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The prevalence of incivility in hospitals and the effects of incivility on patient safety culture and outcomes: A systematic review and meta‐analysis

Abstract

Aim

Workplace incivility is a barrier to safe and high-quality patient care in nursing workplaces and more broadly in tertiary hospitals. The present study aims to systematically review the existing evidence to provide a comprehensive understanding of the prevalence of co-worker incivility experienced and witnessed by nurses and other healthcare professionals, the effects of incivility on patient safety culture (PSC) and patient outcomes, and the factors which mediate the relationship between incivility and patient safety.

Methods

A systematic review with narrative synthesis and meta-analysis was undertaken to synthesize the data from 41 studies.

Data Sources

Databases searched included MEDLINE, PubMed, SCOPUS, CINAHL, PsycInfo, ProQuest, Emcare and Embase. Searches were conducted on 17 August 2021 and repeated on 15 March 2023.

Results

The pooled prevalence of experienced incivility was 25.0%. The pooled prevalence of witnessed incivility was 30.1%. Workplace incivility was negatively associated with the PSC domains of teamwork, reporting patient safety events, organization learning/improvement, management support for safety, leadership, communication openness and communication about error. The composite pooled effect size of incivility on these domains of PSC was OR = 0.590, 95% CI [0.515, 0.676]. Workplace incivility was associated with a range of patient safety outcomes (PSOs) including near misses, adverse events, reduced procedural and diagnostic performance, medical error and mortality. State depletion, profession, psychological responses to incivility, information sharing, help seeking, workload and satisfaction with organizational communication were found to mediate the relationship between incivility and patient safety.

Conclusion

Experienced and witnessed incivility is prevalent in tertiary hospitals and has a deleterious effect on PSC and PSOs. A better understanding of the mechanisms of this relationship will support the development of interventions aimed at reducing both incivility and patient harm.

Implications for the Profession and/or Patient Care Impact

This study quantifies the effect of incivility on PSC and outcomes. It provides support that interventions focusing on incivility are a valuable mechanism for improving patient care. It guides intervention design by highlighting which domains of PSC are most associated with incivility. It explores the profession-specific experiences of workplace incivility.

Reporting Method

This report adheres to PRISMA reporting guidelines.

Patient or Public Contribution

No patient or public contribution. The focus of this study is the nursing and healthcare workforce, therefore, patient or public involvement not required.

Assessing care dependence status and associated influencing factors among middle‐aged hemiplegic stroke patients during the post‐acute rehabilitation phase: A correlational study

Abstract

Aims

To comprehensively examine the prevailing condition of care dependence among middle-aged individuals who have experienced hemiplegia subsequent to a stroke and were currently undergoing post-acute rehabilitation. Additionally, the study sought to analyse the determinants that impacted this phenomenon.

Design

A single-centre, cross-sectional study design.

Methods

During the period from January 2020 to October 2022, a cohort of 196 hemiplegic stroke patients, aged between 40 and 65, and within 6 months of their stroke onset, was selected from the cerebrovascular outpatient clinic at a tertiary hospital in Hangzhou. The demographic and disease-related data, care dependence level, mental state, nutrition and depression status were collected. Furthermore, all collected data were analysed by descriptive and correlative statistical methods.

Results

The care dependence level was 51.04 ± 9.42, with an incidence of care dependence of 78.1%. Multivariate regression analysis showed that age, history of falls, physical dysfunction, chronic comorbidities, depression, nutritional status and cognitive dysfunction were influencing factors for care dependence in the participants after a stroke.

Conclusion

The incidence of care dependence among hemiplegic patients aged from 40 to 65 years old in the early stage after a stroke was high. Nursing staff should focus on these patients with a history of falling, physical dysfunction, comorbidity, depression status, nutritional status and cognitive dysfunction in clinical practice.

Relevance to Clinical Practice

The incidence of care dependence in middle-aged hemiplegic patients following a stroke is significantly increased. Some risk factors should be assessed, monitored, and controlled by nursing staff as early as possible in order to reduce the dependence levels in post-acute rehabilitation period and improve the quality of life of hemiplegia patients.

Reporting Method

Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies (see Table S1).

Patient or Public Contribution

No patient or public contribution.

