Developmental regression is when children lose one or more skills they have established. Families caring for these children need timely recognition to assist diagnosis and tailored interventions. Families also need support to develop practical skills for caregiving and strategies to promote family well-being and community participation. Given the high caring demands, flexibly delivered approaches are needed to accommodate family routines. Online delivery of health-related interventions that provide coaching, information, or both has been found to be a feasible and effective option for families. Family Focus is a new family-centred online programme, co-designed with parents and family advocates, clinicians, and researchers to support and empower primary carers.

This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation.

Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies.

ISRCTN25513446.

Major depressive disorder (MDD) is a leading cause of disability among adolescents, yet available treatments remain limited. Bright light therapy (BLT) is a non-pharmacological intervention with demonstrated efficacy in adults. However, its clinical utility and underlying neural mechanisms in adolescents remain unclear. This trial aims to evaluate the clinical efficacy, time to onset, safety and applicability of home-based BLT in outpatient adolescents with MDD, and to explore its underlying neural mechanisms using functional near-infrared spectroscopy (fNIRS).

This is a randomised, placebo-controlled, three-arm multicentre clinical trial. A total of 126 outpatient adolescents aged 13–17 years with MDD will be randomly assigned to receive high-intensity BLT, medium-intensity BLT or placebo dim red light using a portable light box in a home-based setting for 40 min each morning over 4 weeks, followed by a 2-week follow-up. 42 age-matched and gender-matched healthy controls will also be enrolled for baseline assessments only, serving as normative references for comparison. The primary outcome will be the change in total scores on the 17-item Hamilton Rating Scale for Depression from baseline to week 4. All analyses will follow an intention-to-treat framework to ensure methodological rigour. The primary outcome will be analysed using analysis of covariance and linear mixed-effects models. Secondary outcomes will include response and remission rates, time to onset, maintenance of efficacy, self-reported depressive symptoms, sleep quality, cognitive function, anxiety, irritability, suicidal ideation, non-suicidal self-injury, self-efficacy and the overall safety profile of BLT. Prefrontal cortical activity will be measured using fNIRS at baseline and week 4 to explore potential neural mechanisms. Approximately 15% of participants will additionally take part in a qualitative substudy exploring experiences and acceptability of BLT.

The study protocol has been approved by the Ethics Committee of Peking University Sixth Hospital (approval number: 2025–24). Written informed consent will be obtained from all participants and their legal guardians prior to enrolment. Study findings will be disseminated through peer-reviewed journals and conference presentations.

NCT06913309.

Aortic dissection (AD) is a life-threatening cardiovascular emergency with a high mortality rate, and acute Stanford Type A AD is the most dangerous form, often requiring surgical intervention. Factors contributing to the progression of AD include increased heart rate, blood pressure and the rate of ventricular contraction (dP/dt). While heart rate control is a cornerstone of preoperative management for AD per existing guidelines, the recommended target (eg, ≤60 bpm in American Heart Association 2010) is consensus-driven (Level C) and thus not grounded in high-level evidence. The ESCORT (Efficacy and Safety of preoperative Controlling heart Rate in patients with acute Type A aortic dissection) trial is designed to address this critical gap by providing high-level evidence from a randomised controlled trial to define the optimal preoperative heart rate target.

The study is a multicentre, single-blind, RCT involving adult patients diagnosed with acute (Stanford Type A) AD, scheduled for aortic arch prosthetic vascular replacement and elephant trunk stent implantation surgery. 680 patients will be randomised into two groups: low heart rate target group (55–65 beats per minute) and standard heart rate target group (75–85 beats per minute). The intervention involves protocol-directed medication to achieve the target heart rates, with esmolol as the primary recommended agent. The primary outcome measure is the rate of major adverse cardiovascular event within 30 days after surgery, and secondary outcomes include various clinical, economic and biochemical measures.

The ESCORT study is the large-scale RCT to investigate the optimal preoperative heart rate control in patients with acute type A AD. The results of this study have the potential to fill the evidence gap in current clinical guidelines and provide evidence-based support for clinical management. The findings may influence the standard of care by either endorsing lower heart rate targets or providing alternative guidance for managing heart rate in this high-risk patient population. The study’s results will be disseminated through publications and presentations at both national and international conferences, ensuring that the results are accessible to the medical community and relevant patient organisations.

