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The aim of this study was to investigate factors affecting psychosocial adaptation in intestinal stoma patients and to identify central symptoms that might guide future interventions through network analysis.
A multicenter cross-sectional study.
All intestinal stoma patients were evaluated for psychosocial adaptation using the Ostomy Adjustment Inventory-20 (OAI-20). Univariate and multivariate linear regression were used to analyse the potential relationship between the level of psychological adjustment of intestinal stoma patients and individual factors. By network analysis, we calculated the centrality indicators for each node in the ostomy psychosocial adaptation network at different levels of low, medium and high, respectively.
This study ultimately enrolled a total of 19,909 intestinal stoma patients from 202 Chinese hospitals, out of which 6408 reported low psychosocial adaptation. It was found that there is a negative association between being female, partially self-care, completely dependent on others for care and having no medical insurance with psychosocial adaptation scores. In the low-level psychosocial adaptation network, no. OAI-14:limited activity, no. OAI-9: worried about ostomy, and no. OAI-11:always like a patient were identified as central indicators.
Being female, partially self-care, completely dependent on others for care, and having no health insurance can be considered characteristics of patients with lower psychosocial adaptation. Network analysis results provide intervention targets to improve adaptation.
Individualised and precise interventions can be carried out in terms of both the influencing factors and the most influential nodes of psychosocial adaptation in order to improve the level of psychosocial adaptation in intestinal stoma patients.
No patient or public contribution.
The study examines the associations between nursing competence, work environment, and health system resilience. It also analyzes how nursing competence and work environment relate to different patterns of health system resilience.
A multiple center cross-sectional study was conducted between December 2023 and January 2024 across 33 hospitals in eastern China, involving 2435 nurses.
Questionnaires measuring nursing competence, work environment resources, nurse disaster resilience, and organizational commitment to resilience were utilised, along with the collection of additional personal demographic data. Structural equation modelling and cluster analysis were performed to explore the underlying mechanisms within the overall model and across multiple groups. Multivariable regression was conducted to identify variables associated with resilience in different subgroups.
Structural equation modelling demonstrated significant influences of nursing competence and work environment support on system resilience. Cluster analysis identified four resilience patterns: strong, marginal, low, and critical vulnerability. Strong resilience correlated with balanced individual-organizational resources, while vulnerable systems relied heavily on environmental support.
Our findings support policymakers and managers in developing systematic strategies with distinct focal points—targeting nurse workforce investment and optimised work environment—to enhance health system resilience across varying levels of public health emergencies.
This study validated the framework connecting individual and organizational resilience, offering evidence-based insights for nurse training and resource allocation to enhance healthcare systems' adaptability during disasters.
The study addressed how nursing competence and work environment significantly influenced resilience during public health emergencies, identified four resilience patterns, and provided insights to guide policymakers and healthcare managers in developing targeted, effective strategies.
Strengthening the Reporting of Observational studies in Epidemiology checklist.
No patient or public contribution.
Nurse-led self-care interventions represent a promising approach for chronic pain management. However, a comprehensive synthesis of their efficacy is lacking.
This systematic review and meta-analysis assessed the impact of the interventions on four key outcomes in chronic pain patients: pain intensity, quality of life, anxiety levels, and depression severity.
The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search for relevant articles spanning from inception to November 2024 was carried out across multiple databases, including EMBASE, PubMed, CENTRAL, Web of Science (Core Collection), CINAHL, Scopus, and PsycINFO. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies. The meta-analysis was conducted using Stata 18 and Review Manager 5.4, and a GRADE evidence profile was subsequently generated.
The systematic review and meta-analysis involved 30 studies in total. The results of the data analysis indicated that the interventions alleviated pain intensity (SMD = −0.30, 95% CI: −0.41 to −0.20, Z = 5.57, p < 0.001). They also enhanced quality of life (SMD = 0.28, 95% CI: 0.14 to 0.42, Z = 3.83, p < 0.001), while reducing anxiety (SMD = −0.15, 95% CI: −0.29 to −0.01, Z = 2.11, p = 0.03) and depression symptoms (SMD = −0.27, 95% CI: −0.45 to −0.09, Z = 2.88, p = 0.004).
