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This study examined the moderating effects of income inequality and nurse–patient relationships on the association between occupational stress and nurse turnover intentions in large urban hospitals in China, providing evidence for developing targeted retention strategies.
A cross-sectional study.
Data from 13,298 nurses in 46 hospitals in Xi'an, China (October–December 2023) were analysed using hierarchical regression to assess associations between occupational stress, organisational and professional turnover intentions and the moderating roles of the expected income achievement rate (calculated as [actual/expected income] × 100%) and nurse–patient relationship quality.
Eighty-three percent of nurses reported moderate-to-severe occupational stress. Compared to nurses experiencing mild stress, those with moderate/severe stress demonstrated significantly higher organisational and professional turnover intentions. After adjusting for covariates, significant interaction effects were observed. Higher expected income achievement rate showed a modest but significant moderating effect, associated with reduced turnover intentions. While the nurse–patient relationship also moderated this relationship, its protective effect was attenuated under conditions of severe stress. Despite small effect sizes, the consistent patterns and theoretical coherence of these interactions warrant further investigation.
Occupational stress significantly predicts nurse turnover intentions in urban Chinese hospitals, with income inequality and nurse–patient relationship quality serving as modifiable moderating factors. Interventions should integrate equitable compensation, nurse–patient relationship enhancement programmes and stress management initiatives.
This study demonstrates that equitable income consistently buffers the effects of occupational stress on nurse turnover, while nurse–patient relationships show stress-level-dependent moderation. By implementing region-specific compensation benchmarks and structured communication training, healthcare policymakers can effectively address economic security and relational care quality in workforce stabilisation.
The study has been reported following the STROBE guidelines.
No patient or public contribution.
To investigate the experience and perceptions of the effectiveness of retention strategies of nurses and nursing associates in district nursing services.
Mixed methods cross-sectional online survey.
Electronic invitations were circulated via district nursing professional networks to complete an online survey in England. The survey questions were developed from international evidence-based guidance. Quantitative data were analysed descriptively and using multinomial regression analysis, tested the variation in experienced strategies by job and work characteristics. Content analysis informed qualitative data analysis.
Three hundred and forty-five completed surveys were received. Over 60% of respondents reported experiencing strategies related to a safe working environment (75%), flexible work schedules (65%), well-being (64%) and professional development opportunities (60%). The least frequently reported strategies experienced were involvement in service policymaking (26%), reducing job demands (31%); and creating cohesive nursing teams (40%). Nurses on lower pay grades were statistically less likely than those on the higher pay bands to experience strategies involving professional growth opportunities and involvement in service decision-making. Nurses working in affluent areas were statistically more likely to report experiencing more types of retention strategies than those working in socio-economically deprived areas. Participants' views on effective strategies were mixed but attention to financial aspects (particularly travel costs), manageable workloads, flexibility in work scheduling plus tailored induction/support for those new to district nursing were given the most testimony as effective.
Retention strategies are created and enacted by those within employing organisations, district nursing services and district nursing teams, but within the context of a wider health care and labour market system. We suggest the findings could be the starting point for review by district nursing services experiencing high vacancy rates. Our findings raise questions for subsequent investigation across health systems.
This paper adhered to the relevant Equator guideline A Consensus-Based Checklist for Reporting of Survey Studies (CROSS), https://doi.org/10.1007/s11606-021-06737-1.
This study did not include patient or public involvement in its design, conduct or reporting.
Identifying the core information needs of breast cancer radiotherapy patients serves as the foundation for delivering targeted information services. The Kano model, a qualitative tool for classifying service needs, is increasingly being employed to prioritise patient needs and enhance healthcare quality.
This study aims to examine the informational needs of breast cancer patients undergoing radiotherapy using the Kano model as the analytical framework.
Between October 2024 and February 2025, 260 patients with breast cancer undergoing radiotherapy were recruited as study participants. A cross-sectional survey was conducted using the Information Needs Questionnaire. Kano analysis was applied to identify and assess the information needs of these patients. This study adhered to the STROBE guidelines.