This study, including the study protocol (version 1.3, 3 December 2022), was approved by the Ethics Committee of Fuwai Hospital, CAMS and PUMC (approval number: 2022-1886). Additional approvals were obtained from the ethics committees of participating subcentres (approval numbers are listed in the main text). The findings will be disseminated through publications in peer-reviewed journals and presentations at scientific conferences.

ChiCTR2300067811.

Multimorbidity among patients with chronic hepatitis B (CHB) infection has emerged as a priority for healthcare and public health systems worldwide.

This study aimed to characterise time-trends in multimorbidities among patients with CHB infection. We identified multimorbidity clusters and combinations and quantified their associations with healthcare services utilisation.

A retrospective observational study, using electronic medical record data.

A large tertiary general hospital in China.

The study included 23 137 patients with CHB infection admitted between 2011 and 2023.

Latent class analysis and association rule mining (ARM) were performed to identify multimorbidity clusters and combinations, respectively. Multivariable logistic regression quantified associations between the identified multimorbidity patterns and length of stay (LOS), daily expense and 1-year readmission for liver-related conditions (OYRL).

The mean number of multimorbidities among hospitalised patients with CHB infection was 2.82±1.89. From 2011 to 2023, mean age increased from 44.2±13.7 to 48.4±13.1 (p

Multimorbidity imposes a substantial burden on CHB-infected patients. Our findings highlight the importance of early diagnosis and treatment of CHB infection, as well as tailored integral strategies for multimorbidity management in individuals with CHB infection.

This study aimed to systematically synthesise and analyse nurses’ experiences in implementing clinical nursing research (CNR) to inform administrators and researchers involved in CNR.

Qualitative meta-synthesis.

The following six databases were searched: PubMed, Cochrane Library, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO) and Embase. The search period included material published up to December 2024.

We included qualitative studies exploring perspectives, experiences and other similar factors. JBI Critical Appraisal Tool (2024 edition) was used to evaluate the quality of included studies.

Two reviewers independently conducted the literature search, study selection and data coding. Using principles of similarity and integration, findings from the included studies were grouped into general categories. A final synthesis was produced through analysis of the relationship between categories.

11 studies were included, from which four themes were identified: feelings and motivations prior to participation in CNR; understanding the role of the clinical nursing researcher; factors hindering CNR implementation; and expectations for CNR development. These themes comprised 12 sub-themes.

This review highlights nurses’ experience in implementing CNR. Strengthening motivation and clarifying the roles and responsibilities associated with CNR may facilitate the translation of research findings into clinical practice. In parallel, healthcare administrators should foster a supportive CNR culture and provide resources to address barriers to implementation.

CRD42025631159.

This randomised controlled trial aims to evaluate the impact of low-dose intravenous nalmefene on anaesthesia recovery in adult patients aged 18–65 undergoing surgery under general anaesthesia.

This was a multicentre, randomised, double-blind trial with two parallel arms clinical study.

Four hospitals from China

A total of 514 patients aged 18–65 who underwent elective orthopaedic, urologic and thoracic surgeries.

On completion of skin suturing, the intervention group received a single intravenous dose of nalmefene (0.25 µg/kg). The control group received an equivalent volume of normal saline at the same time point.

The primary outcome was the interval time between the end of anaesthesia and the Aldrete score ≥9 being achieved in the postanaesthesia care unit (PACU). The secondary endpoints included the time interval from the end of operation to extubation; Richmond Agitation Sedation Scale (RASS) score at extubation; the time at Montreal Cognitive Assessment Scale (MoCA) orientation score ≥5; visual analogue scale (VAS) score in PACU and 24 hours postoperatively.

514 patients were included in the Intention-to-Treat (ITT) analysis. The time interval between the end of anaesthesia and Aldrete score reached ≥9 in PACU was significantly shorter in the intervention group than in the control group (mean (SD) 24.8 (11.8) min vs 33.8 (12.5) min; 95% CI –8.8 (–10.8 to –6.7); p

In patients aged 18–65 who underwent elective orthopaedic, urologic and thoracic surgeries, low-dose nalmefene administered at the end of surgery can accelerate postanaesthesia recovery without compromising analgesic effects.

NCT04713358.

Hand osteoarthritis (OA) is a prevalent and debilitating joint disorder that impairs daily functioning and quality of life. Current treatments are often inadequate in managing the symptoms and progression of the disease. The cytokine interleukin (IL)-17 has been implicated in the inflammatory processes associated with OA, making it a potential target for therapeutic intervention. This trial aims to evaluate the efficacy of vunakizumab, an IL-17A inhibitor, in reducing pain and improving functional outcomes in patients with erosive hand OA.

