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To analyse current Glasgow Coma Scale practice among emergency nurses in China and identify factors influencing assessment quality.
A quantitative, multicenter cross-sectional design.
A convenience sample of 1740 emergency nurses from secondary and tertiary hospitals across 21 provinces completed a validated structured questionnaire between March and April 2025. Participants had at least 6 months of emergency nursing experience. Data analysis included descriptive statistics, chi-square tests, and multiple logistic regression to examine factors influencing correct Glasgow Coma Scale application.
Participants had a mean age of 29.8 years (SD = 6.2). Only 52.5% of nurses demonstrated correct Glasgow Coma Scale application despite 97.0% having theoretical knowledge of scoring criteria. While 56.8% had received Glasgow Coma Scale training, significant standardisation deficiencies emerged. Notably, 41.8% of departments lacked operational guidelines, and 53.7% of nurses experienced scoring disagreements with colleagues. Clinical utilisation varied substantially by patient population: traumatic brain injury (97.8%), neurological diseases (96.9%), and systemic critical illness (85.8%). Multivariate analysis identified six significant factors influencing correct application: standardised training (OR = 2.252, 95% CI: 1.789–2.825), manageable workload ≤ 4 patients/shift (OR = 1.652, 95% CI: 1.327–2.057), departmental guidelines (OR = 1.523, 95% CI: 1.233–1.881), extensive work experience ≥ 9 years (OR = 1.534, 95% CI: 1.182–1.992), while multidisciplinary collaboration issues (OR = 0.559, 95% CI: 0.439–0.712) and special patient experience (OR = 0.520, 95% CI: 0.406–0.666) were associated with reduced accuracy.
Substantial standardisation challenges exist in Glasgow Coma Scale practice among Chinese emergency nurses, characterised by significant gaps between theoretical knowledge and clinical application. Major barriers include insufficient standardised guidelines, inconsistent training approaches, and inadequate interdisciplinary collaboration.
Healthcare administrators should develop national standardised guidelines, implement simulation-based training programs, optimise emergency workflows, and integrate alternative assessment tools to enhance consciousness assessment accuracy and improve patient safety.
STROBE statement adherence.
No patient or public contribution.
Preventing skin tears (STs) in older adults is an urgent public health concern, especially in long-term care (LTC) facilities. However, limited research on ST prevention among care workers exists due to a lack of suitable assessment tools. This study aims to develop and psychometrically evaluate the Knowledge, Attitude and Practice instrument for care workers in preventing Skin Tears (KAP-ST) in older adults.
The KAP-ST was developed and validated in four phases during May–October 2024. First, an item pool was generated through a comprehensive literature review. Second, a preliminary instrument was developed through a Delphi expert consultation and pilot testing. Third, the items and the final instrument were optimised through a cross-sectional survey involving 317 care workers from 29 LTC facilities in China. Finally, a psychometric evaluation was conducted in another cross-sectional survey involving 373 care workers from 18 LTC facilities.
The final KAP-ST contains 35 items across knowledge, attitude and practice dimensions. Exploratory factor analysis (EFA) revealed a nine-factor structure (factor loadings ranging from 0.451 to 0.799, accounting for 61.35% of total variance). The Item-Level Content Validity Index (I-CVI) values ranged from 0.926 to 1.000, and the Scale-Level Content Validity Index (S-CVI/Ave) was 0.991. The instrument's Cronbach's α, split-half, and test–retest reliability coefficients were 0.887, 0.744, and 0.934, respectively. The CFA analysis revealed an ideal absolute fit validity (RMSEA = 0.068; RMR = 0.029) and parsimony fit validity (PGFI = 0.684).
The KAP-ST demonstrates strong reliability, structural validity and content validity. It is well-suited for assessing care workers' knowledge, attitudes and practices in preventing STs among older adults. Further research is required to enhance and confirm its validity.
STs in the spotlight recently necessitate the use of appropriate investigative tools to facilitate in-depth research, especially for care workers, who should prioritise access to specialised knowledge. Introducing professional guidance in LTC facilities is recommended to enhance the knowledge, attitude and practice of care workers.
Standardised Guidelines for Scale Construction and COSMIN checklist.
