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by Kerong Wang, Guoliang Li, Xiuci Yang, Meiling Ji, Shuainan Hong, Cong Liu, Mengyao An, Jiangning Yin
ObjectiveThis study aims to find a quick bedside ultrasonography evaluation technique that evaluates the optic nerve sheath diameter to eyeball transverse diameter (ONSD/ETD) ratio and middle cerebral artery (MCA) flow parameters at 6 hours post-return of spontaneous circulation (ROSC) for early neurological prognosis.
MethodsThis retrospective study included 49 patients who achieved return of spontaneous circulation (ROSC) and were admitted to our emergency department between September 2023 and September 2025. Collected data encompassed baseline characteristics, GCS-M scores, APACHE-II scores, and bedside ultrasound measurements of ONSD, ONSD/ETD at 6, 24, and 48 hours post‑ROSC and middle cerebral artery hemodynamic parameters at 6, 24 hours post‑ROSC. The statistical analyses included the Mann-Whitney U test, t-test, and Receiver Operating Characteristic (ROC) curve analysis.
ResultsThe ONSD/ETD ratio at 6 hours post-ROSC was a robust predictor of unfavorable neurological outcomes (AUC 0.922, P = 0.001), outperforming ONSD alone (AUC 0.866, P = 0.003), with an optimum threshold of 0.256 (sensitivity 76.5%, specificity 100%). The ONSD/ETD ratio was a significant predictor of CPC scores (OR = 1.979, P = 0.010). Although the majority of middle cerebral artery hemodynamic measures revealed no significant changes, all patients displaying cerebral circulatory arrest (CCA) waveforms or advancing to such waveforms demonstrated a dismal neurological prognosis. The alteration in Pulsatility Index (PI) was borderline significant (P = 0.05), with a threshold of 0.269 (AUC 0.90, sensitivity 80%, specificity 100%).
ConclusionThe ONSD/ETD ratio assessed six hours after cardiac arrest accurately forecasts neurological prognosis, especially for unfavorable results (CPC 4–5). Transcranial Doppler can continuously monitor patients exhibiting an increased pulsatility index or identified cerebral circulatory arrest waveforms. The integration of various methodologies for dynamic evaluation enhances risk categorization and aids clinical decision-making for patients who attain ROSC. However, these findings are preliminary and require validation in larger cohorts.
by Xinyi Qiu, Limei Guan, Hui Liu
BackgroundAdolescent diabetes mellitus (DM) constitutes a significant global public health challenge. This study seeks to quantify the burden of DM in adolescents aged 10–19 years from 1990 to 2023 and to forecast trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) through 2040.
MethodsEpidemiological data for DM among adolescents in 204 countries and territories were obtained from the Global Burden of Disease (GBD) 2023 database. The global burden was evaluated using age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR), stratified by region, sex, age, and Socio-demographic Index (SDI). Health inequality was assessed using the slope index of inequality (SII) and concentration index (CI). Future trends were forecast using an autoregressive integrated moving average (ARIMA) model with model-specific validation (AICc, Ljung-Box test).
ResultsFrom 1990 to 2023, global adolescent DM burden increased substantially. ASIR, ASPR, and ASDR rose consistently, whereas ASMR remained relatively stable with a slight decline. In 2023, an estimated 6.07 million adolescents were living with DM (ASPR: 458.07 per 100,000). The highest ASPR was observed in low-SDI regions (482.25 per 100,000), followed by high-SDI regions (442.81 per 100,000). Low-SDI regions also carried the highest DALY and mortality burdens. Males progressively exceeded females in both incidence and prevalence by 2023, although this observed sex reversal may partly reflect changes in screening and diagnostic practices. The overall burden increase was primarily driven by adolescents aged 15–19 years. ARIMA forecasts indicate that ASIR, ASPR, and ASDR are projected to continue increasing through 2040, while ASMR is expected to remain low and stable.
