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Ayer — Octubre 2nd 2025Tus fuentes RSS

Patients sense of gain experience and its influencing factors: a cross-sectional study in Foshan, China

Por: Xia · P. · Liang · B. · Zeng · Q. · Wang · L. · Zhai · L. · Li · M. · Chen · L. · Yang · H. · He · H. · Xu · X. · Gong · W.
Objectives

Patients’ sense of gain experience (PSGE) is the comprehensive feeling throughout the treatment process, which is a critical benchmark for evaluating comprehensive medical and health system reform in China. This study aims to assess the current status of PSGE in public hospitals and identify important associated factors, providing evidence-based recommendations for improving healthcare services.

Design

This was a cross-sectional study conducted from October to November 2023.

Setting

A total of 14 public hospitals in Foshan, Guangdong Province, China.

Participants

There were 3223 responses, including 1592 from outpatients and 1631 from inpatients.

Primary outcome measure

PSGE was assessed across five domains: time accessibility, service accessibility, cost affordability, patient participation and efficacy predictability. Participants were also asked to provide an overall rating of the PSGE.

Results

The overall score for PSGE was 4.47±0.53 (mean±SD), with service accessibility receiving the highest score (4.68±0.50) and affordability the lowest (4.17±0.86). Secondary hospitals scored an overall PSGE of 4.55±0.50, while tertiary hospitals scored 4.42±0.54. Key factors associated with PSGE were overall satisfaction (β=0.164, p

Conclusions

This study found that patients reported a positive PSGE with service accessibility but reported a less positive PSGE with cost affordability. A tier-based disparity was evident, with secondary hospitals outperforming tertiary hospitals in overall PSGE outcome. Stronger PSGE was positively associated with higher scores in overall satisfaction, treatment satisfaction, satisfaction with medical reforms, patient loyalty and hospital reputation. Demographic and institutional factors, such as hospital level, patient type and household registration, were associated with the PSGE. Efforts can be focused on enhancing clinicians’ willingness and competence in discussing treatment costs during clinical encounters. It is essential for policymakers to address disparities in healthcare experiences among patient groups across hospital tiers to advance equitable, patient-centred systems.

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Natural history, clinical outcomes and predictors of disease course in paediatric IgA vasculitis: protocol for a multicentre prospective cohort study in Guangxi Zhuang Autonomous Region, China

Por: Jiang · H.-H. · Meng · X.-Y. · Liang · Q. · Li · R.-J. · Tang · Q. · Huang · L. · Yun · X. · Shan · Q.-W. · Chen · X.-Q.
Introduction IgA vasculitis (IgAV, formerly Henoch-Schönlein purpura) is a systemic small-vessel vasculitis. The aetiology of IgAV is multifactorial, involving environmental triggers in genetically susceptible individuals. Evolving socioeconomic and environmental factors may be altering the contemporary aetiological and precipitant spectrum of IgAV. Prospective observational studies are therefore crucial for elucidating disease management, prognostic factors and long-term outcomes. Although numerous studies exist on paediatric IgAV, prospective cohort data remain limited. This multicentre prospective observational study aims to characterise the natural history, aetiological/precipitant spectrum, incidence and outcomes of gastrointestinal and renal involvement, factors influencing therapeutic efficacy and the predictive value of biomarkers for disease activity.

Methods and analysis

We will recruit 478 paediatric patients with newly diagnosed IgAV across multiple centres. Participants will undergo prospective longitudinal assessment at disease onset and at 1, 3, 6 and 12 months postdiagnosis. Standardised evaluations will include clinical manifestations, physical examinations, laboratory parameters and patient-reported outcomes. The data will be analysed statistically with SPSS software (V.27.0), adopting a significance threshold of p

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of the First Affiliated Hospital of Guangxi Medical University (2024-K0480), the Ethics Committee of the First People’s Hospital of Yulin (YLSY-IRB-SR-2025060), the Medical Research Ethics Committee of the Liuzhou Workers’ Hospital (KY2024356) and the Ethics Committee of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region (No. (2025–1)003) and written informed consent was obtained from all the parents or guardians of the patients involved. It will be disseminated by publication of peer-reviewed manuscripts and presentation in abstract form at national and international scientific meetings.

Trial registration number

ChiCTR2500099716.

Do-not-resuscitate status in patients with shock in the emergency department in a tertiary hospital in China: a retrospective observational study

Por: Zhang · H. · Jiang · J. · Lv · L. · Liang · L. · Tian · W. · Wu · Q.
Objectives

The study aims to define the prevalence of Do-Not-Resuscitate (DNR) orders among patients with shock in the emergency department (ED) and explore their impact on clinical management and mortality outcomes.

Design

A retrospective observational cohort study was conducted involving patients presenting to the ED with shock.

