Conectar
To assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.
A convergent parallel mixed-methods design.
From January and September 2022, eight top-tier hospitals in mainland China were selected using convenience sampling. The proportion of master's degree nurses, turnover rates, and recruitment outcomes were investigated and analysed using descriptive statistics. Concurrently, seven nursing administrators from these eight hospitals were interviewed using semi-structured interviews, and transcribed data were thematically analysed through inductive content analysis.
Among the eight hospitals surveyed, the average proportion of master's degree nurses was 3.58% (range: 0.58%–9.43%). The average ratio of planned to actual recruitment was 3.28, with four hospitals showing near parity (approximately 1:1) and three institutions failing to recruit any master's degree nurses. The annual turnover rate of master's degree nurses was 1.18%. Three themes emerged from the qualitative analysis: (1) shortages coexisting with oversupply; (2) nursing leaders' retention efforts versus limited institutional policy support; and (3) prioritisation of research and management over advanced clinical roles.
In China, even among top-tier hospitals, the proportion of master's degree nurses remains relatively low. There is an overall shortage of these nurses, juxtaposed with localised oversupply in specific institutions. Promotion to nursing supervisor or administrative roles is the only developmental pathway, while structured career progression pathways for advanced nursing practice remain conspicuously absent.
The study highlights the need to develop targeted policies that support the career advancement of master's degree nurses, particularly by expanding career options in Advanced Practice Nurses (APNs) rather than limiting roles to nursing management or education. This shift would better leverage their clinical expertise and strengthen healthcare systems through specialised practice and innovation.
What problem did the study address?: This study maps the supply–demand dynamics of master's degree nurses in leading hospitals and identifies retention, utilisation, and motivation policies and strategies from the perspective of nursing administrators. What were the main findings?: The proportion of master's degree nurses is low in China's top hospitals. There is both an oversupply and a shortage of master's degree nurses. Neither the government nor hospitals have policies in place to encourage the clinical involvement of master's degree nurses, and their career progression is limited to managerial roles. Where and on whom will the research have an impact?: Nursing administrators and other health policy makers in China and comparable global health systems will be affected. It will also influence nursing associations, nursing educators, and general nurses.
This study adhered to the Mixed Methods Article Reporting Standards.
No contributions from patients or the public were involved in this study.
To assess career satisfaction among Chinese nurses, explore influencing factors, and examine the mediating role of role breadth self-efficacy (RBSE) in the relationship between subjective age and career satisfaction.
A multi-centre, cross-sectional study.
Between June and October 2024, 2033 questionnaires were distributed to nurses across seven geographic regions in China, collecting data on demographics, subjective age, RBSE, and career satisfaction. Descriptive statistics, Pearson correlation analysis, multiple linear stepwise regression, and path analysis were used to identify determinants of career satisfaction and test the mediating effect of RBSE.
The effective response rate was 97%. Chinese nurses reported moderate-to-high career satisfaction, younger subjective age relative to chronological age, and moderate RBSE levels. Multivariate linear regression analysis identified education level, work institution, salary, weekly working hours, subjective age, and RBSE as significant predictors of career satisfaction. Path analysis revealed a significant negative association between subjective age and career satisfaction (β = −0.23, p < 0.001), which was partially mediated by RBSE (indirect effect = −0.11, 95% CI: −0.18 to −0.05).
The career satisfaction of Chinese nurses is at a moderately high level; the influencing factors include the intensity of nursing work and salary levels. There is a certain difference between the subjective age and the chronological age of Chinese nurses. RBSE partly mediates the relationship between subjective age and career satisfaction.
Valuing the breadth of nurses' roles, self-efficacy, and subjective age may help improve job satisfaction.
What problem did the study address?: This study elucidates the present level of career satisfaction among nurses in China and the variables affecting it. What were the main findings?: The subjective age of Chinese nurses influences career satisfaction, with RBSE partly mediating the connection between subjective age and career satisfaction. Where and on whom will the research have an impact?: This study presents novel variables of subjective age and RBSE in the investigation of factors influencing career satisfaction among Chinese nurses, offering new avenues for enhancing career satisfaction in this demographic in the future.
