Conectar
IgG4-related disease is a chronic fibroinflammatory disease with multiorgan involvement. Glucocorticoids and/or immunosuppressants as well as rituximab are both first-line treatments in remission induction therapy. However, relapse is common during the maintenance period, particularly in patients with re-elevation of serum IgG4 level. This study aims to evaluate whether adding mycophenolate mofetil (MMF) during the maintenance phase for such patients can reduce the risk of disease flare.
This study is a multicentre, randomised, double-blind, placebo-controlled study. A total of 108 eligible patients with re-elevation of serum IgG4 level during maintenance therapy will be included in this study and randomised in a 1:1 ratio to receive add-on MMF 0.5 g one time per day or placebo for 52 weeks. The primary outcome is the proportion of patients experiencing relapse at week 52. Secondary outcomes include time-to-relapse, changes in disease activity and serum IgG4 level, stratified relapse rate according to the elevation level of IgG4. Analyses will follow the intention-to-treat principle.
The study has been approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (approval no. K3231). Written informed consent will be obtained from all participants before enrolment. Findings will be disseminated through peer-reviewed journals and conference presentations.
Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.
To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.
In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.
Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%).
Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.
PROSPERO (CRD42022358717). No Patient or Public Contribution.
by Dandan Liu, Huixia Ji, Ye Chen, Tongzhou Zhou
BackgroundMetabolic dysfunction‑associated steatotic liver disease (MASLD) is a multisystem metabolic disorder. The impact of occupational noise exposure on metabolic processes through non-auditory pathways is also closely associated with hepatic steatosis in addition to obesity. Most studies examine noise exposure or Body Mass Index (BMI) alone on ultrasound-detected hepatic steatosis(UDHS), while few examine BMI’s interaction with occupational noise duration. The underlying mechanisms of these combined effects remain unclear. The correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers is examined, as well as the interactive role of BMI
ObjectiveThis study investigates the correlation between occupational noise exposure duration and UDHS in automotive manufacturing workers, as well as the interactive moderating effect of BMI on this association.
MethodsA retrospective study involved 769 male workers exposed to occupational noise. Ultrasound was used to diagnose hepatic steatosis. Modified Poisson regression with robust variance estimation was used to analyze variable associations. A slope analysis and Johnson-Neyman test were used to validate BMI and variable interactions. A sensitivity analysis was performed to ensure robustness.
ResultsOverall, 53.2% of workers had UDHS. Noise exposure duration showed a significant independent association with UDHS,with a negative interaction effect on BMI (P = 0.006) after adjusting for confounding factors. In normal-weight workers, each additional year of noise exposure was associated with an 8.2% higher UDHS likelihood (P < 0.001), but not statistically significant in overweight/obese individuals; BMI = 27.7 kg/m² represented the critical threshold where the magnitude of this association approached zero. Alcohol consumption and overweight/obesity were independent risk factors.
ConclusionNoise exposure is associated with UDHS risk among male workers, yet BMI modifies this association, whereby the magnitude of this association weakens as BMI increases. These findings are specific to male factory workers and cannot be generalized to female populations. Accordingly, tailored occupational health protection strategies can be developed for noise-exposed populations.
Operating room noise levels during ankle fracture open reduction and internal fixation (ORIF) can reach levels well above the WHO recommended 35 dB(A) threshold for hospital treatment rooms. Neuroimaging evidence confirms that primary auditory cortex remains responsive to acoustic stimuli even under general anaesthesia (bispectral index 40–60), suggesting intraoperative noise may trigger stress responses via subcortical pathways. Active noise-cancelling (ANC) headphones combined with music therapy represent a promising non-pharmacological intervention for enhanced recovery after surgery protocols, yet no study has employed factorial design to isolate the independent and interactive effects of noise reduction and music therapy on postoperative recovery.
