Hyperkalaemia (HK) is common in the emergency department (ED) and can cause life-threatening arrhythmias. Patiromer is a potassium binder whose role in acute HK management is uncertain; therefore, we investigated the efficacy and safety of patiromer as an adjunct to the standard of care treatment of HK in the ED.

A prospective, randomised, double-blind, placebo-controlled study.

16 ED sites across the USA.

Patients aged ≥18 years treated at a participating ED who were found to have serum potassium ≥5.8 mEq/L.

Participants were randomised 1:1 to standard combination therapy (25 g intravenous dextrose, 5 units intravenous insulin and 10 mg albuterol) with either patiromer or placebo. The initial dose was given within 1 hour of the potassium result, and the second dose 24 hours later.

The primary endpoint was net clinical benefit (NCB) at 6 hours, defined as the change in number of potassium-lowering interventions minus change in serum potassium. Adverse events (AEs) were also recorded.

The study was terminated early and did not reach the prespecified sample size. Overall, 111 patients (53 patiromer and 58 placebo) were analysed. Mean (SD) age was 61.34 (15.21) years, 34% were female, 48% white and 22.5% received chronic haemodialysis. Mean baseline potassium was 6.5 mmol/L. NCB at 6 hours was similar between patiromer and placebo (–0.6 vs –0.4; p=0.44). Potassium levels at 2, 4 and 6 hours were similar between the groups (5.50 vs 5.70, 5.45 vs 5.65, 5.50 vs 5.60; patiromer and placebo (all p>0.05)). The number of interventions per patient was similar (p>0.05) between groups at each time point. The proportion of patients experiencing AEs was not significant between the patiromer and placebo groups (16.98% vs 32.76%; p=0.08).

No differences in efficacy were reported in this study, which was underpowered to detect statistical efficacy of patiromer over placebo.

NCT04443608.

This scoping review protocol aims to examine the role of the Internal Regulation Core (IRC) as an intra-hospital governance structure that coordinates capacity and patient flow and may function as a strategic hub for disruptive innovation in hospital management. By integrating organisational routines, rules and, when available, enabling technologies, IRCs may strengthen operational efficiency and contribute to higher-quality care delivery. As hospitals face increasing operational complexity and constrained resources, clarifying what IRCs are, how they are implemented across settings, and what innovations and impacts are reported has become a priority.

This scoping review will follow the Joanna Briggs Institute guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A comprehensive search will be conducted across five databases (MEDLINE/PubMed, Embase, Scopus, Web of Science and LILACS) and grey literature sources, without language or date restrictions. The searches were conducted up to 6 July 2025. Two reviewers will independently screen studies and extract data using a standardised form; disagreements will be resolved by consensus or a third reviewer. Findings will be synthesised descriptively and thematically, with results presented in tables and narrative summaries, including innovation streams.

Open Science Framework (10.17605/OSF.IO/HWZJS).

Glaucoma is an optic neuropathy caused by the gradual degeneration of retinal ganglion cells. This study aimed to investigate the knowledge, attitude and practice (KAP) towards glaucoma among ophthalmic inpatients.

A web-based questionnaire.

Local hospital.

Ophthalmic inpatients (n=1238).

The primary outcome was the patients’ KAP.

Multivariable logistic regression analysis showed that rural residence (OR=0.488, 95% CI 0.313 to 0.762, p=0.002), college education or above (OR=4.996, 95% CI 2.942 to 8.483, p

Ophthalmic inpatients might have moderate knowledge and attitude, but a proactive practice towards glaucoma. A history of glaucoma, previous glaucoma surgery, education level, residency and alcohol consumption were potentially associated with knowledge and attitudes towards glaucoma among ophthalmic inpatients.

During 2009–2018, the Emory Global Health Institute conducted the Tobacco-Free Cities (TFC) programme in 22 cities in mainland China. This study aims to assess the sustained impact of the TFC programme.

A qualitative study using semi-structured interviews was adopted, which focused on the leadership and capacity building, city-level smoke-free policies, tobacco control activities, outcomes of tobacco control, sustainability post TFC programme and the accomplishments of tobacco control. The thematic analysis was employed for qualitative data analysis.

Online in-depth personal interviews.

This qualitative study recruited 17 participants from 10 cities which participated in the TFC programme (five with comprehensive and five with partial smoke-free policies). Interview participants included TFC programme leaders, TFC staff and current tobacco control staff.

First, TFC members reported enhanced competencies in smoke-free policy effort and leadership. Five cities with comprehensive smoke-free policies had a high degree of public support, while cities with partial bans faced barriers such as lack of leadership support and experiencing tobacco industry influence. Tobacco control activities, including media campaigns, policy enforcement, cessation programmes and monitoring activities, were sustained in almost all cities. Enhancement in smoke-free social norms, decrease in smoking rate and second-hand smoking exposure were perceived. Challenges to sustainability included reduced financial and personnel resources and weakened policy enforcement.

