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To identify the barriers and enablers in the implementation of evidence-based physical activity (PA) programmes for the improvement of health outcomes among pregnant women with gestational diabetes mellitus (GDM), and to develop strategies for implementing this evidence in clinical practice.
A convergent mixed-methods study was conducted, integrating a descriptive qualitative research design with a cross-sectional survey. In-depth interview was used to collect the views and cognitions about physical activity from medical staff, leaders and pregnant women. The qualitative data was analysed using directed content analysis, guided by the Ottaw Model of Research Use (OMRU). A self-designed questionnaire, which was based on the current best evidence for physical activity during pregnancy, was administered to gather data regarding nurse’ knowledge of physical activity (PA safety, managing blood glucose with PA, etc.), their management practice (timing of assessments, provision of information, etc.), as well as the knowledge levels of physical activity among pregnant women with GDM (principles of exercise, PA precautions, etc.).
A total of 12 medical staff members and 14 pregnant women were interviewed. Ten nurses and 102 pregnant women with GDM completed the questionnaire. We generated 12 subthemes organised within three themes of the OMRU from the data, including insufficient professional autonomy, positive attitudes towards evidence implementation, shortage of nursing staff, implementation climate, etc. The average knowledge score of physical activity among nurses and pregnant women was 5 (SD 2.36) points and 5.2 (SD 1.70) points, respectively. Ten strategies for overcoming barriers and amplifying enablers for the implementation of the physical activity improvement programme for pregnant women with GDM, under the guidance of the OMRU were constructed.
An accumulation of evidence, adopters and practice environment factors across the OMRU domains explains why physical activity improvement initiatives for pregnant women with GDM are hard to implement.
This study helps to recognise barriers and facilitators to physical activity improvement particularly at the evidence, potential adopter and practical environment level.
Healthcare workers (doctors, nurses, etc.) and pregnant women with GDM in a university hospital located in Sichuan Province.
To explore the factors influencing the intention of patients with coronary heart disease to undergo cardiac rehabilitation.
This is a qualitative content analysis study.
Semi structured, face-to-face interviews were conducted in the Department of Cardiology at a tertiary Grade-A hospital in Baoding, China, from January to March 2025. To ensure sample diversity, purposeful sampling was employed. The interview guide was based on the Reasoned Action Approach theory, literature review, and team deliberations. Data were analysed using deductive content analysis.
Twenty patients with coronary heart disease participated in the interviews (average age 57.9 years; 10 males, 10 females; 0–360 months disease course). Nine themes were identified from the three dimensions of RAA attitudes, perceived norms, and perceived behavioural control, reflecting patients' attitudes regarding cardiac rehabilitation (rehabilitation is beneficial, safety concerns, and non-essential treatment strategy); the impact of external factors on cardiac rehabilitation in patients (lack of professional recommendations, lack of awareness among friends and family); and barriers and facilitators in the implementation of cardiac rehabilitation (limited resources, insufficient self-efficacy, responsibility-driven, and individualised needs are challenging to fulfil).
To enhance the cardiac rehabilitation intentions of patients with coronary heart disease, healthcare providers should comprehensively assess influencing factors from the patient's perspective. Tailored interventions should focus on cognitive restructuring, support system enhancement, and patient empowerment.
This study highlights factors influencing patients' cardiac rehabilitation intentions. Nurses, equipped with relevant knowledge and skills, can provide systematic cardiac rehabilitation education during hospitalisation, thereby enhancing intentions and improving participation in cardiac rehabilitation.
This study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist guidelines.
Patients with coronary heart disease participated in the interviews and provided essential insights for this study.
by Mengzhen Qin, Mengyuan Qiao, Yuying Dong, Haiyan Wang
ObjectiveCompared with those without such impairment, middle-aged and older adults with sensory impairment (SI) demonstrate a greater prevalence and severity of depressive symptoms, significantly affecting their mental health. We aimed to develop and validate a depression risk prediction model for middle-aged and elderly individuals with SI.