ConclusionsThe burden of adolescent DM increased considerably from 1990 to 2023, with marked heterogeneity by age, sex, and geography. The rising non-fatal burden (incidence, prevalence, DALYs) contrasts with stable mortality, suggesting improvements in acute care alongside growing morbidity. Persistent health disparities and projected increases underscore the need for age-, sex-, and region-specific public health strategies.
by Aline Veras Morais Brilhante, Christina César Praça Brasil, Raimunda Magalhães da Silva, Marjan Askari, Luciana Andrade da Mota Sampaio, Jonas Loiola Gonçalves, Layane Sabóia, Lucas Alessandro Macedo Cruz, Helena Rodrigues Dias, Luciel Almeida Cavalcanti, Maria Julya Albuquerque Parente, Mariana Tavares Rocha, Melania Maria Ramos de Amorim
Autistic women experience increased obstetric and perinatal risks, partly driven by communication barriers within maternity care. Evidence on how these barriers are experienced in low- and middle-income countries remains scarce. This study aimed to analyze communication barriers in perinatal care based on narratives of autistic women who experienced pregnancy, childbirth, and postpartum care in Brazil. A qualitative study was conducted using the Hermeneutic-Dialectic Circle (HDC) approach. Thirty-four autistic women (22 with support level 1 and 12 with support level 2, including three non-speaking participants with complex communication needs) were recruited through convenience sampling, supplemented by active recruitment through participant referral, and participated in semi-structured interviews conducted in multiple accessible formats (video call, real-time messaging, in-person, and augmentative and alternative communication). Data were analyzed using constant comparative methods within the hermeneutic-dialectic framework, guided by the social model of disability and the neurodiversity paradigm. Three central categories were constructed: (1) communicational demands of autistic women and their non-recognition, including alexithymia, sensory hypersensitivity, and need for predictability; (2) institutional and interpersonal communication failures, encompassing symptom invalidation, disrespectful care, and exclusion of non-speaking women; and (3) experiences of respectful and effective communication, demonstrating that adapted strategies promote safety and autonomy. Participants’ narratives indicate that communication barriers in perinatal care for autistic women operate systemically rather than individually. Training healthcare professionals and implementing accessible communication strategies are essential to promote respectful, safe, and inclusive maternity care.° Se han desarrollado muchos modelos de probabilidad de complicaciones en tejidos normales (PCTN) para predecir los efectos no deseados después de la radioterapia en pacientes con cáncer de cabeza y cuello, pero la mayoría de ellos no se han validado lo suficiente de forma externa, es decir, no se han analizado lo suficiente en pacientes que no participaron en el estudio original de desarrollo del modelo, para saber cómo de bien predicen realmente los efectos no deseados.
° Para los modelos analizados en dos o más estudios además de sus estudios originales de desarrollo del modelo, la calidad de las pruebas y el informe de sus resultados fue generalmente deficiente, por lo que es difícil saber su utilidad.
° Se necesitan más estudios mejor diseñados para investigar este tema en el área del cáncer de cabeza y cuello.
La probabilidad de tener efectos adversos como resultado de la radioterapia se puede calcular mediante los denominados modelos de PCTN. Los modelos de PCTN calculan el riesgo de efectos secundarios inducidos por la radiación según la información del paciente, su enfermedad y su tratamiento.
La radioterapia es la base del tratamiento de pacientes con cáncer de cabeza y cuello. Sin embargo, la radioterapia expone a radiación partes sanas, a veces esenciales, de la región de la cabeza y el cuello. Esto puede provocar daños en estos órganos normales, p. ej. alteración de la producción de saliva, que puede tener consecuencias importantes para la calidad de vida de los pacientes con cáncer de cabeza y cuello tratados con radioterapia. Los modelos de probabilidad de complicaciones en tejidos normales (PCTN) podrían ser útiles para lograr un equilibrio óptimo entre el control del tumor y prevenir los efectos secundarios inducidos por la radiación. Estos modelos predicen el riesgo de efectos secundarios inducidos por la radiación a partir de la información del paciente, su enfermedad y su tratamiento. Ha habido un número considerable de modelos de PCTN para pacientes con cáncer de cabeza y cuello. Se quería averiguar cuál es la calidad del diseño, la ejecución y el análisis de los estudios (es decir, el riesgo de sesgo) y la eficacia de estos modelos para predecir el riesgo de efectos secundarios inducidos por la radiación.
Se buscaron estudios que desarrollaran o validaran modelos de PCTN en pacientes con cáncer de cabeza y cuello.
En la mayoría de los 592 modelos desarrollados a partir de 140 767 pacientes en 143 artículos identificados, la calidad de los modelos no fue suficiente; y para el 81% de estos modelos no se ha investigado cómo de bien funcionan en otros pacientes. Del 19% restante de los modelos, se encontraron 152 validaciones externas en 34 304 pacientes de 41 artículos. Solo hubo nueve modelos con dos o más validaciones externas. Los modelos pudieron distinguir bien a los pacientes con y sin el desenlace, pero a menudo no estuvo claro si sus predicciones concordaban con lo observado, porque esto último no siempre se evaluó o se proporcionó. En general, la calidad de la mayoría de estos estudios fue baja.
