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Ayer — Octubre 2nd 2025Tus fuentes RSS

Master's Degree Nurses: A Mixed‐Methods Study on Supply, Demand, and Utilisation

ABSTRACT

Aims

To assess the supply, demand, and utilisation of master's degree nurses in China's top-tier hospitals and identify recruitment and retention challenges.

Design

A convergent parallel mixed-methods design.

Methods

From January and September 2022, eight top-tier hospitals in mainland China were selected using convenience sampling. The proportion of master's degree nurses, turnover rates, and recruitment outcomes were investigated and analysed using descriptive statistics. Concurrently, seven nursing administrators from these eight hospitals were interviewed using semi-structured interviews, and transcribed data were thematically analysed through inductive content analysis.

Results

Among the eight hospitals surveyed, the average proportion of master's degree nurses was 3.58% (range: 0.58%–9.43%). The average ratio of planned to actual recruitment was 3.28, with four hospitals showing near parity (approximately 1:1) and three institutions failing to recruit any master's degree nurses. The annual turnover rate of master's degree nurses was 1.18%. Three themes emerged from the qualitative analysis: (1) shortages coexisting with oversupply; (2) nursing leaders' retention efforts versus limited institutional policy support; and (3) prioritisation of research and management over advanced clinical roles.

Conclusion

In China, even among top-tier hospitals, the proportion of master's degree nurses remains relatively low. There is an overall shortage of these nurses, juxtaposed with localised oversupply in specific institutions. Promotion to nursing supervisor or administrative roles is the only developmental pathway, while structured career progression pathways for advanced nursing practice remain conspicuously absent.

Implications for the Profession and/or Patient Care

The study highlights the need to develop targeted policies that support the career advancement of master's degree nurses, particularly by expanding career options in Advanced Practice Nurses (APNs) rather than limiting roles to nursing management or education. This shift would better leverage their clinical expertise and strengthen healthcare systems through specialised practice and innovation.

Impact

What problem did the study address?: This study maps the supply–demand dynamics of master's degree nurses in leading hospitals and identifies retention, utilisation, and motivation policies and strategies from the perspective of nursing administrators. What were the main findings?: The proportion of master's degree nurses is low in China's top hospitals. There is both an oversupply and a shortage of master's degree nurses. Neither the government nor hospitals have policies in place to encourage the clinical involvement of master's degree nurses, and their career progression is limited to managerial roles. Where and on whom will the research have an impact?: Nursing administrators and other health policy makers in China and comparable global health systems will be affected. It will also influence nursing associations, nursing educators, and general nurses.

Reporting Methods

This study adhered to the Mixed Methods Article Reporting Standards.

Patient or Public Contribution

No contributions from patients or the public were involved in this study.

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Relationship between anion gap and 28-day all-cause mortality in patients with acute pulmonary edema: A retrospective analysis of the MIMIC-IV database

by Ping Guo, Yuwen Liu, Xiaomi Huang, Yanfang Zeng, Zhonglan Cai, Guang Tu

Background

Acute pulmonary edema is a severe clinical condition with high mortality. The anion gap, reflecting metabolic acid-base disturbances, is often elevated in critically ill patients. However, its relationship with outcomes in acute pulmonary edema remains unclear.

Objective

To explore the association between admission anion gap levels and 28-day all-cause mortality in patients with acute pulmonary edema.

Methods

This retrospective cohort study utilized data from the MIMIC-IV database (2008–2019) and included adult patients with acute pulmonary edema. Patients were categorized into quartiles based on anion gap levels. Cox regression models analyzed the relationship between anion gap and mortality, with restricted cubic spline (RCS) curves, Kaplan-Meier analysis, and subgroup analyses.

Results

A total of 1094 patients were included. Univariate Cox regression showed a positive correlation between anion gap levels and 28-day mortality (HR = 1.13, 95%CI: 1.09–1.17, P P P  Conclusion

Admission anion gap levels predict 28-day all-cause mortality in acute pulmonary edema patients, particularly in younger patients and those without renal disease. Clinically, anion gap monitoring should be emphasized, and individualized prognostic and treatment strategies should be developed with factors like age and renal status to improve outcomes.

