Conectar
by Haojie Wang, Mengxiang Li, Xiaomeng Liang, Weijian Wang, Pengren Luo, Jiaji Zhang, Yuxuan Du, Tan Liu, Boyu Zhang, Xu Wang, Zhefeng Jin, Yilin Zhu, Tao Han
Background & objectivePrevious biomechanical studies on pediatric flexible flatfoot have treated the subject as a single analytical unit, thus failing to elucidate mechanical transmission within the lower extremity closed kinetic chain. This study investigates the impact of distal arch collapse on macroscopic gait parameters, static joint alignment, and dynamic kinematic deviation by integrating a dual-level analytical strategy at both the subject and individual limb levels.
Methods153 children with pediatric flexible flatfoot (25 unilateral, 128 bilateral) were included, and 3D gait data from 306 lower extremities were analyzed. At the subject level, macroscopic spatiotemporal parameters were compared using the Mann-Whitney U test. At the limb level, linear mixed-effects models (LMMs) compared static 3D joint angles and Gait Variable Scores (GVS) between normal feet and flatfeet, treating subject as a random effect and adjusting for age, body mass index (BMI), and unilateral leg length.
ResultsAt both the subject and limb levels, no significant between-group differences were observed in any core spatiotemporal parameters (e.g., Mean Velocity, Frequency, and Step Width) (P > 0.05). Regarding static joint alignment at the limb level, the static Hip Rotation angle on the flatfoot side exhibited significantly less external rotation (i.e., relative internal rotation) compared to the normal side (−2.11° ± 0.67° vs. −5.79° ± 1.79°, P = 0.043). During dynamic walking, the Hip Abduction/Adduction GVS on the flatfoot side was significantly elevated (P = 0.032). However, comprehensive gait indices, including the GDI and GPS, showed no significant overall between-group differences.
ConclusionPediatric flexible flatfoot was associated with subtle proximal biomechanical alterations despite preserved macroscopic gait characteristics. Changes in static hip alignment and dynamic frontal-plane hip kinematics may therefore provide complementary information beyond conventional gait measures, supporting a broader kinetic-chain assessment in clinical evaluation and follow-up.
Single-arm trials (SATs) with objective performance criteria (OPCs) or performance goals (PGs) are increasingly used for regulatory approval of medical devices and other interventions. However, the comparability of study design characteristics between SAT and their external comparator sources remains unclear. This scoping review aimed to evaluate the comparability of study design characteristics between SATs and their matched OPC/PG sources.
Scoping review.
PubMed, Embase, the Cochrane Library and four Chinese databases—China National Knowledge Infrastructure, Wanfang Data, CQVIP and SinoMed—were searched from inception to 30 April 2026.
We included SATs that used one or more OPCs or PGs as external comparators to evaluate safety and/or effectiveness endpoints and reported specific numerical values of OPCs or PGs.
Two reviewers independently screened the retrieved records and extracted data using a standardised form. For each included SAT, we retrieved the cited OPC/PG sources and extracted study design characteristics data (age, sex, health conditions, outcome definitions and measurement time points) for comparison. Age and sex were compared using summary t-tests and ² tests; health conditions were assessed by two clinicians based on eligibility criteria and baseline characteristics. Results were stratified by OPC versus PG.
A total of 1243 records were identified, and 133 SATs were included. Most studies used PGs (84, 63.2%); 34 (25.6%) claimed to use OPCs, and 15 (11.3%) could not be classified. Of the 60 age comparisons available from 41 studies, 30 showed statistically significant differences; of the 82 sex comparisons available from 59 studies, 60 showed significant differences. Health conditions, outcome definitions and time points were assessed descriptively in a subset of studies, and discrepancies were also observed.
