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To explore the network characteristics of symptom clusters in people with type 2 diabetes mellitus through network analysis, identify the core and bridging symptoms within the symptom network, and provide a foundation for targeted interventions and symptom management in people with T2DM.
A cross-sectional survey.
A total of 360 people with T2DM who were hospitalised in the endocrinology departments of two hospitals with Grade A in Daqing City between August 2024 and February 2025 were selected using a convenience sampling method. The symptoms of people with T2DM were measured using the Chinese version of the Diabetes Symptom Checklist-Revised (DSC-R). Symptom clusters were identified through factor analysis, and network analysis was used to identify core and bridging symptoms. This research adhered to the STROBE guidelines.
Six symptom clusters were obtained from factor analysis, which were psychological-behavioural symptom cluster, ophthalmological-neuropathy symptom cluster, cardiovascular symptom cluster, metabolic symptom cluster, body symptom cluster and nephrotic symptom cluster. Symptom network analysis revealed that ‘Deteriorating vision’ exhibited the highest strength centrality and expected influence. The top three symptoms with the highest bridge strength and bridge expected influence were ‘Aching calves when walking’, ‘Queer feeling in the legs or feet’ and ‘Sleepiness or drowsiness’.
People with T2DM commonly exhibit a range of symptoms. ‘Deteriorating vision’ is the most core symptom in people with T2DM. ‘Aching calves when walking’, ‘Queer feeling in the legs or feet’ and ‘Sleepiness or drowsiness’ are identified as the bridging symptoms in the network analysis. Healthcare professionals can design targeted interventions based on symptom clusters, core symptoms and bridging symptoms, thereby improving the efficiency of symptom management and optimising outcomes for people with T2DM.
No patient or public contribution.
This study aimed to develop and validate a standardised transitional care programme for postoperative gynaecologic cancer patients utilising the Omaha system framework.
A preliminary transitional care programme was constructed through literature review, semi-structured interviews and multidisciplinary team discussions. The programme was refined via two rounds of Delphi expert consultations involving 17 oncology nursing specialists. Consensus criteria included expert authority coefficient (Cr), Kendall's W test and coefficient of variation (CV).
The Delphi consultation demonstrated robust expert consensus, with high authority coefficients (Cr: 0.886 in Round 1; 0.906 in Round 2), exceptional participation rates (88.2% and 100% response rates across two rounds) and statistically significant concordance as evidenced by Kendall's W values (0.233–0.358 and 0.326–0.383; all p < 0.01). All coefficients of variation (CV) metrics fell within acceptable ranges (0.09–0.42 in the initial phase; 0.08–0.27 post-refinement).
The Omaha system-based transitional care programme exhibits strong expert consensus, scientific rigour and clinical applicability, providing a structured approach to improving postoperative recovery in gynaecologic cancer patients.
This protocol standardises postoperative care transitions for gynaecologic oncology patients by integrating multidimensional assessments (physiological, psychosocial and health behaviour domains) and family-centred education. Clinicians can utilise its evidence-based framework to reduce preventable complications, enhance caregiver preparedness and improve continuity of care between hospital and home settings.
Six postoperative gynaecologic cancer patients and eight family caregivers participated in semi-structured interviews to identify unmet transitional care needs. Their insights informed the design of intervention components, including self-management education and psychosocial support strategies. Patients reviewed draft materials for clarity and cultural appropriateness during Delphi Round 2.
by Tyler Marshall, Karin Olson, Adam Abba-Aji, Xin-Min Li, Richard Lewanczuk, Sunita Vohra
BackgroundShared decision-making (SDM) is a process in which healthcare providers (HCPs) and patients make health-related decisions collaboratively, guided by the best available evidence. Previous research suggests that emerging adults (aged 18–29) with mental health concerns might prefer SDM over traditional approaches; however, it remains unclear whether prevalent symptoms of anxiety, depression, or health-related quality of life (HRQL) are associated with the level of SDM that occurs during a clinical encounter.
ObjectiveThis study explored whether prevalent symptoms of anxiety, depression or HRQL among emerging adults were associated with the perceived level of SDM involvement during a single clinic visit at a primary care or community addiction and mental health (AMH) setting.
MethodsA cross-sectional survey was conducted using a subset of data (emerging adults and their HCPs) obtained from an overarching study on SDM in adults (18–64 years) in Alberta, Canada. Sociodemographic data were collected and reported descriptively. SDM was the primary outcome variable and was measured dyadically (i.e., the mean score between HCPs and patients) using the Alberta Shared Decision-Making Instrument (ASK-MI). Symptoms of patient anxiety/depression and HRQL were measured using the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D-5L. Pearson R correlation matrices were conducted to explore relationships between SDM, anxiety/depression, HRQL, and demographic variables.
ResultsForty-two emerging adult patients and 31 HCP dyads were recruited from six community AMH settings and eight primary care settings. The mean SDM dyad rating was 8.69 (SD, ± 2.01), indicating an “excellent” level of SDM. Symptoms of anxiety, depression, and HRQL were not significantly correlated with SDM dyad ratings during the clinic visit. Post hoc analyses showed that patient age was inversely related to SDM dyad ratings; R = −0.34, p = 0.03.
DiscussionIn this study, emerging adults reported high levels of perceived engagement in SDM, regardless of their HRQL or symptoms of anxiety and depression. However, several limitations, such as the risk of performance bias, should be considered when interpreting these findings. To strengthen the evidence base, future research should aim to address these limitations.
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