Conectar
Patients’ sense of gain experience (PSGE) is the comprehensive feeling throughout the treatment process, which is a critical benchmark for evaluating comprehensive medical and health system reform in China. This study aims to assess the current status of PSGE in public hospitals and identify important associated factors, providing evidence-based recommendations for improving healthcare services.
This was a cross-sectional study conducted from October to November 2023.
A total of 14 public hospitals in Foshan, Guangdong Province, China.
There were 3223 responses, including 1592 from outpatients and 1631 from inpatients.
PSGE was assessed across five domains: time accessibility, service accessibility, cost affordability, patient participation and efficacy predictability. Participants were also asked to provide an overall rating of the PSGE.
The overall score for PSGE was 4.47±0.53 (mean±SD), with service accessibility receiving the highest score (4.68±0.50) and affordability the lowest (4.17±0.86). Secondary hospitals scored an overall PSGE of 4.55±0.50, while tertiary hospitals scored 4.42±0.54. Key factors associated with PSGE were overall satisfaction (β=0.164, p
This study found that patients reported a positive PSGE with service accessibility but reported a less positive PSGE with cost affordability. A tier-based disparity was evident, with secondary hospitals outperforming tertiary hospitals in overall PSGE outcome. Stronger PSGE was positively associated with higher scores in overall satisfaction, treatment satisfaction, satisfaction with medical reforms, patient loyalty and hospital reputation. Demographic and institutional factors, such as hospital level, patient type and household registration, were associated with the PSGE. Efforts can be focused on enhancing clinicians’ willingness and competence in discussing treatment costs during clinical encounters. It is essential for policymakers to address disparities in healthcare experiences among patient groups across hospital tiers to advance equitable, patient-centred systems.
This study examined the moderating effects of income inequality and nurse–patient relationships on the association between occupational stress and nurse turnover intentions in large urban hospitals in China, providing evidence for developing targeted retention strategies.
A cross-sectional study.
Data from 13,298 nurses in 46 hospitals in Xi'an, China (October–December 2023) were analysed using hierarchical regression to assess associations between occupational stress, organisational and professional turnover intentions and the moderating roles of the expected income achievement rate (calculated as [actual/expected income] × 100%) and nurse–patient relationship quality.
Eighty-three percent of nurses reported moderate-to-severe occupational stress. Compared to nurses experiencing mild stress, those with moderate/severe stress demonstrated significantly higher organisational and professional turnover intentions. After adjusting for covariates, significant interaction effects were observed. Higher expected income achievement rate showed a modest but significant moderating effect, associated with reduced turnover intentions. While the nurse–patient relationship also moderated this relationship, its protective effect was attenuated under conditions of severe stress. Despite small effect sizes, the consistent patterns and theoretical coherence of these interactions warrant further investigation.
Occupational stress significantly predicts nurse turnover intentions in urban Chinese hospitals, with income inequality and nurse–patient relationship quality serving as modifiable moderating factors. Interventions should integrate equitable compensation, nurse–patient relationship enhancement programmes and stress management initiatives.
This study demonstrates that equitable income consistently buffers the effects of occupational stress on nurse turnover, while nurse–patient relationships show stress-level-dependent moderation. By implementing region-specific compensation benchmarks and structured communication training, healthcare policymakers can effectively address economic security and relational care quality in workforce stabilisation.
The study has been reported following the STROBE guidelines.
No patient or public contribution.
To describe patient outcomes for patients at high risk of mortality (with a prognosis of three months or less to live) where a Palliative Care Nurse Consultant (PCNC) was embedded in a General Medicine team. To explore patients and/or their carers feedback and allied health, nursing professionals' perspectives on integrating a palliative care approach in the General Medicine ward.
Prospective exploratory study.
