate health outcomes and identify risk factors for reinfection and persistent symptoms among COVID-19 survivors 4 years after hospital discharge.
Longitudinal cohort study.
Two hospitals in Wuhan, China.
1076 COVID-19 survivors discharged from hospital.
Self-reported symptom questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test, Hospital Anxiety and Depression Scale and Checklist Individual Strength (CIS) fatigue subscale. Long covid was defined according to WHO criteria.
Median age was 58 years and 50.2% were male. Reinfection during December 2022–April 2023 occurred in 36.1%; 21 developed pneumonia and 14 required hospitalisation. At least 12 months after reinfection, 12.1% reported sequelae compared with 46.9% after the initial infection. At 4 years, 16.7% reported long covid symptoms, commonly fatigue, chest tightness, cough and dyspnoea. In multivariable analysis, risk factors for abnormal fatigue (CIS ≥27) included age (OR 1.020, 95% CI 1.007 to 1.034; p=0.003), reinfection (OR 2.393, 95% CI 1.708 to 3.352; p
At 4 years post discharge, symptom burden was lower than at earlier follow-up time points for most survivors. Reinfection and older age were associated with persistent symptoms.
by Vu Nhi Ha, Le Chi Cao, Tran Hai Dang, Dao Thi Huyen, Nguyen Tien Dung, Le Huu Song, Nguyen Linh Toan, Truong Nhat My, Thirumalaisamy P. Velavan
BackgroundHepatitis E virus (HEV) causes sporadic outbreaks worldwide, with zoonotic and waterborne genotypes contributing to infections. In Vietnam, HEV genotypes 3 and 4 circulate among humans and swine, but data from remote, ethnic minority populations remain limited.
MethodsA cross-sectional study was conducted among 272 ethnic minority students at Thai Nguyen University of Medicine and Pharmacy (TUMP) to determine HEV infection markers and associated risk factors. Anti-HEV IgM and IgG were tested in serum samples using Wantai ELISA kits, and HEV RNA was detected by nested PCR targeting the ORF1 region. Demographic and exposure data were collected via structured questionnaires. Statistical analyses were performed using binary logistic regression.
ResultsOne participant (0.37%) tested positive for anti-HEV IgM, and 69 (25%) were positive for anti-HEV IgG, while HEV RNA was undetectable. HEV-IgG seroprevalence increased significantly with age (p = 0.004) but showed no sex-related differences. Consumption of tap or mixed water sources (p = 0.043) and raw or undercooked pork liver (p = 0.018) were significantly associated with HEV-IgG positivity. Multivariate analysis confirmed these factors as independent predictors of prior HEV exposure (adjusted OR = 1.6 and 4.8, respectively).
ConclusionsA moderate HEV seroprevalence among ethnic minorities indicates substantial prior exposure in northern Vietnam. Strengthening water sanitation, food safety awareness, and routine HEV surveillance is recommended to mitigate infection risk in vulnerable communities.
Single-modality motor rehabilitation is often insufficient to address the complex functional restoration needs of patients with chronic ankle injuries following surgery. Research indicates that non-invasive neuromodulation techniques, such as intermittent theta-burst stimulation (iTBS), may enhance motor recovery by increasing cortical excitability and facilitating neural network reorganisation. Compared with exercise therapy alone, this study aims to explore the rehabilitation efficacy of combining iTBS with exercise therapy in patients with chronic ankle injuries following surgery. It also investigates the associated cortical network modulation, providing scientific evidence to optimise rehabilitation strategies for these patients.
This study is a prospective, multicentre, randomised controlled trial with single-blind assessment. A total of 28 patients with chronic ankle injuries following surgery were enrolled and randomly assigned to either the experimental group or the control group according to centre-stratified randomisation. The experimental group will receive iTBS combined with exercise therapy, while the control group will receive sham iTBS combined with exercise therapy. Both groups will undergo one session per day, 5 days per week, for a total of 3 weeks. The primary outcome measure will be the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS). Secondary outcome measures will include isokinetic muscle strength assessment of the ankle dorsiflexor and plantarflexor muscles, Visual Analogue Scale (VAS) scores, ankle joint range of motion (ROM) and the 10-Metre Walk Test. Functional near-infrared spectroscopy (fNIRS) and transcranial magnetic stimulation (TMS) will also be used to assess cortical functional activity and neurophysiological changes. All outcome measures will be collected at baseline prior to enrolment, post-intervention at week 3, and at follow-up at week 6. Primary outcomes analyses will use group-by-time comparisons to examine between-group differences in functional and neurophysiological measures.