This systematic review demonstrated that nurse-led self-care interventions benefit chronic pain patients. Future research should conduct more rigorous randomized controlled trials to strengthen the evidence base for using such interventions in chronic pain management.
To summarise the symptom clusters (SCs), assessment tools and their evolution at different stages of postsurgical chemotherapy in oesophageal cancer patients, providing reference for future research design and precise symptom management.
A systematic search and literature review were conducted according to the Joanna Briggs Institute Scoping Review Methodology framework and PRISMA extension for scoping reviews (PRISMA-ScR) guidelines.
Databases searched include PubMed, Cumulative Index to Nursing and Allied Health Literature (CINHAL), Web of Science, Embase, the Cochrane Library, Scopus, China National Knowledge Infrastructure, Wanfang, VIP Chinese Journal and China Biomedical Literature Database. The search covered the period from database inception to 30 November 2024, and references were traced backward.
Patients aged ≥18 years with postsurgical oesophageal cancer undergoing adjuvant chemotherapy; studies focusing on SCs before, during or after chemotherapy; original quantitative research; published in Chinese or English. Exclusion criteria included neoadjuvant or palliative chemotherapy, reviews, conference abstracts and inaccessible full-text articles.
Two independent reviewers screened, extracted and cross-checked the data. Content analysis was employed to summarise the SCs, assessment tools and phase-related changes.
A total of 11 studies were included (8 in Chinese, 3 in English). Twelve SCs were identified, with gastrointestinal-related, eating-related and physical function-related clusters being the most common. Eleven assessment tools were used, with MD Anderson Symptom Inventory-Gastrointestinal Cancer Module and its Chinese version being the most frequently applied. Difficulty eating was the most prominent SC before chemotherapy, gastrointestinal symptoms were the most severe during chemotherapy and psychological-physical symptoms dominated in the postchemotherapy phase.
The composition of SCs in oesophageal cancer chemotherapy evolves dynamically across different stages. However, the existing evidence is mainly derived from small sample cross-sectional studies, with high heterogeneity in tools and methods. Standardised assessment criteria and longitudinal validation are needed to develop stage-specific, evidence-based interventions that can be widely applied.
To assess the current situation of nursing staff exposed to workplace violence in a teaching hospital in China, and analyze the relationship between workplace violence and their physical and mental health status, aiming to establish a foundation for enhancing the working conditions for nursing staff.
Cross-sectional study.
In 2024, a cross-sectional survey was conducted at a teaching hospital in Hubei Province, China, involving 3681 nursing staff. Assessments included workplace violence experiences and health outcomes using validated scales such as the Depression Screening Scale, Anxiety Disorder Screening Scale, Perceived Stress Scale, Psychological Resilience Scale, and Self-rating Symptom Scale. Statistical analyses incorporated propensity score matching and logistic regression.
Among the 3681 nursing staff surveyed, 33.4% (1228) reported experiencing workplace violence. Moreover, 53.6% (1974) reported symptoms of mild to severe depression, and 34.5% (1270) reported symptoms of mild to severe anxiety. Commonly reported physical health conditions included peptic ulcers (6.8%, 250), autoimmune diseases (6.6%, 241), hypertension (3.0%, 112), malignant tumors (2.0%, 73), and diabetes (1.5%, 54). Workplace violence exposure showed significant associations with gender, weekly working hours, professional roles, living situations, and alcohol consumption.
Workplace violence significantly increases the risk of both physical and psychological health problems among nursing staff. Relevant authorities should implement proactive prevention strategies to reduce the occurrence of workplace violence and thereby mitigate its associated adverse outcomes, including anxiety, depression, elevated stress levels, and chronic physical conditions.
This study found a high prevalence of workplace violence (33.4%) among nursing staff, linked to physical and mental health impairments. Screening for vulnerabilities and providing tailored psychological support can enhance resilience, reducing the frequency of violence and its detrimental impacts on staff well-being.
This study adhered to the STROBE checklist for observational studies.
This study did not include patient or public involvement in its design, conduct, or reporting. The contribution of patients/members of the public was limited solely to data collection.
Nurses commonly experience negative experiences after experiencing a patient safety event, triggering a domino effect on the nurses themselves, subsequent patients, and healthcare organisations, thus requires urgent attention.
