Conectar
by Ratikorn Chaisiwamongkol, Rattapon Uppala, Phanthila Sitthikarnkha, Leelawadee Techasatian, Suchaorn Saengnipanthkul, Pope Kosalaraksa, Kaewjai Thepsuthammarat, Sirapoom Niamsanit
Background and aimsDiabetic ketoacidosis (DKA) remains a major cause of pediatric morbidity and death. This study examined national trends in DKA hospitalizations and factors associated with in-hospital mortality among Thai children.
Materials and methodsA nationwide, retrospective cohort study was conducted using data from the National Health Security Office (NHSO) during 2015–2023. Children aged 1 month to under 18 years hospitalized with DKA were identified using International Classification of Diseases, 10th Revision, Thai Modification (ICD-10-TM) codes. Prevalence and mortality were described by year and region. Factors associated with death were assessed with multivariable logistic regression; model discrimination used area under the curve (AUC).
ResultsAmong 10,669 admissions, national DKA prevalence increased from 4.5 to 11.8 per 10,000 pediatric hospitalizations, with Bangkok showing the highest rates. The overall intubation rate was 10.2%, peaking in infants and older adolescents. Although national mortality declined from 2.2% to 0.6%, regional and age-specific fluctuations persisted. Independent associations with mortality included malignancy (Adjusted odds ratio [AOR] 5.25, 95% CI: 1.63-16.92; p=0.005), septic shock (AOR 2.93, 95% CI: 1.71-5.03; p Conclusion
DKA hospitalizations are increasing in Thailand, with regional variation and persistent mortality risk, particularly among patients with critical complications and vulnerable groups. Although declining mortality trends and lower mortality in recurrent cases suggests improved protocol-based treatment, targeted prevention strategies remain essential for high-risk populations.
Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.
by Hongfei Yang, Chao Sun, Ya Li, You Zhou, Rui Wang, Yingxue Li
ObjectiveThe triglyceride-glucose index and estimated glucose disposal rate serve as notable surrogate markers of insulin resistance, demonstrating established links to cardio-cerebrovascular disease. However, their combined prognostic value in predicting cardio-cerebrovascular disease outcomes remains unexplored. The current investigation examined the interaction between the TyG (triglyceride–glucose index) index and eGDR (estimated glucose disposal rate) concerning the danger of cardiovascular disease within a clinical population.
MethodsThis investigation employed data sourced from the China Health and Retirement Longitudinal Study (CHARLS). The median TyG index and eGDR scores were used to stratify the participants into 4 categories: low TyG/high eGDR, high TyG/high eGDR, low TyG/low eGDR, and high TyG/low eGDR. Clinical characteristics across groups were systematically compared. Cox proportional hazards regression models evaluated the distinct and interconnected associations of the TyG index and eGDR with the risk of cardio-cerebrovascular disease, with multiplicative and additive interaction effects subsequently assessed through formal interaction analysis.
ResultsThe final study cohort comprised 7,330 participants, with 1,336 individuals (18.2%) developing cardio-cerebrovascular disease during the 9-year follow-up. Stratification using median thresholds (TyG: 8.59; eGDR: 10.55 mg/kg/min) yielded four groups: low TyG/high eGDR (n = 2,991), high TyG/high eGDR (n = 1,375), low TyG/low eGDR (n = 1,372), and high TyG/low eGDR (n = 2,292). Multivariable-adjusted Cox regression analyses revealed markedly increased risks of cardio-cerebrovascular disease among the various exposure groups when contrasted with the low TyG/high eGDR reference: high TyG/high eGDR (HR: 1.31, 95%CI: 1.10–1.57, ppp Conclusion
The TyG index and eGDR demonstrate independent associations with cardio-cerebrovascular disease risk, while their combined assessment reveals synergistic predictive capacity. Combined assessment of the two allows for further accurate stratification of the population based on insulin resistance and improved prediction of cardio-cerebrovascular disease.
by Chao Feng, Guodong Chen, Yan Shu, Jing Chen, Wenxin Ye, Ligang Ren
IntroductionGiven the high recurrence rate of bladder cancer (BCa) and the significant adverse effects associated with conventional treatments, it is urgent to search for new clinical therapeutic targets and safer natural-derived compounds. Resveratrol (Res) has been demonstrated to exhibit cytotoxicity against various tumors. However, the signaling pathways and targets involved in inhibition of BCa cells still need further exploration. This study aims to investigate the mechanism of Res in Bca via suppression of the AURKA/STAT3 axis, providing important theoretical basis for subsequent further researches on Res for treating BCa.
