Conectar
Given the rapidly evolving therapeutic landscape for type 2 diabetes (T2D) and chronic kidney disease (CKD), this study aimed to characterise the clinical profiles and real-world outcomes of patients with T2D and CKD in China who initiated sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA).
Retrospective cohort study.
Demographic and clinical data of patients from a regional electronic health records database in Tianjin, China between 2012 and 2019 were used.
Adult patients diagnosed with T2D and CKD who initiated SGLT2i or GLP-1 RA from 2012 to 2019.
Baseline demographic and disease characteristics, comorbidities and comedications, healthcare resource utilisation (HRU), and clinical outcomes were assessed using descriptive statistics.
A total of 935 and 4821 patients were included in SGLT2i and GLP-1 RA cohorts, with the mean ages of 59 and 56 years, respectively. Both cohorts had similar durations of T2D (mean: 5 years) and CKD (mean: 3 years). In SGLT2i and GLP-1 RA cohorts, 54.4% and 56.9% of patients had hemoglobin A1c (HbA1c) >7%, and 50.5% and 54.1% were classified as CKD stage 1 at baseline. During the follow-up period (median 1.4 months for SGLT2i cohort and median 2.3 months for GLP-1 RA cohort), higher numbers of specialist visits compared with general practitioner visits were observed numerically for both cohorts. The incidence rates (95% CI) of kidney failure per 100 person-years were 3.1 (1.0, 7.3) for SGLT2i cohort, and 4.9 (3.9, 6.0) for GLP-1 RA cohort during follow-up.
This study provides descriptive evidence regarding the clinical characteristics and outcomes of patients with T2D and CKD who initiated SGLT2i or GLP-1 RA in China. The results are important for understanding the existing HRU and residual risk of severe clinical outcomes in such patient populations. The findings also provide a solid foundation for future research aimed at examining the clinical outcomes of new therapeutic options for T2D and CKD.
Depression is a significant global health burden, affecting over 300 million people worldwide and contributing substantially to disability and healthcare costs. Despite the widespread use of antidepressants, many patients experience limited efficacy or adverse effects. Non-invasive brain stimulation (NIBS) and acupuncture have emerged as promising non-pharmacological interventions for depression. However, the heterogeneity of treatment protocols and the lack of direct comparisons limit the development of optimal treatment strategies. This study seeks to perform a network meta-analysis (NMA) to compare and rank the comparative efficacy and acceptability of NIBS and acupuncture interventions for depression. This review is expected to inform evidence-based decision-making by comparatively evaluating efficacy and acceptability; any clinical implications will depend on the certainty and consistency of the evidence.
A comprehensive literature search will be conducted across 14 academic databases and registries (PubMed, Cochrane Library, Web of Science, Embase, OVID, Scopus, ProQuest, CNKI, Wanfang, CBM, VIP, ICTRP, ChiCTR and ClinicalTrials.gov) from inception to May 2025. Eligible studies will include randomised controlled trials assessing NIBS and/or acupuncture for depression. Two reviewers will independently conduct study selection, data extraction and risk of bias assessment using the Cochrane Risk of Bias 2 tool. Primary outcomes will include depressive symptom severity and acceptability (measured by all-cause discontinuation). Secondary outcomes will include response rate and adverse events. At the time of protocol submission, the literature search had been substantially completed, while study selection and data extraction had not yet commenced. Pairwise meta-analyses will be executed applying Review Manager V.5.4 and Stata V.17.0. A Bayesian NMA will be conducted via the GeMTC package in R V.4.2.2, and Stata will also be used for additional statistical analyses and visualisation. Subgroup and sensitivity analyses will explore sources of heterogeneity, and the certainty of evidence will be appraised using the Confidence in Network Meta-Analysis framework.
Ethical approval is not warranted since the study does not involve any confidential or private patient records. The results will be disseminated through publication in peer-reviewed journals.
CRD420250651706.
Nurses commonly experience negative experiences after experiencing a patient safety event, triggering a domino effect on the nurses themselves, subsequent patients, and healthcare organisations, thus requires urgent attention.