Among the 36 items analysed, 15 items (41.7%) were classified as one-dimensional attributes, primarily related to adverse reaction identification and self-management information. 11 items (30.5%) were identified as attractive attributes, mainly concerning the impact of radiation therapy and social–emotional needs five items (13.9%) were must-be attributes, focusing on basic radiotherapy information. Five items (13.9%) were indifference attributes, including the impact of radiotherapy on breast reconstruction, and guidance on image-related concerns during radiotherapy. The quadrant chart findings revealed that 15 needs were predominant in Area I, five in Improving Area II, five in Secondary Improving Area III and 11 in Reserving Area IV.
The information needs of breast cancer radiotherapy patients are diverse. Kano model analysis aids medical staff in developing health guidance and meeting patients' informational needs.
Understanding the differentiated informational needs of patients with breast cancer undergoing radiotherapy provides valuable insights for developing targeted educational interventions, ultimately improving patient engagement and outcomes.
The contributions of patients/members of the public were limited solely to data collection.
The efficacy of radiotherapy and the satisfaction of patients can be significantly improved by adequately addressing their information needs. This process is impeded by the current lack of a comprehensive tool for assessing these needs.
To develop an Information Needs Questionnaire for patients with breast cancer undergoing radiotherapy and to assess its reliability and validity.
The initial item pool for the questionnaire was developed through a literature analysis and semi-structured interviews with 12 patients with breast cancer receiving radiotherapy. The Delphi method was employed to consult 16 experts and the questionnaire content was refined based on expert feedback and item ratings to form the first draft. A pre-investigation was conducted on 30 patients with breast cancer treated with radiotherapy to refine the item expression. From March–October 2024, item analysis, factor analyses, and reliability tests were conducted on 220 patients. This study adhered to STROBE guidelines.
The final questionnaire comprised 36 items. Exploratory factor analysis revealed 5 dimensions, with all item factor loading within their respective dimensions being ≥ 0.4 and no items exhibiting multiple loadings. These five factors accounted for 72.805% of the total variance. The overall content validity index was 0.980, with item-level content validity index ranging from 0.900 to 1.000. The Cronbach's α coefficient for the entire questionnaire was 0.959, and the coefficients for each dimension ranged from 0.786 to 0.958.
The Information Needs Questionnaire demonstrated excellent reliability and validity in patients with breast cancer undergoing radiotherapy. It can effectively guide medical staff to accurately assess the information needs of patients with breast cancer who are undergoing radiotherapy.
Identifying the authentic informational needs of breast cancer patients throughout the entire radiotherapy process is instrumental in enabling medical staff to devise personalised and targeted information support interventions.
A total of 220 participants provided perspectives on their information needs.
To develop a deep learning-based smart assessment model for pressure injury surface.
Exploratory analysis study.
Pressure injury images from four Guangzhou hospitals were labelled and used to train a neural network model. Evaluation metrics included mean intersection over union (MIoU), pixel accuracy (PA), and accuracy. Model performance was tested by comparing wound number, maximum dimensions and area extent.
From 1063 images, the model achieved 74% IoU, 88% PA and 83% accuracy for wound bed segmentation. Cohen's kappa coefficient for wound number was 0.810. Correlation coefficients were 0.900 for maximum length (mean difference 0.068 cm), 0.814 for maximum width (mean difference 0.108 cm) and 0.930 for regional extent (mean difference 0.527 cm2).
The model demonstrated exceptional automated estimation capabilities, potentially serving as a crucial tool for informed decision-making in wound assessment.
This study promotes precision nursing and equitable resource use. The AI-based assessment model serves clinical work by assisting healthcare professionals in decision-making and facilitating wound assessment resource sharing.
The STROBE checklist guided study reporting.
Patients provided image resources for model training.
