Conectar
To systematically identify and appraise existing risk prediction models for EN aspiration in adult inpatients.
A systematic search was conducted across PubMed, Web of Science Core Collection, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure (CNKI), Wanfang Database, China Biomedical Literature Database (CBM) and VIP Database from inception to 1 March 2025.
Systematic review of observational studies.
Two researchers independently performed literature screening and data extraction using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS). The Prediction Model Risk of Bias Assessment Tool (PROBAST) was employed to evaluate both the risk of bias and the clinical applicability of the included models.
A total of 17 articles, encompassing 29 prediction models, were included. The incidence of aspiration was 9.45%–57.00%. Meta-analysis of high-frequency predictors identified the following significant predictors of aspiration: history of aspiration, depth of endotracheal intubation, impaired consciousness, sedation use, nutritional risk, mechanical ventilation and gastric residual volume (GRV). The area under the curve (AUC) was 0.771–0.992. Internal validation was performed in 12 studies, while both internal and external validation were conducted in 5 studies. All studies demonstrated a high risk of bias, primarily attributed to retrospective design, geographic bias (all from different parts of China), inadequate data analysis, insufficient validation strategies and lack of transparency in the research process.
Current risk prediction models for enteral nutrition-associated aspiration show moderate to high discriminative accuracy but suffer from critical methodological limitations, including retrospective design, geographic bias (all models derived from Chinese cohorts, limiting global generalisability) and inconsistent outcome definitions.
Recognising the high bias of existing models, prospective multicentre data and standardised diagnostics are needed to develop more accurate and clinically applicable predictive models for enteral nutrition malabsorption.
Not applicable.
PROSPERO: CRD420251016435
With ambient listening systems increasingly adopted in healthcare, analyzing clinician-patient conversations has become essential. The Omaha System is a standardized terminology for documenting patient care, classifying health problems into four domains across 42 problems and 377 signs/symptoms. Manually identifying and mapping these problems is time-consuming and labor-intensive. This study aims to automate health problem identification from clinician-patient conversations using large language models (LLMs) with retrieval-augmented generation (RAG).
Using the Omaha System framework, we analyzed 5118 utterances from 22 clinician-patient encounters in home healthcare. RAG-enhanced LLMs detected health problems and mapped them to Omaha System terminology. We evaluated different model configurations, including embedding models, context window sizes, parameter settings (top k, top p), and prompting strategies (zero-shot, few-shot, and chain-of-thought). Three LLMs—Llama 3.1-8B-Instruct, GPT-4o-mini, and GPT-o3-mini—were compared using precision, recall, and F1-score against expert annotations.
The optimal configuration used a 1-utterance context window, top k = 15, top p = 0.6, and few-shot learning with chain-of-thought prompting. GPT-4o-mini achieved the highest F1-score (0.90) for both problem and sign/symptom identification, followed by GPT-o3-mini (0.83/0.82), while Llama 3.1-8B-Instruct performed worst (0.73/0.72).
Using the Omaha System, LLMs with RAG effectively automate health problem identification in clinical conversations. This approach can enhance documentation completeness, reduce documentation burden, and potentially improve patient outcomes through more comprehensive problem identification, translating into tangible improvements in clinical efficiency and care delivery.
Automating health problem identification from clinical conversations can improve documentation accuracy, reduce burden, and ensure alignment with standardized frameworks like the Omaha System, enhancing care quality and continuity in home healthcare.
Many studies have identified the negative psychological impact of in vitro fertilisation and embryo transfer (IVF-ET) on couples with infertility, but there remains a paucity of research clarifying both positive and negative effects within the context of Chinese culture.
To explore the dynamic psychosocial experiences and underlying mechanisms of couples in the whole process of IVF-ET, and to construct a theoretical framework that elucidates this phenomenon within the context of Chinese social-culture.
A grounded theory study.
Guided by constructivist grounded theory methodology, semi-structured face-to-face interviews were conducted in the reproductive medicine outpatient department of a tertiary-level hospital located in northwest China between January and October 2023. Purposive and theoretical sampling methods were used to recruit couples undergoing IVF-ET. Data were analysed through three iterative steps: initial coding, focused coding, and theoretical coding, utilising constant comparative methods and reflective memo-writing. The study is reported using the COREQ checklist.
