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Chronic kidney disease (CKD) is a significant public health problem that requires effective preventive and conservative methods to limit morbidity and death.
This study aims to give clinical practice an evidence-based basis for the clinical practice of healthcare professionals by methodically looking for the best available data on conservative strategies and CKD prevention in high-risk and early-stage patients.
The 6S evidence resource model was followed and states that evidence retrieval was done top-down, gathering necessary studies from January 2014 to July 30, 2024. Databases searched included BMJ Best Practice, DynaMed, NICE, GIN, SIGN, JBI Evidence Synthesis, JBI Evidence Implementation, Cochrane Library, and PubMed. Following the JBI grade of evidence and recommendation methodology, two reviewers independently examined and assessed the literature, extracting and summarizing evidence.
Seventy-nine publications were identified: 18 guidelines, 1 randomized controlled trial, 2 expert consensus statements, 36 evidence summaries, and 22 systematic reviews and meta-analyses. Key findings were summarized across eight aspects: risk assessment and early detection, risk factors and prevention of genetic factors, management of diabetic nephrology, impact of bariatric surgery on preventing CKD, screening and diagnosis, treatment and prevention strategies, lifestyle modifications, and CKD prevention.
This study summarized the best evidence for preventing CKD from eight aspects, which can help clinical or community medical professionals develop and apply CKD preventive strategies for high-risk groups and early-stage patients. By using these evidence-based strategies, healthcare professionals can reduce the incidence and progression of CKD, leading to fewer hospitalizations, improved kidney function preservation, and enhanced long-term survival and quality of life for patients. Future research should address identified gaps and explore the implementation of these strategies in diverse clinical settings.
To clarify the role performance of gerontological nurse specialists (GNSs) and identify associated factors.
A cross-sectional survey.
A self-designed questionnaire based on the Donabedian model was developed to assess structure, process, and outcome variables using a 5-point Likert scale. The questionnaire was administered to 230 GNSs. Descriptive statistics (e.g., means, standard deviations, frequencies) were calculated in SPSS to summarise GNSs' role performance, and multiple regression analysis identified factors influencing GNSs' role performance.
Ninety-six GNSs (response rate of 44.3%) scored 3.15 to 3.81 out of 5 in GNSs' role performance, including clinical practice, education and guidance, consultation, research, leadership and coordination. High self-ratings were observed in clinical practice and consultation, whereas research and leadership scored lower. Education and guidance, as well as consultation, were primarily performed among hospital nurses, with GNSs' role performance largely confined to the hospital. Multiple regression revealed that GNSs' role performance was significantly associated with factors such as GNS competency, identification of stakeholder needs and perceived social recognition of GNS.
To enhance the role performance of GNSs, it is necessary to expand their activities outside the hospital, improve gerontological nursing competency, and promote the social recognition of their role. The results also suggest that it is important for GNSs to understand the needs of patients, nurses, and other related healthcare workers, and enhance collaboration with multiple professionals.
Clarifying the role performance of GNSs in China enables future outcome evaluations. Identifying influencing factors provides insights for effective support, which will further contribute to the success and development of GNSs.
No public or patient involvement.
Diabetes is a leading cause of morbidity and mortality, contributing to complications such as cardiovascular disease, kidney failure and lower-limb amputations. Diabetic foot complications, such as structural deformities, ulceration and infection, present significant risks, necessitating early detection and intervention. This study explores the development and validation of artificial intelligence (AI) image analysis for diabetic foot screening, focusing on structural deformity identification which includes callus, hallux valgus and hammer toes, because they represent the earliest detectable visual risk markers for ulceration, preceding wound formation. Leveraging datasets comprising over 1000 healthy foot images and 215 diabetic foot deformity images, the model employed YOLOv5 for object detection, a convolutional autoencoder for anomaly detection, and DenseNet201 for anomaly classification. Initial internal validation yielded 91.1% anomaly detection accuracy, while anomaly classification accuracy improved to 88.57% following refinement. External validation using 27 participants achieved an overall accuracy of 85.2% and anomaly classification accuracy of 66.7%. Final evaluation on 35 unlabelled images demonstrated promising performance, with 88.57% accuracy, 90.47% precision and an F1 score of 86.11%. Integrated into the ‘Foot at Risk’ (FAR) mobile application, this AI-driven solution offers a scalable tool for early diabetic foot deformity detection. With larger dataset input for training and development, it can be utilised as an early screening tool for diabetic foot and integrated into existing community diabetic care model, facilitating timely intervention and improving patient outcomes.