Suboptimal comparability of study design characteristics was observed between SATs and their OPC/PG sources, which might influence the treatment effect estimates. Greater attention to the comparability of study design characteristics in SATs with OPC/PGs may improve the validity of evidence.
by Yuta Nemoto, Fumie Otsuka, Shihoko Suzuki, Saori Kataoka, Tomoko Nakanishi, Takuya Ueda, Susumu Ogawa, Sumika Karasawa, Mikiko Shimaoka, Hiroto Narimatsu, Ung-il Chung
BackgroundEsports (competitive and organised video gaming) may enhance physical and cognitive health in older adults. The aim of this study was to examine the feasibility and effects of a multicomponent program incorporating esports on physical and cognitive function in community-dwelling older adults.
MethodsThis parallel, non-randomised controlled trial was conducted in Yokosuka, Kanagawa, Japan. Twenty-six participants who 1) were aged 60 years or older, 2) had no cognitive impairment, 3) had no major health problems, and 4) had no prior experience with digital games were allocated to either the intervention (n = 12) or the control (n = 14) group. Participants in the intervention group attended weekly 90-minute sessions consisting of health education, exercise, and esports for 12 weeks. The feasibility of the program was assessed based on adverse events, participant retention, adherence to the program, engagement in digital games outside the program, enjoyment of the program, and willingness to continue playing esports after the study period. Additionally, psychological status, physical and cognitive function, and body composition were assessed.
ResultsNo adverse events were reported; 10 of the 12 participants attended ≥80% of the sessions, all participants reported enjoying the program, and no participants dropped out during follow-up. Positive psychological status scores increased from before to after each session among participants in the intervention group. Furthermore, adjusted analyses showed more favourable changes in gait speed and balance in the intervention group than in the control group (p < 0.05). However, the effects on physical function remain uncertain because the analyses were exploratory.
ConclusionsThe program showed potential for high retention and adherence among older adults, with no adverse events. Larger-scale trials are needed to confirm the effectiveness of this intervention program, as the analyses in this study were exploratory.
Trial registrationThe study protocol was registered with the UMIN-CTR (ID: UMIN000055350; date of first registration: 27 August 2024).
Diabetic neuropathy is one of the most common and disabling complications of diabetes mellitus. Current management strategies are largely limited to glycaemic control and symptomatic relief, and few therapies have demonstrated definitive disease-modifying effects. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown multiple metabolic and vascular benefits. However, the efficacy and safety of SGLT2 inhibitors as adjunctive therapy for diabetic neuropathy have not yet been systematically evaluated. This protocol aims to describe the methodology for a systematic review and meta-analysis that will comprehensively assess the therapeutic value of SGLT2 inhibitors in diabetic neuropathy.
A systematic search will be conducted in PubMed, Embase, Cochrane Library and Web of Science, as well as in clinical trial registries including the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov, from database inception to 31 May 2026. Eligible studies will include randomised controlled trials evaluating SGLT2 inhibitors in combination with conventional therapy in patients with diabetic neuropathy. Two reviewers will independently perform study selection, data extraction and methodological quality assessment. Extracted data will include study characteristics, participant demographics, intervention details, outcome measures and adverse events. Risk of bias will be assessed using the Cochrane Risk of Bias 2 tool. Quantitative synthesis will be conducted using meta-analytic methods, with the choice of statistical model determined by the degree of heterogeneity, as assessed by Cochran’s Q test and the I² statistic. Where appropriate, meta-regression, subgroup analyses, sensitivity analyses and trial sequential analysis will be performed. Publication bias will be assessed using funnel plots and Egger’s regression test, and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.
Ethical approval is not required because this study will involve only the analysis of published data. The findings will be disseminated through publication in a peer-reviewed journal.
CRD420261389933.
The DEVT and DIRECT-MT trials showed that endovascular thrombectomy (EVT) alone is non-inferior to intravenous thrombolysis (IVT) followed by EVT in achieving 90-day functional independence for stroke patients with large-vessel occlusion (LVO). However, it is unclear whether EVT alone is non-inferior to IVT followed by EVT among patients with acute basilar artery occlusion (BAO). Therefore, additional studies are needed to explore the potential benefits of EVT alone in these patients.