Artificial intelligence tools for optimising recruitment and retention in clinical trials: a scoping review protocol

Por: Lu · X. · Chen · M. · Lu · Z. · Shi · X. · Liang · L.
Introduction

In recent years, the influence of artificial intelligence technology on clinical trials has been steadily increasing. It has brought about significant improvements in the efficiency and cost reduction of clinical trials. The objective of this scoping review is to systematically map, describe and summarise the current utilisation of artificial intelligence in recruitment and retention process of clinical trials that has been reported in research. Additionally, the review aims to identify benefits and drawbacks, as well as barriers and facilitators associated with the application of artificial intelligence in optimising recruitment and retention in clinical trials. The findings of this review will provide insights and recommendations for future development of artificial intelligence in the context of clinical trials.

Methods and analysis

The review of relevant literature will follow the methodological framework for scoping studies provided by the Joanna Briggs Institute. A comprehensive electronic search will be conducted using the search strategy developed by the authors. Leading medical and computer science databases such as PubMed, Embase, Scopus, IEEE Xplore and Web of Science Core Collection will be searched. The search will encompass analytical observational studies, descriptive observational studies, experimental and quasi-experimental studies published in all languages, without any time limitations, which use artificial intelligence tools in the recruitment and retention process of clinical trials. The review team will screen the identified studies and import them into a dedicated electronic library specifically created for this review. Data extraction will be performed using a data charting table.

Ethics and dissemination

Secondary data will be attained in this scoping review; therefore, no ethical approval is required. The results of the final review will be published in a peer-reviewed journal. It is expected that results will inform future artificial intelligence and clinical trials research.

IMPROVE study protocol, investigating post-stroke local muscle vibrations to promote cerebral plasticity and functional recovery: a single-blind randomised controlled trial

Por: Julliand · S. · Papaxanthis · C. · Delphin · C. · Mock · A. · Raumel · M.-A. · Gueugnon · M. · Ornetti · P. · Laroche · D.
Introduction

Spasticity is a frequent disabling consequence following a stroke. Local muscle vibrations (LMVs) have been proposed as a treatment to address this problem. However, little is known about their clinical and neurophysiological impacts when used repeatedly during the subacute phase post-stroke. This project aims to evaluate the effects of a 6-week LMV protocol on the paretic limb on spasticity development in a post-stroke subacute population.

Methods and analysis

This is an interventional, controlled, randomised, single-blind (patient) trial. 100 participants over 18 years old will be recruited, within 6 weeks following a first stroke with hemiparesis or hemiplegia. All participants will receive a conventional rehabilitation programme, plus 18 sessions of LMV (ie, continuously for 30 min) on relaxed wrist and elbow flexors: either (1) at 80 Hz for the interventional group or (2) at 40 Hz plus a foam band between the skin and the device for the control group.

Participants will be evaluated at baseline, at 3 weeks and 6 weeks, and at 6 months after the end of the intervention. Spasticity will be measured by the modified Ashworth scale and with an isokinetic dynamometer. Sensorimotor function will be assessed with the Fugl-Meyer assessment of the upper extremity. Corticospinal and spinal excitabilities will be measured each time.

Ethics and dissemination

This study was recorded in a clinical trial and obtained approval from the institutional review board (Comité de protection des personnes Ile de France IV, 2021-A03219-32). All participants will be required to provide informed consent. The results of this trial will be published in peer-reviewed journals to disseminate information to clinicians and impact their practice for an improved patient’s care.

Trial registration number

Clinical Trial: NCT05315726

Dataset

EUDRAct

Deep learning model to predict lupus nephritis renal flare based on dynamic multivariable time-series data

Por: Huang · S. · Chen · Y. · Song · Y. · Wu · K. · Chen · T. · Zhang · Y. · Jia · W. · Zhang · H.-T. · Liang · D.-D. · Yang · J. · Zeng · C.-H. · Li · X. · Liu · Z.-H.
Objectives

To develop an interpretable deep learning model of lupus nephritis (LN) relapse prediction based on dynamic multivariable time-series data.

Design

A single-centre, retrospective cohort study in China.

Setting

A Chinese central tertiary hospital.

Participants

The cohort study consisted of 1694 LN patients who had been registered in the Nanjing Glomerulonephritis Registry at the National Clinical Research Center of Kidney Diseases, Jinling Hospital from January 1985 to December 2010.

