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Real-world safety of aliskiren in primary hypertension: A cross-database study

by Meirong Shan, Qian Guo, Ruofei Li, Ni Li, Yanhua Fu, Huanyu Qi, Ge Zhang, Qian Wang, Xingli Xu, Jinchuan Lai

Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7–282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.

Development and Internal Validation of a Gradient Boosting Model for Pressure Injury Risk in the ICU

ABSTRACT

Pressure injury (PI) is common in the ICU and not well captured by single-risk tools such as the Braden scale. We aimed to develop and internally validate a machine-learning model to predict new-onset PI using routinely collected ICU data. This retrospective single-centre cohort included adult ICU patients with length of stay ≥ 48 h (2018–2023). The primary outcome was new-onset PI during ICU stay. Candidate predictors were pre-specified: minimum albumin, maximum lactate, SOFA, APACHE II, first recorded Braden score, age, BMI, a nutrition score and treatment indicators. Missing values were imputed (median/mode). A gradient boosting model (GBM) was evaluated with stratified 3-fold cross-validation; a random forest (RF) served as a benchmark (stratified 70/30 train–test split). Discrimination (AUC) was primary; calibration, Brier score, decision-curve analysis (DCA) and feature importance were secondary. Logistic regression quantified independent associations. Among included ICU stays, 14.6% developed PI. On multivariable analysis, higher lactate, lower albumin, lower Braden scores, older age, CRRT, prone positioning, enteral nutrition and analgesic exposure were associated with increased PI risk, whereas sedatives showed an inverse association. The GBM achieved AUC≈0.69 with acceptable calibration and net clinical benefit across thresholds commonly used in preventive workflows (≈0.10–0.50). Single markers or simple combinations displayed only modest discrimination. A GBM built from routine ICU data provided moderate, well-calibrated discrimination for predicting new-onset PI and demonstrated decision-relevant net benefit. The model can complement Braden-based screening by refining risk stratification and prioritising intensified prevention for patients most likely to benefit. External validation and prospective evaluation are warranted.

Efficacy of heparin in respiratory support of near-term rabbits with meconium-induced acute lung injury: Linear regression model analyses

by Siyu Xie, Qiang Gu, Guiyin Zhuang, Xiaojing Guo, Bo Sun

Objectives

To explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications.

Methods

Newborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models.

Results

Significantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible.

Conclusion

The comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.

Reliability and validity of EuroQol-5 Dimensions-5 Levels in patients with haematologic malignancies: a cross-sectional study in China

Por: Qin · W. · Chen · Y. · Ouyang · Y. · Xiao · H. · Yu · D. · Zeng · C. · Chen · J. · Chen · T. · Huang · H. · Qian · Z. · Chen · W. · Xu · Y.
Objectives

Robust assessment of health-related quality of life (HRQoL) is essential for evaluating the disease burden in patients with haematologic malignancies. This study examined the performance of the EuroQol-5 Dimensions-5 Levels (EQ-5D) instrument in patients with multiple myeloma (MM), acute leukaemia (AL) and lymphoma using time trade-off (TTO)-elicited utility scores as the reference, and explored factors contributing to discrepancies between EQ-5D and TTO utilities.

Design

We performed a cross-sectional observational study using EQ-5D and TTO to assess HRQoL.

Setting

A leading tertiary care hospital in China.

Participants

158 patients consecutively admitted to hospital for MM (n=50), AL (n=63) and lymphoma (n=45) between January and August 2024.

Outcome measures

The primary outcome was the EQ-5D performance in terms of internal consistency (Cronbach’s α), criterion validity (Spearman’s correlation with TTO), and structural validity (exploratory factor analysis). The secondary outcome was the patient characteristics associated with discrepancies between EQ-5D and TTO utilities.

