Conectar
by Meirong Shan, Qian Guo, Ruofei Li, Ni Li, Yanhua Fu, Huanyu Qi, Ge Zhang, Qian Wang, Xingli Xu, Jinchuan Lai
Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7–282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.
Oncology nurses are frequently subjected to significant psychological stress due to the demanding nature of cancer care, which negatively impacts their mental and physical health as well as the quality of patient care. Although Mindfulness-Based Stress Reduction has been demonstrated to be effective in alleviating stress, practitioners often encounter barriers such as limited engagement and difficulty maintaining regular practice.
To enhance engagement and adherence, we integrated art elements into the Mindfulness-Based Stress Reduction framework, creating the Mindfulness-Based art therapy program, and evaluated its effectiveness among oncology nurses.
A three-arm randomized controlled trial.
90 oncology nurses participated (Mindfulness-Based Art Therapy group = 30, Mindfulness-Based Stress Reduction group = 30, waitlist controls group = 30) in an 8-week program. Stress, anxiety, depression, fatigue, and mindfulness levels were assessed at baseline, immediately after the fourth week of intervention, and immediately after the intervention concluded. Compliance and satisfaction were evaluated using attendance rates and satisfaction questionnaires. Descriptive statistics were used to analyze general data; intervention effects were compared using one-way ANOVA and generalized estimating equations, and compliance and satisfaction were compared using independent samples t-test.
Both Mindfulness-Based Art Therapy and Mindfulness-Based Stress Reduction significantly improved stress, physiological markers, and mindfulness vs. controls. Mindfulness-Based Stress Reduction better reduced depression (β = −2.980, 95% CI: −5.427, −0.533, p = 0.017), while Mindfulness-Based Art Therapy was superior for fatigue (β = −11.582, 95% CI: −20.615, −2.550, p = 0.012). Mindfulness-Based Art Therapy had higher adherence (93.3% vs. 73.3%, p < 0.05) and satisfaction (3.27 ± 0.45 vs. 2.40 ± 0.52, p = 0.01).
For oncology nurses, Mindfulness-Based Art Therapy is as effective as Mindfulness-Based Stress Reduction for improving stress and mindfulness, while providing greater adherence, satisfaction, and more consistent fatigue reduction.
Chinese Clinical Trial Registry, ChiCTR2300078124 (http://www.chictr.org.cn), 30/11/2023
by Hang Sun, Haozhi Xu, Junying Li, Xiaoman Xie, Junmei Zhang, Hongjie Dong, Huanhuan Xie, Qi Wang, Guihua Zhao, Kun Yin, Jingyu Yang, Jianwei Zhou, Ruili Wu, Chao Xu
Gastric cancer (GC) is one of the most common and lethal cancers globally. methyltransferase-like 3 (METTL3)-mediated N6-methyladenosine (m6A) RNA methylation plays a crucial role in tumor initiation and progression by regulating RNA function. STM2457, a highly efficient METTL3 inhibitor, can inhibit METTL3 activity and may serve as a potential therapeutic strategy in cancers. However, the role of STM2457 for GC cells is still unknown. In this study, we analyzed the expression profile data of GC in TCGA and GEO databases, and further explored the expression involvement of METTL3 in GC cell line, investigated the therapeutic effect of STM2457 targeted inhibition of METTL3 in GC both in vitro and in vivo experiments. The results indicated that STM2457 could suppress GC cell proliferation and migration by inhibiting METTL3, and also promoted cell apoptosis and arrest the cell cycle in S phase. In addition, STM2457 could inhibit tumor growth in subcutaneous xenotransplantation mouse model. Our findings suggested that STM2457 had great potential for the treatment of GC and could serve as a foundation for future clinical applications.by Siyu Xie, Qiang Gu, Guiyin Zhuang, Xiaojing Guo, Bo Sun
ObjectivesTo explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications.
MethodsNewborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models.
ResultsSignificantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible.
ConclusionThe comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.
This study aims to explore the latent profiles and influencing factors of engagement in medication safety among elderly patients with cardiometabolic multimorbidity.
A cross-sectional study.
The study was conducted at a class III hospital in Jiangsu, China.
The study included a sample of 316 older adult inpatients with cardiometabolic multimorbidity.
Participants completed the Inpatients’ Involvement in Medication Safety Scale and the Multimorbidity Treatment Burden Questionnaire. Latent profile and multivariate regression analyses were used to identify subgroups and their associated factors.
