Conectar
Emerging evidence supports a role for interleukin 6 (IL-6), a pro-inflammatory cytokine, in the pathogenesis of treatment-resistant major depressive disorder (TRD). However, interventional studies targeting IL-6 in this population remain scarce. Tocilizumab is a humanised monoclonal antibody that inhibits IL-6 signalling and is approved for the treatment of autoimmune conditions such as rheumatoid arthritis. The primary objective of this study is to examine whether IL-6 inhibition via tocilizumab can impact depressive symptoms, inflammation-related biomarkers and cognition in patients with TRD. A secondary objective is to compare the biological profiles of patients with TRD with elevated inflammation to those of healthy controls.
This is a proof-of-concept, randomised, parallel-group, triple-blind, placebo-controlled clinical trial. 22 adult outpatients diagnosed with TRD and evidence of low-grade inflammation (serum C reactive protein≥3 mg/L) will be randomised (1:1) to receive either one intravenous infusion of tocilizumab (8 mg/kg; maximum 800 mg) or normal saline, administered as an add-on to their ongoing treatment. Psychiatric, cognitive and biomarker assessments will be performed at baseline and at follow-up visits on days 7, 14 and 28 post-infusion. Additionally, 10 healthy controls with no psychiatric history will undergo the same baseline assessments for biomarker comparison.
The study has been approved by the Research Ethics Committee of the Hospital de Clínicas de Porto Alegre (Project number: 2025-0245, CAAE: 88904825.7.0000.5327). Findings will be disseminated through peer-reviewed publications, scientific meetings and, on request, lay summaries for participants.
by Ye Xu, Peimin Hua, Ye Shen
BackgroundSevere maternal morbidity (SMM) is a significant public health concern. This study analyzed the incidence, trends, causes, and pregnancy outcomes of SMM in Wuxi to inform future clinical and public health strategies.
MethodsA retrospective analysis was conducted on 315 critical maternal cases identified from 156,435 deliveries in Wuxi between October 1, 2020, and September 30, 2024. Data were extracted from a citywide near-miss maternal surveillance system. Statistical analyses were performed using SPSS 25.0, employing chi-square tests and Cochran-Armitage trend tests to evaluate trends, and chi-square tests for comparisons between groups.
ResultsThe overall incidence of SMM was 0.20%. Initially, this rate remained stable at 0.19% across the first three cycles (P > 0.05); however, it significantly increased to 0.24% during the cycle from October 2023 to September 2024 (χ² = 5.24, P = 0.02). This increase was closely associated with a rise in the proportion of women of advanced maternal age (≥35 years), which reached 26.03% (χ² = 11.76, P = 0.001). Over time, the distribution of risk levels shifted. Initially, the high-risk group was dominant (63.29%), but in recent cycles, the moderate-risk group became more prominent (64.44%). The moderate-risk group was associated with a higher rate of adverse outcomes (25.00–25.71%) compared to the high-risk group (17.11–20.69%; χ² = 10.83, P = 0.01). Direct obstetric factors were the primary causes, accounting for 79.05% of cases, with obstetric hemorrhage being the most prevalent (53.97%). In contrast, the proportion of cases attributable to indirect obstetric factors increased from 17.81% to 26.67%, primarily due to heart disease and infectious diseases.
ConclusionImproving maternal safety involves dynamic risk assessments, tiered referrals for moderate-risk pregnancies, better multidisciplinary management of complications, optimized emergency responses in primary care, and refined regional referral systems to reduce preventable SMM and mortality.
In the first 2 years of the COVID-19 pandemic, Hong Kong adopted strict public health and social measures to stop community transmission of SARS-CoV-2. These include border screening and control, isolation of cases and quarantine of their contacts and universal masking. During this period, attack rates in Hong Kong were among the lowest globally.
To estimate the seroprevalence of COVID-19 among healthcare workers (HCWs) in Hong Kong in 2020 and 2021.