Rapid response teams and recommended ward-based management of acute deterioration: a single-centre retrospective cohort study in an inner-city London (UK) teaching hospital

Por: Hadfield · S. · Zentar · M. · McPhail · M. · Helme · E. · Broderick · R. · Logan · F. · Loveridge · R. · Madine · E. · Vining · I. · Wendon · J. · Metaxa · V. · Hadfield · D.
Objectives 

  • To describe the associations between Rapid Response Team (RRT) patient review and other predefined clinical management actions, with risk of in-hospital cardiac arrest and in-hospital mortality in the first unplanned admission (UPA) to the adult intensive care unit (ICU) from the ward environment for each patient.

  • To describe a novel RRT assessment tool for ward-based care for patients who were deteriorating.

  • Design

    A retrospective cohort study.

    Setting

    A large multispecialty, tertiary referral and teaching hospital in England, UK.

    Participants

    The study included 3175 consecutive adult ICU UPAs from hospital wards over a 6-year period (2014–2019).

    Outcome measures

    Ward-based management of deterioration prior to ICU admission was assessed by the RRT, using a scored checklist—the UPA score. Admissions were compared in two groups according to their exposure to an RRT review in the 72 hours before ICU admission. Associations with in-hospital cardiac arrest within 24 hours before ICU admission and all-cause in-hospital mortality were estimated, using unadjusted and adjusted odds ratios (aORs) with 95%CI.

    Results

    RRT review occurred in 1413 (44.5%) admissions and was associated with reduced odds of in-hospital cardiac arrest (aOR 0.51; 95% CI 0.36 to 0.78; p

    Conclusions and relevance

    An RRT review in the 72 hours prior to ICU admission was associated with reduced odds of in-hospital cardiac arrest but did not impact in-hospital mortality. Higher UPA scores were associated with increased incidence of both in-hospital cardiac arrest and in-hospital mortality. In addition, this study describes a novel and adaptable RRT scoring tool (the UPA score) for safety monitoring and quality improvement.

    Quality and Bias in Randomized Controlled Trials Published in Latin American Nursing Journals: A Meta‐Epidemiological Study

    ABSTRACT

    Introduction

    Randomized controlled trials (RCTs) are essential for evidence-based nursing care. However, the quality of reporting and adherence to methodological standards in Latin American nursing journals remains unclear. This study evaluates the characteristics, reporting quality, and potential risk of bias of RCTs published in Latin American nursing journals.

    Objective

    To assess the reporting compliance and risk of bias of RCTs published in Latin American nursing journals.

    Design

    Meta-research study.

    Methods

    A comprehensive handsearch of 29 Latin American nursing journals was performed covering publications from 2000 to 2024. Identified RCTs were assessed for adherence to CONSORT reporting guidelines and evaluated for risk of bias. Outcomes were classified using the COMET taxonomy. A descriptive analysis was performed.

    Results

    A total of 6377 references were screened, identifying 34 eligible RCTs, most published after 2018. The median CONSORT compliance was 19 reported items (IQR 16–22). High compliance (> 90%) was observed in abstract reporting items, study objectives, and participant selection criteria. However, critical methodological features such as randomization procedures, blinding, and protocol registration showed low adherence (< 40%). Risk of bias was mostly rated as having “some concerns”, largely due to insufficient reporting. According to the COMET taxonomy, the most frequently reported outcome domains were “Delivery of care” and “Physical functioning”.

    Conclusions

    Reporting compliance and risk of bias of RCTs published in Latin American nursing journals presents significant gaps, particularly in key methodological domains. These shortcomings hinder transparency, reproducibility, and integration into evidence synthesis. Strengthening editorial policies and enforcing reporting standards could enhance the quality and reliability of published research in Latin American nursing journals.

    The Mediation of AI Trust on AI Uncertainties and AI Competence Among Nurses: A Cross‐Sectional Study

    ABSTRACT

    Aim

    This study aimed to validate the mediating role of nurses' AI trust in the relationship between AI uncertainties and AI competence.

    Design

    A cross-sectional study.

    Methods

    A purposive sample of 550 registered nurses with at least 1 year of clinical experience from three tertiary and two secondary hospitals in Jinan and Hangzhou, China, was used. Data were collected using structured questionnaires assessing AI uncertainty, trust and competence. Demographic data included gender, age, education level, years of clinical experience, professional title and hospital level. Mediation analysis.

