Conectar
by Hongzhen Yin, Tong Wang, Changshun Zhong, Yingya Cao, Xiaogan Jiang, Qiancheng Xu, Weihua Lu
Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014–30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51–72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.Embryo aneuploidy increases substantially with maternal age, contributing to implantation failure and miscarriage. Conventional morphological assessment cannot determine euploidy. Non-invasive preimplantation genetic testing (ni-PGT) evaluates cell-free DNA in spent embryo culture medium, potentially improving embryo selection without trophectoderm biopsy. Robust evidence of clinical benefit in women aged 35–42 years remains limited.
This is a multicentre, open-label, parallel-group randomised controlled trial conducted in three centres in China. Infertile women aged 35–42 years undergoing their first intracytoplasmic sperm injection cycle and having ≥2 good-quality days 5–6 blastocysts (Gardner grade ≥4BC,defined as an expansion grade of at least 4, with an inner cell mass grade of B or better and a trophectoderm grade of C or better) will be randomised 1:1 to ni-PGT-guided embryo selection or conventional morphology-based selection. Randomisation will be stratified by study centre using variable permuted block sizes of 4 and 6 and implemented through a unified centralised randomisation system. After a multicentre set-up period for investigator training and harmonisation of spent culture-medium sampling procedures, during which no participant was enrolled or randomised, recruitment and randomisation commenced on 14 February 2025 at the lead site; additional sites started recruitment after local ethics approval and site initiation. A freeze-all strategy will be applied; frozen-thawed single blastocyst transfer will start from the second menstrual cycle after oocyte retrieval.
For the primary endpoint, embryo transfers using embryos from the index retrieval cycle that occur within 12 months after randomisation and within the first three frozen-thawed single embryo transfer attempts will contribute to the cumulative outcome, whichever occurs first. Clinical care will not be restricted beyond this prespecified analysis range. The primary outcome is the cumulative ongoing pregnancy rate within 12 months after randomisation, defined as the proportion of participants achieving at least one ongoing pregnancy (clinical pregnancy continuing to ≥12 weeks’ gestation) following a qualifying embryo transfer within the prespecified analysis range. Key secondary outcomes include early miscarriage rate (
The trial will be conducted according to the Declaration of Helsinki. Ethics approval has been obtained from all participating centres before participant recruitment at each site. Written informed consent will be obtained from all participants. Results will be disseminated through peer-reviewed publication and conference presentations.
ChiCTR2400088283
by Yanan Zhu, Qian Wang, Huiying Jia, Gaiyun Zhao, Yunpeng Lü, Xinhong Zhang, Haijing Dong
This randomized controlled trial is aimed at evaluating whether external fixation of the urinary catheter to the body surface represents a low-value nursing intervention for patients undergoing transurethral resection of the prostate (TURP). A total of 208 patients who received indwelling urinary catheters after TURP in a tertiary hospital in Qingdao, China between June 2024 and May 2025 were randomly assigned to one of two groups: a nonexternal fixation group (n = 103) and an external body surface fixation group (n = 105). A between-group comparison of outcomes included postoperative hematuria, incidence of catheter-associated urinary tract infection (CAUTI), unplanned catheter removal, occurrence of urinary catheter-related meatal pressure injury (UCR-MPI), and associated economic costs. No significant differences were observed between the two groups in terms of postoperative hematuria or CAUTI incidence (P > 0.05). Unplanned catheter removal did not occur in either group. However, UCR-MPI occurred significantly more frequently in the external fixation group (9 patients) than it did in the nonexternal fixation group (1 patient) (Pby Lu Zhang, Si Wang, Jie Lei, Lingrui Zeng, Ailin Lu, Yongqing Wu, Yuan Shi, Jing Yang, Mengrui Yuan, Hongyi Liu
BackgroundDiabetic peripheral neuropathy (DPN) is a common complication of type 2 diabetes mellitus (T2DM) and is closely linked to immune and inflammatory dysregulation. Multi-component pharmacological interventions have been explored as complementary approaches for metabolic and immune modulation; however, their effects on DPN and related mechanisms remain incompletely understood.