We reviewed contact tracing data from the Hong Kong Department of Health to identify COVID-19 cases reported among HCWs. Between June 2020 and December 2021, we conducted a longitudinal cohort study to estimate the seroprevalence of COVID-19 among HCWs working in hospitals and clinics in Hong Kong during the first 2 years of the COVID-19 pandemic.
Overall seropositivity of COVID-19 by plaque reduction neutralisation test during the first (May–October 2020) and second round (November 2020–April 2021) of the study was 0% (95% CI 0.00% to 0.49%) and 0.52% (95% CI 0.14% to 1.33%). After COVID-19 vaccines were offered to HCWs in February 2021, seroprevalence by surrogate virus neutralisation assay among cohort participants who provided biannual blood samples rose to 68.7% (95% CI 65.9%, 71.3%) and 80.2% (95% CI 76.8%, 83.2%) in round 3 (May–October 2021) and the first 2 months of round 4 (November–December 2021).
Seroprevalence in Hong Kong HCWs in our study was low despite considerable exposure to confirmed COVID-19 cases in some study participants. However, the low rate of community transmission may have also contributed to the observed low seroprevalence among HCWs in our cohort.
Workplace violence remains a persistent threat in emergency departments (EDs), yet violence risk is often assessed only at triage as a single-time-point activity. In practice, risk frequently evolves during care, shaped by situational stressors and interactional dynamics. How frontline situational awareness can be translated into structured, actionable risk management within ED workflows remains insufficiently explored.
To develop and pilot a nurse-led, triage-embedded, trigger-based pathway for dynamic violence risk management in the ED.
A mixed-methods study was conducted. Quantitative data (September–October 2025) captured trigger-initiated reassessments using the Dynamic Appraisal of Situational Aggression (DASA) during routine care. Qualitative focus groups explored trigger recognition, reassessment decision-making, and feasible responses. Findings were integrated to inform pathway development and refinement, followed by a one-month pilot.
Among 8443 adult ED encounters, 172 (2.0%) involved at least one trigger-initiated reassessment. Reassessments most commonly occurred during waiting and transitional phases of care and were frequently associated with increases in DASA scores. Nearly all aggressive incidents occurred in encounters that underwent trigger-initiated reassessment rather than baseline triage assessment alone. Qualitative findings indicated that reassessment was prompted by cumulative behavioural, interactional, and contextual changes, reflecting nurses' situational awareness. Reassessment was valued for formalizing intuitive concern, supporting communication, and legitimizing proportionate early action, while feasible responses were concentrated at lower to moderate perceived risk levels.
Violence risk in the ED is dynamic and closely linked to workflow and situational context. A trigger-based pathway that operationalizes nurses' situational awareness into structured reassessment and proportionate response may support earlier, more feasible violence risk management within routine emergency care.
This study was reported in accordance with relevant reporting guidelines for mixed-methods research, including the STROBE checklist for the quantitative component and the COREQ checklist for the qualitative component.
by Quan He, Xiong Zou, Chunyan Zheng, Jiawei Zhang, Jialing Li, Liping Hu, Ting Zeng, Zijuan Huang, Peipei Zeng, Jinli Wei, Haichen Cui, Yongjian Su, Hai Li
BackgroundResidual mother-to-child transmission (MTCT) of hepatitis B virus (HBV) remains a significant clinical challenge despite standard immunoprophylaxis. Identifying molecular markers is crucial for improved prevention and diagnosis.
MethodsWe conducted a case-control study using the Guangxi Liuzhou HBV MTCT registry. Peripheral blood RNA sequencing (Illumina HiSeq) was performed on infants from HBsAg-positive mothers: cases (HBsAg-positive, n = 6) and controls (HBsAg-negative, n = 10). All infants receive HBIG and the first dose of hepatitis B vaccine within 24 hours after birth, followed by completion of the three-dose vaccination series. Differentially expressed miRNAs (DEMs; adj-p 1) were identified. Target genes were predicted (miRanda/RNAhybrid) and functionally analyzed (GO/KEGG enrichment, PPI network). HBV-associated target genes were identified by cross-referencing GeneCards/NCBI.
