Conectar
by Yu Cui, Yuxuan Gao, Na Meng, Xiaojuan Li, Na Zhao, Lili Yu
Atezolizumab is a widely used immune checkpoint inhibitor (ICI) for cancer treatment, and postmarketing testing is important. This study aims to provide a reference for the safe and rational use of drugs in clinical practice by mining and analyzing the adverse event (AE) signals of atezolizumab on the basis of the FDA Adverse Event Reporting System (FAERS). This research extracted AE reports from the second quarter (Q2) of 2016 to Q2 of 2024 from the FAERS. AEs were standardized and classified on the basis of the System Organ Class (SOC) and Preferred Term (PT) from the Medical Dictionary for Regulatory Activities (MedDRA) version 23.0. This study utilized disproportionality analysis (DPA) for signal mining and analysis, including the reporting odds ratio (ROR) method, the Medicines and Healthcare Products Regulatory Agency (MHRA) method, and the Bayesian confidence propagation neural network (BCPNN) method. We obtained a total of 3,124 AE signals and identified 640 PTs and 21 SOCs for atezolizumab. The highest signal intensity was systemic immune activation (n = 15, ROR = 449.20, PRR = 449.07, IC = 8.06), and the most frequently reported AEs were death, pyrexia, infectious pneumonia, anaemia, and febrile neutropenia. The top 100 PTs in terms of signal intensity involved a total of 16 SOCs, including those associated with endocrine disorders; respiratory, thoracic and mediastinal disorders; and renal and urinary disorders. This study revealed that AEs in the endocrine, respiratory and urinary systems need to be monitored in clinical practice.Labour companionship is a recommendation by WHO that health authorities enable women to choose a companion during labour to ensure a safe and dignified labour experience for the birthing woman. However, most healthcare facilities in low- and middle-income countries do not necessarily consider this maternal need, which hampers a positive maternal experience during labour.
This study aims to examine midwives' perception towards the involvement of male partners in labour companionship.
An exploratory phenomenological approach was chosen and semi-structured interviews were used for this study.
The four main themes identified in this study include ‘Understanding of male partners' involvement in labour companionship’, ‘Involvement of midwives in decision-making’, ‘Barriers to male partners' involvement in labour companionship’ and ‘Facilitators of male partners' involvement in labour companionship’.
This study found a lack of understanding among midwives of the significance of male partners' involvement in labour companionship; and the identification of hierarchical and authoritarian leadership as a barrier to midwives' participation in decision-making highlights the need for transformational leadership styles to empower midwives. Overall, the findings of this study can inform maternity care policy as well as resource development, education and professional training in the field of midwifery.
To synthesise the evidence on digital health technologies in home care for children with medical complexity in order to inform improvements in care practices.
Scoping review.
The search was conducted in August 2025, covering five databases.
Two reviewers independently retrieved full-text studies and conducted the initial screening of titles and abstracts, followed by full-text analysis and data extraction.
A total of 30 articles were included in this review. Articles were published between 2015 and 2025. The digital health technologies identified were categorised into six primary types and these technologies were found to serve five core functions.
Digital health technologies show broad potential in home care for children with medical complexity, optimising care and empowering families. Future work should evaluate long-term effectiveness, integrate systems, and prioritise personalised, culturally adaptive designs.
This study addresses the challenge of managing home-based care for children with medical complexity. It identifies six types of digital health technologies and their five core functions, providing a framework to guide healthcare professionals, organisations, policymakers, and developers in creating more effective, integrated support systems for these children and their families.
This study adhered to the PRISMA-ScR guideline.
No patient or public contribution.
