Enteral nutrition (EN) constitutes a critical therapeutic intervention in the management of patients with sepsis; however, the optimal timing for its initiation remains uncertain. This study sought to evaluate the impact of early versus delayed EN on mortality rates and clinical outcomes among adult patients with sepsis in intensive care units (ICU).

Retrospective cohort study using propensity score matching (PSM) methodology.

A tertiary hospital ICU in Hebei Province, China, from 2015 to 2024.

This retrospective analysis involved adult ICU patients with sepsis (meeting Sepsis 3.0 criteria) from January 2015 to December 2024 who began EN within 7 days of admission. Patients were classified into early (within 2 days) or delayed (2–7 days) EN groups based on when nutrition was initiated.

Primary outcomes were 28-day and 60-day mortality, with secondary outcomes including hospital/ICU stay length, mechanical ventilation duration and nutrition-related complications.

A study of 2205 patients compared early EN (EEN) in 1500 patients (68.0%) with delayed EN in 705 patients (32.0%). After PSM, the EEN group showed a higher mortality risk at 28 days (HR 1.44, 95% CI 1.08 to 1.92) and 60 days (HR 1.45, 95% CI 1.11 to 1.89), confirmed by multivariable Cox regression and inverse probability weighting. EEN patients also had more gastric retention (OR 1.77, 95% CI 1.14 to 2.79). The increased mortality risk was notably pronounced in younger male patients with a body mass index of less than 24 kg/m², abdominal infections, those with severe sepsis and patients necessitating vasopressor support at a norepinephrine equivalent of ≥0.1 µg/kg/min. Sensitivity analyses supported these findings.

Our retrospective analysis of 2205 propensity score-matched patients with sepsis found that EEN is linked to higher short-term mortality, especially in younger males, those with severe illness, abdominal infections or needing moderate to high vasopressor support. This suggests that personalised nutritional timing might be better than universal early feeding. However, these findings are preliminary and need confirmation through randomised controlled trials.

Falls are a major global public health challenge and a leading cause of severe consequences, such as fractures, traumatic brain injuries and even death among older adults. Older adults with knee osteoarthritis (KOA) are at a higher risk of falling and tend to experience more severe injuries due to impaired balance. Baduanjin, a mind-body exercise, has been shown to improve lower limb muscle strength and balance in older adults and to reduce fall risk in those with KOA; however, its specific mechanisms remain unclear. Therefore, this study aims to examine the effectiveness of Baduanjin in reducing fall risk among older adults with KOA and to preliminarily elucidate its underlying mechanisms.

In this prospective trial, 72 KOA participants will be recruited and randomly assigned (1:1:1) to perform Baduanjin training, brisk walking training and health education. The health education group will conduct health education for the participants in the group once a month, a total of 3 times. Based on the health education group, the Baduanjin group and the brisk walking group were respectively subjected to 12 weeks of Baduanjin exercise intervention (40 min each, 3 times a week) and 12 weeks of brisk walking exercise intervention (60 min each, 3 times a week). The primary outcome will be the fall-risk self-assessment questionnaire and modified falls efficacy scale. The secondary outcome will be balance function test, gait subscale of the Tinetti performance-oriented mobility assessment, lower limb muscle strength and functional MRI (fMRI). In addition to the fMRI scan, the results will be measured before and after the intervention. Other primary and secondary outcomes will be measured at baseline, at week 6 at week 12 (at the end of the trial) and after an additional 12-week follow-up period. The linear mixed model will be used to observe the effect of intervention.

This study was approved by the Ethics Committee of Bao'an District People’s Hospital, Shenzhen (No. BYL20230811). Our research findings will be published in peer-reviewed journal articles and conference presentations.

ChiCTR2400081342.

The incidence of silent brain infarction (SBI) and perioperative neurocognitive disorders (PND) is higher in cardiac surgery. However, standard preventive strategies remain unknown due to limited evidence.

This multicentre, prospective, randomised controlled clinical trial with a 1-year follow-up includes patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). 912 participants are randomly assigned 1:1 into either the intervention group with neuroprotective anaesthesia targets (mean arterial pressure 65–90 mm Hg, bispectral index 40–60, bilateral regional cerebral oxygen saturation ≥60%, arterial inflow temperature

The trial was approved by the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital (Approval No. 2024-2445) and all participating centres. We will disseminate the trial findings in peer-reviewed journals and present the results at national or international conferences.

NCT07048002.

Cardiovascular disease (CVD) represents a significant health and economic burden in China. Despite extensive research on CVD management in primary care, the cost-effectiveness of current practices remains suboptimal. The overall aim of this study is to test the efficacy of an integrated, cost-effectiveness-oriented management (CEOM) intervention to improve CVD risk and harm management in primary healthcare settings in Anhui, China.

