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Death preparedness is an important prerequisite for improving the quality of life and the quality of death in advanced cancer patients. However, research on the level of death preparedness in patients is insufficient, and there is little understanding of the current status and influencing factors of death preparedness in advanced cancer patients.
This study aims to assess the current status of death preparedness and its influencing factors in advanced cancer patients.
Based on the PRECEDE-PROCEED model, a structured survey questionnaire was designed to collect data on personal factors (such as gender, age and residence area), interpersonal factors (such as social support, caregiver readiness and healthcare worker readiness) and social factors (such as care resources, policy support and information supply). Through multiple linear regression and BP neural network analysis, the study explores the impact and significance of these influencing factors on death preparedness in advanced cancer patients.
A total of 930 valid questionnaires were collected in this study. The death preparedness score in advanced cancer patients was 72.18 ± 22.82, indicating a moderate level, with the highest score being the ‘reflexive care’ dimension and the lowest score being the ‘hospice programme’ dimension. Multivariate analysis revealed that meaning in life and social support were the most significant predictors of death preparedness in advanced cancer patients. In addition, personal factors such as dignity, household income and coping style, also played an important role. Interpersonal factors like social support, as well as social factors such as care resources and policy support, also had an impact on patients' death preparedness to some extent.
Death preparedness in advanced cancer patients is generally at a moderate level, and death preparedness is influenced by a combination of personal factors, interpersonal factors and social factors.
This study is based on the PRECEDE-PROCEED model to comprehensively explore the influencing factors of death preparedness in advanced cancer patients. It provides theoretical support for improving life services for advanced cancer patients. It offers valuable practical experience and insights for societal attention and reform in end-of-life care.
No Patient or Public Contributions were included in this paper.
Obtaining clean-catch urine (CCU) samples from non-continent infants is a common clinical challenge due to low urine volume and irregular urination. Non-invasive stimulation techniques, such as the bladder stimulation technique (BST) and the Quick-Wee method, have been proposed to improve success rates and reduce contamination. However, the supporting evidence remains inconsistent, and no multicentre randomised trials have directly compared the effectiveness and safety of Quick-Wee, BST and standard CCU.
The study will enrol 342 infants aged 1–12 months requiring urinalysis, recruited from paediatric wards across three tertiary hospitals in China. Eligible participants will be randomly assigned in a 1:1:1 ratio to one of three intervention groups: BST, Quick-Wee or standard CCU. The primary endpoint is the success rate of urine collection within 5 min of intervention. Secondary endpoints include time to urination, 5 min urination rate, infant discomfort scores, parental and clinician satisfaction, and urine contamination rates. Safety will be evaluated by monitoring the incidence of adverse events.
This study was approved by the Biomedical Ethics Review Committee of West China Hospital, Sichuan University (No. 114/2025). Written informed consent will be obtained from all participants’ parents prior to enrolment. Study findings will be published in peer-reviewed journals and presented at relevant conferences. Individual participant data will be kept strictly confidential and securely stored in compliance with data protection regulations.
ChiCTR2500098691.
To investigate diabetes family involvement, including supportive and nonsupportive family behaviours in China, and explore the relationships among opposite forms of family involvement, diabetes self-management and glycaemic control.
A cross-sectional study.
Type 2 diabetes patients were recruited from hospitals in Nanjing, Shanghai and Jinan, and communities across China, between April 2023 and August 2023. A total of 1648 patients completed questionnaires regarding diabetes family involvement, diabetes self-management, perceived glycaemic control and patient characteristics. Data analysis was conducted using SPSS 26.0 and PROCESS macro.
The mean scores for supportive and nonsupportive family behaviours were 19.14 out of 40 and 12.47 out of 30, respectively, resulting in an overall family involvement score of 6.67. Overall family involvement, especially supportive family behaviours, was positively related to diabetes self-management and perceived glycaemic control, whereas nonsupportive family behaviours were not. Diabetes self-management partially mediated the relationships between both overall family involvement and supportive family behaviours with perceived glycaemic control.