To explore the mediating role of psychological capital and coping styles between neurotic personality and negative experiences of nurses' second victims, and to provide theoretical guidance for nursing administrators to develop targeted strategies to mitigate negative experiences of nurses' second victims.
In June–July 2023, a general information questionnaire, a neurotic personality subscale, the Chinese version of the Second Victim Experience and Support Scale, the Nurses' Psychological Capital Questionnaire, and the Coping Styles Questionnaire were used to conduct an online survey of 213 nurses' second victims and structural equation modelling was constructed to clarify the relationship between these elements.
Psychological capital and coping styles partially mediated the relationship between neurotic personality and negative experiences in the nurses' second victims, with a total indirect effect value of 0.203 and a total effect value of 0.303, for a mediating effect of 33.00%.
Neurotic personality and immature coping styles negatively predict the degree of negative experience, while psychological capital and mature coping styles positively predict the degree of negative experience. Psychological capital and coping styles play a partial mediating role between neurotic personality and negative experience.
After a patient safety incident, nursing managers can mitigate the negative experiences of nurses' second victims in patient safety incidents by reducing their neurotic personality tendencies, enhancing their level of psychological capital, and guiding them to adopt mature coping styles.
No patient or public contribution.
Frailty affects over 35% of maintenance haemodialysis (MHD) patients globally—2–3 times higher than the general elderly—and is strongly linked to higher mortality, hospitalisation, and functional decline. Despite its clinical impact, frailty is often underdiagnosed in dialysis settings due to inconsistent assessments and limited resources. Existing prediction models vary widely in predictors and methods, requiring systematic review to guide clinical use and improve risk-stratified care.
To systematically identify, describe, and evaluate the existing risk prediction models for frailty in patients undergoing MHD.
Systematic review and Methodological appraisal.
A comprehensive search was conducted across multiple databases—PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China Biomedical Literature Database (CBM), Wanfang Database, VIP Database—covering studies up to November 1, 2024.
Two researchers independently conducted literature searches, screening, and data extraction. They used the Prediction Model Risk of Bias Assessment Tool (PROBAST) to evaluate the risk of bias and the applicability of the included models.
Fifteen studies (21 models) were analysed, with sample sizes 141–786 and frailty incidence 11.00%–59.57%. Model AUCs ranged 0.720–0.998 (potential overfitting at extreme values). Key predictors included age, serum albumin, gender, Charlson comorbidity index, and activities of daily living scores. Methodological appraisal using PROBAST revealed moderate applicability but high bias risks: 53% of studies used retrospective designs, 95% lacked external validation, and limitations included small samples, non-standard variable selection, and inadequate handling of missing data.
While models demonstrate initial predictive utility, widespread bias and developmental-stage limitations hinder clinical application. Future research must prioritise TRIPOD-guided model development, emphasising large prospective cohorts, rigorous validation, and transparent reporting to enhance reliability and clinical utility in frailty risk stratification for MHD patients.
by Yinyin Wu, Wei Ding, Yuying Liu, Qianhong Deng, Fengqin Tao, Hanbin Chen, Chang Chen, Meng Xiao, Bilong Feng
BackgroundStandardized guidelines for optimal tunnel length in tunneled peripherally inserted central catheters (PICCs) are lacking.
ObjectivesThe objective of this study was to evaluate the real-world impact of tunnel length on clinical outcomes.
MethodsThis retrospective cohort study included 207 cancer patients who received tunneled PICCs, categorized into a control group (tunnel length > 4 cm, n = 134) and an observation group (tunnel length ≤ 4 cm, n = 73). Propensity score matching (PSM) was used to address baseline heterogeneity. Cox regression analyses were used to assess the risk of complication during a 120-day follow-up.