To explore the mediating role of psychological capital and coping styles between neurotic personality and negative experiences of nurses' second victims, and to provide theoretical guidance for nursing administrators to develop targeted strategies to mitigate negative experiences of nurses' second victims.
In June–July 2023, a general information questionnaire, a neurotic personality subscale, the Chinese version of the Second Victim Experience and Support Scale, the Nurses' Psychological Capital Questionnaire, and the Coping Styles Questionnaire were used to conduct an online survey of 213 nurses' second victims and structural equation modelling was constructed to clarify the relationship between these elements.
Psychological capital and coping styles partially mediated the relationship between neurotic personality and negative experiences in the nurses' second victims, with a total indirect effect value of 0.203 and a total effect value of 0.303, for a mediating effect of 33.00%.
Neurotic personality and immature coping styles negatively predict the degree of negative experience, while psychological capital and mature coping styles positively predict the degree of negative experience. Psychological capital and coping styles play a partial mediating role between neurotic personality and negative experience.
After a patient safety incident, nursing managers can mitigate the negative experiences of nurses' second victims in patient safety incidents by reducing their neurotic personality tendencies, enhancing their level of psychological capital, and guiding them to adopt mature coping styles.
No patient or public contribution.
People living with HIV (PLWH) frequently encounter mental health symptoms. Yet, a notable gap exists regarding the divergence in core mental health symptoms among PLWH across developed and developing regions. This study aims to explore the differences in mental health symptom networks among PLWH in both developed and developing regions.
A multicenter cross-sectional study was conducted in China from April 2022 to April 2023. Six designated HIV hospitals enrolled 2436 participants, including 1430 PLWH from developed regions and 1006 PLWH from developing regions. The study assessed 40 mental health symptoms across six dimensions: somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication, and social adaptation among PLWH.
The diverse developed regions exhibited varying mental health symptoms among PLWH, particularly concerning their core symptoms. In the developed regions of China, PLWH predominantly experience core symptoms centered around “Sadness,” “Anger,” and “Distress.” In contrast, PLWH from developing regions tends to manifest core symptoms such as “Inability to integrate into society,” “Difficulty in managing daily work and study,” and “Hostility.”
The regional variation in mental health symptoms among PLWH underscores the disparities in their circumstances. This insight is crucial for crafting tailored intervention strategies for urban PLWH. In developed regions, psychological interventions such as catharsis and empathy are integral to clinical practice, while in less developed regions, family support interventions are paramount, given the limited social interactions available to PLWH.
This study was reported according to the STROBE checklist.
No patient or public contribution.
Smoking cessation is a pressing public health concern. Behavioral therapy has been widely promoted as a means to aid smoking cessation. Acceptance and commitment therapy (ACT), based on the principles of cognitive behavioral therapy, can help participants accept, rather than suppress, the physical and emotional experiences and thoughts associated with not smoking, identify experiential avoidance behaviors, strengthen the determination to quit, and ultimately commit to adaptive behavioral changes guided by smoking-cessation-related values, thereby achieving the goal of quitting smoking.
To assess the effects of ACT compared with other smoking cessation interventions by examining three key outcomes: cessation rates, smoking behaviors, and psychological outcomes.
We searched 8 databases and 2 registration platforms, covering the period from inception to March 26, 2025. We included only randomized controlled trials that recruited adult smokers and implemented ACT for smoking cessation, with the comparison group receiving either active treatment, no treatment, or any other intervention.
A total of 23 studies involving 8951 participants were included. The findings indicated that, compared with all types of control interventions, ACT significantly increased smoking cessation rates both immediately postintervention (RR = 1.48, 95% CI [1.03, 2.14], p = 0.04, I 2 = 81%) and at short-term follow-up (RR = 1.63, 95% CI = 1.31 to 2.01, p < 0.01, I 2 = 0%). Subgroup analyses showed that ACT significantly improved short-term cessation rates compared with behavioral support (RR = 1.60, 95% CI [1.27, 2.02], p < 0.01, I 2 = 0%), while, compared with the blank control, ACT significantly increased smoking cessation rates across three different time points (postintervention: RR = 3.11, 95% CI [2.13, 4.54], p < 0.01, I 2 = 0%; medium-term follow-up: RR = 2.55, 95% CI [1.32, 4.93], p < 0.01; long-term follow-up: RR = 3.33, 95% CI [1.66, 6.68], p < 0.01). Narrative synthesis suggested that compared with behavioral therapy, ACT may confer benefits in improving psychological outcomes, while compared with the blank control, it may also reduce daily cigarette consumption and nicotine dependence, and enhance psychological outcomes.