MethodsA rat model of T2DM-associated peripheral neuropathy was established, and a multi-component pharmacological intervention (MPCI) was administered for 8 weeks. Peripheral nerve dysfunction was evaluated by motor and sensory nerve conduction velocities (MNCV and SNCV), behavioral outcomes, and histological/ultrastructural assessments. In parallel, spleen tissues were collected for transcriptomic profiling. RNA sequencing was performed to identify differentially expressed genes and immune-related pathways, and representative molecules involved in inflammatory regulation were further validated using western blotting and quantitative real-time PCR in sciatic nerve tissue.
ResultsMPCI administration significantly ameliorated peripheral nerve dysfunction in T2DM rats, as evidenced by improved nerve conduction velocities and pathological features. Transcriptomic analysis of spleen tissue revealed that MPCI was associated with broad remodeling of diabetes-related immune and inflammatory gene programs. In parallel, sciatic nerve analyses showed attenuation of NF-κB/c-Jun–associated inflammatory signaling and modulation of inhibitory regulators at both the protein and mRNA levels.
ConclusionThese findings indicate that MPCI improves T2DM-associated DPN and is associated with splenic immune remodeling and attenuation of peripheral nerve inflammatory signaling, providing exploratory evidence for associations between splenic immune transcriptomic remodeling and peripheral nerve inflammatory signaling.
To summarize the current evidence on reducing loneliness among informal caregivers of people with dementia, such as family members or friends.
A systematic review.
The methodological quality was evaluated using the revised Cochrane risk-of-bias tool for randomized controlled trials and the revised JBI critical appraisal checklist for quasi-experimental studies. Data were extracted as predefined and synthesized narratively. The Template for Intervention Description and Replication checklist was used to report the intervention characteristics.
Six electronic databases (MEDLINE via PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL Plus, and Web of Science Core Collection) were searched for studies published in peer-reviewed English journals from the inception of each database until 28 January 2024.
Eight studies were included in this review, published between 2002 and 2023, with three being randomized controlled trials. All included interventions were psychosocial. Only one study reported significant improvements in loneliness. Five studies utilized remote and online interventions, such as social networking, psychotherapy, and online social support. Interventions varied in their impact on secondary outcomes, including stress, depressive symptoms, anxiety, and caregiver burden. Four studies demonstrated a positive effect on caregiver stress levels. One pilot trial reported a positive impact on depressive symptoms, and another study noted potential improvements in anxiety. One pilot study reported an average improvement in caregiver burden.
While the evidence is insufficient for conclusive statements, this systematic review suggests potential benefits of interventions to reduce loneliness and improve mental health among these caregivers. It highlights the promise of remote interventions in addressing loneliness among dementia caregivers.
The findings suggest that tailored interventions, especially those delivered remotely, can enhance the support provided to caregivers, potentially improving their mental health and overall well-being.
This systematic review adhered to the PRISMA statement.
No patient or public contribution.
To assess the resilience of nurses exposed to workplace violence and analyse its influencing factors.
A cross-sectional study.
From October 2023 to April 2025, 396 nurses were recruited from hospitals in Shanghai and Nanjing, China. Personal Information Form, Hospital Workplace Violence Questionnaire, Resilience Assessment Scale for Medical Staff, General Self-efficacy Scale and Social Support Rating Scale were used to collect data. Descriptive statistics, t-tests, analysis of variance, Pearson's correlation analysis, multiple regression analysis and mediating effect analysis were used to analyse the data.
The mean resilience score was 67.38 ± 15.52. Professional title, self-efficacy and social support were the main influencing factors on resilience among nurses exposed to workplace violence. Resilience showed a significant positive correlation with both self-efficacy and social support. Self-efficacy was directly and positively associated with resilience, and was positively associated with social support, and social support partially mediated the relationship between self-efficacy and resilience.
Self-efficacy is directly and positively associated with resilience. Social support partially mediates the relationship between self-efficacy and resilience. These findings highlight the interaction between personal and environmental factors in shaping the resilience of nurses exposed to workplace violence.
Enhancing resilience among nurses exposed to workplace violence has important implications for increasing patient satisfaction and improving the quality of nursing.
