Caesarean delivery accounts for more than 21% of all births worldwide, with rates exceeding 30% in several countries, yet objective physiological markers for monitoring postoperative maternal recovery remain scarce. Heart rate variability (HRV), a non-invasive index of autonomic nervous system integrity, has demonstrated prognostic value in general surgical populations. This scoping review will map the extent, range and nature of evidence on HRV monitoring in caesarean populations within a recovery-assessment framework.

The review follows a Population–Concept–Context framework. The primary population comprises women undergoing elective caesarean delivery, with emergency procedures analysed as a distinct subgroup. The concept covers any validated measurement of HRV parameters (time-domain, frequency-domain and non-linear indices). The context spans the perioperative-to-postpartum continuum, from preoperative baseline through 6 weeks after delivery. Adhering to the Joanna Briggs Institute methodology, we will employ a three-step search strategy across PubMed, Embase, CINAHL, Cochrane Central Register of Controlled Trials and Web of Science. Two independent reviewers will screen records and extract data. Findings will be synthesised narratively and presented via temporal evidence mapping, an evidence gap map, and structured summary tables.

Formal ethics approval is not required because this review exclusively analyses published data. We will disseminate our findings through publication in a peer-reviewed journal and presentations at relevant academic conferences.

This study aims to explore the latent profiles and influencing factors of engagement in medication safety among elderly patients with cardiometabolic multimorbidity.

A cross-sectional study.

The study was conducted at a class III hospital in Jiangsu, China.

The study included a sample of 316 older adult inpatients with cardiometabolic multimorbidity.

Participants completed the Inpatients’ Involvement in Medication Safety Scale and the Multimorbidity Treatment Burden Questionnaire. Latent profile and multivariate regression analyses were used to identify subgroups and their associated factors.

Latent profile analysis identified three distinct profiles: ‘passive participation’ (22.47%), ‘moderate participation’ (52.53%) and ‘active participation’ (25.0%). Multivariate logistic regression revealed that occupational status, marital status, medical payment method, daily medication type and treatment burden were significant independent factors distinguishing among these profiles (p

The study confirms significant heterogeneity in medication safety engagement among older adults with cardiometabolic multimorbidity. The identified profiles and their specific influencing factors provide a basis for clinicians to stratify patients and develop targeted interventions, particularly for the vulnerable ‘passive participation’ group, to improve medication safety outcomes.

Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.

To estimate tuberculosis (TB) incidence trends in the high-altitude Xizang, China, and to explore the key intervention strategies on achieving the WHO 2030 TB control target.

We developed a susceptible–exposed–infectious–recovered transmission model using routinely reported TB surveillance data from 2004 to 2022. Scenario-based simulations were conducted to project future TB incidence under alternative intervention strategies. Model assumptions are as follows: (1) a stable population, (2) lifelong vaccine-induced immunity, (3) infectiousness of active TB cases, (4) relapse risk after recovery and (5) homogeneous mixing within the population.

Seven prefectures of Xizang Autonomous Region on the Tibetan Plateau, China.

An estimated population of approximately 3 million individuals residing in Xizang.

We assessed the epidemiological impact of four interventions implemented independently: increasing vaccine efficacy rate, reducing transmission rates of susceptible individuals, decreasing progression rate from latent TB infection to active disease and reducing relapse rate among successfully treated patients, compared with continuation of current control measures.

The estimated basic reproduction number (R₀ ) for TB in Xizang was 0.39 (95% CI 0.21 to 0.71) in the absence of additional interventions, which was the highest among all regions of China. Model simulations indicated that all four evaluated interventions were each likely to reduce TB incidence, but only reducing the latent-to-active TB progression had a substantial effect. A 50% reduction in the progression rate was predicted to lower TB incidence from 66.56 (62.00–70.11) to 40.54 (37.15–43.77) cases per 100 000 population, meeting the WHO 2030 TB control target.

Targeted management of individuals with latent TB infection should be strengthened to substantially reduce TB transmission in high-altitude areas.

To assess Chinese medical staff’s knowledge and attitudes towards insomnia and explore their association with mental health status.

