To investigate the correlation between fat-to-muscle ratio (FMR) or other body composition and secondary osteoporosis (OP) in patients with rheumatoid arthritis (RA) and to develop a predictive model using FMR and related clinical factors.
Cross-sectional observational study with machine learning-based risk modelling.
Tertiary hospital in eastern China, secondary care level.
A total of 670 hospitalised RA patients (135 males and 535 females; aged 58.00 (50.00–67.00) years; disease duration 8.00 (2.00–16.00) years) and 126 healthy controls were recruited between October 2019 and October 2022. There were no differences in basic indicators such as gender, age distribution and body mass index between the two groups. RA diagnosis followed American College of Rheumatology (ACR) 1987 or ACR/European League Against Rheumatism 2010 criteria. Exclusion criteria included major organ dysfunction, endocrine disease, infection or long-term hormone or psychotropic drug use.
Primary outcomes included total skeletal muscle mass, fat mass, FMR measured by bioelectrical impedance analysis and bone mineral density measured by dual-energy X-ray absorptiometry. Secondary outcomes included RA disease activity scores (clinical disease activity index (CDAI), simplified disease activity index, disease activity score in 28 joints (DAS28)) and glucocorticoid use. Logistic regression and four additional machine learning algorithms were used to build predictive models for OP.
The RA group (age, 58.00; duration, 8.00; DAS28, 5.03; rheumatoid factor, 104.75; C-reactive protein, 25.65; erythrocyte sedimentation rate (ESR), 59.00) exhibited reduced total skeletal muscle mass (19.49 vs 25.38, p
FMR may serve as a useful clinical indicator of secondary OP in RA patients. A model based on FMR and associated risk factors can predict the possibility of secondary OP.
by Xing Chen, Zhixiong Zhang, Jiwei Xiang, Ruliu Xiong, Xingmao Zhou
BackgroundSoft tissue and other extraosseous sarcomas (STSES) are rare malignant tumors originating from mesenchymal tissues with complex etiologies. A systematic analysis of global burden trends is urgently needed.
MethodsUtilizing the Global Burden of Disease (GBD) 2021 database, we assessed STSES incidence, mortality, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) across regions and countries from 1990 to 2021, stratified by sociodemographic index (SDI). Spatiotemporal models, Joinpoint regression (to calculate average annual percentage changes, AAPC), and decomposition analysis were employed to evaluate the impacts of population growth, aging, and epidemiological factors on disease burden.
ResultsIn 2021, there were 96,201 new STSES cases globally, resulting in 50,203 deaths and 1.678 million DALYs. While age-standardized rates (per 100,000 person-years) showed declining trends (AAPC for ASIR = −0.13, ASMR = −0.60, ASDR = − 0.94), absolute burden increased by 77.97% due to population growth. Males exhibited consistently higher burden than females, with incidence peaking at 55–74 years. Notably, young females (10–29 years) transiently surpassed males in DALYs. Significant regional disparities emerged: High-SDI regions (e.g., Western Europe) demonstrated lower ASMR attributable to advanced diagnostics and treatment, whereas low-SDI regions (e.g., Uganda, ASMR = 1.96/100,000) faced poorer prognoses due to healthcare deficiencies. SDI exhibited a nonlinear association with disease burden—middle-SDI regions (0.4–0.8) showed rising ASIR, potentially linked to industrial pollution and improved diagnostic capabilities. These findings underscore the critical need for context-specific prevention and resource allocation strategies to address the evolving global STSES burden.
ConclusionsThe global STSES burden is predominantly driven by population growth, necessitating targeted prevention strategies addressing occupational exposures in males and subtype-specific risks among young females. While high-SDI regions demonstrate mortality reduction through precision oncology, low-SDI regions require urgent improvements in healthcare accessibility to mitigate survival disparities. Persistent regional heterogeneity underscores the imperative for international collaboration to standardize diagnostic protocols and ensure equitable resource allocation. These insights emphasize the need for stratified surveillance systems and translational research to optimize context-specific intervention frameworks.
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.
A multi-centre cross-sectional study.
Thirty universities and colleges in eastern, central and western China.