Setting

An ED in a tertiary hospital in western China.

Participants

2001 patients (aged ≥18 years) presenting to the ED with shock from 1 January 2022 to 31 December 2023.

Methods

The enrolled patients were divided into DNR (order issued within 24 hours of ED admission)/non-DNR groups. Demographics, vitals, comorbidities, laboratory values, medications and prognoses were obtained from electronic healthcare records. DNR prevalence and its associations with mortality, ICU admission, vasopressor administration and antibiotic administration were assessed via logistic regression.

Results

Compared with patients without DNR orders, patients with DNR orders (n=399 (19.9%)) were older (p

Conclusions

Compared with patients with shock in the ED who did not have DNR status, those with DNR status (prevalence ~20%) had higher in-hospital and 30-day mortality (but most survived) and similar ICU admission and intervention treatments.

Effectiveness of Oral Cooling in Alleviating Thirst of ICU Patients: A Meta‐Analysis

ABSTRACT

Background

Thirst is the most common self-reported symptom in intensive care unit (ICU) patients. There is evidence that oral cooling interventions may alleviate thirst symptoms in ICU patients. However, the evidence needs to be critically evaluated.

Objective

To investigate the effect of oral cooling interventions on alleviating thirst symptoms of ICU patients and explore the effectiveness of different types of oral cooling by subgroup analysis.

Methods

The PubMed, Ovid Embase, the Cochrane Library, Wanfang Data and China National Knowledge Infrastructure databases were searched from inception to 29 October 2023. Randomised controlled trials (RCTs) that reported thirst intensity or thirst distress as outcomes were included. The certainty of the evidence was evaluated by the GRADE approach.

Results

The meta-analysis comprised eight RCTs that included 813 ICU patients. The pooled analysis from eight RCTs showed that oral cooling interventions had significant beneficial effects on thirst intensity (weighted mean difference [WMD] = −2.73, 95% confidence interval [CI] = −3.62 to −1.85, p < 0.01; moderate certainty). The pooled analysis from four RCTs showed that oral cooling interventions could significantly lower the thirst distress scores (standardised mean difference = −0.80, 95% CI = −1.13 to −0.47, p < 0.01; low certainty). Subgroup analysis indicated that cold stimulation (WMD = −3.12) and cold combined with menthol stimulation (WMD = −1.72) could significantly lower the thirst intensity scores.

Conclusion

Oral cooling interventions including cold and menthol had beneficial effects on thirst intensity and thirst distress in ICU patients. The high heterogeneity in methods should be considered when interpreting the results.

Relevance to Clinical Pratice

This study provides references for the application of oral care strategy in the ICU care field, and encourages nurses to apply the oral cooling plan to improve patients' comfort.

No Patient or Public Contribution

This was a meta-analysis based on data from previous studies.

Trial Registration

PROSPERO: CRD42023416059

Self‐Care Behaviours and Associated Factors in Older Adults With Multiple Chronic Conditions: A Cross‐Sectional Study

ABSTRACT

Aims

To describe self-care behaviours and explore factors associated with self-care behaviours in older adults with multiple chronic conditions (MCCs).

Background

The prevalence of MCCs is increasing in a rising trend. MCCs complicate the self-care behaviours of older adults. There is limited evidence regarding the factors associated with self-care behaviours in older adults with MCCs.

Design

A cross-sectional design was adopted using the convenience sampling method.

Methods

Participants were recruited from a community health service centre. Measurements included the Self-Care of Chronic Illness Inventory, a single item for loneliness, the 6-item Lubben Social Network Scale, the 4-item Patient Health Questionnaire, the 15-item Tilburg Frailty Indicator, and a self-developed questionnaire for sociodemographic and disease-related characteristics. Descriptive statistics were used as appropriate. Multiple linear regression and multivariate logistic regression were adopted to examine the influencing factors.

Results

A total of 223 participants were enrolled in this study. Among the 223 participants, 49.3%, 32.7% and 28.7% achieved a cut-off score of ≥ 70 in self-care maintenance, monitoring and management, respectively. The linear regression models indicated that smoking status, frailty and self-care confidence were significantly associated with self-care maintenance; education level, per capita monthly household income and self-care confidence were significantly associated with self-care monitoring; and employment status and self-care confidence were significantly associated with self-care management. In addition, multivariate logistic regression showed that living in cities or towns was significantly associated with higher odds of adequate self-care management.

Conclusion

Three domains of self-care behaviours were influenced by distinct factors, and self-care confidence demonstrated consistent associations with all three domains of self-care behaviours. Self-efficacy-focused interventions may have the potential to promote self-care behaviours in older adults with MCCs.

Implications for the Profession and/or Patient Care

Healthcare providers need to take into account the pivotal factors influencing self-care behaviours of this cohort to deliver structured and effective education and support. Clinicians should consider adopting confidence-building strategies in routine education for this cohort.