La evidencia está actualizada hasta el 8 de enero de 2024.
To provide practical insights that delve into the ethical issues and regulatory implications of generative artificial intelligence (GenAI) in healthcare. Ethical Challenges and Regulatory Impact in China is used as an example.
Despite China's efforts to strike a delicate balance between protecting public welfare and promoting technological advancement, numerous unresolved issues persist in the practical integration of generative artificial intelligence into healthcare settings.
Key issues such as data application, privacy protection, cost-effectiveness and regulatory remain areas of ambiguity that require clarification. Stringent ethical guidelines, data privacy protection measures and continuous supervision and evaluation of artificial intelligence decisions will help enhance the expected benefits of GenAI in healthcare.
The potential use of GenAI in healthcare has garnered widespread attention, emerging as a significant global research topic. However, its application in this domain presents substantial ethical and regulatory challenges. Compared to other fields, GenAI's role in healthcare is more sensitive and complex, necessitating an urgent assessment of its ethical implications for future development and deployment. Challenges and ethical considerations are particularly pronounced in developing countries with limited healthcare resources.
by Michael E. J. Stouthandel, Danial Forouhar, Charlotte Debbaut, Jurgen Deviche, Liesl De Graeve, Bernard Depypere, Maarten Meire, Dominique Adriaens, Tom Van Hoof
IntroductionA better 3D visualisation of the lymphatic system could provide more accurate cancer treatment approaches, but this requires contrast agent injections. Since lymphatic vessels are very small, cannulations to administer contrast agent are very difficult to perform manually. As such, a dedicated set up for lymphatic vessel micro cannulations is required.
Materials and methodsA micromanipulator rig for full body micro cannulations was constructed. The rig consists of an aluminium frame that can be positioned over a dissection table. It combines the micromanipulator with a sliding gantry plate and a double jointed positioning system to provide as many possible angles of approach as possible. Fluid pressure control devices and a surgical microscope can also be included in the set up.
ResultsMicro cannulations on a full body could successfully be performed using the micromanipulator rig. After only a short learning curve to explore the movement possibilities/range of the device, the micromanipulator rig quickly outperformed manual micro cannulations.
ConclusionsGiven the short learning curve and the success rate of the micro cannulations with the micromanipulator rig, we would strongly recommend other microvascular researchers to use the micromanipulator rig for future experiments involving micro cannulations.
by Isabela Oliveira Sousa, João Lucas Pinheiro Leite, Amanda Oliveira dos Santos Melo, Adriano Souza Santos Monteiro, Carolina Ferreira Cavalcanti Xavier, Valmira de Jesus Santos, Ana Paula Silva de Lemos, Samanta Cristine Grassi Almeida, Ana Paula de Oliveira Menezes, Soraia Machado Cordeiro, Joice Neves Reis
BackgroundMonitoring the prevalence and serotype distribution of Streptococcus pneumoniae nasopharyngeal carriage is essential for understanding transmission dynamics and assessing the impact of pneumococcal conjugate vaccines (PCVs). In Brazil, PCV10-GSK is routinely administered at 2 and 4 months of age with a booster at 12 months. This study aimed to determine the nasopharyngeal carriage rate, serotype distribution, antimicrobial susceptibility, and factors associated with carriage among healthy children aged 2–5 years vaccinated with PCV10-GSK under the Brazilian routine immunization program.
MethodsA cross-sectional study was conducted from August to November 2023 among children aged two to five years from 10 randomly selected schools in Salvador, Brazil. Within each school, all eligible children whose parents or legal guardians provided written informed consent were enrolled. Nasopharyngeal swabs were collected, and demographic, vaccination, and risk factor data were recorded. S. pneumoniae isolates were serotyped using multiplex polymerase chain reaction and/or the Quellung reaction. Antimicrobial susceptibility was evaluated using disk diffusion and gradient strip minimum inhibitory concentration methods. Risk factors for carriage were assessed using univariate and multivariable logistic regression analysis.
ResultsAmong the 400 children enrolled, the overall S. pneumoniae carriage rate was 39.5%. White race was independently associated with lower odds of carriage compared with mixed race, whereas none of the evaluated factors was significantly associated with carriage of non-PCV20 serotypes among colonized children. The most frequent serotypes were 6C (17.9%), 19A (13.0%), 11A (9.3%), 15B (8.6%), 23A (8.6%), and 15A (7.4%). Estimated vaccine serotype carriage was 3.2% for PCV10-GSK, 17.3% for PCV13/PCV15/PCV10-SII, and 39.5% for PCV20. Penicillin non-susceptibility was observed in 21.8% of isolates, with the highest rates among serotypes 19A (71.4%), 23A (35.7%), and 6C (20.7%).