A total of 826 nursing graduate students from thirty universities and colleges participated in this study in April 2024.
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.
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).
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.
To develop a structured intervention aimed at enhancing family communication to reduce relapse in adolescents with depression.
This study follows a multi-stage process guided by the Intervention Mapping procedure with the Medical Research Council framework, assessing the layers of complexity. Its design comprises four interrelated stages to construct a family communication intervention, culminating in a pilot randomised controlled trial.
The program has four stages: (1) Identifying family interaction gaps through literature review and expert input; (2) Investigating communication needs of depressed adolescents and their families via a mixed methods study to develop a model intervention; (3) Refining the intervention with focus groups and expert e-Delphi; and (4) Finalising the intervention based on pilot randomised controlled trial outcomes. The research will be conducted in Greater Accra, Ghana.
The process will result in a family communication intervention tailored to the needs of adolescents with depression and their families. It will be pilot tested, and the results will inform a nationwide efficacy trial.
This research integrates qualitative and quantitative data to inform the development of an evidence-based family communication intervention. The program will carefully examine data integration and contextual challenges encountered during its implementation.
The intervention has the potential to enhance family communication, thus playing a crucial role in adolescent depression recovery by reducing relapse rates. Healthcare professionals will benefit from a structured, evidence-based communication tool that can be used in clinical settings.
The study focuses on improving communication between families of adolescents with depression, aiming to develop a family communication package for clinical and community use. This intervention may enhance recovery outcomes and reduce relapse risk for adolescents.
This study adhered to the GUIDED guideline for reporting intervention development studies.
No Patient or Public Contribution.
Physiological, psychological, and social changes may make older adults more vulnerable to stressors and lead to adverse health outcomes. It remains unclear whether interventions targeting coping strategies in older adults are effective.
This study aimed to systematically review and summarize existing interventions aimed at improving coping strategies in older adults and analyze intervention effectiveness.
A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases for randomized controlled trials (RCTs) and quasi-experimental studies. Two researchers independently performed literature screening, quality assessment, and data extraction.
A total of 9 studies were included, comprising 7 RCTs and 2 quasi-experimental studies. Meta-analysis revealed that the interventions significantly enhanced the use of problem-focused coping strategies among older adults (SMD = 0.37, 95% CI: 0.12 ~ 0.63, p = 0.005, I 2 = 39%). However, there was no significant effect on emotion-focused coping strategies (SMD = −0.07, 95% CI [−0.62, 0.48], p = 0.80, I 2 = 76%). Moreover, no significant statistical differences were observed between the intervention group and the control group in terms of positive (SMD = 1.49, 95% CI [−0.23, 3.21], p = 0.09, I 2 = 98%) or negative coping strategies (SMD = −0.76, 95% CI [−1.79, 0.28], p = 0.15, I 2 = 96%).
Interventions targeting coping strategies can significantly improve the problem-focused coping strategies of older adults. It is crucial to help older adults accurately recognize daily stressors, acquire emotional regulation strategies, and enhance coping skills. More large-scale RCTs are needed to draw more robust conclusions.
This study examines the incidence and risk factors of euglycaemic diabetic ketoacidosis (euDKA) in patients undergoing coronary artery bypass grafting (CABG) and evaluates their postoperative outcomes over a 6-month follow-up period.
This study is a single-centre, nested case-control study, conducted in Tianjin, China.
An international cardiovascular hospital.
A total of 1524 patients, with a mean age of 64 (9) years, who underwent isolated elective CABG surgery were reviewed.
Data were extracted from electronic medical records. EuDKA cases were identified by reviewing laboratory examination results until discharge, including arterial blood gas analysis and urine samples. Logistic regression analysis was used in a case-control design to identify potential risk factors of sodium-glucose cotransporter 2 inhibitor (SGLT2i)-associated euDKA. Post-discharge follow-up was conducted through regular outpatient visits.