This multicentre, randomised, placebo-controlled, double-blind trial will enrol 150 participants aged 30–80 years with symptomatic erosive hand OA. Participants will be randomised in a 1:1 ratio to receive either vunakizumab 120 mg or placebo subcutaneously every 4 weeks for 24 weeks, with a loading dose injection period during the first 4 weeks. The primary outcome is the change in hand pain assessed by the Visual Analogue Scale at 28 weeks. Secondary outcomes include changes in physical function measured by the Functional Index for Hand Osteoarthritis, the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Health Assessment Questionnaire, as well as changes in grip strength and radiographic and MRI evaluations of the hands.

Written informed consent will be obtained from all participants. The study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (2024–217) and will adhere to the Declaration of Helsinki. Research results will be published in peer-reviewed journals.

ChiCTR2500101031; https://www.chictr.org.cn/showproj.html?proj=264789.

Osteoporosis (OP) is a systemic skeletal disorder that increases fragility and susceptibility to fractures. Despite the availability of teriparatide for the treatment of patients with acute fractures with better efficacy, its long-term daily injection and high cost limit its broader use among a wider patient population, especially for those living in low- and middle-income countries. This study aims to evaluate the efficacy of a novel sequential treatment with teriparatide daily for 6 months followed by denosumab every 6 months for another 18 months, in comparison with denosumab monotherapy every 6 months for 24 months, in reducing the risk of fractures in patients with newly diagnosed osteoporotic fractures. The study will also explore the possible difference between two sequential treatments (shifting to denosumab treatment at 6 or 12 months) in their effect on increasing bone mineral density (BMD).

This study is designed as a multicentre, open-label, randomised controlled trial among 2478 patients with newly diagnosed osteoporotic fractures from 58 hospitals across China. Participants will be randomly assigned in a 10:10:1 ratio to three treatment groups: 24 months of denosumab monotherapy, early sequential treatment (teriparatide for 6 months followed by denosumab for 18 months) and late sequential treatment (teriparatide for 12 months followed by denosumab for 12 months). The primary outcome is the incidence of vertebral fractures over 24 months of treatment. Secondary outcomes include changes in BMD at the lumbar spine, total hip and femoral neck, changes in bone turnover markers (β-carboxy-terminal telopeptide of type 1 collagen and procollagen type 1 N-terminal propeptide), treatment adherence and cost-effectiveness. Follow-up assessments are scheduled at 3, 6, 9, 12, 18 and 24 months post-randomisation for primary and secondary outcomes, and biannually afterwards for the primary outcome.

The study protocol has been registered on ClinicalTrials.gov and has received ethical approval from the Peking Union Medical College Hospital Medical Science Research Ethics Committee (1-22PJ939). The findings will be disseminated through peer-reviewed scientific journals.

NCT05866029.

Globally, work rumination is a common phenomenon related to nurse burnout. However, most existing studies focus on the single negative impacts of rumination, with less exploration of its dual effects and antecedents. Therefore, comprehensively exploring the effect of nurse work rumination and its influencing factors is crucial for enhancing the accuracy of nursing management.

Identify the antecedents and dual effects of nurse work rumination to deepen understanding of this phenomenon and provide references for formulating interventions that enhance nurses’ well-being and improve the quality of nursing work.

Included studies were original research articles focusing on work-related rumination of nurses in clinical settings. Excluded studies were those involving nurses without patient contact, rumination unrelated to work, studies not addressing the effects or influencing factors of rumination and non-Chinese or non-English language publications.

CINAHL, Cochrane, EMBASE, MEDLINE, Pubmed, Scopus, Web of Science, Sinomed, Wanfang, VIP and CNKI were searched to identify articles about nurse work rumination which were published up to January 2025.

A scoping review of the published articles of nurse work rumination was performed with the methodological process guided by the framework proposed by Arksey and O’Malley. A three-step coding procedure was used to synthesise the impacts and antecedents of nurse work rumination, which were subdivided into four categories individually based on the conservation of resources theory, the three-dimension theory of happiness and the distinctive features of the nursing profession.

30 articles from 12 countries were included. The findings indicate that nurse work rumination has 28 kinds of impacts, including positive, negative and double-edged sword effects, in four aspects: nursing quality and safety (n=7), happiness (n=7), health (n=10) and relationship (n=4) from 29 articles. The findings also suggest that from 26 articles, work rumination will be influenced by 31 factors, which are based on conservation of resources theory classified into four categories: resource depletion (n=14), resource protection (n=4), consequences of resource depletion (n=5) and behaviour and cognition (n=8).