Diabetes family involvement was suboptimal. Overall family involvement, especially supportive family behaviours, could not only directly improve glycaemic control but also indirectly enhance it through promoting diabetes self-management.
The findings highlight the importance of promoting supportive family involvement and patient self-management in diabetes management.
This study endorses the necessity for healthcare professionals to integrate the family unit into diabetes management and implement interventions at the family unit level, to address the neglect of families in current interventions. It also advocates for promoting supportive family involvement rather than all family involvement in future interventions. Promoting supportive family involvement and patient self-management can better improve patients' glycaemic control and alleviate the burden on medical and social systems.
This study adheres to the STROBE guideline of reporting.
No Patient or Public Contribution.
Coronary artery bypass grafting (CABG) is a technically demanding procedure where surgical skill directly influences outcomes. Traditional evaluation relies on expert subjective judgement, which is resource-intensive and lacks scalability. The emergence of computer vision and deep learning offers potential for objective, automated skill assessment. Prior research has explored phase recognition and gesture classification in surgery; however, few studies have applied AI-driven evaluation in high-stakes cardiac procedures. Therefore, the objective of this study is to develop and validate an artificial intelligence (AI)-based framework for the automated assessment of surgical technical skills in CABG using real-world surgical videos, benchmarked against expert ratings.
This study is a prospective, single-centre observational study conducted in a high-volume surgical hospital. Eligible participants are adult patients undergoing elective CABG with complete intraoperative video data. Videos are analysed using a hybrid AI pipeline to generate scores based on visual impression and tool trajectory accuracy. The primary outcome is the feasibility of AI annotation, that is, the intraclass correlation coefficient value of AI predicted score and human rating data. Secondary outcomes include the consistency between AI and expert skill assessments, analysis of surgical instrument trajectories and the correlation of AI-derived skill scores with intraoperative graft flow and resistance. Exploratory outcomes aim to correlate surgical skill with graft patency at 1 year and major adverse cardiovascular events within 6 months and 12 months postoperatively.
The Ethics Committee in Fuwai hospital approved this study (2024-2563). The results of the study will be submitted for publication in a peer-reviewed journal.
To examine the relationship among leadership, clinical teaching competencies, and structural empowerment of nursing clinical instructors in China.
A cross-sectional study.
A total of 152 nurses who come from three Grade A tertiary hospitals located in Beijing, Kunming, and Liaoning Province, China, completed an online questionnaire that included general information, clinical teaching information, the Conditions of Work Effectiveness Questionnaire-II, nurse leadership, and structural empowerment. SPSS 26.0 and AMOS 26.0 were used for normality test, descriptive statistics, correlation analysis, regression analysis, and structural equation model.
The study revealed that nurse leadership (r = 0.402) and structural empowerment (r = 0.568) both positively correlated with clinical teaching competencies. Specifically, the level of nurse leadership exhibited a low but direct positive effect on these competencies (β = 0.22), while the level of structural empowerment demonstrated a moderate direct positive effect (β = 0.56).
Enhancing nurse leadership and structural empowerment positively influence the clinical teaching competencies of nursing instructors.
Constructing a structural equation model to describe the relationship between leadership, structural empowerment, and teaching ability can provide the most intuitive direction for future research, so as to better improve the teaching ability of clinical nursing teachers.
No patient or public contribution.
The aim of this study was to innovatively utilise the BERTopic model for topic modelling in order to comprehensively identify and understand the factors contributing to bed falls.
Retrospective study.
The study collected 241 reports of bed fall accidents recorded by nurses from Peking University Third Hospital Nursing Department from 2014 to 2024. Among them, 102 reports met the inclusion and exclusion criteria.
This study follows the Minimum Information for Medical AI Reporting (MINIMAR). It collected patient bed fall reports from Peking University Third Hospital between 2014 and June 2024, preprocessed the texts, utilised the BERTopic library in Python for topic modelling, and manually aggregated secondary topics by combining visualisation results and professional knowledge.