No patient or public contributions.
by Congli Jia, Fu Yang
ObjectiveThis study employs integrated network toxicology and molecular docking to investigate the molecular basis underlying 4-nonylphenol (4-NP)-mediated enhancement of breast cancer susceptibility.
MethodsWe integrated data from multiple databases, including ChEMBL, STITCH, Swiss Target Prediction, GeneCards, OMIM and TTD. Core compound-disease-associated target genes were identified through Protein-Protein Interaction (PPI) network analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were subsequently employed to elucidate the potential molecular functions and biological pathways associated with these key targets. Molecular docking using AutoDock Vina was conducted to investigate the binding interactions between the core genes and 4-NP. Furthermore, the miRDB database was utilized to identify potential microRNAs (miRNAs) that may exert regulatory control over the pivotal genes.
ResultsFive hub breast cancer target genes associated with 4-NP exposure were screened, containing TP53, HDAC1, ESR1, CTNNB1 and MYC. GO and KEGG analyses revealed that intersecting genes mainly influenced PI3K-Akt signaling, MicroRNAs in cancer, Chemical carcinogenesis−receptor activation and MAPK signaling. Molecular docking confirmed strong binding affinities of 4-NP to these hub genes. Subsequently several high-confidence candidate regulatory miRNAs especially miR-22, -148a, -181a and −152 were identified that shed light on miRNA regulatory mechanisms by which 4-NP increases breast cancer risk.
ConclusionOur study demonstrates that 4-NP exposure perturbs protein conformational of hub targets, activating cascades and dysregulating signaling pathway to potentiate breast cancer risk. Furthermore, we identify a novel miRNA-mediated regulatory axis alongside MAPK signaling as critical mechanisms underpinning 4-NP toxicity.
To co-design an information booklet to support adults living with a peripherally inserted central catheter (PICC) at home.
A sequential, mixed-method approach using Boyd's co-design framework.
A diverse project team led co-design of a PICC booklet based on preferences and PICC management strategies identified through content analysis of interviews with 15 Australian health consumers (January 2022–March 2023) using a qualitative descriptive approach. A draft booklet was developed, reviewed by the team and prototyped, which was evaluated by consumer participants and an external nurse panel, with readability assessed using Flesch Reading Ease and Flesch–Kincaid scores. The project team reviewed feedback, reached consensus on changes and collaborated with designers to produce the final booklet.
Consumer participant strategies were classified into four categories: enhancing coping, taking responsibility and understanding information, modifying life and accessing supports. Two pre-determined categories were included (participant recommendations for PICC education resource content and top tips for living with a PICC). The prototype was evaluated as highly relevant (3.9/4), comprehensive (3.8/4) with an appropriate writing style and visual appeal. Readability scores were 76.1/100 (Flesch Reading Ease) and 6.9 (Flesch–Kincaid grade level). The final booklet contained 13 sections.
A co-design approach successfully created a novel PICC information booklet with positive evaluations.
Provides understanding of consumer information preferences to inform PICC education and offers insight into consumer-developed strategies and knowledge for living with a PICC.
A co-designed PICC information booklet based on consumer knowledge may augment nursing education for people living with a PICC to improve outcomes.
The qualitative component follows the EQUATOR network COREQ guideline. A co-design research reporting standard is not available.
A consumer representative was a member of the project team and contributed to study design, interpretation of findings and development of the booklet and manuscript.
To validate a practical method for estimating total Glasgow Coma Scale (etGCS) scores in intubated traumatic brain injury (TBI) patients and evaluate its reliability when integrated into established ICU severity scoring systems.
TBI is a global health issue, often leading to high mortality and disability. The Glasgow Coma Scale (GCS), essential for assessing TBI severity, is less reliable in intubated patients due to the inability to assess verbal responses.
Retrospective cohort study.
Data were extracted from the MIMIC-IV database. The reliability of the etGCS was evaluated through its association with in-hospital mortality and its performance when integrated into established ICU severity scoring systems. Multiple statistical approaches were used to validate the findings.
Among 886 intubated TBI patients, the etGCS showed consistent reliability in predicting in-hospital mortality (AUC: 68.22%, 95% CI: 64.29%–72.14%). When combined with pupillary assessment (etGCS-P), the predictive performance remained stable (AUC: 71.99%, 95% CI: 67.89%–76.08%). Furthermore, the estimation method demonstrated reliable performance when integrated into established severity scoring systems. The removal of etGCS from these systems resulted in decreased predictive performance, confirming its valuable contribution to mortality prediction.
