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Delirium is a common complication following cardiac surgery and significantly affects patient prognosis and quality of life. Recently, the application of artificial intelligence (AI) has gained prominence in predicting and assessing the risk of postoperative delirium, showing considerable potential in clinical settings.
This scoping review summarises existing research on AI-based prediction models for post-cardiac surgery delirium and provides insights and recommendations for clinical practice and future research.
Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, eight databases were searched: China National Knowledge Infrastructure, Wanfang Database, China Biomedical Literature Database, Virtual Information Platform, PubMed, Web of Science, Medline, and Embase. Studies meeting the inclusion criteria were screened, and data were extracted on surgery type, delirium assessment tools, predictive factors, and AI-based prediction models. The search covered database inception through January 12, 2025. Two researchers independently conducted the literature review and data analysis.
Ten studies from China, Canada, and Germany involving 11,702 participants were included. The reported incidence of postoperative delirium ranged from 5.56% to 34%. The most commonly used assessment tools were Confusion Assessment Method for the Intensive Care Unit, Diagnostic and Statistical Manual of Mental Disorders-5, and Intensive Care Delirium Screening Checklist. Key predictive factors included age, cardiopulmonary bypass time, cerebrovascular disease, and pain scores. AI-based prediction models were primarily developed using R (6/10, 60%) and Python (4/10, 40%). Model performance, as measured by the area under the curve, ranged from 0.544 to 0.92. Among these models, Random Forest (RF) was the most effective (5/10, 50%), followed by XGBoost (3/10, 30%) and Artificial Neural Networks (2/10, 20%).
AI-based models show promise for predicting postoperative delirium in cardiac surgery patients. Future studies should prioritise integrating these models into clinical workflows, conducting rigorous multicenter external validation, and incorporating dynamic, time-varying perioperative variables to enhance generalizability and clinical utility.
This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To characterise and analyse doctoral programmes in nursing in Latin America through an exhaustive review of the official websites of the universities.
Descriptive and multiple correspondence analysis. Existing programmes were mapped out, identifying their geographic distribution and curricular characteristics.
A review of 59 doctoral programmes in nursing was conducted through the official web portals of universities in Latin America that were currently available (as of 2025) and that provided the required information. Thereafter, a matrix was built in Excel to consolidate the data.
The study identified an increase in the number of doctoral programmes in nursing offered in Latin America. Furthermore, these programmes were found to be more strongly concentrated in countries such as Brazil, Peru and Mexico, while other countries, including Guatemala and Uruguay, have recently incorporated such training.
Doctoral education in nursing in Latin America has experienced significant growth in recent years, consolidating itself as a fundamental pillar for the development of the discipline and the generation of knowledge in health. However, structural challenges persist, including limited funding for research, a lack of cooperation between universities, and the absence of programmes focused on Advanced Nursing Practice.
This contribution helps identify trends in the offering of doctoral programmes and inequalities in their geographic distribution, allowing for an understanding of how training varies across countries in the region while also consolidating Nursing as an academic and professional discipline.
To determine common and distinct factors experienced by nurses working in acute care settings during the second year of the COVID-19 pandemic.
An online qualitative descriptive study with eight open-ended questions and a comprehensive demographic profile administered via the Qualtrics XM survey software.
Thirteen countries formed teams and led online data collection in their respective countries through various approaches. The data collection period occurred between January 1, 2021, and February 28, 2022. Descriptive thematic analysis was conducted in English (with translation), Spanish, and Korean to analyse the qualitative data. Descriptive statistics summarised the responses to the demographic profile.
Worldwide, a final sample size of n = 1814 produced 6483 qualitative data points for analysis. The results identified ongoing occupational risk factors for nurses during the pandemic's second year, including mental health issues, yet showed some improvements in access to personal protective equipment and resources. Four themes emerged from the qualitative analysis, highlighting role changes, living states, and insights into the implementation of pandemic response measures.
Despite individual occupational risks nurses described, structural factors associated with healthcare delivery produced common nursing experiences during the pandemic. Additionally, at least two distinct stages of pandemic response implementation were demarcated by treatment availability (e.g., vaccine development).
There is potential for common pandemic response policies for nurses, centered on specific factors, such as the increased provision of mental health support services by healthcare organisations.
This study helped determine the common and distinct work experiences during the second year of the COVID-19 pandemic. Nurses simultaneously experienced increased workload, role changes, perpetual fear and fatigue, daily hostility, and chaos in the implementation of pandemic responses. The results will impact nurses and those they serve along with future pandemic response policies.
We have adhered to the SRQR reporting guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
To evaluate bioecology and environmental influences of patients presenting with alopecia regarding decisions made for hair camouflage.
A descriptive qualitative design was used.
Sixteen adult patients with alopecia were purposefully recruited from two specialised trichology clinics across the Jiangsu Province, China. Surveys and in-depth semi-structured interviews were conducted between October 2024 and December 2024. Practical thematic analysis of transcribed data was informed through Bronfenbrenner's ecological systems theory.
Five major facilitators (camouflaged demands drive, camouflaged psychological resilience, habituation and dependence, family resilience and cross-border support, social acceptance) and four major barriers (limited future orientation, perceived coordination barriers, marginalisation of camouflage-related information, runaway costs) to hair camouflage were identified. These themes align with different levels of the ecological systems theory.
This study captures the complex ecological and intersectional nature of choice, experience and decision-making in patients' views on hair camouflage amid alopecia. Nursing professionals must understand these complexities to provide informed support and evidence-based interventions throughout patients' experiences with alopecia.
