This study aimed to systematically synthesise and analyse nurses’ experiences in implementing clinical nursing research (CNR) to inform administrators and researchers involved in CNR.

Qualitative meta-synthesis.

The following six databases were searched: PubMed, Cochrane Library, Web of Science, CINAHL (EBSCO), PsycINFO (EBSCO) and Embase. The search period included material published up to December 2024.

We included qualitative studies exploring perspectives, experiences and other similar factors. JBI Critical Appraisal Tool (2024 edition) was used to evaluate the quality of included studies.

Two reviewers independently conducted the literature search, study selection and data coding. Using principles of similarity and integration, findings from the included studies were grouped into general categories. A final synthesis was produced through analysis of the relationship between categories.

11 studies were included, from which four themes were identified: feelings and motivations prior to participation in CNR; understanding the role of the clinical nursing researcher; factors hindering CNR implementation; and expectations for CNR development. These themes comprised 12 sub-themes.

This review highlights nurses’ experience in implementing CNR. Strengthening motivation and clarifying the roles and responsibilities associated with CNR may facilitate the translation of research findings into clinical practice. In parallel, healthcare administrators should foster a supportive CNR culture and provide resources to address barriers to implementation.

CRD42025631159.

Acute pain following pulmonary surgery can affect the recovery process of patients. The use of intrathecal morphine (ITM) injections offers a long-lasting analgesic effect, but its clinical application remains controversial. This study aims to investigate the impact of combining bupivacaine with ITM injections on the quality of postoperative recovery in patients who have undergone pulmonary surgery.

This multicentre, randomised, double-blind, controlled trial will enrol 254 patients undergoing elective lung surgery, who will be randomly assigned in a 1:1 ratio to either group IT (receiving an intrathecal injection of 3 mg bupivacaine and 0.25 mg morphine before general anaesthesia induction) or the control group (C group). The primary outcome includes postoperative recovery quality on day 1 (quality of recovery, QoR-15), with secondary outcomes encompassing postoperative recovery quality on days 2 and 3 (QoR-15), pain scores within 72 hours postoperatively, analgesic rescue, intraoperative haemodynamic parameters, opioid consumption, postoperative adverse reactions, recovery metrics, complications, chronic pain incidence and sleep quality.

The results will be disseminated through peer-reviewed publications. This study protocol (V.2.0, 30 October 2024) involves human participants and has been approved by the Ethics Committee of Affiliated Hospital of Yangzhou University (number 2024-08-02-2), Taicang Hospital Affiliated to Soochow University (number 2025 SR-041) and Yichang Central People’s Hospital (number 2024-513-02). Each individual who agrees to participate in the research will provide written informed consent after the objectives and procedures of this study are explained to them.

ChiCTR2400092935. Registered on 26 November 2024.

To assess the level of knowledge, attitudes and practices (KAP) among patients with type 2 diabetes mellitus (T2DM) regarding cardiovascular risk factors (CVRF) and diabetes-related complications in two hospitals in the West Region of Cameroon during the COVID-19 pandemic.

This was a prospective cross-sectional study conducted over 5 months from April to September 2022.

This study was conducted in two tertiary hospitals in the West Region of Cameroon, in Central Africa.

It included all patients with T2DM receiving care at these two hospitals, having agreed to participate and followed up in both hospitals for at least 3 months.

Sociodemographic, clinical and treatment data were collected using a data sheet, and KAP scores were based on the Essi and Njoya framework. Data collection and analysis were performed using SPSS V.23.0 software. Logistic regression was used to identify the factors associated with unacceptable KAP (p

A total of 140 participants (71 women) with an average age of 63 years and an average diabetes duration of 6.14±5.7 years were included. Most (55%) were managed by general practitioners. The main CVRFs identified were hypertension (11%) and overweight (6%), while the leading complications included visual disorders (10.7%), hypoglycaemia (6.4%) and erectile dysfunction (2.1%). Knowledge was good in 34.3% of participants, only 25.7% demonstrated correct attitudes, and merely 15.7% engaged in adequate practices. Unacceptable knowledge was associated with diabetes duration between 3 months and 5 years (OR: 0.34 (95% CI 0.14 to 0.85), p=0.021), follow-up by a specialist (OR: 0.31 (95% CI 0.13 to 0.74), p=0.009), the presence of at least one CVRF (OR: 0.03 (95% CI 0.00 to 0.23), p

Few people with T2DM presented good knowledge, right attitudes and adequate practices. Enhanced patient education and increasing specialist numbers are essential to promote self-management of the condition and to decrease the incidence of complications and mortality.

