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To investigate the physical activity levels of lung cancer survivors, analyse the influencing factors, and construct a predictive model for the physical activity levels of lung cancer survivors based on machine learning algorithms.
This was a cross-sectional study.
Convenience sampling was used to survey lung cancer survivors across 14 hospitals in eastern, central, and western China. Data on demographic, disease-related, health-related, physical, and psychosocial factors were also collected. Descriptive analyses were performed using SPSS 25.0, and predictors were identified through multiple logistic regression analyses. Four machine learning models—random forest, gradient boosting tree, support vector machine, and logistic regression—were developed and evaluated based on the Area Under the Curve of the Receiver Operating Characteristic (AUC-ROC), accuracy, precision, recall, and F1 score. The best model was used to create an online computational tool using Python 3.11 and Flask 3.0.3. This study was conducted and reported in accordance with the TRIPOD guidelines and checklist.
Among the 2231 participants, 670 (30%), 1185 (53.1%), and 376 (16.9%) exhibited low, moderate, and high physical activity levels, respectively. Multivariate logistic regression identified 15 independent influencing factors: residential location, geographical region, religious beliefs, histological type, treatment modality, regional lymph node stage, grip strength, 6-min walking distance, globulin, white blood cells, aspartate aminotransferase, blood urea, MDASI score, depression score, and SRAHP score. The random forest model performed best among the four algorithms, achieving AUC-ROC values of 0.86, 0.70, 0.72, and 0.67, respectively, and was used to develop an online predictive tool (URL: http://10.60.32.178:5000).
This study developed a machine learning model to predict physical activity levels in lung cancer survivors, with the random forest model demonstrating the highest accuracy and clinical utility. This tool enables the early identification of low-activity survivors, facilitating timely, personalised rehabilitation and health management.
The development of a predictive model for physical activity levels in lung cancer survivors can help clinical medical staff identify survivors with relatively low physical activity levels as early as possible. Thus, personalised rehabilitation plans can be formulated to optimise quality of life during their survival period.
Physical activity has been used as a nonpharmacological intervention in cancer patient rehabilitation plans. However, a review of past studies has shown that lung cancer survivors generally have low physical activity levels. In this study, we identified the key factors influencing physical activity among lung cancer survivors through a literature review. We constructed a prediction model for their physical activity levels using machine learning algorithms. Clinical medical staff can use this model to identify patients with low physical activity levels early and to develop personalised intervention plans to improve their quality of life during survival.
The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation.
During the data collection phase, participants were recruited to complete the questionnaires.
To explore the mediating effects of psychological flexibility and anxiety between knowledge and health behaviour in stroke patients, and to provide a reference for improving the health behaviour of stroke patients.
A cross-sectional study.
A convenience sampling method was used to recruit 219 stroke patients from a tertiary hospital in China from July to November 2024. Patients were surveyed using an electronic questionnaire containing demographic questions and validated scales for stroke knowledge, psychological flexibility, anxiety and health behaviour. IBM SPSS v26.0 software and PROCESS Process macro were used for data analysis.
The health behaviour score of stroke patients was 54.2 ± 3.8, and health behaviour was positively correlated with stroke knowledge and negatively correlated with psychological flexibility and anxiety. There was a significant chain-mediated effect of psychological flexibility and anxiety in the relationship between stroke knowledge and health behaviour.
Stroke knowledge not only directly predicts health behaviour in stroke patients, but also indirectly influences the health behaviour of patients through the chain mediation of psychological flexibility and anxiety.
This study highlights the importance of caregivers focusing on the interactions between patient knowledge, psychological flexibility, anxiety and health behaviour when caring for stroke patients. Comprehensive interventions aimed at enhancing stroke patients' knowledge, improving patients' psychological flexibility and reducing anxiety have the potential to improve patient health behaviour.
Patients completed questionnaires.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was applied to report the results.
To investigate the incidence and the factors associated with paternal postpartum depression amongst new fathers in Singapore.
A prospective repeated measures study was conducted from September 2023 to March 2024.
A total of 200 fathers aged 21 years and above who had a neonate born at full term and no serious health events for both mother and neonate were recruited from a local hospital via convenience sampling. Fathers completed questionnaires at the third trimester of pregnancy (baseline) and 1 month postpartum. Multiple regression analyses were used to identify significant factors associated with postpartum depression in fathers.