ResultsCompared to the control group (tunnel length > 4 cm), the observation group (tunnel length ≤ 4 cm) had a significantly higher adjusted overall complication risk (HR = 2.92, 95% CI: 1.07–7.94, P = 0.036) and unplanned catheter removal rate (4.4% vs. 0.0%, P = 0.027), confirming the safety of longer tunnels despite comparable comfort levels between groups. After PSM, Cox regression analysis showed results consistent with those from the unmatched cohort. Subgroup analyses revealed a reduced risk of complications with longer tunnels in patients with BMI ≤ 25 kg/m² (HR = 0.29, 95% CI: 0.11–0.82), without hypertension (HR = 0.36, 95% CI: 0.13–1.00), without diabetes (HR = 0.38, 95% CI: 0.15–0.97), and with solid tumors (HR = 0.31, 95% CI: 0.11–0.85).
ConclusionThe results show that tunnel lengths > 4 cm reduce overall complications and prolong catheter retention, supporting the implementation of standardized protocols while advocating for personalized adjustments based on BMI, comorbidities, and cancer type.
Pressure injuries remain a significant concern in military hospital settings, leading to increased morbidity and healthcare costs. Understanding the interplay of multiple risk factors is critical for effective prevention. To identify key risk factors and their combined effects on pressure injury development among inpatients in multi-centre military hospitals using factor analysis. A cross-sectional study was conducted involving 4876 inpatients across multiple military hospitals. Data were collected on 15 potential risk factors, including incontinence, care dependency, mobility limitations, comorbidities, medication use, nutritional status, and demographics. Factor analysis with principal component analysis and varimax rotation was applied, and maximum canonical correlation coefficients were calculated to evaluate the predictive contribution of single and combined factors. Single-factor analysis identified incontinence as the strongest predictor (MaxCanonicalCorr = 0.50126), followed by care dependency (0.31982) and bedridden status (0.30061). Two-factor analysis revealed incontinence combined with care dependency as the highest-performing model (MaxCanonicalCorr = 0.50867). Three-factor models incorporating incontinence, health conditions, and care dependency achieved the greatest predictive capacity (MaxCanonicalCorr = 0.5157), demonstrating that multi-factor interactions enhance risk prediction beyond single-factor effects. Incontinence is the primary modifiable risk factor for pressure injury in military hospital inpatients. Integrating continence management with assessments of functional status and comorbidities can improve early identification of high-risk patients and guide targeted preventive strategies.
Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide, with most Chinese patients diagnosed at a locally advanced stage. Neoadjuvant chemotherapy (NAC) is increasingly used to improve resectability and survival. Laparoscopy-assisted distal gastrectomy (LADG) provides short-term recovery benefits compared with open distal gastrectomy (ODG), but its safety and oncologic efficacy following NAC remain uncertain. This trial aims to determine whether LADG is non-inferior to ODG in terms of long-term survival outcomes in patients with locally advanced distal gastric cancer (LAGC) after NAC.
This is a multicentre, randomised, controlled, non-inferiority trial conducted at high-volume GC centres in China. Eligible patients (aged 18–75 years; cT3–4a, N0/+, M0) with histologically confirmed distal gastric adenocarcinoma who have completed standard NAC will be randomised 1:1 to LADG or ODG with D2 lymphadenectomy. Surgical quality will be standardised through operative manuals, intraoperative video recording and central auditing. The primary endpoint is 3-year disease-free survival. Secondary endpoints are 3- and 5-year overall survival. A total of 998 patients (499 per arm) will be enrolled, providing 80% power to test non-inferiority with an absolute 8% margin, accounting for 15% attrition. Analyses will follow the intention-to-treat principle, with Cox models used for survival comparisons and subgroup analyses according to nodal status, tumour size and pathological response.
This trial has been reviewed and approved by the Biomedical Ethics Committee of West China Hospital, Sichuan University (Approval No. 2025 (865), 16 July 2025). Written informed consent will be obtained from all participants. The results will be disseminated through peer-reviewed journals and international conferences, providing high-level evidence to guide the surgical management of LAGC after NAC.
Chinese Clinical Trial Registry, ChiCTR2500109677; registered on 23 September 2025. Protocol V.2.1, dated 29 June 2025.
Advance Care Planning (ACP) has the potential to enhance end-of-life care and improve the allocation of healthcare resources for patients with cancer. However, its successful implementation requires considerable effort to overcome challenges and deliver health benefits. Healthcare providers and patients are key players in ACP, and their perceptions of the process must be understood to address implementation challenges effectively.
