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Women with overweight or obesity tend to engage in low levels of exercise and face challenges in initiating and maintaining exercise throughout pregnancy.
This study aimed to evaluate the effectiveness of a peer-led walking and mobile health (mHealth) app intervention on self-efficacy and change in exercise behavior stage, based on the transtheoretical model (TTM), of women with overweight or obesity from pregnancy to one month postpartum.
The study was a randomized controlled trial with an experimental design. A total of 114 pregnant women (BMI ≥ 24 kg/m2 and gestation < 16 weeks) were recruited from prenatal clinics in Taiwan from July 2021 to May 2022. The intervention group (IG) received the peer-led walking program with mHealth support, while the control group (CG) received standard antenatal care. Follow-ups were conducted at 24–28 weeks (T2), 36–40 weeks (T3), and one month postpartum (T4).
The IG had significantly higher exercise self-efficacy scores from T1 to T3 compared to the CG. IG participants showed notable progress in exercise behavior stages, transitioning from the contemplation stage at T1 to preparation and action stages at T2 (χ 2 = 13.208, p < 0.01), with some reaching the maintenance stage by T3 (20.9%, χ 2 = 9.49, p < 0.05). In contrast, most of the CG participants remained at the contemplation stage throughout pregnancy to early postpartum.
The peer-led walking intervention with mHealth has the potential to enhance self-efficacy and promote sustained exercise behavior of women with overweight or obesity during and after pregnancy and is a valuable approach to establishing long-term exercise behavior.
ClinicalTrials.gov: NCT 05022680
The incidence of psychological distress in patients with malignant tumors is high, which seriously affects the treatment compliance and quality of life of patients and even reduces the survival time. Non-pharmacological interventions are acceptable to patients because of their minor side effects. However, among the numerous interventions, which non-pharmacological intervention has demonstrated the most significant effect is still unclear.
This study aimed to compare the efficacy of different non-pharmacological interventions on psychological distress in patients with malignant tumors.
The databases, including Wanfang databases, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, SinoMed, PubMed, Embase, Web of Science, Cochrane Library, and PsycINFO, were searched systematically for randomized controlled trials on non-pharmacological interventions for psychological distress in patients with malignant tumors that were published up to July 5, 2025. Revman 5.3 and Stata 18.0 were used for paired and network meta-analysis, respectively.
A total of 43 randomized controlled trials were included. The area under the cumulative sorting curve was ranked as Naikan Morita therapy (99.6%) > acceptance and commitment therapy (79.0%) > music therapy (78.3%) > logotherapy (77.8%) > behavioral activation (67.5%) > solution-focused nursing (66.1%) > dignity therapy (51.2%) > mindfulness-based stress reduction (50.6%) > mindfulness-based cognitive therapy (46.7%) > Mika app (39.8%) > psychological education (38.5%) > multi-dimensional collaborative nursing (29.0%) > life review therapy (26.0%) > exercise therapy (14.7%) > usual care (5.0%).
Non-pharmacological interventions had overall benefits in reducing the psychological distress of patients with malignant tumors, especially Naikan Morita therapy, acceptance and commitment therapy, music therapy and logotherapy. However, more high-quality randomized controlled trials are still needed to obtain more reliable conclusions.
Chronic heart failure (CHF) is a progressive life-limiting condition that necessitates early implementation of advance care planning (ACP). However, patients and caregivers encounter emotional, informational, and cultural barriers to effective ACP engagement. This meta-synthesis consolidates qualitative evidence to deepen our understanding of ACP practices in CHF care.
This study aimed to explore experiences of CHF patients and their caregivers in ACP, which is defined as a proactive decision-making process to establish future treatment plans based on patients' values. The study also aimed to identify barriers and facilitators influencing ACP decisions and assess the impact of flexible, personalized ACP approaches on care quality.
Using qualitative meta-synthesis, we analyzed 10 qualitative studies on CHF patients' and caregivers' ACP experiences. Data were thematically synthesized to identify emotional, relational, and practical factors that influence engagement in ACP.
Three themes emerged: (1) heart failure patients and caregivers face difficulties in ACP (difficulties from patients, difficulties from the family, and difficulties from the society), (2) multidimensional drivers and impacts of ACP (advance care planning drivers, acceptance and implementation of ACP, emotions and effects of ACP), (3) flexible, personalized ACP delivers tangible benefits (timing and effectiveness of ACP discussions, patients and caregivers have personalized needs for ACP, and patients and caregivers affirm ACP benefits).
ACP plays a critical role in improving end-of-life care quality and reducing emotional and decision-making burdens on caregivers. Flexible and personalized ACP strategies supported by trained healthcare professionals more effectively meet the unique needs of patients and families. To overcome persistent barriers and promote broader ACP adoption, healthcare systems should prioritize provider communication training, ACP education, and support systems tailored to diverse cultural contexts.
Evidence-based practice (EBP) should be implemented in clinical settings and practiced by registered nurses as it improves healthcare quality, safety, costs, and patient outcomes. For this to occur, nurses need to be skilled and acculturated. An EBP culture needs to be developed and sustained, both in initial academic programs and in clinical settings. Implementation models already exist and are being used, but outcomes are not consistently measured.