MethodsDifferentially expressed genes were identified through bioinformatics methods and the binding sites of resveratrol were also identified. The cell survival rate was detected by the CCK8 method to calculate the concentrations of Res for 30% inhibition and for 50% inhibition. Then, flow cytometry was used to detect the cell cycle and apoptosis after treatment with different concentrations of Res. Immunofluorescence staining was used to detect the effects of Res and MLN8237 on the expression of STAT3. Western blot and qPCR analyses were used to verify the reliability of the effects of Res and MLN8237 on target proteins.
ResultsAURKA was identified as the potential target of Res by computational analysis. Further validation through CCK8 assays and flow cytometry demonstrated that Res could inhibit BCa cells and their cell cycle in a time- and dose-dependent manner. Immunofluorescence staining revealed both Res and MLN8237 suppressed STAT3 expression in BCa cells. Additionally, western blot and qPCR analysis confirmed that Res and MLN8237 inhibited the expression of AURKA and known target genes (VEGF, Bcl-2, and Cyclin D1).
ConclusionOur findings suggest that Res may regulate BCa cell expression through the AURKA/STAT3 axis, providing a theoretical foundation for the structural optimization of Res and the development of multi-target drugs for clinical application.
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.
by Carmen Villagrasa, Giorgio Baiocco, Zine-El-Abidine Chaoui, Michael Dingfelder, Sébastien Incerti, Pavel Kundrát, Ioanna Kyriakou, Yusuke Matsuya, Takeshi Kai, Alessio Parisi, Yann Perrot, Marcin Pietrzak, Jan Schuemann, Hans Rabus
Biological effects induced by diverse types of ionizing radiation are known to show important variations. Nanodosimetry is suitable for studying the link between these variations and the patterns of radiation interactions within nanometer-scale volumes, using experimental techniques complemented by Monte Carlo track structure (MCTS) simulations. However, predicted nanodosimetric quantities differ among MCTS codes, primarily because each code employs distinct molecular-scale particle interaction models. This multi-code study examines these variations for low-energy electrons (20–10,000 eV), which play a critical role in energy deposition and biological effects by virtually all types of ionizing radiation. Specifically, the hypothesis tested in this work is that inter-code variability in nanodosimetry results is mainly caused by differences in assumptions regarding total interaction cross sections. Ionization cluster size distributions and derived nanodosimetric parameters were simulated with seven MCTS codes (PARTRAC, PHITS-TS, MCwater, PTra, and three Geant4-DNA options) in liquid water as a surrogate for biological tissue. Significant inter-code differences were observed, especially at the lowest energies. They were substantially reduced upon replacing the original cross sections in each code with a common, averaged dataset, created ad-hoc for this study and not based on theoretical assumptions. For example, for 50 eV electrons in 8 nm spheres, the variability in the predicted mean ionization numbers decreased from 23% to 5%, and in the probability of inducing two or more ionizations from 34% to 7% (relative standard deviations). This quantification demonstrates that total interaction cross sections are the primary source of uncertainty at low electron energies. A sensitivity test using DNA damage simulations with the PARTRAC code revealed that cross section variations notably affect biological outcome predictions. Replacing the code’s original cross sections with the averaged ones increased the predicted double-strand break yield by up to 15%. These findings underscore the urgent need for improved characterization of low-energy electron interaction cross sections to reduce uncertainties in MCTS simulations and enhance mechanistic understanding of radiation-induced biological effects.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.