To identify barriers and facilitators to ACP implementation in Chinese oncology settings, providing a foundation for culturally appropriate healthcare strategies.
A qualitative study guided by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (n = 30) were conducted between April and August 2022 to synthesise the perspectives of nurses, physicians, patients with cancer and their families who had participated in ACP. Data were analysed using a directed qualitative content analysis approach, and reporting followed the SRQR guidelines.
Twenty implementation determinants were identified across four CFIR domains, including 13 barriers and 7 facilitators. Key barriers included limited adaptability of ACP to local cultural and family norms, high complexity of ACP processes, insufficient knowledge and skills among clinicians, unclear team responsibilities, low organisational readiness, limited resources and poor public awareness. Facilitators included strong team culture, clinician motivation, supportive leadership and alignment with national policies. Two determinants showed mixed influences: the relative advantage of ACP compared to existing practices, and the extent of collaboration with external organisations.
Our study highlights the challenges of implementing ACP in China, as well as the unique and specific barriers to implementation. These findings contribute to a deeper understanding of context-specific determinants and offer actionable insights to inform the development of culturally tailored ACP implementation strategies in resource-limited healthcare settings.
To inform the development of implementation strategies to promote ACP in healthcare systems dominated by traditional medicine.
Flexible ureteroscopy has advanced modern stone management; however, lower pole renal stones remain a challenge due to suboptimal ureteroscope deflection and navigation using conventional flexible and navigable suction ureteral access sheaths (FANS). The SCULPT trial is designed to assess whether the novel steerable FANS—which enables active controlled deflection—can improve the success rate of lower pole access during flexible ureteroscopy.
This multicentre, prospective, single-blinded, randomised controlled superiority trial will recruit 400 adult patients (aged 18–75 years) with solitary lower pole renal stones ≤2 cm diagnosed by CT from 20 high-volume urological centres in China. Participants will be randomised 1:1 to undergo flexible ureteroscopy with either steerable or conventional FANS. The primary outcome is the success rate of navigating into the lower pole calyx (defined as successful direct stone visualisation, laser lithotripsy and aspiration without adjunct use). Secondary outcomes include immediate and 1 month stone-free rates, operative time, complication profiles (graded by Clavien–Dindo), instrument damage rates, quality-of-life assessments and cost analysis. Statistical analysis will be performed using appropriate tests for continuous and categorical data, with their significance set by prespecified superiority margins.
The study protocol has been designed in accordance with the Declaration of Helsinki and ICH-GCP guidelines. Ethical approval was centrally granted by the Institutional Review Board of The First Affiliated Hospital of Guangzhou Medical University and adopted by all participating centres following local feasibility review. The trial results will be disseminated via peer-reviewed publication and presentation at international conferences.
by Bing Wu, Pengli Wei, Jiaxiang Deng, Yuanyuan Rui
BackgroundThe atherogenic index of plasma (AIP) is a recognized marker of atherosclerosis and cardiovascular disease (CVD). However, the association between AIP and the risk of acute kidney injury (AKI) in critically ill patients with sepsis has not yet been investigated.
MethodsThe data used in this study were derived from the Medical Information Mart for Intensive Care (MIMIC-IV) database. The clinical outcome was the occurrence of AKI. Logistic regression was used to assess the association between AIP and the risk of AKI in sepsis patients. Restricted cubic spline (RCS) analysis was applied to explore potential non-linear relationships. Threshold analysis confirmed a turning point at this value. Subgroup analyses evaluated the consistency of the association across different strata. Mediation analysis was performed to explore potential intermediate variables.
ResultsAmong 1,874 sepsis patients, higher AIP levels were associated with increased AKI incidence. Logistic regression showed a significant association between AIP and AKI in unadjusted and partially adjusted models, but the association was no longer significant after full adjustment. RCS analysis revealed a nonlinear relationship with a peak AKI risk at AIP = 1.333. Threshold analysis confirmed a turning point at this value. Subgroup analyses showed consistent associations, while nonlinear effects were more evident in specific groups. Mediation analysis suggested that SOFA score, creatinine, WBC count, and respiratory rate partially mediated the AIP-AKI relationship.