Results

TTO utility scores were highest in AL (0.798), followed by lymphoma (0.755) and MM (0.693). EQ-5D utility values were consistently higher than TTO across all groups. Among the three groups, EQ-5D demonstrated the best psychometric performance in patients with MM, with excellent internal consistency (Cronbach’s α=0.899), strongest correlation with TTO (r=0.538, p

Conclusions

EQ-5D performed well in patients with MM, supporting its use in this population. In patients with AL, adjustments for clinical characteristics such as chronic kidney failure may improve the accuracy of EQ-5D utility values. The poor psychometric performance of EQ-5D in patients with lymphoma raises concerns about its appropriateness as a standalone instrument for HRQoL.

The Impact of Observed Workplace Ostracism on Nurses' Helping Behaviour: The Role of Moral Courage and Employee Resilience

ABSTRACT

Aim

This study investigates how observed workplace ostracism affects nurses' helping behaviour from a bystander's perspective, examining the mediating roles of moral courage and employee resilience to inform strategies for fostering workplace harmony in nursing settings.

Design

A cross-sectional study design was adopted.

Methods

A survey of 346 nurses from two Grade III, Level A hospitals in Henan, China, utilised scales measuring workplace ostracism, moral courage, helping behaviour and employee resilience. SPSS Statistics 26.0, Mplus 8.3 and the SPSS macro program Process 4.1 plugin were used to test the associations among variables.

Results

Observed workplace ostracism positively correlated with nurses' helping behaviour, with moral courage partially mediating this relationship. Employee resilience moderated both the link between observed workplace ostracism and moral courage, and the indirect effect of observed workplace ostracism on helping behaviour through moral courage.

Conclusion

Nurses with high levels of resilience demonstrate moral courage when observing workplace ostracism and engage in helping behaviours towards those ostracised.

Impact

This study examines how workplace ostracism undermines nursing team cohesion and individual well-being. It highlights that bolstering nurses' resilience and moral courage can alleviate these adverse effects, thereby improving patient care quality. Nursing managers are advised to adopt targeted strategies, such as resilience training, to mitigate workplace ostracism.

Implications for the Profession and/or Patient Care

This study employs a questionnaire to explore nurses' views of workplace ostracism and helping behaviours, aiming to inform strategies for fostering nursing team harmony and improving care quality.

Reporting Method

This study strictly follows the STROBE reporting guidelines to ensure the clarity and credibility of the research findings.

Patient or Public Contribution

Data were collected from hospital nurses through electronic questionnaires.

Development and Psychometric Testing of a Low Extremity Lymphedema Risk Management Behaviours Questionnaire for Patients With Gynecologic Cancer

ABSTRACT

Background

Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.

Aims

To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer.

Design

This was a methodological study.

Methods

Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test–retest reliability were also evaluated.

Results

A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.

Conclusions

The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.

Implications for the Profession and/or Patient Care

The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.

Reporting Method

This manuscript followed the STROBE guidelines.

Patient or Public Contribution

Patients with gynecologic cancer participated in this study and provided the data through the survey.

Mediating Effects of Resilience and Perceived Social Support Between Gratitude and the Adaptability to Return‐To‐Work in Cancer Patients

ABSTRACT

Aims

This study aims to explore the mediating role of resilience and perceived social support in the relationship between gratitude and the work reintegration adaptability of cancer patients in China.

Design

A cross-sectional and correlational study.

Methods

A total of 402 participants were collected from July to December 2023 from a tertiary hospital in Jiangsu Province, China, using a convenience sampling method. The survey utilised the General Information Questionnaire, the Gratitude Questionnaire-6 (C-GQ-6), the Cancer Patient Return-to-Work Adaptation Scale, the resilience Scale (CD-RISD), and the Perceived Social Support Scale (PSSS) to collect data. The theoretical hypothesis was tested using structural equation modelling (SEM) analysis, with model fit corrections performed to examine the internal relationships and pathways among gratitude, resilience, perceived social support and return-to-work adaptability.