Reporting Method

We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Patient or Public Contribution

No patient or public contribution.

Exploring the core characteristics of competence in healthcare assistants: a scoping review protocol

Por: Cui · N. · Liang · R. · Yan · X. · Song · Y. · Meng · L. · Zhang · H. · Chu · Y.
Introduction

The global healthcare landscape is undergoing a significant shift in demographics, evolving disease epidemiology and an ageing population, prompting the expansion of healthcare roles, including the healthcare assistant (HCA). However, there remains limited clarity regarding the scope and standards of their competence.

Methods and analysis

A scoping review will be conducted following the updated Joanna Briggs Institute methodological framework. Five databases encompassing PubMed, Cumulative Index to Nursing and Allied Health Literature Complete (EBSCOhost), EMBASE, Web of Science and PsycINFO (EBSCOhost) will be searched. Selected studies will include all types of studies on the competence of HCAs. Two reviewers will independently perform the screening and data extraction process. The quality of evidence in this review will be assessed by the Crowe Critical Appraisal Tool. Data synthesis will be presented using the narrative descriptions and tabular illustrations. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will be employed for transparent reporting.

Ethics and dissemination

No ethical clearance is required for this review. The final review will be submitted for publication to a peer-reviewed journal. Additionally, the results of the final review will be disseminated both locally and nationally to inform clinical practice.

Registration

This protocol has been registered with the Open Science Framework. Registration number is OSF.IO/5RGUC.

Exploring potential target drugs for vision-threatening diabetic retinopathy using the human plasma proteome: a Mendelian randomisation study

Por: Liang · Y. · Huang · Y. · Zhang · X. · Du · Z. · Wang · Y. · Yu · H. · Hu · Y.
Background

Diabetic retinopathy (DR) is a common microvascular complication of diabetes that has the potential to progress to vision-threatening DR (VTDR) even in the absence of symptoms. Plasma proteins in response to physiological and pathological conditions in the body may be intricately connected to the initiation of VTDR.

Objective

To determine the causality between 4489 plasma proteins and the risk of VTDR to explore potential therapeutic targets for VTDR.

Design

A Mendelian randomisation (MR) study.

Setting

A two-sample MR study was performed to investigate the causality between plasma proteins and VTDR.

Participants

Genetic information on plasma proteins and VTDR in European populations from IEU OpenGWAS.

Primary and secondary outcome measures

Mediation analysis was performed to evaluate the indirect impacts of plasma proteins on VTDR via related risk variables. Furthermore, the druggability and potential role of the target proteins in VTDR were explored.

Results

According to the MR study, 92 proteins out of 4489 plasma proteins had causal relationships with VTDR. Five potential proteins (MMP8, BST1, ARL1, MRPL33 and SDF2L1) were causally related to both VTDR and risk factors. Mediation analysis revealed that the protein-mediating effects on VTDR outcomes were achieved through risk factors (body mass index; glycated haemoglobin). Seven drugs that interacted with MMP8 were potential target drugs for VTDR.

Conclusions

Our investigation elucidated the causal connections between plasma proteins, risk factors and VTDR, identified MMP8 protein as a potential drug target and highlighted seven candidate drugs. These results provide a translational framework for developing novel therapies for VTDR.

Mitigating Nurse Turnover in Urban China: Income Inequality and Nurse–Patient Relationships as Moderators of Occupational Stress

ABSTRACT

Aim

This study examined the moderating effects of income inequality and nurse–patient relationships on the association between occupational stress and nurse turnover intentions in large urban hospitals in China, providing evidence for developing targeted retention strategies.

Design

A cross-sectional study.

Methods

Data from 13,298 nurses in 46 hospitals in Xi'an, China (October–December 2023) were analysed using hierarchical regression to assess associations between occupational stress, organisational and professional turnover intentions and the moderating roles of the expected income achievement rate (calculated as [actual/expected income] × 100%) and nurse–patient relationship quality.

Results

Eighty-three percent of nurses reported moderate-to-severe occupational stress. Compared to nurses experiencing mild stress, those with moderate/severe stress demonstrated significantly higher organisational and professional turnover intentions. After adjusting for covariates, significant interaction effects were observed. Higher expected income achievement rate showed a modest but significant moderating effect, associated with reduced turnover intentions. While the nurse–patient relationship also moderated this relationship, its protective effect was attenuated under conditions of severe stress. Despite small effect sizes, the consistent patterns and theoretical coherence of these interactions warrant further investigation.

Conclusion

Occupational stress significantly predicts nurse turnover intentions in urban Chinese hospitals, with income inequality and nurse–patient relationship quality serving as modifiable moderating factors. Interventions should integrate equitable compensation, nurse–patient relationship enhancement programmes and stress management initiatives.