ConclusionsA high pneumococcal carriage rate, predominantly involving non-PCV10-GSK serotypes, was observed among children vaccinated under the Brazilian PCV10-GSK program. The limited serotype coverage of PCV10-GSK, together with antimicrobial resistance among circulating serotypes, underscores the need for ongoing surveillance to guide vaccine policy and antimicrobial stewardship in Brazil.
Nature-based interventions aimed at promoting health, enhancing well-being and supporting medical treatment have long been a focus of public health research. In particular, forest therapy and forest bathing are well established in Asia as evidence-informed approaches to stress reduction. In Europe, research on forest therapy is expanding although the field remains comparatively young. Existing studies have mainly focused on the short-term effects of single forest visits while evidence on multiweek interventions and potential medium-term to long-term effects remains limited. The project Forest|Health (Wald|Gesund), embedded within the research consortium T!Raum-Initiative One-Health-Region Pomerania located in northern Germany, aims to address this gap by developing a structured forest therapy intervention tailored to three different target groups.
The study protocol describes a pilot study to evaluate a modular forest therapy intervention with regard to feasibility indicators as well as stress-related and symptom-related exploratory outcomes. A total of 120 participants will be recruited across three target groups: community-dwelling adults aged 65 years and older, adults with arterial hypertension and adults with depressive symptoms recruited from treatment waiting lists. Using a multimethod approach, two preliminary studies were conducted: a survey of community-dwelling individuals in the region and focus groups with regional stakeholders. Additionally, a 2-week pilot study of the intervention was conducted. Based on these findings, a 4-week modular forest therapy intervention will be implemented. Participants will be assigned to intervention modules with distinct content using a quasi-randomised procedure. The intervention will follow a pre–post design with follow-up assessments. Feasibility indicators will be assessed as key process outcomes. The primary exploratory outcome will be stress while secondary exploratory outcomes will include psychological and physiological health-related measures.
The study was approved by the Ethics Committee of the University Medicine Greifswald. Participants will provide informed consent, receive information about potential risks and support options. The results will be disseminated through scientific publications, conferences and public outreach.
This study protocol is preregistered on the Open Science Framework (OSF; Registration DOI: 10.17605/OSF.IO/C2D5P; last update 16 December 2025).
To evaluate the effectiveness of a dyadic illness management–based intervention (Dyadic Guidance and Empowerment Program, D-GEP) in alleviating demoralization among women with gynaecological malignancies and their family caregivers during the hospital-to-home transition.
An assessor-blinded, two-arm parallel randomized controlled trial with repeated outcome assessments.
Women-caregiver dyads were recruited from a tertiary hospital in Changchun, China (June–August 2025) and randomly allocated to the intervention or control group (1:1). The intervention group received D-GEP, comprising two pre-discharge face-to-face sessions, a 4-week WeChat-based video education programme comprising 20 videos, and a dyadic telephone follow-up conducted 3 weeks after discharge. The control group received standard discharge planning and a telephone follow-up. Outcomes were assessed at baseline (T0), immediate post-intervention (T1) and 3 months post-intervention (T2). Data were analysed according to the intention-to-treat principle.
A total of eighty-four women-caregiver dyads were recruited. Eighty women (95%) and 78 caregivers (93%) completed the full protocol. At 3 months, D-GEP significantly reduced demoralization among both women and family caregivers compared with standard care, with large intervention effect sizes observed. In addition, the symptom burden of women and family caregiver burden were also significantly reduced, whereas dyadic mutuality and family hardiness (women-reported) improved. However, no significant effect was found on women's self-perceived burden. The intervention demonstrated high adherence rates and minimal attrition.
The D-GEP effectively reduces demoralization and improves key dyadic outcomes for women with gynaecological malignancies and their family caregivers.
Nurses can implement this theory-driven dyadic programme to mitigate psychological distress and enhance mutual support, thereby facilitating improved continuity and quality of care during discharge and follow-up.
To our knowledge, this study provides randomized controlled evidence that a theory-driven dyadic intervention may effectively reduce demoralization among women with gynaecological cancer and their family caregivers during the transition from hospital to home care. The scalable D-GEP model, combining brief in-person sessions, video education and telephone follow-up, offers a practical framework for oncology nurses to integrate dyadic care into routine discharge planning. These findings have important implications for oncology practice in Asian healthcare systems and other settings where family engagement is central to cancer care delivery.