Provided valuable insights into workplace violence within the nursing profession. Social support partially mediated the relationship between self-efficacy and resilience. Improving nurses' resilience requires enhancing personal self-efficacy and strengthening social support systems.
STROBE checklist was used.
To estimate the prevalence of loneliness, social isolation, and their co-occurrence among people living with HIV and to explore factors explaining heterogeneity between estimates.
A systematic review and meta-analysis.
PubMed, Cochrane Library, SciELO Citation Index (via Web of Science), Scopus, Embase, PsycArticles, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception until November 1, 2024 for relevant studies.
Study eligibility, data extraction, and methodological quality assessment were conducted independently by two reviewers. Random-effects meta-analysis was used to estimate pooled prevalence. Subgroup analyses were performed.
A total of 66 studies were included. The pooled prevalence of loneliness was 46.9% and that of social isolation was 25.9%. However, heterogeneity was very high across studies, and these pooled estimates should therefore be interpreted cautiously. Subgroup analyses suggested regional variation in both loneliness and social isolation. Other subgroup findings should be interpreted cautiously because some subgroup estimates were based on small numbers of studies.
Loneliness and social isolation are highly prevalent among people living with HIV. Population-specific intervention strategies are needed to reduce this burden, and future studies should further examine contextual and demographic differences to guide intervention design.
Routine HIV services should include screening and referral pathways for loneliness and social isolation.
This systematic review identified the pooled prevalence of loneliness and social isolation among people living with HIV, highlighting a substantial and clinically relevant burden. The findings may influence HIV nurses' practice and inform care approaches for other clinical populations experiencing loneliness and social isolation.
This systematic review followed the PRISMA and MOOSE reporting guidelines.
No patient or public contribution.
To systematically review the evidence on diagnostic prediction models for depression in patients with breast cancer.
Systematic review.
Ten databases were searched from inception to 22 August 2025, with an updated search on 17 December 2025, to identify original studies developing and/or validating diagnostic prediction models for depression in patients with breast cancer.
Data were extracted using the Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) framework. Two reviewers independently assessed risk of bias and applicability of included studies using the Prediction Model Risk of Bias Assessment Tool (PROBAST).
Eleven studies were included. Reported area under the curve (AUC) values ranged from 0.784 to 0.890. All included studies were judged to be at high risk of bias, and seven raised high concerns regarding applicability. There was substantial heterogeneity in predictor selection across studies, with age, income level and family support being the most frequently reported predictors.
Although preliminary research on diagnostic prediction models for depression in patients with breast cancer has been undertaken, their methodological quality remains weak. Reporting of external validation and calibration assessment was limited. Current evidence is therefore insufficient to support their routine use in nursing practice. Future research should standardise model development and validation and strengthen the evaluation of model performance.
This review suggests that existing diagnostic prediction models for depression in patients with breast cancer are not yet sufficiently robust for routine nursing use, but may provide a reference for future nursing screening research and the optimisation of related tools.
This review synthesises the available evidence on diagnostic prediction models for depression in patients with breast cancer and provides a basis for future model development, validation and optimisation.
This review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis: Systematic Reviews and Meta-Analyses (TRIPOD-SRMA) checklist.
No patient or public contribution.
To establish optimal pre-pregnancy body mass index (BMI)-specific gestational weight gain (GWG) ranges for twin pregnancies and compare their association with maternal and neonatal adverse outcomes against Institute of Medicine (IOM) recommendations.
Retrospective cohort study. Retrospective cohort study. Adjusted ORs (aORs) with 95% CI were used to quantify associations; average marginal effects (AME) with 95% CI (in percentage points) were used to compare absolute risk differences.
Perinatal data from >70 obstetric institutions in Wuhan, China, collected via the Wuhan Maternal and Child Health Service Management Information System.
10 636 women with twin deliveries at ≥28 weeks (2011–2023). Pre-pregnancy BMI categorised using Chinese cut-offs: underweight
Hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM), small for gestational age (SGA) and large for gestational age.