    Results

    Most nurses were from tertiary hospitals (88.9%), held a bachelor's degree (87.6%), and had over 6 years of experience. The mediating role of AI trust between AI uncertainties and AI competence is validated. AI uncertainties affected AI trust (B = 0.39, p < 0.0001), explaining 10% of the variance. AI uncertainties and AI trust affected AI competence (B = 0.25 and 0.67, p < 0.0001), explaining 63% of the variation. AI trust's total effect was 0.51, comprising direct and indirect effects of 0.25 and 0.26, respectively.

    Conclusion

    Hospitals can reduce uncertainty through an AI-transparent decision-making process, providing clinical examples of AI and training nurses to use AI, thereby increasing trust. Second, AI systems should be designed to consider nurses' psychological safety needs. Hospital administrators utilise optimised AI technology training and promotional techniques to mitigate nurses' resistance to AI and enhance their positive perceptions of AI competence through trust-building mechanisms.

    Implications for the Profession and/or Patient Care

    Impact: Enhancing nurses' AI trust can reduce uncertainty and improve their competence in clinical use. Strategies such as transparency, explainability and training programmes are crucial for improving AI implementation in healthcare.

    No Patient or Public Contribution

    This study focused solely on clinical nurses and did not include patients or the public.

    Reporting Method

    The study adhered to STROBE guidelines.

    Utilisation of ambulatory ECG monitoring for prediction of heart failure and stroke events and healthcare expenditure in treated and untreated patients: a retrospective cohort study

    Por: Schwennesen · H. · Li · Z. · Hammill · B. G. · Clark · A. G. · Pokorney · S. D. · Hytopoulos · E. · Turakhia · M. P. · Cambra · J. · Piccini · J. P.
    Objective

    We evaluated the performance of risk models that incorporate ambulatory ECG data and clinical information for prediction of healthcare expenditures related to heart failure (HF) and stroke events in treated and untreated patients.

    Design and setting

    A retrospective cohort study of Medicare patients who underwent Zio XT ambulatory monitoring in the USA was conducted between 2014 and 2020.

    Participants and outcomes

    14-day ambulatory ECG data and claims data were evaluated in the study sample which included 89 923 patients in the HF hospitalisation group, 75 870 in the new-onset HF group and 90 159 in the stroke hospitalisation group. Predictive models for new-onset HF, HF hospitalisation and stroke hospitalisation were generated using LASSO Cox regression with ambulatory ECG variables and components of the CHA2DS2-VASc. For each outcome, we scored patients using standardised linear predictors from three composite risk models, and we evaluated the association between risk score and total Medicare cost.

    Results

    The following hazard ratios per one SD increase in the new risk score were observed for the model that included all CHA2DS2-VASc components and ECG variables: HF hospitalisation in treated 2.94, 95% CI 2.75 to 3.15; new-onset HF in treated 1.84, 95% CI 1.75 to 1.93; HF hospitalisation in untreated 3.51, 95% CI 3.23 to 3.82; and new-onset HF in untreated 1.92, 95% CI 1.85 to 2.00. Risk scores generated by the model were also predictive of Medicare cost in both treated and untreated patients, with patients in the high-risk category for all outcomes having the greatest Medicare costs during 1 year of follow-up.

    Conclusions

    Integrating arrhythmia data from ambulatory ECG monitoring into clinical risk models allows for better prediction of healthcare utilisation and cost in both treated and untreated patients at high risk for HF and stroke events.

    Gestational diabetes mellitus and its associated factors among women of advanced maternal age in Malaysia: Findings from a national survey

    by Chean Tat Chong, Lalitha Palaniveloo, Sulhariza Husni Zain, Muhamad Khairul Nazrin Khalil, Kishwen Kanna Yoga Ratnam

    Gestational diabetes mellitus (GDM) is a growing public health concern, particularly among women with advanced maternal age. Understanding the prevalence and associated sociodemographic factors is crucial for targeted interventions. This study aimed to determine the prevalence of GDM and its association with sociodemographic factors among Malaysian women with advanced maternal age. This study utilized data from the National Health and Morbidity Survey 2022: Maternal and Child Health, a nationwide cross-sectional survey employing a two-stage stratified cluster sampling design. GDM was identified based on the result of a modified oral glucose tolerance test (MOGTT) recorded in the mother’s antenatal book. The 75-g MOGTT was performed according to the Clinical Practice Guidelines for the Management of Diabetes in Pregnancy in Malaysia. Sociodemographic variables, including ethnicity, locality, education, employment, and household income, were analysed. Multiple logistic regression was performed to identify factors associated with GDM. The prevalence of GDM among women with advanced maternal age in Malaysia was 33.7% (95% CI: 30.9%−36.5%). Ethnicity was significantly associated with GDM, with Indian women showing the highest prevalence (48.8%) and odds (AOR: 7.31, 95% CI: 2.58–20.72; P 