To explore latent profiles of social isolation in maintenance haemodialysis (MHD) patients and to analyse the factors influencing different latent profiles.
Multicentre cross-sectional study.
Between November 2024 to March 2025, 305 MHD patients from the haemodialysis centres of three hospitals in Henan Province, China, were recruited using a convenience sampling method. All participants completed the general information questionnaire, Lubben Social Network Scale 6 (LSNS-6), UCLA Loneliness Scale-6 (ULS-6) and Personal Mastery Scale. Latent Profile Analysis (LPA) was used to classify the participants into potential subgroups with different types of social isolation. The influencing factors of profiles were explored by univariate analysis and multiple logistic regression analysis.
Social isolation of 305 patients can be divided into three profiles: the family-friend dual isolation group (14.10%), friend isolation-only group (47.54%), and social network well-being group (38.36%). Multivariable logistic regression analysis revealed that monthly personal income, living arrangement, social participation, dialysis time, post-dialysis fatigue, number of comorbidities, loneliness and personal mastery were identified as factors influencing the profiles.
There is heterogeneity in social isolation among MHD patients. It is therefore necessary to implement targeted intervention measures based on the distinct characteristics of each subgroup to facilitate their social reintegration.
Nurses should identify differences in social isolation among MHD patients. It is necessary to establish tripartite connections between families, hospitals and communities, and develop personalised psychosocial interventions to alleviate social isolation.
The study identified distinct subgroups of social isolation among MHD patients, while emphasising the impact of psychological resources such as loneliness and personal mastery on social isolation. This may offer critical insights for nurses to develop targeted interventions for patients' social health.
The study followed the STROBE guidelines for cross-sectional studies.
No patient or public involvement.
by Lei Guo, Jun Ge, Li Cheng, Xinyi Zhang, Zhengzheng Wu, Meili Liu, Hanmei Jiang, Wei Gong, Yi Liu
BackgroundThe incidence of ulcerative colitis (UC) remains high, with an increasing prevalence among elderly patients. Cellular senescence has been widely recognized as a contributor to UC susceptibility; however, the underlying molecular mechanisms remain incompletely understood. This study aimed to identify senescence-associated biomarkers in UC to provide new insight for diagnosis and treatment.
MethodsBy integrating transcriptomic data from UC patients with established aging-related databases, we identified aging-associated differentially expressed genes (DEGs). Using weighted gene co-expression network analysis (WGCNA) and Cytoscape, we pinpointed the core genes involved. A diagnostic model for UC was then developed based on these core genes, and their expression patterns were characterized at single-cell resolution. The roles of these genes were ultimately validated through in vitro and animal experiments.
ResultsWe identified 24 aging-related DEGs in UC, which were primarily implicated in inflammatory responses and cytokine-receptor interactions. Further analyses pinpointed three core genes (CXCL1, MMP9, and STAT1) that were predominantly expressed in macrophages. A diagnostic model constructed using these genes exhibited robust predictive performance. Experimental validation confirmed that the expression levels of all three core genes were significantly upregulated in both a UC mouse model and in macrophages compared to controls. Additionally, pathway analyses revealed elevated levels of CXCL12 and VEGFA in the enriched pathways.
DiscussionOur findings underscore the pivotal roles of CXCL1, MMP9, and STAT1 in UC-associated cellular senescence. The analysis positions these molecules as promising macrophage-mediated diagnostic biomarkers and therapeutic targets. Collectively, this work provides novel insights into UC pathogenesis and lays a foundation for developing precision medicine strategies that target senescence pathways.
To explore the competency of nursing graduates from the four dimensions of clinical practice, research ability, teaching ability and management ability, analyse its influencing factors and provide data support for improving the post ability of nurses with a master's degree.