This scoping review constructs a conceptual framework of ‘antecedent factors-nurse work rumination-dual impacts’ by systematically synthesising 30 studies. Rooted in the conservation of resources theory, three-dimensional theory of happiness and nursing professional characteristics, the framework clarifies the classification logic and internal connections of 31 influencing factors and 28 bidirectional impacts. The positive effect of work rumination can promote nurses’ personal development by facilitating the problem-solving pondering. Nursing managers can leverage this integrated framework to design targeted intervention strategies, maximising the constructive effects of rumination while mitigating its adverse impacts. Classifying the factors affecting nurse work rumination according to the conservation of resources theory provides an important basis for exploring the influence mechanism of nurse work rumination. Future research should focus more on empirical studies on rumination to reduce nurses’ burnout and improve the quality of nursing work.

The aim of the study was to develop a nursing-sensitive quality indicator system for emergency care of patients with severe trauma, providing a scientific measurement tool for evaluating the quality of emergency trauma nursing.

A modified Delphi study.

Experts working in emergency surgery or trauma surgery departments were recruited. First, initial nursing-sensitive quality indicators were derived from an analysis and synthesis of existing evidence and semistructured interviews with 12 clinical experts. Subsequently, two-round expert consultations were conducted with 15 experts from various regions of China to refine and finalise the indicators. Finally, the analytic hierarchy process was used to determine the weights of each indicator.

The valid response rates of questionnaires in the two rounds of expert consultation reached 88.89% and 93.75%, respectively, and the expert authority coefficients were 0.856 and 0.880. The experts ultimately reached a consensus, establishing a nursing-sensitive quality indicator system for emergency care of patients with severe trauma, comprising 3 first-level indicators, 11 second-level indicators and 49 third-level indicators.

This study provides a tool for the assessment of emergency nursing service quality for patients with severe trauma, establishing a scientific and effective nursing-sensitive quality indicator system to evaluate and improve the quality of nursing services provided by emergency nurses to patients with severe trauma.

Dementia contributes to the disease burden worldwide, and people with hypertension or type 2 diabetes are at an elevated risk of developing dementia. It is essential to prevent or delay cognitive decline in people at high risk within the community. Our trials aim to evaluate the effects of adaptive cognitive training on community-dwelling older adults with hypertension or type 2 diabetes but no dementia.

Two multicentre, double-blind, randomised, placebo-controlled trials, named COgNitive Training in community-dwelling older adults at high risk for demENTia and with Hypertension (CONTENT-Hypertension) and COgNitive Training in community-dwelling older adults at high risk for demENTia and with Diabetes (CONTENT-Diabetes), will be conducted to investigate the effects of adaptive cognitive training on participants aged 60 years or above who have been diagnosed with hypertension or type 2 diabetes but no dementia. Each trial will enrol 120 participants. Participants will be recruited from the local community in Shijingshan and Haidian Districts, Beijing, and allocated to either the intervention or control group using a 1:1 ratio. The intervention group will engage in 12 weeks of adaptive cognitive training, while the control group will receive 12 weeks of placebo cognitive training. A 24-week follow-up assessment will be conducted for all participants to evaluate the persistence of the effects. The primary outcome is the 12-week change in Montreal Cognitive Assessment (MoCA) Basic scores from baseline to the end of the intervention (12 weeks). Secondary outcomes include 6-week and 24-week changes in the MoCA from baseline; 6-week, 12-week and 24-week changes in Trail Making Test-A&B (TMT-A, TMT-B), Digit Symbol Substitution Test, the WHO/University of California at Los Angeles Auditory Verbal Learning Test and Boston Naming Test scores of cognitive functions; 6-week and 12-week changes in Geriatric Depression Scale, Generalised Anxiety Disorder-7 (GAD-7), Pittsburgh Sleep Quality Index and 12-week change in blood pressure (CONTENT-Hypertension) or fasting blood glucose and glycated haemoglobin (CONTENT-Diabetes) from baseline.

This study will adhere to the ethical principles outlined in the Declaration of Helsinki and comply with international standards for Good Clinical Practice. All participants will sign the informed consent at baseline. This study has been approved by the Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (approval numbers: 2023-139 and 2024-162). The findings of the trials will be disseminated through publications in peer-reviewed scientific journals and presented at academic conferences.

NCT06512922 and NCT06524388.