This study was conducted and reported in accordance with the CONSORT 2025 guidelines for randomized controlled trials.
No Patient or Public Contribution.
Chinese Clinical Trial Registry, No. ChiCTR2500104008. Registered on 10/06/2025, first recruitment on 20/06/2025.
Cardiovascular disease (CVD) is the leading cause of death in the USA, with significant disparities affecting racial/ethnic minority populations particularly in Philadelphia. Although effective self-management can improve outcomes for those with CVD risk factors, social and economic barriers often impede implementation of recommended health behaviours in underserved communities. This study aims to (1) determine the effectiveness of the Decision-making Education for Choices in Diabetes Everyday (DECIDE)+ intervention in improving CVD self-management skills among Philadelphia residents with CVD risk factors and unmet social needs compared with standard community health worker (CHW) engagement and (2) assess the reach, adoption, fidelity and maintenance of DECIDE+.
Using a type 1 hybrid effectiveness-implementation design, this quasi-experimental study will compare outcomes between participants who enrol in the DECIDE+ group (n=250) or receive standard CHW services (n=250). DECIDE+ combines a structured nine-session problem-solving programme for chronic disease management with ongoing CHW support addressing social needs. Both groups will be randomly assigned to either monthly or biweekly CHW follow-up to examine the impact of contact frequency on health behaviour outcomes. Primary outcomes include CVD self-management skills measured by the Self-care of Chronic Illness Inventory. Implementation outcomes will be assessed through a mixed-methods approach including structured interviews with CHWs and analysis of programme-level data.
This study was approved by the University of Pennsylvania Institutional Review Board (Protocol #856216). Written informed consent is obtained from all participants prior to enrolment. This pragmatic trial addresses cardiovascular health disparities by simultaneously enhancing problem-solving skills for chronic disease management and addressing social and environmental barriers to effective self-management. The study will provide valuable insights into the effectiveness of multilevel CHW-delivered interventions and optimal implementation strategies in real-world community settings. Findings will be disseminated through peer-reviewed publications and scientific conference presentations.
Perioperative monitoring requires clinicians to integrate multiple physiological data streams while managing interruptions and audible alarms. The Visual Patient Avatar (VPA) is an avatar-based monitor visualisation that integrates vital signs and sensor states into an animated virtual patient. This protocol evaluates whether VPA implementation is associated with objective changes in monitoring and alarm outcomes during routine perioperative care.
This investigator-initiated, dual-centre, quasi-experimental pre-post observational study uses routine perioperative monitoring and alarm data from NewYork-Presbyterian/Weill Cornell, USA and University Hospital Zurich, Switzerland. It includes approximately 58 000 anaesthesia cases (16 000 and 42 000, respectively); adult and paediatric cases will be analysed separately. Data span pre-implementation, adaptation and post implementation phases; technical deployment intervals are excluded. Each anaesthesia case is one unit of analysis. The primary outcome is the duration of vital-sign deviation per 60 min of valid measurement. Secondary outcomes are a time-based area under the curve metric and audible alarm burden (count, time and reaction time). Multivariable models will adjust for patient, procedure and care-context covariates. Analyses will be performed separately by centre.
The Weill Cornell Medicine Institutional Review Board approved the study and granted a waiver of informed consent (IRB No. 22-05024803). At University Hospital Zurich, only cases from patients with written general consent for research use of routinely collected health data were included. The Cantonal Ethics Committee Zurich issued a declaration of non-jurisdiction (BASEC Req-2021-00756; 6 July 2021), and the University Hospital Zurich Data Governance Board approved data export and anonymisation (DGR0000504; 31 January 2025). A data-sharing agreement was established on 11 April 2023. Data-collection windows are complete; extraction, linkage and quality control are ongoing, and no comparative outcome analyses have been performed. Findings will be disseminated through peer-reviewed publications and conferences.
Obesity disproportionately impacts people with intellectual disabilities (PwID). Given the challenges that PwID face, such as cognitive deficits, differences in motivation and communication difficulties, the need for tailored interventions for weight management in PwID is recognised. Yet, this population is underserved, with limited weight management interventions for them compared with the general population. Existing reviews suggest that ‘multi-component’ interventions (including physical activity and dietary advice) are impactful at reducing weight in PwID; however, less is known about how these interventions are tailored for PwID, particularly in addressing their cognitive and communication difficulties which may influence how they understand and engage with strategies. Additionally, the acceptability and impact of these interventions on health behaviours are less explored. These indicate a need for a better understanding of these aspects to inform the future development and implementation of impactful interventions. To address this need, this review aims to assess the effectiveness of behaviour change interventions for weight management for PwID at reducing weight and improving healthy weight behaviours (eg, physical activity and diet), evaluate their acceptability, and explore how the interventions are tailored for PwID.
