Conectar
by Juliana Ju Yun Hoo, Shumetha Sidhu, Kok Wei Tan
Rapid urbanization has increased disconnection from nature, especially in cities. While research on restorative environments has largely focused on non-tropical regions, little is known about the restorative potential of tropical urban green spaces (UGSs). This study assessed the perceived restorativeness of tropical UGSs in Malaysia using 120 environmental stimuli from nature, urban, and mixed urban-nature settings. 87 participants were randomly assigned to one of the three modalities: audio-only, visual-only, or bimodal. Each participant rated a subset of 30 stimuli on perceived restorativeness. Results showed that nature and mixed urban-nature scenes were in general rated as more restorative than urban scenes. An interaction effect indicated that, in the visual-only modality, mixed urban-nature scenes were perceived as more restorative than nature scenes, while no significant differences were observed in the audio-only and bimodal modalities. Moreover, perceived restorativeness for nature scenes was comparable across bimodal, visual-only, and audio-only presentations. These findings suggest that small pockets of urban nature (e.g., tree-lined streets, rooftop gardens) can offer greater psychological restoration than wild, untamed forests. In addition, high-quality nature sounds (e.g., birdsong, flowing water) can provide restorative benefits comparable to visual exposure when access to green views is limited. Such insights can inform urban planning strategies to design more restorative and liveable cities.by Yishu Wang, Ling Zhu, Shuna Jin, Yuhan Wang, Zhaoxiang Zeng, Yunzhou Zuo, Xingliang Xiang, Xugui Li, Rongzeng Huang, Chengwu Song
BackgroundSex hormones play critical roles in the pathogenesis and progression of osteoarthritis (OA), yet the hormone-related molecular networks remain poorly defined. This study aimed to identify candidate sex hormone-associated genes in OA and to explore their potential functional enrichment and immune-related characteristics using bioinformatics analysis.
MethodsOA gene expression data were obtained from the GEO database and integrated with candidate sex hormone-associated genes retrieved from GeneCards. The R package “limma” was then used to identify differentially expressed genes (DEGs) and sex hormone-associated DEGs (SADEGs). OA-associated SADEGs, termed OA-SADEGs, were selected using weighted gene co-expression network analysis (WGCNA), and their potential biological functions and pathways were explored by GO and KEGG enrichment analyses. Hub genes were identified using three machine learning models. xCell analysis was used to estimate immune infiltration and its associations with hub genes, and hub gene expression was further evaluated in external datasets and peripheral blood samples.
ResultsWe identified 32 sex hormone-associated genes in OA, enriched in extracellular matrix remodeling, receptor signaling, and antigen presentation pathways. Three candidate hub genes (LOXL1, HLA-DRA, and CYBB) were consistently upregulated in OA and showed significant correlations with immune infiltration scores. xCell analysis identified 13 differentially enriched immune cell types, of which three were associated with hub genes. External dataset analysis and peripheral blood qRT-PCR showed upregulation of LOXL1, HLA-DRA, and CYBB in OA samples.
ConclusionThis study integrated bioinformatics and immune analyses to identify candidate sex hormone-associated genes in OA. These findings provide associative bioinformatics evidence for sex hormone-associated molecular features in OA.
To provide evidence for selecting and developing reliable clinical assessment tools for hypoglycemia in diabetic kidney disease patients during haemodialysis.
Review.
Systematic searches were performed in 9 Chinese and English databases to collect literature regarding the development of hypoglycemia risk prediction models in haemodialysis patients with diabetic kidney disease. Two reviewers independently performed literature screening, data extraction, risk-of-bias assessment, and applicability evaluation. The Prediction Model Risk of Bias Assessment Tool was used to assess the risk of bias and applicability of the included studies. Meta-analysis was conducted using R software.
CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, EMbase, Web of Science, and CINAHL. The search period covered from the establishment date of each database to December 2025.
Six studies, comprising six prediction models, were included. Two studies performed internal validation, and three conducted external validation. All models reported the area under the curve, ranging from 0.813 to 0.866, and calibration measures. Four studies were rated as having a high risk of bias, while all six demonstrated good overall applicability. The meta-analysis showed that the pooled AUC value of the six studies was 0.846 (95% CI: 0.823–0.867).
