Conectar
by Hyun Ju Kim, Kyung-Ah Cho, So-Youn Woo
Skin inflammation arises from complex interactions among immune cells, particularly T cells and neutrophils. Mesenchymal stem cells (MSCs) exhibit potent immunomodulatory properties, but the specific roles of tonsil-derived MSCs (T-MSCs) in regulating neutrophil extracellular trap (NET) formation and cell death, as well as T cell migration in inflammatory skin conditions, remain poorly defined. In this study, the therapeutic effects and mechanisms of T-MSCs were investigated in a 2,4-dinitrochlorobenzene (DNCB)-induced skin inflammation model, with a focus on NET formation and T cell migration. T-MSCs were intravenously administered to mice with DNCB-induced skin inflammation; inflammation severity and immune cell dynamics were evaluated using histological analysis, flow cytometry, immunostaining, microarray profiling, NET assays, and T cell migration assays. T-MSC treatment reduced DNCB-induced skin inflammation, as demonstrated by decreased epidermal thickness and neutrophil infiltration. Although T-MSCs enhanced NET formation in vitro, they suppressed neutrophil accumulation in vivo. T-MSCs also modulated the distribution and activation of T cell subsets in the skin and secondary lymphoid organs. Gene expression profiling revealed that T-MSCs regulated pathways associated with inflammation and neutrophil activity, including those involved in immune cell trafficking and NET formation. Moreover, T-MSCs promoted T cell migration, although this effect was influenced by neutrophil presence, indicating complex interplay among immune cells. These findings demonstrate that T-MSCs exert anti-inflammatory effects in DNCB-induced skin inflammation by modulating NET formation and T cell migration, revealing a novel immunoregulatory mechanism and supporting their therapeutic potential for inflammatory skin diseases.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.Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum-based 1H nuclear magnetic resonance (NMR) measurement combined with short-time Fourier transform (STFT) for time-frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time-frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision-guided treatment strategies.
Examine the relationships between workplace trust, interpersonal trust, and nurses' physical and mental health, and specifically investigate the mediating role of resilience.
Nurses are central to healthcare delivery but frequently experience workplace violence, adversely affecting their well-being. Trust represents a higher-order mechanism that fosters positive attitudes and professional growth, potentially safeguarding nurses' resilience in coping with adversity. However, research elucidating how trust influences nurses' health via resilience remains limited.
A cross-sectional study was conducted using convenience sampling. A total of 2855 clinical nurses from general hospitals in Fujian Province, China, were surveyed between August and October 2022. Workplace trust and interpersonal trust were served as independent variables, Physical Component Summary and Mental Component Summary scores as dependent variables, and resilience as a mediator. Mediation analysis was performed using Mplus 8.3. The study was prepared and reported according to the STROBE checklist.
Mean scores were Physical Component Summary: 51.12 ± 8.90, and Mental Component Summary: 48.20 ± 10.18. Workplace trust had significant direct effects on both Physical Component Summary and Mental Component Summary. Interpersonal trust had no significant direct effects on Physical Component Summary or Mental Component Summary. Resilience demonstrated significant mediating effects: for workplace trust on Physical Component Summary and on Mental Component Summary; and for interpersonal trust on Physical Component Summary and on Mental Component Summary.
Workplace trust directly enhances nurses' physical and mental health. While interpersonal trust lacks a direct link to health outcomes, both workplace and interpersonal trust significantly improve nurses' health indirectly by bolstering resilience. Resilience serves as a critical pathway through which trust fosters well-being.
No patient or public contribution.
Nurse managers and healthcare administrators should prioritise interventions to cultivate workplace trust (e.g., fostering trust among colleagues, and between nurses and the organisation/management) and strengthen interpersonal trust and psychological resilience. Enhancing these protective factors will better equip nurses to manage occupational and personal stressors, ultimately safeguarding and improving their physical and mental health.
To examine factors, including symptom burden profiles and self-care, associated with quality of life among individuals with heart failure and multimorbidity.
A cross-sectional design.