The hyperactivity of the sympathetic nervous system after a traumatic event contributes to the development of post-traumatic stress disorder (PTSD). Polarised light stellate ganglion irradiation (PLSGI) is a non-invasive and effective physiotherapy method for regulating the sympathetic nervous system. This study aims to investigate the effects of perioperative PLSGI on PTSD and pain-related outcomes in patients undergoing emergency surgery.

This multicentre, randomised, double-blind, controlled trial will include 510 adult patients scheduled for emergency trauma surgery. Patients will be randomly assigned in a 1:1 ratio, stratified by anaesthesia type (propofol general anaesthesia or other anaesthesia), to either the PLSGI group or the control group. The PLSGI group will receive perioperative PLSGI, while the control group will receive a sham PLSGI procedure. All patients will receive multimodal analgesia, consisting of intraoperative flurbiprofen axetil, ropivacaine infiltration at the end of surgery and postoperative patient-controlled sufentanil. The primary outcome is the incidence of PTSD 1 month postoperatively. Secondary outcomes include the severity of PTSD, delayed-onset PTSD, four symptom clusters (intrusive re-experiencing symptoms, avoidance symptoms, negative alterations in cognition or mood symptoms, and hyperarousal and reactivity symptoms), severity of dissociative symptoms, the amount of emergency postoperative analgesia, heart rate variability, sleep quality, anxiety, chronic pain, postoperative opioid use (sufentanil consumption) and need for rescue analgesia. Safety outcomes include hypotension, bradycardia, hypertension, tachycardia, interventions for haemodynamic events, malignant arrhythmias, hoarseness, localised allergy or burning pain, dyspnoea and coughing while drinking. All analyses will be conducted in the modified intention-to-treat population.

Ethical approval was obtained from the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20210129-2023040), the Ethics Committee of Suzhou Xiangcheng People’s Hospital (2023-KY-02) and the Ethics Committee of Xuzhou Renci Hospital (XZRCLL-KT-202302001). All patients will provide written informed consent. The results of this study will be published in a peer-reviewed journal.

ChiCTR2300070852.

The burden of chronic kidney disease (CKD) is increasing globally, with significant variations in disease levels and trends across different countries and regions. Currently, despite a wealth of research reporting data on adult and paediatric populations, there has been a lack of in-depth focus on the burden of CKD in adolescents and young adults (AYA). We aim to assess the global prevalence of CKD among AYA.

We implemented a cross-sectional study.

A systematic retrieval of data was conducted from the Global Burden of Disease (GBD) database, primarily using the most recent updated information from 2021.

We used GBD data and methodologies to characterise the changes in CKD burden among AYA, including incidence rates, death rates and disability-adjusted life years (DALYs). Additionally, we employed decomposition analysis, frontier analysis and health inequality analysis to investigate the prevalence of CKD in countries or regions with varying levels of socioeconomic development.

On a global scale, between 1990 and 2021, the number of AYA with CKD increased from 232025.4 (95% UI 153243.5–323838.5) in 1990 to 387070.1 (95% UI 287311.6–508428.3) in 2021. For AYA, the primary causes of CKD are other and unspecified causes (congenital anomalies of the kidney and urinary tract, etc), followed by glomerulonephritis. Over the past 30 years, the decline in CKD burden among AYA has been most significant in countries like China, Japan, South Korea, Spain, Portugal, Russia, France and Italy. In contrast, the countries or regions with the fastest-growing CKD burden are Somalia, Mozambique, Chad, Uganda, Niger and Angola in sub-Saharan Africa, followed by Afghanistan, Saudi Arabia, Yemen, Iraq and Pakistan in the Middle East or South Asia. Despite improvements over the decades, the burden of CKD among AYA remains concentrated in low-income countries and populations with poorer economic conditions.

From 1990 to 2021, the death and DALYs burden of CKD among AYA globally remained relatively stable, but the incidence rate is steadily increasing. AYA in sub-Saharan Africa, the Middle East and parts of South Asia tolerate the highest burden, particularly in countries with lower socioeconomic status. To prevent worsening inequalities associated with socioeconomic development, there is an emphasis on the importance of increasing investments in kidney health for AYA in low-income countries.

Neck pain is a common global health problem and a leading cause of disability, imposing significant personal and societal burdens. Musculoskeletal manipulations are recommended as the first-line treatment for neck pain in clinical practice guidelines, valued for their non-invasive and cost-effectiveness.