The findings can guide the strategic implementation and development of digital health tools to enhance care coordination, support family caregivers, and improve the quality and experience of home-based care for children with complex medical needs.
by Lin Zhang, Feng Luo, Yalin Chai, Lijie Sun, Xuan Wang, Le Yin, Congjuan Luo
Acute kidney injury (AKI) remains a major clinical challenge due to its high morbidity and mortality, with ischemia-reperfusion injury (IRI) as one of its primary causes. Severe IRI-associated AKI (IRI-AKI) can progress to irreversible renal failure, yet no effective therapies are currently available. Ferroptosis, an iron-dependent regulated cell death, has recently been implicated in the pathogenesis of IRI-AKI. Moreover, IL-22 may alleviate AKI by modulating the ferroptosis process through regulation of the P62-Keap1-Nrf2 signaling axis. In this study, we examined the protective role of the immune cytokine interleukin-22 (IL-22) in IRI-AKI and its mechanistic association with ferroptosis. Using a murine IRI model and an HK-2 cell hypoxia/reoxygenation system, we systematically assessed the impact of IL-22 treatment. IL-22 administration significantly enhanced renal function, reduced histological injury, and limited both reactive oxygen species accumulation and ferroptotic cell death. Further mechanistic studies demonstrated that IL-22 suppresses ferroptosis in vitro through an Nrf2-dependent mechanism and is associated with activation of the P62-Keap1-Nrf2 signaling pathway. These findings offer experimental evidence supporting IL-22 as a potential therapy for IRI-AKI and highlight ferroptosis modulation as a promising therapeutic strategy.by Kexuan Chen, Sarah Miller, Kristine Goy, Tina Lam, Marlène Maeusli, Rosemary She, Brad Spellberg, Brian Luna
Metallo-β-lactamases (MBLs) hydrolyze the beta-lactam ring in beta-lactam antibiotics, rendering them ineffective. Infections caused by MBL-harboring bacteria result in higher mortality, more costs and prolonged hospital stays due to the limited treatment options. Recently, antimicrobial susceptibility testing using RPMI-1640 has been found to have more accuracy in predicting in vivo efficacy due to its zinc deficiency. We sought to expand the previous studies of accessing in vivo efficacy using zinc-limited media versus conventional media to more antimicrobial agents and MBL-producing strains. The susceptibility of isolates was determined by performing minimum inhibitory concentration (MIC) assays using traditional cation-adjusted Mueller Hinton broth (CAMHB) or zinc-limited media. In vivo outcomes were evaluated using the Galleria mellonella infection model and neutropenic mouse thigh infection model. The MICs of MBL-harboring strains decreased in zinc-limited media compared to in nutrient-rich media, suggesting susceptibility of a subset of resistant strains when tested in zinc-limited media. Notably, we observed statistically significant MICs decreasing against imipenem, which demonstrated the best efficacy among the six tested antibiotics. Additionally, the outcomes of in vivo tests in both the G. mellonella model and the mouse model were better predicted with in vitro MIC assays performing in zinc-limited media. The use of zinc-limited media may lead to increased accuracy of the prediction of in vivo efficacy of beta-lactams against MBL-harboring bacteria.The aim of this study was to innovatively utilise the BERTopic model for topic modelling in order to comprehensively identify and understand the factors contributing to bed falls.
Retrospective study.
The study collected 241 reports of bed fall accidents recorded by nurses from Peking University Third Hospital Nursing Department from 2014 to 2024. Among them, 102 reports met the inclusion and exclusion criteria.
This study follows the Minimum Information for Medical AI Reporting (MINIMAR). It collected patient bed fall reports from Peking University Third Hospital between 2014 and June 2024, preprocessed the texts, utilised the BERTopic library in Python for topic modelling, and manually aggregated secondary topics by combining visualisation results and professional knowledge.
We utilised cluster bar charts to visually display the distribution of the 22 secondary topics and further consolidated them into five core topics through the use of a topic distribution diagram and a topic similarity matrix diagram. These topics were related to patient factors, ward equipment and surroundings factors, medication risk factors, caregiver factors, and nursing practice factors. The study highlights the environment's specificity in bed falls, especially bedside safety and patient-bed rail interaction.
The innovation of this study lies in the successful utilisation of BERTopic technology to identify topics of risk factors for bed falls through alternative data sources, providing a scientific basis for formulating preventive measures. The findings aim to optimise nursing processes, improve ward environments and enhance educational training, ultimately reducing patient bed falls and enhancing medical safety, nursing quality and patient experience.