ResultsRNA-seq identified 62 DEMs (19 upregulated, 43 downregulated). Target prediction yielded 5,014 genes. Functional enrichment highlighted key pathways and processes. PPI analysis pinpointed highly connected genes. Integration with HBV databases revealed 3 key target genes potentially modulated by 4 specific DEMs (hsa-miR-6747-3p, hsa-miR-4772-3p upregulated; hsa-miR-4676-5p, hsa-miR-485-5p downregulated).
ConclusionThis study identifies dysregulation of 4 key miRNAs and their association with 3 HBV-linked target genes as potential contributors to residual HBV MTCT. These findings provide novel insights into the molecular mechanisms underlying HBV MTCT and suggest potential targets for intervention.
by Chia-Ying Li, Hung-Yu Lin, En-Pei Isabel Chiang, Hung-Chang Hung, Feng-Yao Tang
Sucralose, a widely utilized non-caloric sweetener, is frequently added to food and beverage products as a sugar substitute aimed at lowering energy consumption and reducing obesity-related health risks. However, epidemiological studies have indicated a possible association between high intake of sucralose and increased prevalence of coronary artery disease (CAD). Prior research has demonstrated that diminished levels of circulating human endothelial progenitor cells (hEPCs) are linked to a higher risk of CAD. Although sucralose is broadly consumed, its direct biological impact on hEPCs has not been comprehensively characterized. In this study, we investigated the cellular effects of sucralose on hEPCs using a variety of in vitro techniques, including assays for viability, migration, capillary-like tube formation, lactate dehydrogenase (LDH) release-cytotoxicity assay, and protein expression profiling by Western blotting. Our results revealed that increased concentrations of sucralose significantly impaired hEPCs viability, motility, and neovasculogenic function, accompanied by increased expression of markers associated with apoptosis, inflammasome activation, and pyroptosis. Mechanistic analysis further demonstrated that sucralose strongly activated endoplasmic reticulum (ER) stress/PERK pathways in these cells. Inhibition of ER stress via 4-phenylbutyric acid (4-PBA) substantially attenuated sucralose-induced cell death and reduced the expression of pyroptosis-related proteins and inflammasome markers. Taken together, these findings suggest that sucralose disrupts hEPCs function in part by triggering ER stress, which promotes both apoptotic and pyroptotic cell death programs.Kidney transplant recipients are at increased risk of surgical site infections (SSIs) due to procedural complexity and immunosuppression. This retrospective single-centre study examines the influence of BMI on SSI risk and identifies common pathogens. A total of 230 renal transplant patients were included in this analysis 2017 and 2019. All patients received a cephalosporin for prophylaxis, and wound swabs were taken from those who developed SSIs. SSIs occurred in 45 patients (19.6%) and were not significantly associated with age, sex or donor type. The most common organisms were coagulase-negative staphylococci (26.7%), Staphylococcus epidermidis (24.4%), Enterococcus faecalis (22.2%) and Candida albicans (22.2%). SSIs were significantly linked to surgical revision (p < 0.001) and higher BMI (p = 0.027). A BMI ≥ 28.1 was associated with threefold higher odds of SSIs (OR = 3.0; p = 0.001). Each one-unit increase in BMI was associated with a 7.2% increase in the odds of SSI occurrence (OR = 1.072; p = 0.020). Staphylococcus (p = 0.019) and Enterococcus (p = 0.048) infections were more common in patients with BMI > 28.1. Therefore, SSIs are a frequent complication posttransplant and are strongly associated with high BMI. Standard antibiotic regimens may not cover all relevant pathogens in obese patients, underscoring the need for tailored prophylactic strategies.
Language-concordant care, or healthcare in one’s preferred language, is important both for health equity and for improving health outcomes. Linguistic minorities, like Francophones in Ontario, Canada, are at risk of poorer clinical outcomes if they receive non-language-concordant primary care. However, common ratio-based access measures can provide misleading views of minorities’ actual access levels. This cross-sectional geospatial study demonstrates a new way to measure primary care access using average travel time to the nearest five English- and French-speaking family physicians. We also introduce the concept of primary care access fragility, where a region’s primary care access may depend on one or a few local family physicians. Our research question is: are there differences in travel burden and access fragility for census subdivisions (CSDs) across language (English/French), rurality (urban/rural) and region (north/south) in the province of Ontario, Canada?