Impact

This study demonstrates that equitable income consistently buffers the effects of occupational stress on nurse turnover, while nurse–patient relationships show stress-level-dependent moderation. By implementing region-specific compensation benchmarks and structured communication training, healthcare policymakers can effectively address economic security and relational care quality in workforce stabilisation.

Reporting Method

The study has been reported following the STROBE guidelines.

Patient or Public Contribution

No patient or public contribution.

Construct prediction models for low muscle mass with metabolic syndrome using machine learning

by Yanxuan Wu, Fu Li, Hao Chen, Liang Shi, Meng Yin, Fan Hu, Gongchang Yu

Background

Metabolic syndrome (MetS) and sarcopenia are major global public health problems, and their coexistence significantly increases the risk of death. In recent years, this trend has become increasingly prominent in younger populations, posing a major public health challenge. Numerous studies have regarded reduced muscle mass as a reliable indicator for identifying pre-sarcopenia. Nevertheless, there are currently no well-developed methods for identifying low muscle mass in individuals with MetS.

Methods

A total of 2,467 MetS patients (aged 18–59 years) with low muscle mass assessed by dual-energy X-ray absorptiometry (DXA) were included using data from the 2011–2018 National Health and Nutrition Examination Survey (NHANES). Least Absolute Shrinkage and Selection Operator (LASSO) regression was then used to screen for important features. A total of nine Machine learning (ML) models were constructed in this study. Area under the curve (AUC), F1 Score, Recall, Precision, Accuracy, Specificity, PPV, and NPV were used to evaluate the model’s performance and explain important predictors using the Shapley Additive Explain (SHAP) values.

Results

The Logistic Regression (LR) model performed the best overall, with an AUC of 0.925 (95% CI: 0.9043, 0.9443), alongside strong F1-score (0.87) and specificity (0.89). Five important predictors are displayed in the summary plot of SHAP values: height, gender, waist circumference, thigh length, and alkaline phosphatase (ALP).

Conclusion

This study developed an interpretable ML model based on SHAP methodology to identify risk factors for low muscle mass in a young population of MetS patients. Additionally, a web-based tool was implemented to facilitate sarcopenia screening.

Effects of standardised patients (SP) combined with case-based learning (CBL) in Chinese clinical education: a systematic review and meta-analysis

Por: Yu · Z. · Zhao · Z. · Chen · X. · Shi · J. · Liang · Y. · Zhang · X. · Qu · M. · Huang · M. · Li · P. · Li · D. · Li · M. · He · J.
Objectives

Combining standardised patients (SP) with case-based learning (CBL) enriches the learning experience by immersing learners in diverse clinical scenarios. This meta-analysis study aims to assess the intervention effects of this teaching approach on Chinese medical students’ and resident physicians’ teaching satisfaction, theoretical knowledge achievements and clinical practice performance.

Design

A systematic review and meta-analysis through Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement.

Data sources

PubMed, Web of Science, Cochrane Library, Education Resources Information Center, China National Knowledge Infrastructure, Wanfang Database and the VIP Database from their inception up to 30 April 2025.

Eligibility criteria

Included studies were randomised controlled trials (RCTs) comparing SP+CBL (experimental group) with lecture-based learning (LBL) (control group) among Chinese medical students and resident physicians, with outcomes including teaching satisfaction, theoretical knowledge scores and clinical practice performance. Non-English/non-Chinese studies, non-RCTs, duplicate publications, studies with incomplete data or irrelevant topics were excluded.

Data extraction and synthesis

Two researchers (JS/XC) independently screened records. Disagreements were resolved by a third reviewer (ZZ). Study quality was assessed using the Cochrane Risk-of-Bias 2.0 tool (ROB 2.0). Meta-analysis used Stata V.17.0. A random effects (RE) model was prespecified due to anticipated heterogeneity, final model selection RE or fixed effects was based on I2 statistics. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Evidence profiles were generated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Publication bias was assessed using funnel plots and Egger’s test. Subgroup analyses compared theoretical/clinical outcomes between medical students and resident physicians to explore heterogeneity sources.

Results

A meta-analysis of 31 RCTs (n=2674), SP+CBL pedagogy outperformed traditional methods in three domains. Teaching satisfaction showed substantial improvement (OR 7.19, 95% CI 3.80 to 13.60, p

Conclusions

Despite some high outcomes heterogeneity stemming from unavoidable methodological constraints in education, our meta-analysis and systematic review of eligible literature demonstrate that integrating SP and CBL facilitates students and resident physicians in acquiring theoretical knowledge and practical skills. It also boosts teaching satisfaction and positively impacts Chinese clinical education.

INPLASY registration number

INPLASY202560118.