We adhered to STROBE guidelines for cross-sectional research.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Jinghui Xie, Haofang Guan, Maohui Liu, Weijun Ding
BackgroundCurrent obesity treatments include behavioral interventions, pharmacotherapy and surgery. Recently, the combination of ‘medicinal food’ products such as the plant Crataegus pinnatifida and its interaction with the gut microbiota has shown promise as an alternative therapeutic strategy to treat obesity.
MethodsWe obtained secondary metabolites (SMs) of obesity-related gut microbiota and Crataegus pinnatifida from gutMGene database and NAPSS database. bioinformatics analysis was used to elucidate key target and signaling pathways, whereas molecular docking (MD), molecular dynamics simulation and quantum chemical calculations identified crucial SMs involved in these pathways. The toxicity and physicochemical properties of these SMs were also assessed.
ResultsPhosphoinositide-3-kinase regulatory subunit 1 (PIK3R1), a key mediator in the phosphoinositide 3-kinase (PI3K)/ Protein Kinase B (Akt) pathway that is crucial for regulating insulin signaling and adipogenesis, emerged as the central hub within the PPI network. Strong binders to PIK3R1 were predicted to be quercetin, kaempferol and naringenin chalcone, suggesting their potential as therapeutic agents to treat obesity.
ConclusionThe synergistic combination of Crataegus pinnatifida and the obesity-related gut microbiota holds promise as a novel therapeutic strategy for obesity by targeting PIK3R1 and modulating the PI3K/Akt signaling pathway. Further experimental validation is necessary to confirm these findings.
by Linlin Bao, Haibo Zhao, Haiyue Ren, Chong Wang, Su Fang
Hair follicle stem cells (HFSCs) play critical roles in adult hair regeneration, owing to its self-renewal and multipotent differentiation properties. Emerging evidence has shown that long noncoding RNAs (LncRNAs) are implicated in biological processes such as proliferation, differentiation and apoptosis. However, the specific role of LncRNA RP11-818O24.3 in regulating HFSCs remains unclear. To explore the effect of LncRNA RP11-818O24.3 on HFSCs, stable LncRNA RP11-818O24.3 overexpression and knockdown HFSCs were established using a lentivirus vector system. The effect of LncRNA RP11-818O24.3 on proliferation was evaluated by Cell Counting Kit-8 (CCK8) and EdU incorporation experiments. The differentiation of HFSCs into neurons and keratinocyte stem cells was detected by immunofluorescence staining. We showed that LncRNA RP11-818O24.3 overexpression promoted the proliferation and inhibited cell apoptosis in HFSCs. High levels of LncRNA RP11-818O24.3 promoted the differentiation of HFSCs into CD34+K15+ keratinocyte progenitors and CD34+Nestin+neuron-specific enolase (NSE)+ neural stem cells. Additionally, LncRNA RP11-818O24.3 increased fibroblast growth factor 2 (FGF2) expression and the subsequent activation of the PI3K/AKT signaling pathway. These data demonstrated that LncRNA RP11-818O24.3 promotes self-renewal, differentiation, and the capability to inhibit apoptosis of HFSCs via FGF2 mediated PI3K/AKT signaling pathway, highlighting its potential role as a therapeutic strategy for treating hair loss diseases.To evaluate the effectiveness of levosimendan in promoting weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with refractory cardiogenic shock through a meta-analysis of clinical trials.
Systematic review and meta-analysis.
PubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception to January 2025.
Studies were included if they were clinical trials comparing outcomes between patients receiving levosimendan and those not receiving it during VA-ECMO support. Eligible studies reported on at least one of the predefined outcomes.
Two independent reviewers extracted data and assessed study quality. The primary outcome was successful VA-ECMO weaning. Secondary outcomes included 30-day mortality, in-hospital mortality, duration of ECMO support and length of stay in the intensive care unit (ICU). A random-effects model was used to synthesise data and estimate pooled effect sizes, with heterogeneity assessed using the I² statistic.