We conducted a cross-sectional geospatial analysis to estimate English-language and French-language primary care travel burdens and access fragility in Ontario, Canada. We used population and boundary data from Statistics Canada’s 2021 census, road-network data from OpenStreetMaps, and family physician practice locations and language abilities from the College of Physicians and Surgeons of Ontario. We measured travel burden using Valhalla, an open-source road-network analysis platform.
We conducted our analysis for Ontario, Canada’s 577 CSDs, which correspond roughly to municipalities and with populations ranging from 5 inhabitants in Rainy Lake 17B to a high of 2 794 356 in Toronto.
Using public data from January 2026, we identified 15 762 family physicians practising in Ontario, of whom 11.0% reported speaking French. Patient data were obtained from the most recent 2021 census.
Our first primary outcome measures were CSD-level mean travel time to the nearest five English-speaking family physicians, and CSD-level mean travel time to the nearest five French-speaking family physicians, which we compared to explore regional inequities in travel burden. Our secondary outcome measures were based on a novel notion of the travel burden component of ‘primary care access fragility’. This metric indicates how dependent a region’s access is on a small number of local physicians and is defined as the difference between the CSD-level mean travel time to the nearest one physician and to the nearest five physicians. As the difference in travel times grows, so too does access fragility.
Median differences in French-language and English-language travel burdens were strongly significant across rurality, regions and overall (median difference 13.4 min, p
Compared with the general public, Ontario’s French-speakers face higher travel burdens to language-concordant family physicians and higher access fragility, especially in rural and northern regions. Our results are of interest to policymakers and health-system planners, and our methods are applicable to other populations and regions.
by Xiuqun Yuan, Yuting Chen, Huihui Lu, Pei Zheng, Yanyan Zhang, Min Chen, Xia Sheng
ObjectivesPost-prostatectomy patients experience urinary incontinence, fluctuating quality of life, and psychosocial distress during early survivorship. Evidence-based nursing models addressing long-term supportive needs remain limited. This study developed and evaluated an enhanced survivorship-oriented care model designed to improve postoperative functional recovery and quality-of-life outcomes.
MethodsA retrospective study was conducted at a tertiary urologic center. The improved survivorship model was developed based on our previous PROSTATE care model, integrating nurse-led continuous follow-up, psychosocial support, and structured rehabilitation. A total of 1062 patients who underwent radical prostatectomy between June 2024 and May 2025 received the enhanced survivorship care, compared with 673 patients treated between June 2023 and December 2023 under the previous PROSTATE care model. Outcomes included urinary continence, quality of life, postoperative complications, and length of stay. Between-group comparisons were performed using independent-samples tests, and repeated-measures ANOVA was applied to assess longitudinal changes.
ResultsBoth groups demonstrated significant improvements in urinary recovery and quality of life over time (time × group interaction, P Conclusion
The enhanced survivorship care model demonstrated clinically meaningful improvements in quality of life and continence recovery, while maintaining patient safety. These findings support its clinical value and potential for wider implementation as a structured survivorship strategy following radical prostatectomy.
Survival outcomes for early-stage breast cancer have improved substantially; however, many survivors experience persistent treatment-related toxicities that adversely affect long-term quality of life (QoL) and functional recovery. Prospective survivorship data from China remain limited. The PERSEVERE study aims to characterise longitudinal trajectories of QoL and treatment-related toxicities among Chinese women treated for stage I–III breast cancer and to identify factors associated with suboptimal recovery.