Latent profile analysis identified three distinct profiles: ‘passive participation’ (22.47%), ‘moderate participation’ (52.53%) and ‘active participation’ (25.0%). Multivariate logistic regression revealed that occupational status, marital status, medical payment method, daily medication type and treatment burden were significant independent factors distinguishing among these profiles (p
The study confirms significant heterogeneity in medication safety engagement among older adults with cardiometabolic multimorbidity. The identified profiles and their specific influencing factors provide a basis for clinicians to stratify patients and develop targeted interventions, particularly for the vulnerable ‘passive participation’ group, to improve medication safety outcomes.
To analyse the current status of psychological resilience in Parkinson's disease (PD) patients and its correlation with social support and coping style.
A cross-sectional study.
PD patients hospitalized in a tertiary-level hospital in Shijiazhuang, Hebei Province, from March 2022 to March 2023 were selected for the study using the convenience sampling method. A general information questionnaire, psychological resilience scale, Medical Coping Modes Questionnaire and Perceived Social Support Scale were used to investigate 111 cases of PD. SPSS 25.0 software was used for statistical analysis. The data were analysed using independent samples t-test, one-way ANOVA, multiple linear regression analysis and the Pearson correlation coefficient.
Parkinson's disease patients have a moderate level of psychological resilience. The results of the Pearson correlation analyses showed that the level of psychological resilience was positively correlated with social support and confrontation and was negatively correlated with avoidance and acceptance-resignation. The results of multiple linear regression analysis showed that social support and acceptance-resignation were the influencing factors of psychological resilience in PD patients.
The psychological resilience of PD patients is at a moderate level. Social support and acceptance-resignation are the factors influencing the psychological resilience of PD patients.
This study analysed the level of psychological resilience in PD patients and its correlation with social support and coping style from the perspective of positive psychology to provide some reference for targeted clinical interventions. Our study found that social support and acceptance-resignation are influential factors in psychological resilience in PD patients. Medical staff should encourage patients to face the disease positively and their social support should be increased in order to improve their level of psychological resilience.
No patient or public contribution.
To evaluate the impact of game-based teaching on undergraduate nursing students' learning satisfaction, clinical thinking, clinical skills, and anxiety.
Systematic review and meta-analysis.
China National Knowledge Infrastructure, Wanfang, Weipu, SinoMed, CINAHL, PubMed, Web of Science, Cochrane Library, and Embase. Our systematic literature search was conducted up to 31 October 2024 and included all studies published before this date, with no restrictions on publication year.
The study quality was appraised using version 1 of the Cochrane risk-of-bias tool and the JBI Critical Appraisal Tools for Quasi-Experimental Studies. A meta-analysis was performed using STATA version 12.
1712 undergraduate nursing students from 19 studies were included. Meta-analysis showed that game-based teaching improved undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. Game-based teaching did not significantly enhance undergraduate nursing students' problem-solving skills.
Our research findings indicated that game-based teaching had more significant potential to enhance undergraduate nursing students' learning satisfaction, critical thinking, clinical decision-making, and clinical skills. However, game-based teaching did not show a substantial advantage in improving problem-solving skills compared to other teaching methods. Limited studies of the effects of game-based teaching on clinical reasoning and anxiety in nursing students cannot be meta-analysed. Future studies could improve how game-based learning is designed to support undergraduate nursing students' development of these competencies.
This study explores the effects of game-based teaching in nursing education and finds that it promotes learning satisfaction, critical thinking, clinical decision-making, and clinical skills in undergraduate nursing students, while having no significant effect on problem-solving skills. Game-based teaching can be a functional pedagogical approach to guide nursing educators to improve learning outcomes for undergraduate nursing students.
Inapplicable.
This study investigates the impact of the hospital environment on nurse job productivity in the post-pandemic era, with a focus on the moderating role of occupational calling, based on the person-environment-occupation-productivity (PEOP) theory.
A mixed-methods approach was employed, combining two-stage quantitative surveys and qualitative interviews.
In April 2022, 230 nurses from 11 Chinese public hospitals participated in a two-stage quantitative survey. Additionally, qualitative interviews were conducted with 10 nurses and 2 physicians. Quantitative data were analysed using partial least squares structural equation modelling (PLS-SEM), while qualitative data were analysed through Colaizzi's method to identify themes. To ensure the validity and reliability of the mixed-methods design, the study adhered to the Mixed Methods Appraisal Tool (MMAT) guidelines. Both sets of data were used to evaluate the relationships between hospital environments, job productivity, and occupational calling.