The incidence of paternal postpartum depression was 5.26% at 1 month post-childbirth, using the Edinburgh Postpartum Depression Scale (EPDS). Using the Gotland Male Depression Scale (GMDS), 7% of the fathers were identified with high risk of depression and 14.3% of the fathers had moderate depressive symptoms. Paternal postpartum depression at 1 month post-childbirth could be predicted by paternal postpartum depression scores at baseline measured by EPDS and GMDS, as well as by baseline perceived social support and parental self-efficacy at 1 month post-childbirth.
This study found that a considerable number of fathers in Singapore are at risk of postpartum depression. There is an urgent need for the development of more comprehensive tools to measure postpartum depression in fathers that are culturally adapted to the local context.
Early screening during antenatal visits enables timely intervention and access to support, benefiting the entire family. Nurses could help fathers to be more involved by extending patient education and teaching infant care skills to both parents. When counselling patients, the involvement of extended family members and navigating new roles as caregivers of a new baby and breadwinners are important considerations for new parents.
This study is the first of its kind to measure the incidence of postpartum depression amongst new fathers in an urban multicultural Asian setting, like Singapore. The study found that the incidence of postpartum depression in fathers were 5.26% when measured using EPDS and 14.3% when measured using GMDS at 1 month postpartum. These findings could inform future family-centred and father-specific interventions to improve the mental health outcomes of new parents.
This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
No patient or public contribution.
To develop a deep learning-based smart assessment model for pressure injury surface.
Exploratory analysis study.
Pressure injury images from four Guangzhou hospitals were labelled and used to train a neural network model. Evaluation metrics included mean intersection over union (MIoU), pixel accuracy (PA), and accuracy. Model performance was tested by comparing wound number, maximum dimensions and area extent.
From 1063 images, the model achieved 74% IoU, 88% PA and 83% accuracy for wound bed segmentation. Cohen's kappa coefficient for wound number was 0.810. Correlation coefficients were 0.900 for maximum length (mean difference 0.068 cm), 0.814 for maximum width (mean difference 0.108 cm) and 0.930 for regional extent (mean difference 0.527 cm2).
The model demonstrated exceptional automated estimation capabilities, potentially serving as a crucial tool for informed decision-making in wound assessment.
This study promotes precision nursing and equitable resource use. The AI-based assessment model serves clinical work by assisting healthcare professionals in decision-making and facilitating wound assessment resource sharing.
The STROBE checklist guided study reporting.
Patients provided image resources for model training.
To evaluate the prevalence of frailty and its impact on quality of life (QoL) in older Chinese breast cancer (BC) patients, which have not been thoroughly reported in this population.
A prospective multi-centre cross-sectional registry study.
Data were collected from Cancer Hospital of the Chinese Academy of Medical Sciences, Peking University Third Hospital and Beijing Chaoyang District San Huan Cancer Hospital between October 2021 and July 2023.
BC patients aged over 65 years were enrolled in this study. They completed three assessment scales including the FRAIL scale, Hospital Anxiety and Depression Scale (HADS) and European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 (EORTC QLQ-C30), to screen for frailty, related factors and QoL. Clinical and pathological data were also collected. Analysis of frailty and prefrailty risk factors was performed via logistic regression. A multivariable linear regression model was used to evaluate the mean differences in scores for each QoL domain between patients with different frailty statuses.
A total of 946 patients were enrolled from three hospitals in Beijing between October 2021 and July 2023. Their median age was 69 years and 73.6% of them had early-stage breast cancer. Further, 37.2% of these patients had ≥ 1 comorbidity. The prevalence of frailty was 8.8% and frailty was more common in those with aged ≥ 75 years (22.3%), those with advanced tumours (15.6%), those with anxiety (31.3%) and those with depression (29.3%). More than half (57.2%) of the patients were prefrail. Regression analysis revealed that older age (odds ratio [OR] 1.12 [95% CI 1.07–1.17], p < 0.001), an advanced tumour (OR 2.27 [1.33–3.89], p = 0.003), anxiety (OR 2.74 [1.37–5.48], p = 0.004) and depression (OR 3.84 [1.97–7.49], p < 0.001) were significantly associated with frailty. After adjusting for other factors, different frailty states were shown to be independent influencing factors for QoL in both the functional and the symptom domains (all p < 0.05).
Our study provides data on the prevalence of frailty and prefrailty in older Chinese patients with BC. Both conditions are closely related to poor QoL. It is helpful for oncologist and clinical care to making intervention and better treatment decisions.