PERSEVERE is a prospective, multicentre, observational cohort study enrolling approximately 3000 women with newly diagnosed stage I–III invasive breast cancer across cancer centres in China. Data are collected at baseline and serially for up to 5 years, including clinical variables, a validated suite of patient-reported outcome measures collected via a centralised REDCap electronic platform and baseline biospecimens. The primary outcome is the change in the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 global health status/QoL score from baseline to 12 months. Longitudinal and time-to-event analytical approaches appropriate for observational cohort studies will be applied, with exploratory analyses planned to investigate symptom trajectories and biological correlates.
The study protocol (ID: NCC25/629-5575) has been approved by the Independent Ethics Committee of the National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences. Written informed consent will be obtained from all participants. Study findings will be disseminated through peer-reviewed open-access publications and presentations at national and international conferences, with summaries shared with clinicians and patient advocacy groups.
Turnover intention among nurses poses a significant threat to both workforce stability and the overall quality of healthcare delivery. However, few studies have comprehensively examined the associations between turnover intention and nurses' individual and team-level resources within a multilevel framework. Our study aims to provide an in-depth exploration of the relationship between turnover intention and nurses' individual and team-level resources.
The multicenter cross-sectional study adopted a stratified convenience sampling approach to enroll 773 clinical nurses from 62 teams across eight hospitals in Shandong Province, China.
We used the 10-item Connor-Davidson Resilience Scale for psychological resilience, the Perceived Social Support Scale for perceived social support, the 51-item Analyzing and Developing Adaptability and Performance in Teams to Enhance Resilience Scale for team resilience, and a single-item turnover intention measure. Multilevel logistic regression modeling was conducted to examine the simultaneous impacts of individual-level (psychological resilience and perceived social support) and team-level (team resilience) factors on turnover intention, while controlling for key demographic and organizational covariates.
The multilevel analysis revealed several key findings: (1) The prevalence of turnover intention reached 35.6%, indicating a substantial workforce stability challenge; (2) Multilevel modeling demonstrated significant between-team variance (ICC = 0.19), confirming the importance of examining nested data structures; (3) At the individual level, both psychological resilience (OR = 0.78, CI: 0.62–0.99) and perceived social support (OR = 0.75, CI: 0.60–0.94) showed significant negative associations with turnover intention; (4) At the team level, higher team resilience predicted lower turnover intention (OR = 0.73, CI: 0.56–0.94). These results were obtained after controlling for key demographic and organizational covariates, highlighting the robust protective effects of multilevel resources against nurses' turnover propensity.
The prevalence of turnover intention was relatively high in this study. Nurses with higher psychological resilience, perceived social support, and team resilience exhibited lower turnover intention. Healthcare administrators need to increase investments in nurses' multilevel resources to stabilize the nursing workforce and ensure the sustainability of the healthcare system.
Understanding the multi-level factors influencing nurses' turnover intention can help nursing managers develop targeted strategies from multiple perspectives in clinical settings, thereby reducing nurses' turnover intention.
To evaluate the feasibility, effectiveness, and acceptability of a spherical video-based virtual reality training programme aimed at helping nurses manage workplace violence.
A convergent mixed-methods study.
This study included nurses from a tertiary medical centre in Taiwan. The training programme involved four interactive 360° scenarios focused on recognising, de-escalating, and responding to workplace violence. Quantitative measures included risk perception, confidence in coping with aggression, and technology acceptance. Qualitative measures included the participants' learning experiences. Quantitative and qualitative findings were integrated through joint displays.
The programme was feasible, with all participants completing the training. Nurses reported high levels of perceived usefulness and ease of use. Quantitative data revealed considerable improvements in risk awareness and confidence in responding to incidents of violence. Qualitative data revealed that immersion and emotional resonance enhanced engagement, fostered self-reflection, and reinforced learning. Technical challenges included subtitle placement and speech recognition accuracy.
Spherical video-based virtual reality is a feasible, acceptable, and effective training approach that improves nurses' preparedness for managing workplace violence by enhancing situational awareness and confidence in addressing high-risk situations.
Integrating spherical video-based virtual reality into continual education may strengthen nurses' workplace safety competencies, prevent harm from incidents of violence, and improve patient care in stressful environments.