The study found significant correlations between the hospital's indoor, spatial and sanitary environments and nurses' job productivity. Additionally, the research revealed that occupational calling moderates the relationship between indoor and spatial environments and job productivity to varying extents. However, occupational calling does not significantly moderate the impact of the sanitary environment on job productivity.
This study provides insights into the transformative effects on hospital environments in the post-pandemic era, emphasising the importance of combining personal intrinsic and environmental extrinsic factors to boost nursing productivity. It proposes strategies for optimising hospital indoor, spatial, sanitary environments and enhancing nurses' occupational calling, providing practical, theoretical and educational insights to healthcare policymakers and practitioners.
There was no patient or public contribution in this study, as the focus was on nurses.
Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.
To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.
A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.
Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.
Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.
No patient or public contribution.
Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.
To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer.
This was a methodological study.
Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test–retest reliability were also evaluated.
A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.
The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.
The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.
This manuscript followed the STROBE guidelines.
Patients with gynecologic cancer participated in this study and provided the data through the survey.
Health-promoting lifestyle (HPL) is strongly associated with health outcomes. In clinical practice, health-promotion behaviours in patients with head and neck cancer (HNC) are not good, which seriously affects patients' prognosis. This study aims to investigate the current status and influencing factors of HPL in HNC patients.
A cross-sectional study.
This study used a convenience sampling method to select 264 consecutive HNC patients who attended a tertiary hospital in northeast China from November 2023 to May 2024 for the survey. Data were collected using the Questionnaire for General Information, the Health-Promoting Lifestyle Profile Revised-II (HPLP-II R), the Health Literacy Management Scale (He LMS) and the Acceptance of Illness Scale (AIS).
The HPLP-II R scores of HNC patients were generally average (93.10 ± 15.60), with the highest scores on the nutrition dimension and the lowest scores on the exercise dimension. HPL was significantly and positively correlated with health literacy and disease acceptance. Multiple linear regression analysis showed that educational level, cancer recurrence, health literacy and disease acceptance were the influencing factors of HPL among patients with HNC, which altogether explained 25.9% of the total variance.
The HPL of HNC patients is at an average level and still has much room for improvement. Patients with high literacy levels, cancer recurrence, high health literacy and disease acceptance levels had relatively high levels of HPL.
HPL can enhance patients' internal motivation, enhance their self-management ability and improve their daily functional performance while reducing complications and improving their quality of life. This suggests that medical staff should give personalised health guidance according to patients' different health literacy in clinical work, improve patients' disease acceptance and pay attention to the development of HPL.
STORBE guidelines.
No patient or public contribution.
To identify and evaluate the magnitude of the association between caregiver psychosocial factors and depressive symptoms among people with dementia.
Systematic review and meta-analysis.
A systematic review with meta-analysis used a random-effects model to estimate the effect size.
Medline, PsycINFO, CINAHL, Scopus and Embase databases were searched for peer-reviewed studies from inception to 25 November 2023.
The review included 88 articles, with 61 selected for meta-analysis. Seven caregiver psychosocial factors were determined for the meta-analysis: caregiver quality of life, distress, positive aspects of caregiving, depression, burden, quality of the relationship and anxiety.
This study suggested that depressive symptoms in people with dementia were associated with caregiver quality of life, distress, burden, depression and positive aspects of caregiving.
Recognising the association between caregiver psychosocial factors and depressive symptoms in people with dementia has essential nursing implications. Adopting family-centred care models and integrating respite care and psychological support for caregivers can help improve patient outcomes and overall dementia care.
This study highlights the association between caregiver psychosocial factors and depressive symptoms in people with dementia. Caregiver distress, burden and depression were linked to increased depressive symptoms in people with dementia, while caregiver quality of life and positive aspects of caregiving were associated with depressive symptoms in people with dementia. These findings underscore the need for tailored interventions to enhance dyadic health.
This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
There was no patient or public contribution.
This review was registered in PROSPERO (2024 CRD42024511383).
This study aims to explore the mediating role of resilience and perceived social support in the relationship between gratitude and the work reintegration adaptability of cancer patients in China.
A cross-sectional and correlational study.