Results

Gratitude, resilience, and perceived social support were significantly correlated with work reintegration adaptability. Resilience and perceived social support independently mediate the relationship between gratitude and work reintegration adaptability, with mediation effects of 56.63% and 7.77%, respectively. Additionally, resilience and perceived social support fully mediate the relationship between gratitude and work reintegration adaptability, with a chain mediation effect of 35.60%.

Conclusion

Gratitude can affect cancer patients' return to work adaptation through resilience and perceived social support.

Impact

Healthcare professionals should focus on the impact of gratitude on cancer patients' adaptability to work reintegration. Interventions targeting resilience and perceived social support should be developed to enhance patients' work reintegration and promote their overall recovery and social reintegration.

Reporting Method

STROBE checklist.

Patient or Public Contribution

No patient or public contribution.

Experiences and Responses to Cancer‐Related Anorexia Across Patients, Caregivers and Healthcare Professionals: A Qualitative Meta‐Synthesis

ABSTRACT

Aim

To synthesise qualitative evidence on how patients, caregivers and healthcare professionals perceive and respond to cancer-related anorexia (CRA), and to develop a multi-level framework for improving CRA care.

Design

A qualitative meta-synthesis using the Joanna Briggs Institute (JBI) methodology, informed by the Social Ecological Model (SEM).

Methods

Seven databases were searched for qualitative studies from inception to April 2025. Studies were assessed using the JBI Critical Appraisal Checklist. Meta-aggregation was used to synthesise findings, and the ConQual method assessed confidence levels.

Data Sources

PubMed, Embase, CINAHL, PsycINFO, Cochrane Library, CNKI and WanFang.

Results

Seventeen studies from 10 countries were included, reflecting the perspectives of patients, caregivers and healthcare professionals. Four synthesised findings were identified. At the individual level, CRA was linked to physical decline, emotional distress and changes in identity. The interpersonal level involved feeding-related tensions and caregiver burden. Organisational barriers included delayed care and poor cultural responsiveness. Policy-level factors such as limited insurance coverage and rural access further impeded care. Overall confidence in these synthesised findings was low to moderate.

Conclusion

CRA is not solely a biological condition but a multidimensional experience. Addressing CRA requires integrated and context-sensitive strategies across personal, relational, organisational and policy domains.

Implications

Nurses and clinicians should address not only physical symptoms but also the emotional and social dimensions of eating. Structured support for caregivers and improved service access, particularly in underserved settings, are needed.

Impact

This study provides a multi-level understanding of CRA. The findings support better patient care, caregiver support and more equitable healthcare policy design.

Reporting Method

JBI methodology and ENTREQ guideline.

Patient or Public Contribution

No Patient or Public Contribution.

Trial Registration

PROSPERO Database: CRD420251041265

Cross-cultural adaptation and psychometric testing of the Evidence-Based Practice Mentoring Scale in Chinese nurses

Por: Wang · M. · Sun · S. · Guo · M. · Qian · J. · Sun · Y. · Chen · M. · Yu · X.
Objectives

Mentoring has been identified as a promising strategy for implementing and sustaining evidence-based practice (EBP) in healthcare organisation. However, no appropriate tools were specifically developed or cross-culturally adapted into Chinese context to assess nurse’s perceived EBP mentoring, impeding comprehensive evaluation of the effects of mentoring intervention studies. This study aimed to cross-cultural adapt the Evidence-Based Practice Mentoring (EBPM) scale into Mainland China and evaluate its psychometric properties, including validity and reliability.

Design

A comprehensive translation and adaptation process was adopted to achieve the Chinese version of the EBPM (C-EBPM) scale. It consists of four steps: (1) trilateral translation procedure, (2) cognitive interview, (3) psychometric testing and (4) cross-time confirmatory factor analysis (CFA).

Setting

This study was conducted in four 3A-level hospitals located in Shaanxi and Zhejiang provinces, China, during two different data collection periods.

Participants

A total of 598 registered nurses participated in this study.