The study adhered to the STROBE checklist.
This study provides detailed data on the prevalence of frailty in older Chinese patients with BC and correlative factors. It suggests that clinical care should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.
Patients participated in the implementation of the project (including the informed consent and questionnaire process). No other public contribution to this research.
This study provides data on the prevalence of frailty in Chinese older BC patients and correlative factors. It indicates that clinicians should fully assess patients' frailty before making treatment decisions and provide early intervention for related factors.
ChiCTR2200056070
This study aimed to explore the risk factors related to home-based operation management leading to the occurrence of peritoneal dialysis-associated peritonitis (PDAP).
An observational research was conducted.
A retrospective analysis was conducted among patients with maintenance peritoneal dialysis (PD) between 1 January 2019 and 31 December 2022. The patients were grouped according to the occurrence of PDAP. General characteristics and home operational data were collected and logistic regression analysis was performed to identify independent risk factors for PDAP associated with home operations. This study complied with the Appendix S1.
Of 458 PD patients included in this study, 82 were in the peritonitis group. Their average age was 53.34 ± 13.62 years, and the average dialysis vintage was 35.57 ± 32.74 months, with males accounting for 54.6%. Multivariate logistic regression analysis revealed that age; primary disease, such as diabetes mellitus; dialysis vintage; improper storage of dialysis fluid; failure to verify the quality of protective-caps with povidone-iodine; and improper handwashing were risk factors of PDAP. Daytime ambulatory PD mode was significantly negatively associated with PDAP.
Improper storage of dialysis fluid, failure to check the quality of protective-caps and improper handwashing at home are independent risk factors for PDAP caused by home-based operation management. Nurses should strengthen relevant training or retraining to address this.
These findings serve to highlight the key areas for training in PD management and aim to empower patients to effectively conduct self-management practices.
We appreciate the patient's understanding and support.
The study aimed to investigate the current status of physical activity (PA) levels and associated factors among lung cancer survivors who have undergone nonsurgical treatments.
PA has been incorporated as a nonpharmacological intervention in the rehabilitation programmes of cancer patients, playing a crucial role in alleviating symptom burden and enhancing the quality of life among lung cancer survivors. Understanding the potential influencing factors of PA levels aids in formulating targeted intervention strategies.
A multicentre cross-sectional study.
Convenience sampling was utilised to survey lung cancer survivors from the respiratory and oncology departments of 12 hospitals across Eastern, Central and Western China, spanning from June 2023 to January 2024. Social demographic characteristics, disease-related features, health behaviour abilities, psychological factors and levels of PA were collected through a combination of clinical case systems used to record patients' treatment and medical conditions and self-reported questionnaires. Additionally, measurements of grip strength and the 6-min walk test were conducted for patients. Descriptive analysis, bivariate analysis and multivariate logistic regression were conducted.
Only 109 patients (16.2%) achieved high PA levels. Multivariate logistic regression analysis indicated differences in age, residential location, employment status, religion, lung cancer stage, grip strength, albumin concentration, blood urea, Anderson symptom, depression and health behaviour capacity among lung cancer survivors with varying PA levels.
Significant associations were observed between age ≥ 75 years, residing in urban areas, unemployment, absence of religious beliefs, Stage IV lung cancer, lower grip strength, lower albumin concentration, higher blood urea, higher Anderson symptom scores, lower health behaviour capacity scores, higher depression scores and lower PA levels among lung cancer survivors. These potential factors should be considered when developing PA intervention plans.
This study offers insights for developing subsequent PA intervention programmes. In clinical practice, healthcare professionals should continuously educate patients about the benefits of exercise and help them incorporate PA into their daily lives. Additionally, emphasising multidisciplinary collaboration involving physical therapists, nutritionists and mental health experts is crucial for ensuring safe and effective PA, thereby improving patients' quality of life.
Our study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist: cross-sectional studies.
At the phase of collecting data, participants were recruited to fill the questionnaires.
Chinese Clinical Trial Registry: ChiCTR2300072609
To explore the effect of post-stroke fatigue (PSF) on post-stroke depression (PSD) and examine the mediating effects of fear of disease progression (FOP) and resilience between PSF and PSD.
A cross-sectional study.