Improving tuberculosis treatment adherence: a qualitative study of patients perspectives from a pragmatic trial of the tuberculosis treatment support tools intervention

Por: Roberti · J. · Morelli · D. M. · Aguilar-Vidrio · O. A. · Suyanto · A. · Carmiol-Rodriguez · P. · Tolentino · A. · Chen-Liang · E. · Sprecher · J. · Rubinstein · F. · Iribarren · S.
Objective

To explore patient perspectives on using a digital adherence technology (DAT) for tuberculosis (TB) treatment, specifically, the TB Treatment Support Tools (TB-TST) intervention, which integrates a mobile app designed to enhance patient-centred support, monitoring and communication, alongside a drug metabolite test.

Design

Qualitative study conducted as part of a pragmatic randomised controlled trial.

Setting and participants

Four public reference hospitals in Argentina. All patients in the intervention group were invited to participate; 33 patients in the intervention group and five treatment supporters were included.

Data collection and analysis: semistructured interviews were conducted. The normalisation process theory guided analysis to understand factors that enable or hinder the intervention’s integration into routine practice for TB treatment medication adherence.

Results

Patients identified medication reminders, educational messages and direct communication with treatment supporters (TSs) as the most helpful components of the intervention. Many reported using the app to ask TSs questions they felt uncomfortable raising with physicians in person. Initially, many patients did not fully understand the purpose and use of the metabolite test. Over time, their understanding of the app improved, though some continued to misinterpret the test results. Motivation to adhere to TB treatment was primarily driven by a desire to protect family members and resume normal daily activities. Reported barriers to app use included time constraints due to work, technical issues, limited internet connectivity and the burden of medication side effects. While the intervention was generally perceived as supportive and user-friendly, patients suggested improvements such as faster response times from TSs, expanded availability and better technical reliability and internet access.

Conclusion

These findings highlight the importance of tailoring digital adherence interventions to meet the diverse needs of patients and reinforce the pivotal role of the TS as a trusted and accessible source of guidance throughout TB treatment.

Trial registeration number

NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789.

Factors influencing the psychological well-being of patients undergoing haemodialysis in Taiwan: an observational study

Por: Liang · C.-Y. · Yen · H.-L. · Lin · S.-C. · Chen · C.-C. · Chang · Y.-C. · Fang · Y.-W.
Objectives

We aimed to understand the factors affecting psychological well-being of patients undergoing haemodialysis (HD). First, we explored how physical symptom severity, emotional distress and social support influence psychological well-being. Second, we examined the impact of different types of social support. Third, we investigated whether any variables mediate the relationship with psychological well-being.

Design and setting

A cross-sectional study, a type of observational design, was conducted on patients at a medical centre in Taiwan in 2020.

Participants

A total of 117 outpatients who had undergone regular HD for at least 3 months were enrolled.

Primary outcome measures

The psychological well-being was assessed through self-report questionnaires.

Results

We found that emotional distress (β=–0.25, p=0.033) had a significant negative impact on psychological well-being. However, the presence of appraisal support mitigated this effect. Specifically, appraisal support fully mediated the adverse impact of emotional distress on psychological well-being. In addition, the severity of physical symptoms was generally mild and did not influence psychological well-being.

Conclusion

Receiving appraisal support from family, friends and healthcare professionals not only alleviates emotional distress but also enhances psychological well-being both directly and indirectly among patients undergoing HD. Healthcare professionals should address issues of personal importance while serving as consultants, educators and evaluators to support patients in managing their chronic condition.

Assessing the quality of myopia prevention videos on Chinese short video platforms: a cross-sectional content analysis by source

Por: Li · M. · Liang · R.-B. · Zhou · Y. · wang · k. · Yang · R. · Li · T. · Zhou · X.
Objectives

The prevalence of myopia has been rising, whereas prevention efforts have shown limited success. Educational short videos have become crucial sources for health information; however, their quality regarding myopia prevention is uncertain. This study aimed to evaluate the quality and content of short videos on myopia prevention disseminated via major Chinese short video platforms and compare content differences between healthcare professionals and non-professional creators.

Design

A cross-sectional content analysis.

Setting

Top-ranked videos from three dominant Chinese platforms (TikTok, Kwai and BiliBili) in 6–10 August 2024.

Participants

284 eligible videos screened from 300 initial results using predefined exclusion criteria, including 97 videos from TikTok, 94 from BiliBili and 93 from Kwai.

Methods

Videos were assessed using the Global Quality Scale and a modified DISCERN tool. Content completeness was evaluated across six predefined domains. Videos were categorised by source (healthcare professionals vs non-healthcare professionals), and intergroup differences were statistically analysed.