This prospective, randomised, participant and outcome-assessor-blinded, four-arm, 2x2 factorial design trial will enrol 224 adult patients (aged 18–65 years) scheduled for elective ankle fracture ORIF under standardised anaesthesia combining saphenous nerve block with popliteal sciatic nerve block plus general anaesthesia at Deyang Sixth People’s Hospital, Sichuan, China. Patients will be randomised 1:1:1:1 to: (1) NC-MT group: ANC plus personalised music; (2) NC group: ANC only; (3) MT group: passive isolation plus personalised music and (4) Sham group: passive isolation only. All groups will wear identical Soundcore Space One headphones, applied after anaesthesia induction (loss of consciousness) and removed before emergence (Bispectral Index<60), so that patients cannot perceive between-group difference in device operating mode. The primary outcome is the 15-item Quality of Recovery score (QoR-15) at 24 hours postoperatively. Secondary outcomes include pain (Visual Analogue Scale), anxiety (6-item State-Trait Anxiety Inventory), sleep quality (Richards-Campbell Sleep Questionnaire), melody recognition test, opioid consumption and adverse events.
This study was approved by the Institutional Review Board of Deyang Sixth People’s Hospital, Sichuan, China, on 23 December 2025 (DSLYIRB-2025-11) and is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice of the International Council for Harmonisation (ICH-GCP) guidelines. Written informed consent will be obtained from all participants prior to enrolment. Findings will be disseminated through peer-reviewed publication and academic conference presentations.
ChiCTR2600123100.
Postherpetic neuralgia (PHN) is the most common chronic complication of herpes zoster, characterised by persistent pain after the rash subsides with a particularly high incidence among the elderly population. Its pathological mechanism involves peripheral and central sensitisation, often leading to severe pain, sleep disturbances, emotional issues and a decline in quality of life, posing a significant burden on healthcare and society. Current clinical treatments primarily rely on pharmacological and interventional therapies yet their efficacy remains suboptimal. Stellate ganglion block (SGB), as an interventional technique targeting the sympathetic nervous system, is believed to alleviate PHN by modulating neurovascular function, inhibiting inflammatory responses and blocking pain transmission pathways. However, evidence-based data on its efficacy and safety remain insufficient and existing study results are inconsistent. Therefore, this study aims to comprehensively evaluate the effectiveness and safety of SGB in treating PHN through a systematic review and meta-analysis.
This systematic review and meta-analysis will be conducted in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search will be performed for relevant randomised controlled trials published from the inception of each database until 31 December 2025, in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database and VIP Database. Two researchers will independently complete the literature screening, data extraction and cross-verification. The methodological quality of the included studies will be assessed using the Cochrane Risk of Bias tool. Statistical analysis will be performed using RevMan V.5.4 software: continuous variables will be analysed by calculating the mean difference and 95% CI, and dichotomous variables will be analysed by calculating the OR and 95% CI. Based on the results of heterogeneity testing (I² statistic), either a fixed-effects model or a random-effects model will be employed for data synthesis. Subgroup analyses and sensitivity analyses will be conducted to explore sources of heterogeneity, and a grading system will be used to assess the quality of the evidence.
Ethical approval is not required for this study, as it does not involve the collection of primary data from individual patients. Findings will be disseminated through peer-reviewed publication and conference presentations.
CRD420251128909.
Recanalisation rates following standard intravenous thrombolysis (IVT) for acute ischaemic stroke due to medium or large vessel occlusion (MeVO/LVO) remain unsatisfactory, leading to poor clinical outcomes. Tenecteplase (TNK), a fibrin-specific thrombolytic agent, demonstrates potential advantages over alteplase, including higher recanalisation rates in LVO. Preliminary evidence suggests that a second dose of thrombolytic in patients with persistent vessel occlusion after initial IVT may be feasible and beneficial. This study aims to evaluate the efficacy and safety of a second intravenous dose of TNK administered to patients with acute anterior and posterior circulation MeVO/LVO who have not recanalised 1 hour after standard IVT.