353 adults aged 50 years or older with heart failure and at least one additional chronic condition were recruited from a university-affiliated hospital. Three symptom burden groups were identified (low, moderate, and high) through latent profile analysis of the Edmonton Symptom Assessment Scale scores. The Heart Failure Self-care Index and EuroQoL-5D-5L measured self-care behaviours and quality of life. This study examined group differences and associations overall and stratified by symptom burden groups via multivariable linear regression.
A higher disease burden and the high symptom burden group compared to the low symptom burden group were associated with lower quality of life. Self-care maintenance was positively associated with a higher quality of life, but not in the high-burden group. Among individual symptoms, pain and depression were associated with lower quality of life. In the high-burden group, older age was positively associated with quality of life. Higher symptom burden groups included a greater proportion of women and middle-aged adults.
Symptom burden and self-care maintenance show significant associations with quality of life in multimorbidity. Symptom burden profiles identified through latent profile analysis may complement conventional approaches by targeting high-risk individuals, such as middle-aged individuals and women with high symptom burden, for follow-up and integrated multimorbidity management.
For healthcare providers, including nurses, these findings underscore the importance of holistic, symptom-based care approaches combined with routine support for self-care maintenance. Adopting a life-course approach, through early identification and management of high-risk individuals, may help promote aging in place with a better quality of life for those with heart failure and multimorbidity.
STROBE checklist.
No patient or public contribution.
by Yanan Fu, YuXin Wei, ZiKun Pang, Jie Yang, XinGang Sun
PurposeThis study outlines the changes in the age- and sex-specific burden of motor neuron disease (MND) in China from 1990 to 2021, focusing on the prevalence, incidence, number of disability-adjusted life years and mortality. Additionally, these trends are evaluated in comparison to the Global Burden of Disease data.
MethodsPublic data from the Global Burden of Disease database covering the period from 1990 to 2021 were analyzed to explore the burden of motor neuron disease in China and worldwide. Trends in prevalence, incidence, disability-adjusted life years (DALYs) and mortality were examined in the analysis. The average annual percentage change was calculated using Joinpoint, and the relevant 95% confidence intervals (95% CIs) were examined to identify changes in the MND burden over time. Additionally, a thorough comparative analysis was performed to investigate the differences in the MND burden between China and other regions worldwide, considering factors such as age, sex, and time periods.
ResultsFrom 1990 to 2021, the age-standardized incidence rate (ASIR) of motor neuron disease (MND) in China declined from 0.65 per 100,000 to 0.46 per 100,000, whereas the global ASIR decreased slightly from 0.81 per 100,000 to 0.77 per 100,000. In contrast, the age-standardized prevalence rate (ASPR) in China increased from 2.131 per 100,000 to 2.298 per 100,000, whereas the global ASPR decreased slightly from 3.356 per 100,000 to 3.31 per 100,000. The age-standardized mortality rate (ASMR) in China increased from 0.151 per 100,000 to 0.181 per 100,000; the global ASMR also increased from 0.38 per 100,000 to 0.46 per 100,000 during this period. Moreover, the age-standardized disability-adjusted life year (ASDR) rate in China decreased slightly from 7.995 per 100,000 to 7.672 per 100,000, whereas the global ASDR increased from 11.221 per 100,000 to 12.167 per 100,000. The average annual percentage changes (AAPCs) for the ASPR, ASIR, ASDR, and ASMR in China were −1.10%, 0.25%, 0.57%, and −0.14%, respectively. In contrast, the global AAPCs were −0.16%, −0.04%, 0.58%, and 0.26%, respectively. Age and sex played distinct roles in shaping MND burden. The ASIR of MND decreased but then increased for both sexes, remaining higher for males. Its ASPR trends differed: a slight increase in males versus an increase then decrease in females. While the ASMR was consistently higher for males, the DALYs for males started to decrease but surpassed those for females. Global MND rates have remained stable.