ConclusionAIP was nonlinearly associated with AKI in sepsis, with a clear threshold effect. This relationship was partially mediated by SOFA score, creatinine, WBC, and respiratory rate. AIP may serve as a useful marker for AKI risk assessment.
by Xiaoliang Wan, Feiyao Deng, Xue Bai, Chenxi Xiang, Chuan Xu, Linxiao Qiu
Dysregulated serum chloride levels are prevalent in critically ill patients. However, their clinical impact remains unclear. This first systematic review and meta-analysis quantified the prevalence of hypochloremia and hyperchloremia, and their associations with mortality and acute kidney injury (AKI) in critically ill populations. We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies reporting hyperchloremia prevalence or outcomes in adult ICU patients until August 2025. Statistical analyses were conducted using Stata v16.0, and study quality was assessed using the Newcastle-Ottawa Scale. 34 studies (n = 175,021 patients) were included. The aggregated prevalence of hyperchloremia was 34% (95% CI [26%−43%]) and hypochloremia was 14% (95% CI [1%−28%]). Meta-analysis demonstrated that both hyperchloremia and hypochloremia were significantly associated with increased mortality, conferring a 28% (OR = 1.28, 95% CI [1.08–1.52]) and 55% (OR = 1.55%, 95% CI [1.33–1.81]) elevated risk for mortality, respectively. Crucially, a dose-response analysis revealed a non-linear relationship between serum chloride levels and mortality, confirming that the risk is independently elevated at both extremes. Furthermore, hyperchloremia was linked to an increased risk of AKI (OR = 1.40, 95% CI [1.07–1.85]). These findings establish dysregulated serum chloride as a common and clinically significant biomarker, underscoring the necessity of monitoring and managing both high and low chloride levels in critically ill patients. Future large-scale studies are warranted to validate these results and elucidate the mechanistic pathways linking chloride dysregulation to such adverse outcomes.Coronary artery involvement remains the primary focus in the long-term management of Kawasaki disease (KD). However, previous studies suggest that myocardial abnormalities frequently persist beyond coronary artery involvement in KD patients. Yet, their temporal evolution and clinical implications remain poorly characterised. To address this gap, we established the Kawasaki disease cardiac imaging (KDCI) cohort, integrating cardiac magnetic resonance (CMR) with echocardiography, coronary CT angiography (CCTA) and invasive angiography. These multimodal imaging approaches enable comprehensive assessment of cardiac abnormalities and elucidate the role of cardiac imaging in optimising long-term KD management.
The KDCI cohort is a prospective study aiming to enrol 400–500 KD patients diagnosed at West China Second University Hospital from September 2018 to September 2035. To date, 207 participants have been recruited. Participants will perform the multimodal cardiac imaging including echocardiography, CMR, CCTA, invasive angiography and comprehensive laboratory testing under a scheduled protocol in the follow-up.
The KDCI cohort has established baseline characteristics for 207 KD patients. Of those included to date, 72.0% (149/207) received intravenous immunoglobulin (IVIG) treatment, with 26.1% (54/207) demonstrating IVIG resistance, and 37.7% (78/207) exhibiting coronary artery dilatation. Longitudinal follow-up data are available for 80.7% (167/207) of participants, with a median follow-up duration of 2.7 years and a follow-up patient-years of 594 patient-years. Of the 207 patients, 16.9% (35/207) patients experienced endpoint events, encompassing coronary artery thrombosis (8.2%, 17/207), coronary stenosis/obstruction (5.3% 11/207) and clinical myocardial infarction (1.9%, 4/207). Based on the data collected, we have demonstrated the cardiac abnormalities beyond coronary artery involvement in KD by CMR and CCTA.
The KDCI cohort will maintain ongoing recruitment and longitudinal follow-up, with a projected enrolment exceeding 400 participants by 2035. This expansion will yield a median follow-up duration of 10 years, providing robust long-term outcome data. We have implemented standardised protocols for scheduled follow-up assessments and data collection in newly enrolled patients. Furthermore, planned genomic analyses will be incorporated to investigate the molecular pathogenesis and prognostic determinants of KD.