A total of 315 stroke patients participated in the questionnaire survey between November 2022 and June 2023. Data were collected using the General Information Questionnaire, Fatigue Severity Scale, Fear of Disease Progression Questionnaire-Short Form, Connor–Davidson Resilience Scale-10 Item and Hospital Anxiety and Depression Scale-Depression Subscale. Data were analysed by descriptive analysis, Mann–Whitney U-test, Kruskal–Wallis H-test, Pearson or Spearman correlation, hierarchical regression analysis and mediation analysis.
PSF had a significant positive total effect on PSD (β = .354, 95% CI: .251, .454). Additionally, FOP and resilience played a partial parallel-mediating role in the relationship between PSF and PSD (β = .202, 95% CI: .140, .265), and the total indirect effect accounted for 57.06% of the total effect.
FOP and resilience parallelly mediated the effect of PSF on PSD, which may provide a novel perspective for healthcare professionals in preventing PSD. Targeted interventions aiming at reducing PSF, lowering FOP levels and enhancing resilience may be possible ways to alleviate PSD.
Interventions that tail to reducing PSF, lowering FOP levels and enhancing resilience may be considered as possible ways to alleviate PSD.
This study enriched the literature by exploring the effect of PSF on PSD and further examining the mediating effects of FOP and resilience between PSF and PSD. Findings emphasized the important effects of PSF, FOP and resilience on PSD.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to guide reporting.
One tertiary hospital assisted participants recruitment.
To investigate the frailty status of inpatients with chronic heart failure (CHF) and analyse its influencing factors, so as to provide evidence for the early identification of high-risk groups and frailty management.
Early identification of frailty can guide the development and implementation of holistic and individualized treatment plans. However, at present, the frailty of patients with CHF has not attracted enough attention.
A cross-sectional study.
From June 2022 to June 2023, a convenience sample of 256 participants were recruited at a hospital in China. Multivariate logistic regression analysis was used to explore the influencing factors of frailty in patients with CHF, and an ROC curve was drawn to determine the cut-off values for each influencing factor. STROBE checklist guides the reporting of the manuscript.
A total of 270 questionnaires were sent out during the survey, and 256 valid questionnaires were ultimately recovered, resulting in an effective recovery rate of 94.8%. The incidence of frailty in hospitalized patients with CHF was 68.75%. Multivariable logistic regression analysis showed that age, self-care ability, nutritional risk, Kinesiophobia and NT-proBNP were risk factors for frailty, while albumin and LVEF were protective factors.
Multidimensional frailty was prevalent in hospitalized patients with CHF. Medical staff should take measures as early as possible from the aspects of exercise, nutrition, psychology and disease to delay the occurrence and development of frailty and reduce the occurrence of clinical adverse events caused by frailty.
This study emphasizes the importance of the early identification of multidimensional frailty and measures can be taken to delay the occurrence and development of frailty through exercise, nutrition, psychology and disease treatment.
Patients contributed through sharing their information required for the case report form and filling out questionnaires.
To identify the contaminated areas of the hand collection and analyse the distribution characteristics of bacteria in the hand after swab collection.
This study used a cross-sectional design.
A cross-sectional study sampling 50 pairs of hands (sampling hand and auxiliary hand) of healthcare workers was performed. Ten samples were collected from each participant. The optimal hand hygiene rates and bacterial colony counts of the whole hand and different hand sections without hand hygiene were identified as the primary outcomes.
The optimal hand hygiene rates of the sampling hand and auxiliary hand were 88.8% (222/250) and 91.6% (229/250), respectively. The lowest optimal hand hygiene rates for the sampling hand and the auxiliary hand were both on the dorsal side of the finger and the dorsum of the hand (86.0%, 86.0% vs. 90.0%, 86.0%); the optimal hand hygiene rates for both sites of the sampling hand were 86.0% (43/50), and the optimal hand hygiene rates for the auxiliary hand were 90.0% (45/50) and 86.0% (43/50). The bacteria colony counts did not differ between the sampling hands and auxiliary hand.
The dorsal side of the finger and dorsum of the hand were the most likely to be contaminated during oropharyngeal swab collection. Therefore, it is essential to pay extra attention to hand hygiene care of these two sites during the collection process to minimize the risk of cross-contamination.
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study.
While previous research has established that resilience is affected by various factors, these studies have primarily focussed on individual variables associated with resilience, without providing insights into how to influence the rate of change in resilience.