Results

After two rounds of the trilateral translation procedure, a 9-item version of the C-EBPM scale was generated. Ten registered nurses participated in cognitive interview understood the meaning of all items but the response options. All items had significant critical ratio values (t=15.866~20.584, p²/df=65.681/27 0.950, Tucker-Lewis Index=0.966 > 0.950, and standardised root mean square residual=0.026 0.70) and average variance extracted was 0.60 (>0.50).

Conclusions

The 9-item C-EBPM scale demonstrated robust reliability and validity and is suitable for assessing EBP mentoring among nurses.

Prophylactic norepinephrine versus phenylephrine infusion on postpartum blood glucose in women undergoing caesarean section: a randomised controlled trial protocol

Por: Zhang · K. · Cao · H. · Ji · H. · Yu · G. · Wu · L. · Shen · Q. · Qian · W. · Tao · W.
Introduction

Norepinephrine (NE) and phenylephrine (PE) are routinely administered vasopressors used to maintain haemodynamic stability during caesarean section. Emerging evidence suggests that sustained infusion of these agents may disrupt maternal blood glucose regulation. This randomised controlled trial aims to compare the effects of NE and PE infusion on changes in postpartum blood glucose levels, insulin concentrations and insulin resistance in women after caesarean delivery.

Methods analysis

In this double-blind, randomised trial, 100 eligible parturients will receive prophylactic intravenous infusion of either NE or PE at a rate of 30 mL/hour immediately after subarachnoid anaesthesia, continuing until the end of surgery. The primary outcome is the difference between maternal preoperative and immediate postoperative blood glucose levels. Secondary outcomes include immediate and 6-hour postoperative insulin levels, as well as Homeostasis Model Assessment of Insulin Resistance.

Ethics and dissemination

The Institutional Ethics Committee of Xuancheng People’s Hospital approved the trial protocol (ID: 2025-yjky022-02). Findings will be published in an appropriate journal, and original data will be made available in November 2029 via the ResMan primary data-sharing platform of the China Clinical Trial Registry (http://www.medresman.org.cn).

Trial registration number

ChiCTR2500107683.

Effectiveness of E‐Health Interventions on Improving Physical Activity in Pregnant Women: A Systematic Review and Meta‐Analysis

ABSTRACT

Aims

This study aimed to (1) evaluate the effectiveness of e-health interventions in improving physical activity and associated health outcomes during pregnancy, (2) compare the e-health functions employed across interventions and (3) systematically identify the behaviour change techniques (BCTs) used and examine their interrelationships.

Design

A systematic review and meta-analysis following the PRISMA 2020 guidelines.

Methods

Randomised controlled trials were included. Meta-analyses and subgroup analyses were performed using RevMan 5.3. Social network analysis was conducted to determine the most central BCTs within the intervention landscape.

Data Sources

Ten databases were searched, including PubMed, Embase, Web of Science, Cochrane Library, ProQuest, Scopus, SinoMed, China National Knowledge Infrastructure, WanFang and the China Science and Technology Journal Database, from inception to April 22, 2024.

Results

Thirty-five studies were included. Pooled analyses indicated that e-health interventions significantly improved both total (SMD: 0.19; 95% CI: 0.10 to 0.27; I 2 = 55%) and moderate-to-vigorous physical activity (SMD: 0.16, 95% CI: 0.06 to 0.26; I 2 = 53%) in pregnant women. Subgroup analyses revealed that interventions based on theoretical frameworks and those not specifically targeting overweight or obese women demonstrated greater effectiveness. Additionally, e-health interventions were associated with significant reductions in both total and weekly gestational weight gain. Six of the twelve e-health functions were utilised, with ‘client education and behaviour change communication’ being the most prevalent. Thirty unique BCTs were identified; among them, ‘instruction on how to perform the behaviour’, ‘self-monitoring’, ‘problem solving’, and ‘goal setting’ showed the highest degree of interconnectedness.

Conclusion

E-health interventions are effective in enhancing physical activity and reducing gestational weight gain during pregnancy. Incorporating theoretical frameworks and well-integrated BCTs is recommended to optimise intervention outcomes.

