Conectar
by Yufeng Li, Athia Haron, Chaofan Lin, Yuan Tang, Andrew Weightman, Glen Cooper
The prevalence of diabetes is expected to be 650 million people by 2030, and diabetic foot ulceration (DFU) is one of its most severe complications. It poses a significant challenge to global health and brings substantial social and economic burdens. Although many studies have explored the mechanisms of DFU development, they are still not fully understood. Due to the high cost of the experimental research, many recent studies have employed the computational modelling approaches to simulate the effects of diabetes on foot tissues from mechanical, thermal, fluid, and cellular perspectives. This study aims to provide a comprehensive review of computational modelling approaches used to investigate various factors influencing DFU, discuss current knowledge gaps and limitations, and outline future research directions. A systematic search was conducted in Web of Science, Scopus, and PubMed databases, identifying a total of N = 1631 records up to March 2025, 31 of which studies met the inclusion criteria and were analysed in this study. Results showed that DFU-related computational models can be categorized into five types: mechanical stress models, thermal models, vascular and nerve system models, multiphysics models, and cellular-based models. These models explore the formation mechanisms of DFU from different perspectives, including biomechanics, temperature, fluid dynamics, HHμm neural signalling, and cellular responses. However, except for mechanical stress models, the other approaches remain in the early stages of development, and the single physics modelling strategies are unable to provide understanding on the coupled processes with the foot and their effect on DFU. Future research should further develop modelling approaches and couple these together to develop comprehensive understanding of DFU pathogenesis.Scaling and root planing (SRP) combined with adjunctive antibiotic therapy is widely adopted in the management of periodontitis in patients with type 2 diabetes mellitus (T2DM), with the aims of ameliorating glycaemic control, alleviating local inflammation and facilitating periodontal tissue regeneration. As a topically administered adjunctive antibiotic for periodontal treatment, minocycline hydrochloride (MH) ointment has shown favourable clinical efficacy in systemically healthy patients with periodontitis. However, robust evidence supporting its clinical efficacy and potential glycaemic-improving effects in patients with periodontitis complicated by T2DM remains limited. The present study is designed to test the null hypothesis that no significant differences in clinical outcomes exist between SRP combined with MH and SRP alone in the management of periodontitis among patients with T2DM, with its primary objective to investigate whether MH as an SRP adjunct confers superior clinical benefits to SRP alone.
We will conduct a randomised, single-blind, placebo-controlled clinical trial. 56 patients with T2DM-associated stage III/IV periodontitis will be recruited from the Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, China. Eligible participants will be randomised into two groups: the experimental group will undergo SRP combined with topically administered MH ointment and the control group will undergo SRP with a matched placebo. The primary outcomes will include probing depth (PD) changes at periodontal pocket sites with a baseline PD ≥6 mm at 6 months post-baseline, with a specific focus on the percentage of such sites with PD reduced to ≤5 mm. The secondary outcomes will comprise PD changes at pocket sites with a baseline PD ≥5 mm at 6 months post-baseline, as well as clinical attachment loss, the plaque index, bleeding index, the levels of IL-1β, IL-17, calprotectin and insulin levels in gingival crevicular fluid and serum, complete blood count, blood biochemistry, including glycated haemoglobin levels, and the composition of subgingival plaques at baseline, and 2 and 6 months post-baseline.
This study was approved by the Ethics Committee of Peking University School and Hospital of Stomatology (PKUSSIRB-2024102139b). Results will be published in a peer-reviewed scientific journal.
ChiCTR2400092305.
V.3.1 (date: 6 January 2026).
The incidence of depression among children and adolescents has been increasing in recent years, posing significant challenges to public health and clinical care. A variety of treatments, including pharmacotherapy, psychotherapy and physical interventions, are widely used in clinical practice. However, a comprehensive synthesis of the evidence on the efficacy and acceptability of all these treatment modalities is currently lacking. This study aims to use network meta-analysis (NMA) to compare the efficacy and acceptability of all available treatments for depression in children and adolescents, offering valuable insights to inform clinical decision-making and guide future research in this critical area.
