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The treatment of bladder cancer often involves radical cystectomy and urostomy, which increase survival rates but cause significant physical, psychological and social distress. While existing evidence emphasizes treatment and interventions to improve the quality of life, few studies have explored the continuous health management experience and needs of urostomy patients from diagnosis through recovery.
To construct a journey map of the healthcare management needs of urostomy patients to explore key pain points in their rehabilitation process and provide a reference for continuous health management.
A descriptive qualitative study was conducted. Using purposive sampling, 25 participants who underwent urostomies were recruited from a tertiary hospital in Tianjin, China. Data were collected through semi-structured face-to-face in-depth interviews. Conventional content analysis was used to analyse the data, extract themes and visualize dynamic changes in patient needs via a patient journey map.
The patient journey map delineated four phases and extracted 12 themes. During the screening and diagnosis phases, participants experience symptom distress, information overload and fear of recurrence. The perioperative phase was marked by challenges in symptom management, frustration in learning stoma skills and abrupt transitions in caregiving models. During the transitional adaptation and continuing treatment phases, participants experience survival fatigue due to the dual burden of early complications, chemotherapy reactions and financial pressure. In the long-term self-management phase, participants struggle with cumbersome self-management routines, anxiety about recurrence and barriers to psychosexual and social reintegration. Fortunately, some participants show posttraumatic growth and resilience after urostomy.
The rehabilitation of urostomy patients is a complex process accompanied by information overload, shifts in caregiving and the superimposition of physical and psychological symptoms. Healthcare professionals should prioritize these multidimensional needs across stages, establish an intelligent continuous care platform led by ostomy specialist nurses and be supported by multidisciplinary collaboration.
Healthcare professionals should establish an intelligent, continuous care platform led by ostomy specialist nurses to monitor home-based rehabilitation. The implementation of staged multimodal health education across all disease phases is crucial. Furthermore, clinical practice must actively provide psychosexual counselling, support social reintegration and deliver targeted interventions to alleviate the immense psychological burden on family caregivers.
This study followed the COREQ guidelines for reporting qualitative studies.
No patient or public contribution.
by Qianqian Jia, Lili Zhang, Yang Han, Yating Yang, Qian Sun, Zhuo Liu, Chenxi Wu, Qiujun Wang, Fei Liu, Shujuan Liang
BackgroundUltrasound-guided external oblique intercostal plane block (EOIPB) is a modified block technique used in the past few years for anterolateral upper abdominal wall analgesia. This study observed the efficacy of EOIPB in laparoscopic common bile duct exploration (LCBDE).
ObjectivesTo evaluate the efficacy of EOIPB in patients undergoing LCBDE.
MethodsSixty patients undergoing elective LCBDE were randomly assigned to two groups, an EOIPB group and a control group. In the EOIPB group, the patients received ultrasound-guided right EOIPB with a total of 20 mL of 0.5% ropivacaine before anesthesia induction. In the control group, the patients received no intervention before anesthesia induction. The primary outcomes were visual analog scale (VAS) scores within 24 h postoperatively and the number of patient-controlled analgesia (PCA) uses 24 h postoperatively. The secondary outcomes were dermatomal coverage of EOIPB, intraoperative vital signs, the intraoperative dose of remifentanil, and the 24-h postoperative quality of recovery-40 (QoR-40) score of the two groups.
ResultsIn the EOI group, VAS scores at rest and movement were significantly lower than in the control group at 30 min, 6 h, and 12 h postoperation (p p > 0.05). The number of PCA uses within 24 h was significantly lower in the EOIPB group (1.60 ± 0.89) compared to the control group (2.50 ± 1.11, p p p p p p Conclusion
The use of EOIPB in LCBDE can reduce VAS scores and the number of PCA uses 24 h postoperatively. EOIPB also steadied the intraoperative vital signs, reduced the dose of remifentanil, and improved the quality of recovery. EOIPB can be safely and effectively used in LCBDE.
by Hongyi Chen, Danyu Xu, Wenjing Wang, Xinyin Luo, Xiaocong Jiang, Ningyi Wan, Yuhuan Wei, Ting Wang, Li Zhang, Xuemei Li, Xinyu Zhou
BackgroundMajor depressive disorder (MDD) is highly prevalent in adolescents, and a substantial proportion of patients show inadequate response or limited tolerability to first-line treatments such as selective serotonin reuptake inhibitors and cognitive behavioral therapy, highlighting the need for additional treatment options. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in adults with depression, but evidence in adolescents remains limited. Resting-state functional connectivity MRI (rs-fcMRI) may provide a circuit-informed approach for individualizing rTMS target selection within the dorsolateral prefrontal cortex (DLPFC) based on its functional connectivity with the subgenual anterior cingulate cortex (sgACC).