The TFC programme was regarded by participants as an effective model that provided the necessary training and technical support to develop and enforce effective and sustainable tobacco control policies and initiatives at the city level in China. Future tobacco control training should focus more on developing concrete solutions for sustainability challenges.

This study aimed to identify and validate risk factors for suicidal ideation (SI) and non-suicidal self-injury (NSSI) among nursing staff through the development and application of a risk model and nomogram.

A cross-sectional online survey was conducted in Dehong District to collect relevant data.

A total of 1774 Chinese nursing staff members were enrolled in this study.

Multiple factors were independently associated with SI among nursing staff. These included divorce or other non-marital status (OR=2.42, 95% CI 1.07 to 5.44), drinking frequency (OR=1.34, 95% CI 1.001 to 1.79), loneliness (OR=1.26, 95% CI 1.11 to 1.44), depressive symptoms (OR=1.13, 95% CI 1.09 to 1.18), childhood trauma (OR=1.03, 95% CI 1.02 to 1.05) and life quality satisfaction (OR=0.63, 95% CI 0.49 to 0.80). Similarly, for NSSI among nursing staff, independent risk factors were identified, such as smoking frequency (OR=1.37, 95% CI 1.01 to 1.85), drinking frequency (OR=1.42, 95% CI 1.05 to 1.91), loneliness (OR=1.21, 95% CI 1.05 to 1.39), depressive symptoms (OR=1.13, 95% CI 1.09 to 1.18) and childhood trauma (OR=1.03, 95% CI 1.01 to 1.05). A nomogram for assessing SI/NSSI was established and demonstrated good calibration, with a Concordance Index of 0.82 (95% CI 0.79 to 0.86) for SI and 0.81 (95% CI 0.78 to 0.85) for NSSI.

The findings of this study can be used to identify nursing staff at risk of developing SI/NSSI. By using the developed nomograms for self-assessment, individuals might gain a better understanding of their occupational stress levels while performing routine work tasks. However, it should be noted that the study lacks external validation, which limits the generalisability of the findings at this stage.

Dysregulated immunity may account for an increased risk of infection and other adverse outcomes among frail hospitalised persons. The primary objective of this study is to examine whether baseline frailty is associated with the risk of developing ventilator-associated pneumonia (VAP) or other intensive care unit (ICU)-acquired infections among invasively ventilated adults. Additional objectives are to examine the relationship between frailty and hospital length of stay, discharge to a long-term care facility and vital status. We hypothesise that persons with frailty compared with others would have an increased risk of VAP and other infections, a longer hospital stay, higher probability of discharge to a long-term care facility and higher mortality.

This is a preplanned secondary analysis of the PROSPECT trial (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) which enrolled patients across 44 ICUs in three countries. We will use Cox proportional hazards regression analysis to assess the association of frailty with the clinical outcomes of interest, adjusting for other baseline variables. Baseline demographic and descriptive outcome data will be reported using descriptive statistics. Regression results will be presented as adjusted HRs or ORs with 95% CIs for the associations of each independent variable with the primary, secondary and tertiary outcomes.

Participating hospital research ethics board approved the PROSPECT trial and data collection. The protocol for this study was approved by the Hamilton Integrated Research Ethics Board on 20 August 2015 (Project ID:19128). This study will identify whether frailty is associated with risk of VAP and other healthcare-associated infections in invasively ventilated patients, adjusted for other baseline factors. Results may be useful to patients, their caregivers, clinicians and the design of future research. Findings will be disseminated to investigators at a meeting of the Canadian Critical Care Trials Group. We will present study results at an international conference in the fields of critical care and infectious diseases, to coincide with or precede open-access peer-review publication. To aid knowledge dissemination, we will use a variety of formats. For example, for traditional and social media, we will create two different visual abstracts and infographics of our results suitable to share on clinician-facing and public-facing platforms.

NCT02462590.

To identify challenges in stroke care services and stakeholders’ expectations for the role of stroke advanced practice nurses (APNs) in the neurology department of a tertiary hospital in ainland China.

A field study using participatory observation and in-depth interviews.

The neurology department of a tertiary hospital in Sichuan Province, China.

The principal researcher conducted participant observation in the capacity of a clinical nurse. In-depth individual interviews were conducted within 7 stroke patients and their carers, 4 doctors and 10 nurses.

Key challenges included a shortage of specialised professionals, imprecise, untimely and discontinuous care, poor medical–nursing collaboration, limited nursing expertise and unmet patient needs. Stakeholders expected stroke APNs to fulfil six roles: stroke care expert, advanced clinical practitioner, collaborative coordinator, specialist care innovator, specialised educator and role model.

Stroke APNs should provide precise, timely and continuous care for patients while enhancing team cohesion, overall competence and service quality.