    Risk factors for dysphagia in elderly patients with COPD: a systematic review and meta-analysis protocol

    Por: Zhu · T. · Yang · M. · Weng · L. · Cheng · F.
    Introduction

    Given the global trend toward population ageing, chronic obstructive pulmonary disease (COPD) has emerged as an increasingly common health concern. As a chronic pulmonary disorder frequently encountered in clinical settings, COPD typically involves multiple organ-system impairments. Among these impairments, dysphagia is a significant complication in elderly patients with COPD. Dysphagia profoundly compromises the patients’ quality of life and increases risks such as malnutrition and aspiration pneumonia, thereby exacerbating the overall disease burden. Although systematic reviews evaluating dysphagia prevalence in COPD populations, the quantitative synthesis of associated risk factors has been hindered by inadequate reporting in the original studies. At present, no systematic reviews or meta-analyses specifically address the risk factors associated with dysphagia among elderly patients with COPD. Therefore, this systematic review aims to identify and systematically analyse these risk factors, ultimately providing reliable evidence to facilitate early identification and improve clinical management strategies.

    Methods and analysis

    The literature will be meticulously searched through a variety of electronic databases, including Web of Science, PubMed, Embase, Cochrane Library, China Biomedical Literature Service System (CBM), Chinese Scientific Journal Database (VIP), Wan Fang Database and China National Knowledge Infrastructure (CNKI). We will conduct a thorough investigation of the literature focusing on risk factors associated with dysphagia in elderly individuals diagnosed with COPD, spanning from the inception of each database up to October 2025. Two investigators will independently review the literature, evaluate the quality of studies and extract data based on clearly defined inclusion and exclusion criteria to maintain rigour and consistency. The analysis will employ Stata V.14.0 software for the purposes of data merging and assessment of potential biases. OR along with 95% CI will serve as integrated statistical metrics. Statistical heterogeneity will be assessed using the I2 statistic.

    Ethics and dissemination

    Since this study involves an analysis of previously published literature without direct patient participation, obtaining ethical approval is not required. The outcomes of the current investigation will be disseminated through academic journals following a stringent peer-review process.

    PROSPERO registration number

    CRD420251006411.

    Evaluating the health and well-being effects of increasing biodiversity within multiple small parks in Edinburgh, UK: a protocol for a mixed-methods, longitudinal, pre-post natural experiment

    Por: Malden · S. · McDougall · C. W. · Ward Thompson · C. · Wendelboe-Nelson · C. · Ross-Perez · A. · Clemens · T. · Mason · S. · Villegas-Diaz · R. · Hoadley · A. · Hunter · A. · Jepson · R. · Williams · A. J.
    Introduction

    Recent legislation in the UK regarding requirements for new developments to increase biodiversity may have significant implications for the environment and population health. Despite this, relatively little is known regarding the health and social benefits of increasing biodiversity in densely populated urban areas.

    Methods and analysis

    This protocol outlines plans for a mixed-method, longitudinal, natural experiment study which will evaluate the planned, biodiversity-focused redevelopment of six small urban parks in Edinburgh, Scotland (UK). Using systematic observation (at baseline, 1 month post-intervention and 1 year post-baseline) and a longitudinal household survey (at baseline and 1 year post-baseline), the primary outcomes of personal well-being, and secondary outcomes of nature connectedness and park usage behaviours, will be assessed, respectively. Consent for data linkage of respondent’s health records will also be sought. Process evaluation will employ semi-structured, qualitative interviews with stakeholders and walk-along interviews with local residents in order to understand implementation processes. Space-related well-being will also be assessed using citizen science approaches.

    Ethics and dissemination

    This study was approved by the University of Edinburgh’s School of Health in Social Sciences ethics committee. This study will provide further evidence for policymakers, the public and researchers of the health and social well-being effects of urban biodiversity interventions. Study findings will be disseminated via public forums such as community workshops and through publication in peer-reviewed journals and presentation at scientific conferences.