Research on hypoglycemia risk prediction models in haemodialysis patients with diabetic kidney disease remains in the developmental stage. Although the included prediction models exhibited satisfactory apparent discriminatory ability and clinical applicability, most of the original studies suffered from a high risk of bias and lacked adequate validation. The true predictive performance and clinical application value of these models remain to be further verified. Accordingly, routine and unconditional clinical application is not recommended at this stage. Future studies should include more high-quality, multicenter external validation and develop models with high generalizability, favourable clinical applicability, and robust predictive performance to facilitate early identification of hypoglycemia risk in this population.
This study systematically evaluated the hypoglycemia risk prediction models for diabetic kidney disease patients during haemodialysis, and the research on hypoglycemia risk prediction models for maintenance haemodialysis patients during dialysis is still in the development stage. This study provides a reference for clinical medical staff to select or develop hypoglycemia risk prediction and assessment tools for diabetic kidney disease patients during haemodialysis.
This study was conducted in accordance with the relevant guidelines of the EQUATOR Network and followed the TRIPOD-SRMA Checklist.
No patient or public contribution.
PROSPERO: CRD420251243352
Worldwide, billions of children and young people live in areas affected by war. Suicide remains one of the three leading causes of death worldwide among people aged 15–29 years. However, little is known about the effect of war on suicidal behaviours in this group. This review aims to assess suicides, suicide attempts and suicidal ideation among children and young people exposed to war or armed conflict.
A scoping review of studies was conducted using Web of Science, PubMed, Embase and PsycINFO databases from their inception to 18 November 2025, without any restrictions on geographical location. We included only observational studies with full-text, peer-reviewed English articles reporting any suicides, suicide attempts and suicidal ideation of children and young people aged 0–24 years exposed to war. The quality of the included articles was assessed using the Quality Assessment with Diverse Studies. The protocol of the review was registered with the Open Science Framework on 29 March 2022 (https://osf.io/7kszh/).
Of the 3229 articles retrieved, 37 studies were eligible for review, providing data from 24 countries and covering a period of almost a hundred years (1921–2025). Most studies (>20) focused on conflicts ongoing during or until the 2000s, whereas only three focused on World War II. The reported outcomes were suicides (n=9), suicide attempts (n=15) and suicidal ideation (n=21). Included studies spanned six continents, from Latin America (n=5, Colombia only) to Europe (n=10). We assessed the suicide rates during and after wars. There was some evidence of a decrease in suicide rates during war, but no clear trend in suicide rates post-war was observed. The prevalence rates of suicide attempts and suicidal ideation varied widely, without uniformity in the definitions used. War-related trauma, mental health problems, substance abuse and exposure to suicide or suicide attempts were identified as risk factors, while protective factors included family and social support.
There is a need for more methodologically consistent and rigorous research on suicidal thoughts and behaviours in children and young people exposed to war or armed conflicts. Future research should identify mediator/moderating factors influencing suicidal behaviours and their links to mental health.
by Yanan Zhu, Qian Wang, Huiying Jia, Gaiyun Zhao, Yunpeng Lü, Xinhong Zhang, Haijing Dong
This randomized controlled trial is aimed at evaluating whether external fixation of the urinary catheter to the body surface represents a low-value nursing intervention for patients undergoing transurethral resection of the prostate (TURP). A total of 208 patients who received indwelling urinary catheters after TURP in a tertiary hospital in Qingdao, China between June 2024 and May 2025 were randomly assigned to one of two groups: a nonexternal fixation group (n = 103) and an external body surface fixation group (n = 105). A between-group comparison of outcomes included postoperative hematuria, incidence of catheter-associated urinary tract infection (CAUTI), unplanned catheter removal, occurrence of urinary catheter-related meatal pressure injury (UCR-MPI), and associated economic costs. No significant differences were observed between the two groups in terms of postoperative hematuria or CAUTI incidence (P > 0.05). Unplanned catheter removal did not occur in either group. However, UCR-MPI occurred significantly more frequently in the external fixation group (9 patients) than it did in the nonexternal fixation group (1 patient) (Pby Eui Jun Lee, Jae Yun Jung, Do Kyun Kim, Joong Wan Park, Young Ho Kwak