ConclusionThe prevalence, incidence, DALYs and mortality of motor neuron disease in China decreased between 1990 and 2021, suggesting a relative decrease in the total burden of MND in the country. Age influences the burden of MND, with a higher occurrence incidence in children and middle-aged individuals; the prevalence of MND is highest in the younger population, whereas MND-related mortality is the highest within the middle-aged and senior populations. Compared with females, males are more likely to be affected by MND and have a greater likelihood of death. Given the rapid population aging in China, MND is expected to remain a significant public health issue.
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.
To evaluate the prognostic significance of tumour deposit (TD) across different N stages in patients with stage III colon cancer and to develop and validate a novel N staging system that incorporates TD count to improve prediction of cancer-specific survival (CSS).
Retrospective cohort study based on population-based data and external validation.
Secondary and tertiary care settings; data from the SEER database, a population-based cancer registry capturing cancer incidence and survival information (USA, 2010–2017); and a single-centre validation cohort from South China (2015–2019).
A total of 8739 stage III colon cancer patients from the SEER database who underwent curative surgery were included; 1335 (15.3%) had TD. Patients with
The outcome was cancer-specific survival (CSS). The prognostic impact of tumour deposit (TD) and the comparative performance of the novel N staging system versus the AJCC system were evaluated using the Fine-Gray competing risks model, time-dependent area under the curve (AUC) and Brier score.
TD was independently associated with poorer CSS: 1 TD (SHR=1.23, 95% CI 1.04 to 1.47, p=0.017), 2–3 TDs (SHR=1.36, 95% CI 1.17 to 1.58, p3 TDs (SHR=2.02, 95% CI 1.73 to 2.35, pet al, TDs were converted to metastatic lymph nodes (mLNs) using the following weighting: 1 TD=3 mLNs (N1c), 1 TD=2 mLNs (N1) and 1 TD=1 mLN (N2). The novel N staging system stratified patients as nN1a (1 nLN), nN1b (2–3 nLNs), nN2a (4–6 nLNs) and nN2b (≥7 nLNs). This approach showed improved prognostic accuracy compared with AJCC N staging: 3-year AUC (0.623 vs 0.614) and Brier score (0.151 vs 0.157, p
TD significantly worsens prognosis in stage III colon cancer, particularly in lower N stages. Incorporating TD counts into the N staging system with different weightings based on N stage enhances prognostic accuracy and risk stratification within stage III disease, particularly for the heterogeneous AJC N1c category. This novel staging system provides better prognostic value and more accurate treatment guidance and should be considered for broader clinical use, subject to further (eg, prospective) validation.
This study aimed to investigate the association between smoking behaviours during early pregnancy and the risk and severity of gestational diabetes mellitus (GDM), with a particular focus on smoking status, smoking intensity and secondhand smoke exposure.
Secondary analysis of prospectively collected cohort data.
Multi-centre study conducted in South Korea (Korean Pregnancy Outcome Study) between March 2013 and January 2017.
From 4537 pregnant women initially enrolled, 3457 singleton pregnancies were included after excluding cases with transfer, loss to follow-up, twin pregnancies, miscarriages and pre-existing diabetes mellitus. All participants were women of Korean ethnicity.
Primary outcome was GDM and its subtypes (A1GDM: diet-controlled; A2GDM: insulin-requiring). Secondary outcomes were associations with active smoking (before pregnancy and during early pregnancy), smoking intensity dose–response relationships (pack-years) and secondhand smoke exposure among never-smokers.
Among 3457 participants, 231 women (6.7%) were diagnosed with GDM (198 A1GDM, 33 A2GDM). Active smoking before pregnancy (adjusted OR (aOR) 3.98, 95% CI 1.58 to 9.30) and during early pregnancy (aOR 9.90, 95% CI 2.97 to 29.45) were significantly associated with A2GDM, while no significant association was observed with A1GDM. A clear dose-response relationship was observed, with smoking intensity >4 pack-years markedly increasing A2GDM risk (aOR 20.68, 95% CI 6.75 to 59.39). Detailed pack-year analysis showed 4–6 pack-years (aOR 20.57, 95% CI 5.80 to 65.46) and >6 pack-years (aOR 25.98, 95% CI 3.21 to 146.45). Among never-smokers, secondhand smoke exposure showed a borderline association with overall GDM risk (aOR 1.33, 95% CI 0.98 to 1.81).