15 patients with euDKA, all with type 2 diabetes, were identified post-surgery, 13 of whom were SGLT2i users. The cumulative incidence of euDKA within 7 days after surgery was 1% in the cohort, increasing to 7.6% among those who discontinued SGLT2i 1–6 days (n=171) before surgery. A case-control study added seven additional confirmed euDKA patients to the case group, resulting in 20 cases and 95 controls. Univariate regression analysis revealed that the risk of euDKA was 7.304 times higher (95% CI 2.517 to 21.197; p–1 (OR: 6.882, 95% CI 1.822 to 25.997; p=0.004) were associated with a higher risk of euDKA. Compared with controls, euDKA patients experienced a higher rate of type 5 myocardial infarction (6/20 (30%) vs 9/95 (9.5%); p=0.035) and recurrent ketosis post-discharge (3/19 (15.8%) vs 0/87 (0%); p=0.005).
This cohort study highlights a notable incidence of euDKA following CABG, particularly among patients using SGLT2i. Close monitoring in the ICU is recommended for patients with intraoperative abnormal blood glucose and pH levels to prevent euDKA.
To explore the illness coping experiences of patients with moderate-to-severe burns and provide a reference for healthcare professionals to formulate coping strategies.
Qualitative study using a descriptive phenomenological approach.
From 1 June to 30 September 2024, semi-structured interviews were conducted with 19 patients with moderate-to-severe burns. Colaizzi's seven-step method was used for data analysis.
Seven subthemes and three higher order themes were identified: (1) perception of illness experience; (2) coping with disease threats; and (3) benefits of coping with illness. Most of the participants faced multiple difficulties in their disease experiences, such as increased financial pressure, higher pressure on family caregiving, deformed physical conditions and negative emotions. Positive psychological qualities, family and social support played significant roles in coping with these challenges.
Patients with moderate-to-severe burns experience multiple difficulties during their recovery. Effective coping resources can help them overcome these challenges.
Healthcare professionals should work with patients with moderate-to-severe burns and their families to establish an effective support system that enhances patients' coping abilities and promotes their overall recovery.
Patients with moderate-to-severe burns face diverse challenges. However, their experiences and coping processes during recovery remain unclear. This study provided valuable insights into their illness experiences and coping strategies. The findings highlighted multiple difficulties, such as a significant increase in financial pressure and dependence on family caregiving, painful and deforming physical conditions and various negative emotions. Positive psychological qualities, family and social support play an important role in coping with these challenges. Healthcare professionals should work with patients and their families to establish effective support systems to promote overall recovery.
No patient or public involvement.
To assess the global burden of pressure injuries from 1990 to 2021 and project trends to 2050.
A cross-sectional survey.
Using the Global Burden of Disease 2021 data from 204 countries (1990–2021), we performed a multilevel analysis incorporating age-period-cohort modelling, stochastic frontier analysis and Bayesian projections to 2050. Key metrics included age-standardised incidence rates, disability-adjusted life years and socio-demographic index stratification.
Global incident cases increased by 160.3%, from 1.22 million to 3.18 million. By 2050, cases are expected to reach 8.4 million, with 72.4% in low-middle socio-demographic index areas. Mortality among those aged 95 and older may triple.
The study emphasises the need for global collaboration to address the burden of pressure injuries through equitable prevention and improved healthcare infrastructure, especially in ageing and resource-limited regions.
The escalating global burden of pressure injuries in geriatric populations necessitates evidence-based approaches to optimise healthcare resource allocation and advance nursing-led prevention frameworks.
The STROBE checklist guided reporting.
Global Burden of Disease collaborators extracted the data and analysed it.
Advanced cancer not only affects the physical, psychological, and social functions of patients, but it also impacts their adolescent children. There is a dearth of information regarding the understanding of family functioning and specific needs of patients with advanced cancer and their adolescent children.
This qualitative study aimed to explore the experience and needs regarding family functioning of patients with advanced cancer and their adolescent children, as well as understanding potential approaches for maintaining positive family functioning.
A descriptive qualitative study was employed.
This study was conducted at three tertiary hospitals in Changsha, China, from January to September 2023. Purposive sampling was adopted to recruit participants. 17 stage III and IV patients with cancer and 11 adolescent children were interviewed.
