Conectar
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.
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.
To explore how children, caregivers and healthcare providers experience shared decision-making in real time within an interdisciplinary paediatric feeding clinic in multicultural Singapore.
A qualitative ethnographic approach was used.
Data collection involved one-time participant observations of interdisciplinary feeding clinic consultations, observations of healthcare providers-only debrief and follow-up interviews with caregivers. Data were collected from July 2024 to November 2024. Participants included caregivers, healthcare providers and otherwise well children presenting with feeding difficulties. Fieldnotes, including observational matrices, reflexive journals and interview transcripts, were analysed thematically using Braun and Clarke's six-step process for thematic analysis.
Twenty observations and 11 interviews were conducted. Four themes were identified: (1) Centring the child: building trust and respect; (2) Tensions and teamwork: negotiating expertise and expectations; (3) Feeding across cultures; and (4) Parenting under pressure: the social context of feeding choices.
In an interdisciplinary feeding clinic, shared decision-making extends beyond the clinical encounter, reflecting relational, cultural and structural realities. The feeding clinic modelled effective shared decision-making through child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. However, divergent perceptions of what problematic feeding entails, caregivers' hesitancy in taking on an active role in consultations, and the external pressures caregivers contended with constrained this process. These findings highlight the need for inclusive, culturally responsive care models and more caregiver support interventions that acknowledge the full complexity of feeding care.
Nurses, with their central role in relational and communicative care, are uniquely positioned to bridge tensions between medical paternalism and collaborative, family-centred approaches. By facilitating trust, clarifying goals and supporting caregiver participation in feeding decisions, they play a critical role in advancing child health outcomes while strengthening caregiver agency within multicultural healthcare systems.
This study revealed how cultural, familial and systemic pressures shape caregiving practices, often constraining caregiver participation and shared decision-making in clinical encounters. Shared decision making in an interdisciplinary feeding clinic comprised of child-centred care practices, balancing biomedical expertise with lived experiences, actively engaging caregivers and codesigning culturally responsive and sustainable feeding strategies with the family. This study expounds on the potentially critical role nurses could play within the multidisciplinary team to negotiate expectations, foster caregiver agency and contribute to culturally responsive, family-centred feeding care.
The reporting of this study is guided by the Standards for Reporting Qualitative Research (SRQR).
This study did not include patient or public involvement in its design, conduct or reporting.
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.
Ethnic minoritized women face cultural and systemic barriers in accessing antepartum and intrapartum care. Healthcare providers play a pivotal role in addressing these challenges, but their perspectives and experiences in delivering culturally competent care remain underexplored.
To synthesise healthcare providers' experiences and perspectives on providing culturally competent antepartum and intrapartum care for ethnic minoritised women.
A qualitative meta-synthesis study design was employed. Six electronic databases were searched from their inception date till January 2025. The included studies were assessed using the method of the Critical Appraisal Skills Programme tool, and findings were meta-synthesised using Sandelowski and Barroso's six-step approach. This review was registered via the International Prospective Register of Systematic Reviews.
Overall, 38 studies were included, and three themes emerged. The first theme revealed how providers' biases and professional training distorted their ability to understand and respect cultural practices. The second theme underscored the impact of systemic barriers such as time constraints, resource scarcity and lack of representation among providers. The final theme highlighted healthcare providers' aspirations for improved communication, targeted training and guidance on building trust to enhance care delivery.
Healthcare providers encounter notable challenges in delivering culturally competent antepartum and intrapartum care, but remain hopeful about bridging gaps in communication and understanding. Practical recommendations include implementing mandatory cultural competency training at all levels of healthcare professional education, increasing resources for interpreters and cultural liaisons and fostering diversity within the healthcare workforce. Future research should explore patient-centred interventions and systemic reforms to improve care for ethnic minoritised women. These findings highlight the need for policies and practices that empower providers to deliver equitable, culturally respectful antepartum and intrapartum care.