Maternal active smoking before and during early pregnancy, as well as higher smoking intensity, was associated with an increased risk of pharmacologically treated GDM (A2GDM). Although secondhand smoke exposure did not reach statistical significance, the trend suggested a potential association with GDM risk among never-smokers. These findings provide important evidence for public health strategies for prenatal care, as smoking cessation and environmental smoke avoidance during prenatal and early antenatal care in women reduce the risk of gestational diabetes.
To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
To identify the latent frailty trajectory and explore corresponding predictors among older adults living with frailty who experience hip fracture surgery within 3 months after discharge.
From December 2022 to November 2024, 178 individuals were consecutively enrolled in a longitudinal observational study conducted at a tertiary hospital in Zhejiang Province, China.
The Reported Edmonton Frail Scale measured the frailty level at 5 points, which included baseline (pre-fracture), at discharge, 2 weeks, 1 and 3 months after discharge. Latent class growth models were set up for the frailty trajectory. Multinomial logistic regression was performed to explore the predictors of frailty trajectory classes.
One hundred fifty-three participants completed the full follow-up. Latent class growth models identified 3 frailty trajectories. Class 1: moderate frailty transformed to severe frailty (n = 27; 17.65%); Class 2: mild frailty transformed to moderate frailty (n = 86; 56.20%); Class 3: pre-frailty transformed to mild frailty (n = 40; 26.15%). A higher-level D-Dimer at admission and the five-item version of the Geriatric Depression Scale increased the incidence of Class 2 compared to Class 3. The higher scores of the Abbreviated Mental Test decreased the incidence of Class 2 compared to Class 3. Longer surgical waiting time, a higher-level five-item version of the Geriatric Depression Scale and the Age-Adjusted Charlson Comorbidity Index increased the incidence of Class 1 compared to Class 3. The higher scores of the Abbreviated Mental Test and Mini Nutritional Assessment Short Form decreased the incidence of Class 1 compared to Class 3.
Three frailty trajectory classes were identified among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories.
Modifiable factors such as improving nutrition and cognitive status and managing depression, comorbidities and preoperative evaluations provide methods for future interventions to prevent or mitigate frailty among this population.
What problem did the study address? Frailty is an inherent dynamic among older adults living with frailty who experience hip fracture surgery after discharge within 3 months. Some factors affect the mitigated frailty process in this population. What were the main findings? Three frailty trajectory classes were identified in this study. And the level of their frailty worsens 3 months after surgery compared to pre-fracture. D-Dimer at admission, surgical waiting time, depressive symptoms, cognitive status, comorbidity index and nutritional status are associated with these fluctuating frailty trajectories. Where and on whom will the research have an impact? The findings of this study provide screening, intervention and discharge plan evidence for healthcare workers in orthopaedics and geriatrics Departments. Helping community healthcare workers and primary caregivers set the theoretical basis for home-based intervention programs.
We have adhered to relevant EQUATOR guidelines using the STROBE reporting method.
No patient or public contribution.
Type 2 diabetes mellitus has been associated with an increased risk of cognitive decline and dementia, with patients being 1.5–2 times more likely to develop these conditions. While both sodium-glucose co-transporter 2 (SGLT2) inhibitors and thiazolidinediones (TZDs) have shown potential neuroprotective effects in previous studies, their comparative effectiveness for preventing neurodegenerative outcomes has not been established. This study aimed to compare the risk of stroke, dementia and Alzheimer’s disease (AD) between patients treated with SGLT2 inhibitors and those treated with TZDs.
Multicentre, retrospective, observational, new-user, active-comparator cohort study.