To examine (1) the mediating roles of self-efficacy and future-oriented time perspective (FTP) in the association between workplace culture of health (COH) and diabetes self-management and (2) the moderating effect of diabetes distress on the relationship between self-efficacy and FTP among employees with type 2 diabetes mellitus (T2DM).

A cross-sectional survey.

This study was conducted among employees with T2DM recruited from the Endocrinology Outpatient Departments at three tertiary hospitals in Taiyuan City, Shanxi Province, China, between March and October 2024.

The participants were 462 employees with T2DM who had been employed at their current organisations for at least 3 months following their T2DM diagnosis.

Data on demographics, diabetes-related and work-related factors, workplace COH, self-efficacy, time perspective, diabetes distress and self-management performance were collected via a survey. The moderated mediation effects were examined using Hayes’s PROCESS macro.

Workplace COH was associated with diabetes self-management both directly (β=0.251, 95% CI 0.080 to 0.422, p self-efficacy -> diabetes self-management (indirect effect=0.207, 95% CI 0.110 to 0.308); (2) workplace COH -> self-efficacy -> FTP -> diabetes self-management (indirect effect=0.093, 95% CI 0.051 to 0.144). However, the indirect pathway: workplace COH -> FTP -> diabetes self-management was not significant (indirect effect=0.004, 95% CI –0.055 to 0.063). Additionally, a significant interaction (β=–0.356, 95% CI –0.566 to –0.146, p

This study demonstrated that workplace COH was associated with diabetes self-management both directly and indirectly, specifically through self-efficacy alone and serially through self-efficacy and FTP; it also confirmed that diabetes distress weakens the effect of self-efficacy on FTP, thereby providing a basis for developing interventions to improve self-management among employees with T2DM.

This scoping review synthesises the application of patient journey mapping (PJM) in breast cancer care to provide insights for enhancing patient-centred services and improving the quality of life for patients with breast cancer.

Scoping review.

Web of Science, PubMed, Cochrane Library, CINAHL, Embase, CNKI, Wanfang and SinoMed were systematically searched for relevant studies published between 1 May 2005 and 1 May 2024.

Studies involving adults (≥18 years) with breast cancer that examined patient journeys were eligible, regardless of whether a formal PJM approach was used. All study designs in healthcare or community settings were considered. Exclusions included studies on other cancers, duplicates, inaccessible full texts, non-English/Chinese publications and non-original articles.

Two reviewers independently screened and extracted data, with a third resolving discrepancies. Information on study characteristics, methods and PJM applications was narratively synthesised and tabulated.

A total of 20 studies published from 2011 to 2024 were included. Four primary approaches to PJM in breast cancer care were identified, with cancer care stage mapping being the most prevalent. PJM illustrated patients’ trajectories, experiences and emotions, revealed critical interaction points such as diagnosis, decision-making and follow-up, and highlighted delays, coordination gaps and opportunities for service improvement. Most studies incorporated four core elements—patients, touchpoints, timelines and experiences—and emphasised patient perspectives across the care continuum, despite methodological heterogeneity.

This review shows that PJM has been applied to illustrate longitudinal healthcare experiences, identifies key touchpoints and supports the design and improvement of breast cancer care services. Most studies underscored patient perspectives and emotional needs, but current PJM applications remain fragmented, hospital-focused and weakly integrated across care settings and families. Future research should refine methodologies and apply digital technologies to develop personalised, dynamic maps that may enhance patient-centred care.

Postoperative cardiac injury, encompassing myocardial infarction (MI) and myocardial injury after non-cardiac surgery (MINS), is a major perioperative complication associated with substantial morbidity and mortality. While numerous prediction models have been developed using traditional statistical and machine learning approaches, their comparative performance, calibration quality and methodological rigour remain unclear. This protocol outlines a systematic review and meta-analysis to comprehensively evaluate multivariable risk prediction models for postoperative cardiac injury in adults undergoing non-cardiac surgery.

Following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, this PROSPERO-registered systematic review will search PubMed, Embase, Web of Science, Cochrane Library, Scopus, grey literature and trial registries for studies developing, validating or updating multivariable prediction models for postoperative cardiac injury (MI or MINS) occurring within 72 hours of non-cardiac surgery. Two reviewers will independently extract data and assess quality using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and PROBAST (Prediction Model Risk of Bias Assessment Tool) tools. The primary outcome is discriminative performance (area under the receiver operating characteristic curve), with calibration metrics and diagnostic accuracy measures as secondary outcomes. Random-effects meta-analyses will pool performance estimates for models validated in multiple cohorts. Heterogeneity will be explored through subgroup analyses and meta-regression, examining factors including model methodology (regression-based vs machine learning), predictor types and validation contexts. Sensitivity analyses will test the robustness of findings.

Ethical approval is not required for this study, as it is a systematic review and meta-analysis based on previously published data.

CRD420251041628.