We will include randomised controlled trials evaluating active interventions for depressive disorders in children and adolescents. Seven electronic databases (PubMed, Embase, the Cochrane Library, Web of Science, PsycINFO, Scopus and ClinicalTrials.gov) were searched from inception to 2 July 2024 and updated on 2 November 2025. Two of four investigators will independently screen studies, extract data from eligible articles and assess the risk of bias using the Cochrane Risk of Bias 2.0 tool. The primary outcome will be the change in depressive symptoms. Secondary outcomes will include acceptability (all-cause discontinuation), response rate, remission rate and overall functioning. Pairwise and Bayesian NMA will be conducted. Small-study effects and publication bias will be assessed. The certainty of the evidence will be evaluated according to the Confidence in Network Meta-Analysis approach.
As this review involves secondary analysis of previously published studies, ethical approval is not required. The findings will be disseminated through publication in peer-reviewed journals.
PROSPERO-ID CRD42024557384.
To examine whether Indigenous Peoples’ and Local Communities’ (IPLC) ontologies are associated with knowledge, attitudes and practices (KAP) related to wildlife cohabitation and zoonotic disease transmission in biodiversity-rich areas of Latin America.
Cross-sectional household survey using a standardised KAP questionnaire. Ontologies were classified using latent class analysis. Associations between ontology classes and outcomes were assessed using multivariable logistic regression models.
Urban, rural and protected areas in biodiversity-rich regions of Bolivia, Brazil, Chile and Guatemala.
A total of 2903 individuals aged ≥10 years were recruited through random household sampling (response rate 85%).
Primary outcomes were defined according to the KAP framework. Knowledge outcomes comprised combined knowledge of zoonotic disease transmission from wildlife to humans and knowledge of zoonotic risks associated with wildlife trade. Perceived training needs related to zoonotic disease prevention were analysed as a secondary knowledge outcome measure. Attitudes were measured through risk perception, operationalised as concern about zoonotic disease transmission. Practices included self-reported hunting and slaughtering of wildlife.
The analysis identified three distinct ontology classes: Relational environmentalism (52% of the population), characterised by strong spiritual connections to animals and a tendency to protect wildlife; Dualistic environmentalism (28%), with a weaker spiritual connection to animals but a commitment to wildlife conservation; and Neutral (20%), demonstrating little spiritual connection to animals and a neutral attitude towards wildlife conservation. In the logistic regression analyses, both environmentalism groups exhibited greater knowledge of zoonotic transmission and concern about outbreaks, with members of the Relational class demonstrating higher levels of these attributes. Furthermore, members of the Dualistic environmentalism class were less likely to have close contact with animals.
In Latin America’s biodiversity-rich regions, individuals whose ontology aligns with environmentalism appear to demonstrate a heightened awareness of zoonoses, particularly those who adhere to a Relational environmentalism perspective. Consequently, the integration of IPLC cultural knowledge holds potential to enhance wildlife conservation measures and contribute to the mitigation of disease transmission. Further research is needed to explore causal pathways and the integration of culturally grounded approaches into public health interventions.
by Yishu Wang, Ling Zhu, Shuna Jin, Yuhan Wang, Zhaoxiang Zeng, Yunzhou Zuo, Xingliang Xiang, Xugui Li, Rongzeng Huang, Chengwu Song
BackgroundSex hormones play critical roles in the pathogenesis and progression of osteoarthritis (OA), yet the hormone-related molecular networks remain poorly defined. This study aimed to identify candidate sex hormone-associated genes in OA and to explore their potential functional enrichment and immune-related characteristics using bioinformatics analysis.
MethodsOA gene expression data were obtained from the GEO database and integrated with candidate sex hormone-associated genes retrieved from GeneCards. The R package “limma” was then used to identify differentially expressed genes (DEGs) and sex hormone-associated DEGs (SADEGs). OA-associated SADEGs, termed OA-SADEGs, were selected using weighted gene co-expression network analysis (WGCNA), and their potential biological functions and pathways were explored by GO and KEGG enrichment analyses. Hub genes were identified using three machine learning models. xCell analysis was used to estimate immune infiltration and its associations with hub genes, and hub gene expression was further evaluated in external datasets and peripheral blood samples.