To explore the symptom experiences and self-management strategies of patients with chemotherapy-induced hand-foot syndrome (HFS), and to identify approaches for improving symptom control and quality of life.
A qualitative study using semi-structured interviews and thematic analysis.
We conducted this study in the oncology inpatient ward of a tertiary hospital in Shanghai, China.
We used a purposive sampling approach to recruit 25 inpatients with chemotherapy-induced HFS from July 2022 to March 2024. The interviews were audio-recorded and transcribed verbatim. We employed an adapted version of Colaizzi’s qualitative analysis approach to examine the data.
25 patients (mean age 58 years; 56% male) with grade I–III chemotherapy-induced HFS were interviewed. Four inter-related themes emerged.
(1) Symptom experience: pain, numbness and burning sensations disturbed sleep; visible peeling and hyper-pigmentation triggered embarrassment and self-consciousness.
(2) Emotional responses: most participants accepted symptoms as ‘part of treatment’, yet persistent anxiety about progression and guilt over becoming a family burden were common.
(3) Social impact: patients avoided outdoor activities, stopped caring for grandchildren and reported lost income because ‘hands can’t touch cold or rough items’.
(4) Future expectations: participants wanted pictorial self-care guides, a nurse hotline after discharge and earlier introduction of pain-relief strategies. All expressed frustration at ‘no-one to ask’ once home.
Chemotherapy-induced HFS imposes a considerable multidimensional burden. Tailored, patient-centred interventions that integrate education, psychological support and family involvement are essential to improve symptom management and overall well-being. Future work should develop and test sustainable, long-term support strategies in broader populations.
This study provides the first qualitative evidence base for understanding and managing chemotherapy-induced HFS in Chinese patients, informing nurse-led interventions, patient-reported outcome development and national supportive-care policy.
The working-age population (WAP) refers to individuals aged 15–64, who are the main drivers of production. Among the various factors affecting their productivity, hearing loss plays a significant role. However, epidemiological data on hearing loss in the WAP remain limited. The study analyses the global, regional and national situation of hearing loss in the WAP and predicts the disease burden up to 2040.
This study was based on data from the Global Burden of Disease (GBD) 2021 study, covering 204 countries and territories from 1990 to 2021.
The study population included all individuals aged 15–64 years, consistent with the United Nations definition of the WAP and adopted in the GBD 2021 study.
Data on the prevalence and years lived with disability (YLDs) due to hearing loss among the WAP were extracted from the GBD database. The disease burden was represented using both absolute numbers and age-standardised rates (ASRs). Trends were analysed with the estimated annual percentage change (EAPC). Subgroup analyses on sociodemographic index (SDI), gender, disease severity and causes were performed, and projections for 2040 were estimated using the Nordpred model.
Globally, from 1990 to 2021, the number of hearing loss cases in the WAP increased from 558.08 million to 1.04 billion, and the number of YLDs rose from 14.45 million to 26.55 million. In 2021, the prevalence in the WAP was 19 607.24 per 100 000, with YLDs at 501.81 per 100 000. The EAPC shows an upward trend: the change in age-standardised prevalence is 0.11 (95% uncertainty interval (UI 0.10, 0.12), and the change in age-standardised YLDs is 0.10 (95% UI 0.08, 0.11). High SDI regions have the lowest burden of hearing loss globally. At the regional level, as SDI increases, the age-standardised prevalence and YLDs of hearing loss show a downward trend. In contrast, the burden is higher in Oceania, Southeast Asia, South Asia, Eastern Sub-Saharan Africa and East Asia. The top three countries in terms of prevalence and YLDs are Madagascar, Malawi and Kenya. By 2040, the global prevalence and YLDs of hearing loss in the WAP are projected to be 1.31 billion and 33.30 million, respectively, with ASRs of 19 890.33 and 512.27 per 100 000 population.
The burden of hearing loss in the WAP is gradually increasing, with differences in prevalence and YLDs across regions, countries and SDI levels. Continued attention is needed for this vulnerable group’s hearing loss, along with the implementation of effective measures to reduce future burdens.
