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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
Norepinephrine (NE) and phenylephrine (PE) are routinely administered vasopressors used to maintain haemodynamic stability during caesarean section. Emerging evidence suggests that sustained infusion of these agents may disrupt maternal blood glucose regulation. This randomised controlled trial aims to compare the effects of NE and PE infusion on changes in postpartum blood glucose levels, insulin concentrations and insulin resistance in women after caesarean delivery.
In this double-blind, randomised trial, 100 eligible parturients will receive prophylactic intravenous infusion of either NE or PE at a rate of 30 mL/hour immediately after subarachnoid anaesthesia, continuing until the end of surgery. The primary outcome is the difference between maternal preoperative and immediate postoperative blood glucose levels. Secondary outcomes include immediate and 6-hour postoperative insulin levels, as well as Homeostasis Model Assessment of Insulin Resistance.
The Institutional Ethics Committee of Xuancheng People’s Hospital approved the trial protocol (ID: 2025-yjky022-02). Findings will be published in an appropriate journal, and original data will be made available in November 2029 via the ResMan primary data-sharing platform of the China Clinical Trial Registry (http://www.medresman.org.cn).
ChiCTR2500107683.
To advance the understanding of chronic illness self-management among Chinese immigrants in Western countries by synthesising evidence and through the lens of the Middle Range Theory of Self- and Family Management of Chronic Illness.
Integrative review following Whittemore and Knafl.
Two reviewers used Covidence software to screen potential articles. After identifying the sample, reviewers extracted data into a matrix and appraised study quality using Critical Appraisal Skills Programme checklists. Reviewers used the constant comparative method to categorise data into categories: (1) facilitators/barriers, (2) processes and (3) outcomes. Findings were then synthesised and mapped to the theory domains.
MEDLINE, CINAHL, Web of Science, Embase, PsycINFO and ProQuest Central (database inception—August 2025).
Of 3205 records screened, 20 studies met the inclusion criteria with acceptable quality. Personal characteristics/health status, resources/environment, Chinese-Western cross-cultural experiences, family and healthcare systems, and linguistic barriers shaped the processes of Focusing on Illness Needs (developing illness insights, taking ownership of health needs, and health promotion); Activating Resources (Western health care, traditional Chinese practices, community and family support, and blended spiritual resources); and Living with a Chronic Illness (processing emotions, adjusting, integrating, and meaning-making). These processes lead to outcomes including improved disease control, psychological/cognitive well-being, and healthcare utilisation and unintended negative consequences such as emotional burden and delayed care-seeking.
While Chinese immigrants share certain aspects of self-management with Western populations, their approaches are shaped by culturally grounded, family-centred values, traditional health practices, and immigrant experiences, which underscore the need for culturally and contextually sensitive self-management support. The findings also expand the applicability of the guiding theory by identifying new cultural elements.
Nurses can support self-management among Chinese immigrants by developing culturally and linguistically tailored interventions, engaging family members in health education and treatment planning, enhancing accessible digital, community and navigational resources, providing language assistance and strengthening staff training.
We used the PRISMA 2020 checklist for adherence to review protocols.
This study did not include patient or public involvement in its design, conduct or reporting.
To examine bronchopulmonary dysplasia (BPD) epidemiological data in Chinese very preterm infants and compare agreement between four diagnostic definitions and their predictive accuracy for discharge outcomes.
Observational epidemiologic study of a multicentre cohort of the Chinese Neonatal Network (CHNN).
Tertiary neonatal intensive care units participating in the CHNN.
42 664 preterm infants born at
BPD was diagnosed using four definitions: Shennan 1988, the National Institute of Child Health and Human Development (NICHD) 2001 and 2018, and the Neonatal Research Network (NRN) 2019 definitions. BPD prevalence and severity were examined. Agreement was assessed using kappa statistics. Predictive accuracy for discharge outcomes was evaluated using c-statistics from multivariable generalised estimating equation models.
Among 42 664 infants (mean gestational age, 29.0 weeks; 43.1% females), BPD prevalence varied significantly: Shennan 1988: 37.0%, NICHD 2001: 51.1%, NICHD 2018: 37.0%, NRN 2019: 37.0%. NICHD 2001 and 2018 definitions classified more infants as severe BPD (16.4% and 10.1%, respectively), while NRN 2019 classified more as grade 2 (moderate; 15.0%). Shennan 1988 showed good agreement with NICHD 2018 (=1.0) and Jensen 2019 (=1.0). Shennan 1988 (c-statistic range: 0.921–0.974), NICHD 2018 (0.948-0.978) and NRN 2019 (0.949-0.982) demonstrated higher discriminative accuracy for discharge outcomes than NICHD 2001 (0.854–0.925).