Methods

We developed a deep learning algorithm to predict LN relapse that consists of 59 features, including demographic, clinical, immunological, pathological and therapeutic characteristics that were collected for baseline analysis. A total of 32 227 data points were collected by the sliding window method and randomly divided into training (80%), validation (10%) and testing sets (10%). We developed a deep learning algorithm-based interpretable multivariable long short-term memory model for LN relapse risk prediction considering censored time-series data based on a cohort of 1694 LN patients. A mixture attention mechanism was deployed to capture variable interactions at different time points for estimating the temporal importance of the variables. Model performance was assessed according to C-index (concordance index).

Results

The median follow-up time since remission was 4.1 (IQR, 1.7–6.7) years. The interpretable deep learning model based on dynamic multivariable time-series data achieved the best performance, with a C-index of 0.897, among models using only variables at the point of remission or time-variant variables. The importance of urinary protein, serum albumin and serum C3 showed time dependency in the model, that is, their contributions to the risk prediction increased over time.

Conclusions

Deep learning algorithms can effectively learn through time-series data to develop a predictive model for LN relapse. The model provides accurate predictions of LN relapse for different renal disease stages, which could be used in clinical practice to guide physicians on the management of LN patients.

Interventions to improve nurse–family communication in the emergency department: A scoping review

Abstract

Aim

To determine and describe what interventions exist to improve nurse–family communication during the waiting period of an emergency department visit.

Background

Communication between nurses and families is an area needing improvement. Good communication can improve patient outcomes, satisfaction with care and decrease patient and family anxiety.

Design

Scoping Review.

Methods

A scoping review was conducted following the Joanna Briggs Institution methodology: (1) identify the research question, (2) define the inclusion criteria, (3) use a search strategy to identify relevant studies using a three-step approach, (4) select studies using a team approach, (5) data extraction, (6) data analysis, and (7) presentation of results.

Data Sources

Medline, CINAHL, EMBASE, PsychInfo and grey literature were searched on 3 August 2022.

Results

The search yielded 1771 articles from the databases, of which 20 were included. An additional seven articles were included from the grey literature. Paediatric and adult interventions were found targeting staff and family of which the general recommendations were summarised into communication models.

Conclusion

Future research should focus on evaluating the effectiveness of interventions using a standardised scale, understanding the specific needs of families, and exploring the communication models developed in this review.

Implications for Clinical Practice

Communication models for triage nurses and all emergency department nurses were developed. These may guide nurses to improve their communication which will contribute to improving family satisfaction.

Reporting Method

PRISMA-ScR.

Trial and Protocol Registration

Protocol has been registered with the Open Science Framework, registration number 10.17605/OSF.IO/ETSYB.

Patient or Public Contribution

No patient or public contribution.

Efficacy of auricular acupressure on lung function among chronic obstructive pulmonary disease: A meta‐analysis of randomised controlled trials

Abstract

Objectives

To systematically evaluate the efficacy of auricular acupressure on lung function, sleep quality and quality of life in chronic obstructive pulmonary disease patients.

Background

Auricular acupressure has been increasingly used in chronic obstructive pulmonary disease patients, such as lung function and sleep quality, but the efficacy has not yet been unified.

Design

A meta-analysis of randomised controlled trials.

Methods

Randomised controlled trials comparing auricular acupressure intervention with non-auricular acupressure intervention in chronic obstructive pulmonary disease patients were included. We searched English databases and Chinese databases from the inception to 26 December 2022. The risk of bias was assessed by the Cochrane risk of bias tool. The PRISMA statement was used to report a meta-analysis.

Results

A total of 12 randomised controlled trials with 987 chronic obstructive pulmonary disease patients were included. The meta-analysis showed that auricular acupressure had significant differences in improving lung function, including FEV1 (MD = 0.29, 95% CI: 0.21 to 0.37, p < .0001), FVC (MD = 0.24, 95% CI: 0.14 to 0.34, p < .0001) and FEV1/FVC (MD = 4.70, 95% CI: 3.63 to 5.78, p < .0001). There was also a positive effect on sleep quality (MD = −0.71, 95% CI: −0.89 to −0.53, p < .0001) and quality of life (MD = −3.20, 95% CI: −3.92 to −2.49, p < .0001).

Conclusions

The results indicated auricular acupressure had a positive efficacy in chronic obstructive pulmonary disease patients to improve lung function, sleep quality and quality of life, but these results should be treated with caution due to the low quality of included studies. Future researchers need to conduct more high-quality randomised controlled trials to provide a solid basis to demonstrate the efficacy of auricular acupressure in chronic obstructive pulmonary disease patients.