This open-label, multi-centre, cluster-randomised controlled trial will be conducted in 32 village clinics in Anhui Province, China. Clinics will be randomised (1:1) to the CEOM intervention or usual care. The CEOM intervention integrates a prospective cost-effectiveness analysis from a societal perspective into the clinical workflow. It assesses patient eligibility and prioritises intervention themes and specific items based on predicted incremental cost-effectiveness ratios (ICER), guiding clinicians to deliver tailored management procedures. Implementation is supported by standardised training, automated performance feedback and peer support. Participants (n=1920) are permanent residents aged ≥35 years with diagnosed hypertension, diabetes and/or CVD. The primary outcome is the ICER, using Quality-Adjusted Life Years (QALYs) as the primary effect measure. The ICER will be evaluated based on cumulative QALYs and direct and indirect costs assessed at 12 and 24 months. Secondary outcomes include changes in knowledge, attitudes and practices, major adverse cardiovascular events, QALYs as estimated using the EQ-5D-5L ratings and direct and indirect costs. Data will be analysed using linear mixed models and generalised estimating equations following intention-to-treat principle.

The study was approved by the Medical Ethics Committee of Anhui Medical University (83230358). Results will be disseminated via peer-reviewed journals, conferences and policy briefs.

ISRCTN registry, ISRCTN87887485. Registered on 28 January 2026.

This study aimed to investigate the effects of different types of exercise on body composition in women with overweight or obesity and to compare the relative effectiveness of these interventions using a systematic review and network meta-analysis.

Systematic review and network meta-analysis using the CINeMA (Confidence in Network Meta-Analysis) approach.

PubMed, Embase, CINAHL, SportsDiscus, the Cochrane Library, Web of Science and Scopus were searched through September 2025.

We included randomised controlled trials enrolling adult women with overweight or obesity that evaluated structured exercise interventions, including aerobic exercise, resistance training, aerobic exercise with resistance training, high-intensity interval training or whole-body vibration training. Eligible studies compared these interventions with control conditions or other exercise modalities and reported at least one body composition outcome, including body fat percentage, body mass index, fat mass, lean body mass or waist circumference.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Cochrane Collaboration and Evidence Project tools. Network meta-analysis was conducted using random effects models. Confidence in the estimates was assessed using the CINeMA approach.

43 randomised controlled trials involving 2315 women were included. For body fat percentage, aerobic exercise with resistance training, high-intensity interval training and aerobic exercise across varying intensities were associated with greater reductions relative to control conditions, with vigorous aerobic exercise showing the highest probability of benefit. A similar pattern was observed for other adiposity-related outcomes: vigorous aerobic exercise appeared most favourable for body mass index, high-intensity interval training for fat mass and moderate to vigorous intensity aerobic exercise for waist circumference. No intervention was associated with statistically significant improvements in lean body mass compared with control; however, resistance training demonstrated a comparatively favourable ranking profile.

Structured exercise confers meaningful improvements in adiposity among women, particularly with aerobic-based modalities, whereas effects on lean mass remain limited. These results underscore the importance of tailored exercise strategies for optimising body composition in female populations.

CRD420251161064.

Total knee arthroplasty (TKA) is a common and effective procedure for end-stage knee osteoarthritis, yet patients frequently encounter a complex and dynamic symptom experience during the initial period that can significantly impact their rehabilitation and quality of life. This study aimed to explore the symptom experience of patients within 6 weeks after TKA.

A longitudinal qualitative study using semi-structured interviews.

This study was conducted in an orthopaedics department of a tertiary general hospital in China.

Interviews were conducted with 16 patients at 3–5 days postoperatively, 14 patients at 2 weeks postoperatively and 10 patients at 6 weeks postoperatively.

Data were collected between July 2024 and November 2024. A purposive sampling method was used to recruit patients. Data were analysed using directed content analysis, with data collection and analysis performed concurrently.

Three themes and nine subthemes were identified: (1) symptom perception, including perceived complexity of symptoms, self-identity conflict due to functional limitations, activation of negative emotions and psychological adaptation and interaction and amplification effects among symptoms; (2) symptom evaluation, characterised by the dynamic cognitive reframing of symptom meaning, self-blame tendency and internalisation of responsibility and interference from social and medical information; (3) symptom coping, involving dynamic evolution of active coping strategies and self-efficacy reinforcement, temporal characteristics of passive coping patterns and rehabilitation barriers.

The symptom experience of patients who had TKA is complex and dynamic. Healthcare providers should implement tailored interventions based on patients’ symptom experiences at different stages to facilitate symptom management, alleviate distress and negative emotions and improve quality of life.