Optimal GWG ranges were: underweight 18.0–25.0 kg, normal 14.0–24.0 kg, overweight 12.2–24.0 kg, obesity 13.3–20.0 kg. Compared with IOM guidelines, study-derived ranges showed more favourable risk identification. In normal weight women, excessive GWG increased HDP risk (aOR 1.79, 95% CI 1.49 to 2.14); 13.57% versus 8.79%, AME 5.90 pp (95% CI 3.88 to 7.91 pp). In underweight women, inadequate GWG increased PROM (aOR 1.64, 95% CI 1.05 to 2.57); 14.48% versus 7.51%, AME 4.18 pp (95% CI 0.31 to 8.06 pp) and SGA (aOR 1.72, 95% CI 1.29 to 2.31); 45.58% versus 41.40%, AME 11.74 pp (95% CI 5.55 to 17.94 pp). In overweight women, excessive GWG increased HDP (aOR 1.81, 95% CI 1.21 to 2.70); 24.39% versus 16.32%, AME 9.68 pp (95% CI 2.49 to 16.88 pp) and inadequate GWG increased SGA (aOR 1.60, 95% CI 1.20 to 2.14); 35.15% versus 27.82%, AME 9.85 pp (95% CI CI 3.72 to 15.97 pp), which IOM failed to detect. In obese women, inadequate GWG increased SGA (aOR 2.76, 95% CI 1.37 to 5.53); 27.18% versus 17.16%, AME 17.95 pp (95% CI 5.74 to 30.17 pp), which was missed by IOM.
Our findings support adopting region-specific GWG standards for twin pregnancies in Asian populations.
Major depressive disorder (MDD) is a leading cause of disability among adolescents, yet available treatments remain limited. Bright light therapy (BLT) is a non-pharmacological intervention with demonstrated efficacy in adults. However, its clinical utility and underlying neural mechanisms in adolescents remain unclear. This trial aims to evaluate the clinical efficacy, time to onset, safety and applicability of home-based BLT in outpatient adolescents with MDD, and to explore its underlying neural mechanisms using functional near-infrared spectroscopy (fNIRS).
This is a randomised, placebo-controlled, three-arm multicentre clinical trial. A total of 126 outpatient adolescents aged 13–17 years with MDD will be randomly assigned to receive high-intensity BLT, medium-intensity BLT or placebo dim red light using a portable light box in a home-based setting for 40 min each morning over 4 weeks, followed by a 2-week follow-up. 42 age-matched and gender-matched healthy controls will also be enrolled for baseline assessments only, serving as normative references for comparison. The primary outcome will be the change in total scores on the 17-item Hamilton Rating Scale for Depression from baseline to week 4. All analyses will follow an intention-to-treat framework to ensure methodological rigour. The primary outcome will be analysed using analysis of covariance and linear mixed-effects models. Secondary outcomes will include response and remission rates, time to onset, maintenance of efficacy, self-reported depressive symptoms, sleep quality, cognitive function, anxiety, irritability, suicidal ideation, non-suicidal self-injury, self-efficacy and the overall safety profile of BLT. Prefrontal cortical activity will be measured using fNIRS at baseline and week 4 to explore potential neural mechanisms. Approximately 15% of participants will additionally take part in a qualitative substudy exploring experiences and acceptability of BLT.
The study protocol has been approved by the Ethics Committee of Peking University Sixth Hospital (approval number: 2025–24). Written informed consent will be obtained from all participants and their legal guardians prior to enrolment. Study findings will be disseminated through peer-reviewed journals and conference presentations.
This study aimed to explore the lived experiences of fear of complications (FoC) among hospitalised people with type 2 diabetes (T2D) in China and to provide insights for targeted nursing interventions.
A phenomenological research approach was employed to conduct semistructured interviews and the Colaizzi’s seven-step analysis method was used for data analysis. This study followed the Consolidated Criteria for Reporting Qualitative Research checklist.
15 people with T2D were purposively recruited between March and July 2025 from the endocrinology departments of two tertiary hospitals in Daqing City, Heilongjiang Province.
Three themes and 11 subthemes were identified: (1) experiencing multiple negative psychological responses (distress from negative emotions, contradictory and painful psychological states, social alienation); (2) the triggers of fear are complex (adverse outcomes of similar patients, illness uncertainty, symptom burden, self-perceived burden, economic burden) and (3) employing diverse coping strategies (negative avoidance, positive self-adjustment, seeking social support).
