This study aimed to identify and validate risk factors for suicidal ideation (SI) and non-suicidal self-injury (NSSI) among nursing staff through the development and application of a risk model and nomogram.

A cross-sectional online survey was conducted in Dehong District to collect relevant data.

A total of 1774 Chinese nursing staff members were enrolled in this study.

Multiple factors were independently associated with SI among nursing staff. These included divorce or other non-marital status (OR=2.42, 95% CI 1.07 to 5.44), drinking frequency (OR=1.34, 95% CI 1.001 to 1.79), loneliness (OR=1.26, 95% CI 1.11 to 1.44), depressive symptoms (OR=1.13, 95% CI 1.09 to 1.18), childhood trauma (OR=1.03, 95% CI 1.02 to 1.05) and life quality satisfaction (OR=0.63, 95% CI 0.49 to 0.80). Similarly, for NSSI among nursing staff, independent risk factors were identified, such as smoking frequency (OR=1.37, 95% CI 1.01 to 1.85), drinking frequency (OR=1.42, 95% CI 1.05 to 1.91), loneliness (OR=1.21, 95% CI 1.05 to 1.39), depressive symptoms (OR=1.13, 95% CI 1.09 to 1.18) and childhood trauma (OR=1.03, 95% CI 1.01 to 1.05). A nomogram for assessing SI/NSSI was established and demonstrated good calibration, with a Concordance Index of 0.82 (95% CI 0.79 to 0.86) for SI and 0.81 (95% CI 0.78 to 0.85) for NSSI.

The findings of this study can be used to identify nursing staff at risk of developing SI/NSSI. By using the developed nomograms for self-assessment, individuals might gain a better understanding of their occupational stress levels while performing routine work tasks. However, it should be noted that the study lacks external validation, which limits the generalisability of the findings at this stage.

Dysregulated immunity may account for an increased risk of infection and other adverse outcomes among frail hospitalised persons. The primary objective of this study is to examine whether baseline frailty is associated with the risk of developing ventilator-associated pneumonia (VAP) or other intensive care unit (ICU)-acquired infections among invasively ventilated adults. Additional objectives are to examine the relationship between frailty and hospital length of stay, discharge to a long-term care facility and vital status. We hypothesise that persons with frailty compared with others would have an increased risk of VAP and other infections, a longer hospital stay, higher probability of discharge to a long-term care facility and higher mortality.

This is a preplanned secondary analysis of the PROSPECT trial (Probiotics to Prevent Severe Pneumonia and Endotracheal Colonization Trial) which enrolled patients across 44 ICUs in three countries. We will use Cox proportional hazards regression analysis to assess the association of frailty with the clinical outcomes of interest, adjusting for other baseline variables. Baseline demographic and descriptive outcome data will be reported using descriptive statistics. Regression results will be presented as adjusted HRs or ORs with 95% CIs for the associations of each independent variable with the primary, secondary and tertiary outcomes.

Participating hospital research ethics board approved the PROSPECT trial and data collection. The protocol for this study was approved by the Hamilton Integrated Research Ethics Board on 20 August 2015 (Project ID:19128). This study will identify whether frailty is associated with risk of VAP and other healthcare-associated infections in invasively ventilated patients, adjusted for other baseline factors. Results may be useful to patients, their caregivers, clinicians and the design of future research. Findings will be disseminated to investigators at a meeting of the Canadian Critical Care Trials Group. We will present study results at an international conference in the fields of critical care and infectious diseases, to coincide with or precede open-access peer-review publication. To aid knowledge dissemination, we will use a variety of formats. For example, for traditional and social media, we will create two different visual abstracts and infographics of our results suitable to share on clinician-facing and public-facing platforms.

NCT02462590.

To identify challenges in stroke care services and stakeholders’ expectations for the role of stroke advanced practice nurses (APNs) in the neurology department of a tertiary hospital in ainland China.

A field study using participatory observation and in-depth interviews.

The neurology department of a tertiary hospital in Sichuan Province, China.

The principal researcher conducted participant observation in the capacity of a clinical nurse. In-depth individual interviews were conducted within 7 stroke patients and their carers, 4 doctors and 10 nurses.