RITIS-TNK2 is a prospective, randomised, open-label, blinded endpoint, multicentre, superiority trial. Eligible patients will be randomly assigned (1:1) to receive a second dose of TNK (0.25 mg/kg intravenously, capped at a maximum total dose of 16 mg) plus standard medical care or standard medical care alone. The primary efficacy outcome is the recanalisation rate of the occluded artery at 24 hours after randomisation. The primary safety outcome is symptomatic intracranial haemorrhage within 24 hours. Secondary outcomes include functional status at 90 days (modified Rankin Scale score). The expected recanalisation rate at 24 hours in the control group is estimated at 45%. We hypothesise rescue TNK will raise 24-hour recanalisation rate from 45% to 65%, representing an absolute 20 percentage-point improvement and a relative 44.4% increase. A maximum of 198 patients are required to test the superiority hypothesis with 80% power according to a two-sided 0.05 level of significance.
This study has been approved by the central Institutional Review Board (General Hospital of Northern Theater Command; IRB: Y (2025) 502). The study results will be disseminated through peer-reviewed journals and presentation at relevant national and international scientific conferences, regardless of the direction of the findings.
Fibrosing interstitial lung diseases (F-ILD) affect substantial patient populations with significant mortality and socioeconomic burden. Approximately one-third of patients with F-ILD develop a progressive fibrosing phenotype with poor outcomes. Current monitoring methods, including pulmonary function testing and high-resolution CT (HRCT), often lag behind increases in fibrotic activity, limiting early risk identification and optimal treatment timing. Fibroblast activation protein (FAP) imaging can capture fibrotic activity at the pathological level. This study aims to evaluate the incremental value of ⁹⁹Tc-FAPI single-photon emission CT (SPECT)/CT for early warning of disease progression in F-ILD and develop a predictive model integrating fibroblast activation protein inhibitor (FAPI) quantitative parameters with clinical variables.
This prospective, single-centre, observational cohort study will recruit 380 adult patients with confirmed F-ILD diagnoses from December 2024 to June 2027, with 12-month follow-up. Comprehensive baseline evaluation includes pulmonary function testing, 6-min walk test, laboratory investigations and ⁹⁹Tc-FAPI SPECT/CT imaging. Follow-up visits at 3, 6 and 12 months will assess clinical outcomes. The primary outcome is disease progression within 12 months, defined as ≥5% forced vital capacity decline, ≥10% diffusing capacity of the lungs for carbon monoxide decline, increased fibrosis on HRCT, acute exacerbation or death. Cox proportional hazards regression models will be used for predictive model construction, with internal validation using bootstrap resampling and temporal split methods.
The study protocol has been approved by the Ethics Committee of Fujian Provincial Hospital (K2024-11-010) and will be conducted according to the Declaration of Helsinki and Good Clinical Practice guidelines. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publications and academic conference presentations. De-identified individual participant data will be available upon reasonable request after primary publication.
Chinese Clinical Trial Registry ChiCTR2400093808.
Malignant biliary obstruction (MBO) is a common complication of pancreaticobiliary and periampullary malignancies and is associated with substantial morbidity and reduced survival. Multiple biliary drainage strategies are available, including endoscopic, percutaneous and surgical approaches, as well as adjunctive therapies. However, direct head-to-head comparisons remain limited, and the relative effectiveness and safety of these interventions are not well established. This study aims to compare the effectiveness and safety of different biliary drainage strategies for MBO using a network meta-analysis, allowing both direct and indirect comparisons and enabling ranking of treatment strategies.
This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. We will systematically search MEDLINE via PubMed, Embase via Elsevier, Web of Science Core Collection via Clarivate, and the Cochrane Central Register of Controlled Trials via the Cochrane Library from inception to 30 June 2026. Randomised controlled trials (RCTs) and non-randomised comparative studies will be included. Interventions of interest include endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound-guided biliary drainage (EUS-BD), percutaneous transhepatic biliary drainage (PTBD), surgical bypass and adjunctive therapies combined with drainage (eg, photodynamic therapy or radiofrequency ablation). Primary outcomes will include technical success, clinical success and quality of life. Secondary outcomes will include adverse events, reintervention rates, overall survival, 30-day all-cause mortality, stent patency duration and length of hospital stay. Risk of bias will be assessed using the Cochrane Risk of Bias two tool for RCTs and the ROBINS-I tool for non-randomised studies. A random-effects network meta-analysis will be conducted within a frequentist framework. Consistency and transitivity assumptions will be assessed, and treatment ranking will be estimated using the surface under the cumulative ranking curve. Subgroup analyses will be performed according to clinically relevant factors, including obstruction site, stent type, tumour type and treatment setting. The certainty of evidence will be evaluated using the GRADE approach adapted for network meta-analysis.