This study found a high prevalence of BPD among very preterm infants in China, varying by definitions. The Shennan 1988, NICHD 2018 and NRN 2019 definitions showed good agreement and better predictive accuracy for outcomes at discharge compared with NICHD 2001. These definitions could be prioritised for clinical use in our population.
Research indicates that most individuals will experience at least one traumatic event in their lifetime. Some individuals may develop post-traumatic stress disorder, while others may exhibit subclinical levels of post-traumatic stress disorder symptoms alongside comorbid conditions such as depression and anxiety. As a body-based adjunctive intervention, trauma-informed yoga is increasingly used to mitigate post-traumatic stress disorder symptoms in individuals who have experienced trauma, including those with or without a formal post-traumatic stress disorder diagnosis. However, the efficacy of this approach remains a topic of contention in published studies.
To identify relevant trials, a literature search will be conducted across seven electronic databases. We will include randomised controlled trials and pre-post studies that assess trauma-informed yoga in trauma-exposed adults. Data obtained from these sources will be synthesised and analysed meta-analytically using RevMan 5.4. The primary outcome measure will be the total score of post-traumatic stress disorder symptoms, while secondary outcome measures will encompass anxiety and depression scores. The methodological quality and risk of bias of the included trials will be evaluated using the 12-item National Institutes of Health quality assessment tool and the revised Cochrane Risk of Bias tool (version 2). Furthermore, the overall strength of the evidence will be rated according to the Grading of Recommendations, Appraisals, Developments and Evaluations framework.
No formal research ethics approval is required. The results will be submitted for publication in a peer-reviewed journal.
CRD420251113495.
Da Parteira à Enfermeira Especialista em Enfermagem Obstétrica: evolução da formação entre 1836 e 1988
Resumo
Contexto: Em Portugal, a escolarização das Parteiras teve início no século XIX, a partir de 1836, altura em que os cursos de partos começaram a ser ministrados nas Faculdades de Medicina, pelos professores da “arte obstétrica”. Desde essa altura e até 1988, ano em que o Ensino de Enfermagem foi integrado no Sistema Nacional do Ensino Superior, esta formação foi palco de uma enorme evolução que importa explorar, realçando os marcos e os contextos que mais a caracterizaram: a partir de 1943 os cursos decorreram nas Maternidades Alfredo da Costa, Júlio Dinis e Bissaya Barreto, onde estavam sediadas as delegações do Instituto Maternal, cuja extinção, em 1967, motivou a transição desta formação para as escolas de enfermagem, Calouste Gulbenkian em Lisboa, S. João no Porto e Bissaya Barreto em Coimbra; em 1983 os cursos transitaram para as Escolas de Enfermagem pós-básicas até 1988.
Objetivo: Descrever a evolução da formação das enfermeiras parteiras entre 1836 e 1988 no contexto português, e em especial na cidade do Porto, desde a altura em que se designavam por “Parteiras” até ao momento em que passam a titular-se como “Enfermeiras Especialistas em Enfermagem Obstétrica.
Metodologia: Método histórico, através da revisão da literatura e da análise documental de fontes primárias e da produção legislativa.
Resultados: Entre 1836 e 1988, a formação das parteiras passou por várias mudanças institucionais e identitárias. Inicialmente, os cursos eram ministrados por médicos nas faculdades de medicina. A partir de 1943, a formação começou a integrar monitoras Enfermeiras Puericultoras ou Enfermeiras Obstetras, na docência. No total formaram-se 892 profissionais no Porto, incluindo cinco homens.
Conclusão: Entre 1836 e 1988, a formação de Parteiras e Enfermeiras Especializadas na área da saúde materno-infantil na cidade do Porto, decorreu em diferentes instituições e sob a influência de reformas sucessivas. Estas reformas elevaram o nível técnico e científico da profissão, contribuindo para fortalecer o reconhecimento social e a valorização profissional das Enfermeiras Especialistas em Enfermagem Obstétrica.
Palavras-chave:
Ensino, Parteira, Enfermeira Parteira, Enfermeira Obstetra, Enfermagem Obstétrica.