Acceptance and commitment therapy may be a beneficial approach for improving cessation rates, enhancing smoking cessation behaviors, and promoting psychological well-being among adult smokers. However, the quality of the included evidence was limited, thereby weakening the strength of these findings. Future rigorously designed trials with larger sample sizes, particularly those comparing ACT against other smoking cessation interventions, are warranted to further confirm its effects.
by Yinli Shi, Shuang Guan, Sicun Wang, Muzhi Li, Yanan Yu, Jun Liu, Weibin Yang, Zhong Wang
BackgroundAlthough filgotinib, a selective Janus kinase 1 inhibitor, has been increasingly applied in the treatment of inflammatory diseases, its comprehensive safety profile remains insufficiently characterized. Using data from the FAERS database covering Q1 2014 to Q2 2024, this study attempts to analyze adverse event signals linked to filgotinib and provide guidance for the safe and sensible clinical usage of filgotinib.
MethodsFrom Q1 2014 to Q2 2024, information on adverse drug events (ADEs) associated with filgotinib was gathered. The reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network (BCPNN), and multi-item gamma Poisson shrinker (MGPS) were among the signal detection methods that were employed for analysis following data normalization.
ResultsFilgotinib was shown to be the main suspected medication in ADE reports, exposing 103 preferred terms (PTs) in 17 system organ classes (SOCs). Infections, gastrointestinal disorders, and musculoskeletal and connective tissue disorders were the most commonly reported adverse effects. Additionally, atrial fibrillation, alopecia, elevated serum creatinine, blood creatinine increased, pulmonary embolism, epididymitis, respiratory failure, and osteopenia were identified as potential disproportionate reporting signals for filgotinib, although these were not listed in the official drug label. Notable significant signals included large intestine erosion (ROR 2186.05, 95%CI(ROR): 1015.94–4703.86, PRR 2176.18, 95%CI(PRR): 1014.64–4667.42), mesenteric arterial occlusion (ROR 1832.17, 95%CI(ROR): 897.68–3739.48, PRR 1822.71, 95%CI(PRR): 896.17–3707.20), repetitive strain injury (ROR 1149.27, 95%CI(ROR): 363.16–3637.01, PRR 1147.05, 95%CI(PRR): 363.24–3622.15), oligoarthritis (ROR 755.02, 95%CI(ROR): 310.74–1834.54, PRR 752.59, 95%CI(PRR): 310.60–1823.51), and periostitis (ROR 676.03, 95%CI(ROR): 319.36–1431.06, PRR 672.98, 95%CI(PRR): 318.97–1419.87). The subgroup analysis identified obvious sex and age-specific trends in filgotinib-related adverse reactions, emphasizing a higher risk of renal disorders in females, a preponderance of gastrointestinal events in males, and age-dependent trends involving mesenteric occlusion, increased serum creatinine, and immunoglobulin reduction.
ConclusionWhile filgotinib demonstrates therapeutic efficacy, it is associated with a range of potential adverse events, underscoring the need for vigilant clinical monitoring. Particular attention should be given to gastrointestinal, cardiovascular, respiratory, and metabolic complications.