The study has received approval from the Medical Ethics Committee of Jiangsu Province (Suqian) Hospital (Application No. 2025-SR-0333). All participants will provide written informed consent before enrolment. Results will be disseminated through peer-reviewed journals and scientific conferences.
ChiCTR2500110905.
V1.0.
This study aims to explore occupational burnout among Chinese nurses from two perspectives: first, by comparing changes in emotional exhaustion, depersonalisation and personal accomplishment before and after the COVID-19 pandemic; and second, by identifying long-term work-related stressors and structural factors contributing to burnout.
A mixed-methods approach was adopted, combining a systematic review with qualitative interviews. The qualitative component involved semi-structured interviews with 53 hospital-employed nurses from various departments and regions across China, focusing on the three core dimensions of occupational burnout.
The systematic review included both Chinese and English-language studies published between 2016 and 2023 that used the Maslach Burnout Inventory to assess burnout among nurses. A total of 22 studies met the inclusion criteria, selected independently by two researchers using the JBI critical appraisal tool. In parallel, the qualitative interviews explored nurses' subjective experiences and coping strategies related to work stress, emotional fatigue and professional identity.
Bayesian factor analysis indicated no significant differences in emotional exhaustion (BF01 = 2.202), depersonalisation (BF01 = 2.761) or personal accomplishment (BF01 = 2.747) before and after the pandemic. Qualitative findings revealed that burnout was primarily driven by long-standing systemic stressors, including promotion pressure, clinical workload, organisational demands and work–family conflict. Although many nurses relied on self-regulation strategies to maintain psychological stability, they continued to experience ongoing physical and emotional exhaustion. Some reported emotional numbness, but most retained empathy and a strong sense of responsibility. Their sense of personal accomplishment often stemmed from patient recovery and recognition of professional value.
Occupational burnout among Chinese nurses remained largely stable before and after the COVID-19 pandemic. Its root causes stem from persistent work-related stressors and systemic issues, rather than the pandemic itself. Effective mitigation requires institutional strategies, including better staffing, clear career pathways and sustained emotional support.
Short-term crisis responses alone are insufficient to address enduring burnout. Nursing leadership should prioritise systemic reforms—such as optimising shift schedules, defining promotion channels and integrating regular psychological support—to enhance nurse well-being and care quality.
No patient or public contribution.
Cough, a prevalent and debilitating symptom of lung cancer, remains poorly managed. Accumulating evidence on non-pharmacological interventions for lung cancer cough necessitates systematic evaluation to assess their efficacy.
To synthesise evidence on non-pharmacological interventions for managing cough in lung cancer patients.
A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guideline.
Nine databases were searched from inception to December 2024 to identify randomised controlled trials. Study quality was appraised using the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. Meta-analyses were performed for quantitative synthesis, with sources of heterogeneity examined using meta-regression and subgroup analyses.
Thirty-eight studies representing 2995 lung cancer patients were identified. These studies investigated acupuncture therapy, moxibustion, pulmonary rehabilitation, self-management intervention, physical exercises, psychoeducation support, mindfulness, and multicomponent interventions. Non-pharmacological interventions showed positive effects on cough severity and cough-related quality of life. Additional benefits were observed for expectoration, dyspnea, and general quality of life. Pulmonary rehabilitation showed a greater effect on cough severity than other non-pharmacological interventions.
Non-pharmacological interventions are promising in improving cough, expectoration, dyspnea, and general quality of life among lung cancer patients. Pulmonary rehabilitation showed the most promising effect. Future research should adopt objective cough measures in addition to self-reported measures.
Non-pharmacological interventions demonstrated potential effects in relieving cough and additional benefits in improving expectoration, dyspnea, and general quality of life among lung cancer patients. Healthcare professionals may adopt pulmonary rehabilitation for cough and related symptoms in lung cancer patients.
As the first meta-analysis addressing non-pharmacological interventions for lung cancer cough, this study provides evidence supporting their clinical efficacy for improving cough and associated symptoms among patients with lung cancer.
No patient or Public contribution.
PROSPERO CRD42024588729.