Pediatric emergency triage is a safety-critical task, and recent studies have explored whether artificial intelligence, including language models, can support triage decision-making; however, evidence on fine-tuned open-weight language models remains limited. We conducted a retrospective benchmark study using de-identified triage records from a tertiary pediatric emergency department in Korea collected from January 2020 to April 2025. After exclusions, 74,170 encounters were included. Each encounter was reconstructed into a case-level text sequence from triage-time structured variables and nurse-authored narratives. Qwen3-8B-Base was fine-tuned with Low-Rank Adaptation and Group Relative Policy Optimization using a safety-oriented reward design and was compared with a structured-data XGBoost model on a common evaluable test subset of 14,832 encounters. The fine-tuned model achieved an accuracy of 58.60%, a macro-F1 score of 0.417, and a quadratic weighted kappa of 0.535. Within-one-level agreement was 97.13%, and strict under-triage, defined as true Korean Triage and Acuity Scale levels 1 or 2 predicted as levels 4 or 5, occurred in 0.65% of cases. The structured-data comparator showed higher overall performance, with an accuracy of 69.40%, a macro-F1 score of 0.618, and a quadratic weighted kappa of 0.651. However, the fine-tuned model showed fewer extreme errors and lower strict under-triage in selected high-acuity groups, at the cost of higher over-triage. In this real-world pediatric benchmark, the fine-tuned language model did not surpass the structured-data comparator in overall performance but showed a distinct safety-oriented error profile. These findings support its potential role as a decision-support aid for human triage review rather than an autonomous triage system. External and prospective validation will be necessary before clinical implementation.To identify and differentiate workload patterns across shifts and to provide evidence for optimizing nursing workforce allocation in emergency departments:
A cross-sectional study.
Real time data were collected from an emergency department in a general hospital in Seoul, South Korea, between October 30, 2023 to October 24, 2024. Smartphones, beacons, and smartwatches were used to capture nursing time, physical activity, work-related characteristics, and location transitions across 238 shifts. A multiclass eXtreme Gradient Boosting model was developed and evaluated to classify working shifts (day, evening, night). Shapely Additive exPlanations were applied to identify key contributing features, and shift-specific differences were examined using analysis of variance with post hoc tests.
The model demonstrated strong performance in distinguishing shifts. Key features included the number of admissions, discharges, assigned patients, and both direct and indirect nursing time, all of which varied across shifts. In contrast, location transition patterns were relatively consistent.
Shift-specific nursing workloads in emergency departments can be effectively identified using multidimensional, real-world nursing activity data.
Findings support the development of staffing strategies that account for variation in workload across shifts, with potential to improve efficiency and maintain quality of care.
This study addresses the lack of objective evidence for shift-specific workload differences in emergency nursing. It demonstrates that multidimensional activity data can distinguish workload patterns across shifts. The findings may inform staffing decisions for emergency department nurses and support improvements in workforce management and patient care.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
No patients or members of the public were involved in the design, conduct, analysis, or reporting of this study.
Disparities in cancer care among lesbian, gay, bisexual and transgender (LGBT) individuals persist across healthcare systems worldwide. Nurses play an important role in delivering culturally competent cancer care; however, limited research has examined nurses' practices in caring for LGBT individuals with cancer and identified factors influencing such care, particularly in non-Western cultural contexts.
To examine nurses' experiences in providing cancer care for LGBT individuals, their cancer care behaviours, influencing factors and perceived needs regarding knowledge, skills and care settings for delivering culturally competent cancer care.
Cross-sectional survey.
Between September and December 2024, a cross-sectional survey was conducted in Taiwan across two hospitals, ten nursing associations, five cancer-related foundations and three online nursing communities. A total of 608 nurses with experience caring for patients with cancer were recruited through purposive and snowball sampling. Nurses completed either an online or paper-based survey.
Nearly half of the nurses had no prior experience providing cancer care for LGBT individuals. Experience providing such care was associated with older age, non-heterosexual identity, longer length of service, higher LGBT-related care competencies and higher levels of job-related compassion satisfaction and stress. Affirmative cancer care behaviours were associated with a broader and more integrated set of competencies, including knowledge, attitudes, skills, affirmative beliefs and job-related compassion satisfaction. Nurses also reported unmet needs regarding knowledge, skills and care settings for delivering culturally competent cancer care to LGBT individuals.
These findings highlight the importance of education, resources and resilience support to strengthen nurses' delivery of culturally competent cancer care for LGBT individuals.