by Zihang Zhao, Xiang Zhang, Xi Hou, Zihan Liu, Zhiyong Hou, Lianxin Song, Ruipeng Zhang
Percutaneous Bunnell repair and open modified Kessler repair remain debated options for acute Achilles tendon rupture (AATR). We retrospectively compared a minimally invasive percutaneous Bunnell technique (Group A) with an open modified Kessler repair (Group B) within a standardized early functional rehabilitation (EFR) protocol at a single center. Fifty-five adults with closed AATR treated between January 2021 and December 2022 were analyzed (Group A, n = 25; Group B, n = 30). Between-group comparisons used Welch t tests for continuous variables and χ² or Fisher exact tests for categorical variables; American Orthopaedic Foot & Ankle Society (AOFAS) and Achilles Tendon Total Rupture Score (ATRS) were assessed at 12 and 24 weeks, with Holm adjustment applied within each scale. Compared with Group B, Group A had shorter operative time (56.6 ± 15.1 vs 68.2 ± 23.2 minutes; mean difference −11.6; 95% CI −22.05 to −1.15; P = 0.030), less intraoperative blood loss (28.4 ± 8.4 vs 74.7 ± 19.4 mL; −46.3; 95% CI −54.22 to −38.38; Pby Jianhua Liao, Jun Cheng, Baoqing Liu, Yuzhi Shao, Chunyan Meng
The growing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections, coupled with the increasing resistance to existing antibiotics, underscores the critical need for novel therapeutic approaches to combat this pathogen. In this study, the role of yqhG, a conserved gene encoding a periplasmic protein, in MRSA virulence and stress adaptation was investigated. yqhG deletion in MRSA significantly attenuated virulence in a murine infection model, leading to reduced bacterial burden in infected organs and improved host survival. In vitro, the yqhG mutant exhibited impaired membrane integrity, reduced motility, and increased sensitivity to oxidative stress, but did not affect biofilm formation. These defects were fully restored upon genetic complementation. These findings highlight the critical role of yqhG in maintaining MRSA’s ability to withstand host-imposed stresses, suggesting that yqhG is a key determinant of MRSA pathogenesis. The study provides new insights into the stress-defense mechanisms employed by MRSA and underscores yqhG as a potential target for therapeutic strategies aimed at combating MRSA infections.by Mengzhi Cheng, Jianbin Zhang, Lili Jin, Caihua Yu, Zhonghai Xie, Dong Li, Qinhua Gu, Qibin Shen
Primary results of the CORIN trial indicated that, compared with chemotherapy, icotinib significantly improved 3-year disease-free survival (DFS) in patients with Epidermal Growth Factor Receptor (EGFR)-mutated stage IB non-small cell lung cancer (NSCLC). However, evidence regarding the outcomes of adjuvant icotinib in patients with high-risk factors remains limited. This retrospective study evaluated the efficacy and safety of adjuvant icotinib in patients with EGFR-mutated high-risk stage IB NSCLC. We enrolled 37 patients with completely resected EGFR-mutated high-risk stage IB NSCLC. The median follow-up time was 31 months, and the 3-year DFS rate was 91.4%. Two patients experienced disease recurrence and were successfully switched to osimertinib upon identification of an EGFR (T790M) mutation. Although overall survival (OS) and central nervous system (CNS)-DFS data were not mature, no deaths or central nervous system metastases were observed by the end of follow-up. 29 (78.4%) patients experienced grade 1–2 adverse events (AEs), no grade 3 or higher AEs occurred. This study suggests a potential DFS benefit and well-tolerated profile of adjuvant icotinib in patients with EGFR-mutated high-risk stage IB NSCLC. However, longer-term follow-up is necessary to assess the long-term outcomes.To examine how gender differences in the nursing work environment shape nurses' perceived quality of care and to identify gender-specific predictors and evaluative mechanisms.
A mixed-methods design was employed, integrating quantitative data analysis with qualitative in-depth individual interviews.
This study was conducted in two phases: The first phase was a quantitative analysis, based on a large national dataset from the 2017 Chinese Nursing Work Environment Survey (N = 16,382), in which secondary analysis was performed using hierarchical linear regression, relative importance analysis, and network analysis to identify key predictors. The second phase was a qualitative study, in which in-depth individual interviews were conducted with 30 clinical nurses (15 male and 15 female), and thematic analysis was applied to explore gender-differentiated experiences.
The core finding of this study is that gender-differentiated factors within the work environment significantly shape nurses' perception of care quality. Quantitative results showed that the strongest predictor for female nurses was professional development, whereas recognition of value was most salient for male nurses. Qualitative results corroborated these findings: female nurses emphasised continuing education and emotional support, while male nurses emphasised fair evaluation and professional identity. Both groups reported that high-intensity workloads hindered the delivery of ideal humanistic care, inducing moral distress and emotional suppression and exposing ethical gaps in organisational support.