by Lijun Zheng, Hui Zhang, Yuchao Sun
Acute kidney injury (AKI) is a critical clinical syndrome with limited therapeutic options. This study investigated the renoprotective effects of lycopene, a potent antioxidant, in both in vivo and in vitro AKI models. In a murine cecal ligation and puncture (CLP)-induced sepsis-AKI model, pretreatment with lycopene (10, 20, 40 mg/kg) dose-dependently ameliorated renal histopathological damage (HE staining) and restored serum biomarkers (AST, ALT, BUN, CREA). Mechanistically, lycopene suppressed oxidative stress and apoptosis by downregulating the PI3K/Akt axis: it significantly reversed the CLP-induced upregulating of p-PI3K and p-Akt, and the pro-apoptotic proteins (Bax, Cleaved Caspase-3), while increasing Nrf 2 and SOD1. Consistent results were observed in LPS- and H₂O₂-induced cellular AKI models, where lycopene attenuated cell death and restored redox homeostasis in a dose-dependent manner. Immunofluorescence assays further validated these trends. Crucially, PI3K siRNA or cDNA transfection experiments confirmed that lycopene’s antioxidant and anti-apoptotic effects were PI3K-dependent. Our findings highlight lycopene as a promising therapeutic agent for AKI, acting via PI3K/Akt-mediated activation of Nrf 2 to counteract oxidative damage and apoptosis. This study provides novel insights into the molecular mechanisms underlying lycopene’s renoprotection and supports its potential clinical translation for sepsis or oxidative stress-associated AKI.Nurses' health status significantly impacts their well-being and patient safety. Workflow interruptions, perceived workload, and missed nursing may potentially affect their physical and mental health. However, there is currently a lack of systematic studies on the relationships between these factors.
This study aims to explore how workflow interruptions influence nurses' health status through perceived workload and missed nursing, and provide strategies to promote nurses' health.
In October 2024, an online survey was conducted among 646 clinical nurses from three healthcare facilities in Henan Province. The survey covered nurses' demographic information, workflow interruptions, health status, perceived workload and missed nursing. Statistical analysis and model construction and validation were performed using SPSS 25.0 and AMOS 26.0 software.
Workflow interruptions were significantly negatively correlated with both physical component summary and mental component summary. Perceived workload and missed nursing served as mediators between workflow interruptions and physical and mental component summaries.
Workflow interruptions directly affect nurses' health status and indirectly influence it through perceived workload and missed nursing. Therefore, strategies should be implemented to optimise workflows, reduce workflow interruptions, lower perceived workload and take measures to minimise missed nursing. Future research could explore how to implement workflow optimization to improve nurses' health status effectively.
This study provides important guidance for improving nurses' health. The results reveal that optimising workflow and reducing work interruptions can effectively reduce nurses' perceived workload, thereby decreasing the occurrence of nursing omissions, and ultimately contributing to the overall improvement of nurses' health.
This study adhered to the cross-sectional Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.
No patient or public contribution.
by Bing-Nan Zhao, Zi-Yang Xie, Jia-Ning Liu, Xiao-Ran Chen, Xin-Xin Wang, Jia-Yi Li, Rui Zhang, Chao Si
Fermented spent coffee grounds (FSCG) serve as a valuable soil amendment to improve soil structure and fertility, while earthworms play a well-established role in enhancing soil processes and plant growth. However, their combined effects on bioactive compound accumulation in medicinal plants remain unclear. This study investigated the individual and interactive effects of FSCG (0%, 10%, and 20%, v/v) and earthworms (with and without Pheretima guillelmi) on the growth and phytochemical content of Glechoma longituba, a common medicinal herb, under greenhouse conditions. Results showed that 10% FSCG generally promoted plant growth, whereas 20% FSCG generally enhanced the accumulation of total flavonoids, chlorogenic acid, and soluble protein. Earthworms enhanced aboveground biomass and node number but significantly reduced chlorogenic acid content. These findings highlight the potential of FSCG as a sustainable soil amendment in medicinal plant cultivation and underscore the need to consider earthworm activity when optimizing both plant biomass and phytochemical quality.by Wenya Bai, Shixuan Liu, Guilin Zhou, Xuelian Li, Huan Jiang, Jianlin Shao, Junchao Zhu
BackgroundMicroglia polarization plays a crucial role in the progression of cerebral ischemia-reperfusion injury (CIRI), but the mechanisms remain largely undefined. The preset study aimed to investigate the mechanism of microglia polarization following CIRI.
MethodsCIRI was modeled in C57BL/6J mice through middle cerebral artery occlusion-reperfusion and in BV2 cells via oxygen and glucose deprivation/reoxygenation. Reverse transcription-quantitative PCR, western blotting, flow cytometry and fluorescence staining were used to detect the expression levels of key proteins associated with microglia polarization, as well as the expression of TNFAIP3 and RACK1. The interaction between TNFAIP3 and RACK1 was verified by co-immunoprecipitation. TNFAIP3 or RACK1 gene interference (overexpression and/or silencing) was employed to examine the role of the TNFAIP3/RACK1 axis in microglia polarization following CIRI.