Electronic health record-based databases from 11 secondary and tertiary institutions in South Korea from 1 January 2014 to 31 July 2025. The study period began in 2014, following the post-marketing surveillance initiation of SGLT2 inhibitors in Korea (November 2013), to ensure adequate drug availability and clinical adoption.
Patients aged 40 years or older who were newly prescribed either SGLT2 inhibitors or TZDs without prior exposure.
Propensity score matching (1:1) was performed using sex as the primary covariate due to data availability constraints in the Observational Medical Outcomes Partnership Common Data Model framework. The HRs with 95% CIs were measured via Cox regression analysis.
The study analysed 24 172 matched pairs for stroke outcomes (40 483 person-years in the SGLT2 inhibitor group and 39 363 person-years in the TZD group), 25 111 matched pairs for dementia (41 924 person-years in the SGLT2 inhibitor group and 40 726 person-years in the TZD group) and 25 237 matched pairs for AD (42 139 person-years in the SGLT2 inhibitor group and 40 895 person-years in the TZD group) across 11 participating hospitals. After a 1:1 propensity score matching, the SGLT2 inhibitors showed no significant difference in stroke risk (HR 1.18, 95% CI 0.62 to 2.23, p=0.62), while having significant reductions in dementia risk (HR 0.66, 95% CI 0.45 to 0.98, p=0.04) and AD risk (HR 0.54, 95% CI 0.35 to 0.83, p=0.005). Moreover, these protective effects for neurodegenerative outcomes were shown to be consistent across multiple hospital sites.
SGLT2 inhibitors are associated with a reduced risk of dementia and AD compared with TZDs in patients aged 40 years or older with type 2 diabetes and have neutral effects on stroke risk. These findings confirm the potential selective neuroprotective benefits of SGLT2 inhibitors for neurodegenerative outcomes, which may inform therapeutic decision-making for diabetic patients at risk of cognitive decline.
Mentoring has been identified as a promising strategy for implementing and sustaining evidence-based practice (EBP) in healthcare organisation. However, no appropriate tools were specifically developed or cross-culturally adapted into Chinese context to assess nurse’s perceived EBP mentoring, impeding comprehensive evaluation of the effects of mentoring intervention studies. This study aimed to cross-cultural adapt the Evidence-Based Practice Mentoring (EBPM) scale into Mainland China and evaluate its psychometric properties, including validity and reliability.
A comprehensive translation and adaptation process was adopted to achieve the Chinese version of the EBPM (C-EBPM) scale. It consists of four steps: (1) trilateral translation procedure, (2) cognitive interview, (3) psychometric testing and (4) cross-time confirmatory factor analysis (CFA).
This study was conducted in four 3A-level hospitals located in Shaanxi and Zhejiang provinces, China, during two different data collection periods.
A total of 598 registered nurses participated in this study.
After two rounds of the trilateral translation procedure, a 9-item version of the C-EBPM scale was generated. Ten registered nurses participated in cognitive interview understood the meaning of all items but the response options. All items had significant critical ratio values (t=15.866~20.584, p²/df=65.681/27 0.950, Tucker-Lewis Index=0.966 > 0.950, and standardised root mean square residual=0.026 0.70) and average variance extracted was 0.60 (>0.50).
The 9-item C-EBPM scale demonstrated robust reliability and validity and is suitable for assessing EBP mentoring among nurses.
Chronic kidney disease (CKD) is a significant public health problem that requires effective preventive and conservative methods to limit morbidity and death.
This study aims to give clinical practice an evidence-based basis for the clinical practice of healthcare professionals by methodically looking for the best available data on conservative strategies and CKD prevention in high-risk and early-stage patients.
The 6S evidence resource model was followed and states that evidence retrieval was done top-down, gathering necessary studies from January 2014 to July 30, 2024. Databases searched included BMJ Best Practice, DynaMed, NICE, GIN, SIGN, JBI Evidence Synthesis, JBI Evidence Implementation, Cochrane Library, and PubMed. Following the JBI grade of evidence and recommendation methodology, two reviewers independently examined and assessed the literature, extracting and summarizing evidence.