Gender differences in the nursing work environment shape pathways to perceived care quality and expose deeper managerial and ethical challenges. A gender-sensitive, ethics-oriented management approach can enhance nurse satisfaction and care quality, providing empirical support for optimising workforce allocation and sustaining healthcare systems.
Findings direct nurse leaders to tailor improvement strategies—enhancing professional-development infrastructure for women and strengthening recognition mechanisms for men—while embedding explicit ethical support to reduce moral distress and improve both workforce well-being and patient outcomes.
No patient or public contribution.
This study aims to develop dynamic networks and examine the longitudinal relationships of mental health symptoms among persons living with HIV (PLWH).
A longitudinal study.
We collected data between October 2022 and December 2022 using Wenjuanxing (Questionnaire Star), an online survey platform. The study tracked weekly data across 10 sessions, involving 123 PLWH in Beijing, China. A total of 40 mental health symptoms with six dimensions (somatization symptoms, negative affect, cognitive processes, cognitive function, interpersonal communication and social adaptation) were included in the symptom network, which consists of temporal, contemporaneous and between-person networks.
In the temporal network, ‘feeling inferior to others’ had the largest in-strength value, whereas ‘suicidal ideation’ exhibited the largest out-strength value. In the contemporaneous network, ‘feeling inferior to others’ showed the highest bridge strength, indicating it had the most connections to other mental health symptoms.
We found that ‘feeling inferior to others’ had the highest number of predictors, with up to seven mental health symptoms potentially triggering this particular symptom. Additionally, ‘suicidal ideation’ emerged as a powerful predictor, influencing the greatest number of mental health symptoms across five dimensions.
Our study enhances the understanding of the sequential development and consequences of mental health symptoms among PLWH, which may provide an important basis for designing precise mental health symptom management interventions.
This study was reported according to the STROBE checklist.
No patient or public contribution.
by Yunhao Jiang, Gang Liu, Yulun Du, Siteng Cai, Zhichao Si, Jing He, Xiangbing Zhou
Urban large-scale complexes, such as shopping malls, pose significant challenges for fire safety management due to their intricate spatial layouts, high population density, and diverse occupancy characteristics. Efficient fire evacuation strategies are critical for minimizing casualties and economic losses; however, existing approaches often overlook the dynamic interplay between fire propagation and human behavior, resulting in suboptimal safety assessments. This study proposes an integrated simulation framework to optimize evacuation strategies by coupling fire dynamics with pedestrian flow modeling, aiming to enhance both evacuation efficiency and personnel safety. The methodology comprises three key steps: (1) Fire scenario simulation: A Building Information Modeling (BIM)-based digital platform is constructed to simulate fire propagation. Critical fire parameters (e.g., heat release rate, combustion model) are calibrated to quantify temporal variations in smoke temperature, CO concentration, and visibility across different zones. (2) Evacuation dynamics modeling: A pedestrian evacuation model is developed by integrating demographic factors (age structure, movement speed, population density) and fire-induced regional risks, enabling realistic simulation of crowd movement under fire conditions. (3) Safety performance evaluation and strategy optimization: Safety margins at staircases are assessed by comparing Required Safe Egress Time (RSET) and Available Safe Egress Time (ASET), followed by a safety grading system to identify high-risk bottlenecks. Evacuation strategies are then optimized to mitigate these risks. A case study was conducted on a shopping mall in Chengdu to validate the framework. Simulation results indicate an initial evacuation time of 260.4 seconds. Safety performance analysis revealed critical risks at staircases A and C (1st floor) and D (2nd floor) due to insufficient safety margins. After strategy optimization, the total evacuation time was reduced to 245.5 seconds, with safety margins at the three high-risk staircases increased by 130.8 s, 115.2 s, and 72 s, respectively, fully meeting safety requirements. The overall evacuation efficiency was significantly improved. This study demonstrates the effectiveness of the proposed framework in quantifying fire risks and optimizing evacuation strategies for large-scale complexes. The integrated simulation approach provides a scientific basis for evidence-based safety management and evacuation planning, offering valuable insights for urban fire safety engineering and emergency response optimization.To describe the level of family decision-making self-efficacy and its associated factors among Chinese family members of ICU patients.
Cross-sectional descriptive quantitative study.