No patient or public contribution.
by Simon Söderholm, Martin Ulander, Vanessa William Toma, Sara Kaufmann, Xiangyu Qiao, Daniel Berglind, Susanna Calling, Bledar Daka, Ludger Grote, Mats Martinell, Frida Bergman, Pontus Henriksson, Carl-Johan Östgren, Wen Zhong, Claudio Cantù, Fredrik Iredahl
Coffee is the most common drink in the world, second only to water. This makes caffeine, the ingredient of coffee known for its wakefulness-promoting effects, one of the most used psychoactive substances. The psychoactive property of caffeine is well-characterized, and entails its interaction with the adenosine receptors, involved in sleep regulation. While studies have shown a deleterious immediate effect of caffeine on sleep, less is known about the effects of chronic caffeine exposure. In the present cross-sectional study, we investigated this relationship across a large cohort of 30,154 individuals participating in the Swedish Cardiopulmonary Bioimage Study (SCAPIS), which allowed us to compare habitual coffee intake with sleep habits, subjective estimate of daytime sleepiness, and underlying genetic variants. According to our analyses, different degrees of coffee consumption, confirmed by statistical association with previously reported genetic variants, showed very low association with estimated patterns of sleep habits or perceived daytime sleepiness. These results indicate that coffee may be less impactful on sleep habits than previously thought, or that other mechanisms, such as the adaptive capabilities of the adenosine system in adult coffee users, may dampen its psychoactive potency.To explore the experiences and perceptions of Singaporean parents in managing feeding difficulties among children with developmental disabilities.
A descriptive qualitative study design was used.
Twenty parents were recruited via convenience sampling from a paediatric feeding clinic in a public hospital in Singapore between July and October 2024. One-to-one interviews were conducted using a semi-structured interview guide. Thematic analysis was used to analyse the data.
Four themes were identified: (1) Feeding as a ‘guessing’ game; (2) mutual understanding within the family and community; (3) beliefs regarding developmental disabilities and feeding difficulties; and (4) challenges in accessing adequate support. There were a total of nine subthemes supporting these themes.
This study revealed that parents of children with developmental disabilities faced challenges in adjusting to their child's feeding preferences, dealing with conflicting views on feeding practices among caregivers, and accessing adequate support. Parents also valued instrumental support from grandparents and domestic helpers, as well as emotional support from online peers. Additional research and targeted interventions are needed to better support parents of children with developmental disabilities in managing feeding difficulties.
Policies should facilitate the provision of feeding-specific resources, treatment, and education for parents. Additionally, healthcare providers should proactively assess feeding-related concerns and address misconceptions to enhance parental awareness of feeding difficulties and how they can improve the feeding practices of their children with developmental disabilities. Future research should obtain a more in-depth understanding of how differing beliefs in feeding difficulties between parents can impact the child's developmental outcomes, as well as the support and resources that may address feeding needs in these children.
This study followed the reporting guidelines outlined by the Consolidated criteria for Reporting Qualitative (COREQ) research checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
Dysphagia not only affects the nutritional intake of head and neck cancer (HNC) patients but may also lead to social avoidance, emotional fluctuations, and a decline in life confidence. Furthermore, dysphagia places an additional psychological and physical burden on caregivers, significantly altering their lifestyles.
This study employed a qualitative systematic review approach to comprehensively analyse the experiences and coping strategies of HNC patients and their caregivers in relation to dysphagia. Relevant qualitative studies published from the inception of the database through September 2024 were selected. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research (2016), and a meta-aggregation method was applied to synthesise and categorise the research themes. This study standardised the presentation of results in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.
A total of 14 studies were included, resulting in 63 research outcomes, which were consolidated into 12 new categories and integrated into 4 main themes: (1) the impact of dysphagia on daily life; (2) coping with the changes caused by dysphagia; (3) understanding of dysphagia and related needs; and (4) the physiological and psychological challenges faced, and the efforts to seek support.
The dual physiological and psychological challenges posed by dysphagia profoundly affect patients' daily lives, prompting ongoing adjustments to cope with these changes. Both patients and caregivers have a limited understanding of dysphagia but exhibit a strong need for support. These findings underscore the importance of providing comprehensive, individualised support for patients and caregivers to improve their quality of life and coping experiences.
No Patient or Public Contribution. This study aims to analyse and synthesise the experiences and perspectives of patients and their caregivers reported in existing research. As no original data were collected and no direct interaction with patients or the public occurred, specific patient or public contributions are not included.
At-risk mothers experience disproportionately higher rates of antenatal depression and anxiety, which can hinder mother–infant bonding and adversely affect infant socioemotional development. Despite growing evidence on postpartum mental health, antenatal risk factors among psychosocially vulnerable mothers remain underexplored, particularly in multi-ethnic Asian settings.