A multicentre cross-sectional survey conducted across hospitals in China using convenience sampling.

Multiple hospitals across different regions of China; level of care primarily secondary.

A total of 654 medical staff enrolled from 23 hospitals between April and June 2023, with 420 (64.22%) nurses. Inclusion criteria encompassed hospital staff involved in patient care; exclusion criteria included those on leave or unwilling to participate. Data on sex and ethnicity were collected but not specified in the abstract.

Primary outcomes included insomnia knowledge and attitudes, assessed by a structured questionnaire. Secondary outcomes encompassed mental health status, measured via the Depression-Anxiety-Stress Scale (DASS)-21 (stress, anxiety and depression). The interactions between these variables were analysed using structural equation modelling (SEM).

Of the participants, 392 (59.94%) reported insomnia symptoms. The median scores for insomnia knowledge and attitudes were 16.0 (range 0–24) and 27.0 (range 7–35), respectively. The median DASS-21 score was 30.0; 189 (28.90%) experienced stress, 400 (61.16%) anxiety and 302 (46.18%) depression. SEM analysis indicated that night shift work (β=–0.101, p=0.024) and job satisfaction (β=–0.258, p

Medical staff showed limited understanding of insomnia and a high prevalence of stress, anxiety and depression. Targeted education, optimised shift scheduling and accessible mental health support are recommended to promote staff well-being and improve care quality. Nevertheless, the findings should be interpreted with caution because of the cross-sectional design and convenience sampling method.

Current medications used for neonatal MRI sedation may lead to complications such as decreased oxygen saturation, apnoea and bradycardia. There has been no study investigating the application of midazolam oral solution in neonatal MRI examinations. Therefore, this study aims to observe the safety and efficacy of midazolam oral solution for sedation during neonatal MRI examinations, providing a reference for clinical application.

We designed a double-blind randomised controlled trial. A total of 140 neonates who underwent MRI are included. The neonates are randomly assigned into two groups of n=70 each to receive either midazolam oral solution or chloral hydrate oral solution. The primary outcome indicator of the study is the success rate of sedation as assessed by the University of Michigan Sedation Scale (UMSS). In addition, the time to a UMSS score of 2 or greater after drug administration, the number of sedation remedies, the behavioural scores of the children while taking the drug and the movement scores during the MRI performed are collected as secondary outcome indicators.

Ethical approval for the study was obtained from the Ethics Committee of the Chengdu Women’s and Children’s Central Hospital (Approval No. 2023 (18)–2). The study findings will be submitted for peer-reviewed publication in a scientific journal.

ChiCTR2300069996.

By adopting the shared decision-making (SDM) model, this study aims to improve treatment adherence and patients’ subjective initiative. It intends to systematically explore the barriers and facilitating conditions for patients who had a stroke to participate in rehabilitation SDM through the analysis and integration of qualitative research methods. The ultimate goal is to provide a basis for optimising the formulation of rehabilitation plans, enhancing the quality of nursing services and improving patients’ medical experience.

The following databases were searched, with only literatures published in English or Chinese included: Cochrane Library, PubMed, Embase, Scopus, Web of Science, CNKI (China National Knowledge Infrastructure), CBM (Chinese Biomedical Literature Database) and Wanfang Database. The search covered the period from the establishment of each database to 1 March 2025. The quality of the included literatures was evaluated using the Qualitative Research Quality Assessment Tool provided by the Joanna Briggs Institute in 2016, with a focus on factors affecting participation of patients who had a stroke in rehabilitation SDM.

A total of 1502 articles were retrieved in the preliminary search, and 10 were finally included. From these included literatures, 31 findings were extracted. Similar results were categorised and grouped into 10 new categories, which were further integrated into 3 core integrated findings: (1) patient-related factors, including interference from negative emotions, the gap between rehabilitation expectations and reality, the impact of socio-demographic factors and self-efficacy with stage-specific autonomous needs; (2) family-related factors, including family support, the impact of patients’ sense of responsibility to their families on decision choices and trade-offs forced by economic burden; (3) healthcare provider and environmental factors, including paternalistic models undermining autonomy, insufficient information and difficulty in screening hindering decision-making and discontinuity in the rehabilitation system and lack of resources increasing decision-making burden.