Using convenience sampling, 154 ICU patients and their family members from two tertiary hospitals completed a paper-based questionnaire assessing sociodemographic characteristics of patients and their family members, patients' disclosure of preferences to their family members, and family members' decision-making self-efficacy, anxiety and depression, uncertainty of illness, coping and social support. The data were analysed using independent-samples t-tests, one-way analysis of variance, Pearson correlation and multiple linear regression.
The average scores of self-efficacy in treatment, comfort promotion and facing death decision-making were 4.3 (SD = 0.6; range = 1–5), 4.2 (SD = 0.6; range = 1–5) and 3.5 (SD = 0.6; range = 1–5), respectively. Active coping was a predictor of self-efficacy in treatment, comfort-promoting and facing death decision-making. Patients' disclosure of preferences regarding mechanical ventilation, family members' anxiety and illness uncertainty were predictors of self-efficacy in treatment decision-making. Patients' disclosure of preferences regarding expensive medications was a predictor of self-efficacy in comfort-promoting decision-making, and patients' age was a predictor of self-efficacy in facing death decision-making.
Chinese family members of ICU patients reported relatively high self-efficacy in treatment and comfort promotion decision-making but lower self-efficacy in facing death decision-making. Active coping plays a critical role in enhancing decision-making self-efficacy across these three types of decisions. The predictors of decision-making self-efficacy varied according to the specific type of decision.
For Chinese family members of ICU patients, targeted strategies to strengthen their active coping skills are key to enhancing their confidence in making decisions with or for patients. Patients' disclosure of preferences to their family members is helpful for improving family members' confidence in making treatment and comfort promotion decisions. Extra support is especially needed for end-of-life decision-making, particularly when the patient is younger.
This research informs future interventions by highlighting active coping and patients' disclosure of preferences to family members as key factors to strengthen decision-making self-efficacy among Chinese family members of ICU patients. However, family members' decision-making self-efficacy appears to be culturally specific, underscoring the need to design family-centered critical care approaches that are tailored to cultural contexts in other settings. Besides, while our research found a positive association between anxiety and self-efficacy in treatment decision-making, the relationship between them requires further investigation.
STROBE guidelines.
No Patient or Public Contribution.
To explore the abnormal experiences of time and space among transitional-age youth with major depressive disorder.
A descriptive phenomenological qualitative study.
The study was conducted at a psychiatric hospital in China. Purposive sampling was used to recruit transitional-age youth with major depressive disorder. Data were collected through semi-structured interviews and analysed using Colaizzi's method.
Seventeen participants were interviewed. The abnormal experiences of time and space among transitional-age youth with major depressive disorder were synthesised into five overarching themes: (1) Disturbance of Time Order; (2) Slackening of the Flow of Time; (3) Vital Inhibition; (4) Desynchronisation of Social Rhythms; and (5) Disturbance of Lived Space.
This study highlights that pervasive abnormalities in temporal and spatial experiences characterise transitional-age youth with major depressive disorder. These disturbances shape their sense of self, personal development, relationships and engagement with the world, underscoring the need for interventions that address these temporal and spatial disturbances within the context of developmental transition.
This study addresses a knowledge gap regarding the subjective experience of time and space among transitional-age youth with major depressive disorder. This study highlights that transitional-age youth with major depressive disorder experience desynchronisation across temporal, spatial, bodily and social domains. Moreover, the desynchronisation of social rhythms appears to be a unique and developmentally salient challenge for transitional-age youth with major depressive disorder. These insights expand phenomenological understandings of major depressive disorder and highlight the developmental vulnerabilities of major depressive disorder as it navigates this critical life phase.
Five participants were involved in reviewing and providing feedback on the interview content and results. Their contributions included enhancing the authenticity and credibility of the findings.
The study followed the Consolidated Criteria for Reporting Qualitative Research guidelines.
by Xiaoying Ji, Hongda Chen, Sheng-dong He, Min Huang, Xiaoli You, Chuan Xiao, Zhifeng Chen, Jinwen Cai
BackgroundNeutrophilic asthma (NA) is an allergic airway inflammation disease featuring heterogeneous neutrophil infiltration, which is driven by the interactions between dendritic cells (DCs) and T helper (Th) 17 cells. Neutrophils release neutrophil extracellular traps (Nets), which promote disease progression and glucocorticoid resistance. Therefore, targeting the interaction among Nets, DC and Th17 is a promising pathway for preventing organ damage. Traditional Chinese Medicine (TCM), especially Xiao-qing-long-tang (XQLT), has shown potential in managing eosinophilic asthma by modulating Th2 cell-mediated inflammation, reducing eosinophilic infiltration, and airway remodeling. However, XQLT’s effect on Nets and DCs-Th17 interactions in NA remains unclear.