To examine the longitudinal impact of time-varying factors on US youth’s trajectories of initiation and use of e-cigarettes and cigarettes during the transition from adolescence to young adulthood.
Longitudinal.
Nationally representative US survey, the Population Assessment of Tobacco and Health (PATH) Study.
2682 US youth (aged 16–17) at wave (W)1 of the PATH Study across six waves (2013–2020) into young adulthood (aged 22–23).
Unweighted longitudinal latent class analyses identified trajectory classes of e-cigarette and cigarette use, separately. Nationally representative weighted multinomial logistic regression analyses examined time-varying harm perceptions, substance use problems and tobacco product first tried as predictors of these trajectory classes.
Five e-cigarette classes (2013–2020; 41.5% Persistent Never Use, 12.6% W5 Initiation, 19.9% W3 Initiation, 15.2% Prior Initiation, 10.8% High Frequency Past 30-Day (P30D) Use) and five cigarette classes (2013–2019; 58.6% Persistent Never Use, 11.5% W4 Initiation, 10.9% W2 Initiation, 9.6% Prior Initiation, 9.5% High Frequency P30D Use) were identified. Time-varying harm perceptions and substance use problems were associated with trajectories of initiation and use for both products. Cigarettes, cigarillos, other combustibles and any smokeless tobacco as first product tried were associated with e-cigarette initiation and/or progression to high frequency use. E-cigarettes and hookah as first product tried were associated with later cigarette initiation. High Frequency P30D Cigarette Use was less likely if the first product tried was e-cigarettes, cigarillos, hookah or any smokeless tobacco product.
Results reinforce the need for identification and intervention of early substance use among younger adolescents and targeted public health messaging to address changing harm perceptions and prevent initiation among older adolescents.
This study employs network analysis to examine the interrelationships between psychological distress, workplace challenges and adaptive capacity in ICU nurses.
ICU nurses experience significant psychosocial challenges due to high-stress environments, traumatic events and heavy workloads. While prior research has identified high levels of psychological distress, workplace challenges and reduced adaptive capacity among ICU nurses, these factors are often studied in isolation.
This cross-sectional study involved 498 ICU nurses from 18 tertiary hospitals in Jiangsu, Zhejiang and Shanghai, conducted between February 10 and March 15, 2025. The survey employed the Profile of Mood States—Short Form (POMS-SF), Body Image State Scale (BISS), Perceived Stress Scale-4 (PSS-4), Workplace Violence Scale (WVS), Minnesota Satisfaction Questionnaire (MSQ), Connor-Davidson Resilience Scale (CD-RISC) and Pittsburgh Sleep Quality Index (PSQI) to measure the mood states, body image, perceived stress, workplace violence, job satisfaction, resilience and sleep quality of ICU nurses. Network analysis was performed using R version 4.3.3 to identify key symptoms within the network.
Stress (PSS), sleep quality (PSQI) and workplace violence (WVS) were central in the network, with the strongest association between job satisfaction (MSQ) and mood disturbance (TMD) (edge weight = −0.322). Mood disturbance (strength = 1.254) had the greatest impact on the network. Mood disturbance (TMD), job satisfaction (MSQ) and sleep quality (PSQI) had the highest network predictability, indicating they are key targets for interventions.
Mapping ICU nurses' psychosocial challenges as an interconnected system shifts focus from isolated symptoms to systemic drivers. Stress, sleep quality and workplace violence are high-yield targets for interventions.
Focusing on these key targets can help healthcare organisations develop more effective strategies to support the mental health and resilience of nursing staff, improve patient care and reduce burnout rates among ICU nurses.
No patient or public contribution.
Both air pollution and temperature variability (with cold wave as an extreme form) may influence the incidence of ischaemic stroke (IS). This study aimed to examine the association between winter air pollution-cold wave sequential events (persistent air pollution followed by cold waves) and IS incidence among adults aged>=60 years.