Involving 2083 patients across 16 studies, levosimendan significantly improved VA-ECMO weaning success (OR=2.44, 95% CI: 1.72 to 3.48; p2=57%) compared with the control group. Additionally, it notably reduced 30-day mortality (OR=0.48, 95% CI: 0.29 to 0.81; p=0.006; I2=56%) and in-hospital mortality (OR=0.47, 95% CI: 0.26 to 0.88; p=0.02; I2=70%). Noteworthy, however, is the association of levosimendan with prolonged VA-ECMO support (days; n=1314; weighted mean difference (WMD): 2.86, 95% CI: 1.73 to 4.00; p2=60%) and extended ICU stay (days; n=629; WMD: 5.69, 95% CI: 2.19 to 9.20; p=0.001; I2=61%).
Levosimendan improves VA-ECMO weaning success and reduces mortality. Further high-quality randomised controlled trials (RCTs) are required to confirm its clinical benefits in VA-ECMO patients. While the findings consolidate existing evidence favouring levosimendan, they also highlight residual heterogeneity and moderate-to-high risk of bias in several included studies. Therefore, future investigations, particularly well-powered RCTs with robust methodology, may help further delineate its role in specific patient populations.
Until now, there has still been a lack of sufficient evidence on patient-reported outcomes (PROs) measured by the EuroQol-5 Dimension (EQ-5D) in patients with systemic lupus erythematosus (SLE) in China. This study aims to comprehensively assess EQ-5D outcomes and influencing factors in Chinese patients with SLE.
A multicentre, cross-sectional study based on the Chinese Systemic Lupus Erythematosus Treatment and Research Group registry.
101 hospitals across 27 provinces of China.
1336 patients with SLE.
The information on EQ-5D was collected via an online questionnaire. Medical records were obtained from the Chinese Rheumatology Data Centre (CRDC). Clinical influencing factors related to the reported health problems were identified using multivariate logistic regression. Then, each health state was converted into a health utility score based on the Chinese 2014 tariff. Given the ceiling effects, Tobit regression models were used to analyse the factors influencing health utility scores.
A total of 1336 patients with SLE were included. Of them, 626 patients (46.9%) reported health problems using EQ-5D. The proportions of patients reporting problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 12.80%, 5.24%, 14.90%, 27.47% and 30.46%, respectively. The mean utility score was 0.89 (SD: 0.15), and the mean Visual Analogue Scale (VAS
EQ-5D may be a useful, preference-based PRO measure for SLE and could potentially be integrated into routine clinical monitoring of patients with SLE and applied in economic evaluations in the future.
Postoperative pain is particularly pronounced in spinal surgery. Inadequate management of acute postoperative pain not only reduces patient satisfaction and delays recovery but also increases the risk of developing chronic pain. Local infiltration analgesia (LIA) is a widely used technique for perioperative pain management. However, even with the use of long-acting local anaesthetics, such as ropivacaine, postoperative analgesia often remains insufficient. Preliminary evidence suggests that combining diprospan, a mixture of betamethasone disodium phosphate and betamethasone dipropionate, with ropivacaine can significantly reduce analgesic requirements in the immediate postoperative period. However, concerns about steroid-related complications, including hyperglycaemia and surgical site infections, highlight the need to identify the minimum diprospan concentration to achieve a balance between efficacy and safety. This randomised, controlled, evaluator-blinded trial aims to investigate the dose-response relationship of diprospan as an adjunct to ropivacaine for LIA in spinal surgery to determine the minimum effective dose for effective and safe pain management.
This is a single-centre, randomised, evaluator-blinded, controlled, dose-mapping study in which subjects will be randomised in a 1:1:1:1:1 ratio to the control group or to receive diprospan at concentrations of 0.003%, 0.006%, 0.009% or 0.012%. Patients will receive either 0.5% ropivacaine alone or a corresponding dose of diprospan combined with 0.5% ropivacaine for LIA. All participants will be followed for a duration of 3 months. The primary outcome measure will be cumulative sufentanil consumption within the first 48 hours postsurgery. Secondary outcomes will include additional assessments of analgesia, steroid-related adverse events and other complications within the 3-month follow-up period.
This study protocol was approved by the Institutional Review Board of Beijing Tiantan Hospital (KY2024-365-02-1). Written informed consent will be obtained from all participants. The results will be submitted for publication in a peer-reviewed journal.