Theoretical saturation was achieved after interviewing 22 couples. The substantive theory was synthesised into one core category: ‘forward or backward’, which captured the ambivalent psychosocial experiences of couples undergoing IVF-ET within the context of Chinese culture. This theory described three overarching stages: making the decision, undergoing the treatment, and facing the result, with each stage linked to specific promoting and hindering factors.
This study establishes a theoretical foundation for further implementation of comprehensive reproductive health management within the Chinese sociocultural context. It is crucial for healthcare providers and policymakers to focus on the dyad of couples undergoing IVF-ET, pay attention to both negatively and positively psychosocial fluctuations, and enhance both medical care and sociocultural support systems accordingly.
No patient or public contribution.
by Yuping Shan, Gulijinaiti Abulikemu, Lu Liu, Youzhong Zhang, Zhaoxia Ding
BackgroundIdentifying high-risk groups for adverse outcomes after conization is crucial for developing targeted treatment plans for patients with cervical adenocarcinoma in situ (ACIS). This study aimed to analyze the clinical characteristics of patients with ACIS and identify risk factors associated with adverse outcomes.
MethodsPatients diagnosed with ACIS through colposcopic biopsy at the Affiliated Hospital of Qingdao University and Qilu Hospital between January 2012 and December 2022 were selected. After meeting the inclusion and exclusion criteria, we collected their clinical data. Chi-square (χ2) tests and logistic regression models were employed to determine independent risk factors.
ResultsA total of 379 patients with ACIS were included in this analysis. About 26.1% of these patients tested positive on preoperative endocervical curettage (ECC), while 79.4% had a single lesion. Among the 334 patients who underwent cervical conization, 17.1% had positive surgical margins. Additionally, residual lesions were present in 53.6% of cases, and pathological upgrading occurred in 7.8% of patients. Multivariate analysis indicated that age (p p = 0.033), and the number of ACIS lesions (p p = 0.011), preoperative histopathological results from ECC (p = 0.030), and surgical margin statuses at cervical conization (p p = 0.035) was confirmed as a predictor of postoperative pathological upgrading.
ConclusionsOlder, multiparous patients with ACIS and abnormal preoperative ECC results require deeper diagnostic excision. Patients with positive conization margins necessitate further treatment, particularly when accompanied by abnormal ECC results. For women who wish to preserve their fertility, a repeat conization may be appropriate; however, in older and multiparous women, a hysterectomy would be recommended.
The global population is aging, and it is becoming increasingly common for older people to suffer from multiple diseases. The development of digital health technologies has assisted the self-management of multimorbid older patients. Currently, there is a lack of qualitative review that synthesizes the needs and experiences of multimorbid older patients using digital health technologies for self-management.
To synthesize the needs and experiences of multimorbid older adults using digital health technologies for self-management.
The following six electronic databases were searched: PubMed, Embase, Web of Science, Scopus, Cochrane Library, and CINAHL. The search timeframe was from construction to November 4, 2024. Thematic synthesis by Thomas and Harden was used for meta-synthesis. Study selection and data extraction were conducted independently by two researchers, and quality was evaluated using the 10-item Critical Appraisal Skills Programme tool.
Ten studies were included. Three themes and seven subthemes were synthesized: (1) different impressions and perceptions, (2) challenges of use, and (3) conveniences and benefits. Older adults with multiple medical conditions have positive or negative impressions and perceptions of digital health technologies and experience multiple challenges in their use (lack of expertise, technical and equipment barriers, need support), while at the same time, digital health technologies offer huge benefits for their self-management (improved communication with healthcare professionals, enhanced self-management skills).
This review provides support for healthcare professionals to understand the experiences of multimorbid older adults using digital health technologies for self-management. Healthcare professionals and technology developers should establish collaborative relationships to design comprehensive, usable, and less burdensome digital health technologies for older adults with multiple morbidities. Additionally, comprehensive technical support services should be provided to ensure the effective utilization of these technologies by older adults.
PROSPERO number: CRD42024599433
The study investigated the influence of quality of discharge teaching (QDT) on readiness for hospital discharge (RHD) and pathways involved in patients with first-episode stroke, aiming to provide a theoretical framework for enhancing RHD levels and reducing readmission rates.
Cross-sectional study.
A total of 372 inpatients completed the Quality of Discharge Teaching Scale, Readiness for Hospital Discharge Scale, Chronic Disease Self-efficacy Scale and Southampton Stroke Self-Management Questionnaire. Structural equation modelling and Pearson's correlation analysis were utilised to elucidate relationships and action pathways among these variables.