The ATTENTION IV trial is a prospective, multicentre, non-inferiority, blinded endpoint assessment, randomised controlled clinical trial to assess the effect of EVT alone compared with IVT plus EVT in acute BAO patients within 4.5 hours of symptom onset. Patients will be randomised in a 1:1 ratio to either the EVT-alone group or the IVT-plus-EVT group. A score of 0–2 on the 90-day modified Rankin Scale (mRS) was designated as the primary outcome for this study. Primary analysis will follow the intention-to-treat principle with a 15% non-inferiority margin. Secondary outcomes encompass functional status (mRS shift, excellent/good/fair outcomes), quality of life, early neurological recovery and radiological outcomes alongside safety endpoints of intracerebral haemorrhage and mortality.
This study has been approved by the Ethics Committee of the First Affiliated Hospital of the University of Science and Technology of China (2023KY-055) and will be conducted following the Declaration of Helsinki. Study results will be published in peer-reviewed academic journals.
ClinicalTrials.gov (NCT05827042).
by Hongxiao Lv, Xinyu Yang, Yutong Liu, Junwei Zhou, Wentao Yu
BackgroundTanshinone IIA (TSA) is the core liposoluble active component of Salvia miltiorrhiza, a traditional Chinese medicine, and exhibits multiple pharmacological activities including anti-inflammation, anti-oxidation, anti-apoptosis and mitochondrial function improvement. Studies have confirmed that TSA can ameliorate cognitive function in rats with vascular dementia (VaD) by alleviating cerebral ischemic injury, inhibiting neuroinflammation, protecting the blood-brain barrier and other pathways. However, it has not been reported whether TSA exerts its neuroprotective effect by regulating the cuproptosis pathway. Focusing on cuproptosis, this study investigated the effects of TSA on cognitive impairment, neuronal injury and cuproptosis-related mechanisms in a rat model of VaD.
MethodsA rat model of VaD was established by permanent bilateral common carotid artery ligation (2-VO), and the model rats were treated with TSA. The cognitive impairment of VaD rats was evaluated by the Morris water maze test. Hematoxylin-eosin (HE) staining and Nissl staining were used to detect neuronal injury and loss in the hippocampus of VaD rats. Transmission electron microscopy (TEM) was performed to observe the ultrastructure of mitochondria in the hippocampus; Western blot (WB) assay was adopted to detect the expression levels of cuproptosis-related proteins, including solute carrier family 31 member 1 (SLC31A1), ferredoxin 1 (FDX1), lipoic acid synthetase (LIAS) and dihydrolipoamide transacetylase (DLAT).In vitro, an oxygen-glucose deprivation/reoxygenation (OGD/R) model was established in HT-22 cells to evaluate the effects of TSA on cell viability (CCK-8), intracellular reactive oxygen species (ROS) levels, and copper accumulation (Coppersensor-1 staining), further validating the involvement of copper homeostasis in TSA-mediated neuroprotection.
ResultsThe results revealed that TSA markedly alleviated cognitive dysfunction and neuronal damage in VaD rats. It also reversed the cuproptosis-related abnormal changes in the brain of VaD rats, and modulated the expression of SLC31A1/FDX1 pathway proteins. In vitro, TSA protected HT-22 cells from OGD/R-induced injury by reducing oxidative stress and copper accumulation.These changes were associated with amelioration of copper overload and mitochondrial damage, suggesting that TSA may exert neuroprotection partially through the regulation of cuproptosis-related pathways.
ConclusionTSA effectively alleviated cognitive impairment and neuronal injury in VaD rats, and exerted neuroprotective effects both in vivo and in vitro by attenuating copper-dependent cytotoxic stress, preserving mitochondrial integrity, and modulating the SLC31A1/FDX1 axis. This study provides a new perspective and theoretical basis for the future development of targeted drugs for VaD.