    Effects of chitosan oligosaccharide on the growth performance, antioxidant capacity, immune function, intestinal digestive capacity and morphological structure in growing female minks

    by Hongfei Liu, Wenli Li, Gaoqiang Fan, Qiaoyi Chen, Shulei Zhang, Beibei Zhang

    This study aimed to investigate the effects of dietary chitosan oligosaccharide (COS) supplementation on growth performance, antioxidant capacity, immune function, duodenal digestive enzyme activity, and jejunal morphology in growing female minks. Ninety-six 12-week-old minks were randomly assigned to six groups (0, 100, 200, 300, 400, or 500 mg/kg COS), with 8 replicates per treatment and 2 minks per replicate, for an 8-week trial. The results showed that average daily gain (ADG) increased quadratically with increasing COS levels (P P P P P P 

    Nurses' Opinions About Clinical Nursing Research: A Cross‐Sectional Study

    ABSTRACT

    Aim

    To examine nurses' opinions and assess their level of engagement in clinical research.

    Design

    An observational study employing a cross-sectional online survey from April to August 2024.

    Methods

    A convenience sample of registered nurses in a metropolitan health service in Victoria, Australia completed a self-report survey from April to August 2024. The survey consisted of fixed-response questions (5-point Likert scale) that measured nurses' opinions about clinical research and level of research involvement. Data were analysed using descriptive and univariate statistics, and content for two free-text open-ended questions.

    Results

    There were 186 participants who reported positive opinions towards the role of clinical nursing research in improving patient outcomes and quality of care. Lower ratings were observed for items concerning confidence in understanding and conducting research, enjoyment of reading research articles and access to resources necessary for participation in research. Few participants had previous experience in study design, data analysis and manuscript preparation and publication. Nurses with higher academic qualifications (e.g., Master's, PhD), and those employed in senior roles, had more positive opinions about clinical nursing research and were more actively engaged in it. Content analysis revealed five themes: (1) Accessibility and awareness of research opportunities, (2) Support and resources, (3) Time constraints and workload, (4) Professional development and (5) Integration of research into clinical practice.

    Conclusions

    Whilst nurses perceive the importance of research, the findings underscore the need for targeted strategies to build their confidence and capacity to engage in clinical nursing research.

    Implications for the Profession

    Nurses face significant barriers to active participation in research. Consideration is needed regarding how nurses are prepared for and adequately resourced to increase their involvement in clinical nursing research.

    Impact

    This study addresses the gap in evidence regarding nurses' opinions and level of engagement in clinical nursing research. Research leaders need to develop and test interventions to increase nurses' involvement in research.

    Patient or Public Contribution

    This study did not include patient or public involvement in its design, conduct or reporting.

    Mentor‐Student Relationship and Graduate Students' Satisfaction With Mentors: A Moderated Mediation Model

    ABSTRACT

    Objective

    To explore how the mentor-student relationship affects nursing graduate students' satisfaction with mentors, as well as how mentoring mode and learning motivation work together.

    Design

    A multi-centre cross-sectional study.

    Setting

    Thirty universities and colleges in eastern, central and western China.

    Participants

    A total of 826 nursing graduate students from thirty universities and colleges participated in this study in April 2024.

    Methods

    Data were collected using the general information questionnaire, mentor-student relationship entry, mentoring mode questionnaire, graduate students' satisfaction item and learning motivation scale. Data were analysed using SPSS 25.0 software. The PROCESS macro-plugin and the bootstrap method were utilised to examine the mediating and moderating effects of learning motivation and mentoring mode.

    Results

    There was a positive correlation between nursing graduate students' satisfaction with mentors and the mentor-student relationship (r = 0.377, p < 0.001), learning motivation (r = 0.600, p < 0.001), and mentoring mode (r = 0.292, p 0.001). Learning motivation exerted a partial mediation effect between the mentor-student relationship and graduate students' satisfaction with mentors (mediation effect value = 0.182, 95% CI = 0.148–0.218). Mentoring mode moderated the path of learning motivation in the mentor-student relationship (interaction term coefficient = 0.031, 95% CI = 0.005–0.056).

    Conclusion

    Mentor-student relationship positively predicted nursing graduate students' satisfaction with mentors significantly. Learning motivation played a partial mediating effect between mentor-student relationship and graduate students' satisfaction with mentors and mentoring mode moderated between mentor-student relationship and learning motivation pathways. Therefore, cultivating positive teacher/helpful friend relationship, boosting students' learning motivation and improving mentoring mode techniques can all increase nursing graduate students' satisfaction with mentors.