SQUIRE reporting guidelines was adopted for the study reporting. This study was conducted over six weeks in a general medicine ward at Monash Medical Centre in Melbourne, Australia. Participants were 20 patients aged > 65 years with non-malignant, chronic conditions at high risk of mortality within three months and had 18 nursing and allied health professionals involved in their care. Quantitative data were analysed descriptively and qualitative survey data were analysed thematically.
Twenty patients participated, with an average age of 87 years. 55% spoke a language other than English. PCNC interventions, focused on care coordination and family liaison, were found to facilitate timely referrals to other support services, improve communication and better address end-of-life care needs. Healthcare professionals recognised the benefits of PCNC involvement; however, a key qualitative theme was staff reluctance to raise palliative care needs due to perceived role boundaries and limited confidence. While PCNC presence improved communication and advocacy, barriers included time constraints and patient/family resistance.
Embedding a PCNC in a general medicine team appears to enhance care coordination and support timely palliative care integration. Addressing barriers and optimising workflow can improve patient, carer and clinician experience as well as improve resource utilisation.
The model has the potential to enhance patient-centred care and clinician support in acute general medicine settings.
The research will have an impact on acute care settings, particularly general medicine units, by informing models of integrated palliative care for patients with complex needs and enhancing staff capability and confidence in providing timely, person-centred care.
Patients or members of the public were not involved in the design, conduct, analysis or manuscript preparation of this study. The project was a prospective observational study with limited scope and resources, which did not include a formal patient or public involvement component.
Diabetes is a significant modifiable risk factor for cognitive dysfunction. There are currently no effective treatments that delay or reverse the progression of cognitive dysfunction. Accumulating evidence demonstrates that specific antidiabetes medications hold promise in improving cognitive function. However, the comparative effects of various antidiabetic drug classes on cognitive protection remain to be fully elucidated. This study aims to investigate and compare the cognitive benefits of liraglutide, empagliflozin and linagliptin on achieving mild cognitive impairment (MCI) remission in individuals with type 2 diabetes (T2D).
The LIGHT-MCI trial is an investigator-initiated, multicentre, open-label, parallel-group, randomised, superiority trial involving T2D patients with MCI, consisting of a 48-week core study followed by an extension phase through to 76 weeks. A total of 396 participants will be randomly allocated 1:1:1 to receive liraglutide, empagliflozin or linagliptin treatment. The primary outcome measure is the efficacy difference of liraglutide, empagliflozin and linagliptin in achieving MCI remission in individuals with T2D. The key secondary outcome measures include changes in scores of general cognition and various cognitive subdomains (including processing speed, executive function, immediate memory, visuospatial construction ability, language, attention and delayed memory), basic and instrumental daily living ability, MRI-derived normalised measures of total brain volume, cerebral microstructures, cortical and nuclear volume, white matter hyperintensity, volume, white matter microstructural integrity, odour-induced brain activation and resting-state functional connectivity, olfactory function and metabolic parameters.
The LIGHT-MCI trial has received approval from the Ethics Committees of the Drum Tower Hospital Affiliated to Nanjing University Medical School (2022-092-02) and other participating centres in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonisation for Good Clinical Practice (ICH GCP E6). Informed consent is required for participation. Findings from this trial are disseminated through peer-reviewed publications, conference presentations, newsletters and social media.
The Kun–Qi birth cohort (KQBC) was established to investigate the incidence, aetiology and risk factors of chronic kidney disease (CKD) in early childhood (0–6 years). Additionally, the study analysed developmental phenotypic trajectories and their associated paediatric diseases.
Infants registered or residing in Kunshan and Qidong, Jiangsu Province, who participated in the Chinese Child Healthcare Programme (0–6 years) were enrolled. The baseline population was stratified into enhanced and basic cohorts. General characteristics, periconceptional and perinatal information and health check-up data were collected from each participant. Dual screening (urinary ultrasound and urine dipstick tests) was conducted during scheduled check-ups. Structured CKD questionnaires were administered, and biosamples (urine and dried blood spots) were obtained for the long-term storage and analysis using standard procedures. Based on the proposed referral procedure, participants with abnormal results were referred for further diagnosis and evaluation.