ResultsWe identified 32 sex hormone-associated genes in OA, enriched in extracellular matrix remodeling, receptor signaling, and antigen presentation pathways. Three candidate hub genes (LOXL1, HLA-DRA, and CYBB) were consistently upregulated in OA and showed significant correlations with immune infiltration scores. xCell analysis identified 13 differentially enriched immune cell types, of which three were associated with hub genes. External dataset analysis and peripheral blood qRT-PCR showed upregulation of LOXL1, HLA-DRA, and CYBB in OA samples.
ConclusionThis study integrated bioinformatics and immune analyses to identify candidate sex hormone-associated genes in OA. These findings provide associative bioinformatics evidence for sex hormone-associated molecular features in OA.
To examine the trajectories, core characteristics, and maintenance factors of social avoidance in patients with breast cancer during the first postoperative year.
Longitudinal, explanatory sequential mixed-method design.
This longitudinal study enrolled 176 postoperative breast cancer patients, conducting six follow-up assessments over 1 year. Latent class growth analysis was employed to identify heterogeneous trajectories of social avoidance behaviour, with multivariate logistic regression subsequently analyzing predictive factors. Building on these quantitative findings, semi-structured in-depth interviews were administered to target individuals identified through the analysis. Phenomenological methods were then utilized to elucidate core manifestations and maintenance factors of social avoidance.
Among the 176 enrolled breast cancer patients, 138 completed all six follow-up assessments. Latent class growth analysis identified two distinct subgroups with significant differences in social avoidance trajectories: ‘persistent high social avoidance’ and ‘persistent low social avoidance group’. Logistic regression revealed melancholic temperament as an independent risk factor for ‘persistent high social avoidance group’, while choleric temperament demonstrated protective effects. Phenomenological analysis of qualitative data systematically identified four core themes: (1) affective manifestations, (2) behavioural patterns, (3) psychological drivers, and (4) environmental determinants of social avoidance.
This study revealed heterogeneous dynamic trajectories of social avoidance behaviour in breast cancer patients, with core manifestations encompassing both affective and behavioural dimensions, sustained by multiple factors of personality, psychology, and environment.
This mixed-methods study systematically examined the developmental trajectories, core manifestations, and sustaining factors of social avoidance behaviour in breast cancer patients. The results provide robust evidence to inform precision screening for social avoidance risk, early prevention initiatives, and tailored intervention strategies in clinical nursing practice.
Journal article reporting standards for mixed-methods research.
No patient or public contribution.
by Sicheng Huang, Xuebao Zhang, Long Chen, Xihe Ni, Ying Fan, Chaomin Zhao, Junfeng Xiao, Feng Ruan
BackgroundA public health emergency information system serves as a critical tool for collecting and analyzing data from sudden public health events, thereby providing a scientific basis for governmental decision-making. However, research on the systematic construction of such information system frameworks within China’s public health infrastructure is lacking.
ObjectiveTaking Zhuhai city as a case study, this study aims to construct a comprehensive public health emergency information system framework applicable to public health departments at the municipal, county, and street/township levels.
MethodsFirst, through a literature review and expert group discussion, the preliminary framework of system indicators is determined. Second, through two rounds of the Delphi method, 41 experts are invited to qualitatively select the system framework indicators, with the aim of obtaining consensus among experts. Finally, the system is improved through application, feedback, and redesign.
ResultsAfter two rounds of consultation, the final system at the city and county levels consists of 5 first-level indicator modules and 21 second-level indicator modules, whereas the system at the city, county, and street/township levels consists of 4 first-level indicator modules and 17 second-level indicator modules. Most of the indicators in the “emergency preparedness” and “emergency response” modules are considered important and should be retained as they can play a role in collecting and analysing information on infectious disease outbreaks through practical applications.