MethodsData from the 2018 China Health and Retirement Longitudinal Study were randomly partitioned into training and validation sets at a 7:3 ratio. Within the training set, least absolute shrinkage and selection operator (LASSO) regression analysis and binary logistic regression were used to identify predictor variables, and a risk prediction column‒line graph was subsequently developed, with depression status among middle-aged and elderly individuals with SI as the dependent variable. Predictive performance of the training and validation sets was assessed via receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis.
ResultsIn total, 5308 middle-aged and older adults with SI were included, with 50.1% (n = 2657) developing depression. Multifactorial logistic regression analysis identified several depression predictors, including sex, education level, place of residence, marital status, self-rated health, life satisfaction, pension insurance status, nighttime sleep duration, functional impairment status, and pain (all P CI = 0.783–0.811) and 0.778 (95% CI = 0.755–0.800), respectively. The Hosmer–Lemeshow values were P = 0.176 and P = 0.606 (P > 0.05), and the calibration curves revealed significant agreement between the model and actual observations. ROC and DCA curves indicated good predictive performance for the column‒line graph.
ConclusionThis study presents a reliable, validated, and acceptable predictive model for depression risk in middle-aged and elderly individuals with SI, and the identified predictors have potential applications in public health policy and clinical practice.
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.
Moral sensitivity, missed nursing care and moral distress among healthcare professionals have received considerable attention in recent years. These factors represent important healthcare challenges for new nurses (graduation to 2 years of work experience). However, studies on the relationships among these variables in the context of new nurses in China remain lacking.
To explore the relationships among moral sensitivity, missed nursing care and moral distress in the context of new nurses in China.
A cross-sectional descriptive survey was conducted.
A total of 228 new nurses were recruited from three tertiary hospitals in Qingdao, Shandong Province, China. Participants provided their sociodemographic and professional information and completed the Chinese Moral Sensitivity Questionnaire-Revised Version, the Chinese Missed Nursing Care Survey Version and the Chinese Moral Distress Scale-Revised Version. The data were analysed using Spearman's correlation analysis and multiple linear regression analysis.
The means and standard errors of moral sensitivity, missed nursing care and moral distress were 40.71 (0.39), 9.82 (0.78) and 34.87 (2.41), respectively. The variable of missed nursing care exhibited a significant negative relationship with moral sensitivity and a significant positive relationship with moral distress. Regression analysis revealed that the main factors influencing new nurses' moral distress were educational background, nature of job, current unit, frequency of night shifts and the dimensions of moral strength and responsibility. These factors can explain 14.9% of the total variation.
The findings revealed that higher rates of missed nursing care were associated with lower moral sensitivity and greater moral distress among new nurses. Therefore, developing interventions to reduce missed nursing care may be a promising strategy for improving moral sensitivity and preventing moral distress among new nurses.
In hospitals, moral distress can be improved by focusing on modifiable factors such as staffing resources, leading to better promoting new nurses' health and improving the quality of care. This study can highlight practices accounting for moral sensitivity and missed nursing care in nursing research and training programmes.
Strengthening the reporting of observational studies in epidemiology (STROBE) statement.
No patient or public contribution.
To investigate the status and influencing factors of caring readiness among parents of children undergoing liver transplantation transitioning from the intensive care unit, and to explore the associations between caring readiness and other variables.
A cross-sectional study.
A total of 126 parents of children who underwent liver transplantation at a tertiary hospital in China took a questionnaire survey via convenience sampling. Independent t-test, ANOVA and correlation analysis were conducted to analyse the data. Multivariable stepwise linear regression was used to analyse the influencing factors of caring readiness. The PROCESS macro (Model 4) was used to verify the mediating effect of caregiver burden between social support and caring readiness.
The STROBE checklist was used as a guideline in this study.
The mean score of caring readiness among parents of children who had undergone liver transplantation and were transitioning from the intensive care unit was 23.62 ± 5.34. Multivariable stepwise linear regression analysis indicated that experience with caregiving, intensive care unit length of stay, social support and caregiver burden were the factors associated with caring readiness, explaining 18.6% of the variance in caring readiness among parents. Caregiver burden partially moderated the relationship between social support and caring readiness (20.93%).