Related training courses, curricula and supporting resources are essential to enhance nurses' culturally competent cancer care practices for LGBT individuals.
STROBE checklist.
No patient or public contribution.
Mycoplasma pneumoniae (MP) is a major cause of community-acquired pneumonia in children. In East Asia, the prevalence of macrolide-resistant MP (MRMP) has surged, leading to treatment failures and prolonged illness. While doxycycline is an effective alternative, its use in young children has historically been limited due to concerns about tooth discolouration. This study aims to evaluate the efficacy and safety of doxycycline compared with azithromycin as a first-line treatment for children with pneumonia suspected of MRMP infection.
This is a multicentre, randomised, open-label, parallel-group superiority trial conducted at 14 tertiary hospitals in South Korea. A total of 208 children (aged 3–17 years) with pneumonia and confirmed or suspected MP infection will be randomised 1:1 to receive either doxycycline (4 mg/kg/day in two divided doses for 7–14 days) or azithromycin (10 mg/kg on day 1, then 5 mg/kg on days 2–5) (). Randomisation will be stratified by age (3–7 years vs 8–17 years). A standardised ‘rescue therapy’ protocol ensures patient safety by allowing control group patients to switch to doxycycline if no clinical improvement is observed within 48–72 hours. The primary outcome is the defervescence rate within 72 hours after randomisation. Secondary outcomes include treatment failure rate, length of hospital stay, symptom duration and adverse events. Safety assessment will specifically include tooth discolouration evaluation at Day 28, focused on children aged
This study has been approved by the Institutional Review Boards (IRB) of all participating centres. Written informed consent will be obtained from parents or legal guardians, and assent will be obtained from children aged 7 years and older. Results will be disseminated through peer-reviewed publications and conference presentations.
by Seo-Yun Choi, Yuri Jang
Perceived neighborhood danger poses significant risks to mental health in later life, yet the underlying psychological mechanisms remain unclear. Given that environmental stressors can compromise sleep health, we conceptualize insomnia symptoms as a potential mediator in the association between perceived neighborhood danger and depressive symptoms. Data from 2,240 adults aged 65 or older from Wave 3 of the National Social Life, Health, and Aging Project (NSHAP) were analyzed. Multivariate analyses showed significant associations of both perceived neighborhood danger and insomnia symptoms with depressive symptoms after controlling for sociodemographic and health covariates. Bootstrap mediation analysis provided supportive evidence for the indirect effect of perceived neighborhood danger on depressive symptoms through insomnia symptoms (B = .04, SE = .01, bias-corrected 95% CI = [.02, .07]), accounting for 25.8% of the total effect. Insomnia symptoms were identified as an important pathway through which perceived neighborhood danger undermines mental health in older adults.Cardiac rehabilitation (CR) is an effective intervention for improving outcomes in patients with coronary heart disease (CHD). However, the actual participation rate is unsatisfactory and exhibits significant gender disparities. This study aimed to investigate gender-specific determinants of the decision to participate in CR among patients with CHD, together with underlying causes.
Cross-sectional study.
A cross-sectional survey of 264 patients with CHD from 3 Chinese tertiary hospitals between February 2024 and February 2025. Data were collected using questionnaires based on the Information Need in Cardiac Rehabilitation scale, the Chinese version of Cardiac Rehabilitation Barriers Scale, the Family APGAR index questionnaire, and the International Physical Activity Questionnaire-Short Form.
There were 158 men aged 66 (SD = 13.3) and 106 women aged 66 (SD = 11.0). 55.1% of men CHD patients decided to participate in CR, significantly higher than in women patients (34.0%; χ 2 = 11.351, p = 0.001). Logistic regression analysis for men indicated that the facilitators of the decision to participate in CR were the level of family functioning and ≥ 2 comorbidities. The barriers included emergency/safety information needs and functional status. For women, the facilitators were retirement, family functioning level, being overweight/obesity, ≥ 2 comorbidities, and work/vocational/social factors. The barriers included medication information needs, logistical factors, and functional status. Fairlie decomposition revealed gender differences primarily driven by work/vocational/social factors (contribution: 71.19%), functional status (50.50%), and retirement (−39.16%) (all p < 0.05).
This study highlights the necessity of gender-specific interventions during the decision-making phase for CR. Healthcare professionals should tailor CR strategies to address women's social role barriers and men's emergency risk concerns, while enhancing family functioning and targeting support for functional status and work-related factors.