Face-to-face individual interviews were conducted among patients with advanced cancer and their adolescent children. The data analysis employed Braun and Clarke's thematic analysis method. The McMaster family functional model theoretical framework was utilised to facilitate the identification and organisation of topics, ensuring a comprehensive analysis of the data.
Six themes were identified: communication challenges; impaired family role functioning; positive/negative feelings; over-involvement; change of behaviour control pattern; Needs for medical and psychological support. Both patients with advanced cancer and their adolescent children expressed collective views and needs regarding family functioning.
The findings of this study reveal an understanding of family functioning and needs among patients with advanced cancer and their adolescent children. The identified themes provide valuable insights for designing and implementing targeted intervention strategies.
Nursing interventions should focus on helping patients with advanced cancer and their adolescent children improve family functioning and communication skills. The findings indicate that communication challenges are a significant aspect of impaired family functioning, necessitating targeted interventions to enhance communication. Healthcare providers should be trained to recognise the diverse communication needs of families, which include providing resources for age-appropriate communication, counselling, and guidance on maintaining family routines. Enhancing the communication skills of patients and their children is crucial for addressing problem-solving needs and mitigating negative feelings, thereby fostering a more supportive family environment.
by Lijun Jiang, Qian Yu, Hui Li, Fudong Wang, Feng Liu, Zhenxing Xu
ObjectiveTo determine the association between blood pressure variability (BPV), coagulation indexes, and germinal matrix-intraventricular hemorrhage (GMH-IVH) in preterm infants with gestational age ≤ 32 weeks. In addition, we aimed to determine whether the combination can predict the occurrence and outcome of GMH-IVH.
MethodsThis retrospective study included 106 preterm infants. According to the presence of GMH-IVH, the preterm infants were divided into GMH-IVH (51 patients) and no GMH-IVH (55 patients) groups. Furthermore, according to the short-term prognoses, the GMH-IVH group was subdivided into good outcome (30 patients) and poor outcome (21 patients) groups. Coagulation function and BPV indexes were collected at admission. Univariate analysis, logistic regression model, and receiver operating characteristic curve were used to analyze the relationship between indexes and the occurrence and outcome of GMH-IVH in preterm infants.
ResultsUnivariate analysis showed that the difference between maximum and minimum (Max-Min); standard deviation (SD); coefficient of variation (CV) of BPV, prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and proportion of premature rupture of membranes (PROM) were higher in the GMH-IVH group than the no GMH-IVH group (P ). Logistic regression analysis showed that INR and DBP SD were directly correlated with GMH-IVH, and the joint curve had the largest area under the curve (AUC) (82.4% sensitivity and 79.7% specificity). BPV SD, BPV CV, APTT, and INR were higher in the poor outcome group than in the good outcome group (P ). Logistic regression analysis showed that INR and DBP SD were directly correlated with poor outcomes in preterm infants with GMH-IVH. The joint curve had the largest AUC (sensitivity 76.2% and specificity 90.0%).
ConclusionIncreased INR and DBP SD are directly associated factors for the developement and poor short-term outcome of GMH-IVH, and combined monitoring of INR and DBP SD has certain reference value for the early identification and prognosis evaluation of GMH-IVH in preterm infants with gestational age ≤ 32 weeks.
To investigate the physical activity levels of lung cancer survivors, analyse the influencing factors, and construct a predictive model for the physical activity levels of lung cancer survivors based on machine learning algorithms.
This was a cross-sectional study.
Convenience sampling was used to survey lung cancer survivors across 14 hospitals in eastern, central, and western China. Data on demographic, disease-related, health-related, physical, and psychosocial factors were also collected. Descriptive analyses were performed using SPSS 25.0, and predictors were identified through multiple logistic regression analyses. Four machine learning models—random forest, gradient boosting tree, support vector machine, and logistic regression—were developed and evaluated based on the Area Under the Curve of the Receiver Operating Characteristic (AUC-ROC), accuracy, precision, recall, and F1 score. The best model was used to create an online computational tool using Python 3.11 and Flask 3.0.3. This study was conducted and reported in accordance with the TRIPOD guidelines and checklist.