To identify factors associated with antenatal depression, anxiety, and maternal–fetal bonding among at-risk mothers.
This cross-sectional observational study was nested within an ongoing randomised controlled trial. Two hundred at-risk mothers, defined as single, of low socioeconomic status, referred for psychosocial support, at risk of depression, with adverse childhood experiences, or with a fetus with a congenital malformation, were recruited from outpatient obstetric clinics between February and September 2024. Participants completed online self-administered questionnaires assessing antenatal depression, anxiety, perceived stress, social support, parenting self-efficacy, and maternal–fetal bonding. General Linear Models were used to analyse data and identify factors associated with depression, anxiety, and bonding.
Higher perceived stress was associated with increased depression (β = 0.28, p < 0.001) and anxiety (β = 1.28, p < 0.001) and poorer bonding (β = 0.08, p = 0.02), while greater social support predicted lower anxiety (β = −0.31, p < 0.001). Higher parenting self-efficacy was linked to stronger bonding (β = −0.09, p = 0.06). Younger mothers (β = −2.68, p = 0.025) and Indian mothers (β = 7.46, p = 0.017) were particularly vulnerable to anxiety, whereas post-secondary education was protective against depression (β = −1.44, p = 0.02). Model fit ranged from 0.14 to 0.65.
Perceived stress, social support, and parenting self-efficacy significantly influenced antenatal mental health and bonding in at-risk mothers. These findings underscore the need for culturally sensitive, nurse/midwife-led interventions that integrate early screening, stress reduction, and empowerment strategies within routine antenatal care to strengthen maternal mental health and early bonding outcomes.
(1) Nurses and midwives play a critical role in screening for antenatal depression and anxiety in mothers with risk profiles highlighted in this study. (2) Culturally responsive nursing practice that demonstrates sensitivity towards sociocultural pressures is needed to provide individualised care. (3) Integration of digital and community-based antenatal education programs could provide more equitable access to care for at-risk mothers who may face barriers to in-person care.
(1) Despite having a higher susceptibility for antenatal mental health conditions, risk factors for antenatal depression, anxiety, and maternal–infant bonding have been underexplored in at-risk mothers. (2) Antenatal stress and anxiety are universally associated with depression across risk groups, while maternal self-efficacy and perceived social support serve as key protective factors. (3) The findings from this study suggest the need for early screening and nurse-led interventions that support maternal parenting self-efficacy and stress management to improve maternal mental health outcomes among at-risk mothers.
STROBE reporting checklist.
No patient or public contribution.
Supporting dementia caregivers is essential for improving patient outcomes and reducing caregiver burden, and it has become a core element of comprehensive dementia care. Accurate assessment of caregivers’ support needs is crucial for designing effective and targeted interventions. Although several instruments have been developed to assess these needs, there is limited evidence from systematic reviews regarding their measurement properties. Conducting a systematic review of the psychometric evidence for these instruments is therefore necessary to inform the selection and application of reliable tools in both research and practice. This review aims to identify and evaluate existing instruments for measuring support needs among dementia caregivers, summarise their psychometric properties and provide evidence-based recommendations for their use and future development.
This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols 2015 guidelines. A comprehensive search will be conducted in eight electronic databases from 1 August 2025 to 31 January 2026 to identify studies reporting the development or use of instruments measuring support needs among dementia caregivers. Two reviewers will independently perform literature screening, data extraction and methodological quality assessment, with disagreements resolved by discussion or consultation with a third reviewer. The measurement properties of the included instruments will be appraised in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments methodology.
Ethical approval is not required for this study as it will use data from previously published literature. The results of this systematic review will be disseminated through presentations at national and/or international conferences and publication in a peer-reviewed journal.
CRD420251129741.
by Qiaoling Li, Jing Zhang, Shasha Meng, Fengxiang Tian, Qinqin Mei, Hui Wang, Hong Qi
BackgroundSelf-regulated fatigue is often assessed in studies of chronic diseases. Research is needed on the self-regulation of fatigue and physical activity in lung cancer patients undergoing treatment, and the impact of these factors on this population.
ObjectiveThe goal of this study is to investigate the current status, influencing factors, and correlation between self-regulatory fatigue and physical activity in lung cancer patients undergoing comprehensive treatment.