This study uses patient voices to offer ecological insights for a holistic understanding of their experiences. It provides knowledge relevant to nursing practice and alopecia patient support. Understanding patient-identified barriers and facilitators in alopecia camouflage is essential to inform more patient-centred approaches to choice, decision-making and psychological adaptation. Nurses are pivotal in this process, making enhanced understanding crucial for improving patients' psychological wellbeing and quality of life.
Our research reveals factors that equip nurses and the broader healthcare team to develop targeted counselling strategies, educational programs and resources related to camouflage for patients with alopecia. The hair-camouflage industry can use these insights to create more personalised and accessible products, better addressing patients' concealment needs and preferences.
Standards for Reporting Qualitative Research.
No patient or public contribution.
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 systematically compare nurse-led versus traditional rehabilitation in improving clinical outcomes for stroke survivors.
Systematic review and meta-analysis.
Data were extracted from Cochrane, PubMed, Embase, and Web of Science (searched up to July 2024). Analyses with standardized mean differences (SMDs) and risk ratios (RRs) as the estimates were performed in Review Manager 5.4 and Stata 15.0. Randomized controlled trials investigating nurse-led stroke rehabilitation with outcomes such as mental component summary (MCS) and physical component summary (PCS) of quality of life, self-efficacy, National Institutes of Health Stroke Scale (NIHSS), stroke-specific quality of life (SS-QOL), Barthel Index (BI), Geriatric Depression Scale-15 (GDS-15), and pain were included. Sensitivity analyses and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed.
A total of 12 articles were included. The quality assessment indicated that most studies did not have a serious risk of bias. Nurse-led rehabilitation showed significant improvements in SS-QOL (SMD: 3.33, 95% CI: 1.26, 5.40; very low-quality evidence), depressive symptoms (GDS-15, SMD: −2.21; 95% CI: −2.80, −1.63; high-quality evidence), pain (SMD: −1.61; 95% CI: −2.14, −1.08; high-quality evidence), and BI (SMD: 0.24, 95% CI: 0.01, 0.48; low-quality evidence). However, there were no significant differences in MCS, PCS, self-efficacy, or NIHSS between the two groups. Sensitivity analysis showed that the results for SS-QOL and BI were unstable and should be interpreted with caution.
Nurse-led rehabilitation is effective in improving psychological outcomes, particularly depression (GDS-15) and pain, although this high-quality evidence is based on a single study. Functional independence (BI) and SS-QOL are also improved, but the evidence for these outcomes is of low quality and highly unstable in sensitivity analyses. No significant benefits are found for other outcomes. The evidence quality varies, and future high-quality studies are needed to confirm these findings.
Incorporating nurse-led rehabilitation into stroke guidelines and implementing standardized depression screening programs and non-pharmacological pain interventions in community rehabilitation could be beneficial for populations with depressive symptoms and chronic pain.
This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for transparent reporting of systematic reviews.
This study did not include patient or public involvement in its design, conduct, or reporting.
To explore the possible barriers and facilitators to implementing the Upright Positions in the Second Stage of Labour (UPSSL) programme in Chinese healthcare settings.
A mixed-method convergent design with the guidance of Consolidated Framework for Implementation Research (CFIR).
An online survey study and semi-structured interviews were conducted between March and May 2023. Healthcare professionals were recruited from four hospitals in Shijiazhuang, China. One hundred and thirty-one participants completed the survey study, and 23 of them were interviewed individually. Descriptive statistics evaluated the possible barriers and facilitators of implementing the UPSSL programme within the CFIR framework quantitatively. Guided by the CFIR framework, qualitative data were analysed using directed content analysis to summarize healthcare professionals' perspectives on barriers and facilitators of the UPSSL programme.
Multiple intersectional barriers and facilitators were identified from the survey and semi-interviews. Healthcare professionals believed that the UPSSL programme has a scientific evidence base, systematic contents, and possible benefits for women. However, various barriers existed at individual, system, and organizational levels. Major barriers included healthcare professionals and women's safety concerns towards the use of upright positions during childbirth, the healthcare professionals' unfamiliarity with assisting an upright position birth, poor adaptability of the programme protocol, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting.
To facilitate the implementation of the UPSSL programme in China, tailored antenatal education on upright positions, especially addressing safety-related issues, should be provided to pregnant women, their families, or peers to enhance their understanding of and familiarity with such positions. Healthcare professionals should also be offered adequate training opportunities and necessary facilities. Furthermore, national-level policy changes might be required to address midwifery workforce shortages. Additionally, further research is warranted to select, adapt, and test effective implementation strategies for programme adoption.
What problem did the study address? The adoption of upright positions during the second stage of labour could promote better maternal and neonatal outcomes and a positive childbirth experience. However, the adoption of upright positions during the second stage of labour is suboptimal in healthcare settings in China. Barriers and facilitators of implementing upright positions during childbirth are unclear. What were the main findings? A range of barriers and facilitators within the CFIR framework to promote upright positions during childbirth from healthcare professionals' perspectives were identified, and the major barriers included safety concerns towards and unfamiliarity with an upright position birth, inadequate facilities and staffing, and a lack of readiness to change in the clinical setting. Where and on whom will the research have an impact? This study will enable a better understanding of the barriers and facilitators to promoting upright positions in the second stage of labour in China. The smooth and effective implementation of the UPSSL programme could help to promote better maternal and neonatal outcomes and improve women's childbirth experiences.
The reporting of this study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Good Reporting of A Mixed Methods Study (GRAMMS) guidelines.
In this study, healthcare professionals were involved in refining the topic guides and survey questions. Additionally, findings from the interviews were returned to them for comments and corrections.
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