MethodsThis is a randomized, double-blind, three-arm, sham-controlled pilot trial. Forty-five adolescents with MDD will be assigned in a 1:1:1 ratio to conventional left DLPFC-targeted rTMS, rs-fcMRI-guided rTMS targeting the individualized DLPFC site showing the strongest negative connectivity with the sgACC, or sham stimulation. Treatment will be delivered over 4 weeks. Primary outcomes will include recruitment feasibility, intervention adherence, 6-month retention, preliminary clinical efficacy, and safety, assessed by enrollment, completion of 20 treatment sessions, completion of 6-month follow-up, CDRS-R-based response and remission, and adverse events/serious adverse events. Secondary outcomes will include depressive and anxiety symptoms, suicidality, sleep quality, global clinical status and improvement, rumination, and pediatric health-related quality of life.
DiscussionThis pilot trial will provide preliminary evidence regarding the feasibility, acceptability, safety, and early clinical efficacy signals of rs-fcMRI-guided rTMS in adolescents with MDD. By comparing individualized circuit-informed targeting with conventional left DLPFC stimulation and sham stimulation, the study may help clarify whether this imaging-guided neuromodulation approach is practicable and clinically informative in this population. The findings are expected to support refinement of study procedures, outcome selection, and trial design for a future fully powered randomized controlled trial.Trial registration: ClinicalTrials.gov NCT07185438.
Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
People living with HIV (PLWH) frequently encounter mental health symptoms. Yet, a notable gap exists regarding the divergence in core mental health symptoms among PLWH across developed and developing regions. This study aims to explore the differences in mental health symptom networks among PLWH in both developed and developing regions.
A multicenter cross-sectional study was conducted in China from April 2022 to April 2023. Six designated HIV hospitals enrolled 2436 participants, including 1430 PLWH from developed regions and 1006 PLWH from developing regions. The study assessed 40 mental health symptoms across six dimensions: somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication, and social adaptation among PLWH.
The diverse developed regions exhibited varying mental health symptoms among PLWH, particularly concerning their core symptoms. In the developed regions of China, PLWH predominantly experience core symptoms centered around “Sadness,” “Anger,” and “Distress.” In contrast, PLWH from developing regions tends to manifest core symptoms such as “Inability to integrate into society,” “Difficulty in managing daily work and study,” and “Hostility.”
The regional variation in mental health symptoms among PLWH underscores the disparities in their circumstances. This insight is crucial for crafting tailored intervention strategies for urban PLWH. In developed regions, psychological interventions such as catharsis and empathy are integral to clinical practice, while in less developed regions, family support interventions are paramount, given the limited social interactions available to PLWH.
This study was reported according to the STROBE checklist.
No patient or public contribution.
This study aims to develop an indicator system for assessing the humanistic care competencies of nurses in infectious disease hospitals and provide a scientific measurement tool to understand the current humanistic care competencies level of infectious disease nurses.
A mixed-methods design integrating qualitative interviews and a modified Delphi study.
Initially, we derived a list of potential indicators of humanistic care for nurses in infectious disease hospitals from literature reviews and interviews with a nominal group technique (n=41). Following this, 26 experts from across China participated in two Delphi rounds from May to July 2023. Then the indicators were screened, revised and supplemented using the boundary value method and expert opinions. Next, the hierarchical analysis method was utilised to determine the weights of the indicators.
The average effective response rate across the two Delphi rounds was 94%. The authority coefficients for the first and second rounds were 0.85 and 0.90, respectively, suggesting the experts were highly authoritative. There was a consistent rating among experts with a coordination coefficient for each indicator (p < 0.001). Ultimately, this study identified 4 primary indicators, 8 secondary indicators, and 35 tertiary indicators. The four primary indicators and their weights are basic care competency (0.158), therapeutic care competency (0.544), spiritual care competency (0.158) and safety care competency (0.140).
This research provides a scientifically rigorous and comprehensive framework to evaluate the humanistic care competencies of nurses in infectious disease hospitals in China. This system will serve as an effective tool for evaluating the humanistic care competencies of nurses in specialized infectious disease hospitals in China and other overseas regions.
This study provides a new tool to assess the humanistic care competencies of nurses in infectious disease hospitals. Form an effective humanistic care competencies index system that can be used to build and develop the need for nurses to possess different aspects of humanistic care competencies tailored to infectious disease patients in hospitals.
No patients or public contribution.
Within the context of limited childcare resources and a high prevalence of multigenerational co-residence in China, grandparents play a pivotal role in the caregiving of infants and toddlers. However, discrepancies in parenting philosophies across generations may lead to conflict, thereby impacting maternal psychological well-being and parenting experiences. Identifying the typologies of intergenerational co-parenting relationships is therefore essential for informing targeted health interventions.