Seventy-nine publications were identified: 18 guidelines, 1 randomized controlled trial, 2 expert consensus statements, 36 evidence summaries, and 22 systematic reviews and meta-analyses. Key findings were summarized across eight aspects: risk assessment and early detection, risk factors and prevention of genetic factors, management of diabetic nephrology, impact of bariatric surgery on preventing CKD, screening and diagnosis, treatment and prevention strategies, lifestyle modifications, and CKD prevention.
This study summarized the best evidence for preventing CKD from eight aspects, which can help clinical or community medical professionals develop and apply CKD preventive strategies for high-risk groups and early-stage patients. By using these evidence-based strategies, healthcare professionals can reduce the incidence and progression of CKD, leading to fewer hospitalizations, improved kidney function preservation, and enhanced long-term survival and quality of life for patients. Future research should address identified gaps and explore the implementation of these strategies in diverse clinical settings.
Patients undergoing abdominal surgeries have a chance to experience surgical-related anxiety. But the most effective non-pharmacological interventions in managing this anxiety have not yet been identified.
To examine the effectiveness of different types of non-pharmacological interventions, and identify the effective components on pre- and postoperative anxiety management among patients undergoing abdominal surgeries.
A systematic search of randomized control trials (RCTs) examined the effects of non-pharmacological interventions on preoperative and/or postoperative anxiety (Primary outcomes) among patients undergoing abdominal surgery was conducted across MEDLINE, Ovid Nursing, AMED, PsycINFO, CINAHL, EMBASE, Cochrane Library, HyRead, and WANFANG DATA from 1987 to March 1, 2024. Secondary outcomes including postoperative pain, postoperative analgesics consumption, resumption of postoperative bowel movements, and length of hospital stay were also examined. Cochrane Risk of Bias Tool (version 2.0) was used for quality assessment. Meta-analysis was performed to synthesize the findings. Narrative summaries were provided for the studies that could not be included in the meta-analysis.
This review included 35 RCTs. The interventions of included studies were categorized as prehabilitation, sensory stimulation, preoperative counseling, information provision, and psychological interventions. Meta-analysis revealed that preoperative counseling was beneficial in managing preoperative anxiety (SMD = −1.36; 95% CI = −1.96, −0.76), postoperative anxiety (SMD = −1.30; 95% CI = −1.62, −0.98), and postoperative pain (SMD = −0.84; 95% CI = −1.21, −0.47). Meanwhile, psychological interventions adopting relaxation exercises had potential effects in reducing postoperative opioid consumption and shortening time to postoperative bowel movement.
Adopting preoperative counseling is suggested for the management of pre- and postoperative anxiety and postoperative pain among patients undergoing elective abdominal surgeries. A one-off lasting for 20–45 min preoperative counseling including individualized information about the coming surgery and perioperative process, and a discussion addressing patients' concerns is recommended. Future research is needed to explore the effects of relaxation exercise on important patients' outcomes such as postoperative analgesics consumption and time to resume bowel movement among patients undergoing abdominal surgery.
PROSPERO registration number: CRD42023359484
To assess the association between ambient ozone (O3) exposure and semen quality among men with unhealthy behaviours and low income.
A case-control study was conducted from February 2024 to January 2025, in which male participants aged 18–45 years were recruited from Foshan, and following propensity score matching, a total of 820 participants were included in the final analysis.
The evaluated the association between O3 exposure during the 70–90 days, 10–14 days, 0–9 days and 0–90 days prior to semen collection and semen quality using stepwise conditional logistic regression analyses, and restricted cubic splines were incorporated into the models.
O3 exposure during the 70–90 days and 0–90 days preceding semen sample collection was significantly associated with an increased risk of low semen quality, with ORs of 1.020 (95% CI 1.003 to 1.039) and 1.056 (95% CI 1.008 to 1.108), respectively. Additionally, O3 exposure during the 0–90-days period showed a significant positive association with abnormal sperm concentration. A non-linear relationship between O3 exposure and sperm concentration was also observed. Notably, O3 exposure during the 0–9 days before semen collection was inversely associated with the risk of low semen quality. Subgroup analyses across age, lifestyle factors and socioeconomic strata revealed no significant effect modifications.