Ethical approval is not required, as this study is based on published data. Findings will be disseminated through peer-reviewed publication.
CRD420261373097
Hand expression is a manual method of milk expression that requires no equipment and is commonly used in the early postpartum period, particularly when direct breastfeeding is not possible or not effective. Randomised trials have reported mixed findings across different maternal–infant contexts. This review aims to synthesise randomised evidence on the effects of postpartum hand expression on expressed milk volume and breastfeeding outcomes.
We will include individually randomised parallel-group controlled trials involving human postpartum women expressing breast milk in the early postpartum period. The intervention is postpartum hand expression; comparators will include electric or manual pump expression and usual care without structured hand-expression training. We will search PubMed, Embase, CINAHL, PsycINFO, Web of Science and CENTRAL from inception, without language or date restrictions and also search OpenGrey, ClinicalTrials.gov and WHO ICTRP, plus reference lists. Two reviewers will independently screen studies, extract data and assess risk of bias using the Risk of Bias tool for randomised trials, version 2. Eligible outcomes include expressed milk volume, breastfeeding outcomes, supplementation, time to onset of copious milk secretion and maternal outcomes. Where appropriate, we will conduct pairwise meta-analyses, calculating risk ratios for dichotomous outcomes and mean differences or standardised mean differences for continuous outcomes with 95% CIs. Heterogeneity will be assessed using ² and I², with prespecified subgroup and sensitivity analyses. Certainty of evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
This study will be based on previous research findings, so that ethics approval is not required. Data searching commences in June 2026 and expects to complete in January, 2027. The findings will be disseminated through peer-reviewed journals and academic conferences.
CRD420261327070.
by Hongxiao Lv, Xinyu Yang, Yutong Liu, Junwei Zhou, Wentao Yu
BackgroundTanshinone IIA (TSA) is the core liposoluble active component of Salvia miltiorrhiza, a traditional Chinese medicine, and exhibits multiple pharmacological activities including anti-inflammation, anti-oxidation, anti-apoptosis and mitochondrial function improvement. Studies have confirmed that TSA can ameliorate cognitive function in rats with vascular dementia (VaD) by alleviating cerebral ischemic injury, inhibiting neuroinflammation, protecting the blood-brain barrier and other pathways. However, it has not been reported whether TSA exerts its neuroprotective effect by regulating the cuproptosis pathway. Focusing on cuproptosis, this study investigated the effects of TSA on cognitive impairment, neuronal injury and cuproptosis-related mechanisms in a rat model of VaD.
MethodsA rat model of VaD was established by permanent bilateral common carotid artery ligation (2-VO), and the model rats were treated with TSA. The cognitive impairment of VaD rats was evaluated by the Morris water maze test. Hematoxylin-eosin (HE) staining and Nissl staining were used to detect neuronal injury and loss in the hippocampus of VaD rats. Transmission electron microscopy (TEM) was performed to observe the ultrastructure of mitochondria in the hippocampus; Western blot (WB) assay was adopted to detect the expression levels of cuproptosis-related proteins, including solute carrier family 31 member 1 (SLC31A1), ferredoxin 1 (FDX1), lipoic acid synthetase (LIAS) and dihydrolipoamide transacetylase (DLAT).In vitro, an oxygen-glucose deprivation/reoxygenation (OGD/R) model was established in HT-22 cells to evaluate the effects of TSA on cell viability (CCK-8), intracellular reactive oxygen species (ROS) levels, and copper accumulation (Coppersensor-1 staining), further validating the involvement of copper homeostasis in TSA-mediated neuroprotection.