Among the 2231 participants, 670 (30%), 1185 (53.1%), and 376 (16.9%) exhibited low, moderate, and high physical activity levels, respectively. Multivariate logistic regression identified 15 independent influencing factors: residential location, geographical region, religious beliefs, histological type, treatment modality, regional lymph node stage, grip strength, 6-min walking distance, globulin, white blood cells, aspartate aminotransferase, blood urea, MDASI score, depression score, and SRAHP score. The random forest model performed best among the four algorithms, achieving AUC-ROC values of 0.86, 0.70, 0.72, and 0.67, respectively, and was used to develop an online predictive tool (URL: http://10.60.32.178:5000).
This study developed a machine learning model to predict physical activity levels in lung cancer survivors, with the random forest model demonstrating the highest accuracy and clinical utility. This tool enables the early identification of low-activity survivors, facilitating timely, personalised rehabilitation and health management.
The development of a predictive model for physical activity levels in lung cancer survivors can help clinical medical staff identify survivors with relatively low physical activity levels as early as possible. Thus, personalised rehabilitation plans can be formulated to optimise quality of life during their survival period.
Physical activity has been used as a nonpharmacological intervention in cancer patient rehabilitation plans. However, a review of past studies has shown that lung cancer survivors generally have low physical activity levels. In this study, we identified the key factors influencing physical activity among lung cancer survivors through a literature review. We constructed a prediction model for their physical activity levels using machine learning algorithms. Clinical medical staff can use this model to identify patients with low physical activity levels early and to develop personalised intervention plans to improve their quality of life during survival.
The study adhered to the relevant EQUATOR reporting guidelines, the TRIPOD Checklist for Prediction Model Development and Validation.
During the data collection phase, participants were recruited to complete the questionnaires.
As a disorder of gut–brain interaction, irritable bowel syndrome (IBS) is a common reason for patient visits in primary and specialist care settings. IBS is associated with recurrent abdominal pain, altered bowel habit, resulting in alternating constipation and diarrhoea, bloating, without serious organic diseases. The bidirectional relationship between IBS and psychological factor is also complex. Studies have suggested that tricyclic antidepressants can effectively control the concomitant symptoms of IBS, especially some severe and refractory symptoms. At present, the conventional treatment of IBS remains somewhat unsatisfactory. Studies have shown that the antidepressant effects of esketamine are rapid and significant, whether a single low dose of esketamine is effective in IBS deserves further investigation. In this study, we hypothesise that a single low dose of esketamine will be effective for IBS.
This is a single-centre, randomised, double-blind, placebo-controlled trial. Patients with IBS are divided into three levels according to the severity of IBS: mild, moderate and severe. 92 patients in the esketamine group and 92 patients in the control group who are scheduled for colonoscopy will be prospectively recruited in each level. The primary outcome is the IBS Severity Scoring System at baseline and at 3 days, 1 week, 3 weeks, 6 weeks after colonoscopy. The secondary outcome includes IBS-Quality of Life, Bristol Stool Form scale, Hospital Anxiety and Depression Scale, Patient Health Questionnaire-12 Somatic Symptom Score and adverse events. The allocation sequence is assigned by a random number table using a block randomisation method by SPSS (Version 26, IBM Inc., USA) Statistics software. All enrolled patients, anaesthesiologist B and researchers responsible for follow-up and data collection and analysis are therefore fully blinded. All data will be performed using SPSS Statistics software, and a p value
The protocol has been approved by the Medical Ethics Committee of Beijing Tiantan Hospital affiliated to Capital Medical University (KY2024-414-02). All participants will sign a written informed consent form. The results will be submitted for publication in peer-reviewed journals, presented at international conferences, and shared with participants via hospital newsletters.
Efficacy of Esketamine for Patients With Irritable Bowel Syndrome (NCT06788444).
To explore rehabilitation training adherence as well as its related influencing factors among adult patients with traumatic limb fractures to provide a basis for clinical intervention strategies.
Cross-sectional study.
Department of Rehabilitation Medicine.
Adults within 1 year postoperative for traumatic limb fractures and who underwent rehabilitation training were included in this study.
Not applicable.