Clinical data were sourced from the Tianjin Medical and Health Big Data Platform (covering 81 secondary/tertiary hospitals), and meteorological/air quality data were sourced from the National Meteorological Science Data Centre. Spearman rank correlation analysis was used to assess the relationships between meteorological variables (eg, 24-hour temperature decrease), atmospheric pollutants (including Air Quality Index (AQI)) and elderly IS incidence. A distributed lag nonlinear model (DLNM) was applied to analyse lagged effects of winter air pollution and cold wave sequential events on IS incidence, while a generalised additive model (GAM) was used to evaluate additive interactions between air pollution and cold waves on IS incidence.
The study included 109 513 adults aged >=60 years with first-onset IS from 2016 to 2019. Eight winter air pollution-cold wave sequential events were identified over 4 years, with higher daily IS incidence during event periods (67 new cases/day), lag periods (68 new cases/day) than non-event periods (60 new cases/day). Subgroup analysis showed that among adults aged ≥80 years, proportional incidence during both events (80 to 85 years old: 1.89, 95% CI 0.52 to 3.26; 85 to 90 years old: 1.96, 95% CI 0.59 to 3.33) and lag period (80 to 85 years old: 0.90, 95% CI 0.02 to 1.78; 85 to 90 years old: 1.52, 95% CI 0.64 to 2.40) increased compared with the non-event period. Daily IS incidence was positively correlated with 24-hour temperature decreases, AQI and other air pollutants. DLNM showed that lag effects emerged 4 days post-exposure, with the highest IS risk at a 9-day lag (RR=1.122, 95% CI 0.443 to 2.838). GAM confirmed positive additive interactions between air pollution and cold waves on IS incidence (p
Winter air pollution-cold wave sequential events exert a synergistic, lagged effect on IS incidence in the elderly, with adults >=80 years being the most vulnerable. The observed risk patterns and underlying mechanisms underscore the importance of integrated environmental and public health strategies to reduce IS burden in this high-risk population.
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 assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.
A convergent parallel mixed-methods design.
From January and September 2022, eight top-tier hospitals in mainland China were selected using convenience sampling. The proportion of master's degree nurses, turnover rates, and recruitment outcomes were investigated and analysed using descriptive statistics. Concurrently, seven nursing administrators from these eight hospitals were interviewed using semi-structured interviews, and transcribed data were thematically analysed through inductive content analysis.
Among the eight hospitals surveyed, the average proportion of master's degree nurses was 3.58% (range: 0.58%–9.43%). The average ratio of planned to actual recruitment was 3.28, with four hospitals showing near parity (approximately 1:1) and three institutions failing to recruit any master's degree nurses. The annual turnover rate of master's degree nurses was 1.18%. Three themes emerged from the qualitative analysis: (1) shortages coexisting with oversupply; (2) nursing leaders' retention efforts versus limited institutional policy support; and (3) prioritisation of research and management over advanced clinical roles.
In China, even among top-tier hospitals, the proportion of master's degree nurses remains relatively low. There is an overall shortage of these nurses, juxtaposed with localised oversupply in specific institutions. Promotion to nursing supervisor or administrative roles is the only developmental pathway, while structured career progression pathways for advanced nursing practice remain conspicuously absent.
The study highlights the need to develop targeted policies that support the career advancement of master's degree nurses, particularly by expanding career options in Advanced Practice Nurses (APNs) rather than limiting roles to nursing management or education. This shift would better leverage their clinical expertise and strengthen healthcare systems through specialised practice and innovation.
What problem did the study address?: This study maps the supply–demand dynamics of master's degree nurses in leading hospitals and identifies retention, utilisation, and motivation policies and strategies from the perspective of nursing administrators. What were the main findings?: The proportion of master's degree nurses is low in China's top hospitals. There is both an oversupply and a shortage of master's degree nurses. Neither the government nor hospitals have policies in place to encourage the clinical involvement of master's degree nurses, and their career progression is limited to managerial roles. Where and on whom will the research have an impact?: Nursing administrators and other health policy makers in China and comparable global health systems will be affected. It will also influence nursing associations, nursing educators, and general nurses.
This study adhered to the Mixed Methods Article Reporting Standards.
No contributions from patients or the public were involved in this study.
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