Obtaining clean-catch urine (CCU) samples from non-continent infants is a common clinical challenge due to low urine volume and irregular urination. Non-invasive stimulation techniques, such as the bladder stimulation technique (BST) and the Quick-Wee method, have been proposed to improve success rates and reduce contamination. However, the supporting evidence remains inconsistent, and no multicentre randomised trials have directly compared the effectiveness and safety of Quick-Wee, BST and standard CCU.
The study will enrol 342 infants aged 1–12 months requiring urinalysis, recruited from paediatric wards across three tertiary hospitals in China. Eligible participants will be randomly assigned in a 1:1:1 ratio to one of three intervention groups: BST, Quick-Wee or standard CCU. The primary endpoint is the success rate of urine collection within 5 min of intervention. Secondary endpoints include time to urination, 5 min urination rate, infant discomfort scores, parental and clinician satisfaction, and urine contamination rates. Safety will be evaluated by monitoring the incidence of adverse events.
This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 114/2025). Written informed consent will be obtained from all participants’ parents prior to enrolment. Study findings will be published in peer-reviewed journals and presented at relevant conferences. Individual participant data will be kept strictly confidential and securely stored in compliance with data protection regulations.
ChiCTR2500098691.
To identify obstacles faced by nurses when using health technologies in Intensive Care Units (ICUs).
Systematic review following PRISMA and registered in PROSPERO.
Six databases were searched. Two reviewers independently screened studies and appraised methodological quality using the Joanna Briggs Institute tool. Data were synthesized narratively.
Eight studies met eligibility criteria. Barriers clustered around limited training and technical competence, shorter professional experience, increased workload with multiple devices, organizational culture, and reduced direct patient contact, which may undermine patient-centered care. Heterogeneity of study designs precluded meta-analysis.
Obstacles to technology use in ICUs arise from individual and organizational factors. Addressing these barriers requires structured education, mentoring for novice nurses, workload management, and supportive policies that integrate technology without displacing bedside care.
Nursing leaders and educators should implement ongoing, ICU-specific technology training and mentoring. Managers and policymakers must ensure adequate staffing and promote Health Technology Assessment to align device implementation with clinical needs, safeguarding patient safety and the human dimensions of care.
This study aims to evaluate relationships between self-reported fine motor ability and quality of life (assessed by life satisfaction and life problems) from people with spinal cord injury (SCI) at T1 and above.
Observational cohort study (current analysis from a cross section)
279 individuals with SCI at T1 or above
Community members sampled from records from two Midwestern hospitals and a speciality hospital in the Southeast United States
Fine motor ability was assessed via the Spinal Cord Injury Functional Index-Short Form 9A, while two facets of quality of life, life satisfaction and life problems, were assessed by the Life Situation Questionnaire-Revised version (LSQ-R). Pearson correlations and multivariate analysis were utilised to identify cross-sectional relationships between fine motor ability, life satisfaction and life problems.
Fine motor ability was positively correlated with total life satisfaction score (r=0.16; p=0.02) and was negatively correlated with the total life problems score (r=–0.18; p=0.01), health problems factor (r=–0.24; pβ=0.25; p=0.02), fewer life problems (β=–0.40; pβ=–0.11; pβ=–0.10; p
The results identified significant, modest associations between self-reported outcomes, as better fine motor ability was related to less social isolation, fewer health problems and higher life satisfaction. Further investigation into the relationship between fine motor ability, life satisfaction and life problems is warranted.
We aimed to identify the barriers and facilitators to participation in interventions aimed at improving cognitive function among older adults with type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) in rural areas.
This study is the qualitative phase of a larger randomised controlled trial and employs a descriptive approach.
We conducted in-depth, semi-structured face-to-face interviews with older adults diagnosed with T2DM and MCI in rural areas of China in November 2023. The interviews were guided by the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). The interview recordings were transcribed and analysed using NVivo V.11 software. Two research assistants independently coded the transcriptions, and the identified barriers and facilitators were mapped to the corresponding domains within the COM-B model and TDF.
A total of 26 older adults, aged 60–87, participated in the interviews. Nine themes were identified, including disease awareness, disease attitude, social interaction, responsibility and health, emotion guidance, organisational management, expertise and benefits, self-perception and role identity crisis. These themes mapped onto the three core components of the COM-B model as well as the nine domains of the TDF, which include: knowledge, environmental context and resources, social influences, intentions, emotions, reinforcement, beliefs about consequences, beliefs about capabilities and social identity.