This study aimed to explore the experience of decision conflict among surrogate decision-makers for patients with critical illness undergoing neurosurgery.
A qualitative descriptive research design was used. Participants were selected using a purposive sampling method, and semi-structured interviews were conducted to collect data, which were then analysed using Colaizzi’s seven-step analysis method.
The study was conducted in a tertiary hospital in China.
This study included 15 surrogate decision-makers for patients with critical illness undergoing neurosurgery as interview participants.
In this interview study, two main themes and nine subthemes were identified：(a) core conflict in the decision-making process: conflicts between the quality of life and the length of life, conflict between patient and surrogate preferences and conflict between the expected and realistic treatment outcomes; and (b) complex causes of decisional conflict: the burden of decision-making in critical care, inadequate decision-making information, erosion of patient-physician trust, socio-cultural pressures, overwhelming financial burden and negative emotional distress.
Surrogate decision-makers for patients with neurological critical illness often experience complex decision conflicts during the clinical decision-making process. This underscores the need for healthcare providers to identify high-risk individuals for decision conflicts early on and provide personalised decision support strategies to mitigate such conflicts and enhance decision quality.
To develop a comprehensive and psychometrically validated scale for evaluating the core competencies of community nurses for public health emergencies.
A study of instrument development and validation was conducted.
A total of 1057 community nurses provided valid responses for this study conducted in Shanghai, China. Building upon previous study findings of the adapted core competency model and integrating the World Health Organisation's Framework for Action, this study was conducted in two phases. First, scale items were developed through systematic review, qualitative research, stakeholder meeting, and Delphi survey, refined with cognitive interviews to establish version 1.0 of the scale. Second, item analysis was performed with item-total correlations, Cronbach's alpha, and exploratory factor analysis, resulting in version 2.0. The final scale was produced after assessing the validity (content validity, confirmatory factor analysis, known-groups validity) and reliability (internal consistency, test–retest reliability).
The final scale consisted of 47 items categorised into four competency factors: prevention, preparation, response, and recovery competency. Factor analysis results indicated adequate factor loadings, excellent model fit, and well-established construct validity. The overall scale and its sub-factors exhibited high internal consistency and good test–retest reliability.
The study presents a theoretically grounded and scientifically validated scale measuring the competencies that community nurses need for public health emergency response.
This study enhances the theoretical framework of community nurses' core competencies in public health emergencies, provides a validated assessment tool, and clarifies their role in enhancing preparedness and effectiveness.
The study addressed the need for a standardised tool for assessing community nurse core competency for public health emergencies and will impact policy initiatives to enhance early prevention, emergency response, and integrated recovery practices in crisis management.
Strengthening the Reporting of Observational studies in Epidemiology checklist.
No Patient or Public Contribution.
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.
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 assess the acoustic environment of operating rooms (ORs) and its impact on nurses' perceptions in three surgical departments in a general hospital.
A mixed-methods study.
This study integrated sound level measurements, structured behavioural observations and a cross-sectional questionnaire survey. Acoustic data were collected during 41 surgeries in orthopaedics, general surgery and obstetrics–gynaecology. Observations identified typical noise events, and a validated questionnaire was used to assess perceived noisiness, communication and work efficiency interference, annoyance and the importance of a quiet environment.
Average noise levels in ORs exceed safety recommendations. The highest noise intensities occurred in the preoperative stage, primarily due to anthropogenic sources such as conversation, door movement and instrument collisions. Mid-frequency noise is dominant and overlaps with speech frequencies. Nurses identified conversation as the most frequent and disturbing noise source. Greater years of experience correlated with higher perceived noisiness, communication interference and annoyance.
Operating room noise affects nurses' communication, work efficiency and psychological comfort. As clinical experience increases, perceived cognitive load also rises. Anthropogenic noise sources are a major disruptive factor in a healthy OR environment and should be addressed through targeted interventions.
Noise mitigation should combine behavioural management, acoustic design and spatial optimisation to enhance nursing well-being and performance.
The study examined the impact of excessive OR noise on nurses' work performance and subjective well-being. OR noise exceeded safe thresholds, with conversation identified as the dominant and most disturbing source, particularly during preoperative phases. The findings inform OR design, management and training practices in surgical environments globally, with benefits for nursing staff.
This study followed STROBE guidelines.
No patient or public contribution.
Chinese Clinical Trial Registry (ChiCTR): ChiCTR2000038787
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.
FreshRSS 