Conectar
To explore the latent categories and influencing factors of dyadic decision self-efficacy among stroke patients and their caregivers.
A cross-sectional survey involving 305 patient-caregiver pairs was conducted using standardised questionnaires. Latent profile analysis was used to identify dyadic self-efficacy categories and multinomial logistic regression was employed to analyse influencing factors.
The dyadic decision self-efficacy of stroke patients and their caregivers was classified into three categories: low common decision self-efficacy group (35.6%), patients' high decision self-efficacy and caregivers' moderate decision self-efficacy group (38.6%), and high common decision self-efficacy group (25.8%). Influencing factors included patients' education level, income and health literacy, as well as caregivers' education, caregiving duration and social support.
The levels of dyadic decision self-efficacy among stroke patients and their caregivers are heterogeneous. Clinicians can develop targeted interventions involving both patients and caregivers, based on the population's characteristics and influencing factors, to improve their dyadic decision self-efficacy.
This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
To examine the effects of depression on dyadic self-care in stroke patients and their caregivers, as well as the potential mediating role of self-efficacy in this relationship.
A multi-centre cross-sectional study design was employed.
From May to September 2022, stroke patients and their caregivers were recruited from China using a multi-centre stratified sampling method. Data analysis was conducted using a structural equation model based on the Actor-Partner Interdependence Model extended to include mediation. Depression in patients and caregivers was assessed using the Patient Health Questionnaire-9. The self-care self-efficacy scale was utilised to measure patient self-efficacy, while the caregiver self-efficacy in contributing to patient self-care scale was used for caregivers. Patient self-care was evaluated with the Self-Care of Stroke Inventory and caregiver contributions to self-care were assessed using the Caregiver Contributions to Self-Care of Stroke Inventory.
This study followed the STROBE checklist.
306 patient-caregiver dyads were enrolled. The direct effect between depression and dyadic self-care was not confirmed in stroke patients and their caregivers (p > 0.05). Patient self-efficacy had significant indirect actor effects on self-care maintenance (β = −0.173, p < 0.001), monitoring (β = −0.146, p < 0.001) and management (β = −0.186, p < 0.001). Caregiver self-efficacy had an indirect actor effect on caregiver contributions to self-care maintenance (β = −0.096, p < 0.001), monitoring (β = −0.073, p < 0.001) and management (β = −0.106, p < 0.001). The partner effect analysis showed caregiver self-efficacy plays a potential mediating role in the relationship between patient depression and caregiver contributions to self-care maintenance (β = −0.037, p = 0.036), monitoring (β = −0.028, p = 0.032) and management (β = −0.040, p = 0.036). Caregiver depression reduced caregiver self-efficacy, lowering patient self-care monitoring (β = −0.040, p = 0.004) and management (β = −0.047, p = 0.002) levels.
The findings indicate interactive effects between depression, self-efficacy and dyadic self-care among stroke patients and their caregivers. Therefore, the development of targeted dyadic interventions to address depression and enhance self-efficacy in both patients and caregivers should be considered.
To investigate evidence-based practices and examine rates of adherence to bundles on maintenance of central venous catheters among intensive care unit nurses in 22 selected hospitals.
Although there has been an overwhelming increase in the use of evidence-based practices to reduce Central Line-Associated Bloodstream Infections, also known as bundles, there continues to be a considerable gap between clinical practice and evidence.
This study employs a multi-center cross-sectional design.
Registered nurses who worked in the ICUs of 22 selected hospitals were included. Evidence-based procedures were developed based on Central Line Bundles, which include an 11-area and 35-item checklist. Rates of adherence to bundles were calculated and analysed after reaching 22,000 central line days in 22 units. The study was reported using the STROBE checklist.
The average adherence rate to evidence-based procedures for CVC maintenance among ICU nurses in the 22 units was 87.40%. The adherence rate of five areas of the evidence-based procedure based on the Central Line bundle was above 90%, including ‘Selection of regulated skin disinfectants’, ‘Tube sealing’, ‘Tube flushing’, ‘Dressing and catheter fixation’ and ‘Sterilized skin and catheter’. The three lowest-achieving areas of bundles were ‘Catheter and insertion site assessment,’ ‘Hand hygiene’ and ‘Sterilized catheter access hubs’. The lowest-achieving item of bundles is ‘Assess during multidisciplinary patient care rounds with signature confirmation’. The adherence rates in hospitals where CLABSI occurred were all less than 90%.
ICU nurses' adherence to maintenance bundles for CVC is moderate, implying that boosting adherence rates is critical for improved results. As a result, comparable studies should be done in ICUs where the bundle has been deployed to assess and improve adherence rates through effective interventions. To minimise CLABSI in future practice, novel strategies must be developed and implemented via continued education and regular evaluation.