    No Patient or Public Contribution

    No patient or public contribution.

    Changed Personal Attitudes Predict Sexual Behaviours Among Men Living With HIV in the Era of U=U: A Half‐Longitudinal Study

    ABSTRACT

    Introduction

    In the era of ‘Undetectable = Untransmittable’ (U=U), reductions in condom use and increases in casual partnerships may contribute to elevated risks of coinfection with other sexually transmitted infections (STIs) and HIV super-infections among men living with HIV. These trends may reflect a shift in personal attitudes towards sexual behaviour and HIV risk, yet their influence on actual behaviours remains unclear.

    Aim

    To investigate how changes in personal attitudes and safe sex self-efficacy influence sexual decision-making.

    Design

    Two-wave longitudinal study design.

    Methods

    We conducted a 3-month longitudinal study from March to December 2023 among HIV-positive men (≥ 18 years) initiating ART in Changsha, China. Cross-lagged panel analysis and half-longitudinal mediation analysis were used to examine how changes in personal attitudes influenced sexual behaviours.

    Results

    427 men living with HIV were included at baseline, and 301 completed the follow-up survey. Sexual behaviours were associated with personal attitudes, namely safe sex fatigue, viral load/transmission beliefs, and sexual sensation seeking. More positive personal attitudes in these domains at baseline predicted lower safe sex self-efficacy over 3 months, while reduced baseline self-efficacy increased the likelihood of engaging in condomless sex and/or multiple sexual partners. All three personal attitude domains had significant indirect effects on sexual behaviours via safe sex self-efficacy.

    Conclusion

    In the era of U=U, the changed personal attitudes among men living with HIV may lead to the increased likelihood of engaging in condomless sex and/or having multiple sexual partners, and safe sex self-efficacy serves as a mediator in this relationship.

    Impact

    This study highlights the potential influence of attitudinal changes on sexual behaviours among men living with HIV in the ‘U=U’ era. Findings provide valuable evidence for developing more targeted interventions that address not only behavioural outcomes but also underlying personal attitudes.

    Patient or Public Contribution

    No patient or public contribution.

    Impact of the COVID-19 pandemic on the mental health of those who identify as women of low socioeconomic status and living with diabetes: a scoping review protocol

    Por: Pucnin · N. · Bowen · J. M. · Hassan · D. · Stanimirovic · A. · Rac · V. E.
    Introduction

    With the COVID-19 pandemic driving people into social isolation, causing a financial crisis and creating uncertainty, individuals were at an even greater risk of experiencing negative mental health outcomes. Individuals who identify as women living with diabetes mellitus (DM) of low socioeconomic status (SES) are potentially at increased risk of negative mental health outcomes secondary to health-related risks of COVID-19, as well as financial barriers to access to medications and diabetes-care supplies.

    Objective

    The objective of this scoping review is to investigate how the COVID-19 pandemic affected the mental health of those who identify as women living with DM of low SES including the consequences of public health measures put in place to stop the spread of the virus. The review aims to identify what is known about the impact of COVID-19 on this and identify potential areas for further investigation.

    Methods and analysis

    The scoping review protocol was developed with guidance from the framework created by Arksey and O’Malley and refinements from the Joanna Briggs Institute and Levac et al published studies employing experimental and correlational designs to collect quantitative and/or qualitative data will be considered. Search strategies were developed for the MEDLINE, Embase and PsycINFO databases to identify relevant sources. Article titles and abstracts will be screened for eligibility by two independent reviewers. Full-text review will be conducted by two reviewers with a third reviewer being included if disagreement must be resolved. Data extraction will be conducted by two reviewers, one extraction and one quality check, and a third will resolve conflict if necessary. Data will be synthesised and reported in a narrative structure that provides a thematic analysis of the currently available literature.

    Ethics and dissemination

    As this is a scoping review, there are no ethical approval requirements. There is to be a full publication of findings and analysis in a peer-reviewed journal.

    Do longer holidays worsen quality of care for patients with STEMI? A retrospective observational study using the nationwide China cardiovascular association database-chest pain centre registry

    Por: Tao · W. · Zhang · L. · Li · Y. · Bai · Y. · Chen · T. · Wei · W. · Lin · X. · Chen · M. · Wen · J.
    Objectives

    To examine whether longer holidays are associated with worse quality of care for patients with ST-segment elevation myocardial infarction (STEMI) compared with weekday admissions and to evaluate the impact of holiday duration on both process indicators and mortality outcomes.