A total of 402 participants were collected from July to December 2023 from a tertiary hospital in Jiangsu Province, China, using a convenience sampling method. The survey utilised the General Information Questionnaire, the Gratitude Questionnaire-6 (C-GQ-6), the Cancer Patient Return-to-Work Adaptation Scale, the resilience Scale (CD-RISD), and the Perceived Social Support Scale (PSSS) to collect data. The theoretical hypothesis was tested using structural equation modelling (SEM) analysis, with model fit corrections performed to examine the internal relationships and pathways among gratitude, resilience, perceived social support and return-to-work adaptability.
Gratitude, resilience, and perceived social support were significantly correlated with work reintegration adaptability. Resilience and perceived social support independently mediate the relationship between gratitude and work reintegration adaptability, with mediation effects of 56.63% and 7.77%, respectively. Additionally, resilience and perceived social support fully mediate the relationship between gratitude and work reintegration adaptability, with a chain mediation effect of 35.60%.
Gratitude can affect cancer patients' return to work adaptation through resilience and perceived social support.
Healthcare professionals should focus on the impact of gratitude on cancer patients' adaptability to work reintegration. Interventions targeting resilience and perceived social support should be developed to enhance patients' work reintegration and promote their overall recovery and social reintegration.
STROBE checklist.
No patient or public contribution.
To explore the current status and associated factors of advance care planning intentions among people living with dementia in China.
An explanatory sequential mixed-methods design was adopted.
The research is guided by the knowledge-attitude-practice model and the theory of planned behaviour. Quantitative surveys were used to assess advance care planning intentions and associated factors in people living with dementia, followed by qualitative semi-structured interviews to delve into participants' perceptions and feelings about advance care planning. Quantitative data were analysed using multiple linear regression, while qualitative data were analysed using thematic analysis.
The overall advance care planning behavioural intention was at a moderately high level. The quantitative results revealed that higher education level, certain religious beliefs, greater advance care planning knowledge, positive behavioural attitudes and stronger subjective norms were significantly positively associated with advance care planning intentions. Qualitative analysis identified three themes: positive attitude but limited ACP awareness, supportive relationships enable early ACP consideration and cultural norms shape willingness to engage in ACP.
Advance care planning intentions among people living with dementia are shaped by a combination of social, familial and individual factors. Increasing public awareness, addressing cultural challenges and establishing professional teams are crucial to promoting advance care planning practices. Future research should focus on larger, multicenter studies to enhance intervention strategies.
Although the attitude toward advance care planning is more positive, various factors need to be carefully considered in the process of constructing relative intervention strategies.
This study did not include patient or public involvement in its design, conduct or reporting.
This qualitative study aimed to explore the self-management dilemmas faced by patients with diabetes in Chinese primary care and collect suggestions for improvement.
Qualitative methods are used in this study. Thematic analysis was used to analyse the transcripts.
Four primary care communities in Beijing. The interviews were conducted between April and August 2025.
This qualitative study used face-to-face, semi-structured interviews with 32 patients with type 2 diabetes. Data collection continued until information saturation was reached.
Four core themes and multiple subthemes were identified. The first theme, ‘Inadequate Disease Cognition and Health Literacy’, showed that patients had a limited understanding of diabetes, often delaying diagnosis and only learning about complications after they appeared. Misconceptions about diet and a lack of medication management knowledge were also common. The second theme, ‘Suboptimal Daily Management’, highlighted that physical activity was unstructured, glucose monitoring was irregular and emergency response capabilities were poor. The third theme, ‘Fragmented Healthcare Resources and Inadequate Family Support’, revealed systemic barriers such as limited primary care competencies, homogeneous health education formats that failed to meet patients’ needs and insufficient family support. The fourth theme, ‘Limitations in Self-Management Decision-Making’, demonstrated that patients’ decision-making processes were predominantly experience-driven, relying on personal or communal anecdotes rather than scientific medical evidence.
The self-management challenges among Chinese patients with diabetes in primary care are a complex interplay of inadequate individual cognition, suboptimal daily practices and fragmented support systems. The study suggests that future interventions should focus on enhancing general practitioner training, developing culturally sensitive health education and rebuilding family and community support networks to sustainably resolve these management dilemmas.
Mortal distress encompasses emotional, cognitive, physical and behavioural responses to death and dying among healthcare staff who frequently encounter mortality in hospital settings. Healthcare workers often experience heightened levels of mortal distress due to their regular exposure to patient deaths, which can negatively impact both their personal and professional lives, leading to burnout and high turnover rates.
To identify and quantitatively synthesise correlates of mortal distress among hospital healthcare staff and examine moderating factors affecting these relationships.