Delayed post-polypectomy bleeding (DPPB) remains a significant complication of endoscopic resection, contributing to morbidity and increased healthcare costs. Although prophylactic clipping is widely practised to mitigate this risk, evidence from recent randomised controlled trials (RCTs) regarding its efficacy is inconsistent. This protocol outlines a systematic review and meta-analysis to evaluate the effectiveness of prophylactic clips following thermal resection.

We will conduct a comprehensive search of MEDLINE, EMBASE and the Cochrane Library from inception to 10 February 2026, to identify RCTs comparing prophylactic clips vs no clips in patients undergoing thermal endoscopic resection of non-pedunculated polyps. The primary outcome is DPPB within 30 days, defined as overt bleeding requiring medical intervention or a haemoglobin decrease ≥2 g/dL. Secondary outcomes include DPPB in proximal large (≥20 mm) lesions, perforation, post-polypectomy syndrome and procedure time. Data synthesis will use a random-effects model. Methodological quality will be assessed using the Cochrane Risk of Bias 2 tool. Publication bias will be visualised using funnel plots. We will quantify the effect of potential effect modifiers by meta-regression if appropriate. The quality of evidence will be evaluated according to the Grading of Recommendations Assessment, Development and Evaluation framework.

This study will not use primary data, and therefore formal ethical approval is not required. The findings will be disseminated through peer-reviewed journals and committee conferences.

CRD420251246840.

A good limb position (GLP) plays an important role in the rehabilitation process of patients who have had a stroke with hemiplegia. However, there remains a lack of effective assessment tools for clinical nurses to evaluate their GLP management practices.

This study aimed to develop and test the psychometric properties of the Good Limb Position Management Scale for Stroke Patients with Hemiplegia by Nurses (GLPMSSPHN).

A quantitative and cross-sectional design.

89 hospitals in 16 cities of China.

A total of 516 participants completed the questionnaire and were finally used for the analyses.

An initial scale was developed based on the Capability, Opportunity and Motivation-Behaviour model combined with a comprehensive literature review, semi-structured interviews, Delphi expert consultations and a pilot test. A field survey was then performed using the initial scale to test the reliability and validity of the scale. Reliability analysis was conducted by calculating Cronbach’s α coefficients and test–retest reliability. The results of exploratory factor analysis and confirmatory factor analysis were used as the validity index to further verify the model structure of the scale and develop a formal scale.

The GLPMSSPHN was formulated with 4 dimensions and 35 items. Exploratory factor analysis extracted four factors, with a cumulative variance contribution rate of 81.842%, and confirmatory factor analysis indicated that the scale had good construct validity. The Cronbach’s α coefficient of the scale was 0.978, and the test–retest reliability was 0.863.

The GLPMSSPHN has ideal reliability and validity and provides a valid and reliable tool for clinical nurses to identify and assess the management level of GLP in patients who have had a stroke with hemiplegia.

Postoperative urinary retention (POUR) is a common perioperative complication that can cause delayed mobilisation and discharge, and increase the need for catheterisation. Suprapubic temperature stimulation is a simple bedside, nurse-led approach but its effectiveness and safety have not been synthesised in a focused review.

We will systematically search PubMed, Embase, CINAHL, PsycINFO, Web of Science and CENTRAL from inception to the final search date, without language or date restrictions and will also screen trial registries and grey literature. We will include randomised controlled trials evaluating suprapubic temperature stimulation for prevention or treatment of POUR, compared with usual care, sham/no intervention or other non-thermal strategies. Two reviewers will independently screen studies, extract data and assess risk of bias using RoB 2, with arbitration by a third reviewer. Where appropriate, we will pool effects using ORs for dichotomous outcomes and mean differences or standardised mean differences for continuous outcomes, each with 95% CIs. Heterogeneity will be assessed using the ² test and I² statistic, with planned subgroup analyses by thermal modality and timing, and sensitivity analyses based on risk of bias. Certainty of evidence will be appraised using the Grading of Recommendations Assessment, Development and Evaluation.

This review will be based on previously published studies; therefore, ethics approval is not required. Data searching will commence in June 2026 and is expected to be completed in January 2027. The findings will be disseminated through peer-reviewed journal publication and academic conference presentations.

CRD420261325021.

The incidence of depression among children and adolescents has been increasing in recent years, posing significant challenges to public health and clinical care. A variety of treatments, including pharmacotherapy, psychotherapy and physical interventions, are widely used in clinical practice. However, a comprehensive synthesis of the evidence on the efficacy and acceptability of all these treatment modalities is currently lacking. This study aims to use network meta-analysis (NMA) to compare the efficacy and acceptability of all available treatments for depression in children and adolescents, offering valuable insights to inform clinical decision-making and guide future research in this critical area.