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.
Patients undergoing orotracheal intubation (OTI) are prone to oral mucosal pressure injuries (OMPI), yet clinical recognition and prevention remain insufficient. The knowledge, attitudes and practices (KAP) of ICU nurses regarding OMPI prevention are unclear, particularly in multicentre settings.
To assess ICU nurses' KAP on OMPI prevention in Western China, identify gaps, and inform targeted training and practices.
Cross-sectional survey.
A multicentre cross-sectional survey used convenience sampling. ICU nurses completed a 36-item KAP-OMPI questionnaire online. Data were analysed using R 4.3.3 and Zstats 1.0. Cronbach's α assessed internal consistency. Group comparisons used chi-square, Mann–Whitney U or Kruskal–Wallis tests (α = 0.05). Multivariate linear regression and mediation analysis (1000 bootstraps) tested the KAP pathway.
A total of 667 questionnaires were returned from ICU nurses in 48 hospitals. Median total KAP-OMPI score was 136. Knowledge scored 30, attitude 40 and practice 64. Univariate analysis showed that education, professional title, age, years of experience, prior OMPI care, training and active literature learning were significantly associated with all scores (all p < 0.05). Multivariate regression identified lack of training, no prior OMPI care and no active literature learning as independent predictors of lower total, knowledge and practice scores (all p < 0.05). Mediation analysis showed attitude partially mediated the knowledge–practice relationship (indirect effect 0.294), accounting for 31.35% of the total effect.
ICU nurses showed positive attitudes and moderate-to-high practices, but knowledge, assessment and evidence-based learning gaps persist. We recommend targeted training on staging and standardized protocols to improve OMPI prevention and reduce OTI-related complications.
Leveraging these findings, OMPI staging training and standardized protocols should be implemented to bridge the KAP gap and reduce intubation-related OMPI.
No patient or public involvement; data from anonymous nurse surveys only.
Chinese Clinical Trial Registry: ChiCTR2500112798 (Date: November 19, 2025)
To propose an ethical decision-making framework for artificial intelligence (AI) involvement in person-centred fundamental care, organised around the relational dependency of care activities and grounded in the Fundamentals of Care Framework and the Caring Life Course Theory.
Discursive paper integrating care ethics, the Fundamentals of Care Framework, the Caring Life Course Theory, person-centred care theory and technology ethics scholarship.
Peer-reviewed literature (primarily 2006–2026, plus seminal earlier care-ethics works) from nursing, bioethics, technology ethics and health informatics was searched across CINAHL Complete, PubMed, PsycINFO and Scopus. Policy documents from the World Health Organisation (WHO), the International Council of Nurses (ICN) and the European Union (EU) were also reviewed.
The Relational Care–Artificial Intelligence Alignment (RCAA) framework operates within the three established dimensions of the Fundamentals of Care Framework (relationship, integration of care and context) and classifies fundamental care activities by relational dependency into three zones: Zone 1 (high dependency), where AI serves as background support; Zone 2 (moderate dependency), where collaborative human–AI partnership is appropriate; and Zone 3 (low dependency), where autonomous AI operation under human oversight is acceptable. Five ethical principles guide zone placement: relational autonomy, non-maleficence of depersonalisation, universal access to person-centred fundamental care, transparency and explicability and proportionality. Each is grounded in established care ethics, bioethics or AI governance traditions. Establishing the nurse–patient relationship and eliciting patient preferences sit at the entry point of the framework.
The framework offers a structured approach for determining where AI can participate in fundamental care while preserving the relational essence of nursing. It is offered as a heuristic to facilitate discussion and action across clinical, educational and policy settings.
The framework can inform institutional AI adoption policies, guide nursing curricula and support regulatory standards for technology deployment in care.