Workplace violence undermines nurse safety and patient care. Current training modules often lack contextual realism. Our programme improved nurses' awareness, confidence, and reflective learning and was feasible and well accepted. The findings are relevant to nursing educators, hospital administrators, and policymakers seeking sustainable strategies for addressing workplace violence.
This study adhered to the Revised Standards for Quality Improvement Reporting Excellence.
Patients or the public were not involved in the design, conduct, or reporting of this study.
Women with overweight or obesity tend to engage in low levels of exercise and face challenges in initiating and maintaining exercise throughout pregnancy.
This study aimed to evaluate the effectiveness of a peer-led walking and mobile health (mHealth) app intervention on self-efficacy and change in exercise behavior stage, based on the transtheoretical model (TTM), of women with overweight or obesity from pregnancy to one month postpartum.
The study was a randomized controlled trial with an experimental design. A total of 114 pregnant women (BMI ≥ 24 kg/m2 and gestation < 16 weeks) were recruited from prenatal clinics in Taiwan from July 2021 to May 2022. The intervention group (IG) received the peer-led walking program with mHealth support, while the control group (CG) received standard antenatal care. Follow-ups were conducted at 24–28 weeks (T2), 36–40 weeks (T3), and one month postpartum (T4).
The IG had significantly higher exercise self-efficacy scores from T1 to T3 compared to the CG. IG participants showed notable progress in exercise behavior stages, transitioning from the contemplation stage at T1 to preparation and action stages at T2 (χ 2 = 13.208, p < 0.01), with some reaching the maintenance stage by T3 (20.9%, χ 2 = 9.49, p < 0.05). In contrast, most of the CG participants remained at the contemplation stage throughout pregnancy to early postpartum.
The peer-led walking intervention with mHealth has the potential to enhance self-efficacy and promote sustained exercise behavior of women with overweight or obesity during and after pregnancy and is a valuable approach to establishing long-term exercise behavior.
ClinicalTrials.gov: NCT 05022680
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
by Peiling Zuo, Huanhuan Zhu, Chunying Sun, Xiaohan Ma, Sheng Chen, Rong Tang, Tong Wu, Ding Zhang, Xiao Tang, Wenquan Lv, Wenzhong Chen, Xiawei Wei, Encun Hou, Minsheng Wu, Minghe Jiang
BackgroundEvidence indicates that the Endothelial Activation and Stress Index (EASIX) is a predictor of mortality in endothelium-related conditions; however, its association with mortality risk in atrial fibrillation (AF) remains uncertain. Accordingly, this study examines the relationship between EASIX and mortality risk among patients with AF.
MethodsThis retrospective analysis utilized data from the Medical Information Marketplace in Intensive Care IV (MIMIC-IV) database, which includes critically ill patients diagnosed with AF. To examine the association between EASIX scores and mortality, Kaplan–Meier survival analysis, Cox proportional hazards models, and restricted cubic spline regression were applied to evaluate the relationship between EASIX and all-cause mortality. Subgroup analyses were conducted to explore potential interactions with key patient characteristics, and sensitivity analyses were performed to further confirm the robustness of the results.
ResultsA total of 3,193 patients were included in the analysis. KM survival analysis showed that elevated EASIX levels were associated with a higher risk of both in-hospital and ICU mortality. After adjusting for potential confounders, increased EASIX levels remained significantly associated with in-hospital mortality [HR, 1.09 (95% CI 1.03, 1.15), P = 0.0002] and ICU mortality [HR, 1.10 (95% CI 1.04, 1.17), P = 0.0002]. Stratified analyses revealed a significant interaction between sepsis, respiratory failure, and EASIX in relation to both in-hospital and ICU mortality. To evaluate the robustness of the findings, a sensitivity analysis was performed. After additionally adjusting for metoprolol and heparin as covariates, patients in the highest EASIX group continued to demonstrate the greatest mortality risk: the HR for in-hospital death was 2.08 (95% CI: 1.51–2.85), and the HR for ICU death was 1.83 (95% CI: 1.21–2.65).