Diabetic ulcers are chronic wounds that are notoriously difficult to treat, leading to significant physical and psychological distress and increased healthcare costs. Their multifactorial aetiology necessitates long-term interdisciplinary collaboration and various complementary treatment measures. While numerous studies suggest that electrical stimulation (ES) positively impacts diabetic ulcer healing, the robustness and consistency of these findings require further evaluation to optimize clinical application. We searched databases including PubMed, the Cochrane Library, Embase, Web of Science and the China National Knowledge Infrastructure (CNKI). Only randomized clinical trials (RCTs) comparing ES treatment to placebo or conventional treatment were included. Extracted information included objective healing measures and data for assessing effect sizes. Ten RCTs involving 451 patients met inclusion criteria. ES improved ulcer healing rate compared to control or placebo (MD 20.37, 95% CI: 16.89–23.85, p <0.001) and increased the number of healed ulcers (RR 1.45, 95% CI: 1.18–1.78, p <0.001), with both results being statistically significant. The observed benefits are likely due to the positive effects of ES on the vascular and neurological functions of the lower limbs in patients with diabetic ulcers. Both low-frequency, moderate-intensity alternating current and low-intensity or high-voltage direct current have demonstrated efficacy in promoting ulcer healing. The results suggest ES may be a promising approach of managing diabetic ulcers. However, the optimal method of ES application remains undetermined; therefore, high-quality and large-scale studies are essential.
by Zihao Wang, Huan Xia, Yunfa Ding, Ranran Lu, Xinling Yang
BackgroundParkinson’s disease (PD) is a neurodegenerative disorder, primarily characterized by motor impairments. Vitamin D has several regulatory functions in nerve cell survival and gene expression via its receptors. Although research has shown that vitamin D deficiency is prevalent among PD patients, the causal link to PD risk remains unclear. This study aims to investigate the causal relationship between vitamin D and PD using a bidirectional two-sample Mendelian randomization (MR) analysis method.
MethodsThis study applied a bidirectional two-sample MR analysis to explore the causal link between vitamin D and PD. We selected statistically significant single nucleotide polymorphisms (SNPs) related to 25-hydroxyvitamin D (25(OH)D) as instrumental variables (IVs), ensuring no association with known confounders. The analysis used GWAS data from over 1.2 million Europeans across four major published datasets, elucidating the genetic correlation between vitamin D levels and PD.
ResultsWe identified 148 instrumental SNPs associated with 25(OH)D. After adjustment for confounding-related SNPs, 131 SNPs remained in the analysis. Data from three PD cohorts revealed no significant correlation between 25(OH)D levels and PD risk using the IVW method (Pcohort1 = 0.365, Pcohort2 = 0.525, Pcohort3 = 0.117). The reverse MR analysis indicated insufficient evidence of PD causing decreased vitamin D levels (P = 0.776).
ConclusionThis is the first study to use bidirectional MR across three PD cohorts to investigate the causal relationship between vitamin D and PD. The results indicate that vitamin D levels are not significantly causally related to PD risk at the genetic level. Therefore, future studies should exercise caution when investigating the relationship between vitamin D levels and PD risk. While no direct causal link exists between vitamin D levels and PD, this does not preclude the potential of vitamin D levels as a biomarker for PD diagnosis. Furthermore, larger-scale longitudinal studies are necessary to evaluate the diagnostic and predictive value of vitamin D levels in PD.
by Dijin Mu, Jianan Meng, Sangju Wang, Shizhen Xiao, Hao Wang, Xiangxuan Sun, Pan Wu
Studying the apportionment of source-specific health risks and control factors for heavy metal pollution in karst regions is crucial for prevention and management. A typical karst basin was chosen in this study to investigate the pollution characteristics of heavy metals, source-specific health risks, and control factors. The results indicate that during the rainy season, As, Cd, and Pb, as well as As during the dry season, were the primary elements responsible for water pollution in the watershed. Comparative analyses showed that the absolute principal component-multiple linear regression (APCS-MLR) model better identifies and quantifies the sources of heavy metals in karst basin waters. The analysis of health risks revealed that during the dry season, heavy metals in the basin posed a moderate cancer risk to adults (10−4 −3), whereas during the rainy season, these heavy metals posed a non-cancer risk (total hazard index (THI) > 1) and a moderate to high cancer risk (10−4 −2). The APCS-MLR model combined with the health risk analysis showed that Industrial waste discharge sources are the main contributors to the health of basin residents (29.39%-52.57%), making dry season As a non-cancer risk for basin residents, as well as rainy season As and Cd a non-cancer risk and a high cancer risk for basin residents. Therefore, reasonable planning for upstream industrial production should be developed, and priority should be given to monitoring and treating As and Cd pollution in water. Analyses also showed that input pathways, dilution effects, and hydrochemical characteristics may influence the spatial and temporal variability of heavy metals in the basin. The results provide essential information and significant reference for prioritising and managing the health risks associated with heavy metal pollution in water bodies in karst areas.