What problem did the study address? The absence of a systematic ethical framework, anchored in established person-centred fundamental care theory, for determining appropriate boundaries of artificial intelligence involvement in fundamental nursing care. What were the main findings? A relational dependency-based classification, situated within the Fundamentals of Care Framework, can guide artificial intelligence involvement through three zones of human–machine collaboration while preserving patient choice and the centrality of the nurse–patient relationship. Where and on whom will the research have an impact? Nurses, healthcare organisations, policymakers and technology developers working through artificial intelligence integration into person-centred care.
This study did not include patient or public involvement in its design, conduct or reporting. We acknowledge this as a limitation and discuss it explicitly in the Strengths and Limitations section.
Opioid-induced nausea and vomiting (OINV) in patients with cancer imposes a substantial clinical burden and may compromise adherence to opioid therapy. Naldemedine, a peripheral μ-opioid receptor antagonist, is currently approved for the treatment of opioid-induced constipation. Recent evidence suggests similar benefits for the treatment of OINV. This study aims to evaluate the preventive effect of naldemedine on OINV in patients with cancer pain initiating opioid analgesics.
This multicentre, double-blind, randomised, placebo-controlled, parallel-group comparison trial will be conducted across 20 hospitals and clinics in Japan. An estimated 120 patients with cancer scheduled to initiate opioid analgesic therapy will be recruited and randomly assigned (1:1) to receive either naldemedine or placebo on day 1 (visit 1). From days 1 to 7, patients will receive blinded study medication concurrently with opioid analgesics and will be followed for 8 days. The primary endpoint will be the proportion of patients achieving a complete response (CR) on day 5, defined as no vomiting and no use of rescue antiemetics for up to 120 hours after initiation of opioid analgesics. Key secondary endpoints will include the proportion of patients achieving CR on days 1, 2, 3 and 7; changes in Numerical Rating Scale scores from baseline; duration of nausea; proportion of patients who experience vomiting; proportion of patients using rescue antiemetics and frequency of rescue antiemetic use. Additionally, the incidence of adverse events and serious adverse events will be recorded throughout the observation period.
This study has been reviewed and approved by the Hattori Clinic Certified Review Board (approval number: CRB3180027). Written informed consent will be obtained from all participating patients before study commencement. The results of the study will be presented at academic conferences in Japan or overseas and submitted for publication in a peer-reviewed journal.
NCT07038551 and jRCTs031250128.
To synthesize evidence on continuous bedside pressure mapping for pressure injury prevention in adult hospital and long-term care settings and its impact on staff and family members.
Mixed-methods systematic review following the Joanna Briggs Institute convergent segregated approach.
Double screening, standardized data extraction and quality appraisal were performed. Quantitative findings were synthesized using meta-analysis where appropriate or summarized without pooling, and qualitative findings were synthesized thematically, followed by integrated synthesis. The review was registered with PROSPERO (CRD42024537519).
PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, CNKI, Wanfang Data and VIP were searched from inception to September 20, 2025. Manual checking of relevant sources, including citation and reference checking, was also conducted.
Eighteen studies were included. Observational cohort studies suggested lower pressure injury incidence in selected high-risk settings, but randomized trials showed no significant overall preventive effect. An exploratory interface pressure meta-analysis showed a borderline reduction with substantial heterogeneity and was not robust to sensitivity analysis. The technology was associated with process improvements in the timeliness of repositioning, staff knowledge, patient awareness and acceptability. Barriers included cost, technical concerns, workflow disruption and limited economic evidence.
Continuous bedside pressure mapping may support pressure injury prevention as a workflow-integrated decision-support tool, but evidence of clinical effectiveness remains limited and context-dependent. Implementation should include staff training, protocolized repositioning, patient and family communication and evaluation of care processes, clinical outcomes, workload and costs. High-quality randomized trials with standardized protocols and economic evaluations are needed.