Through the meta-synthesis of qualitative studies, this research shows that negative emotions and realistic gaps reduce patients’ participation in decision-making. While family support helps enhance patients’ confidence in decision-making, economic burden affects their decision choices. Additionally, one-way doctor–patient communication, insufficient information support and discontinuity in the rehabilitation service system increase patients’ decision-making burden.

To analyse temporal trends of respiratory infectious diseases (RIDs) in Baiyin City from 2014 to 2023, aiming to explore the epidemiological patterns of these diseases (tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella) and provide evidence for developing effective prevention and control strategies.

A descriptive epidemiological study was conducted to analyse the incidence of tuberculosis, scarlet fever, pertussis, measles, influenza, mumps, varicella and rubella in Baiyin City, China, from 2014 to 2023, using data from the national notifiable disease reporting system.

All reported cases of eight notifiable RIDs in Baiyin City between 2014 and 2023 were included in the analysis. Data were categorised by age and sex.

Joinpoint Regression Software was employed to estimate both the annual percentage change in incidence and the average annual percentage change, facilitating a phased comparison of incidence trends.

Between 2014 and 2023, the annual incidence of major bacterial RIDs (tuberculosis, scarlet fever and pertussis) in Baiyin City fluctuated between 52.69 and 87.94 per 100 000 population, demonstrating an overall declining trend. Specifically, the annual decrease rates for the age groups of 0–14 years, 15–59 years and ≥60 years were 11.62% (95% CI –20.26% to –2.16%), 6.44% (95% CI –10.37% to –2.46%) and 5.15% (95% CI –9.12% to –1.07%), respectively. The annual incidence of major viral RIDs (measles, influenza, mumps, varicella and rubella) fluctuated between 111.70 per 100 000 and 541.12 per 100 000. No significant temporal trend was observed for major viral RIDs in Baiyin City. With the exception of pertussis, measles and rubella, the overall incidence rate was significantly higher in males than in females (p

From 2014 to 2023, the annual incidence of major bacterial RIDs in Baiyin City showed an overall decline, mainly due to a reduction in tuberculosis incidence, whereas the annual incidence of major viral RIDs fluctuated and rose sharply in 2023. The overall incidence of both major bacterial and viral RIDs was consistently higher in males, with major viral RIDs occurring predominantly in children aged 0–14 years and major bacterial RIDs being more common in older adults aged ≥60 years. Further efforts are needed to monitor the epidemiological patterns and develop strategies to reduce the incidence of major viral RIDs, particularly among children aged 0–14 years.

While numerous evidence-based studies have been conducted on procedure-based treatments (PBTs) in traditional, complementary and integrative medicine (TCIM) (eg, acupuncture, special diets, lifestyle modification, yoga, Tai ), high-quality research reports accepted by the academic community remain scarce. Key factors contributing to the low evidence quality in this field include researchers’ insufficient grasp of clinical research methodology concepts, inadequate study designs and lack of pilot studies. Scholars now widely recognise that establishing a robust evaluation framework for PBTs in TCIM is crucial for progressively refining research protocols and advancing clinical practice. Therefore, this scoping review aims to systematically map current evaluation methods for PBTs in TCIM, analyse their critical procedural components and lay the groundwork for developing a tailored evaluation framework.

Forty-three databases will be systematically searched using comprehensive search strategies. Two independent reviewers will screen potential literature and select eligible studies. Literature management will be performed using NoteExpress and Excel 2016, with a pre-designed standardised Excel sheet employed for data extraction.

This scoping review will include literature that provides multidimensional evaluation (eg, efficacy, safety and health economics) for PBTs in TCIM. This encompasses methodological guidelines, systematic protocols outlining evaluative structures, procedural steps and core components, as well as conceptual or theoretical frameworks describing phased evaluation processes. Screening and data extraction will be conducted independently by two researchers. Inter-rater agreement will be assessed using the Kappa statistic. Any discrepancies will be resolved through consultation with a senior reviewer or correspondence with original authors.