ConclusionElevated EASIX levels correlate with higher mortality rates, underscoring its potential as an accessible tool for identifying high-risk patients and informing clinical decisions. However, further studies are needed to explore the underlying mechanisms and validate its applicability across diverse patient populations.
Ample evidence has shown the benefit of high-fidelity simulation (HFS) in promoting learning in pre-licensure nursing students, but the evidence for practising registered nurses has not been synthesised.
To evaluate the effects of HFS training on learning outcomes and satisfaction in practising registered nurses.
In this systematic review and meta-analysis, we searched PubMed, CINAHL, ERIC, Cochrane Library, Web of Science and China National Knowledge Infrastructure (CNKI) for studies published in English or Chinese from database inception to 31 May 2023 (updated on 20 April 2025). All randomised controlled trials (RCT) or quasi-experiments that compared HFS training with traditional methods (e.g., lecture) for practising registered nurses and reported learning outcomes and satisfaction were included. Risk of bias was assessed by the Cochrane risk-of-bias tool for randomised trials (RoB 2) and non-randomised trials (ROBINS-I). Inverse-variance random-effect models were used to calculate standardised mean differences (SMDs) with 95% confidence interval (CI). We followed the PRISMA 2020 guideline.
Of 1404 records, eight eligible studies (five RCTs and three quasi-experiments) involving 275 practising nurses were identified. Two RCTs had high risk of bias, while others showed some concerns or moderate risk of bias. Meta-analyses showed that HFS could promote knowledge acquisition (SMD = 0.65, 95% CI, [0.35, 0.95], p < 0.01, I2 = 0%), professional skills (SMD = 0.72, 95% CI, [0.41, 1.04], p < 0.01, I2 = 0%) and learning satisfaction (SMD = 1.24, 95% CI, [0.35, 2.13], p < 0.01; I2 = 67%), compared with traditional methods. The pooled effect on self-confidence was marginally insignificant (SMD = 0.59, 95% CI, [−0.04, 1.22], p = 0.07; I2 = 67%).
Compared with traditional training methods, HFS is effective in promoting knowledge acquisition, professional skills and learning satisfaction and may enhance self-confidence among practising nurses. To strengthen the evidence base, more rigorous RCTs with larger sample sizes, adequate reporting of HFS design, and standardised outcome measures are warranted.
PROSPERO (CRD42022358717). No Patient or Public Contribution.
To describe the lived decision-making experiences of parents during the first 6 months after their children's new cancer diagnoses.
Descriptive phenomenological study.
This study was conducted from 2022 to 2023 at an academic teaching hospital in Taiwan. Parents of children newly diagnosed with cancer within the previous 6 months were recruited using purposive sampling. Data were collected via in-depth interviews with 18 participants and subsequently analysed using the Giorgi method.
Three major themes emerged: (1) making decisions without choices, with the subthemes of parallel universes and realities and overwhelming information and unanswered questions; (2) deferring decisions to expert judgements, with the subthemes of trust in professionals, working together, and seeing the future; and (c) balancing quality of life and survival, with the subthemes of confronting and suffering, mental preparation and worry, and being a strong supporter and carrying burdens. Hope for their children's survival sustained parents, empowering them to become steadfast sources of strength and support. Through hope, they transitioned from feeling helpless to actively advocating and assuming the primary caregiver role.
After deciding to proceed with their children's cancer treatment, hope for survival becomes the strongest factor motivating parents to navigate, explore, and move forward in an environment filled with uncertainty. Psychological preparation and understanding ease parental anxiety.
The development of clear, structured care plans is recommended to help parents feel supported and transition early from novices to confident guides.
The findings of this study highlight the shift in parents' roles following children's cancer diagnoses from facing unavoidable decision-making to actively striving to balance children's quality of life with treatment outcomes. They provide guidance for the support of parents' engagement with decision-making plans in clinical practice.
Standards for Reporting Qualitative Research.
None.