To determine the most effective musculoskeletal manipulation for neck pain by integrating both direct and indirect evidence through a network meta-analysis, enabling comparisons among interventions even in the absence of direct head-to-head evidence.

Systematic review and network meta-analysis.

Web of Science, the Cochrane Library, Embase, PubMed, Clinical Trials Registry, China National Knowledge Infrastructure, VIP Database and Wanfang Data were searched from January 2013 to May 2025.

Randomised controlled trials (RCTs) involving adults (aged ≥18 years) with neck pain receiving musculoskeletal manipulations.

Paired reviewers independently extracted data. The primary outcome was pain intensity, assessed using the visual analogue scale or numeric rating scale (with total scores of 10 or 100 points). Secondary outcomes included neck disability measured by the neck disability index (with total scores of 50 or 100 points), cervical range of motion (flexion and extension) measured in degrees using a universal goniometer and adverse events. All included studies were assessed for risk of bias using the RoB 2.0 tool and categorised as ‘low’, ‘some concerns’ or ‘high’. A frequentist random-effects network meta-analysis was conducted to calculate weighted mean differences with its 95% confidence intervals were calculated. Comparison-adjusted funnel plots were used to assess publication bias when 10 or more studies were included, and the Grading of Recommendations, Assessment, Development and Evaluations approach was applied for the quality of evidence.

A total of 101 RCTs involving 7633 participants were included. Overall, 62 (61.3%) had high risk of bias, 18 (17.8%) had some concerns and 21 (20.7%) had low risk of bias. Moderate to very low-certainty evidence showed significant reduction in neck pain intensity compared with no treatment: multimodal treatment (pooled weighted mean difference (WMD): –36.65, 95% CI –61.02 to –12.28), active control (pooled WMD: –36.62, 95% CI –62.67 to –10.57), manual therapy (pooled WMD: –35.85, 95% CI –59.86 to –11.83), soft tissue technique (pooled WMD: –28.72, 95% CI –51.65 to –4.79) and mobilisation (pooled WMD: –20.23, 95% CI –39.87 to –0.06), with multimodal treatment being the most effective intervention (surface under the cumulative ranking curve (SUCRA)=100%). No publication bias was detected for neck pain intensity. Moreover, multimodal treatment was the most effective for reducing neck disability (SUCRA=96.3%), whereas manipulation was the most effective for improving cervical range of flexion (SUCRA=81.3%) and extension (SUCRA=78.2%).

Multimodal treatment (the combined use of two or more musculoskeletal manipulations) is the most effective intervention for reducing both neck pain intensity and neck disability. Manipulation is the most effective for improving cervical range of motion.

Patients’ sense of gain experience (PSGE) is the comprehensive feeling throughout the treatment process, which is a critical benchmark for evaluating comprehensive medical and health system reform in China. This study aims to assess the current status of PSGE in public hospitals and identify important associated factors, providing evidence-based recommendations for improving healthcare services.

This was a cross-sectional study conducted from October to November 2023.

A total of 14 public hospitals in Foshan, Guangdong Province, China.

There were 3223 responses, including 1592 from outpatients and 1631 from inpatients.

PSGE was assessed across five domains: time accessibility, service accessibility, cost affordability, patient participation and efficacy predictability. Participants were also asked to provide an overall rating of the PSGE.

The overall score for PSGE was 4.47±0.53 (mean±SD), with service accessibility receiving the highest score (4.68±0.50) and affordability the lowest (4.17±0.86). Secondary hospitals scored an overall PSGE of 4.55±0.50, while tertiary hospitals scored 4.42±0.54. Key factors associated with PSGE were overall satisfaction (β=0.164, p

This study found that patients reported a positive PSGE with service accessibility but reported a less positive PSGE with cost affordability. A tier-based disparity was evident, with secondary hospitals outperforming tertiary hospitals in overall PSGE outcome. Stronger PSGE was positively associated with higher scores in overall satisfaction, treatment satisfaction, satisfaction with medical reforms, patient loyalty and hospital reputation. Demographic and institutional factors, such as hospital level, patient type and household registration, were associated with the PSGE. Efforts can be focused on enhancing clinicians’ willingness and competence in discussing treatment costs during clinical encounters. It is essential for policymakers to address disparities in healthcare experiences among patient groups across hospital tiers to advance equitable, patient-centred systems.