We will include randomised controlled trials evaluating active interventions for depressive disorders in children and adolescents. Seven electronic databases (PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO, Scopus and ClinicalTrials.gov) were searched from inception to 2 July 2024 and updated on 2 November 2025. Two of four investigators will independently screen studies, extract data from eligible articles and assess the risk of bias using the Cochrane Risk of Bias 2.0 tool. The primary outcome will be the change in depressive symptoms. Secondary outcomes will include acceptability (all-cause discontinuation), response rate, remission rate and overall functioning. Pairwise and Bayesian NMA will be conducted. Small-study effects and publication bias will be assessed. The certainty of the evidence will be evaluated according to the Confidence in Network Meta-Analysis approach.

As this review involves secondary analysis of previously published studies, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals.

PROSPERO-ID CRD42024557384.

Treatment options remain limited for patients with advanced hepatocellular carcinoma (HCC) who experience oligoprogression during first-line systemic therapy (FLST), especially given the modest efficacy and restricted availability of second-line systemic therapy (SLST). This trial aims to evaluate whether continuing FLST combined with radiotherapy (RT) to oligoprogressive lesions can improve progression-free survival (PFS) compared with an early switch to SLST in patients with oligoprogressive HCC while maintaining an acceptable safety profile.

The continuation of first-line therapy with radiotherapy for oligoprogression versus early switch to second-line therapy in oligoprogressive hepatocellular carcinoma trial is a prospective, multicentre, randomised phase III study that will enrol 132 patients with advanced HCC who experience their first oligoprogression during FLST. Oligoprogression is defined as one to five progressive lesions involving no more than one to three organs. Participants will be randomised (1:1) to either continuation of FLST combined with RT to all oligoprogressive lesions or discontinuation of FLST followed by initiation of SLST. RT will be delivered with a biologically effective dose (linear–quadratic model, α/β=10) of at least 60 Gy whenever feasible. The primary endpoint is PFS. Secondary endpoints include overall survival, objective response rate, disease control rate, duration of response and quality of life. Predefined exploratory analyses include circulating tumour DNA profiling, optional paired tumour biopsies, functional imaging with fibroblast activation protein inhibitor positron emission tomography-CT and longitudinal immune profiling.

This study has been approved by the Ethics Committee of the Affiliated Cancer Hospital of Shandong First Medical University (number: SDZLEC2025-025-02) and has been registered in ClinicalTrials. gov (NCT06841172). Final study results will be disseminated through peer-reviewed journals.

NCT06841172.

Referrals to speech and language pathology are infrequent for people with Parkinson’s disease (PD), despite speech and communication being often affected and greatly impacting their quality of life. This study investigated the knowledge, self-competence and challenges faced by speech and language pathologists (SLPs) in Malaysia when managing PD cases.

Participants self-administered an online-survey in a cross-sectional study design. The survey consisted of 14 questions on current practices of SLPs with their patients with PD, self-perceived competence when assessing and managing PD and perceived barriers for catering to patients with PD. Inferential statistics were run on self-perceived competence across domains and their relationship with demographic/current practice factors. Descriptive statistics were used to analyse perceived barriers.

The survey was administered in English through Google Forms.

54 Malaysian SLPs with at least one active case of PD in their caseload were invited via email and WhatsApp Messenger. These contacts were obtained from the Speech-Language Therapists Association of Malaysia (SPEAK), and snowball sampling was encouraged to recruit additional SLPs through other social networks.

To quantify Malaysian SLPs’ self-perceived competence levels (assessed on 5-point Likert scales) in assessing and managing five key domains in patients with PD: speech, language, oro-motor skills, cognition and swallowing; and to identify the frequency and types of barriers encountered in clinical practice with patients with PD through structured multiple-choice questions. Secondary outcomes included quantifying current service delivery patterns (frequency of PD referrals, stage at referral, caseload size), multidisciplinary consultation patterns and confidence levels in managing rehabilitation risks associated with PD, all measured through structured survey items with categorical or ordinal response options.

Most participants had 1–5 patients with PD in their active caseload, referred at a middle or advanced stage of the disease. The majority of participants felt competent in assessing and managing motor speech and language in patients with PD. Conversely, most of them did not feel competent in assessing and managing cognition in these patients, regardless of demographic factors or current practices. This difference was significant. Most participants also reported facing barriers such as health conditions or comorbidities, family expectations on the therapy outcome and the unavailability of a multidisciplinary approach.

The study reveals that SLPs working in Malaysia feel competent in working with motor speech and language in individuals with PD. However, it highlights a need for additional training to address cognitive assessment and management as a crucial tool to boost functional communication in people with PD. The study also reveals a need for promoting a multidisciplinary approach.