We registered the trial with the US Clinical Trials Registry (ID: NCT06085690, Name: Multicenter Clinical Translational Study of ‘ICU-NO CRBSI’ Based on Improvement Science, https://ichgcp.net/clinical-trials-registry/NCT06085690)
Nurse administrators and policymakers can develop strategies and interventions for improving the quality of CVC care toward evidence-based practice. Minimising the gaps between evidence and practice will reduce the incidence of CLABSI to enhance the survival of critically ill patients.
In addressing the status of evidence-based practices among ICU nurses, this study enhances healthcare quality and outcomes.
There was no patient or public contribution.
by Zenglei Liu, Ailian Gao, Hui Sheng, Xueling Wang
Diabetic retinopathy, a retinal disorder resulting from diabetes mellitus, is a prominent cause of visual degradation and loss among the global population. Therefore, the identification and classification of diabetic retinopathy are of utmost importance in the clinical diagnosis and therapy. Currently, these duties are extensively carried out by manual examination utilizing the human visual system. Nevertheless, manual examination is sometimes arduous, time-consuming, and prone to errors. Deep learning-based methods have recently demonstrated encouraging results in several areas, such as image categorization and natural language mining. The majority of deep learning techniques developed for medical image analysis rely on convolutional modules to extract the inherent structure of images within a certain local receptive field. Furthermore, transformer-based models have been utilized to tackle medical image processing problems by capitalizing on global connections among distant pixels in the images. Considering these analyses, this work presents a comprehensive deep learning model that combines convolutional neural network and vision mamba models. This model is designed to accurately identify and classify diabetic retinopathy lesions displayed in fundus images. Furthermore, the vision mamba component incorporates the bidirectional state space method and positional embedding to enable the location sensitivity of visual data samples and meet the conditions for global relationship context. An evaluation of the suggested method was carried out by comparison experiments between state-of-the-art algorithms and the proposed methodology. Empirical findings demonstrate that the suggested methodology surpasses the most advanced algorithms on the datasets that are accessible openly. Hence, the suggested approach may be regarded as a helpful tool for therapeutic processes.
To investigate symptom clusters and sentinel symptoms in breast cancer survivors based on self-reported outcomes, explore the impact of sentinel symptoms on patients' quality of life and psychological distress, provide a basis for implementing accurate symptom management.
A cross-sectional survey.
The study was conducted from September 2021 to December 2022. We recruited 281 patients who were re-examined in an outpatient department of a tertiary hospital in Hebei Province. The European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire - Core30 (QLQ-C30), the EORTC Quality-of-Life Questionnaire Breast Cancer - 23 (QLQ-BR23), the Hospital Anxiety and Depression Scale (HADS) were used to conduct the survey. Symptom clusters were explored using principal component analysis, sentinel symptoms were explored using the Apriori algorithm. Correlation analysis was used to explore the relationship between sentinel symptoms and quality of life, correlation with psychological distress. This paper adhered to the STROBE guidelines.
Breast cancer survivors have a wide range of self-reported symptoms in the form of four symptom clusters: a fatigue symptom cluster, a gastrointestinal symptom cluster, a sickness symptom cluster and a surgical trauma-related symptom cluster. Three sentinel symptoms were explored: pain, alopecia and limited function of the upper limbs. Except for sexual function, all of the sentinel symptoms were negatively correlated with patients' quality of life and positively correlated with psychological distress (p < .05).
Breast cancer survivors have a variety of symptoms in the form of four symptom clusters. Pain, alopecia and limited function of the upper limbs are the sentinel symptoms, which affect patients' quality of life and psychological distress.
Although potential risk factors for sternal wound infection (SWI) have been extensively studied, the onset time of SWI and different risk factors for superficial and deep SWI were rarely reported. This nested case–control study aims to compare the onset time and contributors between superficial and deep SWI. Consecutive adult patients who underwent cardiac surgery through median sternotomy in a single center from January 2011 to January 2021 constituted the cohort. The case group was those who developed SWI as defined by CDC and controls were matched 6:1 per case. Kaplan–Meier analysis, LASSO and univariate and multivariate Cox regressions were performed. A simple nomogram was established for clinical prediction of the risk of SWI. The incidence of SWI was 1.1% (61 out of 5471) in our cohort. Totally 366 controls were matched to 61 cases. 26.2% (16 of 61) SWI cases were deep SWI. The median onset time of SWI was 35 days. DSWI had a longer latency than SSWI (median time 46 days vs. 32 days, p = 0.032). Kaplan–Meier analyses showed different time-to-SWI between patients with and without DM (p = 0.0011) or MI (p = 0.0019). Multivariate Cox regression showed that BMI (HR = 1.083, 95% CI: 1.012–1.116, p = 0.022), DM (HR = 2.041, 95% CI: 1.094–3.805, p = 0.025) and MI (HR = 2.332, 95% CI: 1.193–4.557, p = 0.013) were independent risk factors for SWI. Superficial SWI was only associated with BMI (HR = 1.089, 95% CI: 1.01–1.175, p = 0.027), while deep SWI was associated with DM (HR = 3.271, 95% CI: 1.036–10.325, p = 0.043) and surgery time (HR = 1.004, 95% CI: 1.001–1.008, p = 0.027). The nomogram for SWI prediction had an AUC of 0.67, good fitness and clinical effectiveness as shown by the calibration curve and decision curve analyses. BMI, DM and MI were independent risk factors for SWI. DSWI had a longer latency and different risk factors compared to SSWI. The nomogram showed a fair performance and good effectiveness for the clinical prediction of SWI.