This study not only helps nurses identify risk factors for patient bed falls, but also provides important guidance for developing effective prevention strategies.
No patient or public contribution applied.
by Xiaohui Xu, Liang Cai, Xuan Dang, Jianbin Han, Yan Kou, Chunyan Rong, Junjie Kou
BackgroundTriggering receptor expressed on myeloid cells-1 (TREM-1) is a potent amplifier of inflammatory responses and plays a critical role in the pathogenesis of various infectious diseases. Notably, emerging evidence suggests that TREM-1 is also involved in the development and progression of cardiovascular diseases, such as atherosclerosis and atrial fibrillation. However, its role in myocardial ischemia/reperfusion (I/R) injury remains unclear. This study aimed to investigate the role of TREM-1 in myocardial I/R injury and to explore the potential underlying molecular mechanisms.
MethodsA hypoxia/reoxygenation (H/R) model was established using HL-1 cardiomyocytes subjected to 6 hours of hypoxia followed by 6 hours of reoxygenation. Pyroptosis levels were assessed by Hoechst-PI staining, lactate dehydrogenase (LDH) release assay, CCK-8 assay, and Western blot analysis. In vivo, a myocardial I/R injury model was established in C57BL/6 mice by subjecting them to 30 minutes of ischemia followed by 24 hours or 7 days of reperfusion. Evaluation was performed using TTC staining, Western blotting, echocardiography, histochemical staining, and immunohistochemistry.
ResultsIn this study, we found that TREM-1 expression was significantly upregulated in both in vitro and in vivo models of myocardial ischemia-reperfusion injury (MIRI). Pharmacological inhibition of TREM-1 by LR12 effectively reduced the levels of cardiomyocyte pyroptosis and suppressed activation of the NF-κB signaling pathway. In addition, LR12 treatment alleviated myocardial inflammation and fibrosis and improved left ventricular function in mice.Intervention experiments with MCC950, a specific NLRP3 inhibitor, confirmed that NLRP3 inhibition could mimic the anti-pyroptotic effect of LR12 and reduce the expression of pyroptosis-related proteins. Immunofluorescence experiments further verified that inhibition of NF-κB decreased NLRP3 expression, clarifying the association between TREM-1 downstream signals and NLRP3. Long-term follow-up experiments showed that LR12 treatment significantly reduced the area of myocardial fibrosis at 7 days after reperfusion.
ConclusionOur findings indicate that inhibition of TREM-1 alleviates cardiomyocyte pyroptosis during MIRI by suppressing activation of the NF-κB signaling pathway. Therefore, TREM-1 may represent a promising therapeutic target for the treatment of myocardial ischemia-reperfusion injury.
by Yuxuan Gao, Shiyao Jiang, Yu Cui, Yumeng Wang, Lili Yu
With the extensive clinical application of immune checkpoint inhibitors (ICIs), immune-related adverse events (irAEs) associated with these agents have increasingly garnered significant attention. Unlike other irAEs, endocrine irAEs are mostly irreversible, with variable and nonspecific symptoms, which poses challenges for clinicians in diagnosis. As a result, this study leveraged the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER) pharmacovigilance databases to conduct an in-depth investigation into adverse events induced by PD-1/PD-L1 inhibitors, with a focus on irAEs induced by PD-1/PD-L1 inhibitors. This study pioneers the systematic cross-database validation of endocrine irAEs induced by PD-1/PD-L1 inhibitors. The integration of data from the JADER offers unique safety insights for Asian populations, bolsters global pharmacovigilance efforts, and uncovers regional variations in irAEs reporting. Notably, this study revealed a higher prevalence of endocrine irAEs among men aged over 50 years receiving PD-1/PD-L1 inhibitors. Both PD-1 and PD-L1 inhibitors are strongly associated with thyroid dysfunction, adrenal insufficiency, and pituitary inflammation. Additionally, it identifies several previously undocumented endocrine irAEs. This result unearthed safety signals hitherto unreported in drug inserts, underscoring the imperative for updating the safety labeling of PD-1/PD-L1 inhibitors with respect to endocrine irAEs. The emergence of off-label uses further underscores the need for additional clinical trials to assess their efficacy and safety.To develop a comprehensive decision-making checklist for paediatric advance care planning tailored to the needs of terminally ill children and their families.