This study validated a practical and reliable method for estimating total GCS scores in intubated TBI patients. The estimated scores showed consistent predictive value and enhanced existing severity scoring systems, supporting its clinical utility in ICU settings.
This validation of a practical GCS estimation method supports nurses in delivering accurate patient assessments, facilitating clinical communication and making informed care decisions for intubated TBI patients.
This retrospective study involved no patient or public participation in the design or conduct.
This study aimed to establish a comprehensive set of nursing-sensitive quality indicators (NSQIs) for patients with dysphagia following tracheotomy due to acquired brain injury (ABI), based on the ‘structure-process-outcome’ model.
A Delphi survey.
The research utilised a mixed-methods approach, including systematic literature reviews, qualitative interviews and two rounds of Delphi expert consultations. A diverse team comprising specialists in dysphagia rehabilitation and nursing management conducted the research, which involved defining and refining NSQIs through extensive evaluations and consensus among recruited experts.
The finalised NSQI includes 4 structural indicators, 13 process indicators and 4 outcome indicators, covering key aspects such as resource allocation, patient assessment and clinical outcomes. The expert consensus provides verification. Kendall's harmony coefficients are 0.304 and 0.138 (p < 0.001), respectively, and the mean importance assignments of indicators at all levels are 3.90–5.00. The final care of patients with tracheotomy and dysphagia after brain injury was constructed. The evaluation indicators include a total of 4 first-level indicators, 23 second-level indicators and 52 third-level indicators.
The established NSQIs offer a systematic framework to enhance the quality of nursing care for ABI patients with posttracheotomy dysphagia. This model facilitates precise monitoring and proactive management of nursing practices, promising better patient outcomes and streamlined care processes.
This study develops targeted NSQIs to improve dysphagia management in ABI patients’ posttracheotomy, fostering better patient outcomes and advancing nursing education through essential specialised training.
Expert-driven insights from experienced clinicians informed the NSQIs, ensuring their relevance and effectiveness in enhancing patient-centred care.
To evaluate and summarize the available evidence on the prevention and management of nasogastric aspiration in critically ill patients to inform the development of evidence-based clinical practice.
This study was an evidence summary according to the evidence summary reporting standard of the Fudan University Center for Evidence-Based Nursing.
According to the ‘6S’ model of evidence resources, evidence on the prevention and management of aspiration in critically ill patients on nasogastric feeding was retrieved, including clinical decision-making, best practices, guidelines, evidence summaries, expert consensus and systematic evaluations.
UpToDate, BMJ Best Practice, JBI, National Guideline Clearing-house, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Care Excellence, Registered Nurses Association of Ontario, Yi Mai tong Guidelines Network, the Cochrane Library, PubMed, Web of Science, Embase, OVID, Sinomed, CNKI, Wan Fang database. The search period was from January 2013 to June 2023.
We included a total of 30 high-quality articles and summarized 36 pieces of evidence from them. These pieces of evidence covered 11 dimensions of multidisciplinary management, aspiration risk assessment, tube location, nutritional infusion management, position management, airway management, and oral hygiene. The level of evidence in the study was predominantly level 1 and level 5, with 27 pieces of evidence recommended as ‘strong’ and 9 pieces of evidence recommended as ‘weak’.
This study summarizes 36 pieces of evidence on preventing and managing aspiration in critically ill patients with nasogastric feeding. But the characteristics of hospitals should be considered in the application of future evidence.
Aspiration is the most serious complication during nasogastric feeding, which seriously affects the prognosis of patients. Preventing and managing aspiration in nasogastric patients has proven to be a challenging clinical problem. This study summarized 36 pieces of best evidence in 11 dimensions, including multidisciplinary team, assessment and identification, line position, feeding management, and so on. The implementation of these evidences is conducive to standardizing the operation behaviour of nasogastric feeding in clinical medical staff and reducing the occurrence of aspiration.
This research followed the evidence summary reporting specifications of the Fudan University Center for Evidence-based Nursing.