This review will be structured using the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) and Population, Intervention, Comparison, Outcome and Study frameworks. PubMed, CINAHL, Embase, Scopus and Web of Science will be searched for weight management interventions for PwID. The titles, abstracts and full texts of the identified articles will be screened by two independent reviewers followed by data extraction into a predetermined form. The quality of the included articles will be assessed using the Cochrane Collaboration Risk of Bias 2 tool (for randomised controlled trials) and the Mixed Methods Appraisal Tool (for all other study designs). Meta-analyses will be conducted to synthesise the overall impact of the interventions on weight-related and behavioural outcomes (where feasible). Quantitative data ineligible for the meta-analyses and qualitative data about the intervention characteristics and acceptability will be narratively synthesised.
Ethical approval is not required for this study, as it will use publicly available data only. The findings will be disseminated via publication in a peer-reviewed journal.
CRD42024621920.
Congenital myopathies (CMYO) are a group of rare hereditary muscle diseases defined by characteristic abnormalities on muscle biopsy. Several types, including the core myopathies central core disease and multi-minicore disease, nemaline myopathy and centronuclear myopathy, have been identified based on the characteristic histopathological changes and attributed to various genetic backgrounds. The most prominent clinical features are generalised muscle weakness often pronounced axially, variable cardiorespiratory and bulbar impairment, and skeletal and joint involvement. Currently, no curative therapies are available for CMYOs; however, a few phase I and II trials have been performed or are expected in the near future. To reach trial readiness, an informed understanding of the disease course and a selection of relevant and sensitive clinical and functional outcome measures, and blood and imaging biomarkers is necessary. Furthermore, additional symptoms such as muscle fatigability have been recognised but not investigated systematically yet. The lack of understanding muscle fatigability in CMYO in particular calls for a cross-sectional study as this feature may be a treatment target.
In collaboration with patient representatives, two studies have been designed: (1) a prospective cohort study with five 6-monthly visits over a 2-year period; and (2) a cross-sectional study on muscle fatigability. For both studies, patients from the same study population will be included. We aim to include 45 patients in study 1 and 75 in study 2. Patients are invited to participate in both studies. In study 1, we will perform a range of assessments covering patient-reported outcomes, clinical and functional outcome measures, and blood and imaging biomarkers. For study 2, we will assess the muscle fatigability and neuromuscular junction transmission. Baseline data will be analysed using descriptive statistics and correlation analysis. To assess disease progression, mixed models will be used. Multiple linear regressions will be used to explore the relationship between potential disease-modifying variables and disease severity.
This study was approved by the Central Committee on Research Involving Human Subjects (CCMO, registration number NL83069.000.23). Findings will be shared with the participating patients and the funder. It will be presented at conferences and shared through peer-reviewed publications.
To determine the prevalence and characteristics of urinary catheter blockage in older patients using objective indicators and to characterize obstructive materials and microbiota.
A cross-sectional study.
Patients aged ≥ 65 years with an indwelling catheter for ≥ 24 h were recruited from a long-term care hospital. Blockage was defined using objective indicators including residual urine volume, leakage, reinsertion urine volume and resistance to saline injection. Samples were analysed for composition and microbiota.
Among 77 patients, 29.9% experienced catheter blockage. Blockage was associated with shorter catheterization duration and greater intraluminal narrowing. Proteus mirabilis and Campylobacter ureolyticus were more abundant. Most blockages occurred at the catheter tip (81.0%), with struvite as the predominant material (71.4%). Microbiota varied by material composition.
Catheter blockage occurred in 29.9% of patients, mainly at the catheter tip and associated with struvite. Microbiota differed by blockage status and material composition.
Objective identification of catheter blockage supports early detection and targeted management and provides a basis for research on mechanisms. These findings provide a foundation for future research to develop and evaluate evidence-based nursing interventions for preventing catheter blockage in older adults.
This study addressed the lack of objective criteria and limited understanding of catheter blockage. It showed that about 30% of patients experienced blockage and identified distinct microbiota and material characteristics. These findings may improve catheter management and support future research on mechanisms and prevention.
STROBE checklist.
Patients contributed to data collection by providing information on symptoms related to catheter blockage through structured assessments, while nurses during the study period facilitated data collection and conducted clinical assessments.