A Delphi Study.
Underpinned by Delphi methodology, a four-phase procedure was adopted: (1) drafting items by the working group, (2) refining items based on an experts' survey, (3) further refining based on the same experts, and (4) final adaptations and approval. This study was initiated by the Paediatric Palliative Care Subspecialty Group of the Paediatrics Society of the Chinese Medical Association. The process involved 60 healthcare providers (physicians, nurses, and social workers) from 14 paediatric palliative care teams.
The developed checklist included 5 topics, 24 subtopics, and 45 items. Five topics were (1) medical and nursing decision-making, (2) social support planning, (3) psychological support planning, (4) spiritual support planning, and (5) posthumous affairs planning. This checklist addresses symptom management for terminally ill children, integrating support for their psychological, social, and spiritual well-being, and addresses the care needs of their family members.
The study provided a paediatric advance care planning checklist derived from the expert consensus that includes key elements and items.
This checklist provides healthcare providers with a structured framework to set paediatric advance care planning and ensure that all aspects of children's well-being and their families' needs are considered. This study also lays an evidence-based foundation for the design of related documents.
This study developed a comprehensive paediatric advance care planning checklist with 5 topics, 24 subtopics, and 45 items. This study provides a comprehensive decision-making checklist for healthcare providers and families, ensuring that critical decisions are addressed timely.
This article is presented in accordance with the CREDES guidelines.
Limited patient and public involvement was incorporated, focusing on reviewing the initial checklist draft.
To identify predictors of nurses' perceived care quality, explore their understanding of high-quality care and propose improvement strategies to inform clinical practice.
A mixed-methods design, integrating quantitative data analysis and qualitative in-depth individual interviews.
Quantitative analysis used cross-sectional data from the 2017 Chinese Nursing Work Environment Survey (C-NWES). Chi-square tests and logistic regression were used to examine how demographic characteristics, work environment and occupational burnout predicted perceptions of care quality at hospital and unit levels. Qualitatively, 42 frontline nurses were interviewed in 2024 to explore their perceptions of care quality, predicting factors and improvement strategies in a post-pandemic context. Thematic analysis was applied to code and synthesise the interview data.
Quantitative analysis revealed that gender, education, workload, experience, work environment and burnout had differing impacts on nurses' care quality perceptions at hospital and unit levels. In-depth individual interviews revealed that nurses perceive high-quality care as patient-centred, predicted by factors such as human resources, occupational burnout, patient and family cooperation at the unit level and environmental and policies factors at the hospital level. Unit-level strategies included improving communication, team collaboration and leadership support, while hospital-level recommendations focused on welfare benefits, continuing education, flexible scheduling and resource optimisation. Through the mutual validation of quantitative analysis and in-depth interviews, this study revealed the multidimensional understanding and key predictors of care quality among frontline clinical nurses in China.
Work environment, occupational burnout and demographic factors significantly impact nurses' perceived care quality, highlighting the need for targeted organisational improvements at both unit and hospital levels to enhance care quality.
The findings highlight the importance of organisational interventions. Nursing managers should promote a positive work environment and mitigate burnout. Future research should develop testing models to explore the relationship between work environment and perceived care quality and validate their effectiveness.
No patient or public contribution.
by Wenya Bai, Shixuan Liu, Guilin Zhou, Xuelian Li, Huan Jiang, Jianlin Shao, Junchao Zhu
BackgroundMicroglia polarization plays a crucial role in the progression of cerebral ischemia-reperfusion injury (CIRI), but the mechanisms remain largely undefined. The preset study aimed to investigate the mechanism of microglia polarization following CIRI.