To examine the trajectory of resilience and identify the factors associated with changes in resilience among spousal caregivers of patients with newly diagnosed advanced cancer receiving treatment during the first 6 months.
An observational longitudinal study.
A total of 312 spousal caregivers of patients with newly diagnosed advanced cancer were recruited from January 2022 to December 2022 in Yancheng, China. Three data collection points were established, spanning from the first month to 6 months after initial cancer treatment. A latent growth model was employed to depict the resilience trajectory at various time points. A latent growth model with time-invariant covariates was adopted to determine the factors influencing resilience trajectory. The study adhered to the STROBE checklist for proper reporting.
Throughout the follow-up period, the participants experienced a significant increase in resilience. Gender, family income, the patient's health status, spirituality and belief in familism were significantly associated with the baseline resilience level. Moreover, family income, the patient's health status, spirituality, caregiver burden and belief in familism were significantly associated with the rate of resilience change over time.
Spousal caregivers demonstrated a linear increase in resilience during the first 6 months after initial treatment. Meanwhile, changes in resilience were influenced by multiple factors during the early phase of cancer treatment. Thus, more attention should be paid to early identification and implementation of targeted interventions.
Healthcare professionals should understand the change in resilience among spousal caregivers and conduct timely mental health interventions to enhance the resilience of families affected by cancer.
The Guidance for Reporting Involvement of Patients and the Public-Short Form reporting checklists were used to improve patient and public involvement.
To determine the contributions of different kinds of symptoms to the quality of life and mediating effect of psychological and physical symptoms between heart failure symptoms and quality of life.
A multi-centre cross-sectional study.
2006 chronic heart failure patients from four cities were recruited in China from January 2021 to December 2022. Patients' symptoms and quality of life were self-reported, and data were analysed using correlation analysis, dominance analysis and mediating effects analysis.
The dominance analysis revealed that the overall mean contributions of heart failure, psychological and physical symptoms were .083, .085 and .111; 29.5%, 30.2% and 39.5% of the known variance. And heart failure symptoms could negatively affect quality of life through psychological and physical symptoms, accounting for 28.39% and 22.95% of the total effect. Heart failure symptoms could also affect quality of life through the chain-mediated effect of physical and psychological symptoms, accounting for 16.74%.
Physiological symptoms had the strongest effect on quality of life and heart failure symptoms had the weakest. Most of the effect for heart failure symptoms on quality of life in chronic heart failure patients was mediated by psychological and physiological symptoms.
It is important to design non-pharmacological intervention plans for the enhancement of physical and psychological symptoms' management skills, to reduce the adverse impact of heart failure symptoms on quality of life.
Study methods and results reported in adherence to the STROBE checklist.
No patients or members of the public were involved in the study.
Vicarious trauma can significantly affect the physical and mental health of nurses, as well as their ability to provide quality of care. However, the concept of vicarious trauma has received limited attention and remains controversial in the nursing context.
The purpose of this study was to clarify and define the concept of vicarious trauma as it pertains to the nursing context.
The Schwartz and Kim's three-stage hybrid concept analysis method was used to define the concept. In the theoretical phase, PubMed, CINAHL, OVID, Medline, Embase, Web of Science, Scopus, ProQuest, PsycINFO, CNKI database, VIP database and Wanfang database were used using keywords “nurs*”and “vicarious trauma*”, resulting in a total of 25 papers. In the fieldwork phase, we conducted participatory observations in three hospitals and semi-structured in-depth interviews with 18 clinical nurses from seven cities. In the analysis phase, the results of the previous two phases were integrated to develop a comprehensive concept of vicarious trauma in nursing.
Based on the results of the theoretical and field phases, we propose the concept of vicarious trauma in nursing as follows: vicarious trauma is a psychological trauma impacting nurses' cognitive schema which they may experience in clinical settings or on social media, resulting from deeply empathize with the physical or emotional trauma of patients, family, or colleagues, such as patients' physical injuries or death, family's grieving feelings and colleagues' received threats and attacks. Positively, vicarious trauma can transform into vicarious post-trauma growth through repositioning and connection, nourishing nurses and promoting their personal and professional development.
The concept of vicarious trauma in nursing is multidimensional and holistic. This study clarifies the concept of vicarious trauma in nursing using the hybrid concept analysis, providing a framework for future research and practice on vicarious trauma in the nursing field.
Nurses contributed to the conduct of the study by participating in the data collection via interviews.
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