Key challenges included a shortage of specialised professionals, imprecise, untimely and discontinuous care, poor medical–nursing collaboration, limited nursing expertise and unmet patient needs. Stakeholders expected stroke APNs to fulfil six roles: stroke care expert, advanced clinical practitioner, collaborative coordinator, specialist care innovator, specialised educator and role model.

Stroke APNs should provide precise, timely and continuous care for patients while enhancing team cohesion, overall competence and service quality.

To examine (1) the mediating roles of self-efficacy and future-oriented time perspective (FTP) in the association between workplace culture of health (COH) and diabetes self-management and (2) the moderating effect of diabetes distress on the relationship between self-efficacy and FTP among employees with type 2 diabetes mellitus (T2DM).

A cross-sectional survey.

This study was conducted among employees with T2DM recruited from the Endocrinology Outpatient Departments at three tertiary hospitals in Taiyuan City, Shanxi Province, China, between March and October 2024.

The participants were 462 employees with T2DM who had been employed at their current organisations for at least 3 months following their T2DM diagnosis.

Data on demographics, diabetes-related and work-related factors, workplace COH, self-efficacy, time perspective, diabetes distress and self-management performance were collected via a survey. The moderated mediation effects were examined using Hayes’s PROCESS macro.

Workplace COH was associated with diabetes self-management both directly (β=0.251, 95% CI 0.080 to 0.422, p self-efficacy -> diabetes self-management (indirect effect=0.207, 95% CI 0.110 to 0.308); (2) workplace COH -> self-efficacy -> FTP -> diabetes self-management (indirect effect=0.093, 95% CI 0.051 to 0.144). However, the indirect pathway: workplace COH -> FTP -> diabetes self-management was not significant (indirect effect=0.004, 95% CI –0.055 to 0.063). Additionally, a significant interaction (β=–0.356, 95% CI –0.566 to –0.146, p

This study demonstrated that workplace COH was associated with diabetes self-management both directly and indirectly, specifically through self-efficacy alone and serially through self-efficacy and FTP; it also confirmed that diabetes distress weakens the effect of self-efficacy on FTP, thereby providing a basis for developing interventions to improve self-management among employees with T2DM.

This scoping review synthesises the application of patient journey mapping (PJM) in breast cancer care to provide insights for enhancing patient-centred services and improving the quality of life for patients with breast cancer.

Scoping review.

Web of Science, PubMed, Cochrane Library, CINAHL, Embase, CNKI, Wanfang and SinoMed were systematically searched for relevant studies published between 1 May 2005 and 1 May 2024.

Studies involving adults (≥18 years) with breast cancer that examined patient journeys were eligible, regardless of whether a formal PJM approach was used. All study designs in healthcare or community settings were considered. Exclusions included studies on other cancers, duplicates, inaccessible full texts, non-English/Chinese publications and non-original articles.

Two reviewers independently screened and extracted data, with a third resolving discrepancies. Information on study characteristics, methods and PJM applications was narratively synthesised and tabulated.

A total of 20 studies published from 2011 to 2024 were included. Four primary approaches to PJM in breast cancer care were identified, with cancer care stage mapping being the most prevalent. PJM illustrated patients’ trajectories, experiences and emotions, revealed critical interaction points such as diagnosis, decision-making and follow-up, and highlighted delays, coordination gaps and opportunities for service improvement. Most studies incorporated four core elements—patients, touchpoints, timelines and experiences—and emphasised patient perspectives across the care continuum, despite methodological heterogeneity.

This review shows that PJM has been applied to illustrate longitudinal healthcare experiences, identifies key touchpoints and supports the design and improvement of breast cancer care services. Most studies underscored patient perspectives and emotional needs, but current PJM applications remain fragmented, hospital-focused and weakly integrated across care settings and families. Future research should refine methodologies and apply digital technologies to develop personalised, dynamic maps that may enhance patient-centred care.

Postoperative cardiac injury, encompassing myocardial infarction (MI) and myocardial injury after non-cardiac surgery (MINS), is a major perioperative complication associated with substantial morbidity and mortality. While numerous prediction models have been developed using traditional statistical and machine learning approaches, their comparative performance, calibration quality and methodological rigour remain unclear. This protocol outlines a systematic review and meta-analysis to comprehensively evaluate multivariable risk prediction models for postoperative cardiac injury in adults undergoing non-cardiac surgery.