Healthcare professionals should pay greater attention to FoC among people with T2D. Early psychological assessment, identification of fear triggers, strengthening social support and promoting adaptive coping strategies may help reduce fear and improve quality of life.
This study investigated the knowledge and attitudes (KA) towards perioperative pulmonary embolism (PE) in patients undergoing major orthopaedic surgery, a population at particular risk.
A single-centre, cross-sectional study.
A tertiary care hospital in Shanghai, China.
454 patients scheduled for major orthopaedic surgery (Grade III or above) were enrolled between February and September 2024. Selection criteria included adult patients undergoing eligible procedures, while exclusion criteria encompassed cognitive impairment or refusal to participate. All enrolled participants completed the study.
The primary outcomes were the total scores on validated knowledge and attitude questionnaires. Secondary outcomes included the identification of demographic factors associated with these scores and the analysis of the direct relationship between knowledge and attitude using structural equation modelling (SEM).
The average knowledge score was 52.9% (23.82/45), indicating poor understanding. The average attitude score was 66.4% (29.88/45), indicating a moderate attitude. The multivariable analysis showed that a college diploma (OR=4.824, 95% CI 2.399 to 9.703, p
Patients undergoing major orthopaedic surgery possess poor knowledge but moderately positive attitudes toward PE. Educational level is a key factor influencing KA. Improving patient knowledge and attitudes is crucial for supporting informed surgical decision-making and enhancing perioperative self-management, though the complex relationship between knowledge and attitude warrants further investigation.
Mechanical ventilation during patient transport is a high-risk clinical practice. While the novel Mindray TV80, a high-performance emergency transport ventilator, offers potential advantages for use across complex transport settings, rigorous clinical data comparing its oxygenation performance in critically ill, mechanically ventilated patients during transport are lacking. This study aims to address this gap by evaluating the non-inferiority of TV80 to Hamilton T1 in maintaining oxygenation stability.
This is a prospective, single-blind, single-centre, parallel-group, non-inferiority randomised controlled trial. Mechanically ventilated patients (18–80 years) requiring intrahospital or interhospital transport will be recruited. Eligible patients will be randomised at a 1:1 ratio to the TV80 group (intervention) or Hamilton T1 group (control) using a permuted block design stratified by transport type (intrahospital vs interhospital) via the electronic data capture system. The intervention involves using the assigned ventilator during transport, with parameters replicated from the patient’s pre-transport ventilator. The primary outcome is the difference in oxygenation index (P/F) before (within 1 hour) and after (within 1 hour) transport as measured by blood gas analyser. Continuous SpO2 monitoring will be performed throughout the transport period to capture real-time oxygenation changes. Secondary outcomes include transport preparation time, changes in PaCO2 and pH, variability of ventilator parameters (tidal volume, FiO2) and vital signs (heart rate, SpO2, mean arterial pressure) and incidence of adverse events (AEs)/serious AEs. Sample size is 98 (49 per group) to achieve 80% power with a non-inferiority margin of –30 mm Hg. Pre-specified subgroup analyses by transport type will be performed.
This study has been approved by the Human Research Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (approval number: LSY-2025-0903). Written informed consent will be obtained from participants’ legal representatives. All results will be submitted to a peer-reviewed journal for publication.
NCT07198269 (ClinicalTrials.gov).
by Qian He, Xu Huang
BackgroundSepsis-induced immunosuppression is a key factor contributing to high mortality rates. However, suitable biomarkers for routine clinical monitoring of immune function are currently lacking. Serum cholinesterase levels are markedly diminished in sepsis and are associated with unfavorable prognoses, its role in the immunosuppression pathology and the mechanisms involved remain inadequately understood.