In September 2024, a convenience sampling method was used to administer a self-designed questionnaire regarding post-graduation post-competency to 330 nursing master's degree graduates from 68 tertiary hospitals and five medical universities across China.
The average scores of clinical competence, research competence, teaching competence and management competence of nursing graduates were more than 7 (out of 10 points). Based on the Benner model, all the abilities of the participants were at the level of competent. Multivariate linear regression analysis indicated that marital status (p < 0.001), years since graduation (p < 0.001), major (p < 0.001) and et al., significantly influenced clinical competency. Furthermore, marital status, major, hospital rank and graduate type were key research competency factors. For teaching competency, major, training nature and professional title played a crucial role, whereas major, professional title, marital status and hospital rank were essential for management competency. Multivariate logistic regression analysis indicated that job position (χ 2 = 11.375, p = 0.01) significantly influenced SCI publication, whereas the training nature and type of graduate school were independent factors affecting publication in Chinese core journals. Moreover, years since graduation and professional title were independent factors that influenced the publication of scientific core journals.
The post-competency scores of nursing master's degree graduates in the four dimensions of clinical, research, teaching and management were moderate, indicating substantial potential for enhancement. Managers should develop personalised training programs based on different factors that influence the overall competency of nursing master's degree graduates, thereby improving nursing quality and ensuring patient safety.
by Jiawei Jiang, Ai Theng Cheong, Shariff Ghazali Sazlina, Zarina Haron, Shanyu Wu, Chenli Liang, Qi Jiang
BackgroundWith the global population ageing rapidly, especially in China, promoting active ageing is crucial for ensuring healthy longevity. However, limited studies have examined the levels and predictors of active ageing at the community level in provincially designated age-friendly communities.
MethodsA cross-sectional study was conducted from August to November 2024 in two age-friendly communities in Yanji City, China. We invited 553 older adults aged 60 years and above using simple random sampling methods. We collected data through structured face-to-face interviews using validated instruments that measured socio-demographic and physical, environmental, health-related, and social variables. We used multiple linear regression to identify significant predictors of active ageing.
ResultsA total of 513 older adults participated 56.9% were female, and 90.4% were aged 60−79. The mean active ageing score was 100.98 (SD = 16.78). Higher educational attainment (β = 0.138, 95% CI [0.513, 8.736]), higher income levels (β = 0.144, 95% CI [1.265, 10.266]), moderate physical activity levels (β = 0.073, 95% CI [0.004, 0.181]), better cognitive function (β = 0.214, 95% CI [0.522, 1.088]), stronger family support (β = 0.124, 95% CI [0.399, 1.535)], close social connectedness (β = 0.277, 95% CI [0.595, 1.021]), and use of community (β = 0.176, 95% CI [3.597, 9.532]) and cultural facilities (β = 0.116, 95% CI [1.659, 6.583]) three or more times a week were significantly associated with higher active ageing. Depression had a significant negative impact on active ageing scores (β = −0.170, 95% CI [−1.362, −0.570]).
ConclusionThe findings underscore the need for integrated strategies encompassing environmental design, social support systems, physical activity promotion, and mental health care to foster active and meaningful ageing in age-friendly community settings.
by Hua-Hong Wu, Ya-Qin Zhang, Cheng-Dong Yu, Fang-Fang Chen, Jun-Ting Liu, Shao-Li Li, Xin-Nan Zong
BackgroundBrachydactyly type A3 (BDA3), a common finger deformity, demonstrates an inverse epidemiological relationship with population height, suggesting a potential link with individual stature. We aimed to investigate the distribution of BDA3 and its association with shorter stature in Chinese children.
MethodsFrom 2022 to 2023, we conducted a cross-sectional survey in 10 randomly selected schools in Beijing with children aged 3–18. We measured height on-site, obtained left hand-wrist X-rays, calculated predicted adult height (PAH) based on height and bone age, and diagnosed BDA3 deformity based on the X-ray images. And we compared the height and PAH between the BDA3 and Non-BDA3 groups by t-test or chi-square test, examined the association of BDA3 with shorter stature and shorter PAH using binary logistic regression model.