The registration number is ‘ES20221368’.
Establishing a nomogram to estimate the probability of oral mucosal membrane pressure injury of endotracheal tube-intubated hospitalized patients in intensive care unit.
Multicentre prospective cohort study.
Using Lasso regression and COX regression, variable selection was performed on demographic, clinical and laboratory data of 1037 ICU endotracheal tube-intubated hospitalized patients from West China Hospital, to construct a nomogram. External validation was conducted on 484 ICU endotracheal tube-intubated patients from People's Hospital of Zhongjiang County.
Among 38 potential predictors, five variables emerged as independent predictors, integrated into the nomogram: administration of antibiotics, nutritional therapy duration, agitation, hypotension and albumin levels.
We established a nomogram based on the hospital characteristics of ICU endotracheal tube-intubated patients, aiding in the prediction of the occurrence of oral mucosal membrane pressure injury.
The study followed TRIPOD guidelines.
The nomogram we developed can assist clinical worker in better identifying at-risk patients and risk factors. It enables the implementation of evidence-based nursing interventions in care to prevent the development of oral mucosal membrane pressure injury.
The study has been registered with the Chinese Clinical Trial Registry (http://www.chictr.org.cn) under registration number ChiCTR2200056615.
To investigate knowledge, attitudes, and practices regarding the application of the Injury Severity Score (ISS) among emergency department nurses in China and the factors influencing these variables.
ISS is the first trauma scoring method to be developed and the most widely used in clinical practice. The correct application of the ISS by emergency department nurses plays an important role in assisting in the diagnosis and treatment of trauma patients, and it is crucial to understand nurses' knowledge, attitudes and practices.
A cross-sectional multicentre study.
Nurses from the emergency departments of 25 grade II and grade III hospitals in Gansu Province, China participated in this study. Data was collected online using a self-administered questionnaire. Student's t-test or analysis of variance was performed to compare the differences between the groups. Multiple logistic regression analysis identified factors influencing nurses' knowledge, attitudes and practices regarding applying ISS. A STROBE checklist was used to report findings.
Among 459 nurses, a good level of attitude and passing levels of knowledge and practice regarding applying the ISS were revealed. Nurses in higher hospital grades, who had been exposed to ISS and received training had higher levels of knowledge and practices. Previous exposure to the ISS and training related to it were factors that influenced nurses' attitudes.
Chinese emergency department nurses' knowledge, attitudes and practices of applying the ISS still need to be improved. Hospitals and nursing managers should provide training opportunities for nurses about ISS knowledge and practices, while grade II hospitals should pay more attention to training and continuing education in this area.
In hospitals, nursing managers may benefit from enhancing related education and training to promote the emergency department nurses' knowledge and practice of the ISS, by developing specific curricula and providing continuing education and training opportunities, while grade II hospitals should pay more attention to training and continuing education in this area.
This study focused on emergency department nurses' knowledge, attitudes, and practices regarding the application of the ISS. The research questions and design were derived from clinical nursing practice, literature review, and expert panel review, and patients or the public are temporarily not involved.
The utilization of 27-G TSV, or 27-Gauge Transconjunctival Sutureless Vitrectomy, poses distinct difficulties in the context of paediatric patients, particularly those younger than 14 years old, on account of the dearth of exhaustive documentation concerning the efficacy and results of these operations. Therefore, this retrospective study was to evaluate the safety and efficacy of 27-G TSV in paediatric patients, with emphasis on management of intraoperative and postoperative complications and postoperative wound healing. A total of 54 eyes of 52 paediatric patients who underwent 27-G TSV at Sichuan Provincial People's Hospital were included in the study. The average duration of follow-up was 9.32 ± 3.35 months. The complication with the highest incidence rate was Rhegmatogenous Retinal Detachment (RRD), which was detected in 27.8% cases. Familial Exudative Vitreoretinopathy (FEVR) and Persistent Fetal Vasculature (PFV) each accounted for 16.7% of the cases. Retinopathy of Prematurity (ROP) and Vitreous Haemorrhage (VH) constituted 11.1% and 14.8%, respectively, of the reported cases. Lens injury (1.9%), cannula slippage (7.4%) and wound leakage (5.6%) were intraoperative complications. Iatrogenic retinal detachment occurred at 3.7%. Hypotony (10.8% of patients), vitreous haemorrhage (9.3%), cataract formation (9.3%), ocular hypertension (8.1%) and retinal detachment (5.6%) were postoperative complications. Effective management strategies were executed, such as performing in situ trocar puncture to address cannula slippage and promptly suturing to address wound leakage. 27-G TSV exhibited promise as the therapeutic alternative for range of vitreoretinal disorders in paediatric patients, accompanied by complications that were controllable during and after the procedure. Strict preoperative planning and precise surgical technique are indispensable in order to maximize patient outcomes and guarantee effective wound healing and recovery within this particular demographic.