This study found that O3 exposure during the 70–90 days and 0–90 days before sampling was associated with reduced semen quality in men with unhealthy behaviours and low income.
To explore the lived experiences and daily interactions of older couples living with multimorbidity.
A descriptive-interpretive qualitative study based on a generic interpretive description framework.
A total of 20 dyads were recruited using a purposive sampling strategy, and 24 semi-structured in-depth interviews were conducted between May 2023 and January 2025. Reflexive thematic analysis was used to analyse data.
Four overarching themes were generated: (1) dynamic relationship structures; (2) diverse interaction patterns; (3) double burdens; and (4) double resilience. Dynamic relationship structures occurred in dyadic and triadic forms. Diverse interaction patterns involved independence, interdependence and dependence. Double burdens manifested as physical toll, financial hardship, emotional contagion and perceptual misalignment, whereas double resilience was reflected in the nudge effect, emotional resonance and promotion of family ownership of health.
This study adopted a dyadic perspective to explore the experiences and interactions of older couples living with multimorbidity. The caring dynamics and blurred roles of patient and care partner deviate from the traditional unidirectional, linear model of ‘one person caring for the other’. Formal or informal caregiving support from third parties, as well as the nudge effect and emotional resonance between spouses, may help orient older couples as they navigate the challenges associated with multimorbidity.
Our findings indicate that community nurses can play a proactive role in identifying older couples living with multimorbidity through routine care attendance and assessments, enabling early recognition of health management needs. Geriatric nurses can leverage insights into couples' interaction patterns to tailor more effective care plans at different stages of illness, monitor emerging risks and identify optimal timing for third-party support. By facilitating a responsive triadic network, nurses can help ensure continuous and sustainable health care.
Adhered to SRQR guidelines for qualitative research.
This study did not include patient or public involvement in its design, conduct, or reporting.
Active self-management by patients following acute coronary syndrome (ACS) can reduce recurrent events. Patient education for transitioning from hospital to home promotes effective self-management but can be limited in the acute setting due to time and resource pressures. Patients from ethnic minority and immigrant backgrounds face additional language, cultural and health literacy barriers to receiving patient education. Self-administered virtual patient education presents an innovative solution to these challenges. This study aims to evaluate a co-adapted, virtual avatar nurse-guided, discharge education application (app) for Chinese-speaking patients following ACS.
This multicentre, assessor-blinded, randomised controlled trial will recruit 98 Chinese-speaking inpatients following ACS with evaluation at 1 and 3 months postdischarge. Control participants in the control group will receive the usual ward-based patient discharge education. Intervention participants will additionally receive the education app installed on their devices before hospital discharge with unlimited access during the study period. Cultural relevance and linguistic accuracy for this Chinese version of an existing app were ensured through co-adaptation with Chinese-speaking consumers; the primary outcome will be coronary heart disease (CHD) knowledge, and secondary outcomes will include knowledge, attitudes and beliefs regarding heart attack symptoms and responses, CHD self-management behaviours, utilisation of healthcare services and quality of life. A process evaluation will be conducted alongside the trial to assess the acceptability and feasibility of the app. Between-group comparisons will be made using 95% CIs, accounting for baseline differences using linear mixed effects or mixed effects logistic regression models.
The Western Sydney Local Health District Human Research Ethics Committee has approved this study protocol (26 February 2024, amendment number 2) (2024/STE00147), with site-specific authorisations obtained from each participating hospital. The results will be disseminated through peer-reviewed journal articles and presentations at scientific conferences.
ACTRN12624000408583.
This study aimed to investigate the network structural characteristics of self-efficacy and professional resilience among emergency nurses, identify core nodes within the network, and elucidate the key interactive mechanisms between these constructs.
Descriptive cross-sectional study.