MethodsWe conducted a translational study integrating clinical research, bioinformatics analysis and animal experiments. Initially, within a single-center clinical cohort, we investigated the correlation between serum cholinesterase levels and lymphocyte subsets in patients suffering from sepsis, subsequently evaluating its association with disease severity (APACHE-II and SOFA scores) and clinical outcomes. Subsequently, by integrating sepsis transcriptome data with cholinergic anti-inflammatory pathways and immune-related gene sets, we identified the hub gene RORA and validated it across multiple dimensions using public databases. Finally, in the CLP sepsis mouse model, we measured cholinesterase activity and specifically quantified RORA mRNA expression in the spleen. We then analyzed the correlation between these measurements and changes in key immune cell counts.
ResultsClinical data revealed significantly reduced serum cholinesterase activity in sepsis patients. Decreased cholinesterase levels positively correlated with elevated disease severity scores (APAChE-II, SOFA) and reduced counts of CD4 ⁺ T cells, CD8 ⁺ T cells, and NK cells. Bioinformatics analysis identified RORA as a hub gene linking sepsis, cholinesterase, and immune responses. Across eight independent GEO datasets, RORA expression exhibited a consistent downregulation trend in sepsis with high diagnostic value. Analysis of immune cell infiltration revealed significant positive correlations between RORA and counts of CD4 ⁺ T, CD8 ⁺ T, and NK cells in sepsis. In the CLP mouse model, reductions in spleen CD3 ⁺ T, CD4 ⁺ T, and CD8 ⁺ T cell counts coincided with notable decreases in serum cholinesterase and spleen RORA mRNA levels. Both serum cholinesterase concentration and spleen RORA mRNA expression exhibited positive correlations with CD4 ⁺ T and CD8 ⁺ T cell counts.
ConclusionThis study establishes serum cholinesterase as a valuable clinical biomarker for assessing sepsis diagnosis, disease severity, and immunosuppression. For the first time, through multiomics integration and experimental validation, RORA has been identified as the key molecular bridge linking the cholinesterase activity and immunosuppression in sepsis. This not only provides a new direction for understanding immune dysregulation in sepsis but also lays a theoretical foundation for the future development of RORA-targeted immunomodulation and treatment strategies for sepsis.
To synthesise existing qualitative and conceptual literature on the implementation, ethical considerations and policy implications of Medical Assistance in Dying for Mental Disorder as a Sole Underlying Medical Condition (MAiD MD-SUMC) in Canada and internationally.
A qualitative evidence synthesis using a thematic analysis approach. Empirical, conceptual and policy papers addressing MAiD for mental disorders were identified through major databases and grey literature. Studies were thematically analysed to identify recurring ethical, clinical and policy themes related to eligibility, assessment and implementation.
Data was extracted from a systematic search of Medline and Embase for peer-reviewed studies published from 1974 onwards, supplemented by relevant policy documents and legal cases.
Studies were included if they examined MAiD MD-SUMC and explored ethical, legal or clinical considerations or provided stakeholder perspectives. Exclusion criteria included studies focusing solely on non-psychiatric conditions or not published in English.
Two independent reviewers screened, extracted and analysed data using an iterative thematic synthesis approach. Key themes were identified through consensus discussions.
The synthesis identified four major themes: (1) Irremediability and treatment resistance—persistent uncertainty regarding when mental disorders can be considered irremediable. (2) Capacity and vulnerability—ongoing debate about assessing capacity amid fluctuating symptoms and social influences. (3) Ethical and policy considerations—divergent interpretations of autonomy, justice and safeguards highlighting the need for standardised criteria. (4) Public and professional perspectives—public and family support for inclusion, although clinician hesitancy exists.
The evidence supports a thoughtful, structured approach to potential implementation of MAiD MD-SUMC in Canada. Future priorities include refining criteria for irremediability, standardising capacity assessments, addressing disorder-specific complexities and strengthening mental health infrastructure. Continued research, engagement and transparent policy dialogue will be essential to ensure that any expansion of MAiD upholds ethical integrity, protects vulnerable persons and maintains public trust.
To improve the rates of central line–associated bloodstream infections in an intensive care and non-intensive care setting in a large Australian health service.
Evidence-based care bundles targeting central line practices were developed and implemented using a pragmatic action research–approach.
Wards recruited change facilitators to implement the bundles. Compliance and ward engagement were measured, and pre-intervention and intervention central line–related infection rates were compared.
