Conectar
To systematically analyse international empirical literature and establish a comprehensive understanding of the push and pull factors influencing retention and turnover among mid-career nurses.
An integrative review.
PubMed, Web of Science, Scopus, EMBASE (Ovid), and CINAHL (EBSCO) were searched for studies published between January 2001 and November 2024.
An integrative literature review was conducted following the five-step process outlined by Whittemore and Knafl. Articles were screened by title, abstract, and full text based on predefined inclusion and exclusion criteria. The quality of eligible studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Data were extracted and synthesised narratively, and the findings were presented according to the socio-ecological framework.
A total of 1930 studies were identified, with 14 included for analysis: 10 qualitative, 3 quantitative, and 1 mixed-methods study. Guided by the socio-ecological framework, four themes and 10 subthemes emerged: (1) Intrapersonal (professional knowledge/skills, health issues, work-family balance); (2) Interpersonal (professional collaborative relationships, supervisor support); (3) Organisational (organisational characteristics, work characteristics, career development); and (4) Societal (salary/benefits, Social/governmental recognition).
This review reveals the heterogeneity of research on this topic and confirms previous findings. It identifies certain push-and-pull factors common to nurses across all stages of their careers. However, mid-career nurses face unique challenges, including more complex healthcare demands, declining health status, growing family caregiving responsibilities, unclear organisational roles, underutilisation of professional skills, career stagnation, and limitations on salary growth. These findings highlight the need for tailored retention strategies for mid-career nurses.
A “one-size-fits-all” retention strategy does not meet the needs of all nurses. To improve nurse retention rates, it is essential to address the shifting demands and priorities that arise as nurses reassess and transition through different career stages. For mid-career nurses, acknowledging and valuing their expertise and capabilities, providing sufficient resources, and fostering a supportive work environment that promotes career development may be effective strategies for retaining these experienced professionals.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
by Ming Li, Jingang Ma, Jing Zhao
Since Transformers have demonstrated excellent performance in the segmentation of two-dimensional medical images, recent works have also introduced them into 3D medical segmentation tasks. For example, hierarchical transformers like Swin UNETR have reintroduced several prior knowledge of convolutional networks, further enhancing the model’s volumetric segmentation ability on three-dimensional medical datasets. The effectiveness of these hybrid architecture methods is largely attributed to the large number of parameters and the large receptive fields of non-local self-attention. We believe that large-kernel volumetric depthwise convolutions can obtain large receptive fields with fewer parameters. In this paper, we propose a lightweight three-dimensional convolutional network, LKDA-Net, for efficient and accurate three-dimensional volumetric segmentation. This network adopts a large-kernel depthwise convolution attention mechanism to simulate the self-attention mechanism of Transformers. Firstly, inspired by the Swin Transformer module, we investigate different-sized large-kernel convolution attention mechanisms to obtain larger global receptive fields, and replace the MLP in the Swin Transformer with the Inverted Bottleneck with Depthwise Convolutional Augmentation to reduce channel redundancy and enhance feature expression and segmentation performance. Secondly, we propose a skip connection fusion module to achieve smooth feature fusion, enabling the decoder to effectively utilize the features of the encoder. Finally, through experimental evaluations on three public datasets, namely Synapse, BTCV and ACDC, LKDA-Net outperforms existing models of various architectures in segmentation performance and has fewer parameters. Code: https://github.com/zouyunkai/LKDA-Net.In recent years, the critical role of health literacy in diabetes management has become increasingly prominent. The aim of this study was to investigate the impact of social support on health literacy among patients with diabetes, to test the mediating role of self-efficacy and empowerment between social support and health literacy, and the moderating role of eHealth literacy.
A cross-sectional study conducted between August 2023 and June 2024.
This study adopted the cluster sampling method and conducted a questionnaire survey among 251 patients with diabetes in a tertiary hospital in Wuhu City, Anhui Province. The questionnaires included the Social Support Rating Scale, the Self-Efficacy for Diabetes scale, the Health Empowerment Scale, the eHealth Literacy Scale and the Diabetes Health Literacy Scale.