Patient information was collected using a self-designed general information form. Rehabilitation training adherence was evaluated using the Exercise Adherence Rating Scale (0/64, higher values=higher adherence). Barriers to and facilitators of rehabilitation were assessed using sociodemographic data, ability to perform daily life (ADL), General Self-Efficacy Scale (GSES) and Visual Analogue Scale. Pearson’s (r) and determination (R2) correlation coefficients were calculated to determine the strength of associations between variables. Potential correlates were explored using multiple linear regression analysis.
Between December 2022 and December 2023, 170 subjects were recruited. The age of the participants ranged from 18 to 93 years, with a mean age of 41.5 years (SD 15.6). The mean Exercise Adherence score was 30.31 (SD 5.8). Adherence to postoperative rehabilitation training tended to be lower in participants of older age (–1.30; 95% CI –2.14 to –0.46; p=0.003), and those who had higher pain scores on the movement (moderate pain (–3.25; 95% CI –4.56 to –1.95; p
Patients with limb fractures require rehabilitation but often struggle with adherence to interventions. Strategies that focus on targeted education programmes, pain management and self-efficacy improvement may be considered to guide future research and programmatic approaches to enhance adherence to rehabilitation training.
by Weiyong Chen, Zhongrong Yang, Xing Wang, Weiwei Wang
ObjectiveThis study aimed to investigate the demographic characteristics of Men who have Sex with Men (MSM) recruited online and identify the factorsassociated with meeting homosexual partners at fixed offline locations.
MethodsUnivariate and multivariate logistic regression analyses were used to examine the factors that influenced their meeting up with homosexual partners at fixed offline locations.
ResultsA total of 604 MSM were included, with 133 participants (22.02%) meeting homosexual partners at fixed offline locations. Multivariate logistic regression analysis showed that participantswho were willing to engage in commercial sex, engage in behaviors such as alcohol consumption, drug use, or aphrodisiac use during homosexual activities, and hadused HIVPre-Exposure Prophylaxis (PrEP) in the last six months were more likely to meet homosexual partners at fixed offline locations.
ConclusionsThe proportion of participants meeting homosexual partners at fixed offline locations was relatively high, emphasizing the need to increase education and awareness among MSM to reduce relatedbehaviors during homosexual activities. Further promotion of the proper use of PrEP and avoidance of commercial sex are essential for lowering the risk of HIV infection among this population.
To investigate the status of discharge readiness of patients undergoing daytime lung cancer surgery and analyse its influencing factors.
This was a cross-sectional study.
In this study, patients who underwent daytime lung cancer surgery from August 2022 to February 2023 at a Tertiary Care Hospital in Shanghai were selected via the convenience sampling method. A general data questionnaire, the Readiness for Hospital Discharge Scale, the Brief Illness Perception Questionnaire and the 10-item Connor Davidson Resilience Scale were used to assess 203 patients. Multiple linear regression analysis was used to analyse the factors influencing discharge readiness.
The total Readiness for Hospital Discharge Scale score for patients who underwent daytime lung cancer surgery was 72.76 ± 20.91. Multiple regression analysis revealed that residence, monthly family income, the presence of postoperative adverse effects, illness perception and resilience were influencing factors for discharge readiness (p < 0.05), with illness perception (β = −0.391, p < 0.001) and resilience (β = 0.317, p < 0.001) being the most significant factors, which together explained 44.9% of the total variance.
The discharge readiness of day surgery patients with lung cancer is moderate, indicating room for improvement. Clinical practice should focus on lower-income, rural or postoperative patients with adverse reactions. Additionally, promoting patients’ positive perceptions of their illness and increasing their resilience can further enhance their discharge readiness.
The reporting of the study was guided by the STROBE checklist: cross-sectional studies (Table S1).
Healthcare professionals should focus on assessing patients’ readiness for discharge, consistent with the World Health Organization's emphasis on patient-centred discharge planning. We recommend (1) establishing post-discharge support systems for rural and low-income patients, (2) including resilience-building interventions in preoperative education and (3) adopting a multiform health promotion approach to change negative illness perceptions and coping strategies. Additionally, we strongly advocate for the development of nurse-led transitional care plans that address both medical and psychosocial needs to optimise patient recovery and long-term well-being.