STROBE checklist, cross-sectional.
Three tertiary hospitals assisted in participant recruitment.
Deprescribing is important because inappropriate polypharmacy increases the risk of adverse drug events, treatment burden, reduced adherence and healthcare costs, while potentially compromising patient safety and quality of life. This study aimed to investigate the perceived barriers and enablers experienced by healthcare professionals (HCPs) in Indonesia regarding deprescribing in patients with type 2 diabetes (T2D) and polypharmacy.
A qualitative study using focus group discussions (FGDs) and thematic analysis.
Four FGDs were conducted with general practitioners, specialists (internists) and pharmacists from healthcare facilities in West Java Province, Indonesia. Each group included 3–4 participants from the same discipline, with one mixed group that included one participant of each profession. In total, 13 participants were included in the study.
HCPs across disciplines recognised the goals of deprescribing as optimising treatment, reducing polypharmacy risks and preserving treatment outcomes. However, implementation was hindered by the lack of clear guidelines, hierarchical dynamics, limited training and resource constraints, particularly in rural and high-volume settings. Enablers included clinical competence, effective communication, access to comprehensive clinical data and interprofessional collaboration. Patient education level, family support and community engagement were also key, underscoring the need for system-level support and shared decision-making to achieve effective deprescribing.
Deprescribing in T2D with polypharmacy is shaped by clinical competence, interprofessional collaboration, patient engagement and system-level resources. Improving practice in Indonesia requires clear guidelines, targeted HCP training, stronger interprofessional communication, better access to patient data and active involvement of patients and families. These strategies could provide context-specific insights to guide practice and policy on deprescribing initiatives.
766/UN6.KEP/EC/2024
Parenting concerns, stemming from cancer's projected impact on children, are a common and significant source of emotional distress for parents. A quantitative synthesis of existing data is critically absent, and the role of modulating factors (e.g., male sex, single parenthood, and the number of children) remains unclear.
This meta-analysis aims to quantify the association between parenting concerns and emotional distress in cancer patients, examining male sex, single parenthood, and number of children as key moderators.
This systematic review and meta-analysis followed PRISMA guidelines. Searches (PubMed, Embase, PsycINFO, Airiti Library; inception-November 2025) identified observational studies of adult cancer patients with minor children. Data on parenting concerns, anxiety, and depression were extracted and appraised using a modified JBI Checklist. Correlations were synthesized. Meta-regression addressed the quantitative void, examining male sex, single parenthood, and number of children as key moderators. Publication bias and sensitivity were assessed.
We included 12 studies (N = 3895). Our meta-analysis found significant positive associations (r = 0.50, p < 0.001) between parenting concerns and both anxiety and depression. Meta-regression, controlling for time since diagnosis, identified male sex, single parenthood, and fewer children as significant moderators for anxiety (p < 0.001), with similar trends for depression.
This meta-analysis highlights parenting concerns linked to distress in cancer patients, with fathers, single parents, and those with fewer children particularly vulnerable. Routine assessment and tailored, family-centered psychosocial interventions are urgently needed.
This systematic review was registered with the International Prospective Register of Systematic Reviews and Meta-analysis (PROSPERO; Registration No. CRD42024592899).