The KQBC enrolled 10 127 infants (5392 boys and 4735 girls) with a mean age of 2.11±1.68 months. Urinary system ultrasound and urine dipstick screening showed positivity rates of 8.9% (900/10 083) and 6.5% (532/8233), respectively. Baseline ultrasound screening facilitated timely surgical intervention in six children. Among the 7965 respondents, only 13% demonstrated awareness of paediatric CKD. Additionally, 7273 dried blood spots and 7990 urine specimens were collected and stored. A paediatric CKD screening platform was developed.
According to our plan, the KQBC will be followed up for 3–6 years to investigate the incidence, aetiology and risk factors of early onset CKD. In-depth developmental phenotypes, such as urinary multiomics and ultrasound imaging, should be studied for longitudinal paediatric kidney health. We aim to develop multimodal risk prediction models by integrating genomics and artificial intelligence algorithms. The KQBC also enables prospective cohort studies addressing extensive research questions.
Abdominal pain is one of the most common symptoms in patients with IgA vasculitis (IgAV), adversely affecting both physical and mental health. Clinical studies have demonstrated that acupuncture can quickly alleviate pain and reduce the duration of abdominal pain episodes. Given its growing acceptance in clinical practice, acupuncture is increasingly being adopted for managing IgAV-related abdominal pain. The objective of this systematic review is to evaluate and synthesise evidence regarding the efficacy and safety of acupuncture for IgAV abdominal pain.
Eight databases will be systematically searched from their inception to 1 June 2025: China National Knowledge Infrastructure, Chinese Biomedical Literature Database (China Biology Medicine), VIP Database, Wanfang Database, PubMed, Embase, Cochrane Library and Web of Science. Only randomised controlled trials investigating acupuncture for IgAV abdominal pain, published in Chinese or English, will be included. Two independent researchers will perform study selection, data extraction and risk-of-bias assessment. The primary outcomes include symptom and sign scores and time to abdominal pain resolution. Secondary outcomes comprise recurrence rate, incidence of adverse events and urinalysis results. Risk of bias will be evaluated using the Cochrane Risk of Bias Tool (V.2.0). Meta-analyses will be conducted using Review Manager software (V.5.3). For continuous data, we will calculate standardised mean differences with 95% CIs. For dichotomous outcomes, relative risks and 95% CIs will be calculated. Subgroup analyses will be performed where feasible. The overall evidence quality will be graded using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Ethical approval is not required for this study as it does not involve the collection of primary patient data. The results of this meta-analysis will be disseminated through peer-reviewed publications.
CRD42023483770
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterised by deficits in social communication and repetitive behaviours, often accompanied by sleep disturbances. These sleep problems, including prolonged sleep latency and fragmented sleep, affect more than half of autistic individuals, exacerbating functional impairments and diminishing quality of life. Cognitive behavioural therapy (CBT) has shown promise in addressing sleep disturbances in ASD, with preliminary studies indicating improvements in sleep quality. However, no systematic review has comprehensively summarised the effects of CBT on sleep in autistic individuals.
This systematic review and meta-analysis will synthesise evidence on the efficacy of CBT for improving sleep quality in individuals with ASD. We will search multiple databases (eg, PubMed, Web of Science) for studies published until May 2025. Inclusion criteria encompass randomised controlled trials, single-arm studies and observational studies involving children and adults with ASD and moderate sleep problems. Interventions targeting sleep quality using CBT techniques will be considered. Data extraction will focus on study details, participant information, intervention specifics and sleep outcome measures (eg, total sleep time, sleep onset latency, etc). Risk of bias will be assessed using tools such as Cochrane Risk of Bias Tool V.2, Risk Of Bias In Non-randomised Studies—of Interventions and Review Manager 5.3. A meta-analysis will be conducted using Stata 18, with heterogeneity evaluated using the I² statistic and Cochran’s Q test.