ConclusionThe public health emergency information system constructed in this study can be applied to public health departments such as disease prevention and control centres. Promotion can improve the efficiency of handling infectious disease outbreaks and provide a scientific basis for decision-making analysis.
To develop a machine learning model for predicting Taiwanese adults' intention to sign an advance directive (AD) and to identify the psychosocial, demographic, and system-level predictors relevant to culturally sensitive nursing. This study distinguishes between the reflective process of advance care planning (ACP) and the formal legal act of AD completion, addressing the need to understand cultural and system-level influences.
This was a cross-sectional quantitative study.
A survey was conducted with 1412 Taiwanese adults by using validated instruments, such as the Knowledge of Advance Care Planning Questionnaire and Advance Care Planning Attitude Scale. Data were analyzed using linear regression, random forest, and extreme gradient boosting models to predict the intention to sign an AD. A SHapley Additive exPlanations analysis was performed to interpret the model and investigate the effects of personal values and system-level barriers.
The extreme gradient boosting model outperformed the other models, with mean absolute error and root mean squared error values of 1.68 and 2.13, respectively. The SHapley Additive exPlanations analysis highlighted attitude toward ACP as the strongest predictor of signing intention. In addition to psychosocial factors, system-level factors such as procedural unfamiliarity and high consultation costs emerged as key barriers. Furthermore, older age and a higher number of children were associated with a weaker intention to sign an AD, reflecting a preference for informal family consensus over formal legal documentation.
Machine learning models effectively identify the interplay between personal attitudes, family dynamics, and institutional conditions that shape AD-related decision-making. The transition from ACP dialogue to formal AD signing is determined by both cultural values and structural factors.
Nurses should adopt a dual-track strategy—supporting advance care planning through family-inclusive dialogues and serving as “system navigators” to help patients overcome legal and financial barriers to advance directive signing. Data-driven insights from the present study may inform precise, culturally responsive interventions that honor patient autonomy.
The Tianjin Health and Chronic Disease Study (THCDS) is a longitudinal dynamic cohort study established in 2022, aiming to investigate risk factors and intervention targets of common non-communicable diseases (NCDs) in Tianjin, China.
A total of 14 324 participants (average age: 53.48, 34.8% females) were recruited for the baseline survey from July 2022 to November 2023. All participants underwent routine medical examination, including anthropometric (height, weight and blood pressure), ECG, colour Doppler ultrasound (thyroid, carotid artery, heart, abdominal and reproductive system), chest imaging measurements (X-ray or computerised tomographic scanning), and plasma, urine and faeces sample test and a standardised questionnaire, including demographic information, lifestyle factors (smoking, alcohol consumption, diet, sleep factors, physical activity, cognitive activity and social activity) and self-reported history of common chronic diseases. Participants older than 60 were also invited to perform cognitive function tests using the Montreal Cognitive Assessment scale. Follow-ups were tracked annually through routine medical examinations and standardised questionnaires to detect their health status.
Key baseline findings revealed sex disparities in disease prevalence and clinical characteristics, with males showing higher rates of hypertension (46.60% vs 34.23%), type 2 diabetes (17.39% vs 9.54%) and gout (33.47% vs 15.59%), while females had higher prevalence of hyperlipidaemia (15.47% vs 18.26%), insomnia (5.42% vs 10.00%) and cancer (1.75% vs 3.23%) (all p
THCDS is an ongoing prospective cohort with long-term follow-up (at least 15 years). Ongoing follow-ups will be used to investigate longitudinal trajectories of risk factors and chronic diseases and to identify modifiable determinants to inform NCD prevention strategies.
ChiCTR2400083075; pre-result.
Epic MyChart, used as a patient portal or within Epic Healthy Planet programmes, is integrated with the Epic electronic health record system, enabling secure access to health information, communication with clinicians and self-management tools. Despite increasing portal adoption in the UK and internationally, there is fragmented and unclear evidence demonstrating impact on clinical outcomes, engagement, safety, experience, efficiency and equity. This scoping review will map existing research on Epic MyChart, identify barriers and facilitators to uptake, and explore technical and operational determinants influencing implementation.