We utilised cluster bar charts to visually display the distribution of the 22 secondary topics and further consolidated them into five core topics through the use of a topic distribution diagram and a topic similarity matrix diagram. These topics were related to patient factors, ward equipment and surroundings factors, medication risk factors, caregiver factors, and nursing practice factors. The study highlights the environment's specificity in bed falls, especially bedside safety and patient-bed rail interaction.
The innovation of this study lies in the successful utilisation of BERTopic technology to identify topics of risk factors for bed falls through alternative data sources, providing a scientific basis for formulating preventive measures. The findings aim to optimise nursing processes, improve ward environments and enhance educational training, ultimately reducing patient bed falls and enhancing medical safety, nursing quality and patient experience.
This study not only helps nurses identify risk factors for patient bed falls, but also provides important guidance for developing effective prevention strategies.
No patient or public contribution applied.
Stroke survivors frequently experience multiple co-occurring symptoms that cluster together, significantly affecting their quality of life and rehabilitation outcomes. However, previous research has predominantly focused on individual symptoms in isolation, limiting the potential to inform more comprehensive, symptom cluster-based approaches to post-stroke care.
This scoping review aimed to synthesize existing evidence on the assessment tools used to evaluate them, the analytical techniques employed to identify them, and the composition of symptom clusters in people with stroke.
A comprehensive literature search was conducted across seven databases (PubMed, EMBASE, APA PsycInfo, CINAHL, Web of Science, China National Knowledge Infrastructure, and Wanfang) for studies published between 2001 and April 2025. Methodological quality was assessed using the JBI Critical Appraisal Checklists. Data were extracted on study characteristics, measurement instruments, analytical techniques, and symptom cluster composition.
Fourteen studies comprising 6556 stroke patients were included. A total of 11 assessment tools and six analytical techniques were identified, with exploratory factor analysis being the most commonly used. Seven common symptom clusters were synthesized: pain and fatigue, somatic movement dysfunction, cognitive impairment, affective disturbance, mood and sleep dysregulation, psychological distress, and gastrointestinal symptoms. The most frequently reported symptom cluster was pain and fatigue. Considerable heterogeneity was found across studies in terms of measurement instruments, analytical techniques, and symptom cluster composition.
This review highlights the methodological inconsistencies and diversity in symptom cluster research in stroke populations. The findings underscore the need for standardized, culturally adaptable assessment tools and longitudinal designs to capture the dynamic nature of symptom clusters. This comprehensive review summarizes common symptom clusters in stroke patients and provides clinicians and researchers with valuable insights to help them develop more effective symptom management strategies and ultimately improve patient outcomes.
PROSPERO: CRD420251069463
Postoperative sore throat and hoarseness are common complications following lung isolation with double-lumen tubes (DLTs) in video-assisted thoracoscopic surgery (VATS). Laryngeal mask airway (LMA) combined with a visual bronchial blocker (VBB) may reduce airway trauma while maintaining effective lung isolation.
This is a prospective, randomised, controlled, single-blind, multicentre clinical trial conducted at three major thoracic surgery centres in Shanghai, China. A total of 270 patients aged ≥18 years scheduled for elective VATS anatomical lung resection will be randomly allocated 1:1 to either the VBB group (n=135) using LMA combined with VBB or the DLT group (n=135) using conventional DLT (see Consolidated Standards of Reporting Trials diagram). The primary outcome is the incidence of sore throat and hoarseness at 24 hours postoperatively. Secondary outcomes include sore throat and hoarseness at 1 and 48 hours, intraoperative device performance, lung collapse quality, intubation time, haemodynamic changes, emergence quality, device-related complications and hospital length of stay.
The study protocol was approved by the Ethics Committee of Shanghai Chest Hospital (KS24042). Results will be disseminated through peer-reviewed publications and conference presentations.