Addressing barriers and leveraging facilitators can effectively enhance the willingness of elderly patients in rural areas to participate in interventions aimed at improving cognitive function. A multi-layered approach should be adopted, focusing on disease knowledge and attitudes, social interactions, the impact of the disease burden on both family and individuals, emotional state, organisational management, team expertise and timely assessment, individual self-efficacy and role perception.
The study adheres to the COREQ reporting guidelines.
The participants in this study were older adults with T2DM and MCI from rural areas. Participants were involved in the development of the interview guide and were subsequently interviewed regarding the facilitators and barriers to their participation in cognitive function interventions.
Postoperative ileus (POI) is a common complication after colorectal surgery, characterised by impaired gastrointestinal motility leading to abdominal distension, delayed flatus and defecation, nausea and vomiting. Self-abdominal massage (SM) can promote bowel peristalsis, but its clinical efficacy on improving colorectal cancer patients with POI treated with an intestinal decompression tube remains to be further verified. Therefore, this study aims to evaluate the efficacy and safety of SM in improving gastrointestinal function in colorectal cancer patients with POI treated with an intestinal decompression tube.
This is a prospective, single-centre, randomised controlled, assessor-blinded and statistician-blinded trial. A total of 102 colorectal cancer patients with POI undergoing intestinal decompression tube placement will be recruited. Participants will be randomised in a 1:1:1 ratio to receive basic treatment (BT), BT plus SM (BT-SM) or BT plus simple physical stimulation (BT-SPS). The primary outcome is the time to first defecation after intestinal decompression tube placement. Secondary outcomes include time to first flatus, radiological evaluation, time to tolerability of semiliquid and solid foods, severity of nausea, vomiting, pain and abdominal distension, analgesic consumption, time to intestinal decompression tube removal, incidence of complications and adverse events after intestinal decompression tube placement. Outcome measures are collected at baseline, at 1, 2, 3 and 4 days after the end of the intervention. The primary time point will be 4 days postintervention.
This study has been approved by the ethical application of the Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine Ethics Committee (2025-K-49-01). All patients will be required to provide informed consent. Study results will be disseminated through publication in peer-reviewed journals and international conferences.
ITMCTR2025001401.
To investigate the impact of residual refraction within ±1.0 dioptre (D) on uncorrected distance visual acuity (UDVA) in pseudophakic eyes.
Cross-sectional study.
This study was based on retrospectively collected electronic refraction records from a tertiary care academic ophthalmology centre in southern China between May 2022 and July 2025.
Patients aged ≥40 years who underwent uneventful phacoemulsification cataract surgery with in-the-bag monofocal intraocular lens implantation and achieved a postoperative corrected distance visual acuity (CDVA) of ≤0.1 logarithm of the minimum angle of resolution were enrolled. They were stratified by astigmatism subtypes: minimal astigmatism (
Postoperative evaluation (≥1 month) included spherical equivalent (SE) refraction, UDVA and CDVA. UDVA was compared across eyes with SE intervals of 0.50 D within ±1.0 D. ORs were calculated to assess the relative risk of failing to achieve a UDVA of 0.1 or better for postoperative SE within ±1.0 D, using 0.00 D as the reference.
The study included 1333 eyes from 1333 patients (mean (SD) age, 66.1 (8.96) years; 532 male (39.9%)). Overall, and particularly in the minimal astigmatism (
The impact of refractive errors (≤1.0 D) on UDVA was associated with the magnitude and type of astigmatism. Residual astigmatism of ≥0.50 D exerted a significant negative effect on UDVA. A plano SE (0 D) was optimal for minimum and WTR astigmatism, whereas slight hyperopia yielded superior UDVA in ATR and oblique astigmatism.
To explore experiences of healthcare providers, stroke survivors and caregivers on stroke transitional care delivery at a tertiary hospital in Tanzania.
A qualitative descriptive design with a phenomenological approach was used. Colaizzi’s thematic analysis was conducted using Dedoose software to identify significant information that describes the transitional care experiences of the study participants.
This study was conducted in the internal medicine and outpatient departments of a tertiary hospital in Tanzania.
15 triads of healthcare providers, stroke survivors and caregivers were purposively recruited to participate in semi-structured in-depth interviews between June and September 2024.