Given that the dataset for this investigation is derived from publicly accessible databases, there is no direct interaction with patients; thus, ethical approval is not required.
CRD42025643701.
Systemic lupus erythematosus (SLE) is a chronic and complex multisystem autoimmune disease with high mortality. Telitacicept is a new strategy for the treatment of SLE, inhibiting the maturity, proliferation and differentiation of B cells, and thus, reduces disease activity. However, the effectiveness and safety of telitacicept in patients with SLE are not yet established.
Five English databases (Pubmed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, Cumulative Index of Nursing and Allied Health Literature) and four Chinese databases (China National Knowledge Infrastructure, Wanfang Data, China Science and Technology Journal Database and Sinomed) will be searched from database inception to 1 June 2025. Two investigators will independently conduct study selection, data extraction and quality assessment. Outcomes include disease activity, incidence of flares, organ damage, several immune-related laboratory parameters and adverse events. Risk ratio with 95% CI and mean difference or standardised mean difference will be used as measures of effect sizes, in order to pool the data using either a random-effect model or fixed-effect model according to the heterogeneity of studies. Subgroup analysis and sensitivity analysis will be performed to explore the source of heterogeneity and evaluate the robustness of the results. We will use the Risk of Bias 2 tool and Risk of Bias In Non-Randomized Studies of Interventions tools to assess the quality of the included studies, and use the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) system to assess the certainty of evidence.
No ethical approval is required since this review is based on previously published studies. The findings of this study will be presented at international conferences or published in a peer-reviewed journal.
CRD42024558180.
To provide practical insights that delve into the ethical issues and regulatory implications of generative artificial intelligence (GenAI) in healthcare. Ethical Challenges and Regulatory Impact in China is used as an example.
Despite China's efforts to strike a delicate balance between protecting public welfare and promoting technological advancement, numerous unresolved issues persist in the practical integration of generative artificial intelligence into healthcare settings.
Key issues such as data application, privacy protection, cost-effectiveness and regulatory remain areas of ambiguity that require clarification. Stringent ethical guidelines, data privacy protection measures and continuous supervision and evaluation of artificial intelligence decisions will help enhance the expected benefits of GenAI in healthcare.
The potential use of GenAI in healthcare has garnered widespread attention, emerging as a significant global research topic. However, its application in this domain presents substantial ethical and regulatory challenges. Compared to other fields, GenAI's role in healthcare is more sensitive and complex, necessitating an urgent assessment of its ethical implications for future development and deployment. Challenges and ethical considerations are particularly pronounced in developing countries with limited healthcare resources.
To investigate the relationship among dyadic coping, mental health and the individual and mutual influences on stroke survivors and their spouse caregivers.
A cross-sectional descriptive study was conducted in China from November 2019 to August 2020. The STROBE checklist was used to report the present study.
The analysis included 224 dyads of stroke survivors and their spouse caregivers in China. Data on stroke survivors and their spouse caregivers were collected using the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire nine-item scale (PHQ-9) and the Generalised Anxiety Disorder seven-item scale (GAD-7). The dyadic analysis was conducted based on the Actor-Partner Interdependence Model (APIM).
Regarding actor effects, spouse caregivers' dyadic coping and perceived dyadic coping had a negative predictive effect on their own anxiety and depression. Stroke survivors' perceived dyadic coping had a negative effect on their own depression. Regarding partner effects, spouse caregivers' perceived dyadic coping also had a negative predictive effect on the depression of the patients. In contrast, stroke survivors' perceived dyadic coping was positively associated with spouse caregivers' anxiety and depression. These findings suggested that mental health of stroke survivors and their spouse caregivers was affected by various dyadic coping dimensions.
Our research has the potential to contribute to the understanding dyadic coping and mental health of stroke survivor-spouse caregiver dyads. The findings reveal that the coping strategies employed by stroke couples are closely related to the mental health of both partners.