Following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines, this PROSPERO-registered systematic review will search PubMed, Embase, Web of Science, Cochrane Library, Scopus, grey literature and trial registries for studies developing, validating or updating multivariable prediction models for postoperative cardiac injury (MI or MINS) occurring within 72 hours of non-cardiac surgery. Two reviewers will independently extract data and assess quality using CHARMS (Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) and PROBAST (Prediction Model Risk of Bias Assessment Tool) tools. The primary outcome is discriminative performance (area under the receiver operating characteristic curve), with calibration metrics and diagnostic accuracy measures as secondary outcomes. Random-effects meta-analyses will pool performance estimates for models validated in multiple cohorts. Heterogeneity will be explored through subgroup analyses and meta-regression, examining factors including model methodology (regression-based vs machine learning), predictor types and validation contexts. Sensitivity analyses will test the robustness of findings.

Ethical approval is not required for this study, as it is a systematic review and meta-analysis based on previously published data.

CRD420251041628.

To investigate the nutritional status and its influencing factors in elderly patients aged 60 years and above with malignant tumours.

A retrospective observational study.

The First Affiliated Hospital of Chengdu Medical College, a tertiary care hospital in Chengdu, China.

A total of 450 elderly patients with cancer (aged ≥60 years) admitted between January 1, 2022, and January 1, 2023. Patients were selected based on their clinical records, excluding those with communication disorders, mental illness or incomplete data.

Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Participants were categorised based on the presence or absence of malnutrition. Multivariate logistic regression was used to identify independent risk factors for malnutrition.

Of the 450 patients included, 63.7% were male and 36.3% female, with a median age of 69 years. The prevalence of severe malnutrition was 46.4%. Univariate analysis showed significant associations between malnutrition and factors such as older age (p

Malnutrition is highly prevalent in elderly patients with cancer and is significantly associated with age, BMI, albumin levels and self-care ability. Early identification and targeted nutritional interventions may improve outcomes and quality of life in this population.

To evaluate the association between the stress hyperglycaemia ratio (SHR) and baseline stroke severity in patients with acute ischaemic stroke (AIS) and to investigate whether the relationship is non-linear.

Retrospective cohort study.

A tertiary hospital in Zhejiang Province, China.

1479 consecutive AIS patients admitted within 24 hours of symptom onset between 2016 and 2022.

SHR was calculated as fasting plasma glucose (mmol/L) divided by glycated haemoglobin (HbA1c, %). Stroke severity was assessed by the NIH Stroke Scale (NIHSS) and categorised as mild (NIHSS ≤5) or moderate to severe (NIHSS >5). Associations between SHR and stroke severity were examined using multivariable logistic regression, generalised additive models and threshold effect analysis.

Patients with more severe strokes had significantly higher SHR values (median 0.99 vs 0.94; p

SHR is independently associated with greater stroke severity at admission. Values below 1.3 may reflect heightened metabolic stress and could help inform early risk stratification in AIS management, but their discriminative power is limited and should be interpreted in conjunction with other clinical indicators.

To understand current practices and identify barriers and facilitators to implementing guideline-recommended core osteoarthritis (OA) treatments in China.

An exploratory mixed-methods design

Public and private clinical institutions across mainland China.

A total of 498 healthcare professionals participated. The qualitative phase included semistructured interviews (n=15) and a qualitative survey (n=181). The quantitative phase consisted of a survey with 302 respondents across 19 provinces, representing seven health professions.

Five themes identified as barriers during the qualitative phase: misconceptions about OA; limitations in current medical insurance policies; insufficient multidisciplinary collaboration; lack of workplace support and low patient adherence to self-management. Three themes identified as facilitators: telehealth and community-based delivery pathways; professional training and patient education resources; and personalised services with positive feedback. Quantitative findings showed that physical agent therapy (56%) and traditional Chinese medicine (22%) were the most frequently used OA treatments, while exercise therapy was implemented in only 9% of cases. The average OA knowledge score was 31.2 (±8.9) out of 55, with the lowest self-rated confidence in interdisciplinary collaboration (3.4±0.1, ‘somewhat confident’). The most applicable factors impacting the implementation of core OA treatments included patient comorbidities, knowledge of pain science and exercise therapy, and financial support (all 2.8±0.8, ‘applicable’).