Relevant to Clinical Practice

Auricular acupressure has the advantages of being non-invasive, convenient and without significant side effects. This review suggested auricular acupressure could be considered a non-pharmacological intervention for patients. Clinical nurses can teach chronic obstructive pulmonary disease patients to perform auricular acupressure to help self-manage complications.

Patient or Public Contribution

No Patient or Public Contribution.

The association of leader–member exchange and team–member exchange with nurses' innovative behaviours: A cross‐sectional study

Abstract

Aim

To measure the association of leader–member exchange and team–member exchange with nurses' innovative behaviours through social exchange theory.

Background

The field of nursing is actively advocating innovation. Other fields have proven that leader–member exchange and team–member exchange can promote innovative behaviour, but such an association is not clear in nursing.

Design

A cross-sectional study.

Methods

A total of 560 nurses were selected from five tertiary hospitals in Henan Province (China) by multistage sampling. Data were collected from a self-report questionnaire. Thirty nurses in the pre-survey were used to verify the validity of the questionnaire. SPSS PROCESS macro was used to verify the association of leader–member exchange and team–member exchange with nurses' innovative behaviours.

Results

Leader–member exchange and team–member exchange were significantly associated with nurses' innovative behaviours, and team–member exchange had a mediating effect on the relationship between leader–member exchange and innovative behaviour.

Conclusions

Leader–member exchange and team–member exchange positively affect nurses' innovative behaviours. Leader–member exchange can promote nurses' innovative behaviours through the mediating role of team–member exchange.

Impact

This study indicated that leader–member exchange and team–member exchange should be given more attention in promoting nurses' innovative behaviours. This finding has implications for the promotion of innovative behaviours in nurses. Leaders need to focus on the innovative needs of nurses and offer support. Meanwhile, leadership training programs are necessary for managers to create positive team relationships.

Patient or Public Contribution

No patient or public involvement.

Comparative study on wound healing and infection between open and minimally invasive surgical methods in pediatric otolaryngology surgery

Abstract

Pediatric otolaryngology surgeries are crucial interventions requiring careful consideration of surgical methods to optimize outcomes. The choice between open and minimally invasive surgical approaches in this context warrants thorough investigation. While both methods aim to address ear, nose, and throat conditions in children, a comparative study assessing their impact on crucial factors such as intraoperative parameters, wound healing, complications, and postoperative pain is essential. This study aims to compare the effects of open and minimally invasive surgical methods on wound healing and infection in pediatric otolaryngology surgery, and provide a scientific basis for the selection of surgical methods. Two groups of patients were selected, with 90 people in each group. One group received open surgery and the other received minimally invasive surgery. Recording the intraoperative time, anesthesia time, and intraoperative blood loss; the number of days required for wound healing; the occurrence of wound-related complications; the comparison of pain on postoperative Days 1, 3, and 7; and the factors influencing postoperative wound healing were analyzed. In the minimally invasive surgery group, the intraoperative time was shorter, the anesthesia time was relatively reduced, and the amount of bleeding was significantly reduced. Wounds also take fewer days to heal and have lower rates of wound-related complications. When comparing the pain on 1, 3, and 7 days after surgery, the minimally invasive surgery group had relatively mild pain. Analysis of postoperative wound healing factors showed that minimally invasive surgical methods have a positive impact on healing. In pediatric otolaryngology surgery, minimally invasive surgery performs better than open surgery in terms of intraoperative operation time, anesthesia time, blood loss, wound healing time, complication rate, and postoperative pain. Therefore, minimally invasive surgery may be a safer and more effective surgical method.

Association of nurse managers' paternalistic leadership and nurses' perceived workplace bullying: The mediating effect of organizational climate

Abstract

Aims

To explore the association between nurse managers' paternalistic leadership and nurses' perceived workplace bullying (WPB), as well as to examine the mediating role of organizational climate in this association.

Background

There is a lack of empirical evidence regarding the relationship between nurse managers' paternalistic leadership, organizational climate and nurses' perceived WPB. Clarifying this relationship is crucial to understand how paternalistic leadership influences WPB and for nursing managers to seek organizational-level solutions to prevent it.