by Yuting Wang, Jun Li, Zhongsu Yu, Shuyuan Li, Yuxia Chen, Yun Pan, Liangping Cheng, Guangyuan Yu
Acute pancreatitis (AP) is a severe inflammatory disorder in which pyroptosis—a pro-inflammatory form of programmed cell death—may contribute to pathogenesis. However, the complete transcriptional profile of pyroptosis-related genes (PRGs) in AP and their potential as diagnostic biomarkers remain underexplored. This study aimed to systematically characterize pyroptosis-associated transcriptional signatures and identify the reliable biomarkers for diagnostic purposes. Three transcriptomic datasets from murine AP models were integrated to identify pyroptosis-related differentially expressed genes (PRDEGs). Functional enrichment and immune cell infiltration analyses were conducted to elucidate the biological pathways and immune microenvironment alterations associated with these genes. mRNA-transcription factor (TF) and mRNA-microRNA (miRNA) regulatory networks were constructed to investigate underlying molecular interactions. Machine learning techniques, including support vector machine (SVM) and least absolute shrinkage and selection operator (LASSO), were applied for feature selection, leading to the identification of key diagnostic markers and the development of a logistic regression model. The regression model were then assessed using an independent cohort of human peripheral blood samples. Eleven PRDEGs were identified, with enrichment observed in processes such as cytoskeletal organization, cell-substrate adhesion, and critical inflammatory signaling pathways, including MAPK and NF-κB. Immune infiltration analysis revealed significant correlations between these PRDEGs and various immune cell subsets, particularly M1 macrophages, Treg cells, and monocytes. A four-gene diagnostic signature, comprising ANXA3, IQGAP1, RELA, and VTN, was established through SVM and LASSO analysis. In the independent human cohort, the fixed-coefficient four-gene model demonstrated reduced discrimination, which likely reflects interspecies and tissue-specific variations. However, after optimizing the model to exclude non-significant predictors, a refined two-gene signature (ANXA3 and IQGAP1) exhibited improved accuracy, with excellent calibration and clinical net benefit. This study offers a comprehensive transcriptomic analysis of the pyroptosis-mediated landscape and immune microenvironment in AP. An optimized two-gene signature, comprising ANXA3 and IQGAP1, was validated in a human cohort with superior accuracy, reflecting critical disruptions in inflammatory pathways and cytoskeletal organization. Notably, ANXA3 demonstrated potential for stratifying disease severity. Although these markers hold potential for molecular diagnosis, further prospective studies are essential to establish their clinical specificity and generalizability across diverse populations.To identify body temperature dynamic patterns and develop a machine learning model for the early detection of nosocomial infections.
A retrospective and observational study of patients hospitalised in the haematology department of the Chinese People's Liberation Army General Hospital between January 2014 and December 2023.
A latent class trajectory model was used to discover patterns in patients' body temperatures over time. Machine learning models were then built to predict nosocomial infections and evaluated using standard metrics (AUROC, sensitivity, specificity). SHAP (SHapley Additive exPlanations) values were used to interpret the final model.
Among 6989 patients, we identified four distinct body temperature trajectories. Bloodstream infections were most common in patients exhibiting either a slow rise followed by a gradual decrease or a rapid rise followed by a quick decrease in body temperature. The XGBoost model showed excellent predictive performance (AUROC = 0.801), with balanced sensitivity (0.718) and specificity (0.701). The top five predictors of nosocomial infections were elevated procalcitonin, neutropenia, prolonged central venous catheter use and two specific temperature trajectories: ‘stable and relatively high’ and ‘a rapid rise followed by a quick decrease’.
The XGBoost model effectively predicted nosocomial infections. Dynamic body temperature trajectories provided early, objective warning signs of infection. This predictive tool empowered nursing staff to proactively monitor nosocomial infection, allowing for timely, data-driven interventions in vulnerable hematologic patients.
The developed machine learning predictive tool can help clinical medical staff identify nosocomial infections as early as possible, facilitate personalised rehabilitation and health management plans, aligning with the philosophy of patient-centred precision nursing. Further, the four body temperature trajectory patterns identified provide nurses with objective, dynamic indicators for recognising potential infection subphenotypes, supporting a shift from experience-driven reactive care towards data-driven proactive nursing.
Previous studies suggested that body temperature could indicate the severity and prognosis of infections, but the pattern was unknown. In this study, we found that body temperature trajectories could signal infection subphenotypes, such as bloodstream infections being most common in patients with a slow rise followed by a gradual decrease in body temperature or with a rapid rise followed by a quick decrease. By integrating body temperature trajectories with key clinical biomarkers, the developed prediction model enables early and accurate identification of nosocomial infections in hematologic patients. The application of this tool may significantly shorten the time window between infection onset and intervention, potentially reducing infection-related complications, mortality and healthcare costs, thereby improving overall care quality and patient outcomes.
The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation.
The research team included nursing staff and clinicians responsible for infection surveillance and control in the hospital, who contributed real-world insights into the definition of predictors, interpretation of temperature trajectories, clinical implications of the prediction model and preparation of the manuscript. Their expertise helped ensure that the study addressed relevant clinical questions and that the findings are interpretable and actionable in practice.
To systematically map the landscape of central venous access device research from 2014 to 2024, identifying critical gaps in evidence that may impact nursing practice and patient outcomes across the full device lifecycle from selection through to removal.