ResultsThe results revealed that TSA markedly alleviated cognitive dysfunction and neuronal damage in VaD rats. It also reversed the cuproptosis-related abnormal changes in the brain of VaD rats, and modulated the expression of SLC31A1/FDX1 pathway proteins. In vitro, TSA protected HT-22 cells from OGD/R-induced injury by reducing oxidative stress and copper accumulation.These changes were associated with amelioration of copper overload and mitochondrial damage, suggesting that TSA may exert neuroprotection partially through the regulation of cuproptosis-related pathways.
ConclusionTSA effectively alleviated cognitive impairment and neuronal injury in VaD rats, and exerted neuroprotective effects both in vivo and in vitro by attenuating copper-dependent cytotoxic stress, preserving mitochondrial integrity, and modulating the SLC31A1/FDX1 axis. This study provides a new perspective and theoretical basis for the future development of targeted drugs for VaD.
by Wenyi Qin, Jiajun Huo, Xiongsheng Xiao, Siyi Li, Haiqing Luo, Yongkang Wu, Weijie Chen, Zhuoting Chen, Changwei Zheng, Muge Liu, Baibei Li, Guiping Zhou, Zhibin Huang, Xuemeng Li, Jinquan Li, Zhi Zhang, Jian Ye
BackgroundThe changes of intestinal flora and thyroid hormone levels before and after operation for papillary thyroid cancer (PTC) and their relationship are not clear. It may interfere with the intestinal thyroid axis, change the systemic thyroid hormone regulation and exogenous treatment response. It is recognized that this microbial involvement is clinically related to long-term metabolic outcomes, and future strategies for microbial targeted adjuvant therapy are suggested. This study aims to provide direct evidence and a comprehensive understanding of the relationship between intestinal flora and thyroid hormone levels before and after surgical treatment of papillary thyroid cancer through metagenomic analysis.
MethodsAs a paired before and after observation study, 20 patients diagnosed with papillary thyroid cancer were included in the study. Fecal samples and thyroid hormone levels were collected within 3 days before operation and 72 hours after operation. First, the intestinal microbiota of these 20 patients was analyzed for metagenomic differences, such as α and β diversity analysis, PCoA, ANOSIM, Spearman correlation analysis, FDR correction, KEGG pathway enrichment and correlation network analysis. Subsequently, the changes of hormone levels were examined in combination with the collected intestinal microbiota.
ResultsThere were significant differences in the diversity and composition of the gut microbiota in patients with papillary thyroid cancer before and after surgery. At the species level, the eight most significantly different groups identified were Bacteroides sp., Clostridium sp., Bacteroides fragilis, Alistipes sp., Parabacteroides sp., Bacteroides thetaiotaomicron, Phocaeicola dorei, and Oscillibacter sp. Notably, Clostridium sp. higher abundance in the pre-operative group, whereas Bacteroides sp., Bacteroides fragilis, Alistipes sp., Parabacteroides sp., Phocaeicola sp., and Bacteroides thetaiotaomicron were more prevalent in the post-operative group. After operation, FT4 showed an upward trend, while TSH, PTH and HTG showed a downward trend. The primary differential pathways associated with these changes pertained to iron uptake and regulation, polysaccharide utilization and transport, as well as metabolism and stress response. The pre-operative group was predominantly involved in ribosome biosynthesis, along with amino acid synthesis for valine and leucine. In contrast, the post-operative group primarily engaged in lipoic acid metabolism, glycosaminoglycan degradation, and bacterial secretion systems.
ConclusionThis study found that the composition, diversity and function of intestinal flora changed in patients with papillary thyroid cancer after operation. Specific microbial taxa may be associated with fluctuations in thyroid hormone levels. In the future, regulating intestinal flora can be used as an adjuvant therapy for hormone regulation in patients undergoing PTC surgery.