MethodsWe used a convenience sampling method to enroll 188 lung cancer patients admitted to two tertiary hospitals in Chengdu from October 2024 to April 2025. Data were collected using a general information questionnaire and two scales: the Self-Regulatory Fatigue Scale (SRF-S) and The International Physical Activity Questionnaire-long form (IPAQ-L).
ResultsThe mean self-regulatory fatigue score was 42.19 ± 9.06. The total metabolic equivalent (MET) of physical activity was 544.00 (0.00, 1386.00) MET-min/week, with leisure-time activity accounting for 429.00 (0.00, 1188.00) MET-min/week (data presented as median and interquartile range). Significant negative correlations were observed between Self-Regulatory Fatigue total scores and energy expenditure from housework, leisure activities, as well as total physical activity expenditure. Furthermore, self-regulatory fatigue was negatively correlated with both moderate-intensity and low-intensity physical activity, but positively correlated with high-intensity physical activity (P P R² = 0.306).
ConclusionEngaging in appropriate leisure and household activities at moderate-to-low intensity may help alleviate the severity of self-regulatory fatigue in lung cancer patients undergoing comprehensive treatment. Healthcare providers should encourage appropriate activity to reduce the psychological burden and conserve self-regulatory resources.
Urinary incontinence, often perceived as embarrassing, perpetuates the stigma that delays treatment and encourages concealment. This stigma significantly diminishes quality of life and imposes both financial and medical burdens. Although prior research has examined stigma reduction in urinary incontinence, it persists as a widespread issue. Most studies have focused on interviews, primarily addressing urine leakage, with a limited understanding of the factors influencing urinary incontinence stigma and their interrelations. More in-depth quantitative studies are crucial to inform targeted interventions.
(1) To develop targeted interventions aimed at alleviating urinary incontinence-related stigma in older adults. (2) To identify factors that mitigate stigma in older adults with urinary incontinence. (3) To examine the associations between these factors and stigma.
Cross-sectional survey.
A cross-sectional survey was conducted with 510 older adults across three hospitals in Guangdong from July 2022 to January 2024, utilising the SSCI-24 and Incontinence Severity Index. Three multivariate linear regression models, adjusted for covariates based on directed acyclic graphs, were employed to explore the relationships between variables and stigma. Additionally, subgroup analyses were performed.
Participants reported higher levels of self-stigma compared to perceived stigma. Multivariate analysis revealed significant associations between urinary incontinence type, severity, frequency of micturitions and stigma. Key factors contributing to stigma reduction include managing incontinence severity, reducing frequency of micturitions and preventing the progression to mixed incontinence.
The study identified associations between urinary incontinence characteristics—type, severity and frequency of micturitions—and stigma. Strategies for stigma reduction are proposed, underscoring the vital role of nurses in this process.
The findings of this study contribute to a deeper understanding of stigma surrounding urinary incontinence in older adults and provide insights for developing more effective interventions by healthcare professionals and community caregivers.
This study adhered to the STROBE checklist for observational studies.
No patient or public contribution.
To identify and synthesise the available evidence of nurses' perceptions and experiences of providing bereavement care.
Systematic literature review of qualitative studies with meta-synthesis of findings.
We searched six databases, PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, and PsyINFO. Initial search in October 2023, and updated in December 2024.
The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Two reviewers independently conducted study selection and data extraction, and quality appraisal was assessed using the Critical Appraisal Skills Program tool for qualitative research. Data synthesis was conducted using thematic analysis.
A total of thirteen studies were included, revealing nine sub-themes and three descriptive themes: challenges in bereavement care, coping strategies, and multifaceted job requirements. Six sub-themes were graded as high confidence and the other three were moderate confidence.
Bereavement care is a personalised, long-term and complex process, presenting nurses with unique challenges and requirements that must be measured through the authentic experiences of this group. Educational and practice policies should focus on nurse-centred strategies. Through this meta-synthesis, we can demonstrate to healthcare administrators how to enhance nurses' bereavement care practice experiences and meet their needs, thereby advancing future palliative care development and fostering professional fulfilment.