This systematic review and meta-analysis evaluate the impact of ultrasound-guided subsheath versus extrasheath sciatic nerve blocks on postoperative wound pain in tibial and foot surgeries, crucial for effective pain management and patient recovery. Adhering to PRISMA guidelines, this study used a PICO framework, focusing on patients undergoing tibial and foot surgeries and comparing the efficacy and safety of subsheath and extrasheath sciatic nerve blocks. The literature search spanned four databases without time restrictions, assessing various outcomes like success rate, onset time, duration of analgesia and complication rates. Quality assessment employed the Cochrane Collaboration's risk of bias tool, and statistical analyses included heterogeneity assessment, fixed-effect and random-effects models, sensitivity analysis and publication bias evaluation using funnel plots and Egger's linear regression test. From an initial pool of 1213 articles, six met the inclusion criteria. The subsheath group showed a significantly higher success rate of complete sensory blockade within 30 min compared with the extrasheath group (OR = 5.39; 95% CI: 2.82–10.28; p < 0.01). No significant differences were found in procedure duration or incidence of nerve-related complications between the two techniques. The subsheath approach also demonstrated a quicker onset time of sensory blockade (MD = −8.57; 95% CI: −11.27 to −5.88; p < 0.01). Sensitivity analysis confirmed the stability of the results, and no significant publication bias was detected. Ultrasound-guided subsheath sciatic nerve blocks are more effective than extrasheath blocks in achieving rapid and complete sensory blockade for tibial and foot surgeries, with a quicker onset time and comparable safety profile. Subsheath injections are thus recommended as a preferred method for anaesthesia and postoperative pain management in these surgical procedures, enhancing overall patient outcomes.
Diabetic foot ulcer, is a chronic complication afflicting individuals with diabetes, continue to increase worldwide, immensely burdening society. Programmed cell death, which includes apoptosis, autophagy, ferroptosis, necroptosis and pyroptosis, has been increasingly implicated in the pathogenesis of diabetic foot ulcer. This review is based on an exhaustive examination of the literature on ‘programmed cell death’ and ‘diabetic foot ulcers’ via PubMed. The findings revealed that natural bioactive compounds, noncoding RNAs and certain proteins play crucial roles in the healing of diabetic foot ulcers through various forms of programmed cell death, including apoptosis, autophagy, ferroptosis and pyroptosis.
Objetivo principal: Identificar la evidencia disponible en la literatura sobre el efecto de la musicoterapia en el dolor de pacientes adultos durante el postoperatorio. Metodología: Revisión integradora de literatura realizada en las bases de datos CUIDEN, CINAHL, PubMed, LILACS, SCIELO, EBSCO, SCOPUS, Web of Science y Google Scholar considerando artículos desde 2019, al 2022, utilizando los descriptores “musicoterapia”, “dolor postoperatorio” y “adulto”. Los datos se presentan de forma descriptiva. Resultados principales: Se encontraron 314 artículos, una vez filtrados se analizaron 18. Todos los pacientes presentaron algún nivel de dolor durante su periodo postoperatorio, algunos además, experimentaron depresión, temor y ansiedad y la musicoterapia demostró disminuir todos estos síntomas, ningún estudio reportó la presencia de alguna complicación durante su implementación. Conclusión principal: La música bien utilizada produce efectos positivos en los pacientes con cáncer, dolor, depresión, estrés, temor durante el periodo postoperatorio y en pacientes sometidos a procesos invasivos, es una intervención económica, inocua. Se puede utilizar por los enfermeros como parte del cuidado holístico y como tratamiento complementario de la farmacología analgésica.
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