This study analysed the clinical outcomes and healthcare costs associated with diabetic foot ulcer (DFU) within a tertiary healthcare centre in Singapore.
This is a retrospective, single-centre study. Patient data were extracted from the hospital’s electronic health system, including demographic, clinical and hospitalisation information. Hospitalisation costs were categorised into DFU-related and other hospitalisation costs. A one-way sensitivity analysis was performed to estimate the total healthcare costs associated with DFU.
Tertiary centre within a population suffering from a diabetic epidemic.
All patients aged 18 years or older who received DFU treatment between January 2019 and December 2023 at the Singapore General Hospital were included.
A total of 2857 DFU patients were included in the study. In-hospital mortality remained stable at 5%–6% annually. Among the cohort, 39.1% underwent minor amputations, 19.6% had major amputations and 9.0% experienced both minor and major amputations. The median length of stay for surgical patients ranged from 10 (IQR 4–24) to 13 days (IQR 6–31), compared with 4 (IQR 2–8) to 5 (IQR 3–9.5) days for non-surgical patients. Total costs per admission for patients with DFU-related surgery ranged from US$28 588.96 to US$34 204.77, while for those without surgery, costs ranged from US$6637.59 to US$7955.23. Total hospitalisation costs for DFU during the study period ranged from US$65.87 million to US$72.16 million. All figures were inflation adjusted to 2023 US dollars.
DFU poses a significant clinical and economic burden in Singapore. Understanding the costs associated with DFU is essential for resource allocation and planning in DFU management.
by Du Chigan, Jianbei Liu, Yang Zhao, Jianyou Zhao
Highway freight transport is the backbone of Tibet’s logistics network, accounting for 76.4% of regional freight movement (Tibet Bureau of Statistics, 2024). Challenging alpine road conditions—characterized by steep grades, sharp curves, and narrow lanes—combine with the substantial dimensions of heavy trucks to create significant operational difficulties. Autonomous truck development offers a potential solution; however, their trajectory planning algorithms exhibit limitations in high-altitude environments. To address these challenges, we propose a novel trajectory planning method using quartic Bézier curves. These 4th-order parametric curves provide G² continuity. Our approach integrates speed profiles into a three-dimensional curve representation and employs a two-phase optimization process to ensure safety and efficiency. Simulation results demonstrate the method’s effectiveness in maintaining truck stability while enabling responsive maneuvering under Tibet’s demanding road conditions.by Haoyang Zhou, Jinfeng Yang, Na Li, Jinying Li, Jianxin Ran, Yan Zheng, Yifan Long, Fang Cheng, Yuanpeng Liao
BackgroundSarcopenia is an age-associated disorder characterized by a progressive decline in skeletal muscle mass, strength, and physical function. The condition is linked to low levels of anabolic hormones such as insulin-like growth factor 1 (IGF-1), with its downstream phosphatidylinositol 3 kinase (PI3K)/ protein kinase B (AKT)/ forkhead box protein O3 (FOXO3) signaling pathway. There is growing evidence that resistance training (RT) or vibration training (VT) could improve physical functioning in individuals with sarcopenia. However, the related physiological influence of exercise on sarcopenia remains elusive.
MethodThis prospective randomized controlled trial will be conducted among 96 participants, aged between 65 and 80 years. In participants, sarcopenia diagnosis will be confirmed based on the Asian Working Group for Sarcopenia criteria, and participants will be randomized into either control, RT, VT, or RVT (combined RT and VT) groups. The intervention will last 12 weeks, with assessments performed at baseline, 12 weeks (after intervention), and 24 weeks (follow-up). The primary outcomes will include skeletal muscle mass, handgrip strength, and gait speed. Secondary outcomes comprise IGF-1 concentrations, PI3K/AKT and FOXO3 protein activity, quality of life, and timed-up-and-go test performance assessments.
DiscussionThis clinical study aims to elucidate the potential modulation of molecular mechanisms in vivo for combined RT and VT in sarcopenia patients and to identify the effects of the intervention on physical function.
Trial registrationChiCTR, ChiCTR2400083643. Registered on April 29, 2024.