Data extraction will capture: general information, types and number of included primary studies, interventions assessed, evaluation dimensions, procedural workflows for evaluation, version iterations of evaluation frameworks, staging configurations for evaluation, framework development methods, as well as documented strengths and limitations of the frameworks.

Results will be structured following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Findings will be presented through tables, charts and figures, with narrative synthesis describing key outcomes.

No private information was issued in the entire process of the systematic review. Therefore, ethical approval is not required. Findings of the scoping review will be published in a peer-reviewed journal and/or disseminated through conference presentations.

The protocol has been archived in the Open Science Framework (Registration DOI: https://doi.org/10.17605/OSF.IO/92DRM).

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

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

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

ITMCTR2024000534.

Physical activity (PA) has considerable benefits for older adults, yet they often face various barriers that hinder participation. Peer-led or peer-supported PA interventions represent a promising strategy to address barriers, such as cost and lack of motivation. Although existing reviews suggest that these interventions improve PA adherence, combining randomised controlled trials (RCTs) with other study designs may weaken their validity. Furthermore, their effects on PA levels and physical function are inconsistent, and their impacts on cognitive abilities, psychosocial well-being and social support, as well as the influence of peer characteristics and programme design, remain unexamined. This review aims to synthesise evidence regarding the effectiveness of peer-led or peer-supported PA interventions across multiple health outcomes and identify possible influencing factors.

The search will encompass six English and three Chinese databases, namely, PubMed, Web of Science, Embase, Cumulative Index to Nursing and Allied Literature, PsycINFO, CENTRAL, China National Knowledge Infrastructure, Wanfang Data and the Chinese Biomedical Literature Database. It will cover literature from inception to December 2025. Trial registries will be searched, and a manual search of relevant studies will also be conducted. RCTs that focus on community-dwelling older adults participating in peer-led or peer-supported PA interventions will be included. Outcomes include PA levels, physical function, cognitive function, psychosocial well-being, self-efficacy, social support, health-related quality of life (HRQoL) and programme adherence. Two reviewers will independently screen the literature, extract data and evaluate the risk of bias by using the Cochrane Risk of Bias Tool 2.0. Meta-analyses will be conducted for outcomes reported in at least two studies, and narrative analyses will be performed for others. Subgroup analyses, metaregression, sensitivity analyses and assessments of publication bias will be conducted as appropriate. The Grading of Recommendations, Assessment, Development and Evaluations approach will be used to assess the certainty of evidence.

Ethical approval is not required because only published data will be used. Results will be disseminated through peer-reviewed publications and conference presentations.

CRD420251112127.

Minimally invasive techniques have been widely adopted for hysterectomy, including Transumbilical Laparoendoscopic Single-Site Surgery (TU-LESS) and Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES). However, their efficacy in patients with an enlarged uterus (≥280 g) remains not fully illustrated due to surgical complexity. We will compare the perioperative outcomes and recovery profiles of TU-LESS and vNOTES of this population in this study.

This single-blinded, two-arm, parallel-group, randomised controlled trial will take place in West China Second University Hospital. A total of 210 women with benign or precancerous uterine enlargement undergoing total hysterectomy (±salpingectomy/adnexectomy) will be randomised (1:1) to TU-LESS or vNOTES. The trial will span 2 years, including a follow-up of half a year. The primary outcomes will be the proportions achieving the indices of enhanced recovery after surgery respectively, including liquid diet tolerance, flatus passage, unassisted urination and mobility, during 24 hours after surgery and discharge within 2 days. Secondary outcomes include pain scores, operative duration, blood loss, complications, scar quality, analgesic use and pelvic/sexual function. Data collection occurs at baseline, perioperatively and 3/6 months postoperatively.

This study was approved by the Ethics Committee of West China Second University Hospital (2023 medical scientific research for ethical approval No.321). Written informed consent will be collected from all participants. Results will be shared through publication in peer-reviewed journals and presentations at conferences.

NCT06663553