This study aimed to identify latent profiles of mother–grandparent intergenerational co-parenting relationships in families with infants and toddlers in Shenzhen, China, using the Grandparent-Parent Co-parenting Relationship Scale (GPCRS) dimensions. It further sought to examine how maternal psychosocial factors (parenting stress, perceived stress, depressive symptoms, sleep quality), the quality of spousal co-parenting relationships and intergenerational caregiving role arrangements are associated with profile membership.
A cross-sectional survey study.
A total of 366 mothers with children aged 0–3 years was recruited from maternity and child healthcare institutions in Shenzhen, China, between January 2023 and May 2024. Validated scales were used to assess intergenerational and spousal co-parenting, parenting stress, parenting sense of competence, perceived stress and depressive symptoms. Latent profile analysis was employed to identify patterns of intergenerational co-parenting relationships, and multinomial logistic regression was conducted to examine the associated predictors.
Three distinct intergenerational co-parenting profiles were identified: the Discordant Group (29.2%), the Balanced Group (46.7%) and the Harmonious Group (24.0%). Higher spousal co-parenting scores were positively associated with more harmonious profiles. Lower levels of parenting stress, perceived stress and depressive symptoms, as well as higher sleep quality and grandparental involvement in caregiving were all associated with more positive relationship profiles. However, higher maternal parenting competence was paradoxically linked to greater intergenerational conflict.
Mothers in the Discordant Group, marked by low agreement/support and high conflict, reported the highest stress and depressive symptoms, whereas those in the Harmonious Group showed the most favourable psychosocial outcomes, with the Balanced Group in between. Stronger spousal co-parenting, better sleep quality and grandparental caregiving were associated with membership in the Harmonious class. These findings underscore the importance of fostering harmonious co-parenting across spousal and intergenerational subsystems to enhance maternal well-being and family functioning in early childhood.
Nurses and healthcare professionals could implement family-based interventions tailored to identified profile characteristics, thereby more effectively supporting maternal mental health and fostering greater harmony in intergenerational co-parenting families.
This study aims to develop dynamic networks and examine the longitudinal relationships of mental health symptoms among persons living with HIV (PLWH).
A longitudinal study.
We collected data between October 2022 and December 2022 using Wenjuanxing (Questionnaire Star), an online survey platform. The study tracked weekly data across 10 sessions, involving 123 PLWH in Beijing, China. A total of 40 mental health symptoms with six dimensions (somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication and social adaptation) were included in the symptom network, which consists of temporal, contemporaneous and between-person networks.
In the temporal network, ‘feeling inferior to others’ had the largest in-strength value, whereas ‘suicidal ideation’ exhibited the largest out-strength value. In the contemporaneous network, ‘feeling inferior to others’ showed the highest bridge strength, indicating it had the most connections to other mental health symptoms.
We found that ‘feeling inferior to others’ had the highest number of predictors, with up to seven mental health symptoms potentially triggering this particular symptom. Additionally, ‘suicidal ideation’ emerged as a powerful predictor, influencing the greatest number of mental health symptoms across five dimensions.
Our study enhances the understanding of the sequential development and consequences of mental health symptoms among PLWH, which may provide an important basis for designing precise mental health symptom management interventions.
This study was reported according to the STROBE checklist.
No patient or public contribution.
To identify and reach consensus on dimensions and criteria of a competence assessment instrument for health professionals in relation to the process of evidence-based healthcare.
A two-round Delphi survey was carried out from April to June 2023.
Consensus was sought from an expert panel on the instrument preliminarily established based on the JBI Model of Evidence-Based Healthcare and a rapid review of systematic reviews of relevant literature. The level of consensus was reflected by the concentration and coordination of experts' opinions and percentage of agreement. The instrument was revised significantly based on the combination of data analysis, the experts' comments and research group discussions.
Sixteen national and three international experts were involved in the first-round Delphi survey and 17 experts participated in the second-round survey. In both rounds, full consensus was reached on the four dimensions of the instrument, namely evidence-generation, evidence-synthesis, evidence-transfer and evidence-implementation. In round-one, the instrument was revised from 77 to 61 items. In round-two, the instrument was further revised to have 57 items under the four dimensions in the final version.
The Delphi survey achieved consensus on the instrument. The validity and reliability of the instrument needs to be tested in future research internationally.
Systematic assessment of nurses and other health professionals' competencies in different phases of evidence-based healthcare process based on this instrument provides implications for their professional development and multidisciplinary team collaboration in evidence-based practice and better care process and outcomes.
This study addresses a research gap of lacking an instrument to systematically assess interprofessional competencies in relation to the process of EBHC. The instrument covers the four phases of EBHC process with minimal criteria, highlighting essential aspects of ability to be developed. Identification of health professionals' level of competence in these aspects helps strengthen their capacity accordingly so as to promote virtuous EBHC ecosystem for the ending purpose of improving global healthcare outcomes.
This study was reported in line with the Conducting and REporting of DElphi studies (CREDES) guidance on Delphi studies.
No patient or public contribution.
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