This systematic review synthesises evidence concerning nurses' experiences of providing bereavement care, revealing the multidimensional challenges, coping strategies, and professional demands encountered in practice. The findings offer significant implications for nursing education, clinical practice, and health policy development. Currently, research on nurses delivering bereavement support remains insufficient; further investigation into this group could help bridge gaps between grief counselling theory and practice while highlighting the identified societal issues they face.
Not applicable.
PROSPERO: CRD42024590469
by Yizhe Yang, Ruifeng Liang, Yan Luo, Doudou Zhu, Yi Liu, Yuyan Guo, Jiafen Zhang, Qiao Niu
ObjectiveInvestigate the Knowledge-Attitude-Practice (KAP) of students from Medical College towards emerging infectious diseases, and assess their impact, can provide a scientific basis and practical guidance for enhancing medico’s prevention and control capabilities.
MethodsA total of 2,395 participants from various grades and majors at Medical University were randomly selected using a stratified cluster sampling method. This cross-sectional study was conducted between April 25 and May 31, 2020, using a self-administered questionnaire developed on the Wenjuanxing platform to assess COVID-19-related knowledge, attitudes, and practices (KAP) among medical students.
ResultsA total of 2,245 participants (aged 16–28 years) were included in the study, coming from five medical disciplines: Clinical Medicine, Preventive Medicine, Nursing, Clinical Pharmacy, Health Inspection and Quarantine. The average scores for the COVID-19 epidemiological knowledge and the control measures for the epidemic were 4.92 ± 1.03 and 4.50 ± 0.78, respectively. Among them, the scores of epidemiological knowledge exhibited significant differences in sex, nation, type of dwelling place, major, grade, annual per capita household income, and age. The scores of preventive knowledge significantly differed by sex, major, grade, physical condition, and age. Further, behavioral data indicated that 96.0% of the students thought the pandemic had severely affected their daily life, while >90% maintained consistent mask usage and >80% insisted on health-protective practices. Practice scores finally varied significantly by sex, family structure, and ethnicity.
ConclusionsAltogether, medical students possess certain basic knowledge in controlling emerging infectious diseases, but some still generally suffer from insufficient cognitive depth and anxiety. Colleges can systematically enhance students’ rational cognitive level which include offering specialized courses as well as promoting cutting-edge research achievements, and through standardized operations stabilize their psychological states.
Postoperative rehabilitation after anterior cruciate ligament reconstruction (ACLR) is crucial for functional recovery. Prehabilitation, performed before surgery, is considered to optimise the patient’s condition and improve postoperative outcomes. However, the evidence supporting the effectiveness of standardised prehabilitation protocols remains insufficient, particularly in comparison to conventional home rehabilitation programmes. This study aims to evaluate the impact of a 2-week standardised preoperative prehabilitation programme versus home rehabilitation training on perioperative functional outcomes and medium-term to long-term recovery in ACLR patients through a randomised controlled trial, providing evidence-based guidance for optimising rehabilitation pathways.
This study is a single-centre, prospective, assessor-blinded, randomised controlled trial. Eligible participants will be randomly assigned in a 1:1 ratio to the experimental group (receiving 2 weeks of standardised preoperative rehabilitation) or the control group (receiving 2 weeks of home-based rehabilitation training). Both groups will undergo 12 weeks of standardised rehabilitation postoperatively. The outcome measures include International Knee Documentation Committee Score (IKDC), Knee Injury and Osteoarthritis Outcome Score, Visual Analogue Scale, muscle strength, joint range of motion, anterior cruciate ligament-Return to Sport after Injury Index and Tegner score. The assessment time points are as follows: baseline (T0), 1–3 days preoperatively (T1), postoperative day 1 (T2), 30 days (T3), 90 days (T4), 180 days (T5) and 360 days (T6). All assessments will be performed at fixed time intervals within the same department of rehabilitation medicine, with the testing order randomised. The primary outcome (IKDC) will be analysed using a linear mixed model (LMM), including time, group and their interaction as fixed effects, with individuals as random effects. Secondary outcomes will be analysed using LMM, repeated measures analysis of variance or ² tests. Missing data will be handled using the multiple imputation method, under the assumption that data are missing completely at random and effect sizes will be evaluated using Cohen’s d (α=0.05).