Nurses should use continuous bedside pressure mapping as an adjunct to clinical judgement and established protocols, rather than as a stand-alone intervention. Adoption should include staff training, agreed repositioning protocols and alert thresholds, patient and family explanation and monitoring of care processes, workload, outcomes and costs.
This systematic review adhered to the PRISMA 2020 reporting guideline.
No patient or public contribution.
To retrieve, evaluate, and summarize the evidence related to nutritional risk screening and assessment in adult critically ill patients, providing an evidence-based decision-making reference for clinical healthcare professionals.
This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing.
According to the ‘6S’ model of evidence resources, evidence on nutritional risk screening and assessment in adult critically ill patients was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus, and systematic evaluations.
Up to date, BMJ Best Practice, Cochrane Library, Joanna Briggs Institute (JBI), Embase, PubMed, WanFang Medical, China Biomedical Literature Database, CNKI, and relevant professional society websites including the National Institute for Health and Care Excellence (NICE), GIlN, the National Guideline Clearinghouse, and Yi Maitong were searched from the establishment of these databases to Dec. 2024.
Eleven literature sources were included, comprising 8 guidelines, 2 expert consensuses, and 1 evidence summary. Through rigorous synthesis, 18 best practice recommendations were distilled across eight critical domains: multidisciplinary team formation, screening targets, screening timing, screening instruments, screening frequency, assessment targets, assessment core parameters, and assessment frequency.
This study summarizes the current best evidence regarding nutritional risk screening and assessment in adult critically ill patients, providing optimal evidence support for standardizing nutritional risk screening and assessment in this population. In clinical practice, it is essential to select the best evidence for localized and individualized application while continuously updating the evidence to standardize nursing practice.
Clinical medical staff are encouraged to use evidence-based recommendations for the screening and assessment of nutritional risks in adult critically ill patients. By implementing these best evidence practices, healthcare professionals can enhance patient care and improve clinical outcomes, ensuring that nutritional needs are effectively addressed.
The effective screening and assessment of nutritional risk in critically ill patients are crucial for optimizing patient outcomes. This study summarizes 18 pieces of best evidence concerning nutritional risk screening and assessment, highlighting their importance in clinical practice. Implementing these recommendations can enhance the quality of nutritional care, reduce complications, and ensure that patients receive appropriate nutritional interventions tailored to their needs. By focusing on these best practices, healthcare providers can significantly improve the management of nutrition in critically ill patients.
This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.
The registration number is ‘ES20221368’
Sleep problems are common among primary care nurses and are closely associated with psychological stress and maladaptive cognitive processing. Understanding the complex interplay among these psychological factors is critical for improving health outcomes and care quality.
This study aimed to examine the relationships between perceived stress, rumination (both positive and negative), and sleep quality in primary care nurses using a network analysis approach.
A cross-sectional study was conducted among 316 primary care nurses in public primary healthcare institutions in Shapingba District, Chongqing, China. Participants completed standardized self-report measures assessing perceived stress, rumination tendencies, and sleep quality. Network analysis was used to model the associations between these variables and to identify the most influential components.
Approximately 64.6% of participants reported poor sleep quality. Network analysis revealed that sleep latency and perceived tension were the most central nodes within the network. Sense of tension and enjoy happiness showed the highest bridge strength, indicating their roles in connecting different psychological domains. Negative rumination—particularly suppression of positive emotions and negative attribution—showed strong links to sleep-related variables, suggesting its importance in the network structure.
Perceived stress and negative rumination were closely related to sleep problems among primary care nurses. The findings suggest that stress reduction and cognitive-emotional interventions targeting maladaptive rumination may be effective strategies to improve sleep quality and overall well-being in this population.