Systemic therapies for advanced gastric cancer (GC), including chemotherapy, targeted therapy and immunotherapy, have evolved significantly in the past few years. The combination of immune checkpoint inhibitors (ICIs) and chemotherapy has become the standard first-line (1L) treatment for advanced gastric or gastro-oesophageal junction (G/GEJ) cancer, although there remains a need for improvement in efficacy. Fruquintinib, an oral and highly selective vascular endothelial growth factor receptor inhibitor, has shown a synergistic antitumour effect when paired with ICI or chemotherapy. Moreover, it has demonstrated a tolerable safety profile and high potential for synergy with chemotherapy or immunotherapy, suggesting that a combination of fruquintinib, sintilimab and oxaliplatin+capecitabine (CAPEOX) can be a promising treatment for locally advanced G/GEJ cancer. This phase 1b/2 study aims to investigate the safety and efficacy of the combination of fruquintinib, sintilimab and CAPEOX regimen as a 1L combination therapy for unresectable advanced or metastatic G/GEJ cancer.
The FUNCTION trial (NCT06329973) is a single-arm, prospective, multicentre, phase Ib/II clinical trial that will consist of a dose escalation phase and an expansion phase. The study is planned to be conducted at 16 public hospitals. A total of 70 participants will be enrolled, comprising nine in the dose escalation phase and 61 in the expansion phase. The dosing regimen during the dose escalation phase will include three different doses of fruquintinib (3 mg, 4 mg and 5 mg, per oral, once per day days 1–14) + sintilimab, 200 mg, intravenous, day 1 +oxaliplatin 130 mg/m2, day 1, intravenous, + capecitabine 800 mg/m2, per oral, twice daily, days 1–14, every 21 days. The recommended phase 2 dose (RP2D) and maximum tolerated dose will be determined in the escalation phase, and the RP2D will be used in the expansion phase. The primary endpoints will be the maximum tolerated dose and objective response rate; the secondary endpoints will include OS, progression-free survival, disease control rate, duration of response, surgical conversion rate and adverse events and identification of molecular biomarkers for efficacy. The results from this study will provide evidence for expanding the clinical applications of fruquintinib plus sintilimab and CAPEOX as a 1L combination therapy in metastatic or non-resectable, locally advanced G/GEJ cancer and lay the foundation for future large-scale clinical investigations.
This study will be conducted in full compliance with the ICH (The International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, ICH) GCP (Good Clinical Practice, GCP) guidelines, the rules of the Declaration of Helsinki and ICH E2A (Clinical Safety Data Management: Definitions and Standards for Expedited Reporting) Guidelines . The study protocol has received approval from the Henan Cancer Hospital ethical committee (Approval No. 2023-237-002). Written informed consent will be obtained from all patients prior to enrolment. For patients who have the mental capacity for informed consent, their consent for participation will be sought and will not be overridden by their family members. For patients who have impaired cognition, informed consent will be sought from their legally acceptable representative. On completion of the analyses, the study findings will be disseminated locally and internationally through manuscript publications in peer-reviewed journals and conference presentations.
The application of artificial intelligence (AI) technology in the screening of diabetic retinopathy (DR) has made significant strides. However, there remains a lack of comprehensive validation and evaluation of AI-derived quantitative indicators in DR screening.
This study aims to assess the diagnostic performance of retinal microvascular indicators in the early detection of DR in patients with type 2 diabetes and to identify potential novel indicators for early DR screening.
This cross-sectional study included 533 community-recruited patients with type 2 diabetes mellitus who underwent fundus imaging. Based on the results of the fundus examination, the eyes were categorised into non-DR, mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR and severe NPDR groups. AI systems were employed to quantify various retinal microvascular indicators, including microaneurysms (MAs), haemorrhage count (HC), haemorrhagic area (HA), the ratio of HA to retinal area (HA/RA), the ratio of HA to MA (HA/MA) and HC and/or MA (H/MA). Multivariable logistic regression was used to analyse the association between fundus indicators and DR severity, and receiver operating characteristic (ROC) curve analysis was performed to assess the predictive and screening value of these indicators, determining sensitivity, specificity, ROC area under the curve (AUC) and optimal cut-off values.