To review the content, format and effectiveness of shared decision-making interventions for mode of delivery after caesarean section for pregnant women.
Systematic review and meta-analysis.
Six databases (PubMed, Web of science Core Collection, Cochrance Network, Embase, CINAHL, PsycINFO) were searched starting at the time of establishment of the database to May 2023. Following the PRISMAs and use Review Manager 5.3 software for meta-analysis. Two review authors independently assessed the quality of the studies using the risk of bias 2 tool. The protocol was registered in PROSPERO (CRD42023410536).
The search strategy obtained 1675 references. After abstract and full text screening, a total of seven studies were included. Shared decision-making interventions include decision aids and counselling that can help pregnant women analyse the pros and cons of various options and help them make decisions that are consistent with their values. The pooled results showed that shared decision-making intervention alleviated decisional conflicts regarding mode of delivery after caesarean section, but had no effect on knowledge and informed choice.
The results of our review suggest that shared decision-making is an effective intervention to improve the quality of decision-making about the mode of delivery of pregnant women after caesarean section. However, due to the low quality of the evidence, it is recommended that more studies be conducted in the future to improve the quality of the evidence.
This systematic review and meta-analysis provides evidence for the effectiveness of shared decision-making for mode of delivery after cesarean section and may provide a basis for the development of intervention to promote the participation of pregnant women in the decision-making process.
This research is intended to explore the influence of second and first degree closure methods on the degree of wound pain and swelling of the face following the removal of the mandible. For the purpose of this study, three data sets, including PubMed and Embase, were selected. A separate statistical analysis was conducted on the choice of the trial, the collection of data and the risk of bias. Differences between trials were analysed with a chi-square approach, with data analyses dependent on I 2. A sensitivity analysis was conducted, and a possible publication bias was evaluated. Ultimately, nine qualifying trials were chosen out of an original pool of 1922 related trials following an in-depth evaluation under the eligibility and exclusion criteria, as well as a follow-up screening. The results indicated that there was no statistically significant change in the degree of post-operation pain after 1 day operation between one or secondary closures of treatment (MD, −0.46; 95% CI, −0.93, 0.01, p = 0.06); the results showed that there were no statistically significant differences in post-operation wound pain after 3 days in two group (MD, −0.15; 95% CI, −0.68, 0.37, p = 0.56); the results showed that there were no statistically different effects on the post-operation wound pain after the 7th day in two groups (MD, −0.14; 95% CI, −0.31, 0.03, p = 0.1). The results showed that there were no statistically different effects on the post-operation wound pain after the 1 day in two groups (MD, −0.26; 95% CI, −0.38, −0.13, p < 0.0001); on the 3rd day after surgery, the face was significantly smaller swelling in the secondary closure of closure compared with the first-stage closure group (MD, −0.70; 95% CI, −1.40, −0.00, p = 0.05). While there is no obvious effect on post-operation wound pain in patients with mandibular surgery, there is significant difference in post-operation face swelling. The findings do not support a preference for any of these methods.
The research was conducted to examine the correlation between nutritional status and wound healing in individuals who were receiving treatment for head and neck cancer. Specifically, this study sought to identify crucial nutritional factors that influenced both the recovery process and efficacy of the treatment. From February 2022 to September 2023, this cross-sectional study was undertaken involving 300 patients diagnosed with head and neck cancer who were treated at Tianjin Medical University Cancer Institute and Hospital, Tianjin, China. In order to evaluate nutritional status, body mass index (BMI), serum protein levels and dietary intake records were utilized. The assessment of wound healing was conducted using established oncological wound healing scales, photographic documentation and clinical examinations. After treatment, we observed a noteworthy reduction in both BMI (p < 0.05) and serum albumin levels (p < 0.05). There was slightly increased prevalence of head and neck cancer among males (61.0%, p < 0.05). Over the course of 6 months, significant enhancement in wound healing scores was noted, exhibiting overall improvement of 86% in the healing process. An inverse correlation was identified between nutritional status and wound healing efficacy through multivariate analysis. A logistic regression analysis revealed a significant positive correlation (p < 0.05) between elevated levels of serum protein and total lymphocytes and enhanced wound healing. Conversely, negative correlation (p < 0.05) was observed between larger wound size at baseline and healing. The research findings indicated noteworthy association between malnutrition and impaired wound repair among individuals diagnosed with head and neck cancer. The results underscored the significance of integrating nutritional interventions into therapeutic protocol in order to enhance clinical results. This research study provided significant contributions to the knowledge of intricate nature of head and neck cancer management by advocating for multidisciplinary approach that incorporates nutrition as the critical element of patient care and highlighted the importance of ongoing surveillance and customized dietary approaches in order to optimize wound healing and treatment efficacy.