The correlation analysis demonstrated significant positive pairwise correlations between QDT, RHD, self-efficacy and self-management (r = 0.376–0.678, p < 0.01). The final model exhibited a good fit with the following indices: χ 2/df = 3.286, RMSEA = 0.078, SRMR = 0.0303, GFI = 0.984, AGFI = 0.926, CFI = 0.991 and TLI = 0.970. The impact of QDT on RHD in patients with first-episode stroke was observed through one direct and three indirect pathways: (1) QDT exerted a direct influence on RHD (p < 0.001); (2) QDT indirectly influenced RHD via self-efficacy (p < 0.001); (3) QDT indirectly affected RHD through self-management (p < 0.001); and (4) QDT had an indirect effect on RHD via both self-efficacy and self-management (p < 0.05).
QDT was found to directly influence RHD in patients with first-episode stroke and also exerted indirect effects through self-efficacy and self-management, either independently or in combination. Early screening of RHD levels in patients before discharge is recommended, along with the enhancement of QDT through the development of tailored guidance plans according to different disease stages, ultimately improving RHD levels and facilitating a safer transition from hospital to home or community.
Healthcare professionals should assess both QDT and RHD levels to provide targeted interventions. The establishment of transitional care teams and implementation of long-term poststroke management are essential for reducing stroke recurrence and mortality rates.
To find potential biomarkers based on miRNA and their potential targets in splenic monocytes in burn-injured mice. Male Balb/c mice were subjected to sham or scalding injury of 15% total body surface area. Spenic CD11b+ monocytes were purified with magnetic beads. The monocytes were cultured in the presence of lipopolysaccharide. The proliferation of monocytes was detected by MTT assay, and the cytokines in the supernatant were examined by enzyme linked immunosorbent assay. The purified monocytes were also under total RNA extraction. The differential monocytic miRNAs expression between the sham and burn-injured mice was analysed by miRNA microarray. The activity of monocytes was comparable between the two groups (p > 0.05). However, monocytes from burn-injured mice secreted higher levels of tumour necrosis factor (TNF)-α and transforming growth factor-β, but lower level of monocyte chemoattratctant protein-1. A total of 54 miRNAs were differentially expressed in monocytes from burn relative to sham-injured mice (fold >3). Further quantitative reverse transcription polymerase chain reaction confirmed that the expression of miR-146a was significantly down-regulated, while miR-3091-6p was up-regulated after burn injury. Using the combination of Miranda and TargetScan softwares, we found that mir-146a may regulate 180 potential target genes including TNF receptor related factor 6 (TRAF6), interleukin-1 receptor related kinase 1 (IRAK1) and CD28. Mir-3091-6p may regulate 39 potential targets, including SOCS7 (cytokine signal transduction inhibitor 7) and ARRB2 (arrestin, β 2). The miRNAs expressed by monocytes after burn injury may be involved in the regulation of innate immune response in burn injury.
To investigate the impact of socio-demographic factors and job stressors on the emotional intelligence of psychiatric nurses.
Emotional intelligence plays a crucial role in enabling nurses to effectively manage their own emotions, comprehend the emotions of others and assist individuals in dealing with diverse stressors. Nevertheless, a comprehensive conceptualization of the relationship between job stressors and emotional intelligence remains lacking.
This study employs a multi-centre cross-sectional design.
A multi-centre cross-sectional survey involving 1083 registered nurses from 11 psychiatric hospitals across four provinces in China was conducted. Non-probability sampling was utilised. The survey encompassed assessments of nurse job stressors, emotional intelligence using a scale and socio-demographic characteristics using a questionnaire. A multiple linear regression model was applied to identify significant variables associated with emotional intelligence based on demographic attributes and various nurse job stressors. The study adhered to the STROBE checklist.
The findings revealed a noteworthy negative correlation between nurse job stressors and emotional intelligence. Socio-demographic factors and job stressors of certain nurses were able to predict emotional intelligence and its dimensions among psychiatric nurses, with percentages of 44.50%, 40.10%, 36.40%, 36.60% and 34.60%.
Providing emotional intelligence training for psychiatric nurses could enhance their capacity to cope effectively with workplace stress, particularly among younger nurses who engage in limited physical activities.
The analysis of the relationship between emotional intelligence and nurse job stressors could facilitate early detection and intervention by managers based on pertinent factors. This, in turn, could elevate the emotional intelligence level of psychiatric nurses.
This study did not recruit participants, so details of participants were not be involved.
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