We will conduct a scoping review guided by Arksey and O’Malley’s framework, refined by Levac et al, and report according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and PRISMA-Equity guidelines. Eligible studies will include original research evaluating Epic MyChart or Epic Healthy Planet programmes, reporting outcomes related to patient-reported measures, clinical effectiveness, engagement, safety, efficiency or equity. Searches will cover MEDLINE, CINAHL, PsycINFO, EMBASE, Cochrane CENTRAL, Scopus, trial registries and grey literature. Two reviewers will independently screen records and extract data on study characteristics, outcomes, equity factors and implementation determinants. Quantitative findings will be synthesised narratively using synthesis without meta-analysis guidance; qualitative data will undergo thematic synthesis. Stakeholder consultations with health informatics experts, clinicians, data scientists and health system managers, alongside a patient and public involvement workshop, will support interpretation of findings. A logic model will illustrate relationships between portal features, implementation factors and outcomes. Although focused on Epic MyChart, the review will offer insights relevant to other patient portals, as many implementation and equity considerations are shared across digital health systems.
Ethical approval is not required as the review uses published data. Findings will be disseminated through peer-reviewed publication, conferences and stakeholder engagement to inform implementation of patient portals internationally.
The protocol is registered on the Open Science Framework (https://osf.io/5azdh/overview).
by Yanan Zhu, Qian Wang, Huiying Jia, Gaiyun Zhao, Yunpeng Lü, Xinhong Zhang, Haijing Dong
This randomized controlled trial is aimed at evaluating whether external fixation of the urinary catheter to the body surface represents a low-value nursing intervention for patients undergoing transurethral resection of the prostate (TURP). A total of 208 patients who received indwelling urinary catheters after TURP in a tertiary hospital in Qingdao, China between June 2024 and May 2025 were randomly assigned to one of two groups: a nonexternal fixation group (n = 103) and an external body surface fixation group (n = 105). A between-group comparison of outcomes included postoperative hematuria, incidence of catheter-associated urinary tract infection (CAUTI), unplanned catheter removal, occurrence of urinary catheter-related meatal pressure injury (UCR-MPI), and associated economic costs. No significant differences were observed between the two groups in terms of postoperative hematuria or CAUTI incidence (P > 0.05). Unplanned catheter removal did not occur in either group. However, UCR-MPI occurred significantly more frequently in the external fixation group (9 patients) than it did in the nonexternal fixation group (1 patient) (PThis study aimed to (1) implement a Safety Protocol of Thirst Management (SPTM) as an evidence-based practice for quenching postoperative thirst and (2) evaluate its effectiveness using a comparative pre-and-post induction design.
A quasi-experimental study using propensity scored matching.
Guided by the Iowa Model, the SPTM was implemented at a tertiary medical centre in Taiwan in 2023. Outcomes were compared between adult surgical patients admitted in 2023 (post-induction) and those admitted prior (pre-induction). Data on thirst and pain intensity, body temperature, and PACU length of stay (LOS) were analyzed for 15,168 patients.
A standardized SPTM flow diagram was established. Following SPTM induction, mean thirst scores significantly decreased from 5.76 to 1.30 (p < 0.001). Although pain intensity and PACU LOS (63.63 vs. 62.23 min) showed statistically significant increases, these changes were clinically marginal. Body temperature remained stable with no incidence of perioperative hypothermia.
The Iowa Model effectively guides nursing organizations in translating evidence into practice. The SPTM provides a safe, consistent framework for nurses to alleviate postoperative thirst, significantly enhancing the quality of surgical care.
This study addresses the lack of standardized thirst management. Results demonstrate that an evidence-based SPTM protocol effectively quenches thirst without increasing adverse clinical risks.
The SPTM was triggered by patient reports of thirst-related distress. During the design phase, patient feedback on the acceptability of cold oral stimuli was used to refine the protocol. While patients did not participate in the data analysis, the primary outcome (thirst intensity) was selected based on its significance to patient-cantered care.