Among the 533 participants (mean age 64.03±9.71 years; 51.6% female), the DR prevalence was 10.0%. After adjusting for age, gender, body mass index, hypertension, diabetes duration, glycated haemoglobin levels, smoking and alcohol consumption, multivariable logistic regression indicated that HA/RA (OR 1.873, 95% CI 1.453 to 2.416) and HA/MA (OR 1.115, 95% CI 1.063 to 1.169) were associated with mild NPDR. Similarly, HA/RA (OR 1.928, 95% CI 1.509 to 2.464) and HA/MA (OR 1.165, 95% CI 1.112 to 1.220) were associated with moderate NPDR, and HA/RA (OR 2.435, 95% CI 1.921 to 3.086) and HA/MA (OR 1.171, 95% CI 1.117 to 1.226) were linked to severe NPDR. ROC curve analysis revealed that before adjustment, HA/RA demonstrated the highest screening value for DR, with an AUC of 0.917, sensitivity of 86.14%, specificity of 93.41%, Youden’s index of 0.796 and an optimal cut-off value of 0.063. After adjusting for confounding factors, the AUC for HA/RA in diagnosing DR was 0.900, with sensitivity of 83.17%, specificity of 86.28%, Youden’s index of 0.695 and an optimal cut-off value of 0.093.
The HA/RA and HA/MA show robust screening performance for early DR. These indicators should be considered for inclusion in AI-based early DR screening systems in the future.
Mediastinal and/or hilar lymphadenopathy (MHL) is increasingly identified owing to various underlying conditions. Minimally invasive biopsy techniques, including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), transbronchial mediastinal cryobiopsy (TBMC) and transbronchial forceps biopsy (TBFB), are common diagnosis tools. However, their safety and diagnostic efficiency remain unclear. This trial aims to compare the diagnostic yield and safety of these three techniques.
This study is a three-arm, parallel-design, randomised controlled trial involving 972 adult patients with MHL recruited from multiple medical centres. Participants will be randomly assigned to the EBUS-TBNA, TBMC via a tunnel or TBFB via a tunnel group. The primary outcome is diagnostic yield, and the secondary outcomes include diagnostic sensitivity, sample quality and procedure-related complications. Statistical analyses will be conducted using the appropriate methods. An independent sample ² test will be used to test the differences in the diagnostic yield and incidence of procedure-related complications.
Ethics approval was obtained from the China-Japan Friendship Hospital Ethics Committee (2022-KY-194).
Written informed consent will be obtained from all patients or their guardians before their enrolment in the study. This study will be conducted per the principles established in the Declaration of Helsinki and the International Council for Harmonisation Guidelines for Good Clinical Practice.
To translate the Supportive and Palliative Care Indicators Tool (SPICT) into Chinese and conduct preliminarily tests of its performance in hospitalized patients with cancer.
A cross-sectional validation study conducted from January to March 2024.
SPICT 2022 was translated in both directions, following the Brislin translation model, and the Chinese version culturally debugged through expert consultation and pre-testing. Content validity was evaluated by expert scoring. Tool internal consistency was evaluated using KR-20 coefficient, and retest reliability was evaluated using kappa coefficient. The screening performance was evaluated by sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).
Of 388 hospitalized cancer patients included, approximately one-quarter had potential palliative care needs. Content validity of the Chinese version of SPICT was good, as were internal consistency and test–retest reliability. Accuracy (0.905), sensitivity (0.806), specificity (0.943), PPV (0.845), and NPV (0.926) for the Chinese version of SPICT indicated that it is an acceptable instrument.
The Chinese version of SPICT can be applied for screening of palliative care needs in hospitalized patients with cancer in China.
The Chinese version of SPICT had been adapted to assist clinicians or nurses in quickly identifying hospitalized patients with cancer who may have palliative care needs. This is conducive to help clinical team to start palliative care consultation, care goal discussion and (or) referral for patients in clinical practice. And it probably helps to advance integration between palliative care assessment and routine oncology care assessment.
This study provided a screening tool for palliative care, with good validity and reliability, as well as excellent screening performance to facilitate palliative care need screening in clinical practice, promote palliative care referrals and improve patient quality of life.
This study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.
No patient or public contribution.
To conceptualise information distortion in Electronic Health Records (EHRs), with the goal of providing a theoretical foundation for improving documentation practices.