The uptake of core OA treatments in China remains suboptimal, constrained by limitations in insurance coverage, workforce capacity and interdisciplinary integration. Enhancing telehealth accessibility, strengthening professional training and refining policy incentives may help bridge this evidence-practice gap and improve OA management in China.

Diabetes is a significant modifiable risk factor for cognitive dysfunction. There are currently no effective treatments that delay or reverse the progression of cognitive dysfunction. Accumulating evidence demonstrates that specific antidiabetes medications hold promise in improving cognitive function. However, the comparative effects of various antidiabetic drug classes on cognitive protection remain to be fully elucidated. This study aims to investigate and compare the cognitive benefits of liraglutide, empagliflozin and linagliptin on achieving mild cognitive impairment (MCI) remission in individuals with type 2 diabetes (T2D).

The LIGHT-MCI trial is an investigator-initiated, multicentre, open-label, parallel-group, randomised, superiority trial involving T2D patients with MCI, consisting of a 48-week core study followed by an extension phase through to 76 weeks. A total of 396 participants will be randomly allocated 1:1:1 to receive liraglutide, empagliflozin or linagliptin treatment. The primary outcome measure is the efficacy difference of liraglutide, empagliflozin and linagliptin in achieving MCI remission in individuals with T2D. The key secondary outcome measures include changes in scores of general cognition and various cognitive subdomains (including processing speed, executive function, immediate memory, visuospatial construction ability, language, attention and delayed memory), basic and instrumental daily living ability, MRI-derived normalised measures of total brain volume, cerebral microstructures, cortical and nuclear volume, white matter hyperintensity, volume, white matter microstructural integrity, odour-induced brain activation and resting-state functional connectivity, olfactory function and metabolic parameters.

The LIGHT-MCI trial has received approval from the Ethics Committees of the Drum Tower Hospital Affiliated to Nanjing University Medical School (2022-092-02) and other participating centres in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonisation for Good Clinical Practice (ICH GCP E6). Informed consent is required for participation. Findings from this trial are disseminated through peer-reviewed publications, conference presentations, newsletters and social media.

NCT05313529.

To analyse the trends and differences of metabolic risks related non-communicable diseases (NCDs) globally and across various sociodemographic index (SDI) regions from 1990 to 2021.

Observational study.

The data of global and all SDI regions were obtained from the Global Burden of Disease Study 2021 database.

Age-standardised deaths rate and disability-adjusted life-years (DALYs) percentage of NCDs attributable to metabolic risk were analysed worldwide and across SDI regions from 1990 to 2021. Besides, we analysed the regional trends of metabolic risk summary exposure value (SEV). A detailed analysis of the specific disease burden of various body systems caused by metabolic risks was also provided.

From 1990 to 2021, all regions showed increased SEV for metabolic risks, with the most notable growth in middle (total change: +84.8%, 95% uncertainty intervals (95% UI) 72.6% to 96.0%) and low-middle SDI regions (+84.5%, 95% UI 70.5% to 95.5%). While high SDI regions had the highest SEV (29.916 in 2021, 95% UI 26.968 to 32.237), they experienced significant reductions in mortality (–49.6%, 95% UI –53.5% to –46.2%) attributable to metabolic risks. DALYs associated with metabolic risks, particularly high body mass index (HBMI), increased notably, especially in less-developed regions (DALYs of NCDs due to HBMI in low-middle SDI regions: +99.9%, 95% UI 76.4% to 114.5%). In these areas, notable DALY rises were observed for conditions including cardiovascular diseases, digestive diseases and particularly metabolic risk-related cancers (>80.0%), reflecting a distinctive shift in the distribution of NCD burdens related to metabolic risks.

The rising metabolic risk exposure and associated NCD burden, particularly in less developed regions, underscores the need for targeted public health interventions to mitigate these growing health challenges.