ResultsThe results revealed that Arg-1 expression decreased, inducible nitric oxide synthase expression increased and TNFAIP3 was upregulated 24 h after CIRI. Furthermore, TNFAIP3 interacted with RACK1 to deubiquitinate and increase the expression of RACK1. These results indicate that knocking down either TNFAIP3 or RACK1 promotes microglia M1 polarization, and overexpression of RACK1 can promote microglia M2 polarization. RACK1 exerts its neuroprotective effects through NF-κB, as demonstrated by the use of NF-κB inhibitors.
ConclusionThe present findings indicate that TNFAIP3 inhibits M1 microglial polarization via deubiquitination of RACK1 after CIRI, RACK1 exerts its effects through NF-κB.
The main purpose of this hypothesis-driven study was to assess levels of change fatigue, adaptive performance and organisational support among ICU nurses; to explore the effects of change fatigue and organisational support on adaptive performance; and to examine the mediating role of organisational support in the relationship between change fatigue and adaptive performance.
A multi-site, cross-sectional survey.
From February to April 2025, 621 ICU nurses from 12 public secondary and tertiary hospitals in Guizhou, Zhejiang, Anhui and Hebei Provinces were recruited via convenience sampling. A questionnaire assessed their change fatigue, perceived organisational support and adaptive performance.
The surveyed ICU nurses in this study exhibited moderate change fatigue, adaptive performance and perceived organisational support. Change fatigue was negatively correlated with both adaptive performance and perceived organisational support (both p < 0.05), while adaptive performance was positively correlated with perceived organisational support (p < 0.05). Perceived organisational support mediated between change fatigue and adaptive performance, accounting for 29.17% of the total effect.
The level of change fatigue can directly affect adaptive performance and influence it indirectly through the mediating role of organisational support. Managers should establish a multidimensional organisational support system to enhance the adaptive performance of ICU nurses.
The findings of this cross-sectional study suggest administrators provide both instrumental and emotional support to ICU nurses to mitigate change fatigue, and recommend implementing resource depletion alert systems and adopting targeted interventions.
No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.
The utilisation of artificial intelligence in the context of nursing education has become increasingly extensive. However, various studies show differing perspectives and attitudes among nursing students, and the findings have not been systematically synthesised.
To systematically review the perceptions and attitudes of nursing students on the application of artificial intelligence in nursing education.
Mixed-methods systematic review.
A comprehensive literature search was conducted across 10 databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, Scopus, China Science and Technology Journal Database, SinoMed, China National Knowledge Internet, and WanFang database, the inclusive years of articles searched were from 1969 to 2025. Two researchers independently screened the literature and extracted the data. The mixed methods assessment tool was used to evaluate the risk of bias in the included literature. The relevant data were extracted and synthesised according to the Joanna Briggs Institute's convergence synthesis method, ensuring the comprehensive integration of qualitative and quantitative results. These results were then integrated into the Technology Acceptance Model.
A total of 28 articles were included, including 13 qualitative studies, 13 quantitative studies, and 2 mixed-method studies. According to the Technology Acceptance Model, the perceptions and attitudes of nursing students on the nursing education's adoption of artificial intelligence were integrated into 10 categories of three comprehensive themes: (i) Nursing students' perceptions and attitudes of the ease of use of artificial intelligence in nursing education, including 3 categories; (ii) nursing students' perceptions and attitudes on the usefulness of artificial intelligence in nursing education, including 4 categories; (iii) nursing students' behavioural intention, including 3 categories.
Overall, our study demonstrated that nursing students had an active willingness to utilise artificial intelligence. However, they acknowledged that certain issues persist regarding the ease and practicality of artificial intelligence in nursing education.