Surgical-site infections (SSIs) are a major complication after open abdominal surgery, especially in high-risk patients (obesity, diabetes, immunosuppression). Prophylactic negative-pressure wound therapy (pNPWT) may reduce SSIs. This study evaluated pNPWT versus standard dressings and developed an SSI risk prediction nomogram. A single-centre retrospective study included 83 high-risk adults undergoing open abdominal surgery (2022–2024). Patients received pNPWT (n = 38, −125 mmHg for 5–7 days) or standard dressing (n = 45). Primary outcome: CDC-classified SSI within 30 days. Secondary outcomes included wound dehiscence, epithelialisation time, hospital stay, 30-day readmission and 3-month scar quality. Multivariate logistic regression identified SSI predictors; a nomogram was built and assessed (discrimination: AUC, calibration: bootstrap, utility: decision curve). SSI incidence was significantly lower with pNPWT (5.3% vs. 35.6%; p = 0.002). Compared with standard dressings, pNPWT shortened time to complete epithelialization (10.2 [8.90–11.4] vs. 14.5 [12.3–17.7] days; p < 0.001) and reduced postoperative length of stay (10.3 [8.88–12.2] vs. 13.4 [10.5–17.4] days; p < 0.001). In multivariable analysis, pNPWT was independently protective (adjusted OR: 0.030, 95% CI: 0.001–0.298; p = 0.011), while higher BMI (adjusted OR: 1.476; p = 0.013), higher HbA1c (adjusted OR: 3.726; p = 0.016) and longer incision length (adjusted OR: 1.441; p = 0.016) were associated with increased SSI risk. pNPWT significantly reduces SSIs and improves wound healing in high-risk open abdominal surgery. The developed nomogram accurately predicts individual SSI risk, aiding personalised prophylaxis. Prospective multi-centre RCTs with economic evaluations are needed to confirm findings and guide practice.
To examine the association between nursing experience and paediatric adverse nursing event (ANE) harm risk, and whether SOP accessibility modifies this association.
Retrospective cohort study, 2015–2024.
We analysed paediatric ANEs reported from 2015 to 2024 at a tertiary children's hospital in western China. The primary outcome was whether an ANE resulted in harm (yes/no). The exposure was years of nursing experience, grouped into five categories (< 1, 1–< 3, 3–< 5, 5–< 10 and ≥ 10 years), and SOP accessibility served as an effect modifier. Multivariable logistic regression models and stratified analysis with interaction tests were applied.
Among the 3199 paediatric ANEs, 1341 (41.92%) resulted in harm. Harm risk was highest among nurses with ≥ 10 years of experience (adjusted OR = 1.93, 95% CI: 1.33–2.81 vs. < 1 year), with no significant elevation in the intermediate nurses (1–10 years). SOP accessibility modified this association (p for interaction = 0.004). When SOPs were accessible, the elevated risk in the ≥ 10-year group persisted (adjusted OR = 1.95, 95% CI: 1.33–2.87); when SOPs were inaccessible, it was no longer evident, and a protective association appeared in the 3–< 5-year group (adjusted OR = 0.15, 95% CI: 0.03–0.76).
Nursing experience exhibited nonlinear association with paediatric ANE harm risk, and this relationship was significantly modified by SOP accessibility. Harm risk was highest among nurses with ≥ 10 years of experience. However, given the retrospective observational design, causal inference is precluded, and the underlying mechanisms remain to be elucidated.
No patient or public contribution.
by Dongrun Liu, Qixu Zhou, Shiwei Ma, Song Zhang, Yang Liu, Huanhuan Zhang, Kaige Li, Chaoran Chen
PurposeYoung nurses represent the primary workforce for the future of the nursing industry. However, they often experience a heightened sense of overqualification, which can easily lead to silence behavior, negatively impacting personal well-being, organizational development, and the quality of nursing care. The purpose of this study is to explore the relationship between perceived overqualification and silence behavior among young nurses, as well as the mediating role of surface acting and the moderating role of perceived organizational support.
MethodThe Scale of Perceived Overqualification, the surface acting dimension of the Emotional Labor Scale, the Employee Silence Scale, and the Perceived Organizational Support Scale were used to conduct a cross-sectional survey of 1,095 young nurses from six general hospitals in China. A moderated mediation model was constructed, and data were analyzed using Hayes’ PROCESS macro (Models 4 and 59).