Methods

A cross-sectional survey was performed from 4 January to 10 February 2022, in six tertiary hospitals in mainland China. Demographic information, Paternalistic Leadership Scale, Organizational Climate Scale and Negative Acts Questionnaire-Revised were used in the survey. Descriptive statistics, Spearman correlation analyses and a structural equation model were used for data analysis.

Results

A total of 5093 valid questionnaires were collected. Moral leadership and authoritarian leadership have both direct and indirect effects on WPB through the mediating effect of organizational climate. The former is negatively related to WPB and the latter is positively related to WPB. Benevolent leadership was only negatively associated with WPB via the mediating effect of organizational climate.

Conclusion

The three components of paternalistic leadership have different effects on WPB through the mediating effect of organizational climate. Nurse managers are recommended to strengthen moral leadership, balance benevolent leadership, reduce authoritarian leadership and strive to create a positive organizational climate in their efforts to mitigate WPB among nurses.

Impact

This study enhanced our comprehension of the relationship between different leadership styles and WPB. Greater emphasis should be placed on moral leadership in the promotion of nursing managers and nursing leadership training programs. Additionally, nursing managers should focus on establishing a positive organizational climate that helps to reduce WPB.

Patient or Public Contribution

No patient or public contribution. This study did not involve patients, service users, caregivers or members of the public.

The ILC Maine statement: Time for the fundamental care [r]evolution

Abstract

Aim

The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice.

Design

Position paper.

Methods

This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice.

Results

The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership.

Conclusion

The ILC Maine Statement calls for ongoing action – [r]evolution – from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally.

Implications for the Profession and/or Patient Care

We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems.

Impact

Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally.

Patient or Public Contribution

Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement.

What Does this Paper Contribute to the Wider Global Clinical Community?

The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.

Lightweight high-precision SAR ship detection method based on YOLOv7-LDS

by Shiliang Zhu, Min Miao

The current challenges in Synthetic Aperture Radar (SAR) ship detection tasks revolve around handling significant variations in target sizes and managing high computational expenses, which hinder practical deployment on satellite or mobile airborne platforms. In response to these challenges, this research presents YOLOv7-LDS, a lightweight yet highly accurate SAR ship detection model built upon the YOLOv7 framework. In the core of YOLOv7-LDS’s architecture, we introduce a streamlined feature extraction network that strikes a delicate balance between detection precision and computational efficiency. This network is founded on Shufflenetv2 and incorporates Squeeze-and-Excitation (SE) attention mechanisms as its key elements. Additionally, in the Neck section, we introduce the Weighted Efficient Aggregation Network (DCW-ELAN), a fundamental feature extraction module that leverages Coordinate Attention (CA) and Depthwise Convolution (DWConv). This module efficiently aggregates features while preserving the ability to identify small-scale variations, ensuring top-quality feature extraction. Furthermore, we introduce a lightweight Spatial Pyramid Dilated Convolution Cross-Stage Partial Channel (LSPHDCCSPC) module. LSPHDCCSPC is a condensed version of the Spatial Pyramid Pooling Cross-Stage Partial Channel (SPPCSPC) module, incorporating Dilated Convolution (DConv) as a central component for extracting multi-scale information. The experimental results show that YOLOv7-LDS achieves a remarkable Mean Average Precision (mAP) of 99.1% and 95.8% on the SAR Ship Detection Dataset (SSDD) and the NWPU VHR-10 dataset with a parameter count (Params) of 3.4 million, a Giga Floating Point Operations Per Second (GFLOPs) of 6.1 and an Inference Time (IT) of 4.8 milliseconds. YOLOv7-LDS effectively strikes a fine balance between computational cost and detection performance, surpassing many of the current state-of-the-art object detection models. As a result, it offers a more resilient solution for maritime ship monitoring.

Physical activity and cognitive function in adults born very preterm or with very low birth weight–an individual participant data meta-analysis

by Kristina Anna Djupvik Aakvik, Silje Dahl Benum, Marjaana Tikanmäki, Petteri Hovi, Katri Räikkönen, Sarah L. Harris, Lianne J. Woodward, Brian A. Darlow, Marit S. Indredavik, Stian Lydersen, Paul Jarle Mork, Eero Kajantie, Kari Anne I. Evensen

Objective

Individuals born very preterm ( Study design

Cohorts with data on physical activity and cognitive function in adults born very preterm/very low birth weight and term-born controls were recruited from the Research on European Children and Adults Born Preterm, and the Adults Born Preterm International Collaboration Consortia. A systematic literature search was performed in PubMed and Embase.