No patients or members of the public were directly involved in this systematic review, as the study synthesised existing literature.
by Yunhao Jiang, Gang Liu, Yulun Du, Siteng Cai, Zhichao Si, Jing He, Xiangbing Zhou
Urban large-scale complexes, such as shopping malls, pose significant challenges for fire safety management due to their intricate spatial layouts, high population density, and diverse occupancy characteristics. Efficient fire evacuation strategies are critical for minimizing casualties and economic losses; however, existing approaches often overlook the dynamic interplay between fire propagation and human behavior, resulting in suboptimal safety assessments. This study proposes an integrated simulation framework to optimize evacuation strategies by coupling fire dynamics with pedestrian flow modeling, aiming to enhance both evacuation efficiency and personnel safety. The methodology comprises three key steps: (1) Fire scenario simulation: A Building Information Modeling (BIM)-based digital platform is constructed to simulate fire propagation. Critical fire parameters (e.g., heat release rate, combustion model) are calibrated to quantify temporal variations in smoke temperature, CO concentration, and visibility across different zones. (2) Evacuation dynamics modeling: A pedestrian evacuation model is developed by integrating demographic factors (age structure, movement speed, population density) and fire-induced regional risks, enabling realistic simulation of crowd movement under fire conditions. (3) Safety performance evaluation and strategy optimization: Safety margins at staircases are assessed by comparing Required Safe Egress Time (RSET) and Available Safe Egress Time (ASET), followed by a safety grading system to identify high-risk bottlenecks. Evacuation strategies are then optimized to mitigate these risks. A case study was conducted on a shopping mall in Chengdu to validate the framework. Simulation results indicate an initial evacuation time of 260.4 seconds. Safety performance analysis revealed critical risks at staircases A and C (1st floor) and D (2nd floor) due to insufficient safety margins. After strategy optimization, the total evacuation time was reduced to 245.5 seconds, with safety margins at the three high-risk staircases increased by 130.8 s, 115.2 s, and 72 s, respectively, fully meeting safety requirements. The overall evacuation efficiency was significantly improved. This study demonstrates the effectiveness of the proposed framework in quantifying fire risks and optimizing evacuation strategies for large-scale complexes. The integrated simulation approach provides a scientific basis for evidence-based safety management and evacuation planning, offering valuable insights for urban fire safety engineering and emergency response optimization.Improving global access to pain management medications for cancer patients remains a critical priority. Nurses are now understood to play an essential role in cancer pain medication management, yet the barriers and facilitators they encounter require urgent identification.
This systematic review aimed to identify the barriers and facilitators for nurses in managing cancer pain medication.
This systematic review followed the Joanna Briggs Institute (JBI)'s guidelines for qualitative systematic reviews.
Eleven databases (PubMed, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, OPENGREY.EU, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Science and Technology Journal Database (VIP) and SinoMed) were searched from their inception to 9th July 2025. Articles were evaluated for quality using JBI critical appraisal tools. Data extraction was performed according to JBI standardised protocols, and evidence synthesis was conducted using JBI meta-aggregation, which involved extracting findings, categorising them into thematic groups and synthesising them into comprehensive statements.
Twenty-four qualitative studies were reviewed in the present study. Two synthesised findings regarding the barriers and facilitators for nurses in managing cancer pain medication were integrated: (1) Barriers for nurses to manage cancer pain medication were summarised into five categories: systemic barriers, resource barriers, knowledge and skills barriers, financial and cultural barriers and communication and psychological barriers; (2) Facilitators for nurses to manage cancer pain medication were summarised into three categories: nursing capacity building, supportive care environments and collaborative support systems.
Multilevel barriers impede nurse-led cancer pain management, necessitating policy reforms (e.g., tiered prescribing), investments in telehealth/training and culturally responsive interprofessional collaboration. Prioritising facilitators, capacity building, supportive environments and collaboration is vital to empower nurses in delivering equitable, evidence-based pain relief.
This review equips clinical managers and policymakers with evidence to implement policy and practice reforms, such as tiered prescribing and interprofessional collaboration, which are critical to empower nurses in delivering effective cancer pain management.
This systematic review was prospectively registered in PROSPERO prior to the initiation of the search (Registration ID: CRD42024570807).
There was no patient or public contribution.
To identify and synthesise the levels of death anxiety and potential moderating factors in patients with advanced cancer.
A systematic review and meta-analysis of observational studies.
A comprehensive search was conducted across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, CINAHL, PsycINFO, Scopus, Chinese Biomedical, China National Knowledge Infrastructure, and WANFANG, covering publications in both English and Chinese from inception through June 18, 2025.
Two independent reviewers performed study selection, data extraction, and quality assessment. Meta-analyses were conducted using STATA 16 software. Predefined subgroup analyses and meta-regression were carried out to examine variations in death anxiety among advanced cancer patients based on participant characteristics, disease-related factors, and study-level variables.