ResultsThere are significant correlations among perceived overqualification, surface acting, silence behavior, and perceived organizational support (p Conclusion
Reducing young nurses’ perceived overqualification, decreasing surface acting, and enhancing perceived organizational support may help reduce the occurrence of silence behavior. Nursing managers should provide young nurses with appropriate career development opportunities, offer training in emotional regulation and stress management, and foster an open, psychologically safe communication environment and supportive organizational climate. These strategies may effectively intervene in silence behavior and contribute to improving team vitality and the quality of nursing services.
by Hongyi Chen, Danyu Xu, Wenjing Wang, Xinyin Luo, Xiaocong Jiang, Ningyi Wan, Yuhuan Wei, Ting Wang, Li Zhang, Xuemei Li, Xinyu Zhou
BackgroundMajor depressive disorder (MDD) is highly prevalent in adolescents, and a substantial proportion of patients show inadequate response or limited tolerability to first-line treatments such as selective serotonin reuptake inhibitors and cognitive behavioral therapy, highlighting the need for additional treatment options. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated efficacy in adults with depression, but evidence in adolescents remains limited. Resting-state functional connectivity MRI (rs-fcMRI) may provide a circuit-informed approach for individualizing rTMS target selection within the dorsolateral prefrontal cortex (DLPFC) based on its functional connectivity with the subgenual anterior cingulate cortex (sgACC).
MethodsThis is a randomized, double-blind, three-arm, sham-controlled pilot trial. Forty-five adolescents with MDD will be assigned in a 1:1:1 ratio to conventional left DLPFC-targeted rTMS, rs-fcMRI-guided rTMS targeting the individualized DLPFC site showing the strongest negative connectivity with the sgACC, or sham stimulation. Treatment will be delivered over 4 weeks. Primary outcomes will include recruitment feasibility, intervention adherence, 6-month retention, preliminary clinical efficacy, and safety, assessed by enrollment, completion of 20 treatment sessions, completion of 6-month follow-up, CDRS-R-based response and remission, and adverse events/serious adverse events. Secondary outcomes will include depressive and anxiety symptoms, suicidality, sleep quality, global clinical status and improvement, rumination, and pediatric health-related quality of life.
DiscussionThis pilot trial will provide preliminary evidence regarding the feasibility, acceptability, safety, and early clinical efficacy signals of rs-fcMRI-guided rTMS in adolescents with MDD. By comparing individualized circuit-informed targeting with conventional left DLPFC stimulation and sham stimulation, the study may help clarify whether this imaging-guided neuromodulation approach is practicable and clinically informative in this population. The findings are expected to support refinement of study procedures, outcome selection, and trial design for a future fully powered randomized controlled trial.Trial registration: ClinicalTrials.gov NCT07185438.
To identify the barriers to timely access to palliative care from the perspective of Australian inpatients and their families.
A co-designed mixed methods study with an equal status explanatory design (QUAN ➔ QUAL).
Quantitative data were collected in Phase 1 via surveys to assess participants' knowledge and experience of palliative care. In the second phase, qualitative data were obtained via semi-structured interviews to explore participants' perceptions of palliative care and to identify barriers to palliative care.
A total of 194 complete patient survey responses and 52 family/visitor responses were received. Mean self-rated knowledge of palliative care was slightly higher than self-rated knowledge of end-of-life care in both groups. Patient respondents scored a mean of 9.3 out of 13 on the Palliative Care Knowledge Scale and family visitor respondents had a mean score of 9.7. Statistically significant differences in the mean Palliative Care Knowledge scores were found when patient and family respondents reported being familiar with palliative care. A total of 11 patients and nine family members participated in an interview in Phase 2. Three main themes and nine subthemes were identified. The three main barriers were Communication, Knowledge and Perceptions, and Accessibility.
Patients and family members perceived a range of barriers to palliative care at the individual, health professional, and system level. These findings highlight areas where targeted interventions should be developed to improve timely access to palliative care.