ResultsA total of 5,567 children participated, with 573 diagnosed with BDA3 (a detection rate of 10.3%). Notably, girls exhibited a significantly higher detection rate than boys (14.5% vs. 6.3%). The detection rate in children 12 years(15.3% vs. 7.6%). The average height and PAH were 0.30 SD and 0.22 SD lower, and the risk of shorter stature and shorter PAH were 1.57 times and 1.47 times higher in the BDA3 group than in the Non-BDA3 group, respectively. And, children >12 years in the BDA3 group had a significantly lower PAH than those in the Non-BDA3 group (about 2.0 cm). Conclusion: Children with BDA3 are more likely to have shorter stature and shorter PAH than those with no BDA3 in Chinese children aged 3–18 years.
Workplace violence is a pervasive issue in healthcare systems, with nurses being among the most vulnerable healthcare professionals. Despite the recognition of high prevalence, the consequences and mechanisms of workplace violence on professional competency, particularly patient safety competency, warrant further investigation.
This study aimed to examine the relationships among workplace violence, organisational silence behavior, psychological resilience, and patient safety competency among Chinese nurses.
A descriptive cross-sectional correlational design was employed among a convenience sample of clinical registered nurses from public hospitals in Hunan Province, China. An online anonymous questionnaire was utilised to collect research data. SPSS statistical software was used to perform descriptive statistical analyses, Pearson correlation analyses, and mediation effects analyses.
A total of 1440 clinical registered nurses participated in this study, with physical assault being the most prevalent form. Pearson correlation analysis revealed a positive relationship between workplace violence and organisational silence behavior (r = 0.93, p < 0.001), and a negative relationship with psychological resilience (r = −0.84, p < 0.001) and patient safety competency (r = −0.89, p < 0.001). Mediation analysis indicated that organisational silence behavior mediated the negative relationship between workplace violence and patient safety competency, while psychological resilience moderated this association among nurses (All p < 0.05).
This study provides empirical evidence that workplace violence significantly impairs patient safety competency among nurses. The findings underscore the critical role of organisational silence behavior in mediating this relationship, while psychological resilience serves as a protective factor. Targeted interventions aimed at reducing workplace violence, fostering open communication, and enhancing psychological resilience are essential to safeguarding patient safety and improving healthcare quality.
This study offers valuable insights for the development and implementation of targeted support programs and intervention strategies to mitigate workplace violence and enhance patient safety in healthcare settings. Government agencies and healthcare institutions must prioritize preventing all forms of workplace violence against nurses, enhancing psychological resilience, and ensuring patient safety competency to improve healthcare quality and patient outcomes.
To describe the perspectives of individuals receiving haemodialysis regarding health literacy in fluid management.
A qualitative descriptive approach using directed content analysis of interviews from an explanatory mixed methods study.
Semi-structured individual interviews were conducted from September 2020 to February 2021 with 28 individuals receiving haemodialysis who had attended a prior quantitative study. A directed qualitative content analysis approach was used to identify categories and subcategories emerging from the data.
Six categories of health literacy were identified: (1) active health management, (2) engagement with healthcare providers, (3) understanding and support from healthcare providers, (4) social support, (5) health information literacy and (6) navigation of the healthcare system.
Based on their real-life experience, individuals receiving haemodialysis have unique health literacy needs regarding fluid management. A comprehensive understanding of these unique needs is crucial in creating person-centered interventions to address inadequate fluid restriction.
Interventions to address inadequate fluid restriction should be person-centered, considering each individual's unique health literacy needs. This involves conducting a comprehensive assessment of individuals' health literacy needs, empowering individuals to actively engage in health, engaging the entire support network and facilitating health information literacy in line with individuals' preferences.
This study offers detailed insights into the health literacy needs related to fluid management in individuals undergoing haemodialysis. The findings could inform the development of person-centered fluid management strategies for these individuals.
We adhered to the Consolidated Criteria for Reporting Qualitative Research checklist.
No patient or public contribution.
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