This study was reported according to TIDieR guideline.
To assess caregiver burden and its relationship with health literacy, self-efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.
Explanatory sequential mixed-methods design.
In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023–April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self-Efficacy Scale, Tuberculosis-related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi-structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.
Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self-efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self-efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.
Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self-efficacy, strengthen social support systems, and implement targeted stigma-reduction strategies while considering developmental-stage-specific needs.
Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.
This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well-being in tuberculosis management.
This study adheres to the Good Reporting of A Mixed Methods Study checklist.
None.
To estimate the prevalence of loneliness, social isolation, and their co-occurrence among people living with HIV and to explore factors explaining heterogeneity between estimates.
A systematic review and meta-analysis.
PubMed, Cochrane Library, SciELO Citation Index (via Web of Science), Scopus, Embase, PsycArticles, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception until November 1, 2024 for relevant studies.
Study eligibility, data extraction, and methodological quality assessment were conducted independently by two reviewers. Random-effects meta-analysis was used to estimate pooled prevalence. Subgroup analyses were performed.
A total of 66 studies were included. The pooled prevalence of loneliness was 46.9% and that of social isolation was 25.9%. However, heterogeneity was very high across studies, and these pooled estimates should therefore be interpreted cautiously. Subgroup analyses suggested regional variation in both loneliness and social isolation. Other subgroup findings should be interpreted cautiously because some subgroup estimates were based on small numbers of studies.
Loneliness and social isolation are highly prevalent among people living with HIV. Population-specific intervention strategies are needed to reduce this burden, and future studies should further examine contextual and demographic differences to guide intervention design.
Routine HIV services should include screening and referral pathways for loneliness and social isolation.
This systematic review identified the pooled prevalence of loneliness and social isolation among people living with HIV, highlighting a substantial and clinically relevant burden. The findings may influence HIV nurses' practice and inform care approaches for other clinical populations experiencing loneliness and social isolation.
This systematic review followed the PRISMA and MOOSE reporting guidelines.
No patient or public contribution.
To systematically review the evidence on diagnostic prediction models for depression in patients with breast cancer.
Systematic review.
Ten databases were searched from inception to 22 August 2025, with an updated search on 17 December 2025, to identify original studies developing and/or validating diagnostic prediction models for depression in patients with breast cancer.
Data were extracted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) framework. Two reviewers independently assessed risk of bias and applicability of included studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Eleven studies were included. Reported area under the curve (AUC) values ranged from 0.784 to 0.890. All included studies were judged to be at high risk of bias, and seven raised high concerns regarding applicability. There was substantial heterogeneity in predictor selection across studies, with age, income level and family support being the most frequently reported predictors.
Although preliminary research on diagnostic prediction models for depression in patients with breast cancer has been undertaken, their methodological quality remains weak. Reporting of external validation and calibration assessment was limited. Current evidence is therefore insufficient to support their routine use in nursing practice. Future research should standardise model development and validation and strengthen the evaluation of model performance.
This review suggests that existing diagnostic prediction models for depression in patients with breast cancer are not yet sufficiently robust for routine nursing use, but may provide a reference for future nursing screening research and the optimisation of related tools.
This review synthesises the available evidence on diagnostic prediction models for depression in patients with breast cancer and provides a basis for future model development, validation and optimisation.
This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis: Systematic Reviews and Meta-Analyses (TRIPOD-SRMA) checklist.
No patient or public contribution.
Postoperative nausea and vomiting (PONV) is a common and distressing complication following surgery, persisting despite advances in prophylactic regimens. Growth differentiation factor-15 (GDF-15) has been identified as a biomarker inversely associated with PONV risk and severity. As metformin is known to elevate circulating GDF-15 levels, we hypothesise that preoperative metformin use may be associated with a lower incidence of PONV. This study aims to evaluate the association between a history of preoperative metformin administration and the occurrence of PONV in adults undergoing general anaesthesia.