MethodsCIRI was modeled in C57BL/6J mice through middle cerebral artery occlusion-reperfusion and in BV2 cells via oxygen and glucose deprivation/reoxygenation. Reverse transcription-quantitative PCR, western blotting, flow cytometry and fluorescence staining were used to detect the expression levels of key proteins associated with microglia polarization, as well as the expression of TNFAIP3 and RACK1. The interaction between TNFAIP3 and RACK1 was verified by co-immunoprecipitation. TNFAIP3 or RACK1 gene interference (overexpression and/or silencing) was employed to examine the role of the TNFAIP3/RACK1 axis in microglia polarization following CIRI.
ResultsThe results revealed that Arg-1 expression decreased, inducible nitric oxide synthase expression increased and TNFAIP3 was upregulated 24 h after CIRI. Furthermore, TNFAIP3 interacted with RACK1 to deubiquitinate and increase the expression of RACK1. These results indicate that knocking down either TNFAIP3 or RACK1 promotes microglia M1 polarization, and overexpression of RACK1 can promote microglia M2 polarization. RACK1 exerts its neuroprotective effects through NF-κB, as demonstrated by the use of NF-κB inhibitors.
ConclusionThe present findings indicate that TNFAIP3 inhibits M1 microglial polarization via deubiquitination of RACK1 after CIRI, RACK1 exerts its effects through NF-κB.
by Xin Ling, Ziyan Hao, Yixuan Shi, Yuting Li, Kehan Wang, Yunshan Zhang, Yue Wang
The diversity of microbiota and metabolites plays a key role in regulating metabolism, host immune response, neurobehavioral effects and detoxification mechanism in the digestive tract gut. Formaldehyde (FA) affects the gastrointestinal tract and its microbiota, whereas ascorbic acid (VC) improves gut health and selectively promotes microbial growth. In this study, we employed 16S rRNA sequencing and non-targeted metabolomics approaches to investigate these interactions. Our results demonstrated that Lachnospiraceae_NK4A136_group, Lactobacillus, Ligilactobacillus, Clostridiales_unclassified, and other microflora significantly decreased following FA exposure, whereas the intestinal flora changed in the exact opposite way following VC administration. And compared with FA group, the number of 492 ions were regulated, in which 382 feature was up-regulated and 304 feature was down-regulated in FA + 150 mg VC group. In addition, a correlation between gut microbiota and metabolites was observed. These results reveal the effects of FA or VC on the gastrointestinal tract and its microbiota, and our understanding in the treatment of FA-induced damage to the digestive tract.Within the context of limited childcare resources and a high prevalence of multigenerational co-residence in China, grandparents play a pivotal role in the caregiving of infants and toddlers. However, discrepancies in parenting philosophies across generations may lead to conflict, thereby impacting maternal psychological well-being and parenting experiences. Identifying the typologies of intergenerational co-parenting relationships is therefore essential for informing targeted health interventions.
This study aimed to identify latent profiles of mother–grandparent intergenerational co-parenting relationships in families with infants and toddlers in Shenzhen, China, using the Grandparent-Parent Co-parenting Relationship Scale (GPCRS) dimensions. It further sought to examine how maternal psychosocial factors (parenting stress, perceived stress, depressive symptoms, sleep quality), the quality of spousal co-parenting relationships and intergenerational caregiving role arrangements are associated with profile membership.
A cross-sectional survey study.
A total of 366 mothers with children aged 0–3 years was recruited from maternity and child healthcare institutions in Shenzhen, China, between January 2023 and May 2024. Validated scales were used to assess intergenerational and spousal co-parenting, parenting stress, parenting sense of competence, perceived stress and depressive symptoms. Latent profile analysis was employed to identify patterns of intergenerational co-parenting relationships, and multinomial logistic regression was conducted to examine the associated predictors.
Three distinct intergenerational co-parenting profiles were identified: the Discordant Group (29.2%), the Balanced Group (46.7%) and the Harmonious Group (24.0%). Higher spousal co-parenting scores were positively associated with more harmonious profiles. Lower levels of parenting stress, perceived stress and depressive symptoms, as well as higher sleep quality and grandparental involvement in caregiving were all associated with more positive relationship profiles. However, higher maternal parenting competence was paradoxically linked to greater intergenerational conflict.