This study provides evidence for the significant impact of dyadic coping on the psychological well-being of stroke survivors and their spouse caregivers. Therefore, dyadic interventions aiming at strengthening dyadic coping may have positive effects on their mental health.
This study directly involved the patients and family caregivers in hospital settings.
The triglyceride glucose (TyG) index has been confirmed a predictive value for type 2 diabetes mellitus (T2DM). However, no research has yet confirmed whether there is a linear correlation between the TyG index and MACCEs in DFUs. The present study aimed to delve into the association between the TyG index and the risk of MACCEs in patients with DFUs. A total of 960 inpatients with DFUs were recruited. All participants were followed up every 6 months for 11 years with a median of 83 months. According to the cut-off value of the TyG index acquired from receiver operating characteristic (ROC) analysis, the subjects were divided into two groups: low-level (<9.12, n = 480) and high-level (≥9.12, n = 480). The relationship between the TyG index and MACCEs was evaluated by the multivariable Cox regression model, restricted cubic spline (RCS) model, stratified analysis and the Kaplan–Meier survival analysis. Out of 960 participants, 271 experienced MACCEs (28.22%), of whom 79 (29.15%) died. ROC analysis got the optimal TyG index cut-off value of 9.12. Multivariable Cox regression analysis combined with the RCS model showed that the TyG index was positively associated with MACCEs in an S-shaped non-linear dose-dependent manner within the range of TyG index 7.5–9.5 (p < 0.001). The Kaplan–Meier survival analysis indicated the higher the TyG index, the greater the cumulative incidence of MACCEs (log-rank, p < 0.001). The study first confirmed an S-shaped non-linear dose-dependent positive relationship between the TyG index and the risk of MACCEs in DFUs. Consequently, lowering the TyG index level aids in improving the prognosis of patients with DFUs.
The efficacy of episiotomy, particularly the angle of incision in mediolateral episiotomies, remains a significant area of inquiry in obstetrics. This meta-analysis aimed to evaluate the impact of low-angle mediolateral episiotomy on perineal wound healing and pain outcomes in women undergoing vaginal childbirth. Adhering to PRISMA guidelines, a systematic review was conducted using the PICO framework. Studies were selected based on predefined inclusion and exclusion criteria, focusing on randomised controlled trials (RCTs) involving low-angle mediolateral episiotomies. Comprehensive literature searches were performed across major electronic databases including PubMed, Embase, Web of Science and Cochrane Library. Data extraction and quality assessments were meticulously carried out by independent reviewers, employing the Cochrane Collaboration's risk of bias tool. A total of 1246 articles were initially identified, with 8 articles meeting the strict inclusion criteria for the final analysis. The meta-analysis revealed significant heterogeneity among studies regarding postoperative pain (p < 0.0001, I 2 = 77.5%), and employed a random-effects model. Results showed that low-angle episiotomies significantly reduced postoperative pain (OR = 0.27, 95% CI: 0.17–0.42, p < 0.001), and increased first-degree healing rates (OR = 2.95, 95% CI: 2.20–3.96, p < 0.001) compared to traditional angles. Sensitivity analyses confirmed the stability of these findings, and no significant publication bias was detected. The analysis suggests that low-angle episiotomies can potentially reduce postoperative perineal pain and enhance wound healing. However, the limited number and varying quality of the included studies warrant cautious interpretation of these results. Further well-designed studies are needed to corroborate these findings and guide clinical practice.