Results

Five cohorts with 1644 participants aged 22–28 years (595 very preterm/very low birth weight and 1049 controls) were included. Adults born very preterm/very low birth weight reported 1.11 (95% CI: 0.68 to 1.54) hours less moderate to vigorous physical activity per week than controls, adjusted for cohort, age and sex. The difference between individuals born very preterm/very low birth weight and controls was larger among women than among men. Neither intelligence quotient nor self-reported executive function mediated the association between very preterm/very low birth weight and moderate to vigorous physical activity. Results were essentially the same when we excluded individuals with neurosensory impairments.

Conclusion

Adults born very preterm/very low birth weight, especially women, reported less moderate to vigorous physical activity than their term-born peers. Cognitive function did not mediate this association. Considering the risk of adverse health outcomes among individuals born preterm, physical activity could be a target for intervention.

Systematic review and network meta‐analysis of mesenchymal stem cells in treating diabetic skin ulcers in animal models

Abstract

Background

Diabetic cutaneous ulcers often pose considerable challenges in the healing process. These challenges stem from factors including inadequate perfusion of the ulcer's surrounding environment, persistent inflammation, tissue damage and microbial proliferation. The existing standard treatment modalities prove insufficient in fully addressing the complex pathogenesis of these ulcers. As a novel approach, researchers are exploring cellular therapies employing mesenchymal stem cells (MSCs) for the treatment of diabetic skin ulcers. MSCs are readily found in various tissues, including bone marrow, adipose tissue, placenta, amniotic membrane, amniotic fluid and umbilical cord. However, the optimal source of MSCs for effectively treating diabetic skin ulcers remains a topic of ongoing discussion.

Methods

We conducted a comprehensive search of Embase, PubMed and Web of Science databases, spanning from their inception to November 2022. Subsequently, we rigorously screened the literature following predetermined inclusion and exclusion criteria and evaluated the quality of the selected studies using the SYRCLE scale. Finally, the included literature underwent analysis, employing the Bayesian school of thought-based R language. To ensure transparency and accountability, we registered this study with PROSPERO's International Systematic Review Prospective Registry, with the Registration ID: CRD42023387421.

Results

We included a total of 11 articles in our analysis, all of which were randomized controlled studies involving 218 animal models. Among these studies, two utilized adipose-derived MSCs, six employed bone marrow-derived MSCs, one utilized amniotic membrane-derived MSCs and three utilized umbilical cord-derived MSCs. Our network meta-analysis results revealed that there were no statistically significant differences in the healing rates of diabetic skin ulcers among MSCs derived from amniotic membrane, adipose tissue, umbilical cord and bone marrow on days 7–8, 10–12 and 12–14. Notably, according to the probability ranking table, the most effective treatment for diabetic wounds was found to be amniotic membrane-derived MSCs.

Conclusion

There was no statistically significant difference in the efficacy of MSCs derived from amniotic membrane, adipose, umbilical cord and bone marrow in the treatment of diabetic skin ulcers during the short-term observation period, and the probability ranking graphs indicate that amniotic membrane-derived MSCs may be the best choice for the treatment of diabetic skin ulcers.

Association between asymptomatic hyperuricemia and risk of arthritis, findings from a US National Survey 2007-2018

Por: Liang · Z. · WU · D. · Zhang · H. · Gu · J.
Background

Arthritis is thought to be closely related to serum uric acid. The study aims to assess the association between asymptomatic hyperuricemia (AH) and arthritis.

Methods

A multistage, stratified cluster was used to conduct a cross-sectional study of adult US civilians aged≥20 years from the 2007–2018 National Health and Nutrition Examination Survey. Participants with hyperuricemia and without hyperuricemia prior to gout were included. A questionnaire was used to determine whether participants had arthritis and the type of arthritis. Logistic regression was used to investigate the association between hyperuricemia and arthritis.