This is a single-centre, prospective, observational cohort study. We plan to enrol 909 adult patients scheduled for surgery under general anaesthesia with endotracheal intubation from December 2025 to December 2028. Participants will be divided into two groups based on their preoperative metformin exposure: an exposed group (n=303) with a documented history of metformin use and a non-exposed group (n=606) without such history, using a 1:2 ratio. The metformin regimen (choice of agent and daily dosage) will be determined by the attending physician as part of routine clinical care, independent of this study. The primary outcome is the incidence of PONV, defined as the occurrence of any nausea, retching or vomiting, within 120 hours post-surgery. Secondary outcomes include the incidence of PONV in the early (0–24 hours) and late (24–120 hours) postoperative phases; the severity of PONV symptoms and the requirement for rescue antiemetic medication during these intervals; the quality of recovery (assessed at 0–24, 24–48, 48–72, 72–96 and 96–120 hours); potential PONV risk factors in blood or urine and long-term survival rates at 1, 3 and 5 years.
This study protocol (version 04, dated 23 November 2025) was approved by the Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University (Approval No. 2025ZSLYEC-689) prior to the initiation of participant recruitment. The first participant was enrolled under protocol version 04. A subsequent protocol amendment (version 05, dated 25 December 2025) was approved by the same Ethics Committee. This amendment added a quality of recovery assessment using the 15-item quality of recovery scoring system questionnaire at 30 days postoperatively. This amendment did not alter the primary or secondary outcomes, the sample size calculation, or any other key elements of the study design. The results of this study will be disseminated at scientific conferences and published in international peer-reviewed journals.
Infertility affects millions of people globally. The presence of key indicators of infertility and fertility care is critical to monitoring access and utilisation of services as part of universal health coverage. In the area of infertility, it is important to track both clinical and non-clinical outcomes of care. Previous reviews have examined clinical indicators for infertility and fertility care; however, non-clinical indicators have received limited attention. This systematic scoping review aims to map the literature related to the non-clinical indicators of fertility care and their types and dimensions.
This review will adhere to the established reporting guidelines for systematic scoping reviews and has been registered in the PROSPERO database to avoid duplication. A systematic literature search strategy will be developed and adapted to four electronic bibliographic databases (Medline [PubMed], EMBASE [Embase.com], CINAHL [EBSCOhost] and Web of Science [Clarivate]). Supplemental searches will be performed to obtain relevant grey literature from major health research institutes and international organisations. The search will be limited to literature published from 1990 to date. This review will cover all non-clinical interventions relevant to human infertility and fertility care. Two reviewers will independently screen papers and identify relevant studies for inclusion using predetermined criteria and extract data based on a predefined template. Types and dimensions of non-clinical indicators will be identified and a descriptive narrative synthesis will be used to describe the overall landscape. This review is expected to start on 1 June 2026 and conclude by 15 December 2026. A preliminary search strategy has been developed.
As this study is based on a review of publicly available literature, ethical approval is not required. This scoping review will provide a comprehensive overview of the existing non-clinical indicators used to measure, report and monitor infertility and fertility care services. The findings will provide a comprehensive evidence base for developing a set of core indicators to monitor infertility and fertility care that can be adopted globally. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars.
CRD420251177901.
In 2023, cholera caused over 95 000 deaths globally, predominantly in low-income and conflict settings, and contributed to the wasting, stunting and malnutrition of millions in countries where the disease is endemic. Moreover, the frequency and magnitude of cholera outbreaks are rising. As a result, the demand for outbreak control interventions is quickly outpacing existing resources. Oral cholera vaccination (OCV) is one intervention among many used to limit further transmission. Since 2022, one-dose OCV (OCV1) has replaced the standard two-dose OCV due to limited global supply. However, only a handful of on-the-ground surveys of OCV1 effectiveness presently exist.
This study aims to assess the transmission of cholera in outbreak settings using digital public health approaches and quantify OCV1 effectiveness in complement to on-the-ground surveys.