This review was conducted in accordance with the Guidance for producing a Campbell evidence and gap map and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.
PubMed, Cumulative Index to Nursing and Allied Health Literature Complete, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched with additional hand-searching of reference lists from included reviews.
We systematically reviewed literature published between 2014 and 2024, mapping 710 studies on central venous access device interventions and outcomes. Studies were categorised by design, population, setting, device characteristics, intervention types, and outcomes. Evidence was evaluated using the National Health and Medical Research Council levels of evidence framework.
Of 710 included studies, 89 were systematic reviews and 621 primary studies, of which 41.1% (n = 292) were randomised controlled trials. Research was primarily conducted in high-income countries (n = 405, 65.2%) and focused on adults (n = 370, 59.6%) in hospital inpatient settings (n = 588, 94.7%). Catheter insertion and infection prevention dominated the evidence base, while device selection and removal procedures were less studied. Infection outcomes were extensively reported (bloodstream infection: n = 455, 13.6% of 3349 outcomes), while patient-reported outcomes (n = 218, 6.5%) and cost (n = 60, 1.8%) were underrepresented.
This review reveals that central venous access device research is predominantly focused on insertion and infection prevention while other key parts of nursing practice are under-supported.
Future nursing research should address these gaps to improve evidence-based care across diverse populations and healthcare contexts, particularly focusing on understudied device types, settings, and vulnerable populations.
This review was conducted and reported in accordance with the Guidance for producing a Campbell evidence and gap map.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore surrogate decision-making practices regarding end-of-life care for people with dementia in Korean long-term care hospitals from the perspective of healthcare providers.
A qualitative descriptive study.
The data were collected through individual semi-structured interviews with 24 healthcare providers (physicians, oriental medicine doctors, registered nurses and social workers) involved in dementia end-of-life care in their current long-term care hospitals in South Korea. The data were analysed using a conventional content analytic technique.
The analysis yielded three categories and nine subcategories describing surrogate decision-making practices regarding end-of-life care for people with dementia: (a) typical circumstances of end-of-life care planning, (b) expected roles of key personnel and related challenges and (c) important considerations. Participants discussed available treatment options within long-term care hospitals and the potential transfers to acute care hospitals during admission and periods of health decline. Physicians typically led such end-of-life care planning, with nurses playing a supportive role and family members making the final decisions. However, they faced challenges in performing their roles. In end-of-life care discussions, participants weighed the patients' autonomy and best interests alongside family members' interests and other external concerns such as potential lawsuits and insufficient medical resources.
Surrogate decision-making regarding end-of-life care in the context of dementia within long-term care hospitals is considerably complex and challenging for healthcare providers, requiring multifaceted institution-sensitive support.
The study findings suggest the need for targeted education and training to enhance healthcare providers' competencies in end-of-life care discussions, advance care planning and the development of policies and regulations supporting end-of-life care-related practices within long-term care hospitals.
This study was reported in accordance with the COREQ checklist.
No patient or public contribution.
To explore the experiences, perceptions, and role adaptation of nursing PhDs in hospital settings in China.
A descriptive phenomenological qualitative study.
Individual in-depth interviews were conducted with eight female nursing PhD holders from eight tertiary hospitals across five provinces between November 2024 and February 2025. Data were concurrently collected and analysed using NVivo 11.0, guided by Colaizzi's seven-step analysis.
Four main themes were identified: (1) Multidimensional motivations for choosing hospital work; (2) professional challenges; (3) perceived professional value and benefits; and (4) career expectations and developmental recommendations. Fifteen subthemes further detailed these dynamics.
This study offers a nuanced understanding of the career development of nursing PhDs within hospital settings. The findings reveal the complex interplay of factors influencing their decisions to enter clinical practice. Moreover, it underscores the dual challenges of role ambiguity and limited resources, while also illustrating the transformative potential of applying academic training to drive clinical innovation among nursing PhDs in hospital environments.
These findings offer critical insights for hospital administrators and educational policymakers. By elucidating the career development challenges and opportunities for nursing PhDs, the study underscores the need for tailored talent management frameworks and targeted educational reforms. The findings have important implications for hospital settings in China and offer guidance for global strategies in talent management and clinical education reform, ultimately contributing to improved patient care and healthcare outcomes.
Adhered to COREQ guidelines for qualitative research.
None.
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