A concept analysis.
Walker and Avant's strategy for concept analysis was used. The defining attributes, antecedents and consequences were identified.
A comprehensive search was conducted across PubMed, Web of Science, Embase, CINAHL and Scopus from their inception to December 2024. Studies published in English that addressed information distortion in EHRs were included.
A total of 37 studies were included. The three defining attributes were: real-world health truth, representation of reality and mismatch relationship. Antecedents were divided into five categories: people-related factors, equipment factors, regulatory factors, working environment factors and management factors. The consequences of information distortion in EHRs included threats to patient safety, poor operational performance, eroded trust, compromised research quality and health inequity.
This concept analysis enhances the understanding of information distortion in EHRs and provides a foundation for further empirical validation. The findings may contribute to the development of measurement instruments and strategies to mitigate information distortion in healthcare settings.
By undertaking a concept analysis of information distortion in EHRs, healthcare professionals will be better equipped to recognise and assess this ethical phenomenon, thereby supporting the development of targeted interventions to mitigate potential harms to healthcare practices. In addition, the clarity of this concept could provide a new angle from which to analyse the origins of flawed EHR documentation and its ripple effects across healthcare systems.
No patient or public involvement.
by Min Wang, Yushun Yan, Wanqiu Yang, Ruini He, Lingdan Zhao, Yikai Dou, Yuanmei Tao, Xiao Yang, Qingqing Xiang, Xiaohong Ma
Psychiatric nurses represent a high-stress occupational group that experiences elevated levels of suicidal ideation (SI), emphasizing the need for focused mental health interventions. The main purpose of this study was to examine the prevalence of SI among psychiatric nurses and to identify the psychological and occupational factors associated with SI. A total of 1,835 psychiatric nurses completed questionnaires on depressive symptoms (PHQ-9), SI, quality of work-related life (QWL), and burnout. Multivariate logistic regression and phenotypic network analyses were conducted to identify factors associated with SI and the potential pathways linking depressive symptoms, burnout, and QWL to SI. The results indicated that 11.33% of the participants had SI in the past two weeks. Multivariate logistic regression revealed that emotional exhaustion, depersonalization, personal accomplishment, stress at work, general well-being, and the home-work interface were significant predictors of SI. Network analysis further revealed that psychomotor changes, guilt, sad mood, low energy, and appetite changes were the symptoms most directly associated with SI. In addition, sad mood, general well-being, and work-home interface were linked to job and career satisfaction, whereas sad mood and low energy were associated with emotional exhaustion and SI. These findings contribute valuable large-scale evidence on the mental health challenges faced by psychiatric nurses and highlight the importance of addressing mood disturbances, energy loss, and work-related stress in SI prevention efforts for this vulnerable group.by Jiaxu Chen, Lin Zhao, Jinghui Liu, Gaolei Wang, Zhan Guo
To quantitatively analyze the coupling relationships between railway safety risk factors, identify key factors contributing to railway accidents, and develop scientific strategies for accident prevention, this study introduces a complex network-based N-K model to investigate the coupling relationships of railway safety risk factors. First, we identified 18 railway safety risk factors by analyzing case data from railway accidents. The occurrence probabilities and coupling values of these risk factors were then calculated using the N-K model. Subsequently, based on the constructed railway safety risk complex network, reachability and centrality analyses were performed to determine the key factors of railway safety risk. Results indicate that the occurrence of railway accidents is directly proportional to the risk coupling value; the greater the number of coupling factors, the higher the risk value. The coupling of personnel factors and equipment factors is particularly prone to leading to railway accidents. Conversely, effective management of the coupling between personnel and equipment factors can significantly reduce the likelihood of accidents. Inadequate maintenance and unsafe human behavior were identified as critical factors contributing to railway accidents and should be prioritized in prevention efforts.Oesophageal squamous cell carcinoma (ESCC) ranks among the most aggressive malignancies and carries a poor prognosis. Lymphocytes play a key role in combating infections and suppressing tumourigenesis. Many studies have established a close association between lymphocyte depletion and adverse therapeutic outcomes in oesophageal cancer. Nevertheless, high-quality data validating the clinical efficacy and safety of lymphocyte-sparing thoracic radiotherapy regimens for ESCC remain scarce.