Wards showed a reduction in central line–related infections by 90% during the intervention for up to 2 years. Adherence to bundles was high in both settings. Improvements in insertion practices were observed after baseline and were sustained, with the largest improvement seen in documentation. Maintenance and removal practices showed less variation than insertion practices.
Care bundles are an effective intervention to reduce central-line-related infections over a sustained period when clinician adherence is high.
Care bundles can be effective in high-risk settings beyond intensive care units, including haemodialysis.
Central lines were identified from local hospital data as a major contributor to health care–associated infection rates. Care bundles were implemented in high-risk settings and demonstrated sustained reductions in central-line-related infections. Care bundles are an effective intervention for health care organisations to reduce and sustain preventable infections in high-risk patient cohorts.
We adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework.
No patient or public contribution.
Cardiac rehabilitation (CR) is an effective intervention for improving outcomes in patients with coronary heart disease (CHD). However, the actual participation rate is unsatisfactory and exhibits significant gender disparities. This study aimed to investigate gender-specific determinants of the decision to participate in CR among patients with CHD, together with underlying causes.
Cross-sectional study.
A cross-sectional survey of 264 patients with CHD from 3 Chinese tertiary hospitals between February 2024 and February 2025. Data were collected using questionnaires based on the Information Need in Cardiac Rehabilitation scale, the Chinese version of Cardiac Rehabilitation Barriers Scale, the Family APGAR index questionnaire, and the International Physical Activity Questionnaire-Short Form.
There were 158 men aged 66 (SD = 13.3) and 106 women aged 66 (SD = 11.0). 55.1% of men CHD patients decided to participate in CR, significantly higher than in women patients (34.0%; χ 2 = 11.351, p = 0.001). Logistic regression analysis for men indicated that the facilitators of the decision to participate in CR were the level of family functioning and ≥ 2 comorbidities. The barriers included emergency/safety information needs and functional status. For women, the facilitators were retirement, family functioning level, being overweight/obesity, ≥ 2 comorbidities, and work/vocational/social factors. The barriers included medication information needs, logistical factors, and functional status. Fairlie decomposition revealed gender differences primarily driven by work/vocational/social factors (contribution: 71.19%), functional status (50.50%), and retirement (−39.16%) (all p < 0.05).
This study highlights the necessity of gender-specific interventions during the decision-making phase for CR. Healthcare professionals should tailor CR strategies to address women's social role barriers and men's emergency risk concerns, while enhancing family functioning and targeting support for functional status and work-related factors.
STROBE checklist, cross-sectional.
Three tertiary hospitals assisted in participant recruitment.
This study aimed to retrieve, evaluate, and synthesize the best available evidence on noise management in neonatal wards to establish a foundational basis for implementing effective noise control practices.
Guided by the “6S” evidence pyramid model, a systematic search was performed across multiple sources including clinical decision support systems, guideline repositories, professional websites, and major databases up to April 12, 2025. Literature types encompassed guidelines, evidence summaries, expert consensuses, and systematic reviews. Following quality appraisal, two researchers independently extracted and synthesized the evidence.
Sixteen publications were included: one guideline, six evidence summaries, six systematic reviews, and three expert consensuses. From these, 33 pieces of best evidence were synthesized and categorized into five key domains: noise sources, measurement techniques, threshold levels, reduction interventions, and clinical effects of noise.
This work provides a scientifically rigorous and comprehensive evidence summary for neonatal ward noise management, offering valuable guidance for clinical practice. Successful application requires adaptation to local contexts. Developing tailored, evidence-based implementation plans is recommended to bridge the evidence-practice gap and enhance neonatal outcomes.
Given neonates' heightened vulnerability, standardized noise management in the NICU is crucial. This summary provides clinicians with a robust, evidence-based framework to develop localized protocols. Its implementation is expected to improve the acoustic environment, thereby promoting physiological stability, supporting neurodevelopment, and reducing noise-related complications.
This evidence summary followed the reporting specifications of the Fudan University Center for Evidence-Based Nursing (Joanna Briggs Institute methodology) and was registered (ES20257726).
No Patient or Public Contribution.
FreshRSS 