While the perspectives of health professionals are well known, the perceptions of patients and families on the barriers to palliative care are underreported. A wide variety of complex issues that could impede timely access to palliative care were identified at the individual, health professional and system level. Health consumer perspectives are essential to fully understanding the barriers to palliative care access. The findings of this research can be used to inform future interventions to improve access to palliative care.
Good Reporting of A Mixed Methods Study (GRAMMS) checklist (Data S2) (O’Cathain et al., 2008).
The study was guided by a steering group of health consumers and health professionals working in partnership with the research team through all stages of the research process.
This meta-synthesis of qualitative studies aimed to explore the experiences and perspectives of healthcare providers in the Intensive Care Unit (ICU) setting regarding the implementation of early mobilization.
A qualitative systematic review and meta-synthesis was conducted. The review protocol was registered with PROSPERO (CRD420251057721).
Six databases (PubMed, EMBASE, Web of Science, CINAHL, CNKI and Wanfang Data) were searched from inception to March 5, 2025. A total of 759 records were identified, and 34 studies met the eligibility criteria and were included in the final meta-synthesis.
We evaluated the quality of the included studies using the Critical Appraisal Skills Programme-Qualitative Research Checklist.
Thirty-four studies conducted in 13 countries and involving 699 ICU healthcare providers were included. Four analytical themes were generated: characteristics of early mobilization, the inner setting of implementation, the key role system and core determinants of successful implementation.
Early mobilization in ICUs should be understood as a multidimensional implementation process rather than a single rehabilitation task. Sustainable practice depends on the characteristics of the intervention, organizational readiness, clearly defined interprofessional roles, patient engagement and process-level strategies such as preplanning, real-time monitoring, debriefing and feedback. The findings support the development of context-sensitive implementation strategies to translate early mobilization evidence into routine ICU care.
This review underscores the critical importance of organizational support, team collaboration mechanisms and the professional capacity building of healthcare providers in advancing early mobilization within ICU settings. Frontline clinicians should be equipped with targeted training and structured planning tools, while leadership is encouraged to foster a culture of shared responsibility and continuous improvement.
This qualitative systematic review did not involve original patients or the public. Therefore, this is not applicable.
With antiretroviral therapy, HIV has become a manageable chronic condition, shifting focus to improving health-related quality of life (HRQoL). Non-pharmacological interventions offer distinct advantages for optimizing long-term health outcomes in people living with HIV.
To identify optimal non-pharmacological interventions for improving overall HRQoL and its domains (physical, psychological, social, environmental, independence, spiritual).
Ten databases (Embase, MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, CENTRAL, CBM, CNKI, VIP Information, Wanfang Data) were searched from inception to August 2025. Bayesian network meta-analyzes were performed for direct and indirect comparisons. The Cochrane Rob-2 and the CINeMA tools were used to assess risk of bias and the certainty of evidence, respectively.
37 articles were included. Exercise was most effective for overall HRQoL (SMD = 1.00, 95% CI [0.43, 1.58]) and physical (SMD = 0.69, 95% CI [0.11, 1.27]), psychological (SMD = 0.93, 95% CI [0.37, 1.51]), and social (SMD = 0.57, 95% CI [0.06, 1.08]) domains. Mindfulness-based interventions ranked second for overall HRQoL (SMD = 0.82, 95% CI [0.24, 1.40]). Cognitive behavioral therapy ranked second in the psychological domain (SMD = 0.73, 95% CI [0.16, 1.29]). Insufficient data precluded network meta-analysis for environmental, independence, and spiritual domains.
Future research should explore how different exercise types affect specific HRQoL dimensions and conduct large-scale, head-to-head RCTs to confirm the efficacy of exercise, cognitive behavioral therapy, and mindfulness interventions, especially for the environmental, independence, and spiritual domains. Methodological improvements—including blinding of outcome assessors, intention-to-treat analysis, standardized measurement tools, and protocol transparent reporting—are needed.
PROSPERO: CRD420251118087
FreshRSS 