ClinicalTrials.gov (NCT07117539).
by Jianhua Liao, Jun Cheng, Baoqing Liu, Yuzhi Shao, Chunyan Meng
The growing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections, coupled with the increasing resistance to existing antibiotics, underscores the critical need for novel therapeutic approaches to combat this pathogen. In this study, the role of yqhG, a conserved gene encoding a periplasmic protein, in MRSA virulence and stress adaptation was investigated. yqhG deletion in MRSA significantly attenuated virulence in a murine infection model, leading to reduced bacterial burden in infected organs and improved host survival. In vitro, the yqhG mutant exhibited impaired membrane integrity, reduced motility, and increased sensitivity to oxidative stress, but did not affect biofilm formation. These defects were fully restored upon genetic complementation. These findings highlight the critical role of yqhG in maintaining MRSA’s ability to withstand host-imposed stresses, suggesting that yqhG is a key determinant of MRSA pathogenesis. The study provides new insights into the stress-defense mechanisms employed by MRSA and underscores yqhG as a potential target for therapeutic strategies aimed at combating MRSA infections.To investigate the status of social isolation among middle-aged and elderly breast cancer patients and identify its influencing factors. Additionally, to explore the mediating role of self-perception of aging between frailty and social isolation, as well as the moderating effect of menopausal symptoms.
A cross-sectional study guided by the Strengthening the Reporting of Observational Studies in Epidemiology.
This study was conducted on middle-aged and elderly breast cancer patients from September 2022 to February 2023 in Guangzhou, China. Related data were assessed by structural questionnaires. Correlation analysis and regression analysis were performed by SPSS 26.0 while PROCESS macro v4.0 was used to test the moderated mediation model.
Breast cancer patients aged 45–82 years experienced moderate social isolation. It was influenced by educational level, residence, menopause symptoms, self-perception of aging, and frailty. The moderated mediation model involving self-perception of aging and menopausal symptoms for explaining how frailty causes social isolation was supported. The mediating role of self-perception of aging gradually strengthens as menopausal symptoms become severe.
Social isolation resulting from frailty in middle-aged and elderly breast cancer patients is mediated by self-perception of aging, with menopausal symptoms amplifying this effect. Interventions focused on improving self-perception of aging and managing menopausal symptoms may help reduce social isolation by mitigating the impact of frailty.
This study highlights the importance of addressing frailty, self-perception of aging, and menopausal symptoms in clinical nursing practice, which may help reduce social isolation among breast cancer patients.
Patients contributed by completing the questionnaire, ensuring the accuracy and completeness of the information with assistance from the research team.
Postoperative ileus (POI) is a common complication after abdominal surgery that significantly delays recovery. Evidence suggests that the general anaesthetic propofol inhibits gastrointestinal motility, potentially contributing to POI. Ciprofol, a newer general anaesthetic characterised by the addition of a cyclopropyl group to the propofol structure, has uncertain effects on gastrointestinal recovery. This randomised trial aimed to evaluate the effect of ciprofol compared with propofol on gastrointestinal function in patients undergoing laparoscopic colorectal cancer resection.
This prospective, single-centre, single-blinded, randomised controlled trial will enrol patients aged 18–65 years undergoing laparoscopic radical resection for colorectal cancer. A total of 176 participants will be randomly assigned to either the ciprofol group (experimental) or the propofol group (control), with 88 patients in each arm. General anaesthesia will be induced and maintained with ciprofol in the experimental group or propofol in the control group. The primary outcome is the time to first postoperative flatus. Secondary outcomes include key parameters associated with enhanced recovery after surgery. Patients will be followed at baseline and every 24 hours postoperatively.
The study protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Xi’an Jiaotong University (XJTUAF2024LSYY-415–03). Results will be published in peer-reviewed journals and presented at scientific conferences.
ChiCTR2400093434.
Although previous studies have examined the psychological benefits of physical activity in cancer survivors, the underlying psychological mechanisms among lung cancer survivors remain poorly understood. This study aims to examine the parallel mediating roles of social connection and self-efficacy in stress coping in the association between physical activity and psychological distress (anxiety and depression) among Chinese lung cancer survivors.
A cross-sectional observational study.
A tertiary care hospital in Shanghai, China.
A total of 588 lung cancer survivors were recruited and assessed physical activity, anxiety, depression, social connection and self-efficacy in stress coping. Path analysis was conducted to examine the parallel mediating effects of social connection and self-efficacy in stress coping in the association between physical activity and psychological distress (anxiety and depression).