To explore the effect of clinical nursing pathway on wound infection in patients undergoing knee or hip replacement surgery. Computerised searches of PubMed, Web of Science, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database, China National Knowledge Infrastructure databases were conducted, from database inception to September 2023, on the randomised controlled trials (RCTs) of application of clinical nursing pathway to patients undergoing knee and hip arthroplasty. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. RevMan 5.4 software was employed for data analysis. Overall, 48 RCTs involving 4139 surgical patients were included, including 2072 and 2067 in the clinical nursing pathway and routine nursing groups, respectively. The results revealed, compared with routine nursing, the use of clinical nursing pathways was effective in reducing the rate of complications (OR = 0.17, 95%CI: 0.14–0.21, p < 0.001) and wound infections (OR = 0.29, 95%CI: 0.16–0.51, p < 0.001), shortens the hospital length of stay (MD = −4.11, 95%CI: −5.40 to −2.83, p < 0.001) and improves wound pain (MD = −1.34, 95%CI: −1.98 to −0.70, p < 0.001); it also improve patient satisfaction (OR = 7.13, 95%CI: 4.69–10.85, p < 0.001). The implementation of clinical nursing pathways in clinical care after knee or hip arthroplasty can effectively reduce the incidence of complications and wound infections, and also improve the wound pain, while also improving treatment satisfaction so that patients can be discharged from the hospital as soon as possible.
As neurosurgery has advanced technologically, more and more neurosurgical implants are being employed on an aging patient population with several comorbidities. As a result, there is a steady increase in the frequency of infections linked to neurosurgical implants, which causes serious morbidity and mortality as well as abnormalities of the skull and inadequate brain protection. We discuss infections linked to internal and external ventricular and lumbar cerebrospinal fluid drainages, neurostimulators, craniotomies, and cranioplasty in this article. Biofilms, which are challenging to remove, are involved in all implant-associated illnesses. It takes a small quantity of microorganisms to create a biofilm on the implant surface. Skin flora bacteria are implicated in the majority of illnesses. Microorganisms that cause disruptions in wound healing make their way to the implant either during or right after surgery. In about two thirds of patients, implant-associated infections manifest early (within the first month after surgery), whereas the remaining infections present later as a result of low-grade infections or by direct extension from adjacent infections (per continuitatem) to the implants due to soft tissue damage. Except for ventriculo-atrial cerebrospinal fluid shunts, neurosurgical implants are rarely infected by the haematogenous route. This research examines established and clinically validated principles that are applicable to a range of surgical specialties using implants to treat biofilm-associated infections in orthopaedic and trauma cases. Nevertheless, there is little evidence and no evaluation in sizable patient populations to support the success of this extrapolation to neurosurgical patients. An optimal microbiological diagnostic, which includes sonicating removed implants and extending culture incubation times, is necessary for a positive result. Additionally, a strategy combining surgical and antibiotic therapy is needed. Surgical procedures involve a suitable debridement along with implant replacement or exchange, contingent on the biofilm's age and the state of the soft tissue. A protracted biofilm-active therapy is a component of antimicrobial treatment, usually lasting 4–12 weeks. This idea is appealing because it allows implants to be changed or kept in place for a single surgical procedure in a subset of patients. This not only enhances quality of life but also lowers morbidity because each additional neurosurgical procedure increases the risk of secondary complications like intracerebral bleeding or ischemia.
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