Result

During the past 12 years, the percentage of participants with arthritis changed from 25.95% (22.53%–29.36%) to 25.53% (21.62%–29.44%). The prevalence of osteoarthritis (OA) increased from 8.70% (95% CI: 6.56% to 10.85%) to 12.44% (95% CI: 9.32% to 15.55%), the prevalence of AH changed from 16.35% (95% CI: 14.01% to 18.40%) to 16.39% (95% CI: 13.47% to 19.30%). Participants with AH were associated with onset of arthritis (OR=1.34, 95% CI: 1.07 to 1.69), but the association was muted after adjusting demographic and socioeconomic factors. For participants aged 40–49 years, AH is associated with incident arthritis (OR=1.96, 95% CI: 1.23 to 2.99) and the relationship remained after adjusting for education level, income to poverty ratio, body mass index, diabetes, hypertension and smoking (OR=2.00, 95% CI: 1.94 to 3.36). Compared with male, female participants with AH are more likely to develop arthritis, especially in OA (OR=1.35, 95% CI: 1.14 to 1.60).

Conclusion

Our data identified AH as the risk factor for incident arthritis, especially for OA, which might be exaggerated in aged population and female population.

Seroprevalence of Japanese encephalitis virus-specific antibodies in Australia following novel epidemic spread: protocol for a national cross-sectional study

Por: Winkler · N. E. · Koirala · A. · Kaur · G. · Prasad · S. · Hirani · R. · Baker · J. · Hoad · V. · Gosbell · I. B. · Irving · D. O. · Hueston · L. · O'Sullivan · M. V. · Kok · J. · Dwyer · D. E. · Macartney · K. · on behalf of the Australian Japanese Encephalitis Virus Serosurvey Gr
Introduction

Japanese encephalitis virus (JEV) is a mosquito-borne flavivirus that causes encephalitis and other morbidity in Southeast Asia. Since February 2022, geographically dispersed JEV human, animal and vector detections occurred on the Australian mainland for the first time. This study will determine the prevalence of JEV-specific antibodies in human blood with a focus on populations at high risk of JEV exposure and determine risk factors associated with JEV seropositivity by location, age, occupation and other factors.

Method

Samples are collected using two approaches: from routine blood donors (4153 samples), and active collections targeting high-risk populations (convenience sampling). Consent-based sampling for the latter includes a participant questionnaire on demographic, vaccination and exposure data. Samples are tested for JEV-specific total antibody using a defined epitope-blocking ELISA, and total antibody to Australian endemic flaviviruses Murray Valley encephalitis and Kunjin viruses.

Analysis

Two analytic approaches will occur: descriptive estimates of seroprevalence and multivariable logistic regression using Bayesian hierarchical models. Descriptive analyses will include unadjusted analysis of raw data with exclusions for JEV-endemic country of birth, travel to JEV-endemic countries, prior JEV-vaccination, and sex-standardised and age-standardised analyses. Multivariable logistic regression will determine which risk factors are associated with JEV seropositivity likely due to recent transmission within Australia and the relative contribution of each factor when accounting for effects within the model.

Ethics

National Mutual Acceptance ethical approval was obtained from the Sydney Children’s Hospitals Network Human Research Ethics Committee (HREC). Local approvals were sought in each jurisdiction. Ethical approval was also obtained from the Australian Red Cross Lifeblood HREC.

Dissemination

Findings will be communicated to participants and their communities, and human and animal health stakeholders and policy-makers iteratively and after final analyses. Understanding human infection rates will inform procurement and targeted allocation of limited JEV vaccine, and public health strategies and communication campaigns, to at-risk populations.

Snoring Survivors: the impact of obstructive sleep apnoea and continuous positive airway pressure use on in-hospital mortality, length of stay and costs among patients hospitalised with acute cardiovascular disease - A retrospective analysis of 2016-2019

Por: Ogbu · I. · Hakobyan · B. · Sossou · C. · Levisman · J. · Obiagwu · C. · Danielian · A.
Background

The routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction (AMI) has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure (CPAP) use in patients hospitalised with acute cardiovascular disease and concomitant obstructive sleep apnoea (OSA) remain to be elucidated.

Methods

In this retrospective case–control analysis, using 10th International Classification of Diseases, Clinical Modification (ICD-10) codes, we searched the 2016–2019 Nationwide Inpatient Sample for patients diagnosed with unstable angina (UA), AMI, acute decompensated heart failure (ADHF) and atrial fibrillation with rapid ventricular response (AFRVR), who also carried a diagnosis of OSA. We identified in-hospital CPAP use with ICD-10-Procedure Coding System codes. In-hospital death, length of stay (LOS) and hospital charges were compared between patients with and without OSA, and between OSA patients with and without CPAP use.