    Design

    Retrospective observational study.

    Setting

    Nationwide study across 3278 hospitals in China participating in the China Cardiovascular Association Database-Chest Pain Centre Registry.

    Participants

    A total of 616 382 STEMI episodes from 1 January 2016 to 31 December 2021 were included.

    Primary and secondary outcome measures

    Primary outcome was in-hospital mortality. Secondary outcomes included process indicators: initial ECG acquisition within 10 min, thrombolytic treatment within 30 min and door-to-balloon time within 90 min. Admissions were categorised as weekday (reference), weekend, short-term holiday (3–5 days) or long-term holiday (7–10 days).

    Results

    Long-term holidays were associated with a 10% increased risk of in-hospital mortality (OR=1.10, 95% CI: 1.02 to 1.18, p

    Conclusions

    Longer holidays, particularly the Spring Festival, are associated with slightly worse outcomes for patients with STEMI in China. While initial assessments may be expedited during holidays, delays occur in providing definitive treatment. These findings highlight the need for targeted strategies to maintain high-quality STEMI care during extended holiday periods.

    Knowledge, attitude and practice of pregnant women towards pre-eclampsia in Chongqing, China

    Por: Li · D. · Wen · L. · Zhong · X. · Li · X. · Peng · T. · Gong · M.
    Objectives

    This study assessed the knowledge, attitude and practice (KAP) of pregnant women in Chongqing, China, regarding pre-eclampsia and examined their inter-relationships.

    Design

    A cross-sectional survey was conducted using validated questionnaires.

    Setting

    The study was conducted between May 2023 and August 2023 in Chongqing, China.

    Participants

    A total of 427 pregnant women were included, with 68.15% aged ≤30 years and a mean pregnancy duration of 238.18±45.01 days.

    Interventions

    This was an observational study, and interventions were applied.

    Primary and secondary outcome measures

    The primary outcomes were the KAP scores (knowledge: 0–40; attitude: 12–60 and practice: 10–50). The correlations and structural equation modelling (SEM) analyses were conducted to explore the relationships among KAP.

    Results

    Mean scores were 22.19±12.17 (knowledge), 46.38±6.14 (attitude) and 41.96±5.96 (practice). Knowledge positively correlated with attitude (r=0.586, p

    Conclusions

    Pregnant women exhibited inadequate knowledge and a suboptimal attitude but a proactive practice. Targeted interventions to improve knowledge and attitudes are recommended for better clinical outcomes, particularly in regions where few such studies have been conducted.

    Implementing relational continuity in general practice--understanding who needs it, when, to what extent, how and why: a realist review protocol

    Por: Tzortziou Brown · V. · Park · S. · Mahtani · K. R. · Taylor · S. · Owen-Boukra · E. C. · Taylor · J. · Richards · O. · Begum · S. · Wong · G.
    Introduction

    Relational continuity of care (RCC) refers to the sustained therapeutic relationship between a patient and a clinician, which fosters trust, enhances communication and facilitates the accumulation of knowledge about the patient. RCC is associated with enhanced patient outcomes, reduced hospital admissions, lower mortality rates, decreased healthcare costs and improved patient experience. Despite these benefits, reorganisations within the NHS and workforce challenges have led to an increased reliance on multidisciplinary and part-time working, resulting in fragmented care and a decline in RCC. Our study aims to explore who needs RCC, under what circumstances, to what extent and why, with the goal of informing optimal implementation strategies.

    Methods and analysis

    We will conduct a realist review to develop an evidence-based programme theory explaining the mechanisms underlying RCC, the populations that benefit most, the contextual factors influencing RCC and effective care models. Following Pawson’s five iterative stages, we will: (1) Locate existing theories, (2) Search for relevant evidence, (3) Select appropriate articles, (4) Extract and organise data and (5) Synthesise findings to draw conclusions. A stakeholder advisory group, comprising policymakers, healthcare professionals, public contributors and patients, will be engaged throughout the process. We will adhere to Realist And Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) for realist reviews to ensure methodological rigor.

    Dissemination and ethics

    Our findings will inform practical, evidence-based recommendations for optimising RCC within general practice. Outputs will include peer-reviewed publications, conference presentations, plain English summaries, social media infographics, a short video and end-of-study events. Collaborations with stakeholders and public involvement will ensure both accessibility and impact. Ethical approval is not required for this review.

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