To examine the association between nursing experience and paediatric adverse nursing event (ANE) harm risk, and whether SOP accessibility modifies this association.
Retrospective cohort study, 2015–2024.
We analysed paediatric ANEs reported from 2015 to 2024 at a tertiary children's hospital in western China. The primary outcome was whether an ANE resulted in harm (yes/no). The exposure was years of nursing experience, grouped into five categories (< 1, 1–< 3, 3–< 5, 5–< 10 and ≥ 10 years), and SOP accessibility served as an effect modifier. Multivariable logistic regression models and stratified analysis with interaction tests were applied.
Among the 3199 paediatric ANEs, 1341 (41.92%) resulted in harm. Harm risk was highest among nurses with ≥ 10 years of experience (adjusted OR = 1.93, 95% CI: 1.33–2.81 vs. < 1 year), with no significant elevation in the intermediate nurses (1–10 years). SOP accessibility modified this association (p for interaction = 0.004). When SOPs were accessible, the elevated risk in the ≥ 10-year group persisted (adjusted OR = 1.95, 95% CI: 1.33–2.87); when SOPs were inaccessible, it was no longer evident, and a protective association appeared in the 3–< 5-year group (adjusted OR = 0.15, 95% CI: 0.03–0.76).
Nursing experience exhibited nonlinear association with paediatric ANE harm risk, and this relationship was significantly modified by SOP accessibility. Harm risk was highest among nurses with ≥ 10 years of experience. However, given the retrospective observational design, causal inference is precluded, and the underlying mechanisms remain to be elucidated.
No patient or public contribution.
To examine longitudinal associations among maternal health literacy, psychological empowerment and health-promoting behaviours across pregnancy among rural pregnant women.
Prospective cohort study.
Between 1 May 2023 and 15 January 2024, 694 rural pregnant women were assessed at 12, 24 and 32 gestational weeks (T1, T2 and T3). Descriptive, correlation and cross-lagged panel analyses were used.
Significant reciprocal cross-lagged associations were observed among maternal health literacy, psychological empowerment and health-promoting behaviours across pregnancy. Maternal health literacy at T1 significantly predicted psychological empowerment at T2 (β = 0.183, B = 0.056, 95% CI [0.036, 0.075], p < 0.001), and psychological empowerment at T2 predicted health-promoting behaviours at T3 (β = 0.256, B = 0.373, 95% CI [0.246, 0.500], p < 0.001). Longitudinal indirect pathway analysis showed that maternal health literacy at T1 was indirectly associated with health-promoting behaviours at T3 through psychological empowerment at T2 (β = 0.047, B = 0.021, 95% CI [0.010, 0.031], p < 0.001).
Maternal health literacy, psychological empowerment, and health-promoting behaviours were longitudinally and reciprocally associated across pregnancy. Psychological empowerment also carried the longitudinal indirect association between earlier maternal health literacy and later health-promoting behaviours. Early gestation may represent an intervention window.
Integrating literacy-sensitive and empowerment-based interventions into antenatal care may help rural pregnant women support sustained health-promoting behaviours throughout pregnancy.
Clarifies the longitudinal role of maternal health literacy. Demonstrates a significant indirect longitudinal role of psychological empowerment. Supports early-stage capability-based interventions within rural maternal healthcare.
This study is consistent with the STROBE statement for cohort studies.
This study did not include patient or public involvement in its design, conduct or reporting.
This study explored the specific experiences of clinical nurses regarding micro-breaks during work intervals, aiming to provide a reference for nursing managers in building supportive work environments.
The study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. From September to November 2025, purposive sampling was used to select 12 clinical nurses from a large teaching hospital in Shanghai. Guided by the Conservation of Resources Theory, we employed a descriptive qualitative research design with semi-structured in-depth interviews. Data were analyzed using directed content analysis.
The experiences of clinical nurses regarding micro-breaks were summarized into three main themes and seven subthemes: (1) the diverse practical forms of micro-breaks (physical disengagement, cognitive detachment, and minimal replenishment); (2) the complex impacts of micro-breaks (potential social costs, potential psychological costs); and (3) the feasibility of micro-breaks in different work environments (department characteristics and work pace, organizational culture and leadership style).
Micro-breaks serve as a proactive self-regulation strategy for clinical nurses in high-intensity work environments. They provide not only a momentary physical pause but also an opportunity for psychological and emotional recovery, contributing to the maintenance of professional resilience. Nursing managers should recognize and respect this behavior, strengthen external environmental support, and aim to enhance nurses work well-being and overall quality of care.