Social support was positively associated with health literacy in patients with diabetes. Self-efficacy and empowerment mediated the relationship and formed chained mediation pathways respectively. eHealth literacy has a moderating role between self-efficacy and empowerment.
The results revealed that social support influences health literacy among patients with diabetes through the mediating pathways of self-efficacy and empowerment, and that this process is moderated by eHealth literacy. These findings provide a theoretical basis and practical insights for improving health literacy among patients with diabetes.
Enhancing health literacy among people with diabetes by strengthening social support, self-efficacy and empowerment levels, while focusing on the technology-enabling role of eHealth literacy in this context.
This study adheres to the relevant EQUATOR guidelines based on the STROBE cross-sectional reporting method.
We thank all patients who participated in the study for their understanding and support.
This study explores the intricate relationship between chronic periodontitis (CP) and its implications for wound healing, particularly in the context of arteriosclerotic occlusion (ASO) in the lower extremities. A cohort of 90 individuals was categorized into three groups: those with CP, those with both CP and ASO (ASO + CP) and a healthy control group. Comprehensive assessments including oral examinations, blood tests and questionnaires were conducted. Key oral health indicators such as probing depth (PD), bleeding on probing (BOP) and periodontal inflammatory surface area (PISA) were evaluated to gauge the severity of periodontal wounds. The study found that the ASO + CP group showed a significantly higher number of missing teeth and increased PD compared to the CP group (p < 0.05). Both CP and ASO + CP groups exhibited elevated PD, BOP and PISA compared to the control group (p < 0.05), indicating exacerbated periodontal wounds. Serum analyses showed heightened total cholesterol (TC) and high-sensitivity C-reactive protein (hs-CRP) levels in the ASO + CP group, suggesting a stronger inflammatory response and potential for atherogenesis. Interestingly, FPG and triglycerides (TG) levels did not significantly vary across groups (p > 0.05). Regression analysis identified PD (β = 2.271, p < 0.001) and PISA (β = 0.027, p = 0.001) as significant predictors for ASO presence in CP patients. The findings underscore the clinical correlation between chronic oral wounds in CP and the development of ASO in lower extremities, highlighting the critical need for integrated management strategies focusing on periodontal health to prevent and manage such complex conditions effectively. Elevated inflammatory markers in the ASO + CP group further reinforce the necessity for vigilant monitoring and targeted interventions in these patients.
A meta-analysis investigation was executed to evaluate the effect of tumour necrosis factor-a inhibitor exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. A comprehensive literature investigation till October 2023 was applied, and 82 470 individuals with orthopaedic surgery were in the chosen investigations' starting point. Odds ratio (OR) in addition to 95% confidence intervals (CIs) was utilized to compute the value of the effect of tumour necrosis factor-a inhibitors exposure on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery by the dichotomous approaches and a fixed or random model. Tumour necrosis factor uses had significantly higher surgical site infections (OR, 1.65; 95% CI, 1.21–2.25, p = 0.001) compared with tumour necrosis factor non-use in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections (OR, 0.61; 95% CI, 0.35–1.05, p = 0.07) in rheumatoid arthritis patients undergoing elective orthopaedic surgery.Significantly higher surgical site infections was found comparing tumour necrosis factor uses to non-use; however, no significant difference was found between discontinued and continued tumour necrosis factor on surgical site infections in rheumatoid arthritis patients undergoing elective orthopaedic surgery. However, care must be exercised when dealing with its values because of the low sample size of some of the nominated investigations for the meta-analysis.