The analysis identified four themes: communication and exchange of information, involvement of patients and caregivers in transitional care, coordination of transitional care and experiences with changing care setting. Effective communication and information exchange among healthcare providers, survivors and caregivers ensured that survivors and their caregivers were well informed about the care process, clinical condition, prognosis and transitional care needs. A collaborative care approach enabled survivors and caregivers to actively participate in care, decision-making and discharge planning during hospital-to-home transition. Coordination of care was equally important during hospital-to-home transition as it provided survivors with home-care instructions and opportunities for follow-up care. However, miscommunication among the healthcare team, insufficient information exchange, inadequate discharge planning, poor social support and lack of care coordination prevented smooth hospital-to-home transition leading to a crisis at home.
The experiences of healthcare providers, patients and caregivers during stroke transitional care in Tanzania highlight achievements and key areas for improvement. Hospital-to-home transition is often characterised by uncertainty and emotional strain, emphasising the need for effective communication, involving patients and caregivers in care, as well as coordinating transitional care to address medical and psychosocial needs of survivors and their caregivers during and after discharge.
Patient self-testing (PST) for warfarin management is well-established in developed countries but remains underused in developing regions. This study compared the safety and effectiveness of PST with usual care (UC) in China.
A multicentre, open-label, randomised, controlled trial.
A total of five centres participated in this study, including one provincial tertiary hospital, two municipal tertiary hospitals and two primary hospitals.
Patients undergoing mechanical heart valve (MHV) replacement at five centres were prospectively enrolled. Patients were trained and stratified according to time on warfarin at enrolment and were randomly assigned to the PST or UC group.
The PST group used a point-of-care testing device for at-home international normalised ratio (INR) monitoring with pharmacist-guided warfarin dosing, while the UC group attended outpatient clinics for INR monitoring and dosing.
The primary outcome was the difference in time in therapeutic range (TTR). The secondary outcomes were incidences of major bleeding, thromboembolism and all-cause deaths in 12 months.
From March 2021 to March 2023, a total of 556 patients were enrolled, with a mean age of 47.5 years, 45.1% being male. 342 were newly initiating warfarin therapy, while 214 had been on warfarin for over 6 months. Baseline characteristics were similar between the PST and UC groups. The PST group showed significantly higher TTR (67.2% vs 55.1%, p
A pharmacist-led PST intervention with ongoing education and counselling led to improved TTR and clinical outcomes in patients with MHV in China.
China Clinical Trial Registry (ChiCTR2000038984).
Skin temperature, including absolute temperature (at bony prominence areas under long-term compression) and relative temperature (the difference between bony prominence and adjacent control area), may serve as early warning indicators for PI. However, the optimal indicator remains unclear. This meta-analysis therefore synthesises evidence on their association with PI risk to identify the best indicator and evaluate its early-warning accuracy.
Systematic review and meta-analysis.
We included prospective cohort studies of adult patients investigating longitudinal associations between skin temperature and subsequent PI development. We pooled standardised mean difference (SMD) and odds ratios, complemented by summary receiver operating characteristic (SROC) curve analysis. The overall quality of evidence was evaluated using the GRADE method.
We researched PubMed, Embase, CINAHL, Cochrane Library (CENTRAL), Wanfang and CNKI databases from inception to September 25, 2024.
After screening 1354 titles and abstracts, ten studies comprising 1742 participants were included in the final synthesis. No significant difference in absolute temperature (combined SMD) was found between the PI and non-PI groups (seven studies included). In addition, decreased relative temperature (< −0.1°C) was associated with a 16-fold increased likelihood of PI (95% CI 6.38–40.19, I 2 = 79.4%) (three studies included), with the SROC curve analysis showing an AUC of 0.776. According to GRADE, the evidentiary certainty was very low for AT and low for RT.
Relative temperature is significantly related to the risk of PI, supporting its role as a promising early warning indicator. Future studies should establish a standardised measurement protocol to facilitate its clinical application.
Monitoring skin temperature changes holds promise as a non-invasive tool for early warning of PI risk. However, the amount and quality of available evidence limit our confidence in these findings, underscoring the need for further research before a definitive conclusion can be drawn.
This study followed PRISMA guidelines.
No patient or public contribution.
PROSPERO CRD42024550099
FreshRSS 