MethodsWe developed two models: an ovalbumin (OVA)/lipopolysaccharide (LPS)-induced NA mouse model with interventions using either XQLT or sivelestat, and a series of bone marrow-derived dendritic cells (BMDCs)-Th17 cell differentiation models induced by Nets, OVA/LPS, OVA/LPS/Nets, XQLT, OVA/LPS/Nets/XQLT, or corresponding inhibitors. The chemical composition of XQLT was analyzed using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Key parameters were evaluated via histopathology, immunohistochemistry, immunofluorescence scanning, flow cytometry, Western blot (WB) analysis, and enzyme-linked immunosorbent assay (ELISA).
ResultsIn OVA/LPS-induced mice, treatment with sivelestat in OVA/LPS-induced mice reduced airway inflammation, Nets formation characterized by citrullinated histone H3 (CitH3) and myeloperoxidase (MPO) expressions, Th2/17 cell proportions in lungs, and interleukin (IL)-4, 6, 17, and 23 levels in bronchoalveolar lavage fluid (BALF). In vitro, OVA/LPS/Nets promoted IL-6/23 secretions and Th17 differentiation through increased p38 mitogen-activated protein kinase (MAPK)/nuclear factor κB (NF-κB) signaling phosphorylation in DCs. Fifty-one compounds were identified in XQLT, with 11 predicted to bind MAPK proteins with high affinity. XQLT significantly inhibited Nets-DCs-Th17 Axis and p38MAPK/NF-κB signaling in both NA mouse and cell models.
ConclusionXQLT offered a promising treatment strategy for regulating the Nets-DCs-Th17 axis in NA.
Quarantine during the COVID-19 pandemic resulted in longer-term sedentary behaviours and mental health problems. Our study aimed to evaluate the impact of the Otago exercise programme (OEP) on physical function and mental health among elderly with cognitive frailty during COVID-19.
Lockdowns and restrictions during the COVID-19 pandemic result in longer-term sedentary behaviours related disease and mental problem. Older people with cognitive frailty are more vulnerable to be influenced. Timely intervention may achieve better outcomes, OEP exercise was designed as a balance and muscle-strengthening programme for elderly people.
A parallel-group, assessor-blinded randomised controlled trial was performed according to CONSORT guidelines.
This study was conducted from July 2020 to October 2020 among 62 elderly people with cognitive frailty from a nursing home. Participants were randomly divided into an OEP group (n = 31) or a control group (n = 31). Both groups received sleep- and diet-related health education. The OEP group also received a 12-week group exercise programme. The Five Times Sit to Stand Test (FTSST), Berg Balance Scale (BBS), and Timed Up and Go Test (TUGT) were used to assess physical function. The Geriatric Depression Scale-15 (GDS-15) and the 12-Item Short Form Health Survey Mental Component Summary (SF-12 MCS) were used to assess mental health. Outcomes were measured at 6 and 12 weeks.
Physical function and mental health were similar in the two groups at baseline. At 12 weeks, the OEP group (difference in change from baseline: FTSST, −2.78; TUGT, −3.73; BBS, 2.17; GDS-15, −0.72; SF-12 MCS, 2.58; all p < .001) exhibited significantly greater improvements than the control group (difference in change from baseline: FTSST, 1.55; TUGT, 1.66; BBS, −0.10; GDS-15, 1.07; SF-12 MCS, −5.95; all p < .001).
Our findings showed the OEP group had better physical function and mental health outcomes than the control group. OEP can be used to improve the physical and mental function among elderly people with cognitive frailty during the COVID-19 pandemic.
Relevance to clinical practice: Otago exercise program intervention programmes should be implemented to improve physical function for cognitive frailty elderly to reduce the harm of longer-term sedentary behaviours, and to ruduce depression symptom and improve mental health, particularly during COVID-19 pandemic period.
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