This study has received approval from the Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University (Number: 2025012). All participants will provide written informed consent after reviewing documentation containing comprehensive details regarding the study procedures, risks and benefits, enabling informed decision-making about participation. The findings generated from this research will be disseminated via publication in an open-access, peer-reviewed journal and presented at relevant scientific conferences.
ChiCTR2500097293.
The study aims to calculate the curative care expenditure (CCE) from different comorbidity states of chronic hepatitis B (CHB), to provide a reference for the relevant government departments to optimise health insurance protection measures for this disease.
A prevalence-based retrospective study.
This study included 1600 medical institutions, covering general hospitals, traditional Chinese medicine hospitals, specialised hospitals and maternal and child health hospitals.
The cohort included 238,617 CHB outpatients and 4312 inpatients.
CCE for CHB was estimated based on System of Health Accounts 2011.
The total CCE of CHB in Sichuan Province in 2019 was USD 85.49 million. The majority of CCE was spent by outpatient services (USD 67.16 million), the main source of financing schemes was household out-of-pocket payment (75.71%). Conversely, the CCE for inpatient services (USD 18.33 million) was mainly financed by public financing schemes (46.38%). More than 70% of the CCE flowed to general hospitals, and less than 20% flowed to primary healthcare institutions. The CCE varied significantly across different comorbidity groups. The CCE for patients with no additional comorbidities and those in the low comorbidity group was mainly spent by patients aged 30–39 years and those aged 40–49 years, respectively. The CCE in the high comorbidity group was mainly spent by patients aged 50–54 years.
The present study shows that a high proportion of the CCE allotted to CHB is financed by household out-of-pocket payment. This situation poses a heavy medical burden not only on individuals, but also on society. Therefore, the financing structure needs to be optimised urgently. Potential policy directions may improve the outpatient mutual aid protection mechanism.
Endometriosis, a chronic oestrogen-dependent disorder, presents significant clinical challenges including pelvic pain, dysmenorrhoea, dyspareunia and infertility. While numerous interventions exist, evidence guiding the choice among surgical, hormonal and non-hormonal therapies is fragmented. This protocol outlines a systematic review and network meta-analysis designed to comprehensively evaluate the comparative effectiveness and safety of all available treatments for endometriosis-associated pain and infertility.
We will systematically search PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and WHO International Clinical Trials Registry Platform. Randomised controlled trials evaluating any intervention for endometriosis will be identified through a two-stage independent screening process by two reviewers. Primary outcomes are overall pain reduction and live birth rate. Secondary outcomes include clinical pregnancy rate, miscarriage rate, endometriosis recurrence, relief of other endometriosis-related symptoms, adverse events, quality of life and obstetrical outcomes. Data will be synthesised using pairwise and network meta-analyses.
This systematic review of published literature does not require ethical approval. Results will be disseminated through peer-reviewed publication. The findings aim to establish a robust evidence base for clinical decision-making and to inform future research priorities in endometriosis management.
CRD420251051917.
To clarify the concept of life space in community-dwelling older adults to provide a clear and standardised conceptual basis for further research.
Rogers' evolutionary approach was used to identify surrogate terms, related terms, attributes, antecedents and consequences.
Literature from 1936 to 2025 was searched from PubMed, CINAHL, ProQuest, Cochrane databases, Scopus, Web of Science and CNKI.
A total of 46 articles were included for further analysis and synthesis. The attributes of life space in community-dwelling older adults were dynamic variability, multidimensionality and interaction between intrinsic abilities and external environmental demands. Antecedents were classified into four categories, namely, individual, physical, psychological and social factors. Life space can bring positive consequences, promoting walking, assessing the risk of falling, predicting cognitive decline, facilitating rehabilitation and improving quality of life, as well as negative consequences, causing diminished subjective well-being, heightened loneliness, increased risks of hospital readmission and mortality.
Life space, as a spatial indicator of a person's range of mobility, reflects older adults' physical range of motion, the frequency of activity, their need for assistance and the level of social participation. Older adults with adequate life space in the community are more likely to engage in outdoor activities. In contrast, restricted life space can lead to adverse outcomes.
Surrogate terms, related terms, attributes, antecedents and consequences identified by the concept analysis approach will contribute to a greater understanding of life space. These analytical findings establish an essential conceptual framework for future research while offering evidence-based theoretical guidance to improve life space in community-dwelling older adults, ultimately enhancing health outcomes and quality of life.
No patient or public contribution.