No patient or public contribution.
by Taotao Peng, Yu Li, Yukun Ren, Mi Yang, Zonghong Long, Dukun Zuo, Lu Huang, Huawei Liu, Zhenxin Duan, Hong Li
Pulmonary complications in non-pulmonary sepsis (PC-NPS) are the leading cause of morbidity and mortality in the intensive care unit. Early prevention and monitoring are paramount since the prevention strategies remain limited yet. Magnesium, an essential electrolyte involved in inflammation and vascular regulation, may influence the development of such complications. This retrospective cohort study used data from the MIMIC-IV database to explore the relationship between baseline serum magnesium levels and PC-NPS among 4,836 patients with non-pulmonary sepsis. Survival analysis demonstrated that patients who developed PC-NPS had significantly higher 90-day mortality compared with those without lung injury. When stratified by baseline serum magnesium quartiles, patients in the highest quartile (>2.1 mg/dL) showed the poorest survival. Multivariable logistic regression confirmed that elevated magnesium was independently associated with increased risk of PC-NPS, and restricted cubic spline modeling revealed a U-shaped, nonlinear association between baseline magnesium concentration and PC-NPS risk. Inflection points at 1.26 and 1.91 mg/dL identified a range of relatively lower risk. These findings suggest that baseline serum magnesium levels exhibit a U-shaped relationship with the risk of PC-NPS. Evaluating these levels may aid in clinical prognostication and the exploration of underlying mechanisms.To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual.
Systematic review and meta-analysis.
Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined.
A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025.
A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n = 5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence.
This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships.
These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce.
This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
The research protocol was registered with PROSPERO (CRD420251027354).
by Xiaodong Zhang, Lan Zou, Dunfu Zhang, Bangtao Yao, Junge Chen, Tianfeng Wei, Zhouping Fu, Xin Chang, Lijuan Chen, Yan Geng
BackgroundForearm radial artery occlusion (RAO) is a common complication after transradial coronary procedures. Traditional patent hemostasis, relying on operator-dependent assessment, results in labor-intensive processes and inconsistent RAO rates.
MethodsThis is a single-center, prospective, randomized, open-label, parallel-group superiority trial. We plan to enroll 818 patients scheduled for transradial coronary angiography. Participants will be randomly assigned (1:1) to either a novel balloon pressure monitoring system (integrating high-precision digital manometry with physiologically-phased decompression) or traditional patent hemostasis. The primary outcome is the incidence of ultrasound-confirmed forearm RAO at 24 hours post-procedure. Key secondary outcomes include rates of access-site vascular complications and bleeding events, as well as objective metrics of hemostasis efficiency. Recruitment Status: Recruitment commenced in September 2024 and is ongoing; the target sample size is anticipated to be reached by May 2026. Analysis will follow the intention-to-treat principle.
Results/ Trial StatusAs a protocol paper, no results are reported. The trial is currently in the recruitment phase.
ConclusionsThis trial will provide the first large-scale randomized evidence on whether digital manometry-guided compression reduces RAO, potentially bridging the efficacy-effectiveness gap between optimized research protocols and routine practice.
Trial registrationThe trial was registered with the Chinese Clinical Trial Registry (ChiCTR) in August 2024, under the registration number ChiCTR2400088258.
To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.
Explanatory sequential mixed-methods design.
In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023–April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.
Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.
Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs.
Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.
This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management.
This study adheres to the Good Reporting of A Mixed Methods Study checklist.
None.
The rising prevalence of cognitive impairment has made it a critical public health priority. Nurses are central to chronic disease management, yet the efficacy of the interventions in older adults with cognitive disorders remains uncertain.
To evaluate the efficacy of nurse-led interventions in older adults with cognitive disorders.
A comprehensive search was conducted across seven electronic databases from their inception to August 2025. This meta-analysis focused on nurse-led interventions. The primary outcome was cognitive function, and secondary outcomes included depressive symptoms and quality of life. Due to the heterogeneity of the studies, we employed a random effects model for the meta-analysis.