This prospective, open-label, randomised controlled trial aims to determine whether lympho-nTRT-ESO reduces the incidence of acute grade 3–4 lymphopaenia in patients with ESCC undergoing neoadjuvant chemoradiotherapy (nCRT), compared with conventional thoracic radiotherapy (RT). A total of 212 participants will be enrolled and randomly allocated in a 1:1 ratio to either the lymphocyte-sparing RT (RT) group or the conventional RT group. All patients will receive standardised nCRT, which will deliver a total dose of 41.4 Gy in 23 fractions. For the lymphocyte-sparing RT group, RT planning prioritises the planning target volume (PTV) coverage and conventional organ-at-risk (OAR) constraints while applying dose constraints to lymphocyte-related OARs (LOARs). These LOARs include the T1–T12 vertebral bodies, ribs, spleen and major cardiovascular structures (heart and large blood vessels), with optimisation performed only after PTV coverage and standard OAR constraints are satisfied.
This trial was approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine (RJ 2024–210) on 11 July 2024 and registered on ClinicalTrials.gov (NCT06596954) before participant recruitment. All participants should provide written informed consent to be eligible. We planed to publish the primary and secondary results of this study in scientific peer-reviewed journals and present at radiation oncology conferences.
Acute decompensated heart failure (ADHF), characterised by rapid deterioration of cardiac function, imposes substantial clinical and economic burdens due to high mortality (10%), frequent rehospitalisations (30% within 3 months) and impaired health-related quality of life. While exercise-based cardiac rehabilitation (ExCR) is a guideline-recommended intervention for stable heart failure, its utilisation remains critically low (11%) in ADHF populations, particularly during the vulnerable period spanning 90 days post-discharge—a high-risk phase marked by elevated mortality and morbidity. Current evidence gaps persist regarding optimal ExCR timing, dosage and efficacy during this critical window. This randomised controlled trial investigates the feasibility and impact of early ExCR initiation in the ADHF vulnerable period, evaluating outcomes in physical capacity, cardiac function and quality of life to inform evidence-based exercise protocols for this high-risk population.
This prospective, non-inferiority, randomised controlled trial will recruit 88 patients with ADHF. Participants will be randomised 1:1 to a 12-week personalised ExCR group or a traditional health education-based CR control group. Assessments will occur at baseline and 1, 2 and 3 months. The primary outcome is the change in 6 min walk distance post-intervention. Secondary outcomes include changes in grip strength, New York Heart Association Classification(NYHA class), brain natriuretic peptide, left ventricular ejection fraction, hospital stay, Short Physical Performance Battery score, Activities of Daily Living, Minnesota Living with Heart Failure Questionnaire score, and frailty status. Safety measures include all-cause readmission and mortality within 3 months post-discharge, as well as adverse events during the trial.
The study protocol was approved by the Peking University First Hospital Ethics Committee (Approval No. 2024yan180-002) in accordance with the Declaration of Helsinki. All participants will provide written informed consent prior to enrolment. The findings will be disseminated via peer-reviewed publications and conference presentations.
This study protocol was registered at ClinicalTrials.gov (Identifier: NCT06795737,
by Wanbo Lu, Qibo Liu, Haofang Li
This paper employs the mixed-frequency Granger causality test, reverse unconstrained mixed-frequency data sampling models, and Chinese data from January 2006 to June 2024 to test the nexus between consumer confidence and the macroeconomy. The results show that changes in the real estate market, GDP, and urban unemployment rate are Granger causes of consumer confidence. In reverse, consumer confidence is a Granger cause of the CPI. Second, GDP and the real estate market (CPI and urban unemployment rate) have a significant positive (negative) impact on consumer confidence, while the conditions of industrial production, interest rate, and stock market do not. Third, the “animal spirits” extracted from consumer confidence cannot lead to noticeable fluctuations in China’s macroeconomy. This suggests that the “animal spirits” will not dominate economic growth, even though they affect the macroeconomy slightly and inevitably. The results are robust after replacing the dependent variable and considering the influence of the global financial crisis and the COVID-19 pandemic.
FreshRSS 