Mothers in the Discordant Group, marked by low agreement/support and high conflict, reported the highest stress and depressive symptoms, whereas those in the Harmonious Group showed the most favourable psychosocial outcomes, with the Balanced Group in between. Stronger spousal co-parenting, better sleep quality and grandparental caregiving were associated with membership in the Harmonious class. These findings underscore the importance of fostering harmonious co-parenting across spousal and intergenerational subsystems to enhance maternal well-being and family functioning in early childhood.
Nurses and healthcare professionals could implement family-based interventions tailored to identified profile characteristics, thereby more effectively supporting maternal mental health and fostering greater harmony in intergenerational co-parenting families.
To explore determinants impacting an Electronic Health Record-based information system implementation and their association with implementation fidelity based on the Theoretical Domains Framework (TDF) from nurses' perspectives.
Exploratory sequential mixed-method design.
In stage one, semi-structured interviews with 53 purposively selected nurses informed the exploration of TDF domains influencing the implementation of the information system with directed content analysis. In stage two, a cross-sectional survey, informed by the qualitative findings, was conducted among 482 nurses to identify the most relevant and relatively important TDF domains by running generalised linear regression models.
The qualitative interviews generated 13 TDF domains that were identified as major influencing factors, including technology characteristics, knowledge, attitudes, role agreement, self-efficacy, goal-setting, information circulation, and communication among nurses. Quantitative findings showed that 70% of nurses used and printed the written form through the information system, and only 34% offered verbal education consistently. Regression analysis identified nine domains that were relevant and important factors for implementation fidelity, including knowledge, skills, role identity, beliefs in consequences, beliefs in capabilities, intentions, goals, memory and decision processes, and environmental context.
Our findings confirmed previous evidence on determinants of implementing digital health technologies, including knowledge, competencies, perceived effectiveness, role agreement, intentions, decision processes, and environmental context. Additionally, we highlighted the importance of goal-setting for successful implementation.
This study investigated the relatively important associated factors that can impact the successful implementation of the nurse-led information system for post-acute care based on nurses' perspectives. These results can guide nurse practitioners in implementing similar initiatives and support evidence-based decision-making. Researchers can also further investigate the relationships between the identified determinants.
Journal Article Reporting Standards for Mixed Methods Research.
No patient or public contribution.
by Ariffin Kawaja, Aminath Shiwaza Moosa, Eric Kam Pui Lee, Ian Kwong Yun Phoon, Andrew Teck Wee Ang, Zi Ying Chang, Aileen Chelsea Ai’En Lim, Jonathan Yap, Weiting Huang, Ding Xuan Ng, Melvin Yuansheng Sng, Hao Yuan Loh, Chirk Jenn Ng
IntroductionRecent hypertension guidelines recommend ambulatory blood pressure monitoring (ABPM) for accurate diagnosis and monitoring. However, patients’ experiences with cuff and wearable ABPM devices in primary care remain unclear. This study compared the acceptance of three devices (oscillometry cuff, tonometry wrist, and photoplethysmography chest devices) among patients with hypertension in primary care.
MethodsA multi-method study was conducted. Thirty-five participants with hypertension were recruited from two public primary care clinics in Singapore. All participants used cuff-based and either wrist or chest wearable devices for 24 hours. Structured surveys and in-depth audio-recorded interviews were used to gather feedback on their views, experiences, and challenges using the devices. The interviews were thematically analysed, and the surveys were analysed using descriptive statistics.
ResultsAll participants used the cuff (n = 35) device, while the wrist and chest devices were used by two-thirds (n = 22) and a third (n = 11) of the participants, respectively.The device usability questionnaire found that most participants were satisfied with the chest device, which did not disrupt their daily activities. Conversely, cuff arm devices interfered with daily activities (48%) and sleep (26%), were cumbersome (32%), and caused embarrassment (26%). The wrist device was uncomfortable (33%) and painful (22%) for some participants.The qualitative data were categorised into five themes: comfort, convenience, perceived accuracy, and impact on routine and sleep. Participants found the chest device more comfortable and convenient than the cuff and wrist devices. The cuff device was perceived as the most accurate due to its inflation-based BP measurement. All devices minimally affected routines and sleep, though participants expressed safety concerns about the cuff device, particularly while driving.