Colonoscopy is an essential procedure for the early diagnosis of colorectal conditions; however, over 60% of patients undergoing non-sedated colonoscopy report moderate to severe pain. This study aims to investigate the central analgesic mechanisms of transcutaneous electrical nerve stimulation based on wrist-ankle acupuncture theory (TENS-WAA). A multimodal approach combining electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) will be employed to assess pain-related brain activity, with artificial intelligence applied to model the relationship between objective neurophysiological signals and subjective pain experience.

This is a single-centre, randomised, double-blind, controlled trial involving 60 patients undergoing colonoscopy without anaesthesia. Participants will be randomly allocated (1:1) to either an electrical stimulation group receiving TENS-WAA or a sham stimulation group. EEG and fNIRS data will be acquired before, during and after the procedure. The primary outcome is the analysis of EEG-fNIRS signals to characterise cerebral responses associated with pain modulation. Secondary outcomes include patient-reported pain using the Visual Analogue Scale (VAS), total colonoscopy duration and the correlation between EEG-fNIRS indicators and VAS scores. A deep learning framework will be used to enhance pain prediction accuracy.

This study has received ethical approval from the Ethics Committee of Changhai Hospital, Shanghai (approval reference CHEC2025-006), and has been registered at ClinicalTrials.gov. Written informed consent will be obtained from all participants. Findings will be disseminated in peer-reviewed academic journals and at relevant scientific conferences, regardless of outcome, contributing to evidence-based, non-pharmacological pain management strategies.

ClinicalTrials.gov, NCT06813703.

To explore whether vaccine confidence and vaccine delay intention mediated the effect of the pay-it-forward intervention on human papillomavirus (HPV) vaccine uptake.

This secondary mediation analysis of a two-arm randomised controlled trial was conducted among female adolescents aged 15–18 years in Chengdu, China, from July 2022 to June 2023.

This study was conducted in four residential areas representing diverse economic backgrounds in Chengdu.

A total of 321 parents of girls aged 15–18 years who had not received the HPV vaccine participated in the study.

Participants were randomly allocated into two arms. Pay-it-forward participants received a community-contributed subsidy (47.7 USD) to support the HPV vaccination, along with educational postcards and an opportunity to donate to support others. In the standard-of-care arm, participants paid for their vaccination.

Primary outcome was the receipt of the first HPV vaccine dose within a 3-month period following an intervention. Based on previous literature, we hypothesised that vaccine confidence and vaccine delay intention were potential mediators. Vaccine confidence was measured using the vaccine confidence index. Vaccine delay intention refers to the caregiver’s preference to postpone HPV vaccination for their daughter until the preferred vaccine type becomes available, rather than accepting the immediately accessible HPV vaccine. Data on these mediators were collected via a self-administered online questionnaire conducted after the intervention but before vaccination.

Among urban participants, when compared with the standard-of-care arm, about 39% of the effect of the pay-it-forward intervention on vaccine uptake was mediated by a reduction in vaccine delay intention. Notably, vaccine confidence did not appear to mediate the effect of the intervention on vaccine uptake. Among suburban participants, no mediation effects were observed. In the suburban setting, caregivers who vaccinated their daughters showed poorer prior awareness of the HPV vaccine before participating in the trial compared with those who did not vaccinate their daughters (41.5% vs 21.1%; p=0.011).

Our findings indicate that among urban participants, the pay-it-forward may have effectively reduced vaccine delay intention, which was associated with an increased uptake of the HPV vaccine. However, in suburban areas, enhanced awareness might be a potential contributing factor to improved vaccine uptake, but further research is necessary to affirm this.

Chinese Clinical Trial Registry: ChiCTR2200055542.

This study assessed the knowledge, attitude and practice (KAP) of pregnant women in Chongqing, China, regarding pre-eclampsia and examined their inter-relationships.

A cross-sectional survey was conducted using validated questionnaires.

The study was conducted between May 2023 and August 2023 in Chongqing, China.

A total of 427 pregnant women were included, with 68.15% aged ≤30 years and a mean pregnancy duration of 238.18±45.01 days.

This was an observational study, and interventions were applied.

The primary outcomes were the KAP scores (knowledge: 0–40; attitude: 12–60 and practice: 10–50). The correlations and structural equation modelling (SEM) analyses were conducted to explore the relationships among KAP.

Mean scores were 22.19±12.17 (knowledge), 46.38±6.14 (attitude) and 41.96±5.96 (practice). Knowledge positively correlated with attitude (r=0.586, p

Pregnant women exhibited inadequate knowledge and a suboptimal attitude but a proactive practice. Targeted interventions to improve knowledge and attitudes are recommended for better clinical outcomes, particularly in regions where few such studies have been conducted.