A multi-center cross-sectional study was conducted from January to February 2025, involving 612 emergency nurses from 20 hospitals in Sichuan, China. Data were collected using a self-administered demographic questionnaire, the General Self-Efficacy Scale, and the Chinese Emergency Nurse Professional Resilience Tool. An adjacent network integrating professional resilience and self-efficacy was developed. Key covariates—including title, position, tenure in the hospital or emergency department, education, and exposure to workplace violence—were included as control variables. Network precision and stability were evaluated using the correlation stability coefficient and confidence intervals for edge weights. To further test the robustness of the network model, sensitivity analyses were performed by adding each significant covariate to the original model. The Network Comparison Test was then used to compare the covariate-adjusted and unadjusted networks, assessing differences in network structure, overall strength, and edge weights.
The analysis identified S9 as the central node in the network. The overall network showed satisfactory stability and precision. The Network Comparison Test showed no significant differences in network structure or global strength between the adjusted and unadjusted models, indicating that the network was stable and robust to covariate adjustment.
This network analysis revealed the interaction mechanisms between self-efficacy and professional resilience among emergency nurses through contemporaneous network modelling and identified S9 as the core node, suggesting that this coping strategy plays a key role in regulating psychological resources. The overall network demonstrated good stability and precision, with no statistically significant differences between the adjusted and unadjusted models according to the Network Comparison Test. These findings indicate that the network structure was robust to covariate adjustment and provide a reference for developing and optimising intervention strategies to enhance professional resilience among emergency nurses.
For Emergency Nurses and the Management of Emergency Nursing Practice: What problem does this study address?
This study addresses the gap in understanding how self-efficacy and occupational resilience interact in emergency nurses under high-stress conditions.
A contemporaneous network analysis revealed a central node linking self-efficacy and resilience, highlighting key pathways in their mutual influence.
The findings offer practical guidance for emergency nursing management, supporting the development of targeted strategies to strengthen nurses' resilience, enhance professional competence, and improve the quality of emergency care.
This study is reported using the STROBE guidelines.
No Patient or Public Involvement: This study did not include patient or public involvement in its design, conduct, or reporting.
To translate, culturally adapt and validate the first Spanish version of the Person-centred Practice Inventory-Care (PCPI-C) instrument.
Cross-cultural adaptation and psychometric validation.
Two-phase research design: (1) the PCPI-C's translation and cultural adaptation from English to Spanish following the ‘Translation and Cultural Adaptation of Patient-Reported Outcomes Measures-Principles Guide of Good Practice’ tool; and (2) a cross-sectional quantitative survey to assess the Spanish version's psychometric properties.
A sample of 200 patients participated to obtain the PCPI-C's Spanish version. No significant issues arose during the translation process or the consulting sessions. No item exhibited an inadequate value following adjustment via the weighted kappa index (−scale-level content validity average of 0.95 for clarity and 0.97 for relevance). Psychometric evaluation revealed acceptable internal consistency (Cronbach's alpha from 0.67 to 0.84) and strong construct validity. Exploratory and confirmatory factor analyses supported a five-dimensional structure consistent with the domain Person-Centred Processes. Fit indices improved after model refinements, achieving CFI = 0.92, SRMR = 0.05 and RMSEA = 0.07. This study's observed psychometric properties confirm that the PCPI-C's Spanish version retains the original instrument's theoretical integrity, while showing strong reliability and validity in the new context.
The PCPI-C's Spanish translation was psychometrically valid when tested with Spanish patients, thus providing a culturally appropriate, psychometrically sound tool to evaluate Spanish-speaking patients' perception of person-centred care.
This study provides a validated instrument that allows for the assessment of person-centred practice in Spanish-speaking clinical environments. It enables healthcare professionals to measure patients' perceptions, track the implementation of person-centred principles and supports international comparative studies, contributing to the development of more ethical and responsive models of care.
Patients participated in cognitive consultations and completed the survey for psychometric testing, ensuring that the translated items were understandable, culturally appropriate and reflective of their experiences of person-centred care.
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