ConclusionWhile wearable ABPM devices offer increased comfort, convenience and reduced impact on patient’s daily activities, concerns regarding their accuracy must be addressed before the widespread adoption of these devices in routine clinical practice.
by Min Lu, Zixuan Bu, Nana Xiang, Juebo Yu
COVID-19 Vaccinations are associated with higher allergic reactions risk among adults. However, evidence on whether no vaccinated with COVID-19 vaccine is associated with fewer incidence among individuals with atopic diseases remains limited. This study is to investigate whether COVID-19 Vaccination is associated with increased risk of adult atopic diseases. A cross-sectional survey was conducted using data from the 2021 US National Health Interview Survey (NHIS) that included 29201 respondents aged 18 years or older adults. Multivariable logistic regression was conducted to estimate the association of COVID-19 vaccination and atopic disease. Crude and adjusted odds ratios (aORs) and 95% CIs were estimated. Analysis of the data was performed from October 01, 2023, to January 22, 2024. Of 29201 respondents (mean [SD] age, 52.6 [18.4] years; 13240 [45.3%] male), the US prevalence was 49.6% (unweighted, 95% CI, 49.1%−50.2%) from all years of the2021 NHIS for self-reported hay fever, 13.7% (unweighted,95% CI, 13.3%− 14.1%) for asthma, 10.9% (unweighted, 95% CI,10.1%−11.3%) for skin allergy, 10.0% (unweighted,95% CI, 9.7%−10.4%) for food allergy, and 45.1% (unweighted,95% CI, 45.6%−45.7%) for no COVID-19 vaccination, 6.4% (95% CI, 6.1%−6.9%) for one COVID-19 vaccination, 43.1% (unweighted, 95% CI, 42.6%−43.7%) for two COVID-19 vaccinations, 5.3% (unweighted, 95% CI, 5.1%−5.6%) for more than 2 COVID-19 vaccinations. In multivariable analysis across the 2021 NHIS, COVID-19 vaccinations does not increase the risk of skin allergy(aOR, 1.03;95%CI, 0.86–1.28; P = 0.135), asthma (aOR, 1.05;95%CI,0.98–1.13; P = 0.164), and food allergy (aOR, 1.03;95%CI, 0.95–1.12; P = 0.437) in adults, compared with adults without COVID-19 vaccination; whereas, in patients with COVID-19 vaccination had significantly higher odds of hay fever (aOR, 1.21;95% CI, 1.15–1.27;PThis study aims to investigate whether higher levels of depression predict increased physical frailty over time and whether worsening physical frailty predicts higher levels of depression over time, at both the between-person and within-person levels.
A longitudinal study.
A total of 269 patients who underwent cardiac surgery were included in this study at T1 (admission). We followed up depression and physical frailty at T2 (the seventh day after surgery), T3 (the day before discharge), and T4 (the three-month follow-up). To determine the temporal order of the association between depression and physical frailty at both between-person or within-person levels, we employed the cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects).
The cross-lagged panel model findings revealed a time-dependent shift in directionality: physical frailty initially predicted depression between T1 and T2, whereas depression subsequently emerged as a significant predictor of physical frailty from T2 to T4. These between-person effects suggest that the dominant direction of influence may vary across different perioperative stages. Notably, the random intercept cross-lagged panel model results identified a robust unidirectional within-person effect, indicating that increases in depression consistently predicted subsequent increases in physical frailty over time, while the reverse pathway was not statistically significant. This finding underscores the potential causal role of depression in driving physical frailty progression, beyond the influence of stable between-person characteristics.
This study advances understanding of the depression-physical frailty relationship in middle-aged and older cardiac surgery patients by delineating temporal precedence and disentangling within- and between-person effects. Depression emerges as a key driver of physical frailty, underscoring the need to prioritize its management in postoperative care protocols. Future research should explore mechanisms linking intraindividual depression to physical frailty progression and evaluate integrated psychosomatic interventions to optimize recovery outcomes.