Results

Of the 284 videos, 48.9% were uploaded by healthcare professionals and 51.1% by non-healthcare professionals. Overall video quality was suboptimal. Videos by ophthalmologists had significantly higher quality scores than those by other creators. Healthcare professionals focused more on definitions, symptoms and risk factors of myopia, whereas non-healthcare professionals emphasised prevention and treatment outcomes. Ophthalmologists more frequently recommended corrective lenses (including both standard spectacles and specially designed lenses for myopia control) and low-dose atropine, whereas non-healthcare professionals favoured vision training.

Conclusions

Significant quality gaps exist in myopia prevention videos. Healthcare professionals, particularly ophthalmologists, produce higher-quality and more comprehensive content. Strategic engagement by healthcare professionals in digital health communication and platform-level quality control is needed to improve public health literacy on myopia.

Pay-it-forward and social network distribution to increase doxycycline post-exposure prophylaxis uptake among men who have sex with men and transgender women in China: study protocol for a three-arm randomised controlled trial

Por: Zhao · P. · Xu · W. · Tucker · J. D. · Tang · W. · Weideman · A. M. · Enders · K. · Liang · P. · Huang · S. · Fitzpatrick · T. · Wang · C.
Introduction

Doxycycline postexposure prophylaxis (doxy-PEP) can prevent sexually transmitted infections (STIs) among men who have sex with men (MSM) and transgender women (TGW). STI rates are high among MSM and TGW in China, and implementation strategies are needed to optimise doxy-PEP services. Pay-it-forward and social network distribution approaches may increase uptake of STI services and could increase the uptake of doxy-PEP. We present the protocol for a randomised controlled trial evaluating the effectiveness of pay-it-forward strategies with and without adjunctive social network distribution among MSM and TGW in China.

Methods and analysis

A total of 399 MSM and TGW will be recruited at seven sites in China and randomly allocated in a 1:1:1 ratio to (1) self-pay, (2) pay-it-forward alone or (3) pay-it-forward with adjunctive social network distribution of doxy-PEP. Participants assigned to the self-pay arm can purchase a doxy-PEP packet out-of-pocket. Participants in the pay-it-forward arm will be offered a free doxy-PEP packet and the opportunity to donate to support doxy-PEP for future participants. Participants in the pay-it-forward arm with social network distribution will receive the pay-it-forward intervention as well as additional free doxy-PEP packets to distribute to peers. Those randomised to the self-pay and the pay-it-forward with social network distribution arms (ie, index participants) will receive and distribute referral cards to recruit additional peers (ie, alter participants). Alter participants recruited through the control arm will be referred to the clinic to purchase doxy-PEP. Alter participants recruited through the pay-it-forward with adjunctive social network distribution arm will receive doxy-PEP directly from referring index participants. Both index and alter participants in each arm will be asked to complete a follow-up survey 3 and 6 months after enrolment. The primary outcome will be the proportion of participants who report using doxy-PEP within 72-hours of condomless anal or oral sex on one or more occasions during follow-up.

Ethics and dissemination

Ethical approval was obtained from the ethics review committee of the Dermatology Hospital of Southern Medical University (Approval number: 2023109). The findings will be disseminated in peer-reviewed publications.

Trial registration number

The study has been registered with the Chinese Clinical Trial Registry (trial ID ChiCTR2300074903). Date of registration: 18 August 2023.

Perceptions of Nurses and Nursing Students Regarding Evidence‐Based Nursing: A Qualitative Systematic Review

ABSTRACT

Aim

To consolidate and synthesise the literature reporting perceptions of nurses and nursing students regarding evidence-based nursing.

Design

Qualitative systematic review.

Data Sources

Seven electronic databases (Cumulative Index to Nursing and Allied Health Literature, Embase, ProQuest Dissertations & Theses Global, PsycInfo, PubMed, Scopus and Web of Science) were searched from their respective inception dates to January 2025.

Methods

The Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines guided this review. The quality of included studies was assessed using the Critical Appraisal Skills Programme tool, and data were synthesised thematically using Sandelowski and Barroso's two-step approach.

Results

Thematic analysis of the 19 included studies, published from 2007 to 2025, identified three key themes: (1) Advancing nursing through evidence, (2) Personal, structural and systemic challenges and (3) Promoting a new evidence-based nursing culture.

Conclusion

Evidence-based nursing can elevate nursing care standards and enhance patient outcomes. Numerous factors that encourage and hinder the implementation of evidence-based nursing among nurses and nursing students were reported.

Implications for the Profession and/or Patient Care

This review suggests the need to incentivise nurses to champion evidence-based nursing initiatives, provide nurses and nursing students with continuing education, and develop updated evidence-based nursing guidelines. These strategies could help in cultivating a supportive evidence-based nursing workplace culture and improving the implementation of evidence-based nursing.

Impact

Valuable insights into the facilitators and barriers associated with the implementation of evidence-based nursing were reported by nurses and nursing students—the key personnel responsible for practising evidence-based nursing. Future research could be undertaken to explore the perceptions of nurses and nursing students across varied cultural settings and in underrepresented regions.