The results indicated that nurse-led interventions significantly improved cognition (SMD = 0.64; 95% CI, 0.39–0.88; p < 0.05), substantially alleviated depressive symptoms (SMD = −0.32; 95% CI, −0.53–0.11; p < 0.05) and enhanced quality of life (QoL) (SMD = 0.40; 95% CI, 0.17–0.64; p < 0.05).
The results of this study indicate that nurse-led interventions are highly beneficial for elderly individuals with mild cognitive impairment (MCI) or dementia. In future research, it is necessary to comprehensively consider the roles that nurses undertake. They should play an active role in the recovery from chronic diseases. These findings provide an important basis for policymakers and clinicians.
PROSPERO Registration number: CRD42024619016
Adequate self-management support following percutaneous coronary intervention (PCI) remains a recognised challenge. This study evaluated the Integrated Psychocardiology Transitional Care (IPTC) programme’s effect on self-management and quality of life, and the mechanism of their interaction.
Retrospective cohort study.
Outcomes were analysed for 697 patients after propensity score matching from an initial PCI registry cohort of 1148.
The primary outcome was change in Coronary Artery Disease Self-Management Scale Score over 12 months. Secondary outcomes included the Seattle Angina Questionnaire (SAQ), 36-Item Short Form Health Survey (SF-36), Generalised Anxiety Disorder 7 and Patient Health Questionnaire 9 scores. Mixed-effects models and time-lagged mediation analysis were used to examine longitudinal changes and the mediating role of self-management.
No between-group difference in self-management was observed at 1 month. Significant differences in self-management emerged at 3 months, 6 months and 12 months (all px time interaction effects (F=183.1, p
The IPTC programme is associated with improved quality of life in PCI patients, and this association appears to be partly explained by enhanced self-management. These findings suggest that integrating psychology-informed transitional care into post-PCI care may be beneficial.
by Hongtao Li, Li Xu, Longxin An, Xiaojing Li, Linjing Zhang, Jun Liu, Kaili Zhai, Xuecheng Sun, Naibo Feng
PurposeTo evaluate whether posterior column screws penetrate the posterior cortical surface of the acetabulum when assessed using obturator oblique radiographic imaging.
MethodsComputed tomography (CT) scans were performed on the right acetabulum of 50 healthy adults to measure the angle (α) between the posterior wall of the acetabulum and the sagittal plane at the level of the femoral head’s maximal diameter. In addition, five cadaveric pelvises were subjected to C-arm fluoroscopic imaging. A 6 cm long, 1.5 mm Kirschner wire was positioned along the posterior surface of the acetabular posterior column, aligned with the greater sciatic notch, and imaged in both the 45° and α-degree obturator oblique views. The radiographic line visualized from the Kirschner wire in the obturator oblique view was defined as the posterior iliac line, and its anatomical relationship with the posterior surface of the posterior column was analyzed. Subsequently, a 2.5 mm Kirschner wire was inserted into the posterior column at the standard entry point for screw placement using an electric drill, with the wire tip intentionally positioned between the posterior iliac line and the posterior rim in the 45° obturator oblique view. The trajectory of the wire was assessed under both 45° and α-degree obturator oblique views to determine its relation to the osseous corridor.
ResultsThe measured angle between the posterior surface of the acetabular posterior column and the sagittal plane was (60.2 ± 2.5)°. In the 45° obturator oblique view, the posterior iliac line corresponded with the outer edge of the iliac crest superiorly and the outer edge of the ischium inferiorly, while the posterior wall was projected posterior to the midpoint of the posterior iliac line. In the α° obturator oblique view, the posterior iliac line maintained this alignment but intersected centrally with the posterior acetabular wall. The 2.5 mm Kirschner wire remained within the osseous corridor under the 45° view but potentially extended beyond it under the α° view.
ConclusionWhen the posterior column screw is visualized posterior to the posterior iliac line in the 45° obturator oblique view, further assessment using a α° view is necessary. If the screw appears anterior to the posterior iliac line in the α° view, it indicates that the posterior cortical surface has not been breached.
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