We have adhered to the STROBE guideline.
This study did not include patient or public involvement in its design, conduct, or reporting.
To identify barriers and facilitators to nurse prescribing implementation through a synthesis of qualitative studies.
The roles of healthcare professionals are expanding in response to the growing demand for access to high-quality healthcare services. Advanced practice nurses are a global trend, and nurse prescribing is a crucial feature of advanced practice nurses that can meet the needs of growing healthcare services. The development and promotion of nurse prescribing varies significantly across countries, and it is essential to identify the factors influencing the implementation of nurse prescribing.
A systematic search of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Wan Fang and Weipu database was conducted to retrieve literature on barriers and facilitators related to the implementation of nurse prescribing. We searched records from inception to 29 March 2025. Two researchers independently performed literature screening, literature evaluation, data extraction and synthesis. Literature screening and data extraction adhered to the predefined inclusion and exclusion criteria. Literature quality was evaluated using the JBI Checklist for Qualitative Research. The results were synthesised using the thematic synthesis approach. Information was extracted using the Consolidated Framework for Implementation Research (CFIR) in a deductive way, and barriers and facilitators to the implementation were categorised based on the CFIR. Report rigour assessed via ENTREQ.
The synthesis of 14 included papers identified 18 thematic categories, yielding two key findings. The main barriers identified included failure to anticipate the cost of nurse prescribing, legal constraints, social pressures, poor organisational structure, insufficient prescribing education, lack of competence of nurses leading to psychological changes, opposition and lack of cooperation of team members, and insufficient planning of nurse prescribing. Facilitating factors included prescribing experience, resource and labor conservation, cost reduction, resources, nurses' prescribing training, leadership support, patients' needs, nursing professional development, nurses' competence, and team cooperation and support.
Identifying barriers and facilitators to nurse prescribing is critical for informing policy-making and clinical prescribing practices. The results offers practical guidance to develop strategic plans that enhance implementation and adoption of nurse prescribing.
Nurse prescribing improves patient access while mitigating healthcare strain. By streamlining medication delivery and optimising resource use in overburdened systems, this model strengthens patient-centered care while allowing physician specialisation in complex cases. This workforce innovation enhances team-based care and ensures continuity for vulnerable populations.
This paper identifies barriers and facilitators, offering policymakers, healthcare administrators, and educators actionable insights to enable nurse role expansion, reduce physician workload, and enhance outcomes through holistic care.
No patient or public contribution.
The aim of the study was to develop a set of nursing-sensitive quality indicators for accelerating spine surgical rehabilitation.
This is a modified Delphi study. A two-round Delphi study was conducted from November to December 2023.
Based on an evidence-based perspective and semi-structured interviews, an outline of nursing-sensitive quality indicators for accelerated rehabilitation in spine surgery patients was formulated. The Donabedian structure-process-outcome theory model was used as the theoretical framework to develop the indicator system; the indicators were improved and refined after two rounds of Delphi surveys, and the weights of the indicators were determined by the analytic hierarchy process. A total of 23 experts from 10 hospitals in 7 Chinese provinces completed the two rounds of the modified Delphi process.
The experts reached a consensus on the definition of the indicators, the calculation formula and the data collection method, and included a sensitive quality indicator system for accelerated rehabilitation care in spine surgery with 3 primary indicators, 9 secondary indicators and 26 tertiary indicators.
A set of indicators about accelerated rehabilitation care in spinal surgery covers the key aspects of patient education, assessment, measures, and rehabilitation, and its content is scientific, comprehensive, and targeted, which can provide a basis for objective evaluation of the quality of accelerated rehabilitation care in spinal surgery.
Medical institutions can routinely collect monthly data based on this indicator, conduct horizontal comparisons of the quality of accelerated rehabilitation care in spinal surgery among hospitals at the same level with the assistance of a national or even global networked auditing platform, and establish an internal safeguard mechanism for evaluating the quality of perioperative care.
This study follows the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies.
No patient or public contribution was made in this study.
FreshRSS 