Proximal humerus fractures are common in clinical practice, and there are relatively a few studies on postoperative incision infections of such fractures. The purpose of this study was to explore the risk factors for surgical site infection (SSI) after internal fixation in patients with closed proximal humerus fractures. Patients with closed proximal humerus fractures who underwent surgery from January 2016 to January 2022 were retrospectively analysed. Cases with superficial or deep infections within 3 months after surgery were in the infection group and the remaining cases were in the non-infection group. The types of pathogenic bacteria in the infection group were analysed. The potential risk factors for SSI in all patients were recorded: (1) patient-related factors: gender, age, body mass index (BMI), smoking, comorbidities; (2) trauma-related factors: mechanism of injury, Injury Severity Score, visual analogue scale, fracture type, soft tissue condition and combined dislocation; (3) laboratory-related indexes: haemoglobin, albumin; (4) surgery-related factors: time from injury to surgery, American Society of Anesthesiologists anaesthesia classification, surgical time, fixation mode, intraoperative blood loss, suture method, bone graft and postoperative drainage. The risk factors for the occurrence of SSI were analysed using univariate analysis and multivariate logistic regression. The incidence of SSI was 15.7%. The most common bacterium in the infection group was Staphylococcus aureus. High BMI (p = 0.033), smoking (p = 0.030), an increase in mean time from injury to definitive surgery (p = 0.013), and prolonged surgical time (p = 0.044) were independent risk factors for the development of SSI after closed proximal humeral fractures. In patients with closed proximal humerus fractures, weight loss, perioperative smoking cessation, avoidance of delayed surgery, and shorter surgical time may be beneficial in reducing the incidence of SSI.
A meta-analysis was conducted to investigate the effects of platelet-rich plasma (PRP) in the treatment of burn wounds and to provide a scientific basis for clinical drug therapy. We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure and Wanfang databases to identify randomised controlled trials (RCTs) on PRP in treating burn wounds, with the control group being treated with conventional treatments and the intervention group being treated with PRP alone or combined with PRP on the basis of the control group. The search duration was each database's inception to September 2023. The literature was screened, data were extracted and quality was assessed by two independent researchers. Data analysis was performed using the Review Manager 5.4 software. Eighteen RCTs comprising 1463 patients were included in the analysis. The meta-analysis revealed that the application of PRP significantly improved the wound healing rate (standardised mean difference [SMD]: 1.11, 95% confidence interval [CI]: 0.54–1.67, p < 0.001), shortened wound healing time (SMD: −1.69, 95% CIs: −2.21 to −1.17, p < 0.001) and reduced the incidence of adverse events (7.03% vs. 18.93%, odds ratio [OR]: 0.32, 95% CI: 0.20–0.53, p < 0.001), and also significantly reduced patients' pain (SMD: −1.86, 95% CI: −2.47 to −1.25, p < 0.001) of burn patients when compared with the control group. This study showed that PRP is effective in repairing burn wounds, promoting wound healing, reducing the incidence of adverse events and reducing patient pain, making it worthy of clinical promotion and application.
A meta-analysis was performed to compare the effects of laparoscopic splenectomy (LS) and open splenectomy (OS) for splenic rupture on postoperative surgical site wound infections and postoperative complications. A comprehensive computerised search was conducted for studies comparing LS with OS for the treatment of splenic rupture in the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases, with the search including studies published in any language between the creation of the databases and August 2023. Two researchers independently screened the literature and extracted the data. Literature quality was assessed using the Newcastle-Ottawa Scale, and the included data were collated and analysed using Stata 17.0 software for meta-analysis. Twenty-two studies involving 1545 patients were included. LS was superior to OS in the following aspects: reduced risk of postoperative surgical site wound infection (OR = 0.19, 95% CI: 0.11–0.34, p = 0.000), shortened hospital stay (standardised mean difference = −1.73, 95% CI: −2.05 to −1.40, p = 0.000), and reduced postoperative complication rate (OR = 0.22, 95% CI: 0.16–0.31, p = 0.000). Compared with OS, LS has a lower rate of postoperative wound infection, shorter hospital stay, and reduced rate of postoperative complications. LS is safe and effective for the treatment of splenic rupture and can be promoted clinically.
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