This study did not include patient or public involvement in its design, conduct, or reporting.
Nurses in high-acuity settings face continuous resource depletion that can compromise both their well-being and patient safety. This study offers evidence-based insights into how clinical nurses spontaneously use micro-breaks as a proactive self-regulation strategy to restore personal and social resources. By identifying the diverse forms, dual impacts, and contextual determinants of micro-breaks, the findings provide actionable guidance for nursing managers and healthcare organizations to design psychologically supportive work environments. Recognizing and legitimizing micro-breaks as a legitimate recovery practice may serve as a low-threshold, low-cost intervention to mitigate burnout, sustain work engagement, and ultimately protect the quality and continuity of patient care.
Difficult peripheral intravenous cannulation affects a substantial proportion of hospitalized patients, yet factors associated with cannulation failure among cases assisted by a dedicated intravenous therapy team on general wards remain poorly characterized.
To identify patient-related, operator-related, and procedural factors independently associated with non-first-attempt success in peripheral intravenous cannulation performed by an intravenous therapy team on general medical and surgical wards.
Prospective observational study and secondary analysis of prospectively collected clinical data.
Cannulation events recorded by an intravenous therapy team over a 1-year period were analysed. The primary outcome was non-first-attempt success, defined as requiring two or more insertion attempts. A generalized linear mixed model accounted for repeated events within hospitalizations. Three sensitivity analyses assessed robustness.
Approximately one in five events required two or more attempts. Five factors were independently associated with non-first-attempt success: lower nurse experience, reduced patient mobility, smaller catheter gauge, replacement prompted by difficult access, and lower-limb or trunk insertion sites. Patient age, sex, comorbidity burden, and body mass index were not independently associated. Findings were robust across all sensitivity analyses.
Nurse experience, catheter gauge, and insertion site are modifiable factors associated with first-attempt success. Patient mobility emerged as a novel, easily assessable risk indicator.
Findings can inform intravenous therapy team training priorities, catheter gauge and insertion-site selection protocols, and prospective bedside risk screening to reduce repeated cannulation attempts.
This study clarified which factors drive cannulation failure on general wards, identifying five independently associated factors—three of them modifiable—and highlighting patient mobility as a novel indicator relevant to intravenous therapy teams, ward nurses, and hospitalized adults internationally.
This study adhered to the STROBE reporting guideline for observational studies.
No patient or public contribution.
by Hongyi Chen, Danyu Xu, Wenjing Wang, Xinyin Luo, Xiaocong Jiang, Ningyi Wan, Yuhuan Wei, Ting Wang, Li Zhang, Xuemei Li, Xinyu Zhou
BackgroundMajor depressive disorder (MDD) is highly prevalent in adolescents, and a substantial proportion of patients show inadequate response or limited tolerability to first-line treatments such as selective serotonin reuptake inhibitors and cognitive behavioral therapy, highlighting the need for additional treatment options. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in adults with depression, but evidence in adolescents remains limited. Resting-state functional connectivity MRI (rs-fcMRI) may provide a circuit-informed approach for individualizing rTMS target selection within the dorsolateral prefrontal cortex (DLPFC) based on its functional connectivity with the subgenual anterior cingulate cortex (sgACC).
MethodsThis is a randomized, double-blind, three-arm, sham-controlled pilot trial. Forty-five adolescents with MDD will be assigned in a 1:1:1 ratio to conventional left DLPFC-targeted rTMS, rs-fcMRI-guided rTMS targeting the individualized DLPFC site showing the strongest negative connectivity with the sgACC, or sham stimulation. Treatment will be delivered over 4 weeks. Primary outcomes will include recruitment feasibility, intervention adherence, 6-month retention, preliminary clinical efficacy, and safety, assessed by enrollment, completion of 20 treatment sessions, completion of 6-month follow-up, CDRS-R-based response and remission, and adverse events/serious adverse events. Secondary outcomes will include depressive and anxiety symptoms, suicidality, sleep quality, global clinical status and improvement, rumination, and pediatric health-related quality of life.
DiscussionThis pilot trial will provide preliminary evidence regarding the feasibility, acceptability, safety, and early clinical efficacy signals of rs-fcMRI-guided rTMS in adolescents with MDD. By comparing individualized circuit-informed targeting with conventional left DLPFC stimulation and sham stimulation, the study may help clarify whether this imaging-guided neuromodulation approach is practicable and clinically informative in this population. The findings are expected to support refinement of study procedures, outcome selection, and trial design for a future fully powered randomized controlled trial.Trial registration: ClinicalTrials.gov NCT07185438.
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