The aim of this study was to investigate the relationship between burnout and post-traumatic stress disorder (PTSD) among frontline nurses who went to assist the epidemic situation in Wuhan, China, during the outbreak in 2020. The study also explored the mediating role of depression and the moderating role of age in the main relationship.
The relationship between burnout and PTSD in nurse has rarely been investigated in the context of the COVID-19 pandemic. Understand the relationship between these variables can provide empirical evidence for developing interventions and protocols that improve the health of nurses in future public health emergencies.
An online cross-sectional survey of targeted local 327 nurses who went to assist the COVID-19 epidemic situation in Wuhan during the initial outbreak.
This study was conducted in August 2020, the burnout scale, the PTSD scale and the depression scale were used to survey participants. The moderated mediation model was used to test research hypotheses.
Burnout could affect the PTSD symptoms in nursing staffs and depression could mediate this relationship. Age moderated the relationship between burnout/depression and PTSD, and the effects was strong and significant among younger participants in the relationship between burnout and PTSD.
Burnout was identified as a core risk factor of PTSD in nurses. Depression and age played significant roles in the relationship between burnout and PTSD.
PTSD, as a symptom that manifests after experiencing a stressful event, should be a key concern among frontline healthcare professionals. This study suggests that PTSD in nurses can be further reduced by reducing burnout. Attention should also be paid to the PTSD status of nurses of different age groups.
Patients and the public were not involved in the design and implementation of this study. Frontline nurses completed an online questionnaire for this study.
Intimate partner violence (IPV) is associated with multiple adverse health consequences. Nurses (including midwives) are well positioned to identify patients subjected to IPV, and provide care, support, and referrals. However, studies about nursing response to IPV are limited especially in low- and middle-income countries (LMICs). The study aimed to examine nurses' perceived preparedness and opinions toward IPV and to identify barriers and facilitators in responding to IPV.
An explanatory sequential mixed-methods study was conducted by collecting quantitative data first and explaining the quantitative findings with qualitative data.
The study was conducted in two tertiary general hospitals in northeastern (Shenyang city) and southwestern (Chengdu city) China with 1500 and 1800 beds, respectively. A total of 1071 survey respondents (1039 female [97.0%]) and 43 interview participants (34 female [79.1%]) were included in the study. An online survey was administered from September 3 to 23, 2020, using two validated scales from the Physician Readiness to Manage Intimate Partner Violence Survey. In-depth, semistructured interviews were conducted from September 15 to December 23, 2020, guided by the Consolidated Framework for Implementation Research.
The survey respondents largely agreed with feeling prepared to manage IPV, e.g., respond to discourses (544 [50.8%] of 1071) and report to police (704 [65.7%] of 1071). The findings of surveyed opinions (i.e., Response competencies; Routine practice; Actual activities; Professionals; Victims; Alcohol/drugs) were mixed and intertwined with social desirability bias. The quantitative and qualitative data were consistent, contradicted, and supplemented. Key qualitative findings were revealed that may explain the quantitative results, including lack of actual preparedness, absence of IPV-related education, training, or practice, and socially desirable responses (especially those pertaining to China's Anti-domestic Violence Law). Commonly reported barriers (e.g., patients' reluctance to disclose; time constraints) and facilitators (e.g., patients' strong need for help; female nurses' gender advantage), as well as previously unreported barriers (e.g., IPV may become a workplace taboo if there are healthcare professionals known as victims/perpetrators of IPV) and facilitators (e.g., nurses' responses can largely meet the first-line support requirements even without formal education or training on IPV) were identified.
Nurses may play a unique and important role in responding to IPV in LMICs where recognition is limited, education and training are absent, policies are lacking, and resources are scarce. Our findings support World Health Organization recommendations for selective screening.
The study highlights the great potential of nurses for IPV prevention and intervention especially in LMICs. The identified barriers and facilitators are important evidence for developing multifaceted interventions to address IPV in the health sector.
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