The primary outcome was the examination of the mediating effects of social connection and self-efficacy in stress coping on the relationship between physical activity and psychological distress, assessed using path analysis.
Social connection (p=0.003 for anxiety; p
These findings suggest that social connection and self-efficacy in stress coping may serve as critical psychological mechanisms underlying the association between physical activity and emotional well-being among Chinese lung cancer survivors. Interventions targeting anxiety and depression in lung cancer survivors may benefit from integrating strategies to enhance physical activity while promoting social connection and self-efficacy in coping to optimise psychological outcomes.
To clarify the concept of life space in community-dwelling older adults to provide a clear and standardised conceptual basis for further research.
Rogers' evolutionary approach was used to identify surrogate terms, related terms, attributes, antecedents and consequences.
Literature from 1936 to 2025 was searched from PubMed, CINAHL, ProQuest, Cochrane databases, Scopus, Web of Science and CNKI.
A total of 46 articles were included for further analysis and synthesis. The attributes of life space in community-dwelling older adults were dynamic variability, multidimensionality and interaction between intrinsic abilities and external environmental demands. Antecedents were classified into four categories, namely, individual, physical, psychological and social factors. Life space can bring positive consequences, promoting walking, assessing the risk of falling, predicting cognitive decline, facilitating rehabilitation and improving quality of life, as well as negative consequences, causing diminished subjective well-being, heightened loneliness, increased risks of hospital readmission and mortality.
Life space, as a spatial indicator of a person's range of mobility, reflects older adults' physical range of motion, the frequency of activity, their need for assistance and the level of social participation. Older adults with adequate life space in the community are more likely to engage in outdoor activities. In contrast, restricted life space can lead to adverse outcomes.
Surrogate terms, related terms, attributes, antecedents and consequences identified by the concept analysis approach will contribute to a greater understanding of life space. These analytical findings establish an essential conceptual framework for future research while offering evidence-based theoretical guidance to improve life space in community-dwelling older adults, ultimately enhancing health outcomes and quality of life.
No patient or public contribution.
To develop a CERT SCORE utilising both odd-chain and even-chain ceramide species, and to evaluate its association with short-term and lifetime cardiovascular risk in patients with coronary atherosclerotic heart disease (CAD).
Prospective cohort study.
A patients-based cohort in the Beijing Anzhen Hospital, Capital Medical University.
CAD patients were defined as having at least one coronary artery stenosis of ≥50% as assessed by coronary angiography or CT angiography.
Major adverse cardiac events (MACE) including all-cause death, myocardial infarction, heart failure, cerebral infarction and readmission.
We quantified 13 ceramide species and calculated the ratios of Cer(d18:1/14:0) and Cer(d18:1/24:0). Based on these measurements, Cer(d18:1/19:0), Cer(d18:1/19:0)/Cer(d18:1/14:0), Cer(d18:1/19:0)/Cer(d18:1/24:0) and Cer(d18:1/21:0)/Cer(d18:1/24:0) were selected to construct the CERT SCORE. Using this score, patients were classified into two distinct risk categories for MACE: low-risk (score 0–6) and high-risk (score 7–12). The high-risk group exhibited a significantly higher short-term risk of MACE (HR 2.10; 95% CI 1.50 to 2.94) compared with the low-risk group. The cumulative MACE risk in the low- and high-risk groups during the 1000-day follow-up was 25.45% and 44%, respectively. Subgroup analyses revealed that the presence of multivessel coronary artery lesions did not significantly modify the association between the CERT SCORE and short-term MACE risk (p value for interaction=0.967). Furthermore, in the age groups of 41–50 years, 51–60 years and 61–70 years, lifetime risk was significantly elevated in the high-risk group compared with the low-risk group.
We have developed a ceramide-based risk stratification tool (CERT SCORE) that demonstrates robust predictive value for identifying high-risk MACE patients among CAD patients. This tool offers considerable clinical utility for guiding patient management and informing therapeutic decisions.
FreshRSS 