The aim of this scoping review was to gather and map the use of EBP implementation models as well as their implementation strategies and outcomes.
The methodology for the JBI Scoping Reviews was applied. The databases queried were PubMed, CINAHL, EMBASE, EMCARE, AMED, BNI, HMIC, PsycInfo. Inclusion criteria were as follows: Any primary study that describes the implementation of EBP in nursing, clinical, or academic settings. Studies using the following EBP implementation models were included: the ARCC Model, ARCC-E Model, IOWA Model, Stetler Model, Johns Hopkins Nursing EBP Model, ACE Star Model as well as PARIHS and i-PARIHS. They must have used Proctor's taxonomy for implementation outcomes as well as described implementation strategies according to the ERIC classification. Data extraction was performed by four independent reviewers in February 2024. There was no language or date limitation. Three independent reviewers performed an initial selection on titles and abstracts. Reading of the full texts was carried out by two independent reviewers using the JBI SUMARI.
A total of 2244 articles were retrieved. After removing duplicates and applying the inclusion criteria, 26 articles were reviewed, and data extracted. The most used implementation model was the PARiHS or i-PARiHS model followed by the IOWA model, the ARCC model combined with the JHNEBP model and the Stetler model. Nearly all studies used the implementation strategy domain “Use evaluative and iterative strategies” of ERIC classification. Overall, the selected studies used between 1 and 2 outcomes from Proctor's eight available.
The underuse of existing taxonomies (Proctor, ERIC) prevents an exhaustive mapping of the use of implementation models. The vocabulary used is too vague, and the implementation strategies are sometimes poorly described. An effort needs to be made to report on all work done to transfer the results to other settings and thus improve health care practices.
A call for action has been issued nationwide to prevent suicide among nurses. An increased understanding of contributing and protective factors associated with suicidal ideation in nurses is needed to implement preventive measures. Factors needing exploration include nurses' burnout, mental well-being, physical health, and workplace characteristics.
This study aimed to determine factors associated with suicidal ideation in 501 moderate-to-high-risk nurses, including their mental health, level of burnout, health-related personal beliefs, healthy lifestyle behaviors, and workplace characteristics.
A descriptive, cross-sectional correlational study was conducted on baseline survey data that was completed before the nurses were randomized to one of two interventions as part of their participation in a randomized controlled trial investigating the efficacy of a combined mental health screening program and cognitive-behavioral skills building intervention versus a screening program alone. Nurses were recruited from across the United States via email. Only nurses identified with moderate-to-high-risk adverse mental health outcomes, including suicidal ideation, were included. The survey used valid and reliable measures to assess burnout, anxiety, depression, suicidal ideation, post-traumatic stress, healthy lifestyle behaviors, health-related personal beliefs, resilience, job satisfaction, self-perceived mattering to the workplace, and intent to leave. Bivariate tests were performed.
Burnout, anxiety, depression, and post-traumatic stress were individually correlated with increased odds of suicidal ideation, as were nurses working 12-h shifts and those who reported an intent to leave their jobs. Protective factors against suicidal ideation included resilience, positive health-related personal beliefs, healthy lifestyle behaviors, job satisfaction, and workplace mattering.
There is an urgent need for policies and implementation of evidence-based interventions to address mental health issues in nurses to ultimately prevent suicide. Burnout should be considered as a possible precursor to serious adverse mental health problems and not just an operational retention issue. Leaders need to invest in resources to enhance nurses' mental health, fix system problems that are at the root cause of burnout, routinely recognize employees for their excellent work, and communicate that they matter. Leaders should listen carefully to their nurses, prioritize their ideas for impactful change, and appreciate those who contribute to improving culture and caring practices.
Work-related stressors have been associated with physician suicide. Physician burnout and depression were exacerbated by the COVID-19 pandemic, remain unresolved and of national concern. Future pandemics are predicted. This study is the first to characterize professional and pandemic-related stressors in physician suicides during the COVID-19 pandemic.
This study aimed to evaluate whether there was a change in reported job-related stressors after the beginning of the COVID-19 pandemic.
Physician suicides were identified within the National Violent Death Reporting System dataset (March 1, 2020 to December 31, 2021). Free-text law enforcement and medical examiner notes for physician suicides were analyzed using reflexive thematic analysis.
Of 307 physician suicides, 70 included professional or pandemic-related stressors associated with death. Themes included pandemic-related dysregulation, financial distress, relationship issues, mental/physical/substance use problems, grief, and discipline.
While loss of employment, physical, mental health, legal, and substance use issues continue to be associated with suicide, grief and pandemic-specific stress were novel findings. Fear of disease, quarantine, and prolonged illness due to contracting COVID warrant psychological support. Psychological support is also indicated for recent discharge, grief management, transition into retirement, and during disciplinary processes. The stress of a pandemic may exacerbate previous risks. Proactive physician suicide prevention measures remain indicated.
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