Using Haiti and Cameroon as natural case studies representing two disparate geographical and sociodemographic contexts, we employed computational digitisation techniques to extract weekly case counts from non–machine-readable images of outbreak epidemic curves. We then leveraged the R package EpiEstim to derive estimates of the effective reproduction number (Rt). To assess OCV1 effectiveness in the two considered countries, we applied VaxEstim, an extension of EpiEstim requiring three inputs: the basic reproduction number (R0), Rt, and vaccine coverage. Notably, our work provides the first known real-world application of VaxEstim in low-resource settings.
Early in either outbreak, weekly estimates of Rt were elevated (Haiti, 2.60 (95% credible interval (CrI) 2.42 to 2.79); Cameroon, 1.90 (95% CrI 1.14 to 2.95)). Thereafter, Rt estimates oscillated around the critical threshold of 1 in both settings. Haiti exhibited marginally higher OCV1 effectiveness than Cameroon (75.3% (95% CrI 54.0 to 86.4%) versus 54.9% (95% CrI 18.9 to 84.9%)).
This study underscores the value of combining digitised case data with computational techniques and the utility of VaxEstim for rapid, inexpensive estimation of vaccine effectiveness in data-poor outbreak settings.
The literature on sustainability performance frameworks for healthcare organisations varies in its applicability to different types of organisations and settings, functions and activities, and definitions and dimensions of sustainability. This fragmentation creates implementation barriers which may be overcome by consolidating existing evidence in a format that can be linked directly to organisations’ business models. This protocol proposes a scoping review to assess the extent of the literature on frameworks for monitoring and evaluating the multidimensional sustainability performance of healthcare organisations and to assemble a consolidated framework in an operationally relevant format to support progress towards sustainable healthcare organisations.
The search strategy will be applied across Semantic Scholar, Google Scholar, Web of Science, MEDLINE, Embase, Academic Search Premier, CINAHL and Business Source Premier databases. Search results from 2009, coinciding with the publication of the WHO’s ‘Healthy Hospitals, Healthy Planet, Healthy People’ report, will be considered. The scoping review will include studies reporting on multidimensional sustainability monitoring or evaluation frameworks applied or developed for use at the level of healthcare delivery organisations. Studies relating to operational units within organisations or to healthcare systems will be excluded. The review’s context will be restricted to operational sustainability and will not consider the literature on sustainable design planning and construction of new facilities. No specific exclusion criteria will be applied to the types of healthcare delivery organisations nor participants implicated in the frameworks. Title and abstract screening against the inclusion and exclusion criteria, followed by full-text assessment of remaining articles, will be performed by two reviewers. Data from included studies will be extracted using a custom-designed extraction tool, analysed using topic or thematic analysis to consolidate themes and presented within the triple-layered business model canvas.
Only publicly available sources will be used; research ethics approval is not required. Findings will be submitted to a peer-reviewed journal and presented at scientific meetings.
Public health students face academic and training pressures as well as challenges arising from patient and community expectations, which may adversely affect their quality of life (QoL) and contribute to burnout and student dropout. This study aimed to examine psychological self-care, burnout and QoL as well as the factors associated with these outcomes among university students.
A cross-sectional study conducted between January and March 2024.
Universities in northern, southern and northeastern Thailand.
A total of 1426 health-related students aged 18–25 years were recruited using non-probability sampling.
Data were collected using a self-administered questionnaire, which included the Thai version of the World Health Organization Quality of Life-BREF instrument (WHOQOL-BREF-THAI), the Maslach Burnout Inventory to assess emotional exhaustion (EE) and cynicism (CY) and a psychological self-care assessment.
Most participants (79.9%) reported a moderate level of QoL. The prevalence of burnout was 18.9%. Pearson’s correlation analysis indicated statistically significant relationships between psychological self-care, EE, CY and QoL (all p values
Good mental healthcare behaviours and lower levels of burnout are associated with higher QoL among public health students. Universities and programme administrators should implement mental health support strategies, including routine screening, counselling services and self-care promotion, to reduce burnout and improve students’ overall well-being.
FreshRSS 