Relevant to the Clinical Practice

Integrating e-health interventions into existing perinatal care models holds promise for enhancing physical activity among pregnant women and improving maternal health outcomes.

Reporting Method

This study adhered to the PRISMA checklist.

Patient or Public Contribution

No patient or public involvement.

Trial Registration

The study protocol was preregistered in the International Prospective Register of Systematic Reviews (CRD42024518740)

Refining Fall Risk Assessment Scale for Nursing Homes Among Older Adults With Cognitive Impairment: A Mokken Analysis

ABSTRACT

Aim

To refine fall risk assessment scale among older adults with cognitive impairment in nursing homes.

Design

A cross-sectional survey.

Methods

Mokken analysis was conducted to refine the assessment scale based on unidimensionality, local independence, monotonicity, dimensionality, and reliability. Data were gathered from cognitively impaired older adults in a nursing home from January to February 2023. Trained nursing assistants conducted face-to-face assessments and reviewed medical records to administer the scale.

Results

Emotion and State Dimension did not meet unidimensionality criteria (H = 0.14), particularly item Q9, which also violated local independence. Monotonicity analysis showed all items exhibited monotonic increases. After refinement at c = 0.3, the scale consists of nine items. With increasing c-values, the first seven items were ultimately retained to form the final version of the scale. Both optimised scales (9-item and 7-item) satisfied reliability requirements, with all coefficients (Cronbach's α, Guttman's lambda-2, Molenaar-Sijtsma, Latent Class Reliability Coefficient) ≥ 0.74.

Conclusions

The scale is suitable for assessing fall risk among older adults with cognitive impairment, with a unidimensional scale of the first seven items recommended for practical use. Future efforts should refine the scale by exploring additional risk factors, especially emotion-related ones.

Implications for the Profession and Patient Care

The refined 7-item scale provides nursing home staff with a practical, reliable tool for assessing fall risk in cognitively impaired older adults, enabling targeted prevention strategies to enhance safety and reduce injuries.

Impact

The refined 7-item scale provides nursing home staff with a reliable, practical, and scientifically validated tool specifically designed for assessing fall risk in older adults with cognitive impairment. Its simplicity enables efficient integration into routine clinical workflows, empowering caregivers to proactively identify risk factors and implement timely, targeted interventions. This approach directly enhances resident safety by translating assessment results into actionable prevention strategies within daily care practices.

Reporting Method

This study was reported in accordance with the STROBE guidelines.

Patient or Public Contribution

No Patient or Public Contribution.

Interruptive versus Non-Interruptive Reminders for Statin tHerApy in Primary Care (INIRSHA-PC): protocol and statistical analysis plan for a randomised clinical trial

Por: Wright · A. P. · Choi · L. · Nairon · K. G. · Gatto · C. L. · Dear · M. L. · Van Winkle · G. · Lagalante · S. · Neal · E. B. · Wright · A. · Rice · T. W. · for the Vanderbilt Center for Learning Healthcare · Bernard · Dittus · Luther · Pulley · Self · Semler · Qian
Introduction

Statins are a cornerstone of cardiovascular disease prevention yet remain underused among eligible patients. Clinical decision support systems embedded in electronic health records (EHRs) are commonly used to encourage guideline-concordant prescribing. Interruptive reminders (eg, pop-ups) may be effective but interfere with clinical workflows and contribute to alert fatigue. Non-interruptive alerts are less intrusive, but their effectiveness remains unclear. The Interruptive versus Non-Interruptive Reminders for Statin tHerApy in Primary Care (INIRSHA-PC) trial is designed to evaluate the comparative effectiveness of interruptive and non-interruptive reminders on statin-prescribing rates.