Reporting Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

No Patient or Public Involvement

This study did not include patient or public involvement in its design, conduct, or reporting.

Effectiveness and sustainability of peer support interventions for patients with obesity: a realist synthesis protocol

Por: Li · H. · Huang · L. · Li · X. · Wang · D. · Su · Y. · Liang · R. · Hu · J.
Background

Recent economic development and evolving lifestyles have contributed to a global rise in overweight and obesity, which are now acknowledged as critical public health challenges. Previous research examining the effectiveness of peer support interventions for individuals who are overweight or obese has produced inconsistent and sometimes conflicting results. However, recent systematic reviews and meta-analyses have suggested a potential association between peer support and reductions in both weight and body mass index. In response to these emerging findings, the present study employs a realist synthesis approach to elucidate the context–mechanism–outcome (CMO) configurations identified in literature that meets stringent inclusion and exclusion criteria, thereby addressing the pivotal question: under what conditions can peer support effectively mitigate obesity? This study seeks to clarify the underlying mechanisms that contribute to the efficacy and sustainability of peer support interventions, ultimately informing the development of robust, high-quality obesity management programmes.

Methods and analysis

This study employs a realist synthesis methodology in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards. Initially, a preliminary theoretical framework will be developed through a scoping review of grey literature and international project frameworks. Systematic searches in databases—including PubMed, EMBASE, Web of Science, ProQuest, CINAHL, CNKI, Wanfang and VIP—will be conducted to generate relevant evidence. Qualitative research methods, facilitated by NVivo software, will be used to code and organise the data into themes related to the research context, mechanisms and outcomes, thereby refining the theoretical framework.

Ethics and dissemination

This research proposal and its corresponding realist synthesis do not require ethical approval. The study employs a realist synthesis approach to construct a theoretical framework that integrates CMO configurations, thereby elucidating how peer support can effectively and sustainably benefit individuals with obesity. The findings will be disseminated via peer-reviewed journals, academic conferences and formal reports.

PROSPERO registration number

CRD42024587409.

Acupuncture for preventing chemotherapy-induced peripheral neuropathy: study protocol for a randomised controlled trial

Por: Li · B.-Y. · Liu · C.-Z. · Zhou · H. · Wei · X.-Y. · Jia · J.-Y. · Wang · J. · Guo · X.-Y. · Liang · W. · Tu · J.-F. · Wang · L.-Q. · Shi · G. · Yang · J.-W. · Yang · N.-N.
Introduction

Chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent non-haematological, dose-limiting adverse event associated with platinum derivatives and taxanes. Currently, no effective prophylactic interventions for CIPN have been established. However, several studies have shown that acupuncture may alleviate symptoms of peripheral neuropathy, proposing it as a potentially effective strategy for CIPN prevention. This pilot trial will help determine the feasibility and efficacy of acupuncture for preventing CIPN. The results will provide valuable insights for designing a larger clinical trial and conducting power calculations.

Methods and analysis

This is a randomised sham-controlled trial. A cohort of 60 patients scheduled to receive chemotherapy will be enrolled and randomly assigned to either the electroacupuncture group or the sham acupuncture group. Eligible patients will receive nine treatment sessions administered over the course of three chemotherapy cycles. The primary outcome is the change in CIPN-related quality of life (QOL) measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) CIPN20 from baseline to the end of cycle three. Secondary outcomes include: neurotoxicity symptoms assessed by the Numeric Rating Scale, incidence of CIPN, chemotherapy status, insomnia symptoms measured by the Insomnia Severity Index, depression symptoms evaluated using the Beck Depression Inventory-II, anxiety symptoms assessed with the Generalised Anxiety Disorder-7 and fatigue symptoms measured by the Brief Fatigue Inventory. Adverse events will be meticulously recorded.

Ethics and dissemination

The study protocol (V.1.0, 29 July 2024) has been approved by the First Affiliated Hospital of Zhengzhou University (2024-KY-0853–001). All patients will provide oral informed consent and written informed consent before participating in this study. Trial results will be disseminated in peer-reviewed publications.

Trial registration number

ITMCTR2024000390 (International Traditional Medicine Clinical Trial Registry, http://itmctr.ccebtcm.org.cn/zh-CN/Home/ProjectView?pid=16387992-8971-4218-9cd0-b623af91f9f3), registered on 3 September 2024.