Twenty-one studies involving 4337 patients with advanced cancer met the inclusion criteria. These studies, published between 1978 and 2025, were conducted across five countries. Meta-analyses were performed separately for 16 studies using the original 15-item dichotomous Templer Death Anxiety Scale and 3 studies using an adapted five-point Likert version. Both analyses indicated high levels of death anxiety among patients. Differences in participant age, country, continent, and publication year contributed to the variation in findings.
Advanced cancer patients experience high levels of death anxiety, with age, country, continent, and publication year identified as key moderating factors. Targeting these factors through tailored interventions, promoting a supportive culture around death, and providing effective psychological training for patients can help reduce anxiety. These efforts aim to equip patients to understand and cope with the realities of death, ultimately improving their psychological well-being.
This review highlights the high levels of death anxiety in advanced cancer patients and identifies potential moderators. It underscores the need for targeted interventions to improve psychological care, particularly in end-of-life settings.
No patient or public contribution.
The review was registered on PROSPERO (registration number: CRD420251033114).
To develop the Preschool Children eHealth Cardiac Rehabilitation programme based on the Interaction Model of Client Health Behaviour, and to evaluate its effects on children after congenital heart surgery.
A parallel two-arm randomised controlled trial was conducted.
A total of 84 participants were recruited from July 2022 to June 2023 and randomly assigned to either the intervention group (n = 40) or control group (n = 44). The intervention group participated in a 3-month eHealth Cardiac Rehabilitation programme, while the control group received routine care. Outcomes were measured at baseline, 3 months post baseline (intervention endpoint), and 6 months post baseline. Eighty participants completed the study.
Compared to the intervention group, the control group demonstrated significantly worse outcomes at both 3 and 6 months, including a higher risk of heart failure, lower left ventricular ejection fraction scores, and shorter 6-min walk distance tests. The intervention group engaged in significantly more vigorous physical activity. Significant between group differences were also observed in parental knowledge, attitudes, behaviours and trust levels. Additionally, the proportion of parents experiencing anxiety decreased significantly more in the intervention group by 6 months post baseline.
This pioneering eHealth programme transforms home-based rehabilitation for preschool children with congenital heart disease, addressing a critical gap in accessible and long-term paediatric cardiac rehabilitation care.
The use of eHealth programmes is valuable for improving paediatric cardiac rehabilitation by empowering parents, enhancing care continuity, and reducing barriers to accessing specialised services in paediatric care, especially in areas with limited medical resources.
This study establishes the first validated eHealth framework for family-centred cardiac rehabilitation in preschool children following congenital heart surgery, addressing the critically low uptake of previously home-based rehabilitation. It also provides clinicians with a scalable solution for delivering care in underserved regions lacking access to specialised cardiac services.
This study adhered to the CONSORT checklist guidelines for reporting randomised controlled trials.
This study did not include patient or public involvement in its design, conduct, or reporting.
This study was a randomised controlled clinical trial. The research protocol was registered with the China Clinical Trial Registration Center (registration number: ChiCTR2200062022; https://www.chictr.org.cn/showproj.html?proj=174261).
To conceptualise information distortion in Electronic Health Records (EHRs), with the goal of providing a theoretical foundation for improving documentation practices.
A concept analysis.
Walker and Avant's strategy for concept analysis was used. The defining attributes, antecedents and consequences were identified.
A comprehensive search was conducted across PubMed, Web of Science, Embase, CINAHL and Scopus from their inception to December 2024. Studies published in English that addressed information distortion in EHRs were included.
A total of 37 studies were included. The three defining attributes were: real-world health truth, representation of reality and mismatch relationship. Antecedents were divided into five categories: people-related factors, equipment factors, regulatory factors, working environment factors and management factors. The consequences of information distortion in EHRs included threats to patient safety, poor operational performance, eroded trust, compromised research quality and health inequity.
This concept analysis enhances the understanding of information distortion in EHRs and provides a foundation for further empirical validation. The findings may contribute to the development of measurement instruments and strategies to mitigate information distortion in healthcare settings.
By undertaking a concept analysis of information distortion in EHRs, healthcare professionals will be better equipped to recognise and assess this ethical phenomenon, thereby supporting the development of targeted interventions to mitigate potential harms to healthcare practices. In addition, the clarity of this concept could provide a new angle from which to analyse the origins of flawed EHR documentation and its ripple effects across healthcare systems.
No patient or public involvement.
FreshRSS 