Methods and analysis

INIRSHA-PC is a single-centre, pragmatic, three-arm, parallel-group randomised controlled trial embedded in the EHR at Vanderbilt University Medical Center. The trial will enrol adults aged 18–74 seen in primary care who are eligible for, but not currently prescribed, statin therapy. The planned sample size is 3000 patients (1000 per arm). Enrolled patients will be randomised 1:1:1 to (1) interruptive reminder, (2) non-interruptive reminder or (3) no reminder (usual care). The primary outcome is statin prescription within 24 hours of enrolment. Secondary outcomes are statin prescribing within 12 months and low-density lipoprotein cholesterol levels measured between 30 days and 12 months after enrolment. Enrolment began on 14 August 2024. The study is expected to be completed on 19 November 2025.

Ethics and dissemination

The trial has been approved by the Vanderbilt University Medical Center Institutional Review Board with waiver of patient informed consent (IRB number: 240419). Results will be disseminated through peer-reviewed publication and presentation at scientific conferences.

Trial registration number

NCT06456658.

Effects of Nursing Workforce and Work Environment on Health System Resilience in Public Health Emergencies: A Multicenter Cross‐Sectional Study

ABSTRACT

Aim

The study examines the associations between nursing competence, work environment, and health system resilience. It also analyzes how nursing competence and work environment relate to different patterns of health system resilience.

Design

A multiple center cross-sectional study was conducted between December 2023 and January 2024 across 33 hospitals in eastern China, involving 2435 nurses.

Methods

Questionnaires measuring nursing competence, work environment resources, nurse disaster resilience, and organizational commitment to resilience were utilised, along with the collection of additional personal demographic data. Structural equation modelling and cluster analysis were performed to explore the underlying mechanisms within the overall model and across multiple groups. Multivariable regression was conducted to identify variables associated with resilience in different subgroups.

Results

Structural equation modelling demonstrated significant influences of nursing competence and work environment support on system resilience. Cluster analysis identified four resilience patterns: strong, marginal, low, and critical vulnerability. Strong resilience correlated with balanced individual-organizational resources, while vulnerable systems relied heavily on environmental support.

Conclusion

Our findings support policymakers and managers in developing systematic strategies with distinct focal points—targeting nurse workforce investment and optimised work environment—to enhance health system resilience across varying levels of public health emergencies.

Implications for the Profession

This study validated the framework connecting individual and organizational resilience, offering evidence-based insights for nurse training and resource allocation to enhance healthcare systems' adaptability during disasters.

Impact

The study addressed how nursing competence and work environment significantly influenced resilience during public health emergencies, identified four resilience patterns, and provided insights to guide policymakers and healthcare managers in developing targeted, effective strategies.

Reporting Method

Strengthening the Reporting of Observational studies in Epidemiology checklist.

Patient or Public Contribution

No patient or public contribution.

Comparative Efficacy of e‐Health Interventions for Quality of Life in Patients With Cancer: A Network Meta‐Analysis of Randomized Controlled Trials

ABSTRACT

Background

In clinical oncology nursing practice, the preservation of quality of life is an essential component. E-health interventions have been proven effective in improving quality of life in patients with cancer, but the optimal content and delivery format remain undetermined.

Objectives

To compare the efficacy of e-health interventions with varying contents and delivery formats in improving quality of life in patients with cancer.

Design

Network meta-analysis of randomized controlled trials.

Data Source

Six databases, including Medline, Web of Science, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and PsycINFO, were searched from inception to October 25, 2025.

Methods

Two reviewers independently screened studies and extracted data. A pairwise meta-analysis and a network meta-analysis were performed sequentially to determine the efficacy of different contents and delivery formats of e-health interventions in improving quality of life in patients with cancer.

Results

A total of 50 studies included e-health interventions with eight contents and five delivery formats. The results identified health education (SUCRA = 82.2%), symptom management (SUCRA = 72.2%), and rehabilitation interventions (SUCRA = 71.1%) as the three most effective e-health intervention contents for improving quality of life in patients with cancer. Among delivery formats, app-based (SUCRA = 82.1%), internet/web-based (SUCRA = 71.5%), and telephone-based e-health interventions (SUCRA = 53.3%) ranked among the top three.