Chronic dyspnoea is a prevalent symptom, and primary care is ideally placed to identify and manage it. However, chronic dyspnoea is under-reported by patients and can be a diagnostic dilemma for practitioners. A fully automated system of patient screening, coupled with a clinical decision support system (CDSS) that uses a validated and evidence-based dyspnoea algorithm, may improve detection, diagnosis and management of the condition. There is currently no CDSS validated for chronic dyspnoea diagnosis and management in primary care in Australia. The objectives of this study are to assess the clinical impact of a CDSS for chronic dyspnoea in primary care. We hypothesise that the use of the CDSS will lead to a clinically significant improvement in patient-reported dyspnoea scores, reduced time to diagnosis and healthcare costs at 12 months compared with standard care.
The BREATHE study is an open-label, cluster-randomised controlled trial of standard of care compared with a CDSS. General practices (n=40) in metropolitan, regional/rural and rural/remote settings will be recruited and randomised equally to pre-screening for chronic dyspnoea and usual standard-of-care management or pre-screening and CDSS-guided management. The CDSS includes an algorithm derived from a robust data and clinical knowledge model and incorporates evidence-based recommendations for the assessment and management of chronic dyspnoea. It is integrated into general practice medical software systems, fitting in the workflow of general practitioners (GPs). Eligible patients will be ≥18 years old and will have previously consented to receive SMS communication from their practice. In-scope patients will receive an automated text message prior to their GP appointment and will be screened for chronic dyspnoea (≥4 weeks). Patients identified with chronic dyspnoea will be invited to participate in the BREATHE study and followed up for 12 months. The primary outcome is improvement in the Dyspnoea-12 (D-12) score from baseline to 12 months, measured by the Dyspnoea-12 (D-12) questionnaire. Secondary outcomes include disease-specific questionnaires to assess changes in clinical outcomes, time to final diagnosis, quality of life, healthcare utilisation and costs incurred to patients.
The trial is registered at ANZCTR (ACTRN12624001451594). ANZCTR is a primary registry that meets the requirements of the ICMJE and is listed on the ICTRP Registry Network.
The study protocol has been approved by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and complies with the National Health and Medical Research Council ethical guidelines. Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practice reception area.
Postoperative ileus (POI) is a prevalent complication following abdominal surgeries, significantly compromising patients’ quality of life and imposing a socioeconomic burden. Electroacupuncture (EA), a widely used therapeutic approach in China, has shown promise as an effective intervention for POI. However, the neural mechanism underlying its therapeutic effects remains unclear. Thus, this study aims to evaluate the efficacy of EA treatment for POI and investigate its central mechanism by functional MRI (fMRI).
This randomised controlled clinical trial will be conducted across three hospitals in China. A total of 50 eligible patients with colorectal cancer scheduled for elective laparoscopic surgery will be randomly assigned to either the EA or sham electroacupuncture (SA) group in a 1:1 ratio. All patients will undergo 5 sessions of 30 min EA or SA over 5 consecutive days post-surgery (once daily). Resting-state fMRI (rs-fMRI) scans will be performed at baseline and the end of treatment to examine brain functional changes related to EA treatment. The primary outcome is the time to first defecation. Secondary outcomes include the time to first flatus, ambulation, tolerability of semiliquid and solid food; length of postoperative hospital stay; severity of postoperative pain, abdominal distension and nausea; frequency of postoperative nausea and vomiting episodes; rate of readmission. Postoperative complications will be monitored and documented throughout the trial duration. Credibility and expectancy evaluation, along with blinding assessment, will be conducted after the first treatment session. Pearson/Spearman correlation analysis will be performed to determine the relationship between clinical variables and rs-fMRI metrics.
This protocol has been approved by the ethics committees of Beijing University of Chinese Medicine (number 2024BZYLL0113), Cancer Hospital Chinese Academy of Medical Sciences (number 24/323-4603), Beijing Friendship Hospital Affiliated to Capital Medical University (number 2024-P2-081-01) and Beijing Chaoyang Huanxing Cancer Hospital (number 2024-011-02). Participants will sign the paper-based informed consent form before enrolment. The results will be disseminated through peer-reviewed publications.
ITMCTR2024000504.
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