The study shows caring readiness was moderate among parents of children who have undergone liver transplantation and are transitioning from the intensive care unit. It reveals that lack of caregiving experience and children's short intensive care unit length of stay should be emphasised, preventing inadequate readiness of parents. Furthermore, enhancing social support interventions and burden-reduction strategies are important for improving parents' caring readiness.
The findings demonstrate that health care professionals should provide timely and appropriate intervention strategies to enhance parents' caring readiness, which could potentially be achieved by increasing social support and reducing caregiver burden.
Parents of children who underwent liver transplantation participated in this study via a questionnaire survey.
Virtual reality is an emerging non-drug treatment for pain caused by endoscopy procedure. We conducted a meta-analysis to evaluate the effectiveness and safety of virtual reality based interventions for pain during endoscopy.
PubMed, EMBASE, Cochrane Library, Web of Science and Clinical Trials database were searched until 26 May 2024. Randomised controlled trials on the application of virtual reality in endoscopic examinations were included. The standardised mean difference (SMD) was calculated using random-effects models, and included studies were appraised using Cochrane Risk of Bias tool version 1. Meta- analysis was conducted using Stata Statistical Software version 17.0.
Overall, 21 studies enrolling 1721 participants were included. Our results demonstrated that the patients receiving the virtual reality intervention had lower pain scores than those receiving the usual care (SMD = −0.42; 95% CI = −0.65, −0.20). Subgroup analysis showed that real-time assessment of pain scores during the medical process had less heterogeneity (I 2 = 20.2%, p = 0.257) and a smaller range of confidence intervals (95% CI = −0.43, −0.14) than retrospective assessment (95% CI = −0.75, −0.09). For different types of endoscopes, virtual reality was statistically significant for reducing pain during colonoscopy (SMD = −0.70; 95% CI = −1.12, −0.28), cystoscopy (SMD = −0.28; 95% CI = −0.53, −0.04) and laparoscopy (SMD = −0.54; 95% CI = −0.98, −0.10). Additionally, statistically significant improvements in relieving anxiety were reported when using virtual reality (SMD = −0.56; 95% CI = −0.78, −0.35).
The application of virtual reality can effectively relieve the pain and anxiety of endoscopy. The types of endoscopy and the way of retrospective evaluation of pain scores were the main sources of heterogeneity. More rigorous studies about the relationship between virtual reality and endoscopic pain relief will be needed.
The application effect of virtual reality technology on endoscopy was verified by summarising several randomised controlled trials. Patients and healthcare providers can be better informed about the use of such intervention to relieve pain.
Virtual reality is recommended as being potentially useful and practical for reducing the pain of endoscopy.
Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases.
Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022.
Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types.
Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions.
This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies.
The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies.
Patient or public contribution does not apply to this study.
To describe the lived experiences of family caregivers of individuals with dementia during the coronavirus disease (COVID-19) outbreak in China.
This study used a descriptive phenomenological research method.
Between May and September 2021, semi-structured interviews were conducted with 22 family caregivers of people with dementia. Colaizzi's method was used for manual analysis.
Qualitative data revealed an overarching experience of finding ‘There is always good fortune in misfortune to encourage us in coping with difficulties’. Three themes emerged: family reactions to the COVID-19 outbreak, feeling supported by multiple resources performing respective functions and resilient adaptation to new situations.
During the COVID-19 outbreak, family caregivers of people living with dementia in China looked for positive aspects among difficulties and experienced corresponding reactions, social support resources and resilient adapted coping styles.
Nurses in China and other countries facing similar pandemic characteristics, cultures or economic development levels, can guide family caregivers to look at family hardships from a positive perspective, develop interventions to rapidly respond to families' reactions after a disaster and help them identify social support resources and form adapted coping styles.
We identified the resilience and the positive experiences of Chinese family caregivers of individuals with dementia during the COVID-19 outbreak. The results can inform countries with similar cultures and economic levels, offering measures to support their adaptation to pandemics.
This study followed the COREQ guidelines.
Family caregivers of people with dementia who met the inclusion criteria and who were interested in sharing their understanding of their experiences, participated in the study.
FreshRSS 