Systematic review and meta-analysis following PRISMA 2020 guidelines
Two independent reviewers screened and extracted data from studies published between January 1990 and December 2024 across eight databases (five English: CINAHL, MEDLINE, ProQuest, PubMed, Scopus; three Chinese: Airiti, CNKI, Wanfang). Quality assessment was conducted using the Mixed Methods Appraisal Tool. Meta-analysis was performed using Comprehensive Meta-Analysis 3.0.
Analysis of 94 studies identified three factor domains: personal, job-related and situational. Four job-related factors demonstrated the strongest correlations with mortal distress: competence in coping with death in healthcare contexts, needs for death-related or hospice care training, quality of end-of-life communication, and working in departments with high patient mortality rates. Four significant moderators influenced correlation strength: publication language, geographic region, study quality, and measurement tools used for assessing mortal distress.
This synthesis provides evidence regarding the magnitude and strength of factors associated with mortal distress among healthcare staff. The identification of main and moderator effects emphasises the critical need for developing culturally sensitive, tailored interventions to help healthcare workers navigate mortality-related challenges.
The results can guide healthcare organisations in developing targeted interventions and training programs, inform medical and nursing education curricula by encouraging the inclusion of life and death education, and ultimately enhance staff well-being while improving the quality of patient and family care, especially in palliative care contexts.
This study did not include patient or public involvement in its design, conduct, or reporting.
PROSPERO number: CRD42021275460
by Jingwen Ji, Xiangyuan Wu
Heavy metal pollution in coastal agricultural soils poses significant threats to food security, human health, and marine ecosystems. Effective prevention and control require systematic analysis of their spatial distribution and sources. This study integrated geostatistics, principal component analysis (PCA), positive matrix factorization (PMF), and finite mixture modeling (FMM) to comprehensively analyze the spatial variability and sources of five heavy metals (Cr, Pb, Cd, Hg, As) across 877 sampling sites in the coastal area of eastern Zhejiang. The results indicate that overall soil quality is good, though enrichment occurs at some sites due to anthropogenic activities. Pollution displays a spatial pattern of lower levels in the south and higher levels in the north. Pb is widely distributed, while Cd, Hg, and As are concentrated in agricultural plain areas. PMF-based source apportionment revealed that mobile sources (traffic) contributed the most (52.5%), followed by industrial sources (30.4%) and agricultural sources (17.1%). The consistency of multi-model results validated the reliability of source identification. By implementing precise management strategies based on pollution source contributions, it is expected to effectively curb the further deterioration of heavy metal pollution in agricultural soils in Zhejiang Province, gradually improve soil environmental quality, and ensure the safety of agricultural products and the sustainable development of agriculture.by Jingwen Gao, Yasushige Shingu, Ryota Azuma, Satoru Wakasa
BackgroundInflammatory response plays a pivotal role in myocardial injury and post-infarction remodeling after acute myocardial infarction (AMI). Mechanical unloading (UL) of the left ventricle (LV) has been proposed as a potential therapeutic strategy to preserve cardiac function; however, its effects on myocardial inflammation remain incompletely understood.
MethodsWe employed a rat model of partial UL using heterotopic heart-lung transplantation following AMI. RNA sequencing (RNA-seq) was performed to evaluate transcriptomic changes, with a specific focus on inflammatory pathways in the non-infarcted remote area. Immune cell abundance was estimated using deconvolution analysis (QUANTISEQ). Quantitative PCR was performed to analyze some inflammatory cytokines, and macrophage polarization was evaluated by immunohistochemistry.
ResultsAMI significantly impaired cardiac function, which was mitigated by UL. RNA-seq analysis revealed marked activation of inflammatory pathways and identified several hub genes involved in cytokine signaling following AMI, while these transcriptional changes were not significantly altered in UL groups after AMI. Immune cell profiling demonstrated an increase in M2 macrophages after AMI, while UL preserved M2 macrophage levels. Histological analysis further supported UL’s modulatory effect on macrophage polarization. Pro-inflammatory cytokines TNFα and IL1β were upregulated after AMI but showed attenuation with UL.
ConclusionPartial UL potentially attenuates cardiac functional deterioration after AMI while exerting substantial effects on inflammatory gene expression and macrophage polarization. These findings suggest that the cardioprotective effects of UL may be correlated with the modulation of inflammatory pathways in the remote area after AMI.
FreshRSS 