Our study aims to investigate the associations between sexual minority stressors, resilience factors and substance misuse outcomes, using an intersectional framework to examine heterogeneities across sexual minority populations (SMPs) in the United States of America (USA). We hypothesised that stressors would be positively associated with substance use, and that resilience factors would be negatively associated, with these associations varying across intersectional strata.
The current study employed a secondary data analysis strategy to analyse cross-sectional data using Bayesian hierarchical modelling and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).
Data were obtained from the Generation Study Wave 1 (data collected from 2016 to 2018), a nationally representative cohort of SMPs in the USA.
The study included 1518 participants aged 18–59. Combinations of education, birth sex, sexual orientation, income and race/ethnicity defined intersectional strata. Participants were selected based on self-reported demographic and behavioural data.
Primary outcomes were the risks of alcohol use and drug use, measured using validated scales (AUDIT (Alcohol Use Disorders Identification Test) and DUDIT (Drug Use Disorders Identification Test)). Explanatory variables included resilience factors (social support, life satisfaction, social well-being and community connectedness) and sexual minority stressors (everyday discrimination, perceived stigma, healthcare stereotype threat and internalised homophobia).
In descriptive analyses, group differences on psychosocial scales were small to modest, with higher everyday discrimination in lower-income and Black participants. In Bayesian regressions, everyday discrimination was the strongest positive correlate of both alcohol and drug use, whereas perceived stigma was inversely associated. In MAIHDA models, demographic factors were associated with higher AUDIT among males and those with college-or-more education, and with higher DUDIT among low-income participants; relative to bisexual participants, gay (AUDIT) and lesbian (DUDIT) groups had lower scores. The strata-level variance component was small in null models and approached zero after adjusting for demographics and psychosocial factors, indicating that disparities are primarily driven by differential exposure to these factors rather than unexplained heterogeneity between strata.
While minority stressors and resilience factors are salient predictors of substance use among SMPs, their effects are consistent across diverse intersectional identities. The application of MAIHDA demonstrates that substance use disparities are better explained by the main effects of demographics and psychosocial experiences than by the unique combination of identities. This highlights the importance of universal interventions in reducing discrimination and enhancing resilience across the entire SMP population.
To identify factors influencing hypoglycaemia in patients with type 2 diabetes mellitus (T2DM) undergoing colonoscopy and to construct a predictive model for assessing hypoglycaemia risk.
A retrospective cohort study.
We retrospectively collected data on 598 T2DM patients who underwent colonoscopy and randomised them into a developmental cohort and a validation cohort in a 7:3 ratio. We used multivariate logistic regression to develop a predictive model for hypoglycaemia during colonoscopy and identify independent predictors in pre- and post-colonoscopy hypoglycaemia groups.
We identified 112 of 598 (18.7%) T2DM patients who experienced hypoglycaemia during the peri-colonoscopy period: 43 pre-colonoscopy, 61 post-colonoscopy and 8 at both junctures. Ultimately, five predictors—insulin, SGLT2 inhibitors, fasting after colonoscopy, fasting C-peptide and estimated glomerular filtration rate (eGFR)—were integrated into the predictive model. The AUC for predicting hypoglycaemia was 0.78 (95% CI, 0.71–0.84) and 0.82 (95% CI, 0.74–0.90) in the development and validation cohort, respectively. Variables associated with pre-colonoscopy hypoglycaemia included SGLT2 inhibitors, fasting C-peptide and eGFR, whereas the post-colonoscopy hypoglycaemia group was associated with metformin, duration of diabetes, fasting C-peptide and fasting after the examination.
This study successfully developed and validated a predictive model for assessing hypoglycaemia risk in T2DM patients during peri-colonoscopy.
Early identification of patients at high risk for peri-colonoscopy hypoglycaemia allows nurses to implement personalised preventive strategies. The predictive model enables clinical nurses to deliver tailored interventions based on individual risk factors, potentially reducing hypoglycaemia-related complications and improving patient safety outcomes.
This study provides nurses with a validated risk prediction tool for identifying high-risk type 2 diabetes patients during colonoscopy, enabling targeted blood glucose monitoring protocols and preventive interventions in clinical practice.
This study follows the STROBE guidelines for reporting cohort studies.
Diabetes patients contributed electronic health record datasets.
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