Brolucizumab efficacy and safety single-arm descriptive trial in patients with persistent diabetic macular edema (BEST study): protocol for a single-centre, open-label, single-arm clinical trial in China

Por: Huang · Z. · Hu · Y. · Shen · C. · Li · J. · Liang · A. · Fang · Y. · Zeng · J. · Liao · H. · Zheng · C. · Ouyang · S. · Hu · Y. · Cao · D. · Yu · H.
Introduction

Persistent diabetic macular edema (DME) with inadequate responsiveness to conventional inhibitors of vascular endothelial growth factor (VEGF) has caused significant vision loss and substantial treatment burdens. Brolucizumab is a new-generation anti-VEGF agent with better anatomical efficacy and prolonged duration of action. This single-centre, open-label, single-arm design clinical trial aims to evaluate the efficacy and safety of intravitreal brolucizumab 6 mg in Chinese subjects with persistent DME.

Methods and analysis

A total of 52 adult subjects with persistent DME will be recruited from Guangdong Provincial People’s Hospital. All study eyes will receive three consecutive 6 mg brolucizumab injections at intervals of 6 weeks. Disease activity assessment (DAA) will be arranged at week 18, and if disease activity is detected, subjects will continue with dosing of brolucizumab every 6 weeks (at weeks 18 and 24). Otherwise, the dosing will be adjusted to every 12 weeks (at week 24). The primary endpoints will be the proportion of patients with central subfield thickness (CST)

Ethics and dissemination

This study has been approved by the Ethics Review Committee of Guangdong Provincial People’s Hospital (KY2024-319). This study will be conducted in accordance with the ethical principles that have their origin in the Declaration of Helsinki and that are consistent with the ICH E6 guidelines for Good Clinical Practice and the applicable regulatory requirements. The study results will be submitted to a peer-reviewed journal and presented at both local and international congresses.

Trial registration number

NCT06498050.

Serum 25(OH)D levels and mortality risk among middle-aged and elderly populations in the U.S.: A prospective cohort study

by Yaowen Hu, Faliang Gao, Yuan Yang, Wei Yang, Huibo He, Jie Zhou, Yujie Zhao, Xi Chen, Wenyan Zhao, Xiaopeng He

Objective

To investigate the prevalence of vitamin D deficiency and its relationship with all-cause and cause-specific mortality among middle-aged and elderly populations in the U.S.

Methods

Data were sourced from the National Health and Nutrition Examination Survey (NHANES) 2001–2018. A total of 22,130 participants aged 40–70 years were included. Serum 25-hydroxy vitamin D [25(OH)D] concentrations were measured and categorized. The primary outcome was all-cause mortality, and secondary outcomes were cardiovascular disease (CVD) and cancer mortality. Multivariable-adjusted models and various statistical analyses were employed.

Results

The prevalence of vitamin D deficiency (≤50.00 nmol/L) was 33.59%, and insufficiency (≤75.00 nmol/L) was 71.74%. For all-cause mortality, the multivariate adjusted hazard ratios (HRs) across different 25(OH)D levels (p = 0.0069, 0.59 (0.49,0.72) p p  Conclusion

This study found that higher serum 25-hydroxyvitamin D concentrations are linked to lower all-cause, cardiovascular, and cancer mortality. The relationship is nonlinear: increases in concentration reduce death risk below a certain threshold, but above it, the association weakens. Further research is needed to understand causal mechanisms.

Palliative care and its association with the quality of death in patients with advanced cancer in China: a cross-sectional study with a family caregivers perspective

Por: Wen · B. · Xie · F. · Ma · J. · Chen · J. · Liang · L. · Zeng · Q. · Ding · J. · Tang · S.
Objectives

To determine the factors influencing palliative care utilisation in patients with advanced cancer and to assess its association with the quality of death (QOD).

Design

A cross-sectional study.

Setting

This study was conducted in tumour hospitals in the Hunan and Sichuan provinces of China. In 2021, the country launched a ‘palliative care standard wards’ project, identifying 16 medical institutions as the first pilot sites.

Participants

Deceased patients who met the admission criteria for a standard palliative care unit were the study subjects, and their caregivers were recruited for questionnaires.

Interventions

No interventions were applied in this study.

Primary and secondary outcome measures

A self-reported questionnaire survey was administered to caregivers of deceased patients with advanced cancer in mainland China. Binary logistic regression was used to identify factors influencing palliative care utilisation. The association between utilisation of palliative care and the QOD was tested using an independent samples t-test.

Results

Of 947 patients, 342 (36.1%) received palliwiative care. Data were collected from 400 caregivers (42.2%). Palliative care utilisation was associate with intrusion operation (adjusted OR (aOR): 1.7, 95% CI: 1.05 to 2.92, p=0.032) and relationship with patients caregiver age (aOR=6.5, 95% CI: 3.6 to 12.7, p

Conclusions

Patient and caregiver characteristics influence palliative care utilisation, and use of palliative care contributes positively to most dimensions of the QOD. Future research should further explore multiple factors influencing palliative care utilisation and examine whether they contribute to the QOD.

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