Results

Our sample included 2 959 991 patients, of which 1.5% were diagnosed with UA, 30.3% with AMI, 37.5% with ADHF and 45.8% with AFRVR. OSA was present in 12.3%. Patients with OSA were more likely to be younger, male, smokers, obese and have chronic obstructive pulmonary disease, renal failure and heart failure (p

Conclusion

Our study showed that patients with recognised OSA hospitalised for AMI, ADHF and AFRVR had significantly lower mortality regardless of CPAP use, while CPAP treatment among these patients was associated with significantly higher in-hospital mortality and resource utilisation. The routine use of CPAP during acute cardiovascular encounters could neutralise the impact of chronic intermittent ischaemic preconditioning.

Priming transcranial direct current stimulation for improving hemiparetic upper limb in patients with subacute stroke: study protocol for a randomised controlled trial

Por: Zhu · F. · Xu · X. · Jin · M. · Chen · J. · Feng · X. · Wang · J. · Yu · D. · Wang · R. · Lian · Y. · Huai · B. · Lou · X. · Shi · X. · He · T. · Lu · J. · Zhang · J. J. · Bai · Z.
Introduction

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that modulates brain states by applying a weak electrical current to the brain cortex. Several studies have shown that anodal stimulation of the ipsilesional primary motor cortex (M1) may promote motor recovery of the affected upper limb in patients with stroke; however, a high-level clinical recommendation cannot be drawn in view of inconsistent findings. A priming brain stimulation protocol has been proposed to induce stable modulatory effects, in which an inhibitory stimulation is applied prior to excitatory stimulation to a brain area. Our recent work showed that priming theta burst magnetic stimulation demonstrated superior effects in improving upper limb motor function and neurophysiological outcomes. However, it remains unknown whether pairing a session of cathodal tDCS with a session of anodal tDCS will also capitalise on its therapeutic effects.

Methods and analysis

This will be a two-arm double-blind randomised controlled trial involving 134 patients 1–6 months after stroke onset. Eligible participants will be randomly allocated to receive 10 sessions of priming tDCS+robotic training, or 10 sessions of non-priming tDCS+robotic training for 2 weeks. The primary outcome is the Fugl-Meyer Assessment-upper extremity, and the secondary outcomes are the Wolf Motor Function Test and Modified Barthel Index. The motor-evoked potentials, regional oxyhaemoglobin level and resting-state functional connectivity between the bilateral M1 will be acquired and analysed to investigate the effects of priming tDCS on neuroplasticity.

Ethics and dissemination

The study has been approved by the Research Ethics Committee of the Shanghai Yangzhi Rehabilitation Center (reference number: Yangzhi2023-022) and will be conducted in accordance with the Declaration of Helsinki of 1964, as revised in 2013.

Trial registration number

ChiCTR2300074681.

The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper

Abstract

Aim

Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame.

Design

Discursive paper.

Method

This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections.

Conclusion

Nursing recognizes the patient–nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections.

Impact on Nursing Practice

A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors.

No Patient or Public Contribution

There was no patient or public involvement in the design or writing of this discursive article.

Global burden and trends of disability‐adjusted life years and mortality for decubitus ulcer: A systematic analysis

Abstract

The management of chronic wounds has presented a significant dilemma, which is evident not only in clinical treatment but also in the substantial burden it places on medical resources. The global COVID-19 pandemic in 2020 is likely to further exacerbate this trend. Therefore, it is imperative to delve deeper into the impact of chronic wound on disease burden across different regions and populations. In this study, we focused on decubitus ulcers (DU) as representative chronic wounds and utilized data from the Global Burden of Disease (GBD) 2019 database (http://ghdx.healthdata.org/gbd-results-tool) pertaining to age, gender, region, year and socio-demographic index (SDI) group. Disability-adjusted life years (DALYs) and mortality were utilized as indicators to assess the burden of DU. The analysis and visualization were performed using R software (version 4.2.3). A decrease in the global ASRs of DALYs and mortality for DU was observed across most regions between 1990 and 2019. The reduction in burden was particularly significant in regions characterized by a high SDI, while regions with a high-middle SDI experienced an increase. The burden of DU increased with age for both males and females, with males generally experiencing a higher burden compared to females. Strengthening population-based data on the prevalence of DU and implementing dynamic monitoring at the public health level will enable policymakers to develop evidence-based strategies for efficient allocation of healthcare resources.

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