Conclusions

This study explored the efficacy of different contents and delivery formats of e-health interventions in improving quality of life in patients with cancer. These results are expected to provide an evidence-based basis for clinical oncology nursing practice.

Trial Registration

PROSPERO number: CRD42025638829

Nurse‐Led Self‐Care Interventions for Chronic Pain: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials

ABSTRACT

Background

Nurse-led self-care interventions represent a promising approach for chronic pain management. However, a comprehensive synthesis of their efficacy is lacking.

Aims

This systematic review and meta-analysis assessed the impact of the interventions on four key outcomes in chronic pain patients: pain intensity, quality of life, anxiety levels, and depression severity.

Methods

The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. An electronic search for relevant articles spanning from inception to November 2024 was carried out across multiple databases, including EMBASE, PubMed, CENTRAL, Web of Science (Core Collection), CINAHL, Scopus, and PsycINFO. The Cochrane Risk of Bias Tool was used to assess the quality of the included studies. The meta-analysis was conducted using Stata 18 and Review Manager 5.4, and a GRADE evidence profile was subsequently generated.

Results

The systematic review and meta-analysis involved 30 studies in total. The results of the data analysis indicated that the interventions alleviated pain intensity (SMD = −0.30, 95% CI: −0.41 to −0.20, Z = 5.57, p < 0.001). They also enhanced quality of life (SMD = 0.28, 95% CI: 0.14 to 0.42, Z = 3.83, p < 0.001), while reducing anxiety (SMD = −0.15, 95% CI: −0.29 to −0.01, Z = 2.11, p = 0.03) and depression symptoms (SMD = −0.27, 95% CI: −0.45 to −0.09, Z = 2.88, p = 0.004).

Linking Evidence to Action

This systematic review demonstrated that nurse-led self-care interventions benefit chronic pain patients. Future research should conduct more rigorous randomized controlled trials to strengthen the evidence base for using such interventions in chronic pain management.

The Relationship Between Organisational Innovation Climate and Nurses' Innovative Behaviour: Roles of Knowledge Sharing and Person‐Organisation Fit

ABSTRACT

Aim

The aim of this study was to integrate Social Exchange Theory and the Ability—Motivation—Opportunity (AMO) Theory to examine the influence of organisational innovation climate on nurses' innovative behaviour, considering the mediating role of knowledge sharing and the moderating effect of person-organisation fit, thereby providing a multidimensional theoretical foundation for enhancing nurses' innovative behaviour.

Design

A cross-sectional research design was adopted.

Methods

Participants included 380 nurses from two Grade-A tertiary hospitals in Henan Province, China. Data were collected using the Organisational Innovation Climate Scale, Knowledge Sharing Scale, Nurses' Innovative Behaviour Scale and Person-Organisation Fit Scale and analysed via descriptive statistics, correlation analysis, regression analysis and bootstrap testing for mediation and moderation effects.

Results

Organisational innovation climate was positively correlated with nurses' innovative behaviour and knowledge sharing partially mediated this relationship. Person-organisation fit positively moderated both the direct relationship between organisational innovation climate and knowledge sharing and the indirect effect on innovative behaviour.

Conclusion

Under a supportive organisational innovation climate, nurses with high person-organisation fit are more likely to engage in innovative behaviour through knowledge sharing.

Impact

Establishing an organisational innovation climate and improving person-organisation fit can enhance nurses' work engagement and loyalty, advancing innovation and development in nursing.

Implications for the Profession and/or Patient Care

Nursing managers should cultivate an innovation-friendly climate and facilitate knowledge sharing to inspire proactive problem-solving and innovation among nurses, ultimately improving nursing practice and patient care.

Reporting Method

STROBE guidelines were followed.

Patient or Public Contribution

This study clarifies how organisational and individual factors jointly affect nurses' innovative behaviour, providing a theoretical foundation for improving nursing management, service quality and disciplinary innovation.

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