This study aims to explore the association between the triglyceride-glucose (TyG) index and all-cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63-month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low-level (≤8.75, n = 185), moderate-level (8.76–9.33, n = 185) and high-level (≥9.34, n = 185). The association between the TyG index and all-cause mortality in patients with DFUs was then assessed. During the follow-up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all-cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341–2.241; p < 0.001). Compared with the low-level TyG index, the moderate-level TyG index (HR = 1.685; 95% CI = 1.011–2.810; p = 0.045) and the high-level TyG index (HR = 2.769; 95% CI = 1.678–4.568; p < 0.001) were positively correlated with all-cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250–2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240–2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008–2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339–2.791; p < 0.001) showed a positive correlation between TyG index and all-cause mortality rate in patients with DFUs. Furthermore, in the high-level TyG index group compared, males (HR = 2.699; 95% CI = 1.457–4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972–4.242), with the TyG index level increase by 1.0, the risk for all-cause mortality increased 3.277-fold in females (HR = 4.277; 95% CI = 1.645–11.124) and 1.909-fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486–5.695), respectively. Kaplan–Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all-cause mortality in patients with DFUs (log-rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all-cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all-cause mortality than other populations in daily clinical practice.
This study aimed to explore the association between metabolic-associated fatty liver disease (MAFLD) and ulcer recurrence risk in patients with diabetic foot ulcers (DFUs) through an ambispective longitudinal cohort. From December 2013 to December 2022, a total of 482 inpatients with DFUs (PEDIS grade 3 and above with a severe infection) were eligible for inclusion in this study. This was an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 36 months. According to whether having MAFLD or not, all subjects were placed into two groups: non-MAFLD (n = 351) and MAFLD (n = 131). The association between MAFLD and ulcer recurrence in patients with DFUs was then evaluated through multivariate Cox regression analysis, stratified analyses and Kaplan–Meier survival analysis. Throughout the follow-up period, out of 482 subjects with DFUs, 68 had ulcer recurrence (14.1%). Three Cox regression models were established for data analyses. In the model I (unadjusted), MAFLD was significantly associated with the ulcer recurrence rate in patients with DFUs (HR = 1.79; 95% CI = 1.097–2.92; p = 0.02). Model II (adjusted model I with gender and age) (HR = 1.781; 95% CI = 1.09–2.912; p = 0.021) and model III (adjusted model II with CVD, duration of diabetes and Cr.) (HR = 1.743; 95% CI = 1.065–2.855; p = 0.027) also showed that MAFLD was significantly related to the ulcer recurrence risk in patients with DFUs, respectively. Stratified analysis indicated that subjects aged ≥60 had a greater risk of ulcer recurrence in MAFLD than in non-MAFLD (HR = 2.31; 95% CI = 1.268–4.206; p = 0.006). Kaplan–Meier survival curve analysis showed that ulcer recurrence rate had a significant association with MAFLD (log-rank, p = 0.018). This study indicated a close association between ulcer recurrence risk and MAFLD in patients with DFUs, especially in the elderly (aged ≥60). Therefore, special attention should be paid to the elderly with both DFUs and MAFLD because they have a higher ulcer recurrence rate than other general populations in routine clinical practice.
We sought to investigate the effects of fast-track rehabilitation nursing on pressure ulcers, length of hospital stay and postoperative complications in patients with inter-trochanteric fractures (ITF). The PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure and WanFang databases were searched for randomised controlled trials (RCTs) published from inception to September 2023 on the application of fast-track rehabilitative nursing to ITF. Two investigators independently screened the literature and performed data extraction and quality assessments using the Cochrane Risk of Bias Assessment Tool. The meta-analysis was performed using RevMan 5.4. Overall, 22 RCTs involving 1904 patients were included. Meta-analysis revealed that after fast-track rehabilitation nursing intervention in patients with ITF, the occurrence of pressure ulcers (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.18–0.47; p < 0.001) and postoperative complications (OR: 0.19; 95% CI: 0.14–0.26; p < 0.001) were significantly reduced and hospital stay was significantly shorter (standardised mean difference: –3.10; 95% CI: −3.82 to −2.38; p < 0.001). Nursing care for patients with ITF based on the concept of fast-track rehabilitation is conducive to reducing the occurrence of pressure ulcers, lowering the occurrence of complications, shortening the length of hospitalisation and promoting postoperative rehabilitation.
FreshRSS 